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Children living in the shadows of addiction. Episode 4. The Damage..... · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:10
  SPEAKER_00: Hello and welcome back.
• 0:11
  SPEAKER_00: This is Kim Lee, child and adolescent psychotherapist, and this is episode four in the series Children Living in the Shadow of Addiction.
• 0:22
  SPEAKER_00: This episode is entitled Children in Pain, the Hidden Psychological Cost.
• 0:30
  SPEAKER_00: Sometimes I lay awake listening.
• 0:34
  SPEAKER_00: I can hear doors closing and sometimes slamming, or voices downstairs or nothing at all.
• 0:44
  SPEAKER_00: That can be the worst bit.
• 0:47
  SPEAKER_00: Because when it's quiet, I don't know what's happening.
• 0:51
  SPEAKER_00: And when I don't know what's happening, I fill the rest in in my head.
• 1:00
  SPEAKER_00: Living in an unpredictable emotional environment places a significant burden on a developing nervous system.
• 1:08
  SPEAKER_00: Children become hyperattuned to potential threats, and their minds learn to anticipate danger.
• 1:16
  SPEAKER_00: Their bodies remain in a state of alertness.
• 1:20
  SPEAKER_00: Research in developmental neuroscience strongly suggests that prolonged exposure to unpredictability can shape the systems responsible for emotional regulation and stress responses.
• 1:33
  SPEAKER_00: And these adaptations may later appear as anxiety, hypervigilance, or difficulties with trust.
• 1:42
  SPEAKER_00: But these are not responses that are underpinned by weakness.
• 1:48
  SPEAKER_00: They're psychological states.
• 1:50
  SPEAKER_00: And these psychological states do not self-resolve.
• 1:55
  SPEAKER_00: What happens is they become embedded and they form a kind of internal program which can be triggered at any given time, later in life.
• 2:09
  SPEAKER_00: And when we consider the psychological effects of addiction upon children, some of the findings are very concerning.
• 2:18
  SPEAKER_00: And of course, this doesn't happen quickly, it happens in a slowly unfolding kind of way, quietly, and across the years of childhood development, the child grows up in an emotional environment which is shaped by unpredictability, fear, tension, and the constant possibility of instability, and somehow the developing mind must adapt.
• 2:51
  SPEAKER_00: We know that through repeated experiences of consistent caregiving, children gradually learn how to regulate their emotions, tolerate stress, and develop a sense of safety in the world.
• 3:05
  SPEAKER_00: But if that learning process is frequently punctuated by emotional unavailability, fear, uncertainty, routines which are disrupted by events.
• 3:20
  SPEAKER_00: This creates the right environment for a child to develop something we call hypervigilance.
• 3:27
  SPEAKER_00: And in such states, children learn to monitor tones of voice, facial expressions, noises.
• 3:35
  SPEAKER_00: And this doesn't appear dramatically, it develops.
• 3:42
  SPEAKER_00: And it often appears, or the effects often appear quietly.
• 3:48
  SPEAKER_00: Difficulty sleeping, heightened anxiety, problems concentrating at school, a persistent sense of unease that is difficult to explain and doesn't appear to be connected to anything in particular.
• 4:03
  SPEAKER_00: And sometimes a deep and unspoken sense of shame.
• 4:09
  SPEAKER_00: Now research over the past two decades has repeatedly shown that children raised in households affected by addiction face significantly elevated risks from a range of psychological difficulties.
• 4:24
  SPEAKER_00: And these include anxiety disorders, depression, post-traumatic stress symptoms, emotional dysregulation, and difficulties forming secure relationships.
• 4:37
  SPEAKER_00: Very worryingly, studies across Europe and North America also show that children of parents with substance abuse disorders are between two and four times more likely to develop substance misuse problems themselves.
• 4:55
  SPEAKER_00: Many of the adult patients I have seen over the years who have addictive disorders come from families where a parent or both parents had the same difficulty.
