The Benefits of a Trauma-Sensitive Approach to Healing Shame
Moving from Self-Criticism to Self-Understanding
Posted Jul 16, 2015
The events of childhood do not pass, but repeat themselves like seasons of the year.
As I have written previously, I believe that self-compassion is the antidote to debilitating shame. In a program I developed called The Compassion Cure, I have identified five components to self-compassion as it applies to those who were abused in childhood and the overwhelming shame that is inherent in that abuse. These five components include: 1) self-understanding, 2) self-forgiveness, 3) self-acceptance, 4) self-kindness, and 5) self-encouragement.
Kristin Neff was one of the first people to do research on self-compassion. Based on that research, and drawing from social psychology and Buddhist tradition, she divided self-compassion into three core components: self-kindness, common humanity, and mindfulness. “First, it requires self-kindness, that we be gentle and understanding with ourselves rather than harshly critical and judgmental. Second, it requires recognition of our common humanity, feeling connected with others in the experience of life rather than feeling isolated and alienated by our suffering. Third, it requires mindfulness—that we hold our experience in balanced awareness, rather than ignoring our pain or exaggerating it. We must achieve and combine these three essential elements in order to be truly self-compassionate.” (Neff 2011, 41)
I agree that for the average person these three components are essential in order to become truly self-compassionate. But based on my years spent specializing in working with both victims and abusers, I believe the situation is somewhat different for victims of child abuse.
First, due to the amount of debilitating shame victims of child abuse experience, being able to practice self-kindness is extremely difficult. I would go so far as to say that practicing self-kindness is nearly impossible for many former victims until they first decrease the amount of shame they experience. This is because most victims don’t believe they deserve self-kindness.
Therefore, in order for you to be willing and/or able to begin to practice self-kindness, you will need to practice what I consider to be three prerequisites: self-understanding, self-forgiveness, and self-acceptance. Without these prerequisites, most former victims of child abuse will have neither the motivation nor the ability to practice self-kindness. Once former victims come to better understand that they were not to blame for the abuse and to realize that many of the negative behaviors they engaged in were the only way they could cope with the abuse and/or function in the world, they tend to be more likely to accept and forgive themselves. Then and only then will they truly begin to practice self-kindness.
Self-encouragement is an essential component of self-compassion for victims of child abuse, because without it you will likely slip back into old habits of judging yourself harshly and focusing on your so-called failures rather than your accomplishments.
While acknowledgment of their common humanity is important for former victims of child abuse, I believe that the experience of child abuse really does separate its victims from the general population. So while victims of child abuse do share experiences with everyone else in the world, they also have unique experiences that need to be addressed.
I incorporate the concepts of mindfulness and common humanity throughout my program. They support us through all our efforts to understand, forgive, accept, encourage, and be kind to ourselves as we grow in our ability to be self-compassionate.
Component No. 1: Self-Understanding
In this article I will focus on the first component of my model: self-understanding. Through self-understanding you can begin to view your symptoms and negative ways of coping, such as alcohol and drug abuse, overeating, self-harm, sexual acting out, and sexual addiction as attempts on your part to cope and as safety strategies. Only by gaining self-understanding will you be able to stop blaming yourself for the abuse and relieve yourself of the burden of being so critical and judgmental of yourself for the ways you have harmed yourself and others. Without self-understanding you will find it difficult if not impossible to practice the other four components of self-compassion.
Without self-understanding, those who were abused in childhood tend to continue putting themselves down for their mistakes and shortcomings instead of making the all-important connection between their current behavior and the abuse they experienced. I am not encouraging you to make excuses for problematic behavior, but without understanding why you have acted as you have, you will not only continue to experience debilitating shame and blame yourself unnecessarily, but you will have a more difficult time letting go of troubling behaviors.
Former victims of child abuse are particularly hard on themselves. They have unusually high expectations of themselves, and they chastise themselves unmercifully when they make mistakes, especially when their behavior harms another person. And they seldom, if ever, search compassionately for reasons why they may have behaved as they did. Instead, they tend to have a “no excuses” policy regarding their own behavior. (Interestingly, they often don’t have the same policy regarding the behavior of others, frequently making excuses for others’ insensitive or abusive behavior.)
This is very sad when you think about it. As a former victim of childhood abuse, you no doubt experienced sometimes horrendous pain and suffering at the hands of your parents or other adults, yet you not only won’t allow yourself to acknowledge your suffering but you expect yourself to walk away from the abuse unscathed—to move on with life without receiving any help or healing.
Unfortunately, there is a huge price to pay for this way of thinking. First, if you were a victim of childhood abuse, you were traumatized by the experience. You may not have been aware of it at the time, but you were. And you may not be aware of how the trauma affected you, but it did nevertheless. As a comparison, let’s say you were in a plane crash, and fortunately you could walk away and your physical injuries are now healed. But the experience of the crash was in itself traumatic. There were the moments leading up to the crash: the realization that your life was in danger, the fear of what was going to happen. Then the crash itself: the terror and pain of the physical impact, the overwhelming sights, sounds, and smells.
