Gentling: A Practical Guide to Treating Ptsd in Abused Children, 2nd Edition

by William E Krill, E Krill William, Marjorie McKinnon (Foreword by)

Overview

Breakthrough Treatment Offers New Hope for Recovery

Revised and Expanded 2nd Edition with 3 new chapters on adolescents
Gentling represents a new paradigm in the therapeutic approach to children who have experienced physical, emotional, and sexual abuse and have acquired Post Traumatic Stress Disorder as a result. This text redefines PTSD in child abuse survivors by identifying child-specific behavioral signs commonly seen, and offers a means to individualize treatment and measure therapeutic outcomes through understanding each suffering child's unique symptom profile. The practical and easily understood Gentling approaches and techniques can be easily learned by clinicians, parents, foster parents, teachers and all other care givers of these children to effect real and lasting healing. With this book, you will:

Learn child-specific signs of PTSD in abused children

Learn how to manage the often intense reactivity seen in stress episodes

Gain the practical, gentle, and effective treatment tools that really help these children

Use the Child Stress Profile (CSP) to guide treatment and measure outcomes

Deploy handy 'Quick Teach Sheets' that can be copied and handed to foster parents, teachers, and social workers

Clinicians Acclaim for Gentling

"In this world where children are often disenfranchised in trauma care--and all too often treated with the same techniques as adults--Krill makes a compelling case for how to adapt proven post-trauma treatment to the world of a child."
--Michele Rosenthal, HealMyPTSD.com

"Congratulations to Krill when he says that 'being gentle' cannot be over-emphasized in work with the abused."
--Andrew D. Gibson, PhD Author of Got an Angry Kid? Parenting Spike, A Seriously Difficult Child

"William Krill's book is greatly needed. PTSD is the most common aftermath of child abuse and often domestic abuse as well. There is a critical scarcity of mental-health professionals who know how to recognize child abuse, let alone treat it."
--Fr. Heyward B. Ewart, III, Ph.D., St. James the Elder Theological Seminary, author of AM I BAD? Recovering From Abusew

Cover photo by W.A. Krill/ Fighting Chance Photography

Learn more at www.Gentling.org

From the New Horizons in Therapy Series at Loving Healing Press www.LovingHealing.com
Available in hardcover, trade paper, and eBook editions

FAM001010 Family & Relationships : Abuse - Child Abuse
PSY022040 Psychology : Psychopathology - Post Traumatic Stress Disorder
FAM004000 Family & Relationships : Adoption & Fostering

Product Details

ISBN-13:	9781615991075
Publisher:	Loving Healing Press
Publication date:	09/01/2011
Series:	New Horizons in Therapy
Edition description:	2nd Revised ed.
Pages:	274
Product dimensions:	6.69(w) x 9.61(h) x 0.63(d)

Read an Excerpt

CHAPTER 1

Gentling

What would the world be like without gentleness? Gentleness is such a basic human characteristic that we often take it for granted. Gentleness appears to be so basic that even animals can be seen behaving in a gentle fashion following the birth of offspring. Some may argue that such behavior is simply instinctive for the animal mother; a measure to ensure the growth of the baby and thus the continuation of the species.

Certainly human beings bring meaning to what may be an instinctive behavior set. While gentleness may be instinctive, our experience of gentleness from others further teaches the subtleties of human kindness, and in turn, shapes how we are gentle with others. It would not be a stretch to say that a person's capacity for gentleness is an indication of civility; even a marker of what makes a human being human in the largest sense.

Hopefully, if the reader were to play a brief game of word association, they would soon list the word "mother" or "father" in association with gentleness. And, what could be more nurturing than a parent's gentleness? Unfortunately, not all people are able to make this association so easily; their mother (or father) has not been gentle in their lives; they have experienced abuse and trauma at the hands of their loved ones.

Most people will also associate healing with gentleness, even though healing may involve some discomfort. Even when healing is not a possibility, there is gentleness to ease the discomfort of pain, and even the transition to death. "Gentling" is the process of delivering the balm of gentle gestures.

These gestures are complex and even at times may appear paradoxical: gentleness involves a kind of strength and assurance in the giver, and the gentleness may be delivered in a firm and assertive fashion. Of course, gentling also includes a calming countenance, a safe tone of voice sometimes paired with eyes filled with compassion, and an empathetic touch that can be as light as feather or as firm as a safe, encompassing hug.

