The post Psychotherapeutic Work with Intergenerational Trauma appeared first on Confer.

The post Further reading appeared first on Confer.

One of the challenges common to the various treatments of historical trauma is the difficulty in forming an alliance with the survivors. This should be kept in mind when reflecting on the protocols listed below.

Holocaust survivors: According to Kellerman (2001), Holocaust survivors in Israel do not want to be treated as psychiatric patients. Whilst acknowledging that there is a dearth of research in treating Holocaust trauma he discusses a number of aspects of treatment as offered by the AMCHA, ‘National Israeli Center for Psychosocial Support of Survivors of the Holocaust and the Second Generation’. Treatment approaches and techniques vary according to age, status as an adult or child survivor etc. A draft of this paper can be found here.

Native Americans: Brave Heart (1998) conducted research on a 4-day psychoeducational intervention aimed at 45 Lakota human service providers. She found that as individuals became more informed about the nature of historical trauma, they became better able to understand its impact and association with emotions such as grief. Contexts such as the one provided by Dr Brave Heart can function as fora where powerful stories, songs, histories and strategies for resilience can also be shared, initiating or reinforcing the intergenerational transmission of resilience (Denham 2008).

Aboriginal communities: Atkinson and Ober (1995) established the We-Al-Li Workshops. Their treatment protocol involves equipping a core group of members of the community with the skills to assist vulnerable people in overcoming violent, unlawful or self-destructive behaviours. These authors highlight the difficulty in establishing a working relationship between a potentially distant indigenous community and a service provider who may be initially treated in a mistrustful way. A summary of the tasks and activities of such a group can be found in Atkinson et al. (2010) and also here and here.

Afro-Caribbean communities

Dr Aileen Alleyne (2004, 2005) emphasises treating the “enemy within”, which she defines as an intergenerationally transmitted ego structure that prioritises pathological relationships with white people as a potentially primary determinant of self-organisation. She recommends that when working with individuals or communities there is a need to recognise pathogenic scripts emanating from the enemy and their effects, reframing these self-defeating scripts, exploring personal agency, and making space for personal rights. She stresses highlighting strengths and defining identity in ways unrelated to white people. Differentiation between what belongs to the self and the other can heal ego-splits and prevent acting out based on projected aggression.

Joy Angela LeGruy (2005) introduced the concept of post-traumatic slave syndrome. She explores in depth adaptive behaviours prior to slavery and analyses current maladaptive behaviours of contemporary African Americans. A core aspect of her treatment recommendations involves the healing of “vacant esteem” (associated with feelings of hopelessness, anger and manifests outwards in destructive and self-destructive behaviours) through the adoption of pre-slavery values.

Omar Reid, Sekou Mims and Larry Higginbottom (no date) in the USA recommend a holistic treatment program for post-traumatic slave syndrome that is specifically designed to be sensitive to the cultural needs of African-American individuals. This package involves a group-based stage-approach to treatment starting with abstinence from substances and the teaching of a meditation that includes a ritual commemoration of the individual’s ancestry. The next stage, as in LeGruy’s work, involves drawing from pre-slavery coping mechanisms to build a repertoire of healthy personal and relational strategies.

Familial trauma

Family therapy / Family systems approach

When thinking about familial trauma we are attempting as much as possible to restrict the definition to families where there has not been a history of disorganised attachment, but that a reasonably secure attached family contains a traumatic pocket due loss, or separation that has not been talked about. As such the specific nature of the unspoken content it is likely to reveal itself only during the course of therapy.

A family systems approach is described by Dyregrov (2014) and includes managing secrets and handling traumatic reminders amongst other interventions. Psychoeducation (for instance gender differences in managing trauma or parent and child differences) involving helpful practices on fact sharing, managing traumatic reminders and accessing to support groups is also a part of this intervention.

Psychodynamic therapy

Psychoanalytic views would generally converge on the hypothesis that something which cannot be thought or talked about is likely to be acted. Like attachment trauma below, working with enactments is likely to be a significant part of the work. These may reveal dissociated interpersonal scenarios that have been “transposed” into the mind of the child and are subsequently played out in the relationship with the adult client. Prophecy Coles (2011) discusses a number of cases involving familial trauma where the unmetabolised content was enacted between therapist and client.

Relational psychoanalysis

Relational Psychoanalysis is a broad church consisting particularly of US clinicians. However, in the UK it has become associated with attachment work and this model has found a home at the Bowlby Centre in London. Some prominent US clinicians who are well known to write about trauma and enactment already mentioned are Bromberg (2006, 2011), Brothers (2008), and Stern (2010). The work of the intersubjectivist Robert Stolorow (2007) combines his evolution of self-psychology with continental psychoanalysis. In terms of applying their work to the area of familial trauma we could hypothesise that the “not me”/dissociated parts of the client related to familial trauma are not as extensive as in early attachment trauma (see below) and enactment not the most habitual occurrence in therapy. However, it is only through enactment that these parts can be known according to these clinicians. The family’s idiosyncratic post-trauma relationship amongst its members and with the community, as well the absences created by death or loss, are only likely to become understood once they are contextualised in the therapeutic relationship. The attachment lens can illuminate how the trauma is expressed in the client’s movement to and fro the therapist, and the client’s own approach or avoidance of ideational content in his or her own mind.

