Tag Archives: Children & Adolescents

Losing face: How Facebook disconnects us

By Jennifer L. Cline August 26, 2014

This past February, Facebook celebrated its 10th birthday. According to its website, Facebook now boasts more than 1.28 billion active users, and on any given day, more than 60 percent of those users access the site. Facebook’s stated mission is “to give people the power to share and make the world more open and connected.”

But has Facebook, in fact, increased our social connectivity? Facebook and other forms of Neck-plug-Smallsocial media have inarguably enhanced the dissemination of information and allowed for more frequent, albeit often superficial, exchanges between people. However, the reliance on Facebook for connectivity has raised considerable concerns about its impact on the authenticity of the human experience.

Ironically, in a technologically advanced world in which we are able to keep in touch at all times with all people, citizens of the United States are feeling more alone and disconnected. According to the General Social Survey in 1985, before the dawn of social media, Americans reported having on average three confidants — the people with whom they discussed vitally important personal matters. By 2004,the average number of reported confidants had dropped to two, and the most commonly offered response was “zero confidants.” In 2010, the Pew Research Center collected comparable data on “core discussion networks” and found the average number of reported confidants remained at two.It seems that despite the use of communicative technology to connect, people are actually feeling more socially isolated.

The frightening prospect of face-to-face interaction

At this 10-year mark for Facebook, I think it is fitting that we critically examine the impact of interpersonal technology on our real-life social connections. As a counselor and researcher, I decided to engage in dialogue with young adults, a particularly “plugged in” generation, about their use of social media. For the past year, I have been learning directly from young adults about what is working for them and what is not. I spoke with 55 college students, 30 in a focus group setting and 25 in individual interviews, and this article highlights some of the most interesting and relevant findings from those conversations.

Certainly, some individuals use social media in a way that enhances their connectivity, while others supplant their embodied interactions with technology. This made me wonder about the importance of preference. Therefore, I began by asking this group of young adults if they preferred social media or face-to-face communication for social interactions. Their responses were intriguing.

On the surface, almost everyone expressly stated that they preferred face-to-face interactions. However, their stories quickly revealed that this “preference” was not that simple. They knew, at least intellectually, that the best way to communicate was face to face. At the same time, they felt pressured by the spontaneity of embodied conversation and felt interpersonally vulnerable when engaging with someone face to face. Therefore, using social media was an easy and convenient way to bypass those challenges while still getting their interpersonal needs met. In fact, some of these young adults admitted to engaging with social media while in the presence of others so they would appear occupied and unavailable for conversation. They also confessed that they were particularly likely to use social media to address conflicts with others — even if that person was physically present in the same room with them.

Not surprisingly, these young adults acknowledged wishing they felt more competent when relating to others face to face. Unfortunately, being “out of practice” created a vicious cycle in which lack of social competence led to greater dependence on social media use, which led to even more interpersonal awkwardness.

Implications for counselors

What does this mean for counselors? At its most fundamental level, the counseling experience is based on the ability to build a therapeutic alliance between client and clinician. And by nature, most clinical experiences are intense, face-to-face, interpersonal interactions. Initiating counseling is a brave endeavor for anyone, but if young adults increasingly avoid face-to-face interactions, especially if those interactions might be emotionally charged, how much more difficult will it be for them to reach out for help?

Furthermore, as clinicians, we see the value and merit in working through difficult experiences as simple as not knowing what to say in a given moment or asking someone out on a date and being rejected. Out of these events, we develop skills for dealing with difficult times, surviving painful disappointments, working through conflicts and directly facing the inevitable challenges of close relationships. However, if the current generation uses social media to bypass these less consequential growth experiences, how will they build these skills so that they have something to draw from when the difficulties and consequences are higher and more intense?

Finally, we know that meaningful interpersonal connections are important to our psychological health. Choosing more online interactions to meet the need for interpersonal connection allows users to avoid the difficulties of embodied relationships. Relationships in real life are often messy, frustrating and complex. Friends and loved ones are not always available to us, relating to others in the moment requires give-and-take, and our encounters sometimes leave us hurt and disappointed.

Online relationships, on the other hand, provide opportunities for less risky interactions that also require less giving of oneself. An online interaction does not require that we compromise our needs or delay gratification because friends are always available on Facebook, and when we’re finished with them, we simply click off. Choosing this one-dimensional interpersonal relationship potentially reduces online friends into self-objects that unidirectionally feed the user. Concern for the other is not required.

Social media motivations

My discussions with young adults about motivations for using social media resulted in answers that paralleled those about preference. Initially, they acknowledged their desire to keep in touch, to stay current and to take advantage of the ease and convenience of this technology — all answers that could be anticipated. However, upon further discussion, a tacit motivation for the use of social media emerged — the desire to psychologically protect themselves through enhanced control of social interactions and self-presentation. For example, I discovered that many college students use social media to covertly learn about others through passive observation and Facebook “stalking.” Then, using the information they have gathered, they approach these individuals in a manner that is likely to be well received, thus increasing the odds of interpersonal success.

Covertly learning the personal details of someone else’s life changes our experience of emotional intimacy. According to a 2010 article by Max van Manen, intimacy is created when there is a purposeful revelation of secret parts of oneself to another individual within the context of a trusted relationship. Facebook, however, reveals and makes public what was once personal, thus changing the meaning of privacy and intimacy. A continuous stream of social media updates allows a person to know what another is doing in a way that feels intimate or familiar, as if two people have spent all their time together. However, feeling emotionally intimate is not the same as being emotionally intimate, nor is feeling familiar the same as being familiar. Social media makes it easy to confuse the two.

facebookUsing Facebook is a bit like rummaging through a person’s medicine cabinet. You can look through either and learn a great deal about another person, some of which is quite private. However, it is fundamentally different to learn something about someone in this manner versus experiencing a purposeful revelation that requires vulnerability in the telling and empathy in the receiving. Counselors, of all people, know the value of being emotionally intimate, familiarly known and fully present with another human being. Fundamentally, reliance on social media sacrifices quality of interaction for quantity of interaction.

The college-age students I interviewed also described the heightened sense of control they felt over their self-presentation when engaging with others online. They explained their desire to present only their best selves online — their best pictures and their greatest moments — painting the picture of a happy, full and active life. These findings confirm recent research conducted by Catalina Toma and Jeffrey Hancock, who found that technology affords users the ability to select and edit their statements and take unlimited time to compose messages, allowing them to craft optimized versions of themselves online. Facebook, by definition, enables users to highlight treasured personal characteristics in an online profile and publicly display social connections with friends and family in an effort to be affirmed by other Facebook users.

These ideal self-presentations have multiple levels of impact on both the social media poster and the social media viewer. First, the ability to engage in self-promotion online, as well as the ability to maintain many shallow relationships, is a breeding ground for narcissistic traits. Furthermore, we have all suffered from the impostor syndrome, fearing that people would not really like or accept us if they really knew us, and social media can heighten this dynamic by promoting the creation of a reinvented self online. Posters may experience an increase in internal incongruence because they know that their real selves — the selves they actually know and experience — are different from the idealized selves they have presented online. Finally, even though Facebook consumers know that putting your “best face forward” is the rule online, they still look at others’ posts, compare themselves with those idealized self-presentations and begin to believe that others have better lives and a greater sense of well-being than they do.

The experience of anonymity and ‘online muscles’

One final area of conversations with these young adults related to their decreased awareness of others while using social media — or experiencing a sense of deindividuation. According to psychologist Philip Zimbardo, who studies personal responsibility and group behavior, this phenomenon is strongly fostered in situations that provide some level of anonymity. It involves a diminished sense of individuality and, consequently, a reduction in the sense of personal responsibility, leading to behavior that is incongruent with one’s personal standards of conduct. In other words, deindividuation means we are more likely to engage in socially inappropriate or self-serving behaviors when we do not feel that our behaviors are closely associated with our identity.

