This is a collection of two stories, one fiction and one non-fiction, in communication with one another. Both stories explore how trauma can transform a life. In "Tabula Rasa," Mena is unable to recall her past after being beaten and left for dead. She must choose whether to uncover her past or forget it and move forward with her life. Set in a town run by witches, Mena learns that both choices are dangerous. In "Eternal Second," the narrator recounts the aftermath of her husband's suicide. She explores how trauma invades all aspects of her life. In both stories, women must navigate a new life created by the destruction of the old one.

In the proposed study it is hypothesized that resiliency will moderate the relationship between child abuse and psychiatric outcomes. Secondly, it is expected that shame will mediate the above mentioned relationship. Mediation and moderation effects will be tested via SPSS REGRESSION. Data was collected from 160 women at California State University, San Bernardino. The following measures were used to examine the hypothesis: Childhood Trauma Questionnaire, Brief Symptom Inventory, Experience of Shame Scale, Self-Esteem Inventory, the Life Orientation Test-Revised, and the Social Support Inventory.

Thesis (PhD (Psychiatry))--University of Stellenbosch, 2005. / Many gaps remain in our current state of knowledge about the epidemiology, phenomenology, neurobiology, and psychopharmacology of posttraumatic stress disorder (PTSD) in children and adolescents. Empirical evidence, particularly in non-Western settings, is sparse and there is little convergent understanding of the interrelationship of epidemiological factors, PTSD symptom expression, full and partial syndromes, disorders comorbid with PTSD, and pharmacotherapeutic interventions. Clinicians are faced with the difficult task of treating this often complicated and debilitating disorder in youth in the absence of data from well-controlled clinical trials. The studies detailed here are a point of departure for understanding the confluence that exists between epidemiological, phenomenological, and pharmacotherapeutic aspects of adolescent PTSD. Two studies were conducted to investigate the prevalence and effects of violence exposure and PTSD, clinical and functional correlates of full and partial syndromes, and associated gender differences in school and clinic samples, respectively. Two preliminary open-label trials assessed the efficacy and safety of a selective serotonin reuptake inhibitor (SSRI) in adolescents with at least moderate severity PTSD. The results indicate that (i) partial PTSD is a common nosological entity in adolescents, (ii) gender-related differences in PTSD, even if not manifest in differences in prevalence (i.e., in the rates of trauma exposure and full and partial PTSD), may well manifest in symptom expression (i.e., higher symptom burden in girls), associated morbidity, and functional impairment, and (iii) SSRIs may be effective in treating core PTSD symptoms in this age group. While not yet demonstrated, the partial subtype may have similar biological underpinnings to full PTSD in adolescents and may benefit from similar pharmacotherapeutic interventions. This is an area deserving of further investigation. Controlled SSRI data are needed to establish if these should be agents of choice for paediatric PTSD.

Thesis (MA)--University of Stellenbosch, 2002. / ENGLISH ABSTRACT: A century of clinical observations and literature has repeatedly noted that trauma responses occur in across a spectrum and on a continuum of severity. The existing, DSMIV trauma response classifications include Acute Stress Disorder and PTSD as anxiety disorders. Complex PTSD or DESNOS was considered as a proposed, alternative classification during the DSM-IV PTSD Field Trials. It was not included as a separate diagnosis, but briefly mentioned as an associated feature ofPTSD. Subsequent research and replica studies have not proved conclusively whether Complex PTSD should be a separate or associated feature ofPTSD, and the controversy continues to date. Childhood traumatization is strongly associated with adult psychopathology, and various Axis I and Axis II disorders, especially Borderline Personality Disorder, and to a lesser extent, Antisocial Personality Disorder. Prolonged, repeated traumatization during adulthood is also associated with subsequent Axis II pathology, including Borderline, Obsessive-Compulsive and Avoidant Personality Disorders. Chronically traumatized people with Axis II pathology often present with comorbid Axis I disorders including