In Uncategorized on August 8, 2011 by Trauma Informed Practice with Children and Families
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Did you know that just learning to relax is key to trauma-informed intervention, resiliency and recovery from a variety of disorders? Dr. Roger Klein, expert on the impact of relaxation training with children and adolescents, presented a workshop “Helping Children and Teens Self-Regulate Using Imagery and Relaxation” at a recent trauma conference. In this presentation, Klein underscores that that there are many ways children and teens can learn to regulate their responses to stress and traumatic events. Additionally, using imagination along with relaxation activities and resilience-focused thinking, young people can learn to minimize their responses to every day stress and traumatic experiences.
Relaxation is a state of being in which there is an absence of tension and hyperarousal, two common reactions to stress or traumatic events. Roger Klein and other experts on trauma propose that practicing relaxation skills over time is a highly effective way to mediate and reduce the effects of stress on the body and mind. Without the ability to relax, we may stay locked in a “fight or flight” response; the latter leads to chronic feelings of anger, depression, panic, and burnout and even stress-related medical conditions. In other words, there are many benefits to practicing relaxation including reduced susceptibility to disease, improved concentration and most of all, increased happiness and life satisfaction.
Meditation is one form of relaxation and is often defined as a form of mindfulness, the bringing of one’s complete attention to the present experience on a moment-to-moment basis. Mindfulness meditation has been studied for several decades and has proven to be effective in the treatment of pain, anxiety, stress and even addictions. Many trauma specialists now regularly apply some form of mindfulness practice in work with clients of all ages, including children, because of the outstanding evidence indicating that meditation actually “changes” our brains in positive ways. Mindfulness expert Jon Kabat-Zinn developed a now widely used protocol called Mindfulness-Based Stress Reduction (MBSR) to treat chronic stress and the illnesses that repeated exposure to psychological trauma causes, including high blood pressure, heart disease and weakened immune system functioning.
Just recently researchers at University of California at Los Angeles (UCLA) found that certain areas in the brains of individuals who meditated for many years were larger than those individuals who did not engage in regular meditation. They also found that those people who meditate have more gray matter and show less age-related brain atrophy (weakening), suggesting that meditation may be good for everyone because our brains naturally shrink in size over our lifespan. In follow-up studies, these researchers found that the benefits of meditation are not isolated to one part of the brain, but involve many parts including the cortex, limbic system and brain stem.
When it comes to children, some readers may ask, “Well, how do we successfully adapt what is known about meditation, mindfulness and relaxation to young people?” One popular technique I have used with children for many years is called “Lion’s Breath” and uses an imaginative metaphor (the lion’s roar) to help young people learn the same relaxation skills that teens and adults may learn through traditional methods and yoga breathing:
“I am going to teach you about a way to let go of worries or thoughts that might be bothering you. It’s called the Lion’s Breath and I want you to imagine you are a lion. Remember, a lion has a really, really big roar—can you roar? Now I want you to sit up with your legs crossed; if you feel more comfortable sitting up against a wall with your legs crossed, go ahead and do that (some children feel safer with their backs against a wall). Now, get ready to make your roar! Let’s try one all together as a group (we all roar in unison).
Before we roar again, let’s all think of a worry that we would like to let go off. For a minute I want you to watch me and see how I roar. First, I am going to take in a really, really deep breath through my nose and then let my roar out through my mouth, sticking my tongue out at the same time and stretching out my arms out as far as I can in front of me. Let’s all try it together, okay?” (Leader and children perform the breathing and roaring together, sticking out their tongues and stretching out arms) (Malchiodi, 2000, p. 14).
Repeat this activity several times; inevitably the deep breathing, roaring and stretching lead to a child-friendly (and fun) form of relaxation. For more information on relaxation with children and teens, visit Roger Klein’s website.
Be well,
Cathy Malchiodi, PhD, LPAT, LPCC
References
Malchiodi, C. (2000). Creative activities manual for children from violent homes. Salt Lake City, UT: WIJ Publications.
The statistics on homelessness in the United States are astounding. According to the National Child Traumatic Stress Network (NCTSN) (2011), more than 1.3 million children are homeless at some time each year and on the average day, at least 800,000 Americans, including 200,000 children are without a home. These individuals have also encountered trauma before becoming homeless and homelessness itself can exacerbate or re-traumatize children and adults. Ultimately, it is an experience that has powerful effects not only on individuals and families, but also on our neighborhoods and communities.
