Tag Archives: Psychological trauma

Abuse in the Church: Pastoral Responsibilities, Ministry Opportunities


This afternoon I will be speaking to pastors, ministers, elders, and key ministry leaders of the Bible Fellowship Church denomination at their annual conference. Their website states they have over 65 churches and over 10,000 in worship on a given Sunday.

It is a wonderful opportunity to talk about a difficult subject: abuse in the church.

We would like to believe that it happens elsewhere. But the church is not free from those who would harm children. The church has never been free from matters of abuse. The Apostle Paul takes a church to task for putting up with what sounds like abuse and incest. Thankfully, the evangelical church is waking up to the need to educate leaders about sexual abuse and how to care for both victims and perpetrators.

If you are interested in seeing what I will be talking about, here’s the slide show: Abuse In the Church

NEED MORE RESOURCES?

If you are new to this blog, use the search engine to find many other posts about preventing and responding abuse in the church. Or, click the image to the right for a 5 plus hour DVD on this very topic. Or check out www.netgrace.org for excellent resources and help on dealing with abuse in Christian settings.

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Filed under Abuse, christian counseling, Christianity: Leaders and Leadership, trauma

What PTSD might feel like


If you haven’t experienced PTSD from a traumatic experience, you might wonder what a traumatic reaction might feel like. What I give below is just a teeny window. Note that what I write about is NOT PTSD but shares some of the same features on a very small and temporary scale.

Imagine the following:

You are sleeping peacefully but at 3:30 am by a horrible metallic crash just outside your home. You recognize the sound as a car crash. What follows that sound is continued crashes, spinning tires, shifting gears, more smashing sounds, shifting gears, then your house rocks when the vehicle hits your porch. You grab your glasses and stumble to your feet, find your pants and start for the phone to dial 911. Without yet seeing what is happening, you imagine that someone is choosing to smash another vehicle in order to get revenge. In a flash you imagine someone very angry who may be dangerous. You try to dial 911 but its dark and you are not yet awake. On the 3rd try, you get it right and the operator comes on the line. She asks several questions (who are you, spell your name, where do you live, what is your nearest cross street, what is your telephone number, what is the emergency, is anyone hurt, etc.). You struggle to answer these questions because of the distress of the situation and the tightening knot in your stomach. You hang up and look out the window. The sound of the offending vehicle dies away. You look outside and see a smashed car crossways the road. It is dark so you cannot tell if anyone is in the vehicle, if anyone is hurt, if danger is outside. You feel paralyzed and sick to your stomach. Should you go outside and see? What if the violent person is still out there?

Soon, the police arrive and neighbors pour out of houses. You venture out to learn that a drunk driver lost control and smashed into a parked car. the driver ended up on your neighbor’s grass and the repeated smashes were the result of his attempt to get back onto the street. Each neighbor describes what they heard or saw. The police arrive and take their reports and photographs. As neighbors share stories and laugh (even the one whose car was destroyed), you feel your stomach relax and you return to you bed for what is left of the night.

The next day, you go to work a bit more tired than usual. You tell a colleague or two about the experience. You perform your duties without significant difficulty. BUT, at moments of silence, you keep hearing the noises of the smashes, spinning tires, more smashes. You feel your stomach tense. You feel embarrassed that you struggled to communicate to the 911 operator. You feel embarrassed about your hesitation to go outside. You feel somehow that you would have failed to protect your family if they were really in danger (due to paralysis). You remember 2 other times you didn’t respond well to a crisis. The next night, you find yourself wound up and unable to sleep.

Again, this little vignette does not make a PTSD diagnosis. Those who have experienced terrible traumas (e.g., sexual assault, witnessing sudden death or forced to participate in a killing) would likely feel this event is simplistic. They are right and yet, you might see how the body/mind may respond to a crisis or the perception of a crisis.

  • Experience of danger
  • Inability to get away from it
  • Horror response
  • re-experiencing intrusive memories
  • Hypervigilance
  • Attempts to shut down the intrusive memories and emotions

Notice in this situation, some of these PTSD symptoms are not present and not likely to form. the problem resolves quickly and, more importantly, the shared conversation with neighbors afterwards reduces much of the isolation that is often common in traumatizing experiences. And yet, notice that sounds of the accident keep coming back to the person. In addition, this person feels some level of guilt and shame about the response to the event. This feeling can increase isolation and negative ruminations about personal failures.

