A further subset of C-PTSD is betrayal trauma. Freyd et al. (2007) described betrayal trauma as a phenomenon of attachment failure. A child must create maladaptive survival strategies to survive abusive caregiving by a primary attachment figure. These coping mechanisms continue well into adulthood. These adult survivors who have experienced much betrayal can lose the ability to detect future incidences of betrayal. These can lead to a tendency in survivors to get revictimized through seemingly unrelated traumas (Freyd et al., 2007). Gomez et al. (2016) described relational trauma as trauma that happens in the context of a powerful bond. Betrayal trauma comes about as a result of a violation of trust between two people. This type of trauma tends to overwhelm the attachment system. It interferes with a deep-rooted connection with another process. Emotional support and self-care are indicated for healing this type of trauma. Journaling, dance, nature, and spirituality can help connect these individuals with who they are. A sense of self is broken instead of a bone. The medical model places the pathology into the betrayed person instead of getting placed into the betrayer (Gomez et al., 2016).
Birrel and Freyd (2006) emphasized the impact of significant human bond violations and loss of relationships in the context of betrayal trauma. They advocated for a relational model of healing that acknowledges the more significant impact of relational traumas. Gobin and Freyd (2014) proposed that betrayal trauma inhibits a survivor’s ability to make sound choices regarding whom they can trust. Platt and Freyd (2015) proposed a continuum of betrayal from low to high. They suggest that betrayal itself is a crucial dimension of trauma that may be a factor contributing to PTSD. Hocking et al. (2016) correlated child maltreatment and adult interpersonal trauma. Traumas higher in betrayal, such as parental betrayal, have a more significant impact on adult survivors. The results of their study indicated that child abuse is associated with adult betrayal trauma, with the anxious attachment being the partial mediator of this phenomenon (Hocking et al., 2016).
According to Hughes (2017), familial and relational trauma can result in developmental trauma disorder (DTD). Disruptions of attachment play out well into adulthood. These adult survivors often go underserved or undetected. Their symptoms play out especially in the context of one’s primary attachment, leading to affect dysregulation, relationship struggles, and behavioral problems. Survivors get left with feelings of shame, rage, and dissociation. Regardless of whether survivors leave their original family chaos, the trauma lives on in their hearts and marital relationships as adults. Attachment is the most researched area of human development, and human functioning is at its best in the context of a supportive primary attachment (Hughes, 2017).
Van der Kolk (2005) is a primary advocate of a new diagnostic category of developmental trauma, which accounts for the complexities of complex trauma in family systems. He cited nearly one million cases of confirmed child abuse in the U.S. each year. Van der Kolk proposed that this places childhood trauma as a leading preventable health concern in America. He detailed the impact of trauma and its response to bottom-up approaches to healing trauma in the form of CTs (Van der Kolk, 2005). Rahim (2014) examined the relationship between poor attachment relationships and DTD. J. D. Ford et al. (2018) define DTD as the biopsychosocial sequelae of early trauma and attachment wounds. These children have interpersonal victimization and attachment wounds that lend themselves to symptoms such as negative emotions, blame, self-harm, and reckless behaviors (J. D. Ford et al., 2018).
Siverns and Morgan (2019) found that parents with a trauma history struggled with child-rearing themselves. Specifically, mothers with a history of sexual abuse veered on the side of emotional enmeshment with their children. Sheinbaum et al. (2015) found positive correlations between role reversal, insecure attachment, and schizophrenia. In addition, schizophrenia is a biological condition that cannot be created by the environment itself. It can, however, be exacerbated by stress and experiences. Bradfield (2013) further identified intergenerational trauma as a subset of developmental trauma. Spinazzola et al. (2018) reported the significant debate in the trauma field regarding the lack of DTD’s inclusion in the most recent Diagnostic and Statistical Manual (DSM; APA, 2013). Van der Kolk and Courtois (2005) further advocate for a specific term called complex DTD (2005). Schimmenti (2012) highlighted the impact of pathological shame in DTD. In severe cases, these individuals cannot form relationships due to their belief that they are inherently defective. Busuito et al. (2014) also correlated attachment rooted in childhood trauma with increased PTSD.
