As you may recall from the last edition of this newsletter, Dr. Bessell Van der Kolk presented a series of interesting workshops on the effects of trauma on the brain, as well as on other body systems at the recent ATTACh conference in Omaha. He also spoke at length about the treatment implications of severe, chronic trauma. In this article, we will explore his comments on the treatment needs of severely traumatized children.

Dr. Van der Kolk noted repeatedly that traditional approaches to therapy are useless for severely traumatized people, but especially for children because they fail to reach the areas of the brain that were most impacted by early trauma. He stated, "Our biggest challenge for traumatized people is to help them be here and not always there, and not to replay the same things over and over again." Traditional therapies keep people stuck in the "there", and don't help people find a way to get to "here". In addition, traditional therapy encourages people to become overly dependent on the therapist as a rescuer, rather than helping the person learn how to rescue themselves from being caught up in the past. Group therapy is particularly useful in helping people to recover from severe trauma, especially if the therapist focuses the discussion on solutions, rather than on the problem. He also stated that, "therapy that goes over trauma again and again without changing the outcome [of the traumatic events] reinforces the trauma and prevents healing." Remembering the helplessness and rage through play and/or talking without being able to resolve them definitely DOES NOT help!!

Dr. Van der Kolk noted that attachment therapy (although he admitted that he knew very little about it before coming to the ATTACh conference) probably works for these severely traumatized children because the therapy takes the child through the feelings of helplessness and rage, but then focuses on helping the child find a different outcome for the trauma. Therapists need to help children to find "flexible memory systems" where they can consider alternative outcomes. For example, the therapist can ask, "What would have happened if the police had come to help you", and help the child see the past and the future differently. "If you stay stuck with the old memories, you are stuck with the old behavior." Only changing the outcome of past events can result in new behavior in the future because the purpose of memory is to prepare you to deal with future events. If you are stuck in old memories, you can't have new behavior. This also helps kids to restore their imagination, which is often lost as a result of chronic trauma. Simply telling children that it wasn't their fault doesn't help because a child's brain has no way to understand the world from another person's perspective.

In addition, traditional therapy focuses on talking about or playing out conflicts, which accesses the left side of the brain, while traumatic memories are stored in the right side of the brain. If the traumatic memories and experiences are to be resolved, the therapist must engage in activities that access the right side of the brain. Traumatic memories are often stored in the limbic system, which is responsible for attention, arousal, and attachment, but are usually stored as somatic (body sensations) memories. Traditional therapy does not even begin to approach the limbic system to resolve the trauma, so a therapy that accesses body memories (like attachment therapy does) is much more effective. EMDR is useful for resolving many traumatic memories, although it is not at all clear why it works. Dr. Van der Kolk suspects that it works because doing the eye movements distracts the person from the traumatic memories and allows the brain to be changed. He thinks that any physical activity a person does while recalling trauma will work just as well.

Dr. Van der Kolk also noted that for therapy to work there must be a high level of arousal for the client (since the traumatic memories were stored in conditions of high arousal, resolving them can only be accomplished when high arousal is present). Traditional therapies usually focus on reducing arousal, so they don't help at all to change the results of the trauma (again, although he knew little about attachment therapy before coming to the ATTACh conference, Dr. Van der Kolk noted that attachment therapy would be quite useful with traumatized children because it results in high levels of arousal, and then helps the child to resolve the trauma).

Once the right side of the brain has been triggered to produce traumatic memories, the focus of therapy then needs to shift to triggering the left side of the brain, as it has the ability to help children resolve trauma, while being stuck in the right brain only results in staying stuck in the trauma. The therapist then needs to help the child use language (a left brain function) to provide a meaningful scheme for the traumatic memories so that mastery can be gained over the memories. Therapists need to constantly be aware of the intense loneliness experienced by severely traumatized children, as adults become meaningless to these children when in the depths of loneliness and they will push away help and support unless adults (including therapists) push hard to make the child let them in. Most therapists make the mistake of trying to help children avoid intense feelings, thinking that this helps keep children from getting too upset about the trauma. Unfortunately, this DOES NOT help children to resolve trauma. If the therapist tries to avoid emotions, children will conclude that their emotions are bad or somehow too dangerous, and so they will hide their emotions. Children need to know that they can have intense feelings, that the therapist can handle those feelings, and that the therapist can help the child to resolve those feelings by going through them and having a better outcome to them. Children need to learn how to manage intense emotions, not how to hide from them. Traumatized children feel that there is no end to their problems, and therapists need to help them find solutions that result in an end.

Therapists should not assume that children abused by a male should have a female therapist, as children may feel that the mother failed to protect them and will lack trust in females more than in males. In such cases, a male therapist can be more healing for children. Therapists need to pay attention to an individual child's needs, and not make a broad assumption about the gender of the therapist the child needs.

Finally, Van der Kolk noted that attachment therapy is not retraumatizing for children because its focus is on resolving the trauma. Therapies that leave the child still stuck in the trauma are retraumatizing and should not be used with traumatized children.

For those of you who are interested in more information about Dr. Van der Kolk's workshops at the ATTACh conference, you can contact the ATTACh office at (602) 912-5340 to get information about ordering tapes of this presentation. You can also check these tapes out of the Attachment Center at Evergreen's library. Call our office (303) 674-1910 for more information.

© The Attachment Center at Evergreen