Doctors used to say that babies didn’t feel pain. Sometimes they even operated on newborns without anesthesia. But in the last 30 years, those beliefs have changed radically, and today medical professionals commonly work to address not only physical but also emotional pain in the youngest of children.
Gael Thompson, infant and early childhood mental health program coordinator at the St. Paul-based Wilder Child Guidance Clinic, practices trauma-informed child-parent psychotherapy for children as young as six months old who have experienced significant trauma in their young lives.
The therapy is designed for children under 5 and their caretakers. Thompson, a licensed social worker, helps children who have experienced traumatic events like the death of a parent, physical abuse or witnessing violent acts to heal and grow to live healthy lives.
For young children, emotional trauma can reveal itself in behavioral issues or developmental delays. Thompson’s clients usually meet with her weekly in her toy-filled St. Paul office. The sessions can be hard, but she believes that the long-term payoff is worth the effort.
“Sometimes young children are exposed to terrible things,” Thompson said. “They carry those experiences with them in their bodies. Working with their caregivers, we try to help them restore their sense of safety and attachment.”
Last week, Thompson and I talked about her practice and the children she is dedicated to serving.
MinnPost: Please describe your clients.
Gael Thompson: We work with children age 5 and under who have experienced one or more life-threatening events or have witnessed a life-threatening event and are experiencing emotional-behavioral responses as a result. We also work with their parents or caregivers. Typically the caregivers have a history of trauma, too.
MP: How do children and families hear about your services?
GT: Often we just get calls from parents or caregivers who have concerns about their child’s behavior. Sometimes pediatricians will refer their patients to us. Sometimes child protection workers will make referrals. They know that Wilder does this kind of therapy.
MP: You work with children as young as 6 months. How does witnessing or experiencing trauma manifest itself in a child that age?
GT: Depending on the child, responses can vary. We think about trauma interfering with developmental paths. If we are thinking about an infant, one of the things a baby of that age is working on is learning how to regulate. All development takes place in the context of relationships. Parents help infants regulate. If a baby is crying, the mom picks her up and helps her soothe. Babies don’t know how to do that on their own.
In infants that experience trauma, we might see some impairment in those typical kinds of developmental stages. You might see babies who aren’t sleeping at all, or they are not eating. They aren’t suckling. They aren’t as interested in learning about the outside world as we might expect them to. They shut down and exhibit a lack of emotion. If you’ve spent any time around babies that young, you know that they definitely have plenty of emotions. So a baby that’s lacking emotion would stand out.
MP: Do toddlers react to trauma differently?
GT: For an older kid just starting to walk, there is typically an interest in moving and discovery. They want to explore their universe. They want to know all about everything. They want to know what things feel like and taste like. So they do a lot of exploration.
Toddlers who have experienced trauma may no longer be interested in doing that. They get really, really clingy. They are mostly interested in sticking to their mom’s side. There might be some impairment in development. Language might not develop as quickly. They might have some delays in motor skills, like walking and running. More often we see a language delay.
MP: I know this may sound insensitive, but do babies as young as 6 months really register the experience of trauma? Do these experiences stick with them into their lives?
GT: I hear that a lot. “She’s so young. How could she remember it?” It’s important to go back to the concept of attachment and the idea that babies are born pre-programmed to attach to one person. That’s a basic survival strategy. When you are a helpless infant, you need to have somebody around at all times who can protect you. Babies do that by bonding to one primary caregiver. Usually in our society it is a mom, but it doesn’t have to be.
From birth, the baby and the parent learn a language or a dance. The baby cries and is distressed. The mom meets her needs. Often enough the mom is attuned and consistent in her care, so there a secure attachment is formed. When the baby’s needs are met in a good enough way, the baby knows that he or she can trust her parent.
That person who meets the baby’s needs becomes of primary importance to the baby. If something happens to that person and she or he isn’t there anymore, or if something really scary happens to that person, the experience is going to be enormously distressing to the child. If not addressed, it can have lasting effects over a person’s lifetime.
MP: Are there other ways that pre-verbal children react to trauma?
GT: I worked with a little girl who was about 9 months old. She had experienced really horrendous, profound physical abuse by her mother. She had been placed in the care of her grandmother. This girl experienced significant delays in language. At 9 months she wasn’t babbling. She had no language. She was very wary of strangers. Whenever she got upset she’d bang her head really hard. She’d go down on her hands and knees and bang her head on the ground.
What we came to understand was this was a re-enactment of what had happened to her: When emotions got high in her home, she often would get abused. She started to re-enact some of that behavior. One time, Grandma got frustrated with this little girl and she jumped out of her chair and stomped her foot on the ground. The little girl looked at her grandma, froze, and started banging her head. That’s an example of how kids let us know through behavior without language.
MP: So how do you do therapy with children that young?
GT: Psychotherapy is traditionally designed for the client and the therapist. The dyad we are working on here is helping the parent or caregiver understand what is going on with this little baby or child and then providing them with the skills that can set the child back on track developmentally.
In my therapy, I am providing a lot of psychoeducation, helping the parent or caregiver to understand typical child development and then understand their child’s development and how we can help them get back on track. We spend a lot of time learning about what is their role as a parent. I may occasionally see the caregiver or parent alone. But I never see the child alone.
MP: What does your office look like?
GT: My office is full of baby dolls, big-people dolls, a doll’s house, a toy ambulance, a school bus, a doctor’s kit. We use these elements in play with parents and children to help them manage their feelings and reactions around the trauma they’ve experienced and their memories of the trauma.
When I start to work with a family, it starts with non-directive play. The child is just getting used to my office. As therapy progresses, I get more directive in how they play. I usually know what the child witnessed. Say their dad came to the home. He was high and threatened the mom and the kids. Then the police came and dad had to be taken away in a police car. The child witnessed all this.
I might have the mom and dad and kid dolls out. I’d also have police cars out. I’d prep ahead of time with the parent. I’d say to the child, “We’re going to talk about what happened to you. We are going to play that.” Then I’d let the child play out that experience.
MP: What are the goals of trauma-informed therapy?
GT: One of the things we like to work on is helping the child be able to react calmly to trauma triggers, like not shrieking whenever they see a police car. Children might always remember a trauma in a body-based way, but a big part of our work is helping them be able to tolerate these triggers without a major stress reaction.
We also want the child to be able to tolerate being separated from their parent or primary caregiver. It helps to address some of those issues that might impact future relationships. When we go back and think about attachment, children who have secure attachments grow up to be flexible, creative, hopeful and optimistic about the future. They have successful relationships with other people. Children who haven’t experienced responsively attuned relationships with caregivers often don’t trust as easily. They might have problems understanding their own feelings and the feelings of others.
MP: This kind of therapy sounds like hard work. How often do you see positive results?
GT: Often we see children and families with experiences of complex, multigenerational trauma. Therapy is an investment in time and emotional energy on the part of parents and caregivers. It is once a week. We are talking about hard and painful stuff. With families who’ve stayed the course as much as they can, I do see positive changes in children’s behavior. I see changes in parents’ behavior, too.
The times when you see that light bulb go off are amazing. I remember talking to a parent. We’d been developing common language around the concept of a “trauma trigger.” We were talking about something that had happened in her life and the parent was able to ask, “That was a trauma trigger, wasn’t it?” That was a light-bulb moment. Then we were able to really start talking about the bigger issues like, “What was it like for you?”
There’s no question that a parent or caregiver really has to take a risk to do this kind of work. I have to give people tons of recognition for that. It’s not easy. But it’s important. When you are working with very young children, the earlier you intervene the better.