This blog is my place to vent and share resources with other parents of children of trauma. I try to be open and honest about my feelings in order to help others know they are not alone. Therapeutic parenting of adopted teenagers with RAD and other severe mental illnesses and issues (plus "neurotypical" teens) , is not easy, and there are time when I say what I feel... at the moment. We're all human!

Monday, June 30, 2014

Matching emotional level

"I found it interesting reading that when a child is worked up in therapy, the therapist matches their emotional level and then helps them calm down. Can you give me an example of this, say, with Kitty, even if this may or may not be a regular part of her therapy? Would it be something like her, say, coming in and going on a rant about all the things she hates, how mean people are, etc, and yelling and screaming her comments at the therapist, and the therapist yelling and screaming things back? Can you elaborate a little?" - Anonymous

Matching emotional level - this is from Dan Hughes Arousal Regulation in Traumatized Children (2007).
Co-Regulating Child’s State of Arousal: Use of Self

  •  Matching Vitality Affect
  •  Match tone
  •  Match intensity
  •  Match prosody (the patterns of stress and intonation in a language)
  •  Don’t match the emotion

Match or lead the expression of affect.

When an adult matches a child’s nonverbal affective expression of his or her underlying emotion, the child often is able to experience the adult’s empathy for his or her experience and better regulate the underlying emotion. The adult’s affective communication of his or her experience of the child’s emerging experience enables the child to become aware of—and deepen—his or her own experience.

When children (and probably adults as well) give expression to their inner lives, they do so with an expression of affect that reflects both the information and energy that characterize the focus of their attention. The particular emotion associated with an event that they are describing is conveyed with a unique facial expression, voice prosody, and gestures and movements that best convey the particular meaning of that event for the child. The rhythm and intensity of the nonverbal expression conveys “how” and “how much” the event affected the child. When the adult matches that affective expression (often without feeling the child’s underlying emotion), the adult is able to convey that he or she “gets it,” and the child feels “felt.” In other words, the child experiences the adult’s experience of empathy for him or her in a way that words would never communicate alone. For example, if a child screams “I hate my dad!” in a therapy session, and the therapist replies, with the same intensity and rhythm as the child’s expressions, “You are really angry with your dad right now!” the child is likely to feel that the therapist does “get” his experience. If, however, the therapist says “you are really angry with your dad right now” in a flat tone of voice, the child is not likely to experience the therapist as “getting it.”

Along with conveying empathy for the child’s experiences, matching the affect also helps the child to regulate his or her experience. When a child experiences intense anger, that expression of anger is demonstrated by an intense affective expression in his or her voice, face, and gestures. If the child does not experience a similar response from an adult, the intensity is likely to escalate, as the child may struggle to regulate the emotion. If the child lacks general affect-regulation skills, any increase in intensity only increases the risk
of dysregulation. By matching the intensity and rhythm of the affective expression (and remaining regulated him- or herself), the adult is able to help the child to remain regulated. By finding the adult with him or her in the intense experience, and communicating with the adult about it, the child often finds him- or herself becoming less distressed and agitated.

Children may have trouble identifying an experience because it is new. They may be uncertain how to communicate it or worry that maybe they should not have it. This is especially true of children raised in circumstances where aspects of their inner lives are not seen or encouraged or when they have experienced traumatic events. In those situations, if a therapist is able to make sense of the child’s experience and take the lead in its nonverbal affective expression, the child is often able to experience it more deeply and communicate it more fully him- or herself.
            - Hughes, D. (2009). Attachment-Focused Treatment for Children. In Clinical pearls of 
wisdom. Kerman, M. (Ed.). New York: Norton. 169-181.

Ex.  Kitty's therapist matches Kitty's emotional level in pretty much every session.  When Kitty comes into a session she jumps into fight/ flight/ freeze mode pretty quickly.  Usually she gets agitated and starts venting and yelling.

The therapist stays focused on Kitty and matches her intensity, but not her anger.  Meaning if Kitty is  agitated and upset, then the therapist is empathetic and non-judgmental.  She is asks Kitty questions about what she's feeling, and by explaining her feelings to the therapist, Kitty learns to identify them for herself.  The therapist never says things like "You had every right to be angry.  She was mean to you." or "You need to calm down.  You shouldn't be mad, because she didn't mean to do that."  The therapist doesn't agree or disagree, instead she restates Kitty's thoughts and often helps her identify her feelings for her.   "You sound really angry at your sister.  She really hurt your feelings."

The therapist displays curiosity and asks questions about what Kitty says.  She stays calm and regulated (and helps Hubby or I if we get upset - which is easy to do when you're being yelled at and dealing with someone who is completely irrational). She never makes the mistake we make, which is to try to explain things rationally or ask Kitty to understand reality.

The therapist will also try to verbally get Kitty to self-regulate.  The therapist never tells Kitty to calm down (that would just triggers Kitty's need to be defiant).  Instead she will ask Kitty to notice how the emotion feels in her body. Honestly this also triggers Kitty, but I think Kitty still notices the feeling.  By staying calm and regulated herself, the therapist helps Kitty get regulated.  I do feel that this I am able to do 90% of the time.  It helps me to remember why she acts the way she does.

Kitty is really stressed about moving to Biomom's house.  Totally normal of course.  Friday night we were on a way to dinner with the family and she snapped at Bob - accusing her, and then the whole family of wanting her to leave and being happy about it.  Hubby pulled her aside to talk to her and she immediately went into fight/ flight/ freeze.  He tried to calm her down, but just couldn't.  Mostly because he's male and an authority figure.  She wanted to run.

I took over.  It took almost an hour for me to calm her down.  Some of which was me forgetting and trying to rationally to explain to Kitty why her perception of what was happening was distorted (she was worried about moving and trying to distance herself from us so it wouldn't hurt as much).  I finally got her to come inside.  She said she wasn't hungry, but I encouraged her to take food "to eat when she got hungry later."  She ended up eating happily with the cousins.  Switch flipped.


Anonymous said...

This makes a lot more sense now. Thanks for explaining. From what I've read about therapy in the past, it sounded so much more confrontational than it may be today, when therapists focused more on the child's outer displays of anger, not the feelings the anger was covering up--sadness, shame, fear, etc. I know that not every attachment-challenged child may benefit from the model used by one therapist, and that there are different therapists who've trained under different seasoned therapists, who use different techniques to treat children, with some being a little more confrontive than others. Glad you were able to help Kitty to calm down and are able to be such a good support to her. I thought she'd already moved though going by things you'd said in your earlier post. Or is she still living with you? Keep us posted. We are with you.

marythemom said...

This is a major life event for Kitty. Plus with her black and white thinking it feels like she is leaving one world for another, so in a lot of ways she feels that she is "losing" her family here (totally not the case of course!).

You probably meant physically moving -- she leaves tomorrow. :)

Anonymous said...

So, tomorrow will be a big day for your family. Maybe a bittersweet one: Kitty gets to be with people she cares about (while still, I'm sure, caring about your family, or at least just you, even if it doesn't always feel that way), and bitter because you know that her anxiety level and emotional instability may go up as the time of her departure gets closer and closer. How is she getting to Nebraska? Be sure to blog about it sometime, please.

marythemom said...

She bought a plane ticket with her high school graduation money.

I'll be sure to keep you posted! ;)

Anonymous said...

Looking forward to hearing more. When she's gone, don't forget to take care of yourself and spend some quality time with those in your life that fill, not drain, your love tank. People who give back to you after you've given to them. All the best.

Anonymous said...

How was yesterday? I've been thinking about you.