Transformation of Perception of Trauma by Child Survivors of the Holocaust in Group Therapy

Intensive work with child survivors of the Holocaust has made us aware of the clinical importance of understanding the ways children perceive their traumas and the conclusions they draw about how they must live their lives. When these perceptions are transformed congruently with the child's development, the survivors can cope quite well. In this paper we refer to now middle-aged survivors who are still guided by their child perceptions. We will describe how we have used conjoint group psychotherapy to facilitate processes of transformation even at this late stage. The model we provide for trauma work with Holocaust survivors whose traumatization occurred decades ago may well provide tools to reduce future suffering of children who are victims of massive traumatization today.     

The Reconstruction of Criterion A in DSM-5: Is it a True Incorporation of Secondary Traumatization into the PTSD Diagnosis?

In DSM-5, the event criterion (criterion A) for PTSD includes indirect exposure as a potential source of PTSD. In light of the revised criterion A, it is now important to reevaluate the concept of “secondary traumatization” vis-á-vis the PTSD diagnosis. I argue that, while including indirect exposure in DSM-5 was an important step forward, there is still a considerable gap between what DSM views as indirect trauma exposure and what research has taught us about the underlying mechanisms of secondary traumatization. Thus, while DSM-5 certainly moved in the right direction, researchers are encouraged to explore new avenues of research in order to bridge the gap between the existing empirical and theoretical knowledge about secondary traumatization and the diagnostic criteria for PTSD.     

The Power of Shame

Abstract

The reality of lesbian partner violence has been long under-recognized and misunderstood. Treatment protocols based solely upon work with heterosexual batterers and victims are inadequate when working with lesbians. In fact, without recognizing the specific needs of lesbians, treatment may compound rather than cure the problem. This article explores lesbian battering as a response to and reenactment of cultural oppression, internalized homophobia, and religious/psychological shame. The cycle of domestic violence can be the acting out of the traumatization of homophobia/heterosexism, compounded by sexual and religious shaming. A theology of liberation and the psychology of healing from trauma are explored as critical ingredients to treating victims and perpetrators.     

Dissoziative Störungen des Bewusstseins

Dissociative disorders often develop after chronic traumatization. But they can also occur without preceding traumatization. Newer psychodynamic concepts explain dissociation as a specific defense-constellation and as a result of specific neurobiological and neuroanatomical effects of trauma. In dissociative disorders differentiated interdisciplinary somatic and psychiatric diagnostic procedures should be performed. Many somatic and psychiatric disorders should be considered concerning the differential diagnosis. Specific therapeutic techniques have to be applied.     

Muster früher Traumatisierung und die Effekte stationärer Psychotherapie

Early traumatic experiences of neglect, physical and sexual abuse in adult patients undergoing inpatient psychotherapeutic treatment were retrospectively assessed. Associations between these three forms of trauma and with patient gender were analyzed. The effects of early traumatization in general, gender and patterns of specific experiences on the symptom level, level of everyday functioning and treatment outcome were also investigated. A total of 191 patients in a psychosomatic psychotherapy ward of a university hospital were assessed using standardized questionnaires on sociodemographic and clinical variables on admission and at discharge. The type and extent of early traumatization before the age of 18 years were estimated after the initial interview from standardized reports of the therapists. The results indicate that the probability of being exposed to one of the traumatic experiences under study are not independent of each other. Furthermore, female patients were victims of sexual abuse and neglect more often than males. Compared to non-traumatized patients, trauma victims exhibited more psychological symptoms in the symptom checklist 90 revised (SCL-90-R) and a lower level of functioning according to the global assessment of functioning (GAF) but achieved a comparable relative benefit from treatment. Sexual abuse (SCL-90-R and GAF) and neglect (SCL-90-R only) affected the levels of impairment on admission and at discharge in a similar way; however, only weak evidence for differential effects of trauma patterns on therapy outcomes was found. Methodological limitations of the present approach and implications for the design of inpatient psychotherapeutic interventions in adult patients with early traumatic experiences are discussed.     

The Impact of Social Support on the Relationship between Trauma History and PTSD Symptoms in Motor Vehicle Accident Victims

The present study examined how different types of social support differentially moderated the relationship between trauma history characteristics and the development of posttraumatic stress disorder symptoms (PTSS) following a motor vehicle accident (MVA). Two hundred thirty-five MVA victims self-reported levels of social support and trauma history, and were evaluated for PTSS 6- and 12-months post-MVA. Results indicated that after controlling for gender, injury severity and income, number of prior trauma types and subjective responses to prior traumatization predicted subsequent PTSS (ps < .05). Appraisal social support was a significant moderator of the total number of types of trauma (appraisal: 6-months β = -.16, p < .05; 12-months β = -.17, p < .05) and subjective physical injury during the prior trauma (appraisal: 6-months β = -.14, p < .05; 12-months β = -.19, p < .05) in predicting PTSS. Results underscore the importance of examining both trauma history and social support as multi-dimensional constructs and suggest merit to addressing social support in trauma victims with a prior trauma history.     

