During the ESTD conference in 2016 we have had our first full track on Child and Adolescent presentations since the start of the ESTD 10 years ago. This is a very exiting development, which the present Board made possible. All the child and adolescent therapists who attended the conference were appreciative of this positive step in the ESTD. The child and adolescent presenters represented 8 different countries; interesting and relevant information was shared with participants. In most cases the training rooms were packed to capacity. In the hope that we will attract more child and adolescent therapists to our next conference in Bern, Switzerland, in 2017, highlights of the child and adolescent tracks are shared with the readers.
The conference started with a pre-conference day where there were two child and adolescent presentations. Julian Ford is a clinical psychologist and tenured Professor of Psychiatry at the University of Connecticut School of Medicine where he is the Director of the Centre for Trauma Recovery and Juvenile Justice. He presented on Trauma Affect Regulation: Guide for Education and Therapy (TARGET) for Complex Trauma with specific reference to the adolescents who might move into delinquency.
Renée Potgieter Marks, clinical lead at Integrate Families in the UK presented on the Child and Adolescent Guidelines, which were published on the ESTD website at the end of 2015. The focus was mainly on assessment and treatment of children with dissociation and was richly illustrated with case studies, transcripts of actual treatment sessions, and DVDs.
The highlights of the child and adolescent track was the excellent plenary talk by Karl Heinz Brisch, who presented on the assessment and treatment of traumatised and dissociated children with attachment disorders. Dr Brisch very eloquently presented the well-known attachment styles by showing DVDs of the strange person situation with running commentary by him. The stress of watching the children's distress was positively interrupted by Dr Brisch's humour, explaining how our adult clients might display similar behaviours after our return from the conference. This information was all too familiar, returning to the overwhelmed client who could not cope without the therapist, as well as the responses of clients with dismissive and unresolved attachments. Dr Brisch also shared very important information on how mothers are triggered by their babies and the impact this has on the mirroring and development of the attachment and the self of the baby. Treatment of the mother can result in significant reduction of her symptoms and the mother can become more attuned to her infant as illustrated with the DVD shown.
The child and adolescent track also covered relevant information about the importance of understanding and working with attachment disruption and the parents' role. Doris D'Hooghe from Belgium explained that the caregivers’ ability to mentalise, regulate, contain, and play with the child might play an important role in the quality of the attachment.
Two presentations from the Czech Republic were delivered in the child and adolescent track. Ivo Urbánek, professor of psychology at the Masaryk University presented the outcomes of a study where the TAT (Thematic Apperception Test) was used on a sample of girls who were exposed to multiple, chronic, and prolonged adverse traumatic interpersonal events. This was compared to a group of girls whose trauma was not chronic and a group of girls who did not suffer significant trauma. TAT stories of the traumatised girls were less developed and more fragmented. Severely traumatised girls also displayed more dissociative phenomena and illogical verbalisations in their TAT stories. Petr Stephanek, a colleague of Ivo's,presented research on depression and suicidality in polytraumatised adolescent girls. It was evident from this research that therapy for this population has to be adapted to specifically meet their needs.
Further presentations from Colin Maginn and Sean Cameron, from Pillars in Parenting in the UK, discussed how leadership impacts on effective therapy with young people and introduced a new approach of treating traumatised children in residential care homes, where each child receives an individualised programme. Spijker van Vuuren presented on a psychological first aid tool for families with intellectual disabilities, their families and caregivers, which was published in 2014.
The most neglected area in working with children and adolescents, namely the medical arena, was highlighted by Aad Stierum, psychiatrist from the Netherlands who presented on the use of medication in this child and adolescent population. It was evident from his presentation that medication does not appear to cure the trauma or dissociation but, in selected cases, might bring enough relief to aid the psychotherapeutic process. Aad recently published a chapter on this important topic in the book of Waters (Healing the Fractured Child, 2016. Renée Potgieter Marks presented on the impact and treatment of children who were exposed at different times, to traumatising medical procedures, both once and on long term. It was evident that both a single traumatic medical experience and multiple traumatic medical experiences might cause significant dissociation in children, and need to be thoroughly explored and treated in order to avoid long term psychological problems and significant dissociation.
Arianne Struik, a well-known psychologist from the Netherlands, who now resides and works in Australia, shared information about the assessment and treatment of emotional regulation and stability in children and adolescents. Arianne presented the six steps that she developed to safely treat children with complex trauma and dissociation. She also challenged the view of many professionals in the field that complex trauma should be “left” and not treated. Arianne’s concept of “Slapende honden? Wakker maken!” (“Don’t let sleeping dogs lie”) (which is also the title of her books, 2011 & 2014), clearly illustrated the importance for child and adolescent therapists to work directly with the trauma in this population of children and adolescents. Renée Potgieter Marks shared this presentation and presented on practical aspects of emotional regulation in children and how children’s emotional regulation can be improved at home and in the therapy room.
Arianne Struik’s relevant and interesting case discussions illustrated her next presentation on reducing dissociation by systemic intervention. There were further presentations on research on the prevalence and consequences of child abuse and exposure to intimate partner violence in child and adolescent psychiatry by Hevig Kalen and Ole Hultman from the University of Gothenburg, Sweden. Signe Brager and Annika Lichtenstein from the BUP trauma unit in Sweden presented on the use of EMDR in the treatment of traumatised children and adolescents. Leoniek Kroneman presented on a literature study on the opportunities to enhance adolescents' motivation for therapeutic treatment in compulsory residential care.
Leony Coppens, Marthe Schneiderberg, and Carina von Kegten presented on Trauma Sensitive Education. They advocate that the school/teacher needs to look at the child through the trauma lens and establish safety, trust, stable relationships, own self-regulation, work as a team, and have a knowledge of trauma. They also developed the concept that the traumatised child attends school with an ‘invisible suitcase’ filled with the trauma experiences, which impacts the child’s capacity to learn. Teachers need to be aware of this and have to ‘connect before correct’. These presenters have also just released a book on this topic, which is specifically written for schools in order to manage traumatised children more effectively. (Lesgeven aan Getraumatiseerde Kinderen: Een praktisch handbook voor het basis onderwijs, 2016).
Children and adolescents with complex trauma and dissociation find themselves in a conundrum of external pressure to conform with expectations from adults caring for them, schools and society, while their internal world mostly reflects the chaos, fear and anger of their traumatic experiences. Most children and adolescents also report that they ‘lose control’ and due to the dissociative states are not always able to do what is expected from them. It is also evident that this group of children and adolescents need an adaptation in their treatment plans and that both parents, carers and schools need to be involved. Evaluating the child and adolescent track of the 2016 conference, we had a very good selection of presentations, which addressed the most crucial problems and areas of children with complex trauma and dissociation. We also trust that we will have even more professionals attending our Bern conference in November 2017 to share in updated information and empower the therapists working in this field to provide effective therapy and services to these vulnerable children and adolescents.