Simple and Complex Post-Traumatic Stress Disorder

Strategies for Comprehensive Treatment in Clinical Practice

Mary Beth Williams, John F Sommer Jr.

• Éditeur: Routledge
• Année: 2014
• ISBN:
  9781317790754
• Édition: 1
• Sujet: Psychology
• Sous-sujet: Industrial & Organizational Psychology

Discover the latest treatment strategies from the leading experts in the field of trauma! This unique book, by the authors of the classic Handbook of Post-Traumatic Therapy, provides the "how to" of clinical practice techniques in a variety of settings with a variety of clients. Simple and Complex Post-Traumatic Stress Disorder: Strategies for Comprehensive Treatment in Clinical Practice delivers state-of-the-art techniques and information to help traumatized individuals, groups, families, and communities. From critical incident debriefing to treating combat veterans with longstanding trauma, it covers the full spectrum of PTSD clients and effective treatments. This valuable book assembles some of the most highly respected experts in trauma studies to discuss the practical applications of their research and their experience treating clients with PTSD. Simple and Complex Post-Traumatic Stress Disorder addresses concerns about the efficacy of critical incident stress debriefing, examines the value of a variety of innovative treatment methods, and explores the differences between treating complex PTSD and the aftermath of a one-time traumatic event. Simple and Complex Post-Traumatic Stress Disorder discusses the issues, stages, and modalities of PTSD treatment, including:

• assessment and diagnosis
• psychopharmacological treatment
• cognitive behavioral treatment
• short-term treatment
• group treatments
• treatment strategies for traumatized children, families, hostages, police, and veterans
• media issues

Simple and Complex Post-Traumatic Stress Disorder is an indispensable resource for clinicians, researchers, law enforcement officials, and scholars in the field of trauma.

SECTION IV:
CHILDREN, STUDENTS, AND FAMILIES

Chapter 10

Treatment Strategies for Traumatized Children

Mary W. Lindahl

In recent years, trauma has received a great deal of attention from psychologists and other mental health professionals. Most of the research, however, has been directed at adults rather than children. In the course of a thirty-year career, this author has found the techniques available to treat traumatized children inadequate to deal with the complexities of their situations and, thus, over the years, has been constantly confronted with the need to develop new approaches. This chapter, building on past research, presents new ideas and techniques that have worked to help children who have experienced many types of traumatic events, including those caused by human design (physical, sexual, and emotional abuse; domestic violence; witnessing a violent crime or the murder of a parent; parental death by suicide or sudden line-of-duty death in a law enforcement parent; kidnapping; and the deliberate terrorizing and attempted emotional destruction of the child) as well as those caused by nonhuman forces (fires, natural disasters, airplane and automobile accidents, death of a parent through illness or accident; necessary medical treatments, and discovering a mutilated body).

BRIEF OVERVIEW OF THE LITERATURE

Estimates of the percentage of children who develop PTSD after trauma vary considerably according to type of trauma, age and sex of the child, availability of family support, and strictness of criteria required to make the diagnosis (Vogel and Vernberg, 1993). A number of studies, using both qualitative and quantitative approaches, have examined the responses of children exposed to traumas of witnessing severe violence (Eth and Pynoos, 1985b; Malmquist, 1986; Nader et al., 1990; Schwartz and Kowalski, 1991; Zeanah and Burk, 1984); natural disasters (Galante and Foa, 1986; Garrison et al., 1995; Gould and Gould, 1991; Shaw et al., 1995); child abuse (Herman, 1992; van der Kolk, MacFarlane, and Weisaeth, 1996); being held hostage (Butler, Leitenberg, and Fuselier, 1995; Jessee, Strickland, and Ladewig, 1992); accidents resulting in physical injury (Jones and Peterson, 1993; MacLean, 1977); exposure to warfare (Arroyo and Eth, 1985; Garbarino, Kostelny, and Dubrow, 1991); and painful and frightening medical treatments (Nir, 1985).

