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Simple PTSD

When a child goes through a one off traumatic incident there is a possibility that they will develop the symptoms of PTSD. These includes signs of wanting to avoid thinking or talking about the event and being emotionally numb; being on high alert; and re-experiencing the event through flashbacks, bad dreams and intrusive thoughts.

Children under the age of six can also develop post-traumatic stress but it can look a little different to older children. Younger children are likely to show disturbed or repetitive play where there are themes of fear, anxiety and distress. Younger children are also likely to show anxiety at separating from their parents/carers, and other signs of distress such as bed wetting, disturbed sleep and challenging behaviour. Young children may not be able to put words to their feelings, but they can suffer with a post-traumatic stress reaction just as older children can.

PTSD develops because the traumatic event becomes ‘frozen in time’ for the child and they act and feel as if the threat is still ongoing. Therapy aims to help the child to process the trauma memory and re-learn that they are safe.

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How we work with Simple PTSD in children and teenagers

We will first carry out a gentle and sensitive assessment of how the trauma has impacted the child, which may include PTSD symptoms but may also include other difficulties impacting on home life and school life.

Our assessment will take into account the child’s voice and the parents/carer’s observations, and if helpful we can involve the school in building up a holistic picture of how the child is managing. Sometimes it can be helpful to use psychological measures to get a fuller picture of how the child is feeling.

This usually takes place over two sessions, and after that we will share with the parents and the child our impressions of how the trauma is affecting the child and our recommendations for the therapy.

We will then offer an evidence-based therapy to directly address the traumatic memory.  This might be Cognitive Behavioural Therapy or EMDR; and for very young children, play therapy is also brought in to the therapy. We often take what is known as a ‘systemic’ approach to the therapy, which means that we support the parents and the school to understand and help the child, as well as working directly with the child.

Once the main trauma symptoms have been addressed, we may bring in other therapeutic approaches to help the child and family develop a new story for themselves about how the trauma came, how they recovered and how they will take their experience positively into the future. Sometimes at this stage we offer family therapy for the final phase of moving on from the trauma.

Developmental Trauma

When repeated trauma happens early on in a child’s life it can lead to what is known as ‘Developmental Trauma’. Developmental Trauma can be seen in children who have lived in an environment of ongoing danger, maltreatment and inadequate caregiving. When caregiving is inconsistent or frightening in itself, children are unable to ‘regulate’ their levels of arousal as their source of comfort is also a source of fear. This leads to a breakdown in the child’s ability to process and make sense of what is happening, and a breakdown in their ability to manage their ‘internal states’.

This trauma in the early experience of being cared for is known as ‘attachment trauma’, as it occurs within the child’s key attachment relationships. Children with Developmental Trauma and insecure attachment patterns have significant problems in most areas of development. These children are highly ‘dysregulated’ which means they cannot identify their internal emotions, they cannot manage their feelings or behaviour and they cannot communicate their emotions in a stable way.

The imprints of children’s early trauma remain embedded as bodily and emotional memory even when the immediate danger has passed. Even though there may be little or no conscious memory of their experiences, a child who has suffered early trauma will continue to experience dysregulation, rage, and a fear of intimacy yet a longing to be cared for.

It can be extremely tough for parents and carers to look after children who are chronically traumatized because the ‘good enough parenting’ is often not enough for these children. The adult and the child often find themselves in a dance – where the child craves safe dependence on their parent/carer and at the same time is terrified of it.

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How we work with Developmental Trauma

At Beacon House we understand that a child who has suffered chronic trauma is doing their best to survive a world which has been extremely threatening. Their behaviours are all survival strategies, which at one point in their life were effective and necessary to keep their caregiver as close but as safe as possible.

We following the NICE Government Guidelines where they are available in the treatment of Developmental Trauma, and between the team members, we also bring to the service many years’ experience and learning from working with these children and their carers.

Assessment of Developmental Trauma

Before we begin a piece of therapy work with a child who is chronically traumatized, we usually carry out a therapeutic needs assessment, unless the child has already been recently assessed. This will take into consideration:

  • The child’s background
  • The child’s voice
  • Their parent/carer’s observations and insights
  • Information from school and other professionals in the child’s network.
  • Information from existing assessments
  • An observation of the child at home and at school
  • Psychological measures to help us gain a window into the child’s internal emotional world.

