Dr. Harrington's Interview with New England Psychologist

Clinician works wit traumatized, abused children

The heightened awareness around issues of sexual abuse and trauma in the public forum helps shine a light on the prevalence of the issue in all age groups. As the country goes through what feels like a domino effect of sexual harassment and abuse allegations, public awareness helps victims to come forward for treatment and reduces the stigma surrounding the trauma, leading to better outcomes. According to Antoinette Harrington, Psy.D, a psychologist who specializes in working with children and adolescent victims, the increased attention also allows families to better understand and identify trauma reactions in children and know when to seek help.

A Brunswick, Maine, clinician who is also licensed in New Hampshire and Rhode Island, Harrington has seen how certain barriers, like a lack of appropriate caregivers, can exacerbate already difficult situations. To address access to care issues, she has worked to expand her reach to rural areas to offer services through telehealth.

She spoke with New England Psychologist’s Catherine Robertson Souter about her work with children and how the use of telehealth technology has helped her to begin to bridge the gap for undeserved populations.

Q: What is important for psychologists and other health professionals to understand around childhood trauma?

A: One in six boys and one in four girls will be sexually abused by their 18th birthday. Those statistics are alarming. Three out of four [of those] adolescents are victimized by someone they know. It’s likely happening to someone you know, in your neighborhood, in your child’s school, in your church.

As parents, we need to be vigilant in educating our children about body safety. As psychologists, it’s important to screen for childhood trauma during an initial diagnostic intake. As health professionals, it is vital to know the behavioral and emotional signs of child abuse and understand that it’s rarely an isolated incident and often perpetrated by someone of authority that the child knows.

Q: We talk about working with children but, of course, it’s the entire family with whom a psychologist will work?

A: The relationship and communication a child has with his/her caregivers is vital to overall social, emotional and cognitive development. How important people in a child’s life respond to them forms the basis of their identity and how they think and feel about themselves. We call this mirroring and it serves as the foundation to healthy attachment.

Q: In the past decade, have you seen many changes in the family dynamic that affect your work?

A: Parents today are overworked and physically and emotionally drained. We live in a technological era where the tablet or some other electronic device sometimes replaces quality interaction between children and caregivers. Children want to be seen and heard. Allowing a child to tell his/her daily story offers an opportunity for mirroring. In my therapeutic work with families, I teach basic skills in communication, behavior, time management and play. Yes, play. You would be surprised to learn how many parents do not know how to get down on the floor and play. Very often young children don’t have the language to put to their emotional experience and their “acting out” behavior gets misinterpreted by parents and teachers as being oppositional and defiant when the child may be scared or hurting. Play is instrumental in giving them the space to process overwhelming feelings in a safe and contained way in an otherwise adult-controlled world.

Q: With trauma, especially sexual abuse since that is so much in everyone’s minds today, have we gotten more aware, less stigmatized around reporting it? Are people getting more help?

A: With organizations like the National Children’s Alliance and local Child Advocacy Centers (CAC), more and more children are being served and more perpetrators are being incarcerated than ever before. I served on the board of The Granite State Children’s Alliance and Hillsborough County NH CAC for two years. The CAC model is an extraordinary one that is truly child-focused, allowing the child to only have to tell his/her trauma story once to a team of law enforcement and social service professionals. Children never have to see or talk directly to the team, thereby reducing re-victimization by not having to retell the worst parts of their story.There is a total of 822 CACs nationwide and just last year more than 300,000 children were served through local CACs. Through CAC community outreach programs, more than a million people were educated about child abuse prevention and intervention. So, I would say with a resounding yes, we are understanding more and helping more victims get the services they need.

Q: You also work with clients not in your immediate area through telehealth. Why have you chosen this path?

A: When I was pregnant with my twins, I went into preterm labor and, at 26 weeks, I was put on bed rest. I had heard about telemedicine but didn’t know too much about it. With the help of my professional mentor, we did some research and spearheaded the teletherapy services at the Counseling Center of Nashua, N.H., where I worked for eight years prior to relocating to Maine.

Q: So, you continued to see clients this way once you moved to Maine. How much of your practice today is through telehealth?

A: I see approximately 32 patients per week and roughly four or five of them are teletherapy.There are many benefits to teletherapy, namely continuity of care. In today’s market, people can wait two to three months for a first-time appointment. Teletherapy also removes the barrier and access to treatment when patients struggle with a physical disability. It’s important to note that teletherapy is not appropriate for all presenting problems. For example, I do not recommend teletherapy for children 12 and younger or with individuals with acute PTSD, active substance use or severe mental illness.Teletherapy has been most successful with adolescents who are accustomed to communicating via social media and video chat outlets and who maybe suffering from depression or anxiety.

Q: An obvious question now: Why is it important to get help, especially for children and adolescents, when it comes to trauma?

A: There are social, emotional, behavioral and cognitive impacts of trauma, not to mention physical health impacts later in life.The attachment piece cannot be under stated. Healthy attachment begins in infancy between children and caregivers. The world is predictable and safe which translates into feeling loved and cared for. This love is internalized and is the foundation for healthy identity formation later and is the prerequisite to establishing future healthy intimate attachments/relationships.When early attachments are unsafe and unpredictable, children learn that they cannot rely on others for help. Subsequently, abused and/or neglected children/adolescents are more vulnerable to stress and struggle with emotional expression and regulation.

Not all children who suffer a traumatic event will develop PTSD. For others, it can be lifelong course. There are several protector factors including intelligence, ability for the child to form relationships and having a reliable supportive other [caregiver] through the process all aid in more positive outcomes.

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