Tag Archives: abuse

Touched by trauma

By Laurie Meyers February 22, 2019

Licensed professional counselor (LPC) Ryan T. Day often refers to himself as a trauma survivor turned trauma therapist. When he was 11, Day was molested several times by a family friend. He had also already endured serious bullying brought on by a temporary childhood speech impediment. Day eventually began to act out and get into trouble at school. At age 13, as punishment for this misbehavior, he was severely beaten by his father, a preacher in a Pentecostal African-American church who interpreted the saying “spare the rod, spoil the child” literally.

Once he was molested, Day says he began to feel that something was wrong — he was constantly angry and often used his fists to express that anger. Day knew he wasn’t feeling “normal,” but it didn’t occur to him that what he was feeling was tied to the molestation. He says there was simply no awareness of any kind about trauma in his community, which he describes as a rough area of Richmond, Virginia, where residents learned to ignore the sounds of gun shots and to turn away from domestic violence.

“I never knew that violence was an issue,” Day says. To him, it was just a normal part of life. Nor did Day know what sexual abuse was. Although he took a sex education class in high school, he says that sexual violence was never mentioned.

Day was also an athlete in high school, but instead of changing clothes in front of other students, he would retreat to a bathroom stall. “I felt uncomfortable around males. I didn’t trust men,” he says, adding that his feelings were not about homophobia but simply about not feeling safe. “Locker room shenanigans triggered me and made me want to fight or freak out.”

Still grappling with emotional and personal barriers as a young adult, Day earned his bachelor’s degree in information technology and then decided to become a counselor. He says his counseling program didn’t emphasize self-assessment, however, so it wasn’t until he confronted a crisis during his internship that Day finally made the trauma connection.

During this time, Day had become suicidal, in part because he realized he was married to someone he didn’t love. Day says he hadn’t learned how to establish personal connections growing up, so, as he puts it, “I married the first person to show me some affection and love.” The religious tradition in which Day was raised didn’t consider divorce an option. In addition, Day and his wife were expecting a child, so he didn’t see a way to escape the stress of his marriage.

Fortunately, one of Day’s supervisors realized that he was experiencing a crisis and referred Day to a therapist. Day was in therapy for five months before he started talking about his childhood. The therapist helped Day see how his traumatic childhood experiences had shaped him and, in some cases, held him back.

After Day earned his counselor licensure, his first few clients were adolescents who had experienced multiple traumas and were living in violent neighborhoods. Their experiences paralleled Day’s own, and he realized that his personal history with trauma gave him extra insight. And that was it — Day decided to become a trauma specialist, and he’s never looked back, including presenting an education session on complex trauma at the ACA 2018 Conference & Expo in Atlanta.

Like Day, many clients don’t initially present to counseling for trauma but rather for help handling other issues. “You have an individual coming in for treatment, coming in for depression, etc., but the further you get into [the person’s] history, there’s so much more story,” Day says, adding that it’s like unpeeling the layers of a client’s life.

Day doesn’t screen for trauma during a client’s first session — he prefers to reserve that for beginning to build the therapeutic relationship. But he does complete a screening within the first few visits, often using the Life Events Checklist from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Day says he also probes for trauma as he listens to clients’ stories, asking questions such as “Have you had trouble sleeping?”; “Are you having any relationship issues?”; “Have you ever been in a serious romantic relationship?”

Why the questions about relationships? Day explains that difficulty forming and maintaining personal relationships is a hallmark symptom of complex trauma, which is different from — and not as familiar to most people as — posttraumatic stress disorder (PTSD).

Complex trauma vs. PTSD

PTSD is typically considered to be the result of a single traumatic event that occurs at any point over the life span, whereas complex trauma is the result of repetitive trauma that begins early in life and endures for a prolonged period of time, explains Cynthia Miller, an LPC in Charlottesville, Virginia, whose practice specializes in trauma. Complex trauma might result from numerous occurrences of the same kind of trauma — such as ongoing physical or sexual abuse — but it can also develop from the accumulation of different kinds of trauma.

“It’s the difference between taking a single blow versus absorbing multiple blows over the course of years,” says Miller, an American Counseling Association member. “The accumulation of those blows causes a different kind of damage than what is caused by a single blow. The damage doesn’t impact just one system but multiple systems. With a single blow, I may have swelling and bruising and scarring, but that will be confined to one area. With multiple blows over time, I will have bruising and swelling in multiple places at different times and scar tissue all over.”

People with complex trauma or PTSD may experience some of the same symptoms, such as hyperarousal, disturbances in cognition, intrusive memories and avoidance of triggers, but there are critical differences between the two types of trauma. For instance, people with complex trauma have much more trouble with interpersonal relationships and their overall self-concept, Miller says. “In addition to all the usual PTSD symptoms, they will struggle with their sense of identity, with building stable relationships and with making meaning of the world and their lives,” she explains.

Miller says it is vital that counselors understand and recognize the differences between PTSD and complex trauma because misdiagnoses are common. Complex trauma is often mistaken for borderline or other personality disorders or, in some cases, diagnosed as PTSD with co-occurring mental health issues such as depression, anxiety and somatic disorders.

“People can end up with a bunch of different diagnoses which don’t really encapsulate and accurately formulate the total problem. The trauma gets lost in the various diagnoses,” Miller says.

In addition, the treatment approach for complex trauma is not the same as that for PTSD. “Treatment differs mostly in the sequence of interventions one might use, along with the length of treatment,” Miller explains. “Gold-standard interventions for PTSD typically involve the exposure and reprocessing therapies like EMDR [eye movement desensitization and reprocessing], prolonged exposure therapy, etc. Those treatments can be effective, but they can also destabilize clients, at least in the short term, and clinicians need to be really careful to ensure that clients have strong and varied coping skills in place before doing exposures.”

Although prolonged exposure therapy and EMDR are popular therapeutic methods that can be very effective, Miller believes clinicians should be more flexible in their approaches to treating trauma. “It’s great to be trained in EMDR or prolonged exposure therapy, but those approaches don’t work for every client,” she stresses. “Some clients are just dubious of them, others don’t want to do the exposure, and others just aren’t comfortable with it. [Also,] people don’t necessarily need to process the trauma in order to get better. I’ve had clients come into my practice who have stopped seeing other therapists because the therapist was too wedded to a particular approach and, when the client expressed discomfort with it, the therapist either couldn’t or wouldn’t adapt. You have to be able to tailor treatment to the client, not tailor the client to the treatment.”

Miller routinely uses cognitive behavior therapy (CBT) and psychoeducation to help clients understand what is going on with them, how trauma has impacted their life and what can be done about it. “This, in and of itself, is really helpful for clients,” she says. “They often believe that they are deficient in some way and have caused all their problems. Once I explain what [complex trauma] is and how it affects people, they really start to understand themselves better and feel less shame.”

Miller recommends workbooks such as Life After Trauma: A Workbook for Healing by Dena Rosenbloom, Mary Beth Williams and Barbara E. Watkins and Seeking Safety: A Treatment Manual for PTSD and Substance Abuse by Lisa M. Najavits. The workbooks “have great psychoeducational handouts and readings for clients that provide education on how trauma affects the body and the brain,” she says. “I typically use the first few sessions of therapy to go over the handouts and help clients notice ways in which what is described applies to them and does not apply to them.”

Regardless of the methods clinicians choose, the initial stage of any therapeutic intervention for complex trauma should focus solely on client safety, helping them remain in the present and build their coping skills, Miller says. She adds that this is usually the longest phase of treatment.

To help clients learn how to stop symptoms such as flashbacks and dissociation, Miller teaches grounding skills. “Groundings skills involve different ways of trying to get the brain’s attention, helping it focus on what is literally happening in the moment instead of focusing on a memory from the past or checking out entirely,” she explains. “Grounding skills can involve techniques that use the five senses or techniques that attempt to engage the cognitive portion of the brain.”

Exercises that involve the senses include tasks such as asking clients to feel their feet on the ground, inhaling a relaxing scent such as lavender or running cold water over their hands. “We [also] might teach them how to describe everything they are seeing around them in detail, as if they were trying to paint the picture of a room with their words,” Miller continues. “One of my favorite grounding skills for using in emergencies is holding an ice cube in the palm of your hand or against your cheek. The sensation of cold, and then nonharmful pain, tends to get the brain’s attention fairly quickly and help someone reorient.

“Cognitive grounding skills can include things like reciting the ABCs backward, or naming every state in alphabetical order or [naming] every make of a car that one can remember. These skills try to engage the frontal cortex, which tends to go offline when someone is having flashbacks or dissociating.”

Miller also helps clients reframe their cognitions, making them aware that their past is not continually playing itself out in their present. “We help them notice how today is just today,” she says. “For example, clients often have difficulty with the anniversaries of traumas that have happened to them. They get anticipatory anxiety and, as the date approaches, they will fall apart. We work in therapy to help them notice ways in which the upcoming date is different from the date of their trauma. The year is different, their age is different, the people around them are different, their life circumstance is different, etc. It’s helping them be fully in their present and in the reality of that instead of in their past.”

Counselors also need to be mindful of the accumulative physical toll of long-term trauma, Miller adds. Research has shown that experiencing trauma — especially when it is prolonged and repetitive — rewires the nervous system in ways that cause hyperarousal and persistent anxiety. This continuous stress causes the body to release cortisol, which can cause chronic inflammation. Over time, the inflammation leads to negative health effects. To help counteract this cascade of neurological and physical damage, practitioners can teach clients skills for calming their nervous systems, Miller says. Again, counselors should tailor the treatment to the individual client. Some clients may find yoga or meditation helpful, whereas others might benefit more from neurofeedback.

Triggers and trauma responses

Debbie Sturm, an LPC in Virginia and South Carolina, has extensive experience working with trauma survivors. Currently an associate professor and director of counseling programs at James Madison University in Harrisonburg, Virginia, at one point Sturm counseled clients through the state of South Carolina’s crime victims support service, which allows people who have experienced a crime to receive 20 state-funded counseling sessions.

