Category Archives: Articles

Incorporating Parents into EMDR Therapy with Children

Confident parentI’m a big advocate for including one or both (or more) parents into EMDR therapy with children – when parents are equipped to be supportive and when the children are comfortable with the parents being present.

I prepare parents for the child’s EMDR therapy by saying something like this: “EMDR processing happens internally, so there will be long silences where your child isn’t speaking. We don’t want to interrupt this internal process, so for the most part, you’ll be a silent but comforting presence. However, I may turn to you and ask a question occasionally. I will do this when I think your child is a little stuck and when I think your natural response will be helpful.”

By keeping parents present:

  1. The child feels more secure.
  2. The parent grows in understanding for what the child has experienced.
  3. As the parent becomes more attuned, the child feels closer to the parent.

Regressed Behaviors in Traumatized Children

lonely child“Why is my 9-year old smearing feces on the wall?”  “Why is my 14-year old stealing food from the cupboards in the middle of the night?”

When my own children were small, I remember reading a passage by child expert T. Berry Brazelton MD describing the phenomenon that every parent has observed at one time or another: regression. He explained that all children “regress” to a slightly younger developmental age when they are stressed by ordinary environmental challenges.

Children who have experienced life as dangerous and frightening due to abuse or neglect often have sudden experiences of extreme emotional and behavioral regression.  Francine Shapiro’s Adaptive Information Processing model can help us understand this.  The model explains that traumatic events become stored in separate neural networks along with emotions, sensations, and perceptions present at the time of the events.  Trauma-related material stored in this way does not become processed, so it remains very separate and isolated in the brain.

Even after an abused or neglected child has been provided a new, safe life, a trigger of some kind can subconsciously light up the unprocessed traumatic memories, causing the child to regress to thoughts, feelings, and behaviors that were present at the time of the traumas.   Many traumatized children regress around certain dates or holidays, certain times of day, or certain types of people.  An angry face, a scolding, or raised voices are particularly triggering due to stored trauma-related feelings of fear, shame, and powerlessness.

A triggered, regressed child may suddenly urinate in strange places, wet the bed, play with feces, masturbate compulsively, steal shiny trinkets, throw tantrums, baby-talk, cling and cry, scavenge through cupboards for food, hide food, or run away.  Regressed children do not have access to their higher order cognitive processes. Many severely traumatized children have become “stuck” developmentally so that their behaviors resemble those of a younger child on a day-to-day basis.

Behaviors caused by regression cannot be disciplined away.  The antidote to regressed behaviors includes strengthening the child’s feelings of security and trust with caregivers, addressing trauma with effective therapy, and reducing environmental triggers.  If you are a parent of a child who exhibits regressed behaviors, be kind to yourself.  It is vital that you find the emotional support you need so that you can maintain your own emotional health while you provide attunement and connection with your challenging child.

Understanding the Problems of Parents and Children Through the Lens of Attachment

Parents Comforting Their SonThe Advantages of a Secure Attachment

 The research in the field of attachment opens up a whole new world for all of us in understanding the problems of parents and children.  Attachment is the emotional connection between any two people.  However, life’s first attachments are by far the most important, as they set a template for all later relationships.  Attachment between children and parents evolved naturally eons ago, as the children who developed a strong need to remain near their parents were the ones who were most likely to survive – both physically and psychologically.

Children who feel the most secure in their early relationships with their parents have tremendous advantages in life.  They tend to grow up feeling good about themselves and others.  They cope well with life’s ups and downs, and they have a strong capacity for empathy.  These children naturally form other healthy, close relationships as they go out into the world.  Children who have not developed a healthy, secure attachment with parents tend to grow up feeling more anxious and insecure, disconnected, and angry.

 Four Ingredients of Secure Attachment

There are four main ingredients to a secure attachment relationship.  The first is affectionate touch and eye contact.  Cradling an infant, cuddling a toddler, and hugging a teenager all increase the sense of connection, especially if loving contact takes place on a daily basis throughout the growing up years.

The second ingredient is emotional attunement.  Children feel close when they sense their parents care about their feelings.  When parents soothe the distressed infant, reassure the frustrated toddler, or comfort the worried preschooler they are strengthening the parent-child bond.

The third ingredient is shared pleasure.  Parents and children enjoy one another through shared play, games, jokes, and giggles.  Mutual enjoyment increases children’s feelings of connection with their parents.

Finally, children need an environment that is consistent, predictable, and safe in order to be vulnerable, open and trusting with their parents.  Without this kind of protective, dependable environment children develop emotional walls to keep their parents and others at a distance.

