Stress, Trauma and Support in Child Welfare Practice

This study from the University of Toronto measured the extent to which exposure to stress and trauma impacted social workers.

Results suggested that child welfare workers are exposed to a significant amount of traumatic stimuli and exhibit high levels of post-traumatic stress.

Mental Health First Aid Guidelines Project for Traumatic Events

I have been privileged by the University of Melbourne by being invited to share my insights as an expert panel member for a project titled the Mental Health First Aid Guidelines Project for Traumatic Events.

Panel members are mental health professionals and researchers, people who have experienced traumatic events in the past and who work to help others with handling trauma as part of their careers.

Eating your feelings

"There is not enough fried chicken on the planet to soothe a broken woman."

"I would eat so I didn't have to talk, drink so I didn't have to feel, smoke so I didn't have to be close to another soul."

"Nothing is better for numbing your soul than the sheer, unbridled love of the carbohydrate."

"You can eat your life into submission, or drink it down with so many bottles of wine, or smoke it away on a patio. You can look for love and respect in the eyes of another, and it still will not fill you up. This I have finally learned. Nothing will ever make you whole except you."

- Laurie Perry, Drunk, Divorced and Covered in Cat Hair

Unfinished business

"Once in a while, a piece of old business surfaces; some item on life's agenda you thought you'd dealt with years ago.

"Suddenly, it's there again at the top of the page, competing for your attention, despite the fact that you're completely unprepared for it."

- Sue Grafton, O is for Outlaw

Wise words from an Ohio foster care alumna

"If I'm ever gonna get over it,
first, I've got to get it out."

Kudos to the courage of this young person facing her past and working through difficulties!

Quotes from Torey Hayden book "Twilight Children"

A friend of mine was sexually abused as a child, and she has never talked about it. She doesn't want anyone to know. She has been reunified with her mother after a stint in foster care, but doesn't trust her mother to be able to handle the knowledge.

Her counselor is ready, willing and able to help her -- but she finds it difficult to open up her mouth and speak about what happened.

After a traumatic experience, when you discuss these things, it is painful, because you find yourself reliving it all over again. The violation. The fear. The feelings of powerless.

This is because traumatic experiences encode themselves in the brain via images and emotions, not words. We remember the taste, the touch, the sight, the sound...

But it is by giving them words, verbalizing the experience, that we are able to lasso these huge, powerful, scary experiences and get them under control.

After our phone conversation, I sent this young woman the following quote by Torey Hayden, from her book Twilight Children. Torey is talking with a young girl named Cassandra, and she says:

"What's wrong with you is inside of you. So, wherever you go, your trouble goes inside of you...

"Some really awful things have happened to you. Things children shouldn't have to experience... (Now) you are just trying to protect that troubled place inside of you, because it hurts so much, and you don't want it to get hurt again."

Torey continues:

"Unfortunately, there is a really big problem in doing this. And the problem is: You've protected your troubled place so well that you've ended up taking its side."

"Our minds are kind of funny things. When something big happens to us, it tends to stay really big in our minds and won't become a proper memory unless we talk about it. Our minds, on our own, don't seem to be able to get big events sorted out enough to squish them down to size with our other memories. We need to talk about it.

"Talking helps our minds to organize what happened... It lets us put away things that have happened to us, so they aren't in the way every time we are thinking.

"We talk about them until our mind gets organized about what happened. Then, they're not such a big deal anymore. Finally, they start to feel like ordinary memories and we can stop thinking about them all the time.

"We don't forget them, (but) they stop taking up all our thinking... (so) we can get on with what's happening now in our lives and not worry any more about it."

"BUT just the opposite happens if we have to keep something big a secret. First of all, we have to create a special place in our minds to keep it... chock full of all the stuff we can't tell...

"You have to lock it up really tight, so even you can't get there very easily. And if you don't, then you don't have any room in your mind for other thinking."

"When you first do it, first create a Troubled Place and manage to get it locked up, it's easy to think you've made it go away.

"But the fact is... just the opposite is true... Everything you put in there, it keeps really fresh, like its just happened. So, if you accidentally crack open the door... everything will hurt horribly all over again."

"What happened to you... didn't happen to you because you are a bad person. It didn't make you a bad person because it happened. It just happened.

"And now it's time for it to be OVER. It's time to open the door on the troubled place and clean all that junk out. Not to throw it away, because those memories are a part of your memories, part of what makes you 'you.'

"But it's time to make them ordinary. To talk about them until you understand how you felt, what you feel did, what other people did.

"To talk about them until there aren't any secrets left in your Troubled Place to stay fresh and scary, to talk until you're bored with them. That will turn them into ordinary memories, like all the rest of memories in your life."

Men and fear of intimacy

"She prefers the senseless pain that we inflict on each other to the pain that we might otherwise inflict upon ourselves."

