Robert Allan Hafetz MS/MFT
Author bio at end of article.
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This methodology is based on the work; A Primer On Memory Reconsolidation And Its Psychotherapeutic Use as A Core Process Of Profound Change by Bruce Ecker, Robin Ticic, and Laurel Hulley, published in The Neuropsychotherapist, issue 1 April-June 2013.
Awareness of trauma as a major factor in the problem behaviors of children is increasing among professionals in foster and adoption organizations. The role of trauma, attachment, and adverse childhood experiences (ACE) are generally identified as important issues in adoptive and foster families. There can, however, be a tendency in conferences and seminars to focus more on desired outcomes than on specific methods of intervention that therapists can apply in practice. The goal of this article is to spell out the guidelines for the interventions that I have used successfully in my practice. It is not a cookie cutter approach, rather a presentation of a process that can be applied to any theoretical orientation or therapist’s style.
The Process
Trauma memories occurring before age 4 are held in the limbic system. The limbic system cannot comprehend cognitive interventions, making any cognitive based approach ineffective.
The neocortex and the limbic brain system do not spontaneously comprehend each other. The explicit verbal thoughts in the cortex are incongruent with limbic implicit memories.
Interventions must involve both brain systems in the same task.
Children have limited verbal skills and are unable to apply cognition to identify implicit trauma memories.
In order to reach the first step in healing, which is discovery, I use artistic expression to engage both brain systems in the same task.
I create a narrative having the child explain their drawing. This accomplishes the second step, integration. The child identifies emotional trauma memories in words that inspire congruence between the neocortex and the limbic system.
Parents listen to the child’s narrative and express empathy, acceptance, and validation. This creates the transformation experience. If parents are not present, possibly with adult adoptees, then the therapist must provide that role.
Experiences that sharply contradict the implicit trauma memories, while those memories are being triggered, inspire healing. If possible, the child and parents are encouraged to hug using touch to further intensify a secure attachment experience.
Healing is defined as a reduction in the emotional schema while the biographical memory remains intact.
Flow of Sessions:
This is to be used as a guide the therapist can adopt to their own style and orientation. The individual responses and concerns will guide sessions after the initial steps are completed. This is simply how I do it and is offered as a reference or starting point.
First I will present them as a list, then will elaborate on each below.
Session 1. Parents attend without children present for adoption parenting education, statement of concerns, current diagnosis and history from birth to present.
Session 2. Parents and child attend. Draw 10 emotions, name them, associate with a color, and place on the body silhouette.
Session 3. House Tree Person projective test.
Session 4. Draw your life story.
Session 5. Trauma Therapy for specific traumatic events.
Session 6. Differentiate between primal mother and adoptive mother. Draw picture of each or write a letter to each one and explain it to the adoptive mother.
I encourage the child to express him/herself artistically so as to engage the neocortex and limbic system on the same theme. I help the child create a narrative from the art and facilitate a healing experience from the parents’ participation. Transformative healing comes about through the parents listening to the child’s narrative, expressing empathy, acceptance and validation. The therapist can act as the validating person when parents are not available.
Detailed explanation of sessions:
1) Write 10 emotions on piece of paper
Write 10 emotions on piece of paper
Connect each one to a color
Place the color on the drawing of the body where you feel it.
I help the child create a dialogue after each feeing is written and when placed on the body. Here again, parents create a healing experience by expressing empathy, acceptance, and validation.
2) House Tree Person Projective Test
The goal of this test is to further connect thoughts to feelings and reveal the child’s unconscious feelings and memories. The Person drawing may indicate abuse while in foster care or other indications of Developmental Trauma or Complex trauma. The Person drawing is a representation of the inner self. Typical among adoptees is a tree with no roots and a knothole. Look for hard shading on the trunk indicating defensiveness and branches full of leaves and fruit or barren. Attachment incongruity is often expressed in the tree. Adoptees are often open to attaching but feel anxiety at the same time.
The House will give a picture of the adoptee’s beliefs about the current adoptive home. Traditional interpretations apply.
3) Draw your life story
This is a modification of (TANT) Trauma Art Narrative Therapy (developed by Lyndra J. Bills MD). It is very powerful and I never employ it until the child is strong enough to do it. They may stop at any time as emotions can be overwhelming. Drawings begin with the moment of birth, as the child imagines it. Then it progresses to each step in the child’s early life leading to the present. Parents can offer biographical information for each step since the child’s memories will be based on current emotional interpretations. What we want the is child’s view of the present through the filter of the past. Adoptees love to tell their life story and the potential to validate and heal inner pain can occur in the moment.
4) Differentiate between the primal mother and the adoptive mother
Draw or write a letter to your birth mother. Explain it to your adoptive mother. The goal is to separate the emotional response that’s been created by the primal loss and then transferred to the adoptive mother. The adoptive mother is often held to a standard of perfection that’s impossible to meet and anger about the primal mother may be transferred to the adoptive mother or female mother figures.
Brief Case Example:
Below is a drawing from a 13 year old child who was experiencing intense shame. He would dysregulate emotionally, have suicidal ideation, and be unable to function when he failed at sports. In the drawing he shows his mother throwing him into a trash can. He looked at the drawing and stated he believed he was trash because his mother refused to keep him. After a few minutes he wrote recycled on the trash can symbolizing his adoption. In that moment he became more than trash. In the month that followed his symptoms decreased. Discovery, integration, and transformation occurred very quickly.
Conclusion:
At this point in the process individual responses will determine where the sessions go next. Healing involves collaboration between therapist parents and child. Memories not previously known may arise and have to be addressed. Healing is a long process and may take months or even years. As the child develops, the effect of trauma memories may intensify or change. Primary emotions experienced are grief, shame, and anger. As one abates another may rise to the surface. The ultimate goal is to create a secure attachment in the adoptive family and restore optimal development in the child.
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Robert Allan Hafetz MS/MFT has developed a series of educational interventions that use artistic expression to create a narrative that teaches the child to use words to express emotions. He then uses the narrative to create experiences that inspire healing with the assistance of the parents. He teaches parents how to attach securely and respond effectively. The misbehavior is not the problem, its the child's solution to the problem.
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