Tag Archives: Psychology

September 16, 2014 · 9:27 pm

Institutional betrayal: Secret ingredient to PTSD


We live in the world where human frailty and pathology is viewed in individual terms. When we see sickness we imagine that the person must have some weakness in biology, faith, or behavior. Rarely do we think about the role the system or community has played in the development of that person’s pathology. This is true when we think about a person diagnosed with PTSD. We therapists hypothesize about individual factors (personality factors, early childhood experiences (a slight nod to external causes) and neurobiological risk factors) and situation factors (the frequency, duration, and intensity of overwhelming trauma events) when we try to answer the “why” of the development of PTSD in a person.

The problem with this kind of thinking is that it fails to take into consideration of known research that suggests that environmental response to an individual’s trauma experiences may be a determining factor in whether PTSD or chronic traumatic reactions form.

In the most recent American Psychologist (2014, 69:6, 575-587), Carly Parnitzke Smith and Jennifer Freyd write about the concept of institutional betrayal. Traumatologists recognize Freyd’s name as the researcher who developed “betrayal trauma theory”, pointing to the especially toxic form of PTSD caused by those who were supposed to be safe and protective. These begin to examine “institutional action and inaction that exacerbate the impact of traumatic experiences…”

How can an institution betray a victim?

When a person trusts that a system designed to defend, respond, protect, or seek justice will do its job after an interpersonal trauma, and when that system either chooses not to respond (omission) or worse, chooses to lay blame at the feet of the victim (commission), institutional betrayal occurs. Examples include law enforcement accusing rape victims of “asking for it” with their clothing, church leaders allowing offender clergy to “leave with their reputations” or refusal to investigate a case of date rape when the reported offender is an important leader in the community.

In summarizing a couple of studies, Smith and Freyd point out that institutional betrayal after a trauma experience leads to higher rates of dissociation, sexual problems, and health difficulties. This is even more likely when the trauma takes place in an environment where protection of the members is trumpeted (i.e., church or military).

What are the common characteristics of betraying institutions?

Smith and Freyd note several characteristics found in institutions at greater risk for betraying members.

  • membership requirements to define in group identity. This produces a need for members to act in ways to maintain such an identity
  • Prestige (both leaders and institutions). Prestige produces both trust and fear, dependency and power
  • Priorities. “Institutional betrayal may remain unchecked when performance or reputation is valued over, or divorced from the well-being of members.” As the authors note, maintaining reputation as a priority will lead to neglect or attack of those who challenge reputation
  • Institutional denial. Blame a few bad apples, avoid institutional blame or responsibility

Those institutions that do make efforts to prevent abuse within its community may still yet fail to respond well. They may fail to use adequate screening procedures, normalize abuse, fail to utilize or follow appropriate response procedures, punish whistleblowers, and aid cover-ups.

What to do?

Smith and Freyd argue that transparency (about past actions/failures to act as well as power structures) and priority to protect the well-being of all members will move institutions away from the risk of betraying individual members. I would argue that the shift to protect moves from the institution as a whole to protection of the most vulnerable.

Let me recommend a few resources that have appeared here in the past:

  1. Diane Langberg’s 5 part video about narcissistic leaders and the institutions they lead. She too describes systemic narcissism.
  2. Why some spiritual leaders abuse (and systems allow it)
  3. Narcissistic systems
  4. Resources to combat narcissism one person at a time

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August 19, 2014 · 12:10 pm

Why Oppressed People May Not Jump At Chance For Freedom


Ever wonder why those who experience systematic abuse and violence don’t jump when they get a chance for freedom? Consider the abused teen choosing not to reveal the abuse to an inquiring teacher but rather stays in the abusive home in silence. Consider the victim who refuses the help of a friend in order to leave a domestically violent spouse. What is the psychology that supports these responses to oppression?

Brilliant Mhlanga has written a short memoir of his experience of being from an oppressed people group in Zimbabwe. Under the guise of “independence” his people and his family suffered tremendous violence. Family members were raped and murdered in grisly fashion. He labels what happens a genocide (from 1980-1987).

