Overview of Supporting Children Living with Grief and Trauma

Last week I attend a training hosted by the Office for Victims of Crime on Supporting Children Living with Grief and Trauma: A Multidisciplinary Approach. The following is a brief review of the information along with some references for further reading.

Children are exposed to violence in every country and every society and across all social and economic groups. There are many ways to categorize these acts. Three of the most common are interpersonal violence, institutional violence, and structural violence.

According to the FBI, 27% of all violence occurs in a family setting. (National Indicent-Based Reporting System, 1996.)

Every year, 3 to 10 million children witness domestic violence. (Carter, Weithorn, Behrman, 1999.)

Children who witness violence at home display emotional and behavioral disturbances as diverse as withdrawal, low self-esteem, and nightmares; and aggression against peers, family members, and property. (Peled, Jaffe, Edleson, 1995.)

About 3.3% of all reported crimes reported take place on school property. Crimes were highest in October.

More than half of the arrestees associated with school crime were arrested for simple assault or drug/narcotic violations.

Children who watch a lot of TV news tend to overestimate the prevalence of crime and may perceive the world to be a more dangerous place than it actually is. (Smith, Wilson, 2002.)



Risk factors that determine if a child will be susceptible to experiencing trauma:
Pre-Event
Age, genetics, intelligence, medical factors
Family stability/instability/lack of bonding
Developmental level
Psychological problems of the child
Previous trauma experiences/early losses
Self-esteem issues of the child
Gender (girls are more likely than boys to suffer trauma)

During the Event

Chaos, lack of control, suddenness of the event
Duration of the event
Age and gender
Inability to help
Time needed to process the event
Physical closeness to the event
Amount of gore, blood exposure, and/or level of atrocity
Perception/mean of the event
Number of incidents
Relationship to victim and/or perpetrator (intentional/accidental)

Post-Event
Media coverage
Cultural influences
Threat of reoccurrence
Shame
Resulting changes and losses
Existence of grief and survivor guilt
Problems with confidentiality
Changes in family and health
Stigma put on child by others, e.g., shunning
Criminal investigation/court involvement
Responses of organization (church, school, community resources)



Impact of Trauma on the Fetus

New studies are showing that there are many complex, long lasting connections between genetics and external factors that influence a child’s brain development. Studies have shown that trauma impacts children while they are still in the womb. When mothers are under heavy stress or have PTSD, the fetus is impacted in a number of ways. Studies of pregnant women who witness the 9/11 World Trade Center collapse showed that the mothers passed on markers of PTSD to their unborn babies. Higher cortisol levels (stress hormones) in mid-pregnancy result in smaller fetuses.

Please see my previous post on how trauma impacts the brains of children,  Effects of Maltreatment on Children

One interesting antidote of the training was the story of the children who were being held in the Branch Davidian compound in Waco, Texas. These children were being interview by the local child protective service agency and were assessed as not having been impacted by the abuse that they had endured at the hands of David Koresh. However, Dr. Bruce Perry came in and engaged in activities with the children that led to his eventually being able to connect them to EEG and EKG machines. When he asked them about what happened to them in the compound the trauma reactions were recorded on the EEG and EKGs, proving that the children were experience trauma responses internally. They had, however, learned in the compound not to express distress outwardly due to the danger of further abuse.



According to Dr. Perry www.childtrauma.org/ there are six core strengths that are an essential part of healthy emotional development of children. They are:

Attachment – the capacity to form and maintain healthy relationships and healthy emotional bonds.

Self-regulation – the capacity to notice and control primary urges such as hunger and sleep, as well as emotions such as fear, anger, and frustration. A child who self regulates learns how to put a moment between an impulse and an action.

Affiliation – the capacity to join others and contribute to a group. The child needs a predictable, safe environment with their peers.

Attunement – recognizing the needs, interests, strengths, and values of others.

Tolerance – the capacity to understand and accept how others are different from the self. Tolerance builds on adult modeling of appreciation of differences.

Respect – appreciating the worth in self and in others.

Core strengths are developmental characteristics that help a child grow into a mature and responsible adult. Resiliencies are the characteristics that allow a child to recover after a traumatic event. Resiliencies include: insight, independence, relationships, initiative, humor, creativity, and morality. Please see www.resiliency.com/  for more information.

