INTERGENERATIONAL TRAUMA

Transcription

1 INTERGENERATIONAL TRAUMA

2 MANY WAYS TRAUMA CAN BE TRANSMITTED Genetic vulnerability Direct transmission, e.g., child abuse Indirect transmission, e.g., domestic violence Cultural transmission Environmental transmission (dangerous neighborhoods, poverty)

3 INTERGENERATIONAL TRANSMISSION OF TRAUMA Intergenerational trauma occurs when unresolved trauma is passed from one generation to the next 30% of children who are maltreated grow up to maltreat their own children (Kaufman and Zigler, 1987) Parental experiences of abuse may place their children at risk for child abuse

4 EFFECTS OF INTERGENERATIONAL TRAUMA Withdrawal Fear Secondary traumatization Parenting problems Children s behavior problems Divorce

5 SECONDARY TRAUMATIZATION Secondary traumatization typically occurs when a person is affected by someone else s traumatic experiences It may also occur when a person lives with someone who has been traumatized It results in post-traumatic symptoms like hypervigilance, irritability, startle responses, distrust of others, negative thoughts/feelings/ beliefs, avoidance, and isolation Children can be particularly susceptible to secondary traumatization

6 ENVIRONMENTAL TRAUMA Any environment that causes a person to live in fear and danger Growing up in the Hood Living on a Native American reservation Being surrounded by racism Neighborhood violence Environmental disaster

7 CULTURAL TRAUMA Cultural trauma is caused by attacks on a society s fabric that damages the community s essential character Trauma becomes the core of the cultural narrative Events leave engrained marks on the members of the group who survive Examples of cultural trauma: Native American reservations Slavery Apartheid

8 HISTORICAL TRAUMA Historical trauma is the cumulative effects of multigenerational trauma experienced by a specific cultural, racial, or ethnic group It is expressed as: Focus on ancestral traumas Loyalty to the suffering of ancestors Survivor guilt Unresolved and disenfranchised grief Internalized oppression Hypervigilance to the potential for further victimization/exploitation Distrust of the dominant culture and its systems and programs

9 Examples of historical trauma include: The Holocaust The Armenian genocide Cambodian Killing Fields The Rwandan Genocide The Navajo Long Walk HISTORICAL TRAUMA

10 HISTORICAL TRAUMA Historical trauma results in high rates of: Depression Suicide Homicide Domestic violence Child abuse Alcohol and drug abuse Poverty

11 HISTORICAL, CULTURAL, AND MULTI- GENERATIONAL TRAUMA ARE INTERTWINED Mass traumatic events and systematic oppression reverberate through cultures, generations, families, and individuals

12 TREATMENT OF TRAUMA IN CHILDREN AND ADOLESCENTS

13 TREATMENT OF PTSD: MEDICATION? Some medications may be used to treat symptoms of PTSD: Antidepressants Mood stabilizers Anticonvulsants Anxiolytics not benzodiazepines Not antipsychotics There is no medication that specifically treats PTSD Only Prozac, Zoloft, and Paxil have been approved

14 TREATMENT OF TRAUMA Parent-Child Interaction Therapy (PCIT) Integrative Treatment of Complex Trauma (ITCT) Trauma-focused Cognitive- Behavioral Therapy (TF-CBT) Eye Movement Desensitization and Reprocessing (EMDR) Dialectical Behavior Therapy (DBT) Seeking Safety

15 PARENT-CHILD INTERACTION THERAPY week manualized intervention based on social learning and attachment theories Provides parents with behavior modification skills that reduce child behavior problems Uses live coaching via one-way mirror Two phases: Child-directed interaction Parent-directed interaction Urquiza & Timmer, in Ford & Courtois, 2013

16 TRAUMA-FOCUSED COGNITIVE-BEHAVIORAL THERAPY sessions of skill-building and trauma processing for 3-18 year olds Affect expression, cognitive coping, and trauma processing for children Parenting skills for adults Conjoint parent-child sessions Has the most research support of any child trauma treatment (Cohen, Mannarino, & Deblinger, 2012) Training is free!

