trauma & development...-gabor maté, in the realm of hungry ghosts: close encounters with...
TRANSCRIPT
Trauma & DevelopmentRose Messina, LCSW
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Outline For the Day
• Introductions
• Intentions, mine & yours
• Material: Lecture, Video, Table Discussion
• Break (around 10:30-10:45)
• Material: Lecture, Video, Table Discussion
• Lunch provided (12:30-1:00)
• Material: Lecture, Video, Table Discussion
• End at 3:30
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Intention For the Day
• Brain & Neruoplasticity
• Understand how trauma “works”
• Better understand what trauma does to the body, relationships,
thinking, behavior
• Refine/consider means of intervention:
• How we currently intervene
• How we’d like to intervene
• Discuss protective factors
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What Each of Us May Need
• Take care to notice how you are doing
• Fidgets
• How you typically participate in training
• Notes for follow up practice/drills
• Who we are in the room
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• My Intro:
• Quick introduction exercise: Why a trauma
training? Paired sharing
• Who is in the room, which FRC, County
• Grounding ourselves to go deeper
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Setting the Tone for How We
Engage
• Cleveland Perspective video
• https://www.youtube.com/watch?v=cDDWvj_q-
o8&noredirect=1
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–Laura van Dernoot Lipsky
“All of the wisdom you are about to encounter
is known to you already. This text is simply to
help you remember.”
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Early Brain Development
• We develop from the brain stem up
• First order of development is regulation
• Close behind is attachment (parallel)
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Neuroplasticity
• The brains ability to change in response to
repeated stimulation (both positive & negative)
• The brain’s potential to adapt is a result of genetics
& experience
• Historically, theory suggested a very limited
window (0-5 or 0-12)
• Current research: The Brain That Changes Itself,
Norman Doidge, M.D.
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The Body
Keeps the
ScoreBessel van der Kolk 2014
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Metabolizing Experience
The brain takes experiences and
processes them, much like the digestive
system processes food. That is, if an
experience is properly “digested,” it is
integrated into the system and supports
healthy growth. If a traumatic experience
is not integrated because of how it is
stored in the brain, a person can suffer,
both physically and emotionally
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The Attachment and
Biobehavioral Catch-Up (ABC)
• Mary Dozier, Ph D
• Nurturance even when children do not appear to
need it
• Mutually responsive interactions in which
caregivers follow children’s lead/need
• Care that is not frightening or overwhelming to
children, adults regulating themselves
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Why Discuss Trauma?
• ACEs: Adverse Childhood Experience Study
• www.ted.com/talks/nadine_burke_harris_how_chi
ldhood_trauma_affects_health_across_a_lifetime
• The cost of not knowing, not speaking
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Post ACEs video
discussion
What stood out?
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• ACEs calculator (handout)
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What is Trauma?
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“Trauma is not an event in itself but, rather, a
response to an experience that is so stressful
that it overwhelms an individual’s capacity to
cope.”
-Susan Craig (2008) Reaching and Teaching
Children who Hurt
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Understanding Trauma &
Intersection with Attachment
• Parental separation
• Parental unavailability
• Harm at the hands of parents/caregivers
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Taking Care of Ourselves
• Time for a stretch
• Connecting to our own resilience
• How do you build this into your day?
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Attachment & Why it Matters
• One thing we share with other species is an
evolutionary-based instinct to seek protection
from a parent or caregiver when we experience
danger.
• The development of attachment is especially
important for the human infant, since it is a
considerable time before we are able to move,
feed, or defend ourselves.
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• Attachment processes are social and psychological
in nature, yet are based in the biology and
chemistry of the child’s developing brain.
• Brain development is profoundly influenced by
attachment experiences
• The young brain is like a super sponge, absorbing
every experience into its neural architecture.
