Trust and Relationship Building: Cornerstones of Healing for Traumatized and Neurodivergent Children in Mental Health

Written by: Nikoo Chamani | Early Childhood Intervention Specialist

Working with children who have experienced trauma and are neurodivergent in the mental health sector

presents a unique and profound challenge. Their internal worlds can be complex, often shaped by past adversities and differing neurological pathways. In this intricate landscape, while various psychological interventions exist, the bedrock upon which all effective treatment rests is the development of unshakeable trust and a robust therapeutic relationship. Without these fundamental elements, even the most evidence-based strategies are likely to falter.

The Wounds of Trauma: Why Trust is Paramount

Children who have endured trauma, whether it be abuse, neglect, natural disaster, or other significant distressing events, often develop a deep-seated distrust of adults and the world around them. Their experiences have taught them that those who should protect them may instead cause harm, or that the world is an unpredictable and dangerous place. This leads to a protective stance, characterized by hypervigilance, difficulty with emotional regulation, and a reluctance to open up [1]. For these children, the therapeutic setting can initially feel like another potential threat, another situation where they might be let down or hurt.

Therefore, the very first "intervention" for a traumatized child is the consistent, patient, and genuine effort to build trust. This isn't about grand gestures, but rather a series of small, reliable actions:

• Consistency and Predictability: Adhering to scheduled appointments, clear communication about session structure, and predictable responses help to re-establish a sense of safety and control that was often absent in their past [2].

• Active Listening and Validation: Truly hearing their experiences, even if unspoken, and validating their feelings, no matter how intense or confusing, communicates empathy and respect. It tells them, "I see you, I hear you, and your feelings are valid." [1].

• Non-Judgmental Stance: Children who have experienced trauma often carry shame and guilt. A therapist's ability to remain non-judgmental, accepting them fully for who they are, creates a safe space for vulnerability.

• Respecting Boundaries: Allowing the child to set the pace, respecting their "no," and not pushing them before they are ready, demonstrates a profound respect for their autonomy and helps rebuild a sense of control.

  
  

Navigating Neurodiversity: Tailoring Relationships

For neurodivergent children – those with conditions such as Autism Spectrum Disorder (ASD), ADHD, or Tourette's Syndrome – building relationships requires an even more nuanced approach. Their unique ways of perceiving, processing, and interacting with the world can sometimes be misinterpreted or misunderstood in neurotypical settings.

• Understanding Communication Styles: Neurodivergent children may communicate differently. Some may be non-verbal, others may use direct and literal language, and some may struggle with social cues. Therapists must be adaptable, learning to understand and respond to their individual communication methods, whether through visual aids, augmentative and alternative communication (AAC), or simply allowing for different forms of expression.

• Respecting Sensory Sensitivities: Many neurodivergent children experience heightened or diminished sensory sensitivities. Creating a therapeutic environment that is calming and predictable, free from overwhelming stimuli, is crucial for their comfort and ability to engage. This might involve dimming lights, providing fidget toys, or allowing movement.

• Interest-Based Engagement: Tapping into a child's specific interests can be a powerful tool for connection. Incorporating their passions into therapy sessions – whether it's through specific games, characters, or topics – can make the therapeutic process feel less like a chore and more like a shared activity, fostering genuine engagement.

• Patience and Flexibility: Building rapport with neurodivergent children is a slow process. It requires immense patience, a willingness to adapt strategies, and a recognition that progress may not always be linear.

  
  

The Therapeutic Relationship as a Vehicle for Change

Once trust is established and a strong relationship cultivated, it becomes the most potent therapeutic tool. It provides a secure base from which the child can:

• Explore Difficult Emotions: Feeling safe and supported, children are more likely to acknowledge and process the painful emotions associated with trauma.

• Develop Coping Mechanisms: Within the context of a trusting relationship, therapists can teach and practice new coping strategies for managing stress, anxiety, and dysregulation.

• Challenge Negative Beliefs: Trauma can embed negative self-beliefs. A positive therapeutic relationship can help children re-evaluate these beliefs and develop a healthier self-concept.

• Practice Social Skills: For neurodivergent children, the therapeutic relationship can serve as a safe laboratory to practice social interactions and understand social nuances.

• Experience Corrective Emotional Experiences: The consistent positive regard, empathy, and reliability from the therapist can be a "corrective emotional experience," counteracting past negative relationships and fostering a new sense of security and belonging.

Navigating Systemic Barriers: Funding Limitations and Unrealistic Expectations

While the importance of trust and relationship-building is undeniable, clinicians working with children with complex trauma and neurodiversity in Australia often face significant systemic barriers.

1. Constrained Funding Models: A Patchwork of Short-Term Solutions

Australia's government funding systems frequently offer limited provisions that fall critically short of the intensive, long-term support required for these complex presentations. The issue isn't a complete absence of support, but rather a pattern of short-term, episodic funding that struggles to address the chronic and pervasive impacts of complex trauma and the ongoing needs of neurodivergent children.

