Relationship closeness and trauma narrative detail: A critical analysis of betrayal trauma theory

Betrayal Trauma Theory (BTT) holds that certain traumas, such as incest, should be uniquely categorized as betrayal trauma: a subcategory of trauma in which the violation of trust, within a close relationship, occurs in the context of a traumatic event. According to BTT, betrayal trauma results in either partial or complete traumatic amnesia because repression is adaptive when a victim depends on a perpetrator for physical or emotional needs. In a test of BTT, undergraduates screened for betrayal and non‐betrayal trauma histories provided detailed accounts of these events. In order to account for threats to internal validity that are often overlooked by traumatic amnesia researchers, we also assessed factors known to compromise narrative detail. Consistent with BTT predictions, more betrayal was associated with less detailed trauma narratives. However, this relationship was no longer significant after controlling for survivor age, avoidance symptoms, gender and purposeful omission of detail. Copyright © 2008 John Wiley & Sons, Ltd.     

Couples Therapy with Childhood Sexual Abuse Survivors (CSA) and their Partners: Establishing a Context for Witnessing

This article proposes a clinical practice for therapy with couples in which one partner suffered sexual abuse in childhood. Such couples often encounter unique difficulties with physical contact, intimacy, sexuality, communication, and trust, and their relationship dynamic may be marked by reenactments of past traumatic relational patterns. This clinical practice is founded on the assumption that establishing the witnessing lacking during the traumatic event in childhood can break the traumatic reenactments in adulthood, and spur recovery. The suggested practice may facilitate twofold witnessing: the couple's therapist witnesses the reenactments of the trauma in the couple's relationship; and the survivor's partner witnesses the trauma's effect on the survivor's personal life and relationship. Twofold witnessing can help break the cycle of traumatic reenactment and help the survivor integrate the events of her life into a more coherent, continuous narrative. The partner's presence also facilitates acknowledgement of what happened to the survivor, and helps the survivor elaborate on her stories of resistance, survival, and strength. Finally, each of the partners is able to appear more wholly and fully, and together to tell the preferred stories of their life as a couple, replete with the multiple relational patterns they wish to live, which may contradict the characteristics of the original trauma.     

Social Trauma and Testimony: A Reading of Maryan S. Maryan’s Notebooks Inspired by Sándor Ferenczi

The purpose of this paper is to present the relational dimension of trauma according to Sándor Ferenczi, illustrating it by using the testimonial material produced during the analysis of Maryan S. Maryan, a visual artist, survivor of Auschwitz. Furthermore, a few formulations are proposed on being witness to traumatic experiences in psychoanalytic practice, as well as what can be considered as ethics and politics in psychoanalysis when facing situations of social trauma and violence.

     

Buffalo Creek Survivors in the Second Decade: Comparison with Unexposed and Nonlitigant Groups1

This study investigated the second-decade effects of the Buffalo Creek dam collapse and flood that occurred in West Virginia in 1972. One hundred twenty-one survivors who had participated in an earlier lawsuit against the coal company that built the collapsed dam were compared to 78 nonlitigant survivors on self-reported symptoms, clinical ratings, and diagnoses. A nonexposed sample from a geographically and culturally similar neighborhood was investigated as well. Findings showed no differences between the litigant and nonlitigant survivor groups. The survivor groups together showed higher rates of anxiety, depression, and hostility symptoms and diagnoses than the nonexposed sample. The findings were discussed in the context of the nature of the traumatic event, social and cultural influences on recovery, and the constellation of symptoms which differentiated the groups.     

Differential Influence of Social Support in Emerging Adulthood Across Sources of Support and Profiles of Interpersonal and Non-Interpersonal Potentially Traumatic Experiences

Social support is protective against the negative effects of trauma, yet how these effects vary across sources of support and patterns of trauma exposure has not been examined. High co-occurrence exists among different types of trauma across domains and ages, yielding patterns of trauma exposure that may affect social support. This study identified profiles of potentially traumatic events (PTEs) experienced by 252 college students and examined the relationships between social support and mental health across these profiles. Five profiles emerged: “Non-Interpersonal Trauma Exposure,” “Adult Intimate Partner Violence,” “Poly-trauma Exposure,” “Low Trauma Exposure,” and “Childhood Family Violence.” The link between social support and adjustment differed across profiles. Family support was valuable for promoting resilience across patterns of PTEs. Friend and romantic partner support were related to lower mental health problems. Support from family and friends is particularly valuable in the context of adult intimate partner violence and childhood family violence.     

