M OTHERS ’ N ARRATIVES OF T RAUMA : A N EXPLORATORY STUDY OF HOW MOTHERS NARRATE THE IMPACT OF TRAUMA ON THEIR FAMILIES D R. S TEPHEN C OULTER Q UEENS U NIVERSITY, B ELFAST S. QUB. AC. UK IFTA C ONFERENCE, P ANAMA C ITY 7 TH M ARCH 2014 S. QUB. AC. UK Supported by the British Academy – Small Grant Scheme

O BJECTIVES OF S TUDY  To hear what mothers said about the impact of Trauma on them and their families  To do this before they are inducted into professional therapy speak  To see the extent to which this maps onto a PTSD focused frame  To consider variation across types of cases  To see what questions may be raised by the findings

T HE S TUDY T HESIS  The experience of trauma has been over-medicalised and reduced to a relatively narrow set of ‘symptoms’ associated with diagnostic categories such as Post- Traumatic Stress Disorder (PTSD)  This pathological conceptualisation strongly influences mental health professionals’ interventions with victims/survivors of trauma, which then have the potential to obscure important dimensions of the phenomenological experience of being traumatised that are significant to the victim/survivors and their families

R ATIONALE FOR S TUDY  It is tempting to see Trauma as a linear concept: Traumatic event happens post-trauma symptoms  But an adverse event does not always (or even usually) lead to trauma – it is how it is experienced that counts and the experience is co-constructed in the relational, social and cultural milieu  In recent years in the West a dominant medicalised discourse on adverse events using the nosology of Psychiatric Disorder, particularly Post-Traumatic Stress Disorder (PTSD) has emerged.

B RIERE AND S COTT ASTUTELY NOTE  “…not all psychological injury can be encompassed by a list of symptoms or disorders. Trauma can alter the very meaning we give to our lives, and can produce feelings and experiences that are not easily categorised in diagnostic manuals.” (2006, p. 17)  Therefore, it is important, to listen to personal accounts of the impact of traumatic events  A concern is that we could colonise our clients trauma experience by imposing a pathologising approach based on an epistemological error regarding ‘trauma’

PTSD – SYMPTOMS ARE CATEGORISED INTO 3 SUB - GROUPS AS FOLLOWS :  re-experiencing symptoms – sufferers involuntarily re-experience aspects of the traumatic event including repetitive and distressing intrusive images, flashbacks, nightmares; other sensory impressions from the event. Reminders of the traumatic event arouse intense distress and/or physiological reactions

PTSD –S YMPTOMS (2)  avoidance/numbing symptoms – include (a) physical avoidance of reminders of the trauma including - people, situations or circumstances associated with the event and (b) psychological avoidance through trying not to think about the traumatic event, emotional numbing, feeling detached from other people, and decreased interest in usual activities  hyperarousal symptoms - include hypervigilance, exaggerated startle response, irritability, difficulty in concentrating and problems with sleep disturbance  To qualify for a diagnosis of PTSD a person is required to have at least 1 intrusive symptom, 3 avoidant or numbing symptoms including at least 1 avoidant and 1 numbing symptom, 2 hyperarousal symptoms, and evidence of functional impairment at 1 month after the traumatic event or longer (APA, 1994)

H OW THE D ATA WAS C OLLECTED ?  Sample - 10 mothers families - a convenience sample from families who attend their initial appointment at the ‘Wednesday morning’ clinic at the FTC  Methodology - ‘Narrative Interview’ methodology: Early in the initial session, the mother was asked the SQUIN (Single Question aimed at inducing Narrative(s)) “Please tell me your story of how [the presenting traumatic event] has affected you and your family?” Her response was actively listened to without interruption and may then be invited to expand on aspects of her account via prompts.  A problem arose – any ideas?

H OW THE D ATA WAS A NALYSED ?  The interviews were transcribed, anonymised and analysed thematically, manually sentence by sentence  Inter-rater reliability - Initial scoping for content – discuss results – re-read independently and agree a numbered list of content items of reach case.  Low level grouping of content for each case independently – each content item listed only once – compare results and agree subthemes and the content items associated with each.  Independently group subthemes into themes in each case – discuss and agree themes (include number of each items).  Combine themes across cases – and identify super-themes.

T HEORETICAL R ATIONALE P APADOPOULOS ’ S (2006) T RAUMA G RID

W HAT DOES IT LOOK LIKE ?

W HAT DOES IT LOOK LIKE (2)?

W HAT DOES IT LOOK LIKE (3)?

W HAT DOES IT LOOK LIKE (4)?

W HAT DOES IT LOOK LIKE (5)?

