H. Norman Wright Shaelyn Tristan, Princess & James Jacob & Alex The Risk of Working with Traumatized Children 1. Empathy 2. Trauma in our life – unresolved trauma 3. Children’s trauma 4. Mission failure—“I didn’t help them.” Part of being human is the ability to be affected by the people and circumstances of our lives. 1. We are vulnerable to secondary stress. We have already noted that the literature suggests that trauma therapists often manifest symptoms similar to their client. The research says if you sit with trauma long enough, it will traumatize you too. 2. We are vulnerable to spiritual struggles. Not only can therapists demonstrate symptoms of secondary stress disorder, they can also reflect the person’s struggles to hold simultaneously the reality of evil and suffering with the eternal truth of a loving and sovereign God. If you do not ask questions, then its doubtful that you have truly entered into the other’s suffering. However, such questions easily lead to wondering whether or not God is good, whether or not he is love. 3. We may find our voice silenced. Our voice can be silenced when feelings become numb and we make an effort to avoid certain thoughts and activities. Voice can be silenced when we must carry intense, difficult material alone because of the need for confidentiality and the absence of anyone with which to debrief. Voice can be stilled by thoughts such as, No-one believes this anyway. 4. We may feel isolated. Isolation occurs when a counselor or pastor experiencing PTSD shows diminished interest in normal activities or begins detaching from others. 5. We may feel powerless. We were meant to have influence, to create, to govern. We were not intended to be invisible, helpless people who leave no mark. However, trauma therapy can overwhelm us with feelings of helplessness. Dr. Diane Langberg Loss is a Part of Life Loss of a favorite toy Dropping an ice cream cone in the dirt Not receiving an anticipated gift A friend starts playing with someone else Parents decide to move away from the familiar neighborhood A pet gets lost or dies Divorce—Mom or Dad remarries Being promoted to an advanced class and leaving your friends behind A teacher leaving in the middle of the school year A class mate dies Having your friends promoted to an advanced class and being left behind Not making the Little League or soccer team Not getting invited to a birthday party Not getting a favorite teacher of your sibling A grandparent dies Gaining weight Discovering you were adopted Loss of innocence Losing a library book Catching the “tooth fairy” in the act Five-year-old – “What does dead mean?” What are Children Taught About Loss & Grief? – Usually Five Myths 1. Don’t feel Sad Mad Scared Happy Lonely The Funeral Fable The Anxiety Fable The News Fable The Bad Dream Fable Sharing a narrative about a favorite activity provides important information that may reflect developmental and cultural influences in terms of their comfort with, and language abilities for, articulating details and communicating with adults. A baseline narrative, for example, might reveal that the child has a very limited vocabulary for identifying feelings and is unable to offer more than three-word sentence descriptions about the favorite activity. Therapist: I’m really enjoying getting to know you, and I wondered if you would tell me about an activity you participated in recently that you really enjoyed. Can you tell me about a favorite activity or a party you went to recently that you enjoyed? Child: Well, I could tell you about a birthday party I went to this weekend, but it wasn’t that much fun. Therapist: That’s OK. I’d like to hear about it anyway. Child: OK. Therapist: I didn’t go to that birthday party, so could you tell me all about it? Tell me everything that happened from the time you arrived to the time the birthday cake was brought out. And maybe you could tell me how you were feeling and what you were saying to yourself during the party. As much as possible, allow the child to provide a spontaneous narrative. However, when there are very long pauses or the child gets significantly off task you may jump in with one of these questions or statements: 1. Ask broad, open-ended questions: “What were you thinking?” “What were you saying to yourself?” “How were you feeling?” “What happened next?” 2. Make clarifying and reflective statements: “Tell me more about it… “I wasn’t there, so tell me…” “I want to know all about…” “Repeat the part about…” Repeat this exercise, this time applying it to a traumatic experience. Therapist: Can you tell me why your mom brought you to see me? Child: I think she wants me to ask to talk about what happened when the police took my dad away. Therapist: I’d like you to tell me more about that. You did such a good job telling me all about what happened at the birthday party. Now I’d like you to tell me about everything that happened on the day the police came to your home. Would you like to tell me about what was happening before the police came or what happened after the police came to your home? Child: I’ll tell you what happened after the police came ‘cause I don’t think you want to hear the scary stuff before they came. Therapist: I’d like to hear about the scary stuff too, but today I’d like you to tell me everything that happened from the time the police arrived at your house until they left with your dad. And please tell me what you were feeling and what you were saying to yourself while all this was happening. Child: OK. I’ll try. 2. Replace the Loss “Mr. Hamster you were a good hamster. I’m sorry