IIRP PRESIDENTIAL PAPER SERIES, NUMBER 4 | SUMMER, 2021 FRIDA C. RUNDELL, PH.D.

, LPC
PROCESSING TRAUMA USING
THE RELATIONAL CARE LADDER

Frida C. Rundell, Ph.D., LPC

Professor
IIRP Graduate School

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ABSTRACT

While the process of dealing with trauma is complex, the Relational Care Ladder offers a helpful framework
that focuses on supporting the need for safety, awareness, the expression of feelings, and empowerment
for children growing up. The Relational Care Ladder allows practitioners to recognize developmental gaps
in children or youth, address immediate behavioral issues, and prevent or ease trauma following them into
adulthood. Grounded in the work of developmental theorists, the Relational Care Ladder was developed by
the author based on years of experience in educational psychology and restorative practices. When working
with young people who’ve experienced trauma, it is critical that adults and other professionals are accountable
for creating structure, nurturing, and supporting engagement and appropriate confrontation skills. If adults
neglect or fail to provide the rungs of the Relational Care Ladder, children and youth may experience trauma
and a deregulation of the central nervous pathways. Support and regulation from professionals and parents
are pivotal in trauma proofing our developing youth. This paper offers an explanation of the rungs in the
Relational Care Ladder as a quick and easy framework that adults, professionals, and parents may use. Further,
restorative processes are shown to be supportive of this work. The Relational Care Ladder provides appropriate
guidance when one’s emotions demonstrate implicit trauma memory experiences. Adults, whether parent or
professionals, communicate equal accountability for meeting and attending to children’s or client’s respective
needs. The range of applicability of the Relational Care Ladder framework will be discussed.

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INTRODUCTION

Following years of experience as an educational

psychologist studying developmental theory
and using restorative practices, I was left with a
question: How does restorative practices address
the developmental issues of childhood that are
neglected? It did not. I began my investigation
of this question by exploring the importance that
restorative practices places in acknowledging a sense
of belonging, voice, and agency or purpose for every
individual (Bailie, 2019). The result of my query is the
Relational Care Ladder, which can help to identify
when behavioral issues may be the result of gaps in a
child’s development that have caused harm or trauma
and to show how restorative processes can help to Trauma has become a buzz word used to
address those gaps. The opportunity to address explain away most deficiencies seen in
trauma could also help to prevent decades of future children, youth, and adults today.
problems as childhood harm or trauma can follow a
person into adulthood if unaddressed.
shows “the clinical expression of psychological
Trauma has become a buzzword used to explain distress following exposure to traumatic or stressful
away most deficiencies seen in children, youth, events result in fear- or anxiety-based responses
and adults today. Trauma was initially identified and may occur within the womb onwards” (5th
by the medical profession in soldiers arriving ed.; DSM-5 Guidebook; APA; p.189, 170). The right
home from World War II and then Vietnam and hemisphere of the brain develops in the first two
became known as post-traumatic stress disorder years of a child’s life, creating body and spatial
(Levine, 2015). The symptoms of trauma were awareness, and social and emotional awareness.
specific to re-experiencing a traumatic event with This in turn promotes attachment and emotional
recurrent dreams, thoughts, and images with an security during early stages of development
intensity that creates avoidance and fear. This where the child encounters the outside world.
could result in difficulty sleeping or concentrating, The result is that this process reinforces a child’s
a hypervigilance or exaggerated startle response, inner understanding of the world and their place
nightmares, and recurring negative images. The in it (Schore & Schore, 2008). But when a child has
onset of post-traumatic symptoms can occur up experienced trauma that disrupts the development
to six months after the event. Currently, trauma of the right hemisphere, this makes attachment and
and stressor-related disorders include reactive emotional security of the outside world difficult if
attachment and disinhibited social engagement not impossible.
as well as a range of stress, anxiety, and mood
disorders (5th ed.; DSM-5 Guidebook; American Emotional security is dependent on physical
Psychiatric Association, 2014; p.169, 496). structure and regulation and child experiences
from birth. Structure and nurturing feed the central
Diagnosing post-traumatic stress in children is a nervous pathways that flow through the body. It is
significant and relatively recent change. Research important to note that when the central nervous

PROCESSING TRAUMA USING THE RELATIONAL CARE LADDER 2 WWW.IIRP.EDU

system is compromised, the memory is also to cope with change. Safety and physical and
affected. Levine further explains that the memory emotional regulation establish and stabilize the
of incidents is stored in the motor movement organism (van der Kolk, 2015; Levine & Kline,
of the cortex, not in the brain. This gives rise to 2008). Experiences that establish structure for
triggers that involuntarily manifest in a bodily a child must be accompanied with nurturing:
experience. Any slight trigger can cause the person stress-free affirmations that acknowledge self-
to experience an uncomfortable feeling somewhere worth. An example would be using a warm vocal
in the body. Consequently, without thinking, the tone that invites and encourages reciprocal
person reacts to the trigger with an automatic responses in playful ways. A reassuring adult
response (e.g., biting lip, stomachache, obsessive presence accommodates and confirms a safe
movement or thought) (Levine, p. xiii). Bessel van environment. Adults should try to express
der Kolk (2015) purports that trauma is a very feelings through gestures that encourage
physical experience, one that can become “stuck” interaction and reciprocity. In fact, this is what
in our bodies for years after the trauma-causing we do when a baby arrives in a mother’s arms.
incident has taken place. If physical structure and emotional nurturing are
not met during childhood or adolescence, they
The uninterrupted development of the central impact a person later in life (Levine & Kline, 2008;
nervous system creates resiliency and the ability Levine, 2015; Siegel, 2013).

