An urgency for trauma recovery focused professionals

It’s adoption week, which seems a good time to think about the challenges and privilege of parenting.

Parenting is hard!

All parents need support and all of us parents find the task and honour of raising children has significant ups and downs alongside frequent feelings of exhaustion and confusion!

I often mention both in my own role as a mum of four and in my work life as psychotherapist, that I think that each child should be born with a handbook that pops out after the placenta which specifies what kind of personality the child has, how sensitive they are, how creative they will be, what their primary interest will be and therefore what would be the best use of extra curriculum money and time and what skill will be ignored in adulthood! Sadly this doesn’t happen and so we all try our best and sometimes misread and misunderstand our kids as we get to know them as they develop their own unique personality and opinions!

Some children have lives which are simple and they seem to enjoy everything and flourish in pre school, school and hobbies. Some find things challenging and we spend hours and days wrestling with the questions of why they struggle to play with others, eat at mealtimes, toilet train at the right time or read and write. As parents we seem to often struggle with guilt that we may be missing something or that there is a reason for our child to be struggling in some ways. Many of us will experience anxiety as we drop off our child at pre school, their first sleepover or at their new friend’s house. It’s not an easy, or simple ride for most of us, but a journey full of surprises and learning as we go along.

When children have hard times

When children have been experienced challenges along the way, we know that there is an impact. It could be a school move, house moves, being bullied or teased, not flourishing in a sport or other passion, and we need to call on all our resources to navigate them through these experiences with minimal negative impact and even possibly increased internal strength, self-awareness and knowledge.

When we adopt children, we know they have been through many challenges. Often they have been through far too many challenges that no baby or child should have to experience, whether that is pre-birth womb anxiety or early childhood turmoil that led to the need for adoption. We know that these challenges, or traumas have had an impact on them and we hope that our love, kindness, nurture and practical provision will heal these internal wounds.

Neuroscience is now giving us evidence that the impact of these challenges and traumas is complex and due to the fact that the turmoil that they often experiences was pre-verbal, there are usually no words for them to use to express the feelings that always accompany trauma. This means that their behaviour becomes the primary source of communication, rather than words, and this can often be misunderstood as naughtiness.

Current support for adoptive parents

I had assumed that all adoptive parents were given the information and knowledge that I love to give to those who come to my Introduction to Trauma training days and read my books. I have certainly worked with some fabulous adoptive parents who have been given training, have been given books and have been supported along the way as they parent their children.

I have a celebrity friend however, who has not had this support. She adopted two children and gave them everything that she could to enable them to experience a positive and healthy family life. In the journey of parenting she has not been given training on the impact of trauma, book recommendations or resources to support her in parenting but instead has seems to have had professionals judge, make assumptions, misunderstand and shame her. I have been shocked by the responses of professionals to her asking for advice when her adoptive children displayed behaviour that began to show that their pre-verbal trauma was beginning to impact them during adolescence.  Professionals appear to have made shocking assumptions of her parenting, which by all standards, was very loving, including popular methods of discipline like using the naughty step to reflect on behaviour. She was surprised by how these methods were not hugely effective and sometimes seemed to be like adding fuel to a match and yet not one professional explained to her the impact of trauma and the need to have specific parenting approaches.

Sadly in this case, and others I have heard of, the children were taken away from their adoptive parents on a spiral of misunderstanding and/or miscommunication, too little time to really get to know the parent to find out what is going on and too little time and resources to train, equip and educate adoptive parents on the impact of trauma and the complexity of pre-verbal trauma. I have also found that if professionals aren’t specifically trained on how to work with trauma there can often be reactionary assumptions made and poor support given to the family to navigate the situation together.

The impact of this specific fast moving situation with a celebrity adoptive parent who just asked for help from professionals, whose responses then demonstrated misunderstanding and judgement, led to this parent becoming anxious, the children becoming anxious and therefore escalating trauma symptoms.

From an outside observer, it is obvious that these trauma symptoms were not caused by parenting behaviours such as encouraging the children to eat healthy food and being told to be on the naughty step when they were presenting with challenging behaviour, but were due to subconscious traumatic memories that were bubbling to the surface due to both adolescence, the sudden presence of professionals in the house asking questions and the subsequent sudden anxiety in the home.

Now we have a loving mother who has to watch her children living in foster homes where there doesn’t seem to be enough food, the lack of attention to detail is breaking her heart and her kids are becoming increasingly unhealthy. She is powerless to help and yet is reading and learning about the impact of trauma so that she can repair the trauma that has been caused by this horrific situation as well as the original trauma that the children had before they were adopted.

We need to resource adoptive parents

We need to provide trauma training for all adoptive parents (and professionals) and we then need to ensure that they are supported in a non-judgemental, non-shaming way that assumes that they are trying their best, just like the rest of us. We cannot stand by and let more families be split apart from lack of knowledge and then professionals lack of empathy and perception.

I am now committed to offering more free training places on my courses to adoptive parents who haven’t had any other training in the impact of trauma and attachment.

 

Betsy de Thierry. MA. Psychotherapy and counselling; B.Ed (hons) Dip couns; PG.Dip Play Therapy; Dip Life coaching; MBACP.

Author of books on trauma: A Simple Guide to Child Trauma; Teaching the Child on the Trauma Continuum.

Director of Trauma Recovery Centre UK

Director of BdT Ltd Training and Consultancy

 

 

 

 

An intern speaks!

Trauma happens when a person feels a sense of terror and powerlessness. This is something I wasn’t aware of until I began interning at the Trauma Recovery Centre. Having attended training days and read more on the topic of trauma, I now understand more about the trauma continuum and the neurology of trauma. However, what I’ve learnt most during my internship at the TRC is about how vital trauma recovery focused interventions are: that, contrary to popular belief, it’s not about management, but recovery.

Trauma recovery happens through an empathetic, stable, and emotionally healthy relationship. Relationships take time and in a world of instant gratification epitomised by next-day delivery and on demand TV, that’s not something people generally want to hear. They want a quick-fix, an instant healer. But what I’ve learnt as an intern, getting glimpses of the interactions between therapists and their clients, parent support workers and the parent and carers, is that relationships are powerful. It makes sense that what was ruptured in relationship must be healed in relationship.