Here’s how he describes the impact of this systematic oppression (emphasis mine, British spellings his)

The psychology of oppression, then, becomes a phenomenon derived from the state where the oppressed, given their existential experience, adopt the attitude of ‘adhesion’ to the oppressor (ibid: 45). Freire adds that under these circumstances the oppressed cannot consider their situation clearly and objectively in a bid to discover themselves outside the spectacles of their oppressor. As discussed earlier, the oppressed rationalise and internalise their suffering. Their state of mental warping makes them appear as walking symbols of conformity. Such conformity makes them reject their enlightened brethren whom they tend to perceive as ‘trouble makers’. To them anyone who advocates change of their state of being is likely to bring them more trouble, as they cannot know the likely outcome. They fear change. This is the state of people who have lost a sense of hope in their full potential without the help of the oppressor.

Notice some of the features of the oppressed:

  • Identity tied to oppressor
  • Belief that one cannot exist outside this relationship (fear of being in relationship, fear of not being in relationship)
  • Internalize suffering (blame self)
  • See those who would fight for their freedom as dangerous (the devil you know may be better than the one you don’t know)
  • Reject change as dangerous

Now these features are not found in everyone who is abused but they are worth noting. Those who would want to help the oppressed must consider these challenges and develop interventions that do not automatically trigger the fear reactions. This might include,

  • Identifying self-blame and raising doubts
  • Giving freedom to control response to oppressor (not coercing leaving oppressor)
  • Identifying possible future
  • Validate change as scary

Quote: Mhlanga, B. (2009) On the psychology of oppression: Blame me on history! Critical Arts, 23:1,106 — 112

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August 12, 2014 · 12:11 pm

Brooks on journaling about emotions


Friend Jeff McMullen pointed out a recent David Brooks op ed in the New York Times. (Read it here). While I’m not sure I agree fully with his journaling/not journaling point he says something very important about the timing of writing one’s emotions after a traumatic event. He says,

When people examine themselves from too close, they often end up ruminating or oversimplifying. Rumination is like that middle-of-the-night thinking — when the rest of the world is hidden by darkness and the mind descends into a spiral of endless reaction to itself. People have repetitive thoughts, but don’t take action. Depressed ruminators end up making themselves more depressed.

Then later, this important distinction between immediate processing of emotions and later processing,

We are better self-perceivers if we can create distance and see the general contours of our emergent system selves — rather than trying to unpack constituent parts. This can be done in several ways.

First, you can distance yourself by time. A program called Critical Incident Stress Debriefing had victims of trauma write down their emotions right after the event. (The idea was they shouldn’t bottle up their feelings.) But people who did so suffered more post-traumatic stress and were more depressed in the ensuing weeks. Their intimate reflections impeded healing and froze the pain. But people who write about trauma later on can place a broader perspective on things. Their lives are improved by the exercise.

David points to some research that exists that suggest CISD is unhelpful for some participants. Some are made worse. Yet, narrating one’s trauma in the broader context of a life tend to see a reduction of symptoms. The difference seems to be whether the focus in on life or mostly on the trauma. Trauma in perspective is the goal. Just reviewing trauma may in fact strengthen the traumatic reaction rather than weaken it.

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June 25, 2014 · 12:55 pm

My next two weeks in East Africa


Starting Monday I will be off traveling to Kampala, Uganda and then on to Rwanda for Global Trauma Recovery Institute. I welcome your prayers for myself, my students, and the attendees. In addition, Diane Langberg and myself will be leading a group of 12 Americans (10 GTRI students) on a listening/dialogue immersion trip throughout Rwanda. Some of the highlights of our trip(s) will include,

  • 2 day trauma healing community of practice in Kampala with the Bible Society of Uganda
  • 3 day trauma healing community of practice in Rwanda with the Bible Society of Rwanda
  • Afternoon mini-conference with pastors in Southern Province, Rwanda
  • Day with the newly forming Association of Christian counselors in Rwanda
  • Visits to NGOs working with trauma victims and street children
  • Church services
  • Visits to genocide memorials
  • Visit to a refugee camp
  • Numerous conversations, formal and informal over the next two weeks

I will make some attempts to update all on my trip as I go. You can follow me here and @PhilipGMonroe or @BTSCounseling. If you are interested in seeing more about the GTRI engagement model, check out this short video. And, if you would like BTS to continue doing this kind of missional work, feel free to go here and donate before the end of our fiscal year, June 30.

