Tag: adolescent trauma

Categories
Mental Health PTSD Recovery

Treating PTSD in Children and Adolescents

Post-Traumatic Stress Disorder (PTSD) is not just for adults:Blossom©saritzrogers

it also occurs in children and adolescents. Children and teens that witness violence and have post-traumatic stress symptoms require psychological care, but studies are suggesting that while children may experience the full range of post-traumatic stress symptoms, the manifestation of symptoms can differ from that of an adult.

 

The Journal of Pediatric Psychology says, “in the DSM-IV, eight criteria require verbal descriptions of experiences and emotional states. The lack of developmental modifications may result in an under-diagnosis of PTSD. “(Pynoos, Steinberg, & Goenjian, 1996). Scheeringa et al. (1995) Additional  “evidence suggests that children may experience disabling PSS (post-traumatic stress symptoms) that warrant treatment, but not meet criteria for PTSD (Carrion, Weems, Ray, & Reiss, 2002).

 

What has become crucial in defining this diagnosis for adolescents is the way in which clinicians understand how PTSD presents in youth. There is still a debate within the field of pediatric psychology about whether or not distinct youth criteria should be established — thus far, post-traumatic stress symptoms have been assessed primarily using criteria outlined for adults.  When assessing youth for PTSD, the adaptation for youth includes the “simplification of language and concepts.” However, there continues to be discussion amongst clinicians about the need for separate qualifiers for youth.

 

Symptoms of PTSD might include classic stress responses such as nightmares, fear and a general response to distress, but according to the American Academy of Child and Adolescent Psychiatry, there may be some symptoms unique to children and adolescents like:

 

  • Reenactment of the event
  • Regressed behavior
  • Separation anxiety,
  • Specific forms of behavioral, academic, and somatic problems”

Did you know: Between 25 and 87% of youth report experiencing at least one traumatic event before age 20, with girls reporting more episodes (Elklit, 2002)

 

Noelle Rodriguez, Psy.D. and Visions Outpatient Psychological Assistant shared some of her experience working with teens who suffer from PTSD. She listed some of the manifestations she sees and how she helps treat them:

  • High levels of depression because PTSD is misdiagnosed
  • Inability to formulate trusting relationships
  • Drug use to attempt to access or regulate feelings

Noelle also finds teens with PTSD also present with some or all of the following:

  • Poor time management
  • A need to find a voice but feels silent inside
  • Loss of self, feeling fragmented
  • Somatic symptoms i.e., body pains, headaches, etc.
  • Disassociation
  • Sexual promiscuously–looking to feel connected
  • Paranoia
  • Lack of boundaries, which leads to more mistrust

Noelle takes her PTSD clients through a process of deep, insightful work that helps them strive toward shifting their paradigm to include:

  • Empowerment;
  • Sobriety (if applicable) on their own terms;
  • Replacing maladaptive behavior with healthy behaviors, for example:
  • Learning to ask for help, finding a support group, becoming able to  recognize and identify PTSD symptoms before they have a chance to fully manifest
  • Self-care
  • Learn how to identify danger vs. safety
  • Develop tools with which to to deal with blame, shame and doubt
  • Time management
  • Honesty in relationships
  • Finding their voice and learning how to speak up for themselves
  • Learning to get grounded when one is in emotional pain.

 

Peter A. Levine, Ph.D, originator and developer of Somatic Experiencing and the Director of the Somatic Experiencing Trauma Institute has transformed the way in which I personally view PTSD.  He says in his book In an Unspoken Voice, “I hope to convey a deeper appreciation that their lives are not dominated by a ‘disorder’ but by an injury that can be transformed and healed.” Like Noelle, he talks about the need for someone working with PTSD to learn to self-regulate. Levine says this self-regulation “allows us to handle our own states of arousal and our difficult emotions,” and that it is what fosters the ability to “evoke a sense of being safely ‘at home’ within ourselves, at home where goodness resides.” Trauma work is a deep process. It involves learning how to hold ourselves with a sense of compassion while we look at the darkness that has swaddled our hearts.

 

So whether or not the DSM catches up, knowing that we have clinicians who are well versed in trauma work and who are willing to guide our youth to recovery is profound. Triggers eventually become tools we work with instead of against. And ultimately, with deep, consistent work, we develop the skills to change our relationship to our trauma and to heal.

Categories
Mental Health Recovery Therapy Trauma Treatment

Boston Marathon: Emotional Care During Tragedy

Boston Marathon Finish Line.1910. Author: Unknown. (Photo credit: Wikipedia)

We are once again faced with the darkness of another tragedy: the bombing at the Boston Marathon. Events like this inevitably bring up our past traumas, leading to feelings of deep sadness, and often confronted by some of our unfettered grief. There is also a huge sense of confusion when we are faced with the unanswerable question of “Why?”

 

As parents, it is important to be transparent and honest with our kids in times like this. This does not mean sharing gruesome photographs of the event with them or feeding them gory details. Talking to our kids and allowing them to have a voice in a traumatic time is important. When the bombing at the Boston Marathon happened, we sat down with our son and talked to him about it. We wanted to make sure he heard it from us and not from the rumor mill of middle school, where hyperbole and fear mongering are the norm. He felt shock, confusion, and sadness. For parents, it was and continues to be our responsibility to honor the feelings of our kids and provide a safe container for them to express themselves. The world can be a scary place, especially with the effects of random acts of violence. Our son had many questions about what happened in Boston, many of which mirrored the questions of so many—kids and adults alike: “Am I safe?” “Why is there so much violence?” “Why would someone do that?” “Should I be worried?” “Will it happen here?” It’s important that his questions are answered and that he is allowed to process what he’s heard, lest we create another environment of trauma.