- William Hurt, Altered States

"Too many women mistake a man's hostility for wit and his silence for depth."

- Sue Grafton, L is for Lawless

The aftermath of rape

http://www.backinskinnyjeans.com/2006/01/the_last_time_i.html

More Quotes from The Unsayable

- "At first, words are babbling stream of sound. And though very young children play with words and sounds in turn-taking rhythms with others, they don't use language with the purpose of communicating.

"But as a child begins to see that words can make things happen, can call forth specific response from others, she is able to make what Lacan calls 'a demand.' This is a request for recognition of what she means and for a response that affirms she is loved."

- "Provided with food and warmth, yet without recognition or any evidence of love, a child will become lethargic, stop growing and even die. The capacity to ask for something, and make herself understood, is crucial to a child's sense of being loved. But making a demand requires a risk; the other person may not understand, or may understand and say no."

Source: The Unsayable by Annie G. Rogers, PhD

Quotes from The Unsayable

"Although some see me as an 'expert' on trauma, I'm not. Trauma is bigger than expertise of any sort - it's in our midst, in our language, our wars, even the ways we try to love, repeating, repeating. No one is an expert on trauma."

"Even then I had a reputation for reaching 'unreachable' children... If a child is suffering, in that quiet invisible way that children really do suffer, I am drawn to find that child and make contact. Maybe I am going back to myself as a child... I simply won't be turned away."

"In my practice I want to hear children in a way that invites them to say more, to find words for the unsayable - and this necessarily means listening to the unconscious."

"I gradually learned that trauma follows a different logic, a condensed psychological logic that is associative, layered, nonlinear, and highly metaphoric."

"Trauma is a letter written on the body in vanishing ink.... a message emerges that demands to be read, to be known."

Source: The Unsayable by Annie G. Rogers, PhD

The Myth of Child Resiliency

Bruce Perry has made it his life's work to understand how trauma affects children, and to develop innovative ways to help them cope with it. In 1996, he founded the Child Trauma Academy, since research demonstrates that the impact of PTSD is far greater on on children than it is on adults.

Children can recover from unspeakable trauma -- but adults' responses to children during and after traumatic events can greatly affect their chances of recovery.

Quotes from The Boy Who Was Raised As A Dog:

- "It's hard to imagine today, but when I was in medical school in the early 1980's, researchers didn't pay much attention to the lasting damage that psychological trauma can produce. Even less consideration was given to how trauma mgiht harm children. It wasn't considered relevant. Children were believed to be naturally "resilient" with an innate ability to "bounce back."

- "The brain is a historical organ. It stores our personal narrative. Our life experiences shape who we become by creating our brain's catalog of template memories, which guide our behavior, sometimes in ways we can consciously recognize, more often via processes beyond our awareness."

- "if anything, children are more vulnerable to trauma than adults... Resilient children are made, not born. The developing brain is most malleable and sensitive to experiences - both good and bad - early in life."

- "Children become resilient as a result of the patterns of stress and nurturing that they experience early on in life... we are rapidly and easily transformed by trauma when we are young. Though its effects may not always be visible to the untrained eye, when you know what trauma can do to children, sadly, you begin to see its aftermath everywhere."

- "Ultimately, what determines how children survive trauma, physically, emotionally , or psychologically, is whether the people around them - particularly the adults they should be able to trust and rely upon - stand by them with love, support and encouragement."

The story in this book that most deeply affected me as a reader was one about a three-year-old girl named Sandy who witnessed her mother's murder, and almost died herself.

Yet, her CPS caseworker did not believe that she needed to see a mental health professional. For nine months, Sandy was moved from foster home to foster home, with no counseling whatsoever -- and the details of her life were not shared with any of her foster parents because she was in hiding from the murderer.

No Man's Woman; Nobody's Child

"I could see in a flash the extreme pleasure I'd taken in being related to no one.

"I'd actually managed to feel superior about my isolation, I was subtle about it but I could see that I'd turned it into a form of self-congratulation.

"I wasn't the common product of the middle class. I wasn't a party to any convoluted drama. The feuds, the unspoken alliances, secret agreements and petty tyrannies.

"Of course, I wasn't a party to the good stuff either."

- Sue Grafton, J is for Judgment

"Pain and sadness are homeless beggars in my life, displaced feelings that come and go, plopping down for their own reasons, sleeping in any corner of my brain. They wear at me with a constant tiredness that I have to chase out.

"Sometimes, though, a trigger pulls inside me, and the pain goes off, getting bad. It isn't like I know all the triggers, but school newness is a definite."

- Clinton, Cathryn. The Eyes of Van Gogh.

