homework due Saturday using the intervention of therapy role play !!! research paper 2-4 pages APA paper format with research

trauma and loss in children

Healing Trauma, B i l i i Resilience: SITCAP in Actiijf William Steele and Caelan Kubaíñ

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Trauma and loss are not seen as diagnostic disorders but as painful experiences with which the child is struggling to cope. Interventions involve children in their own healing so that they feel safe and empowered—no longer victims but survivors and thrivers.

Since 1990, the National Institute for Trauma andLoss in Children (TLC) has pioneered strength- based, resilience-focused interventions with young people. Instead of being a detached di- agnostician, the helping adult becomes a witness seeking to understand the deeply painful expe- riences of traumatized children. How traumatized youth interpret them- selves, their interactions with others, and their en- vironment guide treatment. The collective voices of traumatized youth have repeatedly said:

If you don't think what I think...feel what I feel... experience what I experience...see what I see when I look at myself, others, and the world around me...how can you possibly know what is best for me?

Childhood trauma is marked by an overwhelm- ing sense of terror and powerlessness. Loss of lov- ing relationships is yet another type of trauma that produces the pain of sadness and grief. The resulting symptoms only reflect the neurological, biological, and emotional coping systems mobi- lized in the struggle to survive. These young peo- ple need new strategies for moving beyond past trauma, regulating emotions, and coping with future challenges.

Neuroscience confirms that trauma is experienced in the deep affective and survival areas of the brain where there are only sensations, emotionally con- ditioned memories, and visual images. These de- fine how traumatized youth view themselves and the terrifying world around them. Reason, lan- guage, and logic needed to make sense of past ex- periences are upper brain cognitive functions that are difficult to access in trauma (Levine & Kline, 2008; Perry, 2009; van der Kolk, 2006). This ex- plains the limitation of traditional talk therapy or narrowly cognitive interventions. Therefore TLC's Structured Sensory Interventions for Traumatized

Children, Adolescents, and Parents (SITCAP) starts with the subjective experience of youth which drives their behavior.

SITCAP provides the opportunity to safely revisit and rework past trauma, beginning with sensory memo- ries which youth have experienced and stored. Trau- ma-related symptoms can be reduced and resilience strengthened to support posttraumatic growth as youth engage in SITCAP (Steele & Kuban, 2013). The process is designed to support safety, emotional regula-

tion, and empowerment.

Curiosity by the adult allows youth to take the lead and set

the pace of intervention, which is empowering.

Every SITCAP session is structured to begin and end with safe activities such as guided imagery or breathing techniques that engage youth in self-regulation practice. Trauma-focused ques-

tions are open ended and tied to the non-language, sensory-based activities used to address common themes of trauma such as worry, fear, hurt, and an- ger. These questions are designed to keep the prac- titioner in the role of a curious witness rather than the "all-knowing" therapist.

Curiosity of the adult also allows youth to take the lead and set the pace of intervention, which is em- powering. They are giving permission to say "yes" or "no" to whatever they are asked to talk about and discover that saying "no" is honored. This genuine interest is essential to allow the youth to experi- ence the intervention as safe and the practitioner as trustworthy. Their safety remains the primary focus. The SITCAP process helps youth identify the ways their body responds to stress. Young people recognize how posttraumatic memories can be ac- tivated by current events and learn to "resource" their body to regulate their reactions.

SITCAP in Action As is shown in the following two case examples, SITCAP uses drawing as a primary therapeutic ac- tivity. More than words, drawing allows children to access and externalize the sensations, memo- ries, and iconic images shaped by trauma. Draw- ing activities can focus on the primary themes of trauma—terror, worry, hurt, anger, revenge, guilt, shame, and powerlessness. The drawing process it- self yields far more information than only asking youth to talk about their experiences. Drawing also enables young people to create new images of self that are strength-based and resilience-focused.

