Читать книгу Healing Traumatized Children - Faye L. Hall - Страница 11
ОглавлениеThe Trauma Lens Paradigm Shift The Trauma Lens Paradigm Shift
I tried to keep Allan close by so that I could keep him safe. But he would slip away. One day he came into the house after playing outside. My sister and I were visiting together in the living room. Allan could not stand still while talking to us. He kept shaking his leg. My sister, a nurse, was always concerned about Allan’s health. As she investigated his ailment, a live bird fell out of his pants. He gathered up the bird and freed it outside. His grandfather witnessed a similar incident wherein Allan hid baby rabbits he’d captured in the field.
My quest for answers continued. I searched through training documents given to us when applying for the foster care license. With six hours of training, they should have covered noncompliant behaviors. I found nothing. I searched through stacks of files the agencies provided about Allan’s early years: court documents, foster care placement reports, psychological evaluations and school reports. Hours of reading provided detailed information about Allan’s abuse, neglect, abandonment and his multiple diagnoses. A new world emerged for me with unfamiliar mental health terms and diagnoses.
As I read more, Allan’s behaviors started making sense. His trapping skills were learned from a dad who earned extra money from trapping alligators to sell and trade. He learned to hide from the police when the authorities were attempting to arrest his father for his drug use and dealing. His chaotic lifestyle did not lend itself to good hygiene or healthy meals. He learned to scavenge through the neighborhood for food. He did not live with his mother, making “mom” experiences unfamiliar.
I could now make more sense of Allan’s strange behavior—why he was responding to me so differently from my biological children. But my search for new parenting skills was futile. The problem was that this was 1994 and no resources existed. I was determined nevertheless to find answers on how to parent this child.
The following year, while searching through the vast number of books at the largest library in the area, I found a new book, The Discipline Book, by William Sears, MD, and Martha Sears, RN. It differentiated the “connected” from the “unconnected” child. Their description of the unconnected child sounded like Allan. I then called the director of the volunteer agency and asked whether they were teaching new parents to attach to their infants. How would you teach a parent to attach to a nine-year-old child? The director had no answers. Some may think that the answer is obvious—it should be just like the myriad of ways you attach to your birth children.
But my experience was different. The things I could do for my birth children seemed to make Allan’s behavior worse. Days flowed into weeks, weeks into months and nothing improved. The Downward Spiral continued. Allan began to sneak out of his bedroom at night and raid the kitchen for the foods he was allowed in limited quantity during the day. He would eat ice cream straight from the carton. I began to lose sleep, worried about his safety overnight. When we installed a motion detector at his bedroom door, he began to entertain himself by setting it off “by accident.”
Finally, while Christmas shopping in December of 1996, I found the greatest present I could have received. On a rack of sale books outside a store I found a book entitled Adopting the Hurt Child by Gregory Keck and Regina Kupecky. The authors gave a description of Reactive Attachment Disorder. There in the cold of December, I couldn’t stop reading the book. Our life started to make sense. The authors clearly understood children like Allan—here were some answers to my quest. I had no illusions that the road ahead would be easy. But now my despair was assuaged with hope.
—Faye Hall
Predicting treatment success begins by assessing two factors: the family’s engagement in treatment and their faith in the treatment professionals. Our new model offers a third factor: Treatment success for children with a history of early trauma and attachment disruptions rests on the parent’s paradigm shift of viewing the child and his or her disruptive behaviors through the “trauma lens” and accepting and using a different parenting model.
Imagine the impact of parents and professionals educated in trauma, child development and attachment before the child is placed in the home. Parental expectations will be aligned with the child’s capacity for healthy relationships. The parents and professionals will be equipped with effective interventions to support restructuring internal belief systems, emotional maturation and opportunities for attachment. Parents will have support and encouragement from trained professionals. The child will be encompassed by treatment consistency while developing relationships that heal. Treatment will be difficult but energized with new hope.
Even after a child is placed in the home and the family is coping with disruptive behaviors, hope is not lost. An educated treatment team can help the family repair damaged relationships and spur new connections through trauma psychoeducation and healing interventions. It may take more time, but these parents will truly understand that trauma impairs a child’s development, decision-making skills and the ability to form healthy and reciprocal relationships. Underlying parental issues, attitudes and personal characteristics may prevent the paradigm shift, thus hindering success. When these barriers are identified and addressed, they can be diminished, if not fully removed, by the parents and the treatment team.
FLAWED ELEMENTS OF FAMILIAR PARENTING STYLES
1. All Human Beings with Problems Respond to Behavioral Interventions.
The current therapeutic culture strongly emphasizes behaviorism and assumes that human beings can universally learn via rewards and consequences. If one rewards good behavior, good behavior will ensue and continue. If one “consequences” poor behavior, the poor behavior will stop. If the modification plan fails, then one assumes the reward was not good enough or the consequence not severe enough. An underlying principle is that all behavior is a choice. Behavioral approaches foster the delusion that parents can address every problematic behavior effectively. They also assume that early trauma does not impede the child’s ability to choose good behavior. Finally, behavioral environments are often overly structured, with little time and energy for nurturing relationships.
Brandon’s Family
Bob decided to start summer vacation with a new behavior chart he had created for the emotional support classroom in which students could earn token rewards for each good behavior. Brandon liked playing with building toys, so Bob thought he would be motivated to earn a new set each week for completed chores. Bob proudly hung the chart on the refrigerator. Brandon was excited to earn the fireman set and the first week went well: Brandon got the set. Yet he struggled completing his chores the following week. He was very disappointed that he did not earn another set, but promised he would try harder. By Tuesday of the third week, Brandon was angry and defiant. He declared that Bob gave too many chores. He stopped playing with the building sets and became more interested in physical activities.
