I just listened to an Innovation Hub interview with Dr. Jack Shonkoff director of Harvard’s Center on the Developing Child (you can listen to this interview by clicking on the link). The core of this interview discusses the long term effects of toxic stress.
Dr. Shonkoff suggests that everyone knows how it feels to be
stressed. Your heart is pounding, your blood pressure is up, and you feel a
rush of adrenaline. Now, imagine feeling like that all the time. For many
children living in unstable home environments that feeling is a reality and
that kind of constant stress has some serious health implications.
Effect on the Body
“That can have a real wear and
tear effect on the body if that level of stress is present a lot of the time,”
he says, “particularly for a young child whose brain is developing, whose other
organ systems are maturing and developing.”
Dr. Shonkoff, who is also professor of Child Health and
Development at Harvard School of Public Health, in the interview discussed the
“wear-and-tear” effect of toxic stress (chronic stress) on the body—how it can
accelerate aging, lead to disease, and disrupt brain development. In young
children, much of the delicate brain circuitry develops between ages 3 and 5,
so “not doing anything before age 4 for children at greatest risk is a huge
mistake that we pay a tremendous price for later. The key to overcoming these
chronic stressors is boosting positive, predictable interactions between
children and their caregivers.
Effects on School
Not only are these children more prone to conditions like
hypertension or heart disease, but they’re also less likely to develop skills
that are essential to succeeding in school, like paying attention and following
directions. That means that when many children begin attending school for the
first time, a gap has already opened up between students with unstable home
environments and their more well-off peers.
Another good video that this interview led me too was a forum discussion titled “The Toxic Effect of Early childhood Adversity”. It is one hour in length and next time I will summarize the core of it. If you would like to view it now please click on the link. If you would like to read more about the Centers work with toxic stress please click on the link provided.
For anyone who is new to the counseling
experience, it can feel intimidating. After all, it involves disclosing
personal information that can leave one feeling quite vulnerable. I frequently
meet people who have either never been to counseling and hold preconceived
ideas regarding the process or who have kept themselves away due to negative
Reservations are ok
I want to start by saying that it is okay
to feel reservations about counseling- whether from a past negative situation
or just venturing into the unknown. Very few people are comfortable with
complete vulnerability. And counseling can cause differing vulnerability for
individuals from varying walks of life. This is quite normal and
To those of you who have had negative
experiences while seeking counseling may I as a therapist say that I am so
deeply sorry for your experiences. I realize how courageous it was for you to
reach for expertise, in the first place. To instead be met with disappointment
and confusion is not okay. As therapists we are trained to uphold ethical
standards and guidelines that sadly, are not always followed as thoroughly or
honorably as expected. As a therapist, I have seen therapists in my own life
and had some not so great experiences. Unfortunately, I am all too familiar
with such things and empathize with those who have shared similar situations.
Let’s face it, it is not easy to sit
facing someone whom you don’t know intimately and share your life. It can be
challenging not to feel judged or fear being misguided. Moreover, there can be
valid uncertainty with the person in whom one is sharing. A person might wonder
if the therapist can provide competent psychotherapy even with a degree hanging
on a wall. Other times, it might be difficult to relate to relate to different
personalities. It may take considerable time to build that trust and rapport
and some people may find themselves leaving the process too early.
Not just a job
One of the reasons I enjoy working where
I do is that my colleagues really do care about the clients and work that they
do. And more importantly, see the work that they do as God’s ministry for
others. In other words, it is not just a ‘job’. These are the types of
therapists who want to be where they are and do what they do.
with upholding ethical guidelines, there is a deeply held value and honor
knowing that the people we are meeting are of great worth to God. Now that puts
things into perspective! Even more value held is understanding that we too are
human-beings, vulnerable to pain, which provides us with empathy and compassion
for those we are privileged to meet.
Together on a journey
As therapists we may not share the same
social constructs, religious affiliations, or cultural backgrounds as our
clients, but we honor and hold space for them nonetheless. What we do share is
common humanity. And it is important to remember this as a therapist and
client. We are all on a sacred journey through life that is often met with
peaks and valleys.
