Trauma can be divided into two main categories:

1. Events that are almost always traumatic no matter who experiences them: war, severe emotional, physical or sexual abuse, rape or assault, catastrophic injuries and illnesses and loss of a loved one.

2. Events that can be traumatizing but that we may not think of as traumatic: minor car accidents, invasive medical and dental procedures, falls and other “minor” injuries, natural disasters, illnesses, sudden loud noises, birth, abandonment, accidental poisoning, prolonged immobilization.

After working for many years with people who have experienced trauma and other trauma workers, I became interested in understanding the impact of this work on the helping person. For seven years, a colleague of mine, Dr. Ned Rodriguez, and I led groups for the Victim Advocates from the Los Angeles District Attorney’s office, focusing on vicarious trauma and self care.

Vicarious trauma was first named and described in l990 by psychologists Laurie Anne Pearlman and I.L. McAnn. Other specialists have given the condition other names, such as Compassion Fatigue, or Secondary Trauma.

Vicarious trauma can be defined as the effects of bearing witness to the suffering of trauma survivors. The trauma worker’s empathic connection with clients and their traumatic experiences is transformative. It is impossible not to be affected by what we hear. It’s normal to be horrified, angry, sad, to feel vulnerable. We often have mental pictures of what has been described to us. Those pictures are very real.

Vicarious trauma is unavoidable, because we listen with empathy, we bear witness with feelings and we feel compassion and responsibility. These effects are an inescapable part of trauma work.

Noticing changes in ourselves is crucial. Social withdrawal, despair, cynicism, hopelessness, and post-traumatic stress symptoms can all be warning signs of vicarious trauma. With awareness, we trauma workers can learn to sustain our effectiveness in treating others by taking care of ourselves.

In helping couples discover how to find satisfaction in their relationships, I’ve learned that each couple comes needing different kinds of help.

Some couples need to learn how to fight and make up after a fight. Some may need to learn how to be more vulnerable and open when there is conflict. Others need practice listening to and empathizing with each other. Many times, issues from childhood interfere with the ability to connect in healthy and satisfying ways with one’s partner.

I believe strongly that in many relationships, learning to accept differences, rather than trying to resolve them or change the other person, is the key to happiness. Couples often need help differentiating issues that can be resolved and those that can’t, things that can be changed and things that can’t. Developing friendship and respect are also important ingredients in a satisfying and healthy relationship.

I have a great interest in how male and female sex role expectations and training and biology affect relationships and enjoy working with straight couples as well as lesbian and gay couples.

Although parents usually go into a new marriage and stepfamily wanting one big happy family, that’s not generally how things begin. There are challenges and difficulties unique to stepfamilies.

Many children feel torn between loyalty to their biological parent and stepparent. They often feel that if they love or accept the stepparent, they are being disloyal to their biological parent.

Children struggle with belonging to two different households with different values, rules and lifestyle. Relationships between stepsiblings may be difficult.

Parents may want a stepchild to love, trust and respect them right away, when in reality, these feelings often take years to develop. It’s not helpful for the child to feel pressured into expressing affection before it’s authentic. For example, demanding that children call the stepparent “mom” or “dad” is counterproductive and possibly damaging to the child.

Stepparents often try to discipline their stepchildren, which most children resent. It takes time to develop that kind of relationship. The stepparent needs to focus on developing relationships with the children so that when love and trust do evolve, the children will accept discipline from them.

Parents are caught in the middle between their new spouse and their children. When a parent sticks up for her children, her partner may get upset. But when she allows her partner to set new rules, the children may feel betrayed.

Divorce expert Dr. Patricia Papernow found that most stepfamilies go through a series of seven stages as they learn to live together.

1. Fantasy: adults sometimes fantasize that they’re rescuing children from a single parent family. Children may hope the stepparent will disappear or that their parents will get back together.

2. Back to reality: the fantasy starts to crumble. The stepparent experiences a lack of belonging. The biological parent may be angry with the stepparent for a seeming lack of desire to be in the family.

