WORKING WITH CHILDHOOD TRAUMA: THE TRAUMAPLAY MODEL

Öz

Most children experience stressful life events while growing up which may compromise emotional and physical development and may have long-term effects on their mental health. These negative experiences include, but are not limited to maltreatment, growing up in a chaotic family environment, domestic violence, loss, natural disasters, terrorism, war, and refugee conditions. Multiple factors including the child's age, temperament, resilience, and family support and coping determine whether the child develops difficulties including trauma symptoms. Children experience and give meaning to traumatic life events in their own unique way. Initial assessment should be family-centered and the developmental level of the child, risk factors and functional impairment should be assessed. In order to fully understand risk factors related to early interpersonal trauma, cultural, socio-economic and social factors that shape the caregiver-child relationship should be thoroughly assessed. TraumaPlay, developed by Goodyear-Brown (2010; 2019), offers a developmentally sensitive approach by using the facilitating power of play. The therapist acts as a safe base and container for the child, and treatment takes place through this healing relationship with the trusted therapist. Through sensitive and carefully timed interventions, the traumatized child is helped in working through feelings of loneliness, abandonment, maltreatment, and loss. The safe space provided by the therapist offers a milieu to drain the toxicity of disturbing memories and rediscover hope.

Anahtar Kelimeler

• Flexibly sequential play therapy
• TraumaPlay
• Interpersonal trauma
• Complex trauma
• Child neglect
• Child Abuse

ÇOCUKLUK DÖNEMİNDE TRAVMA İLE ÇALIŞMAK: TRAVMAOYUN MODELİ

Öz

Çocukların büyürken karşılaştıkları stresli yaşam olaylar, onların zihinsel, duygusal ve fiziksel gelişimleri üzerinde kalıcı ve uzun süreli etkilere sahiptir. İstismar, kaotik aile yapısı içinde büyümek, aile içi şiddet, kayıp, doğal afetler, terör, savaş ve mülteci olma durumu bu stresli yaşam olayları arasında yer almaktadır. Çocuğun yaşı, mizacı, psikolojik dayanıklılığı, ailenin desteği ve travmayla ne şekilde başa çıktıkları gibi çeşitli etmenler, bu yaşantıların çocuğu ne şekilde etkileyeceğinin ve travma semptomlarının belirleyicilerindendir. Her çocuk travmatik olayı kendisine özgü bir şekilde anlamlandırır. Travma yaşantısı ile terapiye gelen değerlendirilirken, risk faktörleri, çocuğun gelişimsel seviyesi ve işleyişi aile merkezli bir yaklaşımla, bütüncül ve çok yönlü bir şekilde ele alınmalıdır. Çocuğun istismarı ile sonuçlanabilecek her türlü durumu çok yönlü anlamak için ebeveyn çocuk ilişkisini şekillendiren ailevi, kültürel, sosyoekonomik ve toplumsal faktörlerin dikkate alındığı sosyal psikolojik bir yaklaşım önemlidir. Goodyear-Brown (2010; 2019) tarafından geliştirilen TravmaOyun, oyunun kolaylaştırıcı gücünü kullanarak çocuğun gelişimine duyarlı bir yaklaşım sunmaktadır. Terapist çocuk için güvenli bir üs görevi görür ve çocuk, terapist ile iyileştirici bir ilişkiyi deneyimler. Bir yetişkinle istikrarlı, güvenli bir ilişkinin merkezindeki hassas ve dikkatle zamanlanmış müdahaleler yoluyla, travma yaşamış çocuklar, yalnızlığa, terk edilmiş olma, kayıp, kötü muameleye ilişkin duygularını iyileştirir. Travmatik yaşantının zehirleyici etkisinden arınma sağlanıp, semptomların kontrol altına alınmasıyla, terapistin sağladığı güvenli alan sayesinde, çocuğun geleceğe dair umutları geliştirilir.

