Risk and parenting assessments in child welfare court proceedings – a psychodynamic approach

This article discusses a court directed parenting and risk assessment of a mother who has a chronic history of trauma and abuse. It addresses the complex unconscious dynamics that need to be managed by social workers when working with parents in court proceedings regarding their children. Often such parents present with their own complex histories of trauma and abuse and despite their conscious intentions to do so this has contributed to their inability to provide adequate care for their own children. An understanding of the powerful unconscious processes in operation more effectively gauges the risk factors that such parents present. However, such cases and enactments on behalf of parents can be bewildering to social work practioners. This may potentially lead to the social worker feeling persecuted during the process, resulting in impulsive, unprocessed and poor decision-making despite their best conscious intentions. To mitigate these challenges there is discussion of the support needs required for social workers, who engage with such complex unconscious dynamics.     

Remembering Hiroshima

Visions of the post-conflict reintegration process in Sierra Leone as a moment of healing, reconstruction, opportunity and rehabilitation do not take into account the experience of women and girls who were raped during the conflict. For them, the post-conflict period is often characterized by trauma, silence and stigmatization. This article examines wartime rape in relation to the liberal family model and the perception of sex as a ‘private’ social concern rather than a public security issue.     

Healing from Childhood Sexual Abuse: A Meta-Synthesis of Qualitative Studies

ABSTRACT

Although the global prevalence of childhood sexual abuse (CSA) is very high, the experience of healing after such abuse has not been well documented. The goal of this study was to characterize the healing experience among CSA survivors presented in the literature. Metaethnography was used to synthesize an integrative literature review. The CINAHL, PubMed, PsycINFO, and Web of Science databases were used as data sources. Eight articles that explored healing experiences from CSA, published between 2007 and 2017, were included in the analysis. After performing a quality assessment, line-of-argument synthesis was used to construct the integrating scheme of healing experiences from CSA. CSA healing experiences included dissociating oneself from the memories of CSA, finding peace by creating a comfort zone, disclosure as the start of healing, attempting to establish identity through ongoing self-reflective activities, feeling comfort by sharing experiences and connecting with CSA survivors, and accepting CSA as part of the life history and stepping forward. Healing experiences from CSA synthesized from the analysis focused on personal growth, supporting previous theory on CSA health in the broader literature. A tailored care plan could be developed for CSA survivors who are at varying stages of healing.     

The Development and Implementation of a Multi‐Couple Therapy Model with Torture Survivors in the Democratic Republic of the Congo

In this article, we present development and feasibility of implementation of a multi‐couple group for use with torture‐surviving couples. The model was developed in the Democratic Republic of the Congo in a community that experienced widespread torture during the wars from 1998 to 2004. The Torture‐Surviving Couple Group model is a short‐term intervention designed to use few human resources to address relational difficulties resulting from exposure to traumatic stressors. The model was guided by critical and feminist epistemologies and employed an ecological lens to incorporate neurobiology and attachment processes along with narrative therapy techniques. An existing multi‐couple group model for addressing violence (Stith, Rosen, McCollum, & Thomsen, 2004 ), and a stage model for healing trauma (Herman, 1992 ) also informed the structural development of the Torture‐Surviving Couple Group model. Couple groups were conducted using a 10‐session program with 13 couples who met weekly. Session themes were incorporated into four phases emphasizing: (a) preparation; (b) safety and stabilization; (c) processing the relationship effects of trauma and grief; and (d) reintegration and rebuilding couple and family life. Couples reported and showed remarkable progress in their relationships after participating in the groups. Clinical and research implications and discussed along with the feasibility of developing and testing the model in a post‐conflict low income setting.     

Working with Narratives

ABSTRACT

This article will discuss healing across cultures and describe narrative practice as a means of access to coping strategies in African American folk beliefs and traditional healing practices. Four elements were found in empirical research on folk healing among African Americans: spirituality, ritual, the power of words, and dreams. These culture-specific healing elements often emerge as themes in personal narratives about coping in response to stress, crisis, and trauma. Viewing healing elements as themes is a useful framework for construing meanings from clients' experiences of stress, trauma, and crisis and coping strategies embedded in folk beliefs and traditional healing practices.

