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Creating PRESENCE with Dr. Sandra L. Bloom

By Laura Braden Quigley, CTIPP's director of communications and outreach

Creating PRESENCE is an innovative approach to creating trauma-responsive organizations.

It was created by CTIPP’s co-founder and Board Chair, Dr. Sandra L. Bloom. Dr. Bloom is a pioneer of the trauma-informed movement, internationally renowned for the Sanctuary Model. She is a Board-Certified psychiatrist, a graduate of Temple University School of Medicine, and currently an Associate Professor of Health Management and Policy at Drexel University’s Dornsife School of Public Health. Dr. Bloom is perhaps best known and credited for leading the team that came up with the shift from “what is wrong with you?” to “what has happened to you?”

Creating PRESENCE provides basic knowledge about trauma, adversity, and stress, and it advances the emergence of trauma-informed values, knowledge, practices, and skills.

PRESENCE is an acronym for the below guiding principles, and they are associated with a knowledge base and universally applied tools that are designed in sequence to provide brain regulation skills, communications tools, group engagement skills, and complex management skills.


Just as individuals and families today function within their silos, so to do our organizations. Once, communities in America functioned as supportive and meaningful networks for the people that lived within them. Still, under the impact of modern stress, those networks have become severely degraded and, in many places, have disappeared altogether. Democratic processes are being tested around the world. It has been said that democratic practice embodies the notion of safe struggle and that exposure to repetitive trauma can destroy that capacity. At the same time, the skills necessary for participatory practices are antidotes to the very problems that adversity and trauma create for both children and adults.

Creating PRESENCE explores the attitudes and skills necessary to engage in a truly collaborative relationship with each other and the people we serve. That means learning, sometimes for the first time, what it means to share power. We need to rediscover the enormous benefit of collective power because the only way humanity has survived throughout our evolution without sacrificing individual achievement, empowerment, and pride has been through participatory processes. Democratic, participatory governance is the best method human beings have thus far evolved to balance those vital and parallel needs.


Biologists, chemists, and physicists now agree that having life emerge on this planet billions of years ago was miraculous regardless of how that happened. Whether a person believes in a Higher Power or how a person manifests that belief doesn’t matter, as long as they can experience a sense of reverence for the fact that it did happen. Reverence is an elevated form of respect combining basic human decency with spiritual purpose. The recognition that every cell in the body of the person before us is comprised of elements that came into being at the origin of the universe is awe‐inspiring. Knowing that life emerged out of inorganic elements, that it is endangered, and that it must be preserved must be sufficient to motivate significant change in our current attitude toward each other, the other life forms that populate and maintain life’s balance, and the planet itself. A sense of deep and universal respect for all life in protecting it, maintaining health, and RESTORING integrity to what has been damaged is what we mean by REVERENCE. This is what we need to demonstrate in our daily lives with the people around us and our children, which manifests in what we do and what we don’t do.

Exposure to trauma and adversity, particularly when that begins in childhood, might be experienced as “moral injury” and often sabotages an individual’s sense of purpose, meaning, and integrity. Restoration may be the end of a healing journey, or it may be the very beginning and foundation of all healing. To achieve healing at this level, reverence for life and establishing and maintaining an ethical climate must be foundational for leaders, care providers, and clients within the environments where care is being delivered.

In enacting Creating PRESENCE, the practice of the reverent treatment of others – currently often missing in our caregiving environments ‐ must be restored. Everywhere in our culture, there is a concern about “justice,” but this is often expressed via retributive behaviors. The form of justice that we now understand is based on the principles of “Hurt people, hurt people,” which requires applying the principles of Restorative Justice. We need to look at all of our daily lives, in the media, in political life, and in our conduct; we have seen the erosion of this basic belief in decent, fair, respectful social behavior. Then together, we must decide how to restore reverence as both a practical and spiritual mission.


As a species, our emotions developed as survival skills in our evolutionary history as mammals, long before we could engage in logical thought and language. Today, humans are endangering ourselves, our children, and all life by ignoring the development of our emotional intelligence that ‐ given the right circumstances ‐ may develop into emotional wisdom.

In CREATING PRESENCE, we define emotional wisdom as the ability to use emotional intelligence to make sound decisions based on experience, knowledge, judgment, and enlightened purpose combined with relational intelligence and empathic concern. Besides connecting us, one vital function of emotional intelligence is to provide us with information about the value in the world around us beyond materiality. Deciding what is valuable and what is not is vital to our ability to survive and thrive.

We know enough now about the long‐term impact of chronic stress, adversity, and trauma to be able to recognize the extent to which these challenges negatively influence the development of emotional wisdom in dealing with each other. It’s time to turn a negative into a positive by using that knowledge to build an entirely different paradigm for dealing with each other, a paradigm that recognizes empathy as a primary – and primal – source of human strength. But to do that, we must analyze – with respect – how we have become emotionally numb and dumbed down and then use the many tools available to enhance emotional intelligence in all our settings.


Every organization has a culture and usually many subcultures. Safety culture is one in which values, attitudes, and behaviors support a safe, engaged workforce and reliable, error‐free operations. Maintaining a safety culture is essential if we are to be effective in helping traumatized people to recover. If we live or work where we do not feel safe, our cognitive functioning and ability to solve complex challenges deteriorate significantly. But safety is a complex idea that encompasses physical safety, psychological safety, social safety, moral safety, and cultural safety. Unless we can be secure in all five safety domains, we are not truly safe.

