Adverse Childhood Experiences: Why the past won’t just go away (Part 1).

As a psychologist who provides therapy to adults, I am often struck by how often it becomes clear to me, early on in therapy, that so many of the individuals I treat have survived one or more adverse experiences from childhood. Sometimes these are extreme and fall into the category often referred to as a “Capital T trauma” but other times these adverse events took the form of repeated emotional abuse or neglect over time, resulting in what is often referred to as “developmental trauma” (Van dear Kolk). Either way, it has been intuitively clear to many of us in the field of psychotherapy for a number of years, that direct links exist between individuals’ negative childhood experiences and the myriad of issues that bring them to therapy as adults years later. Fortunately we now have research data that supports and validates these clinical “hunches”.
What is now commonly referred to as the “ACE Study” involved a collaboration between Kaiser Permanente (a managed care consortium)and the Centers for Disease and Control. Although research studies had already looked at specific types of child abuse individually, this was the most comprehensive study of this type to date, in that it looked at ten types of potentially abusive experiences simultaneously. The participants were 17,337 individuals who received routine medical services from Kaiser Permanente at a facility in San Diego. They completed questionnaires between the years of 1995 and 1997 and were subsequently followed for fifteen additional years.The results of this study provided data that unquestioningly bridged the gap between childhood trauma and the long term negative effects that often show up later in life. The Table below provides information about the percentages of individuals  who experienced each of the 10 ACE’s defined in the original study. It is worth noting that at least two thirds of the participants reported having experienced at least one ACE.

The prevalence estimates reported below are from the entire original ACE Study sample (n=17,337).

Prevalence of ACEs by Category for CDC-Kaiser ACE Study Participants by Sex, Waves 1 and 2.

ACE Category Women Men Total
Percent (N = 9,367) Percent (N = 7,970) Percent (N = 17,337)
ABUSE
Emotional Abuse 13.1% 7.6% 10.6%
Physical Abuse 27% 29.9% 28.3%
Sexual Abuse 24.7% 16% 20.7%
HOUSEHOLD CHALLENGES
Mother Treated Violently 13.7% 11.5% 12.7%
Household Substance Abuse 29.5% 23.8% 26.9%
Household Mental Illness 23.3% 14.8% 19.4%
Parental Separation or Divorce 24.5% 21.8% 23.3%
Incarcerated Household Member 5.2% 4.1% 4.7%
NEGLECT
Emotional Neglect3 16.7% 12.4% 14.8%
Physical Neglect3 9.2% 10.7% 9.9%

Note: 3Collected during Wave 2 only (N=8,629). Research papers that use Wave 1 and/or Wave 2 data may contain slightly different prevalence estimates.

Additionally since 2010, Washington, DC and ten states (HI, ME, NE, NV, OH, PA, UT, VT, WA, and WI) have been systematically collecting information about ACE’s with the purpose of obtaining data to support the need for specific types of social programs that address the needs of abused children and their families.

My main hope in writing this piece is to share with you just how prevalent childhood traumatic experiences are. If you’ve had these experiences, please know that you are not alone. Since adverse childhood experiences often occur in the isolation of one’s family home, they can be very stigmatizing and difficult to discuss. This becomes especially true when children are specifically instructed not to disclose these experiences outside of the family. These requests that are often accompanied with explicit or implicit threats. According to Felitti, one of the chief investigators in this study, “Traumatic experiences are often lost in time and concealed by shame, secrecy, and social taboo”. In my own dissertation research I examined the prevalence of disclosure to a trusted person following experiences of child sexual abuse. Sadly, I discovered that as children, the majority of individuals in my study either hadn’t told anyone for fear of negative reprisals, or found that when they did tell, they typically  were met with dismissive responses.
In subsequent posts I’ll offer you a chance to gauge your own ACE score, I’ll go over  the relevance of high ACE scores and how they correlate with mental and physical health challenges, and I’ll discuss how “trauma informed” therapy can assist with the healing process from these past ACE’s no matter how long ago they occurred.
References
Van der Kolk, B., (2014). The body keeps the score. New York, New York: Viking.

What is Forgiveness?

