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Stress Responses in Sexual Trauma Victims and in Others
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Contents:
Incidents of Non-Sexual Psychological impact of Multiplicity of stress responses Complex PTSD and DID: Effects PTSD: How Its Symptoms Intrusive Ideation: Too Much Avoidance and Diminished Hyperarousal and Hypervigilance: Self-help strategies for traumatized What Can I Expect After Trauma? What Can I Do and What Should “I Am a Survivor!”: Now, How When Should I Seek “Open Session”: Previewing Searching For A Therapeutically Therapy Power: Transforming Making Essential Healing What Survivors Say They Found Other Desirable Benefits of Most Popular Procedures Used |
INCIDENTS OF SEXUAL ABUSEThough the frequency of child and adult sexual victimization is estimated to be high, when it comes to understanding, assessing, and intervening with these survivors it is important to recognize that each person suffers a unique style and pattern of stress response—in general distress, loss of psychological and physical well-being, and lost of efficiency, self-esteem, and sense of competence in relating to self and world. Generally, rates of childhood sexual abuse (CSA) for females range from 6 to 62% with an estimate of 25% occurring during the childhood years. The National Crime Victimization Survey (NCVS) estimated that 500,000 persons were sexually assaulted in the United States during the period between 1992 and 1993. Of this figure, 28% were attempted rapes, while over 33% were completed sexually traumatizing assaults.1 More recent statistics indicate that in 2001 there were 249,000 victims of rape, attempted rape, or assault. Reporting incestuous experience with father before the age of 18 are 4.5% of women, while 4.9% were abused by their uncles.2 ________________ Sixty-six percent of prostitutes were abused by their father or father figures.3 While one in every six American women have been victims of attempted or completed rapes in their lifetime, on American college campuses one in every five women reported being a rape victim at some time during their lives.4 One in 5 children will be abused by age 18, and 85% of these will be abused by adults they know. According to the National Center for Victims of Crime and Crime Victims Research and treatment Center, an estimated 683,000 women suffer sexual assault (SA) each year, and nearly one third of victims (approximately 211,000) suffer post-traumatic stress disorder (PTSD) at some time in their lives as a result of the crime. Studies reveal that CSA rates for males are 3 to 24% with an estimate of 1 in 10 up to 1 in 6 abused as children. Society adds a particular burden on male rape victims by viewing them as weak and labeling them as cowards and homosexuals. Compared to girls, boys are more likely to be abused by non-family members, such as coaches, priests or ministers, and instructors. Quite characteristic of male sexually abused victims are the emergence of two common stress response solutions, subconsciously organized to manage anxiety and low self-esteem: the substance abuse solution and the violence/abuse perpetrator solution. While the former “solution” represents a self-medicating practice to regulate alterations in brain functions that accompany abuse, the latter often results in the manufacture of new abuse victims. Though less frequent than in males, female victims may also show a tendency to violence and sexual escapades as negative coping patterns. The pervasive post-abuse psychological symptoms that occur in boys may never come to the attention of parents, teachers, or therapists. They are more likely to suffer silently in the aftermath of the abuse, but muted emotional turmoil may take the form of deadly interpersonal violence and victimization of other people. This violence tendency is a psychological defense against abuse-related feelings of humiliation, degradation, anxiety, shame, low self-esteem, and a vanquished sense of masculine identity. INCIDENTS OF NON-SEXUAL PSYCHOLOGICAL TRAUMAAt some point in their lives, an estimated 7.8 percent of Americans will experience PTSD. Women are twice as likely as men to develop the disorder. About 3.6 percent of U.S. adults aged 18 to 54 have PTSD during the course of a given year. Reporting at least one traumatic event were 60.7% of men and 51.2% of women.5 In terms of gender differential in traumatic suffering, PTSD for men is chiefly associated with combat exposure, childhood neglect, and childhood physical abuse, while for women PTSD is associated with rape, sexual molestation, physical attack, being threatened with a weapon, and childhood physical abuse.6 Over half of all male Vietnam veterans and almost half of all female veterans have experienced serious symptoms of war stress. The lifetime prevalence of PTSD has been estimated among American Vietnam theater veterans is 30.9 for men