Real Stories of Attachment from This American Life

I was listening to a podcast of This American Life called Unconditional Love this weekend and thought these stories might be of interest to those of you who are interested in attachment theory. The prologue of the episode talks about the history of attachment theory. Act one, Love is a Battlefield, tells the story of a couple and the son they adopted from a Romanian orphanage.  Act two, Hit Me With Your Best Shot, is about a family with an autistic child.  Both stories are very compelling.

“You Should Be Over It by Now”

These seven words can extend the experience of grief, guilt and shame of many survivors of sexual assault and other types of trauma.  Unfortunately, these words are often said by someone that the survivor looks to for support such as a family member or mental health professional.  Childhood sexual assault survivors have told me of instances when they were expected to engage in family activities that include the perpetrator of their abuse because the family feels “it is all in the past and you should forgive and forget.”

This refusal to accept the ongoing impact of the abuse in a person’s life can increase the shame, guilt, and sense of loneliness and isolation that a survivor feels. 

According to researchers Koss and Harvey (1991), “victims of sexual assault show very high distress levels within the first week that peak in severity by approximately 3 weeks postassault.  The distress then continues at a high level for the next month but begins to improve by 2 to 3 months.  After 3 months, rape victims do not differ from nonvictims on most symptom{s}” (p. 57).  However, even though these levels of distress will gradually diminish there are long term effects that can impact the life of the victim.  Women who have been sexually assaulted are more likely than others to experience a lifetime prevalence of clinical depression, addiction to drugs or alcohol, anxiety disorders, and post traumatic stress disorder.  (Koss & Harvey 1991 as quoted by End Violence Against Women International).

Trauma survivors may be also be experiencing long term effects of grief.  A trauma survivor is no longer the same person that he/she was before the assault took place.  The world no longer feels safe and the impact of the assault changes the persons physically, emotionally, and spiritually.  Experiencing grief at the loss of the pre-trauma person is a normal response to the horrific event.

Many victims have fewer episodes of reliving the assault as time goes by.  However, there comes a point in the recovery process where they realize they are not able to simply “get over” the trauma as easily as they originally thought.  This may be due to a crisis that floods the person with memories or (as noted above) contact with the perpetrator or someone who looks like the perpetrator. 

Many of the women that I have worked with find that their recovery from the trauma is impacted by the validation or lack of validation by important people in their life.  If a family member denies that sexual assault occurred against a young child or teen, that victim often feels as if the family has colluded with the perpetrator and/or blames the victim for any disruption to the family.  The victim then learns to suppress their emotions often leading to drug or alcohol abuse, depression, and anxiety.

When a trauma survivor asks me how long it will take to “get over” what has happened, I respond by letting them know it will take as long as it takes.  Some days will be better than others and eventually the good days will number more than the bad days.  However, the event or series of events will always be with them.  I encourage survivors to find ways to be in contact with other survivors so they know they are not alone, but I still want them to feel validated in their uniqueness.  No one likes to be told (as one woman recently related to me) that the rest of the world has problems, too.  Yes, the rest of the world has problems, too, but this woman just wanted her family member to acknowledge her pain. 

Being able to move on does not mean getting over.  The impact of the abuse will always be there.  Eventually the person does become stronger at the broken places and can transform the pain.  However, no one can predict how or when that happens.

Citations are from Victim Impact: How Do Sexual Assault Victims Respond? And How Can Law Enforcement and Other Community Professional Respond Successfully? By  Kimberly A. Lonsway, PhD and Sergeant Joanne Archambault (Ret.), May 2007, www.evawintl.org

Book Review – Strong at the Broken Places – Building Resiliency in Survivors of Trauma by Linda T. Sanford (Neari Press, 2005)

I was really surprised to find this book.  Originally published in 1990, it was two years ahead of Judith Herman’s book, Trauma and Recovery, and well ahead of its time in discussing the long term impact of childhood trauma. 

This book is full of stories from survivors of trauma and how they were able to find their inner capacity to heal and overcome the preconceptions and stigma often associated with childhood survivors.  Linda Sanfield discusses and debunks the three most harmful theories associated with childhood survivors: 1) childhood survivors grow up to be offenders; 2) victims develop learned helplessness; and 3) victims identify with their aggressor in order to gain mastery of the trauma.  Her studies, statistical analysis, and interviews tell a much different story of hope and recovery, of inner resilience, and the ability to learn lessons from one’s childhood in order to be empowered in the present.

