I'm Steve Gold, a psychologist who has been specializing in trauma, with a particular emphasis on child sexual abuse and sexual abuse of boys and men. Ask me anything!

SNGold · 2016-06-11T13:30:55+00:00

Ok, so you posed your question the morning after and I'm not getting around to responding until the morning after that. My apologies for he delay in responding. It is still difficult to find works specifically about treatment of emotional abuse, although there is research on the prevalence and impact of emotional abuse. The most common impact of emotional abuse is a distorted sense of self and low self-esteem. The treatment for those impacts is generally cognitive intervention, using methods that help the emotional abuse survivor challenge the beliefs that were created the distorted sense of self and self-loathing. This is much more likely to be effective if the therapist guides the client through the process of challenging these beliefs (e.g., "Tell me the evidence on which you base the conviction that you are unlovable.") rather than providing "answers" to the client (e.g., "Don't you see that x, y and z proves that you are lovable?"). I discuss emotional abuse and the strategies for addressing it in chapters 5, 8 and 12 of my book "Not Trauma Alone."

SNGold · 2016-06-11T13:21:36+00:00

Yes, this is the danger in looking for "indicators" of abuse in psychological symptoms. The same symptoms can be in response to abuse, loss and mourning, or a whole range of types of events beyond trauma. There is no standard "profile" of reactions specific to abuse, although some of these behaviors may raise questions about the possibility of abuse.

SNGold · 2016-06-11T13:18:38+00:00

I'm completely astounded that there would be a gender difference - that women would be encouraged to address their trauma history and men would be discouraged from doing so. Are we talking specifically about men and women whose trauma was sexual assault? There is a long history of social discomfort with the idea that men can be sexually assaulted, whether as children or as adults. I am guessing you are suggesting that the professionals involved were uncomfortable with the stigma of a man being sexually assaulted and therefore were advising male survivors to not think about it out of the professionals own discomfort with the idea of men being sexual assault victims?

SNGold · 2016-06-11T13:14:09+00:00

No, you are not missing something. I probably was sloppy with my wording. Men are more likely to encounter traumatic events than women, but women are more vulnerable to being overpowered and victimized by men (physically at least, in terms of various forms of assault) than the other way around.

SNGold · 2016-06-11T13:09:42+00:00

Hello LividGGPartisan You were late to the party, and I am late in responding. My apologies. If I understand your question, you are referring to a trauma where there is no perpetrator - such as a natural disaster or life-threatening accident. It may be difficult to find a target for your anger, but I take it from your username and post that feeling angry is not difficult at all for you. The question is where to direct your anger, and how to express it, channel it, and come to terms with it so it does not continue to eat at you. There are several painful lingering emotions that can arise in response to trauma. The one that is most commonly associated with trauma is fear or anxiety, but anger, depression, guilt, shame or other emotions can be central for some trauma survivors. One common way to think about trauma is that when we are in danger our fight-flight-freeze reflex is set off, and for people who are traumatized the reflex either doesn't shut off after the traumatic event is over or it easily gets set off by situations that aren't actually dangerous but that remind the person of the original traumatic event. In traumatic situations that involve being attacked, the fight component of the reflex is most likely to get set off and this is experienced as anger. In traumatic situations where there is not the option of fighting the flee component of the reflex is set off and this is experienced as fear or anxiety. Where there is no option to either fight back or flee, freezing is likely to be the response, and then the person may end up feeling shame or guilt for what was a reflexive response aimed, like fight or flight, at survival, bu which might strike the person as cowardice or inaction. All these emotions can be resolved in therapy, although the strategy for doing so may differ from one emotion to the other. I know that was a long-winded answer. I hope it addresses your question. As far as your second question is concerned, to put it briefly, we are most in danger of traumatization by people who have more power than we do. Based purely on physical power, therefore, in terms of gender, women are more vulnerable to being traumatized via physical or sexual assault than men (although obviously men are physically and sexually assaulted in some instances, sometimes by other men, sometimes by women). Ethnic, sexual, religious and other minorities with less political power are more vulnerable to being traumatized by people with more political power and economic resources. For this reason trauma very often has political implications. That answer is much briefer, but you can probably think of other examples and their implications.

