Multi-systemic trauma and regulation: Re-centering how to BE with clients

Systems of oppression, adult violence exposure, and adverse childhood experiences interact to contribute to traumatic-stress related disorders, which manifest in affective, cognitive, and interpersonal challenges. This paper focuses specifically on emotional/physiological dysregulation as a central driver of trauma-related difficulties. The ability to recognize, assess, and intervene with children and adults for whom the capacity to regulate is compromised is critical in social work practice. This paper seeks to a) describe the role of (dys)regulation in social work practice and to b) apply this understanding to interventions that aim to address trauma-related challenges. Consistent with social work's mission, we focus on the application of these approaches to socially and economically marginalized populations from low-resourced communities. We discuss current trauma-informed concepts and models that focus on regulation as an important accompaniment to traditional cognitive-centered or insight-oriented approaches. Furthermore we argue that how to be with clients (e.g., our presence in relationship/alliance) is as important to client outcomes as what we do with clients. We present case examples to illustrate the use of interventions informed by leading theoretical models including Window of Tolerance, Polyvagal theory, and the Neurosequential Model of Therapeutics. Implications for teaching and practice are discussed.