Teachers as trauma-treatment professionals

Happy New Year to all of the teachers and school counselors out there! I hope your classes are full of bright shiny faces smiling contentedly as they work. However, my years of experience (and the data) tell me that most of you will have at least one kid in your class who’s just capable of driving you nuts before Thanksgiving.

You know the kid. The one who:

– can’t sit still, ever.

– doesn’t listen to you unless you shout.

– can’t finish a worksheet or project, even with extra time.

-clings to or actively avoids adult visitors to the room.

– freaks out during fire drills.

– won’t go in the bathroom alone, OR won’t come out.

– has a full-blown, toddler-style temper tantrum at least every other week.

– you can’t ever predict the tantrum, or the cause.

– won’t share.

-steals things.

-lies about really obvious facts.

-smells bad and/or comes to school dirty.

-manipulates and/or terrifies the other kids.

-but is really very bright.

Sound like anyone you know?

I’ve known scores of kids who fit that description. The behaviors vary from individual to individual, year to year, but they’re always angry, distracted- and smart. You know that IF you could just get underneath all that anger and bluster, you could really actually teach this kid. But getting there is so, so, so hard. Every time you think you’ve made a little progress, the kid will change things up and do some new annoying/terrifying/destructive thing. How do you teach this kid without totally loosing your own mind?

In short, it’s not easy. But teaching really tough kids is also not impossible. With the caveat that every difficult kid is different, here are a handful of ideas to try:

1. Shift your own internal dialogue about the child and his/her behavior. What I’ve described here are classic symptoms of complex trauma in early childhood. You’ll see the same things, with a few modifications, in adolescents. Simply seeing these behaviors as symptoms of a traumatic past (or present) will help you be more effective in your approach. The kid isn’t bad; he’s in pain, he’s scared, and he needs you to understand.

As a teacher, it’s certainly not up to you to make any sort of diagnosis. However, you can become more aware of the common symptoms of childhood trauma, and learn how to intervene in effective ways to help the children impacted by trauma to learn more effectively. It’s not important for you to know the details of what happened (unless it’s ongoing, in which case you need to make a child protective services report). What IS important is controlling your reactions to the behaviors you’re seeing. If the child is in foster care, there is a trauma history.

2. Set up classroom routines and keep to them. Kids who come from chaotic, violent homes and neighborhoods do not like surprises. Part of what you’re seeing is that the kid’s flight or fight defense system is stuck in the “on” position. Your job is to find ways to bring down their levels of arousal and vigilance. If you’re planning a surprise celebration, tell these kids ahead of time. Vary the day to day routine as little as possible. Write or draw the schedule for the day on the white board, every day, even if  you’re a high school teacher.

3. Minimize distractions, especially noise. Kids with trauma histories often have great difficulty screening out background sounds. Essentially, they’re always scanning the environment for danger, and hearing is a key pathway. They have a particularly hard time screening out the noise of all of the other kids in the room when you’re trying to talk. Make quiet a priority. If the noise level remains high, pull this kid(s) over to your desk and re-explain what you said, holding his/her hand and making eye contact (if it’s ok with the child, these things can also be scary, so ask first). Touch and eye contact help them focus on your voice. If you’re a male teacher, this will be easier, since the lower frequency sounds are less likely to get screened out (I learned all of this from Dr. Stephen Porges, who is brilliant – you should all read his book). Yelling, from you, is totally off-limits. Educate your colleagues about auditory hypersensitivities and help them learn to speak in less shocking tones if needed.

4. Encourage movement, especially with a beat. Kids with a variety of learning problems, as well as kids with trauma issues, will benefit from this one. Take 10-15 minute breaks throughout the day to sing, dance, and move. Songs that are highly rhythmic and use clapping or stomping to go with the words are wonderful for this purpose. Kids and adults with trauma issues are often disconnected from their bodies in many ways, which contributes to problems with attention regulation and focus. Moving and especially singing (or playing a wind instrument) helps relax critical neural circuits, lowers the heart rate, and helps broaden a sense of safety. Hand-clapping games are also good, but be sure to do some breathing in there somewhere.

5. Incorporate explicit activities to build a “tribe” in your classroom. If the students can learn to trust each other, the whole room will be remarkably more relaxed and much more learning can happen. Avoid activities that require students to compete, replace them with activities that help the kids learn about each other and learn to care, rather than scorn, blame, or exploit each other. There are tons of resources available online for accomplishing this, just do some google research. Lou Cozolino discusses this in his book, “The Social Neuroscience of Education”, which I think all licensed educators should be required to read. It’s a quick read,  packed full of interesting ideas.

Beyond these basic steps, keep working at it. Don’t ever give up on a kid. You may be the last hope he/she has. And, of course, make referrals to mental health professionals as needed.

