Child Development | Psychotherapy Toronto

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Domestic Sex Trafficking: Hidden in Plain Sight

March 11, 202000Adverse Childhood Experiences, Child Development, Conformity, Emotional Abuse, Featured news, Sex, Trauma March, 20

Source: geralt at Pixabay, Creative Commons

When she was a young girl, Danielle (name changed) was recruited into domestic sex trafficking from her long-term foster home. She was only able to leave this life once her mother regained custody of her.

Sex trafficking, a term used to describe the phenomenon of individuals performing commercial sex through the use of force, fraud, or coercion, is an epidemic. It affects about 25 million people globally. The US-based National Human Trafficking Hotline received 6,244 calls of domestic sex trafficking cases in 2017. Because of the difficulty in obtaining precise information, it is likely that the number affected is higher.

A common misconception about sex trafficking is that it is fundamentally a trans-border phenomenon—that the victim must have been moved from one country to another for the event to be considered trafficking. This is not the case. While both domestic and international sex trafficking share the feature of forcibly relocating an individual so that the person might perform commercial sex, domestic sex trafficking occurs within the borders of the victim’s country, and sometimes within their own community.

Victims of sex trafficking are controlled by the trafficker. Victims do not choose their clients, or the locations where they work, nor do they keep the money that they receive from clients. They are monitored by the trafficker and cannot leave; their life is at risk if they try to escape. They work in prostitution, pornography, strip clubs, escort services, brothels, massage parlors, and over the internet. While there are people who work in these services by choice, and control their work and earnings, there are many who have been coerced into it and are controlled by a trafficker.

There are many ways sex traffickers lure victims into the sex trade. In many cases, sex traffickers are expert manipulators who prey on a person’s emotional or financial vulnerabilities and offer exactly what the individual needs or desires, such as love and care, lavish items, shelter, money, or a job, with the hopes of later exploiting them. The victim is initially oblivious to the trafficker’s, or their proxy’s, real identity and intentions. The relationship begins as positive but becomes abusive, with the person being forced into the sex trade, and forced to stay in it, to work for the trafficker.

Some populations are particularly vulnerable. One of the top risk factors in becoming a victim of sex trafficking is having experienced childhood trauma. In an interview with The Trauma and Mental Health Report, Megan Lundstrom, CEO of Free Our Girls (a US-serving anti-trafficking organization) and a survivor of sex trafficking herself, reports the findings from her 2017 project:

“What we found is what we’re calling ‘The Perfect Storm.’ Upwards of 90 percent of the women that we interviewed for that project had experienced some form of child abuse, primarily some form of childhood sexual abuse. When you have that high of a correlation that most women in the commercial sex trade experienced some kind of childhood sexual abuse, clearly there’s something going on there.”

Lundstrom continues by paraphrasing one of the young ladies in her study: “I almost feel like I had a sign written on my forehead that said, ‘I’m damaged goods, please exploit me,’ in that traffickers know how to single in on those vulnerabilities.”

This is also true for Ana (name changed), whose trafficker was the owner of a tattoo shop. She recalls: “He asked me a bunch of questions, clearly testing my victim potential before-hand, all under the guise of a tattoo artist apprentice. I took the bait. I had childhood trauma, so I had ‘bait’ practically written across my forehead.”

In terms of recruitment locations, the National Human Trafficking Hotline reports that 15 percent of US sex trafficking recruitment occurs at homeless and domestic violence shelters. A victim of domestic sex trafficking, Jessica, recounts her experience that relates to this finding. She had been abused by her parents as a child, and found herself homeless after being thrown out of the house at age 14. She describes the circumstances of her victimization: “One day I was at a soup kitchen having coffee and stale muffins for breakfast when I was approached by an older guy, probably late 20s. He asked me to have a real cup of coffee with him and I agreed…mostly because it was nice to have someone speak to me like I was a human being.”

She describes her trafficker using the most common recruitment tactic: posing as a romantic partner (otherwise known as a Romeo Pimp), and convincing her that he would love and take care of her: “When he asked me to be his girlfriend, I felt like the luckiest girl alive. God, I was so dumb.”

