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• WHAT IS TRAUMATIC INCIDENT REDUCTION (TIR)?TIR, or Traumatic Incident Reduction, is a one-on-one non-hypnotic highly structured and systematic method of locating, reviewing and resolving traumatic events. It involves repeated viewing of a traumatic memory under conditions designed to enhance safety and minimize distractions. Once a person has used TIR to fully and calmly view a painful memory or sequence of related memories, life events no longer trigger it and cause distressing symptoms.
The TIR technique, which has roots in psychoanalytic theory and exposure theory, is a unique regressive, repetitive, desensitization procedure. The protocol is highly focused, directive, and controlled, yet at the same time it is carried out in a wholly person-centered, non-interpretive, non-judgmental and respectful context.
Although Traumatic Incident Reduction is best known as an extremely effective brief therapy in the rapid resolution of trauma-related conditions, including post-traumatic stress disorder (PTSD), it also proven useful in relieving a wide range of fears, limiting beliefs, suffering due to losses (including unresolved grief and mourning), depression, anxiety and other PTSD symptoms.
Traumatic Incident Reduction (TIR) - along with Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) - is one of the Green Cross | Academy of Traumatology approved brief treatments for post-traumatic stress disorders. The Green Cross Academy of Traumatology (formerly the Green Cross Foundation) was founded by professor Charles Figley and established in 1997 to bring together world leaders in the study of traumatology for the purpose of establishing and maintaining professionalism and high standards for this new field.
The Traumatic Incident Reduction Association (TIRA) regularly teaches and/or co-sponsors this Workshop - an intensive and hands-on four-day, 28 hour Clinical Skills Program for mental health professionals and others in the helping and healing professions.
The TIR Workshop offers experiential training that can have an immediate impact on your personal and professional life. Through this intensive, small group experience, participants will develop a deeper understanding of how trauma can impact individuals and how to set up conditions to help them heal completely from such traumas, whether they occurred recently or as long ago - as is often the case - as childhood.
The TIR Workshop presents a new paradigm for helping another person and valuable data on how to create a safe space in which healing can occur. In addition to developing clinical skills, participants often describe the workshop as a valuable personal growth experience.
To learn more on TIR, please see FAQs, Essays & Literature on Traumatic Incident Reduction.« Return to the Quick Index for Traumatic Incident Reduction: Information on Trauma Bonds and Treatments
• ABSTRACTSexual abuse and domestic violence are such pervasive societal problems that full understanding of their causes, dynamics, and effects are of primary importance to those in the helping professions. Each year in the United States, nearly one million children are determined to be victims of abuse and/or neglect, and it is likely that many more experience adversity that could be classified as maltreatment. In substantiated cases, more than 80% of the perpetrators were parents and 58% were mothers [U.S. Department of Health and Human Services, 2004]. People with childhood histories of trauma make up almost the entire criminal justice population of the USA. [Teplin et al 2002]
It is well documented that victims of domestic violence and sexual abuse develop post-traumatic stress disorder (PTSD) [Kemp, Green, Hovanitz, & Rawlings, 1995 and Dutton & Painter, 1993] and complex PTSD [Herman, 1997]. PTSD carries its own set of symptoms and behaviors that explain many aspects of behavior that are manifested in victims of domestic violence and sexual abuse. There is, however, another dominant difficulty in the treatment of these populations. This difficulty is explained in the concept of "trauma bonding", which has also been referred to as the "Stockholm Syndrome" and "betrayal bond" [Carnes, 1997, James, 1994; Dutton & Painter, 1993: deYoung & Lowry, 1992, van der Kolk, 1989, Graham, Rawlings, & Rimini, 1988]. Trauma bonds are bonds between two or more people that find their beginnings and strength in shared and earlier trauma. A Trauma bond is evidenced in any relationship wherein the connection defies logic and is very hard to break. This article will define and give an overview of traumatic bonding, as well as present a treatment approach that will help in relieving these resistive bonds.« Return to the Quick Index for Traumatic Incident Reduction: Information on Trauma Bonds and Treatments
• UNDERSTANDING AND TREATING TRAUMA BONDS
Abuse and Trauma Bonding Domestic violence and sexual abuse transcend cultural, socioeconomic, and age distinctions. The World Report on Violence against Children published by the United Nations in 2006 confirms this fact. It is a global problem of enormous proportions from which no country is immune. Progress has been made in efforts to understand these things better and develop effective ways to treat their victims and to break the cycle from one generation to the next.
