Systemic effects of trauma in clinic couples: An exploratory study of secondary trauma resulting from childhood abuse
Nelson, Briana S
Clinical literature suggests that those close to a trauma survivor may experience intrapersonal and interpersonal distress because of indirect or secondary e, effects of the trauma. The focus of this study is on the association between reported childhood physical and sexual abuse and current individual stress symptoms, relationship satisfaction, and family adjustment: The participants included 96 clinic couples who reported a history of childhood physical or sexual abuse in one or Both partners and 65 clinic couples in which neither partner reported such abuse. Couples in which one or both partners reported childhood abuse reported significantly lower marital satisfaction, higher individual stress symptoms, and tower family cohesion than couples with no abuse history: No significant differences were found between individuals who reported a history of abuse and their partners who reported no history of childhood abuse, suggesting support for secondary trauma theory. Clinical and future research implications are discussed.
Traumatic events were once thought to be rare circumstances, experienced by only a few individuals. According to earlier editions of the American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; 1987), trauma-producing events were considered to be “outside the range of usual human experience” (p. 247). In the last two decades, a surge cif interest and empirical study on the effects of trauma has expanded our conceptualization of what events are considered potentially traumatic. Traumatic events were previously limited to a few rare events, such as war trauma. Now several very different events, many more common than once thought, are viewed as potentially traumatic, including war, childhood physical and sexual abuse, natural disasters, traumatic accidents, illness, and the witnessing of such events (APA, 1994). The DSM-IV (APA, 1994) states that trauma may result when a “person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self and others [and] the person’s response involved intense fear, helplessness, or horror” (p. 427–128). Thus, events may be described as traumatic not because of the frequency of occurrence but because of their effects an human life (Herman, 1992).
Individual Effects of Trauma
Traumatic effects traditionally have been viewed through an individual lens focused on the person who has directly experienced the event. The effects on the individual may include trauma symptoms, such as flashbacks, intrusive thoughts about the traumatic event; psychic numbing, sleep disturbances, exaggerated startle responses, increased anger, and isolation (APA, 1994). These individual effects are referred to as a collection of symptoms called Posttraumatic Stress Disorder (PTSD; APA, 1987, 1994). The trauma survivor’s PTSD symptoms have been the primary focus of much clinical and empirical trauma literature.
One area of traumatology that has received clinical and empirical attention is related to childhood abuse (Finkelhor; Hotaling, Lewis, & Smith, 1989, 1990; Herman, 1992). Childhood sexual abuse has been correlated with greater psychological symptoms (Maynes & Feinauer; 1994) and sexual dysfunction (Mermen & Pearlmutter, 1993; Noble, 1995; Wilson & James, 1992) in adult survivors. Problems related to a lack of trust, anger, hostility, anxiety, depression, isolation, loss of power, psychological symptomatology, substance abuse, and self destructive behavior also have been reported in the child abuse literature (Briere, 1989; Busby, Glenn. Steggell, & Adamson, 1993; Cameron, 1994; Kerewsky & Miller, 1996; Mermen & Pearlmutter, 1993; Neumann, Houskamp, Pollock, & Briere, 1996; Wilson & James, 1992). Childhood abuse, whether it is physical, sexual, or emotional, has been recognized as a legitimate trauma, and survivors are susceptible to severe trauma symptoms (Briere, 1989; Herman, 1992).
Systemic Effects of Trauma
Trauma affects the survivor through individual trauma symptoms, but survivors often experience interpersonal problems as well, including marital disruption (Finkelhor et al., 1989), sexual dysfunction (Chauncey, 1994; Mermen & Pearlmutter, 1993; Wilson & James, 1992), communication problems (Reid, Wampler, & Taylor, 1996), and problems with intimacy (Noble, 1995). Many of the problems reported by individual trauma survivors also are reported by their partners, including individual stress symptoms, isolation, poor relationship quality, and reduced intimacy (Coughlan & Parkin; 1987; Maloney, 1988; Solomon et al:, 1992; Verbosky & Ryan, 1988; Williams, 1980). The available literature suggests that trauma and trauma symptoms affect not only the individual but also the people with whom traumatized persons have a significant relationship (e.g., spouses, partners, children); however, this literature on the systemic effects of trauma is predominantly clinical in nature. In order to gain a greater understanding of these systemic effects, empirical research that expands the current clinical literature needs to be conducted. The interpersonal or relational effects of childhood trauma are the focus of the current study.