for the times I didn’t clean your cage. I was mad the time you bit me, but that’s okay. I wish you didn’t have to get sick and die. I wanted to play with you more. I loved you, and I know that you loved me. Good-bye, Mr. Hamster.” Completion is the action of discovering and communicating, directly or indirectly, the undelivered emotions which attach to any relationship that ends. Reviewing a relationship helps children discover the feelings they wish had ended different, better or more. The review will also reveal unrealized hopes, dreams and expectations about the future. The child will discover things they wish they had said or done and things they wish they hadn’t said or done. After uncovering those areas that are emotionally incomplete, there is one more step before those undelivered emotions can be communicated. They must be converted into one of four emotional categories, which lead to completion. The categories are simple: apologies forgiveness significant emotional statements fond memories. Apologies – Mr. Hamster, “I’m sorry for the times I didn’t clean your cage.” Forgiveness – “Mr. Hamster, you were a good hamster…I was mad the time you bit me, but that’s okay.” Significant emotional statements – “Mr. Hamster, you were a good hamster. I wish that you didn’t have to get sick and die.” Fond memories - “I loved you and know that you loved me.” 3. Grieve Alone 4. Be Strong 5. Keep Busy I am not sure exactly how it works, but this is amazingly accurate. Read the full description before looking at the picture. The picture below has 2 identical dolphins in it. It was used in a case study on stress levels at St. Mary’s Hospital. Look at both dolphins jumping out of the water. The dolphins are identical. A closely monitored scientific study revealed that, in spite of the fact that the dolphins are identical, a person under stress would find differences in the two dolphins. The more differences a person finds between the dolphins, the more stress that person is experiencing. Look at the photograph and if you find more than one or two differences you may want to take a vacation. What is Grief The “crazy” feelings of grief are actually a sane response to grief. The following examples are all symptoms of normal grief: • distorted thinking patterns, “crazy and/or irrational thoughts, fearful thoughts • feelings of despair and hopelessness • out of control or numbed emotions • changes in sensory perceptions (sight, tasted, smell, etc.) • increased irritability • may want to talk a lot or not at all • memory lags and mental “short-circuits” • inability to concentrate • obsessive focus on the loved one • losing track of time • increase or decrease of appetite and/or sexual desire • difficulty falling or staying asleep • dreams in which the deceased seems to visit the griever • nightmares in which death themes are repeated • physical illness like the flu, headaches or other maladies • shattered beliefs about life, the world, and even God Grief will take longer than you’ve imagined. It tends to intensify at three months, special dates and the one year anniversary. Grief is a journey, a process and there is resolution. A seven-year-old girl lived with her mother and her mother’s live-in boyfriend, who hit her mother on an ongoing basis. The seven-year-old child called the 911 dispatchers. She was articulate and quite knowledgeable. She lived with her mother and her mother had passed out on the floor. The little girl described the symptoms and then said her mother wasn’t breathing. The dispatcher heard the little girl go over and check the mother’s pulse and then, over the phone, heard the little girl give her CPR. Unfortunately, the mother died. The phone line was kept open and the dispatcher heard the sheriff’s deputy arrive and heard him pick up the little girl and hold her and talk to her for twenty-five minutes. 1. 2. 3. 4. Describe how you would introduce yourself to the child. Describe what you believe this child has experienced. What information do you need at this time? What is your goal in working with this child? 5. What questions might you ask? What questions might the child be wondering but not asking? How would you bring these questions to the surface as well as answer them? 6. What is your response if she says, “Mama’s boyfriend hit her?” 1. Be sure to get down on the child’s level or sit next to her on the couch. Ask her name and then say, “My name is and I came over to spend some time with you to see if I could help in any way. Tell me a little about you.” Just being there, being present and providing safety for the child is our task. I might ask if she has a favorite stuffed toy she would like to hold and if so send someone to bring it. 2. The child has been traumatized. Not only has she seen her mother die in front of her but she wasn’t able to save her. Here are some possible results of this experience. Her thinking process has been distorted. She could experience confusion, a distortion of time, difficulties in solving problems and in figuring out what’s best to do next. In other words, as a result of trauma, something happens in the brain that affects the way she processes information. It affects how she (or any person, for that matter) interprets and stores the event she’s experienced. In effect, it overrides her alarm system. Hypersensitivity can actually become wired into her basic brain chemistry and bodily functions. Her body is out of sync. Her heart could be pounding. She could experience nausea, cramps, sweating, headaches, and even muffled hearing. Emotionally she’s riding a roller coaster. She could be irritable, afraid, anxious, frustrated, and angry or just numb. You may eventually expect extremes of behavior—either overresponding or underresponding. Either way, her behavior may be off. She’s probably slower in what she does, wanders aimlessly, is dejected, has difficulty remembering and could be hysterical, out of control and hyper. These are all possibilities. 