Perpetrator Closeness Matters When Considering Effects of Trauma

Perpetrator Closeness Matters When Considering Effects of Trauma

A new study conducted by Portland Psychotherapy’s Melissa Platt, along with colleague Jennifer Freyd, finds that perpetrator closeness matters when considering the effects of trauma. In this study, 124 female survivors of trauma were recruited to participate. Participants completed a set of questionnaires related to trauma, shame, dissociation, and fear. Next, they were randomly assigned to either see a set of images depicting threatening events of an interpersonal nature such as depictions of sexual harassment and interpersonal violence, or a set of images depicting threatening events of a non-interpersonal nature such as depictions of car accidents and natural disasters. After viewing the images, participants again completed self-reports of fear, shame, and dissociation.

Our hypotheses were guided by betrayal trauma theory, which proposes that people who experience traumatic events perpetrated by someone close, trusted, or depended on for survival (high betrayal trauma; HBT), are more likely to dissociate the abuse from awareness compared to survivors of events perpetrated by someone not close, or non-interpersonal events (low betrayal trauma; LBT). Several studies provide support for betrayal trauma theory as it relates to dissociation. In the current study, we aimed to extend the scope of betrayal trauma theory by assessing whether people who have experienced HBT may also be more likely to experience shame, rather than fear, in the context of trauma-relevant cues. The rationale for this has to do with survival. If a person is assaulted by a stranger, it is likely to be adaptive for that person to experience fear and its action tendency to flee and get the heck out of the dangerous situation and away from the source of threat. However, if a person is assaulted by someone who is depended upon for survival, or someone who feels needed for survival such as a life partner, fleeing may seem to be life-jeopardizing, and in the case of abuse by a caregiver, fleeing truly may be life-jeopardizing.

Rather than responding to HBT-relevant cues with fear, we predicted that people would respond with shame (in addition to dissociation). Shame is an emotional experience that is very painful, tends to stop a person in her tracks, and tends to elicit sympathy in others. In addition, shame either shifts the person’s attention inward to thoughts of being flawed or bad, or else causes the mind to go blank. In either case, awareness is shifted away from cues to suggest that the person is being harmed by someone they need and/or love, and therefore protects the relationship with that person, albeit at a cost.

Results of the study showed that, first of all, there was no overall difference in responses between the interpersonal and non-interpersonal threatening images. It was only when we took into account the person’s individual history of HBT and LBT experiences, that differences in responses to the images showed up. In particular, people with a higher number of HBT experiences in their history became more ashamed and dissociative when they saw the interpersonal threatening images, but not the non-interpersonal ones. What’s more, they did not experience an increase in fear in response to either set of images. On the other hand, people with a higher number of LBT experiences in their history became more afraid when they saw the non-interpersonal images. What’s more, they did not experience an increase in shame or dissociation in response to either set of images.

Thus, we found evidence supporting the idea that shame and dissociation may serve a similar function in survivors of HBT, and that HBT and LBT survivors may have quite different experiences in the context of trauma reminders. This would also suggest that treatment needs may differ depending on type of trauma(s) the person has endured. We believe that these findings have particular significance for exposure therapies, such as prolonged exposure, which has a theoretical underpinning based on fear habituation. Before beginning PE with your client, it may be worthwhile to assess whether your client’s primary emotional reaction is indeed fear rather than shame or some other emotional experience and whether he/she tends to dissociate when reminded of the trauma, which may interfere with the ability to learn that memories are not dangerous and thereby the opportunity to heal.

UPCOMING TRAINING EVENTS


De-Mystifying Self-As-Context in ACT: Practical Strategies for Clients

Brian Pilecki, PhD and Kati Lear, PhD
December 3rd, 2021 from 12pm-1:30pm

This workshop will outline how self-as-context can be used to conceptualize commonly discussed topics in therapy such as self-esteem, confidence, identity, and inner conflict. Participants will learn how to flexibly practice practical self-as-context interventions that can be used with clients, as well as have a chance to practice newly learned skills through structured role-play exercises in breakout groups. Read More.


