Breaking The Trauma Myth

The Way We're Treating Trauma is Failing Survivors. Here's Why.

Susan Clancy • 10/25/2016 • 8 Comments

As a graduate student at Harvard in the mid-1990s, I participated in research studies carried out by the psychology department that began in October 1996 and continued until August 2005 to interview adults who had experience sexual abuse as children and learn what effects the abuse had had on their lives. Although I was sure I knew what I would discover—that the abuse would be remembered as a horrible experience that overwhelmed the people I interviewed with fear when it happened and had always been viewed as a traumatizing occurrence—what I heard in the hundreds of interviews I conducted was quite different. In nearly all the cases, the adults I questioned had not experienced the abuse as traumatic when it occurred and only came to regard it as so years later. And in many of the cases, they had never been questioned about their evolving sense of the abuse and the ongoing impact that it had on their lives, but only about what the traumatic experience had been like at the time. These findings led me to question the progress professionals in the sexual abuse field have made when it comes to understanding and treating child sexual abuse.

Certainly we have advanced to the point that the right things are being said (sexual abuse is common and harmful; it is never the child's fault). Funding in the trauma field has been secured, research conducted, studies and books published, treatment centers established, and public awareness raised through sex-education programs and campaigns in the media. But is any of it translating into actual progress for victims? Do they feel that they're being helped, that they're understood and their needs are being served effectively?

The trauma model's main purpose—one of the primary reasons why mental health professionals welcomed it with such enthusiasm in the 1980s—was to provide an explanation for how and why sexual abuse wreaks such psychological and social havoc in victims. Armed with a better understanding of the impact of abuse, mental health professionals hoped to be better able to help victims cope with and recover from these damaging crimes.

The problem is that today, after more than twenty-five years, predictions based on the trauma model have not proved accurate. Characteristics of the sexual abuse experience related to trauma (like how frightening it was, whether penetration or force was involved, and how many times it happened) do not do a good job of forecasting the level of long-term psychological harm experienced. There appears to be no direct, linear relationship between the severity of the abuse and the psychosocial difficulties victims experience in adulthood. Worst of all, we have developed no clearly effective treatments for sexual abuse victims. They continue to suffer from psychological and social problems in the aftermath of their abuse, and mental health professionals still have not reached a consensus as to exactly why or what precisely to do to help them recover.

This state of affairs is far from surprising. How can trauma be the cause of harm if most victims say that the abuse was not traumatic when it happened? A growing number of scholars in the sexual abuse field are coming to agree that understanding how and why sexual abuse damages victims probably has little to do with the actual abuse and a lot to do with what happens in its aftermath. For example, as David Finkelhor concluded in his recent book Childhood Victimization, continuing research efforts that seek to track the consequences of early events through developmental, cognitive, and behavioral pathways may prove more fruitful than continuing the restrictive focus on the severity and nature of event-specific trauma. I believe that the victims themselves have always known this.

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Jen was a sixty-five-year-old, divorced, retired administrative assistant. A tall, big-boned redhead with long purple fingernails, she was up front about lots of things. She did not like the coffee I gave her, my office was too cold, and she did not like the color of my hair. We were at the part of the interview when I asked her to rate how traumatic her abuse had been when it occurred. She did not like the questions I asked.

"Nothing personal," she said, "but these questions are kind of dumb. If you are trying to do what you say you're trying to do, and figure out why the abuse screwed me up so badly, why are you asking so many questions about what it was like when it happened? What you need to be focusing on was what it was like later on."

I asked what she meant. "What I mean is that what it was like when it happened and what it is like now are two separate things entirely."

I knew I had to consider Jen's words seriously. From that point on, I asked my question in two parts: What was the experience like when it happened? And what is the experience like for you today, looking back on it.

By the end of the study, the data was clear. Although sexual abuse was not a particularly awful experience for many victims when it happened, looking back on it, from their perspective as adults, it was awful—ratings of shock, horror, disgust, and even fear were all high. Obviously, perceptions of abuse when it occurs and when victims look back on it years later are entirely different. In addition, sexual abuse is very different from other kinds of terrible life experiences. For example, getting into a car accident is traumatic both at the time it happens and later when it is recalled. Sexual abuse, however, becomes traumatic later on. Why? What happens in the aftermath of sexual abuse?

