Some of the oldest research in psychology
demonstrates that insight can follow behavior change. Children with PTSD
obviously have some special problems, but they are also children. There
is a lot of powerful research about the coping skills kids need to adjust
successfully. If their history of victimization is not to become the
central fact of their lives, they need to learn to verbalize, rather than
acting out or internalizing problems, and they need to learn to use the
interpersonal resources in their environments and to follow society’s
rules. Jails and homeless shelters are full of vets with PTSD who were
legitimately traumatized and even war heroes, but who did not get the help that
they needed to resolve their problems. Juries and even prosecutors may
sympathize, but those people end up in the penal system anyway.
Perhaps the contingencies need to be
adjusted re behaviors such as injuring themselves. Keep in mind that a
kid may tell that to an adult because they want protection. Obviously
that needs a different level of reinforcement from a kid who is discovered
injuring him/herself, but not as much reinforcement as the kid who tells a
staff member that he/she FEELS like hurting him/herself but wants to talk about
the problem instead. If the kid is ever going to be allowed outside of an
institutional environment, that’s a skill that the kid is going to need
to master. The reaction of getting dropped a level for attempting to
injure oneself is nothing compared to the response that the kid will encounter
for demonstrating similar behavior in a community school. In that case,
the kid may well find him or herself expelled. If we ever want
these kids to be able to function outside, we have to make sure they learn the
skills they will need to do so. All children rely on well-learned, if
more primitive, behaviors until they are required to learn more age appropriate
skills. We aren’t doing kids any favors be avoiding the real-life
contingencies that can help them to master the skills they will need later.
Liability concerns almost certainly play a
part in institutional decisions – imagine what would happen if a kid
disclosed a self injury and the hospital took no precautions, and then
something more serious happened.
From:
owner-CHILD-MALTREATMENT-RESEARCH-L@xxxxxxxxxxx [mailto:owner-CHILD-MALTREATMENT-RESEARCH-L@xxxxxxxxxxx]
On Behalf Of Hannah K. Galvin
Sent: Wednesday, May 26, 2004
12:34 PM
To: Child Maltreatment Researchers
Subject: Re: Treating Kids with
PTSD
Perhaps it helps the practitioners, but I
wonder if it really helps the kids? I'm going into pediatrics, so I don't
have the psychology training that many of you do, but it seems to me that a
Level system promotes behavioral modification, but does not really address the
kids' problems. A child can very easily figure out that the way to get
out of the hospital is to say and do the right thing...but this does not help
them deal with their symptoms - it just makes them more manageable to maintain
in an inpatient setting. I worry that if we make behavioral modification
the goal, many of these patients are going to direct their symptoms further
inwards. It just seems that instead of allying ourselves with the kids,
we are setting up all sorts of rules and regulations. Sure, they need a
structured environment, but are we sending the message that we only care about
their outward behaviors and not what is really bothering them? When I've
rotated through psych wards, I have often thought that maybe we are doing these
kids an injustice...maybe we are encouraging them to go into hiding? I've
known patients who, after being dropped a level for telling a staff member
about self injury, etc., have said that they won't tell anyone again.
This is what concerns me. I have no knowledge of research on the issue,
but I'd be interested in others' thoughts....
----- Original Message -----
Sent: Wednesday, May 26,
2004 2:18 PM
Subject: Re: Treating Kids
with PTSD
Robert ...
Quite the contrary. I used to be the clinical director of a psychiatric
hospital for children and adolescents. Most of our clients were from DCFS
and had extensive hx of abuse and neglect. The Point and Level system, in
fact, established a basis on which we were then able to make important
individual therapeutic accomplishments.
Best to you.
Daniel Fallon, Psy.D.
www.licensed-psychologists.com
