Childhood Abuse Inhibits Psychosocial Development of “Casandra”
David Bottorff
Loyola University of Chicago
IPS 555, The Human Person and Psychological Development; Dr. Charlotte Dillon
26 April 2010
Abstract
This essay examines the story of “Casandra,” with an eye toward forming a psychotherapeutic strategy for her. Complex post-traumatic stress disorder (C-PTSD) triggered by extended childhood abuse adversely effected her psychosocial, cognitive, emotional, spiritual, and moral development. After reviewing the developmental factors behind her current life situation, I propose a strategy for treating her C-PTSD with an eye toward alleviating some of Casandra’s psychosomatic ailments, and bringing her onto a happier and less isolated life path.
Childhood Abuse Inhibits Psychosocial Development of “Casandra”
The human psyche is dynamic, not fixed or static. This fact makes interpreting the freeze-frame vignette of Casandra risky, except as a purely academic exercise. With reservation stated, I intend to examine Casandra’s story with an eye toward forming a psychotherapeutic strategy for her. I am particularly concerned about her Complex Post-Traumatic Stress Disorder (C-PTSD) and the way it may be adversely effecting her psychosocial, cognitive, emotional, spiritual, and moral development. My hope is that by treating the C-PTSD, we can alleviate some of her psychosomatic ailments, and bring her back onto a happier and less isolated path.
Considering her traumatic history, I am impressed by Casandra’s notable positive attributes. Importantly, the assessment indicates she does not suffer from explicit learning or communication disabilities that could interfere with traditional psychotherapy. To the contrary, she appears to be an intelligent, well educated and successful professional who is personally gifted. Her advanced coping skills indicate she will respond well to therapy and be able to successfully address her presenting problems.
Presenting Problems
Casandra presents with a variety of problems, including: unspecified “major health concerns” of apparent psychosomatic origin; a string of troubled relationships; poor self-esteem; general lack of emotional safety; concern about relational safety and sexual discrimination; apparent addiction to work; and general social anxiety evidenced by her avoidance of coworkers, minimal social life, and desire to only vacation in environments where she and her same-sex partner feel safe and accepted.
Post-traumatic stress disorder (PTSD) can contribute to these and other symptoms (Newman & Newman, 2009). PTSD can be caused when children are severely abused or exposed to intense violence (Hamblen, 2003). Although not part of the Diagnostics and Statistics Manual IV-R, C-PTSD is commonly described as a particular type of PTSD caused by extended exposure to traumatizing events (Herman, 1997). These C-PTSD traumas include the kinds of sexual, physical, emotional, and intellectual abuse to which Casandra was subjected.
The assessment indicates Casandra does, in fact, suffer from C-PTSD. In addition to experiencing strong emotional reactions when recalling traumatic events, people with C-PTSD can exhibit somatic responses (Newman & Newman, 2009), perhaps not dissimilar from the unspecified physical ailments exhibited by Casandra. “In girls, the symptoms are … likely to be dissociation, gastrointestinal symptoms, and pain,” Newman and Newman (2009, p. 313) write.
Casandra reports being subjected to physical, emotional, intellectual, and sexual abuse as a child. She was chronically beaten by both parents, sexually abused by an older male relative, and lived in a closed family system.
One of the most telling signs of C-PTSD is hypervigilance and increased arousal, which is triggered by early beliefs the trauma could have been avoided had the individual been more vigilant (Dalgleish, Moradi, Taghavi, Neshat-Doost, & Yule, 2001). This may well be the case with Casandra, who seeks isolation with her trusted partner and avoids social interaction, even when looking to use the bathroom at work.
Herman (1997) poignantly summed up the effects of C-PTSD when she wrote:
The child trapped in an abusive environment is faced with formidable tasks of adaptation. She must find a way to preserve a sense of trust in people who are untrustworthy, safety in a situation that is unsafe, control in a situation that is terrifyingly unpredictable, power in a situation of helplessness. Unable to care for or protect herself, she must compensate for the failures of adult care and protection with the only means at her disposal, an immature system of psychological defenses. (p. 96)
Casandra’s problems with attachment and trust are evidenced by the series of enmeshed and dysfunctional partnerships prior to her current commitment. Seeing as she views her current partner as a “soul mate,” there is a good chance she is again entering an enmeshed, as opposed to differentiated, relationship.
