CHAPTER 5: INTO THE NEW MILLENNIUM:
CHILD ADVOCACY AND EMDR
Dr Scott Borrelli
2002
"Life breaks you, and you get stronger in the broken places."
Hemingway, from 'The Sun Also Rises'
Children are precious; children are innocent. These are my firmly held convictions,
even when face-to-face with a distraught family's anger and confusion typically
directed at the child. This is not a romantic notion, but an ever more necessary
one to counteract the inevitable blaming of the victim, of those without power,
which can include the elderly, the disabled, and cultural and sexual minorities.
Because children hold the future of a wayward earth in the palms of their still
developing hands, we must learn to provide better nurturing environments.
This Borrelli Chapter serves as more of a position paper on the rights of the
child. It is a call not to replace, displace or transfer blame, but to extend
the responsibilities of adults in society, especially parents and family therapists.
Secondarily, a brief case vignette celebrates the demonstrated ability of EMDR
to care well and proactively for our children, and for our futures.
THE HURT CHILD’S POTENTIAL:
A child’s insight into the significance of traumatic events is blurred by
a mosaic of coping and defensive manoeuvres to help keep fears of obliteration
at bay. Painful realities of abuse are submerged beneath loyalties and the needs
for security and survival. This protective layer of adaptive defence lends clear
testimony to the natural and superb ability of each of us to survive under almost
any conditions. However, based on the degree of psychological injury, a child’s
quality of life can, never the less, be severely hampered by adaptive choices
based primarily on survival. Insight into the workings and meanings of trauma
can illuminate a life. Emotional processing can highlight a person's strengths,
free-up adaptive energy, and make even more suitable change possible. The promise
of EMDR is it's flexible applicability to persons of all ages and backgrounds,
it's assumption that innate potential for healing exists in all of us, and it's
guiding force toward the empowerment of the individual toward positive change.
EMDR, in theory and in practice, is nearly perfect for a world that tends to divide
the haves (i.e., adults as perpetrators) from the have nots (i.e., children as
victims). By equalising emotional opportunity, EMDR’s multi-modal approach
can touch us all.
Trauma history is an insidious and always significant phenomenon, manifesting
itself through an infinite array of behaviours, self- and world concepts, and
sometimes fantastic attempts at the management of stress. Trauma history impacts
all aspects of human development and organisation. Children, less (i.e., "differently")
able both cognitively and expressively to understand and communicate their confusion,
are more likely to "act-out" their pain. This holds true for the family
as a system, and each uniquely adjusted member. Degrees of "acting-out"
depend greatly on the family context, severity of abuse, age and developmental
stage of the child. Unfortunately, the younger and more vulnerable a child is,
the more dependent they are on the parent. In a reciprocal fashion, the greater
the parental abuse, the greater the dependency. Such is a life. Although the commonly
seen "attachment disorders" which induce acting-out, detachment, and
arrogance in abused children only seem to worsen their plight. The degree of these
behaviours is almost always in direct proportion to the need for healthy attachment
and progressive development.
TREATMENT PLANNING:
When planning treatment for a child, we must assess carefully the developmental
issues (internal press) that seem to be ascendant at different life stages, the
context (external press) in which these issues are being accomplished and probably
frustrated, and secondary gains issues. Especially for a child, the risks of change
must be prepared for. Family therapy theories remind us that as the child improves,
the status quo of the family "crisis" will also need to adapt. We’re
all aware of the obvious and subtle resistances to change offered by family members.
all of whom might be vying for survival guarantees. A sensitive assessment of
the family context, then, is an essential aspect of the treatment process. Which
family members are most likely to be allies in the quest for change, and who are
the most at risk, and likely to challenge positive changes?
The perceptive clinician can uncover aspects of both obvious and subtle trauma
history, the latter being displayed in the family's current attitudes toward the
child as the 'identified patient'. Either the family environment illuminates the
developmental path, or it darkens it, leaving the child 'off-track' and still
actively searching for the light. Trauma history coupled with covert perceptions
held by adults about the 'bad' child are likely to exaggerate and/or distort normal
developmental tasks and related stresses. In all cases, traumatised children strive
toward healthy adjustment, setting into motion the most creative collections of
coping manoeuvres to help insure that the process continues, no matter what. Identification
of these manoeuvres and their sources present a great challenge.
APPLYING EMDR:
The application of EMDR work with children offers a stimulating therapeutic experience.
The emphasis here on 'stimulating' refers to the child clinician’s efforts
to keep the therapy sessions both interesting (for child AND therapist) and progressive.
More than a few times, I used to sit and wonder what to talk about next, not always
looking forward with enthusiasm to the next game or activity that might bring
about some therapeutic resolve! Although structured 'enough', EMDR allows considerable
tailoring to the individual child, works more quickly than traditional 'play therapy'
in my experience, and engenders a dynamic therapeutic relationship. Perhaps most
importantly, EMDR has generated results which convince the beleaguered family
and therapist that there is light at the end of a now shorter tunnel.
CASE VIGNETTE: Jimmy, Age 10:
The story of Jimmy is such a story, demonstrating the impact and particular expressions
of trauma history in the present, even when the history is only ten years old.
