The Link between Childhood Trauma and Mental Illness: Effective Interventions for Mental Health Professionals
Publication Year: 2001
This informative book gives mental health professionals who are not child abuse specialists knowledge and skills that are especially relevant to their direct service role and practice context. It introduces to these practitioners a conceptual bridge between biomedical and psychosocial understandings of mental disorder, providing a multidimensional approach that allows professionals to think holistically and connect clients' abusive pasts with their present-day symptoms and behaviors. It includes reviews of the most up-to-date findings with direct practice guides in helping clients.
- Front Matter
- Back Matter
- Subject Index
Part 1: Theory and Knowledge
- Chapter 1: Why We Often Miss a History of Childhood Trauma
- Systemic Barriers
- Individual Barriers within Mental Health Professionals
- Barriers within Survivors
- Chapter 2: A Multidimensional Model of Understanding
- The Need for a New Model
- Dimensions of the Model
- A Multidimensional Model
- Chapter 3: The Research Story
- Issues in Abuse Research
- Prevalence Rates: Community Samples
- Prevalence Rates: Clinical Populations
- Prevalence Rates for Specific Disorders
- Mental Health Professionals' Response to Childhood Trauma
- Chapter 4: Recognizing the Signs and Symptoms
- Complex Posttraumatic Stress Disorder
- Four Defining Signs
- Physical Indicators
- Emotional Indicators
- Relational Indicators
- Chapter 5: The Controversy Surrounding Traumatic Memory
- Why We Need to Know about Memory
- Memory Storage and Retrieval
- Traumatic Memory
- Recovered Memories
- Memory and Suggestibility
- The False Memory Syndrome Foundation
- Practice Issues for Mental Health Professionals
- Chapter 6: Asking about Abuse
- Why Professionals Resist Asking
- Research on the Asking Process
- Asking about Abuse
- Appendix A
Part 2: Effective Interventions
- Chapter 7: Understanding Power
- Mental Health Laws as “Power over”
- The Voluntary Helping Frame, or “Power with”
- Healthy “Power with” Relationships
- Liberation Tactics
- Using “Power over” Responsibly
- Appendix A
- Chapter 8: The Healing and Recovery Process
- How Does Talking Help?
- Therapy Defined
- The Therapeutic Tasks of Recovery
- Chapter 9: Treatment Models
- Models Defined
- Cognitive-Behavioral Therapy
- Solution-Focused Therapy
- Eye Movement Desensitization and Reprocessing
- Treatment for People with Dissociative Identity Disorder
- Group Therapy
- When Nothing Works
- Chapter 10: Promoting Client Safety
- Relational Safety
- Emotional Safety
- Physical Safety
- Safety in Inpatient and Involuntary Settings
- Chapter 11: How to Listen to, Hear, and Understand Clients' Stories
- The Time and Place for Storytelling
- Listening, Hearing, and Understanding
- Final Cautions
- Chapter 12: Crisis Care
- Recognizing and Preventing Crisis States
- Crisis Assessment: Basic Principles and Techniques
- Suicide, Assault, and Homicide Risk Assessment
- Planning and Implementing Crisis Care
- Chapter 13: The Invisibility of Men's Pain
- Prevalence Rates
- Myths about Male Survivors
- The Role of Gender Socialization
- Case Studies
- The Work of the Group
- Chapter 14: Racism, Oppression, and Childhood Trauma
- Epidemiology and Definitions of Child Abuse
- Broadening the Definition of Child Abuse: Community Violence, War, and Torture
- Epidemiology and Definitions Reconsidered
- Mental Health
- Problems, Critiques, and New Frameworks
- Implications for Practice
- Chapter 15: Personal and Professional Self-Care
- Personal Balance
- Professional Effectiveness
- The Work Environment
- Vicarious Traumatization
- Professionals Who are Survivors of Childhood Trauma
[Page ii]To our clients, past and present.
To all survivors of childhood trauma, and to the dedicated mental health professionals who walk with them, one step or many, on their journey toward healing and recovery.
Copyright © 2001 by Sage Publications, Inc.
All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher.
Sage Publications, Inc.
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Sage Publications Ltd.
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Printed in the United States of America
Library of Congress Cataloging-in-Publication Data
The link between childhood trauma and mental illness: Effective interventions for mental health professionals / by Barbara Everett and Ruth Gallop.
ISBN 0-7619-1698-9 (alk. paper) — ISBN 0-7619-1699-7 (pbk. : alk. paper)
1. Adult child abuse victims. I. Gallop, Ruth. II. Title.
RC569.5.C55 E94 2000
This book is printed on acid-free paper.
01 02 03 04 05 06 07 7 6 5 4 3 2
Acquisition Editor: Nancy Hale
Production Editor: Sanford Robinson
Editorial Assistant: Candice Crosetti
Typesetter: Danielle Dillahunt
Indexer: Jean Casalegno
Cover Designer: Michelle Lee
Many people seeking help from the mental health system have histories of childhood trauma, defined in this work as sexual and physical abuse. In fact, up to two thirds of women hospitalized in psychiatric settings report a history of child abuse. Although many authors write on the topic of specialized therapy for abuse survivors, little is available for other mental health professionals, such as psychiatric nurses, case managers, rehabilitation counselors, crisis and housing workers, occupational and physical therapists, family physicians, and social workers. These important practitioners are often the first to hear about abuse, and they are likely to be caring for clients experiencing the severest consequences. They see firsthand the devastating results of child abuse, and they have a crucial role to play in helping clients heal and recover. They also have learning needs that differ from those of trauma treatment professionals. This book is designed for them.
