İhanet Travmasının Psikodinamikleri ve Terapötik Yaklaşımlar

Öz

Fiziksel bir zarara maruz kalma veya buna tanık olma durumlarında hissedilen çaresizlik, dehşet ve korku, sıkıntıdan farklı olarak travma diye tanımlanmaktadır (Krupnik, 2019). Psikiyatri ve psikolojide karakteristik özelliklerine bağlı olarak değişik travmanın türleri (Brooks vd., 2019) ve gelişim süreçlerine bağlı etkileri belirtilmiştir Lebois vd., 2022). Bu travmalardan biri de ihanet travmasıdır (Wills vd., 2022). Ülkemizde çok fazla incelenmemiş olan ihanet travmasının psikodinamik özellikleri ve bunlara yönelik psikoterapi yaklaşımları hakkında bilgi verilmesinin alan uzmanı ve uzman adayları için yararlı olacağı düşünülmektedir. İhanet Travması Teorisine (Betrayal Trauma Theory; BTT) göre, bir kişinin korunması, ihtiyaçlarının karşılanması ve hayatta kalması için güvendiği, sevdiği kişi veya kurumlar o kişinin güvenini, inancını veya huzurunu ihlal ettiğinde bu tür bir travma ortaya çıkmaktadır (Freyd, 1991). Diğer travma türlerinde olduğu gibi ihanet travmasının da kendi içinde çeşitli türleri bulunmaktadır. Bunlar: a) çocuklarda cinsel istismar, b) kurumsal ihanet (akademik ve askeri kurumlarda, hukuki yaptırımlarda ve sağlık sisteminde) ve c) romantik ihanet ve aldatma olarak adlandırılabilir (Schimmenti, 2018). Kişinin yaşadığı istismar, aldatma veya kurumsal ihanet travma türüne, olayın yoğunluğuna veya mağdurun kişilik yapısına bağlı olarak, travma sonrası ortaya çıkacak tepkiler kişiden kişiye farklılık göstermektedir (Freyd, 2017). Çocukluk istismarındaki bağlanma etkisi ile eşler arasındaki aldatma durumundaki bağlanma etkilerinin hasarı ile ortaya çıkan travma etkileri farklı olabilir. Nitekim sadakatsizlik travmasında, öfke, kuşku ve suçluluk duyguları yanında öz de- ğer kaybı da olabilmektedir. Eşin aldatma eylemini kiminle ve hangi ortamda yaptığı, çocuk sahibi olamama veya olma durumu, ihanet travması yaşayan veya yaşatan kişinin küçükken istismara uğrayıp uğramadığı, travma yanında değişik türden bağımlılıkların veya kişilik bozukluklarının varlığı gibi birçok duruma bağlı olarak travmanın etkileri değişmektedir. Bu çalışmada adı geçen travma türlerine yönelik en çok uygulanan terapötik kuramsal yaklaşımlara örnek olarak kabul edilen (1) bilişsel davranışçı, (2) psikoanalitik ve (3) farkındalık yaklaşımları (Briere ve Scott, 2014, s. 87) sunulmuştur. Birbirinden oldukça farklı olan bu psikoterapi yöntemlerinin her birinin temel kuramsal yaklaşımlarının neler olduğu kısaca özetlenmiştir. Sonuç olarak tüm travmaya psikoterapi tedavilerinde yer alan bazı ortak temel değerlerin var olduğu belirtilmiştir. Bu değerler terapötik içsel işleme sürecinde yer alan saygı, olumlu tutum, şefkat ve umut gibi temel insani değerleri kapsamaktadır. Bu şekilde acı çeken insanların korunması mümkün olabilmektedir. Hangi türden olursa olsun tüm terapötik yöntemlerde bulunan ortak temel tedavi ilkeleri olarak şunlar sayılabilir: (a) güvenlik sağlama ve güvenceye al; (b) istikrar sağla ve güvenceye al, (c) olumlu ve tutarlı bir terapötik ilişki sürdür, (d)terapiyi danışana uygun sürdür, (e) toplumsal cinsiyet konularını dikkate al, (f) sosyokültürel konuların farkında olarak hassas ol, (g) karşı aktivasyonu izle ve kontrol et, (h) etik ve bakım standartlarına uygun çalış (Briere ve Scott, 2014). Travmaya yönelik tüm terapötik yaklaşımlarda bu temel ilkelerin kullanılması sürecin sağlığı açısından önemlidir. Aynı şekilde travma sonrası olumlu büyümenin gerçekleştirilmesi için bireyin zorlu yaşam deneyiminde olumlu psikolojik değişimi kendi içinde yaşaması gerekir. Bunu sağlayan değişkenler olarak koşulsuz sevgi ve kabul ile öz şefkatin gerçekleştirilmesi yadsınamaz. İhanet travmasına maruz kalanların da kendisini ön yargısız bir şekilde rasyonalist bir açıdan değerlendirebilmesi gerekir. Bunun da ancak profesyonel bir uzmanın mesleki etik standartlarında uygun gördüğü psikoterapi desteği ile gerçekleştirilebileceği bilinmelidir.

