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ORIGINAL ARTICLE

An Ecological Perspective: Therapist Practices with Children who

Experienced Abuse and Trauma ap_73 321..328

Claudia Edwards and Wally Karnilowicz

Social Sciences and Psychology, Victoria University

This qualitative study explores experiences of psychotherapists working in public settings with children who experienced abuse and trauma. The
study sought to investigate and understand factors which intruded upon and or supported the capacity for psychotherapists in a community
clinic to cognitively process and understand supportive and constraining aspects of the professional context. An important focus was the
organisational context of psychotherapists. Nine psychotherapists were interviewed to gain an understanding of their experiences with and
perceptions of the needs of children including factors considered important in therapy, the inuences of their organisational context, and
challenges and rewards of the work. An Interpretative Phenomenological Analysis of interview data revealed three broad themes identied as
relational, organisational, and systemic. An ecological metaphor was used to conceptualise these themes as they related to psychotherapists
and the children with whom they worked. The ndings demonstrated the importance of the psychotherapists organisational context on how
they experienced their work. This study also considered the need to conceptualise therapy with children who have experienced trauma within
the interaction of the child and therapists relational, organisational, and systems context.

Key words: child trauma; interpretive methods; organisational psychology; phenomenology.

What is already known on this topic What this paper adds

1 Therapeutic practices with traumatised children are informed by
a variety of different theoretical approaches.
2 The effects of these therapeutic practices effects the everyday
lives of the practitioners.
3 The organisational context is important and inuential with
therapist practices involving persons experiencing the effects
of trauma.
1 An interpretation of therapist practices through their experi-
ences using an ecological systems metaphor.
2 A focus on the dynamic interaction between the therapist,
children, their families and systems, and the organisational
context of therapists.
3 An examination of the potential for systems to constrain or
support therapy with children.

Childhood trauma, including abuse and neglect, is a significant
public health challenge in developed countries (van der Kolk,
2005). Recognition of the long-term consequences of abuse-
related trauma in childhood has led to increased public and
government efforts targeted at prevention and treatment. As a
result, the Victorian State government through the Department
of Human Services (2007) has funded a range of specialist
community-based agencies offering therapeutic treatment for
children who have experienced sexual abuse, physical abuse,
neglect, or exposure to family violence.
Current psychotherapeutic practices within these agencies
and associated services is often informed through the relational
context within which the trauma occurred as a major factor in
Correspondence: Wally Karnilowicz, Social Sciences and Psychology,
Victoria University, Footscray Park Campus, Ballarat Rd., Footscray, PO
Box 14428, Melbourne, Vic 8001, Australia. Fax: +61 3 99194324; email:
wally.karnilowicz@vu.edu.au
Accepted for publication 23 March 2012
doi:10.1111/j.1742-9544.2012.00073.x
understanding impacts (e.g., Cairns, 2002; Cook et al., 2005;
Jenmorri, 2006; van der Kolk, 2005; Perry, 2006). Furthermore,
the need to attend to relational issues within and outside
psychotherapy has been suggested as an important compo-
nent of effective treatment (Cairns, 2002; Cook et al., 2005;
Kinniburgh, Blaustein, Spinazzola, & van der Kolk, 2005; van
der Kolk, 2005; Perry, 2006).
In addition to the relational aspects, also emphasised is the need
for multi-systemic intervention strategies at the level of the carer,
agency, and environment (Cairns, 2002). For example, Cook et al.
(2005) argue that the responses of a childs social support system
in mediating the effects of trauma are more important than objec-
tive elements of victimisation. Thus, an important corollary is a
treatment intervention which enhances a childs social support
system (Cook et al., 2005). The importance of the childs systemic
context has been supported in current psychotherapeutic litera-
ture on children who have suffered trauma and abuse (Cairns,
2002; Cook et al., 2005; Kinniburgh, Blaustein, Spinazzola, & van
der Kolk, 2005; Stone, 2006; Weston, 2006).