From this in depth assessment, we come to a detailed understanding of how the child’s early trauma has impacted their development. We will make clear recommendations for an intervention package, which may include therapy from Beacon House in addition to outreach work with the child’s network. If the child is not ready for therapy, we will make suggestions for interventions that, over time, will help to prepare them for therapy.

Treatment of Developmental Trauma

The Government Guidelines suggest that a long-term relational therapeutic approach is most effective for children with Developmental Trauma. Our experience shows us that there is no one therapy method which fits all children, and we draw on a range of treatments depending on our assessment of what would work best for the child and their family. The therapies we offer that are known to be effective for Developmental Trauma include:

Dyadic Developmental Psychotherapy

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DDP is an attachment-focussed family therapy, developed by the psychologist Daniel Hughes, to support families who are caring for a traumatised child. DDP is often used with fostered and adopted children, as well as children being cared for by their birth parents.

This approach principally involves creating a playful, accepting, curious, and empathic (known as PACE) environment where the therapist attunes to the child’s experiences and reflects this back to the child through eye contact, facial expressions, gestures and movements, voice tone, timing and touch. By doing this, the therapist “co-regulates” emotions and “co-constructs” an alternative life story with the child. The child’s parents or carers are supported to share the same role, and the hope within DDP is that in time, the child and his or her parent/carer will have a more attuned relationship and a closer emotional connection.

For more information about DDP visit www.ddpnetwork.org.

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EMDR

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EMDR is a psychotherapy that enables children to heal from emotional distress that is the result of disturbing or stressful life experiences. EMDR is a powerful and very effective therapy for a range of traumatic events from ‘minor’ one off events to more complex, repeated traumas. It is also used with great effect to help broader difficulties such as low mood; low self-esteem, anxiety and phobias.

At the time of a traumatic event strong emotions interfere with a child’s ability to completely process the experience – and bad experience can become ‘frozen in time’. When that distressing event is remembered, it can feel to the child like they are re-living it all over again because the smells, sounds and images still feel as real as they did when the traumatic event happened. This can keep the child stuck in fight-flight-freeze mode because their brain is trying to survive danger which it perceives, but which is no longer there.

EMDR psychotherapy works by ‘unfreezing’ the traumatic memories, enabling the child to resolve them. Over time, the disturbing memory and associated beliefs and feelings become digested and worked through until the child is able to think about the event without re-living it. The memory is still there, but it is far less upsetting and no longer has such a big impact on the child’s quality of life.

A number of us in the team are specifically trained to offer EMDR to children and teenagers. EMDR is offered in a phased, playful and creative way to take into account the child’s age and their ability to cope with strong negative emotions. For more information on EMDR visit www.emdrassociation.org.uk.

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Attachment focused therapy

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We are able to offer individual attachment focussed therapy for children as young as five years old and up through to young adulthood. Attachment focussed therapy involves talking, drawing, playing and using the arts in a creative and child-led way. This way of working holds in mind the child’s unmet emotional needs; and in particular, their need for security, nurture, stability and predictability in the therapist. Attachment focussed therapy tends to take place over a number of months, which enables the child or young person to gradually come to trust their therapist, and open up to the possibility that their needs could be met and understood. Attachment focussed therapy is effective for children and young people who have suffered loss and trauma in their relationships; and who are struggling to trust others, tolerate intimacy and regulate their emotions. In some cases this work will bring the parents/carers together with their children to strengthen their bond, and ideas can be shared with the child’s support network about how to enable them to reach their own unique potential.

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Child Psychotherapy

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Child and Adolescent Psychotherapy is a form of therapy offered to children and young people to help them make sense of their experiences, build up their internal resources and heal unresolved trauma. This way of working uses the therapeutic relationship between the psychotherapist and the child or young person to create a sense of containment, and a safe place to explore and ‘act out’ distress in other parts of the child’s life and history. Child and Adolescent Psychotherapy is offered with only the child in the room. Parents of younger children are updated with the therapy progress at intervals during the work; however adolescents may prefer for the work to remain completely confidential, and this is respected.

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Systemic Family Psychotherapy

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Family Therapy – or to give it its full title, Family and Systemic Psychotherapy – helps people in a close relationship help each other. It enables family members, couples and others who care about each other to express and explore difficult thoughts and emotions safely; to understand each other’s experiences and views; appreciate each other’s needs; build on strengths and make useful changes in their relationships and their lives. Individuals can also find Family Therapy helpful as an opportunity to reflect on important relationships and find ways forward.

