Decreasing the Alarm State

It is important to understand that the brain altered in destructive ways by trauma and neglect can also be altered in reparative, healing ways. Exposing the child, over and over again, to developmentally appropriate experiences is the key. With adequate repetition, this therapeutic healing process will influence those parts of the brain altered by developmental trauma. Unfortunately most of our therapeutic efforts fall short of this.

We can also be good role models: in all our interactions with children we can be attentive, respectful, honest, and caring. Children will learn that not all adults are inattentive, abusive, unpredictable, or violent.

It is paramount that we provide environments which are relationally enriched, safe, predictable, and nurturing. Failing this, our conventional therapies are doomed to be ineffective.

If a child is in a therapeutic relationship, we can help him better understand the feelings and behaviours that are the legacy of abuse and neglect. Information helps. A traumatized child may act impulsively and misunderstand why — perhaps believing she is stupid, bad, selfish or damaged. We can also teach adults in a child's life about how traumatized children think, feel, and behave.

Among the possible therapeutic options to help maltreated and traumatized children are cognitive-behavioural therapy, individual insight-oriented psychotherapy, family therapy, group therapy, play or art therapy, eye-movement desensitization and re-programming (EMDR), and pharmacotherapy. Each of these has some promising results and many disappointments.

Therapy with maltreated children is difficult for many reasons. In the long term, the wisest strategy is to prevent abusive, neglectful, and chaotic caregiving. In that way, fewer children will require therapy.