Through my internship, however, I have also become increasingly aware that many professionals – clinicians, teachers, police, and more – still don’t recognise trauma and how it can affect a child or young person. They don’t realise that the pre-frontal cortex (the part of the brain responsible for reasoning and rational thinking) and the Broca’s area (responsible for speech) go offline when a threat response is triggered, meaning a traumatised child or young person can struggle to speak or explain how they feel or why they acted a certain way. The threat response can result in a child fighting, fleeing, or freezing, and thus exhibiting what adults can see as negative behaviours. This lack of understanding can lead to misdiagnosis or a child being labelled as ‘naughty’ or worse. As a receptionist making drinks for clients and saying a friendly hello when they arrive, I get to see the impact the TRC has. It’s sad to think that without the work of the TRC these children and young people, parents and carers, would get lost in the system and not get the help they need.

When compiling grant applications, I often use a sentence Betsy wrote: “There is clear evidence that therapy can change the trajectory of a child’s life.” Not only do I get to see this evidence in statistics when writing grant applications, but I see it every day in the work the TRC carries out. It’s beautiful to see clients go from shy, sad children to ones that bounce in the door chattering away, knowing they are in a safe place and in safe hands.

 

written by Beth Palmer May 2018

Understanding the impact of trauma on children

How does trauma affect behaviour, relationships, learning, thinking, feeling and doing?

 Trauma impacts relationships because when someone they know has hurt them, either on purpose or because they were nearby when an awful thing happened such as abuse or violence. The child is left with questions and confusions around trust. When a child is around events or relationships that make them feel scared, they can end up not being sure who to trust and feel confused about how to relate to adults or other chidren and this can lead to other problems like loneliness or isolation or bullying or worse still, being exploited.

Trauma impacts the childs emotions because they don’t have enough internal ‘space’ to hold all the negative feelings that they feel. They don’t know what to do with these feelings and they end up ‘leaking’ their feelings by behaving in ways that even disappoint them at first. This negative behaviour, which is actually a way of communicating that they need help, often causes them to get labeled as defiant, bad or naughty and then they often get treated as if they are naughty or bad. This can makes them feel bad inside and rejected and worthless. They can lose the ability to see their gifts or talents and just see themselves as others see them because of their behaviour.
The feelings of low self esteem can lead to feelings of depression or anxiety. A child may end up trying so hard to prove that they are good and worth loving that they become perfectionists or they may just act up to the label and get naughtier and naughtier.

As they get older they could end up self harming or engaging in dangerous activities to take risks because they feel so numb and sad inside. Drugs and alcohol can be tempting because they give highs and or numb the internal pain. The world can be too scary and rejecting so a world full of drink and drugs can be more tolerable but actually, of course, leads to further complications. They can often hide their vulnerability by acting angry or tough or like they don’t care. But they do. It’s just another way of protecting themselves because they are so used to be being rejected and mistreated, so they can rarely trust someone enough to show them how scared or sad they feel. Gangs could be appealing as a place to belong with others who act tough as they can have a sense of community.

It can be hard to get out a cycle of trauma because once its happened, the emotional response can be so strong that unless adults help the child, they can behave in ways that then lead to other behaviours that further impact on relationships, learning, self esteem, and an understanding of the world and future decisions. They could ‘act out’ which is visible to the adults or ‘act in’ where feelings of sadness build up and internal coping mechanisms form and become habitual.

Children and young people are dependent on adults understanding this and offering skilled and effective support to enable them to break the trauma cycle and process their strong feelings.

It is recognised that ‘trauma is perhaps the most avoided, ignored, belittled, denied, misunderstood, and untreated cause of human suffering’ (Levine & Kline, 2007, p.3). Yet there is now evidence that shows us that unprocessed trauma can lead to increased mental health difficulties during adulthood and a host of social problems, such as drug use, school failure, anti- social behaviour etc. It can also lead to other problems, such as post-traumatic stress disorder (PTSD), conduct disorders, and dissociative disorders, and unprocessed trauma can also lead to medical challenges, such as asthma and heart disease (Perry & Szalavitz, 2011).

When trauma is processed in the context of a warm and genuine relationship, the impact is minimalised if not altogether transformed into greater resilience, thus changing the impact on the child and their future.

Anyone who has experienced trauma can be triggered by anything that is linked in their subconscious to their trauma experience, and this can cause a threat response (when the lower, reptilian brain sends an alarm reaction to the emotion brain and thinking goes ‘off line) as if there is a real risk of danger or death. Common triggers are sensory related, for example sounds, sights, feelings and smells, or thoughts such as ‘you’re going to reject me’. In a school setting, a child who responds with a brainstem, survival response, by kicking, screaming, running or hiding, would often be expected to immediately discuss the reasons for their behaviour with a teacher. However, the usual cognitive abilities of the child would not be available due to the overwhelming response of the brainstem; their thinking, cognitive, intelligent, rational brain response is ‘off line’, as is their ability to access speech and language.

When adults understand that a child is unable to respond with rational, mature thinking from their thinking brain (pre-frontal cortex) because their brain is still pumping chemicals that are responding to the threat, then that adult can respond with greater patience and empathy, which in turn helps a child feel safer and recover faster. When children feel calm and safe, they can focus their energy on learning. Children who are dealing with trauma are often in a chronic state of crisis and fear, and can be in a continual state of threat response; their focus is on trying to feel ‘OK’ or normal not on learning information that seems irrelevant to survival.

Trauma impacts a person’s behaviour, emotions, relationships and future.

A story of personal trauma facilitating positive growth, despite the heartache

This blog follows from a  previous one on this site called ‘The day I cried non stop’..

I am blessed to have several wise and experienced clinical and organizational supervisors who support me in the role of Director of a growing charity for traumatised families. They help me with both the emotional challenge of supporting vulnerable families and all the consequences of that and also the structural developments and changes that are ongoing.

In one session with a supervisor, I was exploring the irony of the traumatic four years of harassment and stalking that I have experienced since starting the charity, which has led to relocating our family of six to a new area and working with the police since the arrest of my stalker and the bail period of 8 months.

Throughout my profession and the professions of my supervisors we all live with the stark reality of the rarity of prosecution in most criminal cases. We work with many families who have, for example, clear evidence of sexual abuse or assault who have never had the relief of even having their cases being reviewed by CPS let alone the victory of any prosecution. It is known that few abuse cases are reported, fewer still are investigated and even fewer are taken to trial. In stalking cases, approximately 5% of cases are reviewed by CPS and only 1% of those end up in court, out of over 2 million cases being reported. The statistics will be revealed this weekend in The Independent Newspaper (Easter Sunday 2015).