While some of the stories may trigger trauma responses in some readers, it is still a valuable book for survivors who are searching for stories about other people who have experienced childhood trauma.  The stories tell of the abuse but also of the recovery.  The writer also explains the trauma response in a way that trauma survivors will be able identify and understand.

The chapter “Human Doings: Survivors and Their Work” is specifically written for those of us who have chosen to work for and support victims of abuse after experiencing our own trauma.  Linda Sanfield discusses how we can become almost addicted to our work as a way of proving our value; and how we can also use our work as a healthy way to heal from and make meaning out of our own experiences.   

I highly recommend this book for both advocates and survivors.

Abused teens show mental scars

This article by Michelle Hackman, staff reporter for the Yale Daily News (Tuesday, January 10, 2012)
 was forwarded by Susan Blumenfeld of the National Center of Domestic Violence, Trauma and Mental Health.


Adolescents who experienced abuse or neglect as children have fewer brain cells than teens who did not undergo childhood maltreatment, a new Yale study finds.

A study conducted by scientists from the Yale School of Medicine, published in the Dec. 5 edition of Archives of Pediatric Adolescent Medicine, found that adolescents who were exposed to maltreatment as children showed a reduction in gray matter in areas of the brain that control emotions and impulses, though they had not been diagnosed with a psychiatric disorder. It found that the specific brain areas affected may differ according to whether adolescents reported experiencing abuse or neglect, whether the maltreatment was physical or emotional and whether they were male or female. Experts cautioned that the results of the study were only an association, and longer-term studies were needed.

“Though these kids do not have a diagnosable psychiatric disorder, they are still showing physical signs of maltreatment,” said Hilary Blumberg, associate professor of psychiatry in the Child Study Center and the senior author of the study. “The results could explain possible difficulties in school or future depression or behavioral issues.”

Forty-two adolescents filled out questionnaires that measured their perceived exposure to physical and emotional abuse, as well as physical and emotional neglect as children. Structural MRI scans found reductions in the prefrontal cortex, important in emotional and behavioral regulation, across all cases of maltreatment. Other areas affected depended on the type of maltreatment reported.

Those who reported physical or emotional neglect, for example, showed reductions in the cerebellum, which controls motor functions and regulates pleasure and fear. Those who had been exposed to physical abuse in particular showed reductions in the insula, an area that controls self-awareness ¬¬— which may explain why so many people who have been abused as children report out-of-body experiences, Blumberg said.

The study also found gender differences in the grey matter losses. In girls, the reduction was concentrated in areas important in regulating emotion, while in boys, the reduction was seen in areas important in impulse control. Because depression is associated with an inability to regulate emotions, this finding highlights the fact that the rate of depression is much higher in women than men, according to Jennifer Pfeifer, an assistant professor of psychology at the University of Oregon, who wrote an editorial on ScienceDaily.com, a major science news website, critiquing the study.

Blumberg said that despite the physical symptoms of childhood maltreatment, some adolescents in the study remained more resilient than others. Pfeifer and her colleague Philip Fisher, also of the University of Oregon, speculated two possible reasons for this apparent resilience in their editorial. The structural decreases may have left adolescents vulnerable to future psychological problems — which just haven’t occurred yet, or the adolescents tested have found alternative mechanisms to adapt to their difficult surroundings.

Because it only shows correlation, the study cannot prove that childhood maltreatment precipitated any structural changes in the brain, said Everett Waters, professor of psychology at the State University of New York at Stony Brook.

“It is also possible that brain problems led to the kids being abused,” Waters said, “or more likely, that some third factor led to both the brain problems and the abuse.”

Waters and Pfeifer both emphasized the importance of conducting a longitudinal study that would track children from infancy, in order to better understand the development of structural differences in the brain. Linda Mayes, a co-author of the study, said she will continue to track this group of adolescents and monitor them to see if they develop psychiatric disorders.

The research was funded by the National Institutes of Health.

Poverty and Trauma - A Paper by Jennifer Frechette, Skidmore College

Dr. Ruby Payne states that the definition of poverty is “the extent to which an individual does without resources.” Payne (2005) states that the resources needed include financial, emotional, spiritual, physical, social support systems, and relationship resources, as well as the knowledge of unspoken social norms (p. 7). Without these, Payne states, people are at higher risk of becoming impoverished and homeless. If these resources and supports are in place the individual is more likely to find stability in others and therefore have support in times of need.


