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CHAPTER 4 CHAPTER 4

Creating the Healing Home with Parenting Goals and Skills Creating the Healing Home with Parenting Goals and Skills

Allan excitedly opened his mail, a letter from his maternal grandmother. She rarely contacted him, but she did remember his birthday. When Allan gazed down at the card, he exclaimed, “Doesn’t she know I am not a little kid?” Throwing down the card, he walked away. I tried approaching the topic throughout the day, but he always changed the subject. It felt like he was punishing us for the card. All day long I was settling fights and handing out consequences. I knew I should talk to him about his fears and sadness, but I could not force him.

Nothing provokes him enough to express his deep feelings. Even letters from his birth family don’t seem to interest him. He did like the dog drawing his birth father sent. Shouldn’t he want to talk about everything that has happened to him? When I told him that he can talk to me about anything, he said, “Why is it that everyone says that to me?” I have no answers.

—Faye Hall

EMOTIONAL COGNITIVE TRAUMA MODEL

Fourteen years of hard work, research, training and experimentation gave birth to the Emotional Cognitive Trauma Model (ECTM). It has changed and morphed since co-author Jeff Merkert began using storytelling to illustrate the impact of trauma on developing infant brains and internal beliefs working with client families. Over the years, Jeff has perfected the presentation and provides it to families and their support systems. We struggled with naming it. Faye gravitates to emotional work and Jeff to cognitive work; thus the name. The story links neurology, the impact of trauma on the brain and the damage created with attachment disruptions.

Throughout this book, parents are encouraged to see themselves as the ones who will help their child heal. The task can be overwhelming, especially for families with more than one foster or adoptive child in the home. The parents are on duty 24/7.

In this chapter, keys to success and goals are clearly defined and parents are instructed in interactive skills with their children. These are the foundations to navigate healing, without which treatment will not be successful. Please remember this is relational and emotional work, not behavioral.

Keys to Success

1. Parents explore their own emotional and cognitive world. Some of our most successful families are those who have explored their own history. They’ve done or, even better, are still doing, the hard work of examining their own fears and changing their response to them. These parents have empathy for their child and can be an encouragement as the child is challenged to do the same. Parents with a trauma history that is not explored or integrated into their narrative tend to be punitive and demeaning. Some have stated that “I got over it, why can’t they?” This lack of empathy prevents co-regulation between parent and child.

2. Parents increase or improve their self-regulation skills. Self-regulation is needed for co-regulation and the ability to remain calm when the child has disruptive behaviors. Our own histories and upbringings leave some parents with a “short fuse” or a feeling of being easily overwhelmed. Parents need to be on their “A” game in self-regulation when interacting with traumatized children. This leaves most of us with room to grow. Fortunately, this growth actually facilitates the same growth in our children. Children with a history of abuse and neglect likely have not learned to co-regulate with their birth parent. This will be one of the first interventions that occurs with treatment. Parents will be handicapped if they cannot regulate their own emotions. Without regulation, parents can overreact to the child’s behaviors and reinforce the child’s N-IWM. Sadly, parents are often counseled to over-regulate their own emotions. The professional may state, “Keep yourself calm; don’t communicate sadness or fear to avoid triggering your child, which causes an escalation cycle.” The problem with this strategy is that observation is the primary tool for learning personal emotional regulation. Can we really expect children to learn from lecture alone without observation of our own emotional responses? Being emotionally regulated does not mean being unemotional or flat in our expression of emotion.

3. Parents model for their children ways to explore their emotional and cognitive world. Parents know that their children follow the parents’ model much more than their words. Children with early trauma are always watching their parents to maintain a sense of safety. This hyper-vigilance drives the child to learn from the parent’s behavior, on a deep, experiential level, much more than the many lectures parents tend to give.

4. Parents use interactive repair. Parents are the adults in the relationship. They should model appropriate behaviors for their children. Interactive repair demonstrates how to repair relationships. Parents have to demonstrate for their children the skills they want them to use. These skills are not gained by lectures or demands. Sometimes, parents state their child was wrong and the relationship cannot be healed until the child “takes responsibility and apologizes.” This stance assumes the child is reflective, evaluates the behavior as wrong and desires to repair the relationship, all of which are higher-level thinking skills and require a healthier internal working model.

5. Parents build the environment to support the child’s development of healthier affect regulation and healthier views of self, others and the world. The environment will either support or hinder healing. The essence of parenting is simply the agreement to supply the growing environment for our children. Chapter 16 has suggestions for environment interventions.