My case was rejected by CPS on the basis that the worst of the criminal behaviour of my stalker was in 2011 before the change in stalking law at the end of 2012 and the awful events is also deemed as ‘historical’ as evidence needs to be within 6 months of the incidents. This is an example of the law that obviously needs changing. I also believe that there needs to be a radical transformation in understanding of this growing crime. We have seen over the last 20 or so years a growing understanding of the impact of sexual abuse and an awareness of the complexities of the court system in these cases. More recently there has been a growing awareness of the impact of human trafficking and laws are changing to reflect that. Soon the impact and trauma of stalking and especially continual cyber stalking and harassment will be understood and the laws will continue to change to reflect it.

It was important to go to the police, despite the incompetence of the law as too many other women had been hurt by this stalker and as women we need to join together for our voice to be heard and to work towards justice.

Why do I feel peaceful about CPS not taking the case despite the 8 months of intense investigation?To answer that I will answer the question one of my supervisors asked me; ‘If your stalker and his group had not continually harassed you what would you have done over the last four years?’

My answer was that I would have run a small charity and made sure things were simple and easy! Instead I had to keep expanding and developing and making sure that everything we did was excellent because when you are facing utmost challenge you either shrink back or press on. Standing still is not an option.

We would NOT have moved to the most idyllic house and place on earth. We had to move to escape the awful atmosphere of slander amongst this small group of people in Bath but as a family we have never been happier commuting in to work and living a ‘normal’ life at home.

I would NOT have taken our four children out of their schools and risked new schools and new friendships but their new schools far exceed any school experience they had in Bath and they are the happiest they have ever been.

I would NOT have developed the TRC to include twice as many clients as in 2011 as it’s easier to stay small and comfortable but expanding was necessary as I know what living with trauma is like and I have found an answer so we need to help as many families as we can.

I would NOT have expanded to include the project Oakside Education Centre as although I have always wanted to facilitate an answer for these most troubled students to feel safe and recover, I would have avoided the extra responsibility had it not been for the fact that I needed to keep expanding to avoid running away.

I would NOT have agreed to speak in many different places such as the House of Lords and many schools and trainings centres, as I would rather be with my own children in the comfort of my own home. But I needed to keep meeting new people to remember how small the group of stalkers really is.

I would NOT have written a ‘parenting the traumatised child course’ as we would have made do with the parenting course we were using but I needed to make sure we were the best we could be.

I would NOT have written another book about trauma as it takes commitment and time to write a book but I needed to help the schools that are supporting the traumatised children and it may help in Bath to have my name associated with other things other than the gossip and slander and lies that I would hear from this small group.

I would NOT have started another centre in Bristol as that also takes time and commitment alongside courage for the extra funding required. It’s a big responsibility to take on extra clients and ensure that we are consistently excellent in our practice. But I needed to extend beyond Bath, the city where the birthing of the charity had been so painful.

I would NOT have become a trustee for another trauma charity as that requires extra work and travel, but does enable me to see more children helped on a national basis.

I would NOT have written a course that equips people to effectively help traumatised people as it takes effort to work out the core components, but its been proved to be effective and will enable 1000’s of other children to get intelligent support that brings recovery.

I would NOT have met the most amazing people in our new community who we now do life with had we not been forced to leave Bath. I adore these new families and feel so blessed to have them in my life.

I could go on but the point is that despite the heartache of having to live with the confusion of knowing that a very, very small minority of those who I thought I was helping have turned on me and chosen to support my stalker with lies and slander, I feel that this has been yet another season of pain where the manure has brought significant growth for others and for our family. The turmoil of discovering new slander and new impact of that slander is almost unbearable at times but despite this, there is a principle that all things can work together for our good and I personally believe that the manure that is thrown at us can be transformed into an opportunity. I have to say that this has been the case here. This doesn’t devalue the pain and turmoil that I have experienced but merely expresses a decision to use the pain to motivate more positive growth…

I am still left with enormous pain and heartache but my healing will come as it has done for my children since leaving Bath. Our staff and leaders who ache too will know freedom as we see so many other families come into new freedom. The key principle in reframing my experience is forgiveness and I forgive those who seek to harm me. I also know that the bitterness that fuels them will be difficult to live with and I hope that they will someday see the light and seek to move on themselves. Meanwhile I choose to focus on the work that I have been given to do and my precious family who now know more freedom themselves and will seek to see the justice system change for all who need protection.

Helping your child through a crisis

How to help your child in a crisis

It’s tough being a parent sometimes isn’t it? It’s especially tough when we want to protect our children from the harshness of some of the things that happen in the world that we live in. We don’t want their innocence lost when there is tragedy and heartache. Here are some thoughts to help you as you lead your child through…

So how can we help children through difficult tragedies?

It’s important that we don’t forget that children aren’t just mini adults who can digest and process verbal information like we can but they also listen and hear way more than we would like to think is possible and process it slowly and often get the complete wrong end of the stick.

So how do we help them? How do we avoid them becoming traumatised by what happened? How do we cope with their emotions? How do we manage our own emotions around them?

Some Do’s:

• Be as normal as possible and stick to routines to help them feel safe.
• Do recognize the children’s non verbal responses to traumatic experiences, such as being clingy or irritable or anxious or fighting more as a natural response to trauma and say something like, ‘I can see that you seem to be a bit clingy/irritable/worried/quieter/cross and I wonder if you need some time to chat/ time with mummy or daddy/ want to ask me anything/ feel like you are worried about anything?’ This enables them to recognize that they have a need that they may not have known about and helps them understand what they need.
• Do expect that the way children respond can be physiological and behavioural and can bypass their logical brain. They don’t know why they change behaviour patterns so don’t ask them! They could start to wet the bed or be aggressive or daydream more. They could also start to bite their nails, change their eating behaviours, cry more, struggle with sleep, feel very tired, want warm milk again or have nightmares. This is just their subconscious responding to the experience with a survival response, which is not logical or cognitive and so needs to be met with reassurance and kindness rather than reason and logic and then the new behaviours should soon reduce again.
• Do expect them to spontaneously ask questions or respond when there seems to be no reason, and when things seem to have returned to normal. The way that children process means that sometimes it’s easier for them to ignore their strong feelings until they feel safe enough to reflect and wonder about what happened. Be ready at anytime to give them time and space to explore their feelings around what happened.
• Do give the children reassurance in the way that best suits your child- usually hugs, time to read and chat over a hot chocolate, bedtime stories, quieter times with them where they can ask you anything. Make sure there is time for them even if they seem ‘normal’, but avoid being too ‘over intense’ as they will feel a bit odd and pressure can lead to them clamming up.
• Do create a relaxed and unpressured environment where they can ask questions but don’t force them.
• Do watch their reactions to things and when you see them respond in a way that is different from before the accident, use that as an opportunity to reflect that to them; ‘I wonder if you are worried about anything?’ Don’t be surprised or upset if they then tell you that their big worry is about having sausages for lunch rather than the tragedy. Children’s thoughts and feelings can jump from really serious issues to what we think are silly issues and view them as equally important!
• Do validate their emotions. Its ok to feel cross, sad, angry or upset.