Jessica goes on to say that her lack of interpersonal supports, such as friends and family, made it more difficult to leave the life of a trafficked person.

Exposure to adverse childhood experiences has long-term consequences, and impacts potential future victimization. Lundstrom explains why this is:

“When you have been assaulted at a young age, you learn how to shut off mentally, you know how to dissociate, you know how to protect yourself but you also struggle with feelings of ‘my body is not my own, I’m not important, this is maybe the only way people care about me’. So when you have that package, that perfect storm of vulnerability starting at a very young age, traffickers go after that.”

The status quo will continue until we recognize that sex trafficking happens in our communities. We can properly identify, and thus intervene in or prevent such cases, by educating our families and friends, as well as the community. Teachers, the hotel industry, healthcare providers (who can also incorporate trauma-informed care), police, airport workers, and child-welfare workers can be further educated on how to recognize these red flags while dispelling unhealthy myths.

— Riana Fisher, Contributing Writer, The Trauma and Mental Health Report. Chief Editor: Robert T. Muller, The Trauma and Mental Health Report. Copyright Robert T. Muller

This article was originally published on Psychology Today

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Sleep Paralysis: Not the Stuff Sweet Dreams are Made of

December 5, 201900Child Development, Circadian Rhythm, Dreaming, Featured news, Memory, Post-Traumatic Stress Disorder, Sleep December, 19

Source: John Henry Fuseli at Wikimedia Commons, Public Domain

As a child, I would sometimes find myself wide-awake in bed, but unable to move. Some nights, I would hear voices in my room, as I felt invisible forces pinning me down. When I would finally regain control of my body, I was left feeling terrified.

Sleep Paralysis affects roughly 8% of the general population, yet its cause remains speculative, full of competing scientific, cultural and religious explanations.

Our current understanding is that sleep paralysis happens during rapid eye movement (REM) sleep, which is a sleep-cycle in which a person’s eyes and brainwaves move at an accelerated rate, similar to a wakeful state. In this paralyzed limbo between sleep and wakefulness, people may experience multi-sensory dream activity, including auditory and visual hallucinations, that are generally described as terrifying. Scientifically, these interpretations of sleep paralysis are plausible, but one component remains especially elusive. Many report a common visual archetype—a dark figure sitting on their chests.

In Medieval Western philosophy, an “Incubus” was a seductive male demon who rested on the chests of sleeping females. In late Latin, “Incubo,” roughly translates to, “nightmare, one who lies down on (the sleeper).” Similarly, some Inuit communities recognize sleep paralysis as “Uqumangirniq,” a term that in Shamanistic practices refers to an individual who is sleeping or dreaming and whose soul is vulnerable as a result of being consciously unguarded. In Brazilian folklore, the “Pisadeira” is a crone with long fingernails who rests on the bodies of those who fall asleep. Sleep paralysis in Nigerian culture is referred to as “Ogun Oru”, or nocturnal warfare, during which sufferers are visited by a female entity. This malevolent being is present in numerous other cultures as well, including in Ethiopia as “Dukak,” in Egypt as “Jinn,” in Thailand as “Phi am,” and in Newfoundland, Canada as “Old hag.”

In an interview with the Trauma and Mental Health Report, Alison (name changed), explained that she experienced sleep paralysis during childhood, then again in early adolescence, and only a few times in her early twenties. Likewise, Asher (name changed), commented that he experienced sleep paralysis in his childhood and again recently, explaining:

“Over the last few years I have noticed it in particular, and even had some more aggressive and frightening situations occur during this time.”

If sleep paralysis can be understood as being a universal by-product of REM sleep, why do many experience this natural occurrence at random moments in their lives as opposed to every time they sleep? When asked to elaborate on the frequency of sleep paralysis, Alison commented:

“As a child, I remember it happening often. Within that time frame my grandfather was ill, and then passed away. As teen and adult, I can remember about 5 times, during this time there was family illness again- so my best guess was stress was the cause.”

