Transcript Practice learning- reflecting on values and AOP

M OTHERS ’ N ARRATIVES
AN
OF
T RAUMA :
EXPL O RATO RY STUDY O F HO W MO THERS NARRATE
THE IMPACT O F TRAUMA O N THEIR FAMIL IES
D R . S TEPHEN C OULTER
Q UEENS U NIVERS I TY, B ELFAST
S . C OULTE R @ QU B . A C . UK
IF TA C ONFEREN C E , PANAM A C ITY
7 TH M ARC H 2 0 1 4
Supported by the British Academy – Small Grant Scheme
O BJECTIVES
OF
S TUDY

To hear what mothers said about the impact of Trauma
on them and their families

To do this before they are inducted into professional
therapy speak

To see the extent to which this maps onto a PTSD
focused frame

To consider variation across types of cases

To see what questions may be raised by the findings
T HE S TUDY T HESIS

The experience of trauma has been over-medicalised
and reduced to a relatively narrow set of ‘symptoms’
associated with diagnostic categories such as PostTraumatic Stress Disorder (PTSD)

This pathological conceptualisation strongly
influences mental health professionals’ interventions
with victims/survivors of trauma, which then have
the potential to obscure important dimensions of the
phenomenological experience of being traumatised
that are significant to the victim/survivors and their
families
R ATIONALE

FOR
S TUDY
It is tempting to see Trauma as a linear concept:
Traumatic event happens
post-trauma symptoms

But an adverse event does not always (or even usually) lead to
trauma – it is how it is experienced that counts and the
experience is co-constructed in the relational, social and
cultural milieu

In recent years in the West a dominant medicalised discourse
on adverse events using the nosology of Psychiatric Disorder,
particularly Post-Traumatic Stress Disorder (PTSD) has
emerged.
B RIERE AND S COTT ASTUTELY NOTE

“…not all psychological injury can be encompassed by a
list of symptoms or disorders. Trauma can alter the very
meaning we give to our lives, and can produce feelings and
experiences that are not easily categorised in diagnostic
manuals.” (2006, p. 17)

Therefore, it is important, to listen to personal accounts of
the impact of traumatic events

A concern is that we could colonise our clients trauma
experience by imposing a pathologising approach based
on an epistemological error regarding ‘trauma’
PTSD – SYMPTOMS ARE
INTO

CATEGORISED
3 SUB - GROUPS AS FOLLOWS :
re-experiencing symptoms –
sufferers involuntarily re-experience aspects
of the traumatic event including repetitive and
distressing intrusive images, flashbacks,
nightmares; other sensory impressions from
the event. Reminders of the traumatic event
arouse intense distress and/or physiological
reactions
PTSD –S YMPTOMS (2)

avoidance/numbing symptoms – include (a) physical
avoidance of reminders of the trauma including - people,
situations or circumstances associated with the event and
(b) psychological avoidance through trying not to think
about the traumatic event, emotional numbing, feeling
detached from other people, and decreased interest in
usual activities

hyperarousal symptoms - include hypervigilance,
exaggerated startle response, irritability, difficulty in
concentrating and problems with sleep disturbance

To qualify for a diagnosis of PTSD a person is required to have at least 1 intrusive
symptom, 3 avoidant or numbing symptoms including at least 1 avoidant and 1
numbing symptom, 2 hyperarousal symptoms, and evidence of functional
impairment at 1 month after the traumatic event or longer (APA, 1994)
H OW THE D ATA WAS C OLLECTED ?

Sample - 10 mothers families - a convenience sample from
families who attend their initial appointment at the
‘Wednesday morning’ clinic at the FTC

Methodology - ‘Narrative Interview’ methodology: Early
in the initial session, the mother was asked the SQUIN
(Single Question aimed at inducing Narrative(s)) “Please
tell me your story of how [the presenting traumatic
event] has affected you and your family?”
Her response was actively listened to without interruption
and may then be invited to expand on aspects of her
account via prompts.

