Menu Expand
A Therapeutic Treasure Box for Working with Children and Adolescents with Developmental Trauma

A Therapeutic Treasure Box for Working with Children and Adolescents with Developmental Trauma

Karen Treisman



Like a treasure chest, this resource overflows with valuable resources - information, ideas and techniques to inspire and support those working with children who have experienced relational and developmental trauma.

Drawing on a range of therapeutic models including systemic, psychodynamic, trauma, sensory, neurobiological, neurocognitive, attachment, cognitive behavioural, and creative ideas, Dr Karen Treisman explains how we understand trauma and its impact on children, teens and their families. She details how it can be seen in symptoms such as nightmares, sleeping difficulties, emotional dysregulation, rage, and outbursts.

Theory and strategies are accompanied by a treasure trove of practical, creative, and ready-to-use resources including over 100 illustrated worksheets and handouts, top tips, recommended sample questions, and photographed examples.

Overflowing with creative ideas and activities, the thing that makes this resource especially valuable is its sensitivity to the ever-present need for safe containment when using intervention. The author gently prompts our awareness of how creative ways of working can provide safe access to the treasures within, for the children so often hardest to reach.
Logically organised and indexed, each section is held together by well-written, informative insights.

Lisa Nel
BACP - Children, Young people & families
Are you working with traumatized children? Karen Treisman's book is a MUST read!
Liana Lowenstein MSW, RSW, CPT-S, Registered Clinical Social Worker, Certified Play Therapist-Supervisor and Certified TF-CBT Therapist

Relational trauma requires relational repair' says Dr Treisman throughout her book and it's a mantra worth repeating. Her book explains what relational repair really involves, from creating safety and regulation, to exploring complex and layered emotions to tackling rage and sleep disturbances. It is packed with ideas and materials to guide and support therapeutic conversations, much of which could be used by therapeutic parents. What I especially love is the combination of compassion both for child and parent and its insistence on a sound, scientific approach. The pictures, the pebbles, the glue and the glitter are all set within a robust trauma-informed framework that reflect the emotional complexity of building a meaningful relationship with a traumatised child.

For those who labour at the coalface of relational repair, it is a nourishing read that will top up your therapeutic tank and make you feel just that little bit more encouraged and cherished and perhaps even vindicated. It deserves to be widely read by all those involved in supporting the healing of relationally traumatised children from commissioners, policy makers and academics right up to foster carers and adoptive parents.

Sally Donovan OBE, editor for Adoption UK and author of 'No Matter What' and 'The Unofficial Guide to Adoptive Parenting'
This book is truly a treasure trove of ideas, resources, illustrations, and practical photocopiable worksheets. It is written in an accessible, engaging, and practitioner friendly way, with a real focus on the "how to". It combines the latest trauma, neuroscience, sensory, and attachment theories and then describes how to intervene with children in an engaging, creative, and multi-sensory way. The mantra of the book is "relational trauma requires relational repair"; and this ethos echoes throughout the entire book. The book covers the whole spectrum needing to be addressed in a developmental trauma context, from assessment, to strengths and resilience, to self-care, to specific presentations such as outbursts and nightmares; through to endings and goodbyes. This book is a MUST HAVE for mental health practitioners working with traumatized children. In fact, this is the best mental health book I have read in 2017!
Liana Lowenstein
When we lift the lid on a child's trauma it can feel overwhelming and impossible to address. Dr Karen Treisman's accessible, insightful and resource laden book will change this for ever for every practitioner, therapist, parent and carer and the precious children they support.
Jane Evans, Childhood Trauma & Parenting Expert, author of Cyril Squirrel Finds Out About Love and How Are You Feeling Today Baby Bear?
Children are doers more than they are talkers, and when we join them in doing, we find we are able to discover the story at the child's pace. Dr Treisman has given us a wonderful book to help us to do this. Full of ideas, exercises and compassionate ways of joining with children to fully discover who they are, and to help them to manage difficulties that they are experiencing. This is grounded in the best of what we know about relational trauma. This book will enhance the most creative of us, and be a rich resource for those of us who doubt our own creativity. It will give all of us ways to go slower, to help children to feel safe enough to reveal their own story, and to find the confidence to allow us to share this story with their safe parents. Now healing can begin. My treasure box is certainly richer for having this book on my shelf.
Dr. Kim S. Golding, Clinical Psychologist and author
As a Treasure Box, Treisman has created exactly what it says on the tin. Embedded in the relational world of development, this book takes us on a journey of thoughtful, sensitive, creative and deeply moving interventions. The lives and minds of children and young people can only be enriched if we embed this magic in our work.
John Simmonds, OBE, Director of Policy, Research and Development at CoramBAAF, London
This book is an extraordinary achievement. It is packed with myriad, tools, methods and suggestions that will be indispensable to therapists, parents and anyone working with traumatised kids. Most importantly, the book's simplicity is deceptive as every page is built on the firm foundations of the latest science and a deep understanding of the effects of developmental trauma. I predict this will be a book that trauma therapists will be scared to leave home without.
Dr. Graham Music, Consultant Psychotherapist, Tavistock Clinic and author of Nurturing Natures