6. Parents recognize and label their child’s fear level. Parents learn to read their infants’ internal states. Now, the task is reading a child’s internal state that has grown to avoid even the perception of fear. Hurt children often take great care in keeping others from knowing their thoughts and emotions. For healing to begin, parents must recognize their child’s fears and label the emotions for the child. These skills will be new to the child and may initially create more fear.

7. Parents address the child’s stress but not necessarily always the circumstance. In some ways, addressing a healthy child’s stress is easier than changing the circumstance that created the stress. Parents may go to great lengths to eliminate stressors to keep the child more regulated instead of helping the child develop new self-regulatory skills. When a parent knows the child is stressed, they can help with the stress. Not all circumstances have resolutions. Further, it is not unusual for the child’s emotions to not match the circumstances. Identify the disparity.

8. Parents reduce the use of cognitive interventions during emotional responses. As parents use the ECTM, they will understand the neurological impact of trauma and the brain’s response to triggers. When a child has an emotional response, the brain has less ability to process or respond to cognitions.

9. Parents label emotional states and notice the increased cognition. As parents read and label their child’s emotions and offer comfort, the child’s brain may become less emotionally flooded and be freed up to have increased cognition. The goal is for the child to notice how his or her body changes with/without stress. Complex early trauma causes children to avoid feelings of fear and sadness. In the early stages of life, the baby’s brain was dependent upon the caregiver’s brain to facilitate moving out of “fear.” If the relationship with the caregiver did not prompt this change of state, children will lack a dependable means of regulating emotions. They feel as if any small fear could wind up being overwhelming! Since they have no experience with modulating and changing emotions, they default to avoidance. Consequently, such children grow to have just two “emotions,” mad and more mad! We as parents must demonstrate that first we and then they can feel fear and sadness and then stop feeling it. We all have a wide variety of tools we use to accomplish this for ourselves. It is very hard to teach these skills to little brains that have already learned to avoid those feelings as a survival skill.

10. Parents explain what their child experiences without shame or blame. Parent self-regulation is important with this intervention. The parent’s task is to relay what is going on with the child, separate from their frustration about the problematic behaviors that may have occurred. They can use storytelling or just describe the events as if they were talking to a younger child.

11. Parents use “helpful statements” to assist their child in internalizing a healthier sense of self. Interventions are provided in chapters 16 and 17.

12. Parents provide a wide range of developmental activities for their child. Due to Trauma-Disrupted Competencies, most children with early trauma experience developmental delays. To help children mature, they must be exposed to multiple age activities. Children who have not fully mastered skills at one developmental level will experience “gaps” in their ability to function at the next developmental level. When healing begins and the child feels security, he or she will often automatically gravitate toward activities that are not necessarily age-appropriate. These activities will become the building blocks for more “mature” activities. They should not be seen as primarily pathological.

13. Parents accept, enjoy and parent their child at his or her developmental level. These children need unconditional love, not relationships based on academic success, appearance or skills. Their egocentric nature causes them to blame themselves for removal from their birth family and changes in placements. Even when children deny it, there is no motivational substitute for parental attention. They will always grow in the direction of our attention. It can be extremely difficult to find and enjoy the small, fearfully hidden positive elements of traumatized children. Our attention that nurtures their growth may require a very strange skill set to enjoy playing with building blocks with a nineteen-year-old or a twelve-year-old sitting with mom reading a picture book. But these activities are often just what the child needs to facilitate acquisition of previously un-mastered skills. The new skills in turn allow for eventual mastery of chronological age skills.

TREATMENT GOALS

As with any model, success is dependent on the participants. We have established goals that can be measured (useful in treatment planning) and explain what needs to be accomplished during the process. Goals are dependent upon the number of times the parent uses components of the ECTM.

1. To explain confusing emotional reactions. This reduces a child’s feelings of shame.

2. To explain the source of the emotions driving a child’s behavior.

3. To reorganize and redirect the familial system’s efforts at recovery from an external focus (to change others) toward an internal focus (how I can change).

4. To illustrate that the child is not “sick” or “bad,” but has a hurt part, a part that learned not to trust others, that the child is unlovable and the world is dangerous.

5. To increase internal reflection for parents and children by the application of an alternate and more accurate assessment of their own emotional world as the motivational source for their actions.

6. To interpret present emotions and behaviors and link them to past events.

7. To predict emotional responses to future events.

8. To base personal responsibility and accomplishment on something other than immediate change in the child’s behavior.

9. To reduce parental interpretations of malice as the origin of children’s behaviors.

10. To increase parents’ healthy trauma-informed behavioral expectations for their children, the verbal and non-verbal expressions of which will build the child’s self-image.