A more contemporary and dynamic form of psychotherapeu-
tic practice considers a systemic ecological framework which

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encourages understanding the role of the environment in
creating, contributing, or recovering from trauma (Adamson,
2005). This approach allows for the integration of a variety
of theoretical explanations and interventions and enables
various sets of knowledge to be held together and drawn
upon simultaneously. An ecological paradigm has its origins in
Bronfenbrenners (1979) ecological systems theory of human
development. Bronfenbrenner argued that development must
be understood as an interaction between the developing person
and their environment (ODonoghue & Maidment, 2005) and
suggested a three-person model with the environment consti-
tuting the third person (Bronfenbrenner & Mahoney, 1975).
Applied to psychotherapy, an ecological perspective is inter-
disciplinary and metatheoretical. Individuals are part of an
ecosystem in which multiple contexts are considered and
interventions are targeted at various levels (Conyne & Cook,
2004).
Common with many psychotherapeutic approaches is an
emphasis on the childs relational context including the thera-
peutic relationship and the importance of familial and systemic
interventions. Consistent with the holistic ecological perspec-
tive, understanding the third person environment within the
experiences of psychotherapists engaged in a therapeutic rela-
tionship with the child are also important in understanding
treatment effectiveness. Within this framework and apart from
considering the relational and systemic aspects of therapeutic
practices with traumatised children, the occupational and per-
sonal health and well-being of psychotherapists has implications
for treatment outcomes for these children.
Working with traumatised children may disrupt a psycho-
therapists everyday life (Canfield, 2003) and includes frustra-
tion and difficulty in working with multiple, often fragmented
systems in the childs life, for example, the challenges in
working with legal, child protection, and foster care systems
associated with sexually abused children (Pistorius, 2006)
and/or specifically with children in the foster care system (Lon-
ergan, OHalloran, & Crane, 2004). The challenges for the psy-
chotherapist and source of emotional difficulty include the
family, dealing with systems in community health agencies
(Edgeson, 2006), and being exposed to traumatic material.
Nonetheless, there is a paucity of published research on
the experiences of psychotherapists working specifically with
children who experienced trauma and abuse. Among the few
studies most have been qualitative (e.g., Biggs, 2003; Canfield,
2003; Edgeson, 2006; Hill, 2006; Lonergan et al., 2004; Pisto-
rius, 2006; Powell, 2005) and or unpublished dissertations (e.g.,
Biggs, 2003; Canfield, 2003; Edgeson, 2006; Pistorius, 2006;
Powell, 2005; Young, 1999). In contrast, more plentiful research
on the experiences of psychotherapists focused on working with
adults within a narrow framework of negative effects (e.g.,
Saakvitne, 2002) and the relationship between therapist and the
perpetrators of abuse (e.g., Steed & Bicknell, 2001). However, a
theoretical framework for conceptualising the negative effects
and the relationship between positive and negative effects
remains unclear and instead the focus of research has been on
how psychotherapists cope with the challenges and negative
impacts of their work (e.g. Canfield, 2003; Edgeson, 2006;
Pistorius, 2006; Young, 1999). The personal, professional, and
organisational domains have been identified as integral in terms
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C Edwards and W Karnilowicz
of therapists managing the impacts of their work (Lonergan,
1999).
Included among the personal coping mechanisms in psycho-
therapists working with children are support from colleagues,
family, and friends, spirituality, engaging in personal therapy,
self-awareness, addressing personal issues, and possessing com-
passion and empathy (Pistorius, 2006). Self-care strategies
are also considered important (Canfield, 2003; Edgeson, 2006;
Pistorius, 2006). In contrast, professional strategies in managing
the challenges of work include debriefing, peer support, and
supervision. It has also been suggested that there are parallels
in the needs of psychotherapists and the needs of clients.