Therapeutic models for working with children and grief include cognitive behavioral therapy http://tfcbt.musc.edu/, Eye Movement Desensitization Reprocessing (EMDR) www.emdr.com/, art therapy trauma-informed-art-therapy, writing therapy, play therapy, equine assisted therapy animal-assisted-therapy-heals-childhood-trauma, and group therapy. 

I encourage you to explore the above links to learn more about what can be done to help children who have experienced trauma and grief. 

Trauma and Recovery: The Aftermath of violence-from domestic abuse to political terror by Judith Herman

 - a book review by Jennifer Frechette, graduate student from Skidmore College.

Jennifer is a case manager at Monadnock Family Services in Keene, NH and is currently undertaking an independent study course on Trauma and Intimate Partner Violence. I am her independent study instructor for this course. She wrote this review as an assignment and it was so well done I asked for her permission to reprint it here.


Trauma and Recovery: The Aftermath of violence-from domestic abuse to political terror, written in 1992 by Judith Herman, published by Basic Book New York, NY reviews the history of psychological trauma including hysteria, shell shock and sexual and domestic violence. Judith Herman also wrote Father-Daughter Incest and other various journal articles. Judith Lewis Herman is a psychiatrist, researcher, teacher, and author whose primary focus has been on the treatment and knowledge of those that have had traumatic experiences as well as those that are victims of incest. Dr. Herman is a Professor of clinical psychiatry at Harvard University Medical School and Director of Training at the Victims of Violence Program in the Department of Psychiatry at the Cambridge Health Alliance in Cambridge, Massachusetts. She is also a founding member of the Women’s Mental Health Collective (Retrieved from http://en.wikipedia.org/wiki/Judith_Lewis_Herman). She received multiple awards ranging Lifetime Awards for Traumatic Stress Studies, Science Awards, and Psychiatric Association awards. Herman created the term “complex post-traumatic stress disorder,” which has now been included as an extension of PTSD (Post Traumatic Stress Disorder). Lenore Walker states that, “Herman's brilliant insights into the nature of trauma and the process of healing shine through in every page of this rich and compassionate book. Must reading for all who are concerned with this most crucial issue of our time" (Hopper, 1996-2010). Laura Davis, Coauthor of The Courage to Heal praised Herman’s work as a, "A triumph. Trauma and Recovery is astute, accessible and beautifully documented. Bridging the worlds of war veterans, prisoners of war, battered women and incest victims, Herman presents a compelling analysis of trauma and the process of healing. She presents a convincing case for the empowerment and care of all trauma victims” (Hopper, 1996-2010).

One of Herman’s biggest contributions to the field of psychology is the concept of complex post-traumatic stress disorder (CPTSD) which is an extension post-traumatic stress disorder (PTSD) to include repeated trauma and its impact on the psyche. (Wikipedia citation) Herman’s purpose for writing this book is to inform the reader of the effects of trauma on the victim, such as hyper arousal, inability to trust and disconnection. Herman cites the women’s liberation movement as the driving force behind her courage and reasoning for writing the book as well as the work that she did during her fellowship which is the backbone to Trauma and Recovery. Herman’s main concentration in Trauma and Recovery is to outline the fundamental stages of recovery which she designates as, “establishing safety, reconstructing the trauma story, and restoring the connection between survivors and their community“(Herman, 1992, p. 3). Herman (1992) cites that her reason for writing Trauma and Recovery was to give a voice to the numerous people who have participated in witnessing other people’s traumatic experience and expanding it to include a united front by which counselors can go forth to assist victims of trauma (p. 237).

The first section of Herman’s book, titled A Forgotten History, outlines the history of hysteria as it pertains to its relation to sexual trauma and the lack of acknowledgement of it in the psychiatric society. Herman states that the women’s movement was the breakthrough for the acknowledgement of women’s sexual and domestic violence and trauma histories and eliminated the silence that permeated psychology society. Herman (1992) states that “To study psychological trauma is to come face to face both with human vulnerability in the natural world and with the capacity for evil in human nature” (p. 7). One of the points that stood out to me in this first section was the importance that victims report their perpetrators and for others who know of violent and sexual crimes to report as well, as Herman (1992) states, “ All the perpetrators asks is that the bystander do nothing” ( p. 7).