价值观对蓄意创伤受害者创伤后应激障碍症状的影响

探讨价值观对蓄意创伤受害者创伤后应激障碍（Posttraumatic Stress Disorder ,简称PTSD）症状的影响方式。方法：采用事件冲击量表、受害人认可评价量表、施瓦兹价值观量表作为测查工具,测查了163 名蓄意创伤受害者。结果：（1）蓄意创伤受害者的PTSD三大症状表现有显著差异,闯入症状水平最高,回避症状水平次之,高警觉症状水平最低。（2）蓄意创伤受害者所持的价值观和对外界接纳的评价能较好地预测PTSD三大症状。（3）内敛价值类型通过诸如社会接纳等反映外在标准的因素影响PTSD的闯入症状。结论：蓄意创伤受害者PTSD症状表现有其自身的特点,对外界接纳的评价和自身所持的价值观对其PTSD症状有直接或间接的影响     

Predicting post‐traumatic growth and post‐traumatic stress in firefighters

Emergency service workers (e.g., firefighters, police, and paramedics) are exposed to elevated levels of potentially traumatising events through the course of their work. Such exposure can have lasting negative consequences (e.g., post‐traumatic stress disorder (PTSD)) and/or positive outcomes (e.g., post‐traumatic growth (PTG)). Research had implicated trauma, occupational and personal variables that account for variance in post‐trauma outcomes yet at this stage no research has investigated these factors and their relative influence on both PTSD and PTG in a single study. Based in Calhoun and Tedeschi's model of PTG and previous research, in this study regression models of PTG and PTSD symptoms among 218 firefighters were tested. Results indicated organisational factors predicted symptoms of PTSD, while there was partial support for the hypothesis that coping and social support would be predictors of PTG. Experiencing multiple sources of trauma, higher levels of organisational and operational stress, and utilising cognitive reappraisal coping were all significant predictors of PTSD symptoms. Increases in PTG were predicted by experiencing trauma from multiple sources and the use of self‐care coping. Results highlight the importance of organisational factors in the development of PTSD symptoms, and of individual factors for promoting PTG.     

Secondary Traumatic Stress in Social Science Researchers of Trauma-Exposed Populations

There is an expanding research database regarding secondary trauma exposure among helping professionals across disciplines and settings. However, there is limited research on the incidence of secondary traumatic stress in social science researchers studying traumatized populations. Various disciplines engage in this area of research, which exposes them to the details of aversive events, especially those engaging in qualitative research. This study explores the impact of such exposure by measuring indicators of secondary traumatic stress (STS), burnout (BO), and compassion satisfaction in a group of 104 researchers. Findings revealed high rates of exposure to traumatic material and a subset of researchers at risk for STS. Regression analyses revealed potential risk factors for STS and BO, and qualitative analysis was conducted to further explore the effects of this work on researchers from multiple disciplines.     

Lifetime Trauma,Prayer, and Psychological Distress in Late Life

The purpose of this study is to see whether prayer helps older people cope more effectively with the adverse effects of lifetime trauma. Data from a nationwide survey of older adults reveal that the size of the relationship between traumatic events and depressive symptoms is reduced for older people who believe that only God knows when it is best to answer a prayer and when they believe that only God knows the best way to answer it. The findings further reveal that these beliefs about prayer outcomes are especially likely to offset the effects of traumatic events that arose during childhood.     