Some researchers postulate early exposure to harsh or abusive conditions hijacks the more primitive and reactive areas of the brain, especially the brainstem, thereby inhibiting development of cerebral cortex empathy, self-control, and higher-order problem-solving skills that might allow them to modulate strong impulses (Perry, 1994; Science Daily, 2007). Brainstem hypersensitivity, and the concomitant inability of the cerebral cortex to inhibit impulses, may be behind Casandra’s psychosomatic and social anxiety problems. Notably, however, Casandra does not appear to be out of touch with her higher reasoning faculties, as evidenced by such factors as her robust vocational path and her ability to maintain a long-term partnership.
Family System
The problems Casandra faces are echoed by the problems her siblings display in their own dysfunctional families. Casandra’s two younger sisters appear to have inherited the same abusive patterns exhibited by the parents, including spousal and child psychological, physical, intellectual and emotional abuse, and even passed this behavior down to their children. This type of violence transmission is common (American Psychological Association, 1996; Garbarino, 2001; Newman & Newman, 2009). It appears child abuse disrupted the entire family system (Nichols, 2008). Casandra, living as she did in a closed and rigid family system as described by Minuchin (1974) in his Structural Family Therapy model, felt trapped by an emotional environmental she “survived” until old enough to flee.
Sexual Orientation
Now 35 years old, Casandra reports her sexual orientation is known to her family, and the family appears to accept her partner. The family, however, never discusses Casandra’s same-sex relationship and does not restrain from sharing gay-bashing jokes, which represents a continuation of the emotional abuse established earlier in life.
Although Casandra self-identified as lesbian at the age of eight, she could not name her experience until she was in college, presumably some time between the ages of 18 and 22. It is not at all uncommon for people of nonconforming gender orientations to experience a distance between the points of self-identification, self-labeling and self-disclosure (Coleman, 1982; Savin-Williams, 1996). As was the case with Casandra, girls may identify their sexual orientation in prepubescence and early adolescence prior to self identifying as lesbian (Diamond, 2000; Stevens, 2004). While disclosure of sexual orientation can be stressful and even meet with open hostility (Harrison, 2003), it is important minority-orientation youth find parental acceptance and maintain family closeness. Failure to do so can lead to disruption of identity development (Floyd, Stein, Harter, Allison, & Nye, 1999).
Collective social messages in opposition to same-sex orientation causes many homosexuals to feel ostracized and isolated (Savin-Williams, 1996). This sense of being different, unwanted and inferior is exemplified in part by Casandra’s recollection of feeling “too much” for her mother to handle, and that she was constantly criticized for not being good enough.
Casandra also reports having been subjected during her teen years to the form of psychological abuse colloquially called “gaslighting,” in which false information about the victim is presented (Florence, 1980). In particular, Casandra said her mother would lie about something she did and wait for the father to harshly beat her. This gaslighting can take the form of intimate betrayals that are discovered and denied (Freyd, 1997). As a result, she felt she was powerless and had to submit to the beatings.
Attachment Style
The importance of healthy attachment patterns cannot be underestimated when assessing a client’s mental health (Bowlby, 1988; Bretherton, 1992). There can be little doubt Casandra’s interpersonal attachment style was heavily influenced by her inability to rely on father or mother for love and protection. Although we do not have an opportunity to test her (Fraley, 2000), Casandra appears to operate with a high level of anxiety and a high level of avoidance, possibly placing her in the fearful-avoidant quadrant of attachment style, as described by Bartholomew (1991).
Casandra’s caregivers exhibited frightening, negative and abusive behavior. Although one could imagine her exhibiting either avoidant or resistive attachment style, as described by Ainsworth (1989), she likely falls in the disorganized/disoriented attachment style proposed by Main (Main, Kaplan & Cassidy, 1985). Casandra’s hypervigilance, anxiety and marked mistrust of others is indicative of this attachment style.
Psychosocial Development
Casandra’s eagerness to work for the benefit of the world, contrasted against her isolation, anxiety and other problems, indicates a struggle with resolution of the generativity versus stagnation psychosocial crisis of middle adulthood, as described by Erikson (1963). Although violence can shape a person’s psyche at any stage in life, Nelson & Nelson (2009) focus on violence and abuse as a key psychosocial factor middle childhood, which spans the ages of roughly six to 12. According to psychosocial theorists like Erikson (Capps, 2004), it is during this period children work to develop gender identification, early morality, self-theory and peer play. This developmental stage also challenges children to resolve the so-called industry versus inferiority psychosocial crisis.
