This training is designed to help those who work with children see at a deeper level how healing takes place and why we need to work hard to encourage expression with our young clients. Understanding troubled young people is half the challenge when we work to help them. Experienced therapists know that this is much easier said than done. Troubled young people often do all they can to keep adults guessing, they often work against their own best interests, and they generally disguise what is really going on for one primary reason—to avoid vulnerability. Since therapy is all about vulnerability the challenge is very real. Children do not come into this world with anxiety and mental health struggles. It is true that some problems have genetic factors, but the human brain has an amazing ability to adapt, and it seeks to overcome any deficiencies it may encounter. The reason young people struggle is not primarily nature (genetic loading) but nurture or what happens in the environment they are born into. Unfortunately, too many children encounter an environment not well suited to promote their success in life. The Adverse Childhood Experiences research says that if a child has four listed traumas in childhood, the odds are very high they will have life-long mental and physical disabilities or challenges. Jasper children average 6 of the listed traumas. Issues such as a child trying to raise a child (teen mothers), substance abuse, poverty, domestic violence neglect and other forms of child abuse are the most common issues that most troubled young people share concerning their early lives.
Trauma and the need to heal
There is sufficient research over the last thirty years to fully explain why adverse childhood experiences produce young people with mental, emotional and behavioral disorders. And these are the majority of children who come to us for help, but our children do not often ask for our help and may work against it. All individuals are unique, but troubled children often share a common past, it is how they respond to their past that is unique. We must realize that even if two children have the same experience, the results can be very different. Trauma is actually less about what has happened and more about what happens inside the individual’s brain. This is because how someone perceives an event will usually determine its meaning and its impact. As helpers we must never assume that we know the meaning of trauma to a specific child and instead take the time to learn how the young person views what has happened and the resulting response. However it is often not easy to get this information out of the child.
Trauma is any event that overwhelms an individual’s ability to cope. Serious events may not cause trauma with some individuals, while a minor event can be very impactful to others. Trauma is an internal experience rather than an external event. We once viewed post-traumatic stress as something mainly associated with soldiers and wartime or what used to be called “Shell Shock Syndrome.” However, this condition is now much more associated with non-military individuals who have gone through one or a series of experiences that significantly affected the individual’s ability to manage an event. Children are a classic example of how psychology now views trauma. Children must rely on adults for their very survival. When adults become threats rather than protectors, then the child must go into self-protective survival mode, resulting in the child avoiding vulnerability at all cost. Most children lack the emotional or behavioral ability to protect themselves, and threatening events can be experienced as a risk to their survival. The brain and autonomic nervous system are prepared with a fight or flight built-in response to survival threats. However, activating this primitive brain system does not come without a cost. The results of traumatic events come on a continuum from minor to life-changing impacts.
There are far too many negative impacts of trauma to cover here but the most typical and impactful results of trauma will be mentioned. Trauma has a major impact on the brain. After the individual’s brain has experienced an event it could not cope with, a trauma memory is seared into the limbic brain in order to ensure any similar future situation be avoided if possible. The primary impact of this is not just avoiding similar serious events, but all new sensory information coming into the Thalamus (the gateway of the brain) will now be processed through the brain’s limbic trauma memory. This is why a soldier may leave the war-zone but the war-zone does not leave the soldier’s brain. As you know for children, trauma has a major negative impact on self-regulation and the ability to manage strong emotions. Trauma changes perceptions of situations with the primary goal of identifying all potential threats. Traumatized individuals also struggle with interpersonal relationship and often misperceive the intentions and motivations of others. These and many other results of trauma can drastically impair an individual’s ability to manage life’s challenges and struggles. It is important to consider how the child is perceiving you, will you use my information or vulnerability to hurt me like other adults have.
