Amy Mackay/ September 14, 2019/ Dramatherapy or Dramatherapist, Lifelong Learning/ 0 comments

At the dramatherapy conference last weekend, I attended Workshop 11 which included two papers on adoption, one by Catherine Lake and one by Anna Seymour. The two presenters shared their perspective as both dramatherapists and as adoptive parents with a short discussion afterwards.

The first presentation (the focus of this blog) was from Catherine Lake

“Since the introduction of the Adoption Support Fund there has been significant growth in the area of therapeutic post adoption support leading to an increased involvement from Dramatherapists. From both a professional point of view and lived experience I believe that there is a need for raising awareness and understanding of the unique challenges and traumas experienced within an adoptive family.

This paper will explore the multifaceted complexities of trauma within adoption and how Dramatherapists can effectively work with adoptive families to develop a genuine resilience as individuals and as a family. The impact of adoptee and adopter pre-adoption trauma, the trauma within the adoption process, trauma within the adoptive family dynamic and the impact of environmental trauma from experiences with external agencies will also be examined.

The paper will also explore the unique complexities found in adoption that are often unknown to professionals because of their invisible and unspoken nature. Adoptee poetry and three metaphorical stories based on lived experience and research into trauma within adoptive families will creatively highlight the level and complexity of trauma that can present at the point of engagement. Anecdotal evidence from adopters on their experience of therapy offer insights into best practice when working in adoption and will close the presentation.

British Association of Dramatherapists (BADth) Annual Conference and AGM 2019 programme. Page 24

Catherine movingly spoke about two children called “trauma boy” and “lost girl” as an analogy for experiences of adoption. They are adopted into their forever home having already lived through a lot of adverse childhood experiences. How can you learn to trust this “forever family” when your only model for family has been dangerous or disrupted?

Trauma boy feels like he has two people inside him, the person who knows this is a safe home and loving family, and the traumatised child who believes they are bad. If one of the first lessons you learn in survival is “don’t trust anybody” how do you respond to someone offering you love?

Lost girl struggles to adapt to the new family. She is more used to the birth family than trauma boy and one of her roles is to look after him. How can she learn to let this “mum” parent trauma boy? What is her identity now in this new place? Lost girl lives her life behind a glass wall to protect her, to separate her.


Big T Trauma and little t trauma

The traditional view of trauma is that it is an event, such as being sexually assaulted or experiencing war. More recent research indicates that there are many different types of trauma including: being neglected, or experiencing constant verbal abuse, or never feeling accepted for who you are. These constant, but potentially low-level experiences, are sometimes called “little t trauma” as opposed to “big T trauma” for the big events.

That is not to say that one is worse than the other, the way we react to trauma is very personal and will depend on our proximity to the trauma, the duration of the trauma and our personal resilience. Two people who experience the same bomb explosion in a war zone may respond very differently – one may develop PTSD and one may not, or they may both develop PTSD, but it may manifest in very different ways.

In some cases the little t traumas may have a much larger impact on a person’s well-being than the big T traumas – if we consider domestic abuse, often there is a gradual and persistent eroding of the victims confidence through several criticisms, acts of control, neglect and power dominance all designed to make the victim believe “I am bad”, “I do not deserve to be well treated”, “I cannot survive alone”. The effect of that small t trauma may take much longer to heal, and have a much greater impact on the person’s life, than the Big T trauma of being hit within the same relationship.

Developmental Trauma

Within adoptive families, often the children have experienced several traumatic experiences with their birth families before they enter the care system, and may then experience further traumas while in foster care and / or children’s homes.

John Bowlby talked about the importance of the first three years in life, where a child is forming a secure attachment with their parents. When the baby cries the mother soothes them, feeds them, changes them. When the baby is awake the mother plays with them, gazes at them, shows them the world and encourages them to interact with it. All these things help the child to learn that they are loved and safe.

Many adopted children have a very different start. Perhaps while in the womb they absorb some of the mother’s stress hormones, preparing them to be born into an unsafe world. Perhaps they are born addicted to drugs or alcohol which has already altered their brain chemistry and from which they must detox during their first few months. Perhaps when they cry, they are routinely ignored, so they learn not to cry when they are in discomfort. Perhaps when they go to their parent for comfort, they are roughly pushed away, so they learn that parents are not safe. Perhaps instead of being regularly changed, they are left in a soiled nappy, or when they are hungry, they are not fed, so they do not learn how to regulate their body to ease pain and discomfort. Perhaps they experience no love, so believe that they are unlovable. Perhaps they experience no safety, so they believe the world is dangerous.

All these early lessons will impact on how the child thinks, feels, and responds.

Once in care, there may be further trauma for the child, who may experience several different short-term homes with different routines, rules and expectations. If the child believes they are no good they may try to force their new parents to confirm that belief by deliberately or unconsciously being disruptive; If you are unlovable it is easier to accept someone’s rejection than accept their love.