It may seem odd that the phenomenon of deindividuation would apply to Facebook, given that one’s identity is known on the social media site. However, the young adults I interviewed observed repeatedly that users post things on Facebook that they would never say in real life, including inappropriate self-disclosures, aggressive comments, rude insults and extremist opinions. They revealed that behind the protection of a screen, users grow what one woman called “online muscles.” Although they said that knowing the identity of a Facebook user should make people feel accountable for their words, they acknowledged that the psychological distance created by the technology allows for the phenomenological experience of anonymity.

When students reflected on this phenomenon, they posited that not being able to see the other person allowed them to reduce the interaction to “just words.” As a result, they felt less accountability for how they might affect another person. Furthermore, they theorized that the phenomenological experience of anonymity was related to an altered sense of reality that many users experience while engaging with others on social media. Cognitively, these students were aware that Facebook is a venue for interacting with many people simultaneously, a way to “talk to everyone.” Yet time after time, they described losing track of their audience and feeling as though they were actually talking to no one. They characterized their experience as “talking to the computer, basically,” “talking to self” and “it’s just you and your words … you and the computer screen.”

Social media, a form of mediated communication, creates technological distance, which allows people to treat others in ways they would not consider if they were engaged in embodied interactions. In the process of becoming caught up in themselves, users forget their audience and say things they would not say in real life.

Final thoughts

Our adoption of social technology is happening at astronomical speed, and my conversations with college students, although certainly not conclusive, suggest that this is not a benign development. Instead, social technology is a bit like the Trojan horse — seducing us with its beauty and stated mission, but all the while secretly sabotaging our most human qualities.

The ability to make meaningful interpersonal connections is of profound importance to our psychological health. Rather than promoting social connections as Facebook posits, social media technology separates people from the relational and promotes the individualistic and narcissistic. Self-interest ultimately leads to a loss of self and a decreased awareness of others. Eventually, we are unable to see and fully experience the humanity of others, creating the psychological distance that allows us to treat others in inhumane ways. This represents a loss of our most essential human qualities — a loss that we cannot afford.

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Jennifer L. Cline is a licensed professional counselor and approved clinical supervisor in Verona, Virginia. Contact her at jenniferclinelpc@gmail.com.

Letters to the editor: ct@counseling.org

Involving parents in child-centered play therapy

By Phyllis B. Post August 25, 2014

When young children, ages 2 to 9, are experiencing emotional and behavioral problems, the usefulness of talk therapy is limited because they often cannot communicate effectively using words. Play therapy continues to gain momentum as a viable approach to work therapeutically with young children because it is based on the premise that children communicate best through Dad&daughter_smalltheir usual way of relating — play. Using play in therapy is the most natural and effective way to help children.

Children are most often referred for play therapy when they demonstrate problems with friends, at home or at school. There are many different approaches to play therapy, but all are structured, theoretically based and developmentally appropriate, allowing young children to communicate and learn in the way that is most natural to them. Play therapy is different from “just” playing. It helps children express their feelings, assume responsibility for their behaviors and develop problem-solving skills. Play therapists are trained mental health practitioners who specialize in helping young children. An increasing number of master’s degree programs in counseling are including course work and training in play therapy. In addition, mental health practitioners can attend training provided by the Association for Play Therapy and the newest division of the American Counseling Association, the Association for Child and Adolescent Counseling.

As mentioned, a variety of approaches to play therapy exist, but I have found child-centered play therapy, as developed by Garry Landreth, to be particularly effective. Based on the work of Carl Rogers, a basic premise in child-centered play therapy is that children possess an innate force within themselves to grow and heal. Therefore, child-centered play therapists do not direct children on how to resolve their problems or use interpretation with children to promote their growth. Instead, child-centered play therapists relate to children in the playroom in ways that demonstrate a firm belief that children learn the most and heal most effectively when they themselves decide what to do in therapy sessions. Through a supportive and caring relationship with child clients, therapists help these children understand themselves, accept their feelings, assume responsibility for their behaviors in the playroom and learn to control their own behaviors.

Why work with parents?

Although there is consensus among play therapists that effective consultation with parents can maximize beneficial outcomes for children, parental involvement in the process often does not extend beyond the intake session and brief periodic check-ins when parents bring their children to therapy. But effective parent consultation can help parents better understand why play therapy is beneficial for their children, how play therapy interventions are purposeful and that the effectiveness of the interventions can be assessed. In addition, these consultations can provide parents support and hope, both of which help prevent early termination by the parents.

Although play therapists may be aware of the importance of parent consultation in helping children, many therapists are not confident about how to approach consultation with parents. In a national survey in 2008, Tim VanderGast found that play therapists identified consulting with parents as one of their greatest needs in clinical supervision. Because child-centered play therapists focus on the relationship with the child rather than on the presenting problem, they face unique challenges when helping parents understand how this popular theoretical approach helps children with specific goals that are established to assess progress.

The goal of this article is to provide some practical guidelines for therapists as they consult with parents when conducting child-centered play therapy. In addition to describing child-centered play therapy to the parents, these guidelines include:

  • Learning about the child and developing a trusting relationship with parents
  • Addressing objectives and goals
  • Relating established goals to the child-centered approach in the playroom
  • Providing ongoing parent consultations

Learn about the child and develop a trusting relationship with the parents

Parenting is often difficult and stressful. When issues create the need to involve a young child in therapy, the counselor’s ability to convey to parents the core conditions (as described by Rogers) of empathy, acceptance and genuineness cannot be overemphasized. It is through these conditions that a strong therapist-parent alliance starts to form. Additionally, consultation meetings provide an opportunity to model the person-centered approach with parents, showing them the power of the basic principles that will be used with their child in child-centered play therapy. To begin building this trusting relationship, I recommend that therapists meet parents for the initial session without any children present.

The first step is listening to the parents’ description of the child. This process results in a better understanding of the parents’ perception of the problem, as well as their worldview and the child’s cultural context. For example, when a mother who had not completed high school described her reasons for bringing her child to play therapy, the therapist sensed the mother felt uncomfortable in the elementary school environment and felt intimidated by her child’s teacher. In this situation, the therapist could demonstrate sensitivity to the mother’s perspective by responding to her feelings of uncertainty and discomfort in that environment. However, I would caution that even as therapists attend to the parents’ concerns, the focus should remain on the child’s issues rather than on the parents’ issues.

Address objectives and goals

Communicating the objectives and establishing specific goals for therapy are important for several reasons. First, the process demonstrates to parents that play therapy interventions are purposeful, which might not be as obvious in child-centered play therapy as it is in talk therapy with older children or adults. In addition, the objectives and goals are useful in evaluating the effectiveness of the play therapy. They become the benchmarks to assess progress during ongoing consultations with parents. Finally, we cannot ignore the fact that outcome goals are required in the managed care environments in which many counselors work.

As described by Landreth in the third edition of his book Play Therapy: The Art of the Relationship, child-centered play therapy adheres to the objectives of helping children become:

  • More self-reliant
  • More accepting of themselves
  • Better problem solvers
  • Better able to assume responsibility for their own behaviors

The idea of setting specific goals in addition to those four broad objectives can feel uncomfortable to child-centered play therapists. They may fear that they unconsciously possess some expectations and biases that could inadvertently cause them to direct the child in play therapy or to view the child’s behaviors in the playroom through the lens of the established goals. Awareness of this possibility is important and should be monitored through clinical supervision. However, a combination of broad objectives and specific behavioral goals is optimal for monitoring the effectiveness of therapy.

Focusing on the overarching objectives that can be observed in the playroom and in the child’s life outside of the playroom helps us to recognize broad-based changes. Focusing on more specific goals related to the issues presented by parents ensures that attention is also directed to changes in those behaviors that might not be observed in the playroom. Therefore, using both broad objectives and specific behavioral goals is useful in monitoring the effectiveness of play therapy interventions.

In the initial meeting with the parents, the play therapist strives to establish goals that reflect the family’s cultural context, given that each family has its own expectations and experiences with the meaning of help seeking, mental health and play. During this process, play therapists must be sensitive to the parents’ cultural backgrounds because the parents’ values will influence the types of goals established for their child. For example, in some cultures, compliance with authority, both at school and at home, is highly valued. Thus, the goals that evolve for the child through the therapist-parent interaction could focus on compliance and responsiveness to limits. In other cultures in which children experience more permissive relationships with their parents, the goals for play therapy might include enhancing the child’s self-confidence and ability to make decisions. This collaborative process between parents and therapists will result in a consensus on the goals for play therapy.