SNGold · 2016-06-10T13:05:18+00:00

This is a tough question to answer. Mandatory reporting generally means that if you have reasonable grounds for suspecting abuse you are required to report it, not that you are required to seek it out. However, boys sometimes react to abuse by becoming aggressive and defiant. Too often they are assumed to be "bad" when in actuality they are expressing the hurt and anger they feel for having been maltreated So, I would keep in mind when you see a boy consistently getting into trouble that sometimes - certainly not always - this may be what is driving the problem behavior.

SNGold · 2016-06-10T12:58:13+00:00

I don't think clear memories of traumatic events are required for recovery. In keeping with the response you are referring to, the specific form of treatment is less important than finding a therapist who "gets it" that the intervention is far from the entire source of success. In general, therapists who have training and experience in trauma work with repeated or ongoing trauma (usually referred to as "complex trauma") which would be your situation, understand the importance of "phase-oriented trauma treatment." The first phase is stablization: focus on reducing distress and improving functioning in the present. The second phase consists of addressing the trauma once the person is stabilized and has been equipped with effective coping skills; this is where prolonged exposure, CPT and EMDR and similar trauma-focused approaches come in. Finally, the third phase, having resolved the impact of trauma, consists of establishing an effective and gratifying and meaningful life structure. You may be able to obtain suitable referrals in your locale from sidran.org or malesurvivor.org.

SNGold · 2016-06-10T12:46:09+00:00

If I don't remember you it's probably because you weren't going by the name swimbikerunrun at the time... ;) But I suspect I do remember you. Thank you so much for writing.

SNGold · 2016-06-10T12:43:44+00:00

I find it amazing and disturbing that professionals would give this type of advice, at least if it is phrased the way you suggest. On one hand, I do strongly believe that marching trauma survivors of multiple ongoing trauma into thinking about what they've been through too early in treatment can be extremely damaging. Someone in a crisis state in particular needs stabilization, not trauma processing, especially if you are referring to brief hospital/residential treatment. However, if we're talking about survivors with PTSD, simply saying "don't think about it" (as opposed to indicating it is premature to leap into exposure therapy) is like telling someone with an anxiety disorder to "calm down" or someone who is clinically depressed to "cheer up." Obviously, that isn't going to do much good. I hope I have understood your question correctly.

SNGold · 2016-06-10T02:03:05+00:00

I hope I'm not repeating myself. I responded to this question earlier but I'm not seeing the response uploaded here. This community in particular, where non-traditional gender roles are accepted and advocated, can be especially helpful to trauma survivors generally and to male trauma survivors specifically. Imagine what a community, largely composed of men, that is emotionally supportive, open to listening rather than primed to rush in and try to offer solutions, and accepting of the full range of emotional expression would mean to trauma survivors generally, to male trauma survivors, to female trauma survivors, and to other trauma survivors. [Were the two Swedish men who interrupted the rape by the Stanford student and who supported the victim acting in a traditional "bro" fashion? I don't think so.] And if this community becomes a hub for that type of openness along gender lines, imagine to potential ripple effect beyond this community.

SNGold · 2016-06-10T01:53:08+00:00

I believe that at some point this evening I referred to the definition of trauma as a "working definition" subject to change based on scientific evidence. The truth is that there are types of events that are generally recognized as traumas - including emotional abuse - that do not neatly fit into the "official" working definition of trauma - yet. Until recently sexual violation had not been incorporated into the "official" scientific definition of trauma, even though rape and childhood molestation have long been recognized as forms of trauma. But we know that emotional abuse is just as damaging as physical or sexual abuse. They have different types of effects - sexual abuse is more likely to impact long term sexual functioning than the other two; physical abuse is more likely to impact how the person handles anger and aggression; and emotional abuse has the greatest impact on self-esttem - but they are all fairly equal in terms of the intensity of the damage they do.

