Silence and survival: Working with strategies of denial in families of traumatized pre-school children

Silence and denial about previous traumatic experiences are common features in families exposed to organized violence. Mutual protection between family members, and especially between parents and children, is seen as the fundament for the silencing of traumatic experiences. This strategy is suggested to have adaptive advantages in dangerous situations in general, where it serves the function of saving the child's internal representations of his/her parents as secure bases. If, however, the dangerous situation escalates and a psychic trauma cannot be avoided, the strategy of mutual silence concerning the event(s) becomes an obstacle for giving traumatized children parental support and professional treatment. It is argued that clinicians need to take seriously the strong reasons families have for upholding their strategy of denial, if they want to help traumatized families to a better functioning. A case presentation is made to illustrate how it is possible to use refugee children's re-enacting play as a source of information about past traumatic events in order to change destructive post-traumatic family dynamics and improve parental support to the child.     

Impact of traumatic incidents on family-of-origin functioning: An empirical study

This pilot study was an attempt to empirically validate some of the clinical observations made about traumatic incidents and families in the literature. The study hypothesized that there would be a significant difference in family functioning between those subjects that reported feeling traumatized and those subjects that did not report feeling traumatized, there would be a significant difference in anxiety between the identified trauma group and the identified non-trauma group, and there would be a significant difference in the breadth of support systems between the two groups. The results indicated that there were significant differences between groups of individuals who were identified as traumatized or non-traumatized. The differences included family functioning, individual feelings of anxiety, and report of familial support systems. The findings of this study were congruent with and supportive of much clinical literature on families and traumatic incidents.     

“It takes a village to heal a child”: Necessary spectrum of expertise and benevolence by therapists,Non-Governmental Organizations,and the United Nations in managing war-zone stress in children traumatized by political violence

This article highlights the post-traumatic stress responses in some war-zone children who were exposed to political violence—witnessing unspeakable horror, maimings, brutal beatings, torture, and murders. Children inducted into rebel military units to serve as child-soldiers further traumatized self and others by raping and killing children and adults. Additionally, some children go without food, shelter, and adult protection, while finding themselves as refugees in a foreign country. This article advances some conceptual, technical, and practical issues in intervention with these children and provides a model of intervention that seeks to integrate established international policies of the United Nations (UN) and Non-Governmental Organizations (NGOs) along with cognitive, behavioral, and psychodynamic clinical approaches in the context of cultural/racial sensitivity and indigenous folk medicine. The child's adaptational strengths are discussed, and the recognition and management of transference and countertransference are not ignored in the treatment of traumatized children. Basically, the author's point of view is that Western models of interventions are very useful, but that the personal, cultural, social, spiritual, and economic resources of the child's homeland or village probably constitute the best system for healing and integration after brief or continuous exposure to political violence.     

Addiction in Maternity: Prevalence of Mental Illness,Substance Use,and Trauma

Women living in vulnerable neighborhoods experience higher rates of poverty, homelessness, psychiatric issues, illicit substance use, rates of HIV, and a lowered life expectancy. The aim of the study was to further explore the history of mental illness and trauma in a sample of women (N?=?31) who had recently given birth and had a substance use problem while pregnant. We investigated sociodemographic characteristics, history of trauma and post-traumatic stress disorder (PTSD), rates of substance use and dependence, and psychiatric symptoms. Childhood and adult traumatic experiences were found in the majority of the sample, and one-third presented with suspected PTSD diagnosis at the time of the interview. Women-centered services are in great demand, as well as trauma informed care, and further research on appropriate treatment for substance using, traumatized, women with a mental illness.     

The ethics of trauma: re-traumatization in society's approach to the traumatized subject

The paper starts from a question about the subconscious needs and anxieties which may underlie society's current responses to trauma. In particular, the author argues that the interest in the trauma of torture and man-made violence is a reaction to the increasingly dehumanizing and death-denying culture we live in. After proposing that the various categories of societal responses-the author focuses on evaluation, treatment, and advocacy-to traumatized subjects hide defenses of denial, distortion, refusal, with respect to the challenge of mortality, meaning-making, and mourning, the author then makes the thesis that they can derail and corrupt the project of post-traumatic repair. The paper proceeds with an examination of the ethics and politics that are implicit in contemporary North American society's current approach to trauma. The central argument is that the current approach may contain a collective acting out that often ends up being re-traumatizing to the traumatized subjects.     

