Tag Archives: transitions

“A Healing Place”: Part IV

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Anticipate Problems

It is always important to anticipate problems. That means, for example, anticipating stressful events, the effect of a high conflict relationship, and transitions.

Stressful events may include a visit home from the orphanage, a birthday or other special occasion, a test at school. High conflict relationships can cause stress at home with a caregiver or sibling, or at school with a teacher or a classmate. Any observer on the playground during free play at school will witness many problematic exchanges; sometimes these exchanges are repeated in the same relationship day after day, and those patterns can be anticipated.

Transitions are difficult for all children, indeed, for people of all ages. Children with developmental problems – and as I have said, that includes all children with significant histories of neglect and maltreatment – have even greater difficulty with transitions than others. This is because ideal developmental outcome is evidenced by the smooth integration of experience and function at different levels and in different domains in a continuous flow. In this case, a transition – which necessitates the taking apart of the organization that was functioning in the previous state and creating a new organization to deal with the new one – is manageable. For example, when a “healthy” person wakes from sleep, the complex physiological, emotional, and motoric transitions that are required to move from bed to upright and to preparing for the day are no big deal. If, however, the person suffers from a mood disorder or has a fever or has a developmental problem related to autism or trauma or cerebral palsy, for example, this transition can seem or even be actually impossible. The same is true for the transition from home to school or to work or even from one classroom activity to another or one work situation to another. One must never underestimate transitions, because transitions are challenges to organizational capacities, and these capacities are the first to be affected when development follows a problematic pathway.

Prepare for Transitions

Preparing for transitions can be done in many different ways according to the needs and capacities of the individual child. It is often helpful to make a schedule of predictable events and display it in some central place in the child’s bedroom or in the home. Some children respond better to visual cues. For example, a teacher in the preschool where I work has created a beautiful laminated strip of photographs of classroom events (children engaged in these activities) in the order in which they occur to use as a visual reminder for a child with a developmental problem. This child also has a laminated strip with the steps in hand washing (turning on the tap, taking soap from the dispenser, rubbing hands together, rinsing hands, drying hands with paper towels, throwing towels in the trash). This has proved to be extremely helpful and has turned an often oppositional struggle into a calmer series of redirections to keep on task.

It is also helpful to give friendly warnings to prepare for transitions. Although this seems routine, caregivers often forget. If the caregiver anticipates the need for the warnings, they can be given without the annoyance generated by noncompliance. First, the caregiver can give a 5 minute warning, then a 2 minute warning, and finally a 1 minute warning, for example. If a schedule similar to this is given routinely, a ritual is established. The child knows what to expect, and the caregiver is not stressed to think of how to respond.

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“A Healing Place”: Part II

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I continued with the workshop, referring to Bruce Perry (as I so often do) as I addressed what Rachel had described to me as the caregivers’ discouragement. I told them that the parts of the brain that influence this problem behavior “have been shaped over many years with hundreds and thousands of repetitions”, and that traditional therapies that typically take place in 45 or 50 minute sessions at a frequency of once a week cannot be expected to reverse years and years of traumatizing experiences (Perry & Hambrick, 2008, p. 39). I wanted to talk about changing the brain in healthy directions and how that improves behavior, but mindful of the role of consultant and the necessity of staying close to the caregivers’ stated concerns, I addressed the need to respond to problem behavior “right now”.

Changing Behavior Right Now: Think Ahead

(1) Know the child. (2) Make realistic expectations. (3) Anticipate problems. (4) Prepare for transitions. (5) Be predictable, but not too predictable. (6) If something is not working, stop and try something else. (7) Resolve conflict. (8) Give rewards and consequences.

I will go into detail in the first point in this posting and continue with the subsequent ones in the following postings.

Know the child:

It is important to keep in mind the child’s strengths and weaknesses, and also to remember the child’s story of pain. The role of the child’s traumatic background is easy to forget when you are dealing with his problem behavior, but it is important to bring it to mind now and then, because it can help you with how to respond. First of all, remembering the child’s story of pain can refresh your empathy for the child. Second, it can help you identify “triggers” or special challenges for this individual child. For example, a child who has been sexually abused will often be triggered (have a traumatic reaction) to certain kinds of touch or to intrusive behavior (someone putting his or her face too close to the child’s face, or looming over him or her). Remember what I said about children on the autistic spectrum. Often these children will also react violently to someone coming in too close.

Again, channeling Bruce Perry, I emphasized the importance of special relationships – For traumatized children, “The relational environment of the child is the mediator of therapeutic experiences.” (Perry & Hambrick, 2008, p. 43) In fact, in the fortunate case that there are multiple good caregivers available, such as is true at Love and Hope, the child may choose one person who can help him feel calm, another whom the child can rely on to be firm, and another who can help him have active, rough housing kind of fun. This is not so different from what happens in families, especially big families.

We know that it is also important for the relationships that partners make with each other – such as adult partners or even close friends at any time in life – to include a mix of these functions. That is, we would not choose a partner or close friend for whom we could not rely on both for fun and also for comfort. Yet these children may require time to put it altogether, and a “family” environment in which these relationship functions are offered by different people is often a first step.

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Read this blog in Spanish.