Herman introduces the concept of hysteria and neurosis as a field dominated by Janet, Freud, and Breuer who reported that the physical manifestations of hysteria represented past traumatic experiences which had been suppressed in the subconscious. This concept, however, which eventually manifested in the discovery of the high percentage of child sexual abuse, was not well accepted by the public. Dora, a patient of Freud’s who had been sexually abused by her father, received the brunt of the negative public view of Freud’s finding which resulted in Freud dismissing Dora’s trauma history and invalidating her feelings. Herman (1992) also reviews the combat neurosis of what she calls the “sex war” and the prevalent public humiliation and degradation that women who have been raped experience which results in a societal decrease in reporting rape. Herman (1992) discusses the power of psychological trauma, the effects that it has on the somatic nervous system, as well as the significant changes in memory, emotions, adaptive abilities, and arousal (p. 34). She cites memory triggers as a debilitating force that can rear its ugly head at the most unexpected times. Herman outlines that memory for those that have been traumatized is not “ normal memory” and therefore encodes in a different way and triggers constant recitation of the traumatic memories causing constant intrusion into everyday experiences. Herman (1992) goes on to describe constriction or “numbing” which Herman cites as the “third cardinal symptom of post-traumatic stress disorder” (p.42). In this stage people literally become numb to the abuse and begin dissociating in order to cope with the trauma. She states that the most obvious feature of post-traumatic stress disorder is what she calls the “dialectic of opposing psychological states” (Herman, 1992, p. 47).

Herman’s third chapter is titled Disconnection. In this chapter she outlines the way in which traumatic experiences impact the community surrounding those that are traumatized. Herman (1992) cites Janoff- Banc as stating that, “traumatic events destroy the victim’s fundamental assumptions about the safety of the world, the positive value of the self, and the meaningful order of creation” (p. 51). This impacts the traumatized person’s ability to start new relationships, trust others, and maintain current long standing relationships and decreases the person’s ability to believe in themselves. This distrust also manifests into distrust of faith and can result in loss of faith completely. Herman (1992) describes a phenomenon of the traumatized person either clinging to or isolating themselves from those around them and the frequency of changing between the two. This is a phenomenon that I am very familiar with due to working with clients that have PTSD (p. 56).

Herman discusses the impact that trauma has on those it touches and the vulnerability that those face that have been traumatized. Herman (1992) states that the “experience of terror and disempowerment during adolescence effectively compromises the three normal adaptive tasks of this stage of life: the formation of identity, the gradual separation from the family of origin, and the exploration of a wider social world” (p. 61). Herman goes on to encourage reconnection and the vast improvements that it has on the traumatized person’s acuity of life prior to the trauma. She addresses the difficulty of rebuilding a sexual relationship due to distrust, triggers, and previous sexual experiences. Herman encourages open communication between sexual partners and the acknowledgement of the previous trauma by the other member of the sexual relationship. Commonly, women who have been raped experience blame for their actions in being raped as well as a shroud of secrecy regarding their rape by those around them not acknowledging it by its name (Herman, 1992, p. 67).

Captivity, the title of Herman’s fourth chapter, addresses the prolonged repeated trauma that those in captivity experience. She highlights the concepts of psychological domination citing the definition of “seasoning” which is “the systematic use of coercive techniques to break women into prostitution” as an example of psychological domination (Herman, 1992, 76). Alongside “seasoning” comes “breaking” whereby the women being isolated, beaten, and conditioned eventually break and become compliant to their abuser. Herman (1992) states that there are two stages to being “ broken,” stating the first one as when the person “ relinquishes her inner autonomy, world view, moral principles, or connection with others for the sake of survival”( p. 85), and the second is when the person loses the want to live. Herman also describes the phenomena of the victim bonding to the perpetrator due to the victim being emotionally bonded to the perpetrator through the traumatic experience.

