Transcript Impacts of victimizations and victim recovery

Chie Maekoya
Tokiwa International Victimology Institute
The 11th Asian Post Graduate Course on Victimology and Victim Assistance
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What is a traumatic experience?
Possible reactions to a traumatic situation
Effects of victimization
Ecological view of psychological trauma
Recovery
Treatment
Resilience
Posttraumatic growth
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Traumatic event
Experience that causes physical, emotional,
psychological distress, or harm. It is an event
that is perceived and experienced as a threat
to one's safety or to the stability of one's
world.
The person’s response involves intense
fear, helplessness or horror
e.g.) natural disaster, war, terrorism,
physical assault, sexual assault, spousal
abuse, child abuse, traffic accident
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An event is likely to be traumatic if:
 It happened unexpectedly.
 It was unprepared.
 Victim felt powerless to prevent it.
 It happened repeatedly.
 Someone was intentionally cruel.
 It happened in childhood.
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Emotional Effects
 shock
 terror
 irritability
 blame
 anger
 guilt
 grief or sadness
 emotional numbing
 helplessness
 loss of pleasure derived from familiar activities
 difficulty feeling happy
 difficulty experiencing loving feelings
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Cognitive Effects
 impaired concentration
 impaired decision making ability
 memory impairment
 disbelief
 confusion
 nightmares
 decreased self-esteem
 decreased self-efficacy
 self-blame
 intrusive thoughts/memories
 worry
 dissociation (e.g., tunnel vision, dreamlike or
"spacey" feeling)
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Physical Effects
 fatigue, exhaustion
 insomnia
 cardiovascular strain
 startle response
 hyper-arousal
 increased physical pain
 reduced immune response
 headaches
 gastrointestinal upset
 decreased appetite
 decreased libido
 vulnerability to illness
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Interpersonal Effects
 increased relational conflict
 social withdrawal
 reduced relational intimacy
 alienation
 impaired work performance
 impaired school performance
 decreased satisfaction
 distrust
 externalization of blame
 externalization of vulnerability
 feeling abandoned/rejected
 overprotectiveness
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Negative emotion brings questions that sometimes damage
what one believes about oneself, others, and the world
Basic assumptions victims hold
about themselves and their world
Traumatic event
• Belief in personal invulnerability
• Perception of the world as meaningful
• Perception of oneself as positive
change assumption
Threat
Danger
Insecurity
self-questioning
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Individuals are not equally vulnerable to, nor
similarly affected by, traumatic events.
Persons, events, environments factors may
influence an individual post-traumatic
response and recovery.
Person
Traumatic
Event
Event
Environment
Reaction to
the traumatic event
Recovery
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Person
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Age
Developmental stage
Initial distress level
Intelligence
Personality
Affects
Cognition
Coping styles
Role
Relationship between victim and offender
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Event
◦ Frequency
◦ severity and duration of the event experienced
◦ degree of physical violence and bodily violation
involved
◦ the extent of the terror and humiliation endured
◦ whether trauma was experienced alone or in the
company of others
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Environment
◦ context within which the traumatic event was
experienced (home, school, work place or other context)
◦ victim’s natural support system
◦ the ability of that system to foster adaptive rather than
maladaptive coping
◦ the degree of safety and control afforded the victim
post-trauma
◦ attitudes and behaviors of first respondents
◦ action and understanding of family, friends, caregivers,
significant individual/ group
◦ community attitude and values
◦ political and economic factors attending victimization
◦ the quality, quantity, accessibility and cultural relevance
of victims care and advocacy resources
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Normal response to loss, particularly to the loss
of someone or something to which a bond was
formed.
Five Stages of Grief and Loss (Kubler-Ross, 1969)
 Denial “This can’t be happening to me. ”
 Anger “Why me?” “How can this happen to me?”
 Bargaining “Make this not happen, and in return I
will __.”
 Depression “I’m so sad.”
 Acceptance “It’s going to be okay.”
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Post Traumatic Stress Disorder (PTSD)
◦ Re-experiencing the traumatic event
◦ Avoidance and emotional numbing
◦ Increased arousal
Acute Stress Disorder (ASD)
Anxiety disorders
Mood disorders
Substance abuse
Eating disorders
Sexual dysfunction
Self medicating
Suicide
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A personal and unique process that reflects a change
in one’s attitudes, values, feelings, goals, skills, and
roles, and it involves the development of new meaning
and purpose in one’s life. It moves a person from the
state of pain, confusion, and anger to a state of
normativeness.
Psycho/social coping theory (Dussich, 2006)
focusing on the presence and strength or the absence
and weakness of individual coping resources.
Three psychosocial recovery conditions:
 Absence of major symptoms
 Positive identity of self
 Resumption of a functional daily life
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Establishment of
safety
Remembrance and
mourning
Reconnection with
ordinary life
Herman, 1992
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A guiding principle of achieving recovery is to
help a person regain power and control.
 Establishing safety begins by focusing on control
of the body and gradually moves outward toward
control of the environment.