Therapy involves being a witness to clients stories, and thera-
pists also need a witness (Pistorius, 2006) often in the form of
supervision.
The training and supervision needs of child trauma psycho-
therapists are crucial in supporting professional development
(Bustos, 1990; Pearlman & Maclan, 1995; Walker, 2004; Wells,
Trad, & Alves, 2003) and can ameliorate the potential negative
effects of trauma therapy (Cerney, 1995; Neuman & Gamble,
1995; Rosenbloom, Pratt, & Pearlman, 1995; Yassen, 1995).
Walker (2004) suggests that the role of the supervisor is to
provide space, safety, and containment for the therapist. The
containment function facilitates the therapists capacity to hold,
contain, and manage what is unconsciously communicated by
clients (Walker, 2004). However, despite widespread agreement
on the importance of supervision for trauma therapists (e.g.,
Bustos, 1990; Figley, 1995; Neuman & Gamble, 1995; Pearlman
& Maclan, 1995; Schauben & Frazier, 1995; Wells et al., 2003;
Yassen, 1995), there is a lack of research into therapists expe-
riences of supervision.
Investigations in the needs of therapists who work with trau-
matised populations also consistently emphasises the impor-
tance of their organisational context (Adamson, 2005; Altman,
1995; Morrison, 2002; Walker, 2004). Several have examined
these issues (Canfield, 2003; Edgeson, 2006; Hetzel, 2006;
Powell, 2005) and attest to the importance of the organisa-
tional context in supporting or constraining the work of child
psychotherapists. The organisational context of psychothera-
pists who work with children is important for several reasons.
First, groups and organisations are affected as a consequence of
working with traumatised or abused populations. It has been
suggested that the unconscious dynamics of traumatised clients
can be paralleled at the group and organisational level often
manifesting in a climate of anxiety (Bustos, 1990). This has
also been described in terms of common experiences of abuse
survivors such as isolation, alienation, secrecy being re-enacted
in group, and organisational dynamics (Catherall, 1995a,
1995b). Therefore, these effects need to be understood within
the context of the potential effects on the organisations in
which they work. Second, the crucial role that organisations
play in supporting therapists is frequently discussed but rarely
researched. Finally, therapists, organizations, and their rela-
tionships need to be understood as part of the therapeutic
milieu for clients and is inextricably linked with the quality
of the work environment (Morrison, 2002). Organisational
factors such as high caseloads and multiple work demands con-
tribute to symptoms of distress among child therapists
(Edgeson, 2006).
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C Edwards and W Karnilowicz
In summary, research and theoretical literature regarding
the effects of abuse-related trauma on children has developed
greatly as has the development of therapeutic treatment models.
The therapeutic relationship is often emphasised in the treat-
ment literature as is the need for systemic interventions.
However, while theoretical knowledge informing child trauma
treatment has developed greatly in the past decade, there is
a gap between theoretical treatment models and day-to-day
clinical practice (Canfield, 2003). Large-scale treatment efficacy
studies often use manualised treatment packages which may
not be used by clinicians in community-based settings and over-
look the influence of the therapeutic relationship. The voice of
therapists who undertake this work is often absent and this
focus leaves little room for understanding their experience.
Exposure to traumatic material associated with child therapy
may not be the most difficult aspect of the work (Arnold,
Calhoun, Tedeschi, & Cann, 2005; Edgeson, 2006; Lonergan
et al., 2004; Pistorius, 2006), and systemic issues associated with
the professional and organisational context have been reported
as especially challenging. The need to examine positive effects
for therapists as well as the presence of a relationship between
the challenges and rewards has emerged in recent research
(e.g., Arnold et al., 2005; Brady, Guy, Poelstra, & Brokaw, 1999;
Hetzel, 2006; Iliffe & Steed, 2000; Stamm, 2002; Steed &
Downing, 1998; Young, 1999). Consequently, consistent with
the ecological approach, there is the need for a more holistic
exploratory approach to understanding the rewards and chal-
lenges from the perspective of the therapists.