3. Awareness: stepfamily members gradually begin to understand what is happening and can name their painful feelings. It’s helpful for parents to talk to other adults in stepfamilies.

4. Airing differences: adults express more needs, feelings and perceptions. The stepparent is able to talk about issues and the biological parents feel distress.

5. Working together: once differences are aired, committed spouses can work together to build a solid relationship and cooperate on discipline. Family members can acknowledge the differences between this family and their original families.

6. Intimacy: spouses can relate both honestly and intimately with one another. Children and stepparents can talk openly about issues.

7. Resolution: relationships feel solid and reliable.

Relationships in stepfamilies take time to build. Papernow found that the average stepfamily requires about seven years to complete the cycle. Knowing this helps normalize the family’s struggles.

Visit The Stepfamily Association of America website and divorcepartner.com for more information.

In my practice, I’ve listened to the life stories, the struggles and the pain of all three segments of the adoption triad: the adoptee, the birth family, and the adoptive family. Speaking truths, acknowledging the losses in their lives, sharing the joy and healing, they have given me great insight and empathy into the complexity and depth of their unique experiences.

In her booklet “What is Written on the Heart: Primal Issues in Adoption,“ Marcy Wineman Axness writes “Babies who have lost their original mothers, permanently, or have suffered other painful or traumatic experiences, need to express their grief and their anger.” She goes on to say that in learning to understand and empathize with the infant and child, adoptive parents can create a deep and lasting bond with their child.

Each developmental stage has its challenges for the adopted child. There are many excellent books and resources for the adoptive parent to help them help their child navigate the rough times.

Birth parents are often the invisible part of the triad. What kinds of choices were open to them at the time? How has the relinquishment affected their life since? Did they get stuck in their lives, did they go on to have a family and does their family know? Have they ever had the opportunity to deal with their grief and loss?

I participated in an intense, year-long training with experts in the field of adoption, Sharon Kaplan Roszia, M.S., and Deborah Silverstein, LCSW, at the Kinship Center in Tustin, California. This background has strengthened the guidance I’m able to offer adoptees, adoptive families and birth families in moving through the underlying roots of their pain and struggles.

Visit The Kinship Center website for more information.

For more information about the work of Marcy Wineman Axness, visit quantumparenting.com

For gay and lesbian people, therapy can be treacherous. The fear of finding themselves sitting with someone who judges them as sick, mentally ill or unhealthy or sees them only in terms of their sexuality can be intimidating and prevent honest expression.

Understanding the experience of gays and lesbians and the special challenges of being gay in the world is important for a therapist working with them. Issues of coming out or not, relationships with families of origin, religious upbringing, dating relationships, marriage, children and divorce all need to be seen through the lens of the gay and lesbian experience.

Understanding homophobia and how it is internalized is crucial in working with gay and lesbian clients.

I’ve found counseling parents of gay children to be a deeply moving experience as well, as they work through their own fears, stereotypes and conditioning.

Along with seeing lesbians and gay men in my private practice, I have years of experience leading groups and workshops on gay issues. I currently facilitate a group for lesbian and gay parents who have become parents through fostering and then adopting their children.

• Have you been in an intimate relationship in which you’ve been physically hurt? Are you now?

• Have you been in a relationship in which you felt you were treated badly?
  In what ways?

• Has your partner ever destroyed things that you cared about?

• Do you feel afraid of your partner?

• Has your partner prevented you from leaving the house, seeing friends, getting a job or continuing your education?

• Does your partner use drugs or alcohol? Is he verbally or physically abusive when drunk or high?

• Has your partner humiliated you or called you names?

• Has your partner harmed or threatened to harm someone or something you love?

• Have you been forced to have sex when you didn’t want it?

• Have you been forced to participate in sexual practices you didn’t want to do?

• Do you have guns in your home? Has your partner threatened to use them when he was angry?

Battering is the use of physical, psychological, and sexual force to control and maintain power over another person. It involves frightening, intimidating and humiliating another person repeatedly over time. It often involves the destruction of personal items and pets. Battering is not a series of isolated incidents. It is a process of deliberate intimidation intended to coerce the victim to do the will of the victimizer.

