Posts Tagged ‘Trauma’

Living in a Virtual War Zone: The Children and Adolescents of Domestic Violence

Wednesday, April 25th, 2012

A 2006 survey of American households revealed that nearly 30% of children, many of whom are very young, live in homes where there is some form of intimate partner/domestic violence. Children and adolescents who witness or experience trauma, including domestic violence, display increases in stress hormones comparable to those displayed in combat veterans. This research finding makes sense from the perspective that these children and adolescents are living in a virtual war zone! Children and adolescents may experience long term effects from chronic exposure to domestic violence which may include: impaired academic performance; reduced levels of motor and social skills; behavior problems; substance abuse; self-harming behaviors; changes in brain physiology and function; and emotional difficulties including depression, anxiety disorders and post-traumatic stress disorder.

Many times the question that people ask is, “Why doesn’t she just leave?” By the time the family reaches the point where this question is being asked, the family is deeply entrenched in the cycle of violence and abuse. The mother and children are living in a constant state of fear and anxiety and they are dominated by responses of flight, fight or freeze. The neurobiological impact of trauma and the emotional, cognitive and behavioral adaptations that the family makes impacts their ability to makes decisions, develop safety and exit plans, and to fundamentally believe in their own ability to find safety. The ability “to leave” is profoundly trumped by the need “to survive”.

The coping strategies that families develop may help them survive the abuse and violence in their lives and those strategies will often go on to create patterns that wreak havoc on the rest of their lives.

On June 1st, at my workshop at the Institute entitled, “The Impact of Domestic Violence on Children and Families,” we will identify maladaptive coping strategies that families develop to manage their reactions to abuse and violence. We will identify interventions that reinforce positive and nurturing parenting skills and explore stress reduction strategies to address the neurobiological, emotional, somatic, and cognitive aspects of traumatic stress they have experienced. We will focus on enhancing self-regulation skills and skills that support social and peer group competence. We will focus on collaborating with families in their healing from domestic violence by supporting secure attachment between children/adolescents and their non-abusive parent as we enhance their safety and stability.

The Impact of Sandusky on Clinicians and Clients

Wednesday, December 21st, 2011

I can only imagine how the Sandusky scandal has impacted your practices. For my clients it has been profoundly triggering. The ongoing reality that children continue to be betrayed and violated while adults look away- minimizing, rationalizing, and denying the unimaginable horrors that someone with power can inflict on innocent lives –has opened healed wounds and caused new ones. My clients get angry all over again, and re-connect with the grief, despair, and helplessness they experienced in childhood. For them, the onslaught of new disclosures and the tepid empathy shown towards the victims reinforces the relentlessness of their own experiences, and the lack of protection and compassion they felt from others whenever they did find the courage to come forward with their trauma narratives.

As clinicians we have a difficult task ahead of us. It is unclear how this story will play out in the media and the courtroom. How vocal and articulate will Sandusky’s supporters be? How much “blaming the victim” will be woven into the story? Will his attorneys attempt to distort the truth, downplaying the seriousness of his offenses or the long-term adverse effects on his victims? Will Sandusky take any responsibility for his actions or be held sufficiently accountable in a court of law? And what will be the short and long-term effects on our clients?

As is often the case, I find myself confronted with the reality that there are many things that happen in this world that are not within our control. And there are some things that are- including the meaning we choose to attach to events, the extent to which we learn and grow from them, and what we do with them once they have occurred.

I encourage my colleagues to use this very difficult event as an opportunity to continue educating both clients and the community at large about the dynamics of abuse and victimization. Focus on the innocence of children and the need to proactively protect them from predators. Let it be known that “looking the other way” makes you an accessory, and is an unacceptable and unconscionable response. Challenge the media when they use the word “relationship” to describe “rape.” Empower survivors of sexual abuse to find the courage to share their experiences, ending generational cycles of secrecy and denial. Educate anyone who downplays the severity of what was done to these children. Keep the discussion alive- it not only validates experiences, it gives survivors a voice and communicates to them that we care, deeply, about their pain and believe, deeply, in their capacity to transcend it and heal.

Remembering 9/11

Sunday, September 11th, 2011

At this time of year, I always reflect upon the trauma and tragedy of 9-11. Like so many of you, the details of that day are forever etched in my mind, proving, in part, how vividly we can retain the emotional and somatic memories of something that profoundly affects us. I cannot tell you what I ate for breakfast three days ago, but I can tell you, in exquisite detail, all about that Tuesday morning, 10 years ago. And so can anyone I talk to about that day.

Putting aside the feelings of terror, the surreal nature of it all, the overwhelming anger and grief- New York is my home, and home to my family- I remember the extraordinary “coming together” that we all experienced for weeks, even months afterwards. When the second tower fell, I think there was a universal sense of vulnerability. And with that vulnerability came our hard-wired, reflexive drive to reach out, protect, and comfort one another as best we could. For an extended period of time after 9-11, we were kinder to one another. We were more patient, more compassionate. It was implicitly understood that every one of us had been shaken to our core and we had become untethered. Reaching out, assisting each other in ways we hadn’t before, even making eye contact and smiling at strangers, helped us to feel moored again. We re-connected with our humanity and were reminded of the importance of “being there” for each other.

My wish, as we acknowledge the 10th anniversary of this tragic time in our history, is for each of us to again remember the importance of reaching out, connecting, supporting, and comforting one another. Trauma is insurmountable when we cannot find any meaning in it. May we continue to find meaning beyond the senselessness of 9-11 and the wisdom to act on the lessons we can learn. Remember the healing power of reaching out to others in gratitude and love. May you find comfort and peace this 9-11.

