Interrupting Cycles of Early Loss, Trauma and Abuse

Therapeutic Challenges

Toni Heineman

• Publisher: Routledge
• Year: 2015
• Print ISBN: 9781138780477
• eBook ISBN: 9781317672340
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This volume offers rich and detailed illustrations of the complex emotional needs of the children and parents in vulnerable families. The chapters also highlight the psychological toll that working with at risk groups takes on therapists and others charged with providing care for children and families whose internal worlds are often fragile and external worlds are often dangerous and chaotic. Above all, the contributions, whether taken together or individually make it abundantly clear that short-term solutions are simply not possible for adults or children who have been traumatized many times over. They also underscore the need for those working with traumatized groups to protect themselves from psychological exhaustion in order to maintain the emotional vitality that is necessary for effective work.

This book was originally published as a special issue of the Journal of Infant, Child and Adolescent Psychotherapy.

Introduction

Toni Heineman

I am honored to have the opportunity to bring the articles in this special issue of the Journal of Infant, Child, and Adolescent Psychotherapy to the attention of our readers. Each article offers a rich and detailed picture of the complex emotional needs of one or more vulnerable populations. The articles also highlight the psychological toll that working with at risk groups takes on therapists and others charged with providing care for children and families whose internal worlds are often fragile and external worlds are often dangerous and chaotic.

The children and parents we meet in this volume come to treatment with a multitude of challenges that are not easily understood or addressed. Yet in the current economic and therapeutic climate, those in the mental health fields are often expected to produce quick and measurable results with very limited resources. Too often, those with the least training are asked to do the hardest work with the least amount of support.

The articles in this volume, whether considered individually or together, make it abundantly clear that quick fixes simply are not possible for adults or children who have been traumatized—frequently many times over. They also underscore the need for those working with traumatized groups to protect themselves from psychological exhaustion in order to maintain the emotional vitality that is necessary for effective work.

The first article in the volume was a keynote address at the Nurturing Parents Conference held in Denver, Colorado, in October 2011. “‘Terrible Twos’ and ‘Terrible Teens,’” by Joan Raphael-Leff, brings a developmental lens to the world of teen parents and their children.

“Containment, Trauma, and Coherence,” by Marian Birch and Quen Zorrah, was the keynote address at the May 2011 Conference of the Washington Chapter of the World Association of Infant Mental Health. The authors walk us through the almost paralyzingly painful family treatment following the infant’s being brutally abused by his father.

As the title indicates, “The ‘Dead Mother Syndrome’ and the Child in Care: A Framework for Reflecting on Why Some Children Experience Multiple Placement Breakdowns,” by Carolyn Hart, explores the psychological contributions to the frequent moves many children suffer in foster care.

“When the Lullaby is Missing: Healing from an Infancy in Foster Care” by Amy L. Cooper describes the integration of the practice of QiGong into a psychodynamic treatment of a young teenager who spent her infancy on the streets with her homeless mother followed by a series of abusive foster homes.

The special issues facing teen mothers who are entwined with physically and sexually abusive partners is the subject of “Relationship Violence and Teenage Parents” by Ambra Born.

“Fostering Healthy Attachment Between Substance Dependent Parents and Their Infant Children,” by June Madsen Clausen, Rosana M. Aguilar, and Mark E. Ludwig, discusses the outcomes of a program based on infant massage.

Finally, “Fostering Relationships with Children Who are ‘Too Much to Handle,’” by Saralyn Ruff and Julia Baron, introduces a web-based program for staff working with pregnant and parenting teens and youth transitioning from the foster care system.

In every article, we are reminded how easily those with few emotional resources or external supports can become disregulated and what a profoundly deleterious effect that can have on all aspects of their lives. These articles also stress the importance of allowing ourselves to truly know the horrors that so many disenfranchised populations face on a daily basis, including those who receive few monetary, social, or psychological rewards for working with traumatized populations. The temptation to look away, minimize, or rationalize the pain of chronic trauma can be overwhelming. I hope that the articles in this volume will help us all remember that engaging our minds is one of the ways that we individually and together can stay psychically alive and able to continue to work in almost impossible situations.

“Terrible Twos” and “Terrible Teens”: The Importance of Play

Joan Raphael-Leff

In the process of individuation, toddlers and their adolescent parents share similar dynamics; that is, both are involved with anxiety-laden preoccupations about difference and separateness and about bodily changes, loss of control, and containing aggression. Both experience internal struggles between emotional vulnerability and a sense of invincibility; both make fierce self-assertive bids coupled with a powerful need for guidance. When synchronized, such teen-toddler similarities can create a bond of mutual excitement; when their intentions clash, however, a terrible battle of wills erupts, fuelled by furious frustration or intense despair.

It is suggested that play can provide an essential bridge between teen parent and toddler, enabling each to work through his/her anxieties and passionate reactions of love and hate. Joint play increases reciprocal understanding. However, a teen deprived of play in childhood, or one who resents her/his own playtime being curtailed by parenthood, may become intrusive or controlling, projecting disowned aspects of her/his self into their mutual play. The parent thus breaks the play frame, creating confusion in the child between pretence and reality.

