Treating Traumatized Children: Somatic Memories and Play Therapy

Drawing on psychoanalytic theories of infant development and children’s preverbal memories, this article explores the somatic memories in young children who experienced trauma and the level interventions necessary to facilitate the transformation of these traumas from concrete to symbolic representations. The clinical case of a 3-year-old boy who experienced hospitalizations and multiple surgeries prior to the age of 2 is used to illustrate the efficacy of play therapy for traumatized children. We argue that children do remember traumas from their infancy, and interventions geared toward re-enacting the traumas through play are necessary to help these children symbolize their experiences and alleviate their trauma symptoms.     

Psychoanalyse und Traumatherapie

The author is of the opinion that for patients with combined traumas of commitment and violence a psychoanalytical long-term treatment which takes into consideration the peculiarities of this group of patients will continue to be the therapy of choice. Special ??trauma therapies?? may be useful after acute traumas and in cases in which external conditions exclude psychoanalytical treatment. Depending on the situation of the individual case, though, specific modifications of the technique may be necessary, which possibly include proven specific trauma therapeutic techniques as parameters. Based on the parallelism of the economic aspect of the trauma and the aspect of object relationship, a decisive role in the therapeutic process befits the recognition of the traumatic reality and the working out of traumatic transference, which, however, must not traumatize under any circumstances. This is accompanied by the restitution of a good interior object, which only becomes possible within a frame giving security and support. The establishment and preservation of this frame may also be due to especially required parameters derived from trauma therapies, the psychodynamic significance of which must be analyzed with the individual patient. The author's approach is clarified by two case vignettes in which the theoretical reflections have led to very different technical procedures. The author comes to the conclusion that the psychoanalytical trauma therapy shows how therapeutic concepts aiming at an optimum result must still be tailored to the individual case.     

The role of early care and education in addressing early childhood trauma

Young children's experience of trauma is associated with a wide range of adverse events and circumstances, including abuse and neglect, domestic violence, loss of a parent, and community violence. Policymakers and practitioners are increasingly aware that trauma during the first few years of life is especially widespread, and there is growing interest in new ways to support these young children and their families. Many young children who experience trauma attend early care and education (ECE) programs, and these settings offer important opportunities to promote their well‐being. This paper examines strategies currently being implemented in ECE to address early childhood trauma. The paper first examines research on how trauma affects young children's development, ECE environments, and society. We then describe the unique needs of young, traumatized children and features of trauma‐informed care that can address their needs, along with emerging interventions and supports that can be incorporated into or linked with ECE settings as part of a trauma‐informed approach. We conclude with a discussion of future directions for ECE and trauma research, policy, and practice, bearing in mind both the promise of new approaches and a limited evidence base to date.     

The protective role of maternal posttraumatic growth and cognitive trauma processing among Palestinian mothers and infants

War survivors use multiple cognitive and emotional processes to protect their mental health from the negative impacts of trauma. Because mothers and infants may be especially vulnerable to trauma in conditions of war, it is urgent to determine which cognitive and emotional processes are effective for preventing negative trauma impacts.” This study examined whether mothers’ high posttraumatic growth (PTG) and positive posttraumatic cognitions (PTC) protected (a) their own mental health and (b) their infants’ stress regulation and sensorimotor and language development from the effects of war trauma. The participants were 511 Palestinian mothers and their infants living in the Gaza strip. The mothers were interviewed in their second trimester of pregnancy (T1) as well as when the infant was four months (T2) and twelve months (T3). Mothers reported posttraumatic growth (PTG; Tedeschi & Calhoun, 1996) at T1 and posttraumatic cognitions (PTCI; Foa et al., 1999) at T2. They also reported their exposure to traumatic war events both at T1 and T3 and described their mental health conditions (e.g., PTSD and/or depressive and dissociation symptoms) at T3. The Infant Behaviour Questionnaire (IBQ) was used to measure infants’ stress regulation at T2 and sensorimotor and language development at T3. The results, based on regression analyses with interaction terms between trauma and PTG, showed that high levels of traumatic war events were not associated with high levels of PTSD, depressive, or dissociation symptoms among mothers showing high levels of PTG. This suggests that PTG may protect maternal mental health from the effects of trauma. In turn, positive maternal PTCs appeared to protect the infants’ stress regulation from the effects of war trauma. The study concludes by discussing ways to develop and implement preventive interventions for mother-infant dyads in war conditions.     