Even though you were able to walk away from the crash, you would expect to carry the experience of the trauma with you, right? You’d replay the crash over and over in your head, remembering everything you experienced throughout the whole episode. You might expect yourself to be in shock long after the trauma, and to suffer from post-traumatic stress symptoms—nightmares, fear of airplanes, even terror responses when you hear airplanes passing over you—for quite some time to come. It would make sense to you that you would have suffered emotional and psychic wounds as well as physical injuries.
The same is true of children who experience childhood abuse and/or neglect. In addition to debilitating shame, you have carried the memories of the trauma and the stress that these memories continue to create. And these post-traumatic symptoms take their toll.
I have often found myself explaining to clients that I have actually never met a victim of childhood abuse who didn’t react to the abuse with problematic behaviors—abusing alcohol or drugs, binging or purging, sexual acting out, sexual or other addictions, self-harm, abusive behavior toward loved ones, or a pattern of staying in abusive relationships. These behaviors just seem to come with the territory.
Instead of viewing yourself as a bad person because you have reacted to the trauma of your childhood abuse in sometimes troubling ways, you can will begin to understand your behavior better. This will in turn allow you to become less critical of yourself as you come to recognize that the negative things you have done do not represent who you are at your core. Rather, they are the ways you learned to cope with the trauma you experienced. Self-understanding will also help you begin to treat yourself in far more compassionate ways, and as you come to realize how common it is for victims to react as you have, you’ll feel less alone. Making the important connection between your current (and past) behavior and your trauma experiences will help you become more compassionate toward yourself and less impatient, judgmental, and angry about your behavior.
The most common effect of any type of abuse is post-traumatic stress disorder or PTSD. PTSD is a severe anxiety disorder with characteristic symptoms that develop after the experience of extreme trauma, such as the threat of severe injury or death to oneself or to someone else, or a violent assault on one’s own or someone else’s physical, sexual, or psychological integrity, overwhelming one’s ability to cope.
People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached and estranged, and these symptoms can be severe enough and last long enough to significantly impair the person’s daily life. PTSD is marked by clear biological changes as well as psychological symptoms. It is complicated by the fact that it frequently occurs in conjunction with related disorders such as depression, substance abuse, and problems of memory and cognition.
PTSD symptoms tend to fall into three major categories: re-experiencing, avoidance, and hyper-arousal. Re-experiencing symptoms include flashbacks (reliving the trauma over and over, often accompanied by physical symptoms like sweating or a racing heart), bad dreams, and frightening thoughts. Avoidance symptoms include avoiding places, events, or objects that are reminders of the experience; emotional numbness, strong guilt, depression, or worry; loss of interest in activities that were enjoyable in the past; trouble remembering the traumatic event. Hyper-arousal symptoms include being easily startled, feeling tense or on edge, difficulty sleeping, and having angry outbursts.
As you read the above, you may have been surprised to realize that many of the symptoms you suffer from are actually symptoms of PTSD, and that you may have been suffering from PTSD for years. This realization may bring you some comfort in that finally you’re able to understand some aspects of your behavior and explain it to others. This can be the beginning of your gaining self-compassion for your suffering.
In some cases of PTSD, the symptoms can actually become more debilitating than the trauma. For example, intrusive memories are mainly characterized by sensory episodes rather than thoughts. These episodes aggravate and maintain PTSD symptoms, since the individual re-experiences trauma as if it were happening in the present.
Many victims of childhood abuse can be diagnosed with PTSD, and many are plagued by these sensory episodes. For example, I had a client I will call Martha who frequently felt the presence of her brother, who brutally sexually abused her starting when she was 3 years old. Sometimes she would wake up in the middle of the night in terror because she thought she felt him sitting on her bed. Other times, when she was in the shower, she sensed him come into the bathroom. Each time these episodes occurred, Maria was re-traumatized by the experience. It’s no wonder people with PTSD look for any way possible to cope with these episodes.
The disorder is further associated with impairment of a person’s ability to function in social and family life, including occupational inability, marital problems, family discord, and difficulties in parenting. Those with PTSD are particularly vulnerable to repeating the cycle of violence for the following reasons:
1. Many people with PTSD turn to alcohol or drugs in an attempt to escape their symptoms.
2. Some characteristics of PTSD can create abusive behavior, including irritability (extreme oversensitivity to noise or minor stimuli), explosive behavior, and/or trouble modulating and controlling anger.
3. Some characteristics of PTSD can create victim-like behavior, including helplessness and passivity, self-blame and a sense of being tainted or evil, and attachment to trauma (relationships that resemble the original trauma are sought).