Some Don’t:

• Don’t change the subject if the tragedy is mentioned and don’t avoid answering questions as this will lead to the children bottling in their emotions and questions, which could lead to anxiety. Your answer can be ‘I’m not really sure but we could think about that couldn’t we?” or ‘Sometimes I don’t know answers to really big questions but I do know that I love you and I will try my best…’ This gives permission to the children to ask questions and gives permission to be ok about not knowing answers to everything. This facilitates a healthy response to tragedy and develops a trusting relationship with you.
• Don’t talk about the event, your feelings or air your thoughts when you think toddlers or children aren’t listening. They are often listening even when they look engaged in play and can get quite confused about what happened or what will happen and this can lead to illogical fears and phobias. If they do overhear anything, take time to explain to them what they heard in ways that are helpful to them.
• Don’t allow your emotions to be completely unregulated (for example continually cry all the time for days) as the children will become overwhelmed and distressed. They will rarely tell you that they feel overwhelmed because of your response, but will begin to express their anxiety through behaviours such as aggression or anxiety. They need you to be an adult and be available to care for them.
• Don’t hide your own emotions completely either. It is healthy for the children to see you cry and explain that you feel sad, or express your concern fro your friends and suggest you make a cake. If they see you express an emotion and name it and then do something about it, this models healthy emotional processing which will enable them to adapt the same skills.
• Don’t talk about the incident too often and ask them how they feel too often, because they need to be able to have time to reflect and think in their own time. Children pick up on our emotions more than we would like to think, so if you ask them with an anxious voice all the time if they are ok, they may begin to feel anxious.
• Don’t worry if they sound relaxed and un-empathetic about what has happened. Children can often grasp things in a simplistic way and can feel quite settled once they have processed their questions and don’t understand why us adults can take our time. Or they are choosing to be distracted at the moment but when they are ready will respond with emotion.
• Don’t think it’s insensitive if they ‘play out’ the incident using cars and lorries whilst playing at home. Children process what’s happened by playing, just like we process by chatting or reflecting and so they need to repeat events over and over again. If the ‘story’ doesn’t sound accurate, don’t correct it. They could mix fantasy up with the incident and that could be their way of coping. Children often play in the metaphor too when they are worried so they could have an accident with animals or minions. This is all a positive processing process.

Talking about death

This is such a taboo subject and one that many adults struggle to verbalise. There are many beliefs and traditions that surround our views of death but for children to not feel afraid it seems important to give them some understanding of a loved one being ‘somewhere’. Some people speak about them going to heaven, whilst others speak about them being a star in the sky watching over us. Others speak about them going to a place where there is a party and others say that the loved one is always watching us and smiling at us. Children struggle like us with a sense of finality so its important to give them some concept that helps them to feel some hope and less devastation.

Children often ask if they will die soon or when you will die. It’s good to explain that usually peoples bodies only stop working when they are really really, old and that you expect to be with them until you are really, really old.

Death can be explained using words like, ‘their body stopped working’. They rarely need to know more details than that.

Some helpful activities to do with children who have lost a friend or loved one about the loss of that person

Some children like to write letters, make cards, or make a present to give to the loved one that they have lost. These can be given to the family or left on a grave. Some like to choose a special colour balloon and write a note and send it off into the sky whilst saying ‘bye’. Others like to choose a star that they think is the loved one and look for it often and wave and say anything they need to say. These activities can be essential for some children in order to be able to think, reflect and express emotion and feel a sense of closure.

Let them draw pictures if they want to of the event or the people they have lost and don’t ‘interpret’ or analyze them.

The most helpful adult you could be is one who is:

Calm, authentic about their own feelings, caring, relaxed and not too intense, easy to ask questions and talk about worries and one who doesn’t pretend but does protect.

 

If your child remains sad, or their behaviour has changed for longer than a few weeks and you are worried about them:

Do seek help. There are people to help you. Health visitors, your GP or counselling organisations like ours-  The Trauma Recovery centre. www.trc-uk.org.

The small print:

I have written this post as a mother of four and as a child psychotherapist who works with traumatised children. I lost twin babies 13 years ago and had to help my own 5 and 3 year olds navigate their way through the loss of their brothers lives whilst dealing with others’ grief in their schools and my own grief.

Betsy de Thierry

Recovering from trauma. A child’s journey.

What will the journey look like for the survivors of Rotherham?

In order to comprehend the recovery journey for a child such as those in the recent sexual exploitation cases in Rotherham, this paper shall paint a picture of the journey for a child victim from the point of disclosure.

The first disclosure

For a child to disclose abuse of any nature, it takes immense courage and usually requires them to have a relationship with an adult that they know cares for them deeply. In the context of this trusting relationship, a child may feel able to question the events in their life that are causing a sense of confusion and pain and if the listener is actively listening rather than being dismissive, the child may begin to disclose a few crucial details. These details are often mentioned with tension and nervousness to test the adult, to explore if that adult will respond or dismiss with mocking, blaming words. If the exploration is facilitated gently in a warm and respectful environment the child will feel safe and believe that the adult will ‘make things better.’ Sadly, for many children, they test the waters in conversations with trusted adults to find that they probably won’t be believed- or worse still- they will be reprimanded for any suggestions that another adult has done anything so awful. For many children, the right environment to share their concerns was never facilitated and shame and fear silenced them, often for years.

Disclosure to appropriate professionals

Following the initial disclosure the child then has to find the courage to speak to many different professionals about the events that are too horrific to share. Trauma shuts down the broca area of the brain that is responsible for speech and language, so to ask a traumatised person repetitive questions about the most awful experiences that words would struggle to describe, can further re traumatise a child unless there is great effort made to enable them to feel a sense of safety. The use of small hand held toys to enable them to squish, fiddle or puzzle while they speak softens the clinical questions of a professional who needs details in order to fulfill their role of protection of children and prosecution of the perpetrator. A warm, engaging, empathetic approach can make the difference between the child remaining in a state of shock and horror or feeling understood and cared for. The need for forensic medical examinations exacerbates the stress levels of the child, but a caring adult bringing reassurance can reduce the horrific intensity of the traumatic invasion.

