Journal of Developmental & Behavioral Pediatrics:
Lorain County Health and Dentistry; Lorain, Ohio
Childhood Trauma Handbook: A Guide for Helping Trauma-Exposed Children and Adolescents
by Ricky Greenwald, PsyD, Binghampton, NY
Haworth Maltreatment and Trauma Press and the Haworth Reference Press, Imprints of the Haworth Press, Inc., 2005, 342 pp., $39.95, paperback
This is a fascinating and very useful book, presented as though the reader were participating in a workshop run by the author. It is written in a conversational style, that is easy to read, and addressed primarily to mental health workers. However, it has useful information for anyone who works with troubled children or adolescents on a regular basis. The author refers to personal experience of the effectiveness of this approach but also sites published and ongoing research confirming its usefulness. In addition, he lists a short bibliography at the end of each section and a more extensive one at the end of the book. The overall premise and therapeutic approach make good sense. It describes the effect of past trauma and suggests ways of helping the traumatized child and family see and deal with their painful reality successfully.
The author starts with a clear description of trauma and how it can affect different children in different ways. He describes what some of the ameliorating and exacerbating internal and external conditions that can either help a child adjust to trauma or become overwhelmed by it. He reminds the reader that all behavior has a meaning or serves a purpose, even if the person who is acting out is not aware of the origins, meaning, or purpose of their behavior. He uses a storybook analogy to illustrate this process, relating each step to the story. This child's trauma (the dragon), adaptation to the trauma (the people protecting themselves), problem behaviors resulting from the adaptation (the protective measures themselves becoming destructive) and steps in therapy to recovery (attaining the princess) for the child (the hero) and family (the hero's helpers) are all described in this way. The various steps described empower the child and the family, with the coaching of the therapist, to take the lead in their own recovery; to achieve recognition of the past trauma and its current effects and to overcome it all.
The author also reminds professionals who work with traumatized children regularly that they need to take care of themselves if they hope to adequately and consistently give care to these children and their distressed families. He points out that professionals can contribute to their own “burn out” and that this can add to the child's difficulty in recovery. As in a good workshop, he gives readers exercises to help them relax and avoid traumatizing themselves with their current work. He also reminds the reader that even well seasoned, well-trained senior professionals benefit from sharing cases and getting second opinions from their peers.
The textbook/workshop then takes the reader, step by step, with exercises, examples and specific scripts of conversations, through the therapeutic process. The intake session is designed to teach the child and family what to expect from therapy, to identify the positive conditions for the child and family and the situations bothering them, and to help the child identify goals/behaviors that can replace the troublesome ones. The next step, not the first one, is to identify the trauma, without so much detail that it will overwhelm the child. Helping the child and family recognize how the past trauma affects current behavior and then helping the child successfully change the current behavior comes next. Facing the actual past trauma comes after the child and family have had success in easier tasks. Finally, helping prevent relapses is also discussed.
Though the book is easy to read, it is not a book one can read through quickly and immediately incorporate into practice. It is worth taking the time to read, digest and practice each step. It might even be more effective to go though it with a trusted colleague, as though in a small workshop. It is an excellent book, for whatever amount of information, self help, or practice skills one chooses to take away from it.
Conleth M.C. Crotser, MD
Lorain County Health and Dentistry