CJ 520 Violence and Trauma Blog
After reading Shelly Rambo’s Spirit and Trauma (2010), I have been reading about spirituality and trauma, especially in terms of spiritual care’s effect on mental health. One of the studies I read compiles some research showing spirituality is related to various improvements and resiliencies in mental health. The protective function of spirituality is measured in decreased in negative mood, a greater sense of personal growth and resolution of interpersonal violence “by mediating pathways of hope and self-acceptance,” decreased depressive symptoms, decreased suicidal thoughts and behaviors, decreased substance abuse behaviors, “increased psychological well-being including life satisfaction, positive affect, and higher morale” (Hipolito et al, 2014). Spirituality is “empowering,” they declare. Empowerment from a trauma-informed perspective “reflects people’s ability to successfully access the skills and resources needed to effectively cope and grow in the post-trauma period (Johnson, Worell, & Chandler, 2005)” (Hipolito et al, 2014).
The problem is that there’s not a lot of research as to how “spirituality influences well-being in the post-trauma period” (Hipolito et al, 2014). I wondered this myself. It sounds nice to say that spirituality helps, but how does it help? There are various theories and measures of spiritual fitness, often referencing connection to transcendence, morality, and an increased ability to construct hope. The Encyclopedia of Trauma: An Interdisciplinary Guide describes the five components of spiritual intelligence as “the capacity to transcend the physical and material, the ability to experience heightened states of consciousness, the ability to sanctify the everyday experience, the ability to use spiritual resources to solve problems, and the capacity to be virtuous” (Figley, 2012).
In the study I’m referencing here, they measured participants’ spirituality by their responses to questions like, “How often do you pray?” and their perception of the “transcendent (God, the divine) in daily life by reviewing statements like, “A feeling of deep inner peace or harmony (Hipolito et al, 2014). Both the Encyclopedia’s definition and the study’s way of analyzing spirituality are problematic however. First, they seem explicitly biased toward Christian spirituality. Can we compare Buddhist meditation, Muslim salah, and praying a Catholic rosary? Is the mere act of commitment to prayer the beneficial part or is there something intrinsic to the type of prayer that is beneficial? Furthermore, they qualify the perception of the transcendent in terms of experiences of “peace” and “harmony,” which just sounds like an extremely limited understanding of transcendent experiences.
It just seems clear that the frameworks have been designed ahead of the research. There are numerous models for spiritual assessment, but I don’t know of any that are specifically related to mental health outcomes. First it seems necessary to research the influence of spirituality on specific mental health issues (e.g., moral injury, depression, anxiety, PTSD, etc.), rather than broadly to mental health. Second, we need to find ways of assessing why prayer and meditation are effective so that spiritual caregivers can know what sorts of spiritual practices to encourage.
All of this will be extremely useful for chaplains creating a spiritual care plan. Once the spiritual assessment has been made, the chaplain needs to decide how to best support this person, and this needs to come from a place of peer-reviewed research that is also trauma informed.
An example of trauma informed spiritual care would be resisting the urge to ask the careseeker to retell their trauma history. Part of being a chaplain is offering a non-judgmental presence, and this presence may encourage a person to open-up. The chaplain may unknowingly encourage a survivor to re-tell their story and may unwittingly re-traumatize them. Chaplains may also encourage patients to close their eyes or they my try to hold their hand while praying, unaware that this might be an unsafe physical action for them.
All to say, it is encouraging that spirituality is correlated with resilience and improvements in mental health, but there is much research to be done. We need to know what aspects of or what types of spirituality are most effective, assess why they are effective, and then use that data combined with trauma informed care in order to provide chaplains the most effective form of spiritual assessment and care planning.
Figley, C., & Ebrary. provider. (2012). Encyclopedia of trauma an interdisciplinary guide (Gale virtual reference library). Thousand Oaks, Calif.: SAGE.
Hipolito, E., Samuels-Dennis, J., Shanmuganandapala, B., Maddoux, J., Paulson, R., Saugh, D., & Carnahan, B. (2014). Trauma-Informed Care: Accounting for the Interconnected Role of Spirituality and Empowerment in Mental Health Promotion. Journal of Spirituality in Mental Health, 16(3), 193-217.
Rambo, S. (2010). Spirit and trauma : A theology of remaining (1st ed.). Louisville, Ky.: Westminster John Knox Press.