Not all victims of childhood abuse suffer from PTSD, but those who have experienced interpersonal victimization at home or in the community have been shown to be at a very high risk for PTSD. Studies have shown that childhood abuse (particularly sexual abuse) is a strong predictor of the lifetime likelihood of PTSD.
Children who are exposed to multiple and/or chronic traumas, usually of an interpersonal nature, suffer a unique set of symptoms that can differ somewhat from those of PTSD. These children suffer from serious behavioral, interpersonal, and functional problems, such as a disrupted ability to regulate their emotions, behavior, and attention. This phenomenon is known as complex trauma. Like those who suffer from PTSD, victims of complex trauma often attempt to cope with their problems by self-medicating, and thus often become alcoholics, drug addicts, or compulsive overeaters, or suffer from other addictions. Those who have experienced such trauma often repeat the cycle of abuse—either becoming abusers or continuing to be victimized. The name for this is intergenerational transmission of trauma.
Rates of major depression, anxiety disorders, substance abuse, and personality disorders are especially high among this group (even more so than among those who suffer from PTSD). Unless former victims are able to recover from the adverse effects of trauma, these effects may continue throughout their lives—most significantly in the area of interpersonal relationships.
In addition to suffering from most of the problems that those with PTSD suffer, victims of complex trauma tend to experience:
Extreme behaviors (self-injurious behaviors such as cutting, head banging);
Difficulties with sexual adjustment (confusion regarding gender or sexual preference);
Creating high-risk or painful situations in order to counteract feeling numb or dead inside (self-harming behaviors);
Sudden outbursts of anger;
Suicidal ideation or suicide attempts;
Extreme risk-taking behavior;
Re-enacting unhealthy relationships.
If you suffered multiple traumas in childhood (for example, you were neglected or emotionally abused by your parents, you were sexually abused as a child over several years’ time, and you were raped when you were an adolescent) you likely suffer from complex trauma. Note which items above describe your symptoms.
Trauma-Sensitive and Trauma-Informed Treatment
By treating yourself and your symptoms in trauma-sensitive and trauma-informed ways, you increase your ability to treat yourself in a more compassionate way. The terms trauma-sensitive and trauma-informed refer to more helpful and compassionate ways of perceiving the behavior of people who have been traumatized. A trauma-sensitive approach challenges the way we tend to look at trauma victims, encouraging them to treat themselves (and be treated by professionals) with more dignity, respect, and compassion than they usually do. The term trauma-informed implies that victims and service providers alike have been educated or trained in the consequences of trauma. It involves understanding, anticipating, and responding to the issues, expectations, and special needs of a person who has been traumatized.
The trauma-sensitive perspective frames many post-traumatic symptoms as understandable attempts to cope with or adapt to overwhelming circumstances, and is therefore more empathetic and more potentially empowering for victims.
The primary goal of a trauma-sensitive or trauma-informed approach is to help you better understand the role trauma has played in shaping your life. More specifically, there is a focus on helping you recognize that many of the behaviors you are most critical of in yourself (and are criticized for by others) are actually coping mechanisms or attempts at self-regulation. These include efforts to cope with high levels of anxiety (with smoking, drinking, and self-harm) and behaviors that result from an inability to self-soothe in a healthy way (alcohol and drug abuse, overeating).
Below are some of the principles of a trauma-informed way of thinking; I encourage you to recall these as you continue to focus on healing your shame and any other effects of the abuse you suffered.
The impact of trauma narrows a victim’s life, constricts her choices, and undermines self-esteem, taking away control, and creating a sense of hopelessness and helplessness.
Many behavioral problems former victims experience are actually adaptive responses to trauma. So symptoms—including troubling behaviors—need to be viewed as attempts to cope with past trauma and seen as adaptations rather than pathology.
Substance use and certain psychiatric symptoms may have evolved as coping strategies at a time when options were limited. Every symptom helped a former victim in the past and continues to help in the present, in some way.
The focus should be on what happened to the person rather than what is wrong with the person.
Former victims are doing the best they can at any given time to cope with the life-altering, frequently shattering aftereffects of trauma.
With this perspective, instead of blaming yourself for your efforts to manage traumatic reactions, you can begin to recognize the adaptive function of your symptoms. For example, drinking and other forms of substance abuse often arise out of a former victim’s efforts to cope with high, sometimes intolerable levels of anxiety. Recognizing this and having compassion for yourself is a significant step toward change. Next, you can focus on learning strategies that help you feel more comforted and in control, such as writing in a journal, taking a warm bath, applying a cool washcloth to your forehead, or practicing grounding exercises or deep breathing—all of which can help with self-soothing deficits.
The benefits of trauma-informed thinking include:
It transforms you from being “bad” to being hurt (or wounded), opening the door for a more empathetic, constructive attitude toward yourself.