3. There are a number of practical matters such as caregiving for this child as well as continued counseling in the weeks ahead. It’s as though you have a dual role of interacting and helping the child as well as making sure she’s safe and taken care of in the future. 4. A counselor’s goal is to provide support, comfort and safety for this child. There are many questions we could use to help her at this time. When you ask these it will be at your discretion. When children experience a crisis or trauma it’s important to help children feel free to speak freely and to voluntarily tell you about their experiences of what happened. Never force or pressure them to tell you anything they are not yet willing to verbalize. Once they feel safe and comfortable, they may want to share with you what they went through. Here is a list of what you can say to support children who are ready to tell their story. You may need to talk in this manner: It’s often helpful to talk about what happened. Talking about what happened can help you let go of painful thoughts and memories. Draw a picture of what’s in your mind. Who would you like to spend time with now? Write a story about what’s in your mind. Thoughts cannot make bad things happen or prevent them from happening. I can handle whatever you would like to tell me about. Your thoughts don’t scare or worry me. Anything you think about is normal for what you have been through. Who would you like to tell your story to? Having frightening thoughts does not mean you are going crazy. What happened was crazy, you are not. What do you think happened? What do you wonder about it? What most concerned you? What’s your most painful moment or memory? Where is that pain right now? What was your first reaction? What’s not being talked about? Are other people right or wrong about what they’re saying happened? What was handled well? Who was helpful and why? All of your thoughts before, during and after this event are normal. 5. It’s difficult to predict their questions but here are some possibilities: “Did I cause my mommy’s death?” “Isn’t she just sleeping and will she wake up soon?” “What happens when someone dies?” “Why didn’t God save her?” “I keep hearing her breathe, when will that stop?” “What will happen to me now?” “Can I go where they’re taking my mommy?” “What did I do wrong?” “Can I talk to my mommy if she’s in heaven?” Please forward to cat lovers everywhere who, like myself, are very concerned about their hygiene. Thoroughly clean the toilet. Add the required mount of shampoo to the toilet water, and have both lids lifted. Obtain the cat and soothe him while you carry him towards the bathroom. In one smooth movement, put cat in the toilet and close both lids (you may need to stand on the lid so he cannot escape). CAUTION: Do not get any part of your body too close to the edge, as his paws will be reaching out for any purchase they can find. Flush the toilet three or four times. This provides a “powerwash and rinse” which I have found to be quite effective. Have someone open the door to the outside to ensure that there are no people between the toilet and the outside door. Stand behind the toilet as far as you can, and quickly lift both lids. The now-clean cat will rocket out of the toilet, and run outside where he will dry himself. Domestic violence is a pattern of control over the behavior, emotions and choices of a partner. The methods of control can include physical abuse, sexual abuse, psychological abuse, financial abuse, social restrictions and the destruction of property and/or family pets. Being exposed to domestic violence affects children’s emotional, developmental and physical well-being. These children are more likely to be abused themselves, may be caught in harm’s way during a violence episode and be inadvertently injured, may experience behavioral problems related to anger, aggression and oppositional behaviors and are more likely to experience depression and anxiety than other children. They also tend to spend less time with their friends, worry more about the safety of their friends, and are less likely to have a best friend. At school, children exposed to domestic violence may present with elevated rates of behavior problems, hyperactivity, social withdrawal, and learning difficulties. Children exposed to domestic violence are also a higher risk of being exposed to other forms of abuse. Exposure to domestic violence may also cause other long term effects such as an increased risk of entering the juvenile justice system, attempting suicide, committing sexual assault crimes, and abusing drugs and alcohol. A crime against one’s own family—against a spouse or a child—shatters the trust upon which healthy families are built. It cause psychological and emotional damage that often cannot be repaired. It can be the most damaging and debilitating force in a child’s life. How does this impact a child? This kind of violence is very damaging. It robs the child of the feeling of personal safety. A child loses the sense that the world is a safe place. Children have the psychological choice of remaining helpless or identifying with the aggressor. Aggression has been their only model Children may