27 Jun The Role of Healthy Relational Interactions in Buffering the Impact of Childhood Trauma
The social milieu, then, becomes a major mediator of individual stress response baseline and reactivity; nonverbal signals of safety or threat from members of one’s “clan” modulate one’s stress response. The bottom line is that healthy relational interactions with safe and famil- iar individuals can buffer and heal trauma-related problems, whereas the ongoing process of “tribalism”—creating an “us” and “them”—is a powerful but destructive aspect of the human condition that only exac- erbates trauma in individuals, families, and communities attempting to heal.
The experiences of early life have the profound ability to shape the infant, child, adolescent, and ultimately the adult. Each child has his or her own unique genetic potential, yet this potential is expressed dif- ferentially depending upon the nature, timing, and patterns of devel- opmental experience (see Perry, 2001, 2002). An understanding of how early experiences shape neurodevelopment is imperative if we seek to impact the lives of children with whom we live and work. This is espe- cially true in the case of children growing up in homes plagued by vio- lence, maltreatment, and neglect.
For many, childhood is a very violent time; for others, childhood is permeated with unpredictability, chaos, threat, and other forms of adverse developmental experience. There is a wealth of research describ- ing the negative impact of childhood trauma on the physical, behav- ioral, cognitive, social, and emotional functioning of children (Perry & Pollard, 1998; Bremner & Vermetten, 2001; Read, Perry, Moskowitz, & Connolly, 2001; Malinosky-Rummell & Hansen, 1993; Fitzpatrick & Boldizar, 1993; Graham-Berman & Levendosky, 1998; Margolin & Gordis, 2000; Sanders-Phillips, 1997; Berenson, Wieman, & McCombs, 2001; Anda et al., 2006). Children exposed to trauma have increased neuropsychiatric problems (e.g., posttraumatic stress disorder [fusion_builder_container hundred_percent=”yes” overflow=”visible”][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][PTSD], depression, dissociation, conduct disorders), school and academic fail- ure, involvement with the juvenile justice system, drug and alcohol use, antisocial behaviors, and engagement in high-risk sexual behavior and teenage pregnancy. The impact of early trauma is so profound because it occurs during those critical periods when the brain is most rapidly developing and organizing. Because the experiences of early life deter- mine the organization and function of the mature brain, going through adverse events in childhood can have a tremendously negative impact on early brain development, including social and emotional development.
The brain of a newborn is composed of billions of neurons and glial cells that, from conception, have been changing—dividing, moving, specializing, connecting, interacting, and organizing. This organiza- tion takes place from the bottom, simplest area (brainstem) to the high- est, most complex (cortex). The various functions of the brain parallel this structure: The brainstem regulates the simplest re exive functions (e.g., body temperature and heart rate), and the cortical areas medi- ate complex functions such as abstract thought and language (Perry, 2001). The brain is a use-dependent organ that changes in response to patterned, repetitive activity. Thus the more any neural network of the brain is activated, the more that part will change. Among other things, this process is the basis for memory, learning, and development.
All experience, therefore, changes the brain—even if in the subtlest, microscopic ways. Yet experiences in childhood have disproportionate power in shaping the brain. Early in life the brain organizes at an incredible rate, with more than 80% of the major structural changes taking place during the rst 4 years. Experiences that take place during this window of organization have a greater potential to influence the brain—in either positive or negative ways. Because the majority of brain growth and development takes place during these first years, early developmental trauma and neglect have a “disproportionate influence on brain organization and later brain functioning” (Perry & Hambrick, 2008; see also, Perry, 2008). Unfortunately, traumatic experiences that take place during this critical window impact the brain in multiple areas and can actually change the structure and function of key neural networks, including those involved with regulating stress and arousal (Perry, 2008). These stress response systems in the brain are designed to sense and respond to threats, either from internal (body) or external sources. Thus, the end effect is that children who are exposed to chronic threat develop overactive and overly reactive stress response neural systems. In short, they live in a persistent state of fear. Although these neuronal changes are useful and protective when the child is living in an abusive environment, they lead to problems in other settings. For example, a hyperaroused child is often preferentially alert to non- verbal cues, which is adaptive with an unpredictable, violent parent but maladaptive in a classroom where the child will miss much of the verbal information presented by a teacher.
