Medicine:Trauma-informed feminist therapy

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Short description: Therapy model

In psychology, Trauma-informed feminist therapy is a model of trauma for both men and women that incorporates the client's sociopolitical context.

In feminist therapy, the therapist views the client's trauma experience through a sociopolitical lens. In other words, the therapist must consider how the client's social and political environment could have contributed to their trauma or perpetuated it. Feminist theory argues that certain traumas are produced and maintained by institutionalized discrimination and social hierarchies.[1]

Background

The diagnosis of Post-traumatic stress disorder, or PTSD, was first recognized in 1980 and published in the third edition of the Diagnostic and Statistical Manual of Mental Disorders.[2][3] The original PTSD diagnosis was formulated to fit the symptomology of veterans returning home from combat.

Feminist psychologists modified the diagnosis when treating patients with exposure to childhood sexual assault, chronic abuse, and gender-based trauma.[4] Trauma-informed feminist therapy challenged both the traditional conceptualization of the PTSD diagnosis, as well as the overall standard approach to trauma treatment, by proposing new models of trauma that incorporate sociopolitical context.[5]

Feminist therapy began in the 1960s during the second wave of feminism. According to its proponents, a sexist power structure in American psychotherapy was harmful to women suffering trauma. Initially, groups of women began to meet at leader-less "consciousness-raising," meetings where women shared their experiences with sexism in therapy. Many women evoked opinions that oppressive cultural norms affect mental health. To them, the groups acted as a way to both draw attention to the oppression within the mental health system, as well as a way to empower women.[6]

The original consciousness-raising meetings evolved into an integrated set of principles to be applied in therapy. Today, feminist therapy has expanded to reflect the ideas of the third wave of feminism, that the patriarchy is harmful to both men and women.[7] Another part of feminist therapy is a focus on social justice issues for people, regardless of their gender, culture, sexuality, social class, phenotype, or national origin.[8]

Feminist models of trauma

Feminist theory argues that certain traumas are produced and maintained by institutionalized discrimination and social hierarchies [1] Root (1992) coined the term "insidious traumatization," to describe the distress that builds when one is the member of a marginalized group and subjected to constant threat of discrimination.[9] Exposure to insidious trauma is thought to creates both unique vulnerabilities and unique strengths. Feminist theory argues that insidious traumatization can lead to full blown PTSD symptoms.[10]

Freyd (1996) expanded the idea of insidious traumatization to include the term "betrayal trauma," to describe the specific kind of trauma that occurs when a child is abused by their caregivers; Feminist theory argues that betrayal trauma is inherently different from single-incident trauma, mainly because betrayal trauma tends to manifest specifically as interpersonal difficulties and dissociative symptoms, while traditional intrusive symptoms are usually not present.[11]

Trauma diagnosis within feminist therapy framework

Overall, feminist theory argues against the use of diagnoses, except in instances where a diagnosis would assist the service user in gaining access to mental health care.[12] Feminist therapy aims to move away from pathologizing responses to trauma in favor of framing responses as "survival techniques."

For example, in regard to diagnoses that relate to trauma, feminist theory takes issue with the diagnosis Borderline Personality Disorder (BPD), a disorder that is often linked to severe childhood trauma.[13] Feminist theory posits that a diagnosis of BPD, unnecessarily pathologizes normative and adaptive responses to betrayal trauma.[14]

In addition, feminist theory argues that chronic exposure to inescapable trauma, such as childhood abuse, is better captured by the diagnosis of Complex Post-Traumatic Stress Disorder (CPTSD);[15] CPTSD has been proposed as an alternative diagnosis for those responding to sever trauma with BPD-like symptoms, in an attempt to view symptoms as a survival response as opposed to a personality disorder.

Trauma treatment with feminist therapy framework

Trauma-informed feminist therapy encourages therapists to take an eclectic approach to trauma treatment, allowing the service user to be the expert of their own experience.[16][17] Feminist therapy seeks to break down what it terms the inherent power differential between clinician and client, by actively constructing an egalitarian relationship.[18]

In addition, feminist therapists strive to understand their client's experience with trauma by acknowledging and exploring how social structure influenced the trauma.[19] Trauma-informed feminist therapy argues that successful treatment is not about creating an absence of symptoms; instead feminist therapy aims to assist trauma survivors in creating a non-blaming view of their traumatic experience from which they can gain a sense of empowerment.[20]

