A "Trauma Story" Told by a Very Young Child

S.O.S

Yesterday was a cloudless Summer day in Southern California, and I was done early with my clinical hours. COVID-19 hit and everything has been on shutdown since mid-March. It’s now mid-September, and I’ve been feeling the need for some sun to drink into my skin. I drove over to the local pool (that is now re-opened, yay!) and lay down on the warmed and water splotched, beige concrete deck. Immediately I was alerted to a distressed toddler in the pool who was, in fact, with a swim instructor protesting into a water safe swim lesson. As the minutes sludged on, I found myself on the edge of my bandwidth of tolerance. This toddler was in distress. Instead of acting on my strong urge to leave the pool deck (and relieve my own viscerally triggered memory of being a tiny girl forced into a swim lesson that I wasn’t ready to experience), I stayed anyhow and breathed through my own triggering moments for the next twenty minutes. I wanted to really understand this child’s distress process, and to be frank, my own as well.  

No matter the constant protests of, “Towel!”, “Dada!”, “Hug!” and visceral sounds of the attachment cry that only a baby can produce, the swim instructor in her sun-worn, wide-brimmed straw hat remained calm and collected. She made constant, reassuring eye contact with the toddler and used encouraging, simple words with him. She stayed physically connected and responsive to this young boy. Apparently the instructor’s aim was to teach him to roll over onto his back and float after she induced a brief underwater submerge by letting go of him while gently pushing forward her arms. Upon his little head bobbing to the surface, she then guided him to the edge of the pool, and he would pull himself out onto the pool deck. He went through this trial over and over, all the while crying out with “Towel!”, “Hug!”. This was a real survivor reality show - moment, after moment, after agonizing moment! And just like on TV, I knew all would be well in the end. Despite my headspace knowing the outcome, in those excruciating twenty minutes I struggled to stay present, calling on all my robustness to tolerate my own emotional distress in this desperate boy’s calls to survive those moments, the moments that reverberated through my whole body and being. I can only imagine what it was like for him…

Happy Hour

At last, the swim instructor’s voice gave a lilt that implied the lesson was over. Three o’clock, a brand new definition of Happy Hour for me. When the toddler’s father approached the edge of the pool deck, the swim teacher made a polished water-airlift-hand-off of the boy to his dad, and suddenly the protestations muffled into a whimper, then ceased all together as a plush, wide-striped blue and white towel securely bound the little one’s big and raw emotions. Now there were just two little feet and a towhead on the other end. In silence, his father swooped up this little burrito. Teacher gave a pleasant recap of the swim safety lesson while dad agreeingly smiled and nodded. I couldn’t see the boy’s face anymore because he had buried it next to the safety of his dad’s chest and armpit. Finally! My nerves were beginning to calm down a bit. But I was wondering (with a slight dose of worry attached) whether the boy was experiencing a dissociative rebound, or was calmly resting in his father’s arms…

A few minutes later, after father had gathered up his little man, I found myself joined by the swim teacher who has taking a break dangling her shins over the edge of the pool deck (6 ft. apart!) by me. I took this unexpected opportunity to tell her how grateful I felt that someone like her had such importance in the lives of people. Water safety is so crucial for little ones. She returned, “It must’ve been hard to watch because he was having such a difficult time today, but I’m actually used to it.” Searching her hazel eyes I believed her. “With the three-year-olds and older, I can reason with them easier,” she easily imparted. What she told me next put everything into context.

The Trauma Story

“This little guy fell into a pool. That’s why his mom brings him.  It’s been a few weeks now…Tuesdays and Thursdays. He usually calms down after a minute or so, but today his dad brought him.” Now I was piecing things together. “The first few times his mom brought him, he’d say ‘Fall! Fall!’ repeatedly throughout the lesson, but he doesn’t do that really anymore.” Matter-of-fact-like she offered, “He only speaks one word at a time.” Before my filter could kick in, I shared back with her, “That makes sense…” I qualified my previous comment that unintentionally blurted out as if I was still thinking to myself. “I’m a psychologist.” I didn’t know how she’d take that in the context of our impromptu conversation, but in that moment I decided to move forward anyway. “In his own way, he must have been telling you his trauma story, just like I think he was doing today.”

Turning Off Alarm Systems

At the risk of her taking it defensively, I first complimented her on being so welcoming and calm in the face of this boy’s abject terror. “I admire how you were able to be so even-keeled just then. This boy truly couldn’t calm down. I think he needed something really important to happen first. Would it be alright if I gave you a tip?” 

