Avoiding Avoidance

Source: Wokandapix/Pixabay

This is Part 2 of a series on childhood trauma. Part 1 can be found here. Part 3 here; Part 4 here.

In this series, I am discussing four interventions that caregivers can utilize to help a child recover from a potentially traumatic event (PTE):

1. Acknowledge and respond to the PTE’s impact on the child.

2. Maintain, restore, or increase structure in the child’s life.

3. Recognize misbehavior and withdrawal as attempts to regain control and respond to them with opportunities to cooperatively increase their control.

4. Take care of yourself.

Studies of the relationship between reactions during and immediately after the traumatic event (peritraumatic period) have revealed that dissociative reactions and patterns of avoidance show a particularly high correlation to the development of PTSD. Each of the interventions listed above is about moving in the opposite direction than dissociation and avoidance. Trauma-focused treatment encourages movement towards engagement, acknowledgment of the events, and addressing their impact. Therefore, these suggestions are intended as gentle ways caregivers can do the same at home.

Part 1 of this series began to explore the first intervention (acknowledge and respond to the PTE’s impact on the child) by focusing on the caregiver’s recognition and naming of emotions and behaviors in the child that appear linked to the PTE. Here, in Part 2, we explore how the first intervention can help both the caregiver and child to avoid avoidance.

Acknowledge and respond to the PTE’s impact on the child (continued):

When a child you love is hurt or frightened, it is normal for a caregiver to want to avoid reminders of what happened. It’s part of a protective reflex; we want to make the bad feelings and memories go away. This is, in its essence, a good thing. However, the reflex fails to make important distinctions.

Remembering a bad thing can be a good thing. It is why human beings have evolved to have such effective memory capacity; remembering helps to safeguard against repeating past errors and against remaining vulnerable to aggressions. Forgetting our painful experiences would—to paraphrase Santayana and Churchill—condemn us to repeat them.

Forgetting also condemns us to live in a state of much greater anxiety. Imagine waking one morning to discover that you have a bruised and swollen face, but no memory of how it happened. This would reasonably cause tremendous anxiety because the not-knowing would probably lead to a generalized fearfulness of everyone and everything.

If, on the other hand, you are then gently reminded that your injuries were caused by falling down a flight of stairs, your anxiety will be focused on an appropriate area of concern—stairs. Your fear might be quickly mastered by incorporating new, cautionary habits when traversing a flight of stairs. Specifics can make a threat something that is manageable.

When we long to forget or wish to keep a child safe from a painful memory, we probably intend to protect them from persistent upset and fear. Memories, after all, are our recollections of past events. Memories don’t hurt us, but they can trigger difficult feelings. A traumatic past event cannot be changed, but the feelings that arise in us can be altered, lessened, and even eliminated by a healing process.

In addition, if the caregiver avoids the topic of a scary event, this can be a message to the child that the caregiver, too, is frightened of the memory, the feelings, and the possibility that it will happen again. Or if the caregiver never mentions the traumatic event and seems to have forgotten that it even took place, the caregiver is certainly not prepared to keep them safe.

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Avoidance should, therefore, be avoided. Caregiver interactions with a child about traumatic events should be as fearless as possible, whether addressing generalities or specifics.

Important note: Experts generally agree that the focus of a caregiver’s interactions with a child shortly after a PTE should remain focused on the present. The PTE itself, the details of a scary or harmful event, are not “the specifics” I am referencing here. The specifics of which we speak are those feelings, thoughts, concerns, fixations, and behaviors that manifest in the child in the present moment.

Detailed descriptions of abuse are not what the child and caregiver need to be attentive to. They need to be attentive to the experience of the child in the present moment and moving forward.

Let the child know that it is OK for them to speak about the PTE if they want to. It is also important to explicitly let them know that they don’t have to talk about it. What the caregivers want is to work together with the child to heal from the PTE “so that you aren’t scared to go back to school,” or “so you can sleep better at night.”

Research (Shimshoni et al., 2017) has demonstrated and discussed how maternal acceptance (“a pattern of behavior characterized by mothers’ warm and accepting responses to their child’s behaviors”) tends to offset anxious avoidance in children. Children who received less acceptance from their caregiver tended to become more symptomatic.

If a child needs to speak about the specific details of an abusive event—usually indicated by bringing up the PTE themselves—the caretaker should remain focused on listening, being curious in order to develop understanding of the child’s thoughts, experiences, and feelings, and they should provide plenty of expressions of support, affection, and love.

If a boy references the abuse as “when Johnny touched my pee-pee,” adults should resist the desire to edit the child’s language towards more scientific terminology. While there can be benefits to teaching children scientific terminology for body parts, this is not the right time to do so. Professionals have learned that if we want to understand the child’s experience of the abuse and of the symptoms, we need to accept and explore their language—not correct it.

Physical and sexual abuse often produces a feeling of culpability in a child. Despite the reassurances from caring adults that they did nothing wrong, an abused child is often feeling responsible for what was done to them and for all the ways the disclosure of the abuse upset others.

Source: Gerd Altmann/Pixabay

If we want to communicate to the child that they are not responsible for the abuse or the effects of the abuse, we must embrace their expressions of their own thoughts and feelings, including the words they choose, with warmth, concern, and acceptance.

This is the second entry of an ongoing series. The next entry will focus on the second intervention: Maintain, restore, or increase structure in the child’s life.