Sekundäre Traumatisierung

During the past several years there has been a growing interest in the negative effects that therapy may have on therapists. Of special interest is a phenomenon called secondary traumatization, which can arise while working with traumatized clients. As yet it has not been verified that secondary traumatization consists of posttraumatic symptoms and leads to clinically significant distress. In an exploratory study 21 therapists were interviewed who declared that they had experienced an incident of this form of work-related stress. The presented study reveals that in fact such a ?vicarious“ traumatization can arise, even without direct contact to the original trauma. It consists of post-traumatic stress disorder (PTSD)-like symptoms, but in severe cases it can also manifest itself in symptoms which are far beyond the typical PTSD spectrum. Conditions for the development of secondary traumatization are high empathic ability and dissociative processing of the trauma material by the therapist.     

And Then There Was Intersubjectivity: Addressing Child Self and Mutual Dysregulation During Traumatic Play

ABSTRACT

This article asserts that a traumatized mother, to maintain her psychobiological homeostasis, must avoid intersubjective connection with a child who is seeking it to regulate his own distress. In this case, what Lou Sander described as a “moment of meeting” cannot take place (Sander, 1995 Sander, L.. (1995), Identity and the experience of specificity in a process of recognition. Psychoanal. Dial., 5: 579–593.[Taylor & Francis Online] , [Google Scholar], p. 590). Case examples are used to illustrate how, when all are together in the consulting room, the reflective, mutually regulating therapist can facilitate moments of meeting between therapist, a mother who has been subjected to interpersonal violence, and her child, who has similarly been traumatized. Furthermore, I show how the therapist, in the face of the child’s traumatic reenactment in play that can further trigger and dysregulate the traumatized parent, can intervene to coconstruct meaning, for both the traumatized child and mother, obviating mother’s need to avoid the child’s distress and post-traumatic re-experiencing. This allows meeting to occur, reordering the implicit relational knowing of both mother and child.     

The influence of extreme traumatization on body, mind and social relations

Extreme traumatization affects the individual's relation to others in several social and psychological ways. The post-traumatic experiences are characterized by helplessness, insecurity, anxiety, loss of basic trust, and fragmentation of perspectives on one's own life. Special considerations should be given to the destruction of the ability to regulate negative emotions (extreme fear, distress, anguish, anger, rage, shame) in relation to others and activate internal good and empathic object relations. Destruction of the capacity for symbolization of traumatic experience may threaten the mind with chaotic states against which the 'I' tries to defend itself and find a balanced psychic mise-en-scene. The authors emphasize three dimensions that the analyst should observe in his understanding of the traumatized mind and its conflicts. The proposed dimensions are called the body-other dimension, the subject-group dimension, and the subject-discourse dimension. All three dimensions have specific structural characteristics that are expressed in the analytic relation. Extreme trauma causes disturbances in each of these dimensions. The authors present clinical material from a traumatized refugee to illustrate the analytic work.     

Trauma Accommodation and Anniversary Reactions in Children

Anniversary reactions in traumatized children have been well recognized in the literature. Examined herein are temporal issues in the mourning process often realized by traumatized children. The case study of Laura is presented as a clinical illustration of problems in trauma accommodation that include anniversary reactions in children. Anniversary reactions in children are more common than is generally recognized in clinical practice. Such reactions are more likely to be found among children who exhibit persistent, repetitive, but insufficient efforts of trauma mastery through their incomplete grief and inadequate mourning process. Clinical issues are discussed.     

