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Trauma refers to events, witnessed or experienced, that threaten our well-being and overwhelm our ability to cope. Traumatic events involve helplessness and fear and dramatically alter our sense of self, relationships and perception of the world. Examples include physical, sexual, and emotional abuse, accidents, loss, disaster, illness and domestic violence. Childhood trauma, in particular, can lead to significant disruptions in emotional regulation, impulse control, self-esteem and interpersonal relatedness.
Many women who come to Saint Luke Institute for treatment exhibit behavioral problems that are rooted in childhood trauma (most commonly physical, sexual and emotional abuse). These include depression, anxiety disorders, self-destructive behaviors,addictive and compulsive behaviors,and chronic medical conditions. Child-hood abuse is often a complex trauma because it is repetitive or prolonged and can involve harm or neglect by caregivers. Unlike singular traumatic events, complex traumas require long-term treatment for lasting change.
A person abused as a child tends to react to innocuous stimuli as if it were threatening. Defenses, over time, become default behaviors. When childhood trauma remains unresolved, it gets played out in community life.
For instance, a woman may be referred for treatment because she is overly sensitive, easily upset and defensive when offered constructive feedback. She may show a lack of self-care and overly needy or controlling behaviors, quit jobs or relationships without negotiation, have difficulty standing up for herself and appear anxious, particularly around authority figures. These behaviors may have developed as self-protection. Many of these women function effectively early in religious life, with trauma symptoms causing the most impairment later.
Some traumatized women have difficulty identifying feelings and particularly struggle with anger, guilt, fear and shame. Fear of losing emotional and behavioral control is common. Some women are apologetic when their
emotional responses belie the image of a “good” religious. They believe they should be able to “handle it” or be“over it” when feelings about past abuse emerge. They may employ emotional numbing, dissociation, distraction and denial to avoid their feelings. At other times, they may be emotionally over-whelmed and preoccupied with details of their abuse, experiencing intrusive thoughts, nightmares, flashbacks and emotional outbursts. They may engage in maladaptive behaviors to reduce tension and stress, which over time become problems of their own (e.g., substance abuse).
Childhood abuse disrupts identity formation and damages self-esteem. Abused persons often feel unlovable and undeserving of happiness, internalizing the erroneous belief that the abuse was their fault. Abuse can lead a woman to feel bad because of who she is, although she tries hard to do the “right” thing. Relationships also may be disrupted. Wary of getting hurt, persons with abuse histories have difficulty trusting others, asking for and accepting help, and managing relational conflict. They feel like outsiders and worry about“messing up” the therapeutic relationship, fearing rejection from the therapist.
At Saint Luke Institute, the goal ofthe initial phase of treatment is to help these women feel safe enough to engage in psychotherapy and to instill a sense of hope that healing is possible. Treatment focuses on helping them tolerate
and accept their emotions, develop supportive relationships and stabilize other conditions (e.g., depression). Treatment is carefully paced to gradually build skills to contain traumatic material before going into detail about the trauma.
Clients learn techniques to identify and manage emotions by noticing the manifestation of feelings in their bodies. They come to understand their emotional triggers and develop more effective coping strategies (e.g., journaling, mindfulness, relaxation, cognitive reframing). They learn how trauma affects the neurobiology of the brain, thus
relieving the distorted belief that the trauma was their fault. They realize they are not weak or crazy for reacting the
way they have and that their once protective symptoms are no longer adaptive.
As clients develop skills to regulate emotions, they are better able to focus on their feelings without becoming overwhelmed or shutting down. They become curious about their experiences without self-judgment, understanding that emotions ebb and flow and that negative emotions dissipate more quickly with acceptance. Clients learn to observe memories and reactions associated with trauma rather than reliving them. Grief,mourning and anger may surface as they encounter the truth of their experiences.
Treatment helps clients increase their emotional range, enhancing their capacity to experience positive feelings. Problem-solving and decision-making skills improve. They learn to establish authentic relationships with appropri-ate boundaries. They replace distorted beliefs with more accurate ones. Their spiritual lives also deepen. While the treatment of complex trauma takes time and courage, it can empower clients to develop a life beyond the trauma that surpasses their wildest imagination.
Emily Ray, Ph.D., is a psychologist in the residential program at Saint LukeInstitute.
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