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Blue Knot Foundation Blog

Check out our recent blog posts to stay up to date with our work, latest research and articles curated by the Blue Knot Foundation Marketing & Communications team. Should you have any suggestions or contributions please contact us via email: marketing@blueknot.org.au.

Articles

01

 

April is Sexual Assault Awareness month, a month in which we focus on the needs of victims of sexual violence of all ages. While all sexual violence is abhorrent and often profoundly damaging this article speaks to the needs of adults who were sexually abused as children.

Just over a year ago, after five years of operation, our nation’s ground-breaking Royal Commission into Institutional Child Sexual Abuse closed its doors. It lifted the lid on the scourge of child sexual abuse within our churches, charities, schools and sporting bodies. And its recommendations mapped out a plan for systemic change within our institutions many of which are currently being enacted. The Commission conducted a forensic examination of the systemic failures which allowed and enabled the protection of perpetrators, institutions and hierarchical cover-ups.

In addition, it also provided a platform to give survivors a voice – a voice long denied, dismissed and minimised. A voice which showed us as a community, just how damaging the crime of sexual abuse perpetrated by people in positions of power, trust and care often is, over time. It also showed us the importance of listening, hearing and believing, what was often seemingly ‘unbelievable’.

More than 4,000 survivors from 1,691 religious institutions revealed that they were sexually abused as children to the Royal Commission. These crimes were perpetrated by priests, ministers, teachers, youth leaders and others. Many children suffered under the care of religious leaders and institutions, whose responses to discovering this abuse, were painfully inadequate.

However, the terms of reference of the Commission, although broad in Commission terms, were narrow for the tens of thousands of Australian survivors who missed out. These are people who were sexually abused within the apparently sacrosanct haven of the home and family. Just as institutional child sexual abuse was, and in some cases still is, treated with secrecy, stigma and cover-up, the home and family has traditionally been seen as a private space – what goes on behind closed doors stays behind them and what happens within the family is family business.

But this needs to change. And it needs to change now. That’s because the vast majority of child sexual abuse is perpetrated within those sacred walls. And the damage reaped is often monumental not just for individuals and their families but for the very fabric of our society.

Children depend on their caregivers for their very survival. For this reason, they need to attach and bond to them, even when they are being abused by them. And many abused children remain loyal to their abusing caregivers for the same reason. Emotionally and physically dependent children whose brains are still developing at the time they are abused are unable to process the enormity of the betrayal of being sexually abused by a family member. This can leave the child feeling confused and unsafe, and unable to focus on learning and exploring to meet their developmental needs. This is because they are preoccupied with trying to be and feel safe in their inherently unsafe world. Additionally, within a family setting, a perpetrator often has ready access to a child. No-one asks questions; no-one sees. This leaves the child particularly vulnerable as they are trapped and can’t escape. The prevailing power imbalance of the abusing parent, caregiver or other family member over a child means the child feels helpless and powerless, living in fear, awaiting the next assault.

Child sexual abuse is a betrayal of trust and an abuse of power. The perpetrator often tricks the child into believing that the abuse is an act of love, and that they are responsible. But a child is never to blame for being sexually abused. Often threats, fear and manipulation are used to maintain the child’s silence, protect their secrecy and keep the child a victim. Within the family, a child can fear that speaking out will break the family up or cause another member to be harmed, if that is what their perpetrator has led them to believe.

Child sexual abuse doesn’t only impact the victim. It decimates families, polarising them into those who believe the victim and support them, and those who don’t. Or those who are trying to preserve the external image of the family and its place within the community, despite the crimes being committed within.

The Royal Commission showed us the importance of being listened to, heard, validated and believed. It is time for us as a society and a community to listen to survivors of child sexual abuse within the family. We must embrace them so they know and believe that they are not to blame. We must help erode the shame they often feel and to reach out and show them that they are not alone. There is hope and there is help and we must show survivors that with the right support, they can find a path to healing. 

The orignal article written by Dr. Cathy Kezelman AM was published here



 

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24


Having a basic understanding of current research about how memory works will help health and legal practitioners to better understand and support the many people who experience traumatic memory, writes Pam Stavropoulos, head of research at Blue Knot Foundation – the National Centre of Excellence for Complex Trauma.

In the article below, Stavropoulos says the inclusion of updated information on the nature of memory in tertiary, vocational and professional development training is urgently overdue and will correct misconceptions and improve service provision.


