For young boy reeling from traumatic childhood, therapy offers a path back into the world

Published on
August 22, 2017

When I first met 4-year-old Kole, he would barely speak. When he did, his voice was adorably raspy. When I asked how he was feeling, using a “feelings chart” as a visual aid, he responded by vomiting in the corner of the room. He seemed to be suffering from intense anxiety. His mother, who I’ll call Vera, told me that Kole does not trust new people, for reasons I’d soon come to learn.

Vera was a victim of domestic violence, and Kole witnessed many instances of abuse during his earliest years, including one incident in which his father tried to choke his mother.

Over the course of a few therapy sessions, Vera described to me chaotic scenes of yelling and screaming, to the point where neighbors got involved. After one particularly bad incident that involved the police, Kole and his mother were placed into an emergency domestic violence shelter, and then transitioned to long-term community housing. These moves happened quickly, and most of their relationships with family, friends, schoolteachers, and neighbors were severed. While Vera kept referring to Kole’s trust issues, I quickly picked up that Vera was also referring to her own personal struggles with trust.

Experts on the effects of trauma on child development, such as Bruce Perry, Alicia Lieberman, and Connie Lillas, argue that a child’s brain is constantly organizing itself to its environment, especially while sleeping. In other words, hearing parents become physically aggressive toward one another can actually wire a child’s brain to be more aggressive, angry, and irritable, providing less room for adaptive skills like frustration tolerance, patience, and impulse control. For this reason, many children and parents like Kole and Vera are referred to child parent psychotherapy (CPP), an evidenced-based practice for treating infants and toddlers with a history of trauma.

Over the course of a few therapy sessions, Vera described to me chaotic scenes of yelling and screaming, to the point where neighbors got involved. After one particularly bad incident that involved the police, Kole and his mother were placed into an emergency domestic violence shelter.

Based in attachment theory, child-parent psychotherapy is the leading style of therapy for small children and their parents who have suffered trauma. Developed over the past 20 years, the therapy aims to help families combat the toxic stress and trauma by strengthening the child-parent relationship and their shared sense of safety.

Kole was referred for child-parent therapy to not only address the trauma he experienced with his mother, but to address his behaviors and emotions that emerged afterwards. Kole became physically aggressive in preschool, where he would hit, push, punch, kick, and bite children and other adults. He was impulsive, and demonstrated little self-control when he became emotionally triggered. He was often in a depressed mood, and didn’t seem to enjoy his mother’s company, despite Vera’s loving and caring attitude towards him. He struggled with basic things like sleeping throughout the night without nightmares, and he overate, one way that people soothe their stress in the wake of trauma. He was hyperaware of his environment, responding with tensed limbs and alert eyes and ears when he heard an unfamiliar or unpredictable sound.

In the wake of a traumatic episode, young children like Kole can become highly vulnerable, living in survival mode day and night. They are at-risk for developmental delays, low self-esteem, academic problems, and behavioral and emotional issues. As they grow older, trauma left untreated can make these kids more vulnerable to substance abuse, poverty, crime, and serious illnesses such as heart disease and diabetes. Newer research is also exploring the link between trauma and certain types of cancer.

In trauma-informed play therapy with toddlers and their parents, the goal is to help families heal from these emotionally disruptive periods of their lives. For example, Vera and I collaborated on an age-appropriate trauma narrative that we shared with Kole together:

“When you were a smaller, you saw daddy hit and push mommy. Mommy and daddy yelled and screamed while you were asleep. This was very scary for you to see and hear, and it’s made your body feel scared, nervous, and angry. Now, anytime you remember seeing this, you hit, scream, and yell. We will be playing together each week to understand our big feelings and to learn how to use your words and not our body when you are scared or upset. Mommy will also be learning how to keep your body safe, so you don’t feel so alone in your big feelings.”

After his mom and I shared this story with Kole, he sat frozen but alert, mumbling that he wanted to play with the dollhouse, figurines, and dollhouse furniture. He was fond of a small puppy figurine, who became the protagonist of his play each week. Kole started off by placing a family outside of the dollhouse. Each week, the furniture changed, and new additions or subtractions were made to the home environment. Nothing was consistent. The puppy was always lost, confused, and angry. The puppy repeatedly hid behind furniture as the mother and father characters fought.  Then, the puppy would routinely hit the other children in the family.

As Vera began to trust the therapeutic process more, she began to make links between Kole’s play process and actual experiences that she and Kole faced together. Within six months of repeatedly playing out themes of isolation, fear, and anxiety, Kole surprised us both: He arranged the family inside of the dollhouse, and together they began playing hide-and-seek with the puppy and the mother figurine. Kole and Vera went back and forth for weeks in this play sequence, creating many moments of joy and laughter. The two never played together before. Now, as they repeatedly played this game of hide-and-seek together, Vera was able to show Kole she wasn’t going anywhere. She could always be found. Never had it been so clear to me the significance of laughing and smiling with children. In this instance, laughter was an essential part to this pair’s healing.

Kole’s depression appeared to be lifting, and he was much better behaved in school. He was even talking more in therapy sessions, and had begun to use his words to express his feelings and needs in a clear manner. Vera had become an expert in reading Kole’s thoughts, feelings, and cues. She also became quite skilled in responding to his needs in a way that was calming for him. Vera helped her son heal from the trauma by offering him a feeling of safety within their relationship. After a year of treatment, the pair graduated from therapy.

In early childhood trauma work, we can’t change the fact that the trauma has happened. But we can give parents and children the sense of safety, reciprocity, and hope that they can overcome the negative effects and move forward with their lives. I still hear from Vera and Kole from time to time. They’re living in their own home, Kole has graduated first grade, and Vera tells me her son is doing much better in his relationships with others. Together, they’re thriving.

[Photo by Norbert Eder via Flickr.]