Herman thoroughly describes throughout the fourth chapter what victims fear, how they are traumatized continually, and the features that epitomize post-traumatic stress disorder, such as hypervigiliance, anxiety, distrust and at times dissociation. She also addresses the somatic symptoms that can manifest such as headaches, abdominal, back, and pelvic pain, and stomach complications (Herman, 1992, p. 86). Herman describes the ways in which victims stay alive in captive situations not by concentrating on how to escape from their captures but making their situation better; many times this involves dissociation. Herman (1992) completes the chapter by discussing the concept of “survivor syndrome” where survivors often identify themselves alternatively to who they were before the trauma and identify as less than human and often this results in suicide (p. 94). Herman (1992) cites a study where out of 100 battered women, 42 had attempted suicide, stating that “the survivor may direct her rage and hatred against herself. Suicidality, which sometimes served as a form of resistance during imprisonment, may persist long after release” (p. 95).

Herman’s fifth chapter focuses on child abuse and ties together Freud’s diagnosis of hysteria with the modern day diagnosis of multiple personality disorder which incorporates sexual dysfunction, depression, suicidality, amnesia, somatic symptoms, and other symptoms (Herman, 1992, p. 97). Herman (1992) makes it clear that children who are victims of sexual abuse often are “silenced by violence” (p. 98), which often results in distrust and paranoia about telling their story for fear of inadvertently causing harm to their families. Herman goes into detail of what child victims endure during their abuse ranging from forced feeding, sleep deprivation, and the increase in bodily alert systems that they learn i.e. knowing the sounds of the footsteps of their abuser.. Children utilize avoidance techniques and what Herman calls doublethink to cope with the abuse, which many times they carry on into their adult lives which carries into their interpersonal skills and ability to form meaningful, trusting relationships with others. Many survivors of abuse begin to self harm as a way to relieve pain. Herman (1992) states that, “the adult survivor is at great risk of repeated victimization in adult life. The risk of rape…is approximately doubled for survivors of childhood sexual abuse” (p. 111).

In chapter six A New Diagnosis, Herman addresses the need for change in the mental health field for diagnosis mislabeling as well as the need for a new way to look at long term trauma. Here Herman introduces her concept of “complex post-traumatic stress disorder” (CPTSD) which includes “prolonged, repeated trauma” (Herman, 1992, p. 119). Herman (1992) outlines the diagnostic underpinnings of CPTSD including;

1. A history of subjection to totalitarian control over a prolonged period ( months to years)

2. Alterations in affect regulation

3. Alternations in consciousness

4. Alterations in self-perception

5. Alterations in perception of perpetrator

6. Alterations in relations with others

7. Alterations in systems of meaning (p. 121).

Herman (1992) states that she is troubled by the diagnoses that victims of trauma receive citing somatization disorder, borderline personality disorder, and multiple personality disorder as three of them (p. 123). Herman reports that she believes that these are negative diagnoses and can result in complications with standard of care with mental health workers and cooperation from family members. Herman (1992) goes on to elaborate about the diagnosis of borderline personality disorder and the qualifying diagnostic traits that they frequently exhibit such as clinging and withdrawing, unstable relationships, and fear of abandonment (p. 124).

In the second section her book, Stages of Recovery, Herman provides an overview of her stage therapy process which includes establishing safety, remembrance and mourning, and reconnection. In Herman’s overview she discusses the importance of each of these in the process of healing from trauma and provides the reader with working examples of how the stages are worked through as well as other stage theories that have come before hers. Herman outlines that the first task of a therapist is to identify the diagnostic markers and to collect as much information about the patient as they can.

Herman (1992) states that “The first principle of recovery is the empowerment of the survivor” (p. 133), which includes establishing safety within the therapeutic relationship and trust among the support systems that the survivor surrounds herself with. Herman recognizes the difficulty that therapists face with working with victims and the stress that it can place on the therapists stating that “the therapist is called upon to bear witness” (Herman, 1992, p. 135) and by being called upon must align him or herself with the victim and the victim’s experience. Herman discusses the challenges that the therapeutic relationship can face such as counter transference and mistrust as well as the challenges that the survivor faces when attempting to establish safety, especially when she continues to be in an unsafe environment at home. Herman(1992) states that in order to combat the feeling of safety which is taken away from victims when they are traumatized, “ the guiding principle of recovery is to restore power and control to the survivor” ( p. 159). In this section of her book, Herman gives many graphic descriptions of what survivors have been through and uses stories from her own patients to illustrate her therapeutic techniques as it relates to real life traumatic experience.