Facing the everyday world

Often a whirlwind of appointments and professionals can materialise and then stop just as suddenly. The child is often left to ‘get on with life’ as if nothing has happened. School seems like a different world, full of noise and chaos; laughter and innocence. The child can feel dirty, different, ashamed, awkward and isolated in the midst of the happy faces. Panic can rise quickly and without warning, for example when a teacher shouts, because that angry face resembles other abusive adults shouting commands or sly manipulating requests. Flashbacks, panic attacks, the sound of internal screams all become things to be managed whilst attempting to avoid being told off for fear of more anger and pain. If the school grasps these challenges the smallest things can transform the child’s experience. If the child has a teacher greet them kindly, warmly and say something gentle such as ‘if you need some time out, if you need to chat, if you need to find somewhere safe, just come and find me in room 2 and I’ll/ or Miss R will be there for you.’ If the child could find school to be a place of understanding, with staff who are kind, non-judgemental, accepting and with genuine warmth, this can lower the stress levels of the child immediately which in turn reduces the intensity and quantity of trauma symptoms that develop to enable the child to survive.

A child needs support

The CPS Guidelines on Prosecuting Cases of Child Sexual Abuse recognizes that children need support.

‘Children and young people who have been the subject of sexual abuse are likely to require a very high level of support. The police will be responsible primarily for facilitating this, although they will not be responsible for delivering emotional or psychological support.’

The DSM-5 lists the reasons that emotional support will probably be needed. Trauma symptoms could become part a child’s narrative having experienced traumatic, abusive experiences that render a child powerless. These symptoms range from dissociative reactions such as flashbacks, persistent avoidance of stimuli associated with the traumatic event, avoidance of or efforts to avoid distressing memories, or external reminders that arouse distressing memories, thoughts or feelings closely associated with the traumatic event(s). The child could experience frightening dreams, marked physiological reactions, persistent and exaggerated negative beliefs or expectations about oneself others or the world. Persistent negative emotional state, markedly diminished interest or participation in significant activities, feelings of detachment or estrangement from others, persistent inability to experience positive emotions, irritable behaviour and angry outbursts, reckless or self destructive behavior, hypervigilance and so the list goes on.

These symptoms generally do not subside with time. They can become more entrenched as behavior patterns that protect and enable a child to survive in the harshness of a world that would allow such horrific things to happen to them. The CPS guidance ‘Provision of Therapy for Child Witnesses Prior to a Criminal Trial’ is clear that the best interests of the victim or witness are the paramount consideration in decisions about therapy. There is no bar to a victim seeking pre-trial therapy or counselling and neither the police nor the CPS should prevent therapy from taking place prior to a trial.

The United Nations Convention on the Rights of the Child (UNCRC) 1989 says that is essential ‘to take all appropriate measures to promote the physical and psychological recovery and social reintegration of child victims of violence’.

Therapy as an essential intervention for recovery

The NSPCC report in 2001 discovered an estimated 55,000 children who have been sexually abused received no therapeutic support each year due to a short fall in the availability of therapeutic services. Yet it is recognized that;

Long term therapeutic work for children who have been abused is a necessary and important way of helping with issues of confused feelings, including those of boundaries, intimacy, anger, abandonment, control and lack of control.’ (Murphy. J. 2001.p123)

Children need a safe place to process their experiences in an environment that doesn’t rush them and gives them time and space to go at their pace. The three phase treatment plan of most trauma therapy intervention begins with the stabilization and safety phase and this can take time as the children learn how to build trust with another adult having had that trust shattered through the abuse experience. The focus is on building safety for the child and often the first piece of work is identifying and reflecting on the very concept of ‘safe’. Often therapeutic provision stops at this stage and doesn’t allow the time to progress into the processing of the experiences to enable the memories to be become part of the child’s narrative, with emotional appropriate language and an understanding of the experience. The feelings of shame, guilt, confusion, distrust, powerlessness and negative belief patterns need to be processed. The final stage is the rebuilding and future focused work where the child no longer feels their identity is the abuse experience but rather has a greater and richer sense of who they are in the world. This can take years but prevents long term mental and physical health challenges in their future.

Other helpful recovery aids

Every child benefits from supportive, warm, genuine, kind adults who are safe, playful, curious and affirming. Children also find recovery is faster if they develop hobbies and interests that build resilience, such as sport, music, or art based activities experienced in safe, group times. They need their basic needs met of exercise, rest, play, healthy food, positive routines and a sense of belonging to a family and a community.

 

Recovery is possible

We need to prioritise the recovery journey for children who experience trauma. A recovered child is a child who is confident, at ease and has a voice. For this to happen there needs to be an increased investment into therapeutic services for children, increased parenting support projects and increasing training for professionals such as social workers, police, doctors, barristers and teachers on the impact of trauma on a child.

Betsy de Thierry

The day i cried non stop (and I know they’ll think they’ve won because of that)

The day I cried non stop.

So after three years of anxiously waiting on hyper alert for the next email, letter or message from my harasser, I heard that he was arrested. The day was spent informing funders and people who had supported us as a charity amidst of the horror of stalking; so I had not had time to think or feel… then suddenly the tears just didn’t stop coming…with wails and deep airy breaths of shock. He really had been arrested.

He spent 9 hours in a cell because he has caused destruction to my life, my family, my staff and many others…. I know that in some ways this is just the beginning as the next hurdle is facing him in court, where he and his lawyer will probably verbally tear me apart and laugh at me…but just for now… he’s arrested. Finally, I am believed. The horror I have experienced with every waking breath has been understood as criminal behaviour.

Since the very first texts on January 3rd 2011 where he promised to ‘rid Bath of the scourge of my evil’ and ‘speak forth’ of all that I had done, (which I still am unsure of, apart from support his wife) I have lived not knowing what any day will bring. Every single day could bring encounters with people staring at me curiously because they have heard lies that he made up; or it could bring anonymous threatening emails which are obviously sent to intimidate me, but still create the fear and freakiness that you may imagine…The day could be full of phone calls from other agencies or funders explaining rather awkwardly that they had received an anonymous complaint saying that we are being investigated by the local authority, or yet another allegation that my qualifications aren’t real..