The Adverse Childhood Experience (ACE) Study confirmed earlier research showing a highly significant relationship between adverse childhood experiences and depression, suicide attempts, domestic violence, cigarette smoking, obesity and sexually transmitted diseases. In addition, the more adverse the childhood experiences, the more likely a person was to develop heart disease, cancer, stroke, diabetes, fractures and liver disease.
A unique difficulty in the identification and treatment of domestic violence and sexual abuse victims arises from the victim's attachment to the abuser. For many years the observation has been made that many women who were beaten would return to their abusive spouses. They would often drop charges against their spouses once the crisis was over [Dutton & Painter, 1981]. Children who had been sexually abused by a parent would come forward reluctantly, and then were unwilling to discuss the details of the abuse because of strong emotional ties held with the abuser [deYoung & Lowry, 1992]. Women and children who demonstrated the above behaviors were viewed as having pathology that somehow created the abuse they were receiving. Women in abusive relationships were believed to be masochistic and children who had been sexually abused were viewed as somehow enticing the parent to commit the sexual abuse [Dutton & Painter, 1993; deYoung & Lowry, 1992, Graham, et al, 1988].
In recent years, however, a different observation and perspective has been offered. First, post-traumatic stress disorder has been more fully recognized and defined and victims of abuse frequently met the criteria for PTSD and complex PTSD [Herman, 1997]. Compelling information is now appearing in the literature that describes the effects of trauma on our brain chemistry. This information gives further insight as to the behavior of many abuse victims towards their perpetrators. This information will be summarized later in this article.
As far as abuse in of itself creating a bond with a perpetrator, Carnes, 1997, wrote: "Logic would say that using fear and threat is not a good way to gain cooperation and loyalty. The irony is that in a perverse way it is. Fear immobilizes and deepens attachment." In addition to these recognitions and new perspectives, the important concept of "Trauma bonding" has been identified and defined.
One comprehensive description of the mechanisms of trauma and how they relate to Trauma bonding is contained in van der Kolk's article, The Compulsion to Repeat the Trauma," 1989. In this article he explains "...how the trauma is repeated on behavioral, emotional, physiologic, and endocrinologic levels, whose confluence explains the diversity of repetition phenomena." [p. 389]
In 1992, de Young and Lowry defined traumatic bonding as: "the evolution of emotional dependency between two persons of unequal power, adult and a child, within a relationship characterized by periodic sexual abuse. Feelings of intense attachment, cognitive distortions, and behavioral strategies of both individuals distinguish the nature of this bond that paradoxically strengthen and maintain the bond." [p. 167]
With regards to children, James  makes the distinction between attachment and traumata bonds: "An evaluator may confuse attachment and trauma-bond relationships. There is a tendency to see attachment and trauma-bonding as extremes of an attachment continuum rather than as the two distinct processes they really are, each with its own specific etiology and outcomes."
Trauma bonding is far more complex and severe for children, given their factual dependency on the person with whom they share a trauma bond. That coupled with their lack of cognitive abilities, depending on their developmental stages, results in far more damage being done through a traumatic bond [Carnes, 1997]. This subject requires extensive study, as the literature is sparse in this area.
Dutton and Painter  define Trauma bonding as the situation in which ". . . powerful emotional attachments are seen to develop from two specific features of abusive relationships: power imbalances and intermittent good-bad treatment." [p. 105]
While this article will continue to utilize the phrase "power imbalance", it might be said that the problem in a family abuse situation isn't about power and control so much as it is about oppression and control. Power in and of itself is not a negative quality. The word comes from the Latin posse, which means, "to be able" [World Book Dictionary, 1977; p. 1633]. From observation, truly powerful people are indeed able and secure and generally empower others. Those who abuse power more than likely do so as a result of a reaction formation to their own basic insecurity and inadequacy which is reinforced by social permission for violence. Oppression would be a better term to utilize in these cases as its definition includes "cruel or unjust treatment" which more aptly describes violent relationships [World Book Dictionary, 1977; p. 1459].
While the basic power differential can be seen as the physical strength that the abuser holds over the victim, this differential can also manifest in financial matters, as in many cases the abuser is in control of the finances. Emotional abuse can also contribute to a power differential, as the abuser can convince the victim that she is useless, no good, and can't live without him.
Under the heading of a power differential is the situation wherein the abused person experiences social isolation. Allen, , observes that "the continually overpowered person feels increasingly incompetent and helpless, ever more reliant on the person with power. Moreover, the abused individual is held captive, secluded from other potential sources of support." [p. 4].