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May 12, 2014 · 12:58 pm

Counselors talking about themselves? Additional thoughts


Last week I described some research supporting counselor self-disclosures, research that suggests clients appreciate disclosures revealing (a) similarities between counselor and client, and (b) vulnerabilities or personal emotions. While this research flies in the face of conventional wisdom in most counselor training programs, I cautioned counselors to ask some questions first before talking too much about self. With this post, I would like to press the caution just a bit more.

Why do counselors talk about themselves?

Why do counselors talk about their personal life with clients? Read the following numbered list to see some of the main reasons (and the sub-points in italics as illustrations of that reason). Then, consider the bracketed sub point as an alternative to self-disclosure.

  1. We want to put clients at ease and we think knowing something about ourselves might help
    • I can see you are anxious about whether taking antidepressants is appropriate for faithful Christians. I take them and it has only helped my faith.
      • [You’re not alone with that question so let’s explore the pros and cons to taking an antidepressant. Why don’t you start by telling me the reasons you’ve heard or thought about for not taking Prozac?]
  2. We believe our personal history will help a client understand, accept, or challenge something about their struggle
    • I know this treatment for panic disorder is difficult for you but I can tell you it works. It worked for me.
  3. We want to please an inquiring client
    • Yes, I am married and I have 2 children.
      • [Sure, I don’t mind telling you who is in my family, but could you first tell me why that is an important question for you?]
  4. We want to earn their respect and believe that our history will help
    • Well, for starters, I want you to read my book. It is now in its second edition and has been translated into 4 languages. I think you will find it very helpful for your problem.
      • [I’d like for you to start reading about your problem. There are a couple of books out there that I think you might find helpful, including one I wrote. But, feel free to look these over on Amazon and choose the one that seems right for you.]
  5. We like talking about ourselves; our personal stories seem difficult to avoid
    • You and I have a lot in common. My wife has the same problems as your husband. So, I know how lonely you must feel. We’ve tried…
      • [Though you are not saying so, I wonder if you feel lonely in your marriage.]
  6. We see the relationship more like a friendship with mutual sharing
    • I’m so glad to see you today. You are a bright light in a dull day. I look forward to our stimulating conversations. Just yesterday I was thinking about you and wishing to have coffee with you to discuss your career future. 
  7. We want to be seen as human rather than just professional
    • Yes, it has been a stressful day. I could use a back rub after all these sessions today.
      • [You know, some days are harder than others, but I’m curious why you asked this today?]
  8. We want the client to help us in some way
    • I was thinking about your need to work and my need to have someone edit my website. Or, I’m headed out on a mission trip next month. Well, I am if I can get enough donations. I’m about $1000 short thus far but I know God will come through.
      • [neither of these need to be said!]

Is it necessary? Is it helpful?

While self-disclosures may improve client perceptions of counselors, I suspect that empathic, client-centered therapists evoke these same feelings by asking good questions making observant reflections yet still minimizing disclosures, especially those where we initiate them and those that force the conversation to our personal history. There are some disclosures that are in response to client questions (e.g., have you ever struggled with addictions? Are you married? Do you believe in medications? Are you angry with me?) that warrant an answer. When giving this answer, work hard at keeping it brief and returning to the client’s story.

Don’t forget about social media self-disclosures

Clients sometimes “hear” our disclosures through social media. Imagine a client reading, “Well, that was a difficult session, glad I’m done for the day” having been that counselor’s last appointment! Blogs (like this!), Twitter, Facebook, and Instagram can be forms of self-disclosure. Be wary of these. Conventional wisdom says to avoid social media contacts with most clients so as to avoid harm to the counseling relationship. While we need not require an outright ban of these connections, a thoughtful counselor will review connections via social media for potential harm.

Be human

Despite these efforts to avoid letting our selves intrude too far into the session, sometimes life gets in the way. A counselor has a health or a family crisis. Clients have ways of finding this out and often want to ask how things are going. Here it is appropriate to say something brief, thank them for their concern and then start the session. In other situations a client discovers a shared passion for food, a sporting team, a connection through mutual friends. Enjoy these connections, acknowledge them, but be sure not to linger there during the session proper. We are, after all human. Don’t be surprised when counselor and client humanness come into contact.

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March 11, 2014 · 6:33 am

How does small-time tyranny last?


Tyrants use fear to control subjects. Thus, we understand how North Korean leader Kim Jong Un is elected by 100% of his constituency. To abstain or cast any other vote would be suicide. But since most do not live under such oppression we may wonder how individuals cave to lower-level tyranny here in democracies or locations where we have choice about who we vote for and where we live and work. Why do organizations allow dictatorial leadership? Can’t we all just walk away?