Sturm’s clients had experienced a range of terrifying incidents. Among others, she worked with a bouncer who had been shot at work, a woman who had been stabbed and left for dead by someone trying to steal the cash from her paycheck, people who had witnessed a homicide and a client who had been held captive by an abusive family member. Some of her clients also lived in violent neighborhoods or had histories of adverse childhood experiences. “[All] of my clients, however, were just regular people going about their daily lives [who had] experienced something awful,” says Sturm, a member of ACA.

Most of the people Sturm counseled didn’t necessarily meet all the criteria for PTSD, but they all presented with numerous trauma symptoms. The core issue for these clients was that the distress of what had happened, combined with how unfamiliar, uncomfortable and often frightening these new symptoms were for them, caused them significant difficulties. Typical symptoms included anxiety, fear, hypervigilance, sleep and eating disturbances, a compromised sense of safety and, sometimes, anger, resentment, blame or self-blame, shame and helplessness.

“For those who experienced violence, the shock of the violence and the damage to [their] personal sense of safety, control or power could be profound,” Sturm says. However, the intensity of the trauma response did not necessarily line up in the expected way, Sturm continues.

Many people assume that the most “serious” or violent events are more traumatic than a less dramatic experience, but that is often not the case, she says. A person’s trauma response is always unique to the individual and the circumstances surrounding his or her traumatic experience. “It’s really important for the clinician to hold that belief and really honor whatever response each individual is having,” Sturm emphasizes.

The treatment path that Sturm followed with each client revolved around how that person was experiencing his or her symptoms. Sturm says that identifying clients’ triggers played an important role in their recovery. She did that in part by asking: “When do you feel like things are at their worst? What is happening around you? What do you do for comfort or reassurance? As you feel that sense of fear or hypervigilance welling up, how can you start to recognize it sooner and listen to what it’s telling you?”

“Helping people really recognize when their [sense of] fear and lack of safety is starting to elevate can also help them get out of a situation or connect to something or someone safe sooner,” she explains.

Interestingly, the triggers were not always tied directly to the client’s trauma. For example, one client who had been sexually assaulted at work would “lose time” whenever she saw a white truck. The vehicles had no connection to her assault, but for whatever reason, they triggered her, Sturm recounts. But for other clients, the triggers were connected to their previous traumas.

The search for what triggered trauma symptoms provided some therapeutic benefit in and of itself, Sturm says. The clients’ “discoveries” also allowed Sturm to suggest strategies for responding to their fears. For example, the client who feared white trucks connected a sense of safety to her mother, so Sturm suggested that when she was driving and spotted a white truck, that she pull over and call her mom.

Employing such strategies helped Sturm’s clients increase their sense of efficacy, power and control because they were no longer passive captives to their symptoms. Instead, they were armed with strategies that brought comfort and helped dispel their fear.

A person’s traumatic response is typically adaptive and can even be protective, Sturm says. “For example, consider hypervigilance. If something horrible has happened and your sense of safety is shattered, the most adaptive and protective thing you could do psychologically is to be on alert. After all, the world is now proven to be quite unsafe. So, be alert!”

At the same time, the state of alertness involved in hypervigilance is very uncomfortable, can be frightening and takes a toll on trauma survivors psychologically, neurologically and biologically, Sturm says.

Traumatic environments

In some cases, a certain place is the trigger for the person’s trauma response because it isn’t safe and will never become safe, Sturm says. Part of trauma therapy might involve talking with clients about the possibility of removing themselves from that environment. Unfortunately, leaving isn’t always an option.

ACA member Leah Polk, a licensed master social worker with Change Incorporated in St. Louis, asserts that trauma can never be treated separately from the environment in which it occurred. While some survivors of traumatic events go on to reestablish safety in their lives, others must continue living in places that are directly linked to their traumas or in environments that are violent or dangerous, such as unsafe neighborhoods, war zones or violent homes. Ultimately, practitioners must accept that they cannot prevent clients from experiencing or reexperiencing traumatic events, stresses Polk, whose specialties include helping clients recover from trauma.

However, to help clients cope, counselors can support the survival skills that these clients have while distinguishing the times and places in which those skills are useful or necessary, Polk explains. “For example, perhaps it’s crucial to be vigilant while walking home alone at night from the bus stop, but that same vigilance is not required at one’s place of work or a doctor’s office,” she explains.

Practitioners can also provide clients a safe place to express the emotions tied to the burden of living in an unsafe environment, Polk says. Clients can express the sadness and frustration of not having their needs met, the pain and anger caused by social and economic oppression, and the fear that comes from living in an unpredictable and chaotic environment.

Polk says counselors can become a safety resource for clients wrestling with trauma by modeling a consistent and predictable relationship within a contained environment. “Often … clients’ trauma is founded by a violation of trust, confidence or safety from what should have been a trusted figure in their lives,” she explains. “Without establishing an explicit alliance within the [therapeutic] relationship, much of this work is nearly impossible.”

Polk also works with clients to identify other sources of support in their lives, such as caring relationships or enjoyable hobbies and interests. To help regulate emotional arousal, she teaches clients relaxation techniques such as brief meditation, deep breathing, body scanning (to identify where in their bodies they might be holding tension) and progressive muscle relaxation.

Miller has also worked with clients who could not escape traumatic environments. “I would have loved to send my clients in prison to entirely different communities and home environments when they finished their sentences,” acknowledges Miller, who has previously worked with female inmates at correctional facilities. “It would have helped a lot, but it’s just not possible. So, what do you do when [clients] have to go back to the same environment?

“It’s not a great solution, but I think part of what you can do is help clients learn how to take control of what they can in an environment that feels uncontrollable. You can help them learn to set better boundaries around how they will allow themselves to be treated. You can teach them skills for asking for help when they need it. You can link them with supportive resources. You can also help them focus on their strengths and resiliencies and learn how to calm their system when there’s chaos all around them. Any little bit of control someone can feel is better than feeling no control at all.”

For many clients who have been through complex trauma, especially those who have been physically or sexually abused, the idea that they can have any say over how people treat them is a new concept, Miller says. “They are very used to being controlled by others and being told who they can and can’t talk to, what they can say and what they can’t, where they can go and where they can’t, even down to what they can eat or wear. They are also told that they must do whatever people want them to do. So, helping them set boundaries begins with helping them see themselves as people who have rights and who don’t have to tolerate any and everything.”

When counseling these clients, Miller says, “we work on building self-esteem and teaching assertiveness skills. Just helping them learn how to say ‘no’ can take time. We practice it in session through role-plays. We also focus on helping them learn ways to keep themselves safe when saying no to someone who might not take kindly to it. This can include having them take a personal safety class or a self-defense class that is geared specifically toward [assault] survivors. It can also include talking through how to determine how much risk is involved in a given situation.”

Body guards

When it comes to cases involving sexual trauma, the person’s own body can feel like the “unsafe environment.” Therefore, feeling safe in one’s own body constitutes the core of work with these survivors, says Laura Morse, an LPC and a sex and relationship therapist in Lancaster, Pennsylvania, who specializes in helping clients recover from trauma.

Morse starts by providing psychoeducation about the fight-or-flight response to trauma. This step helps normalize the symptoms that her clients are experiencing. Morse also teaches clients how to self-soothe and ground themselves. She pairs mindfulness and deep-breathing techniques with tapping, using either EMDR or self-tapping. During the tapping work, Morse has clients practice deep breathing accompanied by a calming scent, which gives them a method to ground themselves and self-soothe wherever they are.

Polk notes that clients with a history of complex trauma may never have possessed a sense of confidence or autonomy about their bodies. She uses mindfulness-based stress reduction exercises to help clients integrate the mind and body. This might include a guided meditation in which the client’s anchor of awareness is an upward scanning of the body, from toes to head. During the exercise, the client may notice that certain areas within the body elicit specific emotions or sensations.

“Once the client is discovering feeling in these areas, the client may offer compassionate thoughts or phrases to the impacted areas,” Polk says. “The client may also be encouraged to continue compassionate exercises such as offering gratitude for the ways in which their body has helped them survive trauma.”

Clients can also explore nonsexual touch, such as different temperatures (a cold compress versus a warm bath) or textures (a soft brush versus a silk ribbon) and journal about their experiences, says Polk, who is also seeking certification as a sex therapist.

“If the client wants to move toward reclaiming their sexuality, it may be important to discuss their sexual self-perception and relationship with themselves,” she says. “Are they able to achieve pleasure through masturbation? If not, what seems to get in the way? If certain touches are uncomfortable or triggering, the client’s sense of choice must be paramount — they can choose to try something different or set a limit around specific experiences.

“For example, while caressing and external stimulation may be pleasurable, penetration leaves the client feeling overwhelmed and tearful. Therefore, the counselor would encourage the client to observe their thoughts and feelings about their self-exploratory experience and determine what feels right for them in that moment. The sense of agency that comes with integrating the mind and body, along with rediscovering self-pleasure, can be a life-changing concept for survivors of chronic sexual trauma. Therefore, the counselor must give plenty of patience and space for these experiences.”

Sexual assault survivors also frequently experience problems with sexual intimacy. Says Morse, “I use the dual-control model for sexual intimacy to empower survivors to understand the ‘brakes’ that are keeping them safe [but] may be preventing them from enjoying experiences that they used to in the past. And then we begin to learn ‘accelerators’ of what is helpful.”

Brakes are sexual-inhibition factors such as a history of trauma, body image issues, relationship conflict, unwanted pregnancy, depression, anxiety or, as Morse puts it, “everything you see, hear, touch, taste, smell or imagine that could be a threat.”

