Elements prior to trauma intervention in children and adolescents.

A reflection on what is taken into account in adapting psychotherapy in the face of early trauma.

Regardless of the therapeutic approach, any psychotherapeutic intervention with children and young people requires the following knowing how to adapt the intervention appropriately.

To do so, we must begin the therapeutic approach from the perspective of neurodevelopment and attachment, properly understanding the emotional and maturational states associated with the experience of trauma that they may have undergone.

Adapting psychotherapeutic intervention in children.

To the extent that the trauma has been earlier and the resources of the present are scarce, the initial focus of the intervention should be directed to the game of interaction.. That is to say, to propitiate the relationship through the game, stimulating the curiosity to be able to arrive through this game, as much to the regulation as to the bond.

Play is an extraordinary means of captivating attention and interest. This implies that the child therapist has to possess or develop the ability to integrate play in a playful and enjoyable way, not as a duty in the therapeutic process, but as a pleasure and curiosity..

In addition, he/she must be able to transmit to the family that play is therapeutic per se, and make them participate in it if the parents are ready for it. If they are, they should participate in the dynamics of play and encourage them between sessions; if not, the parents should be prepared beforehand, as far as possible. There is nothing more bonding and better than sharing moments of joint satisfaction.

In the case of adolescents, it will be very important to to have batteries of dynamics that will captivate their interest and that are the means to access their inner world.

Attachment

Integrating attachment figures or caregivers in the process is fundamental; there is no child or adolescent without parents or caregivers. They are the ones who have the capacity to cushion the impact of life, both positive and negative experiences.

The best intervention is not one that exclusively addresses the symptomatology presented by the child or the young person, but one that also understands how the attachment, the relationship within the family system, amplifies or hinders the exit from the cycle of the symptom or problem behavior..

Biological aspects of attachment

When the attachment is not secure enough, hormonal biology can guide us towards the states we want to emulate and reach so that an evolution in the attachment style towards a more secure attachment takes place.

In secure interactions there is a balance between several hormones. On the one hand, oxytocin, which stimulates the bond and is activated when we show interest through warm facial expressions, eyes, glances, with caresses and hugs, with empathy and full attention directed towards someone or towards ourselves (as occurs in meditation).

Thus, oxytocin makes it easier for us to focus our attention on the positive sensations and emotions of the experience.Oxytocin is the shy hormone that is inhibited by lack of interest and contact.

In addition, these safe interactions promote the presence of serotonin, known as the the hormone of joy or self-esteem.We secrete serotonin when we feel the joy of success and achievement, as well as when we discover the satisfaction and pride that others feel when we become aware of our merits. Similarly, serotonin is also facilitated by sports, nature, and is inhibited by stress, lack of sleep, adversity or bad news.

And the third hormone present in safe interaction is dopamine. dopamine, which is secreted in the presence of pleasure, excitement, pleasant and pleasurable sensations, and is also inhibited in the presence of stress, lack of sleep, adversity or bad news..

For the baby and the child all that pleasant sensory experience is achieved in contact with their primary attachment figure, usually the mother. It is not surprising that it is said that the separation of a baby from its main attachment figure, usually the mother, generates a reaction similar to abstinence.

And if we observe the game well, we will see how it is the ideal activity that can lead us to that relaxed and pleasant relationship, in which therapist and parents focus all the attention. In that interaction through the game and the relationship the balance between the three hormones is produced.

Play therapy

The therapy of the game knows very well the benefits of this one; thus, the combination of dynamics of game in the phases of psychological stabilizationThus, the combination of play dynamics in the phases of psychological stabilization, in which the experience of what is missing or lacking in family interactions is encouraged, opens up new opportunities to repair or amplify the regulatory systems.

All this will favor both regulation in contact with the other, dyadic, and self-regulation without falling into over-focusing the game, where the other is annoying.

Know reading the child's body language in the present momentThis gives us the opportunity to create a state of co-consciousness that will allow us to transform and change the underlying beliefs.

In childhood and adolescence the therapy is based on the interrelationship generated through play and the development of narrative.. Both allow the child and young person to take ownership of their history. And it is essential that the family system accompanies and goes along with them. If this does not happen we will only be able to solve the symptom temporarily.

Trauma intervention

Sometimes we therapists are too daring when dealing with childhood and adolescence and we consider that, with a child, anything goes: telling a story, tapping while we tell it, etc. And we are not aware that we are exposing the child, with early traumatic experience, to information and an internal experience that he/she does not know how to communicate and manage.

It is therefore essential to be adequately trained in trauma-focused therapies, such as EMDRIt is therefore essential to be properly trained in therapies with a trauma focus, such as EMDR, and to follow the training course for child and adolescent therapy, in order to become a good EMDR practitioner for children and adolescents.

EMDR Europe recommends that only therapists trained in EMDR children and adolescents intervene therapeutically with the EMDR model with the child and adolescent population and with adults with cognitive disabilities, since only they will be prepared to make the necessary adaptations to each stage of development, both cognitive, emotional and psychomotor.

Author: Cristina Cortes Viniegra, EMDR Trainer Children and Adolescents and Director of Vitaliza Psicología de la salud.