Tag: <span>PTSD</span>

TF-CBT Kalamazoo
Child Counseling Grief and Loss PTSD • • By Jeffrey LaPonsie 0 Comments

What is Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)?

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a widely used and effective therapy. TF-CBT helps children ages 3-18 years-old and their families who are struggling with the effects of trauma and Post Traumatic Stress Disorder (PTSD).  Multiple randomized clinical trials have prove TF-CBT’s effectiveness.  TF-CBT is a gold-standard treatment for addressing trauma in children.  The California Evidenced Based Clearinghouse for Child Welfare gives its highest rating for TF-CBT as an evidenced-based treatment for children impacted by trauma.  When children or adolescents have gone through trauma they may experience a combination of any of the following: intrusive thoughts, fear, anxiety, mistrust, depression, troubles with sleep, aggression, and various other symptoms.

Types of Trauma addressed by TF-CBT

Types of trauma commonly treated by TF-CBT include sexual abuse or assault, physical abuse, a sudden or traumatic death, violence at home or in the community, a natural or man-made disaster, a car accident, community violence and animal attacks.

What makes  it work?

There are two major components of TF-CBT that make it work: parent/caregiver involvement and a concept called gradual exposure. Parent/caregiver involvement can include meeting one-on-one with the therapist, or meeting at least a part of every session.  These meetings are intended to help therapists and parents be on the same page about current symptoms and parental concerns. This is also a wonderful time to educate parents about trauma and its impact on children.  It also can also be a good time address any of their child’s difficult behaviors, emotional outbursts, and safety concerns.

Gradual exposure includes intentional exploration of trauma reminders for the purpose of achieving desensitization to them. Gradual exposure begins with small intentional doses and is increased over time.  In TF-CBT, gradual exposure does not mean children need to immediately talk about what happened.  Humans don’t usually throw children in the deep end to teach them to swim.  To use the swimming analogy again, we get used to the temperature of the water before going under.  In the first sessions of TF-CBT, clients will receive education about common effects of the specific trauma they went through and by the end of treatment they will have created a narrative about what they went through and how they were impacted by it. The narrative, along with the other forms of gradual exposure, helps the child and family to reduce their avoidance and other PTSD symptoms.  There any many myths about PTSD and children, gradual exposure is an important part of PTSD treatment.

Steps of TF-CBT

First, children and adolescents will learn about trauma and how it commonly impacts people. They will learn relaxation skills to help them calm down when they are anxious, mad, etc. Next, kids will learn healthy ways to identify and express their feelings. Then, the child or adolescent will learn strategies to change negative or unhelpful thoughts to ones that are more positive, or helpful.  This is especially important for “stinking thinking” related to the traumatic event. Once children and teens gain confidence in these skills, they will move into creating a story about the trauma they experienced. The narrative will include some general information about the client, what happened before, during, and after the traumatic event(s), their feelings and thoughts surrounding the trauma, and what advice they would give to other kids like them. Once the narrative is completed, it is usually shared with the parent or caregiver in a conjoint session. Further sessions will address any triggers that may be inhibiting the child or adolescent, finding ways to overcome them, and increasing safety for the family as they move forward.

Kylie Bader and Jeff LaPonsie LMSW

Kylie Bader was an Intern from Western Michigan Univeristy’s School of Social Work.  Her graduate studies including trauma across the lifespan, and Trauma Focused Cognitive Behavioral Therapy.

jeff laponsie LMSW kalamazoo therapy

Jeff LaPonsie is a clinical social worker at Kalamazoo Child and Family Counseling, PLLC. He provides counseling to children and families in the Kalamazoo, Portage, Mattawan, and the South West Michigan area. He is passionate about helping challenging children and frustrated parents. Jeff has over seven years of experience working with at risk youth. His clinical expertise includes providing play therapy with children with behavioral, anxiety, attachment and trauma related disorders.