 

The tragedy those in Boston are confronted with never should have happened; but it did. It is real and it is heinous. Those directly affected by the devastation at the Boston Marathon will have deep trauma and grief to process and they will need support. When I see and hear of things this atrocious, I am reminded of a few things we can and should do in times like this:

  • lean into our circles of support,
  • be of service,
  • remember and honor those thrust into sudden loss and tragedy of senseless acts of violence.
  • Look at the positive: the people helping, the survivors, the community that reaches out to strangers.

 

In his book Trauma-Proofing Your Kids Dr. Peter Levine talks about the ways Somatic Experiencing is used in a crisis. Somatic Experiencing is focused on “symptom relief and in resolving the underlying ‘energy’ that feeds those symptoms.” (p.214)  Instead of asking kids to “tell the story” of what happened, they are asked to share their “post-event difficulties,” i.e., the physical or emotional fall-out they are experiencing after the event occurred. For example: fatigue, headaches, difficulty sleeping or eating, stomach aches, spaciness, emotional numbing, worry, guilt, et cetera.  The goal is not to re-traumatize the individual, but to help the process of self-regulation and emotional discharge.

 

Please make sure you are getting what you need if you are experiencing emotional difficulty since the tragedy at the Boston Marathon. If you find that you are having a hard time:

  • Take a break from the media.
  • Do some movement: jump rope, hike, do yoga, just move your body.
  • Be kind to yourself.

“Trauma can be prevented or transformed; it does not have to be a life sentence.”

Dr. Peter Levine

Categories
Recovery

Aleksandra Petrovic, LMSW — Trauma Specialist

Aleksandra Petrovic, LMSW, is a trauma specialist, coming to Visions via New York where she worked with underprivileged children and their families. Aleksandra’s work led her to a hospital outpatient program for dual-diagnosed adolescents, which used DBT (Dialectical Behavioral Therapy) as their primary modality of treatment. Continuing to help underprivileged youth, Aleksandra went on to work at a state-run adolescent recovery center with children ages 5-16 who had been shuffled through the foster care system until they could no longer be placed due to their behavior. Aleksandra earned her B.A at Columbia University, double majoring in psychology and French literature, with a minor in neuroscience. She went on to earn her masters degree in social work at Hunter’s School of Social Work in NYC.

Aleksandra has completed her training in EMDR at the EMDR Institute under its founder Francine Shapiro. She uses EMDR (Eye Movement Desensitation and Reprocessing) and TF-CBT (Trauma Focused Cognitive Behavioral Therapy) regularly when working with clients and their trauma(s).

EMDR is a

“one-on-one form of psychotherapy that is designed to reduce trauma-related stress, anxiety, and depression symptoms associated with posttraumatic stress disorder (PTSD) and to improve overall mental health functioning. (via SAMSHA)

TF-CBT is a

“psychosocial treatment model designed to treat posttraumatic stress and related emotional and behavioral problems in children and adolescents. Initially developed to address the psychological trauma associated with child sexual abuse, the model has been adapted for use with children who have a wide array of traumatic experiences, including domestic violence, traumatic loss, and the often multiple psychological traumas experienced by children prior to foster care placement.” (via SAMHSA)

Aleksandra will use TF-CBT by having a client paint or write their story several times until there is a full range of emotions expressed. The repetition of reading and writing eventually desensitizes the severity of the impact of one’s memories. Aleksandra also uses Internal Family Systems (IFS) to help her clients safely access their trauma, helping them “go back” into the traumatic scene and “save” their younger selves. Processes such as these require a commitment to doing difficult work, but they are worth the efforts.   Deep trauma work employed in the modalities Aleksandra uses is extremely beneficial for treating trauma in adolescents and helping them process their trauma in a safe, therapeutic way.

Aleksandra uses the treatment modality most beneficial to her client’s needs whether it’s EMDR, TF-CBT, IFS, writing, movement, or art. Her approach and style are right in line with the Visions’ holistic, client-based approach to adolescent treatment. Her work with the kids at Visions is very individualized–Aleksandra first focuses on building a rapport with the kids, and creating a trusting, safe environment for them to express themselves. When she treats trauma, she assesses where the client is emotionally, whether their trauma was chronic or an isolated event, their awareness surrounding their trauma, if it is repressed or glaringly present, and whether or not there are any psychological issues like mood disorders, depression, or mania present resulting in a dual diagnosis.

Aleksandra has taken her own trauma recovery and transformed it into a path of being of service to adolescents struggling with their own deep traumas. She believes that treating trauma is a crucial step in working on one’s recovery from addiction, eating disorders and other mental health issues. Aleksandra recognizes the influence of major and minor traumas as often being the underlying cause of substance abuse and self-harming behaviors.  We are so fortunate to have such a compassionate, caring trauma specialist as part of our clinical team at Visions Our clients now have access to trauma treatment in both our residential and outpatient programs, as we recognize the deep impact unresolved trauma has on one’s recovery.

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