Reflections on the Trauma Model

In the introduction to Ambivalent Goddesses, I mentioned the trauma model was insufficient for complete recovery from sexual abuse. Nevertheless, I started the project by focusing on the trauma model with enthusiasm. Before I shift focus a bit — sill relying on the trauma model (including introducing the model of structural dissociation) yet adding other perspectives and approaches — I want to share my reservations about the trauma model and how they relate to my understanding of recovery from sexual abuse.

Recovery from sexual abuse is a recent phenomena, although gender violence is not. Women have been experiencing sexual abuse since at least the Sumerian civilization codified laws around 2100 B.C.E. that legalized the maltreatment of women, including the lawful physical assault on prostitutes who veiled themselves in public. [1] Myths that highlighted the rape of their venerated goddess Inanna also emerged. [2] Ever since then, and everywhere on the planet, girls and women have lived with the possibility of sexual violence and coercion, and with sexual violence being part of the collective imagination. (Hunter gatherer societies, in contrast to civilizations and some tribal cultures, have not exhibited the same degradation of the feminine.) Yet the development of formalized methods for recovery didn’t become available until the 1980s. Only for 40 years or so has there been a focused effort to help girls, adolescents, and women recover from the affects of sexual abuse. Nevertheless, sexual abuse continues to be a threat to girls and women and part of the cultural imaginary.

If you have been a client or patient in the mental health field, perhaps like me you not only encountered therapists who had no idea how to support recovery from sexual abuse, you also worked with therapists whose methods aggravated your problems. The same can be said for some psychiatrists and their prescribing of medications. The trauma model has become an antidote to much of the uncertainty and unhelpful (if not harmful) approaches to recovery from sexual abuse and other traumas. It’s success is derived in large part from the reliance on research of neurobiology and human development. The trauma model has led to modalities that markedly improve well-being. Equally important, the focus on trauma as the source of mental suffering has created opportunities for people to openly speak about their histories of trauma rather than be diagnosed with a mental disorder that blames suffering on biology or poor character.

Like all psychotherapeutic approaches, the expertise and compassion of the practitioner is relevant to clinical success, as is the unique personhood of the client. In this regard, despite the scientific rigor of the trauma model, psychotherapy remains a ‘soft’ science. This is not a drawback. On the contrary, when the goal becomes formulating a ‘perfect’ scientific model in the mental health field, that is when problems arise. Most recently, the drive for an all-encompassing scientific approach can be witnessed in the proliferation of psychotropic drugs and attempts to medicalize psychological suffering as the product of synaptic gaps, neurotransmitters, and the like. The side effects of many psychotropic medications have led to reduced quality of life as well as shortened life spans. Furthermore, because many of the drugs are highly addictive, it takes a protracted period of time to withdraw from them.

The trauma model has also made errors in its quest for scientific validation. For instance, efforts to test desensitization led a significant number of veterans to prematurely end treatment because of the suffering experienced when expected to ‘relive’ their traumas. Another type of harm can arise when those of us who advocate for the trauma model foolishly try to reduce all aspects of recovery to the neurobiology of trauma. Not only do such efforts misrepresent the nature of trauma and recovery, they potentially prioritize a particular trauma-focused discourse, which in effect silences those who need to find their own way to express what they have experienced.

Granted, the trauma model is the scientifically based model that validates speaking our truths. It identifies the source of our problems in what happened to us, rather than something being wrong with us. Nevertheless, at the core of recovery from sexual abuse and other traumas is creating one’s own narrative and one’s own explanation of the nature of mind or psyche, along with the opportunity to grow into who one chooses to be. Sexual abuse is fundamentally about power, coercion, and degradation of the victim. Sexual abuse involves someone using his or her power and will to transform another human being to serve his or her needs and fantasies. The experience is a profound loss of selfhood that fragments one’s very being. Putting the pieces back together usually becomes an effort to find oneself again. Recovery works best when the survivor is in control of this process and decides for herself how best to story her life.

For centuries, girls, adolescents, and women have not been able to articulate their suffering. Most survivors still continue to cope with sexual abuse through silence, numbness, and dissociation. This is how women have been dealing with sexual abuse since the beginning of civilization. By now, such reactions may even be innate, since they have likely contributed to survival. Those who have not been able to silence their suffering have been at greater risk for further victimization. Even in the mental health field, women with histories of sexual abuse have typically received derogatory mental diagnoses such as hysteria and borderline personality disorder, and until recently, poor, if not inhumane, treatment.

In the United States an extraordinary number of youths with histories of sexual abuse end up in the juvenile justice system, many after escaping sexual abuse in the home. According to one study, in Oregon an astounding 93 percent of the female youths in their juvenile justice system had been sexually or physically abused as children. In California 81 percent of the girls in their juvenile justice system had histories of sexual abuse and other forms of adverse childhood experiences. Many of their actions — such as running away from home, self-medicating with drugs or alcohol, school truancy, shoplifting, and other defiant behaviors — are the outcome of the psychological, physiological, and social affects of sexual abuse and other forms of abuse. Yet what psychologists and social workers identify as reactions to abuse are regularly treated by the justice system as “status” offenses — behaviors that would not lead to incarceration as an adult, but can lead to incarceration as a juvenile because of their perceived antisocial aspects. Furthermore, according to researcher Linda Teplin of Northwestern University Medical School, girls who spent time in juvenile detention are five times more likely than the general population to die violently. In effect, the United States legal system implicitly colludes with the idea that girls and young women are somehow complicit in their own victimization when it treats them as criminals.