Forgiveness is something that comes up pretty often in therapy. Folks often view it as something they “should” do or “can’t” do. I actually know a good deal about forgiveness as it was my dissertation topic. However, as with many complex topics, the more I learn about forgiveness, the less I know. Since forgiveness is so complex, this will be the first in a series of posts on the subject. I am passionate about making research understandable for laypeople. Too often there is a huge divide between psychological research and applying it to real life. My goal with this series is to make a complex topic understandable for people so that they can move toward the life they want to have.

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In doing my readings for dissertation, I was struck by how quick authors are to identify what forgiveness is not. For example, most researchers agree that forgiveness is different from forgetting, condoning, excusing, pardoning, or reconciling. In other words, you can forgive someone even though you still remember what they did. You can forgive someone even though you do not support or agree with what they did. You can forgive someone even though you allow them to suffer the consequences of their actions. Finally, and perhaps most importantly, you can forgive someone even though you have discontinued your relationship with them. These things are related to forgiveness and often coincide with forgiveness; however, it is important to remember that they are not the same thing as forgiveness and they are not necessary for forgiveness to occur.

Ok, so now we have an idea of what forgiveness is not. Let’s talk about the definition of forgiveness that all researchers agree upon. *Insert long pause with chirping crickets.* There’s the rub. There actually isn’t a definition of forgiveness that everyone agrees upon. That is one of the things that makes forgiveness so complicated. People are using the same word to describe different things! There are nearly as many definitions of forgiveness as there are researchers on the subject. Furthermore, remember all of those things that I listed above that researchers agree are different from forgiveness (e.g., forgetting)? Well, when you ask most laypeople what they think forgiveness is, they often will give a definition that includes forgetting, pardoning, etc. So researchers can’t agree with each other on what forgiveness is and researchers and laypeople definitely don’t agree on what forgiveness is. In the words of Peg Plus Cat, “we’ve got a really BIG PROBLEM!” But all is not lost. Even though researchers and laypeople can’t agree on specific definitions of forgiveness, there are similarities between definitions that can help us have an idea of what the heck we are talking about.

First, forgiveness is a process. It is something that unfolds over time. In most instances, forgiveness does not happen automatically or instantly after someone has been wronged. As for the steps in the process, there are a number of different theories as to how many steps and what they are. Something that Dr. McCullough (a forgiveness guru) and his colleagues have done is to divide the steps of forgiveness into two phases: 1) letting go and 2) moving on. The first phase is the letting go phase, which is considered a more passive phase. It involves a decrease in negative feelings such as anger or resentment toward the wrongdoer. It also is comprised of a decrease in thoughts or actions involving revenge. For example, let’s say I received news that someone who had hurt me in the past recently got a new job. If I were not in the process of forgiving that person, then I might feel angry and think ,”I hope they get fired.” Whereas if I were in the letting go phase of forgiveness, I would not have these thoughts and feelings. This first phase is characterized by and absence of negativity. The second phase of forgiveness is the moving on phase and it is much more active. It involves an increase in positive thoughts, feelings, and behaviors toward the wrongdoer. If I were in the moving on phase and heard the news about my wrongdoers new job, I might think, “I am happy for her.” This phase is characterized by the presence of positivity.  

Now, something interesting that I noticed in my dissertation research was the tendency for some sort of event to occur between the letting go and moving on phase. I might run into the wrongdoer for the first time in a long time. The wrongdoer might reach out for an apology. I could hear a song that reminds me of what happened. Over and over in my research and my clinical practice I have heard people say, “well I thought I had forgiven, but then X happened.” It seems people tend to stay in the letting go phase of forgiveness until they are somehow reminded of what was done to them. When this happens, for some people it prompts them to shift into the moving on phase. For other people, it is not so simple or quick. This leads to another conundrum. If forgiveness is a process, then what is the endpoint of that process? How do you know when you’ve “arrived” at total and complete forgiveness? As I mentioned before, people oftentimes think they have forgiven someone only to find they actually have not. Again, this is another question about forgiveness without a clear answer.

