Tag Archives: trauma

Trauma and Children

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Here’s a short article I wrote for the local paper…

Trauma and Children – Do we always recognize the effect on children and adolescents? 

Much of what we know about trauma and how it affects our children is based on the work of mental health professionals that have focused on adults, including the large amounts of research done on PTSD (post-traumatic stress disorder).  My early work with children that had experienced domestic violence in the home was during a time when very little was known about the effects or the proper treatment to help these children or their mothers.  However, new developmental research, mostly in the past two decades, have concentrated on children and adolescents that experience domestic violence in the home, school violence, physical and sexual abuse, emergency medical care, and car accidents.  The fear, the anxiety, and the sense of helplessness that accompanies such events often results in dramatic reactions and behavioral changes in the child.

The American Psychological Association (APA) defines ‘trauma’ as a threat of injury, death, or an event that is experienced by the child as threatening the physical integrity of self or other personcausing fear, terror, or helplessness.  The behavioral changes may include separation anxiety in the child, sadness or anger that was not observed prior to the event, sleep disturbances, or difficulties in the ability to focus or concentrate – often causing problems in the home or in school.  Oftentimes, because the family may be suffering, or because of cultural or ethic factors, parents may not be able to make sense of the behaviors or notice if the changes are slight and gradual. The children may not show immediate effects to the event, for example to a dog bite or a car crash. In the case of sexual abuse, the parents may not know right away of its occurrence – and so the signs or symptoms exhibited will not be understood by the parents.

Further, the responses of children and adolescents will vary, depending on the child’s age, their developmental level, and of course, previous exposure to the threat or traumatic experience.  That is, if the threat or event is chronic – as in domestic violence in the home – or is  acute, happening now – for example, a bad car crash.  Some estimates (from psychological studies) suggest that 2/3 of children up to age 16 have experienced or been exposed to trauma, or the threat of trauma.  Up to nearly 5 million children have been exposed to or experienced trauma – many from abuse, both sexual and physical – and violence in the home.

As the diagnostic criteria have recently been more adequately studied, we can understand the apparent increase in disorders of anxiety in children, including the increase in diagnoses of post-traumatic stress disorder. (PTSD is a sub-category of anxiety diagnosis).  Intrusive thoughts or memories related to the trauma will interfere with the child’s thinking, as well as their ability to focus.  As the experience is far outside the realm of normal experience, the child’s normal mechanisms for adapting to the environment or situation may fail him or her, leaving them feeling more vulnerable.  The child or the adolescent cannot make sense of the experience as it does not conform to their usual experience, and thus cannot adapt and master the thoughts and emotions that are occurring to them.

Different professionals will have different perspectives on what constitutes trauma, and how best to approach it therapeutically. There are not sufficient studies to support the effectiveness of any one therapeutic approach yet, though cognitive behavioral therapy is perhaps seen by many as the most effective. The need for what is referred to as ‘evidence based treatment’ continues – treatment that has been shown to be effective for children, adolescents, and adults – based on reliable and valid research.

What has been shown to be effective is that the quality of the therapeutic relationship is the key to success.  The safe, secure, and trusting relationship between the therapist and child, the parents, and the school personnel – all of whom can support the strengths and resources of the child or adolescent ­ needs to be fostered.  Coping skills must be identified and strengthened – and these can be supported through psychotherapy or counseling, individual help through tutoring (giving child individual attention), stress reduction exercises, such as mindfulness activities or meditation, and fostering leisure activities.

It is also important to establish and maintain the structure and routines of everyday life, with meals and school or extracurricular activities as good ways to provide the necessary structure.  Finally, it is important to engage the community, letting school or church personnel know of the event or experience, as well as others that have contact with the child, so that their child’s behavior is understood in the proper context by the teachers or counselors. These suggestions will help foster a support network for the child or adolescent – with trusted and safe adults.

More information on trauma is available through the American Psychiatric Association and the American Psychological Association.  Please also feel free to email me with questions or comments on the subject.

Rudy Oldeschulte, M.A., J.D. is a Del Rio psychotherapist, specializing in individual  psychotherapy and parent guidance.  He has served on the faculty of the University of  Arizona College of Medicine and the British Association of Psychotherapists. Post- graduate training and education was done in London and at the University of Michigan.

            Email address is: roldeschulte@gmail.com and his website is: www.rudyoldeschulte.com

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Amor fati…

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Challenges…and the ‘love of your fate’…

“Nietzsche was the one who did the job for me. At a certain moment in his life,the idea came to him of what he called ‘the love of your fate.’ Whatever your fate is, whatever the hell happens, you say, ‘This is what I need.’ It may look like a wreck, but go at it as though it were an opportunity, a challenge. If you bring love to that moment—not discouragement—you will find the strength is there. Any disaster you can survive is an improvement in your character, your stature, and your life. What a privilege! This is when the spontaneity of your own nature will have a chance to flow.
“Then, when looking back at your life, you will see that the moments which seemed to be great failures followed by wreckage were the incidents that shaped the life you have now. You’ll see that this is really true. Nothing can happen to you that is not positive. Even though it looks and feels at the moment like a negative crisis, it is not. The crisis throws you back, and when you are required to exhibit strength, it comes.”

Joseph Campbell – Reflections on the Art of Living

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The Persistence of Memory

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“Of all Daniel L. Schacter’s seven sins of memory it is the last, persistence, that is the most polarised in its effect (Schacter, 1999). While the persistence of memory can be vital to our survival, at the same time it can leave us haunted by past events we might rather forget. As in surrealist Salvador Dali’s most famous painting, ‘The Persistence of Memory‘, memories can weigh heavily on our minds; thoughts, like ants, scurrying: endlessly searching for who knows what.”

http://www.spring.org.uk/2008/02/persistence-of-memory.php 

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Turning Adversity into Creative Growth

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There’s little doubt that trauma can be immensely painful, often leaving deep emotional and psychological scars long after the stressful experience has passed. But can there be a silver lining?