Thanks to one of my students, Dan McCurdy, I pass on this recording from This American Life about a “small-time” tyrant in an upstate New York school district. The story is about the dictatorial dealings of a facilities manager of the school district–not of a principal, teacher, or even a school board member.

How is it possible for one with so little power (so we would normally assume) could wield such power over employees? How could he set off bombs, fire individuals, vandalize homes, threaten others with harm, simulate sex, and more without getting fired?

How? It is simple. He was,

surrounded above and below, by people who looked the other way. (near the end of the above recording)

Why do we look the other way?

We look away for all sorts of reasons. Consider a few of them:

  • Fear that no one will come to our defense if we stand up to abuses (which of course will be true if no one else sees or responds)
  • Need to protect what we have (e.g., position, income, career, reputation, etc.)
  • Cover up own failings (e.g., if he goes down…I will go down)
  • Perceive benefits outweigh consequences (i.e., in this case, school board received lowered energy costs, fewer worker complaints)
  • The people who complain of injustice matter little to us
  • Believe psychological abuse does not really happen

In Anjan Sundaram’s Stringer, he describes the most powerful of dictators are ones who instill fear when present and yet also instill fear of what life might be when that person is gone.

What to do?

When we hear of crazy stories such as the one in the recording, we shake our head and imagine ourselves standing up to power, standing up for the little guy. Too often our imagination never see the light of day. So, how can we keep ourselves sensitized to injustice and ready to act for the good of the weakest community member?

  • Identify our current fears. Who has power over us? What does love and grace look like when responding to this power?
  • Identify places we have chosen safety over truth. Who can help us rectify this problem?
  • Identify those places where we have power over others. Who do we have power over? How do we wield it? Who has God-given us the responsibility to protect? Where do we need to give power back (when taken or used inappropriately)?
  • Fix eyes on how Jesus uses power. How does he wield it with those who have the most power? The least power?
  • Identify habits of cover-up. Where, for reasons of shame, guilt, or comfort do we cover up and present self as someone we are not?

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February 19, 2014 · 12:46 pm

When you imagine something does your brain think you see it?


What is the difference between imagination and reality? Sometimes, not that much.

The February 2014 edition of the Monitor on Psychology (v. 45:2, p. 18) lists a brief note about a study published in Psychological Science that looks at eye pupil constriction when imagining light. Here’s the abstract from the link above (emphasis mine):

If a mental image is a rerepresentation of a perception, then properties such as luminance or brightness should also be conjured up in the image. We monitored pupil diameters with an infrared eye tracker while participants first saw and then generated mental images of shapes that varied in luminance or complexity, while looking at an empty gray background. Participants also imagined familiar scenarios (e.g., a “sunny sky” or a “dark room”) while looking at the same neutral screen. In all experiments, participants’ eye pupils dilated or constricted, respectively, in response to dark and bright imagined objects and scenarios. Shape complexity increased mental effort and pupillary sizes independently of shapes’ luminance. Because the participants were unable to voluntarily constrict their eyes’ pupils, the observed pupillary adjustments to imaginary light present a strong case for accounts of mental imagery as a process based on brain states similar to those that arise during perception.

So it seems that thinking about something causes your brain to respond as if it is really seeing. What might this mean about those who are trying to break free of addictions?

  • Would imagining heroin use create observable changes in they body that would make it harder to maintain abstinence
  • Would recalling sexual images create responses that make sexual addictions harder to break?

So, what is the difference between imagining an affair and actually engaging in one? From a brain perspective, maybe not that much. Certainly Jesus’ expansion of the seventh commandment suggests there isn’t a difference between the two from God’s perspective. And yet, we know that actual adultery creates more damage to more people than merely fantasizing about having an affair.

Rumination: the health killer!

I’m currently teaching students a course on psychopathology. Each week we consider a different family of problems. Thus far we have explored anxiety disorders, mood disorders (depression, mania), anger/explosive disorders and addictions. Soon we’ll look at eating disorders, trauma, and psychosis.

There is one symptom that almost every person fitting one of those above categories experiences–repetitive, negative thought patterns.

Rumination.

The content of the repetitive thoughts may change depending on the type of problem (i.e., anxious fears, depressive negative thoughts, illicit urges, fears of weight gain, fears of being hurt, irritability, etc.) but the heart of the problem is the vicious cycle that negative thought patterns produce.

