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Treat Childhood Trauma by Building on Parental Memories of Loving Care

Infants and preschool-aged children who live in daily circumstances of potential trauma and danger can develop the resilience to cope through treatment that focuses on// strengthening parent-child bonds, according to an expert in child development.

Speaking at the American Association for the Advancement of Science annual meeting in San Francisco, Alicia Lieberman, PhD, explored how children’s emotional and moral development is affected by catastrophes in the news and in their own lives. She is founder and director of the University of California, San Francisco Child Trauma Research Project at San Francisco General Hospital Medical Center.

Her presentation was part of a panel on “Ecologies of Danger and Cultures of Resilience: Children in Extreme Situations,” organized by leaders in the National Child Traumatic Stress Network.

Randomized studies by Lieberman and others have shown that a treatment method developed at UCSF, called Child-Parent Psychotherapy, improves normal development for small children traumatized by the violence and abuse that they witness at home and in their communities.

One key element for these traumatized children and their parents, Lieberman says, is to step beyond traditional treatment that focuses primarily on the parents’ own experiences of helplessness and fear. “It is important to focus on trauma, but we have learned that it is more effective to simultaneously help parents to focus on events in their lives that give them pleasure, fulfillment and hope as they raise their children,” Lieberman says.

She credits Bill Harris, chairman of the Children's Research and Education Institute of Belmont, Mass., for coining the phrase "angels in the nursery" to describe the shared effect of moments when the child feels understood, accepted and loved.

By helping parents recall their own “angels” -- childhood moments when they felt unconditionally loved and accepted by benevolen t caregivers -- CPP helps them break their own generations-long cycles of maltreatment. By helping parent and child build a new shared experience of love and trust, CPP helps develop the child’s core sense of security and self-worth, and the mother’s competence and confidence in her ability to meet her child’s needs.

Young children experience normal anxieties about danger and normal fears of losing the protection and love of their parents, but traumatic events can shatter the child’s sense of safety and well-being, setting the stage for behavioral problems in childhood and sometimes for mental illness as adults, Lieberman says. This can occur even when the child himself is not directly harmed.

Other speakers at the AAAS session discussed the effects of fears generated by news coverage of danger and by children’s experience of large-scale catastrophes.

Trauma is an everyday experience, hardship is the everyday norm, and danger persists in the past and the present for most of the 400 infants, toddlers, preschoolers and their parents who are served each year by the UCSF Child Trauma Research Project, in the CTRP clinic and in a variety of community settings.

“While we serve all types of families, the majority are minorities, underserved, with low incomes – those with the most life stresses and the fewest resources. One has to understand the ecology of these families' lives in order to treat them effectively,” says Lieberman.

Most of the parents are mothers, often living in violent relationships or fleeing domestic violence. While they are referred to the CTRP clinic because of the infant’s or child’s behavioral or developmental problems, most mothers also have life histories of trauma and abuse.

“Trauma has a very disruptive effect in people’s lives, leading them to be aggressive, to be depressed, to not feel effective in coping with the stresses of daily life, including the stresses of raisin g children,” Lieberman says. Yet research shows that traumatized mothers often draw on inner stores of resilience to help their children cope with difficult circumstances. The CPP program supports parents in a range of situations by taking advantage of the natural attachment between parents and infants, and the infant’s reliance on that attachment to develop effective responses to danger and safety.

CPP treatment typically lasts between 6 months and a year. A psychotherapist works with parent and child, often in their homes. Parents may also have treatment sessions on their own as needed.

In a study published in 2005, Lieberman and colleagues treated 75 children aged 3 to 5 and their mothers, who were randomized to receive a year’s course of CPP treatment or to receive care from a case manager who arranged individual psychotherapy and social services in the community. Children who received CPP showed significantly better results than the controls in behavior problems, traumatic stress symptoms and other measures, while mothers showed significant improvement in PTSD-related avoidance symptoms and a trend towards improvement in other measures of mental health.

A follow-up study published in 2006 showed that mothers continued to improve after the termination of treatment, showing significantly better scores in overall symptoms than mothers in the control group. Children's improvements were maintained six months after the end of treatment.

“We interpret these findings to mean that help for mothers improved their pleasure and competence in raising their children, and was beneficial to their own mental health," Lieberman says. "Our results support the notion that healthy relationships are the building blocks for individuals' mental health.”

At UCSF, Lieberman holds the Irving B. Harris Endowed Chair in Infant Mental Health and is vice chair for academic affairs in the UCSF Department of Psychiatry.

She also is director of the Early Trauma Treatment Network, a collaborative of four university sites funded by the federal Substance Abuse and Mental Health Service Administration. ETTN is part of the National Child Traumatic Stress Network, a 40-site national initiative with the mission of increasing the access and quality of services for children exposed to trauma in the United States.

Lieberman is active in several major national organizations involved with mental health in infancy and early childhood. She is president of the board of directors of Zero to Three: National Center for Infants, Toddlers and Families.


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