The role of the body as the medium in child psychotherapy: snapshots of therapy with an 11-year-old,severely abused,multiply placed girl

In Victoria, Australia, children with a history of abuse and severe attachment difficulties, and who have experienced multiple carers and placements, have been traditionally viewed by mental health services as unsuitable for psychoanalytic psychotherapy. A number of factors, including the lack of integrated, long-term case planning; unstable residential placement; and the belief that psychotherapeutic treatment will be of an extended duration, have influenced the decision not to provide individual psychotherapy for these children. Currently, the movement within mental health services is towards responsive and briefer treatment models. The child psychotherapist is challenged to re-think theory, technique and practice. This paper identifies contextual constraints that have led to these children being precluded from accessing psychotherapy. An alternative model of intervention is discussed and illustrated with clinical material. The contributions of Alvarez, Trevarthen, Schore and other writers are drawn on to underpin the clinical work. This model involves a change in technique and role and the use of a time-limited intervention. Intrinsic to the model is the understanding of the child's psycho-biological experience of trauma and disrupted attachment. The child's experiences are conveyed in the pre-verbal, gestural domain to enable history to be given voice.     

Thinking about and working with depressed mothers in the early months of their infant's life

This paper illustrates how my work has developed over the years and informed my thinking about, and work with, depressed mothers. It also describes the work of the Parent Infant Foundation in Sydney where pregnant women and mothers with infants and toddlers are seen in groups and individually through home visits. The relevance of the support of a peer group when doing such difficult work is described. The paper draws on a central theme: the depressed mother, returning to her own infant beginnings through pregnancy and birth, confronts a dead mother-dead infant dyad. Trauma from the mother's own infancy is seen to have created an internal, autistic, deadened, psychic space. It is argued that behind this deadness lies the primeval pain of abandonment and loss. The associated rage, previously repressed but now awakened by her alive infant and his powerful primitive demands, invade the mother's psyche. The internal deadness freezes her alive processes as mother to her baby. Unbearable pain is awakened - and she may be in terror and unable to move, or she may experience herself as drowning in something catastrophic. SUMMARY This paper illustrates how my work has developed over the     

Prenatal trauma and autism

Through the clinical history of a little girl, this paper explores some possible traumatic prenatal experiences of children who have autistic features from birth. It establishes a tentative connection between the precocity of the onset of pathology and potentially traumatic prenatal situations such as threats of miscarriage or pathological mental states in the pregnant mother. It is suggested that a psycho-physical retreat from the auditory experience of the mother's voice, which normally stimulates foetal proto-mental activity and may lead to the development of a 'sound-object', might contribute to the later autistic child's isolation and non-mental clinging to tactile sensations.     

The Multidimensional Trauma Recovery and Resiliency Instrument

Abstract

This paper describes two studies leading to the construction of and psychometric support for the MTRR-99, a shortened version of the Multidimensional Trauma Recovery and Resiliency Scale (MTRR-135, formerly MTRR). In the first study, the original body of MTRR-135 data was reevaluated to remove psychometrically weak or theoretically unnecessary items. The remaining 99 items were then assessed for reliability, validity, and internal consistency. In the second study, the new MTRR-99 was applied to assess the recovery status of 164 incarcerated women prisoners with extensive abuse histories. Together, these two studies further document the utility of a multidimensional approach to assessing trauma impact, recovery, and resiliency; in addition, they provide preliminary evidence for the MTRR-99 as a viable measure for use with clinical and non-clinical populations.     

Mothers and Children Together

Summary

Treatment groups for both mothers and children together who have experienced mother assault is a unique therapeutic milieu which has been underutilized in the treatment field. This article presents a 10-week feminist-informed family systems group model as part of a treatment approach for children exposed to family violence and can be used with families of children from pre-school to adolescence. This model provides a context in which the experience of family violence can be debriefed, and issues related to trauma, safety, secrecy, and post-abuse family restructuring can be addressed by family members together. In addition, play and art therapy based interventions are presented and are tailored for the beginning, middle, and end of the group process.     