Several approaches have been used to conceptualize the impact of an individual’s symptoms on another, including the systems-theory concepts of “mutual influence” (Whitchurch & Constantine, 1993), “symptom bearer” (Minuchin & Fishman, 1981 ), and the interpersonal effects of depression (Coyne, 1976; Gotlib & Beach, 1995). Although such general ideas are useful, much is to be gained by applying what is known about the impact of trauma on individuals to an understanding of the impact on the relationship itself, as well as the effect on the partner of an individual who has experienced a traumatic event. In considering the potential relational effects on a couple or family system coping with the stress of a trauma, the theory of “secondary traumatization” has been used as a means of taking what is known about the impact of trauma on the individual and expanding it to gain an understanding of the impact on the system. Secondary traumatization has been used to describe the effects on the child of a parent experiencing PTSD (Rosenheck & Nathan, 1985), the spouse/partner of a traumatized individual (Figley, 1983; McCann & Pearlman, 1990; Nelson & Wright, 1996), and clinicians and other professionals working with trauma survivors (Figley, 1995). Although Figley (1983) and McCann and Pearlman (1990) discuss the intense emotional effects experienced by family members of victims, direct empirical support for the theory of secondary trauma is lacking. The idea behind secondary trauma is that individual stress symptoms are communicable or that those close to the trauma survivor can be “infected” with (Catherall, 1992; Figley, 1995) or experience problems that “mimic” (Coughlan & Parkin, 1987) the problems of the primary survivor: Figure 1 provides a theoretical description of the pervasive effects of traumatic events from a systemic perspective.
The dilemma with this secondary traumatization hypothesis is that the concept primarily stems from clinical experience. The literature on secondary traumatization briefly mentions this concept, citing clinical support (Coughlan & Parkin, 1987; Figley, 1983, 1989; Maloney, 1988; McCann & Pearlman, 1990; Solomon et al” 1992; Verbosky & Ryan, 1988; Williams, 1980). The principal focus in the general trauma literature has been on the primary victim of the trauma, with partners and others close to the survivor largely ignored (Figley, 1995; Maloney, 1988; Maltas & Shay, 1995; Nelson & Wright, 1996; Reid et al., 1996).
The purpose of our study was to provide an initial step toward the empirical testing of secondary trauma theory with the recognition that the mechanisms undoubtedly are quite complex. This model, which has not been tested previously, provides a base from which to understand and identify the systemic effects of trauma. No previous studies have been conducted that directly address systemic trauma or secondary trauma, nor is there empirical literature that addresses the differences between “dual-trauma” (both partners report a trauma history; Balcom, 1996) and “single-trauma” (only one partner reports a trauma history) couples.
Our aim in the current study was to identify how a history of trauma, specifically childhood physical and sexual abuse, might affect current individual and couple functioning, A reported history of physical and/or sexual abuse by one or both partners mas identified as the primary independent variable. Participants who reported physical abuse, sexual abuse, or both in their families of origin were compared to those who reported no abuse history. Dual abuse, one-partner abuse (male only and female only), and no-abuse couples also were compared. The dependent variables were marital adjustment, measured using the Dyadic Adjustment Scale (DAS; Spanier, 1976); individual stress symptoms, measured using the Brief Symptom Inventory (BSI; Derogatis, 1993); and family adjustment, measured using the Family Adaptability and Cohesion Scale (FACES III: Olson, Portner, & Lavee, 1985h). Our hypotheses were:
1. In couples in which only one partner reports a history of childhood abuse, the partner with a history of abuse will score lower on the DAS, higher on the BSL, and lower on FACES than the nonabused partner
2. In couples in which one or both partners report a history of childhood abuse, the partners will score lower on the DAS, higher on the BSI, and lower on FACES than the partners in couples where no history of childhood abuse is reported by either partner.
3. In couples in which both partners report a history of abuse, the partners will have lower DAS scores, higher BSI scores; and lower FACES scores than the partners in the male-only, female-only, and noabuse groups: Similarly, partners in the male-only and female-only groups will have lower DAS scores, higher BSI scores, and lower FACES scores than the partners in the no-abuse group.
The participants in the study were 161 heterosexual couples who sought couple or family therapy over a 30-month period at a university marriage and family therapy clinic. This clinic serves a large and diverse community in the southwest. All couples completed intake questionnaires at the first therapy session, from which data for the current study were obtained. Of all couples, 96 clinic couples were identified as having at least one partner who reported a history of childhood physical and/or sexual abuse on the intake form. The no-abuse group consisted of 65 couples in which no history of childhood abuse was reported by either partner. Combining physical and sexual childhood abuse into one category has been used in previous research in comparing psychological symptoms among clients who report an abuse history and clients who report no history of abuse (Busby et al., 1993). It is impossible to verify that clients who did not indicate childhood abuse on the intake form were not abused (e.g., they may not remember the trauma or may prefer not to disclose information regarding childhood abuse). Rather, it is only possible to verify that the abuse was not reported, which follows the standard set by Busby et al. ( 1993).
