1. Using Words And Play To Support Preschoolers With Early Trauma Alicia F. Lieberman University of California San Francisco San Francisco General Hospital

2. Healthy Relationships Shape Healthy People

3. How The Brain And The Mind Develop The brain needs experience to grow and develop into a mind Areas of the brain that register pain, danger, and pleasure are nearly mature at birth Early experiences shape children’s expectations, what they can learn, and what their minds hold

4. Danger And Hope In Early Childhood Violence predicts negative child outcomes Poverty predicts negative child outcomes Violence and poverty often overlap Supportive relationships improve the odds

5. Children must be understood in the context of their relationships. “There is no such thing as a baby.” (Donald Winnicott) Attachment is...

6. Attachment Is... A Primary Human Drive Breathing, eating, sleeping, exploration and... Attachment. ALL children form attachments unless SEVERE deprivation.

7. Secure Base, Safe Haven: Fear, Attachment And Exploration AttachmentExploration Protection Learning Fear

8. Normative, Developmentally Appropriate Stress Emotionally Costly Stress Traumatic Stress A Continuum from Stress to Trauma

9. Universal, Normative Fears Fear of pain Fear of loss Fear of losing love Fear of body damage Fear of being bad Fear of dying

10. Fear of Body Damage https://www.youtube.com/watch?v=LDR6 S3xhL8c

11. Characteristics Of Trauma External threat to life or physical safety Unpredictability Terror Helplessness What is safe? What is dangerous? The 3 Fs: Fight, Flight, Freeze

12. Frequent Traumatic Stressors in Infancy and Early Childhood Exposure to violence Child Abuse, Domestic Violence, Community Violence Accidents Car crashes, Near Drownings, Burns, Falls, Dog Bites Much more frequent in the first five years than in the rest of a child’s life

13. Do Young Children Remember Trauma? After acquiring language, children describe what happened when they were pre-verbal Children may misunderstand an event The body remembers: Trauma triggers Fight, flight, freeze happen in the classroom

14. Ghosts In The Nursery Children learn by imitation From victim to perpetrator: We do to others what was done to us unless we remember our pain Aggression protects against fear: Speaking to the suffering under the rage

15. Young Children’s “Out Of Control” Behaviors May Be Signs Of Traumatic Stress

16. Post-Trauma Growth Happens The world is a dangerous place and trauma exposure is an ever-present risk for humans Suffering can stimulate a search for meaning that may lead to compassion for others and emotional growth Some of the greatest spiritual, artistic, and scientific achievements resulted from this search

17. Universal, Normative Pleasures Food Warmth Sensory pleasures Human relationships Beauty Meaning

18. Caregivers Can Protect Against External Dangers And Inner Fears

19. Role of Caregivers: “Bigger, Stronger, Wiser, And Kind” A consistent, caring relationship with an adult promotes child resilience by –Promoting social skills –Improving school performance –Decreasing behavior problems

20. Creating Angels In The Nursery Childcare setting as a safe place ECE staff as agents of hope Asking: “What happened to you?” Instead of: “What is wrong with you?” © Alicia F. Lieberman, Ph.D.

21. Experience: --You saw… --You heard.. Behavior, Feelings: --And now you… Intervention: This is a place where … Lieberman & Ghosh Ippen, 2014 Treatment Experience Behavior, Feelings Hope: Things can change for the better Creating Interventions Protective Steps: Creating safety

22. OVERARCHING GOAL: RESTORE DEVELOPMENTAL PROGRESS Affect Regulation Trust in Human Relationships Joy in Exploration and Learning

23. Domains Of Intervention: Sensorimotor Disorganization Emotional Dysregulation: Temper Tantrums Low Frustration Tolerance Aggression Non-Compliance

24. Intervention Strategies Effective calming activities Joining action to words -- Holding, containing -- Soothing voice -- Offering transitional objects -- Reassuring -- Rhythmic movement -- Books, Bubbles, Breathing

25. Domains Of Intervention: Recklessness, Self-Endangering, Accident-Prone Behavior

26. Meanings of Self Endangerment Cognitive immaturity, impulsiveness Mismatch between child temperament and environmental conditions Child search for adult reassurance --Will you look for me? --Do you love me?

27. Intervention Strategies Always take protective action -- Developmental guidance -- Active modeling Seek meaning of the behavior -- Child need for adult teaching -- Child urge to know parent will protect

28. The Dangers Of Caring Working with traumatized parents and children is stressful: –Hopelessness, anger, rescue fantasies Burnout and vicarious traumatization are real Self-care is essential to be effective

29. PRACTICE WHAT YOU TEACH Take care of yourself Cultivate time out Protect your private life Seek out supervision or consultation Build support systems at work

30. TAKE HEART! Small changes matter Mistakes can be repaired You don’t need to be a therapist to be therapeutic Define yourself as part of a therapeutic community