Parent infant psychotherapy (also see in attachment trauma) can be used in a manner of prevention when there is sufficient diagnostic information that the parent has been affected by familial trauma.

Attachment trauma

When we speak of intergenerational transmitted attachment trauma find ourselves in the territory of work with disorganised attachment resulting from significant neglect or abuse due to the caregiver’s own disorganisation of attachment (Main & Hesse 1990). The result is usually a global difficulty in thinking, feeling, and forming and maintaining relationships, rather than the more localised or domain specific impairments seen in neurosis. Such work with adults is likely to involve addressing personality difficulties or personality disorder. Therefore, the principles of Mentalization Based Therapy (Bateman & Fonagy 2004, 2006) or Transference Focused Therapy (Yeomans et al. 2002, Clarkin et al. 2015) may be helpful frameworks for clinicians working with individual clients.

Family therapies are likely to be particularly helpful for assisting traumatised children or adolescents. One such example is the Intergenerational Trauma Treatment Model (ITTM) developed in California, USA. Read the protocol here.

For children clients, the Child Trauma Academy in Texas, USA has developed the he Neurosequential Model which translates neuroscientific principles into play therapy. Please find relevant information and papers here.

Another intervention aimed at children is Dyadic Developmental Psychotherapy (DDP), a form of attachment informed therapy developed by Dan Hughes to help children affected by abuse or neglect. It involves both therapy with the child and parenting assistance provided to parents. More information can be located here.

Last but not least, parent infant psychotherapy can be very helpful to mothers who have experienced trauma shortly before or after birth. The advantage of this approach is that it allows for early intervention that can disrupt the possibility of trauma transmission. One such case can be found in the work of Belt et al. 2011, who describe the treatment of a woman affected by the loss of her partner during pregnancy. A draft version of a case study by Schechter et al. (2003) can be found here.

Bibliography

Atkinson, J. & Ober, C. 1995, ‘We Al-li-fie and water: a process of healing’, in K Hazelhurst (ed.), Popular justice and community regeneration: pathways to Indigenous reform (pp. 201-18), Praeger Press, Westport, CN.

Bateman, A & Fonagy, P 2004, Psychotherapy for borderline personality disorder, Oxford University Press, Oxford, England.

Bateman, A & Fonagy, P 2006, Mentalization-based treatment for borderline personality disorder, Oxford University Press, Oxford England.

Belt, R, Kouvo, A, Flykt, M, Punamaki, R, Haltigan, J, Biringen, Z & Tamminen, T 2012, ‘Intercepting the intergenerational cycle of maternal trauma and loss through mother-infant psychotherapy: a case study using attachment-derived methods’, Clinical Child Psychology and Psychiatry, [online] vol. 18, no. 1, pp. 100-120, available at: [Accessed 19 Oct. 2014].

Brave Heart, M. (1998). The return to the sacred path: Healing the historical trauma and historical unresolved grief response among the Lakota through a psychoeducational group intervention. Smith College Studies in Social Work, [online] 68(3), pp.287-305, available at: http://dx.doi.org/10.1080/00377319809517532 [Accessed 19 Oct. 2014].

Clarkin, J, by Yeomans, FE & Kernberg, OF 2015, Transference-focused psychotherapy for borderline personality disorder, American Psychiatric Publishing, Arlington, VA.

Coles, P 2011, The uninvited guest from the unremembered past, Karnac Books, London, England.

Denham, A. (2008). Rethinking historical trauma: Narratives of resilience. Transcultural Psychiatry, [online] 45(3), pp.391-414, available at: http://dx.doi.org/10.1177/1363461508094673 [Accessed 19 Oct. 2014].

Dyregrov, A (2014), ‘Family recovery from terror, grief and trauma’, available at:http://earlytraumagrief.anu.edu.au/files/Family%20Recovery%20from%20Terror%2C%20Grief%20%26%20Trauma.pdf

Iyengar, U, Kim, S, Martinez, S, Fonagy, P. & Strathearn, L 2014, ‘Unresolved trauma in mothers: intergenerational effects and the role of reorganization’, Frontiers in Psychology, [online] vol. 5, available at: [Accessed 19 Oct. 2014].

Kellerman, NPF 2001, ‘The long-term psychological effects and treatment of Holocaust trauma’, Journal of Loss and Trauma, [online] vol. 6 no. 3, pp. 197-218, available at: http://dx.doi.org/10.1080/108114401753201660 [Accessed 19 Oct. 2014].

LeGruy, J 2005, Post traumatic slave syndrome, Joy DeGruy Publications, Portland, OR.

Schechter, D, Kaminer, T, Grienenberger, J & Amat, J 2003, ‘Fits and starts: a mother-infant case-study involving intergenerational violent trauma and pseudoseizures across three generations’, [online] Infant Mental Health Journal, vol. 24, no. 5, pp. 510-528, available at: http://dx.doi.org/10.1002/imhj.10070[Accessed 19 Oct. 2014].

Yeomans, F, Clarkin, J & Kernberg, OF 2002, A primer on transference-focused psychotherapy for the borderline patient, J. Aronson, Northvale, NJ.