Strategies for Coping With Panic

1. Remember that although your feelings and symptoms are very frightening, they are not dangerous or harmful.

2. Understand that what you are experiencing is just an exaggeration of your normal bodily reactions to stress.

3. Do not fight your feelings or try to wish them away. The more you are willing to face them, the less intense they will become.

4. Do not add to your panic by thinking about what "might" happen. If you find yourself asking "What if?" tell yourself "So what!"

5. Stay in the present. Notice what is really happening to you as opposed to what you think might happen.

6. Label your fear level from zero to ten and watch it go up and down. Notice that it does not stay at a very high level for more than a few seconds.

7. When you find yourself thinking about the fear, change your "what if" thinking. Focus on and carry out a simple and manageable task such as counting backward from from 100 by 3's or snapping a rubber band on your wrist.

8. Notice that when you stop adding frightening thoughts to your fear, it begins to fade.

9. When the fear comes, expect and accept it. Wait and give it time to pass without running away from it.

10. Be proud of yourself for your progress thus far, and think about how good you will feel when you succeed this time.

Source:
Jerilyn Ross, M.A., L.I.C.S.W., The Ross Center for Anxiety and Related Disorders, Disorders, Inc., Washington, DC. Adapted from Mathews et al., 1981.

PMS and PTSD: A bad combination

The reason that PTSD survivors are affected differently from others when faced with the same stressful situation is that person carries a different emotional history inside our bodies. The external event may reawaken the lingering memories of similar events from the past, memories that carry their own set of anxieties.

The residue of emotional trauma from earlier in life can be held deep inside the body where it influences the way we live our lives, and disrupts normal bodily functioning. When an event occurs that is similar to the originating event, it can aggravate the hidden emotions and cause them to flare up, worsening our behavior and exacerbating our physical problems.

Post-traumatic stress disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened.

Many people with PTSD repeatedly re-experience the ordeal in the form of flashback episodes, memories, nightmares, or frightening thoughts, especially when they are exposed to events or objects reminiscent of the trauma. Anniversaries of the event can also trigger symptoms.

Emotional symptoms can include:
■ Hypervigilence
■ Exaggerated startle response
■ Irritability or outbursts of anger
■ Heart-stopping terror
■ Emotional numbness
■ Depression, anxiety
■ Feelings of intense guilt
■ Sleep disturbances such as nightmares and recurring dreams of the event

People with PTSD tend to have abnormal levels of key hormones involved in response to stress. Fear, an emotion that evolved to deal with danger, causes an automatic, rapid protective response in many systems of the body. For people with PTSD, the "fight or flight" response becomes inappropriately aroused.

PMS: Pre-Menstrual Syndrome
Emotional symptoms can include:
■ Mood swings
■ Fear, nervous tension
■ Feeling overwhelmed, powerless, out of control
■ Depression, anxiety, suicidal thoughts
■ Phobias, feelings of suspicion
■ Sleep disturbances

The words used to describe panic disorders are often frightening. But there is great hope: Treatment can benefit virtually everyone who has this condition.

Several types of medication, particularly the selective serotonin reuptake inhibitors and other antidepressants, can help relieve the symptoms of both PMS and PTSD.

Additional treatment options:
■ Breathing exercises: Control breathing to avoid hyperventilation
■ Replace alarmist thoughts with calmer ones
■ Approach fearful situations gradually
■ Join a support group

Source:
National Institute of Mental Health
Toll-Free: 1-88-88-ANXIETY (1-888-826-9438)
E-mail: nimhinfo@nih.gov
NIMH Web site: http://www.nimh.nih.gov/

Recent research on PTSD

According to the National Institute of Mental Health:

■ In brain imaging studies, researchers have found that the hippocampus—a part of the brain critical to emotion—appears to be different in cases of PTSD. Scientists are investigating whether this is related to short-term memory problems. Changes in the hippocampus are thought to be responsible for intrusive memories and flashbacks that occur in people with this disorder.

■ People with PTSD tend to have abnormal levels of key hormones involved in response to stress. Some studies have shown that cortisol levels are lower than normal and epinephrine and norepinephrine are higher than normal.

■ When people are in danger, they produce high levels of natural opiates, which can temporarily mask pain. Scientists have found that people with PTSD continue to produce those higher levels even after the danger has passed; this may lead to the blunted emotions associated with the condition.

For more information:
National Center for PTSD: http://www.ncptsd.org/

Source:
National Institute of Mental Health
Toll-Free: 1-88-88-ANXIETY (1-888-826-9438)
E-mail: nimhinfo@nih.gov
NIMH Web site: http://www.nimh.nih.gov/

Helping Traumatized Children Learn

The Massachusetts Advocates for Children has released a report and policy agenda to help ensure that children traumatized by family violence succeed in school.

