Fall 2024 Issue

Intergenerational Trauma
By Taryne Knott, MSSW, LCSW, CCATP
Social Work Today
Vol. 24 No. 4 P. 18

Breaking the Toxic Cycle

Intergenerational trauma first appeared in literature in 1966, when Canadian psychiatrist Vivian Rakoff, MD, was studying psychological distress among children of Holocaust survivors.1 Since then, intergenerational trauma—also called generational trauma—has been defined as the transmission of trauma when an older person unconsciously externalizes their traumatized self into a developing child’s personality, thus transmitting dysfunctional patterns from one generation to the next.2

Intergenerational trauma, particularly related to abuse and neglect within families, is a complex topic. When individuals have experienced abuse or neglect in their own lives, it can have long-lasting effects on their mental, emotional, and physical well-being. These effects can then be passed down to their children and future generations, creating a toxic cycle that can be challenging to break.

Trauma is transmitted in numerous ways, all of which are unintentional. We inherit pain, and when it is not coped with, that pain gets passed on again. Research suggests that applying trauma-informed services influences intergenerational trauma. Such services often incorporate trauma-informed approaches that are based on trauma theory and emphasize understanding the psychological and emotional impact of traumatic experiences.3

An examination of perspectives from care consumers and providers can provide valuable insight as to which trauma-informed services are the most effective.

Trauma-Informed Services
Existing studies have shed light on the benefits of trauma-informed services in addressing the complex and interconnected effects of trauma across generations. Trauma-specific services and trauma-informed care are terms that are often used interchangeably but have distinct meanings. Trauma-specific services refer to clinical interventions that are specifically designed to address the needs of individuals who have been exposed to traumatic stress, while trauma-informed care goes beyond individual interventions and focuses on creating a supportive organizational culture and practice that considers the impact of trauma.

A commonly practiced intervention is trauma-focused behavioral cognitive therapy (TF-CBT). Although TF-CBT is primarily practiced with children and adolescents, it can be used with adults and families. The trauma modality is an evidence-based approach designed to treat PTSD and other related behavioral problems; it’s also been proven to be one of the most effective interventions in reducing trauma-related symptoms and improving overall well-being for those who have experienced trauma. Researchers conducted 25 randomized controlled trials in the United States, Europe, and Africa to compare TF-CBT with other treatment approaches and found that TFCBT outperforms other treatments when it comes to improving children’s trauma symptoms and responses.4

When parents or caregivers are included in the treatment process, TFCBT can play a crucial role in addressing intergenerational trauma. The trauma-informed service equips parents with skills to provide emotional validation, promote healthy coping mechanisms, and foster resilience within the family system. The collaborative approach provided by TF-CBT strengthens the family unit and promotes healing from the inside out.

Additionally, the intergenerational trauma treatment model (ITTM) is essential for addressing the deep-rooted impact of trauma across generations. ITTM stands out from other interventions by blending cognitive-behavioral and psychoanalytic strategies to better comprehend and address the impact of trauma on families.5 The model recognizes the importance of the parent-child bond, thus emphasizing the use of parents as catalysts for change in their children’s healing process. ITTM consists of three phases that include six group-based trauma information sessions, eight individual parent sessions, and eight child and caregiver sessions. This comprehensive approach ensures that both parents and children receive the necessary tools and support to heal from generational trauma.

When individuals go through difficult and traumatic experiences in their early years or when they experience significant emotional neglect, it can influence the way they form attachments with others. Experiencing such adverse events can result in varying levels of security or insecurity in relationships, along with a sense of disorientation or disorganization in attachment patterns, which are closely tied to how our brains and bodies regulate emotions and responses, ultimately leading to a compromised attachment style. Incorporating the parent or caregiver into the child’s treatment, as ITTM does, can gradually repair the child’s attachment that trauma previously damaged.

Evidence-based interventions such as those discussed serve as first-line interventions when treating generational trauma. It’s important to note that the trauma-informed services previously discussed are only a few of many interventions. Research on provider perspectives for a multitude of trauma-informed services is scarce. However, it is ultimately a provider’s role to determine the best form of intervention for affected individuals.

Provider and Consumer Perspectives
A quantitative study compared Adverse Childhood Experiences scores of children and their caretakers by using the family well-being assessment (FWbA), a trauma-informed assessment widely used in hospital programs.6 FWbA assesses for two generations of trauma, evaluates for resilience, identifies patient’s needs, and creates an action plan.6 The results of the study showed that the FWbA was effective in improving the documentation and recognition of intergenerational trauma in hospital settings. The researchers found that the assessment tool proved to be effective in hospital settings, improving documentation and recognition of intergenerational trauma, although some providers were concerned that the screening could result in secondary trauma.