The post Historical trauma appeared first on Confer.

Intergenerational or trans-generational trauma has complex and multi-layered historical causes that commonly stretch from social conditions to the most intimate attachment relationships. Often there is an interplay between each of these levels and people seeking psychotherapy may be suffering from just one or all levels.

Levels of intergenerational trauma

Historical trauma

Definition

Historical trauma or historical grief is a relatively new term which originated in the mid-1990’s with the work of Dr Maria Brave Heart (Brave Heart 1998, 1999a, 1999b, Brave Heart & DeBruyn 1998, Brave Heart-Jordan & DeBruyn 1995) on trauma in Native Americans. This outer layer of intergenerational trauma refers to a massive cumulative rupture inflicted upon the community through, for example, slavery, holocaust, war, genocide, ethnic cleansing, forced acculturation, or repressive regimes. Populations that have been affected by historical trauma include African Americans and Afro-Caribbeans, First Nations people, Indigenous Australians, and families impacted by the Holocaust – to name just a few. Recent research studies in this area have involved Indian residential schools (Bombay et al. 2013), the offspring of former Burundian child soldiers (Song & de Jon 2014), the children of Cambodian parents affected by the Khmer Rouge regime of 1975 to 1979 (Field & Sochanvimean 2014), Cosovan families (Schik et al. 2014), and young second generation Latino immigrants (Phipps & Degges-White 2014).

For elaborations of this theme in this module, please listen to Aileen Alleyne, Dori Laub, Isha Mckenzie-Mavinga, Maya Jacobs-Wallfisch

Examples in specific communities

Descendants of afro-caribbean enslaved peoples

Dr Aileen Alleyne (2004, 2005) focuses on historical trauma and its interrelation with current conditions on trauma survivors and economic migrants. Her work focuses on the “enemy within”, the internalised oppressor. She clarifies that the internalised oppressor is part of the ego structure and therefore different from internalised oppression. She describes the internal oppressor as the agent of a developmental arrest that prioritises a dysfunctional relationship between black and white, at the expense of self-development. A split in the ego arises which necessitates the projection of self-hatred and shame and hatred/denigration of the white other.

Joy Angela LeGruy coined the term Post Traumatic Slave Syndrome to describe residual impacts of generations of slavery. This concept combines theories of multigenerational trauma together with continued oppression leading to the absence of opportunity to heal or access the benefits available in the society.

Omar Reid, Sekou Mims and Larry Higginbottom co- authored the book, Post Traumatic Slavery Disorder: Definition, Diagnosis and Treatment propose that the descendants of African slaves endure a direct relationship with post-traumatic stress disorder (PTSlaveryD), thus negatively affecting them in a variety of ways from drug abuse, broken families, crime and low educational attainment to an inability to reverse poverty, achieve unity and build strong Black-owned institutions.

Descendents of Jewish holocaust survivors

The first therapeutic studies on historical trauma originated from a psychoanalytic tradition in the 1960s. One of the first investigators of the effects of the Holocaust was Judith Kesteneberg, a prominent member of a group of psychoanalysts whose work was published in Generations of the Holocaust by Bergmann and Jucovy (1982). Kestenberg’s work focused both on child survivors of the Holocaust, as well as children of the survivors (1980, 1982). She was particularly interested in the way that survivors experienced a collapse of time between the generations. Similar views were expressed by Haydee Freyberg (1980) a little later, whereas Ilse Grubrich-Simitis (1984), working with children of Holocaust survivors investigated the loss of symbolic thinking as a result of trauma.

Natan Kellerman, an Israeli Psychologist, conducted a literature review (2001) on psychopathology in children of Holocaust survivors and concluded that non-clinical populations did not show any significant signs of psychopathology more than other populations. However, clinical populations appeared to conform to “a particular psychological profile which included difficulties in separation and individuation, a vulnerability to post traumatic stress disorder and a contradictory mix of resilience and vulnerability when confronted with stressors”. Given that there is ambiguity about the extent of traumatisation in first, second and third generation individuals, his research advocates for a move away from epidemiology to the study of the way that trauma is experienced by those parts of the population that are affected.

Descendents of native American genocide

Dr Maria Brave Heart (Brave Heart 1998, 1999a, 1999b, Brave Heart & DeBruyn 1998, Brave Heart-Jordan & DeBruyn 1995) is the leading figure in historical trauma among Native Americans. Her research focuses on the Lakota and the cumulative trauma of events starting at least from the Wounded Knee Massacre in 1890. She uses a “Holocaust model” model of research given that individuals display similar psychopathology as Holocaust survivors and their offspring (for example depression, alcohol abuse, suicidality and physical health problems.

Aboriginal Australians genocide

Atkinson et al. (2010) have investigated the cultural transmission and normalisation of historical trauma. They have linked these process with what Memmott et al. (2001) has termed “dysfunctional community syndrome”: There is an exponential increase in both the instances of violent behaviour and its intensity in each generation, identifying, for example pack rape committed by children as young as 10 years old.

