The Journey to Wholeness: Helping Children Heal Preverbal Loss and Trauma

Transcription

1 The Journey to Wholeness: Helping Children Heal Preverbal Loss and Trauma Debra Wesselmann, MS, LIMHP The Attachment & Trauma Center of Nebraska

2 Over the Past 15 Years Three-quarters of a million children have been adopted from the U.S. foster care system. One-quarter of a million children have been adopted from institutions overseas.

3 Over the Past 15 Years Adoptive families utilize clinical services at two to five times the rate of biological families, and parents are four to seven times more likely to seek residential care for adopted children. Evan B. Donaldson Adoption Institute (October 2010) Keeping the Promise: The Critical Need for Post-Adoption Services to Enable Children and Families to Succeed.

4 Neural Development in Infancy and Early Childhood Left brain is not on-line. (Left brain unable to modulate right brain emotions.) (Alan Schore) Child s brain is mostly functioning in limbic and lower cortical areas, nonverbal processing. Prefrontal brain is still developing (Unable to modulate emotions from top down.)

5 Neural Development in Infancy and Early Childhood Amygdala pretty well-formed at birth (reacting to perceived threat with cortisol). Cortex and hippocampus are still developing (Unable to properly interpret and manage danger).

6 Early Development of Self-Regulation Self-reflective capacity and emotional regulation dependent upon coregulation. Developing ability to communicate and interpret vocalizations and facial expressions through the attachment relationship. Developing systems of meaning about others, self, and the world, through attachment experiences.

7 Infants Have Heightened Vulnerability to Losses and Fear Insufficient brain processes for managing fear Dependence upon attachment figures for selfregulation Changes/losses of parent figures, other adverse experiences, leave infant with overwhelming anxiety. The internal emotions and sensations as well as the external stimuli become associated with danger.

8 When There Are No Words Implicit memory bypasses language and involves procedures and internal states that are automatic. Infants and young children can feel emotions, but cannot place them in context. No narrative.

9 Over Time Prolonged state of anxiety from early caregiver changes, medical procedures, orphanage care, or other traumas leaves the brain flooded with stress hormones. High cortisol and adrenaline over time causes a sensitization in the part of the brain associated with the stress response.

10 Repeated Preverbal Anxiety/Fear Leaves the brain wired for survival. Poor communiction between the emotional right brain and the logical left, and between the upper cortex and the lower regions controlling physiology. The poorly integrated brain leaves the child with emotion-focused coping.

11 May Lead to an inundation of emotions, vivid sensations, and behavior impulses. internal experiences disconnected from context, understanding, and explicit memory.

12 May Lead to Dissociation Behavioral dysregulation Attempts to lower anxiety by controlling the environment Other primitive coping mechanisms selfregulation through rocking, picking, eating, masturbating, tantrumming, etc.

13 Integrated Vs. Poor Brain Integration Problem-focused Coping I feel it. I think about what I am feeling. I solve whatever the problem is -- or I talk about it, or I ride out the feeling and trust it won t last forever. Emotion-focused Coping I feel it. I automatically get rid of the feeling any way I can, as fast as I can.

14 When Development Goes Off-Course Natural developmental task of exploration-- learning new information, learning about self others, and the world, developing relationships and social skills are sacrificed in service of hypervigilance and more primitive survival and coping strategies. (Bessel van der Kolk: proposed Developmental Trauma Disorder diagnosis)

15 Children with Early Trauma or Loss May Present with Any or All of the Following Externalized Behaviors Aggression Meltdowns Lack of trust Need to be in control Defiance Lying, stealing Sexualized behaviors Food & bathroom issues

16 They May Experience Anxiety Depression Trouble concentrating or problem-solving Difficulty delaying gratification Panic attacks Compulsions Obsessions Thoughts of self-harm

17 Understanding the Child s Behaviors Overall: The anger, aggressions, and many of the challenging behaviors help the child avoid underlying, vulnerable feelings of loss, hurt, sadness, and fear.

18 Keys to Healing

19 Mindfulness (for Child, Parent, and Therapist!)

20 Identify the Beliefs Driving the Behaviors For Example. I can t trust moms or dads. It s not safe to be close. People leave or hurt you. I have to be in charge of getting my needs met. I am not good enough. My feelings are too much. I am not safe.

21 Identify the Source of the Negative Beliefs Losses Changes in caregivers Early pain or medical trauma Orphanage or foster care Chaotic or unpredictable environment Frightening events Painful events

22 Mindfulness Thinking about thinking Thinking about emotions Thinking about sensations Thinking through actions and reactions

23 Self-Regulation Through the Body Self-calming through belly-breath. (Place a toy on the belly and watch it move up and down.) Self-calming through the cooked noodle exercise. (Practice holding body stiff like an uncooked spaghetti noodle, and then limp and relaxed like a cooked noodle.)

24 Mindfulness with Emotions Teach the child: Feelings come and feelings go. Everybody has feelings. Feelings are normal. These feelings will pass. You can ride it out. You can have these feelings and be okay. You don t have to act on your feeling.