Therapeutic Alliance,Interpersonal Relations,and Trauma Symptoms: Examining a Mediation Model of Women With Childhood Abuse Histories

The current study explored the dimensions of the early therapeutic alliance (tasks, goals, bonds, and other-therapist [people important to clients who support their involvement in therapy]) as mediators between clients’ interpersonal relations problems and outcome measures of trauma symptoms (dissociation and total trauma symptoms). Seventy-six female participants who were receiving treatment for posttraumatic stress due to child abuse (CA), were recruited from a university training clinic. The bond and other subscales mediated the association between interpersonal relations problems and dissociation. The element of client trust associated with the alliance bond, as well as clients’ sense that people who are important to them support their involvement in therapy, should be focal in treating CA survivors. Clinical implications revolve around developing, maintaining, and repairing the therapeutic relationship, especially the bond, within the context of dissociation, as well as exploring clients’ views of important others and its impact on their therapy.     

Forgetting of trauma cues in adults reporting continuous or recovered memories of childhood sexual abuse

According to betrayal trauma theory, adult survivors of childhood sexual abuse (CSA) who were molested by their caretakers (e.g., a father) are especially likely to dissociate ("repress") their memories of abuse. Testing college students, some reporting CSA, DePrince and Freyd (2004) found that those scoring high on a dissociation questionnaire exhibited memory deficits for trauma words when they viewed these words under divided-attention conditions. Replicating DePrince and Freyd's procedure, we tested for memory deficits for trauma words relative to neutral words in adults reporting either continuous or recovered memories of CSA versus adults denying a history of CSA. A memory deficit for trauma words under divided attention was expected in the recovered-memory group. Results were inconsistent with this prediction, as all three groups exhibited better recall of trauma words than neutral words, irrespective of encoding conditions.     

Retrospective treatment of incest victims: suggested analytic attitudes.

This paper includes a brief consideration of literature relevant to childhood sexual abuse detection and prevalence. That literature indicates that such detection may be difficult and that the occurrence of childhood sexual abuse is widespread. These findings, as well as a consideration of literature relevant to trauma, stress, and the identification of survivors of sexual abuse, suggest an analytic attitude of receptivity to the hypothesis of the event of sexual abuse as well as the fantasy of sexual abuse. A second analytic attitude suggested concerns diagnosis. Childhood trauma is implicated in the development of BPD, as the majority of borderline patients have experienced the trauma of child abuse. Further, trauma can lead to dissociation as a defense against stress, and multiple personality disorder is an extreme example of dissociation. The analytic attitude suggested here is that the diagnosis of BPD or MPD may be a necessary but not a sufficient explanation when the symptomatology is a defensive reaction to the traumatic event of childhood sexual abuse. Lastly, it is suggested that the abuse may need to be central to the treatment in analytic work with sexually abused victims. This is suggested in light of the importance of recovery and integration of traumatic memories with their associated affects.     

The loss and restoration of community: The treatment of severe war trauma

Abstract

One of the most devastating outcomes of trauma is the violation of trust and the subsequent loss of the survivor's sense of community. War is the breakdown of the very concept of community. The acts of war may leave combatants questioning their own suitability for community membership and the community rejecting them as members. Severe trauma also destroys the ability to trust to the extent that the conditions necessary for conducting therapy may no longer exist. Creating an infrastructure to conduct therapy requires that professionals actively demonstrate trust in their own community as a model. Survivors may engage and test the trustworthiness of the professional community before therapy can proceed.     

