Question 1. My general impression of Christina’s story is two-fold: First, I was horrified that a 6-year-old in her situation was subjected to the kind of “treatment” she described, which seems like the psychiatric hospitals during the bad old days. That no one addressed her sexual assault was not just NOT TIC, it was criminal malpractice in my opinion. Secondly, I was thoroughly impressed by Christina’s insight around her response to being violated, believing that “any kid would have done what I did,” knowing that she didn’t need to be drugged, she needed to be HEARD, and realizing that she is not her diagnosis, she is a person with strengths and challenges who needs resources not judgment. That Christina took charge of her own recovery at a relatively young age speaks volumes about her capacity for resilience.
If I were counseling Christina, I would definitely have listened to her first and foremost and behaved in a way that showed her I was worthy of her trust. I would have validated her insights, affirmed her resilience, and co-created a plan to connect her with the resources she needed, because that’s what helps people recover from trauma.
Question 2. I have used something very similar to the Adverse Childhood Effects Calculator to help certain adults–especially those presenting with complex trauma–gain insight into their present symptoms and difficulties, and to help shift their mindset from deep shame and self-blame to at least an understanding of the factors that may have contributed to their troubles. My purpose was not to give them ready-made excuses for problematic choices and behavior or diagnoses stemming from neurological factors, but rather to provide a realistic context that might give some meaning to an otherwise chaotic and confounding life. I have also used it with parents to help them understand the risk factors their foster or adopted children are contending with and why certain treatment approaches might be more successful than others. I have not used it directly with children, nor would I feel comfortable do so. I prefer getting to children’s trauma history through a more narrative approach that starts out fairly general then more specifically targets any red flags.
I really like the Life Events Checklist and can see myself using it with adults and older adolescents, as it’s brief and simple yet fairly comprehensive in terms of types of trauma, but I might worry that the questions themselves might retraumatize some clients, especially younger or very vulnerable teens.
I feel like I would use the PTSD Checklist only with adult clients because it seems wordy and the rating scale might frustrate teens.
Question 3. In working with Selena, I would first establish safety (providing a “No-Judgment Zone)” and trust through my words and affect in our sessions. I would listen to her story without interruption, and I would give her every opportunity to make her own choices in our work together. I would use an illustration I have to convey that “There is more than one way to look at something,” pointing out that while in the illustration neither way is right nor wrong, in life one way might be more helpful than another. I would help her examine the meaning she made of her story (blaming herself for not insisting her group stay together, and choosing the “convenient” ride home, or perhaps misjudging the boy she “barely knew”) and see those things in a different, more forgiving way. I would help her see herself as a survivor and identify real-life examples of her resiliency. I would help her identify resources that might help her overcome her fear of falling asleep by practicing good sleep hygiene, changing the narrative in her nightmares, and being sure she had some relaxation techniques in her toolbox. Finally, I would help her find an appropriate support group for survivors of sexual assault.