Association for Training on Trauma and Attachment in Children

Resources Blog

Helping Children Cope with Trauma

Terry Levy, Ph.D., B.C.F.E.
Director at Evergreen Psychotherapy Center/ Licensed Clinical Psychologist

Resilience means “bouncing back” from adversity. The primary factor in
resilience is having supportive and caring relationships that include trust, love, healthy role models, encouragement, and support. Nurturing relationships between parents and children have the power to heal trauma.
Exposure to trauma makes children feel frightened and helpless, and they need calm, caring and consistent caregivers. Remaining calm when they are agitated and teaching calming techniques reduces the anxiety and emotional arousal that affects their mood, behavior, sleep, and concentration.
Children must learn that adults are dependable, caring, patient and safe. Parents become a ” secure base” by being emotionally available, sensitive, responsive, and helpful. To do so means that parents have to be able to manage their own emotions and stress effectively. The following are tips for parents who want to help their children mend emotional wounds:

• Talk with your child: Communication builds trust and is a constructive
coping skill; find times they are likely to talk; start the conversation;
let them know you are interested.

• Listen: Listen to their thoughts, feelings, and points of view with
empathy; don’t interrupt, judge, or criticize; listening opens the door to a
trusting relationship.

• Accept feelings: Anxiety, irritability, anger, and depression are normal
reactions to loss and trauma and will subside over time in a safe
environment.

• Be patient and supportive: It takes time to come to terms with trauma
and grieve losses; each child’s path to recovery is unique; offer comfort
and reassurance; be available when they are ready.

• Encourage healthy expression: Children act out distress negatively
without constructive outlets; foster the use of art, play, music,
sports, journaling, and other healthy forms of expression.

• Maintain consistency: Structure and routines enhance security and
stability; provide appropriate rules, expectations, boundaries, and
consequences.

• Promote a sense of control: Children feel helpless and powerless in
response to trauma; help them believe they can successfully deal
with challenges via constructive activities (e.g., hobbies, sports, clubs,
volunteering).

• Make home a safe place: Your home should be a “safe haven,” a place
of comfort, security and peace; stress and chaos provoke traumatic
reactions; minimize conflict and give discipline with calmness and love.

• Foster new beliefs: Children develop negative beliefs about themselves and others when traumatized; offer “listening time” to give children a chance to share feelings, problem-solve, establish trust and create positive beliefs.

• Be honest: Children make up their own stories if adults don’t help them
understand the truth; honesty is essential, but keep in mind their age
and emotional ability; avoid details that could re-traumatize them.

• Help with trauma stories: Children are asking for help when they tell
their stories; listen, be supportive, help them “make sense” of what
happened; send the message that it was not their fault, and help them
understand their feelings.

• Don’t take it personally: Children can “push your buttons;” you are less
likely to be angry or anxious if you know your own emotional triggers—then you can remain calm and respond in a helpful way.

• Focus on the positive: Acknowledge and praise positive behavior; “catch your
child doing something right;” have fun, laugh—humor reduces tension
and creates connection; playing is a great way to bond.

• Limit media: TV, movies, and video games may be frightening and
over- stimulating; monitor and supervise media based on your child’s emotional needs and reactions.

• Be aware of body language: Your tone of voice, facial expressions, and
body language communicate more than your words; show via body language that you are safe, understanding, and supportive.

• Maintain perspective: You can’t change the fact that tragic events
happened, but you can change how you interpret and respond to those
events; help children accept what can’t be changed and focus on things
that can be changed.

• Have an “opportunity mindset:” People often grow following tragedy and
hardship: better relationships, self-worth, inner strength, spirituality,
and appreciation for life; help children use their experiences to learn
and grow.

• Inspire a sense of belonging: Being a part of a family and community
enhances children’s security, identity and loyalty; traditions and rituals
increase their sense of belonging (e.g., celebrate birthdays, holidays,
cultural customs and practices).

• Volunteer as a family: Charitable actions turn pain into something
positive, create a sense of purpose and control (“I can make a
difference”),which leads to reclaiming hope; assisting others also benefits
the helper.

• Avoid labels: Labeling a child can have negative consequences; the
child labeled as “difficult” can develop a reputation that follows him
or her everywhere; when children see themselves as bad they act bad.

• Take care of yourself: Stay healthy so that you can take care of your
children; be a good role model of self-care and stress management—
eat well, exercise, get plenty of rest and support, avoid alcohol and
drugs, do yoga, meditation, and spiritual practices; surround yourself
with loving and supportive friends and family.

