How to open a can of worms: enquiry about past abuse – how and why
Past trauma, especially childhood abuse and neglect, is emerging as a key source of vulnerability for most emotional and mental disorders, even the most severe. All of which have become regarded as entirely biological or behavioural in recent years. Little regard has been paid to providing skills for assessing or responding to past adversities in clinical training programmes. Research findings will be presented about clinician responses to the discussion of client’s past abuse which indicates high levels of clinician discomfort, and identifies that there are significant barriers in doing so. Evidence about the effects of a range of adverse experiences, their neurological and affective sequal will be presented and the possible clinical presentations of these effects in adults, along with differential diagnoses.
The key strategies for identifying and responding to past trauma to be discussed are: ‘These adverse experiences are far more common among patients than the general population and have often had a significant negative effect on their mental health’. ‘Patients are often waiting to be asked about past abuse, so as to have a chance to disclose and receive an empathic response. ‘ Often an empathic response is the only response required at the time. ‘ These processes can be summed up as attempting to provide normalisation and validation of the patient’s experience. Simple strategies for approaching this subject with patients, examples of disclosures and possible treatment responses will be given.