The second stage of recovery, according to Herman, is Remembrance and Mourning. By completing this stage women reconstruct the memory and are able to “transform the traumatic memory, so that it can be integrated into the survivor’s life” (Herman, 1992, p.173). The therapist’s position is that of witness and an advocate for the survivor. Herman states that it is important to incorporate the feelings of safety and empowerment throughout this stage from the first stage of creating a safe therapeutic relationship. Reconstructing the survivor’s story involves reviewing their life story before and after the abuse. The survivor has to discover what the abuse meant to them. Two common techniques for this are “direct exposure” and “flooding” which are both used to overcome the traumatic experience (Herman, 1992, 181). Finally, after this stage is complete the survivor has to decide what they would like to do about the abuse and have to come to “terms with the impossibility of getting even” (Herman, 1992, p. 189).

The next and final step in Herman’s step theory is Reconnection. In taking this step, survivors make new connections, renew old connections, and incorporate their trauma into their everyday lives. Herman (1992) states that there is a need for the survivor to “taste fear” (p. 198) in this stage and learn how to stick up for themselves. By doing so, they are able to begin to self advocate and might even be able to confront their perpetrator. Herman reflects on the deepening of the therapeutic relationship through the reconnection process and states that the patient (or survivor) becomes able to self evaluate and reflect on the improvements she can make on herself. Herman goes on to discuss the importance of group therapy in mourning the traumatic experience and creating greater connections through common experience. In this ending portion she presents the reader with examples of positive group interactions and the benefits it can have towards survivor’s recovery.

I found Judith Herman’s book a refreshing and vivid look into the world of traumatic experience and therapy interactions. Herman was clear on her stage presentation and provided examples of survivors working through the stage as well as complications that she herself experienced while working through the stages with the survivor in the therapy relationship. Herman didn’t allow for lax conversation in her book and presented the reader with vivid, graphic, and sometimes sickening trauma that victims have gone through and the ways in which she was able to help as well as ways that she was not. I was able to connect the body of work that I have read previously to Herman’s stage theory and found hers to be clearer and more precise than many of the other theorists I have read about. Her ability to adapt to the survivor’s individual experience while maintaining the integrity of her stage theory provided me with a clear opinion that she was versatile and wanting to truly assist survivors in the recovery process.


Works Cited

Herman, J. (1992). Trauma and Recovery: The aftermath of violence-from domestic abuse to political terror. New York, NY: Basic Books.

Hopper, J. (1996-2010). Praise, Table of Contents, & Excerpts [Review of the book Trauma and Recovery]. Retrieved from http://www.jimhopper.com/trauma_and_recovery/

Retrieved from: http://en.wikipedia.org/wiki/Judith_Lewis_Herman.

Things I Have Learned From Trauma Survivors

I spend a lot of time talking to trauma survivors and have learned so much from them that I have decided to share.


1. It takes a lot of courage to get needs met. Victims of domestic and sexual violence often feel that they are weak or that they do not deserve to have their needs met. Often, in relationships with caregivers or partners, asking for what they need meant being refused, punished, ignored, invalidated, or abandoned. At times, it may even be difficult to pinpoint exactly what is needed because there is no experience of having a need met.

When a trauma survivor learns to ask for what she needs and is met with a positive response, it can be a life changing for her. A survivor recently told me that she had a medical procedure that due to her childhood abuse could have been extremely traumatic for her. However, she was able to explain to the medical personnel what her needs were in the situation and told them how they could help her through the procedure. The medical staff responded positively and the woman was able to get through the procedure without experiencing flashbacks or nightmares. She felt empowered.

Not all survivors are ready to ask to have their needs met when they first start working with advocates or counselors. It may take small steps and advocates need to be aware that. . . . . .

2. Sometimes survivors use different skills than we would use in order to get their needs met. I often hear service providers use the terms “manipulative,” “resistant,” “defensive,” “adversarial,” or “borderline” to describe trauma survivors. They are often accused of “using the system.” Because of their experiences and the responses that they have received from persons in their past, trauma survivors develop a certain set of skills in order to protect themselves, get what they need, and feel safe. These skills may seem counter-productive or negative in the greater world; however, in the world of ongoing invalidation, abuse, and abandonment that they have lived in, these skills are what have worked for them. And – they have not had the safety or the time to learn the skills that many people would prefer they use. It is similar to asking someone from a country where they do not speak English to start speaking English the moment they arrive. It takes time and safety, trusting relationships, and support to be able to learn the skills that are necessary to get needs met in the larger world. As long as they are expecting to be harmed, they will use the skills they have always used.