As a counsellor I have spent hours of my life helping people reflect on their inner pain due to sexual, physical and emotional abuse and have been privileged to support them as they vocalised the horror of their journey’s. They have expressed the depth of betrayal, rejection, shock, shame and horror of being wounded, often by those who knew them.

I had no idea of the extent of the devastating affect of cyber bullying, stalking, strategic slander, defamation and psychological abuse until it became a part of my narrative three years ago. Surprisingly, verbal, psychological, and emotional abuse has the same effects as the physical variety [Psychology Today, September/October 2000 issue, p.24].

The scars of psychological abuse are not visible to the human eye but can be profoundly deep, devastating and life changing. There seems to be such a distinct contrast between the empathetic response of family and friends to physical wounds and injuries and yet little understanding of the affect of being harassed. So the emotional pain is intensified due to the isolation of no hospital visits, no doctors and no visible scars that shock and facilitate any support.

I now bear the emotional scars and the physical consequences of being stalked and harassed for three years. I know that everything I say may be used against me to damage my reputation and cause hours of distraction from the work that I do in helping other victims of trauma. I’m never sure who is recording me, who is going to feed back to them what I say so that it can be twisted and used to harm me. We have moved to a secret location and my four children have been disrupted from their schooling to try and limit the damage of the abuse. The financial, emotional and practical implications have cost us as a family, despite our aim to reduce the stress on them in the longer term. The traumatic stress still affects me every day as I live in the reality of the unknown and in a constant state of psychological alertness, ready to respond to the next challenge that my harasser creates.

I live with the knowledge that when we, as a charity, have any success which becomes public, my harasser and his colleagues will probably write to as many people as they can think of to make complaints about me.

This strategic system harassment, alongside the four twitter accounts used to defame and slander me, the 40 domain names in my name which were bought up, the website account in my name on google, the anonymous emails threatening and mocking me, the slander around the city where I work has taken it’s toll on me. Every word they have spoken is so full of hate and poison against me.

The harassment never seems to stop. He is probably watching me. Our successes cannot be celebrated publicly without the knowledge that there will be horrible consequences. We can’t ever make a mistake, as it would cost us dearly, more than for other organisations. We have people waiting for us to make any mistake that they can highlight, and he would ensure we faced consequences for any tiny error that he uncovered.

I imagine if I had been lying in a pool of blood with scars all over my body there may have been more understanding, but the silent, secret, sometimes subtle nature of the constant harassment and hate campaign leads to an isolation. The inability to speak of the situation has caused my staff and I to stumble in conversations when people question our busyness and tiredness. For 3 years we have not spoken of the constant harassment, apart from to a small group of friends, because don’t want to be people who defame another person. But now I have been advised to speak out about my horrific experience to protect any other potential victims. Our hope is that this group of people find peace and another purpose in life, rather than them living from a place of obsession and projecting all their anger towards me, for reasons they have never disclosed to me.

The trauma of harassment is the same as constant sexual or physical abuse and yet the justice system is only just responding to the importance of appropriate intervention. The consequences of harassment, strategic defamation and stalking are the same as any other constant, unrelenting traumatic experience where the victim is powerless and consistently damaged. The impact of trauma is still relatively misunderstood as a reality for many and ironically my life’s work is to educate and inform people of the neurobiological and psychological consequences of trauma.

Sadly because it is such a misunderstood area of trauma, there are few professionals who are ready to support a victim of stalking or harassment. I have been so grateful for the professional wisdom of Jennifer Perry at Digital Stalking (www.digital-stalking.org) and have been grateful to consult with her regarding the latest laws and what is the correct procedure for a case such as mine. Her guidance, support and knowledge has been a huge anchor in the storm of this situation.

‘Trauma is perhaps the most avoided, ignored, belittled, denied, misunderstood, and untreated cause of human suffering.’ (Levine and Kline 2007;3)

 

There are a few research papers that have begun to evidence the damage of this abuse. They all evidence that the affect of consistent stalking and harassment can lead to post traumatic stress in many cases. This is made evident in the paper, ‘Occupational Effects of Stalking’, Abrams and Robinson, (2002) Can J Psychiatry 2002;47:468–472

‘Abuse of all kinds also interferes with the victim’s ability to work. The researchers found important psychological problems resulting from the stalking, including these:

• Increased anxiety and arousal for 80 percent of victims
• Chronic sleep disturbance for 75 percent of victims
• Recurring thoughts or flashbacks to the stalking, resulting in distress for 55 percent of victims (often triggered by ordinary events such as a ringing telephone or doorbell)
• Appetite disturbance for 50 percent of victims
• Excessive tiredness, weakness, or headaches for 50 percent of victims
• Numbing of responses to others, including feeling of detachment for 38 percent of victims
• Nausea before going to places associated with the stalking for 33 percent of victims
• Increased alcohol or cigarette use for 25 percent of victims
• Contemplation of suicide for 25 percent of victims.

 

Here’s another list from another professional:

Although not exhaustive, the following are some of the more common effects that victims of stalking experience:

(Accessed https://www.stalkingriskprofile.com/victim-support/impact-of-stalking-on-victims)

Effects on mental health

• Denial, confusion, self-doubt, questioning if what is happening is unreasonable, wondering if they are over-reacting
• Frustration
• Guilt, embarrassment, self-blame
• Apprehension, fear, terror of being alone or that they, others or pets will be harmed.
• Feeling isolated and helpless to stop the harassment
• Depression (all symptoms related to depression)
• Anxiety, panic attacks, agoraphobia (frightened to leave the house, never feeling safe)
• Difficulty concentrating, attending and remembering things
• Inability to sleep – nightmares, ruminating
• Irritability, anger, homicidal thoughts
• Emotional numbing
• Symptoms of Post-traumatic Stress disorder e.g. hypervigilance (always on the lookout), flashbacks of frightening incidents, easily startled
• Insecurity and inability to trust others, problems with intimacy
• Personality changes due to becoming more suspicious, introverted or aggressive
• Self-medication alcohol/ drugs or using prescribed medications
• Suicide thoughts and/or suicide attempts