According to victims, they did not experience the abuse as awful when it happened because most simply did not understand clearly the meaning or significance of the sexual behaviors they were engaging in. That being said, at some point later on in life, they do. Over time, the "cloak of innocence lifted," as one victim described it. Victims reconceptualized the formerly "confusing and weird experiences" and understood them for what they were—sexual in nature and clearly wrong. Only at this point—when the sexual abuse is fully apprehended—does it begin to damage victims.

Betrayal

When they discover that they have been abused, victims most frequently report feelings of betrayal. As Cheryl, a forty-three-year-old high school teacher on maternity leave with triplets, put it, "I realized that I trusted him, what he was doing, and I should not have. He knew he was doing something wrong, and he knew I didn't know. . . . It was all an elaborate game of sexual betrayal." As Neil, an AIDS activist working for a hospital in Boston, said, "I realized that it wasn't just what he did to me physically. At that moment [of discovery] I lost my father. He was no longer someone who loved and took care of me. I was just being used by him for his personal gratification."

For the victims who spoke to me, the degree of the betrayal was a function of two main variables. First, it depended on how close the victim felt to the perpetrator, on how much he or she trusted, cared about, or loved him. The second variable was the degree to which the victim believed he or she had been emotionally manipulated by the perpetrator or "taken in" by the situation. In those cases in which the abuse was traumatic when it happened (it involved force, violence, or pain), victims subsequently felt less betrayal. Since in these cases the children clearly understood the wrongness of the situation, any sense of betrayal arose immediately. And, because the children understood they were being victimized, the abuse was unlikely to happen again (or if it did, the child remained well aware of his or her victimization). Thus, victims did not have to undergo long periods in which they unknowingly fell prey to, as one subject told me, the perpetrator's "elaborate games of sexual betrayal."

As a consequence, many told me, this betrayal forced them to rethink the past. For many victims, a former sense of security is shattered; many report feeling a new sense of interpersonal insecurity and vulnerability. As Maria told me, "The day I understood what happened to me, I completely lost my own sense of security. The childhood I imagined I had—the safety that enveloped me—was shattered. The people who were supposed to be looking out for my well-being [and] taking care of me were not."

Betrayal affects not only victims' feelings of security and trust in others but also their self-worth. They feel that since they must not have been loved, perhaps they were not worth loving. As Charles, a history professor, explained to me, "You learn that who you are and what you might want or need just does not matter."

Considering the degree and extent of the betrayal victims felt, I expected anger at the perpetrator to be a common reaction. Yet only 5 percent spontaneously reported feeling angry at their abuser. Why would the victim of a crime punishable in almost any court system in the world not be angry at the perpetrator? According to victims, it is because they turned the anger inward. Most, to a shocking extent, blamed themselves.

No professionals explicitly discuss with victims or highlight the real dynamics of sexual abuse—that victims rarely resist it, often care about the perpetrators, and often receive "benefits" for participation, like praise, attention, and gifts. In fact, this kind of information may actually be suppressed. It appears to be an article of faith among professionals that you should not talk about aspects of sexual abuse that run counter to the trauma model at all.

Today, victims need to hear the truth. This requires us all to highlight publicly the true dynamics of sexual abuse—to expose the painful reality that most victims care for and trust the perpetrator (before, and sometimes during and after, they are abused), that they do not really understand the nature of what is being asked of them, that they feel they are receiving love and attention, that it does not hurt and sometimes feels good, and that, for all these reasons, participation is common.

Once exposed to the truth about how victims feel and behave during sexual abuse, victims need to hear, loudly and clearly, why they were not at fault. We cannot accomplish this with platitudes or blanket statements like "You were not to blame" or "It was done against your will." They consented not because they were forced to but because they did not understand enough not to. And victims need to know that this is normal. Although they made an error of judgment—ideally they should have said no; they should have resisted—we must reassure victims that given their age and level of cognitive and physical development, this error of judgment was understandable.

