Treating Childhood Trauma

A Brief Overview (Article Summary)

What Will be Covered

What is Childhood Trauma How to Diagnose 3 Basic Principles of Treatment 3 Potential Complications Treatment Modalities Treatment Through Development What is EMDR

What is Childhood Trauma?

More complicated than effects of single events Simple traumas (Type I) Complicated traumas (Type II) Crossovers single situation that creates longterm, ongoing insults to childs development If trauma is part of the childs life experience, must become part of the childs treatment

Complex PTSD

Diagnosing Childhood Trauma

1) Define traumatic events 2) Obtain full story & full symptomatology 3) Construct a formulation

1) Define Traumatic Events

Describe fears they experience differently
Death & injury Feelings of dehumanization & huiliation connected with some traumas

Universal childhood fear being cut off from caregivers & home
Loss of primary attachment

1) Define Traumatic Events

Fears of being exposed in public, bullied, isolated by peers Witnessing a terrible event
What Where Relationship Personal responsibility Belief about what happened

Meaning the child/teen affixes to the event

2) Obtain Full Story & Symptomatology

Review all pertinent records Childs own account
Can you describe what happened to you? I need to hear the whole story.

Takes a few sessions

Repetitions Have you done anything weird or something that got you in trouble? Indications of emotional, cognitive, physical turn-offs and numbings Concerns with trusting others Lack of faith in future

3) Construct a Formulation
Type and nature of the event Childs current &/or future support systems Childs current & future developmental stages What a child thinks & feels guideline for treatment

Treating Trauma Using 3 Basic Principles

1) Abreaction 2) Context 3) Correction

1) Abreaction
Full & complete expression of emotions connected to the trauma Feelings mixed or no vocabulary
Using fairy tales or here & now How would it feel to be Little Red Riding Hood? Who cried at preschool today? What do you think she was feeling?

1) Abreaction
David Levy mid-20th century child psychiatrist & psychoanalyst
Using abreaction techniques on children with anxieties connected with unexplained tonsillectomies & other such medical procedures 3 important points
Children should be told whats going to happen Parents should be with children through hospitalizations Expressing previously unexressed feelings helps traumatized children

1) Abreaction
No longer the only technique used Tell stories or play out emotions
Dinosaurs, doll houses, rap songs

Biochemical & functional imaging studies

Amygdala important site for emotional memory Amygdalar memories reactivated more amenable to reconsideration & reorganization

2) Context
Understanding, clarification, & perspective on a trauma Benefit from more historical, geographical, rhythmical, poetical, scientific perspective Context offered must be geared specifically to age & stage of development Context developed spontaneously after trauma Personalized meanings maybe bizzare, difficult to rework
Must be tackled & revised

3) Correction
Act of finding a behavioral or fantasized way of turning a trauma around Behavioral solutions mix in well with psychodynamic therapies
Take responsibility for pets Bring treats to class at school Learn driving

Must feel right to the child Therapeutically corrected by looking to the future, what might be done in the country Must be geared to particular nature of trauma & childs age, stage, mental/physical abilities

3 Potential Complications to Trauma Treatment

1) Memory 2) Attachment 3) Transference & Countertransference

1) Memory/Reconstruction

Reconstructive memory work not necessary to childhood trauma treatment Avoid suggestion & let the child lead the way Direct attempts to elicit forgotten stories e.g. hypnosis, EMDR, anatomically correct dolls must be used with great caution Need not strain to remember but work in the here & now
Client of any age may pick up suggestion & internalize

Real information can be shared when client is ready

Hospital or police reports Eyewitness statement Newspaper account Visit trauma scene What the parents know

2) Attachment
Attachment issues often seen as primary
Broken relationships, abandonments, foster care, institutional living Often associated with trauma
Abuse Neglect On-off connectedness

3) Transference & Countertransference

Single uncomplicated event

Not usually an issue See therapist as a nice & helpful talking doctor if accompanied by painful procedures in hospital Honest about filing report or visiting school about the trauma Ok to look at wound without touching; better with parent or assistant present

3) Transference & Countertransference

Abused by one or more caretakers
good doctor not to be trusted Sexually or physically abused may act angry, withdrawn, seductive, manipulative Gradually proves therapists can be trusted
Respond to mutual interest with therapists Talking/playing without meat to conversations good for breaking past transferential blockades

3) Transference & Countertransference

Horrifying stories may leave clinicians feeling pain, anxiety, phobias or depression Occupational burn out is common
Regular professional peer support Occasional consultations with seniors Spread out appointments Do research preserve interest in trauma beyond single case Get away totally Keep friends and family close Write Teach

Treatment Modalities
1) 2) 3) 4) Talk Therapy Play Therapy Parental Counseling Interventions with Schools, Hospitals, Churches, Coaches 5) Mixing Modalities of Treatment

Talk Therapy
Feel relatively pleasant Encourage 3 healing expressions: abreaction, context, correction Playful jokes, games, magic Practice scenarios Superheroes Movies Mutual story telling techniques
Metaphoric tale encompassing abreactions, contexts, corrections

Play Therapy
Extremely expressive & successful ways to treat psychodynamically Post-traumatic play inevitable Enters the childs play directly
Takes instruction from child or throws in inventive idea to add to play

Effect abreaction, context, or correction not all at once usually Psychoanalytically based, Jungian sand tray, cognitivebehavioral, mixed Option to include parents/siblings for toddlers, preschoolers, school-age children Not ways to cure abusive parents

Parental Counseling
Provide guidance Separate sessions or 5-10 minutes from each session Parents come first helpful for nonforthcoming children Parents come after maybe considered as breach of confidentiality Helpful to involve another family member if family in grief or parents also traumatized

Interventions with Schools, Hospitals, Churches, Coaches

Convey treatment plan to lawyer Explain to teachers about childs special needs Hear about childs symptoms outside of home Those with distinct bearing on clients wellbeing What happens in hospital may further traumatize

Mixing Modalities of Treatment

CBT proven effective as short-term treatment for childhood trauma Helps with context (cognitive) & corrections (behavioral) Mix in well with other talking or playing modes of treatment Medications may be used

Treatment Through Development

Meaning may change
Attachment; injury or death; sense of identity

Tell children & parents no total cure

New external event; new phase Symptomatic recurrence dealt with within few weeks to months

Conclusion: Psychodynamic psychotherapy works well for traumatized children

What is EMDR?
Eye Movement Desensitization Reprocessing http://www.youtube.com/watch?v=wHdnKoq 9gc4 For Children http://www.youtube.com/watch?v=VxXWBDr 5RCA

The AIP Model

Adaptive Information Processing Clinical complaints that are not organically based or caused by insufficient information are viewed from an AIP perspective as being caused by inadequately processed experiences that are maladaptively stored unable to link with adaptive information Dysfunctional/pathological traits, behaviors, beliefs, affects, body sensations are manifestations of the unprocessed memories encoded at the time of the event

The AIP Model

The information processing system in the brain and the stored associative memories are the primary focus of treatment Pathology & health are manifestations of the stored memory experiences
unprocessed memories are the basis of pathology processed memories are the basis of health

Procedures are geared to access & process dysfunctional memories & incorporate adaptive ones Negative experiential contributors to current dysfunction are any disturbing or adverse life events that continue to have a lasting impact on the individual, whether traumatic or not