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Unsullied-Non-Knowing: The Essence of Discovering What Matters Most

September 11, 2013

By TLC Founder William Steele, PsyD

James Dyson, the creator of the Dyson vacuum cleaner, powerful fans and other household appliances, is an engineer and a billionaire. He credits his success to the principle of hiring “unsullied” people because he says, “I want us (our team) to approach projects as knowing nothing but willing to experiment on something” (10 questions, Time, August 19, 2013 p. 60). In essence he is defining curiosity. In “Working with Grieving and Traumatized Children and Adolescents: Discovering What Matters Most Through Evidence-Based Sensory Interventions” (Steele and Kuban, 2013) an entire chapter is devoted to curiosity and the value of being a non-knowing practitioner as a means to encourage children to take us deeper in the world and the ways they experience themselves and their world as they know it. Hughes (2009) wrote, “When curiosity is directed toward the child’s experience rather than toward the factual events in his life and when it is conveyed with both affective and reflective features, the child is likely to go with the therapist very deeply into his or her life story and experience a co-regulating of emotions related to what is being explored and the meaning given those events” (p.169).

Being curious does not come natural to many practitioners simply because they have been taught to be the knowing practitioner, able to determine what is best for struggling children rather than allowing children to teach them what matters most in their world. Unfortunately, in the clinical setting, county and state regulators and reimbursement entities insist that we plan ahead and devise our treatment plans following the initial intake interview. It forces practitioners into being the all knowing, being confident about what is best for children following such a very brief period of time. Padesky wrote about therapists who are too confident with where they are going. He stated, “(They) only look ahead and miss a detour that can lead to a better place.”

girldrawIt always amazes me, when conducting trainings, how difficult it is for practitioners to be naturally curious. For example, when I assume the role of a child who experienced a house fire and ask participants what they’re curious about regarding that house fire, rarely does anyone ever ask, “Are you OK and did anyone die?” If you were a close friend, your initial natural curiosity would be immediately directed at wanting to know if I was OK and, if so, you would immediately want to know if anyone died or was seriously hurt. Similarly, after drawing a picture of what happened and presenting this to participants they will begin by asking, “Tell me what this is about.” When I respond that my grandma is dying, rather than asking questions about her dying, such as, “What she is dying from or how long she has been dying?” they immediately redirect their questions to the other elements of the drawing. In essence, they immediately begin to look ahead, trying to make sense of what this all means, rather than being curious about where I initially take them — to grandma dying.

Dyson also stated in the same interview, “We don’t use technicians because it’s in the building, which is a mundane thing to do, that you really start to understand what you are doing.” Curiosity really is the cornerstone of building an empathetic relationship in which children feel we are attuned to their world. Once they experience this, they then reciprocate by taking us further into their worlds in ways that allow us to better understand what matters most to them, not what we think will matter most. What matters to children is not how technically efficient our clinical skills are but how much time we spend in their world, not as knowing clinicians but as curious witnesses, building an understanding of what we must provide to be helpful.

Hughes, R. (2009). Attachment Focused Treatment for Children. In Kerman, M. (Ed.). Clinical Pearls of Wisdom. New York: Norton 169-181.

Padesky, C.A. (1993). Socratic Questioning: Changing minds or guiding discovery? A keynote address delivered at the European Congress of Behavioral and Cognitive Therapies, London, 24, September.

Steele, W., & Kuban, C. (2013). Working with Grieving and Traumatized Children and Adolescents: Discovering What Matters Most Through Evidence-Based Sensory Interventions. New Jersey: Wiley

Come Together and Grow

August 7, 2013

JeanAssembly TLC Guest Blogger: Jean West, LCSW, CTC-S, CT

I admit I am still on a training “high.” It’s that feeling you get when you have the opportunity to be around like-minded passionate practitioners whose goal is the same as yours, to learn more about helping others heal from trauma.

As I write this blog, I am contemplating why it feels so good to come together and grow. Maybe it is because the work we do can be so incredibly difficult at times.

I remember last winter two brothers were referred to me whose father had committed suicide. They had walked in with their mom and found their dad after he had committed the act. I went through the drawing process separately with both boys, one after the other. I often quote the movie “Warhorse” in trainings, where the mom is describing why the father who has returned from war is so silent on his experience. She says, “there are some things there are no words to describe.”

