Suicide in Group Therapy: Trauma and Possibility

Abstract

This paper compares and contrasts the experiences of two different long term psychodynamic psychotherapy groups in which a patient suicided. The acute reactions and longer term process of each group is described in detail and discussed. The reactions of the two leaders, married to each other and in a shared supervisory group with the late Anne Alonso, and their own working through of the traumatic losses are explored. Their experiences highlight the importance of open discussion of the suicides in the groups, consultation with senior colleagues, and continual processing of their own reactions as a means of fostering posttraumatic growth. The authors discuss their experience in light of the literature on trauma in groups and the emerging literature on posttraumatic growth and they reflect on implications for the community of group therapists.     

Dissociative Experiences and Trauma Exposure Among Newly Arrived and Settled Young War Refugees

War-traumatized refugee adolescents are a vulnerable and understudied group. This study of two different groups of war-traumatized youth (N = 77) resettled in Sweden (newly arrived refugee adolescents, n = 42, 13–19 years, and settled students with childhood war experiences, n = 35, 11–18 years) evaluated their war experiences, refugee journey, general trauma exposure, posttraumatic stress symptoms, and dissociative experiences. Both groups had experienced many traumas and a substantial proportion reported levels consistent with posttraumatic stress (71% in the newly arrived group and 34% among the settled students) and dissociation (36% and 23%, respectively). The study also provides information about the type of adverse events experienced by war-refugee adolescents, including their own subjective appraisals of the worst events. The results show that the extent of trauma exposure and posttraumatic and dissociative symptomatology among refugee adolescents are considerable even after a period of resettlement, a finding that has educational, clinical, and social implications.     

Treatment for Psychosomatic Blindness Among Cambodian Refugee Women

A number of older Cambodian women came to the attention of the authors because of their overrepresentation among a larger group of people who exhibited functional or psychosomatic blindness: visual loss with no physiologic basis. Myriad problems are faced by the psychosomatically blind Cambodian refugee, including war-based trauma, improper diagnosis resulting in denial of claims of disability, and feelings of severe depression and isolation. It was our intention to design and test an intervention program for the 150 psychosomatically blind Cambodian women whom we have seen over a four year period. Working with fifteen of these clients, we wished to test the relative effectiveness of two different treatments in reducing psychological distress and improving well-being and visual acuity: (1)Skills in living group: treatment consisted of group sessions designed to teach minimal skills such as using the telephone and public transportation; and (2) Therapy group: treatment consisted of group therapy conducted by a Cambodian therapist. Both treatment modalities were designed to be culturally relevant, implemented by Cambodians and in the Khmer language. Extensive pre and post-treatment interviews were conducted to assess level of visual acuity, psychological and physiological functioning and experiential background. Comparison of pre and post measures showed significantly better perceived well-being and improved visual acuity in the treatment groups as compared to the control group. Such findings may be beneficial in reducing psychological distress and improving vision.     

A Review of the Use of Trauma Systems Therapy to Treat Refugee Children,Adolescents, and Families

ABSTRACT

Children and adolescents within refugee families face adverse childhood experiences emanating from multiple sources. These traumatic events can begin with persecution within their country of origin, during the migration process, and within their re-settled countries. More specifically, these children and their families are more prone to the four core stressors being: traumatic, acculturative, isolative and resettlement stress. Trauma Systems Therapy for Refugees (TST-R) is a promising treatment model to address child and adolescent mental health disparities revolving around direct and vicarious trauma. In TST-R, the treatment team systematically targets the needs of the child, while collaborating with cultural brokers from the refugee community, their school, and family unit. Researchers have used TST-R as an intervention for reducing trauma symptoms in Somali, Somali-Bantu, and Bhutanese children, adolescents, and their families. We review the strengths and limitations of this model. Further research is needed to determine its applicability to other communities within the United States and abroad.     

Contributions of Loss Events to Loss Distress and Trauma Symptoms in Recently Resettled Refugee Women at Risk

This research examined contributions of loss events to loss distress and trauma symptoms (accounting for trauma events) for refugee women at risk. Participants (N?=?104) responded to the Multidimensional Loss Scale (loss events and distress) and Harvard Trauma Questionnaire (trauma events and symptoms). Loss events contributed uniquely to loss distress (explaining additional 50.8% variance), and made a unique contribution to trauma symptoms (explaining additional 5.2% variance) approximately equal to trauma events. Appropriate response to psychic distress in refugee women at risk requires assessment of both loss and trauma and consideration of cultural differences in ways loss is expressed and meaning ascribed to symptoms.     

