Latest / Inside The Consulting Room - Understanding the Child Behind the Behaviour / PTSD. Episode 3. Traumatic Memories In Children

Transcript

PTSD. Episode 3. Traumatic Memories In Children · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:00
  SPEAKER_00: To the series on post-traumatic stress disorder in children and young people.
• 0:06
  SPEAKER_00: This this is episode three, and what we're going to do today is to look at the symptomatic expressions and the ways in which those find expression through behavior.
• 0:21
  SPEAKER_00: So I've entitled this script as The Memories That Will Not Rest.
• 0:26
  SPEAKER_00: I want to remind people that trauma isn't simply what happened to a child, it's what the mind was forced to carry afterwards.
• 0:37
  SPEAKER_00: Now in the previous episode, we explored how trauma affects the brain, how the nervous system can become organized around survival, but trauma also affects other things.
• 0:51
  SPEAKER_00: One of those is memory, because for many traumatized children and young people, memories don't behave in the way that we formally or normally expect memories to behave.
• 1:03
  SPEAKER_00: Instead of them settling into the past, they can return suddenly, powerfully, and most often without warning.
• 1:14
  SPEAKER_00: Most memories gradually become part of the story of our lives.
• 1:20
  SPEAKER_00: They kind of connect together and weave an albeit unsteady but nonetheless sort of significant chain of events to create the story of who we are and how we got here.
• 1:33
  SPEAKER_00: And we can remember them.
• 1:35
  SPEAKER_00: And sometimes we remember things that are difficult, but we don't feel overwhelmed.
• 1:41
  SPEAKER_00: But traumatic memories are very different because instead of becoming quiet recollections, they remain emotionally unfinished.
• 1:51
  SPEAKER_00: And sometimes the things that trigger those memories are seemingly ordinary associations, a smell, a sound, a place, a sudden movement, even a facial expression.
• 2:08
  SPEAKER_00: And any of these can activate that memory again.
• 2:13
  SPEAKER_00: And when this happens, the child the child may feel as though, remember I said feel as though the event is happening all over again.
• 2:23
  SPEAKER_00: Because the thinking brain once again gets overwhelmed.
• 2:30
  SPEAKER_00: And this this is quite important in the in in my work with patients when I help them to understand the difference between then and now.
• 2:41
  SPEAKER_00: But I'll come on to that at another time.
• 2:47
  SPEAKER_00: A little girl said to me that she couldn't sleep at night because the things came out, and the things that she was referring to had to do with events within the household some while ago that had to do with significant conflict.
• 3:10
  SPEAKER_00: Now that resulted in the parents separating, and she said, sometimes I know it's not happening anymore.
• 3:23
  SPEAKER_00: And that was the arguments, things being broken.
• 3:27
  SPEAKER_00: And then she said, But my body still feels like it is.
• 4:09
  SPEAKER_00: I wouldn't say it's as I wouldn't say it takes control, but it takes priority.
• 4:14
  SPEAKER_00: As a result, the experience doesn't become organized and integrated into a coherent narrative.
• 4:21
  SPEAKER_00: Instead, it remains unfinished.
• 4:25
  SPEAKER_00: And unfinished memories have a way of returning.
• 4:30
  SPEAKER_00: Another girl, 16 years old, came to therapy several months after an experience that had left her deeply unsettled and wounded.
• 4:43
  SPEAKER_00: She'd been to a party and drunk far more alcohol than she intended, and there was a suspicion that alongside the alcohol there may have been drugs.
• 4:54
  SPEAKER_00: Now later that evening, someone she trusted took advantage of her vulnerable state and crossed a boundary that she hadn't agreed to being crossed.
• 5:08
  SPEAKER_00: In the weeks that followed, she struggled to sleep.
• 5:13
  SPEAKER_00: She struggled to concentrate.
• 5:16
  SPEAKER_00: She felt ashamed and fearful, and sometimes fragments of the experience returned suddenly, not as a clear narrative, but as flashes or of sensation and emotion, feeling of helplessness, a sense of confusion, a moment that she couldn't fully piece together.
• 5:40
  SPEAKER_00: What troubled her most was that the memory didn't behave like something that was over.
• 5:47
  SPEAKER_00: Instead, it kept appearing unexpectedly, as though the mind was still trying to understand what happened.
• 5:55
  SPEAKER_00: Now, when traumatic memories return in this way, they are sometimes and often described as flashbacks.
• 6:02
  SPEAKER_00: And a flashback isn't simply remembering something unpleasant.
• 6:07
  SPEAKER_00: It's a moment when the brain briefly relives the experience.
• 6:11
  SPEAKER_00: A flashback is not the same as recall that we have some degree of control over.
• 6:18
  SPEAKER_00: Flashbacks happen automatically and by association.
• 6:23
  SPEAKER_00: So the body's reacting as though the threat has returned, and all of the physical symptoms to prepare the body to go into survival mode will happen.
• 6:35
  SPEAKER_00: A 12-year-old boy at once witnessed a frightening and very violent incident in his neighborhood.
• 6:43
  SPEAKER_00: And although months later he appeared to be coping well, one day at school a heavy metal tray fell on the floor, and the sudden noise kind of echoed through the classroom.
• 6:57
  SPEAKER_00: But this boy pushed his chair backwards and ran to the door.
• 7:03
  SPEAKER_00: His teacher misunderstood what the boy was doing and for a moment thought he was behaving disruptively.
• 7:13
  SPEAKER_00: But what was actually happening was something very, very different.