Recovering the context in posttraumatic stress disorder: The psychosocial trauma in victims of political violence and terrorism

Abstract

Throughout history, humans have frequently carried out harmful actions against one another. Often, these actions result in intensive and long lasting pain and suffering. Posttraumatic stress disorder (PTSD) diagnosis has been the theoretical tool used mostly by psychologists to understand the physical, emotional and behavioural symptoms following a traumatic experience. Due to its clinical and medical roots, PTSD diagnosis represents man in a social vacuum, a man without context, and a model of health closely tied to illness. The aim of the paper is to reintroduce the social context of human beings into trauma diagnosis, and to develop a health model that is more focused on well-being than on illness. Both points of view help us to seek a theoretical way for better understanding the psychosocial trauma that result from political violence and terrorism. Psychosocial trauma has definite roots, and destroys our inner world—the world of our most valuable meanings—infects our minds with hate against others, and breaks the social fabric we belong to.     

The protective role of compassion satisfaction for therapists who work with sexual violence survivors: an application of the broaden-and-build theory of positive emotions

Therapists who work with trauma survivors, such as survivors of sexual violence, can experience compassion satisfaction while experiencing negative effects of trauma work, such as secondary traumatic stress. We examined whether the negative effects of secondary traumatic stress on therapist adjustment would be buffered by compassion satisfaction and whether the broaden-and-build theory of positive emotions could be applied to examine the factors (positive emotions and positive reframing) that relate to compassion satisfaction. Sixty-one therapists who work with sexual violence survivors completed measures of secondary traumatic stress, compassion satisfaction, adjustment, positive emotions and positive reframing. Hierarchical multiple regression analyses found that compassion satisfaction buffered the negative impact of secondary traumatic stress on therapist adjustment when adjustment was conceptualised as anxiety. Using non-parametric bootstrapping, we found that the relationship between greater positive emotions and greater compassion satisfaction was partially mediated by positive reframing. The findings indicate that compassion satisfaction is likely to be helpful in ameliorating the negative effects of secondary traumatic stress on anxiety in therapists who work with sexual violence survivors and that the broaden-and-build theory of positive emotions may provide a strong theoretical basis for the further examination of compassion satisfaction in trauma therapists.     

A psychodynamic perspective on early childhood trauma in an adult: A case study

Abstract

This paper uses a long-term case to illustrate, from a psychodynamic perspective, a number of issues arising in working with an adult survivor of early childhood trauma. The paper takes an overview of the case study, identifying issues which are inextricably interwoven in the client's experience of trauma, and which impact on the working alliance. The therapeutic relationship forged with the client is discussed in terms of its intrinsic successes and failures together with the implications of early traumatic experiences for the termination of counselling.     

Trauma in the Lives of Older Men: Findings from the Normative Aging Study

Research on the prevalence of traumatic exposure has tended to focus on younger populations, limiting our knowledge about trauma and its effects in older adults. In this study, lifetime trauma exposure was assessed in a sample of 436 male military veterans of World War II and the Korean Conflict (age 59–92). A clinician-administered screening measure, the Brief Trauma Interview, was developed to assess lifetime exposure to 10 categories of trauma using DSM-IV criteria. PTSD was assessed in interview and questionnaires. Despite a high prevalence of trauma exposure, symptom levels were relatively low. Few men met criteria for current or lifetime PTSD. Secondary analyses found that lifetime symptom severity was higher in men who met the DSM-IV A.2 criterion, in contrast with men who did not meet A.2. Findings indicate that trauma is highly prevalent among older men, although many may be asymptomatic.     

Working in the Midst of Unfolding Trauma and Traumatic Loss

Abstract

Training developed for New York City social workers in the evolving aftermath of September 11, 2001 is introduced, offering a conceptual framework for clinical practice in the midst of unfolding trauma and traumatic loss. A focus is placed on the shared, collective process of learning and discussion among colleagues, as an effort parallel to work with clients, progressing together to establish meaning and hope through relationships. Professional training framing this catastrophe within trauma and traumatic loss perspectives, and addressing its impact on clinician, client, work, and treatment relationship, is needed. Also providing on-going support, a process of continuity, and a context of community, this training becomes a collective response to the profound impact and complex, evolving needs of this time.     

Pharmacotherapy to Blunt Memories of Sexual Violence: What's a Feminist to Think?