Scientific studies have reported a correlation between sleep paralysis and posttraumatic stress disorder, explaining why for some, these incidents manifest during stressful periods of life. However, this does not explain why many who have endured stressful events do not suffer from sleep paralysis at all.

And how do we understand the shadowy figure that appears to some? Alison explains:

“Most of my experiences involved seeing a shadow at the end of my bed. The scariest was when it felt like someone was pushing me down – standing or floating above my body.”

Similarly, Asher described what he remembers:

“Something viewing my own motionless body, and oddly enough I have felt my breathing feel as though it was slowing down.”

In Alison’s case, the shadow was visualized as being either at the end of her bed or floating above her paralyzed body. The reason that some feel a demon resting on their chest is explained as the psychological interpretation of the chest pressure experienced during motor paralysis.

The feeling is experienced as very frightening, even traumatic, as described by Keira (name changed). Keira says she continuously endures sleep paralysis roughly four nights a week, with her earliest recollection from when she was about eight-years-old. She explains:

“I’ve seen hands reaching at me from the ceiling. . . demons on my chest, figures around my bedroom and I’ve felt insects crawling under my skin.”

-Courtney Campbell, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

-Copyright Robert T. Muller

This article was originally published on Psychology Today

Pressures to Breastfeed Can Harm Maternal Mental Health

January 24, 201900Child Development, Decision-Making, Embarrassment, Featured news, Guilt, Mental Health, Parenting, Postpartum, Stress, Suicide January, 19

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Florence Leung of British Columbia, Canada went missing on October 25, 2016 while struggling with post-partum depression. Less than a month later, her family discovered that she had taken her own life, leaving behind a husband and infant son.

In an emotional public letter, Leung’s husband Kim Chen wrote an impassioned plea to new mothers asking them to seek help if they felt anxiety or depression. He also revealed that his wife’s difficulties with breastfeeding, and the resulting feelings of inadequacy, likely contributed to her condition. Urging women not to criticize themselves about an inability to breastfeed or a decision not to breastfeed, Chen wrote:

“Do not ever feel bad or guilty about not being able to exclusively breastfeed, even though you may feel the pressure to do so based on posters in maternity wards, brochures in prenatal classes, and teachings at breastfeeding classes.”

Speaking with the Trauma and Mental Health Report, Melissa (name changed) said that she was struck by Chen’s words, and recalled the scrutiny around breastfeeding she experienced with her first child:

“I was tired, sore, and the baby was cranky and constantly wanting to feed. It surprised me that, despite my vocal frustration and obvious difficulty breastfeeding, the nursing staff and lactation consultants were adamant that I continue to breastfeed exclusively.”

The frustration worsened once the couple returned home. The week that followed was exhausting, spent trying to calm a screaming newborn who constantly wanted to feed. The couple attended several breastfeeding clinics that reiterated the same message: breast is best. Melissa and her husband felt confused and defeated.

Shortly thereafter Melissa became completely overwhelmed:

“I began to get scared, and not trust myself. My inability to easily nurse and soothe my baby without intense discomfort led to feelings of failure. My emotions were overwhelming. I wasn’t sleeping because I was constantly pumping breastmilk or nursing.”

Within a week after giving birth, Melissa’s infant was suddenly much quieter and less agitated. Upon closer examination, she noticed that the baby looked pale, and was lethargic and dehydrated. A frantic trip to the emergency room (ER) revealed the newborn was not getting enough liquids and nourishment—despite the many scheduled feedings. Melissa said:

“When the ER doctor apologized for the miscommunication and advised us that supplementing with formula is not only okay, but sometimes necessary, I felt a mixture of relief and betrayal. Relief because I knew we would be okay, yet betrayed by some health professionals who put their personal agendas above our health and well-being.”

In an interview with the Trauma and Mental Health Report, Diane Philipp, a Child and Adolescent Psychiatrist at SickKids Centre for Community Mental Health in Toronto, shared that she meets many mothers suffering from stress, shame, and guilt associated with breastfeeding. Philipp explained that the judgements of others place unnecessary pressure on mothers:

“It’s important for mothers to have access to frank and open discussions that are safe and non-judgemental where they can seek out information and make the most knowledgeable decision that is best for their child and for themselves in terms of breastfeeding.”

