Stauffer, K. A. (2021)
W. W. Norton & Company

I believe it was during a conference in 2015 when I first heard Martin Teicher talk about the impact of neglect in young children; how there was growing evidence that in comparing the “neglect trajectory” and “abuse trajectory” for the deleterious impact on the developing brain, neglect may be more harmful than abuse. Since then, we have been watching the accumulation of further evidence to support this bold claim, coming out of various labs. As research in this area became more nuanced over the years, we started to see that “neglect” means something different than emotionally ignoring infants and young children. For a lot of trauma clinicians, this created a persistent question about what exactly this may mean in terms of what happens in the therapy room: How do these different experiences present differently in adulthood, and how may the various trauma-focused approaches and interventions result in different outcomes based on the nuances of the impacts of the experiences? Dr. Kathrin Stauffer’s Emotional Neglect and the Adult in Therapy: Lifelong Consequences to a Lack of Early Attunement (2021) provides a cohesive response to these questions by pulling together experience-informed effective theories, principles, and specific interventions for the treatment of adults who were emotionally neglected as infants and young children.

In the first part of the book, Dr. Stauffer wisely and helpfully presents the overlaps and nuances between emotional neglect and trauma experiences. She emphasizes that predictably, there is significant overlap between the world of trauma and emotional neglect, both in terms of situational and interpersonal risk factors and clinical presentations. On the other hand, in describing the emotional neglect cases, she emphasizes shame as the most prominent tell-tale sign of emotional neglect. To demonstrate both the clinical presentations and the suggested interventions, four different cases are used. The definitions, descriptions, theories, and interventions come to life in these case excerpts that Dr. Stauffer turns to regularly throughout the book. Using a developmental framework, emotional neglect is defined as the experience of not having a primary caregiver who is able to interpret and/or appropriately respond to the needs of the infant/young child. She uses the term “ignored children” throughout the book to describe individuals who have suffered emotional neglect. From this perspective, shame has two fundamental prongs: the shame of having needs (e.g. the need to be close to others) and the shame of being someone who deserves all the painful experiences of the past. “Deserving the painful experiences” comes from the common understanding that for the ignored children (and for those who have suffered early and chronic interpersonal traumas), it is safer to assume responsibility to preserve the “goodness” of others, to avoid the biggest threat of all: isolation.

In terms of clinical presentations, the author uses attachment theory and body psychotherapy as her guiding posts. She uses attachment theory to understand insecure attachment and body psychotherapy to understand self-regulation, and the “schizoid character style” and “oral character style.” She explains that in literature, schizoid character style is thought to develop from severe trauma in the earliest stages of life, and she claims that there are parallels with the ignored children. On the other hand, she claims that while “ignored children do not have a narrative for how unpleasant their experiences had been, schizoid characters may have more of an awareness of themselves as victims of some kind.” According to Dr. Stauffer, oral character style develops when the baby is misread and neglected by the caregiver. Consequently, the baby decides that they do not have the right to need anything, so they either experience an ever-present and aching need (collapsed oral character) or they will work hard not to need anything (compensated oral character). The “compulsive caregiver,” someone who connects with others by solely focusing on meeting the needs of others, with no regard for their own needs, develops from the compensated oral character.

Primarily, biodynamic theory in explaining “hypo-responsiveness” and relational trauma therapy (developed by Holm Brantbjerg, 2020) is used to conceptualize the ignored children cases. Admittedly, I am not familiar with these approaches, so I depended on the information provided in the book; it was easy to read and understand. Much like muscles that go flaccid when encountering a force that overwhelms their strength, hypo-responsiveness is described as giving up instead of engaging and attempting to rise to the challenge in psychological terms. The parallels of motor development and psychological development are described through the biodynamic theory. Dr. Stauffer also describes that much like the process of strengthening underdeveloped muscles, interventions that provide emotional challenges can only be psychotherapeutically effective, when they do not overwhelm the available resources. Given how hypo-responsive ignored children are, she strongly cautions against challenging and confronting in therapy, suggesting alternatives that are primarily designed to validate and support. Throughout the book, the relational and body/physical aspect of the psychotherapy process is emphasized to help improve available resources for the emotional experience of the clients. For example, Resource Oriented Skills Training (ROST), relational trauma therapy’s movement-based exercise schedule, is one of the primary components of therapy. Given the fact that emotional neglect and its impact starts early in development, the emphasis on physiology and relationship aspects of therapy made sense.

Using Stephen Porges’ Polyvagal Theory principles, Dr. Stauffer explains the approach she describes from a neuroscience perspective as well. I found it fascinating to read about the “toxic shame” that overwhelms the psychological apparatus in connection to the dorsal vagal complex that triggers the freeze response. The connection between attachment, internalized shaming, and stuck shamed states, and how these systems can be explained by the Polyvagal Theory, were also clearly laid out, suggesting an intervention roadmap based on these foundations.

The last two chapters are dedicated to principles and specific interventions for working with adults who were neglected as children. Using the amorous transference example provided earlier in this section, the author demonstrates how the emotional relational aspect of therapy can be used to strike a balance between the support of positive feelings and appropriate boundaries. The process also brings forth a countertransference reaction, as the client admits to needing something and articulates it (very critical aspects of treatment), the therapist is not able to reciprocate and meet the need of the client. “Dosing down,” the incremental engagement of challenges to “underdeveloped muscles” to be able to facilitate growth and increase capacity for “emotional muscles” is emphasized. Of course, as was the case throughout the book, shame mechanisms and addressing shame in the therapy room is brought up repeatedly during this section as well. The treatment process was laid out to show three aspects: using trauma treatment approaches, support for good feelings, and “nourishing the soul,” allowing in what feels good with no hesitation or shame. There is a significant emphasis on making sure there is a physical aspect to the treatment plan and biodynamic massage is one of the recommendations. Again, I was not familiar with this modality, so reading about it here and understanding how it would “fit with” using various other approaches such as attachment, humanistic, Jungian, and integrative therapies was intriguing.

Overall, I found this book valuable in presenting a comprehensive treatment approach for the hidden developmental trauma of emotional neglect. An integrative approach is evident that pulls together strengths of psychodynamic, humanistic, and interpersonal approaches, and incorporates neuroscience for trauma syndromes and ego state work. Clinicians who work with complex trauma cases and developmental traumas will find this book to be beneficial.

Reviewer bio:
Z. Benek Altayli, PsyD is the executive director of Wellness Center at University of Colorado Colorado Springs. She has been practicing as a psychologist for 15 years and has focused interest in psychological trauma assessment, diagnosis and treatment; more specifically, she is interested in complex traumatic stress and its treatment. Dr. Altayli has experience and expertise with disaster preparedness and response and is a part of APA’s Disaster Resource Network. Additionally, she works with and trains other professionals on behavioral crises and emergencies assessment and intervention. Currently, Dr. Altayli holds APA and Division 56 memberships. Dr. Altayli is currently serving as a Colorado State suicide prevention commissioner representing higher education, assessment task force member for the Colorado National Collaborative, and El Paso County suicide prevention collaborative member.

Deborah A. Stiles

There are no words.

I am a white woman who is a professor and psychologist; I suffered a traumatic loss in 2022 when my 34-year-old African American foster daughter was murdered. Although we were not biologically related, I was her mother, and she was my daughter; I deeply cherished and depended upon our relationship. To quote the message from a fellow foster parent and dear friend, “She was your daughter—born of your heart.”

Here I am writing about my personal perspective. I am not writing about everything that happened; I am writing about what has been most important for me as I have been transformed by the loss of my beloved daughter. Because I am a professor, I am also connecting my personal experiences with professional literature.

I would describe myself as a mild-mannered professor and peace psychologist. When my daughter was killed, I was in Europe and presenting at an international psychology conference. I did not learn about my daughter’s death until l returned to the United States. According to the newspapers, it was a brutal murder; she was shot to death. Learning about her violent death was shocking and scary for me. Violent crimes are associated with extreme distress for victims (Norris & Kaniasty, 1994). A friend who is a private investigator told me that due to the intentional killing of my daughter, she had concerns about my personal safety. Later, I read that concerns about physical safety are not uncommon for family members when there has been a murder; observations of the grief of parents of murdered children have found that the parents are often fearful about their own safety (Peach & Klass, 1987).

These frightening circumstances shook me to my core, and I resolved to continue to read everything I could so I might understand what had happened. For instance, I found out that “Homicide is a leading cause of death for young adults and typically leaves in its wake survivors who struggle to face life following this traumatic form of loss. The demography of death is not democratic, as some cultural groups are far more likely to experience traumatic bereavement than others… a disproportionate number of murder victims in the United States are African American” (McDevitt-Murphy, et al., 2012, p. 2011). Later, I read an article, “Development and Validation of the Inventory of Stress and Coping for African American Survivors of Homicide Victims” (Sharpe et al., 2022). The subscales in the Inventory of Stress and Coping for African American Survivors of Homicide Victims (ISCASHV) measure were Cultural Trauma, Reactions to Homicide, Culture of Homicide, Racial Appraisal, and Coping (p. 6). The article included the coping strategies that Black homicide survivors use. I discovered that I followed two of the most common coping strategies of Black homicide survivors: “spiritual coping and meaning making” and “maintaining a connection to the deceased.”

