Sunday, July 18, 2010

What Can We Learn about Trauma from Lizbeth Selander?

I have been reading Stieg Larsson's Millennium Trilogy Bundle: The Girl with the Dragon Tattoo, The Girl Who Played with Fire, The Girl Who Kicked the Hornet's Nest by Stieg Larsson (Knopf; 1 edition, May, 2010). I have seen the Swedish movies based on the first two books. This marvelous series features Lizbeth Selander. Lizbeth has been systematically badly abused and has experienced profound trauma. We root for her so strongly that in the theater when I saw the first movie, the entire audience burst into applause when she achieved revenge against one of her abusers. Yet Lizbeth is strange, difficult, hostile and quirky, much as many of our clients are. In our sympathetic engagement with Lizbeth, we can learn a lot about trauma.
How has Lizbeth been shaped by her experiences?

• She is strong, resourceful, and has many skills and strengths.

• She is fiercely independent. She refuses to take help from any one. Even when she is in the hospital she hates to call the nurse because she wants to take care of everything herself.

• Lizbeth is very private. Even with the person who is closest to a friend (Miriam Wu) she does not want to reveal anything about herself. To her, giving someone knowledge is giving them power they will probably use against her.

• She is covered with tattoos and piercings, and she presents herself as other, as an outsider. Her presentation pushes people away.

• She participates in sex in an anonymous, unconnected way, then disappears from that person’s life.

• She is fiercely protective of her mother.

• She is available for connection, but is very skittish. The guardian who treated her well earned her respect and love. But she put him through many tests, then left his hospital room and didn’t come back when she thought he was dying.

• She assumes people will treat her badly. When (in the third book) some policemen are actually respectful to her, she assumes they have ulterior motives and are trying to trick her. She doesn’t talk with them.

• She forms a strong connection to a man, but cannot trust it. When she sees him on the street laughing with another woman, she immediately assumes that she was crazy to think he would ever want her and assumes that he was just using her.

• She goes to extremes. She doesn’t check out her experiences with him. She refuses to ever talk with him again and runs away.

Do any of these things sound familiar and remind us of our clients? In the context of Lizbeth’s experience, they make sense and seem entirely understandable. If you read these books (and I highly recommend them) maybe we can use them to deepen our understanding of our client’s reactions.

I would love to talk about this further. If you are reading this series click on comment and tell me your reactions.

Saturday, July 10, 2010

Vicarious Traumatization and Foster Care

"I’ve been a foster parent for sixteen years" said Michelle. "And this is the first time anyone has ever asked about how this job affects me."

The last session in my six module training for foster parents was entirely focused on them. How does this very difficult work affect them? We started with the definition of vicarious traumatization (VT) from Risking Connection© (Sidran Foundation). It is:

"VT refers to the negative changes in the helper as a result of empathically engaging with and feeling, or being, responsible for traumatized clients." We can see these affects physically, emotionally, in our thoughts, in our sense of safety, in our relationships, our spirituality, and our sense of hope.

We did the Silent Witness exercise from Risking Connection© training. In this exercise, participants write anonymously on a piece of paper three ways that their job affects them in negative ways. On the back of the page they write three ways the job has affected them in positive ways. The leaders collect the pages and read them anonymously to the group. First, we read the negative ways, then we discussed them.

The foster parents spoke of not being able to sleep because of worrying what their child will do. They described the isolation of being alienated from friends and family who do not understand why they do not just punish the child more severely. A parent described how hard it can be when she has been desperately worried about a runaway foster daughter and then the girl returns and acts mean to her and seems to think her behavior was fine. A father talked about being with his son when a planned visit with the bio mother was cancelled due to her not showing up. A mother spoke about how tired she always feels, and how she no longer wants to go out with her friends or even do her favorite scrapbooking because she just wants to sleep. One parent said that for him the hardest thing is not knowing what to do, how to respond, and beginning to doubt himself. Several parents described the effects on their biological children, who resented the attention taken by the foster child and who at times had themselves been physically hurt.