Perpetrators

The intergenerational transmission of trauma is not limited to victims. Mitscherlich and Mitscherlich (1975) discuss the German people’s shame at their complicity in the Holocaust and the shared defence against identification and association with the Third Reich. Volkan (1998) wrote about the silence and speechlessness of Germans and inability to speak of their shame and guilt given that they were the “victimiser group”. This process impedes the differentiation of contemporary Germany from Nazi Germany.

Familial trauma

Definition

Familial or societal trauma represents trauma that has occurred within the family such as the death of child, parent or grandparent, other loss or separation, or sexual abuse. The resulting changes in the family’s structures in the aftermath of trauma can be understood by using Bion’s work on groups (Berger 2014). Families are “working groups” whose function is “procreative, protective, nurturant, and educative” (Berger 2014, p.170). In the aftermath of trauma, boundaries, authority structures, and roles can change markedly as a result of a perpetual unconscious anxiety regarding the threat of exposure, amongst other factors. The family becomes “basic assumption group” (Bion 1960).

The phenomenology of these changes is varied. The development of family secrets is a common occurrence. Secrets can be particularly destructive, especially when they occur between parents and children resulting, for example, in parents increasing physical distance from children in order to preserve secrecy (Dyregrov 2014). Another result of familial trauma is the change in family members’ roles, particularly the well-known phenomenon of parentification (Chase 1999). This is likely to happen when a parent becomes unable to care psychologically and emotionally for the children, and one of the children fills the vacant role. Unusual rules or rituals are also common to defend against the pain or shame of the truth.

However, the unconscious effects of familial trauma on children are also of importance, but sadly harder to detect. Coles (2011) offers a number of illuminating clinical examples demonstrating how clients can relate in ways that have been affected by familial trauma of which the clients may know little about initially. The internal object relation representing the familial trauma is likely to be enacted by the therapeutic couple with participants unconsciously adopting a number of roles at different times.

For examples from this module, please listen to Prophecy Coles, Doris Brothers, Fran�oise Davoine, Dori Laub, Franz Ruppert and Maya Jacobs-Wallfisch.

Attachment trauma

Definition

Disorganized infant attachment is a second-generation effect of unresolved loss or trauma in the parent (Main and Hesse 1990). Clara Mucci (2013), for example, divides attachment trauma into two categories. The is first explored by Allan Schore (2011) who describes the lack of synchronised exchanges between primary caregiver and infant due to the parent’s difficulty attuning to the infant. The second, and more severe type, is due to significant neglect or abuse (psychological, physical, or sexual), with incest being the worst predictor of later psychopathology in the child.

Peter Fonagy and colleagues (Fonagy et al. 2002) write about the lack of “contingent” and/or “marked” mirroring by the parent, which can create difficulties in the child’s perception of reality: The child and later adult regresses to the employment of primitive modes of thinking which affect his or her capacity to understand his or her own and others’ minds and therefore the capacity for affect regulation. As a result of attachment trauma, entire worlds of affective experience become foreclosed for the child, as affects are not seen as signals, but as threats of becoming overwhelmed (Stolorow 2007). Both Bromberg (2006) and Brothers (2008), writing from an American relational perspective, stress the disruption in the child’s sense of self-continuity and the use of dissociation as a strategy for restoring a sense of self.

For elaborations of this theme in this module, please listen to Pamela Alexander, Clara Mucci, Franz Ruppert and Estela Welldon

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Volkan, VD 2002, ‘The psychotherapeutic study group for people affected by the Holocaust: towards ending the “silence” in Germany’, in VD Volkan, VG Ast & W Greer (eds), The Third Reich in the unconscious (145-160), Brunner-Routledge, New York, NY.

Wheaton, B 1987, ‘Assessment of fit in overidentified models with latent variables’, Sociological Methods Research, vol. 16, pp. 118-154.

Whitbeck, LB, Adams, GW, Hoyt, DR & Chen, X 2004, ‘Conceptualizing and measuring historical trauma among American Indian people’, American Journal of Community Psychology, vol. 33, no. 3-4, pp. 119-30.

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Mechanisms of transmission – Historical trauma

There is some difficulty in isolating transmission mechanisms because the current context that is the result of historical events (for example the boarding school catastrophe in American Indians) can continue to affect traumatised populations (Whitbeck et al 2004). With that in mind, Kellerman (2001a) has identified four pathways of transmission, each corresponding to a different theoretical model: Sociocultural and socialisation models, family systems models, psychodynamic models and biological models.

Sociocultural and socialisation models of transmission are based on social learning theories and focus on the child’s learning certain behaviours by observing the parents and the social environment. According to Kellerman, the earliest psychoanalytic conceptualisations of “survivor syndrome” following the holocaust (Barocas 1975) led to the identification of a number of symptoms in the parents that included anxiety, depression, guilt, nightmares, and numbing. All of these can be detected by children. Yehuda et al. (2008) found that the presence of post-traumatic symptoms in the offspring of Holocaust survivors was related to the children’s perception of their parents’ symptoms. Research has also demonstrated that children of survivors may feel that their parents pass a burden on to them (Letzter-Pouw & Werner 2013, Letzter-Pouw et al. 2014, Kellerman 2001b).