Major Depression, PTSD, Substance Abuse, Somatization Disorder, and Dissociative Disorders. There are divergent views regarding the etiology of personality disorders in chronically traumatized individuals. On the one hand, repeated, prolonged trauma could cause enduring personality dysfunction in individuals despite normal premorbid functioning. On the other hand, genetics, temperament, environmental factors and even a pre-existing stress diathesis in the pre-trauma personality could contribute to the development of post-trauma personality disorders. These two views do not necessary contradict each other, but illustrate the complexity the human stress reaction. Despite the controversy the inclusion of DESNOS into the diagnostic canon, it is a valuable measure of predicting prognosis to existing treatment options. The present main psychological treatment for post-traumatic stress disorders has been a cognitive-behavioral based, exposure intervention. Alternative therapies include psychodynamic approaches, pastoral interventions and more recently, ecological and recovery based models. The Complex PTSD conceptualization contributes to a better understanding of the personality structure of chronically traumatized people. There are three main areas of disturbance. Firstly, a complex symptomatic presentation including somatization, dissociation, and affect dysregulation. Secondly, deep characterological shifts including deformations in concepts of relatedness and identity. Thirdly, and increased vulnerability to harm, either self-inflicted or at the hands of others. The usefulness of integrating these three concepts into the personality conceptualization of chronically traumatized individuals is illustrated a case study. / AFRIKAANSE OPSOMMING: Die literatuur en kliniese waarneming vand die afgelope eeu dui herhaaldelik op trauma reaksies oor 'n spektrum. In die bestaande DSM-IV stelsel, val trauma reaksies net Akute Stress Steuring and Post-Traumatiese Stress Steuring. Hoewel Komplekse PTSD in 1992 voorgestel was as 'n alternatiefin die DSM-IV, is dit nie as aparte diagnose ingesluit is nie, maar wel wel gelys as geassosieerde symptoom van PTSD. Latere navorsing en duplikaat studies het nog nie konklusiefbewys of Komplekse PTSD 'n geassosieerde or aparte simptoom van PTSD is nie, en debat duur nog voort. Trauma gedurende kinderjare word sterk geassosieer met volwasse psigopatologie en verskeie As I en As II steurings, veral Grenslyn Persoonlikheids Steuring, en tot In mindere mate, Antisosiale Persoonlikheids Steuring. Langstaande, herhaalde traumatisering gedurende volwassenheid word ook geassosieer met latere As II patologie, insluitende, Grenslyn, Obsessief-Kompulsief en Vermydende Persoonlikheids Steurings, Kronies getraumatiseerde individue met As II patologie presenteer ook dikwels met komorbiede As II steurings insluitende Major Depressie, Post-Traumatiese Stres Steuring, Somatiserings Steuring, and Dissosiatiewe Steurings. Daar is uiteenlopende sienings oor die etiologie van persoonlikheids steurings in kronies getraumatiseerde individue. Aan die een kant, kan langstaande, herhaalde trauma persoonlikheids veranderinge veroorsaak ongeag normale premorbide funksionering. Aan die ander kant, kan genetika, temperament, omgewing en'n pre-morbide stressvatbaarheid almal bydra tot die ontwikkeling van post-trauma persoonlikheids steurings. Hierdie twee sienings weerspreek mekaar nie noodwendig nie, maar dui op die kompleksiteit van die menslike stres reaksie. Ongeag die akademiese debakeloor die insluiting van die Kompleks PTSD konseptualisasie in DSM-IV diagnostiese stelsel, is dit 'n waardevolle praktiese meetinstrument van prognose onder bestaande behandelings opsies. Tot dusver word die primere sielkundige intervensies gebaseer op 'n kognitiewe-gedragsterapie model. Alternatiewe terapieë sluit in psigodinamiese, pastorale en meer onlangse ekologiese en herstel-gebasseerde intervensies. Die Kompleks PTSD konseptualisasie dra by tot beter kennis oor die persoonlikheids struktuur van kronies, getraumatiseerde mense. Daar is drie hoof areas of versteuring. Eerstens, a komplekse simptomatiese presentasie insluitende somatisering, dissosiasie en affek disregulasie. Tweedens, diep veranderings in karakter insluitende versteurings in identiteit en interpersoonlike verhoudings. Derdens, in groter vatbaarheid vir seerkry, of aan hulle eie hande, of aan die hande van ander. Die waarde van die integrasie van hierdie drie konsepte in die persoonlikheids konseptualisasie van kronies getraumatiseerde individue word geillustreer deur 'n gevallestudie.