Pam Stavropoulos writes:

The nature of memory, particularly the relationship between memory and trauma, is topical and often contentious. Increased awareness of child sexual abuse following the Royal Commission, and of sexual assault highlighted by the #MeToo movement, raises questions about the veracity of memory.

Current research on the nature and processes of memory allows greater understanding to enhance the informed practice of health, legal and justice practitioners to achieve more constructive health and justice outcomes.

Neuroscientific and other research confirm that memory is not a single entity.

As highlighted by Peter Levine in his book, Trauma and Memory: Brain and body in a search for the living past, complex neural networks are associated with different types of memory which are stored in different areas of the brain. The two main types of memory are explicit (conscious) and implicit (largely non-conscious) memory.

Most references to `memory’ describe explicit memory, including in measures used by psychologists regarding memory retention. Explicit memories, that is of facts, information, and consciously recollected experience, are generally verbally accessible.

This contrasts with implicit memories which are often situationally accessible and elicited by environmental prompts such as a fragrance, sight or sound. Implicit memory, Levine has written, is also organised around emotions, skills and/or procedures which the body does automatically. Implicit memory enables us to recall how to ride a bike, while the memory of the day we learnt to ride is explicit memory.

As Levine has highlighted, academic and clinical psychologists as well as psychotherapists emphasise conscious memory in a culture which privileges thought, cognition and reason over unconscious processes.

Trauma and memory

A traumatic experience so overwhelming that it can’t be processed impedes the functioning of the hippocampus – the part of the brain which is central to encoding memory and conscious recall.

Traumatic experience is `split off’ into fragments of implicit memory and stored in the body. These implicit memories can be `triggered’, often many years later, by events which stimulate the senses or which are reminders of prior trauma.

In trauma, in which memories are implicit, ‘forgetting’ or lack of conscious recollection can serve survival purposes. This is especially for children who must attach to caregivers on whom they are dependent to survive.  The younger the child and the more severe the trauma, the more likely the trauma will not be consciously recalled. This allows the child to maintain the vital attachment bond.

Traumatic amnesia and the subsequent recovery of conscious recollection occurs with diverse types of trauma (for example, war, the Holocaust, and natural disasters) as well as that of child sexual abuse. From the 1990s, the veracity of recovered memory has been challenged in the media and by cognitive psychologists only in relation to child sexual abuse.

While neither explicit nor implicit memory is infallible, studies show that `recovered’ memory is no more or less reliable or unreliable than continuous, explicit memory.  

In their critique of `false memory’ regarding delayed recall of child sexual abuse, many psychology textbooks show little awareness  that traumatic  memory is implicit, that it differs from explicit memory, and that both types of memory may be unreliable. Many also fail to distinguish between explicit and implicit memory, which accounts for their inaccurate depiction of traumatic memory. Numerous cases in various parts of the world have demonstrated that recovered memories have been corroborated by independent evidence, admissions of guilt by perpetrators, or findings of guilt by courts.

Any consideration of memory must also include the social context in which memory is generated. This is particularly pertinent in relation to child sexual abuse and sexual assault regarding the dynamics of power, dependence, secrecy and the potential repercussions of disclosure. For example, disclosure has the obvious risks of not being believed or of being stigmatised.

Basic understanding of current research in relation to memory will enable health and legal practitioners to better understand and assist the many people who experience traumatic memory.

Inclusion of updated information on the nature of memory, particularly the difference between explicit and implicit memory, in tertiary, vocational and professional development training will correct misconceptions and is urgently overdue.

It will also enhance service provision which fosters recovery from the impacts of trauma, and enable safe, less destabilising interactions within legal and justice processes.

You can read the original article here.

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18
For many the Easter holiday season is a time to relax, take a break from our hectic life and connect in with family, friends and our faith-based commu...

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Trigger warning: sexual abuse, sexual assault, child abuse. The announcement of the Royal Commission into Institutional Responses to Child Sexual Abu...

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Cardinal George Pell was last year convicted of sexually abusing two choirboys in 1996, but the Victorian County Court has not allowed media outlets t...

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Cardinal George Pell was last year convicted of sexually abusing two choirboys in 1996, but the Victorian County Court has not allowed media outlets t...

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08

The Power Threat Meaning Framework is a radically new approach to understanding distress and unusual experiences without using psychiatric diagnosis. Very few people are offered this information, or encouraged to make a choice about how they understand their distress.