That is why drawing is such a powerful tool, enabling us to help the integration of the right and left brain, and helping others to be able to put their experiences into words. After going through these two sessions, I was emotionally, physically and even spiritually exhausted. I ran home and laid down in front of my fireplace and took a short nap, needing rest from the stories that spring forth from our children’s souls.

That is why I love the TLC Summer Assembly. It is rest, rejuvenation, excitement, relationship and renewed learning for me. This is crucial for the work we do. However, I realize that all of us may not be able to attend trainings as much as we would like. How do we stay positive, focused and continue to grow?

First, when we do have the opportunity to attend workshops or trainings from anyone, stay positive. I have heard so many coworkers lament the fact that they are required to go to this or that. They have “too much work back at the office” to be away. However, it is even more important when we are feeling that overwhelmed to have a time away to remember why we are doing what we are doing. If we lose our purpose and joy in our work, how long can we remain a positive relationship in our client’s lives? In Daniel Siegel’s book, “The Whole-Brain Child,” he states, “The kinds of relationships our children experience will lay the groundwork for how they relate to others for the rest of their lives.” Our relationship teaches those with whom we work important relational skills, such as communicating and listening well, interpreting facial expressions, understanding nonverbal communication and much more. Never underestimate the power of a positive relationship in regards to healing.

Second, find a system for using what you learn. It is too easy to file away new knowledge without applying it to our current work. I recommend a checklist for every learning opportunity you receive:

  1. What are three concepts I learned I don’t want to forget?
  2. What is one area I caught a glimpse of that I want to learn more about?
  3. What is one hands-on activity I can use right away with those I work with?

JeanAssembly2Third, I imagine we have all been to a workshop where we thought, “Oh no, I picked the wrong one!” (Hopefully not mine!) I have learned long ago that there is always, always something I can learn and take away. It has to do with having a teachable spirit and being open to new ideas that maybe are different from our own. Last winter I attended a breakout session at a conference where I kept thinking, “Oh boy, I’m not sure about this.” The majority of the presentation was not my favorite, but I decided to stay and be positive. At the very end, the presenters brought forth a concept that spoke to me. I immediately saw how it could be a tool in family therapy and have been using it with great success since. Continue to be open to new learning!

Finally, find the one main concept in each book or article that you read regarding the work that we do that speaks to your heart and write it down. I am an avid reader, and until I learned this concept I wasn’t quite sure how to decide what was important to remember from all that I read and how to keep track of it. What I do now is keep a notebook of what I have read and the most important concept for me from each book that I learned. Some books will have more then one idea, but I limit my list to no more then two or three. This has helped me to remember and use what I am learning on an ongoing basis.

However you choose to grow, continue to grow as a person and a practitioner. When we are whole, we have more to give.

Keep growing, my friends, and keep impacting lives every day.

Sources:

Siegel, D. & Payne Bryson, T. (2011). The Whole-Brain Child Revolutionary Strategies to Nurture Your Child’s Developing Mind. Delacorte Press.

Get Up Off the Chair! Repairing the Relationship to the Body

June 17, 2013

TLC GUEST BLOGGER:  Carmen Richardson, MSW, RSW, RCAT, REAT

“She danced to free her spirit and to free other spirits too…she danced for the living and for the dead in birth and in mourning for peace, beauty and creative expression.”  –Shiloh Sophia

Trauma and the Body
What happens to a child or adolescent’s relationship to their body when they have experienced trauma? When trauma happens there is significant impact on our physiological, emotional and psychological states. The ability to delight in and feel safe within our body becomes impaired. In essence trauma has the potential to create a disconnection to the body. Children learn and begin to believe things like, “My body is not safe,” “My body cannot be trusted” and “I feel chaotic and out of control.”