The mean age of the male partners was 33.36 SD = 8.55; range = 18-f>4), and the female partners’ mean age was 31.45 (SD = 8.29; range = 17-fi4): The average length of the relationship was 6.9 years (SD = 7.46; range = l month to 40 years). The majority (46%o) were married, 25% were remarried, a few (6%) were divorced or separated, and the rest (23%) were dating, never married, or cohabiting. Seventy-two percent of the men and 45% of the women were employed full time. The majority of the men (55%) and women (48%) had some college education; 17% of the men and 22% of the women had completed college or pursued graduate training. An annual income under $20,000 was reported by 53% of the couples. The majority (81%) were European American, with 13% Hispanic and 6% in other ethnic groups. Fifty-seven percent were receiving therapy for marital/couple issues, while 43% were receiving family therapy. There were no statistically significant differences between the two groups on demographic variables except for men’s education level. The men in the na-abuse group were slightly more educated than men in the abuse group, t ( 154) _ -1.86; p
Identifying abuse and no-abuse groups. To identify a childhood abuse history, the following criteria identified by questions from the intake form were used: (I) one or both partners indicated incest, physical childhood abuse, or sexual childhood abuse as problems that are now a concern to them; (2) one or both partners indicated that physical abuse, unwanted touching, or sexual abuse had happened to them before 18 years of age; and/or (3) one or both partners indicated that physical abuse, unwanted touching, or sexual abuse had occurred in the household in which they were raised before 18 years of age. Partners who indicated at least one of the above problems were identified as having a history of childhood abuse, and the couple was placed in the childhood abuse group. Thus, of the 161 total couples, 96 were identified as reporting a history of childhood abuse in one or both partners, and 65 couples reported none.
General symptomatology. The Brief Symptom Inventory (Derogatis, 1993) is a 53-item self report symptom inventory. The scale is designed to reflect severity of psychological distress over nine primary symptom categories/dimensions and three global symptom indices: The nine symptom categories include: somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. The global symptom indices include the global severity index, positive symptom total, and the positive symptom distress index. The item format consists of a 5-point Likert scale, ranging from 0 (not at all) to 4 (extremely): This measure has demonstrated good internal consistency with Cronbach’s alpha coefficients ranging from .71 (on the psychoticism subscale) to .85 (for the depression subscale; Derogatis, 1993). The scale also has demonstrated good test-retest reliability for the overall distress score (GSI = .90; Derogatis, 1993). Construct validity for the BSI also has been supported, demonstrating high convergent validity coefficients with the SCL-90-R (.92-.99) and moderate correlations with the MMPI (.33-.72). Thus, the BSI has received support as a general measure of stress/psychological symptoms. The T score for the global severity index based on separate male and female norms for nonclinical samples (Derogatis, 1993) was used in this study as the measure of stress symptoms.
Quality of current relationship. Relationship quality was assessed with the 32-item Dyadic Adjustment Scale (Spanier, 1976). The DAS has demonstrated good internal consistency on the total score (a = .96) and on each of the subscales: dyadic satisfaction (.94), dyadic cohesion (.81), dyadic consensus (.90), and affectional expression (.73; Fischer & Corcoran, 1994). The DAS has high convergent validity correlations (.86-.88) with the Locke-Wallace Marital Adjustment Test (LAbate & Bagarozzi, 1993).
Family adjustment. The Family Adaptability and Cohesion Scale (Olson et al., 1985b) focuses on the level of Cohesion and Adaptability in the couple/family system. The scale contains 20 items (10 Cohesion items and 10 Adaptability items) that are rated on a 5-point Likert scale. FACES IlI has demonstrated moderate internal consistency (Cronbach’s a: Adaptability _ .62; Cohesion = .77; Total = .68; Fischer & Corcoran, 1994) and adequate validity results (Olson et al., 1985x).
Differences between Partners
The first hypothesis of the secondary trauma model is that the partner who experienced childhood abuse directly (primary trauma) would indicate poorer functioning than the nonabused partner. To test Hypothesis 1, paired t tests were conducted to determine differences between the abused and nonabused partners (see Table 1). In couples where the male partner reported an abuse history, no significant differences were found between the primary trauma survivor and his partner on the DAS, BSI. and FACES Adaptability and Cohesion. In couples where the female partner reported a history of childhood abuse, the women’s DAS scores were significantly lower than their partners, as predicted. There were no significant partner differences between BSI scores or FACES Cohesion scores. In addition, contrary to prediction, the male partners of women with an abuse history reported Lower Adaptability scores than their female partners. With the exception of abused women reporting lower DAS scores than their partners, Hypothesis I was not supported.
Differences between Abuse and No-Abuse Couples
Multivariate analysis of variance (MANOVA) was used to determine whether couples with a history of abuse in one or both partners were more impaired on the dependent measures than couples who reported no history of abuse (Hypothesis 2). Two MANOVAs were completed, one with the DAS and BSI as dependent variables and the second with the Cohesion and Adaptability subscales of FACES, due to missing FACES data. Both MANOVAs were 2 x 2 mixed designs, with couple abuse (abuse vs. no-abuse) as a between-subjects variable and partner (male vs. female) as a repeated-measures variable. For the DAS and BSI measures, the multivariate F test reached statistical significance, (F(2, 153) = 9.05, p .05). The interaction effect between couple abuse and partner was not significant (F(2, 153) _ .09, p > .05).
Although a significant multivariate F test was not found for the FACES measure, univariate F tests revealed a significant difference between the abuse and no-abuse groups on the Cohesion subscale for male partners and for female partners; however, no significant differences were found on Adaptability scores (see Table 2). Thus, when there is an abuse history reported by at least one partner, men and women have significantly lower cohesion scores than nonabused partners. No difference was found between spouses, and no significant interaction effect was found in the FACES analysis.