Every woman’s situation is unique. Lifestyle habits, medication use, and medical and psychological history can complicate the post-partum experience. With this context in mind, the healthcare team should provide a comfortable environment—free of judgement—when discussing post-partum issues, including how to provide an infant’s nourishment.

For mothers who are unable to nurse, be it for medical, physical, or personal reasons, their decision can be supported and honoured in a way that promotes emotional well-being and encourages healthy parent-child bonding. Philipp said:

“For parents who can’t breastfeed for whatever reason, wonderful attachment bonds can still be made. Breast milk is not the only ingredient in a valuable, long-lasting relationship.”

Melissa, now a mother of two healthy school-age children, remains sensitive to others’ assumptions of breastfeeding:

“I felt so pressured to get it right, and so judged when I couldn’t provide for my child. Even when you come to terms with your decision not to breastfeed, people question your choice. Looking at my children today, I know I did the right thing.”

– Kimberley Moore, Contributing Writer, The Trauma and Mental Health Report.

-Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

-Copyright Robert T. Muller

This article was originally published on Psychology Today

Mental Illness in Youth Often Goes Undetected

December 27, 201800Adolescence, Anxiety, Child Development, Decision-Making, Depression, Emotion Regulation, Featured news, Mental Health December, 18

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When university student Kinga (name changed) was young, she struggled with symptoms she couldn’t identify. She had shortness of breath and would suddenly get anxious. Her mother took her to a doctor, and Kinga was diagnosed with asthma. Despite asthma treatment, her inability to catch her breath persisted, and she had feelings of panic.

In retrospect, Kinga isn’t so sure she had asthma at all, believing she was misdiagnosed. In an interview with the Trauma and Mental Health Report, she explains:

“The doctors never knew what was wrong with me, probably because I didn’t have the right words to explain what was happening, and maybe because I wasn’t failing in school.”

Some mental illnesses, even those that are familiar, such as anxiety and depression, can be hard to identify. For youth with subtle to moderate symptoms, diagnosis can be especially difficult. Psychiatrist Peter Jenson and colleagues emphasize that diagnoses tend to rely on adults noticing symptoms. Children and teenagers often don’t have the knowledge to recognize their own mental-health difficulties.

As Kinga entered her pre-adolescent years, she always felt tired. Everything she did took a little more effort. While she continued her day-to-day activities, her symptoms followed her around. She says:

“I always performed well in school. I went out with friends, attended dance and language classes, but the fatigue was almost too much to bear. I had to fight the fogginess in my head to concentrate in school, and push myself through the exhaustion in dance class.”

Struggling pre-teens may not even realise that their mental health is at risk. They might only feel a little more tired or pessimistic. But these symptoms can hinder their ability to perform to their full potential.

Kinga also experienced other symptoms, like irritability:

“Sometimes, I would scream at my parents or siblings over the smallest things. My mom called it ‘being a teenager’, she didn’t realise, none of us realised, that it was more than that.”

Despondent and unable to get help, Kinga took matters into her own hands and researched her symptoms on the Internet. She recalls:

“I was so fed up with feeling like this. So I turned to Google. I searched ‘what is tiredness a symptom of?’ In my 16-year-old mind, that was all it was. I was just tired. I clicked on a link— ‘symptoms of depression.’ Other symptoms listed were feelings of hopelessness, negative thoughts, difficulty concentrating, feelings of numbness… I suddenly realised what must be going on.”

With this new information, she went back to her doctor.

“I finally had a name for these feelings. But for so long, I was doing too well for anyone to notice something was wrong. I suffered for years, believing that everyone felt like this—everyone felt a little out of breath, a little empty.”

A form of depression where people appear to function normally is called dysthymia, and it often begins in childhood. Although it may not be as debilitating as major depression, dysthymia can prevent positive feelings and interfere with daily tasks. On average, it lasts five years, does not usually resolve on its own, and requires treatment. About 75% of those with dysthymia develop severe forms of depression if left untreated.

