Treatment Offers Hope for Imprisoned California Siblings
Posted January 17, 2018 3:26 p.m. EST
The California case in which 13 siblings were found imprisoned at home earlier this week is shocking, but not without precedent. Lurid cases have come to light over the years of children locked in closets and basements, held captive by parents who have crumbled under the weight of drugs, extreme religious conviction, personality disorders or their own abusive backgrounds.
The good news, trauma experts say, is that recovery is indeed possible. Victims can reclaim their lives.
“The clinical data is encouraging,” said John A. Fairbank, co-director of the National Center for Child Traumatic Stress. “There are good treatments available for children seriously abused and traumatized.”
In particular, said Fairbank, a professor of psychiatry and behavioral sciences at Duke, good results have been shown with a relatively short-term cognitive behavioral therapy tailored for trauma patients, an approach developed in the early 1990s but widely disseminated in the last 15 years.
A significant hurdle to recovery for the California siblings and children in analogous situations, said psychologists, is that their captors were not stranger-kidnappers but their parents.
“In doing the healing work, you look at what the patient’s support systems are,” said Priscilla Dass-Brailsford, a trauma psychologist and an adjunct professor in the department of psychiatry at Georgetown University. “The biggest supports are parents and family. These kids don’t have that. The parents were the aggressors.”
Experts interviewed for this article, who underscored that they had no direct knowledge of the California case, said that because the siblings’ primal assurance of unconditional love and safety had been ripped away, they would almost certainly struggle to trust and attach to future supportive figures.
“The notion that this was done by parents increases a child’s helplessness and hopelessness,” said Nora J. Baladerian, a Los Angeles psychologist who often treats traumatized individuals.
Dass-Brailsford compared the 13 siblings’ situation to that of prisoners of war, who have been deprived of food, freedom and sufficient nurturing.
“One glimmer of hope is that they did not go through this alone,” she said. “Prisoners of war are isolated as part of their torture. These children at least had each other.”
Before formal therapy can begin, the siblings must be placed in a safe, nurturing environment where kind treatment will be a positive constant they can rely upon, experts said. They added that keeping as many siblings together as possible would be important, to sustain their bonds.
Daniel L. Davis, a forensic psychologist in Columbus, Ohio who has treated victims and perpetrators and evaluates children for juvenile court, said that there is not one behavioral model that adequately describes a typical parent perpetrator.
“There are risk factors, certainly,” he said. A list might include a prior history of abuse, domestic violence, and a cluster of personality disorders such as antisocial personality disorder, borderline personality disorder and narcissistic personality disorder. Such people, he said, might be overly emotional, unpredictable, manipulative and exploitative.
But like other trauma experts, Davis emphasized that children can be remarkably resilient. He treated an elementary school-age boy whose parents had kept him locked away for such a long period that the child showed significant developmental delays. “But with intensive treatment and real effort by a support team, his growth was impressive,” Davis said. “His parents were sent to prison.”
Other examples of children locked away from society by parents do occasionally emerge. A documentary “The Wolfpack” tells the story of seven siblings isolated in a Lower East Side apartment by their father. In 2015, three siblings were found locked by their parents in a urine-and-feces infested room in Spotsylvania County, Virginia. That same year, a teenage girl in Murfreesboro, Tennessee, was also discovered having been locked in her bedroom for months by her parents, who had allowed her three siblings to travel at will.
Davis said that while poverty is an element in many cases, it is certainly not a signature characteristic; indeed in the California case, the family lived in a middle-class neighborhood and the father, David Allen Turpin, had reportedly once been employed as an engineer. But poverty-afflicted situations may come to light more often, Davis noted, “because the perpetrators don’t have the resources to keep shielding from public scrutiny.”
Formal treatment begins after children are placed in a secure home and assessed for trauma-related symptoms, including post-traumatic stress disorder. They may be unwilling or unable to describe their experience. Nightmares may roil them. The slightest trigger — the rattle of keys, for example — might send them into a hysterical tantrum. They may seem hyper-aroused or vigilant, ever alert and cringing, braced to flee or fight. Younger children may act out the trauma as they play; for others, the emotional pain may be so overwhelming that they seem numb.
“But the majority of these children can bounce back,” said Anthony P. Mannarino, director of the Center for Traumatic Stress in Children and Adolescents at Allegheny General Hospital in Pittsburgh. “I’m not saying they’ll forget it but they can find a way to go forward.” Mannarino is a co-developer of trauma-focused cognitive behavioral therapy (TF-CBT). The typical treatment, he said, is 12 to 16 sessions.
First, a therapist works with a child to manage terrifying thoughts and feelings about the experience. Next a therapist helps the child gradually discuss the trauma.
“Those memories are really scary,” Mannarino said. “Maybe the parents said, ‘You deserve what you’re getting, it’s your fault,’ and the child may have internalized shame. Helping them talk and processing that distortion gives them a chance to understand that they are not to blame.”
Finally, TF-CBT involves the child’s new caregivers. “We work with them to understand that the child’s behavior expresses what happened to the child, as opposed to who they really are,” said Mannarino.
Of numerous therapies developed to address traumatized patients, TF-CBT is one of the most studied. In a 2004 randomized, multisite study published in the Journal of the American Academy of Child and Adolescent Psychiatry, 203 children between eight and 14 who had symptoms of PTSD related to sex abuse, and their caretakers, were randomly assigned to TF-CBT or “child-centered” therapy — a talk therapy model often use in rape-crisis or sex-abuse treatment centers. TF-CBT patients showed significantly more improvement in markers such as PTSD, depression and behavior.
Baladerian hoped that not only would the California family receive sufficient services, but that “the attention will also help other victims whose cases might not have been attended to with such alacrity.”