Importance of Transition Plans

Transition plans are identified strategies for parents to use to help maintain consistency, predictability and stability in the life of a child, when change in their environment and relationship is about to occur. These changes in placement can happen through divorce, death of a caregiver, or in foster or adoptive care.  Plans are also helpful in cases when there is a change such as a move, change in school or caregiver.  Where court proceedings have been a part of the placement plan, many times parties become conflict-ridden and opposed.  Transition plans are an effort to bridge these critical junctures by bringing the parties together to serve the best interests of the child or children involved.

The main goal of a transition plan is to ease the inevitable change a child will experience. Helpful strategies include building in comfort and security around already existing routines as well as developing rituals that alleviate anxiety and stress.  It is important to understand how any given child responds to both separation and comfort, so the plan will be personalized to fit the unique characteristics of each child.  If the new environment can copy features that already serve as a source of security to the child, these will ease some of the stress that is a part of any change.  Objects of comfort, which can be taken along, also serve to provide the child with a feeling of safety in an uncertain situation.

In order to honor a child’s current emotion and development, the best transition plans allow for identifying the child’s cues, indicating their current level of security or stress. Adult stressors also have to be taken into account, as the child will take many cues from both what they see and hear from the people in charge of the transition.  In addition to what is being said, facial expression (such as fearful expressions versus a confident, warm and smiling expression), voice modulation (such as rapid speech versus an even tone) and body movements (such as speaking at the child’s level versus standing over) all communicate an adult’s feelings about the situation. Support for the adults who are also experiencing loss and conflicted feelings will be needed. It is important that emotion-laden feelings be expressed away from the child, as children have no means of controlling this situation, and will mirror the distress being presented.

Most change is naturally stressful for individuals, both young and old, who must adapt to a change in daily routine that has become expected.  Allowing a child to utilize their personal strengths to dictate the pace and manner in which they move through the change is again, the best way to honor an individual child’s needs.  Patience is key in allowing all parties to feel their way through a new process.  Allowing a child to slowly revisit the environment or people they are about to lose, with continued contact as can be arranged and emotionally managed, will help a child realize that out of sight doesn’t have to be out of mind.  Pictures, recordings of significant people reading favorite stories, letters to read, and other reminders that will serve as touch points for the significant relationships the child has experienced can be helpful. Rituals and routines that have been established, in the face of a sometimes-chaotic move, need to be given special attention. Monitoring your child’s ability to maintain regulation, usually in the form of eating, sleeping and elimination, along with behavior and emotional management, needs to be closely watched. Developmental regression (the child’s functioning at an earlier stage of development-such as wetting the bed once potty trained, or wanting to sleep with you once being able to sleep alone) is to be expected during this period and should be allowed until the child can regroup and move forward.  Increased comfort, including smiles, holding, rocking and other sensory comforts, such as blankets, teddy bears, etc., should be an integral part of the plan.  Frequently, heightened fear, anxiety and confusion are all part of the move for the child.  A child many times will not act out, but withdraw internally to deal with the outside uncertainty.

Be aware of the child’s developmental stage and acquaint yourself with social, emotional and periods of neurological development that are age-related.  Don’t try to encourage new developmental tasks (potty training, trying new foods, sleeping alone) during this period as this can cause an overload on an already emotionally taxed child. Initially limit the number of people involved with the child to the few family members who will be a part of the daily routine.  Additionally, limit the sensory input from television and other sources so the child is able to self-soothe and regulate with the primary caregivers.  The child needs to develop security in the new environment to develop a feel for both their surrounding as well as new people that will allow for the building of a secure sense of the new space as well as the new relationships.

Prepare the child verbally by discussing what is to happen in manageable chunks of time-morning, after lunch and evening. I find it helpful to wake the child slowly, with gentle sensory stimulation such as rubbing backs, playing with their hair, etc.  This followed by an explanation of what is occur that morning allows a child to visualize a predictable routine.  Upon a working parent’s re-entry into the home, it is important to take some time to physically regulate to one another, by possibly having lap time, in order that the parent and child can physiologically become in “sync” with one another. When we hold another or are being held, our blood pressure and respiration becomes the same.  This allows us to be attuned to our child in a manner that allows us to “be on the same page” and come together after the busyness of each of our days.  Reading a book together, discussing day and evening expectations can ease uncertainty. Utilizing fun distractions such as piggyback rides or other games/fun interactions can also help parents to facilitate switching or transitioning within the daily routine, such as preparation for bath, or bedtime. Give information in age-appropriate doses and language, such that the child can start to develop a concrete awareness of what to expect.