According to the National Child Traumatic Stress Network (NCTSN), homelessness results from severe poverty, the inability to find housing that is affordable, single parenthood, and lack of social supports (2005, p. 1). Those who experience homelessness have an increased susceptibility to trauma, loss of community, family, and security. Families who live in shelters are confronted by many problems such as “the need to reestablish a home, interpersonal difficulties, mental and physical problems” (NCTSN, 2005, p. 1). Homelessness makes families more likely to experience various traumas including physical and sexual assault as well as increased anxiety due to feelings of being overwhelmed and hyper vigilance pertaining to maintaining personal safety (NCTSN, 2005, p. 1). Payne (1996) outlines important things to know about poverty. Firstly, poverty is relative; meaning that it depends on your surroundings and community. Second, poverty occurs everywhere in the world. Third, economic class is ever changing. Fourth, there are different types of poverty, those being generational and situational. Generational, as defined by Payne, is “being in poverty for two generations or longer” whereas situational poverty is caused by circumstances and generally lasts a shorter amount of time. Fifth, society as a whole operates under middle class norms and finally, Payne states that in order to move from “poverty to middle class or middle class to wealth, an individual must give up relationships for achievement.”

The NCTSN ( 2005) states that children bear the most trauma from homelessness stating that homeless children get sick “ twice the rate of other children” and that they “suffer twice as many ear infections, have four times the rate of asthma, and have five times more diarrhea and stomach problems” ( p. 2) . Among these statistics homeless children go hungry twice as often as non-homeless children and are twice as more likely to have difficulty completing each grade of school, as well as are more likely to have difficulties emotionally and behaviorally in school (NCTSN, 2005, p. 2). The NCTSN (2005) states that, “half of school-age homeless children experience anxiety, depression, or withdrawal” (p. 2).

It is important for children in poverty to receive assistance from those around them, including shelter staff. But what is essential is that those that choose to support homeless families provide a safe environment which includes positive role models, positive social interaction, and equality. The NCTSN (2005) states that

By making families co-participants in establishing rules and regulations, and by housing caregivers and children together, programs can help prevent re-traumatization. Programs can also empower families by maximizing their choice and control, thereby ensuring that they constructively use services to attain personal stability and heal emotional hurt (p. 2).

Shelters are the primary safe zone for homeless families in the United States. Many shelters work closely with community health agencies as trauma specific care givers to homeless families (NCTSN, 2005, p. 2). It is important to restore stability, assess trauma within the family, and create a safe net to understand and address the trauma between family members in order to best address and assist each individual family members needs. NCTSN (2005) states that it is important to train shelter staff to understand the link of homelessness and traumatic experience by “promoting wider awareness of the role of trauma in precipitating and extending family homelessness” (p. 2). Collins et al (2010) cite Figley (1988) state that,

"Trauma can impact the family system through several distinct pathways: simultaneous exposure when all members of the family are exposed to the same event; vicarious traumatization or contagion of trauma from an exposed family member to others in the family; intrafamilial trauma when one family member is the perpetrator of the trauma; and secondary stress when traumatic distress symptoms disrupt family functioning (30).Balancing these various pathways for and of trauma can many times distance supports from the

purpose of working with family members who have been exposed to traumatic experiences. Validating each individual in the family’s experience with trauma while balancing the family’s impact or possible perpetration of that event can be difficult. However, what is important to keep in mind is that each family member has a right to be heard and each one is likely to have experienced victimization at some time or another. Balancing the various traumatizations and homelessness of families can be cumbersome; however, there are multiple other factors that play a key role in family functioning. "

Families living in poverty are at risk of facing a number of stressors including conflict within family, violence, various abuses, and neglect from society and are vulnerable to homelessness, financial disparity, and substance abuse (Collins, K., Connors, K., Davis, S., Donohue, A., Gardner, S., Goldblatt, E., Hayward, A., Kiser, L., Strieder, F.& Thompson, E. , 2010, p. 30). Putnam and Tricett (1993), as cited in Collins (2010) state that there is a concern, among impoverished, about physical safety which is found among multiple generations (p. 30).