Brandon had developed a negative internal working model (N-IWM) from his early trauma. He could transfer his belief system to the external world through the “miracle” of disobedience and have this belief system reinforced through consequences administered as part of the treatment plan. Poor behavior would be identified as “bad,” “evil” and “mean.” A N-IWM causes an inability to effectively make decisions in a positive environment. The child feels a sense of “wrongness” when behaving in the expected way, as it runs counter to the N-IWM. Therefore, this inability to make positive decisions is essentially a “hurt part,” an injury that needs to heal like a broken leg would need to heal before a child can run again. Behavioral approaches assume that the child does not have this “hurt part,” but is instead capable of making good decisions (that is, that the child has a positive internal working model [P-IWM]).
Even after Brandon lost the reward, he preferred to believe, as Bob did, that he had “made the choice” to lose. Instead, the trauma-informed understanding is that Brandon is currently too weak for now to tolerate the fear that comes with success and the challenging of his N-IWM. Most children with early trauma damage will feel more comfortable with the interpretation that they chose the behavior (“I am bad,” instead of “I am too weak to do right.”) The negative consequence feels better to the child (accurately aligns with the child’s belief about self and adults) than the assumption that he or she is weak. But in reality, this child is no more able to make positive choices than a child with a broken leg is able to walk. By trying to implement a strictly behavioral approach, parents fail to account for the trauma damage—namely, the resulting negative internal working model (N-IWM) that will inevitably sabotage the behavior modification plan.
2. Parents Are Capable.
To begin the foster and adoptive process, parents must attend classes, be assessed and be found competent to parent a child. Responding to reference requests, friends and colleagues vouch for their moral integrity and social competence. Their home is inspected and other children in the home are questioned. Successful completion of the evaluation process and granting of the adoption or foster care license convinces parents that they are capable of parenting any child brought their way. Their flourishing birth children further persuade them that “We can do this!”
Corey’s Family
Rebecca felt so confident when Corey arrived. He took his toiletries basket to his room and politely asked about dinner time: “I want to make sure I wash up before we eat,” he said. Rebecca was sure that he was a good fit for their family. He reminded her of her son Andy. A few weeks went by before she noticed food missing from the kitchen. Rebecca searched Corey’s room while he was outside playing. To her dismay she found food and wrappers hidden all over his room. That evening, Danny and Rebecca explained to Corey that he was not allowed to take food without asking. He promised he would never do that again. Unfortunately, the next night Andy’s friend was coming for dinner and Rebecca could not find the dessert she’d made. Rebecca began to question their decision to adopt.
During the integration process, most parents use their familiar parenting skills. It is not until problem behaviors escalate that parents begin to question why their child’s behavior is not improving. Rebecca calmly and clearly outlined for Corey why the behaviors were wrong or not needed. She checked his understanding by having him repeat her explanation, just as parenting classes advise. She provided him with suggestions for alternate behaviors and obtained from him a commitment to do things differently. After all, the parenting manual they had received provided the same techniques that they’d been applying successfully to their birth children. Their intuition told them that Corey really did understand and was contrite about the “oversights.”
But Corey continued to steal and stash food. Rebecca and Danny were faced with either needing to modify their perception of themselves or of Corey: either “I guess we are wrong. We are not good parents, just lucky that our birth children are all right,” or “We are good parents, but Corey is just bad.” And there it was, Corey’s N-IWM invading the here-and-now and infecting the parent-child relationship.
The parents’ belief of themselves as capable and good directly clashes with the child’s belief of the parents as incompetent and hurtful. Successful, capable parents like Danny and Rebecca can be comfortable (or at least less afraid) by interpreting the dilemma as “this child is bad.” They now must grieve the loss of their conviction that their parenting of their adoptive child would require not much more effort than that of their birth children and accept that they will have to put in long, hard work requiring constant attention and active learning.
Danny and Rebecca gained access to a new in-home service. They told the team about their flourishing birth children and how difficult it was to parent Corey. They said with a combination of sadness and frustration that unless this new service could “work magic,” other placement options might become necessary.
3. My Child’s Problems Are a Reflection on My Parenting Skills.
Once parents feel they are competent and have a “We can do this” attitude, the child’s persistent poor behavior may eventually begin to feel like a flaw in their basic parenting skills rather than the persisting aftermath of early trauma. Parents then routinely perceive others as judging them when their child misbehaves. Well-meaning friends, family and sometimes strangers just as routinely suggest that the parents should be more loving or more strict. Schools often reinforce this belief when the child is problematic. Eventually the parents begin to worry that the child’s misbehavior is reflecting badly on the extended family—grandparents, aunts and uncles.
Sally’s Family
Jane needed to have someone to talk to about Sally’s behaviors: someone to listen, have empathy for the problems she was experiencing, brainstorm solutions and validate her experience of the difficulty. Yet every time she called her sister, she regretted the call. Her sister would begin a tirade about how Jane had had no parenting experience and should never have adopted Sally. Her sister clearly interpreted Sally’s poor behavior as proof positive of Jane’s lack of parenting acumen. Jane could not turn to her parents for moral support—her mother considered worrying a virtuous badge of honor! Jane felt alone. Her sister, like so many others with no understanding of early trauma in children, fell back on the simplistic notion that good parents don’t have poorly behaving children.
Sally’s school staff eventually called Child Protective Services after Jane continued to insist that Sally complete her homework even if it took four or more hours per evening. This intervention instilled even deeper in Jane’s heart that she was an incompetent parent.