• 7:16
  SPEAKER_00: The sound had triggered his brain's alarm system, and for a brief moment his nervous system reacted as though the early danger had returned.
• 7:26
  SPEAKER_00: It reminds me of a patient I worked with who I called him the boy who would run.
• 7:37
  SPEAKER_00: Going to school for him was incredibly difficult difficult.
• 7:40
  SPEAKER_00: And sometimes he would just not be able to get out of the car once once they'd arrived near the school and would curl up in the footwell.
• 7:51
  SPEAKER_00: And on those occasions, occasions when he was able to be gently coaxed out of the car, there was a point at which on approaching the entrance he just ran and disappeared.
• 8:08
  SPEAKER_00: And what was and I've seen this in more than one child, that was not something he had control over.
• 8:19
  SPEAKER_00: And it's a very, very common reaction in children who have unprocessed, untreated trauma.
• 8:30
  SPEAKER_00: It's not the only explanation for that behavior.
• 8:34
  SPEAKER_00: And I suppose because memories can be so distressing, children often develop strategies, ways, and means to avoid reminders of the event.
• 8:46
  SPEAKER_00: They might avoid certain places, certain activities, sometimes even conversations about what's happened, because the avoidance protects the child from immediate distress, but also it prevents the memory from being fully processed.
• 9:05
  SPEAKER_00: Now, this this this kind of behavior can often be misinterpreted as social anxiety disorder or a phobia.
• 9:15
  SPEAKER_00: Well, I suppose, yes, that is those are features, but those are the presenting symptomatic features.
• 9:25
  SPEAKER_00: Underneath all of that, something else is going on.
• 9:28
  SPEAKER_00: And there are some similarities in the psychoneurology or the bioneurology in those conditions, but we're focusing on trauma.
• 9:39
  SPEAKER_00: I had a nine-year-old boy who was referred to therapy because they become unusually quiet and withdrawn, and his father had been struggling with severe alcohol problems.
• 9:54
  SPEAKER_00: And during certain episodes when he was intoxicated, he sometimes crossed physical boundaries that left the child feeling frightened and confused.
• 10:08
  SPEAKER_00: Now, for a long time she said, sorry, he said nothing.
• 10:12
  SPEAKER_00: And children often believe that speaking about such experiences might cause harm to their family or bring consequences that they can't control.
• 10:24
  SPEAKER_00: And quite often such children will be told, if you say anything you won't be believed, or if you say anything, something bad will happen.
• 10:35
  SPEAKER_00: Now it wasn't known at the time when this child was referred that what lie beneath his presenting difficulties was very worrying, very concerning abuse.
• 10:54
  SPEAKER_00: But over time he began to, through play and through talk, talking about how things were, he began to say things like, I thought it was something I did wrong.
• 11:10
  SPEAKER_00: And then it left me thinking and a feeling that that simple sentence reveals one of the deepest psychological effects of trauma.
• 11:22
  SPEAKER_00: The child absorbs responsibility for something that was never theirs to carry.
• 11:27
  SPEAKER_00: And I've seen this in so many cases.
• 11:31
  SPEAKER_00: I've referred before to this thing I call uncommon sense.
• 11:36
  SPEAKER_00: Children aren't automatically equipped to see the world and make sense of the world in the same way that grown-ups do.
• 11:44
  SPEAKER_00: And what we have to do as grown-ups is to remind ourselves to look at the experience through the eyes of the child.
• 11:52
  SPEAKER_00: And children will very often take responsibility for what's happened, even when the bad things that have happened have been done by a grown-up.
• 12:03
  SPEAKER_00: Recovery from trauma often involves helping the child's brain to finish a process that was interrupted.
• 12:11
  SPEAKER_00: The memory must gradually become organized into a story, something that happened once.
• 12:19
  SPEAKER_00: That said it could be that that something had happened more than once.
• 12:27
  SPEAKER_00: But that it's something that belongs in the past.
• 12:30
  SPEAKER_00: Now, saying that to a child who is suffering with PTSD is a complete waste of time.
• 12:39
  SPEAKER_00: That's not what we do, but I suppose that is our direction of travel.
• 12:44
  SPEAKER_00: That's what we want the child to be able to internalize.
• 12:49
  SPEAKER_00: It happened and it's stopped now, and it's not going to happen now.
• 12:56
  SPEAKER_00: I'm okay, but of course, we can remember that part of the brain that's saying, ah, but it could happen again, you know, and entirely understandable.
• 13:04
  SPEAKER_00: But that's a that's that's another part of the treatment process.
• 13:10
  SPEAKER_00: I referred to EMDR, and I think this can really help the brain resume its natural processing so that the memory becomes less intrusive and the nervous system learns something new.
• 13:24
  SPEAKER_00: But I also talked about the importance of the relationship, the importance of whether it's a child, an adolescent, or a patient, an adult patient, the importance of the therapist being someone who can bear the pain.
• 13:47
  SPEAKER_00: And that's not about being strong, it's about being able to be with someone who is in intense pain and not collapse.
• 13:58
  SPEAKER_00: And someone who can help the child, adolescent, adult do something that I call utter the unutterable, to be able to say the words that the mind can't easily cope with hearing.
• 14:15
  SPEAKER_00: That's our job as therapists.
• 14:19
  SPEAKER_00: In the next episode, we will explore another way of understanding trauma by comparing the psychological injury to something very familiar, and that is physical wounds, because when physical trauma is left untreated, the body will heal badly and form scalp tissues, and in many ways, exactly the same is true of psychological wounds.
• 14:45
  SPEAKER_00: I look forward to welcoming you back to episode four, and thank you for listening.