Here’s the dilemma: “Traumatized patients want clinicians to help them to forget traumatic events, in order to move on with their lives. Clinicians who offer trauma-focused treatments encourage patients to revisit the past, repeatedly and in detail, as a means of processing the traumatic event(s) as a verbally accessible memory.” The quote is from an excellent article published in the journal Dialogues in Clinical Neuroscience exploring the treatments we offer for trauma and patients’ perspectives of these treatments.
How do children experience trauma? How do they report it? How can we help to treat it? The questions are especially complex within a framework where we could do more harm than good if we’re not careful; when removing a band aid from a child, it’s best to rip it off – but ripping away the protections a child has built around trauma can leave the wound raw and unmanageable and retraumatizing a child can be every bit as real and debilitating as a child’s first experience of trauma.
In part, that’s why the British Psychological Association recommends that only children older than age 9 recall and verbalize traumatic events like an adult might. The article writes that, “trials… indicate that patients are able and willing to face their past. But they may need to approach it, and tell their stories in different ways.” This is especially true of children, who may need to approach trauma through metaphor, both because they may lack the words to describe trauma and because metaphor and symbolic description allows a sense of safety between the child and traumatic events.
The article points out that there is no one, universal treatment for a child’s trauma and that practitioners instead adapt their approaches from child-centered play therapy, CBT, EMDR and a handful of other therapies.
There are a couple strong suggestions that emerge from the article, namely that a child’s trauma treatment includes stages of stabilization and reintegration – first, “regular communication, affect regulation, grounding patients in the present, and challenging belief systems about the world, self and others” and then “assisting the patient to return to meaningful activity, including education and social activity; strengthening social networks and enhancing intimate and family relationships.”
But then beyond these specifics, the takeaway seems that treating trauma with caution is more appropriate in children than treating it with probing purpose. In play therapy and all other therapies, it seems best to let a child lead with metaphor closer and closer to his or her trauma.
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