Carly P. Smith

The Courage to Study What We Wish Did Not Exist

This editorial marks the final issue of Volume 15 of the Journal of Trauma & Dissociation (JTD). Much like the work of compiling manuscripts for this volume, it reflects a collaboration between the editorial assistant (Smith) and the editor (Freyd). We bring to this editorial our perspectives from our JTD work but also our insights from work as researchers of institutional betrayal. Most recently, our thoughts about what it means to be trauma researchers and clinical scientists have been shaped by our efforts to address sexual violence on our own university campus.

Collusion, torture, and inequality: understanding the actions of the American Psychological Association as institutional betrayal

ABSTRACT The Hoffman Report (Hoffman et al., 2015) documented devastating information about the American Psychological Association (APA) and the profession of psychology in the United States, prompting a public apology and a formal commitment by APA to correct its mistakes (APA, 2015). In the current article, we utilize betrayal trauma theory (Freyd, 1997), including betrayal blindness (e.g., Freyd, 1996; Tang, 2015) and institutional betrayal (Smith & Freyd, 2014b), to understand and learn from APA’s behaviors. We further situate this discussion in the context of inequality, both within APA and in American society generally. We detail how the impact of APA’s institutional betrayals extended beyond the organization, its members, and the psychology profession, highlighting the potential for disproportionate harm to minorities, including those who were tortured; Muslims, Middle Easterners, Afghans, and non-Americans who were not tortured; and other minority individuals (Gómez, 2015d). Acknowledging, understanding, and addressing its institutional betrayals offers APA the opportunity to take meaningful corrective and preventive measures. We propose several institutional reparations, including making concrete changes with transparency and conducting self-assessments to inform further needed changes (Freyd & Birrell, 2013). By engaging in institutional courage, APA has the potential to grow into an ethical governing body that fulfills its mission to “advance the creation, communication and application of psychological knowledge to benefit society and improve people’s lives” (APA, 2016).

Experience of a Lifetime: Study Abroad, Trauma, and Institutional Betrayal

ABSTRACT This study is the first to expand the investigation of study-abroad risks to include a range of traumatic experiences for male and female students and to examine effects of institutional betrayal (i.e., an institution’s failure to prevent trauma or support survivors). In an online survey of 173 university students who had studied abroad, many respondents (45.44%, n = 79) reported exposure to at least 1 traumatic experience while abroad, most frequently natural disasters, sexual assault, and unwanted sexual experiences. Of students exposed to potentially traumatic events, more than one third (35.44%, n = 28) also reported at least 1 form of related institutional betrayal, which uniquely correlated with posttraumatic distress in some participants, when controlling for lifetime trauma history.

First, do no harm: institutional betrayal and trust in health care organizations

Purpose Patients’ trust in health care is increasingly recognized as important to quality care, yet questions remain about what types of health care experiences erode trust. The current study assessed the prevalence and impact of institutional betrayal on patients’ trust and engagement in health care. Participants and methods Participants who had sought health care in the US in October 2013 were recruited from an online marketplace, Amazon’s Mechanical Turk. Participants (n = 707; 73% Caucasian; 56.8% female; 9.8% lesbian, gay, or bisexual; median age between 18 and 35 years) responded to survey questions about health care use, trust in health care providers and organizations, negative medical experiences, and institutional betrayal. Results Institutional betrayal was reported by two-thirds of the participants and predicted disengagement from health care (r = 0.36, p < 0.001). Mediational models (tested using bootstrapping analyses) indicated a negative, nonzero pathway between institutional betrayal and trust in health care organizations (b = −0.05, 95% confidence interval [CI] = [−0.07, −0.02]), controlling for trust in physicians and hospitalization history. These negative effects were not buffered by trust in one’s own physician, but in fact patients who trusted their physician more reported lower trust in health care organizations following negative medical events (interaction b = −0.02, 95%CI = [−0.03, −0.01]). Conclusion Clinical implications are discussed, concluding that institutional betrayal decreases patient trust and engagement in health care.

