"Authority Figure" by a 16 year old adolescent in juvenile detention
Back in 1993, I taught a university course on developmental approaches to art therapy that included a section on the impact of bullying on children and teenagers. Surprisingly, at that time bullying was not discussed as a serious mental health issue and it certainly was not included as a possible cause of trauma reactions or posttraumatic stress disorder in young clients. While we still have a long way to go to eliminate bullying from our schools, workplace, and culture, helping professionals are now more acutely aware of the affects of bullying and how to recognize and address its affects on young people.
One of the activities I used as an example for the course and as a way to address bullying with adolescents was called “The Authority Figure” (Malchiodi, 1993). I based it on the Erikson principle that teenagers struggle developmentally both with identity and authority [parents, teachers, adults in general] during adolescence. Since that time I have used this activity not only with teens, but also adults, adults in the workplace, and even couples. The concept of “authority” is metaphor that evokes both positive and negative feelings, including admiration, respect, leadership, rule-making, protection, power, and control, among others.
Before I start this activity with any group, I always begin with a discussion of “what is authority” to see what participants understand about the concept. “Authority” is an abstract term and depending on the cognitive abilities of your client or group, it may not be well understood by some teens and even adults. Through inviting discussion, I also want to see if the group or individual is ready to engage with this theme; the concept of authority can be very confrontational under some circumstances. Imagine, for example, a person who has experienced interpersonal violence or abuse; the authority figure can quickly become the “perpetrator” in this case. Bullies can fall into the same category because of the emotional and physical violence they inflict on others. On the other hand, there may be a point in intervention when inevitably the need to confront an authority becomes appropriate and of course, with the helping professional’s guidance, support and sensitivity to any trauma reactions.
With individuals, you can use large white paper [18 x 24 inches] and colored drawing materials [felt markers or oil pastels] and invite the person to “make an image of what you think an authority figure looks like.” In working with groups and if there is sufficient time, I prefer to offer a larger piece of paper [such as Kraft paper that comes on a roll] and collage materials [magazine images and text, colored papers] so that several participants can work together, discuss and create an image. If you are working with an adolescent group that focuses on issues of bullying, you can facilitate and support participants’ exploration and decision-making about how to portray positive and negative aspects of authority through this activity.
With this and any other sensory-based activity, always remember that teens who have experienced bullying feel intimidated, overwhelmed, and even threatened. They need you to validate what are often very powerful and sometimes frightening emotions and experiences. While an activity can address some of their feelings, we also have to remember that all survivors of bullying need careful monitoring and that their fears and worries are being taken seriously. Most of all, as helping professionals our goal is to assist them in realizing that being bullied is not their fault and to help them begin the process of strengthening a positive self-image and enhancing personal resilience [think about how you can use your art and play trauma intervention skills!].
Be well,
Cathy Malchiodi, PhD, LPCC, LPAT
Reference
Malchiodi, C. (1993). Developmental art therapy. Syllabus for California State University Sacramento, graduate art therapy program.
Safran and Safran (2008) note that victims of bullying can benefit from opportunities to express themselves in a safe, creative way. In particular, art expression offers opportunities to communicate and explore more deep-seated feelings about being bullied, emotions that may not be addressed in school-based anti-bullying programs. Fear, worry, confusion, and rage toward the perpetrator and some well-meaning teachers and counselors who fail to protect the victim may emerge in a drawing or collage before articulated with words.
Safran and Safran recommend individual and/or group art therapy for bullying victims; they emphasize that drawing can be one way to eventually explore self-image, perceptions of bullies, and a trauma narrative. The latter is particularly important with those children who can benefit from telling their stories and sharing their images with either the helping professional (Malchiodi, 2001) or with peers who may be able to empathize with the victim.
Collage is another medium I frequently use with older children and adolescents. To begin any collage activity, do some preparation work by collecting colored paper and many magazines; pre-cut a variety of images from the magazines to put into a “picture collage” box (Malchiodi, 2006). Be sure to include a wide range of images of people, environments, objects, and phrases/text and of course, remember to ensure that cultural diversity in present in these magazine photos. Avoid just handing out magazines to your client or group; pre-cutting the images will prevent your young clients from wasting time flipping through magazines rather than engaging in the activity of creating a collage.
