Creative therapies are very well suited to working with children or adolescents who have experienced trauma. Throughout this text, note that “trauma” refers to both Type 1 and Type II trauma, i.e., Single shock or developmental.
Trauma affects many areas of the body and brain. For example, the brainstem, provides for life supporting autonomic functions, including defence mechanisms. These defence mechanisms can reflect early patterns of trauma, giving the therapist clues as to how best attend to the child.
Pathogenesis of Trauma
What is traumatic to one, may not be traumatic to another, to some degree it is the ability of the child or adolescent to integrate the traumatic experience(s) which will trigger sustained traumatic responses. One could simplify the categorisation of childhood trauma into
- the experience which includes the nature of and duration (or repetition) of the trauma;
- how the child reacts to the trauma exposure; to what extent the experience overwhelms a child’s inability to cope and integrate the experience leading to extreme fear or helplessness.
Often, when we think of trauma, we think of terrible events, but trauma can be experienced without such dramatic causes. Consistent fissures or breaks of attachment can be considered potentially traumatic.
The focus of trauma treatment is shifting from a cognitive perspective to the emotional development of the brain (Shore, 2012) and we now understand that trauma can become the organising principle of the brain (Perry, 2009). The brain develops from the bottom up and trauma affects neurological developmental pathways; trauma treatment requires that clinicians understand the critical milestones of the nature of brain development in order to provide effective therapeutic interventions. Understanding the impact is more helpful than knowing the details of the actual trauma(s) (De Bellis, 2001).
Recent developments in neuroscience have challenged and elucidated our understanding of childhood trauma. Trauma during childhood impacts psychobiology and certain areas of the brain such as the prefrontal cortex and frontal lobes, these are the areas of the brain that determine executive functioning (EF). If EF is impacted, it may result in problems with “planning ahead, self-reflection, working memory, concentration and behavioural inhibition” (Music, 2014). Other important areas of the brain that are affected due to trauma include the limbic system, cerebellum and the corpus callosum. Trauma has been shown to inhibit regulatory processes of the autonomous nervous system, particularly the vagus (vagal tone) and elevated parasympathetic arousal (Porges, 2017). In short, disruptions cause a non-integration of experience meaning a bias on the child’s cerebral operations from the more primitive lower brain regions and “contributes to severe emotional states and may be related to emotional states of ‘immobilisation’ such as extreme terror (Porges, 1997, p. 75).
At present, there is no official definition of complex or developmental trauma in either DSM V or ICD-10, presently children may receive a diagnosis of Post-traumatic stress disorder, van der Kolk (2017) and others have argued that a diagnosis of PTSD misses the specificity of childhood trauma and have proposed a new categorisation; Developmental Trauma Disorder. Terr (1991) defines childhood trauma as
the mental result of one sudden, external blow, or a series of blows, rendering the young person temporarily helpless and breaking past ordinary coping and defensive operations” (Terr, 1991).
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