As we discussed this list, several parents commented on how depressing it was. Then Arlene said: "but it is so good to know I am not alone in feeling this way." Several people said they could have written everything on the list. The parents felt that only others in this field could understand what it is like.

We then turned to the list of positive benefits. Many parents felt that they had become better people because of doing this work. They were more patient, more understanding, and more creative. They felt they had become better parents to their bio children. In fact, many also felt that their bio children had become better people because of the foster children. Repeatedly people spoke of how much it meant that your life had a purpose, that you were doing something very important, that you were making a difference in a child’s life.

The positives do not take away the negatives. They are both real. It is through the intensity of the work that personal transformation happens.

Again and again the parents said how important it was that they could talk about the affect of the work on themselves, with people who understood.

We have to make sure that it is not sixteen more years before they get another opportunity to do so.

Thursday, July 01, 2010

Born for Love: Why Empathy Is Essential--and Endangered

Book Review

Born for Love: Why Empathy Is Essential--and Endangered

Bruce D. Perry, Maia Szalavitz
William Morrow (April 6, 2010)

Bruce Perry’s new book focuses less on therapy and more on society. The book is a plea to us all to fight the many threats to the development of empathy in our children, and a passionate description of why empathy is essential to all human life.

From birth, when babies' fingers instinctively cling to those of adults, their bodies and brains seek an intimate connection, a bond made possible by empathy—the ability to love and to share the feelings of others.

In this provocative book, renowned child psychiatrist Bruce D. Perry and award-winning science journalist Maia Szalavitz interweave research and stories from Perry's practice with cutting-edge scientific studies and historical examples to explain how empathy develops, why it is essential for our development into healthy adults, and how it is threatened in the modern world.

Perry and Szalavitz show that compassion underlies the qualities that make society work—trust, altruism, collaboration, love, charity—and how difficulties related to empathy are key factors in social problems such as war, crime, racism, and mental illness. Even physical health, from infectious diseases to heart attacks, is deeply affected by our human connections to one another.

Born for Love describes the conditions that are necessary to produce compassionate adults. Although Perry and Szalavitz focus on society as a whole, it is also interesting to consider whether we are creating those conditions within our treatment programs. For example, empathy is created through the mirror neurons. Because these parts of our brain experience what we see others do, the children we treat will experience our caring responses directly. When we realize that the brain develops what it needs to be successful in the environment it faces, it is essential that we pay attention to what creates success in our environment. Does the child have to be loud and in distress to evoke empathy? If so, the brain will develop more distress.

Perry and Szalavitz emphasize the importance of safety, and how living with danger inhibits IQ development, makes it harder to fight infections, and floods the brain and so makes learning harder. This puts even more pressure on us to make sure that our treatment environments feel safe to the children who live in them.

We feel more empathy for those we think are more like us, for those who are part of "our group" and less for those we label "other". We are vulnerable to the influence of our group. What can we do to create a sense of belonging in our places? Rituals and rhythmic sharing help.

When children watch television and other media, they hear human voices but have no response to their own actions or talk. TV thus in some ways is a "frozen face" as in the famous experiments, in which a mother’s frozen face leads to escalation and then retreat in her baby.

Perry and Szalavitz report on how studying the hierarchical structure in baboons can illuminate our own response to leadership. The higher the perceived danger, the more likely animals are to blindly follow the leader. The larger the status differential between leader and follower, the more distress is seen in the follower. Sometimes depression becomes an adaptation to low status- a resignation to the impossibility of effective action. How does this relate to what happens between the youth in our programs?

Iceland, Perry and Szalavitz report, scores highest of all countries on all measures of happiness and social health. They attribute this to such factors as maternal/paternal leave and good child care but also to a feeling in that country that “We’re all in it together”. There are fewer difference and power differentials and more social cooperation. How can we develop communities like that?

In conclusion Perry and Szalavitz state that humans have a fundamental yet developmentally vulnerable capacity for empathy. In order to maximize it we need to practice love. We know that kind social contact relieves stress, and that developing empathy and relieving stress decreases both social and medical problems.

Do we practice love and offer kind social contact in our programs?