Anahtar Kelimeler

• Esnek sıralı oyun terapisi
• TravmaOyun
• Kişilerarası travma
• Karmaşık travma
• Çocuk ihmali
• Çocuk istismarı

Kaynakça

1. Baggerly, J. N. ve Green, E. J. (2014). Mending broken attachment in displaced children finding “home” through play therapy. C. A. Malchiodi ve D. A. Crenshaw (Ed.), Creative arts and play therapy for attachment problems (s. 275–293) içinde. The Guilford Press.
2. Booth, P. B ve Jernberg, A. M. (2010). Theraplay: Helping parents and children build better relationships through attachment-based play. John Wiley & Sons.
3. Boyes, M. E., Hasking, P. A. ve Martin, G. (2016). Adverse life experience and psychological distress in adolescence: moderating and mediating effects of emotion regulation and rumination. Stress & Health, 32(4), 402-410. https://doi.org/10.1002/smi.2635.
4. Bulut, S. (2008). Erken çocukluk dönemi cinsel istismarının psikodinamik oyun terapisi ile teşhisi ve tedavi edilmesi. Türk Psikolojik Danışma ve Rehberlik Dergisi, 29(3), 131-144.
5. Bunchanan, G., Gewirtz, A. H., Lucke, C. Ve Wambach, M. R. (2020). The concept of childhood traumna in psychopathology: Definitions and historical perspectives. G. Spalletta, D. Janiri, F. Piras ve G. Sani (Ed), Childhood trauma in mental disorders: A comprehensive approach (s. 9-28) içinde. Springer.
6. Calam, R., Bolton, C., Barrowclough, C. ve Roberts, J. (2002). Maternal expressed emotion and clinician ratings of emotional maltreatment potential. Child Abuse & Neglect, 26(10), 1101–1106. https://doi.org/10.1016/S0145-2134(02)00373-3.
7. Cohen, J. A., Mannarino, A. P. ve Deblinger, E. (2017). Treating trauma and traumatic grief in children and adolescents. The Guilford Press.
8. Cook A., Blaustein, M., Spinazzola, J. ve van der Kolk, B. (2003). Complex trauma in children and adolescents: White paper. Allston, MA: National Child Traumatic Stress Network, Complex Trauma (NCTSN) Task force.