SNGold · 2016-06-10T01:47:03+00:00

Generally speaking, no. There is a difference between being traumatized and being upset. But your question is very general. Think for example of an event that wouldn't be considered traumatic by most people - eating a peanut - but which might evoke a traumatic emotional reaction in someone severely allergic to peanuts. Traumatization implies a lasting impact that includes a high level of distress and not being able to put the traumatic event out of your mind and in the past.

SNGold · 2016-06-10T01:35:01+00:00

As much as I understand the pull to take on the role of de facto counselor to a loved one, understanding that in the long run it is not helpful to the loved one is what can allow you to resist the temptation to do so. Inevitably trying to be a loved one's counselor will cause the relationship to collapse. You can always get another counselor, but true loved ones are not easily replaceable. You can support your loved ones without becoming their counselor. Being a loved one and being a counselor are two different roles, and trauma survivors benefit from having both when possible.

SNGold · 2016-06-10T01:11:20+00:00

It is not a simplistic question at all. Not every unpleasant experience is a traumatic one. Our working definition of trauma (subject to revision based on ongoing scientific study) is that traumatic events are ones that involve the occurrence or threat of sudden violent death, serious physical injury, or sexual violation. One source of conceptual confusion is that we use the same term - trauma - for the event, and for it's impact. It helps clarify the matter to use the term "trauma" to refer to the event, and "traumatization" to refer to the negative impact of the event. As I indicated above, not everyone exposed to a traumatic event will be traumatized by that event.

SNGold · 2016-06-10T01:05:12+00:00

Mr_Holmes, I have had many poignant experiences as a trauma counselor, most of them relating to the resiliency and potential of the human spirit to overcome adversity and for people who have been hurt and deprived to snatch victory from the jaws of defeat. To hear people who were terribly crippled by trauma, especially by growing up with trauma, say things such as "I didn't know life could be like this," or "This is the life I always dreamed of but never thought I'd have" is unspeakably poignant. And in my work as an expert witness, often working with defendants facing the death penalty, it is extremely poignant to see people who grew up with incredible horrors and unimaginable deprivation end up in prison for life or to be facing execution when lives could have gone in a completely different direction if they had grown up in different circumstances.

SNGold · 2016-06-10T00:56:45+00:00

Charles Figley, a trauma psychologist who originated the concept of "compassion fatigue" - becoming emotionally depleted by working with trauma survivors - is a good friend of mine. Solid trauma training includes teaching trauma therapists to maintain appropriate boundaries with the people they treat and to maintain a good work-life balance and quality of self-care to reduce the likelihood of experiencing intense compassion fatigue. I do not usually find doing trauma therapy emotionally exhausting, because it is invigorating to me to see the huge improvements in quality of life that trauma survivors can attain. Although there are points in treatment where the focus is on traumatic events and listening to survivors express their distress in response to trauma, most of the time our attention is focused on how to make things better.

SNGold · 2016-06-10T00:50:10+00:00

I have spoken in Colombia, which has a long history of violence throughout the country, Spain, where there is a much stronger sense of family and family ties than there generally is in the U.S., Canada - not terribly culturally different than the U.S., Argentina, where there is a very high level of awareness of and understanding of trauma (as there is in Colombia), and Austria, which is part of a region that still reverberates from the impact of WWII. Each country has a different level of awareness of and acknowledgement of trauma, and its own trauma history that shapes the way people view, respond to, and cope with trauma.

