Family-Focused Trauma Intervention: Using Metaphor and Play with Victims of Abuse and Neglect

213 Pages·2010·0.64 MB·English

by  Pat Pernicano

Family-Focused
Trauma Intervention

Family-Focused
Trauma Intervention
Using Metaphor and Play with
Victims of Abuse and Neglect
Pat Pernicano, PsyD
JASON ARONSON
Lanham (cid:129) Boulder (cid:129) New York (cid:129) Toronto (cid:129) Plymouth, UK
Published by Jason Aronson
An imprint of Rowman & Littlefield Publishers, Inc.
A wholly owned subsidiary of The Rowman & Littlefield Publishing Group, Inc.
4501 Forbes Boulevard, Suite 200, Lanham, Maryland 20706
http://www.rowmanlittlefield.com
Estover Road, Plymouth PL6 7PY, United Kingdom
Copyright © 2010 by Jason Aronson
All rights reserved. No part of this book may be reproduced in any form or by
any electronic or mechanical means, including information storage and retrieval
systems, without written permission from the publisher, except by a reviewer who
may quote passages in a review.
It is permissible for therapists to photocopy the stories and the handout/
worksheet pages for use within their own practice.
British Library Cataloguing in Publication Information Available
Library of Congress Cataloging-in-Publication Data
Pernicano, Pat, 1954–
Family-focused trauma intervention : using metaphor and play with victims of
abuse and neglect / Pat Pernicano.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-7657-0772-7 (cloth : alk. paper) — ISBN 978-0-7657-0774-1
(electronic)
1. Psychic trauma in children. 2. Abused children—Psychology. 3. Abused
children—Rehabilitation. 4. Child psychotherapy. 5. Family psychotherapy. I.
Title.
RJ506.P66P47 2010
618.92’8521—dc22
2009050674
(cid:2) ™
The paper used in this publication meets the minimum requirements of
American National Standard for Information Sciences—Permanence of Paper
for Printed Library Materials, ANSI/NISO Z39.48-1992.
Printed in the United States of America
Contents
Acknowledgments xi
Introduction 1
1 Impact of Trauma and Overview of Treatment 7
PTSD 9
Story: A Bear of a Different Color 11
Treatment Interventions 15
Bear Drawing Activity 15
Bear Body-Tracing Activity 15
Bear Trauma Narrative 15
Alternate Trauma Narrative: A Night at the Movies 16
Changing the Story 17
Handout: Use Your Common Senses 18
Handout: Magic Remote 20
Take-It-Home Discussion Questions 21
Symptoms of PTSD 22
Story: Lucky the Junkyard Dog 23
Treatment Interventions 26
Family Activity: Match Game 26
Parent Group Discussion 26
PTSD Guided Imagery 26
Take-It-Home Discussion Questions 27
Handout: The Lucky Family Match Game 28
Sibling Abuse 29
Story: Stick Together 30
v
vi Contents
Treatment Interventions 33
Desert and Oasis Activity 33
Take-It-Home Discussion Questions 33
Residual Effects of Trauma 33
Story: Thyme to Heal 35
Treatment Interventions 38
Family Drawing 38
Take-It-Home Discussion Questions 38
2 Establishing Appropriate Roles and Boundaries in Families 39
Age-Appropriate Expectations 41
Story: Velma Crowe’s Sticky Situation 42
Treatment Interventions 47
Stick, Babies, Stick! 47
Role Reverse (Parenting Group) 47
Bird School for Velma 48
Take-It-Home Discussion Questions 48
3 The Fight of Fight or Flight: Self-Control and Modulation
of Affect 49
Self-Control 51
Story: Keep Your Lion on a Leash! 53
Treatment Interventions 56
Lion Drawing Activity 56
Leashing Activity 56
Cool Down the Volcano! 56
Take-It-Home Discussion Questions 58
Power and Control 58
Story: The Nearsighted Tyrant 59
Treatment Interventions 63
Focusing Activity 63
Take-It-Home Discussion Questions 64
4 Reducing Hyperactivity and Agitation 65
Treatment Interventions 66
The Turtle Technique 66
Up, Up, and Away: Guided Imagery for Stress Reduction 68
Darcie’s Dots 69
