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Articles by
staff members:
"Acting-out"
Behaviors As Symptomatic of PTSD in
Children and Adolescents:"
A Treatment Approach
By Wayne D. Parks, MA, CFC, DAPA
Director, Family Trauma Services, Inc.
In recent years, a large body of research
has been presented which would seem to substantiate theories regarding
the significant impact of emotional trauma on children and adolescents.
Prior to the availability of empirical validation of children's Post
Traumatic Stress Disorder (PTSD), mental health clinicians, parents,
teachers, social workers, and court services staff concentrated
primarily on gaining control of the manifested "acting-out"
behaviors. A cognitive-behavioral treatment model was the clinical
approach of choice for aggressive, destructive, violent and sexually
inappropriate youth. Wherever possible, the lack of internal willingness
on the client's part to comply with any behavioral modification program
was augmented by a court order or other threat of negative consequences.
In repeat offenders or chronic cases long term commitment with exposure
to a behavioral modification model was desirable. Therefore, the
"willingness" to comply was "supplied from the
outside". Eventually, the goal of instilling conscious/cognitive
behavioral blocks was hopefully realized. The child or teen was then
able to go forward and live a reasonably successful life predicated upon
their ability to maintain a hyper-vigilant adherence to certain
behavioral standards. In addition, the client may have been encouraged
to seek follow-up outpatient mental health therapy to explore any
feelings of anger or resentment toward an abusive environment, caretaker
or situation from their past. However, the primary concern, the
"acting-out" behavior was controlled. Or was it?
As emerging empirical evidence has
identified the connecting thread between childhood victims of physical,
emotional and sexual abuse, with certain anti-social
"acting-out" behaviors, clinical and community support
services have begun giving strong consideration to the etiology of these
behaviors. It has become increasingly more apparent that these behaviors
may be symptomatic of a diagnosable disorder-PTSD-which requires that
immediate intervention and direct treatment be accomplished before the
client has a fair chance at functioning, for any extended period of
time, symptom free.
Dr. M.J. Horowitz (1986), in his studies
of Stress Response Syndromes, suggested that the client will continue to
re-enact the original trauma until it is therapeutically worked through.
Further, that it is likely that self-destructive re-enactments may
cognitively "feel good". The act may serve to medicate the
emotional pain of the original trauma. Adolescents often exhibit
illegal, dangerous, disruptive, hurtful and hostile behavior as a way of
coping with depressive feelings (Lustig et. al., 1985).
This PTSD "acting-out" behavior
often appears as an effort to externalize a felt sense of pain, fear and
anger. In addition, children/adolescents become quite adept at
utilization of these maladaptive coping mechanisms. The behaviors have
been normalized for them through both the original trauma, as well as
the subsequent response to the trauma. Children and adolescents often
pride themselves and how well they've maladapted and how emotionally
defended they've become.
Dr. Mark Schawrtz (et. al., 1992), in his
research into PTSD, Compulsivity and Dissociative Disorder, suggest that
the PTSD victim so fears the potential abuse of others that they move to
the opposite extreme, becoming actively abusive. The result of this
powerless ineffective interaction with others, heighten by self-efficacy
and esteem issues, as well as repeated abuse re-enactments serves only
to foster more frustration, powerlessness, and rage. Old rage from the
childhood trauma and now shame-based rage combine and reinforce one
another, leading cyclically to even greater victimization of self and
others.
The clinical staff at Family Trauma
Services, Inc., representing extensive center-based residential, and
home-based experience, has developed an integrated treatment model which
combines several approaches. Clinicians in the center-based individual
and group therapy component utilize the cognitive-behavioral and PTSD/Abreaction
model. The primary goal of abreaction therapy, according to Dr. Mark
Schwartz (et. al., 1992) is the empowerment and reclaiming control over
one's life by stopping the re-victimization due to early trauma-coded
adaptation. Home-based Family Therapist work from a combined family
systems and relapse prevention model. The relapse prevention approach,
advanced by Dr. Pithers (et. al., 1987, 1988) was designed to increase
the client's awareness and range of choices concerning his behavior, to
develop specific coping skills and self-control capacities, and to
create a general sense of mastery or control over one's life. The
external supervisory dimension of the relapse prevention model increase
the efficiency of this approach by creating an informed network of
collateral contacts who can assist in monitoring the client's behavior.
These contacts include family members, school staff, probation
counselors, mental health providers, and other community resources
engaged with the client. The home-based family therapist facilitates the
constant exchange of information throughout the collateral contact
network.
This integrative treatment model, as
referred to by Dr. Barbara Schwartz in her study of effective treatment
techniques for sex offenders (1992), aims at responding to the
individual complexity of the client. It recognizes that the client's
acting-out/exhibited behavior and/or affect is a complex combination of
physiological, cognitive, affective, social, cultural, and even
spiritual issues. The successful treatment approach must be as
multifaceted as the condition itself.
Horowitz, M.J. (1986) Stress Response
Syndromes - a Review of Post Traumatic and Adjustment Disorders.
Pithers, W., Cumming, G., Beal, L.,
Young, W., & Turner, R. (1987, 1988) Relapse Prevention
Schwartz, M., Masters, W., & Galperin,
L. (1992) Dissociation and Treatment of Compulsive Reenactment of Trauma
Schwartz, M. (1992) Sexual Compulsivity
as Post Trauma Stress Disorder: Treatment Perspective
Schwartz, B. (1992) Effective Treatment
Techniques for Sex Offenders |