In short, in order to help victims feel less stigmatized in the aftermath of sexual abuse, we must all communicate that they were helpless victims—not, as the trauma model portrays them, literally helpless but metaphorically helpless, victims of their own level of development.

This information needs to be highlighted in the form of prevention campaigns, books, websites, and other culturally accessible outlets. Until that happens, victims will continue to feel alone, guilty, and ashamed.

This blog is excerpted from "The Trauma Myth" by Susan Clancy. The full version is available in the March/April 2010 issue, Haunted: The Growing Debate Over the Legacy of Trauma.

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Illustration © iStock

Topic: Trauma

Tags: childhood traumas | post traumatic stress | PTSD | ptsd and depression | Trauma | trauma and recovery

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8 Comments

Friday, October 28, 2016 10:46:36 AM | posted by Cheryl Mlcoch
Excellent article, Susan! I must admit, as a mental health counselor for over 15 years, I never agreed with the 'Trauma Model'. I stuck to my intuition and my clients story as my guide as well as what I had learned and experienced as a trauma survivor. Getting a brief snapshot of how they felt and perceived the abuse at the time it occurred was noted, but I mainly focused on how they had functioned since the abuse. Listening to how they processed the events, behaved in relationships, how they viewed themselves, and if they were able to give and receive love in a healthy way were my markers to focus on in their healing. Combining this information with their strengths and creating safety in our relationship gave me something to work with in their individual path to healing. This article is definitely important for other counselors to understand, so thank you again for taking the time to write it! Continued success to you, Cheryl Mlcoch, LPC

Friday, October 28, 2016 10:57:25 AM | posted by Rachael McDougall
THANK YOU! I am 61 years old - years of therapy [behavioral and medication] - self help. I am a licensed clinical psychologist. The effects of trauma run so deep - washing over every aspect of your life. I still am 'haunted' by triggers and nightmares - especially during times of stress [which is often professionally and personally]. NO - I don't think what we are learning is accessible enough to survivors and presented in a manner that helps us see over the top of the maze of research, new approaches, etc.

Saturday, October 29, 2016 3:24:55 PM | posted by Cynthia Mann, LCSW
I appreciate your take on the issue. I worked in public schools in California for 24 yrs (36 yrs LCSW ). It seems to me that adults clients should be involved in system response planning. A bigger problem in our part of the country, the dearth of prevention programs. We have a huge struggle to bring programs that do exist to the children.

Saturday, October 29, 2016 3:55:12 PM | posted by Cindy
I suppose this is why young victims start bedwetting, self mutilating, experience overwhelming fears, have episodes of rage and anger and nightmares not to mention suicide attempts as early as age 8 and 10 do what they do? No damage done until later? Give me a break.

Saturday, October 29, 2016 5:20:33 PM | posted by Sptopper
Clancy's book was the first time I saw that I was not completely abnormal and that my childhood experience and reaction to it at the time did not mean I was a freak. It was a great relief to read her book.

Sunday, October 30, 2016 12:30:10 PM | posted by Barbara
Even saying error in judgement (even if it is because a victim is developmental unable to judge), still suggests they did something wrong....and once again the wave of unnecessary shame arrives. You will at that point, lost the client in your trust. It was impossible or them to know how to say no or judge the situation. That needs to be your focus.

Sunday, October 30, 2016 7:40:42 PM | posted by rmweidner@yahoo.com
Nothing new here, pls don't disguise the article as something beyond what we have been doing for years. Thank you

Wednesday, November 2, 2016 4:44:01 PM | posted by Paul Odegaard
I've been using EMDR for many years in the treatment of victims of sexual abuse and I believe it has been very effective. It does subscribe to the 'trauma model' but I think you fundamentally misunderstand the trauma model and treatment approaches that involve 'in the moment' processing of memory/experience. Experiential models recognize that there are many complex factors operating, especially the subsequent experiences and associations that shape the automatic reactions or symptoms. Therapy is oriented towards fostering adaptive information processing. The patient/client comes to her own functional conclusions about her experience without being corrected or educated. When you say, "Victims need to hear the truth", you're revealing that you're not a therapist. I do however agree that there is important information that could be provided to the public as you suggest in your last paragraph.