Body-Focused Interventions
In therapy we want to activate the necessary function of the left hemisphere, which is shut down during trauma experience. The body is a key entryway to help with this activation. Stein & Kendall (2004) state that the neurological basis for providing body-focused interventions such as expressive arts is:

“…because traumatic memories are often firmly lodged in the right hemisphere, children tend to be controlled by negative emotions and self-defeating behaviors. Thus an important goal of treatment is to help children process experience through as many modalities as possible (i.e. images, thoughts, emotions, sensations, and movement), and to design experiences that can activate both hemispheres, especially the left (i.e. experiences that stimulate positive emotions and encourage initiative and action.” (p.137).

van der Kolk (2005) emphasizes the need for interventions that involve movement and pleasure. He states:

“Complexly traumatized children need to be helped to engage their attention in pursuits that do not remind them of trauma-related triggers and that give them a sense of pleasure and mastery. Safety, predictability and “fun” are essential for the establishment of the capacity to observe what is going on, put it into a larger context, and initiate physiological and motoric self-regulation. Only after children develop the capacity to focus on pleasurable activities without becoming disorganized do they have a chance to develop the capacity to play with other children, engage in simple group activities, and deal with more complex issues.” (p. 407).

As trauma-informed practitioners, it is useful to understand how we can bring awareness to the impact of trauma on the body and how to support the reconnection to the sensory experiences of feeling free and safe within the body.

The Body’s Natural Language is Movement
Mindful movement brings one back into the body. We can help children and youth re-establish healthy connections to their bodies and help repair any disruptions of their own attachment to their bodies by designing safe ways to connect to the body through awareness and movement. If we offer a safe, creative play space for our clients, the repair through mindful movements can assist with:

  • increasing trust in the body’s integrity
  • reestablishing a sense of pleasure and ability to delight in positive sensations
  • creating opportunities for self-soothing experiences
  • experiencing power within their own body through self-regulating experiences (i.e. move from sadness to playfulness)

As therapists we help children notice the sensations associated to their inner world, we invite experiences and experiments to expand the sensations and then teach how to savor these positive sensations/feelings. These experiences help children begin to experience in a bodily way, the innate ability of their body to experience play, pleasure and calm.

We do not have to be trained dance/movement therapists to integrate play, gesture, movement into our practice with young people. Movement is a natural part of our life, however, we may have been conditioned to primarily use talk therapy and to stay still and stay put in our respective client-therapist chairs. We are conditioned as human beings to live mostly in our heads, moving in the world as though we don’t have bodies. If we check within ourselves as therapists, we will likely encounter our own notions/ideas about moving in therapy – perhaps our own discomfort in our bodies. It is important that we feel comfortable moving in our own bodies if we are to invite our clients to engage in mindful movements.

Ideas for Practice
The following are some simple ways to bring movement into the creative therapeutic space in our work with children/teens. It is not only the activity itself that can be healing, it is the mindful awareness we bring to the movement, that is noticing the sensations that are aroused, to be curious about them and to invite experimentation through movement (i.e. “What movement expands that openness in your chest – when we stretch way up high or when you put your hand on your chest?”).

1. Beginning of Sessions (fun openings that increase sense of pleasure and playfulness)

  • toss a ball
  • play with sticks (I have 3’ long doweling sticks that I painted a variety of colors) -use these sticks to balance between two people or on your own
  • various games with tossing balloons
  • blowing bubbles

2. Middle of Sessions (used within a structured and evidence-based approach to treating trauma such as Structured Sensory Interventions – TLC)

  • show me the hurt – gestures, dance
  • use the drum to tell the story of the hurt
  • body scan – tuning into the inner world of feelings and sensations and mapping them out on a life-size body outline, find movements/gestures that correspond with those sensations and feelings
  • use stories and rhymes to act out the various rhythms of fight, flight, freeze

3. Ending Sessions (returns the body to a sense of calm, playfulness, self-presence and we are grounded in the here and now)

  • Movement Thumb Ball (I love this ball – if you are coming to the Summer Assembly, pick one up at the Self-Esteem Shop!)
  • play songs our clients like and dance with scarves
  • Yoga Deck – client chooses a card and we make the pose
  • mirroring movement with or without music (one person moves and the other follows, switch roles)

Just a reminder: These are not just therapeutic activities to be used randomly. They are important interventions that are part of a well-thought-out practice framework that guides the treatment of trauma in children and teens.

“She danced to free her spirit and to free other spirits too…
She danced for the living and for the dead
in birth and in mourning
for peace, beauty and creative expression.”
Shiloh Sophia

References:

Stien, P. & Kendall, J. (2004). Psychological trauma and the developing brain: Neurologically based interventions for troubled children. New York: Haworth Press.

van der Kolk, B. (2005). Developmental trauma disorder: Towards a rational diagnosis for children with complex trauma histories. Psychiatric Annals. 35(5), 401-408.

