The value of the details of trauma

August 29, 2020

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There's a division in therapeutic circles—should we focus on the details or trauma or not?

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This is a scholium: a short commentary on something interesting.


As a follow up to an article about our problematic fixation on 'repressed memories', I thought it might be useful to highlight a debate that often surfaces in therapeutic circles about approaches to trauma-based therapy.

Feedback has mostly been questions around the therapeutic usefulness of concentrating on the details of a traumatic event. Therapists are also a little divided on the issue.

A good example of this division is the academic romance between existentially-oriented psychiatrists Irvin Yalom and David Spiegel. I'll cut a segment from a study that originated from their professional interactions. Pay attention to the difference between Yalom's preference for a focus on the present and Spiegel's focus on the trauma.

Also note that the sexy trend at the moment is trauma-focused cognitive-behavioural therapy, given it's great success with young people. This approach emphasises both present and trauma to a greater or lesser extent depending on the therapist, though these highly specified types of therapy have their drawbacks too. See for example Spiegel's recent comments on that. Regardless, the most important thing by far, in any therapeutic approach, is the relationship between the therapist (or members of one's social circle) and client.

Here's the excerpt:

The best means for therapeutically addressing these ill effects is still a matter of scientific investigation. Indeed, the impetus for this study comes from a friendly disagreement between Irvin Yalom and David Spiegel, two master therapists, regarding the most effective approach to treating adult female survivors of childhood sexual abuse.

Yalom’s view is that, although the survivor’s abuse history may explain much of why the survivor has adapted as she has, examining and understanding that history is not necessary to her recovery. Instead the therapeutic focus is on examining current functioning, illuminating in the here-and-now...maladaptive expectations and behaviors that undermine current functioning, and beginning to learn new ways of interacting and experiencing...

One important goal of present-focused therapy is that the survivor develop an awareness of current maladaptive interaction styles that may have originated with the abuse, although it is not necessary that she be conscious of that fact...

In contrast, Speigel’s view is that successful treatment requires activation of the traumatic material, exploration of the memories and their associated affects and meanings, investigation of the links between early experiences and current difficulties, and a restructuring of the survivor’s understanding of these events so that they no longer distort her current experience and functioning...

The fundamental assumption underlying trauma-focused group therapy is that it is vital for successful treatment that the adult survivor explore and restructure her memories of the abuse.

[A Treatment Manual for Present-Focused and Trauma-Focused Group Therapies][5]

Regardless, both methods emphasise a focus on emotion, which I maintain is the priority.

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