Homelessness affects individuals of all ages and in all areas of the US; it disproportionately affects people of color and single parent families, but it also impacts people of all ethnicities. For children, the loss of a stable home environment may include loss of pets and possessions, previous routines, school changes, and lack of privacy, compounding the stress related to homelessness. There can be additional stresses too, including abrupt separation, interpersonal or domestic violence, or illness that add to emotional challenges and risk for increased trauma reactions. Children may experience higher incidence of ear infections, asthma attacks and stomach problems; may develop learning and cognitive difficulties; and may have emotional problems that require professional intervention, but frequently go without recognition or treatment. According to NCTSN, by the time homeless children are 8 years old, one in three has a major emotional disorder. Additionally, trauma-related symptoms make recovery more difficult for these youngsters.
A recent episode of CBS’s 60 Minutes addresses how children are impacted by sudden homelessness in the U.S. and highlights the unique challenges children and families face when displaced from home and familiar routines. If you missed this compelling episode, take a few minutes to watch it and hear firsthand accounts from children who are confronting the realities of homelessness in their daily lives:
So what can we do to help homeless children and families? Here are just a few evidence-based, trauma-informed, and resilience-focused practices:
Work to ensure that children and families are not re-traumatized after entering a shelter or program;
Respond in trauma-informed ways to support resilience and empower individuals;
Provide safe and non-threatening environments that maximize choice and control for individuals;
Model positive behavior, maintain clear boundaries, allow participants to make decisions and share power, and respond with cultural sensitivity;
Help children and adults learn skills to self-regulate and reduce trauma reactions;
Provide support for both emotional and physical health, adaptive coping, and culturally appropriate services that address trauma and the experience of homelessness;
Above all, help children and families become survivors and eventual “thrivers” who are capable and empowered to overcome challenges and move forward with hope and dignity.
Be well,
Cathy Malchiodi, PhD, LPCC, LPAT
Reference
National Child Traumatic Stress Network. (2011). FactsonHomelessandChildren. Retrieved on June 28, 2011 at http://www.nctsn.org.
If you are a trauma specialist, you may have heard the terms “compassion fatigue,” “secondary posttraumatic stress” and “vicarious victimization.” Most commonly, practitioners speak of “burnout” and the majority who work with traumatized individuals have experienced one or all of these conditions from time to time.
Compassion fatigue has many faces, but these are some of the more common symptoms in mental health and healthcare professionals:
* Sadness and lack of pleasure in activities that were previously enjoyable
* Emotional and physical exhaustion
* Emotional outbursts
* Unresolved anger and conflicts
* Chronic ailments such as recurrent colds, stomach problems, and headaches
* Preoccupation and difficulty in concentration
* Denial of emotional stress and blaming of others for distress
* Inability to express emotions in a productive manner
* Isolation from others
* Compulsive behaviors (overspending, overeating, and other addictive activities)
* Nightmares, sleep disruption, and intrusive memories of traumatic events
So what do you do when you realize that you may have or be at risk for compassion fatigue? Just how do you keep going when your job includes providing trauma intervention for children, adults, and families on a daily basis? If you do not attend to the symptoms in a timely way, those symptoms eventually refuse to be ignored and emotional crisis occurs.
There are several steps you can take to address compassion fatigue right now. The first step is to reach out to others, including colleagues, to share your feelings and obtain support and validation. The other step begins with you—take the time to build in self-care and personal resilience-enhancement. Join an exercise class, take up yoga or meditation, and focus on a healthy diet. Most of all be kind to yourself, accept that you are not perfect, set good boundaries for work-related activities, and express your needs to others.
Finally, enhance your ability to deal with compassion fatigue through education such as McHenry’s upcoming workshop. One of the most well researched ways of reducing secondary posttraumatic stress reactions is through education. So take the opportunity to increase your awareness through learning and listening to the opportunity to increase your awareness through learning and listening to the stories of other professionals struggling with compassion fatigue’s effects.
