When Miriam Flores’ husband began to be verbally abusive, she hoped he would change, but he drank too much and it became worse.
She endured the escalating abuse for three years until one day he nearly beat her to death; the episode led to her husband’s incarceration and later deportation, but Flores’ children witnessed everything.
An immigrant from El Salvador and now single mother of three, alone in San Francisco, Flores needed help.
After going to a pediatrics clinic at San Francisco General Hospital (SFGH), she discovered the Child Trauma Research Program.
Developed by University of California San Francisco psychotherapist Alicia Lieberman in 1996 (herself an immigrant and a survivor of trauma), the free program was the first of its kind and has now been adopted in 30 states as well as parts of Europe and South America. Lieberman is a professor and vice-chair for Academic Affairs with the UCSF Department of Psychiatry. Her program was designed specifically to help children who were traumatized in their first five years to overcome the effects of domestic violence (witnessed or experienced), the death of a loved one, life-threatening accidents, illnesses or disasters.
Growing up in Paraguay, some of Lieberman’s first memories are of the civil war.
“I remember the fear that I felt,” she said. “And I could not talk about it.”
Overcoming the difficulty of her childhood traumas made Lieberman want to help others deal with their own.
Latinos currently account for 60 percent of the patients who participate in the Child Trauma Research Program, and immigration traumas are present in a large share of the cases. The parents, and their children, have often gone through terrible things while crossing the border and while in their countries of origin.
“Many of the children we see here have seen the police take their parents away,” Lieberman said.
According to Lieberman, very young children are more vulnerable to internalizing traumatic experiences than older children. The first five years of life are when children learn whether they deserve love and care, if their parents are able to protect them, if the world is a safe place. When the message is consistently “no,” children grow with a distorted view of the world that can be hard to change.
The brain is still developing at this stage, Lieberman explained, and when a child experiences a traumatic event(s), they are affected physiologically. Their stress hormones rise, damaging the areas of the brain that regulate learning and danger identification.
“It’s like you stamp the child with trauma,” she said.
These children become anxious, fearful and aggressive, to the point of reversing their development—sometimes even going back to baby talk, diapers and crawling.
During one therapy session, Lieberman recalled an episode where a child pinched his mother after being told to put away the toys. “Don’t tell me what to do. I am the boss,” said the child, echoing what he saw his father do.
“People ask, ‘What’s wrong with this child?’ and the question really needs to be, ‘What happened to this child?’” Lieberman said.
The treatment focuses on making children feel safe again, helping them to talk about what happened with the use of toys in a friendly and relaxed environment. It’s about “giving words to the unspeakable,” Lieberman said.
Immigration status is no obstacle
The Child Trauma Research Program found that just 19 percent of those who were in need of mental health support actually sought help.
In addition to the stigma of seeing a psychotherapist, immigration status plays a factor, as about half of the parents who go to the program worry about being reported.
A recent study conducted by UCLA Labor Center’s Dream Resource Center found that the threat of deportation, for themselves and their family, can itself take a severe toll on the mental health of an undocumented youth.
Fear of deportation can manifest as fear of the police, according to Lieberman.
“Often the child will be very aggressive with the police in play,” she said. “They will say, ‘The police are bad. The police will take my mommy away. The police will hurt my daddy.’”
One of the primary goals of the program is to raise awareness of the importance of getting help as soon as the traumatic event happens.
“It is not a stigma to ask for help,” Lieberman said.
Flores finally sought help in October 2012. She and her 4-year-old child started doing therapy with psychotherapist Maria Torres.
“The children learned to use their words,” Flores said.
Putting their problems into words, her children became less aggressive. Now, Flores said, when they see violence, they say, “Hands are not for hitting. They are for caressing, eating, saying hello.”
The Child Trauma Research Program at San Francisco General Hospital is freely available to those who need help no matter what their immigration status may be, and can be reached at 415-206-5311.