Trauma

Traumas are normal stress reactions to abnormal circumstances. The subsequent effects of trauma comes in different forms for different people as trauma interacts with our individual biological, sociological and psychology makeup. Just as how the effects of trauma differ from person to person, the best method of treatment varies according to individual mental state and personality. Some might find certain methods too emotionally overwhelming. Thus, there is a need to choose the method which you personally can relate to the most. 

Sexual abuse

Sex is not just about having sexual intercourse but it consists of the full spectrum of physical intimacy with another just like how sexual abuse does not just refer to sexual intercourse only. Our body is ours to give and to have it taken from us without our consent is a violation of personal boundaries. 

 Violation of sexual boundaries can come in many forms:

• Sexual Harassment refers to coaxing done in order to have sexual activities without mutual interest from both parties
• Molest refers to a violation of physical boundary by inappropriate sexual touching 
• Sexual Abuse refers to a systematic and ritualistic manner of acting sexually towards an unwilling person of less power i.e. someone with less physical strength, underdeveloped maturity or of lower status  

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What affects the magnitude of trauma? 

Age Period

The younger the age where sexual violations are first encountered, the more enduring and pervasive the effect of the trauma. This is due to the inability of the brain and mind, which has not yet fully developed, to actually process the trauma experienced.

Frequency

This does not just refer to the actual actions of sexual violations but also encompasses the psychological overstepping of boundaries as well. Being in the presence of the perpetrator without further sexual violations taking place can trigger the same reactions as the act of violations themselves due to the similar neural firing processes that are activated in our brains. 

People involved

Typically, the perpetrator is someone the victim knows, trusts, or who has an authority over them. Such a relationship between the perpetrator and victim has a significant impact on how the victim subsequently perceives relationships and themselves as well as the world in general. Furthermore, anybody involved in the violations are considered perpetrators as they had empowered the primary perpetrator to commit the abuse with either their actions or inaction. 

Protective factors:

– Internal

Inner resources such as creativity, intelligence, confidence and courage and even having a good autographic memory can help us integrate our experiences better. As our traumatic memories are usually fragmented, having strong inner resources allows us to piece those memories together to form a coherent narrative and promote faster healing. Focusing on these strong points also helps the victims see themselves as being more than just their trauma. 

Healthy and strong attachment figures such as our parents and caregivers lay the foundation in how we attach to other people later on in life. They provide a sense of safety and security and help us feel okay when we are plagued by trauma and keeps us feeling protected in a safe space. 

– External

External resources such as the availability of a strong healthcare system with ample educational opportunities and sufficient financial resources are also important in minimizing the effects of trauma.

(Learn more about psychodynamic theory).

Effects of trauma

Physical

Trauma often leads to repressed emotions within the victim which can induce somatic complaints such as headaches or body aches. Trauma can also result in frigidity, a common sexual dysfunction in women that is rooted in sexual anxiety and trauma response. 

Self-identity

The pervasive effect of trauma can strip away external sources of validation by others and bring about identity disturbances in victims. As a result, victims may see themselves as unattractive or disgusting and contact with others may be avoided to protect against an expected rejection. 

Relational

The experience of having been betrayed by the perpetrator may override previous positive encounters and becomes the impression that we hold at the forefront when we imagine further interactions with other people. This inevitably influences the way we perceive people as well as our ability to trust others, hence affecting our relational intimacy. 

Flashbacks, fragmented memories

During the occurrence of a trauma, our mind may shut down as a means of protection. This shutdown is meant to protect the victim from the unbearable emotional and physical pain. While in this state of drifting in and out of consciousness, memories can be fragmented and even totally repressed. Victims experience flashbacks after the trauma event in order to piece together a coherent narrative of what happened in an attempt to assist the healing process. This intrapsychic process is intrinsic in our human psychological make-up. It occurs beyond the victim conscious will.  

Why is it so hard to talk about sexual abuse?

Secrecy & Shame

When the perpetrator is someone close to the victim, such as a relative or family member, the victim may choose to not disclose about the abuse for fear of nobody believing them or be supportive of them. They may feel a need to protect family members from the emotional hurt of knowing the violation which can cause the relationship of the family to break apart. Paradoxically, this secrecy weakens the cohesiveness of the family due to severe tensions and animosity between the perpetrator and victim which the other family members are not aware of. Relationships with unaware family members can be adversely affected since the victim does not feel safe enough to rely on family, resulting in emotional distancing. Furthermore, the impact of the violation on the victim does not diminish under the veil of secrecy and shame. More often, the impact is magnified. 

Re-traumatisation

Victims may also choose not to disclose about their sexual abuse as the experience of the trauma may re-surface and they will be forced to relive the painful experience. It is of great importance to deliberate carefully about how the veil of secrecy of the sex abuse should be lifted in order to allow healing and not re-traumatisation to take place. 