Accelerators are sexual-excitation factors such as a partner’s smell or appearance, a sense of novelty, new love or “everything you see, hear, touch [or] smell that is a turn-on,” Morse says.

Morse also helps clients who are in relationships to create sexual scripts with their partners. “When creating a sexual script with a couple, I will do the exercise both with the couple [and] individually,” she says. “I ask the couple, with their permission, if we can create a line-by-line script of the actions that lead to intimacy. This may start with affection at breakfast or date night, well before intimacy in the bedroom begins.”

Creating the script encourages couples to reflect on their usual sexual patterns and, in individual sessions, allows each partner to express any barriers they may be experiencing or areas where novelty or changes could be incorporated.

Polk believes that when clients who have experienced sexual trauma say they are ready to reengage in partnered sex or physical intimacy, it is important for the counselor to assess how they came to that conclusion. “While being supportive of their desires, the counselor may want to ask if this interest arose from their partner, from their own interests or collaboratively. The client’s sexual self-efficacy, or ability to reliably communicate and have sexual needs met, is of paramount interest when approaching this topic.”

Sexual assault survivors who are already in a sexual relationship may also find that trauma symptoms create barriers to intimacy. Clients may experience psychological symptoms such as depression, PTSD, traumatic reenactment and anxiety. Decreased libido or arousal and painful sex are also common, as are sexual avoidance and conflict in the relationship.

To combat these negative impacts, Polk helps clients create a sexual consent model. “The sexual consent model is used to negotiate sexual boundaries and mutual agreements between partners,” she explains. “This is more than a ‘yes’ or ‘no’; [it] is explicit and entails ongoing dialogue between partners. Research currently tells us that men are more likely to see consent as a one-time event, so gender scripts must be considered when approaching this model.”

Polk provides examples of possible script dialogue:

  • “I know I said oral sex was OK last week, but right now, I am uncomfortable.”
  • “If we try this position, it doesn’t mean that you have to always do this.”
  • “After sex, can you make time to cuddle so that I am not left alone?”
  • “While having sex, I noticed that you got unusually quiet. Is everything OK?”

Morse recommends sensate therapy to her clients. She describes sensate therapy as a series of sex therapy exercises that allow for sensual touch to be achieved without anxiety. “Typically,
this will start with just having a couple carve out time twice a week where intimacy is not centered around the genitals and penetrative sex,” she says. “Masters and Johnson initially developed a series of exercises which are now commonly adapted based on a couple’s specific needs.”

Morse recommends the book Sensate Focus in Sex Therapy by Linda Weiner and Constance Avery-Clark for counselors who want to learn more.

Trauma education

Day believes there are still too many people walking around with trauma who have no idea that they can be helped. He says counselors need to be proactive in educating the public about trauma because many of the people who could benefit will never show up in their offices. Day also stresses the need for trauma education in schools but says that because school counselors have so much on their plates, clinical counselors need to step in and be willing to give their time.

“Counselors don’t always have to sit behind the desk,” he states. “Go to places where people are uncomfortable about having these conversations, such as schools, community centers, churches.”

One of the things that Day loves most about being a trauma counselor is getting the word out. He gives presentations, participates on panels and has even talked about trauma on the radio.

“Individuals have to have that conversation,” he says.

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

  • “Moving through trauma” by Jessica Smith
  • “The Counseling Connoisseur: The contour of hope in trauma” by Cheryl Fisher
  • “Informed by trauma” by Laurie Meyers
  • “Salutogenesis: Using clients’ strengths in the treatment of trauma” by Debra G. Hyatt Burkhart and Eric W. Owens
  • “Coming to grips with childhood adversity” by Oliver J. Morgan
  • “The toll of childhood trauma” by Laurie Meyers
  • “Traumatology: A widespread and growing need” compiled by Bethany Bray
  • “All trauma is not the same” by Tara S. Jungersen, Stephanie Dailey, Julie Uhernik and Carol M. Smith
  • “The high cost of human-made disasters” by Lindsey Phillips
  • “Lending a helping hand in disaster’s wake” by Laurie Meyers

Books and DVDs (counseling.org/publications/bookstore)

  • Disaster Mental Health Counseling: A Guide to Preparing and Responding, fourth edition, edited by Jane Webber and J. Barry Mascari
  • Youth at Risk, sixth edition, edited by David Capuzzi and Douglas R. Gross
  • Crisis Stabilization for Children: Disaster Mental Health, DVD, presented by Jennifer Baggerly

Webinars (aca.digitellinc.com/aca/pages/events)

  • “Traumatic Stress and Marginalized Groups” with Cirecie A. West-Olatunji (CPA24341)
  • “Counseling Students Who Have Experienced Trauma: Practical Recommendations at the Elementary, Secondary and College Levels” with Richard Joseph Behun, Julie A. Cerrito and Eric W. Owens (CPA24339)
  • “Counseling Refugees: Addressing Trauma, Stress and Resilience” with Rachael D. Goodman (CPA24337)
  • “Dissociation and Trauma Spectrum” with Mike Dubi (CPA24333)
  • “Children and Trauma” with Kimberly N. Frazier (CPA24331)
  • “ABCs of Trauma” with A. Stephen Lenz

Podcasts (aca.digitellinc.com/aca/store/5#cat14)

  • “Treating Domestic Violence” with Tali Sadan (ACA282)
  • “Counseling African-American Males: Post Ferguson” with Rufus Tony Spann (ACA285)
  • “Harm to Others” with Brian VanBrunt (ACA248)
  • “Child Sexual Abuse Survivors, Their Families and Caregivers” with Kimberly Frazier (ACA200)

ACA Mental Health Resources (counseling.org/knowledge-center/mental-health-resources)

  • Gun Violence
  • Trauma and Disaster

ACA Interest Networks (counseling.org/aca-community/aca-connect/interest-networks)

  • Traumatology Interest Network

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

 

Letters to the editorct@counseling.org

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

What’s left unsaid

By Lindsey Phillips January 3, 2019

A child discloses that her grandfather has been sexually abusing her, and the mother’s response is shock that his abuse didn’t stop with her when she was a child. This scene is not uncommon for Molly VanDuser, the president and clinical director of Peace of Mind, an outpatient counseling and trauma treatment center in North Carolina. As she explains, adult survivors of child sexual abuse often assume that the offender has changed or is too old to engage in such actions again. So, the abuse persists.

Concetta Holmes, the clinical director of the Child Protection Center in Sarasota, Florida, has treated clients with similar intergenerational abuse stories. “In that unresolved trauma … what has happened is now a culture of silence around sexual violence that is ingrained in the family,” she says. “That [affects] things like your feelings of safety, security [and] trustworthiness, and it reinforces that you should stay with people who hurt you.”

Kimberly Frazier, an associate professor in the Department of Clinical Rehabilitation and Counseling at Louisiana State University’s Health Sciences Center, acknowledges that people often don’t want to think or talk about child sexual abuse, but that doesn’t stop it from happening. The nonprofit Darkness to Light reported in 2013 that approximately 1 in 10 children will be sexually abused before they turn 18.

Because of the culture of silence that surrounds child sexual abuse, it is safe to assume that the true number is even higher. Cases of child sexual abuse often continue for years because the abuse is built on a foundation of secrets and fear, Frazier points out. Survivors frequently fear what will happen to them (or to others) if they tell, or the shame they feel about the abuse deters them from disclosing.

Societal norms can also diminish a survivor’s likelihood of disclosing. For example, society has for decades implicitly sanctioned sexual interactions between boys who are minors and adult woman, but it is still abuse, says Anna Viviani, an associate professor of counseling and director of the clinical mental health counseling and counselor education programs at Indiana State University. Holmes adds that gender stereotypes such as this can cause boys to feel as though they shouldn’t be or weren’t affected by sexual abuse, which is not the case.

“I think the biggest fallacy [counselors have] is that [child sexual abuse] is going to impact people from a particular demographic more than another,” Viviani says. “Childhood sexual abuse cuts across every demographic. I think the sooner we can accept that, the sooner we’re going to be better at identifying clients when they have this issue in their history.”

Putting on a detective hat

Identifying signs of child sexual abuse is neither easy nor straightforward. Part of the difficulty lies in the fact that the signs are not clear-cut, says VanDuser, a licensed professional counselor (LPC) and an American Counseling Association member. Regressive behaviors such as bed-wetting can indicate abuse, but they might also be the result of other changes such as a recent move, a new baby in the family or a military parent deploying, she explains.

VanDuser also warns that child sexual abuse is insidious because a lot goes on before the offender actually touches the child. “Childhood sexual abuse sometimes leaves no physical wounds to identify,” she says. Some examples of noncontact abuse include peeping in the window at the child, making a child watch pornography or encouraging a child to sit on one’s lap and play the “tickle game.” Such activities are part of the grooming process — the way that offenders build trust and gain access to the child.

In addition to physical signs such as bladder and vaginal infections, changes in eating habits, and stomachaches, survivors of child sexual abuse also demonstrate behavioral and emotional changes. One major warning sign is if the child displays a more advanced knowledge of sex than one would expect at the child’s developmental stage, VanDuser says.

Other possible behavioral signs include not wanting to be alone with a certain person (e.g., stepfather, babysitter), becoming clingy with a nonoffending caregiver, not wanting to remove clothing to change or bathe, being afraid of being alone at night, having nightmares or having difficulty concentrating. In general, counselors should look for behaviors that are out of character for that particular child, VanDuser advises.

Viviani, a licensed clinical professional counselor and an ACA member, also finds that people who have experienced child sexual abuse have higher rates of depression, anxiety, panic disorders and posttraumatic stress disorders.

Because the signs of child sexual abuse are rarely clear-cut, counselors must be good investigators, Viviani argues. In her experience, adult survivors present with an array of symptoms, including health concerns, relationship problems and gaps in memory, so counselors have to look for patterns to discover the underlying issue.