To address the specific problems experienced by both the abuse and the no-abuse couples, Pearson correlation coefficients were conducted on the BSI subscales (nine symptom categories). The results indicated low to moderate positive correlations between the partners’ subscale scores in the couples where at least one partner reported a history of abuse. There were statistically significant positive correlations between male and female partners’ scores on the subscales for somatic complaints, X94) _ .22, p
Differences between Both-Abuse, One-Partner Abuse, and No-Abuse Couples
Hypothesis 3 was tested using two 4 x 2 mixed MANOVAs to determine whether there were differences in DAS, BSI, or FACES scores between couples with no abuse (n = 65), male partner only abuse (n = 24), female partner only abuse (n = 57), or both partners reporting childhood abuse (n = 15). The repeated measures variable was partner (male vs. female). It was expected that couples reporting no abuse would indicate less individual and relationship distress than couples in which one partner reported abuse, and couples in which one partner reported abuse would indicate less distress than couples in which both partners reported abuse.
This hypothesis was partially supported. For the DAS and BSI measures, the multivariate F test reached statistical significance (F(6, 302) = 4.QG; p
Univariate F’ tests indicated significant group differences between the groups for the men’s BSI and the women’s BSI (see Table 3). Planned comparisons revealed that male partners reported significantly higher BSI scores in the male-partner only abuse group than the male partners in the no-abuse group (t(1, 157) _ -2:96; p = .002) and higher BSI scores in the female-partner only abuse group than in the no-abuse group (t(1, 157) _ -2.23; p = .013). There was no significant difference in the male partners’ BSI scores between the other groups. Thus, men who reported an abuse history and men with no reported history of abuse but whose female partners reported an abuse history had significantly higher individual stress symptoms than male partners in couples with no abuse history. Similarly, female partners reported significantly higher BSI scores in the male-partner only abuse group than the female partners in the no-abuse group (t( I, 157) _ -3.12; p = .001) and higher BSI scores in the female-partner only abuse group than in the no-abuse group (t( 1, 157) _ -3.10; p = :001). Thus, men and women in the couples where only one partner reported an abuse history had significantly higher stress symptoms than the partners in the no-abuse couples. There were no significant differences between the both-abuse group and the other groups. Thus, Hypothesis 3 was not supported: partners in the both-abuse group did not report significantly higher BSI scores and lower DAS scores than the other groups (see Figure 2).
As with the previous two-group (abuse vs. no-abuse) analysis> there was a significant main effect for partner (male vs. female; F(2, I 51 ) = 9.53; p c .0001 ). Women reported significantly lower DAS scores than their male partners (F( 1, 152) = 19.16; p .05). There was not a significant interaction between abuse group and partner (F(6, 302) _ .43; p > .05), and no significant MANOVA results were found for the FACES subscales.
The results from this study suggest that couples in which one at both partners report a history of physical and/or sexual abuse in childhood experienced lower relationship satisfaction and higher individual stress symptoms than those couples where neither partner reports an abuse history. Based on clinical and empirical literature on traumatic stress symptoms, it was hypothesized that the partners who reported direct exposure to a traumatic event would report more individual and relational impairment. Male and female partners in couples where at least one partner reported a history of abuse reported significantly higher BSI scores than the partners in couples with no reported abuse history. This was true even when comparing BSI scores of men who did not report an abuse history but whose female partners did report an abuse history and in the BSI scores of women with no reported abuse history whose male partners reported an abuse history. This result is particularly interesting because, when partners who reported an abuse history were compared with their no-abuse partners, there was not a significant difference between the partners on BSI scores. According to secondary trauma theory, the symptoms reported by the nonabused partner may parallel the symptoms experienced by the abused partner. Thus, the significant difference between groups (abuse vs. no-abuse), with no difference between partners, suggests support for secondary trauma effects in the nonabused partners of abuse survivors. It appears that, in the current study when there was a reported abuse history in at least one partner. both partners seem to experience greater individual stress symptoms.
There were mixed results on the DAS. In general, men in abuse couples reported lower relationship satisfaction than men in the no-abuse couples. Significant results were not found for the women’s DAS scores, perhaps because women reported lower DAS scores overall than men. It may have been difficult to detect significant differences between the groups because of low satisfaction scores in clinical samples. The. DAS results do suggest support for the theory of secondary trauma, as couples with an abuse history in at least one partner tended to report less satisfaction with their relationship than couples where neither partner reported an abuse history.
In general, the FACES results indicate that couples with a history of childhood abuse score lower on Cohesion than no-abuse couples. This result reflects a distance or lack of closeness experienced by couples where one or both of the partners reported a history of childhood abuse. Emotional distance and isolation often are problems reported by individuals who have experienced abuse. There were no significant differences found between the groups in terms of Adaptability; however, men whose partners reported a history of abuse had lower Adaptability scores than their female partners, suggesting a potential lack of flexibility in these couples. However, strong conclusions cannot be drawn from the FACES results because several cases were dropped due to incomplete data and because of the limited number of significant statistical results with the FACES data.
