Stress Inoculation for Abused Children Through Healthy Differentiation
Protect Children From Stress Triggers
Stress Inoculation is a process to help victims of Post Traumatic Stress Disorder or Acute Stress Disorder to become less reactive to things that remind them of the bad things that have happened to them. Differentiation is a process of growth in a human being. Healthy differentiation is the individual’s ability to be able to be in close intimate contact with another person and not feel anxious or “lose” hold of themselves. When a child has healthy differentiation, they are able to stand up for themselves, are free to make their preferences known, naturally set personal boundaries, have a genuine, unique self identity and good self esteem. A well differentiated child knows that they can openly disagree with adults in a respectful manner. A child with healthy differentiation is able to manage stress by drawing on a reserve of coping skills. Differentiation gives the child the ability to be assertive, take care of themselves, and get along well with others.
Most children who have stress disorders can not do these things. Many have stress symptoms due to the family experience that they have endured. These children can have very underdeveloped or weakened self identity. When a child lives in an abusive and often chaotic household, they may be unable to adequately develop along a normal emotional growth curve. The parent(s) or caretaker may have such an overwhelming and overbearing way of dealing with the child that the child becomes “fused” with the adult. The child becomes an extension of the adult, and not a person unto themselves. Often, these children are treated as if they were owned objects instead of cherished people. The child becomes a slave to the adult’s desires and whims, and a victim of any destructive lifestyle that the adult leads. The child has no control over anything in their life. If the parent or caretaker is also a perpetrator of abuse on the child, the child will live with a “rolling stress” that never lets up. The child never knows when the adult will be kind and care giving, or cruel and abusive.
It may seem strange that children who live with parents who have mistreated them by neglect or abuse would become over attached (fused) to the parent. But the child has no choice but to cling to their parent, because that is all they have. The child develops an “automatic reaction” when they are around the parent. At the same time that they are fearful and cautious, they may also demonstrate affection and enthusiasm to please the parent. They know the cost of not being cautious, and the benefits of keeping the parent in a good mood.
Children with such a level of constant stress will oftentimes begin to generalize this reactivity to other adults than their abusive parent or caretaker. Many children who are victims of stress disorders become not only victims in their families, but victims to other perpetrators in the community as well, because when under stress, they “roll over” into submission.
When such a child comes into foster care, the foster parents may notice that the child shows both extreme caution and enthusiasm to please early in their care. This is that generalized reactivity: they are doing the same with you as they did with their parent or caretaker. The child will also begin to try to interact with you at a deeper level the same way they did when they were in their biological family. This may include manipulation, threats, or actual verbal and physical assault. The child will bring with them to your family all of the family illness that was in their family. Any time the child is reminded of the bad times in their family, or of a particular traumatic event in their past, they may have a strong stress reaction.
Anything can be a reminder: an object, a smell, a time of day, bathing, or even a tone of voice. Essentially their little bodies react the same way that they did when the trauma was happening. Their heart rate rises, their blood pressure spikes, they begin to breathe differently, chemicals like adrenaline rush into their bloodstream. They enter into a stress episode that may include rage, violence, soiling themselves, harming themselves, among other behaviors This automatic process can be reversed. The child can get better.
The challenge is to “inoculate” them to the stress. Stress Inoculation is just like taking a flu shot to avoid getting a full blown case of the flu. The shot itself may be a bit uncomfortable, makes your arm sore for couple of days, and you may even have some mild flu symptoms. When the virus comes around, the inoculation keeps you from getting it, or if you do, it will be a much milder case.
Caring and effective adults treating a child with a traumatic stress disorder help the child when they find ways to encourage the child to differentiate in a healthy, age normal fashion. Remember that differentiation is the individual’s ability to be able to be in close intimate contact with another person (or stressor) and not feel anxious or “lose” hold of themselves.
The goal is to end the automatic physical, emotional, and behavioral reactions. One way to do this is to build and develop the child’s ego to withstand stress and build emotional freedom with emotional self regulation. They need to be able to “hold on to themselves” when reminders of their trauma appear before them.
