Healing from Childhood Abuse, Trauma and Neglect (Part 1)

When searching for counselling and therapy to heal the wounds of trauma, childhood abuse, and/or childhood neglect one can be faced with an overwhelming myriad of choices.   Most treatment techniques (both  medical and psychological) that are studied scientifically take into  account that a significant percentage (actual numbers vary based on condition or treatment being studied) of those being studied get better spontaneously simply because they believe they are being given a  (called the placebo effect).

A number of new approaches that take into account the recent discoveries of neuroscience, made possible by modern brain imaging techniques, have been shown either scientifically (in placebo controlled randomised blind or double-blind studies) or anecdotally (based on empirical observations and patient/client reports) to be highly effective in a shorter period of time than conventional "talking only" therapy. All of these approaches, of course, need to be integrated by a skilled and experienced clinician, into an overall treatment style and plan that will include talking therapy as well as a healthy respect for the power of the therapeutic relationship and the need for the therapist to earn the client's trust by creating safety.

Below I list some of the approaches that have been shown to be effective  with survivors of adult trauma and childhood physical, sexual, and emotional or psychological abuse, plus a link to another blog entry I wrote on effective  approaches for those suffering from the effects of "poor affect regulation",  commonly caused by emotional neglect or the unavailability of reliable  soothing in early childhood.  I only list those methods that I have personally learned and tried and observed to be effective, and the reasons (if known) that they work. 

Affect regulation treatment approaches are also useful with survivors of trauma and/or childhood abuse. The basis for this is  described in a separate blog entry (Learning to Comfort and Soothe) as they are more generic therapy approaches used for a broader range of problems and causes.  Since writing that entry, I have been learning about "memory reconsolidation" which claims that rather than going through the painstaking process of learning to "regulate" out of control feelings, one can "re-write" the implicit memory itself so that feelings become self-regulating, as they would have been if the original "dysfunctional implicit memory" hadn't been laid down in the first place. I will explore this in depth in another blog entry (coming as soon as I finish writing it).

I mention anecdotal or scientific (placebo-controlled) in brackets next to the name of each approach to identify the type of documentation of  effectiveness. I include approaches that have primarily anecdotal evidence because it is extremely difficult to measure approaches to complex trauma and dissociation in a laboratory setting. In my opinion, there are too many uncontrollable variables once you try to measure treatment effects with this population, especially since it isn't ethical to in any way limit access to anything that might help simply because it could confound the scientific evidence of your study.  The DNMS, Sensorimotor Psychotherapy,  and Ego State Work, for example, have ample anecdotal evidence presented in scientific journals as controlled case studies, and are based upon modern scientific insights into the brain,  but that is not the same as evidence based on rigorously controlled scientific studies.

Ego State Therapy (anecdotal)

Founders: John and Helen Watkins

The concept of segmentation of personality into discreet parts of self has been around for many years, but has only recently been validated scientifically by new brain scanning technologies. These technologies, by measuring blood flow patterns in the brain, demonstrate how ego states are formed by neural clusters repeatedly firing together (and therefore "wiring together"). 

Such neural nets form the basis for most implicit learning - such as learning how to ride a bicycle - a skill that improves and eventually "clicks" as the neurons, which fire together in the same pattern whenever riding is practised, form a network with a particular skill set. When such a neural net forms in the context of a relationship, it will develop a unique point of view and way of behaving.

Ego states exist as a collection of perceptions, cognitions and emotions in organised clusters. An ego state may be defined as an organized system of behaviour and experience, whose elements are bound together by a common principle. Ego states may also vary in volume. A larger ego state may include all the various behaviours activated in one's occupation, whereas a smaller ego state might be formed around a simple action, such as using a mobile phone. They may encompass current modes of behaviour and experiences or include many memories, postures, feelings, etc., that were learned at an earlier age.

The human mind is a collective "family of self" within a single individual. How well these "family" members get along, and how effectively they cooperate can vary considerably from individual to individual. 

This segmentation has been called many names over the years, depending upon which psychological theory is being used. In Freudian language we are all divided into Ego, Id and Superego; Jungians refer to "complexes" which are described almost identically to ego states; Transactional Analysts talk about the internal Parent, Adult and Child; and Psychosynthesis refers to "sub-personalities." Ego states exist on a continuum of separateness, with the most extreme dividedness being caused by the most extreme early relational trauma.

Although everyone has ego states, those states formed in response to loving supportive experiences do not tend to require psychotherapeutic intervention. When ego states are more split off and engage in internal battles, Ego State Therapy can be employed to help resolve some of these conflicts, often using techniques found in conflict resolution, group or family therapy, to enable a kind of internal diplomacy. This approach has demonstrated that complex psychodynamic problems can often be resolved in a much shorter period than with analytic therapies. 

PLEASE NOTE: The techniques described here have been integrated into PSI^TM (PsychoSomatic Integration), an overall approach I teach for working with trauma and abuse survivors. PSI^TM is described here in more detail.  