FIGURE 1: TYPES OF MEMORY, LEVINE (2015)

EXPLICIT IMPLICIT

PROCEDURAL
DECLARATIVE EPISODIC EMOTIONAL (BODY MEMORY)

MOST CONSCIOUS LEAST CONSCIOUS

Reproduced from P. Levine (2015), Trauma and memory: Brain and body in a search for the living past. North Atlantic Books.

Childhood neglect or harm leaves an indelible gap is based on my education and training as a
in the development of a young person. However, developmental psychologist, my experience
children learn to be resilient while experiencing the working with traumatized children and adults, and
neglect or harm by becoming managers or firefighters my expertise in restorative practices, both as a
for their survival. It is this resilience that they take into teacher and a practitioner. Essentially, in trauma,
adulthood. But managing and firefighting may hinder the human organism has crashed and the child or
their potential in adult life due to the intensity or youth needs a caring individual to help realign the
inappropriateness of the control or rescuing behavior central nervous system and the memory to maintain
that they learned as children. safety. The Relational Care Ladder—with its
Structure, Nurturing, Engagement, and Challenge
I offer the Relational Care Ladder as a framework rungs—acts as a guide to help professionals and
to help practitioners to recognize developmental adults in any caring field become mindful and
gaps in children or youth, address the immediate consistent in creating predictable pathways for
behavioral issues, and prevent or ease trauma healing for the individual who experienced neglect,
following them into adulthood. The framework harm, or adversity.

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FIGURE 2: THE RELATIONAL CARE LADDER, RUNDELL (2017)

CLIENT NEEDS PROFESSIONAL COMPETENCIES

TO BE USED

Empowerment CHALLENGE Competence, Mastery, Play

Joy of Companionship,
Feelings ENGAGEMENT
Attunement, “Now Moments”

Security, Self-worth,
Awareness NURTURE
Stress Reduction

Safety STRUCTURE Safety, Organization, Regulation

Restorative practices intersects with the Relational Honestly sharing feelings allows everyone to
Care Ladder in two ways. First, since restorative stay present and promotes empathy. Setting up
practices is often initially used to address harmful responsive circles to challenge behaviors that are
behavior, especially in schools, restorative not acceptable should only be introduced once
educators need to recognize when certain proactive circles are a common practice. Fair
unacceptable behavior may be rooted in trauma. practice (Kim & Mauborgne, 1997), one of the
The Relational Care Ladder can help identify principles that restorative practices values, with
where trauma occurred and which developmental its emphasis on engagement, explanation, and
need is missing, and the practitioner can consider expectation clarity, also complements the Relational
this information in their restorative response. Care Ladder. The Relational Care Ladder helps us
Second, restorative practices is complementary to be transparent and do things “with” our clients,
to the Relational Care Ladder because many of a goal of restorative processes. It should be noted
its processes are naturally supportive. Consider that the more challenging processes that restorative
the use of circles, for example. A circle process, practices can offer will only be successful after the
so common in restorative practices, is a structure first three rungs of the ladder are achieved. Overall,
that creates safety. In that circle, the use of the Relational Care Ladder is supported by the
affective statements or questions nurtures and proactive aspects of restorative practices.
creates awareness for everyone within that circle.

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THE RELATIONAL CARE LADDER

The four rungs of the Relational Care Ladder To understand how the Relational Care Ladder can
provide an easy developmental reference to help address disruptive behavior that occurred
determine what has been lacking in someone’s life. earlier in life, let’s take a closer look at each rung
Inappropriate behavior by an individual may reveal to see why it matters and what is required to
an absence or distortion of a need. To provide an successfully navigate it. The rungs are as follows:
appropriate response for healing to take place, the Structure, which serves to provide safety needs;
professional or adult should identify which rung Nurturing, which promotes awareness in a human
on the ladder appears to be an issue for the child being; Engagement, which supports the essential
or youth, then move one rung below to build on a expression of feelings; and finally, Challenge,
secure foundation and to begin to address the need which invites human endeavors to build a sense of
of the child or youth. Consistency, predictability, empowerment (Rundell, 2017, Figure 2). It should
and remaining nonjudgmental are essential at all be noted that you can move up and down the
times. Without these three components, healing will ladder at different times in your life and even within
be sporadic and temporary. a single day.

Inappropriate behavior by an individual may reveal an absence or distortion of a need.