Types of abusive behavior include:

1. Physical assaults

2. Sexual assaults (pressured, coerced or forced sex)

3. Threats of violence against victim, others or self

4. Attacks against property or pets and other intimidating acts

5. Emotional abuse, humiliation, degradation

6. Isolation of the victim

7. Use of children against the victim

8. Economic coercion

Batterers are not all the same. Some are violent inside and outside the home and have a history of antisocial behavior. They can be sadistic and have low empathy. Others are extremely jealous, and the violence is exclusively or predominantly in the intimate relationship. There is often depression, anxiety, and their attachment to their spouse is fearful and angry. According to Donald Dutton in his book, The Abusive Personality: Violence and Control in Intimate Relationships, the “overcontrolled batterer” often has a cheerful persona, tries to avoid conflict, masks his dependency, has an overlap of violence and alcohol use, chronic resentments and is passive aggressive.

Why does a woman stay in an abusive relationship?

1. She often has a very real fear that the violence will escalate when she tries to leave. The batterer may threaten to kill her if she leaves. Even without an explicit verbal threat, his actions may indicate that he will do so. Research shows that an increased risk of serious injury and death at the time a battered woman leaves her partner. He may have told her and/or she believes he would harm the children, other family members or pets if she leaves.

2. There is a lack of real alternatives for housing, employment and financial assistance.

3. She believes her children need an intact family, that they need their father.

4. She believes that she could not provide her children with a decent home, clothing and schooling.

5. She is immobilized by psychological or physical trauma.

6. She has cultural, religious or family values that encourage maintenance of the family unit at all costs.

7. She believes the violence is her fault.

8. She still loves him. She doesn’t want to end the relationship; she just wants the violence to stop.

9. She is ashamed to be in this situation or thinks that no one will believe her or support her.

Children are victims in domestic violence situations. In about half of domestic violence cases, children are physically abused as well. Even when they are not, witnessing domestic violence can have profound effects upon them.

If you are involved in a domestic violence situation or know someone who is, get help from someone who understands battering. There are phone hotlines, shelters for battered women and their children and programs for batterers.

Therapy by someone with experience in domestic violence is very important. These are not simply couples with conflict. When there is ongoing violence it is important that the couple not be treated together. There are issues of power and control and it is not safe.

Rape is a crime of violence. Sexual violence is a violation of the body and spirit. While individual experiences may differ, it is a shared experience of the female gender that can happen to any woman or girl.

Though changes in consciousness over the last 25 years have improved many aspects of women’s lives, too many women live with unresolved issues from sexual violation. It is a crime that still occurs with alarming frequency.

As a society, we’ve been learning about the experiences of boys and men who are also victims of sexual violence. Although it is not the epidemic for men that it is for women, men who have experienced sexual violence suffer many of the same symptoms as women.

Unfortunately, many survivors retreat into silence or compartmentalize their pain. It can take years for survivors to be ready to face their wounds. People use unhealthy coping methods to escape the pain and shame, such as alcohol, drugs and other addictive behaviors.

Sometimes survivors are resigned to living with depression, anxiety, insomnia, eating disorders, hyper-vigilance and other symptoms they may not associate with the experience of sexual violence.

My experience has taught me that the capacity to heal is within every survivor. I am always honored to work with that person where they are in their process, when they are ready to take on these issues.

For more information, visit Peace Over Violence.

Help for victims of sexual violence came initially from women supporting other women, and changing the societal beliefs about who is responsible for sexual violence, debunking the myths about rape. My Santa Monica counseling practice developed within that context. I have worked with child abuse survivors throughout my years as a clinical social worker. Couples with conflict are often dealing with the effects of child abuse on one or both of the partners.

I’ve found over the years that many clients are surprised to discover that they were abused when they were children. They come into therapy because of unhappiness in their lives, feeling stuck and unable to move forward, finding themselves in the same kinds of relationships and situations over and over.

Denial is a powerful defense mechanism that helps children survive and helps protect them from feelings that are too painful. They move into adulthood not recognizing that what happened to them was abuse.

