Rethink Child Trauma Using Feedback Loops
Unhealed child trauma impacts not only the child but the family as well. I often see family members with trauma symptoms when they are dealing with an out-of-control, traumatized child.
One father told me: “As the dad, I am supposed to protect my child from hurt and pain. When my daughter started cutting on her arms with our kitchen knives, I was a deer in headlights. I didn’t know what to do; I became traumatized, too.”
At the Family Trauma Institute, the evidence-based FST Family Systems Trauma Model, is used to train and certify mental health professionals to become family trauma experts. One technique, feedback loops, is used to rethink child trauma through a family systems lens.
Let’s look at the case study of 16-year-old Lucy to illustrate this technique.
- Lucy is 16 years old and resides with biological parents and younger siblings: Bertie, 15, Katie, 12 and Eli, 9.
- There is extreme conflict between Lucy and her parents as well as her three younger siblings.
- Lucy, the identified client, is in treatment due to self-harming behaviors (cutting), symptoms of depression, and anxiety.
- Lucy was bullied through 9th grade at school, but she kept it a secret. Since this traumatic event, her grades continue to plummet, her attendance is sporadic, and she suffers from depression and anxiety.
- The family is embroiled in a cycle of extreme verbal aggression. Lucy curses at her father almost daily. Lucy berates and curses at her mom until mom gives in. Lucy keeps the house is in chaos until everyone is upset or she has gotten her way. Even though Lucy initiates the abuse, her perception is that it is her family that is abusive.
- Both parents are overwhelmed and feel like they don’t know how to help. They love Lucy and want better relationships with her. Dad can be emotionally reactive and feels the need to protect the family. Mom has feelings of guilt because of her mental health diagnosis and admits that following through is difficult.
- Counseling services initiated in January 2018. Lucy and her family are seen several times per week, every other week. Lucy is seen one-on-one at least two times during the week with family sessions on a third day.
- After six months of treatment, Lucy and the family are stuck in maintenance mode. Lucy is stable, but Lucy and her family have not made significant progress.
INTRODUCING FEEDBACK LOOPS
The family therapist who worked with Lucy and her parents asked that I consult on the case. I used WebEx to conduct the family therapy session after the family signed a release of information.
In accordance with the FST Model, I requested that the extended family – grandparents and siblings – be present. The rationale for this important tactical decision can be found in our May trauma playbook: Get the Lights On: Basic Needs Before Psychological Needs.
About 30 minutes into the session, I introduced the feedback loop technique using the following transition statement:
“Before our meeting today, I spent time drawing what we call feedback loops. These visually illustrate my best guess on how you communicate and talk to each other when Lucy is having problems of verbal aggression, anxiety, or cutting. I will show one loop at a time on my PowerPoint slide. After I draw each loop, I will pause and ask you all if it is accurate or if I should change it. Please remember that it is my best guess.
My first drawing is what we call a Before Feedback Loop or what I think is happening in your family right now to prevent you from solving Lucy’s problems. After we see the Before Feedback Loops, I will show you my best guess on what I call “after” feedback loops (link to after feedback loop image), or what can happen in the future using what I call wound or trauma playbooks. Let’s begin.”
This feedback loop technique allows the trauma specialist to move the parents and other family members from what Prochaska, DiClemente, and Norcross (2007) term as a Precontemplative Stage of Readiness (i.e., “It is 100% a child only problem” or “Fix my child, I do not see that I am part of the problem or solution.”) to the Contemplative Stage of Readiness (i.e., “Seeing what you call a feedback loop suddenly gives me have new insight. It’s a family problem in which we all have to change”).
We discovered an important fact. Parents were not resistant to family trauma treatment because they did not want to change. They were resistant because they did not have feedback loop drawings to reach a contemplative understanding of why they were needed to heal their child’s trauma.
For a detailed step-by-step guide to using feedback loops in your practice, read Chapter Six of Treating the Traumatized Child: A Step-by-Step Family Systems Approach.
