Violence Unsilenced: Trauma and Bearing Witness

One thing I love about the Blogosphere is encountering sites and projects that inspire me and further my thinking about trauma and healing.  In the midst of my recently discussed  musings regarding connections, I discovered a new site that addresses the ideas of community support and witnessing: Violence Unsilenced. Part of what is damaging about abuse is the sense of isolation, of being cut off from and different from others.  The reality is that abuse is in fact a far too common experience and survivors may gain a sense of connection and further their healing by reclaiming their voices and telling their stories.  Keeping the secret of abuse only furthers the agendas of abusers.

To have a witness to the horrors that were once secret can be empowering.  I see myself as a therapist as serving in that witness role. Connecting to a larger survivor community can help too. The internet offers opportunities for survivors to connect in all sorts of new ways.  A caveat: as with in-person disclosure, it is important to work on making informed choices about who/which sites to trust.  Please be sure to check out sights/sources/online communities.  Run them by your therapist or get references from others you trust.

Violence Unsilenced has created a site where survivors of domestic violence and sexual assault can tell their stories in the context of an online community that bears witness and pledges to listen.

Read their mission in their own words:

This blog was created with the sole intention of shedding light on the epidemics of domestic violence and sexual assault by giving their survivors a voice. I believe one of the last hurdles to eradicating abuse is the culture of silence and shame that exists yet today. I believe that you have people in your life that are being abused, you just don’t realize it. I believe victims are led to believe they are alone, that no one will believe them, and that people will think less of them. I believe every situation is complicated and unique. I believe that every single survivor of abuse is different from his or her comrades, and that by sharing stories here we can educate the public as to just how pervasive domestic violence and sexual assault is, and how it crosses all cultural, racial, gender, sexual orientation, and socioeconomic lines. I believe this is society’s collective problem, not simply a problem of those directly impacted. I believe there are 70 million blogs out there, and that one in four women will experience abuse in her lifetime. I believe we who are active in the blogosphere have a responsibility to listen to our friends and to spread the word, so that we can strip abusers of this critical power.

Please keep in mind that reading the stories of others may be very triggering for survivors, so check in with yourself before and after.  If you have a dissociative disorder (like DID), think about how to check in with all parts of you, or make choices about which parts of you will view such information.

You can submit your story and/0r  take the pledge to support trauma survivors.

What do you think?

Would it further your healing to share your story with others?

Do you feel able to be a witness to the abuse stories of others?

Do you think that is important?

Why or why not?

Kathleen Young, Psy.D.

Trauma and Invisible Illness

Many mental health issues can be invisible illnesses. Anxiety, depression, post traumatic stress disorder (PTSD), dissociative disorders are examples of conditions that may not be seen by many in the sufferers life, or if some symptoms are identified they may be misattributed to other causes. For example, how many depressed people have encountered the hurtful myth that they are just “lazy” or unmotivated? And if the conditions themselves are not seen, the causes can be even more misunderstood. I have written about how often traumatic experiences underlie many mental health conditions, not just PTSD. There is also research to suggest that some chronic physical illnesses and symptoms may be associated with childhood trauma.

Trauma impacts many and has further reaching consequences than is usually understood. Kessler et al. (1995) found that 60% of men and 51% of women in the general population reported at least one traumatic event at some time in their lives. Almost 17% of men and 13% of women who had some trauma exposure had actually experienced more than three such events. As a therapist, I expect that most people seeking help will have experienced some sort of trauma in their lives.

What follows is an overview. Every individual is different and context can intensify or ameliorate the impact a traumatic event will have. Do you have a support system? Was your family relatively healthy and able to meet your emotional needs? Was this one in a series of traumatic events? Were you able to talk about it and receive help right away? All these factors and more play a role. “Approximately 73% of individuals exposed to a traumatic incident will experience dissociative states during the incident or in the hours, days, and weeks following…However, for most of those people these dissociative incidents will subside on their own within a few weeks after the traumatic incident subsides”. -International Society for the Study of Trauma and Dissociation

Sometimes traumatic events lead to a particular constellations of reactions and symptoms that are called Post Traumatic Stress Disorder (PTSD). This is defined as and recognized as caused by a traumatic event. It is my understanding that the impact of trauma is even broader than commonly understood and is also a component underlying many psychological diagnoses.

