Keynote Presentation: Therapists and ‘Messy’ Heart-sink Moments during Covid Pandemic in Clinics, Schools and Families: Relational Rupture-Repair Cycles

Over the last 10 years advances in trauma-informed care are increasingly informed by and based on mother-infant video studies, child developmental research and the neuroscience of relational and attachment trauma. Schore, Porges, van der Kolk, Beebe, ACE’s studies, and others, provide corroborative neuroscience evidence to link early adversity - abuse, neglect and relational trauma/dissociation.

The COVID pandemic, and its aftermath, has added to the sense of unsafely and crisis, leading to more ‘messy’ and complicated presentations.

The COVID pandemic isolation, especially in Victoria, has added a new level of complexity. We face new challenges to manage once familiar clinical problems of ADHD, eating disorders and other serious behavioural, developmental, emotional and family relational problems.

Many ‘messy’ moment-to-moment clinical encounters are understood and explained by a focus on the mechanisms - pathogenesis - of traumatic rupture and repair cycles. ‘Vicarious trauma’, burnout, compassion fatigue, moral trauma, each pose specific risks to therapies. We can reduce risks by foregrounding pre-verbal sensory-motor channels of communication - trauma informed care - to increase reparative moments.

Individual, family or group interventions, taking note of COVID stresses, which provide bridges to link early deprivation and privation, and the well-known risks of adverse childhood experiences (ACE’s), to common presenting behavioural, emotional and relational conditions, offer the best long-term outcomes for common conditions.

Dr George Halasz

George Halasz is a consultant child and adolescent psychiatrist and Adjunct Senior Lecturer at School of Psychology and Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University.

From 1992–2005 a member of the Editorial Board of the Australian and New Zealand Journal of Psychiatry; the Editorial Committee of Australasian Psychiatry (2005–current). He was consultant to Psychodynamic Diagnostic Manual (PDM)–2 (edit. V. Lingiardi & N. McWilliams, Guilford Press, 2017).

Publications cover: child psychotherapy; ADHD; ethics, (mis)diagnosis and iatrogenesis; the interface between psychotherapy and spirituality; generational transmission of trauma: clinical and research. He has lectured and workshopped on various trauma related themes in the UK, Israel, Poland, Hong Kong, US, NZ, and Australia. He was a regular panellist on Melbourne Radio Station RRR’s “Radiotherapy” for close to twenty-five years.