The report sets forth an education and policy agenda to help schools become more supportive environments where traumatized children can focus, behave appropriately, and learn.

http://www.massadvocates.org/helping_traumatized_children_learn

MICKY: POST - TRAUMATIC STRESS DISORDER

MICKY: POST - TRAUMATIC STRESS DISORDER

Another survivor of the system shares statistics and information about PTSD...

Intimacy can bring emotional damage to the surface

Whatever the surface appearances, most human beings come equipped with convoluted emotional machinery... With intimacy, the wreckage starts to show.

- Sue Grafton, D is for Deadbeat

Postcard Project on the Culture of Foster Care

Link to "Without A Tribe"

http://withoutatribe.blogspot.com/2007/05/session-with-betty-throwing-yourself.html

Triggers and Vietnam War veterans

Some veterans from the Vietnam War were so traumatized that any loud noise similar to the sound of gunshot triggered flashbacks of the war.

Grown men rolled into a gutter in order to 'take cover' from the sound of a car backfiring. The sound triggered a full-body reenactment of the war experience.

This experience of post-traumatic stress disorder was not under the veteran's concious control. It was an automatic response when the neural network associated with the trauma of war was triggered.

Again, take note that a Harvard/Casey study has proven that foster care alumni experience post-traumatic stress disorder at a rate twice that of Vietnam War veterans.

Source:
McGraw, Patricia. It's not your fault: How healing relationships change your brain and can help you overcome a painful past. IL: Bahaii Publishing, 2004.

Learning to disconnect from thoughts, feelings and behavior

Behavior doesn't come out of a vacuum. Underneath the surface, there are deep roots from which that behaviour has grown.

When babies are born, as part of the imprinting process, a baby experiences their parents' emotions as if they were his/her own. It's an emotional merger, wherein the parent and child are meant to "attune" to one another's experience.

Ideally, the environment would be stable and safe.
Ideally, the growing child will be given words to describe his/her emotions.

In this ideal situation, a child would be secure and ensured of protection and love. This child would learn to identify feelings when experiencing them, and think about how to respond to that emotion.

But what if a child's safety and well-being are seriously threatened?
What is there is an external threat that seems frightening and insurmountable?
What if the first relationships of a child's life are broken?

Foster care creates repeated trauma. Children learn to disconnect with thoughts and feelings in order to survive.

Trauma can also create a disconnection with personal behavior: If you, or someone that you know, are involved in self-destructive behavior, over and over, examine their pasts for imprints of relationship patterns in which that type of behavior was born.

Consider a child who was sexually molested -- and ends up exploiting his/herself through unhealthy relationships or becoming a stripper or prostitute. In a sense, what this person is doing is reenacting the abuse from their past in order to make sense of it.

Numbing out: Victims of trauma often try to escape their emotional pain. They try to numb out by sexualizing events, eating emotions, drinking to dull the event, smoking to feel the buzz of nicotine or using drugs to make the situation temporarily 'disappear.'

These are survival techniques. In the face of danger, memories become fragmented, mental processes shut down and the only focus is on survival.

But emotions are basic to survival. When a person's outer life and inner life are disconnected, that person cannot heal.

It takes courage to seek help.
It takes courage to stop running and look yourself in the eye.
Even after the healing process has begun, there will be moments of uncertainty.

In post-traumatic stress disorder, fear from the past raises its ugly head and causes the body to react with fight-or-flight or freeze responses. This experience can be very unpredictable and confusing.

Here are the stages of healing, according to Dr. McGraw:

1.) Attunement to self: Take time to be aware of your emotions, including physical symptoms such as increased heart-rate. Journal about the emotions and bodily sensations that you are experiencing, as well as the thoughts and memories that emerge.

You need this time to remind yourself that your physical state and emotions are important.

Learn what your 'triggers' are... To be triggered is to reexperience an event from the past in the present. You will experience the bodily sensations and emotions of a terrifying event that happened long ago.

2.) Strengthening and stabilization: Create safe and stable life circumstances for yourself. Inasmuch as it is in your power, keep your everyday life free of crisis and chaos. Do not participate in behaviors that you have been using to avoid or act out traumatic experiences.

You need this time to give yourself a base of happier memories and safe experiences.

3.) Working through traumatic experiences: After having a base of happier memories, adults find that they are better able to deal with the past.

-This stage should not be rushed. Rushing this process can be damaging and counterproductive.

-Simply talking about a problem will not heal it. The actual events are less important than their emotional impact.

-Pace yourself. Take baby steps. If a conversation becomes too painful, end it. Revisit the problem later, when the emotional intensity has subsided.

Shocking, surprising or overwhelming yourself with emotional experiences that you are not prepared to handle will not help you heal.

4.) Acceptance and service: This is characterized by:

-No longer hiding from yourself, your past or your true feelings. See yourself within your own story with compassion and empathy. Be the hero of your own story.

