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.

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. 

Surviving the Holidays

The holidays are often a difficult time for trauma survivors. Family activities, while joyous times for some people, are often difficult reminders of the past and can cause distress. For some survivors, the holidays are anniversaries of traumatic experiences. For other survivors, it may mean being in the presence of the sexual perpetrator or the abuser.

Survivors may not always be aware of how they are being triggered or may feel guilt and shame for not being able to rise to the same level of excitement and anticipation that others feel during this period. Even if they seem to have recovered well from past trauma, they may begin to have more problems with sleeping, over or under eating, increased anxiety, and a sense of impending disaster.

Here are some tips to help survivors manage stress during this time:

1. Have an exit strategy. Some survivors are able to say “no” when expected to attend family gatherings where a perpetrator may be present. A sense of obligation to other family members may make it difficult to stay away. If someone is planning to attend a family gathering where a perpetrator is present, it is good to limit the amount of time spent in the situation. Arriving late, having one’s own form of transportation, having an agreement with another family member to assist in maintaining distance are all possibilities.

2. Good self care. With all the stress of the holiday season, immune systems become compromised. Illness and fatigue can increase susceptibility to triggers and make it more difficult to manage reactions and heightened emotional vulnerability. High intakes of sugar through this time can also reduce the ability to combat infection, increasing vulnerability. Any activities that increase a sense of well being such as support groups, mindfulness activities, exercise, and creative projects can help fight off depression.

3. Support. Isolation is often a strategy for managing this time of year that can end up being very unproductive. Existing support groups or informal support of understanding friends may help alleviate some of the loneliness that occurs during the holidays.

4.  Limit alcohol intake.  Alcohol is a depressant and can also affect the immune system.  It also decreases inhibitions and affect sleep patterns which can then lead to increased vulnerability to the effects of trauma or additional trauma. 

Moderation in consumption of food, alcohol, and activity can be a very valuable for surviving the holidays.

Please feel free to add any other ideas you may have in the comment section below.

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.

Effects of Maltreatment on Brain Development

There have been a few requests lately for more information on how trauma affects a child’s brain and the child’s ability to form attachments and learn. The following is a summary of an article, Understanding the Effects of Maltreatment on Brain Development, published by the US Department of Health and Human Services’ Child Welfare Information Gateway www.childwelfare.gov/pubs/issue_briefs/brain_development

Thanks to the relatively recently developments in the study of brain development including functional magnetic resonance imaging, there is now evidence to show that brain function is altered significantly. “…genetics predisposes us to develop in certain ways. But our experiences, including our interaction with other people have a significant impact on how our predispositions are expressed. In fact, research now shows that many capacities thought to be fixed at birth are actually dependent on a sequence of experiences combine with heredity. (Shonkoff and Phillips, 2000).”

An infant is born with almost all of the brain neurons that it will ever have. As the brain developed in the fetus these neurons began to specialize, developing specific tasks for the lifespan of the person. This development continues after birth and on into adulthood. The first regions to develop are those concerned with bodily functions and maintaining life. “But the majority of brain growth and development takes place after birth, especially higher brain regions involved in regulating emotions, language and abstract thought. Each region manages its assigned functions through complex processes that involved chemical messengers (Perry, 2000a).”

Plasticity is the term used to describe the brain’s ability to change in response to stimulation. This is dependent on the stage of development and the specific region of the brain that is affected. The part of the brain that is “wired” to respond to the human voice or facial expression anticipates the exposure and when this does not happen, the brain will discard these pathways. The brain will discard pathways that are not being used and develop other pathways that are needed for survival.

There are sensitive periods for the development of certain capabilities. “For example, infants have the genetic predisposition to form strong attachments to their caregivers. But if a child’s caregivers are unresponsive or threatening, and the attachment process is disrupted, the child’s ability to form any healthy relationships during his or her life may be impaired )Perry, 2001a).

Babies are born with implicit memory which means they have a perception of the environment that can be recalled in unconscious ways (responding to the sound of mother’s voice). Explicit memory is tied to language development and provides children around the age of 2 with the ability to talk about themselves in the past or future or in different places or circumstances. However, children who have been abused or suffered other trauma may not be able to retain the explicit memories that they need to be able to tell about their trauma. Instead, they will experience the implicit memories such as bodily or emotional sensations that manifest as nightmares, flashbacks or other uncontrollable reactions.

Children can learn to tolerate moderate stress and greater amount of stress can be tolerated if he/she has a positive relationship with an adult caregiver. However, without this positive interaction in significant amounts at critical periods, the brain can be altered by the toxic stress. Specific effects depend on the age of the child, whether the trauma was one-time or chronic, the identity of the abuser, and whether there is a dependable nurturing adults present, the type and severity of the abuse, the intervention, and how long the maltreatment lasted.

“Altered brain development in children who have been maltreated may be the result of their brains adapting to their negative environment. If a child lives in a threatening, chaotic world, the child’s brain may be hyperalert for danger because survival may depend on it. But if this environment persists, and the child’s brain is focused on developing and strengthening its strategies for survival, other strategies may not develop as fully. The result may be a child who has difficulty functioning with a world of kindness, nurturing, and stimulation.”