At this point, many helping professionals often say, “create a collage that represents bullying and/or the victims of bullying.” That’s a relevant directive, but try to think about the topic of bullying more globally and create and use themes strategically. When working with adolescents, I like to use this directive—“create a collage that represents what the feelings of powerful and powerless mean to you.” If I am working with a group, I might initiate a short discussion about these two feelings and give them some options for how to construct the collages. I sometime suggest that, “you can fold your paper in half and put the images of powerful on one side and images of powerless on the other. Or, if you want to, you can mix them up in any way that you like.” For this activity, I generally supply 12 by 18 inch colored construction paper or poster board, glue sticks or white, non-toxic school glue, and scissors if appropriate.
After everyone finishes creating the collages, let each present their pictures to the group. Have each participant talk about at least one image in his or her collage that represents “powerful” and one that was chosen to show “powerless.” Depending on how the discussion unfolds, participants may want to share their own experiences with bullies, including whether they have been the targets of bullying (powerless) or been a bully (powerful). Encourage further exploration of how one can be powerful when confronted with bullying and other aspects of powerful-powerless dynamics.
There are many, many variations to this activity; what is important is that you consider your group’s needs and adapt this activity to meet those needs. If you missed the two previous blogs on bullying, see Bullying 101 and What is Relational Bullying for more information; remember TLC has an excellent online course on bullying and cyber-bullying, too. Next up: More creative interventions to help children and adolescents address bullying.
Malchiodi, C. (2006). The art therapy sourcebook. New York: McGraw-Hill.
Safran, D., & Safran, E. (2008). Creative approaches to minimize the traumatic impact of bullying behavior. In C. Malchiodi (Ed.), Creative interventions with traumatized children (pp. 132-166). New York: Guilford Press.
According to the American Academy of Child and Adolescent Psychiatry, as many as half of all children are bullied at some time during their school years, and at least 10% are bullied on a regular basis. Most helping professionals know that bullying can include physical intimidation and verbal threats or gossip, including cyber-bullying via online social networks and e-mail.
You probably also know that children who are bullied experience tremendous suffering, anxiety or depression, may have cognitive problems that interfere with schoolwork, and may be challenged socially and developmentally. But have you ever considered the dynamics involved in bullying? Caelan Kuban, LMSW, Program Director and Certified Trainer for the National Institute for Trauma and Loss in Children, explains the role of not only the bully, but also the bully’s impact on the victim and the witness:
The Victim
Terror – scared for one’s safety/one’s life;
Powerlessness – unable to do or say anything to stop the current situation;
Hurt – physical and emotional hurts from being bullied physically/verbally;
Fear – never knowing if/when bullying is going to happen next;
Anger – anger at the bully, anger at self for not being able to do anything to stop it, at witnesses for not helping put a stop to the bullying behavior and anger at adults for not doing anything to stop the bullying behavior;
Revenge – wanting to “get back” at the person who bullied;
Victim Thinking – “I am the target of bullying, I am no good, Nobody likes me.”
The Witness
Terror – scared for the victim’s safety/life;
Powerlessness – “If I can’t protect others, how can I protect myself?”
Hurt – viewing physical and emotional abuse and sometimes becoming desensitized to hurtful behavior;
Guilt – “I should have stopped it.”
Survivor Grief – “I’m okay but he/she is not.”
Fear – “Is it going to happen again? Could it happen to me? If I help will I be an outcast too?”
Anger – mad that the victim “takes it”. Angry that the bully’s “bullies.”
Revenge – wanting to “get back” at the person who bullied;
Victim Thinking – “I could be next. I’m no good for not jumping in or stopping the bullying.”
The Bully
Terror – “I’m out of control, I even scare myself. If I can hurt someone else like this, I could hurt myself too.”
Powerlessness – “I can’t stop what I am doing.”
Hurt – physical hurts from bullying behaviors/violence;
Fear – “I have to stick up for myself – nobody else will.”
Anger – “I am angry at the victim for making me do it.”
Revenge – “I want to get back at my Dad for beating me but he’d kill me, instead I’ll take it out on this little kid.”
Victim Thinking – “I’ll always be a bully. I’m too stupid not to fight.”
In upcoming posts, you’ll read more about some strategies for addressing bullying with children and adolescents, including the dynamics of bully, victim, and witness. If you want to learn more about bullying and cyber-bullying, why not register for TLC’s excellent online course with Caelan Kuban? The Bullying and Cyber-bullying course provides the foundation for working with youth involved in bullying regardless of their place within the bullying circle – victim, perpetrator, or witness. Upon successful completion of assignments, tests and evaluation you can download a CE Certificate of Completion. This course provides 6 continuing education contact hours.