It has recently been discovered that propranolol—a beta‐blocker traditionally used to treat cardiac arrhythmias and hypertension—might disrupt the formation of the emotionally disturbing memories that typically occur in the wake of traumatic events and consequently prevent the onset of trauma‐induced psychological injuries such as Post‐traumatic Stress Disorder. One context in which the use of propranolol is generating interest in both the popular and scientific press is sexual violence. Nevertheless, feminists have so far not weighed in on propranolol. I suggest that the time is ripe for a careful feminist analysis of the moral and political implications of propranolol use in the context of sexual violence. In this paper, I map the feminist issues potentially raised by providing propranolol to victims of sexual assault, focusing in particular on the compatibility of propranolol use and availability with an understanding of the social and systematic dimensions of rape's harms. I do not deliver a final verdict on propranolol; in fact, I show that we do not yet have enough information about propranolol's effects to do so. Rather, I provide a feminist framework for evaluating the possibilities and perils opened up by therapeutic memory manipulation in the context of sexual violence against women.     

Cumulative trauma and midlife well-being in American women who served in Vietnam: effects of combat exposure and postdeployment social support

Background and Objectives: Research increasingly demonstrates that trauma exposure can have cumulative effects, yet much remains to be learned about effects of cumulative trauma, particularly regarding longer term adjustment. One such trauma, combat exposure, is insufficiently understood, especially for women, who are increasingly engaged in professional combat activities. Design: The study comprised a cross-sectional survey assessing multiple aspects of current well-being in women approximately 25 years after their service in Vietnam during the Vietnam War. Methods: Participants were 1374 women (78% military and 22% nonmilitary; mean age = 59.7). This study investigated the relations between three separate categories of trauma exposure (childhood, adulthood, and combat) and well-being and examined whether perceived social support at return from Vietnam moderated the association between combat exposure and well-being. Results: While both childhood and adulthood trauma exposure related to midlife well-being, combat exposure still uniquely predicted outcomes. Further, postdeployment perceived social support moderated the association of combat and well-being: recollected higher perceived social support at homecoming buffered participants from the links between combat exposure and well-being. Conclusions: These results may have important implications for interventions to reduce the impact of traumatic experiences, particularly in light of the increasing exposure of women to direct combat events.     

Soziales Trauma

Social traumatization is targeted at entire victim groups and occurs in a societal context. The classification of posttraumatic stress disorders in DSM-5, which intentionally fails to differentiate between different types of traumatic events, ignores the social factors of traumatogenic pathologies. Whereas clinical practice unanimously embraces the thorough exploration of patients’ individual life experiences and history of suffering, taking the relevant social and environmental factors into account, in the classification systems (DSM-5 and ICD-10) it has been decided to address posttraumatic disorders as individual pathologies and not as social phenomena. Even equating social trauma with a disease may foster this partial exclusion, which in turn can contribute to perpetuation of the posttraumatic condition.     

Vicarious Trauma in Social Workers: The Role of Trauma History,Social Support,and Years of Experience

Vicarious trauma, a disruption in schemas and worldview often accompanied by symptoms similar to those of posttraumatic stress disorder, occurs as a result of chronic secondary exposure to traumatic material. The aim of this study was to examine the role of personal trauma history, social support, and experience level in the development of vicarious trauma among licensed social workers in Maryland (N = 160). Results indicated an increase in social support and in experience level of social workers predicted less severe vicarious trauma. In addition, an interaction effect between trauma history and social support trending on significance indicated higher levels of social support might help protect those without a trauma history but not those with a trauma history against vicarious trauma. Research and clinical implications are discussed.     

Psychotherapy with children in refugee families who have survived torture: Containment and understanding of repetitive behaviour and play

Children of refugee families who have survived torture often have emotional, psychosomatic and behavioural problems as well as problems with learning. In order to understand the difficulties of these children, we have to recognize the complicated interaction of cumulative traumatic strain and recurring exposure to shocking violence. The traumatic experiences of the child in the country of origin take place in the broader context of chronic danger and persecution, often to be followed in the country of exile both by recurrent family strain and social estrangement. In the transference this complicated mixture of repeated trauma and chronic strain may show as a pervasive tendency to retreat to defensive survival strategies combined with continual repetition of more specific traces of the impact of the trauma on the individual. This paper focuses on how the enacted survival strategies can be contained and understood in the transference. In due course the compulsive repetition can be given meaning as a precondition for better integration through symbolic thought and self-understanding.