My house is still filled with photos of my daughter, and I think about her every day. Because I was very afraid of some members of my daughter’s family, I was not part of the “collective caring” described by Sharpe et al. (2022).

My grief about my daughter’s death has been profound and complicated for many reasons. I was a foster parent, and I met my daughter when she was 14-years-old. She had a terrible and violent childhood; she told me she did not want to be adopted by me because she felt she had been her own parent from a very young age. And so, when she was 16-years-old, I helped her become legally emancipated and a “mother to herself.” Even so, she always called me Mom, and we remained close until her death.

I am five feet, five inches tall with straight blond hair and my daughter was only five feet tall; she had black hair in a new hairstyle almost every day. Despite the obvious differences in our appearance, most strangers we met knew that we were mother and daughter. My daughter and I had the same cheekbones, smile, and interests. We both loved learning, art, creative writing, poetry, fashion, wearing high heels, and dancing. After her death, I attended a webinar titled “Transformed by Loss” and later made a sketch of us (see Author Image 1).

Through reading books and articles, I learned that the death of a child from homicide creates a “particularly difficult form of bereavement and one that involves multiple losses of both an actual and symbolic nature” (Rinear, 1987, p. 315). As for me, I lost my family, my identity as a mother, my identity as a member of an interracial family, my holiday plans, my happiness, my well-being, etc. I also read that, “The grief of parents who have lost children to murder is extreme, prolonged, and unique” (Kashka & Beard, 1999, p. 22). This previous quote is from an article written by two professors of nursing, both of whom had lost children to homicide. I learned from their article that [survivors of homicide] “feel stigmatized and isolated from others in their social network” (p. 27). Their observation matches my own experience; I eventually realized that the word “murder” is a conversation stopper. When people asked me how my daughter died and I answered, “She was murdered,” our conversation would be over.

I also discovered that it was rarely helpful for me to talk with people who had not known my daughter. Three exceptions were the conversations I had with the pastor of my church, a friend who is a licensed professional counselor, and a session with a dance movement therapist (DMT).

When I did speak with my friends who had known my daughter, the most common response was “There are no words.” My friends were right about words being inadequate. The murder of my daughter disrupted my sense of self and dysregulated my body sensations and movement. I knew in my heart of hearts that “talk therapy” was not what I needed. I read that “trauma affects somatic functioning, nervous system regulation, relational engagement, and personality integration” (Dent, 2020, p. 435).

As I continued to read, I became intrigued by an article titled, “Thriving after trauma: The experience of parents of murdered children”; this article described sixteen parents of murdered children who experienced posttraumatic growth (Parappully et al., 2002). Based on questionnaires and interviews from the sixteen parents of murdered children, the article describes these parents’ journeys from profound traumatization to personal transformation related to thinking, feeling, and behavior. The bereaved parents described finding meaning in the tragedy and making a personal decision “to rise up phoenix-like from the ashes” (Parappully et al., 2002, p. 46). I identified with the sixteen participants’ determination, compassion, spirituality, and desire to maintain a continuing affective bond with their deceased children. Early on, I made a promise to myself to live in a way that would honor my daughter’s memory.

Although I am inspired by the sixteen parents who experienced posttraumatic growth, I know myself and I know my continuing journey towards thriving will be different from their journeys. Because “there are no words,” I am exploring healing without words through running and art therapy. There is no strong “evidence-base” for the benefits of using running and art therapy as grief interventions (Asgari et al., 2022). However, both silent pursuits are working well for me. I run almost every day; and when I run, I am moving forward and not stuck in grief. For me, running is not a chore, but a source of happiness and the sweet joy of movement. The physiological benefits of running may include leading to the growth of new nerve cells and blood vessels as well as improving brain functioning and heart health. Running also helps me think of my daughter and the times we enjoyed running together.

For me, drawing is a way of accessing my innermost self. In this pencil drawing (see Author Image 2) of a photograph taken almost seventeen years ago, I am giving my daughter away as I walk her down the “aisle” for her wedding in my backyard. I think I chose to make this drawing of me giving her away because I am releasing her to whatever might be beyond life. She no longer lives on the earth, but I can, and I do honor her memory.

Jessica Krukowski, Ed St. Aubin, & Karen Robinson
Section Editor: Sydney Timmer-Murillo

Black women live in an intersection between two marginalized identities: their Blackness and their womanhood (King, 2019). Oftentimes the challenges Black men and boys face become synonymous with the entire Black experience (Patton et al., 2016). As a result, solidarity becomes asymmetrical, and the lived experiences of Black women and girls become marginalized (Johnson, 2013). Black women encounter a similar asymmetry with sexism. Sexism as experienced by White women and by Black women is not equivalent. Because the Black woman’s particular experience is not recognized, that experience of sexism is dismissed (Sesko & Biernat, 2010). Because the impact of racism and sexism have been historically explored separately, the unique intersectional forms of racist and sexist oppression Black women face are less understood and have remained invisible to larger social justice movements (e.g., civil rights, Black power, feminism/women’s liberation, workers’ rights, Me Too, Black Lives Matter; Coles & Pasek, 2020). This imposed invisibility has perpetuated the systematic silencing of Black female voices (Kota, 2020). As a result, Black women have been consistently underrepresented and historically overlooked in research, leaving a gaping hole in the scientific literature (Allen, 2018). Methodologies exploring stress and trauma in Black women are no exception. Presently, the body of stress and trauma literature has found pervasive effects on the mental health (Turner & Turner, 2021) and well-being (Harrell, 2000) of Black people, but the methods employed have not been conducive to understanding the lived experience of Black women in particular. Thus, it is imperative for researchers to provide the space for Black women to use their voices to guide future scholarship. Raising the voices of Black women will help to close this gap, adding a strength-based and intersectional lens.

Method

The sample consisted of Black women varying in age, income, and sexual orientation living in Milwaukee, Wisconsin; see Krukowski et al. (2022) for additional study methodology. The purpose of this mixed-methods study was to explore how the low-point narratives from Black women relate to quantitative measures of mental health and well-being. Written informed consent was obtained before completing a 90-minute, semi-structured, one-on-one life-story narrative interview (McAdams, 2015) which was audio recorded in real-time with a Black/African American female researcher trained in the interview protocol. The low point prompt requests that the participant describes in as much detail as possible the lowest point in her life. These women were asked what happened, when and where it occurred, who was involved, and what they were thinking and feeling. Participants were asked to recount why this particular moment was so difficult and what the scene may say about them or their life (McAdams, 2015). This prompt qualitatively elucidates experiences of stress and trauma without explicitly asking to recount a specific traumatic event.

Following the interview, participants completed an online survey battery including the Perceived Stress Scale (PSS), a 10-item stress assessment instrument to help researchers understand how various situations affect a participant’s feelings and perceived stress over the last month (Cohen et al., 1983); the Depression Anxiety Stress Scales (DASS), a 21-item scale with three sub-scales designed to measure the emotional states of depression, anxiety, and stress (Lovibond & Lovibond, 1995); the Psychological Well-Being scale (PWB), an 18-item instrument based on the participant’s attitudes about themselves and others which investigates quality of life as it relates to benefits gained through overall psychological health and stable self-concept (Ryff, 1989); and the Social Well-Being scale (SWB), a 15-item instrument that explores quality of life as it relates to benefits gained through understanding of self as a social being and maintenance of stable social relationships (Keyes, 1998). Each participant was compensated for their time. After data collection, all interviews were deidentified and transcribed verbatim. The low-point portion from each Life Story Interview was compiled. Other facets of the Life Story Interview were not considered for this project.

To ensure cultural responsiveness, there was a council of five Black female community leaders and academics who consulted the team at every step of the project’s design including identification of all measures used and the implementation of the study. Further, each of the interviews were conducted by Black women members of the research team and Black women were part of interpreting the narrative material participants told.

Results

There were 62 participants with both interview and survey data. A thematic scoring system was created to determine which women described an event that would meet Criterion A of posttraumatic stress disorder (PTSD) from the Diagnostic and Statistical Manual of Mental Disorders. Criterion A events are defined as ones in which a person is exposed to actual or threatened death, serious injury, or sexual violence either directly, as a witness, from a loved one’s experience, or from repeated or extreme exposure to adverse (disturbing) details of a traumatic event; Criterion A does not apply to exposure through electronic media, television, movies, or pictures unless this exposure is work related (APA, 2013). Of the 62 responses, 38 women (61.3%) described an event that would qualify as Criterion A. Using independent samples t-tests, we tested whether there was a mean difference between women who described a Criterion A trauma and those who did not on six measures of wellness. There were no significant differences. What we get from these data is a constellation of how this group of women’s voices relate to mental health and well-being.

Discussion

This demonstrates that more than 6 out of 10 Black women from Milwaukee tell stories of the low point in one’s life narrative that meet the criteria for an event to be considered potentially traumatizing. Yet, when compared to those in this study whose low point did not meet Criterion A for trauma, there are no group differences on several indices of wellness.