What constitutes child abuse?

1. physical abuse

2. sexual abuse

3. physical and emotional neglect

4. psychological abuse

5. witnessing domestic violence

6. cruel and unusual punishment

7. corporal punishment

Acknowledging abuse can feel shameful and embarrassing; children get the message that there will be terrible consequences if they tell anyone. Admitting that one’s parents are less than perfect is difficult for most children. As children, we want and need to believe the best about our parents.

Faced with a choice between blaming our parents or blaming ourselves, we usually choose ourselves. “I was bad,” “I was wrong,” “I must have deserved it,” “I needed to be punished,” are all common, if false, beliefs of the abused child.

Acknowledging one’s childhood abuse is often a first step toward getting unstuck and moving forward in one’s life. It’s a journey worth taking.

In general, we tend to avoid grief. We will do almost anything to escape these deeper feelings. We will mask the pain through misuse of alcohol and drugs, food, shopping, relationships, sex and technology and anything that helps us avoid these painful feelings.

But loss is part of life. No one can escape it.

We often feel so deeply that it scares us. We’ve often learned from the people around us and from the culture that it’s better to just move on, better to suck it up, be “strong”, “tough”, “brave” etc and not let our feelings get the better of us or take us over, or interfere with our lives.

Some people feel that if they start crying they will never stop.

The ending of a relationship, the death of a loved one, the loss of feeling safe after a trauma, the loss of the image of the idealized parent you believed you had, the loss of physical abilities through aging or accident or illness, the loss of a pet, the loss of a job, or having to let go of a dream or long held goal - are all losses.

Grief is a natural response to loss.

Healing takes the time it takes and it is different for each person. Although many people have talked about the various stages of grief, it truly is a very personal process that unfolds over time. Elizabeth Kubler Ross defined the five stages of grief as: Denial, Anger, Bargaining, Depression and Acceptance. It can be helpful to be able to identify a part of the process that you are experiencing. But, as I said earlier, it is different for every person and grief can show up unexpectedly. It can be a call to pay attention.

Finding friends and family to talk with, creating rituals that are meaningful, finding helpful books to read, exploring religious or spiritual avenues of dealing with loss and grief - there are many ways to find support and guidance. Therapy is one of those ways. People often are aware that they are stuck in the process, or feel they need someone outside of their circle to talk with. We need a witness, someone or others to go through it with us, to help us bear the loss.

Group therapy can be very helpful because sharing with others experiencing similar losses can be very supportive and can normalize the feelings that they are having.

Individual therapy can also be very helpful.

I have been helping people deal with grief and loss in their lives for over 25 years. I have found it to be one of the most powerful and meaningful experiences for them and for me.

Addiction is often misunderstood as merely a physical dependency on substances, but it encompass much deeper layers of emotional and psychological pain. Renowned experts like Dr. Gabor Mate and Pema Chodron offer profound insights into the true nature of addiction and its roots in trauma and disconnection. 

Dr. Gabor Mate, a physician and expert on addiction, emphasizes that addiction is not a choice or a moral failing but a response to deep-seated trauma. In his book, “In the Realm of Hungry Ghosts,” Mate explains that addiction is a way of coping with unbearable pain and unmet needs. He argues that addressing addiction effectively requires understanding the traumatic experiences that underpin it. Healing from addiction involves creating environments where individuals feel safe, supported and connected.

Pema Chodron, a Buddhist nun and teacher, offers wisdom on working with addiction through mindfulness and compassion.  Shenpa is the word for “urge”. Her teachings encourage individuals to stay present with their urges, their cravings and discomfort, rather than seeking immediate relief through addictive behaviors. Buddhism through its precepts encourage us to not delude ourselves, to stay aware and awake and conscious, to cultivate a mind that sees clearly. 

The Adverse Childhood Experience (ACE) study conducted by Felitti and Anda, highlights the profound impact of childhood trauma on long term mental and physical health and addiction.

At its core, addiction is often a manifestation of a profound sense of disconnection - from oneself and from others and from the world. Reconnecting with oneself and others is a path to healing.