Psychological trauma is likely among the homeless for three reasons, (1) The sudden or gradual loss of one's home, (2) the conditions in a shelter and (3) the occurrence of past sexual or physical abuse history previous to homelessness (Goodman, Saxe, and Harvey,1991, p. 1219). Goodman et al( 1991) state that learned helplessness is a potential effect of homelessness that can be prevented by creating an empowering environment around post trauma living and a rebuilding of expectations and norms within the individuals social constructs (p. 1219).

The event of losing one’s home is traumatic enough. What accompanies loss of home is loss of neighbors, community, and places the family that is in this transition in a state of perpetual stress. Goodman et al (1991) cite Shinn, Knickman, & Weitzman (1989, 1991) and Sosin, Pihavin, & Westerfelt (1991), as stating that the transition from being housed to being homeless lasts days, weeks, months, or even longer. Most people living on the street or in shelters have already spent time living with friends or relatives and may have experienced previous episodes of homelessness (p. 1219).

Collins et al ( 2010) cite Wethington et al (2008) as stating that “Although exposure to the social ecology of urban poverty carries significant risk, most children continue to function well and do not develop PTSD” (p. 13). Through supportive relationships with family and friends, these children learn and use coping and problem-solving skills that encourage positive adaptation. Problem solving, coping skills, trauma history, intelligence, supports, poor attachments, and gender of the child are some of the risks and protective factors that children living in poverty can either benefit from or limit children’s ability to adapt and grow (Collins et al, 2010, p. 13) .

Children are the most susceptible to traumatic experience and this susceptibility only increases when they are faced with displacement of home. Goodman et al (1991) state that those that are homeless experience trauma from the process of being homeless but also are traumatized by lack of safety and loss of control in the shelter system (p. 1219) . For many children, stability means going to school each day where their friends are and going home at the end of the day to their family to their bedroom and their space.

One of the most traumatizing experiences that the homeless have is that of leaving the societal norm of what is considered normal for housing and entering into something that is viewed as less than desirable by society. (Goodman et al, 1991, p. 1220). Bowlby ( 1969, 1973) as cited in Goodman et al (1991) states that humans need intimate and long lasting attachments and for homeless children the loss of safety and autonomy makes creating secure emotional attachments difficult (p. 1220). Van der Kolk( 1987) as cited in Goodman et al ( 1991) proposes that “psychological trauma is the perceived severance of secure affiliative bonds, which damages the psychological sense of trust, safety, and security” (p. 1220). Trauma victims that are placed in an unknown and perceivably unsafe living situation often exacerbate their trauma and this often causes distrust and isolation from the social supports of the traumatized, homeless victim ( Goodman et al, 1991, p. 1220). Goodman et al (1991) state that homeless individuals who are able to enter into shelters in their own communities are better off because they can maintain already established connections; otherwise, those made to move out of their neighborhoods many times experience difficulty maintaining ties to that community. Goodman et al (1991) states that, “Physical distance may engender a sense of psychological distance that increases the sense of isolation. Shelter providers should encourage and help homeless residents maintain social networks, thereby building on strengths rather than focusing on deficits” (p. 1222).

By becoming homeless, the individual can often no longer continue their normal routine or functioning extending to work, friends, and otherwise. They lose control over their personal space and their needs which they are forced to rely on others for. Goodman, Saxe, and Harvey (1991) state that the homeless, “may depend on help from others to fulfill their most basic needs, such as eating, sleeping, keeping clean, guarding personal belongings, and caring for children” (1221) . Many shelters separate families, women and children go into one shelter and men in another making what is a stressful situation even worse by further fragmenting families and taking away natural supports put in place within the family as well as removing a potential “safe person” for each individual in the family.

The victimization experienced by homeless women in New York City ranged from 43% being raped by a member of their family, 74% reporting physical abuse, and 25% were robbed (D'Ercole & Struening, 1990 as cited in Goodman et al, 1991, p. 1222). Bassuk and Rosenberg (1988) compared homeless and housed mothers in Boston and found 41% of homeless compared to 5% of housed experienced physical abuse during childhood, and 41% of homeless and 20% of housed had experienced intimate partner violence in their adult lives (Goodman et al, 1991, p. 1222). Collins et al (2010) found in a national study that “50% to 90% of adults in the United States have experienced one or more traumatic events; and 10% to 20% of those exposed will develop all of the symptoms necessary to establish a diagnosis of PTSD” ( p. 21) . Wilson( 2005) cited Newmann and Sallman’s ( 2004) finding that women who experience child abuse are at much higher risk to develop disorders such as anxiety, and substance abuse than women who did not experience child abuse. It was also found that women who experienced sexual abuse as a child ran a higher risk of developing mental health problems such as depression, anxiety, posttraumatic stress disorder among others.