Thesis (MEdPsych)--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: As I engaged in a therapy journey with a single client, the possibilities for research on the integrative use of narrative therapy and EMDR unfolded. I investigated recent literature and realised that much had been written about narrative therapy as single approach to therapy within the postmodern paradigm. There was also extensive writing on EMDR and its integrative use with other therapies in assisting people who struggle with upsetting memories of trauma. Since I was unable to find any literature to date on the integrative use of narrative therapy and EMDR, I realized that there was much to be discovered and learned on such an integrative research journey. The client's experiences and descriptions of overwhelming emotional distress (as the problem in her life) during the process of integration was the main focus of this qualitative case study. During our therapy conversations knowledges were gathered and deconstructed. Video or tape recordings, photographs, work with clay, sketches, letters and other documents were useful in keeping track of the research journey. A reflecting team and the participation of the client's boyfriend contributed and enriched both the therapy and research journeys. / AFRIKAANSE OPSOMMING: Tydens terapeutiese werk met 'n enkele kliënt het die moontlikhede van navorsing oor die integrasie van narratiewe terapie en EMDR vir my 'n werklikheid geword. Ek het onlangse navorsing bestudeer en besef dat narratiewe terapie as 'n enkele benadering tot terapie binne die post-moderne paradigma, al 'n geruime tyd lank nagevors is. Daar bestaan ook literatuur oor EMDR en die integrasie daarvan met ander terapeutiese benaderings in die ondersteuning van persone wat probleme ondervind met ontstellende herinnerings van trauma. Aangesien ek tot op hede geen literatuur oor die integrasie van narratiewe terapie en EMDR kon vind nie, het ek vermoed dat 'n navorsingsreis op hierdie terrein verskeie ontdekkings en die ontginning van nuwe kennis moontlik sou maak. Die fokus van hierdie kwalitatiewe gevallestudie val op die kliënt se belewing en beskrywings van oorweldigende emosies (as probleem in haar lewe) tydens die terapeutiese integrasieproses. Waarhede of kennis is tydens terapiegesprekke versamel en gedekonstrueer. Video- of bandopnames, foto's, kleiwerk, sketse, briewe en ander dokumente was waardevol om die koers van die navorsingsreis aan te dui. Insette en deelname van 'n refekterende span, asook die kliënt se kêrel, het beide die terapie- en navorsingsreise verryk en uitgebrei.

Thesis (MEdPsych (Educational Psychology)--University of Stellenbosch, 2005. / This study demonstrates the use of the transtheoretical model in the context of sexual trauma in middle childhood. Exploring contemporary literature I found that there is no literature in South Africa available on this topic. It was not until 1997 that the transtheoretical model was implemented internationally with regard to sexual abuse. Taking this in consideration, I realised that there was much scope for exploring, discovering and reflecting on the transtheoretical model and its use within the boundaries of childhood sexual trauma. A qualitative case study within the social constructivist/interpretive paradigm, was chosen as research design. The study involved a participant in middle childhood. Elna (pseudonym) was selected from referrals from the Child Protection Unit of the South African Police Services to the Unit for Educational Psychology at Stellenbosch. The reason for referring Elna to the Unit was because of the negative and diverse effects sexual trauma had on her life story. The study explores the transtheoretical model and the appropriateness thereof as alternative treatment model in a case of sexual trauma, as well as insight into progression of the client in the therapeutic process. Data was collected by means of interviews and therapy sessions during which Narrative therapy, EMDR, sandtray therapy (used in a narrative context) and art therapy techniques were used in an integrated manner. The data was analysed by means of interpreting codes, categories and themes. The study concluded with a discussion of the findings and a reflection on the impact the use of the transtheoretical model had on me as a research-therapist-in-training. The literature review and the findings of this research suggest that the transtheoretical model can be applied effectively to a case of sexual trauma in middle childhood. The use of the model also gives insight into progression of the client in the therapeutic process.

