Thursday, December 30, 2010

Book Review – Life After Trauma: A Workbook for Healing by Dena Rosenbloom, Ph.D. and Mary Beth Williams, Ph.D. (2nd Edition) 2010, The Guilford Press.

It is difficult to find workbooks for trauma survivors that are as well thought out as Life After Trauma by Drs. Rosenbloom and Williams. I usually approach workbooks or curriculums for support groups with some trepidation, fearful that the book will promote the telling of one’s trauma story or engaging in reconciliation with the abuser. Life After Trauma quickly dispelled my fears and I found it to be very sensitive in its approach and development of safety for the trauma survivor.
The workbook is primarily for use by an individual but could easily be adapted for group work. However, the ability to take the book at one’s own pace makes it particularly valuable for someone who may feel a need to move through the book thoughtfully and take breaks as needed. I would recommend that anyone who wishes to work with this book use it an excellent adjunct to individual therapy with a therapist who has specialized training in working with trauma survivors.
I was particularly impressed with the book’s progression from recognizing and coping with triggers to understanding reactions to trauma, ending with strategies on how to develop safe and secure relationships and heal for the long term. There are regular check-ins throughout the workbook that provide breathers and the opportunity for the survivor to assess whether or not she/he is able to move on.
The authors appear to use cognitive behavioral trauma- focused therapy techniques to develop strategies for survivors to use in addressing beliefs about the abuse or traumatic event. A strength based approach assists survivors in understanding how trauma has affected their self esteem and how they can gain value, esteem, power, and intimacy in their lives.
The appendix offers valuable information for trauma survivors on how to choose a doctor or other health practitioner and plan for appointments. It also has an excellent bibliography of books, articles and websites. Suggestions for find a therapist for trauma is also included along with a section on how mental health professionals can use the workbook with a warning to non-trauma specialists to not evoke or examine traumatic memories.
Dena Rosenbloom, Ph.D. is a clinical psychologist in Glastonbury, CT and Mary Beth Williams, Ph.D. is an LCSW working in private practice in Warrenton, VA. Dr. Williams is widely published and is an instructor for the Office for Victims of Crime at the U.S. Department of Justice.

Wednesday, December 15, 2010

Trauma and Shame

Trauma victims, particularly those who experienced traumatic events in childhood, are often reluctant to talk about what happened to them for a variety of reasons. Keeping the secrets buried are often due to a deep sense of shame. Because of the intense personal nature of interpersonal violence, victims are often left believing that there is something horribly wrong with them that caused the event to occur and this shame remains within them for years.


Shame and guilt are two separate emotions. Guilt is feeling bad about something that you did. Shame is feeling bad about who you are. Perpetrators are experts at manipulating the victim into believing that the traumatic act was because of whom she/he is and that if they were any different it wouldn’t have happened. The perpetrator’s accusations could range from “you were so beautiful and innocent I just had to have you” to “if you hadn’t been in that place, wearing that particular clothing, being who you are I wouldn't have done what I did." The victim is left feeling as if the violence occurred because of who they are rather than who the perpetrator is.

Shame is common in young children. In early childhood, the brain has not developed the capacity to logically understand the actions of others. Children are unable to think through events to have an understanding of their victimization. Their thinking is very ego-centric, resulting in a belief that “if I was just smart enough, strong enough, pretty enough” bad things would not happen to me and people would love me. This accounts for the prevalence of super heroes in our culture and the rising amount of children’s literature containing young people with special powers to fight evil while grownups are either bystanders or enemies.

Shame is perpetuated when there is little support after the traumatic event. This could be due to the family’s desire to keep a secret or the belief that one must be strong and maintain a good public image of the family unit at the cost of the individual.

I was told the story of a woman who as a five year old girl was taken to her grandfather’s funeral without being told ahead of time the nature of the occasion. She was led to the coffin and held up to see her grandfather for the last time. She told me that she remembered feeling something break inside of her and she immediately became afraid. When she tried to talk to her family about the fear she suddenly felt she was told to keep quiet and judged for her feelings. She grew up believing that fear was something that you avoided and, if you felt any fear you hid it for the sake of the family’s image. She said that she has grown to associate this fear with funerals, although she has no difficulty with death. Her fear appears to be based in the belief that she will do something that will cause others to be angry with her.

Intense shame can lead to isolation, use of drugs and alcohol to numb the pain, and developing survival skills to get needs met. These may be seen as negative by others, but may be productive in many ways. The woman above told me that she learned that when she was afraid in the middle of the night, she could wake up her baby sister and make her cry so that their mother would come and rock the baby. Then the young girl would be able to go to sleep to the sound of her mother rocking her sister. Telling her mother that she was afraid was too scary and meant she would have to let her mother know she was afraid, a cause of great shame in her family.
A lot of survivors do things that seem unproductive in their attempt to keep their secrets because of the shame it involves. To let someone know your secrets sets you up to be re-victimized if that person sees you for who you think you are. This possibly translates into “imposter syndrome,” an overwhelming self doubt that results in a fear that others will find out who you really are.  This can lead to disorganization, procrastination, and possible under achievement or over achievement.  It is all about keeping the secret/s. 

It all comes back to remembering how trauma occurs in relationship and the healing occurs in relationship (Judith Herman).  It takes finding a safe relationship in which a person can release their secrets and discover the truth within their story for healing to take place.  Once this sense of shame is lifted, the person is more empowered to move forward knowing that they are not responsible for what happened to them and can take control of their life.