I hope you come back for part 2, if you would like to read another of Kim’s blogs please click on the link below:
For so long many people have associated post traumatic stress disorder (complex trauma) with only MAJOR events, and while this seems true, it’s not true for every case. As a psychologist (a professional influence of mine) has put it, “trauma is any stress that can disrupt and affect physiology”. In other words anything that occurs that causes stress can have a detrimental effect upon one’s health and physical well-being.
Most all trauma activates the central nervous system. When this occurs, the autonomic nervous system activates it’s own self-correction, self-healing mechanisms. These self-protective methods are the body’s natural way of helping itself, but often cause symptoms and behaviors that aren’t considered ‘normal’ and deemed maladaptive. These methods are a reason for many behavioral diagnosis’s for children acting in ways that are often considered disruptive. Many of these ‘behaviors’ exhibited from both adults and children can be a direct result from trauma and emotional stressors.
Some responses that appear disruptive can look like over reaction, anger, outbursts, anxiety, fear, avoidance, control, and self-harming behaviors. This is not always the case, but often times it is. What does this mean? There are a lot of hurting people in need of healing who walk around trying to ‘function’ but are living with physical and psychological issues as a direct result of trauma.
A lot of these issues have no real correlation or explanation. Anxiety attacks and panic disorder for example, seem to happen out of the blue and come out of nowhere. When they occur they are terrifying thus causing more stress and fear. Though feeling a loss of control can be terrifying, it can be explained. Typically, due to stress, the body has moved into a sympathetic dominance. When this happens the muscles constrict, blood vessels constrict, blood pressure is raised, and insulin production is limited. There is a lot of science to substantiate these factors.
of how trauma can affect the body:
Less severe examples of trauma might include:
a person getting into a fender bender, and so overcome with emotion that he or
she refuses to drive after that. Another person might be a light sleeper and
sleep near a person who jolts and moves around a lot. The light sleeper lays
awake for hours having difficulty getting back to sleep. That light sleeper’s
sleep is continually disrupted thus causing daily exhaustion, dread of going to
bed for fear of not being able to sleep. Stress hormones such as cortisol and
adrenalin are released into the body and cause low functioning throughout the
day, as well as fatigue.
In more severe cases such as death, rape,
abuse, violence, loss, abandonment, etc, a person moves into fight, flight, or
freeze responses. Thus, entering into a sympathetic dominance. Often times
memories are stored in neuro-memory networks and the individual may not have
language for his or her experiences yet having automatic responses due to those
stored memories and experiences.
In psychotherapy we have focused so heavily upon “emotions” rather than physiology. In fact, our culture is so diagnosis based that it’s truly been a travesty for those seeking healing and help. Subsequent to trauma, or even apart from trauma, most people don’t pay attention to what they are experiencing inside of their bodies and the mental health field is just getting this science. Unfortunately, we have a society heavily medicated and not healed! Sometimes however, medication is necessary, but for many it is a detriment. It is important that trauma be examined from a more scientific and less psychological standpoint to help people see that their bodies are responding in normal ways considering their respective experiences.
Self regulation and calm are main goals in therapy for adults and children. A main emphasis in therapy is to help one get into a regulated / relaxed system rather than keeping him or her in sympathetic nervous system. Often replaying traumatic events in a narrative format can dysregulate individuals rather than helping them self-regulate. This is why EMDR is such a useful modality for treating trauma. In conclusion, stress hormones can have dire effects on the body and mind. Many people live with daily stress and dysregulation by merely the pressures of life. Here are some examples of how these stress hormones can have on the body:
Reduces ability to stay focused
Affects sleep patterns
Increases anxiety (phobic
Holds and encodes the emotion
Can erode nervous system proteins
Reduces hippocampus function (the
place in the brain where we attune, reason, and use logic-cognition)
It can also affect the ability to
create sequential memory.
Trauma work is not merely for first responders
and abuse survivors, but for anyone who has had a stress so severe that it has
affected his or her physiology. Hopefully, knowing this will demystify any
stereotypes and assumptions about trauma work and who ‘qualifies’ to have this
type of counseling. I meet people every day who tell me, “I’ve never been
abused or faced anything scary in my life so I couldn’t have trauma”. Sure,
there are varying degrees of trauma, but all deserve healing, wholeness and
calm. Calm is certainly possible. As trauma informed clinicians we understand
this and honor all who come to seek healing and wholeness.
If you would like to read more about the Center’s treatment for childhood trauma please click on the link.
