Domestic violence could be stopped earlier, says study

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abuse, abusive relationships, Children, coercion, control, coping, danger, domestic abuse, domestic violence, fear, harm, health workers, help, impact, isolation, murder, police, professionals, relationships, risk, serious injury, teenagers, training

Domestic violence could be stopped earlier, says study

Victims of domestic violence are abused for almost three years before they get the help they need, and some are subjected to more than 50 incidents during that time, according to a study of the largest database of domestic violence victims in the UK.

The figures from the domestic abuse charity SafeLives reveal that almost a quarter of “high-risk” victims have been to an A&E with injuries sustained during violent abuse, and some went as many as 15 times before the problem was addressed.

Analysis of the SafeLives database, which has records of more than 35,000 cases of adults experiencing domestic abuse since 2009, found that 85% of victims had been in contact with an average of five professionals in the year before they got “effective” help from an independent domestic violence adviser (IDVA) or another specialist practitioner.

“Time and time again no one spots domestic abuse, even when victims and their children come into contact with many different public agencies. It’s not acceptable that victims should have to try to get help repeatedly. This leaves victims living in fear and danger and risks lifelong harm to their children,” said Diana Barran, the chief executive of SafeLives, which was previously called Co-ordinated Action Against Domestic Abuse (Caada).

Barran said the study was “more shocking evidence” that domestic violence could often be stopped earlier. “Every conversation with a professional represents a missed opportunity to get victims and their children the help they need,” she said.

SafeLives estimates that there are at least 100,000 victims at high risk of murder or serious injury in England and Wales, 94% of them women.

The study found that victims and often their children lived with abuse for an average of 2.7 years. Three-quarters reported abuse to the police, and 23% went to A&E because of violence sustained in abusive relationships.

Frances Wedgwood, a GP in Lambeth who provides training on domestic violence to health workers through the national Iris project, said a challenge for doctors was that many women did not come to them to disclose domestic violence.

“Domestic violence is still a very hidden problem and in my experience women do not disclose if they are not asked,” she said. “We need to get better at asking people directly if they need help.”

The study sheds light on the long-lasting impact of living in a family coping with domestic violence. According to the survey, in about a quarter of cases on the domestic violence database the victim has a child under the age of three. The study estimates that 130,000 children in the UK are living with domestic abuse, and that children are directly harmed in 62% of cases.

Among teenagers who suffered domestic abuse in their own relationships, almost half had grown up in households where violence was commonplace, the study found.

Vera Baird, former solicitor general and the current police and crime commissioner for Northumberland, said professionals needed help and training to have the confidence to deal with domestic violence.

“Domestic abuse is not a one-off violent attack. It is deliberate long-term use of coercion to control every part of the partner’s life. Violence, sexual abuse, financial control, constant criticism, isolating from family and friends are all familiar tools,” she said.

“People in that situation do not find it easy to speak and need those who could help to be alert. The alternative is what these figures suggest: victims and their families locked unnecessarily into cruelty and ill-treatment for years.”

Case study

Rebecca, 34, lived with domestic abuse for eight years before she sought help

One time I was having a nap in the afternoon, the baby had been teething so I’d been awake all night, and I woke up he was standing over me with a mop handle carved into a point, like a spear. He was pushing it into my throat, accusing me of cheating. Then he picked me up and threw me against the wall. I ran downstairs but he followed me, kicking and punching me and split my lip.

I locked myself in the bathroom and called 999. When the doorbell rang I heard chatting, calm talking. There was one young male officer, and my ex-partner was telling him that I was postnatal, that I’d gone mental and he was just defending himself. I started shouting at the officer: ‘Why aren’t you helping me?’ I swore and the officer said people could hear me, and it was a public disturbance so I swore again. He put handcuffs on me. He wouldn’t let me put my shoes on, so I wouldn’t move, and he lifted me up by the handcuffs and put me in the back of the car.

I was in a cell for hours asking for a solicitor. The duty sergeant finally came and when he opened the hatch he could see I’d been attacked. He got the officer to come and apologise to me and asked me if I wanted to file a complaint, or if I wanted to press charges against my partner. But I said no. I was exhausted and my baby was at home with my partner, who’d been drinking since the morning. It got worse after that. He was sort of smug, saying he could do what he wanted. I know there’s more training for police now, but that put me off calling the police for years.

By 2003/4 the abuse was worse. We had two girls by that time. I was hospitalised with concussion after he’d kicked me in the head wearing steel-toe-capped boots. The police and the paramedics came and I was patched up and sent home. They asked me if I wanted to press charges but I didn’t want to go through all that, I thought it would make it worse. I didn’t know where the support would come from, where I could get help.

Another time I went to the hospital walk-in. I had a black eye and it wasn’t getting better. A doctor asked me what had happened and I said I’d been punched in the face. He repeated what I said: ‘You were punched in the face.’ I didn’t know what he wanted me to say. I was ashamed, I didn’t want to say my husband did this to me. If he had asked, I’d have told him. But he didn’t.

Social services got in touch because of the paramedics’ reports; he got put on an anger management course. But Christmas Day night he’d been drinking. He grabbed me by the throat and I stumbled and fell; he kept kicking me over and over again. My teeth went through my lip, my nose was bleeding, I couldn’t see. He picked me up and carried me to the bathroom saying: ‘Look what you made me do. Why did you do that?’ I crawled to the living room and phoned the police before he ripped it out of the wall.

I did press charges that time. He was sentenced to four months for ABH. He served two. We were separated, but we got back together. Why? I had such low self-esteem and he was always there, always pestering me, grinding me down. He’d be so nice, helping with the children and I was exhausted, I needed the help. I thought it might be OK.

It was OK for a while. The kids had been on the at-risk register because a couple of incidents had been reported, but they came off that and social services were visiting less. His behaviour just went back to the way it had been before, and that’s when I decided to leave.

I remember the exact moment when I saw the sticker for the Women’s Aid helpline: it was on the back of the toilet door in Asda. It took me a couple of months to call but when I did they offered me refuge. I didn’t even know that existed. They organised transport when he was out. It was quite surreal, but it was such a relief.

Women’s Aid were so helpful, they gave us so much support including counselling. My eldest daughter was seven when we left, her sister was three and their brother was nine months. That was the main reason I left, I was terrified for my kids.

I do think professionals should offer support. If they can’t support victims themselves, they just need to know who can. I think if I’d had that information I would have left earlier.

I was 16 when we got together; he was 23. By the time I was 17 we had a daughter. I thought it was a good relationship, he helped with the parenting and around the house, but about a year later, in 1999, slowly controlling behaviour crept in. He wouldn’t like certain friends, or me going out without him, wearing certain clothes or makeup. It was quite subtle at first, but then when we argued there was pushing, then hair-pulling – each time it was a little worse than before.

Soon it was normal to have slapping, kicking, punching, throwing things. At first I didn’t tell anyone; my self-esteem was very low. I just tried to pretend it wasn’t happening, I didn’t know anything about domestic abuse.

One in 10 do not have a close friend and even more feel unloved, survey finds

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contentment, employment, family, friends, health, loneliness, love, money, relationships, well-being

One in 10 do not have a close friend and even more feel unloved, survey finds

Millions of people in the UK do not have a single friend and one in five feel unloved, according to a survey published on Tuesday by the relationship charity Relate.

One in 10 people questioned said they did not have a close friend, amounting to an estimated 4.7 million people in the UK may be leading a very lonely existence.

Ruth Sutherland, the chief executive of Relate, said the survey revealed a divided nation with many people left without the vital support of friends or partners.

While the survey found 85% of individuals questioned felt they had a good relationship with their partners, 19% had never or rarely felt loved in the two weeks before the survey.

“Whilst there is much to celebrate, the results around how close we feel to others are very concerning. There is a significant minority of people who claim to have no close friends, or who never or rarely feel loved – something which is unimaginable to many of us,” said Sutherland.

