As a member of International Society of Traumatic Stress Studies (ISTSS), I am able to offer you a link to a free issue of their journal, Journal of Traumatic Stress.
Click this link for the February issue page with links to download individual articles. Several essays relate to PTSD treatment for veterans, at least one essay re: child maltreatment in Uganda.
In October I represented Biblical Seminary’s Global Trauma Recovery Institute at a conference co-hosted by the World Reformed Fellowship and North West University in Potchefstroom, South Africa. Previously I posted the accompanying slides here. Now, WRF has made available the video for this presentation. Presentation runs about 30 minutes plus a Q and A at the end with another speaker.
Main objectives of the video?
Link to video here.
At the beginning of 2013, Biblical Seminary launched Global Trauma Recovery Institute to train recovery specialists here and around the world. We’re small but thus far we have taken 20 students through 120 hours of continuing education, another 15 have just begun, and we are now preparing some of those first students to travel to Rwanda to observe and participate in trauma recovery training with local caregivers. Those students we serve are from or located in three continents plus the United States. In addition, we have represented GTRI in trainings in South Africa and Rwanda this year as well as engaged Christian counselors in Romania during one of their trainings. Our hope for 2014 includes more of this kind of training as well as our first immersion trip with students. Think we are just focused on the international scene? No! The “abuse in the church” video on the right hand bar of this site was sponsored by GTRI as well.
Maybe you wonder what we do and how we handle cross cultural challenges. Check out this short 3 minute video below to see our (myself and Diane Langberg) heart for raising up capable recovery specialists here and around the world as they follow Jesus into the world.
Want to support? After viewing the video, please consider supporting us with prayer and even tax-deductible donations. If you do choose to donate, this link will bring you to a donation page. You can give to the seminary’s general fund (without their support, GTRI would NOT exist!) or you can give a specific gift to GTRI. Just note that in the comments section. Your gifts will enable us to serve more international students and to begin the formation of learning cohorts on other continents!
[Note: Link on image is broken, click here to see the video]
I am finally getting around to read Ethan Watters’ polemic Crazy Like Us: The Globalization of American Psyche (Free Press, 2010). In this book he details the way America has exported not only its pharmaceuticals but have redefined mental health and disease. As the promotional material on the front cover says, the book “[uncovers] America’s role in homogenizing how the world defines wellness and healing.”
As I read the book, I find he is overly negative and pessimistic, even as he right points out some major bumbling when bringing Western mental health ideas to the world. And yet, consider this…
In chapter two he examines the way Western mental health providers flooded (bad pun but appropriate picture) Sri Lanka after the Tsunami to treat all the PTSD that would most definitely come to light. They “educated” the country about the symptoms of PTSD and trained caregivers and counselors to provide counseling interventions. When certain symptoms weren’t presenting widely, some helpers assumed victims must be living in denial.
Watters describes how one researcher began looking to see how Sri Lankans described symptoms of poor responses to trauma–instead of using a pre-determined set of symptoms. This researcher concluded that Sri Lankans experience trauma quite differently.
1. Sri Lankan PTSD symptoms were primarily physical in nature.
2. Sri Lankans did not identify anxiety, numbing, fear symptoms but rather identified isolation and loss of social connection as key to PTSD symptoms.
The root problem in PTSD?
So, is PTSD internal or external? Intrapsychic or social? Most Westerners think of psychopathology in terms of the individual. A sick individual will likely find their social lives eroding and less supportive. It appears Sri Lankans think of pathology in terms of social connection which when broken results in some of the physical symptoms. So, does trauma cause psychological damage which in turn harms social networks…or does trauma harm social networks which in turn causes distress?
Your answer to this question likely reveals whether you see the world as a community or a group of individuals. Or, your answer reveals whether you focus on universal human experiences or constructed human experiences.
One semi-helpful answer
My answer? Our minds, bodies, spirits and social networks are not disconnected. While distinct entities, we are far more connected than disconnected. To paraphrase the bible, if the eye is sick, the whole body is sick. Psychopathology does not reside only in one location, even if we can see it’s impact in one specific location (e.g., cells not functioning). We would not assume that seeing the destruction after a tornado would be all that is needed to find the cause of that same tornado. Whatever interventions we devise, we will not find a one-size-fits-all solution. For some, we will intervene first in the interior of their lives (medications, private counseling). For others, we will start with social reconnection.
If you read much about matters of politics and the military, you are well aware of the significant problem of PTSD in returning veterans of Iraq and Afghanistan. While only 20-30% meet criteria for PTSD, all have been forever impacted. Rightly so, the military and traumatology researchers are expending oodles of money and time trying to understand (a) ways to reduce trauma symptoms and (b) improve resilience. Thankfully, we are seeing some helpful interventions being developed. However, there is much work to be done in perfecting treatments (finding ways other than just medicating vets into a stupor), ensuring that practitioners are competent, and improving societal acceptance of PTSD as a real disorder and not just something someone can just decide not to have.
And yet, these wounded and changed warriors have something to teach us about how we see ourselves and our world. Sometimes, it takes a life-changing experience to recognize serious blind spots. Even if you haven’t served in a combat setting, you can understand a bit if you’ve gone on a mission trip and returned with a different perspective and a sense you could no longer go about life the same way.
This article is a worthy read to consider what we can learn from those who were willing to sacrifice their lives, their futures for our safety. If you are indeed thankful for a vet’s service, take a minute to read it.
Filed under Post-Traumatic Stress Disorder
A few months ago I asked readers to give me ideas about how the church could better serve victims of trauma experiencing PTSD and other
related symptoms. I did so as I was thinking about the presentation I would make to conference attendees in Potchefstroom, South Africa on October 18, 2013. So, I post these slides (in advance) for those who can’t join me there or who were there, but want a copy.