Given this situation and it’s randomness, the person is not likely to remain distressed. Symptoms such as these tend to fade quickly. If, instead, the scenario contained sexual violence by a loved one, confusing physical responses, threats to one’s life if you cried out, you can quickly see how the symptoms would not easily fade but would grow in intensity, frequency and duration.

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Filed under Psychology, ptsd, trauma, Uncategorized

Want consultation for your difficult trauma cases?


Just a reminder to those of you who are counselors and therapists out there, starting in January, Dr. Langberg and I will be offering group and individual consultations to mental health professionals seeking help for their domestic and international trauma recovery cases. We will be running a once a month group consultation on Fridays beginning mid January (runs for 6 months) here in the Philadelphia region. If you have any interest in joining the group or having your own private consultation, please check out our website for application and consent forms: http://globaltraumarecovery.org/group-consultation/

Group consultations are a great way to get feedback on a difficult case, learn from peers, as well as easier on your pocketbook.†

 

†consultations can not be considered supervision as we have no authority over your practice.

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Filed under Abuse, christian psychology, counseling, counseling skills, Post-Traumatic Stress Disorder, Psychology

The biological roots of PTSD…and resilience


Brain structures involved in dealing with fear...

Brain structures involved in dealing with fear and stress. (Photo credit: Wikipedia)

A good friend of mine pointed me to a recent Nature essay that describes the biological markers for PTSD and resilience–and provides some of the answer of why some seem to recover fairly quickly while others continue to struggle. Here’s a couple key quotes:

“Functional magnetic resonance imaging (fMRI), which tracks blood flow in the brain, has revealed that when people who have PTSD are reminded of the trauma, they tend to have an underactive prefrontal cortex and an overactive amygdala, another limbic brain region, which processes fear and emotion…”

“People who experience trauma but do not develop PTSD, on the other hand, show more activity in the prefrontal cortex.”

Of course, we need to understand that we are complex beings with complex histories and current social connections. We don’t only look at neural activity but with increasing understanding, we learn how experiences such as childhood trauma, poor social support influence brain activity.

Some worry that the discussion of biological features of PTSD will lead only to increasing chemical interventions (meds, surgeries, etc.). I do not believe this to be the case given that we are also learning about the ways that current relationships and psychotherapies are altering brain activity.

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Filed under counseling, counseling science, Post-Traumatic Stress Disorder, Psychiatric Medications, Psychology

Dissociation (amnesia) and remembering abuse anew?


How is it that someone could forget a horrific event or experience? What is happening when something new is remembered about a very old event? Is it possible to forget (lose the capacity to recall) for long periods of time but then later remember?

Continuing my series on memory, abuse, and the controversies of recovered memories [you can read my previous posts: here, here, and here], I now want to address the issue of dissociation, amnesia, and remembering abuse. In those previous posts we have looked at how memory can be degraded by intent (conscious denial or unconscious rejection), by other overwhelming stimuli, or by failure to encode. But, since I have not spent much time on the topic of dissociation and repression, I want to say just a few words about these two ideas–in part because they are frequently used but poorly defined.

What is Dissociation? Is Amnesia a better term?

People define dissociation in a variety of ways but most definitions include some disconnection from present reality–sensations of disconnection from self, others, or time–and exists on a continuum. The most mundane forms happen everyday. You are driving from point A to point B but realize you cannot remember what you saw along the way. While we could describe this as a failure to encode data into memory, we could also describe the process, a disconnecting from what is happening in the present. Some dissociation is even beneficial. If you have ever been in pain but then got a distracting phone call, your pain perceptions probably decreased. You were, in effect, dissociating from the present experience of pain.