Purpose of the Study
This study explores the experiences of a group of Australian
therapists who work in public settings with children who have
suffered abuse and trauma. This study investigates factors which
intrude upon and/or support the capacity for psychotherapists
in a community clinic to cognitively process and understand
supportive and constraining aspects of the professional context.
Specifically, the research question deals with the examination
of the psychotherapists view of their working within a
community-based agency dealing with children who had expe-
rienced abuse and trauma. Incorporated within this question are
perceptions of the needs of children including factors considered
important in therapy, the influences of their organisational
context, and challenges and rewards of the work.
Method
Procedure
This qualitative study investigated subjective accounts of thera-
pists working in public settings with children who have expe-
rienced trauma and abuse. Interviews lasted between 60 and
90 min and addressed a variety of content areas including the
influence of the therapists organisational context. A phenom-
enological epistemology focusing on understanding perception
and meaning (Barker, Elliott, & Pistrang, 2002) was applied to
explore how therapists understand the needs of children who
have suffered trauma and abuse and examine factors important
in the provision of effective therapy. The construction of the
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Therapists perspectives practice
semi-structured interview schedule was guided by the central
research question specifically examining their view of working
within a community-based agency dealing with children who
had experienced abuse and trauma. Open-ended questions
were formulated to access areas of interest. For example, ques-
tions related to the theoretical and therapeutic orientation
included the following: What have been the most significant
influences on how you approach work with traumatised chil-
dren? In addition, questions related to the impact of work
included: What helps you understand the potential impact on
therapists of this type of work? Other open-ended questions
included those related to the therapist background, effective
therapy with traumatised children, and general questions
related to contemporary issues significant in clinical practice.
Participants
Participants were therapists employed by public or community-
based agencies within specialised trauma and abuse pro-
grammes. After obtaining university ethics approval, nine
practicing therapists,1 two men (John and Andrew) and seven
women (Lucy, Kate, Simone, Jean, Susan, Alex, and Jody)
consented to participate and completed interviews in 2007. The
participants included a group who received some training in
Psychology, an occupational therapist, social workers, and reg-
istered psychologists. The experience of therapeutic practice
varied and included sexual assault, family violence, and child
counselling; working with refugees who had experienced
torture and trauma; sexual abuse counselling to children and
adolescents; working with adolescents who had engaged
in sexually abusive behaviours; mens counselling; childrens
counsellor in a domestic violence service and with children
involved in the Child Protection system; child therapy with an
agency that provided counselling for children and adolescents
who experienced trauma and abuse; disability services; teaching
school psychologist at an alternative school with high risk ado-
lescents; and, in infant, child, and adolescent mental health.
Data Analysis
The interviews were recorded using digital audio equipment
and then transcribed verbatim. Data were analysed using Inter-
pretative Phenomenological Analysis (IPA; Smith, Jarman, &
Osborn, 1999). The analysis is idiographic in that the accounts
of individual cases were read and eventually considered in order
to make broader claims representative of the group. Consistent
with the views of Smith et al. (1999), the analysis is interpre-
tative to the extent that the researchers acknowledge their own
views and due to their own conceptions try to make sense of
the participants personal experiences through an interpretive
method. This method requires the researcher to reflectively
engage with the transcripts in order to generate meaning with
respect to the phenomenon under investigation.
Consistent with IPA, individual transcripts were analysed in
turn which first involved reading the transcript a number of
times and noting initial thoughts and impressions. The inter-
views were then re-read and interpreted more thoroughly with
the identification of emerging themes identified as recurring
patterns of meaning throughout the text. The next stage of
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analysis was to . . . search for themes reflecting shared aspects
of experience for all the participants (Smith et al., 1999,
p. 230). The previous clusters of themes for each individual
transcript were examined in greater detail. After a sustained
process of reflection and engagement with the material, three
major or higher order themes were identified as central
organizing constructs (Smith et al., 1999, p. 234). These three
major themes were labelled Relational, Organisational, and tionship. The general view was that a child felt safe when a
Systems. The third step involved going back to re-examine the
interview transcripts within the more focused lens of major
themes. This phase of data analysis involved moving beyond the
identification of themes to how they were interrelated. It is
important to note that throughout the analytic process, themes
or categories were allowed to emerge from the interview data
rather than being predetermined by the themes that occurred
as a natural consequence of the interview questions.