Family Therapy creates a safe space to enable people to talk, together or individually, often about difficult or distressing issues, in ways that respect their experiences and invite engagement and support recovery. It is a relational process and it is important that everyone in the family is ready and willing to engage in thinking about change.

Research shows Family Therapy is useful for children, young people, adults and older adults experiencing a wide range of difficulties and circumstances including couple relationship difficulties; child and adult mental health issues; the effects of trauma; parenting struggles; illness and disability; eating disorders; fostering, adoption and the needs of Looked After Children; self-harm; and issues related to life cycle changes. A leaflet about Family Therapy can be downloaded here.

The Systemic Family Therapists in the Beacon House Team come with extensive experience working with a large range of problems experienced within families. We warmly welcome working with diversity and difference within family systems.

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Theraplay

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Theraplay® is a child and family therapy for enhancing attachment, self-esteem, trust in others and joyful engagement. It is based on the natural patterns of healthy interaction between parent and child, and is personal, physical and fun. Theraplay® interactions focus on four essential qualities found in parent-child relationships: Structure, Engagement, Nurture and Challenge.

Theraplay® sessions create an active and emotional connection between the child and parents, resulting in a changed view of the child as worthy and lovable and of relationships as positive and rewarding.

Theraplay intervention will often begin with as assessment called the MIM: Marschak Interaction Method. During the MIM you and your child would usually be asked to carry out a series of simple tasks and the session would be video taped. At a later date we would arrange to go through the video footage with you.This is for the purpose of enhancing your relationship with your child and enables you to look at the strengths of your relationship particularly in the areas of Structure, engagement, nurture and challenge and enable us to plan effective therapy.

You the parent, will play a major role in Theraplay® treatment. However, at the beginning of treatment, the Theraplay® therapist will be the more active member of the team and initiate the interactions for the following reasons:

  • To provide a model for a new ways of interacting for you and your child
  • To get past the child’s initial resistance so that your first experience with the new kind of interaction is positive.
  • To help you feel more sure of yourself and comfortable with sensory based games.

Theraplay can involve quite a bit of tactile contact, which needs to be carefully approached. If your child feels uncomfortable with physical contact, we will be sensitive to this. Understanding the principles of Sensory attachment Intervention can greatly help to disarm the fight and flight patterns which are associated with sensory based games. These two types of therapy can work together as a whole to help form good attachment and promote calm, regulated families who can enjoy each other. At Beacon House we have therapists who are able to combine these two ways of working to deliver a tailor made treatment package for traumatised children and teenagers.

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Sensoriotor Psychotherapy

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Sensorimotor psychotherapy is an effective treatment for relieving and resolving the symptoms of early childhood trauma and post-traumatic stress disorder (PTSD). It is also helpful in the treatment of many other emotional and physical trauma-related health problems that comes with complex trauma. This therapeutic approach focusses on the child’s body sensations by working directly with the physiological elements. It uses the body (rather than thoughts or emotion) as a primary starting point which in turn facilitates emotional and cognitive processing. Sensorimotor psychotherapy is especially beneficial for working with dissociation, emotional reactivity or flat affect, frozen states or hyperarousal and other trauma-related symptoms; and it can be effectively used with children, teenagers and adults. For more information visit:
www.sensorimotorpsychotherapy.org

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Dramatherapy

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Dramatherapy is a type of psychotherapy using the art forms of drama and theatre. It is one of the Creative Arts Therapies which include art, music, drama and movement. It can be offered individually or in groups, and is a brilliant way to engage children and teenagers who find it hard to find words for the emotions. Dramatherapy sessions offer a space to express and understand feelings, using various methods including play, storytelling, puppetry, masks and improvisation. This indirect and highly creative approach to psychotherapy can be incredibly freeing for emotionally ‘stuck’ children and teenagers. It also a playful yet powerful way to involve the whole family in the resolution to the problem.

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Mentalisation Based Treatment

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The word ‘mentalizing’ refers to our ability to notice mental states in ourselves and in others as we attempt to understand our own actions and those of others on the basis of intentional mental states. A focus on the ability to notice and understand your own emotional states, and the emotional states of others, is the core of mentalization based treatment (MBT). MBT can help both adolescents and adults to learn how to notice and then regulate their feelings, and express their needs in more healthy, balanced and secure ways. MBT is particularly helpful when the individual’s emotions are very up and down, and when relationships are unstable.

