What is Transgenerational Trauma?
Trauma can occur in many forms and often has severe negative consequences for those directly and/or indirectly exposed. Treatment of trauma has largely focused on single present-life traumatic events (e.g., Sloan, Marx, Lee, & Resick, 2018), despite research suggesting that exposure to trauma likely provokes cascading and interactive effects across multiple dimensions (e.g., biological, psychological, philosophical), domains (e.g., interpersonal, family), and systems (e.g., individual, family, community, culture; Masten & Cicchetti, 2010). In this way, trauma-focused treatment often fails to address the vast and long-lasting impacts of trauma.
Transgenerational trauma, or intergenerational trauma, refers to the impact a traumatic experience in one generation can have on successive generations. Frequently discussed examples of trauma transmission stems from research on Jewish Holocaust survivors, genocides, refugees of color, Indigenous Peoples, and African American slavery (Danieli, 1998; Wilkins et al., 2013). How traumatic effects are passed through generations is not yet fully understood. Possible mechanisms of transmission include communication styles in the discussion of the trauma, parenting practices, interpersonal vulnerability (e.g., fear of personal disclosure, distrust of health care providers), biological effects (e.g., epigenetic changes, earlier death rates; DeAngelis, 2019), poverty, and family work burden. Importantly, these pathways hardly occur independently of one another and often require intersectional conceptualizations.
IPV as a Form of Transgenerational Trauma
One common type of trauma that can have lasting effects across generations is intimate partner violence (IPV)—physical violence, sexual violence, stalking, or psychological aggression (including coercive acts) by a current or former intimate partner (Garcia-Moreno, 2006; CDC, 2017). Experiencing or witnessing IPV is associated with a range of negative outcomes, such as greater risk of substance use, poorer mental and physical health, lower relationship satisfaction and quality of life, as well as later IPV perpetration and re-traumatization. It is critical to note that estimates of IPV prevalence vary, with higher rates observed among persons who identify as sexual and gender minorities and those who identify as non-White (Messinger et al., 2011; Smith et al., 2017). This variation, however, is likely an artifact of a variety of social and structural factors rather than a unique and inherent phenomenon within minority groups. That is, individuals within minority groups may come from lower socioeconomic backgrounds, struggle with more mental and physical health disabilities because of inequities, and have limited access to care, all of which can elevate the risk for further transmission of trauma. Understanding IPV from this lens begs the question: How do we effectively interrupt this transgenerational cycle?
Treatment Approaches
Treatment of IPV is typically conducted through individual and/or dyadic modalities. Although these approaches can be efficacious (e.g., Tirado-Muñoz et al., 2014), rates of recovery are limited (e.g., Hameed et al., 2020) and recidivism rates can be high (e.g., Travers et al., 2021). As such, there is a need for additional, more holistic pathways because current practices either miss, ignore, or underemphasize the role of historical and social context. Possible pathways for interventions include individual, group(s), community, and systems. We posit that interventions should consider and include factors that extend beyond an individualistic, present temporal orientation perspective. This more holistic framework is symbiotic with Bronfenbrenner’s ecological system theory (Bronfenbrenner, 1986), which has already been used in relation to domestic violence and child abuse (e.g., Belsky, 1980; Flake, 2005). Bronfenbrenner's ecological systems theory views individual development as a complex system of relationships affected by multiple levels of the surrounding environment, from the immediate setting (i.e., microsystem), interpersonal relationships (i.e., mesosystem), social settings (i.e., exosystem), culture (i.e., macrosystem, and environmental changes over the lifetime (i.e., chronosystem). To better incorporate the cross-temporal/intergenerational effects, we suggest interventions add a particular and explicit acknowledgment of the chronosystem.
Preliminary investigations into interventions that leverage more holistic process-person-context-time perspectives show promising efficacy (e.g., Strengthening Families, Chaplain-Guided Community Moral Injury Groups). For example, Strengthening Families, designed for First Nation and Native American tribes in Canada and the U.S., aims to prevent early substance use by improving family communication, reducing family conflict, and teaching kids substance-use resistance skills. Some psychotherapeutic interventions incorporate a “survival genogram” which is a pictorial family tree used to connect psychological patterns and well-being to family relationships within the context of transgenerational trauma (e.g., the Transgenerational Trauma and Resilience Geongram; Goodman, 2013). In thinking about extrapolations to perpetration of violence, one recent study found a ceremony in which veterans shared testimony on their moral injury with the general public significantly decreased depression and improved self-compassion, spiritual struggles, personal growth, and psychological functioning (Cenkner et al., 2021). These findings provide preliminary evidence of the healing potential of interventions that encompass the broader context of trauma and that provide opportunities for collective/community engagement. Critically, limited financial means, access to health care, and education are just some of the many barriers to treatment for IPV—all of which can be especially pronounced in minority populations.
Authentic healing from interpersonal violence must acknowledge the intergenerational effects of trauma. A multilayered approach that calls on not only the individual but also on domains and systems is a promising way to expand our efforts in stopping the intergenerational cycle of trauma. There is inherent creativity in interventions that are willing to cultivate space through an intersectional and multitemporal lens, which in practice also serves to decolonize trauma-informed care. Considering the individual within the inextricably linked context of community, culture, and history helps to connect to our group identity and place ourselves in a position to find meaning and purpose in the human experience.
