Intro myself: practice in San Diego, have worked for the Navy, crisis center, in-home therapy, inpatient and outpatient hospital treatment, residential treatment for adolescents and adults and I’m the parent of a high-functioning autistic adult.
Thrilled to have this opportunity to share with you an understanding and a tool that has been instrumental for me personally and professionally.
I am a practitioner vs a researcher. What I present today is from a “practice” point of view. There are many opportunities for research about this subject and I encourage anyone who is interested to contact me.
How many of you are direct treatment providers? Service providers in a broader sense? Administrators?
How often do you get frustrated or baffled by the intrinsic shame expressed by your patients or clients?
Here at the conference we hear the term “trauma-informed”…I have been presenting on the subject of thinking in terms of “what happened to you” for over 10 years.
I encountered this term several years ago while researching the topic. Dr. Ann Jennings work Models for Developing Trauma-Informed Behavioral Health etc succinctly described my view.
We are here to learn about how to help humans who have been hurt. This is how I think about it: Trauma-Informed perspective is first and foremost about “What happened to you?” Trauma-Informed approach is based in compassion and a recognition that all humans experience trauma in their lives. A professional who is “trauma-informed” understands the basic after-effects experienced by survivors.
TIC is an “injury” focused model vs the medical model—a “sickness” focused model.
Of the many injuries suffered during trauma events and circumstances, “self-blame used as a coping strategy” is a primary wound that we need to understand.
If we can understand this concept, then teach it and support our clients to process through it, we will truly be working from what I call “trauma-informed mind”.
If we had 2 or 3 hours I would show you clip after clip and read passage after passage—fiction and non-fiction-- to illustrate the common experience of humans and especially of children who are hurt by adults.
We don’t, so this one will have to suffice, but it makes the point, clearly.
Mark Epstein, the author of The Trauma of Everyday Life has this to say (he quotes Robert Stolorow, a philosopher, psychologist, and clinical professor of psychiatry at UCLA):
“One consequence of developmental trauma, relationally conceived, is that affect states take on enduring, crushing meanings. From recurring experiences of mal-attunement, the child acquires the unconscious conviction that unmet developmental yearnings and reactive painful feeling states are manifestations of a loathsome defect or of an inherent inner badness.”
Explains the self-blame, low self-esteem, self-sabotage of survivors.
Informs us why it is difficult for our clients to accept “it’s wasn’t your fault”.
Understanding this concept and how it shows up in clients’ lives, gives us increased compassion and patience, whatever our setting or role.
Engaging in this coping defense support “betrayal blindness“, helps the child connect and preserves the relationship that is vital for attachment and survival.
Self-blame developed as a coping skill Self-blame was a helpful defense as a child, however in adulthood impedes maturity IBS is a foundation of treatment; working with it will empower client and create progressive environment for therapy IBS makes “it all about me” in ways that clients may not even be aware of—this affects communication, relationships and the accomplishment of goals Ct 1 it’s the anxiety without a cause I’m constantly walking in Ct 2 It’s a lot of shit to deal with Ct 3 It’s the veil of darkness I carry with me
Key “trauma theme” (Seeking Safety), that if understood and emphasized, can give a momentum and structure to treatment, inform the helping professional so as to refrain from personalizing, thus helping to prevent effects of VT
I use the term “Internalized Blame of Self” (IBS—my clients tell me “it’s a lot of crap to deal with!”) for this defense. Dr. Colin Ross calls it “Locus of Control Shift” (The Trauma Model, 2000) but I found this phrase to be a bit cumbersome. Dr. Eduardo Duran speaks of “internalized oppression” resulting from “historical trauma” (Healing the Soul Wound: Counseling with American Indians and Other Native Peoples, 2006). Dr. Duran asserts that this internalized oppression is a primary driver of domestic violence, suicide, family dysfunction and community dysfunction. It may influence the survivor/victim to fear that he or she will become like the perpetrator. In my experience IBS is one of the greatest obstacles to compassion for self and others. Fear-based behavior becomes a way of life for many who are stuck in IBS.
So, now I would like you all to get in touch with your inner 2 year old. WHY--THAT is the KEY—to focus on “what’s the purpose?”
When we can offer understanding about why we do this thing-- in the first place-- we can offer tools for healing it.
It’s a common experience for therapists and other helping professionals to help their clients and patients in their struggle to live with their belief was “my fault”. But, WHY do we humans think this in the first place?
I have worked with countless well-meaning and well-educated practitioners who are “trauma-aware”. However, I believe that to be truly “trauma-informed” we need to understand this idea that thinking “it’s my fault” during the events and circumstances of abuse, neglect, disaster etc, is something that helped the child survive.
For the child, believing “it’s my fault” helped her/him survive. How does that work?
Magical Thinking (Egocentrism)
Causal reasoning that looks for correlation between actor or utterances and certain events: “It’s raining because I’m sad.”
