Identification With the Aggressor and Inward and Outward Aggression in Abuse Survivors

When one tool is not enough: An integrative psychotherapeutic approach to treating complex PTSD

Complex posttraumatic stress disorder (CPTSD) is a term representing the psychopathological implications of exposure to chronic, inter-personal trauma. These include the main symptoms of PTSD, as well as changes in identity, emotion regulation, and inter-personal relationships. Self-harm and dissociation (i.e., disintegration of mental processes) are also quite common in CPTSD. Considering this complex and often severe clinical picture, mental health professionals often find it difficult to effectively treat CPTSD. In this paper, we present an integrative approach to the treatment of CPTSD based on a combination of techniques from several psychotherapy approaches. The case described here illustrates the need for therapeutic flexibility and eclecticism when treating individuals exposed to chronic trauma. We show the advantages of flexible therapeutic attunement, which enables the therapist to respond to the changing need of the patient, as well as her fluid clinical picture and symptom manifestation. The case also illustrates how interventions taken from psychodynamic therapy, Dialectical behavior therapy, and Eye Movement Desensitization and Reprocessing may be applicable in various stages of treatment, alleviating the patient's distress in several psychological and physical domains.

"Caught in the crossfire" - women veterans' testimonies regarding excessively violent acts committed in combat zones

As women in the Israeli Defense Forces (IDF) are increasingly placed in supportive and combat roles in active war zones, they routinely encounter and participate in violent acts. This study focusses on the centrality of gendered inequality and oppression as a factor that shapes not only women's experience in the military but also their responses in cases of excessive violence. The goal of this study was to explore the ways women veterans of combat or combat-support units conceptualize their stance regarding violent acts which they either committed or witnessed in war zones. Using a qualitative approach, we analyzed the retrospective testimonies of 58 Israeli women veterans from the archives of an NGO that documents veteran combatants exposure to excessive violence. Most women explained their violent acts as inherent to the military system and culture, which in our analysis was categorized as examples of either internalized gender oppression or as identification with the aggressor. A smaller number of women described their attempts to protest, as they took a moral stance rooted in a feminine perspective. The three explanations revealed through the analysis of the testimonies reflect the inner tension experienced by many women in the military, as they navigate between two extreme positions, either as victims of male dominance, or as aggressors that are part of a powerful military system. In this study, gendered inequality provides a framework for analyzing the data. Thus, this study contributes to the theoretical knowledge and methodological approaches concerning violent situations in combat areas, focusing on the various ways in which women veterans subjectively and retroactively conceptualize their participation in and responses to violent acts.

A Complex Relationship: Intimate Partner Violence, Identification With the Aggressor, and Guilt

This study explored the relation between guilt and identification with the aggressor (IWA) and the moderating role of IWA in the relation between intimate partner violence (IPV) and guilt. An online survey was conducted among a convenience sample of 700 women. IPV survivors demonstrated elevated guilt, and IWA was related to guilt. Furthermore, IWA moderated the relation between IPV and guilt: Among participants with low IWA levels, IPV was unrelated to guilt, but among participants with high IWA levels, IPV was related to guilt. These findings suggest that IWA may be a key element in explaining guilt among IPV survivors.

"I'm in a Bloody Battle without Being Able to Stop It": The Dissociative Experiences of Child Sexual Abuse Survivors

Dissociation in child sexual abuse (CSA) survivors remains under-recognized and diagnosed, partly because of the difficulties involved in identifying dissociative symptoms. Qualitative research can contribute to a better understanding of the lived experiences of dissociation. This study focused on the experiences of dissociation in the context of CSA. In all, 22 female incest survivors, all diagnosed with different dissociative disorders, provided narratives about their experiences of dissociation. The narratives were analyzed using interpretative phenomenological analysis. The narrative analysis revealed four central themes. The first theme deals with reliving the experience of the abuse. The second theme refers to the experience of disconnection from the body, the self, and the surroundings. The third theme covers the lack of coherence in the narrative, and the fourth theme describes the bridge between voluntary controlled and nonvoluntary uncontrolled use of dissociation. The data are discussed in light of several traumagenic constructs, including a lack of self-sense, being entrapped in a victim-aggressor relationship, and distorted time perception. It is suggested that the extent to which participants can control their dissociation and the coherency of their narratives reflects the severity of their dissociation. Clinicians can consider helping clients use dissociation as an adaptive defense mechanism.

"It was wrapped in a kind of normalcy": The lived experience and consequences in adulthood of survivors of female child sexual abuse

BACKGROUND

Survivors' surveys on the frequency of sexual offenses committed by women indicated a prevalence rate of 9.9 % to 11.6 %. Nevertheless, only a few studies have explored the long-term consequences of abuse on survivors.