 

Transitions need to occur given a child’s cues of emotional and behavioral signals, but should not be prolonged to the point that additional anxiety is created.  The help of a professional who is experienced with these practices can create confidence for the parent in making uncertain decisions.  The parents can also be assisted in managing the myriad of emotions that accompany feelings of uncertainty, grief and loss. The risk of abrupt change can bring long-lasting detrimental effects on a child, particularly if the child has made a series of moves.  These sudden and unforeseen changes can create an internal process whereby the child begins to over-control emotion and behavior, as a self-protective measure.  This affects the ability to form secure attachments, because the child’s intuitive inner voice and heart begin to distrust the adults’ ability to effectively provide care or comfort.  These breaks in attachment can hamper to severely affect further developmental progress, as the child is preoccupied with efforts to self-protect, and bolster their heart from being hurt.

Attachment is the driver of all areas of development, so a transition plan with adults with whom the child is living, along with the adults to whose care the child is preparing to go, is essential when a child is about to experience life-altering change. Providing the best situation for a child dictates that anytime a change is to occur, in environment and relationship, attention is paid to how the child and involved adults move through this process.  It is indeed a process, which should not be fast-forwarded or ignored.  Change will occur, and we are all better served when accompanied on that journey through planning, empathy and respect.

CATHY CHALMERS, MA, LPC, LMFT 

Child, Adolescent & Family Therapies

Tulsa, Oklahoma 

Looking Beyond the Theraplay Activities: A Window into Attachment

Dafna Lender, LCSW, Program Director, The Theraplay Institute

 

Why is Theraplay effective for healing children’s attachment issues?  The key is not the activities.  The activities are just the vehicles that facilitate connection.  The key is that we lend the child, and teach the parents to lend their child, our whole selves to help them organize into healthier, happier people.  How does this happen?

 

Theraplay changes a child’s implicit relational knowing, which is a person’s non-conscious expectation of what will come from interacting with another human being. The patterns of interactions between a parent and child are established during infancy when a parent responds in an attuned way (or not) to the baby’s signals.  These patterns turn into schemas that are neurologically “set” in the brain over the first three years.  The more they are repeated, the more they are reinforced.  These repeated schemas in the brain turn into a child’s internal working model in relation to attachment figures. Most of the children we work with have insecure attachment patterns. In Theraplay, we are giving the child interpersonal experiences that are non-congruent with their (insecure) internal working model, thereby challenging their brain to develop new, healthier implicit relational knowledge of what it’s like to be in a relationship.  For example, when a child is struggling in a Theraplay session and pushes you away with his legs, you say “Boy you’ve got strong legs!  I bet you can’t push me over with these legs on the count of three!” and then hold his two feet in the palms of your hands, count to three, the child pushes and you rock backwards with a big “OOOOHHHH” sound.  When you come back up, you see the child’s face has changed from defensive fear to a moment of proud delight.  What just happened?  By reframing and organizing his resistance into a moment of reciprocal play, you have given the child an opportunity to experience himself as strong, clever and most importantly still connected to the adult rather than bad, rejected and isolated.  You have given him new meaning for what it means to be him.

 

 

Right Brain Development in Early Childhood

The limbic area of the brain is the area that is developing most rapidly in infants starting from the third trimester of pregnancy through the third year of life.  The more logical, verbal areas of the brain, the pre-frontal cortex, develop later.  A parent’s emotional attunement (appropriate levels of touch, rocking, feeding, humming, changes of voice tone, tempo of movement, facial expressions) are the experiential food for the limbic brain areas during early development, as well as in adult life.  The reality of the child’s world is derived from information about the emotional states of others.   Facial recognition centers are in the limbic brain. It is these limbic brain structures that are underdeveloped, damaged, or distorted in the children with whom we work.

 

Theraplay accesses these limbic structures by providing high levels of non-verbal, face to face emotional communications involving, rhythm, eye contact, attuned responses of pacing and intensity that lead to developing positive neural connections.

 

Think of a parent whose baby is upset and crying:  What does that parent do?  She will  hold the baby close, bounce him up and down in strong, rhythmic motions and hum or say “sh, sh, sh, sh” with the same level of energy as the infant is demonstrating in order to soothe him.  The baby can feel the vibration of his mother’s chest as she hums and can feel her intention to help him through this experience.  It is this type of behavior on the part of the parent that lends the infant’s immature nervous system the experiences it needs to learn to calm, organize, and soothe itself.  But what if the parent were to hold the baby loosely, not bounce him, and not verbalize at all?  The baby would likely not feel his parent’s presence and not feel soothed.  If this happens chronically, he will not learn how to soothe himself and manage intense feelings, and he will also learn that no one can help him when he’s distressed.  We see a lot of these children in our clinic when they’re older:  they are the type who easily “lose it” (lack of self-regulation skills) and then they desperately try to keep you or their parents from getting close enough to help them.

