Exam 3 Flashcards
What are the 6 responses of a traumatized child?
WATERU
- Anger
- Withhold expectations
- Try to alter own behaviors
- Reject those they most want
- Elicit negative response
- Unable to sustain an investment in another
Traumatized children play it out or act it out
becomes root of relationship difficulties into adulthood
A child who believes the world is a dangerous place grows up to be the adult who teaches their child the same lesson (even if its not acted out)
TRUE
Younger the age of trauma = worse off the child is
Longer therapy + more resistance
T or F: PTSD is worse for ppl who had prior trauma (responded poorly)
true = Developmental trauma
which is more traumatizing…the event or the relationship?
relationship: the deeper trauma for the child victim may be the absence of love, affection, attention, care and protection
(ptsd - too much emphasis on event, instead of relationship)
An event is traumatic if
it is extremely upsetting and at least temporarily overwhelms the individuals internal resources –> fight-flight-freeze
why is trauma worse for young children?
Children don’t have abstract reasoning = threat specific to person
children are egocentric
Most common trauma for children ?
= Family Abuse
When exposed to trauma _______ % of ADULTS will develop PTSD:
3-14% of adults
exposed to trauma will develop PTSD
When exposed to trauma _______ % of TEENS will develop PTSD:
2-5% of teens
exposed to trauma will develop PTSD
When exposed to trauma _______ % of CHILDREN will develop PTSD:
15-90% of children exposed to trauma will develop PTSD
_______ is the most severe event in childhood
FAMILY ABUSE = most severe event in childhood
________% of female mental health patients report sexual abuse
30-70%
of female mental health patients report sexual abuse
what is complex trauma?
Repeated traumatic events within specific relationships, chronic
1 in 7 or 1 in 10 children
Complex psychological trauma - fundament betrayal of trust in primary relationships (severe form of interpersonal trauma in kinship)
BETRAYAL TRAUMA =
Complex psychological trauma - fundament betrayal of trust in primary relationships (severe form of interpersonal trauma in kinship)
Poly-victimization ?
Children suffer from 1 kind of trauma are at higher risk for multiple vicitimizations = more chronic mental health problems
The affliction of the powerless - at moment of trauma victim is helpless ?
= Psychological trauma
The affliction of the powerless - at moment of trauma victim is helpless
Responses to fear are overwhelming when caused by parent
Teachings of trauma
The people you love hurt you (Seek protection from parent)
To survive, they must scan the environment
Due to experience of violence, academic failure and lack of mental health care - _________ and _______ are more vulnerable to trauma
Due to experience of violence, academic failure and lack of mental health care - ETHNIC MINORITY and LOW INCOME are more vulnerable to trauma
6 domains are potential impairment with complex trauma ?
BASIBI
- Affect regulation
- Information processing (adhd)
- Self-concept (guilt & shame)
- Behavioral control
- Interpersonal relationships
- Biological process
Abuse in early childhood =
Less responsive to crisis intervention
Require long term treatment
Abuse throughout lives =
Behavioral and emotional difficulty
Non-offending parents (non-abuser) =
More likely to unable or unwilling to make the necessary efforts to effect a positive change
Endangered =
Abilities to trust, feel safe or be receptive to a new environment
treatment attempts to preserve =
PTSC
- Trust in people who are untrustworthy
- Safety in a situation that is unsafe
- Control in a situation that is terrifyingly unpredictable
- Power in a situation of helplessness
abused children think THEY ARE BAD due to
EGOCENTRIC
healing occurs only through?
relationships
Healthy relational interactions with safe and familiar individuals can buffer and heal trauma related problems
TRUE
More than ____% of brain structure changes = in first _____ years
More than 80% of brain structure changes = in first 4 years
PTSD play is diff than regular play
TRUE
Re-living the event in therapy is not helpful
TRUE
Therapist presence ?
Witness, steady, consistent, empathic presence
Miniaturization?
