Restoring the Shattered Self

A Christian Counselor's Guide to Complex Trauma

Heather Davediuk Gingrich

• Publisher: IVP Academic
• Year: 2020
• ISBN:
  9780830831890
• Topic: Psicología
• Subtopic: Asesoramiento psicoterapéutico

Nearly every professional counselor will encounter clients with a history of complex trauma. Yet many counselors are not adequately prepared to help those suffering from complex posttraumatic stress disorder (C-PTSD), including survivors of child abuse, religious cult abuse, and domestic violence. A lack of consistent terminology in the field makes finding resources difficult, but without reliable training counselors risk inadvertently retraumatizing those they are trying to help.In this second edition of Restoring the Shattered Self, Heather Davediuk Gingrich provides an essential resource for Christian counselors to help fill the gap between their training and the realities of trauma-related work. Drawing on over thirty years of experience with complex trauma survivors in the United States, Canada, and the Philippines, she ably integrates the established research on trauma therapy with insights from her own experience and an intimate understanding of the special concerns related to Christian counseling.In addition to presenting a three-phase treatment model for C-PTSD based on Judith Herman's classic work, Gingrich addresses how to treat dissociative identity disorder clients, respond to survivors' spiritual issues, build resilience as a counselor in this taxing work, and empower churches to help in the healing process.This new edition is updated throughout to match the DSM-5 and includes new content on how the body responds to trauma, techniques for helping clients stay within the optimal zone of nervous system arousal, and additional summary sidebars. With this thoughtful guide, counselors and pastors will be equipped to provide the long-term help that complex trauma survivors need to live more abundantly.Christian Association for Psychological Studies (CAPS) Books explore how Christianity relates to mental health and behavioral sciences including psychology, counseling, social work, and marriage and family therapy in order to equip Christian clinicians to support the well-being of their clients.

SHATTERED

“HALEY, WHAT HAPPENED TO YOU?!” In shock I looked at the young woman I had seen for only a couple of counseling sessions. The exposed parts of her face, neck, and arms were covered in cuts and scrapes, with bandages hiding what appeared to be more serious wounds. Gradually Haley’s horrific story unfolded. A new Christian, Haley had succumbed to the wishes of a group of women from her new church who, knowing that Haley had recently attempted suicide and was plagued with nightmares and overwhelming flashbacks of childhood torture, wanted to pray for her healing. In the midst of the prayer time one of the women “discerned” demonic activity and proceeded with deliverance prayer, attempting to cast out the offending evil spirits. Without any warning, Haley, not aware of what she was doing but desperate to get away, jumped up and blindly started to run, not realizing that she was heading toward a plate-glass window until her body hurtled through it, shattering the glass with the impact.

I wanted to just sit there in the session and cry as I saw with my own eyes the damage caused by these well-intentioned but ignorant women. I managed to hold my tears in check at the time, but now, twenty years later, I am letting them flow as I write about this incident. I recognize that these women had sincerely been doing their best to help Haley. They saw her pain and did not want her to continue to suffer. I did not know this client very well yet, but her flashbacks were a good indicator that she was a trauma survivor. Unfortunately, the prayer group’s lack of understanding about the process of healing for complex trauma survivors not only prevented them from helping her but resulted in further trauma.

Physical wounds usually heal in time, but emotional ones often take longer. The saddest part of this particular incident is not that Haley had to be rushed to the ER for medical treatment, but that the women who had prayed for her subsequently abandoned her emotionally. Understandably they were freaked out. But rather than acknowledge that they had made a tactical error in their attempts to be helpful, they did what people often do—they blamed Haley, the victim. Haley stayed connected to the church for a short while, but without anyone else coming alongside her, and finding it difficult to deal with the constant rejection she faced from the women who had vowed to support her in her journey toward healing, she eventually stopped attending. The shattered glass of the window that broke due to the impact of Haley’s body crashing through it somehow seemed symbolic to me not only of those broken relationships but also of Haley’s fragmented sense of self and personal history.

Fortunately, there is a happy ending to Haley’s larger life story. Although she gave up on church, Haley did not give up on her fledgling relationship with God. Throughout seven years of therapy with me, and several with another therapist after I moved from the area, I watched Haley’s faith grow as God used the counseling process to heal the deep wounds of the sadistic physical, sexual, emotional, and spiritual torment she somehow endured as a child.

I marvel as I talk to Haley these days. She is moving up in the company that employs her, doing work that she loves with colleagues she enjoys. Haley’s extensive social circle includes several very close friends. Although she shies away from church involvement, fearing that no church community will be able to accept her as she is, she loves God with all her heart and has good Christian friends. This is not to say that scars do not remain. Abuse-related health problems only increase as she ages, and she will probably never be nightmare-free. But she is full of joy, evidence of God’s miraculous restorative power.

THE NEED FOR COUNSELOR TRAINING

The women in the prayer group were concerned laypeople, not counselors, so perhaps they can be excused for not understanding that Haley’s healing process would be excruciatingly painful, complicated, and long-term—that a couple of prayer sessions would not cure her. Unfortunately, Christian counselors also run the risk of unintentionally retraumatizing such clients. While professional counselors are not likely to be as simplistic about the process of change, most have not been adequately trained to work with a client like Haley. While graduate programs in counseling and psychology are beginning to recognize the need to add a class on treating trauma to their course offerings, the focus tends to be on disaster relief or the treatment of posttraumatic stress disorder. Therefore students often are not adequately prepared to work with survivors of chronic relational trauma—such as child abuse—a category of trauma that has come to be known as complex trauma. This is disturbing, as many clients are likely to have had this kind of complex trauma history, even if they have never revealed that information or perhaps do not even know it themselves. This book is intended to help fill the gap between the reality of what counselors face in their clinical work and the deficits in their counselor training programs, particularly regarding the treatment of complex posttraumatic stress disorder in adults.