While clinicians may work under the assumption that clients whose life experiences meet Criterion A are categorically different than those who do not with regards to psychosocial functioning, this study suggests a more nuanced reality. Practicing clinicians working with Black women from Milwaukee, and perhaps in other contexts, need to be mindful that there may not be an increase in their client’s mental health symptoms, or a decrease in their well-being when talking about life threatening or serious injuries that have happened to themselves or to people close to them.

We must remember that the methods and findings of this study are not the same as diagnostic work using Criterion A and that the description of the lowest point does not explicitly ask about trauma. It did, however, elicit responses that clinicians could consider traumatizing at incredibly high rates. These results can be used by mental health professionals to help guide appropriate treatment and intervention for the Black women they work with. This work underscores that if we want to understand individuals as a whole, we need to ask them about their lives. Lives are not checklists.

JESSICA KRUKOWSKI is a fifth-year clinical psychology doctoral student at Marquette University. Her clinical and research interests are rooted in exploring well-being using strength-based and translational methodologies. Upon graduation, she plans to pursue a community engaged clinical and research career aimed toward evidence-based social justice and policy reform.

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ED DE ST. AUBIN is a Psychology Professor at Marquette University. His current research projects integrate qualitative and quantitative techniques, with an emphasis on empowering participants by prioritizing their self-defining life stories. Our work is community-engaged and based on a deep understanding of the impact that culture and structural power dynamics have on individual lives. Core concepts we explore include psychosocial wellness, meaning-making, identity, microaggressions, intersectionality, trauma, and generativity.

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KAREN ROBINSON is the Interim Assistant Dean Graduate Programs and Associate Professor in the College of Nursing at Marquette University. Dr. Robinson’s program of research focuses on racial disparities in maternal-child health. She has centered her research around breastfeeding disparities by examining breastfeeding barriers for African American mothers. Specifically, Dr. Robinson is investigating how racism, implicit bias, and discriminatory behaviors towards African American mothers negatively impact breastfeeding outcomes within this population. She has also studied the positive effects of breastfeeding peer counselors and group prenatal care on breastfeeding outcomes. [See Dr. Robinson’s online profile.]

Citation: Krukowski, J., De St. Aubin, E., & Robinson, K. (2023). Exploring the wellness of black women who describe a criterion A trauma in their life story. Trauma Psychology News, 18(2), 22-25. https://traumapsychnews.com

Traumatic loss strips the world of substance and solidity

“I WILL LOVE YOU FOREVER,” a lover proclaims to a beloved. Love thereby transforms the beloved into a metaphysical entity, replacing the finitude and impermanence of existence with the illusion of eternity. When a beloved dies, not only is the relationship lost; the metaphysical illusion of its permanence and indestructibility crumbles. Such crumbling of metaphysical illusion lies at the heart of emotional trauma.

The crumbling of the illusion of eternal love radically transforms the lover and their world. As Edna St. Vincent Millay poetized it, “Where you used to be, there is a hole in the world, which I find myself constantly walking around in the daytime, and falling in at night. I miss you like hell!”

But the transformation of the bereaved lover’s world entails more than the absence therein of the beloved. Traumatic loss strips the world of substance and solidity, leaving the bereaved ungrounded. This is the process we characterize as a “fragilification of Being.” As one grieving widower described the experience,“ I am thinking I feel lost and disoriented because of Katy no longer being here. She was a stabilizing force–a grounding sweetie. I dreamt I was lost in a huge unfamiliar train station, looking for someone—anyone—to tell me where I was and how to get home.”

Another dream captured the disintegration of his world: “I was wandering through a field of burned out trees and buildings–burned skeletons, the incinerated remains of animals and people who had died most horribly.”

A particularly vivid instance of traumatic fragilification is provided by “the glass delusion,” originally described regarding the experience of Charles VI, King of France. Following a series of shattering traumatic events, Charles suffered from spells in which he believed he was made of glass. Because he was convinced that one wrong move would shatter him, his clothes were reinforced with iron and he had to be bundled carefully. Such ribs of iron are analogues to the dissociative defenses that shelter the vulnerabilities left by trauma. The various forms of psychopathology can be grasped as manifestations of crumbling metaphysical illusions of indestructibility and permanence or as efforts to restore such crumbled illusions. We hope to elaborate on this formulation in future communications.

ROBERT D. STOLOROW is a Founding Faculty Member at the Institute of Contemporary Psychoanalysis, Los Angeles. He has been absorbed, with George Atwood, for more than five decades in the project of rethinking psychoanalysis as a form of phenomenological inquiry. Most recently, they coauthored The Power of Phenomenology (Routledge, 2018).

GEORGE E. ATWOOD is Professor Emeritus at Rutgers University.

Citation: Stolorow, R. D., & Atwood, G. E. (2023). Emotional trauma and the fragilification of being: Traumatic loss strips the world of substance and solidity. Trauma Psychology News, 18(3), 10-11. https://www.apatraumadivision.org/

In brief
Claire J. Starrs & Zaine A. Roberts

Religiosity has been shown to be related to indicators of well-being such as hope, optimism, happiness, and quality of life (Gonçalves, et al., 2017; Panzini, et al. 2017; Peres, et al., 2017), as well as lower distress, even in the face of major stressors, such as cancer, bereavement, and traumatic events like sexual assault (Ahrens et al., 2010; Gudenkauf et al., 2019). Studies have suggested various mechanisms for this protective effect, including through increases in meaning making (Steger & Frazier, 2005), social support (Ellison & George, 1992), self-regulation (Watterson & Geisler, 2012), and self-efficacy (Abdel-Khalek & Lester, 2017). With the rise of secularism in the 20th century, at least in much of the West (Bruce, 2003; Lambert, 2004), broader conceptualizations of religiosity have been considered, under the umbrella term spirituality. Currently, there is some consensus that religiosity captures more formal religious beliefs and values, and collectivistic practices that generally include a public and institutional sphere (Pargament, 1997). Alternatively, spirituality usually describes more humanistic beliefs and values, including feelings of connectedness to the self, others, nature, and the sacred (i.e., to something greater than oneself), and spirituality is typically a more private and internal experience (Chagas et al., 2023; Reed, 1992). These two dimensions are not necessarily separate, as spirituality can be present at any level of religiosity (Zinnbauer & Pargament, 2005). Studies specifically examining spirituality, although less numerous, have supported a protective effect, and supported mechanisms include increases in hope (Gibson & Hendricks, 2006), and meaning making (Salsman et al., 2011).

Coping can be defined as the internal and external resources that are mobilized to manage stressors (Haan, 1977). Coping includes both adaptive and maladaptive strategies, and there is substantial evidence showing that maladaptive coping is associated with higher distress, and adaptive coping with lower distress (e.g., Cukrowicz, et al., 2008; Jaser et al., 2005). At the intersection of religiosity/spirituality and coping, is religious coping (RC, Pargament, 1997). RC is multidimensional, including behaviors (e.g., prayer, meditation), emotions (e.g., comfort through spiritual connection), cognitions (e.g., cognitive reappraisal and reframing), and relationships (e.g., seeking pastoral care). As with general coping, RC can be maladaptive (e.g., interpreting stressors as a punishment from ‘God’ or karma), which has been shown to lower quality of life and increase depression, or it can be adaptive (e.g., finding solace in prayer) leading to less distress and more personal growth (Pargament et al., 1998). Difficulties in defining more secular spirituality have hindered equivalent examinations in non-religious persons. Although, the few existing studies have also shown protective effects. For example, Roming and Howard (2019) found that higher spiritual coping was related to higher life satisfaction in college students.

Black, Indigenous, and People of Color (BIPOC)

Religiosity/Spirituality has been shown to be important across minority groups, including in African American and Black Caribbean groups (Taylor & Chatters, 2010), Latinx communities (Campersino et al., 2009), and Indigenous Americans (Garroutte et al., 2003). Furthermore, despite overall growing secularism, a recent large study found that 41% of Black Americans and 30% of Hispanics reported that their faith had grown stronger during the recent COVID-19 pandemic, compared to 20% of Whites (Gecewicz, 2020). Protective effects include lower suicidality (see Gearing & Alonzo, 2018 for a general review) and decreased depression (see Braam & Koenig, 2019 for a general review). The principal mechanism that has been suggested for this adaptive effect in ethnic minority communities is high levels of RC, as they deal with ongoing minority stress (Bhui et al., 2008). Most studies have examined Black and Latino samples in the US (e.g., Sanchez et al., 2015), however similar effects have been found other minority groups, for example Adam and Ward (2016) showed that RC buffered the negative effects of acculturative stress leading to higher life satisfaction, in a Muslim sample living in New Zealand. Suggested explanations for higher levels of RC across minority communities focus on sources of minority stress such as disparities in access to health care, reluctancy to seek psychological support due to stigma, and the general low cultural competency of health care providers (Harris et al., 2021; Nair & Adetayo, 2019). In addition, there is a long history of medical racism, especially, cruel nonconsensual medical interventions and experimentation on Black and Indigenous persons, in countries such as the US, Canada and Australia, which fuels mistrust in mainstream healthcare (Starrs & Herne, 2021), whereas, spiritual and religious resources are widely available and generally free, making them considerably more accessible than many other mental health focused services.

