Self disclosure and dissociation among trauma survivors: The contribution of attachment and therapy intervention

Many people undergo traumatic events of various kinds, which, unfortunately, leave their deep mark on the victims’ psyches. The key defense mechanism at work during the occurrence of such events is that of dissociation, by means of which a detachment from the event’s raw force is possible, as well as the safeguarding of the person’s psychological wellbeing during the event. This mechanism has multiple and complex physical and psychological implications for the victims following the event, implications that are manifested as, among other things, dissociation from parts of the self and from others (Herman, 1992;Rassin& van Rootselaar, 2006; Steinberg, 1994a; Van Der Hart, 2004).

This dissociation is the foundation of the primary mental struggle of trauma victims, which is expressed as a dialectic of trauma self-disclosure – an inner turmoil and tension between the wish to disavow the traumatic experiences and the wish to articulate them and present them for other people’s consideration (Herman, 1992). The primary goal of this study was to examine the association between the two variables – self-disclosure and dissociation – among trauma victims, and to find out whether this association is moderated by two other variables: attachment style and therapeutic intervention.

People differ in their post traumatic responses, and they differ in the paths of their recovery. These differences are the consequence of complex interrelations between personality traits, the event’s features and environmental factors. In order to cope with the implications of trauma, some of the victims may undergo therapy while others may opt not to (Harvey, 1996). Therefore, in the present study, we examine how dissociation as a response to a traumatic event is the result of the interplay between attachment style and self-disclosure, seen as personality traits; of the number of traumatic events experienced by the victim, as the features of the traumatic event; and of the response of other people to whom the trauma was disclosed, taken as the environmental factor. We also examine the differences between those who underwent therapy and those who did not – both in their dissociative response to trauma and in the level of their self-disclosure.

We began by checking the association between the number of traumatic events that a person experienced and the level of that person’s dissociation. The literature on the subject suggests that exposure to numerous traumatic events may lead to a high level of dissociation (Nilsson, Gustafsson&Svedlin, 2010), and accordingly it was hypothesized that a positive association would be found between the number of traumatic events and the level of dissociation.

As regards personal traits, in the present study we looked into the mitigating contribution of a person’s self-disclosure in generally and the disclosure of the traumatic event in particular. Disclosure contributes to the improvement of mental and physical health, and it is associated with reduced levels of dissociation (Bolton, Glenn, Orsillo, Roemer &Litz, 2003; Grieset al., 2000;Pennebaker, 1993). Therefore, it was hypothesized that a negative association would be found between self-disclosure and trauma self-disclosure, on the one hand,and dissociation, on the other hand. We have also examined the personality trait of attachment style, which was found to be affecting a person’s capability to deal with stressful and psychologically complex situations. This variable is a valuable precursor of the capacity for emotional regulation in such situations, and thus it is associated with the manner in which dissociative symptoms develop, as well as with their severity and magnitude (Besser, Neria& Haynes,2009; Woodhouse, Ayers & Field, 2015). Therefore, it was hypothesized that a positive association would be found between the attachment style – anxiety and avoidance dimension– and dissociation.

In addition, the attachment style constitutes a significant basis upon which a person either initiates or avoids connection. When the attachment style is secure, self-disclosure will be the central strategy for initiating familiarity and intimacy and for preserving relationships, whereas when the attachment style is insecure, the person will avoid initiating connection and experience hostility and distrust in his or her relationships, and accordingly the level of her self-disclosure will be reduced (Bradford, Feeney & Campbell, 2002). It was, therefore, hypothesized that a negative association would be found between the attachment style – anxiety and avoidance dimensions – on the one hand, and self-disclosure and trauma self-disclosure on the other hand.

This study examined an additional, significant aspect that affect the level of dissociation – the environmental factor of the responses witnessed by the trauma victim to the disclosure of his or her traumatic event. A high level of dissociation will be related to a negative response by the person to whom the trauma victim had disclosed the traumatic event (Everill&Waller, 1995; Mueller, Moergeli&Maercker, 2008). That is because a negative response may trigger the victim’s detachment from her close environment and her internalization of the negative messages received (Littleton, 2010; Ullman, 1996). Thus, it was hypothesized that a positive association would be found between the response to the victim’s trauma self-disclosure, perceived as a negative response, and dissociation.