become fearful and withdrawn. Young children often blame themselves for causing a parent’s anger. Older children may blame themselves for causing a parent’s anger. Older children may blame themselves for not intervening Children may “tune it out” Children often have difficulty concentrating at school Children who accompany their mothers to take refuge in shelters continue to have problems, even in a safe environment. Children may suffer from post-traumatic stress The adults may not be able to help their children Young children may accept family violence as a normal way of life. There may be severe problems in these families In general a child grieves differently from an adult. Instead of experiencing ongoing and intense distress, a child is likely at first to deny death, then grieve intermittently for many years. Other features include the following: Grief comes out in the middle of everyday life that can’t be predicted A child can put grief aside easier than an adult One question may be about her grandfather’s death, the next will be about her doll Grief comes out in brief but intense “episodes” Being limited in verbal expression, a child expresses his grief in actions A child often postpones her grief—or at least part of it A child’s grief often lasts throughout childhood; pieces of it last into adulthood Breakfast: 1/2 grapefruit, 1 slice whole wheat bread 8 oz. skim milk Lunch: 4 oz. lean broiled chicken, 1 c. steamed zucchini, 1 Oreo cookie, herb tea. Afternoon snack: Remainder of Oreo package, 1 qt. Rocky Road ice cream, 1 jar hot fudge. Dinner: 2 loaves garlic bread, large pepperoni pizza, 3 Milky Way bars, and 1whole frozen cheesecake, eaten directly from freezer. Trauma What is it to a child? Types and Causes Trauma for a child is Death Sexual Abuse Physical Abuse Family Violence National Disasters Divorce Illness and Injury Trauma by Proxy When the actual catastrophic event happens to someone else, but the child— who could be miles away and who may not know the victim—develops posttraumatic symptoms almost as if the trauma happened to him or her, it’s called trauma by proxy. Children are more vulnerable than adults to being traumatized by distant events. Kids are particularly at risk of developing posttraumatic symptoms after being exposed to events in which they identify with the victim. Kids who have intense emotional and behavioral reactions to traumatic events that happen around them but not to them, such as these: A schoolmate dies in a car accident or fire. A teenager in the child’s school or town or even in a neighboring community commits suicide. A classmate develops cancer. A sibling or friend who has been through a traumatic experience “spreads” his or her posttraumatic symptoms by sharing graphic details of the event with peers, which leads to “contagion” of the posttraumatic reaction. A schoolmate is seriously injured in school violence. Random violence in the community confronts the child every day. A parent of a friend develops a fatal illness. A parent of a friend is injured or killed in a workplace accident. A parent of a friend is injured or killed in a car accident, plane crash or commuter railroad accident. What is complex trauma and what makes it different from all other forms of psychological trauma? Complex trauma generally refers to traumatic stressors that are interpersonal, that is, they are premeditated, planned and caused by other humans, such as violating and/or exploitation of another person. In general, interpersonal traumatization causes more severe reaction in the victim than does traumatization that is impersonal, the result of a random event or an “act of God,” such as a disaster (i.e., a natural disaster such as a hurricane or tsunami, a technological disaster) or an accident (i.e., a motor vehicle or other transportation accident, a building collapse) due to the deliberate versus accidental causation. A third type of trauma, a crossover between the two, refers to accidents or disasters that have a human cause. When trauma occurs within the family between family members or in other closed contexts that involve significant roles and relationships, it is usually repeated and can become chronic over time. Child abuse of all types (physical, sexual, emotional and neglect) within the family is the most common form of chronic interpersonal victimization. Rather than creating conditions of protection and security within the relationship, abuse by primary attachment figures instead becomes the cause of great distress and creates conditions of gross insecurity and instability for the child including misgivings about the trustworthiness of others. When abuse occurs with a member of the family or someone else in close proximity and in an ongoing relationship with the child (i.e., a clergy member, a teacher, a coach and a therapist), it often occurs repeatedly and, in many cases becomes chronic and escalates over time. The victimization might take place on a routine basis or it might happen occasionally or intermittently. Whatever the case, the victim usually does not have adequate time to regain emotional equilibrium between occurrences and is left with the knowledge that it can happen again at any time. This psychological energy that would normally go to learning and development instead goes to coping and survival. Recent studies have documented that abuse and other trauma result in changes in the child’s neurophysiological development, that in turn, result in changes in learning patterns, behavior, beliefs and cognitions, identity development, selfworth and relations with others, to name the most common. What happens to us in trauma? 