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How Good Therapy Can Treat Trauma in a #MeToo World
Ruth Gerson, MD, and Patrick Heppell, PsyD

How does therapy help people who have survived trauma? Ruth Gerson, MD, and Patrick Heppell, PsyD, explain the role of therapy in healing. They are the editors of the new book Beyond PTSD: Helping and Healing Teens Exposed to Trauma. Both teach child and adolescent psychiatry at the NYU School of Medicine.

The impact of childhood trauma and post-traumatic stress disorder (PTSD) is finally, slowly, being recognized in our society. Celebrities like Oprah and Charlamagne Tha God have shared their experiences with abuse and anxiety. But there are still a lot of misconceptions about what trauma is, and how it affects us.

People tend to think of trauma as big, obvious, life-threatening events like assault or war. But for children, trauma can be bullying, or seeing police brutality. Having immigration officers take your parents away. Watching your dad beat up your mom. Having Child Protective Services take you and your siblings away from your parents and put you in foster care, feeling like maybe it’s your fault since you told a teacher about the sexual abuse.

Often kids don’t identify such experiences as traumatic. Or the trauma has been going on for so long that to survive they’ve had to convince themselves that they’re fine, that others have gone through much worse. They’ll say things like, “It doesn’t matter”; “I’m used to it”; or “It’s in the past—it doesn’t affect me anymore. I don’t want to talk about it.”

Girls and women are frequently blamed for the traumatic things that happen to them. It can be obvious and explicit—a police officer or family member blaming a sexual assault on the way the girl dressed or the shape of her body. Or it can be subtle and implicit. Girls grow up learning to tolerate unwanted attention and comments about their bodies. They start to believe that their bodies are their only value, the only way they can earn love and attention.

This is worse for youth of color. One of the most enduring legacies of slavery is that black and brown boys are seen as athletic or intimidating, and girls as sexual. Children of color experience this bias even in places designed to serve kids, like schools and child welfare systems. They learn that you can’t get love and caring for who you are—your thoughts and dreams and talents. You can only get connection or “respect” for what your body can do. Fighting and sex become the closest thing you can get to a hug.

More Than PTSD

image by YC-Art Dept

And fighting and reckless sex can come out of trauma. There is a misconception that trauma “just” causes PTSD, meaning anxiety or nightmares. But trauma, especially trauma in childhood and in relationships (e.g., abuse by someone you know) can cause a wide range of different troubles. These can range from depression and anxiety to rage outbursts, trouble in relationships, attention problems, learning problems, low self-esteem, impulsive risk-taking, and even physical symptoms. Too often kids get blamed for these behaviors, without anyone trying to understand what’s underneath.

Effectively treating trauma starts with showing youth respect for their opinions, their emotions, their experiences, their goals. If they say about a traumatic experience in their past that “It’s not a big deal” or “I don’t want to talk about it,” they probably have good reasons for feeling that way. Maybe people they loved told them “It’s not a big deal” when they reached out for help, or maybe it’s too painful to talk about it and to feel shame or self-blame for what happened.

As therapists, we respect that, and share with them that this is a normal and common reaction when someone has gone through something painful. We recognize how much strength it has taken to get to a place where it feels like “no big deal.” We show empathy and validation for how hard that must have been to get to this place, and maybe how hard it
still is.

Respect and Empathy

We help them look at how some of the things they struggle with now, from conflicts in relationships to trouble at school or “anger issues,” might be related to what they’ve been through. We respect their mixed feelings about treatment. We help them identify their goals to see if trauma treatment might help them reach those goals. We validate the girls who’ve been sexualized and catcalled and called “ho” by pointing out that this is a problem with the world, not with them. We remind them that women from every race, class, and income level struggle with getting the respect they deserve, and even with believing that they truly do deserve that respect. The #MeToo movement is so important but also shows how far we still need to go.

Scientists say that every experience we have changes our brains. Trauma in childhood causes our brains to be wired for survival in an unsafe world. That wiring makes sense while you’re being abused, but makes it hard to learn, feel safe with others, and love and feel loved when you’re away from the abuse.

Trauma treatment starts with giving kids a different experience: a respectful, curious, empathic and validating adult who wants to look past the surface behaviors to the hurt, anger, and sadness underneath. We let the girls know we’re not concerned with their appearance or their sexual history; we are interested in what they think and feel and hope for.

From there, good trauma treatment provides education about how trauma affects our thinking and behavior, teaches coping skills for relaxation and positive self-talk, and helps forge healthier connections with others. Often it includes looking back at what happened and questioning the self-blame that so often accompanies trauma, particularly from sexual abuse. And then treatment focuses on the future: how to stay safe, find meaning, and meet one’s goals. But all of this rests on a foundation of respect and empathy. Safe and respectful relationships change our brains, and our sense of ourselves in the world, for the better.

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