It was important to briefly mention above what trauma does in order to return to our current topic, how children express strong negative emotions and how this relates to healing. The impact of trauma on emotions and perceptions puts a young person in the difficult position of first–not knowing what they are feeling, and second–what to do about strong emotions. They generally have had very poor modeling from adults with handling strong emotions. There are a few emotions that come quite naturally. These emotions include the big three–fear, anger/rage and frustration. However, the difficulty is these surface emotions often mask the real feelings under the surface. For example, if a young person expects something good to happen and it does not go as planned, he or she may express anger when they are actually saddened by the disappointment. S29 However, because of the negative disposition of the limbic brain, the surface emotions take precedence and the young person lacks the insight to find the underlying primary emotion. The result is that most traumatized young people lack the internal understanding of emotions, much less the ability to effectively express emotions. So your therapeutic goal is first to help the child experience real emotions and then to understand what they are feelings—not an easy task.
To understand challenging young people, we must take the time to climb inside of their world since they continually struggle to understand our world. This is one of the key roles the therapist plays at Jasper Mountain. To help do this, take a moment to answer the question what are the most unpleasant emotions you experience? For most people the big three negative emotions–fear, anger/rage and frustration top the list. Most of us do our best to avoid situations that will result in these experiences. Avoidance is a major strategy for everyone, and it is generally effective. Therefore, it is not a surprise that troubled young people use avoidance as a major method to cope. Young people avoid persons, places and things that they anticipate will result in unpleasant emotions. A list of a few things they may often avoid includes: school, difficult tasks, physical and/or mental challenges, unfamiliar places or activities, and adults who have expectations of them—thus therapy may top their list. The most difficult emotions for these young people are the deeper feelings under the surface. You mission impossible, if you choose to accept it, is to travel into the child’s brain and find these emotions (and come back in one piece).
Emotional expression after trauma
With this background, including the probability that the young person is unaware what he or she is actually feeling, we can now directly cover how troubled young people express unpleasant emotions before addressing the mental healing process.
Sadness – A pervasive emotion for young people after trauma is sadness. It is not difficult to understand why. The difference between what a young person deserves and what they often receive would produce a level of sadness in a normal healthy individual, and after trauma these young people are often neither normal nor healthy. Sadness is what can be called an emotional set point in some individuals, meaning that sadness is a default mode or most common emotion. Therefore, sadness is not only a frequent emotion because it makes an individual vulnerable, but it is pervasive. To make matters worse, sadness is a passive emotion. Meaning it is something the individual usually experiences alone and is often brought on by either another person or a situation where the individual feels like a victim. When someone loses a pet or a loved one, the expected emotion is sadness. Because of the passive nature of sadness, it makes individuals vulnerable to the situation or other people. The last thing a traumatized young person wants is to be vulnerable. Therefore, sadness will most often be expressed by an active emotion—anger, rage or frustration. After trauma, young people do not want to be the victim of other people or situations. An automatic response to avoid vulnerability is to express the active emotion of anger with the situation. Anger is an emotion we can express in a direct and powerful way and is very different than feeling or expressing vulnerability. It is often a good idea when a troubled young person is angry to consider if the underlying deeper issue is some level of sadness. Therefore part of your therapy approach is to address sadness and normalize it. This is not to say that troubled young people are unable to express sadness. In fact, some individuals after trauma get stuck in chronic sadness and develop a passive negative emotional set point that has been recognized in diagnostic mental health conditions such as dysthymia and depression. Whether you are working with a troubled child who is stuck in either anger or in sadness, there may be more similarities than differences in the two negative emotional states.
Fear – After trauma, fear can become a pervasive emotional state. Since trauma resets the brain around perceived or actual threats, fear is not only a common emotional state, it is an expected state. It would be unusual after trauma for the individual not to have heightened levels of fear. For example, after being in a serious car crash, heightened levels of fear would be expected when traveling in a car. However, fear places the youth is one of the most vulnerable states there is. Even when the individual may be experiencing fear, the brain may try to avoid vulnerability in the only way possible and that is to block the experience or in Psychology what is called dissociation. As therapists we must monitor dissociation because when this occurs any therapeutic value at that moment ends. Dissociation can be expressed on a continuum, and can range from daydreaming and not paying attention, to fainting or being unresponsive. Fear can also be expressed by a traumatized child as excessive compliance. It is never a good thing for a troubled young person to follow every direction and rule without question. In such cases the odds are good that the child is experiencing fear brought on by a perceived threat that is being expressed by doing exactly as the threatening person is demanding. It may sound odd to some adults, but some resistance is actually healthy because the individual is dealing with the situation by having an opinion or a preference, and this includes your therapy. Fear is the only emotion for a child who has been harmed that is less desirable than sadness. Fear may be expressed in active (fight responses) or passive (flight responses). It can be difficult to determine if fear is the underlying primary emotional state, but it should be considered as a possibility. For these reasons you must address fear in your therapeutic plan.