If counselors notice any of these signs, VanDuser recommends asking the client, “When did this problem (e.g., bed-wetting, cutting, nightmares, acting out in school) begin?” Counselors can then follow up and ask, “What else was going on at that time?” The answers to these questions often reveal the underlying issue, she notes. For example, if the client responds that his or her depression or vigilance to the environment began around age 12, VanDuser says she will dig deeper into the client’s family relationships.

Frazier, an LPC and a member of ACA, suggests that counselors can also look for patterns in a child’s drawing — for example, what colors they use, how intensely they draw with certain colors, or if they scratch out certain people or choose not to include someone — or in the choices children make with activities such as feeling faces cards (cards that depict different emotional facial expressions). When Frazier asked one of her clients who had come to counseling because of suspected sexual abuse to select from the feeling face cards, she noticed the client consistently picked cards with people wearing glasses. Frazier later discovered that the child’s abuser wore glasses.

For Frazier, becoming a detective also involves going outside of the office to observe the child in different spaces, such as in school, in day care or at the park. Frazier includes the possibility of outside observations in her consent form, so the child’s parent or guardian agrees to it beforehand. She advises that counselors should take note of whether the child’s behavior is consistent across all of these spaces or whether there are changes from home to school, for example. In addition, she suggests asking the parents or guardians follow-up questions about how the child’s behavior has changed (e.g., Has the child lost the joy of playing his or her favorite sport? Is the child withdrawn? Is the child fighting?).

Speaking a child’s language

Young children may not have the words or cognitive development to tell counselors about the abuse they have been subjected to. Instead, these children may engage in traumatic play, such as having monsters in the sand tray eat each other or being in a frenzied state and drawing aggressive pictures, VanDuser says.

“One of the most important things for clinicians to remember when they’re working with kids and abuse is that it’s really critical to be working within the languages that children speak,” says Holmes, a licensed clinical social worker and a nationally credentialed advocate through the National Organization for Victim Assistance. “Children speak through a variety of different languages that aren’t just verbal. They speak through play. They speak through art, through writing [and] through movement, so it becomes really important that clinicians get creative in using evidence-based practices and different modalities to talk with children through their language. … Talking in a child’s language allows them to feel like the topic at hand is less overwhelming and less scary.”

For example, children can use Legos to build a wall of their emotions, Holmes says, with counselors instructing clients to pick colors to represent different emotions. If orange represents sadness and red represents frustration and 90 percent of the child’s wall contains orange and red Legos, then the counselor gets a better visualization of what emotions are inside the child, she says.

Next, counselors could ask clients what it would take to remove a red brick of frustration or what their ideal wall would look like, such as one that contains more bricks representing happiness or peace. Counselors can also ask these clients to rebuild their Lego walls throughout therapy to see how their emotions are changing, Holmes says. This method is easier than asking children if their anger has decreased and by how much, she adds.

Frazier, past president of the Association for Multicultural Counseling and Development, a division of ACA, also finds that working with children keeps counselors on their toes. Children are honest and will admit if they do not like an intervention, so counselors have to be ready to shift strategies quickly, she says. For this reason, counselors need to have a wide range of creative approaches in their counseling bag. She recommends drawing supplies, play school or kitchen sets, play dough and sand trays.

With sand trays, Frazier likes to provide dinosaurs and other nonhuman figurines for children to play with because it helps them not to feel constrained or limited. This allows them to freely let a dinosaur or car represent a particular person or idea, she explains.

Frazier also recommends the “Popsicle family” intervention, in which children decorate Popsicle sticks to represent their family members and support systems. This exercise provides insight into family dynamics (who is included in the family and who isn’t) and allows children to describe and interact with these “people” like they would with Barbie dolls, she says.

Frazier advises counselors to keep culturally and developmentally appropriate materials on hand. For example, they should have big crayons for young children with limited fine motor skills, and they should have various shades of crayons, markers, pencils and construction paper so children can easily create what they want.

Being multiculturally competent goes beyond ethnicity, Frazier points out. Counselors should understand the culture the child grew up in and the culture of the child’s current locality because what is considered “normal” in one city or area might differ from another, she says. For example, in New Orleans, where she lives, people regularly have “adopted” family members. So, if a child from New Orleans were creating his or her Popsicle family, it wouldn’t be strange to see the child include several people outside of his or her immediate family and refer to them as “cousin” or “aunt,” even if they aren’t blood relatives.

Thus, Frazier stresses the importance of counselors immersing themselves in the worldview of their child clients. “You can’t be a person who works with kids and not know all the shows and the stuff that’s happening with that particular age group, the music, the things that are on trend and the things they’re talking about,” Frazier says. “Otherwise, you’ll always be behind trying to ask them, ‘What does that mean?’”

With adolescents, Holmes finds narrative therapy to be particularly effective, and she often incorporates art and interview techniques into the process. For example, the counselor could ask the client to draw a picture of an emotion that he or she feels, such as anger. Next, the client would give this emotion a name and create a short biography about it. For example, how was anger born? How did it grow up to be who it is? What fuels it? Why does it hang around?

Next, Holmes says, the counselor and client could discuss the questions the client would ask this emotion if it had its own voice. Then, the client could interview the initial picture of the emotion and use his or her own voice to answer the questions as the emotion would. The answers provide insight into the emotional distress the client is feeling, Holmes explains.

Frazier will do ad-lib word games with older children, who are often more verbal. While clients fill in the blanks to create their own stories, she looks for themes (e.g., gloomy story) or the child’s response to the word game (e.g., eager, withdrawn). 

Long-lasting effects

Unfortunately, the effects of child sexual abuse don’t end with childhood or even with counseling. “Children revisit their trauma at almost every age and stage of development, which is every two to three years,” Holmes notes. “That might not mean they need counseling each and every time, but they find new meaning in it or they find they have new questions … or new emotions about it.”

Viviani, VanDuser and Frazier agree that recovery is a lifelong process. As survivors age, they will have sexual encounters, get married, become pregnant or have their child reach the age they were when the abuse occurred. These events can all become trigger points for a flood of new physical and emotional symptoms related to the child sexual abuse, Viviani says.

Often, an issue separate from the abuse causes adult survivors to seek counseling. In fact, VanDuser says she rarely gets an adult who discloses child sexual abuse as the presenting issue. Instead, she finds adult clients are more likely to come in because their own child is having behavioral problems or because they’re feeling depressed or anxious, they’re having nightmares or they’re married and have no interest in sex.

Adults survivors often experience long-term physical ailments. According to Viviani, who presented on this topic at the ACA 2018 Conference & Expo in Atlanta, some of the ailments include diabetes, fibromyalgia and chronic pain syndromes, pelvic pain, sexual difficulties, headaches, substance use disorders, eating disorders, cardiovascular problems, hypertension and gastrointestinal problems.

Another long-term issue for survivors is difficulty forming healthy relationships. Because child sexual abuse alters boundaries, survivors may not realize when something is odd or abusive in a relationship, VanDuser says. For example, if an adult survivor is in a relationship with someone who is overly jealous and possessive, he or she may mistakenly translate that jealously into a sign of love.

Child sexual abuse can also affect decision-making as an adult around careers, housing, personal activities and sexual intimacy, Viviani notes. For example, one of her clients wanted to attend a Bible study group but didn’t feel safe being in a smaller group where a man might pay attention to her. In addition, Viviani finds that adult survivors sometimes choose careers they are not interested in just because those careers provide a safe environment with no triggers.

To help adult clients make sense of the abuse they suffered as children and move forward, Viviani often uses meaning-making activities and mindfulness techniques. She suggests that counselors help these clients find a way to do something purposeful with their history of abuse, whether that involves sharing their story with a testimony at church, volunteering for a mental health association or participating in a walk/run to raise awareness of suicide prevention.

Finding self-compassion

Survivors of child sexual abuse often blame themselves for the abuse or the aftermath once the abuse is revealed, especially if it results in the offender leaving the family, the family losing its home or the family’s income dropping, VanDuser says. One of her clients even confessed to thinking that she somehow triggered her child sexual abuse from her stepfather.

“Sometimes the worst part is the dread [when the child knows the sexual abuse is] coming eventually. So, sometimes a teenager will actually initiate it to get it over with because the only time they feel relief is after it’s done,” VanDuser explains. “Then they know for a while that they won’t be bothered again.”

Counselors often need to shine a light on survivors’ cognitive distortions to help them work through their guilt and shame, VanDuser says. She tries to help clients understand that the sexual abuse was not their fault by changing their perspective. For example, she will take a client to a park where there are children close to the age the survivor was when the abuse happened. She’ll point to one of the children playing and ask, “What could the child really do?” This simple question often helps clients realize that they couldn’t have done anything to prevent the abuse, VanDuser says.

Viviani takes a similar approach by talking with clients in the third person about their expectations of what a child would developmentally be able to do in a similar situation. She asks clients if they would blame another child (their grandchild or niece, for example) for being sexually abused. Then she asks why they blame themselves for what happened to them because they were also just children at the time.

“As you frame it that way, they begin to have a little bit more compassion for themselves, and self-compassion is something that’s so important for survivors to develop,” Viviani says. In her experience, survivors are hard on themselves, often exercising magical thinking about what they should or should not have been able to do as a child. “As we help them develop self-compassion and self-awareness, we see the guilt begin to dissipate,” she adds.

Regaining a sense of safety

Safety — in emotions, relationships and touches — is a critical component of treatment for a child who has been sexually abused, Holmes stresses.

Counselors should teach clients about safe and unsafe touches, personal boundaries and age-appropriate sexual behavior rules, adds Amanda Jans, a registered mental health counseling intern and mental health therapist for the Child Protection Center in Sarasota. Counselors can also help clients “understand that they are in charge of their bodies, so even if a touch is safe, it doesn’t mean they have to accept it,” she says.

