Addressing the Impact of Trauma – Lisa Wright
The Trauma Focused Therapy Service offers long term 1-1 psychological therapy to a small number of men in the North West prisons aimed at reducing the effects of childhood trauma on current functioning. This involves developing individualised formulations that allow service users to understand how their childhood experiences have influenced their emotional, cognitive and sexual development, their offending behaviours and then, using these formulations as a guide, utilising appropriate therapeutic approaches to produce change in these areas.
Psychological therapies that have been used in mental health services for many years are utilised in the Trauma Focused Therapy Service. EMDR (Eye Movement Desensitisation and Reprocessing) Therapy and Schema Therapy are the approaches most often used. These therapies use methods that enable us to ‘re-process’ memories of key experiences, leading to new, more adaptive perceptions of self and others.
Schema Therapy conceptualises offending behaviours as having originated in a child’s coping responses to their adverse experiences and unmet needs for safety and acceptance (Young, Klosko & Weishaar, 2003). Imagery re-scripting is the method used to work with traumatic memories, allowing clients to emotionally connect to and heal their ‘vulnerable child’ self and weaken the long standing feelings of abandonment, deprivation, defectiveness or mistrust that that have driven offence related maladaptive modes of functioning.
Eye Movement Desensitisation Reprocessing (EMDR)
EMDR therapy is based on the Adaptive Information Processing (AIP) model, which is described as a naturally occurring process that links new experiences with relevant stored information to produce adaptive learning (Shapiro, 1995; 2017). The usual AIP process can be ‘blocked’ by negative or overwhelming emotions during adverse or traumatic experiences, which can result in the perceptions of an event remaining ‘frozen’ in their original state. This includes cognitions, emotions and physical sensations. These various thoughts, emotions or sensations are subsequently triggered by similar situations, influencing present perceptions. For example; seeing a child that reminds the individual of their own sexual abuse can trigger the perceptions of the original abuse event/s, which could involve distress, confusion, pain or more ‘positive’ perceptions such as feelings of connection, care, excitement and sexual arousal.
EMDR therapy allows the individual to engage in AIP so that the ‘frozen’ memory can be re-processed in connection with existing adaptive stored information. This can be information that has been learned more recently, such as the effects of sexual abuse. This re-processing brings about adaptive changes in perceptions of the memory, which includes cognitive restructuring and change or elimination of the maladaptive emotions and physical sensations, including sexual arousal, that were associated with the original experience (Ricci, Clayton & Shapiro, 2006; Wright & Warner, 2020).
Laying the groundwork
Trauma re-processing is a very emotionally demanding experience and can also be lengthy as clients need to emotionally connect to difficult, painful and sometimes shameful experiences. Time therefore needs to be spent developing the therapeutic relationship as the service user needs to feel safe enough with the therapist to fully engage in processes that expose their vulnerable child self. The service user’s ability to manage negative emotions occurring both within the therapy room and following sessions is carefully assessed and preparation phases can strengthen these abilities before engaging in more intense work.
Changing perceptions of one’s abuse and adverse experiences, although more adaptive, can also feel like a loss, particularly if clients had held onto a ‘positive’ view of these experiences. This can also bring about significant change in the way that they view their own victims and connect to the impact of their offending. This can be distressing, needs careful monitoring and the therapeutic relationship is used to support clients with this process. Endings also need careful consideration; the therapy relationship may be the first time that the client has felt accepted and safe. However, if the ending is managed well, clients will internalise this feeling and bring it into future relationships.
Dr Lisa Wright, Consultant Clinical Psychologist
Mersey Care NHS Foundation Trust
Ricci, R. J., Clayton, C. A., & Shapiro, F. (2006). Some effects of EMDR on previously abused child molesters: Theoretical reviews and preliminary findings. The Journal of Forensic Psychiatry and Psychology, 17, 538–562.
Shapiro, F. (1995). EMDR: Basic principles, protocols, and procedures. New York: Guilford Press.
Shapiro, F. (2017). Eye movement desensitization and reprocessing (EMDR) therapy. Basic principles, protocols, and procedures (3rd ed.). New York: Guilford Press.
Young, J.E., Klosko, J.S. & Weishaar, M. E. (2003). Schema Therapy: A Practitioner’s Guide. New York: Guilford Press
Wright, L. & Warner, A. (2020). EMDR Treatment of Childhood Sexual Abuse for a Child Molester: Self-Reported Changes in Sexual Arousal. Journal of EMDR Practice and Research, 14, 2, 90-103.