Trauma: Contemporary Directions in Theory, Practice, and Research

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Edited by: Shoshana Ringel & Jerrold Brandell

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    Introduction

    Although there has been much scholarship devoted to the study of trauma, the field has expanded rapidly during the past decade as a result of several significant developments. From an earlier focus on the interpersonal aspects of trauma, including child abuse and domestic violence, traumatic experiences have taken on a political and social dimension, for example, the events of 9/11, the war on terror, and combat trauma associated with recent wars in Afghanistan and Iraq. Finally, the rash of school shootings in American public schools, increasingly linked to the problem of bullying, has also entered the domain of public awareness. These social and political phenomena have added to the magnitude of traumatic experiences in everyday life and created a more complex task for mental health professionals dealing with the effects of trauma.

    This book will present new developments in the conceptualization of trauma and trauma-related interventions from diverse clinical perspectives, including cognitive-behavioral therapy, psychodynamic therapy, and attachment theory. Clinical chapters will focus on various populations and themes associated with trauma: the use of art therapy with children who suffer loss and bereavement and who lost a parent during the 9/11 terror attacks, the impact of bullying on school children, developmental trauma in the lives of gay men, cultural and historical trauma among Native Americans, and finally, the impact of combat trauma on Israeli soldiers and the link between traumatic experiences encountered in combat and the grief associated with the loss of comrades and commanders.

    Because of its broad scope as well as its emphasis on the application of diverse theoretical viewpoints to a variety of posttraumatic situations, we believe this anthology represents a new and different, transtheoretical approach to clinical scholarship on trauma. Indeed, no social work text of which we are aware, and few written by authors with other professional backgrounds, has focused specifically on theoretical and clinical issues associated with trauma.

    This book is designed to provide a clear and accessible description of contemporary theoretical perspectives on trauma as well as clinical applications for treatment with a variety of populations, including both research outcomes on the utility of the approach and clinical vignettes to illustrate its usefulness.

    The following is the outline of the book:

    Chapter 1. Overview

    This chapter explores the history of trauma treatment for “shell-shocked” soldiers during World Wars I and II and after the Vietnam War. It considers the inclusion of PTSD in the American Psychiatric Association's Diagnostic and Statistical Manual in the 1980s and the influence of the women's movement on examining sexual abuse and violence against women. Finally, recent controversies regarding debriefing procedures in the aftermath of 9/11 and current trends regarding diagnosis and treatment of complex PTSD and developmental trauma are discussed.

    Part I. Theoretical Frameworks

    Chapter 2. Cognitive-Behavioral Theory

    In this chapter, the authors begin with a summary of cognitive-behavioral therapy and its application to clinical practice with traumatized individuals, including learning theory, cognitive models that address an overactive schemata regarding danger, failure to discriminate between safe and unsafe, cognitive dissonance, and disengagement from the trauma memory. Cognitive and behavioral approaches to treatment are also described, including cognitive restructuring (Beck), systematic desensitization (Wolpe), imaginal exposure and prolonged exposure therapy (Foa), virtual reality exposure, eye movement desensitization and reprocessing (Shapiro), and self-instructional therapy (Meichenbaum). The chapter concludes with a review of empirical evidence regarding cognitive-behavioral therapy and behavioral treatment approaches.

    Chapter 3. Psychoanalytic Theory (Part I)

    This chapter examines the development of psychodynamic thinking in relation to trauma, including Freud's earliest conception of loss and bereavement, Ferenczi's work with survivors of sexual abuse, Rank's theory of birth trauma, and the British (independent) object relations group including Fairbairn, Winnicott, and Balint. The chapter concludes with an examination of self psychological perspectives on trauma, illustrated in part through a case example.