Insult, then Injury: Interpersonal and Institutional Betrayal Linked to Health and Dissociation

ABSTRACT Psychological trauma, particularly trauma involving betrayal, has been linked to health problems. Betrayal trauma is also characterized by dissociation and difficulty remembering as victims face conflicting demands presented by a harmful but important relationship. Institutional betrayal is related to, but distinct from, interpersonal betrayal and in need of research on its unique effects. The current study has two related goals. First, the association between institutional betrayal and health problems is examined. Second, the previously documented association between institutional betrayal and dissociative symptoms is re-examined, while controlling for betrayal trauma. This study utilizes a sample of 302 college students (70% female, 63% Caucasian) who reported their trauma history (Brief Betrayal Trauma Survey), institutional betrayal history (Institutional Betrayal Questionnaire), distress related to health problems (Patient Health Questionnaire), and dissociative symptoms (Wessex Dissociation Scale). We found that institutional betrayal is uniquely associated with both health problems and dissociative symptoms even when controlling for betrayal trauma exposure. Findings add to the understanding of how institutional betrayal is uniquely associated to trauma-related physical and mental health outcomes. Small effect sizes, likely due to low base rates of health problems and dissociative symptoms in college students, and problems generalizing these results to clinical samples are discussed.

When Home Is Where the Harm Is: Family Betrayal and Posttraumatic Outcomes in Young Adulthood

ABSTRACT Research on institutional betrayal has found that institutional wrongdoing that fails to prevent or respond supportively to victims of abuse adds to the burden of trauma. In this two-study investigation with young adult university students, we demonstrated parallels between institutional betrayal and ways that families can fail to prevent or respond supportively to child abuse perpetrated by a trusted other, a phenomenon we call family betrayal (FB). In Study 1, psychometric analysis of a new FB questionnaire provided evidence of its internal consistency, unidimensionality, and convergent and discriminant validity. The majority (approximately 72%) of young adults abused in childhood reported a history of FB, with an average of 4.26 FB events (SD = 4.45, range 0–14). Consistent with betrayal trauma theory, Study 2 revealed that FB was 4× more likely to occur in relation to childhood abuse by someone very close to the victim (vs. non-interpersonal victimization), with a particularly strong effect for female participants. FB history predicted significant delay to disclosure of a self-identified worst traumatic event (ηp2 = .017) and significant increases in dissociation (∆R2 = .05) and posttraumatic stress (∆R2 = .07) symptoms in young adulthood. Moreover, with FB in the regression models, only FB—not child abuse nor recent interpersonal victimization—predicted dissociation and clinically significant elevations in posttraumatic stress. Findings suggest that FB is a prevalent phenomenon among young adults abused as children and that it explains unique, clinically significant variance in posttraumatic distress, warranting increased attention from trauma researchers and clinicians.

Behind closed doors: university employees as stakeholders in campus sexual violence

Purpose The purpose of this paper is to examine employees’ experiences of institutional betrayal after a campus sexual assault. Design/methodology/approach University employees completed online measures evaluating various attitudes toward the university. Findings The majority of participants reported institutional betrayal in the university’s response to the case. Employees who reported institutional betrayal indicated significantly lower attachment to the university than employees who reported no institutional betrayal. Institutional betrayal mediated the relationship between institutional attachment and institutional forgiveness. Social implications Universities’ failure to respond effectively and promptly to sexual violence does not go unnoticed by employees. Institutional actions after sexual assault have the power to damage employees’ attachment to the university – employees who experienced institutional betrayal were less attached, and ultimately less forgiving of the institution. Universities’ poor prevention and response efforts impact their entire campus community and compromise community members’ ongoing relationship with the school. Originality/value College students’ active resistance to sexual violence on campus is featured prominently on the pages of major news outlets. Yet, less featured in research and media is the impact of campus sexual assault on university employees, particularly after sexual assault cases are mishandled. This study offers perspective on employees’ experiences and reactions after a prominent sexual assault case.