Reactions to a traumatic event may include any or all of the following:

• Anxiety
• Eating Disturbances
• Sleep Disturbances
• Sexual Dysfunction
• Low energy
• Chronic, unexplained pain
• Depression, spontaneous crying, despair, and hopelessness
• Memory Disturbance
• Panic Attacks
• Fearfulness
• Compulsive and Impulsive Behaviors
• Irritability, angry outbursts
• Emotional numbness

In my practice I understand many diagnostic categories as trauma related and best seen as complex trauma aftermath. Especially when we take into account the breadth of traumatic experiences (big T and little t) it becomes clearer that things like anxiety, panic attacks, depression, substance abuse, compulsive behaviors, eating disorders , dissociative disorders and personality disorders can all be related to trauma. Individuals with complex trauma histories are also often misdiagnosed! Just a couple of examples: some children diagnosed with ADHD may actually be dealing with unresolved trauma and research shows that people with Dissociative Disorders spend an average of seven years in the mental health system before getting the correct diagnosis.

Without the awareness of the role that trauma plays, standard approaches to mental heath and substance abuse treatment and other human services may re-traumatize individuals who have experienced violence. This can interfere with getting useful treatment of even lead to giving up on seeking help at all!

Our culture continues to stigmatize mental health issues and has difficulty recognizing the pervasiveness of trauma. Emotional disorders and issues are often still considered somehow less valid than physical illnesses. In reality our emotional and physical selves are connected and impact each other. Individuals suffering from any chronic illness or condition deserve appropriate treatment, understanding and respect. Speaking plainly and factually about mental health issues such as anxiety, depression and PTSD hopefully will help those impacted feel able to recognize these issues within themselves. Recognition and visibility is the first step. We cannot address what we cannot see.

Kathleen Young, Psy.D.

Forgiveness and Trauma: Are Some Things Unforgivable?

Forgiveness is often a complex issue for trauma survivors.  Many times clients arrive in my office grappling with the belief that they “ought” to forgive those who have abused and betrayed them.  Sometimes they even see their difficulty accomplishing this as further proof that something is wrong with them. Or sometimes clients report having already forgiven an abuser, but seem to have perhaps skipped over part of their process in the rush to do so.  Our culture is full of messages about the benefits of forgiveness. Religions and pop psychology alike stress its importance, sometimes to the point of threatening dire emotional (or spiritual) consequences unless one forgives.

Forgiveness is universally believed to be good for us, it seems. But it isn’t always clear exactly how it is accomplished. Or if there are exceptions. True to our culture’s love of all or nothing thinking, the alternative to forgiveness is framed as a complete negative.  For example, a quick Google search turns up this claim from the Mayo Clinic:

When someone you care about hurts you, you can hold on to anger, resentment and thoughts of revenge or embrace forgiveness and move forward.

Must it be that black or white?

Is healing without forgiveness possible?

Are there some harms that are unforgivable?

In thinking about these questions I consider how forgiveness is or is not the same for survivors of severe trauma. What happens when the very people who are supposed to love, care for, and protect you are the ones who instead abuse you? What happens when this abuse is ongoing or appears to be done with ill intent? If betrayal and violation in the context of our closest connections has a different impact, surely forgiveness may be a different thing in these situations.

In my process of thinking about forgiveness, I suddenly seem to come across discussion of it everywhere! Isn’t it something how that can happen?

I came upon this post at Blooming Lotus (just one of several excellent posts about forgiveness after abuse): How to Forgive an Abuser after Child Abuse. I really liked the expanded concept of what forgiveness can look like, the focus on allowing room for exploration of feelings about the abuse/betrayal and the focus on forgiving oneself.  From there I also discovered Heal and Forgive by Nancy Richards. Both sites are incredibly rich and worth exploring in depth.

Reading these sites  reminded me of a book I own but have not looked at in quite a while: Forgiving and Not Forgiving: Why Sometimes It’s Better Not To Forgive by Jeanne Safer, Ph.D. I was drawn to this book many years ago while contemplating these same questions. The premise of this exploration of forgiveness in intimate relationships is that it can be equally valid and healthy for some individuals to choose not to forgive.

Forgiving and Not Forgiving proposes a paradigm shift. It challenges the conventional wisdom and offers a new and consoling perspective: that forgiveness as it is commonly understood is only one of many routes to resolution, humanity and peace, and that reengaging with the past is the best way to change to future. It charges that false forgiveness damages self and society, and that not forgiving without vindictiveness can be morally and emotionally right. (p.2)

Reengaging with the past is the best way to change to future- what does this mean? I see this at the root of all trauma therapy. The unexamined and sometimes unremembered past continues to influence us all. It is in fact sometimes most powerfully driving our behavior and choices when we have not examined and come to terms with it.  By bringing the past out into the light, especially in the context of a current safe relationship, transformation can happen.