Some children are both hyperaroused and dissociative depending on the situation. They may be activated by stressful life events and act out behaviorally. When the situation becomes too much they collapse into dissociation. This wide swing makes it extremely difficult for parents to follow. It seems as though they are on a wild ride over a little issue. This is also why some traumatized children are incorrectly diagnosed as bipolar.
I frequently talk with parents about noticing where their child is on this chart. The parent needs to become the co-regulator so that when a child starts to get a little elevated he/she can help him calm rather increase the child’s stress and cause more problems.
Experienced parents have learned to notice little behaviors or mannerisms that alert them to impending difficulties. A child may start to pick at his fingers, tap his foot or bite his lip. This may be a subtle sign that he is getting frustrated and is starting into hyperarousal where if pushed further he may become aggressive, defiant and completely out of control. When sternly corrected at this stage he may become distressed to the point of collapse into dissociation where he curls up in a ball and checks out; numb to those around him.
As a therapist I have learned to watch for subtle clues in
my clients behavior. These clues clearly inform me if a client is ready to
explode or check out. Successful therapy depends on my ability to follow the
clues and keep my client regulated. If he is twisting his hands together I know
not to push but provide a regulating activity like squeezing play dough.
When he begins to look tired and numb I provide him with
stimulating activities like tossing a ball. I take on the responsibility for
regulation since most of my clients do not have the ability to regulate
themselves. In this setting the child is
able to do difficult work.
Being part of a family or succeeding at school is also very
difficult work for traumatized kids. They can be productive only if a parent is
supporting them in regulation. This does not prevent a parent from correcting
or disciplining a child it only informs the times a child can learn from these
conversations or consequences. If he is
in hyper or hypo arousal his brain is not available to receive instruction. In
addition the best instruction ever is learning how to regulate with a loving
and attuned parent.
The chart and the information in this blog come from Dr. Bruce Perry. For more information you can log onto his you tube channel. If you would like to read more about the Center’s work with children click on the link.
This week we will take the first 2 core strengths for healthy brain development which are attachment and self-regulation.
Attachment is the capacity to form and maintain healthy emotional bonds with another person. It begins in infancy, as a child interacts with a loving, responsive and attentive caregiver.
It is important because this strength is the cornerstone of all the others. A childs interactions with the primary caregiver create their first relationship. Healthy attachments allow a child to love, to become a good friend, and to have a positive model for future relationships. As a child grows, other consistent and nurturing adults such as teachers, family friends, and relatives will shape his or her ability for attachment. The attached child will be a better friend, student, and classmate, which promotes all kinds of learning.
Signs of struggle: A child who has difficulty with this has a hard time making friends and trusting adults. They may show little empathy for others and may act in what seems to be ways that show no regret. Children unable to attach lack the emotional anchors needed to buffer the violence they see. They may self-isolate, act out, reject anothers friendliness because they distrust it, or socially withdraw.
What can we do to help? Dr. Bruce Perry suggests the following:
Model good social language, eye contact, smiling, listening and positive-affirming touch
Use gentle humor and be aware of your body language so that children see that you are relaxed and accessible
Avoid sarcastic humor and be aware that many times children are their own harshest critics
Self-regulation is the ability to notice and control primary urges such as hunger and sleep, as well as feelings such as frustration, anger, and fear. Developing and maintaining this strength is a lifelong process. Its roots begin with external regulation from a caring parent, and its healthy growth depends on a child’s experience and the development of the brain.
It is important because we all need to take a moment between an impulse and an action. Acquiring this strength helps a child physiologically and emotionally. But it is a strength that must be learned–we are not born with it.
Signs of struggle: When a child does not develop the capacity to self-regulate, they will have problems sustaining friendships, and in learning and controlling their behavior. The child may blurt out a thoughtless and hurtful remark, express hurt or anger with a shove or by knocking down another child’s work. Just seeing a violent act may set them off. Children who struggle with self-regulation are more reactive, immature, impressionable, and more easily overwhelmed by threats and violence.
What can we do to help? Dr. Perry suggests the following:
In your words and actions, model self-control
Step in quickly and stop any hurtful action or language you hear.
Praise your child’s thoughtful actions, remarks, reactions and problem-solving skills.
For the next blog we will take the next 2 core strengths which are affiliation and attunement. If you would like to read more about The Child Trauma Academy please click on the link.
