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THE POWER OF THE HORSE

EQUINE ASSISTED PSYCHOTHERAPY WILL HELP YOU GREET YOUR DAY WITH INTENTION, FOCUS, LOVE & RESPECT

The experience with horses provides a natural entry into the emotional questions—and answers—that give your life connective energy and meaning. 

With individual Equine-Assisted Therapy, some of the same actions come into play, but it’s a one-on-one, intimate encounter with the horse. This can be very therapeutic for young adults suffering with addictions. If you have body image problems, you can relate to the touching of the horse, which appreciates the concern. As you groom the horse, you can feel the nicks and scrapes on the horse’s body and talk about your own scars. You begin to understand that all creatures have wounds, but all are beautiful. Self esteem, self respect automatically rises. And problems begin to find living solutions.

For the Hamiltons and for the teens that enter the Round Pen, The horse is a living metaphor for healing and strength, a wise teacher, and, as Jane says, “ a wonderful partner.”  Sue Hunter

Excerpt from Mental Fitness Magazine for Teen


FULL ARTICLE FROM MENTAL FITNESS MAGAZINE FOR TEENS & Parents

 

Who Defines Trauma in the Lives of

Young Children and Teens

Stephanie Rabenstein

14-month old Tanya[1] grabbed her grandmother’s hot coffee off the table scalding her arm and chest. Her severe burns required a lengthy hospitalization and excruciating skin grafts. By the age of 13 she reported a lifelong history of concentration and sleep problems, hypersensitivity to sudden movements and loud sounds. Tanya struggles to manage strong emotions but has no actual memory of the event.  

Three year old Ali was knocked over by an exuberant but harmless puppy. Afterwards, he startled more easily and frantically grabbed at his parents, eyes wide screeching, “UP! UP! UP!” when he saw a dog.

Six year old Mara was teased by two nine year old girls every recess. She became irritable and physically aggressive with her younger brother at home. Nightmares woke her up regularly and, in the morning, her parents often found her asleep at the foot of their bed. She begged not to go to school.

Nine year old Mac was on his bike when he swerved into oncoming traffic and was struck by a car.

12 year old Ann listened to the angry words and the sounds of glass breaking night-after-night for several years. Her parents thought that she was oblivious to conflicts that characterized their troubled relationship because they waited until she was asleep to fight.

The traumatic experiences of these six children vary as much as the children themselves. In our rapidly evolving understanding of trauma, and its impact on youngsters, it can be challenging to figure out child-by-child what defines an overwhelming event and how it effects the victims of it.

This article looks at what, and who, defines trauma in the lives of children, how we know that a child is negatively affected and what we, as the adults surrounding the child, can do to support them[2].

What is a traumatic event?

Within the past 30 years, our understanding of trauma in the lives of children has been refined by clinical work and research. Some of these findings have been incorporated into the Diagnostic Statistic Manual, fifth edition (DSM 5) published in 2013. It provides the criteria for physicians and other health care professionals to diagnose trauma based disorders like Post Traumatic Stress in children and adults.

How the Experts Define Trauma

The DSM 5 defines trauma experienced by children six years and older, adolescents and adults as:

·      Being directly involved in the traumatic event where death or serious injury occurs or is threatened or where actual, sexual violence or abuse takes place or is threatened

·      Witnessing any of these occurrences happening to other people

·      Learning about the actual or threatened death of a close family member or friend

For the first time, the DSM 5 provides a customized definition that applies to the unique experience of children 6 and younger. It recognizes the critical importance of primary caregivers for the infants, toddlers, preschoolers and kindergarteners. For little ones, trauma is defined as:

Being directly involved in the traumatic event   

Watching the event happen to othersespecially parents”

Learning that a traumatic event has happened to a parent or caregiver.

Humans have a remarkable capacity to overcome adverse events. Depending on the nature of the trauma, roughly two thirds of adults who experience a traumatic event eventually recover without debilitating, long-term effects. For the remaining one third, their psychological injury is significant and pervasive. The healing process is slow and requires formal intervention. Similarly, most youngsters, though more vulnerable than grown-ups, can and do recover from trauma with the support of their caregivers and other important people in their lives while a smaller group requires more formal intervention.

It is often assumed that Post Traumatic Stress Disorder (PTSD) is the most frequent outcome among the minority of trauma survivors across the life span who are moderately and severely effected. Not true. Trauma will manifest as separation anxiety, especially among very young children, as generalized worries and as physical complaints without medical explanations. It will also appear as attention and concentration problems, as anger-based, acting out behavior or depression.