Dr. Safer focuses on “intimate betrayal” vs. damage done by strangers stating:

Intimate betrayal requires a special kind of forgiveness…betrayal destroys faith in love, trust, and honor. Betrayers have no regard for the impact of their actions on victims they know intimately, even those they love. This disregard is especially devastating, because it confronts you with the knowledge that at least for a time, you did not matter at all to someone who mattered deeply to you (p.43)

This is the crux of the matter for trauma survivors.  How do you come to terms with abuse and betrayal at the hands of a loved one, a spouse, partner, parent or other trusted figure. Part of the wounding is to your very ability to trust and believe in relationships and safety.  How can you forgive someone who has done such profound damage to you and your life?

How do we even define forgiveness? Too often it gets used in ways that seem to mean excusing or forgetting the wrong in order to reconcile with the abuser.  For individuals who have already had the experience of putting their needs, feelings, very safety on the back burner in relationships with abusive others this could just feel like more of the same. This version of forgiveness becomes just another way to deny or overlook  normal reactions to mistreatment or injustice.  Dr. Safer  suggests a broader perspective on what forgiveness can entail:

any state of mind that enables a person to reconnect psychically with a betrayer and to change the meaning and impact of the trauma, even if considerable anger remains.

Some approaches to forgiveness seem to lump all wrongs into the same category. For example, I found yet another forgiveness article:  Four Elements of Forgiveness by Ryan Howes, Ph.D.  In it he breaks forgiveness into the following steps:

A. Express the emotion

B. Understand why

C. Rebuild safety

4. Let go

I like the steps.  It reminds me very much of the process Dr. Safer describes as the sort of therapeutic work that is necessary to achieve genuine forgiveness rather than the forced, automatic forgiving because you have to variety. This is the “reconnecting psychically with a betrayer” work. “Let go” or letting go is often used as synonymous with forgiveness. I resonate with it as it seems much less value-laden, less loaded.

However, this article loses me with its example of a nearly unforgivable offense (although I imagine this was meant in jest). Returning someone’s car in bad condition is light years away from the types of violations and betrayals clients of mine struggle to forgive. I also very much believe forgiveness is a process you can accomplish yourself, it does not necessitate any interaction with the abuser. Perhaps that is an example of why so many mainstream approaches to and discussions of forgiveness fall short of the mark to me.

Like every therapeutic issue, I believe that forgiveness is highly personal and individual. I fully support clients in coming to terms with what makes sense in their lives. I think it is important to ask yourself why you feel the need to forgive? Is your motivation external? Is it a “should” coming at you from others or something that is important to your internal process? Is it a part of making meaning from the abuse or an attempt to side step delving into it more fully? Dr. Safe identifies a type of “false forgiveness” that can be damaging rather than healing.

Sometimes the right option for you as an individual may be to choose to not forgive. This may be temporary. Perhaps you will not forgive while your healing is still in progress, while you have yet to fully explore all feelings and the meaning associated with the abuse, or when your personal safety has not yer been re-established.  If you have a dissociative disorder, parts of you may differ greatly on whether to forgive an abuser or not. Gathering and assessing the reasons behind the different views is a crucial part of the decision making process.

Not forgiving can be the outcome of deep emotional work and careful consideration. It can be the right outcome for some to further their healing and make sense of the world.  Not forgiving can be an act of opposing injustice: a way of taking a stand even within yourself and saying this occurred and it was wrong. Period.

It can also be an acknowledgement that there is no way, for you, to reconnect positively, even within your mind  with your abuser. For some the damage is too pervasive. The toxicity too great. There is not always something positive to reclaim and reconcile with. There can be a peace in even this devastating realization. It can be freeing. The abuse and hatred of abuser no longer dominate your life. You do not hold yourself accountable or buy into illusion that if you were different/did something different you could change the other or the relationship.

Forgiveness or unforgiveness can also be partial. This can come in the form of the painful realization that the type of connection you wish for is not possible or that your self or life is not fully accepted (so often the case for LGBT individuals). Holding onto this complexity and ambivalence, that the people we love and choose to continue to relate to have and continue to wound us, is painful but real. Many parent are loving and flawed.  Some people find a resolution that allows for connecting to the good and letting go of the toxic.

