Attachment-Focused Trauma Treatment for Children and Adolescents: Phase-Oriented Strategies for Addressing Complex Trauma Disorders

234 Pages·2015·4.01 MB·English

by  Niki Gomez-Perales

Attachment-Focused Trauma
Treatment for Children and
Adolescents
Attachment-Focused Trauma Treatment for Children and Adolescents brings together two
powerful treatment directions that exponentially expand the knowledge and
skills available to child and adolescent trauma therapists. The book provides
theoretical knowledge, clinical approaches, and specific, detailed techniques
that clinicians will find indispensable in the treatment of the most challenging
and high-risk young trauma victims. Also included are case studies, developed
from over three decades of experience, that show the reader how to use the
techniques in real-life settings. The treatment approach described here is
flexible enough to adapt to real clients in the real world, regardless of trauma
and attachment histories, family and living situations, or difficulties engaging in
supportive therapeutic relationships. Clear and cohesive, the model presented
here allows room for the individuality and approach of each therapist so
that the therapeutic relationship can evolve in a genuine and unique way. An
appendix of photocopiable worksheets gives interactive tools for therapists to
immediately use with clients.
Niki Gomez-Perales, MSW, RSW, has over twenty-five years’ experience
working with children and adolescents impacted by complex trauma and
attachment. She is a child and adolescent therapist in Hamilton, Ontario, and
is an active member of the International Society for the Study of Trauma
and Dissociation (ISST-D).
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Attachment-Focused
Trauma Treatment
for Children and
Adolescents
Phase-Oriented Strategies for
Addressing Complex Trauma
Disorders
Niki Gomez-Perales
First published 2015
by Routledge
711 Third Avenue, New York, NY 10017
and by Routledge
27 Church Road, Hove, East Sussex BN3 2FA
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2015 Niki Gomez-Perales
The right of Niki Gomez-Perales to be identified as author of this work
has been asserted by her in accordance with sections 77 and 78 of the
Copyright, Designs and Patents Act 1988.
All rights reserved. The purchase of this copyright material confers the
right on the purchasing institution to photocopy pages which bear the
photocopy icon and copyright line at the bottom of the page. No other
parts of this book may be reprinted or reproduced or utilized in any form
or by any electronic, mechanical, or other means, now known or hereafter
invented, including photocopying and recording, or in any information
storage or retrieval system, without permission in writing from the
publishers .
Trademark notice : Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and explanation
without intent to infringe.
Library of Congress Cataloging-in-Publication Data
Gomez-Perales, Niki.
Attachment-focused trauma treatment for children and adolescents :
phase-oriented strategies for addressing complex trauma disorders /
by Niki Gomez-Perales.—1 Edition.
pages cm
Includes bibliographical references and index.
1. Attachment behavior in children. 2. Attachment behavior in
adolescence. I. Title.
RJ507.A77G66 2016
618.9289—dc23
2014049067
ISBN: 978-1-138-80005-2 (hbk)
ISBN: 978-1-138-80008-3 (pbk)
ISBN: 978-1-315-75565-6 (ebk)
Typeset in Baskerville
by Apex CoVantage, LLC
Contents
Acknowledgments vi
Introduction viii
1 Complex Trauma and Dissociation in Children
and Adolescents 1
2 The Neurobiology of Attachment and Trauma 18
3 Complex Trauma in a Clinical Setting 32
4 Attachment and Attachment-Focused Therapy 53
5 Phase-Oriented Psychotherapy 67
6 Bringing It Together: The Treatment Frame 73
7 Phase One—Stabilisation and Relationships: Process
and Conceptualisation 88
8 Beginning Phase One: First Session and Assessment 109
9 Phase One: Strategies and Interventions 124
10 Phase Two: Trauma Processing and Integration 172
11 Phase Three: Moving Forward 183
12 External Systems 196
Appendix—Worksheets 205
Index 219
Acknowledgments
I first want to thank my family for their endless patience as I sacrificed so much
of my time and energy during the long process of writing this book. We had
no idea at the beginning what this last year was going to bring, or just how dif-
ficult it would be to keep this going. Brian and Liam, you have been incredibly
generous with my time and with your own, and I am so grateful to have you
both in my life. I want to thank my sister Lia for picking up so many burdens
and responsibilities. You made this possible. My mother, Helen Gomez-Perales,
provided boundless enthusiasm, excitement and support, not just this year, but
always. I want to thank my late father for passing on his determined beliefs in
social justice and encouraging me to follow in his footsteps. I want to thank
Juan for believing in me and encouraging me, and my late grandmother, Nata-
lia Kohuska, for teaching me that anything can be accomplished and nothing is
out of reach if you are stubborn enough. Lisa, you have taught me more about
parenting, attachment and relationships than you can ever know. I am lucky to
have you in my life.
I have been lucky to be surrounded by supportive, caring colleagues who
have alternately cheered me on and challenged me to learn more. Hillary Meg-
gison, Jennifer Boshis, Karen Timmerman, Van Vu, Margarita Rabinovitch,
Danielle Clement, Louise Oke, Dina Bednar and Geri VanEngen have con-
tributed by teaching me, questioning me, challenging me and encouraging me.
I want to thank Gord Greenway for believing in me when others didn’t, and
Kathy de Jong for standing up for me and putting up with me. I particularly
want to thank Diane Ribbins for being who she is and doing all the things she
has done to support and sometimes save me over the past twenty years. This
book would not exist without any of you.
I owe a debt of gratitude to the members of the Hamilton Dissociative Dis-
orders Discussion Group, particularly Marilyn Korzekwa, David Cree, Susan
Wortman and Debbie Davis. I have learned so much from the International
Society for the Study of Trauma and Dissociation, particularly the wonderful
members of the Child and Adolescent Committee. Dr. David Benner was my