Miniaturization =
what is really big & overwhelmed in their world gets put into a small object
Parental reactions to trauma are embedded in their ______
Parental reactions to trauma are embedded in their CULTURE
Culture = protection & risk
culture Provides meaning to lived experience with trauma
TRUE
______ = signal something is wrong
When children don’t play = signal something is wrong
Posttraumatic play
• Repetitive reenactments of trauma
Like adults, children can move from hypo-arousal to hyper-arousal
Show re-enactments in constriction of play
goal of Posttraumatic play ?
mastery & control over a scary internalized event (don’t push play with words, actions or goals)
how to begin POSTTRAUMATIC PLAY
Just like landreth (invite to look around - play with anything you like)
Even more important to follow childs lead
Traumatized children may avoid the emotional work (avoidance of stimuli that reminds them of trauma)
Don’t get stick with having the child verbally retell the trauma
(concrete relationships age 8 = no narrative)
trauma play is literal rather than symbolic
TRUE
• Literal
• Robotic
• Repetitive
• Self-absorbed - no interactions (in own world)
• Dissociative
• No affect
• Trauma repeated through play
• Allows them to face what was unbearable - initiated by client
•Natural means of achieving gradual exposure to his or her traumatic experiences
must provide objects specific to needs
Non-trauma play
NON TRAUMA PLAY • Symbolic • Emotional • Spontaneous • Interactive • Present
for posttraumatic play prepare the room by…..
Use objects that could be used in literal re-enactments of trauma
2 types of trauma play?
dynamic & toxic
dynamic posttraumatic play
- Achieves a sense of mastery for the client
- Makes symptoms decrease
- Enough distance
toxic posttraumatic play
- Becomes stuck w/out movement, without relief, devoid of new options, explorations or release
- Symptoms increase
- Same play for several weeks with no changes in narrative or play (robotic, joyless, no emotion)
posttraumatic play becomes toxic due to =
not enough distance to reflect on it or play about it
2 solutions for toxic posttraumatic play
- help create distance (allows them to engage/talk to liven play)
○ Careful not to minimize or hurry the child along
Ex: video tape session- show to child, use of mirrors-watch self, drawn on storyboard
- New endings
a. Solutions rather than problems
b. Child is guided by the therapist to emphasize healing power rather than pathology
c. May speak through the dolls, or invite to speak to different dolls in the play
Make sure child isnt agreeing to your ending so you like them
5 steps of posttraumatic play
- Begin like landreth
- Prepare the room
- Witness the play
- Participates as child determines
- If play becomes toxic posttraumatic play
a. Create distance
b. New endings
Identification Model ?
need to integrate identity
- Victim - don’t want to be the monster (disowning parts of self alike monster)
• NO Assertive, power, agency
• Integrate: agency, strength connect to anger of monster - Perpetrator - don’t want to feel helpless again
• Integrate vulnerability connect to sadness of victim
Both = switch to “survivor”
when Working with Children with Interpersonal Trauma
Always choose crayola crayons
TRUE
Parents devastated by death of baby and have another baby to make up for it =
replacement child
3 wishes = helps gauge a child
3 wishes
· If you had 3 wishes what would they be?
· Emotionally distressed = I wish daddy loved me.
· Adjusted = I want money
Helps gauge a child
Color Your Feelings ?
· Color in parts of the body using different colors that represent those feelings
· What makes you sad?
· What color would sad look like?
Use that color and color in the part of the body that feels sad
Nightmares ?
- Create a scene from nightmare
- Talk together about option to provide different ending “If I had a…”
- Create new option
- Put new option in the picture
Gets kids beyond the stuck
” the childs psyche tricks itself into cutting of the harmful, unbearable external elements of trauma and suppresses them in the unconscious, so that the trauma becomes removed (or suppressed) from consciousness”
DISSOCIATION
Assimilation:
*necessary component of therapy
○ involves incorporating new experiences into our current understanding “schema”
○ (necessary - in order for child’s self to resolve trauma they need assimilation)
Childs bodily excitations are given mental representation by transitional archetypal figures so that they eventually can reach verbal or symbolic expression and can be trusted
TRUE = If this never happens - change never happens
how you change internal working model
Attachment theory - 5 important ingredients in child-rearing ?