Through his eyes, I could appreciate the importance of removing obstacles that
were obscuring meaningful attachment and development, capitalising on his zealous
and intrinsic press to grow healthfully, and to attach meaningfully, no matter
what.
Jimmy had recently arrived from America to the United Kingdom to live for the
first time with his father and father's new family, which now included four additional
children whom he had never met. Jimmy's original mother, living with a severely
critical and probably abusive boyfriend, sent Jimmy to his father admitting she
was no longer capable of managing his misconduct. I am sure she was right, and
it was probably better for Jimmy to leave. However, one can only imagine the extreme
abandonment issues generated by this move, compounded with an abuse history, and
the original loss of his natural father.
The latest of a variety of recent distress signals in his 'new' home, and which
finally landed Jimmy in my office, was 'play-acting' a dramatic hanging scene
during school lunch-time. The horrifying scene was brilliantly staged to be 'realistic.
The alarm was sounded by school officials where he was already gaining the reputation
of being 'odd and aggressive', and decidedly precocious in his sexual behavior.
Suicide gesturing in a child is the quintessential signal of a society that is
failing at it's most essential obligation to nurture and protect the young. We
seem to be witnessing all too many forms of rage in our children today, which
more often is directed toward the child-self. .
An incomplete history suggested that his mother's staunchly Christian environment
was punctuated by a variety of excesses and boundary violations, alcohol and drugs,
and physical abuse. His natural father suspected that he had been sexually abused
by mother’s boyfriend and, perhaps, baby-sitters. Jimmy was often left on
his own to make sense out of serious inconsistencies, in a home replete with mixed
messages. Ever more extreme attempts to gain attention and mastery while also
managing symptoms of an anxious depression existed within a training ground for
conduct disorder and potential personality disorder, especially sociopathy. Importantly,
further self-abuse and even suicide potential would need to be monitored closely
and periodically re-evaluated. He had already been expelled form his school back
at "home", and was at a similar risk at his new school. He was becoming
increasingly regarded as odd, and peers were detaching themselves from him.
Jimmy's new family, although more stable, also represented the stress of change
that modern families now undergo as a matter of fact - divorce, reconstitution,
reorganisation, step and half-family members. Where histories and, therefore,
traditions are entangled, competing, not easily shared, or even known. Raising
children is tough enough. Factor in differences in behavior that are genetically
derived (i.e., children with different mothers and fathers), competing varieties
of conflicting parent figures and family cultures, and a society which is increasingly
emotionally isolating in its preference for speed and technological advance. We
must empathise with all members of these post-modern families. The acknowledgement
and education of families and their predicaments has become an essential aspect
of the treatment objective.
Jimmy was introduced into a family in which he was relatively unknown, justifiably
resented by a busy stepmother and displaced step siblings, and his father who
barely knew him. Jimmy was no longer the oldest child (which gave him some sense
of control), that role transferred to his younger sister who remained behind with
his mother. Family assessment sessions revealed a marriage already strained by
different approaches to parenting, and a stepmother exclaiming that she "did
not need another child", and was mistrustful of Ben's (sexual) influence
on her own children. I attempted to allay stepmother's fears that Ben might abuse
the younger children, and emphasised that he should not be perceived as the (potential)
perpetrator but, more likely, a victim of various abuses and losses. His current
family, I explained, was not at risk as long as there were cautious but clear
attempts to trust him within reasonable boundaries. I explained that we must not
reinforce Ben's probable negative self-perception as a defective, unwanted, or
dangerous figure, and that the best way to begin the healing process was to provide
a safe and validating family environment with clear structure and behavioural
consequences. I had studied my behavior modifications rules well!
Developmental issues for the average ten-year old boy include the maturation of
initiative and mastery, providing a sound foundation for the inevitable identity
search that will follow in early adolescence. Obvious issues of rejection and
abandonment, on the heels of what had been a family history of conflict, instability,
and neglect/abuse, have increased Jimmy's need to stand-out and be seen and heard,
mostly to convince himself that he mattered. However, acting-out behaviors for
attention only resulted in the further realisation of his worst fears, including
mother's abandonment. Defensive behaviours promised to reach new levels of seriousness
and desperation as he grew into adolescence. A fairly stable new family promised
brighter possibilities, and there was now more hope for Ben’s rescue. Stress
trauma, however, was certainly being aggravated by the adjustment stress of the
move.
Once the family assessment sessions were complete, along with the gathering of
relevant history, EMDR treatment could begin. Jimmy was a charming, handsome,
articulate, and communicative young boy, eager to be listened to. During the individual
EMDR preparation session, Jimmy eloquently described the construction of an elaborate
fantasy world of safety and power, as 'king of his castle'. Clearly, he was attempting
to create a safe world in which he could proceed through the necessary developmental
tasks in spite of his fears. Although these fantasies had taken on some power
of reality to ensure psychic survival, it would be a grave mistake to pass them
off as primarily delusional and pathologic. Kids can look crazy when they are
only attempting to cope, and because their faculties for coping cannot match the
sophistication (and subtleties) of the developed adult. In keeping with the belief
in the healthy potential in each of us, I displayed a lively interest in his imaginary
'home', its protective guards and servants where he could rule all, encouraging
him to introduce them to me through drawings and dreams, and in an environment
of safety and validation. His wish to maintain excessive control over his environment
was in clear proportion to his experience of little control. I openly applauded
his imagination and coping genius, with my initial task being to clearly communicate
genuine respect and interest. Once hurt and loss could be processed openly, his
genius could certainly progress from gasps of hope, to full breaths of coping
achievement. Although I knew he trusted no one, I hoped to encourage an appreciation
in his survival style, and trust in his ability, desire, and need to trust someone.