Moreover, a qualitative study examined the perspectives of therapists on the effectiveness of TF-CBT in treating trauma in children. Twelve therapists were recruited for the study and had already been trained in TF-CBT by their place of employment. After undergoing a 12-question interview, the researcher determined that the model decreases traumatic symptoms and increases functioning.7 However, a limitation of this study is the small sample size and lack of diversity. There were only 12 participants in the study, all of whom were women. A larger sample size would have increased generalizability, while a male therapist could have brought a different perspective into the study.

A different study explored consumer perspectives on TF-CBT and found that those who received the intervention did not believe the service by itself was enough to meet their needs.7

Equally important, a mixed methods study analyzed the health care preferences of trauma-exposed women and found that trauma-informed services are crucial for postpartum care.8 Research shows that women who have been exposed to trauma are more likely to seek health care during pregnancy and postpartum as part of their regular care, which presents a pivotal moment in which to implement interventions that address intergenerational cycles of trauma and violence while also encouraging resilience.8 Intervening at that vulnerable yet valuable time to provide support for the mother and child increases the chances of breaking the cycle of intergenerational trauma.

The research revealed that along with trauma-informed services, mothers prefer a holistic approach in their healing journey—one that would include treating the whole person vs one aspect.8 In this case, a holistic approach would include treating such issues as the mother’s physical postpartum needs, mental/emotional needs, and childcare. Therefore, the trauma-informed services alone are not enough to meet their needs.

Deficits in Current Research
The scarcity of information on the impact of trauma-informed services on intergenerational trauma hinders the ability to fully comprehend the effectiveness of such services in breaking the cycle of generational trauma. It leaves significant gaps in knowledge and limits the capacity to provide comprehensive and tailored support to families affected by generational trauma.

There are several existing studies that focus on either intergenerational trauma or trauma-informed services, but only a relative handful of studies have specifically examined trauma-informed services and their effect on intergenerational trauma. Also, most existing research tends to focus more on the mother’s perspective and needs, but there’s little, if any, research specifically exploring or including the father’s viewpoint, let alone the whole family perspective. Incorporating other family unit members, such as the father, into future research will contribute to understanding how generational trauma affects the entire family system and to developing familial interventions.

Applying trauma-specific services has a significant impact on addressing intergenerational trauma in families. It allows providers to recognize and understand the complex dynamics of intergenerational trauma, enabling them to provide more targeted and effective support while also helping them identify potential cases of secondary trauma. For consumers, trauma-specific services create a safe and supportive environment in which their experiences are validated and understood. It empowers them to break the cycle of intergenerational trauma and promotes healing and resilience within their families.

— Taryne Knott, MSSW, LCSW, CCATP, is a Doctor of Social Work student at Spalding University’s School of Social Work, as well as an intensive outpatient therapist and the secretary board member at a Child Advocacy Center. She earned her Master of Science in Social Work from the Kent School of Social Work at the University of Louisville, where she focused on drug and alcohol counseling.

References
1. DeAngelis T. The legacy of trauma. Monitor on Psychology. 2019;50(2):36-43.

2. Greene CA, Haisley L, Wallace C, Ford JD. Intergenerational effects of childhood maltreatment: a systematic review of the parenting practices of adult survivors of childhood abuse, neglect, and violence. Clin Psychol Rev. 2020;80:101891.

3. Holistic.Merriam-Webster website. https://www.merriam-webster.com/dictionary/holistic. Updated August 29, 2024.

4. About Trauma-Focused Cognitive Behavior Therapy (TF-CBT). TF-CBT National Therapist Certification Program website. https://tfcbt.org/about/

5. Scott KL, Copping VE. Promising directions for the treatment of complex childhood trauma: the intergenerational trauma treatment model. Journal of Behavior Analysis of Offender and Victim Treatment and Prevention. 2008;1(3): 273-283.

6. Kottenstette S, Segal R, Roeder V, et al. Two generational trauma-informed assessment improves documentation and service referral frequency in a child protection program. Child Abuse Neglect. 2020;101:104327.

7. Okamura KH, Skriner LC, Becker-Haimes EM, et al. Perceptions of evidence-based treatment among youth and caregivers receiving trauma focused cognitive behavioral therapy. J Child Fam Stud. 2020; 29(6):1712-1722.

8. Muzik M, Ads M, Bonham C, Lisa Rosenblum K, Broderick A, Kirk R. Perspectives on trauma-informed care from mothers with a history of childhood maltreatment: a qualitative study. Child Abuse Neglect. 2013;37(12):1215-1224.