By providing a safe space to explore conflictual feelings through joint play, thoughtful practitioners can foster better emotional awareness and mentalization in troubled young parents and their toddlers.

The crucial issue in parenting is how to survive having life and death responsibility for the development of an incomprehensible vulnerable baby who turns into a defiant risk-taking toddler. I argue that this challenge is exacerbated for teenage parents, since they, like their children, are still engaged in developmental processes—some of which powerfully recapitulate issues first encountered during their own toddlerhood.

This paper addresses developmental parallels between toddlers and teens, exploring some aspects of clashes, conflicts, and co-operation between them. By presenting both perspectives, it aims to enhance emotional understanding in practitioners who work with this high-risk group.

At this time of rapid change, both toddler and teen undergo massive physical and emotional changes, alternating between use of more primitive and sophisticated areas of the brain. In addition, like the toddler, the teenager vacillates between dependency needs and desired autonomy. This conflict manifests in blunders and tantrums when infantile processes intrude into reasoned decision making. It also shows up in rebellious altercations with authority figures over limits and rules. Both teen and toddler experience internal struggles between emotional vulnerability and a sense of invincibility, fearing loss of control and uncontained aggression. For many teenaged parents, previous defences prove inadequate to cope with the toddler’s escalating demands and their own pressing internal issues, resulting in terrible emotionally charged battles.

I suggest that playfulness offers a way of reducing tension, to restore contact between warring young parent and toddler. While play enables each to work through his/her own intense issues and passionate experiences of love and hate, it also increases awareness of the other’s feelings. Imaginative play also serves a variety of crucial functions for both teen and toddler’s developing minds, learning to manage their respective anxieties and practicing confrontations in relative safety. Pretend role-reversal facilitates better understanding of each other and fosters mentalization in both teen and toddler. However, for some adolescents, play itself feels dangerous, liable to arouse unresolved feelings, especially when previous defenses prove inadequate to cope with the rapid evocations of past, present, and future internal and external issues.

The emotional effects of such failed defences are amplified when a child is involved. Parents who are preoccupied with their own issues will find it hard to mirror a child’s emotions without engaging their own. Unable to reflect or to have fun, they resort to controlling, intrusive, or dissociated behaviors while playing with the toddler.

Channeling Desire

For both toddler and teen we may distinguish between an early period of false belief that s/he can be and do anything and a sobering time of discovering limitations. For the toddler, the painful experience of having to renounce previous unrealistic omnipotence and oedipal longings is made tolerable by the promise of someday becoming big and powerful, finding a mate outside the family, and having a baby of his/her own. These relinquished desires are re-examined again in the light of bodily changes in puberty. Loss of the comparative safety of childhood brings new gains: when an adolescent becomes sexually active the old oedipal triangle is rotated and rather than excluded, s/he is now one of an erotic couple. The new combination of fertility and greater physical strength is a heady yet frightening experience—having the actual power to seduce, conceive, destroy, or even kill. No longer just in fantasy, now a real possibility, it dictates new responsibilities.

For some teens, this new power heightens awareness of the potential consequences of their actions, instigating a greater sense of body ownership and self-restraint. Others, for a variety of nonconscious reasons, get caught up in competitive rivalry, reckless physical excitement, or escapist activities, using their bodies to externalize their own internal conflicts and desires.

Adolescence can be an alarming time for young people who, fluctuating between intensely upbeat and despondent emotions, sometimes fear that they are going mad. In vulnerable teens, reawakened conflicts thus lead to intensified risk-taking activities. Escapist solutions are common and may consist of eating disorders (e.g., anorexia, compulsive binging, bulimia), abuse of alcohol, and other addictive substances; compulsive masturbation, excessive exercise, social isolation, or disproportionate Internet use; sexual promiscuity, self-mutilation or dramatic suicidal bids, tyrannical or delinquent tendencies, or violence toward others.

In girls, such activities often reflect difficulties in differentiating from the same-sex mother. Cutting or self-burning may be a disguised attack on the maternal body or on the changed pubertal body. Similarly, premature motherhood can be seen as a message to the mother: an unconscious communication of neediness or competitiveness. Pregnancy can also alleviate a pubertal girl’s anxiety about losing her mother’s care. Refinding maternal support with her baby reassures her that she has not killed or damaged her mother by usurping her (Laufer, 1996). Sometimes, pregnancy may seem to offer a way of bypassing adolescence and refusing its challenges.

However, many of these escapist manifestations are now so commonplace among Western teenagers that practitioners regard them as a social trend rather than recognizing external expressions of depression, persecutory disorders, anxiety states, or posttraumatic stress disorder (PTSD) following childhood insecurity, deprivation, or abuse.

Gender and Generativity

During adolescence, salient issues of identity, gender, and sexual desire take on new meanings as childhood appetites and fantasies undergo a further round of reappraisal. Western societies allocate a prolonged period for exploration and modification of these expectations before assigning young people to adult commitments and responsibilities. However, for reasons of their own, some teens choose to speed up generational succession by becoming parents themselves.