• Medicare Benefits Schedule (MBS): While MBS items exist for mental health services, including psychological therapy, they are often capped at a limited number of sessions per calendar year (e.g., typically 10 individual sessions, with potential for further allocation upon review by a GP or psychiatrist) [10]. For children with complex trauma, who may require extensive, phased interventions to process traumatic memories, rebuild attachment, and develop self-regulation skills, these caps are woefully inadequate [2]. Similarly, for neurodivergent children, ongoing support for social skill development, emotional regulation, and managing co-occurring conditions often extends far beyond a few sessions. This forces clinicians to prioritize immediate crises over developmental healing, or burdens families with significant out-of-pocket costs that many cannot afford.

  
  

• National Disability Insurance Scheme (NDIS): While the NDIS aims to provide support for people with permanent and significant disabilities, recent changes and ongoing scrutiny have led to increased emphasis on "reasonable and necessary" supports, often interpreted through a lens of short-term, goal-oriented interventions [11]. While some therapeutic supports are funded, there can be pressure to demonstrate rapid progress or for interventions to fit within specific categories. The focus on individual plan funding can sometimes neglect the need for broader systemic support, and the process of plan reviews and funding allocation can be complex and time-consuming, leading to gaps in consistent care [11]. The NDIS is not designed as a general mental health service, and complex mental health needs, particularly those stemming from trauma that are not directly linked to a primary disability, can fall into funding gaps [3].

  
  

• Child Protection and Family Services: State-based child protection systems are primarily mandated to ensure child safety and often focus on immediate risk management. While mental health support may be recognized as a need, the provision of therapeutic services can be inconsistent, often limited in duration, and dependent on available resources [12]. Referrals for therapy may come with similar short-term expectations, driven by case management cycles rather than the child's developmental timeline.

  
  

• The Orange Door (Victoria) and Victims of Crime Programs: Services like The Orange Door in Victoria, designed as central points for family violence and child wellbeing concerns, aim to provide integrated intake and support [13]. Similarly, Victims of Crime assistance programs offer counselling and support for those affected by crime [14]. While invaluable, these programs often operate with a similar model of time-limited counselling (e.g., a set number of sessions, with extensions granted upon review and justification). While critical for initial crisis support and stabilization, they may struggle to provide the sustained therapeutic engagement necessary for deep, transformative work with children who have endured prolonged and complex trauma. The "upon approval extension" often means additional bureaucratic hurdles for clinicians, diverting time from direct client work. This system is criticised for creating a "merry-go-round" of unintegrated care, risking re-traumatisation [15].

  
  

These short-term, session-limited models create a significant "systemic hole." They are profoundly ill-suited for children with complex trauma and neurodiversity because:

• Healing is not linear: Trauma recovery and neurodevelopmental support are often non-linear processes with periods of intense work followed by integration. Short-term models fail to accommodate this natural ebb and flow.

• Relationship takes time: As highlighted, building trust is paramount, and it simply cannot be rushed. A child who has experienced betrayal and instability needs consistent, long-term presence to feel safe enough to engage in deep therapeutic work.

• Piecemeal approach: These funding limitations often lead to a fragmented approach to care, where children receive bursts of therapy followed by gaps, hindering consistent progress and potentially re-traumatizing them through repeated ruptures in care [15].

  
  

2. Unrealistic Parental and Caregiver Expectations: The "Fix It" Mentality

Compounding the funding limitations are the often unrealistic expectations held by parents and caregivers. Driven by desperation, societal pressures, and sometimes a lack of understanding of complex trauma and neurodevelopmental differences, families may arrive at therapy with a "fix it" mentality. They often expect immediate and dramatic changes in their child's behavior and responses.

This "fix it" pattern of thinking places immense pressure on clinicians [7]. Parents may:

• Demand rapid symptom reduction: Overlooking the underlying complexities, they may solely focus on eliminating challenging behaviors, rather than understanding them as manifestations of trauma or neurodevelopmental differences. This can lead to requests for quick "behavior modification" rather than deeper therapeutic work.

• Expect a quick resolution: The idea that a few sessions can undo years of trauma or fundamentally alter neurodevelopmental pathways is a common misconception, leading to frustration when progress is not instantaneous [16]. This is particularly challenging when government funding reinforces this short-term view.

• Attribute difficulties solely to the child: This can sometimes lead to a lack of engagement in family-based interventions or a reluctance to consider their own role in the child's environment and healing process, which is often crucial for sustainable change. Research indicates that parental expectations can significantly influence child outcomes, and unrealistic expectations can lead to stress and negative mental health impacts for the child [17, 18].

• "Shop around" for therapists: When quick results aren't seen, families may move from clinician to clinician, inadvertently disrupting the very trust and relationship-building that is essential for therapeutic progress, and exacerbating the child's sense of instability. Parental expectations about treatment effectiveness significantly predict engagement and retention in therapy [19].

  
  

Clinicians are then put in the difficult position of managing these expectations while advocating for the child's long-term needs within a restrictive funding environment. This can lead to burnout, moral distress, and a sense of inadequacy if they cannot meet the immediate demands, even when they are working diligently to establish the foundational trust necessary for true, lasting change [7]. The intersection of limited funding and high, often misinformed, expectations creates a challenging environment for both children and the dedicated professionals striving to support them.