Writing about Native Americans, Duran and Duran (1995) suggested that because historical trauma becomes part of the cultural memory of a community, it is transmitted by the same mechanisms as all cultural memory and is therefore normalised.

The family systems model focuses on communication between generations, what is talked about or kept a secret, the blurring of boundaries between generations, and the reconfiguration of roles within the family. The parents’ fear that children may fall under threat means that they will often become overprotective, and the children themselves over dependent, as was reported in research with Holocaust survivors (Barocas & Barocas 1980, cited in Kellerman 2001b). Additionally, research has suggested that adolescence is a particularly difficult period for such parents to manage because of their own historical problems (Krell 1997, cited in Kellerman 2001b). Communication problems (Trossman 1968, cited in Kellerman 2001b), and difficulties expressing and managing emotions (Nadler et al. 1985, cited in Kellerman 2001b) have also been identified.

The psychoanalytic perspective which pioneered single case study research from the 1960’s made a significant contribution to the understanding of pathogenic transmission mechanisms. Judith Kestenberg (1970, 1980, 1982) wrote of a “time tunnel” to describe the transmission of trauma in Holocaust survivors. She described the process as a resurrection of dead objects that have not been sufficiently mourned by the parent in the mind of the child. The child’s own psychic centre is dislocated to accommodate the “transposed” context.

Haydee Freyberg similarly wrote of “a telescoping of generations”, a “tyrannical intrusion of history” (1980, p. 99). Ilse Grubrich-Simitis (1984), also working with children of Holocaust survivors, put forward the concept of “concretism” to describe the child’s ego’s lack of capacity to use metaphor to structure time, as a result of the parent’s failure to support the child’s developing ego. A particularly eloquent account of aspects of the above authors’ work is offered by Connolly (2011, p. 612).

Thus the death of time creates a dissociation between history and memory with the result of the creation of a history without memory, history as abstract dead facts, and a memory without history, purely subjective, mythical and therefore ineffective for the creation of meaningful narratives.

Dr Aileen Alleyne (2004, 2005) has focused on the passing of a “legacy of pain” in Afro-Caribbean descendants of slaves, leading to a preoccupation with this pain in what she calls “the cycle of events”. The various ways that black individuals communicate with others and themselves, their values and belief systems, their parenting styles and life choices, and their drive, determination and self-worth are partially affected by the intergenerational transmission of the “enemy within”. This involves the transmission of scripts detailing anxieties and the ensuing defences/adaptations about relationships with white people. Splits in the ego and paranoid-schizoid processes lead to self-hatred, hypervigilance, and the anticipation of conflict. A significant part of black identity, Dr Alleyne suggests, is structured in relation and in contrast to whiteness.

Volkan (1998, no date), writing from his experience with primarily Eastern European populations affected by armed conflict, writes of “chosen traumas” and the “depositing” (Volkan 2011) of an already formed self or object image in the child’s developing self-representation that acts as a “psychological gene” and impels the child to perform tasks such as to repair the mother’s psychological well-being or to represent an opportunity for dealing with the trauma in the future. Many more papers are available at Dr Volkan’s website.

Mechanisms of transmission – Familial trauma

A particular approach to understanding the intergenerational transmission of familial trauma has been put forward by Susan Berger (2014). In this psychodynamic account, which implicitly also contains a family systems component, the main route of transmission is through changes in family structures. She attempts to understand this by conceptualising the family as a working group (Bion 1960). She argues that tolerating aggression is a central task in a family in order to manage the tasks of individuation and separation faced by the next generation. However, the parent’s identification with the aggressor, a common outcome of abuse, is often transmitted to the child resulting in confusion and complication of these developmental tasks as aggression cannot be appropriately localised to present circumstances. Additionally, in the case where the family becomes isolated due to the use of unusual adaptations in the community, there is a risk that an “us and them” mentality develops that is organised around the fight or flight basic assumption (Bion 1960).

Fonagy’s model of mentalization (Fonagy et al. 2002) was originally developed to explain early abuse or neglect but, given the ambition of the mentalizing model, (see below), its explanatory potential is not limited to overt early trauma. In an attempt to explain dissociation in the absence of discernible early trauma, Fonagy (1999) focuses on the mechanism by which dissociative defences can be directly transmitted from caregiver to offspring. This model expands on Winnicott’s views on the risk of the parent mirroring his or her own mental state to the infant, resulting in the absorption of the parent’s self-structure by the infant’s self-representation. This can include the parent’s dissociative defence. Fonagy explains that this process differs from identification in that a space is created in the infant’s mind in which traumatic content can be directly transmitted. This model can be applied to both historical and familial trauma depending on the content that has become dissociated.

Mechanisms of transmission – Attachment trauma

An understanding of how attachment trauma is transmitted from parent to infant arguably dates back to the work of Sandor Ferenczi. Ferenczi’s (1949) theorised the installation of an “alien transplant” in the psyche of the child when “adult passions” (particularly around sexuality and aggression) breached the “tenderness” of the child. The parent’s own denied traumas would find a way in the child’s psyche that would introject the childhood guilt of the adult aggressor, leading to a chronic sense of feeling bad and unworthy.