9. Crosson-Tower, C. (2014). Understanding child abuse and neglect. Pearson Education.
10. Crouch, E., Strompolis, M., Bennett, K.J., Morse, M. ve Radcliff, E. (2017). Assessing the interrelatedness of multiple types of adverse childhood experiences and odds for poor health in South Carolina adults. Child Abuse & Neglect, 65, 204- 211. https://doi.org/10.1016/j.chiabu.2017.02.007
11. Cuffe, S. ve Shugart, M. (2001). Child abuse and psychic trauma in children. H. B. Vance ve A. J. Pumariega (Ed.), Clinical assessment of child and adolescent behavior (s. 470-497) içinde. John Wiley & Sons.
12. D’andrea, W., Stolbach, B., Spinazzola, J. Ve van der Kolk, B. (2012). Understanding Interpersonal Trauma in Children: Why We Need a Developmentally Appropriate Trauma Diagnosis. American Journal of Orthopsychiatry, 82(2), 187-200.
13. Dube, S. R., Felitti, V. J., Dong, M., Giles, W. H. ve Anda, R. F. (2003). The impact of adverse childhood experiences on health problems: Evidence from four birth cohorts dating back to 1900. Preventive Medicine, 37(3), 268-277. https://doi.org/10.1016/S0091-7435(03)00123-3
14. Elbrecht, C. (2015). The clay field and developmental trauma in children. Creative interventions with traumatized children. C. A. Malchiodi (Ed.), Creative interventions with traumatized children (s. 191-212) içinde. The Guilford Press.
15. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P. ve Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experience (ACE) study. American Journal of Preventive Medicine, 14, 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8
16. Finkelhor, D., Turner, H., Ormond, R. ve Hamby, S. L. (2009). Violence, abuse, and crime exposure in a national sample of children and youth. Pediatrics, 124, 1411–1423. http://dx.doi.org/10.1542/peds.2009-0467.
17. Haselgruber, A., Sölva, K. ve Lueger-Schuster, B. (2020). Validation of ICD-11 PTSD and complex PTSD in foster children using the International Trauma Questionnaire. Acta Psychiatrica Scandinavica, 141(1), 60–73. https://doi.org/10.1111/acps.13100
18. Gil, E. ve Dias, T. (2014). The integration of drama therapy and play therapy in attachment work with traumatized children. C. A. Malchiodi ve D. A. Crenshaw (Ed.), Creative arts and play therapy for attachment problems (s. 100-120) içinde. Guilford Publications.
19. Goodman, R. ve Scott, S. (2012). Child and adolescent psychiatry. Wiley-Scott.
20. Goodyear-Brown, P. (2010). Play therapy with traumatized children: A prescriptive approach. John Wiley & Sons.
21. Goodyear-Brown, P. (2012). Flexibly Sequential Play Therapy (FSPT) with sexually victimized children. P. Goodyear-Brown (Ed.), Handbook of child sexual abuse: Identification, assessment, and treatment (s. 297–319). John Wiley & Sons.
22. Goodyear-Brown, P. (2019). Trauma and play therapy: Helping children heal. Routledge. https://doi.org/10.4324/9781351216869
23. Gümüş, A. E. ve Karaırmak, Ö. (2018). İstanbul’da bazı devlet liselerinde eğitim gören, travmaya ve stres yükleyici olaylara maruz kalan ergenlerin travmatik belirti şiddetinin karşılaştırılması. Klinik Psikiyatri, 21, 261-270. DOI: 10.5505/kpd.2018.64326
24. Iwaniec, D. (2006). The emotionally abused and neglected child: Identification, assessment and intervention, a practice handbook. John Wiley & Sons.
25. Hoffman, K. T., Marvin, R. S., Cooper, G. Ve Powell, B. (2006). Changing toddlers’ and preschoolers’ attachment classifications: the circle of security intervention. Journal of Consulting and Clinical Psychology, 74(6), 1017-1026.
26. Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Benjet, C., Evelyn, J., Bromet, E. J., Cardoso, G., . . . Koenen, K. C. (2017). Trauma and PTSD in the WHO World Mental Health Surveys. European Journal of Psychotraumatology, 8(5). https://doi.org/10.1080/20008198.2017.1353383
27. Kohl, P. L., Kagotho, J. N., & Dixon, D. (2011). Parenting practices among depressed mothers in the child welfare system. Social Work Research, 35(4), 215–225. https://doi.org/10.1093/swr/35.4.215.
28. Kovachy, B., O’Hara, R., Hawkins, N., Gershon, A., Primeau, M. M., Madej, J., ve Carrion, V. (2013). Sleep disturbance in pediatric PTSD: Current findings and future directions. Journal of Clinical Sleep Medicine, 9, 501–510. http://dx.doi.org/10.5664/jcsm.2678.
