Not Trauma Alone: Therapy for Child Abuse Survivors in Family and Social Context

by Gold,Steven

• ISBN13: 9781583910276
• ISBN10: 1583910271
• Edition: 1st
• Format: Hardcover
• Copyright: 2000-06-21
• Publisher: Routledge

Summary

Until now, psychotherapy for child abuse survivors often centered on the trauma of their abuse experiences. However, survivors frequently reveal a history suggesting it was not abuse trauma alone that created their difficulties, but growing up essentially alone - without the consistent emotional support and guidance needed for development of effective functioning. This book presents an alternative to trauma-focused treatment that, though effective for treatment of other forms of trauma, can induce deteriorated rather than improved functioning in survivors of prolonged childhood maltreatment. The contextual therapy presented inNot Trauma Alonedelineates a psychotherapeutic approach that emphasizes helping survivors develop the capacities for effective functioning that were never transmitted to them during their formative years. Detailed descriptions of the methods and interventions comprising contextual therapy are included in this critical book for all mental health professionals, clinicians,academics, and students in the field.

Table of Contents

Series Foreword	xi
Foreword	xv
Preface	xix
Acknowledgments	xxvii
PART I ABUSE IN CONTEXT: THE CONCEPTUAL FRAMEWORK
Abuse: The Trauma Model	3	(9)
The Social Context of the Recognition of Abuse Trauma	4	(2)
Abuse, Trauma, and Memory	6	(2)
Distinguishing Recollection from Recovery	8	(4)
Family: Beyond the Trauma Model	12	(16)
The Consequences of Child Abuse: Beyond PTSD	13	(3)
Child Abuse in Family Context	16	(10)
Divergent Groups of ``Adult Survivors''	26	(2)
Alone: Growing Up in an Ineffective Family	28	(20)
An Interpersonal Context of Silent Complicity	29	(3)
Found in the Mall: A New Way of Living	32	(4)
``Maybe That's My Family'': Longing and Denial	36	(2)
Moving On	38	(2)
Undeserving: The Enduring Family Legacy	40	(2)
Family and Identity: The Entanglement of Attachment and Separation	42	(3)
The Core Issue: To Be Cherished	45	(3)
Unprepared: The Legacy of an Ineffective Family Background	48	(11)
Beyond Survivorship: A Broader Perspective	48	(4)
Inadequate Transmission of Essential Living Skills	52	(3)
Two Related Pathways to Impaired Adjustment	55	(2)
Why Trauma-Focused Treatment is Inappropriate for Survivors of Prolonged Child Abuse	57	(2)
Impact: Intersecting Varieties of Abuse and Deficient Family Context	59	(11)
Beyond Sexual Abuse	60	(1)
Varieties of Abuse: Divergent and Convergent Effects	61	(4)
Clinical Implications	65	(5)
Society: Beyond Family Context	70	(15)
Levels of Analysis	71	(1)
Individual Problems in Adjustment	71	(1)
Traumatic Antecedants of Current Problems	72	(1)
Abuse Trauma in Family Context	73	(2)
Analysis at the Level of Social Context	75	(2)
Society: Holding Ourselves Accountable	77	(8)
PART II TREATMENT IN CONTEXT: FOUNDATIONS OF THE THERAPEUTIC MODEL
Collaboration: Forming a Therapeutic Alliance	85	(19)
The Anticipation of Distain	85	(2)
Fear of Abandonment	87	(5)
Dependent Longing	92	(1)
Navigating Obstacles to a Collaborative Alliance	93	(3)
Dependency and Power	96	(2)
The Need for Structure	98	(3)
The Therapeutic Alliance in Family and Social Context	101	(1)
Personhood: Avoiding Rigid Categorization	102	(2)
Conceptualization: Constructing Order From Chaos	104	(14)
Distinguishing the Impact of Abuse From That of Family Context	104	(2)
Anchoring Exploration Around Focal Problems and Goals	106	(4)
Client-Directed Exploration	110	(1)
Formation and Revision of Hypotheses	111	(2)
Conceptualization as a Collaborative Process	113	(2)
The Multiple Functions of Conceptualization	115	(3)
Planning: Prioritizing Treatment Goals	118	(13)
The Rationale for Prioritized Treatment Goals	118	(3)
The Component Skills	121	(10)
PART III ACQUIRING TOOLS FOR DAILY LIVING: THE STRUCTURE OF THE THERAPEUTIC PROCESS
Security: Managing and Modulating Distress	131	(23)
The Collaborative Alliance: A Higher Priority Than Treatment Goals	133	(2)
The Relation Between the Therapeutic Alliance and Distress Reduction	135	(2)
The Transition From Relationship Building to Goal-Oriented Collaboration	137	(2)
Facilitating Self-Sufficient Problem Resolution	139	(1)
The Importance of Practice and Accountability	140	(6)
Reducing Anxiety: The Need for the Therapist to Be Familiar With a Range of Techniques	146	(1)
Identifying and Mobilizing Existing Skills and Resources	147	(1)
Reducing Depression: Concrete Behavioral Strategies	148	(6)
Focus: Fostering Experiential Presence and Continuity	154	(24)
A Family Context Model of Dissociation	155	(2)
DID: Risks of Excessive Emphasis on Extreme Forms of Dissociation	157	(3)
Absorption: Risks of Overlooking Subtle Forms of Dissociation	160	(2)
Training in Grounding Techniques	162	(5)
Learning to Modulate Absorption	167	(1)
Learning to Disrupt Dissociative Episodes	168	(2)
Addressing Dissociative Amnesia	170	(1)
Addressing Identity Fragmentation	171	(7)
Reasoning: Learning to Exercise Critical Thinking and Judgment	178	(20)
Adverse Experiences	179	(1)
Pernicious Programming	180	(1)
Deficient Transmission of Reasoning Skills	181	(1)
Cognitive Processes: Developing Critical Reasoning Skills	182	(6)
Cognitive Content: Re-examining and Revising Erroneous Convictions	188	(3)
Cognitive Content: Common Core Distortions	191	(7)
Coping: Breaking and Replacing Maladaptive Patterns	198	(15)
Conceptualizing Maladaptive Behavior Patterns	198	(2)
Precautions Regarding Maladaptive Behavior Patterns and PCA Survivor Treatment	200	(1)
Disrupting Maladaptive Behavior Patterns	201	(7)
From Maladaptive Patterns to Adaptive Functioning	208	(5)
Liberation: Resolving the Trauma of Abuse	213	(9)
The Dangers of Trauma-Focused Treatment for PCA Survivors	213	(2)
The Shift Away From A Primarily Trauma-Focused Perspective	215	(1)
Addressing Trauma: Keeping the Client in Charge	216	(3)
When Exposure to Traumatic Material Is Appropriate	219	(3)
Transformation: The Miracle of Living Well	222	(19)
The Challenge of Maintaining Flexibility	222	(3)
Case Example: Resolving the Impact of Multiple Forms of Abuse and Disturbed Family Context	225	(6)
Theoretical, Clinical, and Empirical Implications	231	(2)
The Miracle: It's Not a Big Deal At All	233	(8)
PART IV CONCLUSION
Epilogue: The Inextricable Tie	241	(4)
References	245	(12)
Subject Index	257	(12)
Author Index	269