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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?