 

What we do in Theraplay is to intervene at the appropriate physiologic level to connect with this type of child and capture the “attention” of his whole body.  For example: grabbing a child’s hand and making a game of “ring around the rosy” out of a child who was previously running around the room chaotically, and then quickly placing him in your lap, facing out, and making finger prints in play dough or feeding him something chewy, is a common Theraplay sequence.  What happened on a regulatory level is that the therapist met the child at his highly aroused level and helped to organize it, and then quickly provided both the structure and the engagement to help him calm down and focus his attention on a more soothing level, being ever mindful that because the child’s whole system is overstimulated and reactive, it is best not to insist on face to face contact but use body contact, which is less intense.

 

Vitality Affects

Keying in to and responding appropriately to a child’s vitality affects is our job: whether the goal is to down-regulate the child’s affect as illustrated above, or to match it (such as in the cotton ball hockey game, patty cake, etc), or amplify it (a child notices an interesting freckle on her hand and the therapist looks with interest and admires it further), we serve as guides in regulating the rhythm and intensity of the relationship.  For example, if you’re doing a quiet “check up” with a child, it’s because you are attuned to her basic state of physiologic arousal and have judged that the child is able to sit still and focus long enough for you to capture her attention.  If she becomes interested in the freckle you found and stares at it intently, you respond with a quiet, rich, energy filled voice: “Yeah, uh huh, neat freckle.”  But if she were to stare off past you and look bored or disconnected, you would vary the activity or change it altogether in order to reestablish the connection.

 

Another unique attachment opportunity that a Theraplay session provides are the many moments of surprise:  these are moments of increased intensity, where there is a sudden dynamic shift.  We set up these opportunities for dynamic shift all the time in Theraplay.  For example:  You are quietly studying a child’s face in Theraplay and he reaches out to touch your nose and you make a resounding “BEEEEEP” sound; the child is suddenly completely alert and, looking straight into your eyes, he giggles spontaneously at the surprising, funny shared event between the two of you, and you laugh in turn. The discrepancy between what the child expected and what actually happened is surprising.  This element of surprise, so important in Theraplay, is the growing edge for a child to learn that new things can happen, but that these new things can be both fun/exciting and safe.

 

Now Moments

Related to the scenario described above, a now moment is when two people are sharing a dyadic state of consciousness.  For those few seconds after you made the beep sound, you and the child are in a brand new, shared space created by the two of you, and you are intensely focused on each other.   You each give meaning to the event as pleasant and the giggling both conveys and amplifies the moment.  The more now moments occur, the more the child learns that it is pleasureful and safe to be completely caught up in a moment of shared joy or attention with another person.  Once this has happened, there is no going back—a deeper sense of connection has been established between the two of you.

 

Now moments can also be seen as trance-like or hypnotic states when the dyad is not aware of the passing of time, is not self-conscious and is intensely focused on the object of shared attention between the two people.  This is a common experience for people when they are doing their favorite activity with another person such as playing music, dancing, etc.  It is the common goal for many Theraplay activities that require reciprocity, such as pat-a-cake, peek a boo, beep and honk, cheek pop, etc.

 

For all of the activities mentioned above, it is the fact of you and the child, or more importantly the parent and the child, being together in a connected way that achieves the goal of improved attachment capacities between parent and child.

 


Sources:

Makela, J. (2003).  What Makes Theraplay® Effective: Insights from Developmental Sciences. The Theraplay® Institute Newsletter of Fall/Winter.

Panksepp, J. (2001).  The long-term psychobiological consequences of infant emotions: prescriptions for the twenty-first century.  Infant Mental Health Journal, Vol.  22(1-2), 132-173

Schore, A.N. (1994) Affect regulation and the origin of the self:  The neurobiology of emotional development.  Hillside, NJ; Erlbaum.

Schore, A. (2003)  Affect Regulation and the Repair of the Self.  New York: W.W. Norton.

Schore, A.N. (1997) Early organization of the nonlinear right brain and development of a predisposition to psychiatric disorders.  Development and Psychopathology 9, 595-631.

Siegel, D.J. (1999) The Developing Mind: Toward a Neurobiology of Interpersonal Experience.  NY; Guilford Press.

Siegel, Daniel A. (1999)  The Developing Mind.  New York: The Guilford Press.

Slade, A. (2005)  Parental reflective functioning: An introduction.  Attachment and Human Development; 7 (3): 269-281

ATTACh Email Group

Sign up for the ATTACh Email list to receive updates, news, research, training and event info.

Contact ATTACh

612-861-4222

questions@attach.org


310 E 38th Street, Suite 320
Minneapolis, MN 55409