Now, when we talk about dissociation from a counseling perspective, we are talking about a more significant disconnection from present experiences, one that often seems to happen outside the conscious control of the person (but may be a practiced habit that happens without mindful decision). Dissociative experiences include feeling unreal, disconnected from the body, unable to engage the present, unable to remember salient portions of pesonal identity, or even, rarely, the presentation of alternate personality states that appear to fight for control of the individual.

You can imagine that if you are in the position of a repeated trauma (such as child sexual abuse by a parent figure) and unable to escape it, you might develop ways of dealing with the pain by disconnecting from the present. As a result, you might find that any time you begin to feel unsafe, you naturally disappear in some minor or major way. What happens during that “disappearance” depends on the individual. For some, they are reliving some other experience (I’m no longer present but reliving a painful event in my life). For others, they report being blank–thinking and feeling absolutely nothing. The most telling sign to a therapist is that the client no longer seems to be present in the room (nonreactive or reacting clearly to something other than is going on in the present). Whatever the form of disconnection, most then experience some level of inability to remember portions of the trauma.

Interestingly, there is some evidence that those who dissociate have greater capacity to self-hypnotize. In addition, McNally describes a study (in Remembering Trauma) that followed a person with psychogenic amnesia who had altered brain function when in amnestic states.

Does dissociation lead to forgetting traumatic data?

Can a person dissociate enough to create a persistent amnesia for a traumatic event? There is evidence that those who experience frequent disconnected states have greater difficulty remembering important details of traumatic events. However, many would say that repression is a better conceptual tool to explain such forgetting. But then, repression is not well-defined either (even Freud himself interchanged repression and suppression when talking about decisional vs. unconscious forms of forgetting). Despite the frequent use of repression in common parlance (and without the Freudian baggage) I would suggest that amnesia or motivated forgetting may be better terms, a bit more descriptive and less connected to psychoanalytic theory.

Whatever you call it, some level of forgetting can happen to those experiencing relentless traumas.

  • a young Jewish woman forced into an internment camp has her infant child ripped from her and killed. After the war, a relative asks the woman about the child and the woman responds, “what baby?” Only much later does she remember having a child or how this child died.
  • A young male cannot remember much about his childhood. When asked about his Uncle (only 5 years older than he), he can only remember a vague uncomfortable feeling. His younger brother recounts this uncle would routinely enter their bedroom at night to sodomize both boys. Only after numerous conversations does the older brother begin to remember abuse details, even beyond those supplied to him by his younger brother.

Forgetting then Remembering anew?

In my 23 years of counseling I have never encountered someone who recovered memories of a trauma after completely blocking all memory (I believe it is theoretically possible but extremely rare). I have, however, had a number of clients recall previously long forgotten or vaguely remembered traumas. Often when they recall events with VASTLY new interpretations, so new that it feels like an entirely new memory even as they admit the memory isn’t new to them. Here’s a real example (with details changed to disguise identity),

Alice, a 52-year-old elementary school principal, enters individual therapy at her husband’s insistence to deal with her irritability at home. She admits she has developed a fantasy of leaving her husband for the new (and younger) president of the school board. She discloses that this fantasy began not long after her husband suffered a work-related accident rendering him partially disabled. During the initial intake Alice denied any history of trauma or abuse. As the therapy progressed, it became evident that Alice connected her personal identity to that of being pursued–something that her husband no longer attempted. In addition, her attempts to flirt with the school board president had been ignored. In a moment of frustration, Alice exclaimed, “I’ve always known that men found me very enticing, ever since I developed [breasts] at an early age. I’ve always had to be so careful around men, especially married men. I knew they wanted me and that made me feel dangerous but desirable. Now, who am I if no one wants me?” Alice’s therapist asked her to recount a bit of her early sexual history and without much delay Alice reported her first sexual experience at age 12 with her 35-year-old, married Sunday School teacher. She recalled her teacher hugging and fondling her breasts while telling her about his failing marriage and the need for the two of them to avoid further sexual temptation. At age 16, she reported that she and a 4o-something father of a child she babysat engaged in a 6 month sexual relationship.  Alice’s counselor indicated some surprise at how Alice described both experiences. She asked Alice how she would describe the same interactions between one of her current 6th grade students and a school teacher. Alice immediately flushed with horror. “Why, it would be child abuse!” Once Alice regained her composure, she explored how she had always remembered herself as the protagonist in both experiences. In that session and over the next several weeks, Alice reported a flood of new memories, mostly about things done or said by the two sexually abusing men and now interpreted to be predatory behavior. On several occasions she reported that it felt like she had never had these memories before even though she recounted that she never forgot the sexual encounters. The new interpretations and labels created the experience of recovering long-lost memories–ones that seemed blocked as long as she was responsible for the trysts but freed in light of her victim interpretation.

