Basic Assumptions for Working with Traumatized Family Members with Attachment Problems

Last week I attended the New Hampshire Infant Mental Health Conference.  The primary focus of the conference was evaluating for and treating trauma in children.  Cassie Yackley, Psy.D. of the Dartmouth Trauma Intervention Research Center adapted and presented the following from Dan Hughes’ Basic Assumptions for Parenting and Treating Traumatized, Attachment-Resistant Children.  I thought it would be valuable to post here.

Whenever you are working with a parent or child who has suffered trauma remember:

1.      They are doing the best they can.

2.      They want to improve.

3.      Their life, as it is not, is “a living hell.”

4.      They try to be safe by controlling everything in their environment.

5.      They try to be safe by avoiding everything that is stressful and painful.

6.      Their “attacks” reflect a fear of your motives for the nurturing and support you provide.

7.      Poor affect regulation, fragment thinking, a pervasive sense of shame, inability to trust, and lack of behavioral controls inhibit them from being able to have the relationships they desire.

8.      For them to change, they will need you to accept, comfort, and teach them.

9.      You will need to validate their sense of self (and family) while teaching them important developmental skills.

10.  You will need to understand their developmental stage and adjust your expectations to match so that they will have success, not failure.  Your physical and psychological presence are the foundation of your comforting and teaching them.

11.  Under stressful emotional conditions, they will regress and revert to basic, solitary defenses that they have used to survive.

12.  They will have to work hard to learn how to live well.  You cannot do the work for them, nor can you save them. You can comfort and teach them.

13.  You will need support and consultation from trusted others if you are to be able to successfully comfort and teach them.  You will make mistakes and will need to face these, learn from them, and continue.

Trauma and Self Harm – When Hurting Helps the Pain

As domestic violence and sexual assault advocates we often come into contact with situations that we don’t feel equipped to handle.  Even though we understand the dynamics of power and control and receive training and education on providing empowering services that allow for the victims/survivors to make their own choices, we are often taken aback and feel powerless when we meet someone who has scars from injuries that were self-inflicted.  Unless we understand the underlying motivations behind self-harm we are at risk of over-reacting by assuming the injury is a part of a suicidal gesture or we under react by ignoring the evidence of internal pain.

According to Solomon and Farrand (1996) “the assumption is that the alternative to self-injury is ‘acting normally,’ but on the contrary . . .  the alternative to self-injury is total loss of control and possible suicide.  It becomes a forced choice from among limited options.”  In other words, when a person engages in self-injury she/he may be doing so in order to relieve the pain and anxiety and reduce the feelings of wanting to commit suicide.  “A basic understanding is that a person who truly attempts suicide seeks to end all feelings whereas a person who self-mutilates seeks to feel better (Favazza, 1998).”

Another misconception regarding persons who self-injure is that they are “attention seeking.”  Most people who self-harm are trauma survivors and experiencing extreme internal pain and ongoing activation of the flight-fight-freeze response (see my BrainTalk).  Throughout their lives they may not have had this internal pain validated.  In fact, many survivors have been accused of lying and manipulating by those people and systems that were supposed to help them.  When this type of pain is not recognized, an external expression of pain may feel necessary in order to have others see some sort of manifestation of what is happening internally.

According to Bessel Van der Kolk, “neglect [was] the most powerful predictor of self-destructive behavior.  This implies that although childhood trauma contributes heavily to the initiation of self-destructive behavior, lack of secure attachments maintains it.  Those… who could not remember feeling special or loved by anyone as children were least able to control their self-destructive behavior.”  This neglect leads to a person feeling that there are not of value and not worthy of any care or support.

People who self-injure do so in order to feel something or to not feel so much.  If a person is dissociating (feeling disconnected from self or surroundings) she/he may self-injure in order to be able to feel something and be able to feel grounded within the body again.  Some people may be feeling so much, the emotions are so activated, that the self-injuring may be a way to calm down and possibly reach a state where the feelings are less intense,

The following are some guidelines for responding to someone’s self-injuring:

Show that you see and care about the person in pain beyond the injury. 

Show concern for the injury, address safety (is the cut deep, has the person cleaned or treated the injury, etc.) and then move to validating the pain the person must be in to have done the injury. 

Make it clear that it is okay to talk about self-injury and convey your respect for the person’s efforts to survive.  She was doing the best that she could.

Help the person make sense of the self-injury.  When did it start?  What was happening then?  Explore how self-injury has helped the person survive in the past. 

Encourage the person to find safe ways to deal with buried feelings and seek support in order to care for herself.

Acknowledge that is frightening to think about living without self-injury and that reducing how often it occurs can be the first step.  She may need to learn there are other things that work before she can make different choices.

It is important mostly to remember that by validating the pain beneath the injury we are letting the person know that they are of value and recognized as a survivor.