Parents see and hear blame from many sources. They feel directly accountable for the child’s misbehavior. They are the ones who must pay damages for property destroyed by their children. They are the ones who must pay truancy fines. So once again, the child’s N-IWM is reinforced rather than confronted and challenged. Eventually, more and more of the parents’ energy is dissipated in the service of defending against the perception that they are bad, that they are the problem. Almost inevitably and ironically, their constant efforts to “look good” are seen by others as proof of their inadequacy as parents. Jane had never imagined the scenario of forcing her daughter to sit at the table for over four hours in an evening to finish homework, but only inadequate parents have children who do not complete their homework!
4. All the Child Needs Is Love.
Parents desire to love a child and perceive that the child will respond to their love. They are convinced that enough love will enable the child to grow and flourish. After all, “All you need is love” and “Love conquers all” ooze abundantly out of our daily diet of songs, books and movies. Often agency workers convey that the child’s core problem is not having been loved enough in his birth home or in prior placements. This further bolsters the parents’ conviction that their bottomless spring of love will make the difference. Parents inflicted with unrelenting fertility problems and desperately wanting a child may be even more susceptible to this fallacy.
Amy’s Family
Lori was so happy to be a mom. She could not have loved Amy any more than she did. She was pleased to start her workday early so that she could transport her daughter to soccer practice in the evening. She worked overtime on Saturdays to pay for the expensive bike Amy wanted. If Amy needed a little “extra picking up after” from time to time, it was all worth it. After all, doing things for others demonstrates love via sacrifice. Surely, Amy will feel loved and will reciprocate. But then, why did Amy tantrum nightly and destroy property and threaten to hurt her mom? Eventually Lori had to halt all her outside interests. She spent all of her time and energy “filling Amy’s love tank.” She became exhausted, lonely and resentful. Lori began to feel like a failure. Her love was not healing Amy. Maybe Lori’s love was even making Amy worse! But thinking it not enough, Lori was determined to try to show more love to Amy every day.
Because there are books upon books written on ways to express our love, the belief that all our child needs is love will result in a burnt out, exhausted, emotionally bankrupt parent. With each new expression of love the parent strives to provide, the parent experiences rejection, failure and condemnation when the child’s behavior does not change. The impact of early trauma is present but unrecognized, rendering the child incapable of accurately understanding and feeling the loving actions. As parents repeatedly experience rejection, exhaustion and condemnation, the relationship begins the Downward Spiral, the end of which is that nobody is experiencing love in the relationship. Again, the child’s N-IWM is mirrored and reinforced.
5. The Child Will Be Filled with Gratitude.
It seems so logical that a child from a deprived environment will be thankful for a new home and family. We evaluate ourselves as parents and can realistically list all the positive opportunities and items that we can provide for a child. We naturally believe that the child will experience them as positive and be grateful to us for them.
Human communication and interaction undergird the principle of reciprocity. We give and receive. We expect to receive based on what we give. When we work hard, we should be paid well. When we provide good gifts, we should receive gratitude. But consider this analogy: Can you express gratitude to a serial killer who offers to take you to dinner? The N-IWM of traumatized children forces them to view their parents as scary and hurtful. Therefore, even when parents give them good things—like the serial killer springing for dinner—the children experience discomfort. Their N-IWM actually produces a fear reaction to the good things the parents are providing, seeing the kind gesture though a lens of suspicion and mistrust, resulting in some sort of wary, guarded response, if not an outright hostile one.
Amy’s Family
James and Lori knew that Amy had suffered years of deprivation. Their hearts ached when thinking about Amy’s missed experiences. They decided to “make up” for those years. At first it was a delight to be able to buy her all the most hip styles and brand-name clothes for which Amy expressed interest. Who could blame her for wanting so much after having so little? But Lori noticed over time that Amy’s “thank you’s” became fewer and more perfunctory. She did not take care of the clothing, tearing or staining items or giving them away on a whim. Lori became angry and reduced her spending on Amy. Amy resented this “deprivation” and, in screaming fits, also blamed Lori for her not fitting in at school.
James brought home a new toy for Amy every Friday. It would be a family thing, something they would remember later in life. Amy usually played with the toy briefly and then relegated it to the cavernous box of ignored toys. That is, if the toy were put away at all. Usually it was just left wherever it dropped. Lori always reminded Amy to thank her dad for the toy. Finally one evening Amy griped that she did not ask for the toys and they were not even the ones she wanted. She said she was just being nice by playing with them, so that Dad would not be angry with her.
The child driven by a N-IWM will commonly declare that his new bicycle is not the best bike on the market and find fatal flaws in it—“It’s not good enough to do the jumps. What a piece of crap!” The child will “fulfill the prophesy” by “accidentally” stripping bolts with excessive tightening and then complaining when the wheel falls off. Children from deprived environments may experience excessive stress at the effort it takes to manage possessions: cleaning, storing, organizing, choosing and matching. These children may express dissatisfaction or even condemnation of the parent’s purchases for them. Thus, parents experience an emotional slap when expecting a “thank you.” Constant repetition of this theme leaves parents fearful and avoidant of giving. So, once again the child’s N-IWM is reinforced in the current environment. Amy’s teacher complained to the therapy team that the parents did not have the proper school supplies. Lori and James responded, “We don’t feel like buying her anything. What’s the point? She doesn’t appreciate it anyway!”