More approaches to come....to be continued

Myths and Truths about "Happy Couples"

                                        by Judy Lightstone © January 2012

This article is partially based on extensive laboratory and longitudinal scientific research about couple satisfaction in long term relationships as presented in the book The Marriage Clinic, by John M. Gottman, published by WW Norton & Company in 1999.  Please see this book for more resources.

Most of us know by now that the fairy tale happily ever after stories are full of holes. Dashing men on horses don't usually rescue helpless women and live happily ever after in real life.  But most of us don't know how inaccurate our current popular expectations and beliefs are about what makes "marriage" work are (and by this I mean any long term committed romantic relationship).  

Mostly we look around at such things as divorce statistics and see that a lot of them don't work  This assessment is also unfair, given that this doesn't include long term committed relationships outside of marriage, nor does it consider that relationships may last several decades and still be included in divorce statistics. Most importantly, the numbers don't tell us what allowed some relationships to last and others to break up, and they don't tell us how much overall satisfaction existed in those relationships that stayed together or broke up.

Many of the following cultural myths perpetuate some of the problems that bring couples to counselling.

MYTHS
1. Arguing = trouble.
2. Distance = trouble.
3. Opposites attract.
4. Flattery will get you nowhere.
5. You have to agree on the BIG issues (like children, sex and money).
6. People divorce because they “grow apart”.
7. Couples divorce because they get older and change physically.
8. The more sex the better.
9.  A fat woman will lose her man.
10. Both partners have to be equal in a good marriage.

TRUTHS

1. Fighting per se is not necessarily a problem.  If there is basic mutual respect, the ability for partners to cool down and soothe each other afterward, and lots of good stuff in the "emotional bank account", the tendency to fight is more a result of personality style than trouble in the relationship.  In his book The Marriage Clinic, John Gottman talks about the "emotional bank account"  and the "fondness and admiration system" in which he describes the ability of a couple to draw on "stores" of good feelings that have been deposited there by each partner.  It is the ratio of negative interactions and positive interactions -he advises the ratio should be at least 5 (positive) to 1 (negative) -that is more of a predictor of a satisfying relationship than the number of arguments.  Some couples like to handle problems directly, and if each of the two people are this way, then they may resolve their problems more quickly and with less bitterness if they approach them head on.

2. Other couples are more avoidant and have a similar level of tolerance for putting off confrontations.  It is the compatibility of problem solving style between the two people rather than the style itself that is more predictive of failure. When two people prefer to avoid conflict together they don't necessarily get into trouble unless this escalates to avoidance of positive regard for one another.  If they can accept each other's differences and remain loving toward one another they may be able to avoid conflict for a long time.  It is more a problem if one is a conflict avoider and the other is a conflict confronter.  This difference can be worked out (although sometimes help from a therapist is required) if there's a lot of overall positive regard.

3.  Differences may make the courtship stage of a relationship more exciting, but they can make a lasting relationship more difficult.  Not all differences are alike, however.  The most important differences that can cause trouble are: difference in conflict style (see above), differences in mutual respect for each other's life dreams (note I did not say the dreams had to be alike, only the amount of respect accorded the other person for his/her dreams), differences in libido (sexual drive), differences in lifestyle (e.g. degree of accumulation vs. simplicity desired), etc.  All of these differences can be worked out in a healthy relationship and don't necessarily signal danger - they just make things harder rather than easier.

4. Some would say the solution to all marital difficulties is honesty - always saying what is on your mind because that is the Truth.  But in my practice I have seen this become an excuse for disrespect and contempt, and these are the things that will cause ruptures rather than healing.  True, people need to be able to express themselves freely to their partners, but this doesn't mean there is no room for tact.  And what may feel "honest" at one moment, may feel irrelevant at another.  Flattery, if that means complimenting your partner frequently, showing your affection regularly in symbolic or romantic ways, and bragging about her or him to others - will get you everywhere.  I don't mean saying things that aren't ever true, but focussing on the positive and building up credit in that emotional bank account makes a huge difference in how well your relationship will weather rockier times.

5.  There isn't a couple around today that doesn't have some "BIG" issue that it can't resolve.  There are too many choices and options available today to assume they must all be agreed upon in each romantic partnership.  Gottman estimates that 60% of all problems couples encounter are ultimately irresolvable.  Once again, the issue isn't the problem itself,  it's how couples learn to manage perpetual problems over the long haul.  This point is critical to understand.  As in other areas of life, many problems stay with us a long time- some throughout the life span - what matters is how we cope with this fact.  Do we comfort each others' experiences of frustration? Do we accept that there are some things that may never be perfect but know that we can keep trying anyway? Do we have enough good stuff in the bank to get us through? Gottman calls this the ability to "dialogue with perpetual problems".  Ultimately, it's the quality of the dialogue, not the seeming seriousness of the problem itself, that will predict the success of the relationship.

6.  Although this may be somewhat true when couples meet at a young age, because the younger they start, the more quickly they will change and might simply become so different they are no longer compatible, for most couples who claim they just "grew apart", this is an excuse that tends to gloss over the deeper issues that can cause serious trouble in a love relationship. 