and 26.9 for women. Additionally, 15.2 percent of all male Vietnam theater veterans and 8.1 percent of all female Vietnam theater veterans were “current cases” of PTSD back in 1988.7 More than half of all male Vietnam veterans and almost half of all female Vietnam veterans have experienced serious stress symptoms. Some estimates of PTSD among Gulf War veterans is as high as 8 percent. PSYCHOLOGICAL IMPACT OF CHILDHOOD SEXUAL ABUSE, ADULT SEXUAL ASSAULT, AND OTHER TRAUMASStudies and clinical experience reveal that CSA victims are more likely to suffer severe mental illness, along with impulsive behavior, violence, suspiciousness, hostility,8 depression, anxiety, PTSD, borderline personality disorder, and self-destructive behavior. Women with sexual abuse histories were more likely than non-abused women to experience their sexual encounters with much less friendliness and more negative affect (i.e., hostility). These women were found to have almost three times as many sexual partners, as well as engaging in high-risk sexual practices when compared with women without a child sexual abuse history.9 Depending on the age of the person at the time of the trauma, adult patterns of sexual trauma symptoms differ significantly (e.g., trauma in early childhood vs. at the adolescent years, etc.).10 Child sexual abuse and assault victims of both genders often respond with numbing of emotions, and avoidance of feelings, people, places, and circumstances that may trigger horrific remembrance. They experience, moreover, memory problems, and high levels of anxiety. Also, many reexperience aspects of the abuse in waking and sleeping states, and go through the sense of being dazed or “spaced out,” feeling as if perceptions of self and world are dreamlike or illusory. Trauma prevalence studies have consistently found high rates of PTSD among survivors of rape and physical assault. In a desperate attempt to cope with the onslaught of intrusive thoughts, depression, sense of helplessness, and high levels of hyperarousal, rape victims were found to be 13.4 times more likely to have a serious alcohol problem, and are 26 times more likely to have a serious drug abuse problem.11 MULTIPLICITY OF STRESS RESPONSES AND LIFELINE EFFECTS AND ALTERATIONSThere are three types of psychological responses associated with sexual abuse or assault—normal, pathological, and growth-enhancing. Normal responses occur after overwhelming events, and often recede into the background in a very short period of time. However, some responses may persist, making it more difficult for the survivor to conduct his or her day-to-day routines. In this case, the unresolved stress responses adversely affect the person’s mind and body. These problematic reactions often result in behavioral and attitudinal patterns that interfere with survivors’ ability to use the blueprint (or innate potentialities) of their pre-trauma lives. These normal responses become pathological when they persist for several weeks or months after the event and, instead of working through to completion or integration remain a pernicious psychological and biological influence on mind and body. The traumatic experience tend to distort each stage of the lifeline—childhood, adolescence, adulthood, middleessence, and senescence (or the senior years). Some responses and symptoms of this almost radical personality alteration are seen in the following response tendencies in victims:
(2) Traumatic sexualization (disturbance in sexual desire and functioning—either hypersex or sex avoidant). (3) Eating disorders. (4) Self-harming behavior. (5) Avoidance as a way of life—of thoughts, feelings, place, conversations, and taking action. (6) Flashbacks to the sexual trauma event. (7) Pervasive sense of vulnerability. (8) Sense of inner fragmentation and dissociation. (9) Sense of betrayal. (10) “Holding in” anger. (11) Pervasive sense of helplessness. (12) Low ambition. (13) Disturbance of memory—too much (hypermnesia), too little or non-existent (amnesia). (14) Concentration and attending difficulties. (15) Futurelessness. (16) Powerlessness. (17) Disturbed ideals. (18) Sense of hopelessness. (19) Pervasive relational disturbance. (20) Self-stigmatization. (21) “Sitting duck” behavior that leads to revictimization. (22) Pervasive sense of personal defilement. (23) Amnesia. (24) Distrust as a way of life—in relating to self (not trusting one’s own body, thoughts, feelings, and actions). (25) Self-blaming. (26) Self-despising. (27) Low self-esteem. Complex PTSD and DID: Effects of Extreme, Prolonged TraumaEarly childhood trauma shatters the victim’s identity system, resulting in three major outcomes characterized by disorders of extreme stress (“Complex PTSD” also known as “Disorders of Extreme Stress” [DES]),12 dissociative identity disorder (DID), and post-traumatic stress disorder (PTSD).13 DES occurs when the victim is exposed to “extreme, repetitive trauma”14-15 