The power imbalance can reverse at times when the abused person tries to leave the relationship. The roles can reverse and the abuser loses power. One possible explanation of this phenomenon is the concept of "identification with the aggressor," wherein the victim now assumes the role of the abuser [Freud, 1937]. While Graham, et al., 1988, views this identification as a defense mechanism wherein "...the victim incorporates the world view of the aggressor", it is suggested here that this reversal of the power structure is part of what keeps victims hooked into the relationship. In domestic violence, this reversal is seen when the abused threatens to leave and the abuser implores the victim to stay. Blizard and Blume  see identification with the aggressor in abuse victims as "...a defense used to preserve the self by taking the power of the abuser at a time when the victim is totally powerless." [p. 387]
Understanding that victims can identify with their aggressor also offers another possible reason as to why victims are often so resistive to those who try to help them. However, it is noteworthy that not all victims identify with the aggressor, and many times the apparent power of the victim is only a passing phase in the cycle of violence.
Another important aspect needed for a traumatic bond to form is intermittent good-bad treatment. Intermittent reinforcement forms one of the strongest behavioral patterns. And so it is with abusive relationships - abuse or good times occur intermittently. In either event, a strong attachment to the cycle of behavior can form.« Return to the Quick Index for Traumatic Incident Reduction: Information on Trauma Bonds and Treatments
• The Stockholm Syndrome and Trauma BondsThe Stockholm Syndrome is the name given to the situation wherein hostages bonded to their captors. Graham, Rawlings, and Rimini (1988), differentiate between Trauma bonding and the Stockholm Syndrome with regards to battered women. They give the following four conditions that must be present for the Stockholm Syndrome to develop in abuse victims:
- A person threatens to kill another and is perceived as having the capability to do so;
- The other cannot escape, so her or his life depends on the threatening person;
- The threatened person is isolated from outsiders so that the only other perspective available to her or him is that of the threatening person; and
- The threatening person is perceived as showing some degree of kindness to the one being threatened. [p. 219]
Points one, two, and three can be explained within the context of a power differential, and the fourth point clearly describe intermittent good-bad treatment. What is being described as a separate syndrome could also be viewed as a more intense traumatic bond. There have been two prominent examples of this in the news in recent years, Elizabeth Smart and Shawn Hornbeck. Both are excellent examples of the manifestation of the trauma bond leaving those who heard about it baffled by the captives seeming lack of desire to escape.
• Betrayal BondsCarnes, 1997, in his comprehensive book about this subject, refers to a trauma bond as a betrayal bond, as he considers that it more accurately describes what occurs. He notes that exploitive relationships, with varying degrees of trauma, create betrayal bonds, which are evidenced when someone bonds to someone who is destructive to him or her.
• Why Trauma Bonds FormTrauma bonds are able to form only because human beings have a biological need to form attachments with others (Bowlby, 1988). In times of stress and danger, people have a greater need to be cared for and attach to others. Research has shown a correlation between the degree of PTSD that develops after a traumatic event and the degree of loss of attachments and interpersonal supports [Saporta and van der Kolk, 1992]. Any attachment is better than no attachment, a fact that is evidenced by the reality of relationships that are otherwise incomprehensible.
Felicity de Zulueta, in her description of "Traumatic Attachment" says: "Such an attachment can be understood as the internalized product of repeated experiences in which these children have felt both terrified and - paradoxically - desperately in need of their caregiver, whose protection is felt as essential for their survival."
A possible explanation for the trauma bond, a form of "traumatic attachment", is described by Felicity de Zulueta as follows: "In traumatic states of helplessness, both responses are hyper-activated in the infant, leading to 'an inward flight' or dissociative response. Children, and later adults who have lived in fear of their caregiver, will maintain their attachment to their desperately needed caregiver by resorting to dissociation; in other words, they will develop an idealised attachment to their parent by dissociating off their terrifying memories of being abused. The resulting working models are those of an idealised attachment relation and that of a 'dysregulated self in interaction with a mis-attuning and frightening other' [Schore, 2001; p. 240]."
Another theoretical explanation of why Trauma bonds form has to do with arousal theory and post-arousal bonding. Straton, , in defining different types of catharsis, describes the Cathexis model, which involves the concept of bonding: "Usually this is conceived as the emotional attachment between one person and another; however it can be broadened to include emotional attachment to a belief, or view of the self or the world. Phobic objects are negatively cathected, while beliefs and attached objects are positively cathected. Š A central idea in this model is that such cathexes develop at changing arousal, and that arousal diminishes, an object in that vicinity may become positively cathected." [p. 550]
This concept was described by van der Kolk, , as follows: "...there are two powerful sources of reinforcement: the 'arousal-jag' or excitement before the violence and the peace of surrender afterwards. Both responses, placed at appropriate intervals, reinforce the traumatic bond between victim and abuser." [p. 385]
Herman,  in describing the difficulty in forming meaningful relationships after being in an abusive one, writes "no ordinary relationship offers the same degree of intensity as the pathological bond with the abuser." [p. 92] It is possible that the intensity of the pathological bond is the result of the cathexis as described above.