Adverse Childhood Experiences (ACEs)

Developmental trauma is sometimes called “Adverse Childhood experiences”. This was originally a list of 10 traumas, but many people have since proposed others. These experiences have been identified as underlying reasons for adults to seek therapy and have been linked to several mental and physical health problems. They include:

  1. Physical abuse
  2. Sexual abuse
  3. Emotional abuse
  4. Physical neglect
  5. Emotional neglect
  6. Loss of a parent from divorce or separation
  7. Parental domestic abuse (verbal and/or physical violence)
  8. Member of household has a mental illness
  9. Member of household jailed or sent to prison
  10. Member of household addicted to or abusing drugs and/or alcohol
  11. Member of household died
  12. Being abandoned or thrown out of the family home (or being threatened with)
  13. Being bullied
  14. Experiencing prejudice (racism / sexism / homophobia…)
  15. Experiencing crime or having your home or property stolen or vandalised
  16. Living around community violence (e.g. war, terrorism, gang violence)
  17. Changing schools
  18. Dislocation or relocation (Moving home, loss of community or family, taken into care)
  19. Being an immigrant or refugee
  20. Being made homeless

The more ACEs a child experiences, the longer the length of those experiences (or repeated experiences) and the greater the severity of those experiences, the more likely it is that the child will develop mental ill health and/or behavioural difficulties. This makes sense because you need to develop to survive in the world you live in, there is no use being trusting if the world is cruel, there is no use being gentle if the world is violent, but once those responses are learnt it can be difficult to learn new ones.

Children in care and adopted children often have high ACE scores indicating that they have experienced several different traumatic events.

Catherine explored the long-term impact of such early experiences on the development of adopted children through poetry, including this poem written by her son:

Trauma by Joshua Halliday-Lake They send me home and I sit on my bed  So I start thinking, and I'm thinking with dread  Have you ever been locked up with like 3 others inside your head  To the extent you cry yourself to sleep, wishing you were dead Cause when the others inside come out all you see is red  And every bit of decency you have is shred  Cause now you've got four people inside of your brain  Trying to move your limbs but you can’t take the pain  So you throw away everyone  Your parents, your siblings and the other  You don't get a second chance at life but you're still begging for another  They don’t give it to you so you crawl under the cover  Of the bed that's too cold  You're feeling alone,  You want your story told  but you feel so unknown, by everyone  The amount of people that care about you totals to none  Now you see your whole life as a con  Cause you're 13 and going through some sort of crisis  You've discovered that although this world’s not the nicest  Compared to your own mind this world is a sudden bliss
Trauma by Joshua Halliday-Lake

(Reproduced with permission)

Trauma Bonds

When a sibling group of children are taken into care, the social workers often try to keep them together; There are many benefits in surviving those early experiences together, and the sense of belonging and identity which can come from maintaining a birth family bond. But for some children, the sibling bond is not one which is positive, but one which is built on the dysfunctional early dynamics of their birth family:

“They share a “trauma bond.” Often we think of trauma bonds that are created during unhealthy relationships such as divorce, incest, kidnapping, rape, and other crisis relationships. An emotional attraction develops between the victim and the perpetrator, creating the trauma bond.

For our sons, this bond was created during a crucial part of their emotional development. In infancy and early childhood, they lived with neglect and chaos. The unrest bound them together. Even after joining a family with healthy relationships, when they were together, they tried to re-create the chaos and unrest because it was what they always did when they were together. Re-creating it felt familiar and gave then comfort. “

Toni (11.01.2011) Trauma Bonds in Foster/Adopt Children.

Catherine spoke about the relationship between her two children, and how it played out in the power dynamic of their relationship, and on their sense of self – “who am I in relation to you”. It can be difficult to let go of such patterns even when surrounded by a new, loving, non-abusive adoptive family.

Secondary Trauma

Another consideration is the trauma within the adoptive family. Adoptive parents have often experienced the trauma and loss associated with infertility prior to even deciding to adopt. The adoption assessment process is invasive, designed to find any weaknesses within the potential new families, and requiring parents to expose and explore their own vulnerabilities. Once approved and matched with children, Catherine spoke about social workers withholding information, and then promising to offer multiple forms of support before delaying this support and prevaricating. As the adopting date approached, signalling that these children would be legally Catherine’s, she insisted that she would not sign the papers until this promised and needed support was in place; the social workers threatened to remove the children from her as this would be a sign of her refusing to parent. Upon signing the papers she was then told that the children were her responsibility and that no support would now be offered. All these types of experiences could be traumatic for an adoptive family.

