Introduction
Life is a series of situations, which comprise gains, losses, crises, and sometimes trauma. Some crises are expected, but in most cases, they come as a surprise. Apparently, crises are inevitable, but every time individuals encounter a crisis, they acquire skills to take control of the situation. By being persistent, people discover means to deal with crises and in the future, the problem becomes easy to resolve.
At times, individuals encounter problems beyond their capability to cope and even support system from other people may not work too (Malia, 2007). This scenario describes a crisis, which can be developmental or situational, and it may lead to trauma. Therefore, trauma is the encounter to multiple depressing scenarios with long-term effects.
In addition, trauma can be referred to an overwhelming situation beyond someone’s capability to contain. Sexual abuse instills shame in the victim, thus causing trauma. Sexually abused children are often too naïve and young to talk about their predicament or look out for assistance. Sexual trauma affects not only the victims and their family, but also the entire society.
Traumatic experiences can result in physical, psychological, and spiritual wounds. Trauma and sexuality is a controversial topic since the early days of psychoanalysis. However, the advances made about this topic are important as they articulate psychotherapeutic establishments, which are necessary to deal with issues of trauma (Bisson & Cohen, 2006, p. 585)).
A number of theories have been developed to help in understanding how people develop and react to crises during their life span. Developmental theories by Freud, Erikson, and Piaget alongside the Maslow’s hierarchy of needs articulate human development and motivation. During early stages of growth in children, parental warmth is needed to help the child to gain self-esteem.
This sense of self-worth buffers the child from early traumatic events. According to Hastings (2010), children’s close relationships with their parents help them to learn adaptive skills to traumatic events. In addition, mentorship programs are necessary for the child.
Theoretical and Practical Elements of Trauma
The defining elements of sexual abuse may differ across different societies and nationalities. The Incest Survivors Network qualifies erotic use of a child, be it physically or emotional, as sexual exploitation. Mostly, children experience sexual abuse from family members or in the hands of a trusted adult.
Sexual abuse affects both children and adults regardless of socio-economic, ethnic, religious, educational, and regional affiliations. The most prevalent result of sexual abuse is post-traumatic stress disorder (PTSD).
PTSD arises when events overwhelm one’s capacity to cope and it may result in emotional and physical responses (Becker-Blease & Freyd, 2005). Physical reactions may involve increased heart rate, trembling, dizziness, or loosening of the urethra muscles, thus allowing uncontrolled urine passage.
The impact of sexual abuse on children can change their perceptions about sexual behavior and influence their judgment in having intimate relationships. This scenario may degenerate into early sexual engagements, high number of sexual partners, and risk of sexual violence (Weiss, 2004).
It can also lead to changes in cognitive behavior. Bad performances and low concentration levels may be witnessed in schools. Dissociation with other peers and withdrawal from normal engagements may also occur.
Nature, Causes, and Results of Trauma
Traumatic events are of different nature and magnitudes depending on the victim’s age, gender, and the capacity to cope. Physical abuse, emotional abuse, psychological maltreatment, exposure to natural disasters such as floods, and the bereavement by loved ones may result in toxic stress responses. The ability of a child to bounce back to normality after a traumatic event is uncommon.
Few children, who have close relations with their parents, are in a position to come out of this situation independently. Those who develop self-esteem during early childhood development are willing to talk about their issues. Many children, who are unwilling to talk about their traumatic experiences, acquire profound long-term effects.
Perennial occurrence of traumatic cases can result in “brain disorders, difficulties in peer and family relations, risk behavior and health disorders” (Zeuthen & Hagelskjaer, 2013, p. 749).
For example, a sexually abused child is mentally aware that he/she is living the present time and place, but the body acts as if it were still in the days of assault. This situation of living the present and experiencing the past is highly harmful to the health and wellbeing of the victim.
Children’s responses to traumatic conditions vary. Not all children show symptoms of traumatic stress despite being exposed to traumatic experiences. The children’s developmental stage and age are determining factors.
At an advanced age of development and with the right support from a caregiver, a child may be in a position to fathom some of the crises. According to Kaplow, Dodge, Amaya-Jackson, and Saxe (2009), mental and emotional strength determines the extent to which a child can cope with traumatic conditions.
The disparate degrees of traumatic cases include
- Acute trauma, which “is a single traumatic event, which occurs within a limited time span, such as a bomb blast, suicide, or an earthquake among other natural disasters” (Weiss, 2004, p. 46).