Many of us, when thinking about the poor, automatically turn to third world countries; however, the statistics regarding American children are astounding. According to Collins et al (2010), “49% of American children in urban areas live in low-income families” and that “Families constitute two-fifths of the U.S. homeless population.” (p. 4). 83% of inner city teens have experienced at least one traumatic even and that in that same population, 59%- 92% who are involved in the mental health system report traumatic experiences and urban females are four times more likely to develop severe traumatic stress (Collins et al, 2010, p. 4).

In order to assist those traumatized by and in the homeless and poor communities it is important to keep in mind the family system and structure as a whole. What is important, is treating the family as a whole while recognizing past, present, and future traumas as a whole as well as the various trauma modes experienced by each individual and how that impacted each individual in the collective. Evans & English (2002) and Esposito ( 1999) as cited in Collins et al (2010) state that “There are few well-developed, standardized and empirically supported family therapies for treating family systems impacted by trauma” ( p. 2), meaning those treating family systems in impoverished communities face even a more difficult time finding a successful treatment regime. It is important to understand the effects of trauma and poverty on different family members and among familial relationships, as well as understanding the full range of family members’ responses to trauma and poverty, is critical to improving outcomes.

Collins et al (2010) states that the traumatic context of urban poverty has pervasive effects that slowly erode parent and family function and affect outcomes. Contextual risks of urban poverty (meager resources, crowded conditions, trauma, etc.) affect everyone exposed, but effects on children are exaggerated by reduced parental well-being and family functioning (p. 6).

Understanding the risks of poverty and supporting families, children and parents alike, is essential for actions by parents on children’s problem behaviors (Collins et al, 2010, p. 6).

Goodman et al (1991) states that by viewing homelessness as a psychologically traumatic experience has a number of implications for psychologists and other mental health practitioners. Given that the presence and severity of psychological trauma depends in large part on community response to victims and the overall environment in which they function (see, e.g., Green et al., 1985), improving the psychosocial conditions of shelter life could mitigate or even prevent the development or exacerbation of psychological trauma (p. 1222).

Homelessness in of itself is traumatic. The relief that supports in shelters and social services can provide victims of homelessness is insurmountable.

Homeless children and families experience trauma by virtue of losing their home, community, and stability. Homeless and impoverished people are more likely to experience other forms of trauma as well, such as physical and sexual abuse. What the homeless and impoverished need is support in finding stable employment and housing as well as assistance in addressing their past traumatic experiences. What can assist with decreasing trauma caused by homelessness is support from the surrounding communities and a willingness from society to accept poverty as a reality while breaking down barriers caused by economic status. These actions need to be taken to fully address the trauma the homeless and impoverished experience daily in the United States.


Works Cited:
Collins, K., Connors, K., Davis, S., Donohue, A., Gardner, S., Goldblatt, E., Hayward,

A., Kiser, L., Strieder, F. Thompson, E. (2010). Understanding the impact of trauma and urban poverty on family systems: Risks, resilience, and interventions. Baltimore, MD: Family Informed Trauma Treatment Center.

http://nctsn.org/nccts/nav.do?pid=ctr_rsch_prod_ar or

http://fittcenter.umaryland.edu/WhitePaper.aspx

Goodman, L., Saxe, L., & Harvey, M. ( 1991). Homelessness as psychological trauma: Broadening perspectives. American Psychologist, 46( 11), 1219- 1225.

National Child Traumatic Stress Network: Homelessness and Extreme Poverty Working Group

( 2005) . Facts on trauma and homeless children . www. NCTSNET. org.

Payne, R.K. (1996). Understanding and working with students and adults from poverty. Instructional Leader 4(2).

Payne, R.K. (2005). A framework for understanding poverty.Highlands, Tx : AHA! Process inc.

Wilson, D. ( 2005). Poverty and child welfare: Understanding the connection. Northwest Institute for Children and Familes.