I thought to myself, “Oh God. Maybe I’d just ruined the moment between us.” “Maybe his distress cries needed your validation [aka therapist-speak: mentalization] first before he could calm himself through your being close to him, holding him in the pool.”

We went on exchanging conversation about her experiences as a swim instructor and my understanding of how kids reveal their traumas. “Really?” She raised her eyebrows. “Yeah. Whatever he brings you in terms of his trauma retelling, you can accept it in the moment verbally and with your presence too, and then with good timing redirect his attention to being reassured— as much as he needs it, moment by moment. Like if he says ‘Fall!’, you can let him know, ‘Yes, you fell into a pool. That was really hard…’ Then take a moment to look into his eyes and acknowledge his way of communication. And then… let him know ‘You’re safe now here with me. I’ve got you!’ If he doesn’t mention the fall but is stressing really hard like today, you can say something like ‘I see you. I hear you. It’s sooo not easy for you right now, and I’m here with you. You’re safe now.’”

I sensed she wanted to hear more, so we continued, “That kind of in-the-moment validation will do a lot to turn off his alarm system because he’s got your great and calm presence, with your reassurances over the span of the whole swim lesson.” Of course because I couldn’t help myself, I went all out. “I feel like letting you know that you’re a kind of trauma therapist yourself for ones like this little boy today!” She brimmed. I was happy too that I took the chance to share in this unexpected exchange with her.

Attachment

“Attachment is where it all happens. The good. The bad. And the ugly,” Ed Tronick, author of the Still Face experiment said. When we help very young children make sense of their experience, when we are able to quickly and responsively repair attachment disruptions, and when we provide a good enough constancy of rapport, children can grow up to be securely attached and robust, even in the face of traumas.

The good news is that “the bar” is actually set pretty low. Attachment theory, notably via Donald Winnicott’s writings,  imparts the notion that the standard for secure attachment development is set at about 1/3 of the time (or more) for caregiver-child interactions—and I add here this proportion assumes the absence of emotional, physical, and/or sexual abuse. Wow! It turns out that the human condition is inherently robust. This idea is confirmed by The Adult Attachment Interview (AAI) data that indicate in the world populous, approximately 55-60% of adults are securely attached.

Bottom line is: as adults in a position to influence the lives of children, we can all be inoculators against the effects of big and little traumas. We can all intentionally be the promoters of secure attachment and a protective factor against the development of PTSD and other trauma-related conditions in children. The attachment cry is the human condition’s way of communicating, “I need help!,” and validating this unique communication is just as important as being soothing and calm in any little one’s distress.

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A "Trauma Story" Told by a Very Young Child

Photo by Marc-Antoine Roy on Unsplash

Trauma Bonding and Dissociative Coping

Tu Te Calme!

I had never witnessed anything like this scene before, yet I’ve heard similar (and more severe) first-hand accounts of this nature when people make their way into therapy. One of those moments I’ll never forget--apparently helpless to do anything but affront the blatant abuses with my burning stare, I almost immediately regretted my inaction.

Last week I was traveling in Costa Rica and had visited its most popular national park near the town of Manuel Antonio. I was next in line to enter the two-stall women’s restroom that had an open entryway. There was a young girl probably five or six who suddenly made a loud fuss aimed at her mother who was next to the washbasin.

The mother’s was jarringly louder and shriek-like than the young girl’s protests, “Tu te calme! Tu te calme!” pinballed in the pink cement interior as she boxed the little girl’s ears—twice! Shockingly, it seemed I was witnessing a well-practiced motion. The woman glanced out at me before asserting her right hand along her side, and the brown-pig-tailed girl silently obliged her little fingers into her mother’s stronghold.  Just as suddenly as she had protested near the washbasin, this small girl had been screamed at to be calm while she was being physically and emotionally abused! Within one second after her ear-boxing, this little one adjusted herself into a slight smile with glazed-over eyes as she walked out of the restroom in a kind of lock step with her mother. Something tells me that this sort of mother-daughter exchange had happened many times before with them.

Then an older girl with a dour face, maybe nine or ten, peered out of the restroom’s threshold with furrowed brow spying on her mother and sister (I assume) who absorbed into the nearby sea of tourists exiting the national park. As she lost sight of them within a couple of seconds, the taller sister flashed a panicked face, began running after the pair, and caught up with them just outside the entrance. With jerky and erratic motions, the mother’s left arm seemed to signal her older daughter to scramble toward the right side of her younger sister’s back. And then they were lost.