Levers (2012) described sexual violence as one of the most distressful types of trauma due to its intimate nature is a common type of trauma experienced in dysfunctional family systems. Early childhood is defined as the first 8 years of life. Around 50% of children exposed to domestic violence are under this age. The brain develops rapidly between birth and age 2; therefore, attachment issues with caregivers have a severe impact on the developing brain of a young child. Levers cited the work of Bowlby (1982), who founded the idea of attachment theory. This theory is based on the idea that children need a secure base to help them learn affect regulation, security, communication, and expression of feelings. Four phases of attachment happen from birth to 18 months. The infant develops a pattern of attachment in response to the caregiver’s interactions. If the caregiver is attentive and responsive, the attachment pattern is healthy. The infant can develop anxious, avoidant, or disorganized attachment when the primary caregiver rejects the infant’s attempts to attach. These patterns can play out in adult relationships in maladaptive ways (Levers, 2012).
According to Levers (2012), child maltreatment includes assault, sexual abuse, emotional abuse, neglect, and abandonment by the caregiver to the child. The child struggles to reconcile with the caregiver as both harmful and comforting. Domestic violence is another form of attachment trauma. Infants can experience symptoms of hyperarousal that usually correlate to the level of the mother’s distress. Ongoing trauma that extends into adolescence can result in developmental trauma. This dynamic is where trauma inhibits the adolescent or child’s ability to achieve everyday developmental tasks. Strong faith and the involvement of parents can help protect against developmental trauma. Being that violence often happens in a family setting, adolescents are also susceptible to family-related traumas. Stressors include the break-up of families, relocation, conflict in families, poverty, unemployment, substance abuse, and mental illness (Levers, 2012).
Levers (2012) explained that these symptoms that might have started in early attachment trauma extend into the lives of adult survivors. Survivors might have a complex type of PTSD due to developmental and attachment trauma from the same perpetrator. Often, this perpetrator is a primary caregiver. They might struggle with trust and sleep issues, somatization, depression, affect dysregulation, shame, and relationship struggles. They often present with substance abuse issues, eating disorders, and depression. Therefore, clinicians must screen survivors for attachment issues. These survivors need the attachment healing involved in a stable therapeutic relationship with a competent clinician. Unfortunately, they might often struggle with issues of trust and unstable relationships, which make it difficult for them to bond with the therapist. The trust and kindness experienced by the therapist might just be outside of the realm of their lived experiences. They often have unbalanced lives, and therefore need long-term treatment. The therapist can help them modulate hyper and hypo arousal symptoms. These clients benefit from somatic therapies that help them reconnect to their bodies. The therapeutic relationship is the attachment relationship that might bring up all of their attachment issues (Levers, 2012).
Levers (2012) pointed out that these adult survivors often experience co-morbid conditions formerly called Axis I and II disorders. They might struggle with BPD, schizotypal disorder, dissociative identity disorder (DID), bipolar disorder, and substance use disorder. The neurobiology of these children can be significantly impaired. They might benefit from expressive arts therapy to non-verbally process their traumas. The therapeutic alliance can support needed stability to move into the processing stages of trauma. It provides an alternative narrative to the lack of safety survivors usually feel in relationships. They might transfer feelings of betrayal onto the therapist from their lived experiences. These clients can also benefit from yoga, meditation, DBT, eye movement desensitization reprocessing (EMDR), and art therapy (Levers, 2012).
Complementary Therapies and Developmental Trauma. Heller and LaPierre (2012) presented the neuroaffective relational model (NARM) to heal complex developmental trauma. NARM seeks to help clients bring forward an increased sense of connection. They describe symptoms such as reduced eye contact, limited range of effect, fibromyalgia, and irritable bowel syndrome as seemingly unrelated symptoms of developmental trauma. NARM uses five types of connection survival styles to identify ways clients learned to adapt to trauma. Issues include disconnection to self, difficulty relating to others, difficulty knowing what one needs, feeling one’s needs are unworthy to be met, feeling unable to depend on anyone, feeling like one always has to remain in control, feeling burdened, difficulty saying no, difficulty connection heart and sex, and self-esteem based on looks and performance. Heller and LaPierre (2012) recommend the use of somatic mindfulness to address the disruption of core lifeforce lost during trauma. These adults end up caught in sympathetic activation. Shame-based identification includes shame at existing, feeling like a burden, feeling like one does not belong, shame at being unable to feel, feeling undeserving, and feeling unlovable. Pride-based counter identifications include disdain for humans, pride in not needing help, pride in being a loner, pride in being rational, being needy, and feeling intellectually or spiritually superior to others (Heller & LaPierre, 2012).