While some kids live hyper-aroused and are incorrectly
diagnosed with Attention Deficit Hyperactive Disorder other children respond to
early trauma by dissociating. This is particularly true if they experienced
trauma as infants or toddlers. The three choices any human has to stress is
flight, fight or freeze. Infants are incapable of running or fighting so they
are left with freeze. In The Neurodevelopmental Impact of Violence in
Childhood Bruce Perry describes
dissociation as disengaging from the external work and attuning to the internal
world. This can include distraction, avoidance, daydreaming and at the extreme
end fainting or catatonia.
Children experience dissociation as going to a “different
place”, assuming the persona of superheroes or animals, a sense of “watching a
movie that I was in ” or just floating. Often parents don’t even notice that
their child is dissociating; they may just appear compliant or quiet. They may present as numb, robotic, day
dreaming or just staring off with a glazed look. They frequently don’t remember instructions or
even doing things they should not.
It is important to recognize that the child is dissociating
so the parent can help them to cope with situations in a more productive way.
It also may be a sign that the child needs some therapeutic work to recover
from early trauma.
This chart from the Child Trauma Academy illustrates the normal range of responses and those of the dissociative person.
Our goal would be to join with the child in regulation; making it safe for him/her to stay present even in stressful situations. Sadly a stressful situation for a trauma victim may be a parents stern face. We will explore answers for these children in future blogs. If you would like to read the first blog in this series please click on the link and thanks again for reading our blog.
Parenting traumatized children requires regulation rather
Regulation is what these children missed as babies and toddlers. Healthy children had moments where loving parents picked them up and calmed them. The parent held them when they were angry or distressed. They calmly helped them handle a frustration. Neglected and abused children missed these experiences and they have no ability to calm themselves when distressed.
When we work with children we begin by looking at regulation. The chart attached shows a healthy child that has ups and downs that are in the normal range. The hyperaroused child hovers at the top; close to explosion at any moment.
Children that are traumatized are hyperaroused and waiting for the next dangerous moment to hit. I had a child in therapy that had learned to hide behind a chair or under the bed when the parents started fighting. He knew the next likely thing to happen would be for the children to be hit so he had to be ready for anything. It’s similar to adults walking through a jungle or a snake infested area. We would be on alert, watching for the danger. When the snake appeared we would go sky high and be in terror. That’s the way a child trauma victim lives, so it seem like a little thing takes them from normal to over the top when actually they were never at normal arousal.
In future blogs we will talk about how to help these children whose brains are on continual alert. Detailed information on these topics can be found on the Perry youtube channel.
This week I thought I would introduce you to a method of therapy that a few of our therapists are trained in, it is called Sensorimotor Psychotherapy.
What is Sensorimotor Psychotherapy
This method is a body-centered approach that aims to treat the symptoms of unresolved trauma in the body. While traditional talk therapies utilize the words of a person as the first step for treatment, this type of therapy depends on the bodily experiences of the individual as an entry to awareness and treatment of traumatic events.
Pat Ogden, founder and director of the Sensorimotor Psychotherapy Institute, and Janina Fisher, a clinical psychologist specializing in trauma, put together psychological and medical models to help explain why we physically respond to stimuli the way we do. Many clients ask questions during sessions like “Why is my body so tight?” or “Why can’t I sleep at night?” People want to know why their bodies react to psychological stressors such as frustration, trauma, rejection, fear, and anxiety. Why do our bodies seem programmed to respond to these stimuli?
Interventions for Trauma and Attachment
Ogden and Fisher wrote a book, Sensorimotor Psychotherapy: Interventions for Trauma and Attachment, which describes how the brain-body connection influences our lives — our emotions, thoughts, and physiological responses. This connection is especially important for clients who have traumatic histories. In the 19th century, most people believed that emotions were the only explanation for disease, stress, and other somatic complaints. Now, most scientists, psychiatrists, and mental health professionals believe that many disorders have a biological foundation — they can be triggered or influenced by biology. For example, autism spectrum disorders, depression, anxiety, and bipolar disorder are all said to have a biological basis.
