Families and trauma

Trauma doesn't occur in a vacuum, and neither do the symptoms related to past trauma and abuse. Families are affected in a number of ways, and this post presents some current thinking on the topic. The articles referenced are listed at bottom, and numbered in the text.

Trauma therapy for individuals strives to not only help people to locate and relieve disturbing symptoms, but to find positive motivations in the present to move forward. It's not much different with families. With families, one family member's traumatic experience may lead to difficult family issues, or the entire family may be dealing with a trauma together, such as the loss of a loved one, or a car accident.

There is a "golden window" of opportunity for a family experiencing a trauma, in which the family is strained to the point that seeking help is desirable. If you are in this position, take heart. Families who seek therapy at the height of a crisis most often make not only "first-order change" (getting over the crisis), but also "second order change" (greater closeness, improved ability to deal with stress). And research shows that this is much more likely when families see a family therapist (5). Marriage and Family Therapists have special training to work within families both as groups and individuals, leading to more meaningful therapy (1)

People with PTSD can be hard to live with for any number of reasons, such as severe irritability and anger, disturbing symptoms like flashbacks and panic attacks, or the lack of ability to return to normal (which may mean work that keeps the family afloat). Research demonstrates what common sense would expect: people with PTSD most often don't seek treatment unless they feel safe and supported (3). This becomes a "catch-22," which can only be solved by family therapy. The family has to own the trauma of the one member and make the right choice to seek help together.

A family's way of coping with a traumatic event was first described in 1949 by the "father of family trauma therapy," Dr. R. Hill, who studied the families of returning WWII veterans. Dr. Hill called his model "ABC-X," in which A represents the stressful event, B represents the family's existing resources (emotional and otherwise) for dealing with the event, and C represents the family's perception of the stressor. Lastly, X is the result of adding these up--the likelihood that the family will go into crisis mode (4). This model shows how families who are under financial or other strain are more likely to suffer a bad crisis, and explains why families already dealing with one traumatic event are more likely to be traumatized again and again. But it also shows that regardless of family strength, if A (the event) is bad enough, there can be serious consequences.

A more recent discovery is that when there is a community disaster, such as Hurricane Katrina, rescue and clean-up are only the beginning. After such an event, there is a significant increase in family violence, psychological abuse, and child neglect (2). Entire neighborhoods can be thrown into chaos, and while buildings may be rebuilt, the worst trauma can come from within the family itself. This principle holds true for any family stressor--the resulting imbalance can be shifted onto other family members in terrible ways.

Family therapists help families to draw on their existing emotional resources, which they may have forgotten due to shock or grief. Family therapists help families to reframe a crisis as working together to solve a challenge (3). Therapists may work with an individual, primarily, and supplement with some family sessions. Or, therapists may work with each family member individually with some family sessions--or simply work with the family all together. Knowing what to do is why seeking out a family therapist is important. The family has the power to heal. Someone treated individually who goes back home to a hostile family is unlikely to maintain change. But even with very basic, brief therapy, I have seen levels of family, community, and spiritual support that prevent an individual from developing a traumatic disorder, even when the event was horrible and self-blame seemed inevitable. Family therapists can work magic, but 90% of the time we work with existing family strengths that are hidden under crisis.

The fact is, traumatized individuals within functioning families, and functioning families who undergo a shared trauma, are the most likely to notice the need for help early on (3). The family, in other words, can be like a smoke alarm that brings aid before the fire spreads to the whole house.

What should you do? Talk it through if possible to define the problem, and then consult a family therapist trained in trauma therapy. We aren't hard to find. You can search for family therapists at www.AAMFT.org, and look at their specialties.

One last note, and it's an important one. All too often, a family member is the perpetrator of violence or abuse, and may or may not still be in the house, or seen at family events. Families can react poorly in two ways. First, I have seen families cope by collectively forgetting, leaving the victim feeling like the problem. Second, the offending family member may be thrown out of the family by divorce or legal means, leading to a sense of justice, but the victim's trauma symptoms may not be validated.

Thankfully, the family's "fire alarm," as I described it, does not depend on the entire family hearing it. It may be one family member who initiates change and brings the willing members together to solve the crisis. That person may be you!

References:

1) Figley, C. R. (1989). Helping traumatized families. San Francisco: Jossey-Bass.

2) Figley, C. R. (Ed.) (1997). Burnout in families. New York: CRC Press

3) Figley, C. R. (2000). Post-Traumatic Stress Disorder. AAMFT Clinical Updates, 2(5).

4) Hill, R. (1958). Generic features of families under stress. Social Casework, 40, 139-150.

5) Riggs, D. S. (2000). Marital and family therapy. In E. B. Foa, T. M. Keane, & M. J. Friedman (Eds.), Effective treatments for PTSD: Practice guidelines from the international society for traumatic stress studies (pp. 280-301). NY: Guilford.