A problem arose – any ideas?
H OW THE D ATA WAS A NALYSED ?

The interviews were transcribed, anonymised and analysed
thematically, manually sentence by sentence

Inter-rater reliability - Initial scoping for content – discuss
results – re-read independently and agree a numbered list of
content items of reach case.

Low level grouping of content for each case independently –
each content item listed only once – compare results and agree
subthemes and the content items associated with each.

Independently group subthemes into themes in each case –
discuss and agree themes (include number of each items).

Combine themes across cases – and identify super-themes.
T HEORETICAL R ATIONALE
PAPADOPOULOS ’ S (2006)
T RAUMA G RID
W HAT
DOES IT LOOK LIKE ?
W HAT DOES IT LOOK LIKE (2)?
W HAT DOES IT LOOK LIKE (3)?
W HAT DOES IT LOOK LIKE (4)?
W HAT DOES IT LOOK LIKE (5)?
R ESULTS
T YPE
OF
T RAUMA
Case 1
Shooting witnessed by 10 year old daughter
Case 2
Overdose by 16 year old daughter
Case 3
Sexual assault of 16 year old daughter
Case 4
Suicide by hanging of 13 year old son
Case 5
Physical assault of 15 year old son in school
Case 6
14 year old daughter self harming with razor
Case 7
Threat to dad by gunmen – witnessed by 9 year old son
Case 8
Sexual assault of 21 year old daughter
Case 9
On-going threats &intimidation of dad and whole family
Case 10
Sectarian assault of 16 year old son
R ESULTS
Final Analysis Framework
& Summary Results
Victim 34
PTSD Symptoms 48 (22.4%)
Mother 14
Victim 77
Whole Family Emotional Response 29
Individual Distress 214 (36.7%)
Psychological Distress 166 (77.6%)
Mother 89
Family Values Challenged 57
Identified Losses 18
Negative Impact on Family Wellbeing 104 (42.1%)
-ve Changes in Communication 8
-ve Changes in Relationships 35
Negative Changes in Family Dynamics 43 (17.4%)
Family/Relational Distress 247 (42.4%)
Fam. Coping with Adverse Health 21
Associated Family Pressures 100 (40.5%)
Ongoing Harassment 64
Ongoing Criminal Proceedings 15
Individual Coping 41
Individual Resilience 47 (38.5%)
Individual Adversity Activated Development 6
Dyadic Coping 37
Resilience 122 (20.9%)
Dyadic Resilience 41
Relational Resilience 75 (61.5%)
Dyadic Adversity Activated development 4
Family Coping 27
Family Adversity Activated Development 7
Whole Family Resilience 34
S UPRA -T HEME C ATEGORIES
Prior History
of Adversity
121 items
(16.6%)
Individual Distress
226 items (31%)
Resilience
122 items (16.7%)
Family/Relational Distress
260 items (35.7%)
I NDIVIDUAL D ISTRESS
PTSD
Symptoms
48 items (21.2%)
Psychological Distress
178 items (78.8%)
FAMILY /R ELATIONAL D ISTRESS
Associated Family
Pressures
113 items (43.5%)
Negative impact
on family wellbeing
104 items (40.0%)
Negative
Changes in
Family Dynamics
43 items (16.5%)
R ESILIENCE
Whole Family
Resilience
34 items (27.9%)
Dyadic Resilience
41 items (33.6%)
Individual
Resilience
47 items (38.5%)
C OMMENT ON R ESULTS 1

The study thesis is supported by the findings, i.e.
that a primary focus on PTSD symptoms (only 8.2%
of the total relevant narrative content) misses the
complexity of the impact of traumatic life events on
victims and their families.