Setting goals with parents is hard work, and it takes practice. Goals must be concrete, measurable and observable to ensure that progress can be tracked. In addition, goals that are strength-based and that focus on solutions provide hope for parents.

As parents talk about the reasons they sought play therapy for their child, the work of the play therapist is to help them “translate” their concerns into specific behaviors that can be assessed and to set benchmarks to determine how they will know when their child has changed. For example, a mother brought her 5-year-old son to play therapy because he was “out of control” at home and at school. The therapist asked, “What does ‘out of control’ look like?” With that helpful nudge, the mother was able to elaborate, saying, “When it is time for him to get dressed in the morning, he screams for about 15 minutes and hits himself. He says ‘no’ to every request I make of him. And the teacher sends home a note almost every day about him yelling and hitting other children at school.” Based on this specific description of the boy’s behaviors, it became possible to establish realistic goals.

One question therapists can ask parents is, “How will you know when your child has changed and no longer has this problem?” This information provides the basis for benchmarks for change. In the example above, goals were created that specified how many days each week the child would comply with his mother’s requests, not have a tantrum at home, not hit himself and not receive a report from the teacher about problem behaviors in the classroom. Such clearly stated goals are helpful not only in assessing change but also in managed care environments that require the monitoring of behavioral outcomes for insurance reimbursements.

It cannot be overstated, however, that establishing such goals with parents prior to the start of child-centered therapy does not change the way that play therapists relate to the child in the playroom. There are no predetermined interventions during the counseling sessions that seek to change the child’s behavior. Instead, therapists consistently offer a safe relationship and an environment in which the child is free to be self-directive. In fact, in a chapter for the 1997 book Play Therapy Theory and Practice: A Comparative Presentation, Landreth and Daniel Sweeney recommended that child-centered play therapists continually reflect upon their way of being in clinical supervision to address the issue of inadvertently directing the child’s behavior.

Relate established goals to the child-centered approach the playroom

Perhaps the most challenging part of the initial consultation with parents is explaining how the behaviors of the counselor in the playroom help children achieve both the broad objectives and the established goals of play therapy. Play therapists can help parents by describing how each of the established goals could be addressed in the playroom. Using the earlier example, if a young child is “out of control” at home and school, the play therapist might explain to the parents that through the safe relationship with the therapist, the child will learn to assume responsibility for his decisions in the playroom and will have opportunities to demonstrate self-control if setting limits is necessary in the play therapy session. In this way, parents can recognize that what occurs in the nondirective playroom can be helpful in addressing issues occurring at home and at school.

Provide ongoing consultations

Every four or five sessions, therapists should meet with the parents without the child being present. The purpose of the ongoing consultations is to maintain and foster a strong therapist-parent alliance, allow the parents and play therapist to collaboratively assess the progress toward goals, and further educate parents about child development, parenting skills and community resources.

It is important for child-centered play therapists to maintain case notes to document significant events, attitudes and play themes in the play sessions. In addition, reviewing case notes can be useful when assessing progress toward goals. For example, if a child is experiencing anxiety outside of the playroom, case notes can help identify changes in behavior that indicate anxiety in the playroom as well, such as when making decisions about what to do in the playroom, facing the therapist or interacting with the therapist. For a child presenting with goals related to aggressive behavior outside of the playroom, documentation of play sessions could note changes in the child’s response to limits setting. Case notes can be reviewed to identify play session themes (for example, themes of power, mastery or nurturance) to share with the parents. When meeting with parents, play therapists should remain sensitive to maintaining the child’s confidentiality by not disclosing specific play behaviors or the child’s verbalizations during play sessions.

Maintaining and fostering a strong therapist-parent alliance: A primary goal for these meetings is to foster a warm relationship with the parents. The counselor can do this by acknowledging the parents’ experiences, struggles and feelings and responding with empathy and care. Through listening to the parents, the play therapist is better able to support and educate when it is appropriate.

Assessing progress: If parents share more general concerns about themselves at the beginning of the session, the counselor can focus the session on the child by asking an open-ended question such as “How have things been going with ___?” Using active listening skills at this time ensures shared understanding of what the parents are saying. Play therapists should listen for information related to the stated goals for therapy. If the parents do not address each of the goals identified in the first intake session, the therapist can systematically address the goals not mentioned. It is not uncommon for a review of the original goals to surprise parents. Some parents will have no memory of certain goals because the issues will have resolved themselves.  

During these ongoing consultation sessions, the therapist can share themes observed in the play therapy sessions, especially if they relate to the established goals of therapy, such as the child’s ability to control behaviors when limits are set or an increasing ability to assume responsibility for decisions. After reviewing the goals, the therapist and parents collaboratively determine whether the original goals were met, whether they need to be modified or if it is time to terminate the relationship.

Providing education on parenting skills and community resources: If the decision is made to continue play therapy, the therapist and parents set a time for their next meeting. Once it is established that the parents will be returning, the play therapist can also share appropriate parenting skills based on the needs of the parents and child. Most parents are eager to learn new approaches to discipline and highly value the skills of limits setting and choice giving. In addition, teaching the skills of responding to the child’s feelings and returning responsibility to the child has been found to reduce parental stress and create a more positive environment in the home. That outcome can influence the entire family system.

Ongoing meetings with parents also provide opportunities to address other needs the child may have that are not currently being met. The therapist can then provide or recommend appropriate resources. For example, if a child appears to have a learning disability, the play therapist should make an appropriate referral for the child to be assessed for needed services.

Conclusion

Child-centered play therapists focus on the relationship with the child rather than the presenting problem. Thus, therapists face unique challenges in helping parents understand how this theoretical approach supports children in progressing toward specific goals. To demonstrate the effectiveness of their work with children and to respond to the demands of managed care in agency settings, play therapists must skillfully share the objectives of child-centered play therapy, establish behavioral outcome goals and then assess progress toward achieving those goals. The guidelines proposed in this article are specifically designed so that child-centered play therapists can collaborate with parents to more effectively help young children.

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Phyllis B. Post is a professor in the Department of Counseling at the University of North Carolina at Charlotte and the founder of the Multicultural Play Therapy Center at the university. She is a licensed professional counselor supervisor and registered play therapist. Contact her at ppost@uncc.edu.

Letters to the editor: ct@counseling.org

Partnerships and urban youth

By Amie Tat and Rebecca L. Toporek June 25, 2014

urban“Michael Taurus” is a C student who, as a ninth-grader, gave very little thought to his options after high school. If pressed, he probably would have mentioned going to community college or getting a job. Michael’s parents immigrated to the United States shortly after he was born and did not have the opportunity to continue their education beyond elementary school. Michael’s father struggled with job security, working odd construction jobs whenever they were available, while Michael’s mother worked the graveyard shift, cleaning hotel rooms to help support their family of six. Michael, the eldest of four children, spent most of his time after school taking care of his younger siblings in his parents’ absence.

According to a 2012 report from the National Center for Education Statistics, gaps across almost all measures of achievement and persistence in education are greatest for children living with poverty, children who are English language learners and children from ethnic minority groups most represented in low-income urban communities. Urban youth often have difficulty envisioning and investing in their futures fully due to other circumstances that require more immediate attention. For example, students worried that their families will be evicted from their homes may have difficulty focusing their attention on applying to colleges or preparing for employment.

The current state of the education system and the challenges that urban youth face affect the way that all counselors, not just college and school counselors, work with individuals, schools and communities. In short, systems-level solutions and partnerships are needed. This article explores issues confronting urban youth and describes one example of an equity-based partnership designed to promote a “college-going culture” in underresourced urban high schools. This effort is cultivated through the development and maintenance of community, school and higher education partnerships.

Consistent with scholarly definitions of urban youth, we are referring to young people, mostly ethnic minority, who reside in densely populated, lower socioeconomic, inner-city neighborhoods. A combination of internal and external challenges affect the ability of urban youth to succeed academically and become self-sufficient adults. Common environmental challenges include lack of adequate resources, limited access to social services and communities stricken by the influence of drugs and alcohol, violence and poverty.