Using a clinical sample of 63 girls aged 5 - 16 years, the Psychoanalytic Rorschach Profile (PRP; Burke et al., 1988), a measure of drive, ego, and object relations functioning, was examined for differences between sexual abuse (SA) victims and distressed but nonabused (NA) peers. The hypothesis that the SA group would evidence more pathological, less developed levels of drive, ego, and object relations functioning than the NA group was not supported. Limitations of the use of archival data are discussed. The effects of controlling for the number of responses (R) in Rorschach research were examined by comparing entire protocols of a clinical sample of girls from 5 - 16 years of age to shortened versions which included only the first one (N = 89; R = 10) or two (N = 17; R = 20) responses to each blot. Of 12 PRP scales compared, differences between the R = 10 and entire protocols were found on 5 variables, but when R was increased to 20, only 2 differences remained. Support was given for the notion of uniform Rorschach administration in which 2 responses per card are solicited.

M.A. / The Truth and Reconciliation Commission (TRC) Act was passed in 1995 and the TRC started its hearings in 1996. The purpose of the TRC was to promote national unity and reconciliation by establishing as complete a picture as possible of the human rights violations that had occurred during the apartheid era and to offer reparations to those who had been affected, as well as to grant amnesty to those who had committed these human rights violations. The TRC had to appoint people to help carry out its functions and deliver a report about human rights violations. Most of the people employed by the TRC to help carry out these functions were South African. Furthermore every South African had been involved in the past in one way or another, purely by being a South African. In this project the author explores, analyses and interprets the experiences of some of the people who were employed by the TRC. The focus of this project is to find out whether being employed by the TRC and having to listen to the stories being brought to the TRC exposed anyone to the possibility of developing what is called secondary traumatisation. This kind of traumatisation is different from the traumatisation that the people relating the stories had gone through during the apartheid years. This kind of traumatisation is said to develop from being exposed to traumatised people.

A thesis submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg in fulfilment of the requirements for the degree of Doctor of Philosophy. February 2016 / South Africa is regarded as one of the most violent countries in the world. Colonialism and apartheid laid the foundations for a divided and segregated society where violence was accepted as a legitimate means of conflict resolution in order to ensure the domination of one racial group over all other groups. As social and economic inequalities have become more entrenched in South African society, criminal violence has escalated. However, the nature of violence in the country has changed from political violence to criminal violence. Against this backdrop of violence and associated trauma, the South African Police have the insurmountable task of trying to maintain law and order. The science of traumatology is a burgeoning field; traditionally empirical research has focused on the responses of primary trauma victims. However, in recent decades the secondary effects of traumatisation on those who counsel the victims of primary trauma, has received significant attention. Located within the South African Police Service, is an often forgotten secondary group of professionals who assist the police officials through assuming the roles of occupational and forensic social work. The profession of social work is inherently stressful and demanding, especially in a country like South Africa, where social problems are ubiquitous and pervade every facet of South African society. Furthermore, a particular occupational stressor significantly impacting on these social workers as they investigate child abuse or provide counselling for a police officer, is secondary traumatisation. The questions arise: firstly, how these social workers are affected by the amount of traumatic material to which they are exposed by the very nature of their work, and secondly, what coping strategies they employ. It was therefore deemed imperative to explore the effects of secondary traumatisation experienced by these social workers in the South African Police Service in order to understand and ameliorate the negative effects of secondary traumatic stress. Furthermore, social work supervisors can enhance the quality of care their social workers provide to clients if they are adequately supported. It was therefore also considered necessary to explore the stressors these social workers experience and to identify the necessary support mechanisms appropriate to such therapeutic endeavors. The primary aim of this study was therefore to explore the nature and extent of secondary traumatic stress experienced by social workers employed by the South African Police Service. The research design adopted for this study was exploratory, descriptive and correlational, while the research methodology employed was a hybrid of both quantitative and qualitative paradigms. As this study involved an in-depth analysis of a bounded system comprising social workers employed at SAPS, the research