"Working the System"

A couple of months ago I was at a conference where a speaker was discussing children and trauma. He told a story to illustrate the resourcefulness and resiliency of a 15 year old girl whose mother was a prostitute and a drug addict. This young girl also had four brothers and sisters and they were all left to their own devises, basically raising themselves. The gentleman had asked the young girl what she was doing for food. She responded that she was having a hot meal every night of the week. He was surprised. “How do you do that?” he asked. “Well, I know if I go to my friend’s house on Tuesday nights and am hanging around there between 5 and 5:30 that her mom will ask me to stay for dinner. I like that because Tuesday is spaghetti night at her house. On Friday night the Congregational Church as a free dinner and there are other places that serve meal on other nights. I’ve got it covered most nights” she told him. The speaker went on to talk about how resourceful this young girl was. I raised my hand and asked him, “What happens between the age of 15 and 25? Why is it that we can call her resourceful at 15 and at 25 we accuse her of working the system?”

That is the question I want to ask of people. If someone grows up in poverty and is living under the rules of a welfare system, this is the system in which their skill base is built. In fact, there may have been few if any opportunities to learn other skills with which to build a life. Many of us judge people in poverty from our middle class viewpoint, expecting people to have had the same level of support and education that we have had. Unfortunately, this is not true. People who grew up in poverty and trauma have many skills that have served to help them survive. These include knowing where to get a hot meal, how to manage on food stamps, how to keep the landlord at bay, where to sleep in order to stay warm, and what to say or do in order to get needs met. This may mean “lying,”, “manipulating,” and “working the system” in order to have these needs met, because they have learned in the past that telling the truth did not always get needs met and the system is set up in a way that it requires someone to “work it.”

As advocates, we can provide opportunities to learn new survival skills once the person feels safe and stable. Safety and stability means being treated with non-judgment and with recognition of the resiliency and resourcefulness that has gotten her to your door. If she continues to use old skills even after learning new skills, then remember how long it has taken you to learn something new and apply it, or to break an old habit, or just remember that she may not feel safe enough to change yet.

Building relationships based on trust is a key to recovering from trauma. Knowing that you are emotionally safe from judgment is a key component in building that trust.

Book Review – The Boy Who Was Raised as a Dog and other stories from a child psychiatrist’s notebook by Bruce D. Perry, M.D., PhD., and Maia Szalavitz

I have had a number of survivors ask me questions about what trauma has done to their children and how they can help them recover from the impact of witnessing domestic violence or suffering from sexual abuse. Amidst the stories of children who experienced extreme abuse and neglect, Dr. Perry and Ms. Szalavitz, in their book, The Boy Who Was Raised as a Dog, provide hope and encouragement for parents and those who work with traumatized children.

First of all, let me warn you, this book is not for bedtime reading or for reading in large doses. It is hard to put down, but the reader should take breaks, practice self-care, and not focus solely on the horrific stories, but also on the successes that have occurred by providing nurturing, healing environments for children.

Included are the stories of the children of the Branch Davidian cult in Waco, Texas, the effects of living in extreme neglect (a child from a eastern European orphanage, a baby left alone for 8 hours a day by a babysitter who only returned to the house to change his diaper), and children who had suffered from sexual abuse. There is also the story of the children in Gilmer, TX who were the focus in an investigation which led to hysteria and accusations of ritual Satanic abuse.

In addition to describing how trauma affects the brain of a developing child, Dr. Perry also describes how treating the child as if they were still at the age during which the abuse occurred results in the brain being able to get back on track developmentally. The writer’s tell the story of Mama P. who taught a young mother how to nurture her child after the doctors had learned from Mama P the importance of cuddles and hugs. This is not the story of doctors in labs studying rats, but the story of a doctor willing to learn from children and parents about what is best for the child. Dr. Perry spent many hours on the floor with the child, paper and a box of crayons, letting the child lead the way rather than forcing therapy on a child who did not feel safe.

According to the authors, “The human brain develops sequentially in roughly the same order in which its regions evolved. The most primitive, central areas, starting with the brainstem, develop first. As a child grows, each successive brain region, in turn, undergoes important changes and growth. But in order to develop properly each area requires appropriately timed, patterned, repetitive experiences. The neurosequential approach to helping traumatized and maltreated children first examines which regions and functions are underdeveloped or poorly functioning and then works to provide the missing stimulation to help the grain resume a more normal development.” Basically, if a child missed out on a lot of play, nurturing, etc, the then need to have those experiences to be able to develop into full functional adult.