-Being aware of your triggers and not letting your emotions take you hostage. Creating a strategy for coping and recovering when triggers occur.

-Building the capacity to develop warm, loving relationships with others. Avoid or discard harmful relationships. Seek to build new, positive connections.

-Establish a goal and direction for your life. What unique abilities do you have to offer the world?

Source:
McGraw, Patricia. It's not your fault: How healing relationships change your brain and can help you overcome a painful past. IL: Bahaii Publishing, 2004.

Poem about empty promises

He leaves
and comes back

He leaves
1 week
2 weeks
6 months
2 years

Every time it gets worse
he comes home
and with no thought of how I feel
he leaves

When he first gets home he promises
“I won’t be back in there”
as he complains to us
about the thick metal bars
foul food
and nothing to do
later I wake up and
he leaves

With no info of:
when he’ll be back
what he did
or why
he just
leaves

We communicate slightly
only through phone
his picture is a dusty memory in my mind

He says “I miss you boy”
and I say “I miss you too”
but do I really mean it
do I really miss him

“I wish you would come see me” he says
but do I want to?

so I can walk through the metal door
and see his orange suit
scruffy face
sad eyes

so now you see?
let him leave

-Shawn Hanning

Wired for survival

"Brain development begins soon after conception and continues after birth. The changes that take place in the brain in the early years of life ensure that an infant becomes highly attuned to the environment into which she was born.

"An infant raised in perilous surroundings will develop brain connections and chemical responses that are highly sensitive to signs of danger.

"Early development is for the long-term. It assumes the environment into which an infant is born will not change significantly over the span of her lifetime.

"Hence the brain connections or chemical tendencies laid down in a dangerous environment at the beginnings of life become entrenched even if an individual finds herself in a safe and secure environment in her adult years, her brain is likely to stay on constant lookout for the slightest signs of danger."

- Early Years 2: Putting Science into Action by Hon. Margaret Norris McCain, J. Fraser Mustard and Dr. Stuart Shanker

Free online classes through Child Trauma Academy

Research and study at the University of Chicago and the Baylor College of Medicine has revealed the complexities and multi-dimensional nature of the problems of childhood abuse and neglect.

The Child Trauma Academy started out as a university-based, medical model working group, but then evolved into an independent, not-for-profit "community of practice."

Their online university offers free online courses.

Right now, the courses they are offering are:
1.) "The Amazing Human Brain and Human Development"
2.) "Surviving Childhood: An Introduction to the Impact of Trauma"
3.) "The Cost of Caring: Secondary Traumatic Stress and the Impact of Working With High-Risk Children and Families"
4.) "Bonding and Attachment in Maltreated Children"

For more information, please visit:
http://childtraumaacademy.org/

Life stories to address attachment issues

Child protection: serious business.: Scrapbook Life Story Work with Kids in Foster Care.

Trauma-related beliefs and resilience

In the general public, physical abuse is likely to occur twice as often as sexual abuse.

Within the foster care system, however, the rate of substantiated allegations of sexual abuse is higher than that of physical abuse.

While there are no significant differences regarding physical abuse or neglect for boys vs. girls in foster care, studies have demonstrated that girls are at greater risk for sexual abuse within the foster care system.

Girls with a history of sexual abuse:
-Experience twice as many placement changes than girls with no history of sexual abuse
-Are more likely to be housed in a group home or residential placement

Trauma-related beliefs related to sexual abuse:
- Self-blame/stigmatization
- Betrayal
- Powerlessness
- Traumatic sexualization

84 women between the ages of 18 - 25 years old participated in a study supported by the Orphan Foundation of America.

65% of participants reported a history of sexual abuse.

Where sexual abuse takes place:
1.) Prior to entering foster care
2.) While in foster care (35% of participants)
3.) In both settings (highest rate of self blame/stigmatization)

Tool utilized in study: Trauma-Related Beliefs Scale, which has been shown to be a reliable measure of beliefs for sexual abuse survivors.

Powerlessness was found to make the most significant impact on the resiliency of foster care alumna. Recovery from sexual abuse is aided by having an internal locus of control. (See previous blog entry on attribution theory).

Source:
Breno, Anjey and Galupo, M. Paz. Sexual abuse histories of young women in the U.S. child welfare system: A focus on trauma-related beliefs and resilience, Towson University.

Traumatic stress as experienced by children in the child welfare system

Here is a link to the current issue of Focal Point, which focuses on traumatic stress and children within the child welfare system: http://www.rtc.pdx.edu/pgFPW07TOC.php

Articles include the following:

Traumatic Stress and the Child Welfare System

Walker, J. S., & Weaver, A. This article defines child traumatic stress, describes some events that can cause traumatic stress, and summarizes the effects it has on children, youth, and society.