R ESULTS

T YPE OF T RAUMA Case 1Shooting witnessed by 10 year old daughter Case 2Overdose by 16 year old daughter Case 3Sexual assault of 16 year old daughter Case 4Suicide by hanging of 13 year old son Case 5Physical assault of 15 year old son in school Case 614 year old daughter self harming with razor Case 7Threat to dad by gunmen – witnessed by 9 year old son Case 8Sexual assault of 21 year old daughter Case 9On-going threats &intimidation of dad and whole family Case 10Sectarian assault of 16 year old son

R ESULTS

S UPRA -T HEME C ATEGORIES Individual Distress 226 items (31%) Family/Relational Distress 260 items (35.7%) Resilience 122 items (16.7%) Prior History of Adversity 121 items (16.6%)

I NDIVIDUAL D ISTRESS Psychological Distress 178 items (78.8%) PTSD Symptoms 48 items (21.2%)

F AMILY /R ELATIONAL D ISTRESS Associated Family Pressures 113 items (43.5%) Negative impact on family wellbeing 104 items (40.0%) Negative Changes in Family Dynamics 43 items (16.5%)

R ESILIENCE Individual Resilience 47 items (38.5%) Dyadic Resilience 41 items (33.6%) Whole Family Resilience 34 items (27.9%)

C OMMENT ON R ESULTS 1  The study thesis is supported by the findings, i.e. that a primary focus on PTSD symptoms (only 8.2% of the total relevant narrative content) misses the complexity of the impact of traumatic life events on victims and their families.  This is supported by the fact that almost 80% of the ‘Individual Distress’ category reflected common signs of psychological distress rather than trauma specific PTSD symptoms.

C OMMENT ON R ESULTS 2  Reports of ‘Family/Relational Distress’ were represented more strongly than those of ‘Individual Distress’ (42.4% Vs 36.7%). Similarly instances of relational and whole family resilience were cited considerably more often than individual resilience, i.e. 61.5% compared to 38.5% of the resilience supra-theme.  These results (if replicated) raise questions regarding the re-balancing of professional discourses on trauma and the nature of service provision for people who have experienced potentially traumatising experiences, in the light of narratives of the ontological experience.

Thank You

I MPACT ON V ICTIMS  ‘ We’ve lost a wee part of Alex… the son that I had in June.. really happy-go-lucky… he was a typical teenager… if I’m honest, I’ve lost a part of him’  (mum of 15 year old son physical assault)

I MPACT ON M OTHERS  ‘it kills me, it I’m totally honest, it tears me apart. So for me as a mummy, it was extremely hard’ (mum of 15 yr old son physical assault)  ‘Just I don’t think I am the person I was’ (mum of family experiencing on-going intimidation & threats)  ‘I’m completely changed… a completely different person’ (mum of 13 yr old son suicide)  ‘I didn’t worry before.. it’s not me, you know… I’m used to being the strong person… but now other people have to be strong for me. Do you know what I mean? That annoys me’ (mum of 13 yr old son suicide)

T HEME - L OSS OF C ONTROL  ‘so I was really, I was upset, I was annoyed, I was angry. I was… I have to say the family felt like they didn’t know how to cope with it… they wanted to protect him but we didn’t know how to because it happened out of our hands basically’ (Mum of 15 yr old son physical assault)  ‘what frightens me is you have no control. And no matter what you do, you have no control’ (mum of 21 year old daughter sexual assault)  ‘we had no choice…’ [Meeting perpetrator face-to-face at youth conference] (mum of 16 yr old son sectarian assault)

W HOLE FAMILY IMPACT  ‘they don’t go to bed without me. If the door knocks, I would jump out of my skin… the door isn’t knocked very often but when it does, everybody’s jumping out of their skin’ (mum of 9 year old who witnessed threat by gunman)  ‘everybody’s well like went the wrong way’ (mum of 13 yr old son suicide)  ‘the whole house is nervous’ (mum of daughter who witnessed shooting)  Mum ‘devastated’ – whole family ‘devastated’ (mum of 16 yr old daughter sexual assault)

D YADIC I MPACT  ‘She (daughter) said “I don’t want to talk about it any more. I just want to pretend it didn’t happen”. Contain the pain… And if I’m honest with you, I find it very hard to listen to. I find it so hard… and then she says, it didn’t happen to you, what are you feeling sorry for yourself for? I can’t separate the two, you know what I mean?’  (mum of 21 yr old daughter sexual assault)

COPING NARRATIVES ‘it is hard and I’ve noticed too, It can be hard on Tom because he’s a daddy… I know Tom is very strong and sometimes he doesn’t show the kids sort of how much it has affected him. I see it, but he’ll be strong for them. I would see the different side – he would let his emotion show to me – but he tries his best to always let the kids know that he’s their strength… I cry but he can be the strong one. I’m strong sometimes but I cry because my babies got hurt and they’re still my babies whether they’re 16 or 26, they’re still my babies’ (Mum of 15 year old son physical assault)

R ESILIENCE & MUTUAL SUPPORT  ‘Well, it has made us, want to talk more about problems. We talk about everything. You know, it doesn’t matter what it is. We talk about it. It’s made us more closer. It’s made us more protective of each other, we think. We try not to be over-protective… they go “Mum, don’t worry. Don’t panic”’  (mum of 21 yr old daughter sexual assault)

R EFERENCES  Briere, J., & Scott, C. (2006). Principles of Trauma Therapy: A guide to symptoms, evaluation, and treatment. London: Sage.