Our goals are twofold:
- To provide mental health professionals who are not childhood trauma specialists with particular forms of knowledge and skills relevant to their direct service role and practice context. These professionals need to know when it is appropriate to ask clients about an abusive past, how [Page xii]to listen to disclosures with sensitivity, and how to integrate this information into their helping strategies.
- To introduce a conceptual bridge between biomedical and psychosocial understandings of mental disorder—a multidimensional approach that allows professionals to think in holistic terms and to link clients' abusive pasts with their present-day symptoms and behaviors.
Although each chapter can be read independently, the book is designed as a progression, with each part building upon the previous one. The first section is focused on providing the knowledge necessary to think critically about the many issues and debates that affect how mental health professionals in a variety of roles and settings provide services to survivors of childhood trauma. In Chapter 1, we briefly review the systemic and individual barriers that inhibit the acknowledgment of child abuse as an important factor in clients' backgrounds and constrain the inclusion of this information in our helping strategies. Next, we present a unique multidimensional model of understanding that unites, in a holistic relationship, factors such as the specific nature of the abuse, social and cultural values, genetics and biology, interpersonal relationships, and a sense of self and worldview. Chapters 3 and 4 review the research knowledge about the prevalence of childhood trauma and its potential impact in adult psychiatric and nonpsychiatric populations. Chapter 5 discusses not only the possible ways traumatic memory is stored and recalled, but also the controversial issues of recovered memory and false memory syndrome. Finally, as a lead-in to the book's second section on practice issues, Chapter 6 introduces the topic of asking about child abuse. For many mental health professionals, asking clients about their abusive pasts is anxiety producing. We believe the guidelines in this chapter will facilitate comfort for both the professional and the client.
Part 2 of the book is focused on client-professional relationships and active practice strategies. In Chapter 7, we consider the nature of power in the helping relationship by discussing both “power over” and “power with.” “Given the centrality of abuse survivors” experiences of both powerlessness and the misuse of power, understanding how power works in the mental health system as a whole, as well as in client-professional relationships, is critical. Chapters 8, 9, and 10 highlight issues such as the full recovery process; credible treatment models; the creation of basic relational, [Page xiii]emotional, and physical safety; and ways to listen to clients' stories so that, as professionals, we can make sense of what we are hearing.
In the book's last chapters, we address special topics by utilizing the expertise of three guest authors. Dr. Lee Ann Hoff, an authority in crisis theory and practice, considers the abuse survivor who is overwhelmed by crisis events. She provides both a theoretical basis for action and practical guidelines for offering care and intervention. A chapter is also especially devoted to men's concerns, because research and clinical literature have been focused predominantly on women. Although we have tried to ensure that the book's previous sections are applicable to men as well as women, John McManiman provides his own insights into the needs of men. Dr. Kathy Lawrence works with the families of survivors of civil war and torture, and she writes about the special issues facing clients from diverse ethnoracial and ethnocultural backgrounds. Finally, we address personal and professional self-care, because working with survivors of childhood trauma has special dangers, such as secondary trauma and vicarious traumatization, both of which go well beyond burnout.
As joint authors, we represent a partnership between theory and practice that has functioned as a unifying force in our own thinking. Throughout the writing of this text, we have endeavored to present a balanced review of current models, practice strategies, and controversies. It is our hope that our work will deepen professional understanding of the link between childhood trauma and mental disorder and improve the capacity of mental health professionals to provide real, meaningful help.Note
1. Emotional abuse is also a component of childhood trauma, but there is little research defining its consequences. Thus, the principal focus of this text will be sexual and physical abuse.[Page xiv]
About the Authors[Page 329]
Barbara Everett, M.S.W., Ph.D., has worked in both hospital and community mental health services in a variety of professional roles, from social worker to senior manager. Her clinical focus has been the provision of psychotherapy for people suffering from complex posttraumatic stress disorder. She presently works as a consultant providing services such as clinical skills development workshops, clinical consultation and supervision, and program development and evaluation. She is also the author of A Fragile Revolution: Consumers and Psychiatric Survivors Confront the Power of the Mental Health System and has published a number of journal articles.
Ruth Gallop, R.N., Ph.D., is Professor and Associate Dean of Research in the Faculty of Nursing, University of Toronto. She is cross-appointed to the Department of Psychiatry and the Women's Mental Health Program at the Centre for Addiction and Mental Health. She writes, researches, and consults extensively on issues related to the treatment and care of women in the mental health system who receive the diagnosis of borderline personality disorder and of women in the mental health system who have experienced childhood sexual abuse.
[Page 330]Lee Ann Hoff, Ph.D., author of People in Crisis and (with K. Adamowski) Creating Excellence in Crisis Care, is an internationally renowned educator, crisis practitioner, nurse-anthropologist, and consultant. She is the first recipient of the National Services Award for her work in developing crisis service standards.
Kathy J. Lawrence, Ph.D., C. Psych., is a clinical psychologist who is currently working with young offenders and their families at Lutherwood Community Opportunities Development Association (CODA) in Waterloo, Ontario, Canada. Her primary clinical and research interests are in the areas of psychosocial impact of sexual violence against adolescents and adults, sexual offending behavior, and the development of clinical and community-based interventions. She has worked extensively with women and men who have been traumatized by family violence, and she has also worked with those who have been traumatized by community-based violence and civil war. Dr. Lawrence has provided workshops for health care professionals regarding the identification and assessment of and interventions related to woman abuse, and she has published in the area of posttraumatic stress disorder.
John McManiman, M.Ed., M.Div., Th.M., in 1988 co-led one of the first Toronto groups for male survivors of sexual assault, and he has continued to work extensively with traumatized men throughout his career. He added to his knowledge by becoming an addictions counselor and a co-leader of numerous groups for violent men. Presently, he works for a family-counseling agency, and in his spare time, he writes.