Children who have experienced trauma are vulnerable to a wide variety of negative outcomes. An excellent literature review by Armsworth and Holaday (1993) documents the following effects of various kinds of traumas on children:

1. Cognitive: time distortions, development of omens, a foreshortened sense of future, memory impairment, decreased ability to learn, loss of academic skills, and impaired concentration

2. Affective: emotional reexperiencing, intrusive images and avoidance, depression, guilt and shame, feelings of helplessness and powerlessness, negative self-perceptions, and constricted emotions

3. Behavioral: increased aggression and disruptive behavior, withdrawal, regressive symptoms such as enuresis and encopresis, muteness, disturbances in attachment, repetitive play and reenactment including sexualized behavior, suicide attempts, chemical dependency, self-destructive and risky behaviors, and impaired social skills

4. Physiological: hypervigilance and nervous system changes (see also Famularo, Kinscherff, and Fenton, 1992; Finkelhor and Browne, 1985; Friedrich, 1993; Lewis et al., 1989; Green et al., 1991; Green, 1993; Payton and Krocker-Tuskan, 1988; Osofsky, 1995)

EVALUATION AND TREATMENT PLAN

A thorough evaluation resulting in a well-designed treatment plan is crucial to the effective treatment of potentially traumatized children (Brohl, 1996; Everstine and Everstine, 1989; Levin, 1993; McNally, 1991; Miller and Veltkamp, 1995; Putnam, 1996; Pynoos and Eth, 1986; Scheeringa et al., 1995; Viglione, 1990). Ideally, assessment begins with a broad range of psychological testing:

1. Cognitive measures: the Weschler Intelligence Scale for Children-Third Edition (WISC-III) (Wechsler, 1991); the Woodcock-Johnson Psychoeducational Battery-Revised (WJ-R) (Costenbader and Perry, 1990); and the Wide-Range Achievement Test-Revised (WRAT-R) (Reinehr, 1987)

2. Projective tests: the Rorschach Inkblot Technique (Rorschach, 1921); the House-Tree-Person Projective Drawing Technique (Buck, 1981); the Roberts Apperception Test (Roberts, 1982); and the Rotter Incomplete Sentence Blank (Rotter and Rafferty, 1950)

3. Checklists: Trauma Symptom Checklist for Children (TSCC) (Briere, 1996); the Children’s Depression Inventory (CDI) (Kovacs, 1992); the Revised Children’s Manifest Anxiety Scale (RCMAS) (Reynolds and Richmond, 1985); Devereux Scales of Mental Disorders (Naglieri, LeBuffe, and Pfeiffer, 1994); and the Child Behavior Checklist (CBCL) (Achenbach and Edelbrock, 1986)

4. Structured interview formats (to assess symptoms of PTSD): the Post-Traumatic Stress Disorder Reaction Index (PTSD-RI) (Pynoos et al., 1987); Children’s Post-Traumatic Stress Disorder Inventory (CPTSDI) (Saigh, 1991); and the Children’s Impact of Traumatic Events Scale (CITES) (Wolfe, Gentile, and Wolfe, 1989)

In addition to psychological testing, less formal interviews should be conducted with the child and family to gather as much information as possible about the events and circumstances surrounding the trauma.

Several interviews are usually needed with the child and parent or accompanying adult to complete the assessment and formulate a treatment plan. These interviews also educate about traumatic reactions, help the child tell the story of the trauma, target individual symptoms, evaluate the need for medication, encourage the expression and working through of feelings about the event(s), help the child’s efforts to understand and find a meaning in the trauma, explore developmental and characterological issues and vulnerabilities, assess and strengthen family and social support, and refer to and collaborate with other sources such as group therapy or school support.

EDUCATING THE CHILD AND FAMILY ABOUT TRAUMA

Children tend to be fascinated by psychological information. They are intrigued to learn that the therapist has seen children with similar experiences before. Explaining the symptoms and naming the reaction (PTSD or depression, for example) brings them relief. It is helpful to give information to the child and then ask him or her to present that information to the parent. This retelling enables the therapist to see if the child understood the information and also helps her initiate a sense of control over the trauma.