The stress responses associated with DES include a highly negative view of self as damaged with weak regulatory controls over the tendency to emotional reactivity in relation to anger, guilt, shame, and other emotions. Additionally, survivors experience self-destructive tendencies, as in suicidal thoughts, and self-mutilative behaviors (e.g., self abuse seen in wrist-cutting), seen chiefly in sexual trauma survivors, and in adrenergic “living-on-the-edge,” self-destructive, risk-taking behavior in war veterans. Survivors of sexual trauma also suffer distressing physical symptoms and medical conditions, poor social functioning, experiencing the “spaced out” feeling of being “unreal.” These difficulties often chip away at rational decision-making and general sense of well-being. Further complicating the chances of making positive forward movement in life, is the survivor’s problematic meaning system (e.g., absence of hope, lack of capacity for forgiveness, crushed religious faith, and distorted beliefs about self and others). Severe early childhood abuse often results in the fragmenting of the identity system into DID, in which there is an absence of inner coherence among “the working parts of the self” (thinking, feeling, action, and the body’s sensory system). In this disorder, the survivor experiences various “personalities,” isolated into distinct, compartmentalized identities that fail to share information with each other. In the past this disorder was known as “multiple personality disorder.” PTSD: How Its Symptoms Undermine the Sense of Competence
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While intrusive ideation leads to a lifestyle of hiding from life itself through persistent disengagement from self and world, the development of avoidance and numbing over time lead to human developmental arrests due to diminished awareness. This occurs when the survivor misses out in being exposed to the available diversity of stimuli from people, environmental features, situations, and certain events.
PTSD sufferers experience a reduction in awareness and avoid feelings, shutting down the self so the warmth or fire of emotions is replaced by cold numbness and emotional distancing. When this symptom goes on for a long time it can undermine the person’s capacity to express emotions, give and receive love, communicate with others on the emotional level, and even being able to experience truly safe relationships as safe, fulfilling, and trustworthy. Numbing and avoidance are observed in the use of alcohol, drugs, hyper-work, hyper-sex, and other exaggerated behavioral patterns.
When what happened to the survivor cannot be integrated into his or her experiential system. The individual may also feel unable to relax due to irritability and constantly feeling as though she or he is under threat of the return of dissociated terror of the original trauma. The body is constantly on alert to prevent any further “trauma/terrorism” from occurring again. Arousal involves becoming suddenly irritable, distrustful of the environment and people, and finding it difficult to focus and concentrate on things or attend to matters of importance. The constant feeling of danger as a consequence of PTSD puts distance between survivor and loved one, between friends, fellow employees, and between one’s church and community.
Unable to modulate anger and anxiety, the victim, in order to cope with trauma-based anxiety, may choose to drink alcohol excessively, use street drugs, or abuse prescription drugs. Many survivors find these practices are maladaptive and compound their problems as time goes on. Panic attacks are also reported among survivors of sexual traumatization.
In order to ensure you do all you can to facilitate the healing process after sexual victimization, here are a few actions you can take to help yourself, children, and family restore individual and collective psychological well being and sense of coherence.
Do engage in meaningful hobbies, finding fun things to do.
Do put forth the effort to engage in regular physical exercise and relaxation procedures.
Do plan to eat well.
Do get sufficient rest.
Do learn how to reduce the “flightiness” (or being out of control) of your breathing.
Do things to normalize your life and its routines by having meals, sleep, work, and exercise at the same time of the day.
Do make a diligent effort to remain free of alcohol or drug use as ways of coping.
(16) Resist eating heavy meals, drinking coffee, and intense physical exercise several hours before going to sleep.
(17) Resist using anger to keep others away, as a “trauma technique” to remain safe from questions, safe from others’ piercing scrutiny, and from feeling vulnerable to the return of dissociated trauma thoughts, feelings, and behaviors.
(18) Resist tendency to stay away from people, and from shopping malls, activities, and places you were accustomed to before the assault.
