The recovery process will need the intervention of therapy and there are different approaches that have evidence of facilitating recovery.
Individual therapies are the backbone of trauma recovery as they offer individually tailored programmes of therapy provided to promote recovery and resilience.
Group therapies can be helpful to bring together children with similar experiences and giving them the opportunity to experience support and learn from each other. It can reduce the isolation that trauma can cause.
Creative therapies are essential for enabling the pre verbal memories or the traumatic experiences, which have caused the broca’s area of the brain, which is responsible for speech and language to shut down. When someone is rendered ‘speechless’ due to the intensity of the trauma and the powerful nature of the brainstem response of fight, fright and freeze, creative therapy can give language to the experience and begin to make sense of it.
Verbal therapies can eventually be helpful for processing trauma and enabling a cognitive response to be developed as part of the child’s transforming narrative.
Family therapies can be helpful for children who are returning to their family of origin to help them create a safe and healing family unit to facilitate recovery.
Therapeutic communities are an intervention that is can facilitate recovery by providing a ‘holding’ environment that can enable a child to grow and recover from some of the harm done to them. Perry and Szalavitz (2006) speak of how the repetition and routine are essential to recovery as the brain changes in response.
It is recognized that short term interventions can be appropriate for children who have experienced Type I trauma such as a one off incident but for children who have experienced longer term or interpersonal trauma longer term therapeutic intervention is essential and short term intervention can be counter productive.
Therapy significantly differs from therapeutic work because in therapy a client will work with the therapist to try to understand the unconscious responses and will process and gain insight into their situation and understanding about themselves. Over time this processing and integrating of experiences and feelings enables the symptoms of the trauma to reduce. The overall aim is to enable a client to change and grow on a personal level in a safe and facilitating environment. The relationship between the therapist and the client is of central importance. Therapy aims to deeply work and uncover difficult emotions and processes looking into the unconscious parts of the client to help them gain more understanding about themselves.
In order to enable the child to feel safe, feel emotionally and physically contained and be confident in positive attachments, it becomes a priority to empower the adults around the child to facilitate a healing environment by becoming therapeutic. Therapeutic work and mentoring aims to only work with what is already known and not work with the unconscious. They aim to enable practical skill development and build self-esteem and self confidence. Working in a mentoring group can also enable clients to negotiate social isolation and social skills.
Therapy and mentoring activities are on different ends of a spectrum or different parts of the trauma recovery triangle (see blog on continuum) but both are vital for the child to have a full recovery. The therapeutic interventions form an essential foundational base for a child whilst therapy is essential to explore the unconscious responses in the higher end of the triangle.
Oaklander (1989) spoke of the centrality of relationship in the recovery from trauma and this can occur in any therapy approach and therapeutic intervention.
‘Nothing happens without at least a thread of a relationship. The relation- ship is a tenuous thing that takes careful nurturing. It is the foundation of the therapeutic process and can, in and of itself, be powerfully therapeutic.’
Bruce Perry (see below) echoes the idea that the therapy (healing) takes place in doses both within therapy and the therapeutic environment (school and home). Given the idea the brain forms (and therefore repairs) from bottom (brain stem) to top (neo cortex) and to bottom, he explains that there are core elements of positive, developmental, educational and therapeutic experiences:
Relevant (developmentally matched)
Rhythmic (resonant with neural patterns)
Respectful (child, family, culture)It might be worth adding
➢ Reciprocal (taking turns, which will happen once a child begins to feel able to be in relationship)
Through these experiences in therapy and throughout the environment of the home the child’s brain can rewire from bottom (brain stem) to top (neo cortex) and between the left and right brain. This is an ongoing process and the more damaging the early experiences have been and the older the child the more repetitive, rewarding and rhythmic experiences need to happen over a longer period of time to enable the new connections in the neural pathways to become strong.