Adverse Childhood Experiences and Interpersonal Relationships
Nicole Zlate
527-1 Special Topic: Trauma-Informed Approaches
Adler Graduate School
Adverse Childhood Experiences
Adverse childhood experiences (or ACES) is defined as childhood exposure to traumatic events such as emotional abuse, verbal abuse, sexual abuse, physical abuse, exposure to violence, neglect, abandonment, exposure to substance abuse, and other harmful events that the child may carry with them into adulthood. When trauma occurs during childhood, a significantly impressionable development life stage, it can have a lasting impact on that individual's perspectives, beliefs, thought processes, style of life, and interpersonal relationships (Briere & Scott, 2015). It may contribute to the development of complicated or traumatic grief, major depression, depression with psychotic features, anxiety, panic disorders, somatic symptom disorder, psychosis, substance use disorders, borderline personality disorder characteristics, and stress disorders including posttraumatic stress disorder and complex posttraumatic stress disorder (Briere & Scott, 2015). Adverse childhood experience were found to be associated with substance use, criminal behaviors, and increased risk of dissociation which may be utilized as a survival mechanism (Zyromski, Dollarhide, Aras, Geiger, Oehrtman, & Clark, 2018). Kealy and Lee (2018) reported that cumulative traumatic exposure during childhood was correlated with an increased risk of psychiatric distress and suicidality in adults.
Impact on Attachment
Secure attachment during childhood is ideal for healthy child and adolescent development. It sets the foundation for improved self-esteem, self-worth, fairness, trust, empathy, and supportive interpersonal relationships. Traumatic exposure during childhood can have a detrimental effect on secure attachment during childhood which may result in the maintenance of distrust to other people throughout childhood and into adult relationships (Clark, Classen, Fourt, & Shetty, 2015). This can disrupt the establishment of secure relationships throughout the individuals life span (including adulthood) and can have a negative impact on employment, receiving appropriate medical and mental health disturbances, maintaining a supportive social support system, and achieving a satisfying and healthy romantic relationship (Clark et al., 2015).
Impact on Relationships
An individual who had experienced adverse childhood experiences may instead be more inclined to feel betrayed in relationships, keep secrets, feel invalidated, and lack a sense of safety which is more likely to result in social isolation (Clark et al., 2015). Berkowitz (2012) stated that exposure to traumatic experiences during childhood, particularly violence and substance abuse by a caretaker, can contribute to the development of social withdrawal, depression, defiance, aggression, and cognitive issues in children and adolescents. Without interventions there is an increased risk of carrying those behaviors and concerns into adulthood, further adding to interpersonal relationship and communication issues.
Implications for Practice: Trauma Informed Care
The importance of trauma-informed care in mental health services is clear from the previous discussion. One of the things I personally reflect on is the prevalence of traumatic experience in the general population, even if it is not readily apparent in an individual's behaviors, and how not every traumatic experience may meet criteria for a traumatic stress disorder. For these reasons it is important to maintain an awareness of the possibility of traumatic influences in every client even if they have not disclosed any traumatic exposure. Inadequate trauma-informed care may increase the risk of a client experiencing a traumatic reenactment which can be described as a harmful reaction to a triggering stimuli (Clark et al., 2015) and could be incredibly hurtful to the therapeutic alliance and trust.
In keeping with trauma-informed practice, a counselor should excercise patience and take the time necessary to build trust and the therapeutic alliance, consider the client's personal goals, develop a safe space in the therapeutic environment, provide psychoeducation, be respectful, empathetic, compassionate, benevolent, and collaborate with the client in an effort to increase the client's sense of control in the therapeutic process (Clark et al., 2015). Further implications for my own practice would include the continual process of learning about traumatic exposure risks and the different ways it could present in individuals. Since every person is unique and has their own life style, worldview, beliefs, and interpretations it is important to continue learning both from valid research sources and from the clients themselves. One of the traits I personally carry into my own practice is "kindness" because we can never know someone's full history and perceptions without an immense amount of disclosure and even if we pass someone in the general community that kindness could go a long way for someone who may be struggling in that moment.
References
Berkowitz, S. J. (2012). Childhood trauma and adverse experience and forensic child psychiatry: The Penn center for youth and family trauma response and recovery. Journal of Psychiatry & Law, 40, 5-22.
Briere, J. N., & Scott, C. (2015). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment (2nd Ed.). CA: SAGE Publications Inc.
Clark, C., Classen, C. C, Fourt, A., & Shetty, M. (2015). Treating the trauma survivor: An essential guide to trauma-informed care. NY: Routledge.
Kealy, D., & Lee, E. (2018). Childhood trauma among adult clients in Canadian community mental health services: Toward a trauma-informed approach. International Journal of Mental Health, 47(4), 284-297. doi: 10.1080/00207411.2018.1521209
Zyromski, B, Dollarhide, C. T., Aras, Y., Geiger, S., Oehrtman, J. P., & Clark, H. (2018). Beyond complex trauma: An existential view of adverse childhood experiences. Journal of Humanistic Counseling, 57, 156-172. doi: 10.1002/johc.12080
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