WHAT IS COMPLEX POSTTRAUMATIC STRESS DISORDER?

Perhaps the best way to gain an understanding of complex posttraumatic stress disorder (C-PTSD) is to briefly examine the history of the psychological trauma field, including posttraumatic stress disorder (PTSD), the early child sexual abuse literature, and the more recent publications on C-PTSD. I will also use case examples to illustrate the differences between PTSD and C-PTSD.

Posttraumatic Stress Disorder (PTSD). The literature on PTSD has its base primarily in research studies on United States war veterans who served in the two World Wars, Vietnam, the Gulf War, and more recently Iraq and Afghanistan. Studies on Vietnam veterans were particularly influential in identifying specific clusters of symptoms that were associated with exposure to psychological trauma. This lead to the first inclusion of PTSD in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which was released in 1980.1

The symptom clusters that currently make up part of the diagnostic criteria for PTSD in the fifth edition of the DSM (DSM-5) are intrusive, avoidance, alterations in cognitions and mood, and alterations in arousal and reactivity. This represents some changes in terminology from the fourth edition of the manual (DSM-IV) as well as the addition of new clusters.

SYMPTOM CLUSTERS OF PTSD

• ■ intrusive symptoms
• ■ avoidance symptoms
• ■ negative alterations in cognitions and mood
• ■ marked alterations in arousal and reactivity

Intrusive symptoms occur when aspects of the traumatic event are relived in some way. This is the equivalent of the DSM-IV category labeled reexperiencing. I think that a combination of these terms—that is, intrusive reexperiencing—provides the best description of this symptom cluster because it makes clear that these symptoms intrude into the lives of traumatized individuals, and that the intrusion takes the form of reexperiencing, or reliving, aspects of a traumatic experience. Although not an official term, the word flashback is commonly used by both professionals and laypeople to indicate a type of intrusive symptom in which the survivor relives the trauma as though it is happening here and now. Other intrusive symptoms include nightmares, visual images, intense emotions associated with the traumatic event (e.g., terror or shame), intrusive thoughts, and physical reactions.

The PTSD symptom cluster of avoidance includes attempts to stay away from anything that could trigger an intrusive symptom. Individuals with PTSD tend to alternate between intrusive and avoidance symptoms as they try desperately, but often unsuccessfully, to not be at the mercy of the traumatic event they experienced at some earlier point in their lives.

Falling under the symptom cluster of negative alterations in cognitions and mood are increased frequency of negative emotional states, diminished interest in significant activities, social withdrawal, and reduction in expression of positive emotions. This category was not included in earlier versions of the DSM, but these symptoms were found to be so common that they were added to the diagnostic criteria for PTSD.

While hyperarousal was the term used for a symptom cluster in the DSM-IV, in the DSM-5 it was changed to marked alterations in arousal and reactivity. Use of the word alteration could imply that the change in arousal involves either heightened arousal (i.e., hyperarousal) or the opposite, lessened arousal (i.e., hypoarousal). However, this posttraumatic symptom cluster only includes hyperarousal. High anxiety, anger outbursts, irritability, lack of concentration, and sleep disturbance are some examples of increased reactivity as a result of a nervous system that is in a highly excited or aroused state. I had one client, for example, whose pulse never went below 120 because his nervous system was always highly activated. New to this symptom category in the DSM-5 is inclusion of increased reckless or dangerous behavior.

At times hyperarousal takes the form of hypervigilance, when individuals are on high alert for danger in specific situations. This prepares them to either fight the perceived source of the danger or to run away from it. Such a “fight-or-flight” response is common not only in humans but also in other mammals and will be discussed in more detail later.

Irene’s story. The following vignette illustrates a straightforward case of PTSD that was easily resolved.

“Would anyone be willing to volunteer to be the ‘counselee’ so that I can demonstrate this technique?” I was teaching a counseling theories course in a seminary graduate counseling program in the Philippines and wanted to demonstrate the behavioral technique of systematic desensitization. A middle-aged woman, Irene, raised her hand, explaining that she was terrified of the sound of airplanes flying overhead. Upon investigation I found out that she was a recent trauma survivor. Just over a month before, Irene had barely escaped with her life when the entire hillside subdivision in which she lived was swept away by a raging river of mud produced by torrential rains. The sound of jet engines reminded Irene of sliding mud and triggered flashbacks of this traumatic event.

Irene showed evidence of typical PTSD symptoms. The terror she felt when she heard airplanes flying overhead was actually an intrusive reexperiencing of her previous trauma-related fear, the panic she felt as she ran for her life from the mud she could hear gaining on her. Nightmares that replayed scenes from the night of the mudslide were also evidence of intrusive posttraumatic symptoms. Irene showed evidence of avoidance because she actively pushed away intrusive thoughts and was reluctant to talk to anyone about the mudslide. Also, despite missing her former neighbors, Irene’s desire to avoid reminders of the tragedy kept her from seeking them out. Finally, Irene’s alertness to a sound that resembled moving mud and her impulse to run upon hearing such a sound were examples of hyperarousal. Many people who live close to an airport will not even notice a plane’s presence,...