A preliminary list of thematic codes within each of the major
themes was then examined and the thematic codes were clus-
tered together dependent upon the salience of their inter-
relationship. At this stage, participant quotes were distributed
according to their specific relationship with the respective the-
matic code. The major and supporting themes emerged consis-
tently and were substantiated in participants accounts. They
addressed the research questions, and they linked together in a
meaningful and coherent manner. Using illustrative quotes, the
themes were then incorporated into a narrative account.
The analysis was ongoing throughout the process of writing
and is a recognised method of inquiry (Richardson, 2000). The
writing process communicated and substantiated the findings
from the point of view of the reader. This reflective strategy
informed a clarification, development, and exploration of the
relationships between themes. The participants also commented
on their completed transcript as a method of member checking
(see Lincoln & Guba, 1985).
Results and Discussion
Despite the professional, theoretical, and experiential diversity
of therapists who participated in the study, the major themes
Relational, Organisational, and Systems emerged consis- . . . theres two things that we bring to the tablefirst our sense of
tently from the data. The following interpretation of findings
related to each of these themes is based on the therapists
narratives and represents the researchers interpretation of their
views and opinions.
Relational Context
The relational context refers to the interpersonal interactions
specifically between the therapist, child, and primary caregiver.
The effect of trauma and abuse on children is best understood
within a relational context and is a more important predictor
than objective details of the trauma (Cook et al., 2005). For
example, secure attachment bonds between a child and primary
caregiver may mitigate the effects of trauma and abuse (van der
Kolk, 2005).
Within this community-based agency, the therapist needed to
consider the primary caregiver and the therapeutic relationship
given the relative importance of each in helping to repair effects
of trauma. The therapist necessarily provided a therapeutic
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C Edwards and W Karnilowicz
relationship to facilitate the child and primary caregivers rela-
tionship and worked with the child and their parents or carer to
maintain a safe, predictable, and attuned caregiving relation-
ship. Fundamental to the primary caregiving relationship was
the capacity to ensure that a child perceived their selves as
physically, emotionally, and psychologically safe. It was also
important to provide the children with a safe therapeutic rela-
therapists relational qualities included patience, empathy, con-
sistency, acceptance, respect, predictability, interest, playfulness,
and the capacity to listen to and hear.
However, withstanding the emotional communications
children displayed in therapy was difficult. The knowledge
therapists engaged to recognise, understand, and be part of the
emotional responses of the child was essential in guiding
responses and allowed therapists to endure and make sense of
childrens challenging behaviours.
I dont think youd want to prevent the impact of the work because
thats part of the countertransference . . . part of the therapeutic
process . . . [is] . . . that you become part of these childrens lives
. . . and that you, to be useful, they make you feel . . . what theyve
felt and thats how you understand them. Not only is it not pre-
ventable, you wouldnt want to prevent it, its part of the treatment.
(Kate)
However, a childs capacity for thinking and reflection is
impaired by abuse and neglect (Henry, 1983; Stone, 2006). The
relational processes in the therapy room were equally relevant
to what happens outside the room and how therapists think
about a child and their capacity to keep the child in mind.
The therapist . . . must be able to think about and consider
the possible horror of the childs . . . experiences (Stone, 2006,
p. 88).