The transition to college requires more than just academic preparation. Urban youth face motivational barriers and bleak expectations of their potential for college due to a lack of positive or knowledgeable role models who demonstrate academic success. In addition, many community members in urban neighborhoods struggle financially to support their families. Children are often expected to assume greater responsibility within the household or work outside the home to help support the family. Managing these obligations often interferes with students’ ability to perform well academically. Furthermore, their families’ lack of monetary resources and limited knowledge of financial aid can influence urban students’ attitudes toward higher education because the importance of earning money to help support their families is more urgent than spending money to go to school. Given the immediate financial needs for survival, the long-term investment of school is costly, both in terms of the funds needed to attend school and the delayed earning of wages. These circumstances lead many urban youth to become disengaged academically and less likely to pursue higher education.

Nevertheless, many urban families do their best to support their children’s educational efforts despite the challenges to financial stability and their limited knowledge of preparing for and navigating the transition to college. Making comprehensive support systems available to these families early in the high school experience can help address these difficulties and encourage urban youth to proceed in a positive direction.

Formal structures such as schools are expected to provide knowledge and skills for successful adulthood transition, either through higher education or employment. But in school systems with inadequate resources and overwhelmed staff, the school’s potential to have a direct impact on its students’ successful transition to college is disrupted. This is further intensified when schools lack a strong college-going culture.

Many urban high schools face significant behavioral and social challenges, such as community violence, conflict within the school and the influence of crime and gangs on the school community. These factors frequently require school administrators, counselors and teachers to focus on discipline and safety issues. Consequently, more effort is placed on addressing delinquent behavior than on promoting student achievement. Inadequate resources also hinder a school’s ability to expose students to higher education settings through field trips to college campuses and other activities. Because the influences and needs of students are so complex, a comprehensive partnership approach is indispensable.

A study of partnerships

System-level solutions are required to address the complex challenges faced by urban communities. For example, one of the major ongoing issues in underresourced urban schools is inadequate staffing due to tumultuous public funding issues. Frequent turnover among administrators, teachers and counselors inhibits the systematic ways schools can prepare students for postsecondary institutions. Changes in leadership create inconsistencies within the many structures of the school.

Partnerships that involve organizations committed to maintaining an ongoing and visible presence at the school can help establish and maintain stable relationships with students despite fluctuations in public funding. Sustained relationships with the community also contribute to greater cultural understanding of the students and their families. Counselors who develop and maintain their multicultural competence and advocacy competence as well as their skills in facilitating group systems are a tremendous resource, both within the school and the community.

A fundamental condition of creating a college-going culture and fostering successful transition to adulthood involves getting students to see themselves as having the potential to attend college or secure employment successfully. Counselors, school staff, agency staff and community members can work together so that students become aware early on of college and career counseling interventions. Students can then continue to connect with staff throughout various events and milestones in the process. Each of these partners contributes to greater understanding of the challenges faced by urban youth, the cultural values and styles of communication they revere and the strengths these students and their families present. Agency and school staff members who are bilingual and culturally competent are especially important in this environment to ensure that communication with families is clear and welcoming. Each partner also contributes to a more seamless functioning of a system that expects the best from students and conveys a belief in their success.

Developing initial and ongoing partnerships

This article focuses on the partnership between Seven Tepees Youth Program and John O’Connell High School (JOCHS) in San Francisco. The College and Career Centers of the Seven Tepees Youth Program are equity-based programs launched in 2007 to promote a college-going culture in two urban high schools through the development and maintenance of community, school and higher education partnerships.

The parent organization, Seven Tepees, was established in 1995 as a nonprofit organization in San Francisco’s Mission District. (The name Seven Tepees was given by one of the organization’s founders, Native American healer Hully Fetiçó. The name represents the diversity of the seven continents and the Native American tradition of connection to nature and care of the land. Although the program does not primarily serve Native American students, the richness of the world’s cultures is an integral part of all program components.) The organization works with urban youth to foster the skills needed to make lifelong positive choices and to create their own opportunities for success.

The primary mission of the College and Career Centers is to increase the number of students who enroll in college from the partner high schools and to work with these students to cultivate the skills necessary to transition to successful adulthood. The program serves all students regardless of GPA. The needs of the partner schools and communities, along with the alarming state of education, led Seven Tepees to recognize that systems-level solutions and partnerships were necessary for student success.

JOCHS, also located in the Mission District, was identified as an underperforming school by the state of California and mandated to undergo transformation. To provide some context, according to the San Francisco Unified School District School Accountability Report Card (2012), of the 471 students at JOCHS in 2011-2012, 58.2 percent identified as Latino, 15.9 percent as African American, 11.7 percent as Asian or Asian American, 7.4 percent as Filipino, 3.6 as white, 0.8 percent as American Indian or Alaska Native and 0.8 percent as multiracial. Moreover, 76.6 percent of the student population was identified as socioeconomically disadvantaged, 49 percent of the students were English language learners and 17.4 percent were identified as having disabilities. In addition, the continuity of school staff at JOCHS has been greatly challenged during the past decade, with 25 deans and administrators coming and going during that time.

Youth-proudly-raise-their-scholarship-letters-to-City-College-of-San-Francisco

Students proudly show their scholarship letters to City College of San Francisco.

From the time students enter JOCHS, they are exposed to the College and Career Center because of its central location on the high school campus. Student assistants work in the center, further contributing to its atmosphere as a hub of excitement and activity. These students also increase awareness of the center and of college as a real option through their existing social networks within the school. In this way, students begin to feel as though they belong in this space.

Exposure to the College and Career Center is enhanced with outreach to students early in their high school years. Then, during the middle of the 11th-grade year, a staff member from the center initiates the first formal individual meeting to discuss each student’s postsecondary goals. For some students, these goals may reflect a desire to enter the workforce rather than pursue postsecondary education. Regardless, the College and Career Center staff determines eligibility for college admissions for all students and facilitates a discussion of goals with each individual student. Prior to these meetings, some students favor employment over postsecondary plans due solely to the assumption that they would not be accepted to attend college or would be unable to pay for college. When provided with concrete information regarding possible resources, they are better able to examine their options fully and share information with their families to begin making decisions.

To meet with students individually, school partnerships and systems work cooperatively. For example, partnerships must be established with the teaching staff to create and implement procedures for supporting college-going culture goals, including releasing students from class for their individual appointments with the College and Career Center. An atmosphere of teamwork and trust is required so that school staff will approach this as a collaborative effort and treat it with the same importance as their curriculum. The College and Career Center must convey the connection between establishing a college-going culture and the need to meet with students individually. College and Career Center staff must also be strategic in seeking noninstructional times to meet with students — for example, during homeroom, lunchtime, free periods and after school — to keep disruptions to their academic courses to a minimum. If disrupting class time is unavoidable, the next task becomes determining which teachers are amenable to dismissing students from class. This process can be a challenge unless school personnel feel the goal is mutual. It is essential to have open and regular conversations with all partners regarding their perspectives on the value of transition goals, inclusive of vocational training as well as college.

The extent to which school counselors are directly involved in career and college counseling varies by district and state. This is often related to resources as well as policymakers’ visions of the role of school counselors. In urban schools, the ratio of counselors to students is often so low that counselors are stretched thin just handling safety and crisis concerns, basic course scheduling responsibilities and other administrative duties. But even in districts or schools where school counselors are unable to be directly involved in college readiness activities, they can still contribute to the process. School counselors may have existing relationships with students and families, knowledge of student histories, insights for working with students with specific needs or simply access to student records such as class schedules and academic transcripts. On a very basic level, school counselors can adjust student schedules to reflect the courses needed for graduation and college eligibility. Mutual sharing of information is essential as students are encouraged to set and reach milestones.

Other major partners within schools include school wellness centers and afterschool programs. In urban schools, these programs are often provided by community-based organizations (CBOs). Each of these partners expands the net of support for urban youth through mental health counseling, nutrition education, connection to social services, tutoring services, enrichment courses and credit recovery options. Students who receive such services may have a large network of therapists, tutors, mentors, case managers and social workers working collectively to ensure students’ overall well-being.

