Preverbal Trauma – Therapy Problems
A. R. Quintiliani, Ph.D., LADC
Preverbal trauma (hereafter PVT) is one of the most pervasively troubling human conditions. PVT occurs when a preverbal child is exposed to parental, caretaker, or other forms of abuse. This abuse may be sexual, physical, or emotional. This form of abuse is so destructive because the child has no cognitive/executive/verbal ways to understand and respond to the experience. The long-term bio-psycho-social-spiritual effects of PVT are quite difficult to treat effectively. One reason for this is that some therapist are determined to utilize their favorite approaches (mainly forms of pure talk-therapy and psychodynamic holding) despite the limited effectiveness that these forms of therapy results in. Still worse for the client is generic talk therapy, often a mixture of various talk-therapy components but no actual evidence-based method of helping. Remember it is our obligation to Do No Harm and to use therapeutic interventions beyond alliance that are effective. There may be moral if not ethical implications here.
It is best to keep in mind that both The American Psychological Association and The Agency of Healthcare Research and Quality found recently that correctly applied CBT is the therapy of choice for most forms of trauma. These investigations were thorough and completed in an independent manner. The APA is a professional guild group representing the interests of psychologists, but the AHRQ is a semi-governmental research arm looking into how we spend healthcare dollars. Their main concern is that we spend healthcare funds doing evidence-based interventions with good outcomes. In the interest of research, of course other therapies have been found to be effective with trauma. To mention a few, these are EMDR, DBT, PET, and, Briere’s self-trauma therapy with slow, complete exposure work. MBSR and ACT may be helpful regarding emotional dysregulation in traumatic re-experiencing and self-empowerment. Of course effective attachment therapy with very specific object relations correctives is also helpful.
The following list contains many conditions that make PVT difficult to treat. These suggest that therapy modifications may be needed. The effects of PVT may include:
- The non-verbal experience itself;
- Somatics of ACEs;
- Unexplained body sensations and feelings;
- Unexplained bodily awareness;
- Problems with long-term memory formation about the event/s;
- Visual observation without clear cognitive understanding;
- Painful and uncomfortable sensory experiences without apparent causation;
- Possible increased limbic fear reactions without clear rationale;
- Emotion dysregulation without grounding about specific stimuli and variables;
- Parts-of-body reactions without clear causes;
- Classically conditioned emotional responses without clear conscious cause and effects; and
- Brain sensitivity to future traumatic experiences.
Hopefully this list will encourage you to re-examine the form of therapy you may be using for PVT. Hopefully, this list of intense suffering of a child due to PVT will motivate you to use an evidence-based approach.
Anthony R. Quintiliani, PhD., LADC
From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont and the Home of The Monkton Sangha
Author of Mindful Happiness