Ghost Baby Did It, Not Me: Addressing Dissociative Phenomena in Traumatized Children

1. Ghost Baby Did It, Not Me: Addressing Dissociative Phenomena in Traumatized Children Joyanna Silberg, Ph. D.

2. Dissociation Disruption in the usually integrated functions of consciousness, memory, identity or perception.

3. New definitions must take into account • How the brain learns association? • The constructive nature of the mind. • The role of an adaptive and nurturing vs. pathological environment. • The dynamic evolution of self.

4. How the brain learns association • Interpersonal experience with attuned caregiver. • Experience mediated by affect.

5. When your inner life is a place you have to stay out of, having an identity is impossible. Remembering not to remember, fractures you.Lynda Barry, One Hundred Demons, 2002

6. I try to forget to remember. It hurts to remember. It gives me bad dreams. 6 year old Billy when asked about sexual abuse.

7. Dissociative Symptoms • Fluctuating behaviors and skills • Trances, lapses in attention • Suicidal, self-mutilating, depressed • Flashbacks, sleepwalking, nightmares, fears • Vivid imaginary companions, using more than one name • Denial of observed behavior • Visual and auditory halluciantions • Multiple physical complaints • Promiscuous sexuality • Antisocial or assaultive behavior • Talking to self aloud.

8. Domains of assessment • 1. spacing out, trances. • 2. amnesia • 3. dividedness • 4 fluctuations—knowledge, mood, ability, memory • 5. depersonalization, derealization • 6. post-traumatic symptoms • 7 family

9. Adina’s description of dissociation • It’s like a brain seizure. Your brain does this so don’t have thoughts, and you don’t know what’s going.

10. A Healthy Mind. . . • Seamlessly manages the transitions between states, between affects, between contexts, in a way that is appropriate to each shifting environmental demand.

11. Approach to Child • Non-judgmental • Indirect communication • Sincere curiosity

12. Finding out about voices • Some children hear the voices of people they used to know still talking to them in their mind. (Ask about deceased parents, or birth parents.) • Sometimes children do things they wish they had not done. Has that happened to you? • Sometimes they feel like they didn’t want to but someone or something made them feel like they had to. Do you have anything like that? • Sometimes children feel like their own brain is fighting with them. Does yours feel that way? • Do you hear the fight?

13. Normal Uses of Imaginary Companions • Embodiment of wished for traits • Handling temporary conflict about unacceptable impulses • Internalization of harsh expectations • Help with loneliness

14. Finding out about Imaginary Friends • Some children have toys that they have had for a long time that are particularly special to them. Do you have this? • Can you talk to it? • Can you hear it talk to you? • Some children have invisible friends that others can’t see. Did you have this? Do you feel sometimes like it is still there? Can you see them? (Find out about conflict, control, how disturbing, how segregated.)

15. Finding out about Imaginary Friends/Enemies • Some children feel like when they do something they wish they didn’t do , that it did not feel like them. Does this happen to you? • What does that feel like?

16. Maladaptive fantasy in traumatized children • Lack of control • Sense of conflict • Can’t differentiate between real and imagined

17. Questions about trance, spacing- out • What are you doing when you are spaced out like that? Not paying attention?What was that? • Do you ever finding yourself blanking out, not paying attention at all? What are you doing at those times? What are you thinking, hearing, seeing? • Try to see if there is a connection to the imaginary friends phenomena, often there is.

18. Questions about Amnesia • Forgetting things you should remember—what you did with friends, places you went • Forgetting what you did when you are angry. • Testing the limits of amnesia. Create Context for Remembering, Provide Cues, Identify with the feelings, Incentives to remember • Do you ever Forget Good things that Happened to You?

19. Fluctuations in tastes, moods, behaviors • Do you feel sometimes like you can do something one day, and have great trouble doing it the next day? • Does it surprise you when your moods change? Give examples. • Do your tastes change from day to day?

20. Dissociation Focused Interventions • Educate: about dissociative processes • Dissociation Motivation • Understand what’s hidden. • Claim as own affects of shame, fear, sexuality, anger. • Affect regulation/Attachemnt • Triggers and Trauma • Every part makes up the integrated self.