The Relationship Between Attachment and Addictions

May 15, 2013

TLC Guest Blogger: Lori Gill, M.A.

We know we are born primed for connection, with the most significant relationship in a child’s life being his or her primary caregiver – but what happens when this does not occur? These relationships help us learn to self-regulate, develop a sense of self-worth and act as an emotional template for future relationships, shaping our view of people and the world around us. When these relationships are conflict-ridden, the outcome may lead to challenges with forming and maintaining future relationships (Perry, 2001).

Mate (2008) suggests that individuals with addictions are constantly seeking something outside of themselves to alleviate their insatiable need for relief and fulfillment. It is as a result of this longing and emptiness that individuals pursue substances or other self-harming/self-soothing behaviors, with the hope that it will provide some relief. Andrews (2010) further supports that it is through this fight to regulate and ultimately survive that the litany of behaviors begin, behaviors that will temporarily give relief from fear and the pain they suffer.

Mate (2008) indicates that addictions — regardless of the form they take — always result from pain, conscious or unconscious, with the addiction serving as an “emotional anesthetic.” It is human nature to want to be seen, to feel worth, and to have the connection. When this does not occur, we feel the void and seek desperately to fill this in any way we can. However, without intervention and support, individuals will remain in a state of despair, constantly seeking something to fill the void, potentially shifting from one addiction to another in attempt to find some relief.

parentsI have used TLC’s “Adults and Parents in Trauma” program to very effectively target underlying issues at a deeper sensory level. I remain humbled and amazed by my clients’ experiences and have observed that many, in spite of some unfathomable and violent traumas, identify their most significant trauma as something relating back to early childhood experiences of disrupted attachment. This supports the notion that at our core, we all just truly want and need to be loved. It is not the addiction that is the problem; this is just the bandage used in attempt to cope with the underlying problem. As clinician’s we need to help our clients find alternate options to heal their hurts.

How to help:

Compassionate Care: Trauma-informed treatment includes shifting to a place of compassion and awareness rather than blaming or questioning, asking instead “What happened to you?” This helps to understand what function the addiction serves and determine the underlying issue.

Education and Awareness: Becoming trauma informed and being able to share this information with clients in a compassionate manner is essential. Helping clients understand the automatic and subconscious processes of the brain and the automatic brain response patterns that develop. The brain seeks to find meaning from our experiences when we have previously used substances as a form of coping. The brain acts for us: “I know this feeling. When I feel this way I do this. This helps me feel better.” When we provide education and awareness to our clients, it leads to permission for compassion for self and awareness.

Empowerment and Nurture: We need to help individuals learn to nurture themselves and become empowered through new resources and increased awareness. Although addiction behavior is not ideal and not helpful in the long run, it is what is holding them at this time, perhaps even keeping them alive. It is an attempt to cope rather than just succumb to the pain. Our role as clinicians is to help expand their toolkit with items and strategies that nurture them. Yoga, sensory distraction, mindfulness and affirmation statements are all excellent tools.

Connection and Opportunity: The significance of attachment is that we are born primed for attachment.  If we don’t experience this, learn how to self-regulate, learn self-worth and learn how to form healthy relationships, this can impact us throughout life. Insight into the impact our early life experiences have had and providing opportunities to develop self-worth and inner awareness can shift this blueprint. Helping clients to experience authenticity, while tuning into their needs and wants, can be incredibly empowering. Working through what a healthy relationship looks like, with one’s self and others, and providing opportunities for connection can help reconstruct this blueprint.

Lori will be presenting on addictions, The Secret World of Substance Abuse, at this year’s TLC summer assembly.  This is a fantastic learning and networking opportunity.  To register or learn more, visit http://www.starrtraining.org/assembly2013#secret

References:

Andrews, E. (2010). Being trauma informed [power point slides]. St. Catharines, Ontario, Canada: Art Therapy Services.

Perry, B. (2001). Bonding and attachment in maltreated children: Consequences of emotional neglect in childhood. Retrieved (July 15, 2011) from: www.childtraumaacademy.org

Mate, G. (2008). In the realm of the hungry ghost: Close encounters with addiction.  Toronto, Ontario, Canada: Random House.