LGBTQ+ Communities

The picture is more complex within the gender and sexual minority community. There are many studies showing increased distress in LGBTQ+ individuals related to discrimination, oppression and rejection stemming from religiously motivated homophobia and harmful clinical practices, such as conversion therapies (e.g., Newman & Fantus, 2015; SAMHSA, 2015), and this distress effect may be even higher in those with intersectional identities (Jaspal et al., 2021). Furthermore, there has been a recent rise in religious based discriminatory legislation against LGBTQ+ individuals, especially transgender youth, across several countries, which raises serious concerns about related decreases in health and well-being (Richgels, et al., 2021). Regarding intra-individual processes of religiosity and distress in LGBTQ+ individuals, research has mostly focused on internalized homophobia. Internalized homophobia refers to negative attitudes about homosexuality that are applied to the self (Meyer & Dean, 1998). Internalized homophobia has been associated with poorer mental health and suicidality (see Newcomb & Mustanski, 2010 for review). Furthermore, exposure to non-gay affirming religious settings has been shown to increase internalized homophobia, thus creating an additional stress burden for queer individuals (Barnes & Meyer, 2012). Research suggests that to resolve the internal conflict created by religious doctrine around homosexuality, sexual minority individuals adopt various strategies including changing religions, reexamining, reframing and/or rejecting certain teachings, abandoning religion either temporarily, completely or stopping attending formal services and turning to a more personal sense of spirituality (Leong, 2006; Schuck & Liddle, 2001; Yip, 1997, 2005). Another concerning issue highlighted by the research is that many gender and sexual minority individuals are reluctant to seek help in times of distress (Bivens et al., 1995; Schaefer & Coleman, 1992), especially for those in non-gay affirming environments. For example, Wolff and colleagues (2016) found that college religious affiliation was associated with poorer mental health outcomes for sexual minority students.

There is considerable evidence showing higher levels of suicidal ideation and attempts in gender and sexual minority persons than in cisgender heterosexuals (Haas et al. 2010; King et al. 2008; McDaniel et al. 2001; Plöderl et al., 2010). At the same time, research in community samples has shown that religiosity confers some protection against suicidality (e.g., Dervic, et al., 2004; Gearing & Lizardi, 2009). Studies examining this protective effect in LGBTQ+ samples are sparse. One exception is Kralovec et al.’s study in an LGB Austrian sample (2014), who found that religious affiliation was associated with higher internalized homophobia but with fewer suicide attempts and a sense of belonging to one’s religious community was associated with significantly less suicidal ideation during the last 12 months. These authors suggested that religion might therefore be both a risk and a protective factor against suicidality in religiously affiliated sexual minority individuals (Kralovec et al., 2014).

Multiple Minority Communities

Finally, given the findings supporting religiosity-spirituality as a resilience factor in BIPOC communities, an interesting additional area of research is studies with multiple minority members of the LGBTQ+ community. As with the non-intersectional research, findings suggest considerable differences by population, and that different components of religiosity-spirituality may be toxic for people with marginalized identities (Bliss, 2011; Hackney & Sanders, 2003). However, there is also emergent research showing protective effects. For example, one study showed that religious support, along with family and social support, negatively correlated to psychological distress experienced by Black sexual minority college students (Lefevor, et al., 2020). In a qualitative study, Singh and McKleroy (2011) analyzed the experiences of transgender BIPOC persons who had survived severe trauma (e.g., hate crimes) and showed that, cultivating spirituality and hope for the future was connected to resilience and increased well-being. And in a recent study, Currin et al. (2021) showed that young adults who identified as BIPOC and LGBTQ+ reported lower distress, higher resilience and hope, as well as significantly higher spiritual support than White LGBTQ+ participants.

Clinical implications

Although psychotherapy has sometimes been seen as incongruent with religion and spirituality, overall, the research suggests that it is a salient part of people’s social and psychological identity, even if that salience may be on the decline (Siddiqui & Kapoor, 2021). Furthermore, given the existing findings suggesting that R/S is especially important in certain ethnic, cultural and social communities, and that it is a significant contributor to resiliency and/or vulnerability in these populations, that are already dealing with heightened levels of minority stress, to not explore the subject and it’s impacts in therapy is problematic. Approaches that harness the aspects of spirituality that have been shown to be protective, in particular, the development of meaningfulness and trust, of values and connectedness with the self and others, should be prioritized. As well as, exploring and reframing those aspects that may be contributing to distress. Minority communities face high levels of stressors that are outside of their personal control, particularly those related to discrimination and oppression, and systemic economic disadvantage (Williams, 2019; Sutton & Perrin, 2016). As such, avenues of intervention that support growth and well-being beyond just those that focus on changing stressful events themselves are essential. Furthermore, research has shown that individuals who have experienced religious conflict, report several helpful resources including extended social support, such as reaching out to alternative LGBTQ+-affirming congregations and leaders, as well as books and online communities, that can provide emotional support through peers and role models, as well as appraisal support for validating their experiences (Schuck & Liddle, 2001; Mallari, 2023) Thus, therapist should be prepared to refer clients to external resources such as support groups, and gay- affirming congregations, when possible. One positive aspect of the lockdowns related to the recent COVID-19 pandemic, is that many R/S communities were forced to explore the use of online spaces, and recent studies have confirmed that these on-line groups can positively contribute to well-being (e.g., Keisari et al., 2022), thus extending the availability of resources that can be offered to clients who may be geographically isolated from supportive communities (e.g., LGBTQ+ youth in non-affirming environments). Finally, the majority of mental health professionals are not themselves members of the communities that they treat, for example in 2015, 86% of psychologists in the US were White (Lin, et al., 2018), as such, including some focus on spirituality in psychotherapy with minority clients could be an effective and culturally responsive approach for non-minority clinicians.

CLAIRE J. STARRS, PhD is a researcher in the Department of Psychology at the Université du Québec à Montréal (UQAM), and an adjunct lecturer at McGill University. Her research focuses on historical and intergenerational trauma, as well as risk and resiliency in diverse populations, especially LGBTQ+ communities. For more information, see her lab website: https://starrslab.weebly.com

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ZAINE A. ROBERTS graduated from SUNY Potsdam with a BA, major in Psychology and Criminal Justice, and a minor in Human Services. He is currently a second-year graduate student in the Applied Clinical Psychology program at Penn State Harrisburg. Recently, he became the Vice President of their PRIDE organization where he works with the community to promote a safe and accepting campus environment for LGBTQ+ students. His research interests include youth, religion, gender and sexuality processes. He will be applying to doctoral programs in Fall 2024.

Citation: Starrs, C. J., & Roberts, Z. A. (2023).Religiosity/spirituality and wellbeing in BIPOC and LGBTQ+ communities: In brief. Trauma Psychology News, 18(3), 16-20. https://traumapsychnews.com

Review by Omewha Beaton, PhD

By Petra Winnette , PhD and Jonathan Baylin, PhD

2017

Jessica Kingsley Publishers

Working with traumatic memories to heal adults with unresolved childhood trauma: Neuroscience, attachment theory and Pesso Boyden system psychomotor psychotherapy is a collaborative effort by Petra Winnette, PhD, a psychotherapist, and Jonathan Baylin, PhD, a clinical psychologist. The book offers a comprehensive exploration of the Pesso Boyden System Psychomotor Psychotherapy (PBSP) framework and its potential to address unresolved childhood traumas in adults. By seamlessly integrating insights from neuroscience and attachment theory, the authors explore how childhood trauma shapes brain development, disrupts secure attachment bonds, and leads to lasting negative effects in adulthood. This book fills a critical gap in the literature on evidence-based trauma therapies for adults with unresolved childhood traumas.

Structured into 10 chapters across four sections, the book thoroughly examines the complexities of unresolved childhood trauma. The first section lays the foundation by offering a detailed overview of childhood trauma’s development and enduring effects. Following this, the PBSP therapeutic model is introduced, laying a theoretical foundation. Section 3 demonstrates PBSP in action through compelling case studies, bridging theory with real-world application. The final section features an insightful interview with Albert Pesso, co-creator of PBSP, offering insights into its development and evolution.

In Chapters 1 through 3, Winnette and Baylin integrate insights from neuroscience and attachment theory to explain how childhood trauma can shape brain development and disrupt secure attachment bonds. Winnette, the primary author, emphasizes the profound influence of early caregiver relationships on a child’s coping skills and emotional well-being, stressing the importance of safe and nurturing interactions. Conversely, neglect or abuse can cause developmental trauma, impeding a child’s ability to form secure attachments. Building on Winnette’s ideas, Baylin incorporates a neurobiological perspective explaining how traumatic experiences can physically alter the brain’s structure and function, leading to symptoms such as hypervigilance and intrusive memories. Both authors underscore a key insight: memories are not fixed, suggesting that even entrenched developmental traumas can be reworked to facilitate healing.

Chapter 4 introduces PBSP, a mind-body interactive therapeutic approach pioneered by Albert Pesso and Diane Boyden-Pesso. Within a safe therapeutic environment, PBSP allows individuals to re-enact and re-script past experiences, aiming to facilitate healing. Winnette provides a comprehensive overview of PBSP, focusing on its history, core principles, and techniques. Baylin explores the neurobiological underpinnings of PBSP, explaining why PBSP has the potential to resolve traumatic memories by altering maladaptive neural circuits and fostering the rewiring of neural circuits associated with trauma.