    Chapter 4. Psychoanalytic Theory (Part II)

    Contemporary relational and intersubjective writers, including Benjamin, Ghent, Bromberg, and Bach, and their ideas regarding dissociation, mastery and submission, and “the third” are described in this chapter. The chapter also examines Davies and Frawley as well as Shane, Shane, and Gale and their contributions to the understanding of patient-therapist traumatic enactments; Stolorow's intersubjective traumatology theory; and Lichtenberg, Lachmann, and Fosshage's contemporary self psychological approach to trauma. Brief clinical vignettes are used to highlight these differing conceptions of trauma.

    Chapter 5. Attachment Theory, Infant Research, and Neurobiology

    In this chapter, attachment theory as applied to the study of trauma and disorganization is examined in detail. Bowlby's work on children's separation and loss is also summarized. Another focus is that of attachment disorganization and its sequelae in children and adults, highlighting the contributions of Mary Main, Lyons-Ruth, Liotti, Solomon, George, and others. The work of infant researchers including Beebe and Tronick is also presented in regard to infant/parent disorganization. The Adult Attachment Interview and the four attachment criteria are then discussed as they relate to traumatic experiences. Finally, neurobiological findings in regard to attachment disorganization are presented, including the work of Schore and others.

    Part II. Clinical Applications with Selected Populations

    Chapter 6. Art Therapy with Traumatically Bereaved Children

    Art therapy has been used effectively in the treatment of traumatized client populations for many years. As a nonverbal, sensory-based, enactive modality with narrative and symbolic potential, art making within a therapeutic relationship can access aspects of trauma experience that evade verbal processing. Brain research supports art therapy as a treatment that promotes hemispheric integration, linking the verbal with the nonverbal while containing affect. Specific techniques have been developed by art therapists, such as the instinctual trauma response to work with PTSD. Parental loss for children is considered traumatic, even when anticipated, due to the developmental stage of the child. When the death is sudden and violent, as in accident, suicide, or murder, actual trauma intensifies and complicates the grieving process. Art therapy application to bereavement work with children is the focus of this chapter. Case examples illustrate its effectiveness with specific traumatizing aspects of loss. Highlighted is work with children who lost parents in the 9/11 terror attacks.

    Chapter 7. Military Bereavement and Combat Trauma

    The stresses and traumas of combat and intervention paradigms have been studied intensively in the United States and Israel. In contrast, combat bereavement has not received due attention. The authors review posttraumatic stress in the military and current directions in intervention work. In particular, they distinguish between two main themes: PTSD due to life threat in combat and the experiences of interpersonal loss associated with the loss of valued “buddies” and commanding officers. The chapter concludes with research and clinical findings, with particular attention to work with combat bereavement and trauma in Israel.

    Chapter 8. The Trauma of Bullying Experiences

    This chapter offers an overview of bullying among children and adolescents. The various forms and their effects are reviewed, including direct (e.g., physical and verbal bullying), indirect (e.g., rumors and exclusion), and cyber forms (e.g., use of electronic technology to threaten, harass, and damage reputations). Research demonstrating the devastating effects of the various forms of bullying is also presented. As defined in this chapter, bullying is conceived as a relationship problem that requires relational solutions at the various levels of a child's or youth's social world, including individual, peers, school, family, community, and society. The chapter discusses the ways in which bullying of children and adolescents can be experienced as traumatic. A case example is also offered to highlight the importance of validation and attunement by adults to prevent or diminish the likelihood that a child or youth will experience bullying as traumatic.

    Chapter 9. Traumas of Development in the Gay Male

    This chapter examines the theme of trauma as it relates to the experience of being gay in contemporary American society. Themes include the specific issues associated with being gay and human immunodeficiency virus, gay identity formation, coming out, and the social oppression of gay men.

    Chapter 10. Cultural and Historical Trauma among Native Americans

    This chapter provides clinicians with information to enable them to recognize cultural and historical trauma and to be sensitive to its effects when developing and implementing intervention plans with Native Americans. The concepts of cultural and historical trauma are defined, and a discussion of pertinent theories (e.g., Alexander, Brave Heart, Salzman, and others) is provided. The nature of Native American cultural and historical trauma is also described, and its psychological and social effects across generations of Native Americans are addressed. The interactive effects of cultural and historical trauma and current personal traumas are examined. Finally, clinical issues such as assessment, cultural sensitivity, and appropriate intervention strategies are explained.

