This chapter explores vicarious trauma, compassion fatigue, and burnout and the potential impact on professionals who treat victims of military sexual trauma (MST). Professionals who provide counseling to sexual trauma survivors will be affected by the exposure to the personal and, sometimes, graphic accounts of sexual victimization reported by their clients. Although brief exposure to extreme or shocking trauma material can have a significant impact on the helping professional, prolonged exposure to emotional pain and the explicit details of other people’s suffering can be more problematic. Psychologist Jacob Lindy pointed to this concern in his book on treating war veterans with posttraumatic stress disorder (PTSD). Burnout was originally used in the 1970s by psychoanalyst Hebert Freundenberger in reference to occupational exhaustion. Burnout may involve psychological, physical, or behavioral symptoms in both personal and professional settings.

Complex trauma is prevalent in the general therapy population and is rooted in early neglect, and traumas of long duration, resulting in posttraumatic stress disorder (PTSD), dissociative disorders, attachment problems, and personality disorders. This chapter provides information that will help Eye Movement Desensitization and Reprocessing (EMDR) therapists enhance their ability to provide effective EMDR treatment for clients diagnosed with complex trauma who are also dealing with current health problems. It highlights the use of the adverse childhood experiences (ACE) questionnaire, which provides much needed information on childhood abuse, neglect, attachment disorders, PTSD, and dissociation. This questionnaire, when combined with a broad developmental and health history, will be very helpful in case conceptualization and development of targets for work in phases 4 to 7. Additionally, the chapter describes the links between the ACE issues and later health risks and problems that make these clients difficult to treat.

A balanced, more robust policy approach to sexual violence must place a greater emphasis on the needs and well-being of the rape victim. One positive step has been the development and implementation of sexual assault nurse examiner (SANE) programs. Following the assault, victims experience heightened levels of psychological distress and are more likely to experience post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), depression, anxiety, and suicidality. The work of SANE programs is multifaceted, attending to the psychological and physical needs of their patients. Whereas the primary goal of SANE programs is attending to the health needs of their patient, they also receive extensive training in the collection of forensic evidence. The strong emphasis on criminal justice system outcomes and sex offender policies, paired with the substantial stockpiles of unsubmitted and unprocessed rape kits, may appear to undermine the advances of SANE programs.

This chapter discusses major empirical data and studies on the prevalence of sexual assault and treatment for sex offenders and includes a discussion about issues associated with special sex offender populations. The Bureau of Justice Statistics (BJS) suggests that sexual assault includes a wide range of victimizations, separate from rape, or attempted rape. The feminist movements of the 1970s gave public voice to issues of adult sexual and domestic violence. The victim-offender relationship has been shown to be a key factor for violence, apart from depressive symptomatology and other pervasive mental health disorders, such as posttraumatic stress disorder (PTSD), substance abuse, fearfulness, and other somatic complaints. Sexual assault victimization has numerous costs and consequences for the victim, the offender, their families, and society at large. Criminal justice costs of sexual violence include those incurred for law enforcement, court proceedings, personnel, public education, and incarceration of convicted offenders.

The chapters of the book examine neuroplasticity as it manifests in maturation, development, information processing, and the disorders associated with each. Growth, development, and integration of neural networks, as manifestations of neuroplasticity, are the mechanisms underlying consciousness, parenting, interpersonal relationships, and the healing process of psychotherapy. Today, neuroplasticity is increasingly understood to be an underlying mechanism of neurofunction at any age. The adult brain appears to possess a tendency toward neural stabilization, while at the same time maintaining a potential for plastic reorganization. More and more, we see evidence that the brain is capable of reorganization in response to changes in stimulation. Some examples of these changes are dramatic and result, in great part, from the application of sensory stimulation. The robust effect of eye movement desensitization and reprocessing in type I posttraumatic stress disorder is one such example.

Eye movement desensitization and reprocessing (EMDR) therapy may be particularly useful for phobic conditions with high levels of anxiety, with a traumatic origin or with a clear beginning, and for which it is understandable that resolving the memories of the conditioning events would positively influence its severity. This chapter illustrates how EMDR therapy can be applied in the treatment of specific fears and phobic conditions. It discusses four cases where clients actually underwent the dental treatment they feared, most within 3 weeks following EMDR Therapy treatment. The efficacy of EMDR therapy was also tested in a randomized clinical trial among 30 dental clients who met the DSM-IV-TR criteria of dental phobia, and who had been avoiding the dentist for more than 4 years, on average. Clients in the EMDR Therapy condition showed significant reductions of dental anxiety and avoidance behavior as well as in symptoms of posttraumatic stress disorder (PTSD).

When panic disorder is accompanied by severe avoidance of places or situations from which escape might be difficult or embarrassing, it is specified as “panic disorder with agoraphobia”. Despite the well-examined effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in the treatment of posttraumatic stress disorder (PTSD), the applicability of EMDR therapy for other anxiety disorders, like panic disorders with or without agoraphobia (PDA or Pathological Demand Avoidance), has hardly been examined. This chapter illustrates how EMDR therapy can be applied in the treatment of panic disorder with or without agoraphobia. The EMDR protocol for panic disorders with or without agoraphobia is scripted. To determine whether a client suffers from panic disorder with or without agoraphobia, and its severity, a standardized clinical interview, such as the Structured Clinical Interview for DSM-IV Axis I disorders should be administered.

Recent studies on preventing postpartum depression (PPD) and on childbirth-related post traumatic stress disorder (PTSD) have identified the risk factors, including anxiety and depression related, trauma related, family and/or relationship related, and financial and/or work related risks. Primary PPD prevention can take place in a group setting or in an individual setting. The Eye Movement Desensitization and Reprocessing (EMDR) Therapy Protocol for the prevention of birth trauma and PPD in the pregnant woman was designed improve the woman’s performance and reduce risks of childbirth trauma, and strengthen the woman’s resiliency while reducing the negative effects of stress suffered in childbirth. By means of bilateral stimulation (BLS), expectant mothers can both reprocess any maladaptive encoding information that would interfere with future childbirth performances, and anchor positive information associated with images and scenes, which represent personal resources to be used in coping with the critical moments of childbirth.

Trauma refers to exposure to events that pose a significant threat. The Diagnostic and Statistical Manual of Mental Disorders-5 added the contingency that the experience can be based on learning of such a threat to someone with whom one has a meaningful relationship. Trauma can be experienced in a wide range of ways that can be an event, or an abuse experience over a period of time in one's formative years or as an adult, as in childhood abuse or interpersonal violence. Complex trauma and developmental trauma perspectives address these distinctions. The implications for attachment processes in formative years have received more attention, particularly in relation to neurological adaptations. This chapter discusses dissociative symptoms related to anxiety, trauma informed care, post traumatic growth, secondary/vicarious trauma and moral injury. It presents the intersectionality/resilience formulation as a format for diagnosing anxiety disorders from a strength based perspective.