Gentleness also may be easily associated with "spiritual". Most of the major religions of the world have an expression of their deity that is compassionate. As a person whose degree is in Pastoral Counseling, compassion is a core value of my vocation, how I help others, and why I do what I do. Even the secular clinician will recognize the value of using gentleness as a tool in their approach to helping others, and perhaps has even experienced the "miraculous" movement forward for a patient when they have had their empathic efforts accepted and used by the patient.

Though this approach has many familiar components that are certainly not new to the compassionate and caring helper, it is different because it uses these components in a very intentional, specific, and timely fashion. "Gentling" as a treatment for stress disordered children has its didactics and techniques, just like other approaches to helping children, but the foundation on which it is built is a firm and abiding faith in the power of gentleness and compassion. In a world where everything has a price, where the costs of violence are truly expensive, where hundreds of thousands of children each day face the harsh realities of traumatic events, gentleness is free.

CHAPTER 2

Trauma

A trauma is an event that has happened to a person that has had a profound and life changing effect. The event may have resulted in the person having ongoing and uncomfortable symptoms. The symptoms might include re-experiencing (memories), avoidance, numbing, detachment, relationship problems, and alterations in the way that they view the world and physical symptoms that are similar to panic attacks.

Trauma affects everyone, either directly or indirectly. We all have people in our lives that have had difficult, and perhaps terrible things happen to them. Many times a day, we likely come into contact with people that we least expect to have had very traumatic experiences, and yet, they do.

In recent months, I have come to learn more about a friend and colleague's life before I met her, and her life story could not be guessed from her current life. Each of us has had events in our own lives that have traumatized us and have caused us discomfort as a result. While one person's experience at having had a dog bite them may not be as dramatic or life-altering as a person who has survived a hurricane, torture, or rape, the process and discomfort are no less real.

Since trauma is all around us on a daily basis, and is what makes media headlines to catch viewers' attention, it is easy to become numb to it. Certainly the "newsworthy" traumas beg for our attention, but there are countless private, quiet traumas that occur daily as well. On the nightly news we hear of young men and women who have died in the Global War on Terrorism, and see their grieving families.

Each day there are hundreds, if not thousands of children who are being neglected and abused in their families, by neighbors, strangers, or by the effects of war. Many of these children survive, for better or worse. Some do not survive. Sometimes survivors who gain healing go on to productive and happy lives, while others descend into lifelong pain, dysfunction, and may become perpetrators of trauma themselves.

Trauma always affects body, mind, emotions, and spirit. It stands to reason that a person who has had a physical trauma, such as a motorcycle accident, will have difficult emotions surrounding his or her misfortune. When a person is a victim of a psychological and emotional trauma, such as in the case of witnessing a loved one assaulted or abused, they may develop physical symptoms as a result of chemical changes in their body that occurred at the time of the assault. In situations where a child has been sexually abused, their body, mind, emotions, and spirit are altered and damaged. When viewed in this way, trauma can be seen for what it is: an all encompassing and profoundly life-altering disability.

To most of us, the reason why one person becomes symptomatic following a critical incident and another does not is often a mystery. New research is beginning to demonstrate that in fact people who suffer symptoms for a long time after a trauma may have a brain chemistry that is prone to developing these symptoms. It does appear (and stands to reason, with their still developing brains) that young children may be more vulnerable to developing acute stress or post-traumatic stress.

Preconditions such as mental health disorders or high levels of everyday stress are also likely to be a factor. Children who live in marginal family situations with parents who have their own daily struggles to survive, or have mental health issues may also be more susceptible to developing symptoms. Children who, by circumstance, have poor ego strength may be more vulnerable to the effects of trauma and stress. By ego strength, it is meant the natural and developed internal resources to cope with changing environments and situations, including stressful ones.

In families with intergenerational histories of domestic abuse, not only is abuse "inherited", but also stress disorders as well. However, the question of discerning the biophysical and genetic possibilities of connections between domestic abuse, child abuse, and PTSD are beyond the scope of this book.

Some children live in conditions with their biological families that are highly volatile, abusive, uncertain, and chaotic. These children may not have one single traumatic event that can be pinpointed as the source of their stress signs and symptoms. In their lives, the constant high level of stress may create behavioral effects in them that look very much like the ones seen in children who have survived other, more specific trauma. The diagnostic and treatment community needs to recognize and codify this kind of traumatic stress as just as valid as acute and posttraumatic stress. The sources of specific symptoms, study of how symptoms develop for some people but not others, alternate treatment approaches, and treatment outcomes of trauma are far from complete.