1• Reflective dialogue
○ parents shows sensitivity and responsiveness to subjective life of child (best guess of whats going on in child)
2• Repair of ruptures in attunement =
○ taking ownership of trauma
3• Emotional communication -
○ sharing of positive emotion & soothing negative emotions ( back & forth communication)
4• Coherent narrative -
○ child life gets a story to it where they can piece together this is what happened to me
5• Contingent communication
○ perceiving the childs signals (nonverbal)
○ making sense of them
& providing timely response - allows child to feel “felt” by parent or therapist
Posttraumatic play ALLOWS FOR….
- The opportunity for an emotionally connected relationship
- The positive & safe env that contains selected & appropriate symbols that children can use for expression, creation & management of difficult, painful, and confusing posttraumatic experiences
Child learns traumatic memory to be tolerated
Displacement
Affords the opportunity to gradually own her painful emotions after first externalizing them in a manner that the client can tolerate
7 characteristics of play
- Play requires a safe, predictable and caring adult presence in the background
(without - childs world is constricted) safety = child to explore/change
- Play follows the invitation of the sensuous world -
(things play with egocentric child-objects have own intentionality (objects arent distant things to be manipulated-nondualistic) need to use materials that invite/excite child to explore (not narrow)
- Play is an exercise in empathy -
(magical thinking fosters empathic relationship/connection to people /things )
- Play explores / elaborates the affective dimension of the childs lived world -
(egocentrism = world is extension of child (not distant/separate) and allows child to rearrange feelings towards environment/people “make world safe “ )
- Symbols are discovered through an emotional and sensory contact with things and people before they become cognitive or linguistic -
(nonverbal way of expressing emotions thru miniatures –> objects take on symbolic affective form & manipulation of toys = restructures childs experiences of their own emotions *profound functions of play = differentiates/represents childs evolving emotional life)
- Play involves the creation of a meaningful coherent world with ordered locations /scripts -
(creation of scripts = archetypal nature (typical plots)
by elaborating/individualizing scripts, child makes sense of emotions/thoughts )
- Plays is the locus of the childs developing capacity for intentionality; the self is revealed and affirmed in the play-world without directly announcing itself -
(honors egocentrism = allows awareness w/out self-awareness & reflection w/out self reflection
makes emotional intentions visible, reveals self w/out directly announcing it)
without ___________ the childs world/play becomes constricted
without = the presence of loving caregivers to provide safety for child to explore world & be shaped by it
tramatized children typically exhibit:
hypervigilance + excessive self-monitoring of self/others + need for consistent routines
children with PTSD may exhibit:
high anxiety + hypervigilance + problems in executive functioning (inability to find solutions to problems = increases anxiety)
Reflective dialogue
parents shows sensitivity and responsiveness to subjective life of child (best guess of whats going on in child)
Repair of ruptures in attunement
taking ownership of trauma
sharing of positive emotion / soothing negative emotions ( back/ forth communication)
Emotional communication -
child life gets a story to it where they can piece together this is what happened to me
Coherent narrative
Contingent communication
perceiving the childs signals (nonverbal)
making sense of them
providing timely response - allows child to feel “felt” by parent or therapist
Contingent communication allows child to feel “felt” by parent or therapist
TRUE
_____________________________
can buffer and heal trauma related problems
Healthy relational interactions with safe and familiar individuals can buffer and heal trauma related problems
_______ % of adults
exposed to trauma will develop PTSD
3-14% of adults
exposed to trauma will develop PTSD
_______ % of teens exposed to trauma will develop PTSD
2-5%
_______ % of children exposed to trauma will develop PTSD
15-90%
Repeated traumatic events within specific relationships, chronic
complex trauma
BETRAYAL TRAUMA ?
