Case Example 1 Marissa, age 42, was sexually abused by her father during childhood and reported that she still saw him on holidays and took her children to visit him. Although the overt sexual fondling and undressing no longer continued, she disclosed that he still kissed her on the lips with his tongue in her mouth and pressed his pelvis against hers at every greeting. Some of the first work in Marissa’s treatment was to empower her to refuse this type of greeting and to ensure that her children were never alone with him, as she discussed her concern over whether they, too, were at risk. Safety from self includes the cessation of any self-harming behaviors, including substance abuse, suicidality, self- mutilation, eating disorders, and unsafe sexual encounters. Some of these behaviors can be understood as symbolic or re-enacting of the original traumatic events (Courtois & Ford, 2012). Case Example 2 Louise made the connection between her self-described “promiscuous” behaviors in her 20s and a rape she experienced as a teenager. She said, “It didn’t seem to matter anymore if someone had access to me sexually after the rape; it just mattered that I decided who it was and when I chose to give access. At some level it felt as if I was redoing the original rape—but my way this time.” The goal of establishing even basic self-care may be fraught with difficulty and contention for survivors of chronic childhood abuse because the belief systems that they may have developed do not include a sense of worthiness or self-respect. Some of these self-harming behaviors may provide relief from pain; therefore, more adaptive behaviors need to be learned before the client may be willing to surrender these behaviors. This stage of the treatment can take weeks, months, or years, depending on the degree to which the behaviors and the underlying belief systems are entrenched. Based on the client’s level of maturity, age, or ability to maintain self-care, other family members or community resources may need to be engaged to support this basic level of safety (Briere, 2019). In addition to basic stabilization and safety, other work during this first stage includes naming the problem— meaning that the client identifies and puts into words the nature of the trauma and the effects it has had on their life (Herman, 1997). Information sharing on the part of the clinician is extremely helpful at this juncture to bind the anxiety that is associated with beginning to come to terms with traumatic life events. Naming a problem in words gives an individual some initial power and mastery over it that leaving it unnamed and formless does not allow. Another task of this first stage includes helping the client to regain some control over the areas of their life that feel out of control, both externally and internally (Courtois & Ford, 2012). The basic life tasks of eating and sleeping should not be overlooked. Everything is harder for a person who is fatigued or poorly nourished. A sense of control and mastery needs to be regained over all four areas of self: The emotional self, the cognitive or mental self, the physical body, and the spiritual self. (Specifics of how to address healing in these four arenas will be covered more fully in the next chapter.) Respecting the client’s autonomy and choices is crucial; the clinician should take care not to engage in a power struggle around issues of self-care. The SAFER Acronym . James Chu (2011) describes this work through the acronym SAFER: S: Self-care and symptom control The first step includes gaining control over self-destructive behaviors and reducing vulnerability to repeat victimization. Recognition of the need for self-care and learning self-
soothing techniques and stress management skills will aid in this endeavor. Symptom control includes limiting intrusive thoughts and increasing the ability to remain grounded, centered, and safe. A : Acknowledgement At this early stage, naming and acknowledging the nature of the traumatic experiences and their effect on functioning, without delving into the details or the affect, are key. This area also begins to address the core of meaning-making that is derived from early or chronic experiences of abuse and neglect. F: Functioning The client is encouraged and supported in maintaining their current level of functioning in the world (at work, at school, in their family and social networks), and additional supports are encouraged and offered by the clinician, as needed, to optimize healthy functioning. Staying anchored in current daily life and reality is supported. E: Expression The client is encouraged to begin to find expression in words for the unspeakable realities of their traumatic experiences. Verbal reporting, as well as alternative and expressive therapies, which can allow the client to speak without words (such as art, movement, energy work, photographs), can be employed. The clinician also needs to monitor and pay attention to containment and prevent the spilling of too much information or affect. The client needs to learn to be able to tolerate the experience of feeling states without becoming dysregulated. R: Relationships A therapeutic alliance and other supportive relationships are formed that are mutual, supportive, collaborative, and empathic. The difference between healthy and unhealthy patterns of relating is addressed. Attention to and work on the establishment of trust is highlighted. Crisis Intervention . When the trauma is a recent acute crisis, the model of crisis intervention is fairly common. Crisis intervention focuses on a brief treatment model and a fairly rapid return to normal daily functioning. If the client has additional factors in their life that complicate the brief treatment approach, this approach may accomplish only the first stage of the recovery and more in-depth treatment may be called for in the future. Stabilization of symptoms is not the same as a full and integrated recovery (van der Kolk, 2014). Stage 2: Remembering and Mourning The remembering and mourning phase of treatment involves a reconstruction of the narrative of events that have occurred, connecting the appropriate affect with them, and then sufficiently resolving the affect (Herman, 1997). This stage involves the significant task of transforming traumatic memory into simple memory. The question “What does a person have when traumatic memory has been successfully processed?” is answered by the statement “Just a memory.” Taking the negative emotional charge off the events, through narrative and nonnarrative work methods, helps the client to transform the childhood or victimized perspective that originally accompanied the events to a more nuanced, resourced, adult, and rational point of view. The goal of reframing traumatic events is to help the client move from the stance of “I am helpless and powerless and everything is my fault” to “I am no longer helpless, these events are in the past, and I can clearly see who is responsible for what.” Placing appropriate blame on perpetrators and acknowledging the differences as well as the similarities between abuse and nonprotection are parts of this work. In addition, finding ways to atone for or make restitution, if the client actually harmed others, is crucial for restoring
Page 101
Book Code: SWPA1525
EliteLearning.com/Social-Work
Powered by FlippingBook