- Chronic trauma refers to “recurring assaults to a person’s mind and body such as sexual abuse, family violence, or physical abuse” (Weiss, 2004, p. 46).
- Complex trauma happens when a child feels betrayed by those who are supposed to be caring. Exposure to chronic trauma often comes from parents or those trusted to care, support, and protect the child.
In most cases, children re-experience the depressing and disturbing feelings, which are associated with previous situations, if they come across or remember anything regarding the same.
Due to complex traumas, children may develop psychiatric conditions characterized by re-experiencing the event through flashbacks and nightmares for undefined period of time, decreased attention and mood changes, social disengagement, and peer difficulties.
Types of Trauma
As aforementioned, trauma comes in different types and forms, but focus is geared towards trauma experiences based on sex abuse on children and the implications on the family.
Complex trauma – in most cases it occurs when sexual abuse or assault is involved. Sexual abuse refers to the situation where the perpetrator is a family member or in a caretaking role of the victim.
Sexual assault or rape is the situation whereby sexual contact or exposure to sex is executed under the watch of other people, viz. non-caretakers. Both actual and attempted sexual contact involving penetration, fondling, and exposure to phonographic material or witnessing sexual activity can cause complex trauma. Sexual exploitation of a minor by an adult to get money may also be traumatizing.
Therefore, complex trauma is long lived especially when the child is not given immediate attention to address the issue (Barrera, Calderon & Bell, 2013). Since children are very sensitive to trauma caused by their caregivers, parents should stay close and engage them in talks concerning life expectations.
Guiding Principles for Trauma- Informed Practice
Trauma-informed workforce is trained to address several challenges that traumatize children and their families. Skilled workforce aims at eliminating the loopholes that undermine the successful healing of traumatized and stressed people and it focuses on the key elements of trust, safety, choice, and self-empowerment. The following principles are necessary when dealing with trauma stress.
- General assumption is made that everybody who receives services has previously experienced trauma either directly or indirectly
- The application of knowledge from trauma-informed model in every possible situation, with a goal of minimizing the impact of previous trauma and avoiding it in the future
- Ensuring frequent checks on traumatic stress symptoms from early stages of development and master coping methods that work for different people
- Referring and assisting families to gaining appropriate treatment
- Combining efforts with all those involved with the patient coupled with using the available science and medical skills to effect and support the recovering process of the patient
- Engaging in the available pre-service and in-service trauma training to gain skills to reduce negative impacts of developed traumatic stress
Factors Necessary for Successfully Coping with Trauma
After a trauma, people go through a wide range of normal reactions. Such reactions may be affect the people who experienced the trauma together with those that heard about it or are involved indirectly (Connor, 2006). These normal reactions to abnormal events can at times appear unrelated.
Some of these physical responses include changes in sleep patterns, becoming vulnerable to diseases, alcohol and drug abuse, and sense of fear to unexpected touch. Emotional reactions may involve restlessness, flashbacks, feeling out of control, nightmares, disorientation, sense of denial, urge for revenge, suicidal thoughts, and concern over burdening others with problems.
People adopt different helpful coping strategies to the aforementioned traumatic reactions such as mobilizing a support system. This approach involves reaching out and connecting with others, especially those who may have had similar experience or shared the stressful event. This aspect provides a platform for people to speak out their problems.
Through the support system, individuals know what other people experienced, how they managed to get over the issue, and how they are coping with the situation currently (Landau, Mittal, & Wieling, 2008). This aspect helps the victim to borrow ideas and find the best way to get out of the situation.
Enhancing the child’s wellbeing by ensuring that they feel safe and loved is critical. This aspect leaves the child with high expectations in life and it facilitates positive responses after traumatic events. Children who feel physically and psychologically safe create adaptive measures to expected traumas. In most times, traumatic events create emotions and most people get to their breaking points, and thus they resort to crying.
Crying is therapeutic, as it makes people feel relieved and ready to move on even when nothing has changed. When children are sexually offended, they tend to cover the issue by pretending that they are fine. Caregivers around these children should give them space and let them cry. However crying may not work for everybody, but to some, it is assuaging.
Prayer, meditation, and spiritual guidance are important during tempting times. For those who believe in divine works, they can choose to visit their spiritual leaders for advice. Alternatively, they can engage in prayer, which helps the mind to redirect thoughts to positive activities and forget the traumatic events.