Celebrating Loved Ones Who Are Gone

May 7, 2013

Bwoman looking at photosy TLC Guest Blogger: Robin A. Edgar

As Mother’s Day and Father’s Day approach, families look for ways to let our loved ones know how much they appreciate them. For those who are separated from or have lost a parent or a child due to death or illness, this can be a time of sadness.

Reminiscing about a meaningful time with that loved one is a wonderful way to ease the pain and celebrate the time you had together. The question is, how do you recall those significant memories?

The best way to start is to follow your nose, since the senses are proven to help trigger significant long-term memories. You can also round up some old photos or objects to help you recall significant events from the past.

As you share your memory with others, even a sentence or two can grow into a story. Here are some prompts to get you started:

  • Is there a certain aroma, such as a particular perfume, bread baking in the oven or fresh mowed grass, which reminds you of a special time in your life?
  • Do sounds, like grating and chopping in the kitchen, a certain song or the slamming of the back porch screen door, trigger any memories?
  • Perhaps a piece of jewelry, an article of clothing or furniture reminds you of your loved one.

Once you’ve found them, you can develop a simple ritual or family tradition from these memories such as baking your loved one’s favorite recipe, planting a tree or going fishing. This allows you to celebrate them in your own personal way.

Adapted from In My Mother’s Kitchen: An Introduction to the Healing Power of Reminiscence (copyright Robin A. Edgar, 2002).

Healing with Words, Rhythm and Voice

April 17, 2013

TLC GUEST BLOGGER:  Carmen Richardson, MSW, RSW, RCAT, REAT

April is National Poetry Month in North America. It is a time to celebrate poetry and increase awareness and appreciation for the gift of this art form. Poetry therapy is a form of bibliotherapy, which uses a wide range of literature/books for healing and personal growth. Poetry is one of many expressive arts modalities used therapeutically for a wide range of clinical issues, including the treatment of trauma (Levine & Kline, 2006, Loue, 2012, Nicholas, 2003). Like many art forms, it may often be dismissed as a therapeutic resource if we, as therapists, feel we lack the propensity to write poems. Yet poetry can be used within a solid therapeutic framework in a variety of ways.

I see these interventions as invitations to our clients, whether it is bringing created poems, lyrics or rhymes to the session or writing poetry. The following section outlines only some of the ways poetry may be incorporated in the therapy session:

1. Invitations: Use already created or well-known poems/stories. I have a folder with many poems, lyrics and quotes that I personally have loved or ones that clients have brought to me to use in their therapeutic work.

Poem Ideas:

  • “Autobiography in Five Short Chapters” – Portia Nelson
  • “Summer Day” – Mary Oliver
  • “The Journey” – Mary Oliver
  • “She Danced” – Shilo Sophia
  • “Prelude” – Oriah Mountain Dreamer
  • “Rhymes and Stories to Prevent and Heal Trauma” – Peter Levine and Maggie Kline

Book ideas:

  • “The Fall of Freddie the Leaf” – Leo Buscaglia
  • “The Giving Tree” – Shel Silverstein
  • “My Many Colored Days” – Dr. Suess
  • “The Velveteen Rabbit” – Margery Williams

As therapists, we may have a sense, in terms of right timing, to share a poem or story that may have meaning for our clients. I also invite my clients to bring a special poem, quote or story that is important to them. We then use that writing in our work. How has this poem or story been important to them? Is there a particular line that stands out? What if they took that line and used it as a starting point to their own poem or story?

Another intervention is to invite our client to read the poem. It is sometimes in the reading of the poem in their own voice that the connection to the meaning and essence of the writing becomes clearer. We can really slow down this process and stay with whatever emotion arises.

 2. Use poem prompts. Using prompts can be a nice springboard to the inner world of our clients. Some prompt ideas include:

  • My hurt is like…My body is…I feel most alive when…The “me” nobody knows…The inside “me”…The outside “me”…
  • Write a poem with the title: “No One Heard Me” or “The Feelings I Hide”
  • Or write a poem in the voice of a young girl or boy or in the voice of a hero or superstar.