Casandra came into self-awareness of her same-sex attraction squarely in the middle of the middle childhood developmental stage. Although not detailed, it is quite likely the sexual, physical, emotional, and intellectual abuse began during this stage, disrupting her ability to embrace industry over inferiority. Failure to resolve a given developmental stage’s psychosocial crisis can have a cascading effect on subsequent personal development (Capps, 2004). For Casandra, by embracing inferiority rather than industry, she likely adopted alienation over group identity as the coping strategy of early adolescence between the ages of 12 and 18. Casandra’s desperate attempt to “survive” until old enough to move out of the house signals she quite likely functioned in a mode of isolation, unable to secure peer or adult support to extricate herself from the abusive family system. The closed and isolating character of Casandra’s family, along with an emphasis on normal outward appearance, would have made it difficult for her to seek assistance from outside sources (Nichols, 2008).
The later adolescence developmental stage of ages 18 to 24 challenges an individual to resolve a psychosocial crisis between individual identity and identity confusion. Casandra’s series of failed relationships indicates she may have had trouble resolving her role experimentation, thereby falling pray to identity confusion.
Suffering from a sense of inferiority, alienation and identity confusion, it is no wonder Casandra prefers isolation as an early adult, shunning intimacy with all but her trusted partner, who also appears to prefer isolation. Casandra apparently clings to her “soul mate” while remaining unwilling to participate in social endeavors except when guaranteed safe, as in her biannual one-week working vacations.
Intellectual Development
Casandra’s career and educational successes indicate she operates solidly in formal operational thinking, which usually is established by roughly age 11, according to Piaget (Commons, Richards & Armon, 1984; Hsueh, 2005; Newman & Newman, 2009). This was about the time of life during which Casandra may have been subjected to much of the domestic abuse.
Some researchers believe cognitive development extends beyond Piaget’s four basic categories. “The cognitive processes associated with psychotherapy, diplomacy, and spiritual leadership are all examples of what might be considered post-formal reasoning,” Newman & Newman (2009, p. 332) write. Judging from the trouble Casandra has with other people and with God, she may be having some difficulty embracing the post-formal operational cognition that accompanies higher levels of spiritual and moral thinking.
Spiritual Development
Casandra’s abuse occurred in the context of a religiously fundamental family. It is little wonder, then, she associates untrustworthy personalities with religiosity (Love, Bock, Jannarone, & Richardson, 2005). A person’s relationship with parents may influence that individual’s God image (McDonald, Beck, Allison, & Norsworthy, 2005; Winnicott, 1971). Considering the traumatic relationship Casandra had with her parents, it is no surprise she feels a distressed relationship with God and insists there not be any “God talk” during therapy.
In terms of her God attachment style (Starky, 1999), we might speculate Casandra resides in the fearful-avoidant quadrant, as may well be the case with her interpersonal attachment style. If it is true Casandra’s post-formal operational reasoning has not developed sufficiently enough to embrace the ambiguities of spirituality, she may be struggling to enter what Fowler (1981) calls the individuative-reflective stage of spirituality. During this stage, the locus of authority is moved from external to internal, and previously held values and group affiliations are reorganized. In this stage the sprouts of an advanced relational theology reside.
This level of spiritual awareness requires a capacity to tolerate tension and ambiguity. Casandra, however, appears to be unable or unwilling to appreciate the fact religious thought can contain both good and bad ideas at the same time. Her prohibition against “God talk” indicates she has thrown the spiritual baby out with the religious bathwater, so to speak.
Casandra may be stuck in the synthetic-conventional stage of faith, in that she externalizes God as a tool of her enemies and shapes her spirituality on the views of others. Thus, the locus of control remains externalized and her spiritual judgment remains compromised by the abuse of her fundamentalist family members. This is an adolescent faith that lacks the sophistication of the individuative-reflective stage, let alone the more advanced conjunctive or universalized faith of later adulthood. I very much agree with this paragraph.
Casandra may be mired in spiritual despair, unwilling to recognize the fact that her adult relationships with God and others need not resemble those of her childhood.
God may prove to be a reassuring resource for the counselor, flowing through him or her as though through a hollow bone, but should not be mentioned explicitly during early sessions. Just having faith God is present can give the therapist an additional curative resource.
Moral Development
Moral development is said to closely track psychosocial, intellectual and spiritual development (Reed, 2008). Although Casandra exhibits concern for the greater world, her possible inability to resolve the adolescent identity crisis may have prevented her from moving fully into what Kohlberg (1984) describes as the social contract moral orientation of post-conventional thought. If true, we may be led to believe she is stuck in what Kohlberg (1984) calls the authority and social-order moral orientation. The possible discrepancy between Casandra’s seeming generative sensibilities and the less advanced authority and social-order moral orientation can be explained by Kohlberg’s theory that some individuals fail to fully integrate the stages of morality into which they are moving. His universal ethical principles and hypothetical transcendental morality stages remain on the horizon.