An evolutionary analysis of psychological pain following rape. III: Effects of force and violence

Mental pain has been hypothesized to reflect psychological adaptation designed by selection to detect and cope with the occurrence of social problems that reduced individuals inclusive fitness in human evolutionary history. According to the hypothesis, mental pain is brought about by social tragedies in the lives of individuals and focuses an individual's attention on the events surrounding the pain, promoting correction of the pain-causing events and their avoidance in the future. The hypothesis applied to rape victims argues that in human evolutionary history raped females had increased fitness as a result of mental pain, because the pain forced them to focus their attention on the fitness-reducing circumstances surrounding rape, which are discussed. Some of the hypothesis' predictions about the psychological pain of rape victims are examined using a data set of 790 rape victims who were interviewed about their psychological traumatization within five days after the assault. Earlier analyses of these data have indicated that, as predicted, both a victim's age and marital status are proximate causes of the magnitude of psychological pain following rape: Reproductive-aged women appear to have been more severely traumatized by rape than older women or girls and married women more than unmarried women. The analyses herein indicate that, as predicted, reproductive-aged women are more likely to be victims of force and/or violence during rape than are older women or young girls. When force and/or violence was controlled, reproductive-aged women were still more psychologically traumatized by rape than were either older women or young girls. The results suggest that the psychology that regulates mental pain processes information about age and mateship status in the event of a woman's rape. The analyses reported here indicate that stranger rapes are more forceful and violent than either friend or family-member rapes.     

A Family Therapeutic Approach to Transgenerational Traumatization

The phenomenon of transgenerational traumatization has currently become widely recognized and described, although the task of disentangling the underlying interactional mechanisms remains a difficult one. These transgenerational mechanisms were first detected in families of the survivors of the Holocaust, but they may be equally prominent in families of parents who have been traumatized in other ways, for example, as victims of child neglect and abuse, as orphaned children, or during military service. In cases in which parents have themselves been subjected to early parental deprivation, one or more children may become projectively identified with a parent's (posttraumatic) "bad child"-self, whereas the parent him/herself has identified with — enacts the role of — the idealized internal "martyr" parent. A case study is presented describing the individual and family therapeutic treatment of a woman who, as a child, had been traumatically separated from her parents.     

Notes on Diversity and Working Together Across Cultures on Traumatization and Forgiveness: Siblings by Choice

The article addresses problems of severe collective traumatization by wars and discrimination not only for victims and perpetrators but also for the generations of children, nephews, and grandchildren. Two historical processes are exemplified in biographical experiences, slavery and oppression of African-American families, and the effects of Nazi ideology and World War II on German and Czech population. Aspects of forgiveness and healing are presented and discussed. One model of dissolving collective animosity and denial is explored in the intentional cooperation of caregivers and trainers in pastoral care and counseling from different cultures and religious traditions: siblings in struggle, siblings by choice.     

Prevalence of poor psychological morbidity following a minor road traffic accident (RTA): The clinical implications of a prospective longitudinal study

Few Road Traffic Accident (RTA) victims have their psychological needs attended to in hospital or afterwards. We conducted a small-scale preliminary investigation exclusively focussing on the prevalence of poor psychological morbidity following minor road traffic accidents (RTAs). Participants (N?=?50) completed assessments one-month after their minor RTA and (N?=?39) at 4-months follow-up. The identification of clinically significant anxiety, depression and post traumatic stress disorder (PTSD) in this minor RTA sample supports both evidence reported elsewhere and our specific predictions. Seven (14%) participants at baseline and five (12.8%) at follow-up met diagnostic criteria for PTSD. The clinical implications for identifying and meeting the psychological needs of minor RTA victims are discussed in the context of cognitive behavioural conceptualizations of mental disorder.     

Reply to Panel Follow-up Questions

When both therapist and client share a traumatic event, there are multiple levels of vulnerability to traumatization for the therapist. Our personal vulnerability is not only a backdrop for our clinical work but also an acknowledged fact in many therapeutic relationships, a situation that changes the frame of the work. In addition to clinical challenges, shared trauma increases a therapist's vulnerability to vicarious traumatization; VT is defined as the negative transformation of the therapist's inner experience as a result of his or her empathic engagement with and responsibility for a traumatized client. Emphasizing the importance of awareness, self-care, meaning, and community, the article summarizes important steps to anticipate, address, and transform the therapist's experience of vicarious traumatization.     