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STRUCTURE

Structure means that a child learns to identify and response. This is critical for any healing to begin.
address daily tasks and needs in an orderly way. The brain has signaled an amygdala alert. The
This order provides a sense of safety, organization, hippocampus cannot handle the trigger. It then
and regulation. Providing structure for children moves into a bodily response, which is known as
requires that adults offer rituals that regulate an implicit memory that may cause the individual
daily activities in their lives. Attachment to these to become emotional or choose to subconsciously
structures creates trust and safety, an inner knowing behave in a ritualistic way (e.g., bite your lips,
and self-acceptance, which in turn provides a wash your hands, bite your nails; Levine, 2015).
responsive flexibility (Schore & Schore, 2008; Supportive adults and professionals need to teach
Porges, 2011; van der Kolk, 2015). the child a process or protocol to respond to and
recover from the trigger.
Researchers have found that children who lack
structure tend to be overactive, unfocused, over- On the Structure rung of the Relational Care
stimulated, and have a desperate need to control a Ladder, the primary need is for safety. Providing an
situation (Schore & Schore, 2014; Siegel, 2013). Parents environment that is clear of stressors when working
who experienced no structure during their childhoods with a traumatized child is essential. Safety requires
grow up to be poorly regulated and disorganized, a responsible adult to make decisions to get the
and have difficulty setting limits or being a confident traumatized person into a quiet environment without
leader. They rely on verbal and cognitive structuring other voices. Safety for all concerned within a family,
or resort to over- or understimulating their children. classroom, or organization requires the environment
to be regulated. In restorative practices we teach the
To change the negative patterns of a child who has child to move to a safe space, breathe, and splash
experienced relational trauma, it is necessary to the face with cold water. This gives permission and
provide a similar direct, interactive, and sensitive time for the trigger to be deactivated. Creating
emotional experience that challenges old patterns a norm around how to take care of themselves is
and expectations (Schore & Schore, 2014). instrumental to creating structure.

The brain needs the adult to meet the child’s Teaching individuals to use the R.A.I.N. practice
younger emotional needs, to find ways to calm increases their awareness of what’s happening to
the dysregulated child, and to create feelings them when in distress.
of safety for the traumatized child (van der Kolk,
2015). Predictability is important since the child R is for recognizing that I have a trigger. I am feeling ...
seeks confirmation of even maladaptive internal A is for accepting and acknowledging the
representations. Communication with the child sensation. State it without judging it.
helps them change their internal representations I is for investigating and asking what I need. Where
and provides the necessary developmental support does it sit in my body?
(Makela & Rooney, 2014). N is for nurturing myself by moving somewhere that
gives me a quiet environment. Breathe five deep
Structure in our surroundings and environment breaths, stretch, and do something that brings a
provides confidence. It also helps regulate the sense of peace.
neural pathways. Coaching individuals to breathe (Adapted from Zylowska, L. The R.A.I.N. Practice,
when feeling unsafe helps deactivate the alarm Mindful.org)

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Any adult can provide a simple and quick response Schools meet children’s need for safety when
as described above. They could clear the area they offer specific schedules for each day and
of people or remove the person to a quiet breaks for lunch, recess, and special activities.
environment; have the person control their breath by Within a restorative school, practices like using a
blowing into a paper bag or a balloon; or have them circle for check-in and check-out routines within
take a quiet walk with a calm adult. It’s advisable each classroom can provide additional structure
not to overwhelm them with questions or a need to
and also help teachers build relationships with
respond. Staying with them and having someone
and among their students (Wachtel, 2013).
be present in a nonthreatening way is critical. This
is a drain-off period where only quiet affirmations
Structure is also needed in the adult world.
and validations work. The aim is to achieve normal
nervous system regulation (Makela & Rooney, 2014). Companies have opening and closing times, return
policies, and vacation and sick leave policies.
There are a number of competencies that adults Dismissal protocols and employment benefits are
need to put in place to help ensure that the safety all structures that allow employees to feel secure
needs of the Structure rung are attained. Levels of within their respective organizations. Professional
regulation and organization bring the predictability learning groups can provide additional useful
of events and happenings into focus. Think of structures for business colleagues working on
the routines we create at home around regular different projects (Sheety & Rundell, 2012).
mealtimes, sleep patterns, celebrations for birthdays
and anniversaries, waking up and getting ready, Within any setting, professionals regulate by
and exercise. A family could have weekly family
introducing predictable ways for clients or
meetings to discuss issues, distribute chores, and
employees to meet and share feelings, gain
plan fun activities. Greetings at the beginning of
awareness, and challenge themselves through the
the day and farewells at the end of the day must
application of circles, impromptu groups, or one-
be done regularly; introduce proactive circles
that share feelings and fun experiences, as well as to-one discussions. Feeling secure and a sense
acknowledge support gained through the week. of belonging is dependent on being proactive in
Learn a new word each day and collectively use any family, school, or business. Remember that
it throughout the day for fun. These predictable consistency and unconditional regard are keys to
patterns help provide a sense of safety for the child. the success of any structure.

Think of the routines we create at home around regular mealtimes, sleep patterns, celebrations for
birthdays and anniversaries, waking up and getting ready, and exercise.