Values in Therapy: An Intro to Working with Values from an ACT Perspective

Jenna LeJeune, PhD
January 21, 2022 from 12pm-2:00pm

This workshop will provide a theoretical and conceptual overview of values from a contextual behavioral science perspective. We will cover the “what”, “why”, “when”, and “how” of values within ACT. While we will also provide an overview of various values exercises and measures that can be used with clients, the emphasis in this workshop will be on providing a foundational framework that will help clinicians approach values work from a functional perspective rather than a primarily technique-focused approach. Read More.



Culturally Responsive Therapy: How to Apply Anti-Racist Values in Session

Christy Tadros, LPCC and RaQuel Neal, LCSW
February 4th, 2022 from 1:30pm-4:45pm
and February 5th from 9:00am-12:00pm

This 2 day 6-hour training will help therapists develop their ability to support clients from a different racial background than them, with a particular focus on Black, Indigenous and People of Color. Through a multicultural social justice framework, it will integrate research and clinical experience to teach a therapeutic model for rapport building, assessment, and treatment. This model is not a rigid therapeutic modality, but provides a contextual lens to build a strong, culturally grounded therapeutic relationship. It is a flexible model and can align with many therapeutic modalities, including a contextual behavioral approach to therapy. Read More.


Truffle Hunting: Bringing Values to Life in the Therapy Room

Jenna LeJeune, PhD
February 25, 2022 from 12pm-2:00pm

This brief workshop is designed to help clinicians deepen their values work with clients by shifting the focus from the content of values conversations to the quality of those conversation. By listening for and deepening the qualities of effective values conversations participants will get a taste for how more experiential and relationally-based values work can supercharge therapy. Participants will have opportunities to both observe demonstrations and practice in small groups with the benefit of feedback. Read More.


Values Prototyping: Using Action to Help Clients Explore Their Values

Jenna LeJeune, PhD
March 11, 2022 from 12pm-2:00pm

This workshop will focus on one specific experiential tool called “values prototyping” that helps clients learn more about their values through engaging in intentional valuing. As participants will hopefully already have a solid foundation of some of the core concepts of the values process in ACT, this workshop will dive right in on how to use values prototyping to help clients learn more about what they would choose to value in their life. You will have the chance to practice developing a values prototype in small groups with the benefit of feedback, so that by the end of the workshop you will be able to use this tool in your work with clients. Read More.


The Invitation to Change Approach: Helping Families Affected by Addiction

Jeff Foote, PhD and Cordelia Kraus, LPC, CADC 1, certified CRAFT clinician
May 13th and 14th, 2022 from 9:00am-5:00pm
at University of Portland, Terrace Room
This two-day in-person workshop will provide skills training for professionals focused on the process of working with clients who have a loved one struggling with substance use issues. The Invitation to Change Approach draws on CRAFT (Community Reinforcement and Family Training), MI (Motivational Interviewing), and ACT (Acceptance and Commitment Therapy) to provide a compassionate and collaborative way of working with the families and concerned significant others of people who struggle with substance use. Read More.


Therapy and Research in Psychedelic Science (TRIPS) Seminar Series

Second Friday of each month from 12:00 PM – 1:00 PM (PT)

TRIPS is an online seminar series that hosts speakers discussing science-informed presentations and discussions about psychedelics to educate healthcare professionals. This series was created to guide healthcare providers and students preparing to be professionals towards the most relevant, pragmatic, and essential information about psychedelic-assisted therapy, changing legal statuses, and harm reduction approaches in order to better serve clients and communities. This seminar series is a fundraiser for our clinical trial of MDMA-assisted psychotherapy for social anxiety disorder that Portland Psychotherapy investigators are preparing for and starting in the Fall of 2021. All proceeds after presenter remuneration will go to fund this clinical trial. Read more.

January 14th, 2022Psilocybin-Assisted Therapy of Major Depressive Disorder using Acceptance and Commitment Therapy as a Therapeutic Frame with Jordan Sloshower, MD, MSc

February 11th, 2022 – Drug-Drug Interactions Between Psychiatric Medications and MDMA or Psilocybin with Aryan Sarparast, MD

May 13th, 2022Implementing Culturally-Attuned & Anti-Racist Psychedelic Therapy: Impact over Intention with Jamilah R. George, M.Div, M.S.