Tuesday, March 27, 2018

Update Six
Trauma & Therapy

The Traumatized Child: A Malleable Mind
An Essay
by Dr. Marcy Davidson

Traumatized 15 Year Old Girl Self-Portrait

by Anthony Servante

In this update, I decided to address the approach that therapists take toward traumatized children. I talked to two experts in the field: A therapist and an academician. Dr. Marcy Davidson agreed to write a summary of children's therapy from diagnosis to goal-setting.

Let's begin.

Trauma & Treatment for Troubled Children
by Dr Marcy Davidson

What is a troubled child? If you ask any parent, you'd receive a variety of answers. Parents tend to focus on the actions and behavior of their kids for their answers, rather than on the child's frame of mind or the source of the troublesome activities. My child shoplifts food that he would never even eat; his closet is filled with canned goods and moldy cheese. My child walks until he is so exhausted, I have to go pick him up and drive him home; I've driven as far as the beach once, and we live in Los Angeles. That's a six hour walk. My child pretends to go to sleep, and when my husband and I are asleep, she watches TV using headphones to stay quiet. Her teachers have told us that she sleeps in class and in the lunch area. She is ridiculed by her fellow students, but it doesn't bother her at all. My child talks aloud to herself; she says she's trying to drown out the voices in her head. The anti-psychotics don't help at all. My child gets into fights with anyone who meets eyes with her. My child washes her hands till they're raw. My child suffers nightmares that she describes as "more real" than her home life. My child cries for no reason, and minutes later, she happy as can be.

But if you ask these parents why their children act out in this way, they'll say that it is because they have problems with authority, they're going through a teen phase, or they may be Autistic. Maybe they are seeking attention. Maybe they are displaying symptoms of early onset Schizophrenia. Maybe they are on illegal drugs.

But rarely do parents say that their kids are suffering from traumatic stress and they don't know how to deal with it.

That's why the first step a therapist must take when meeting with a patient alone (the primary meeting with parents, therapist, and patient determines whether the child qualifies for therapy or if the anti-social behavior is rooted in non-traumatic circumstances, such as reacting to a divorce situation at home). The evaluation serves to eliminate non-therapy problems, including issues with environment, until only the issues of the child's mental health can be assigned a corresponding treatment. Once it is determined that therapy may provide solutions for the problem child, the parents are brought in to sign off on the prescribed treatment. Root causes for the problematic behavior are spoken of only in general terms. Here goals are set for the child so the parent can have indicators to observe and track at home and to share with teachers at the patient's school to also track indications of progress or regression.

Once the parents agree to the therapy goals, the therapist meets with the patient to discuss their home environment, school environment, and typical routines of the child. The environmentalization process is the beginning to finding the underlying patterns that hint at an internalization of psychotic or social trauma. For instance, was the child touched in an inappropriate way at home or school or is the child bullied? Perhaps the news on television about the death of a child his or her own age brought about a break in an old routine or created a new branch for a new routine that may be deemed "odd" for the child. The therapist maps the patient's external social life in an effort to find the source of the anti-social breaks in the environmental maps.

Then we pinpoint neurotic behaviors in the maps, repetitive social tics that can indicate a causal relation lying behind each neurosis. For example, Anxiety manifests as fear of animals, strangers, dark places, or bad memory triggers. They child may take a different route home from school or a different route to school from home that may indicate an avoidance of a particular memory. Denial manifests itself as displaced reality, where fantasies become the new version of the source of the trauma. The child may disappear into elaborate video games, TV shows, books, or fantasy card games where certain characters take on an importance in the child's routines. Protective states such as withdrawal or excessive daydreaming render the child unapproachable. The child may avoid conversation or answer in monosyllabic responses or not communicate at all. Insomnia reflects possible night terrors, nightmares, or fear of uncontrolled memories (as unleashed in dreams). The child may deliberately stay awake in an effort to suppress bad memories that bad dreams may unleash. This, of course, is but a brief list. Once the underlying neurotic triggers correspond with the environmental maps, therapeutic techniques and their goals are then considered and chosen.

Hereafter, communication is the primary source for gathering indicators. The therapist, the parents, and the teachers must pool their findings of the child's activities to adjust the therapy until the right environmental paths can lead us to these goals to help change the child's self-destructive behavior.

Firstly, if the patient is inclined, the therapist can talk with the child. The good in this oral form springs from the information that can be gathered while also observing the manner and tone of the child's voice and their body language; the bad is the difficulty for the therapist to determine whether or not the child is telling the truth or manipulating the account in order to shape the therapist's own expectations. Secondly, a medium can be selected by the patient to put down their thoughts; this form includes drawing, painting, writing poems or stories, molding clay figures, dream interpretation, or any other tangible artistic outlet that the child feels comfortable with regarding sharing their internalized trauma via an external objective outlet. This can also include texting by cellphone between patient and therapist and taking photographs with the cellphone to capture images that remind the patient of something relative to the past.

Two areas of the child's mind are being brought to the surface with these play techniques: One, the unconscious motivations for the problematic behavior; two, the triggers for this behavior. The roots of the problem can be revealed to understand the manner of hiding the roots (projection, denial, aggression, withdrawal, etc) while the surface reasons for the bad actions can be correlated to the environmental maps. Here the therapist takes on the role of translator and interpreter, but one must be careful with such therapy as such techniques also bring with them the risk of the therapist's own subconscious weaknesses (fear of misreading the maps and play, anxiety about transference from the preteens and adolescents, and worry about too many hours spent in conference with the child--over ten hours a week in some cases). In nearly all cases, the therapist must work with the parents during each step of the child's therapy, from diagnosis to "play" therapy techniques. At minimum, the therapist should consult with a fellow therapist to compare notes in regards to diagnosis, selection of therapy, play, and progress.

As you can see, therapy is a village, not a doctor-patient relationship. As always, progress is the main goal. For childhood trauma, there is rarely a cure, but making it through each day adds up to weeks, months, and years of leaving the trauma in the past, even if only a minute at a time. With consistent therapeutic play and measurement, the child can learn to deal with the trauma well into his or her adult life.

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