In a recent summary published in Cerebrum from the Dana Foundation, Regina Sullivan offers intriguing research data on how early negative experiences cause developmental changes in the brain, biochemistry, and psychosocial responses. Like many researchers in the area of child abuse and early intervention, she notes that there is wide agreement that providing nurturance, positive interactions, and experiences of safety have a long-lasting impact on children’s brain development.
When abuse goes undetected or is allowed to continue to impact children’s development, Sullivan cites that approximately 80 percent of abused individuals are diagnosed with a major psychiatric disorder by adolescence. Additionally, brain scans brains of individuals who have experienced abuse during childhood show abnormalities in areas of cognition and emotion. But something even more intriguing is also detectable in the brain function of children who are abused and maltreated. Changes in neurodevelopmental areas go even deeper than just brain function; abuse literally can change one’s genes.
Simply put, the influence by environmental and social factors on our genes is a field of study known as epigenetics. In brief, when an epigenetic change occurs, the biochemistry of how the gene is expressed is altered. In the case of child abuse, how gene expression is changed by abuse may tell us why many of the effects of child abuse do not appear until adolescence and why many maltreated individuals eventually become abusers themselves. Sullivan cites an intriguing study of the brains of individuals who committed suicide to underscore the profound influence of abuse and just how it may alter genetic expression. Of the individuals who committed suicide and who were the subjects of this particular study, some had been abused early in life and others had not. The brains of those who were abused showed significant genetic changes in the hippocampus function that could predispose them to life-long stress responses; those who were not abused, but had died from suicide, did not show similar changes. Individuals who died of natural causes also did not show changes to the hippocampus.
This finding may imply that abuse causes severe alterations in the hippocampus in those who have experienced abuse in childhood; these alteration are not found in others, even those individuals who may have conditions such as depression or anxiety that predispose them to suicide. And while these changes occur early in life, their presence may not be observed behaviorally until later in life, making early detection and intervention for abuse all that much more critical. Because of the nature of epigenetic changes, Sullivan speculates that these alterations may be present for at least two generations, a possible partial explanation for the intergenerational cycle of abuse that trauma specialists see in their work with abuse and domestic violence.
Despite the profound impact of child abuse, we know that we can counter the effects through early intervention and identification of maltreatment and provision of caregiving and conditions that provide positive social interaction and stimulation. As trauma specialists, it is undeniable that we face difficult challenges in our work with abused children and the impact of maltreatment over the lifespan. Fortunately, emerging research is continues to inform us on how to better meet these challenges on behalf of children and how to improve our efforts as trauma informed practitioners.
P. O. McGowan, A. Sasaki, A. C. D’Alessio, S. Dymov, B. Labonté, M. Szyf, G. Turecki, and M. J. Meaney, “Epigenetic Regulation of the Glucocorticoid Receptor in Human Brain Associates with Childhood Abuse. Nature Neuroscience 12, no. 3 (2009): 342–348.
Has someone ever rescued you? When I say ‘”rescue,” I don’t mean rescue in the sense of “save the day” or “self-sacrifice.” I mean rescue in the sense of changing, or even saving, a life. As trauma specialists, that is what we ultimately hope to achieve with the children we see. Our central goal and intention in trauma work is to engage in actions that redirect, repair, and restore children’s lives.
Most of us in helping professions probably experienced one or more life-changing events that altered the course of our lives for the better. It’s those people in our lives who affected us in deeply positive ways at critical moments are also those who profoundly impacted our worldview and set us on the life-long path to pay it forward to others. Emmanuel Jal is a very dramatic example of an individual whose life changed in an instant when someone liberated him from a world of violence, trauma, and war. Jal is now a renowned musician and a former child soldier; his life is a tale of redemption, but mostly it’s about salvation and a pivotal moment in his life when he was rescued by British aid worker, Emma McCune. Here is Jal’s story, as he tells it in his own words:
My Name is Emmanuel Jal, and I was born in war torn Sudan.
I do not know when I was born, but I believe I took my first breath of oxygen sometime in the early 80s.
My country has been at war for over a decade. I am from southern Sudan where the people are tall and beautiful with smooth skin similar in colour and texture to that of roasted beans.