Chapters 5 through 9 vividly portray PBSP theoretical concepts in action through compelling case studies. For instance, one case study explores the journey of a client named Silvester, who grappled with depression and felt disheartened by his life stemming from childhood neglect and abuse. During one of his PBSP structures (therapy sessions), Silvester reenacted pivotal scenes from his childhood, expressing his unmet needs for love and safety to his therapist within a small group setting. Two group members assumed the roles of stand-ins for his parents, directed to provide the ideal parental responses he had never received. After this session, Silvester reported feeling a shift. He noted a reduction in his distress and preoccupation with his family and even described improvements in his ability to connect with others in his life. These case studies illustrate the power of PBSP to help adults navigate deep-seated trauma and reclaim autonomy in their lives.

The final chapter features an engaging interview between Winnette and Albert Pesso, the co-founder of the PBSP. This insightful dialogue provides a chronology of the historical development, evolution, and therapeutic underpinnings of PBSP. Drawing from his personal experiences and reflections, Pesso offers concrete examples and expert perspectives on applying PBSP in clinical settings.

This compelling text presents a robust framework for addressing unresolved childhood trauma in adults, emphasizing the importance of relational connection, emotional regulation, and self-compassion. The book effectively outlines PBSP’s core principles and techniques, showcasing its potential through compelling case studies. For instance, the case of Silvester powerfully demonstrates how PBSP can help individuals reprocess and release emotional pain from past experiences. However, further research is needed to validate PBSP’s efficacy on a larger scale. Additionally, PBSP’s emphasis on group work and emotional expression may not be suitable for everyone and may require a longer time commitment. Nonetheless, this text is an invaluable resource for trauma psychology professionals and those interested in trauma treatment through an integrative framework.

Review by Omewha Beaton, PhD

Dr. Beaton specializes in trauma psychology and holds a PhD in Clinical Psychology. She serves as the Director of the O’Neth Group Psychotrauma & Crisis Center and is an Assistant Professor and Program Coordinator for the Trauma Psychology program at St. James the Elder University.

A tri-essay collection
Traumatic Family and Hustle Culture by Minh D. Phan
Apocalyptic Anxiety and the Fragilification of Time by Robert D. Stolorow
Trauma-Informed Yoga as a Path to Trauma Healing by Monaé Weathington

Traumatic Family and Hustle Culture by Minh D. Phan

When I was between the ages of two and four, my parents sent me back to my maternal grandparents to take care of me because they were buried in work. Growing up in a family where my parents were under pressure to put food on the table taught me not to disturb them. More horribly, there was a time when I saw my mother attempting to commit suicide in front of me and my father in her battle with depression over work.

I adopted all the social norms and cultural expectations at school to meet my survival needs. They could have ranged from refraining from speaking out, nagging, or expressing certain ‘disturbing’ emotions — anything that annoyed people. I hoped I could be comforted in exchange for my submission. Even worse, the standardized education and the ranking system were built to demand a ‘perfect 10’ performance to guarantee my sense of security.

For a long time, I was used to seeing myself as full of weaknesses. I didn’t know what my advantages were, all I could see were my mistakes pointed out by my father. However, some of the most painful words from my father were “I’m going through distress because of you” when he saw I didn’t fit in the gender norms. I felt ashamed of being my true self. Indeed, what’s the point of being proud when society, especially your close ones, sees you as a defective product?

Growing up, I learned and adopted the necessary strategies and working skills to cover up my vulnerabilities. Not having empathy and tolerance for making mistakes made it hard to admit them and say sorry to others. To avoid feeling shameful and receiving enough attention and support, I strived for perfectionism and refrained from showing flaws in front of people. Hence, this mindset made me susceptible to letting others determine my self-worth.

Surprisingly, modern economics jumped in as a one-size-fits-all solution. It was conditioned to give rewards and recognition for people to strive for ‘success’ in professional work, which were the things I longed for to make up for my insufficiency of acknowledgment.

At work, I experienced imposter syndrome when facing the absence of consistent positive feedback in my code reviews from a senior. Therefore, I kept working harder to cope with my inadequacy when comparing myself to anyone. I became a covert narcissist as I felt bad whenever I tried to establish my borderline. I tortured myself whenever I said no to people’s wills as I projected my emotions onto the rejected ones in the name of empathy.

Feeling full of despair, I indulged myself in any means of entertainment and materialism to boost my dopamine and feel content. Paradoxically, does materialism want me to feel sufficient? Regardless of how often the hustle culture wore me out and made me feel ‘not enough,’ I also took pride in overcoming those obstacles by refusing to stay stagnant. I fell into the trap of overt narcissism where I constantly tried to stand out as a pick-me in any scope as if it was never enough to be praised in only one field when I could become multi-talented.

In the modern world, such narcissistic traits are pretty much welcomed and praised by most organizations to establish customer relationships and maintain the retention rate, while simultaneously converting them into revenues. Driven by a chronic fear of being rejected, people numb all their present emotions while living in shame, making us suffer for being just ordinary humans and finding life isn’t worth living.

Nevertheless, it hit the hardest when I ruined some of my relationships by picking up that attitude at work and invalidating other team members’ feelings due to the strenuous workload. Finally, I became a piece of the puzzle named Hustle and Bustle.

Apocalyptic Anxiety and the Fragilification of Time by Robert D. Stolorow

Heidegger (1927) distinguished sharply and famously between fear and existential anxiety (Angst). Whereas fear is about a dangerous entity, Angst is about human existence as such, specifically its finitude. When one is anxious, everyday ways of fleeing from finitude have broken down, and one is confronted with the inevitability of death and nothingness. Existentially, we are “always already dying.”

I have found that, in general, trauma disrupts the linear conception of time and fractures the unitary structure of our temporal existence. Experiences of emotional

trauma become freeze-framed into an eternal present in which one remains forever trapped, or to which one is condemned to be perpetually returned through the retraumatizations supplied by life’s slings and arrows. In the region of trauma, all duration or stretching along collapses, past becomes present, and future loses all meaning other than endless repetition. Traumatic temporality is disclosed in our traumatizing confrontations with human finitude and correspondingly, as Heidegger developed extensively, in the affective state of anxiety.

Typically, humans evade finitude by constructing emotional worlds populated by metaphysical entities that replace transience and existential vulnerability with permanence and invincibility. A common example is the lover who proclaims to the beloved, “I will love you forever,” eternalizing both lover and beloved. The crumbling of such metaphysical illusions of permanence is a common source of emotional trauma (Stolorow, 2021).

The ordinary experience of time amalgamates two essential dimensions. One is a metaphysical conception, harking back to Aristotle’s metaphysics, picturing time as an infinite succession of “nows” unfolding in linear fashion toward an open future. In the existential conception of time, by contrast, every “now” transcends itself and points back to the past and ahead toward the future. The relationship between the two essential dimensions is a grounding relationship. In the ordinary conception of time, the metaphysical conception (objective time) grounds the existential (my time), and the two are joined in a seamless unity. By nullifying all future possibilities, the traumas of climate change destroy this grounding unity of time.

It is planet earth that provides a home for the human kind of being. For humans, to be is to dwell on earth, and to dwell requires that they safeguard and preserve the earth that houses them (Stolorow, 2020). Characteristically, such protectedness is sought in metaphysical illusion—the transformation of this vulnerable planet into an invincible everlasting entity. This age-old metaphysical illusion is not faring well in the face of the perils of climate change. The human way of being cannot survive the impending homelessness foreshadowed by climate change, a prospect so horrifying that people turn way from it altogether, thereby evading the threat and abandoning the search for solutions.

The specter of climate change confronts us with the destruction of not just individual lives but of human civilization itself; and the destruction of human civilization would also terminate the historical process, through which we make sense of our individual existences. I want to call the horror that announces such a possibility “apocalyptic anxiety.” Apocalyptic anxiety anticipates the collapse of all meaningfulness. And it is from apocalyptic anxiety that we turn away when we deny the extreme perils of climate change.

Such turning away perpetuates the dangers and shields them from ameliorative action. The practice of a therapeutic comportment that I call “emotional dwelling” with one another could be of help here. If we could embrace one another as “siblings in the same darkness,” our shared apocalyptic anxiety could become more tolerable and less prone to evasion, making possible a greater caring for future generations and for the planet that would be their home. If future possibilities and the unity of time can be recovered, it will be through such emotional bonds with one another.

Citation: Stolorow, R. D. (2024). Apocalyptic anxiety and the fragilification of time. Trauma Psychology News, 19(1), 10-11. https://traumapsychnews.com

ROBERT D. STOLOROW, PhD, PhD, is a Founding Faculty Member at the Institute of Contemporary Psychoanalysis, Los Angeles, and at the Institute for the Psychoanalytic Study of Subjectivity, New York City. He is the author of World, Affectivity, Trauma: Heidegger and Post-Cartesian Psychoanalysis (2011) and Trauma and Human Existence: Autobiographical, Psychoanalytic, and Philosophical Reflections (2007) and coauthor of eight other books, including The Power of Phenomenology (2018) He received his PhD in Clinical Psychology from Harvard University in 1970, his Certificate in Psychoanalysis and Psychotherapy from the Postgraduate Center for Mental Health, New York City, in 1974, and his PhD in Philosophy from the University of California at Riverside in 2007.