Trauma,Treatment, and Religion

Abstract

When children and youth are traumatized, caretakers must attend to behavioral, cognitive, physiological, ecological and spiritual/existential aspects of their reactions. This article focuses on the latter facet of traumatization. The Hebrew Scriptures and the New Testament offer little about the traumatic symptoms of victims. Using many of the same sources, Fundamentalist Christians, Jews, mainline Christians and secularists may offer children different interpretations of the meaning of trauma events. Understanding these interpretations is crucial for children who develop symptoms which suggest a diagnosis of PTSD. Caretakers, other than mental health professionals, can understand and use various techniques explicated in the TREAT model for treatment of PTSD. Concepts discussed can be used, within a spiritual/existential framework, to support traumatized youngsters.     

The Narcissistic Injury and Psychopathology of Migration: The Case of a Nicaraguan Man

Cultural and ethnic issues commonly surface as important therapeutic themes among many minority patients. Identity formation, self-concept, perception, and the effects of migration on the aetiology of psychiatric symptomatology are reviewed. Trauma resulting from migration, stress, and prolonged affect-laden situations in the precipitation and onset of physical disease and illness is discussed. A clinical presentation of a 68-year-old Nicaraguan man is presented to highlight the aforementioned issues, i.e., traumatization, the development of psychopathology, and the onset of physical illness as a result of forced migration.     

Adolescents in Secure Accommodation in Scotland: Exposure and Impact of Traumatic Events

The current study sought, for the first time, to assess the nature of trauma exposure and resultant symptoms in adolescents (n = 17) in secure accommodation in Scotland. A case study mixed methods design involved analysis of case files, trauma history interviews, and standardized trauma symptom questionnaires with adolescents and program staff in 1 facility. A developmental trauma framework was applied to file analysis. Despite extensive abuse and resultant symptoms identified in files, few explicitly reported traumatization. Adolescents in interview, however, reported numerous domestic and institutional traumatic events. High levels of posttraumatic stress (65%), depression (65%), and dissociation (18%) were identified. It appears adolescent traumatization is pervasive in 1 secure accommodation facility in Scotland. Studies across Scotland’s secure facilities are needed to assess reliability of findings. Indications are that staff in secure accommodation need to have an understanding of trauma exposure, resultant symptoms, and how to respond to traumatized adolescents.     

Bullying and Victimization in Adolescence: Concurrent and Stable Roles and Psychological Health Symptoms

From an initial sample of 1,278 Italian students, the authors selected 537 on the basis of their responses to a self-report bully and victim questionnaire. Participants' ages ranged from 13 to 20 years (M = 15.12 years, SD = 1.08 years). The authors compared the concurrent psychological symptoms of 4 participant groups (bullies, victims, bully/victims [i.e., bullies who were also victims of bullying], and uninvolved students). Of participants, 157 were in the bullies group, 140 were in the victims group, 81 were in the bully/victims group, and 159 were in the uninvolved students group. The results show that bullies reported a higher level of externalizing problems, victims reported more internalizing symptoms, and bully/victims reported both a higher level of externalizing problems and more internalizing symptoms. The authors divided the sample into 8 groups on the basis of the students' recollection of their earlier school experiences and of their present role. The authors classified the participants as stable versus late bullies, victims, bully/victims, or uninvolved students. The authors compared each stable group with its corresponding late group and found that stable victims and stable bully/victims reported higher degrees of anxiety, depression, and withdrawal than did the other groups. The authors focus their discussion on the role of chronic peer difficulties in relation to adolescents' symptoms and well-being.     

The association between reality-based beliefs and indirectly experienced traumatization

The purpose of the study was to examine the association between belief types and the magnitude of indirect traumatization. Specific types of beliefs were defined in terms of the cognitive orientation theory, which is a cognitive-motivational approach to the understanding, predicting, and changing of behaviors. Belief types that were analyzed included beliefs about self, general beliefs, beliefs about norms, and goal beliefs as they relate to personal growth. Study participants included 38 rescuers (body handlers), 37 nurses, and 31 rehabilitation workers who treated injured civilians that had been exposed to politically motivated violence. The Cognitive Orientation for Posttraumatic Growth Scale was used to assess beliefs about personal growth. The Revised Posttraumatic Stress Disorder Inventory was administered to evaluate indirect traumatization. The results indicate that three of the four belief types related to personal growth were associated with the level of indirect traumatization. Optimistic and positive beliefs about self and general beliefs were associated with a lower level of indirect traumatization symptomatology, suggesting that these types of beliefs may counteract indirect traumatization. On the other hand, stronger goal beliefs were associated with greater indirect traumatization. The negative association between positive goal beliefs and indirect trauma may be related to the gap the individual perceives between the hoped-for ideals and the trauma-stricken reality. These results indicate the importance of cognitive beliefs and their possible role in determining the response to indirect traumatization.     

