EMDR Brief Overview

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Young Lives Today Scotland 14th March 2006
Trauma and the links with High risk behaviour in
adolescents
Richard Cross (Operations
Manager), CareVisions Group Ltd
UKCP registered
Psychotherapist Author of Invitation to Change
- therapeutic interventions for Anti Social Youth
(New Zealand Corrections Dept) e-mail
info_at_carevisions.co.uk
telephone [phone]
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Outline of Presentation

• Why Look at the effects of trauma?
• What are the affects?
• What can we do to help?
• What if we do nothing?
• Conclusion.

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Indications of the Problem

• Child Protection Registers
• YEAR ENDED 31 MARCH 2002
• 2,018 Children (0-15 yrs / 2.1 per 1000)
• (Scottish Executive),
• Year ended 31st March 2001
• 26,840 England,
• 2,126 Wales,
• 1,414 Northern Ireland
• (Department of Heath)

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Trauma Dissociation

• Trauma can be understood to mean a profound
  emotional shock (Oxford Dictionary 1992)
• Dissociation disruptions in the integration of
  memories, perception, and identity into a
  coherent sense of self, and may develop following
  childhood maltreatment. (see Marlene Steinberg
  (2001) The Stranger in the Mirror Dissociation
  the Hidden Epidemic)

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Why Study Trauma?

• Numerous studies link trauma and criminal
  behaviour.
• Mann (1995) Found 74 of a small sample of
  adolescents offenders held with secure conditions
  were experiencing symptoms consistent with PTSD.
• Boswell (1995) - Amongst those committing the
  most serious of crimes, over 90 experienced
  childhood trauma in the form of abuse and/or loss
  and frequently both.

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Why Study Trauma?

• Burgess et al (1987) - found a link between
  sexual abuse and the occurrence of drug abuse,
  juvenile delinquency and criminal behaviour a few
  years later.
• Dissociation may mediate the cycle of violence
  research indicates pathological dissociation in
  adolescent offenders 14.3 28.3 (Moskowitz,
  2004)

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Trauma Symptoms and Conduct Disorder

• Aggression
• Impulsivity
• Impaired empathy
• Anger
• Disregard for the future

• Substance abuse
• Risk-seeking behaviour
• Reactivity

We need to look beneath the behaviour?
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The Mechanism

• Belief system
• Behavioural re-enactment
• Other mental health problems
• Developmental impact
• Physiological response
• (Mal)adaptive coping strategies

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Response to sexual trauma
Re-enactment Visualisation Flashbacks Triggering
of memories Inappropriate sexual activities
Hyperarousal Startle Nightmare Sleep
difficulties Irritability Distractibility
Avoidance People / places Things that remind of
abuse Dissociation
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How children are affected by trauma Belief system

• Provide an environment that feels safe
• I am safe here.
• Adults will keep me safe here. I can learn how to
  keep myself safe.
• I must not do things to make others feel unsafe,
  and others must not do things to make me feel
  unsafe either.

• Sense of trust and safety are undermined
• I am not safe.
• The world is a dangerous and a scary place.
• I have to fight and be strong to keep myself
  safe.

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Behavioural Re-enactment

• Young people can expose themselves, seemingly
  compulsively, to situations reminiscent of the
  original trauma.
• In behavioural re-enactment of the trauma, the
  self may play the role of victim/perpetrator/re
  scuer.
• Three key ways Harm to Others
  Self-destructiveness Re-victimization.
• Children seem more vulnerable than adults to
  compulsive behavioural repetition and loss of
  conscious memory of the trauma.

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Drug use self medication
- Young people may attempt to deal with symptoms
associated with trauma through self medicating
behaviour.
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Developmental Impact

• Survivors of childhood trauma can have mild to
  severe deficits in being able to
• self-soothing
• seeing the world as a safe place
• trusting others
• organized thinking for decision-making
• avoiding exploitation

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Physiological Response

• The normal physiological responses to extreme
  stress lead to states of physiological hyper
  arousal and anxiety.
• When this happens repeatedly, our bodies learn to
  live in a constant state of readiness for war
• Poor impulse control
• scanning
• aggression
• distrust

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(Mal)adaptive Coping Strategies

• It is useful to think of all trauma "symptoms" as
  adaptations. These symptoms represent the childs
  attempt to cope the best way they could with
  overwhelming feelings and events.
• They have been used to shield and defend
  themselves as much as possible from harm at the
  time of the abuse, e.g. hyper vigilance,
  dissociation, avoidance and numbing.

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Breaking The Chain of Abuse
Avoidance
Fear
Safety Containment Attachment Openness..
Detachment
Disintegration
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What can we do?
Nurturing safe Environment
Therapeutic Parenting Team
Assessment e.g. Trauma Symptom Child Checklist
(Briere)

• Safety
• Containment
• Attachment

Formal Therapy
Potential Space For recovery
Foundation Openness.Communication.Predictability
. Integrated working
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Safety Stabilisation

• Be warm, empathic and understanding
• BE NURTURING, COMFORTING AND AFFECTIONATE, BUT BE
  SURE THAT THIS IS IN AN APPROPRIATE 'CONTEXT,
• Avoid exploring the trauma until The young
  person is safe and risk has been minimised as to
  possibility of further exposure.
• Help the young person develop the skills to
  manage the emotions and symptoms arising from the
  trauma.
• The relationship and the nature of the
  environment can hold the young person on their
  process of recovery.

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What can we do cont?

• PROVIDE A CONSISTENT, PREDICTABLE PATTERN FOR THE
  DAY,
• WATCH CLOSELY FOR SIGNS OF
• RE-ENACTMENT (e.g., in play, drawing,
  behaviours),
• AVOIDANCE (e.g., being withdrawn, daydreaming,
  avoiding other children)
• HYPER REACTIVITY (e.g., anxiety, sleep problems,
  behavioural impulsivity)

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Using Drawing with high risk adolescents

• Simple is best,
• Let young person create own symbols,
• Remember safety must be in place first,
• Young person has developed self care strategies,
• Remember, at times process might need to return
  to stabilisation phase.

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What was happening around me
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What was I thinking
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What was I feeling?
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He is laughing at me.
If I dont hit him first he will hit me!
Walking down street and see Joe who I dont
like.
6/10
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If we do nothing the Legacy?

• Increase in distress
• Higher Criminal Justice costs.
• We will be letting our children down
• We wont be doing everything we can to stop
  victimisation,
• Higher society costs (Mental health, Health,
  social services).
• What might lay ahead for the children of the
  children.

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Trauma and High Risk Behaviour - Summary

• Trauma / dissociation regularly features in the
  lives of young people who are offending,
• Trauma can have a significant impact on young
  people and may link to offending behaviour.
• We can break the cycle There are effective
  treatments for trauma and its effects treat
  it.

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The Future can be different