My junior year of college my best friend went through a series of difficult events and sicknesses which eventually triggered and lead to the uncovering of suppressed childhood trauma. I still remember the night that she had her first painful and fully embodied flash back. Following that night, she had fairly severe PTSD. I remember driving to therapy sessions with her and her boyfriend—now husband. We would sit in the waiting room during her sessions and then afterward the therapist would invite us in to teach us different strategies to intervene in helpful ways during difficult flashbacks and nightmares. We learned grounding techniques and breath practices, and I am forever thankful for that experience. I am additionally thankful that my friend trusted me to walk through that journey with her. She is still my dearest friend.
The reason I mention that is because—though she never fully recovered the details of her trauma— the trauma she experienced took the shape of repeated abused by a woman close to her, though not a family member. During some of her more difficult flash backs I was unable to sit near her or touch her in any way because it sent her into further panic. It took many weeks of therapy and yoga for her to begin to feel safe in her own body again, and to feel comfortable with another female touching her. It was difficult not being able to hug my best friend; not being able to rub her back or hold her hand when she couldn't catch her breath.
After one of my friend’s therapy sessions the therapist talked to me and mentioned that my friend wanted to begin to work on experiencing safe touch again, and because she trusted me she wanted me to enter into that work with her. The therapist gave me some articles on abuse survivors and the recovery to trusting touch again, but she also pointed me in the direction of a method that has fascinated me ever since. She told me about a massage therapy certification program called Trauma Touch Therapy. Though the program is still only offered at a select number of schools around the country, I was fascinated by the literature around it. The program website states that the program itself is “designed to train massage therapists to work at an advanced level with individuals who have experienced trauma and abuse” (http://www.csha.net/advanced/trauma.html).
Though I am not a licensed massage therapist—which is a requirement for the further Trauma Touch licensing—I became extremely interested in the fact that there were methods outside of the confines of the talk-therapist’s office or the pharmacy for dealing with PTSD. At this point in my education I was very unfamiliar with trauma and had not studied it at all. The concept of trauma being stored in the body as we have read in Bessel van der Kolk (Van Der Kolk 2014) was absolutely revolutionary to me. One article that I first encountered says, “People who have been traumatized are no longer at home in their bodies. Talk therapy alone does not always adequately address the fear and mistrust that has been encoded into their bodies. In a multidisciplinary context, massage therapy can help bring clients back into themselves by increasing their ability to feel safety and mastery in the world, to be freely curious without fear, to feel comfortable with their body, and to experience boundaried intimacy with another human being.” (Dryden 2000)
I still hope to someday (hopefully soon) become a licensed massage therapist and become certified in Trauma Touch therapy. Though my friend and I were able to walk through her PTSD journey in different ways and recover her sense of embodiment and non-threatening touch, Trauma Touch therapy is a skill that I would love to have to be able to legally extend that healing to many more people.
Dryden, T., M.ED.,R.M.T. (2000, March 21). Recovering Body and Soul from Post-Traumatic
Stress Disorder. Retrieved April 21, 2017, from https://www.amtamassage.org/articles/3/MTJ/detail/1817
Van Der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of
Trauma. NY, NY: Penguin Books.
Studies have proven that severe mental health problems are more closely related to emotional abuse than physical abuse because emotional abuse is often times not taken as seriously because of its relative “invisibility” in comparison to physical abuse, resulting in delay in recognition and action (Rees 2009). This is reflected in the low political priority in developing prevention and intervention programs for emotional abuse, and the lack of funds allocated for resources and training (Rees 2009). In this way, the inadequate methods for providing children with resources to cope with emotional abuse, are seen to contribute to its longevity and permanency in affecting the lives of at least a quarter of American children. The most important aspect of treatment for children that have experienced emotional abuse is its timely start, because of the magnitude of long term effects of trauma that can develop. In The Body Keeps Score Bessel van der Kolk (2014) proposes that “child abuse’s overall costs exceed those of cancer or heart disease” and that “eradicating child abuse in America would reduce the overall rate of depression by more than half, alcoholism by two-thirds, and suicide, IV drug use, and domestic violence by three quarters” (pg. 150). As the number of ACEs increases so does an individual’s overall healthcare utilization, which makes federally funded insurance policies and private insurance policies more expensive to maintain, eventually resulting in increased tax rates for all (Felitti, & Anda, 1998). In addition, when early intervention techniques are facilitated it leads to an overall healthier environment that encourages positive relationships in society.