was considered a case study. The study comprised two phases: In the first phase questionnaire booklets containing seven standardised research tools and open-ended questions, were administered in group settings. In addition, questionnaires were posted to social workers who were not able to attend the group meetings along with a self-addressed envelope. The research tools measured the nature of secondary trauma exposure, levels of secondary traumatic stress, vicarious trauma, compassion satisfaction, burnout, coping resources and dimensions of the work environment. Two hundred questionnaire booklets were distributed and 128 usable questionnaires were returned. Descriptive and inferential statistics were used to analyse the quantitative data, through the use of statistical programmes, SAS and SPSS. In the second stage of the study, 30 participants who participated in the first part of the study and who indicated that they were willing to be interviewed, were purposively selected. A structured research tool was used to guide the interview in order to explore the participants’ perceptions and experiences of secondary trauma while working for SAPS. The interviews were conducted either face-to face, telephonically or through Skype. The qualitative data that emerged from the interviews were analysed through the use of Atlasti, a qualitative computer programme, which assisted the researcher in the thematic analysis. Through the process of incorporating qualitative techniques, the researcher also made use of reflexivity when analysing the qualitative data. In total 128 social workers participated in the study, of whom 102 were occupational social workers while 26 were forensic social workers, all located within South Africa. The extent of exposure to secondary trauma varied substantially between both occupational and forensic social work when considered as separate divisions, as well as within each discipline. This variation manifested in frequencies and duration of cases. In the interviews forensic social workers identified particularly traumatic cases as those where the sexual abuse was severe or the child had died as a result of extreme abuse. In comparison, occupational social workers identified some of the worst cases they had dealt with as cases where the police officers became disabled; and where they were required to deal with police suicides and police family murders or femicide-suicides. Most participants presented with high or average levels of secondary traumatic stress and vicarious trauma as well as with moderate and low levels of burnout. Furthermore, there was a strong positive correlation between levels of secondary traumatic stress and burnout. The majority of participants experienced average levels of compassion satisfaction from their work. Participants identified various coping strategies and resources incorporating different individual dimensions, namely, physical, emotional, cognitive, social and spiritual. Participants showed high levels of resilience and findings indicated that resilience was negatively correlated with vicarious trauma. There were numerous significant differences between the different ranks of the participants. Participants of higher rank reported greater trauma exposure and had significantly higher secondary traumatic scores. Coloured participants experienced significantly lower levels of vicarious traumatisation than Black participants. Furthermore, there were numerous statistically significant differences apparent between the forensic and occupational social workers. Forensic social workers manifested significantly higher levels of vicarious trauma than occupational social workers, and forensic social workers had greater distortions regarding self-intimacy than occupational social workers. In addition, forensic social workers presented with lower coping resources and lower levels of resilience than occupational social workers. Participants also experienced below average levels of satisfaction within the work environment at SAPS. The results from the work environment scale showed that in particular the relationship aspects in the work environment were problematic and that colleague support levels were below average. There were also significant differences in work satisfaction levels between Black and White participants. These findings enhance understanding of trauma in racially polarised societies. Multivariate analysis revealed the complex relationships existing between the numerous variables in the study, further contributing to the theory of trauma in divided societies. Two structural equation models were developed to show the relationships of the variables measured in the study which were identical apart from the vicarious trauma variable which was separated to incorporate beliefs about self and beliefs about others. The models revealed that coping mechanisms moderated the relationship between traumatic stress exposure and vicarious trauma (self) and that such mechanisms moderated the resilience and burnout relationship. These findings of the study highlight the need to involve social workers at SAPS in the drafting and implementation of a self-care policy which would help to promote empowerment and responsibility of social workers for their own mental health. Recommendations for social work policy, education, practice, supervision and support as well as future research are also provided. / MT2017