There have been numerous recent contributions from the relational perspective (particularly American intersubjective and relational psychoanalysis). Brothers (2008) and Storolow (2007) emphasise that trauma shatters familiarity and leads to a loss of meaning and loss of a coherent and recognisable sense of self. Brothers argued that trauma destroys what she calls Systemic Emergent Certainties (SEC) which are replaced by “trauma generated certitudes”. The latter rely on dissociation to exclude affecting knowledge and experience which threatens to disrupt the continuity of the traumatised self. The effect of dissociation is a loss in context sensitivity so that the same expectations come to be generalised across a vast range of situations. The traumatised parent feels under threat from the affective expressions of the infant, because the complexity of these presents a threat to the rigid and simplistic trauma generated certitudes, resulting from the restriction of affective experience by dissociation.

There is probably a general agreement in developmental psychology, intersubjective/ relational psychoanalysis, and British psychoanalysis that the effects of trauma are transmitted through moment to moment exchanges between an infant and his or her primary caregiver, a process which is largely nonverbal. The traumatised parent is unable to offer attunement and affective synchronisation to the infant. Allan Schore has studied this process in depth (Schore 2003a, 2003b).

In a British context, Fonagy’s theory of mentalizing (Bateman & Fonagy 2004, 2006, Fonagy et al. 2002) is a useful framework to understand the intergenerational transmission of attachment trauma. It is not the particular early relational templates that are transmitted, but the parent’s own mentalizing difficulties that complicate the parent’s capacity to hold the child in mind. This process inevitably results in the child’s emergent mentalizing capacities being undermined. Additionally, the parent’s own split off experiences of trauma become communicated to the child in the form of an installation of an alien self which then needs to be projected in order to restore the coherence of the self.

Bibliography

Alleyne, A 2004, December, ‘The internal oppressor and black identity wounding’, Race andCulture, [online] available at: https://www.confer.uk.com/modules/intergenerational/pdf/aileen-alleyne-paper2.pdf[Accessed 17 Oct. 2014].

Alleyne, A 2005, ‘Invisible injuries and silent witnesses: the shadow of racial oppression in workplace contexts’, Psychodynamic Practice, [online] vol. 11, no. 3, pp. 283-299, available at: http://dx.doi.org/ 10.1080/14753630500232222 [Accessed 17 Oct. 2014].

Barocas, H 1975, ‘Children of purgatory: reflections on the concentration camp survivalsyndrome’, International Journal of Social Psychiatry, [online] vol. 21, pp. 87-92, available at: http://dx.doi.org/10.1177/002076407502100202 [Accessed 17 Oct. 2014].

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Bateman, A & Fonagy, P 2006, Mentalization-based treatment for borderline personality disorder, Oxford University Press, Oxford England.

Berger, S 2014, ‘Whose trauma is it anyway? Furthering our understanding of its intergenerational transmission’, Journal of Infant, Child, and Adolescent Psychotherapy, [online] vol. 13, no. 3, pp. 169-181, Available at: http://dx.doi.org/10.1080/15289168.2014.937975 [Accessed 1 Nov. 2014].

Bion, WR (1960), Experiences in groups, Routledge, London, England, 1968.

Brothers, D 2008, Toward a psychology of uncertainty, Analytic Press, New York, NY.

Connolly, A (2011), ‘Healing the wounds of our fathers: intergenerational trauma, memory, symbolization and narrative’, Journal of Analytical Psychology, [online] vol. 56, pp. 607-626, available at: http://dx.doi.org/10.1111/j.1468-5922.2011.01936.x [Accessed 17th Oct. 2014].

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Ferenczi, S 1949, ‘Confusion of the tongues between the adults and the child: the language of tenderness and of passion’, International Journal of Psychoanalysis, [online] vol. 30. Pp. 225-230, available at: http://kevinsartain.com/aps/confusion-of-the-tongues-between-the-adults-and-the-childe28094the-language-of-tenderness-and-of-passion.pdf [Accessed 17 Oct. 2014].

Fonagy, P. (1999). The transgenerational transmission of holocaust trauma. Attachment & Human Development, [online] vol. 1, no. 1, pp. 92-114, available at: http://dx.doi.org/10.1080/14616739900134041[Accessed 17 Oct. 2014].

Fonagy, P, Gyorgy, G, Jurist EL & Target, M 2002, Affect regulation, mentalization, and the development of the self, Other Press, New York, NY.

Freyberg, J 1980, ‘Difficulties in separation-individuation as experienced by offspring ofNazi Holocaust survivors’, American Journal of Orthopsychiatry, vol. 50, no. 1, pp. 87-95, available at: http://dx.doi.org/10.1111/j.1939-0025.1980.tb03265.x [Accessed 19 Oct. 2014].

Grubrich-Simitis, I 1984, ‘From concretism to metaphor: thoughts on some theoretical and technical aspects of the psychoanalytical work with children of Holocaust survivors’. Psychoanalytic Study of the Child, vol. 39, p. 301ff.

Kellerman, NPF 2001a, ‘Transmission of Holocaust trauma: an integrative view’, Psychiatry, vol. 64, no. 3, pp. 256-267.

Kellerman, NPF 2001b, ‘Perceived parental rearing behavior in children of Holocaust survivors’, Israel Journal of Psychiatry and Related Sciences, vol. 38, pp. 58-68.