Hopelessness – The feeling of being hopeful or not hopeful is primarily about the future in relation to the past and present. Many troubled young people experience a lack of either future orientation or hope for the future, and can we blame them? When children have not received the care and consideration they deserve growing up, why would we expect them to think the future will be different? Afterall, many young children do not realize that abuse and neglect are not what life should be like, it is the only experience they have. Many of these children are unaware that other children live in a very different world of nurturance and love. To lack hope drains the individual of what motivates most people—anticipation, confidence and optimism for what lies ahead. Because many young people know only that living equals pain, hopelessness can be the primary emotional state they experience. This would lead most any individual to a host of negative emotions and behaviors. Hopelessness can result in lethargy (internalized) or anger (externalized). It can also result in responses on a continuum between lack of interest in most everything, to extreme risk taking and self-harm. When a young person is acting in ways that work against their own interests and well-being, it would be wise to consider if there is an underlying emotional state of hopelessness. With internal pervasive negative emotions prompted by trauma and a desire to avoid vulnerability at all costs, the result is often strong emotional expression as far from the primary affective state as possible. The most common results are some of the easiest emotions to express that do not signal vulnerability to others. Such easy to express emotions include: frustration, irritation, hostility and being generally grumpy and cranky. These emotional states will be very familiar to anyone who spends much time around troubled young people. These are the go-to feelings, letting others know that the young person is not liking what is going on but responding with an active rather than passive response in order not to reflect powerlessness and vulnerability.
So your therapeutic task is to address these and other emotions that generally are at a deeper level than what the child is willing to express without your help to do so.
Understanding the expression of emotions after trauma
So far what we have not covered is what to do about pervasive negativity and problematic internal feeling states. This is in part because the first step is understanding where persistent negative emotions come from. The first thing to realize is that as unpleasant as it is for you to be around some of these young people, consider what it must be like for the child. Seeing only the negative in the world would be demoralizing indeed. The young person must live full time in the negative world they perceive. With some understanding of how their past has clouded their present and their future, it can help us have compassion for living with the brain that has been sculpted by trauma.
When we understand what the world looks like through the eyes of a troubled young person, it is important to reflect this in how we engage with these children. Do we understand the child’s resistance to therapeutic work? Do we understand their attempts to keep us distant? Do we accept them where they are and join them in their pain? If so, you are on the right path. The only positive direction that is possible is to disconfirm the young person’s fatalistic belief that life is a continual series of hardship and pain. We must show them that it is possible to take command of our perceptions and emotions. But this in only possible by having some understanding of emotions. When we are faced with a reactive and negative individual, we must model that we have the ability to determine what we feel and are not controlled by what is outside of us. This is part of the therapist becoming an attachment figure for the child in order to trust and learn from your modeling.
What we all want for these young people is to have a chance to have a life that includes meaning, enjoyment and contentment, in other words something very different than their everyday experience. The strongest teaching tool is modeling. It may not be apparent to you that you are having a strong influence on the young person, but it is likely that you are. How you are influencing the child toward a positive or negative direction depends on whether your interactions result in you being either positive or negative. It is perfectly understandable if you find yourself being irritated and frustrated by the negativity and nonsense that you experience from a challenging young person. Experienced therapists realize that negative reactions from children are indications you are on the path of touching on sensitive and important issues. There is a parallel process when you face a negative individual while staying positive and this shows the young person that you care and they have the ability to find positive aspects of a world they experience as primarily negative.
