Many trauma survivor dyads pose intense challenges for couples and marital therapists. Interpersonal reactivity, transference, emotional withdrawal, and associated responses complicate these dificult yet ofen rewarding cases. Unique aspects and interpersonal dynamics of these couples include spec@ themes, characteristics, and patterns. Treatment approaches focus on the systemic influences of trauma on interpersonal dynamics and offer interventions to challenge disruptive interactions, attend to the original traumas, and develop healthy relationship patterns.Couples therapists experience unique challenges organizing and implementing treatment when both partners in a couple are trauma survivors, regardless of the nature or origin of the traumas. Often, when one partner is stable, the other is in crisis. The most challenging times are those when both partners are in crisis. Decisions about whom to attend to first, how to manage the mutually resonating crises, and how to ensure safety can overwhelm even experienced therapists.'Regardless of when these couples enter couples therapy (before, concurrent with, or after other treatments), the therapist will have to attend to a plethora of difficulties. These range from overall case management and coordination of the various treatments, to active intervention in the enactment of trauma responses in the couples therapy, to the resolution of other issues unrelated to trauma. Therapists will benefit by having an understanding of the major dynamics presented by dual trauma couples.Often, trauma survivors desperately need to experience improvement in their relationship while progressing in their recovery from trauma. Individual or group treatments may aggravate interpersonal conflicts in these couples since the focus typically ignores the interpersonal dyad in the service of individual progress. When individual stability strengthens while at the same time chaos or crises dominate the life of the couple, disappointed expectations of a better relationship may feel unbearable. One partner may progress rapidly while the other remains captive to the trauma. Couples treatment is often mistakenly delayed while individual or group treatment progresses, and untended couples problems may interfere with other treatment efforts.In this paper I will present a systems formulation for those couples in which both partners are survivors of trauma and offer a systemic perspective on treatment. The primary purpose is to explicate the types of interactions and dynamics characteristic of these couples from a family systems orientation.
Thirteen subjects were administered the Internalized Shame Scale (ISS) before and after EMDR therapy to determine whether Eye Movement Desensitization and Reprocessing (EMDR) significantly reduced internalized shame and increased self-esteem as measured by the ISS. While the study did not control for alternative treatment effects, age, diagnosis, SES, or ethnicity of subjects; statistical analysis indicated a significant decrease in internalized shame subscale scores and a significant increase in self-esteem subtest scores following treatment with EMDR. These results support the hypothesis that EMDR is an effective treatment for internalized shame, even when shame is not the identified target of treatment. These preliminary findings suggest that future research is warranted to explore the efficacy of EMDR in the treatment of internalized shame. KEY WORDS: EMDR; shame; internalized shame scale, self-esteem Eye Movement Desensitization and Reprocessing Treatment of Internalized ShameInternalized shame beleaguers many psychotherapy patients and remains an intractable treatment problem. Although much has been published about shame and self-esteem since 1980. For example, no clearly effective treatment has emerged that consistently results in shame reduction or the enhancement of selfesteem. This pilot study supports the utility of Eye Movement Desensitization and Reprocessing (EMDR) as a method of reducing internalized shame while increasing self-esteem. It is the first identified attempt in the field of published shame studies to support a specific treatment for internalized shame.
Shame remains largely a hidden phenomenon in the treatment of couples. It can manifest itself as a determining factor in events ranging from entrenched blaming to missed appointments. Although there is a growing body of literature on individual shame dynamics and, to a lesser extent, on couple andfamily shame dynamics, there is little written on how to incorporate these theories into treatment. This paper offers working dejnitions of shame, proposes a systemic dejnition of shame as seen in couples, reviews the literature on couple shame dynamics, and explores issues of therapeutic stance and treatment techniques in working with shame in couples therapy.Among the most perplexing challenges encountered by couples therapists are instances where treatment does not proceed according to the therapist's expectations. Couples may become entrenched in blaming, stuck in repetitive arguments, or drop out of therapy. Shame often plays a major and concealed role in these situations.The patterns connected with shame have only recently been recognized and their complexities and connection with other phenomena begun to be explored by systemsoriented couples therapists. Understanding these patterns in couple systems often illuminates a multitude of previously unexplained events, ranging from missed appointments to the escalation of seemingly straightforward problems into spiraling cycles of withdrawal, blame, or violence. Many difficult diagnostic circumstances, including depression, post-traumatic stress disorder, substance abuse, borderline, and other personality disorders, fit into this scheme.Our focus is on couples' shame dynamics, that is, how shame becomes imbedded in the system, is expressed by each member, and becomes both causal and consequential. We propose that clinical thinking in connection with couples therapy be reorganized to include a systemic understanding of shame. The use of shame as a central organizing principle to reexamine couples' dynamics and treatment is important across the full range of therapeutic parameters, including couples' presenting problems, individual diagnoses of the partners, and the therapist's theoretical orientation.Our goal in this paper is to help therapists expand their conceptualization of treatment to consciously include how shame operates in couples. We present a systemic definition of Dennis Balcom, MSW, is in private practice,
Gay men suffering from traumatic experiences can benefit from Eye Movement Desensitization and Reprocessing treatment (EMDR). In the past decade the theory and practice of EMDR has expanded to address acute and chronic childhood and adult traumas, substance misuse or abuse, identity issues including shame and selfesteem, and health issues. Through a process of accelerated information processing, traumatic memories are desensitized and reprocessed, resulting in less distress for the client in the present and future. EMDR can also be useful for developing internal resources and for exploration of relevant themes for the client. Further attention is needed in exploring the use of EMDR for gay men traumatized by hate crimes, sexual issues resulting from traumatic experiences, and internalized homophobia.
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