• 5:10
  SPEAKER_00: And this increased vulnerability is not simply explained by genetics alone.
• 5:17
  SPEAKER_00: Because equally powerful is the psychological environment in which the child grows.
• 5:23
  SPEAKER_00: So children learn how distress is managed by observing the adults around them.
• 5:29
  SPEAKER_00: And if adult if alcohol and drugs become the primary self-medicating means for emotional pain, then those behaviors may gradually become normalized.
• 5:40
  SPEAKER_00: But addiction is not the only possible outcome.
• 5:44
  SPEAKER_00: Some children express their distress in other ways.
• 5:48
  SPEAKER_00: Self-harm, risk-taking behavior, withdrawal, aggression, putting themselves in positions where they're likely to come into contact with the criminal justice system.
• 6:00
  SPEAKER_00: And it's often within the clinical work that this deeper emotional meaning begins to emerge.
• 6:08
  SPEAKER_00: Several years ago, a 15-year-old girl was referred for therapy following a series of increasingly serious incidents, both at school and at home.
• 6:20
  SPEAKER_00: And for the purpose of this discussion, I will call her Leah.
• 6:26
  SPEAKER_00: Leah had been caught stealing from shops, department stores.
• 6:30
  SPEAKER_00: She had been involved in fights in public places.
• 6:34
  SPEAKER_00: She'd been found collapsed after drinking in a public place.
• 6:40
  SPEAKER_00: She'd also been suspended and expelled from schools for a whole variety of episodes for different things that had occurred, including bringing alcohol into the school grounds.
• 6:55
  SPEAKER_00: Now by the time she arrived in the consulting room, she had developed a reputation as being a difficult and highly troubled young person.
• 7:06
  SPEAKER_00: It's true that she had difficulties, very great difficulties, and it's true that she was severely damaged.
• 7:16
  SPEAKER_00: But beneath the story, that surface reputation was far more complex.
• 7:24
  SPEAKER_00: Both of Leah's parents struggled with severe addiction.
• 7:28
  SPEAKER_00: Her father had a long history of alcohol misuse.
• 7:31
  SPEAKER_00: Her mother had become dependent on prescription medication, and the household in which she grew was deeply unstable.
• 7:40
  SPEAKER_00: Arguments and acrimony were common.
• 7:44
  SPEAKER_00: Very often Leah was caught between two highly acrimonious parents.
• 7:52
  SPEAKER_00: Money began to disappear.
• 7:54
  SPEAKER_00: There were long periods when basic routines, meals, school attendance, bedtime simply broke down.
• 8:02
  SPEAKER_00: And Leah began drinking alcohol when she was thirteen.
• 8:06
  SPEAKER_00: Soon after she began experimenting with drugs.
• 8:10
  SPEAKER_00: And around the same time she began harming herself.
• 8:15
  SPEAKER_00: Small cuts on her upper arms at first, then deeper ones.
• 8:22
  SPEAKER_00: When she was able to feel settled in the room, it was possible for me to ask her about those cuts.
• 8:35
  SPEAKER_00: And I said, I wonder when when you do that, when you cut yourself, what does it feel like before and during and afterwards?
• 8:49
  SPEAKER_00: And she described that beforehand it was like she had no choice.
• 8:54
  SPEAKER_00: She had to do it, and she'd been planning it all day.
• 8:58
  SPEAKER_00: She had a particular blade that she used, a particular location.
• 9:04
  SPEAKER_00: And that gave way when she was cutting to a feeling of relief.
• 9:10
  SPEAKER_00: And afterwards she would describe herself as feeling level and calm.
• 9:17
  SPEAKER_00: Now these things may seem startling to hear, but looking at it from a psychothericerapeutic and clinical point of view, to me her behavior made perfect sense.
• 9:36
  SPEAKER_00: It gave her what she needed in a very dysfunctional way, and my task was to translate that into something else.
• 9:45
  SPEAKER_00: And she said, when everything inside me feels like it's chaos, when it's just constant pain, sometimes cutting myself is the only thing that makes it feel quiet.