They are not told that the dominant explanation — in other words, that they are suffering from ‘mental illnesses’ which need to be diagnosed and medicated — is only one viewpoint, which not all professionals agree with.

The Framework was produced jointly with users of services who have decided to leave the medical viewpoint behind, and as a result, have been able to take up lives that are fulfilling and meaningful, even if they still have difficulties.

One of the main aims of the Framework is to offer everyone a way of creating new, more hopeful narratives or stories about their lives and the problems they may have faced or still be facing, instead of seeing themselves as blameworthy, weak, flawed, or ‘mentally ill’.

This can suggest new ways forward, sometimes working alongside professionals and sometimes through self help or peer support.

The workshops will explain how the key questions in the Framework can be used to explore these stories. Attendees from all backgrounds are welcome.

**This article was written by guest author, Dr. Lucy Johnstone, lead author of the Power Threat Meaning Framework and has been republished here. The observations made are those of the author.**

You can register for Power Threat Meaning Framework workshops in Sydney, Melbourne and Brisbane here.

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21
The delay in institutions joining the national redress scheme is a further betrayal and compounds the trauma endured Adult survivors of child sexua...

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17
Blue Knot Foundation is delighted to congratulate Chrissie Foster and Justice Peter McClellan AM who were jointly awarded the Australian Human Rights ...

