overcoming cumulative childhood adversity Friday Morning October 6, 2006 Northamerican Assn. of Masters in Psychology

1. overcoming cumulative childhood adversityFriday MorningOctober 6, 2006Northamerican Assn. of Masters in Psychology Bruce Carruth, Ph.D., LCSW San Miguel de Allende, GTO, Mexico

2. “Neurosis …… is the process of shrinking our world to the point where we can manage” Rollo May (I think)

3. children adapt to what they are given…… for better or worse adaptation to cumulative adversity occurs over time, insidiously, purposefully and productively

4. goals for the workshop grow professionally *recognizing adaptive childhood trauma *better sense of the impact of trauma syndromes *enhance repertoire of therapeutic responses *appreciate awareness of therapist positioning *build new skills *appreciate need to address cognition, affect and self *understand role of resilience and how to tap it *recognizing the interpersonal impacts of trauma: trust, commitment, potency & attachment

5. and grow personally * awareness of our own developmental traumas, * how developmental traumas lead to life’s dilemmas * more compassionate to our own self- wounds, self-acceptance & self esteem * more compassionate to the wounds of others

6. getting organized for the day • work in groups of 4 – same group all day • for each assignment, have one person act as recorder • for each assignment, have one person act as time keeper

7. adverse conditions / environments in childhood physical, emotional and neurological deficits parental dynamics sibling dynamics & the family environment the physical environment of the child societal dynamics

8. compounding adversity • adversity in one area of life tends to create or support adversity in other areas of life. • developmental lags, created by adversity, tend to make it more difficult to achieve higher level developmental tasks, so the child gets further behind psychodevelopmentally • adaptive coping tends to limit opportunities to self-correct the limitations

9. the adaptive stance adversity requires that a child adopt an adaptive stanceto protect self a broad, pervasive theme or pattern that is: …functional, purposeful and productive in childhood …becomes imbedded in the coping repertoire of the person by late adolescence and young adulthood …is comprised of memories, emotions, cognitions, body sensations, meta-beliefs, self-truths …continues to serve the person well in many ways …is resistant to change even when it is not working …and is usually integrally tied to the presenting symptom when person presents in psychotherapy.

10. examples of adaptive character traits includes: feeling repressed boundary confused needy and impulsive unloved and invisible stubborn and obstinate dependent & helpless angry victim chronically dysthymic conning and manipulative wounded phobically anxious obsessively anxious suspicious and mistrusting inadequate & indecisive love / acceptance seeking impression managers defective / shamed alone & isolated failure angry & intolerant

11. the symptoms of cumulative adversity manifest throughall levels of life functioning and across the life span * coping behaviors and interpersonal relationships * patterns of contact between self and the environment * perception, intuition, memories, cognitions based on life experience * patterns of ego defense * affects: primary affects affective themes * self functions the cognitive self character patterns core psychodynamic orientation * soul

12. assignment • choose an adaptive stance (schema) • what are the positive aspects of that stance? • what are the life problems that arise from the stance • describe some of the coping behaviors, cognitions, defenses and affects that accompany the stance • what are the aspects of the stance that would bring you into therapy? • what is your greatest terror entering therapy? • how should the therapist position to be most helpful to you entering therapy?

13. Question? why is it some people who experience cumulative adversity as children are survivors, even thrivers, while others remain wounded & impaired?

14. internal strengths (resilience) character traits that build resilience • external (environmental) supports supports that make a difference • corrective emotional experiences corrective experiences that can reshape the cognitions, affects and self-wounds of cumulative adversity

15. levels of personality impairment • personality quirks • personality traits • ingrained personality patterns • personality disorders

16. cumulative adversity through a trauma lens • Sub-clinical Trauma Syndromes • Cumulative Childhood Trauma 3. Acute Stress Reaction: Apsychophysiological reaction to an overwhelming stimuli 4. Grief Reaction: An inability to experience the emotions of loss 5. Post-Traumatic Stress Disorder(s): A significant wound to an individual’s sense of self / personhood 6. Complex PTSD & Dissociative States: A pervasive and disabling injury to self that produces significant psychiatric complications

17. recognizing trauma syndromes • When people define their life by traumatic events • Rigid or inappropriate behaviors in the face of specific events or triggers • Ego defense, unconscious to the person, that clearly limits functioning difficulty in receiving or giving feedback misrepresentations of the environment misperceptions of self and self-roles

18. Recognizing trauma syndromes (con’t) • Distorted affects displaced / distorted / inappropriate affects exaggerated affects repressed affects • Psychiatric symptoms depression (sad, angry, nihilistic) anxiety (fear, obsessiveness, withdrawal) somatization (pain, sleep disorder, appetite)

19. Recognizing trauma syndromes (con’t) 6. Distorted reactions to life events that involve helplessness, vulnerability, constraint, power/control, shame 7. Distortions in relationships: Trust, commitment, potency, attachment

20. using a trauma treatment model for treating cumulative adversity 1. building safety (creating a holding environment) and 2. managing the presenting symptoms 3. exposing the wounded self & telling the tale and 4. grieving 5. emotional healing and 6. integrating history with present

21. childhood adversity is ultimately a wound to self but adversity also manifests as a set of symptoms that interfere with day-to-day living

22. so, what are we treating? Managing and treating the symptoms : (and how adversity manifests in the “now”) symptom management interpersonal struggles coping skills cognitions “reactive” affects Doing “restorative” work that retrieves the trauma and “works it through” core cognitions and schemas primary affects telling the tale and reorganizing the experience building healthy life and relationships

23. do you treat self orsymptoms • when do you focus on symptom containment / resolution? • when do you focus on treating the self?

24. the treatment triangle for addressing cumulative adversity cognitions (the schema) affect (the emotional residue) self-functions (the adaptive stance)