(19) Resist tendency to make home into a defending fortress.
(20) Resist making sweeping changes in your life at this time; for example, like moving away, changing careers, getting divorce, or dissolving long-term relationships—until, as they say, further notice.
(21) Do remember that intrusive thoughts to the trauma are normal and predictable.
(22) Do remember that your trauma intrusive thoughts are mere constructions of the mind; they are not real. That is, the recurring image or thought of the trauma does not mean the original traumatizing experience is reoccurring in the present as your mind-out-of-control would have you believe.
(23) Do seek and get new knowledge about trauma and PTSD’s effect on your thinking, feelings, behavior, and on your perspective for the future. Knowledge is power, and information is truly how you get it. So, it’s also important for you to learn all you can about what happened to you, about your stress responses, and what you can expect whether you decide to deal with our ordeal alone, with friends, or by using professional assistance.
(24) Resist the tendency among victims to use alcohol and drug to reduce anxiety and get sleep.
(25) Since trauma responses take you away from the present, telling you that, despite the fact that you know the trauma is behind you, that, “in reality”, it’s still reoccurring in the present:
| Do use relaxation skills.
Do use all your senses to ground you in the present. Thus, Visually, focus on the color of objects in your immediate environment (“it’s green,” “long and sharp,” etc.). Keep your eyes open, and take note of where you are. Auditorily, do focus on identifying the various sounds you’re hearing at the present time. Tactilely, do touch objects close to you and describe the experience in detail. Touch something cold, warm, or hot and describe the sensory experience. Olfactorily, do become aware of the various smells in your immediate environment. Gustatorily, do think back at something you recently tasted, or select something to eat and describe the taste. Do use self-soothing approaches: Talk to your self in a reassuring language, reminding your self of who you are, where you are, and where you’re going. Say compassionate things to your self. Think of the last time someone said something that you found inspiring, and repeat it to yourself, now. Remember your favorite poem and recite it. |
(27) Resist becoming a workaholic to stave off memories of the trauma. “I Am a Survivor!”: Now, How and When Do I Tell My Children
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| (1) nightmares, (2) broken sleep, (3) amnesia (concerning the event), (4) experiencing anxiety when in or around unfamiliar places, (5) discomfort with new people, (6) experiencing difficult in doing multiple tasks at the same time, (7) experiencing difficulty in maintaining focus on one task at a time until completion, (8) struggle to stay in the present, (9) loss of peace, (10) perpetual sense of having to look over one’s shoulder, (11) not being sure of one’s feelings, with no clear sense of happiness or sadness; (12) not being sure what would restore happiness again, (13) at times afraid people will not understand one’s behavior, (14) feeling as though no one can possible understand what one is going through, (15) problem in communicating with others, (16) difficulty in expressing one’s feelings and thoughts, (17) feeling alone when people are near, even loved ones, (18) distrust of others, especially of men, (19) cannot make eye contact with men, being forced to look toward the ground, (20) decrease in sexual desire, (21) tendency to overeating, and (22) tendency to sabotage positive efforts to improve one’s life. |
| In the group treatment setting, the therapist and members listen to each other tell the tales of their own traumatic stress-related experiences and stress responses mentioned above. More often, survivors feel empty, disconnected, passive, and helpless. They search for a safe place with safety-engendering people who offer respect, and believability (pertaining to her or his narrative about what happened). The sense of being accepted despite the feeling of being “tainted” by violence and “feeling irredeemably unclean,” is a major early achievement of the group. The therapist serves as a healing-integrative bridge. This bridge is over troubled waters of internal traumatic torment and avoidant non-relating—traversing across the world of overwhelming abuse on one end, and the world of safety and health on the other.
