Margaret Blaustein and the ARC Model

Our Partner Elizabeth Warner had a conversation with our dear esteemed colleague and friend, Margaret Blaustein PhD on March 14, 2019.

Upon the 2019 publication of the second edition of Treating Traumatic Stress in Children and Adolescents; How to Foster Resilience through Attachment, Self-Regulation, and Competency, we decided to talk to co-author, and our colleague, Margaret Blaustein, about her years of experience with the ARC model. When asked what she would tell young people interested in the field of child trauma, Margaret pointed out that the knowledge base in the field of trauma and child mental health has gone from nothing to substantial in the 25 years since she started graduate school. “It is a whole different world now.”

But while there are now many treatment techniques available, she would still tell young people interested in the field of trauma to ground themselves in “the field of children” first. “To be a good child trauma clinician, you also have to understand the world of children” and grounding in child development is a necessity. In her own graduate school studies, she spent a year studying infancy, in addition to other developmental coursework. Importantly, she said, “Trauma is a developmental influential process.” We must “always be thinking of trauma within developmental pathways.” I might add, resilience, a consistent theme and light of hope in the ARC framework, is partly a function of developmental plasticity and the child’s capacity to change and grow.

In our informal interview, she laughed when asked about rewriting the book, and said, “We wanted to revise the book from the minute of its first publication [in 2010]…this is a process of constant learning.” Since writing the first edition, Margaret and her co-author, Kristine Kinniburgh, had the opportunity to write a curriculum for caregivers, including foster parents. Margaret says this project helped them realize their understanding that caregiver work was more a “process element” rather than a “target” of treatment. [This curriculum is made available for free by the Annie E. Casey Foundation. See: www.aecf.org/blog/arc-reflections-trauma-training-for-foster-parents-and-caregivers/]. The interaction of caregiver and child had to be woven in at every step along the way. Her experience might also guide clinicians to also ground themselves in family systems theory and practice since working with caregivers will always be part of the work in the case of child trauma treatment.

Similarly, Trauma Experience Integration, the co-authors understand better, is an ongoing part of all the treatment, not a separate phase of the work to get to. Because many of the children served continue to have stressful lives, understanding the state a child is in at any given moment in time – whether distressed or regulated – will determine what interventions to use. This places emphasis on the skills of observation and modulation for every caregiver’s toolbox.

ARC’s use of the word, rhythms, particularly interested the interviewer because in SMART we talk about developing “rhythms of engagement” for attachment-building. The ARC model helps caregivers and providers develop routines and rituals that give predictability to the child and a ‘felt sense of safety’ at home and at school, and the rituals give rhythm to life over time. These meta-rhythms build beautifully on the rhythms we work to build on the physiological and sensory motor level through playful engagement play in the moment of the SMART therapeutic session. Both levels support improved regulation.

Consistent with her lifelong drive to learn, Margaret articulates an ongoing challenge to learn more about the way in which race, culture, and social inequities influence approaches to the work with ARC. It is likely, given her passion and energy that future work will incorporate her new learning over the decade we are now in.

Margaret and her colleague, Kristine, have spent much of their time working at an organizational level by teaching and influencing systems of care, such as residential treatment programs, hospitals, short-term programs, and child welfare systems. She is noticing a gratifying change in the way that people are talking about their work, and a passion in working with traumatized clients, even when stressors on these children and caregivers are many, and resources are few. This might suggest that the ARC framework helps caregivers and providers in all kinds of systems transform perspectives about what and how they are doing in a way that reduces their burnout and increases their energy, motivation, and clarity for their difficult work. It is likely that the ARC framework — with its constructive, hopeful, and informed approach — has been crucial and influential in this transformation.