While there are many very good ancillary mental health treatments (Did you know that daily exercise, getting a good 8 hours of sleep each night, and eating a diet rich in protein supports good mental health and may even prevent re-occurrence of  prior problems?) it is essential for those of us who struggle with imagining negative events to find ways to shut down the production of rumination. Mindfulness techniques, thought-stopping, alternate focus may help to interrupt imaging bad feelings, thoughts, events and thereby interrupt the body reacting as if those bad things are indeed happening.

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February 14, 2014 · 11:34 am

Free Issue of Journal of Traumatic Stress


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.

 

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February 12, 2014 · 11:46 am

Are perpetrators of abuse “other”?


I write, teach, and provide professional care about matters pertaining to child sexual abuse. I sit on a board of a fantastic organization designed to help christian organizations prevent child abuse and respond well when allegations arise. From these experiences I can tell you that victims of abuse struggle the most when they finally get the courage to speak up but then aren’t believed–whether by other family members or those within their community. Since most abuse happens in secret places and since most of us live with happy public facades, it is easy to disbelieve the victim. In fact, the temptation is great since believing the victim means we must alter our perceptions of the perpetrator and the system that supports them. And that alteration disrupts our own lives, threatens our own comfort zone. Since some reports could be, have been false, maybe this one is too…

The first problem in stopping child abuse is the failure to believe victim stories of abuse. Victims know their information will destroy life as it was before the revelation. Believing that they will be singly responsible for damage done by revealing their abuse, they keep silent. Silence always enables further abuse.

But there is another problem, a second problem faced in stopping child abuse: treating abusers as “other,” some sort of monster that is so unlike the rest of us, we can’t imagine being in their presence. Think about these words. Perpetrator. Pedophile. What garish images come to your mind? Or, do you imagine someone with virtue along with their obvious and destructive vices? Do you imagine the image of a victim in that same person?

“Does it make sense to discard an entire oeuvre of work? Or does it simply reflect an inability to live with messiness and ambiguity? To chalk it up as nothing more than the work of a monster, to cast it out of the village, is to senselessly re-affirm the same basic strategy of denial and dehumanization that, ultimately, allows abuse to continue.”

If you are interested in considering the complexities of the person of the perpetrator, I highly recommend this essay where I found the previous quote. It is written by a victim of abuse perpetrated by his father. How do we account for the virtues, the generosities, the humanness, the victim experiences found in individuals who choose to perpetrate against others? Like the author of this essay, I suggest that doing so is absolutely necessary if we are going to make any dent in the incidence of child abuse.

“Most of us would sooner discard all parties who have been tainted by this event than we would look at how tenuous the sanctity of children really is, how commonplace abuse is, or see the capacity for the mostly good to do periodic evil. We live in the same universe as those who abuse kids. We walk among them. If we want to end the sexual abuse of children, it will begin with the recognition that we are simply not that different from them.” (emphasis mine)

Won’t humanizing perpetrators harm victims?

Humanizing perpetrators of abuse does not minimize the need for justice for victims. It does not decrease the place for restitution or incarceration. Naming humanity in perpetrators does not lead to excuse-making (we do that for other reasons!) nor demand explanations for abusive behavior (though sometimes this can be helpful, most would rather have acknowledgement of abuse done). It need not change our triage policy to prioritize victim recovery over all else.

But when we recognize that perpetrators of abuse suffer from the human condition plaguing us all (self-deception, self as the center of the universe, seeing others as objects for self-comfort, choosing fig-leaves rather than truth in response to shame), we have the opportunity to name these conditions wherever they show up in our lives. Naming them early and often hinders the development of the “split-self” where we live publicly one way but privately nurse other shame-inducing habits. And when we are more able to identify these features in ourselves, we may also find that we can identify them in others as well. While we are not responsible for the abuse perpetrated by others, complicity with abusive behavior (failing to respond to evidence of abusive behavior, allowing cover-ups, etc.) does stand as judgment on us.

Let us acknowledge that we are not so different, that “treatment” must start first in our own hearts so that we can help others before abuse takes place.

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July 31, 2013 · 1:06 pm

Treatment of complex trauma: Why mistrust of the counselor is necessary and good!


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)

Challenging Counselor Safety Is Common and Good?

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.

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