5 Flight: Avoidance, Withdrawal, and Dissociation 71
Dissociation 72
Story: The Mouse Who Became Invisible 73
Treatment Interventions 76
Speak (Squeak) Up! 76
Take-It-Home Discussion Questions 77
Contents vii
Avoidance and Denial 77
Story: The Hidey Hole 78
Treatment Interventions 80
Buried Secrets 80
Family Mural: Heads in the Holes 80
Take-It-Home Discussion Questions 80
Depersonalization 81
Story: Time for a Thaw 82
Treatment Interventions 84
The Family Berg 84
Take-It-Home Discussion Questions 84
6 Reducing Worry, Fear, and Anxiety 85
Letting Go 86
Story: The Burden Bag 87
Treatment Interventions 90
No Fishing! 90
Take-It-Home Discussion Questions 90
Anxiety Reduction and Containment 91
Story: Wrap It Up! 92
Treatment Interventions 94
Wrap It Up like a Spider 94
The Smooth Stone 94
Handout: Web Worksheet 95
Take-It-Home Discussion Questions 96
7 Disrupted Attachment: Coping with Loss and Renewing Trust 97
Attachment and Trust 99
Story: Run Away Ralph 100
Treatment Interventions 102
Attachment Hide and Seek 102
Very Special Delivery 102
The Power of Attraction 103
Parent Promises 104
Take-It-Home Discussion Questions 105
Building Positive Attachment 105
Treatment Intervention 105
Stick with It! 105
8 Changing Depressed Mood 107
Mood Management 108
Story: The Black Cloud 109
Treatment Interventions 113
Lighten Your Cloud 113
Handout: Cloud Worksheet 114
Take-It-Home Discussion Questions 115
viii Contents
9 Empathy: Caring for Yourself and Others 117
Heartbreak 118
Story: The Girl with the Plastic Heart 119
Treatment Interventions 122
Heart to Heart 122
Walking in Each Other’s Shoes 122
Make It Better 123
The Blessing 123
Take-It-Home Discussion Questions 124
10 Responsibility and Accountability 125
Externalizing Blame 127
Treatment Interventions 127
Get Ready to Get Mad! 127
The Mad List 127
Handout: Your Mad List 128
Your Day in Court 129
Handout: Your Day in Court 130
Taking Responsibility 132
Story: No More Blame Game 133
Treatment Interventions 136
Give Up the Game 136
Take-It-Home Discussion Questions 137
Blaming the Victim 137
Story: First Things First 138
Treatment Interventions 140
A Helping Hand 140
Healing a Broken Heart 140
Hamburger Hurter 140
Telling the Child’s Story: The Child’s Point of View 141
The Transformer 144
Take-It-Home Discussion Questions 145
Handout: What Went Wrong in Our Casserole? 146
11 Safety and Protection 147
Knowing Who to Trust 148
Story: The Hungry Alligator and the Mean Snake 149
Treatment Interventions 152
Safe and Sound 152
Who’s Who? 153
Red Light, Green Light 153
DOs and DON’Ts: Family Rules 154
A Day Away from the Zoo 154
Warning! Warning! 155
Contents ix
Take-It-Home Discussion Questions 155
Handout: Family Risk List 157
12 The Family Journey: Pathways to Change 159
Moving in a New Direction 160
Story: Gold in the Desert 161
Treatment Interventions 163
Alphabet Journey 163
Water Out of a Rock 163
The Family Journey Mural 164
Family Match Game 164
Take-It-Home Discussion Questions 165
Handout: Family Match Game 166
13 Coming to Terms with Out-of-Home Care 169
Out-of-Home Placement 170
Story: The Good Enough Elf 172
Treatment Interventions 176
The Send Off 176
Take-It-Home Discussion Questions 176
Impact of Neglect 176
Story: The Bruised Orchid 177
Treatment Interventions 179
Orchid Activity 179
Take-It-Home Discussion Questions 179
14 Self-Acceptance and Hope 181
Lowering Defenses 182
Story: Polly’s Plight 183
Treatment Interventions 187
Peeling Your Onion Feelings 187
Peeling Away Memories 187
The Family Cake 187
Handout: The “Onion” Worksheet 188
Handout: Feelings Words 189
A Tough Nut to Crack 190
Take-It-Home Discussion Questions 190
Appendix: Squiggles Stories 191
References 193
Index 197
About the Author 199