• If the sponge is drenched in challenging
experiences, that is what takes up the space
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How Does Attachment
Develop?• Infants and parents are programmed to attune
to each other
• Infant’s primary tasks in the first 3 years are to
learn self regulation, engagement,
intentionality, sense of self, express emotional
ideas
• A parent’s primary task is to teach this
regulation to their baby
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Attachment continued
• Secure attachment develops when a parent
responds with sensitivity and attunement
• What starts as parent’s regulation of baby
evolves into the child’s internal regulation
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Early Development of
Memory
• Repeated experiences strengthen a neuronal
pathway, becomes encoded
• Creation of an Internal Working Model of the
World & Self for survival & Growth (Bowlby)
• Implicit memory
• Explicit memory & language development
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Internal Working Model
• The early caregiving relationship provides a
relational context in which children develop a
model of self, other, and self in relation to
others
• The infant, then, is not simply acquiring an
internal memory of events, but is storing
information about events and then actively
makes predictions based upon a model of the
external world (Bowlby)
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Working Model & Attachment
Secure Attachment
Self = lovable, worthy, good
Others = helpful, trustworthy, good
World = safe and predictable
Insecure Attachment
Self = unlovable, unworthy, bad
Others = hurtful, untrustworthy, coercive
World = dangerous, chaotic
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The Intersection of delay in
development experienced as traumatic
• When one’s biology/physiology is confronted by an
environment that is too much or not enough
• Processing or attentional deficits often lead to
children feeling barraged by environmental demands
• Inability to respond “appropriately” can be interpreted
as willful “behavior”
• Part of human development is learning to notice less
than we are able to see-filtering
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Developing Executive
Function• Categorization
• Relies on the development of time and space
perception (vestibular, auditory, visual,
hippocampus)
• Problems solving capacity is the root of higher
levels of executive functioning
• “As long as you can imagine how things can be
different you will be OK” -Bessel van der Kolk
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Trauma Types
• Developmental Trauma (van der Kolk)
• A traumatic event
• Intergenerational Trauma
• Traumatic experience as a result of
environmental “overwhelm” developmental delay
• Chronic Stress
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• Harvard video on The Impact of Early Adversity on Children’s Development
http://developingchild.harvard.edu/resourcecatego
ry/multimedia/36
Complex Trauma
Complex Traumatic Exposure: refers to
children’s experiences of multiple traumatic
events that occur within the caregiving
system- the environment that is supposed to
be the source of safety and stability in a
child’s life.
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Impact of Trauma on Self-
Regulation
• Difficulty concentrating
• Aggression with peers and adults
• Clinging behavior
• Selective attention to cues of danger
• This is critical when the child’s developmental
task involves learning to modulate affect
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Impact of Trauma on
Readiness to Learn
• Clinginess leads to decreased exploration of the
environment
• Selective attention to danger cues means that
other relevant information is missed
• Inability to concentrate and focus attention
decreases persistence with new tasks
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Adaptations to Complex
TraumaProblems with:
• Regulation of affect and impulses
• Cognitive functioning/ Dissociation
• Somatization
• Sense of self
• Relationships
• In the absence of talking, children often make inaccurate
meaning out of what happened
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Drawing the Unspeakable5 y.o.
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What Causes One’s Brain to
Flip the Lid?• Transitions
• Changes
• Feelings of shame, guilt, vulnerability
• Sensory overload
• Intimacy, strong connection
• Confrontation
• The unknown
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Common Mistakes We Might
Make
• Missing that the person may be having a trauma
response
• Miss our own triggers & react from our feelings
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Addressing Defensive
Behavior• Notice when a person may be triggered
• First person to calm is self
• Connect & redirect
• Provide two options for shifting behavior
• Only provide options that you can provide
• Clear, simple, visual directions
• Body language
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Lisa 911
• Introduce Audio, with transcript.
• www.liveleak.com/view?i=8aa_1359117135
• What do you imagine was happening for the 6
y.o. child, baby?
• What do you imagine was happening for the
mother?
• What do they need?
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Ghosts In The Nursery
(Fraiberg)• Becoming a parent brings back memories of what it
was like to be a child
• Fears & worries that the past may repeat
I might not be a good enough parent
Will I harm my baby?
Will my baby harm me, take over my life, not choose
me?
• Unconscious repetition of the past in the present
• For many parents, their parents were fighting a battle
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Angels in the Nursery
• Lieberman & Van Horn
• Benevolent experiences also last a lifetime
• Importance of bringing up good memories
• Sometimes angels are hidden
• Look for ports of entry
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Breaking the Cycle
• What predicts whether the parent’s past will be repeated
with the child?
• Remembering saves the parent from repeating
Remembering allows the parent to identify with the child
• Those who connect emotions to experience are less
likely to repeat
• Developmental Guidance & Seeing Benevolence
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Unwittingly, we write the story of our future from
narratives based on the past...Mindful awareness
can bring into consciousness those hidden, past-
based perspectives so that they no longer frame
our worldview.’Choice begins the moment you
disidentify from the mind and its conditioned
patterns, the moment you become present…Until
you reach that point, you are unconscious.’ …In
present awareness we are liberated from the past.”
-Gabor Maté, In the Realm of Hungry Ghosts: Close
Encounters with Addiction
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The Protective Factors Framework
Center for the Study Of Social Policy
• Research supports that when these Protective
Factors are well established in a family, the
likelihood of child abuse and neglect
diminishes.
• These Protective Factors also promote optimal
child development.
• They intersect & overlap
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Parental Resilience
• Resilience is the ability to manage types of
challenges that emerge in every family’s life
• Finding ways to solve problems
• Building & sustaining trusting relationships
• Knowing how to seek help when necessary
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Social Connections
• Community in a broad manner
• Emotional support, problem
solving, parenting support
• Opportunities to give back
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Concrete Support in Times of
Need
• First meet basic economic needs (Shelter,
food, clothing, health care)
• The type of support a family needs can really
vary
• Ask about crisis times (past/present)
• If we don’t ask, who will?