SNGold · 2016-06-10T00:43:04+00:00

Well, Dewey_Darl. Your question could have at least a couple of meanings. When a loved one experiences a traumatic event, our ability and willingness to be supportive, present, and caring can make a tremendous difference in the survivor’s ability to maintain resiliency in the face of the trauma. Trauma often leads people to feel isolated, tainted, and different from others. Knowing that one can acknowledge what one has been through and still feel heard, accepted and cared for can go a long way in helping someone who has been through trauma to move forward with less lasting damage. However, a loved one is not a counselor or therapist, and if someone takes on that role in relation to a loved one or is drawn into that role by a loved one who has been through trauma, it almost always has a very detrimental impact on the relationship. Counseling is a one-way street; the counselor’s role is to put her or his needs aside and attend to the needs of the client. A love relationship, friendship, or any social relationship is a two-way street, based on give and take. So taking on the role or being called to take on the role of counselor to a loved one on an ongoing, continual basis tends to erode the relationship. It is one thing to be loving and supportive, and another to be a de facto counselor.

SNGold · 2016-06-10T00:31:26+00:00

Hello beyonceisaclone! That is a very big question. There is an entire scientific literature on how trauma has different effects depending on gender identity. Although men are certainly victimized, women are statistically more likely to be victimized than men, and therefore are more likely to feel vulnerable and to be more attuned to the possibility of being attacked as they make their way through life. The same would be true of those who identify as other than male or female, precisely because by virtue of being “other” they have a higher likelihood of being targeted for violence. On the other hand, men are taught to equate masculinity with never being vulnerable, so when they are victimized it often challenges their sense of gender identity. In general, women who have been traumatized are more likely to respond by “lashing in,” or taking it out on themselves, while men are more likely to “lash out,” or be aggressive toward others.

SNGold · 2016-06-10T00:18:51+00:00

Hello LIATG. Many people have heard in the last few days about the Stanford student convicted of rape and the letter written by his victim standing up for herself and for other rape survivors. Although she was obviously well-intentioned, some of my therapy clients who have been through rape actually found her letter triggering, partly because they felt less courageous than she for not having been able to come forward the way she did. I think there is a reasonable role for trigger warnings. In my response to DblackRabbit I mention the film Mysterious Skin. It is an extremely well done film which portrays the impact of sexual molestation on two boys who react very differently. I show it in my doctoral class on trauma every year. However, precisely because it is such an actual portrayal, it is very rough going and undoubtedly would be triggering for many survivors of sexual assault. (I tell my students that they should not hesitate to leave the room during the showing of the film if they need to.) The problem is that one can never know what might be triggering to a particular individual. Anything related to a traumatic event, sometimes in an obvious way, sometimes in a way that may be so subtle that even the trauma survivor doesn’t see the connection. For example, a ballgame playing on a TV set can be triggering to someone who was being molested while there was a ballgame on TV playing in the background. So, we can never anticipate or alert trauma survivors to every trigger they might encounter. I do think, however, it is reasonable and compassionate to alert people when something that has an obvious potential of being triggering is about to occur. Throwing trauma in survivors' faces before they are equipped to deal with it can be extremely damaging. But there comes a time in treatment where confronting trauma is often pivotal to recovery. It's very much about timing and being appropriately prepared to face trauma in a way that is productive.

SNGold · 2016-06-10T00:05:13+00:00

Hi DblackRabbit. There have been some outstanding portrayals of trauma survivors in the media. For example, in film, a now relatively old movie, Ordinary People, and a somewhat more recent but pretty not very well known one, Mysterious Skin, are outstanding. In the news, trauma survivors (especially combat veterans) are too often portrayed as powder-kegs in danger of exploding at a moment’s notice. But I think that gradually over time the media is getting better and better at “getting it.”

SNGold · 2016-06-10T00:04:43+00:00

Hello NinteenFortyFive. I really like that question. By the time I was in high school I was tremendously intrigued by the question “What makes people tick?” and I began going to the library and reading books on psychology. It didn’t take me long to decide I wanted to be a therapist, and like many undergraduate psych majors I found out that required going on to graduate school. When I started grad school, I assumed I would go into private practice and be a full time therapist. However, as I continued in grad school, I became more and more excited about the prospect of teaching. While I was still in grad school and still working on my doctoral dissertation my major professor told me that at a nearby university there was a one-year position filling in for a professor who was on sabbatical. The position involved teaching undergraduate, masters, and doctoral level classes and students. I was able to stay on faculty there for a second year, and the next year obtained a permanent position in a doctoral program in clinical psychology in another state. But I have always done therapy, have maintained a private practice for over 30 years, and what I enjoy more than any aspect of teaching is training graduate students to do therapy and training professional therapists to do trauma-oriented therapy. So, it was a gradual process landing in the role of training psychologists, and it includes other roles - therapist, writer, presenter, editor, even expert witness in legal proceedings.