PTSD Child Counseling
Child Counseling PTSD • By Jeffrey LaPonsie 0 Comments

5 Myths about Childhood PTSD

For the longest time children were not thought to be able to develop post-traumatic stress disorder (PTSD).   The traumatic events traditionally thought to cause PTSD were not believed to happen to children.  There are many myths about how resilient they were or what made an event “traumatic.”  All of these things impacted how adults thought of children. Myths continue about how if a child were tougher or stronger they would not be bothered by something that has happened in the past, or that that they would have “gotten over it.”

Myth#1 – Children don’t get PTSD

The people who first researched and wrote about post-traumatic stress disorder studied the effects of war on soldiers. It was known that they were exposed to a potentially traumatic event. Children were thought to be are low risk for post-traumatic stress disorder because the most common traumatic events that children are exposed to take place in secrecy and sometimes in the context of a child’s family. Domestic violence, physical abuse, parental substance abuse, and sexual abuse happen most often in secrecy.
For example, sexual abuse, an experience that is unfortunately true for 1 in 10 children before their 18 birthday is incredibly difficult to ‘prove’ but has a tremendous impact on children. The secret nature of child sexual abuse means that many times adults in a child’s life are seeing the impact of a trauma on a child without knowing what may be fueling some behaviors. Of course, children are in car accidents, suffer traumatic losses, and are victims of other violent crimes and these children are at risk to develop PTSD or a traumatic stress response as well.

Myth #2 – It happened so long ago they don’t remember it.

A child’s reluctance to put words to what has happened is often misinterpreted by adults as their inability to remember. Avoidance is one of the hallmark features of PTSD. It is a common reaction for children to try not to think about or express feelings about what happened. Just because kids and teens don’t talk about what happened, or they say they don’t remember doesn’t mean they aren’t experiencing traumatic stress reactions.

Myth #3 – Children are resilient

So this myth isn’t completely wrong. Children have amazing abilities to grow and adapt. What we know about how children’s brain grow, and develop is that brains develop over time, and at certain stages of childhood grow rapidly. This rapid brain growth is wonderful for children who are safe from violence and well nutured.  Trauma has the unfortunate ability to disrupt normal child development. This traumatic stress is now known to effect brain development. Children who have experienced trauma are at higher risk for many mental health problems, like depression, anxiety and PTSD.

Myth #4 -After a while children just get over it.

The idea that children should just “get over” traumatic events shames children who can’t. Not everyone who experiences a traumatic event goes on to develop PTSD.  A traumatic event is a subjective experience, and a series of risk and protective factors impact whether or children do develop PTSD. Some times there are long delays between experiencing a traumatic event, and developing PTSD. Many factors go into determining whether a not a child goes on to develop PTSD. These include: how old they are when the traumatic happened, how long or severe was it, was the child believed and protected, what sort of traumatic event happened, and whether or not the trauma happened in the context of a caregiving relationship..

Myth #5 -You shouldn’t bring it up, or dig too much into the past.

It is normal for parents to want their child to forget about the terrible thing that happened. In fact for some parents that is their litmus test of whether or not a child has healed from a traumatic event. What we know is that children who experience a traumatic even, often remember it. It can be more alarming when children deny remembering anything at all. Although depending how old a child was when something happened, and how long ago it happened it would be very normal to not remember all or parts of it. Some children as part of their avoidance in talking about what happened will say they don’t remember it.
In counseling for childhood PTSD talking about what happened is part of the process of making meaning of what happened, to desensitizing a child to trauma reminders, and to challenge unhelp beliefs a child might have about what happen. The stress that children with unresolved trauma have is tremendous. It is often at the forefront of their mind, often fuels troublesome behaviors.

 

jeff laponsie LMSW kalamazoo

 

 

 

 

 

Jeff LaPonsie LMSW

Jeff LaPonsie is a clinical social worker at Kalamazoo Child and Family Counseling, PLLC. He provides counseling to children and families in the Kalamazoo, Portage, Mattawan, and South West Michigan area. He is passionate about helping challenging children and frustrated parents. Jeff has over seven years of experience working with at risk youth. His clinical expertise includes working with children with behavioral, anxiety, attachment and trauma related disorders.