In conclusion, while the foundational importance of trust and relationship-building in working with traumatized and neurodivergent children cannot be overstated, the current landscape in Australia presents significant hurdles. Addressing these challenges requires not only continued advocacy for more comprehensive, sustained, and flexible funding models but also a concerted effort to educate parents, caregivers, and the wider community about the realistic pathways to healing and support for these vulnerable children. True healing is a journey, not a quick fix, and it demands sustained investment in the therapeutic relationship.

References:

[1] Courtois, C. A. (2004). Complex trauma, complex reactions: Assessment and treatment. Psychotherapy: Theory, Research, Practice, Training, 41(4), 412–425.

[2] Australian Institute of Family Studies. (n.d.). Trauma-informed care in child/family welfare services. Retrieved from https://aifs.gov.au/resources/policy-and-practice-papers/trauma-informed-care-childfamily-welfare-services

[3] Renton, M., & Brown, T. (2023). Therapeutic Supports for Neurodiverse Children Who Have Experienced Interpersonal Trauma: A Scoping Review. Journal of Autism and Developmental Disorders, 53(1), 733-755. https://www.researchgate.net/publication/369655034_Therapeutic_Supports_for_Neurodiverse_Children_Who_Have_Experienced_Interpersonal_Trauma_a_Scoping_Review

[4] Bowlby, J. (1969). Attachment and Loss, Vol. 1: Attachment. Attachment and Loss. New York: Basic Books.

[5] Pynoos, R. S., & Nader, K. (1988). Psychological first aid and the children of Chernobyl. Psychiatric Annals, 18(10), 604–608.

[6] Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2002). Affect regulation, mentalization, and the development of the self. Other Press.

[7] Pearlman, L. A., & Saakvitne, K. W. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. W. W. Norton & Company.

[8] Australian Institute of Family Studies. (n.d.). Supporting children with neurodiversity. Retrieved from https://aifs.gov.au/resources/policy-and-practice-papers/supporting-children-neurodiversity

[9] Cooper, J. K., & Ezzell, M. B. (2021). Recommendations Provided to Families of Neurodivergent Children with Histories of Interpersonal Trauma across Two Clinical Assessment Services within a Major Metropolitan Children's Hospital in Melbourne, Australia. Practice Innovations, 6(4), 211–226. https://pmc.ncbi.nlm.nih.gov/articles/PMC12130377/

[10] Services Australia. (n.d.). Mental health care and Medicare. Retrieved from https://www.servicesaustralia.gov.au/mental-health-care-and-mer/

[11] National Disability Insurance Agency (NDIA). (n.d.). About us. Retrieved from https://www.ndis.gov.au/about-us

[12] Australian Institute of Health and Welfare. (n.d.). Child protection system in Australia. Retrieved from https://www.aihw.gov.au/reports/child-protection/child-protection-system-in-australia

[13] Victorian Government. (n.d.). What is The Orange Door and how does it work? Retrieved from https://www.vic.gov.au/orange-door-annual-service-delivery-report-2018-2019/1-what-orange-door-and-how-does-it-work

[14] Victims of Crime. (n.d.). Get help. Retrieved from https://www.victimsofcrime.vic.gov.au/get-help

[15] Mental Health Coordinating Council. (2014). Trauma Informed Care and Practice: Towards a cultural shift in policy reform across mental health and human services in Australia – A National Strategic Direction. https://mhcc.org.au/wp-content/uploads/2018/05/nticp_strategic_direction_journal_article__vf4_-jan_2014.pdf

[16] IRJMETS. (2024). PARENTAL EXPECTATIONS AND THEIR IMPACT ON ADOLESCENT MENTAL HEALTH IN THE SENIOR SECONDARY SCHOOL. https://www.irjmets.com/uploadedfiles/paper/issue_3_march_2024/51584/final/fin_irjmets1711912271.pdf

[17] Luo, F., et al. (2023). The Influence of Parents’ Educational Expectations on Children’s Development: The Chain Mediation Role of Educational Anxiety and Parental Involvement. Children, 10(9), 779. https://www.mdpi.com/2076-328X/14/9/779

[18] Wang, J., et al. (2019). Academic Expectations and Mental Health in Adolescence: A Longitudinal Study Involving Parents' and Their Children's Perspectives. Journal of Youth and Adolescence, 48(3), 503-518. https://www.researchgate.net/publication/330665424_Academic_Expectations_and_Mental_Health_in_Adolescence_A_Longitudinal_Study_Involving_Parents'_and_Their_Children's_Perspectives

[19] Lebowitz, E. R., et al. (2018). Parent Expectancies and Preferences for Mental Health Treatment: The Roles of Emotion Mind-Sets and Views of Failure. Journal of Clinical Child & Adolescent Psychology, 47(5), 794-809. https://pubmed.ncbi.nlm.nih.gov/29364729/