Healing through emotional expression
For many generations following the emigration of cultures primarily from Europe, the place of children in the family could be summed up by the statement children are to be seen and not heard. One of the worst things that could happen to a parent is for a child to tantrum in public and how this cast shame on the inadequate parent of such a child. Fortunately, those days for the most part are behind us in American society and children are allowed a voice in family life. Most families realize the importance of healthy emotions in order to produce healthy individuals. In the aftermath of any kind of trauma, emotional expression becomes a critical factor in addressing and moving on from the trauma. To again use a previous example, if a child has the misfortune to be in a car crash, subsequently the child may avoid or even refuse to ride in a car afterward. If this trauma is not addressed, it can have far reaching complications for the child and the family. But how can emotions assist in healing the impact of trauma?
In the Western world we do not have a long history of understanding emotions and healing. It was only 100 years ago that Freud stunned the medical establishment with his “talking cure.” Freud demonstrated that illness could be the outgrowth of mental and emotional pain and surgery could not get to emotional pain, but expression could. He was able to cure illnesses of many types by having the patient verbalize such factors as stress and anxiety, phobias, negative thoughts and even disturbing dreams. The field of Psychology grew from this foundation.
The physical body knows how to heal damage. After a laceration, bruise, or abrasion the body’s internal trauma team goes into action. Internally the body does the same thing with viruses, toxins, and even serious conditions such as cancer. As long as the body has the necessary resiliency to fight off disease, it is generally successful at doing so. Much of modern medicine is actually designed to help the body do the job of healing with some outside assistance. The mind is similar. Although the mind (rather than the brain) has no material substance, it is capable of taking advantage of the brain’s primary goal of promoting survival. It does this by managing expression—either preventing expression (dissociation) or promoting expression (tears, rage and frustration). When we share our pain with someone who supports us, the emotional pain is reduced. It is helpful to consider infants, when hungry they scream, when they want to be held, they let the world know. An infant’s brain faces the threat of survival all through the day and the one way the brain has to handle this is by expression to summon help. After help is received the emotional pain is resolved and when this happens again and again, the brain learns to express emotional pain to heal and return to a state of emotional health, otherwise the ability to cope with life. Most Jasper Mountain children do not have the experience of coping.
Another example of healing through expression can be found in our societies view of grief. A few decades in the past, the conventional wisdom to manage grief and loss was to move on, get busy and fill your life with distractions to disguise the grief. This seldom worked and often prolonged the pain. Today when someone we love dies, we are not advised to put the grief aside and simply move on and try to forget. Instead, we are advised to feel the loss, express the pain and face it directly as the healthiest way to heal the loss and not allow grief to consume our lives indefinitely.
The impact of trauma is often at a neurologically deep level. It involves primitive and subconscious parts of the brain’s limbic region. Expression is a primary function of the limbic region and emotional expression goes deep into the region of the fear center (amygdala) and the trauma memory center (hippocampus). Emotional expression can therefore play a role to go straight to the emotional damage in regions of the brain that are outside our voluntary control and assist in the emotional healing. This is the deeper level of therapy that our children need.
Emotional expression related to trauma is seldom enjoyable or convenient. One of the reasons infants receive immediate attention is first the caring of the parent, but also the desire to reduce their unpleasant expression. Research has found that a crying baby is one of the most difficult sounds for an adult to cope with and is sometimes used in hostage situations to wear down and encourage criminals to give up. The expression coming from past trauma of the children at Jasper Mountain is never enjoyable or convenient, but it is essential for healing. Like the sound of a baby crying, most adults would prefer for the crying, the screams, the name calling and the many forms that tantrums can take to end as soon as possible. But that is the point of deeper therapy, we must encourage and accept negative emotional expression in many forms for Jasper Mountain to be a healing place.