It externalizes your problem. You can see yourself as basically good, with some problems that have intruded on your life but do not represent your core being—the symptoms are the problem, not you.
It normalizes. Former victims tend to feel they are not normal—bad, stigmatized, broken, sick. Trauma-informed thinking helps you see yourself as having normal and reasonable (understandable) reactions to unfortunate events.
It emphasizes strengths and resources. Because you’re likely to be critical of yourself, especially of the problematic ways you have sometimes behaved due to the abuse, it’s important to look for your strengths and give yourself credit for them.
It mobilizes victims to discover healthier and more productive coping strategies.
When you come to understand where the problem comes from, when you can feel compassion for your suffering, you will begin to feel more capable, more empowered to solve the problem, and have more hope for improvement.
Putting Your Behaviors in Context
It has been shown that negative self-concepts that develop as a result of traumas such as childhood abuse have the potential to persist throughout one’s lifespan (Cloitre et al, 2006). Subsequently, many adult survivors of childhood abuse engage in maladaptive coping strategies in order to modulate their lasting experience of distress and/or negative self-appraisals (Dawson, Grant, & Ruan, 2005; Sartor et al., 2008; Sub, Rufflins, Rubins, Albanese, & Khantzian, 2008).
For example, it has been proved that childhood abuse is directly related to alcohol dependence in adulthood:
“A history of childhood abuse has been consistently linked to heightened risk for adverse outcomes across the lifespan (Messman-Moore, Walsh & DiLillo, 2010), including a greater number of alcohol-related problems in adulthood" (Brems, Johnson, Neal, & Freeman, 2004; Downs, Capshaw, & Rindels, 2004; Enoch, 2011; Sartor, Agrawal, McCutcheon, Duncan, & Lynskey, 2008; Simpson & Miller, 2002).
Gaining a better understanding of why you have adopted certain behaviors as a way of coping with the abuse you experienced will lead to less shame about troubling or problematic behavior and allow you to feel less critical of yourself. The following exercise will help you build on your self-understanding.
Exercise: The Connection between the Abuse and Your Behaviors
1. Make a list of your most troubling behaviors—the things you have done that cause you the most shame (like abusing alcohol or drugs, sexual acting out, compulsive gambling, or abusive behavior).
2. Take a close look at each behavior and see if you can find the connection between the behavior and your abuse experiences. For example: “I drink alcohol as a way of self-medicating when I am in emotional pain.” Now tell yourself: “Given my history of abuse, it is understandable that I would behave like this.”
3. Once you have made this all-important connection and stated that it is an understandable one, check to see if you feel more compassion for yourself and your suffering.
4. The next time you find yourself behaving in an unhealthy or self-destructive way, instead of chastising yourself for the behavior (or for the desire to act in an unhealthy way), repeat the sentence above, or simply say to yourself, “I understand why I’m acting like this.” If possible, think of healthier ways to soothe yourself.
While some people are more resilient than others, the damage inflicted upon a victim of childhood abuse has long-term consequences, as we have discussed. Putting yourself down for behaving in such predictable and understandable ways is not going to help you stop negative and destructive behaviors. In fact, it will only make you feel worse about yourself and consequently less motivated to change. But gaining self-understanding will help. Self-understanding stops you from adding to the already overwhelming amount of shame you carry around with you, and it can also act as fuel to motivate you to grow and change.
One of the primary goals of self-understanding is for you to stop the constant self-judgment and focus instead on beginning to understand your faults and failures. Instead of blaming yourself for your mistakes or omissions, it is important that you begin to believe you had a good reason for your actions or your inaction. This is a huge step, but one that is essential if you are to begin ridding yourself of the debilitating shame that has burdened your life.
It is also a step you’ll find yourself needing to take whenever you become too critical of yourself for your current or past behavior. Remind yourself: “Given all I have experienced and suffered in my childhood, it’s understandable I would have this symptom or exhibit this behavior.” Or simply say, as calmly and compassionately as you can, “It’s understandable why I do this.” Over time, the self-understanding will sink in deeper.
It will help to remind yourself from time to time that the very behaviors you feel the most shame about are actually coping methods and survival skills. They’re not so powerful and persistent because you are stupid or bad—quite the contrary. They were clever and effective ways for you to cope with sometimes unbearable anxiety, fear, pain, and shame.
No matter what your past or present mistakes, no matter what troublesome behaviors you still cling to, no matter whether you continue to be victimized or have become abusive, by practicing self-understanding—an important component of self-compassion—you can learn that your childhood environment likely set you up for your current behavior. By connecting compassionately with the suffering you have experienced, your self-awareness will eventually lead to self-empowerment.
The information in this article is based on my new book, It Wasn’t Your Fault: Freeing Yourself from the Shame of Childhood Abuse with the Power of Self-Compassion (New Harbinger, 2015).