Understanding Trauma

Impact of Trauma on Children and Youth 

The 36 slide PowerPoint for this presentation can be seen at 

Understanding Trauma

Sandra Privanic, a clinician at BOOST, described trauma as a single or series of events – the salient characteristic of a traumatic event is its power to render helplessness and terror. She emphasized that trauma cannot be measured – it is never simple.

Events that can traumatize a child include experiencing physical or sexual abuse or witnessing violence. The sudden death of a loved one or a natural disaster (fire, hurricane) can also cause a trauma response. War and genocide can be part of the family trauma narrative. There is added complexity and a negative impact for the child if the parent is the abuser, and if there is a history of inter-generational abuse.

When trauma comes from within the family, children frequently experience a crisis of loyalty and organize their behaviour to survive. Many, who must keep silent about what they see or experience, deal with their helplessness with compliance or defiance, and accommodate to their abusive situation in any way they can.

Where the child-caregiver relationship becomes the source of trauma, children’s attachment process is impacted.  As well, when many critical development competencies are severely disrupted, children become unable to process or integrate what is happening (see slides 11, 12 and 13).  The consequences of these traumatic events are likely to derail a child’s healthy biological, emotional, cognitive and social development.

Trauma can interfere with the attachment process (slides 14 – 17). Attachment is described as the building block of the foundation of mental health.   Attachment greatly affects how child responds to trauma – how they will heal. A secure attachment can mitigate against the impact of trauma.

The common reactions to trauma (see slides 21 – 23) include: anger, confusion, sadness, worry, numbness, hurt, disbelief, fear, anxiety, minimization, denial, guilt, betrayal, embarrassment. Trauma often leaves lasting imprint on the body — it is “unremembered but unforgotten” (Winnicott). Trauma memories remain un-integrated and are very powerful.

Children may react to trauma in a number of different ways that include: nightmares, physical symptoms, hyper-vigilance, difficulty concentrating, dissociation (although physically present they may not be mentally there at all), avoidance (staying away from places, people, things that remind them of the traumatic event), intense fear and worrying, anger, intense sadness; remembering the traumatic event/ flashbacks when seeing, hearing or smelling something that reminds the child or youth about their experience.

A child’s reaction to trauma can also include re-enactment of the traumatic event – expressing fears and elements of trauma through play. Trauma may result in a child remaining silent and/or loss of acquiring communication skills. Silence can sometimes be misinterpreted. Sometimes a child will be silent because they cannot remember. Many of the above reactions are normal responses to distressing or difficult experiences. They become a concern when they begin to impact daily functioning.

Complex Trauma (see slides 24 – 29).

  • Children’s exposure to multiple or prolonged traumatic events, and the impact of that exposure on their development was discussed. Complex PTSD better describes the pervasive negative impact of chronic repetitive trauma than does PTSD alone.  Many children come to BOOST for assessment – a case example demonstrated the need for a comprehensive approach, which takes from 5 – 7 sessions.

Treatment (see slides 30 – 35)

Treatment can take a year, or more. BOOST helps children and youth create a safe space to look at the traumatic experiences, make sense of their emotional, cognitive and physical reactions and, help them find new ways of coping.

 

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QUESTIONS, ANSWERS, COMMENTS

COMMENT:  We work with First Nations, and encounter many clients with complex trauma, and inter-generational trauma.  Often they need to go back and try to remember, in order to feel a sense of control over the traumatic events that occurred. We learned that it’s important to differentiate complex grief from the trauma.

 

RESPONSE:  It is important for the therapist to be aware of her own triggers — the client can pick up on how you react – very quickly.

 

 

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COMMENT:   We have a large, culturally diverse client base – how can we best serve diverse communities?

 

RESPONSE:  My advice is — look for whatever is alive in the client — if it is their spirituality/ religious beliefs — then use that to bring back to a whole whatever is broken.

 

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COMMENT:   In cases where children do not talk – where they show no emotion – they don’t appear as if they have been impacted. We need to educate police, crowns, CAS – to see through a trauma lens — to help those other professionals understand the impact of trauma.

 

RESPONSE:   A child’s inability to respond doesn’t mean they don’t know or don’t have something to say – it means that it is just too much. So, it is important that whoever is dealing with the child recognizes this.

 

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QUESTION: What techniques are best to use for complex trauma?

Body-centered psychotherapies – not just cognitive  — but working with the whole body

  • Sensory motor
  • Psychotherapy
  • TFCB
  • Cognitive therapy
  • Relational
  • Mindfulness and yoga
  • Play therapy
  • “My little beating heart” –  a toy with heartbeat that is very self- soothing

 

 

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COMMENT:   Some police worry that  therapy will interfere with the investigation.

 

RESPONSE :  The role of therapy is not to find out what did or did not happen. It is about dealing with the emotions.

Children and youth need support throughout the process. If it is before trial, the clinician may discuss coping skills, or problems around court. But they would not be discussing the statements children could make in court.

 

 

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QUESTION:   Are victim impact statements a source of re-traumatization?

 

ANSWER:   Some of my clients have done it — it has been healing. It can also be read by someone else – or taped

 

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QUESTION:   In cases where there isn’t enough evidence to proceed with the charge, and the accused offender is living in the home….. what would the clinician’s role be?

 

ANSWER:   Work with the non-offending caregivers, as well as abused. But there are exceptions. Even if the case does not go through, it is important that the clinician continues to listen carefully, in case the child does say something more. Tread water more carefully – be mindful that the child needs to be safe. So new information needs to immediately be told to police. The clinician would probably discuss safety plans.

 

COMMENT:  (from the floor) – If the non-offending parent is in denial — that is also source of trauma for the child.

 

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QUESTION:  Are all children traumatized as a consequence of abuse?

 

ANSWER:  The majority of children experience some degree of trauma. The earlier we can respond to these kids — the shorter the trauma therapy will be.  But often children are coming in with complex trauma.

 

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COMMENTTrauma training is crucial for all agency professionals who have contact with the child or family.

 

COMMENT:  – NWT is trying to create a mandate for all victim service workers to have trauma training.

 

COMMENT:   – Judges need to be aware of the impact of trauma and trauma symptoms.

 

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