SOURCES OF HELP AND SUPPORT FOR ADULT SURVIVORS
If you are currently experiencing an emotional crisis and you or someone else are at risk
-- please phone your local Emergency Service: Dial 111
Go to your nearest Hospital Emergency Department
ORPhone your local DHB Mental Health Crisis Team -- [LINK]
MOST people WILL benefit from talking to someone about their experience of trauma, but unlike in the old days of compulsory debriefing post "critical incident", HOW and WHEN this occurs, and with WHOM are perhaps most important. If YOU feel the need to talk to someone NOW, keep on asking until you find the right person.
General Information about Dealing with, and Recovering from, Trauma -- [LINK]
If you're looking
for general information on Psychology and better coping, please go here -- [LINK}
-- these resources will also be valuable if you're coping with the effects of abuse and trauma,
but I'd recommmend you first consider some "crisis management skills" -- see --[LINK}.
If you have more time available, and are reluctant to be "dependent" if you can avoid it -- though in theory I'd always getting the support of otheres as much as possible (but this is not always available) -- take a look at my page on Tapping -- [LINK], and in particular, listen to Terri Cole's (2012) 42 min MP3 on Tapping for Childhood Trauma -- [LINK]
help with managing emotional distress - Use of Acceptance and Metaphors
-- practising the techniques suggested in this video by Joan Klagsbrun, PhD in Counseling,
may help with managing emotional distress -- [LINK]
SPECIFIC TREATMENT FACTORS
PRESCRIPTION DRUGS FROM YOUR DOCTORS
See Blog Post -- Functional Contextual View of Drugs,
from Psychiatrist Dr Rob Purssey [LINK]
- Who Cares In Sweden is a superb documentary in 3x1-hour long parts exploring common adverse effects of SSRI’s, and why we are so often unaware of these. It features the best experts in the world on these matters, and presents the material in a highly engaging, sober and measured manner. [LINK]
I highly recommend Who Cares In Sweden to anyone taking these medications, prescribing them, or knowing anyone who is taking or prescribing SSRI’s.
NON-SPECIFIC FACTORS IN TREATMENT
There are certain essentials if one is to recover successfully from the effects of childhood abuse and neglect. The first is a good relationship with oneself, the keys to which are self-awareness, self-forgiveness and self-compassion, and the second is a good relationship with another, the key to which is acceptance of you by the other as you are, warts and all, and that is not to say they do not wish to see you doing better than you are, and their capacity to validate you as a worthwhile human being. Indeed, this "comprehensive validation" has been shown to be even more effective in some ways, therapeutiaclly, than one of the standard therapies for childhood abuse and resulting personality difficulties - Dialectical Behavior Therapy (Linehan et al., 2002 -- [LINK]). Many of those suffering from depression, especially despression born of childhood trauma, have instead a negative relationship with themselves, sometimes even a self-hating relationship, the sort of relationship they don't share with other people, that others often don't even know about. Those from such backgrounds are often self-isolative, and "socially disconnected" from others, to such an extent that this is almost their primary defining characteristic (Dorahy, 2010) -- [LINK]
See my discussion of
PROTECTING YOUR SAFETY IN TREATMENT -- A GENERAL INTRODUCTION
-- [LINK]
See my discussion of
FIVE ESSENTIALS OF EFFECTIVE TRAUMA TREATMENT
-- [LINK]
Cloitre et al (2011) -- [LINK] -- see also -- [LINK] -- report the results of a survey of experte in the treatment of Complex Trauma:
Ratings from a mail-in survey from 25 complex PTSD experts and 25 classic PTSD experts regarding the most appropriate treatment approaches and interventions for complex PTSD were examined for areas of consensus and disagreement. Experts agreed on several aspects of treatment, with 84% endorsing a phase-based or sequenced therapy as the most appropriate treatment approach with interventions tailored to specific symptom sets. First-line interventions matched to specific symptoms included emotion regulation strategies, narration of trauma memory, cognitive restructuring, anxiety and stress management, and interpersonal skills. Meditation and mindfulness interventions were frequently identified as an effective second-line approach for emotional, attentional, and behavioral (e.g., aggression) disturbances. Agreement was not obtained on either the expected course of improvement or on duration of treatment. The survey results provide a strong rationale for conducting research focusing on the relative merits of traditional trauma-focused therapies and sequenced multicomponent approaches applied to different patient populations with a range of symptom profiles.