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NURTURING

Nurturing may be defined as the task of tending, rangers and compulsively self-reliant. Parents who
caring, supporting, and cultivating other people lack nurturing themselves tend to be dismissive,
to help them develop. When positive affect is harsh, or punitive; have difficulty with touch; and are
experienced between two people, their self-worth unable to show emotion (Panksepp, 2008).
increases. Nurturing children requires that adults
provide a sense of security, affirmation of self- To begin responding to the trauma created by a
worth, and a low-stress environment. Negative and lack of nurturing, professionals and other adults
judgmental comments are not nurturing practices need to provide traumatized children with soothing,
and have a detrimental impact on the self-worth hands-on experiences that are repetitive, rhythmic,
of a child. Consequently the child will experience a and rewarding (Panksepp, 2008). Appropriate
bodily reaction to negative comments. This physical levels of stimulation to the areas of the brain that
response becomes a trigger response. The body are involved in affect regulation are important in
remembers this long after the incident. Trauma retraining the central nervous system. The child/
rebounds in the body. When a child experiences a youth requires adults to nurture the child’s self-
caregiver who is indifferent or neglectful, critical, worth through affective statements and affective
judgmental, or shaming, that will trigger body questions that demonstrate respect for the child.
memories, which creates emotional pain (Williamson Showing respect and teaching appropriate verbal
& Anzalone, 1997; Panksepp, 2008; Siegel, 2006). and bodily experiences to the child or youth
also underscore appropriate touch experiences
Children who experience lack of nurturing (Williamson & Anzalone, 1997). Examples of
demonstrate overactive, aggressive, anxious, or appropriate touch begin with playfully touching
pseudomature characteristics; they are often lone different surfaces and naming what the surfaces
feel like (e.g., sand, mud, water, sandpaper, being
touched with a feather). Affirming and naming
feelings or sensations is essential in children’s
sensory growth. Verbalizing the touch experiences
helps later to know when touch does not feel okay.

Physical and emotional experiences develop

realizations and awarenesses essential for
recognizing reciprocity between self and others.
The key to providing positive affirmations is to do
it in calm spaces. Helping a child first to identity
and then verbalize their feelings provides them
with a structure they can use that allows their
neural pathways to make appropriate connections.

When a child experiences a caregiver who is You will recognize when behavior is rooted in a
indifferent or neglectful, critical, judgmental, lack of nurturing as a child or a client will respond
or shaming, that will trigger body memories, positively to the affirmations or validations you
which creates emotional pain. offer them. The nurturing phase requires an adult
to be present, provide security, continue affirming,

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and whenever the emotions get too overwhelming, The aim in helping a person build awareness is to
guide them back to breathing. identify specifically what happens within the body
at the time of the trauma trigger. Allow time for
The opportunity for a child or client to gain awareness expressing the stormy first draft (SFD), whether
is important here. It is a significant development they share it orally or in writing to let off steam.
if they can learn to recognize a trigger that is This may not be pretty. Do not take it personally.
causing them a level of discomfort and remove The SFD must be torn up or shredded. Only then
themselves from it, perhaps by leaving the situation can the child or client present in a nonthreatening
and, again, splashing their face with water to ease way to someone in the room. The oxytocin that
their discomfort. Awareness can help them begin is produced in the brain of an individual when
to identify their triggers more quickly and, with they are with someone in a nonthreatening way
assistance, learn not to respond with a fight-or-flight is important. Once the individual becomes aware
reflex, withdraw, or attack themselves. In restorative of where they are and that the sensations in their
practices, we use the Compass of Shame to reveal body have calmed down, they may be ready for the
how a child, a client, or anyone responds at a next phase. They are no longer in hyperarousal or
subconscious level to a feeling of disempowerment. hypoarousal (Levine, 1997; Siegel, 1999, Figure 3).
It has been used even with very young children to
help them identify their reactions to shame. FIGURE 3: WINDOW OF TOLERANCE: LEVINE,
1997; SIEGEL, 1999
Within the brain, implicit memory is any emotional
response or procedural memory patterns that arise
HYPERAROUSAL
when the client least expects it (Levine, 2015, Figure
1). Providing something that soothes—such as
walking, squeezing a rubber ball, or having a mantra
to say to themselves during this time—is helpful to
some. Yoga, exercise, or some sequential movement OPTIMAL
that allows regulation of breathing to take place AROUSAL AROUSAL
helps the procedural memory to feel secure again. ZONE

Gaining awareness into what has happened requires

someone to guide the individual to recognize the
sensations in their body. Guiding the individual
through the process of identifying the body
HYPOAROUSAL
sensations they’re experiencing and the feelings
associated with those sensations is important in
healing trauma and learning how to respond when
HYPERAROUSAL HYPOAROUSAL
they are triggered. To help foster awareness, you
Defending Flat affect
can invite the child or client to use any images that
Emotional reactivity Inability to think clearly
may pop up in their minds through their senses.
Hypervigilance Numbing
Then ask about what behavioral response became
Intrusive imagery Disabled orientating
apparent as they were triggered. Did they feel any
Obsessive/cyclical Defensive responses
affects such as sadness, anger, disgust, or fear
cognitive processing
(Levine, 2015)? As the Window of Tolerance (Figure
3) shows, this can result in either hyper-arousal or
From Waking the Tiger: Healing Trauma by Peter A. Levine,
hypo-arousal, manifesting in some of the behaviors published by North Atlantic Books, copyright © 1997 by Peter
or attitudes indicated for each state. A. Levine. Reprinted by permission of publisher; & D. Siegel
(1999), The Developing Mind, Guilford Press.