Hula hoops provide a creative way to discuss personal space boundaries with clients, Holmes notes. Counselors can use hula hoops of different sizes to illustrate safe and unsafe boundaries with a parent, sibling, friend or stranger, she explains.

VanDuser helps clients engage in safety planning by having them draw their hand on a piece of paper. For each finger, they figure out a corresponding person they can tell if something happens to them in the future.

Counselors can also take steps to ensure that their offices are safe settings. Jans, an ACA member who presented on the treatment of child sexual abuse at the ACA 2018 Conference, uses noise machines to ensure privacy and aromatherapy machines to make the environment more comfortable. She also has a collection of kid-friendly materials, so if a child starts to feel dysregulated during a session, he or she can take a break and play basketball or color.

Likewise, if clients are hesitant to discuss the topic, Jans allows them to take a step back. For instance, she has clients read someone else’s experience (either real or fictional) rather than having them write their own story, or she has clients role-play with someone else serving as the main character, not themselves. This distance helps clients move to a place where they eventually can discuss their own stories, she says.

Another technique Jans uses to ease clients into writing and processing their own stories is a word web. Together, Jans and a client will brainstorm words related to the client’s experience and put the words on a web (a set of circles drawn on a paper in a weblike pattern). Jans finds this exercise helps clients get comfortable talking about the subject and, eventually, these words become part of their narrative.

VanDuser also suggests getting out of the office. Sometimes she takes child and adolescent clients to a store to get a candy bar. On the way, she will ask them what they are feeling or noticing. If clients say that someone walking by makes them feel strange, VanDuser asks how they would address this feeling or what they would do if someone approached them. Then they will talk through strategies that would make the client feel safe in this situation.

Taking back control

Survivors of child sexual abuse often feel they can’t control what happens around them or to them, Frazier says. So, counselors can get creative using interventions that return control to these survivors and make them feel safe.

Viviani helps clients regain some sense of control in their lives by teaching grounding and coping skills. “Coping skills are so important to helping them begin to trust in themselves again so that they have the skills to really uncover and deal with the abuse,” she explains.

In sessions, counselors can help clients recognize what their bodies feel when they are triggered. Then they can help clients learn to deescalate through grounding skills such as noticing and naming things in their current surroundings or reminding themselves of where they are and the current date, Viviani says. Rather than reliving the incident — being back in their bedroom at age 5, for example — clients learn to ground themselves in the here and now: “This is Jan. 10, 2019, and I’m sitting in my office.”

VanDuser highly recommends trauma-focused cognitive behavior therapy (TF-CBT) for work with survivors of child sexual abuse. TF-CBT is a short-term treatment, typically 12-16 sessions, that incorporates psychoeducation on traumatic stress for both the child and nonoffending parent or caregiver, skills for identifying and regulating emotions, cognitive behavior therapy and a trauma narrative technique.

For a creative approach, VanDuser suggests letting children use crayons and a lunch bag to create a “garbage bag.” She first writes down all the bad feelings (e.g., fear, anger, shame) the client has about the abuse. As the child finishes working on one of the bad feelings, he or she puts the feeling in the garbage bag. When all the feelings are in the bag, VanDuser lets the client dispose of it however he or she wishes — by burning it, burying it, throwing it in the actual garbage or some other method.

Jans and Holmes suggest empowering clients by giving them some control in session. For example, if clients are feeling sad, the counselor can remind them of the coping strategies they have been working on (perhaps progressive muscle relaxation and grounding techniques) and ask which one they want to use to address this feeling. The counselor could also list the goals of therapy for that day and ask clients which one they want to work on first, Holmes says.

Holmes acknowledges that clients may never make sense of the abuse they suffered, but counselors can help them make sense of the abuse’s impact and aftermath. For Holmes, this meaning making involves clients being empowered to reclaim their lives after abuse rather than being held hostage by it, realizing that trauma doesn’t have to define them and learning to be compassionate with themselves.

The hero who told

Holmes encourages counselors not to shy away from discussing child sexual abuse. “If clinicians hesitate, clients will hesitate. If the clinician avoids it, the client will avoid it,” Holmes says. “It’s the clinician’s responsibility to take the lead on this topic. Sexual abuse is so widespread in our society that we do our clients a disservice when we don’t incorporate sexual abuse histories into our [client] assessments.”

Typically, however, counselors are not the first person a child will tell about the abuse. Often, children first disclose the abuse to a teacher or other school personnel, and their reaction is crucial in ensuring that the child gets help, Viviani says.

Thus, she advises counselors to partner with schools and child advocacy organizations to educate them on what they should do if a child discloses sexual abuse. “They need to know what to do,” Viviani emphasizes. “They need to know what to say to support that child because we may not get another chance, at least until they hit college age when they’re not under that roof anymore, or we may never get that chance again.”

Counselors must also empower survivors of child sexual abuse. “They shouldn’t be waiting for the therapist … or their best friend to ride in and save them. We want them to be the hero of their own story,” Holmes says. “And how we do that is through finding ways they can start to recognize and make safe and healthy decisions about different pieces of their life, and we want to model that even within the therapy environment.”

The end result of TF-CBT is the child writing his or her own narrative of the sexual abuse. VanDuser emphasizes that no matter how the child’s sexual abuse story begins, it always has the same ending: the hero — the child — who told.

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist living in Northern Virginia. Contact her at consulting@lindseynphillips.com or through her website at lindseynphillips.com.

Letters to the editorct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The wise support system in domestic violence rescue efforts

By David L. Prucha April 9, 2018

A lot has been written about domestic violence, the cycles that keep people in violent relationships and how to get out of them. The commentary focuses on the role of substance abuse, the role of personality disorders and a cycle of conflict that ends with the exchange of a “never again” promise. Wash, rinse, repeat.

Although I believe these are relevant factors in violent relationships, a dynamic often emerges between the victim and her concerned loved ones, and this dynamic might play a role in keeping the violent relationship intact. It is of course sensible to think about the relationship between the abuser and the victim, but what else can we learn by looking at the relationship between the victim and her potential safety net?

If you are a family member looking from the outside in on a violent relationship, things look pretty black and white. The abuser is a bad guy. In fact, it’s probably better to use the word “evil.” He is taking advantage of someone smaller than him, he’s probably done this in previous relationships, and his promise to change can’t be trusted. He is one-dimensional: bad. The hottest place in hell is reserved for men of his ilk.

For those on the outside looking in, this is terrifying. Their loved one is in danger, she is captive, and if that wasn’t bad enough, she seems ambivalent about her chains. This leads family and friends to express their hatred for the abuser, but in their desperation, they might also express their frustration with the victim: “You’re smarter than this. I can’t believe you got yourself into this.” For those in the victim’s support system, a life might be hanging in the balance, so this seems no time to mince words.

If you are on the inside of the relationship looking outward, however, the picture can appear very different. Although the victim can certainly recognize her partner’s shortcomings, she cannot quite see what her support system sees. She doesn’t see a one-dimensional evil man.

Instead, she sees someone who is conflicted, someone who hates himself, someone who can’t get a grip on his emotions. Because she knows the “inner him,” she struggles to reconcile the blunt feedback from her family with the person she loves. The two pictures just don’t add up.

Could her partner really be as manipulative and cold as they say? Surely not. His regret and anguish are sincere. She has witnessed him cry out of self-hatred, and evil men don’t do that. He is broken but not bad. He wants to change, and she can’t imagine leaving because she doesn’t want to be like everyone else who has left him in the past.

 

A disciplined rescue

Before people are open to receiving help, they have to trust that the complexity of their problem is well-understood. When families characterize their loved one’s abuser as pure evil, a demonic caricature with cloven hoof, it delegitimizes their feedback, because for the victim, this evil cartoon character is nowhere to be found. In fact, the blunt feedback often has the opposite effect — it reinforces for the victim that the goodness of her partner isn’t being taken into account. This hardens her conviction that she is alone in understanding the situation, and this has the unintended consequence of further isolating her.

Given that explanation, what can be done? One way to intervene is to help the victim understand that there is a difference between evil people and destructive people, but both types of people can do the same amount of damage. In making this distinction, it validates that her partner is not a one-dimensional monster without dismissing the fact that a destructive reality still exists that needs to be addressed. This approach doesn’t isolate the victim from her support system. It also helps her understand why her situation feels so gut-wrenching: She has to leave someone who is partly good.

But partly good is not good enough. When we offer the truth that people are never entirely good or entirely evil, we offer an alternative worldview that enables victims to refine their partner-selection process in the future.

No longer should they reassure themselves if a destructive person shows goodness, because displays of goodness are no longer sufficient criteria for choosing a partner. Instead, the criteria become more nuanced. Despite the display of goodness, is this person also destructive? Victims learn that the presence of goodness and vulnerability are not the only variables to consider.

A second way to help is to teach victims that empathy is a morally neutral disposition: It can lead to both health and destruction. After all, the best predators use empathy to scan for the psychological vulnerabilities of other people. This maximizes predators’ ability to exploit.

In the cases of victims of domestic violence, their empathy is doing them harm. They are spending too much time thinking about how leaving the relationship would impact their partner and not enough time thinking about how they are themselves being harmed. Their high capacity for empathy has led them to walk around in the mind of their abuser for far too long, thinking his thoughts and feeling his feelings. The victim is not in her situation because she is foolish but because she has not learned how to manage her empathic impulses. Learning how to power down her empathy is vital, and she can do this by learning how to reprioritize her own needs.

Reprioritizing her needs can lead to feelings of guilt, and this comes from a sense that she is being selfish. The victim is in the habit of giving 100 apples to her partner without taking one for herself, so now taking 50 apples feels incredibly wrong. However, with the right help, she can learn that meeting her own needs is not selfish but is instead necessary to be truly generous.

