What does trauma treatment look like with a child?

What does trauma treatment look like with a child?

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.


Pressuring a child to speak in therapy is not helpful, but nor is waiting for a child to ever mention what happened. Going with the child and opening up the conversation is helpful, and checking in with your child at home on a regular basis helps too.

When a child has been abused, some of the things we want to help them with are as follows:

  • regulate feelings, lots of mixed feelings and big feelings come up and need to be sorted out
  • feeling the painful emotions instead of keeping them all hidden inside
  • learn how to express feelings to loved ones, finding the words to use to talk about what happened, figuring out how to talk about it and learning how to have a voice is very important because often that voice has been silenced in abuse situations
  • decrease symptomatic behavior like withdrawing or acting out
  • desensitize the traumatic memories and also correct faulty beliefs about what happened
  • promote integration by helping them have a sense of cohesion in their thoughts, feelings and behavior
  • finding motivation to grow and succeed

John Bowlby said that people have to speak the unspeakable. Karp and Butler (1996) said:  “the child’s work is to gain the courage to go back to the frightening thoughts and images of the trauma and explore them in a safer environment when there is a better sense of control. The child must then gain the skills necessary to cope with what may be seen as a frightening world in which to grow up as a healthier adult.”

If children or adults are experiencing dissociation, we can help with that too:

  • Develop a language for dissociation: sometimes you go far away, what do you call it when you do that? Is that spacing out? Zoning out? Getting little? Going inside? Daydreaming?
  • Assess the use of the dissociative response, time of day, what’s going on before or right after?
  • Normalize it, explain that everyone can do this, how does it help them
  • Talk about the disadvantages, there’s time it’s not wise to do this, like during a school lesson, or riding a bike
  • Work on ways to intervene with unhelpful dissociation with the goal of heightening their ability to dissociate at will.
  • Establish a sequence of responding with dissociation, what happens behaviorally, physiologically, cognitively, affectively and sensory. Identify the earliest clue that it’s happening and this becomes the point of intervention.
  • Explore alternatives to flight, work on affect tolerance and modulation. Work on feeling parts of their bodies, knowing the boundaries of their physical and spiritual self, listen to heart beat, engage in physical activity, take snapshots, look in the mirror and describe what they see

Some of the books that are useful in trauma treatment, are the books by Chandra Gosh.

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.

Amazon Book

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.

Mama's Waves

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.

You Were'nt With Me
The effects of trauma

The effects of trauma

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.


The benefit of rebuilding is that now you can build something sturdier and better than before.

According to Crittenden there is a lot of work to be done in extracting learning information from the trauma. Do you think you’ve resolved your trauma? If you have, can you answer the following questions:

  • 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.


Trauma can remain unresolved. If it does, it could remain with you in these ways:

  • threatening information pervades mental processes, information is split, distorted, manipulated.
  • there is a preoccupation with the trauma or a refusal to acknowledge it. Preoccupation with trauma means that too much is taken forward. Everything in life is seen through the lens of the trauma. There is intense affective arousal and cognitive confusion.

I think of a time that a dear friend had died, and someone had asked me about my friend. I was happy for the opportunity to remember him and his influence on my life. But in the moment that I started to speak of him, I forgot where I was, I talked for a long time, and it was as if I was back reliving some moments with him. I because emotional, and later felt that I had overshared. This is just a small example of how the trauma can influence us if we haven’t processed it. In more extreme cases, it can lead to temporal confusion, confusion of person, erroneous placement of the self at the event, confusion around the causes or implications, overly simplified emotional responses, simplified reasoning about responsibility for the causes, irrational belief in the high probability of repetition of the event and hypervigilance.

  • there is dismissing trauma which means that we leave too much in the past. This can sound like someone being dry and unresponsive, dismissing the importance of the event, and leading to consequences in limiting feelings.

We could go as far as to omit the dangerous event, speak with extreme brevity about danger, have an absence of affect, make overt claims that the event had no importance to the self, believe that the self caused it or place the self as distant from the event.

Another very common response to unresolved trauma is called dissociation. When trauma produces dissociation, what do we do with this?

Do I really need to face my trauma?

Do I really need to face my trauma?

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.


You are going to find a way to make meaning about what happened, and you could easily make inaccurate meaning. This happens particularly to children, who don’t have the ability to think abstractly yet.

So, with trauma, very often there is either too much irrelevant information taken from the incident, or too much relevant information is lost. And this will lead to unresolved trauma. This means that the trauma will continue to affect the way that you do life. This lack of resolution increases the risk for psychopathology and means that the threatening event has not been integrated.  Imagine that you are walking down a road that is long and straight and can get you to a lovely destination

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.


Because you haven’t learnt as much as you can from what happened before. You don’t have the added skills from having to move that rock away, haven’t learnt to uncover your original path, or had to work your way back to it. There is learning that you are losing out on. Now you might be so scared of any rocks, that as you’re walking down the road, you are constantly scanning for rocks, and you’re scanning so hard for them that you end up missing the snake lying in the road right in front of you.

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.

What is Trauma and why does it affect some more than others?

What is Trauma and why does it affect some more than others?

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!


Van de Kolk 1987 refers to trauma involving “a debilitating loss of control”.

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.


So why are some people affected by things that others are not. The same experience can happen to 2 different people and one can end up with trauma and then other not. In the mental health field, we talk about risk factors and protective factors. So, if you add these up in different columns, it explains why an incident could cause 1 person to topple over, while another could keep on standing. Remember that human beings need a certain amount of stress in life to actually get anything done, this optimal amount of stress is called Eustress. If there is no stress, we’d lie around all day and not do a thing. On the other hand, too much stress is debilitating. And so much stress that it actually drains all of our resources and puts us at a deficit leads to trauma – we can lose ourselves, trust in ourselves, we feel like we have zero control to even protect ourselves. Unfortunately, once this has happened to you, it can then more easily happen in the future again too. Trauma begets trauma.

Take a look at this table from Eliana Gil’s book, and see what the factors are that influence the impact that a traumatic event could have on you:

Table: Individual characteristics that may influence whether the traumatic impact of a stressor is high or low


  • 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


  • Coping develops and grows
  • Coping strategies succeed
  • Internal resources available
  • External resources available
  • Expression is achieved
  • Symptoms decrease
  • Hopefulness increases
  • Personal control is restored
  • Existential crisis can be resolved
  • Trauma can be 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.


For caregivers you want to consider their past and current psychopathology and their trauma history.

For the caregiver-child relationship it depends on their relationship quality and their perception of child.

Trauma is an interesting phenomenon. There are scary things that happen in the world and the impact that they have on us affects us differently. Some people topple over, and others remain standing in the face of dangerous events. It depends on the tools and resources that we have, to cope with the incident and danger.