“Relationships are the asset which can get us through good times and bad, and it is worrying to think that there are people who feel they have no one they can turn to during life’s challenges. We know that strong relationships are vital for both individuals and society as a whole, so investing in them is crucial.”

The study looked at 5,778 people aged 16 and over across England, Wales, Northern Ireland and Scotland and asked about people’s contentment with all aspects of their relationships, including their partners, friends, workmates and bosses. It found that people who said that they had good relationships had higher levels of wellbeing, while poor relationships were detrimental to health, wellbeing and self-confidence.

The study found that 81% of people who were married or cohabiting felt good about themselves, compared with 69% who were single.

The quality of relationship counts for a lot, according to the survey: 83% of those who described their relationship as good or very good reported feeling good about themselves while only 62% of those who described their relationship as average, bad or very bad reported the same level of personal wellbeing.

The survey, The Way We Are Now 2014, showed that while four out of five people said they had a good relationship with their partner, far fewer were happy with their sex lives. One in four people admitted to being dissatisfied with their sex life, and one in four also admitted to having an affair.

There was also evidence of the changing nature of family life – and increasing divorce rates – in the survey, which found that almost one in four of the people questioned had experienced the breakdown of their parents’ relationship.

When it comes to the biggest strains put on relationships, a significant majority (62%) cited money troubles as the most stressful factor.

The survey also found that older people are more worried about money, with 69% of those aged 65 and over saying money worries were a major strain, compared with only 37% of 16 to 24-year-olds.

When it comes to employment, many of those questioned had a positive relationship with their bosses, but felt putting work before family was highly valued in the workplace.

Just under 60% of people said they had a good relationship with their boss, but more than one in three thought their bosses believed the most productive employees put work before family. It also appears that work can be quite a lonely place too: 42% of people said they had no friends at work.

Nine out of 10 people, however, said they had a least one close friend, with 81% of women describing their friendships as good or very good compared with 73% of men.

Young people are sexting – but that doesn’t mean they necessarily want to be, says research

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relationships, sexting, young people

Young people are sexting – but that doesn’t mean they necessarily want to be, says research

With the rise of smartphones and Snapchat, sexting is in vogue – but a new study has found that many young people engage in the practice without really wanting to.

More than half (52.3 per cent) of young adults have engaged in “ unwanted but consensual sexting with a committed partner”, according to research to be published in February in the journal Computers in Human Behaviour.

Most did so for flirtation, foreplay, to fulfil a partner’s needs, or for intimacy, but women were more likely to consent to unwanted sexting because of anxieties about their relationships.

The research, which was carried out by scientists at Indiana University-Purdue University Indianapolis (IUPUI), polled 155 undergraduates in committed relationships on their sexting habits.

Fifty-five per cent of the female respondents said they had previously engaged in unwanted sexting, while 48 per cent of men had done the same.

The results show similarities between sexual behaviour online and off: in both cases, couples will willingly go along with sex, even when they do not feel like it, from reasons ranging from satisfying their partner to avoiding an argument.

But while women are often considered to engage in unwanted sex more than men, the research shows only a small difference in the number of men and women partaking in unwanted sexting.

The authors of the article argued “gender-role expectations” could be to blame. Men might be more likely to agree to undesired sexting because doing so is “relatively easy and does not require them to invest more into the relationship,” while women might be discouraged from virtual sex because it fails to help them attain their relationship “goals”.

The survey also showed that people who were anxious about their relationships were more likely to send begrudging sexts, in a bid to alleviate fears about alienation or abandonment by their partners.

Why have young people in Japan stopped having sex?

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'celibacy syndrome', Japan, relationships

Why have young people in Japan stopped having sex?

Ai Aoyama is a sex and relationship counsellor who works out of her narrow three-storey home on a Tokyo back street. Her first name means “love” in Japanese, and is a keepsake from her earlier days as a professional dominatrix. Back then, about 15 years ago, she was Queen Ai, or Queen Love, and she did “all the usual things” like tying people up and dripping hot wax on their nipples. Her work today, she says, is far more challenging. Aoyama, 52, is trying to cure what Japan’s media callssekkusu shinai shokogun, or “celibacy syndrome”.

Japan’s under-40s appear to be losing interest in conventional relationships. Millions aren’t even dating, and increasing numbers can’t be bothered with sex. For their government, “celibacy syndrome” is part of a looming national catastrophe. Japan already has one of the world’s lowest birth rates. Its population of 126 million, which has been shrinking for the past decade, is projected to plunge a further one-third by 2060. Aoyama believes the country is experiencing “a flight from human intimacy” – and it’s partly the government’s fault.

The sign outside her building says “Clinic”. She greets me in yoga pants and fluffy animal slippers, cradling a Pekingese dog whom she introduces as Marilyn Monroe. In her business pamphlet, she offers up the gloriously random confidence that she visited North Korea in the 1990s and squeezed the testicles of a top army general. It doesn’t say whether she was invited there specifically for that purpose, but the message to her clients is clear: she doesn’t judge.

Inside, she takes me upstairs to her “relaxation room” – a bedroom with no furniture except a double futon. “It will be quiet in here,” she says. Aoyama’s first task with most of her clients is encouraging them “to stop apologising for their own physical existence”.

The number of single people has reached a record high. A survey in 2011 found that 61% of unmarried men and 49% of women aged 18-34 were not in any kind of romantic relationship, a rise of almost 10% from five years earlier. Another study found that a third of people under 30 had never dated at all. (There are no figures for same-sex relationships.) Although there has long been a pragmatic separation of love and sex in Japan – a country mostly free of religious morals – sex fares no better. A survey earlier this year by the Japan Family Planning Association (JFPA) found that 45% of women aged 16-24 “were not interested in or despised sexual contact”. More than a quarter of men felt the same way.

Many people who seek her out, says Aoyama, are deeply confused. “Some want a partner, some prefer being single, but few relate to normal love and marriage.” However, the pressure to conform to Japan’s anachronistic family model of salaryman husband and stay-at-home wife remains. “People don’t know where to turn. They’re coming to me because they think that, by wanting something different, there’s something wrong with them.”

Official alarmism doesn’t help. Fewer babies were born here in 2012 than any year on record. (This was also the year, as the number of elderly people shoots up, that adult incontinence pants outsold baby nappies in Japan for the first time.) Kunio Kitamura, head of the JFPA, claims the demographic crisis is so serious that Japan “might eventually perish into extinction”.

Japan’s under-40s won’t go forth and multiply out of duty, as postwar generations did. The country is undergoing major social transition after 20 years of economic stagnation. It is also battling against the effects on its already nuclear-destruction-scarred psyche of 2011’s earthquake, tsunami and radioactive meltdown. There is no going back. “Both men and women say to me they don’t see the point of love. They don’t believe it can lead anywhere,” says Aoyama. “Relationships have become too hard.”

Marriage has become a minefield of unattractive choices. Japanese men have become less career-driven, and less solvent, as lifetime job security has waned. Japanese women have become more independent and ambitious. Yet conservative attitudes in the home and workplace persist. Japan’s punishing corporate world makes it almost impossible for women to combine a career and family, while children are unaffordable unless both parents work. Cohabiting or unmarried parenthood is still unusual, dogged by bureaucratic disapproval.

Aoyama says the sexes, especially in Japan’s giant cities, are “spiralling away from each other”. Lacking long-term shared goals, many are turning to what she terms “Pot Noodle love” – easy or instant gratification, in the form of casual sex, short-term trysts and the usual technological suspects: online porn, virtual-reality “girlfriends”, anime cartoons. Or else they’re opting out altogether and replacing love and sex with other urban pastimes.