Trauma-Informed Yoga as a Path to Trauma Healing by Monaé Weathington

Trauma survivors encounter distinct trauma-related barriers when using psychotherapy due to worries about reliving and confronting painful events and memories (Kantor et al., 2017). Additionally, talk therapy primarily focuses on cognition, which may not be accessible to all trauma survivors (Sibrava et al., 2019). Due to these problems, treatment strategies that specifically address emotional and physiological dysregulation are required.

Research data suggest yoga is an effective prevention practice and adjunctive treatment for various medical and mental health conditions (e.g., chronic pain, anxiety, and depression) (Lemay et al., 2019; Roland et al., 2012; Sherman, 2011). Additionally, research findings suggest that yoga and mindfulness practices are beneficial treatments for depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms due to modifying neurotransmitter levels, reducing rumination and negative thoughts, reducing physiological stress, and encouraging adaptive thinking (Macy et al., 2015). Therefore, scientific research supports yoga as a promising treatment for a number of general and trauma-related mental health issues.

Trauma Center Trauma-Sensitive Yoga, founded by David Emerson, addresses the unique symptoms and needs of trauma survivors. Trauma-informed yoga (TIY) focuses on interventions that engage the parasympathetic nervous system (PSNS) (i.e., restorative poses and breathing exercises). Through TIY, students can learn more effective and non-threatening strategies to regulate their bodies (Justice et al., 2018). TIY deliberately fosters bodily autonomy, freedom of choice, and empowerment, all of which are often violated in traumatic events (Nolan, 2016). With an emphasis on present awareness and interoception, TIY stresses asana postures and modifications that meet the psychological and physical needs of the person (West et al., 2017). Furthermore, TIY combines emotional safety and trustworthiness (Cook et al., 2017).

By Tihamér Bakó & Katalin Zana
Translated by R. Robinson. Routledge
2023

It is widely agreed in the academic community that COVID-19 is a contemporary event of loss and trauma (see Miller, 2020). The reality of global and pervasive trauma forced mankind to stand together for the first time in history in the face of uncertainty, loss, vulnerability, and death.

Trauma is cognitively harmful (Stolorow, 2011, 55), separating (Ferro & Foresti, 2008, 1046), hurtful to people’s structure of external reality and trust-building (Oliner, 1996, 286-287), and blurring the limits of the self. Based on the above understanding of trauma and their own original thoughts on group-level trauma, two Hungarian psychoanalysts, Tihamér Bakó and Katalin Zana, are eager to tell readers in the book Psychoanalysis, COVID, and Mass Trauma: The Trauma of Reality (2023) the impact of the intense event on an individual, the threshold at which it becomes traumatic, the differences in the experience when it occurs in a group. This necessitates the portrayal of painful reality both inside and outside of the individual, as well as sufficient attention to the here-and-now during COVID-19 between February 2020 and the end of July 2021.

The book, with comprehensive clinical diaries by both writers and abundant oral history of patients from many walks of life, gives a wonderful example today to make the academic context recount the role of diaries, the medium from which psychoanalysis was founded and evolved (i.e., Sigmund Freud’s Interpretation of Dreams and Sándor Ferenczi’s Clinical Dairies, among others). The journal itself is an important historical record of social suffering and the horrific mental reality that we all faced at the time. It also provides us with anew resource to re-examine clinical practice for trauma and even the subject of psychoanalysis in the aftermath of the massive health catastrophe that shares power but differs in nature from the two world wars witnessed by many senior analysts such as Freud, Otto Rank, D. W. Winnicott, Wilfred Bion, and others.

Theory: The Transference of You with Me

“My mom was unexpectedly diagnosed as a COVID patient,” one of my dearest friends notified me via video chat on a routine lockdown day in 2021. That’s when my unclear and disjointed recollections of SARS in 2008 became an unsymbolized trauma that sent me back in time. Unlike prior studies’ negative definitions, the only recollection remained in my mind was staying and living with my family, and the so-called traumatic time was translated into the family bond.

COVID, once again, provided me with the opportunity to explore what I consider to be the most important core concept of the book: the atmosphere or the “third” (Bakó & Zana, 2021b, 521-522) as a result of the group’s “intersubjective space” based on the dialectic logic of “abolishing of self or me” developed by pioneers like Winnicott (1956). What made this period distinct was the sense of belonging provided by the invisible infection and repeated lockdown regulations. I definitely felt that my friends, the community, and I were connected together, especially when we were all compelled to stay at home or relocate to a centralized quarantine area.

In the aftermath of the tragic tragedy, my community came together as one. It was via snapshots, as the writers emphasized repeatedly in the first half, that I discovered who I am and integrated myself into the wider community in which I live as we survived and moaned together. This demonstrates to me the cohesion or even the good side of group-level trauma.

The range of words from many patients who left their sentiments in the book piqued my interest, and I think I got more out of it. Both our symbolic diaries and our unsymbolized sentiments imply that we are not simply snapshots of the complete event here-and-now, but also the integration of our experiences there-and-past. Thus, the transference of you with me, as repetitively stressed by the authors, in the same painful occurrence assumes a matrix in which I preliminarily experienced, felt, forgot, and assimilated both internal and exterior reality as an individual capable and willing to embrace others as a collective.

The writers have so far provided me with information on how individuals as a community, regardless of vocation, age, or country, respond to the COVID as a health emergency, political movement, and unique framework for psychotherapy. The fact itself demonstrates the collective aspect of trauma as a node connecting me and you, therapist and patient, today and then. In my opinion, the neutral or even positive side of trauma, particularly on the group level, should be further developed in the future. In the clinical context, the trauma shared by both analyst and analysand may be viewed as a mental field with additional opportunities to elicit, re-modify, and treat the dyad’s forgotten pictures in the consultation room.

What’s More and Less in the Future?

More book-related questions should be investigated. How might we adopt a somewhat successful method to fit into the post-COVID age, where patients, at least in China, prefer to consult over the Internet? How could we utilize the authors’ new word, Atmosphere, to position ourselves as psychoanalysts? To what degree may diaries, as a subset of literature, assist researchers and practitioners from other disciplines in collaborating to delve into affections, feelings, responses, and sub-conscious decisions? How might therapists tell the difference between the trauma spinning from politics and the health crises or other natural disasters?

The less part would be seen on the emphasis on the negative role trauma plays in treatment. According to the foregoing, as well as the authors’ here-and-now logic and intersubjective claims, trauma should be accounted for as a third place where we encounter and bind each other. Following this reasoning, I would argue that the space of psychoanalytic therapy should be expanded beyond the chair or the consulting room to multiple everyday contacts in which individuals develop as a group, as I am currently doing with two of my patients.

Furthermore, the ideal dyad connection should be based on a you-with-me transference in a friendly distance. In essence, COVID is not only a trauma, but also, as the subtitle suggests, a mass catalyst and a chance for therapists to re-examine post-COVID professional ethics in light of the works of the intersubjective school of psychoanalysis.

In a nutshell, I considered the book to be informative and multifaceted in its presentation of both facts from COVID and ideas extracted from the era from a professional standpoint, which is a good framework for future trauma studies to follow in order to incorporate both first-hand materials and direct theorization. Students, practitioners, and theorists interested in trauma studies and intersubjective school can benefit from a wealth of oral histories and psychotherapists’ mind maps.

Reviewer: Keren Zhang

Christine A. Courtois & Paul A. Frewen, PhD

We are pleased to announce the availability of a new Professional Practice Guideline for Working with Adults with Complex Trauma Histories, published jointly by the American Psychological Association (APA, Division 56, Trauma Psychology) and the International Society for the Study of Trauma and Dissociation (ISSTD; APA, 2024). The guideline has been under development for a considerable period of time and involved input from an international panel of identified experts in complex trauma. The guideline document is available in its entirety on APA’s website.

At present, there are two different types of professional practice guidelines, per the American Psychological Association: Clinical Practice Guidelines (CPG), and Professional Practice Guidelines (PPG). CPG are based on a systematic review of the Randomized Control Trial (RCT) treatment efficacy research and evaluation of same by a multidisciplinary panel of experts who make graduated recommendations for treatment strategies based on the strength of the evidence. The APA published its first CPG on the treatment of adults with PTSD in 2017 (APA, 2017) and it is currently under revision. In contrast, PPG, such as the new PPG for Working with Adults with Complex Trauma Histories, review available evidence and incorporate clinical consensus descriptions to establish recommendations for clinicians and others regarding treatment approaches, but do not make treatment specific recommendations. Both types of guidelines can thus be considered complementary and can be used together. Of note, a PPG for the treatment of adults with PTSD is also in the APA approval pipeline. Once published, it can be usefully co-applied with the current PPG for working with adults with complex trauma histories. Both PPG offer different but compatible information on the treatment of traumatized individuals across the spectrum of severity and impact.

