At Child HELP Partnership, our mental health services are trauma-specific, meaning that they were developed to address the specific emotional and behavioral responses children have to violence, disaster, and other traumatic events. To help foster healthy development in children, we must first understand what they have been through and how it is currently affecting them. To that end, clinical care begins with a thorough trauma-specific assessment of trauma history, child symptoms, and family functioning. Because we believe caregivers are the key to a successful healing for traumatized children, caregivers are involved in every step, including assessments. Our assessments are repeated during and at the conclusion of therapy to ensure that children and caregivers have benefited from the services. This also gives us an opportunity to make appropriate referrals for additional services if warranted.
Child HELP Partnership offers trauma-specific cognitive behavioral therapies (Trauma-Focused Cognitive-Behavioral Therapy and Alternatives for Families: a Cognitive-Behavioral Therapy). Cognitive behavioral therapy (also known as CBT) builds from the theory that emotions (for example, anxiety) are associated with physiological symptoms (e.g., heart palpitations), cognitions (for example, “I am a failure”), and behavior (for example, avoidance of the cues that elicit those feelings and thoughts). For children and adults exposed to trauma, the physiological, cognitive, and behavioral responses are often reactions to the perception of being in danger. During a trauma, the danger is real. The problem is that trauma survivors perceive that they are in danger when they are not because something (a trigger) reminds them of the trauma.
Trauma-specific CBT begins with psychoeducation and affect identification to define the trauma, help children label and identify emotions and teach the relationship between emotions, thoughts, and behaviors. Relaxation Training provides training in diaphragmatic breathing and progressive muscle relaxation, portable techniques that the children can implement in response to anxiety. Cognitive Restructuring helps children systematically identify and challenge negative or distorted thoughts that may be precursors of emotional and behavioral problems. And gradual exposure helps habituate children to cues of the trauma (e.g., smells, sights, sounds) without the feared consequences, such that emotional distress and avoidance decrease. This process also helps children put the traumatic death into a more meaningful context.
In trauma-specific CBT, caregivers are taught the same coping skills both because they may be experiencing their own stress and because they take on the role of coaching the children to use their skills. And they are given parenting techniques that address children’s acting out and aggressive behaviors. When appropriate, this process is supplemented with a “clarification process,” in which either the abuser or the child’s primary caregiver shares his / her own feelings about the event and then “clarifies” for the child how and why the event occurred. Lastly, the caregivers commit to using what was learned in therapy to keep the child safe in the future.
When the traumatic event is associated with a death, the trauma work is followed by a grief-focused module. CBT techniques that were taught during the trauma-focused module to address trauma-related symptoms are re-applied to promote coping with the absence of the deceased. Initiation of grief is conducted to allow the child to mourn the loss of the loved one – and recognize and resolve ambivalent feelings about the deceased. Transforming the relationship helps the child redefine the relationship with the deceased. They can then commit to and build on present relationships, with the goal of minimizing social isolation. Activities follow that are designed to enable the child to Make Meaning of the trauma and death. Joint child-parent time helps the parent practice communicating with the child about the deceased and plan together for upcoming challenges like holidays and anniversaries.
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