Adolescent Substance Abuse and Trauma

Monday, August 29th, 2011

by Denise Tordella, MA, LPC

Adolescent Substance Abuse is America’s #1 Public Health Problem, according to the June 2011 study by the National Center for Addiction and Substance Abuse (CASA) at Columbia University (www.casacolumbia.org/upload/2011/20110629adolescentsubstanceuse.pdf). The CASA report states that childhood trauma, including: abuse; neglect; and household dysfunction are significant risk factors for adolescent substance abuse. The CASA study also states that a lack of education and training on this topic leads to failure in addressing it with adolescents. Only 6.4% of adolescents in need of treatment receive it and we all know the impact of untreated substance abuse disorders in our clients.

Substance abuse, like any other self-harming behavior, begins as a survival strategy. It starts out as a way to regulate dysregulated arousal states that may develop as a result of: disorganized attachment issues; emotional, physical and sexual abuse; neglect; co-occurring mental health disorders (e.g., depression, anxiety); and grief and loss. Initially drug and alcohol use seem to alleviate stress, either through the increase in pleasurable sensations and emotions or the avoidance of intense, trauma related emotions and sensations. In the long run, substance abuse takes on a life of its own because more of the psychoactive substance is required to achieve the same effect and, eventually, adolescents need to use psychoactive substances to deal with the symptoms of physical and emotional withdrawal. They do not use to “feel good”; they use to “feel less bad” on so many levels. Substance abuse also puts adolescents at risk for additional trauma (e.g., sexual and physical assault, injury).

Trauma, and its impact on mental health and substance abuse issues, must be addressed concurrently in treatment. We need to validate the adolescents’ creative, albeit maladaptive strategies to self-regulate their arousal system and develop compassion and acceptance to counteract the shame and guilt that is the inevitable result of addiction and trauma. When treating this population, we must address how the use of psychoactive substances has helped the adolescent to cope. We should explore the thoughts, emotions and sensations that are being managed by substance abuse in order to identify the symptoms that will be exacerbated as substance abuse decreases. We should identify interventions specifically targeted to increase the range of coping strategies for adolescents as they begin to “crowd out” substance use as their primary coping strategy. I have had the wonderful opportunity to complete Level 1 of Sensorimotor Psychotherapy training as developed by Pat Ogden and I am currently studying Level 2. It is so important to help adolescents recognize sensations in their bodies. Once they are tuned in to these sensations we can teach them to regulate and manage them so they can remain grounded and centered in their bodies. When this is accomplished, they don’t need to use alcohol and other drugs to regulate these experiences in a maladaptive way.

Join us on Monday, September 19 for the workshop, Making the Connection: Adolescent Substance Abuse & Trauma to learn about assessment and treatment strategies for adolescents impacted by traumatic stress and substance abuse. In this training, we will explore how to provide trauma-specific, integrated treatment strategies and interventions for working with adolescents with substance abuse disorders. All of the aforementioned issues will be explored in the training. Please join us for an opportunity to share your knowledge, expand your education, and to learn trauma-specific approaches to address adolescent substance abuse that you can use with your clients the NEXT DAY!

Trauma and the Body

Thursday, August 11th, 2011

I hope you are continuing to get the most out of summer. I wanted to share with you a wonderful experience I had at the Cape Cod Institute, training with Pat Ogden, the brilliant creator of Sensorimotor Psychotherapy. The power of this work cannot be under-estimated and I think it is an absolute necessity to incorporate “the body” in our understanding of how trauma is stored, and subsequently retrieved, de-coded, and processed in therapy.

Pat shared many fascinating videos with us illustrating, first-hand, how quickly clients can re-connect with thoughts, feelings, and memories through an awareness of body movement and sensation. Inviting clients to “go to” body sensation by asking, “what’s happening right now on your body?” not only yields meaningful information, it enhances a state of mindful awareness, which can help clients return to the “present moment” and reduces dissociation.

Tracking, labeling, and articulating sensations of tightness, constriction, collapse, tingling, etc. also helps our clients to stay in their pre-frontal cortex, rather than their limbic system- where flight/fight and freeze responses get activated. Helping our clients heighten their awareness of body posture, movements, and sensations, can be used for centering, re-grounding, containment, and the delineation of healthier boundaries. In turn, these interventions reduce feelings of victimization and strengthen a sense of empowerment.

I was further inspired by Pat’s discussion of how attachment dynamics (secure, insecure, avoidant, ambivalent, and disorganized) all yield messages and affective responses that get imprinted on our bodies and profoundly affect our posture and body movements. We adopt body patterns that keep us safe in the world. Children who feel loved, secure, and accepted have body language and posture that exudes confidence, openness, connectedness, etc. Traumatized, abused, and neglected children have posture that is closed, defeated, collapsed, defensive, protective, etc. In Pat’s words, “the body tells the story of our history.” Exploring body postures and gestures can re-connect clients to long forgotten pain narratives. And when we help clients re-align their bodies, we create the opportunity for new experiences and a letting go of well-entrenched symptoms that often sustain feelings of hopelessness, helplessness, repeated victimization, dissociation, and a sense of being disconnected from others and self. Simple interventions including: elongating the spine, bringing weight onto the balls of the feet, taking a deep breath, expanding the chest, standing up, pushing away with the arms, or putting both feet on the floor, can create profound cognitive and emotional shifts for our clients.

Having a simultaneous awareness of our own body movements, postures, gestures, and sensations can help us remain grounded and present during challenging sessions, and reduce counter-transferential responses that communicate confusing messages to our clients or inadvertently undermine our efficacy. To learn more, I highly recommend Pat’s book, Trauma and the Body. I also encourage you to take some of our wonderful trainings at The Institute that focus on working creatively with the body. It will profoundly enhance the quality of your work! And if you already incorporate Sensorimotor Psychotherapy and other Body Therapies in your work, we welcome your feedback!