In fact, when we compulsively engage with something that damages our well-being, it is not generosity — it is addiction. The person with alcoholism no longer enjoys the drink, and the person addicted to empathy no longer enjoys giving. Instead, they both feel bound to their habits. It’s not that virtue motivates the victim to give away the 100 apples; it’s that she doesn’t know how to give less than 100 apples away.

When victims learn that empathy has become a force for harm in their lives and that true generosity can’t flow forth from inner compulsion, the sense of virtue that they previously associated with staying in the relationship is tarnished. It isn’t that the abuser is without a gradient of goodness; it’s that he is still profoundly dangerous. It’s not that she is motivated by virtue; it’s that her empathy has kept her from seeing that her needs for safety and love should be more important to her than his need to avoid anxiety or sadness.

The hope is that thinking about how support systems can unintentionally create defensiveness and isolation in victims of domestic violence will lead to better rescue strategies. Although it feels repugnant for support systems to acknowledge the goodness in the victimizer, in some cases this might allow the victim to see more clearly the destructiveness of her partner. If members of the support system are able to stop themselves from accusing the perpetrator of simply being evil, this might lead the victim to feel powerfully understood. Perhaps the intimacy of feeling understood will increase the victim’s trust in the bridge away from her relationship and into the arms of those who love her.

 

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David L. Prucha is an adjunct professor of psychology at Johnson and Wales University in Denver, Colorado. He is also a licensed professional counselor who maintains an independent practice that specializes in depressive disorders, anxiety disorders, and trauma and stressor-related disorders. Email him at contact@pruchacounseling.com.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The toll of childhood trauma

By Laurie Meyers June 23, 2014

Little-girl_brandingMention the word trauma to Americans in the 21st century, and their thoughts are likely to turn to images of terrorism, war, natural disasters and a seemingly continual stream of school shootings. The horrific scenes at Newtown and Columbine still dominate public consciousness, particularly when our society discusses child trauma. While those events make headlines, however, counseling professionals say the most pervasive traumatic threat to children is found not in big events or stranger danger, but in chronic and systemic violence that happens in or close to the home.

This kind of ongoing trauma, much of which takes place out of public view, leaves deep scars that can cause a lifetime of emotional, mental, physical and social dysfunction if left untreated. Research shows that chronic, complex trauma can even rewire a child’s brain, leading to cognitive and developmental issues.

The good news is that counselors in all areas of practice — in schools, agencies, shelters, clinics, private practice and elsewhere — can and are working with children and, when possible, their parents to stop the cycle of violence, or at least to mitigate its effects.

Behind closed doors

The number of children exposed to violence in the United States is staggering. According to the National Survey of Children’s Exposure to Violence (NatSCEV), funded by the U.S. Department of Justice and the Centers for Disease Control and Prevention (CDC) and carried out by the University of New Hampshire’s Crimes against Children Research Center, more than 60 percent of children surveyed had been exposed to direct or indirect violence during the 12 months prior to the survey. Nearly half — 46.3 percent — had been assaulted at least once in the past year, meaning they had experienced one or more of the following: any physical assault, assault with a weapon, assault with injury, attempted assault, attempted or completed kidnapping, assault by a brother or sister, assault by another child or adolescent, nonsexual genital assault, dating violence, bias attacks or threats. One in 10 had experienced some form of maltreatment, which includes nonsexual physical abuse, psychological or emotional abuse, child neglect and custodial interference. Other CDC research indicates that 1 in 4 girls and 1 in 6 boys are victims of sexual abuse. However, many experts emphasize that due to the stigma involved, sexual abuse is underreported.

Significant exposure to violence and trauma can also lead to illness later in life. From 1995-1997, the CDC, in collaboration with Kaiser Permanente, collected detailed medical information from 17,000 patients at Kaiser’s Health Appraisal Clinic in San Diego. These patients also answered detailed questions about childhood experiences of abuse, neglect and family dysfunction. The initial study, Adverse Childhood Experiences, as well as more than 50 studies since using the same population, found that adult survivors of childhood abuse are more likely to develop chronic conditions and diseases such as heart disease, obesity, cancer, chronic obstructive pulmonary disease and liver disease. They are also more likely to engage in risky health behaviors such as smoking and drug and alcohol abuse. In addition, adult survivors of child abuse may have autobiographical memory problems; exhibit increased problems with depression, anxiety and other mental illnesses; and struggle with suicidal tendencies.

NatSCEV data, collected between January and May 2008, indicate that one in 10 children surveyed experienced five or more incidents of direct violence. It is this kind of ongoing abuse that can cause polyvictimization, or what many researchers call complex trauma — repeated exposure to traumatic events over time and often at the hands of caregivers or other loved ones.

“This cumulative trauma has much more serious effects than a single event,” says David Lawson, a licensed professional counselor (LPC) and licensed marriage and family therapist in Nacogdoches, Texas, who has worked with victims and perpetrators of sexual and domestic abuse since the 1980s. Because the abuse is ongoing, it disrupts a child’s sense of security, safety and self and alters the way he or she sees others, explains Lawson, an American Counseling Association member who is also a researcher and professor in the school psychology and counseling program at Stephen F. Austin State University in Nacogdoches.

“In childhood, attachments are still forming, and abuse can shatter this developing ability,” says Jennifer Baggerly, an ACA member, LPC and play therapist who studies child trauma intervention. “It can also distort their forming personality and the way they interact with people as a whole.” This distortion can cause the child to believe that the world is an unsafe place and that people aren’t trustworthy, adds Baggerly, an associate professor and chair of the Department of Counseling and Human Services at the University of North Texas at Dallas.

That pattern of uncertainty and instability can cause cognitive distortion, dissociation and problems with emotional self-regulation and relationship formation, and even alter a child’s brain structure, notes Lawson, the author of Family Violence: Explanations and Evidence-Based Clinical Practice, published by ACA in 2013.

“Children get stuck in flight or fight,” adds Baggerly. “Everything is a threat, so instead of strengthening the prefrontal cortex, the brain operates more from the limbic system, which causes them to be more hypervigilant.”

Because they are almost constantly on alert, these children and adolescents most of the time use what Lawson calls their “survival brain” instead of their “learning brain.” Childhood and adolescence are periods in which the brain is developing rapidly and crucial cognitive skills are being learned. If children and adolescents spend too much time in survival mode, they are not accessing areas in the brain that are responsible for learning developmentally appropriate cognitive skills and laying down the neural pathways that are critical to future learning.

“As the child gets older, this chronic hypervigilance — and the overload of cortisol that comes with it — completely remaps the brain and just stifles development,” says Gail Roaten, president-elect of the Association for Child and Adolescent Counseling, a division of ACA. “You see them lose ground cognitively, especially in their ability to learn.”

Support and stability

Traumatized children’s problems with cognition, learning, self-regulation and development can last a lifetime, making it more likely that they will continue the cycle of abuse in their relationships, abuse drugs and alcohol, have trouble finding and keeping jobs or end up in the criminal justice system. Adults who were traumatized as children also are much more likely to face a host of physical and mental health problems.

The situation is far from hopeless, however. Counseling interventions for trauma can make a dramatic difference, and the earlier a child starts receiving therapy, the better. A variety of techniques have proved to be effective, but interventions are most successful when a supportive environment is created, Lawson emphasizes. Whenever possible, a parent or parents should be participants in a child’s therapy (as long as they are not the perpetrators of the abuse), and if not the biological parents, then foster parents or grandparents.

“I try to bring in whoever can help build a support system for the child,” Lawson says, “because an hour a week [of counseling] is woefully inadequate, and I need to have them able to take what they learn in therapy into the home.”

In many cases, parents or caregivers need help learning how to support the abused child emotionally, he says. When parents come to sessions with their children, the counselor can help the parents learn not just the best way to support the child in therapy, but also how to strengthen their parenting skills.

“We really emphasize connection,” Lawson says. “Once they [abused children] have attachment, they may be ready to tell parents about their abuse and may just blurt it out at home. I try to prepare parents to listen to the child. If the parents are not comfortable addressing this [topic], I have them at least write down what the child says and then use that as a therapeutic prompt.”

In sessions, Lawson guides parents, teaching them how to interact and better bond with children who have been traumatized. Some parents and caregivers have never really learned how to play with their children, he says.

At the same time, he notes that learning positive interaction skills is not just about the fun stuff. Parents and caregivers also need to know how to effectively discipline the child. “Many times when parents find out that their child has been abused, they are hesitant to discipline or correct behavior because they feel sorry for them,” he says. “Or they come down too hard.”

Lawson encourages parents to use time-outs, to not respond when a child is acting out with attention-getting behavior and to not use corporal punishment.

In the absence of parents or other supportive adults, the counselor may become the stabilizing adult in a traumatized child’s life. Although the counselor is not with the child as often as a parent or caregiver would be, just having someone who is concerned and will listen to whatever the child wants to say can be enough for an abused child to start to heal, Lawson says, even if he or she never chooses to talk about the abuse. He notes that even in the absence of other supportive figures, the therapeutic bond between counselor and child can help in decreasing hyperarousal.

Counselors need to know that although it may seem best to address the child’s trauma right away, establishing and cementing the therapeutic relationship must come first, Lawson says. The child needs to feel safe and supported — even if it is only in the counselor’s office — before he or she can begin to process the trauma.

“You’re trying to get them in a safe place if possible, or at least a predictable place,” Lawson says. “Then we can start teaching them how to cope [with the trauma] without lashing out or
avoiding it.”

Abused children do not know how to cope with what they are experiencing, Lawson says. It is common for children who are traumatized to lash out in anger when stressed and to feel that the best way to establish some sort of stability in their lives is to try to control everything. They may be moody, irritable or withdrawn. Abused children may also bully and hit other children or turn their anger on themselves and engage in self-abusive behaviors such as cutting.

Once a child feels supported, the counselor can also begin to teach the child how to self-soothe. Lawson guides traumatized children in using calming techniques such as diaphragmatic breathing or grounding themselves by focusing on something external such as the ticking of the clock or the texture of their clothes. “The point is to experience emotions in a safe place and cut out bad coping behaviors,” he says.