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Restorative questions may be used only once the
drain-off of emotions is done. These questions
should never be processed without an adult/
professional present to engage “with” (IIRP, Figure 4).
Answering the restorative questions allows the youth
to open up the limbic system. The openness and trust
in nurturing the process allows access to the logical
brain for processing. The nonthreatening nature of
the questions offered by a supportive, nonjudgmental
human also allows for the production of oxytocin
within the brain.

FIGURE 4: RESTORATIVE QUESTIONS

Restorative Questions 1
To respond to challenging behavior:
• What happened?
• What were you thinking of at the time?
• What have you thought about since?
Encouragement rather than criticism brings
• Who has been affected by what you have
out a collaborative sense of being.
done?
In what way?
• What do you think you need to do to
Reciprocity between individuals through
make things right?
affirmations of self-worth goes a long way in
families, schools, and businesses to nurture each
Restorative Questions 2
person’s worthiness. Encouragement rather than
When someone has been harmed:
criticism brings out a collaborative sense of being.
• What did you think when you realized
It also reduces stress levels caused by inappropriate
what had happened?
expectations. It is important to remember that
• What impact has this incident had on you when correction is needed, we must separate the
and others? deed from the doer, another restorative principle.
• What has been the hardest thing for you? Structuring and nurturing often blend together,
• What do you think needs to happen to especially when both giver and receiver are not
make things right? in competition with each other. Allowing family
O’Connell, T. (2009). The origins of restorative
dinnertime to be a time to share a feeling that
conferencing. Journal for Peace and Justice Studies, arose during the day and be able to voice how you
18, 87–94.
handled that feeling to your advantage is one way
of teaching that all feelings are normal.

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ENGAGEMENT

I define engagement as reciprocal verbal or marked withdrawal to socially engage is seen. Once
nonverbal interaction between human beings to neural pathways have been regulated and the child
encourage spontaneous feelings. Adults support a or client feels safe and nurtured, feelings can be
child’s ability to engage by teaching them about the more easily expressed and processed. The aim is
joy of companionship and attunement to others and to allow the integration of the implicit memory of
offering playful moments of attention that celebrate trauma to merge with the explicit memory (Levine,
“now moments.” The regulation of emotional affect 2015). Helping the child to experience feelings of
takes time and patience (Porges, 2011; Winnicott, safety and self-worth is essential for their healing.
1965; Siegel, 2013; Geller & Porges, 2014). Once again, the five restorative questions are helpful
tools to begin engagement.
Children who missed the Engagement rung on the
Relational Care Ladder display withdrawal, avoid It is essential that questioning the child or client
contact, are anxious and rigidly structured, and are should be reserved for when their thinking or logical
uncomfortable with others. The social impact on brain comes back online and they are no longer
children later in life is that they become followers; emotional. There is no purpose in questioning
they overidentify with others they get involved with someone unless structure and nurturing have been
to fulfill the need; they tend to be excessive people established. I have seen parents and practitioners
pleasers and consequently end up procrastinating use the restorative questions without doing the
due to overcommitments on their part (Porges, 2011; preliminary work of structure and nurturing, and it
Winnicott, 1965; Siegel, 2013; Geller & Porges, 2014). all comes tumbling down like Humpty Dumpty.

The psychological effect of not learning how to The proactive circles common in restorative
engage successfully as children may manifest practices are a great example of nonthreatening
itself generations later. Parents who never learned experiences that embrace structure and nurturing
how to engage may find themselves preoccupied, and encourage feelings to be expressed. Combining
inattentive, and out of sync with their child. They rely the use of a circle with compassionate witnessing
primarily on verbal engagement and simply do not is particularly effective in supporting someone
enjoy the child. They also demonstrate the same who needs a nonthreatening environment to work
characteristics of personal discomfort with crowds. through an experience (Weingarten, 2003, Figure 5).
Compassionate witnessing identifies the central issue
On this rung of the ladder, conversations about through an exploration of the individual’s experience
experiences are important. When behavior indicates of an incident and allows witnesses to respond with
that one lacks the skills to engage, conversation care, curiosity, compassion, and a sense of community
about an experience may not be forthcoming. A (Weingarten, 2003).

The psychological effect of not learning how to engage successfully as children may manifest itself
generations later.

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FIGURE 5: WITNESSING WINDOWS, WEINGARTEN (2003)

EACH WITNESS POSITION AFFECTS: WITNESS POSITIONS CAN CHANGE:

AWARE UNAWARE

FAMILY
EMPOWERED 1 2
COMMUNITY

SOCIETY
DISEMPOWERED 4 3
Reproduced from K. Weingarten (2003), Common Shock. Dutton.

