Shifting the focus: Nonpathologizing approaches to healing from betrayal trauma through an emphasis on relational care

Abstract

As the diagnosis and treatment of mental disorders has become increasingly medicalized (Conrad & Slodden, 2013), consideration for the relational nature of trauma has been minimized in the healing process. As psychiatrist R. D. Laing (1971) outlined in his essays, the medical model is an approach to pathology that seeks to find medical treatments for symptoms and syndromes based on categorized diagnoses. We argue that such a model implicitly locates the pathology of trauma within the individual instead of within the person(s) who perpetrated the harm or the social and societal contexts in which it took place. In this article, we argue that this framework is pathologizing insofar as it both prioritizes symptom reduction as the goal of treatment and minimizes the significance of relational harm. After providing a brief overview of betrayal trauma (Freyd, 1996) and the importance of relational processes in healing, we describe standard treatments for betrayal trauma that are grounded in the medical model. In discussing the limitations of this framework, we offer an alternative to the medicalization of trauma-related distress: relational cultural therapy (e.g., Miller& Stiver, 1997). Within this nonpathologizing framework, we highlight the importance of attending to contextual, societal, and cultural influences of trauma as well as how these influences might impact the therapeutic relationship. We then detail extratherapeutic options as additional nonpathologizing avenues for healing, as freedom to choose among a variety of options may be particularly liberating for people who have experienced trauma. Finally, we discuss the complex process of truly healing from betrayal trauma.

From Fight or Flight, Freeze or Faint, to “Flow”: Identifying a Concept to Express a Positive Embodied Outcome of Trauma Recovery

“…The theory of change simply moves a person from an affected to a cured status in relation to the same concept (i.e., diagnosis). As has been pointed out (Gomez et al, 2016), this implies that a return to a healthy baseline is possible; whereas trauma survivors can never be "unexposed to trauma." So their positive outcome would be more akin to a healthy adaptation, a satisfying, proudly hard-won, workable way of being in the world.…”

“…This may be a particularly important time to highlight alternatives to specialty mental health treatment (Gomez, Lewis, Noll, Smidt, & Birrell, 2016) that could inform health-focused interventions. Nonpathologizing (Gomez et al, 2016; Schauer et al, 2011), relational (Herman, 1997; Jordan, 2010), growth fostering (Birrell & Freyd, 2006; Brown, 2004; Miller, 2012), and integrated (Blount & Bayona, 1994; Seng, 2011; Shonkoff et al, 2012; van der Kolk, 2014) approaches are a few alternatives. These have the potential to be offered broadly and early in the lifespan via primary care and medical homes, schools, and community and humanitarian emergency settings, and they could fill a front-line niche, including the need to provide health care to first responders and aid workers.…”

Attributes, behaviors, or experiences? Lessons from research on trauma regarding gender differences

“…The Richard P. Kluft Award for the Journal of Trauma & Dissociation 2016 Best Article was for the article "Shifting the focus: Nonpathologizing approaches to healing from betrayal trauma through an emphasis on relational care," authored by Jennifer Gomez, Jennifer Lewis, Laura Noll, Alec Smidt, and Pamela Birrell. About the article (Gómez, Lewis, Noll, Smidt, & Birrell, 2016), the award committee commented:…”

As the world becomes trauma–informed, work to do

“…First, there is an emphasis on responding more appropriately to individual pathology. This is in contrast to models of "trauma informed" care, and a long history of clinical work and research, that emphasize connecting personal experiences to broader social systems that give rise to trauma and oppression, victim/survivor empowerment, and relationship building (Gómez, Lewis, Noll, Smidt, & Birrell, 2016;Rosenthal, Reinhardt, & Birrell, 2016). For many, it appears a key component of "trauma informed" care is providing "trauma focused" evidence-based mental health treatments -i.e.…”