The Importance of aTransgenerational Perspective in       American Psychotherapy
Lily Tomlin
   Immigration as Trauma   The Importance of a Transgenerational    Perspective in American Psychotherapy   The Transge...
   Identify traumatic events in a    patient’s family history   Understand the impact of these    events on family relat...
1 minuteo   Do you conduct individual, group or couples    psychotherapy?oo   Are you an immigrant? If not, are you first,...
And my interest grew
In Lithuania
REFUGEES
War, Famine,Religious and    Ethnic Persecution
The VERY Beginning
   European life was dominated by    religiously and politically inspired    violence   The Voyage, aboard crowded and  ...
oA million, dead in Ireland from famine or diseaseo Tens of thousands more died on ―coffin ships‖ on the way to the U.S.o ...
o   17     million, mostly   teenagers,         kidnappedo7       million died en route or in         ―seasoning camps‖o S...
o   20 – 30 million massacred during    the Tai-Ping Rebelliono   Legislation and taxation in U.S.    aimed at excluding t...
 Thousands    killed in the Mexican-American War Size   of Mexico reduced by half Economic  discrimination and racial p...
o   Persecuted in Russia from ancient times    o   Massacred    o   Sold into captivity    o   Confined to the Pale of Set...
•   What is it?•   How does it    occur?
Vamik Volkan(The Third Reich in the    Unconscious)
o   Depressiono   Anxietyo   Low Self-Esteemo   Hypervigilanceo   Suicidal ideationo   Dissociation                       ...
o Behavioral   repetitionso Traumatic   perspectiveso Traumatic   affects
Believes the evidence forTTT is so strong that thereshould be a new DSMcategory that designates itas a mental disorder.
o   Immigrants are preoccupied with survivalo   They are disinclined to examine or disclose    their trauma storieso   Tho...
A “conspiracy of silence”develops around most experiences       of collective disaster
o   Social Modelingo   Insecure, disorganized patterns of    attachmento   Projective Identification    o Depositing perse...
The Shadow of  the Object:Psychoanalysis    of the  Unthought    Known
That body of "knowledge" that isincapable of conscious recapitulation  yet which forms the ground of our        every acti...
All the thoughts you      never seeFrom their song: The Unthought             Known
From Not Knowing to Action Knowledge
With implications for   character and psychopathology
Action              Trauma as   Knowledge              Metaphor      Witnessed      NarrativesNotKnowing                  ...
Action              Trauma as   Knowledge              Metaphor      Witnessed      NarrativesNotKnowing                  ...
   It is adapted from the classic    family genogram   But highlights traumatic family    experiences and dynamics
At Least for Now
 Begin  with your family of origin  and move up. You are the IP—index person, not  identified patient! If you are a man...
 Draw an ―X‖ through a figure to indicate that the person is no longer living. (See Figure 1) Maritalseparation is indic...
   For our purposes, choose only your mother or    father’s side of the family to diagram.   Grandparents are connected ...
Because I didn’tbring any cookies!
 Exposureto war or other forms of   violence Psychiatricdisorders Extreme poverty Immigration Emotional abuse Premat...
Add Some Notes toYour Traumagram
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
The shadow of america’s immigrant ancestors draft 2
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  • The Shadow of our Immigrant Ancestors: The Importance of a transgenerational perspective in American Psychotherapy. I have been accused by a close colleague, Lorraine Wodiska, of having the longest, most complex titles in the history of the world, so I come today, prepared to express my ideas more simply and directly than usual. So here is my alternate title for today's workshop!
  • And, though I have quite a bit to say today, I'm going to put my summary statement right up front!And, though I have quite a bit to say today, I'm going to put my summary statement right up front!And, though I have quite a bit to say today, I'm going to put my summary statement right up front!And, though I have quite a bit to say today, I'm going to put my summary statement right up front!2
  • Indeed, Lily’s observation is my ultimate rationale for the importance of a transgenerational perspective in psychotherapy.As she reminds us, the unremembered, unprocessed and ungrievedpast is always coming forward; Always. It is recapitulated, somehow, not only in psychotherapy, but in all of our important relationships. And if we can understand more clearly what occurred in the past, that is now being re-enacted, we are in a far better position to intervene and help clients transform the traumatic patterns that repeat endlessly across generations. I’m so reticent to say this…but I believe that if we don’t understand the past, ultimately we are ineffectual. And, I'll let William Faulkner say it one more time, in yet another way, because I’m always trying to make this point about memory more…
  • William Faulkner, who said it a bit differently.