6. The Family Assumes Negative Motivations and Intentions.
If parents are unsuccessful in changing the child’s behavior, they are vulnerable to assuming that the child has negative intentions or is incapable of doing right: “He does not like me. He is a totally bad kid. He just did that to get under my skin. He is just trying to make me mad.” Once parents assume negative motivations behind their children’s behaviors, all parental interactions will eventually be tainted by these beliefs. Children with a N-IWM naturally assume negative parenting motivations. And negative parenting motivations do not correspond with parents giving good things. Children become fearful when their external world does not match their internal world. So they act as if their parents are bad in order to match the N-IWM and harmonize their external and internal worlds.
Corey’s Family
Rebecca liked cooking for her family. She took pride in the quality of the food. Corey yelled at her for “trying to kill him with this slop” and spat out his first bites. Food was not an issue for him at school or at friends’ houses. Rebecca could never please him. He consistently disliked her cooking. She expressed her hurt and offered to cook any meal he wanted. Rebecca reported, “I cannot make this child happy. He doesn’t like me.” One day, Rebecca set food in front of Fred, her biological child, with a smile and pat on the back. When she gave Corey his food, she avoided eye contact and made no attempt to engage him. She was protecting herself from the anticipated rejection and thereby once again inadvertently reinforcing Corey’s N-IWM.
WHAT IS THE TRAUMA LENS PARADIGM SHIFT?
Shifting from the Familiar to the New Model, How the Elements Change
Now, let’s make the shift to a new paradigm, where the child and maladaptive behaviors are viewed through the trauma lens. We will adjust traditional elements of the parenting paradigm in making this shift. If we fail to make this shift, the traditional style will remain a barrier to effective parenting as well as to effective therapeutic interventions.
Old: All human problems respond to behavioral interventions.
New: Trauma damage must be healed before consistent behavior change can be expected.
Much behavior is driven by a perceived need to feel safe. Humans are more fundamentally motivated to be less afraid than to be happy. As we have seen, children with a N-IWM will behave in such fashion as to bring their belief system into their world. Strict behavioral approaches bring out the N-IWM in bold relief. They do not bring about favorable change, but they do clearly identify those behaviors in need of change.
Parents cannot always address every problematic behavior. Sometimes we as parents are powerless to promote positive behavior change in our children. It requires great emotional strength and support from others in order to simply be sad about our children’s misbehaviors—instead of becoming angry or demoralized—while waiting for the slow process of positive change to unfold.
Brandon’s Family
When Bob created the behavior chart, he understood how to “structure” Brandon toward greater success. He felt good about his ability to address each behavior to shape and mold his son into the man he could become. Brandon’s past was just something to be overcome. The problem was how to motivate him to make better choices.
Brandon knew he was different from other kids. They seemed to get more fun stuff and did not argue with adults like he did. He constantly had a feeling that something bad was about to happen. He was excited about the behavior modification chart and promptly earned the first reward. But something vague inside told him that bad things were coming. Bob kept talking about how successful Brandon could be as he grew up and kept accomplishing bigger and bigger tasks.
Brandon began to feel weak and scared of failing, sometimes becoming hopeless. He did not recognize that this feeling was identical to the fear he used to feel years ago as a tiny boy who could not keep himself safe. With each “success” Brandon then became more fearful. Accordingly, the fear would diminish substantially if Brandon stopped trying to meet expectations. Bob raised his voice when asking Brandon why he gave up on working for his next reward. Brandon could not recognize within himself nor articulate to Bob that he was fearful of being controlled with prizes and that he felt like a slave having to knuckle under in order to get scraps. Losing a reward comes easily to someone who already feels like a failure.
Brandon did not like feeling weak or like a slave. So he used his anger to be strong and in control again. So what if he didn’t earn the stupid reward that his untrustworthy dad might not give him anyway? It’s better to feel strong and in control without the reward, than weak and vulnerable while trying for success.
Unrestrained behaviorism, when applied to a child with a N-IWM, often leads to “consequences after consequences.” By midsummer the family was sacrificing game nights and outings, because Brandon needed consequences for raiding the freezer and eating all the ice cream. Bob saw this as Brandon choosing bad behavior. The family responded to him with blame and resentment. But Brandon already knew he was a “bad kid” and he knew how to handle shaming. Family life became organized around providing negative reinforcement (ignoring) or punishment for Brandon’s problematic behaviors. There was little time or energy left for nurturing relationships. But nurture needs to occur independently of poor behaviors. When the goal is healing the trauma damage, nurturing activities and connections remain the high priority even during episodes of poor behavior. The hurt must be healed before the child can effectively make good choices. The parental relationship is the “tool” for healing the trauma.
Training in trauma-informed parenting helped Bob and Deena to use the trauma lens to reframe Brandon’s behaviors. They could see that he had different “parts”—a healthy part that wanted to love his parents and a hurt part that was always afraid. They used some new tools that helped them to be sad rather than angry about his behaviors and reframe them as attempts to feel less afraid. They did not feel “perfect” as parents then, but felt great relief at discovering new ways to understand and engage Brandon.
As the parents changed in their approach, Brandon initially grew angry more easily than ever. He redoubled his efforts to provoke anger in Bob and Deena. Their expression of sadness for his hurt infuriated him. He insisted that he had no such part and was choosing to get the consequence, which—by the way—didn’t faze him at all. But his parents persisted in expressing sadness and their hope that he would “feel” the weakness. Each time he made a healthy choice, they celebrated the choice as evidence of his healing and predicted that good choices would become progressively easier for him. To Bob’s great surprise, one day Brandon commented that a consequence “sucked” and expressed pleasure that his hurt “baby part” was healing.
