Trust Based Relational Intervention (TBRI)

Written by Rachel Ealy, M.Ed., LPC-Intern

You start working with a new therapist and she says that she will be utilizing TBRI with your child. What exactly does she mean? TBRI or Trust Based Relational Intervention was developed by Dr. Karyn Purvis and Dr. David Cross. It is a holistic, evidence based, and developmentally respectful practice that meets the needs of the whole child (Atchley, 2019). TBRI is attachment-based and trauma informed; it is often used with children from hard places, such as those who have suffered abuse, neglect, or trauma. The goal of TBRI is to connect with the child by ‘communicating’ through action, reassuring the child that when you cry or express a need, I will be there to comfort you and to meet that need.

“When you connect to the heart of a child, everything is possible”

 –Dr. Karyn Purvis

 The ultimate goal of TBRI is to rewire the child’s brain. The excitatory chemicals in the brain such as norepinephrine, epinephrine, and histamine that increase when the child is in distress are balanced by the inhibitory chemicals such as serotonin, released when the child is comforted by the caregiver (Hall, 2017).

In the beginning stages of TBRI the caregiver is the “external regulator,” which means the caregiver provides all regulation for the child. For example, when the child is cold the caregiver provides warmth. Over time, the child’s brain develops the capacity to self-regulate (Hall, 2017). TBRI is holistic because it considers the safety needs of the child, nutrients, the child’s environment, and the need for appropriate exercise. Through this holistic approach, brain chemistry can be altered and balanced (Hall, 2017). TBRI has been utilized in homes, schools, residential facilities, and orphanages (Atchley, 2019).

TBRI has three guiding principles (Atchley, 2019). The idea is to connect and empower before correcting. We will review each of the principles and their accompanying strategies.

1.     Connecting Principles

a.     Mindfulness Strategies

b.     Engagement Strategies

2.     Empowering Principles

a.     Physiological Strategies

b.     Ecological Strategies

3.     Correcting Principles

a.     Proactive Strategies

b.     Responsive Strategies

Connecting Principles

·           Mindfulness strategies include examining one’s own past, increasing awareness of triggers, and mindful interactions or being engaged in the present moment with the child.

·           Engagement strategies include attunement, nurturing touch, warm eyes, voice quality, and playful engagement. Attunement is being with the child, getting on their level, and making eye contact with the child with warm eyes. Your voice quality should match the situation and the needs of the situation. For example, if a warm and inviting voice is needed or a stern voice to communicate seriousness such as informing the child to not cross the street without an adult. Play is the language of the child and how children explore the world. Engaging the child through play allows the child to express their needs and work through their emotions while building a trusting relationship.

Empowering Principles  

·           Physiological strategies include attending to the child’s hydration, blood sugar, and sensory needs. Simple ways to empower are infant/toddler massage, snack time every 2 hours, carrying a water bottle, cutting the tag out of clothing for children with tactile sensitivity, and physical play (Atchley, 2019). Dehydration influences concentration, anxiety level, and mood (Gillen, 2018).

·           Ecological Strategies include daily rituals, and transitions. Establishing routines creates structure in a child’s life. Create a schedule with your child and put it somewhere that it can be easily seen. Let your child know, with plenty of notice, if it is going to change. During transitions throughout the day, communicate to your child about changes that are happening. This can be done by providing 10 and 5 minute warnings. Try saying, “we are going to leave for lunch in 10 minutes, 5 minutes, 1 minute, etc.”

Correcting Principles

·           Proactive strategies include teaching your child the life value terms (showing respect, using your words, being gentle and kind, who keeps you safe, listening and obeying, and accepting no). This helps communicate a common language between you and your child.

·           Responsive strategies are Immediate, Direct, Efficient, Action-based, Leveled at the behavior, not the child (IDEAL). When responding to a child’s behavior Immediacy is important because better learning typically occurs within 3 seconds of the incident. Be Direct by staying engaged and connected though eye contact and being on the child’s level. Be Efficient by keeping the behavior moving forward and always returning to playfulness. Action-based means having the child physically “re-do” the behavior to create new brain connections. Leveling the response at the behavior communicates to the child that what they did is not who they are (Gillen, 2018).

Contact us to set up an appointment for play therapy.

 References

Atchley, A. (2019). Connection before correction [Powerpoint slides]. 

Gillen, M. (2018). Trust-based relational intervention (TBRI) exploring the empowering, connecting, and correcting [Powerpoint slides]. Retrieved from http://centerforchildwelfare.fmhi.usf.edu/Training/2018cpssummit/Trust_Based_Relational_Intervention_TBRI.pdf

Hall, C. [Karen Purvis Institute of Child Development]. (2017, June 15). TBRI®: Trust-based relational intervention® [Video file]. Retrieved from https://www.youtube.com/watch?v=FWScSJKjn1A