Some of Aoyama’s clients are among the small minority who have taken social withdrawal to a pathological extreme. They are recoveringhikikomori (“shut-ins” or recluses) taking the first steps to rejoining the outside world, otaku (geeks), and long-term parasaito shingurus(parasite singles) who have reached their mid-30s without managing to move out of home. (Of the estimated 13 million unmarried people in Japan who currently live with their parents, around three million are over the age of 35.) “A few people can’t relate to the opposite sex physically or in any other way. They flinch if I touch them,” she says. “Most are men, but I’m starting to see more women.”

Aoyama cites one man in his early 30s, a virgin, who can’t get sexually aroused unless he watches female robots on a game similar to Power Rangers. “I use therapies, such as yoga and hypnosis, to relax him and help him to understand the way that real human bodies work.” Sometimes, for an extra fee, she gets naked with her male clients – “strictly no intercourse” – to physically guide them around the female form. Keen to see her nation thrive, she likens her role in these cases to that of the Edo period courtesans, or oiran, who used to initiate samurai sons into the art of erotic pleasure.

Aversion to marriage and intimacy in modern life is not unique to Japan. Nor is growing preoccupation with digital technology. But what endless Japanese committees have failed to grasp when they stew over the country’s procreation-shy youth is that, thanks to official shortsightedness, the decision to stay single often makes perfect sense. This is true for both sexes, but it’s especially true for women. “Marriage is a woman’s grave,” goes an old Japanese saying that refers to wives being ignored in favour of mistresses. For Japanese women today, marriage is the grave of their hard-won careers.

I meet Eri Tomita, 32, over Saturday morning coffee in the smart Tokyo district of Ebisu. Tomita has a job she loves in the human resources department of a French-owned bank. A fluent French speaker with two university degrees, she avoids romantic attachments so she can focus on work. “A boyfriend proposed to me three years ago. I turned him down when I realised I cared more about my job. After that, I lost interest in dating. It became awkward when the question of the future came up.”

Tomita says a woman’s chances of promotion in Japan stop dead as soon as she marries. “The bosses assume you will get pregnant.” Once a woman does have a child, she adds, the long, inflexible hours become unmanageable. “You have to resign. You end up being a housewife with no independent income. It’s not an option for women like me.”

Around 70% of Japanese women leave their jobs after their first child. The World Economic Forum consistently ranks Japan as one of the world’s worst nations for gender equality at work. Social attitudes don’t help. Married working women are sometimes demonised as oniyome, or “devil wives”. In a telling Japanese ballet production of Bizet’s Carmen a few years ago, Carmen was portrayed as a career woman who stole company secrets to get ahead and then framed her lowly security-guard lover José. Her end was not pretty.

Prime minister Shinzo Abe recently trumpeted long-overdue plans to increase female economic participation by improving conditions and daycare, but Tomita says things would have to improve “dramatically” to compel her to become a working wife and mother. “I have a great life. I go out with my girl friends – career women like me – to French and Italian restaurants. I buy stylish clothes and go on nice holidays. I love my independence.”

Tomita sometimes has one-night stands with men she meets in bars, but she says sex is not a priority, either. “I often get asked out by married men in the office who want an affair. They assume I’m desperate because I’m single.” She grimaces, then shrugs. “Mendokusai.”

Mendokusai translates loosely as “Too troublesome” or “I can’t be bothered”. It’s the word I hear both sexes use most often when they talk about their relationship phobia. Romantic commitment seems to represent burden and drudgery, from the exorbitant costs of buying property in Japan to the uncertain expectations of a spouse and in-laws. And the centuries-old belief that the purpose of marriage is to produce children endures. Japan’s Institute of Population and Social Security reports an astonishing 90% of young women believe that staying single is “preferable to what they imagine marriage to be like”.

The sense of crushing obligation affects men just as much. Satoru Kishino, 31, belongs to a large tribe of men under 40 who are engaging in a kind of passive rebellion against traditional Japanese masculinity. Amid the recession and unsteady wages, men like Kishino feel that the pressure on them to be breadwinning economic warriors for a wife and family is unrealistic. They are rejecting the pursuit of both career and romantic success.

“It’s too troublesome,” says Kishino, when I ask why he’s not interested in having a girlfriend. “I don’t earn a huge salary to go on dates and I don’t want the responsibility of a woman hoping it might lead to marriage.” Japan’s media, which has a name for every social kink, refers to men like Kishino as “herbivores” or soshoku danshi (literally, “grass-eating men”). Kishino says he doesn’t mind the label because it’s become so commonplace. He defines it as “a heterosexual man for whom relationships and sex are unimportant”.

The phenomenon emerged a few years ago with the airing of a Japanese manga-turned-TV show. The lead character in Otomen (“Girly Men”) was a tall martial arts champion, the king of tough-guy cool. Secretly, he loved baking cakes, collecting “pink sparkly things” and knitting clothes for his stuffed animals. To the tooth-sucking horror of Japan’s corporate elders, the show struck a powerful chord with the generation they spawned.

Kishino, who works at a fashion accessories company as a designer and manager, doesn’t knit. But he does like cooking and cycling, and platonic friendships. “I find some of my female friends attractive but I’ve learned to live without sex. Emotional entanglements are too complicated,” he says. “I can’t be bothered.”

Romantic apathy aside, Kishino, like Tomita, says he enjoys his active single life. Ironically, the salaryman system that produced such segregated marital roles – wives inside the home, husbands at work for 20 hours a day – also created an ideal environment for solo living. Japan’s cities are full of conveniences made for one, from stand-up noodle bars to capsule hotels to the ubiquitous konbini (convenience stores), with their shelves of individually wrapped rice balls and disposable underwear. These things originally evolved for salarymen on the go, but there are now female-only cafés, hotel floors and even the odd apartment block. And Japan’s cities are extraordinarily crime-free.

Some experts believe the flight from marriage is not merely a rejection of outdated norms and gender roles. It could be a long-term state of affairs. “Remaining single was once the ultimate personal failure,” says Tomomi Yamaguchi, a Japanese-born assistant professor of anthropology at Montana State University in America. “But more people are finding they prefer it.” Being single by choice is becoming, she believes, “a new reality”.

Is Japan providing a glimpse of all our futures? Many of the shifts there are occurring in other advanced nations, too. Across urban Asia, Europe and America, people are marrying later or not at all, birth rates are falling, single-occupant households are on the rise and, in countries where economic recession is worst, young people are living at home. But demographer Nicholas Eberstadt argues that a distinctive set of factors is accelerating these trends in Japan. These factors include the lack of a religious authority that ordains marriage and family, the country’s precarious earthquake-prone ecology that engenders feelings of futility, and the high cost of living and raising children.

“Gradually but relentlessly, Japan is evolving into a type of society whose contours and workings have only been contemplated in science fiction,”Eberstadt wrote last year. With a vast army of older people and an ever-dwindling younger generation, Japan may become a “pioneer people” where individuals who never marry exist in significant numbers, he said.

Japan’s 20-somethings are the age group to watch. Most are still too young to have concrete future plans, but projections for them are already laid out. According to the government’s population institute, women in their early 20s today have a one-in-four chance of never marrying. Their chances of remaining childless are even higher: almost 40%.

They don’t seem concerned. Emi Kuwahata, 23, and her friend, Eri Asada, 22, meet me in the shopping district of Shibuya. The café they choose is beneath an art gallery near the train station, wedged in an alley between pachinko pinball parlours and adult video shops. Kuwahata, a fashion graduate, is in a casual relationship with a man 13 years her senior. “We meet once a week to go clubbing,” she says. “I don’t have time for a regular boyfriend. I’m trying to become a fashion designer.” Asada, who studied economics, has no interest in love. “I gave up dating three years ago. I don’t miss boyfriends or sex. I don’t even like holding hands.”

Asada insists nothing happened to put her off physical contact. She just doesn’t want a relationship and casual sex is not a good option, she says, because “girls can’t have flings without being judged”. Although Japan is sexually permissive, the current fantasy ideal for women under 25 is impossibly cute and virginal. Double standards abound.