As the brain develops in a use-dependent manner, it requires stimulation at specific times in order for the systems to function at their best (see Perry, 2001; Perry & Szalavitz, 2007). If these sensitive periods of development are missed, “some systems may never be able to reach their full potential” (Perry & Szalavitz, 2007, p. 85). Inconsistent, abusive, or neglectful caregiving in early childhood alters the normal development of neural systems involved in both relationships and the stress response. It is through patterned, repetitive neural stimulation provided by consistent, nurturing, predictable, responsive caregivers that the infant’s brain receives what is needed to develop the capacity for healthy attachment and self-regulation capabilities. The caregiver becomes the external stress regulator for the infant. However, if the caregiver is depressed, stressed, “high,” inconsistent, or absent, these two crucial neural networks (relational and stress response) develop abnormally. The result is a child more vulnerable to future stressors and less capable of benefiting from the healthy nurturing supports that might help buffer stressors or trauma later in life.
Social and Emotional Development
Understanding healthy social and emotional development in children underscores why disruptions to, or disorganization in, early attachment has such far-reaching implications. Attachment is de ned as an enduring relationship with a specific person that is characterized by soothing, comfort, pleasure, and safety. It also includes feelings of intense distress when faced with the loss, or threat of loss, of this person. By far the most important attachment relationship is that of mother and infant. Even before birth, the emotionally healthy mother begins the process of attaching to her baby as she grows attuned to its patterns of movement and the way it responds to stimuli such as sound (Greenspan & Wieder, 2006). Bowlby (1969) describes maternal–infant attachment as a reciprocal relationship. Greenspan and Wieder (2006) note that “the rhyth- mic, near-synchronous patterns of movement and vocalization between infant and caregiver enable the infant to begin attending to and appreciating the world” (pp. 14–15). In fact, many have aptly described this mother–infant relationship as a dance, the moves of which will be used with many partners throughout the child’s life.
Development in many other areas is rooted in the development of a healthy attachment to a primary caregiver. These areas include devel- opment of emotional, social, cognitive, and self-regulatory capabilities. These rst relationships, including those formed with other signi cant people during early childhood, “are the prism through which young children learn about the world, including the world of people and of the self” (Thompson, 2002, p. 10). These early experiences literally provide the organizing framework for the infant/child. Regulation of the infant’s emotional states develops through the repeated appropri- ate responses of an attentive, attuned caregiver to the baby’s changing emotional states (e.g., fear, anger, distress). Through this consistent, predictable, and repetitive nurturing the child develops the capacity to self-regulate these emotional states as well as to communicate his or her emotions (Emde, 1998). These nurturing behaviors also provide feelings of safety and security. According to Lyons-Ruth and Spielman (2004), a mother’s capacity to regulate her infant’s distress and fear is vital to the child’s ultimate sense of security.
Case 1: Caregiver issues impacting bonding and attachment
Mark, age 2, was brought to our clinic by his adoptive mother due to con- cerns that he may have an attachment disorder. He had been adopted at 10 months of age from a small Eastern European orphanage, where he had been placed at birth. His adoptive mother, Sarah, had no knowl- edge of Mark’s biological parents but reported that the orphanage seemed “better than most,” as Mark had relatively stable caregivers to whom he appeared attached and areas in which he could explore and play. She reported that her dif culties with Mark began almost immediately upon returning home. According to Sarah, he would not look her in the eyes, didn’t enjoy being held, and didn’t engage in exploratory play. In an effort to strengthen the attachment bond, she had taken Mark to multiple therapists specializing in attachment. Further, she had been trained in holding therapy and had read countless books on the subject.
In an effort to get to know Sarah and Mark better, clinicians observed their interaction over the course of the first two interview sessions. During the initial interview Sarah sat and talked with the lead clinician while Mark explored the room. Mark quickly discovered that he could climb from the chair to the desk, and within minutes he was happily walking on top of the desk and onto the adjoining table. The observing clinicians watched in dismay as Sarah continued the inter- view with no acknowledgment of her son’s precarious situation. Only when the suggestion was made that Mark might fall and injure himself did she remove him from the table.