Children who have been traumatized exhibit anxious behaviors and often have a lot of “worries.” On June 22, 2011, Dr. William Steele, founder of the National Institute for Trauma and Loss in Children, will present a webinar, “What do parents/guardians really need to know about childhood trauma?” and will address some of the ways to help children and adolescents with trauma symptoms. According to Steele, today’s children and teens are steadily becoming more anxious; recent catastrophic events such as war, economic down turns, violence and natural disasters have possibly contributed to this increase in worried responses.
There may be other more subtle reasons for the persistence of anxiety in this generation of young people. For example, anxiety and depression correlate to our sense of control or lack of control over events in our lives. It is widely accepted that individuals who perceive that they are in charge of their lives are less likely to become worried or sad than those who feel victimized by similar experiences. If you remember your Psychology 101 course, you might recall the standard measure of a sense of control by Julien Rotter in the late 1950s—the Internal-External Locus of Control Scale. Internal control represents the beliefs about control that come from the individual and external control represents the beliefs about circumstances outside of the individual’s control. In brief, studies based on this measure have consistently shown that people who score higher in areas of internal control fare better [less anxiety and depression] than those who score higher in external control areas.
So is there evidence that there has been a decline in children’s and adolescents’ sense of internal control in recent years? From what researchers have learned over several decades, yes there has been a decline and at the same time, an increase in anxiety and depression. For example, Jean Twenge and colleagues (2004) studied young people ages 9 through 14 and college students from 1960 to 2002 and discovered that by 2002 the average young person was more externally-oriented when compared to individuals in 1960. This trend paralleled a rise in depression and anxiety during the same time period.
How do you know when anxiety is more than just passing “worry?” Here is a short list of some indicators found in children and adolescents:
When children and adolescents can no longer perform or enjoy activities enjoyed by their peers;
When anxiety is persistent, lasting more than a month;
When anxiety distresses the entire family system [tension and anxiety during activities that normally are enjoyable];
When young people avoid activities that normally require independence or become overly dependent on parents and caretakers;
When there is avoidance of social activities [fears of social scrutiny and criticism];
When there is constant need for reassurance and/or perfection-oriented behaviors;
When there are unexplained physical symptoms like headaches and stomachaches.
Family histories of anxiety may contribute to an increased risk for anxiety disorders in children as do temperament and personality. Of course traumatic events, particularly repeated incidents, may contribute to that risk. Children and adolescents experiencing extreme levels of parental or family stress [divorce, domestic violence, homelessness, etc] are at higher risk for anxiety and depression. In working with families with anxious children, I often initially ask parents the following questions:
On a scale of 1 to 10, 10 being the highest, how bad do you think your child’s problem is?
On the same scale, how hard is the problem to manage? Are there days when the problem is worse? Give me an example of one or two of those days.
Are there days when the problem is not so bad? Give me an example of one or two of those days if you can.
What do you feel contributes to your child’s anxiety?
Because these questions may not be easily answered, I often ask parents to show me on a visual scale how “big” the problem is and draw images of “good” and “bad” days. Depending on the parent, I might even ask, “what does your anxiety look like when your child is anxious? Can you draw me a picture of that or pick out some magazine photos from these collage materials to show me?”
How is it that some children and adolescents with anxiety do better than others when faced with the same traumatic events? What can parents do to ease their child’s fears while building their resilience in a world that is frightening for adults as well? Dr. Steele will be addressing these and a number of topics related to anxiety in young people along with a variety of practical tips about how to help traumatized youth move from victims to survivors to thrivers. To register, see this webpage and read more about future webinars, too.
Be well,
Cathy Malchiodi, PhD, LPAT, LPCC
Reference
Twenge, J. M., Zhang, L., & Im, C. (2004). It’s beyond my control: A cross-temporal meta-analysis of increasing externality in locus of control, 1960-2002. Personality and Social Psychology Review, 8, 308-319.
With so much news about the death of Bin Laden and devastating tornadoes and floods in the US, we often forget that military are still serving in Iraq and Afghanistan. Last summer, the National Institute for Trauma and Loss in Children presented a special session on the issues of military and their families. Sue Diaz, a journalist and mother of a son who served in Iraq again reminds us of what families and those deployed have encountered, both in the theater of battle and on the home front. Sue explains : “Sergeant Diaz’s [Sue’s son] second deployment put him south of Baghdad in the region aptly termed the Triangle of Death. There his platoon experienced extraordinarily heavy casualties during the height of the Iraqi insurgency. That unit has since become the focus of considerable media attention following events that made headlines in the summer of 2006: an insurgent attack at a remote outpost on three of their own–one killed at the scene, the other two kidnapped, their bodies found days later; and a terrible war crime committed against an Iraqi family by four soldiers from First Platoon.”