Group therapy is frequently used as a healing strategy with survivors of sexual victimization. The group-as-a-whole organizes itself around intense conscious and unconscious perceptions, making available to its members opportunities to process negative relations, painful emotions, and fears associated with the sexual traumatic experience. The group works because it is able to construct a safe space, allows each member to experience self in a different way—in the presence of others, provide a powerful “gallery of mirrors” for survivor to see themselves in others’ reflection. This achievement in the group often results in diminished avoidance, fear, and anxiety, and with increased sense of confidence and competence in interpersonal transactions. Here’s an important caveat we want to mention. Just as all individual therapy experiences are not alike, group therapy experiences are also not alike. By this we mean that not all groups will meet your needs. This is in part because groups my have potentially destructive overt or covert agendas that may not prove in the long run to offer the effective treatment victims feel is essential for dealing with their trauma problems. Some sexual trauma groups that do not work well for its members are those that focus exclusively on: the “badness” of all perpetrators, or on the “goodness” of all victims. The problem with the former focus is that group members get an unrealistic, one-sided view of the interpersonal world. Men are discussed in such a manner as to inadvertently reinforce within the minds of women victims that all men “are potential rapists/abusers”, and that they should thus be on guard around men. This orientation renders havoc on victims’ contemporary intimate relationships. As time goes on, session after session, this negative agenda harms the healing process, deepening avoidance of intimate contact and desire, as well as potentially negative emotions like anger and resentment. Focusing on the exclusive goodness of victims is also harmful, because, in the real world, people have both good and bad “parts.” When one is emphasized as passionately preferred over the other (rather than striving for the integration of the two), the trauma cannot be integrated toward resolution, and become consolidated around the center of the person’s identity and personality. Any untoward process that harms integration, essentially, fails to deal with anger, rage, dishonoring, transgression, and violation. These emphases or group agendas represent an undifferentiated perspective—seeing all men as “villains and potential victimizers,” or all survivors as “true victims, passive, ineffectual.” Dr. Judith Herman of Harvard Medical School speaks on why the group works for trauma survivors, and on the importance of safety-maintenance in group therapy as a precondition for establishing goals, boundaries, reassurance, bonding, individual empowerment, and communal sharing. Maintaining that each trauma group creates its own collective meaning that contributes to the healing potential of the group, she writes, in her renown contribution to the trauma field, Trauma and Recovery, “The psychologist Erwin Parson … invokes the metaphor of the platoon to convey the tight organization of the group: ‘The leader must be able to establish meaningful structure, laying out the group’s goal (mission), and the particular terrain (emotional) to be traversed.’”16 Additionally, the therapist presents self to the survivor as someone with whom it is possible to have a relationship, while demonstrating a capacity and credibility to provide essential safety. The therapist also ensures a balance is achieved over time between revealing/exposing (the survivor to traumatic memories and traumatizing relationships) and growth-enhancing (ensures not only getting over the trauma but achieving increase regulation to better manage memory, emotions, and behavior). The therapist is experienced by the survivors as a good, empathic listener, who is non-judgmental, honest, one who offers the survivor essential tools and corrective experience to enhance the feeling of being competent within, and empowered with an easiness and facility in relating to and being with people. Survivors’ relief often begins with the assurance they’ve found someone who is competent and able to make a difference in their lives. Therapy Power: Transforming Emotion-Based Surviving Into
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Therapy makes it possible, moreover, for survivors, once overcome by the trauma, experienced their own muted voices that were unable to find the language to utter their pain in a manner it would be understood by others. Survivors often cannot find a consensually validated language to tell their narrative. Victims need to testify because they’ve been tested, and have something of value to say to the world. Therapy helps here as well: the victim always has a story to be told, and must be told to someone, sometime, to one who is experienced as trustworthy, supportive, with a facilitating presence. Survivors thus find it essential to be able to tell their own narrative as a healing strategy. Another important healing strategy after sexual victimization is acquiring the capacity to love one’s self. Traumatized women learn how to love themselves—a difficult feat after trauma.