I could go on and on about the different factors that can influence the forgiveness process (e.g., characteristics of the relationship, characteristics of the person who was wronged, or the wrongdoing itself); but this is where we will wrap up for today. My hope as you read this is that you will get a glimpse into how complex forgiveness is. I think in our culture people often feel pressured to forgive others quickly and easily. There are a number of reasons why forgiveness is a healthy choice. However, I think it is important to remember that when we use the word forgiveness, people often mean different things. I also think it is easy to underestimate and oversimplify what forgiveness requires of the forgiver. If you are struggling to forgive someone, remember to show yourself the same compassion and kindness that you are attempting to show the person who wronged you. We will pick up here next time in the second part of this series.

References and Resources:

Enright, R., & Fitzgibbons, R. (2000) Helping clients forgive: An empirical guide for resolving anger and restoring hope. Washington, DC US: American Psychological Association.

M. E. McCullough, K. I. Pargament & C. E. Thoresen (Eds.; 2000), Forgiveness: Theory, Research, and Practice. New York: Guilford Press.

E. L. Worthington, Jr. (Ed.; 2005), Handbook of forgiveness (pp. 557–573). New York: Routledge.

Special thanks to my dissertation committee:

Dr. Amy Peterman, Dr. Charlie Reeve, Dr. Lawrence Calhoun, Dr. Richard Tedeschi, and Dr. Edward Weirzalis

Post-election Stress

Despite the ideological divisions in our country, one thing we can all agree on is that this election cycle has been exceptionally stressful. The ITA founder, Dr. Yael Gold, was recently interviewed by WECT News regarding post-election stress. Dr. Gold provided helpful strategies for managing stress related to the election as well as signs that may suggest seeking help from a professional would be beneficial. A link to her interview is below. We hope our followers will find this information helpful in managing their own post-election stress.

Dr. Gold Discusses Tips for Post-election Stress

Introducing Brenda Knierim, MSW, LCSW

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Hello friends! Thank you for visiting our newly formed blog: healing insights. I am Brenda Knierim, one of the clinical social workers (LCSW) at ITA. I have been fortunate to be a part of this wonderful group for the past four years!

Being in private practice has taught me a tremendous amount about the resilience of the human spirit and drives me to continue this career path. I truly love my work!

So, a little about me and why I chose social work. Social work has been my passion since the mid 90s when I completed my BSW at Lock Haven University. I found myself simply drawn to the helping profession. Some may say I elicit an easy and compassionate approach. I want people to feel safe and free of judgement. My goal is to truly understand their struggle or situation and jointly create positive solutions for change.
I’ve experienced my work from many different angles and perspectives. I have met with individuals, children and families in their homes , in the community, in shelters, in hospitals, in treatment centers and offices. Each of us from different walks of life , an array of experiences that have shaped us ,yet the same commonality and need for a listening ear or yearn for feedback on a challenging life circumstance .

As Brene Brown states, the courage to “be vulnerable “or to “show up,”  the confidence that each individual has to walk into therapy ready to expose themselves emotionally, now that deserves a stand-up ovation! Everyone has a lesson to teach or a story to tell…my hope is that I will be able to assist even in the smallest way to navigate a path for wellness or to feeling whole again.

So along my journey, I felt compelled to go further with my education after working in the field for many years. I completed my MSW at UNC-Chapel Hill in 2007 and immediately pursued my clinical license. I wanted to go all the way and so I accomplished that goal after a long three-year program. Of course it was worth it!

I look forward to meeting you as well as having the access to post on interesting topics or innovative therapeutic interventions!
While I’m away from ITA, you can catch me at the beach, reading, or spending time with my husband and three children.

Introducing Dr. Amanda D’Angelo

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Hi, my name is Dr. D’Angelo, but most people call me Amanda. I am a clinical health psychologist. In a nutshell, I work with people to be the best, healthiest versions of themselves they can be, both inside and out. For the more scientific version of what my title means, click here. To read my professional profile on the ITA website, click here. You can also follow me on Twitter or Facebook.

The Healing Insights blog is a collaborative effort between all of the practitioners here at ITA. We started it for many reasons and each of us brings our own set of knowledge, skills, and talent to the blog. That being said, I would like to share my personal vision for my contributions to the blog. First, I want to use my expertise to help as many people as possible. This includes current, past, and future clients. It also includes other healthcare providers such as physicians, psychiatrists, or other therapists. It also includes people interested in self-improvement that might not be ready (now or ever) for therapy.