This is supported by the fact that almost 80% of the
‘Individual Distress’ category reflected common
signs of psychological distress rather than trauma
specific PTSD symptoms.
C OMMENT
ON
R ESULTS 2

Reports of ‘Family/Relational Distress’ were
represented more strongly than those of ‘Individual
Distress’ (42.4% Vs 36.7%). Similarly instances of
relational and whole family resilience were cited
considerably more often than individual resilience,
i.e. 61.5% compared to 38.5% of the resilience
supra-theme.

These results (if replicated) raise questions regarding
the re-balancing of professional discourses on
trauma and the nature of service provision for
people who have experienced potentially
traumatising experiences, in the light of narratives of
the ontological experience.
Thank You
I MPACT
ON
V ICTIMS

‘We’ve lost a wee part of Alex…
the son that I
had in June.. really happy-go-lucky… he was a
typical teenager… if I’m honest, I’ve lost a part
of him’

(mum of 15 year old son physical assault)
I MPACT
ON
M OTHERS

‘it kills me, it I’m totally honest, it tears me apart. So for me
as a mummy, it was extremely hard’
(mum of 15
yr old son physical assault)

‘Just I don’t think I am the person I was’
(mum
of family experiencing on-going intimidation & threats)

‘I’m completely changed… a completely different person’
(mum of 13 yr old son suicide)

‘I didn’t worry before.. it’s not me, you know… I’m used to
being the strong person… but now other people have to be
strong for me. Do you know what I mean? That annoys me’
(mum of 13 yr old son suicide)
T HEME - L OSS OF C ONTROL

‘so I was really, I was upset, I was annoyed, I was angry. I
was… I have to say the family felt like they didn’t know how to
cope with it… they wanted to protect him but we didn’t know
how to because it happened out of our hands basically’
(Mum of 15 yr old son physical assault)

‘what frightens me is you have no control. And no matter
what you do, you have no control’
(mum of 21 year
old daughter sexual assault)

‘we had no choice…’ [Meeting perpetrator face-to-face at
youth conference]
(mum of 16
yr old son sectarian assault)
W HOLE
FAMILY IMPACT

‘they don’t go to bed without me. If the door knocks, I would
jump out of my skin… the door isn’t knocked very often but
when it does, everybody’s jumping out of their skin’ (mum of
9 year old who witnessed threat by gunman)

‘everybody’s well like went the wrong way’ (mum of 13 yr old
son suicide)

‘the whole house is nervous’ (mum of daughter who
witnessed shooting)

Mum ‘devastated’ – whole family ‘devastated’ (mum of 16 yr
old daughter sexual assault)
D YADIC I MPACT

‘She (daughter) said “I don’t want to talk about it any
more. I just want to pretend it didn’t happen”.
Contain the pain… And if I’m honest with you, I find it
very hard to listen to. I find it so hard… and then she
says, it didn’t happen to you, what are you feeling
sorry for yourself for? I can’t separate the two, you
know what I mean?’

(mum of 21 yr old daughter sexual assault)
COPING NARRATIVES
‘it is hard and I’ve noticed too, It can be hard on Tom
because he’s a daddy… I know Tom is very strong and
sometimes he doesn’t show the kids sort of how much
it has affected him. I see it, but he’ll be strong for
them. I would see the different side – he would let his
emotion show to me – but he tries his best to always
let the kids know that he’s their strength… I cry but he
can be the strong one. I’m strong sometimes but I cry
because my babies got hurt and they’re still my babies
whether they’re 16 or 26, they’re still my babies’
(Mum of 15 year old son physical assault)
R ESILIENCE & MUTUAL SUPPORT

‘Well, it has made us, want to talk more about
problems. We talk about everything. You know, it
doesn’t matter what it is. We talk about it. It’s made us
more closer. It’s made us more protective of each other,
we think. We try not to be over-protective… they go
“Mum, don’t worry. Don’t panic”’

(mum of 21 yr old daughter sexual assault)
R EFERENCES

Briere, J., & Scott, C. (2006). Principles of Trauma
Therapy: A guide to symptoms, evaluation, and
treatment. London: Sage.