She lives in Brattleboro, Vermont where she also maintains a small private practice.
Over the years, you’ve worked extensively as both a clinician and researcher, specializing in the area of adolescent psychology. How did you find your way into working with this specific population?
Thanks for your interest in my work! I can think of maybe three decent explanations for this passion, though at the end of the day, it’s perhaps at the foundation, just more of a compelling feeling.
I grew up with both privilege and a sense of obligation to give back—my family is full of helpers and teachers. When I was about 12, I started volunteering; I think I’ve known I’d be doing something psychological from very early on.
And then I had an, ahem, difficult adolescence of my own; the adults who saw past my angry bluster and believed in me are sort of heroes to me even still. So that’s in the mix, too. But at the end of the day, I really love being with kids and seem to have the capacity to sit with huge emotions without getting discombobulated by them.
Your new book “Treating Trauma in Adolescents: Development, Attachment, and the Therapeutic Relationship” presents an innovative approach to working with traumatized teens. What makes the approach unique?
I’m not sure it’s unique because it’s built on an established theoretical foundation: attachment research, the study of contemporary adolescence and findings from interpersonal neurobiology (IPNB). I don’t need to have the illusion that what I’m calling “Developmental Relational Therapy” (DRT) is pure invention. But I think it offers six elements that are noteworthy and distinguish it from some other ways of working with traumatized teens.
First, the acquisition of skills, per se, is not the primary focus of this work. Conversation about internal states and shifts toward greater balance emerge out of what it feels like being together.
second distinction, related to the first, is that self-soothing is viewed in DRT as a more advanced ability, one that is only addressed once the adolescent can experience and identify states of connection and calm being “co-regulated”—in relationship.
A third, central tenet of this two-person system, then, is that much greater responsibility for regulation is placed on the shoulders of the involved adults. DRT presupposes that therapists first take responsibility for a higher level of attunement and compassion.
Fourth, I’m interested in the growing literature on attachment trauma that suggests using different intervention strategies depending on whether a teen tends to deactivate or hyperactivate under stress. For example, an adolescent who has a dismissive attachment pattern, or who copes dissociatively, will ultimately benefit from relational up-regulation: Bringing emotion and awareness into the room to become more connected.
By contrast, more preoccupied teens tend to become flooded with incapacitating affect. For these adolescents, we’ll rely more on down-regulation strategies; soothing them, helping them untangle their ideas and staying grounded with them.
Fifth, all emotional expression can be attachment-based. A goal of treatment is to help adolescents bring a broader range of expressiveness into therapy, including, for example laughter, tears, terror and authentic bravery.
Finally, DRT focuses on adolescent therapy as something different from child treatment (e.g., traditional play therapy techniques), or approaches to working with adults (e.g., more self-reflective, insight-oriented, problem-solving strategies). Adolescence is a developmental period like no other and as such, it requires a very flexible, engaging approach to intervention—not too infantile but not too abstract, either.
Why was there a need for this book? Why is it so important to treat trauma in adolescents as opposed to other issues such as anxiety, depression, substance use, etc.?
Childhood exposure to adverse and potentially traumatic experiences is arguably our single greatest public health problem in the US. Fifty years in, findings from epidemiological research like the Adverse Childhood Experiences Study (ACES) and many others, seem quite conclusive that somewhere between a quarter and a half of kids are contending with the effects of developmental trauma; it’s obviously even a higher number in some impoverished and under-resourced communities.
When we are treating symptoms or diagnosing abused and neglected kids with multiple other labels (including, for example, ADHD, psychosis, substance abuse, anxiety and depression), we miss the opportunity to be truly helpful by treating what lies below.
I try not to see trauma with a capital “T” everywhere, but it’s a lot more common than most people understand and it has profound cascading effects on thinking, feeling, behaving and relating.
You explore this in-depth in your book, but if you had to boil it down here, what wisdom would you offer for those struggling with teens who are reluctant to engage in the therapeutic process?
At the end of therapy, I always ask my adolescent clients (and families) what was most helpful. They almost invariably speak to my persistence: I didn’t give up.
On that journey, I allowed myself to feel miserable and ineffective and to admit that this kid had strategies for hooking me that were truly next-level. Then I tried to do something different and better.
So: get buy-in through flexibility, collaboration and doing whatever it takes to make this relationship different and special. These kids have plenty of reason to be wary of relationships—it’s on you to make and sustain the connection.
And one more thing: Don’t take it personally.
In the book you also sort of debunk the idea that the ultimate accomplishment of the adolescent years is for a teen to “stand on his own two feet.” Can you talk a little bit about why you challenged this notion?
We expect to be able to depend on others in all the other stages of development, from infancy through old age, so why are we so gung-ho about self-reliance for teens who are uniquely vulnerable? Why do we pathologize and condemn adolescents and young adults who similarly need care?
Sadly, it’s likely that American values of autonomy and individuality may continue to hold significant sway in our culture as long as success is defined by self-reliance, self-enhancement and competition with others. But the costs of thinking this way are immense.
And attachment theory suggests, instead, something that may seem a bit paradoxical at first glance: Secure dependence actually fosters autonomy and self-confidence better than any other strategy. The more securely attached we are, the more separate and different we can be.
In my way of looking at adolescence, health means maintaining a felt sense of interdependency, rather than striving for separation and self-sufficiency.
The belief that early attachment styles remain consistent over time is popular, but as you mention in the book, this belief diminishes the focus in therapy on newer relationships and life events. Can you expand a bit about why this is relevant in the context of treating trauma in adolescents?
One of the many wonderful contributions of interpersonal neurobiology is research on neuroplasticity suggesting that healing relationships actually can heal traumatized adolescent brains.
There is also very encouraging data from explorations into changing attachment patterns over the course of psychotherapy. It turns out we can help our vulnerable and fearful clients become “earned secures.”
So here’s to neuroplasticity and psychotherapy. We can believe that our safe, stable, dependable care actually helps traumatized teens develop a more coherent sense of self—seeing themselves anew as lovable and worthy of love.
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