Adverse Childhood Experiences: What is my Score? (Part 2) By Yael Gold, Ph.D.

Adverse Childhood Experiences: What is my Score? (Part 2)               By Yael Gold, Ph.D.

In my previous post I discussed the “ACE Study”, which looked at the occurrence of Adverse Childhood Experiences in a group of 17,337 adults. It was the largest and most comprehensive study of this type to date and looked at people’s experiences across ten different types of child sexual abuse. The questionnaire utilized for the ACE’s study appears below. If you would like to take it please feel free to, otherwise you may skip down to the section below.

Prior to your 18th birthday:

Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?
No___If Yes, enter 1 __
Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?
No___If Yes, enter 1 __
Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?
No___If Yes, enter 1 __
Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?
No___If Yes, enter 1 __
Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
No___If Yes, enter 1 __
Were your parents ever separated or divorced?
No___If Yes, enter 1 __
Was your mother or stepmother:
Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
No___If Yes, enter 1 __
Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?
No___If Yes, enter 1 __
Was a household member depressed or mentally ill, or did a household member attempt suicide? No___If Yes, enter 1 __
Did a household member go to prison?
No___If Yes, enter 1 __
Now add up your “Yes” answers: _ This is your ACE Score.

You may be wondering what your ACE score may tell you about yourself and I’d like to discuss this, along with providing a few thoughts also, about other factors that can help protect us from the potential harmfulness of These adverse childhood experiences. ACE scores of 4 and higher have been found to correlate with a high incidence of physical illnesses, mental health issues, alcoholism and drug dependency, and interpersonal difficulties.

What this means, is that typically, the more types of traumatic experiences a person endures in childhood, the more difficulty he/she will have later in life. In order to understand this at a deeper level it’s important to know that traumatic experiences affect many areas of our personal functioning including brain development, attachment patterns, the ability to feel connected with our bodies, and emotional regulation. Traumatic experiences also are associated with feelings of shame and self blame, feeling generally unsafe, flashbacks, and dissociation.

I’ll go into these long term effects in subsequent posts but wanted to make sure to also mention that it’s possible for individuals to experience adverse childhood experiences and not go on to develop some of the long term issues mentioned above.

One of the factors that differentiates whether or not long term impact will ensue is whether the child had the emotional support of a caring adult such as a grandparent, aunt or uncle, or a teacher. Feeling valued by a caring individual often helps to mitigate and lessen the long term effects of negative childhood experiences. Similarly, early intervention by helping professionals can help children work though their traumas at a young age.

For adults, “trauma informed” therapy can offer many options for healing from the long term effects of childhood abuse and neglect. This too will be covered in future posts on this blog. My hope is that by reading this post you’ll come away knowing that no one is “doomed”. While we know, beyond the shadow of a doubt, that adverse childhood experiences are detrimental in numerous ways, it is also the case that with compassion, support, insight, and patience, wounds from the past do heal and people go on to be happy and to have meaningful and productive lives.


Starecheski, L. (2015, March 2), Take the ACE Quiz [Blog post] Retrieved from:

Van der Kolk, B., (2014). The body keeps the score. New York, New York: Viking.

Graphic animation figure- GIPHY app

Continue reading “Adverse Childhood Experiences: What is my Score? (Part 2) By Yael Gold, Ph.D.”


Rape Culture and Disney Princesses: Part I


I would like to start out by saying I am a HUGE fan of Disney/Pixar animated films. While growing up, I often wondered when I would stop enjoying cartoons. Well, that day has yet to come; however, over time as I became a psychologist and a feminist, I began to notice troubling messages in my beloved stories. Something I have noticed more and more over time is how rape culture rears its ugly head, even in entertainment designed for children. I do not blame Disney for creating or intentionally perpetuating rape culture. In fact, most of the stories involving the famous Disney Princesses are adapted from fairytales that are centuries old. I think the troubling messages that have shown up in these films over the years are a symptom of a much larger problem. Also, something as insidious as rape culture can stir up emotions in people that lead them to avoid discussing it. With that in mind, animated films can be a useful tool for making a difficult topic more accessible. Let’s discuss this problem of rape culture further and see how it shows up in some of the films that are dear to our hearts. This will be the first post in a two-part (possibly more) series on this topic.


What is rape culture?

Before we can define rape culture, we must first define rape. While this might seem like a straightforward task, it becomes complicated when accounting for the legal implications of this definition. Rape is not merely a word. It is a legal term, which can determine the severity of a perpetrator’s punishment. When defining rape in a legal capacity, it actually depends on the state (as in the United States) in which the rape occurred. Fortunately, from a psychological perspective, our definition can focus on the victim/survivor of the rape, rather than on the consequences for the perpetrator. For that reason, we can consider a broader definition than the ones found in the judicial system. Therefore, we will define rape as sexual intercourse without consent. Sexual assault is a term often used interchangeably with rape; however, it is more of an umbrella term used to describe any unwanted sexual act ranging from rape, to unwanted touching, to verbal sexual harassment. If we think of sexual assault as a continuum, then rape would fall on the most extreme end of that continuum. All rapes are sexual assault, but not all sexual assaults are rape.