So if fighting, avoidance, differences, growing apart, and "honesty" aren't the real problems, and huge differences like children, sex and money don't necessarily predict disaster - why is there so much divorce? And what is the solution?  Gottman refers to the "Four Horsemen of the Apocalypse" as being:  1. Criticism 2. Defensiveness 3. Contempt and 4. Stonewalling, and says these 4 patterns are the most reliable predictors of divorce/separation or of a long but miserable relationship. When these four horsemen take over a relationship, the end is near, even if the couple physically stay together.  But with help (professional help is usually necessary for this) you can learn to consistently "build in the antidotes.¹"

Here are some "antidotes" I have found effective:
*for Criticism: try complaining without suggesting that your partner is somehow defective
*for Defensiveness: try accepting responsibility for a part of the problem
*for Contempt: learn to create a marital culture of praise and pride to replace the contempt, and
*for Stonewalling: provide self soothing, stay emotionally connected and give the listener nonverbal cues of your attention.

7. Attraction is more related to what's in the emotional bank account than to physical appearance.  When loss of attraction or change in physical appearance is used as an excuse for divorce or constant criticisms,  it is more indicative that the person doing the criticising is having self esteem or identity issues.  Although these problems may require individual or couples treatment,  it is not physical changes that are at the heart of the deterioration of a marriage.

8. Sexual compatibility, not frequency, is the key to couple sexual satisfaction.  Difficulties (again, not irresolvable) arise when there is a difference in the amount of sex desired by each member of the couple.  Many satisfied couples have little or even no sex because this is all each of them desires.  Gottman found that it is the nature of the friendship, more than the frequency of sexual relations, that gets people through in the long run. When frequent sex is desired by both partners, and sex is part of the overall fondness and affectional system, it can be a wonderful asset.  When one is wanting more sex than the other, it is likely to cause stress in both partners.  However, more often than not, the development of sexual problems is a symptom rather than a cause of relationship difficulties. Because sexual intimacy requires each partner to be vulnerable to the other, when the relationship is experienced as emotionally unsafe by one or both partners, sexual disturbances will likely arise.

9.  I have worked with many couples who were dealing with changes in one partner's body size.  I have seen some couples break up when there was no perceptible physical change and other couples thrive through considerable physical changes. When there is a wealth of positive regard in the relationship, physical attraction tends to follow that regard.  It is unfortunately common for someone with an eating problem to project their body image insecurities onto a partner.  This can be true for certain same sex couples too- one partner "absorbs" the bad body feelings and the other projects them.  When this is the case it is important for each member of the couple or family to work separately on his or her eating problem and put a special effort into being loving and respectful of the partner's food and body boundaries.  It is not easy to go against the cultural dictate of thinness for everyone, but a family can work together to develop a culture of love and respect for differences that will ultimately solve way more problems than the temporary (for usually it is no more than that) weight gain or loss of one or more of its members.

10. There are many ways for couples to share power and responsibility that do not necessarily correspond to absolute equality in all areas.  What is more important is that each partner have equal influence on the other.  Weiss'² coined the term: "positive sentiment override" (PSO) to describe this ability.  He coined the term "negative sentiment override" (NSO) for the opposite. What this means is that when partners feel trusting  of one another, they tend to hear each other's suggestions and complaints non-defensively. There doesn't have to be agreement on the issue, just willingness to talk about the differences. Statements judged neutral or negative by observers can be interpreted positively by a partner with a couples history of respectful conflict (PSO) just as statements judged neutral or positive by observers can be interpreted as negative by a partner with a  couples history disrespectful conflict (NSO) as in the following examples.

PSO Example:

Partner 1: Will you shut up and let me finish?

Partner 2: Sorry, go ahead.

Though partner 2 may not be very happy about this comment, he still recognises that his partner felt hurt by his interruption and gives her the benefit of the doubt.

NSO Example:

Partner 1: Will you shut up and let me finish?

Partner 2: To hell with you, I’m not getting a chance to finish either. You’re such a bitch, you remind me of your mother.

Here partner 2 assumes negative intent and feels he must defend himself.

In summary, this does not mean that a couple in trouble can just start being loving and affectionate during their arguments.  It takes work and often professional intervention to get out of negative cycles.  Repeating affirmations that have no meaningful basis is not the solution either.  Genuine positive regard, if not already deeply embedded in the marriage, can only emerge once the relationship is made emotionally safe for both partners.
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*   * This article does not apply to couples struggling with physical or sexual abuse. Much stronger interventions are required in those cases to first and foremost keep all parties physically safe.  For resources on this topic, please see: http://www.womensrefuge.org.nz

Link to:  Couples therapy

Notes:

1. Gottman, John M.  The Marriage Clinic, NY:  WW Norton & Company; 1999, page 193.
2. Weiss, R. L. (1980) Strategic behavioral marital therapy: Toward a model for assessment and intervention. In J.P. Vincent (Ed.), Advances in family intervention, assessment and theory (Vol. 1, pp. 229-271). Greenwich, CT; JAI Press.