17 INTEGRATIVE TREATMENT OF COMPLEX TRAUMA An evidence-informed approach Uses standardized assessment protocols The treatment protocol that matches specific problem areas (e.g., post-traumatic stress, attachment insecurity, suicidality) with multiple specific interventions (e.g., affect regulation, relationship building, and safety training) Uses elements from empirically-based treatments such as cognitive therapy, exposure therapy, play therapy, and relational therapy Individual, family, and group modalities Versions for 8-12 year olds and year olds Lanktree & Briere, 2017

18 EYE MOVEMENT DESENSITIZATION AND REPROCESSING Client focuses on distressing image States a belief that goes with it Notices feelings that go with it Identifies body sensations that go with it Therapist passes fingers back and forth, guiding the eyes As this occurs, the images, thoughts, feelings, and body sensations change Adaptive information processing results Used for ages 4-adult Greenwald, 1999

19 SEEKING SAFETY For adolescents and adults Weekly 90 minute sessions lessons Provided individually or in groups Typical group size is 8 members Largely a cognitive-behavioral approach Can be provided by professionals or paraprofessionals 25 topics that overlap between PTSD and Substance Abuse, such as Safe Coping Skills Grounding Anger Boundaries Self-care Honesty Compassion Najavits, 2002

20 DIALECTICAL BEHAVIOR THERAPY Combination of individual therapy and group DBT Skills Training Usually provided in teams with different therapists One therapist carries a beeper and takes emergency phone calls for coaching DBT skills DBT Skills Training group lasts one year, with each topic covered twice Four topics: Mindfulness Interpersonal effectiveness Distress tolerance Emotion regulation Linehan, 2014

21 EVIDENCE- BASED SOCIAL TREATMENTS OF TRAUMA Treatment Foster Care Multi-Dimensional Treatment Foster Care

22 WELLNESS ACTIVITIES Mindfulness Meditation Yoga

23 HEALING INTERGENERATIONAL TRAUMA Healing intergenerational/cultural trauma requires: Traditional healing Rituals Storytelling in all forms Listening sessions Family treatment Reconciliation?

24 HOW YOU CAN HELP

25 WHAT COURTS CAN DO Make the courtroom a safe place to be Become trauma-informed Better yet, become trauma-competent Screen all participants for trauma histories and trauma symptoms Maximize choice and control where possible Act respectfully and nonjudgmentally Provide a stable, encouraging presence in the lives of families

26 PROTECTIVE FACTORS AGAINST PTSD Positive relationship with an adult in childhood Positive experience in therapy as an adolescent or adult Ability to clearly recount childhood abuse Anger directed at perpetrator, not self Social support

27 ONE FINAL WAY TO HELP CHILDREN AND ADOLESCENTS Remember Superkids? They were abused and neglected children, mostly in foster care Q: What did they all have in common? A: One person who cared about them unconditionally Your job is to find that one person

28 RESOURCES

29 ASSESSMENTS FOR TRAUMA ACE questionnaire Your ACE Score.pdf Life Events Checklist 5 5_Standard_Self-report.pdf

30 RESOURCES ON TRAUMA IN CHILDREN Complex Trauma in Children and Adolescents, NCTSN White Paper, available at All.pdf Treating Complex Traumatic Stress Disorders in Children and Adolescents, ed. by Julian Ford and Christine Courtois Developmental Trauma Disorder with Bessel van der Kolk (DVD)

31 BOOKS ON TREATMENT Parent-Child Interaction Therapy by Cheryl Bodiford McNeil and Toni Hembree-Kigin EMDR Therapy and Adjunct Approaches with Children: Complex Trauma, Attachment, and Dissociation by Ana Gomez Eye Movement Desensitization and Reprocessing in Child and Adolescent Psychotherapy by Ricky Greenwald Treating Trauma and Traumatic Grief in Children and Adolescents, by Judith Cohen, Anthony Mannarino, and Esther Deblinger

32 BOOKS ON TREATMENT Treating Complex Trauma in Children and Their Families: An Integrative Approach by Cheryl Lanktree and John Briere Treating Complex Trauma in Adolescents and Young Adults by John Briere and Cheryl Lanktree Seeking Safety by Lisa Najavits DBT Skills Manual for Adolescents by Jill Rathus and Alec Miller

33 INTERNET RESOURCES ON CHILD TRAUMA National Child Traumatic Stress Network International Society for Traumatic Stress Studies: The Trauma Center (Bessel van der Kolk) Child Trauma Academy (Bruce Perry)

34 INTERNET RESOURCES ON CHILD TRAUMA TREATMENT Parent-Child Interaction Therapy: Trauma Focused-Cognitive Behavioral Therapy: and EMDR:

35 INTERNET RESOURCES ON ADOLESCENT TRAUMA TREATMENT ICTC-A Manual, 2nd ed /2016/06/ITCT-A-TreatmentGuide-2ndEdition-rev pdf Dialectical Behavior Therapy: Seeking Safety:

36 Contact: Brian L. Meyer, Ph.D.