Obstacles to a Secure Attachment

All babies and children are biologically programmed to attach to their parents, but not all children develop quality attachments.  There are several situations that can interfere with a good attachment.  For example, children with a difficult temperament may be so highly active or so extreme in their emotions that their parents naturally have difficulty connecting with them either physically or emotionally.  Chronic pain or separations due to hospitalizations may interfere with feelings of comfort and enjoyment, preventing the development of healthy bonds.  Children who endured an abusive or chaotic early life and who are later placed with an adoptive family may have intense fear and hurt, and their emotional walls may be difficult to penetrate.

Parents who live in stressful circumstances may have difficulty creating secure attachments.  Out of necessity they may be so preoccupied with solving the problems of living and coping that they are unable to tune into their children’s feelings and needs.  Parents with addictions are unable to stay attuned to their children or provide a consistent, safe environment because they are preoccupied with the addictive substance or behavior, and the whole family may be on the addictions roller coaster together.

Finally parents who grew up without secure attachment relationships themselves often have difficulty providing the ingredients of a secure attachment relationship with their own children.  Parents who did not experience nurturing and closeness growing up may feel uncomfortable with closeness and may subsequently distance themselves from their youngsters.  Parents who were mistreated as children may have an excessive need to exert control over their children in order to avoid feeling vulnerable.  Parents who were mistreated may perceive normal child misbehaviors as attempts to mistreat or hurt them, leading to angry overreactions.  Parents who feel unlovable may fear their children don’t love them, so they may attempt to placate their children or give them things to get them to love them more.  Parents who were not securely attached in childhood may be disconnected from their feelings, or they may be emotionally overwhelmed.

There is Hope for Parents and Children

Most parents love their children and want to give them the best start in life possible.  By gaining a clear understanding of attachment and the obstacles they are facing, parents can overcome their difficulties and create stronger bonds with their children.  Parents who lacked quality bonds as children can learn to identify and overcome the effects of their own early experiences so that they may give their children a better emotional start to life than the one they had.

(Photo: Dollar Photo Club Purchase)

The Trauma Couple

Lover's holding handsMost traumatized adults are not conscious of the profound ways in which the past permeates their thoughts, emotions, decisions, and actions on a daily basis.  Nor do their partners recognize the way the trauma of the significant other dictates their own lives.

 It’s natural for all of us to see only that which is directly in front of us.  We get caught up in the moment and fail to see the shadows of a past that lurks behind the present-day crisis.  The demons battled by the trauma survivor are not in the partner’s line of vision.  Even the trauma survivor may be in the dark as to the source of unwanted feelings and thoughts.  The intrusive traumatic images, fear, and anger are like fireworks exploding in the survivor’s brain, while the explosions are completely invisible and inaudible to everyone else.

Like an animal cowering from the noisy celebrations on the Fourth of July, triggered individuals become withdrawn and quick-tempered, pushing others away in an attempt to find safety and comfort.  Their significant others are often blind and deaf to what is happening on the inside of the person they love.  They see only the inexplicable emotional wall.  They feel shut out, lonely, and hurt, which may turn quickly into outrage.  Trauma survivors are typically unable to respond with empathy to their partner’s underlying hurt, but react immediately and reflexively to their outrage.  The anger they feel from their partner may be perceived as an assault, leading to escalating fear, pain, and loneliness—and so the chasm grows.  The partner in turn may feel increasingly alienated, hurt, angry, and fearful.

Eventually, the partner comes to resemble the trauma survivor with whom he or she is struggling to relate–reactive, defensive, and searching for relief from emotional pain.  In fact, the partner is suffering a vicarious traumatization.  As the partner’s symptoms and reactions escalate, so do the symptoms of the trauma survivor.  Both individuals can quickly become caught up in an endless negative feedback loop of reactivity.  The physical closeness that used to trigger the release of love hormones may now triggers the release of stress hormones for them both.  Increased closeness equals increased anxiety and stress.

Yet–it is possible for a “trauma couple” to heal.  Neither partner started the relationship intending to cause hurt to the other.  Seeking help from a professional is an important step, as an understanding third party can help sort out the stuck patterns and treat the traumas that lie at the root of everything.  The professional can help the partners communicate from an understanding that neither is to blame and both are equally responsible for becoming part of the healing process.  If just one partner takes the risk of letting go of defenses, it can be enough to interrupt the negative feedback loop and begin a new, healthier pattern of communication, with the help of a therapist.  The alternative is a perpetual stand-off, like two cowboys standing in the dust with guns drawn and ready.

