After 20+ years in the trauma trenches, I’m still searching for answers. Not just more info – but evidence-based research. Good stuff that allows me to be a more effective parent.
Yet connecting the dots in the right order is easier said than done.
This year one of my goals is reading more about trauma.
What really works?
What might work with the right supports?
And what would never work – and could end up creating more chaos in my children’s lives? Re-traumatizing them is always a possibility.
That’s why I’m the gatekeeper – like most involved parents. I know more about my children than anyone. The ongoing challenge is choosing the right gate to open.
Without question, I want results – not more rhetoric about my children’s maladaptive behaviors. Been there, done that.
Unfortunately, we parents often grow desperate and will take any service offered – even when our gut says otherwise.
That brings me to my latest reading. A 70-page research summary from the National Institutes of Health: Social Bonds and Post-Traumatic Stress Disorder by Anthony Charuvastra ad Marylene Cloitre.
Simple and straight-forward, it re-iterated what I had always suspected – but had not seen in research form. Positive social connections lead to healing from past trauma. The entire article can be accessed here.
The article focuses on Post-Traumatic Stress Disorder – which I believe is pervasive, yet under-reported in the trauma, foster care and adoption communities.
The Mayo Clinic describes PTSD as “a mental health condition that’s triggered by a terrifying event – either experiencing it or witnessing it.”
Being removed from one’s birth family for abuse or neglect, spending time in foster care and then suddenly transitioning into a “forever” family via adoption was a “terrifying event” for my children, as I later learned.
While three of my six children came to my home with PTSD (prior to receiving additional diagnoses of Reactive Attachment Disorder and Borderline Personality Disorder), all meet the criteria in my opinion.
Today I share my summary of the research article (with direct quotes in italics). It gave me a richer perspective about the social connections that are incredibly valuable to our children’s healing.
The thesis statement is simple and direct. Social bonds exert a powerful influence on the maintenance of PTSD. Moreover, social bonds enable individuals to develop a sense of safety, which appears to be essential to recovery from PTSD.
The strength of a therapeutic alliance established in the first three sessions of treatment was the most powerful predictor of treatment outcome as measured by PTSD reduction.
How many times have the first three therapy sessions been a less-than-positive experience for your child? The answer is nearly all for my children – thus the reason for their lack of progress. In hindsight, I should have terminated the unproductive relationships sooner than later.
One continued for four years. Not surprisingly, three of my children never liked her.
Only three individual therapists (out of more than 15) stand out. They possessed the skills to make an immediate and appropriate connection upon which trust would emerge. My children truly bonded these therapists/clinicians.
Furthermore, I trusted them too – which allowed the therapist to work freely with my children without direct involvement from me every minute of each session.
Formally, the therapeutic alliance has been defined as a collaboration that has three distinct dimensions:
(1) the presence of a feeling of mutual warmth and understanding, (2) agreement on the goals of the treatment, and (3) agreement on the means by which these goals will be attained.
Strongest was sense of a warm and understanding bond with the therapist, suggesting the importance of the positive emotional experience with the therapist.
With the positive social bond between the therapist and my children, they felt a sense of safety. The therapist uncovered their fears (with some assistance from me – privately and out-of-session). More importantly, the therapist then acknowledged my children’s fears face-to-face in age-appropriate terms that they could understand.
This insight definitely created mindfulness for me. I now realize that my actions (although well-intended) could trigger fear in my children – and their defiant response.
The top six fears for my children weren’t a surprise.
- Fear of hunger without access to food
- Fear of further abandonment
- Fear of judgment without fairness
- Fear of failure and not receiving a second chance
- Fear of not being heard nor fully understood
- Fear of no longer feeling safe with a need to run
These fears could instantly create a “stuck” moment at home, during school or in the community. Fight or flight.
On the flip side of positive social bonding, four therapists re-traumatized my children – several severely because they overstepped the boundaries that we clearly established.
I was shocked each time with the lack of real trauma knowledge. Lack of family appreciation. The lack of empathy. The lack of connection.
Even though I had carefully interviewed each one. No doubt, talk can be cheap when a provider needs clients to bill.
Positive social bonds, however, support the therapeutic process. In turn, therapist-client interaction becomes more intense. Outcomes improve
Trauma memories are treated as the feared objects, and if the client can bring forward the memory of the trauma with sufficient fidelity, intensity and duration, the client’s fearful reactions to the memory will diminish. The therapist must be sufficiently skilled in creating a safe enough context to allow a client to be persuaded to engage in such a process.
Note the continued emphasis on feeling safe. EMDR – Eye Movement Desensitization and Reprocessing – can work wonders with a skilled clinician when our children feel safe.
With less fear in the child’s mind, the therapist can begin work on building social supports.
Evidence relating social support to PTSD suggests the importance of incorporating interventions that take into account (1) social support phenomena including the benefit to PTSD sufferers of positive social support, (2) the risk to health and recovery when social support is low, and (3) the need to effectively manage negative social support.
Treatment could additionally target improvement of interpersonal relationships.
In light of this evidence, we have added to traditional exposure-based treatment components that target the development of interpersonal skills and enhanced affect regulation abilities through the use of role play ad substantial practice both in and out of the treatment session.
DBT – Dialectical Behavior Therapy – is a great intervention for emotional regulation. Many therapists, community mental health centers and residential treatment centers actively employ DBT.
Treatment led to the resolution of impairments in emotion regulation, significant increases in perceived social support, and improved positive relationships with significant others and individuals in the work, home and social environments.
Diminished perceptions of social support despite its evident availability
The results suggest that specific efforts to improve the quality of social bonds can lead to improvement in individual PTSD symptoms, even in the absence of exposure-based work, potentially through self-initiated efforts to engage in emotional processing of trauma.
Yes, the quality of social bonds (beyond the therapist) is vital to continued healing. A dozen teachers proved that point to me. My children excelled in their classrooms and rarely had behavior problems. That same success usually carried over to home.
The same goes for several wonderful neighbors, two dear friends from church and even a caring dance/tumbling instructor.
Meanwhile, a second group of teachers proved the point too. They never connected with my children, nit-picked nearly every day, created fear and reduced feelings of self-worth. My children under-achieved in these classrooms and often had behavior problems that led to school suspensions. Their frustrations at school soon overflowed at home – making my parenting job all the more difficult.
The research is clear. Social bonds truly create connections that enable healing. DCP
Craig Peterson publishes EACH Child every Tuesday. To subscribe, open this link and “Like” the page. EACH Child is Special: Working Smarter Not Harder to Raise Every ONE
To follow Craig’s journey in raising his six children with special needs, click here: Adopting Faith: A Father’s Unconditional Love
To follow my son Andrew’s inspiring story, “Like” his special Facebook page Andrew Peterson Athlete & Advocate
To watch Andrew’s amazing ESPN 14-minute documentary, click here. Andrew Peterson ESPN Documentary