“To be” is to inter-be. You cannot just be by yourself alone. You have to inter-be with every other thing." —Thich Nhat Hanh
About the Authors
Samantha N. Hoffman, MS, is a third-year PhD student at the San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology. Her research and clinical interests focus on understanding the development and maintenance of anxiety and trauma-related disorders. She is further interested in clarifying the mechanisms behind treatment response and long-term recovery to inform novel evidence-based approaches.
Dr. Amanda Khan is a licensed clinical psychologist and researcher working in private practice in California and at Sage Integrative Health, a Bay Area holistic psychedelic clinic. She specializes in the assessment and treatment of PTSD, depression, and anxiety and provides depth and somatic-oriented trauma work, ketamine-assisted psychotherapy, and post-psychedelic integration. Dr. Khan has completed ketamine-assisted psychotherapy training with Polaris Insight Center and MDMA-Assisted Therapy with MAPS. Dr. Khan currently serves as Chair for the ISTSS Moral Injury SIG and Contributing Editor for the Trauma and Diversity column of StressPoints. She volunteers her time mentoring minority trainees, has led numerous diversity-related efforts across several institutions, and gives regular invited talks, presentations, and workshops.
References
Belsky, J. (1980). Child maltreatment: An ecological integration. American Psychologist, 35(4), 320–335. https://doi.org/10.1037/0003-066X.35.4.320
Bronfenbrenner, U. (1986). Ecology of the family as a context for human development: Research perspectives. Developmental Psychology, 22(6), 723–742. https://doi.org/10.1037/0012-1649.22.6.723
Cenkner, D. P., Yeomans, P. D., Antal, C. J., & Scott, J. C. (2021). A pilot study of a moral injury group intervention co-facilitated by a chaplain and psychologist. Journal of Traumatic Stress, 34(2), 367–374. https://doi.org/10.1002/jts.22642
Centers for Disease Control and Prevention. Intimate partner violence: definitions. 2017 (https://www.cdc.gov/ violenceprevention/intimatepartnerviolence/ definitions.html).
Danieli, Y. (1998). Introduction: History and conceptual foundations. In Y. Danieli (Ed.), International handbook of multigenerational legacies of trauma (pp. 1–20). Plenum.
DeAngelis, T. (2019, February). The legacy of trauma. Monitor on Psychology, 50(2). http://www.apa.org/monitor/2019/02/legacy-trauma
Flake, D. F. (2005). Individual, family, and community risk markers for domestic violence in Peru. Violence Against Women, 11(3), 353–373. https://doi.org/10.1177/1077801204272129
Garcia-Moreno, C., Jansen, H. A., Ellsberg, M., Heise, L., Watts, C. H., & WHO Multi-country Study on Women's Health and Domestic Violence against Women Study Team (2006). Prevalence of intimate partner violence: findings from the WHO multi-country study on women's health and domestic violence. Lancet (London, England), 368(9543), 1260–1269. https://doi.org/10.1016/S0140-6736(06)69523-8
Goodman, R. D. (2013). The transgenerational trauma and resilience genogram. Counselling Psychology Quarterly, 26(3-4), 386-405. https://doi.org/10.1080/09515070.2013.820172
Hameed, M., O'Doherty, L., Gilchrist, G., Tirado-Muñoz, J., Taft, A., Chondros, P., Feder, G., Tan, M., & Hegarty, K. (2020). Psychological therapies for women who experience intimate partner violence. The Cochrane Database of Systematic Reviews, 7(7), CD013017. https://doi.org/10.1002/14651858.CD013017.pub2
Masten, A. S., & Cicchetti, D. (2010). Developmental cascades [Editorial]. Development and Psychopathology, 22(3), 491–495. https://doi.org/10.1017/S0954579410000222
Messinger, A. M. (2011). Invisible victims: same-sex IPV in the National Violence Against Women Survey. Journal of Interpersonal Violence, 26(11), 2228–2243. https://doi.org/10.1177/0886260510383023
Sloan, D. M., Marx. B. P., Lee, D.J., & Resick, P. A. (2018). A brief exposure-based treatment vs cognitive processing therapy for Posttraumatic Stress Disorder: A randomized noninferiority clinical trial. JAMA Psychiatry, 75(3), 233–239. https://doi.org/10.1001/jamapsychiatry.2017.4249
Smith, S. G., Chen, J., Basile, K. C., Gilbert, L. K., Merrick, M. T., Patel, N., Walling, M., & Jain, A. (2017). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010-2012 State Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
Tirado-Muñoz, J., Gilchrist, G., Farré, M., Hegarty, K., & Torrens, M. (2014). The efficacy of cognitive behavioural therapy and advocacy interventions for women who have experienced intimate partner violence: a systematic review and meta-analysis. Annals of Medicine, 46(8), 567–586. https://doi.org/10.3109/07853890.2014.941918
Travers, Á., McDonagh, T., Cunningham, T., Armour, C., & Hansen, M. (2021). The effectiveness of interventions to prevent recidivism in perpetrators of intimate partner violence: A systematic review and meta-analysis. Clinical Psychology Review, 84, 101974. Advance online publication. https://doi.org/10.1016/j.cpr.2021.101974
Wilkins, E. J., Whiting, J. B., Watson, M. F., Russon, J. M., & Moncrief, A. M. (2013). Residual effects of slavery: What clinicians need to know. Contemporary Family Therapy, 35(1), 14-28. https://doi.org/10.1007/s10591-012-9219-1