Constructions of Complex Trauma and Implications for Women's Wellbeing and Safety
Complex trauma, involving repeat and prolonged victimization, effects approximately one quarter of women who have experienced gendered violence. This symposium will present the findings of a large Australian study examining how complex trauma is constructed in public policy, institutional practice, professional discourse and women’s narratives.
(1) Constructions of Trauma and Complex Trauma by Women and Professionals
This paper provides an overview of the research project and then presents qualitative data on women’s and professional’s understandings of trauma and complex trauma. The paper explains the ways in which interviewees distinguished trauma from complex trauma, and the implications of women's narratives of complex trauma for professional practice. In particular, while professionals tended to focus on the psychology of complex trauma, women were more likely to emphasise the somatic and relational impacts of complex trauma, often extending across generations. Their accounts trouble the individualistic framing of complex trauma within Western psychiatry and psychology and instead point to complex trauma as the embodied, psychosocial and contextual experience of unfolding abuse and betrayal. The paper also summarises the ways in which women developed new skills and capacities to predict, self-manage and heal from complex trauma.
(2) Health Responses to Complex Trauma
Given the complexity of their needs and experiences, the engagement of women with complex trauma with a spectrum of services and agencies is fraught with potential for misunderstanding and misrecognition. This paper describes the variety of women’s engagement with: community mental health services, inpatient care and hospitalisation, emergency departments, and general practice and psychology services. A consistent theme running throughout their experiences was the risk of traumatisation faced by women when they entered these systems voluntarily or involuntarily. Through self-advocacy and persistence, some women were able to connect with specialist services and professionals who were able to provide trauma care. However, major obstacles to effective and appropriate responses to women with complex trauma included the scarcity of affordable and accessible trauma services, an endemic lack of trauma training and literacy across health care settings, discriminatory attitudes to traumatised and abused women, and convoluted service systems through which women often fell through the cracks. Drawing on interviews with women and professionals, the paper presents a model of 'best practice' in working with women with complex trauma, with a focus on service delivery and system design.
(3) This Work Touches Us at Such a Deep Place: Vicarious Trauma and Working with Complex Trauma
This paper draws on interviews with professionals in the complex trauma field to map the potentially detrimental impacts of vicarious trauma. Symptoms of both secondary traumatic stress and cognitive changes are identified, with some participants articulating concerning symptoms that clearly impair their wellbeing as well as their ability to provide best possible services to clients. Most of the organizations in our study had some policy about vicarious trauma management. Few however, had well conceptualized, robust and systemic vicarious trauma management programs in place. Such programs are increasingly being implemented for trauma exposed workforces across Australia and internationally. Evidence from the literature is sufficient to build successful and cost-effective programs to manage this risk and move beyond reliance on individual self care which is insufficient to effectively manage the risk of vicarious trauma. The paper also emphasises the benefits of complex trauma work and the salutogenic effects of treating complex trauma clients.
(4) Complex Presentations in Complex Trauma Work: Extreme Trauma and Ongoing Abuse
This paper draws on interview data with women and professionals who describe situations in which women are entrapped in severe and ongoing abuse in Australia. While ongoing familial sexual abuse into adulthood has been documented nationally and internationally, it is largely ignored in policy frameworks focused on domestic violence, sexual assault, exploitation or trafficking. Ongoing abuse remains a major clinical challenge for many professionals.
This paper identifies the most common scenarios of ongoing abuse and the presenting concerns of victimised women, and summarises the approaches of the professionals in our study working with ongoing abuse. The paper recognised the invisibility of ongoing abuse in Australian public policy and the challenges that the neglect of ongoing abuse presents to professionals and victimised women, and makes a number of suggestions for improvements in policy and practice responses to ongoing abuse.
This session was originally presented as a live conference session in October 2020.
At the conclusion of this presentation, participants will be able to:
- Identify similarities and differences between client and professional/psychiatric understandings of complex trauma
- Understand how health services and systems can contribute to complex trauma through institutional betrayal
- Apply new knowledge to their practice and/or service to develop more holistic models of treatment for complex trauma
- Analyse the spectrum of "complexity" in complex trauma, including extreme and ongoing abuse
- Better manage vicarious trauma in work with complex trauma clients
Presenter: Michael Salter, BA (Hons 1), PhD
Presenter Bio: Dr Michael Salter is a Scientia Fellow and Associate Professor of Criminology at the University of New South Wales. His research is focused on child abuse and gendered violence, including primary prevention, complex trauma and technologically-facilitated abuse. He is the author of two books, Organised Sexual Abuse (Routledge, 2013) and Crime, Justice and Social Media (Routledge, 2017), and a range of papers on child abuse and gendered violence. A/Prof Salter sits on the Board of Directors of the International Society for the Study of Trauma and Dissociation, who awarded him the 2018 Morton Prince Award for Scientific Achievement. He is an Associate Editor of the journal Child Abuse Review and expert advisor to the Canadian Centre for Child Protection.
Presenter: Elizabeth Conroy, PhD
Presenter Bio: Dr Conroy is a Senior Research Fellow with the Translational Health Research Institute at Western Sydney University and a Registered Psychologist with experience working with asylum seekers and people with drug and alcohol problems. Her research addresses the health inequity experienced by marginalised populations (such as people experiencing homelessness or substance use problems) by understanding the way in which marginalised experiences impact health presentations and researching service designs that improve the resiliency and health outcomes of these groups. Dr Conroy is currently leading a program of research on substance use and gambling comorbidity in addition to her work on resiliency and family among homeless and substance dependent adults.
Presenter: Jackie Burke, B Psych (Hons)
Presenter Bio: Jackie Burke is a Registered Consultant Psychologist with over 20 years experience in counselling, supervision and consultancy service provision. She has worked for the last 12 years researching and assisting individuals and organisations to effectively manage vicarious trauma. She is a Victims Services approved counsellor, fellow of the ANZ Mental Health Association, adjunct fellow at Western Sydney University and scientific committee member of the International Society for the Study of Trauma and Dissociation."
Presenter: Warwick Middleton, MB BS, FRANZCP, MD
Presenter Bio: Warwick Middleton MB BS, FRANZCP, MD., holds appointments as Professor, School of Medicine, University of Queensland, and as Adjunct Professor, School of Public Health, La Trobe University, School of Behavioral, Cognitive & Social Sciences, University of New England, and Department of Psychology, University of. He has made substantial and ongoing contributions to the bereavement and trauma literatures and was with Dr Jeremy Butler author of the first published series in the Australian scientific literature detailing the abuse histories and clinical phenomenology of patients fulfilling diagnostic criteria for Dissociative Identity Disorder. He chairs The Cannan Institute as well as its research and conference organizing committees. In 1996 he was the principal architect in establishing Australia’s first dedicated unit treating dissociative disorders (the Trauma and Dissociation Unit, Belmont Hospital – Healthe Care) and he continues as its Director. He is the first researcher to ever do systematic research into ongoing incestuous abuse during adulthood. He is a Past President and Fellow of the International Society for the Study of Trauma and Dissociation (ISSTD) and a recipient of that Society’s Lifetime Achievement Award. He chaired an editorial grouping that put together a Special (double) Issue of the Journal of Trauma and Dissociation (“The Abused and the Abuser: Victim – Perpetrator Dynamics”), published in 2017 and published also in expanded and updated book-form in 2018 (Routledge). He is Co-Chair of the ISSTD Membership Committee (with Abigail Percifield), Vice Chair of the Scientific Committee and a member of the Webinar Committee.
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