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7. The therapist, parent, and child confer and agree on modified treatment techniques to be employed at home for safe discharge of feelings. The child is rewarded with an agreed-upon privilege. Traumatized children need safe and varied methods to express and discharge their feelings. Frequently they have rage, which may be expressed in violence toward their family members, peers, or property. Providing acceptable discharge of such rage can minimize these destructive episodes. Arranging in advance privileges for safe discharge of intense feelings will encourage the child to employ these techniques.

   The following are some suggested bargains that the parent can negotiate with a dissociative child to help with expressing anger:

   1. punching a pillow or punching bag to earn points toward a toy;

   2. drawing a picture of their feelings and ripping it up to earn points toward renting a video;

   3. making a snow sculpture symbolic of feelings and then smashing it to earn the privilege of a favorite bedtime snack;

   4. making a sand sculpture symbolic of feelings and stepping on it to earn the privilege of inviting a friend over;

   5. making a clay figure symbolic of feelings, and smashing it to earn points toward the privilege of ice skating, roller blading, or roller skating;

   6. running down the driveway or around the block three times a week to discharge anger to earn the privilege of attending a favorite sports event;

   7. using an exercise machine to expel anger in exchange for time playing a computer game;

   8. shooting baskets to expel anger in exchange for watching a favorite television show that day;

   9. journal or write poetry about feelings three times a week in exchange for going to a movie.

   10. Most importantly, verbalizing to the parent the anger felt and requesting parent's help in processing thoughts and feelings in exchange for spending special time with the parent.

   Each family needs to evaluate what opportunities are available and acceptable in their home environment to express rage. One family, who resided in a rural area, agreed on a creative solution for their adopted 10-year-old DID girl. She was permitted to go to the woodshed, which also contained garbage cans, and shake them, scream, and swear. She understood that this was the only place in which she was allowed to use vulgarities toward the abusers who had sworn at her profusely. Another devoted adoptive mother who also resided in a rural area would make use of her quarter-mile driveway when her 8-year-old DID daughter would become rageful at bedtime. The mother would bundle up her daughter and march her up and down the driveway until her daughter was able to calm down and verbalize her anger, hurt, and fears. Then the mother would rock her daughter and put her to bed.

   The therapist and parents need to review techniques which they find acceptable and agreeable and permit their child to voice what she is willing to do to safely discharge negative feelings. Children can suggest creative techniques that adults might have overlooked. Children need to decide with parents what rewards would be meaningful to them when they use appropriate expression of unpleasant feelings instead of destructive behaviors.

8. Therapist, parent, and child agree on code words or symbols to signify the presence of intense, and uncontrollable feelings, thoughts, and behaviors. It is advisable for the therapist, parent, and dissociative child to select code words or symbols which can be verbalized by the child, parent, therapist, teacher, and other appropriate adults to signify that the child is in need of quick stabilization. Code words or symbols can be used for the following purposes:

   1. The child may be experiencing intense and uncontrollable feelings, thoughts, and behaviors which could result in destructive behaviors.

   2. The child may be experiencing a flashback of a traumatic memory and needs to be reoriented to the present.

   3. The child may be dealing with conflicts with alters over executive control of the body or over a desire to hurt someone or oneself.

   4. The child may be disoriented and switching personalities and needs to maintain coconsciousness and cooperation.

The expression of code words or symbols can be a quick way to halt the escalation of serious behaviors without exposing the child to humiliation in front of peers or other adults. This is an intervention tool to redirect the child to being appropriately oriented and under control.

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Written: 01/2003. Reviewed 04/2006