Table of Contents

Section Title Page Action Price
A Therapeutic Treasure Box for Working With Children and Adolescents with Developmental Trauma - Creative Techniques and Activities, by Dr. Karen Treisman 3
1. Introduction to Using the Book, Guiding Principles, and Underpinning Rationale 23
Pitfalls, planning, preparation, principles, and overall factors to be mindful of when implementing the strategies in this book 23
The target audience and the terms used 23
Unique individuals within unique contexts 24
Informed by assessment, formulation, and code of conduct 24
Being mindful of the potential impact of the exercises, and the importance of familiarising and practising the tools before implementing them 25
Believing and investing in the tools 25
Part of a bigger process: exhale, expand, and embed 25
The magic is in the process, not just the product 26
Relational trauma requires relational repair – keeping the relationship at the centre 27
Relational and developmental trauma framework and child development base 27
Prioritising and establishing multi-levelled safety first 27
Viewing behaviour within a context and as a form of communication 28
Holding in mind what ghosts, angels, and other relational dynamic children/families are bringing into the room 28
Working with hesitance and cautiousness 30
Non-verbal communication and whole-body listening 30
Explaining the rationale, linking to other concepts, and gaining consent 30
Timing and location 31
Greetings and hellos 32
Being prepared and handling items with care 32
Areas of difference and selection of materials 33
Starting small and in a manageable way 33
Routine and structure 33
Balanced with strengths and lightness 34
Monitoring and evaluating tools 34
Recording their journey through making a personal folder or box 34
Why creative and expressive tools and techniques might be helpful in the context of relational and developmental trauma and when working with young people 34
2. Tools for Supporting the Assessment and Engagement of and Building Rapport with Young People 37
Introduction 37
Practical, expressive, and creative assessment tools and techniques 37
Free playing and drawing 37
Shared and co-constructing activities 39
Getting to know the child and all-about-me tasks 39
Story of my name 43
Family sculpts, genograms, and eco-maps 44
Directive exercises using the arts 45
Expressing, identifying, and expanding on a range of feelings 48
Children’s goals, wishes, hopes, and dreams for therapy, themselves, their relationships, and their lives 49
Scaling and measuring 49
Visual timeline, path, paper chain, or comic strip 51
3. Working Towards Establishing Multi-Levelled Safety (Inner Safety, Emotional Safety, Physical Safety, Felt Safety) 73
Introduction and why establishing safety is fundamental to interventions within the context of relational and developmental trauma 73
Experience-dependent brain and trauma as multi-sensory experience 73
Survival mode and safety 78
Implications for practice 79
Actively working towards establishing safety within the therapeutic process 80
Practical and creative strategies for contributing to the feeling of multi-levelled safety 81
Conversations about safety and safety collages, images, poems, and sculpts 81
Creating a place of safety (physical) 82
Creating a safe place (cognitive/imaginary) and \nusing creative methods to embed the concept 83
A safe place for an item/object 86
Safety tour 87
Creating a calming, soothing, and self-regulating box 87
Safe person/people 92
Safety shield and protective items 95
Exploring our and others’ multi-layered triggers 95
Self-regulation, centering, and grounding activities to increase feelings of safety 98
Coping and option cards 100
4. Strategies for Supporting Children who have Experienced Relational and Developmental Trauma to Identify, Label, Express, and Regulate their Feelings 119
Introduction 119
Emotional regulation in the context of relational and developmental trauma 119
Implications for practice 124
Practical strategies for supporting children to identify, express, name, and regulate their emotions 125
Role models and everyday naming of feelings 125
Practising and rehearsing 125
Self-reflection and self-care 126
