Intergenerational Trauma: The Ghosts of Times Past (5 page)

REBT makes several assumptions about the way that human processes and functioning. The approach views thinking, emotion, and action as process that are separate but have significant overlap. Emotion is viewed as a strong and persuasive type of thought process. Behaviors and emotion have impacts on the way in which an individual thinks. In turn, thought and emotion create biases that have an impact and direct the behaviors that an individual performs. As a result of this interplay among the three elements of thought, emotion, and behavior, an individual will develop constructive and helpful belief systems about themselves and their environment, or they will create maladaptive belief systems that cause dysfunction and impairment in their lives.

REBT utilizes the theoretical framework of changing an individual’s behaviors that is found in Systematic Desensitization to attempt to change the thinking of an individual about a trigger. When individuals develop a dysfunctional belief system involving triggers, they “catastrophize” the effect of the trigger. In this case, the trigger creates the anxiety-related reaction that releases hormones into their body system and creates the negative experiences associated with PTSD and other disorders. Through REBT, the therapist attempts to re-structure the individual’s belief system and re-frame their view of the triggers as items not related to catastrophic consequences. In changing the individual’s belief system, their thought process is then changed. The thought process then has an impact on the behaviors that the individual performs and also an impact on the emotions that are experienced in correlation with the trigger.

REBT is one of the most investigated approaches to psychotherapy and has a large body of supporting research to its efficacy. It is, however, not without its limitations and critiques. Many have criticized REBT for being very formula driven in how it is applied. There have many some studies that have produced lackluster results regarding the efficacy of REBT treatments being as low as
thirty percent. Even though there have been several critics of the approach, there are still a large number of practitioners who utilize this approach in the treatment of stress-related and trauma-related disorders.

CBT was a psychotherapy that was originally developed to treat depression, but it has since been used to treat a number of disorders and conditions including trauma-related disorders. Throughout the six steps of CBT, individuals will identify critical behaviors relating their disorder, determine if the behaviors are excesses or deficits, determine what their baseline is for the behaviors, and attempt to increase or decrease the targeted behaviors. CBT consists of six phases which include the following: assessment, reconceptualization, skills acquisition, skill consolidation, maintenance, and follow-up. Similar to REBT, CBT was developed through the view that core beliefs are developed through the interaction of thoughts, behaviors, and feelings.

In the early 1980s, a variation of CBT was developed that focused on trauma-related disorders and was especially designed to focus on trauma in children. This variation of CBT is called Trauma Focused Cognitive Behavior Therapy (TF-CBT). Trauma
Focused CBT approaches treatment by considering not only the individual’s thoughts, behaviors and feelings but also the understanding of the individual’s parents and family. This approach served to be one of the first approaches to take into consideration the impact of trauma upon multiple generations. TF-CBT was not designed specifically to focus on the transmission of trauma across generation, but it did address some of the elements that relate to trauma transmission. Throughout therapy, there are some elements that are specific to the child, some that are specific to the parent, and there are some that are jointly applicable to both.

There are eight elements of Trauma Focused CBT. The first element revolved around psychoeducation and parenting skills. This phase focuses on discussion and education about trauma in general and the typical reactions that one can expect as a result of traumatic experience among individuals. During this first phase, the parents receive training on appropriate behavior management techniques and parenting practices that are effective when working with children who have experienced trauma. The second phase involves the development of relaxation techniques. This stages focuses on teaching the child and parents both techniques such as breathing techniques, progressive muscle relaxation, and visual imagery. It is important for the parents to be trained in the relaxation techniques in order to provide support to the child during the implementation of such techniques.

The third phase involves affect expression and regulation. This stage helps the child and parent develop skills and strategies regarding the regulation of emotional reactions that the child may have when presented with reminders of the trauma. In young children, this stage is very important as children have not fully developed the ability to control emotional outbursts. If a parent responds inappropriately to a child’s outburst as the result of a trauma trigger, the child may then be further traumatized. In the fourth stage, the therapist helps parents and child understand the cognitive processes that are different in individuals exposed to trauma. During this phase, the family explores the relationships between thoughts, emotions, and actions. In exploring the connections, the family attempts to identify inaccurate connections and provide corrections to the inaccurate concepts that the individuals have developed.

