When Psychological Safety is Violated by Authority: A Multiple Case Study of Power-Based Psychotrauma in Adult Clinical Clients

Abstract

Psychological trauma has traditionally been conceptualized as a response to discrete, life-threatening events; however, accumulating clinical and theoretical work highlights trauma that arises from violations of expected care, safety, and ethical responsibility by trusted authority figures. This study examines power-based psychotrauma, conceptualized as a psychological injury that emerges when individuals or systems vested with authority or relational power betray fundamental expectations of protection. Using a qualitative multiple case study design, ten anonymized adult clinical cases were drawn from a private psychological clinic in the Philippines, all involving trauma perpetrated by caregivers, family members, intimate partners, or institutional superiors. Archival clinical case reports, including interview material and psychological assessment data, were analyzed using reflexive thematic analysis to identify patterned meanings across cases. Analysis yielded four interrelated themes: (a) Betrayal of Trust and Violation of Safety, reflecting the collapse of role-based protection when authority figures became sources of harm; (b) Complex Psychological Aftermath, characterized by multidimensional trauma sequelae including affect dysregulation, shame, dissociation, relational mistrust, and disturbances consistent with complex trauma presentations; (c) Powerlessness and Identity Disruption, capturing enduring impairments in agency, autonomy, and self-concept rooted in authority-mediated coercion and dependency; and (d) Coping and Meaning-Making in the Healing Journey, illustrating adaptive and maladaptive strategies through which survivors navigated avoidance, help-seeking, narrative reconstruction, and gradual restoration of agency. Interpreted through trauma theory beyond event-based PTSD, betrayal trauma theory, developmental and attachment frameworks, and clinical meaning-making models, the findings demonstrate that trauma perpetrated by trusted authorities produces psychological injuries that extend beyond fear-based symptomatology and are deeply shaped by power asymmetry and relational context. The study underscores the need for trauma-informed clinical interventions that explicitly address betrayal, agency restoration, and identity reconstruction, as well as ethical and institutional accountability in contexts where safety is expected but violated.