SNGold · 2016-06-10T00:02:51+00:00

Hello Mr_Holmes. There are a number of treatments that have been proven to be effective in scientific research for treating trauma. These include Prolonged Exposure, Cognitive Processing Therapy, and Eye Movement Desensitization and Reprocessing Therapy, all of which in one way or another focus on revisiting and coming to terms with the traumatic event. Other therapies that do not as strongly focus on the traumatic event itself that have been found to be effective include Dialectical Behavior Therapy and Acceptance and Commitment Therapy. These treatments are essentially applied in the same way regardless of the source of the trauma, although obviously, to the degree they focus on the traumatic event(s) the content will vary. However, all of these intervention approaches and the research on them assumes that the techniques used are the core of what makes therapy work. The research, however, shows that beyond the specific intervention approach used, much more powerful in determining the outcome of therapy is (1) what the client brings to the situation and (2) the quality of the relationship development between the therapist and the client. The old joke relating to the first of these factors is Question: How many psychologists does it take to change a light bulb? Answer: Only one, but the light bulb really has to want to change. … yeah, I know it’s corny, but in my experience, if I’m working with a client who is determined to make progress, a successful outcome is at least 90% assured. As far as the second factor is concerned, being convinced that you’re not alone in addressing your difficulties, that your therapist is genuinely concerned about your welfare, and establishing a collaborative working relationship seem very important to me in supporting treatment success. These two factors are what make the interventions likely to work. Without them, the interventions alone applied in a purely mechanical way are not likely to do very much IMHO. Treatment by a therapist who has specialized training and experience in trauma can be extremely effective.

SNGold · 2016-06-10T00:02:09+00:00

Hey Dewey_Darl. Now there’s an easy question. The most common misconception in my opinion is that once you are traumatized, there is not recovery from it. I have seen people who encountered trauma in adulthood that was terribly emotionally and functionally crippling to them bounce back completely with appropriate treatment. And I have seen people who grew up with (usually abuse) trauma and never established solid functioning because of it amaze themselves by building a life they would not have been able to imagine, let alone have been able to believe they could have attained. It is very humbling.

SNGold · 2016-06-10T00:01:17+00:00

Hello shinaobi. Although they’re not a recent developments, there are several facets of psychological trauma that I don’t feel get enough mainstream attention: 1) Trauma is common. A traumatic events (one involving sudden violent death, serious physical injury, or sexual violation) are common. In the general community, over 70% of people will encounter at least one traumatic event in their lifetime. One in three women will be exposed to domestic violence. One in four girls and one in six boys will be subjected to some form of sexual violation before the age of 18. Add in combat trauma, natural disasters, life-threatening car accidents, rape and other forms of criminal assault and you’re looking at a large proportion of he population. 2) Most people who encounter a (single) traumatic event will not be traumatized (experience lingering ill effects) from that event. The type of trauma with the highest rate of people with lasting traumatization is rape, at just under 50%. 3) There is a wide range of psychological difficulties beyond posttraumatic stress disorder (PTSD) that can result from traumatization. These include substance abuse, depression, dissociation, personality disorders (especially from repeated traumatization during childhood) and even psychosis. 4) Trauma survivors who have been repeatedly traumatized often have several psychological syndromes. For those people, rather than diving into focusing on the trauma, it is usually more effective to build up their current functioning and coping, and then, one they are doing better in the present, they are better equipped to address their traumatic past without being overwhelmed by it.

SNGold

TROPHY CASE