There are some bad things that can happen if a child’s environment shuts down emotional expression, which is a major reason why our children have not been helped in other settings. If expression meets disapproval or if expression is not allowed, then the deep pain of trauma in the limbic region of the brain reacts in emotional (and possibly physical) fight or flight. This can produce first dissociation and can lead to delusions and even psychosis. But if emotional expression is not supported then the pain remains longer in the mind of the child and is a primary reason why the impacts of trauma can be life-long. As difficult as it is to be present for the emotional expression of children who need to heal from trauma, we must understand why it is important and play a role to help Jasper Mountain continue to be a place of healing emotional trauma. Supporting a child’s expression is similar to being with someone expressing grief and loss. It is not essential that we do anything in particular other than be supportive and be present. The expression of emotional pain is aided by expressing in the presence of a supportive person (a major tenant of the field of psychological treatment).
We must resist the temptation to avoid painful emotional expression in our young clients. As therapist at Jasper Mountain we must do more, we must allow and support the emotional, physical and interpersonal expression of the pain of past trauma. There is nothing easy or even intuitive about our job and our program’s ability to do this well in the past has made us unique. It may seem like supporting tantrums will lead to even more tantrums, and for a time this may be true. But like tears of grief after experiencing a loss, eventually the tears become less frequent even though the memory of the loss remains. This is the healthy outcome of trauma—to have access to the memory of the trauma but to function in life without letting the impacts of trauma adversely impact living a full and successful life.
To do the above is neither quick or easy. It is a bit like being a farmer when you plant the seeds of a positive life, then nurture these seeds, but you may not be around by the time the seeds mature and bear fruit. But even if you believe you have been unable to help a young person heal, the process can teach you a lot about being a caring and optimistic person. Afterall, only an optimist could believe that this young person can someday be a successful and happy individual.
Accessing deeper emotions and their expression can be done in many ways. With some children this may be easy, with others it may seem impossible. Use your therapeutic tool kit—art, sand tray, narrative therapy, use of stories and more. If you are tuned into the child you may find that “all roads lead to Rome” or given a child’s trust in you their brain may take advantage of the opportunity to feel bad (which they understand) for a time in order to feel better (something they must trust that you are correct).
Do your best, include emotional and behavioral expression in your therapy, and remember the young person is watching and learning from you even when you don’t think this is happening. And one last thing–reflect the emotions and behaviors, including your own vulnerability, that you wish for the young person in the future. If you can do this then everyone succeeds.
Test
- Which of the following is the best definition of trauma:
- A near death experience
- Something that produces negative emotions
- Physical or emotional pain
- Anything that overrides our ability to cope
- Most children who have experienced trauma would rather feel anger, rage and frustration rather than sadness. T or F
- What is the most difficult experience for a child who has experienced trauma:
- Expressing pain in the form of a tantrum
- Threating situations
- Vulnerability
- Adults with expectations
- An old name for post traumatic stress was once called the “Stockholm Syndrome.” T or F
- Emotional Set Points are:
- Default modes of emotional experience
- What prevents children from feeling emotions
- Determines pervasive positive or negative emotional states
- a and c
- None of the above
- To help children heal from emotional trauma the first step is to understand the child and be present and supportive. T or F
- When children act in antisocial, aggressive or destructive behavior, our first job is to put a stop to negative behavior so the child can live with a family. T or F
- Which of the following can be said about the body’s ability to heal itself:
- Emotional harm can best be healed through moving on and forgetting the cause.
- Both physical and emotional healing are available to resilient individuals.
- The body can heal physical damage but not emotional damage
- a and c
- Trauma memories exist in the deeper primitive regions of the brain that can be accessed through emotional expression. T or F
- Why has Jasper Mountain managed to be successful with challenging children where families and other treatment programs have not?
- Jasper Mountain has carefully created a healing environment
- Jasper staff are trained to understand the causes of aggressive and antisocial behavior
- Expression in physical and emotional ways are encouraged and supported
- The program focuses on the causes and not just the symptoms
- All of the above
Answers:
- d
- T
- c
- F
- d
- T
- F
- b
- T
- e