Safety first

Jennifer Foster, an assistant professor in the Department of Counselor Education and Counseling Psychology at Western Michigan University, studies child sexual abuse. Much of her research has involved listening to the narratives of abuse victims and how they perceive what has happened to them. Although these children display myriad reactions and emotions, Foster says two themes are always prominent: fear and safety.

“Child victims of sexual abuse often view the world as unsafe and are likely to enter counseling with unresolved fears,” Foster says. “They need help from their counselor to learn how to cope with their fears.”

“Although adults often see disclosure as a positive thing that will put an end to the abuse, for many children it is embarrassing and frightening, especially for those who feel at fault for their abuse and believe they will be blamed or, worse, not believed,” says Foster, who studied the experiences of sexually abused children for her dissertation.

Several counseling interventions are designed to help sexually abused children regain a sense of safety. One is called the “safe place technique,” in which a counselor guides the child in visualizing and vividly describing an imaginary safe place.

“The counselor may say, ‘Close your eyes and picture a special place where you feel completely safe,’” Foster explains. “This can be followed by specific questions to capture additional details such as: What do you see? What do you hear? What do you feel? What are you doing in your safe place? The details are recorded by the counselor and used to create a script.”

Once the safe place has been established, the child can return to it mentally anytime he or she feels stressed or scared, Foster says.

Another intervention called the “comfort kit,” developed by Liana Lowenstein, helps children who engage in nonsuicidal self-injury to learn self-soothing strategies, says Foster. “Counselors help children brainstorm and create a list of items that bring them comfort and make them feel better,” she explains. “Although the process is guided by the counselor, children are the ones who choose what will go inside their box or bag.”

Foster says children commonly include items such as a blanket, music, a favorite stuffed animal, written or recorded guided imagery, a stress ball, a list of relaxation activities, bubbles (for deep breathing exercises), a favorite book, a picture of a caring person or special place, a journal and pen, art supplies and a list of self-affirmations.

Foster is also a proponent of bibliotherapy. “Children’s books about sexual abuse can introduce child victims to others who have had similar experiences, which may lead to decreased feelings of isolation and normalize their trauma-related symptoms,” she says.

Books can also provide comfort, offer coping suggestions and teach kids important lessons such as that the abuse is not their fault, Foster adds.

Because fear is a predominant issue for child victims of sexual abuse, Foster also recommends stories that specifically address feeling afraid. Her suggestions include Once Upon a Time: Therapeutic Stories That Teach and Heal by Nancy Davis and A Terrible Thing Happened: A Story for Children Who Have Witnessed Violence or Trauma by Margaret Holmes. To help older adolescents explore their memories and feelings connected to sexual abuse, Foster recommends The Secret: Art & Healing from Sexual Abuse by Francie Lyshak-Stelzer. Foster notes that the author’s artwork is particularly effective at capturing fear and the myriad other feelings generated by abuse.

Finding relief through play

Play therapy is one of the most commonly used interventions with children, particularly those who have suffered complex trauma, meaning they have experienced long-term (and often multiple types of) abuse, says Roaten, an LPC who works with traumatized children in clinics and schools, and an associate professor at Hardin-Simmons University in Abilene, Texas.

Most therapeutic playrooms feature a fairly specific set of toys that might include an art center, play dough, a Bobo doll (an inflatable plastic doll modeled after the inflatable clown used in Alfred Bandura’s seminal study on children and aggression), a dollhouse with miniature people, animal figures, toy weapons, costumes and a sandbox. These toys and activities help children to act out their experiences in a safe and less negative manner, Roaten says. For instance, she recounts treating one child who “would just attack and slash the doll where the penis was. She was a victim of sexual abuse.”

In some cases, Roaten says, children just “play through,” processing their trauma entirely through play without needing to talk to the play therapist.

In many instances, Baggerly says, traumatized children act out things they aren’t able to verbalize. She once treated a 6-year-old who didn’t speak for about 10 sessions because the girl had a severe case of internalized anxiety and depression. But as the girl played, she would express her rage by taking a gun and shooting the Bobo doll in the head, stomach and groin area. Baggerly took this cue as a chance to ask the child about the anger and hurt she was feeling.

Catherine Tucker, a licensed mental health counselor who works with traumatized children in her role as a counselor supervisor and consultant, uses a child and family therapy called Theraplay, which was developed by the Theraplay Institute in the 1960s. “Theraplay works on a four-dimensional model: structure, nurture, engagement and challenge,” says Tucker, an associate professor in the college of education at Indiana State University.

Theraplay builds and enhances attachment, self-esteem, trust in others and engagement through participation in simple games. The idea is that the four dimensions — structure, nurture, engagement and challenge — are needed by children for healthy emotional and psychological development. The “play” in Theraplay is built around activities that teach participants what the elements of those dimensions are. Ideally, children engage in Theraplay with their parents or caregivers. Participating together teaches skills to parents or caregivers who don’t know how to provide the four dimensions, while enhancing the bond with the child. In the absence of parents or caregivers — whether because they are abusive or because they cannot or do not want to participate — the counselor plays directly with the child so the child can still learn how to interact in an emotionally healthy way.

The games and activities are simple — suitable for children as young as 1, yet still engaging for older children — and include things such as blowing bubbles, playing with stuffed animals, cotton ball hockey, cotton ball wars and newspaper basketball. The activities teach parenting skills and also help traumatized children with affect regulation, impulse control, feeling safe and not feeling like they have to be in control of the world, Tucker says. She notes that, oftentimes, kids who have suffered trauma feel like they have to be in charge either because a parent is abusive or simply doesn’t know how to provide a sense of security or stability, or because the child’s sense of control is being undermined by the abuse he or she experienced at the hands of another adult or peer.

Finding help at school

Counselors who are treating traumatized children should tap all available resources to help these clients, Lawson says, working not only with caregivers or other relatives but also with the child’s school. School counselors may be a source of additional one-on-one counseling for the child, or they could get the child involved in group activities with other children who are trauma victims or with children who share common interests such as music, sports or art, Lawson says. These peer networks provide abused children additional sources of support and can also teach them how to interact with people — something that many abused and isolated children have never learned to do.

Perpetrators of abuse seek to control and isolate their victims. An abusive parent has the power to cut off or severely limit a child’s healthy interactions with people outside of the circle of abuse. “[These] kids often didn’t learn social skills because they are kept away from other people,” Lawson says.

Abuse is often part of a viciously long-lived cycle, handed down from generation to generation, Lawson adds. Parents who were abused as children often grow up to abuse their own children. Even if parents with an abusive background are not abusive themselves, they may still carry on other dysfunctional behaviors, he says.

“You may have three or four generations of people [who] have a very skewed view of how to interact with people,” he says. “So they never learn how to interact with others. You have to help [these children] connect with other sources.”

School counselors also can play important roles as advocates and educators. Many people — including teachers and administrators — do not understand that many children who act out are doing so because they have been or are being abused, Tucker asserts.

“School counselors can really make a difference by making sure that kids get evaluated instead of just automatically disciplined,” Tucker says.

“So many boys end up in the criminal justice system because they were physically acting out in response to trauma,” she adds.

School counselors can also help abused and traumatized children learn how to help themselves, says Elsa Leggett, an ACA member, associate professor of counseling at the University of Houston-Victoria and president of the Association for Child and Adolescent Counseling.

“Talk to kids about safety plans,” Leggett urges. “Ask them, ‘When abusive things are going on at home, where do you go? How do you know when things are getting dangerous?’”

The most important thing that all practicing counselors can do to address childhood trauma is to ask questions, Lawson says. Children — and sometimes adults who were traumatized as children — don’t always recognize what they’ve experienced as abuse, so rather than asking “have you been abused?” Lawson instructs his students to pose questions such as “has anyone ever hit you?” and “has anyone ever touched you in a way that made you feel uncomfortable?”

ACA member Cynthia Miller is an assistant professor of counseling at South University in Richmond, Virginia, and an LPC who has worked with incarcerated women. She has seen the kind of positive change that can occur when people get the help they need, but she has also witnessed the pattern of incarceration, addiction and institutionalization that can become entrenched in generation after generation.

“If you want to decrease the amount of money we spend on treating people with substance abuse or incarceration,” Miller says, “address child abuse.”

Caring for children during a disaster

Although ongoing trauma causes the biggest and longest-lasting kind of damage, one-time events can also create problems that linger. It is particularly important for children to receive timely counseling intervention, experts say.

“Typically, most children will have short-term responses to a disaster that include five basic realms,” Baggerly says. These realms are:

  • Physical: Symptoms include headache or stomachache
  • Thought process: Children exhibit confusion and inattention
  • Emotional: Children are scared and sad
  • Behavioral: Children might become very withdrawn or clingy, or may start sucking their thumb or wetting the bed again
  • Spiritual/worldview: Children may question their beliefs about God and the world

(For more information about typical trauma responses and recommended interventions, see “Children’s trauma responses and intervention guidelines” below.)

“Typically these [responses] don’t last long,” Baggerly says, “but that depends on the kind of support kids get in the immediate aftermath.”

Ultimately, the purpose of any counseling intervention after a traumatic event is to reduce or eliminate a child’s anxiety and stress, Baggerly asserts. She attempts to do that by “resetting” the child and connecting him or her to coping strategies.

“They need caring family and community support,” Baggerly says, “but if it is a huge disaster, then parents and teachers are equally traumatized, so they are not able to give support to kids. That’s when you need to bring people from outside.”

Some children are at greater risk than others, Baggerly says. “Kids who don’t have supportive family [and] who already have anxiety or have some type of developmental disability often will have ongoing symptoms that go longer than 30 days,” she explains. “Counselors need to triage to find out who is at most risk.”