Additionally, the author presents a structured interview questionnaire for identifying folk healing themes, illustrates narrative practice as an approach for integrating folk beliefs and healing practices, and discusses implications for clinical training.     

Curative fictions: The ‘narrative cure’ in Judith Herman's trauma and recovery and Chantal Chawaf's Le Manteau noir

Abstract

The possibility of a so‐called ‘narrative cure’, whereby a survivor of traumatic experience can begin to deal with her past through integrating it into narrative, has become central both to psychotherapy and to literary criticism on writings of trauma as a means of ethical, ‘truthful’ testimony and of healing. This article seeks to question the correlation between testimony and ‘cure’ through analysing the function of the ‘narrative cure’ in a psychotherapeutic text and in a literary text. This highlights how any notion of ‘truthful’ testimony is always underwritten by fiction, which raises crucial ethical questions about the relation between fiction and ‘truth’, testimony and ‘cure’ and psychotherapy and literature. I argue that the ‘narrative cure’ is not a privileged space of curative ‘truth’, but a point of tension between memory and amnesia and between ‘truth’ and fiction; it is precisely this tension, I suggest, which should characterize and structure interdisciplinary responses to trauma.     

Understanding And Misunderstanding In Cross-Cultural Practice: Further Conversations With Suwanrang

Understanding is an essential clinical practice skill, one which draws upon cognitive and affective, conscious and unconscious abilities. This paper explores the challenges posed by cross-cultural understanding. Using concepts from anthropology and data from anthropological field work and clinical practice, it examines cultural differences in the experience and communication of affect. Clinical examples from Northern Thailand are used to illustrate the ways these subtle and complex differences in clients’ affective worlds challenge our capacity to understand those who are culturally different. Implications for cross-cultural social work practice are addressed.Catherine Nye received her MSW from Virginia Commonwealth University, and her PhD in psychology from The Committee on Human Development at the University of Chicago. She is currently Associate Professor at Smith College School for Social Work.     

Reintegration upon return: insights from Ecuadorian returnees from Spain

Using the ECM2 survey data on Ecuadorian migrants returning from Spain, we investigate the determinants of reintegration upon return. We study how the migration experience, but also the before‐ and after‐migration characteristics, correlate with migrants’ outcomes upon return. We adopt a broad conception of reintegration, considering jointly labour market‐related outcomes that proxy for structural reintegration and subjective indicators that provide insights on sociocultural reintegration. The determinants of these two types of outcomes appear to be different: reintegration indeed encompasses multiple dimensions which cannot be captured by a single indicator. Our results suggest that return assistance programmes’ efficiency in helping reintegration could be improved by (I) targeting, ex‐ante, returnees who plan to launch their own business, and, ex‐post, the most vulnerable workers (women, older returnees, unemployed), and (ii) facilitating the labour market integration of foreign‐educated returnees. They also call for further research to better understand the consequences of these programmes.     

Can Anyone Here Know Who I Am? Co-constructing Meaningful Narratives With Combat Veterans

The discourse on psychosocial reintegration of combat veterans in the United States has largely been confined to discussions of the best treatment for those diagnosed with psychiatric disorders. Yet analysis of the data indicates that all combat veterans are changed by their experience. It also indicates that the current medical model of treatment is insufficient. The author suggests that another model is called for; one that benefits from psychoanalytic insights on war and violence. A model that supports veterans’ experience of changed consciousness might best help them form a coherent narrative that connects their past lives and combat experience to their lives going forward. She argues that this approach may not have been taken because the same mental processes that cause combat veterans to split off their experiences also cause society as a whole to distance itself from them. Clinicians can be most effective when they create a link to the veteran by acknowledging the veteran as part of society, not a split off aberration, and recognizing the universal role of aggression within and without in creating the war that the veterans fought, and shaping the social response to their return. Literature drawn from psychoanalysis, cognitive neuroscience, and clinicians from the global south is combined with that of military psychiatry and global relief and development to support these positions.     