Effects on physical health

• Fatigue from difficulty sleeping, being constantly on guard, symptoms of depression
• Effects of chronic stress including headaches, hypertension
• Gastrointestinal problems –
• Fluctuations in weight due to not eating or comfort eating
• Development or exacerbation of pre-existing conditions e.g. asthma, gastric ulcers and psoriasis.
• Dizziness
• Shortness of breath
• Impact on health of increased use of alcohol, cigarettes or drugs
• Sexual dysfunction
• Physical injury due to not concentrating or being under the influence of substances
• Heart palpitations and sweating

Effects on work and school

• Deteriorating school/work performance
• Increased sick leave
• Leaving job or being sacked
• Changing career
• Dropping out of school – poorer education and career opportunities

Effects on social life

• Insecurity and inability to trust others impacting on current and future relationships and friendships,
• Problems with physical and emotional intimacy.
• Avoidance of usual activities e.g., going to the gym, going out.
• Isolation through trying to protect others , feeling misunderstood or psychological symptoms.
• Others withdrawing from the victim because they don’t believe the victim, they are unable to cope with the victim’s mental state or as a direct consequence of third-party victimisation.
• Victim moving to a new area, changing their phone number, name or even their appearance.

Effects on finances

• Loss of wages due to sick leave, leaving job or changing career.
• Costs incurred through legal fees.
• Expense of increasing home and personal security.
• Cost involved in repairing property damage.
• Seeking psychological counselling and medical treatment.
• Cost involved in breaking leases on rented properties.
• Expense of relocation.

What may prevent a victim from seeking help?

• Not understanding that what is happening to them is stalking and/or illegal.
• Trying to pretend that it is not happening.
• Believing that they should be able to deal with the situation, thinking that the stalker will see reason, or not wanting to get the stalker into trouble.
• Fear that others will think they are over-reacting or that they will be blamed for somehow having encouraged the stalker in the first place. The latter is particularly pertinent for those who have had a previous intimate relationship with the stalker, even if it was only brief or just a flirtation.
• Fears about how the stalker will respond either to them or those that they love or care for.
• Direct threats from the stalker
• Feeling isolated in their plight, believing that there is nothing that can be done to help them, or not knowing who to go to.
• Previous requests for help being ignored
• Fear of losing their job or the situation becoming more difficult when the stalking originates in the workplace.
• Financial limitations in regard to seeking legal advice or taking time off to seek help.
• Limited options in respect to changing their situation e.g. relocation to safer housing

 

 

Hope that helps!

 

Betsy de Thierry

Director of the Trauma Recovery Centre http://www.trc-uk.org

MA in psychotherapy and Counselling (awaiting final mark), B.Ed (hons) Primary Education, PG.Dip Play therapy, Dip Couns; Dip life coaching.

 

 

 

 

Stress and trauma in children today

Stress and trauma in children today

Research suggests that there has been a rise in both the quantity of children affected by traumatic experiences and the severity of the trauma experienced (Cafcass, 2009; Donnelly, 2013). These experiences are shown to impact on children’s behaviour, learning and self-regulation, and yet teachers are currently not commonly or consistently informed of this.

Due to developments in neuroscience research throughout the last decade, there has been an increase in understanding of the concept of trauma among the general public. There are frequent commentaries in the media on the latest statistics regarding the traumatic experiences of children and young people, and it is suggested that three children in every classroom have a diagnosable mental health disorder (Daniel, 2014).

Traumatic stress is caused by exposure to or witnessing of extreme and potentially life threatening events. Traumatic exposure may be brief in duration (e.g. an accident), or involve prolonged, repeated exposure (e.g. sexual abuse). The former has been referred to as “Type I” trauma and the latter as “Type II” trauma (Terr, 1991). Knowledge of traumatic stress – how it develops, how it presents, and how it affects the lives of those who suffer with it – may be the first step towards being able to interact positively with those affected by it. Teachers are responsible for the education of many children who exhibit symptoms of behavioural responses to Type 1 and Type 2 trauma.

Alongside the categorisation of Type I and Type 2trauma, there is an increasing recognition of the consequences of interpersonal trauma, in terms of attachment theory, which is now acknowledged in many children’s settings. Traumatic events described as interpersonal trauma are complex in nature, due to emotional involvement with people, usually close family members, who were passively or actively involved in the traumatic experience. While community disasters have invariably provoked a degree of media coverage, sympathy, support and occasionally recovery interventions for children, it is the media’s exposure of interpersonal trauma throughout the last decade that has increased public awareness of the concept and associated problems. This has benefitted the advance in rigorous safeguarding as a norm in working with children and young people (HM Government, 2004, 2010).

Some research suggests that disclosure of multiple, interpersonal traumatic, prolonged events, such as exposure to domestic violence and childhood sexual abuse and exploitation, is continually increasing (Barnardo’s, 2014).

The Diagnostic and Statistical Manual of Mental Disorders (DSM) describes the variable psychological distress reactions following exposure to a traumatic event. The DSM-5 provides a standardised classification system for the diagnosis of mental health disorders in both children and adults, and the diagnosis and identification of trauma symptoms has developed:

‘In some cases symptoms can be well understood within an anxiety– or fear-based context. It is clear, however, that many individuals who have been exposed to a traumatic or stressful event exhibit a phenotype in which, rather than anxiety- or fear-based symptoms, the most prominent clinical characteristics are anhedonic and dysphoric symptoms, externalizing angry and aggressive symptoms, or dissociative symptoms’ (American Psychiatric Association, 2013).

Research highlights depression or dysphoric symptoms as a rising problem for children and young people today, estimating that more than 80,000 children in the UK suffer from severe depression, including 8,000 below the age of 10. The author of this article, which featured these statistics on the front page of a leading newspaper, suggested that, ‘More needs to be done to identify these cases and support the children’ (Donelly, 2013).

Professionals working with children and young people are becoming better at identifying child protection concerns, due to government legislation making it compulsory to attend regular training in safeguarding (Department for Education and Skills, 2004). The requirement of bi-annual training for all who work in education, health and law enforcement has improved understanding of emotional, physical and sexual abuse and neglect, and has increased the responsibility of these professionals to make appropriate referrals. Safeguarding is now, ‘everybody’s business’ (HM. Government, 2010). 

Within the context of increases in safeguarding training and trauma research, it would seem logical to assume that those professionals who children spend the highest proportion of their waking hours with would be trained on the impact of trauma on their daily lives and classroom experiences. However, thus far, research seems to have demonstrated a lack of training for both new and experienced teachers in the identification of trauma symptoms or strategies to support these children.