Second, I would like to help reduce the stigma (i.e., negativity) of mental illness and of asking for help in general. It is common in our culture for people to think that asking for help is a sign of weakness, a sign of failure. In my work I have encountered many people who needed help. After all of my experiences, I can say without hesitation that seeking help is a sign of strength, not weakness. If asking for help were easy, everyone would do it.

I also want to make psychology accessible and enjoyable for laypeople. In case you didn’t already pick up on this, I’m kind of a geek and really enjoy talking and thinking about all things psychology. It’s only the most fascinating subject ever! It is the perfect blend of science and art, the concrete and the abstract, research and practice. I hope there are others out there who would enjoy taking a few minutes out of their day to geek-out with me, be stretched out of their comfort zones, and possibly even learn something.

As for my contributions to the blog, I intend on them reflecting my interests as a therapist and a person. I do a lot of work with survivors of sexual trauma. As a result, I am passionate about promoting a culture where a healthy sex life is possible for everyone. This may seem like a straightforward notion, but there are so many components of our culture that undermine people’s sexuality. I look forward to uncovering some of these and discussing them in my posts. Also, you may be surprised to find the number of topics that intersect with sexuality: body image, social justice, gender roles, university culture, reproductive health, religion/spirituality, consent, substance use, feminism, sports, and the legal system just to name a few! My personal interests include the performing arts, children’s books/films, NPR (Science Friday!), and outdoor activities. I will be looking for ways to incorporate these into my posts as well.

It looks like we have lots to explore together through this blog. I am looking forward to it!

Take care & be well,

Dr. D

Introducing Dr. Yael Gold

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Hello my name is Dr. Yael Gold. I am a licensed psychologist who has been living and working in Wilmington, NC for the past 22 years. Also, I am proud to have been affiliated with Integrated Therapy Associates (ITA) since its formation 10 years ago and I’m thrilled that we’re starting this blog. Let me tell you a little about myself.

I consider myself to be very fortunate in that I find my work as a psychotherapist to be both extremely fulfilling and endlessly rewarding. In fact I often wonder whether I chose this field or whether it chose me! Day in and day out I am deeply moved by the courage of the clients I serve and by the tenacity and resilience of the human spirit. As the daughter of a Holocaust survivor, I have witnessed firsthand, through my mother, what it means to rise above our own circumstances in order to do good in the world. At age 85, my mother, who is a retired therapist in her own right, continues to find ways to help others. She currently volunteers at a soup kitchen in New York City where she helps to feed those in need of a hot meal.

As for me, I am dedicated to a lifelong process of expanding my knowledge of the factors that promote growth, wholeness, well being, and a sense of meaning in our lives. Likewise, to the extent that we find ourselves facing obstacles based on past experiences, I do my best to help my clients overcome anything that might be blocking them from reaching their full potential. I believe that we’re each a tapestry woven from our experiences across our life time, our unique dispositions, and the ways in which we’ve attempted to make sense of these experiences. I also believe that the true self emerges as we sort through and heal from our past difficulties.

As a therapist and in my new role as a blogger, I am committed to staying engaged in my own growth process throughout my own lifetime. As I’m made aware of new and exciting developments in the field of psychology and beyond, I am passionate about passing them on to my therapy clients as well as to a broader audience, to you the readers of this blog. I hope that my contributions to healing insights are helpful to you wherever you might be on your own personal journey. Here’s to your wellbeing!

Intro and Welcome

Welcome to “Healing Insights”, Integrated Therapy Associates’ new blog! We look forward to having this new vehicle for communicating with you. We are a holistically oriented group of six practitioners in private practice all providing services under one roof. Currently we’re comprised of five psychotherapists and a registered dietician. Our intention for this blog is to focus our posts on topics related to the integration of the mind, body, and emotions as this pertains to mental health and emotional healing. At times we may also focus on the role of spirituality. We’ll  start with an introduction by each of our practitioners so you can get a better idea of who we are as individuals. New posts will appear about once every two weeks. We hope that you’ll find our posts to be informative, thought provoking, and inspiring!

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