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Posts from the ‘Child Maltreatment’ Category

Apr 13

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Healing Past Relational Trauma with Wholehearted Presence

The swirling busyness and restless energy settled and a profound stillness permeated the room, enveloping the group like a soft feather blanket. Sitting in silence and sensing the body was unfamiliar territory for most of the two-dozen workshop participants.  After all, for many of them, the body had long-been associated with shame, self-judgment, discomfort, and trauma.  Yet, there they were, courageously bringing compassionate awareness to their embodied experience, one moment at a time.  Opening to the life that had been refused, again and again, until that moment.¹

This is a description of the first day of the first REAC²H workshop, which was conducted with a group of female survivors of childhood maltreatment.  REAC²H is an acronym that stands for Restoring Embodied Awareness, Compassionate Connection, and Hope.  It is an innovative approach to healing past relational trauma by cultivating present-moment awareness and self-compassion.  The workshop was designed by Dr. Jon G. Caldwell, DO, PhD after years of research and clinical work in the fields of traumatology, attachment theory, affective neuroscience, and contemplative practices.

The REAC²H workshop was specifically designed to help individuals who have experienced “relational trauma”, which encompasses various kinds of emotional, physical, and sexual abuse that occur in the context of close relationships.  Relational trauma has meaningful effects on the attachment system – an innate, biological system that facilitates interpersonal connection to adaptively shape human development.  Thus, relational trauma and the resulting disturbances in attachment can have profound effects on a person’s developmental trajectory across the lifespan.

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Feb 28

Recovering From Early Social Adversity: Valuable Lessons from Adopted Orphans

During my first meeting with Rebecca (as I will call her), I asked about her family history of mental and emotional difficulties, which can tell me something about her genetic susceptibilities, and about her early life experience with caregivers.  These two elements of the evaluation often provide critical information about the unique way in which nature and nurture contribute to human development (see my previous article on this topic).

When I asked Rebecca these questions, an unforgettable look flashed across her face that was part shame and part longing as she explained to me that she was adopted and had no “valuable information” to offer on these topics.  All she knew was that she had been adopted by an American family from a Romanian orphanage at the age of two.  In fact, to her surprise, this little bit of information proved to be extremely valuable as we tried to better understand how her challenges in adulthood were related to her early childhood experiences. Read more

May 24

Finding Resiliency in Vulnerability: Shifting Perspectives on Genes and Environment

Clients frequently ask me if their mental and emotional struggles are a result of their genes or their environment.  My answer is always the same – “yes”.  Of course, my simplistic response refers to the interaction between genes and environment that characterizes nearly all mental health conditions, but it clearly belies the centuries of debate on this fundamental and contentious topic.  In recent decades, the Cartesian dualism that has traditionally dominated the nature-nurture debate has given way to scientific theories that describe complex, bi-directional relations between genes and environment.  These theories of human development have also furthered our understanding of “neural plasticity” – the exciting notion that our brains are more malleable and open to change than we once thought.

First, a brief historical regression may be helpful.  In the early part of the twentieth century, psychoanalysis was the dominant perspective in psychology and its guardians were particularly keen on environmental influences.  In fact, parents of the baby-boomer generation were likely told that schizophrenia was entirely caused by cold, unresponsive mothering (i.e., so-called “schizophrenigenic mothers”).  Behaviorism, which rose to prominence in the early-to-middle part of the century, saw human development as a process of learning based on stimulus-response interactions between an organism and its environment. By the nineteen-sixties, the “cognitive-revolution”, with its emphasis on internal mental states and the promise of neuroscience advances, largely eclipsed these theories, but still had relatively little to say about the role of genetics.

In the second half of the twentieth century, geneticists began conducting large twin and adoption studies and found that a number of psychiatric conditions showed evidence of genetic heritability.  For example, studies showed that schizophrenia occurs in 1% of the general population, but this increases to 6% if a parent is affected and 48% if an identical twin is affected.  Findings such as these clearly showed that genetics play a role in many forms of mental illness.  However, by the end of the twentieth century, the pendulum had swung too far in the direction of genetic influence, with some researchers claiming that single genes could be wholly responsible for complex phenomena like depression, violence and even suicide (e.g., one research group claimed to have found “the suicide gene”). Read more

May 8

Attachment, Emotion Regulation, and Resiliency

Often, during the first week of treatment at The Meadows, people will skeptically inquire, “Do experiences in childhood really continue to affect my life as an adult?”  While social scientists and mental health clinicians have been exploring this question for decades, other fields of science and medicine have been slow to recognize the effects of childhood adversity on adult health and wellbeing.  However, this trend may be changing, in part due to a very influential study by a group of researchers at the Centers for Disease Control and Prevention that are examining the long-term effects of adverse childhood experiences (ACE) on various health outcomes in over 17,000 members of a managed healthcare organization in California.

In general, the results of the ACE study1 show that adverse childhood experiences (e.g., abuse, neglect, abandonment) are relatively common and are associated with higher rates of early initiation of tobacco use and sexual activity, adolescent pregnancy, multiple sexual partners and STD’s, intimate partner violence, alcoholism, illicit drug use, depression, and suicide attempts.  Of course, this resonates completely with our clinical experience and treatment model at The Meadows.  However, these investigators also found that adverse childhood experiences are related to elevated rates of liver disease, autoimmune disease, chronic obstructive pulmonary disease, ischemic heart disease, and lower levels of health-related quality of life.

These compelling data suggest that childhood maltreatment is associated with a variety of mental, emotional, social, and physical health problems in adulthood.  In fact, results such as these have led some people to elevate childhood maltreatment to the level of a “public health threat”.  Yet, as indicated by the conceptual model used in the ACE study (see Figure 1), there are considerable gaps in our scientific understanding of the mechanisms and mediating pathways connecting adverse childhood experiences to the host of deleterious outcomes mentioned above.

Attachment theory has proven to be a useful framework for understanding how early relational experiences influence developmental pathways and adult functioning (see earlier article on attachment).  Over fifty years ago, John Bowlby (the “father” of attachment theory) studied adverse childhood experiences in delinquent and homeless children and found that a warm, continuous, and secure attachment relationship between caregiver and child was of critical importance, not only because this biologically-driven bond enhances survival and reproductive fitness, but also because it establishes the foundation for successful social-emotional development and resiliency throughout the lifespan.

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