By highlighting the N-IWM with empathy and sadness for the child’s early trauma, parents can provide an alternate experience of self. Poor behavior previously understood by Brandon and his parents as “I am bad but strong” is viewed through the trauma lens as “I am a good kid with a hurt part.” While this paradigm is initially irritating to the child, it provides a framework for long-term growth. As stated before, it’s as though behavioral interventions expect the child with a broken leg to “choose” to run. With this paradigm shift, a child may initially fear acknowledging that he has a “broken leg.” But ultimately, with the focus on trauma damage and recovery from it, running eventually becomes possible.
Old: Parents are sufficiently capable to parent this child.
New: Even capable parents require additional training that addresses the child’s early trauma.
Parents can be perfectly capable of successfully parenting birth children and meeting adoptive or foster agencies’ parenting requirements. They can have advanced academic credentials. But raising a traumatized child necessitates additional training and skills. This fact does not diminish the qualifications of the parent, but instead it underscores the reality that parenting a traumatized child is so very different from ordinary parenting.
When a child with early trauma enters into a family system, the system changes. This system will absorb and react to the child’s N-IWM. The natural reaction is to begin a Downward Spiral. The Trauma Lens Paradigm Shift offers techniques and interventions that will reverse the spiral and promote healing. These techniques will feel counterintuitive and may be viewed negatively by others. Parents using the old, familiar parenting model would “consequence” a child for a tantrum. The new model explains why the child needs “time in” with the parent rather than being sent for a time out. Being with a sad or scared child—instead of fixing the behavior—requires training and practice in co-experiencing the child’s emotions and co-regulating them with the child.
Corey’s Family
In most cases it is neither easy nor inexpensive to return a child to “the system” after adoption. Rebecca and Danny were willing to try something new to preserve Corey’s placement even when it seemed hopeless. With time and trauma-specific treatment they were able to grieve their lost parenting expectations and accept the new paradigm. They recognized that their parenting failures stemmed from their old parenting methods. The shift did not require so much additional effort as it did adapted strategies. At first they were incredulous at the idea that they did not need to change Corey, just themselves. They were being asked to embark on a parenting effort seemingly more complicated and time-consuming than the crisp behavior modification principles they used so successfully with their birth children.
Rebecca and Danny were annoyed and taken off guard when Corey told them he should not have consequences for making decisions from his “baby part.” But they recovered and with sadness informed him that he needed to learn to recognize how much that hurt part was costing him. “Don’t worry—you’re getting this. I can remember when you didn’t even believe you had a baby part!” they assured. Success is energizing.
Old: My child’s problems are a reflection of my parenting skills.
New: My child’s problems are a reflection of his/her early trauma.
We cannot be ashamed or afraid of our children’s problematic behaviors while at the same time expecting them to acknowledge ownership and endure the fear of recovery. When we say, “No child of mine behaves like this,” we disown the child. Other common damaging statements include: “I cannot handle these behaviors,” meaning “Your behaviors are too big for me.” “I cannot stand it when you behave this way” means, “I cannot stand you.” By learning to see the child’s behaviors as a reflection of his early trauma, we preserve our self-image. We free ourselves to be sad with the child and for the child instead of fearful for ourselves. By increasing our ability to feel the child’s sadness and fear ourselves, we are able to assist him in experiencing his own emotional world. Our reduction of defensiveness makes forming alliances easier, as we no longer frame the problem as one of our defective parenting skills.
Families need to instill in the child a feeling of having been “claimed” by them and “belonging” to and with them, in order for healing to proceed. Statements like “No one in our family does that” or “You cannot behave like that because Granddad is the mayor” send the message that the child will never be a member of our family. The new paradigm allows for the recognition that this family and these parents are working to help the child heal from the early trauma. It transforms and properly elevates the parenting effort as heroic in joining with the child to overcome problems caused by someone else.
Sally’s Family
Jane’s new in-home staff was quick to reframe Sally’s behaviors through the trauma lens. They identified Sally’s attempts to deflect emotional closeness, disrupt adult communications and relationships and recreate the chaos from her past. Jane was reluctant to allow the staff to talk to the school, because of the protective services report with its inferences of her being too harsh with Sally. She had noticed the looks between teachers and heard from them in muted form the same derogatory remarks inflicted by her sister. Nevertheless, she decided to give the staff a chance to meet with the school personnel along with herself. She was surprised at how credible the information sounded coming from knowledgeable professionals. One teacher even admitted that a family member was showing similar behaviors and asked for resources. Buoyed by this experience, Jane scheduled the in-home staff for a meeting with her parents and sister in order to explain to them how early trauma damages a child, the impact on the new family and how to help. The support system thus created allowed Jane to begin to effectively parent a child hurt by someone else.
Old: All the child needs is love.
New: Love is expressed differently to children with early trauma.
Unconditional love is a requirement for healing. Expressing that love to a child of early trauma becomes highly complicated. Parents must understand that the actions that typically express unconditional love actually become fear-inducing due to the child’s N-IWM. Early traumatic experiences predispose the child to assuming that parents are untrustworthy and dangerous. Once that “knowledge” is pre-verbally acquired, the child will experience any parental interaction with suspicion and fear. Parents must understand this, label the child’s behavior as emanating from the early trauma and become able to predict resulting behaviors. That is, we must be able to read the child’s internal state before we can successfully demonstrate unconditional love, assist in recovery and accurately express our emotions to the child.
Otherwise, parents can only offer conditional love and are unable to help their child navigate fear, sadness and anger. Before recovery, most children cannot achieve “average” levels of emotional intensity or regulation. Parents are handicapped in expressing their own full range of emotions due to the constant background of the child’s projected fear. Before the child can accept our love, she must know why it’s so scary to do so. Children absolutely need love. The traumatized child needs to learn how to experience love before she can receive love and interpret the experience. The early trauma damage leaves children without the ability to receive the very thing they need.