MOST POPULAR PROCEDURES USED BY TRAUMA EXPERTS WITH
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| (A) Cognitive Therapy (CT). Here the survivor learns to change irrational, distorting beliefs that maintain and reinforce traumatic distress by weighing the evidence and then using reality-based alternatives. This technique will help you to become aware of and ultimately control your automatic thoughts and how they maintain trauma-based thinking, feelings, and behavior. (B) Anxiety Management (AM). This procedure consists of a wide variety of techniques—relaxation training, breathing retraining, positive self-talk, thought stopping (distracts distressing thoughts), and assertiveness training (making one’s wishes and preferences known in an interpersonally adaptive manner). (C) Acceptance and Commitment Therapy (ACT). Called “ACT” (as opposed to “A-C-T”), this type of behavioral treatment approach begins with the fundamental observation that human beings find it inordinately difficult to be happy, and that the pervasiveness of human suffering is seen the multiplicity of DSM system diagnoses and research findings on such maladies as suicide, high rates of divorce, sexual abuse, and violence. The technology and theory of ACT focus on “functional contextualism”—a focus on the whole event, understanding of the function of the event within a context, and a pragmatic truth criterion.26 In ACT behavioral change occurs when the individual accepts the painful private events associated with the trauma rather than resist them (this form of control is said to be the problem). Acceptance is viewed as a conscious decision on the part of the trauma survivor to abandon a change agenda that has not worked, and to “experience events fully … without defense … as they are.”27, p. 30 In terms of trauma treatment, ACT uses the concept of experiential avoidance to highlight the critical problem that has to be addressed in traumatherapy. Acceptance is the alternative to the futility of emotional avoidance. Acceptance ultimately helps the survivor contain private trauma events in a dispassionate manner that gives support to resolution. Here the individual chooses “being willing” over “feeling willing.” ACT employs a variety of concepts such as (1) “creative hopelessness” by which the person realizes the futility of prior efforts in dealing with his or her problems, (2) “control of private events as the problem” in that such efforts serve a barriers to successful effort, (3) “I as content vs. I as context” by which in part the self is differentiated from negative trauma programming, (4) “letting go of the struggle,” and (5) “making a commitment to action” that fulfills the individual’s chosen values and goals. (D) Systematic Desensitization (SD). This technique will help you to replace anxiety with the relaxation response. (E) Stress Inoculation Training (SIT). This technique will help you learn a number of coping techniques in order to provide you with the critical sense of mastery, to include opportunities to practice the skills in a graduated manner. SIT would be tailored to meet your individual needs directly. (F) Exposure Therapy (ET). Here you are assisted in the very important recovery task of confronting memories, emotions, objects, people, places, and things that are associated with the intense fear you feel. You would be expected to repeatedly go over the traumatic emotions and memories until the once fear-inducing memory no longer evokes fear and anxiety. (G) Cognitive Processing Therapy (CPT). These techniques focus on thinking and feeling processes associated with the trauma, and ameliorates anxiety by deconditioning troublesome thoughts, feelings, and memories of the trauma. You would be asked to write your own narrative or autobiographical sketch and so learn to gain control the degree of re-exposure. |
| (3) The Counting Method. The Counting Method (TCM) is a trauma therapeutic technique devised by Frank M. Ochberg, M.D. to prevent or modulate traumatic memory and associated dysphoric mood, to include terror, fear, and helplessness. It was also designed to enhance trauma victims’ ability to learn how to master the emotional stress responses and disordered behavioral manifestations of trauma. Organized within a larger domain of clinical interventions called Post-Traumatic Therapy, TCM features a relative short history of outstanding results with trauma victims. The therapist counts out loud to 100, while the survivor focuses on and relives a haunting memory and experience associated emotions. There therapeutic action or mechanism of TCM is said to be the linking of problematic, distressing memories with the therapist’s voice and to the experience of the therapeutic partnership, offering