Rehabilitating civilian victims of war through psychosocial intervention in Sierra Leone

This research assessed an intervention (involving drug therapy and psychoeducational counseling) for war trauma in Sierra Leone. We examine the impact of the intervention on symptoms of post‐traumatic stress disorder (PTSD) and indicators of intergroup emotions and attitudes. Civilian war victims were drawn from a rehabilitation program (Intervention, N=50) or a waiting list Control group (N=50). The rehabilitation program combined general psychiatric treatment with additional life skills support. Those in the Intervention group had significantly lower PTSD symptoms and also scored lower on Intergroup Anxiety and Outgroup Blame, than those in Control. The intervention had an indirect effect on PTSD symptoms through Intergroup Anxiety. The reduction in PTSD in the intervention was greater for participants with a stronger identification with Sierra Leone.     

The social and emotional skills of bullies,victims, and bully–victims of Egyptian primary school children

This study examined whether bullies, victims, bully–victims (who are both bullies and victims), and students who reported no or low levels of bullying and victimization differed in their levels of social and emotional skills. Data were collected from 623 children in fifth and sixth grades from four Egyptian elementary schools; their ages ranged from 10 to 12 years. K‐means cluster analysis revealed four groups: bullies (n = 138), victims (n = 178), bully–victims (n = 59), and children who were not involved in bullying behaviour (n = 248). Data were analyzed using multinomial logistic regression. The findings indicated that boys were more involved in bullying behaviour than girls, and both bullies and bully–victims were less likely to adhere to social rules and politeness than children who were not involved in bullying. Both bullies and victims were less aware of the physiological reactions of their emotions than uninvolved children, and were less able to apply social rules in social interaction. Both victims and bully–victims reported less likeability than children not involved in bullying. Verbal sharing, attending to others’ emotions, and analysis of emotions did not have a statistically significant relationship with the probabilities of classifying children to any bullying group versus children not involved in bullying. Social skills were more important than emotional awareness in predicting the likelihood of classifying children in one of the three bullying groups versus children who not involved in bullying. The main conclusion is that social and emotional skills together may provide an effective means of intervention for bullying problems.     

(Not) Thinking about you: Differences in victims’ and perpetrators’ self-focus after interpersonal and intergroup transgressions

We tested the hypothesis that, following a transgression, victims and perpetrators differ in their focus of attention. In three studies (total N = 740), we manipulated participants’ social role (victim vs. perpetrator) in a hypothetical scenario (Studies 1 and 2) and in a perceived real conflict (Study 3) in an interpersonal (Studies 1 and 2) and an intergroup (Study 3) context. Results from all studies confirmed that victims show a stronger self-focus than perpetrators. Moreover, results suggest victims’ higher self-focus as a predictor of willingness to reconcile. Participants’ self-focus mediated the effect of social role on reconciliation intentions as a single mediator (Study 2), or in sequence with their motivation to consider the other party's needs (Study 3). Overall, the present research suggests that victims and perpetrators differ in their focus of attention, and that this difference has important theoretical and practical implications for reconciliation between individuals and between groups.     

Offenders’ claims of taking the victims’ perspective can promote forgiveness,or backfire! The moderating role of correctly voicing the victims’ emotions in collective apologies

In the context of collective apologies, we investigate whether offenders’ claim to have taken the victims’ perspective enhances victims’ conciliation. We argue this depends on whether offenders acknowledge emotions in victims that match victims’ emotional experience. In Studies 1 and 2 (Ns = 152 and 171), using scenarios, we experimentally manipulated offenders’ claim and the qualitative or quantitative match of acknowledged emotions. When acknowledged emotions matched victims’ experience, claimed perceptive‐taking increased conciliatory victim responses; but when emotions did not match, the offenders’ claim reduced conciliatory victim responses. In Study 3 (N = 138), African‐Americans were presented with the U.S. government's apology for slavery. We manipulated the perspective‐taking claim and measured the similarity of the emotion profile expressed in the apology to that experienced by African‐Americans over their enslavement. With greater mismatch, the perspective‐taking claim backfired, reducing conciliatory responses. Correct acknowledgment of emotions is key for victims perceiving perspective‐taking and responding conciliatorily.