The processes and dynamics within therapeutic relationships
were complicated and multifaceted. Balancing the process of
engagement and maintaining appropriate detachment was
complex.
empathy and our capacity to connect . . . But thats also a double-
edged sword, because thats also our worst enemy because thats what
makes you vulnerable. You know your biggest tool is yourself . . . its
how you use who you are and as soon as you do that, youre vulner-
able. (Simone)
The therapist needed to detach to avoid the emotional impact
of working with stories of trauma and abuse. It was necessary to
balance engagement and detachment and use interpersonal and
cognitive skills to engage and think about the needs of clients.
However, becoming too detached or emotionally distant could
compromise the efficacy of therapy.
. . . you can develop a robustness or an outer skin as a
protector . . . and you know you get used to hearing a lot of the
stories . . . I guess its kind of detached and you know I think the
whole balance between connection and attachments with clients is
hugely important in relationships. If youre too connected youre too
emotionally involved, if youre too detached you cant build a warm
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C Edwards and W Karnilowicz
relationship . . . Well I think you can build too much of a protective
skin and then you might move into denying to the self the impact of
the work on you. (John)
The emotional impact of hearing stories of pain, trauma,
and tragedy was inevitable and perhaps necessary. Therapists
emphasised that this emotional impact was important in devel-
oping the therapeutic relationship. Iliffe and Steed (2000) and
Edgeson (2006) described the therapists challenge of balancing
distance and engagement or maintaining a functional level of
emotional distance.
The rewards of the relationship often occurred in the minutiae
of therapeutic dynamics rather than being overtly gratifying.
Having a connection with children was intrinsically rewarding.
This sense of reward was further enhanced when recognising
that the children, due to their history of abuse and neglect, had
difficulty in developing relationships. There was the sense that
the relational rewards of the therapists work were important in
sustaining them and counteracted the many challenges. Stamm
(2002) argued that the satisfaction derived from the work of
helping has largely been ignored and that to understand the
negative costs of caring, the positives must also be understood.
There were associated significant personal outcomes:
. . . theres quite a lot of impact and its . . . something I think about
myself and how I have changed and how I see my world and how do
I interact with other people and I dont know if I would be the same
person I am today if I hadnt worked in this area. (Jean)
The supervisor and the supervisory relationship acted as
a vital buffer in attending to the impacts of the therapeutic
relationship. Good supervision was relational and reparative
(Wells et al., 2003). As with the therapeutic relationship, open-
ness, trust, safety, vulnerability, respect, and collaboration
contributed to the creation of a reflective space in supervision.
There was a need for the therapists to be able to expose them-
selves and feel safe in their relationship with the supervisor.
And the kind of supervision where I feel OK to be vulnerable
. . . Being able to kind of feel safe enough as a therapist, in with my
supervisor to say, like I was so stuck, you know even upon reflection
I still dont know what to do. The safety in that relationship for me is
really important. (Susan)
Supportive relationships with colleagues also buffered against
the difficult impacts of the work. Relationships within teams
were not only viewed as benefiting therapists but also as directly
facilitating their therapeutic work. There was also value in dif-
ferent perspectives as well as a shared sense of responsibility
particularly with complex cases.
I think the important part is being able to work with other people,
and not to work in isolation . . . its really important to share and
explore with others and I think thats where I feel that I get my energy
back, when I understand things and when I understand my reac-
tions. (Jean)
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The Organisational Context
The organisational context refers to the formalised roles
and functions within the community agency. This context
was central to the therapist experiences, behaviours, and
effectiveness;
I always think of the Babushka dolls as a good metaphor for an
organization and you know the clinician or the client might be one
of the smaller dolls and the director might be the larger doll and
each needs to be contained by the one above. And if the one above
is not contained then theyll all kind of fall apart. I think organi-
zations dont think about that stuff enough and if everyones not
contained then theyre not going to be doing their job properly.
(Andrew)
It was strongly believed that the informal and formal organi-
sational structures needed to provide containment. The organi-
sation needed to recognise and attend to the particular needs of
staff working with trauma. Formal structures included supervi-
sion, opportunities for training, and professional development.