Rampage school shooters: A typology

A number of researchers have sought to identify the features that school shooters have in common in terms of family life, personalities, histories, and behaviors. This article examines the cases of 10 rampage school-shooters in an effort to find out not only how they are alike, but also how they differ. Based on available information, these youths are categorized into three types: traumatized, psychotic, and psychopathic. Out of the 10 shooters discussed, three were traumatized, five were psychotic, and two were psychopathic. The three traumatized shooters all came from broken homes with parental substance abuse and parental criminal behavior. They all were physically abused and two were sexually abused outside of the home. The five psychotic shooters had schizophrenia-spectrum disorders, including schizophrenia and schizotypal personality disorder. They all came from intact families with no history of abuse. The two psychopathic shooters were neither abused nor psychotic. They demonstrated narcissism, a lack of empathy, a lack of conscience, and sadistic behavior. Most people who are traumatized, psychotic, and psychopathic do not commit murder. Beyond identifying the three types of rampage shooters, additional factors are explored that may have contributed to the attacks. These include family structure, role models, and peer influence.     

Internal state of emergency – working with an international student suffering from trauma in a student counselling service

In this paper I look at the suicidal state of mind of an international student who comes from a country at war and has been traumatized by a violent event. The student is tortured by an internal dilemma surrounding unbearable feelings of guilt and shame that arise when she leaves her home country to study abroad. Her dilemma or survivor guilt triggers an internal contract with herself, whereby she is internally persecuted when she makes an attachment to the university and her course. I suggest that an individual in this state of mind, suffering from post-traumatic stress, has regressed to a primary state of unintegration where the self is at the mercy of psychotic anxieties and the student is at risk of suicide. It is suggested that a safety net made up of the student services and the wider health service can provide a symbolic or mental space and containment for the student's state of mind until she can function as a student.     

The Question of Survival: The Death of Desire and the Weight of Life

This article aims to document the psychic injuries of torture. Psychic deadness, erasure of intersubjectivity, refusal of meaning-making, perversion of agency, and an inability to bear desire constitute the core features of the post-traumatic landscape of torture. The existential challenges in traumatized lives is examined, and questions are also raised about the ethics and unconscious defensive functions of the term "survival." Clinical materials with various torture patients are reported to explore the process of working through the losses and paradoxes of trauma. The role of unmourned loss and the defense of fetishizing the trauma are highlighted as the motivating force and the problem in the current preoccupation with trauma in modern Western culture.     

Dialectical Behavior Therapy With Prolonged Exposure for Adolescents: Rationale and Review of the Research

Among adolescents, interpersonal trauma has been associated with severe post-traumatic stress disorder (PTSD) and impairments across multiple domains of functioning (e.g., Derosa, Amaya-Jackson & Layne, 2013; Ford, Courtois, Steele, van der Hart, & Nijenhuis, 2005; van der Kolk, 2005). Such difficulties can include high-risk behaviors such as active suicidality (Middlebrooks & Audage, 2008) and nonsuicidal self-injurious behavior (NSSI; Hu, Taylor, Li, & Glauert, 2017). While there have been many advances in the treatment of trauma, treatment dropout for adolescents seeking trauma-informed treatment is predicted by diagnostic comorbidity and complexity (Sprang et al., 2013), as well as the number of traumatic events endorsed (Wamser-Nanney & Steinzor, 2016). Many traumatized adolescents with high-risk behaviors are referred to Dialectical Behavior Therapy (DBT-A). However, DBT-A does not yet include a specific, evidence-based protocol for treating PTSD, without which treatment gains may not be sustained for traumatized adolescents (Harned, Korslund, & Linehan, 2014). While Prolonged Exposure (PE) is indicated as the gold-standard treatment for PTSD and has proven effective for adolescents (PE-A; Foa, McLean, Capaldi, & Rosenfield, 2013), it has not yet been validated with adolescents who are actively suicidal. However, PE has successfully been integrated within DBT for adults with co-occurring Borderline Personality Disorder and PTSD (e.g., DBT-PE; Harned et al., 2014). Based upon this model, the current paper proposes the integration of DBT-A and PE-A to treat adolescents with interpersonal trauma who also present with high-risk behaviors. The paper discusses anticipated complications related to adapting this model for adolescents and provides direction for future research.     