Getting to know the whole child 126
All feelings are accepted 126
Mixed and a melting pot of feelings 127
Creative, expressive, and playful ways to discuss feelings 128
Externalising and metaphors 135
Mind–body links 136
Monitoring arousal levels 137
Strength, Resilience, and Hope-Based Practices 171
5. Finding Ways to Identify, Notice, Celebrate, and Build on Children’s Strengths, Skills, Resilience, and Positive Qualities 171
Why is focusing on building children’s self-esteem so important? 171
Negative self-beliefs reinforced by the wider systems (the power of language) 175
Strengths-based language and storying 176
Our own relationship with praise, encouragement, and positive feedback 178
Finding it difficult and/or uncomfortable to hear and receive praise and positive feedback 179
Children who find it harder to identify positives about themselves 181
Practical and creative strategies for building on children’s self-esteem and positive sense of self 183
Modelling verbally and non-verbally positive self-esteem 183
Naming, validating, and acknowledging a child’s emotions and lived experiences 184
Quality time together and really getting to know the young person 184
Confidence-boosting and curiosity-enhancing activities 184
Providing opportunities for mastery and agency 185
Maximising opportunities for success 185
Normalising and owning mistakes 186
Keeping the young person in mind and showing them this 186
Non-verbal and verbal praise 186
Tangible, creative, and expressive ways of noticing, celebrating, praising, and expanding on the child’s positive skills, strengths, talents, qualities, and attributes 187
Praise boards, strengths cards, and celebration walls 187
Maximising on everyday items and routines 187
Sparkle moments diary, treasure box, journey/jewel jar, and bottled brilliance 187
Positive affirmations 188
Tower of strengths, skyscraper of strengths, patchwork of positives, shield of strengths, blanket of bravery, pillow of positives, and quilt of qualities 189
Rainbow of resources, puzzle of positives, brilliant beautiful body, and star of strengths 190
Strengths doodle bear, blanket, T-shirt, pillow, and scarf 190
Chocolate box of positive qualities, positive pearls, and strength shells/stars 191
Positive name acronym, positive self-portrait, picture of positives, and strengths snowflake 191
Strengths-based jewellery 192
Self-esteem and sensory hand 192
Expanding and embedding each identified positive trait 193
Reflecting on past challenges, what skills the young person has overcome, and what journey they have travelled 194
Externalising confidence and self-esteem 196
Role models and inspirers 197
Tree of Life (Ncube, 2007) 198
Re-shaping ideas and metaphors of negativity and criticism 198
Imagery re-scripting 201
Future-oriented thinking and reconnecting with dreams 202
6. Strengthening and Supporting “Parent–Child” Relationships, Relational Trust, and Interpersonal Connections 231
Who is this chapter for? 231
Positioning these strategies within the context of parent–child therapies and factors to be mindful of 232
Why is it important to focus on parent/caregiver–child relationships in the context of relational and developmental trauma? 232
Some of the complexities of therapeutically re-parenting a child: the parenting orchestra/choir (adapted from Working with Relational and Developmental Trauma in Children and Adolescents–Treisman, 2016) 234
Some underpinning positions and frameworks for promoting positive parent–child relationships in the context of relational and developmental trauma 236
Awareness, sensitivity, and knowledge around the multi-layered impact of developmental and relational trauma and how this requires relational repair 237
Second-chance secure base and safe haven 237
Staying regulated and in one’s thinking mind 238
Acknowledging, naming, and validating emotions and lived experiences 239
Viewing behaviour as a form of communication and as being within a context 240
Developmentally sequenced parenting 242
Whole-brain-body approach 243
Consistent and predictable parenting 244
Picking battles and setting limits 244
Warm, playful, and nurturing parenting 246
Spending quality time together 247
Really getting to know each other 247