 

Book review: Four Ways to Click, Amy Banks (2015)

Amy Bank’s first book, “Four Ways to Click” (2015) New York: Tarcher/Penguin, distills the wisdom of the magnificent Jean Baker-Miller’s theories, infuses them with a new dose of relevance and importance via recent neuroscience findings, and pours out information written for a general audience.  Dr. Banks, who is also a practicing psychiatrist, had some help from professional writer Leigh Ann Hirschman making these ideas come across in such simple and basic language, and I’m very grateful for that. I’ve been at a few training sessions Amy has led over the years, and I always leave feeling like my brain has over-indulged, much like my tummy feels right after Christmas dinner. Her ideas are brilliant, and in this new format, even normals like myself can get a firm grasp on them.

True to its title, the book breaks Dr. Miller’s Relational-Cultural theory (RCT) ideas down into four basic bites: Calm, Accepted, Resonant, Energetic (CARE for short). Each of the four bites,which she calls pathways, has its own chapter, where Amy explains what brain and nervous system parts have to engage to make that bite happen. She also tells us what emotional and behavioral symptoms emerge when that part is out of whack.

Two other key components of this book are the “3 rules for brain change” and a self-scoring assessment readers can use to determine how well balanced (or not) they are with the four basic relational pathways (The CARE parts). The three rules aren’t new to anyone who’s been reading the newer neuroscience books, especially the applied texts. The rules all relate to basic science about neuroplasticity, or what it takes to create new automatic or default thoughts and behaviors. It really boils down to the fact that you have to practice – a lot- to make changes permanent. It’s nice to have the brain science explained, although telling readers to practice a lot would be ok, too.

The self-assessment is pretty handy. It doesn’t purport to be psychometrically sound, which is fine, since it’s not being used as a true diagnostic tool. I was surprised that there doesn’t seem to be (unless I overlooked it) any reference to Liang,et al and the Relational Health Index, which has been around for several years and is quite similar to this scale. Amy’s CARE Relational Assessment is tailored to fit within her framework, while the RHI is designed to fit under the more broad RCT frame. I don’t know the back story on this part of the book, but it does make me scratch my head a bit. The RCT world is small and deeply connected. Amy took pains to thank a lot of people in the acknowledgements section, but the RHI team aren’t there.

I found this little volume (it’s only about 300 pages, with the index, notes, table of contents, etc.) to be very accessible, and I imagine that clients who have at least a 10-12th grade reading level would find it interesting and helpful. I read most of it while waiting for an oil change to be completed, and found it very engaging. I’m encouraging my graduate students to pick it up as a good resource to recommend to their clients who are struggling with out-of-whack neural/relational pathways. It’s a nice introduction to how the brain influences and reflects our relationships, and understanding that interplay can be a life-changer for clients.

Heartache is a Real Thing.

Last night, I watched a documentary called “Shunned” about the old order Amish (old order is sort of like orthodox) practice of shunning. I have no idea how the filmmaker managed to get access to the people s/he interviewed, but the whole film was first-person stories of leaving the order. All of them, including a young woman who had only left home a few days prior to her first interview, talked about how painful it was to disconnect from the world they knew to enter a world they didn’t understand and were raised to believe is evil and dangerous.

The pain of being away from family was compounded greatly by the fact that leaving the order means you’re also excommunicated from the church, which means you’re going to hell. The Amish believe in a very literal, physical afterlife experience, so spending time in a burning pit is not a metaphor for them, it’s a real thing that happens. This belief is part of the reason that the Amish practice of shunning is so effective as a disciplinary method in the community.

In the Amish world, members of the community who don’t follow all of the rules can be shunned, usually for a specific period of time, but sometimes permanently. Shunning involves isolating the person from the group; they sit alone at meals, work alone at chores, sleep alone, sit alone in church. No one speaks to them except to give directions. Once the period of punishment is over, the person is usually able to rejoin the community, but will certainly think twice before making the same mistake again.

The Amish have been using shunning as a way to keep order in their communities since the inception of the religion. It works. Really well.

Shunning is sort of the idea behind our prisons, but far more effective because it’s even more painful. The people in the documentary used the term “heart broken” a lot when describing how it felt to be turned out by all of the people in their lives who matter to them. Heartache is a real, actual experience of pain. If you’ve ever been dumped, you know this. Science, however, has long poo-poo’d the idea of heartache as actual physical pain.

As it turns out, the Amish and dumpees everywhere are right. Emotional pain is just as painful and as real as physical pain. Eisenberger & Lieberman (2005), a couple of neuroscientists, proposed an idea they called “Social Pain Overlap Theory”, or SPOT. Essentially, the point they made is that the pain of social exclusion or teasing processed along the exact same neural and biological pathways as physical pain.