Doing exercises like jogging, yoga, or walking helps the mind to relax and forget the past events. In addition, committing oneself to something meaningful every day helps by distracting the mind from the painful experiences.
Maintaining a balanced diet and keeping uniform sleep cycles also play a central role in dealing with trauma. For example, if a child encounters traumatic events, it is advisable to let him/her play, walk, or have lonely relaxing moments. Parents should identify what works for their children for different situations.
Reactions to trauma may last longer than predicted. For the affected people, it may take varying durations extending from days to years for one regain balance. Expectations from support systems and family may push people to come into terms with the situation before the healing process matures. However, those that manage to heal naturally also create greater capacity to experience joy and self-awareness than ever before.
Spiritual and Professional Approaches to Treatment
According to Wright (2011), when people face difficult situations, they seek help from the clergymen and they pray to God for guidance.
In a bid to understand the role of spirituality in healing traumatic events, one has to understand the “relationship amongst trauma, spirituality, and recovery and how psychotherapists view the role of spirituality in their clients coupled with how spirituality can be linked with psychotherapeutic measures” (Bisson & Cohen. Some spiritual beliefs deny or criticize medical health approaches.
Personal discomfort amounts when prayers, as means of asking God’s intercession, are delayed. The association of traumatic events with the devil turns out to be highly stressing. Some spiritual people relate distress to spiritual lacking, and thus they encourage others to pray consistently and attend religious services regularly. Spirituality emphasizes that traumatized people should avoid negative thinking.
Praying has the power to normalize reactions and bring emotional comfort. Belief in supernatural powers, which are perceived to be in control, brings relief to traumatic happenings. Associating with fellow believers, clergy, and helping the community can result in blessings from a perceived tragedy.
Spiritual guidance by practicing and advocating what the Bible, the Koran, and other religious books give the capacity to cope with stress. Those who lack spirituality cannot understand why bad things happen to them, but the spiritually rich ask God how to respond to what has happened.
Psychotherapists have to understand that a lot of stress can cause people to turn to spirituality as a way of coping (Wright, 2011). Other people may abandon their religious beliefs if they feel that they are not strong enough to turn around their current situations.
Psychotherapists have to find the balance between the traumatic condition and the spiritual engagements of the client. The psychotherapist should appreciate and articulate the client’s views and beliefs in the counselling process.
Spiritual healing activities include the use of prayer, studying scriptures, and engaging other spiritually related activities. Believing and trusting in divine power help people to refrain from analyzing issues that appear complex at the time. Those who endure suffering come out stronger spiritually and more equipped to conquer bigger challenges than before.
It is normal for people to turn to God and pray in times of difficulties. When people face traumatizing events, they create the belief that God is testing their faith, and thus He cannot test them past their capabilities.
When they survive the situations, they tend to feel strengthened and ready for big challenges. Clergymen act as intercessors when people feel weak and in need of comfort in life.
Professional Approaches
Therapy has been identified as an effective approach in the treatment of post-traumatic stress disorders. However, some forms of therapy are executable since trauma comes on different forms and magnitudes. Therapy can help the trauma victims to create new coping skills associated with their symptoms.
This aspect involves letting the person to learn the symptoms and issues related to the type of trauma the trauma experienced. Other cases compel the victim to face the situation, accept it, and deal with the underlying issues. This aspect might involve telling the story many times or letting the body dispose any held energy.
Alexander (2005) argues that in a bid to have successful traumatic healing, one has to undergo early mental health intervention after disasters to ensure dispel any symptoms of mental dysfunction. Bisson and Cohen (2006) advise the traumatized people to establish immediate interventions in a bid to curb adverse post-traumatic stress.
When conducting trauma therapy, the recommended principles include achieving patient’s sense of security and increasing competencies. According to Hoff, Hallisey, and Hoff (2011), this stage is the building phase and therapists can borrow from any evidence-based therapy that leads to increasing coping capability.
In addition, it helps the victims to come to terms with their current situation, move out of the crisis, and prepare for the next stage. Reviewing the trauma memories is the next phase and different approaches can be employed. Someone’s ability to tolerate the distress of revisiting bad memories is crucial to passing this phase. People with complex trauma may take long to adjust and process their trauma.
The final stage involves putting together the benefits. Therapists assist the victims to apply the acquired skills and the gained adaptive experiences. According to Joyce (2007), psychoanalytic approach helps clients to revisit their trauma. Revisiting confirms to the victim that the trauma happened.