At the age of seven I, along with thousands of other children was taken from Sudan to Ethiopia, to learn to read and write. Ethiopia at that time was like a city run by children; there were over 30,000 of us in total. During my time there, I learned 8 languages, but as time passed we learned that we had in fact been bought there to be trained as child soldiers. I escaped from the growing army when people started to lose their vision and started fighting one another. Our common enemy being our Sudanese people from the north. Unfortunately I did not reach home because a number of serious events occurred as we embarked on the long journey home.
I ended up in a town called Waat. It was here that I met aid worker Emma McCune. She rescued me, by disarming me and smuggling me into Kenya. Whilst in Kenya Emma put me into school and adopted me. Emma said, “OK, I’ll take you to school.” That’s what I’d been praying for. She smuggled me onto a flight to Nairobi. I hid among the bags and when we got to Nairobi it was difficult and strange — a different world. But I adjusted to it.
Unfortunately a year after I was rescued Emma was killed in a fatal car accident. After this tragedy things became increasingly difficult for me. I turned to music as a method of therapy and started singing in church. I discovered I had a talent for music at the age of 20. [ from Jal’s Facebook page]
If you have time, take a few minutes to watch a film of Jal’s 2009 talk for TED and listen to his tribute to Emma McCune:
My childhood was by no means as dramatic or crisis-oriented as that of Emmanuel Jal, but it had its challenges. My family life was stable, but it was not a childhood of privilege or without stress. I grew up one street over from public housing; if you have read the book Riding in Cars with Boys, you have read about the actual neighborhood in which I lived and struggles of those who grew up in that neighborhood. I was fortunate to have parents who did their best to help me feel safe. Luckily, I also encountered a number of individuals who recognized my potential at critical moments during my school-age years. One was sixth grade teacher Mr. Harrington who taught me to have a voice and the courage to express myself. Another was a high school teacher Mr. Granucci who saw in me the potential to go to college, something that rarely happened for most teenagers in my neighborhood. Mr. Granucci literally sprung me from high school detention hall [yes, I did time in detention] and convinced me I could tackle subjects like calculus and Latin. I bless Mr Harrington and Mr. Granucci for believing in me—by the end of high school, I graduated fifth in my class of over 500 students.
Emmanuel Jal was a child soldier, immersed in war and terror, but his story is not too different than some of stories we encounter with children we see who survive violent homes or neighborhoods on a daily basis, even in the US. But more importantly, we all have had to survive something in life and we all have been rescued, one way or another. So, who rescued you? You are here today because someone cared, even in some small way. And you may have made a commitment to help others because that someone made the same commitment to help you at a critical moment and ultimately changed your life. Just like Emma McCune did for Emmanuel Jal– and it made all the difference.
In a recent commentary “What Makes Sense?” in the June 2010 TLC Practitioner, Bill Steele remarks, “the full utilization of one’s capacity to learn is predicated upon being in an environment where one feels above all safe and valued.” He goes on to say that feeling safe includes the following: being connected to adults who believe in us and who take the time to become our mentors and guides; exposure to multiple opportunities to engage in meaningful activities; and experiencing environments that encourage our potential to learn and grow.
Feeling personally responsible for our homes, schools, neighborhoods, and communities and those who live in them is another important experience– one that fosters empathy. Not surprisingly, many children who are traumatized by abuse, neglect, loss, or separation from a parent feel disconnected from those around them and often lose their capacity for empathy or concern for both people and their environment. As Steele observes, dignity comes from learning to care about others and how one’s actions impact everyone – and everything – around us.
The capacity to develop empathy is thought to be innate and is commonly seen in children who grow up with strong attachment to an adult and in healthy, safe homes and neighborhoods. We see examples of empathic behavior early in a child’s life when he or she brings a toy or blanket to another child who is in distress or cries in response to the discomfort of another person. Not surprisingly, the environment in which one is raised makes a difference in whether or not empathy develops.
So how do we help children develop empathy and concern for others and for their environments? First, early intervention is key; as most helping professionals know, it is essential that young children have a secure attachment to another person and exposure to empathy from others. Young children who are abused or neglected are particularly vulnerable because in place of positive attachment, these individuals experience misery, abandonment, and punishment that create distrust for others and the environment. Understandably, they also rarely experience empathy.
