Healing Traumatized Children. Faye L. Hall
have benevolent motivations, too.
Corey’s Family
Corey had an answer for everything. If someone brushed up against him or he fell, he claimed “abuse.” He complained that his parents overheated his food and caused him to burn his mouth. Some bruises from a recent fall led to a Child Protective Services investigation. When he accused Danny and Rebecca of inflicting the injuries, they could not understand why he lied. What did he have to gain? He must really hate them. The parents fell victim to Corey’s N-IWM, as caused by traumatic experiences at the hands of his birth parents and possibly also by prior foster parents: He was bad and adults were dangerous.
The new in-home service’s staff answered the “why” questions. Corey’s early life experiences taught him that he was not valuable, that adults were dangerous and that the world was unsafe. He needed to keep himself safe in every situation. His internal monitoring system was always set on “red alert.”
Treatment focused on psychoeducation regarding trauma, attachment and development and on helping the parents notice signs of anxiety in Corey. Their “homework” was to share personal emotional experiences. The family became more aware of fear and sadness. The other children understood how their behaviors spread fear throughout the family when they were reacting to Corey’s fear. Corey was uncomfortable when others seemed to recognize his emotions before he did. The family began to enjoy sharing their daily experiences at dinner. Instead of attacking Corey for his lies, they gave him space and told him his unhealthy part was making decisions. As the family completed their homework in helping Corey notice his emotions and talk about theirs, he relaxed. Gradually the family learned to handle fear better and accept comfort when sad.
HOW IS THIS PARADIGM SHIFT ACHIEVED?
In the previous section we detailed six traditional foster and adoptive parenting tenets. Each family will adhere to the tenets in varying degrees. But a change to the new paradigm is necessary for successful parenting of a traumatized child. How can the Trauma Lens Paradigm Shift be achieved?
Shifting paradigms is hard work and requires education, resources, support and guidance. Parents must have a team of friends and professionals with whom to share responsibilities and from whom to get stress relief. We will address development of the treatment team in the next chapter. We will proceed here as though the family has a treatment team.
Psychoeducation for the Family, Friends and Professionals
The Emotional Cognitive Trauma Model (ECTM) begins with the Two Babies Narrative, a description of how two babies develop opposite internal working models. One baby has an attuned primary caregiver with “good enough” parenting.11 The second infant’s caregiver lacks attunement and responsiveness. This caregiver may hurt the child or allow others to do so. The narrative identifies how the IWM affects relationships, decisions and behaviors and increases understanding of where emotions come from and how the trauma damages were done. It enables the reader to feel empathy for the birth mother and sets the stage for future “reframes.”
The ECTM: Two Babies Narrative leads to the parent’s ability to make the following paradigm shifts:
1. A reframing of current events and behaviors through the Trauma Lens, by linking current behavior to the early abuse or neglect.
2. Thinking of the trauma damage as a “hurt part.” The hurt part is not the whole child. If it’s only a part, the part can be healed.
3. Understanding “parts” as thinking, feeling and acting components. We all have parts, the strength of which varies given different events and triggers.
4. The ability to demonstrate how anger avoids feeling fear and sadness. Anger gives power, while fear and sadness are difficult to manage for a child who lacked an attuned caregiver.
5. The understanding of these children as either more or less angry, but rarely happy.
6. Better parental skill at regulating their own emotions, along with an expanded range of emotional awareness.
Two additional skills parents are encouraged to use are “narration” and “affect matching.” The Two Babies Narrative highlights the role of parental narration of everyday life and of definition of experience. This is an automatic process for healthy parents and children. But children who come from stressful, abusive and neglectful environments most likely have not had this interactive experience. In the new paradigm, parents use the ECTM to narrate their children’s emotional worlds and to define their experiences.
Parents narrate the world for their infants, if you notice. The baby’s every interaction with the environment is described and defined in great detail; what a good sleep the baby had, how comfortable the crib is, the smell of the diaper, the taste of the milk, the empty feeling and the full feeling. Dozens of times a day, parents show baby the world.
So often the parents of traumatized children find themselves asking them questions like, “Why did you do that?” and “When will you stop doing that?” The ECTM encourages parents to stop asking and use the model to provide answers. This greatly reduces defaulting to the N-IWM of “I am bad” and “You are bad.” Now, “Why did you do that?” can be reframed as “You did not trust me, so you took the candy.” Parents will understand that the answer to “When will you stop?” will come with healing.
Corey’s Family
Over the years, Corey continued to steal food from Danny and Rebecca. Danny stated that he did not understand why Corey did not trust them to take care of his needs. Each time he stole food, he had the feeling of meeting his own needs, of being in control, thereby demonstrating that he didn’t need parents. Danny and Rebecca began to narrate their actions as they provided for Corey. Rebecca pointed out times when Danny played with Corey. Danny voiced his appreciation of Rebecca as she took care of each meal. Both Danny and Rebecca described the other parent as being trustworthy. Each reframe of the parent’s trustworthy behavior added meaning to the experience.
Another skill parents are encouraged to use is affect matching. Parents of infants match their affect with the child’s to calm them. This natural process is essential for infant co-regulation. Children with early trauma missed this vital developmental interactive experience. Parents of traumatized children must be taught the importance of affect matching, be provided with examples and encouraged to practice it. The foundation of affect matching is adult emotional self-regulation, followed by intentional co-regulation of the child. Parents use the skills of narrative and affect matching as they shift their paradigm.
The paradigm shift continues with understanding of what we refer to as Trauma-Disrupted Competencies (TDCs). Infant and child development is incremental and builds on each previous skill. If a skill is not learned, the incremental process is disrupted. Parenting a traumatized child becomes easier as the parent looks for TDCs in their child; misbehaviors can then be understood as missing skills instead of behaviors that need consequences.
• Negative Internal Working Model (N-IWM or “maladaptive schema”): A schema is an internal working model of oneself, one’s caregivers and the world. If a child endures trauma from child abuse, neglect and/or loss of the primary caregiver, the result may be distorted and maladaptive schemas. Maladaptive schemas may be linked to adult personality disorders that are very difficult to treat. Consequently, early recognition and attention to maladaptive schemas in children can be preventive. Typical behaviors consistent with a maladaptive schema include not trying (fearing failure) and stealing and lying (not trusting parents to provide).
• Developmental delays: Disrupted relationships are emotionally and developmentally costly. Severely disrupted attachment often engenders lifelong risk of physical disease and psychosocial dysfunction.12 These children may have atypical development of their ability to play or to occupy themselves, may regress under stress to behaviors typical of a younger child, be hyper-vigilant with an inability to focus or use controlling behaviors. Typical behaviors include being bored (an inability to occupy oneself) and not finishing games and projects (lacking in developmentally-appropriate