Complex Trauma in Children and Adolescents

Cook, A., et al. This article provides a core background for understanding the psychological and physiological effects of multiple traumatic stress experiences on the developing brain. Steps for assessment and treatment are also discussed.

A Real Mother's Embrace: Reflections on Abuse and Recovery

Weaver, A. The guest editor of this issue of Focal Point gives a poignant first-person account of his childhood abuse and subsequent recovery. A strong theme of Aaron’s story is the enduring support and love offered by his foster family.

Evidence-Based Treatment for Children in Child Welfare

Stambaugh, L., Burns, B. J., Landsverk, J., & Rolls-Reutz, J. This article reviews several treatment programs for children in the child welfare system who have experienced traumatic stress. The article focuses on treatments for which there is the best evidence of effectiveness.

Early Intervention as Prevention: Addressing Trauma in Young Children

Groves, B. This article focuses on the need for early intervention to address child traumatic stress in young children. The article also describes the characteristics of effective intervention.

Adapting Evidence-Based Treatments for Use with American Indian and Native Alaskan Children and Youth

Bigfoot, D. S., & Braden, J. This article describes the adaptation of several evidence-based treatments (EBTs) for child traumatic stress for use in Native American communities. The EBTs that are discussed attend to the broad cultural, historical, and intergenerational traumas that are part of the life experience of many Native American youth.

Creating a Trauma-Informed Child Welfare System

Igelman, R., Conradi, L., & Ryan, B. One role of the child welfare system is to remove children from abusive or neglectful home environments. However, the system itself can be a source of trauma. This article provides steps for reducing trauma within the child welfare system.

Child Trauma: The Role of Public Policy

Gerrity, E. This article discusses the impact that federal, state, and local government policies have in promoting increased understanding of and effective response to child traumatic stress. Analysis of current policy issues and areas for improvement is included.

Survey on Personal Boundaries

How many of these questions would you say "yes" to?

1.) I can't make up my mind.
2.) I have difficulty saying "no" to people.
3.) I feel as if my happiness depends on other people.
4.) It's hard for me to look a person in the eyes.
5.) I find myself getting involved with people who end up hurting me.
6.) I trust others.
7.) I would rather attend to others than attend to myself.
8.) People take or use my things without asking.
9.) I have difficulty asking for what I want or what I need.
10.) Some people I lend money to don't ever pay me back.
11.) I feel ashamed.
12.) I feel bad for being so "different" from other people.
13.) I feel anxious, scared or afraid.
14.) I spend my time and energy helping others so much that I neglect my own feelings and wants.
15.) I find myself getting involved with people who end up being bad for me.
15.) I feel as if my happiness depends on circumstances outside of me.
16.) I tend to take on the moods of people close to me.
17.) I am overly sensitive to criticism.
18.) I tend to get caught up in the middle of other people's problems.
19.) I feel responsible for other people's feelings.
20.) I put more into relationships than I get out of them.

*Source: Boundaries and Relationships by Charles Whitfield

Boundaries and Core Issues

Healing often occurs within community
To work through whatever core issues are most important to you, it helps to be in the company of safe people who support what you are trying to accomplish.

Early experience(s) of abandonment can lead to feelings of self-doubt and shame.
Sometimes this creates layers of problems, including compulsions and addictions.

As an adult, it's important for us to create safe boundaries in our lives, especially if as a child, those boundaries were broken. We don't want those boundaries to be too rigid, keeping love and safe relationships out of our lives. But, we don't want to allow our need for love to cause us to put up with abusive behavior either.

As adults, we can choose the that we surround ourselves with, and with whom we share our personal information. (Please note that foster care alumni often have an all-or-nothing tendency to overshare or undershare).

Recovery happens in stages

Recovery issues might include:

1.) Grieving
- Stage 1: Identifying our losses
- Stage 2: Learning to grieve
- Stage 3: Grieving past losses
- Sign of recovering: Grieving current losses

2.) Neglecting our own needs
- Stage 1: Recognize that we have needs
- Stage 2: Identify what those needs are
- Stage 3: Begin to get our needs met
- Sign of recovering: Getting our needs met on a regular basis

3.) Being over-responsible for others
- Stage 1: Identifying boundaries
- Stage 2: Clarifying what our personal boundaries are
- Stage 3: Learning to set limits
- Sign of recovering: Being responsible for self, with clear boundaries

4.) Control issues
- Stage 1: Recognize what the control issues are
- Stage 2: Sort through what you can and cannot control
- Stage 3: Let go of some things, take responsibility for others
- Sign of recovering: Achieving more of a balance

5.) All-or-nothing thinking
- Stage 1: Recognize that it's there, and that it is a problem
- Stage 2: Consider possibilities of middle ground