A child may suffer for many years without the proper diagnosis. In some cases, the critical incident(s) may be unknown to the adults around the child. In situations where the child has been sexually perpetrated upon, the child may be holding the secret quite closely. If the child is very young (age six or below), the trauma may have occurred at a time before verbal memory was fully developed; even if they want to tell you about the trauma, they may have a difficult time in recalling enough details of the event or be able to articulate what they are feeling. Though some anecdotal examples exist of people being able to recall memories at early ages, for the practical purposes of the Gentling approach, this is often moot. In this clinician's experience, recall is not very effective in settling the stress reactions in the present moment that abused children are experiencing.

In other situations, the adult caregivers simply do not connect the dots between the critical incident and the child's behaviors. This is especially true in chaotic families that have a long history of domestic violence and varieties of abuse. In these families, the child's behaviors are the norm, and the family only becomes aware of a problem when the child enters school.

What is Post Traumatic Stress Disorder (PTSD)?

The rudiments of a modern understanding of PTSD are reflected in the medical literature as early as the American Civil War, when surgeon Jacob Mendes Da Costa identified what came to be called "soldier's heart", a grouping of symptoms that looked like heart disease, but revealed no physiological abnormalities of heart problems. It came to be understood in the medical field as a grouping of symptoms indicating a severe anxiety reaction associated with battle experience.

By the time of World War I, the popular label for PTSD becomes "shell shock", a reasonable description considering the heavy artillery barrages of that war. Films from the era show soldiers in states of dissociation or uncontrolled trembling, as well as cases of apparent leg and arm paralysis, or sudden, unexplained blindness. In World War II, "battle fatigue" became the phrase for the collection of signs and symptoms. The disorder was still highly misunderstood by most lay people, with soldiers continuing associate the symptoms as a proof of being a "coward", a word that carried much weight for soldiers of that day. Subsequent examination and research of the Holocaust survivors of Nazi concentration camps and the bombing survivors of throughout Europe and Japan revealed extremely similar effects on non-combatants. Not much progress on the issue appears to have been made during the Korean War years.

Many courageous but damaged veterans of the Viet Nam War pressed the mental health community (not to mention the US government) into consideration of the symptom and behavioral sign clusters as something more than a simple and passing anxiety or adjustment to post-battle life. The psychological community traditionally formulates new or adapted diagnoses as a result of a large body of clinical experience, and this appears to be the case for the eventual formulation of 'PTSD' first introduced in the Diagnostic Statistics Manual III (DSM-III) in 1980. It certainly can be argued that there may have been significant political forces at work as to why it took so long after Viet Nam to recognize PTSD, but that is beyond the scope of the present work.

Interestingly, even anecdotal accounts of war-related PTSD symptoms appear to have differences in expression throughout the previously discussed wars, suggesting that present culture may greatly impact the expression of the symptoms and signs of the disorder. It would appear that our understandings of PTSD are still in a stage of adolescence, and are not yet fully mature. I have certainly come to the conclusion that child abuse victims have their own unique expression of PTSD.

The progress of mental health care, treatment, and early intervention in the past thirty years has come to recognize that it is not just war veterans who can develop painful signs and symptoms. Police officers, firefighters, victims of natural disasters, victims of domestic abuse and crime can all suffer from post-traumatic stress. In particular, the last ten to fifteen years of recognition, research, and treatment expansion for stress disorders has progressed significantly.

Indeed, the controversy in the mental health community over the PTSD diagnosis continues with suggestions that developmental trauma (abuse), though not having one single point of critical incident, qualifies for a PTSD diagnosis.

It is likely that any human being, when exposed long enough to repeated critical incidents, will take on a classic acute or posttraumatic stress profile of behaviors. Furthermore, I believe that any person, at any time, may become acutely reactive if an incident occurs at an emotionally vulnerable time and the event has emotional value to them. While the event and circumstance may not be evident to the observer as traumatic, it is the subjective experience that counts the most. We are all vulnerable.

PTSD and Children

Anyone who works closely with victims can tell you how contagious the stress is. Even the most experienced clinicians may experience an emotional toll, have intrusive dream content, and have moments in treatment when they become overwhelmed with grief, fear, and deep sadness (secondary PTSD). Part of the clinician's job is to remember to take care of themselves as well as the victim. I use the word "victim" rather than "survivor" because abused children are victims of a crime, and the effects of PTSD, left under and untreated, continue to keep them victims for years, even decades. For many, time is a second perpetrator. A child can only become a survivor when someone recognizes their PTSD and has effective means to begin to help them to heal.