In parallel with these observations, it may be the case Casandra is functioning in what Kegan (Dombeck, 2007) calls the institutional phase of social maturity but has not yet moved on to his inter-individual stage, where she can hold more than one way to consider a value.
My Style
In our attempt to serve individuals from varied spiritual backgrounds, pastoral counselors run the risk of embracing relativistic theology, the consequence of which could be diluted guidance on crucial transpersonal issues. Similarly, the modern psychotherapist runs the risk of embracing an eclecticism that lacks a central theoretical rationale for therapeutic action. It is essential therapists not switch techniques and theories on an arbitrary basis, but rather only when clinically prescribed. I seek a methodology that brings unity to all these competing aspirations and values; that makes sense of the many skills and techniques at my disposal.
When pondering the ultimate goals of psychotherapy, I cannot help but feel somewhat disheartened by archeological theories. Although past may be prelude, I am reluctant to accept the notion we are locked into clearly defined developmental patterns, as articulated by Erikson (1963) and Piaget (Commons et al., 1984; Hsueh, 2005; Newman & Newman, 2009), or by Freud (Newman & Newman, 2009) and his psychoanalytic school. Rather, I remain faithfully teleological, believing we can lead purpose-driven lives, hope springs eternal, and a person’s life can be rapidly changed if given the appropriate resources. As a result, helping the client deal with the here and now, and helping the client define their system of meaning so they may move forward in a coherent fashion, are at the top of my imperatives list. Operative terms for me are “compassion” and “client-driven solutions.” Guidance can be forceful but resolution depends on the client internalizing a solution.
Although I hold certain values, such as those in the Hippocratic Oath, to be inviolable, it is important to maintain an open mind. I do not have all the answers and I refuse to judge the people with whom I work. One of the great and exciting aspects of psychotherapy is that new discoveries and perspectives are being revealed daily. My potential is linked to an ability to see the individual’s wound from a fresh perspective while also seeing the client in relation to others, as in a family or extended family system. I cannot imagine a more exciting world in with to live than the mind.
Spirituality and transpersonal issues often fall to the background during counseling. I believe in treating the whole person: body, mind and soul. Although a Buddhist with pantheist leanings, I believe acceptance of mystery and hope is crucial for personal development and life on this planet. Setting the immediate case of Casandra aside, I will seldom hesitate to ask the client about their spiritual beliefs. If they choose to discuss this aspect of their life, I intend to be prepared with an open mind. If they choose to reject, I will gladly return to the rich secular world of psychotherapeutic techniques.
Were Casandra to express an interest in theology, particularly of Judeo-Christian lineage, I likely would embrace the teachings of Grant (2001), who says he “understands God and pastoral psychotherapy to live and act in a world of incredible complexity and vitality, where multiple crisscrossing webs of energy and influence lure and coerce, block and inhibit, individuals and communities in relation to an infinity of possible choices” (p. 31). Great quote.
With an eye toward better understanding how to help Casandra from a theological perspective, I likely would discuss with her the five theological worlds articulated by Jones (1989a), and hopefully persuade her to complete a theological world inventory (Jones, 1989b). Understanding a monotheist’s theological world sheds additional light on the individual’s system of meaning and also on their interpersonal attachment style.
Care and Counseling
It is quite possible that at the root of Casandra’s psychosomatic problems is anxiety fueled by C-PTSD. Addressing her C-PTSD will be time consuming, as we want to avoid causing her to relive the childhood traumas until she is ready to visit those experiences. According to Cognitive Behavioral Therapy (CBT) (Ivey, D'Andrea, Ivey, & Simek-Morgan, 2007), helping the client honestly face their experiences is important if they are to unlearn such childhood lessons as, “The world is a dangerous place.”
Although CBT may be helpful in the treatment of C-PTSD, Casandra may not be ready for such an approach at the outset. The aggressive and directive style of an individual such as Ellis (1958) likely would be disastrous. Casandra’s assessment indicates she places an emphasis on trust above theory or discipline. Working with Casandra likely will require extended empathetic listening, such as advocated by Rogers (1980) until a constructive rapport is developed.
Casandra needs plenty of positive reinforcement. I will constantly be on the lookout for her beneficial resources, helping her leverage them to promote physical, mental and social well-being. Once more fully armed with an arsenal of resources, we may begin examining the traumatic experiences and address them directly. Rather than move straight into early recollections work, we might want to start with some dream analysis.