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27
Trauma is a state of high arousal in which severe threat or the perception of severe threat overwhelms a person's capacity to cope. It comprises a range of events, situations and contexts. These include natural disasters, accidents, betrayal in interpersonal relationships, and diverse forms of abuse.
There are differences between the main categories of trauma. Single incident trauma, commonly associated with Post Traumatic Stress Disorder (PTSD), relates to 'one off' events, while complex trauma is cumulative, underlying, and largely interpersonally generated (Shapiro 2010). As well as being more extensive in its effects (Courtois & Ford 2009), complex trauma is more frequent and prevalent (van der Kolk 2003), with complex trauma from childhood experiences being particularly damaging. Unresolved trauma, especially childhood (complex) trauma often has substantial impacts, on both mental and physical health (Banyard et al. 2009) into adult life.
The perception of extreme and overwhelming threat activates the physiological `survival' responses of 'fight-flight-freeze'. These innate, biologically programmed responses 'cannot be helped' as they are not thought about or reflected upon. Their trigger/s are often not clear. Recovery from trauma is not about `will power' or deciding to `move on'.
However it is important to remember that people can and do recover from even early childhood trauma, but that to do so, they need the right services and support (Siegel 2003).
Childhood Trauma And Health
Multiple systems of the body are interconnected. Trauma, particularly childhood trauma, disrupts the connections between the various systems of the body, and compromises a person's physical and psychological health as well as their daily functioning (Cozolino 2002). The greater the severity and duration of childhood trauma `the more severe are the psychological and physical health consequences' (Middleton 2012).
Overwhelming childhood experiences compromise the hormonal, endocrine immune and other body systems, but because chronic conditions evolve slowly these connections are often not recognised (Karr-Morse & Wiley 2012).
Children, like adults, develop coping strategies to protect them from being overwhelmed and help them manage the physiological and psychological effects of the dysregulated arousal, emotions and behaviour which occur with trauma. Such coping strategies are often creative and effective in the short to medium term, but risky and can damage health in the longer term.
The ground-breaking Adverse Childhood Experiences (ACE) Study (Felitti et al. 1998) established the relationship between childhood coping strategies and the development of the `symptoms' of impaired well-being and ill health later in life for unresolved underlying trauma. These findings have been repeatedly replicated in further research.
Childhood Trauma And Mental Health
Childhood (complex) trauma can seriously affect a person's ability to function, their sense of themselves, and their capacity to regulate arousal, emotions and behaviour. It impairs self-conception and cohesion, one's sense of meaning, and the capacity to relate to others (Howell & Itzkowitz 2016). Unlike PTSD, complex trauma disrupts a person's identity, severely adversely affecting a person's relationship to themselves, others and the world.
A history of childhood trauma is `[t]he single most significant predictor' of subsequent contact with the mental health system' (Middleton 2012). People who have complex trauma histories receive diverse psychiatric diagnoses because their trauma presents in many forms, with severe, wide-ranging and comorbid symptoms.
Comorbidity is the norm rather than the exception. Coexisting depression and anxiety are common, as is the diagnosis of personality disorder, particularly Borderline Personality Disorder. While not all childhood trauma leads to psychosis, and not all psychosis is trauma-related, greater insights into the vulnerability of the developing brain to stress are informing our understanding of psychopathology (Howell 2005).
Psychosis features poor reality-testing and inability to distinguish the internal from the external: `[i]t is exactly this distinction that trauma disrupts' (Howell 2005). Childhood trauma is a well-documented potential risk factor for psychosis (Aas et al. 2016; Szalavitz 2012). Presentations related to trauma, particularly around dissociation and dissociative disorders can also be confused with psychosis, including within the mental health system. (Spiegel et al. 2011).
Childhood Trauma And Physical Health
Overwhelming stress such as occurs with childhood trauma negatively impacts the hypothalamic-pituitary-adrenal (HPA) axis which controls a person's reaction to stress and trauma (Siegel 2012). Stress triggers the HPA axis, i.e. `the relationship between the hypothalamus (H), the pituitary gland (P) and the adrenal glands (A) that produces finely tuned chemical messages that connect the central nervous, endocrine and immune systems' (Karr-Morse & Wiley 2012).
Increased stress hormones lead to an elevated inflammatory/ immune response, which is associated with poor health outcomes and increasing cardiovascular, pulmonary and auto- immune disease (Shonkoff & Garner 2012). Chronically overstimulated immune responses can also cause the system to attack the organs, leading to autoimmune disease such as psoriasis and lupus. They can also `catalyse inflammation at various sites in the body', paving the way for conditions such as osteoarthritis, fibromyalgia and irritable bowel syndrome (Karr-Morse & Wiley 2012).
Other diseases linked to overproduction of cortisol include functional gastrointestinal disease, diabetes, anorexia nervosa, hyperthyroidism and Cushing's syndrome (KarrMorse & Wiley 2012). A number of publications substantiate the serious physical impairments associated with trauma in general and complex trauma in particular. For example, research shows that `[t]hose with complex childhood trauma have roughly double the rate of fibromyalgia, chronic fatigue, and disorders of musculoskeletal, digestive, circulatory, endocrine and immune systems' (Banyard et al. 2009).
Physical health issues such as cancer, diabetes, heart disease, and asthma are also highly correlated with early life stress (Karr-Morse & Wiley 2012). The Adverse Childhood Experiences Study replicates these findings, with changes in the ACE score, i.e. number of adverse childhood experience categories, establishing links between childhood experience and adult biomedical disease including liver disease, chronic obstructive pulmonary disease, coronary artery disease and autoimmune disease (Felitti & Anda 2010).
Trauma And Primary Care