Big “T”, Little “t” Events

Capital “T” traumas like Tanya’s or Mac’s are events that all of us consider traumatic. We have come to appreciate the lasting impact that exposure to domestic violence has on kids like Ann and the profound negative effect of childhood sexual abuse on young victims. We are gaining greater understanding of how early, pre-verbal traumas like Tanya’s may reside within the body and in the primitive alarm systems of the human brain. The lasting damage of these incidents is reflected in this new definition of PTSD.

Little “t” traumas like Ali’s unexpected encounter with the large, clumsy dog and peer initiated victimization like Mara’s are less likely to be recognized as being overwhelming for children and having residual effects on them. When occurrences like these terrify kids, the protective functions of the brain immediately imprint the people, places or things related to the child’s experience as dangerous when, from an adult perspective, the experiences are not life threatening or even unsafe.

When Parents Define Trauma

The opposite can also be true. Events that parents perceive as traumatic for the child because it could have been life threatening may have been most disturbing for his or her caregivers but not the child. Rory, a kindergartener, witnessed a fatal knife fight between two men outside his second story apartment. His parents sought treatment for him assuming he was as troubled as they were by what he saw. He wasn’t. When Rory was asked to told the story with toys, he described how “two guys were play fighting then the police came and told them to stop”. Rory showed no other behaviours indicating that he was distressed by what he witnessed. His parents, however, needed psychological first aid to address its impact on them. 

Six year old Maggie received drawings from Joe, her classmate, depicting graphic sexual violence. On it Joe wrote, “This is U!!!”  Maggie’s horrified father, who found it in her backpack, took the drawing to school authorities. All of the adults who saw it were concerned. Parents were contacted, children were interviewed and measures were taken to ensure the safety of every student involved. Days later, the school principal noticed that Maggie seemed pensive and sad and asked Maggie how she was doing. “I am thinking about the picture Max gave me,” Maggie replied. “He drew my room with blue walls but my walls aren’t blue, they’re green!” Maggie’s naiveté buffered much of the potentially harmful effects of Joe’s drawing because she had no idea what the figures in the picture were doing. Deeply shaken by the whole event Maggie’s parents came to understand that, although painful for Maggie, she was not traumatized. Their parenting safeguarded her from information that was not age- appropriate. As the dust settled, the greater collective anxiety was for Joe the artist, whose picture reflected disturbing images far exceeding knowledge appropriate for a six year old.

For Mac, the boy who survived the bike versus car collision, the worst part of his accident was not the invasive medical procedures necessary to set his broken bones or the collision itself of which he had no memory. He related relevant information about all of this in a matter-of-fact tone of voice. However, his eyes welled up with tears as he showed me a photo of the mangled mountain bike that he’d saved his birthday money to purchase. He described the colour, the special handle bars and its customized suspension system in great detail. For him, in that moment, the loss of the bike constituted the most distressing outcome and evoked the strongest emotional response of that potentially life ending accident.

Maggie, Rory and Mac’s stories reflect a fundamental principle of trauma work that is especially true with the very young. The first step is to understand the impact of the event or events from the viewpoint of the victim him or herself by saying, “tell me the story of what happened.” For children, the story may best told with toys, in sand or with markers and paper. The child’s point of view becomes the “North Star” that guides most of the subsequent intervention. As a trauma therapist, I am reminded daily that what I assume to be the most troubling aspect of a traumatic event for my clients often isn’t and the worst part for them is something I wouldn’t know if I hadn’t asked.     

   

Trauma symptoms in the early years

Trauma pioneer Bessel van der Kolk has said, in trauma, “the body keeps the score”. The body also tells the story. When children (as well as teens and adults) are traumatized, their bodies, emotions, thoughts and thought processes tell us exactly how difficult life events affect them. Here are some of specific areas where trauma disrupts the daily experience of the victimized child. These symptoms are identified in the criteria for PTSD outlined in the DSM 5 as it applies to children 6 and older and very young kids 6 and under.

The DSM-5 provides five different types of trauma symptoms. I have highlighted specific behaviours we encounter most frequently in our work with young children.

Intrusive Memories

For kids, unwelcomed and upsetting recollections of the traumatic event begin after the event and are recurring, involuntary, and upsetting. Children six and younger may feel and act as if the trauma is happening again, unaware that what they are going through in that moment took place in the past.

When children in this age group are aware that the event has already happened, the child’s spontaneous and intrusive distressing memories may not necessarily appear distressing to the child in the way that an intrusive memory tends to emotionally charge most, older, children and adults. The traumatized preschooler may describe a horrific scene with wide eyes and tense, focused attention but without apparent fear, anxiety or sadness. She may appear more agitated or excited and brings this affective presentation to her traumatic play described below.

