treating childhood trauma

8/14/2019 Treating Childhood Trauma

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Treating Childhood TraumaA 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 singleevents• Simple traumas (Type I)• Complicated traumas (Type II)•

Crossovers – single situation that creates long-term, ongoing insults to child’s development• If trauma is part of the child’s life experience,

must become part of the child’s treatment

C



Diagnosing Childhood Trauma

1) Define traumatic events2) Obtain full story & full

symptomatology

3) Construct a formulation



1) Define Traumatic Events•

Describe fears they experiencedifferently – Death & injury – Feelings of dehumanization & hui

connected with some traumas• Universal childhood fear – be

off from caregivers & home – Loss of primary attachment



1) Define Traumatic Events•

Fears of being exposed in public, bullieisolated by peers• Witnessing a terrible event

– What – Where – Relationship – Personal responsibility – Belief about what happened

• Meaning the child/teen affixes to the e



2) Obtain Full Story &Symptomatology• Review all pertinent records• Child’s own account

– Can you describe what happened to you? I need to the whole story.

• Takes a few sessions – Repetitions –

Have you done anything weird or something that goin trouble? – Indications of emotional, cognitive, physical turn-

numbings – Concerns with trusting others – Lack of faith in future



3) Construct a Formulation•

Type and nature of the event• Child’s current &/or future suppo

systems• Child’s current & future

developmental stages• What a child thinks & feels

guideline for treatment



1) Abreaction•

Full & complete expression ofemotions connected to the traum• Feelings mixed or no vocabulary

– Using fairy tales or ‘ here & now –

How would it feel to be Little Red RHood? – Who cried at preschool today? Wha

you think she was feeling?



1) Abreaction• David Levy – mid-20th century child psychi

psychoanalyst – Using abreaction techniques on children with

anxieties connected with unexplainedtonsillectomies & other such medical proced

– 3 important points•

Children should be told what’s going to hap• Parents should be with children through hospita• Expressing previously unexressed feelings help

traumatized children



2) Context• Understanding, clarification, & perspective o

trauma• Benefit from more historical, geographical,

rhythmical, poetical, scientific perspective• Context offered must be geared specifically t

& stage of development• Context developed spontaneously after traum• Personalized meanings maybe bizzare, difficu

rework – Must be tackled & revised



3) Correction• Act of finding a behavioral or fantasized way of t

a trauma around• Behavioral solutions mix in well with psychodyn

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 futur

what might be done in the country• Must be geared to particular nature of trauma &

age, stage, mental/physical abilities



3 Potential Complications to Trauma Treatme

1) Memory2) Attachment

3) Transference & Countertransference



1) Memory/Reconstruction• Reconstructive memory work not necessary to childho

trauma treatment• Avoid suggestion & let the child lead the way• Direct attempts to elicit forgotten stories e.g. hypnosis,

anatomically correct dolls must be used with great caut• Need not strain to remember but work in the ‘ he

– 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 asprimary – Broken relationships, abandonmen

foster care, institutional living – Often associated with trauma

• Abuse• Neglect• On-off connectedness



3) Transference & Countertransfere

•

Abused by one or more caretakers – ‘good’ doctor not to be trusted – Sexually or physically abused may ac

angry, withdrawn, seductive, manipul – Gradually proves therapists can be tru

• Respond to mutual interest with therapis• Talking/playing without ‘meat ’ to co

good for breaking past transferential blo



3) Transference & Countertransferen

• Horrifying stories may leave clinicians feeling paanxiety, 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 beyon

case – Get away totally – Keep friends and family close – Write – Teach



Treatment Modalities

1) Talk Therapy2) Play Therapy

3) Parental Counseling

4) Interventions with Schools,Hospitals, Churches, Coaches5) 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 abreactiocontexts, corrections



Play Therapy• Extremely expressive & successful ways to trea

psychodynamically• Post-traumatic play inevitable• Enters the child’s play directly

– Takes instruction from child or throws in inventito add to play

• Effect abreaction, context, or correction –

once usually• Psychoanalytically based, Jungian sand tray, co

behavioral, 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 non

forthcoming children• Parents come after – maybe consid

breach of confidentiality• Helpful to involve another family mem

if family in grief or parents alsotraumatized



Interventions with Schools,Hospitals, Churches, Coaches•

Convey treatment plan to lawyer• Explain to teachers about child’s specia

needs• Hear about child’s symptoms outside of

home• Those with distinct bearing on clients’

being• What happens in hospital may further

traumatize



Mixing Modalities of Treatm• CBT proven effective as short-te

treatment for childhood trauma• Helps with context (cognitive) &

corrections (behavioral)•

Mix in well with other talking oplaying modes of treatment• Medications may be used



Treatment Through Developmen• 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 psychotherapyworks well for traumatized children



What is EMDR?•

Eye Movement Desensitization Reprocessin• http://www.youtube.com/watch?v=wHdnKo

9gc4 • For Children• http://www.youtube.com/watch?v=VxXWBD

5RCA

http://www.youtube.com/watch?v=wHdnKoq9gc4


http://www.youtube.com/watch?v=VxXWBDr5RCA








The AIP Model• Adaptive Information Processing• Clinical complaints that are not organica

or caused by insufficient informationfrom an AIP perspective as being caused byinadequately processed experiences that aremaladaptively stored – unable to link wadaptive information

• Dysfunctional/pathological traits, behaviorsbeliefs, affects, body sensations aremanifestations of the unprocessed memencoded at the time of the event



The AIP Model• The information processing system in the brain

the stored associative memories are the pfocus of treatment

• Pathology & health are manifestations of memory experiences –

– unprocessed memories are the basis of patholog – processed memories are the basis of health

• Procedures are geared to access & processdysfunctional memories & incorporate ada

• Negative experiential contributors to currentdysfunction are any disturbing or adverse lifethat continue to have a lasting impact on tindividual, whether ‘traumatic’ or not

treating childhood trauma

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