Secondly, reenacting helps the victim to learn and articulate a situation, which was once an experience beyond control. Finally, the client is in a position to deal with the situation with renewed energy and positive approach.
Anxiety management skills are needed in cases where the victim lacks essential skills to manage the situation. Therapists teach their clients key anxiety-diminution techniques. Anxiety management is employed especially in cases of sexually abused children. Supportive guidance and counselling has significant relief for clients of post-traumatic stress disorders.
Trauma screening involves the assessment of the client to check evidence of depressing post trauma symptoms and general mental health. It determines possible dangers, thus calling for quick response coupled with deciding the need for mental health referral.
Trauma assessment involves a “comprehensive evaluation to determine the presence of clinical symptoms of trauma by a trained mental health officer” (Zoellner & Maercker, 2006, p. 631). This model looks at the history of the client’s traumatic experiences through data collection. Data obtained from interviewing the client, caregivers, and other close informants is compiled and measures are administered accordingly.
Conclusion
Different approaches to treatment are currently used in trauma therapy. Several models of treatment are available for victims of trauma. However, individuals should adopt the treatment models that suit their cases for optimal intervention. Stage-oriented models come out as the most appropriate since they demonstrate a major overlap and therapists can employ them to achieve favorable results.
Spiritual approaches to healing trauma have gained momentum since most people hold their trust to the existence of divine powers. People believe in healing and they trust God to intercede at times of difficulties. However, religious institutions should not restrict their followers from seeking professional therapeutic measures if they want.
Extensive study to establish new treatment approaches is necessary to match the current needs of the present and future generations. The current treatment models are still relevant, but they have to be integrated with new models to have a highly rationalized model. Advocating the adoption of trauma informed practices is essential since it creates awareness about impacts of trauma coupled with how to prepare to face trauma.
References
Alexander, D. (2005).Early mental health intervention after disasters. Advances in Psychiatric Treatment, 11(3), 12‐18.
Barrera, M., Calderon., & Bell, V. (2013). The cognitive impact of sexual abuse and PTSD in children: a neuropsychological study. Journal of Child Sexual Abuse, 22(6), 625-638.
Becker‐Blease, A., & Freyd, J. (2005). Beyond PTSD: An evolving relationship between trauma theory and family violence research. Journal of Interpersonal Violence, 20(4), 403‐411.
Bisson, I., & Cohen, A. (2006). Disseminating early interventions following trauma. Journal of Traumatic Stress, 19(6), 583‐596.
Connor, M. (2006). Assessment of resilience in the aftermath of trauma. Journal of Clinical Psychiatry, 67(8), 46‐49.
Hastings, C. (2010). Implementing Evidence-Based Practice: effectiveness of a structured Multifaceted Mentorship Program. Journal of Advanced Nursing, 66(12), pp. 2761-2771.
Hoff, A., Hallisey, J., & Hoff, M. (2011). People in crisis: Clinical and diversity perspectives. New York, NY: Taylor & Francis
Joyce, P. (2007). The Production of Therapy: The Social Process of Construction of the Mother of a Sexually Abused Child. Journal of Child Sexual Abuse, 16(3), 1-18.
Kaplow, J., Dodge, K., Amaya-Jackson, L., & Saxe, G. (2005). Pathways to PTSD, Part II: Sexually Abused Children. American Journal of Psychiatry, 162(7), 1305-1310.
Landau, J., Mittal, M., & Wieling, E. (2008). Linking human systems: Strengthening individuals, families, and communities in the wake of mass trauma. Journal of Marital & Family Therapy, 34(7), 193‐209.
Malia, A. (2007). A Reader’s Guide to Family Stress Literature. Journal of Loss and Trauma, 12(4), 223‐243.
Weiss, D., & Vern, L. (2004). Adolescent American Sex. Journal of Psychology & Human Sexuality, 16(3), 43–53.
Wright, H. (2011). The complete guide to crisis and trauma counseling: What to do and say when it matters most. Ventura, CA: Regal.
Zeuthen, K., & Hagelskjaer, M. (2013). Prevention of child sexual abuse: analysis and discussion of the field. Journal of Child Sexual Abuse, 22(6), 742-760.
Zoellner, T., & Maercker, A. (2006). Posttraumatic growth in clinical psychology‐‐A critical review and introduction of a two-component model. Clinical Psychology Review, 26(5), 626‐653.