Developing and, most importantly, maintaining these partnerships with other departments and CBOs within the school becomes integral to helping students transition successfully into adulthood. For example, the Wellness Center and the College and Career Center at JOCHS often collaborate to provide workshops that address concerns such as anxiety or conflicts in the family about moving away for college. Additionally, a partnership with the school’s After School Program allows College and Career Center staff to work with tutors to ensure that students are on track for graduation and completing courses for college admissions. Other CBOs that may offer support and resources for urban youth include organizations that work with youth in foster care, provide employment opportunities or present scholarship opportunities.

Families are also contributing partners to student success and transition to adulthood. This can range from full support to minimal engagement, such as providing income information for financial aid applications. Students such as Michael often come from collectivistic families in which parents have a large influence — and in some cases, the ultimate voice — in students’ postsecondary decisions. Families who do not favor students’ goals, or fear the educational process, may take an adversarial stance.

In urban schools, many parents have limited engagement with the school and educational process for a wide range of other reasons, such as a schedule that involves working two or more jobs, caring for family members or many other obligations. In addition, parents who have limited experience or past negative experiences with educational institutions may hesitate to engage with the school. Schoolwide events that aim to connect with families and address their needs can provide education and support in areas such as financial planning to help overcome informational and pragmatic barriers. In addition to holding events, the College and Career Center welcomes parents to meet individually with staff regarding concerns about college. The center also provides bilingual staff for many families with limited English fluency.

Following Michael: The college and career readiness process 

Throughout his time in high school, Michael had both indirect and direct exposure to a College and Career Center in his high school. When he entered ninth grade, he and his cohort were exposed to schoolwide events, classroom presentations and a centrally located drop-in center devoted to cultivating a college-going culture. During the 10th grade, he was introduced to the PSAT and participated in field trips to colleges and universities. In 11th grade, Michael and all of his classmates met individually with a College and Career Center staff member to talk about post-high school plans and what to expect during senior year.

During this intake meeting, the discussion focused on determining what plans, if any, Michael had beyond high school and gauging his understanding of postsecondary education. Program staff evaluated Michael’s transcripts with him to determine college admissions eligibility and to create an educational plan for the remainder of high school. The plan outlined which courses to take, when he should take the SAT/ACT, deadlines for college applications, appropriate financial aid and scholarships, as well as suggested extracurricular activities and other college preparatory activities. Michael learned that he was eligible for admission to a state university if he made up a few failed courses.

Thrilled with the news, he began to plan for summer school to make up his failed courses, studied for the SAT, researched colleges and universities, investigated scholarships and worked toward maintaining good grades. He participated in “college week” workshops that were facilitated by Seven Tepees staff and university and college partners. The workshops focused on topics such as financial aid and scholarships, admissions, career decision-making and other relevant topics.

At the start of his senior year, Michael was eager to start applying for college, and he had established a bond with the College and Career Center staff. With guidance and assistance, he applied to eight universities and also began looking for and applying for scholarships. Michael was on track to enter a four-year university and was excited to become the first member of his family to graduate high school.

Michael returned after winter break of his senior year noticeably uninspired and disconnected from his studies. He came to school less frequently, and his grades began to drop. The school counselor initiated a meeting that included his teachers and personnel from key departments with which Michael worked closely, such as the College and Career Center, the School Counseling Department, the Wellness Center and the After School Program. During the meeting, Michael’s teachers expressed their concerns with his grades. They shared information Michael had provided regarding his familial obligations as the eldest child and his need to care for younger siblings while his parents worked long hours. Moreover, considering his family’s low income, the teachers speculated that Michael might be experiencing anxiety about the cost of college. The school staff developed a shared understanding of the issues and then invited Michael’s family to collaborate.

Parents of urban youth may be unable to participate fully in this type of process because it would mean missing work and losing necessary income. However, when a student is in jeopardy of not graduating or if the student is losing a potential opportunity to enter college, the parents or guardians usually make the sacrifices necessary to participate to the extent they are able. Sensitivity and cultural competence is critical in these types of discussions. Sometimes, they may require the additional involvement of staff members who can provide a cultural perspective and offer linguistically appropriate communication relevant to the student.

In Michael’s case, everyone on the school team worked together to create a culturally congruent proposal to address the many challenges he faced. Michael’s parents attended a meeting to discuss his potential and the current difficulties given the family’s financial burdens and child care challenges. After the counselor and support staff provided information regarding community resources for the family, Michael’s family was able to devise an alternative plan for child care that would allow Michael to spend more time with tutors after school. His teachers and the After School Program were able to offer tutoring services to help Michael raise his grades, while the Wellness Center provided counseling around the anxiety he was feeling. The College and Career Center worked with Michael to reevaluate and adjust his initial educational plan to get him back on track for college acceptance. The center’s staff also helped him search for scholarships and apply for federal and state financial aid, and discussed more affordable college options with him, including local universities that would allow Michael to live at home, thus reducing housing costs. Michael and his family continued to face challenges, but with guidance and assistance from partners, along with engagement from the family, he was able to move forward and was accepted to several local state universities.

With many students, the vigilance and support of the team can help identify and address challenges that might arise in the transition process before they become prohibitive. For other students, challenges will require a revision of the plan. With the help of counselors and a College and Career Center that is invested in each individual student’s story, a new plan can continue to help these youth move forward toward adulthood in a positive way.

Recommendations for counselors

Counselors are important contributors to the multifaceted approach needed to address students’ transition to adulthood. School counselors, college counselors, wellness counselors, mental health counselors, career counselors and rehabilitation counselors all offer important expertise and perspectives in this area.

The importance of multicultural and advocacy competence cannot be overstated, and it is an ethical imperative for counselors to gain and maintain their knowledge, self-awareness and skills toward these competencies. The Multicultural Competencies and the Advocacy Competencies adopted by the American Counseling Association provide valuable guidance. For example, the Advocacy Competencies describe the ways that counselors can advocate on individual, organizational and policy levels and provide recommendations for the types of skills and knowledge that facilitate the role of advocate at these levels. In addition to providing direct service, counselors can play a pivotal role as a touchstone for the observations of teachers and other staff members, organizing information and facilitating collaboration when interventions are needed in the system.

Conclusion

Michael’s situation offers just one example of the barriers that can prevent forward movement toward successful adulthood transition for urban youth. Partnerships between collaborators become a critical component in helping students such as Michael. Yet the functionality of the model and its results will vary because each individual, family, school and community presents different needs and concerns. The central contributor to success is the development and maintenance of partnerships and collaboration. Everyone is an important player with expertise to share and the ability to foster success.

 

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Knowledge Share articles are adapted from sessions presented at American Counseling Association conferences.

 

Amie Tat is the college success coordinator for the Seven Tepees Youth Program and a second-year graduate student in college counseling in the Department of Counseling at San Francisco State University.

 

Rebecca L. Toporek is an associate professor and coordinator of the career counseling and college counseling specializations in the San Francisco State University Department of Counseling. She served on the task force that developed the ACA Advocacy Competencies. Contact her at rtoporek@sfsu.edu.

 

Letters to the editor: ct@counseling.org

 

The toll of childhood trauma

By Laurie Meyers June 23, 2014

Little-girl_brandingMention the word trauma to Americans in the 21st century, and their thoughts are likely to turn to images of terrorism, war, natural disasters and a seemingly continual stream of school shootings. The horrific scenes at Newtown and Columbine still dominate public consciousness, particularly when our society discusses child trauma. While those events make headlines, however, counseling professionals say the most pervasive traumatic threat to children is found not in big events or stranger danger, but in chronic and systemic violence that happens in or close to the home.

This kind of ongoing trauma, much of which takes place out of public view, leaves deep scars that can cause a lifetime of emotional, mental, physical and social dysfunction if left untreated. Research shows that chronic, complex trauma can even rewire a child’s brain, leading to cognitive and developmental issues.