Supervision was discussed earlier as part of the therapists rela-
tional context but was also part of the organisational context.
Training was an important part of the structural context pro-
vided by organisations and needed to address individual inter-
ests and needs. Therapists required support to integrate their
skills or knowledge.
Time and space for debriefing, thinking, and reflection
were essential. An important containment function of organi-
sational structures enables the therapist to fulfil their thera-
peutic function without external pressures intruding too much
on their role (Wade, Beckerman, & Stein, 1996). In discussing
funding requirements, targets, and performance indicators,
Jean spoke of the containment function of organisations to
. . . be a bit of a buffer between the funding bodies and
whats required, and the people who do the work. Good
management structures were necessary along with the need
for clarity of roles at various organisational levels. The evoca-
tive Babushka dolls metaphor was introduced in this context.
Seniors and managers needed to be appropriately supported
by the organisation to enable them to be available to support
therapists.
The culture of an organisation mediates the impacts of the
work for therapists. Organisational culture determines whether
staff effectively utilise support structures available to them
(Neuman & Gamble, 1995; Sexton, 1999).
I worked in an agency where I just didnt feel like I matched with the
culture or the values of the place . . . you dont realise until you find
a place that has a really good match. You dont feel as motivated and
things like that. So theyre kind of really intangible things that, like
workplace culture . . . (Jody)
Parallels to what was important for children such as trust and
nurturing were evident around organisational culture. A thera-
pist needed organisational holding; an organisational culture
attuned to the challenges of working with trauma and attentive
to a range of mechanisms to address these challenges (Neuman
& Gamble, 1995).
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. . . it seems like theres a lot of lip service given to this idea of the
stressful nature of the work and how difficult it is. . . . Its mentioned
a lot, its talked about a lot, so it seems as if its acknowledged. But I
think if anyone was to say Im experiencing vicarious trauma, Im
very stressed . . . therefore I need to have some time off, or not see as
many clients I think that would be frowned upon. (Lucy)
Systems Context
Systems include references to family systems as well as
legal, foster care, and child protection agencies. The dynamics
of trauma and abuse impact are re-enacted in these systems
(Hunter, 2001; Weston, 2006). An ecological systems paradigm
allows one to understand how trauma and abuse of children
impacts the systems within which they are embedded. A sys-
temic perspective was fundamental to therapists understanding
of the impact of trauma and abuse on the child, and chaotic
and unstable backgrounds were frequently the context for the
abuse. Parallel dynamics of anxiety and fragmentation occurred
within the childs system, and a challenge for many therapists
was dealing with fragmented and dysfunctional systems. Aware-
ness of these dynamics facilitated understanding of complex
systems and informed interventions. Hence, while there was the
need to contain the child within these systems, there was also
the need to contain the anxiety of the system.
. . . often agencies we work with dont think about that stuff enough.
And I wonder at times whether, its actually a defence against how
painful it really is to think about what the experience has been like,
for the kids we work with. . . . Carers, agencies and other profession-
als as well. . . . You forget histories and stuff because theyre awful,
theyre all awful. So why do you want to keep it in your head really?
(Andrew)
The emotional impact of systemic issues was related to
various factors, including feeling powerless and not having
control over the responses and decisions made by the system.
Systemic issues in working with children may increase thera-
pists emotional vulnerability.
. . . when you factor in the neglect stuff and people not really noticing
or taking care of children. And they dont have a voice and what we
can do is provide that for them at some level . . . you can get caught up
with, you know when you want to shake a parent and take a child
home and look after it yourself. . . . But it can consume you this work,
so being aware of that . . . you can live, eat, sleep, breathe this
work. . . . I think theres something particular about working with
children thats a bit seductive on that level. (Simone)
As systems become more complex, the role of the therapist
also became increasingly complex. In addition to providing indi-
vidual therapy, the therapists role entailed navigating and man-
agement of multiple relationships.