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Indicators of the establishment of safety
Victims:
 No longer feel completely vulnerable or isolated
 Able to control most disturbing symptoms
 Able to rely on self and others for support
 Sense of deserving support and care
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Reconstruction of the trauma involves the victims
telling the details of the trauma so that memory
can be integrated into the survivor’s life story.
Process involves intense grief.
Ultimately they are able to put the story,
including the imagery, into words. The victim
achieves the ability to construct not only what
happened but also what he felt.
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The survivor faces the task of creating a
future
They develop
◦ New sense of self
◦ New relationships
◦ A meaning for life “faith”
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Empowerment and reconnection are the core
experiences of recovery.
A sense of power and control will be
increased in this last stage.
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Authority
over the remembering process
Integration of memory and affect
Affect tolerance
Symptom mastery
Self-esteem and self-cohesion
Safe attachment
Meaning making
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An individual has a
new or renewed
authority over the
remembering process.
She can choose to
recall the event or not.
The balance of power
between the individual
and her memories is
reversed.
Authority over the
remembering process
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Memory and affect are
joined.
The past is
remembered with
feeling.
An individual is able to
identify contemporary
feelings about the past.
Integration of memory
and affect
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Affects associated with
traumatic events no
longer overwhelm or
threaten.
Feelings can be felt
and named and
endured without
dissociation.
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Affect tolerance
Persistent symptoms have
decreased and become more
manageable. Stimulus for trigger
of flashback are known and can
be avoided.
An individual might continuously
experience symptomatic arousal,
but she has mastered and
practices healthy coping routines
to reduce arousal and manage
stress.
An individual gains the ability to
predict and manage symptoms.
Symptom mastery
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An individual feels sense of self and self
worse
Feeling of guilt, shame and self-blame are
decreased and new or newly restored sense of
self-worth is given.
Self-critical review is replaced by more
realistic appraisal, reflecting a more positive
new view of self.
Self esteem & Self Cohesion
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An individual entails the
development or the repair
and restoration of a
survivor’s relational
capacities. The pull to
isolation is replaced by a
new or renewed capacity for
trust and attachment.
An individual is able to
negotiate and maintain
physical and emotional
safety in relationship and
views the possibility of
intimate connectedness with
some degree of optimism.
Safe Attachment
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An individual assigns new
meaning to the trauma, to
the self as a trauma survivor
and to the world in which
traumatic events occur.
He might embrace the belief
that misfortune endured has
yielded new found strength
and compassion.
He names and mourns the
traumatic past and imbues it
somehow with meaning that
is both life affirming and
self-affirming.
Meaning Making
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Incidence of dysfunction=
stress + risk factor
social supports + coping skills + self-esteem
(Swift, 1986)
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Personal resources
◦ Physical assets
◦ Psychic assets
◦ Socio assets
Adequate resources result in resiliency, safety, and
an enhanced ability to recover
Recovery is best facilitated by the tailoring of
resources that are person-specific, culturesensitive & situation-realistic (Dussich, 2008).
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victim
citizen
survivor
trauma
Their world
view reduced
to a narrow
focus on their
physical health
and basic
needs
Beginning to find
their place in their
world
make adjustment to
accommodate their
new situation
reestablishing
connection with their
friend and community
Fulfillment of
the individual’s
rights
social
integration and
access to all
aspects of
society
Ferguson, Richie and Gomez
(2004)
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 The
process of recovery is highly
individualistic.
 Victim
services
 The purpose is to reduce victims suffering and
to facilitate victim recovery (Dussich, 2006).
 Victim service providers need to gather
appropriate resources.
Services which facilitate victim’s recovery
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health and psychological care
Advocacy
Personal social support
Justice system services
Financial reparation
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Treatment is necessary if survivors have..
 Experienced of difficulty in social/ personal life
 Long persistence of symptoms
 Risk for suicide and self harming behavior
Possible treatment methods
 Psychotherapy
 Psycho education
◦ Normalization, self blame, give information to help
understanding
 Cognitive Behavioral Therapy (CBT)
working cognitions to change emotion, thoughts and
behaviors
 Eye Movement Desensitization and Reprocessing (EMDR)
accelerated information-processing model to account for
resolution of traumatic memories
 Group therapy
 Play therapy (children)
 Pharmacotherapy (medication)
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Factors in resilience
◦ Caring and supportive relationship within and
outside the family
◦ Capacity to make realistic plan and take steps to
carry them out
◦ A positive view of yourself and confidence in your
strength and abilities
◦ Skills in communication and problem solving
◦ Capacity to manage strong feelings and impulses
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Make connections
Avoid seeing crises as insurmountable
problems
Accepting that change is a part of living
Move toward the goal
Take decisive actions
Look for opportunities for self-discovery
Nurture a positive view of yourself
Keep things in perspective
Maintain a hopeful outlook
Take care of yourself
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Positive changes which occur as a result of
coping with a traumatic event.
PTG includes:
 Improvement of relationships with others
 Openness to new possibilities
 Greater appreciation of life
 Enhancement of personal strength
 Spiritual development
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