The good news is that counselors in all areas of practice — in schools, agencies, shelters, clinics, private practice and elsewhere — can and are working with children and, when possible, their parents to stop the cycle of violence, or at least to mitigate its effects.

Behind closed doors

The number of children exposed to violence in the United States is staggering. According to the National Survey of Children’s Exposure to Violence (NatSCEV), funded by the U.S. Department of Justice and the Centers for Disease Control and Prevention (CDC) and carried out by the University of New Hampshire’s Crimes against Children Research Center, more than 60 percent of children surveyed had been exposed to direct or indirect violence during the 12 months prior to the survey. Nearly half — 46.3 percent — had been assaulted at least once in the past year, meaning they had experienced one or more of the following: any physical assault, assault with a weapon, assault with injury, attempted assault, attempted or completed kidnapping, assault by a brother or sister, assault by another child or adolescent, nonsexual genital assault, dating violence, bias attacks or threats. One in 10 had experienced some form of maltreatment, which includes nonsexual physical abuse, psychological or emotional abuse, child neglect and custodial interference. Other CDC research indicates that 1 in 4 girls and 1 in 6 boys are victims of sexual abuse. However, many experts emphasize that due to the stigma involved, sexual abuse is underreported.

Significant exposure to violence and trauma can also lead to illness later in life. From 1995-1997, the CDC, in collaboration with Kaiser Permanente, collected detailed medical information from 17,000 patients at Kaiser’s Health Appraisal Clinic in San Diego. These patients also answered detailed questions about childhood experiences of abuse, neglect and family dysfunction. The initial study, Adverse Childhood Experiences, as well as more than 50 studies since using the same population, found that adult survivors of childhood abuse are more likely to develop chronic conditions and diseases such as heart disease, obesity, cancer, chronic obstructive pulmonary disease and liver disease. They are also more likely to engage in risky health behaviors such as smoking and drug and alcohol abuse. In addition, adult survivors of child abuse may have autobiographical memory problems; exhibit increased problems with depression, anxiety and other mental illnesses; and struggle with suicidal tendencies.

NatSCEV data, collected between January and May 2008, indicate that one in 10 children surveyed experienced five or more incidents of direct violence. It is this kind of ongoing abuse that can cause polyvictimization, or what many researchers call complex trauma — repeated exposure to traumatic events over time and often at the hands of caregivers or other loved ones.

“This cumulative trauma has much more serious effects than a single event,” says David Lawson, a licensed professional counselor (LPC) and licensed marriage and family therapist in Nacogdoches, Texas, who has worked with victims and perpetrators of sexual and domestic abuse since the 1980s. Because the abuse is ongoing, it disrupts a child’s sense of security, safety and self and alters the way he or she sees others, explains Lawson, an American Counseling Association member who is also a researcher and professor in the school psychology and counseling program at Stephen F. Austin State University in Nacogdoches.

“In childhood, attachments are still forming, and abuse can shatter this developing ability,” says Jennifer Baggerly, an ACA member, LPC and play therapist who studies child trauma intervention. “It can also distort their forming personality and the way they interact with people as a whole.” This distortion can cause the child to believe that the world is an unsafe place and that people aren’t trustworthy, adds Baggerly, an associate professor and chair of the Department of Counseling and Human Services at the University of North Texas at Dallas.

That pattern of uncertainty and instability can cause cognitive distortion, dissociation and problems with emotional self-regulation and relationship formation, and even alter a child’s brain structure, notes Lawson, the author of Family Violence: Explanations and Evidence-Based Clinical Practice, published by ACA in 2013.

“Children get stuck in flight or fight,” adds Baggerly. “Everything is a threat, so instead of strengthening the prefrontal cortex, the brain operates more from the limbic system, which causes them to be more hypervigilant.”

Because they are almost constantly on alert, these children and adolescents most of the time use what Lawson calls their “survival brain” instead of their “learning brain.” Childhood and adolescence are periods in which the brain is developing rapidly and crucial cognitive skills are being learned. If children and adolescents spend too much time in survival mode, they are not accessing areas in the brain that are responsible for learning developmentally appropriate cognitive skills and laying down the neural pathways that are critical to future learning.

“As the child gets older, this chronic hypervigilance — and the overload of cortisol that comes with it — completely remaps the brain and just stifles development,” says Gail Roaten, president-elect of the Association for Child and Adolescent Counseling, a division of ACA. “You see them lose ground cognitively, especially in their ability to learn.”

Support and stability

Traumatized children’s problems with cognition, learning, self-regulation and development can last a lifetime, making it more likely that they will continue the cycle of abuse in their relationships, abuse drugs and alcohol, have trouble finding and keeping jobs or end up in the criminal justice system. Adults who were traumatized as children also are much more likely to face a host of physical and mental health problems.

The situation is far from hopeless, however. Counseling interventions for trauma can make a dramatic difference, and the earlier a child starts receiving therapy, the better. A variety of techniques have proved to be effective, but interventions are most successful when a supportive environment is created, Lawson emphasizes. Whenever possible, a parent or parents should be participants in a child’s therapy (as long as they are not the perpetrators of the abuse), and if not the biological parents, then foster parents or grandparents.

“I try to bring in whoever can help build a support system for the child,” Lawson says, “because an hour a week [of counseling] is woefully inadequate, and I need to have them able to take what they learn in therapy into the home.”

In many cases, parents or caregivers need help learning how to support the abused child emotionally, he says. When parents come to sessions with their children, the counselor can help the parents learn not just the best way to support the child in therapy, but also how to strengthen their parenting skills.

“We really emphasize connection,” Lawson says. “Once they [abused children] have attachment, they may be ready to tell parents about their abuse and may just blurt it out at home. I try to prepare parents to listen to the child. If the parents are not comfortable addressing this [topic], I have them at least write down what the child says and then use that as a therapeutic prompt.”

In sessions, Lawson guides parents, teaching them how to interact and better bond with children who have been traumatized. Some parents and caregivers have never really learned how to play with their children, he says.

At the same time, he notes that learning positive interaction skills is not just about the fun stuff. Parents and caregivers also need to know how to effectively discipline the child. “Many times when parents find out that their child has been abused, they are hesitant to discipline or correct behavior because they feel sorry for them,” he says. “Or they come down too hard.”

Lawson encourages parents to use time-outs, to not respond when a child is acting out with attention-getting behavior and to not use corporal punishment.

In the absence of parents or other supportive adults, the counselor may become the stabilizing adult in a traumatized child’s life. Although the counselor is not with the child as often as a parent or caregiver would be, just having someone who is concerned and will listen to whatever the child wants to say can be enough for an abused child to start to heal, Lawson says, even if he or she never chooses to talk about the abuse. He notes that even in the absence of other supportive figures, the therapeutic bond between counselor and child can help in decreasing hyperarousal.

Counselors need to know that although it may seem best to address the child’s trauma right away, establishing and cementing the therapeutic relationship must come first, Lawson says. The child needs to feel safe and supported — even if it is only in the counselor’s office — before he or she can begin to process the trauma.

“You’re trying to get them in a safe place if possible, or at least a predictable place,” Lawson says. “Then we can start teaching them how to cope [with the trauma] without lashing out or
avoiding it.”

Abused children do not know how to cope with what they are experiencing, Lawson says. It is common for children who are traumatized to lash out in anger when stressed and to feel that the best way to establish some sort of stability in their lives is to try to control everything. They may be moody, irritable or withdrawn. Abused children may also bully and hit other children or turn their anger on themselves and engage in self-abusive behaviors such as cutting.

Once a child feels supported, the counselor can also begin to teach the child how to self-soothe. Lawson guides traumatized children in using calming techniques such as diaphragmatic breathing or grounding themselves by focusing on something external such as the ticking of the clock or the texture of their clothes. “The point is to experience emotions in a safe place and cut out bad coping behaviors,” he says.

Safety first

Jennifer Foster, an assistant professor in the Department of Counselor Education and Counseling Psychology at Western Michigan University, studies child sexual abuse. Much of her research has involved listening to the narratives of abuse victims and how they perceive what has happened to them. Although these children display myriad reactions and emotions, Foster says two themes are always prominent: fear and safety.