Furthermore, the impact of caring for someone who is traumatised can lead to secondary trauma. Here is Christiane talking about secondary trauma’s impact on counsellors:

“For counsellors who are exposed to many accounts of trauma on a daily basis this can have a cumulative impact which can threaten their health and well-being. This is further exacerbated as practitioners have to be containers not only for the survivor but also their own responses and reactions. This can lead to classic PTSD symptoms of hyper-arousal, intrusion, avoidance and numbing.”

Sanderson, C. (2013). Counselling Skills for Working with Trauma: Healing From Child Sexual Abuse, Sexual Violence and Domestic Abuse. London: Jessica Kingsley Publishers. Page 283

A counsellor listens to someone’s trauma for usually one hour per week and usually does not witness the worst behaviours associated with that trauma such as rage or destruction. Imagine how big the impact of secondary trauma could be, on the adoptive parents, who is often, both the target of such rage, and also the one tasked with providing nurture and comfort.

Secondary trauma is not another reason to blame the adoptive parents for their inability to cope; it is a sign of how much they care and how much it is affecting them. Families need support to heal from trauma not more judgement.

Therapeutic Parenting

Catherine said that parenting adopted, and traumatised children is one of the hardest jobs someone chooses to do. Whenever adopted children “misbehave” because they are still held by the impact of trauma, the world turns to the adoptive parents and blames them. Even social workers do not always understand; Catherine spoke about attending parenting courses, full of reward-based strategies or time out, which would not work for her family.

Professional Opinion

Therapeutic Parenting: Unconditional Acceptance as an alternative to rewards and behaviour plans

Daniel Hughes talks about the kind of parenting that is needed by children with developmental trauma by looking at Katie who is trying to learn how to attach securely to her foster mum Jackie.

“What is punitive, is when parents are encouraged to give a consequence that minimises the child’s problems in order to avoid being ‘negative’. A child might engage in a destructive or disruptive behaviour over and over for days, and the consequence each time is a five-minute time out or loosing a TV show or desert. Then the child engages in the same behaviour again and again. What a setup for repeated failure! And that’s supposed to be positive?… It seems to me to be punitive when a child is not able to regulate his emotions, thoughts, or behaviours and so becomes dysregulated and then in trouble.”

“All kid’s, and probably even more so with kids who have to face Katie’s challenges, thrive the most with unconditional acceptance. Evaluations or judgements about their behaviour, expressed as praise, often make them tense and uncertain. Will they be good enough next time? Are you always judging me? What if I don’t do as well – will you disapprove of me? She needs expressions of enthusiastic delight and enjoyment from Jackie – her experience of Katie when they are together, not a cognitive judgement that what she is doing is good.”

Hughes, D. A. (2018). Building the bonds of attachment: Awakening love in deeply traumatised children. Lanham: Rowman & Littlefield. Pages 182 and 227

Many professionals who work with families put themselves into the role of the expert, whether they are a schoolteacher, a social worker or therapist. They have read a book about “this”, so they understand how to fix it, parents like Catherine just need to follow their strategy for proven success.

Such approaches may not consider the specific needs of children who have experienced developmental trauma. It also does not take into account that the experts on this family dynamic are the family themselves, particularly the parent who is doing the best they can to parent within a trauma led environment.

Catherine spoke about constantly feeling judged by professionals, from social workers, to teachers, to the police, to random passers-by. If a child grows up believing they are worthless and unlovable they may try to prove they are right by forcing this new family to respond to them as bad. A sticker chart or time out are not going to do anything to alter that underlying belief which is motivating the behaviour. But the professionals are often unwilling to listen to adoptive parents. Catherine found herself labelled as obstructive when she tried to stand up for her child, and get them the support they needed, to help them to learn to attach securely and rewrite their internal story about themselves.

“Being an adoptive mother you live with ghosts all the time. When they are screaming at you, they are screaming at the mother who was never there”

Catherine Lake, BADth Conference 2019

If instead, professionals could take a collaborative position, working with the parent rather than giving instructions to the parent, and tailoring the support offered to the specific needs of this family, then this would be less shaming and judgemental and more trusting and supportive of the family.

What should therapists know about adoption?

Catherine ended her paper by asking all therapists who work with adoptive families to research the trauma bond, secondary trauma and foetal alcohol syndrome to understand the complexity of being an adoptive parent.

She also asked therapists to connect emphatically to the experience of an adoptive family and to believe adoptive parents know and want the best for their child.

Catherine Lake is a Dramatherapist, Counsellor, Cognitive Behavioural Therapist, EMDR Practitioner, Clinical Supervisor and Trainer with 24 years of clinical experience. Catherine specialises in working with attachment and complex trauma. Catherine is an adopter and has lived experience of the unspoken trauma that significantly impacts on this unique group.”

British Association of Dramatherapists (BADth) Annual Conference and AGM 2019 programme. Page 25
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