Weingarten uses the four windows as a advisable. A choice is made within an individual,
self-reflective tool for parents, teachers and and safety and trust play major roles in allowing the
practitioners to become aware of their witness experience of empathy to occur.
position in any moment in time. Each window
indicates the care that the adult needs to take Engagement may also include using right-brain
before engaging with another individual. activities. Sharing art, music, sculpting, building
Legos, journaling, or any other creative process
Individuals learn empathy and how to offer involving focused activity allows space for chatting
support, which allows them to experience the about anything with which the individual gets
joy of companionship, learn how to be in the in touch.
“now moment,” and get attuned to others. The
Engagement rung’s primary goal is to make space Engagement requires the ability to celebrate joy in
to express feelings (Bluth & Blanton, 2014). Learning companionship. To do this we must be prepared
to be vulnerable requires safety and awareness that to listen and truly stay in the moment with another
you will not be judged. Only then will you share your person (Block, 2008). Too often we see parents who
personal feelings with others. Once someone is able are on their cell phones while ordering their kids
to share their feelings, they can experience empathy. around; then they wonder why their kids are not
Being vulnerable is a moving gage. The capability listening to them. Staying attuned to another person
for vulnerabilty depends on with whom the and giving them your full attention is an art. Listening
individual feels safe and worthy (Brown, 2015). Brown empathetically and compassionately takes time and
explores how empathy and shame exist on the same patience. This will be your true test as a supportive
continuum and identifies specific characteristics adult: to refrain from promoting your opinion and
indicative of each state. The vulnerability a person hear the other person. To respond without judgment
feels is dependent on how safe they feel in a or advice means you are able to mirror someone else
situation and how much trust they have in others with ease. Engagement requires having a voice and
who are involved. These factors can tip them toward being a good listener too. That is attunement and
either shame or empathy. The creation of empathy staying in the “now moment.”
is desirable, but being vulnerable to everyone is not

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CHALLENGE

On the Challenge rung children learn how to deal with and competencies but also to experience challenge,
setbacks, changes, and others’ expectations of them. setbacks, and the expectations of others. Role plays
Meeting challenges requires trial and error to feel a and skill building exercises can also be used to teach
sense of accomplishment and competence. Children flexibility in expectations and reciprocity. All of these
need experiences with others to learn reciprocity of kinds of activities can support a child to satisfy their
sharing, restoring, and collaborating. Developing need for feelings of self-worth and empowerment
competence, mastery of skills, and playfulness and to learn to work through the new emotions
through sports and games teaches reciprocity and that may arise as they move toward building new
the flexibility needed to meet challenges. This in turn competencies.
allows individuals to feel a sense of empowerment.
The impact of learning to navigate challenge is crucial When the Challenge rung is met with appropriate
for neural plasticity of the brain (Porges, 2011; Geller balance during childhood, the adult will continue
& Porges, 2014). Play also allows the child or youth to enjoy a sense of competence and engagement
to learn the give and take, positive or negative, of to support mastering of skills. But a child who has
losing and winning. This is a needed competency missed this rung of the ladder will be an adult fearful
when meeting any challenge. Successfully navigating of encountering loss. They tend to be perfectionists
the Challenge rung can be inhibited by any negative who need to please others. As parents they find it
emotional or verbal experiences with parents or extremely difficult to play with their children, are
others. An individual may have learned helplessness adult in conversation with them, and require adult
due to negative feedback. expectations of perfection, which tend to set up the
children with unrealistic adult ideals. The mature
The ability to be playful should be apparent as a characteristic is honored more than the trial and
regular part of daily activities for a child. Building error of daily life. The resulting tendency for child
these missing skills and competencies requires adults and adult will be to avoid anything unless they can
and professionals to engage in sport or games where be the very best.
winning or losing is not guaranteed. Learning to be a
good loser and gracious winner are important skills to For adults who have missed out on being challenged
acquire early in life. Patterns of avoidance, withdrawal, in childhood because they may have been parentified
or attacking oneself and others are significant during that time, recognizing that this is missing
indicators for the professional or adult to note. To in their life is important. Then they may be able to
counter these behaviors, introduce an activity that is address their relational trauma. Knowing that they
low risk and allows the child’s emotions to be worked have lost the capacity to play begins the journey of
through with affective statements of encouragement. recovery (Brendtro & Larson, 2006). Play serves as a
Involvement in extramural activities where sharing less intense form of affection for a child who fends
and collaborating are extensions of the skill they are off adult caregiving following trauma (Bloom, 2013).
learning is important. In music, this might include For example, when working in South Africa with
learning to play an instrument and joining a band child-headed households where both parents had
or learning to sing and be part of a choir. Learning died of AIDS, we had eight-year-olds responsible for
a skill such as karate with an instructor that gives four or five siblings younger than themselves. These
regular constructive feedback is another example. oldest children had lost the ability to play because
Learning to paint or draw and having the resulting they were looking after and feeding and getting their
works evaluated would not only help to develop skills siblings to school. Often their schoolwork suffered