Carnes, 1997, refers to a "high warmth/low intention" combination, with the high warmth factors being descriptions of high arousal experiences. High warmth given at inappropriate times and without explicitly stated intentions is indicative of manipulation and the potential for forming a traumatic bond.
While many relationships do not start off as abusive, some component of a trauma bond is usually present from the onset of a relationship, which later turns abusive. It is not unusual for those in the beginning stages of a relationship to ignore signs that upon scrutiny are attempts to set up a power differential and intermittent reinforcement. Also, the most innocuous-seeming component and one that we find most attractive is the arousal aspect of a relationship. Courtship can be seen as a series of arousing events that result in bonding. If there is no initial arousal connected to a potential mate there is no continued interest; however, high arousal (warmth) with low intent is an indicator of manipulation and is often present in the beginning stages of an abusive relationship
Trauma bonding is not limited to only victims of domestic violence and sexual abuse. The perpetrators of these acts are almost certainly subjected to this phenomenon. This type of bonding is also given as an explanation for those who are torture victims, hostages, members of cults, exploited at work, abused by clergy, kidnap victims, and those abused in litigation who subsequently bond to their abusers [Carnes, 1997 and Saporta and van der Kolk, "The Biological Response to Psychic Trauma: Mechanisms and Teatment of Intrusion and Numbing .
• Object Relations Theory, Ambivalent Attachment, Self-Psychology and Trauma BondingObject relations theory explains that Trauma bonds form as a result of early childhood abuse and neglect. One theory in object relations maintains that the basic drive in humans is attachment to the primary care-giver. Because of this primary drive, object relations defenses have the purpose of preserving the object, the self, and the attachment [Blizard and Blum, 1994]. Blizard and Blum offered the following explanation:
"An excellent article by Young & Gerson , "New Psychoanalytic Perspectives on Masochism and Spouse Abuse", integrates object-relations and attachment theory with knowledge about the effects of chronic trauma on children in order to make sense of the continuing attachment of battered women to their abusive spouses. They describe how an intermittently abusive relationship with a caretaker can actually cause an infant to become more attached to the caretaker. The child learns early on to endure pain in order to maintain the attachment. This becomes the child's "working model" of the environment and the important people in it, and also of the self as object and agent [Bowlby, 1984]. Later, as the child matures, this model becomes the template for adult marital relationships." [p. 383-384]
In the same article, Young and Gerson  attempt to rename Trauma bonding as "relational masochism," claiming that "...The psychoanalytic concept of masochism may help illuminate psychological processes in some battered women." They acknowledge that "Masochism is a tainted word with strong negative connotations..." but claim that "The concept of relational masochism, as defined in this paper, looks beyond the early definitions..." and attempts to "... highlight the notion that masochism can be used to refer to phenomenon with diverse etiological and dynamic aspects, and to distinguish it from sexual masochism." The Oxford English Dictionary only defines masochism in the context of deriving sexual pleasure from pain, as the word was coined to describe this circumstance. This meaning of masochism is deeply imbedded in our culture and its use to describe why a victim of domestic violence would return to her abuser amounts to blaming the victim. Young and Gerson claim that Dutton and Painter, in defining Trauma bonding "... miss an important point clearly demonstrated in the ethological studies; namely, the strength of an infant's attachment to its parental figure." But further, in their own article, the studies they cite to support that chronically abused women suffered early childhood abuse, report that only between 25 to 50 percent of the battered women reported traumatic childhood events. Clearly, relational masochism, with its definition rooted in earlier childhood abuse, does not explain why a majority of women remain or return to abusive relationships. As noted by Carnes, 1997 "...trauma bonds can happen to anyone." A close, honest inspection of almost anyone's life will reveal some relationship wherein this phenomenon was present, as it is nearly impossible to live a life with only perfect relationships.
A far more meaningful concept to consider, which would lead the way to macro solutions to the problem of Trauma bonding, would be "cultural sadism," which is manifested in the cultural attitudes towards women, children, and victimization and the overall social permission towards violence.
Ambivalent/insecure attachment is attachment that is characterized by clinging behavior towards the object of attachment and less willingness to explore the environment. It has been observed that a baby whose mother was inconsistently available formed ambivalent attachment [Cassidy and Berlin, 1994]. The behavior of the mothers described by Cassidy and Berlin could be classified under the heading of intermittent good/bad treatment, a component of Trauma bonding. The lack of willingness to explore the environment parallels an abuse victim's isolation. While the abuser imposes the isolation, it is possible that it is reinforced by the same mechanism that causes an infant to fixate her attention on her intermittently available mother.