This sensitive bond required patience and time, and I communicated these therapeutic
necessities to his parents. I emphasised (at some risk) the great potential for
recovery demonstrated by resilient and bright children like Jimmy. His identification
with the aggressor(s) could be transformed into an appreciation for pain and the
'real' power which it can generate. I made a promise to listen and understand
him as best I could. Often kids don’t want much more than that.
After proposing the treatment and receiving permission to use EMDR by Jimmy's
well-meaning father, I reinforced the safe place that Jimmy had already constructed
(and which had been considered 'pathological' by a previous therapist) - his castle.
A clinician's typecasting of a child's behavior as psychopathological can have
the same dangerous impact as a family's conclusion that the misbehaving child
is 'bad' or even 'evil'. In some cases, it's simply a substitution of 'crazy'
for 'evil', both implying that the child is fundamentally damaged. The EMDR therapist
is in a strong position to reject such explicit or implied labelling. Children's
fantasies are still often a healthy place for retreat and regrouping when under
stress from the outside, and a fantastic 'place' is no longer so crazy once the
child feels safe enough to invite you in, a real visitor. Since this was the first
time that anyone took any real interest in Jimmy's fantasy life, it all began
to make a great deal of sense. Of course, the EMDR treatment and additional therapeutic
supports would make it more enticing for Jimmy to come out and play in the real
world, and with real and caring people..
I gave Jimmy the option of eye movements, bilateral audio-stimulation as offered
by the CD works of David Grand, or use of the Theratapper, which produces alternating
stimulation to the hands. He chose the Theratapper for the session, and the 'safe
place' was successfully installed. I have found the Theratapper to be a favourite
choice of children his age, offering felt, kinaesthetic stimulation, especially
powerful for the concrete operational child. They enjoy setting the intensity
and pulse-rate controls.
EMDR: SESSION ONE
The Initial Memory: leaving his mother six-months earlier, to go live with his
father and stepmother "indefinitely", and in a new country.
The Image: stepping into the plane and saying goodbye to mother.
The Negative Cognition: I will never see my mother again, because I am a bad child.
SUDS: 10. (This was reduced to 1 after the first session).
The Feelings: fear and anxiety.
The Physical Pain: 'butterflies' in the stomach and overall tension.
The Positive Cognition: I can be happy with my father.
The VoC: 2. (This was increased to 6/7 after the first session).
The first session worked dramatically well to neutralise Jimmy’s sadness
and bereavement regarding his unexpected departure from home in later sessions.
Jimmy's fear of the future with his father and stepfamily was subsequently reduced
in the next two sessions. The strength of self which already resided deep within
him was drawn further out as he realised the value of his coping strengths and
options. He could be proud of his coping accomplishments, having survived a clearly
dangerous home life. He was aware of the ways in which he had necessarily become
extremely pseudo-independent while living with his neglectful mother and her abusive
boyfriend. He began to appreciate the safety that his new home offered, and acknowledged
a desire to let go of the more dramatic attempts to get what he thought he needed
(i.e., negative attention), and became more willing to believe that he could get
more of what he really needed and deserved, (i.e., security and nurturance). He
could, in good time, become a child again, and the strategies he had learned to
survive in difficult situations could always be updated, revised and called upon
to manage future stress. He was no longer the 'damaged' child that he and others
imagined, but replaced his self-perception with one of strength and creativity.
He was becoming a child who had both the experiences and the ability to transform
neglect and injury into constructive and self-enhancing choices. He could more
easily step back onto the moving track of natural childhood development.
FURTHER THOUGHTS:
I want to emphasise that Jimmy's case was unique in terms of his above average
intellect, readiness, and the willingness to join in the therapy with the therapist,
regardless of his history of disappointment in relationships. Although his normal
developmental blue print had been permanently altered through his early and recurrent
abuse, many of these disquieting experiences could now be heralded as forces of
strength and opportunity. He was now better able to proceed through the built-in
tasks of growing up in a more healthy way.
As Jimmy practiced lending his trust to me, he was beginning to further trust
himself , along with his father, his step-mother, his new family and step-siblings,
and perhaps the world at large. After a total of six EMDR sessions, his school
behavior improved, and his teachers were writing positive comments on later report
cards. The work of understanding his natural mother, her neglect and eventual
abandonment, would take more time, and more EMDR sessions. In times of stress,
these experiences would most probably be the biggest hurdle. His new family, however,
saw Jimmy in a brand new light, and he was quickly becoming a family star.
©2002 The EMDR Practitioner - All
Rights Reserved Worldwide