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Trauma Recovery · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:00
  SPEAKER_00: Hello and welcome back.
• 0:02
  SPEAKER_00: This is Kim Lee, child and adolescent psychotherapist, and thank you for joining me for this final episode in the series on post-traumatic stress, post-traumatic stress disorder, and recovery.
• 0:18
  SPEAKER_00: And this episode is about recovery.
• 0:21
  SPEAKER_00: It's about how the mind heals.
• 0:25
  SPEAKER_00: At the beginning of every episode, I've said that trauma isn't simply what happened to a child, it's what the child's mind was forced to carry afterwards.
• 0:36
  SPEAKER_00: Throughout the series, we've looked at the many ways trauma can affect the lives of children and young people, how the brain becomes organized around danger, how memories just refuse to remain in the past and come back in fragments.
• 0:52
  SPEAKER_00: We've talked about emotional scars, shame.
• 0:56
  SPEAKER_00: But trauma is only part of the story.
• 1:01
  SPEAKER_00: Because the human mind also possesses something extraordinary, and that is the capacity to heal, albeit with help.
• 1:11
  SPEAKER_00: So just as the body contains systems designed to repair physical injury, the mind contains processes designed to integrate emotional experience.
• 1:23
  SPEAKER_00: So when distressing events occur, the brain normally begins a gradual process of emotional digestion.
• 1:32
  SPEAKER_00: And over time the experience becomes organized into memory.
• 1:37
  SPEAKER_00: When the emotional intensity softens, the event becomes part of the narrative of the past.
• 1:45
  SPEAKER_00: But that is in spontaneous recovery, whereas trauma can interrupt this process and the experience becomes stuck.
• 1:55
  SPEAKER_00: So the nervous system continues responding as though the danger might still return.
• 2:02
  SPEAKER_00: Recovery, therefore, involves helping the brain complete the healing process that was interrupted.
• 2:11
  SPEAKER_00: One of our most consistent findings in trauma research is that healing rarely occurs in isolation.
• 2:19
  SPEAKER_00: Children recover most effectively when they experience safe and reliable relationships from parents, caregivers, teachers, and of course therapists.
• 2:30
  SPEAKER_00: And when a child experiences a relationship where their emotional world is recognized and understood, the nervous system begins to relax.
• 2:40
  SPEAKER_00: The brain slowly relearns something it once lost, and that is that the world can contain safety again.
• 2:51
  SPEAKER_00: One child has told me frequently it used to feel like everything could go wrong at any moment.
• 2:59
  SPEAKER_00: This was somebody reflecting on how things were when she first came to therapy.
• 3:07
  SPEAKER_00: She now says, but it just feels like something that happened, which is the integration of the experience through the therapeutic relationship.
• 3:19
  SPEAKER_00: I had an 11-year-old girl some years ago who was referred following a frightening burglary that had happened in her neighborhood.
• 3:30
  SPEAKER_00: And although her own home hadn't been entered, she had heard shouting and police sirens late at night.
• 3:39
  SPEAKER_00: For months afterwards, not only did she struggle to sleep, but she had to perform a routine to make sure that all of the windows and the doors had been locked and that things were safe outside.
• 3:55
  SPEAKER_00: And this became something that was pervasive and something that her parents quite understandably had to enter into with her.
• 4:04
  SPEAKER_00: Nonetheless, even with that in place, the part of her that was activated kept her awake.
• 4:12
  SPEAKER_00: Every small noise in the house caused her to sit up in bed and call for her parents.
• 4:19
  SPEAKER_00: And although she had repeated reassurance, it wasn't working.
• 4:25
  SPEAKER_00: It was the right thing to do, but it didn't calm her nervous system because the fear didn't live in her logic, it lived in the brain's alarm system.
• 4:36
  SPEAKER_00: But gradually, through the therapeutic work and the steady reassurance of trusted adults, the intensity of the fear began to soften.