BETRAYAL TRAUMA =
Complex psychological trauma - fundament betrayal of trust in primary relationships (severe form of interpersonal trauma in kinship)
________ is necessary in order for child’s self to resolve trauma
Assimilation
involves incorporating new experiences into our current understanding “schema”
Assimilation
children think they are bad due to
no abstract reasoning & egocentrism
- Play requires a safe, predictable and caring adult presence in the background
(without - childs world is constricted) safety = child to explore/change
- Play follows the invitation of the sensuous world -
(things play with egocentric child-objects have own intentionality (objects arent distant things to be manipulated-nondualistic) need to use materials that invite/excite child to explore (not narrow)
- Play is an exercise in empathy -
(magical thinking fosters empathic relationship/connection to people /things )
- Play explores / elaborates the affective dimension of the childs lived world -
(egocentrism = world is extension of child (not distant/separate) and allows child to rearrange feelings towards environment/people “make world safe “ )
- Symbols are discovered through an emotional and sensory contact with things and people before they become cognitive or linguistic -
(nonverbal way of expressing emotions thru miniatures –> objects take on symbolic affective form & manipulation of toys = restructures childs experiences of their own emotions *profound functions of play = differentiates/represents childs evolving emotional life)
- Play involves the creation of a meaningful coherent world with ordered locations /scripts -
(creation of scripts = archetypal nature (typical plots)
by elaborating/individualizing scripts, child makes sense of emotions/thoughts )
- Plays is the locus of the childs developing capacity for intentionality; the self is revealed and affirmed in the play-world without directly announcing itself -
(honors egocentrism = allows awareness w/out self-awareness & reflection w/out self reflection
makes emotional intentions visible, reveals self w/out directly announcing it)
Parents devastated by death of baby and have another baby to make up for it
Replacement child
3 wishes
· If you had 3 wishes what would they be?
· Emotionally distressed: I wish daddy loved me.
· Adjusted: I want money
Helps gauge a child
in art - cartoons are used as a ________
in art - cartoons are used as a defensive mechanism to hide real feelings
Nightmares
Nightmares 1. Create a scene from nightmare 2. Talk together about option to provide different ending "If I had a…" 3. Create new option 4. Put new option in the picture Gets kids beyond the stuck
Affords the opportunity to gradually own her painful emotions after first externalizing them in a manner that the client can tolerate
displacement
PTSD play is diff than regular play
TRUE
In PTSD play….Re-living the event in therapy is not helpful
TRUE; remembering but not reliving
severe form of interpersonal trauma in kinship
betrayal trauma
7 characteristics of Play S S E A S C S (I)
- Play requires a safe, predictable and caring adult presence in the background (without - childs world is constricted) safety = child to explore/change
- Play follows the invitation of the sensuous world
- Play is an exercise in empathy
- Play explores & elaborates the affective dimension of the childs lived world
- Symbols are discovered through an emotional and sensory contact with things and people before they become cognitive or linguistic
- Play involves the creation of a meaningful coherent world with ordered locations & scripts
Plays is the locus of the childs developing capacity for intentionality; the self is revealed and affirmed in the play-world without directly announcing itself
*profound functions of play
differentiates/represents childs evolving emotional life
- Symbols are discovered through an emotional and sensory contact with things and people before they become cognitive or linguistic
(nonverbal way of expressing emotions thru miniatures –> objects take on symbolic affective form
manipulation of toys = restructures childs experiences of their own emotions)
Treatment of Dissociation involves?
reactivate safe internal schemas “containment” = unconscious symbols + therapeutic relationship + temenos (safe playroom)
dissociation (OPPOSITE OF containment) splitting = (anxiety destroys personality/ego) and leads to disconnection from ego stability to manage world due to self blame/guilt
dissociation is caused by interpersonal trauma that destroys ego & forms internal working model (cognitive misattributions due to egocentric beliefs “self blame”
internalized neg images form “internal working models” (fluid/emergent/spatial patterns)
