Vol.12, No. 3
Welcome to the many new readers for this June edition of Tips and Topics.
David Mee-Lee M.D.
|Trauma-informed assessment, treatment and systems of care are being talked about, and advocated for everywhere these days. And with good reason. It is a neglected area of healthcare and has attracted increasing attention as veterans return home; as well, priests, sports coaches and other prominent people are exposed. For the children and teens who trusted these people, the betrayal and abuse of their boundaries and lives is traumatic and tragic.
This month, as I listened to Peter Pelullo tell his life story, the profound life-long effects of early trauma and abuse hit home with such impact. At age seven, Peter suffered multiple sexual abuse attacks by two older neighborhood teens. Recently Peter shared his journey from sexual abuse, sexual addiction and recovery. He documented this with candid honesty in his book “Betrayal and the Beast”.
About the Author:
“Peter S. Pelullo was the founder and owner of a premiere recording studio in the ’70s and ’80s,where he worked with the Rolling Stones, Stevie Wonder, Foreigner, and Patti Labelle. At present, he is an entrepreneur and a financier focusing on technology startups. Following his journey in recovery, he created the LetGo..Let Peace Come In Foundation, which supports adult victims of childhood sexual abuse throughout the world.”
I want to share some nuggets of information from Peter and the two friends in recovery who accompanied him, Paul and John.
Consider the following observations, awarenesses and coping mechanisms to raise your consciousness about trauma and childhood abuse
Here are some of the “pearls” I wrote down as Peter spoke:
1. “Hurt people, hurt people”
Peter chronicled his pattern of sexual relationships that lacked full intimacy; and the affairs which ultimately cost him his marriage. “I can’t deal with this pain, anxiety and hurt without alcohol or some other drug or addictive behavior.” Then the ravages of addiction compound and hurt themselves and loved ones.
2. “You can’t make a conscious decision unless you are conscious”
3. “You need to have a relationship with yourself, if you are to have a relationship with God or others.”
Who am I? Do I respect who I am? Do I even know who I am or how to find out? Is it safe to trust, love, talk, feel? The Biblical version of this is: ‘Love your neighbor as yourself”.
4. “Be a human being, not a human doing.”
Recognize the Symptoms
“Victims with a history of sexual abuse will often present secondary symptoms before the abuse is uncovered. It is important that these symptoms be recognized as a possible reaction to something greater than the symptomatic condition itself.”
“Some of the behaviors and symptoms exhibited by victims of child sexual abuse are:
Trouble sleeping/ or excessive sleeping
Discomfort around children who are the same age as when the child was themselves abused
Panic and/or anxiety attacks
Sexual acting out
Sexual problems or disinterest in sex
Discomfort with people who are the same gender as their abuser
Lack of memory of being a child or missing large blocks of their childhood
A hunch or intuition that sexual abuse occurred
A pervasive feeling of powerlessness
Suicide attempts or strong suicidal wishes
Repeated victimization such as rape or domestic violence
Unexplained physical or emotional numbness
Lack of trust
People pleasing/rescuing at an early age
Excessive need to control
Obsessive/compulsive behavior patterns
Unhealthy choices in members of the opposite sex
Manic-depressive behavior (extreme emotions)”
That is a long list of possible clinical presentations. Not everyone with elements of these presentations has been a victim of childhood sexual abuse. However, this list is another way of emphasizing that we have to start screening for trauma; because many clients and patients won’t volunteer this information, and will not even know the connection with their presenting concerns.
The society and world around us has perpetuated a conspiracy of silence around this issue. Think about the years of hidden maneuvers of the church dealing with priests and pastors who struggled with their own demons and hurt so many young people. As well there’s the cover-ups of schools, colleges and organizations dealing with sports coaches or teachers who violated young people who trusted them.
How does sexual abuse go on for years without the child speaking up?
(a) There must be something wrong with me.
Think about your own sense of self as an adult. Are you ever unsure if and when you should speak up and assert your opinion, feelings and needs? How can a wounded child speak up? You wonder:
“Am I being too sensitive and reactive?”
“Maybe I’m being too demanding..”
“What do I really want anyway?”
“What if my boss or partner yells at me?”
“Do I really have the right to complain about this?”
“What if I get punished for speaking up and lose a promotion or raise?”
These are inhibitors to speaking up even for people who have not suffered childhood sexual, physical and/or emotional abuse. Imagine what it’s like for a child, or even an adult with arrested developmental issues due to unresolved trauma?
(b) I am alone and must be the only one this has happened to.
Of course, as clinicians, we know millions are affected. But let’s focus on that one single child. They have been told this isa secret to be kept just between you and me or else bad things could happen. They don’t know what they don’t know. They have not formed any sense of identity or healthy boundaries to know they have a right to speak up. Even if they attempt to tell others, they can so easily be blamed or scolded for telling stories or for bringing it on themselves. This only makes them feel more isolated and alone.
