Trauma-Attachment Tangle

Modifying EMDR to Help Children Resolve Trauma and Develop Loving Relationships

Joan Lovett

• Verlag: Routledge
• Jahr: 2014
• ISBN:
  9781317654575
• Auflage: 1
• Thema: Psychology
• Thema: Psychotherapy

Trauma-Attachment Tangle offers informative and inspiring clinical stories of children who have complex trauma and attachment issues from experiences such as adoption, hospitalization, or death of a parent. Some of these children display puzzling or extreme symptoms like prolonged tantrums, self-hatred, attacking their parents or being fearful of common things like lights, solid foods or clothing. Dr. Lovett presents strategies for unraveling the traumatic origins of children's symptoms and gives a variety of tools for treating complex trauma and for promoting attunement and attachment.

Part I
The Clinical Stories

1
Amy

Violent Behavior in an Adopted Toddler

It is not unusual for parents of an adopted child to come to me and say, “Is there any hope? We wouldn’t really send him back, but the thought has crossed our minds. We have done everything we can, and he just doesn’t love us. He hits and kicks and screams and makes our lives miserable.”

Parents who adopt are motivated to share their love, care, time, money, and other resources for a child in need of a loving home and family. However, few of these parents have been educated about the challenges and demands of raising an adopted child. They have no experience or perspective from which to understand or approach the complexities of adopting a child whose early months were spent with little opportunity for consistent, attuned care or adequate developmental stimulation. The child they adopt comes with a history: a history that may include trauma in the form of neglect or abuse. Without the proper guidance, resources or preparation, the adoptive families may not fully comprehend the effects of the trauma their child experienced or the resulting attachment issues that await them. Fortunately, there is hope and help for children who have experienced early trauma: Issues stemming from traumatic experiences can be resolved with therapeutic treatment and specific parenting strategies designed to enhance attachment between the parents and child.

Amy

Emily and Peter had no idea what to do with their two-year-old daughter, Amy. They had adopted Amy from an orphanage in China when she was 19 months old. Emily explained, “We fell in love with her when we saw her picture. She was just a year old then. She had shiny black hair, a dimple in her cheek, a twinkle in her eye, and that charming smile.” Peter added, “I already had a grown son by a previous marriage, and we wanted a daughter. I was in favor of adopting a toddler because I’ve already been through the infant stage, and it’s intense—all that crying and those night feedings.” Peter smiled ruefully, “I thought a girl—and especially a girl who was not an infant—would be easier.” What he didn’t know was that he and Emily would spend years focusing intensively on Amy’s emotional and developmental needs and giving her the nurturing she had missed as an infant.

Their first eight months together as a family were stressful because of Amy’s extremely difficult behavior. Amy didn’t seem to care about anything—she threw toys, tore up books, tortured the family kittens by twisting their bodies, and attacked her parents and other children with unprovoked biting, hitting, and scratching. When she came close to babies, she tried to jab their eyes with her finger.

Amy also hoarded food by keeping it stuffed in her cheeks, and she sometimes refused to swallow for half an hour. She seemed to have no attention span at all, and she wouldn’t listen to a page of a book or play with any toys in an organized way. She just pulled things off the shelves and left them in a jumble on the floor. She slept deeply but appeared to have unhappy dreams and often screamed while asleep.

Peter described the miserable drama he witnessed several times daily: “When Emily or I say ‘no,’ Amy pitches a world-class fit. I mean she flings herself on the floor and launches this prolonged hissy fit with screaming and kicking and spitting and sobbing. I know that toddlers are oppositional, but I’ve never seen anything like this—she goes into attack mode and sometimes goes on for an hour.” Emily looked defeated: “We’ve tried everything—time out only makes things worse. We’ve tried talking to her nicely, but it’s like she’s having a seizure and doesn’t hear us. We’ve tried rewards and punishments. We have a whole closet full of toys we’ve taken away. There’s nothing she cares about enough to motivate her.” Peter added, “I feel really sorry for Emily. I work a lot and travel a lot for work, but she’s stuck at home with Amy. Emily’s exhausted.”

Then there was the other side of Amy. Emily and Peter told me that when Amy wasn’t being difficult, she was pleasant, and she was outgoing around strangers. They said that she smiled a lot and even wanted strangers to pick her up. Toddlers don’t usually want strangers to pick them up, unless they have had to rely on acting charming in order to get basic care from anyone they could attract. Amy’s history of institutionalization and multiple caregivers, her emotional dysregulation, her inability to relate to her parents, her destructive behaviors, and her indiscriminate willingness to go with strangers were red flags for trauma and attachment issues.

While Amy’s early history was a mystery, we did know that Amy was found on the steps of a police station in a remote part of China when she was seven months old. She was small for her age but appeared healthy. She was taken to an orphanage, but we don’t know anything about her life there. Amy stayed in the orphanage until she was 19 months old.

The 19-month-old toddler Peter and Emily met seemed to understand Mandarin but didn’t speak a word. Her motor development was slightly delayed, and she had only seven teeth. (Most babies have more than that when they are a year old.) She was a little clumsy and frequently ran into things. Peter observed, “She looked like a deer in the headlights when the director of the orphanage handed her to us at the hotel where we met.”