100 Year Flood After trauma, even gentle showers of information from everyday experiences may end up flowing in the streams formed by trauma. The brain of the traumatized child, forms itself quite literally around the experiences it encounters. The child responds accordingly. When information comes into the brain that approximates past experiences of terror, the brain rapidly process the information and the child responds accordingly. One of the primary ways the child continues to experience trauma long after the offender is gone or the incident has ended the continuing stress response within the child’s body. Memory of trauma is stored in multiple ways and in multiple places within the brain. The body often remembers much more through feelings, smells, sensations and the body responses (often called state memory) than the cognitive brain can remember. In a variety of ways the brain signals the body long after the initial trauma has ended that the trauma is still occurring. The signal keeps the child in survival mode continuously. On a continuum from mild to extreme, the brain of a traumatized child is caught in a reactive cycle of perceived threats. Many abused children do not understand what they feel or why they act as they do. As adults, one of our most frequent (and unhelpful) questions we ask is, “Why did you do that?” Abused children have had a computer chip installed in their brain by their abuser, which continues the experience of abuse long after the perpetrator is not in the child’s life. This is an analogy of what happens. Emotions that arise from past trauma have neural pathways that bypass cortical processing. In these cases the traumatized child feels stress, threat, terror and a host of other associated feelings instantaneously, without necessarily involving the thinking regions of the brain. The fact that the brain develops sequentially— and also so rapidly in the first years of life— explains why extremely young children are at such great risk of suffering longs effects of trauma; their brains are still developing. The same miraculous plasticity that allows young brains to quickly learn love and language, unfortunately, also makes them highly susceptible to negative experiences as well. At any age, however, when people are faced with a frightening situation their brains begin to shut down their highest cortical regions first. We lose the capacity to plan, or to feel hunger, because neither are of any use to our immediate survival. Often we lose the ability to “think” or even speak during an acute threat. We just react. And with prolonged fear there can be chronic or near-permanent changes in the brain. The brain alterations that result from lingering terror; especially early in life, may cause an enduring shift to a more impulsive, more aggressive, less thoughtful and less compassionate way of responding to the world. This is because systems in the brain change in a “use-dependent” way as we noted earlier. Just like a muscle, the more a brain system like the stress response network gets “exercised,” the more it lunges and the more risk there is of altered functioning. . At the same time, the less the corticol regions, which usually control and modulate stress, are used, the smaller and weaker they get. Exposing a person to chronic fear is like weakening the braking power of a car while adding a more powerful engine: you’re altering the safety mechanisms that keep the “machine” safe (from going dangerously out of control. Such use-dependent changes in the relative power of different brain systems—just like the use-dependent templates one form’s in one’s memory about what he world is like—are critical determinants of human behavior. Flashbacks Traumatic Dreams Memory Disturbance Persistent Intrusive Recollections Anger Irritability Dazed or Numb Appearance Panic Attacks Phobia Formation Startle Response Hyper-Vigilance 1. Ask for just one detail about the trauma (“Just tell me one thing.”) 2. Agree on a certain amount of time to be spent on the trauma narrative (“only 5 minutes”) 3. Plan a fun activity for the end of the session after working on the trauma narrative (e.g., telling jokes, sharing a talent). 4. Encourage positive self-talk (e.g., “I can do this”; “I was very brave for telling.”) 5. Joke (“You don’t remember anything? You gotta be kidding.) 6. Emphasize that you know how hard it is to write this story (“I know that this can be hard, but you’ve shown such courage! I know you can do this.”) 7. Praise (you are one of the bravest kids I’ve ever known.”) 8. Share your personal experience with trauma to model talking about it (if appropriate). 9. Use funky art techniques (we had a kid write the whole trauma narrative on a scarf; another agreed to write it on one of the author’s [J.A.C.] arm but when she said it would be tough to photocopy, he agreed to go with paper). 10. Create the narrative with songs, colors, etc. Let the child pick a song, color, flower, animal, smell, etc., that describes an episode, adding to it gets easier. 11. Use the computer to create the narrative and agree to 10 minutes of a computer game of the child’s choice (within reason) after working on the trauma narrative. 12. Young kids; Let them show you what happened with dolls or puppets, then write it down and read it to them the next session, letting them correct/change your narrative so that it accurately reflects what happened. 13. Ask the child to explain what he/she thinks will happen if he/she talks about the trauma. 