Childhood Abuse Survivors' Experience of Self over the course of Emotion Focused Therapy for PDF
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View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Scholarship at UWindsor University of Windsor Scholarship at UWindsor Electronic Theses and Dissertations 2013 Childhood Abuse Survivors' Experience of Self over the course of Emotion Focused Therapy for Trauma: A Qualitative Analysis Elisabeth Sylvia Heide Mundorf Follow this and additional works at:http://scholar.uwindsor.ca/etd Recommended Citation Mundorf, Elisabeth Sylvia Heide, "Childhood Abuse Survivors' Experience of Self over the course of Emotion Focused Therapy for Trauma: A Qualitative Analysis" (2013).Electronic Theses and Dissertations.Paper 4949. This online database contains the full-text of PhD dissertations and Masters’ theses of University of Windsor students from 1954 forward. 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CHILDHOOD ABUSE SURVIVORS’ EXPERIENCE OF SELF OVER THE COURSE OF EMOTION FOCUSED THERAPY FOR TRAUMA: A QUALITATIVE ANALYSIS by Elisabeth Sylvia Heidi Mundorf A Dissertation Submitted to the Faculty of Graduate Studies through Psychology in Partial Fulfilment of the Requirements for the Degree of Doctor of Philosophy at the University of Windsor Windsor, Ontario, Canada © 2013 Elisabeth Mundorf Childhood Abuse Survivors’ Experience of Self over the course of Emotion Focused Therapy for Trauma: A Qualitative Analysis by Elisabeth Sylvia Heidi Mundorf Approved by: _____________________________________________________ A. Pos, External Examiner York University _____________________________________________________ J. Grant School of Social Work _____________________________________________________ C. Senn Department of Psychology _____________________________________________________ A. Pascual-Leone Department of Psychology _____________________________________________________ S. Paivio, Advisor Department of Psychology September 6, 2013 iii Author’s Declaration of Originality I hereby certify that I am the sole author of this thesis and that no part of this thesis has been published or submitted for publication. I certify that, to the best of my knowledge, my thesis does not infringe upon anyone’s copyright nor violate any proprietary rights and that any ideas, techniques, quotations, or any other material from the work of other people included in my thesis, published or otherwise, are fully acknowledged in accordance with the standard referencing practices. Furthermore, to the extent that I have included copyrighted material that surpasses the bounds of fair dealing within the meaning of the Canada Copyright Act, I certify that I have obtained a written permission from the copyright owner(s) to include such material(s) in my thesis and have included copies of such copyright clearances to my appendix. I declare that this is a true copy of my thesis, including any final revisions, as approved by my thesis committee and the Graduate Studies office, and that this thesis has not been submitted for a higher degree to any other University or Institution. iv Abstract This study is a qualitative approach to understanding how childhood abuse survivors experience and describe their sense of self, as well as how this experience of self changes over the course of therapy. Participants of the present study were adult clients engaging in Emotion Focused Therapy for Trauma (EFTT; Paivio & Pascual-Leone, 2010) to address psychological effects of childhood maltreatment. The data source was audio-recorded therapy sessions in which clients discussed their experiences of self. The author identified and selected excerpts from these therapy sessions that contained client statements about their experience of self (e.g., perceptions and feelings about oneself, sense of identity, self in relation to others, self-conscious emotions, changes observed in self). These session excerpts were transcribed and analyzed using a thematic analysis methodology (Braun & Clarke, 2006). Analysis of these session excerpts yielded three major themes addressing the experience of self of childhood abuse survivors: an unclear sense of identity, not participating actively in one’s life, and feelings of worthlessness. In terms of the process of change over the course of therapy sessions, analysis of client statements yielded themes relating to shifting blame for the abuse from self to the perpetrator, allowing and expressing emotions, and becoming aware of how positive experiences of self are blocked or disallowed. Near the end of therapy most clients reported changes in their experience of self, including a sense of authenticity and being true to oneself, feeling in control of life choices, and increased self-acceptance. The various themes are described and illustrated with excerpts of client statements. The themes are discussed in relation to current theory and research on the effects of childhood maltreatment, and implications of these findings are explored. v Dedication To my husband, Ryan. vi Acknowledgments I would like to thank all of the members of my committee for their valuable contributions and discussions at the various stages of this process. To Dr. Alberta Pos, my external examiner, thank-you for your thought-provoking questions regarding the role of emotions in defining the self as well as your thoughts on qualitative methodology and how to build upon the work I have begun with this study. To my committee members, Dr. Jill Grant, Dr. Charlene Senn, and Dr. Antonio Pascual-Leone, your feedback throughout this process has been invaluable. I have appreciated the collegial and collaborative atmosphere at my proposal, progress meeting and defense, and how, despite holding differing viewpoints, you all helped me to synthesize a variety of ways of understanding the phenomenon of childhood abuse trauma and EFTT. I have grown as a researcher and a clinician through this project and through the discussions we have held as a committee. To Dr. Sandra Paivio, my research advisor for both my master’s thesis and doctoral dissertation, thank-you for helping me to build confidence in my skills as both a researcher and clinician. I have greatly appreciated your support and encouragement, as well as your ability to stimulate me to think in new ways about my research. Thank-you as well for matching