This blog is a continuation of Blue Knot Foundation's literature review  of best approaches to working with adult survivors of child abuse and neglect. Anyone working with survivors are encouraged to read both posts (Best Way to Work with Survivors - Part 1).
5. VIEW SYMPTOMS AS ADAPTATIONS
It is important to view the client’s current behavior in light of their abuse history. Focus on encouraging a change in how the client interprets his/her symptoms and maladaptive behaviors. It is important to understand that the coping strategies survivors used as children were functional for the child-victim dealing with the abuse, but may not be helpful in present life situations. Reframing feelings and behavior as coping strategies that were adaptive to surviving past abuse can be the beginning of positive change.
6. HAVE A BROAD KNOWLEDGE OF TRAUMA THEORY (BOTH THE PSYCHOLOGY AND THE PHYSIOLOGY OF TRAUMA) AND PROVIDE THE CLIENT WITH PSYCHO-EDUCATION
Health professionals can assist survivors by providing accurate information about the nature of trauma and its effects, and by working with the survivor to integrate this new information and its implications into his/her overall perspective.
By understanding how the brain and body process, remember, as well as perpetuate traumatic events, the client learns how to regulate affect and pain. Survivors of childhood abuse find it helpful when their therapists help them relate their intense feelings and maladaptive coping strategies to the trauma.
7. TEACH CLIENTS ADAPTIVE COPING STRATEGIES
Even though childhood coping mechanisms were functional at the time of the abuse, many are no longer constructive in present life situations. Therefore, it is important to teach survivors of child abuse and neglect more adaptive coping strategies.
Survivors can be taught more adoptive coping strategies by teaching them self-care strategies, distress tolerance strategies, and arousal reduction strategies. Research into the adverse impact of child abuse on brain development and hormone secretion, highlights the importance of engaging in self-care, and arousal reducing activities to promote healthy neuro-endocrine functioning.
Research tells us that the bodies of children who are being abused react and adapt to the unpredictable dangerous environments to which they are exposed. Their nervous systems run constantly on high as they anticipate further danger. This state of chronic “hyper-arousal” persists for many survivors throughout their adult years as well.
8. STRATEGIES FOR CLIENTS
Self-caring activities and learning how to soothe themselves emotionally are important skills for survivors. Engaging in self-care activities can be especially challenging for survivors who may have never learned to ‘self-sooth’ or ‘self-care.’ In the act of neglecting, hitting, insulting or abusing a child, an adult sends a clear message to that child that the child is without value or worth. Many abused children grow to adulthood believing that they do not deserve to experience love, care, or warmth.
Childhood abuse interrupts the normal development of a person’s ability to identify and regulate their feelings. In this light, a number of training frameworks emphasize the importance of learning skills to regulate feelings.
The possible over-production of the stress hormone cortisol may contribute to the difficulties tolerating distress experienced by some survivors of childhood abuse. In addition, most survivors never learn to self-soothe in childhood because parents who abuse are also often poor at soothing themselves and, consequently, at teaching their children to self-sooth. The lack of childhood ‘nurturing’ experiences and the lack of being taught how to look after yourself or ‘self-soothe’ also contributes to difficulties tolerating distress. Acquiring distress tolerance strategies or self-soothing techniques are important to those with histories of childhood abuse.
Arousal-reduction tools, i.e., How to Reduce the Pressure
In situations of early childhood abuse, the trauma and shock of the abuse interferes with the ability to regulate emotions, causing frequent episodes of extreme/out of control emotions, including anger and rage. Arousal-reducing tools can assist survivors in regulating their emotions.
A state of anxiety is common among trauma survivors because it is typically generated by experiences that are unpredictable, uncontrollable, or unfamiliar, i.e., the characteristics of trauma or danger.
Anger is usually a central feature of a survivor’s responses to trauma because it is a core component of the survival response in humans. Anger helps people cope with life’s adversities by providing increased energy to persist in the face of obstacles.
- Symptoms caused by hyper-arousal include:
- Having a difficult time falling or staying asleep,
- Feeling more irritable or having outbursts of anger,
- Having difficulty concentrating,
- Feeling constantly ‘on guard’ or like danger is lurking around every corner,
- Over-breathing, hyperventilating, and/or
- Being ‘jumpy’ or easily startled.
Importance of always reducing ‘the pressure’
In order for clients to feel safe in life and therapy, they need to be equipped with tools to help them contain reactions to therapy and triggers, and to halt the out of control acceleration of hyper-arousal. Being able to apply the brakes aids clients in daily life, and also gives them the courage to address difficult issues.
Breathing control exercises
Trauma survivors’ respiration responses when firing too rapidly can chronically over-breathe. This can lead to hyperventilation and may contribute to panic attacks in some people. Controlled breathing techniques are used to slow the respiration rate. Our breathing rate has an impact on our heart rate, blood pressure and the rest of our body. Breathing at the correct rate slows the bodily processes, lowers arousal, and in turn reduces tension and stress. Slowing the breathing rate is an effective method of turning off the ‘fight/flight’ response. The breathing rate normally increases in the presence of a perceived threat.
9. TEACH CLIENTS INTERPERSONAL AND ASSERTIVENESS SKILLS
A child should not equate his/her dependence on an adult for nurture, safety, love and connection with taking a risk. Once betrayed, however, future attachments and interpersonal connections do require risking disappointment and perhaps shame, neglect, and/or abuse. In adulthood, survivors of childhood abuse often find it risky to make connections between their past and present, their thoughts and feelings. Most survivors need the support of interpersonal connections to restore meaning and wholeness in their lives. Research constantly shows that child abuse is linked with difficulties in interpersonal relationships.
It is helpful for interpersonal skills’ training to focus on situations where the objective is to change something (e.g., requesting that someone do something) or to resist changes someone else is trying to make (e.g., saying no). The aim is to maximize the chances that a person’s goals in a specific situation will be met, while at the same time, not damaging either the relationship or the person’s self-respect.
 The Best Way to Work With Survivors, http://www.blueknot.org.au/WHAT-WE-DO/For-Health-Professionals/Resources-for-Health-Professionals/Best-Practice-Guidelines