Trauma and Dissociation

I was really jolted out of my vacation mode having witnessed this abusive scene because who expects to see something like this in public on a beautiful day? I had the urge to confront the mother, but I held myself back. I don’t speak French. Who would I report the abuse to anyway? And if I had done something, anything to let these sisters know that there was an adult who would stand up for them, I could have been placing the girls in much greater jeopardy later when the mother was free from public view. I hate to imagine what happens to those girls in private with their mother.

What I saw unfolding before my eyes with these sisters likely was a desperate coping pattern, the need to attach to their mother at any cost. These girls developmentally do not have the capacity to make sense of their traumatic experience, and they do not have the choice to physically disengage and find safety from their abusive world. There is no perspective yet to put abuse into an appropriate context for their lives, no appropriate assignment of responsibility for the abuse (rightfully resting with the mother).

When the source of care and comfort is also the abuser, this makes for disorganized attachment to the caretaker that mirrors the chaotic behaviors and other unhealthy communications from the caretaker-abuser. Unfortunately, children naturally resort to desperate coping measures in these circumstances by dissociating from their traumatic experience because they cannot psychologically or emotionally handle them, and they cannot physically leave.

Dissociative Identity Disorder

In abusive home atmospheres, children cannot integrate their different ways of being in the abusive milieu into their consciousness. When abuse is severe, begins before the age of five years and is ongoing throughout childhood, dissociative coping often can develop into Dissociative Identity Disorder (DID). Lesser forms of dissociation do not organize a fragmented personality structure around dissociative coping and can be seen in milder forms, such as derealization of the environment, or depersonalization of the body when stressed or triggered. Usually these lesser forms of dissociation are correlated with less severe trauma histories.

While the story of these two unfortunate girls is all too similar to abuse around the world, there is help and treatment for those suffering from current trauma and/or past abuse. Many people do not find relief through treatment until they are adults, and children who are removed from their abusive home environments also incur the pain of longing for their abusive caretakers due to trauma bonding.

What You Can Do

The International Society for the Study of Trauma and Dissociation (ISST-D) has standard of treatment guidelines and therapist referral sources that are publicly available at www.isst-d.org. If you know someone who is in an abusive home atmosphere, please give them information about how they can seek help. If it is a child, please contact a mandated reporter of abuse, such as a school official. Thank you for reading my blog and thereby raising awareness on the phenomena of trauma and dissociation.

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Photo by Aimee Vogelsang on Unsplash

What’s at the Heart of Trauma Resolution

When is it trauma?

So many of us have brushed aside the notion of being traumatized because our self-image, our self-talk, our reliable defensive stance in life don’t allow us to reflect inside. “It was my fault. I shouldn’t have been dressed that way. Maybe then they wouldn’t have followed me outta that bar and beaten me up…” is what I heard one new client referred by the Victim Witness Assistance Program tell me when speaking about their most recent hate crime.

My client didn’t consider themself a victim, and they were proud of that. I respected their personal experience of the beating, and I knew their take on it was protective for them. My understanding of their beating (which I didn’t share with them at intake) was that they had likely dissociated from the vulnerable feelings and sensations that were a part of the beating in that dark parking lot. While this client presented a more obvious story of trauma that therapy could, and would resolve, other traumas are less obvious…yet just as devastating to the mind-body psyche.

Interestingly, conscious awareness at the time of traumatic experience is not a prerequisite for people to [subconsciously] register experience as traumatic. At clinical intake, the psychotherapist may hear, “My childhood? Mine was just great. Wonderful parents! Funny thing though…I don’t remember anything specific about it now that you ask.” Only many sessions later may the therapist begin to discover the client’s abusive/neglectful childhood if there is one. This kind of dissociative process happens automatically as a built-in survival mechanism attendant to the human condition. Why? -----because we are built to cordon off that which we cannot metabolize consciously. And kids are especially susceptible to dissociating when life gets to be too taxing for their burgeoning personal psychology in the midst of abuse and/or repeated experiences of emotional neglect.

My client who had been beaten up did not begin to consciously register their trauma until they sensed it was safe enough with me to explore this possibility within a paced, therapeutically shared internal journey. Resolution of trauma came quite slowly. After careful clinical interviewing, it became apparent to me that this client had Dissociative Identity Disorder (DID), and we worked through a serious history of early trauma extending up to the present at age 21 years. Their trauma healing process took a handful of years altogether in therapy with me.

When does the trauma response cease to be triggered? 

Skilled therapeutic intervention is key to resolving trauma, and fortunately there is not just one method or modality to accomplish resolution of traumatic experiences! At the heart of mental/emotional trauma resolution is therapeutic memory reconsolidation as articulated by Bruce Ecker’s (2018) methodology literature review. Healed trauma cannot be re-triggered. It’s permanently gone. Erasure of memory’s traumatic aspects connected to the declarative (aka, factual) and episodic recall is complete. This is fantastic news!

