Australia Counselling member Francess Day speaks with us about trauma: what it is, how it shows up and what trauma treatments are effective.
What is trauma and how can it affect an individual?
Trauma generally involves an event or prolonged period where you feel helpless, shocked or even experience a threat to your life. The latest diagnostic tool DSM V has broadened the criteria that can lead to Post Traumatic Stress Disorder (PTSD).
Childhood sexual abuse is foremost in the media currently and often causes complex PTSD. However, even being made redundant from a lifetime of employment with government, has proved to cause PTSD in people, especially when redundancies first began. Until then it was a common perception that a job with a government department was a job for life.
The word picture of an earthquake shattering a person’s world, including beliefs, ability to function at one’s normal level of competency and usual way of relating to others has been useful to many people. Generally, events involving human violation inflict a stronger traumatic effect than do natural disasters.
Often a natural disaster involves more than one individual and attracts community and family support, which are all factors known to enhance recovery from trauma. Previous traumas can complicate an individual’s resilience or ability to recover from a simpler form of traumatic event.
Complex PTSD often involves a lonely life-long struggle with self-esteem, depression, anxiety and relationship problems. When trauma continues along the life path, a person may be diagnosed with personality disorders. Children are often isolated and controlled with threats to maintain secrecy, which deprives the trauma sufferer from necessary support. The prolonged, repeated nature of child abuse is also a major cause of the complexity of the PTSD reaction.
Does everyone respond to trauma differently, or are there common responses?
Everyone has an individual journey in that some PTSD symptoms may not show up, or may occur at different timings. People may be plagued by some re-experiencing symptoms such as: flashbacks – intrusive painful memories, reliving the past, nightmares, psychic collapse due to trauma related stimuli, or emotional restrictions. There a number of dimensions of avoidance, which a person may understandably adopt and include: aspects of the trauma not remembered, loss of interest in things, disorientation, alienation from others, feeling emotionally dead, and a sense of no future.
Other difficulties result from the above symptoms including: sleep problems, irritability, temper outbursts, lack of concentration, increased wakefulness, strong reactions to fright, hypervigilance, and physical reactions to trauma related stimuli.
When someone is traumatised, what do they need from friends and family?
To be accepted where one is at, and to be listened to empathically and patiently because sometimes a traumatised person’s talking may seem to be rather repetitive. As a therapist, I’ve found that relationship therapy has become a powerful tool in working with trauma clients. Judith Lewis Herman also begins her book Trauma and Recovery, stating that relationship is foundational to trauma recovery.
Like in groupwork, having more than one person empathise, validate and respond helpfully, seems to multiply the “being understood” aspect.
A major additional help in bringing a person that you live with is that they gain a deep understanding and empathy, plus the skills to keep making the communication an effective form of “processing”. To have somebody “share” this part of the journey is therapeutic, but even more so when that witness is a significant other.
My workbook: “Put together your own life: recover and rebuild life after trauma” has some useful chapters on how family and friends can best support a traumatised person.
What are some of the most common misperceptions about trauma?
There are many misperceptions but it is important to note some, such as:
Time will heal the trauma. In fact, further compounding of PTSD can occur particularly if defence patterns sabotage relationships or lead to a person being re-traumatised, such that as time goes by, a simple trauma can result in complex PTSD.
If you just forget about it, all will be OK. Again the above can occur, but additionally the traumatised person can feel let down by family and friends giving this advice. This can lead to you becoming quite alienated, and also be deprived from the therapeutic effect of active processing, which occurs through talking about reactions and feelings.
Everyone who experiences a traumatic incident will develop post-traumatic stress. In fact, with the right supports, personal resilience factors and good coping skills from immediately following the trauma, not everyone does develop PTSD.
The only effective treatment for post-traumatic stress is long-term trauma treatment. It’s not true that you have to re-experience or remember everything that happened during your traumatic incident(s). The reality is that different people and different types of trauma need a variety of therapy options that address the individual’s personality, coping style, resources and many other factors.
There are only negative effects from trauma. This is often true in the short term, however there are many examples of increased personal depth, and life enhancements that can be derived from what has been termed ‘post-traumatic growth’. Like a number of therapists, I can directly attribute the effectiveness of my counseling work as a trauma specialist to the learning and broadening of my experience derived from a long journey from a shocking trauma.
How does therapy help when someone has experienced trauma?
To recover from a trauma or traumatic event, a person needs to rebuild a sense of safety, trust and control in regards to self, others and life itself.
Usually people need find some meaning or way of integrating the experience into their broader life picture or journey. A therapist with the knowledge and skills to facilitate the above without pushing the person too quickly can assist the person to process the trauma quicker and hopefully more constructively than without therapy. If the person’s natural support network cannot meet the changed needs of the person, a therapist becomes an extremely important relationship as described above.
An experienced therapist can monitor unhelpful beliefs, assess for risks such as depression, suicidality and risky behaviours, and facilitate constructive coping skills. Most importantly, a therapist with a deep understanding of the nature of PTSD can normalize various phenomena when the person fears that they are ‘going crazy’. Good clinical judgment by a therapist involves helpful questions and prompts rather than the natural responses from people without a good working knowledge of PTSD which sometimes leave a person feeling re-traumatised or other detrimental reactions such as defensive, angry, or let down.
Is there a certain type of therapy that is more effective for the treatment of trauma than other types?
My thesis set out to investigate precisely this question, and what the evidence revealed was that no particular therapy works for everyone. The naturalistic research study included 22 participants who were experienced trauma therapists. Focus groups discussed these questions and also described how they determined successful and poor outcomes.
The main component of therapy that was attributed to effectiveness was that of the quality of the relationship coupled with a good understanding of traumatic effects and recovery processes. Many therapists used psychodynamic approaches. My research participants and my own practice have seen both the talking through “processing” of the trauma material and also the somewhat opposite technique of EMDR to be effective.
It seems that there is a time for both approaches and of course, client personality and life circumstances also need to be taken into account when selecting techniques. Other non-verbal techniques like art, music and dance were also described as effective. Numerous Cognitive Behavioural Techniques (CBT) form the basis of counselling approaches, but in working with trauma; Psycho-education is an important component both in the early stages and throughout the “meaning-making” processing.
photo credit: Sascha Grant