Psychological maltreatment is considered a form of abuse on its own but it also often stems from other forms of maltreatment such as neglect, physical abuse, and sexual abuse. When children grow up in a home where their parents are aggressive or incompetent, the psychological abuse that they experience puts them at risk for a myriad of consequences as they mature. There is a strong correlation between the frequency, severity, and proximity of the trauma and the health risk behavior and disease risk in later adulthood. One of the largest conclusive studies about child abuse and neglect and later life health and wellbeing was conducted in Southern California in 1995. This investigation measured the amount of adverse childhood experiences (ACEs) in participants lives. The scores that participants got in three categories: abuse, household challenges, and neglect, represents their cumulative childhood stress. As the number of ACEs goes up so does the risk for substance abuse, depression, heart disease, financial stress, risk for intimate partner violence, risk for sexual violence, poor academic achievement, and many more health related difficulties (Felitti & Anda, 1998). Data collected from this study shows that almost two thirds of participants reported at least one ACE and more than one in five reported three or more ACEs. This shows that although it is fairly common for children to have adverse experiences growing up, their long term effect is determined by the child’s supports and resiliency (Felitti & Anda, 1998).
When a child experiences a traumatic event the overstimulation of their autonomic nervous system can trigger permanent changes in the development of their neural pathways and cause chronic dysregulation of their endocrine systems which alters the epigenetic profile of their DNA. Further, the repeated activation of the hypothalamic- pituitary- adrenal axis (HPA axis) decreases neurogenesis, and therefore decreases the brain’s neuroplasticity, or ability to repair itself (Kiyimba, 2016). The repeated activation of the HPA brought on by childhood stress also elicits pro-inflammatory tendencies which result in the etiology of many chronic diseases. When the stress occurs at such a crucial point in development, the childhood, it begins to dictate how certain body systems develop, notably the immune cells of the body. By allowing children to experience traumatic stress so young and not providing prevention efforts, the government is in effect perpetuating this cycle of abuse twofold, since it becomes engrained in their genes and will be passed down through generations in their DNA and in the way they parent their future children (Kiyimba, 2016).
Trauma- Focused Cognitive Behavioral Therapy (TF-CBT) combines many theoretical approaches, including family systems, development theory, attachment theory, and client- centered therapy as a means of support for children after experiencing trauma and has been proven as the strongest evidence based treatment (Timmer & Urquiza, 2014). TF- CBT is structured, short- term, components based treatment which involves the child and their non-offending caregivers, this form of therapy is thought to relive some of the negative impact of the emotional abuse, as well as improve parenting skills, parental support, and decrease parental distress. Including non offending caregivers in this therapy has its foundation in attachment theory, since parents have such a large influence in providing support and a safe environment for their child, it is important that they are included in the healing process. TF- CBT’s main goal is to provide the child with the appropriate skills and cognitive processes to begin to live a productive life after experiencing trauma (Toth & Manly, 2011).
Following a traumatic event, children develop negative associations for things they experience at the time of the trauma, so they are often afraid when they think of the abuse, so they avoid thinking about it. While this may seem effective at the time, prolonged avoidance of the trauma will make its emotional impact even larger (Reece & Hanson, 2014). Through TF-CBT a therapist can gradually expose children to reminders of the trauma they experience so they can slowly disassemble how they are feeling and cope with the trauma without being re-traumatized. There is strong support for this model of therapy and as more research is done it can be modified to provide further benefits for children and families affected by emotional abuse.
Overall, the most effective forms of intervention are the ones that involved a variety of professionals all working together to help the child. A therapist would be the first step to uncover the depth of the trauma and recommend further treatment. A psychiatrist or pediatrician could prescribe medications if behaviors are severe enough. Social workers can help the family move forward and access appropriate support (Timmer & Urquiza, 2014). Having many different professionals working together as a team allows comprehensive treatment for the child, in hopes to rehabilitate them in all aspects of their lives. When pediatric primary care physicians are able to develop professional and meaningful relationships with the parents of their patients they are able to gain greater insight to the etiology of their health conditions and provide resources and support when necessary.