14. Praise the child for small steps, such as writing one sentence or talking about the trauma in the abstract. 15. Use the “riding the bike” analogy—“It’s had at first but gets easier as you practice” (make sure the child can ride a bike first). 16. Do a “life narrative” instead of a “trauma narrative.” 17. Use the Storybook weaver Deluxe computer software program (available at www.kidsclick.com) and let the child make illustrations for each chapter written. 18. Let the child use window magic markers to create a “public service announcement” about the trauma. I need some help. My cousin’s cat had kittens and he was able to give away all but 3 of them. I told him I would help him find homes for the last 3. I can’t take any because I’m allergic, but if 3 of you could take just 1 it would be such a help and the kittens could have a nice home. Since he lives up by the San Mateo Nuclear Power Plan I’ll go pick them up for you. I’ve attached pictures of the last 3 kittens. Will you help? What are Some Common Behavioral Symptoms of Child Who Has Been Exposed to Domestic Violence? Very young children who have been through a traumatic experience may exhibit the following signs of distress; They may fuss more They may “lose” developmental steps already acquired They may fail to learn new and expected developmental tasks Bullying, physical aggressiveness and insulting behavior toward peers Withdrawal from peers and social contacts and overall poor peer relationships Difficulty separating, especially from the battered parent Oppositional and defiant behaviors with authority figures, especially with the battered parent Increased verbal aggressiveness/talking back Bed-wetting daytime “accidents,” “baby talk,” or other regressive behaviors Difficulty focusing and learning while at school Loss of appetite or changes in eating patterns Failure to thrive in infants Nightmares, insomnia or other sleep problems Increased violent behavior toward siblings and peers Running away from home Role reversal: taking on parental role Physically, verbally or sexually abusing their dating partners Being victimized physically, verbally or sexually by their dating partners Violence toward the battered parent/imitating words and behaviors of the abuser Acting as the battered parent’s “protector” Drug and/or alcohol abuse Poor peer relationships and choices Increased nervousness, anxiety and fear Depressed mood and suicidal thoughts Insecurity Feeling responsible for protecting the battered parent and siblings Excessive worry about the safety of others Embarrassment (not wanting peers to be aware of family violence) Resentment toward the battered parent and siblings Fear of day-to-day arguments Fantasies of standing up to, or hurting the abuser Desire to have the same power as the abuser Confusion regarding “loyalty” to both the abusive and abused parent How Do Children Respond They may become anxious and clingy, not wanting to separate from their parents at nursery school or the babysitter’s house. They may seem to take a step backward in development. They may become aggressive in their play with other children, with their parents, or with their own toys. They may play the same game over and over. They may express magical ideas about the event. (“The storm came because I was so mad” or “Daddy left because I was bad”). They may revert to developmentally earlier coping mechanism, such as an ego-centered view (i.e. thinking that someone died because they had bad thoughts about the person). They may compensate for feeling helpless during the crisis by blaming themselves for elements of what happened. Their lack of control over the trauma may make them feel that their future is unsure, which can lead some children to act recklessly. They may experience a significant change in school performance. It’s not uncommon for a child to have difficulty concentrating and performing in school after a traumatic event. On the either hand, they may become intensely focused on schoolwork to the exclusion of having fun. They may test the rules about bedtime, homework, or chores. They may have an interruption in relating to a best friend. They may experience sleep disturbances. The child might have nightmares or difficulty falling asleep. They may join in reckless play. They may talk about the supernatural. Magical thinking still exists in this age group, though it takes a different form. Adolescents, or “almost adults,” are an inherently erratic bunch, and their responses to trauma reflect their nature. They have a grown-up grasp of the reality of the traumatic situation, but their reactions can swing wildly from that of a mature adult to that of a young child. One minute they’re asking what they can do help out, and the next minute they’re acting recklessly. They often feel that only their peers can understand what they are going through, and they go to their peers for support. They may get involved in risky behaviors, such as experimenting with drugs, becoming sexually active, or being truant from school, as a way of handling their anxiety and countering feelings of helplessness. Teens behave this way because after a trauma they often feel their future is limited. They may develop a negative self-image because they were not able to avoid or alter the situation. They are likely to engage in revenge fantasies against the person or people they hold responsible for the trauma and then feel guilty about their vengeful feelings. They may experience a shift (either an intensification or withdrawal) in the normal developmental tasks of their age, such as dating, friendships, or sense of autonomy.