Parents As Partners in the Treatment of Dissociative Children

Contents

• Introduction

• Child Management Guidelines

  • Use only non-physical forms of discipline

  • Use a calm, low voice when the child is out of control

  • When discussing with the dissociative child consequences, ask the child to have "all your parts (alters, fragments, ego states) watch and listen"

  • No matter who was out or internally influenced the child at the time of the inappropriate behavior, the child still has to be held responsible

  • When the child denies a witnessed, problematic behavior, the parent gives the firm message that the child needs to sort out with the alters what occurred

  • Identify internal helpers who are requested to assume control if the child or an alter attempts to engage in destructive or abusive behavior

  • Modified treatment techniques to be employed at home for safe discharge of feelings

  • Code words or symbols to signify the presence of intense, and uncontrollable feelings, thoughts, and behaviors

• References

By Frances S. Waters, M.S.W.

Effective treatment of the traumatized dissociative child includes engaging the child's family to facilitate the child's ongoing recovery from trauma. As demonstrated repeatedly (Dell & Eisenhower, 1990; Fagan & McMahon, 1984; Silberg & Waters, Chapter 6, this volume), dissociative children who make the most gains from appropriate therapy are the ones in a safe and nurturing environment with consistent parents. Consistent parenting promotes healthy attachment, provides affect modulation and containment, and helps to counteract the pessimism and demoralization learned from the child's abusive experiences. Providing the ideal environment for dissociative children is a challenge, as their behavior may be provocative, rejecting, and out of control. Many parents report that these children may seem uncaring or unattached, and parents are embarrassed by their child or adolescent's unpredictable behavior. Families are hungry for any clues that might help them understand, manage, and normalize their child's behavior.

Parents of dissociative children face many obstacles in managing their children. By learning to accept and interact with the dissociative aspects of the child, learning how to manage difficult traumatic memories, and helping the child manage his extreme emotions, the parent serves as a therapeutic collaborator in the child's treatment. With adequate knowledge, support, and commitment, parents can play an integral role in facilitating their child's recovery. Therapeutic work with parents is an essential component in the full treatment plan. Parental perseverance will facilitate the dissociative child's attainment of trust and attachment and promote the child's development into a functioning adult.

The techniques and recommendations described here are most appropriate for families that are not abusive or in severe turmoil. These are families that may have crises, temporary disruptions, or lapses in judgment, but these families are characterized by stability, commitment, and availability to the child during recovery.

Child Management Guidelines

It is difficult to anticipate the unusual family problems that may arise, with the constant interaction of patients and their alters with parents, siblings, friends and extended family. Clinicians and parents must be flexible in responding to the individual challenges of each unique dissociative child. However, the guidelines below are viewed as universally applicable to all dissociative children and may provide a framework for resolving management questions.

1. Use only non-physical forms of discipline.

   A dissociative child who has been traumatized sexually or physically is very susceptible to tactile triggers related to early memories of abuse, even if the touch is an appropriate one. Incidents such as a sudden tap on the child's back may initiate a profound startle reaction, and parents may become accustomed to avoiding unexpected touches. It is important to stress to parents that purposeful hitting, pushing, spanking, or slapping are never acceptable forms of discipline for a dissociative child. These assaults to the child's body can set off a full blown abreaction to early physical forms of abuse and strengthen the child's dissociative defenses. These children have learned aggression from their maltreatment, and physical forms of discipline may increase these aggressive and retaliatory tendencies.

Because these children are very provocative, they require parents who are well versed in appropriate child management techniques and can work out an agreed plan with the child in advance for appropriate rewards and consequences for chores and problematic behaviors. As with normal children, it is important to give consequences soon after the inappropriate behavior if possible and to employ grounding for a reasonable period of time. However, until there is co-consciousness in which the child and the alters share information and are all attentive, the parent should not expect the child to learn immediately from the behavioral interventions such as grounding and removal of privileges.

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Written: 01/2003. Reviewed 04/2006