It was hypothesized that couples where both partners reported childhood abuse would experience more individual distress, less relationship satisfaction, and poorer family adjustment than couples where only one partner had an abuse history or where neither partner had an abuse history. In general, this hypothesis was not supported. Although men and women in the both-abuse group reported lower DAS scores than the partners in the no-abuse group, and men in the female-partner abuse group reported lower DAS scores than the no-abuse group, no other significant differences were found between groups. Also, men and women in the groups where only one partner reported childhood abuse had significantly higher BSI scores than the partners in the no-abuse group, but no significant differences were found between the both-abuse group and the other groups. In fact, the partners in the both-abuse group reported lower distress scores than the partners in the groups where only one partner reported childhood abuse. These findings are tentative because of the low sample size in the both-abuse group (n = IS). Further research on the individual and relational effects when both partners report an abuse history is necessary. Clinical literature indicates that dual trauma couples present unique dynamics and therapeutic issues (Balcom, 1996). The results of the current study suggest potential differences in individual distress and relationship satisfaction, but firm conclusions based on this data cannot be made.
One potential explanation far these results is that there is a “similarity” in experience between the partners of the both-abuse group, which lends to a greater understanding of or an empathy for the problems experienced by abuse survivors. This empathic awareness may be absent when only one partner has experienced an abusive history.
Another explanation for the both-abuse group reporting lower individual and relationship impairment may be due to an element of denial, or both-abuse couples may present a front that “everything is fine.” Therefore, when only one partner reports an abuse history, it may be more difficult to present a united front because both partners have different perspectives and different baselines from which to compare their relationship functioning. The both-abuse couples may underreport their relationship impairment.
Finally, in the couples where only one partner reports abuse, the nonabused partner may have issues or problems that are similar to those of the partner who reports childhood abuse. Some survivors may select a partner who may not report a history of abuse but who may have other symptoms and impairments. For example; the first author has worked with several couples in which only one partner reported direct physical or sexual abuse as a child, but the other partner reported witnessing severe abuse between family members (e.g., between parents). These types of experiences may add to individual and couple impairments. Further study on the potential problems and issues specific to the nonabused partners is warranted.
Although not all hypotheses were supported in the current study, the fact that significant differences between these groups were found is remarkable. All couples were clinic-based, distressed couples actively seeking therapy services; however, they were not seeking therapy for trauma-related issues (i.e., the couples were not recruited from a PTSD or trauma clinic). Looking at these couples through a trauma lens adds something to our understanding of marriage and family therapy. it is important for marital and family therapists to identify potentially traumatic histories in clinic couples and to begin to understand the systemic symptoms that may relate to that history. The current study provides support for the theory of secondary trauma. The next step is to begin to understand the specific mechanisms involved in traumatized systems.
There are several mechanisms that may provide an understanding of secondary trauma. First, learning of crr hearing about a traumatic event, although not directly experiencing the event, may contribute to secondary traumatic stress effects. The DSM-IV (APA, 1994) provides a description of the experiences that have the potential to be traumatic. Most of the extreme traumatic stressors identified in the DSM-IV involve the “direct personal experience of an event;” however, potentially traumatic events can include “learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate, . . . violent personal assault, serious accident, or serious injury experienced by a family member or a close friend; . . . or learning that one’s child has a life-threatening disease” (APA, 1994, p. 424). Second, a person may experience secondary trauma issues resulting from identification with the trauma victim. Rosenheck and Nathan ( 1985) identify this mechanism in their description of the children of trauma survivors who also may experience symptoms (o.g., depression, guilt, rage) because of an indirect effect, like identifying with the traumatized parent, or more directly through the parent’s behavior toward the child (e.g., anger toward the child). This may result from an internalization process, where family members identify so closely with the experiences of the trauma survivor that they begin to internalize the trauma symptoms of the survivor and experience their own individual stress reactions (Maloney, 1988).
Related to identification, a third mechanism may result from the emotional connection or attachment a person has with a trauma survivor. Johnson and Williams-Keeler (1998) describe the emotional responses and patterns of distance, defense, and distrust that occur in couples in which a partner has a history of trauma, which negatively affects their relationship functioning, reducing the secure attachment necessary for healthy functioning. Thus, individuals with a close emotional connection to the primary trauma survivor also may experience increased intrapersonal and interpersonal problems as a result of trauma.
Fourth, mate selection may contribute to the partner experiencing increased traumatic stress problems. Both partners may share a common history of trauma or an increased vulnerability due to other experiences (e.g., mental illness, low self-esteem). Thus, both partners may have high individual and relational impairment, one because of trauma history and the other because of general insecurities or other issues. These partners may self select because of similar impairments, which may increase the potential for systemic problems.
Finally, a mechanism that may contribute to secondary trauma is the identified trauma survivor’s behaving in traumatizing ways toward the partner (i.e., violence, flashbacks). Matsakis (1988) identifies problems of severe physical violence and intense psychological and emotional abuse of trauma survivors toward their partners. These experiences may be severe enough to contribute to trauma symptoms in the partners of trauma survivors.