    Chapter 11. The Effects of Trauma Treatment on the Therapist

    In exploring the impact that trauma treatment has on the clinician, this chapter examines concepts of vicarious trauma, secondary trauma, and associated constructs that seek to understand the deleterious effects of providing clinical services to traumatized individuals. The chapter explores the role of empathic immersion in this process and situates this occupational hazard in psychodynamic and relational frames. Empirical evidence that demonstrates the impact of trauma work on the clinician is reviewed, and recommendations are given for minimizing and moderating its negative dimensions. Finally, this chapter discusses the impact that vicarious trauma may have on the clinical process.

  • About the Editors

    Shoshana Ringel, PhD, is an associate professor at the University of Maryland–Baltimore School of Social Work. She is the coauthor of two previous books, Attachment and Dynamic Practice (with J. Brandell) and Advanced Clinical Practice: Relational Principles and Techniques (with E. Goldstein and D. Miehls). She has published numerous articles and was certified on the Adult Attachment Interview by Mary Main and Eric Hesse. Dr. Ringel maintains a private practice in Baltimore.

    Jerrold R. Brandell, PhD, is a Distinguished Professor at Wayne State University School of Social Work in Detroit, Michigan. He has published numerous articles and book chapters as well as nine other books, including Attachment and Dynamic Practice (with S. Ringel), Psychodynamic Social Work, and Theory & Practice in Clinical Social Work (2010, Sage). He is the founding editor-in-chief of the journal Psychoanalytic Social Work, which is now in its 18th year of publication, and he maintains a part-time private practice in psychoanalysis and psychotherapy in Ann Arbor, Michigan.

    About the Contributors

    • A. Antonio González-Prendes, PhD, Assistant Professor, Wayne State University School of Social Work, Detroit, Michigan
    • Jan Gryczynski, MA, Research Associate, Friends Research Institute, Baltimore, Maryland
    • Dan Koren, PhD, Professor, Department of Psychology, University of Haifa, Israel
    • James Lampe, PhD, Private Practice, Chicago, Illinois
    • Laura V. Loumeau-May, MPS, ATR-BC, LPC, Journeys Program, Valley Home Care. Inc., Paramus, New Jersey; Caldwell College, New Jersey
    • Ruth Malkinson, PhD, School of Social Work, Tel Aviv University, Israel
    • Faye Mishna, PhD, Margaret and Wallace McCain Family Chair, Professor, and Dean, Factor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada
    • Brian Rasmussen, PhD, Associate Professor, Okanagan University College School of Social Work, Kelowna, British Columbia, Canada
    • Stella M. Resko, PhD, Assistant Professor, School of Social Work and Merrill-Palmer Skillman Institute, Wayne State University, Detroit, Michigan
    • Simon Shimshon Rubin, PhD, Director, International Center for the Study of Loss, Bereavement and Human Resilience; Chairman, Postgraduate Psychotherapy Program, and Professor, Department of Psychology, University of Haifa, Israel
    • Jami-Leigh Sawyer, Hamilton Health Sciences–McMaster Children's Hospital, Hamilton, Ontario, Canada
    • R. Dennis Shelby, MSW, PhD, Director of Doctoral Studies, Institute for Clinical Social Work, Chicago, Illinois
    • Boris Thomas, JD, PhD, Private Practice, Chicago, Illinois
    • Shelly A. Wiechelt, PhD, LCSW-C, Assistant Professor, University of Maryland, Baltimore County School of Social Work, Maryland
    • Eliezer Witztum, MD, Professor, Mental Health Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheba, Israel
    • Shahar Mor Yosef, MA, Department of Psychology, University of Haifa, Israel

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