Now that we have an idea of what rape is, we can take a deeper look at rape culture. Rape culture occurs in any environment that makes it easier or more likely for rape or other types of sexual assault to occur. When exploring rape culture in America three themes often emerge: consent, victim-blaming, and gender roles. The misconceptions in these three areas are perpetuated, in part, by the images we are bombarded with on a daily basis. An extreme example is the common scene of a woman being attacked and sexually assaulted by a stranger in a dark alley or similar setting. This is the image that many people have when thinking about sexual assault, even though most sexual assaults look nothing like it. In this post we will explore the area of consent, and in Part II of this series we will explore victim-blaming and gender roles further.



The predominant misconception regarding consent in our culture is the idea that consent is about saying “no.” Remember our woman being assaulted in the dark alley? How do we know she is being assaulted? She is yelling, trying to escape, and fighting back. When we are presented with this scenario repeatedly, we come to believe that there must be some sort of resistance, either verbal or physical, in order for something to fall under the umbrella of sexual assault. Nothing could be further from the truth. Consent is not about saying “no.” Consent is about saying “yes.” This actually really simplifies things if you think about it. Rather than having a dozen questions regarding if, how much, and how long a person resisted; there is only one question that needs to be asked: “Did the person consent?” Consent must be given. It must be un-coerced. It must be sober. Consent for one activity (e.g., holding hands) does not suffice as consent for another activity (e.g., kissing). Your relationship status with a person does not act as consent for sexual activity with that person. For example, being married to someone does not automatically mean you have consent to have sex with that person. Finally, it is the responsibility of the person initiating the activity to obtain consent for that activity. Let’s look to a few of our fairytale friends for examples.

Two obvious examples of issues with consent can be found in Snow White and the Seven Dwarfs and Sleeping Beauty. Both princesses are awakened from a spell by a kiss. In these movies the kiss is portrayed as being the very romantic climax of the story. And within the context of the story this line of thinking is pretty logical: “There is a princess under an evil spell, obviously she wants me to kiss her in order to save her from said spell.” However, this line of thinking does not translate into say, a party on a college campus: “There is a girl passed out on the couch. Obviously, she wants me to kiss her so that we can live happily ever after.”

This idea of consent also shows up in Ariel’s story: The Little Mermaid. Here we have a character who has literally lost her voice and there is an entire song of the film devoted to all of the reasons why Prince Eric should kiss her. There are even videos showing how creepy this song sounds when sung in a minor chord. This is not to say that there are no situations in which nonverbal cues can be used as consent. But once again, this complicates things. Nonverbal cues can easily be misinterpreted. Also, in Ariel’s story, I think it is important to point out that it is outside pressure from characters other than Ariel that are encouraging Prince Eric to kiss her. This is another common theme in sexual assault. Even if Ariel does want to kiss Eric, the situation makes it nearly impossible for him to be certain that she does.


Also, the “Once Upon a Dream” scene from Sleeping Beauty provides another example of issues with consent. Prince Phillip is watching Aurora while she sings in the woods. He then comes out, surprises her, and grabs her hand repeatedly. Aurora is startled by him at first. Then she continually pulls her hand away from his as she tries to walk away. As a child, I loved this scene. They’re outside singing beautiful music surrounded by woodland creatures and they fall in love. As an adult, I want to shout at my screen “dude, let go of the woman’s hand! Oh wait, now they’re in love…” This scene taps into an important myth regarding consent: if at first you don’t succeed, pressure the person until he/she gives in. This is not obtaining consent. It is coercion. Remember, consent must be given freely without being pressured or coerced.

In part two of this series, we will dive into two other areas of misconception that perpetuate rape culture: victim-blaming and gender roles.

References and Resources

U.S. Department of Justice. 2005, 2007, 2015 National Crime Victimization Survey.

National Center for Injury Prevention and Control & Centers for Disease Control & Prevention. The National Intimate Partner and Sexual Violence Survey: 2010 Summary Report. 2011.

Buchwald, E., Fletcher, P., & Roth, M. (1995). Transforming a Rape Culture. Milkweed Editions: Minneapolis, MN.

R.A.I.N.N. (Rape, Abuse, & Incest National Network)

Easton, A., Summers, J., Tribble, J., Wallace, P., & Lock, R. (1997). College women’s perceptions regarding resistance to sexual assault. Journal of American College Health, 46, 127-131.

Murnen, S. K., & Kohlman, M. H. (2007). Athletic participation, fraternity membership, and sexual aggression among college men: A meta-analytic review. Sex Roles, 57, 145-157.

Lisak, D., & Miller, P. (2002). Repeat rape and multiple offending among undetected rapists. Violence and Victims, 17(1), 73-84.

Kilpatrick, D. G., Resnick, H. S., Ruggiero, K. J., Conoscenti, L. M., & McCauley, J. (2007). Drug facilitated, incapacitated and forcible rape: A national study. Charleston, SC: National Crime Victims Research & Treatment Center.


Photo Credits
Rape Culture Sign
Indecision dice
Sleeping Beauty
Little Mermaid


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)
Emotional Abuse 13.1% 7.6% 10.6%
Physical Abuse 27% 29.9% 28.3%
Sexual Abuse 24.7% 16% 20.7%
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%
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.
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.


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


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

Version 2

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