29. Malchiodi, C. A. (2014). Creative arts therapy approaches to attachment issues. C. A. Malchiodi ve D. A. Crenshaw (Ed.), Creative arts and play therapy for attachment problems (s. 3-19) içinde. Guilford Publications.
30. Malchiodi, C. A. (2015). Neurobiology, creative interventions, and childhood trauma. C. A. Malchiodi (Ed.), Creative interventions with traumatized children (s. 3-23) içinde. The Guilford Press.
31. Mattejat, F. ve Remschmidt, H. (2008). The children of mentally ill parents. Deutsches Ärzteblatt International, 105(23), 413-418. DOI: 10.3238/arztebl.2008.0413.
32. Mauritz, M. W., Goossens, P. J., Draijer, N. ve van Achterberg, T. (2013). Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness. European journal of psychotraumatology, 4, 10.3402/ejpt.v4i0.19985. https://doi.org/10.3402/ejpt.v4i0.19985
33. Nurius, P. S, Logan-Greene P. ve Green, S. (2012). Adverse childhood experiences (ACE) within a social disadvantage framework: Distinguishing unique, cumulative, and moderated contributions to adult mental health. Journal of Prevention and Intervention in the Community, 40(4), 278-290. https://doi.org/10.1080/10852352.2012.707443
34. Pearson, M. ve Wilson, H. (2014). The evolution of sandplay therapy applications. Psychotherapy in Australia, 21(1), 94-100. http://hdl.handle.net/2440/90058
35. Pelendecioğlu, B. ve Bulut, S. (2009). Çocuğa yönelik aile içi fiizksel istismar. Abant İzzet Baysal Üniversitesi Dergisi, 9(1), 49-62.
36. Repetti, R. L., Taylor, S. E. ve Seeman, T. E. (2002). Risky families: Family social environments and the mental and physical health of offspring. Psychological Bulletin, 128(2), 330-366. https://doi.org/10.1037/0033-2909.128.2.330
37. Schore, A. N. (2017). Playing with the right side of the brain. American Journal of Play, 9(2), 105-142.
38. Smith, A. L., Cross, D., Winkler, J., Jovanovic, T. ve Bradley, B. (2014). Emotional dysregulation and negative affect mediate the relationship between maternal history of child maltreatment and maternal child abuse potential. Journal of Family Violence, 29(5), 483–494. https://doi.org/10.1007/s10896-014-9606-5.
39. Spinazzola, J., van der Kolk, B. ve Ford, J. D. (2018). When nowhere is safe: interpersonal trauma and attachment adversity as antecedents of posttraumatic stress disorder and developmental trauma disorder. Journal of Traumatic Stress, 31, 631–642. https://doi.org/10.1037/0033-2909.128.2.330
40. Stien, P. T. ve Kendall, J. C. (2004). Psychological trauma and the developing brain: Neurologically based interventions for troubled children. Routledge.
41. Stoltenborgh, M., Bakermans-Kranenburg, M. J., Alink, L. R. A. ve van Ljzendoorn, M. H. (2015). The prevalence of child maltreatment across the globe: Review of a series of meta-analyses. Child Abuse Review, 24(1), 37–50. https://doi.org/10.1002/car.2353
42. Terr, L. C. (1991). Childhood Traumas: An Outline and Overview. American Journal of Psychiatry, 148, 10-20. https://doi.org/10.1176/foc.1.3.322
43. Turan, A. ve Traş, Z. (2017). An Investigation of The Relationship Between Childhood Trauma Experience of Adolescents and Perceived Social Support. OPUS Uluslararası Toplum Araştırmaları Dergisi, 7(13), 440-458. DOI: 10.26466/opus.349223
44. Van der Kolk, B. Ford, J. D. Ve Spinazzola, J. (2019). Comorbidity of developmental trauma disorder (DTD) and post-traumatic stress disorder: findings from the DTD field trial. European Journal of Psychotraumatology, 10, 1562841.https://doi.org/10.1080/20008198.2018.1562841
45. Vaughan, J. (2004). Rationale for the Intensive Programme. C. Archer (Ed.). Trauma, attachment, and family permanence: fear can stop you loving (s. 148-163) içinde. Jessica Kingsley Publishers.
46. Verduyn, C., Rogers, J. ve Wood, A. (2009). CBT with children, adolescents and families. Routledge.
47. Wamser-Nanney, R. ve Vandenberg, B. R. (2013). Empirical support for the definition of a complex trauma event in children and adolescents. Journal of Traumatic Stress, 26, 671-678. https://doi.org/10.1002/jts.21857
48. Webb, N. B. (2006). Crisis intervention play therapy to help traumatized children. L. Carey ve J. Rubin (Ed.), Expressive and creative arts methods for trauma survivors (s. 39-56) içinde. Jessica Kingsley Publishers.