No abstract

As the diagnosis and treatment of mental disorders has become increasingly medicalized (Conrad & Slodden, 2013), consideration for the relational nature of trauma has been minimized in the healing process. As psychiatrist R. D. Laing (1971) outlined in his essays, the medical model is an approach to pathology that seeks to find medical treatments for symptoms and syndromes based on categorized diagnoses. We argue that such a model implicitly locates the pathology of trauma within the individual instead of within the person(s) who perpetrated the harm or the social and societal contexts in which it took place. In this article, we argue that this framework is pathologizing insofar as it both prioritizes symptom reduction as the goal of treatment and minimizes the significance of relational harm. After providing a brief overview of betrayal trauma (Freyd, 1996) and the importance of relational processes in healing, we describe standard treatments for betrayal trauma that are grounded in the medical model. In discussing the limitations of this framework, we offer an alternative to the medicalization of trauma-related distress: relational cultural therapy (e.g., Miller& Stiver, 1997). Within this nonpathologizing framework, we highlight the importance of attending to contextual, societal, and cultural influences of trauma as well as how these influences might impact the therapeutic relationship. We then detail extratherapeutic options as additional nonpathologizing avenues for healing, as freedom to choose among a variety of options may be particularly liberating for people who have experienced trauma. Finally, we discuss the complex process of truly healing from betrayal trauma.

What does it mean to be ethical in psychotherapy? Does adherence to ethical codes and rules make a psychotherapist ethical? This article examines standard ways of thinking about ethics in the field and argues that these ways are inadequate, creating a false dichotomy between the ethical and the clinical, and that they are designed only for formal and contractual relationships, in which psychotherapy is more often personal and affecting. The ethic of care and the approach to ethics of Emmanuel Levinas are presented as additional approaches, along with their challenges to rationality and autonomy. An ethic of listening is then presented, and it is argued that ethics should be not an afterthought, but the primary consideration of clinical utility.

A frequently studied hypothesized cause of borderline personality disorder (BPD) is experiencing interpersonal trauma. A recent study by L. A. Kaehler and J. J. Freyd (2009 ) found a connection between betrayal trauma and BPD characteristics, with higher betrayal traumas associated with greater BPD characteristics. The present study seeks to expand upon that study by investigating relational health as a potential mediator for the association between betrayal trauma and BPD. A sample of 165 college students completed measures of betrayal trauma life events, relational health, and BPD traits. Mediation analyses showed significant partial mediation for total relational health (bootstrap coefficient = .0168) and its community subscale (bootstrap coefficient = .0204); however, significant mediating effects for the mentor and friend subscales were not found. Given the significant finding for only the community subscale, which may be driving the total relational health effect seen, the results suggest that connection with a valued community may be an important protective factor for BPD after one experiences betrayal trauma.

No abstract