Trauma exposure and post-traumatic stress symptoms among Syrian refugee youth in Jordan: Social support and gender as moderators

This study assessed relations between exposure to trauma and post-traumatic stress (PTS) symptoms, and whether perceived social support from family and friends and gender moderated these associations. Syrian refugee youth (N = 418, 55.0% female) attending public schools in Jordan participated. Boys reported more age-adjusted PTS symptoms than girls. Analyses revealed that family support and gender moderated the association of trauma on PTS symptoms. For males, the benefits of family support were most evident under conditions of high traumatic stress exposure, while for females, benefits of family support were evident when no loss or injury to family members had been reported. Support from friends was not helpful for either gender. School- or family-based interventions designed to treat PTS symptoms need to consider the different needs of boys and girls, particularly within the Syrian Muslim cultural context.     

The “Second Injury” to Victims of Violent Acts

This paper, originally published in 1980, is a significant contribution to the study of psychological trauma and its treatment; particularly countertransference aspects of that treatment. Initially it was widely cited but then became little known, largely because of the inaccessibility of the original publication. The three major concepts in Symond's approach are: (1) self-hate and shame are the key dynamics in post traumatic distress; (2) ordinary professional attitudes of those who are supposed to help often intensify the traumatized person's self-hate and shame. Martin Symonds called this is the second injury; and (3) to counteract the self-hate and the shame, the professional must adopt a much more active attitude and behavior—in contrast to the previous experience the traumatized individual has had with the world of helpers (including family and friends). Here, Symonds addresses the analysts’ vulnerability and shame and their role as active instruments against self-hate and shame.     

Making Meaning of Trauma: Trauma Exposure Doesn’t Tell the Whole Story

Although traumatic experiences are relatively common, there is wide variability in individuals’ responses to them. This study examined trauma exposure, meaning making efforts (indexed by post-traumatic cognitions), and post-traumatic stress symptoms (PTS) in a non-clinical volunteer student sample (N = 631). We further examined the moderating role of gender, the importance of trauma type (interpersonal vs. non-interpersonal), and the impact of cumulative traumatic experiences. About 75% of the sample reported past trauma (n = 475). Women reported more interpersonal trauma than did men. For both genders, trauma exposure was associated with more PTS. A dose–response relationship was found between the extent of trauma exposure and negative post-traumatic cognitions. Importantly, post-traumatic cognitions predicted PTS controlling for amount of trauma exposure. It appears that it is not merely exposure to negative events that matters, but how we construe and make sense of these experiences. This study extends our understanding of gender differences, meaning-making, and responses to trauma exposure, and suggests avenues of clinical treatment.     

Interapy: treatment of post-traumatic stress via the internet

This paper describes the theoretical background and procedures (including psycho-education, screening, treatment protocol and outcome measurement) involved in a protocol-driven internet treatment of post-traumatic stress and grief in a group of people who have suffered from mild to relatively severe trauma. The paper examines the results of 3 outcome and process studies, which were carried out initially in a student population and subsequently in the general population of highly traumatized people. In the latter study, participants in the experimental condition (n = 69) improved significantly more than participants in the waiting list control condition (n = 32), with respect to trauma-related symptoms and general psychopathology. The effect sizes were large. More than 50% of the participants treated showed reliable change and clinically significant improvement after treatment for avoidance and depression. Treatment proved most beneficial for participants who had suffered from intentional trauma and those who had not previously discussed the traumatic events with significant others. Content analysis of the publications indicates a remarkable increase in cognitive coping during treatment. The possibilities for future research into internet-driven treatment of post-traumatic stress symptomatology are discussed, including the proposal to study the effects of sending a final written letter to a significant other person.     

Attribution style and post-traumatic stress severity in the Central Region of Kenya: Influences of dwelling location

This study investigated the influence of attribution styles as predictors of post-traumatic stress severity (PTSS) by dwelling in Kenya. A non-clinical convenience sample of 354 rural (n = 178) and urban (n = 176) Kenyans from the Central Region of Kenya were participants. They responded to a post-traumatic stress screener, attribution style questionnaire and post-traumatic disorder (PTSD) checklist. A regression analysis showed that the urban dweller (UD) sample was significantly more likely to attribute negative events to internal, specific causes than the rural dweller (RD) sample. Findings suggest social support protections in RD to buffer them from negative self-attributions for PTSS among this Kenyan sample.