Working with a child who has experienced chronic, complex trauma and hasn’t yet developed the skills or allowed herself to risk developing a safe, reciprocal, healthy connection is one of the most challenging and rewarding experiences I’ve ever had as a clinician.
I can now look back at Maria, my first long term client in residential care and understand that her constant rejection of my support, impressively skilled ability at pressing buttons I didn’t know I had and motivation to get her needs met in any way she could find (often mislabeled as manipulation), was a function of survival and the fear of connection.
These kids are tough, but I happen to love to work with them. Children with attachment disorders often do not respond to typical therapeutic interventions and require an open minded, reflective approach to their care.
Through a Lens
While their presentations are complicated and their behaviors complex, symptomatology begins to make sense when looking at these clients through a trauma-informed lens. There is rapid brain development during the first years of life, but for children who experienced developmental trauma, this brain development integrates beliefs about themselves, other people, and their environments that drive maladaptive coping strategies and difficult connecting to or accepting support from a caring adult.
Some of those messages include the belief that people do not meet your needs or follow through with responsibilities. Additionally, people are not trustworthy. Adults are not safe. People do not love you. You are not worth loving. You can’t depend on anyone, but yourself. These beliefs can create an innate drive for self-preservation through getting needs met in any way possible, development of strategies to self soothe that are often dangerous and destructive and intense pushes and pulls within interpersonal relationships.
I sat with Katrina twice per week for two and a half years. For the first year, I felt zero reciprocity. It was like being on a bad date twice per week. No matter how hard I tried or what topic we discussed, I couldn’t feel Katrina connect to me. But Katrina’s story touched my soul, and I while she never spoke in details about the trauma she endured, her pain was palpable and I was determined to help her. After several months of feeling burnt out by trying, I reframed my intentions and began to just “be” with her. We found a quiet spot near the program where we could listen to birds and watch turtles in a pond. For a long time, we sat in silence, but for the first time in my work with Katrina, I saw her begin to relax, look comfortable in her own skin, and eventually, at ease in the context of our relationship.
She began to talk. And very very slowly she began to trust. Over two years into our work together, when I left the program to take a director position at another facility, Katrina told me that I was like a mother to her. No words have ever meant so much coming from a client, because I knew at that moment that she had developed the capacity to form a healthy, trusting, and reciprocal connection with another person and hoped that ability would translate to future therapeutic connections to therapists and staff, supportive friendships and safe romantic relationships.
Hurting With No Words
Working with Katrina inspired me to study the impact of complex trauma on regulation and attachment. I studied the work of Bessel van der Kolk and Dan Hughes and began to work at the Trauma Center in Brookline, MA. After I understood it, I learned to appreciate the function of my clients’ disconnection.Now I find joy and feel success in building healthy connections with the un-attached and teaching parents, caregivers, and clinicians to support and foster attachment with their own children.
These children are hurting in a way that has no words. Because of the early nature of their trauma, a time that is pre-verbal and expressive language was not yet developed, children with attachment disorders sometimes literally have no words to explain their experience of the push and pull within interpersonal relationships, out of control behaviors or constant neediness.The intense and conflicting paradigm of needing and wanting a caregiver’s love and attention so desperately, yet being filled with feelings of fear and discomfort in the presence of it, can result in those that care for them feeling unloved, defeated and in a lot of pain.
Over the years, I’ve worked with countless number of parents, especially parents of adopted children, who feel an overwhelming amount of suffer and self-doubt because no matter how much they try to love their child, they do not feel their child loves them back. I’ve supervised many clinicians who experience rejection, frustration and hurt that no matter how much they try to help, their interventions don’t seem to be making progress. Helping kids who have difficulties with attachment is very different than the work we might do with the rest of our clients, but I want everyone who interacts with these incredible children to know it can get better.
Through practicing activities that foster attunement and reciprocity, teaching empathy and perspective taking and providing a wide variety of healthy strategies for regulation, these children and their families can heal.
As featured in Psych Central Pro