While Kinga’s symptoms did not prevent her from continuing her usual activities, if she had not received help when she did, she may very well have developed a more serious mental illness.

In a post on Up Worthy, college student Amanda Leventhal shares a similar experience. Four years passed before she was diagnosed and treated. And Leventhal believes the process took so long because of stereotypes regarding mental illness:

“Even though we’re often told that mental illness comes in all shapes and sizes, I think we’re still stuck with certain ‘stock images’ of mental health in our heads.”

She says that ideas of how mental illness “should look” are so prevalent, it is difficult to believe that someone who doesn’t look mentally ill could be struggling. In fact, a study out of Duke University reports that only half of teenagers with mental health problems receive treatment at all.

Kinga says:

“I don’t know where I would be today if I didn’t get help. I don’t even want to think about that. I know I’m not the only one who suffered from mental illness as a kid, so I hope there is an increase in awareness of mental illness in young people.”

– Anika Rak, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

-Copyright Robert T. Muller

This article was originally published on Psychology Today

What Can A Lizard Tell Us About Mental Health?

December 13, 201800Animal Behavior, Child Development, Epigenetics, Evolutionary Psychology, Featured news, Genetics, Mental Health, Parenting, Stress, Trauma December, 18

Source: Hayke Tjemmes at flickr, Creative Commons

A new study on lizards has found that, when exposed to stress, their responses can be passed down genetically. Scientists now believe there may be more to the process of heritability than once thought. This process is called “Transgenerational Stress Inheritance.”

As recently as 2011, most research did not examine the possibility that parental stress could affect sperm or egg cells. Since genes are transferred to offspring through these cells, anything that modifies them can have an impact on genetic expression in children. The idea that parents’ experiences prior to pregnancy can change gene expression and, therefore, affect offspring behaviour, is novel.

In the lizard study, researchers from Pennsylvania State University exposed young lizards to fire ants (a natural stressor) and compared stress levels to unexposed lizards. Interestingly, contact with the stressor did not affect the lizards’ behaviour later in life. But, their offspring had stronger stress reactions than offspring of lizards who had not been subjected to the ants.

Lead researcher Gail McCormick told PsyPost:

“Our work reveals that the stress experienced by an individual’s parents or ancestors may overshadow the stress that an individual faces within its lifetime. In this study, offspring of lizards from high-stress sites were more responsive to stress as adults, regardless of exposure to stress during their own lifetime.”

These findings suggest that, although early life stress may not manifest later in adulthood, the effects may be passed down to offspring, even if offspring are not directly exposed to the stressor.

A similar study involved researchers conditioning mice to associate the smell of cherries with a mild electric current. When the fragrance permeated the air, the mice were given a small electric shock. And so, the mice began to fear the scent even when the shock wasn’t administered. Even more fascinating was that offspring of these mice, as well as their offspring, experienced fear in the presence of the odor. The fear reaction occurred even though the later generations didn’t experience the conditioning process.

Of course, the question these studies pose is whether there is a similar effect in humans.

As recently reported in the Guardian newspaper, researchers from New York’s Mount Sinai School of Medicine compared the genes of direct descendants of Jews who were “interned in a Nazi concentration camp, witnessed or experienced torture or who had had to hide during the second world war” to the offspring of Jews living outside of Europe who were unharmed. The children of parents who experienced WWII trauma showed genetic changes and a greater risk of stress disorders. These were not present in the other children. The Guardian article stated:

“[The] new finding is [a] clear example in humans of the theory of epigenetic inheritance: the idea that environmental factors can affect the genes of your children.”

In other research, psychologist Margaret Keyes from the University of Minnesota and colleagues examined twins to determine if the behaviour of biological parents could affect offspring who were not raised by them. The study found that children of parents who smoked were more likely to be smokers, even if those children weren’t raised by the parents, and as such, did not have parental smoking behavior modeled to them. Scientists are still questioning, though, whether it’s parental behavior directly affecting these genes or a genetic predisposition to smoking being passed down for generations.

