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RE: Treating Kids with PTSD
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<DIV>I am concerned that therapy for PTSD alone, focusing on the child's
problems as exclusively arising from the abuse experience and not other issues,
which may include neurological ones, like high end autism spectrum issues, and
from even earlier infant attachment problems, will only put a "band-aid" on the
situation (getting the child to be more compliant) without dealing with the risk
of serious, ongoing personality disorders in adulthood.</DIV>
<DIV> </DIV>
<DIV>I would recommend Peter Fonagy's work, accessible at <A
href="http://www.psychematters.com";>http://www.psychematters.com</A> in sample
form (articles posted) and in his new work <U>Affect Regulation, Mentalization,
and the Development of the Self.</U> He seems to be the best expositor of
the relationship between attachment dysfunction and the development of
maladaptive profiles of later behavior in children and adults. He also has
good material on the therapy of adolescents. The BEST practical work I
have found on adult and adolescent therapy, whether for borderline symptomology
or what he terms "closet narcissism" is James Masterson's work.</DIV>
<DIV> </DIV>
<DIV>While altering behavior in the short run may make a child easier to live
with (very important!), it may not make enough of a global difference in
functioning to prevent intergenerational transmission of maladaptive behavior
through dysfunctions in early parenting (also extremely important, given the
heightened potential of abused children to have children early and
dysfunctionally).</DIV>
<DIV> </DIV>
<DIV>The advantage I see of a mechanistic approach is that it is something
families can take home with them and see immediate improvements. The
disadvantage is that it may not go deeply enough into the complex of
relationship problems to carry forward to the next generation of
parenting. </DIV>
<DIV> </DIV>
<DIV>Freya Schultz</DIV>
<DIV>Santa Barbara County Social Services<BR><BR>>>> HeisleKW@chkd.com
05/28/04 07:11AM >>><BR></DIV><FONT face=arial size=2 ?>
<DIV><SPAN class=780415713-28052004><FONT face=Verdana size=2>I would agree that
a level system, based only on behavior and absent anything else, would not help
the child deal with the underlying issues. </FONT></SPAN></DIV>
<DIV><SPAN class=780415713-28052004><FONT face=Verdana
size=2></FONT></SPAN> </DIV>
<DIV><SPAN class=780415713-28052004><FONT face=Verdana size=2>First, any good
program is also going to provide individual, group, and family therapy, where
the issues are explored in depth and where progress in therapy is bulit into the
level system. (Also, many trainees during rotation may not get much
exposure to the psychotherapy that takes place, so the level system may
appear to be just a superficial map to freedom easily manipulated by
children.) Second, a good program will not see too many kids being discharged
simply because they followed all the rules, said the right things, and "reached
their level." In order to be discharged, a child should have made a genuine
effort to engage in therapy, and this can only be measured by sound clinical
judgment of the therapist. Finally, although I do think level
systems help teach and promote structure, something which many children in
these settings lack, it ultimately prevents the milieu from
deteriorating into a place of chaos. In that sense, it is - initially to
most kids - simply an external force, but a necessary one. Without a
level system, the constant disorder in the milieu would be a major obstacle
in helping these kids see and practice social skills, and receive treatment in a
calm, safe, responsive setting. </FONT></SPAN></DIV>
<P><B><FONT face=Verdana color=#000080 size=2>Kurt Heisler, M.S.,
M.P.H.</FONT></B> <BR><FONT face=Verdana size=2>Instructor, Dept. of
Pediatrics</FONT> <BR><FONT face=Verdana size=2>Center for Pediatric
Research</FONT> <BR><FONT face=Verdana size=2>Eastern Virginia Medical
School</FONT> <BR><FONT face=Verdana size=2>Children's Hospital of The King's
Daughters</FONT> <BR><FONT face=Verdana size=2>855 West Brambleton Avenue</FONT>
<BR><FONT face=Verdana size=2>Norfolk, VA 23510</FONT> <BR><FONT face=Verdana
size=2>757-668-6499</FONT> <BR><FONT face=Verdana size=2>757-668-6476
(fax)</FONT> <BR><FONT face=Verdana size=2>heislekw@chkd.com</FONT> </P>
<DIV class=OutlookMessageHeader dir=ltr align=left><FONT face=Tahoma
size=2>-----Original Message-----<BR><B>From:</B> Hannah K. Galvin
[mailto:hannah_galvin@student.hms.harvard.edu]<BR><B>Sent:</B> Wednesday, May
26, 2004 3:34 PM<BR><B>To:</B> Child Maltreatment Researchers<BR><B>Subject:</B>
Re: Treating Kids with PTSD<BR><BR></FONT></DIV>
<DIV><FONT color=#000080 size=2>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....</FONT></DIV>
<DIV><FONT color=#000080 size=2></FONT> </DIV>
<DIV><FONT color=#000080 size=2>Hannah Galvin, HMS-III</FONT></DIV>
<DIV><FONT color=#000080 size=2></FONT> </DIV>
<DIV><FONT color=#000080
size=2>><><><><><><><><><><><><><><><><><><<BR>Hannah
K. Galvin<BR>Vanderbilt Hall Box #330<BR>107 Avenue Louis Pasteur<BR>Boston, MA
02115-5750<BR>(617) 780-5797<BR><A
href="mailto:hannah_galvin@student.hms.harvard.edu";>hannah_galvin@student.hms.harvard.edu</A></FONT></DIV>
<DIV> </DIV>
<BLOCKQUOTE
style="PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #000080 2px solid; MARGIN-RIGHT: 0px">
<DIV style="FONT: 10pt arial">----- Original Message ----- </DIV>
<DIV
style="BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: black"><B>From:</B>
<A title=psychling@att.net
href="mailto:psychling@att.net";>psychling@att.net</A> </DIV>
<DIV style="FONT: 10pt arial"><B>To:</B> <A
title=CHILD-MALTREATMENT-RESEARCH-L@cornell.edu
href="mailto:CHILD-MALTREATMENT-RESEARCH-L@cornell.edu";>Child Maltreatment
Researchers</A> </DIV>
<DIV style="FONT: 10pt arial"><B>Cc:</B> <A title=Robl@NewHopeTreatment.com
href="mailto:Robl@NewHopeTreatment.com";>Longo, Robert</A> ; <A
title=CHILD-MALTREATMENT-RESEARCH-L@cornell.edu
href="mailto:CHILD-MALTREATMENT-RESEARCH-L@cornell.edu";>Child Maltreatment
Researchers</A> </DIV>
<DIV style="FONT: 10pt arial"><B>Sent:</B> Wednesday, May 26, 2004 2:18
PM</DIV>
<DIV style="FONT: 10pt arial"><B>Subject:</B> Re: Treating Kids with
PTSD</DIV>
<DIV><BR></DIV>Robert ...<BR><BR>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.<BR><BR>Best to you.<BR><BR>Daniel Fallon, Psy.D.<BR><A
href="http://www.licensed-psychologists.com";>www.licensed-psychologists.com</A><BR><BR><BR><BR></BLOCKQUOTE><FONT
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