PARENT SKILLS

Now, let’s get to work and define skills that parents will use every day, many times a day, to connect with their children. Parents of infants “help keep arousal within manageable bounds but also help infants develop their own ability to regulate arousal.”¹⁷ These children are lacking in such experiences and in the relationships that create the experiences. They may now be relationship avoidant and extra skills must be learned and used to form trusting relationships and manage stimulation. We will give examples and encourage parents to follow the examples. These skills are not limited to the parents. Anyone in the village who supports the family or treatment will find them valuable. As with all interventions, no one will be perfect, but rest assured the child will repeat the behaviors that allow you to try again and again, until you perfect the interaction.

Parenting is time consuming and exhausting. Slow down and be more mindful. One must be intentional and mindful of emotional reactions to the child’s disruptive behaviors. Being intentional will help parents prioritize the values and beliefs they want to reinforce. This allows parents to pay attention to their internal experiences, sooth their own anxiety and inhibit negative responses. The resulting increased cognition allows the parents to control their emotions and stop trying to control the child. When parents are more mindful and calm, they are open to reading the child’s cues and expressing empathy. As we will cover in the following section, empathy helps the child feel heard and builds the parent/child relationship.

Corey’s Family

Corey stomped into the therapist’s office with a scowl on his face. His anger was obvious. The therapist asked Corey to find the emotion he was feeling on the emotional chart hanging on the wall. Corey glared at the thirty different emotional faces staring back at him. He mumbled, stammered and declared, “frustrated, no frightened, no irritated.” The therapist inquired about his irritation. After ten minutes of traveling down a dead-end therapy road, the therapist asked him to try again. Mom watched impatiently. Time was ticking away, again. Like always, session time was being wasted.

Due to children’s inability to identify and express their emotions and become vulnerable with parents and treatment staff, our model builds on the foundation of four emotions: happy, mad (angry), sad and scared (fear). The limited number allows parents to remain focused on using specific emotions and reduces the children’s avoidance of acknowledging their internal distress. Anger is viewed as a secondary emotion, spurred by sadness or fear. Therefore, when one declares he or she is angry, they are challenged to find the underlying emotion of sadness or fear. A sort of “micro-focus” occurs then, linking the trigger to the underlying emotion more quickly.

KEYS TO CO-REGULATION

According to Bessel Van der Kolk, a clinician, researcher and teacher in the area of posttraumatic stress, “When a baby is in sync with his caregiver, his sense of joy and connection is reflected in his steady heartbeat and breathing and a low level of stress hormones.”¹⁸

This is co-regulation at the infant level and occurs infinite times during infancy and toddlerhood. Unfortunately, most traumatized children missed these vital interactions, which equip the child with the knowledge that “intense sensations with safety, comfort and mastery are the foundation of self-regulation, self-soothing and self-nurture.”¹⁹ We have devoted this section to teaching similar skills that will reproduce this connection. We will explore and learn affect matching, emotional regulation, empathy and narration.

AFFECT MATCHING

According to parenting and relationship authorities Marion Solomon and Daniel Siegel, “Within episodes of affect synchrony parents engage in intuitive, nonconscious, facial, vocal and gestural preverbal communications.”²⁰

• Attunes to child’s emotions, matches affect with empathy and co-regulates

• Identifies and labels child’s emotions

• Narrates the environment for the child

• Remains in close proximity to the child, especially when the child is dysregulated

• Provides comfort if needed²¹

During parent/infant interactions, parents respond frequently to their child’s bids for connection through sounds, facial movements and gestures. These interactions are reciprocal and predictable, creating multiple pleasurable experiences for both parent and child. Babies learn to turn away when over-stimulated. Each learns to read each other’s signals. Just like Goldilocks and the three bears, parents learn how much interaction is “just right.”

Children with histories of early trauma and attachment disruptions may lack pleasurable and reciprocal interactions with their previous caregivers. Even worse, the child may have experienced maladaptive or traumatizing responses from previous attempts to connect to primary caregivers. These children become neurologically wired to avoid parent/child interactions. Parents of foster and adoptive children are challenged to provide new experiences that replicate and/or correct parent/infant interactions via matching affect and co-regulation.

A parent’s face mirrors the child’s experience: “Then her face is an ‘accurate enough’ mirror of the baby’s state” and “not being mirrored reduces the felt experience of the world-making sense of the infant’s inner states.”²² Parents of foster and adoptive children have the opportunity to provide new experiences that replicate the parent/infant interactions via matching affect. When matching the child’s affect, the attuned parent allows the child to “feel heard.”