Kestenberg, J 1972, ‘Psychoanalytic contributions to the problem of children of survivors from Nazi persecution’, Israel Annals of Psychiatry, vol. 10, pp. 311-325.

Kestenberg, J 1980, ‘Psychoanalysis of children of survivors from the Holocaust: case presentations and assessment’, in M Bergmann & M Jucovy (eds), Generations of Holocaust, Basic Books, New York, NY, pp. 137-158.

Kestenberg, J 1982, ‘A metapsychological assessment based on an analysis of a survivor’s child’, in M Bergmann & M Jucovy (eds), Generations of Holocaust, Basic Books, New York, NY, pp. 137-158.

Krell, R 1997, ‘Psychological reverberations of the Holocaust in the lives of child survivors’, [online] available at: http://www.ushmm.org/m/pdfs/20040908-krell.pdf [Accessed 17 Oct. 2014].

LeGruy, J 2005, Post traumatic slave syndrome, Joy DeGruy Publications, Portland, OR.

Letzter-Pouw, SE, Shrira, A, Ben-Ezra, M & Palgi, Y 2014, ‘Trauma transmission through perceived parental burden among Holocaust survivors’ offspring and grandchildren’, Psychological Trauma: Theory, Research, Practice, and Policy, [online] vol. 6, no. 4, pp. 420-429, available at: http://dx.doi.org/10.1037/a0033741 [Accessed 17 Oct. 2014].

Letzter-Pouw, SE & Werner, P 2013, ‘The relationship between female Holocaust childsurvivors’ unresolved losses and their offspring’s emotional wellbeing’, Journal of Loss and Trauma, [online] vol. 18, pp. 396-408, available at: http://dx.doi.org/10.1080/15325024.2012.701126 [Accessed 17 Oct. 2014].

Nadler, A, Kav-Venaki, S & Gleitman, B 1985, ‘Transgenerational effects of the Holocaust: externalization of aggression second generation of Holocaust survivors’, Journal of Clinical and Consulting Psychology, [online] vol. 53, pp. 365-369, available at: http://dx.doi.org/10.1037/0022-006X.53.3.365 [Accessed 17 Oct. 2014].

Schore, A 2003a, Affect regulation & the repair of the self, WW Norton Publishing Inc, New York, NY.

Schore, A 2003b, Affect dysregulation & disorders of the self, WW Norton Publishing Inc, New York, NY.

Stolorow, RD 2007, Trauma and human existence: autobiographical, psychoanalytic, and philosophical reflections, The Analytic Press, Hillsdale, NJ.

Trossman, B 1968, ‘Adolescent children of concentration camp survivors’, Canadian Psychiatric Association Journal, vol. 12, pp. 370-377.

Volkan, VD 1998, August, ‘Tansgenerational transmissions and chosen traumas’, Opening address XIII International Congress International Association of Group Psychotherapy [online] available at: http://www.vamikvolkan.com/Transgenerational-Transmissions-and-Chosen-Traumas.php [Accessed 17 Oct. 2014].

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Whitbeck, LB, Adams, GW, Hoyt, DR & Chen, X 2004, ‘Conceptualizing and measuring historical trauma among American Indian people’, American Journal of Community Psychology, vol. 33, no. 3-4, pp. 119-30.

Yehuda, R, Bell, A, Bierer, LM & Schmeidler, J 2008, ‘Maternal, not paternal PTSD is related to increased risk for PTSD in offspring of Holocaust survivors’, Journal of Psychiatric Research, [online] vol. 42, pp. 1104-1111, available at: http://dx.doi.org/ 10.1016/j.jpsychires.2008.01.002 [Accessed 17 Oct. 2014].

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There is extensive literature on the effects of the Holocaust on adult and children survivors and their offspring. The Holocaust model intergenerational trauma originated in the 1960’s through a primarily psychoanalytic framework and has been highly influential in defining the parameters of studies researching other populations such as American Indians (Whitbeck et al. 2014). The majority of psychoanalytic investigations have consisted of single case studies (e.g., Fonagy 1999). Larger scale empirical studies have mainly employed standardised questionnaires to investigate relationships between variables such as parental symptomatology, parenting styles, and their effects on children.

There are numerous problems with establishing the prevalence of historical trauma and clearly linking historical losses to symptoms of emotional distress and severity in day to day functioning between different populations. One such reason is differentiating between distal and proximal causes to trauma, especially when the current context of a population (e.g., reservation living and boarding schools in Native Americans) can be the source of current trauma (Whitbeck et al. 2014). Below are some examples of diagnostic instruments designed to capture the presence of intergenerational trauma in an individual.

Native Americans: Les B. Whitbeck and his colleagues (Whitbeck et al. 2004) devised the Historical Loss Scale and The Historical Loss Associated Symptoms Scale (Appendix 1).

Holocaust Survivors: Melissa C. Kahane-Nissenbaum (2011) developed a questionnaire to assess historical trauma in third generation Holocaust survivors (Appendix 2).

