Home Clinical Psychology & Psychotherapy Ashamed but not Alone: Trauma Therapy Can Help with the Healing Process

Ashamed but not Alone: Trauma Therapy Can Help with the Healing Process

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There were questions at the time as to why the death of Sarah Everard evoked such a strong outpouring from women across the UK, including public displays of solidarity by a member of the Royal family attending the vigil-memorial set up for her immediately after her death. In similar ways, the disappearance and death of Gabby Petito has created strong resonances in women and strong defensive reactions in men. Putting aside intersectional concerns raised about institutional racism matters in reporting the deaths of certain women and not others, there are strong psychological factors involved in the identification with the issues of both these young women around trauma responses finding a voice. This is also true of trauma responses that remain untreated and debilitating. 

Subsequently, discovering this ‘stranger’ attack was perpetrated by a male police officer raised the identification as it then moved into the dynamics of abuse of a position of trust. This is the most common experience of sexual violence and violence to women; the perpetrator will have been in some position of trust as either a family member or intimate partner. Psychologically the impact is the same. In fact, the victim blaming that is associated with domestic abuse and intimate partner violence and or the rape of women, occurred soon after with a politician suggesting Sarah should have challenged the arrest more strongly. 

Shame and trauma

Trauma treatment for intimate partner sexual violence and intimate partner abuse (the main trauma women, girls and more broadly children of all genders experience), has been challenging for psychological therapies because of the existence of shame. Shame has for a long been a red flag in the use of gold standard trauma therapies such as EMDR. This means where significant shame exists the use of trauma therapy is ‘contra-indicated’, we as professionals are not supposed to use the treatment because of the risk of the patient of the side effects from the treatment being dangerous, such as increased risk of self-harm or suicide, this means that treatment cannot be administered. Shame is often weaponised by the perpetrator as a means of control, and shame is reinforced culturally through victim blaming. 

It should also be noted that definitions of trauma, posttraumatic stress disorder (PTSD) and clinical treatments have mostly been framed through the experience of (largely) men in occupations such as being a soldier or first responder. There are issues involved in that type of trauma which don’t deal with the gender specific issues women face. As is often the case the gender specific issues for men and trauma are not seen as gender specific but are viewed as what trauma is. Everything else is viewed through that assumptive frame. It’s usually the case that gender specific female and age-specific child trauma far outstrips that of male experiences because of the prevalence of sexual violence and intimate partner violence. Additionally, if you include the trauma experienced by sex workers who are predominantly female, rates of gender specific trauma in women are much greater than those for men.

Shame and disgust

In my clinical practice with women and child victims of the rape camps set up during the Balkan’s conflicts in the early and middles 1990s, we were at a loss as to help due to the existence of shame. Shame as a response is intimately linked to disgust. Disgust is a visceral physical response indicating we should avoid something. We feel disgust and the need to vomit in the face of rotten food, the sight of mangled bodies in a car crash etc. These are natural disgust and shame responses to things and events we really should avoid.  Shame is the ultimate move away emotion. All effective gold standard trauma treatments involve safely looking at the trauma and reprocessing it. So, trauma therapy asks the patient to do the opposite of their shame, to move toward and experience that which is labelled toxic and disgusting emotionally and reprocess the experience. And additionally, to do this whilst there remains threat to the patient from a society that is invested in keeping the patient in their proper place of coerced control. 

Making a victim responsible for the dreadful things that occurred to them via shaming is simply a form of control. In the rape camps women were not killed, but released, often pregnant with child from their rapists, as a message of control. The use of rape as a method of war in this way has been recorded from the time we have been recording war as an event. Boudica, the ancient British Queen, was forced to witness the public rape of her daughters as a means of political control via shaming. The women released from the rape camps in the Balkans faced ostracism and shaming from their own cultures and in many cases the threat of honour killings because of the shame they had brought on to their families for surviving the rape. 

Shame is an essential component in sexual trauma and trauma from intimate partner abuse. It is part of the lexicon of control by the rapist and or abuser. It’s important to remember that stranger attacks are the oddity not the norm in sexual violence. Wayne Couzens abused his position as a police officer to subdue, rape and kill Sarah Everard. He abused the psychological position of authority figure (parent) to kill. Psychologically it’s a father killing a daughter.

It’s on balance of probabilities the case that Gabby Petito’s last chance of being saved from her killer was in the iconic footage of her in the back of a police car being grateful to a male police officer for not arresting her or the man who probably would end her life. Of course, that court case has not happened but given that over three-quarters of deaths in intimate partner homicides are women (current or ex-partners). Psychologically, the ‘dad’ – male authority figure – handed her back to the person that statistics tell us is most likely to have been her killer. Her response was to be thankful and to blame herself for the issues because of her OCD about dirt in the van she shared with him. She displayed classic signs of trauma victimisation. As well as classic signs of how a victim will protect their perpetrator from being in any way blamed. This is because the perpetrator will act out aggressively and violently against the victim if the victim suggests the perpetrator is in any way to blame. The authority figure in the form of the police officer bought the victim’s symptoms of trauma on face value and despite overwhelming evidence to the contrary, accepted the situation at face values assessing it a mental health issue. Yet, psychological therapies still struggle with the most common experiences of women that produce trauma – shame, self-blame, fear, isolation, control (obsessive-compulsive disorder) to avoid assault through triggering her abuser into a rage.

Trauma therapy

Shame leaves us afraid and alone. The response of women to identify with Sarah and with Gabby is to say I might be in shame, but I won’t be alone. That is therapy in action. A world-renowned trauma therapist, Bessel Van De Kolk, argues that trauma therapy can only be seen as helpful if it enables the patient to do life again. It’s clear that collective action that supports women doing life (the Sarah Everard vigil) is also trauma therapy. In my personal and professional life, I know very few women who have not experienced sexual violence and or other forms of intimate partner violence, who don’t carry shame and self-victimisation from those experiences. As an adult survivor of childhood intimate partner violence and abuse, I can identify with this shame and isolation and self-blame. 

Therapy is limited by the framework of patriarchal assumptions and limitations. In the treatment of the victims of the Bosnian rape camps we were hindered by the lack of legal protection. Victims of organised rape used as a method of war could not claim refugee status at that point. It took collective political and clinical work by psychiatrists and other mental health specialists working with refugee rape victims, which is detailed in the seminal book Rape as A Method of Torture, to change the law to allow the women and child victims of these atrocities’ legal safety. They cannot be returned to their rapists and murderers. Unlike say Gabby Petito for example who was returned to her killer it seems.

The Met must provide protection

Therefore, the Met need to have their feet held firmly to the fire in these issues of rape and intimate partner violence. They must act as good authority (responsible parents), not as neglectful and often abusive parents (authority figures). Wayne Couzens stands as a metaphor for the ongoing failure to provide protection. The lack of insight into policing the vigil for Sarah Everard as a public protection matter rather than a coronavirus regulations response is profoundly sad. 

Ensuring the shamed traumatised no longer feel alone is the most important first step in healing. We can’t heal without a safe space. It’s the most fundamental technique used in gold standard trauma therapies. Help the patient develop a psychological safe space where they can go when they feel afraid. 

Noel McDermott is a psychotherapist with over 25 years’ experience in health, social care, and education.

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