integrative reassurance, trust, and capacity to persist in memory work. TCM features some elements of EMDR (to be discussed below), in that it pairs the therapist’s activity with unwanted traumatic memories, while fostering relaxation during remembering, and tolerating intense emotions as key therapeutic devices.28 (4) EMDR (Eye Movement Desensitization and Reprocessing). This approach integrates a number of treatment techniques, to include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies. In the therapy the survivor is instructed to focus on past and present experiences while simultaneously focusing on an external stimulus. Organized in eight phases, EMDR incorporates an understanding of trauma history, teaching relaxation skills, identifying vivid images associated with trauma memories, a negative belief about the self, and related bodily sensations and related emotions, a preferred positive belief is identified. Therapist then asks the survivor to focus on the image, negative thought, and body sensations, while moving his or her head following the therapist’s fingers move across the field of vision for 20 to 30 seconds or more. This procedure is repeated several times during the session. The therapist then engages in closure, requesting the survivor keep a trauma journal, and continues doing calmative techniques. At the last phase, the treatment process is re-evaluated and progress noted.29 (5) Drug Treatment (Psychopharmacology). There a number of medications physicians informed in the area of traumatic stress can offer you. Many doctors use the SSRIs (Selective Serotonin Reuptake Inhibitors) as preferred choice in treating PTSD. Among these agents are: Zoloft, Paxil, Prozac, Luvox, Serzone, and Effexor. Other medications to help survivors of sexual victimization with PTSD include tricyclic antidepressants (like Elavil), but the side effects makes them less preferable to the SSRIs. The clinical decision in terms of which services, procedures, and techniques are best suited to meet your needs is made by mental health providers who are experts in the study and treatment of PTSD and associated psychological conditions. The approaches chosen may differ from one provider to another, from one survivor to another, depending on the age, specific trauma symptoms, and degree of impairment. Professional trauma therapists understand that each survivor in therapy is unique, that all rape or incest survivors are not alike, despite the impression given by many writers in contemporary trauma literature. People in therapy for sexual trauma are distinguished from one another by their unique trauma histories, by their unique personalities and coping choices, and by differing pre-trauma, post-trauma, social, political, and economic experiences. Experienced sexual trauma therapist understand that survivors may be “repeaters” due to a prolonged period of acute symptoms, exacerbation by both intrapsychic and environmental memory-activators. Many leave treatment prematurely before the deeper clinical concerns are explored and addressed. This, in our experience, may be due to survivors’ low tolerance from strong affective generated during the normal course of memory processing. In some instances, the survivor’s persistent presentation of acute symptomatology is due to mini-retraumatizing experiences which prevent underlying stress response processes from being worked through to completion and integration.
Copyright 2004. Dr. Erwin R. Parson Erwin R. Parson, (1943-2006) Ph.D., A.B.P.P. was a Diplomate in Psychology, a Master Clinician and Trauma Treatment Technology Developer for over 20 years. Having worked in the area of administration of trauma programs, Dr. Parson also worked in the direct treatment of trauma adult and child victims. He was the author of dozens of articles and book chapters in the area of trauma, ethnicity, and healing.
Read Dr. Erwin R. Parson's other articles on GFW http://www.giftfromwithin.org/html/articles.html Victims of Disasters: Helping People Recover From Acute Distress to Healing and Integration
ONLINE RESOURCES:Gift From Within (www.giftfromwithin.org)
BOOKS ON SEXUAL TRAUMA AND HEALING:From Child Sexual Abuse to Adult Sexual Risk: Trauma, Revictimization, and Intervention, by Linda J. Koenig, Lynda Doll, and Ann O’Leary. Broken Boys/Mending Men: Recovery from Childhood Sexual Abuse, by Stephen D. Grubman-Black. The Courage to Heal: A Guide for Women Survivors of Child Sexual Abuse, by Ellen Bass, Laura Davis. I Never Told Anyone: Writings by Women Survivors of Child Sexual Abuse, by Ellen Bass, Louise Horton. I Cant Talk About It: A Child’s Book About Child Abuse, by Graci Evans, Doris E. Sanford. Male Survivors of Rape or Sexual Assault, by John La Valle.