Complex trauma has received increasing professional and public recognition in the past several decades and new research findings indicate that it is likely to be the most common form of trauma. Quoting from the new PPG for Working with Adults with Complex Trauma Histories:

While the current PPG may apply to persons with various trauma histories, the guidelines have been articulated explicitly in reference to persons with more “complex” trauma histories. The complex trauma formulation expands the definition of trauma from merely physical forms to include other ongoing, progressive trauma and entrapping/coercive interpersonal violence, usually over the course of childhood but occurring at any age and having age- and stage-related developmental and posttraumatic impact. Regrettably, the term “complex trauma” has often been misunderstood within the literature, perhaps owing to authors conceptualizing it to imply a categorical distinction from “simpler” forms of trauma as conventionally defined in the literature, which may have invalidated the experiences of some victims. In contrast, the present guidelines employ a dimensional, continuous model in understanding a person’s trauma history as increasingly “complex,” as a linguistic device, to the degree that they have experienced traumatic life events: (a) repeatedly, (b) in (often significant) interpersonal relationships and (c) under intentional circumstances, (d) that transgressed deeply held moral/ethical principles, and (e) occurred early and across multiple developmental stages. As such, trauma complexity may be best understood on a continuum, from non-interpersonal and accidental (and thereby ethically neutral) circumstances that occurred in a singular instance, to repeated, deliberate, immoral transgressions that occurred within familial, intimate, peer or other close relationships (including in organizations or other systems where they might occur in highly organized forms) from a young age and across the lifespan.

Ford & Courtois (2020) also identified several primary characteristics that differentiate complex trauma from one-time/time-limited and unintentional or impersonal forms of trauma:

• interpersonal experiences and events that often involve relational betrayal and are perpetrated by trusted others;
• Repetitive, prolonged, pervasive and in some cases, ongoing/never-ending events that are often progressive and escalating in severity;
• Involve direct attack, harm, and/or neglect and abandonment by caregivers or other adults who are responsible for responding to or protecting the victims—this may extend to organizations and cultures that are disbelieving of the victimized individuals and deny the occurrence of the traumatic circumstances and so are unresponsive or that support a safe haven for perpetrators;
• Occurs at developmentally vulnerable times in the victim’s life, often beginning in early life (but can also occur late in life with the highly vulnerable elderly);
• Has great potential to compromise severely a child’s physical and psychological maturation and development and to undermine or even reverse important developmental attainments at any point in the lifespan.

Acknowledgement of the effects of additional types of traumatic stressors – including those those that are psychological/emotional as well as physical – and that occurred recently and in the past, has opened greater understanding of the role of revictimization and repeated and layered forms of trauma over the entire lifespan as complex and cumulative trauma. Additionally, collective forms of trauma, many of which are embedded in cultural norms and beliefs that are frequently ancestral / historical / transgenerational in nature, have also been identified as complex.

The diagnosis of Complex Posttraumatic Stress Disorder (CPTSD) was included in the International Classification of Disorders-11 of the World Health Organization (2021), as a “sibling diagnosis” to the recognized symptom criteria of PTSD, such as are similarly defined in the Diagnostic and Statistical Manual, Fifth Edition, Text Revision (American Psychiatric Association, 2022). CPTSD includes additional criteria defined as Difficulties of Self Organization (DSOs) in emotional regulation, identity, and relationship with others and includes attention to dissociation. In addition to these posttraumatic diagnoses, complex trauma is also recognized as being transdiagnostic and, like more conventional forms of trauma, associated with a broad range of psychiatric as well as medical and psychosocial effects. These often compound the treatment and confound treating professionals until they are recognized as posttraumatic by these same professionals using a “trauma lens” in their assessments and determinations.

The PPG for Working with Adults with Complex Trauma Histories identifies and discusses the following 7 principles of treatment including their rationale and application, using the acronym HISTORY as a mnemonic:

• Humanistic, attending to and respecting the uniqueness and value of each individual and their history and context;
• Integrative, applying a variety of treatment strategies according to the unique goals and needs of the individual;
• Sequential, attending to issues of personal safety, stabilization, and skill building prior to direct exposure to trauma processing;
• Timeline, giving attention to the lifespan chronology of the individual’s traumatic exposure;
• Outcomes, establishing and working towards mutually established and defined goals that not only involve symptom reduction but are strength-based and individualized;
• Relational, providing a trustworthy and responsive relationship, a “safe haven” and “learning laboratory” for the client to develop a more secure self and relationship style; and,
• whY, reappraising maladaptive meanings and addressing spiritual and existential questions about the trauma and its impact and role in the individual’s life.

These principles all fall within the scope of Trauma-Informed and Trauma-Responsive Care strategies for professionals and organizations. They also incorporate the guidelines on trauma psychology treatment competencies (APA, 2015).

In the final section of the PPG, several additional issues are addressed. These include the lack of attention to trauma in the training curricula of most service professions, including psychology, and the need for specialized training and consultation/supervision to supplement generic clinical training when providing care to complexly traumatized individuals. As treatment strategies are under constant development, clinicians are further encouraged to keep abreast of current research and treatment literature and to engage in continuing education efforts. Attention to the provider’s overall emotional well-being is also recommended due to the strain and intensity that can accompany working with a highly traumatized population. Clinicians and others should be knowledgeable about vicarious traumatization and treatment traps that are common occurrences when working with adults with complex trauma histories. Such awareness and self-care strategies work against burnout and support sustainability and satisfaction in doing this work. Of necessity, issues of diversity, equity, and inclusion are to be centered in this treatment as the individual’s contextual issues and intersectionality can impact the motivation for and occurrence of traumatization, its understanding by the victim and its impact (including culture-bound idioms of distress and taboos), and the need for specialized considerations in the treatment. Finally, the parallel development of posttraumatic growth in the therapist and the client has been identified. The client’s resolution of traumatic impact and their personal recovery and life restoration can result in a high degree of professional satisfaction and pride for the clinician working with this population.

We hope that psychologists and other mental health professionals will aspire to be guided by the Humanistic, Integrative, Sequential, Temporal, Outcomes-focused, Relational, and Causal (Why?) principles underlined by this new PPG in their work with adults with complex trauma histories.

Monica Sanchez & Yinan Liang

Section Editor:
Kiara Tookes-Williams

Peer Reviewers:
Molly Becker, Olivia Jackson, Jasmine Merlette, Zaine Roberts

Advisor: Antonella Bariani
Opinions expressed by the authors are their own and not necessarily those of APA, Division 56, or any member of the editorial board.

Trauma-informed mental health services are in high demand. Yet, there is a discrepancy in the training and availability of trained clinicians and supervisors in trauma-informed care (Borders et al., 2023; Ellis et al., 2019; Wells et al.,2003). Beginner clinicians are particularly at risk for burnout, secondary traumatic stress (STS), and vicarious trauma due to having little to no trauma-focused training within their programs or practicum sites (Borders et al., 2023; Coleman et al., 2021; Makadia et al., 2017; Sommer, 2008). Trainees of color and those with their own trauma history are especially at risk for secondary effects when not adequately trained for trauma work or when adequate trauma-informed supervision is not available (Borders et al., 2023; Berger et al., 2020). Even our understanding of what constitutes as competent trauma-informed supervision varies throughout our field; thus, more awareness is needed to understand and communicate effective trauma-informed supervision (Berger et al., 2020). Supervisors play a crucial role in mitigating trauma-related outcomes within supervisees and clients, therefore continually examination of supervision practices is warranted.

Trauma and traumatic stress encompass a variety of experiences, can affect people of various identities and backgrounds, can be a single event or chronic condition, and could impact more than one individual (Substance Abuse and Mental Health Services Administration, 2014). Some people have temporary reactions to trauma, while others experience prolonged effects and consequences, such as medical problems, PTSD, substance use, anxiety, and other mood-related disorders (Substance Abuse and Mental Health Services Administration, 2014). It is believed that trauma work can inadvertently have negative impacts on mental health professionals, particularly trainees or those with less trauma-informed training (Makadia et al., 2017). Phenomena such as vicarious traumatization, STS, and compassion fatigue can be experienced by providers doing trauma-intensive work and indirectly being exposed to trauma (Coleman et al., 2021; Sommer, 2008). Vicarious traumatization can appear similar to PTSD, displaying similar symptoms such as negative cognitive distortions of themselves, others, and the world as a result of cumulative exposure to client trauma narratives, but does not include other aspects of PTSD (Coleman et.al., 2021; Makadia et al., 2017; Sommer, 2008). The remaining areas of PTSD, such as intrusions, avoidance, and arousal, are seen more within STS, yet not quite reaching PTSD status and not having a Criterion A trauma (Makadia et al., 2017). Additionally, compassion fatigue refers to a therapist’s emotional exhaustion from their clients, followed by detachment, withdrawal, or even hostility toward the client (Courtois, 2018). Supervisors should ensure supervisees are aware of these risks to mitigate the effects of trauma exposure while maintaining ethical service delivery and prioritizing client welfare.