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and they dropped out, seeking financial opportunities Adults who overachieve on the Challenge rung must
through sex trafficking. Through a Netherlands’ learn that micromanaging or playing the rescuer is
funder, my department at the time established a an attempt at control that keeps them from setting
playground outside a rural school. Every afternoon appropriate boundaries and expectations in caring
after school, we had graduate students facilitating for themselves (Schwartz, 1995).
activities in seven different parts of the playground.
They provided games, storytelling, physical activities, The primary purpose of challenge is to grow as
scavenger hunts, painting, sewing, and sand sculpting a person through competence, mastery, and
to support these child-headed households to engage playfulness. Challenge supports the need to
and challenge themselves in a safe space that allowed empower oneself within one’s environment.
for their needs for self-awareness, the expression of Identifying emotional triggers and making procedural
feelings, and empowerment to be met. behaviors more explicit allows healing to happen
(Levine, 2015, Figure 6).
Learning to challenge an individual or yourself to
experience a sense of empowerment or agency is Levine explains how memories that are quickly and
vital to human dignity. Not learning how to deal with readily accessed are known as explicit memories.
challenge as children creates one set of problems for When trauma or a shocking event occurs, the brain
adults, but if challenge is the only place recognition protects the individual by storing the memory
is given, many individuals become workaholics or in the body. This type of memory then becomes
procrastinators because they need to be perfect. implicit memory and may only be accessed through
Levine & Kline (2008) explain how many adults emotional responses of the body or procedural
become expert at managing or firefighting for memories (e.g. obsessive compulsive behaviors)
others, yet never learn to care for themselves. The when triggered. Learning to recognize that an
denial of a balance between self-care and care for emotion is related to a traumatic memory, and its
others is pivotal. If you are always in your manager or avoidance or survival responses, allows implicit
firefighter role, you cloud out your own self-care. A memories to become explicit and not trigger the
consequence will eventually be professional burnout, same unconscious reaction.
which Schwartz (1995) describes as being in exile.

FIGURE 6: MEMORY SYSTEMS, LEVINE (2015)

Processes needed to move from implicit memory to explicit memory

EXPLICIT IMPLICIT

PROCEDURAL
DECLARATIVE EPISODIC EMOTIONAL (BODY MEMORY)

Lists Nuanced Categorical Skills Approach Survival

Feelings Emotions Avoidance Response

Explanations Eidetic Images

Future Projections Completion & Renegotiation

Foresight Planning

Reproduced from P. Levine (2015), Trauma and memory: Brain and body in a search for the living past. North Atlantic Books.

PROCESSING TRAUMA USING THE RELATIONAL CARE LADDER 14 WWW.IIRP.EDU

HEALING THE HEALER

If needs were not met at a specific rung level, awareness and safety can healing begin. As noted
we enter into adulthood with gaps that may earlier when working with children and youth,
develop into wounds. Being wounded means we the mnemonic R.A.I.N. is equally useful to adults
continue to wound others subconsciously and stay working through past trauma.
on the Compass of Shame without awareness.
Broken relationships due to trauma create three We often become caretakers of others due to
patterns in adult behavior. They are categorized the experiences of our childhood or lack of
psychologically by such terms as insecure avoidant experiences. But adults and professionals must
attachment, insecure anxious attachment, and work through their own issues before they are
disorganized attachment (Porges, 2011; Geller & ready to help others. Learning to stay with painful
Porges, 2014). But for our purposes here, they all experiences, recognize when and where they
mean that adults who have experienced trauma as manifest in the body, and allow for a creative space
children will have trouble forming and maintaining to ask appropriate questions of ourselves, then
relationships through their lives. Much of Peter assessing what our real need is and nurturing it,
Levine’s work speaks to how the adult body carries gives us, as adults, the power to heal others by
with it the traumas of our past. Only through honoring children or clients with the same space.

Learning to stay with painful experiences, recognize when and where they manifest in the body, and
allow for a creative space to ask appropriate questions of ourselves, then assessing what our real
need is and nurturing it, gives us, as adults, the power to heal others by honoring children or clients
with the same space.

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CONCLUSION

Research demonstrates how specific behaviors As adults, we may use the Relational Care Ladder
are present in children and adults when neglect framework as a daily check-up for ourselves and
or absence of developmental consistency exists those we care for. A trigger may require us to revisit
at any one rung of the Relational Care Ladder a rung for a period of time. Healing possible gaps
framework (Brendtro, Brokenleg & Van Bockern, in our development allows the central nervous
2009; Levine, 2015; Panksepp, 2003; Panksepp, system to learn new coping strategies (Geller &
2008; Porges, 2011). Examples were given of these Porges, 2014). This enables one to move safely up
behaviors at each phase. Guidelines were offered and down the rungs of the ladder with ease. Be
on how to assist a process of healing at each rung mindful that the four rungs of the Relational Care
of the ladder, identifying also where and how Ladder framework invite continual revisiting and
restorative processes could be used to support this balancing in our daily lives. Balancing our basic
work. It is worth noting that healing is dependent needs for safety, awareness, expression of feeling,
on frequency, intensity, and duration of each and empowerment rewards one with the foundation
trauma response (Rundell, Sheety & Negrea, 2018). for living richly in the present moment.
Further, the Relational Care Ladder suggests how
intentional one needs to be in creating balance The four developmental rungs become the bedrock
between the four rungs of the ladder that feed for resiliency in everyday life. It is worth noting that
basic human needs. parents and professionals teach what they know,
and we are inclined to reproduce what we are. Using
Understanding and supporting the developmental the Relational Care Ladder as a metronome allows
stages that children and youth require for professionals and parents to recognize what the
establishing resiliency in their central nervous self and others need. Besides that, it increases our
systems give every child a better chance of living ability to respond more efficiently and effectively to
more productively and creatively (Brendtro & harmful experiences when encountered. Remaining
Larson, 2006). The usual stress every child will predictable, consistent, and offering unconditional
experience at home, school, and eventually work regard becomes the mantra (Winnicott, 1965).
will be greater for a child who has missed one of
the rungs and their central nervous system will be
deregulated as a result.