It requires courage for partners to explore their triggers and call themselves out on their own unhealthy methods of self-defense.  It requires a willingness to be vulnerable to open up emotionally and share deeper feelings.  It requires commitment to set aside fear and really listen to the other without blame or guilt.  Both partners are likely to struggle and fall back into old patterns due to the underlying traumas and triggers, but if they can learn to give one another the benefit of the doubt and let go of trivial offenses, they will each come to see the real person behind the survival mechanisms of the other.  If both partners practice staying emotionally present to one another, their mutual sense of understanding and compassion can grow and deepen into a strong and loving relationship.

Photo Credit: Dollar Photo Club

Attachment in the Digital Age

My friend and colleague, Joan Lovett MD,Confident Parent said to me not long ago, “I think there will be a syndrome resulting from infants and children attempting to interact with their parents while the parents are talking on their cell phones or playing on their ipods.”  I am afraid she may be right.  There is so much more to DISTRACT us from being really present with our children than there ever was before.  I myself have carried on a kind of “half there” conversation with a family member while on my laptop or returning text messages.  Truly, it is not possible to be “all there” with someone while simultaneously on an electronic gadget.  Due to technological advances, the “gadgets” are becoming more and more compelling, and as we have more and more ways to communicate electronically, the demands for constant communication are increased.  I think as parents (and even as grandparents!), we need to be mindful to contain our electronics to specific times in our day and avoid allowing “screen time” to bleed over into family time.  “Half there” communication with our offspring breeds insecure attachments and feelings of isolation. Our youngsters need to see themselves reflected in our eyes as we look at them, listening but also attuning to their facial expressions and body language.  Our physical and emotional presence teaches them that they are worthy.

“Trauma Time”

file2841250394300Trauma survivors live with a difficult phenomenon that is sometimes referred to as “trauma time.”  Trauma Time is a phenomenon that has grabbed and deceived almost every survivor of trauma at one point or another. Traumatic memories are stored differently than normal memories.  They are encapsulated in unmetabolized form in the limbic, or emotional region of the brain—an area of the brain in which time has no meaning.  This is actually a good thing in the big picture of “mother nature,” with the many challenges that humans have faced through evolutionary time and the ultimate goal of human survival.

Consider this.  If I have experienced frightening or threatening events in my life, there is a good chance that I live in an environment that may also be unsafe for me in the future.  How am I to survive in such a world?  I must remain vigilant and reactive to suspicious sounds, smells, facial expressions, and actions.  I cannot allow myself to be fooled by the passage of time, because the dangerous element might be watching and waiting for me to let go of my vigilance. Never mind that the original source of my trauma is vanished from my life.  Never mind that I am older, wiser, or beyond its reach. These concepts mean nothing to the limbic brain.

It is one of many miracles of nature that the limbic brain is designed without a clock.  “Forever vigilant” is its motto.  Quality of life is of no concern to this part of the brain.  After all, what is quality of life if there is no life?

If I have suffered a trauma one, two, ten, twenty, or forty years previously, a sound, a smell, or a sight may remind my limbic brain of the original danger, triggering an immediate surge of cortisol into my brain.  The cortisol leaves my heart racing, my palms sweating, and my thoughts disorganized and fragmented.  In a split second I may find myself arguing and fighting or hiding in fear.  I may be as confused as others around me regarding my extreme behaviors, and later I may be overwhelmed by guilt and shame.

Some trauma survivors “dissociate,” meaning that the “front part of self” becomes separated from the “emotional parts of self.”  If suddenly I find myself operating from an emotional part of self that holds the feelings related to the trauma, I may truly lose touch with reality and forget the year, my age, and the passage of time.  I am there again–in the middle of the experience, as pictures flash in front of my eyes, and sounds bombard my brain.  It may take seconds, minutes, or hours until I remember where I am and who I am today, in present time.

To be effective, therapy must strengthen the “front part of self,” helping the traumatized individual develop skills for staying centered, self-aware, and tolerant of stress. After building skills, it becomes possible to help traumatized individuals bring “stuck” memories into the therapy office and integrate those memories with helpful information, work through the feelings in a safe, secure environment, and find a new present-day perspective with which to view the memories.  The therapeutic relationship is vital, for it is impossible to tolerate the vulnerability of the work without a sense of connection and compassion from a supportive other.

Therapies that reach into the emotional region of the brain are important to processing stuck traumas, such as Eye Movement Desensitization and Reprocessing (EMDR).  The EMDR therapist instructs the patient to watch her fingers as she moves them back-and-forth while bringing up memories.  This process stimulates important centers needed for processing the material located in the right and left hemispheres of the brain. Art, music, poetry and other creative methods for expressing feelings also help reach into the emotional brain, where memories are stuck.