The outside world is linked with the child’s internal consciousness: “You’re hurting me, so I must be bad. I’m bad, so you hurt me.”
Children do not have the intellectual capacity to challenge their own “magical thinking”-they believe they are the cause of events happening in their world (Piaget called it “egocentrism”).
Surviving adults, in the face of overwhelming feelings, resort to magical thinking in order to gain a sense of control and to avoid feeling completely vulnerable in a seemingly unpredictable world.
When humans experience trauma, they feel as if their life is threatened; there may be an element of horror and shock, helplessness ensues. After the event or circumstance, a victim needs to recover from feeling vulnerable and out of control of the environment. One way we do this is to engage in self-blame: “it was my fault”.
Mary is 4 years old. At night she hears her parents fighting. Daddy yells at Mommy “why are her toys always in the driveway?!” One day Mary comes home from pre-school and Mommy tells her “Daddy’s not going to live with us anymore”. What does Mary think?
“My toys are in the driveway. It’s my fault.”
Stick figure drawings: after my training with Dr. Ross, I used his concept about “Locus of Control Shift” to help my clients work through their self-blame. I found myself, on a daily basis, drawing these stick figures…
I’ve had one or two people tell me “I did figure it out when I was 4 and I ran away!” I said, “yes, and then what happened?” They took me back there.
How does this help Mary (or Tommy) cope? "Maybe if I keep my bike put away ‘I’ll be good enough' --daddy will come back!" Thus, a pattern of thinking becomes a way of life, for many persons. Children may become adults who are always trying to be 'good enough'. This can mean the grown-up strives to be smart enough, pretty enough, strong enough, rich enough, religious enough—whatever the particular “enough” fits in her (or his) family!
MAGICAL THINKING is the child’s sole resource, thus only way to get a vital sense of psychological control: “I’m bad”, “I caused it”, “I deserve it”
Colin Ross: “…we know that this is a developmentally normal cognitive error. This is how normal kids (and I say: humans) think. The little girl was engulfed by a tidal wave of sadness, hopelessness, powerlessness, and despair. Or, no she wasn’t.” Bessel van der Kolk: (speaking of Piaget’s intuitive stage—age 4-7) The child in this preoperational period is self-centered .Human activities seem to cause natural events. The world revolves around the child: he is not only the master of the world but guilty if anything goes wrong. In Psychological Trauma pg 92, 1987
Now, the child becomes a person who is constantly striving to be ‘good enough’…pretty enough, smart enough, clean enough, strong enough, rich enough, etc.
Unfortunately, this does not work out well in adult relationships. Grown-up Mary relies on her magical thinking rather than become aware of the many adult resources she now has. She often responds to adult situations with immaturity, exhibiting a “self-centered”, helpless personality rather than an empowered identity.
Adult elementary school teacher: “I should have gotten A+ on report cards” Asked, “Can you give A+ on your students’ reports?” Her answer, “No, but I should have gotten A+s”
A woman’s fiancé completed suicide; after the event her only thought: “No wonder he died, look how fat I am…it’s because I’m crazy, too.” Only child out of 8 siblings that was not abused, “I was not good enough” for the abuser. As adult: robbed at gunpoint, wasn’t raped. Her expression? “I’m not even good enough to be raped by a criminal.”
Tonya Harding film clip
Sexual abuse victim: “I was lower than a dog” (Searching for Angela Shelton-film)
This is from an online training I completed (from the Center for Deployment Psychology) for Prolonged Exposure Therapy:
For example, while it is normal for people to have intrusions, to experience discomfort when reminded of the trauma, and to feel agitated and aroused for the first several days or weeks after a trauma, if one’s conclusion is “and therefore I’m weak,” such an interpretation may contribute to a sense of being stuck with the trauma or of being “bad” in some way. A negative self-view may help perpetuate the symptoms. The mechanism for how that works is unclear but there is a link between self-statements and the persistence of trauma-related symptoms.
"The mechanism for how that works is unclear but there is a link between self-statements and the persistence of trauma-related symptoms."!!
IBS explains this... IF we understand and use this explanation of IBS in treatment, THIS is what they address...IBS continues to drive the need to stay in trauma response and Ambivalent Attachment (a subject for another presentation) combines with IBS to keep it going, especially if the perpetrator articulated "you're bad" etc.
For the adult who is attached to a care-giver who hurt him/her as a child—also serves the purpose of making that person ‘right’ if the child was ridiculed…less dangerous to speak out against the abuser than to be focused on self-blame
If we listen for the “IBS” expressions, we’ll be able to look past the overt “acting out” behavior to the defense
The effects of IBS can be quite painful, pervasive and long-lasting: IBS is supported by ongoing cognitively distorted beliefs and thoughts; inability to recognize adult resources—for some contributing to them being called “manipulative, attention-seeking, needy”
Self-sabotage creates a vicious cycle of reinforcement of irrational magical thinking: “I’m bad” “I don’t deserve good”
Victims unconsciously seek out relationships and job situations (for example) that seem to prove the “truth” of their low self-esteem: “I’m just a loser”
When adults become parents, themselves, they may unintentionally create the next generation
Learned helplessness: I can’t, I’m unable
We can equate IBS with “SHAME” why? Because shame is all about “I’m bad, I’m wrong, I’m a loser.” Nowhere does this manifest so clearly as with persons who suffer with alcoholism and other addictive, compulsive behaviors.