The self-psychology perspective as to why a person would form Trauma bonds also looks to early childhood for the cause. According to this theory, any child whose caretakers did not respond empathetically to the child's emotional needs, who did not build a foundation of attachment with the child, and help the child evolve a sense of separateness, would be susceptible to forming unhealthy attachments later in life [Pessein and Young, 1993].
From the self-psychology perspective, it is possible that any female raised in a patriarchal culture, wherein the child is encouraged to see herself mainly in relationship to a male, will be prone to forming Trauma bonds. This could be viewed as thwarting a sense of separateness needed to form healthy attachments. According to the above theories, only those who were abused, abandoned, intermittently cared for, and not given appropriate care for their emotional needs in childhood would be susceptible to Trauma bonding. As there is no research which supports these theories, they do not offer a complete explanation as to why Trauma bonds form. Herman, 1992, observed that "while some battered women clearly have major psychological difficulties that render them vulnerable, the majority show no evidence of serious psychopathology before entering into the exploitative relationship." [p. 116]
• Repetition CompulsionAnother important factor in understanding victims who protect or return to their abusers is the repetition compulsion. Freud first identified repetition compulsion, 1920, which he described as follows: "The patient cannot remember the whole of what is repressed in him, and what he cannot remember may be precisely the essential part of it... he is obliged to repeat the repressed material as a contemporary experience instead of remembering it as something in the past." [p. 260]
Other articles that give a detailed discussion of the repetition compulsion are Chu , van der Kolk , and Wilson and Malatesta .
As repetition compulsion is a general condition that can affect anyone who has received any type of trauma, it is not listed as a specific component of Trauma bonds. As has been noted above, persons with no psychological difficulties have entered abusive relationships and formed Trauma bonds. However, repetition compulsion is a significant contributing factor to a victim's clinging to what is familiar and attracting partners and situations that repeat the content and themes of the relationship wherein they received their first abuse.
• Trauma Bonding and the Psychobiology of TraumaWhat has been brought to light in recent years about the effects of trauma on our brain chemistry also helps to explain the behavior of victims who bond to their abusers.
The body is programmed to release a series of chemicals at times of actual or perceived danger and times when traumatic memories are triggered. These chemicals are intended to help us respond in ways which will aid our survival, whether we "fight" the threat, "flee" from the threat, or "freeze" to prevent attack or deaden the pain from the inevitable attack. However, when traumatic events are completely overwhelming, are repeated too often, or are constantly triggered the very chemicals that are meant to help us begin to do harm to our bodies. For both men and women, repeated trauma or the repeated triggering of a trauma will actually teach our brains to be in a constant state of "fight, flight or freeze." As our brains are use-dependent, if they are constantly used to respond to trauma, that response becomes a person's "normal state", (Perry, 1997 & Carnes, 1997). For those who are stuck in a trauma bond, the trauma chemistry creates new brain pathways and becomes "normal" to the victims. Further, women are particularly susceptible to bonding to those who traumatize them. Women have their very own mixed blessing in the form of oxytocin. Oxytocin is referred to as the bonding hormone and is the chemical that starts the birth process. It is the reason any woman has a second child, as it prevents memory consolidation. If we were to fully remember the pain of childbirth, it is unlikely that we would repeat the experience. It is one of nature's ways of ensuring the continuation of our species. Oxytocin peaks for about 20 minutes after birth, which is why it has been advised to let a new mother be in physical contact with her baby during that time period, as it is critical to bonding.
While oxytocin is a great idea for childbirth, it's a liability for any abuse victim. If someone is violent to a woman, oxytocin is released and she will be less likely to have a consolidated memory of the abuse and she is very likely going to bond to her abuser. If there is no consolidated memory of the abuse, it is very hard to think and act rationally about the event. If the abuser is the only one present after the abuse, the victim is likely to form a stronger bond to him. She may also form these bonds with her children if they are present after the abuse.
A recent paper by Taylor, Klein, Lewis, Gruenewald, Gurung, and Updegraff, 2000, presents very compelling information to support their hypothesis that women do indeed bond in times of trauma; that it seems truer that women's response to danger isn't 'fight or flight' but 'tend and befriend.' In studies cited in the paper, it appears that estrogen amplifies the effects of oxytocin, whereas androgens diminish the effects of oxytocin.
There are now numerous studies about the psychobiology of trauma. Two authors who are experts with regards to the impact of trauma on adults and children are Bessel van der Kolk and Bruce Perry.