However this is not always the case. What about children who experience severe and comprehensive emotional, physical and sexual abuse? Sometimes there is not a positive side to a relationship. Sometimes the level of betrayal and damage is so severe there is nothing positive left. This can be true in adult intimate  relationships as well, but is especially devastating in childhood when the need to love, connect with and depend upon a caretaker is paramount. To find a way to heal, forgive oneself and let go of what is toxic may be the optimal tasks.

Any of the following may be a valid and healing approach for you in coming to terms with the aftermath of abuse and betrayal:

• Forgiveness
• Partial forgiveness
• Understanding but not forgiving
• Letting go of bitterness and hatred
• Active unforgiveness

Making peace with yourself, your past and creating the type of life you desire in the future can occur whether you forgive your abusers or not. That you reach a resolution that makes sense for you matter more than the form it takes. Perhaps this is the most important thing to take away: focus on your healing first. Reconnect with the past, forgive and learn how to provide safety for yourself. Once you have healed sufficiently I trust you will know what needs to happen next in terms of forgiving others or not.

Kathleen Young, Psy.D.

Staying Present During Trauma Therapy: Grounding Techniques

Working through trauma can be scary, painful, and potentially overwhelming. Very often people who have experienced trauma have coped at least in part through some degree of dissociation. While this was necessary for your survival then, continued dissociation (especially forms that are not within your control) is not adaptive once the abuse has stopped. Now the task of therapy is to help you stay present long enough to learn other means of establishing safety in the present. How does someone with automatic survival skills of dissociation learn to do this? Grounding is one skill that can help.

Trauma therapy does not only consist of telling your story or focusing on traumatic memories, though of course that is a crucial part of the work. Bringing trauma memories to mind, talking about them in a trusting relationship, and developing the capacities for managing them while staying present in the moment are all crucial parts of the healing process. A premature emphasis on traumatic material can in fact do more harm than good. Many trauma survivors may first need to learn and practice a variety of self-care skills that you can then employ during the memory work phase of therapy.

In the past, trauma survivors were encouraged to speak about their abuse in the belief that this catharsis would be healing. Sometimes this instead led to re-traumatization rather than mastery of the material or healing. In fact, some trauma survivors are able to tell their stories easily, but in a dissociated manner. Because of the risks involved, this healing work is best done with the help of an experienced trauma specialist who can help you learn techniques to cope with memories effectively. One goal of trauma therapy is to help you connect to the past while staying in the present.

More recent trauma therapies have focused on a stage approach, which includes early preparation, focus on developing coping skills and stabilization. Judith Herman, in Trauma and Recovery, states that the central task of the first phase of therapy must be safety. How can you experience this if you do not even feel safe within yourself, but at the risk of uncontrolled flashbacks? In fact, for many trauma survivors it may have felt that there were only two choices available to them historically: abuse or dissociation. Learning grounding skills so that you can be present enough to develop a whole range of self-care strategies is crucial.

What do therapists mean when we talk about grounding?

Grounding is about learning to stay present (or for some get present in the first place) in your body in the here and now. Basically it consists of a set of skills/tools to help you manage dissociation and the overwhelming trauma-related emotions that lead to it. Processing done from a very dissociated state is not useful in trauma work. Neither is the goal to be so overwhelmed by feelings that you feel re-traumatized. Once you are present, you also need to learn other means of managing the feelings and thoughts associated with traumatic memories.

Every one is different. Different grounding techniques will work for different people. The following are some general categories and ideas. Exploring the pros and cons of various approaches with your therapist can be useful.

-Grounding often takes the form of focusing on the present by tuning into it via all your senses. For example, one technique could involve focusing on a sound you hear right now, a physical sensation (what is the texture of the chair you are sitting on, for example?) and/or something you see. Describe each in as much detail as possible.

-Diaphragmatic or deep breathing: Trauma survivors often hold their breath or breathe very shallowly. This in turn deprives you of oxygen which can make anxiety more intense. Stopping and focusing on deepening and slowing your breathing can bring you back to the moment.

-Relaxation, guided imagery or hypnotherapy techniques- folks with dissociative disorders are engaging in a form of self-hypnosis much of the time. The trouble is, it is out of your control! Some trauma therapists are also trained in hypnosis and can help teach you how to use dissociation in a way that works for you. For example: you can develop a safe container for traumatic material between sessions, create a safe or comfortable place (“safe” may not be a concept some survivors can relate to or may be triggering to some) 0r learn ways to turn down the “volume” of painful feelings and memories.

Grounding and emotion management skills can help you proceed with the work of trauma therapy in a manner that feels empowering instead of re-traumatizing.

Kathleen Young Psy.D.