As children get older, they also need experiences that teach them how to go beyond themselves and learn to care for and about others. In brief, anything that helps children learn to respond effectively to the emotions and circumstances of others can enhance and strengthen empathy. If you attended the opening session of the recent 5th Annual National Institute for Trauma and Loss in Children Assembly of Practitioners in July 2010, you learned at least one intervention to help begin the process of developing empathy with children. Participants were given small rubber ducks and asked to use some simple art materials [colored tissue paper, feathers, chenille stems, paper plates, scissors, and glue] to “create a safe place for your duck” [some photos of this intervention are included with this blog]. This is an activity I have used many times with children to not only explore what a safe environment is, but also to help them learn how to take care of someone needs outside their own.
Caretaking the rubber duck [or similar toy animal] is a way for a child to explore personal needs for safety, love, and respect and capitalizes on art therapy and play therapy as sensory methods to provide the child with an experience of empathy for another entity. For children who have experienced chronic trauma, it’s not enough to just talk about empathy; children must practice what empathy is through activities that teach self-care and care for others.
When children (and adults) lack empathy, the consequences are serious not only for the individual, but also for family, schools, neighborhoods, and communities. Children without the ability to feel empathy not only suffer isolation, frustration, and anger, they may be anti-social or become capable of violence, even murder. More often, they act without regard for the health, well-being, and feelings of peers, parents, siblings, and everyone they encounter. As helping professionals, we have the unique opportunity to help traumatized children replace worry with calm, fear with safety, and punishment with nurturing—and by doing so, introduce the experience of empathy and the sensory experience of just why helping others matters.
I have been working with Mark, an Army officer who has been diagnosed with posttraumatic stress disorder [PTSD], for almost six months now. In addition to medical intervention including medications for anxiety, Mark has been making good progress through a combination of somatic therapy, art therapy, mindfulness approaches, and stress reduction. However, Mark continued to have problems with language and cognition; in contrast, his ability to recognize the onset of stress reactions and reduce hyperarousal steadily improved. My concern led Mark and I to sit down with his doctor at our local clinic and revisit his symptoms and injuries sustained from his tour of duty in Iraq. After a number of tests, his doctor concluded that Mark had an undiagnosed mild traumatic brain injury [TBI], possibly due from a jolt to his head as a result of a bomb blast a week before his return to the US. In fact, Mark did not recall an injury since he had no visible head injury and only recently remembered that there he had been a block away from the bomb blast that likely caused some post-traumatic amnesia and a mild TBI.
We are now adjusting Mark’s psychosocial program to address TBI, in addition to PTSD and anxiety. For Mark, just having been identified has relieved the stress of his symptoms and his treatment can be redirected to focus on returning his cognitive functions to normalcy through rehabilitative efforts, including art therapy, occupational therapy, and other methods. Fortunately, much of the sensory intervention involved in treating his PTSD and anxiety issues were helpful in addressing TBI. Mark is lucky in that he is already in recovery from his TBI and is expected to have no long-term affects from his head injury;
As trauma specialists and mental health professionals, we generally focus on psychological symptoms our clients present and particularly stress reactions and posttraumatic stress in particular. However, when working with survivors of traumatic events who may have been exposed to head injuries, I learned from Mark that I have to take a broader perspective on what may be causing distressful reactions and lack of progress. We now know that returning military are not only susceptible to PTSD, but also TBI, a condition that often goes undiagnosed for days, weeks, or months.
A TBI is most often defined as a blow or shock to the head or a penetratinghead injury that disrupts the function of the brain. TBI has been named one of war’s “signature wounds;” it can be caused by shock waves from bombs, a hit to the head, or a jolt that affects the brain. There may be no visible scars, but lasting cognitive and physical harm may be extensive. In contrast to a missing limb or spinal injury, TBIs are not visible, but still of great concern in the overall treatment of trauma to mind and body. Here are some facts about TBI:
Not all blows to the head result in a TBI;
Concussions are a type of TBI and are also known as closed head injuries.
TBIs can be mild, moderate, or severe, depending on the impact on consciousness and duration of amnesia or other symptoms, post-trauma;
TBI symptoms may occur immediately after an event or may appear days or weeks after an injury;
TBIs may affect thinking, sensing, motor skills, and emotions; their psychosocial impact can appear similar to emotional disorders such as PTSD;
In military, blast injuries are a significant cause of TBIs.
Hundreds of thousands of service members are believed to have suffered TBIs during their service in Afghanistan and Iraq, and many go undiagnosed, suffering the “invisible wounds” of war without explanation. The military is currently addressing TBI and the Pentagon recently opened a new 72,000 square foot facility for TBI research. The intent is to keep a comprehensive database that will follow US troops from the war zone through post-deployment, recording all personnel who are exposed to bomb blasts or similar trauma. Ideally, these individuals will be continuously monitored for developing symptoms weeks and months after exposure to injury.