In cases of sexual abuse, the social worker or therapist usually reassures the child: “Remember, it’s not your fault; only the adult is responsible.” To a child who has been groomed and entrapped in the abusive activity and who has internalized and come to share the cognitive distortions of the abuser, these words have no impact. Even very young children generally understand that, through sexual abuse, they have participated in acts that society and their parents say is wrong. Parents and prevention programs drum into children: “Don’t ‘let’ anyone touch your private parts.” This is “bad touch”; receiving that type of touch means they have done something “bad,” particularly when a child’s body responded pleasurably during the abuse. It is not surprising that children do not tell what happened. Recent approaches, referring to “uncomfortable” or “confusing” touch are an improvement, but still may not effectively capture the child’s experience.

Many offenders begin abuse with subtle and confusing preliminary touches that the child does not understand and thus does not protest. These touches may seem accidental or may occur in the context of ordinary activities such as bathing or roughhousing. By the time there is overt sexual touch, the child believes the rationalizations of the abuser who says, “It’s your fault; why didn’t you say anything before?” These children need to know the information that has been gained in interviews with convicted sex offenders as to how they entice and entrap children (Berliner and Conte, 1990; Burgess and Holmstrom, 1978; Conte,Wolf, and Smith, 1989; Elliott, Browne, and Kilcoyne, 1995; Singer, Hussey, and Strom, 1992).

When trauma takes the form of accidents, natural disasters, or acts inflicted by medical personnel in the course of necessary treatment, the therapist can explain, for example, the formation of the hurricane, the cause of the fire, automobile, or plane crash or the reason for a medical procedure. Explanation helps eliminate misunderstandings about causation and assists with mastery of the event.

THE ROLE OF PARENTS

Whenever appropriate, working with the parents of a traumatized child to support and strengthen the family system can be crucial to a child’s recovery. Parents, to the greatest extent possible, should be cotherapists for the traumatized child. They can often recount the trauma more accurately, as well as explain the child’s background and prior development. Moreover, researchers have reported that the child’s reaction to trauma is heavily dependent on that of the parent (Foy, 1992).

Traumatized children need their parents to be involved closely in their treatment. Therefore, it is important to see them individually when necessary and, when practical, to include one or both parents in part of each session. At times, if the child is in crisis, it may be vital to bring a supportive parent into the session to hold or soothe the child. Of course, all too often, traumatized children do not have an available or supportive parent. For these children, a supportive adult, such as another family member or professional, can be helpful. Educating parents about children’s reactions to trauma is also important. One way to educate them is to recommend a book such as Children and Trauma: A Parent’s Guide to Helping Children Heal (Monahon, 1993). In addition, parents can serve as liaisons between therapists and teachers, as well as put the therapist’s suggestions for ameliorating symptoms and promoting healing into practice between sessions. It is sometimes necessary to refer a sibling or parent, who may, for example, have been involved in the same accident or may simply be devastated by the suffering of the child, to another therapist or to a support group (Heft, 1993; Newberger et al., 1993).

TELLING THE STORY

Lenore Terr (1991) has differentiated between Type I and Type II traumatic events. Type I traumas are single, unexpected events that usually culminate in PTSD. They are often accompanied by detailed memories, omens, cognitive reappraisals, and misperceptions. Type II traumas are caused by long-term repetitive traumas (such as chronic child abuse) from which there is no escape. Victims tend to develop denial, psychic numbing, excessive dissociation, and characterological disturbances.

Regardless of the type of trauma, children often have an extremely difficult time telling the story of what happened. This recounting is perhaps the most difficult part of the treatment. Victims of Type I trauma are too frightened to tell; victims of Type II trauma tend to suffer memory problems and confusion. Sometimes the disclosure is accidental (for example, the child slips and tells a friend “a secret” or gives obvious clues through behavior) and other times purposeful (Sgroi, Blick, and Porter, 1982).

Currently, a wide range of controversy exists about the reliability or suggestibility of children’s memories, particularly in allegations of sexual abuse (Ceci, Ross, and Toglia, 1989; Williams, 1995; Terr, 1988). Researchers have fou...

Table des matières

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Dedication
• Contents
• About The Editors
• Contributors
• Preface
• SECTION I:Introduction
• SECTION II:Treatment of PTSD in General
• SECTION III:Group Treatments
• SECTION IV:Children, Students, and Families
• SECTION V:Special Populations
• SECTION VI:Media Issues
• SECTION VII:Conclusion
• Index