Afro-Caribbean communities: The African American Historical Trauma Questionnaire (AAHTQ) was designed as part of a Dr Myra Miller’s dissertation on schizophrenia in African Americans. As we do not have any more information on this work, please contact Dr Miller at sustainablelifedesign.wordpress.com.

Familiar trauma

The Multi-Tiered Trans-Generational Genogram (MTTG) and the EMDR-Accelerated Information Resourcing (EMDR-AIR) protocols (Tel-Oren 2011, Yoeli & Prattos 2012) have been developed in order to explain both dysfunctional behaviours and adaptive strategies developed by the traumatised individual. These instruments are designed to be used in conjunction with EMDR. The EMDR-Air focuses on behavioural patterns within the client’s personal history in order to contextualise the client’s current response to a traumatic event. The MTTG is used to elicit behavioural patterns within the client’s family history.

The McMaster Family assessment device (Epstein et al. 1983) is given to all family members from the age of 12 and above and consists of 60 statements that family members are asked to indicate their agreement with. It assesses 6 dimensions: affective involvement, affective responsiveness, behavioral control, communication, problem solving, and roles. There is also a 7th scale measuring general family functioning. The protocol can be found here.

The Family Adaptability and Cohesion Scale (FACES-IV) (Olson et al. 2006) comprises of six subscales. Two assess the “mid-range” variables of adaptability and cohesion, and four assess the “extreme” variables of rigidity, chaos, disengagement, and enmeshment. It can be purchased from www.facesiv.com.

Guidance on assessing familial trauma and a number of other free resources can also be found on the National Child Traumatic Stress Network (NCTSN) “Families and Trauma” guide.

Intergenerational attachment trauma

A helpful list of tools to assess trauma in children and adolescents, entitled Standardized Measures to Assess Complex Trauma, has been complied by the National Child Traumatic Stress Network (NCTSN).

Intergenerational trauma in the form of disorganised attachment can be diagnosed using the Adult Attachment Interview (Main et al. 1985). Although using the AAI requires training to administer, the diagnostic process can take up to an hour and a half and the transcribing process well over ten hours, it includes questions that the therapist can ask to generate opportunities to detect the presence of unresolved states of mind and dissociation (George et al. 1985). The interview questions can be found here.

The mentalization concept is an evolution of the attachment paradigm. It postulates that the drive for proximity to the caregiver does not simply arise from the need for physical safety but also from the need to maximise opportunities for the development of the capacity to see oneself and others as having minds. This is achieved through the development of a second order representation of affective states, as a result of “marked” and “contingent” mirroring by the primary caregiver. A recent publication (Bateman & Fonagy 2011) details a framework for the assessment of the individual’s capacity for mentalization and the effects of disorganised attachment on thinking about feeling and feeling about thinking.

A psychoanalytic framework, and particularly its relational and attachment based variants, provides the tools for diagnosing intergenerational trauma though the deployment of many standard analytic techniques. The exploration of enactment and dissociation can be used to capture intergenerationally transmitted “not-me” states linked to dissociated familial history and manifesting in the client’s unconscious relational patterns (Coles 2011, Bromberg 2011, 2006, Brothers 2008, Stern 2010).

Appendices

Appendix 1: Historical Trauma Protocols

Historical Losses Scale

A   The loss of our land
B   The loss of our language
C   Losing our traditional spiritual ways
D   The loss of our family ties because of boarding schools
E   The loss of families from the reservation to government relocation
F   The loss of self-respect from poor treatment by government officials
G   The loss of trust in whites from broken treaties
H   Losing our culture
I    The losses from the effects of alcoholism on our people
J   Loss of respect by our children and grandchildren for elders
K   Loss of our people through early death
L   Loss of respect by our children for traditional ways

Historical Losses Associated Symptoms Scale

A   Feeling sadness or depression
B   Anger
C   Anxiety or nervousness
D   Uncomfortable around white people when you think of these losses
E   Shame when you think of these losses
F   A loss of concentration
G   Feel isolated or distant from other people when you think of these losses
H   A loss of sleep
I    Rage
J   Fearful or distrust the intention of white people
K   Feel like it is happening again
L   Feel like avoiding places or people that remind you of these losses

Appendix 2: The Third Generation Questionnaire

1. Which of your grandparent/s was a survivor?
2. How did you find out about your grandmother’s/grandfather’s/grandparent’s history? How old were you at the time?
3. What were you told about your grandparents’ experiences? How did you feel at the time and how have those feelings followed you through your life if at all?
4. When you think about the Holocaust and what your grandparents went through, what kind of thoughts come to mind?
5. How do you think having a parent who is a second generation survivor has impacted your life? Do you think it has affected your family dynamics, consciousness of being Jewish, or possibly your outlook on life?
6. In what ways if any do you believe the Holocaust has impacted your life?
7. Do you talk about you and your family’s story? If so, what do you say? What is your story? If not, why not?
8. Is there anything else that we haven’t talked about that is relevant to you as a third generation survivor?

Appendix 3: Questions for the Therapist

Does my client/patient come from a social group which has been historically traumatised by war, persecution or discrimination?

What do I know about his/her parents’ and grandparents’ experiences of trauma?

What was the quality and type of attachment relationship that my patient/client experienced in infancy and early childhood?

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