In the last chapter, the authors reiterate what we have also learned from Judith Herman’s book, Trauma & Recovery; healing from trauma occurs best in communities of healthy and nurturing adults. The implications of living in a transient society with less and less money available for safe and stimulating child care, and schools that focus more on cognitive development than on a child’s emotional and physical needs are also discussed, leaving the reader wondering how the recent cuts in many needed programs will affect the next generation.

I highly recommend this book for anyone who is working with traumatized and abused children.

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.

Forgiveness and Recovery from Trauma

I recently had a discussion with a few advocates on the idea of forgiveness and its place in healing the effects of trauma. I have had a few incidences in my work over the years to discuss this with both survivors and advocates and thought that it would be meaningful to generate some more thoughts on the subject.


The idea of forgiving the perpetrator for many survivors is an abhorrent idea. When presented with the idea in a support group curriculum or self-help book a survivor may have many responses. “Why would I forgive him? He hasn’t apologized!” “If I forgive him, that means I have to let him in my life again?” “What? Forgive? That would mean I would have to condone what happened? I can’t do that. First you tell me it was wrong and now I have to forgive?” “I must be a horrible person if I can’t forgive.”

Healing from trauma is a process and so is forgiveness. The process of recovery from trauma has many stages and forgiveness is only a part of one of those stages. Forgiveness may also be something that occurs further along in the healing, after there has been separation from the perpetrator and more manageability of one’s life and emotions.

In Trauma and Recovery, psychiatrist Judith Herman (1997) defines trauma as a disease of disconnection. In her book she describes a three-stage model for recovery – safety, remembrance and mourning, and reconnection.

Early in recovery a survivor is primarily working on issues regarding safety. Forgiving the abuser can often feel unsafe. It may feel as if a crack is being opened in a door that the survivor is working very hard to keep shut. If she is still experiencing feelings of love toward the abuser she may feel that forgiveness would increase her vulnerability and decrease her safety. During this early stage, controlling the environment, both internally and externally, is the most important task. Being able to establish appropriate boundaries with everyone in her life is a part of this task and forgiveness may blur that boundary. This stage is focused on the present and lasts as long as necessary for the survivor to develop skills to reduce the impact of triggers, alleviate anxiety and depression, and negotiate safety in the greater world.

During the remembrance and mourning stage the women is stabilized and begins to focus on the past. She often begins to acknowledge her losses and mourns the loss of the relationship or the dreams that were associated with her relationship. She is using the skills learned in the first stage to self-soothe while she comes to term with the impact of the trauma on the life she thought she would have. It is during this time that she may need to start to forgive herself – not for the abuse – but for what she may perceive her role to have been in the trauma. Many survivors carry a sense of guilt and shame in regards to their abuse and how they may have handled the situation. Hopefully, she will be able to recognize that she did the best she could under the circumstances and can now move on, stronger in knowing that she survived.

If forgiveness of the perpetrator is going take place, it is probably during the third stage – reconnection. This reconnection refers to developing a new self and creating a new future. It does not mean reconnecting with the perpetrator. Forgiveness is often described as a state of “letting go,” a process of releasing the past and moving forward into the future with a light load. It is not an action toward the abuser, but is rather an internal process of living life without resentments, anger or indignation. It is the recognition that until we “let go” the abuser still has power over us. Forgiveness is really not about what it does for the other person, but what it does for the survivor. The perpetrator never needs to know.

Forgiveness is also an action that cannot be forced onto the survivor. It is not to be a prescribed or demanded expectation. This is a process that the survivor comes to of her own choosing and in her own time. She will be able to let go of the past when she feels safe stepping into the future.

New Resource Added to Valuable Links - Stop the Storm

I would like to introduce you to  the blog http://stopthestorm.wordpress.com/ It is a wonderful resource.  This blog is written by a 59 year old survivor of childhood maltreatment who is also a cancer survivor.  She has done extensive research on trauma and how it has affected her ability to be in the world.  She does an excellent job of describing her responses to triggers and how trauma has influenced her relationships.  I highly recommend that you check it out.