I am a member of the international network of healthcare professionals and scientists devoted to the understanding and treatment of the effects of trauma on human beings. The rapidly expanding body of theoretical work, research, and clinical training focused on trauma has powerfully influenced my practice.
Traumatic events have different effects depending on whether they happen to a child or to an adult, and depending on whether the trauma consists of a single event or a continuous experience over time. We have identified a number of risk factors that increase a person’s odds of developing Posttraumatic Stress Disorder after a traumatic incident. These factors include aspects of the event, such as intensity, aspects of the person, including previous trauma history, and the quality of support provided by his or her family and community. Trauma seems to have a cumulative effect so that people who have been through multiple traumatic events in their lifetime are at greater risk of developing psychological problems after an additional incident. People who have experienced multiple kinds of abuse or neglect as children have greatly increased odds of developing a wide range of mental and physical health as adults.
Single Traumatic Incidents: Depression and PTSD
Most adults recover completely from single traumatic incidents. People who do develop posttraumatic psychological disorders are about as likely to be diagnosed with depression as with PTSD, and of those diagnosed with PTSD, many also have depression. We now know that depression is actually the most common aftereffect of a traumatic experience.
Psychological treatments for reactions to single events integrate techniques drawn from most of the established schools of therapy. There is particularly strong evidence for the effectiveness of cognitive behavioral therapy in treating trauma-related depression, anxiety, and decreased self-esteem. Trauma therapy can also include the use of meditation, hypnosis and breath regulation to calm the mind and body.
Sustained Stress and Complex PTSD
When people are subjected to prolonged and repeated trauma, especially when the trauma results from intentional interpersonal violence, they can develop complex, persistent psychological and physical symptoms. Examples of sustained trauma include the wartime experiences of soldiers, POWs, and civilians living in the combat zone. Other examples include being held hostage, or being abducted and sexually assaulted. Sustained trauma can cause survivors to lose some of their ability to think and to feel their emotions in a normal way. Their personalities and inner experience may be changed to the point that they cannot remember or connect with their previous sense of themselves. Their feelings about life and other people may become detached and indifferent, and their previous religious beliefs may be rejected. Trauma specialists refer to these long-term effects as “Complex PTSD” or “Disorders of Extreme Stress.”
Child Abuse Trauma
Child abuse by family members is one of the most destructive kinds of sustained trauma, because children are still developing neurologically and psychologically. They generally cannot escape their abusers, and many do not even choose to do so, because the abusers may be loved family members upon whom the victims are dependent. Subtle kinds of emotional abuse and inappropriate adult behaviors can be as harmful to children as the more obvious forms of domestic violence. Emotional abuse is also more difficult to identify or describe when victims try to communicate their experience to potential helpers, either in childhood or in later years.
Familial child abuse also differs from other kinds of trauma in that family members may ignore the abuse, minimize its importance, or regard it as normal. As a result, abused children tend to become confused about the accuracy of their perceptions and memories, and the appropriateness of their emotional reactions to the abuse. When the therapist inquires about childhood experiences, adult clients often deny or minimize mistreatment by family members and dismiss its role in causing current emotional and interpersonal problems.
Therapy for adults abused or abandoned as children is an intensive process requiring a substantial commitment of time and effort by both the therapist and the client. The good news is that recent progress in the field of trauma therapy offers new hope.Sarah K. Pinches, Ph.D.
People explore in therapy how their childhood experiences shaped their views of themselves and other people. They often express surprise that they are re-experiencing incidents from their childhood in their current relationships with other people. Over time, survivors can change their images of themselves as helpless child victims into images of themselves as empowered, valued adults.
In my work with child abuse survivors I use techniques developed within the psychoanalytic tradition of psychotherapy as well as those developed within the cognitive-behavioral school. I have recently become interested in therapeutic approaches that focus on the “parts” within each person, especially Richard Schwartz’s Internal Family Systems Therapy. I also integrate hypnosis, meditation and guided relaxation training into my work with people who have experienced childhood trauma.