Secondary Wounding When the aftermath of a trauma becomes worse than the event

Transcription

1 Secondary Wounding When the aftermath of a trauma becomes worse than the event What You Will Learn What is Secondary Wounding? How does it show up in the therapy room? What are its impacts on families and trauma care? Special Considerations That s Ok/That s Not Ok Activity How you can help What is Secondary Wounding? The process by which a person experiences a sense of blame, minimization, and expectations about their traumatic experience from trusted individuals in their lives. At its core, secondary wounding occurs when support people (or others) make comments or ask questions that create a sense of doubt, blame, hurt, or minimize, devalue, and invalidate a person s experience. The pain of secondary wounding in a trauma situation can cause long lasting effects that may feel even more painful than the traumatic event. 1

2 Secondary wounding also Is not only a minimization of a victim s pain, but becomes an attack on character, on integrity, and ultimately on self- worth. Has the potential to feed the private logic a person develops around the event, creating not just a perception about the event, but an entire belief system. Some examples Next time maybe you ll remember to wear your seatbelt. It really isn t as bad as you think You ve always been dramatic. How does it show up in the therapy room for Adults? Anger Estrangement Betrayal Disconnection Self-Doubt Isolation Distrust Paranoia/ Suspicion 2

3 How does it show up in the therapy room for Children? Fear Distrust Disconnect Private logic with themes of self-blame, guilt, I m stupid, fault (self-secondary wounding to be discussed) Desperate search for approval from all adults Overcompensation Perfectionism Obsessions and Compulsions How Secondary Wounding Affects Families Destabilization Family is even more shaken up and even start blaming each other Guilt Most secondary wounding that occurs is not intentional, but guilt still erupts. Shame Internal logic that they are unfit parents, caregivers, or supports. Anger - Victim may harbor resentment temporarily. Impacts on Trauma Recovery Estrangement Integral part of trauma narrative Distrust Extended recovery time 3

4 What Can We Do? Psychoeducation - One of the most helpful measures a clinician can take to ease the perceptions that come about from secondary wounding is to share the following information: Definition and examples of SW It is rarely intentional It is not irreparable Help to normalize and relieve guilt the family may be experiencing by indicating that they didn t know what they didn t know What Can We Do? Family Support Sessions/Therapy supportive adjunct family sessions to review secondary wounding as a family unit facilitate a communicative process that allows for apologies, forgiveness, and understanding if difficulty continues, move to Family Therapy (Contextual Family Therapy is ideal) What Can We Do? Individual Strengthening Interventions Selfcompassion, distress tolerance, mindfulness 4

5 Some Favorite Activities That s Ok, That s Not Ok Wish Poem Therapeutic Writing To Be A Child Again Wish Poem to Parents By John Fox Ages: 8 and up Materials: Pen and Paper Purpose: To convey a message without blame, to creatively reframe experience of secondary wounding, to express a survivor s wish to hear something from a parent/caregiver/friend that survivor did not To Be a Child Again By Lora Lee Ages: For parents with children ages 2 to 6 Materials: Dry beans, oversize shirt, dishes, crayons, paper Purpose: To help parents tune into child perceptions and perspectives, to create empathy, to provide perspective on a child s experience of the world 5

6 Mitigating Factors Secondary Wounding can also make space for opportunities of bonding, closeness, and healing. Families who navigate this situation well are noted to have a wide range of system resiliency factors such as: fairly healthy existing interpersonal relationships with each other, a method of overall respectful communication, a desire to remain close, connected, interested, and engaged with one another. Caveats to Healing When Secondary Wounding is actually abusive, controlling, or even intentional. Verbal or emotional abuse already occurring in the family system Lack of family recognition or desire to understand Secondary Wounding Victims may feel unheard and unsupported Cultural considerations Family Resilience Concurrently offer TLC s Resiliency Program 6