A second clinician participated in the third session with the family. While the primary clinician talked with Sarah about healthy development, the second clinician sat on the oor with Mark, who was playing with a large plastic dinosaur. The second clinician engaged in parallel play with another dinosaur. Within a short time, Mark had moved close to the clinician, interjecting his dinosaur into her play. He interacted easily with the clinician, making appropriate eye contact and happily describing the dinosaur’s activity. In subsequent sessions it became clear that the issue was not centered in the child but in the parenting behav- ior. Sarah had experienced abuse at the hands of her own mother as a child. Relationships, it seemed, had been dif cult for her throughout her adult life, but her hope was that by adopting a child she would ll this relational void. Unfortunately, it is not uncommon that caregivers who themselves experienced trauma or maltreatment as children carry these experiences into their own maternal–child relationships. The frightened or frightening behaviors of such a caregiver often creates a contradiction that is impossible for the child to resolve: The caregiver is both the source of, and solution to, the child’s distress (Main & Hess, 1990). Without an acknowledgment of the impact that their own child- hood experiences have on their parenting, these caregivers are unlikely to change their behavior. This was the case with Sarah. Attempts to help her better understand how her own trauma history impacted her ability to respond to her son’s needs and to teach her appropriate nur- turing activities ultimately were unsuccessful, leading ultimately to her decision to relinquish her parental rights. Mark was later adopted by another family who was more open to understanding the impact of his early experiences and to providing the necessary reparative experiences that would allow him to grow into a healthy happy child.
Case 2: The devastating impact of maltreatment on social–emotional development
Sydney never knew her biological parents. She had been removed from their care at birth due to the severe physical abuse of her three older siblings by her mother and father. Sydney was fortunate. She was placed in a loving home with foster/adoptive parents who cared for her as if she were their own child. Sydney thrived in the care of these nurturing, attentive, and attuned caregivers. In her mind, they were her mommy and daddy, and that’s what she called them. Tim and Jan thought of Sydney as their child even though they had been reminded, time and time again by her caseworker, that there was no guarantee that they would be able to adopt her. Despite torturing their older children, the parental rights of Sydney’s parents had not been terminated. The Child Protective Services (CPS) caseworker was concerned about the ethnic differences between the foster parents and Sydney, although that difference was only noticeable to those who didn’t know them. They were a very happy family.
Then when Sydney was 3 years old the judge made a surprising decision. Her biological parents had completed all of the requirements placed upon them by CPS, including parenting classes, anger management classes, and domestic violence and drug and alcohol counseling. It now seemed that after several years they had nally gotten their act together and were once again ready to parent their four children. Syd- ney did know her brothers and sister; they had monthly visits during their time in foster care, although the infrequency of the time together did little to forge a sibling bond. Her parents, on the other hand, had rarely made the parental visits. However, this made little difference as the judge handed down his decision. They were her biological parents and that’s what mattered. Tim and Jan hired an attorney, and they fought Sydney’s removal from their home with all they had—but biology won out. On a crisp February morning, Sydney was taken from them. Jan later described how Sydney’s screams haunted her day and night.
But that was just the beginning of the trauma for Sydney. She had been taken from her mommy and daddy and given to two people whom she didn’t know. They said that they were her “real” mommy and daddy, but she knew that wasn’t true, so she called them by their names. That was only one of the things that infuriated them about her. Within a short period of time, the torture began: beatings, burning with cigarettes, being locked in her room, and denied food. Sydney’s world had completely changed and her 3-year-old mind couldn’t begin to understand why.
When Jan and Tim entered the hospital room, they barely recognized their little girl. Her once beautiful hair was now matted to her head and was completely gone in some places. Her eyes, once so sparkling and full of life, stared right through them. She didn’t speak. Ultimately the results of days of tests and X-rays told the horrible truth. Sydney had suffered countless beatings that ended in broken bones that were never treated. She would have to endure multiple surgeries to chip away the calcium deposits that had formed on the healed bones in her legs. She had regressed in every developmental domain, and she exhibited severe PTSD.