In the Japan Family Planning Association’s 2013 study on sex among young people, there was far more data on men than women. I asked the association’s head, Kunio Kitamura, why. “Sexual drive comes from males,” said the man who advises the government. “Females do not experience the same levels of desire.”

Over iced tea served by skinny-jeaned boys with meticulously tousled hair, Asada and Kuwahata say they share the usual singleton passions of clothes, music and shopping, and have hectic social lives. But, smart phones in hand, they also admit they spend far more time communicating with their friends via online social networks than seeing them in the flesh. Asada adds she’s spent “the past two years” obsessed with a virtual game that lets her act as a manager of a sweet shop.

Japanese-American author Roland Kelts, who writes about Japan’s youth, says it’s inevitable that the future of Japanese relationships will be largely technology driven. “Japan has developed incredibly sophisticated virtual worlds and online communication systems. Its smart phone apps are the world’s most imaginative.” Kelts says the need to escape into private, virtual worlds in Japan stems from the fact that it’s an overcrowded nation with limited physical space. But he also believes the rest of the world is not far behind.

Getting back to basics, former dominatrix Ai Aoyama – Queen Love – is determined to educate her clients on the value of “skin-to-skin, heart-to-heart” intimacy. She accepts that technology will shape the future, but says society must ensure it doesn’t take over. “It’s not healthy that people are becoming so physically disconnected from each other,” she says. “Sex with another person is a human need that produces feel-good hormones and helps people to function better in their daily lives.”

Aoyama says she sees daily that people crave human warmth, even if they don’t want the hassle of marriage or a long-term relationship. She berates the government for “making it hard for single people to live however they want” and for “whipping up fear about the falling birth rate”. Whipping up fear in people, she says, doesn’t help anyone. And that’s from a woman who knows a bit about whipping.

I was sold by Mum and Dad to make images of child abuse

Tags

abuse, Children, dissociation, family, parents, relationships, sexual exploitation, support, Trafficking, trauma

I was sold by Mum and Dad to make images of child abuse

One of Raven Kaliana’s earliest memories is being taken to a family portrait studio by her parents, at around the age of four. The studio was in the basement of a department store in a town 50 miles from their home. Once they had arrived, they waited for another couple to arrive with their own child.

“Would you like to have your picture taken with this cute little boy?” her mother asked, before the parents left the kids with the photographer and retired to the cafe upstairs. But while they sat eating ice cream, the images being made in the studio down below were far from happy family portraits. Raven and her companion had just been sold into the child abuse industry.

It was to be the beginning of a 15-year ordeal, which saw Raven regularly trafficked by her parents and other members of an organised crime ring from her home in a middle-class suburb in the American north-west to locations all over the US and abroad. In her teens, the crimes were often perpetrated in Los Angeles, where many film studios provided ample opportunity for the underground child abuse industry in the 70s and 80s.

Her father, precariously self-employed after losing his teaching job, was violent towards her younger brother, but since she had become the family breadwinner, Raven was granted a peculiar status. “My father always favoured me because I brought in the money – I was supporting our whole family. My younger brother was jealous because of my dad’s special treatment of me.

“My father was also quite affectionate towards me whereas he would beat my brother to a pulp. Although he did hit me, he wanted me to stay intact because the less scars I had, the more I was worth.”

Inevitably, as she grew older, Raven’s value to her abusers decreased and subsequently the kinds of films she was required to take part in became more extreme and violent.

Yet from a young age, she had learned from her parents to rationalise and deny what was going on within the family. “It’s the same way that someone who has a problem with alcohol will rationalise their behaviour – ‘It’s only this many drinks. It’s before noon but, oh well, just today’.

“I remember my mother saying things like, ‘Oh, they’ll never remember it,’ like people do when they get their babies’ ears pierced. I told myself that my parents meant well, that what I was going through was what was necessary to help my family. It was paying our mortgage.”

As we sit talking in a central London cafe, there are two large suitcases on the floor next to us, both full of puppets she has made. A graduate of the puppetry course at the Royal Central School of Speech & Drama in London, Raven turned to this artform as a way of telling her story without the gaze of an audience focusing on her directly – something she finds too uncomfortable.

Her adult life has been driven by the belief that it is important for survivors of child sexual exploitation and trafficking to tell their stories, in order to make people realise that these aren’t crimes that happen “somewhere else, to someone else”. She moved to the UK to create Hooray for Hollywood, an autobiographical play in which the children are represented by puppets, while the adults – their parents – are only shown up to waist height, from a child’s eye view. This critically acclaimed drama has toured the UK, Poland and France, and has been made into a film.

One of the most shocking aspects of Hooray for Hollywood is the banality of the adults’ conversation, as they rationalise the choice they have just made to sell their children, from the cosy confines of a cafe. These appear to be ordinary people, struggling a little to make ends meet; not monsters or weirdos, but the kind of people who might be your nextdoor neighbours.

“You hear about a perpetrator being processed in a certain way, you hear about the police getting hold of the images, but you don’t hear about the reality for the children in those images – whose children are they? How did they come to be in this situation? And how have they been traumatised or damaged by what happened?”

Through her organisation Outspiral, Raven recently launched a national campaign to raise awareness of sex trafficking and familial abuse. She now uses the film of Hooray for Hollywood for public education and training for professionals working in social services, education, law enforcement and children’s charities.

The biggest challenge, she says, is getting the bystanders in the child’s life – neighbours, relatives, teachers, care workers, counsellors – to consider the possibility that a child might be a victim of this form of abuse. Child abuse is such a taboo subject, and the concept of parents being complicit in the crime so unthinkable, that frequently there is a failure to recognise that it might be going on. Yet since Raven’s childhood, the internet has led to an explosion in the industry, which now has a worldwide market value of billions of dollars, according to the UN.

Britain’s Child Exploitation & Online Protection Centre, a division of the police, says the number of indecent images of children in circulation on the internet runs into millions, with police forces reporting seizures of up to 2.5m images in single collections alone, while the number of individual children depicted in these images is likely to be in the tens of thousands. The commonest way that offenders found their victims was through family and personal relationships.

A report by the NSPCC highlighted the particular psychological suffering that children who have been sexually abused within the child abuse industry endure, especially through the knowledge that there is a permanent record of their sexual abuse: “There is nothing they can do about others viewing pornographic pictures or films of themselves, and sometimes their coerced sexual abuse of others, indefinitely.”

For Raven, the psychological effects of her abuse have been extreme. From an early age she began to experience dissociative amnesia – a psychological phenomenon common in victims of inescapable trauma, in which painful experiences are blocked out, leading to gaps in memory. “I started putting things into little rooms in my mind, and it was like: OK, we don’t look in that room,” she says. “When there’s no relief, there’s no one stepping in to save you, and it’s clear you’re just going to have to endure something, then your mind just does that. As a child, dissociation is a serious survival advantage, but in adulthood it can become a disability.”

It was at the age of 15 that the coping mechanisms of denial and dissociation began to break down. “At school, I started getting flashbacks – like remembering being in a warehouse the night before – and I could feel in my body it was true, but it was terrifying because I didn’t want those things to be true.”

Astonishingly, she passed through most of school without anyone picking up on what was happening at home. “I got good marks at school, so teachers tended to think everything was fine. Most survivors I’ve known who experienced extreme abuse did very, very well at school, actually, because that was their sanctuary, a place they could go to be safe.”

Eventually, however, a teacher noticed that Raven was getting thinner. Her mother, by now separated from her father but still facilitating the abuse, had simply stopped buying food for her. “The teacher invited me to stay after school and talk with her one day, and she asked, ‘Tell me the truth, are you anorexic? Bulimic?’ And I started laughing.”

Raven confided some but not all of what was happening at home, but begged the teacher not to report it for fear of reprisals. What the teacher did do, however, was to help her find the wherewithal to move out of home eventually, get a job in a restaurant, and start saving up for college.