The fifth stage is the trauma narrative and processing stage. This phase begins gradual exposure exercises in which the child will give a narrative of the trauma either verbally, written, or using symbolic representation. During the narrative, the therapist and supporting individuals (i.e. the parents, etc.) will identify concepts and beliefs that may be harmful along with connections that individual has made between the trauma and triggers. In addition to identifying harmful beliefs, the therapist will attempt restructure the individual’s harmful beliefs through discussion about the connections the individual may have developed. This process is similar to the disputing phase in REBT treatments. Stage six is the
in vivo
exposure stage.
In vivo
means a live exposure. As the name suggests, the individual is then gradually exposed to live triggers in way that is similar to Systematic Desensitization. This stage aids the individual in learning to control their stress reactions to the triggers in a gradual and safe manner under the supervision of mental health professional.

Stage seven is conjoint stage for parents and children. In this stage, the family works together to enhance their communication about trauma-related issues and create opportunities for healthy discussions about the trauma between the parent and child. It is very important for the family to have a plan in place to be able to discuss the trauma at a later time if needed. Silence often serves to increase the pressure that wells up inside trauma survivors. The final and eight stage of treatment focuses on future growth and further enhancing well-being. The final stage provides the family with information on available resources and provides encouragement for continued maintenance of the skills that were developed throughout therapy.

Trauma-Focused CBT has been proven to be effective in many situations related to trauma. Since the approach is directed towards the treatment of children, the studies have examined its effectiveness in treating the symptoms of PTSD in children. There have over a dozen studies conducted to examine the efficacy of TF-CBT. The studies have found that individuals who have undergone treatment have experienced reductions in anxiety, depression, behavior problems, inappropriate sexualized behavior, and trauma-related shame. Additionally, the studies have found increases in resiliency, trust, interpersonal skills, coping skills, and improved safety skills.

In addition to the therapies that have traditionally been used to treat Post Traumatic Stress Disorder, there have been a few approaches developed in more recent years that focus specifically on Intergenerational Trauma. The intergenerational trauma treatment model (ITTM) was developed as a program that treats not only the trauma that a child may have experienced but also unresolved trauma that a parent may have experienced.  This treatment model attempts address the trauma experienced by two different generations simultaneously by focusing on not only the individual’s processing of trauma but also the interaction between the parent and child. ITTM incorporates many of the practices of CBT along with activities that focus on the attachment between the parent and the child, parenting skills, affect regulation, and development of competency on the parents’ part to handle daily living and life events. The program typically consist of 21 sessions and homework assignments for the parents. The program has been proven to produce results through several clinical reviews conducted.

In addition to therapy, social changes have come about in an attempt to address the causes of large scale historical trauma. These changes have been brought about through legislative changes and changes on societal views of intergenerational trauma. As the issue of intergenerational trauma has gained attention, it has begun to be validated by society as a real issue that has impacted millions of individuals. For the majority of history, such an issue as historical trauma was viewed as being a common thread to many cultures that could simply be forgotten or overlooked, and it would go away and be forgotten. Often it was viewed as “just the way thing are.” Even in more recent times, the issue was viewed as being an issue that society could not change because it was in the past. To affect change, one must note that a problem exists and that change can and should occur.

              Over the past several decades, there have been a variety of other therapeutic interventions developed and used in the treatment of trauma. The efficacy any practices have not been fully examined in relation to the effects on intergenerational trauma, but as the issue becomes more recognized by society, more studies have begun to focus on intergenerational trauma. Until recently, societal views and focuses have failed to acknowledge and address the impacts of trauma from past generations. The changes in societal views truly be seen as having occurred in the last forty years.

Several policies have been adopted worldwide to address large scale historical traumas. In 1948, the United Nations adopted the Universal Declaration on Human Rights in response to the atrocities that occurred during the Holocaust. Numerous policies regarding human rights that have been enacted have cited the events of the Holocaust. In 1978, the US federal government made changes to its policies regarding the treatment of Native American children by passing the Indian Child Welfare Act (ICWA). ICWA has made attempts to preserve Native American families and culture. This change in policy allowed for state and federal officials to provide services to address the cycles of trauma that had been occurring among Native American families for generations. By enacting legislation and policy to address past traumas of people, many surviving generations are provided with some hope for the prevention of future trauma. This alone does not address the past trauma but does serve as a stepping stone to treatment for many individuals.