Primary Caregivers With Attachment Disorders. According to Roth and Friedman (2003), the impact of being raised by a caregiver with an untreated or acknowledged personality disorder can be devastating. Often, survivors struggle to be treated well because they know that betrayal will usually follow. Survivors might cry when they see proper nurturing of children due to their pain of not receiving proper childhood love and nurturing. Survivors serve as the recipient of distortions, projections, and anger from their parents. This dynamic makes it hard for survivors to know their identity. Furthermore, their attachment system may keep them returning to the parent for love and acceptance, again and again, only to be faced with more of the same. The healing process involves letting go of the delusion that these children will ever be able to get their needs met by their parents (Roth & Friedman, 2003).
According to Roth and Friedman (2003), unlike other disorders, those with borderline personality disorder (BPD) are often difficult to leave despite their apparent chaos and destructive tendencies. This dynamic is because BPD is essentially a malfunction of the attachment process transmitted from one generation to the next. Issues like trauma, addiction, abuse, neglect, and shame prohibit caretakers from adequately attaching to their children. This dynamic creates a void in the children that cannot be avoided in their adult relationships, parenting, and marriages. This vicious cycle relentlessly destroys family systems when left untreated. These survivors feel like they are never good enough or achieve enough. Healing requires fully validating and acknowledging what happened in the past without blaming or wallowing in it (Roth & Friedman, 2003).
According to Roth and Friedman (2003), BPD behaviors include frantic attempts to avoid abandonment and rejection, intense and unstable relationships, impulsive and reckless behaviors and addictions, repeat suicide attempts or threats, mood swings, and anger problems. Cognitive distortions are common. These parents might perceive themselves as helpful and caring when in reality, they are negligent. They often try to escape reality. They struggle with impossible relationship expectations and idealize or demonize people. These parents often drink or abuse substances as a priority over parenting responsibilities. They struggle with both boundary violations and enmeshment. These parents act like children and invalidate their experiences. These people are confusing for outsiders who see them as totally usual and loveable. This dynamic further invalidates the survivor’s experience (Roth & Friedman, 2003).
According to Roth and Friedman (2003), survivors try to be perfect, but they often struggle with a deep sense of shame. They feel like something is inherently wrong with them. Survivors often experience increased depression, social anxiety, suicide, self-esteem issues, and intimacy disorders. These issues prevail regardless of what the survivor goes on to achieve. Children often love and idealize their BPD parents and play familiar roles within their family system. People with BPD tend toward black-and-white thinking and splitting. Survivors often grieve their lost childhood, their parent’s trauma, and the pain of the parent having the condition. These BPD parents split siblings into good and bad. Survivors often wonder if they have BPD, but these children need more likely just need additional skills to compensate for learning deficits in childhood. Survivors also need help managing anger and guilt. The authors suggest viewing the situation from a place of conflicting needs. The BPD parent tends to project onto the child. The child needs a stable and sane life. The authors encourage forgiveness, boundary setting, and communication training. It is vital to move forward without dwelling in the past indefinitely. Forgiveness allows survivor to acknowledge their own mistakes and flaws (Roth & Friedman, 2003).