In this little vignette I want to illustrate that memories of abuse can be forgotten, whether only small portions or large, and remembered anew. Recalled or recovered memories are frequent as individuals gain the freedom to explore events from different vantage points. A therapist does not need to go on an abuse hunt or attempt to conjure up forgotten memories for this to happen. Merely exploring the narrative of a prior difficult experience can be all the priming a client needs to begin to experience “new” remembering.

But here’s where good therapy differs from unethical therapy: how the therapist responds to or pursues memories may be the determining factor when it comes to the development of false memories of past abuse. In the next post we will take up the ethics of memory work and explore therapist habits that may produce false memories of abuse.

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Filed under Abuse, counseling, counseling science, memory, Post-Traumatic Stress Disorder, ptsd, Uncategorized

3 important goals for trauma recovery


In the last week we have been discussing the best words used to describe the process of trauma recovery (see related post below). While words are important and carry much meaning, it may be more helpful to consider what recovery goals are in order for trauma victims. While we know recovery road can be long and arduous, it helps to know when we make progress and a general sense of the direction we are headed. In the days before GPS, if you went on a long car trip you probably consulted a map on several occasions in order to make sure you were headed in the right direction. So also, when you are working to get better after a traumatic experience, you want some sense you are still working on good goals. This need is especially great if the traumatic symptoms are complex and the treatment not brief (think war, genocide, child sexual abuse, etc.)

What three goals?

Esad Boskailo, as noted on p. 94 in his memoir (written and reported by Julie Lieblich) works toward these three goals that in turn support the ultimate goal: thriving (notice that the goal is not being free of symptoms, free of triggers, or back to life as if the trauma did not happen).

  • Acknowledge losses
  • Foster resiliency (i.e., build the capacity to use current coping resources)
  • Find meaning in life again

I think these do function well as helpful signposts or intermediate goals in the process of recovery from traumatic experiences. Now, I don’t believe these goals are necessarily in sequence. For some clients, they stumble on something that gives new meaning to life and thus are better able to acknowledge losses. Others get to work on building better coping mechanisms (e.g., a vet puts away items that cause him or her to dissociate, an adult victim of CSA stops cutting and develops acceptance strategies, etc.) and then can acknowledge losses.

So, in the murky water of therapy (and it surely is murky!), the trauma victim can find some comfort in activities pointing to these intermediate goals. Each day they reject self-condemnation for not being who they used to be before the trauma, they are moving toward thriving. Each day they embrace available coping resources (e.g., a friend who will call or pray), they are moving toward thriving. Each day they find one meaningful experience, they are moving toward thriving.

the how we meet these goals is, of course, the 64,000 dollar question…and not something we can set in stone. I will write on some general activities that are common in most treatment modalities in the coming days.

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Filed under christian counseling, counseling, counseling science, counseling skills, Psychology

Trauma recovery? Healing? Integration? Which words communicate a good outcome to you?


Recovery. Healing? Restoration? These words contain both information, movement, and emotion. What words do you like to use when describing the process of getting better after a traumatic experience? How do you communicate that you are better but not so much better that you have no more bad memories; that you have no more nightmares; that you are not triggered into panic when you see someone who abused you?

What words do you shy away from?

Let’s consider healing first.

I was and am being healed?

Some hear healing language as a completed task. “I have been healed.” Past tense. If I was in a wheelchair but now I walk…would I say I have been healed if I walk with a limp or need a walker to get around? Do you ever hear someone say, “I was healed, in part.” Would it be better to say I am being healed or I am recovering. Compared to Greek verb tenses, our English language doesn’t communicate well the ongoing state of something. In Greek, we can communicate a present perfect tense such as, “I was and am currently being healed” all in one verb form. But in English, we cannot communicate such an ongoing process without more words. Thus, when we use the shortcut, “I am healed,” it sounds like a finished job.