(c) Guilt, shame and remorse
“If there’s something wrong with me…..”- shame
“I must have done something to bring this on myself, or something wrong to deserve this” – guilt and remorse
“I am all alone anyway, I must keep this to myself. No one should hear this, see this or know this about me.”- guilt and shame
“I cannot speak up.”
What can be done to change the stigma of sexual abuse and increasing access to care and recovery for the millions who need it?
Peter Pellulo has his ideas about what the next steps are.
(a) Take the stigma away
Children will come forward and speak up when they see adults talking about it. Hearing adults talk about it is much more than just the titillating details or the public outrage on the news and talk shows about the Catholic Church or Jerry Sandusky and his coaching career at Penn State University.
- It means adults coming forward, sharing their pain and journey in recovery much as we have seen with substance-related and gambling addiction. This makes it OK to talk about for survivors and families of sex abuse.
- It means families talking about the power and manipulation adults have over children. That is another reason children can’t speak up about their abuse.
- It means creating a safe environment in the family and society for support and validation of the child when and if they come forward. It gives the message to siblings or friends who have been abused that it is safe to disclose.
- It means facing the reality of the perpetrator who may be a family member or family friend and doing something…now! If it’s too late and in the past, you can still open up the conversation.
- “Let’s see if he will just grow out of it” – no he won’t. It needs to be raised and resolved.
- “Maybe she will forget it and move on. No need to stir something up from the past.” – no she won’t forget it. It is likely a controlling event everyday in his or her life.
(b) Create a sweeping shift in social consciousness
Replace the stigma surrounding childhood sexual abuse with an understanding that it is a serious mental and public health issue. It is intertwined with addiction treatment and many other healthcare and public health concerns. We are changing social consciousness on attitudes about alcohol, nicotine and other substance-related and addictive disorders. Society is rapidly changing its consciousness on same sex relationships and marriage. This arena is still frontier-land.
(c) Increase access to care and self/mutual help meetings
Peter Pellulo and his Foundation is doing this by:
- Identifying qualified trauma therapists across the USA (and eventually the world) to whom adult survivors can be linked.
- Pairing each survivor with a therapist for an allotted 15-20 hours of therapy, which is funded by the Foundation through donations received by Foundation supporters.
- Aligning with John Hopkins Bloomberg School of Public Health to amass the data that will raise social consciousness around this pandemic issue.
- Aiming to establish 1,000 Support and Recovery Rooms across the USA for survivors to attend. Compare that with Alcoholics Anonymous meetings which has more than 114,000 groups in approximately 170 countries. http://www.aa.org/assets/en_US/smf-165_en.pdf
Whether this is your mission or not, we all have a part to play in raising awareness; improving assessment, treatment and systems of care; and in empowering and supporting survivors of sexual abuse.
At the end of the day, I asked Peter Peulullo for the top three messages he would want clinicians to know about childhood sexual abuse.
One, he said, was to be gentle with clients and yourself. That’s good advice to counter the guilt, shame and remorse.
Two, remember to convey to survivors that “You are not alone” – there are millions out there who know what you have been through.
Thirdly, he reminded us of the statistics: You are very likely to know someone in your extended family, network of friends and certainly in your client caseload, who has suffered the trauma of childhood sexual, physical and/or emotional abuse. Don’t continue the conspiracy of silence. Link them with some help. “Send them to the Foundation”, he said.
One of his closing slides summed it up well: “While childhood sexual abuse is life- altering….it doesn’t have to be life-ending…Provided we get the help we need!
Be gentle with clients and yourself; remember you are not alone; and get the help we need. Not bad advice for many wounds we all face.
STUMP the SHRINK
Last month, Tips & Topics addressed Interactive Journaling.
Two readers raised questions. How can Interactive Journaling be used if clients have cognitive conditions? I turned to experts in The Change Companies to respond. Here are the questions and Bill and Frankie’s responses:
“I work at Salvation Army Family Treatment Services (Women’s Way) in Honolulu. We have been using workbooks, or interactive journaling from The Change Companies. We have found that they are very useful. However, we have many women who have severe cognitive damage (traumatic brain injury, Fetal Alcohol Spectrum Disorder, cognitive damage due to long-term drug/alcohol use, etc.) and it is extremely difficult for them to grasp the material unless we do it with them on a one to one basis. Is there something that would work better for this population?”
Beth Kurren Cox, ACSW, LSW, CSAC
Admission and Assessment Coordinator at Salvation Army Family Treatment Services, Women’s Way.
“Thanks for yet another great listserv but I have a concern about the use of journaling as it leaves out many of my clients have cognitive difficulties (due to developmental disorders, head trauma, or trauma) that impair their ability to effectively use their brains as an asset (consider Dr. Bruce Perry’s work) for emotional management. And let’s not talk about literacy skills (I’ve tested many of our clients and a 3rd grade rather than a 6th grade level is common). Yet this and other reading/writing based Evidence Based Practices (EBPs)are constantly pushed. I suggest the development of EBPs that focus on attention development and affect management using as well as literacy before forcing someone to use a skill they simply do not have.”