The Need for a Continuum of Trauma Services

Summary

Since September 2000, residents of Israel have experienced a prolonged period of terrorist attacks that shows no sign of abating. The ramifications of the ongoing trauma permeate every facet of life. Since existing services provided by government and Non-Governmental Organizations (NGOs) are unable to meet the needs that have emerged, the Continuum of Trauma Services (CTS) was developed for victims of terrorist attacks, their families, friends, emergency and mental health professionals and the community at large. This article also describes the Israel Trauma Coalition and its interest groups, which may be seen as the embodiment of an evolving CTS.     

Emotional impact feedback affects how people remember an analogue trauma event

Do external motivational processes—in the form of social influences—shape people's memories for trauma? In this experiment, we examined the effects of social influence on memory and post-traumatic stress disorder (PTSD) symptomology for an analogue traumatic event. Seventy-two participants watched a distressing film; some received feedback about others' reactions to the film that either emphasised or downplayed the distressing nature of the film; control participants received no feedback. A week later, participants reported their symptoms, rated their memory on a number of characteristics and we tested their memory for the film's content. Participants who received feedback downplaying the film reported fewer PTSD-related analogue symptoms and weaker memory characteristics than their counterparts. The results suggest that people's memory phenomenology and analogue symptoms are influenced by others' feedback, but only when others' reactions downplayed the distressing nature of the film.     

Reasoning about highly emotional topics: Syllogistic reasoning in a group of war veterans

Previous studies have generally found that emotion impairs logical reasoning. However, laboratory experiments have typically involved relatively mild levels of emotion where affect is not linked to personal experience. In this study we examined how army veterans reasoned about syllogisms of three types: neutral, generally emotional, and combat-related emotional. We also measured intensity of combat experience. Veterans were more likely to provide logically accurate answers when reasoning about combat-related compared to neutral problems. Participants with more intense combat experiences showed a reduced advantage in reasoning about combat-related emotional problems.     

Protective role of coping flexibility in PTSD and depressive symptoms following trauma

The aim of the study was to examine whether coping flexibility would function as a protective factor for PTSD and depressive symptoms in trauma-exposed adults in Korea. A total of 510 adults with a lifetime history of traumatic events completed the Perceived Ability to Cope with Trauma (PACT), the Korea version of the Posttraumatic Stress Diagnostic Scale (PDS-K), and the Patient Health Questionnaire (PHQ-9). Hierarchical regression indicated that coping flexibility was associated with a reduced level of PTSD or depressive symptoms after controlling for comorbid symptoms, age, and elapsed time since the most distressing traumatic event. The interaction of traumatic events and coping flexibility was significant only on PTSD symptom severity but not on depressive symptom severity. Specifically, individuals with low coping flexibility reported higher levels of PTSD symptoms as the number of traumatic events increased. These findings supported the hypothesis that coping flexibility is a protective factor for PTSD and depression following trauma, and lack of coping flexibility may aggravate the risk for PTSD among people with multiple trauma.     

Retrospective reflexivity: The residual and subliminal repercussions of researching war

Stories of the war have been a known part of my story as granddaughter of Polish post-war migrants. Yet venturing into these stories as researcher has been troubling; I found their closeness and their raw emotion difficult to process. Significant sections of my interview schedules entailed participants recounting their own, their parents' or their grandparents' stories of war and migration, with traumatic episodes frequently intersecting into their stories. As a researcher, these traumatic narratives have had a residual quality, lasting in my subconscious long after the interviews themselves and doctorate for which they were conducted had finished.In this paper, I focus on experiences of, and reactions to listening to, analysing and writing about these traumatic cultural memories. Collins (1998: 3.35) has observed that ‘the emotions experienced, whether by the interviewer or interviewee, are as real, as important and as interesting as any other product of the interview’; my powerfully felt experiences with traumatic content have validated this sentiment. With a retrospective reflexivity I now realise that these cultural memories were not the only ‘product’ of my research, but that how they were narrated and how I dealt with them were also a significant part of the research process, and indeed stories in themselves. Here I attempt to retell how these stories impacted me as the researcher; how in the case of particularly harrowing stories, I also needed time to absorb the narratives, to comprehend the participant's experiences and their ability to narrate such stories, and to recover from the experience of listening to such accounts.