3. Intermodal use of poetry. In a session, if we have started with creating a visual image (i.e. a painting), we may then move to writing one-word responses to the image. I will write out all the words that come to them as they observe their piece. If it is hard to get started, I may offer up some words to begin with. I hand them the words and invite them to create a written response to their piece. Having the one-word responses offers a framework that may be easier to write from than just from the imagination.

On a more personal note, poetry saved my life as a teen. There were certainly no formal resources readily available, and “talking” about problems wasn’t encouraged. I turned to writing poems. My own suffering found a home in words strung together to make sense of untouchable hurts. It was like the poem provided the container for an event or an intense emotion and helped to move it outside of the body and hold it safely, which provided distance, relief and inner calm. Poems came again to my assistance through the grief of my mom dying of cancer and the long process of her illness. The poems seemed to document what I was witnessing and needed to be witnessed through the sharing of my poems with a trusted friend. Still, to this day, I tend to turn toward the arts, in particular to creative writing, as a way to sift through the “stuff of life,” including both the sorrows and the joys.

In my therapy office, I keep a journal that is waiting for me to fill the pages with my responses to what I witness as therapist. These responses reflect the stories and sufferings of many children, teens and adults I see on a daily basis. This journal is my companion. It is reliable, ever ready, even encouraging me, and, at times, begging me to take the time to spill open onto the pages with words and images that surface in my own inner world as a therapist.

Recently I asked a 15-year-old girl with a significant trauma history how poetry or writing has helped her on her life’s journey. Almost immediately she exclaimed, “Get me a paper, get me a pen!” I did, and these are the words that tumbled out within a few minutes:

The steady beat of my heart,
Sounding like the drums of war.
Blood pumping through my veins
coursing like a fire.
As the voice of reason whispers,
“Write it down on this page.”

What is it Our Brains Need Most?

March 8, 2013

GrandparentTLC GUEST BLOGGER: Barb Dorrington, MEd

What is it our brains need most? Much of brain science talks about safety, predictability and nurturing as key ingredients to help the brain thrive. As a school social worker, many of the principals at my school board have developed these same concepts into more user-friendly words for teachers. The simple questions asked by an administrator for a suspendable consequence were: “Was your action fair? Was it kind? Was it respectful?” One particular principal expelled a student for assaulting a teacher and used these questions. The end result was that same expelled student shook hands with the administrator while leaving the school with a police officer, returning a few days later to pay money for previously unpaid school fees. It leaves one to ponder what took place to cause such a responsible result from a particularly troubled student?

The Adverse Childhood Experience (ACE) Studies investigates connections between child maltreatment and later-in-life health difficulties. All the small daily traumas of life create our attitudes and shape our personalities. What can help? History has shown that we continue to feel closest to those people who provide us with a consistently safe and nurturing haven. Likely that student felt protected and safe in the school environment and with that caring principal, even though he was being expelled for an assault.

According to Mark Brady, a neurocscience editor, grandparents have a special place in the hearts of children and stave off the isolation, loneliness and disconnection of hard daily living. He suggests that it is not the number of positive interactions but rather the quality, timeliness and rhythm of these positive interactions. His big brain question to each grandparent is, “Are you there for me?” If that answer is a resounding yes, then that child is acknowledged and feels validated. Brain science supports this need for such affirming repetition to change those dusty ruts in our brains into new strong neural superhighways.

While for some it may be the unconditional love of a grandparent, I had a wonderful Aunt Helen who told my parents I had a lazy eye at the age of two and they needed to attend to it. Some years later, she told them that I needed help with braces on my teeth. My parents loved me but they were busy and led rather chaotic lives, not necessarily vigilant about certain practical matters. Aunt Helen watched over me until her own death. She validated my existence. I always knew my Aunt Helen would be there for me, and I still ask myself, “What would Aunt Helen say?” In turn, I now ask clients about the adult that made the difference for them as children. It is a natural, safe place for us—and people of all ages—to share their stories of the person who made the difference.

The programs at TLC are solidly research-based and designed to validate the experiences of each survivor we help. TLC Founder Dr. William Steele talks about shifting victims to survivors and ultimately thrivers. While TLC offers many programs that honor the work we do with survivors, the website is full of personal stories and articles that are free to read. Do consider attending a workshop at one of the TLC assemblies, as the connection with other like-minded people is well worth the effort.

Barb Dorrington