Power & Control

In sex abuse, there is usually a case of power imbalance between the perpetrator and the victim as the perpetrator is usually the one with a higher power. Sex abuse is then used as a means for them to assert that power and control over the victims. Knowing your legal rights and options can empower you in reclaiming personal power which contributes greatly to rebuilding your sense of self especially if the perpetrator is a powerful figure.

Types of therapy

Body-based psychotherapy

Focuses on resolving trauma through working with the connection between our bodies and our mind.

• Sensorimotor psychotherapy

• Somatic experiencing

Body Works

Adjunctive practices that are helpful in building and repairing damages in parts of our brains that are involved in regulation of the body.

• Therapeutic massages

• Yoga

Creative psychotherapy

Therapy that involves expression of the self without a need to actually verbalize the individual’s inner experience

• Drama, dance & drumming

Brain-based therapy

Focuses on rewiring our brain directly to alter it from a traumatized brain to that of a non-traumatized brain. 

• Neurofeedback helps participants become aware of their brain activities via tracking of brainwaves which allows participants to learn to alter and control their brainwaves.
• EMDR (Eye movement desensitization and reprocessing) guides participants to alternate eye movements while in conversations to regulate distressing emotions. 
• Mindfulness practice or meditation teaches focus on breathing and being present to rewire the neural pathways in the brain.

Cognitive therapy

Involves restructuring of the unhelpful beliefs and thinking patterns to those that are more adaptive to current living. (Read more about cognitive behaviour therapy, a combination of cognitive and behavioural therapeutic approaches).

Attachment focused therapy

Draws theories from the body of psychodynamic psychology. Therapists who conduct attachment focused therapy guide clients towards an understanding of their attachment styles and how to meet their attachment needs. 

Medication

May be necessary in bringing victims to a suitable level of functioning before therapy can have any notable effect. Also, it is important to look for a psychiatrist that you can connect with as the treatment prescribed is closely linked to your experience when seeing the psychiatrist.

Therapy Processes 

Establish safe environment 

The first step in therapy is to create a safe environment which essentially lays the foundation for therapy and allows the discussion of vulnerable issues to be conducted effectively. 

Keep within ‘Window of Tolerance’

It is common to feel dysregulated and experience heightened emotions when talking about trauma. Having the understanding with your therapist about what stabilizing methods to use before talking about the trauma itself is important. 

Encourage interoception

Interoception is awareness of the inside of one’s body. Therapy methods which encourage body interoception builds resilience as clients are empowered to regulate their body and create a stronger sense of self.  

Strength-based approach

Strength-based approach helps to increase awareness of our  internal resources such as affirmative values and personality traits. Harnessing on these strengths equip us to deal with the challenging aspects of trauma more effectively.

Work with repressed memories & dissociations

It is natural for victims to repress their painful memories. Victims may not wish to be reminded of painful memories. Nevertheless, during the early phase of therapy, it is necessary for therapists to assess the extent of repressed and dissociated traumatic memories in order to gauge the frequency and pace of therapy with the clients and devise therapeutic strategies towards full recovery from trauma. 

Recommended Readings

The Body Keeps Score

This book by Dr Bessel Van Der Kolk provides a wealth of knowledge on the different subject matters mentioned earlier pertaining to trauma specifically. 

The Courage to Heal

Another book that more specifically delves into the topic of recovering from sex trauma. 

Q&A

How can we help victims of sexual abuse recognise that it wasn’t their fault?

Victims self blame because they feel that maybe in one way or another by saying or doing something differently, they could have prevented the incident. This is done with the intent of regaining control such that in the event the same situation occurs, they can carry themselves out of that difficult situation. However, self-blaming incurs strong negative emotions towards oneself. A better way would be to practice self-compassion and then develop and review preventative measures for the future. 

How do we deal with blame and shame?

Adding on from what was discussed earlier about blame, shame is rooted in the belief that you are inherently wrong and flawed. When something bad happens to us, thinking that it happened due to something we lacked or that we are inherently not good stirs shame feelings. Fortunately, beliefs are amendable. So choose helpful beliefs that serve to uplift us and not work against us. An example of one such helpful belief would be to develop the realization and understanding that the person who should carry the burden of the wrongdoing done on us should not be us but the perpetrator. Nothing could have changed the situation since we weren’t the direct cause of it. 

How do we make the flashbacks go away?

As previously mentioned, flashbacks are an involuntary way of integrating information into a coherent narrative to aid in the healing process which is the ultimate goal of therapy. In the journey of recovery, it is recommended to start off with brain-based therapy such as neurofeedback and EMDR and also body based therapy such as somatic experiencing.