Caregiver Trauma and Mental Health
When children experience trauma, they are not the only ones impacted. Parents and other caregivers often hurt deeply too. Some caregivers might experience distress associated with learning about or observing their children’s traumatic experiences and symptoms. This is called vicarious trauma; it can impact caregivers’ mental health (manifesting as posttraumatic stress, depression, anxiety, or other symptoms), physical health, and interpersonal relationships.
Beyond vicarious trauma, caregivers may suffer in other ways. Some caregivers and children experience shared traumatic experiences. Domestic violence, community violence, or natural disasters are three examples of events that are often experienced as traumatic by caregivers and children together. In these cases, caregivers may present with their own posttraumatic stress symptoms related to the same experiences causing distress for children.
Caregivers’ own histories of trauma may also impact their functioning following their children’s trauma exposure. Even caregivers who are long healed from their own traumatic childhoods might feel triggered by their children’s experiences. When this happens, symptoms associated with caregivers’ past trauma experiences might re-emerge at the same time that their children are relying on them for support and comfort post-trauma. Other caregivers may have had no treatment or healing related to their own trauma; they are parenting traumatized children while experiencing their own posttraumatic stress symptoms (and possibly vicarious trauma on top).
The relationship between child and parent functioning after traumatic events is still being studied, but clinical experience suggests a positive relationship between caregiver well-being and children’s post-trauma adjustment. Therefore, as we look to reduce children’s distress in the aftermath of trauma and prevent the onset of PTSD, improving the well-being of caregivers is an important (but often overlooked) intervention target. Reducing caregivers’ suffering is also a worthy goal unto itself.
The Child and Family Traumatic Stress Intervention, offered at CASGSL through Project CONTACT, directly addresses caregiver functioning. Initially, engagement specialists work with caregivers to identify and address concrete needs and barriers. As treatment begins, CONTACT clinicians meet individually with caregivers with the goal of understanding of the caregivers’ own trauma histories. Clinicians assess caregivers’ posttraumatic stress and vicarious trauma symptoms using standardized measures. Based on the assessment results, clinicians refer caregivers, as appropriate, for their own treatment. Caregivers who might be reluctant to pursue their own therapy at the beginning of the CFTSI are often much more amendable to seeking professional help by the conclusion of the intervention, having experienced warmth and support from the CFTSI clinicians, and witnessing functional improvements in their children and themselves within span of just five or six sessions.
Caregivers often experience symptom relief directly during (and following) the combined child-caregiver CFTSI sessions. Alongside their children, caregivers receive psychoeducation designed to normalize symptoms and instill hope. Together, children and caregivers learn and practice adaptive coping skills (e.g., self-calming skills, affective expression skills, and positive self-talk) during sessions. At home, they practice and refine these skills and implement routines that are helpful for the whole family, such as sleep hygiene practices, house rules, and parent-child communication.
During caregiver-only CFTSI sessions, clinicians help increase parenting self-efficacy. Caregivers learn how to respond effectively to child trauma symptoms, both internalizing and externalizing. They receive feedback about establishing healthy family boundaries, managing difficult behaviors, and communicating support to their children. This information and skill-building helps caregivers shift to a more internal locus of control. They learn from the CFTSI that they are important forces for good within the lives of their children, and that they can play a powerful role in their children’s trauma recovery. Through implementing new skills and healthy routines at home, improving caregiver-child communication, and experiencing emotional safety and renewed hope for healing and even posttraumatic growth, everyone in the family wins through participation in CFTSI.