As she explores her childhood experiences, Casandra may benefit from such anxiety management techniques as relaxation and assertiveness training. At the same time, she should be offered psychological education about C-PTSD symptoms. Additionally, Casandra may benefit from some desensitization and trust-building exercises, plus “safe place” visualizations.
Given the mind-body connection apparently at work in her life, I would like to use some of the techniques advocated by Schwartz (1995) to help Casandra identify her subpersonalities or “parts” in a somatic way, and perhaps have an empty chair conversation with them. In addition to her managers, exiles and firefighters, she may benefit from a conversation with her risk manager, which appears to be working overtime.
In an ideal world, family members would be brought together in a bid to fix the family system, perhaps following Minuchin’s (1974) Structural Family Therapy and similar traditions.
Finding forgiveness can be a mine-field for abuse victims. The God concept and Jesus model could possibly serve as resources in this area should the subject be broached. Certainly a story such as that of Job in the Hebrew Bible, along with some of the lament Psalms, etc., could prove informative.
Casandra’s insistence on only working with a therapist open to her sexual orientation demonstrates strength of personality but also the depth of personal wound she is trying to protect. In counseling Casandra, I likely will self-disclose my own sexual orientation and some of my own struggles with physical, mental and spiritual well-being, making certain to not compare my experiences with hers. I would take such steps out of countertransference solidarity and a presumed comfort with her and her issues. The main countertransference issue I feel arising in me at the time of this writing is anger toward abusive parents, especially those who would cloak themselves in self-righteous fundamentalist theology.
I also am keen on the power of archetypal patterns as described by Jung (1960). Toward exploring those energies in a socially supportive environment, I might refer Casandra to a program such as Woman Within International. But, I would only feel compelled to refer Casandra elsewhere for psychotherapy if I failed to cultivate trust with her or she indicated an explicit inclination toward self-destructive or psychotic behavior. She may benefit from a psychiatric consultation to diagnose clinical depression or other neurologically based problems that could interfere with psychotherapy. For my own edification, I likely will consult mental health experts familiar with childhood physical, intellectual, emotional, and sexual abuse.
Casandra’s response to her childhood trauma strikes me as perfectly normal. I will reassure her of that belief on my part and help her recognize that although her experiences were unique to her, she is not alone. Similarly situated women may prove a resource to her. Likewise, she may wish to serve as a resource for other women who have undergone childhood abuse. Created as we are for connection and not isolation, group psychotherapy may be indicated at some point as a door to developing better interpersonal skills.
Personal Insights
This course has played a huge role in helping me understand human psychological development from both the biological and social perspectives. The complexity with which biopsychosocial vectors interact was largely unknown to me prior to starting this class.
Similarly, I previously did not recognize the synergy between psychosocial development and growth in the areas of spirituality and morality. I look forward to expanding my understanding in this area.
Of particular interest was our discussion on epigenetics, which I found to be very useful. I believe this area of biological programming deserves further exploration, particularly as it influences psychological development and behavior. “Epigenetics” is a new word in my vocabulary, for which I am grateful.
This class also deepened the complexity of my feelings regarding archeological versus teleological psychological and theological theories. My goal is to work within the framework of a psychotherapeutic theory that allows me to employ a variety of techniques and strategies on an as-needed basis. Developmental Counseling and Therapy (DCT), for example, is based on the “central assumption … that whether child, adolescent, or adult, we metaphorically repeat Piaget's developmental stages of sensorimotor, concrete, formal, and post-formal operations again and again” (Ivey et al., 2007, p. 404). Thus, DCT allows the therapist to use Piaget's tools when working with individuals throughout life. I believe the same logic of metaphor can be applied to other developmental theories, including Erikson’s psychosocial theory.
I look forward to following this class with a deep investigation of psychopathology, and am confident the ideas absorbed this semester will find traction in that work.
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David,
I read your entire paper, without much comment, because you did such a good job. You demonstrated a clear grasp of developmental concepts covered in our class, could use the language appropriately, and were able to apply them toward an excellent understanding of Casandra, given what you were told.
Your use of APA format was excellent. I noted one change on page 4; other than that, I noted no other form alterations. I believe this is the best paper you wrote for our class. Your writing was well organized, written with good grammar and punctuation, and you used vocabulary appropriate for a graduate paper. I am impressed that the developmental scaffolding that I was wanting for each student seems to have been articulated so well. I believe that as you continue to integrate your work at IPS, this framework will be invaluable.
David, I know that you worked hard in our Human Development class, and I assume the same diligence is present in each of your classes. I also know it was not always easy. Know you did a great job on this paper, and that I wish you the best.
Paper grade: 100%
Peace to you,
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