Dispositional and situational coping and mental health among Palestinian political ex-prisoners

We examined, first, differences in dispositional and situational coping, and psychological distress between political ex-prisoners and their matched controls, and second, coping effectiveness in protecting mental health from impacts of imprisonment and military trauma. Thirdly, we tested the hypothesis that compatibility ("goodness of fit") between dispositional and situational coping would predict low psychological distress. Participants were 184 men recruited from a Palestinian community sample, 92 were former political prisoners and 92 non-prisoners. The dispositional coping was assessed as a general response style to hypothetical stressors and situational coping as responses to their own traumatic experiences. Psychological distress was measured by SCL-90-R, and posttraumatic stress disorder, depression and somatoform symptoms by scales based on CIDI 2.1 diagnostic interview. The results showed that, compared to non-prisoners, the political ex-prisoners employed less avoidant, denying, and emotion-focused coping strategies. Military trauma was associated with avoidant and denying coping only among non-prisoners. The ex-prisoners showed more mental health and medical problems, especially when exposed to military trauma. None of the coping styles or strategies were effective in protecting the mental health in general or in either groups. However, main effect results revealed that the high level of active and constructive and low level of emotion-focused coping were associated with low levels of psychiatric symptoms and psychological distress.     

Fact and fantasy in the seduction theory: a historical review

This article surveys Freud's various versions of the seduction theory, from 1896 to 1933. It is concluded that the seduction theory had never been based on the patients' direct statements and conscious recall of seduction by the father in early childhood--unlike what Freud was to state much later (1933). This early seduction was mostly reconstructed by Freud from the patient's verbal material and behavior in treatment (including memories of sexual experiences from later childhood) which he interpreted as disguised and incomplete "reproductions" and reenactments of the original seduction trauma. Further, the external trauma was never meant to account by itself for the later neurotic symptoms. The "delayed action" of its unconscious memory, producing the repression of an event from the time of puberty, was a necessary part of the process. Thus internal psychic transformations and conflicts, anticipating Freud's later emphasis on fantasy and psychic reality, were already an intrinsic part of the seduction etiology of 1896. It is also noted that the father played no central role in the original theory as presented in 1896; it is only in the letters to Fliess that the father emerged as the prime seducer. The implications of this clarification of the seduction theory for the understanding of the changes and continuity in the development of Freud's theories are highlighted; their relevance to ongoing issues in psychoanalysis about the role of external trauma, fantasy, and reconstruction are briefly examined.     

Cumulative Adversity as a Correlate of Posttraumatic Growth: The Effects of Multiple Traumas,Discrimination, and Sexual Harassment

While trauma is, by definition, a necessary precursor of posttraumatic growth, other aspects of individuals’ life experiences affect their ability to cope with trauma, foster resilience, and grow following adversity. Most research on posttraumatic growth overlooks the accumulation of trauma and sub-trauma stressors as possible predictors of growth. In addition, most research on cumulative adversity omits all but the most extreme examples of discrimination and sexual harassment stressors. This exploratory study of 46 university students with trauma histories used measures of posttraumatic growth, trauma, major (sub-trauma) life events, chronic stressors, sexual harassment, and discrimination to examine the relationship between cumulative adversity and the development of posttraumatic growth. We found that cumulative adversity is positively correlated with posttraumatic growth, and that there are important relationships between gender, race, and cumulative adversity. A hypothesized curvilinear relationship between cumulative adversity and posttraumatic growth was not supported. These findings suggest that successfully coping with some amount of sub-trauma adversity may facilitate the development of posttraumatic growth. Additionally, sexual harassment and discrimination were closely linked to the number of chronic stressors; thus, they need to be included in measures of cumulative adversity to more fully represent the experiences of marginalized groups.     

Discussion of “Culturally Imposed Trauma: The Sleeping Dog Has Awakened. Will Psychoanalysis Take Heed?”: Commentary on the Paper by Dorothy Evans Holmes

This commentary expands on the problem of culturally imposed trauma described by Dorothy Evans Holmes. The focus on cultural trauma is both timely and necessary. I applaud Holmes’s attention to this important issue, and her clear articulation of its effects on intrapsychic and interpersonal life and the reluctance of psychoanalysis to engage with cultural trauma. My commentary explores two primary areas in an effort to further elaborate this issue: (a) The problem of defining cultural trauma as a legitimate type of trauma, and recognizing resistance to cultural trauma in psychology and psychoanalysis, and (b) the role of cultural context and narrative in addressing cultural trauma within psychoanalytic work. I aim to extend the range of questions concerning race, culture, and social class that remains to be examined in psychoanalysis.     

