Treating Traumatic Stress in Children and Adolescents: How to Foster Resilience through Attachment, Self-Regulation, and Competency

385 Pages·2010·4.29 MB·English

by  Margaret E. Blaustein PhD

TreaTing TraumaTiC STreSS
in Children and adoleSCenTS

Treating Traumatic Stress
in Children and Adolescents
How to Foster Resilience through Attachment,
Self-Regulation, and Competency
Margaret e. Blaustein
Kristine M. KinniBurgh
The guilFord PreSS
new York london
© 2010 The Guilford Press
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Library of Congress Cataloging-in-Publication Data
Blaustein, Margaret.
Treating traumatic stress in children and adolescents : how to foster resilience through
attachment, self-regulation, and competency / Margaret E. Blaustein, Kristine M. Kinniburgh.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-60623-625-3 (pbk.: alk. paper)
1. Post-traumatic stress disorder in adolescence—Treatment. 2. Post-traumatic stress
disorder in children—Treatment. I. Kinniburgh, Kristine M. II. Title.
[DNLM: 1. Stress Disorders, Traumatic—therapy. 2. Adolescent. 3. Child.
4. Psychoanalytic Theory. 5. Resilience, Psychological. WM 172 B645t 2010]
RJ506.P55B53 2010
618.92′8521—dc22
2009044009
For D. and H.—
for all you have taught us, all you’ve become,
and all you are yet to be
About the Authors
Margaret E. Blaustein, PhD, is a practicing clinical psychologist whose career has focused
on the understanding and treatment of complex childhood trauma and its sequelae. With an
emphasis on the importance of understanding the child-, family-, and provider-in-context, her
study has focused on identification and translation of key principles of intervention across treat-
ment settings, building from the foundational theories of childhood development, attachment,
and traumatic stress. With Kristine Kinniburgh, Dr. Blaustein is codeveloper of the Attach-
ment, Self-Regulation, and Competency treatment framework. She has provided extensive
training and consultation to providers and consumers within the United States, Canada, and
Europe. She is currently the Director of Training and Education at The Trauma Center at Jus-
tice Resource Institute in Brookline, Massachusetts, and is actively involved in local, regional,
and national collaborative groups dedicated to the empathic, respectful, and effective provision
of services to this population.
Kristine M. Kinniburgh, LICSW, is the former Director of Child and Adolescent Services
at The Trauma Center at Justice Resource Institute in Brookline, Massachusetts. She is cur-
rently a practicing clinical social worker and organizational consultant, working with agencies to
integrate trauma-informed and trauma-specific practices into all facets of service delivery. Over
the past 15 years Ms. Kinniburgh has dedicated her practice to work with children and families
affected by trauma in a range of settings including outpatient clinics, schools, residential pro-
grams and hospitals. Her clinical experience, broad in scope, inspired her to explore and sub-
sequently identify core components of trauma-informed intervention that can be implemented
in the array of treatment settings serving this population. Ms. Kinniburgh is the originator and
codeveloper of the Attachment, Self-Regulation, and Competency treatment framework and is
currently training and consulting on this framework with agencies across the United States and
abroad.
vi
Preface
i
t is a rare privilege to have the opportunity to share with others everything you have
ever learned about a field of study. In the pages that follow, you will be introduced to most of
what we know about the understanding and treatment of complex trauma in childhood. We
feel extremely lucky to have entered into our clinical careers at a time when knowledge about
traumatic stress in childhood was ever-expanding, when societal awareness was growing, and
when the opportunities for study, collaboration, training, and intervention were continuously
unfolding.
Approaches and methods for treatment of traumatic stress in childhood are many, and
though there is more consensus than in the past, a great deal of disparity remains within the
field as to the “appropriate” treatment modalities for this population. Given the complexity of
the topic, it is not surprising that this is so—“trauma” is not singular, those who experience it
are not identical, and the contexts and cultures within which each of us lives are as varied as the
blades of grass in a field. We believe it is fair to say that no two individuals, no two families, and
no two communities will ever have the exact same experience, whether traumatic or otherwise.
Because of this complexity—in population, in subjective experience, and in outcome—it makes
sense that certain approaches will have excellent results with one child but variable results with
another. It is difficult for us to believe that any single treatment method would work with every
child, in every family or setting, in every context, every time.
The Attachment, Self-Regulation, and Competency (ARC) treatment framework was devel-
oped in large part because of the awareness of that complexity. It is a components-based frame-
work designed not to replace any of the excellent treatment methods that are currently available
but rather to organize, encompass, and facilitate their use. Although this text is lengthy, the