It wasn’t until she returned home that the healing could begin. Her room was just as she left it—the consistent, nurturing, and safe home was waiting for her. She would need hours of physical and occupational therapy and the efforts of therapists experienced in working with traumatized children. Most important, she needed the love and care of her family to provide the patterned, repetitive, and reparative experiences that would help build the developmental capacities that anger and cruelty had stolen from her. Ultimately Sydney did heal from all this early trauma because of her strong spirit and the parents who never gave up on her.
Haley was adopted from an orphanage outside of the United States when she was 9 months old. While the information her adoptive parents had about her past was minimal, they did know that she had spent the rst 2 months of her life with her biological mother, who was a known alcoholic. At the time she was placed, Haley had a serious illness and several bruises on her legs, and she spent at least a month in the hospital. Haley’s adoptive parents had an opportunity to tour the facility, which they described as a “typical” orphanage—a cold place with large rooms lled with rows of cribs or beds and only a few caregivers.
Upon returning home with their new baby, the parents were surprised by her behavior. She cried very little during the day; she would often just sit and stare into space. At night, however, she would wake several times screaming uncontrollably. No matter what they tried, they were rarely able to comfort or soothe her when she was upset. She didn’t like to be touched or held, and her eating was always rushed, as if she hadn’t eaten in days and didn’t know when she would eat again. Haley would often hurt herself by banging her head or pulling her hair until it came out, and she would also try to hit or bite anyone who tried to hold her.
Haley’s adoptive parents, Kristy and Sam, worked to make home a safe place. Kristy quit her job to stay home with her daughter. They hired a psychologist to come into their home and teach them appropriate attachment techniques such as cuddling, gentle holding, and rocking. They worked very hard to build routines and predictability into Haley’s day. Over time, Haley’s self-injurious behaviors began to diminish, although they did not completely go away. However, following an outing to visit family out of state, Haley’s behaviors regressed significantly. Once again she was rageful, hitting everyone within reach, touch averse, and exhibiting severe sleep disturbances. Only through limiting her exposure to those outside of the family and not venturing outside the home did her behaviors get better.
Haley seemed to be making progress. A massage therapist had worked with the family and now both parents used massage as a way to help soothe and calm their daughter. They built rocking and music and movement into their daily routine. They followed every recommendation to the letter—they were doing everything right. But without warning, Haley’s behaviors began to escalate into severe mood swings. Her parents describe her as exceptionally gentle and loving one minute and defiant, rageful, rejecting, and hurtful the next. Despite all of the empathy, patience, and nurturing, Haley did not seem to be getting better. What Sam and Kristy didn’t know was that the absence of critical organizing experiences during Haley’s neglectful first 8 months was a major contributing factor to the devastating developmental problems they witnessed on a daily basis.
Understanding the power of traumatic events to shape the brain helps us to better determine what a child needs to heal. Although negative early life relational experiences have the ability to shape the child’s developing brain, relationships can also be protective and reparative. The cases of Mark and Syndey are examples of the power of relationships both to injure and to heal. There exists a wide body of research suggesting that social connectedness is a protective factor against many forms of child maltreatment—including physical abuse, neglect, nonorganic failure to thrive—as well as a means of promoting prosocial behavior (Belsky, Jaffee, Sligo, Woodward, & Silva, 2005; Caliso & Milner, 1992; Egeland, Jacobvitz, & Sroufe, 1988; Rak & Patterson, 1996; Travis & Combs-Orme, 2007; Chan, 1994; Coohey, 1996; Guadin, Polansky, Kilpatrick, & Shilton, 1993; Hashima & Amato, 1994; Pascoe & Earp, 1984; Altemeier, O’Connor, Sherrod, & Vietze, 1985; Benoit, Zeanah, & Barton, 1989; Crnic, Greenberg, Robinson, & Ragozin, 1984; Gorman, Leifer, & Grossman, 1993). Sydney’s early experiences had taught her that home was a place where she was safe and loved. Her foster/adoptive parents and their extended family supplied her with the emotional connections, healthy interactions, and nurturing that pro- vided a strong basis for surviving the horrors of life with her biological parents. We can only infer that Mark had something similar built in by his rst caregivers in the orphanage that helped buffer the experiences with his rst adoptive mother.