  • Today, I’d like to present some conceptual material, and then give you the opportunity to “remember” a bit of your own family history.
  • Here are the important concepts I hope to cover today.
  • And then we’ll go on to learn about and begin to construct our personal traumagrams. The traumagram is a tool I’ve developed and used to identify traumatic events in a clients’ family history and to understand the impact of these events on family relationships across generations. Again, I believe that if we can understand the nature of these patterns, we’re in a much better position to transform persistent traumatic that have distorted family relationships across multiple generations
  • . I developed an interest in genealogy after finding this photograph in a box of unopened documents that my husband had received from his mother’s estate. The name on the back of the photo was John Thompson Ray. I googled John, and only meant to spend a minute or two on Ancestry.Com, once I saw that there was information about him (For FREE) on the Ancestry website. In fact I actually spent the several years researching the Rays and the Bonds, and, and then my own far more disturbing family story on all of the not-so-free databases at Ancestry. But I think I began to make connections between my hobby and my work, right here, at the Counseling Center in a case conference meeting. I began to speculate, aloud, about the impact of the immigration experience on the client we were discussing—how it might have affected her parents, who came to America after an experience of collective disaster in China; and how their unprocessed trauma may have impacted their parenting. Someone in that meeting was really interested in this idea, and REALLY interested in going to APA that year, as it was being held in Hawaii. One or the other of us concocted a scheme to develop a presentation about the long-lasting effects of unprocessed immigration trauma. And we did, and it was accepted.
  • Beyond that…I am a psychologist in private practice in Bethesda. I do individual psychotherapy, some couples work, and I conduct a group with my close colleague, Dr. Lorraine Wodiska. I am a 3rd generation American on my mother’s side. And I know that her grandfather came from…
  • I do know my immigration story. It begins in Kovno, Lithuania.
  • We are accustomed to thinking of the United States as a nation of immigrants. When we say this though, we are obscuring some crucial and disturbing facts. It is far closer to the truth to say that we are a nation of refugees.
  • In the New World, the colonists faced diseases, privation and conflict with the indigenous peoples
  • 1/27/2011Economically and racially motivated Anti Chinese legislation taxation and legislation aimed at excluding them from the minesActs of discrimination, intimidation, deportation and murder so widespread that the acquired the dimensions and quality of an ethnic cleansing
  • Land was confiscated. Promised rights were revoked. In the barrios, there was poverty, disease and a high rate of crime. Danger as great as for Blacks in the American SouthTexas Rangers colluded with the mob violence (state-sanctioned terrorism
  • This is my mother’s extended family. Her dad is notably absent from the picture…He and his father were at such odds that he was intermittently estranged from the family.
  • Unfinished psychological tasks
  • Research indicates descendants of those who survive collective disasters experience many post-traumatic effects themselves.
  • Behavioral repetitions including the establishment of persecutory relationships with people and entitiesTraumatic perspectives (suspiciousness, anticipation of catastrophe)Traumatic affects such as rage, hopelessness and fear
  • Collectively, I think of this cluster of behavioral, affective and cognitive impacts of trauma as Traumatic Energy. It’s useful to think of survivors of primary, secondary and tertiary trauma as carrying this energy with them wherever they go and being affected by it, at some level, in all of their daily business. Certain important triggers may lead to an explosion of this energy.
  • Holocaust scholar and Editor of the International Handbook of Multigenerational Legacies of Trauma……
  • I’d like us all to think for a moment about this observation by Danieli. I think it helps us to grasp the inevitability of the transgenerational transmission of trauma.
  • But how does trauma get transmitted from one generation to another?
  • First of all those who are directly affected by the collective disasters that precipitate most immigration never get a chance to process trauma or grieve losses.
  • For these reasons (and others)….(This is Danieli’s term, by the way)
  • So again…
  • Of course, they are different parents than they would have been if they had not been persecuted, terrified, starved, or brutalized.