For toddlers and school aged children, intrusive memories may be expressed through repetitive traumatic play that contains elements of the trauma. Intrusive symptoms appear literally or symbolically. For example, Ali used a stuffed dog to repeatedly knock over small figures as he played on the floor of his bedroom. His play was literal. In the play of a physically assaulted seven year old, a fearsome monster puppet repeatedly chased a finger skateboard - a small toy skateboard propelled by two child-sized fingers. His play was symbolic. The emotional state of the child during traumatic play may be infused with emotions adults consider more congruent with the content or may be characterized by the intense activation focus on the play sequence without the expected emotions of fear, anger or anxiety.

Recurring bad dreams and nightmares are another intrusive symptom that takes place during sleep. The content and/or the emotion of these dreams may be clearly linked to the trauma or take the form of frightening dreams with themes of powerlessness, abandonment or violence without recognizable traumatic content.

Finally, some children may show intense or prolonged psychological distress when exposed to internal or external cues, called triggers, or sparks, that resemble an aspect of the event. This may appear as sudden fear or anxiety, irritability or angry lashing out or, for some children, unconsciously slipping into a momentary, trance-like state called dissociation.

 

Avoiding Behaviours

Avoidance occurs when a traumatized person of any age finds that the distressing memories, thoughts or feelings, as well as people, places or things associated with something painful or fearful, become overwhelming. This extreme discomfort in that moment is most effectively dealt with by turning away literally or figuratively. Every trauma survivor experiences that jolt of fear when confronted by something that reminds them of the event. This is true for children and infants. Sometimes the avoidance is not obvious as is the case when kids six and older cannot not remember an important aspect of the traumatic event even if they want to.

Changes in mood and thoughts associated with the event.

Children often develop recurring or extreme, negative beliefs or expectations about themselves, others around them or the world. These beliefs might include “I am bad” or “I can’t trust anyone.” They also have recurring, distorted thoughts about the cause of the trauma that results in blame. Ann felt that her father’s verbal and physical assaults on her mother were Ann’s fault because she did not pick up her backpack and her father tripped. She blamed her mother for being hit, echoing the words of her father, “Mom should have done what Dad said in the first place.”

 

Children demonstrate an increase in negative emotional states like fear, anger, guilt or shame. Often this is observed by parents, teachers, coaches or other adults who know the child and interact with them over a period of time. The older child might report that he no longer feel positive emotions like happiness or satisfaction. He might describe feeling numb or not feeling anything at all. The caregivers of younger children notice their child is less happy and appears listless.

 

Traumatized school-aged children sometimes lose interest in activities they previously enjoyed before like reading, drawing, participating in sports or in social events. Good students may disengage from learning and marks drop following a traumatic incident. Kindergarteners and preschoolers interact less with peers and adults.  Their play becomes constricted, characterized by less exploration and variety in the toys they play when compared to their pre-trauma play.

 

Changes in arousal and increased sensitivity

Children over six and adolescents may experience an increase in irritability and anger in the aftermath of a traumatic event. They may engage in dangerous or self-destructive activities. Their awareness of the environment is heightened as they scan for recurring danger. They are often more jumpy, have problems paying attention and have new difficulties getting and staying asleep.

Their younger counterparts are also more irritable and angry, lashing out verbally or physically towards people and objects around them. Temper tantrums occur frequently with little or no reason.

 

What parents and caregivers can do

When did this happen?

Sometimes a high-impact event for the child does not immediately come to the attention of a grown up. Caregivers have to decode the stories, symptoms and behaviours of traumatized children by comparing the child’s past behavior to puzzling, current behavior. When any of the behaviours described above emerge in combination with one another we seek out explanations for what might be causing the child to act in these ways now. Mara started grade one in September, she was up early every morning, dressed and eager to get to school. In November, her nightmares, irritability, aggression and sleep disturbances hinted at a new and different story. When questioned by her parents about whether something happened after the Thanksgiving holiday, she tearfully disclosed that, every day, bigger girls were making fun of her on the play yard. Her parents addressed the issue with the teacher who spoke to the other children involved and a safety plan was put into place. Gradually Mara’s irritability and troubling nightmares decreased.  She regained some of her confidence and enjoyment of grade one but remained more subdued for a few months afterward.