Primary health care plays a critical role in health promotion, prevention, screening, early intervention and treatment. For these reasons, primary health care providers need to be able to intervene early and effectively with patients with a lived experience of trauma to promote better care and health and well-being outcomes.
Epidemiological data suggests that on a daily basis a significant proportion of patients attending general practices have trauma histories (Felitti & Anda 2010). Primary care practices work with patients who present with co-morbid mental health challenges, drug and alcohol issues, suicidality and self-harm, sexual health issues as well as cardiovascular disease, asthma, diabetes, obesity, and cancer. All of these challenges can be and often are associated with unresolved trauma in general, and childhood trauma, in particular. Yet primary health services do not routinely screen for trauma.
If people have not connected their distress and health problems to their prior trauma they can't share their concerns. Even patients who suspect their issues are trauma-related might not speak about them fearing a negative response to disclosing.
As many primary care personnel are not adequately equipped to respond effectively to patients who experience the impacts of trauma, they are unable to intervene in trauma-related problems and address the cumulative negative individual, community and systemic legacies.
The health, social and economic costs of unrecognised, untreated or inappropriately treated trauma are substantial. They not only impact the individual health and psychosocial burdens of survivors but also reverberate through families, friends, communities, and society at large. If people don't receive the right support their trauma not only undermines their psychological and physical health but also erodes their capacity for healthy relationships, educational opportunities, and ongoing work participation.
Lost productivity and direct costs also impact substantially on health, welfare and criminal justice budgets. Health budgets are stretched by repeated hospitalisations, crisis intervention, frequent use of services and medication, and the burden of chronic disease, compounded morbidity and premature mortality. The financial costs of not providing adult survivors of childhood trauma in Australia with the services they need are conservatively estimated at $9.1 billion annually (Kezelman et al. 2015).
Not only does trauma literacy highlight the burden of trauma-related disease, morbidity and mortality, but it also provides opportunities for enhanced treatment outcomes when practitioners and practice personnel work from a trauma-informed frame. We owe it to those with a lived experience of trauma to safely screen for, recognise, identify and appropriately address the needs of those affected.
References
Aas, M, Andreassen, OA, Aminoff, SR, Faerden, A, Romm, KL, Nesvag, R, Berg, AO, Simonsen, C, Agartz, I & Melle, I 2016,`A history of childhood trauma is associated with slower improvement rates: Findings from a one-year follow-up study of patients with a first-episode psychosis' BMC Psychiatry.
Banyard, VL, Edwards, VJ, Kendall-Tackett, K (eds) 2009, Trauma and physical health: Understanding the effects of extreme stress and of psychological harm, Routledge, London.
Courtois, C & Ford, J 2009, `Defining and understanding complex trauma and complex traumatic stress disorders', in Treating complex traumatic stress disorders, The Guilford Press, New York, pp. 13–30.
Cozolino, L 2002, The Neuroscience of Psychotherapy, Norton, New York, p. 270.
Felitti, VJ & Anda, RF 2010, `The relationship of adverse childhood experiences to adult medical disease, psychiatric disorders and sexual behaviour: implications for healthcare', Ch. 8 in Ruth, R, Vermetten, E & Pain, C (eds), The impact of early life trauma on health and disease: the hidden epidemic, Cambridge University Press, UK.
Felitti, V J, Anda, RF, Nordenberg, D, Williamson, DF, Spitz, AM, Edwards, V, Koss, MP, Marks, JS 1998, `Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences Study', American Journal of Preventive Medicine, 14 (4), pp.245–258.
Howell, E 2005, The dissociative mind, Routledge, New York.
Howell, E & Itzkowitz, S 2016, (eds), The dissociative mind in psychoanalysis, Routledge, New York, p. 37.
Karr-Morse, R & Wiley, MS (collaborator) 2012, Scared Sick: The role of childhood trauma in adult disease, Basic Books, New York.
Kezelman, C, Hossack, N, Stavropoulos, P, Burley, P 2015, The cost of unresolved trauma and abuse in adults in Australia, Adults Surviving Child Abuse & Pegasus Economics, Sydney.
Middleton, W 2012, `Foreword' to Kezelman, C & Stavropoulos, P, The Last Frontier: Practice guidelines for treatment of complex trauma and trauma informed care and service delivery, Adults Surviving Child Abuse, Sydney, p. x.
Shapiro, R 2010, The Trauma Treatment Handbook: Protocols across the spectrum, Norton, New York, p.11.
Shonkoff, J P & Garner, AS 2012 `The lifelong effects of early childhood adversity and toxic stress', American Academy of Pediatrics Vol, 129, Issue 1.
Siegel, DJ 2012, Pocket guide to interpersonal neurobiology, Norton, New York, A1–37.
Siegel, DJ 2003, `An interpersonal neurobiology of psychotherapy: The developing mind and the resolution of trauma', ch. 1 in Siegel DJ & Solomon, MT (eds), Healing trauma: Attachment, mind, body and brain. Norton, New York, pp. 1–56.
Spiegel, D, Loewenstein, RJ, Lewis-Fernandez, R, Sar, V, Simeon, D, Vermetten, E, Cardena, Dell, PF 2011, `Dissociative disorders in DSM-5', Depression and Anxiety 28: 824–852.
Szalavitz, M 2012, `How child abuse primes the brain for future mental illness', Time, 15 February.
van der Kolk, B 2003, `Posttraumatic Stress Disorder and the nature of trauma', in Siegel DJ & Solomon MT (eds), Healing trauma: Attachment, mind, body and brain, Norton, New York, p. 172.

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“Blue Knot Foundation has a key role to play in the building of community capacity in care provision to those who have experienced childhood abuse and trauma in any environment.”

NIALL MULLIGAN Manager, Lifeline Northern Rivers

“I think Blue Knot Foundation is a fantastic support organisation for people who have experienced childhood trauma/abuse, for their families/close friends and for professionals who would like to learn how to more effectively work with these people.”

Psychologist Melbourne

“It's such a beautiful thing that you are doing. Helping people to get through this.”

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“It was only last September when I discovered the Blue Knot Foundation website and I will never forget the feeling of support and empathy that I received when I finally made the first phone call to Blue Knot Helpline, which was also the first time I had ever spoken about my abuse.”

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