The associations between adult attachment,posttraumatic symptoms,and posttraumatic growth

Background and Objectives: Individual differences after trauma vary considerably and can range from posttraumatic stress disorder (PTSD) to posttraumatic growth (PTG). Current theoretical models cannot fully explain this variability. Therefore, we integrated attachment theory with Ehlers and Clark's model of PTSD to understand whether attachment style is associated with negative appraisals of a traumatic event(s), posttraumatic stress symptoms (PTS), and PTG. Our aim was to test this integrated model PTSD in an analog sample who had experienced at least one traumatic event. Design: We used structural equation modeling to test the association of adult attachment and posttraumatic cognitions (self and world/others) with PTS and PTG using a cross-sectional, correlational design. Methods: The sample comprised 393 university staff and students (Range_Age= 18–49, 85% females) who completed online measures. Results: Attachment anxiety and negative posttraumatic self-cognitions were positively associated. Negative posttraumatic self-cognitions were positively associated with PTS. Attachment anxiety had an indirect effect (via negative posttraumatic self-cognitions) on PTS, whereas attachment avoidance predicted more negative posttraumatic world cognitions and lower perceived PTG. Conclusions: The study highlights the importance of considering how attachment styles influence posttraumatic emotion regulation and cognitive processing of the trauma to determine posttraumatic mental health.     

Legacies of War: Asian American Women and War Trauma

ABSTRACT

Although Asian Americans are diverse in many ways, such as language, culture, ethnicity, religion, generational status, and more, many share a common experience: that of having experienced war first hand or being progeny of war survivors. World War II, the Korean War, the Vietnam War, the Cambodian genocide, along with centuries of oppressive and authoritarian rule, have brought experiences of trauma, directly and historically, to the lives of many Asians. Subsequent experiences of migration and resettlement, as well as life in the United States as an ethnic minority, have also compounded the layers of oppression for many Asian Americans. Sexism in our cultures of origin, as well as sexism in the U.S., represents additional realities and traumas faced by Asian American women. In this article, we explore the experiences of war and subsequent traumas in the lives of Asian American women. We present a brief review of the current state of mental health as it relates to the experiences of war trauma, with the goal of providing a crucial contextual backdrop for our review of the best practices in mental health services to Asian American women. We review some of the best practices and conclude with a narrative reflection based on our own involvement in a small professional women’s group that yielded insights, discoveries, healing, and empowerment from the legacy of war trauma.     

Psychological Adjustment,Coping, and Emotion Regulation as Predictors of Posttraumatic Growth

Abstract

The present study examined factors contributing to reported benefits of traumatic experiences or posttraumatic growth (PTG) in a college sample. Specifically, we examined dimensions typically associated with trauma recovery (i.e., psychological functioning, coping, emotion regulation) and features of the trauma (i.e., number and recency of traumatic events, average, and maximal distress). Participants (N= 193) completed standardized questionnaires measuring these constructs. Results indicated that active coping and subjective well-being independently contributed to PTG, but social desirability and symptom distress were independent of growth. These results were consistent with study expectations. Although not specifically predicted, maximal trauma distress also uniquely predicted PTG. Contrary to expectations, effective emotion regulation did not contribute to PTG.     

Predicting adolescent posttraumatic stress in the aftermath of war: Differential effects of coping strategies across trauma reminder,loss reminder,and family conflict domains

Background and Objectives: The vast majority of youth who lived through the Bosnian war were exposed to multiple traumatic events, including interpersonal violence, community destruction, and the loss of a loved one. This study examined factors that predict post-war psychological adjustment, specifically posttraumatic stress, in Bosnian adolescents. Design: Regression analyses evaluated theorized differential relations between three types of post-war stressors – exposure to trauma reminders, loss reminders, and intrafamilial conflict – specific coping strategies, and posttraumatic stress symptom dimensions. Methods: We examined 555 Bosnian adolescents, aged 15–19 years, to predict their long-term posttraumatic stress reactions in the aftermath of war. Results: Findings indicated that post-war exposure to trauma reminders, loss reminders, and family conflict, as well as engagement and disengagement coping strategies, predicted posttraumatic stress symptoms. Secondary control engagement coping responses to all three types of post-war stressors were inversely associated with posttraumatic stress symptoms, whereas primary control engagement coping responses to family conflict were inversely associated with hyperarousal symptoms. Disengagement responses to trauma reminders and family conflict were positively associated with re-experiencing symptoms. Conclusions: These findings shed light on ways in which trauma reminders, loss reminders, and family conflict may intersect with coping responses to influence adolescent postwar adjustment.     