More than just words
Therapists many times focus on what happens in the mind, psychologically, and what happens to the emotions. In their book Ogden and Fisher highlight the importance of the mind-body connection. When a family comes to therapy to discuss negative feelings between members, many therapists strive to understand how each family member interacts on a daily basis, why certain interpersonal relationships are strained, and how to fix the issue. However therapists who are trained in the mind-body connection explore the positions of certain family members’ bodies during the session, body language (facial expressions, body posture, eye contact), and other somatic responses to stress to understand how these influence all our relationships.
When many parents bring in their kids for help, they feel relieved to know there may be a biological foundation underneath their child’s behavioral disorder. Once they understand this, they often feel optimistic that the therapy may provide some relief. If you would like to read more about the Centers work with trauma and attachment please click on the link.
The Gottman Method is based on observations showing there is a real science to that most indescrible of experiences, love. The method is built on research showing that negativity has a large impact on the brain, and that unless steps are taken to counteract these feelings of negativity, couples grow apart emotionally. It identifies and addresses the thoughts and behaviors shown to underlie intimacy and helps partners maintain a positive orientation to each other that can sustain them in upsetting circumstances.
One of the main insights of this approach is that negative emotions, like anger and contempt, have more power to hurt a relationship than positive emotions have to help a relationship. As a result, the therapy focuses on developing understanding and skills so that partners can maintain admiration and turn toward each other to get their needs met, manage conflict, and know what to do when they mess up (because everyone does). “Negativity just makes a bigger impact on the brain, and unless we take steps to counteract it, slights will accumulate, continually accelerating the likelihood that partners will grow apart emotionally.”
5 to 1
Gottman, who is really into research, has developed a 5 to 1 ratio for positive to negative emotions. The five-to-one ratio is so fundamental it is the first of the “natural principles of love” that he sets forth in his newest book, Principia Amoris, a book he calls his largest and most important work. Building on more than 40 years of research he lays out what are the most important components of a healthy relationship.
All over the world Gottman has found that people automatically evaluate every human transaction on a scale of positive to negative. To repair the damage of missing each other’s desire to connect, individuals benefit from understanding their partner’s needs as well as their own. That, says Gottman, is the measure of trust—the degree to which you believe your partner has your interests in mind and can listen to you nondefensively, even if you can’t stand each other in the moment. It is the single most important factor that takes a marriage beyond the fabled seven-year breakup point.
If you would like to read more about how Mike DeMoss uses the Gottman Method in therapy please click on the link. Thanks for reading our blog and feel free to contact us for any reason.
Just read an interesting research study on play therapy titled “THE EFFECTIVENESS OF CHILD-CENTERED PLAY THERAPY ON THE CHALLENGING BEHAVIORS OF EARLY ELEMENTARY SCHOOL STUDENTS” by Corine Wixson which was published in 2016. The study examined the effectiveness of child-centered play therapy (CCPT) on the challenging behaviors of three kindergarten students.
Why this type of study?
The main reason only a few students were used in this study was to maintain a high level of control using rigorous data collection methods. Research methods were designed to meet the What Works Clearinghouse pilot standards for single-case designs, which uses stringent criteria in evaluating quality of research. The integrity of the CCPT intervention was assessed to ensure accurate implementation when it was performed.
What were the basic results?
Results from direct observational data supports a relationship between CCPT and the improvement of classroom behaviors. In contrast to direct observational data, teacher ratings did not indicate improvements in behavior (I hope to read more of this dissertation and find out why the researchers thought this occurred). Ratings by parents yielded significant results for improving behaviors at home. This study made valuable contributions to the literature by utilizing a strong research design and demonstrating promising findings for CCPT. Practical implications include using as few as eight sessions of CCPT as a behavioral intervention at school and engaging in ongoing teacher consultation to supplement the play therapy.
What are the principles for the CCPT?
The main principles for the play therapy that was performed required that the therapist: (1) creates a warm, caring relationship with the child; (2) accepts the child exactly as he/she is; (3) creates a feeling of safety and permissiveness in the relationship, which allows the child to fully express his/her thoughts and feelings without feeling judged or stifled; (4) remains sensitive to the child’s feelings and reflects those feelings in a manner that fosters self-understanding for the child; (5) believes deeply in the child’s capacity to act responsibly and solve problems on his/her own. Though the Center uses many modalities, the principles of CCPT are an underlying guide for working with children. They produce a safe, therapeutic environment that encourages self-exploration and change for every child.