Transcript overcoming cumulative childhood adversity

overcoming cumulative
childhood adversity
Friday Morning
October 6, 2006
Northamerican Assn. of Masters in Psychology
Bruce Carruth, Ph.D., LCSW
San Miguel de Allende, GTO, Mexico
“Neurosis ……
is the process of shrinking our world
to the point where we can
manage”
Rollo May (I think)
children adapt to what they are
given…… for better or worse
adaptation to cumulative adversity
occurs over time, insidiously,
purposefully and productively
goals for the workshop
grow professionally
*recognizing adaptive childhood trauma
*better sense of the impact of trauma syndromes
*enhance repertoire of therapeutic responses
*appreciate awareness of therapist positioning
*build new skills
*appreciate need to address cognition, affect and self
*understand role of resilience and how to tap it
*recognizing the interpersonal impacts of trauma:
trust, commitment, potency & attachment
and grow personally
* awareness of our own developmental
traumas,
* how developmental traumas lead to life’s
dilemmas
* more compassionate to our own selfwounds, self-acceptance & self esteem
* more compassionate to the wounds of
others
getting organized for the day
• work in groups of 4 – same group all day
• for each assignment, have one person act
as recorder
• for each assignment, have one person act
as time keeper
adverse conditions / environments in childhood
physical, emotional and neurological deficits
parental dynamics
sibling dynamics & the family environment
the physical environment of the child
societal dynamics
compounding adversity
• adversity in one area of life tends to create or
support adversity in other areas of life.
• developmental lags, created by adversity, tend
to make it more difficult to achieve higher level
developmental tasks, so the child gets further
behind psychodevelopmentally
• adaptive coping tends to limit opportunities to
self-correct the limitations
the adaptive stance
adversity requires that a child adopt an
adaptive stance to protect self
a broad, pervasive theme or pattern that is:
…functional, purposeful and productive in childhood
…becomes imbedded in the coping repertoire of the person
by late adolescence and young adulthood
…is comprised of memories, emotions, cognitions, body
sensations, meta-beliefs, self-truths
…continues to serve the person well in many ways
…is resistant to change even when it is not working
…and is usually integrally tied to the presenting symptom
when person presents in psychotherapy.
examples of adaptive character traits includes:
feeling repressed
needy and impulsive
stubborn and obstinate
angry victim
conning and manipulative
phobically anxious
suspicious and mistrusting
love / acceptance seeking
defective / shamed
failure
boundary confused
unloved and invisible
dependent & helpless
chronically dysthymic
wounded
obsessively anxious
inadequate & indecisive
impression managers
alone & isolated
angry & intolerant
the symptoms of cumulative adversity manifest through
all levels of life functioning and across the life span
* coping behaviors and interpersonal relationships
* patterns of contact between self and the environment
* perception, intuition, memories, cognitions based on life
experience
* patterns of ego defense
* affects:
primary affects
affective themes
* self functions
the cognitive self
character patterns
core psychodynamic orientation
* soul
assignment
•
•
•
•
choose an adaptive stance (schema)
what are the positive aspects of that stance?
what are the life problems that arise from the stance
describe some of the coping behaviors, cognitions,
defenses and affects that accompany the stance
• what are the aspects of the stance that would bring
you into therapy?
• what is your greatest terror entering therapy?
• how should the therapist position to be most helpful
to you entering therapy?
Question?
why is it some people who
experience cumulative adversity
as children are survivors, even
thrivers, while others remain
wounded & impaired?
• internal strengths (resilience)
character traits that build resilience
• external (environmental) supports
supports that make a difference
• corrective emotional experiences
corrective experiences that can reshape the
cognitions, affects and self-wounds of
cumulative adversity
levels of personality impairment
• personality quirks
• personality traits
• ingrained personality patterns
• personality disorders
cumulative adversity through a
trauma lens
1. Sub-clinical Trauma Syndromes
2. Cumulative Childhood Trauma
3. Acute Stress Reaction: A psychophysiological
reaction to an overwhelming stimuli
4. Grief Reaction: An inability to experience the
emotions of loss
5. Post-Traumatic Stress Disorder(s): A significant
wound to an individual’s sense of self / personhood
6. Complex PTSD & Dissociative States: A
pervasive and disabling injury to self that produces
significant psychiatric complications
recognizing trauma syndromes
1. When people define their life by
traumatic events
2. Rigid or inappropriate behaviors in the
face of specific events or triggers
3. Ego defense, unconscious to the person,
that clearly limits functioning
difficulty in receiving or giving feedback
misrepresentations of the environment
misperceptions of self and self-roles
Recognizing trauma syndromes (con’t)
4. Distorted affects
displaced / distorted / inappropriate affects
exaggerated affects
repressed affects
5. Psychiatric symptoms
depression (sad, angry, nihilistic)
anxiety (fear, obsessiveness, withdrawal)
somatization (pain, sleep disorder, appetite)
Recognizing trauma syndromes (con’t)
6. Distorted reactions to life events that
involve helplessness, vulnerability,
constraint, power/control, shame
7. Distortions in relationships: Trust,
commitment, potency, attachment
using a trauma treatment model for
treating cumulative adversity
1. building safety (creating a holding environment)
2. managing the presenting symptoms
3. exposing the wounded self & telling the tale and
4. grieving
5. emotional healing and
6. integrating history with present
and
childhood adversity is ultimately a
wound to self
but adversity also manifests as a
set of symptoms that interfere
with day-to-day living
so, what are we treating?
Managing and treating the symptoms :
(and how adversity manifests in the “now”)
symptom management
interpersonal struggles
coping skills
cognitions
“reactive” affects
Doing “restorative” work that retrieves the trauma
and “works it through”
core cognitions and schemas
primary affects
telling the tale and reorganizing the experience
building healthy life and relationships
do you treat self or symptoms
• when do you focus on symptom
containment / resolution?
• when do you focus on treating the self?
the treatment triangle for
addressing cumulative adversity
cognitions (the schema)
affect
(the emotional residue)
self-functions
(the adaptive stance)