Children and Adolescents in Trauma

Creative Therapeutic Approaches

Kedar Nath Dwivedi, Chris Nicholson, Michael Irwin

• Publisher: Jessica Kingsley Publishers
• Year: 2010
• Print ISBN:
  9781843104377
• eBook ISBN:
  9780857003560
• Topic: Social Sciences
• Subtopic: Developmental Psychology
• Index: Social Sciences

Children and Adolescents in Trauma presents a variety of creative approaches to working with young people in residential children's homes, secure or psychiatric units, and special schools.

The contributors describe a wide range of approaches, including art therapy and literature, and how creative methods are applied in cases of abuse, trauma, violence, self-harm and identity development. They discuss the impact of abuse and mistreatment upon the mental health of 'looked after' children, drawing links between psychoanalytic theory and practice and the study of literature and the arts.

This indispensable book provides useful insights and a fresh perspective for anyone working with traumatised children and adolescents, including social workers, psychotherapists, arts therapists, psychiatrists, counsellors, psychologists and students in these fields.

Part I

Trauma

CHAPTER 1

Approaching Trauma

Chris Nicholson

Young people who are received into our children’s homes, psychiatric units, secure units and special schools have found themselves, from an early age, misplaced in their own lives, neither welcomed into the world nor received as whole people. This book is about what happens to children and adolescents such as these, who have experienced the impact of trauma early in life, and what approaches can be used to help them ‘work through’ their experiences. It will show how, by using creative methods and approaches, they can be helped to recover and begin to re-engage more successfully with their personal, educational and social development. At the same time, this book will help to explain the often extreme and sometimes bizarre behaviour that traumatised children and adolescents can exhibit by showing how this behaviour is a natural outcome of their early experiences. Examples will also be given of ways in which young people can be enabled to move beyond fearful and limited modes of relating to others and begin to establish a more stable sense of self. However, there is no way to avoid encountering disturbing behaviour.

We can’t go over it.

We can’t go under it.

Oh no!

We’ve got to go through it!

The children’s story We’re Going on a Bear Hunt by Michael Rosen quoted above, illustrates the point that certain obstacles in life cannot be avoided but rather must be approached and gone through. This is nowhere more true than in the case of trauma, since the after-effects of trauma manifest in ways that are repetitious and unavoidable. Children and adolescents are rarely able to suppress the powerful reverberations of traumatic events, and often act out in powerfully anti-social ways. Since it is then true, both for these young people and their carers, that ‘we’ve got to go through it’, both theoretical and practical structures must be established in order to contain, understand and work through their post-traumatic disorder.

What do we mean when we speak of trauma? Trauma is an experience that breaks into and breaks down the individual’s physical and psychological capacity to cope with the surrounding world. The usual mechanisms that we have to manage ordinary stress, pain or discomfort do not work once the experience goes beyond a certain critical depth. Once this level of impingement is reached auto-physiological responses take over and conscious efforts to manage become less effective. To make this clearer, we can see the same mechanism occurring when a physical injury is suffered and the bodily defences intended to deal with the injury cannot cope and in turn further afflict the sufferer. In The Body Question, for example, Jonathan Miller (1978) describes how inflammation is ‘set in motion by some injury or infection’ (p.128). The blood vessels shrink, anticipating loss of blood, then specialised cells release histamine, causing the blood vessels to expand, so allowing freer circulation through the damaged area and leaving the blood vessel walls more permeable to allow serum to flow into the damaged tissue. This allows the white blood cells to clear away the debris of damaged cells. The stiffness and swelling, caused by the proliferation of cells and serum in the area, discourage use of the damaged limb, which allows for quicker recovery. While pain and discomfort are temporarily increased, they are increased in aid of the healing process. However, if the injury or infection, for example, a piece of shrapnel, ‘proves intractable’ then the ‘inflammation establishes itself and re-establishes itself without fulfilling its purpose, in which case it becomes an illness in its own right’ (pp.126–8).

In the above example, a foreign body has lodged itself inside the flesh and the body’s defences doggedly but hopelessly try to remove it, in turn causing more illness and discomfort to the sufferer. When trauma has a strong psychological dimension, then it is in the mind, rather than the body, that the foreign body is lodged. For example, a man routinely threatens to hurt his eight-year-old daughter if her elder sister’s chores are not completed to his satisfaction. This threat may carry the weight of previous experience where their father did indeed hurt the younger sister. The experience is so powerful and overwhelming that the psychological defences employed to handle more minor problems do not work. The children may dissociate from the experience and entirely shut it out of conscious awareness. They might sublimate their anxiety into manic activity, meticulously cleaning the house while dad is out, or attempt aggressively to over-control their peers during intense game playing at school break-times. Perhaps the children will deny that dad is emotionally and physically abusing them, becoming angry and aggressive at this suggestion and defending their father. These mechanisms might temporarily preserve the integrity of the children’s world, effecting the mental version of a ‘sleight of hand’, symbolically staving off disintegration. Such defences buy some time in which the situation might change through, for example, the external intervention of an adult, or the girls might learn the trick of predicting and pre-planning around dad’s moods and behaviour. If the situation goes on, however, these defences could become normalised, rigid patterns of behaviour, the more intensely relied on, the more their failure increases the fear and anxiety that the children experience.