• 4:47
  SPEAKER_00: One evening she told her mother before she went to sleep something simple.
• 4:53
  SPEAKER_00: It was just, I think it was just something that happened and something that isn't going to happen anymore.
• 5:01
  SPEAKER_00: Now, just that perception, that shift in perception, really marked an important change.
• 5:08
  SPEAKER_00: Her nervous system had begun to recognize that the danger had passed.
• 5:14
  SPEAKER_00: Sometimes traumatic memories require a more direct therapeutic processing, and approaches such as EMDR or eye movement desensitization and reprocessing therapy help the brain resume a more natural information processing system.
• 5:32
  SPEAKER_00: So during EMDR, the person recalls aspects of the traumatic experience while engaging in what I referred to previously, which was the bilateral stimulation, which has to do with particular kind of eye movements.
• 5:48
  SPEAKER_00: Gradually the brain reorganizes the memory and the emotional intensity softens.
• 5:56
  SPEAKER_00: And then the memory becomes integrated into the story of the past.
• 6:01
  SPEAKER_00: So instead of triggering fear, it becomes something that can be remembered without being relived.
• 6:09
  SPEAKER_00: Fifteen-year-old boy who I saw briefly had experienced a very frightening assault whilst walking home from school.
• 6:17
  SPEAKER_00: And in the months that followed, he understandably avoided the street where the incident had taken place.
• 6:25
  SPEAKER_00: Even seeing the road sign caused him to feel anxiety and panic.
• 6:32
  SPEAKER_00: During therapy, he gradually described the event, and at first the memory uh the was only existing in fragments, and this is a very important feature that people very often do not have or are unable to recall a composite memory.
• 6:53
  SPEAKER_00: It's fragmented, and it was made up of images, sensations, moments of fear, and noises, but over time the pieces came together and the story was clearer.
• 7:04
  SPEAKER_00: Now, what we were able to do was to revisit the same street and to do it in stages and to go through what it was that had happened and was not now happening.
• 7:25
  SPEAKER_00: And during that process, which we repeated a few times, he was able to learn that what he had experienced was then, and what he was experiencing in the present were now, was now.
• 7:42
  SPEAKER_00: And what that meant was the sensitivity and the alarm button were quieter and less active.
• 7:50
  SPEAKER_00: So it was not just a physical experience of the walking and the revisiting, it was a central nervous system correction.
• 8:00
  SPEAKER_00: Admittedly, he said it's still not my favorite place, and I don't really want to go there if I have to, but I can manage it, and it doesn't feel dangerous anymore.
• 8:09
  SPEAKER_00: So the memory hadn't disappeared, but then of course it wouldn't.
• 8:12
  SPEAKER_00: But the nervous system was no longer activated in a manner that felt like the danger was still present.
• 8:22
  SPEAKER_00: Now some children, certainly younger children, but not exclusively, don't necessarily respond to EMDR, and that kind of approach that I've just described may not be accessible either.
• 8:39
  SPEAKER_00: So in relational psychotherapy, we often will, with younger children, but again, not exclusively, use play.
• 8:50
  SPEAKER_00: Now, when adults speak about therapy, they often imagine conversation, two people sitting in chairs and talking about difficult experiences.
• 9:01
  SPEAKER_00: But in my experience, that doesn't work too well with small children.
• 9:07
  SPEAKER_00: And so the work doesn't necessarily begin with words, it may begin with play.
• 9:14
  SPEAKER_00: Because play is the natural language of childhood.
• 9:17
  SPEAKER_00: And through play, children will express experiences that may be difficult or impossible to describe directly.
• 9:25
  SPEAKER_00: So in a safe therapeutic setting, toys, drawing materials, sand trays, and imaginative play can become a way for the child to communicate what's being held inside.
• 9:38
  SPEAKER_00: Sometimes a child who has experienced frightening events may repeatedly create scenes of danger and rescue in their play.