It can be concluded from this description of the potential mechanisms involved with systemic traumatic effects that “the results of trauma are multifaceted and affect many varied aspects of functioning” (Johnson & Williams-Keeler. 1998, p. 26). Thus, there is not an easily identifiable mechanism to explain the complexities of traumatic effects. The mechanisms described here provide a description of the potential factors involved, but they do not provide conclusive evidence for systemic or secondary trauma. The current research did not attempt to study the mechanisms described above; rather, it was the intent of the researchers to provide initial support for the systemic trauma theory and model to pursue further research.
In treating abuse survivors, their spouses/partners, and other family members, it is critical to understand how secondary trauma may be a factor in the relational problems they present. understanding the ongoing impact of a traumatic event can allow the clinician to address and educate clients about trauma, determine the unique needs and issues presented by this population, and develop systemic treatment plans to effect change and healing in the primary and secondary survivors of trauma. Too often, the primary survivor is the only family member who receives therapeutic services, and treatment only occurs once trauma has been identified. Therapy often is left an enigma to others in the family, particularly spouses (Reid et al., 1996), and the connection between current relationship dysfunction and previous trauma often is undetected (Mermen & Pearlmutter, 1993; Nadelson & Polonsky, 1991) or, worse, simply ignored. Although conjoint therapy is not the only mode of therapy for addressing trauma issues, we believe it is often not used when it could prove very beneficial for clients. At the very least, the results paint to the importance of a systemic assessment to explore the impact of past abuse on the partner and the couple relationship.
Johnson and Williams-Keeler ( 1998) consider the marital relationship to be “one of the most important elements of the recovery environment” (p. 27), and it is important for therapy to focus on emotional responses to form trust and a secure attachment to provide an environment for trauma recovery within the couple relationship. Clinical interventions should target specific issues in the relationship (e.g., problems with conflict or intimacy), rather than general relationship effects (e.g., relational satisfaction), to determine the primary relational areas that are affected by trauma.
Although the couples in the current study were predominantly European American and all were heterosexual, the concepts behind secondary trauma theory apply to other populations as well. It is important to address issues of sexual orientation, race, and culture in trauma therapy. Kerewsky and Miller (1996) report that the incidence of a dual trauma history may be higher for lesbian couples. A key theme identified by these authors that applies to heterosexual, lesbian, and gay couples with a trauma history is the role that trauma often takes as part of a triangle in the couple relationship. Exposure and externalization of the trauma as part of the couple dynamics are primary components in trauma recovery.
The idea that trauma can have secondary effects is a relatively new, unresearched area. The model presented above suggests that there may be both individual and relational secondary effects from trauma. The results of this study suggest that trauma may affect the individual partner’s level of stress symptoms more than the relational functioning of the couple; however, because trauma is conceptualized as a more “individual” phenomenon, relational effects of trauma are more difficult to operationalize empirically or clinically. To understand the systemic effects of trauma from a therapeutic standpoint, it is important to begin identifying the specific relational effects of trauma through further clinical and empirical research.
One of the limitations of the current study is the use of archived data in the analysis of the relational effects of trauma. The couples were selected based on one or both partner’s indication that they had experienced childhood physical and/or sexual abuse. It is possible that some of the couples in the no-abuse group actually had experienced childhood trauma but did not report it. Also, some participants in the abuse group may have overreported their histories of abuse. These factors could produce confounding, inaccurate results.
Another limitation is that all of the abuse participants were combined into one group, including those who indicated multiple forms of abuse and those indicating only one or two abuse categories: Literature suggests that those experiencing extensive abuse, particularly sexual abuse, endure more psychological and social effects (Busby et al., 1993; Maynes & Feinauer, 1994). It would seem logical that interpersonal or secondary effects also would be more extensive when abuse is more severe or compounded. This is not to discount the experience of various types of childhood abuse/trauma, but to raise awareness of the limitations and potential confounding variables that could result from treating all forms of abuse equally. It should be noted that not having a standardized definition of abuse is a dilemma in conducting abuse research. The current study used self-report data in defining abuse. Future research should focus on understanding the diverse interpersonal effects of physical, sexual, and emotional abuse using more standardized definitions of abuse.
The generalizability of the current study is an additional limitation. Although this study is based on clinical data, the results are limited to couples who actively sought treatment for couple or family issues; however, they were not necessarily seeking help for trauma-related issues and may not be representative of the nonclinical population of couples with a history of abuse.
Finally, it is possible that the results were due to etiological factors other than secondary traumatic stress. For example, the population identified as abuse survivors and their partners may have had elevated symptoms and relationship distress due to high marital conflict or individual psychiatric disorders (e.g., depression, substance abuse). Also, factors related to mate selection could provide a potential explanation for the significant results. That is, partners who were susceptible to individual and relational problems may have attracted and/or selected one another. Understanding these potential explanations is beyond the scope of the current study and requires additional research.