Gender formation is a lifelong process that begins in toddlerhood, emerging dialectically through primary relationships, and physical, psychic, and socio-cultural experience. To become a mature adult, a teenager must re-evaluate the four constituents of gender which s/he first negotiated as a toddler. I define these as “gendered embodiment,” “role representation,” “eroticism,” and “generative agency” (Raphael-Leff, 2007). For most adolescents, the last of these, generative agency (the sense of self as a potential creator), takes the form of sublimated activity, that is, engagement in intellectual or creative pursuits (music, art, film, craft hobbies, school work, games, sports or leisure projects). For others, the subcultural gender-code may dictate quite drastic, often irreversible acts, involving tattoos, body piercings, self-harm, forbidden substances, risk-taking bravado, or gang cultures of crime or violence. Yet others seek self-worth in procreation. To them, the ultimate enticing outlet is to create not a substitute but rather a real baby as did the originary parents. While accidental conceptions do occur, choice of teen parenthood is not randomly determined.

Empirical studies find a five-fold rate of earlier sexual activity and teenage conceptions among girls whose fathers left the family during the daughters’ childhoods (Ellis et al., 2011). When fathers have been peripheral or absent, girls often treat their male peers with considerable contempt, turning to older men, who themselves suffering from lack of self-esteem and inadequate role models, privilege sexual conquest above intimate relationships (Waddell, 2009). In fatherless girls and those unaccustomed to tenderness, a man’s jealous possessiveness and even aggression may be interpreted as caring (“He loves me such much he goes ballistic if another boy even speaks to me”…). Many young people who were fostered or grew up in children’s homes find a biological connection through childbearing. Seeking the family they wish they had had, there is a disproportionate representation of youth leaving the care system among those having babies precipitously. Finally, the propensity to enact conflicts that cannot be symbolized impels some teenagers to choose parenthood as a means of bypassing the emotional work of adolescence. Needless to say, reasons for conceiving are multidimensional, involving conscious design and unconscious motivations, including

• Dicing with fate: magical denial of consequences of unprotected sex; romanticizing an accidental pregnancy;
• Wanting to prove fertility (rather than desire for a baby);
• Low self-esteem: a search for identity, a purpose in life;
• Aspiring to become fully adult/to emulate mother or father;
• Loneliness, disillusionment, or a response to social rejection;
• Needing someone to love and/or someone to be loved by;
• Succumbing to peer or subcultural social pressures;
• A last-ditch attempt to save a failing relationship;
• Hoping to get out of home, or to create a new home;
• Conveying an unconscious message of triumph, need, or despair to one’s own parents;
• A desire to flesh out a fantasy baby;
• Wishing to recapture lost aspects of one’s own babyhood;
• Wanting to repair or renegotiate incomplete developmental tasks;
• A fantasy of creating the perfect family/rewriting history;
• Cheating death (especially if faced with life-threatening circumstances or bereavement).

Trials of Teen Parenting

In general, Western societies grant adolescents an experimental phase of preparation for adulthood. Premature parenthood inevitably deprives a teenager of time to gradually process and resolve the conflictual feelings commonly experienced during adolescence. Furthermore, caring for a baby churns up intense emotions. Thrust into meeting the infant’s needs, the teenaged mother or father finds his/her own preverbal experience powerfully evoked, stretching internal (as well as external) resources to the limit. When the infant becomes a toddler parental depletion is further exacerbated by competition between the child’s omnipotent wish for self-sufficiency (“by’m’self”) and the teen-carer’s need to feel competent, assertive, authoritative, and obeyed.

Inevitably, for both toddler and adolescent, the journey toward greater emotional awareness and physical self-reliance involves anxiety-provoking challenges. In common, teen parent and child are both experiencing massive bodily and social changes which activate their concerns about normality and belonging. Both are preoccupied with experiences of birth, death, and sexuality and with the need to negotiate difference and separateness. Each in his/her own way is very much engaged with finding out about emotions—understanding the feelings of others and their own intense experiences of love and hate, how to contain aggressive feelings and to channel sexual urges.

However, these similarities are asymmetrically loaded: the teen parent has an ethical duty to protect and nurture the more vulnerable child in her/his care.

Intuitively, most carers of young infants speak a form of motherese, that is, a high pitched, repetitive, rhythmic form of baby talk. They spontaneously match the child’s pre...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Citation Information
• Notes on Contributors
• 1. Introduction
• 2. “Terrible Twos” and “Terrible Teens”: The Importance of Play
• 3. Containment, Trauma and Coherence: A Case Presentation and Discussion
• 4. The “Dead Mother Syndrome” and the Child in Care: A Framework for Reflecting on Why Some Children Experience Multiple Placement Breakdowns
• 5. When the Lullaby is Missing: Healing from an Infancy in Foster Care
• 6. Relationship Violence and Teenage Parents
• 7. Fostering Healthy Attachment Between Substance Dependent Parents and Their Infant Children
• 8. Fostering Relationships with Children Who are “Too Much to Handle”
• Index