Normalising and owning mistakes 247
Keeping the young person in mind and showing them that they have been kept in mind 248
Providing opportunities for mastery and agency 248
Strengths, resiliency, and hope 249
Practical and creative strategies for building and improving parent–child relationships 250
Magnifying positives and being strengths-focused 250
Solution-focused ideas and expanding on the unique exceptions 254
Reflecting on what a positive relationship is, exploring each other’s meaning-making around relationships, and using inspirational quotes 256
Understanding the roots and the feeders of some relationship difficulties 257
The journey of one’s relationship 259
Reflecting on wishes and hopes for one’s relationship 260
Perspective-taking and role reversal 260
Sense of belonging and connectedness 261
Turn-taking, building trust, and safe ways of having agency 262
Promoting safe and positive touch 263
Rituals and routines 264
Team Around the Family: Caring for the Caring 281
7. Holding Carers in Safe Hands, Thinking Minds, and Regulating Bodies 281
Who is this chapter aimed at? 281
Why is self-care so important in the context of relational and developmental trauma? 281
Practical strategies for addressing and improving self-care 289
Triggers and hotspots 289
Being informed and supported 290
Personal and professional team of support 290
Expectations and setting yourself up to fail (SMART goals) 293
Integrating feel-good factors into daily routines 294
Self-care plan/pledge and regulating activities 294
De-roleing and going to one’s safe place 295
Strengths-based reflection and positive affirmations 295
Strengths-based strategies 296
Strengths-based, take-back practice letter 296
8. Strategies for Understanding, Reducing, and Responding to Outbursts, Tantrums, Rage, and Expressions of Dysregulation 319
Introduction 319
Understanding further outbursts, rage, and expressions of dysregulation in the context of relational and developmental trauma 319
Experience and relationship to toxic stress and dysregulation 319
Anger as a form of communication and as a protective survival strategy 323
Dysregulation and the interplay with past experiences 325
Social learning theory – learned behaviour 326
Hostile attribution bias 327
Some key messages and principles about anger, rage, dysregulation, and outbursts 328
The feeling is OK and understandable 328
Early intervention and prevention 328
Behavioural change within the context of a relationship 329
Where possible, avoid assumptions 329
The cycle of anger being reinforced: negative discourses 329
Assessment of the behaviours 330
Behaviour as communication 332
Points to be mindful of/tips around the following strategies 333
Practical and creative strategies for reducing and responding to outbursts and dysregulation 334
Role-modelling, self-care, and self-regulation 334
Labelling, identifying, and expressing emotions 335
Monitoring and recording emotions 336
Exploring multi-layered triggers 337
Emphasising the helpfulness of talking and sharing 338
Expectations and goals 339
Behavioural contracts, house rules, and consequences 340
Keeping and breaking rules 341
Praise, encouragement, and positive reinforcement 341
Mastery and a sense of agency 342
Picking one’s battles and problem-solving 342
Creative and playful ways of exploring and externalising “the anger/aggression/outbursts” 342
Exploring, describing, and reflecting on the feeling of anger 342
Making links between the mind and the body through body-mapping 343
Externalising the difficulties 344
Creatively exploring the functions and consequences of “the anger” 346
Role-play and practising 348
Stop, think, and go 349
Sensory, body-based, and regulating activities 350
Coping and option cards – keeping a record of what works 350
9. Supporting Children who are Experiencing Nightmares and Sleep Difficulties 367
Introduction and reflecting on nightmares in the context of trauma 367
Cycles and patterns of nightmares 369
Assessment of nightmares 369
Psychoeducation techniques 371
Normalising, empathising, and modelling 371
Meaning-making, sense-making, and reflecting on the associated thoughts and feelings 371