Healing the Wounds of the Mahantdori

The magnitude of the Mahantdori, or Cambodian holocaust, must be understood by therapists who are trying to help the survivors deal with the illness and injuries that are a product of this destruction. This paper presents an overview of the events that have come to be known as the Mahantdori and a model for treating the multiple levels of trauma with which the Cambodian family must deal. The Contextual Model of Family Therapy, as described by Ivan Borzormenyi-Nagy, is used as the structure for helping to rebuild trust within the family while at the same time treating the injuries of the individual family members. The changing role of Cambodian women and their need to form new support groups because of their devastating loss of family are described.     

Implementing Trauma-Informed Care in Primary Medical Settings: Evidence-Based Rationale and Approaches

ABSTRACT

Chronic stress stemming from trauma exposure and posttraumatic stress disorder (PTSD) leads to many health problems that are typically seen by primary care providers. Unfortunately, providers rarely identify trauma as the root cause of patient difficulties. The present paper provides an evidence-based rationale for implementing trauma-informed care principles and processes into medical primary care systems. Beginning with a review of prevalence of trauma exposure and PTSD in primary care clinics, this article elucidates relationships between trauma exposure and behavioral and medical health problems, as well as clinical and physiological pathways that lead from trauma exposure to illness. The article concludes with exposition of trauma-informed interventions that can be implemented in primary care clinics, and discussion of future directions.     

Healing Their Wounds:

Guatemalan refugee women living in the camps of southern Mexico for the past decade have become a remarkable example of self-empowerment despite the severe psychological trauma of the experiences which led to their exile. The successful organization of these women (the majority of whom are of Mayan ethnic identity) into a productive force for social advancement raises interesting questions about the roles of physical, social, and cultural environment in post-traumatic recovery. This article seeks to explore these issues by looking at the activism of Guatemalan refugee women and examining it in the context of their refugee experience.     

Suicide in group therapy: trauma and possibility

Abstract This paper compares and contrasts the experiences of two different long term psychodynamic psychotherapy groups in which a patient suicided. The acute reactions and longer term process of each group is described in detail and discussed. The reactions of the two leaders, married to each other and in a shared supervisory group with the late Anne Alonso, and their own working through of the traumatic losses are explored. Their experiences highlight the importance of open discussion of the suicides in the groups, consultation with senior colleagues, and continual processing of their own reactions as a means of fostering posttraumatic growth. The authors discuss their experience in light of the literature on trauma in groups and the emerging literature on posttraumatic growth and they reflect on implications for the community of group therapists.     

Narratives of trauma,recovery, and growth: The complex role of sport following permanent acquired disability

ObjectivesThe purpose of this study was to explore how participation in sport may assist an individual in working through experiences of physical trauma.DesignAn instrumental, collective case study was used to illustrate the experiences of two men with acquired disabilities.MethodBoth men participated in sport at a high level and suggested that participation was a central feature of their recovery from trauma. Interviews invited participants to describe their lives pre-trauma, the trauma experience, and the recovery process. A narrative analysis was used to focus on the progression of the plot outlined in each participant's story.ResultsOur results exemplify two narrative types: assimilation and positive accommodation. The narrative of positive accommodation demonstrates how sport provided mastery experiences, enhanced relationships, corporeal understanding and enhanced life philosophies. The alternative narrative of assimilation was associated with resilience to trauma. Our case illustrates that such a narrative may be focused on re-capturing previous life meanings and creating an athletic identity using past definitions of sport.ConclusionWhile the narrative of positive accommodation is most frequently associated with posttraumatic growth, our case outlines the occurrence of synchronous positive and negative experiences, even within the same dimensions of growth. The narrative of assimilation demonstrates the challenges presented by the rehabilitation and sporting environments for an individual who aimed to restore their pre-trauma self and pre-trauma beliefs.     

Pushing (and Pulling) the Boundaries of Emotion Regulation

In response to comments on our model of posttraumatic growth, we consider the validity of reports of posttraumatic growth, appropriate methodology to use to assess posttraumatic growth, and its relation with other variables that appear to bear a resemblance to posttraumatic growth (e.g., well-being and psychological adjustment). The potentially important role of proximate and distal cultural factors is also addressed. Clinicians are encouraged to use interventions that facilitate posttraumatic growth with care, so as not to create expectations for posttraumatic growth in all trauma survivors, and to instead promote a respect for the difficulty of trauma recovery while allowing for the exploration of possibilities for various kinds of growth even in those who have suffered greatly.     