OBJECTIVES

Examine the lived experiences and the long-term consequences of child sexual abuse committed by women.

PARTICIPANTS

Fifteen adult participants who experienced child sexual abuse conducted by female offenders participated in the study.

METHODS

The Interpretive Phenomenological Approach was applied to semi-structured interviews.

RESULTS

Three central themes emerged: types of abuse, characteristics of the perpetrator, and consequences of abuse. Most survivors experienced direct or indirect forms of sexual abuse committed by their mothers. In most cases, the offenders masked their abuse in caregiving, disciplinary or playful behavior. The survivors perceived their mothers as narcissistic, controlling, hostile, and having tremendous difficulties with separation. The survivors reported the need to engage in extensive negative long-lasting psychopathologies, which they attributed partly to having been invalidated and silenced by society. Many participants expressed fears of re-enacting the survivor or perpetrator role, which has led to difficulties in various relationships. They described an altered perception of their bodies as shameful and repulsive, manifesting in self-harm, eating disorders, and the elimination of signs of femininity.

CONCLUSION

This complex form of sexual abuse hampers the internalization and the construction of positive feminine, masculine, and parental identities.

Hyper-Sensitivity to the Perpetrator and the Likelihood of Returning to Abusive Relationships

STUDY QUESTIONS

Although most women who are subjected to intimate partner violence attempt to leave their abusive partners, many return, and resultantly are at risk for even greater violence. Research to date has documented relations between several factors (income and economic dependence, frequency of intimate partner violence (IPV), fear of violence escalations, history of childhood abuse, and post-traumatic stress disorder symptoms) and women's returning to their abusive partners. Nevertheless, the contribution of women's emotional bonds with their violent partners, known as identification with the aggressor (IWA), in explaining their perceived likelihood of going back to the relationship, has remained unclear.

SUBJECTS

The current study, conducted among 258 Israeli women who had left their violent partners, aimed to fill this void.

METHODS

An online survey was conducted. Demographic variables, history of childhood abuse, frequency of IPV, economic dependence on former partner, fear of future violence escalation, post-traumatic stress disorder symptoms, IWA, and perceived likelihood of returning to the relationship, were assessed via self-report questionnaire.

FINDINGS

Results indicated that two aspects of IWA-becoming hyper-sensitive to the perpetrator and adopting the perpetrator's experience-were related to women's perceived likelihood of returning to the relationship. Furthermore, a logistic regression analysis indicated that only two factors-income and becoming hyper-sensitive to the perpetrator-uniquely contributed to explaining the likelihood of returning to abusive partners. Major implications: The current findings suggest that women's tendency to be highly attuned to their partners' feelings and needs, as a part of IWA, may impede their ability to permanently leave abusive relationships.

Child Maltreatment and Subjective Well-being in Chinese Emerging Adults: A Process Model Involving Self-esteem and Self-compassion

Child maltreatment is negatively associated with subjective well-being in emerging adulthood, but the understanding of the mechanisms of this relationship is incomplete. Guided by the stress process model incorporated with a life-course perspective, the present study examined the protective roles of self-related resources (self-esteem and self-compassion) in this association, while considering various maltreatment types (physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse). The Childhood Trauma Questionnaire-Short Form, Rosenberg Self-esteem Scale, Self-compassion Scale, and Satisfaction with Life Scale were used to measure the key variables through an online survey of 358 Chinese college students (226 females, mean age = 19.18) Direct effect of one type of maltreatment on life satisfaction and the three indirect effects through (a) self-esteem; (b) self-compassion; and (c) self-esteem and self-compassion in sequence were examined while controlling for age, gender, and the other four maltreatment types. The results showed that psychological maltreatment was negatively associated with life satisfaction through self-esteem and through the pathway from self-esteem to self-compassion. Indirect effects of the other three types of maltreatment were not significant. This suggests that self-processes are more vulnerable to psychological maltreatment than to other maltreatment types. The type of maltreatment experienced in childhood is worth considering when investigating the extending effect of child maltreatment on individual developmental outcomes. Our findings broaden the understanding of the mechanisms of the stress process model integrated with a life-course perspective. Self-related resources appear to play substantial roles in the long-term association between early stressors of psychological maltreatment in childhood and subjective well-being in emerging adulthood. Highlighting the need to work on improved self-related resources, including self-compassion and self-esteem, might help practitioners to provide treatment for survivors of adverse childhood experiences..