Amy’s Family
It was clear to both James and Lori that “just loving Amy more” was not working. They began a new in-home service that was to help Amy learn to love them. Amy stated that she did not feel loved by her parents: “They are just trying to please Child Protective Services. They don’t like me, ’cause I’m too bad.” James loudly protested, “If anyone else treated my wife the way Amy did, I would have kicked them to the curb long ago!” As treatment progressed, the family learned why Amy constantly feared good things. Lori was taught to help her daughter notice the fear in her body and see how it affected her behavior. Amy enjoyed the activities with her mom and was able to voice when she had “too much good.” James and Lori learned to reduce the number of gifts to special occasions and infrequent surprises. They expressed sorrow and reframed destruction of property as Amy saying that she had “too much.”
Amy was scared of her parents’ deeper understanding, but her fear slowly decreased, as they consistently did not regress to angry reactions toward her behavior. She felt for the first time that her parents understood and accepted her. Working together, the family recognized the early trauma damage, found ways to connect with Amy despite the damage and eventually developed ways to express love that facilitated Amy’s healing.
Old: The child will be filled with gratitude.
New: Because of early trauma, even the good things that I provide will be experienced fearfully.
When the child’s internal world does not match his external world, he will experience fear. A child with a N-IWM will experience a situation as ominous despite others not seeing bad intentions in either themselves or their parents. It’s like the fear you or I would feel while swinging from a trapeze as novices; the performer who slowly learned the skills growing up in the circus would not feel any fear at all.
Parents need to recognize their child’s fear and label it ahead of time. Until the hurt part of the child is healed or begins to heal, they will be scared by, rather than grateful for, any attempts to provide good things.
The new paradigm helps parents to be more reflective and forgiving about the child’s behaviors. Parents are encouraged to find alternative ways to feel good about themselves without expecting reciprocity from their child. Parents can be freed from the need for gratitude and from feelings of rejection, making them more emotionally available to co-regulate with their children.
Amy’s Family
James and Lori assumed that Amy would reciprocate their kind actions. None of the caseworkers explained why this would not occur. Consequently, they interpreted Amy’s actions as rejection and negatively reacted to her in turn. When the family began the new in-home service, Amy could not explain why she felt uncomfortable when receiving gifts. As the team explored Amy’s emotional world, they noticed that she would not talk about being sad or scared. But they recognized and interpreted her nonverbal behavior as “talking.”
For example, Amy deliberately tore a hole in her new jeans. She quickly responded that she did not want these jeans. But what was she really “saying?” In this way, she could avoid feelings of fear or looking good and having good parents. The tearing reduced any feelings of loss to zero and ripping the jeans evoked anger in her, an emotion with which she felt more secure.
But without the paradigm shift, James and Lori interpreted Amy’s behavior as: She’ll destroy things just to get more; she doesn’t appreciate what we do for her; we’ll go broke trying to make her happy; she thinks she’s entitled to anything she wants and we don’t supply good enough things. All of these inferences caused fear in James and Lori. Without the paradigm shift, families succumb to the Downward Spiral. With training and practice, James and Lori were able to stop asking Amy why she did the things she did. Instead they would define the experience through the trauma lens and label her fear.
At first, Amy was angry in response. “That’s not what I’m feeling!” But with constant repetition she began to recognize and tolerate more vulnerable emotions. She went from “I know what you’re thinking” to “it makes sense but I don’t like it” to “when will I stop feeling this way?” It was calming to be able to anticipate feelings and behaviors. The family members felt better about themselves and were able to enjoy their relationships.
Old: The child has negative motivations and intentions.
New: My child’s problematic behaviors are motivated by the need to feel less afraid.
Until parents believe that all of their children’s problematic behaviors are motivated by want of safety, the healing cannot begin. With the new paradigm, “Why can’t he earn a contract reward?” is answered with, “He doesn’t trust the person who created the contract” or “He does not feel he is competent enough to complete the contract.” “Why does he say things like that about me?” is answered with “He doesn’t trust me.” By recognizing the damage of early trauma, parents will have an alternative explanation for the child’s misbehavior. “Parts” theory can help the parents to understand that the “hurt part” of the child is behind poor behavior, while they look to foster development of the “healthy part.” The concept of “parts” also helps the child to become reflective about self and parents and thereby able to ponder whether they may in fact have benevolent motivations, too.
Corey’s Family
Corey had an answer for everything. If someone brushed up against him or he fell, he claimed “abuse.” He complained that his parents overheated his food and caused him to burn his mouth. Some bruises from a recent fall led to a Child Protective Services investigation. When he accused Danny and Rebecca of inflicting the injuries, they could not understand why he lied. What did he have to gain? He must really hate them. The parents fell victim to Corey’s N-IWM, as caused by traumatic experiences at the hands of his birth parents and possibly also by prior foster parents: He was bad and adults were dangerous.
The new in-home service’s staff answered the “why” questions. Corey’s early life experiences taught him that he was not valuable, that adults were dangerous and that the world was unsafe. He needed to keep himself safe in every situation. His internal monitoring system was always set on “red alert.”
Treatment focused on psychoeducation regarding trauma, attachment and development and on helping the parents notice signs of anxiety in Corey. Their “homework” was to share personal emotional experiences. The family became more aware of fear and sadness. The other children understood how their behaviors spread fear throughout the family when they were reacting to Corey’s fear. Corey was uncomfortable when others seemed to recognize his emotions before he did. The family began to enjoy sharing their daily experiences at dinner. Instead of attacking Corey for his lies, they gave him space and told him his unhealthy part was making decisions. As the family completed their homework in helping Corey notice his emotions and talk about theirs, he relaxed. Gradually the family learned to handle fear better and accept comfort when sad.