3. Telling the story can be scary. We often wonder why a person will call a support line or attend a support group once and then never come back. Sometimes it is because she is afraid that if she tells the story (or now that she has) something bad is going to happen. Many childhood sexual abuse victims were told by her perpetrator that bad things were going to happen to her or her family if she told anyone what was happening. As an adult, this message is still held deep in her being and once she tells the story to a therapist, a support group, or family member she may become frightened that something horrible is now going to happen. Unfortunately, this feeling may be validated by negative responses by family members or re-victimization in the systems that are meant to help. She may feel that all of these bad things that are happening are her fault for telling about the abuse. It may take time for her to be able to open up again or to feel safe walking back into an office or support group.

4. It takes as long as it takes. Many survivors have told me that their family members cannot understand why they just can’t “get over it.” A few women I have spoken to have told me that they have been expected to attend family gatherings where the perpetrator from their childhood is present, live in the same neighborhood where the rape took place, or have been told they need to “forgive and forget.” Being told this can be a form of re-victimization in the form of invalidation of the survivor’s internal experience. Memories live deep in the cells of a person’s body and it cannot be predicted when a feeling, smell, color, or sound will ignite that memory into a flame. Survivors can learn ways to manage the responses that occur in their bodies and maybe even lessen how often they are triggered, but it takes as long as it takes and each person is different. To expect someone to be “over it” is often a way a family member tells someone that they don’t like their behavior which leads to………..

5. Families often behave like crabs in a bucket. If you put one crab in a bucket, it can easily climb up the side of the bucket and get out. If you put a few crabs in a bucket, as soon as one starts to climb up the side the others start to grab on and pull the escaping crab back down to the bottom. It looks like a free for all, with all the crabs pulling each other down. This often happens when one person in a family system is trying to learn new skills to manage her trauma or is making changes to be a healthier human being. One person who is making changes can throw off the whole family system and everyone struggles to bring that person back in line with the family dynamics even when that dynamic has been harmful to everyone involved. Speaking up about abuse, getting clean and sober, getting a higher education, or learning to speak one’s personal truth can often lead to being pulled back into the bucket unless there is plenty of positive support to help climb the side. The survivor may find it easier to go back into the bucket for a while, but as long as there is support available, she may eventually find her way to the top and out of the grasping reach of the dysfunctional system.

NAMI | Dissociative Identity Disorder (formerly Multiple Personality Disorder)

The link below is to an excellent fact sheet about Dissociative Identity Disorder. There has been some disagreement in the mental health community regarding the disorder. However, it is agreed that there are different ego states that arise during periods of stress that seem to have their origins in childhood trauma. These ego states continue to operate into adulthood as a survival/coping mechanism.

NAMI Dissociative Identity Disorder (formerly Multiple Personality Disorder)

The 7 P's of Men's Violence by Michael Kaufman and Why Knowledge of the Impact of Trauma Cannot be Used to Justify Male Violence

I have had a few people mention to me that they are concerned about the possibility of society (and defense attorneys) using knowledge of trauma responses as a way to excuse or justify the behavior of batterers. It is very important that we continue to address the batterer's pattern of asserting power and control in the relationship as primary and recognize the privilege and patriarchal systems that continue to perpetuate this behavior. Michael Kaufman's 1999 paper on The 7 P's of Men's Violence discusses this and provides context to understand how male violence is more involved that just a trauma response.   The link to Dr. Kaufman's blog is below.


The 7 P’s of Men’s Violence

Vicarious Trauma: An Interview with Golie Jansen, Associate Professor, Department of Social Work, Eastern Washington University

From The Research & Advocacy Digest, A Publication of the Washington Coalition of Sexual Assault Programs, 2004

WCSAP: What originally led you to do this research project?