Therapists’ Responses to Religious/Spiritual Discussions with Trauma Versus Non-trauma Clients

This research explores therapists’ reactions to discussions of religion and spirituality in secular psychotherapy. We used a mixed method design including qualitative and quantitative components to examine data from 14 mental health professionals. Therapists acknowledged the importance of, and outlined reasons for, engaging in religious/spiritual discussions. They provided examples of the diverse ways in which their own views on religion/spirituality have an effect on their therapeutic work. Therapists view attention to religion/spirituality in trauma therapy as necessary. They see an emphasis on religion/spirituality within the treatment of traumatized clients as possessing distinctive qualities in comparison to their treatment of other populations.     

Reply to Reviews of Awakening the Dreamer: Clinical Journeys by Philip M. Bromberg

I reply here to reviews by three inspiring thinkers, Ethel Person, Susan Sands, and Allan Schore who, though uniquely different from one another in their conceptual frames of reference, share a sensibility as clinicians and creative scholars that has led them to engage and appreciate my work in depth while enriching it with their individual perspectives. Ethel Person's review is meaningful to me for many reasons, not the least of which is the fact that we think very much alike about “how we are” with patients despite the diversity in our families of origin. Her thinking, which extends the boundaries established by any one school of thought, transcends doctrine, especially that of “technique.” I am equally grateful to Susan Sands, whose review stimulated a dialogue between us about the similarities and differences in our views of the analyst's personal role in enactments with severe trauma survivors and whether there is reason to distinguish between life-threatening and developmental trauma. My reply to Allan Schore's review satisfies a long-standing wish to engage with him in dialogue about what he refers to in his review as “a remarkable overlap between Bromberg's work in clinical psychoanalysis and my work in developmental neuropsychoanalysis, a deep resonance between his treatment model and my regulation theory” (this issue, p. 755). In my reply I comment from my own vantage point on how our shared commitment to an interpersonal and intersubjective perspective—my interpersonal/relational treatment model and his “Interpersonal Neurobiology” led us to arrive at overlapping views on developmental trauma, attachment, the dyadic regulation of states of consciousness, and dissociation.     

MATERNAL TRAUMA AFFECTS PRENATAL MENTAL HEALTH AND INFANT STRESS REGULATION AMONG PALESTINIAN DYADS

We examined how diverse and cumulated traumatic experiences predicted maternal prenatal mental health and infant stress regulation in war conditions and whether maternal mental health mediated the association between trauma and infant stress regulation. Participants were 511 Palestinian mothers from the Gaza Strip who reported exposure to current war trauma (WT), past childhood emotional (CEA) and physical abuse, socioeconomic status (SES), prenatal mental health problems (posttraumatic stress disorder and depression symptoms), and perceived stress during their secondtrimester of pregnancy as well as infant stress regulation at 4 months. While all trauma types were associated with high levels of prenatal symptoms, CEA had the most wide‐ranging effects and was uniquely associated with depression symptoms. Concerning infant stress regulation, mothers’ CEA predicted negative affectivity, but only among mothers with low WT. Against hypothesis, the effects of maternal trauma on infant stress regulation were not mediated by mental health symptoms. Mothers’ higher SES was associated with better infant stress regulation whereas infant prematurity and male sex predisposed for difficulties. Our findings suggest that maternal childhood abuse, especially CEA, should be a central treatment target among war‐exposed families. Cumulated psychosocial stressors might increase the risk for transgenerational problems.     

Perspectives on Memory for Trauma and Cognitive Processes Associated with Dissociative Tendencies

Summary

Cognitive science approaches can inform research in traumatic stress studies by articulating separate scientific issues that may be relevant to understanding alterations in memory and awareness for trauma. This article will first address general issues about disrupted memory and “knowledge isolation” for trauma, as well as introduce specific aspects of “betrayal trauma theory” (Freyd 1994, 1996) that inform our understanding of memory impairment. According to betrayal trauma theory, a potent motivation for knowledge isolation (including amnesia, dissociation, and unawareness) in the face of trauma is to preserve apparently necessary human relationships in which betrayal occurs. Results from three recent laboratory investigations of cognitive processes associated with dissociative tendencies are summarized. These laboratory investigations suggest that the attentional capacities of high dissocators are impaired under conditions of selective attention, but not divided attention. Furthermore, in our laboratory tasks high dissocators have impaired memory for emotionally charged words associated with sexual assault and abuse (e.g., “incest”) but not neutral words, as compared with low dissociators. The findings suggest that high dissociators use divided attention and multi-tasking as a way to control the flow of information. Such a view is consistent with betrayal trauma theory. Though in its infancy, this research draws on cognitive science and observations of traumatic response and offers much promise.     

