See no evil,hear no evil,speak no evil: assessing complex trauma in young children

Complex trauma generally refers to a child's exposure to multiple traumatic events often within the context of an interpersonal relationship. Childhood traumatic events are commonplace and can have significant implications for physical and mental health. However, traumatic events are often not assessed by clinicians involved in their care. This paper outlines an approach to assessing complex trauma in young children in clinical settings. This approach involves an initial interview, an assessment of traumatic events and trauma symptoms in the child, an assessment of the parent–child interaction, an understanding of the child's functioning in multiple settings, and an assessment of parental trauma where relevant. Complex trauma takes time to assess and is dependent on the parent's ability to recognise and acknowledge the effect trauma has had. The paper concludes with some of the challenges when assessing complex trauma in young children in clinical settings.     

Childhood trauma and risk for suicidal distress in justice-involved children

Justice-involved children (JIC) have higher rates of trauma exposure and suicidality than the general population. The Childhood Trauma Model predicts that children can accumulate multiple traumatic experiences that can be more harmful than a single traumatic event. The purpose of this study is to investigate the individual and cumulative effects of childhood trauma on suicidal distress among JIC. The study employs logistic regression to analyze panel data on 2367 12–16 year-olds from the Florida Department of Juvenile Justice (FLDJJ). The study shows that 9 types of individual traumatic experiences increased risk for suicidal ideation from 22 to 180%. For one unit increase in the trauma score, the risk for suicidal distress increased 25%, so that JIC who experienced 5 types of traumas were 2.4 times more likely to experience suicidal distress as JIC who experienced a single trauma. These findings illustrate the need to invest mental health services and suicide prevention resources in populations in the juvenile justice system. Intervention must be tailored to serve children who suffered specific traumatic events, as well as those who experience multiple types of trauma. Further, policies that manage JIC as kid criminals rather than as traumatized children may exacerbate their suicidality and problematic behavior.     

Trauma: Conscious and Unconscious Meaning

Developmental, constructivist theory is applied to increase understanding of conscious and unconscious dynamics of trauma experience. DSM-IV criteria provide the accepted standard guiding research and practice for trauma. Concern is raised that rigid adherence to diagnostic categories is problematic for trauma survivors. Trauma survivors are unique in both conscious and unconscious experience. Saari's (2002) levels of cognitive integration of experience based on Nelson's (1985) tripartite theory of meaning are employed as an investigative tool. Understanding the individual's cognitive integration of the traumatic event is central to facilitating reintegration and healing post-trauma. The therapeutic dyad co-constructs a narrative that allows reintegration and healing. A case study of a childhood sexual abuse survivor demonstrates how relationship dynamics facilitate co-creation of a healing narrative.     

Trauma Without Borders: The Necessity for School-Based Interventions in Treating Unaccompanied Refugee Minors

This article explores migration trauma among Mexican and Central American unaccompanied refugee minors (URM) with the purpose of developing an understanding of migration as a tripartite process consisting of: pre-migration exposure to traumatic stressors, in-journey stressors, and post-migration stressors. The migration experience of these youth may be subjectively different depending on a wide range of factors. The complexities of migration are explored as a traumatic, tripartite process. These three salient components of migration may act as precursors, often resulting in psychological sequelae such as: post-traumatic stress disorder (PTSD), anxiety, and depression. Of all migrant groups, URM are more likely to develop psychiatric symptoms. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Cognitive Behavioral Intervention for Trauma in Schools (CBITS), and Mental Health for Immigrants Program (MHIP) are among the most effective interventions in the treatment of PTSD, anxiety, and depression in refugee minors. Social workers in schools are in unique positions to provide mental health services to URM. A case example illustrating a cultural adaptation of TF-CBT in an urban public high school is included. Clinical implications of culturally responsive and trauma-informed treatment of URM in schools will be discussed. Additionally, this article will emphasize the importance of bridging the gap between research and culturally responsive, trauma-informed interventions for URM in schools.     