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Erica, a i6-year-old, was exposed to multiple sexual assaults in her home. She was asked to draw a pic- ture to tell a story about what happened to her. She drew a picture of her abuser and the room where the abuse took place several times a week. At the bottom of her paper, she drew a box and identified this as the "Dance Area." This was not only the room where she was repeatedly abused, but also the room where she would come and dance for hours. She turned her place of terror into a place of safety. There she could engage in a self-regulating activity that buffered the fear she felt every night when it was time to go to bed. This was significant Information that had not been discussed previously but was only revealed through her drawing. Music and dance became the resources of resilience and self-regulation that were integrated into her treatment plan. Erica's story demonstrates that we can help youth trapped by traumatic memo- ries to create a safe refuge where they can begin to regulate the constant worry of being traumatized (Steele & Kuban, 2013).

Being empowered to participate in their own heaiing gives young peopie a renewed sense of seif-controi, safety,

and purpose.

Michelle is a 17-year-old with a history of abuse, ne- glect, sexual assault, and rape. The adult expressed curiosity by asking this trauma-specific question: "Of all that has happened that brought you here to- day, what was the worst part for you?" Michelle was encouraged to tell her story by drawing a picture. She described her worst experience as, "the rape, but not the rape itself...I am an outgoing, strong girl. I was the only girl on our school football team my sophomore year—I am tough! Every day I look back on the situation and just hate myself for let- ting the rape happen." Providing Michelle with an opportunity to tell her story through drawing was a turning point. In spite of months of "talk- ing through" her rape with a very caring aunt and good friends, it was visual images and trauma- specific questions that led to a shift in her view of herself. Michelle looked up from her paper and exclaimed, "I did do everything I could to try to stop the rape from happening. It wasn't my fault." The visual representation allowed Michelle to see that she did everything she could do to escape that situation. There was no longer a need to dwell on feelings of guilt.

SITCAP's healing value is supported by research and practice history in varied settings with youth who have experienced a wide range of trauma-inducing situations.' Young people move from trauma to resilience as they reframe their thinking from the role of victim to survivor. The SITCAP model uses the traumatized youth's own experiences to guide treatment. Trusting bonds and repetitive safe and structured activities provide new opportunities for youth to view themselves and their world with hope and resolve. Being empowered to participate in their own healing gives young people a renewed sense of self-control, safety, and purpose.

William Steele, MSW, PsyD, founded the National Institute for Trauma and Loss in Children (TLC) in 1990, and developed the SITCAP model He trains profession- als to treat childhood trauma not as a deficit-focused di- agnosis, but a series of sensory experiences experienced by traumatized children regardless of their culture. He can be contacted at [email protected]

Caelan Kuban, LMSW, PsyD, is Director of The National Institute for Trauma and Loss in Children (TLC), a program of the Starr Global Learning Net- work. She trains professionals nationwide and is a Certified Trauma Consultant-Supervisor providing trauma assessment and short-term intervention uti- lizing evidence-based practices including the SITCAP model. E-maii [email protected]

References

Levine, P., & Kline, M. (2008). Trauma-proofing your kids: A parents' guide for instilling confidence, joy, and resilience. Berkeley, CA: North Atlantic Books.

Perry, B. (2009). Examining child maltreatment through a neurodevelopmental lens: Clinical applications of the neurosequential model of therapeutics. Journal of Loss and Trauma, 14(4), 240-255.

Steele, W., & Kuban, C. (2013). Working with grieving and trau- matized children and adolescents: Discovering what mat- ters most through evidence-based, sensory interventions. Hoboken, NJ: John Wiley & Sons.

van der Kolk, B. (2006). Clinical implications of neurosci- ence research in PTSD. Annals of the New York Academy of Sciences, i, 1-17.

(Endnotes)

I Further information on research supporting SITCAP pro- grams is listed on the California Evidence-Based Clearing- house and the Substance Abuse Mental Health Services Agency (SAMHSA) National Registry of Evidence-Based Pro- grams and Practices (NREPP).

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