HOW IS THIS PARADIGM SHIFT ACHIEVED?
In the previous section we detailed six traditional foster and adoptive parenting tenets. Each family will adhere to the tenets in varying degrees. But a change to the new paradigm is necessary for successful parenting of a traumatized child. How can the Trauma Lens Paradigm Shift be achieved?
Shifting paradigms is hard work and requires education, resources, support and guidance. Parents must have a team of friends and professionals with whom to share responsibilities and from whom to get stress relief. We will address development of the treatment team in the next chapter. We will proceed here as though the family has a treatment team.
Psychoeducation for the Family, Friends and Professionals
The Emotional Cognitive Trauma Model (ECTM) begins with the Two Babies Narrative, a description of how two babies develop opposite internal working models. One baby has an attuned primary caregiver with “good enough” parenting.11 The second infant’s caregiver lacks attunement and responsiveness. This caregiver may hurt the child or allow others to do so. The narrative identifies how the IWM affects relationships, decisions and behaviors and increases understanding of where emotions come from and how the trauma damages were done. It enables the reader to feel empathy for the birth mother and sets the stage for future “reframes.”
The ECTM: Two Babies Narrative leads to the parent’s ability to make the following paradigm shifts:
1. A reframing of current events and behaviors through the Trauma Lens, by linking current behavior to the early abuse or neglect.
2. Thinking of the trauma damage as a “hurt part.” The hurt part is not the whole child. If it’s only a part, the part can be healed.
3. Understanding “parts” as thinking, feeling and acting components. We all have parts, the strength of which varies given different events and triggers.
4. The ability to demonstrate how anger avoids feeling fear and sadness. Anger gives power, while fear and sadness are difficult to manage for a child who lacked an attuned caregiver.
5. The understanding of these children as either more or less angry, but rarely happy.
6. Better parental skill at regulating their own emotions, along with an expanded range of emotional awareness.
Two additional skills parents are encouraged to use are “narration” and “affect matching.” The Two Babies Narrative highlights the role of parental narration of everyday life and of definition of experience. This is an automatic process for healthy parents and children. But children who come from stressful, abusive and neglectful environments most likely have not had this interactive experience. In the new paradigm, parents use the ECTM to narrate their children’s emotional worlds and to define their experiences.
Parents narrate the world for their infants, if you notice. The baby’s every interaction with the environment is described and defined in great detail; what a good sleep the baby had, how comfortable the crib is, the smell of the diaper, the taste of the milk, the empty feeling and the full feeling. Dozens of times a day, parents show baby the world.
So often the parents of traumatized children find themselves asking them questions like, “Why did you do that?” and “When will you stop doing that?” The ECTM encourages parents to stop asking and use the model to provide answers. This greatly reduces defaulting to the N-IWM of “I am bad” and “You are bad.” Now, “Why did you do that?” can be reframed as “You did not trust me, so you took the candy.” Parents will understand that the answer to “When will you stop?” will come with healing.
Corey’s Family
Over the years, Corey continued to steal food from Danny and Rebecca. Danny stated that he did not understand why Corey did not trust them to take care of his needs. Each time he stole food, he had the feeling of meeting his own needs, of being in control, thereby demonstrating that he didn’t need parents. Danny and Rebecca began to narrate their actions as they provided for Corey. Rebecca pointed out times when Danny played with Corey. Danny voiced his appreciation of Rebecca as she took care of each meal. Both Danny and Rebecca described the other parent as being trustworthy. Each reframe of the parent’s trustworthy behavior added meaning to the experience.
Another skill parents are encouraged to use is affect matching. Parents of infants match their affect with the child’s to calm them. This natural process is essential for infant co-regulation. Children with early trauma missed this vital developmental interactive experience. Parents of traumatized children must be taught the importance of affect matching, be provided with examples and encouraged to practice it. The foundation of affect matching is adult emotional self-regulation, followed by intentional co-regulation of the child. Parents use the skills of narrative and affect matching as they shift their paradigm.
The paradigm shift continues with understanding of what we refer to as Trauma-Disrupted Competencies (TDCs). Infant and child development is incremental and builds on each previous skill. If a skill is not learned, the incremental process is disrupted. Parenting a traumatized child becomes easier as the parent looks for TDCs in their child; misbehaviors can then be understood as missing skills instead of behaviors that need consequences.
• Negative Internal Working Model (N-IWM or “maladaptive schema”): A schema is an internal working model of oneself, one’s caregivers and the world. If a child endures trauma from child abuse, neglect and/or loss of the primary caregiver, the result may be distorted and maladaptive schemas. Maladaptive schemas may be linked to adult personality disorders that are very difficult to treat. Consequently, early recognition and attention to maladaptive schemas in children can be preventive. Typical behaviors consistent with a maladaptive schema include not trying (fearing failure) and stealing and lying (not trusting parents to provide).
• Developmental delays: Disrupted relationships are emotionally and developmentally costly. Severely disrupted attachment often engenders lifelong risk of physical disease and psychosocial dysfunction.12 These children may have atypical development of their ability to play or to occupy themselves, may regress under stress to behaviors typical of a younger child, be hyper-vigilant with an inability to focus or use controlling behaviors. Typical behaviors include being bored (an inability to occupy oneself) and not finishing games and projects (lacking in developmentally-appropriate skills).