G: During my conversations with therapists who worked with sexual assault survivors, I noticed that they made statements and discussed some behaviors that made me question how the work was affecting them. For instance, I heard about instances of therapists saying they were shopping during every lunch break, needed drinks to relax when they got home or just stated that they were not involved in much of anything. So, I started wondering if they were experiencing vicarious trauma because of their work. I also started to question whether the organization had a responsibility to address some of those negative aspects of sexual assault work with their workers. In reading the literature pertaining to vicarious trauma I wanted to determine whether organizational support made a difference in how it mitigates vicarious trauma. Although there is much literature pertaining to vicarious trauma, there is very little literature on the relationship between organizational support and vicarious trauma, so I set out to conduct a research project on the topic.

WCSAP: Can you describe how you designed your research project?

G: We used two standardized instruments: 1) the Traumatic Stress Institute’s (TSI) Belief Scale and 2) the Measure of Perceived Organizational Support, which measures how satisfied workers are with their organization and their perceptions of support they receive from them. These two measures give us a good idea about the relationship between perceptions of support and whether that support has any influence over how vicariously traumatized they are. We distributed the surveys at WCSAP’s annual conference to a variety of participants, including advocates, educational specialists, managers, community outreach specialists and therapists and had a 40% return rate, which is pretty high.

WCSAP: We know your study is still being analyzed and refined, and will be submitted for formal publication in the near future, but can you tell us what your preliminary findings are?

G: Preliminary findings indicate that participants were definitely experiencing vicarious trauma as a result of this work, but we also are finding that when people perceive their organizations to be supportive, they experience lower levels of vicarious trauma. At this point in the analysis, our hypothesis has been strongly confirmed; this study is leading us to believe in the relationship between organizational support and how much this support can mitigate the severity of vicarious trauma. This information is very much needed because it provides recommendations for organizations on how to manage their programs to mitigate or even prevent the effects of vicarious trauma.

WCSAP: Based on your preliminary findings, what are some recommendations that you would give to sexual assault organizations, their workers and management? What is crucial for them to understand?

G: My recommendations are as follows:

• It is important for organizations to understand their role as the managers of all this and to not place the burden of dealing with it on the individual therapists and advocates.

• Younger, less experienced workers may need more training since we’re finding that they tend to be more vicariously traumatized than more experienced workers.

• Organizations have an obligation to inform and a duty to warn those coming into the field of the potential occupational hazards of the work. This can be done as part of the hiring process so they can make informed choices about whether to continue. Organizations can also set this practice up in their personnel protocols. They should, however, not only stress the hazards, but ways advocates can protect themselves and discuss what the organization will do to help minimize the most negative effects.

• Provide more training on trauma in general to students and sexual assault workers so they are aware of its impact. Universities often don’t emphasize this, which ultimately does a great disservice to those going into the work. Consequently the workers have limited exposure regarding the nature of trauma but then find themselves dealing with extremely traumatized people. This also speaks to the need for more intensive staff development.

WCSAP: Those are great recommendations. Is there anything else you would like to add about this topic?

G: One of the ways that vicarious trauma impacts people is that is affects their worldview, spirituality and sense of identity. Someone may initially be an idealistic person who sees the world as a place where things are fair or where people are basically good. But by doing this work you only work with the atrocities that people tell you. Consequently, you may begin to shift the notion of what your worldview looks like and find yourself becoming more cynical, and the whole idea of hope becomes lost. The question then arises, if I as a therapist or sexual assault advocate lose hope, how can I instill it in people who are most vulnerable? How can I demonstrate that there are ways to address it; that there are antidotes? Also, if we don’t see great success in the work, we may think “I’m a bad therapist” or “I’m a bad advocate.” These are issues that agencies can help workers address. Staff meetings and consultation can help people begin to identify ways they are being affected and develop strategies to deal with them, like fostering self-care routines.

I also want to remind people that even though we hear and see atrocities, it is important to remember that people are doing incredible, beautiful and heroic things out there in the world, every day. You can embrace both the atrocities and the goodness. It’s important to keep a balanced perspective.

I have completed another research project by interviewing 15 sexual assault workers from all over the state. It was amazing to see how those workers who have stayed in this field for ten or more years talked about the joy and satisfaction this work gives them. Many of them said that spirituality now had a big place in their life as a result. In doing this work they gained a deeper understanding of what life is like, what relationships really are and how beautiful the world is. So we also need to begin to talk about post-traumatic growth and how resilient we are. This work can deepen our sense of connection in the world because we can overcome trauma and suffering. However, one won’t come to this place if they don’t address the harmful and hurtful aspects of the work, which ultimately can be damaging to our clients.