A holistic view of safety inevitably involves an assumption of social responsibility on the part of every individual and each organization. This concept recognizes that human survival depends on the health of the collective, which requires that we all embrace the notion of a common good. This necessitates a very different definition of what it means to be safe by recognizing and, when necessary, changing the current social norms presently tell us that the only way to be safe is to individually accumulate wealth and sacrifice the public good. Our safety depends on humiliating, disrespecting, or punishing others. Changes in systems occur when we use the tools we have developed in interaction with unsafe children and adults and apply those tools to everyone.


Values are just a lot of talk unless we put them into practice in our busy and sometimes chaotic lives. What does it mean to enact “reverence” and “complexity”? What does it mean to embody “safety” and “emergence”? Without concrete tools, they are just words that can easily become meaningless or misinterpreted.

We are constantly enacting our beliefs through what we do in the world with our bodies and minds. Our beliefs are embodied in our enactments. The experiences that life delivers are engraved on our minds and bodies. Centuries of problems grounded in Cartesian duality – the idea that the mind and the body are disconnected from each other ‐ are finally dissolving in our growing understanding of the complex interaction of minds and bodies. This new knowledge has significant implications for our ideas about healing and recovery.

It has become much clearer that the behaviors we call “symptoms” are cries for help, indicators of unresolved pain and loss that need to be recognized and redirected by others if injured people are to heal. One of the key understandings of the effects that adversity and trauma have on people is the compulsion to repeat, also known as a traumatic reenactment. Empathy makes mutual understanding of reenactment behavior possible. But enactment – what we do or stop doing is what can change a life story. This change in the story is what we all need now if the human story is not a tragedy.


Our planet has been nurturing life for billions of years. We have much to learn about how living systems develop, maintain health, recover from injury or illness, age with dignity, and accept the inevitability of death. The current model that informs organizations is largely based on outdated ideas that apply to non‐living machines but highly damaging to living organisms, including organizations. Modern science has revealed much about our nature that helps us to develop an understanding of how we, as a species, have evolved. That knowledge helps to inform deeper compassion for the multiple dilemmas we face as the stewards of this planet.

We now know far more than we have before about development dynamics and the profound influence of childhood experiences. Our long period of helplessness in infancy and childhood leads directly to an appreciation for the impact of Nurture experiences that are with us throughout our lifespan. People exposed to adversity and trauma as children experience serious and often severe disruptions in their developmental course that can last a lifetime. Healing and recovery must focus on establishing the capacity for healthy attachment within the constraints of each individual.

We need attachment‐based skills that help each of us as individuals and groups of people to comprehend and use the reality that the stewardship of living systems requires of us, a recognition that changes the way we treat each other, our organizations, and the world we are dependent upon.


Put any two or more people together for any but a short period, and we will create a culture. It's what human beings do and have always done to stay alive. We like to think that we are self‐directed individuals, but this is only partially true. We are always being affected by social norms and mental models, and worldviews that are deeply embedded in the various cultures to which we each belong. But largely because we deny that influence, it works unconsciously, determining much of what we think, feel, and do. It’s critically important that we convert what are now the effects of unconscious influences into conscious intention so we can make better decisions about value, meaning, and purpose. We, therefore, need the knowledge and skills that allow us to recognize and respond to group dynamics.

Meanwhile, the study and science of Complex Adaptive Systems (CAS) have yet to be adequately incorporated into our present organizations and communities. CAS science tells us much about the interconnectedness of all living systems, the vital diversity of all human cultures, and how systems change. In this era of accelerating change, our systems must be prepared to meet the challenges that are constantly unfolding before them. To do that, every person and every system must develop skills to address complexity through connection, changes in organizational and social culture, and the critical ideas around self‐organizing change.


The study of evolution is the science of how living systems change. As individuals, we continue to evolve Throughout our brief lifetimes. As a whole species, we are still evolving, and we do not know what the future holds for us. To some extent, because we are conscious creatures, we can do our best to guide that evolution by making emotionally wise decisions that are based on life‐preserving and reverent values. But what will emerge out of what exists today is still unknown.

The short version of understanding the concept of emergence is captured by the phrase “the whole is greater than the sum of the parts.” The problems that confront our families, communities, corporations, and the global community are so complex that we have thus far outstripped our evolved cognitive capacity to confront, much less resolve, those problems. Complex problems can only be solved with complex methods, requiring effective collective methods that emphasize collaboration over competition.

Successful therapeutic processes are the result of emergence. Exposure to trauma and adversity creates complex problems that can only be resolved by a therapeutic journey that incorporates many spiritual, cognitive, emotional, relational, embodied, and enacted approaches. Out of those parts comes a greater, more mature, and wiser whole person. We can say then that on an individual level, that person is evolving.

Whether the focus is on an individual, a family, an organization, a community, or a society, setting the goal of “emergence” helps to drive such developing collective approaches so that ultimately the whole of humanity will indeed be greater than the sum of the parts and that our evolutionary course will continue. But making decisions and doing problem-solving requires the balanced and conscious emergence of new ideas, new beliefs, and new ways of doing things and necessitates the acquisition of skills that are unfamiliar to many people. These need to be taught and felt for human groups to know the joy and creativity of collective conscious experience with true teamwork.


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