My career has placed me in position to care for children who have been neglected, physically abused, sexually abused, and emotionally abused. Many of these children have been removed from their families and live with foster parents, who struggle to care for them despite the behavioral effects of post-traumatic stress. My experience with children has led me to understand that children have their own unique behavioral expressions that do not necessarily match the adult victim's behaviors. As such, many children with Acute Stress Disorder or PTSD may spend years with the wrong diagnosis and ineffective treatment.

Just as in the treatment of physical trauma, both immediate treatment and long-term rehabilitation are needed in psychological trauma. The healing process is not always comfortable, and the healer may need to help the patient tolerate the discomfort of treatment through encouragement and gentle nursing. While some pain is expected and perhaps even necessary for healing, the overriding key to stress disorder treatment in children is the application of the balm of gentleness.

Children, in fact, may experience trauma differently than adults do, and so then the treatment may also call for a different approach than what is used for adults. Adults who experience their critical event as adults naturally have much more history behind them and many more positive healthy ego experiences. As such, the adult survivor has a "well of resources" to draw from in order to begin to make sense of their traumatic event. They have the ability to make comparisons of their life before the events as opposed to after the event.

Small children who have experienced chaotic lives and multiple traumas since birth have no such wellspring to draw from. A child who has lived their entire life in the midst of a war, for example, has nothing to compare their experience to; no safe and comforting memory to retreat to when the time comes that they need to "go somewhere else" in their head to escape the intensity of the moment.

In traditional adult treatment of trauma, the patient is strongly encouraged to get right to the processing of the traumatic events and memories. The adult is encouraged to detail the events and articulate their corresponding emotions. This process may also be effective when used with a child of adolescent age. It can be assumed that the adult or adolescent has a fair understanding and ability to quickly develop trust in the clinician as a helper.

The idea of "counselor" is quite ingrained in most cultures as a positive concept. But what if the child is five or six years old, has an intellectual disability, and has a severe speech impediment? Or what if the child has had multiple adult perpetrators of violence against them?

Young children often have difficulty in articulating their experiences effectively, even if they are not traumatic experiences. Their self-awareness of internal processes is extremely limited, not because of their trauma, but simply because of their developmental stage. It becomes obvious that the treatment approaches for adults and teens becomes awkward at best when applied to young children.

(Continues…)

---

Excerpted from "Gentling"
by .
Copyright © 2011 William E. Krill, Jr. M.S.P.C..
Excerpted by permission of Loving Healing Press, Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

---

Table of Contents

Foreword by Marjorie McKinnon,
Foreword the 2nd Edition by Marian K. Volkman,
Introduction,
Preface To The 2nd Edition,
Acknowledgements,
1 – Gentling,
2 – Trauma,
3 – Signs and Symptoms Profile,
4 – Child-Specific Expressions of Stress Disorder Signs,
5 – Anatomy of the Stress Episode,
6 – A Course of Treatment for Abused Children with PTSD,
7 – Gentling and Treatment Objectives,
8 – Problems with Traditional Behavior Modification Techniques,
9 – Special Considerations in Sexual Trauma Cases,
10 – An Environment of High Nurture, High Structure,
11 – Helping to Break Negative Engagement Patterns,
12 – Face-to-Face Gentling Countenance,
13 – Educating Professionals and the Family,
14 – Stressed Self-Harm Management: Teaching Self-Comforting,
15 – When the Child Begins to Share History,
16 – Understanding Secrets and Abuse,
17 – When a Person is a Known Trigger,
18 – The Family Preservation Bias,
19 – Stress Behavior Data Collection,
20 – Interpersonal Trauma Effects in Teenagers,
21 – Disrupted Attachment Issues,
22 – The Gentling Approach with Adolescents,
23 – Classroom Protocols,
24 – Self-Care for the Clinician or the Differentiated Helper,
25 – Sample Treatment Plan,
Postscript,
Appendix A: Child Stress Profile,
Appendix B: Adolescent Stress Profile,
Appendix C: Handouts for Caregivers,
Appendix D - Quick Teach Sheets,
Appendix E: Stress Behavior Data Collection Forms,
About the Author,
Glossary,
Bibliography,
Index,