This diagram shows how a trauma survivor usually views the world; black and white thinking, labeling, cognitive distortions, often stemming from their IBS and AA Issues….addiction keeps people in a cycle of shame and it is difficult to see that their shame stems from pain that was originally imposed upon them.
In other settings (vs “treatment”), it has helped me exercise compassion toward unhelpful, non-trauma-informed colleagues and it has helped me allow for others’ humanity in various social service settings as regards my son.
Working on IBS=finding empowerment in recognizing current adult resources
Use of Mindfulness to notice one's actions, resources can begin to cause triggering to dissipate
"I have choice" versus being an unwilling, unable to resist victim
Understanding IBS as a coping defense is vital to treatment; saying “it wasn’t your fault”, while comforting does not address how continued use of IBS in adulthood inhibits recovery
It’s great to understand this idea, but what do we do now, to help those we serve? Good news is that most of us all already doing a lot of what is helpful.
AND a shift in focus can help us offer even more empowerment.
Ross quote re “you can’t get away from the art of therapy” Cognitive: especially: LABELs Grief: 3 types/areas Meditation/Mindfulness: “To be free, to come to terms with our lives, we have to have a direct experience of ourselves as we really are, warts and all.” Mark Epstein Self-Compassion: as a concept—NOT ENOUGH TO MODEL—TEACHING it ‘OUT LOUD’ Expressive: art, music to allow ct to claim the IBS and to create tangible work that’s “enough” (vs GOOD enough) Education: sometimes starts at first session: EXPLAIN THE WHY Encourage ct to look for, identify and claim this defense—recognize that it worked in childhood but gets in the way of adult life Therapeutic relationship: demonstrates balance of self-esteem, calls attention to IBS in speech, models compassion—YOU DESERVE YOUR BEST LIFE JUST BECAUSE YOU’RE A HUMAN (Dr Ross quote) Identify IBS moments: aha moments Therapeutic relationship: Ross reading Positive affirmations: identify thoughts, emotions, body sensations and behavior in response to (for example) “I love and approve myself” Somatic work: self-care that, when stuck in IBS, is difficult at best
We are all working to help our patients and clients find freedom so they can move on with their lives—that they can find recovery, using their strengths and the resiliency they’ve already demonstrated by being survivors of trauma. I hope you’ll agree with me that understanding IBS is an important element of Trauma-Informed care and work.
INTRO TO PUPPY STORY.
Presentation for Institute on Violence, Abuse and Trauma, August, 2015, San Diego, California
What Professionals need to know
Cathy S Harris, LCSW
San Diego, California
August 25, 2015
Trauma-Informed perspective is first and foremost about
“What happened to you?” Trauma-Informed approach is based
in compassion and a recognition that all humans experience
trauma in their lives. A professional who is “trauma-informed”
understands the basic after-effects experienced by survivors.
Brain development, social, educational, physical & economic
are not available
MAGICAL THINKING—child’s sole resource
Hard-wired for survival: a necessary illusion of control
Adult, out of 10 siblings, was not abused by
“I should have gotten A+ on report cards”
Asked, “Can you give A+ on your students’ reports?”
Answer, “No, but I should have gotten A+s.”
Adult school teacher’s expression
“I was not good enough” for the abuser.
As adult: robbed at gunpoint, wasn’t raped. This client’s expression?
“I’m not even good enough to be raped by a criminal.”
From “I’m bad, I must be causing you to hurt me”
the child reasons “If I am ‘good enough’ maybe
you won’t hurt me”
The adult exclaims “If only I hadn’t left the house
when I did, I wouldn’t have gotten into a car
accident”… “If only I hadn’t built my house in that
field, the tornado wouldn’t have destroyed it”
When victimizers say “you made me” (hurt you)—
they reinforce the illusion that the victim could
prevent the abuse by being “good enough” in
It gave the child-victim an illusion of control; this
sense of power, though false, allowed the child to
survive, to make sense of circumstances that made
The primary reasons the adult continues to engage in
use of IBS is for avoidance of feelings (perceived
“bad” feelings), gain a sense of control, continue
attachments to those who may have/they perceive
have hurt them
Case Study: “FU, I’m just a screw-up!”
Copyright United Artists, 1995
I’m a bad
I might as
Allows for appropriate detachment (especially with Complex
Provides structure for therapy
Provides explanation for “resistance”
Can help address Vicarious Traumatization
Copyright Pixar Animation/Distributed by Disney Picture,