Discussion of Paper by Warman and Rousseau

The story of trauma, in contemporary culture, has shifted, from one of painful, formative experience, to one of injustice and the imperative to rectify an untoward event. Journalists, politicians, and memoirists have become adept at making a narrative of trauma, at finding the story that focuses away from the experience of the wounds to the injustice of having been wounded. As a result, people tend to seek stories of suffering that have a beginning, middle, and, most important, an end, rather than stories of suffering that are not dramatic, that are not moral, but that have a lasting impact. People coming for therapy or analysis, too, look for the dramatic explanation for their suffering, to be the hero in their own narrative. And those of us who treat the sufferers too often protect ourselves from the universality of pain by looking for the trauma story. In recent therapeutic culture, the trauma story has been of a formulaic kind, which is in keeping with our culturally preferred relationship to trauma.

In this article, I draw from two treatments to illustrate the power of our cultural trauma narrative and my own implication in it.     

Incest and women of color: a study of experiences and disclosure

Clinical literature on incest trauma assumes a homogeneity of experience of all incest survivors including women of color. Experiences relating to community, culture, and family need to be acknowledged as salient aspects of the experiences of women of color who are also incest survivors. Twelve participants were interviewed regarding their experiences related to disclosure and coping. Participants described value systems, community mindedness, social attitudes, negative consequences amongst other social and cultural issues as factors affecting incest disclosure. Participants described cognitive reframing, determination and separation from the perpetrator as ways of coping with incest.     

Conceptualizing child sexual abuse in interpersonal context: recovery of people, not memories

The controversy regarding delayed recall of childhood sexual abuse (CSA) has deflected> attention from the question of whether memory recovery and other trauma-focused treatment approaches are effective for abuse survivors. More than a decade of clinical experience has convinced many experts that as a primary treatment strategy, this approach often leads to decompensation among CSA survivors. However, few treatment alternatives have been clearly articulated. One such alternative, contextual therapy, is grounded in evidence that many CSA survivors grow up in an interpersonal context that fails to transmit the capacities needed for effective daily functioning. Contextual therapy retains trauma-focused interventions as one component of a broader framework aimed at helping survivors develop adaptive capacities that, rather than having been disrupted by trauma, may never have been attained in the first place. From this perspective, abuse trauma is seen as compounding these deficits, rather than as a sole cause of them.     

“From that Moment on My Life Changed”: Turning Points in the Healing Process for Men Recovering from Child Sexual Abuse

Recent research indicates that child sexual abuse often undermines the health of boys and men across the lifespan. However, some male survivors experience a turning point marking a positive change in their health trajectories and healing process. Although frequently discussed in reference to physical health problems or addictions, very little is known about turning points with respect to child sexual abuse for men. The purpose of this secondary qualitative analysis was to describe the different types of turning points experienced by male survivors who completed the 2010 Health and Well-Being Survey (N = 250). Using conventional content analysis, researchers identified seven types of turning points that were classified into three broad categories: influential relationships (professional and group support, personal relationships), insights and new meanings (cognitive realizations, necessity to change, spiritual transformation), and action-oriented communication (disclosure of CSA, pursuit of justice). Implications for clinical practice and future research are discussed.     

The unconscious in economic decision-making: Convergent voices

Mainstream economics assumes that decision-making is a conscious cost-benefit process, ignoring the pervasive role of unconscious thought processes. Recent research in neuroimaging, genomics, and psychoanalysis exposes the role of unconscious and “nonconscious” processes, providing tools for analyzing economic decision-making. Neuroimaging reveals examples of brain function that modulate decision-making, but are not under conscious control. Psychoanalytic research provides evidence of the role of emotions and the unconscious in human behavior and decision-making. We advance the case for integrating psychoanalysis and neuroscience for a new perspective on the role of the mind in decision-making and economic behavior.     

Storying the suicide of one's child

Using selected concepts from Judith Herman's trauma model, psychoanalytic theory, and narrative theory, the clinical work with a griefstricken couple attempting to understand the suicide of their 26-year-old son, is presented. Within a short-term therapy, the goals were the deconstruction of a guilt-saturated narrative about the trauma, and the construction of an alternative narrative.     