6.) Trust issues
- Stage 1: Realize the importance of trusting
- Stage 2: Trusting selectively
- Stage 3: Learning to trust safe people
- Sign of recovering: Trusting appropriately

7.) High tolerance for inappropriate behavior
(often linked with dependence issues)
- Stage 1: Question what is appropriate and what is not
- Stage 2: Define what you will and will not put up with
- Stage 3: Learn to set limits
- Sign of recovering: Being able to set boundaries with others

8.) Fear of abandonment
- Stage 1: Acknowledge that we have been neglected or abandoned
- Stage 2: Talk through those emotions with a safe, trustworthy person
- Stage 3: Work through emotions and learn safe attachment within a caring community
- Sign of recovering: Willing to take the risk to open your heart to another person

9.) Difficulty handling and resolving conflict
- Stage 1: Define the conflict; put it into words
- Stage 2: List the roadblocks to conflict resolution
- Stage 3: Attempt conflict resolution
- Sign of recovering: Conflict resolution, or agreeing to disagree

*Source: Boundaries and Relationships: Knowing, Protecting and Enjoying the Self by Charles Whitfield, M. D.
http://www.markstivers.com/cartoons/

Former Foster Children and Post Traumatic Stress Disorder

Comic from Cyanide and Happiness at http://www.explosm.net/comics/archive/

According to An April 6, 2005 study, former foster children in Washington and Oregon suffer post-traumatic stress disorder at twice the rate of U.S. War veterans.
http://www.casey.org/MediaCenter/PressReleasesAndAnnouncements/NWAlumniStudy.htm

The definition of PSD is "a condition in which victims of overwhelming and uncontrollable experiences are subsequently psychologically affected by feelings of intense fear, loss of safety, loss of control, helplessness and extreme vulnerability. In children, the disorder involves disorganized and agitated behavior."

After having suffered a traumatic event, children believe that if they are vigilent enough, they will recognize the warning signs and avoid future traumas.

Researchers from Harvard Medical School, the University of Michigan and Casey Family Programs reviewed case files of 659 adults, ages 20 to 33, who had lived in foster care between 1988 and 1998. They interviewed 479 of them.

It was the first significant study of how former foster children fared over a long period of time. Most of those studied entered foster care because they had been abused or neglected. More than half reported clinical levels of mental illness, compared with less than a quarter of the general population.

Foster children, the study said, are especially vulnerable to post-traumatic stress disorder.

Peter Pecora, director of research for Casey Family Programs, said a fourth of those studied reported symptoms of the disorder -- twice the rate of U.S. war veterans. "It is a dramatic finding," he said, adding that national studies show that 12 percent to 13 percent of Iraq war veterans and 15 percent of Vietnam war veterans suffer from the disorder.

Post-traumatic stress disorder occurs in some people who experience or witness life-threatening events, such as violent personal assaults, military combat or serious accidents. They often relive the trauma through nightmares and flashbacks, and feel detached or estranged.

Identity development and self-protection among group home residents

Author's premise:
'Although it is a given that children come into foster care with multiple, complex problems that stem from traumatic experiences such as physical abuse, sexual abuse, neglect, parental substance abuse and mental illness, there is little evidence that foster care ameliorates those problems.' (Definition of ameliorate: To make a situation better or more tolerable).

I love this quote from the research study: "There is a dearth of foster care research to elicit the perspective of the child."

In studies that did interview foster youth:
-Very few were able to articulate the reason for their placmment or plans for their future
-Most articulated high levels of insecurity about the permanency of their current placements

Sample:
-Teenagers from ages 15-19 who had been in foster care between 2-11 years
-This sample was drawn from group home settings

Group homes are structured residential settings, housing several foster youth. The use of group care for teenagers is high for many reasons, including a lack of available foster homes for adolescents. Group settings are often chosen for teenagers in order to facilitate their preparation for independent living.

Identity development, according to Erikson, is the process by which a teenager develops a concept of his/herself. It includes the recognition of personal capabilities and limitations.

This process involves:
-Coming to terms with past experiences
-Accepting a realistic self-definition
-Manifesting a future direction (*educational disruptions don't help)

Self-identity is socially bound: A person's sense of self emerges, in part, through their interactions with others. Therefore the social context of living in a group home has a critical influence on the residents' developmental process.

Group home residents experienced:
1.) Development of a stigmatized self-identity (*culture of foster care)
2.) Self-protection

--Institutionalized: Group foster care was described by residents as being 'like an institution.' Despite being based on a familylike philosophy of care, group homes were perceived to be overly restrictive and to lack individual consideration or respect.

--Pathologized: Furthermore, caregivers interpreted normal teenage behavior, when expressed by group home residents, as psychopathological or devient.

--Stigmatized: Entering group care conferred a new status on the child. Being labeled a 'foster child' or a 'group home kid' was experienced as a diminished social status. Other people assumed that the teenager was delinquent or disturbed.