On the whole, these studies make the case that genetic changes can happen a lot faster than previously thought, within a few generations or even one generation. And, as reported in Science magazine, people can see evolution in real time:

“Now, thanks to the genomic revolution, researchers can actually track the population-level genetic shifts that mark evolution in action—and they’re doing this in humans. [Studies] show how our genomes have changed over centuries or decades…”

Research in this field is still new and is subject to several caveats. Perhaps the most important one is the complexity of human beings and their environments. Indeed, there may be too many variables that factor into the human experience for researchers to arrive at definitive conclusions.

But, these studies do suggest that individuals may be affected by the stress felt by ancestors in before them. Further research is required to determine whether these findings are the result of transgenerational stress inheritance or an external factor that has yet to be considered.

– Andrei Nistor, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

-Copyright Robert T. Muller

This article was originally published on Psychology Today

The Making of a Murderer

July 6, 201800Child Development, Featured news, Genetics, Law and Crime, Parenting, Psychopathy July, 18

Source: sarahjgibson at DeviantArt, Creative Commons

In 1993, when Robert Thompson and Jon Venables from Liverpool, England were both 10 years of age, they killed a two-year-old boy. Thompson and Venables kidnapped the victim from a shopping centre, tortured him, and left him to die.

Stories like these raise many questions. Chief among them, how does something like this happen at all? Was it the result of bad parenting? The community certainly thought so, viewing the boys’ upbringing as the cause.

The trial had exposed evidence of domestic problems in both families. The judge stated that Thompson’s and Venable’s parents must take moral responsibility for their children’s actions. So members of the Thompson family had to assume new identities and go into hiding. They moved nine times to escape verbal and physical attacks. The Venables experienced similar threats.

In a recent interview with CNN, family therapist Tricia Ferrara put the onus on parents to understand when their child is in trouble. She said:

“All parents need a better understanding of child development so we can detect when the signals show a child may be moving in an anti-social direction.”

And a study conducted on the Columbine shootings, where two teenagers killed 12 students and a teacher at Columbine High School in Denver, suggested that the community saw parents as partly accountable for the murders.

There’s no doubt that parenting plays an enormous role in child development. Researchhas found that abuse, negative parenting, and prolonged malnutrition are linked to a proclivity toward physical violence.

But, there is also important research pointing to the role biology plays in predisposing some individuals to psychopathy, including violence. The BBC reported that neuroscientist Adrian Raine discovered a decrease in activity of the pre-frontal cortex in the brains of murderers, suggesting a genetic predisposition.

And, research by Elizabeth Cauffman and colleagues from the University of California found that good parenting doesn’t always lead to the outcomes we imagine. In fact, anti-social encouragement by a romantic partner was correlated with the highest level of offending in youth, even when warm relationships endured with parents.

In a TVO documentary Genetic Me, professor Daniel Nettle claimed that personality is stable throughout a person’s life. Individuals have tendencies for some things and not others. Nettle suggests that people are born with predispositions for certain personality traits. He adds, though, that the environment has some effect on bringing out theses inclinations, and that people can fight against them.

NPR reported that there are additional factors that play into a person’s development, perhaps explaining why not all children raised by the same parents are violent. Children in the same families have distinct personalities and varied interests that elicit different parenting. Plus, children experience independent social environments outside the home.

Perhaps the complexity of the matter is described best by neurobiologist James Fallon, who studies the brains of psychopathic killers. He explained in a TED Talk that an interaction occurs between environment and genetics. When presented with a particular brain image, he noted it was clearly a psychopath’s brain. What was most shocking—it was his own brain. Fallon, though, is not a killer, and had a happy upbringing. But, he has a family history of homicide. The first documented murder of a mother by a son was committed by a member of his family, several generations back.

Fallon said that, although some individuals, mostly male, have genes or brain damage that make them more susceptible to becoming murderers, their childhood experiences can make all the difference. For instance, the MAOA gene in particular can give rise to a violent individual if the gene is combined with experiences of brutality.

