My First Exposure to the Treatment of Trauma
I was asked by someone why I always believe women when they tell a story about being traumatized by a man even though I had been hurt be women on multiple occasions. Based on my understanding of memory and my experience treating trauma survivors, I was certain beyond a doubt that Dr. Blasey Ford was the victim of a traumatic assault by Brett Kavanaugh. The theories that suggest doubt are inconsistent and the entire event did not involve recognition of her own trauma, which disturbed me. Even in court cases, the defense attorney will suggest that maybe it wasn't his or her client who hurt her. By attacking her "discrepancies" in the accounting of the assault there was a contradiction in the logic. There was no evidence presented of a conspiracy to keep Kavanaugh from getting this job advancement but that's getting off topic. Kavanaugh's naming of an alternate person who might have hurt her demonstrated that the story of her trauma was believable. So, the insistence that we weren't in the room at the time and didn't know who did it was an issue that was not credible. A person knows who assaulted them in this fashion when the event happens when they are 15. I recognized the trauma reaction she was describing and the symptoms 35 years later was well known to me from having helped similar victims or survivors of trauma of this nature. My point is to describe how I came to recognize trauma and how that defined an important part of my focus as a psychotherapist.
During the second year of my internship as a Master's Student in Social Work, I was working at "The Oaks" in Wilmington, NC. I had volunteered there even before I started my Master's program and was very impressed by the skills of Chris Hauge, DSW, LCSW. Most Clinical Social Workers do not need to get a Doctorate to do clinical work as a Psychologist does because Clinical Social Workers do not do Psychological testing. So, most of the training is on the job, through supervised work, post-graduate training hours, examination and Licensure. Anyway, Chris Hauge had gone a bit further but he was a mentor to me who was very inspiring. He was a bit older than me and said that at the time I was getting my Master's there was a roadmap that would take me through ongoing post-graduate training but not as part of a Doctorate program.
At "The Oaks" in the 90s, we were treating a wide range of psychiatric conditions from Major Depression, to Bipolar Disorder, to Schizophrenia and more. What was most interesting was that almost all the patients that came into the hospital for other disorders that did not include a trauma disorder such as PTSD (Post-Traumatic Stress Disorder), they all had trauma that they were needing to process. He had experiential therapy groups that he was leading. This involved Gestalt therapy approaches and Inner-Child therapy techniques. Experiential is different than just talking in that you do something. It is also important to realize that inpatient stays were very limited in time, two weeks tops, often less. He demonstrated how certain approaches can make a big difference even in a certain two-hour group session. They came into a locked ward in a crisis situation for some non-trauma disorder or diagnosis but we are now treating everyone for trauma disorders. Not every condition would be appropriate for these techniques, specifically, if a person's reality testing is impaired due to a Schizophrenia diagnosis then that patient would not necessarily be a good candidate for these groups, especially if they weren't going to be released any time soon.
There were a few different groups, some dealing with relaxation and anxiety relief, for example, and a Gestalt Empty Chair Technique group along with Inner Child work. Of course, there was an overlap in what we were doing in any one group. A one-hour group might only address relaxation techniques and how to deal with sleep problems. It was truly amazing the benefits that I saw in the effectiveness of these treatment techniques for the patients. It was so rewarding to be a part of that. In fact, Chris had encouraged that his interns practice the techniques themselves instead of just being observers as a medical student or other internships might be conducted. There was a combination of learning in doing, observing, consulting after the group and homework that fascinated me. I was in love with what I was doing.
I started by saying that I could relate to women as trauma survivors. It seems that when men get hospitalized, it's more often that they have a serious psychotic disorder or condition, such as Schizophrenia or Schizoaffective Disorder. In these serious conditions were reality testing is compromised, the experiential work is risky as it can worsen a person's reality testing, which is the opposite of the goal of their hospitalization. Perhaps, it is also true that men have a harder time talking about physical and sexual trauma than women. I grew up with a taboo on ever hitting a woman, where one would look like a wimp or sissy if you ever hit a girl. Apparently, that idea was not a universal idea in the US. It is ironic that in while watching Law and Order - Special Victim's Unit (SVU) they begin by stating that "sexually based offenses are considered especially heinous, when in fact, the best defense is often that it was consensual... the "did you really not want this to happen" defense. Only child victims of sexual assault are universally considered heinous crimes.
The damage to children from physical, emotional, and psychological abuse is infinitely underestimated with or without accompanying sexual abuse or assault. People can be in their 60s and still affected by harm from childhood that no one seems to understand or appreciate. We are told to not dwell on it forever, especially if the abuse did not include sexual abuse. These groups at "The Oaks" made it clear that one is not choosing to dwell on the past. If they walk into the room for group and are not still affected by the abuse or trauma then they will not need to return to these groups. They might gain a few relaxation techniques and skills but they won't engage in the other techniques that are helpful. Also, people hear about false memories from childhood and usually it is assumed that the therapist is asking leading questions or rewarding answers that embrace the abuse from decades earlier that may never have happened. I have observed or lead thousands of hours of group and individual sessions and 99% of the time the therapist did not do anything like that, half of those thousands of hours involved me, as the therapist and I've replayed it over and over in my mind to see if I volunteered anything or lead the person to describe some horrifying event from their past and cannot find any leading, directed, rewarded or suggestive statements. I should say almost any because it is very hard to be perfect but what I do know is that any kind of rewarding remarks did not direct the client to continue a narrative that follows a certain storyline.
Not all traumas are long ago. In the next part of this story, I'll discuss my treatment of a couple of women who had been raped not long before coming to me for individual therapy. I'll also describe treating combat survivors near Camp LeJeune in Jacksonville, NC.