During her roughly dozen years of experience working with chronic trauma and disasters, Baggerly has developed an integrated approach that she calls disaster response play therapy. The approach uses a trauma-informed philosophy in which counselors train parents and teachers in typical and atypical reactions to disasters so they can screen children and determine which ones need more help, she explains. “We also normalize typical symptoms, provide psychoeducation that informs kids about the impact of disasters, teach them coping strategies and provide them with child-centered play therapy.”

Baggerly usually begins by gathering a group of children and talking with them about rebuilding the community. She also encourages children to use expressive arts or drama to communicate their feelings.

“The other part of what we do is facilitate connection and conversation between kids and parents,” Baggerly says. “We may start out with Theraplay and do structured activities, such as holding hands or singing ‘Row, Row, Row Your Boat.’ The point is to have them [parents and children] looking at each other so that the mirror neurons can be engaged.”

Baggerly also educates parents on activities they can do at home with their children. She refers them to an online workbook, “After the Storm,” which has scales of 1 to 10 or a thermometer that kids can fill in to indicate how much stress they are feeling.

Roaten often does volunteer trauma work and provided on-site support in the wake of the April 2013 fertilizer plant explosion in West, Texas, that killed 15 people, injured more than 150 and caused extensive damage to buildings and property.

“One girl, a seventh-grader, had been standing outside in a neighborhood with a view of the plant and observed the explosion itself,” Roaten says. “So she had that image in her head and it would not go away. I taught her some deep breathing and progressive relaxation and did some guided imagery about her favorite place to be.

“When that picture came up in her mind, she could breathe, relax and go to her good place. By the fourth day I was there, she was no longer seeing the image.”

Roaten uses expressive therapy for children who aren’t very verbal or who don’t have the vocabulary to talk about their feelings. She brings a sand tray with miniatures of fences, people and buildings. She then allows children (and even adults) to set up scenarios or vignettes that help them express and act out what they are feeling.

“I might say something like, ‘Create your world before [Hurricane] Katrina; then create your world after Katrina,” Roaten explains.

Roaten also uses trauma-focused cognitive behavior therapy to help children and adolescents learn coping skills.

“You teach them about trauma and its impact on them,” she explains. “Then you teach them relaxation and breathing skills. Once you get them to be able to self-soothe, relax and be calm, you can help them deal with pictures or scenarios that come up. You help them change the story — what they are telling themselves and what that means — which helps them work through the trauma a little bit at a time.”

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Children’s trauma responses and intervention guidelines

 

Preschool through 2nd grade

Typical trauma responses:

  • Believes death is reversible
  • Magical thinking
  • Intense but brief grief responses
  • Worries others will die
  • Separation anxiety
  • Avoidance
  • Regressive symptoms
  • Fear of the dark
  • Reenactment through traumatic play

Intervention guidelines:

  • Give simple, concrete explanations as needed
  • Provide physical closeness
  • Allow expression through play
  • Read storybooks such as A Terrible Thing Happened, Brave Bart, Don’t Pop Your Cork on Monday

 

3rd through 6th grade

Typical trauma responses:

  • Asks a lot of questions
  • Begins to understand that death is permanent
  • Worries about own death
  • Increased fighting and aggression
  • Hyperactivity and inattentiveness
  • Withdrawal from friends
  • Reenactment though traumatic play

Intervention guidelines:

  • Give clear, accurate explanations
  • Allow expression through art, play or journaling
  • Read storybooks

 

Middle school

Typical trauma responses:

  • Physical symptoms such as headaches and stomachaches
  • Wide range of emotions
  • More verbal but still needs physical outlet
  • Arguments and fighting
  • Moodiness

Intervention guidelines:

  • Be accepting of moodiness
  • Be supportive and discuss when they are ready
  • Groups with structured activities or games

 

High school

Typical trauma responses:

  • Understands death is irreversible but believe it won’t happen to them
  • Depression
  • Risk-taking behaviors
  • Lack of concentration
  • Decline in responsible behavior
  • Apathy
  • Rebellion at home or school

Intervention guidelines:

  • Listen
  • Encourage expression of feelings
  • Groups with guiding questions and projects

 

Source: “Systematic Trauma Interventions for Children: A 10-Step Protocol,” by Jennifer Baggerly in Terrorism, Trauma and Tragedies: A Counselor’s Guide to Preparing and Responding, third edition, American Counseling Association Foundation, 201

 

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ACA Traumatology Interest Network

Counselors and counselors-in-training who have an interest in providing counseling services to trauma- or disaster-affected individuals and communities should consider joining the ACA Traumatology Interest Network. Network participants share insights, experiences, new plans and advances in trauma counseling services. For more information on joining the interest network, go to counseling.org/aca-community/aca-groups/interest-networks.

 

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To contact individuals interviewed for this article, email:

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org

Triumph tales: Counselors’ domestic violence research project blossoms into website, social media campaign highlighting survivors’ personal stories

By Bethany Bray March 20, 2014

seethetriumphWhile surveying survivors of domestic violence for a recent research project, Allison Crowe and Christine Murray were thoroughly compelled by the stories they heard. So much so that they knew the stories should be shared with a wider audience rather than limited to publication in an academic journal.

In one case, an interviewee said she was fired because her employer didn’t want her abusive spouse showing up at the workplace to stalk her. In another case, a police officer asked a victim of domestic violence out on a date when she came to the station to file a report. Another participant said her doctor told her she was “stupid” for not leaving an abusive husband.

Crowe and Murray, counselor educators and American Counseling Association members who focus on domestic violence and family counseling, launched the “See the Triumph” campaign in January 2013.

While they still plan to publish their research — their article is currently undergoing peer review at a journal – the duo is putting much of their effort into managing a website and social media campaign to share their research findings and spread awareness of the complicated issues and stigma that surround domestic violence.

The project title, “See the Triumph,” is part of a quote from one of their interviewees, who spoke of the triumph of surviving abuse and starting life over.

“The stories that we heard were overwhelming,” says Crowe, an assistant professor of counseling at East Carolina University, a licensed professional counselor and an approved clinical supervisor. “I was taken aback by the poignancy of what these [people] experienced. When someone sees you as ‘she lets her husband beat her,’ people start forming ideas about you.”

Crowe and Murray surveyed more than 230 men and women for their research.

They believe the website and social media campaign offer more timely and immediate ways of sharing their data, while also allowing them to reach a wider population than those who read professional or academic journals.

“We had the data and felt like we needed to do more with it,” Crowe says. “We decided to spread the results in an innovative, nontraditional way. … We wanted to reach more people.”

Seethetriumph.org hosts a blog written by Crowe, Murray and guest bloggers. It also contains a plethora of information and links to resources about domestic violence, such as a “checklist” of questions domestic violence survivors can ask their potential counselors to see if they are properly trained to deal with such a complicated and nuanced issue.

Through their research, the duo has found that domestic violence survivors want –- sometimes even crave the chance — to “share their stories,” says Murray, an associate professor in the University of North Carolina at Greensboro (UNCG) Department of Counseling and Educational Development.

Participants felt validated by talking about what they had been through, says Murray, a licensed professional counselor and licensed marriage and family therapist.

Additionally, some interviewees felt sharing what they had been through and overcome could help others who were still experiencing domestic violence, says Crowe.

“An incredible takeaway is how [survivors] want to help each other,” she says. “Their enthusiasm and passion for helping each other [and] doing what they can was really mind-blowing.”

Crowe and Murray continue to accept survivor narratives through a survey at seethetriumph.org. They are also launching another round of research focusing on immigrants’ perceptions of domestic violence, stigma and culture. A survey for first- and second-generation immigrants is posted on the See the Triumph home page.

Crowe and Murray’s research project began as an exploration of the term “stigma” and its connection to domestic violence.

“There’s a lot more than just blame in the term ‘stigma’,” Crowe explains. “[It involves] blame, discrimination, labeling, secrecy, shame, social exclusion, stereotyping and losing status or power.”

The duo conducted face-to-face interviews with domestic violence survivors about the stigma they experienced in general society as well as at the hands of professional helpers such as police officers, lawyers, medical personnel, mental health workers and others. Crowe and Murray spoke with 12 women, conducting hourlong interviews with each.

The interviews were poignant, says Crowe, and confirmed that many domestic violence survivors do experience stigma, such as the woman who was asked out on a date by the police officer she turned to for help.

Crowe and Murray then expanded their research, surveying more than 200 men and women in the United States and internationally who had experienced domestic violence. For this second round of research, they conducted an online survey with open-ended questions about stigma.

In case after case, interviewees talked of experiencing stigma, from the assumptions people made, such as the belief that abuse victims somehow invite or bring the abuse upon themselves, to a religious leader who told a victim it was her responsibility to keep her marriage to an abusive spouse together at all costs.

“Our results confirmed what we felt in the first round,” Crowe says. “Those results were unfortunate, but very important to us.”

The duo launched Seethetriumph.org and their social media campaign last year after receiving approval from their universities’ research boards.

“One really surprising and rewarding part of this has been the ability to be a part of someone’s healing,” says Crowe. “[The fact] that they can use this as a vehicle for healing is incredible. I think the role of advocate has really been brought out in me and Christine.”

 

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On the web: seethetriumph.org

 

Sample blog posts:

 

“Finding a counselor who is competent to serve survivors”

bit.ly/1gtBlsL

 

“Five things I wish I had known when I left”

bit.ly/1nU6oUp

 

“Being a victim, being a survivor and triumphing: The words that describe our experiences”

bit.ly/1fzP7y3

 

“Intimate partner violence affects everybody, even you”

bit.ly/1dViTfm

 

 

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See the April issue of Counseling Today for an in-depth feature article on counseling victims, survivors and perpetrators of domestic violence, to which Crowe and Murray contributed.

 

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

 

Follow Counseling Today on Twitter @ACA_CTonline