For trauma specialists working with returning military and their families, the following short film will remind you of the important work we have to do in the next few years with these individuals who will be returning as the US begins troop withdrawals from the region. And for all of us in honor of the upcoming Memorial Day this month, let’s take a moment to remember the sacrifice that military and their families make each and every day to work toward resolution of conflict, both in Iraq and Afghanistan and at home where for some the internal battles continue.
On July 12th, at the Annual National Institute for Trauma and Loss in Children Summer Assembly, keynote speaker Jeff Georgi will talk about “The Adolescent Brain,” including a number of intervention strategies to help adolescents with trauma-related substance abuse, obesity and eating disorders. But why should trauma specialists know more about the adolescent brain in particular? Those of you who work with teenagers might be thinking, “how do you ever know exactly what is going on in an adolescent’s brain anyway?” I have also heard many a parent say, “I think my teenager must be an alien from another planet. This is not the same child I knew a few years ago.” Teenagers’ behaviors continue to mystify and often frustrate both helping professionals and families and we often associate their responses with the need to be autonomous or raging hormones. In reality, what science can now tell us about the adolescent brain is changing how we think about teenagers and reframing how we can best intervene with those at risk.
While most of the human brain develops by age six years, neuroscience tells us that some of most significant spurts of growth occur just around the adolescent years. In particular, the area of the brain called the prefrontal cortex [the part of the brain related to organization, planning, memory, and executive functions] grows just before puberty. In essence, as this area develops more fully, young people are more able to control impulses, make good judgments, and improve reasoning. The cerebellum is another part of the brain that changes, too; it supports physical coordination and complements the cortex’s functions in decision-making, logic and social skills. In brief, the complex circuitry of the human brain is not mature until our early 20s.
Because it was once thought that all brain development essentially happened before age 6, researchers were initially surprised that the brain continued to grow through adolescence. More importantly, some neuroscience researchers believe this is a particularly important time for brain development. Neuroscientist Jay Giedd underscores that what tens do or don’t do can impact them during the rest of their lifespan. For example, an adolescent who is playing a musical instrument, painting pictures, engaging in sports, or mastering a language is hardwiring those interests and skills; in contrast, Giedd notes that the teenager who is lying on the couch or constantly absorbed by computer games are hardwiring a different set of brain connections.
Teenage brains also are still learning how to perceive emotion and do so differently than adult brains. Researchers have concluded that adolescents and adults actually use a different part of their brains to process feelings; adults use the frontal cortex, while teens use the amygdala [limbic system, the area of our brains that is related to instinctual response]. As adolescents become adults, the way feelings are perceived moves from the amygdala to the cortex.
So how do we apply this knowledge to work with teenagers and particularly those who are challenged by traumatic experiences or substance abuse and addictions? First, we know that adolescent behaviors are not just the result of raging hormones or simply the need for independence. More importantly, the brain is a lot more “plastic” (flexible and pliable) than was previously thought, opening up possibilities for intervention based on emerging knowledge.
For information on Jeff Georgi’s keynote and to register for this summer’s Assembly, visit the 2011 Practitioners’ Assembly webpage. During his two decades at Chapel Hill Medical Center in North Carolina, Jeff held clinical appointments in the Departments of Surgery, Obstetrics, and Psychiatry. He remains a clinical associate in the Department of Behavioral Medicine as well as a faculty member of the Duke University School of Nursing. He has contributed to a number of Treatment Improvement Protocols that are part of the best practice guidelines by the Center for Substance Abuse Treatment in Washington, DC. You will not only learn more about the adolescent brain, but you’ll also take away a toolkit of practical interventions and strategies to use in your work with teens.
Increasing numbers of helping professionals are including animal-assisted therapy – sometimes called pet therapy– in their work with clients of all ages. In particular, this approach is being used with children who have been traumatized by abuse or neglect. Consider 10-year-old Robbie who has lived in foster care for the last two years after previously being physically abused by his father and brother for more than seven years. Many of Robbie trauma reactions were helped by art and play therapy and family intervention, but he still had some problems with self-regulation and nightmares.