• 9:47
  SPEAKER_00: A toy figure might hide, another figure might protect it, a building might collapse and then be rebuilt again.
• 9:55
  SPEAKER_00: To an outsider, this may appear simple, but psychologically something important is happening because the child is presenting their internal world.
• 10:05
  SPEAKER_00: And what they're doing is working through the experience.
• 10:10
  SPEAKER_00: Now, sometimes I will use mutual storytelling as a means of eliciting imaginative expression.
• 10:20
  SPEAKER_00: So I might take an idea, I might create a character, and the character may have all sorts of quirky or odd mannerisms or difficulties, and almost always the character will have a bit of vulnerability contained within it.
• 10:39
  SPEAKER_00: And I will make this as interesting as possible, and I'll tell the story or my bit of the story in whichever voice comes to mind, and I have a few.
• 10:49
  SPEAKER_00: Then what happens is the child enters, and they pick the story up and they go with it wherever they want.
• 10:58
  SPEAKER_00: And what I'll be listening for is the direction, and they'll reach a point where they say, You take over, and so I will I will enter.
• 11:09
  SPEAKER_00: And I've got to be careful because I don't want to rush the story, I want to let it unfold.
• 11:14
  SPEAKER_00: But almost always what happens is that the child will project parts of themselves and their experiences into the story, which makes it then possible for me to add a therapeutically restorative component so that the ending is something which is manageable.
• 11:38
  SPEAKER_00: It may be the case that I make the interpretation, the bits of the story are a bit like the child who's with me.
• 11:48
  SPEAKER_00: But sometimes that can be a bit unsubtle.
• 11:50
  SPEAKER_00: We don't need to be explicit about things.
• 11:54
  SPEAKER_00: So entering into the child's emotional world means that we are able to respond with curiosity and understanding and emotional attunement.
• 12:08
  SPEAKER_00: And over time the child begins to experience something that trauma may have disrupted, a relationship in which their feelings are recognized, tolerated, and understood.
• 12:22
  SPEAKER_00: Something's just come to mind, and it was a 14-15-year-old girl who used to spend every session spinning on my office chair in great delight and talking whilst circulating.
• 12:40
  SPEAKER_00: Did make me feel a bit dizzy, but she seemed okay.
• 12:43
  SPEAKER_00: But I remember her, I remember her very first session, and she looked at me almost as if with with something resembling pure pure hatred.
• 12:57
  SPEAKER_00: And she said, I I don't like therapists.
• 13:03
  SPEAKER_00: But but she used a word before therapist that rhymes with ducking.
• 13:08
  SPEAKER_00: And I said, Oh, I said, Oh, so and that and that's because and she said, because they say stupid things, like my last one said, and how do you feel about that?
• 13:21
  SPEAKER_00: And she tilted her head to one side, and I said, and that happened a lot, and she said, Yes, it did, and I said, took a bit of a gamble.
• 13:30
  SPEAKER_00: I said, and how did you feel about that?
• 13:34
  SPEAKER_00: And she fortunately laughed, and we got on really well.
• 13:38
  SPEAKER_00: But actually, what I was doing was I was demonstrating, yeah, that would be that of course you felt that way.
• 13:43
  SPEAKER_00: You know, you you don't need to be spoken to like that.
• 13:47
  SPEAKER_00: Anyway, back to the script.
• 13:50
  SPEAKER_00: A seven-year-old boy who had repeated, or rather experienced, repeated arguments at home, often used small figures during therapy.
• 14:02
  SPEAKER_00: And at the beginning of the work, the scenes he created were pretty chaotic.
• 14:07
  SPEAKER_00: Figures were knocked over, trampled on, thrown, and quite often, all manner of things would be thrown across the play space.
• 14:17
  SPEAKER_00: Sometimes the family figures in the scene appeared frightened, but gradually something began to change.
• 14:26
  SPEAKER_00: And as the relationship developed, the play became more organized.