first teacher on dissociative disorders, and introduced me to the ISST-D.
There are numerous other personal supports and inspirations that deserve
credit. Heather Woods, Monica Stec, Tim Gordon and Stan Donovan stand
Acknowledgments vii
out as friends and supporters. Stan, I wish you were here for this! I will always
be grateful to Ailish, Brittany and Nick for everything you have given me and
everything you have done to support me. Finally I want to thank all of my
young clients and the adults who have worked to support them. You have been
my true teachers, and you are a constant source of inspiration and hope. It is
impossible not to believe in a better world when privileged to witness and be
part of such amazing stories.
The cases written about in this book are a compilation of thirty years of
experience. Most are fictionalised accounts in order to respect the stories and
protect the privacy of the many children, adolescents and adults I have worked
with over the past three decades.
Introduction
Looking back over thirty years in the fields of child welfare and children’s men-
tal health, I am astounded by how much I’ve learned. It would be an easy mis-
take to assume that through those years of learning and exploring, I had been
absorbing knowledge that was already there. It’s a bit of a shock to look back
and realise that I entered the cusp of a new and changing world. As a student
I assumed that my teachers knew things; that I would learn the things that they
knew, and then I would also know things. Of course, it hasn’t been like that
at all, and that has made this process of learning so much more dynamic and
exciting, and also scary. I entered into a world where sexual abuse was consid-
ered rare and physical abuse was almost always considered to be well-meaning
discipline gone wrong. As professionals, we knew that there were “extreme”
situations out there, but we didn’t expect to see them. A judge once asked me
to leave his courtroom for spouting “unthinkable conspiracy theories” while
presenting evidence. I had suggested that the child had been abused by her
father and grandfather, and that her grandmother had been aware of it. When
I first started in child welfare, the intake unit I was part of had eight staff mem-
bers. The current intake department in the same agency is now larger than the
agency itself was at the time.
I suppose the point of these ramblings is that it feels almost like we have
been making this up as we go along. I suspect that this is what most innova-
tion feels like. Yes, there are many brilliant teachers out there who have a lot
of knowledge, and from whom I have learned an incredible amount. They
are to be applauded for their courage in creating responses as they have found
what so many people considered to be unthinkable. I am in no way minimising
the incredible body of knowledge that exists in this field. It is new knowledge,
forged of necessity, researched out of a need to have solutions, and worked
out in collaboration with trauma survivors who were determined to be heard,
understood and helped. I suspect that this was much more challenging than
mastering what others know. We owe these teachers a great debt.
It seems to me that as we have struggled to figure out what we know and
to create what we don’t, a divide has developed between trauma therapy and
children’s trauma therapy. We come from two different directions, each with its
own histories and traditions—children’s therapists who have discovered trauma
Introduction ix
work, and trauma therapists who have begun working with children. We’ve
met in the middle, but haven’t gotten to know each other very well. Coming
from a child welfare and children’s mental health background, the training and
practices I have been most exposed to arise from developmental models and
child welfare models. More recently, attachment work has entered the picture,
providing more of a psychodynamic framework. Overall, the focus is either
on treating children who happen to have been traumatised, or on treating
discrete traumatic events and relationships. We do individual therapy, family
therapy, dyadic treatment, trauma impact work and trauma-focused cognitive
behavioral therapy (CBT). We treat the active symptoms, the behaviour and
the immediate impact. The concept of complex trauma disorders, dissocia-
tive trauma disorders and phase-oriented psychotherapy is often unknown or
undiscussed. Most of what we do is phase one psychotherapy. On the other
hand, many therapists who are treating children using a complex trauma
model, or a phase-oriented model, seem to be treating children as individuals,
without directly and purposefully working within the systemic, the dyadic, the
attachment relationships and the here and now. They are treating the internal
impact of trauma on the child without working with the child’s context.
A s the field of trauma therapy develops we are privileged with new research
and knowledge about the developmental and neurological impact of both
trauma and disrupted attachment relationships. This new knowledge provides
us with insights into the treatment needs of both traumatised children and
traumatised adults. It’s an opportunity to bring together the knowledge from
both areas, in a way that can help us apply decades of knowledge about treat-
ing adults with complex trauma issues in developing a synthesised and unified
model for treating children.
I t is my hope in this book to begin the combining of two very important
models: phase-oriented psychotherapy, which has been the predominant
approach taken in the treatment of complex trauma in adult survivors of child-
hood abuse, and attachment-informed psychotherapy, which is rapidly becom-
ing the predominant approach in the treatment of children with complex
trauma histories. There are many skilled therapists in both fields, and we have
been informed by one another’s knowledge, research and experience for many
years. We use many of the same techniques, and base our work on much of the
same research. How can we bring both models together in a way that works,
in the therapy room, in the real world, with real children and their families? It
will take insight and flexibility, but the results so far seem to be worth the effort.