Another term I really like from neuroscience is “technomyopia” which is the idea that only studies that use fancy machines can prove things we know and have always known from common sense and common experience. SPOT is a great example of that; humans have always known that having your heart broken hurts like hell. In fact, it hurts as much as breaking any other part of you. But because scientists have seen this happen with fMRI’s and other fancy machines, it now has a name and is considered to be empirically true.

And that’s a good thing.

With Eisenberg & Lieberman’s work, therapists and other squishy-feelings types can say, Hey, because SCIENCE! when we talk about the pain of heart ache and social exclusion. So, back to the Amish for a minute.

One of the reasons the old-order Amish continue to exist, although their lifestyle is very harsh, non-luxe, zero-tech, and isolated is that they are geniuses at forming and maintaining communities. Amish families usually live in clumps of a dozen or so. Families tend to be large, so a dozen families can make up a community of enough folks to do all of the farming and other work needed to sustain themselves with almost zero contact with the rest of us. The people in the community come to depend on each other for their survival, as well as for friendship and emotional comfort. They are all important to the community; everyone matters to everyone else.

Amish folks are rarely alone; they work in groups, eat at long family tables, go to church every week without ever sleeping in, children share beds, etc. Shunning works because the communities are so effective. Because every individual matters to the community, the community matters to the individual. Shunning is horrible because the community is wonderful.

The dominant culture in the U.S. isn’t very good at the community thing. When was the last time you sat down to supper with all of your siblings, your parents, and your bachelor uncle? When was the last time you helped your bff build a house? Who grew your salad from lunch yesterday?

Shunning is still painful for the rest of us. SPOT insures that anytime a human being is isolated by others, removed from the communal table, and told they’ve done wrong, it’s terrible. When your co-workers don’t invite you to happy hour, it sucks, even if you’re 40 and you know it’s not really the end of the world.

Even when our communities are loose and poorly constructed, SPOT is real. The Amish are careful to put a time limit on the shunning. Amish people who are shunned know it will end, and they can go back to belonging (usually, excommunication is a little different, but even then, people can return, it’s just a lot harder. Forever shunning is like capital punishment and is reserved for serious offenses, like murder and rape). Shunned Amish people know it will only last a few days or weeks, and then they’ll be accepted right back into the fold.

When we shun or exclude people in our world, there’s no clear limit on how long it will go on, or what the person can do to return. This is particularly damaging for adolescents, who desperately need to matter, but don’t have the social skills to make it happen or the experience in life to know that everything is temporary, and that this too shall pass. To an adolescent who is excluded from the community of his/her peers, it seems like forever, like capital shunning.

And here’s my point: as adults, we know social exclusion hurts. As smarty-pantses, we even have scientific proof of this, the SPOT. We need to do a much better job of making sure there’s a way out of the shunning penalty box for kids. Kids who don’t believe that they matter often don’t think anyone else does, either, and we know where that leads.

Book review: The Interpersonal Neurobiology of Play (2014)

Among my favorite things (cue singing) in the world to read has to be books about brains. I’m fascinated by all brains- human, mammal, lizard, doesn’t matter; love ’em all. What’s a real gem is a book about brains that I don’t need a dictionary to plow through that gives me information I can use for something other than trivia night at the local pub.

Theresa Kestly’s The Interpersonal Neurobiology of Play (2014) is one of those rare finds. It’s the latest entry in Norton’s series on interpersonal neurobiology. In my opinion, it’s one of the stronger offerings. It’s a very tightly edited trim volume of only 205 pages including the index. Every single one of those 205 pages is worth reading.

The prose is clear enough for an absolute beginner to grasp, yet has enough complexity to entertain brain geeks like myself. The book is based around a series of well-designed graphics (another fetish of mine) which make the material at once well-organized and visually compelling. A lot of it is also new to me- I’d never heard of Jaak Panksepp, a brain guy Kestly quotes throughout the book. I really thought I’d heard of all the Big Names in brains by now: Porges, van der Kolk, Siegel, Perry, etc. But here’s a new one! And he has some really interesting ideas that directly apply to play therapy and play in general.

Since this little book is so packed with great information, I’m not going to reveal the details here. Suffice it to say that if you’re a play therapist or a brain geek, you need this little book. It would also make a fab gift for your favorite therapist.

Here’s a link to amazon, although you can buy from any seller. I don’t get any kickbacks for purchases.

http://www.amazon.com/Interpersonal-Neurobiology-Play-Brain-Building-Interventions/dp/0393707490/ref=sr_1_1?ie=UTF8&qid=1417449376&sr=8-1&keywords=kestly