framework is, in many ways, quite simple: It consists of 10 “building blocks,” or key treatment
targets. Nine of these fall within the three primary domains of attachment, self-regulation, and
competency, with the tenth, trauma experience integration, as an overarching target integrat-
ing and building upon all other skills addressed within this framework. Within each block we
identify key treatment goals and their theoretical rationale, primary “skills” or areas of focus,
potential methods of intervention, developmental and cultural considerations, and applications
across contexts. We describe each of these building blocks in detail in Chapters 4 through 13,
grounded in the real-world work that shaped our own understanding of treatment. In the first
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viii Preface
three chapters we describe the theoretical foundations on which this framework is built, and
ways to consider its implementation.
This framework is designed to be applicable across settings. Our hope is that this book has
value for the range of individuals and systems working with children and families affected by
trauma, including (but certainly not limited to) clinicians in outpatient, home-based, and milieu
settings; program administrators; educators; child welfare workers; milieu counselors and line
staff; and biological, foster, and adoptive caregivers. The framework is meant to be adapted; we
have had the great privilege of working with many different agencies and programs that have
incorporated the framework into their work, and no two of them have ever applied the concepts
in the same way. Because our own learning has been greatly influenced by the work of others,
we include examples of applications that have arisen from the creative implementation of our
collaborators.
Our approach to treatment is grounded in a deep belief in the ultimate strength of chil-
dren, families, and systems. We believe strongly that the “symptoms” displayed by children and
adolescents most often represent their generally successful attempts to adapt to their worlds,
and that the impact of trauma must be understood in the context within which it occurred. Our
lens is not one of pathology, but rather of developmental adaptation, and our ultimate goal for
treatment is to build positive developmental pathways and competencies that can support pres-
ent and future resilience. It has been a great pleasure for us to bear witness to the unfolding of
resilience in many children, families, and systems over the years, and to learn from all of them.
It is our sincere hope that this book offers back what we have learned in a way that continues
to ripple.
acknowledgments
T
he development of the Attachment, Self-Regulation, and Competence (ARC) treatment
framework, and ultimately of this book, has been a process of the heart extending over the past
7 years, and has been influenced by the contributions, support, and wisdom of many different
people.
We have the great pleasure of working as part of a strong, vibrant clinical team at the
Trauma Center at Justice Resource Institute (TC-JRI) in Brookline, Massachusetts. We are
extremely appreciative of the support, collegiality, and contributions of our peers over the past
number of years. Although we would love to thank everyone by name, we know that we would
invariably leave out a name or two. So we thank all of our colleagues as a group and pull out a
few “in particulars.” First, our thanks to the Center’s founder, Bessel van der Kolk, and mem-
bers of the senior management team—Alexandra Cook, Richard Jacobs, Joseph Spinazzola, and
Marla Zucker—for their encouragement and administrative support, and for their leadership
in creating and sustaining a center that strives for excellence and innovation in the very real
work of helping those who have been affected by trauma. Our gratitude also to the members
of our small internal ARC team for all of their support, creativity, and downright excellent on-
the-ground work over the past several years: Leticia Buonanno, Marissa Gold, Michelle Harris,
Kristina Konnath, Eva Lambidoni, Kelly Pratt, Jessica Shore, and Dan Williams. To everyone
else at TC-JRI—staff, supervisors, and faculty—it has been a sincere honor and a great pleasure
to work with all of you, and to learn from your wisdom and dedication.
In 2005 our Center had the great privilege of joining the Justice Resource Institute (JRI),
an impressive nonprofit agency that strives for social justice and that has as its mission provid-
ing services to the least served populations among us. Among other partnerships, a number of
JRI programs collaborated with our team in developing applications of the ARC framework in
the range of residential settings serving highly trauma-affected youth. Our thanks to the fol-
lowing individuals from Glenhaven Academy, Cohannet Academy, the Butler Center, and the
Susan Wayne Center for Excellence for their support and creativity in the development of ARC
applications: Laurie Brown, Rick Granahan, Ligia Hammiel, Bryan Lary, Beth Anne Lund-
berg, Candy Malina, Tracy Moore, Mike Morrill, Leah Newton, Molly Ober Fechter-Leggett,
Abby Perham, Christine Robitaille, Alicia Straus, Karen Vincent, and members of the Cohannet
“Trauma Team.”
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