Thank goodness we have come a long way from when soldiers returning from war suffering a traumatic neurosis were seen as malingering, or judged as being weak or cowards. Recognition and validation is now given to the trauma resulting not only from war, or natural disasters, or sexual and physical assault … but also to the traumatizing effects of mental and emotional abuse.
There is a spectrum of traumatic disorders, ranging from the effects of a single overwhelming event (such as a violent personal assault – including sexual assault, physical assault, robbery, or mugging; a natural or manmade disaster; or a serious car or other vehicle accident), to the more complicated effects of prolonged and repeated abuse (as in the case of hostages, prisoners of war, religious cults, domestic physical/sexual/emotional abuse, and childhood physical/sexual/emotional abuse (see Childhood abuse and trauma).
Common symptoms and difficulties that can result from experiencing a single traumatic event include:
- persistent distressing thoughts and memories of the traumatic event;
- persistent distressing dreams about the traumatic event;
- ‘flashbacks’ or reliving the traumatic event;
- feelings of re-experiencing the traumatic event;
- distress and/or physical reaction to reminders of the traumatic event;
- effort to avoid thinking, feeling, and/or talking about the traumatic event;
- avoiding reminders of the traumatic event;
- feeling numb and detached;
- loss of interest in usual activities;
- sleep difficulties;
- irritability/outbursts of anger;
- feeling on edge/easily startled.
However, complex trauma, involving prolonged and repeated abuse, often results in the development of characteristic personality changes, including deformation of relatedness and identity. As a result of this, the traumatized individual can be particularly vulnerable to repeated harm (Herman, 1997, pp. 119). According to Herman (1997), “repeated trauma in adult life erodes the structure of the personality already formed, but repeated trauma in childhood forms and deforms the personality” (p. 96). (see Childhood abuse and trauma)
Cognitive Behaviour Therapy (CBT) can be effective in treating trauma, by:
- providing information and an explanation about the trauma reaction (a ‘normal reaction to an abnormal event’);
- providing a range of strategies for managing distressing symptoms;
- assisting with graded exposure to trauma-related stimuli; and
- the use of cognitive-restructuring to modify distorted thinking and beliefs around the trauma.
Psychodynamic psychotherapy endeavours to provide a safe, supportive, and understanding ambience whereby the nature and meaning of the trauma can be explored, and the painful feelings associated with the trauma can be worked through. The therapeutic relationship can also provide the respect and empathic understanding necessary to develop (or restore) a robust and healthy personality structure (enabling healthy relating). Thereby, psychodynamic psychotherapy is particularly relevant for prolonged and repeated abuse.
Herman, J. L. (1997). Trauma and recovery. New York: Basic Books.