NCAD Spotlight: Intergenerational Trauma Requires Deeper Understanding of Patient`s Family History

Maladaptive coping strategies in patients frequently are a result of the traumatic events experienced by previous generations of patients’ families—a phenomenon known as either intergenerational trauma or transgenerational trauma.

It’s a challenge that requires practitioners to dig deeper in their assessments beyond just the presenting patient and his/her nuclear family, says Alex Ribbentrop, MSW, LCSW, CFTP, owner and psychotherapist at Live Free Psychotherapy in Boca Raton, Florida.

Ribbentrop will discuss the concepts of intergenerational and transgenerational trauma, as well as how personality features may inform a clinical approach and interventions, and more, next month at the National Conference on Addiction Disorders West.

Ahead of his session in Denver, Ribbentrop spoke with Addiction Professional.

[Editor’s note: This interview has been edited for length and clarity.]

Are intergenerational trauma and transgenerational trauma interchangeable terms, or are there differences between the two?

The way I have developed an understanding, they are separate terms with different definitions. Intergenerational trauma is when we are referring to one generation directly influencing a subsequent generation. You can think of it like links in a chain. When we’re talking about transgenerational trauma, that’s a reference to elements skipping a generation. That’s when we say something like there are similarities between a grandmother and grandchild. We’re skipping a generation or two in the middle.

It’s relevant in terms of our conversation and our understanding of intergenerational trauma broadly speaking because it highlights the importance of wanting to look in the past beyond the nuclear family and wanting to get information about generations prior to the presenting family system or individual one may be working with.

Can you provide an example of intergenerational or transgenerational trauma?

Intergenerational trauma is a broad term that covers a lot of territory. What I hone in on the most is the idea that there are patterns of coping mechanisms, beliefs, emotional responses and ways to navigate things personally that are passed from generation to generation. This can be directly or indirectly. A classic example is looking at survivors of the Holocaust, then taking a look at how the children and grandchildren of those survivors have developed coping mechanisms. You see a connection in coping strategies developed out of extreme traumatic situations in the past that are passed from generation to generation. Those coping strategies don’t necessarily fit with the newer generation’s experience, so you have this lack of congruence between a person’s way of coping and dealing with life and their actual experience.

What should practitioners be on the lookout for when assessing patients?

This frame of reference, I believe, can be applicable in the majority of work we do. In one way, shape or form, the perspective is not a brand new one. It’s essentially that we are influenced by factors that include family, genetics and experience. With that perspective, we can apply some of these principles across the board. Again, a lot of what I look at is the power of pattern and where some of these patterns got started. Very rarely do I see an acute presenting issue that is, in and of itself, what it is. Usually, it’s the tip of the iceberg. That is directing us to look beneath the surface and gather some of this intergenerational information, apply some trauma-informed perspectives, and use the collection of that data and understanding to inform our treatment process so—and this is cliché—we are not just treating the symptom or presenting issue, but truly treating those underlying factors that I see spanning generations.

There are a variety of reasons why, for example, addiction is referred to as a family disease. A part of that we know to be a degree of genetic predisposition. There is a part of that has to do with ways of coping and ways of connecting that are passed from generation to generation and involve some form of dependence that manifests in substance use disorder or some other acute form of behavioral acting out.

Do you see any aspects of intergenerational trauma that are commonly misunderstood among practitioners, either in identifying or addressing this type of trauma?

What comes to mind for me is we don’t do things in a vacuum. We do things for a reason. When we have folks who are connected to maladaptive patterns of behavior, coping, perspective, etc., one piece that might be missing from time to time is that a lot of that stuff, especially when we’re talking about trauma, is coming out of survival mechanisms. When we have somebody in a treatment setting acting out all over the place and the clinical team is out of interventions and frustrated by this individual, it is helpful to look at patterns of maladaptive behavior as rooted in survival. These are very powerful forms and mechanisms of behavior and response to the world that at some point were of vital importance, whether real or perceived. It doesn’t just come out of nowhere. That’s acknowledging that some stuff gets passed on. If I have a parent who is reactive because they grew up in an abusive household and that was how they kept themselves safe, I’m not necessarily going to get the best result if I’m solely focused on the child of that parent and addressing that person’s reaction. I have to step back and take a look at where that came from.

We do things for a reason. Survival mechanisms are deeply embedded in our brain, and they’re very, very old. That is a big part of what we are treating—where some of our survival mechanisms got miswired along the way. It can be tough to do some of that rewiring, but it is possible. We have increasing evidence we can point to that tells us that it’s possible as well.