I read Abigail Shrier’s new book this past week: Bad Therapy: Why the Kids Aren’t Growing Up. It’s a thoughtful critique of our focus on being “trauma-informed” in all our work with children, from addressing school discipline to treating anxiety and depression. I highly recommend it.
Over the past 25 years, child welfare, juvenile justice, and education professionals have become increasingly aware of the effects that trauma, abuse, neglect, and chronic stress can have on a child’s developing brain. One of the seminal pieces of research, featured here in a Guardian article from 2000, showed how chronic neglect caused significant damage to the brains of Romanian orphans. Dr. Bruce Perry’s The Boy Who Was Raised as a Dog was a wake-up call for many, followed by The Body Keeps the Score in 2015. Developments in brain science have helped us understand that traumatic events in a child’s life — abuse, chronic parental neglect, foster care drift — often result in developmental delays, increased “fight/flight/freeze” reactive behaviors, and other symptoms that adults too often attribute to “bad behavior” or “an unwillingness to learn.”
In response to what we’ve learned, we’ve developed approaches to addressing children’s behaviors that are trauma-responsive and trauma-reformed: Positive Behavioral Interventions and Supports in the school setting, Trust-Based Relational Intervention for working with children who’ve experienced foster care, Trauma-Focused Cognitive Behavioral Therapy for child sex abuse victims. These techniques are valuable and essential.
What Shrier adds to the conversation is the fact that focusing on trauma too much can rob a child or young adult of agency. Her many interviews with parents, youth, and teachers reveal the unintended consequences of focusing too much on the things that have gone wrong in a child’s life. In attempting to be sensitive to a child’s trauma history, our teachers, school counselors, and other professionals who work with children can sometimes encourage a victim mentality. “You’re feeling depressed today? OK, we’ll excuse you from taking this test.” Or, “Your parents are getting divorced? Don’t worry about your homework.” The result, she contends, is that too many children are entering adulthood without the coping mechanisms and resilience needed to succeed in a dog-eat-dog world.
While Shrier at times seems to devalue the importance of being sensitive to traumas that a child has experienced, she does make a good argument. There is a difference between feeling anxious over a test and using that anxiety as an excuse and not being able to focus on the test because your mother’s boyfriend is sexually abusing you. As she stated recently, “Kids are naturally resilient and capable of doing hard things. They aren’t weak unless we make them so.” In that regard, Bad Therapy is a good reminder that those of us who work with children should be doing all we can to both understand what they’ve gone through and help them build the resilience, coping skills, and strength needed to become healthy adults.
In other news:
England’s National Health Service has stopped providing puberty-blocking hormones to children and youth questioning their gender identity, joining an increasing number of health agencies on the other side of the pond that are reevaluating how gender dysphoria in youth should be treated.
Connecticut is revamping its group homes for children with significant behavioral health issues.
It looks as if legislative efforts in Maine to create a separate child welfare agency have hit a wall.
There’s a renewed move in Congress to make it harder to terminate parental rights.
Here’s a thoughtful op-ed from two experienced foster/adoptive parents.
The Doris Duke Foundation is rolling out a child welfare reform pilot project in four jurisdictions.
Harmony Montgomery’s mother is suing child welfare agencies involved in placing the child with her father, resulting in the child’s murder.
An op-ed in the LA Times notes that while many black families are wary of the child welfare system, at the same time more black families are needed to step up and become foster parents.
Georgia is sending children in foster care who have severe autism and related needs to facilities out of state.
Amid deaths of children in care, Kansas is moving toward more transparency in child abuse records.
Texas has released an RFP seeking bidders to provide Medicaid managed care for the state’s children and young adults with disabilities. Virginia, meanwhile, has awarded its foster care Medicaid contract to Cardinal Care.
New Mexico is moving to expand its services to youth aging out of care.
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