At university, Raven finally made a break from her family, changed her name and started to get counselling – the beginning of a long road to recovery that still continues. “I got into a support group for rape survivors, and it was a great help because all of a sudden I was around other people healing from abuse, too. It also gave me some perspective about how the things that had happened to me were really on the extreme end. I saw people completely devastated by one experience of being raped by a stranger, so it was sobering to realise, ‘Oh, I’ve been raped by hundreds of people.'”

Once she was in a safe environment, finally the rage about what had happened to her bubbled to the surface. “I couldn’t believe how angry I was when I first escaped – so angry. In one support group they let us take a baseball bat to a punching bag and told us to think about a specific abuse event and imagine that we were fighting back against it, and that was very helpful.”

She also saw an integrative bodywork therapist, who used touch, guided movement and vocal expression. “Her premise was that post-traumatic stress is a physical reaction in your body, and that reconnecting the symptom to the source helps you let it go, helps you release it, and that you don’t have to talk out every single thing that ever happened to you. It was very helpful for me because there were a lot of strange things that my body was doing. For example, I used to find any kind of physical touch excruciating – even if someone brushed me in the street I would shudder. She told me that was called armouring, which happens when your body makes a shield out of its muscles to protect the bones and internal organs during physical abuse.”

The therapy made it possible for her to move on and start to enjoy life. “I realised that it is possible to get your life back. I started to gain an appreciation for life and a recognition that I only have so many breaths, so I’ve got to use them well.”

But Raven believes she will always need counselling and that her experiences have made it difficult not to fall into a pattern of emotionally abusive romantic relationships.

Perhaps surprisingly, sex has not been a significant issue, but love is inextricably connected for her with betrayal, as the people who were meant to love her most as a child were the ones who orchestrated her abuse.

Yet, incredibly, she says she felt love for her parents as a child and still does, although she has cut all contact with them. Despite their behaviour, she believes they did love her.

“When I screen my film, a lot of times in the Q&A session afterwards people want to know: how could parents do this to their own children? I tell them that abuse is generational: my parents were also abused themselves, so that was normal to them. They had dissociated in the same way I did; they were in denial. Unlike my generation, they didn’t have access to counselling when they were young, and weren’t born in a time when child abuse was beginning to be acknowledged by society. It’s important to recognise that they weren’t born evil – they were damaged.”

Raven thinks that the way in which child abusers such as Jimmy Savile are demonised is counterproductive. “Demonising the perpetrators elevates them to the realm of the surreal. We need to shift that, so people recognise that they are very sick humans and that there’s a context for their crimes.

“Only then can we tackle the source of this suffering.”

 Outspiral.org.uk

When a child leaves the nest, how does it affect younger brothers and sisters?

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anxiety, change, Children, dynamics, empty nest syndrome, family, home, parents, relationships, siblings, students, transition, university, withdrawn

When a child leaves the nest, how does it affect younger brothers and sisters?

It’s five years since my eldest child left home, but now it’s that time of year again, the shops filled with students buying value sets of crockery and stationery, harassed parents doing the Ikea run. I’m reminded of one of the most unexpected sides to our so-called emptying nest.

When my youngest child, seven years old at the time, became cowed with anxiety by day and unable to sleep at night, I thought at first it had something to do with his new class at primary school. It was a few weeks into the start of a school year, and our previously robust youngest had undergone a massive character change. He had been outgoing but was now withdrawn. He had been a joker; now nothing made him laugh. He started wanting reassurance at night.

It took days of probing to get to the root of the problem. No, he liked his new teacher. Yes, his friendships were all fine. When he admitted, reluctantly, that since his sister left home, it had felt to him as if a piece of the family was missing, I was dumbstruck. It simply hadn’t occurred to me that her leaving would make such a strong impact on him, especially as one sister was still at home.

“Every time I see any of the things she’s left behind, I feel upset,” he tried to explain.

At bedtime, he used to find the music and background chatter from his sisters’ rooms comforting. When one or both of them were out, he knew they would be there later. Now that the eldest had left, for good, as he saw it, he simply couldn’t get to sleep or think about anything but the gap that was left.

Empty nest syndrome is pretty well documented. Parents may well experience feelings of either grief or exuberance – a step towards regaining their freedom – as their brood take their first steps into the big wide world, but it hadn’t occurred to me to pay attention to the effect on her siblings when our first-born left.

On reflection, it seems obvious – even when other siblings remain at home, the departure of one of them affects family dynamics. Relationships shift and alter the way they have to adjust when a new baby is born, with roles altering and pecking orders changing. But there is no “empty nest” label for siblings to attach to their confused feelings, particularly those who are very young (the gap between our youngest and his 18-year-old sister perhaps exacerbated the problem), and my son, unable or unwilling to articulate his sense of loss, was suffering anxiety and sleeplessness instead. I suspect, with the instinctive perception of children, that he might also have avoided telling me why he was affected for fear of upsetting me – I may have mentioned how quiet the house seemed without the eldest or that I missed her, and he picked up some of that and didn’t want to make things worse.

Now I thought about it, I realised that her departure meant that other things had changed in the household, which must have felt unsettling to a young child. Our middle daughter, 16 at the time, had started going out more with her friends, and one or the other of us parents was usually preoccupied with work or study. The house became a place to sleep rather than the family home it had been. With only four of us, rarely all at home at once, we hardly ever gathered for family meals any more. We used to sit and watch TV or films together; now we never did.

What message had this given to our youngest? That it wasn’t worth the effort just for him?

The change must have felt catastrophic. Our first-born leaving was poignant for her parents. It was the end of an era, but it also meant we were embarking on a path that would eventually lead us back to living a child-free life again, to which in some ways we were looking forward.

For our youngest child, who had never known life without his older sister, the change was far more significant. It was uncharted and so potentially scary. It must also have felt final – he had no idea, as we did, that students come scurrying back home every holiday and often in between. As far as he was concerned, if one person could just leave, who was going to disappear next?

But all siblings are affected. Our 16 year old had lost a confidante and ally. The silence in the house was conspicuous now that the two girls’ gossip and summary of their day no longer took place nightly in their room. And, indeed, my middle daughter says it was a difficult transition for her too. “I felt really upset, driving away from her,” she admits. “And I missed her a lot,” she says.

The difference between her and the youngest was that she was able to express her feelings and fill the gap by increasing her social life and endlessly messaging her sister. But the result was that she too edged away from home, leaving the house all the emptier for her younger brother.

Once I began to think about the whole issue of siblings leaving, I remembered that when my elder brother went off on his travels, it catapulted me into adulthood. I was left at home with my younger brother, who at that stage seemed much less exciting, and I was lost. Who would I go to parties and gigs with now? My younger brother (who may also, like my youngest son, have had unexpressed feelings himself) withdrew into his room as he hit puberty, my mother returned to full-time work and my father was out more. When I got in from school, the house was silent, cold and tomb-like. I couldn’t wait to leave and made sure I did, as soon as I could.

Home was no longer the place of solace it had once seemed. Because, of course, accompanying the emotional changes when a child leaves, are economic and practical ones. Parents have to support their older kids through university and may take the opportunity – as mine did – to work more hours, in the process leaving the younger ones behind. The conflict is one I recognise only too well, as the need to earn more to support my older children through further education has been pitted against the responsibility of being around for the younger one. When you’ve been a parent for 18-plus years, it’s easy to feel that it’s time to ease off when they start to leave home, and to give yourself a bit of a break, pursuing interests you may have had to shelve during the child-rearing years, but younger children may feel – and indeed be – sidelined as a result.

There is also an effect on the parents’ relationship. Couples who have worked at staying together “for the sake of the kids”, may give up making the effort once there are fewer kids at home. A friend, the mother of two adult daughters, recounts: “We managed to hold our relationship together while the older one was at home, even though it wasn’t going well. I didn’t realise it at the time, but now I see there was a link between her leaving and our relationship ending. It wasn’t conscious, but it was there. I worry now that my younger daughter must have felt she didn’t matter as much as the older one because we held it together for her sister, but not for her!”