Community based prevention programs are becoming more widespread as politicians and educators are realizing that children who have experienced emotional abuse, or are currently experiencing it, require support and guidance from all spheres of their life. Communities That Care (CTC) is a prevention program designed to be implemented in the community to reduce mental, emotional, and behavioral problems that result from any challenges that children may face in their childhood (Salazar et al., 2014). This program identifies risk factors for each individual child such as family conflict, early behavioral problems, and delinquency. By identifying these factors as early as possible, it is likely to decrease the long- term effects of emotional abuse. In order to make this program as effective as possible, it was designed with a high level of collaboration with the child welfare system and other leaders in the community where it is implemented. Studies have shown that prevention programs based in the community tend to have the most positive effect because of the high degree of support. Before Communities That Care can be implemented more widely more trials need to be performed to assure its effectiveness and the proper training of leaders (Salazar et al., 2014).
Felitti, V. J., Anda, R. F., Nordenberg, D, et. al (1998). Relationship of Childhood Abuse and Household Dysfunction to Many Leading Causes of Death in Adulthood. American Journal of Preventative Medicine, 14(4), 245-258. Retrieved April 17, 2017.
Kiyimba, N. (2016). Developmental trauma and the role of epigenetics. Healthcare Counseling & Psychotherapy Journal, 16(4), 18-21.
Reece, R. M., & Hanson, R. F. (Eds.). (2014). Treatment of Child Abuse: Common Ground for Mental Health, Medical, and Legal Practitioners (2nd Edition). Johns Hopkins University Press. Retrieved April 17, 2017.
Rees, C. (2009). Understanding Emotional Abuse. Archives of Disease in Childhood, 95(1) 59-67. Retrieved April 17, 2017.
Salazar A, Haggerty K, Lansing M, et al (2014). Using communities that care for community child maltreatment prevention. American Journal Of Orthopsychiatry, 86(2):144-155. Retrieved April 14, 2017.
Sterling, J., & Amaya- Jackson, L. (2008). Understanding Behavioral and Emotional Consequences of child abuse. Pediatrics, 122, 3rd ser., 667-673. Retrieved April 16, 2017.
Timmer, S., & Urquiza, A. J. (2014). Evidence-based approaches for the treatment of maltreated children: Considering core components and treatment effectiveness. Dordrecht, NY: Springer. Retrieved April 14, 2017.
Toth, S. L., & Manly, J. T. (2011). Bridging research and practice: Challenges and successes in implementing evidence- based preventative intervention strategies for child maltreatment. Child Abuse and Neglect, 35(8), 633-636. Retrieved April 14, 2017.
Van der Kolk, B., (2014). What's love got to do with it? In The body keeps score: the brain, mind, and body in the healing of trauma (pp. 139-170). New York City, NY: Penguin Books.
In one of my previous discussion posts, I briefly mentioned Richard Hoffman's memoir, Half the House. The book's intention was not to discuss the trauma Hoffman suffered from in his early life, but rather to tell a story about a family. Throughout his memoir, you pick up on multiple traumas he suffered in his childhood which would later cause him to suffer from depression, anxiety and substance abuse issues. I believe that each of the traumas Hoffman suffered from allowed for more trauma to occur. For example, his father was abusive to him and his brothers - often coming home angered and intoxicated and beating the boys for things they could not control. Additionally, a few years later, two of his younger brothers (one who was his best friend) were diagnosed with and dying from muscular dystrophy. His mother devoted the remainder of her life two his dying brothers and Richard was essentially left to fend for himself. He shortly found himself in the hands of his football coach, who continuously manipulated, raped and abused Hoffman at the young age of ten. It is known that child molesters tend to target children who do not have a stable life at home and who are likely in need of attention. These children will not want to tell their family of the abuse that has occurred as they have enough to worry about in the first place. Though unintentional, Hoffman's life story is an excellent example of how children fall subject to these kinds of abuses and traumas. In his collegiate years, Richard Hoffman began abusing alcohol; however, not the same alcohol abuse expected of most college kids. Hoffman wasn't binge drinking at parties to hang out and socialize with friends. Instead he was binge drinking and doing drugs to block out his early life experiences. He soon became an alcoholic and experiences episodes of suicidal thoughts and attempts.