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Post-traumatic stress disorder Kalamazoo Portage Child Counseling
Child Counseling PTSD • By Jeffrey LaPonsie 0 Comments

Post-Traumatic Stress Disorder and Children

Post-Traumatic Stress Disorder (PTSD) can develop after something scary, shocking, dangerous, and or life-threatening happens. Children who are exposed to violence, are victims of physical or sexual abuse, experience a medical trauma, a car crash, or experience a sudden and tragic loss are all vulnerable to develop symptoms of Post-Traumatic Stress Disorder.

Important things to remember about traumatic events

  1. A traumatic event can be anything where there is exposure to actual or threatened death, serious injury or sexual violence.
  2. It’s a child’s perception of an event that is important. The factual nature of their recollection of an event is not important.  Trauma is very subjective; one child may be in a bad car accident and never wish to be a passenger again.  While another child may be in the exact same car accident but get a car immediately afterwards and have no difficulty.
  3. Chronic or ongoing abuse or neglect is often referred to as complex trauma. Complex trauma impacts children differently than single or event-based traumas.  Complex trauma occurs in the context of a parent-child relationship and is often ongoing and unpredictable.  Children who have experienced complex trauma often have impacted development and cognition, and emotional and behavioral dysregulation. This article will discuss event-based or more single-incident post-traumatic stress disorder.

Symptoms of Post-Traumatic Stress Disorder in Children:

Re-experiencing in Post-Traumatic Stress Disorder

When a traumatic event happens a child’s ability to make sense of the event is overwhelmed. A child’s struggle to process a traumatic event can come out spontaneously in a child’s play.  For some children have repetitive or stuck play (think broken record) .  This often a repeating loop that reenacts parts of the traumatic event.  Other Children may think of or remember the event when they do not want to. They may describe the event as playing in their head like a movie, or that a certain picture or image is stuck in their head.

Some children have intrusive memories of the events that appear in their dreams, or nightmares. For some children with post-traumatic stress disorder the distressing dream or nightmare may not be related the traumatic event but the general theme is distressing, anxious or scary.

Previously non-threatening events, places, things, people can trigger anxiety in children who have experienced a trauma. For some children who have been in a car accident the next time they need to ride in a vehicle they may be distressed or worried.  Sometimes these are easy to spot, and other times not-so much.

Avoidance in children with Post-Traumatic Stress Disorder

Children who have experienced a traumatic event may avoid activities, places, or other reminders of the traumatic event. While this may not seem troublesome at first, avoidance often gets in the way of children and their families living their lives the way they would like.  For example a child who was in a bad car accident may find it difficult to ride the bus that takes them to school, causing them to be late, miss the bus or be anxious their entire trip to school.

Avoidance is difficult to help in children because it often alleviates stress and anxiety in the moment for a child.  When a child is successful in avoiding getting in the car, the stress that they had in anticipation of getting in the car is relieved.  This doesn’t make them more capable of tolerating stress or desensitize them to the car—it just teaches them that avoiding works.

Symptoms of hyperarousal, and reactivity in children with Post-Traumatic Stress Disorder

When something terrible or tragic happens in a child’s life their perception of the world as a safe place changes. For some children the awareness that the world can be dangerous leads to being constantly on the lookout, or hypervigilant.   Sleep problems and exaggerated startled responses (think jumping to loud noises) are also common. Trouble concentrating or  mood problems like having  irritable behavioral or angry outburst are also common in children with post-traumatic stress disorder but are often mistake for ADHD or other mental health disorders.

While this is not an exhaustive lists of what or how children with PTSD may act or behave—it’s a good start to thinking about how a child who has experienced or witnessed something traumatic may be responding.   For many children with PTSD, Trauma-Focused Cognitive behavioral Therapy is an effective, evidenced-based treatment that is proven to be effective.

jeff laponsie LMSW kalamazoo

 

 

 

 

 

Jeff LaPonsie LMSW

Jeff LaPonsie is a clinical social worker at Kalamazoo Child and Family Counseling, PLLC. He provides counseling to children and families in the Kalamazoo, Portage, South West Michigan area. He is passionate about helping challenging children and frustrated parents. Jeff has over seven years of experience working with at risk youth. His clinical expertise includes working with children with behavioral, anxiety, attachment and trauma related disorders.

Read more