The psycho-social subject in 'evidence-based practice'

In this paper I provide a theoretical outline, followed by two case examples, of a qualitative method, called the free association narrative interview, which produces evidence that is congruent with the kinds and contexts of knowledge that human service professionals use in their work. Following a critique of assumptions about what constitutes evidence in evidence-based practice and an argument for the use of experiential and theoretical, as well as empirical, ways of knowing, I focus on qualitative methods and the shortcomings of semi-structured interviewing as an alternative method for evidence-based practice. In particular I argue that the theory of the research subject and the research relationship that is assumed in most qualitative methods is misguided and affects the character of the evidence that can be produced. I outline an alternative theory of the (research) subject, a psycho-social subject, drawing on psychoanalytic concepts that emphasise unconscious conflict, defences against anxiety and the centrality of unconscious intersubjective dynamics in the research, as in other, relationships. Two examples follow. The first illustrates the transference and counter-transference dynamics in one of my research interviews, showing their importance for what information was produced. The second example demonstrates the use of experiential, empirical and theoretical knowledge in the analysis of data from an interviewee with agoraphobia. It illustrates how the paradigm of a psycho-social subject can produce a more complex account of people's behaviour. I conclude by arguing that the kind of evidence illustrated here, being congruent with the vicissitudes of most human service professionals' work with clients, could provide a model for evidence-based practice that is not only more appropriate but also helpful for professional development.     

Roundtable Discussion on Sexuality in Development and Treatment II: Clinical Application

This article explores the interesting, yet underinvestigated, phenomenon of unconscious communication. Newer psychoanalytic theories, which have expanded on the centrality of the analyst's subjectivity as well as the patient's experience of that subjectivity, have opened up the analytic space to explore the complexity of transference–countertransference dynamics. Detailed clinical process material is provided to determine if a coconstructed unconscious dialogue ensues, or if, in fact, the intrapsychic dynamics of patient and analyst are on independent yet parallel tracks. Several current theoretical issues are raised, such as how one- or two-person metapsychological frameworks can influence clinical process; the complex nature of enactments; the use of self-disclosure; and the possibility of unconscious communication.     

The ‘recidivist tongue’: embracing an embodied language of trauma

This article analyses selected excerpts from the writing of Antjie Krog and Yvonne Vera in order to theorise strategies for overcoming the disjuncture between the mind and the body that tends to result from violence. Both authors repeatedly return to the bodies of their characters and they insist that psychic and physical pain and trauma reside in the bodies of survivors as much as in their psyches. Acknowledging this corporeal reality of violence circumvents any opportunity to deny the totality of the impact that violence has on the lives of survivors. This has implications for survivors as well as for those who read or hear about violence. By developing an embodied language of violence and trauma, these authors offer new and more comprehensive ways of dealing with traumatic violations. When survivors reclaim their bodies, they are also able to utilise their bodies’ capacity for healing and comfort. When readers, and society at large, are unable to deny the harm that violence does to bodies, they are compelled to recognise the reality of survivors’ suffering. The article illustrates that the body can speak and that we ignore its voice at our peril.     

Constructivist self-development theory: a theoretical framework for assessing and treating traumatized college students.

The authors present a new conceptual framework for assessing and treating traumatized college students. The framework, constructivist self-development theory (CSDT), blends object relations, self-psychology, and social cognition theories. It is founded upon a constructivist view of trauma in which the individual's unique history shapes his or her experience of traumatic events and defines the adaptation to trauma. Within this theory, the authors suggest approaches to setting the frame for trauma therapy, including stabilizing acute symptoms and setting appropriate expectations for treatment. CSDT provides a framework for the systematic assessment and practical treatment of three aspects of the self that are affected by trauma. These include self-capacities, or the ability to tolerate strong affect and regulate self-esteem; cognitive schemas, or beliefs and expectations about self and others in the areas of frame of reference (or identity and world view), safety, trust, esteem, intimacy, power, and independence; and intrusive trauma memories and related distressing affect. Finally, the authors provide guidelines for assessing the need for longer term treatment.