• 14:31
  SPEAKER_00: And when I say organized, I don't mean he was playing properly.
• 14:35
  SPEAKER_00: I mean it was there there was more coherence, and the figures still encountered danger, but there were moments of protection and reparation, moments where the scene could settle again.
• 14:49
  SPEAKER_00: So through the play, the child was doing something very important.
• 14:53
  SPEAKER_00: So he was reworking experiences that had once overwhelmed him.
• 14:58
  SPEAKER_00: Now, play therapy and relational psychotherapy allow children to process experiences at the level where those experiences originally occurred, not only through language.
• 15:11
  SPEAKER_00: As children feel increasingly safe within the therapeutic relationship, the nervous system begins to relax.
• 15:20
  SPEAKER_00: And when that happens, the mind becomes capable of doing what trauma wants prevented.
• 15:27
  SPEAKER_00: It becomes capable of integrating the experience.
• 15:32
  SPEAKER_00: Now, integration in this context means all of those fragments coming together to form a picture that is bearable.
• 15:41
  SPEAKER_00: Play, therefore, becomes more than an activity.
• 15:46
  SPEAKER_00: It becomes part of the recovery process.
• 15:49
  SPEAKER_00: It's a way for children to reclaim the thing that's been disrupted, their sense of safety and their sense of creativity.
• 15:59
  SPEAKER_00: Recovery doesn't mean forgetting the past, it means reintegrating and reinterpreting the experiences in a different way.
• 16:08
  SPEAKER_00: The memory remains, but it's no longer powerful.
• 16:12
  SPEAKER_00: What happened was frightening, but it's no longer happening.
• 16:17
  SPEAKER_00: For some young people, the process of recovery also brings unexpected strengths, greater emotional awareness, a deeper understanding of their own resilience.
• 16:29
  SPEAKER_00: And this is something we describe as post-traumatic growth.
• 16:32
  SPEAKER_00: It doesn't mean trauma is beneficial, but it recognizes that the process of recovery can sometimes lead to psychological development that might not otherwise have occurred.
• 16:46
  SPEAKER_00: Adults who support traumatized children play a vital role in this process.
• 16:52
  SPEAKER_00: Recovery requires patience, not demand.
• 16:56
  SPEAKER_00: Trauma doesn't resolve quickly.
• 16:59
  SPEAKER_00: There may be periods of progress followed by moments when old fears return, and that's not that's okay.
• 17:08
  SPEAKER_00: We call that regression, but it tends to be short term.
• 17:12
  SPEAKER_00: Under stress, we see symptoms, they re-emerge, but it's okay.
• 17:18
  SPEAKER_00: When adults remain calm and consistent and emotionally available, they provide the stability that allows the healing to continue.
• 17:26
  SPEAKER_00: And over time, the child begins to internalize that stability and the nervous system that they encountered gradually shows them it's okay.
• 17:40
  SPEAKER_00: When a child experiences trauma, something changes.
• 17:44
  SPEAKER_00: The world becomes uncertain, safety is fragile, and the future may feel unpredictable.
• 17:52
  SPEAKER_00: But given safety, understanding, and time, the nervous system begins to relearn what is lost, that danger isn't forever, and that relationships can be trusted, and the past does not determine and control the future.
• 18:08
  SPEAKER_00: The child who once lived in a world shaped by fear discovers something new.
• 18:15
  SPEAKER_00: Not simply survival, but hope.
• 18:20
  SPEAKER_00: So too does the child's parents.
• 18:24
  SPEAKER_00: Every wound tells a story, and when the story is fully understood, the mind can heal and recover.
• 18:33
  SPEAKER_00: I hope that this series has been helpful.
• 18:36
  SPEAKER_00: And if you know people who have children or young people who are struggling in a way that suggests that they haven't recovered from traumatic events, maybe let them listen to this, just mention it to them.
• 18:52
  SPEAKER_00: Thank you again, and I will be back with a new series soon.