This conclusion (whilst published in 2011), like most "published" research (the most current research is either reported in professional-to-professional contexts, such as conferences, or in other forms of professional-to-professional commmunication -- one of the initial reasons why "the internet" was established as an academic communication medium) does not reflect the most recent findings in the field, which will be discussed on this site as it appears. More thorough review and understanding of the research, as it has appeared since the time of Cloitre's reeearch, leads me to place a higher value than is consistent with a "second-line approach" on contextual and cognitive factors (such as mindfulness and, psychological flexibility). Naturally, I thus favour Acceptance and Commitment Therapy -- [LINK] as an approach to dealing with Complex Trauma. Certain elements of ACT are well researched, such as acceptance - the opposite of avoidance, mindfulness (especially the non-judgemental acceptance of private experiences such as feelings) -- [LINK], psychological flexibility, commitment to values, getting "unstuck" from past messages from others and from self ("self-stigma"), empathy, and especially self-compassion (Thompson & Waltz, 2008 -- [LINK]; Wei et al, 2011) -- [LINK]. Research considering these factors will be discussed in separate sections of this site.
Thus, the available treatments for Complex PTSD include:
Developments of behavioral methods -- especially cognitive restructuring (CBT) and Prolonged Exposure (PE)
Contextual treatments, especially including Mindfulness training -- such as Dialectical Behavior Therapy (DBT), and Acceptance and Commitment Therapy (ACT)
- Mindfulness-based therapies -- [LINK]
- Psychodynamic treatments, especially those based on "Mentalization"
- Sensorimotor / Sensory Integration, and other forms of "Body Work"';
- Experiential treatments -- such as "Accelerated Experiential Dynamic Psychotherapy"
- Internal Family Systems;
- Narrative Therapy; and, perhaps most commonly and importantly
combination of these and similar treatments, arranged in sequential phases or stages, with an initial focus on reducing hyper-reactivity, improving clients emotion regulation, and other forms of self regulation skills. "Co-morbid disorders" -- typically, Anxiety, Depression, Substance Use and Dependence are best integrated into a "trauma-informed" overall programme -- see my pages on Trauma Treatment Approach (essentials) here [LINK], and the linked audiovisual resources on my Anxiety Treatment [LINK], Depression Treatment [LINK] and other Therapy Resources pages e.g. [LINK] -- please search, a large array of materials are available. These commonly occurring disorders are often difficult, or "resistant to treatment", without addressing and dealing with underlying trauma symptomatology. (Incidentally, some might be tempted to ask: "Can ECT (Electroconvulsive Therapy) be used to treat this "treatment-resistant depression"? -- See my discussion of ECT [LINK])
I acknowledge there are numerous difficulties in carrying out and evaluating the use of "contextual therapies" such as ACT for PTSD / Complex Trauma, but the research has begun (Lang et al, 2012 -- [LINK]; Mulick, Landes & Kanter, 2011) -- [LINK}.
Elsewhere on this site -- [LINK], I provide guidelines for dealing with trauma experienced as an adult, which are adapted from those on the US Government's PTSD Factsheets, but I am adapting these to reflect the multi-problem nature of adult complex trauma of childhood origin and the latest research.
Additional information on this site about treatments for anxiety disorders [LINK]
For now may I recommend, consistent with the above advice, your trying out the following sites:
OTHER RESOURCES on the 'net, publications, audiovisual etcGift From Within -- [LINK]
-- An International Nonprofit Organization for Survivors of Trauma and Victimization
-- Comprehensive range of resources for recovery from a variety of forms of trauma;
some free resources, some for purchase.
Established in 1993 with the intention of giving trauma survivors, their loved ones and supporters a credible online website that was friendly and supportive:
- is a non-profit organization dedicated to those who suffer post-traumatic stress disorder (PTSD), those at risk for PTSD, and those who care for traumatized individuals.
- develops and disseminates educational material, including videotapes, articles, books, and other resources through its website
- maintains a roster of survivors who are willing to participate in an international network of peer support.
Help for Victims of Emotional Neglect -- in some ways, a central focus of this site,
see EmotionalNeglect.com [LINK]
- Hosted by Jonice Webb, Psychologist,
and author of Running on Empty: Overcome Your Childhood Emotional Neglect -- Blog and newsletter resources available.
SELF-HELP & RELATED THERAPY RESOURCES [LINK]
Please NOTE -- whilst patients might benefit from "self-guided" application of the above materials, I strongly encourage you to discuss your use of these materials with your treating therapist.
LOCAL / NEW ZEALAND SERVICES
SERVICES FOR MALE SURVIVORS -- I can no longer endorse the Male Survivors of Sexual Abuse Trust in Dunedin as a provider of services for male survivors -- see my post here [LINK] or here [LINK].
.I set up this website in memory of my late friend Wayne, victim of childhood physical abuse and repeated rape by his father. He died alone due to lack of appropriate support and safe policies and practices by MSSAT Dunedin. In your best interests I recommend NOT dealing with MSSAT Dunedin or MSSAT Christchurch, temporary custodians of MSSAT Dunedin.
However, he did report a great regard for services from MSSAT Auckland [LINK]
and I have had satisfactory dealings with MSSAT Waikato [LINK]Rape Prevention Education New Zealand - -- [link] to Rape Crisis Centres -- [link] -- also has links to services for those with "historical abuse and trauma" - childhood trauma and abuse, particularly sexual abuse -- a significant number of adult women subject to rape have also been abused as children, and most Rape Crisis Centres provide services for victims of "historical abuse" -- childhood abuse and trauma
Mental Health Peer Support services --- a variety of services are available throughout New Zealand. Such services may not specialise in victim issues, but they have support workers with their own stories of experiencing, and recovering, from some of the disorders most often experienced by victim survivors.