Haley, unfortunately, missed out on the nurturing, touch, and love that she needed in order to grow into a healthy, secure little girl. Her brain, literally, was a re ection of the severity of her neglect, likely com- bined with some type of physical maltreatment. Her stress response sys- tem overly active, Haley spent most of her time either hyperaroused or dissociating when her little system could take no more. Also, not surprisingly, the strategies that helped her survive in the environment of the orphanage made it more dif cult for her to “take advantage of good- quality, loving and responsive” caregiving in her new home (Howe & Fearnley, 2003, p. 372). Experience in her earliest caregiving relationships had taught her that adults were frightening, hurtful, unpredict- able, and confusing. Children with early neglect histories and subse- quent attachment-related problems rarely feel safe when placed in new, healthy caregiving situations. Instead, they work to avoid close relation- ships, often becoming aggressive and controlling as a way to protect themselves from further hurt. Howe and Fearnley (2003) aptly describe the situation this way.
Practice and policy implications
Our current mental health, child welfare, and judicial systems, as well as child-placing agencies deal with traumatized and maltreated children as if they were completely unaware of these essential findings in development, attachment, and trauma. We have few metrics to measure the number, quality, and patterns of healthy (or unhealthy) relational interactions; we move traumatized children from therapist to therapist, school to school, foster home to foster home, community to community. Indeed our systems often exacerbate or even replicate the relational impermanence and trauma of the child’s life. We expect “therapy”—healing—to take place in the child via episodic, shallow relational interactions with highly educated but poorly nurturing strangers. We undervalue the powerful therapeutic impact of caring teacher, coach, neighbor, grandparent, and a host of other potential “cotherapists.”
Future effective therapeutic interventions—both preventive and healing—must be developmentally informed and trauma sensitive. There is much to learn, yet we know enough now to begin to evaluate and modify our current therapeutic practices, programs, and policies to take full advantage of the biological gift of the healing power of relationships.
The Adverse Childhood Experiences (ACE) Study
The Adverse Childhood Experiences (ACE) Study is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. The study is a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente’s Health Appraisal Clinic in San Diego. More than 17,000 Health Maintenance Organization (HMO) members undergoing a comprehensive physical examination chose to provide detailed information about their childhood experience of abuse, neglect, and family dysfunction. To date, more than 50 scientific articles have been published and more than100 conference and workshop presentations have been made. The ACE Study findings suggest that certain experiences are major risk factors for the leading causes of illness and death as well as poor quality of life in the United States. Neglect, physical abuse, custodial interference and sexual abuse are types of child maltreatment that can lead to poor physical and mental health well into adulthood. It is critical to understand how some of the worst health and social problems in our nation can arise as a consequence of adverse childhood experiences. Realizing these connections is likely to improve efforts towards prevention and recovery.
If you are suffering with an illness or addiction, finding relationships challenging, attracting the wrong people into your life, continously falling in love with an emotionally unavailable partners, struggling with porn, sex & love addictions, or struggling to find joy in life. There is a very high possibility that you have suffered adverse childhood experiences regardless of how covert they may seem and when left unresolved can manifest in a host of life challenges with Money, Sex, relationships, mental Health, emotional health and physical health.
It is important to note that working through early childhood adverse experiences is not about blaming parents, and does not have to mean talking for long periods of time about experiences that have happened a long time ago. However what is important is to realise is that these experiences when left unchecked, unspoken about and forgotten tend to imprison us in the present through manifestations of mental, emotional, physical and relational stress. Searching for the underlining meaning to our present stress and exploring a new way to be through new ways of relating can have a profound positive impact on our lives, science now shows us that learning how to relate in healthy ways to promote connection instead of withdrawal changes our entire nervous system. This is very often no small task, however one of the most effective strategies to work through early adverse experiences and their presenting symptoms is within the therapeutic relationship. In addressing trauma based symptomology and early childhood adverse experiences it is critical that the Psychotherapeutic approach activates both left and right hemispheres of our brains, it must be body orientated and include an element of mindfulness and focus on the therapeutic relationship for corrective experience. If you can find a psychotherapist that you feel safe with you can begin a rewarding journey of change, reverse symptomology, gain insights and learn a new way to be in the world that promotes a healthy mind and body.