This study provides groundbreaking research on trauma; however, it also raises additional questions. What are the specific primary and secondary symptoms that may result from past abuse? What mechanisms are involved in systemic trauma? Is there a “mimicking” or internalization process that occurs for the partners of abuse survivors? What specific relational components (e.g., communication, intimacy) are affected by past abuse? The complex mechanisms of secondary trauma require continued empirical attention to identify the specific individual and relational factors involved in the systemic effects of trauma. The current study provides an initial step from which future research can proceed.
In sum, couples who reported an abuse history indicated more stress symptoms, lower dyadic adjustment, and lower cohesion than couples who reported no history of childhood abuse. Also, there were no significant differences between individuals who reported an abuse history and their no-abuse partners in couples where only one partner indicated an abuse history; however, the results were mixed between noabuse couples, one-partner, and both-abuse groups. The fact that there were significant differences found between the groups is remarkable because the groups were from a clinic sample and nonclinical, control couples were not included in the study. Also, the measure of abuse was based solely on self-report and did not include measures of severity of abuse, type of abuse, frequency of abuse, or other specific descriptions to differentiate what types of abuse had been experienced. This information would be beneficial in future research on secondary trauma. Also worthy of further exploration are the findings related to couples where both partners reported a history of abuse. These areas could provide important knowledge about the systemic effects of different types of trauma and the dynamics of dual-trauma couples.
The study of trauma from a systemic perspective is a new area of family pedagogy and much additional research is needed. Future research would be beneficial in providing information on specific clinical interventions and secondary effects of other types of traumatic events. The theory of secondary trauma is applicable to a wide array of traumatic experiences. Clinical and empirical expansions to develop an understanding of how trauma affects couples and families are important in the fields of traumatology and marriage and family therapy.
American Psychiatric Association. ( 1987). Diagnostic and statistical manual of mental disorders (3rd ed., revised). Washington, DC: American Psychiatric Association.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association,
Balcom, D. ( 1996). The interpersonal dynamics and treatment of dual trauma couples. Journal of Marital and Family Therapy, 22, 431-442.
Briere,1. (1989). Therapy for adults molested as childrEn: Beyond survival New York: Springer.
Bushy, D. V4., Glenn, E., Steggell, G. L., & Adamson. D. W. (1993). Treatment issues for survivors of physical and sexual abuse. Journal of Marital and Family Therapy, 79, 377-392.
Cameron, C. (1994). veterans of a secret war: Survivors of childhood sexual trauma compared to Vietnam War veterans with PFSD. Journal of Interpersonal Violence. 9, 117-132.
Catherall. D. R. (1992). Back from the brink: A family guide to overcoming traumatic stress. New York: Bantam.
Chauncey, S. (1994). Emotional concerns and treatment of male partners of female sexual abuse survivors. Social Work 39, 669-676.
Coughlan, K., R Parkin, C. ( 1987). Women partners of Vietnam vets. Journal of Psychosocial Nursing, 25, 25-27. Coyne” J. C. ( 1976). Depression and the response of others. Jounral of Abnormal Psychology, 85, 186-193.
Derogatis, L. R. ( 1993). Brief Symptom lnventory: Administration, scoring, mrd procedures manual. Minneapolis, MN: National Computer Systems.
Figley, C. R. ( 1983). Catastrophes: An overview of family reaction. In C. R. Figley & H. I. McCubbin (Eds.). Stress and the family: Coping with catastrophe (Vol. 2, pp. 3-20). New York: Brunner/Mazel.
Figley, C. R. (1989). Helping traumatized families. San Francisco: Jossey-Bass.
Figley, C. R. (1995). Compassion fatigue as secondary traumatic stress disorder: An overview. In C. R. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traesrnatized (pp. I-20). New York: Brunner/Mazel.
Finkelhor, D., Hotaling, G., Lewis, IA-, & Smith, C. ( 1989). Sexual abuse and its relationship to later sexual satisfaction, marital status, religion, and attitudes, Journal of Interpersonal Violence, 4, 379-399.
Finkelhor, D.; Hotaling, G., Lewis, I. A., & Smith, C. (1990). Sexual abuse in a national survey of adult teen and women: Prevalence, characteristics, and risk factors. Child Abuse and Neglect, 14, 19-28.
Fischer, J., & Corcoran, K. ( 1994). Measures for clinical practice: A sourcebook (2nd ed., Val. 1 ). New York: Free Press. Gotlib, I. H., & Beach. S. R H. ( 1995). A maritaL/family discord model of depression: Implications for therapeutic intervention. In N. S. Jacobson & A. S. Gutman (Eds.), Clinical handbook of couple therapy (pp. 411-436). New York: Guilford. Herman, J. L. ( 1992). Trauma and recovery. New York: Basic.
Johnson, S. M., & Williams-Keeler, L. (1998). Creating healing relationships for couples dealing with trauma: The use of emotionally focused marital therapy. Journal of Marital and Family 7hera pc. 24, 25-40.
Kerewsky, S. D., & Miller, D. (1996). Lesbian couples and childhood trauma: Guidelines for therapists. In J- Laird and R. J. Green Fds.), Lesbians and gays in couples and families (pp. 298-315). San Francisco: Jossey-Bass.