• Inappropriate emotional response: Children may become frightened if they sense danger or feel that they are losing control of their environment. The child may have an exaggerated physiological response to stimuli, activating the autonomic nervous system with changes in heart rate, blood flow, respiration and stress hormone secretions. Otherwise stated, their “fight, flight, freeze” reflex is unnecessarily activated. Cognitive processing is then reduced, resulting in an inability to answer questions or make logical decisions. The brain processes information from the autonomic nervous system more rapidly than rational thoughts, as the former call for activation of automatic reflexes to keep the person alive. Typical behaviors include fighting, running away and being unable to answer.
• Object relations problems: Many children have a history of impermanence. Adults appeared and disappeared, caregivers changed, homes changed, people were not constant or permanent. For healthy development, children need consistent, constant and permanent caregivers and environments. Typical behaviors include reliance on smells for comfort (smells provided clues to the environment) and inability to sleep (fear of what happens at night).
• Self-regulation problems: Research reveals that complex trauma leads to “impairment in attachment, biological functions, affect regulation, dissociation, behavioral regulation, cognition and self-concept.”13 Many of the children with whom we have worked are dysregulated in eating, sleeping, temperature regulation, elimination, energy and emotion. Typical behaviors include not knowing when to stop eating (inability to recognize “full”) and wearing a coat in summer (inability to recognize “hot”).
• Sensory processing problems: These often have their roots in early deprivation and abuse. The children may be sensory defensive and hyper-sensitive. Touch tends to be uncomfortable or scary. Food choices may be limited due to previous deprivation. Hearing may be on hyper-alert for dangerous sounds. The children may appear hyper-vigilant to environmental stimuli. Typical behaviors include rejecting mom’s touch (inability to differentiate good touch from bad touch or suspicion about the other’s motives) and only eating macaroni and cheese (comfort with familiar food and little past exposure to a variety of foods).
AN OPPORTUNITY FOR ATTACHMENT
Child Development and the Secure Base/Safe Haven
The Trauma Lens Paradigm Shift encourages changes in the parent’s perception of the child and the child’s behaviors. Parental actions and interactions must support the new paradigm. Parents must form a relationship with their children as they are now, not based on a preconceived notion of who the children should be. New positive interpersonal experiences and interactions build healthy relationships. Attachment research has found that children need a secure and dependable relationship with attuned caregivers before they can explore the unknown. Renowned developmental psychologist Mary Ainsworth depicts the attachment figure as a secure base that allows the infant or child to venture away and return to the parent.14 Gillian Schofield and Mary Beek studied children with early trauma and found that these children have a “profound lack of trust” in the caregiver that prohibits the child from perceiving a secure base. Such children are “highly resistant to accepting or learning from new experiences of responsive and secure care giving.”15 Sheri Pickover, Clinical Director at University of Detroit Mercy Counseling Clinic, notes, “Attachment patterns become a self-fulfilling prophecy, trapping the child in a circle of despair.”16
Intentional therapeutic parenting revolves around emotional and physical security. The child’s perception of that security will ebb and flow over time. Some days the child will be more open to the security than other days. Figuratively, this secure base must be like a concrete foundation without cracks and swept clean of dust and debris. The family will not be perfect, but must be conscious of personal shortcomings and openly share their life struggles. They must “sweep” their foundation daily by discussing life’s difficulties, how they resolved problems and how they managed distress. These experiences become the child’s building blocks for how to handle distress, accept others’ and their own imperfections and learn problem-solving skills.
The secure base includes the child experiencing the parents’ taking care of all physiological, safety and relational needs. At times when the child “perceives” the parent not meeting one of these, their secure base is threatened. Trust is the first relational skill babies learn. When a baby can trust his caregivers to keep him safe, the baby is free to explore. Without this safety, a baby’s exploration is restricted. Early trauma and attachment disruptions prevent healthy growth. Children with early trauma do not always know how to play or even occupy themselves without making poor behavior choices.
Amy’s Family
Lori felt like she was a one-woman entertainment program. All day long, Amy demanded to be played with or occupied. When Lori ran out of ideas, she and Amy went shopping for new toys or clothing. Lori was afraid to ask Amy to play by herself, because she always got into trouble—mostly rummaging through her parents’ belongings or breaking things. Amy was not developing independence or a healthy curiosity about how the world works. Evaluating Amy from a secure base/safe haven model, one would say that she did not have a secure base from which to explore.
Each new independent action supports the child’s belief that “I can do it myself.” Through years of exploration and returning to the secure base/safe haven, children will move through stages with mastery. In a secure base, parents are emotionally regulated and available. Emotionally-attuned parents of infants co-regulate with their children. Co-regulation is a corrective interpersonal and emotional experience that occurs when an infant expresses fear to the parent (cries), the parent feels the same emotion (fear), the parent calms him or herself (understands the infant’s need) and then connects (soothes baby) and conveys that same calmness to the baby via words and actions (meets need). This series of events calms the infant. Healthy babies and caregivers interact similarly dozens of times a day.
Emotionally-dysregulated parents equal insecurity and fear. A dysregulated parent may not be safe or able to meet the child’s needs. Parents will have emotions. As they demonstrate ways to handle their emotions, their child will learn new skills. These skills will be addressed in a later section. Treatment professionals frequently ask that children be taught to regulate their emotions. Emotional regulation cannot be cognitively taught, as cognitive information is stored in the thinking part of the brain. We all lose our ability to think when emotionally dysregulated. We all have emotional responses. Children benefit by watching their parents regulate their own emotions and thereby experiencing co-regulation.