• Definition and Components of a Trauma BondWhile the literature offers explanations as to what components are necessary for a trauma bond to form, no definitive definition was given. A concise definition of trauma bond is offered here: A bond between two or more people that finds its root in trauma. Note that a trauma, which activates this type of bond, does not need to be one with intense physical pain. Neglect, degrees of betrayal, as well as physical pain are also activating events for a trauma bond [Carnes, 1997].
A trauma bond is evidenced in any relationship wherein the connection defies logic and is very hard to break. The components necessary for a trauma bond to form are a power differential, intermittent good/bad treatment, and high arousal and bonding periods.
• Case StudiesSocial work students that were doing their internship at an agency that serves victims of crime provided the following case studies.
First Case StudyIlliana is a Hispanic female in her middle twenties. She had just moved into a woman's shelter when her counseling began. She had been married for seven years and has three children. Regular physical abuse started shortly after the marriage began. The abuse was severe and included attempted strangulation when she was pregnant with her third child. She had only recently found out that a woman's shelter existed and after her most recent beating, she moved in to the shelter with her children. Her presenting problem was her indecision as to whether or not she hated or loved her husband and whether or not she wanted to return to him or not. Her other most noteworthy symptom was severe and frequent headaches. The first 26 steps of the following treatment approach were done in a one-and-one-half-hour session, following her intake. At the end of the procedure, the client concluded that she feels terror at the thought of showing bad feelings to her husband. She saw that she had been treated very badly by him and was glad that she could make it without him in her life.
At a two-month follow-up, the client had not returned to her husband.
Second Case StudyMaya is a 26-year-old pregnant Caucasian who was married for three years. Because of repeated violence and emotional abuse by her husband, Maya was at a women's shelter. She has two children and is pregnant with her third child. She also reported that she is a recovering addict and had felt on the verge of a relapse. The client received three hours of the first 26 steps of the Trauma bonding treatment approach and three hours of addressing traumatic events with her husband. As the result of the work done, the client spoke of her newly found strength. She felt that her strength had always been there and now she was in contact with it and was building it up. She also realized that she definitely wants to remain free of her husband. She could now see the danger that her husband had put her unborn child and herself in by beating her through the pregnancy. The client also decided to seek help for her addiction, before it became a problem.
She is still in counseling and has separated from her husband.
Third Case StudyBarbara is a 48-year-old Caucasian who was married to a violent man for seven years. The abuse culminated in a three-day period that included his kidnapping her, beating and raping her, and constant threats that he would kill her. While she had had previous therapy to address the traumas from the marriage, her current concern was her relationship with her older daughter. She had allowed her 22-year-old daughter and the daughter's four-year-old son to move in with her. The client called for additional therapy as she felt completely grief-stricken, felt her functioning diminish, and knew she needed intervention. From the client's description of her relationship with her daughter, it became evident that the daughter was emotionally abusive towards her mother. The client felt powerless with regards to her daughter, felt duty and guilt-bound to let her continue living in her home. The protocol described below was started, addressing her daughter. Within thirty minutes, the client recognized that her daughter's personality and abuse patterns were very similar to her ex-husband's patterns. She knew her daughter would not agree to family counseling and that her daughter had to leave. The client was smiling and relieved.
The client had her daughter move out.
• ConclusionThe importance of trauma bonding has been under-represented in research. This condition prevents many victims from leaving their violent partners, perpetuates both victims and abusers being drawn to abusive relationships, and can make treating both victims and abusers slow and unrewarding. An approach that directly addresses and eliminates these bonds is critical.
• Treatment Approach for Trauma BondsThe following treatment approach has been utilized at Victim Services Center in Miami, Florida with considerable success. In most cases, the trauma bond would dissolve and clients would be more able to leave the abusive relationship or resolve their sense of ambivalence. A general treatment plan is given here that will have application to any client who is manifesting being caught in a trauma bond.
Therapeutic ProtocolCertain procedural aspects of this approach need to be defined first. This approach is person-centered. No evaluation or interpretation of a client's events is offered. There is no feedback offered or active listening done. When a client has given an answer, a simple, non-evaluative acknowledgment is given, such as "OK," "I understand," or "all right." Clients are allowed whatever time is needed to complete the issue being addressed in a particular session. While all steps of the following program can be completed over many sessions if required, any particular question or set of related questions should be completed in one session. When a traumatic event is being discharged, it is not unusual for a session to last for two hours.
