3.3 Trauma therapy

© Martina Frenznick/Kristin Marunke 2008

Overview

Trauma therapy is a distinct field of psychotherapy concerned with the research and treatment of sever psychological damage.  It defines trauma as "...the experience of vital discrepancy between threatening factors in a situation and personal options for dealing with the situation, which is accompanied by feelings of helplessness and complete abandonment and results in enduring damage to the person’s self image and understanding of the world" (Fischer & Riedesser, 2003, P. 375). This traumatisation can occur in all areas of life: In the personal biography, former relationships, the current relationship or through retraumatisation.

Traumatic experiences have consequences that can endure for months or even years: Repeated experience of the traumatic event (e.g. in dreams), avoidance of stimulus that is associated with the trauma and increased agitation (Diagnostic criteria for a basal psycho-traumatic stress disorder according to DSM IV, analogous to ICD-10). The symptoms include those that can be identified and explained on, among others, the neurobiological level but can also be expressed on a psychological level or passed on across generations. Often the experience remains unspoken, is saved in fragments and therefore cannot be imbedded in previous or current experience. Traumatic experiences are also not always consciously accessible, especially when they occur in early childhood. Those affected sometimes first become aware years later, through an experience that has apparently nothing to do with a trauma, that something is wrong: The fragmented memories are activated through external stimuli and become active.

The focus of trauma therapy is usually the victim and less frequently the perpetrator – although it has been shown that, for example, among sexual offenders trauma therapy is more successful in the long term than cognitive behaviour therapy (Cf. Huber, 2006). In respect to perpetrators, it is appropriate for both the “classical” perpetrator-victim relationship and for couples where both partners exercise violence (see theoretical underpinning).

When considering methods, it can be established that each of the major schools of psychotherapy follows its own principles.  In the practice of trauma therapy, these are integrated above all through the mutually complementary procedures EMDR (Eye Movement Desentization and Reprocessing), debriefing, imaginative and narrative procedures as well as through somatic experiencing and behaviour therapy procedures. Due to this diversity, trauma therapy is suitable for everyone in the first instance. The basic condition is, as in all forms of therapy, the client’s insight and willingness to change something and the capacity for retrospection, i.e. reflection.

Background knowledge about the context in which the relationship is embedded – and therefore knowledge of the norms and values of the community – is indispensible for counsellors and therapists. The LGBT subculture often supports perpetrators through the   concealment or normalisation of domestic violence. This makes it more difficult for the perpetrator to recognise that violence is wrong – the victim often experiences further trauma as a result of this persistent silence by the community. If this is not taken into consideration in counselling and therapy, any form of support can have only limited effect.

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