It is important not to forget the family members of trauma survivors affected by “trauma time.”  Their feelings of powerlessness, fear, and anger need validation.  Psycho-education can help clear up confusion and anxiety in family members, and communication work can help open up new channels for understanding and support.

 

Talking Back to Your Emotional Brain

DepresyonDistressing events from earlier life are stored in the emotional part of the brain along with negative thoughts and beliefs that were present at the time of the trauma.   Old negative beliefs naturally get triggered for any of us when we are feeling vulnerable.  Pay attention to your thoughts.  You may notice yourself thinking, “I’m stupid” or “I’m worthless.”  You may notice yourself thinking, “I’m not safe,” or “Bad things always happen to me.”  All of these thoughts are irrational beliefs that typically accompany traumatic events.

Don’t believe everything you think.  Don’t be complacent and let the negative thoughts run away with you.  You are not your thoughts.  Thoughts are just thoughts.  Beliefs can be accurate, or beliefs can be irrational and false.  Talk back to them.  Remind yourself:  “I don’t have to be perfect.  I’m OK as I am.”

  1. Draw a line down the center of a piece of paper.
  2. Write your irrational negative thoughts on the left side of the paper.
  3. Think about your most rational friend or acquaintance and ask yourself, “What would he/she say to me about these statements?”
  4. Write down the rational responses on the right side of the paper.
  5. Do this exercise again and again on a regular basis.

Catch-22 for Victims of Trauma

Bleached vintage portrait of a sad and lonely teenager I work with trauma victims, young and old.  It is an honor to be allowed to walk the journey of healing with individuals facing challenges brought on by traumatic stress. Although most people sympathize with victims of abuse or violence when they hear about such events in the news, the symptoms experienced by traumatized individuals often include behaviors that cause interpersonal problems, such as aggression, anger, and isolation.  This leads to a “Catch-22,” in that trauma victims need emotional support from others to help the healing process — yet the symptoms lead to relationship problems.  The trauma therapist is often the individual’s first encounter with someone who understands what is happening.

To say that traumatized children have challenging symptoms and behaviors is probably an understatement.  Children affected by chronic traumatic stress often have a poor sense of self and the lowest self-worth imaginable. They are anxious and mistrustful, waiting for the next bad thing to happen. They relive the earlier events of their lives through nightmares or flashes of memories, triggered by reminders of the past, or through compulsive behavioral reenactments of early events.  Children suffering from traumatic stress have chronic high levels of cortisol and adrenaline keeping their nerves on edge and lowering the much needed neurotransmitter, serotonin. Their hyper-arousal makes it difficult for them to access the logical regions of the brain to think, process, delay gratification, or solve problems. Their neurology is wired to fight, flee, and freeze, and so they are reactive, aggressive, and unpredictable.   Their ongoing emotional dysregulation interferes with their cognitive, emotional, and social development.  They think concretely, don’t understand social cues, and have little insight into their own thoughts and feelings.

                An observer in the waiting room of our therapeutic center might see one child sitting quietly, withdrawn, and head down, while another child is bouncing from chair to chair, overturning cushions, and tearing pages out of books.  Many of the children in our waiting room have difficulty recognizing the personal space of others.  They invade privacy by asking personal questions of complete strangers, and they tease and pick on one another. The waiting room observer might see teenagers with ankle bracelets due to house arrest along with pierced body parts, tattoos, and black nail polish.  It’s probably difficult for most adults to view the pandemonium without judgments regarding the children or their parents.   Many of the children are brought in by foster or adoptive parents following removal from birth parents, and the parents themselves are angry, overwhelmed, confused, and frustrated. Teachers, like the one I contacted last week, say things to me like, “I don’t care what happened in his earlier life, he needs to learn his lesson and shape up.”

Society needs more education about trauma in order to better meet the needs of our most vulnerable and hurt citizens. Caregivers of traumatized youngsters also need support, as raising hurt children is a challenging task. For traumatized children to heal, they must learn that the world is now a safe place for them, with adults who care and accept them for who they are.  Unfortunately, the symptoms of traumatized children lead to confusion, anger, and frustration from the adults around them.  The judgments and rejection they see in the eyes of their parents, teachers, and neighbors reinforce their fears, skewed perceptions, and survival mechanisms.  As they mature into adulthood, their unhealed wounds lead to yet another generation of children who become traumatized by the adults who are supposed to protect them.