Recovery?

What about recovery? Restoration? Renewal? Recovery words are popular amongst former addicts. For them it connotes that they are no longer using but making the daily choice for sobriety. However, they recognize the danger exists of falling back into drunkenness and so they communicate that they are in a lifelong process. For some, however, recovery sounds like a failure–failure to find victory and failure to accept a new identity.  The truth is, few people outside of AA use the word recovery in every day speech. The other “r” words are more likely used in Christian circles but not so much in discussion of life after trauma.

Can you integrate trauma?

I have just finished reading Wounded I am More Awake: Finding Meaning after Terror by Julia Lieblich and Esad Boskailo (2012, Vanderbilt University Press). Julia helps tell Esad’s (a Bosnian doctor) experience of being held in 6 different concentration camps. He is now a psychiatrist in the US and works with trauma victims. However, he faced much brutality in being treated worse than one would treat an animal and so was not in good physical or psychological shape when he came to the U.S. I commend the book to those who want a basic understanding of trauma and of this thing we are trying to call healing and recovery. Listen to these quotes from Boskailo the psychiatrist,

 I can’t take away what happened” [said to another survivor]. But [I] can help [you] imagine a better future.

“You are fifty, not twenty-five. You will never be the person you were twenty-five years ago. Even if you didn’t have trauma, you would not be the same.”

What Boskailo is arguing for is integrating trauma into one’s present life. One cannot go back and recover what was lost. A trauma survivor is never going to be free from losses suffered. To do so would be to deny truth. Integration means allowing the reality of trauma and its losses while finding meaning and value to live in the present with hope and even joy. Integration requires acceptance and willingness to look for meaning and purpose.

I like the connotations of integration. But, I am not sure I like the word integration since it also doesn’t connote some level of arrival at a good enough place. What word would you use?

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Filed under Abuse, counseling, counseling science, counseling skills, genocide, Post-Traumatic Stress Disorder, Psychology, ptsd

Listening to Trauma/Scripture Experts


I am attending a “community of practice” hosted by the American Bible Society–a community of global trauma recovery specialists who also are experts in Scripture engagement. It is a very interesting group and most are focused on Africa though some minister in India and South America. While a few of these experts have mental health training, most have other training–missiology, sociology, bible translators, pastoral care, and bible distribution and engagement. All recognize how trauma is a barrier to Scripture engagement and faith development. The big question we are struggling with today is the issue of developing healing/recovery models to be used in another culture. How do we minimize the communication that we in the West have the problems all figured out? How do we help support local leadership (rather than finding leadership that does what we already want to do)? What will be most sustainable?

It is good to hear how God is using diverse ideas and peoples to minister to traumatized communities. And, it is good to remember that God has gifted people across all disciplines to do exceptional trauma healing work.

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Filed under suffering, teaching counseling, trauma

Global Trauma Recovery Institute Launched! Dr. Langberg Joins Biblical Faculty


American Bible Society

American Bible Society (Photo credit: Wikipedia)

It is my pleasure to announce that I and Biblical Seminary are the recipient of a sizeable grant to launch our new Global Trauma Recovery Institute–training for lay and professional recovery experts in the US and around the world. The grant (from an anonymous donor and the American Bible Society) funds the Seminary’s collaborative program with ABS to provide deeper training for those active in both trauma recovery efforts in the US or in training local facilitators in east/central Africa.

Why collaborate with a bible society?

ABS is involved in a trauma healing/scripture engagement project, focused in Africa but with other works going on around the world. This project has been under the work of ABS’ She’s My Sister initiative in the Congo. The bible societies were founded on bringing scripture to bear on the current issues of the time–specifically slavery. So, it make sense that ABS is interested in helping traumatized individuals recover from wounds by showing how God cares and is active in their recovery. Through connections with a few of my students, I and Diane Langberg have become co-chairs of the advisory council to the above-named initiative.

What does this mean for Biblical?