Avoiding awareness of betrayal: Comment on Lindblom and Gray (2009)

Betrayal trauma theory (BTT) predicts that unawareness of abuse by someone on whom a victim is dependent may serve to protect a necessary relationship. Lindblom and Gray (2009) contribute to a growing line of BTT studies by measuring narrative detail in a sample of undergraduates who met Criterion A of the PTSD diagnosis and who rated the abuse as their most distressing trauma. Although many core betrayal traumas do not fit Criterion A, Lindblom and Gray found a small effect in the predicted direction. Having found an effect as predicted by BTT, curiously the authors then argue that PTSD Avoidance is a confound for forgetting the abuse to be statistically managed. This is particularly curious since symptom 3 of Criterion C is ‘inability to recall an important aspect of the trauma’. Despite constraining participant selection and other methodological issues, Lindblom and Gray's results add support to BTT. Copyright © 2009 John Wiley & Sons, Ltd.     

A pilot study of a Scripture-based trauma healing model for adults in Nicaragua

With the rising attention to global trauma, there is increased interest in utilising effective trauma healing (TH) models, especially those that integrate a spiritual component. This paper examines the effectiveness of a Scripture-based TH model developed by the Trauma Healing Institute utilised in a pilot study with Nicaraguan adults who experienced non-sexualised-related crime, disaster-related trauma, and/or interpersonal violence. An additional focus of this study was on whether increased spiritual well-being would result from this healing model. In this first empirical study on the TH model, initial results indicated that participants (N?=?23) experienced both a reduction in trauma-related symptoms as well as an upward trend in spiritual well-being from pre-test to six-month follow-up. Spearman results also showed an inverse relationship between trauma symptoms and spiritual well-being. Factors that may have impacted results, limitations to this pilot study, and considerations for future studies are discussed.     

Vicarious traumatisation of counsellors and effects on their workplaces

The literature on therapists' reactions to clients' traumatic material is Critically reviewed. The various attempts within this relatively new literature to conceptualise this phenomenon include countertransference, compassion fatigue and vicarious traumatisation. The limited research evidence is evaluated and found to support anecdotal accounts by trauma therapists. Empathic engagement with trauma survivors is necessary for effective psychotherapeutic intervention. However, empathic engagement also makes therapists vulnerable to the detrimental effects of vicarious trauma, with consequent negative effects on individual counsellor effectiveness and organisational dynamics in the workplace.     

Trauma and autobiographical memory: contents and determinants of earliest memories among war-affected Palestinian children

The contents of earliest memories (EM), as part of autobiographical memory, continue to fascinate scientists and therapists. However, research is scarce on the determinants of EM, especially among children. This study aims, first, to identify contents of EM of children living in war conditions, and, second, to analyse child gender, traumatic events and mental health as determinants of the contents of EM. The participants were 240 Palestinian schoolchildren from the Gaza Strip (10–12 years, M?=?11.35, SD?=?0.57; 49.4% girls). They responded to an open-ended EM question, and reported their trauma exposures (war trauma, losses and current traumatic events), posttraumatic stress, depressive symptoms and psychosocial well-being, indicating mental health. The EM coding involved nature, social orientation, emotional tone and specificity. Results showed, first, that 43% reported playing or visiting a nice place as EM, and about a third (30%) traumatic events or accidents (30%) or miscellaneous events (27%). The individual and social orientation were almost equally common, the emotional tone mainly neutral (45.5%), and 60% remembered a specific event. Second, boys remembered more EM involving traumatic events or accidents, and girls more social events. Third, war trauma was associated with less positive emotional tone and with more specific memories.