Traumatic Experiences in Childhood and Adult Substance Use in a Nonclinical Sample: The Mediating Role of Arousal/Reactivity

The vast majority of adults in the United States experience at least one traumatic event during childhood. According to the self‐medication hypothesis of substance use disorders, adult survivors of childhood trauma may cope with trauma‐related symptoms via alcohol or drug use. The purpose of this study is to identify through which specific PTSD symptom clusters childhood trauma exposure are associated with adult substance use. Participants of this study (N = 627) were not recruited based on substance use or traumatic exposure. Results of this study demonstrate that arousal/reactivity partially mediates the association between childhood trauma and current substance use. Implications for treatment include recommendations for trauma‐informed approaches that aim to decrease arousal/reactivity and subsequently substance use.     

Posttraumatic Psychological Distress and Resettlement: The Need for a Different Practice in Assisting Refugee Families

Social work practitioners are increasingly confronted with couples and families who have come from war-torn countries. Refugees may have experienced genocide, organized violence, ethnic wars, displacement, and losses of various kinds. Such experiences will often be carried through the post-migratory period and obscure legitimate individual and family processes that are often evaluated through a psychopathology lens. In this context, there is a pressing need to be attentive to refugee situations around the world and to issues related to forced migration and its impact on families. In an attempt to fill the gap in the literature on intervention with refugee families, this article presents two of the most compelling aspects of the refugee experience that can have a lasting impact on families and couples: premigration traumatic events and their potential impact on the refugee resettlement experience, and postmigration social and psychological experiences. The concept of “trauma” is presented within the context of resettlement of asylum seekers and refugees. Key stressors documented as having an impact on the long-term well-being of individuals, families, and communities who have been touched by war and conflict are outlined. Multiple-family group intervention is discussed as one of the promising approaches for helping families cope with pre- and postmigration trauma.     

Radical absence: encountering traumatic affect in digitally mediated disappearance

ABSTRACT

Disappearances keep appearing in the digital sphere: video circulates of Islamic State in Iraq and Syria (ISIS) beheading of a kidnapped journalist; MH370 vanishes into sky yet its real and imagined journeys are traced ceaselessly; friends learn someone close to them has died when Facebook ‘memorializes’ their page. Each is different: a lost airplane, unreported boat people and a deceased life. In the work of trauma studies scholars such as Cathy Caruth [1996. Unclaimed experience: trauma, narrative, and history. Baltimore: The Johns Hopkins University Press] and Shoshana Felman and D. Laub [1992. Testimony: crises of witnessing in literature, psychoanalysis, and history. New York: Routledge], such events are felt but unrecognized, known to have happened but unable to be represented. Yet these are traumas that can be experienced with intensity and immediacy in the mediated worldings of the digital. They are encounters with radical absence. Affect theory offers the means to conceptualize this ‘vicarious trauma’ [Kaplan 2005, Trauma culture: the politics of terror and loss in media and literature. New Brunswick, NJ: Rutgers University Press, p. 87]; it bridges the conceptual gap between an event that happened and the meaning it contains. Since affect is ‘the simultaneous participation of the virtual in the actual and the actual in the virtual, as one arises from and returns to the other’ [Massumi 2002, Parables for the virtual: movement, affect, sensation. Durham, NC: Duke University Press, p. 35], it offers a way of understanding trauma in keeping with the digital: fluid, moving, changeable, multitudinous and even contagious. This paper traces the contours of encounters with video beheadings, the vanishing of MH370, and markers of digital death as encounters with radical absence that are emblematic of the complexity of traumatic affect and mediated trauma in the digital sphere.     

Complex Responses to Trauma: Challenges in Bearing Witness

This paper explores variability in family and individual response to trauma. The discussion draws on results from a study that investigated family adaptation to traumatic brain injury (TBI) and also refers to literature on the Holocaust. Outcomes to trauma are complex and it is argued here that hope can coexist with despair (within families and within particular individuals). The challenge for therapists in bearing witness to testimony following significantly traumatic events is also explored.     

Coping with trauma in domestic migrant worker narratives: Linguistic,emotional and psychological perspectives

Trauma can be defined as an event that goes beyond ordinary modes of experience and linguistic representation. It represents a break not just with a particular form of representation but with the possibility of representation at all. Drawing on a large corpus of domestic migrant worker narratives, the article analyses trauma narratives in which migrant women share their experiences while working for abusive employers. The stories deal with unspeakable suffering and humiliation, and the article attempts to outline the narrative structures that characterise trauma storytelling: broken narratives with voids in the narrative flow. It also analyses the emotional component of trauma narratives focusing on crying, which is seen as an authentication of feeling and meaning. Finally, the article considers how the women make sense of their traumatic experiences, and how peer support becomes essential in the narrators' attempts to rewrite their life stories from victimhood to survival and beyond.     

