“Safety building” as a key moment in therapy of polytraumatized children and adolescents

Children who are victimized as a result of their experience with interpersonal violence are often overwhelmed by emotions, they have difficulties with concentration and are dissociated. Thus, their parents and caretakers are not a source of comfort and safety. Contrarily, they are a source of unpredictable danger, violence and maltreatment. This results to feelings of betrayal, extreme shame, helplessness, threat, intense fear and anger in the children. The core of traumatic stress is the collapse of the ability to regulate inner experience. In the initial phase of treatment, the clinician must prioritize basic stabilization of the client’s health over other psychotherapeutic interventions. Building a safe therapeutic relationship is a key moment of trauma psychotherapy. As a result, this process is extremely demanding for the psychotherapist who has to face a lot of difficulty. Therapist behaviours that can increase the client’s sense of safety and stability include especially the following components of integrative approach to the complex trauma treatment: nonintrusiveness, visible positive regard, reliability and stability and transparency. This approach includes therapeutic exposure, i.e. exposing the client to memories of a traumatic event until the associated emotions are desensitized. The therapeutic window represents a hypothetical “place” where therapeutic interventions are thought to be most helpful. Working towards trust and safety in a therapeutic relationship is essential to being able to start functional therapeutic work. Within this process, the client can verbalize threatening traumatic experiences, reflect them and reintegrate them in his or her life experience.

Jana Schmidtová, The Institute of Psychology of the Academy of Sciences of the Czech Republic, Brno, Czech Republic e-mail: skupina.schmidtova@seznam.czPetr Štěpánek, The Institute of Psychology of the Academy of Sciences of the Czech Republic, Brno, Czech Republic e-mail: step.petr@gmail.comIvo Čermák, The Institute of Psychology of the Academy of Sciences of the Czech Republic, Brno, Czech Republic e-mail: cermak@psu.cas.cz