In the years since our first daughter left for university, she has been back to live at home and moved out again. The middle child has also left, but I made more of an attempt to be aware of how her brother may feel, and to remind him that her “leaving” didn’t mean she was disappearing for ever. But by then he was older and knew that such changes aren’t finite anyway.

There are, of course, advantages to a sibling leaving. Younger children have a chance to try on new identities, to expand into the space left, to have their own room – for the first time in some cases – to take on new roles, and, potentially, to grow closer to other siblings or their parents. My son is 13 now and reaping the benefits of having siblings who have left home. “It was difficult when I was little,” he says. “But now they’re living in London it’s like I’ve got a second home,” he says.

For me, it was a salutary lesson in how strong the bond between my own children really was and how much more sensitive I should have been to the change a child leaving would make to her siblings in the first place. It seemed to me that my children became closer when they started living apart, but perhaps, and more likely, it was simply that I hadn’t realised how close they had always been. We are often the worst witnesses to what is in front of our noses within the family. I am also aware that while for us, the parents, it was a step towards a couple-only lifestyle, for my youngest, life really would never be the same again.

Perhaps these two recollections from friends best illustrate the sense of the gap that can be left when a sibling leaves home. “My sisters shared an attic bedroom just above my room. When they’d both left, I used to lie in bed aware of, and terrified by, the dark, empty hole that was left. I loved it at Christmas when they came home and that dark hole filled with the light and noise of their presence again.”

Another friend, who shared a room with her older sister, recalls how when she left home she wondered who she was going to talk to at night. “I found it devastating when my sister left, and I used to carry on the conversations I would have been having with her when she was there,” she says. “For months after she left, I just kept on talking to an empty bed.”

Stroke survivors and their families left to deal with the emotional impact alone, says report

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anxiety, carers, confidence, Depression, family, relationships, stress, stroke, support

Stroke survivors and their families left to deal with the emotional impact alone, says report

Stroke survivors and their families feel abandoned by health and social services after being left to deal with the emotional impact of stroke alone, a report reveals today.

The report, ‘Feeling Overwhelmed’, published by the Stroke Association, marks the beginning of Stroke Month and details the emotional strain of strokes on survivors and families after they have left the hospital.

More than half of survivors experienced depression and two thirds anxiety, in addition to lack of confidence and fear of recurrent stroke, the association says.

A high percentage of stroke carers are also reported to have experienced depression, stress, anxiety and frustration. Relationships are proven to suffer, with almost three in ten couples separating or considering it following stroke.

Of more than 2,700 people surveyed at the end of last year, 79 per cent claimed to have received no information or advice on how to cope with the emotional consequences of strokes.

Claire Whitehouse, 23, from Bournemouth, suffered a stroke when she was 19. Following her release from hospital, Claire suffered from depression and anxiety which also led to anorexia. She said:  “I wish someone, when I was in hospital, gave me a big leaflet with everyone I’d need to contact and said This is what you’re going to experience and this is the group you need to go to’. We need some information to tell us what’s going on.

“I can push myself to become physically able, but emotionally it’s much harder.”

In response to the findings, the Stroke Association is calling for psychological and emotional support to be as integral to recovery as the physical rehabilitation. It wants information and support to be accessible to everyone, survivors and carers, who have been affected by the illness.

Partner exploitation and violence in teenage intimate relationships

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abuse, relationships, Sexual Violence, Teens, young people

A 2009 report by the University of Bristol and the NSPCC on Partner exploitation and violence in teenage intimate relationships

Why divorce can be so difficult for teenage children

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Children, Divorce, family, parents, relationships, Teens, young people

Why divorce can be so difficult for teenage children

“Peter, just to say, I’m thinking of you and I love you very much. It would be great to talk to you, Dad.”

“Fuck off.”

The text messages between Chris Huhne and his then 18-year-old son, Peter, are painful for any father or son to read.

Over a period of 11 months to May 2011, they show a dad attempting to maintain a connection with his son as he goes through a messy and very public divorce. They also show a son who is absolutely furious with his father – for his “affairs”, for reducing their relationship “to lies and pleasantries”, for being “a pathetic loser and a joke”.

When I was 16 and my parents separated, I vowed that I would never forget what it was like to be a teenager in that painful situation, but reading Peter’s texts, 20 years on, I realised I had.

None of us can judge whether Peter’s anger is justifiable or not, but it is shocking. And it sheds light on an overlooked part of divorce: how deeply it can affect adult, or late-teenage, children.

I know so many people whose parents did something similar to mine: struggled on in a difficult marriage “for the sake of the children”, finally splitting up when the kids went to university or were considered old enough to handle it. This can be a selfless parental act, and is often what the children want: although my parents were visibly unhappy in my teenage years I was desperate for them to stay together.

The upside is that it can be better to maintain the familiar family structure, says Christine Northam, a relationships counsellor for Relate; the downside is that children may develop in “a sterile and not very loving” environment.

Unfortunately, parents who stay together for the children “don’t take into account the model they are presenting to their children”, thinks Northam, and these loveless examples can hamper children in their adult relationships. Parents staying together for the children may have another person in their lives and children learn to keep secrets, or protect mum or dad from the infidelity. Parents “are modelling something that perhaps is not very good for the kids”, says Northam.

My parents divorced in the pre-mobile phone era, although I don’t think I would have sent my dad messages like Peter’s. But I was angry with my father for several years, blamed him for the family breakdown, and sought to support my mum. As a teenager, I was deeply critical of my dad and what I regarded as his flaws. I think my feelings were complicated by my struggle to emerge as a man in my own right: somehow, my dad’s desires and relationships were embarrassing and eclipsed my own and, I felt, inhibited me from expressing desire or forming romances of my own.

“It’s loss, it’s grief, it’s bereavement,” says Northam of the anger felt by late teens whose parents divorce. “Kids of 18, 19 are quite judgmental; it’s all very black and white. They’ve lost what they had – they’ve lost mum and dad together. People just don’t understand that when they think: ‘I’ll have an affair and leave.’ Kids love stability and the family they grew up with, and that is the model we buy into as a society.”

It is easy for parents to assume their late-teenage children are more grownup than they are, says Angharad Rudkin, a clinical psychologist and chartered member of the British Psychological Society who works with adolescents struggling to come to terms with family breakdown. If they are 17 or 18, we may overestimate teenage maturity because they no longer have irrational strops. In fact, research shows that the brain continues to develop until the age of 25 or 26. “Assuming an older teenager will be able to understand why we’ve split up, and is sensible and fair, is still asking an awful lot,” says Rudkin. “Older teenagers can look back and feel like they were living a lie – that this family life they had grown up with and perhaps never questioned was something their parents were just waiting to break up when they went away to university.”

Splitting up when children are young adults may spare everyone awkward enforced access; the weekends with dad or the new life divided between two homes. But it creates a new difficulty: how can a parent who is shunned by a teenage child maintain contact? If they back off to give teenagers space to rage, that can be interpreted as uncaring. After my parents split, I remember feeling that the onus was on my dad to maintain contact with me; luckily for both of us, he did.

When you keep reassuring your teen that you love them, only to be faced by insults or silence, it must be hard not to lash out, or at least tell them it is tough for you too, and they are old enough to deal with it. It is absolutely essential, Rudkin and Northam agree, that divorcing parents of late teens remember to be the grownups. “You will have to swallow your pride and take the more grownup stance – they are still going to be furious little kids under it all,” she says. “It’s the adult’s responsibility to go out of their way to make contact with the teenager, and not expect a gracious response.”