Procedural ModeAnother important aspect of this approach is repetition. Repetition of a technique is used to achieve a deeper level of resolution. This is possible because repetition of a concept or trauma reactivates the material connected to it. This reactivation creates what is described under the concept of state-dependent learning, wherein a person must be in a similar state to the time one learned or experienced something in order to be able to recall it [Goodwin, Powell, Bremer, Hoine, and Stern, 1969]. Repeating an emotionally uncomfortable concept or traumatic event serves to trigger the event or the material connected to the concept, which is stored in state-dependent form. By repeating material that is in a client's conscious awareness, the preconscious material will begin to surface and as the repetition is continued the client will become aware of previously unconscious material.
Many of these techniques use what is called a two-part loop [Gerbode, 1989]. For example, one would ask, "How could I help you?" followed by, "How could you help me?" followed again by the first question, and so on, until a client reaches what is referred to as an "end point". Gerbode  defines an "end point" as "The point at which an activity has been successfully completed. This is the point at which the activity should be ended. It is manifested by a set of phenomena that indicate the successful termination of the activity." [p. 513] An end point includes the fact that a client gains emotion distance from the subject being addressed to a greater or lessor extent, feels and looks better, and has some sort of insight regarding the area being addressed. It is vital to recognize and stop a procedure at an end point. Continuing past an end point can cause a client to engage in a number of undesired outcomes. These include: continuing to create the material that had been resolved which will create self-doubt and uncertainty about his or her ability to unravel issues; becoming immersed in different, unidentified material that the client now misassociates with the subject originally addressed; creating new and uncharged material related to the original subject [Descilo, 1999]. Note that obtaining all answers possible to all of the following questions will not necessarily result in an end point. At times, a client will simply run out of answers or may have no answers. It is important to distinguish whether a clients is evading painful material or truly has no further answers.
Causal DirectionAnother common procedural aspect of this approach is to address an issue from different "causal directions" (CD). A CD is defined as the direction of an activity as observed by an individual. There are four basic CDs. They are: something that has been caused by an outside source which we experience personally, those things which we cause another to experience, what we observe another or others cause for another or others, and what we directly cause ourselves to experience. All four CDs need to be addressed to fully resolve presenting issues [Descilo, 1999].
Rationale and IntentThe first section of the approach helps an often-invalidated person realize that they are right a significant portion of the time. The other sections aim to address the power differential, any identification with the aggressor, the intermittent reinforcement, and the high arousal points that preceded bonding. Some of the following steps have the purpose of helping a client reevaluate themselves against the perpetrator, find closure in terms of receiving validation from the perpetrator, and finding new trust in their own perceptions [Garrison, 1996]. All of the first steps will also help build ego strength, assisting clients in freeing up the needed intention to fully process their traumatic events. The final steps attempt to assist a client to recognize and change previously held beliefs on the subjects of intimacy and relationships. As Carnes, 1997 notes: "The key is to dismantle the reactivity and other trauma solutions that support trauma bonding."
PreliminariesClearly any client intervention would be started with a detailed history and any actions taken to ensure her life was not in danger. One would then fully define the concept of trauma bonding and ensure she understood it fully.
Treatment StepsOnce the above orientation and preliminaries are done, the following techniques would be done in the order given:
- Tell me something you have done that was right.
Repeat this question until the client reaches an end point or has no more answers.
- Remember a time that you did something well.
Repeat this question until the client reaches an end point or has no more answers.
- Tell me something you like about yourself.
Repeat this question until the client reaches an end point or has no more answers.
Note: While it is possible to use this entire protocol on many people in the client's life, the above three questions would only be asked of the client the first time using the protocol. If the client has already done these treatment steps on someone else and a different person is now being addressed, start at Step 4
Do each of the following steps as two-part loops until the client runs out of answers or exhibits an end point. If the client runs out of answers for one part of a two-part loop, keep asking the other part until the client runs out of answers or reaches an end point. In other words, you may need to continuously repeat only "Tell me something you don't like about_____" until the client runs out of answers for that part of the loop before repeating the first part of the loop or the client exhibits an end point.
- Tell me something you like about _______.
- Tell me something you don't like about _______.
- Tell me the problem with ______.
- Get the idea that you want to be over this problem. Tell me about it.
- Get the idea that you want to keep this problem. Tell me about it.
Repeat a. and b. as a two-part loop until the client reaches an insight or runs out of answers.
Repeat step 5 and do a. and b. on the new problem.
Continue to repeat step 5 until the client has no further answers for step 5.
- How are you and _______ similar?
- How are you and _______ different?
Note: If there is more than one abusive person in the client's life, do step 6 on each abusive person. If there are other victims in the client's life, do step 6 on each victim. If there is more than one abuser and/or victim in the client's life do step 7 comparing each to each. If there are no other abusers or victims in the client's life go to step 8.
- Recall a good time with ________. (abuser or victim).
- Recall a bad time with ________.