As with PTSD, returning military with TBIs may have personality changes that impact family members, including their children. Imagine the stress a spouse and children experience when a husband, wife, “daddy” or “mommy” comes home with invisible scars that have altered behavior and interpersonal actions. According to my client Mark, his family might have been able adapt to broken leg or back injury more easily than to his personality changes. He feels fortunate that he and his family are getting the help they need in terms of his TBI and posttraumatic stress; he believes that his children are doing better than others under similar circumstances because they are receiving support and counseling at their schools and that he has benefited from medical and psychosocial care.
Finally, while the focus of this article is on TBI in returning military, let’s not forget that we may see undiagnosed brain injury in anyone, including children. Child and adolescent athletes often sustain a blow to the head, but may not be evaluated for TBI; meanwhile, these youngsters may show signs of cognitive and emotional problems for days and weeks after an incident. Their symptoms, too, may be identified as psychological when, in fact, an undiagnosed head injury is the main cause of behavioral changes and cognitive challenges.
There are a large number of great websites on the topic of TBI and the military; here is a short list of resources to get you started:
Traumatic Brain Injury in Theater: When Blasts Damage the Brain. This website provides a visual overview of various head injuries sustained in battle.
Making Art After Trauma. Listen to a short podcast, see a slide shows, and read about art and art therapy in the recovery process of Bret Hart, with commentary from Dr. Kathleen Bell.
And remember on July 13th, 2010, National Institute for Trauma and Loss in Children will welcome military personnel and their families to the Annual TLC Practitioners’ Assembly at Macomb ISD Education Center, Clinton Township, Michigan. For more information, click here. We hope to see you there!
What do Sesame Street’s Elmo and friends have to do with military children and their families? It all about learning how to “talk, listen, and connect” with family members when dad or mom return home from deployment.
Sesame Street’s “Talk, Listen, Connect: Deployments, Homecomings, Changes” is a DVD series that was launched in 2008 by the Sesame Street Workshop and was designed for military families with young children. It came about in response to the challenges of multiple deployments, homecomings, and changes to family relationships as a result of injuries post-tour of duty. It is also in recognition of the selfless service of the US Armed Forces—Army, Navy, Marines, Air Force, Coast Guard, National Guard, and Reserves. “Talk, Listen, Connect” has helped countless military families to learn how to communicate more effectively with each other with greater understanding, sensitivity, and clarity, strengthening parent-child bonds and attachment.
In true Sesame Street style, these DVDs introduce children and families to the important challenges of reintegration and multiple deployments through the characters familiar to everyone. In one segment, Elmo’s dad has just returned home and Dad, Mom, and Elmo have to readjust to family life after their reunion; as a family, they have to reconfigure their roles as parents and child now that dad is back. In another segment, the viewer also meets Rosita whose father has been injured in the war and now is in a wheelchair. Rosita is understandably anxious, afraid, and confused by the changes in her father and the family’s life and does not want to talk to her mom and dad initially because, like many children, she thinks she might upset her parents. However she eventually learns that there are new ways to be with her father and that she can even play ball and dance with her dad despite his injuries. Overall, the DVDs also instill a sense of pride, honor, and resilience, underscoring both challenges and triumphs. To learn a little more about this program, please take a couple of minutes to watch this short film:
For those readers not yet familiar with the consequences of the current conflicts, over 12,000 children of military have lost a parent since the start of the Iraq and Afghanistan wars over eight years ago. In response, the Department of Defense has again partnered with Sesame Street to produce another military-themed episode called “When Families Grieve.” This particular installment addresses death and loss and how children experience grief when a parent in the military does not return home again. Sesame Street intends to make available approximately 800,000 new resource kits to military families to provide hope and reassurance that they need during the difficult experience of a death of a father or mother. You can find out more information about this latest project at the Sesame Street Workshop website.
And have you made plans to attend the National Institute for Trauma and Loss in Children 2010 Summer Practitioner Assembly? The first day of the conference [July 13th] is dedicated to how practitioners can help military children via a renowned panel of experts on families, US armed services, and reintegration, homecomings, and multiple deployments. The panel includes Retired Brigadier General Don Scott and Betty Scott, Retired Major Margaret Dellio Storey, and other notable experts on military issues and children and families. The remainder of the conference features special sessions focusing on children of the military as well as workshops and courses on intervention with children who have experienced violent trauma, disaster, domestic violence, abuse, deaths, or loss. You will also receive a free copy of Sesame Street’s “Talk, Listen, Connect: Deployments, Homecomings, Changes.” And military personnel and families are invited to attend the July 13th presentation free of charge.
