Do you integrate into your trauma intervention process worksheets listing various statements and thought processes that help educate and normalize for survivors the secondary and self-induced wounding frequently following exposure to trauma? Over the past 20 years I’ve conducted full day trauma trainings to an estimated 60,000 school mental health professionals. I always begin by asking a series of questions to evaluate attendee’s knowledge base. Unfortunately the same limited show of hands to the above question raised 20 years ago has not changed today.
These wounds involve guilt and shame associated elements that survivors rarely reveal without encouragement- in this case a visual aid with a listing of common secondary and self-induced thought processes and space to list other ways they have been wounded. Left hidden and unattended they can and do lead to a number of self-defeating and destructive trauma related symptoms (van der Kolk, 2014).
Secondary wounding is primarily induced by the comments of others and include statements like:
It couldn’t have happened that way.
You really can’t remember that kind of detail.
Your imagination is running away with you.
He/she would never do that.
There are people who have had it harder than you.
Consider yourself lucky.
You’re still young.
You’re overreacting. You need to put this in perspective.
Secondary wounding also occurs when friends and loved ones withdraw their support and comfort or otherwise distance themselves from the survivor.
Self-induced wounding occurs when 1) comparing our actions and reactions to the behaviors and reactions of other survivors, 2) by real or perceived expectations others have of us or we have of ourselves, or 3) when we compare our behaviors and reactions to norms in our society or a culture that is associated with being an “okay person” versus “not okay person.” Examples include,
He was my best friend. I should have known he was thinking about killing himself. It is my fault.”
They tell me I’ll be better if I talk about what happened, but I don’t want to. It’s too hard. What’s wrong with me?
They told me not to, but I wanted to prove I could. I’m so stupid.
Had I not been so scared maybe I could have helped the others; I’m such a coward.
In these combined statements we hear “You are wrong” (guilt) and “What’s wrong with me” (shame). Each is painful, demoralizing and fear driven (Anthony, 2014), attacking every positive view of our self prior to that trauma. Think of guilt and shame each as a heavy weight on opposites ends of an interconnected cord acting like a Spanish Bolas that when thrown is designed to entangle the legs of its victims thereby capturing its victims-in this case capturing that resilient view of self that would otherwise help move us toward recovery - posttraumatic growth. Of the two, shame is the most insidious and infectious. Left to faster it leads to view of self as unlovable, defective, inadequate, cowardly, worthless, and having no honor. It attacks our moral integrity (Neff, 2015), self-worth (Herman & Dearing, 2011) and sense of hope (Knust, 2013).
This initial education/normalizing process makes it easier for survivors to acknowledge, externalize, begin to discuss and integrate their experiences into a new view of self in the face of what they experienced and learned.
Anthony. (2014) Guilt and Shame, Retrieved May 1, 2015 from https://www.myptsd.com/c/thevault/guilt-and-shame.34/
Herman, J. L. & Dearing, R. L. (2011). Posttraumatic stress disorder as a shame disorder. In. J. Tangey (Ed), (2011). Shame in the therapy hour. (pp. 261-275). Washington, DC, US: American Psychological Association.
Knust, J. (2013). When Shame and Hate Tear Hope Apart. Retrieved May 11, 2015 from https://www.psychologytoday.com/blog/headshrinkers-guide-the-galaxy/201301/when-shame-and-hate-tear-hope-apart
van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. NY. Viking