For children like Tanya and Ann, the effects of trauma are life long.  Tanya’s serious burns, and subsequent medical treatment in infancy, calibrated her physiological systems creating or intensifying her struggles with attention, managing strong emotions and hyper-sensitivity to sudden sensory input. This was identified 13 years later by an astute Child and Adolescent Psychiatrist.  For Ann, prolonged exposure to chronic conflict and violence taking place in her home shaped her responses to loud voices and molded her views of responsibility and gender roles in the family.

Tender Loving Care  

Children need more re-assurance and closeness from their caregivers within the first month following exposure to a traumatic event. Structure and predictability in their outer worlds, like home and school, free up the child to do the hard work of making sense of the trauma-induced turmoil in his or her inner world.  

The moments when the day draws to a close are very difficult for traumatized people of any age. Activities of a busy day provide a welcomed distraction from troubling thoughts and emotions then invariably re-emerge when the tired body and mind prepare for sleep. Regular bedtimes and nighttime routines with adult supervision are key re-establishing good sleep and supporting a child’s physical, emotional and cognitive stabilization.

Often children take a developmental step backward after a disturbing event. Newly toilet-trained toddlers soil again or school-aged children who, previously, walked to school alone, ask to be accompanied. This is normal and expected. When caregivers respond with compassionate validation (see below) and support these important milestones are regained within a few weeks.  

Face your Fears

Avoidance is a predictable response to fear-inducing situations. It is natural for children (and the rest of us) to avoid the people, places and things associated with overwhelming discomfort. However, gentle, step-wise exposures to those very triggers brings relief and mastery when done correctly. To address his fear of dogs, Ali’s parents took him to the park to watch dogs playing with their owners. They offered reassurances when Ali grew anxious, kneeling down at his level rather than picking him up. Over the next few weeks, they approached small dogs (with the permission of their owners) and pet the animals, encouraging Ali to do the same. As he became more comfortable Ali began to interact with bigger dogs. Ali and his mother spoke with the owner of the excitable canine who tackled Ali. The man explained that his dog was still young and learning how to behave around people. His puppy liked kids and hadn’t meant to scare Ali. Over time Ali increased his proximity until he could hold the dog’s leash. Eventually, Ali became so comfortable, he could pet and then spontaneously hug his new four-legged friend.

Listen and Validate

The intrusive memories experienced by all traumatized people prompt them to replay the trauma over and over. Much like putting a puzzle together, each telling or replaying of the trauma allows us to make sense of another component of the experience. Gradually, over time, a more complete picture is constructed. When children are in the midst of understanding their trauma story, caring adults need to pay close attention, ask simple questions and attend to the child’s responses. Validating the child’s experience is essential. Validation is the process in which the adult conveys to the child that the child’s feelings, thoughts and behaviours are understandable. Ali’s mother told him, “I see that you are nervous being this close to this dog. You were pretty scary when you got knocked over, right?” Ali, nodded vigorously. His mother continued, “This is a small dog and you are much bigger. You can show your worry that this dog won’t hurt you if you pet her.”  When Mac cried about his irreplaceable bike, I said, “even though you were really hurt, you know you are getting better. You aren’t sure you’ll find another bike as good as the one you had.” Mac, nodded, took a deep breath and his tears stopped.

This type of support and validation is important for all children exposed to trauma. However, for kids like Tanya and Ann, it may not be sufficient to address and correct the injuries of their respective traumas. Focused assessment and multi-faceted treatment may be needed requiring a referral for more specialized care.  

You can get better

It is an exciting time to work with traumatized toddlers, children, adolescents and their families because we understand more than ever that each trauma symptom serves a purpose and can guide intervention. Trauma focused models of treatment that utilize exposure have been scientifically proven to be effective with many types of trauma. For children and teens who are too overwhelmed to manage therapy alone, medication helps ease distressing symptoms so the child can re-engage with school, learn skills for calming their body reactions and thoughts and tolerate the stress associated with therapy. 

Trauma does not need to define a youngster. It can, and should, be one event of many that promotes growth by teaching a child about herself and the world in which she lives.

Read more about trauma and children at:

NCTSNet.org

The National Child Traumatic Stress Network

www.istss.org.

International Society for Traumatic Stress Studies

http://www.traumacenter.org/

Trauma Center at Justice Resource Institute

AnxietyBC.com

A wonderful website with excellent resources for kids, teen and adults experiencing anxiety including PTSD

[1] Names, scenarios and case histories have been changed to protect the confidentiality and privacy of each client.

[2] In this article, I will alternate between genders although both boys and girls are effected by traumatic events.

Stephanie Rabenstein is a Child and Family Therapist at London Health Sciences Centre in London, Ontario, Canada.