Resilience and Post-Traumatic Recovery in Cultural and Political Context

Abstract

Violence against women has been conceptualized in terms of controlling female sexuality, restricting women's autonomy, humiliating and keeping women out of sight, maintaining male control and dominance, and dishonoring other [male] enemies. This paper discusses situations where the violation of women's bodies becomes the site for political rivalries and thus incurring masculine/national honor. The etching of political rivalries onto women's bodies for national honor or to inflict dishonor has a long history and is not unique to Pakistan. Within the theoretical frameworks of ecological psychology and cultural anthropology, this paper highlights the resiliency shown by two Pakistani women in their efforts toward posttraumatic recovery as they situate their traumatic experiences within their immediate structural, political, and cultural contexts, which in turn influence their behavior and shape the specific choices they make.     

Guest referees for 17(4)

Background and objectives: Although intimate partner violence (IPV) has demonstrated strong associations with anxiety and posttraumatic stress, these constructs have rarely been examined simultaneously in IPV research. Gaps in knowledge remain as to their differential associations to substance use problems among IPV-victimized women. Design: A sample of 143 community women self-reported on their current IPV victimization, mental health and substance use problems. Method: Hierarchical entry multiple regressions were used to test for the direct and indirect effects of psychological, physical, and sexual IPV to alcohol and drug problems through anxiety and posttraumatic stress. Results: Higher anxiety symptom severity and higher physical IPV severity were associated with greater alcohol and drug problems. Higher posttraumatic stress symptom severity was associated with greater alcohol and drug problems. Mediation analyses indicated (i) significant indirect pathways of IPV types to alcohol problems through posttraumatic stress symptom severity controlling for anxiety symptom severity and (ii) significant indirect pathways of IPV types to drug problems through anxiety symptom severity controlling for posttraumatic stress symptom severity. Conclusions: In examining the indirect pathways of psychological, physical, and sexual IPV to substance use problems this study highlights that anxiety and posttraumatic stress symptom severity have unique effects on alcohol and drug problems among IPV-victimized women.     

Beyond Resilience: Glimpses into Women’s Posttraumatic Growth after Experiencing Intimate Partner Violence

Abstract

Little focus is given to the pathways victims of intimate partner violence (IPV) use to move toward posttraumatic growth. A sample of 32 female participants was recruited through advertising in domestic violence shelters. Women were interviewed about their experiences with four main themes emerging from women’s narratives related to posttraumatic growth: deliberateness of action, ending the cycle for the children, a changed perspective on life, and alternative perceptions of social support. Opportunities for professions working with this population in a number of various of settings is presented to promote long-term changes for women affected by IPV.     

Proactive coping,gratitude, and posttraumatic stress disorder in college women

Abstract

This study investigated relationships among proactive coping, positive emotions, and posttraumatic stress disorder (PTSD) symptom severity for 182 undergraduate women with trauma histories. Participants were administered the Life Events Checklist (LEC), PTSD Checklist, Proactive Coping Inventory, Proactive Attitude Scale, General Perceived Self-Efficacy Scale, and measures of posttrauma gratitude and emotional growth. An Exploratory Factor Analysis (EFA) with proactive coping, proactive attitude, and self-efficacy items indicated a one-factor solution. The proactive coping style factor and posttrauma gratitude were independently negatively associated with current PTSD symptom level, above and beyond the effects of trauma severity, trauma history, and time elapsed since the trauma. The implications of these results for future research and understanding of the development of PTSD and its treatment are discussed.     

“Giving Back to Society What Society Gave Us”: Altruism,Coping, and Meaning Making by Two Refugee Communities in South Australia

We aimed to explore how refugee people utilised their coping resources and strategies to find meaning in their past and present experiences. Using an experience‐centred narrative approach, we analysed the stories of 24 former refugees from two African countries resettled in South Australia. Data analysis revealed altruism and helping behaviour as a prominent and recurring theme of participants' narrated lives. This meta‐theme encompassed four subthemes: (a) surviving war and exile, (b) adapting to Australian society, (c) reaching back home, and (d) meaning making through religious beliefs. Helping, cooperating, and sharing were entwined with participants' coping strategies and meaning making of experience. Participants' socio‐historical, cultural, and religious context influenced the interpretations of their experiences. Taken together, our findings identified a counter narrative in refugee mental health research beyond trauma and psychopathology. Specifically, we have shown that when the refugee experience is also accompanied by situational contingencies such as receiving help and being called upon to help, together with evaluations such as empathy, identification with suffering, and gratitude, people can be motivated to help others. Future research is needed to explore how altruism and helping behaviour can promote healing from trauma, alleviate distress of separation, and ameliorate acculturation stress among diverse refugee populations.