Robbie’s counselor decided to try animal-assisted therapy with him, believing that positive interaction with an animal might make a difference. She introduced Robbie to Scout, a trained therapy dog; at first Robbie was a little afraid because he had never had the opportunity to play with a dog before in his life. She worked with Robbie to help him feel comfortable, modeling how to pet and play with Scout over the course of several meetings. In brief, through regular animal-assisted play therapy sessions with Scout and his counselor, Robbie’s relationships with others began to noticeably change. His behavior became less erratic and more predictable and his nightmares ceased; Robbie developed more healthy attachments and relationships with his foster family members and other children and a newly-found confidence in himself.
According to well-known play therapist Rise VanFleet (2007) animal-assisted play therapy is “the use of animals in the context of play therapy, in which appropriately-trained therapists and animals engage with children and families primarily through systematic play interventions, with the goal of improving children’s developmental and psychosocial health as well as the animal’s well-being. Play and playfulness are essential ingredients of the interactions and the relationship.” This form of intervention most often involves dogs, but other types of animals [cats, birds, rabbits, horses, and dolphins, among others] can be part of treatment, too.
There are many studies on how and why animal-assisted therapy can help children like Robbie. Some of the benefits of animal-assisted therapy include:
1) reducing resistance and increasing attachment;
2) enhancing empathy;
3) teaching appropriate communication skills;
4) building confidence;
5) enhancing the ability to self-soothe;
6) prevention of animal abuse [sometimes seen in children who have been abused or neglected].
If you are not familiar with animal-assisted therapy, what are your options to include this form of intervention in your work with children? One, of course, is to train your own therapy dog; many of my colleagues have done this with their own pets, but be prepared for a lot of commitment to training and follow-up. Some therapists who have their own therapy dogs keep their animals present at all times in their sessions [barring situations that preclude having animals present]. Others may include dogs in play therapy sessions periodically or for a short portion of the session depending on goals for treatment and the personalities and temperaments of the animal and the child.
The other option is to engage the services of a professional in the field of animal-assisted therapy. In this case, you may want to visit the American Humane Society website (see link below) for more information or your local metropolitan or state organizations for a referral to a qualified and experienced individual in your area. Like many helping professionals who work with children, you might just become interested in learning more about introducing your own “furry therapist” to your work, too!
It’s time to make your plans to attend the 2011 TLC’s Childhood Trauma Practitioner’s Assembly from July 12 to 16th! The Assembly will be held at the Macomb County Intermediate School District’s (MISD) new Educational Service Center. MISD is located at 44001 Garfield Road, Clinton Township, Michigan 48038-1100. This year’s program is about practices that are both trauma-informed and resilience-focused; some are evidence-based, others evidence-supported, as not all evidence-based interventions are appropriate for all traumatized children. Here are some of the leading edge presentations this year:
Relationship & Neurobiological Integration Part 1 Many children of trauma experience changes in brain structure and brain chemistry. This workshop is focused on providing strategies through the caregiver’s relationship to create new pathways for the healing of a child’s body and mind system. We will look at how behavioral approaches discriminate against children with neurodiversity issues. A relational paradigm will then be introduced, and you will be provided with several strategies including: co-regulation, time in, the three A’s (attunement, affection and attention), self exploration, playfulness and humor, acceptance, presence, containment, being a sensory detective, physical affection, entering pain pathways, limbic resonance, the neurophysiological feedback loop, transitional time in, multi-sensory feedback, rupture and repair, collaborative communication, non-verbal communication and many more. Here are just a few of the offerings at this summer’s Assembly:
Group Strategies and Interventions with Youth Exposed to Domestic Violence Participants will learn practical tools and important themes to consider when working with youth exposed to domestic violence. In addition, content presented will help participants gain a trauma-informed understanding about how these strategies and interventions promote safety, emotional expression, coping, validation, and normalizing related to working with youth from violent homes. Participants will also engage in activities and experientials to enhance their awareness and insight about the benefits of using hands-on and creative interventions in group work with traumatized youth.
What Really Gets Worked Out in the Sandtray? Sand, images and the sandtray help create a “safe and protected space” for the builder. This psychodynamic process can be part of a nondirective or directive experience. Participants will see video clips including “Sandtray Storytelling” and a clip of how sandtray was utilized in schools with children whose parents worked in the Twin Towers as shown on the New York cable show, Frontiers in Psychotherapy.
