Healing Traumatized Children. Faye L. Hall
nature causes them to blame themselves for removal from their birth family and changes in placements. Even when children deny it, there is no motivational substitute for parental attention. They will always grow in the direction of our attention. It can be extremely difficult to find and enjoy the small, fearfully hidden positive elements of traumatized children. Our attention that nurtures their growth may require a very strange skill set to enjoy playing with building blocks with a nineteen-year-old or a twelve-year-old sitting with mom reading a picture book. But these activities are often just what the child needs to facilitate acquisition of previously un-mastered skills. The new skills in turn allow for eventual mastery of chronological age skills.
TREATMENT GOALS
As with any model, success is dependent on the participants. We have established goals that can be measured (useful in treatment planning) and explain what needs to be accomplished during the process. Goals are dependent upon the number of times the parent uses components of the ECTM.
1. To explain confusing emotional reactions. This reduces a child’s feelings of shame.
2. To explain the source of the emotions driving a child’s behavior.
3. To reorganize and redirect the familial system’s efforts at recovery from an external focus (to change others) toward an internal focus (how I can change).
4. To illustrate that the child is not “sick” or “bad,” but has a hurt part, a part that learned not to trust others, that the child is unlovable and the world is dangerous.
5. To increase internal reflection for parents and children by the application of an alternate and more accurate assessment of their own emotional world as the motivational source for their actions.
6. To interpret present emotions and behaviors and link them to past events.
7. To predict emotional responses to future events.
8. To base personal responsibility and accomplishment on something other than immediate change in the child’s behavior.
9. To reduce parental interpretations of malice as the origin of children’s behaviors.
10. To increase parents’ healthy trauma-informed behavioral expectations for their children, the verbal and non-verbal expressions of which will build the child’s self-image.
PARENT SKILLS
Now, let’s get to work and define skills that parents will use every day, many times a day, to connect with their children. Parents of infants “help keep arousal within manageable bounds but also help infants develop their own ability to regulate arousal.”17 These children are lacking in such experiences and in the relationships that create the experiences. They may now be relationship avoidant and extra skills must be learned and used to form trusting relationships and manage stimulation. We will give examples and encourage parents to follow the examples. These skills are not limited to the parents. Anyone in the village who supports the family or treatment will find them valuable. As with all interventions, no one will be perfect, but rest assured the child will repeat the behaviors that allow you to try again and again, until you perfect the interaction.
Parenting is time consuming and exhausting. Slow down and be more mindful. One must be intentional and mindful of emotional reactions to the child’s disruptive behaviors. Being intentional will help parents prioritize the values and beliefs they want to reinforce. This allows parents to pay attention to their internal experiences, sooth their own anxiety and inhibit negative responses. The resulting increased cognition allows the parents to control their emotions and stop trying to control the child. When parents are more mindful and calm, they are open to reading the child’s cues and expressing empathy. As we will cover in the following section, empathy helps the child feel heard and builds the parent/child relationship.
Corey’s Family
Corey stomped into the therapist’s office with a scowl on his face. His anger was obvious. The therapist asked Corey to find the emotion he was feeling on the emotional chart hanging on the wall. Corey glared at the thirty different emotional faces staring back at him. He mumbled, stammered and declared, “frustrated, no frightened, no irritated.” The therapist inquired about his irritation. After ten minutes of traveling down a dead-end therapy road, the therapist asked him to try again. Mom watched impatiently. Time was ticking away, again. Like always, session time was being wasted.
Due to children’s inability to identify and express their emotions and become vulnerable with parents and treatment staff, our model builds on the foundation of four emotions: happy, mad (angry), sad and scared (fear). The limited number allows parents to remain focused on using specific emotions and reduces the children’s avoidance of acknowledging their internal distress. Anger is viewed as a secondary emotion, spurred by sadness or fear. Therefore, when one declares he or she is angry, they are challenged to find the underlying emotion of sadness or fear. A sort of “micro-focus” occurs then, linking the trigger to the underlying emotion more quickly.
KEYS TO CO-REGULATION
According to Bessel Van der Kolk, a clinician, researcher and teacher in the area of posttraumatic stress, “When a baby is in sync with his caregiver, his sense of joy and connection is reflected in his steady heartbeat and breathing and a low level of stress hormones.”18
This is co-regulation at the infant level and occurs infinite times during infancy and toddlerhood. Unfortunately, most traumatized children missed these vital interactions, which equip the child with the knowledge that “intense sensations with safety, comfort and mastery are the foundation of self-regulation, self-soothing and self-nurture.”19 We have devoted this section to teaching similar skills that will reproduce this connection. We will explore and learn affect matching, emotional regulation, empathy and narration.
AFFECT MATCHING
According to parenting and relationship authorities Marion Solomon and Daniel Siegel, “Within episodes of affect synchrony parents engage in intuitive, nonconscious, facial, vocal and gestural preverbal communications.”20
• Attunes to child’s emotions, matches affect with empathy and co-regulates
• Identifies and labels child’s emotions
• Narrates the environment for the child
• Remains in close proximity to the child, especially when the child is dysregulated
• Provides comfort if needed21
During parent/infant interactions, parents respond frequently to their child’s bids for connection through sounds, facial movements and gestures. These interactions are reciprocal and predictable, creating multiple pleasurable experiences for both parent and child. Babies learn to turn away when over-stimulated. Each learns to read each other’s signals. Just like Goldilocks and the three bears, parents learn how much interaction is “just right.”
Children with histories of early trauma and attachment disruptions may lack pleasurable and reciprocal interactions with their previous caregivers. Even worse, the child may have experienced maladaptive or traumatizing responses from previous attempts to connect to primary caregivers. These children become neurologically wired to avoid parent/child interactions. Parents of foster and adoptive children are challenged to provide new experiences that replicate and/or correct parent/infant interactions via matching affect and co-regulation.
A parent’s face mirrors the child’s experience: “Then her face is an ‘accurate enough’ mirror of the baby’s state” and “not being mirrored reduces the felt experience of the world-making sense of the infant’s inner states.”22 Parents of foster and adoptive children have the opportunity to provide new experiences that replicate the parent/infant interactions via matching affect. When matching the child’s affect, the attuned parent allows the child to “feel heard.”