Staci Hirsch, Psy.D.- Program Supervisor
NEIGHBORHOOD SERVICES ORGANIZATION
5470 Chene Street
Detroit, MI 48211
Bill Calhoun’s Response:
“Concerns about reading and low literacy levels are probably the most common question we get about Interactive Journaling (IJ) over the past 25 years we’ve been doing this. I’ve heard that in any given population sample in institutional settings there is something like a 9 – 10% illiteracy rate, due to all the reasons stated. For that 1 out of 10 clients, there are good strategies that can help, including partnering with someone with a slightly higher cognitive functioning level and/or working with a mentor. Individual one-to-one sessions have been shown to be helpful also for these clients.
The other key point is that while many of the commonly used EBPs are reading and writing-oriented and very text-heavy, Interactive Journaling® by design does attempt to reduce those barriers by incorporating the use of graphics, color and open space to minimize the intimidating feel of a black and white full text manual or workbook. Having said all that, there will always be a small subset of the population for whom Interactive Journaling, or any reading/writing-based process simply is not a fit. Through IJ we have always attempted to help the greatest number of people but it’s certainly no silver bullet.”
VP of Business Development
The Change Companies®
Frankie Lemus’ Response:
“I agree with everything Bill has stated. Here are a few other items that are helpful to note:
* We have found that clinicians frequently underestimate their clienteles’ ability to read, comprehend, respond and discuss their work in the Journals. As a matter of fact, way back in the day when Don Kuhl (Founder of The Change Companies) was working with (I believe) St. Cloud, MN., someone working at the center did aMasters’ thesis or Doctoral Dissertation on exactly this subject and foundrepeatedly that, in a statistically significant way, staff underestimated their population’s ability to do the journals because of their over-concernclients could not comprehend the materials. On the other side, clients consistently reported that not only were the Journals not a challenge for them to read or understand but served as a key element in their change efforts.
* Our materials have been created to be highly graphic (using core graphics) as well as 4-color -both shown in plenty of research to increasing retention and comprehension.
* In trainings, we strongly encourage that if individuals have literacy challenges there are three effective ways to address it:
(a) Use a buddy system like the Salvation Army taught us; use a tutor that can help them with this challenge; and as additional benefit help them improve their reading, writing, and comprehension skills or use a CSO* help with the reading part.
(* CSO = Concerned Significant Other. We have been using that general term to indicated anyone supportive of the individual’s change process from their surrounding environment- family member, boyfriend/girlfriend, peer, paraprofessional support person such as an advocate or case manager, probation officer, etc. A CSOis anyone who might be a supportive resource for the individual to whom they have access.)
(b) Use the book on tape method one of two ways: 1.Have someone read on tape the Journal and tell the individuals when it is time to turn pages or respond to the question box; or 2. Take someone who had made significant progress in the program and have them read the Journal pages and then how they responded to the questions. Then have that person turn the question back to their fellow client to respond in writing, bullet points or drawings.
(c) Finally, take the time to address the individualized need by working with the participants in 1×1 settings (because reading the Journals content will not be their only life challenge in this area).
* Encourage drawing journal questions versus writing narratives. The drawings can be attached to bullet points or even one word answers as the methods the individualuses to expresses their responses. And then yes, you will have to work with them, like other clients, to glean additional information regardingthe subject area.
PS. It is interesting that one of the questions comes from a Salvation Army program as they were the ones who taught us about the use of a “buddy system” with their beneficiaries to help those individuals work with the Journals.”
Frankie D. Lemus, MA, LMFT
Senior Vice President of Clinical Development
The Change Companies ®
I hope these responses helped, but feel free to contact Bill and Frankie directly.
Here are great resources to help build knowledge and application skills in treating those with trauma-related disorders:
1. Treatment Improvement Protocol of Substance Abuseand Mental Health Services Administration (SAMHSA). TIP 57: “Trauma-Informed Care in Behavioral Health Services” – Assists behavioral health professionals in understanding the impact and consequences for those who experience trauma. Discusses patient assessment, treatment planning strategies that support recovery, and building a trauma-informed care workforce.
Pub ID: SMA14-4816; Publication Date: 3/2014
2. Interactive Journals from The Change Companies
Trauma In Life – (Women’s Specific version) Developed with the Federal Bureau of Prisons for their 16 hour workshop offered through their Resolve Programming. It is focused on risk and resiliency.
Traumatic Stress &Resilience – (Men’s Specific version)- Developed with the Federal Bureau of Prisons for their 16 hour workshop offered through their Resolve Programming. It is focused on riskand resiliency.
Coming Home Series – It is transition focused but also explores PTSD and has some great self-management resources in itfor those dealing with Trauma.
Self-Management Journals– although not ‘specific’ to trauma have great resources in there for individuals with Trauma
Until next time
|Have a great summer (if you are on the northern hemisphere). See you again in late July.