Exploring Trauma with Riggs Clinical Staff Member, E. Virginia Demos, EdD – Part 4
In this six-part series exploring trauma, we will present excerpts from a longer interview with E. Virginia Demos, EdD, a member of the clinical staff at the Austen Riggs Center and an authority on trauma. At the end of the series, we will make the interview, in its entirety, available in our Resource Center.
It sounds like one of the hallmarks of trauma is its obscurity —its hidden-ness. How do you work with that as a clinician?
It is true, sometimes the abuse is not evident right away even when it is quite clear that it occurred. But when we see the array of difficulties I’ve discussed —substance abuse, self-harm, eating disorders, disassociation, and so on —we know there’s some deep trouble somewhere—and that may be a history of abuse or trauma. Of course, it also may not be the case that there was trauma. We take a very thorough personal history and family history, and we also do psychological testing, that includes projective testing, as part of a thorough five or six week evaluation. We look in the family history for traumatic events, especially what’s been chronic and unacknowledged across generations. For example, we may see a third generation Holocaust survivor where the family trauma has never been processed, leaving the child with an unnamed anxiety. We look for possible dislocations or unprocessed losses in the family history, and how the family has dealt with such difficulties or events, so we can begin to get a sense of the kind of trouble that may have been unprocessed in the family and the ways it may have affected our patient.
As all of this data gathering is going on, the patient is also manifesting some of their trouble in the community, and is slowly building an alliance with the therapist, to whom they begin to reveal a little more about themselves, and how they’ve bifurcated their world. Sometimes they protect their family, or the abuser, saying everything was fine, but that they just have all these terrible problems. But often this doesn’t add up. They may continue to protect the abuser for a while, until they begin to believe that the medical and nursing staff take their trouble and their story seriously, and what they have experienced might actually have happened. There may be a lot of resistance for them to see that it is all real because they don’t want it to be true, or they fear it will damage the family or the abuser in some way. Abuse can come from many quarters – a neighbor, a teacher, a stranger, a doctor, a peer, clergy, a grandfather, or older cousin or sibling, or a parent. If the family does not believe the child’s story, or has been involved in abusing the patient, this can lead to a rupture in the treatment. The family may actually pull the patient out of treatment. But other families are ready and willing to work on what has happened, and we then provide family therapy.