21. Educate about Dissociative Processes

22. Explaining the Brain and Dissociation • Draw picture of brain • Show items coming in causing walls to go up • Show how connections are healthy • Have child draw in connection>>>>>>

23. Promote education about traumatic symptoms and dissociation.

24. Psychoeducation starts the process of reeducation of the mind so that interventions can be accepted.

25. Explanation of flashbacks and bad memories. • When your mind doesn’t put things aways neatly, they can keep popping up again when you don’t want them to. • An alarm system going off that’s too sensitive. • Your mind is trying to tell you something is still not safe. Let’s figure out what.

26. Dissociation Motivation

27. What I Learned About Myself • The voices I hear in my mind are like parts of me. They are like my feelings talking to me. • I used to call one of the voices the bad one. I learned that no feelings are bad, feelings like being mad, or feeling sexy, or lonely are not bad.

28. What I learned About Myself • I can become a cosmetologist and I can have my own family one day. • I do not have to be the kind of mother my mother was to me.

29. The Pro Con List • I can do better in school • My friends won’t think I’m weird • It will make my mom happy. • I won’t be lonely. • It is easier. • I can avoid remembering.

30. Understand What’s Hidden

31. Sometimes the self-knowledge is: • Embarrassing • Painful • Frightening • Enraging • DETOXIFY!!!! There is nothing so bad you cannot feel it. Feelings go away. Feelings are not the Trauma!

32. Claim As Own Hidden Affectsand Repair conflicts

33. Shame and fear about the self and its secrets prevents internal awareness • De-stigmatize internal negative self-representations • Promote Self-acceptance

34. Dissociation Focused Interventions • Educate: about dissociative processes • Dissociation Motivation • Understand what’s hidden. • Claim as own affects of shame, fear, sexuality, anger. • Affect regulation and expression. • Triggers and Trauma • Every part makes up the integrated self.

35. Affect Regulation and Attachment

36. Awareness and expression of feelings are the tools which build healthy consciousness.

37. Learning about emotions • What are they? • How do you tolerate them? • How do you manage them? • How do you use them? • How do you avoid contagion?

38. More About Feelings • Difference Between feeling and doing. • Survival Value of Feelings • Why did God create anger? • Why did God (evolution) create sex? • Boundaries: Are feelings contagious? • Desensitization to Expressions of Parents

39. Countering Traumatic Transference in the Therapeutic relationship • “ I can accept you no matter how terrible you think you are.” • “You are in charge of yourself. I cannot control you.” • “I deeply want you to get well, but it is ultimately completely within your control.” • “I can accept your anger and disappointment and not reject you.” • .“You can abandon me, I can’t/won’t abandon you.” • “You don’t have to do anything to please me. We are here for you.”

40. Dysfunctional Beliefs of Traumatized Families • You are damaged just like me. • I deserved it–you deserved it. This is my punishment. • I am helpless to parent you/ The abuser is more powerful than me. • You can never be normal. • I’ll always be there because you can’t protect yourself. • I am better than the ones that hurt you. • You’ll be just like them. I won’t let you do to me what they did. • It’s me and you against the world.

41. Healthy Beliefs for Traumatized Children • Abuse is not their fault. The fault lies outside of them. • They are powerful and able to determine their future. • Suffering is not inevitable for them. • They are intrinsically loveable. • They will gain autonomy and increasing self-determination. • Their caretakers are strong enough to protect them and prevent future suffering.

42. Empowering Messages for Traumatized Children • Your brain is adaptive, not sick. • Be grateful to yourself for your survival strengths. • You can risk attachment and trust. • You can be in charge of your behavior and choose your future. • Love is more powerful than hate. Don’t identify with the abusers. Break the cycle.

43. I am hugging all of you, the grown up you and the little Sammy inside and every feeling and part no matter how it feels or how angry it is.

44. Triggers and Trauma

45. Sometimes a trigger sets off a behavior that is connected by an affective bridge to the original trauma: Sonya

46. Helping Adina Understand Her Angry Reactions • Affect bridge connecting it to powerlessness. • Letter from me reminding her of her power. • Mother learned a set phrase to detoxify the helplessness.

47. Too painful to feel powerless Too painful to blameself Extreme powerlessness The cycle of Traumatic DemoralizationExtreme self-blame

48. Dealing with Powerlessness • Metaphors about natural events, warning systems. • Spiritual Acceptance. • Distinguishing between then and now. • Taking action in the world. • Understanding the power you did have and how you used it.

49. Three Steps in Self-Forgiveness • Know what you did. • Understand what you did. • Make a new commitment

50. My abuser loved me I deserved it. I am worthless. I hate myself. I am unlovable The Cycle of Traumatic AttachmentMy abuser harmed me