Anahtar Kelimeler

• İhanet travması
• psikodinamik
• terapi yaklaşımları

Psychodynamics of Betrayal Trauma and Therapeutic Approaches

Öz

The helplessness, terror and fear felt in cases of exposure to or witnessing physical harm is defined as trauma, as distinct from distress (Krupnik, 2019). In psychiatry and psychology, different types of trauma have been identified depending on their characteristics (Brooks et al., 2019) and their effects on developmental processes (Lebois et al., 2022). One of these traumas is betrayal trauma (Wills et al., 2022). It is thought that providing information about the psychodynamic features of betrayal trauma, which has not been examined much in our country, and psychotherapy approaches to these traumas will be useful for field experts and specialist candidates. According to Betrayal Trauma Theory (BTT), this type of trauma occurs when people or institutions that a person trusts and loves for protection, meeting their needs and survival violate that person’s trust, belief or peace of mind (Freyd, 1991). As with other types of trauma, there are various types of betrayal trauma. These include a) child sexual abuse, b) institutional betrayal (in academic and military institutions, law enforcement, and the healthcare system), and c) romantic betrayal and infidelity (Schimmenti, 2018). Depending on the type of abuse, infidelity or institutional betrayal trauma, the intensity of the event or the personality structure of the victim, the reactions that will emerge after the trauma differ from person to person (Freyd, 2017). The attachment effects in childhood abuse and the trauma effects that occur with the damage of attachment effects in infidelity between spouses may be different. Indeed, in the trauma of infidelity, there may be feelings of anger, doubt and guilt as well as loss of self-worth. The effects of trauma vary depending on many factors such as with whom and in which environment the spouse committed the act of infidelity, the inability to have children or the status of having children, whether the person experiencing or perpetrating infidelity trauma was abused as a child, and the presence of various types of addictions or personality disorders in addition to trauma. In this study, (1) cognitive-behavioral, (2) psychoanalytic and (3) mindfulness approaches which are considered as examples of the most commonly applied therapeutic theoretical approaches for the aforementioned types of trauma (Briere & Scott, 2014, p. 87), are presented. The basic theoretical approaches of each of these psychotherapy methods, which are quite different from each other, are briefly summarized. In conclusion, it was stated that there are some common core values in all trauma psychotherapy treatments. These values include basic human values such as respect, positive attitude, compassion and hope, which are involved in the therapeutic internal processing process. In this way, it is possible to protect people who are suffering. The basic therapeutic principles common to all therapeutic modalities, of whatever kind, include: (a) provide and secure safety; (b) provide and secure stability; (c) maintain a positive and consistent therapeutic relationship; (d) keep the therapy appropriate for the client; (e) consider gender issues; (f) be sensitive and aware of sociocultural issues; (g) monitor and control counter-activation; (h) work in accordance with ethical and care standards (Briere & Scott, 2014). The use of these basic principles in all therapeutic approaches to trauma is important for the health of the process. Likewise, in order to realize positive growth after trauma, the individual must experience positive psychological change within himself/herself during the challenging life experience. The realization of unconditional love and acceptance and self-compassion as variables that enable this cannot be denied. Those who have been exposed to the trauma of betrayal must also be able to evaluate themselves from a rationalist perspective without prejudice. It should be known that this can only be achieved with the support of psychotherapy that a professional expert deems appropriate in accordance with professional ethical standards.

Anahtar Kelimeler

• Betrayal trauma
• psychodynamics
• therapeutic approaches

Kaynakça

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