First conclude all the legal work, making sure that the necessary reports are in and forensic examinations and interviews have been completed. Tell the child the therapist has worked with children who have been touched or hurt on their bodies or on their private parts and have confusing feelings as a result. Give them permission to say as much or as little as they want. The younger the child the shorter the explanation is needed. Take them to the appointment the same way you would schedule a medical or a school meeting. Talk with them about the abuse in a normal tone of voice. Don’t over or underemphasize it. And then follow their lead unless they want to avoid all mention of it.

Once I was Very, Very Scared, Chandra Gosh

This book helps children and parents understand common trauma responses, using animal characters. You can even look on you tube for a reading of this story. It’s been helpful for me to give this to caregivers who are contemplating psychotherapy treatment and aren’t convinced that it is important.

Mama’s Waves, Chandra Gosh

This book helps children put words to experiences of an adult who has substance abuse or mental health difficulties. So often these families have been through so much together, with their loved one and it’s very hard to help the child understand what the caregiver is struggling with. Again, we need to find words that are appropriate, and match the child’s developmental age.

You weren’t With Me, Chandra Gosh

Helping children to deal with separation, it was written in response to the forced family separation related to border crossing/immigration. This is a sad story in which a child expresses their fear and sadness to a loved one who was not there when they were hurt. It is difficult to hear, but is so powerful once a child says these words out loud and gives the caregiver a chance to respond and to take care of them one more.

Imagine an earthquake hitting a city. The city was beautiful and functional before, now it is mostly rubble. There may be areas that are unaffected, but it’s largely changed forever, it will never be exactly the same.

Trauma has a shattering effect, it can break you. It can break what you know. It can break what you had before, the world as you knew it. But it doesn’t mean that you can’t rebuild.

• Have you extracted predictive and protective information from past danger
• Can you apply this to future scenarios to help predict future danger
• Have you developed preventive strategies in the event of danger
• Can you parse out information about the past danger that is not relevant to future safety
• Can you develop strategies to protect self in the future
• Can you accept and accommodate to changes in self and others due to past danger
• Can you transform intense negative feelings around complex emotional states and increase contentment with what remains
• Can you accept that there is ambiguity and uncertainty inherent in life
• Can you find some redeeming or satisfying outcomes that resulted out of what happened

That is a lot of questions, and that is a lot of work. It’s a little like a house that has burned down, and you have gone back once it’s no longer hot, and worked through all the debris, you’ve sorted what can’t be recovered from what can. You’ve sat and grieved in the ashes, recovered memories that were dear, and even started to dream about rebuilding, and what might be similar and what you might change.

Think of dissociation on a continuum. Suppression can be a wonderful thing. It can provide us with immediate relief! The downside to suppression is that it requires sustained effort to maintain and will get in the way of mastery and understanding needed to achieve closure. Imagine the effort that it takes to keep a large beach ball, under the water! Can it be done? For sure. Does it require effort, yes it does. Will it impact the rest of your system, yes it will.

That’s why in the world of emotional health, we believe that the best way to deal with painful memories is to acknowledge them and to understand them. To look through the rubble, and to clear out what needs to go, and to hold on to what needs to stay. Or organize it and build it back into place you can live and function in.

How can that possibly be an important thing to do when it’s so scary?

Trauma involves danger. Trauma happens in the context of danger, and the result is often maladaptive processing of information. When we are in a time of danger, our brain doesn’t fully function, our frontal lobe thinking is shut off so that we can use the mammalian brain to simply respond. This is an effective way for us to respond quickly when there isn’t time to think too much. After the danger is over, we need to go and process what happened, and then use our full brain to make sense of what happened, like doing an analysis or biopsy of what happened, so that we can organize it, learn from it, and make accurate meaning from the event. If we don’t do this, then we come away from this incident with the wrong kind of information, that then can put us on a trajectory for how we live out our life.

But there was a rock fall, and now there is a large rock in the middle of the path. Now when you walk down the road, you get to the rock, and then veer off to avoid it. You end up walking on a different trajectory. If you don’t ever go back and take the rock away or carve a path around it to meet the original path, you will continue to veer off each time, and your pathway in life will land you in a different place than you were headed in before. Not taking that rock away or figuring out a way to move around it, will then create more opportunity for danger in the future.

Resolution from trauma means going back and looking for identifying signals of danger and learning self-protective responses. What did I miss, what signs were there that I wasn’t aware of before, what can I look out for now in the future. How can I prepare myself for future risks and potential danger. What skills can I learn to be in a better position is this happens again. Knowing what to look out for, and having the skills to potentially deal with it, will help us feel more relaxed and confident, and when we approach our road in this way, we are more likely to see the array of signals in front of us because our whole brain is online.

The word Trauma is used so lightly these days. I have referred to many incidents as traumatic myself, that certainly don’t meet the true definition. The Diagnostic Manual for Mental Health  defines trauma as “an event that involves actual or threatened death or serious injury, or other threat as to one’s physical integrity, or witnessing an event that involves death, injury, or threat…”

I think the dilemma with trauma is that you have had or seen something awful happen, which then gets “stuck” in your brain. To heal, you have to get it out, talk about it, process it. And yet to even think about it and remember it affects you so deeply. You are terrified to think about it, and so how do you get “unstuck”. It makes sense that people push these experiences and memories down, and yet keeping them suppressed takes so much energy, it can be exhausting and affect your health. Some quotes in the trauma world, I’m not sure who said them first, but they are catchy and express the terrible bind that trauma ties us into: we have to “feel it to heal it”, we have to “name it to tame it”, and yet feeling the trauma and even naming it seems so scary to do, there’s a sense that naming it means that it comes alive again!

This blog series will talk about some resources that help us more easily put words to these experiences, help us normalize that these things have happened to others too, and will explain a little about why it’s important to even try to bring the trauma out into the open.

HIGH

• Inability to cope
• Coping strategies lacking or unsuccessful
• Internal resources unavailable
• External resources unavailable
• Expressive ability is lacking
• Symptoms persist
• Helplessness persists
• Personal control is lacking
• Existential crisis can’t be resolved
• Trauma can’t be resolved or is negatively resolved

When it comes to how children are affected by these potentially traumatic incidents, you want to consider the variables related to childhood. These are the type of trauma, the level of trauma, the duration of trauma, the child’s age at the time, the child’s previous level of functioning, the caretaking support available and if the child had a past trauma history.

You could also take into account other trauma-related variables like the number, and extent of secondary adversities and stressors. These could include contextual variables like socioeconomic status, current life stress and family support.