REFERENCES:1Ackerman, P. Newton, J. McPherson, W, Jones, J. & Dykman, R. (1998). Prevalence of Post-Traumatic Stress Disorder and Other Psychiatric diagnoses in three groups of Abused Children (Sexual, Physical, and Both). Child Abuse & Neglect, 22, 759-774. 2Crewsdon, J. (1988). By Silence Betrayed. Boston: Little Brown, 1988). 3Silbert, M. (1984). Treatment of Prostitution Victims of Sexual Abuse. Irving Stuart and Joanne Greer (Eds.). Victims of Sexual Aggression. Ed. Irving Stuart and Joanne Greer, van Nostrand Reinhold, 1984). 4National Crime Victims Survey. Bureau of Justice Statistics, U.S. Department of Justice, 1999. 7National Vietnam Veterans Readjustment Study (NVVRS). 8National Crime Victims Survey. Bureau of Justice Statistics, U.S. Department of Justice, 2000. 9Schloredt, K. & Heiman, J. (2003). Perceptions of Sexuality as Related to Sexual Functioning and Sexual Risk in Women with Different Types of Childhood Abuse Histories. Journal of Traumatic Stress, 16, 275-284). 10Shahar, G., Chinman, M., Sells, D., & Davidson, L. (2003). An Action Model of Socially Disruptive Behaviors Committed by Persons with Severe Mental Illness: The Role of Self-Reported Childhood Abuse and Suspiciousness-Hostility. Psychiatry, 66, 42-52. 11National Center for Victims and Crime Victims Research and Treatment Center (1992). Rape in America: A report to the Nation. Arlington, VA: National Center of Crime. 12Ro th, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F. (1997). Complex PTSD in Victims Exposed to Sexual and Physical Abuse. Journal of Traumatic Stress, 10, 539-555. 13American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Washington, DC: American Psychiatric Association. 14-15Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F. (1997). Complex PTSD in Victims Exposed to Sexual and Physical Abuse. Journal of Traumatic Stress, 10, 539-555. Herman, J. (1992). Trauma and Recovery. New York: Basic Books; Parson, E, R. (1988). Post-Traumatic Self Disorders (PTsfD). In J. Wilson, Z. Harel, & B Kahana (Eds.). Human Adaptation to Extreme Stress (pp. 245-283). New York: Plenum. 16Herman, J. (1992). Trauma and Recovery. New York: Basic 17,18Lazarus, R. & Folkman, S. (1984). Stress, Appraisal, and Coping. New York: Springer). 19Brand, B. & Alexander, P. (2003). Coping with Incest: The Relationship Between Recollections of Childhood Coping and Adult Functioning in Female Survivors of Incest. Journal of Traumatic Stress, 16, 285-293). 20Figley, C.R. Compassion Fatigue: Secondary Traumatic Stress Disorders in Those Who Treat the Traumatized. 21Saakvitne, K. Transforming the Pain. New York: Norton. 22Tedeschi, R. & Calhoun, L. (1995). Trauma and Transformation Growing in the Suffering. Thousand Oaks: CA: Sage. 23Frazier, P., Conlon, A., Tashiro, T., & Sass, S. (2004). Search for Meaning in the New Millennium. 24Parson, E. R. (1996, March). "Sexual Trauma: On Cognitive Miscalculation, Affective Misalignment, Memory, Dissociation, and Attachment. A Masters Class Conducted at the Second Annual Conference on Trauma, Loss, & Dissociation: Foundations of 21st Century Traumatology, Georgetown University Medical Center & Kairos Ventures II, Ltd. 25Janet, P. (1889). L’Automatisme Psycholoqique. Paris: Alcan. 26Hayes, S. & Batten, S. Acceptance and Commitment Therapy. European Psychotherapy. 27Hayes, S. (1994). Content, Context, and the Types of Psychological Acceptance. In S.C. Hayes, N. S. Jacobson, V. M. Follette, & M. J. Dougher (Eds.), Acceptance and Change: Content and Context in Psychotherapy (pp. 53-67). Reno, NV: Context Press; Hayes, S., & Batten, S. (1999). Acceptance and Commitment Therapy, European Psychotherapy: Reference. (or multiple references). 28 Frank Ochberg on Post-Traumatic Therapy: The Counting Method. Camden, ME: Varied Directions and Gift From Within. http://www.giftfromwithin.org/html/counting.html 29Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures (2nd ed.). New York: Guilford Press. 30Foa, E., Davidson, J. & Frances, A. (1999). The Expert Consensus Guideline Series: Treatment of Post-Traumatic Stress Disorder (1999). Journal of Clinical Psychiatry, 60, (Supplement 16). 31Friedman, M. (2000). Post-Traumatic Stress Disorder: Latest Assessment and Treatment Strategies. Compact Clinicals. 32Parson, E. R. (1998). Traumatic Stress Personality Disorders (TrSPD), Part III: Mental/Physical Trauma Representations—From Focus on PTSD Symptoms to Inquiry into Who the Victim Has Now Become. Journal of Contemporary Psychotherapy, 28, 141-171.
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