7 Self-Secondary Wounding When secondary wounding turns inward What is Self-Secondary Wounding? By Cherie Spehar A working definition: Self Secondary Wounding is the PROCESS by which a victim applies a disparate meaning to her role in the trauma experience through self-blame Far more intensive than simple negative selftalk. Complex extension of the private logic they may have developed as a child It s my fault..it s my hopeless prayer.. ~37 year old woman, victim of domestic violence 7

8 SELF-SECONDARY WOUNDING Can happen with or without primary secondary wounding Prior low self-esteem victims seem at higher risk Affects identity as a survivor Impairs ability to thrive Impacts trauma healing Does occur in children we will see it in private logic Generally more pervasive in adults why? Complications of Self-Secondary Wounding Low self-worth Altered internal identity Fear of trying new things Hopelessness Enter and perpetuate a Trance of Unworthiness (Brach, 2012) fear of deficiency and separateness How does Self-Secondary Wounding affect the trauma healing process? Interrupts the structured component of the Trauma Intervention Program. Absorption in thoughts and feelings of worthlessness, intense feelings of self-hatred, shame, and self-disappointment. Temporarily, the wounding becomes the trauma source, and therefore needs a specialized kind of attention. 8

9 How to Help Planned Pause in the TLC Structured Sensory Program in order to focus on this area of concern. Drawing Include a component of drawings specifically related to Self-Secondary Wounding. Internal Family Systems Therapy Gentle, Strengths-based, making friends with parts of self. Therapeutic Writing and Journal Therapy Visual Journaling Mindful Self Compassion Skills Journal Therapy Dialogue Letters Between Now Self and Then Self Between self when trauma happened, and current self Between/among parts Between trauma and Self Forgiveness Letters Forgiving self for unhealthy coping strategies (e.g. self-harm, alters) Forgiving a part Forgiving a person Tender Tune In Adapted by Cherie Spehar Ages: Teen and Up Materials: Writing utensils and Paper Purpose: To help client tune in to younger self, vulnerable self, evoke compassion 9

10 Mindful Self-Compassion A way of learning to be with Self, feelings, thoughts and internal/external responses in a gentle, judgment free awareness. Promotes safe mindfulness and selfempowerment. Effective and easily learnable techniques Visual Journaling Moving Forward Remember that Secondary Wounding is rarely intentional Working through Secondary Wounding issues enhances trauma treatment and creates a smoother transition in thriverhood Families can be strengthened and experience lifechanging positives by the recognition of, and healing from, Secondary Wounding 10

11 References Aron, E. (1999). The highly sensitive person's workbook: The practical guide for highly sensitive people and HSP support groups. New York: Broadway Books. Brach, T. (2012). True refuge: Finding peace and freedom in your own awakened heart. New York: Bantam Books. Bridges, W. (2001). The way of transition: Embracing life's most difficult moments. Cambridge, MA: Perseus Pub. References Brown, B. (1999). Soul without shame: A guide to liberating yourself from the judge within. Boston: Shambhala Fox, J. (1995). Finding what you didn't lose: Expressing your truth and creativity through poem-making. New York: Putnam. Fuimano, J. (2005). The journey called you: A roadmap to self-discovery and acceptance. Malvern, PA: Nurturing Your Success. References Germer, C. K. (2009). The mindful path to selfcompassion: Freeing yourself from destructive thoughts and emotions. New York: Guilford Press. Moore, T. (1992). Care of the soul: A guide for cultivating depth and sacredness in everyday life. New York, NY: HarperCollins Neff, K. (2011). Self-compassion: Stop beating yourself up and leave insecurity behind. New York: William Morrow. 11

12 References Self-Compassion. (n.d.). Self-compassion. Retrieved from Sichel, M. (2004). Healing from family rifts: Ten steps to finding peace after being cut off from a family member. New York: McGraw-Hill. Siegel, R., PsyD, & Germer, C., PhD. (2012, December 05). Becoming wise: How wisdom and compassion work together to heal. [Interview by R. Buczynski PhD, Transcript]. In Mindfulness series. References Stahl, B., & Goldstein, E. (2010). A mindfulnessbased stress reduction workbook. Oakland, CA: New Harbinger Publications. Contact Information 12