A Brief Therapy Heals Trauma in Children

New York Times: Every year millions of children from all walks of life become victims of, or witnesses to, abusive or violent events that can result in long-lasting symptoms of distress. The events can range from sexual and physical abuse to involvement in a natural disaster, fire or serious motor vehicle accident.

In many cases, the trauma is unknown to parents and caregivers or never dealt with effectively. The consequences can be devastating for the children and families involved and for society at large. These children are at much greater risk of developing behavioral problems, failing at school, abusing drugs or alcohol and becoming violent themselves.

Without treatment, post-traumatic stress reactions can persist into adulthood, causing eating disorders, personality and mood disorders, relationship difficulties, persistent anxiety, unexplained physical problems, and violent or abusive behaviors.

According to report being released Tuesday by Safe Horizon, a victim assistance group that operates child advocacy centers in New York City, and the Childhood Violent Trauma Center at Yale University, children who are abused or neglected are 59 percent more likely than those who were not victimized to be arrested as juveniles, 28 percent more likely to be arrested as adults, and 30 percent more likely to commit a violent crime. They also face much higher rates of teenage pregnancy and are likelier to abuse or neglect their own children.

Silver Lining

But there’s good news here: The report describes a remarkably effective brief intervention developed at the trauma center that, according to Steven R. Marans, professor of psychiatry at Yale and director of the center, greatly diminishes symptoms in traumatized children and those who care for them.

With the staff at Safe Horizon, the Yale team adapted the program to meet the needs of children and families facing the potentially horrific scars of sexual and physical abuse. I spoke with the mothers of two such youngsters.

One, a stay-at-home mother in Staten Island, was shocked to learn that for three years her 12-year-old daughter had been molested by a priest who, she said, “was like a member of the family.” The priest had threatened the girl, saying her parents would never believe her.

The second mother, a financial executive from Brooklyn, said she was “devastated — my whole world collapsed” when her 10-year-old son revealed that he had been raped by an 11-year-old friend on a play date.

“I was distraught to learn my son had lost his innocence like that,” the woman told me. “His father and I had no idea how to address this.”

Both mothers wasted no time getting help. The Staten Island mother reported the abuse to the police, who referred her to a Safe Horizon center; the other took her son to the emergency room, where a nurse contacted the police, who in turn referred them to Safe Horizon.

In both cases, and scores of others like them, the children and their parents benefited enormously from just four to six structured sessions with trained clinicians. Unlike traditional counseling, which is often unstructured and prolonged and may not involve both child and caregiver, this program follows a proven pattern: first a session with the caregiver, then one with the child, then two sessions with them together. In each session a trained counselor fosters healing through reassurance and support and, with before-and-after tests, measures the effectiveness of the intervention. If necessary, the child or caregiver may be referred for further therapy.

The girl, who had become very distracted in school and repeatedly rejected physical contact with her own family members, is now doing much better in class and enjoys being hugged. Her recollections of the abuse have abated.

The Brooklyn boy and his family, though initially terrified, gained peace of mind and assurance that what happened was not their fault.

“If not for Safe Horizon, which was our calm in a hurricane, we would be really damaged by this event,” the boy’s mother said. “I didn’t want the incident to affect him later on. The therapist worked through things with my son, who now says it’s not a big deal.”

In 2010, Dr. Marans, Dr. Steven J. Berkowitz, now a child psychiatrist at the University of Pennsylvania, and Carla Smith Stover, an assistant professor in the Child Study Center at Yale School of Medicine, published the results of a controlled clinical trial of the new therapy program, called the Child and Family Traumatic Stress Intervention. The study, published in The Journal of Child Psychology and Psychiatry, involved 106 traumatized children ages 7 to 18 and their caregivers, who were randomly assigned to four sessions of the structured intervention or to conventional support for childhood trauma.

When evaluated three months later, those who received the intervention were much less likely to suffer from post-traumatic symptoms like sleep disturbances, intrusive thoughts, depression, anxiety, tantrums or feelings of helplessness or hopelessness.

Remarkable Results

The children completing the intervention were 65 percent less likely than those in the comparison group to have developed full-blown post-traumatic stress disorder and 73 percent less likely to experience partial or full post-traumatic stress disorder, researchers said.

As described in the study released on Tuesday, Safe Horizon’s experience among nearly 500 children who received the intervention “mirrored the results of the original trial at Yale,” said Rita Garza, spokeswoman for the organization.

Dr. Marans reported that children who participated experienced a 54 percent reduction in trauma symptoms, and their caregivers benefited almost as much.

“When children are alone with and don’t have words to describe their traumatic reactions, symptoms and symptomatic behaviors are their only means of expression,” he said. “And caregivers are often unable to understand the connection between the traumatic event and their children’s symptoms and behaviors. To heal, children need recognition and understanding from their caregivers.”

He added: “This intervention inspires hope and confidence. It can make an immediate and palpable difference in the daily lives of children who have suffered even the worst forms of abuse.”

Well over 90 percent of caregivers who participated in the intervention said they had learned new skills and would recommend the program, which could be a boon to child treatment centers throughout the country.

Nancy Arnow, in charge of child, adolescent and mental health treatment services at Safe Horizon, said: “We now have a standardized way to offer children and their families an evidence-based intervention that is both brief and remarkably effective. The number of children who need this kind of help is not decreasing. It’s increasing.”

Ms. Garza said: “Six centers elsewhere are now undergoing training, and we want the program to be replicated across the country. Children everywhere should be able to get this kind of help.”