When Emily and Peter brought Amy home to the US, they had her examined by a pediatrician. Amy was a little behind developmentally, but the pediatrician thought she would catch up quickly. Emily and Peter were sure that love and healthy food were all she needed to thrive.

Emily worked at home and had a Peruvian babysitter take care of Amy. Imagine Amy’s shock at being brought to a home in which no one spoke the language she already understood and two totally foreign languages were spoken. In fact, everything was unfamiliar, scary, and overwhelming for Amy—caregivers, language, smells, food, customs, and expectations.

When I finished taking the history during our first appointment together, Peter had one pressing question: “What should we do about her tantrums? They happen so fast that we can’t prevent them. She suddenly goes crazy. Sometimes we don’t even know what upset her.” I explained to Peter and Emily that Amy’s prolonged tantrums were not their fault or Amy’s fault. I further explained that optimally, during the first year of a baby’s life, a special kind of dance takes place between a baby and his or her most intimate caregiver. The attuned caregiver responds to the baby’s expressions and helps to regulate the baby’s fluctuating states of arousal through touch, voice, facial expressions, and gestures. In response, the baby’s autonomic nervous system becomes regulated and organized to respond to a wide range of internal and external stimuli.

During her first 19 months of life, Amy had not had a sustained relationship with one reliable, attuned caregiver. Amy had become chronically stressed and unable to regulate her strong emotions of fear, frustration, or disappointment. Her sympathetic nervous system, primed to respond to threat, was in overdrive.

Amy’s parents were relieved to learn that they hadn’t caused Amy’s tantrums, and now they had an explanation for how early trauma had affected her ability to regulate her moods. Understanding the cause of her behavior was the first step. Now they needed the tools for dealing with her tantrums.

I advised Emily and Peter that a parent should stay in the room with Amy while she had a tantrum to be sure she was safe. They should stay quiet while Amy was angry. I told them about the work of researchers Green and Potegal, who studied children’s vocalizations during tantrums and have observed that the vocalizations of screaming and yelling, both angry expressions, are intertwined with whimpering, fussing, and crying, which are expressions of sadness. Green and Potegal found that sad sounds tended to occur throughout tantrums, with angry spikes of yelling and screaming superimposed.

They observed that children get past the angry part most quickly if the parent is quiet, and that after the anger subsides, what is left is sadness. When the child feels sad, a parent can use that opportunity to comfort the child and strengthen their intimate connection (Green, Whitney, & Potegal, 2011).

The time to approach Amy and begin to comfort her would be when Amy was sad and whimpering. Emily could say, “I’m your mom, and I’m here for you. I won’t leave you. When you’re ready we can cuddle and I’ll rub your back if you want, and you’ll feel better.” Tantrums do stop eventually, and then there is an opportunity for calming and connection. The end of the tantrum offered an opportunity for Amy to learn that she could count on her parents to comfort her when she felt sad.

Even before I met Amy, I thought about her behaviors from a trauma perspective. What were the experiences that undermined Amy’s sense of safety and well-being and gave her false or distorted beliefs about herself or the world? I asked myself: What did Amy learn from her experiences in her first seven months of life? What did she learn in the orphanage? What do her current behaviors tell us about her early experiences?

I knew that Amy had been taken away from familiar caregivers at least twice. Her history made me suspect that she would have trouble trusting Emily and Peter or other caregivers, even if they were very responsive, caring people. Could she trust that she would get food when she was hungry? Given that she was small for her age and hoarding food, I assumed that she could not be certain she would have that basic need met. It made sense that she hoarded food when food was available so that she would have something when she was hungry.

Could she trust that she would have her basic need for attention and attunement met? Given that she was “charming” and indiscriminately went to strangers to be picked up told me that she probably couldn’t trust that she would get attention when she needed it, so she had learned to seek it and to be charming to get someone’s attention.

Amy had been abandoned by her birth parents and had multiple care-givers in an orphanage. Her early experiences had taught her that attachment leads to pain and disappointment. Trust issues are at the heart of ruptured attachment. Children who have been severely traumatized by early abandonment demonstrate self-loathing. One adopted five-year-old girl told me that she felt “like garbage” because her birth parents didn’t want her, and she was “thrown away.” Other adopted children have shown me their distress when they played in the dollhouse. I have seen the dollhouse baby stuffed into the oven, flushed down the toilet, and suffocated with pillows or buried under furniture. I don’t interpret that play literally but see it as the child’s expression of an emotional experience. I believe that traumatized children “feel bad,” and they think that means they are bad. Later, they attack animals or babies who remind them of their vulnerable, helpless little selves.

I guessed that if Amy could express her negative beliefs about herself, they might have been: “I can’t trust anyone to meet my needs over time, so it’s dangerous to connect deeply with anyone. I’m bad because bad things happen to me. I can’t tolerate it when things don’t go the way I expect or want.” My goal was to help Amy and her parents develop a strong positive emotional bond that would feel good to all of them.