“Child victims of sexual abuse often view the world as unsafe and are likely to enter counseling with unresolved fears,” Foster says. “They need help from their counselor to learn how to cope with their fears.”

“Although adults often see disclosure as a positive thing that will put an end to the abuse, for many children it is embarrassing and frightening, especially for those who feel at fault for their abuse and believe they will be blamed or, worse, not believed,” says Foster, who studied the experiences of sexually abused children for her dissertation.

Several counseling interventions are designed to help sexually abused children regain a sense of safety. One is called the “safe place technique,” in which a counselor guides the child in visualizing and vividly describing an imaginary safe place.

“The counselor may say, ‘Close your eyes and picture a special place where you feel completely safe,’” Foster explains. “This can be followed by specific questions to capture additional details such as: What do you see? What do you hear? What do you feel? What are you doing in your safe place? The details are recorded by the counselor and used to create a script.”

Once the safe place has been established, the child can return to it mentally anytime he or she feels stressed or scared, Foster says.

Another intervention called the “comfort kit,” developed by Liana Lowenstein, helps children who engage in nonsuicidal self-injury to learn self-soothing strategies, says Foster. “Counselors help children brainstorm and create a list of items that bring them comfort and make them feel better,” she explains. “Although the process is guided by the counselor, children are the ones who choose what will go inside their box or bag.”

Foster says children commonly include items such as a blanket, music, a favorite stuffed animal, written or recorded guided imagery, a stress ball, a list of relaxation activities, bubbles (for deep breathing exercises), a favorite book, a picture of a caring person or special place, a journal and pen, art supplies and a list of self-affirmations.

Foster is also a proponent of bibliotherapy. “Children’s books about sexual abuse can introduce child victims to others who have had similar experiences, which may lead to decreased feelings of isolation and normalize their trauma-related symptoms,” she says.

Books can also provide comfort, offer coping suggestions and teach kids important lessons such as that the abuse is not their fault, Foster adds.

Because fear is a predominant issue for child victims of sexual abuse, Foster also recommends stories that specifically address feeling afraid. Her suggestions include Once Upon a Time: Therapeutic Stories That Teach and Heal by Nancy Davis and A Terrible Thing Happened: A Story for Children Who Have Witnessed Violence or Trauma by Margaret Holmes. To help older adolescents explore their memories and feelings connected to sexual abuse, Foster recommends The Secret: Art & Healing from Sexual Abuse by Francie Lyshak-Stelzer. Foster notes that the author’s artwork is particularly effective at capturing fear and the myriad other feelings generated by abuse.

Finding relief through play

Play therapy is one of the most commonly used interventions with children, particularly those who have suffered complex trauma, meaning they have experienced long-term (and often multiple types of) abuse, says Roaten, an LPC who works with traumatized children in clinics and schools, and an associate professor at Hardin-Simmons University in Abilene, Texas.

Most therapeutic playrooms feature a fairly specific set of toys that might include an art center, play dough, a Bobo doll (an inflatable plastic doll modeled after the inflatable clown used in Alfred Bandura’s seminal study on children and aggression), a dollhouse with miniature people, animal figures, toy weapons, costumes and a sandbox. These toys and activities help children to act out their experiences in a safe and less negative manner, Roaten says. For instance, she recounts treating one child who “would just attack and slash the doll where the penis was. She was a victim of sexual abuse.”

In some cases, Roaten says, children just “play through,” processing their trauma entirely through play without needing to talk to the play therapist.

In many instances, Baggerly says, traumatized children act out things they aren’t able to verbalize. She once treated a 6-year-old who didn’t speak for about 10 sessions because the girl had a severe case of internalized anxiety and depression. But as the girl played, she would express her rage by taking a gun and shooting the Bobo doll in the head, stomach and groin area. Baggerly took this cue as a chance to ask the child about the anger and hurt she was feeling.

Catherine Tucker, a licensed mental health counselor who works with traumatized children in her role as a counselor supervisor and consultant, uses a child and family therapy called Theraplay, which was developed by the Theraplay Institute in the 1960s. “Theraplay works on a four-dimensional model: structure, nurture, engagement and challenge,” says Tucker, an associate professor in the college of education at Indiana State University.

Theraplay builds and enhances attachment, self-esteem, trust in others and engagement through participation in simple games. The idea is that the four dimensions — structure, nurture, engagement and challenge — are needed by children for healthy emotional and psychological development. The “play” in Theraplay is built around activities that teach participants what the elements of those dimensions are. Ideally, children engage in Theraplay with their parents or caregivers. Participating together teaches skills to parents or caregivers who don’t know how to provide the four dimensions, while enhancing the bond with the child. In the absence of parents or caregivers — whether because they are abusive or because they cannot or do not want to participate — the counselor plays directly with the child so the child can still learn how to interact in an emotionally healthy way.

The games and activities are simple — suitable for children as young as 1, yet still engaging for older children — and include things such as blowing bubbles, playing with stuffed animals, cotton ball hockey, cotton ball wars and newspaper basketball. The activities teach parenting skills and also help traumatized children with affect regulation, impulse control, feeling safe and not feeling like they have to be in control of the world, Tucker says. She notes that, oftentimes, kids who have suffered trauma feel like they have to be in charge either because a parent is abusive or simply doesn’t know how to provide a sense of security or stability, or because the child’s sense of control is being undermined by the abuse he or she experienced at the hands of another adult or peer.

Finding help at school

Counselors who are treating traumatized children should tap all available resources to help these clients, Lawson says, working not only with caregivers or other relatives but also with the child’s school. School counselors may be a source of additional one-on-one counseling for the child, or they could get the child involved in group activities with other children who are trauma victims or with children who share common interests such as music, sports or art, Lawson says. These peer networks provide abused children additional sources of support and can also teach them how to interact with people — something that many abused and isolated children have never learned to do.

Perpetrators of abuse seek to control and isolate their victims. An abusive parent has the power to cut off or severely limit a child’s healthy interactions with people outside of the circle of abuse. “[These] kids often didn’t learn social skills because they are kept away from other people,” Lawson says.

Abuse is often part of a viciously long-lived cycle, handed down from generation to generation, Lawson adds. Parents who were abused as children often grow up to abuse their own children. Even if parents with an abusive background are not abusive themselves, they may still carry on other dysfunctional behaviors, he says.

“You may have three or four generations of people [who] have a very skewed view of how to interact with people,” he says. “So they never learn how to interact with others. You have to help [these children] connect with other sources.”

School counselors also can play important roles as advocates and educators. Many people — including teachers and administrators — do not understand that many children who act out are doing so because they have been or are being abused, Tucker asserts.

“School counselors can really make a difference by making sure that kids get evaluated instead of just automatically disciplined,” Tucker says.

“So many boys end up in the criminal justice system because they were physically acting out in response to trauma,” she adds.

School counselors can also help abused and traumatized children learn how to help themselves, says Elsa Leggett, an ACA member, associate professor of counseling at the University of Houston-Victoria and president of the Association for Child and Adolescent Counseling.

“Talk to kids about safety plans,” Leggett urges. “Ask them, ‘When abusive things are going on at home, where do you go? How do you know when things are getting dangerous?’”

The most important thing that all practicing counselors can do to address childhood trauma is to ask questions, Lawson says. Children — and sometimes adults who were traumatized as children — don’t always recognize what they’ve experienced as abuse, so rather than asking “have you been abused?” Lawson instructs his students to pose questions such as “has anyone ever hit you?” and “has anyone ever touched you in a way that made you feel uncomfortable?”

ACA member Cynthia Miller is an assistant professor of counseling at South University in Richmond, Virginia, and an LPC who has worked with incarcerated women. She has seen the kind of positive change that can occur when people get the help they need, but she has also witnessed the pattern of incarceration, addiction and institutionalization that can become entrenched in generation after generation.

“If you want to decrease the amount of money we spend on treating people with substance abuse or incarceration,” Miller says, “address child abuse.”

Caring for children during a disaster

Although ongoing trauma causes the biggest and longest-lasting kind of damage, one-time events can also create problems that linger. It is particularly important for children to receive timely counseling intervention, experts say.