Grownup children may become one parent’s confidante or “best friend” and children then feel responsible for their parent’s happiness (as they often take on an unnecessary responsibility for the disintegration of their parents’ marriage). “The parents need to stay in the role of parents,” says Northam. “Fathers need to remember that however grownup your child may look, you are still the father, and you need to be the parent who makes the effort to see your children – it’s not the kids’ responsibility. It sounds a bit banal, but one of the obvious things [for a departing father to do] is to say sorry.”

I have no idea whether Chris Huhne and Peter, who is 20 and at university, have repaired their relationship since those awful text exchanges. I hope they have. And if they haven’t, I hope that Chris is still trying, and Peter feels less fury.

Twenty years on from my parents’ divorce, the fact that I find it easier to empathise with Chris than with Peter’s teenage anger is one sign that my dad and I managed to repair our relationship. My own teenage rage seems a world away. I’m very grateful my dad never stopped trying with me, and I admire him for it now, even though I am not sure that a child ever forgets the pain their parents cause, no matter how grownup they are.

What doesn’t kill us…

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adversity, autonomy, avoidance, cognitive processing, compassion, coping, distress, family, friends, gratitude, Grief, intrusion, measures, personal growth, positive changes, post-traumatic growth, post-traumatic stress, psychologists, psychology, PTSD, relationships, resilience, self-acceptance, Self-esteem, support, theory, trauma, vulnerability, well-being

What doesn’t kill us…

The field of psychological trauma is changing as researchers recognise that adversity does not always lead to a damaged and dysfunctional life. Post-traumatic growth refers to how adversity can be a springboard to higher levels of psychological well-being. This article provides an overview of theory, practice and research. To what extent is post-traumatic stress the engine of post-traumatic growth? How can clinicians measure change? What can help people to thrive following adversity?

Suffering is universal: you attempt to subvert it so that it does not have a destructive, negative effect. You turn it around so that it becomes a creative, positive force.
Terry Waite, who survived four years as a hostage in solitary confinement (quoted in Joseph, 2012, p.143)

Scientific interest in positive changes following adversity was sparked when a handful of studies appeared in the late 1980s and early 1990s, reporting positive changes in, for example, rape survivors, male cardiac patients, bereaved adults, survivors of shipping disaster, and combat veterans. Then, the topic of post-traumatic stress disorder (PTSD) was relatively new (following its introduction in 1980 by the American Psychiatric Association), and was attracting much research interest. The relatively few observations of positive change were overshadowed by research on the ways in which trauma could lead to the destruction and devastation of a person’s life.

But interest in how trauma can be a catalyst for positive changes began to take hold during the mid 1990s when the concept of post-traumatic growth (Tedeschi & Calhoun, 1996) was introduced. It proved to be popular and became the descriptor for a field of inquiry attracting international attention from researchers, scholars and practitioners (see, Calhoun & Tedeschi, 2006; Joseph & Linley, 2008a; Weiss & Berger, 2010). Over the past decade it has developed into one of the flagship topics for positive psychology (Seligman, 2011). This article aims to provide a state-of-the-art review of the psychology of post-traumatic growth.

What is post-traumatic growth?
After experiencing a traumatic event, people often report three ways in which their psychological functioning increases:
1.    Relationships are enhanced in some way. For example, people describe that they come to value their friends and family more, feel an increased sense of compassion for others and a longing for more intimate relationships.
2.    People change their views of themselves. For example, developing in wisdom, personal strength and gratitude, perhaps coupled with a greater acceptance of their vulnerabilities and limitations.
3.    People describe changes in their life philosophy. For example, finding a fresh appreciation for each new day and re-evaluating their understanding of what really matters in life, becoming less materialistic and more able to live in the present.

Several self-report psychometric tools were published during the 1990s to assess positive changes following trauma, the first such measure was the Changes in Outlook Questionnaire (Joseph et al., 1993), followed by the Posttraumatic Growth Inventory (Tedeschi & Calhoun, 1996); the Stress Related Growth Scale (Park et al., 1996), the Perceived Benefit Scale (McMillen & Fisher, 1998), and the Thriving Scale (Abraido-Lanza et al., 1998). Each of these measures asks respondents to think about how they have changed since an event and to rate the extent of their change on a series of items.

Using such measures of perceived growth, and open-ended interviews, a large number of studies have shown that growth is common for survivors of various traumatic events, including transportation accidents (shipping disasters, plane crashes, car accidents), natural disasters (hurricanes, earthquakes), interpersonal experiences (combat, rape, sexual assault, child abuse), medical problems (cancer, heart attack, brain injury, spinal cord injury, HIV/AIDS, leukaemia, rheumatoid arthritis, multiple sclerosis) and other life experiences (relationship breakdown, parental divorce, bereavement, emigration). Typically 30–70 per cent of survivors will say that they have experienced positive changes of one form or another (Linley & Joseph, 2004).

Practitioners in health, clinical and counselling psychology will encounter patients daily whose lives have been affected by such events. Up to now practitioners may have drawn on theories of post-traumatic stress to help their patients. A pressing theoretical issue therefore is the relation between post-traumatic stress and post-traumatic growth. How can these new ideas improve how we work with patients?

Theory and practice of post-traumatic growth
Research is now untangling a seemingly intricate dance between post-traumatic stress processes and post-traumatic growth. The most successful attempt to date is organismic valuing theory, which explains how post-traumatic growth arises as a result of post-traumatic stress. This is a person-centred theory that draws together information processing and social cognitive theories of post-traumatic stress with research on self-determination theory. The theory shows trauma leads to a breakdown in self-structure, signalled by the experiences of post-traumatic stress indicating the need to cognitively process the new trauma-related information. People are intrinsically motivated towards processing the new trauma-related information in ways that maximise their psychological well-being (Joseph & Linley, 2005, 2006).

Organismic valuing refers to how intrinsic motivation is experienced by the person. One woman who was caught up in a fatal shooting in which her close friend was killed, and who had suffered from considerable post-traumatic stress for several years, said how she woke early one morning after a night of restless sleep and got up to look at a picture of her children:

In the silent wee hours of the morning, I sat staring at their picture and began to sob. Through my sobs, I heard the real voice of wisdom I believe we all possess. It was my voice, the voice that knows me best, but a voice that had become muted. Guess what. No one is coming to change the situation. No one will rescue you. No one can. It’s up to you. Find your strength. I realised that as long as I remained a victim, I too made my family a victim. My anxiety could only teach them to be anxious. I was robbing them of happiness and a positive outlook on the world. I had come to the intersection of intersections. I could choose to end my life or I could choose to live. I needed to live for my family – and later I understood most importantly, for myself. (quoted in Joseph, 2012, p.142)

Post-traumatic growth involves the rebuilding of the shattered assumptive world. This can be illustrated through the metaphor of the shattered vase. Imagine that one day you accidentally knock a treasured vase off its perch. It smashes into tiny pieces. What do you do? Do you try to put the vase back together as it was? Do you collect the pieces and drop them in the rubbish, as the vase is a total loss? Or do you pick up the beautiful coloured pieces and use them to make something new – such as a colourful mosaic? When adversity strikes, people often feel that at least some part of them – be it their views of the world, their sense of themselves, their relationships – has been smashed. Those who try to put their lives back together exactly as they were remain fractured and vulnerable. But those who accept the breakage and build themselves anew become more resilient and open to new ways of living.

These changes do not necessarily mean that the person will be entirely free of the memories of what has happened to them, the grief they experience or other forms of distress, but that they live their lives more meaningfully in the light of what happened.