  • Here’s a concept that may capture it all
  • Bollas suggested that we all learn important lessons about being and relating during our early exposure to the holding environment.  For example, we are probably all familiar with patients who had profoundly depressed caregivers. As a result they remain emotionally isolated, unable to ask for love or assistance from others. They are so isolated and alone because they KNOW, with every fiber of their being that love and care are not there for them. This kind of unthought information is very powerful and typically destructive. Remember that patient with the depressed parents? That’s the person that so often withdraws from social interaction, goes unnoticed by others, feels rejected by them and affirmed in their belief that the world is an unloving place. They withdraw further. Unfortunately, unconscious knowing represents the most typical position for many of us.
  • Auerhan and Laub explained that there are at least ten "forms" of “knowing” about trauma—each representing a “consciously deeper and more integrated level of knowing…” about catastrophic events”
  • The most primitive forms of “knowing” are "not knowing" and "screen memories" while the most advanced and integrative forms are "witnessed narratives", "trauma as metaphor" and “action knowledge”. As traumatic experiences become more integrated, affected individuals remember, but distance and prospective are "retained by an observing ego”The memory is very vivid but not immediate"
  • At best people with a traumatic history have action knowledge know the facts surrounding their trauma, how it impacts them, what their traumatic triggers are and how to manage themselves when they are triggered. Having action knowledge is a position in which you have fully integrated knowledge of yourself –knowledge that is accessible when you are under stress. You can feel AND think your way through to a constructive response most of the time, in relatively short order, even when you have powerful feelings.
  • How do we get from a position of “Not Knowing” to “Action Knowledge”?
  • As a patient of mine put it so beautifully in a poem she wrote about her efforts to understand the impact of long-past familial trauma on her own life….
  • This might seem obvious, but, since we all have some hard-wired resistance to “knowing”, in a deep way, it’s easy to skip this part. B&B story. So…your patients are probably not going to volunteer remote history. So you’ll have to resolve not to be a part of the conspiracy of silence around collective disaster. To help them remember what they do not know, you’ll have to ask a few questions.
  • And that’s where the traumagram comes in.
  • Okay, so it’s a younger me.
  • It can sometimes be more helpful to work on the traumagram a little bit at a time. Let’s choose one parent and one set of grandparents to begin with.
  • You don’t need to put in the ages. But the dad goes on the left and the mom on the right and the oldest child is farthest left.
  • Ask yourself about the nature of the relationships between people on your genogram
  • One of my favorite combinations
  • It might feel like a lot’s going on.
  • Traumatic relational patterns include those that are characterized by violence or extreme experiences of fusion or disconnectedness. You can indicate a traumatic relational pattern by adding color to the process symbol. ; Orange indicates emotional abuse. red indicates physical violence
  • Once you’ve come this far you can further specify the nature of traumatic events by making a few notes on your Traumagram. For example, you might make a note of a suicide, or a specific psychiatric disorder or type of substance abuse problem.  Once you’ve come this far you can further specify the nature of traumatic events by making a few notes on your Traumagram. For example, you might make a note of a suicide, or a specific psychiatric disorder or type of substance abuse problem.  Once you’ve come this far you can further specify the nature of traumatic events by making a few notes on your Traumagram. For example, you might make a note of a suicide, or a specific psychiatric disorder or type of substance abuse problem.  Once you’ve come this far you can further specify the nature of traumatic events by making a few notes on your Traumagram. For example, you might make a note of a suicide, or a specific psychiatric disorder or type of substance abuse problem.
  • This might seem obvious, but, since we all have some hard-wired resistance to “knowing”, in a deep way, it’s easy to skip this part. B&B story. So…your patients are probably not going to volunteer remote history. So you’ll have to resolve not to be a part of the conspiracy of silence around collective disaster. To help them remember what they do not know, you’ll have to ask a few questions.
  • The shadow of america’s immigrant ancestors draft 2

    1. 1. The Importance of aTransgenerational Perspective in American Psychotherapy
    2. 2. Lily Tomlin
    3. 3.  Immigration as Trauma The Importance of a Transgenerational Perspective in American Psychotherapy The Transgenerational Transmission of Trauma The Unthought Known The Goals of Transgenerational Treatment
    4. 4.  Identify traumatic events in a patient’s family history Understand the impact of these events on family relationships Transform persistent traumatic patterns that shape current relationships
    5. 5. 1 minuteo Do you conduct individual, group or couples psychotherapy?oo Are you an immigrant? If not, are you first, second or third generation in this country?o Do you know your family’s immigration story?o Are you aware of any traumatic events besides immigration that occurred in the lives of your parents or grandparents?