- Recall a good time _______ had with you.
- Recall a bad time ______ had with you.
- Recall a good time ______ had with another or others.
- Recall a bad time ______ had with another or others.
Do each of the following two steps as four-part loops until the client reaches an end point or runs out of answers.
- Recall a good time you had with yourself because of ________.
- Recall a bad time you had with yourself because of _______.
- Recall a time you felt ______ was more powerful than you.
- Recall a time you felt more powerful than ______.
- Recall a time _______ seemed more powerful than others.
- Recall a time you felt powerful because of ______.
Sometimes a crucial issue with the guilt connected with the abuse is having felt good. Do the following step as a two-part loop.
- Recall a time that ______ caused you to doubt your perception.
- Recall a time that you caused ______ to doubt his perception.
- Recall a time that _____ caused others to doubt their perception.
- Recall a time that you doubted your own perception because of ______.
Note: Step 14 should be adapted to an appropriate question for children who were sexually abused.
- Recall great sex with _______.
- Recall unpleasant sex with _______.
- Is there anything you've done that you wouldn't want ______ to know about? If so, ask for all of the details. Repeat the question until there are no more answers.
Address the following as two-part or three-part loops. Do not repeat steps 16 through 22 when using this treatment protocol on another person in the client's life. If the client has already done steps 16 to 22 when addressing someone else in their life, skip these steps and go on to step 23.
- Recall a time you felt abandoned.
- Recall a time you felt secure.
- Recall a time you craved attachment.
- Recall a time you were unable to attach to someone.
- Recall a time you attached to someone.
- Recall a time another craved attachment.
- Recall a time another was unable to attach to someone.
- Recall a time another was able to attach to someone.
- Remember a time when you felt rejected.
- Remember a time when you felt accepted.
- Remember a time when you rejected another.
- Remember a time when you accepted another.
- Remember a time when another rejected another.
- Remember a time when another accepted another.
Do the following as a two-part loop:
- Remember a time when you rejected yourself.
- Remember a time when you accepted yourself.
Repeat the following steps until the client can't think of another way in which the abuser has put her down:
- Get the idea of feeling connected to _______.
- Get the idea of feeling separate from _______.
Do the following as a two-part loop:
- Think of a way ______ has put you down. Tell me about it.
- Get the idea now that _______ now holds the opposite view. Picture _______ telling you that. Tell me about it.
If the abuser/victim is no longer part of the client's life, ask the following as a two-part loop:
- Get the idea of ________ remaining a part of your life. Tell me about it.
- Get the idea of _______ being out of your life. Tell me about it.
- Recall a time before ______ was in your life.
- Recall a time after ______ was in your life.
- At this point, ask the client for some traumatic event connected with the abuser or victim that holds their attention. Address this event with an approach that integrates traumatic memory. Ensure to ask the client for any traumas in the same vein, but from all causal directions. For example, if the client brings forward an incident wherein she was beaten, the next trauma to ask for is any incident when she beat another. Asking for any incident that contained another beating another would follow this. The last CD would ask for any time she beat herself, which could take the form of self-mutilating.
Another important step to add for both victims and perpetrators is run to Traumatic Incident Reduction (TIR)) on any incident from the point of view of the other person. For example, if a victim has addressed a beating received, she would then process the incident from the point of view of the person who beat her. Or if a perpetrator admits to and addresses an incident where in he abused another, after bringing that incident to an end point, it would again be addressed from the point of view of the victim. Adding this dimension of awareness is very helpful in untangling a trauma bond [Long, 1999.] Continue asking for and resolving traumatic events until a client has no more he or she wishes to address.
Please note that step 27 is by no means intended as an instruction as to how to alleviate trauma. It is only offered as an additional instruction as to how to fully address traumas to those clinicians that are trained in an approach that extinguishes trauma. Repeat the above steps (excluding those that should not be repeated) on any other abuser and/or victims in the client's life and then do the following:
- Fully explore the areas of relationships, partners, past and present expectations by discussing the following with the client: Tell me what you envisioned as your ideal mate and relationship when you were younger. What are the traits you wanted in a partner? What would a good life with someone consist of? What role did your upbringing or culture have in forming those ideas? What do you want now in a partner? Describe your ideal mate and relationship. How is what you envisioned similar to what you have (had) now and how is it different?
- Discuss the idea of intimacy with the client. Find out what they consider it means. A suggested resource for this step is Sheehan's "Treating Intimacy Issues of Traumatized People" , which is published in the book, "Handbook of Post-Traumatic Therapy", by Mary Beth Williams [Editor].
Note: Step 29 should be adapted to whatever relationship the abuser and the client were in.
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