ETM Psychological
Trauma Family/Systems Treatment
This chapter:
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Explains how psychological trauma affects families.
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Describes ETM family psychological trauma treatment theory.
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Overviews ETM family treatment theory of families
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indirectly affected by the trauma,
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directly affected by the trauma
(and not chemical dependency related)
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directly affected by the trauma
(and chemical dependency related).
Family Psychological Trauma
Psychological trauma affects families in 3 ways. First, the trauma establishes
an etiology for each individual comprising the family. Second, trauma induces
etiology into the memories comprising a relationship; for example, the
shared values, beliefs, images and realities underpinning a marriage are
often contradicted by the trauma. Third, trauma induces etiology into the
myriad relationships known as the family: the traumatic event contradicts
collectively (family) held and shared values, beliefs, images and realities.
TRT Phase Five summaries (Clinical/ Long-Term Trauma/ TRT
Phase Five) depict losses resulting from these 3 etiologies:
intrapsychic (individual), interactional (relationship), and systemic (familial)
losses.
In addition, individual survival defense systems (referenced in ETM as
the "paradoxical system of control") for all the trauma victims in a family
are joined at single relationship and familial levels to provide for a
common defense of the 3 etiologies. The family attempts to resolve the
trauma for the individual family members, the relationships, and the family
as a whole; at the same time the family prevents resolution for the same.
Behavioral manifestations of this collective defensive effort are represented
as fusion in certain relationships, including the erosion of boundaries
between the members' identities, individual isolation in others, role reversals,
communications breakdown, projection, counter projection and the adoption
and enforcement of rules that prevent system members from discovering,
identifying, and otherwise reconciling the trauma-induced contradictions
to values, beliefs, images and realities.
Family Psychological Trauma Treatment (Theory)
ETM family treatment resolves the trauma intra psychically, interactionally
and systemically. Resolution activities counter and then neutralize the
defensive rules that have prevented the identification of the etiologies;
etiology-reversal occurs. Reversing the 3 etiologies also restores operational
identity at the same 3 (intrapsychic, interactional and systemic) levels.
Restoration of operational identity ends fusion, boundary erosion, isolation,
projection, counter projection, and reestablishes communications.
Because the etiologies locused in relationship and family existential identities
are retained in the minds of individual family members, resolution for
those members is more thorough for individuals when the resolution activities
include the pertinent single and familial relationships. Understandably,
families and pertinent relationship partners are not always available to
participate in such resolution activities. This chapter (including attendant
application chapters found under "Clinical/ Family Treatment")
considers the problem resulting from lack of availability of pertinent
parties.
Family resolution activities produce another clinical phenomenon. Resolution
of the trauma for any component of the system often initiates resolution
of the trauma for all of the system; the resolution process for the system
can be completed if no external influences like the simultaneous use of
different therapies, drug use or secondary relationships (marital affairs)
prevent the resolution. Individual-to-collective trauma resolution also
serves as a systemic intervention on chemical dependency -- active chemical
use cannot, as a rule, exist within a system where existential identity
(at intrapsychic, interactional and systemic levels) has been or is being
reconstituted.
Denial of the pathological use and accompanying trauma-causing behaviors
is a product of the paradoxical system of control's defending the individuals
of the system and the system as a whole from the traumas' etiologies. Reversing
the etiologies ends the need for the paradox, simultaneously ending the
denial.
Directly and Indirectly Affected Families
ETM categorizes families into "directly" and "indirectly" affected groups.
"Directly" affected families are units where the family as a whole experiences
the trauma as directly as any individual member.
An example of a "directly affected family" is a family where all the members
are involved in an accident, catastrophe, or exposure to the disease of
one of the family members. An example of a directly affected family member
would be a spouse who observed a partner's shooting during an armed robbery.
With the exception of the trauma-affected family member, the indirectly
affected family is not exposed to the trauma-causing event itself. Parents
of the wounded spouse would provide an example of an indirectly affected
family; although these parents would be traumatized by the event, they
would not experience the shooting and related experiences first hand.
Directly affected families are also divided into two additional groupings:
chemical dependency and non chemical dependency related. The armed robbery
and shooting example above provides a representation of a non chemical
dependency related family affected by psychological trauma (even though
the shooters may be chemically dependent people, they are treated in this
instance only as perpetrators).
When chemical dependency is the source of trauma, all family members are
directly affected by the trauma because they are routinely exposed to the
changing and usually aberrant toxic behaviors. Chemical dependency, as
a source of trauma affecting families directly, is accorded its own delineation
because it is combined with chemical dependency treatment, which includes
the facilitation of sobriety; treatment is more complex when addressing
the dual issues.
Individual Professional vs.
Treatment Team Applications
A single ETM certified family therapist can apply the ETM family treatment
model to indirectly affected (by trauma) families; apply TRT to the directly
affected trauma victim and see the indirectly affected family periodically.
A single ETM Certified family therapist can also apply the ETM family treatment
model to directly affected families, but not as a rule when the primary
source of trauma for the family is chemical dependency.
A treatment team, as opposed to an individual family therapist, is required
to deliver the ETM family treatment program to families directly affected
by psychological trauma caused by a member's bizarre drug use behavior.
A single family therapist cannot implement this program alone; the
clinical demands are overwhelming.
Where Clinical/ Facility Operations shows how
individual ETM certified family therapists can interface with ETM treatment
facility operations to provide the chemical dependency family therapy component,
Clinical/ Family Treatment explains the ETM
application to all families; the assumption being that the individual or
team capacity allows for delivery of the models depicted.
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