This being human is a guest house.
Every morning a new arrival.
A joy, a depression, a meanness,
Some momentary awareness comes
As an unexpected visitor.
Welcome and entertain them all!
Even if they’re a crowd of sorrows,
Who violently sweep your house
Empty of its furniture,
Still, greet each guest honourably.
He may be clearing you out for some new delight.
The dark thought, the shame, the malice,
Meet them at the door laughing,
And invite them in.
Be grateful for whoever comes,
Because each has been sent as a guide from beyond.
‐ Julaliuddin Rumi, Sufi poet.
“If it is true that the core of our traumatised and neglected patients’ disorganisation is the problem that they cannot analyse what is going on when they experience the physical sensations of past trauma, but that these sensations just produce intense emotions without being able to modulate them, then our therapy needs to consist of helping people stay in their bodies and to understand these bodily sensations. And that is certainly not something that any of the traditional psychotherapies, which we have all been taught, help people to do very well.”
‐ Bessel Van der Kolk (1998)
When people experience traumatic events—and by 'traumatic' we don’t mean unpleasant or painful, but an event or events that threaten a person’s safety or that of loved ones—then life changes and, in some ways, is never the same again. The event becomes, in the words of Martin Buber, 'a wound in the order of being', life shifts, the world looks different and it will probably never look the way it did before. The person’s world view and the meanings they make of themselves, their life, their place in the world, and their relationship with other humans is irrevocably changed. This does not necessarily mean, however, that the person who experiences trauma is permanently damaged—there are numerous examples of public figures who endured unspeakable pain—just think of Holocaust survivors—and continued to lead fulfilling and full lives, even while still holding some of the pain of the trauma. In recent years, a welcome addition to the field of trauma has come with the concept of 'post-traumatic growth' (Shakespeare Finch; Tedeschi & Calhoun, 2004), which posits that although it is unlikely that a person will ever believe that they are glad the trauma occurred, they may well be able to recognise ways in which they have grown and developed in their relationships with themselves and others, often in quite unexpected ways.
Until fairly recently, most of the literature around trauma focused on the diagnostic category of Post-Traumatic Stress Disorder (PTSD). Increasingly, this is being seen as only part of the picture. PTSD, which will be discussed further below, is more likely to be a result of single-event or time-specific event/s (Briere, 2012). For people who have experienced multiple-event trauma, or long-term, developmental trauma, the concept of 'Complex Trauma' may be more useful. Complex Trauma is most likely when the trauma was interpersonal (that is, inflicted by another human being), long-term with multiple events and developmental (that is, the traumatic events occurred at least partly during pre-adult developmental stages). The effects of Complex Trauma are more diffuse and less distinct than for PTSD; they can include difficulties in emotional and interpersonal regulation, particularly in intimate and family relationships, major changes in meaning (for example, people who experience a single event trauma may be more likely to still be able to see that there is still safety in their world whereas those who experience long-term trauma in an interpersonal context may not be able to experience any relationship as safe), and difficulties in attachment, particularly if the traumatic experiences occurred during early attachment stages.
Males who have experienced sexual assault may have experienced either a single event or multiple events (or both, often) over long periods of their lives, so may experience either or both PTSD and Complex Trauma. Males also bring to their experience of sexual assault a template that is offered to them around ways that men identify, tolerate, avoid or process pain and this is mediated by socially conditioned gender training (Connell, 1995). One of the clearest ways of seeing this is that many men express the hyperarousal associated with trauma (that is, a strong emotion 'spiking' seemingly out of the blue) as anger, whereas the experience of many women who have experienced trauma is sudden arousal of sadness. This may well be because males in Western cultures are conditioned to be more comfortable with both the experience and expression of anger rather than sadness.
Here we will be looking at the application of mindfulness to work with males who have experienced sexual assault. Mindfulness has become the new therapeutic 'flavour of the month', popularised in Australia particularly through Acceptance and Commitment Therapy (ACT) (Hayes, 2001; Harris, 2010). We need to guard against any moves to impose professional ownership on Mindfulness, as it has a long history, particularly in Theravada Buddhism, but also in Christian (centring prayer), Islamic (mystical Sufism) and Hindu (yoga, Transcendental Meditation) traditions.
In this section we will looks at some of the definitions of mindfulness and its practical application to:
- Distress identification.
- Distress tolerance.
- Distress reduction.
This will include looking at ways of dealing with sleep disturbances, including night terrors and trauma nightmares; intrusive thoughts and memories of traumatic events; avoidance of people, places and things; and ways of separating the past from the present.
Part one of the Mindfulness module, including:
- Summary and explanation of terms
- Mindfulness and meditation
- Relaxation therapy
Part two of the Mindfulness module, including:
- Distress identification and awareness
- Distress tolerance
- Distress reduction
- Dealing with avoidance
- Dealing with intrusive thoughts and memories
- Working with time
How to utilise mindfulness practices for your own benefit as a therapist.