This is a passion of ours…. that teachers and other professionals would be trained to identify signs and symptoms of trauma in children and young people. With this knowledge we hope that they would then be offered appropriate intervention to help them recover from trauma. 

the brainstem survival

I thought I would share two principles from Bruce Perry, a child psychiatrist who has studied trauma. These principles can help us understand the brain of a person who is traumatised. They are just two of his fundamental principles that I will explain and illustrate with stories from the kind of children that we work with in our centre. I hope it helps bring you and your loved ones freedom!

 

Principle from Perry No 1: The brain is organized in a hierarchical fashion, such that all incoming sensory input first enters the lower part of the brain.

I see the frustration of this with children who find themselves running away at school and at home. I know children who find themselves told off for years until we have become involved. I have had to explain to many Headteachers and teachers that children who have been consistently abused are not able to understand themselves why they react like this as it is often a brainstem reaction which has meant that the need to flight is stored in their body and has taught their brainstem to react at the slightest sense of danger.

These professionals needed to know that the brainstem and diencephalon are incapable of conscious perception. They thought these children were being naughty and so this neuroscience information has radically changed their view of these hurting children and this has caused changed behavior and created more empathy rather than rejection.  I usually explain to the young clients themselves about the brainstem being the first place to react and how it stops the higher level brain parts functioning until the cortisol has lowered and they feel safer. They usually understand this information and feel more emotional stability because the shame decreases about their behaviour as they were often embarrassed that they did things that their higher rational brain couldn’t understand or justify. The children are then able to learn to recognize their initial feelings of panic and can often self soothe in the classroom context. This one principle has changed the feelings of powerless, stupidity and shame in many young children into feelings of empowerment and ability.

Principle no 2: Neurons and neural systems are designed to change in a use dependent fashion. As we know that many of the traumatised children have experienced chaotic, unpredictable experiences and home, we know the importance of the simple things that we do in our therapy centre such as the beginning and ending rituals. We have a feeling tree and the children always walk up the stairs and have a moment to reflect on their feelings that week and place a colour apple of the tree and at the end they have a similar experience. This repetitive experience offers some stability and a sense of boundary, safety and containment for them as they begin and end the work of the session. We also introduce new experiences to the children. For example I have always worked with a lot of people who have been sexually abused and they often seem to have a huge aversion to anything which is too sensory on their hands and they often have excema and irritable skin. As these abuse memories are locked in their physiology and memory, they have not been able to re-programme their brain with new sensory experiences due to avoidance. When these senses are stimulated they cause neural reactions to enter the brainstem, the neurotransmitter networks send connections firing throughout the rest of the brain and these messages are organized into a response that is dependent on experience, so I have available things such as foam, wet spaghetti, slime and clay which, because we create a sense of safety they feel able to explore and they are able to help activate parts of the brain that would otherwise not be activated. This availability to use the sensory equipment in a repetitive way allows their brainstem to reorganize. It’s important to facilitate them to have frequent usage as this can create a new neural pathway which is positive rather than negative and can help stop the sensory feelings as a trigger.

Hope this helps with more understanding!

Freedom is worth fighting for….

x

being a secure base when a traumatised child having a meltdown…

Caring for children is such a privilege and as we approach Mother’s Day, I am reminded yet again what a miracle it is being a mother. There is nothing more wonderful that giving a child a hug, a special present or spending quality time with them making cakes, picking up leaves, staring at bugs or reading them a story. It’s the small things that we can rush past that we need to remember to treasure!

When we plan on spending time with our young ones it can be such a positive experience for both the adult and the child when things go well and fun and everything ends in fits of laughter and happy faces! However, sometimes, no matter how much we plan, a child can have an emotional outburst that can change the special moment into a nightmare!

Sometimes a child can become upset, have a tantrum or look like they have ‘lost the plot’. It can take the smallest thing for them to become emotionally overwhelmed and the atmosphere can change to tense and escalate to a huge ‘scene’. Usually it happens because the child wanted his or her own way. This is normal developmental behaviour in pre school children but if the children have experienced trauma in the past, they may be re-experiencing strong negative feelings of powerlessness or fear and be unsure how to express themselves and often use regressive behaviour. There are so many reasons why a child may escalate emotionally and it’s useful to learn as caretakers, how to help a child calm down and be able to stop an emotional outburst becoming a huge painful situation. So here are some ideas for soothing and calming a child when they are emotionally dysregulated. They need to be held as ideas for children according to the emotional age of the child at that time…and for those of us working with traumatised children, these are the foundational soothing activities for times of stress and difficulty.

Some simple ideas that we recommend to the families that we work with that help children that are feelings stressed, upset or emotionally dysregulated are often using the five senses. We suggest these and have seen some real safety come to the homes of families recovering from trauma:

Music or seashell listening, swinging outside, having a cosy/ safe corner with blankets, cuddly toys ready, books, puppets to express and be a voice for the reason they became dysregulated, slime putty or playdough to play with (age relevant), journaling or scrap books for collage, favourite smells to smell (in the cosy/safe corner), visualisation exercises with pictures that they have drawn nearby and readily accessible,and of course let’s encourage  the simple art of talking together.

Some more ideas are: slow breathing exercises they can do anywhere, ‘spaghetti arms’ (shaking their arms in a loose fashion) and star jumps, calming music- listening to a CD which helps the child visualise a safe place, listening to ‘happy’ music, playing a musical instrument, drawing, painting, playing with a pet, cuddling a special soft toy, going for a walk, kicking a ball when angry, jumping on a trampoline, dancing and finally and when it really is necessary, visualising the process of putting disturbing, intrusive thoughts/images into a box, closing the lid and locking it.

It is also worth remembering that traumatised children need to learn that adults can be dependable, caring, patient and loving to counteract the negative messages they have often received in the past.  Those who become therapeutic parents or carers for a traumatized child become the children’s secure base by being emotionally available, sensitive, responsive and helpful.  To do so means we have to be able to manage our own feelings and stress so they we have something to give and so that we can try and make sure that we are not going to overflow any of our stress/negative emotions to the children. Therefore as parents and caretakers in this role, we need to get the support we need to be the best carer that we can be…-there’s no shame in needing support and time for ourselves.

So it’s good to try and remind us all that when it looks like things are going wrong, it’s best to not take it personally, be consistent and supportive, listen to the children, say sorry if necessary, accept and validate their feelings by reflecting them, be trigger aware and body language aware, avoid labels and telling them what they are feeling, and treasure the moments where things go well and we can see the little ones enjoying life and experiencing new things!