Building the child’s ego towards their being more differentiated would include providing the child with firm, very clear, very simple boundaries and limits that are repeated frequently. Make clear that the child, too, has the right to state their boundaries and limits. You may need to help them make such a list of limits and boundaries, such as: “no one can come into my room without knocking“, “no one hits in this house” , or “no one can touch my private area”. It is likely that the child has had only inconsistent, confusing, and violated limits and boundaries in the past. Your limits and boundaries as well as helping them to develop their own limits and boundaries helps the child to feel secure.
Giving the child reasonable choices according to their age is also a way to help them build their ego strength. Older children may be invited to decorate their own room, or choose their own clothing purchases. To be able to have some freedom to self govern, even if it is only a choice to have their bath now or after dinner, is an ego building technique.
You can not give a child who is stress disordered enough positve attention and affection. Most are very hungry for these positve strokes. Acknowledging positive behaviors, celebrating individuality and unique talents, and letting the child know that they are valued are all ego builders that develop healthy differentiation.
When the child was with their biological family, emotional expression may have been either very restricted, or very intense. In some cases, only certain people in the house (adults) were permitted to express strong emotions in a strong fashion. The children may not have been permitted to express strong emotions, or if they did, were severely punished or abused. On the other hand, they may have participated just as fully as the adults in the emotional chaos. Children in these kinds of homes are often in an extended, never ending highly emotional, defensive, or aggressive state. Stress disordered children may be hyper reactive to other people’s emotions. They just as often misinterpret or wrongly anticipate emotions in others.
The job is to help the child to experience genuine, safe, emotional freedom, but at the same time, learn the power of self control that comes from emotional regulation. This is primarily done in two ways: by our own consistent demonstration of emotional freedom and regulation when interacting with the child, and by direct, here and now instruction to the child.
Demonstrating consistent emotional freedom and regulation with a child, any child, is easier said than done. Having said that, it is important for anyone working therapeutically with children who have a stress disorder to have a clear plan for their own self care. Working with these children can be taxing not only due to their behaviors, but because of their traumatic pain as well.
It is important to be emotionally honest with children, especially those with stress disorders. Being emotionally free and honest with children does not mean “letting it all hang out” (that is what their biological family probably did). By all means, there are many adult issues and emotions that should not include children! However, it does mean that we should allow ourselves to express our genuine emotions in a controlled fashion when interacting with the child. If we are angry, show anger. If we are happy, proud, irritated, sad, show these openly. In turn, we need to give the child permission also to express their emotions. We need to help them feel safe in expressing negative emotions. We need to help them understand that negative emotions are not necessarily “bad”. Show the child that while two people can be very angry with each other, they can still care for each other and they do not need to hurt each other. Focus on creating strong boundaries between your emotions, and their emotions. By doing these things, we help the child to develop a sense of their own emotions as their own, not owned or caused by someone else. True ownership of our own emotions is a clear sign of growing differentiation.
Direct instruction concerning emotional freedom and regulation should be an ongoing and consistent effort in treatment. One way to do this is to create a set of “emotional rights” and post them on the refrigerator, and then review them often. The list might include such things as “It is o,k. to be angry in this house”, “You have the right to disagree”, “ We work issues through here” or “We compliment a job well done.”
Another way of direct instruction is to educate in the “here and now.” This means in the context of the emotion that is occurring. This would include citing the appropriate “emotional right” during the actual interaction, or drawing attention to how you yourself are behaving in the interaction. Praise the child when they show effort and success at emotional freedom and regulation Reminding the child frequently that you have the ability to teach and guide them in a better way of expressing their emotions, and this will help them to be successful in life is another good method.
When children learn and experience growth of healthy differentiation in a safe, supportive, environment with firm, clear limits and boundaries, they begin to heal. The child develops the a healthier ego and self identity that will allow them to become less reactive, to stand up to the stress reminders, and even perhaps, one day source of their trauma.
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