Trauma symptoms are often experienced and viewed as invasive and malevolent. Helplessness, hopelessness, confusion and a condemnation of self for their existence also appear thematic. The initial layer of trauma treatment is frequently the unraveling of self-loathing for the expression of symptoms themselves; survivor and therapist collude in their endorsement of them as being inherently destructive and are to be eradicated. A divergent perspective could be that symptoms are an expression of health versus illness. Viewing the manifestation of PTSD (Post-traumatic stress disorder) as having utility may offer an alternative understanding of the client’s presentation as offering direction to treatment, internal compassion, decreasing fear of symptoms and can foster a relationship between survivor, therapist and Trauma. Additionally, the externalization and personification of Trauma may illuminate the individual functions of client presentation while offering precise direction for treatment.
In the embodiment of Trauma we view it as something that has characteristics and ways of being in the world that are consistent over time and place (and in this case it’s interaction with people). Defining PTSD according the DSM IV is a means of detecting its’ presence in the life of a survivor while establishing a foundation for this discussion. According to the DSM IV(American Psychiatric Association (1994). Diagnostic and statistical manual of mental health disorders (4th ed). Washington DC: Author), diagnostic criteria include intrusive memories, thoughts, or dreams of an event, a sense of reliving it, and intense distress in response to both internal and external cues that resemble an event(s). Individuals may thus become avoidance of triggers or cues, increase isolation, may have a sense of waiting for the other shoe to drop (a foreshortened future) and of being detached. Sleep difficulties are common; mood labiality, and hyper vigilance are also common (American Psychiatric Association (1994). Diagnostic and statistical manual of mental health disorders (4th ed). Washington DC: Author).
Drawing from the concepts of narrative therapy and the externalization of a problem (the person is not the problem the problem is the problem) allows us to develop a relationship with Trauma and to begin to evaluate its’motivations (Playful approaches to serious problems: Narrative therapy with children and their families. Freeman, Jennifer C.; Epston, David; Lobovits, Dean New York, NY, US: W W Norton & Co. (1997). xvii, 321 pp.). Symptoms could be conceptualized as tools utilized by Trauma on our behalf in order to protect us, remind us of our core values, and to ensure that what happened before won’t happen again. It could be argued that the trauma response corresponds to the level of violation on self and values; a profoundly disturbing event calls for a profoundly disturbing response (from Trauma’s perspective). Analogous to the concept of stuck points in Trauma-Focused Cognitive Behavior Therapy (Akin-Little, Angeleque (Ed); Little, Steven G. (Ed); Bray, Melissa A. (Ed); Kehle, Thomas J. (Ed), (2009). Behavioral interventions in schools: Evidence-based positive strategies, School Psychology (pp. 325-333). Washington, DC, US: American Psychological Association, xi, 350 pp.) flashbacks, dreams, invasive thoughts and triggers provide specific information about the violation the client’s event(s) infringed upon them.
The appraisal of an individual who is “symptomatic” of PTSD could render the view that they are sick, crazy or irrational. They might appear dissociative, clinically depressed, anxious, highly reactive or rageful (or all of the above). Both therapist and survivor may be in agreement that these symptoms are a mark of disease, which connotes that alleviation of symptoms is the obvious goal. An alternative view may be that Trauma will relax once there is a degree of trust in self to clearly identify one’s core values, to reflect his/her significance in the world, and in one’s ability to maintain safety. It will refrain from presenting images (flashbacks and dreams) when the stuck point has been identified (will cease making statements that the individual is culpable for what happened once there is a demonstration of mastery over the event, and it will hold back on invasive, persistent thoughts once the survivor is able to look at the event rather than avoiding it. The way in which the symptoms manifest reflect individual values and provide explicit guidance for healing; if therapist and client are willing to work with trauma, listen and absorb the information it has to offer, it will not compelled to invade with such rigor.
In working with survivors, the aspect of their event that is troublesome can be quite specific and idiosyncratic. Additionally, groups of people exposed to the same event often are disturbed by different parts of it. Trauma may be providing images to the survivor in the form of flashbacks, invasive thoughts or dreams to vehemently demonstrate the specific violation imposed by the event(s). Interpersonal trauma such as child abuse, domestic violence, or sexual assault may render someone feeling responsible for what happened to them, feeling dirty or shameful, betrayed, feeling duped or foolish, unimportant or completely exposed. Trauma might be conveying to someone that they are at fault for an assault because it wants the individual to have a sense of mastery or agency. Helplessness is not acceptable to that particular individual and thus blaming the self is an acceptable tone to assume. Repetitive images of betrayal in the context of trauma and the associated feeling of foolishness would reflect Trauma’s attempt to ensure you do not trust people you shouldn’t. Feeling foolish is unpleasant enough to deter us from repeating the same mistake, and from the perspective of Trauma, will maintain inner safety.
The way in which a survivor expresses their PTSD can vary widely and presentations can be very complex and oppressive. Survivors blame themselves for what happened and often enter into treatment with a great deal of shame because they should have “gotten over it” without help. Viewing their presentation as useful, even critical to their treatment trajectory as well as providing specific insight to their core values may offer some relief from shame. Entertaining the possibility that one does not respond to catastrophic events highlights the conceptualization of symptoms as healthy; a non-response would likely be more problematic than the manifestation of PTSD. In other words, Trauma isn’t irrational in it’s assumptions; its’ response is proportionate to the event experienced by the survivor and is working toward rebuilding that which was lost to tragedy.
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