These services are discussed here [LINK]
Those who present with histories of having suffered childhood abuse, neglect, or trauma may present with a number of, perhaps related, conditions:
- anxiety disorders, including but not limited to, PostTraumatic Stress Disorder (PTSD)
- depressive and other mood disorders
- substance use disordeers
psychosis and schizophrenia (though there is some controversy in the research literature this, there does seem to be, for some individuals at least, a close connection between having suffered childhood adversity and adult psychotic symtoms, perhaps due to additional genetic factors -- see Middleton -- [LINK]
- physical disorders, of a variety of types
General trauma -- including PTSD is discussed here -- [LINK]
Complex Trauma Disorder -- [LINK]
Mood & Substance Use Disorders -- [LINK] -- still to be written -- but see comments in my early research proposal -- [LINK] -- and the local research by Kate Scott of Otago Univeersity, and related reseaarch by Shin et al -- [LINK]. It should be noted that even mild psychological disorder can have such severe effects, longterm, as reduced life expectancy -- [LINK]. Among the first prospective, community-based studies of the relationship between PTSD and adult substane use is that of Haller & Chassin (2012) -- still unpublished, and only recently "available" online -- [LINK] -- when I have had a chance to further review this study I shall report in more detail. In this study, results from path analyses indicated that PTSD symptoms directly influenced risk for adult drug problems, but PTSD symptoms only influenced risk for adult alcohol problems to the extent that PTSD symptoms increased early adult externalizing symptomatology. Early adult internalizing symptomatology did not significantly mediate the influence of PTSD on either adult alcohol or drug problems. These findings suggest that the association between PTSD and future drug problems may be best explained by a PTSD-specific self-medication mechanism, whereas the association between PTSD symptoms and future alcohol problems may be best explained by an increased propensity to engage in externalizing behaviors.
Physical Disorders -- still to be written -- but see other research Professor Scott has conducted, and note the chronic nature of the physical disorders suffered [LINK] -- and earlier research discussed briefly in my initial research proposal -- [LINK]
MORE GENERAL SOURCES OF INFORMATION ON DEALING WITH CHILDHOOD TRAUMA
- the Survivor-to-Thriver manual of the Adult Survivors of Child Abuse ASCA network -- [link]
Resources in the areas of "acceptance" and "defusion" skills, especially those related to mindfulness, fusion/defusion, and values clarification / committed action towards those values:
- ACT Made Simple -- Introduction to Acceptance and Ccmmitment Therapy -- [LINK]
more indepth details on ACT with links to additional resources -- the clinical research literature suggests interventions targeting experiential avoidance and defusion from prior traumatic experiences would be important ACT interventions for recovery from childhood trauma, though this has yet to be tested in research. Recent, but still unpublished, research by Morton, Snowdon, Gopold, and Guymer (Cognitive and Behavioral Practice) -- [LINK] -- has demonstrated that patients with Borderline Personality Disorder (BPD) -- many of whom have histories of childhood abuse -- Lewis & Grenyer [LINK] -- benefit from treatment focusing on psychological flexibility, emotion regulation skills, and mindfulness, produced reductions in BPD symptoms, hopelessness, and anxiety. But as noted by Lewis and Grenyer (2009), not all patients with BPD have Complex Trauma, and whether or not outcomes could be further improved, through incorporating Defusion Skills Training, with patients with Complex Trauma (the subject of my initial research proposal) remains to be explored. There has been a suggestion that the relationship between BPD and PTSD can be explained more clearly if one considers the possibility (still unresearched) that patients with BPD suffer from a dissociative subtype of PTSD, and the long unappreciated broad range of attachment difficulties that can be traumatic, as well as the developmental effects of early trauma discussed by van der Kolk.
- ACT-for-the-Public online discussion list -- [LINK]
- alternative approach to "defusion" -- Tapping -- [LINK]
- Video materials by Fisher, and Klagsbrun -- [LINK]
THERAPY -- AUDIOVISUAL RESOURCES -- video, audio, articles -- [LINK]
Important projects for this site will be brief reports discussing the topics listed, but not detailed above (Mood and Substance Use Disorders; and Physical Disorders), and in particular the development of a table reviewing specific and non-specific treatment factors of likely relevance in the treatment of Complex Trauma. By specific factors, I mean relevant types of treatment (ACT, Cognitive Processing Therapy, in particular). By non-specific factors I mean such "process" factors as those aspects pertaining particularly to therapist-client relationship characteristics -- some of these factors are mentioned in the videos listed here -- [LINK}.
These videos are available via professional-to-professional communication --
please contact me -- [LINK].