Thank you to Margaret Murray and all the reviewers who provided resources and suggestions in editing this
paper. I owe a lifetime of gratitude to all the families who guided my understanding and inspired me to write
this paper.

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REFERENCES

Bailie, J. W. (2019). A science of human dignity: Belonging, voice and agency as universal human needs. IIRP
Presidential Paper Series, 1, 1–16.
Black, D. W., & Grant, J. E. (2014). DSM-5TM guidebook: The essential companion to the diagnostic and
statistical manual of mental disorders (Fifth edition). American Psychiatric Publishing, Inc.
Block, P. (2008). Leadership and the small group. TD Magazine, July, 40–43.
Bloom, S. L. (2013). Creating sanctuary: Toward the evolution of sane societies. Routledge.
Bluth, K., & Blanton, P. W. (2014). Mindfulness and Self-Compassion: Exploring Pathways to Adolescent
Emotional Well-Being. Journal of Child & Family Studies, 23, 1298–1309.
Brendtro, L. K., Brokenleg, M., & Van Bockern, S. (2009). Reclaiming youth at risk: Our hope for the future.
Solution Tree Press.
Brendtro, L. K., & Larson, S. J. (2006). The resilience revolution: Discovering strengths in challenging kids.
Solution Tree.
Brown, B. (2015). Rising Strong: How the ability to reset transforms the way we live, love, parent, and lead.
Random House.
Geller, S. M., & Porges, S. W. (2014). Therapeutic presence: Neurophysiological mechanisms mediating feeling
safe in clinical interactions. Journal of Psychotherapy Integration, 24:178–192.
Kim, W., & Mauborgne, R. (1997). Fair process: Managing in the knowledge economy. Harvard Business Review,
75(4), 65–75.
Levine, P. A. (1997). Waking the tiger. Healing trauma. North Atlantic Books.
Levine, P. A. (2015). Trauma and memory: Brain and body in a search for the living past. North Atlantic Books.
Levine, P. A., & Kline, M. (2008). Trauma-proofing your kids. A parent’s guide for instilling confidence, joy and
resilience. North Atlantic Books.
Makela, J., & Rooney, G. (2014). Framing assessment for career services: Telling our story. Journal of New
Directions for Student Services, 148, 65–80.
O’Connell, T. (2009). The origins of restorative conferencing. Journal for Peace and Justice Studies, 18, 87-94.
Panksepp, J. (2003). At the interface between the affective, behavioral and cognitive neurosciences: decoding
the emotional feelings of the brain. Brain Cognition. 52, 4–14.
Panksepp, J. (2008). The affective brain and core-consciousness: how does neural activity generate emotional
feelings? In M. Lewis, J. M. Haviland, & L. F. Barrett (Eds.), Handbook of Emotions (pp. 47–67). Guilford Press.
Porges, S. W. (2011). The Polyvagal theory: Neurophysiological foundations of emotions, attachment,
communication, and self-regulation. WW Norton.
Rundell, F. C., Sheety, A., & Negrea, V. (2018). Managing trauma: A restorative process. Refugee Education:
Integration and Acceptance of Refugees in Mainstream Education, 11, 17–31.
Schore, J. R., & Schore, A. N. (2008). Modern attachment theory: The central role of affect regulation in
development and treatment. Clinical Social Work Journal, 36(1), 9–20.
Schore, J. R., & Schore, A. N. (2014). Regulation theory and affect regulation psychotherapy: A clinical primer.
Smith College Studies in Social Work, 84(2-3), 178–195.
Schwartz, R. C. (1995). Internal family systems therapy. Guilford Press.
Sheety, A., & Rundell, F. (2012). A PLG (Professional Learning Group): How to stimulate learners’ engagement in
problem-solving. US-China Education Review, 2(5), 497–503.
Siegel, D. J. (1999). The developing mind. Guilford Press.
Siegel, D. J. (2013). Brainstorm: The power and purpose of the teenage brain. Tarcher/Penguin Group.

PROCESSING TRAUMA USING THE RELATIONAL CARE LADDER 17 WWW.IIRP.EDU

Van der Kolk, B. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.
Weingarten, K. (2003). Common shock. Dutton.
Williamson, G. G., & Anzalone, M. E. (1997). Sensory integration and self-regulation in infants and toddlers:
Helping very young children interact with their environment. Zero to Three: National Center for Infants,
Toddlers and Families.
Winnicott, D. W. (1965). The family and individual development. Tavistock Publications.

PROCESSING TRAUMA USING THE RELATIONAL CARE LADDER 18 WWW.IIRP.EDU