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Long Term Effects of Trauma: Implications for Practitioners

Annette McCullough, MSW RSW

Twelve years of work with older women who have survived abuse has taught me that the long term after-effects of having experienced trauma/abuse are profound and largely invisible to practitioners who do not understand survivors' realities.

It is absolutely essential that practitioners working with abuse issues understand how survivors, for the most part, are silenced in many different ways by denial - denial by the self, denial by the perpetrators, denial by families, denial by friends, and denial by society at large. Each time a survivor's reality is denied, another barrier to healing is erected.

The result for many women over the course of a lifetime is a multi-layered wall for secrecy and shame accompanied by maintenance of an "acceptable face" for the outside world. Practitioners are often not aware that survivors at the time of first meeting (consciously or unconsciously) begin to ascertain whether or not the individual they are involved with is likely to be sensitive to survivor issues and comfortable in talking about abuse and emotionally charged experiences. When sensitivity and comfort are evident, disclosures follow (starting very slowly, with relatively 'safe' matters - the "tip of the iceberg" so to speak). When sensitivity and comfort are absent, there is silence, or more likely, discussions which reinforce an "acceptable" public image.

The more I work with women in mid-life and beyond, both in individual counselling and in some small groups, the more I am coming to believe that problems which are so commonly associated with aging are in actual fact problems related to unresolved trauma. Included here are depression, insomnia, loneliness, anxiety, panic attacks, phobias, paranoia, confusion, psychomatic complaints, alcohol and substance abuse, low self esteem, and the broad range of physical health problems which are related to stress. I say this because the more I learn about survivorship and trauma, from older women, from colleagues who work exclusively with adult survivors of abuse, and from my own professional experience, the clearer it becomes to me that practitioners cannot accompany clients to places in the mind and psyche which they themselves are not prepared to go.

What this means to practitioners working with older adults is that very specific on-going training, skill building and support is required, in closed group settings, in order to develop the necessary skills to work with older adults and abuse issues, and to clarify the personal issues which are invariably triggered when working with abuse.

Essentials of the training are the family and social contexts in which abuse takes place, the nature of trauma, the processes of denial, the storage, repression, triggering, retrieval, and processing of traumatic memory and the ongoing consultation and development of practical skills in working with older adult survivors of abuse. Practitioner self care and group support are essential to the training and too often is the last to be considered, if considered at all.

Annette McCullough, MSW RSW
Third Age Counselling & Consulting Associates Inc.
400, 119 - 14th Street N.W.
Calgary, Alberta T2N 1Z6
Ph: (403) 283-6112 Fx: (403) 244-4701

Annette McCullough is a private practitioner in Calgary who specializes in age related issues. Much of her work is with older women survivors of abuse.