I am in El Salvador and am reporting on a recent workshop I gave at the children’s home, Love and Hope, with my colleague and team member, Susana Fragano. Before my departure for El Salvador, I asked Rachel, in one of our regular skypes, what she and the tias and tios (caregivers) would like to have as the focus of the workshop. She said that what they really needed help with was how to manage severe behavior problems. She told me about some of the tantrums, insolence and noncompliance, and sexual behavior, of the children in the home. This behavior has gotten worse in the last year or so since LEPINA, the Salvadoran law that requires institutionalized children to be reunited with their biological families, has been implemented, causing most of the children in the home to be returned to their families in the community. These reunited children, when they return to the home at the request of their families – either for weekend visits or for longer stays – because the families declare themselves unable to care for them – demonstrate more problematic behavior than before the reunification. Whether the worsening in behavior is due to neglect and abuse the children report they have experienced during the time they were living with their families, whether it is a consequence of the disruption of a secure caregiving environment and the traumatic loss of the caring relationships they had enjoyed at the home, or whether it is simply due to their growing older, is not known.
In the next several blog postings I am going to report on my experiences at the home during this visit and the workshop we gave to the caregivers. For a reason that will become clear as I continue, I will call these postings, “A Healing Place”. I have awakened early to write, and as I open the curtains in the window of my favorite hotel in San Salvador, I look out on dark mountains in the near distance, palm trees and other tropical vegetation in the nearer distance, and the “Mister Donut” sign that protrudes above the rooftops and guides us home after a day’s work.
Pathway to Trouble
I introduced the workshop with a review of the sources of the problems that these troubled children now have. I reminded them of the important factors I have spoken to them about many times before: (1) Prenatal stress; (2) Early abuse and neglect; (3) A genetic contribution; (4) and the ongoing trouble caused by the effect of chronic stress on the developing brain. The more you repeat a problem behavior, the better your brain learns to repeat it. I would like to state at the beginning of this series of posts that many of the points I am making about traumatized children are equally valid in relation to children with serious developmental disturbances, such children on the autistic spectrum. That is because for these children ordinary life experiences with other people, even caring attention, can feel traumatizing.
Interrupting that Pathway to Trouble
This is what the stated goal of the children’s homes has always been. Put another way, it is “breaking the cycle” of the consequences of severe neglect and abuse. But this is very hard to do. It is also hard for caregivers to remember, to keep in mind, that the children they take care of have a story about pain and neglect in their brains. They carry it always, and it can emerge unpredictably in response to current experience. This story will not go away with good care. But it can become increasingly less potent, as a new story is created to take its place. The new story is about acceptance, trust, love, and hope. The new story is about healing.
A Healing Place
I then told them about an 8-year old girl I had observed the day before. Let’s call her “Angela”, not her real name. She entered the home at 3-years old as the victim of severe neglect and abuse, including sexual abuse. After 4 years in the home, she was “reunited” with her family. (It is important to remember that this ill-conceived law, LEPINA, was implemented abruptly, without adequate assessment of the families’ competence as caregivers, and without support for these families in the community.) When in Angela’s case the neglect and abuse began again, her family returned her to Love and Hope, with occasional weekend visits to her family. The day before yesterday, after a recent visit Angela made to her family, we observed her playing. She explained that she was making a “botiquin”. Neither Susana nor I understood the reference, so Susana asked her what a botiquin was. She explained that a botiquin was something that contained whatever you needed to make yourself better when you were hurt. With Rachel’s help, she carefully organized the contents she planned to put into the box when it was completed – band aids, tape, pretend thermometer, etc. Another girl in the home offered to help her with the project and was taping clean white paper onto the cardboard box with all the care of wrapping a present. As I watched this hurt child happily engaged in pretend play with the support of her primary caregiver and her friend, I thought to myself that she was representing in play the safety and comfort of Love and Hope. She was creating for herself a healing place.