“Typically, most children will have short-term responses to a disaster that include five basic realms,” Baggerly says. These realms are:

  • Physical: Symptoms include headache or stomachache
  • Thought process: Children exhibit confusion and inattention
  • Emotional: Children are scared and sad
  • Behavioral: Children might become very withdrawn or clingy, or may start sucking their thumb or wetting the bed again
  • Spiritual/worldview: Children may question their beliefs about God and the world

(For more information about typical trauma responses and recommended interventions, see “Children’s trauma responses and intervention guidelines” below.)

“Typically these [responses] don’t last long,” Baggerly says, “but that depends on the kind of support kids get in the immediate aftermath.”

Ultimately, the purpose of any counseling intervention after a traumatic event is to reduce or eliminate a child’s anxiety and stress, Baggerly asserts. She attempts to do that by “resetting” the child and connecting him or her to coping strategies.

“They need caring family and community support,” Baggerly says, “but if it is a huge disaster, then parents and teachers are equally traumatized, so they are not able to give support to kids. That’s when you need to bring people from outside.”

Some children are at greater risk than others, Baggerly says. “Kids who don’t have supportive family [and] who already have anxiety or have some type of developmental disability often will have ongoing symptoms that go longer than 30 days,” she explains. “Counselors need to triage to find out who is at most risk.”

During her roughly dozen years of experience working with chronic trauma and disasters, Baggerly has developed an integrated approach that she calls disaster response play therapy. The approach uses a trauma-informed philosophy in which counselors train parents and teachers in typical and atypical reactions to disasters so they can screen children and determine which ones need more help, she explains. “We also normalize typical symptoms, provide psychoeducation that informs kids about the impact of disasters, teach them coping strategies and provide them with child-centered play therapy.”

Baggerly usually begins by gathering a group of children and talking with them about rebuilding the community. She also encourages children to use expressive arts or drama to communicate their feelings.

“The other part of what we do is facilitate connection and conversation between kids and parents,” Baggerly says. “We may start out with Theraplay and do structured activities, such as holding hands or singing ‘Row, Row, Row Your Boat.’ The point is to have them [parents and children] looking at each other so that the mirror neurons can be engaged.”

Baggerly also educates parents on activities they can do at home with their children. She refers them to an online workbook, “After the Storm,” which has scales of 1 to 10 or a thermometer that kids can fill in to indicate how much stress they are feeling.

Roaten often does volunteer trauma work and provided on-site support in the wake of the April 2013 fertilizer plant explosion in West, Texas, that killed 15 people, injured more than 150 and caused extensive damage to buildings and property.

“One girl, a seventh-grader, had been standing outside in a neighborhood with a view of the plant and observed the explosion itself,” Roaten says. “So she had that image in her head and it would not go away. I taught her some deep breathing and progressive relaxation and did some guided imagery about her favorite place to be.

“When that picture came up in her mind, she could breathe, relax and go to her good place. By the fourth day I was there, she was no longer seeing the image.”

Roaten uses expressive therapy for children who aren’t very verbal or who don’t have the vocabulary to talk about their feelings. She brings a sand tray with miniatures of fences, people and buildings. She then allows children (and even adults) to set up scenarios or vignettes that help them express and act out what they are feeling.

“I might say something like, ‘Create your world before [Hurricane] Katrina; then create your world after Katrina,” Roaten explains.

Roaten also uses trauma-focused cognitive behavior therapy to help children and adolescents learn coping skills.

“You teach them about trauma and its impact on them,” she explains. “Then you teach them relaxation and breathing skills. Once you get them to be able to self-soothe, relax and be calm, you can help them deal with pictures or scenarios that come up. You help them change the story — what they are telling themselves and what that means — which helps them work through the trauma a little bit at a time.”

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Children’s trauma responses and intervention guidelines

 

Preschool through 2nd grade

Typical trauma responses:

  • Believes death is reversible
  • Magical thinking
  • Intense but brief grief responses
  • Worries others will die
  • Separation anxiety
  • Avoidance
  • Regressive symptoms
  • Fear of the dark
  • Reenactment through traumatic play

Intervention guidelines:

  • Give simple, concrete explanations as needed
  • Provide physical closeness
  • Allow expression through play
  • Read storybooks such as A Terrible Thing Happened, Brave Bart, Don’t Pop Your Cork on Monday

 

3rd through 6th grade

Typical trauma responses:

  • Asks a lot of questions
  • Begins to understand that death is permanent
  • Worries about own death
  • Increased fighting and aggression
  • Hyperactivity and inattentiveness
  • Withdrawal from friends
  • Reenactment though traumatic play

Intervention guidelines:

  • Give clear, accurate explanations
  • Allow expression through art, play or journaling
  • Read storybooks

 

Middle school

Typical trauma responses:

  • Physical symptoms such as headaches and stomachaches
  • Wide range of emotions
  • More verbal but still needs physical outlet
  • Arguments and fighting
  • Moodiness

Intervention guidelines:

  • Be accepting of moodiness
  • Be supportive and discuss when they are ready
  • Groups with structured activities or games

 

High school

Typical trauma responses:

  • Understands death is irreversible but believe it won’t happen to them
  • Depression
  • Risk-taking behaviors
  • Lack of concentration
  • Decline in responsible behavior
  • Apathy
  • Rebellion at home or school

Intervention guidelines:

  • Listen
  • Encourage expression of feelings
  • Groups with guiding questions and projects

 

Source: “Systematic Trauma Interventions for Children: A 10-Step Protocol,” by Jennifer Baggerly in Terrorism, Trauma and Tragedies: A Counselor’s Guide to Preparing and Responding, third edition, American Counseling Association Foundation, 201

 

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ACA Traumatology Interest Network

Counselors and counselors-in-training who have an interest in providing counseling services to trauma- or disaster-affected individuals and communities should consider joining the ACA Traumatology Interest Network. Network participants share insights, experiences, new plans and advances in trauma counseling services. For more information on joining the interest network, go to counseling.org/aca-community/aca-groups/interest-networks.

 

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To contact individuals interviewed for this article, email:

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org

OMG: Texting while driving surges among teens even as other risky behaviors continue long-term declines

By Bethany Bray June 20, 2014

U.S. teenagers are smoking cigarettes less frequently but texting while driving more.

The Centers for Disease Control and Prevention (CDC) released the most recent data from its biennial Youth Risk Behavior Survey this week, which showed smoking among teens continues a long-term drop. Cigarette smoking among U.S. high school students is the lowest it has been in 22 years, according to survey data. Sexual activity and alcohol use by teens have also been on a long-term decline since the 1990s.

youth-risk-graphicHowever, close to half of those surveyed admitted to texting or sending an email while driving sometime in the past month.

More than 13,500 U.S. students took the most recent Youth Risk Behavior Survey.

The survey, administered by the CDC every two years, asks young people a wide variety of questions related to health and risk behaviors, from whether they wear a seatbelt while in a car and whether they typically eat breakfast to if they’ve had sex, use birth control or used marijuana, cocaine or other drugs. The questionnaire is voluntary and anonymous.

The survey also includes questions about mental health, including whether a student has thought about attempting suicide or “felt sad or hopeless” consistently.

 

Key findings include:

  • Cigarette smoking rates among high school students have dropped to 15.7 percent.
  • The percentage of high school students nationwide who had been in a physical fight at least once during the past 12 months decreased from 42 percent in 1991 to 25 percent in 2013.
  • Fights on school property have been cut in half during the past 20 years, from 16 percent in 1993 to 8 percent in 2013.
  • Nationwide, 41 percent of students who had driven a car or other vehicle during the past 30 days reported texting or emailing while driving.
  • The percentage of high school students who are sexually active declined from 38 percent in 1991 to 34 percent in 2013.
  • Among sexually active high school students, condom use declined from 63 percent in 2003 to 59 percent in 2013.

 

The survey was taken by students in ninth through 12th grades across the United States, in both public and private schools, between September and December 2012.

The full results are posted at CDC.gov. The data is searchable by state and region; information from past surveys and nationwide trends are also available.

 

 youth-risk-graphic-2

 

 

 

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

 

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