No Bullies-No Victims: Trauma-Informed Bullying Prevention for K-12 This presentation will explore the bullying happening in schools and on the internet and explore specific, effective strategies at the organizational and student levels. Participants will be provided with a workbook outlining those strategies that can then be transferred to their organization or counseling practice. Emphasis will be on building students’ strengths by giving them the skills and strategies they need to prevent the bullying from happening and to deal with it when it does. Participants will also be given strategies for managing the environment and working with school staff and parents in order to help this transformation.
And of course, we hope you will join us for the keynote and full-day courses [to be described in a future post] to become certified in the use of TLC’s school and agency-based SITCAP® programs or, if already certified, to learn additional strategies presented by practitioners in a variety of 3-hour workshops.
The recent and ongoing disaster in Japan once again brings up the question– just how do helping professionals assist children after an acute traumatic event like an earthquake or tsunami? Here are some recommendations:
Establish and maintain close relationships with trusted adults. Even under the most adverse circumstances, most children and adolescents can cope as long as they have connections to adults, including helping professionals and caregivers. Young people who have someone they know is concerned about their well-being, provides them with guidance, structure and information, and spends frequent time with them do better than those who do not have such relationships. While parents are usually the source of support, others (counselors, teachers, childcare staff) can also supply a sense of meaningful connection.
Insure a sense of safety. All children need to feel safe, but particularly those under stress. In acute trauma situations like disasters, sharing knowledge of what is being done to help everyone be safe and secure is important. Many individuals have a tendency to worry more than usual after a catastrophe or negative event; for example, some children believed that airplanes could hit their homes after the events of September 11, 2001. Helping professionals and caregivers can assist them by providing age-appropriate and realistic information to reduce undue fright, anxiety or obsessive thinking. Monitoring children’s exposure to violent images or reports of death or disaster will also reduce feelings of vulnerability and the sense that “it is happening again” when, in fact, there may no longer be a threat.
Practice self-regulation techniques. Knowing a method or two to relieve emotional and physical tension can enhance and build resilience over time. Play is a natural form of self-regulation if it calms and relieves the individual. Talking, drawing, making music or physical activities or sports can help, too. For children and adolescents who are anxious or showing signs of hyperarousal, many of the more well-known self-regulation activities and strategies (breathing, mindfulness, and muscle relaxation) are useful; mastery of a “resilience-building” skill also is positive resilience factor, in and of itself.
Encourage optimism. Traumatic events like disasters make it difficult to feel positive about the world; even children and adolescents who have a natural tendency to see a positive future can be emotionally shaken by certain events. Those individuals who believe that these events are temporary will do better than those who obsessively belief that things will not change for the better. It is extremely important that helping professionals and parents help children and adolescents develop a sense that they can effectively deal with stress.
Identify values and beliefs. Commonly used lists of resilience factors include several concepts that underscore the importance of values and beliefs in trauma informed practice. Individuals who are altruistic, for example, and seek to help others in need build personal resilience and reduce depression and anxiety in the process. Values that involve connection to others are particularly important because they reinforce connection to a larger group and emphasize the welfare of others. After a traumatic event, beliefs about religion or spirituality are also a source of resilience for some individuals; trauma informed practitioners can help identify these beliefs within a framework of cultural sensitivity for individuals’ and families’ preferences for sharing information on religious or other practices.
Practice all of the above. This list of recommendations began with the importance of relationships in resilience-building after a traumatic event, underscoring that one of the most significant factors in resilience and trauma recovery is a meaningful relationship with either a parent or a helping professional. In order to make that possible, parents and professionals must be able to be available and supportive. Practitioners must make sure that they are feeling safe, calm, well-rested, and in good emotional health in order to implement the resilience-building strategies in this list. Practitioners can also help parents/caregivers understand and practice these same principles so that they can be available and supportive to their children.
Finally, it is important to look for any trauma reactions even months after exposure to an acute event; it is common for individuals of any age to begin experiencing symptoms 2 to 3 months after the occurrence. Anxiety, depression, avoidance of certain situations, problems with cognition and concentration and irritability can signal that some resilience-enhancement is in order. If reactions persist, professional assessment may be appropriate to make sure children and adolescents retain the ability to function at home, school, and with peer groups.
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