• 9:59
  SPEAKER_00: Her behavior, the drinking, the self-harm, the stealing, had often been interpreted by adults as defiance, and they were critical of her behavior.
• 10:12
  SPEAKER_00: But they failed to understand that there was a context in which these behaviors could be made sense of.
• 10:20
  SPEAKER_00: And yes, of course, the behaviors needed attention, but so too did their cause, because this wasn't rebellion, these were attempts to regulate unbearable emotional experiences.
• 10:34
  SPEAKER_00: Another young person I worked with, Christopher.
• 10:40
  SPEAKER_00: He'd grown up in a household where alcohol misuse was a persistent presence.
• 10:46
  SPEAKER_00: He was eleven when he first came to therapy.
• 10:50
  SPEAKER_00: Teachers described him as a child who was constantly anxious.
• 10:53
  SPEAKER_00: He struggled to concentrate in class and he appeared exhausted much of the time.
• 10:59
  SPEAKER_00: And in addition, they noticed that he was unkempt.
• 11:02
  SPEAKER_00: His clothes didn't appear to have been washed, and he was losing weight.
• 11:08
  SPEAKER_00: Sometimes he experienced sudden bursts of rage that he didn't understand.
• 11:15
  SPEAKER_00: During one session, he began with playing with some toys in the consulting room.
• 11:23
  SPEAKER_00: And he placed a small child figure on the center of the rug.
• 11:30
  SPEAKER_00: And then he placed two adult figures some distance away.
• 11:35
  SPEAKER_00: And the adults were laying on their sides, not moving, no interaction.
• 11:43
  SPEAKER_00: And then he added a crocodile.
• 11:47
  SPEAKER_00: Now when children play, they're using their imaginations and the toys as vehicles for expression of their internal world.
• 12:01
  SPEAKER_00: It is not for me to tell them what the representation is, it is for me to be curious with them.
• 12:13
  SPEAKER_00: I said this is a really interesting scene.
• 12:18
  SPEAKER_00: That little person over there seems to be watching the grown-ups.
• 12:24
  SPEAKER_00: And he said they're asleep.
• 12:27
  SPEAKER_00: And I said, I see.
• 12:33
  SPEAKER_00: And I asked him, so what's the little boy doing?
• 12:39
  SPEAKER_00: And he said he's waiting.
• 12:41
  SPEAKER_00: And I asked for what?
• 12:44
  SPEAKER_00: And he said for them to wake up.
• 12:48
  SPEAKER_00: And I said, Do you think the little boy might be feeling lonely?
• 12:54
  SPEAKER_00: And he said, and hungry.
• 12:58
  SPEAKER_00: Very, very powerful because what struck me about this wasn't just the image, it was the make the emotional reality that it captured.
• 13:07
  SPEAKER_00: And for many children, growing up in families affected by addiction, childhood becomes a process of waiting, waiting for the adult world to stabilize, waiting for someone to be emotionally available, waiting for the moment when it might feel finally safe.
• 13:27
  SPEAKER_00: When we look at the long-term effects of growing up alongside addiction, another important question emerges.
• 13:34
  SPEAKER_00: Why do some children who experience deeply painful childhood environments later find themselves drawn to similar environments in adulthood?
• 13:45
  SPEAKER_00: Why might someone raised in an addicted household later struggle with addiction themselves?
• 13:53
  SPEAKER_00: Or repeatedly enter relationships characterized by instability.
• 13:59
  SPEAKER_00: Psychoanalytic theory offers an important insight into this pattern.
• 14:05
  SPEAKER_00: Freud described the phenomenon as repetition compulsion.
• 14:11
  SPEAKER_00: Rather than simply remembering the painful experiences from the past, individuals may unconsciously recreate aspects of those experiences in the present.
• 14:24
  SPEAKER_00: And later psychoanalytic thinkers expanded the idea, describing processes known as identification with the aggressor.