Impersonal treatment and disrespect: These assumptions were communicated to group home residents in everyday social interactions, and, in effect, devalued their personal worth.

Negative stereotypes followed them in both their living situations and their larger social world, and were widely held by adults and peers in their neighborhood and school environment. This resulted in biased assumptions and behavioral expectations.

Internalizing the stereotype: In time, the negative views that other people held and communicated through interactions with the teenager were interalized into the teenager's self-view. This led to self isolation and limited future aspirations (lowering the bar of self-expectations).

Process of self-protection
When a child in foster care endures recurring assaults on his or her developing identity, defenses must be developed in order to prevent additional harm. Foster care is rife with uncertainty.

Self-protection is the process by which a child develops those defenses and strategies to protect self from further disappointment, rejection, loss or trauma. This process may begin prior to foster care placement, when a child experiences major losses, neglect or ongoing abuse.

The self-protective process is often accentuated in foster care due to:
-Multiple placement transitions
-Unstable caregiving
-Further episodes of mistreatment within foster placements

1.) The illusion of normality: Upon first entry into foster care, many children are given the illusion that they will be placed in a 'homelike' setting, that they will be safe, and that the people will be like a family. For many of us, this turns into broken promises.

2.) The unpredictability of foster placements is that they so often involve many transitions. Children are often left without a stable core of caregivers. The faces change, at school, in the foster placement. Even permanent foster homes end when a teenager is emancipated, which "terminates" the placement.

Each time you move, it's harder to get close to people: Trust diminishes. Most participants in the study could idenify at least one previous caregiver to whom they have felt close. The loss of that individual had been disappointing and painful. The repeated transitions underscored the original losses or rejections that had caused the young person to enter foster care.

3.) Personal loss and disconnectedness: Quote from participant in the study, "When you move, you always leave a little something behind that was yours"
-Multiple moves
-Difficulty maintaining relationships with siblings, relatives and friends
-Learning how to live without those relational connections

Strategies for self protection
1.) Creating a fictional self to conceal their foster child status: Forethought and selectivity before sharing personal information with another person. First measuring the risks of disclosure, trustworthiness of the person and potential changes in the relationship.

2.) Maintaining a defensive posture about foster care status: Apathy, "I don't care who knows" or defiance, "If they don't like it, it's their problem!" Might involve setting up fronts or barriers to avoid involvement with others or distancing themselves through antisocial behavior.

Quote from participant: "I keep my problems to myself and I solve them in my own mind. That's the way I handle things."

3.) Keeping relationships superficial: Nearly all the study participants reported making a conscious decision not to get too close or make attachments to other people.

One participant said, "I'm not really close to anyone that lives here (the group home). Oh, I'm nice to them, like when I need to borrow something. So I basically just use this place like a motel."

Underlying themes for self-protective strategies:
-"I can and must take care of myself"
-"Others can hurt you"
-"I don't need anyone"

The key defense was a veneer of self-reliance, giving the appearance of self-confidence, competance and independence. This is accomplished by using one's internal resources to combat or cope with external conditions that have a real or potential impact on the self.

It's basically a barrier to protect self from further harm.

Source:
Kools, Susan. Self-protection in adolescents in foster care. Journal of Child and Adolescent Psychiatric Nursing, Vol. 12, No. 2, pp. 139-152.

Does foster care affect boys differently than girls?

*External locus of control: An individual believes that his/her behaviour is guided by fate, luck, or other external circumstances.

*Internal locus of control: An individual believes that his/her behaviour is guided by his/her personal decisions and efforts.

The sample:
56 foster children from a public metropolitan social service area and 56 nonfoster children from the same community completed an external/internal locus of control scale and a brief demographic questionnaire. The male-female ratio of both groups was 28 boys and 28 girls.

The tool:
The Nowicki Strickland Internal-External Locus of Control Scale

The results:
Results indicated that female foster children experience a significantly higher external locus of control orientation. This difference was present regardless of the number of years in foster care.

Relationship between achievement and locus of control:
Other studies have demonstrated that high achievers are significantly more internal in their locus of control than comparison groups.

Please note that internal locus of control, or belief in one's one effectiveness can co-exist with low self esteem.

Speaking personally:
I have a high internal locus of control.

Speaking collectively:
Reading this research study made me concerned for other female alumni of foster care, who might think that their lives are governed by fate or chance, and because of that belief, sit idly rather than working proactively to make their lives better.

Sources:
Jackson, Sonia. Reducing risk and promoting resilience in vulnerable children. IUC Journal of Social Work, 2001/2002.
Wiehe, Vernon (2001). Locus of control in foster and nonfoster children. Journal of Genetic Psychology, 148(2), pp. 183-187.