Identity and Trauma in Adolescents Within the Context of Political Violence: A Psychosocial and Communitarian View

The author explores the concept of identity as a frame of analysis in adolescents responding to various actual experiences of trauma. The author looks into numerous themes including the impact of broken identities, different ways of understanding the “victim identity”, the identities of trauma, the role of transitions, as well as identity dilemmas. By examining the experience of young Mapuche in South America, the experience of war and political violence in Mexico and el Salvador, the identity of displaced young people in Colombia, and a multilevel analysis of child suicides among the Embera ethnic group in Choco, Colombia, a psychosocial and communitarian analysis of the impact of violence and war on youth is offered.     

Trauma management: Chernobyl in Belarus and Ukraine

Although the Chernobyl nuclear disaster happened in the Soviet Union in 1986, we still do not know how the most affected states – Ukraine and Belarus – have managed this tragedy since independence. Drawing on the concept of cultural trauma, this article compares Chernobyl narratives in Belarus and Ukraine over the past 28 years. It shows that national narratives of Chernobyl differ, representing the varying ways in which the state overcomes trauma. Our understanding of post‐communist transformations can be improved by analysing trauma management narratives and their importance for new national identity construction. These narratives also bring new insights to our vision of cultural trauma by linking it to ontological insecurity. The article demonstrates how the state can become an arena of trauma process as it commands material and symbolic resources to deal with trauma. In general, it contributes to a better understanding of how the same traumatic event can become a source of solidarity in one community, but a source of hostility in another.     

Emotional death: the charity advert and photographs of childhood trauma

This essay will use current and historical advertisements by the British charity Barnardo’s to analyse the representation of abused children. In particular, it will focus on the 1999–2003 campaigns to explore the connection between the experience of trauma, death and the photographic image in the context of a first world, Western preoccupation with the spectre of the missing, lost or abused child. It will consider the complex attempt to photographically capture the missing image, to invoke a subjective loss and to conjure up the accompanying wound of trauma. The Barnardo’s adverts, like many charity adverts of abuse, attempt to show a traumatic past, that by its very nature as trauma, defeats easy representation. Trauma as an experience produces a crisis of representation. The traumatic event, with its radical disruption of psychic defences, results in an absence or gap in memory, knowledge and recall. The devastating event so overwhelms the senses that it produces a perpetual sense of “belated uncertainty” about “a truth to which there is no simple access” (Caruth , p. 6). These photographs attempt to capture the dislocation of time and distortion of identity for the traumatised child. Whilst structurally they can be read for invoking a sense of aura or credibility as testimony, they do so in a digital age when the status of the “truth” of the photograph as evidence is called into doubt (Robins ). This dislocation of image from referent can be read for its parallels with the dislocating structures of trauma. As such they raise questions of the ethics of “spectral evidence” in a commercialised charity sector.     

September 11 attacks: prior interpersonal trauma, dysfunctional cognitions, and trauma response in a midwestern university sample

Undergraduate college students (N = 133) were assessed for posttrauma and depressive symptomatology, posttrauma cognitions, and previous traumatic experiences 1 month after the September 11 attacks in the United States. Negative beliefs regarding oneself and the world mediated the relationship between prior interpersonal trauma and acute trauma symptoms. Acute depression acted as a mediator between prior interpersonal trauma and negative cognitions of oneself and self-blame cognitions. The results suggest that even in a nonclinical, nontreatment seeking college sample, prior traumatic events can play an important role in an individual's short-term adjustment following indirect exposure to a significant trauma. The differential relationship of negative beliefs on acute trauma symptoms and depression is discussed.     

What Lies Beneath: Trauma Events,PTSD, and Alcohol Misuse in Driving Under the Influence Program Clients

The prevention and reduction of alcohol misuse is one of the Grand Challenges of Social Work. Addressing client needs beyond alcohol misuse can improve client outcomes. Driving under the influence program clients (N = 1,248) were screened for trauma events and posttraumatic stress disorder (PTSD). Results found that males more often reported having been assaulted with a weapon or that they caused injury to someone else. Females more often reported sexual assault and other unwanted sexual experience. About 26% overall screened positive for PTSD. Social workers need to be alert to various types of trauma and help clients identify the connection between trauma and alcohol misuse.     