Children who are exposed to long term and severe abuse, either emotional or physical/sexual, will develop responses such as a persistent fear response, hyperarousal, dissociation and disrupted attachment (inability to form relationships). The neural pathways have formed these responses as a means of surviving the impact of the trauma. However, these responses also result in increased susceptibility to stress, excessive help-seeking and dependency or excessive social isolation, and the inability to regulate emotions. The effects are cumulative and can lead to life long difficulties in interpersonal relationships.

“Some of the specific long-term effects of abuse and neglect on the developing brain can include (Teicher, 2000): diminished growth in the left hemisphere, which may increase the risk for depression; irritability in the limbic system, setting the stage for the emergence of panic disorder or posttraumatic stress disorder; smaller growth in the hippocampus and limbic abnormalities (areas of emotions and memories in the brain), which can increase the risk for dissociative disorders and memory impairments; impairment in the connection between the two brain hemispheres, which has been linked to symptoms of attention-deficit/hyperactivity disorder.

The U.S. Department of Health and Human Services Children’s Bureau (2009) encourages professionals to promote five “protective factors” that can strengthen families, prevent abuse and neglect, and promote healthy brain development: nurturing and attachment, knowledge of parenting and of children and youth development, parental resilience, social connections, and concrete support for parents.

For additional information go to www.nhcadsv.org to access the recent publication, The Mental Health Needs of Children Exposed to Violence in their Homes.

Editorial Response to Glee Actresses Posing for GQ Magazine

This past week GQ magazine printed photos of Lea Michelle and Dianna Argon of the very popular FOX television series, Glee. These photos are part of the latest issue of GQ. The photos depicted Lea and Dianna as high school students in various states of undress or exposure. In most of the photos they were wearing parts of cheerleader uniforms (though I have never seen a cheerleader in pink spiked heels). In a couple of the photos, they pose with Corey Monteith, another actor on the television show, draped over him in sexualized positions. Corey is fully clothed in all photos and appears to be depicted as the character he plays on the television show.


I have searched and have yet to find a response to the photo shoot from anyone in the feminist or child abuse community. A statement by the Parents Television Council responded to the photos by stating "It is disturbing that GQ, which is explicitly written for adult men, is sexualizing the actresses who play high school-aged characters on 'Glee' in this way. It borders on pedophilia. By authorizing this kind of near-pornographic display, the creators of the program have established their intentions on the show's direction. And it isn't good for families.” GQ responded with "The Parents Television Council must not be watching much TV these days and should learn to divide reality from fantasy," Jim Nelson, editor-in-chief of GQ, said. "As often happens in Hollywood, these 'kids' are in their twenties. Cory Montieth's almost 30! I think they're old enough to do what they want."

I think that GQ is missing the point. I have few objections to Lea and Dianna posing for GQ or any other magazine if they are portraying adult women. The irresponsibility occurs when the photos depict them as high school students and, as in this case, very sexualized high school students.

Looking at GQ demographics we quickly find the age group, 25 to 34, makes up

38% of the readership while 29% of the readership belongs to the 35 to 49 years old

group. The 18 to 24 year olds make up 24% of the readership while the 50 to 64 year

old males make up only 8% and the 65+ age group makes up only 1%. 91% of the

readers are under 50 years of age. Over 36% of the male readers graduated college

while another 37% attended college. 64% of the males have an income of $50,000 or

more, 11% have an income of $40,000 or more, 8% at $30,000 or more and the

balance are the $20,000 or more at 7% and the $10,000 or more and the less than

$10,000 having 10% of the male readership between them. Clearly, the worldview of

GQ is through the eyes of a young, educated, and wealthy American male. (Media and Culture as Manifest in Male Individualism, Bozark, 2003)

My concern is how these American males are viewing adolescent girls. What Lea and Dianna and GQ magazine have done is to set up our teenage daughters and granddaughters up for continuing to be seen as objects of sexual desire for males over the age of 25. It doesn’t matter that Lea and Dianna are in their twenties, they were explicitly depicting adolescent girls in these photos.

Lea Michelle stated in an interview that she had been dealing with body issues and that she enjoyed being able to pose for these photos. She also stated she was surprised at what the photographers were able to talk her into doing. Her statement suggests that she was manipulated into some of the poses. I think that Lea could have taken a more responsible approach and 1) thought about how media had contributed to her issues regarding her body 2) been more pro-active and responsible for what was happening in the photo shoot. I would not be as concerned if she had been responsibly posing as the adult woman that she is, though I would still be concerned with how media presents women as objects and demands perfect bodies.

GQ’s response shows the ongoing irresponsibility of the media in regards to what it sells to its readers. By saying that the PTC is unable to separate fantasy from reality, it is showing that it does not understand that what it is selling to adult males is a fantasy of American teenage girls that sets them up for victimization in a number of ways.
I am an avid watcher of Glee. I find that its portrayal of the struggles of adolescence is spot on and it is willing to take on a number of controversial issues including teen pregnancy and homosexuality. The cast is talented and the musical numbers are entertaining and often inspiring. This recent incident with GQ, however, will now make me think even more about how media depicts teenagers. I will also use this as a teachable moment with my teenage granddaughters. If it is out there, it needs to be discussed.