Why the Current Trauma Model Fails Victims of Abuse

A New Way to Help Traumatized Clients Relieve Guilt, Shame, and Isolation

Susan Clancy

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. 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.

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. Tracking 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.

Early on in my career, I did not have a lot of experience interviewing sexual abuse victims. I had, however, a lot of experience interviewing victims of other kinds of horrible experiences (motor vehicle accidents, combat, natural disasters, abductions), and I had asked these subjects to rate how traumatic the events were at the time.

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.

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.

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.

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." Want to read more articles like this? Subscribe to Psychotherapy Networker Today!

Topic: Trauma

Tags: Bessel van der Kolk | emdr | mental health | mental health professionals | post traumatic stress disorder | PTSD | sexual abuse | shame | guilt

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Wednesday, January 20, 2016 3:10:31 PM | posted by R. David Stitt, EdS, LPC, LMFT
I also appreciate the subject of childhood sexual abuse being addressed and I would note larger factors that certainly need to be considered. As long as adults cannot talk about sex like we talk a lunch, not only will children continue to be sexually abused, they will not have a vehicle for discussion, the awareness will be subsequently lost or blocked until much later, sometime after their own children are violated. If there significant is loss of memory, along with family chaos, the odds are good that sexual abuse occurred. The event may not be recalled or seen as tragic compared to the horror they came to see as normal.

Tuesday, January 19, 2016 8:18:59 PM | posted by Babs Schmerler
This was a great article but not a new idea. As an almost ready to retire therapist, I recall learning a long time ago that how others around the victim react to the abuse determines how the victim will respond to the event. If others are supportive of the victim, reinforce their bravery in disclosing the event, and respond immediately to keep them safe, victims tend to do much better then if they are blamed or made to feel guilty for breaking up the family. I also agree that perspectives change with maturity, as many times the perpetrator is the nurturing adult in the child's life or the child feels special versus manipulated due to the attention they receive. I think it is important to continually give the message that, as people grow and gain more life experience, it is natural to look at major life events in a different way. Maybe the trick will be to help parents and other adults remind children of this when other life events trigger thoughts of past abuse and a need to re-examine what happened to them from their new perspective arises.

Tuesday, January 19, 2016 12:37:10 PM | posted by Pamela Blunt
I don't know what is new about this. Jan Hindmann wrote about the importance of context and aftermath throughout developmental stages and into adulthood in the 80s and 90s. Is the mainstream of the field still so far behind?

Monday, January 18, 2016 8:45:20 PM | posted by Rebecca Olmsted
This is really helpful! Particularly the direction indicated :

"Tracking 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 wish I had had this advice two years ago - it would have been relevant to a client I was working with at the time.

Monday, January 18, 2016 8:03:29 PM | posted by Jeffrey Von Glahn
The field doesn't have a useful method of treatment for ANY trauma because of the mistaken notion of retraumatization. Though a well-intended idea, all extant understandings of it do not offer any criteria for differentiating between emotional experiencing that is re-traumatizing and when it is not. My concept of therapeutic crying (PN, May/June 2012) proposes that crying is the best "medicine" for traumatic events IF it occurs under the following condition. That is, heightened emotional experiencing is therapeutic if it emerges coincident with clients receiving sufficient support for what they have been experiencing. I call this the unforced activation of emotional experiencing. What happens is that the person experiences a fight or flight response caused by the activation of unresolved hurtful events. This response is the pre-therapeutic phase. However, if the client continues to receive sufficient support for his experiencing, it reaches a peak of intensity and spontaneously transitions to a healing phase, of which therapeutic crying is a typical feature. Forced activation of emotional experiencing usually occurs outside of therapy when an unexpected stimulus activates too much unresolved hurt for the nervous system to process at the time. When the client brings such an experience to therapy, it may seem that she is being "re-traumatized."