Women, Trauma, and Self Blame

When working with female victims of trauma, we often come across women who hold a lot of regret and self blame in regards to their actions. It may not be immediately evident to the advocate working with the mother, however, once the women engages in a relationship with an advocate or other service provider, or has the opportunity to work on her relationship with her children, she may begin to voice a sense of failure, disappointment, loss and grief over the years spent using substances.

According to Dr. Stephanie Covington, an expert in women, trauma and substance abuse; “women are strongly attuned to connections and relationships. Because healthy connections are crucial for women, their psychological problems can be linked to disconnection or violation (Miller, 1976). Women frequently begin to use substances in ways that initially seem to make or maintain connections, in attempts to feel connected, energized, or loved when these feelings are otherwise missing in their lives. They may begin to use alcohol or other drugs to alter themselves to fit the available relationships -- typically, in order to please their male partners. They change themselves to maintain the relationships. Women also use substances to numb the pain of non-mutual, non-empathic, and violent relationships. They may turn to substances to provide what their actual relationships are not providing, such as energy, a sense of power, emotional and physical comfort, and relief from confusion. Addicted women often are paired with men who disappoint them by failing to provide emotional and financial support (including support for their children) and who wind up in jail. These women take solace from their disappointment through drug use. When a woman is disconnected from others (in non-mutual relationships) or involved in abusive or other traumatic relationships, she experiences a “depressive spiral” that includes diminished vitality, disempowerment, confusion, diminished self-worth, and a turning away from relationships (Covington & Surrey, 2000).”

Trauma survivors are well tuned-in to the attitudes and judgments of others and tend to internalize messages they receive from their partner, their family, and society. An abusive partner is likely to have planted the seeds of self blame by accusing her of being a bad wife and mother, weak, or keeps her isolated from any persons or activities who could possibly increase her self esteem or empower her to live a life free from abuse.

Tribal messages from family also impact a women’s view of her self. Due to the experience of trauma she may not be able to live up to the standards of womanhood that were imprinted on her throughout her childhood. She may also be grieving the loss of the dream she had of relationships, marriage and motherhood and blaming herself for her perceived failure in achieving those dreams. Societal expectations also play a large role in reflecting disapproval or failure when a woman does not fulfill her role in a respectable way.

“What is less well understood is the impact of trauma on a woman’s capacity to mother. The wounded mother is often the blamed mother. For many of these women, mothering means struggling to parent your child while at the same time struggling to recover. A history of past trauma can affect how a woman experiences parenting and how effective she is as a parent. There are several major parenting issues for trauma survivors:


• Feelings of shame, guilt, and inadequacy can interfere with parenting.


• Interaction with a child can trigger a mother’s traumatic past.

• The mothers are at risk of becoming overprotective of their children.

• At the other extreme, they may be neglectful in order to avoid being “triggered” by their children.

• Addicted mothers may have been inadequately nurtured themselves. (Covington, 2007).”

In order to assist women in resolving their issues surrounding self blame, it is important to help them learn about and establish strong boundaries. Once they have a sense of how their boundaries were violated by the abuser, they can begin to understand how much responsibility was theirs and how much of the blame has been unjustly placed on them. They can also see the part that the trauma had in their addictions and can be given new choices that help to empower them and move forward. By helping them understand that the choices that they made in the past may have been the best they could do under the circumstances. They may be able to move past the regrets and work towards living a new life without the hindrance of self blame. This takes patience with one’s self and constant reminders about mindfully living in the present.

Trauma survivors tend to judge their past behavior on who they are now instead of being able to see who they were. If their children, partners, family, or society are telling them that they are to blame for their actions women can become disheartened. It is important to remind them that recovery is a journey and that others may not choose to join them and instead remain in a place of blame and regret. By moving forward and looking on the past with compassion, they can begin to heal from wounds of blame and regret and become engaged in new relationships that reinforce the person she is in the here and now.

Resource:

Covington, Stephanie, PhD, LCSW, Working with Substance Abusing Mothers: A Trauma-Informed, Gender-Responsive Approach, A Publication of the National Abandoned Infants Assistance Resource Center, Berkeley, CA (Volume 16, No.1, 2007)