A new therapy helps survivors improve their lives by facing the psychological impoverishment that often accompanies abuse
Steven N Gold is a professor at Nova Southeastern University (NSU) Center for Psychological Studies in Fort Lauderdale, Florida. He founded and serves as director of the Trauma Resolution Integration Program (TRIP) at NSU’s Psychology Services Center. His forthcoming book is Contextual Trauma Therapy: Overcoming Traumatization and Reaching Full Potential(2020). Listen here
Edited by Pam Weintraub
As a psychologist in private practice during the early 1980s, I began to establish a specialty in treating survivors of longterm child abuse. One regular source of clients was an agency that helped individuals with a work history hampered by medical or psychological impairments. Some of these people were later authorised to enter therapy with me, but my initial charge was to conduct a comprehensive psychological evaluation with each of them, at the core of which was a detailed interview covering their life history from childhood onward.
I found the preponderance of these clients’ accounts astounding and disturbing. Although varied in detail, they consistently diverged from the prevailing assumptions about what childhood was like for most. One person was accorded ‘independence’ at age four to wander the big city streets unaccompanied by an adult. Another learned toothbrushing for the first time as an early teenager, after escaping from their parental home to live with much older intravenous-drug addicts. Yet another created a ‘game’ called ‘picnic’, supplying the blanket while friends provided the food – that way surreptitiously satisfying the hunger frequently caused by parents who ate first, allotting their child only leftover scraps. Some clients had almost no friends at all because their households were so chaotic and conflict-ridden that they were too embarrassed to let other children enter and see how their families behaved.
It’s crucial to understand that these experiences are not instances of trauma. They do, however, illustrate the circumstances that, with remarkable frequency, accompany another phenomenon called prolonged child abuse (PCA) trauma: growing up in a household where many of the most fundamental conditions needed for adaptive child development are sorely lacking.
As an undergraduate majoring in psychology, my primary faculty mentors had been researchers in developmental psychology, the study of how people grow in competence and complexity through the lifespan. Therefore, what stood out to me was that the psychologically impoverished circumstances conveyed in the assessment interviews – and the relative absence of more salutary ones – were in large part responsible for these clients’ psychological problems and their work limitations. Although I recognised the alarming instances of traumatic child abuse depicted by my clients – beatings, sexual molestation, humiliating treatment – I saw them as ‘landmarks’ within a broader terrain of developmental deprivation and hardship. I came to see incidents of overt abuse as particularly dramatic moments embedded in a broader, unrelentingly detrimental developmental narrative.
It might come as a surprise to many in 2020 but, prior to 1980, the notion that traumatic experience alone could be a major source of psychological difficulty was barely recognised. This state of affairs began to shift in 1980 with the publication of the third edition of the DSM (the Diagnostic and Statistical Manual of Mental Disorders, the standard volume of psychiatric classifications in the United States), in which the diagnosis of post-traumatic stress disorder (PTSD) first appeared. But recognition was far from immediate. At first, awareness of trauma was siloed into separate types of overwhelming events, such as ‘delayed stress response syndromes in Vietnam veterans’, ‘rape trauma syndrome’ and ‘battered woman syndrome’. It became clear that these distinct events could lead to essentially identical psychological consequences only after the effects appeared under the designation ‘PTSD’ in the DSM.
Increased awareness of PTSD illuminated the plight of my PCA clients, a group whose unsettling histories of deprivation were punctuated by heightened incidents of abuse. My clients had two things working against them. First was abuse trauma, consisting of experiences damaging to psychological adjustment. Second was the surrounding context of deprivation – lack of the affection, attention, structure and guidance supportive of psychological development. The dramatic nature of trauma readily captures the attention of observers. The much more subtle (but absolutely detrimental) effects of developmental deprivation are not as easily noticed.
In 1990, after several years’ experience working with trauma survivors in private practice, I established a treatment and research training clinic, the Trauma Resolution and Integration Program (TRIP) at Nova Southern University in Florida, staffed entirely by doctoral-level psychology trainees. Although we serve survivors of all forms of trauma, the vast majority of individuals seeking services at TRIP, in addition to other traumas they might have experienced, report a history of PCA…