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Knowledge of Parenting &
Child Development
• Help parents see the strength, need and
developmental stage
• A parent’s childhood experience often
influences their lens (may have a desire to
be like my family or NOT like my family)
• Developmental guidance/exploration allows
for more conscious parenting
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Social & Emotional
Competence of Children
• A child’s capacity to regulate &
effectively communicate has profound
impact on their relationships.
• Early identification and services critical
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4 cases
What might the child & parents need from us?
• Adam -Complex trauma
• Joseph -Vestibular & hence environment
• Oscar -Neuro-atypicality & MH of parent
• Edwin -Accident & medical trauma
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Common Developmental
Guidance Themes
1) Crying and proximity-seeking are the young child’s
most basic communication tools, and children develop
a healthy sense of competence and self-esteem when
the parent responds by offering comfort
2) Young children have a strong desire to please their
parents, although parents are often unaware of it
3) Separation anxiety is an expression of love and fear
of loss rather than a manipulation
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Common Developmental
Guidance Themes (cont.)4) Young children fear losing their parent’s love and
approval
5) Young children imitate their parents because they
want to be like them
6) Children blame themselves when their parent is
angry or upset (cognitive egocentrism)
7) Young children believe their parents can do
anything
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Common Developmental
Guidance Themes (cont.)
8) Children feel loved & protected when their parents
enforce rules about safety & danger, right & wrong
9) Toddlers & preschoolers use the word “no” as a
way of establishing a sense of autonomy not out of
disrespect for their parents
10) Babies & young children remember, preceding
their capacity to speak. May be more about what they
learned than what they remember
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Common Developmental
Guidance Themes (cont.)
11) Young children feel intensely, but don’t yet
know how to regulate their emotions. They can then
express this intensity in socially unacceptable ways
12) Conflicts between parents & children are
inevitable due to different goals, personalities, &
developmental stage. This can serve a valuable
function in coming to resolution (i.e. sleep)
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Peter Levine
“In the case of trauma patients, we have a
person who is locked in the fight-or-flight
response. A person who is functioning
primarily in the brainstem, and the language
of the brainstem is the language of
sensations. So if you are trying to help the
person work with the core of the trauma
response, you have to talk to that level of the
nervous system.” –Peter Levine
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Peter Levine
“…because the overwhelm and the fight-or-flight
are things that happen in the body, what I would
say is the golden route is to be able to help people
have experiences in the body that contradict those
of the overwhelming helplessness.”
-Peter Levine
http://www.psychotherapy.net/interview/interview-
peter-levine
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Important to Focus on Typical
Developmental Areas too
• Once there is a trauma, not all
experience is influenced by this
• A parent’s grief or shame related
to the trauma can impede their
sense of efficacy to parent
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Trauma Informed Approach
According to SAMHSA’s concept of a trauma-
informed approach, “A program, organization,
or system that is trauma-informed:
Realizes the widespread impact of trauma and
understands potential paths for recovery;
Recognizes the signs and symptoms of
trauma in clients, families, staff, and others
involved with the system;
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Trauma Informed Approach
(continued)
Responds by fully integrating knowledge about
trauma into policies, procedures, and practices; and
seeks to actively resist re-traumatization."
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SAMHSA’s Six Key Principles of
a Trauma-Informed Approach
• Safety
• Trustworthiness and Transparency
• Peer support
• Collaboration and Mutuality
• Empowerment, Voice, and Choice
• Cultural, Historical, and Gender Issues
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As practitioners, we have been
socialized in ways that many others
may not agree with.
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Example of Cultural Assumptions,
Ghosh-Ippen
• Young children remember their experiences
• Traumatic experiences are encoded in the brain and body
• Caregivers are the best people to help children make
meaning of their experiences
• It is good to process and talk about your past experiences
• Young children communicate through behavior and play
• It is good to express your feelings
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Treatment Options
Not all treatment is the right for everyone:
• ABCs of BioBehavioral Catch Up, Mary Dozier
• Child Parent Psychotherapy
• EMDR
• Neurofeedback
• Yoga
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Trauma Has a Tendency to
Fracture & Divide
• What resources does the family need?
• What level of support does the family need to
access these resources?
• What level of coordination across service
systems is needed?
• Encouraging family competency & use of
community
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Keep Learning What is Out
There
• Early Start
Neighborhoodearlystartneighborhood.ning.com
• CSEFEL
• Tolaris Institute
• First Five workshops
• Title IVE workshops
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How we can continue to take Attachment
and Trauma Theory into Account:
• Creating intentional & meaningful processes
• Reflect upon own personal, familial and cultural
experience
• Consult, consult, consult
• Supporting families in getting the culturally and clinically
appropriate services they need
• Ongoing training, support, and education
• Advocate at every level (IEPs, School Districts, Vote)
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–Angela Davis
“I’m no longer accepting the
things I cannot change…I’m
changing the things I cannot
accept…”
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