Given that most survivors of sexual abuse do not tell anyone what happened to them, there is a deep need to be heard, to feel accepted, and especially to feel as if we belong. We usually need encouragement to find our own ways for narrating our experiences, especially as we take on the discourses of those willing to listen to us. We need all the help we can get, yet we also need support to hear our truest voices.

Early in the history of trauma-informed care, there was an emphasis on witnessing the social and political forces that contribute to trauma, as well as efforts to combine psychological, sociological, and political lenses to address clients’ difficulties. Judith Herman observed, “Early investigators often felt strong personal bonds and political solidarity with trauma survivors, regarding them less as objects of dispassionate curiosity than as collaborators in a shared cause.”[3] She also cautioned, “This kind of closeness and mutuality may be difficult to sustain in a scientific culture where unbiased observation is thought to require a distant and impersonal stance.”

Today, professional dynamics between those who provide services and the clients/patients they support tend to ignore evidence from adverse childhood experiences surveys that reveal professionals in the mental health field have some of the highest numbers of adverse childhood experiences. Although professional standards are meant to protect clients and patients from their provider’s unethical disclosure and other behaviors, there is also the risk of failing to recognize the inherent power dynamics present in psychotherapeutic and psychiatric relationships. Furthermore, those of us who had to submit to sexual abuse often have heightened awareness of the subtleties of power, which can interfere with taking risks to express ourselves authentically. I appreciated when psychiatrist Bessel van der Kolk revealed how his own disregard of power in the therapeutic encounter was pointed out to him. He wrote, “Kathy [his patient] turned to me. ‘You know, Bessel,’ she said, ‘I know how important it is for you to be a good therapist, so when you make stupid comments like that, I usually thank you profusely. After all, I am an incest survivor—I was trained to take care of the needs of grown-up, insecure men.”[4]

There are a lot of compassionate trauma-focused therapists, just as most therapists genuinely care about their clients. However, given the current state of the mental health field — its efforts to model the medical industry, the push for narrow specialization, the medical-legal climate that has led therapists to behave more self-protectively than they would like, and the push for unrealistic quick results — the tendency is for the trauma model to become a cure-all that masks the uncertainty and messiness that is an inevitable part of recovery. At the core of recovery from sexual abuse is reintegrating and rediscovering selfhood, which ultimately is a unique journey for each of us. There is not one model. Furthermore, the path of those who have sought recovery from sexual abuse is not well-trodden. We’re pioneers in this effort, whether we want to be or not.

Many seasoned psychotherapists describe the practice of psychotherapy as both a science and an art. Similarly, I have found complete recovery requires a blend of both the sciences and humanities. We need the wisdom of neurobiology, psychology, sociology, politics, history, philosophy, literature, spirituality, and art when we are in recovery. When the science is solid (and not merely theoretical) it should be part of our recovery. However, humans can never be reduced simply to biology.

Every human being has many parts. We each have interests, ways of being social, people we prefer, political ideals, tastes in music, favorite seasons and environs, and the unique and artful expression of our souls. We fantasize, worship, fall in and out of love, get angry and seek justice, and collapse in despair. We want work deserving of our talents, and we want to be talented. We care for the young and the old, and we hope for things to be good, if not better. All of this is really what recovery is about — becoming all that we are, and authentically expressing our personhood before we die.

Yet when the effects of trauma make it difficult to find our humanity and engage meaningfully with what matters to us, or even know what we genuinely care about, we need ways of finding our way home to ourselves. So far, Ambivalent Goddesses has focused on those moments when we get off track — getting off track is part of the process! — and get lost in what Peter Levine called the trauma vortex. [5] Those are the times we need skills and methods for pulling ourselves back to the life we want to live and love. And despite my reservations about the current trend towards explaining almost every reaction a trauma survivor has according to the trauma model, I believe it’s one of the best ways to regain control and establish inner peace.

The material shared in weeks 2 through 10 is what I have found to be some of the most straightforward and supportive approaches to dealing with those moments when overwhelmed, experiencing inevitable setback, or just wanting to feel inner calm. I still use them. I also hope every trauma survivor has the opportunity to work with a trauma-informed specialist. I would not have come as far in my recovery had I not had trauma-focused treatment. Yet I rarely think of myself in terms of the neurobiology of trauma. In fact, my greatest personal growth came after I completed therapy. That’s just me. Others are different. Some even recover without any support from psychotherapists or psychiatrists. But that’s the point I’m hoping to make: we each have an opportunity to uniquely create our path to recovery. This is how it must be. Although, we all need support along the way. That is the one truism of recovery. Nevertheless, no one has all the answers, and that can be scary. Yet committing to recovery can also become one of the most empowering experiences of your life.

Questions to ponder: Is the trauma model supportive of your recovery? How or how not? What have your experiences with the mental health field been like? What conditions do you believe are most supportive of your recovery? 

See you next week,

Laura

References

  1. Rhea Nemet-Nejat, Karen. (1999). “Women in ancient Mesopotamia,” in Women’s Roles in Ancient Civilizations: A Reference Guide. Bella Vivante (Ed.). Westport, CT: Greenwood Press, p. 91.
  2. Noah Kramer, Samuel. (1963). The Sumerians: Their history, culture, and character. Chicago, IL: The University of Chicago Press.

  3. Herman, Judith. (1997). Trauma and recovery: The aftermath of violence—From domestic abuse to political terror. New York: BasicBooks, p. 240.

  4. Kolk, Bessel van der. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Viking, p. 128.
  5. Levine, Peter. (1997). Waking the tiger: Healing trauma. Berkeley, CA: North Atlantic Books.

© 2018 Laura K Kerr, PhD. All rights reserved (applies to writing and photography).