The Mission of Trauma Recovery South Africa
Conference link
Dr. Langberg and I are forming our next cohort interested in studying global trauma recovery principles and practice. If you have thought about getting such training, now might be a good time! Check out this link to our website where you can find descriptions/objectives of courses in the series as well as application materials (see links on the right of the hyper-linked page).
If you aren’t sure about doing the whole series, just try our introductory month-long course. You can get graduate credit 
or 40 hours of CEs for just $500. Here’s a few more details:
The 2013 AACC World Conference continues. Thursday, Drs Harriet Hill, Matthew Stanford, and Diane Langberg and myself will make the above titled presentation. Harriet will present an overview of the American Bible Society’s Trauma Healing Institute work of developing helpers who can help others re-engage Scripture around their traumas. That model is centered around the small but helpful book, “Healing Wounds of Trauma” (you can find this on bibles.com). Matthew’s work is the Mental Health Grace Alliance project of hope groups–structured support groups that have been tested in Bengazi IDP camps and other locations. Diane and I will describe the beginning work of the Global Trauma Recovery Institute which is designed to support the existing work by local caregivers.
Follow This slide show link for our slides.
Filed under AACC, Africa, Diane Langberg, Post-Traumatic Stress Disorder
I am reading Christine Courtois and Julian Ford’s, Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach (Guilford Press, 2013). I won’t be blogging through each chapter but I do recommend it for those working with adult survivors of child sexual abuse, especially those who are new to “complex trauma.”
The first two chapters give an overview of complex trauma reactions and diagnoses. If you want to know more about complex trauma, see this post about another edited book by these two authors. Chapter three, “Preparing for Treatment of Complex Trauma” begins the meat of the book. In this chapter they take up the ever important issue of empathy, safety, and respect as foundation to therapy. They emphasize the need for,
safety within the therapeutic relationship with a therapist who is empathic and respectful yet is emotionally regulated with appropriate and defined boundaries and limitations. (54)
This empathy and trust relationship is both foundation and method of treatment (59). But while the therapist is responsible to see that at safe therapeutic relationship has been built, it requires the client to be involved in building such an environment. The truth is that the client’s role in building safety in the counseling office is by passive and active testing of limits. Most counselors tolerate suspicious questions the first or second time. But, it is important for counselors to,
being prepared to patiently and empathically respond to active or passive tests or challenges to trustworthiness as legitimate and meaningful communication that deserves a respectful reply in action as well as in words. (60, emphasis mine)
If the therapist understands and does not take mistrust as a personal affront, the therapeutic relationship can evolve gradually. The client can begin to recognize that the therapist actually “gets” why he or she is initially skeptical, self-protective, or “realistically paranoid” and does not pressure the client to be a “happy camper” but instead works to earn trust by being honorable, reliable, and consistent. This also implies a view of the client’s initial mistrust as expectable in light of the client’s history–that is, as a strength rather than as a deficiency or pathology. (63)
Sometimes clients can present in an opposite way–to be entirely deferential and affirming the counselor before a track record can be developed. Therapists with these clients need also to be prepared to encourage a healthy level of distrust.
What is not helpful is “artificial neutrality or passive and intellectualized detachment on the part of the therapist…” (64). It is my sense that we usually do this when we are afraid of the client. Not so much afraid of being injured, but afraid of failing or being consumed by the trauma. Or, we get consumed by our own history. A healthy therapist must stay emotionally present yet aware of own internal machinations. A healthy therapist must be able to predict some of the angst that arises in treatment of complex trauma and able to prepare self and client for this inevitable distress.
As a clinician, I have had anecdotal experiences that the trauma experienced by a parent is passed on to a child who presents with many trauma symptoms despite not having experienced the initial trauma. We have witnessed what looks like this kind of transmission in places like Rwanda where children born after the genocide seem to experience many of the same symptoms of their parents.
Thus far, the data about generational transmission has been mixed. Looking at 2nd and 3rd generations of holocaust survivors, some research indicates that later generations can be affected; some research indicates no secondary traumatization. The problem with this research is that much is focused on the content of transmitted symptoms rather than the process. In the latest issue of Psychological Trauma (v. 5:4, 384-391), Lotem Giladi and Terece Bell have published a study looking at both content and process of trauma symptom transmission (“Protective Factors for Intergenerational Transmission of Trauma Among Second and Third Generation Holocaust Survivors”). The authors hope to have a clearer picture of risk and protector factors. As they say,
“The research question was not whether 2G and 3G experienced greater psychopathology than controls, but rather why some of them still carry some Holocaust-related psychological distress whereas others do not.” (384)
These researchers tested whether psychological concepts of differentiation of self (a Bowen concept indicating the ability to balance need for connectedness with family and need for being a separate self) and family communication (a previous study indicated that 2G holocaust survivors suppressed communication of negative emotion around their parents).
What did they find? 2G and 3G both showed greater levels of secondary trauma than controls (though all amounts of STS were in normal range) and surprisingly, the 3G group did not show less secondary trauma than did the 2G group. Indeed, greater differentiation of the self and better family communication among the generations of holocaust survivors positively correlated with few secondary trauma symptoms.
So, how do trauma symptoms get transmitted to the next generation? We do not really know yet but one possible answer is that trauma tends to influence emotion regulation, anxiety regulation, and thus decreased self-soothing behaviors. This may get passed on to the next generation via suppressed negative feelings (children who do not want to make matters worse) and identification with the parent’s distress (and partially responsible for it).
For those readers who might wonder if their own trauma is causing secondary trauma in children, consider these things:
Filed under Abuse, Post-Traumatic Stress Disorder, Psychology, Uncategorized
Musings on Faith and Psychology 