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Non-Violent Resistance Therapy (NVR)

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Non Violent Resistance (NVR) is an innovative form of systemic family therapy, which has been developed for aggressive, violent, controlling and self-destructive behaviour in young people. This approach is described by parents as liberating and empowering, and is shown to help reduce very challenging and sometimes risky behaviours in children.

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Sensory Attachment Intervention

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Sensory Attachment Intervention is a method of treatment pioneered by the Occupational Therapist Eadaoin Bhreathnach which aims to “enable parents and children to learn the art of self-regulation through the use of sensory and engagement strategies”. (Bhreathnach 2013).

Sensory Attachment Therapy is based on the principle that our attachment patterns are linked to our early sensory experiences. It combines the theory of attachment with Sensory Integration theory (Pioneered by Dr Jean Ayres), because strong links have been shown between sensory processing difficulties and attachment. Many children who have attachment difficulties also experience sensory processing difficulties, which affect their ability to self regulate and in turn move in a coordinated way and carry out skills of daily life. These children also have difficulties with staying calm and alert, finding engagement in the classroom difficult.

Having the correct sensory input can enable a child to self regulate. Therapy sessions value parents as key to co-regulation with their child and therapy sessions may provide sensory experiences which help your child to replace unhelpful sensory experiences from his or her early traumas with new, kinder, sensory memories. Often sessions are video taped to enhance effectiveness. The therapist will go over the video footage with parents to facilitate optimum co-regulation. There will be high importance given to nurturing activities such as deep pressure (proprioceptive) to promote calming. Many children are functioning at a high arousal state due to past trauma and the priority in treatment is to “facilitate a controlled and regulated response to sensory stimuli and engagement with others”. (Bhreathnach 2013)

When parents also have an understanding of the child’s (and their own) regulating patterns they can be an effective tool in facilitating regulation and helping the child maintain a calm alert state. A sensory diet (strategies for healthy sensory input) may be worked out with you to help your child regulate his or her arousal levels. This may need to include the therapist going into the child’s school to help key staff who work with your child to know how they can help with sensory modulation/regulation. Here at Beacon House we have two Occupational Therapists who are trained in Sensory Attachment Intervention. Following a thorough assessment, we are able to make recommendations for a bespoke intervention, which is often combined with psychological therapies.

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The Phased Approach

Trauma therapy takes place in phases, and it is very important for this to happen so that the child and their parents/carers remain safe and contained throughout the therapy process.

Phase One – Safety and stabilisation

A priority at the start of therapy is to work towards the child and their carers being safe from ongoing threat. Once this is in place, the child and carers work solely on achieving emotional and behavioural stabilisation. We support the child and his or her network to develop, over time, ways to regulate strong emotion and ways to regulate self-sabotaging behaviours. We also work specifically on increasing the parent/carer’s attunement and sensitivity to the child’s needs, which helps the child to regulate his emotions and start to feel safe.  The time this phase takes varies greatly, and for some very traumatized children it can take one year or more.

Phase Two – Resolution of the trauma

When the child and parents/carers have reached greater stabilization and they can both tolerate strong negative emotions, we move into the trauma resolution phase. Here our goal is to bring the child’s trauma to the forefront of their mind and to help them make sense of what they have been through. We may choose to process some frozen memories using EMDR, and we also bear in mind that for many children, their memories are not accessible and are instead held in their body. We work at all levels with the child in a safe, sensitive and paced way to help them work through the traumas they have been carrying for a long time. We may move in and out of the first and second phase as needed by the child.

Phase Three – Bringing it all together and moving forward

In this phase we work with the child and parents/carers to reflect on the journey they have been on, and the feelings that their progress has left them with. Sometimes there is a sense of loss of the ‘old me’ and hope for the ‘new me’; and sometimes families need to create together a new story for their past, present and future. We support the child and family to think about what ongoing support is needed, and how to prepare for life being full of ups and downs. The relationship with the therapist remains open even when the work is finished, and the child and parents/carers know that they can return at any time.

Our approach to Developmental Trauma is both evidence-based and flexible. We move between different models, and we can do different ‘bits of work’ with a child at different stages of their life. At times of transitions, loss or change the child can need something different from our service and we always strive to meet these needs.

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