Making sense of collective identity and trauma through drawing: the case study of a Palestinian refugee student

Abstract

Identity construction can be very complex for refugee children, especially for Palestinian refugee children. For refugee children, organised violence and immigration are important parts of their life experience that can lead to trauma, which in turn influences how they construct their collective identity. Schools have to consider this specific experience as the development of a meaningful identity is an important factor in refugee students’ well-being and school adjustment. School-based activities centred on creative expression can help refugee students in expressing trauma and in making sense of their identity and migration experience. This paper presents the case study of a 9-year-old Palestinian refugee boy in Canada and explores how he expressed and made sense of his multiple identities in his drawings. Many features of the boy’s drawings evoked a wounded identity, especially spatial disorganisation and enmeshment. Data analysis revealed that the boy might have been experiencing collective identity trauma and that he used drawing and a peer as props to heal his wounded identity. Both drawing and the space offered by his teacher to safely explore and experiment with different identities contributed to the integration of his multiple identities into a meaningful whole, which contributed to his school adjustment.     

Do Secondary Trauma Symptoms in Spouses of Combat-Exposed National Guard Soldiers Mediate Impacts of Soldiers’ Trauma Exposure on Their Children?

This exploratory study examines the associated effects of combat exposure on Soldiers assigned to a Midwestern Army National Guard unit. It also explores the secondary and mediating effects of combat exposure on Soldier’s spouses and children. The correlations of combat exposure with trauma symptoms, substance abuse, domestic violence and secondary trauma symptoms among family members are identified. Survey results suggest that immediate family members of combat-exposed Soldiers with high levels of post traumatic stress disorder (PTSD) are at risk for developing secondary traumatic stress. Secondary trauma symptoms in these spouses are a risk-increasing mediating variable between trauma symptoms in combat-exposed Soldiers and secondary trauma symptoms in their children. Results from this investigation emphasize the need for further inquiry into this topic. They further highlight the need for preventive and treatment efforts targeted toward all family members and relationships in order to lessen the effects of combat exposure.     

Veterans-by-proxy: A conceptual framework of ambiguous loss among children of combat veterans

There are tens of millions of children (youth and adult) of parents who are veterans. These individuals can experience traumatic injury alongside the parent who is a combat veteran. It is a parallel process called “veterans-by-proxy.” A proxy is an individual that acts on behalf of another individual. The proxy witnesses how combat traumatizes their parent and vicariously experience the trauma themselves. When a proxy suffers secondary trauma, ambiguous loss, and insecure attachment, one or more ego functions fail to adequately develop. This article proposes a conceptual framework of the proxy’s loss as it relates to the parent’s trauma and discusses research-based resiliency-focused interventions critical to healing the relationship between the proxy and the parent who is a combat veteran.     

The psychoanalytic structure of trauma: Spellbound

This essay engages in a close analysis of two films, Alfred Hitchcock’s Spellbound (1945) and Ang Lee’s Hulk (2003), in order to examine their approaches to trauma, especially in relation to the psychoanalytic notion of Nachträglichkeit (“afterwardsness”). A complex notion of afterwardsness is proposed whereby it is predicated on a relationship between two events, but where the importance of afterwardsness is not seen to lie in the nature of the events but rather on what determines the relationship between the two events. This determining relation thus leads to a notion of the structure of trauma and the argument that the crucial factor in a psychoanalytic approach to trauma lies not in an uncovering of traumatic events, but rather on the structure that retrospectively makes events traumatic.     

Posttraumatic Play: Towards Acceptance and Resolution

Many children who experience trauma demonstrate it through posttraumatic play (PTP). This type of play is seen by professionals as a repetitive reenactment of the traumatic event within the child’s play. Reliving the event in this way may serve to retraumatize the child and lead to other psychiatric or behavioral problems. This article examines the issues surrounding childhood trauma and PTP. It uses a case study to illustrate the phases of a play therapy approach that incorporates Ericksonian principles, in order for the child to achieve resolution and acceptance. The countertransference issues that a clinician may encounter also are discussed. Editor's Note: This article is the recipient of the Judith Mishne Memorial Award for Excellence in Clinical Social Work Theory and Practice.