At present, there are ten different therapy modalities that have the backing of published scientific research explaining therapeutic memory reconsolidation. Check the list out here.  These distinct therapies provide a framework for established best practices in the field of trauma psychology. The International Society for the Study of Trauma and Dissociation (ISST-D) has treatment guidelines for adults which can be found here, and for child treatment of trauma, the guidelines can be viewed here. Working within these guidelines leaves ample room for applying the various treatment modalities alluded to above. FYI, please look them up!

To be frank with you, in my early years of treating Complex PTSD and DID, I hardly knew how to recognize what the heart of the matter was with these clients! I definitely contributed to the well-known statistic of DID clients being in therapy for an average of seven years before being given an accurate diagnosis of DID.  Fortunately, I found ISST-D via one of my mentors, and my confidence in working with traumatized clients has blossomed over the years. I now utilize the treatment modality of EMDR as a framework with nearly all of my clients, and it requires a specialized, advanced application with traumatized persons. If you are a client needing trauma-informed care, or if you are a psychotherapist treating trauma, aren’t we so fortunate as seekers and deliverers of therapy at the current time when trauma truly can be healed! Please share this blog with anyone you know who may benefit.

Ecker, B. (2018). Clinical translation of memory reconsolidation research: Therapeutic methodology for transformational change by erasing implicit emotional learnings driving symptom production. International Journal of Neuropsychotherapy, 6(1), 1–92. doi: 10.12744/ijnpt.2018.0001-0092

Instinct, Defense, and the Development of Complex Trauma

Not All PTSD Is Created Equal

Pierre Janet (1859-1947) once wrote, “Traumas produce their disintegrating effects in proportion to their intensity, duration and repetition.” (1909) He was the first in a long line of clinician theorists who have attempted to explain what happens to the human condition as a result of enduring repeated, ongoing neglect and all manner of abuse. And though contemporary understandings have made PTSD a commonly recognized acronym, a majority of mental health professionals grapple with efficiently treating the complexity that PTSD often involves. Why? The simple answer is that not all PTSD is created equal. Here’s an illustration: Surviving the fallout from a fiery car crash (having previously enjoyed a trauma-free upbringing) is quite different from surviving the latest trauma of a fiery car crash given the backdrop of an abusive, neglectful and chaotic upbringing.

The roots of psychological disintegration that Pierre Janet so elegantly outlined for us come from an instinctual, desperate attempt to survive perceived threat. Humans (at any age) will do whatever is necessary to survive when escape from perceived threat is impossible. Infants cry instinctually in an attempt to get attention, so their physical survival is maximized. And when aggressors are much larger, the primacy of the fight instinct is abandoned for fleeing as the best way to cope. And when fleeing is not an option, what’s left is to submit and comply with the powerful other’s demands; submittal with analgesia (the body goes limp and internal endorphins are released) is the last survival strategy by instinct. These automatic survival processes are designed by nature to segregate traumatic experiences, especially severe and chronic ones. This process helps the survivor to most efficiently focus on daily life despite their trail of traumatic experiences.

The success of survival from chronic, perceived threat comes at the price of a disintegrated psyche via traumatic learning.

Traumatic learning is very difficult to undo because it holds strong survival value. Here’s an example: A child learns to wall off the realization that the parent who molests her late nights is the same parent smiling and making small talk at the breakfast table the next morning. This child cannot escape the molestations and must carry on a “normal” relationship with that parent. This girl who submits to and experiences the molestations may be remotely aware (or even unaware) of the one who makes small talk with her molester-parent at the breakfast table. This is but one possible effect of traumatic learning processes that are born out of an instinctually defensive purpose to survive.

How Do We Begin To Help Our Clients?

So where do we start as clinicians with treating such complex trauma? We start with gentle kindness, with friendly curiosity. We hold space for our clients’ confusion, their knowing and not knowing about what their past experience holds. And when the time is right, we reaffirm whatever the client had to do in order to survive was alright.  That’s where we begin, and that’s where we stay as long as is necessary.

When we, as clinicians, understand these instinctually defensive roots of traumatic response, we can help our traumatized clients begin to stabilize their daily living and to build customized skill sets that address what is needed to eventually confront the realization of their traumas. Out of this process, our clients will eventually make sense of their trauma in terms of who they intend to become—not only as survivors, but also as thrivers.

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Photo by Camila Quintero Franco on Unsplash