The generous grant will enable Biblical to do the following

  • Commission a research study of the psycho-social impact of trauma in the African context
    • in collaboration with Wheaton College’s Humanitarian Disaster Institute
    • WHY? We need better understanding of the scope of the problem and what locally led interventions will be the most effective (both in terms of success and sustainability)
  •  Develop introductory and advanced global trauma recovery courses that enable MA and postgraduate students to develop specialization in training local trauma recovery facilitators here and around the world
    • These courses will be delivered in a hybrid format starting late 2012; delivered in hybrid system (on-line and in-person)
    • Mental health continuing education credit will be possible
  • A hands-on practical experience under the direction myself and Dr. Langberg will be the capstone experience for students who complete the entire training
    • Likely 2013 in an African context
  • A website providing free and homestudy CE materials for those unable to come to the Philadelphia area
  • Consultation groups formed for those seeking help with cases and projects in domestic and international trauma recovery

How is Dr. Langberg involved?

Dr. Diane Langberg is the leading Christian psychologist with expertise in trauma recovery. Her teaching has taken her to South America, the Caribbean, Africa, Asia, and Europe. Her books on sexual abuse remain popular with both clinicians and victims. She joins Biblical Seminary as a Clinical Faculty member (clinical faculty are practitioners who also lecture and train) and will have a leadership role in the shaping and delivery of the curriculum and trainings. It is safe to say that the counseling department has been most influenced by Dr. Langberg’s training and supervision.

How can I find out about these courses and consultation groups?

Until we launch the institute website, the best way to keep yourself informed is to do one of the following: subscribe to this blog where I will be posting updates; keep checking with www.biblical.edu for more information, or email me at pmonroeATbiblicalDOTedu and I will put your name on a growing list of those who want to be on our mailing list.

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Filed under "phil monroe", Abuse, Africa, biblical counseling, Biblical Seminary, christian counseling, christian psychology, Christianity, counseling science, counseling skills, Post-Traumatic Stress Disorder, trauma

Health effects of traumatic stress on infants


In Rwanda we hear that children born after the genocide exhibit signs of trauma–even though they did not experience it firsthand. You could hypothesize a number of reasons for this:

  • Hearing of the stories of lost loved ones; being told that their neighbors were killers
  • Having peers in school stigmatize: “You are Hutu, you are a killer. You are Tutsi, you are a cockroach.”
  • Seeing pictures of genocide

Notice that all three have to do with the child’s internalization of trauma through their environment.

But what if their trauma began in utero and biologically altered their capacity to handle stress? Consider these words by Maggie Schauer (available to be seen in context here),

Exposure to significant stressors during sensitive developmental periods causes the brain to develop along a stress-responsive pathway. The brain and mind become organized in a way to facilitate survival in a world of deprivation and danger, enhancing an individual’s capacity to rapidly and dramatically shift into an intense, angry, aggressive, fearful, or avoiding state when threatened. This pathway is costly and non-adaptive in peaceful environments. Babies born with a deformed stress-regulating system (HPA-a) experience higher and faster arousal peaks, longer intervals of crying and irritability, and impaired affect regulation (Sondergaard et al., 2003). (p. 398, emphasis mine)¹

How might this information help us better understand how “the sins of the fathers” (or whoever is the abusive individuals or communities) extend beyond primary victims to those victim’s children? How might this help us train survivors to understand what might be happening in their children and support parenting strategies that will encourage healing. Might it also help survivors to feel less guilty for the struggles of their children? Survivors don’t ask to be abused and can’t help the impact on their children while in utero.

Now, not every child with a “deformed stress regulating system” is that way due to the mother’s stress. We just don’t know why one child has a good stress regulation system and why another does not. But we can say that those whose stress regulation seems broken (or different) likely need different parenting strategies and a different paradigm in understanding volition (will) when it comes to their outbursts.

 ¹ Schauer, M., & Schauer, E. (2010). Trauma-focused public mental-health interventions: A paradigm shift in humanitarian assistance and aid work. In E. Martz (ed.) Trauma Rehabilitation after War and Conflict (pp. 389-428). Springer

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