References

  1. ↑ 1.0 1.1 Evans, Kathy M.; Kincade, Elizabeth A.; Marbley, Aretha F.; Seem, Susan R. (July 2005). "Feminism and Feminist Therapy: Lessons From the Past and Hopes for the Future". Journal of Counseling & Development 83 (3): 269–277. doi:10.1002/j.1556-6678.2005.tb00342.x. ISSN 0748-9633. http://dx.doi.org/10.1002/j.1556-6678.2005.tb00342.x. 
  2. ↑ American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 2011 
  3. ↑ Tseris, Emma Jane (2013-04-22). "Trauma Theory Without Feminism? Evaluating Contemporary Understandings of Traumatized Women". Affilia 28 (2): 153–164. doi:10.1177/0886109913485707. ISSN 0886-1099. http://dx.doi.org/10.1177/0886109913485707. 
  4. ↑ Blumer, Markie L. C.; Papaj, Aubree K.; Erolin, Kara S. (April 2013). "Feminist Family Therapy for Treating Female Survivors of Childhood Sexual Abuse". Journal of Feminist Family Therapy 25 (2): 65–79. doi:10.1080/08952833.2013.777871. ISSN 0895-2833. http://dx.doi.org/10.1080/08952833.2013.777871. 
  5. ↑ Brown, Laura S. (2004). "Feminist paradigms of trauma treatment.". Psychotherapy: Theory, Research, Practice, Training 41 (4): 464–471. doi:10.1037/0033-3204.41.4.464. ISSN 1939-1536. http://dx.doi.org/10.1037/0033-3204.41.4.464. 
  6. ↑ Burstow, Bonnie (November 2003). "Toward a Radical Understanding of Trauma and Trauma Work". Violence Against Women 9 (11): 1293–1317. doi:10.1177/1077801203255555. ISSN 1077-8012. http://dx.doi.org/10.1177/1077801203255555. 
  7. ↑ Webster, Denise C.; Dunn, Erin C. (2005-09-14). "Feminist Perspectives on Trauma". Women & Therapy 28 (3–4): 111–142. doi:10.1300/j015v28n03_06. ISSN 0270-3149. http://dx.doi.org/10.1300/j015v28n03_06. 
  8. ↑ Frew, Jon (2012-05-04). Frew, Jon; Spiegler, Michael D. eds. Contemporary Psychotherapies for a Diverse World. doi:10.4324/9780203802045. ISBN 9781136624070. http://dx.doi.org/10.4324/9780203802045. 
  9. ↑ Root, M.P.. "Reconstructing the impact of trauma on personality.". Personality and Psychopathology: Feminist Reappraisals: 229–265. 
  10. ↑ Burstow, Bonnie (2005). "A Critique of Posttraumatic Stress Disorder and the DSM.". Journal of Humanistic Psychology 45 (4): 429–445. doi:10.1177/0022167805280265. 
  11. ↑ Freyd, Jennifer (1996). Betrayal trauma: The logic of forgetting childhood abuse. Harvard University Press. 
  12. ↑ Cohen, Jacqueline N. (2008). "Using feminist, emotion-focused, and developmental approaches to enhance cognitive-behavioral therapies for posttraumatic stress disorder related to childhood sexual abuse.". Psychotherapy: Theory, Research, Practice, Training 45 (2): 227–246. doi:10.1037/0033-3204.45.2.227. ISSN 1939-1536. PMID 22122419. http://dx.doi.org/10.1037/0033-3204.45.2.227. 
  13. ↑ Alafia, J.; Manjula, M. (May 2020). "Emotion Dysregulation and Early Trauma in Borderline Personality Disorder: An Exploratory Study". Indian Journal of Psychological Medicine 42 (3): 290–298. doi:10.4103/ijpsym.ijpsym_512_18. ISSN 0253-7176. PMID 32612335. 
  14. ↑ Kline, N. K., & Palm Reed, K. M. (2018). "Betrayal vs. nonbetrayal trauma: Examining the different effects of social support and emotion regulation on PTSD symptom severity.". Psychological Trauma: Theory, Research, Practice and Policy 28 (2): 441–462. 
  15. ↑ Courtois, Christine A. (2012-09-19). "Feminist Multicultural Counseling with Traumatized Individuals". Oxford Handbooks Online: 373–391. doi:10.1093/oxfordhb/9780199744220.013.0020. ISBN 978-0199744220. http://dx.doi.org/10.1093/oxfordhb/9780199744220.013.0020. 
  16. ↑ Israeli, Anne L; Santor, Darcy A (September 2000). "Reviewing effective components of feminist therapy". Counselling Psychology Quarterly 13 (3): 233–247. doi:10.1080/095150700300091820. ISSN 0951-5070. http://dx.doi.org/10.1080/095150700300091820. 
  17. ↑ Harvey, Mary R. (2007-03-09). "Towards an Ecological Understanding of Resilience in Trauma Survivors". Journal of Aggression, Maltreatment & Trauma 14 (1–2): 9–32. doi:10.1300/j146v14n01_02. ISSN 1092-6771. http://dx.doi.org/10.1300/j146v14n01_02. 
  18. ↑ Williams, Elizabeth Nutt; Enns, Carolyn Zerbe, eds (2012-09-19). The Oxford Handbook of Feminist Multicultural Counseling Psychology. Oxford University Press. doi:10.1093/oxfordhb/9780199744220.001.0001. ISBN 978-0-19-974422-0. http://dx.doi.org/10.1093/oxfordhb/9780199744220.001.0001. 
  19. ↑ Richmond, Katherine; Burnes, Theodore R.; Singh, Anneliese A.; Ferrara, Mel (2017), "Assessment and treatment of trauma with TGNC clients: A feminist approach.", Affirmative counseling and psychological practice with transgender and gender nonconforming clients. (Washington: American Psychological Association): pp. 191–212, doi:10.1037/14957-010, ISBN 978-1-4338-2300-8, http://dx.doi.org/10.1037/14957-010, retrieved 2020-11-25 
  20. ↑ Richmond, Kate; Geiger, Elizabeth; Reed, Carly (2013-09-19). "The Personal is Political". Clinical Case Studies 12 (6): 443–456. doi:10.1177/1534650113500563. ISSN 1534-6501. http://dx.doi.org/10.1177/1534650113500563. 



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