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Secondary Wounding – A Family Healing Approach

December 21, 2012

iStock_000016267513SmallTLC GUEST BLOGGER: Cherie L. Spehar, LCSW, RPT-S, CTS, CTC

In earlier articles, we’ve discussed the impacts of secondary wounding and self-secondary wounding.  We covered some important interventive strategies for healing from this aspect of the trauma experience and how an individual can work within his or her own recovery process to overcome the effects of secondary wounding. Now, we take this a step further by examining how secondary wounding affects healing families.

Family systems are already disrupted and shaken by trauma. It is a time when families search for meaning, context and reason. Well intentioned people in the victim’s circle will say things that meaning to themselves, while inadvertently creating an atmosphere of blame for the victim (e.g., “Well, that makes sense because she was walking home alone in the dark”). To the victim, it implies that people think she did something wrong, and in the context of a traumatic event, that point no longer matters.

Often, effective psychoeducational guidance and support can relieve a family of the pain and guilt associated with this dynamic. At other times, it complicates the healing journey in unexpected ways, and additional supports may need to be considered. Let’s explore the sensitive issue of the traumatized family system, how trauma recovery can be supported or compromised, and some ideas to help.

How Secondary Wounding Impacts Families

When secondary wounding happens in a recovering family system, it can further destabilize it and cause issues with guilt, shame, anger and more.

Guilt – Most secondary wounding that occurs is not intentional. Yet, when family and friends learn about this aspect of trauma and the potential role they had in re-wounding, they are often faced with immense guilt at contributing to the victim’s experience and may berate themselves and blame themselves for “hurting someone I love so much.”

Young Woman ThinkingShame – Like guilt, once a family is introduced to the idea of secondary wounding, it can create a profound sense of shame. With shame, many people, understandably, may not have considered that their words of support could have hurt, and they shame themselves by starting to believe there is something wrong with them to not have known how to support the victim. A person can begin to think they are an unfit parent or friend for doing something that further hurt their child or friend.

Anger – The victim, once learning about secondary wounding, may also feel a temporary sense of anger at his or her perception of having been blamed or at fault. While this calms with continued, gentle psychoeducation, a sting may persist for some time as all family members integrate their understanding of this aspect of trauma.

How It Affects Trauma Recovery

Estrangement – I have worked with families who, because the secondary wounding was so severe, became emotionally, mentally and even physically estranged from one another. This is one of the most serious effects and takes a long time to heal. Victims will focus so heavily on this aspect of their trauma experience that they become stuck and are less able to work through the traumatic experience itself.

Distrust – Trauma already causes a disruption in a person’s ability to trust the world and the people in it. With secondary wounding, this can become exacerbated because by perception, the people they trusted to help them feel better inadvertently created shame, blame and minimization of their pain. Because a person’s view of the world is distorted after a trauma, regaining this trust can be a delicate process.

Extended recovery time – When secondary wounding is very prominent in a family system, or if it is perceived by the victim as particularly hurtful, this will certainly impact the time spent in trauma recovery. Family members may need to learn and relearn more helpful responses, and they in turn will also need their own level of support for their own healing, and to be as present for the victim as possible. Other supportive healing measures must accompany and integrate with the TLC Trauma Intervention Programs.

Integral part of trauma narrative – Because secondary wounding becomes part of the trauma experience, it also becomes part of the healing trauma narrative. It can be used in a positive way to make meaning of the event and how the family attempted to heal.

Intervention Suggestions

Psychoeducation – One of the most helpful measures a clinician can take to ease the perceptions that come about from secondary wounding is to share the following information:

  • What secondary wounding is
  • It is rarely intentional
  • It is not irreparable
  • Help to normalize and relieve guilt the family may be experiencing by indicating that they didn’t know what they didn’t know

Family Therapy – When secondary wounding is of particular prominence, it can impact a victim’s experience of the trauma themes and create a sense of being “stuck.” Family therapy specific to this issue can be most helpful. Sometimes, this can be as minimal as incorporating supportive adjunct family sessions to review secondary wounding as a family unit and facilitate a communicative process that allows for apologies, forgiveness and understanding. At other times, moving temporarily to a family therapy—Contextual Family Therapy is often my intervention of choice—that integrates well with other forms of family therapy to address deeper issues becomes necessary. Be sure to seek consultation about when each is most appropriate with any given case.

Mitigating Factors

Secondary wounding in families, while presenting additional obstacles, can also make space for opportunities of bonding, closeness and healing.  Families who navigate this situation well are noted to have a wide range of system resiliency factors such as fairly healthy existing interpersonal relationships with each other, a method of overall respectful communication, and a desire to remain close, connected, interested and engaged with one another.

Caveats

It is important to note some dynamics that are especially difficult when healing from secondary wounding. There are some situations in which the process of secondary wounding is actually abusive, controlling or even intentional. There may be verbal or emotional abuse already occurring in the family system, and secondary wounding may be “standard practice” in the family’s interactions.

Also, with some of the victim’s supports, it may be quite difficult to generate an awareness or understanding of how and why secondary wounding is detrimental to a victim’s experience and healing.  Victims may feel unheard and unsupported when family members have trouble with this insight and continue to engage in secondary wounding during their interactions.

Layout 1Conclusion

As we have shared together in this series of articles, it is easy to see that secondary wounding is faceted, potentially complex, and in need of specialized attention. In my work, assessing and exploring secondary wounding is an integral part of trauma healing, not only in its acknowledgement, but in incorporating and addressing it as a treatment issue. Watch for new changes in the “Adults in Trauma Intervention Program,” which will specifically offer a process for doing this that weaves seamlessly into the familiar structured sensory interventions!

Cherie L. Spehar, LCSW, CTC-S, RPT-S
Founder and Director at Smiling Spirit Pathways

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