Where do murderers come from? Like all the big questions in mental health, an either-or perspective leaves little room for complexity. In the great genetics versus environment debate, the making of murderers—indeed, the making of us—requires that we look somewhere in-between.

–Anika Rak, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Conversation Cards Help Therapists Dig Deeper

June 29, 201720Child Development, Education, Featured news, Parenting, Trauma, Trauma Psychotherapy June, 17

Source: Michael on flickr, Creative Commons

As a counselor, social worker, or therapist, how do you begin conversations with your clients? What are the best ways to break the ice and generate meaningful discussions? These are questions that Jane Evans, trauma, parenting and behaviour expert, found to be common among her colleagues in the field.

Evans is a therapist and member of NEYTCO, the National Early Years Trainers and Consultants Organization, located in the UK. She has spent over 20 years working with parents and children who experience difficulty in relationships.

In an interview with the Trauma and Mental Health Report, Evans explains:

“I find that many practitioners don’t entirely understand childhood trauma and they struggle to talk to parents about it.”

To facilitate more open dialogue, Evans created Fink Cards—a conversation tool that provides structure to therapy sessions and helps therapists and clients engage in meaningful discussions. The Cards list questions to help parents who have trouble communicating and forming a good relationship with their children. And the Cards help parents and families who have encountered trauma in the past.

Since Evans sees trauma as a major factor in difficult parent-child relationships, she directly addresses this issue with the Fink Cards. They ask questions like “what does the word trauma make you think about?” to open the door to therapy work. The Cards support the counselor in facilitating discussion, and assist clients.

Evans found, while working with families, that parents are not always aware of how their own actions, as well as their interactions with the child, may in fact perpetuate problem behaviours. She says:

“Most parents see the child as the problem; they’re always aiming to fix the child. However, these cards invite them on a different journey. Parents consider what has happened early in their own lives or in their child’s early years and how that impacts their child’s behaviour now.”

Questions like “who was in charge of discipline when you were a child?” and “who notices when you are worried or anxious?” help parents reflect on how their early experiences and current support systems shape their parenting practices, as well as any negative impact these may be having on the child. As parents consider how these events impact their parenting choices, the therapist is able to work with them to implement more effective methods of communication and alternative coping strategies.

Research has shown that conversation cards can help patients become more open about their feelings. In a study conducted by researchers at Stratheden Hospital in the UK, 6D cards were used to facilitate holistic, patient-led communication. 6D cards are a type of conversation card developed to help physicians and nurses ensure a meaningful consultation with female patients in a gynecology clinic. They contain six categories, or dimensions, of health, including healthcare, emotions, lifestyle, interpersonal relationships, symptoms, and life events. The purpose of these cards is to allow the patients to lead the conversation.

Another study, conducted by the Design Council of the UK and the Bolton Primary Care Trust, focused on creating stronger methods of communication and management for diabetic patients with the use of Agent Cards, which are similar to both the 6D and Fink Cards. Agent Card statements encourage patient-led conversations with practitioners. Results of the study showed that using the cards helped facilitate more open discussion.

With Evans’ Fink Cards, clients have the freedom to choose questions from four categories during sessions: the parent’s early childhood and upbringing; the parent’s relationship with his or her child; the parent and child’s worries and anxieties; and how early trauma may have affected the child.

“These cards are a way of having difficult conversations, but it’s not just me putting the questions to the patient and saying ‘you have a problem,’” Evans explains.

While the effectiveness of Fink Cards does require more research, they have already made their way into the marketplace, and look to be a promising resource in clinical settings. Sometimes building rapport or discussing sensitive topics with a client can be difficult, but Fink Cards may go a long way in helping therapists and clients ease into healthy conversations in an educational and comfortable way.

–Afifa Mahboob, Contributing Writer, The Trauma and Mental Health Report

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller.

This article was originally published on Psychology Today

Conversation Cards Help Therapists Dig Deeper

June 29, 201700Child Development, Education, Featured news, Parenting, Trauma, Trauma Psychotherapy June, 17