Some practical and creative tools to help make night time feel and be more comforting 371
Things to avoid 372
Calming and comforting experiences before bed 372
Routine and rituals 373
Holding children in mind and showing children that they are held in mind 374
Making a worry/nightmare box or keeping a worry/nightmare diary 375
Worry monsters and worry eaters (see Photo 9.9) 376
Happy, calming, positive, and safe box 377
Happy, calming, positive, and safe poster (see Photo 9.11) 378
Safe place pillow, blanket, or doodle bear 379
Dreaming diary, book of beauty, positive pad, or artwork of dreams 379
Sleeping well accessories – worry dolls, dream catchers, wishing fairies, magic fairy dust, and guardian angels (see Photo 9.14) 379
Safety and protective items and people 380
Celebrate and notice when the nightmares are absent 381
Externalising and creatively expressing the nightmares 381
Imagery re-scripting 382
Recording what works: coping and option exercises 383
10. Preparing, Planning, Reflecting on, and Expressing Endings, Changes, Goodbyes, and Transitions 387
Why are endings and transitional work so crucial in the context of relational and developmental trauma? 387
Therapists’ own experiences of endings 388
Structure of the chapter: transitions and endings 389
Preparing for and supporting transitions 389
Supporting significant endings and working towards reparative endings 392
Some strategies to support significant endings and goodbyes 392
Naming, acknowledging, and validating the range of feelings evoked by endings, including some mixed feelings 392
Punctuating the stages 393
Creatively reflecting on the journey 393
Reflecting further on changes and progresses made 395
Expanding on the journey, the changes, and the strengths of the therapeutic process and how to take some of those lessons with them 396
Hopes, fears, and expectations for the future 397
Tree of Life (Ncube, 2007) 398
A take-back practice letter 398
Ending gifts and transitional objects 398
Future problem-solving and creating coping cards 398
References 413
Further Reading 419
List of Worksheets 52
Worksheet 2,1 - Assessment areas and questions to consider when undertaking an attachment and trauma-informed assessment 52
Worksheet 2.2 - Pieces of me 61
Worksheet 2.3 - “All About Me” puzzle 62
Worksheet 2.4 - “All About Me” patchwork 63
Worksheet 2.5 - “All About Me” rainbow 64
Worksheet 2.6 - Genograms and cultural genograms 65
Worksheet 2.7 - Sentence-completion ideas 68
Worksheet 2.8 - Making wishes genie 70
Worksheet 2.9 - Wishing wizard or dreaming dragon 71
Worksheet 3.1 - Feeling unsafe/putting up defences 101
Worksheet 3.2 - Multi-layered triggers 102
Worksheet 3.3 - Exploring the feeling of safety 103
Worksheet 3.4 - Exploring the feelings and meaning of safety further 105
Worksheet 3.5 - Exploring my different senses 106
Worksheet 3.6 - My sensory hand 107
Worksheet 3.7 - Things that bug me (triggers) 108
Worksheet 3.8 - Things that push my buttons (triggers) 109
Worksheet 3.9 - Grounding, soothing, and regulating cards 110
Worksheet 3.10 - Octopus of options 114
Worksheet 3.11 - My treasure box of tools 115
Worksheet 3.12 - A sample coping card 116
Worksheet 3.13 - A blank template for creating a coping card 117
Worksheet 4.1 - I recognise when…is feeling…because they show me through their… 139
Worksheet 4.2 - I recognise when I am feeling…because I show it through my… 140
Worksheet 4.3 - Puzzle of different feelings 141
Worksheet 4.4 - Puzzle person of different feelings 142
Worksheet 4.5 - Patchwork of feelings 143
Worksheet 4.6 - Box of feelings 144
Worksheet 4.7 - Feelings and emotions cards 145
Worksheet 4.8 - Table of feelings words 150
Worksheet 4.9 - Anger is (using metaphors)… 152
Worksheet 4.10 - Sadness is (using metaphors)… 154
Worksheet 4.11 - Happiness is (using metaphors)… 156
Worksheet 4.12 -Worry is (using metaphors)… 158
Worksheet 4.13 - Draw or use Play-Doh to show the different emotions on the blank faces 160
Worksheet 4.13 - Feelings wheel 162
Worksheet 4.15 - Head of thoughts and feelings 163
Worksheet 4.16 - House of feelings 164
Worksheet 4.17 - Feelings TV and feelings channels 165
Worksheet 4.18 - Colour, draw, or design where and how you feel the different core emotions in your body 166