So consider taking advantage of this unique opportunity! If you are in the military, you and your family can connect with other families and share your expertise and wisdom with practitioners in attendance. If you are a practitioner, you’ll be enhancing your trauma intervention skills via the National Institute for Trauma and Loss Certification courses; you can attend Level 1 and Level 2 courses in addition to other workshops on non-military trauma and loss subjects during the four-day conference. We look forward to seeing you there!
Most professionals who work with family violence or child protective services know that April is Child Abuse Prevention Month. While identification and intervention for child maltreatment has improved, an average of one million children are identified as being abused each year.
Physical and sexual assault often first come to mind when we hear of the term child abuse. However, emotional abuse is also part of the overall spectrum of child maltreatment and occurs concurrently with physical or sexual abuse. According to the American Humane Association [AHA], emotional abuse [also called psychological maltreatment] is a pattern of behavior by parents or caregivers that can seriously interfere in a child’s cognitive, emotional, psychological or social development. It is not an isolated or singular incident between parent and child, but a series of interactions that “erode and corrode” psychological well-being [Garbarino & Gabarino, 1994]. Types of emotional abuse [summarized from AHA guidelines] include:
Ignoring. Parent or caregiver is not present physically or psychologically to respond to the child. For example, a parent may not call the child by name or may be unresponsive to the child’s cries for assistance.
Rejecting. Parent or caregiver actively declines to respond to a child’s needs, including refusing to touch the child.
Isolating. Parent or caregiver consistently prevents the child from having normal social interactions with peers, family members and adults, confines the child, or limits physical movement.
Exploiting or corrupting. Parent or caregiver forces or coerces the child to participate in stealing, prostitution, or other illegal activities.
Verbally assaulting. Parent or caregiver belittles, shames, or threatens the child.
Terrorizing. Parent or caregiver bullies the child, reinforcing an environment of fear. For example, the parent may threaten danger or harm to the child’s pet or sibling if the child does not act or behave in a certain way.
Neglecting. Parent or caretaker does not provide access to education or to treatment for medical or psychological problems, among other necessities.
Unlike physical abuse that may leave visible scars, broken bones, or bruises, emotional abuse is often a “hidden hurt.” However, it is just as serious as battering or assault and is thought by some to be more predictive of developmental delays than severe physical abuse [Glaser, 2002]. We already know thatinfants who are deprived of emotional contact may become anxious children with delayed motor and cognitive abilities, may fail to thrive, or may even die from lack of appropriate human touch. When asked “which hurts more, being hit or being told you are bad,” you might be surprised that many children will say, “being told I am bad hurts more than being hit.” While physical abuse is traumatizing, children who are emotionally rejected, isolated, or terrorized feel verbal assault is worse than being beaten. A broken bone is undeniably serious, but a broken heart silently and painfully robs a child of his or her life.
While emotional abuse is difficult to detect, children affected by it do exhibit noticeable trauma reactions. Some of the signs and manifestations include destructive behavior [fire setting or animal cruelty], poor self-esteem, insecurity and anxiety, developmental delays, drug abuse, emotional withdrawal, inability to form relationships, and even suicidal thoughts. In brief, psychologically maltreated children grow up believing they are deficient and defective in some way. It is easy to understand that without intervention, these children eventually may become parents who continue the cycle of emotional abuse with their own children years later.
So what can we do to reduce the incidence of emotional abuse and its impact on children? Identifying that a child has suffered emotional maltreatment is the first step in intervention. As helping professionals, we can do this by asking appropriate questions about a family’s history and current behaviors, assessing parent-child interactions, and evaluating deficits, challenges, and resources within the family system. Most importantly, early trauma-informed intervention is key to the reduction of the affects of psychological maltreatment on children. This not only includes intensive resilience-building with a child at risk, but also addressing parents and caretakers who may need to learn relevant parenting skills and may require help in overcoming their own emotional abuse experienced during childhood.
For more information from the AHA, go to their webpage. For actual interventions and resource materials, please visit the National Institute for Trauma and Loss in Children Bookstore; Handbook of Trauma Interventions: Zero to Three, A Time for Resilience, and Raising Resilient Children in a Traumatic World are a few of the helpful resources you will find on that site.