L’Abate, L” & Bagarozzi, D. A. (1993). Sourcebook of marriage and family evaluation. New York: Brunner/Mazel.
Maloney, L. J. 1988). Post traumatic stresses on women partners of Vietnam veterans. Smith College Studies in Social Work, 58, 122-143.
Maltas. C., & Shay, J. (1995). Trauma contagion in partners of survivors of childhood sexual abuse. American Journal qf Orthopsychiatry;; 65, 529-539.
Matsakis, A. (1988). Vietnam wives. Washington, DC: Woodbine House.
Maynes, L. C., & Feinauer, L. L. ! (1994). Acute and chronic dissociation and somatized anxiety ac related to childhood sexual abuse. American Journal of Family Therapy, 22, 165-175.
McCann, I. L., & Pearlman, L. A. (1990). Vicarious traumatization: A framework for understanding the psychological effects of working with victims, Journal of Traumatic Stress, 3, 131-149.
Mermen, F. E., & Pearlmutter, L. (1993). Detecting childhood sexual abuse in couples therapy. Families in Society, 74, 74-83. Minuchin, S., & Fishman, H. C. (1981). Family therapy techniques. Cambridge, MA: Harvard University Press.
Nadelson, C., & Polonsky. D. (1991 ). Childhood sexual abuse: The invisible ghost in couple therapy. Psychiatric Annals, 21, 479-484.
Nelson, B. S., & Wright, D. W. (1996). Understanding and treating posttraumatic stress disorder symptoms in female partners of veterans with PTSD. Journal of Marital and Family Therapy, 22, 455-467.
Neumann, D. A.. Houskamp, B. M., Pollock, V. E., & Briere, J. (1996). The long-tens sequelae of childhood sexual abuse in women: A meta-analytic review. Child Maltreatment. Journal of the American Professional Society on the Abuse of Children, 1. 6-[16.
Noble, E. A. (1995). The negotiation of tactile relationships in the marital dyad of incest survivors. Unpublished doctoral dissertation, Texas Tech University, Lubbock. Texas.
Olson, D. H., McCubbin, H. L, Barnes, H., Larsen. A.. Muxem, M., & Wilson, M. (198Sa). Family inventories. St. Paul: University of Minnesota, Family Social Science.
Olson, D. H., Portner, J., & Lavee, Y (1985b). FACES Hli. St. Paul: University of Minnesota, Family Social Science.
Reid, K. S., Wampler, R. S., & Taylor, D. K. (1996). The alienated partner: Responses to traditional therapies for adult sex abuse survivors. Journal of Marital and Family Therapy, 22, 443-453,
Rosenheck. R., & Nathan, P (1985). Secondary traumatization in children of Vietnam veterans. Hospital and Community Psychiatry 36, 538-539.
Solomon, Z., Waysman. Levy, G., Fried, B., Mikulincer, IvI,. Benbenishty, R., Florian, V., & Bleich, A. ( 1992). From front line to home front: .4 study of secondary, traumatization. Family Process, 31, 289-302.
Spanier, G. B. ( 1976). Measuring dyadic adjustment: New scales far assessing the quality of marriage and similar dyads. Journal of Marriage and the Family, 38, 15-28.
Verbosky, S. J., & Ryan, D. A. (1988). Female partners of Vietnam veterans: Stress by proximity. Issues ire Mental Health Nursing, 9, 95-104.
Whitchurch, G. G., & Constantine, L. L. (1993). Systems theory. in P G. Boss, W. J. Doherty, R. LaRossa, W R. Schumm> & S. K. Steinmetz (Eds.), Sourcebook of family theories and methods: A contextual approach (pg. 325-352). New York: Plenum.
Williams, C. M: ( 1980. The “veteran system” with a focus on women partners: Theoretical considerations, problems, and treatment strategies. In T. Williams (fill.), Posttraumatic stress disorders of the Vietnam vetera,’ (pp. 73-117. Cincinnati: Disabled American Veterans.
Wilson, K., & James, A. L. (1992). Child sexual abuse and couple therapy. Sexual and Marital Therapy, 7, 197-212.
Briana S. Nelson
Kansas State University
Karen S. Wampler
Texas Tech University
An earlier version of this paper was presented at the annual conference of the American Association for Marriage and Family
Therapy, Atlanta, GA, September 1997. Briana S. Nelson, PhD. PhD, is Assistant Professor of Marriage and Family Therapy, School of Family Studies and Human Services,
Kansas State University. Manhattan, KS 66506-1403: e-mail: firstname.lastname@example.org.
Karen S. Wampler, PhD, is Professor and Director of Marriage and Family Therapy, Department of Human Development and Family Studies, Texas Tech University, Lubbock, TX 79409-1162.
We would like to thank Susan Smith, PhD, and Richard Wampler, PhD, for their generosity and assistance with the clinic data set. In addition, we would like to thank three anonymous reviewers for their valuable feedback on earlier versions of this article.
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