FAMILY RESPONSE TO BEFORE FEEDBACK LOOPS
The before feedback loop that was used with Lucy’s family is presented in Figure 1 along with a video except of Dr. Sells’ presentation of this loop during the session.
Figure 1: Lucy and Her Family’s Before Feedback Loops
Relief and Hope
Following the illustration of the Before Feedback Loop, Lucy and several family members cried. Their body language signaled relief and hope. Lucy said:
“For the first time, I see it is not just me. I am not alone, and I am not going crazy. This loop thing shows my family and me why I am stuck. What a relief. It’s not all me. It’s those unhealthy undercurrents and unhealed wound seed that must change.”
Understanding of Unhealthy Undercurrents
The video clip integrates White and Epston’s narrative technique of externalizing the problem within the Before Feedback Loops. The reframe is the disruptive child is not the problem. Instead, the problem or problems are unhealthy undercurrents caused by external unhealed wounds.
In Lucy’s case, the unhealed wound (years of bullying) created the following core unhealthy undercurrents within the family:
- Unresolved grief
- Lack of Nurturance
Lucy’s problems were reframed as Killing the Spider. The Spider represented the unhealthy undercurrents and unhealed wound seed that had its own guest bedroom in Lucy’s house. The spider, however, had overstayed its welcome (four years and counting) and it was time for it to get kicked out of the family.
FAMILY RESPONSE TO AFTER FEEDBACK LOOPS
The after feedback loop that was used with Lucy’s family is presented in Figure 2 along with a video except of Dr. Sells’ presentation of this loop during the session.
Figure 2: Lucy and Her Families “After” Feedback Loops
As illustrated in the second video, new possibilities for future change to Lucy’s trauma were made clear within the after feedback loop. The family would use a Rx prescription or technique called a Kill the Spider Trauma Playbook like an antibiotic to inject key healthy undercurrents into the family and heal Lucy’s trauma. To kill Lucy’s spider of shame, grief, and abandonment, family members in the evening and morning would hug Lucy and hold up cue cards on mini poster board that read:
- You deserve to be loved
- You are part of this family and we love you
- The bullying will not define who you really are in God’s eyes and our eyes- beautiful, a princess, courageous, and a warrior
- You are not damaged, but healing. We are proud of you.
The lies that Lucy told herself all these years since the traumatic event of the bullying would be countered by these truths and unconditional love from her family to Kill the Spider.
FEEDBACK LOOPS OUTCOMES
The feedback loops expanded Lucy’s traumatic symptoms from a child only problem to a family systems solution. And in the process, it also began to heal trauma within the other family members. For example, mom started to report that her own depression was much better, dad reported that the marriage was better, and the siblings reported that they were finally able to forgive Lucy and restore their relationship.
For safety reasons, the Kill the Spider trauma playbook was paired together with an anti-aggression behavioral contract. However, it is important to note that the unhealthy undercurrents of shame, unforgiveness, abandonment, and grief were the drivers of the aggression in the first place. Hurting people, hurt others. Therefore, once these unhealthy undercurrents are healed through the Kill the Spider trauma playbook, Lucy’s symptoms of aggression can be eliminated permanently.
Individual childhood trauma treatment may be sufficient for many cases. However, when a child’s PTSD symptoms do not get discernably better after months of treatment, it is time to try family trauma work.
Family trauma treatment is often the best place to start because the whole is greater than the sum of its parts.
ADDITIONAL RECOMMENDED RESOURCES
Kill the Spider: Getting Rid of What’s Really Holding You Back by Carlos Whittaker
Scott P. Sells, Ph.D., MSW, LCSW, LMFT, is the author of three books, Treating the Tough Adolescent: A Family-Based, Step-by-Step Guide (1998), Parenting Your Out-of-Control Teenager: 7 Steps to Reestablish Authority and Reclaim Love (2001), and Treating the Traumatized Child: A Step-by-Step Family Systems Approach (2017). He can be contacted at firstname.lastname@example.org or through LinkedIn.