Be well,
Cathy Malchiodi, PhD, LPCC, LPAT
References
Garbarino, J., & Garbarino, A. (1994). Emotional maltreatment of children. Chicago: National Committee to Prevent Child Abuse.
Glaser, D. (2002, June). Emotional abuse and neglect (psychological maltreatment): A conceptual framework. Child Abuse & Neglect, 26, 697-714.
A 5th revised edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) will be published in 2013. If you are a mental health professional who has used the current DSM-IV in your work, you may remember that the previous document was introduced in 1994, approximately 16 years ago. Since that time we have witnessed tremendous changes in how emotional disorders are viewed and evaluated. Everything from brain imaging technology, advancements in the understanding of genetic and environmental influences, and how data are collected and analyzed have increased our knowledge of psychiatric conditions, including those disorders resulting from traumatic events during the lifespan.
While there are many ongoing discussions about proposed revisions, there are two discussions in particular that are relevant to our work with traumatized children. The first is the proposed section involving posttraumatic stress disorder (PTSD) in preschool age children; the second is the debate about the proposed section on developmental trauma disorder (DTD).
Posttraumatic Stress Disorder in Preschool Children
Research tells us that the younger a child is at the time of the trauma, the more likely he or she is to develop PTSD. According to the latest information, 39% of preschoolers develop PTSD in response to trauma, while 33% of middle school children and 27% of teens do. Young children (ages 1 to 6 years) react with helplessness and passivity; generalized fear; heightened arousal; cognitive confusion; nightmares and sleep disturbances; anxieties about death; somatic symptoms; freeze responses; and “fussiness,” crying, or neediness. Understandably, these youngsters often have little comprehension of traumatic events because of age and other influences.
With regard to this proposed revision to the DSM, the intention is to create guidelines for identification of PTSD in young children inclusive of developmentally appropriate factors. While the criteria will be familiar to most helping professionals, there is still some disagreement about several items. Two symptoms still under discussion include: 1) negative alterations in cognitions and mood as evidenced by increased negative emotional states in young children exposed to trauma; and 2) reckless or self-destructive behavior. Those of you who work with young children may see these reactions manifest through children’s sensory responses such as play activities in contrast to older children who may express these reactions in other ways. In addition, there is some debate about whether or not children who are exposed to traumatic events that have occurred to close relative or close friend should be included in this category.
Recommendations for severity criteria for this disorder are forthcoming; you can check the APA website for updates here.
Developmental Trauma Disorder
Well-known trauma expert Bessel van der Kolk and colleagues propose Developmental Trauma Disorder (DTD) as a new DSM category intended to identify children who have a history of complex trauma. In brief, this category addresses the differences in the expression of PTSD in children, particularly those who have experienced a series of traumatic events throughout their lifespan. Like many trauma specialists who work with children with complex trauma histories including abuse and neglect, I was particularly excited about the possible inclusion of this category to help identify and address the unique constellation of symptoms in chronically traumatized young people.
As it turns out, this category has been controversial and is not currently included in the final revisions. A recent article by Mary Sikes Wylie called “The Long Shadow of Trauma” by Mary Sikes Wylie (March/April 2010 Psychotherapy Networker), provides some insight as to why this category ended up on the “cutting room floor.” While DTD broadened the symptom range of children with PTSD-like reactions, epidemiologists and researchers generally revise the DSM, not clinicians who actually encounter clients face-to-face. Thus, revisions are based on data gathered through rating instruments, population studies, and other quantitative measures and less on clinical reports or qualitative studies. Others argue, including van der Kolk, that a category such as DTD challenges the structure of traditional research, funding initiatives, and accepted rating scales. In essence, DTD demands that we look at the children we see in treatment as individuals with needs best addressed by a combination of approaches not currently promoted by the status quo in the trauma field. These approaches include mind-body, somatic, sensorimotor, art therapy and other expressive arts therapies, play therapy, and neurofeedback, among others—approaches that promote the integration of mind and body. Bessel van der Kolk’s Trauma Center utilizes a number of these methods, implementing a blend of psychology, integrative approaches, and neuroscience as well as accepted evidence on how the body responds to repeated chronic trauma.
If you would like to read more about the DSM-V and send comments about these two categories and other proposed revisions, you can access the DSM-V website at: http://ow.ly/1oqfI.
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