• 14:35
  SPEAKER_00: When children grow up in environments dominated by powerful and unpredictable adults, they're placed in a profoundly vulnerable position.
• 14:45
  SPEAKER_00: And one of the ways that the psyche attempts to manage this vulnerability is by unconsciously identifying with the powerful figure in the environment.
• 14:56
  SPEAKER_00: So if I become more like the powerful person, perhaps I will no longer feel powerless.
• 15:02
  SPEAKER_00: Over times, these identifications may become embedded within the developing personality.
• 15:10
  SPEAKER_00: The emotional patterns of childhood are internalized as what object relations theorists describe as internal relational templates.
• 15:22
  SPEAKER_00: And those templates can quickly shape the kinds of relationships that feel familiar later in life.
• 15:31
  SPEAKER_00: Sarah was a woman I worked with some years ago, and she was in her early thirties, and she'd come to therapy following a series of disastrous relationship breakdowns.
• 15:48
  SPEAKER_00: And she described a pattern that had repeated itself across several relationships.
• 15:54
  SPEAKER_00: Each partner initially appeared charismatic, exciting, and intensely attentive.
• 16:01
  SPEAKER_00: But over time, the relationship would begin to change, alcohol would become more prominent, arguments would become more frequent, emotional availability would gradually disappear, and eventually the relationship would become chaotic and exhausting.
• 16:20
  SPEAKER_00: And Sarah would find herself desperately trying to stabilize it.
• 16:26
  SPEAKER_00: As we explored her childhood experiences, something important emerged.
• 16:32
  SPEAKER_00: Sarah had grown up with a father who struggled with alcohol addiction.
• 16:36
  SPEAKER_00: And during her childhood, there were many moments when he was affectionate, engaging, and deeply loving, but those moments were quickly followed by periods of heavy drinking and emotional absence.
• 16:50
  SPEAKER_00: And as she reflected on her adult relationship, Sarah noticed something she hadn't previously recognized.
• 16:58
  SPEAKER_00: The emotional rhythm of those relationships felt strangely familiar.
• 17:04
  SPEAKER_00: And after a long pause, she said, I think I've been trying to fix something that happened a long time ago.
• 17:12
  SPEAKER_00: That moment captured something essential about trauma repetition.
• 17:16
  SPEAKER_00: The mind doesn't simply revisit the past in memory.
• 17:23
  SPEAKER_00: Sometimes it attempts to revisit it in lived experience, and often with the unconscious hope that this time the story may end differently.
• 17:36
  SPEAKER_00: I'm reminded of the work of Judith Field in her book Necessary Losses, where she describes each dysfunctional and destructive encounter in relationships is an unconscious attempt to try and have a different outcome.
• 17:54
  SPEAKER_00: Sometimes I think about what it would be like if our house felt calm, if evenings were just normal, where people talk and laugh and nothing suddenly changes.
• 18:10
  SPEAKER_00: I don't think children expect everything to be perfect, but I just want to know that the grown-ups are okay because when the grown-ups aren't okay, you never really stop worrying.
• 18:26
  SPEAKER_00: When children grow up carrying that kind of quiet, persistent worry, it doesn't simply disappear as they get older.
• 18:34
  SPEAKER_00: It becomes woven into the ways they understand safety, relationships, and themselves.
• 18:41
  SPEAKER_00: Something important must also be said.
• 18:46
  SPEAKER_00: Understanding these experiences, bringing them into language is often the first step towards recovery and change.
• 18:56
  SPEAKER_00: Because once the hidden emotional realities of childhood are recognized, the patterns they create no longer have to remain invisible.
• 19:06
  SPEAKER_00: And when they're no longer invisible, they no longer have to be repeated.
• 19:12
  SPEAKER_00: When addiction enters a family, it doesn't affect just one person.
• 19:17
  SPEAKER_00: Its shadow falls across the lives of all of the children who grow up beside it.
• 19:24
  SPEAKER_00: Thank you for listening.