overcoming cumulative childhood

adversity

Friday MorningOctober 6, 2006

Northamerican Assn. of Masters in Psychology

Bruce Carruth, Ph.D., LCSW

San Miguel de Allende, GTO, Mexico

“Neurosis ……

is the process of shrinking our world to the point where we can manage”

Rollo May (I think)

children adapt to what they are given…… for better or worse

adaptation to cumulative adversity occurs over time, insidiously, purposefully and productively

goals for the workshopgrow professionally

*recognizing adaptive childhood trauma*better sense of the impact of trauma syndromes*enhance repertoire of therapeutic responses*appreciate awareness of therapist positioning*build new skills*appreciate need to address cognition, affect and self*understand role of resilience and how to tap it*recognizing the interpersonal impacts of trauma: trust, commitment, potency & attachment

and grow personally

* awareness of our own developmental traumas, * how developmental traumas lead to life’s dilemmas* more compassionate to our own self- wounds, self-acceptance & self esteem* more compassionate to the wounds of others

getting organized for the day

• work in groups of 4 – same group all day

• for each assignment, have one person act as recorder

• for each assignment, have one person act as time keeper

adverse conditions / environments in childhood physical, emotional and neurological deficits

parental dynamics

sibling dynamics & the family environment

the physical environment of the child

societal dynamics

compounding adversity

• adversity in one area of life tends to create or support adversity in other areas of life.

• developmental lags, created by adversity, tend to make it more difficult to achieve higher level developmental tasks, so the child gets further behind psychodevelopmentally

• adaptive coping tends to limit opportunities to self-correct the limitations

the adaptive stanceadversity requires that a child adopt an

adaptive stance to protect selfa broad, pervasive theme or pattern that is:…functional, purposeful and productive in childhood…becomes imbedded in the coping repertoire of the person

by late adolescence and young adulthood…is comprised of memories, emotions, cognitions, body

sensations, meta-beliefs, self-truths…continues to serve the person well in many ways…is resistant to change even when it is not working…and is usually integrally tied to the presenting symptom

when person presents in psychotherapy.

examples of adaptive character traits includes:

feeling repressed boundary confusedneedy and impulsive unloved and invisiblestubborn and obstinate dependent & helpless angry victim chronically dysthymic conning and manipulative woundedphobically anxious obsessively anxioussuspicious and mistrusting inadequate & indecisive love / acceptance seeking impression managersdefective / shamed alone & isolatedfailure angry & intolerant

the symptoms of cumulative adversity manifest through

all levels of life functioning and across the life span

* coping behaviors and interpersonal relationships* patterns of contact between self and the environment* perception, intuition, memories, cognitions based on life

experience* patterns of ego defense* affects: primary affects affective themes

* self functions the cognitive self character patterns core psychodynamic orientation

* soul

assignment• choose an adaptive stance (schema)• what are the positive aspects of that stance?• what are the life problems that arise from the stance• describe some of the coping behaviors, cognitions,

defenses and affects that accompany the stance• what are the aspects of the stance that would bring

you into therapy?• what is your greatest terror entering therapy?• how should the therapist position to be most helpful

to you entering therapy?

Question?

why is it some people who experience cumulative adversity as children are survivors, even thrivers, while others remain wounded & impaired?

• internal strengths (resilience) character traits that build resilience

• external (environmental) supports supports that make a difference

• corrective emotional experiences corrective experiences that can reshape the

cognitions, affects and self-wounds of

cumulative adversity

levels of personality impairment

• personality quirks

• personality traits

• ingrained personality patterns

• personality disorders

cumulative adversity through a trauma lens

1. Sub-clinical Trauma Syndromes 2. Cumulative Childhood Trauma3. Acute Stress Reaction: A psychophysiological

reaction to an overwhelming stimuli

4. Grief Reaction: An inability to experience the emotions of loss

5. Post-Traumatic Stress Disorder(s): A significant wound to an individual’s sense of self / personhood

6. Complex PTSD & Dissociative States: A pervasive and disabling injury to self that produces significant psychiatric complications

1. When people define their life by traumatic events

2. Rigid or inappropriate behaviors in the face of specific events or triggers

3. Ego defense, unconscious to the person, that clearly limits functioning

difficulty in receiving or giving feedback misrepresentations of the environment misperceptions of self and self-roles

recognizing trauma syndromes

Recognizing trauma syndromes (con’t)

4. Distorted affects

displaced / distorted / inappropriate affects

exaggerated affects

repressed affects

5. Psychiatric symptoms depression (sad, angry, nihilistic)

anxiety (fear, obsessiveness, withdrawal)

somatization (pain, sleep disorder, appetite)

Recognizing trauma syndromes (con’t)

6. Distorted reactions to life events that involve helplessness, vulnerability, constraint, power/control, shame

7. Distortions in relationships: Trust, commitment, potency, attachment

using a trauma treatment model for treating cumulative adversity

1. building safety (creating a holding environment) and

2. managing the presenting symptoms

3. exposing the wounded self & telling the tale and

4. grieving

5. emotional healing and

6. integrating history with present

childhood adversity is ultimately a wound to self

but adversity also manifests as a set of symptoms that interfere with day-to-day living

so, what are we treating?

Managing and treating the symptoms :(and how adversity manifests in the “now”) symptom management interpersonal struggles coping skills cognitions “reactive” affectsDoing “restorative” work that retrieves the trauma

and “works it through” core cognitions and schemas primary affects telling the tale and reorganizing the experience building healthy life and relationships

do you treat self or symptoms

• when do you focus on symptom containment / resolution?

• when do you focus on treating the self?

the treatment triangle for addressing cumulative adversity

cognitions (the schema)

affect (the emotional residue)

self-functions (the adaptive stance)