In addition, we examined therapeutic intervention as a significant factor that contributes to the differences in the level of dissociation as well as to the differences in the level of self-disclosure between those who had undergone therapy and those who had not. Our assumption was that therapeutic intervention encourages self-disclosure generally, and specifically the trauma victims’ grappling with the traumatic contents and their disclosure (Bradley &Follingstad, 2001; Farber & Hall, 2002). Therefore, it was hypothesized that a positive association would be found between therapeutic intervention and traumaself-disclosure. Moreover, since therapeutic intervention enables and even encourages the disclosure of traumatic contents, it constitutes a significant and central space in the treatment and processing of trauma and its implications (Bowen, Shelley, Helmes& Landman, 2010). Therefore, it was hypothesized that a negative association would be found between therapeutic intervention and the level of dissociation. Finally, we hypothesized that both attachment style and therapeutic intervention would have a moderating role in the association between self-disclosure and dissociation.

The study was based on a sample of 181 participants, of whom 145 were women and 36 were men, who experienced at least one traumatic event. The number of traumatic life events of various types (sexual abuse, violence, road accident, combat etc.) experienced by the participants ranged between 1 and 17. The participants’ ages were between 18 and 75 years. They were asked to fill out structured questionnaires on demographics, traumatic experiences (Dekel&Hobfoll, 2007), dissociation (Bernstein & Putnam, 1986), self-disclosure (Miller, Berg & Archer, 1983), trauma self-disclosure (Bolton, Glenn, Orsillo, Roemer &Litz, 2003), attachment style (Brennan, Clark & Shaver, 1998), perceived response to trauma self-disclosure (Bolton, Glenn, Orsillo, Roemer &Litz, 2003), and on whether they underwent therapy and the kind of therapy. They were also presented with a questionnaire on the perceived quality of therapeutic intervention.

The study’s main findings corroborate our hypotheses and indicate:1) a significant positive association between the number of traumatic events, the perceived response to trauma, the attachment style – anxiety and avoidance dimensions – and therapeutic intervention, on the one had, and dissociation, on the other hand; 2) a significant negative association between self-disclosure, trauma self-disclosure and the perceived quality of therapeutic intervention, on the one hand, and dissociation, on the other hand; 3) a significant negative association between attachment style – the dismissing kind – and self-disclosure and trauma self-disclosure; 4) a positive association between the perceived quality of therapeutic intervention, on the one hand, and self-disclosure and trauma self-disclosure, on the other hand; and 5) a contribution of the education variable to the predicted level of dissociation.

Several associations, however, were not found in this study: no association was found between the attachment style – anxiety dimension and self-disclosure and trauma self-disclosure; and no association was found between, on the one hand, two examined aspects of therapeutic intervention (undergoing therapy or not, and a sample of participants who said that they underwent at least psychological therapy) and, on the other hand, self-disclosure, trauma self-disclosure and dissociation.

These findings are important for the profound understanding of a complex set of variables that affect the predictability of the extent of dissociation of trauma victims. Dissociation is a condition with severe implications for the victims’ mental and physical health. This understanding of the variables that impact the predictability of dissociation and self-disclosure as a key factor in this variable set establishes extant knowledge and our ability, as researchers and therapists, to aid this population and relieve the distress with which it is forced to cope.

From the perspective of clinical application, the study’s findings may help clinical therapists to better understand the principal variables that affect the prediction of the degree of dissociation, and thus to plan the best interventions for the patients who had been afflicted by trauma. Thus, the findings regarding general self-disclosure and the disclosure of traumatic contents as reducing dissociation stress that these tools are key in working with trauma victims. Moreover, the findings regarding the attachment style as an important factor in the prediction of the level of dissociation contribute to a deeper understanding of the patient’s psyche in its struggle with trauma. Finally, it can be said that a psychological therapeutic intervention that is perceived as significant and effective by the patient indeed can encourage a lower degree of dissociation. Therefore, it can also be said that the therapeutic space is critical for the processing of trauma and for the recovery and healing stages of trauma victims.