Worksheet 4.19 - Feelings thermometer 167
Worksheet 4.20 - Thoughts, feelings, physical sensations, and behaviours 168
Worksheet 4.21 - Head, heart, and hands 169
Worksheet 4.22 - Thoughts, feelings, actions, and sensations diary 170
Worksheet 5.1 - Common core beliefs worksheet 204
Worksheet 5.2 - Magnetic thoughts and feelings worksheet 205
Worksheet 5.3 - Positive reframing and alternatives to “don’t”, “stop”, and “no” 206
Worksheet 5.4 - List of positive descriptors and adjectives 207
Worksheet 5.5 - Reflecting on my strengths and positive qualities 211
Worksheet 5.6 - SMART goals: think SMART 213
Worksheet 5.7 - My treasure box diary 217
Worksheet 5.8 - Gifts I have been given and gifts that I have to give… 219
Worksheet 5.9 - Bottling up special moments 220
Worksheet 5.10 - Puzzle of positives 221
Worksheet 5.11 - Patchwork of positives 222
Worksheet 5.12 - Star of strengths 223
Worksheet 5.13 - Tree of Life Narrative Therapy technique 224
Worksheet 5.14 - Time capsule 226
Worksheet 5.15 - Making wishes genie 227
Worksheet 5.16 - Wishing wizard or dreaming dragon 228
Worksheet 5.17 - Strengths-based approach: writing a take-back practice letter 229
Worksheet 6.1 - Keeping myself safe 265
Worksheet 6.2 - Core emotions and history of emotions exercise 266
Worksheet 6.3 - Listening with my whole body and brain: attending to the multiple layers and different shades of communication 268
Worksheet 6.4 - Exploring the nature and quality of the parent–child relationship 269
Worksheet 6.5 - Similarities, differences, and commonalities 272
Worksheet 6.6 - Our relationship then, now, and in the future 273
Worksheet 6.7 - Bottling up special moments 274
Worksheet 6.8 - Our relationship time capsule 275
Worksheet 6.9 - Wishes for myself, you, and our relationship 276
Worksheet 6.10 - Strengths-based approach: writing a take-back practice letter with a relational focus 277
Worksheet 6.11 - Feeding and strengthening our relationship 279
Worksheet 7.1 - When I feel unsafe and need to protect myself 299
Worksheet 7.2 - Reflecting on my best and worst self visually 300
Worksheet 7.3 - I recognise when I am feeling depleted/stressed because I show it through my… 301
Worksheet 7.4 - Filling my emotional, physical, cognitive, and spiritual containers 302
Worksheet 7.5 - What pushes my reward and feel-good buttons? 303
Worksheet 7.6 - Multi-layered triggers 304
Worksheet 7.7 - Hotspots and triggers with regard to a specific behaviour/situation 305
Worksheet 7.8 - My treasure box diary 308
Worksheet 7.9 - Grounding, soothing, and regulating idea cards 310
Worksheet 7.10 - Coping card template 314
Worksheet 7.11 - My self-care pledge and plan 315
Worksheet 8.1 - Anger is (using metaphors)… 352
Worksheet 8.2 - What does…look like? 354
Worksheet 8.3 - I recognise when I am feeling…because I show it through my… 355
Worksheet 8.4 - Colour, draw, or design where and how you feel the different core emotions in your body 356
Worksheet 8.5 - Externalisation and Narrative Therapy example questions 357
Worksheet 8.6 - Strengths (advantages) and hazards (disadvantages) of expressing the anger 358
Worksheet 8.7 - Thoughts, feelings, and actions diary and reflection log 359
Worksheet 8.8 - Different responses and reflection 360
Worksheet 8.9 - Pot of bubbling feelings 361
Worksheet 8.10 - Thermometer of feelings 362
Worksheet 8.11 - Crib sheet: strengthening and supporting the development of executive function and cognitive skills 363
Worksheet 9.1- Worry is (using metaphors)… 384
Worksheet 9.2 - My nightmare ninja 386
Worksheet 10.1 - When I feel unsafe 400
Worksheet 10.2 - Then, now, and in the future 401
Worksheet 10.3- Sentence-completion ideas and discussion points for the ending experience 402
Worksheet 10.4 - Time capsule 404
Worksheet 10.5 - Bottle up moments 405
Worksheet 10.6 - Magnetic thoughts, feelings, and sensations 406
Worksheet 10.7- Treasure box of lessons, moments, and memories 407
Worksheet 10.8- Wishes for myself, others, and the world 408
Worksheet 10.9- Making wishes genie 409
Worksheet 10.10- Feeding and strengthening myself and carrying on with my journey 410
Worksheet 10.11- Strengths-based approach: writing a take-back practice letter 412
Blank Page