In this instance, both girls are likely to be deeply affected by their experiences and to exhibit features of post-traumatic stress disorder (or PTSD) for many years afterwards. Any effort made to avoid thinking about or remembering the painful realities of their abuse may lead them into patterns of manic anti-social behaviour. At such a young age, trauma has a developmental impact, adversely affecting the child’s global identity. A typical distrust of authority figures, for example, may lead either girl into confrontations with, shop owners or police officers, and should these individuals be male they could provide a legitimate receptacle for the anger they may feel toward their father but cannot, through fear, express. They may become what is called ‘hyper-vigilant’, being extra sensitive and reactive to potential threats in their immediate environment. These preoccupations may mean that their school work suffers because focused attention becomes impossible. Being especially sensitive, the lively atmosphere of school could leave them emotionally over-aroused and prone to over-reaction in social situations. Objects, specific events, words, noises or smells associated with traumatic memories can act as ‘triggers’ causing intrusive memories or ‘flashbacks’. Not surprisingly, the children are likely to experience difficulties sleeping both because they do not feel safe enough to sleep and because they may be afflicted by nightmares. Taken together these symptoms of PTSD have a considerable impact on the girls’ mental health, depending on the constitutional resilience or vulnerability of each child. Without the proper intervention the children’s behaviour may jeopardise their educational success as teachers struggle to manage them in class and begin the inevitable discussion in team meetings about school exclusion. Family members who may ‘foster’ them without the proper knowledge or training about the effects of post-traumatic stress disorder will find the girls’ distrustful and harsh treatment of them difficult to tolerate. It is often most difficult for those closest to the child to recognise that trauma has overwhelmed the children’s ability to cope with ordinary daily life and has led to a gradual breakdown in their psychological and social development.

This is a broad sketch of the workings of trauma, but some such definition is increasingly recognised and used by professionals and writers concerned with this area. For example, Kalsched (1996) takes ‘trauma’ to mean ‘any experience that causes the child unbearable psychic pain or anxiety’ (p.1). This varies, according to Kalsched, from:

…acute, earth shattering experiences of child abuse so prominent in literature today to the more ‘cumulative traumas’ of unmet dependency-need that mount up to a devastating effect in some children’s development (Khan, 1963), including the more acute deprivations of infancy described by Winnicott as ‘primitive anxieties,’ the experience of which is ‘unthinkable’ (1963: 90). (Kalsched 1996, p.1)

This definition certainly applies to the ordeals that the children and adolescents I am thinking about have suffered. These young people will have undergone extremely adverse experiences ranging from specific and often multiple episodes of abuse, to prolonged deprivation of basic love and care, to living within highly unstable home environments characterised by a lack of predictable routine.

Different accounts of, and approaches to, trauma and its effects will be discussed and explored in the following chapters. These are offered by a range of professionals who, in the spirit of collaboration with others facing the same daily problems and dilemmas, seek to illustrate and illuminate the kinds of approaches and practices that lead to better outcomes. For now, the central theme of this book is the relationship between trauma and creativity. If the capacity for creative activity is seen as one of the signs of psychological health, then it is likely that traumatic events will have the opposite effect of reducing the individual to basic patterns of behaviour. Higher order activities such as creative thought and application are smothered by the after-effects of trauma as the individual’s effort to cope with extreme experience pares down activity to the essentials of survival. Nevertheless, might there be something about creativity itself that can incorporate traumatic experiences and help facilitate the task of processing them? Creative endeavour can indeed be a means of recombining damaged parts of oneself and one’s experience with more positive, healthy parts in order to create a new whole and integrated identity.

The earliest manifestations of creative experience are to be found in our infancy, in our pre-verbal but playful relationships with our parents. It is hardly surprising then that traumatised and neglected children have a much reduced capacity to play, since play, while a normal function of childhood, is learned behaviour, a behaviour that comes into being through the interaction of first, baby and parent, and later, infant and their infant peers. Yet the capacity for both creative play and socialisation is inhibited if they are not used. Meares (2005) discusses the chronic ‘parental failure of attunement’ [sic] to the infant (in other words, the failure of the parent to notice the infant’s moods and physical states, such as hunger, distress or boredom, and respond to them). The result of this failure is that ‘the play space is never adequately or securely established’ (p.54), since the ‘play space’ grows out of trustworthy, reciprocal interactions. Thus, we can see wh...

Table of contents

• Cover
• Half Title
• Of Related Interest
• Title Page
• Copyright
• Dedication
• Acknowledgements
• Contents
• Foreword
• Preface
• Introduction
• Part I Trauma
• Part II Story
• Part III Self-Harm
• Part IV Art Therapy
• Part V Violence
• Conclusion
• The Contributors
• Subject Index
• Author Index