If you have three or more adverse experiences as a child, your risk for heart disease is greater than if you smoke – Bruce Perry
Working with attachment disorders with relational neurobiology at Trauma Recovery Institute
Trauma Recovery Institute offers unparalleled services and treatment approach through unique individual and group psychotherapy. We specialise in long-term relational trauma recovery, sexual trauma recovery and early childhood trauma recovery. We also offer specialized group psychotherapy for psychotherapists and psychotherapy students, People struggling with addictions and substance abuse, sexual abuse survivors and people looking to function in life at a higher level. Trauma recovery Institute offers a very safe supportive space for deep relational work with highly skilled and experienced psychotherapists accredited with Irish Group Psychotherapy Society (IGPS), which holds the highest accreditation standard in Europe. Trauma Recovery Institute uses a highly structured psychotherapeutic approach called Dynamic Psychosocialsomatic Psychotherapy (DPP).
At Trauma Recovery Institute we address three of the core Attachment Styles, their origin’s the way they reveal themselves in relationships, and methods for transforming attachment hurt into healing. We use the latest discoveries in Neuroscience which enhances our capacity for deepening intimacy. The foundation for establishing healthy relationships relies on developing secure attachment skills, thus increasing your sensitivity for contingency and relational attunement. According to Allan Schore, the regulatory function of the brain is experience-dependent and he says that, as an infant, our Mother is our whole environment. In our relational trauma recovery approach you will learn to understand how the early patterns of implicit memory – which is pre-verbal, sub-psychological, and non-conceptual – build pathways in our brain that affect our attachment styles. Clinically, we can shift such ingrained associative patterns in our established neural network by bringing in new and different “lived” experiences in the Here and Now.
The Role of the Therapist in transforming attachment trauma: Healing into wholeness takes the active participation of at least one other brain, mind, and body to repair past injuries – and that can be accomplished through a one-to-one therapeutic relationship, a therapeutic group relationship or one that is intimate and loving. In exploring the “age and stage” development of the right hemisphere and prefrontal cortex in childhood, we discover how the presence of a loving caregiver can stimulate certain hormones, which will help support our growing capacity for social engagement and pleasure in all of our relationships. Brain integration leads to connection and love throughout our entire life span. At trauma recovery institute we bring a deep focus to the role of Neuroscience in restoring the brain’s natural attunement to Secure Attachment. Our brain is a social brain – it is primed for connection, not isolation, and its innate quality of plasticity gives it the ability to re-establish, reveal and expand one’s intrinsic healthy attachment system.
Dynamic Psychosocialsomatic Psychotherapy (DPP) at Trauma Recovery Institute Dublin
Dynamic Psychosocialsomatic Psychotherapy (DPP) is a highly structured, once to twice weekly-modified psychodynamic treatment based on the psychoanalytic model of object relations. This approach is also informed by the latest in neuroscience, interpersonal neurobiology and attachment theory. As with traditional psychodynamic psychotherapy relationship takes a central role within the treatment and the exploration of internal relational dyads. Our approach differs in that also central to the treatment is the focus on the transference and countertransference, an awareness of shifting bodily states in the present moment and a focus on the client’s external relationships, emotional life and lifestyle.
Dynamic Psychosocialsomatic Psychotherapy (DPP) is an integrative treatment approach for working with complex trauma, borderline personality organization and dissociation. This treatment approach attempts to address the root causes of trauma-based presentations and fragmentation, seeking to help the client heal early experiences of abandonment, neglect, trauma, and attachment loss, that otherwise tend to play out repetitively and cyclically throughout the lifespan in relationship struggles, illness and addictions. Clients enter a highly structured treatment plan, which is created by client and therapist in the contract setting stage. The Treatment plan is contracted for a fixed period of time and at least one individual or group session weekly.
“Talk therapy alone is not enough to address deep rooted trauma that may be stuck in the body, we need also to engage the body in the therapeutic process and engage ourselves as clients and therapists to a complex interrelational therapeutic dyad, right brain to right brain, limbic system to limbic system in order to address and explore trauma that persists in our bodies as adults and influences our adult relationships, thinking and behaviour.”