Hoffman's memoir and life story is an important reminder of why we need to be careful and cautious when dealing with the lives of children. Young individuals who face difficulties like substance abuse and physical abuse may be more at risk to later suffering from other traumatic experiences. They become more susceptible to others kinds of abuse and often slip through the cracks. It is important for school teachers and professionals to keep up to date with young students and assure that they are doing okay both at school and at home. Additionally, it is essential that children have someone they are comfortable with to disclose certain information to so that they don't bottle up their emotions and cause additional damages to their psyche. Young children are in their prime developmental stages when such abuses take place, and if there is not an outlet for them to release the occurred trauma, they will only suffer even more down the line.
I highly suggest everyone read Richard Hoffman's memoir if you have an opportunity to. It is a short and easy yet excellent read. I was fortunate enough to have Richard Hoffman as a guest speaker in one of my classes and he is an even more incredible man in person. He is also a wonderful example, today, of how survivors of trauma can overcome their experiences and create a life worth living. Today he is sober, has a wife and two children, and is an amazing author and poet. Trauma will only kill a person if they allow it to, and Hoffman is proof that it does not need to and people can eventually move past their experiences.
Hoffman, R. (2015). Half the house: 2015 anniversary edition. Moorhead, MN: New Rivers Press.
In reviewing topics for this blog, I engaged a much younger audience in the conversation about gender and identity. Born in the late 1960s I can’t say that the issue of name calling has never come up. I would like to think that we dealt with it differently and that we outgrew the pain and confusion it caused. However, in preparing this blog I found that this was not the case. My understanding of how traumatic the issue of name calling and verbal abuse was for men, women and children was truly limited.
When did this topic get so complicated? Or did I get stuck in the mud as the world moved by me? Growing up I often heard the rhyme “sticks and stones may break my bones but names would never hurt me” this is the foundation that name calling in my social circle would be built on. When did it all change? Did my generation just ignore the pain experienced by those being verbally assaulted? Did global crises create a more conscious and sensitive society?
Child and Adolescent Trauma
Dr. Rousseau (2017) describes trauma as “an inescapably stressful event that overwhelms people’s existing coping mechanisms”. This fits my understanding of that old nursery rhyme, “sticks and stones”. As a young man, I could escape the name calling by one of two options 1) return the name calling with another just as demeaning or 2) just walk away saying “sticks and stones ….”. That event, as stressful as it appeared never developed into something that was inescapable.
In a presentation by Lynn Smithwick (2017) the topic of child and adolescent trauma was discussed. An example was provided from the National Association of State Mental Health Program Directors defining trauma as “the experience of violence and victimization including sexual abuse, physical abuse, severe neglect, loss, domestic violence and/or the witnessing of violence, terrorism or disasters” (Smithwick, 2017). Are today’s children being exposed to more trauma than ever before? Have the events of September 11, 2001 impacted our current young adult population to the point that name calling and bullying has reached its boiling point? Did this overwhelming and tragic event exceed our coping mechanisms? For many it indeed appears to have changed their outlook on life, others have become numb to the violence and terrorism.
Trauma can occur by being exposed to several events. Among them are disasters, witnessing violence and/or emotional abuse (Smithwick, 2017). These events and the experiences can occur in a single event or over a period. Most importantly trauma is not something that discriminates it affects and impacts people from all walks of life and income levels.
Has identity and self-expression become a source of traumatic experience for individuals? Across college campuses there is an effort to change the way we use and choose our words for self-identification. To take it one step further there are efforts to create a non-gender based form of thinking. Boston University added a gender-neutral housing option for upper-class students beginning in the fall 2013. Salem State University has created a gender inclusive housing process for students. Each example is geared toward creating a more tolerant and accepting environment.
The gender identity and gender expression process I would imagine can be a source of stress for those that feel out of place with the societal expression of self and for those that are required to learn a new form of expression. The website www.mypronouns.org offers a new look into self-identity using personal pronouns. For example, there are additional sets of pronouns that some people might use (e.g. ze/zir, per/pers, ey/em, xe/xem, etc.). I would like to incorporate a more gender-neutral form of expression, however it is very stressful trying to understand the process.
Sticks and stones may break my bones but names are now confusing me....
Rousseau, PhD. LMHC, D. (2017). Violence and Trauma [PowerPoint slides]. Retrieved from lecture notes.
Smithwick, L. (2017) Child and Adolescent Trauma [PowerPoint slides]. Retrieved from lecture notes.