ONLINE CONTINUED PROFESSIONAL DEVELOPMENT (CPD) IN COUNSELLING AND PSYCHOTHERAPY

ONLINE CONTINUED PROFESSIONAL DEVELOPMENT (CPD) IN

COUNSELLING AND PSYCHOTHERAPY LECTURE MATERIAL

Adverse Childhood
Experiences (ACEs)
Underpinning Theory
The Centers for Disease Control and Prevention (CDC) in the USA look at patterns of
illness. In 1985, medical doctor Vincent Felitte was running an obesity clinic in
Santiago, California; he was perplexed that almost 50% of his patients dropped out
each year.

In seeking to understand why this happened, he launched a 25-year research study

involving more than 7,000 members of Kaiser Permanente, a provider of health
insurance and medical care.

Physiological and Psychological Impact

Felitte found that people traumatised by ACEs look for something to numb their
horrific emotional pain; he went on to observe that what they find will kill most of
them prematurely.

There are three broad categories of ACEs:

• physical, emotional and sexual abuse

• neglect

• household dysfunction

The ACE score is a tally of different types of abuse, neglect and other hallmarks of a
rough childhood. A client’s ACE score can inform assessment, but it’s vital to be
properly trained first in how to use this.

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According to ACE studies, the more difficult the person’s childhood, the higher the
score – indicating that they may have a higher risk of health problems in later life.
Common health problems of this type include drug misuse, alcoholism, heart disease
and cancer. In short, ACEs lead to social, emotional and cognitive impairment.

In fact, children who had very difficult childhoods do not develop the same brain
capacity as other more privileged youngsters, especially in the frontal cortex, which
we use in decision-making. This can contribute to adopting high-risk behaviours, e.g.
sexual promiscuity, drug/alcohol misuse and over-eating.

Therapy Basics
Brief therapy is unlikely to be sufficient for clients with ACEs; long-term engagement
will be needed, to allow the young person to build trust with the therapist.

This is likely to take time, especially given that many children who have experienced
abuse have either a disorganised attachment or avoidant-dismissive attachment style.

In short, they are used to having to look after themselves and not trusting people. In
Carl Rogers’ terms, psychological contact must be established and maintained.

In residential settings, children can often choose the therapist they want to work with,
so encouraging trust and autonomy.

Multidisciplinary Approach and Referral

In this kind of work, there will be many other stakeholders and professionals involved
– e.g. social workers, the police, teachers and other school staff and medical
professionals. Linked to this, there will be many possible referral pathways. ACE
assessment can help determine which treatment approach will be most effective.

Physical well-being must be attended to as well as psychological health. Hence,

professional workers will ensure that the child eats properly, looks after their
personal needs (e.g. washing, teeth-cleaning and going to the toilet).

Some children may need medication for their psychological needs, and specialist
psychiatric support. For example, a psychiatrist might work to stabilise the child’s
behaviour while a counsellor/psychotherapist works with the emotional side of
things.

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ONLINE CONTINUED PROFESSIONAL DEVELOPMENT (CPD) IN COUNSELLING AND PSYCHOTHERAPY

People who’ve had very dysfunctional upbringings can sometimes be a danger to

themselves and others. In such cases, dedicated units may be the appropriate service
to help build the young person’s confidence and skills.

Adults and ACE Scoring

The ACE questionnaire has become widely available not only to professionals but also
to the public, meaning that many adults may do it on themselves and realise they
need therapy or another form of support.

If a client has not come across the ACE questionnaire themselves, however,
counsellors should not administer this themselves unless they are trained fully in its
use. Doing so without full knowledge and skills could be harmful to the client,
especially if they then read up on ACEs and see they may be more likely to experience
life-threatening disease in later life.

In fact, the ACE score – using raw data to predict likely outcomes – does not factor in
other variables such as intervention from health professionals, general health risks or
genetic factors. It cannot of course accurately predict the future, instead simply giving
a snapshot of what the future may hold, based on research.

The ACE questionnaire does not comprehensively assess everything (e.g. bullying at
school, bereavement and discrimination); nor does it take into account the context of
a person’s life, such as their age, and the duration and intensity of the trauma and
adversity.

Not everyone who has had a very traumatic childhood struggles as an adult. One
factor that may help protect some people against being traumatised is having had a
safe and supportive relationship, with at least one solid attachment figure.

Phenomenology
A person’s ACE score may not accurately reflect the range and relevance of their
experiences – in other words, a quantitative (number-based) measure cannot truly
reflect the qualitative experience of that person in childhood. Phenomenology
describes the subjective nature of different people’s experiences – meaning that two
or more people could be present in the same objective situation but experience this in
very different ways.

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ONLINE CONTINUED PROFESSIONAL DEVELOPMENT (CPD) IN COUNSELLING AND PSYCHOTHERAPY

Self-Awareness for Therapists

Philosopher and doctor John Locke said: ‘The only fence against the world is a
thorough knowledge of it.’

In the context of counselling, ‘fence’ can be taken to refer to our own resilience in
working with anyone who’s had any form of abuse, because sometimes that can play
into our own insecurities and histories.

In other words, understanding our own emotional journey and personal history –
through personal development and our own therapy – is vital to our own ability to
work safely and ethically with others, being able to identify transference and parallel
process when relevant. Understanding our own attachment style is key in this.

Hope is Key
While living with ACEs may be extremely challenging, there is always hope. None of
our futures is written in stone: we can always influence these through our own
actions. As therapists, we can help others change and experience life more fully.

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