my pace and process as a researcher – you motivated me when I needed a push, and gave me space to reflect when I felt stuck. It has been a pleasure to work with you and I hope to continue collaborating with you in the future. To my friends and family – your support and encouragement these past seven years have been so important to me. I would not have been able to undertake this degree and dissertation without all of you encouraging me. To the many friends I have made in graduate school, internship, and beyond, thank-you for sharing the journey! It has made such a difference to have wonderful people experiencing the triumphs and difficulties of graduate school together with me. A special thanks to my Windsor “family” with whom I shared a home and many adventures – Laura, Cristina, Olivia, Tara, Ashley, and Joanna, among many others – as well as those who shared so many late nights writing at coffee shops in the last big push to finish – Ann, Tiffany, Norann, and Shelley. I am so grateful to have met you all and to have you as part of my life today. To my parents, siblings, and the Mundorf family, thank-you for expressing your love, support, and confidence in me – you have allowed me to know I can succeed at whatever I pursue in life. Finally, to Ryan, my partner of twelve years, and now at last my husband, you have been my rock. Without your calm and caring presence holding my hand as I embarked on this journey, I would not be the person I am today. Thank-you for being willing to support my goals, even though it meant living separately for four years while I pursued my studies. It means the world to me that you have been by my side all these years. I love you and cannot thank you enough. vii Table of Contents Author’s Declaration of Originality iii Abstract iv Dedication v Acknowledgments vi List of Appendices x CHAPTER ONE. INTRODUCTION 1 Objective and Rationale for the Present Study 1 Research Questions 3 Researcher Stance and Assumptions 3 Epistemological Considerations in Qualitative Research 3 Researcher as Instrument 5 Theoretical, Historical, and Cultural Positioning of the Present Study 7 Outline of the Literature Review 10 CHAPTER TWO. LITERATURE REVIEW 11 Theories of Self and Self Development 11 Definitions of “Self” 11 Psychodynamic Views of Self 11 Feminist Views of Self 15 Cognitive-Behavioural Views of Self 16 Constructivist Views of Self 17 Experiential/Humanistic Views of Self 18 Emotion focused therapy 20 Childhood Maltreatment 22 Definitions and Prevalence of Childhood Maltreatment 22 Psychological Outcomes of Childhood Maltreatment 25 Effects of Childhood Maltreatment on Self-Development 28 Self-worth, shame, and self-blame 28 Self-awareness and identity 30 Sense of agency 32 Self-regulation 34 Sources of Disturbance 35 Exposure to trauma 35 Negative experiences with attachment figures 41 Reliance on avoidance 48 Treatment for the Negative Effects of Childhood Maltreatment 52 Emotion Focused Therapy for Trauma 56 The therapeutic relationship in EFTT 56 Emotional processing of trauma memories 58 CHAPTER THREE. METHODS 63 Research Design and Overview of the Present Study 63 Participants 64 Participant Recruitment 64 Participant Inclusion and Exclusion Criteria 64 viii Participant Characteristics 65 Therapy 66 Selection of Data 67 Selection of Participants in the Present Study 67 Selection of Therapy Segments for Transcription and Analysis 71 Data Transcription 73 Analysis and Interpretation Strategy 74 Generating Initial Codes 74 Identifying Themes 75 Creating a Narrative 76 Standards of Trustworthiness in Qualitative Research 77 CHAPTER FOUR. RESULTS 79 Part One: Experience of Self in the Context of Childhood Maltreatment 80 Theme One: Unclear Self-Identity 80 Questioning one’s identity and purpose 80 Something missing inside self 82 Self-doubt 84 Split self 85 The Connection between Unclear Self-Identity and Maltreatment 87 Experiences Lack of support 87 Cutting off emotions 88 Theme Two: Not Participating in Life 89 Dissociative experiences 89 Lack of agency 92 Not expressing oneself 94 Self-sabotage 96 The Connection between Not Participating in Life and Maltreatment 97 Experiences Theme Three: Feelings of Worthlessness 99 Defining self as “bad” 100 Self-criticism 103 Self-blame for maltreatment 104 The Connection between Feelings of Worthlessness and Maltreatment 105 Experiences Direct messages of worthlessness 106 Degrading treatment 107 Unmet attachment needs 109 Part Two: The Process of Change in Experience of Self 112 Note on the Methodology and Research Process 112 Theme One: Shifting Blame for Abuse from Self to Perpetrator 114 Theme Two: Allowing Emotions 119 Theme Three: Awareness of Blocking Positive Experiences of Self 122 Interrupting positive feelings 122 Self-imposed barriers to action 123 Difficulty experiencing positive evaluations of self 124 Part Three: New Views of Self 126 Theme One: Being Myself 127 Authenticity 127 ix Integration 128 Listening to myself 129 Theme Two: Feeling In Control 130 In control of choices 130 Deciding for me 131 Empowerment 132 Theme Three: Self-Acceptance 134 Rejecting perpetrator’s messages 134 Positive self-evaluation 135 Increased self-care 136 Feeling happy 136 Additional Information 140 CHAPTER FIVE. DISCUSSION 142 Understanding the Experience of Self of Childhood Abuse Survivors 142 Emptiness, “Something Missing”, Being “Unreal” 142 Cutting Off Emotions 143 Other-Focused and False Self 146 Powerlessness and Helplessness 148 Shame, Self-Criticism, and Self-Blame 150 Relationships with Attachment Figures 152 Themes on Experience of Self and Implications for Assessment and Diagnosis 154 Implications for Broader Populations 158 Themes on the Process of Change and Implications for Treatment 159 Shifting Blame 159 Allowing Emotions 161 Disallowing Positive Experiences of Self 163 Reflections on the Present Study 165 Cultural Discourse of Childhood Maltreatment 165 Personal Reflection on the Present Study 166 Implications for Training in Clinical Psychology 167 Strengths and Limitations of the Present Study 168 Conclusions and Directions for Further Study 172 References 175 Appendix A. Demographic Characteristics of Therapy Clients 208 Appendix B. List of Low-Level Codes 209 Appendix C. Preliminary Thematic Map 216 Appendix D. Final Thematic Map 217 Vita Auctoris 218
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