“In recent years, psychologists have become increasingly interested in the positive life changes that accompany highly stressful life events, such as being diagnosed with a chronic or terminal illness, losing a loved one, or sexual assault. This phenomenon has been referred to as posttraumatic growth…” See link below

http://blogs.scientificamerican.com/beautiful-minds/2013/05/06/turning-adversity-into-creative-growth/  

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“There is no hope of joy except in human relations.” Review of Relational Trauma in Infancy

This review highlights the need for ‘touching’ in our life, and how that need is therapeutic – in our relationships and in our sense of self.  

Baradon, Tessa (Ed) (2010) Relational Trauma in Infancy: Psychoanalytic, Attachment and Neuropsychological Contributions to Parent-Infant Psychotherapy. Routledge: Taylor & Francis Group. London and New York. 

            As I read this book, my associations kept returning to the thoughts of a scientist that I had read thirty plus years ago during a psychology class.  The professor introduced the class to the work of Jacob Bronowski. The professor continued my introduction to Freud, to the stages of child development from the various schools or orientations, and highlighted each stage remarkable for its place in the mid-1970s period.  He also focused our understanding of what the goals of psychotherapy were, as he was also a practicing clinician. 

            It was this professor’s insistence on our reading this short book of essays by Bronowski (Science and Human Values) that is most memorable.  Bronowski’s underlying theme throughout this work – and undoubtedly my professor’s motivation – was “we must touch others.”  Jacob Bronowski was a scientist and a humanist – but ‘touching others’ in the relational sense was a thread that ran through much of his work. 

            The parallel in this review is on the change possible within relationships. This excellent collection of work brought together by Tessa Baradon aptly demonstrates, especially through the clinical illustrations, the need to touch others – to help those that have been so afflicted by trauma and traumatic circumstances that the relationship between a mother and an infant is so deeply affected and in need of professional understanding and aid. 

            The researcher’s contributions in this collection present their attempts to assess, to integrate, and to document the diagnostic criteria that will be useful in furthering the clinical endeavor.  The data also illustrates the efficacy of the clinician’s work with these traumatized parents and infants.  The focus is on the relationship – touching each other – and, as was underscored by Baradon and Bronfman, the capacity to increase our sensitivity to and understanding of the infant and parent in trouble – and enhancing our therapeutic efforts.  Linda Mayes also highlights this constant thread in all the psychotherapeutic work discussed in the  clinical and the research-oriented chapters, that is, the parent’s ability to reflect on the emotional needs of the infant and, importantly, to the understanding of how the parent’s needs, wishes and behavior “directly impact [the] infant’s feelings and needs.” 

            The essays in this collection cover an extraordinary range of work with parents and their infants, and in their fascinating and encompassing manner, each essay depicts a unique clinical setting.  The parent-infant programs that are established at the Anna Freud Centre are detailed, as are those centered in community locations, such as Sure Start – a governmental enterprise aimed toward preventative intervention. ‘Containment’ is offered as a contextual approach for therapeutic work that is being done with traumatized mothers and their infants.  This work is done by psychotherapy consultants in the community, and their endeavor to contain the anxiety consequent to the impact of poverty and social isolation that frequently attend these relational pairs. Several approaches are offered with richly evocative descriptions of the clinical work with the homeless population – living in hostels – and these attempts utilize health visitors, infant-parent psychotherapists, and a research psychologist. Further therapeutic efforts include the Mother Baby Units (MBU) in a prison, work with immigrants – with particular attention to the trauma visited upon them in their homeland prior to coming to the UK, and last, the enormously unsettling work with very disturbed mothers.  This last category includes vivid vignettes with a woman that could avail herself of the support offered – and those that could not, i.e., ones that could not escape their disturbance enough to progress into a closer relationship with their child. 

            Developmental scientists find their mark in this collection by demonstrating the significant strides that are made in epigenetics, with attention to the gene-environment interaction – and the advances made in molecular genetics in relation to that interaction. The need to integrate the findings of these studies with psychoanalytic theory is addressed, with a very comfortable perspective on understanding the role of environment, the psychological, and genetics in relation to traumatic experiences. The impact of these experiences and their consequences for the individual are discussed.  The ultimate benefit of much of the work presented in this volume will be in early intervention efforts with parents and infants – efforts that have shown dramatic therapeutic results.  Further work in this area of genetics revisits the concept of resilience.  Though not new to the field, the concept is attracting attention once again in light of recent research and findings, and the complex role of resilience in counterbalancing or moderating the effects of adversity is understood more comprehensively in relation to trauma. 

            Similarly, the role of attachment research is featured with respect to neurobiology, as well as the assessment work with the Adult Attachment Interview (AAI), both in relation to preventative work with infants and trauma.  The Parent-Infant Relational Assessment Tool (PIRAT), developed at the Anna Freud Centre, has been shown to be valuable in the effort to identify risk in the relationship between parents and their infants. 

            The “therapeutic endeavor for change,” to use Baradon’s term from this volume, may be thought of as the particular focal point in each of the contributions made in this collection. More directly to the point, the therapeutic work being done by all participants is exceptionally well illustrated by the metaphoric use of ‘ghosts’ and ‘angels’ in the nursery – ghosts or angels that aid or hinder the transformation of a healthy, forward-moving relationship between a parent and their infant.  I am also reminded of a phrase from The Little Prince, “There is no hope of joy except in human relations.”  This is the sine qua non of our therapeutic work.     

Rudy Oldeschulte

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