The implication of organismic valuing theory is that post-traumatic stress is the catalyst for post-traumatic growth. Helgeson et al. (2006) conducted a meta-analytic review concluding that greater post-traumatic growth was related to more intrusive and avoidant post-traumatic stress experiences. As intrusion and avoidance are generally seen as symptoms of PTSD at first glance this result would seem to suggest that post-traumatic growth is indicative of poor mental health, but consistent with organismic valuing theory Helgeson et al. suggest is that these constructs reflect cognitive processing:
Experiencing intrusive thoughts about a stressor may be a signal that people are working through the implications of the stressor for their lives, and these implications could lead to growth. In fact, some might argue that a period of contemplation and consideration of the stressor is necessary for growth to occur. (p.810)

It is in this sense that post-traumatic stress can be conceptualised as the engine of post-traumatic growth. This is also the conclusion of a recent study by Dekel and colleagues (2012), who set out to shed light on the interplay between PTSD and post-traumatic growth. Using longitudinal self-report data from Israeli combat veterans who were studied over 17 years, with assessment at three time points, the researchers found that greater PTSD in 1991 predicted greater growth in 2003, and greater PTSD in 2003 predicted greater growth in 2008.
However, it also seems that the relationship between post-traumatic growth and post-traumatic stress is a function of the intensity of post-traumatic stress. Butler et al. (2005), for example, in their study following the attacks of September 2001, found that greater post-traumatic stress was associated with greater post-traumatic growth, but only up to a point, above which post-traumatic growth declines.

Could there be a curvilinear relationship between post-traumatic stress and post-traumatic growth? Low levels of post-traumatic stress reactions indicate that the person has been minimally affected, thus one would expect minimal post-traumatic growth. A moderate level of post-traumatic stress is indicative that the individual’s assumptive world has in some way been challenged triggering the intrusive and avoidant experiences, but the person remains able to cope, think clearly, and engage sufficiently in the necessary affective-cognitive processing needed to work through. A high level of post-traumatic stress, however, where a diagnosis of PTSD might be considered, is likely to mean that the person’s coping ability is undermined and their ability to affectively-cognitively process and work through their experience is impeded. The inverted U-shape relationship between post-traumatic stress and post-traumatic growth has been reported in several studies (e.g. Kunst, 2010).

Thus, through the above research and theory we are developing a new understanding of psychological trauma that integrates post-traumatic stress and post-traumatic growth within a single conceptual framework which can guide clinical practice. A new constructive narrative framework that can guide practitioners is the THRIVE model (Joseph, 2012). THRIVE consists of six signposts (see box). Starting with ‘taking stock’, the therapist works with the client to alleviate problems of post-traumatic stress sufficiently so as to enable them to engage in effortful cognitive processing. Then follows five further signposts in which the therapist can work alongside the client. Post-traumatic growth provides practitioners with a new set of tools in their armoury for working with traumatised patients. 

New directions
Each of the measures mentioned above provides a particular operational definition of the construct, and they tend to be only moderately inter-correlated. Unlike, for example, the construct of post-traumatic stress disorder, which has an agreed definition provided by DSM around which measurement tools can be developed, there is no gold standard definition of post-traumatic growth. One suggestion arising from organismic valuing theory is to reframe post-traumatic growth as an increase in psychological well-being (PWB) as opposed to subjective well-being (SWB) (Joseph & Linley, 2008b). Traditionally, the focus of clinical psychology has been on SWB, which can be broadly defined as emotional states. Clinical psychology has been largely concerned with the alleviation of negative emotional states. With positive psychology in the background, clinical psychologists are now also concerned with the facilitation of positive emotional states. But post-traumatic growth does not refer to a positive emotional state but to an increase in PWB, defined as high levels of autonomy, environmental mastery, positive relations with others, openness to personal growth, purpose in life and self-acceptance (see box).

The topic of post-traumatic growth has also attracted interest from quantitative researchers in personality and social psychology. People may say they have grown, but have they really? There is a limitation to the above-mentioned measures, which is that they rely on retrospective accounts of change – that is, asking people to report on what positive changes they perceive themselves to have experienced since an event. We might refer to this as perceptions of growth to distinguish from actual growth, as measured by calculating the difference between state measures of psychological well-being before and after trauma.

Research suggests that the strength of association between actual and perceived growth is moderated by the degree of distress: for those who are most distressed there is a weaker correlation, but for those who are less distressed there is a moderate association (Gunty et al., 2011). It may be that perceptions of growth are at times illusory and a way of coping with distress (Zoellner & Maercker, 2006). Therefore researchers do need to be wary of always taking reports of growth at face value, particularly in the immediate aftermath of a crisis when people are most distressed.

However, while we may question people’s perceptions of growth, there is no question that actual post-traumatic growth occurs, as this has been demonstrated in before-and-after studies (e.g. Peterson & Seligman, 2003). What is now needed are more prospective longitudinal studies able to document the development of growth over time, how both actual and perceived growth co-vary over time and how they relate to other variables – both as outcome variables in order to understand the development of growth, and as predictor variables in order to understand the consequences of growth. Research shows that greater post-traumatic growth is associated with: personality factors, such as emotional stability, extraversion, openness to experience, optimism and self-esteem; ways of coping, such as acceptance, positive reframing, seeking social support, turning to religion, problem solving; and social support factors (Prati & Pietrantoni, 2009). But now more sophisticated theoretically informed designs are also called for in which we can begin to understand the factors that mediate and moderate post-traumatic stress and thus lead to post-traumatic growth. As an example of the directions that social and personality researchers may pursue, in one recent study it was found that emotion-focused coping mediated the association between subjective ratings of distress and post-traumatic growth and that emotional intelligence moderated
the association between emotion-focused coping and post-traumatic growth (Linley et al., 2011). While there is much that can be learned from quantitative research, there is also a need for qualitative research to explore new contexts (e.g. Splevins et al., 2011) and interventions (e.g. Hefferon et al., 2008).

Conclusion

The idea of post-traumatic growth has become one of the most exciting topics in modern psychology because it changes how we think about psychological trauma. Psychologists are beginning to realise that post-traumatic stress following trauma is not always a sign of disorder. Instead, post-traumatic stress can signal that the person is going through a normal and natural emotional struggle to rebuild their lives and make sense of what has befallen them. Sadly it often takes a tragic event in our lives before we make such changes. Survivors have much to teach those of us who haven’t experienced such traumas about how to live.

Box

THRIVE
Taking stock (Making sure the client is safe and helping them learn to manage their post-traumatic stress to tolerable levels, e.g. through exposure-related exercises).
Harvesting hope (Learning to be hopeful about the future, e.g. looking for inspirational stories of people who have overcome similar obstacles).
Re-authoring (Storytelling, e.g. using expressive writing techniques to find new perspectives).
Identifying change (Noticing post-traumatic growth, e.g. using the  Psychological Well-Being Post-Traumatic Changes Questionnaire  to track change).
Valuing change (Developing awareness of new priorities, e.g. positive psychology gratitude exercise).
Expressing change in action (Actively seeking to put post-traumatic growth into the external world, e.g. making a plan of activity for following week that involves doing concrete things).

BOX: Assessing growth
Think of how you yourself have been influenced by events in your own life. The Psychological Well-Being Post-Traumatic Changes Questionnaire (PWB-PTCQ) was developed to assess post-traumatic growth as defined by an increase in PWB. The PWB-PTCQ is an 18-item self-report tool in which people rate how much they have changed as a result of the trauma. A short six-item version is shown below.

Read each statement below and rate how you have changed as a result of the trauma.

5     = Much more so now
4     = A bit more so now
3     = I feel the same about this as before
2     = A bit less so now
1     = Much less so now

1.    I like myself
2.    I have confidence in my opinions
3.    I have a sense of purpose in life
4.    I have strong and close relationships in my life
5.    I feel I am in control of my life
6.    I am open to new experiences that challenge me

People may find it useful to use the PWB-PTCQ to gain insight into how they have changed. Often these dimensions of change go unnoticed in everyday life but deserve to be flagged up and nurtured. Clinicians will find the new tool useful as it allows them to bridge their traditional concerns of psychological suffering with the new positive psychology of growth following adversity (see Joseph et al., 2012).

Stephen Joseph is a Professor at the University of Nottingham and Honorary Consultant in Nottinghamshire NHS?Trust
stephen.joseph@nottingham.ac.uk

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