DIR®-informed approach to anxiety and trauma in school age children

Abstract

As dwellers of our planet receive an overwhelming amount of information and live coverages of scary, traumatizing and horrifying events around the globe, anxiety takes the front seat in the clinical discourse. At the same time, children are even more susceptible to anxiety than adults, mainly because of lack of control over their lives, actual helplessness, operating largely on clues and adult whisper rather than on confirmed (and comprehended by them) facts; most of the time, they have no impact on own future. Excessive worry and uncertainty can manifest itself as aggression, “striking out”, low frustration tolerance and impulsivity. Another, not less important, predictor of anxiety is the ability to self-regulate and the speed with which a child can recover from stress or perceived danger and, shutting down the initial response of hypervigilance, go back to the state of homeostasis.

Naturally, all the above greatly depends on individual history and patterns of resilience. Prior history of trauma is the most important marker of emerging symptoms of anxiety and anticipatory anxiety. Mechanisms of trauma processing, as well as family and individual history of trauma and vicarious traumatization should be closely examined in the process of assessment and addressed in psychotherapeutic treatment regardless of the nature and scope of presenting problems.

This paper examines presenting problems of latency age children, stemming from anxiety and/or psychological trauma. The author shares her experience of addressing the above issues in psychotherapeutic work using Developmental, Individual differences and Relationship based approach (DIR®). This diagnostic and treatment model defines and describes the hierarchy of developmental capacities humans are to achieve throughout their early, formative years, individual profile (unique ways of information processing) and employing affect based therapeutic interaction to promote the development of the above. Individual profile includes motor control, praxis, visual spatial capacities and integration of sensory information supplied by five organs of sense and vestibular, visceral and proprioceptive systems, language capacities, and affective relationships. DIR® can be utilized for the purpose of differential diagnosis, as well as an invaluable philosophical base. This diagnostic and treatment paradigm allows for comprehensive scrutiny of co-occurring problems, developmental capacities and a multitude of variations in sensory, medical, familial and environmental characteristics that serve as prequel to symptoms. Additionally, DIR® lends us a treatment philosophy that leaves room for the individuality of the child. Case examples illustrate application of DIR® and utilizing elements of the DIR Floortime.