Emily began to recognize that her daughter’s challenging behaviors indicated an attachment disorder. Emily went online and found the web-site for attach-china.org and several other sites with information about attachment. She began taking naps with Amy and stopped scolding her so often. Even with those few changes, she noticed a decrease in the frequency of Amy’s tantrums.

When Amy and her mom came back to see me the following week, I used a modified version of the Marschak Interaction Method (MIM) assessment to learn more about interactions between Amy and Emily. I wanted to observe the quality of Emily’s interactions with Amy: how she structured her interactions with Amy, how Emily nurtured her, taught her, challenged her and how Amy responded to her mother (DiPasquale, 2000). Emily and Amy followed the instructions to put lotion on one another’s hands, and then they played with dolls, plastic dinosaurs, and stuffed animals. Emily showed her daughter how to help the baby doll be “safe and cozy.”

I observed that Emily was good at paying careful attention to Amy, speaking to her in an age-appropriate way, giving her new vocabulary and expanding on Amy’s words. She was gentle as she showed Amy how to pet the stuffed dog. When it was time to clean up, Emily asked, “Do you want to clean up? Do you want to put the dinosaurs in the basket?” And when it was time to leave my office, she asked Amy, “Do you want to say goodbye?” Amy’s mom repeated these questions many times. Amy ignored her.

When I met with Emily the following week, I complimented Emily on the many ways she was attuned to Amy, and I shared a list of parenting suggestions with her. My plan was to start by encouraging lots of babying activities like rocking, cuddling, feeding, and comforting. I encouraged Emily to cuddle and soothe Amy every day. By starting off the day attuning to Amy and snuggling with her, Emily could help develop her daughter’s capacity for connection and help fill Amy’s “emotional bank.” I encouraged her to notice Amy’s interests, follow her lead while engaging her in play, initiate back-and-forth communication, and invite Amy to do activities with her, like singing songs or picking up toys together. Amy had such a chaotic beginning in life, as well as culture shock, that she needed to begin to see that there are patterns in life that make sense and that she could trust her mom to help her understand the world.

I also thought that teaching Emily to help Amy cooperate would bring some rewards for both Amy and her mother. By asking Amy, “Do you want to clean up? Do you want to put the dinosaurs in the basket?” Emily implied that it was really Amy’s choice about whether or not to help and that she would be happy with whatever decision Amy made. Parents may think that they are being friendly by asking “Do you want to…?” In fact, they are giving their child a false choice. Given a real choice, most children choose not to do something like clean up a mess or stop watching TV. I instructed Emily to “only ask Amy to do what you want once. If she doesn’t comply, gently bring Amy to your side or lap, and tell and show her how ‘we clean up like this,’ then say ‘thank you for following directions’ when she does comply.”

Young children need explicit instructions and clear directions that accurately tell what the parent wants and expects. Children become confused by requests that are presented as choices. For example, “Do you want to hold my hand when we cross the street?” sounds like a choice, but it’s tricky. The parent knows what he or she wants but presents it in a way that sounds like cooperation is optional. “Do you want to hold my right hand or my left hand while we cross the street?” is a more appropriate choice to give a young child.

I also suggested that Emily observe Amy closely and notice when she was beginning to act frustrated or upset. Then Emily could move close to Amy or hug her while she identified what Amy was feeling. She could teach Amy to use words to say how she felt. Then Emily could soothe Amy and tell her exactly what to do. For example, if Amy was becoming upset because she was having trouble trying to take off her shoes, Emily could say, “Oh, I see it’s hard getting those shoes off. It looks like you’re starting to feel frustrated. Let’s see what’s making it hard. The laces are tied. You can pull here to open them, like this, or you can say, ‘Mom, will you help?’ and I will help you.” Amy still needed to learn how her parents could be useful to her.

I showed Emily how to set Amy up for success by giving her tasks she was capable of doing, helping her do them if she had trouble, and then acknowledging when she did something the way her mother liked. I wanted her to praise Amy’s efforts to follow directions and specific behaviors that she liked rather than generalize “good girl,” which implies that she is a bad girl when she doesn’t do exactly what her mom wants.

When Amy and her mom came back the next week, Emily said things were going a little better. “It really helped for me to know that Amy’s tantrums aren’t my fault and that I can help her learn to calm herself. Now that I understand that Amy isn’t just trying to defeat me, I can be calmer. I want to help her learn to regulate her emotions.” Being close to Amy, talking with her calmly, empathizing with her feelings, and soothing her all began to calm Amy. Emily discovered that Amy liked back rubs. Emily started telling Amy that she loved her, because she thought it was beginning to be true. There had not been any biting, hitting, or scratching, but Amy was still obstinate and not paying attention.

I noticed that Amy was very sensitive ...

Inhaltsverzeichnis

• Cover
• Title
• Copyright
• Dedication
• CONTENTS
• Acknowledgments
• Introduction
• PART I The Clinical Stories
• PART II Cultivating Positive Emotions
• PART III Writing the New Story
• Conclusion
• Bibliography
• Glossary
• Appendix
• Index