. . . Ive struggled to hold the child in mind and the work in mind and
the system in mind at the same time. . . . I find it hard to take on both
roles, so not that theyre competing, well theyre intruding on each
other. . . . And I think it comes down to whats your role as a coun-
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sellor or therapistfrom the individual work in the room to more
advocating for the systemic change and moving from one to the other.
(John)
An integral part of the therapists role was to use their unique
knowledge and understanding of the child to enhance the
capacity of others to understand and respond to the child. The
range of responses to working with the childs system included
feelings of frustration, hopelessness, and despair. Jenmorri
(2006) described the challenge of negotiating personal feelings
of hope and despair. There was also the potential to be over-
whelmed, exhausted, and to have doubts about professional
efficacy. The perceived failures of families, systems, and society
to protect children were confronting. In particular, the challenge
for therapists was to integrate their feelings into their beliefs
about their world.
. . . we live in a world where these sort of things go on and for some
people they go on for their whole entire lives . . . and some of that sort
of stuff is quite shocking, awful to think about. I think when its
chronic and its intergenerational . . . it challenges your worldview.
(Lucy)
An Ecological Model of Therapy
The three-person ecological model enriches understanding at
the individual and dyadic level by also allowing for an inter-
pretation of the organisational and systemic context as the
third person (Altman, 1995). Therapy with children who have
experienced trauma is a three-person dynamic with an equiva-
lent consideration of the interaction of the child and therapists
relational and systemic context or organisational context. In
contemporary relational theory, therapy is understood as inte-
grating one-person (intrapsychic) and two-person (interper-
sonal) models (Altman, 1995). In the current study, relational
perspectives were prominent in therapists narratives. As well as
the social and cultural context, such a perspective also includes
the institutional or organisational context of the therapist
and client.
The strength of an ecological framework is that it can be
metatheoretical and interdisciplinary (Conyne & Cook, 2004). A
specific theoretical approach to therapy is not dictated, which is
consistent with the current emphasis in literature on the rela-
tional and systemic needs of children who have suffered trauma.
An ecological perspective has an array of potential applications
and practical utility for therapists, supervisors, and organi-
sations. It is also important for therapists, supervisors, and
organisations to keep in mind a conceptual framework that
acknowledges parallels, to understand and meet the needs of
children, therapists, and organisations.
An ecological approach allows for the findings regarding the
needs of children and the therapists who work with them to
be conceptualised in a coherent and unified framework. Past
research focused on either the needs of children who have suf-
fered trauma and abuse (e.g., Kinniburgh et al., 2005; Reckling &
Buirski, 1996) or the needs of therapists who work with people
who have suffered trauma (e.g., Lonergan et al., 2004; Walker,
2004; Yassen, 1995). A unique contribution of an ecological
Australian Psychologist 48 (2013) 321328
2012 The Australian Psychological Society
C Edwards and W Karnilowicz
approach is that it integrates the children and therapists experi-
ences and needs and emphasises their interdependence.
Summary and Conclusions
This research focused on the perceptions and experiences of
therapists and provides an interpretation of a dynamic inter-
action between children, their families and systems, and the
organisational context of therapists. Systemic issues are a sig-
nificant challenge for therapists. Nonetheless, the potential
for systems and organisations to constrain or support therapy
with children receives minimal attention. There is also a need
to further investigate interactions and relationships between
challenges and rewards for therapists working with children.
The ecological three-person model of therapy provides fertile
ground for the development of a therapeutic model beneficial
for therapists, supervisors, organisations, and ultimately, chil-
dren who have suffered trauma and abuse.
Acknowledgements
This research received no specific grant from any funding
agency in the public, commercial, or not-for-profit sectors. Julia
Scarfe is also acknowledged for her editing and suggestions in
the writing of this article.
Note
1. Pseudonyms rather than actual names are used in each
instance.
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