O presente trabalho se propõe a apresentar uma sistematização teórica de minha experiência clínica enquanto psicanalista, no atendimento com pacientes que, após a remissão de doenças graves tais como diversos tipos de câncer que podem afetar a medula óssea (leucemias e linfomas), apresentavam-se como se ainda estivessem doentes, remetendo-se à doença como se esta fosse um acontecimento atual, identificando-se, em seu discurso, como doentes. Apresentamos dois casos clínicos que estavam com a doença em remissão há mais de dois anos e que foram atendidos em uma instituição hospitalar. O nosso objetivo é possibilitar a compreensão dos processos psíquicos envolvidos nos referidos casos clínicos. Estes atendimentos nortearam a formulação de uma hipótese clinico-teórica. Esta hipótese refere-se à possibilidade de estudar o problema clínico a partir do paradigma conceitual do trauma em Psicanálise, especialmente na acepção desenvolvida por Freud após 1920, com a formulação do segundo dualismo pulsional. Paralelamente, é realizado o percurso teórico que visa discutir a permanência dos pacientes atendidos no lugar de doentes, o que nos conduz à apresentação de um capítulo referente aos paradoxos envolvidos na remissão de uma doença orgânica. A articulação teórico-clínica é baseada em textos de Freud e Ferenczi, além de psicanalistas contemporâneos que têm estes autores como referência. Nesta articulação percorremos os seguintes pontos conceituais: a) a experiência do adoecimento; b) o conceito de trauma e efeito traumático para a Psicanálise; c) as teorias das pulsões; d) o trauma após 1920: as neuroses traumáticas; e) ganho secundário; f) a hipocondria em Freud; g) os paradoxos da cura em Danièle Brun e em Freud; h) sobre o trabalho do luto e da elaboração. A partir da articulação entre a clínica e os conceitos teóricos realizamos a discussão de nossa hipótese clínico-teórica. O percurso teórico-clínico realizado permite verificar que o problema clínico evidenciado pode ser entendido, conforme nossa hipótese clínico-teórica, a partir dos desenvolvimentos de Freud a propósito das neuroses traumáticas, em conjunção com o entendimento de que mesmo algo que era almejado pode não trazer alívio ou realização, mas sofrimento, conforme visto nos paradoxos envolvidos na remissão da doença. O percurso que partiu da clínica nos permite afirmar que o trabalho psicanalítico com pessoas que são acometidas por doenças orgânicas deve contemplar não somente a importância da elaboração psíquica de todo o processo de adoecimento que afeta o corpo, mas também, o que ocorre psiquicamente após a remissão da doença que traz a necessidade de elaboração, pois muitas vezes será no só depois, que estes aspectos poderão ser constatados / The following academic work proposes to present a theoretical systematization of my clinical experience as a psychoanalyst, upon service to patients who, after the remission of severe illnesses such as multiple types of cancer which can affect the bone marrow (leukemia and lymphomas), presented themselves as if they were still sick, referring to the illness as if it was a current event, identifying themselves, within their speeches, as sick people. We present two clinical cases of ones who had had the disease in remission for more than two years and they were cared at a hospital institution. Our goal is to facilitate the comprehension of the psychic processes related in these referred clinical cases. These services have guided the formulation of a clinical-theoretical hypothesis. This hypothesis refers to the possibility of studying the clinical issue from the trauma conceptual paradigm within the Psychoanalysis, especially from the approach developed by Freud after 1920, by formulating the second drives (Trieb) dualism. At the same time, it is done a theoretical trajectory that aims to discuss the attended patients stay at the sick patients place, which conducts us to the presentation of a chapter referring to the paradoxes related to the remission of an organic disease. The theoreticalclinical articulation is based on Freuds and Ferenczis texts, as well as contemporary psychoanalysts who also have these authors as reference. Within this articulation we have scrolled the following conceptual points: a) illness experience; b) the concept of trauma and traumatic effect to Psychoanalysis; c) drivers (Trieb) theories; d) the trauma after 1920: the traumatic neurosis; e) secondary earn; f) hypochondria within Freud; g) the healing paradoxes in Danièle Brun and Freud; h) about the work of grief and the elaboration. From an articulation between the clinic and the theoretical concepts we have discussed our clinicaltheoretical hypothesis. The clinical-theoretical path accomplished allows us to verify that the evident clinical problem can be understood, according to our clinical-theoretical hypothesis, from Freuds developments about traumatic neurosis, in conjunction with the understanding that even something that was desired cannot bring relief or accomplishment, but sorrow, as seen at the paradoxes related on the sickness remission. The path that started with the clinic allows us affirm that the psychoanalytical work towards people that are affected by organic diseases should include not only the importance of the psychic elaboration of the whole illness process that affects the body, but also what occurs mentally after the illness remission that brings the elaboration need, because for several times it will be at deffered action, that these aspects will be able to be determined