There can also be positive growth for supervisees within trauma work, especially around resilience and meaning making from helping highly traumatized clients (Coleman et al., 2021). Supervisors should utilize skills such as trustworthiness, creating relational safety within the supervisory relationship, collaboration, validation, and maximizing supervisee autonomy within their supervision time to provide effective trauma-informed supervision (Berger et al.,2020). Self-disclosure of the supervisor’s first experiences of the secondary impact of trauma work can be extremely useful for supervisees when working on strengthening the relationship and validating the difficulties of the work (Borders et al., 2023; Wells et al., 2003). Participating in ongoing supervision is essential to the growth and protection of those engaged in trauma-informed care. Acknowledging the interrelationship between the trauma, practitioner, helping relationship, and the context of where the services are provided can help supervisees with countertransference (Berger et al., 2020). These concepts are important to understand within training programs, especially for the ethical considerations of supervisees’ overall well-being as they begin trauma work.

Among professional organizations, the National Child Traumatic Stress Network (NCTSN) offers nine core competencies and resources for staff and mental health providers to help prevent secondary traumatic stress of providers and the support and supervision of others (Borders et.al., 2023; Griffin, 2022). The nine core competencies are outlined in a self-rating tool on STS in trauma-informed supervision (Griffin, 2022). Each competency has a set of skills that the supervisor rates as being “not part of my skill set yet, doing OK but need more training, or I have confidence in my skills in this area” as a way to rate one’s supervision capabilities and skills (Griffin, 2022). Another resource they provide is a cross-disciplinary guide for supervision, which also touches on the STS core competencies described above (Griffin, 2022). Although these resources center on the topic of STS, these resources could be useful in the development, conceptualization, and adaptation of other guides, resources, models, interventions, and theories to support trauma-informed services and supervision.

There are many considerations in trauma-informed supervision regarding the prosperity of the supervisee, client welfare, and risk. Supervisors should keep a close eye on supervisees with a similar trauma history to their clients, especially knowing the prevalence of trauma (Borders et.al., 2013). When planning for supervision, areas such as psychoeducation, emotional regulation, validation of supervisee, and self-care will be natural topics, yet a supervisor should be flexible to ensure their supervisee can feel safe within supervision (Borders et.al., 2023). Observation of the supervisee’s in-session interactions and reactions can provide insight about a supervisee’s discomfort and areas of growth. Supervisees can be overwhelmed by the intensity of trauma work and could present to supervision either with a lack of affect, avoidance, or a charged emotional state (Borders et.al., 2023). With parallel processes, supervisors can model appropriate behaviors that can be translated within sessions, including verbiage, interventions, safety assessment, validation, and attending to emotions (Borders et.al., 2023). A study that explored practices of supervisors trained in trauma and clinical supervision reported that some supervisees described achieving greater emotional regulation, feeling more validated, and greater self-control after experiencing trauma-informed supervision practices (Borders et.al., 2023). Further research could capture supervisee voices during the implementation of trauma-informed supervision and the impact of their experience.

Supervision could also become a space where the supervisee discloses their own traumatic experiences and their relevance to the client’s conceptualization. However, supervision is not a personal therapy space for the supervisee. This goes beyond the supervisor’s role by engaging in multiple roles where the supervisee wishes to directly address or process their personal traumatic experience (Berger et al., 2020). Although it is important to discuss aspects of a supervisee’s personal experiences and countertransference, the supervisor must appropriately redirect the conversation to center the well-being of the client (Berger et al., 2020). The supervisor should aim to provide appropriate resources or suggest necessary referrals, help the supervisee in their ability to monitor motivation or intentions when making ethical decisions with self-disclosures, and normalize stress responses related to their own experiences (Berger et al., 2020; Griffin, 2022). However, supervisors must also maintain the emotional safety of the supervisee and their ability to emotionally regulate and self-reflect on best practice (Berger et al., 2020). The supervisor can hold space for the supervisee but must work to maintain that boundary and prevent multiple roles to ensure ethical practice.

With supervisees of diverse backgrounds, additional considerations of the supervision and context will be important to provide culturally competent support. Supervisors should examine ways in which their own beliefs and assumptions uphold discrimination, particularly with instances of lack of cultural awareness throughout supervision (Berger et al., 2020). Recognizing that diverse supervisees may face compounded stressors and effects of trauma work related to systemic oppression, discrimination, or microaggressions, supervisors should practice active listening, validation, and consider the unique challenges of marginalized identities (Berger et al., 2020). This will entail creating space for open dialogue, acknowledging power dynamics, tailoring support to meet individual needs, advocating for equitable policies within the organization, and modeling self-care strategies with trainees to translate skills into action (Berger et al., 2020). Discussions around diversity are part of trauma-informed care and should be reflected within supervision for culturally competent practice.

Recent studies are exploring a foundation for potential models of trauma-informed supervision, such as the Contextual Model of Trauma Treatment within supervision (Ellis et.al., 2019). This model approaches clients and supervisees as “a whole person” who is “shaped by genetics, relationships with caregivers and others, and other life experiences that impact self and worldviews and clinical capacities,” giving a more holistic view to support the supervisees’ overall well-being (Ellis et al., 2019). The aims of this supervision experience include a collaborative working alliance, fostering a flexible trainee-guided conceptualization of skills and treatments, and developing practical professional skills across multiple domains (Ellis et al., 2019). This attends to the relational aspects of the model and continually checks for the growing needs of the supervisee, while also providing practical ways to provide therapeutic interventions for clients.

Employing a relational model of supervision within training programs for beginner therapists is thought to have advantages in helping the healing process through the relational nature of supervision (Wells et al., 2003). As previously mentioned, attending to supervisee’s countertransference or over-identification with victimhood should be addressed to lessen the impact on the client (Wells et al., 2003). Fundamental concepts within this approach include valuing mutual and collaborative growth, focusing on culture and context, use of self-as-instrument for modeling, countertransference as a way to understand reactions, and a focus on self-awareness (Berger et al., 2020; Well eat al., 2003). The supervisee should feel comfortable bringing up feelings of emotionally overinvesting with clients, particularly with beginner therapists, that could lead them to feel drained, confused, overwhelmed, and exasperated (Wells, et al., 2003). Processing their insecurities is essential within this relation model, understanding that similar to clients, the supervisor must assess the developmental level of the supervisee and work collaboratively to avoid creating potential harm by moving too fast (Wells et al., 2003).

Another proposed method to strengthen the supervision of trainees within trauma-intensive sites suggests a blend of Relational Cultural Therapy and Feminist Multicultural supervision approaches. Gomez (2020) offers personal insight into a multicultural approach to supervision that can incorporate the lived complexities of clients and trainees, especially within trauma settings where other supervisors have excluded it from their training. The article highlights how relational cultural therapy emphasizes the importance of relationships, how disconnection from self and others can cause mental distress, and the use of collaboration to engage and shift power within the relationship (Gomez, 2020). Supervision works similarly, in which the relationship with the client is examined to identify any relational breaches, the therapeutic process, and even the utilization of collaboration between the supervisee and supervisor as a way to empower the supervisee (Gomez, 2020). This supervision approach within trauma-intensive sites could help address concerns about the deep impact of a client’s story on a supervisee, especially in thinking of the supervisor’s role in supporting the supervisee in a collaborative manner that allows the supervisee to also empower their client using collaboration. Clinical sites with a large diversity of clients and trainees could also benefit from this theory, as it enables the growth of conceptualizing trauma within complex situations and contexts.

Future considerations for training programs and research are in high demand. Determining what “quality” supervision and training would be like for trainees needs a foundation for mental health professionals (Makadia et al., 2017). More research on existing practices or the effectiveness of current trauma courses and training could hold insight into areas that need to be developed or determine supervisor competencies (Makadia et al., 2017). Additionally, more research on the experiences and development of trainees within trauma-intensive sites and the progression of their development with trauma-informed supervision could be helpful and provide more guidance (Borders et al., 2023; Gomez, 2020). Although trauma-informed care has unique challenges in risk and exposure to traumatic experiences, special attention to this work is essential and needed within psychology to support clients and clinicians (Berger et al., 2020). Strengthening this research could help ensure the safety of our clients and clinicians, as well as provide more support for trauma-informed practice and supervision.

Monica Sanchez (she/her/ella) is a bilingual first-generation student, child of Mexican immigrants, and is now a third-year doctoral candidate in Counseling Psychology at the University of Georgia. Within her clinical and research interests, she primarily focuses on helping clients heal from traumatic experiences using a decolonial and feminist lens, with a focus on children, families, and immigrants. Currently she provides therapeutic services within the Atlanta VA’s Mental Health Specialty Services Practicum which focuses on the treatment of veterans with PTSD and other comorbid conditions.

Yinan Liang (she/her) is a bilingual international student from China and is now a third-year doctoral candidate in Counseling Psychology at the University of Georgia (UGA). Her primary research interests are resilience, multicultural identity development, and mentorship within higher education, especially within Asian and Asian American communities. Currently, she works as a clinical graduate assistant for Mary Frances Early College of Education and Student Affairs and is an advanced practicum student at UGA’s Counseling and Psychiatric Services. She provides bilingual psychotherapy for Chinese students at UGA and advocates for underserved populations with mental health support.

Citation: Sanchez, M., & Liang, Y. (2025). Supporting the well-being of supervisees in trauma-intensive sites and the examination of current trauma-informed supervision practices. Trauma Psychology News, 20(1), 40-45. https://traumapsychnews.com