25 High Alert/Low Alert Help the child identify when he has been on high alert. Help him identify how it feels in his body. Help the child identify when he has been on low alert. Help him identify how it feels in his body. Work out a plan to help the child stay on low alert.

26 Detective work removes judgment and shame, while increasing insight and giving the therapist something to work with. Detective Work

27 Explain the Domino Effect Utilize dominoes to demonstrate. Triggers, feelings, thoughts, sensations are all dominoes. One knocks over the next very quickly, leading to big behaviors.

28 Put on Your Detective Hats Together After a problem behavior, take a matter-of-fact approach by putting on your detective hats together to uncover the trigger, the thoughts, and the feelings that led up to the problem.

29 Implementing the Domino Effect Concept Use the dry erase board or paper to write out each domino. The vulnerability domino The initial trigger The big feelings The upset thoughts The actions The sensations

30 Where Could You Have Pulled a Domino? Where could you have talked to your brain? Could you have talked to the littler child inside? Could you have used belly breath? Could you have asked for help? Could you have asked permission? Mom and Dad, where might you have pulled a domino?

31 Parents Have Their Own Dominoes! Parents triggers, negative beliefs, emotions, sensations, and actions intertwine with the child s dominoes!

32 Brain Talk

33 Talk to Your Brain Teach the child, The big feelings create lightening bolts in your brain! (Ana Gomez, 2010). Your thinking brain can calm the lightening bolts! You can use your thinking brain to help you ride out the feelings until they calm.

34 Talk to Your Brain Teach the child to self-reflect: Who was in charge just then? Was it your feeling brain or thinking brain? What were the upset thoughts? (For example, Moms are mean. I can t trust anyone. I am not safe. ) Is that really true today? What can your smart-thinking brain tell your feeling brain about this? ( I am safe, everything is okay. )

35 Talk to Your Brain (Self-Talk) Talk to your brain. Tell your brain your mom loves you. Talk to your brain. Tell your brain everything is okay. Tell your brain it s time to calm down.

36 Strengthen the Most Grown-up Part of Self Teach the child to identify when he feels big vs. little. How does it feel inside? Teach the child to find his bigger self. ( Think about what you do when you are in your bigger self. ) Notice your feet on the floor. How high can you reach right now? How old are you right now?

37 Inner Child Work With Children We all carry our littler selves with us inside our hearts.

38 The Cycle of Trust Teach the child what babies need What did you need when you were a baby? Do you think you got what you needed?

39 Teach the Child to Talk to the Littler Child Inside What does the littler girl inside your heart think/feel about that? What does that littler boy inside your heart need to understand? I have the littler you on my lap right now. What can you tell him? Mom, what do you want to say to the little one?

40 Developing the Child s Story

41 Don t Avoid the Hard Topics Develop the Child s Story You can t change the child s negative beliefs without addressing the source. Individuals with an earned secure attachment can talk about their early difficult circumstances without becoming disorganized or overwhelmed. Helps organize the disorganized brain Helps access the preverbal trauma so you can work with it

42 Making Sense of the Past Attune to the smaller child within Develop a narrative Help child process the feelings and providing corrective information related to the early traumas and losses Teach skills for present-day coping

43 Healing Implicit Memory Implicit memory operates unconsciously, unless it is made conscious through a bridging to explicit memory that narrates or makes sense of the remembered emotion, sensation, etc.

44 Begin Developing the Child s Story Begin with a simple timeline Gradually add more detail Provide corrective information Go back and note early beliefs at the appropriate places on the timeline. Note in present-day what the child is now coming to understand.

45 Healing the Hard Parts Create a container for the child to use between sessions. Encourage emotional release, while providing regulation through mindfulness and attunement. Therapist and parents together supply emotional support, compassion, and understanding.

46 Narrative Work Provide new, corrective information. Empower the child through sand trays, roleplays, and drawings. You have permission to change this picture any way you wish!

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49 Processing Grief Permission from parents and attunement and empathy are crucial for releasing grief. The most important words the therapist and parent can say: I am so sorry

50 Therapeutic Tools Trauma-focused DBT Play Therapy, Sand Tray, Art Theraplay Narrative Work EMDR (Eye Movement Desensitization and Reprocessing)

51 EMDR Reaches into the limbic brain Helps regulate the brainstem Processes emotionally and somatically We don t have to have pictures and words--we don t have to KNOW everything. Requires special adaptations for children with complex trauma

52 Change the Beliefs! I am not safe. I am not good enough. It s not safe to trust. It s not safe to be close. I have to be in charge of getting my own needs met. I am safe now. I am loved and lovable. I can trust my parents. I want to be close and it s safe. I can depend on my parents to care for me.

53 Integrative Parenting

54 Integrative Parenting Approaches Attune to the vulnerable feelings beneath the child s anger helps integrate the child s right and left hemispheres. (Dan Siegel: Connect, then redirect. ) Daily physical touch and affirmations. Focus on calming and regulating the child, vs. discipline. Build the child s trust.

55 Integrative Parenting Consequences Calming Pre-teaching Empathy Attunement Nurturing

56 Emotion-Driven Parenting Attunement Lecturing Scolding Punishing