    6. 6. And my interest grew
    7. 7. In Lithuania
    8. 8. REFUGEES
    9. 9. War, Famine,Religious and Ethnic Persecution
    10. 10. The VERY Beginning
    11. 11.  European life was dominated by religiously and politically inspired violence The Voyage, aboard crowded and primitive vessels, took many weeks The New World was a “hideous and desolate wilderness…full of wild beasts and wild men.” Only about one in seven survived.
    12. 12. oA million, dead in Ireland from famine or diseaseo Tens of thousands more died on ―coffin ships‖ on the way to the U.S.o Poverty, ethnic and religious discrimination and violence in the U.S
    13. 13. o 17 million, mostly teenagers, kidnappedo7 million died en route or in ―seasoning camps‖o Stripped of culture and languageo Tortured, raped, enslaved
    14. 14. o 20 – 30 million massacred during the Tai-Ping Rebelliono Legislation and taxation in U.S. aimed at excluding them from the mineso Ultimately, an ethnic cleansing
    15. 15.  Thousands killed in the Mexican-American War Size of Mexico reduced by half Economic discrimination and racial prejudice confined the Mexicans to barrios Mob violence and lynching
    16. 16. o Persecuted in Russia from ancient times o Massacred o Sold into captivity o Confined to the Pale of Settlement where most lived in poverty o Pogroms (1881-1921)o Anti-Semitism in the U.S. o Privation and exclusion o U.S. turned away thousands of Jews fleeing the Holocaust
    17. 17. • What is it?• How does it occur?
    18. 18. Vamik Volkan(The Third Reich in the Unconscious)
    19. 19. o Depressiono Anxietyo Low Self-Esteemo Hypervigilanceo Suicidal ideationo Dissociation And…..
    20. 20. o Behavioral repetitionso Traumatic perspectiveso Traumatic affects
    21. 21. Believes the evidence forTTT is so strong that thereshould be a new DSMcategory that designates itas a mental disorder.
    22. 22. o Immigrants are preoccupied with survivalo They are disinclined to examine or disclose their trauma storieso Those around them resist “knowing” the stories as well
    23. 23. A “conspiracy of silence”develops around most experiences of collective disaster
    24. 24. o Social Modelingo Insecure, disorganized patterns of attachmento Projective Identification o Depositing persecutory or victimized contents into children o Creating a persecutory-victim dynamic with them
    25. 25. The Shadow of the Object:Psychoanalysis of the Unthought Known
    26. 26. That body of "knowledge" that isincapable of conscious recapitulation yet which forms the ground of our every action (Wolfreys)
    27. 27. All the thoughts you never seeFrom their song: The Unthought Known
    28. 28. From Not Knowing to Action Knowledge
    29. 29. With implications for character and psychopathology
    30. 30. Action Trauma as Knowledge Metaphor Witnessed NarrativesNotKnowing Auerhan and Laub
    31. 31. Action Trauma as Knowledge Metaphor Witnessed NarrativesNotKnowing Auerhan and Laub
    32. 32.  It is adapted from the classic family genogram But highlights traumatic family experiences and dynamics
    33. 33. At Least for Now
    34. 34.  Begin with your family of origin and move up. You are the IP—index person, not identified patient! If you are a man, draw a square. If you are a woman, draw a circle. indicated by a circle
    35. 35.  Draw an ―X‖ through a figure to indicate that the person is no longer living. (See Figure 1) Maritalseparation is indicated by a single slash along the connecting line. A divorce is indicated by two slashes.
    36. 36.  For our purposes, choose only your mother or father’s side of the family to diagram. Grandparents are connected and diagrammed above the parents (vertically ). Connecting lines extend from the grandparent’s line to the parent. (See Sample Traumagram in Figure 5.)
    37. 37. Because I didn’tbring any cookies!
    38. 38.  Exposureto war or other forms of violence Psychiatricdisorders Extreme poverty Immigration Emotional abuse Premature deaths Other massive losses
    39. 39. Add Some Notes toYour Traumagram
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