Emotional Incest Syndrome. The book, The Emotional Incest Syndrome: What to Do When a Parent’s Love Rules Your Life (Love & Robinson, 1991), is a comprehensive description of family enmeshment with subsequent tools for recovery. Love described this emerging syndrome in great depth, offering various case illustrations and examples from her therapy practice and personal life. This syndrome is becoming recognized with the advent of single-parent homes, but fairy tales have long described such a dynamic. When a violation of the family subsystems happens, the entire family becomes unbalanced. For example, a mother with untreated mental illness may not be a suitable marriage partner, but instead of seeking a divorce, the father may turn to his oldest daughter to fill that emotional void. Often, no sexual boundaries get crossed, but the child is treated more like a mistress than a daughter. There is a reversal of the parent-child roles that wreaks havoc on the child in a similar way sexual incest does. The child may have many mental health and relationship issues as an adult (Love & Robinson, 1991).
Love and Robinson (1991) offered a clear description of the problem, alongside a clear path to recovery. They pointed out that it is often futile to chase relationship issues around without addressing the root cause in the family system. For example, a person’s relationship with their parents and sibling creates a blueprint that impacts their relationships. So, it is vital to address the current relationship with the alive or deceased parents when individuals come into therapy. The goal of her intervention is to help clients avoid enmeshment or estrangement with their parents. Setting boundaries with parents without alienation or avoiding them realigns the client’s blueprint for all relationships. This process is the single most transformative process a survivor of emotional incest must embark upon to heal (Love & Robinson, 1991).
Love and Robinson (1991) stated that often, these children would grow up and leave a wake of multiple marriages behind them. They were treated as either a chosen or left–out child. This dynamic created unrealistic emotional highs that only appear in the initial phases of romance and during an affair. Therefore, as they age, these adult children act in socially inappropriate ways. They are unconsciously recreating the emotional specialness they experienced during their childhood. These children also struggle with work relationships and grandiosity. They compulsively achieve and struggle to know their thoughts and feelings about issues. Parents often undermine their attempts to separate or marry and create families of their own. These children often compartmentalize success to their professional lives. They take up an inordinate amount of emotional space in marriage and struggle to balance closeness and intimacy (Love & Robinson, 1991).
Love and Robinson (1991) detail Love’s own relationship with her alcoholic mother. She came from a system of alcoholics. She implored those reading the book to consider the impact parentification might have had on their own lives and marriages. Love explained that this syndrome often goes unnoticed because no sexual lines are crossed. She described clients who unconsciously get drawn to older married men. This dynamic is an attempt to deal with the inappropriate father intimacy. Likewise, male clients may compulsively marry women who act just like their smothering mothers. They often struggle with a push-pull dynamic with women. These adult children often suffer from in-law trouble if the chosen child is still playing that role as an adult. Rather than rebel, avoid, or condone such behavior, Love offers guidance on how to heal said dysfunction and move on with life. Everyone is designed with needs that can only get met in loving family life. She offered specific steps to stop the intergenerational chaos and heal (Love & Robinson, 1991).
Complementary Therapies for Trauma. Webster et al. (2020) advocated for the integration of Reiki within psychotherapy treatment sessions given its symptom reduction benefits. They use the term psychotherapeutic Reiki (PR) to describe this type of Reiki. Reiki was proven especially effective in adults suffering from oversensitivity to social stressors (Webster et al., 2020). Telles et al. (2012) provided some evidence for the effectiveness of yoga and meditation in trauma-related depression, anxiety, and PTSD. Marotta-Walters et al. (2018) described eye-movement desensitization reprocessing (EMDR) as another potentially effective alternative for treating trauma. Macy et al. (2018) reviewed 185 studies of yoga for trauma. They focused on mindfulness as a critical component lending itself to the utility of yoga. They isolated the meditative parts of yoga as most helpful in treating depression. They recommended that those who wish to offer yoga in clinical practice become certified yoga teachers or therapists. They found evidence that yoga has preliminary evidence as an adjunct treatment for treating trauma, but the studies lacked enough academic rigor to be conclusive (Macy et al., 2018). Although complementary therapies are still gaining needed empirical support, they are beginning to present enough evidence for consideration in the healing ministry of pastoral counselors and lay ministers.
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Brees, Amanda Lynne, “The New Age of Christian Healing Ministry and Spirituality: A Meta-Synthesis Exploring the Efficacy of Christian-Adapted Complementary Therapies for Adult Survivors of Familial Trauma” (2021). Doctoral Dissertations and Projects. 3168.