Lack of understanding of the behaviors and symptoms of traumatized children are obstacles to solving the problems of abuse and neglect.  In my work with hurt kids, I have to be mindful of my own judgments and frustrations.  I have to stay committed on a daily basis to connecting the dots between their current behaviors and the traumas that drive them.  I feel I owe it to them to give them my best self.    My dream is that knowledge of early trauma and its devastating effects can spread, so that the eyes of society will one day reflect a picture of hope and healing for these youngsters.

 

 

Attachment in Adulthood – Early Bonding Contract

Lendora_Clifford_002Infants are born with a natural instinct to bond.  There is an innate fear that without a loving adult present, they will die.  Separation anxiety grows stronger throughout the first year of life, as the infant becomes more attached and feels even more dependent upon one or two primary attachment figures.  Although an infant does not yet have language, infants are wonderful observers and fast learners.  (Ninety percent of brain development occurs in the first two years of life!)  The infant begins developing a set of rules for himself to keep his parent closer and to ease his anxiety.  The rules are the essence of the “early bonding contract.” (I heard this term first from Bertrand Cramer, M.D., at a presentation at the Menninger’s Clinic in Topeka.)

A healthy bonding contract might include, “If I express my needs, I will get my needs met.  If I smile, I can get my parent to smile back.  I don’t have to worry, someone will always be there for me.”

But an infant in greater distress might hold the following rules: “I must keep quiet to keep my parent nearby,”  “I must blend into the woodwork,” “I must not have needs.”  Or another infant might find that the opposite rules are more effective:  “I must yell, scream, kick, and make myself heard in order to get someone to notice and give me what I need to live.”

Infants and children do what they have to do to survive.  If the bonding contract rules work for the infant, he can keep his anxiety at a low ebb.  If the rules work sometimes and not other times, the infant may stay continuously on high alert.

Later in life, an early bonding contract may become an “unlivable agreement” (a term I heard years ago from Landry Wildwind during an EMDR workshop) that causes problems in adulthood relationships.  If I learned to shut down my feelings and show no vulnerability in order to keep my attachment figures around, my partner or potential partner may find me  hardened and unfeeling.  If I learned to scream and yell to get my attachment figures to meet my needs, my partner or potential partner may find me demanding, dramatic, and overwhelming.  What worked to survive as an infant, may potentially sabotage my relationships in my adult life.

The real problem with the unlivable agreement, in my opinion, is its tenaciousness. Because the early bonding contract consists of rules for survival, and breaking those rules means potential annihilation, breaking the rules at any age sends alarms up through the nervous system.  One adult might say, “Expressing myself when I am supposed to be quiet makes me feel like I will die.”  Another might say, “Keeping calm and trusting that my partner will stay with me feels like a recipe for abandonment.”

I’m a big believer in the power of inner child work to address deep-seated beliefs and fears that are rooted in infancy and toddlerhood.  Creating a safe place for the younger self, providing safety, care, and nurturing through imagery can be a powerful tool for healing.  EMDR is a modality that increases the power by reaching into the limbic system with bilateral stimulation.  Awareness is the first step.  The rest consists of self-nurturing, self-compassion, healing, and intentional changes in small steps.

When I walked into the office this morning…

MiaI conducted a training along with my wonderful colleagues Stefanie Armstrong and Cathy Schweitzer here in Omaha yesterday, and the entire group became involved in a discussion regarding how traumatized children and adults over-read anger on faces.  Even facial expressions that exhibit sadness, boredom, or fatigue can be easily read as anger or disapproval.  Voice tones that are monotone or bored are read the same way.   We teach parents the importance of lifting the eyebrows, using a lighter voice tone, being playful and light, as part of developing stronger bonds with hurt children.

I woke this morning a little dismayed about the idea of going into work after conducting a 3-day training here (still jet-lagged from Hong Kong–plus a couple of inches of new snow on the ground to deal with.)  However, when I walked into the office, I was greeted by the kind of scenario that plays itself out all the time here.  My colleagues Cathy and Bonnie were bantering with all the children and the adults in the waiting room.  There was lots of laughter and chaos.  There was a cute, red-haired kiddo lobbying for a good movie for the DVD player.  The atmosphere of laughter and love that we have here immediately lifted my mood and energized me for the day.  Though our group is made up of 10 women who are extremely skilled professionals, there is no pretense, stuffiness, or arrogance in this group. The tone is light, the atmosphere is one of warmth and acceptance.   No wonder so many kids and adults feel immediately at home here.  I am really grateful for this.