Moving On From Trauma Bill O'Hanlon, M.S. LMFT
Possibilities, 551 Cordova, # 715, Santa Fe, NM 87505 505.983.2843; Fax 505.983.2761; PossiBill@aol.com
[Feel free to share this handout with others; please keep my name and contact information on it and contact me specifically to get permission to use it in any money-making activity]
1. Nobody can tell you the "right" or best way to respond to trauma. And not all the effects of trauma are necessarily bad. Some people move on relatively easily and quickly from trauma and some seem to never get over it. Some people use the trauma as a wake up call to re-examine and change their lives, say someone something they haven't said and needed to say, or to work to help others. Other people withdraw from others, become embittered and are haunted by the event or incident for the rest of their lives. These are all within the range of human responses and are all valid responses. Having said that, most people can and do get over trauma. There are many ways to move on and get over trauma.
One of the first suggestions then is to just let yourself feel what you feel, think what you think, and so on without trying to judge it, fix it or correct it or be bamboozled by "experts" who think they know more about your trauma experience and recovery than you do.
2. Next, many people resolve trauma not by revisiting the past, but by connecting to a future with possibilities and meaning. Viktor Frankl spoke powerfully about this in his work and in how he and others made it through the atrocities in Nazi death camps. You might try linking the post-trauma experience to things that help move you into the future, for example, every time you catch yourself having a flashback, you could take one action that might move you a little way toward your preferred future. Find something that gets you through the day, the night or the decade because it gives you a sense of hope and possibility for the future.
3. People often get stuck in post-traumatic experience as if they are "frozen in time," that is, they repeat the same feelings, thoughts, actions, interactions, images, and so on. One way to get unstuck is to change any part of the repeating pattern in any small way you can. Focus on some other image, change one small action, think something different, change your language slightly, and so on, to break yourself out of the "frozen in time" negative trance. Some suggestions:
--Find anything you do in the same way related to the trauma and change how you do it. --Change what you are paying attention to in the present or in the memory. --Change your thinking about the situation. Do less "all or nothing" thinking and more inclusive or proportional thinking. Embrace seeming contradictions or opposites. --Notice the times when you are doing things that work rather than don't work. Do more of those solution actions. --Many therapists have found that the new, experimental trauma treatment techniques like EMDR, TFT, EFT, NLP's V-K Dissociation and others, while unproven scientifically, work clinically. They seem to work in part by breaking up the neurological processing patterns that have been "frozen in time" in regard to the trauma. Other therapists are angry and hostile to these approaches, considering them hoaxes. So, be a good consumer. There are fanatics and fundamentalists on both sides of the fence. If it works, use it; if it doesn't, move on. Beware of claims of miracle cures and claims of cynics.
4. Many people disconnect in the wake of trauma; disconnect from themselves internally (from their bodies, their feelings, their memories, and so on) or disconnect from others and the world. Without knowing what is best for you, if you have the sense that you have disconnected and that is part of the problem for you, I suggest you take some small steps to reconnect. You might draw upon what you have done in the past to connect with yourself or others (get a massage to reconnect with your body, call a friend and make a lunch date to reconnect with others, and so on).
5. Related to the previous section, some people find it useful to contribute to the world or other people in order to move on or deal with traumatic events. For example, if you were sexually abused, you might contribute money or time to organizations helping to prevent or help people help from sexual abuse. If you feel depressed, you might consider volunteering at a homeless shelter. The people who are volunteering at "Ground Zero," helping feed and support the rescue workers, may be sad and upset, but at least they feel they are doing something that contributes to their and others healing.
6. Healing rituals are a time honoured tradition for resolving trauma. Many cultures have used rituals to help people make transitions and give people a sense of tradition and stability. I distinguish two kinds of healing rituals. The first, designed to bring stability and a sense of connection to people, I called Connective Rituals. The second, designed to help people move on and leave something behind, I call Transition Rituals.
Connective Ritual examples: 1. Do regular volunteer work. 2. Write in a journal daily. 3. Do some regular exercise. 4. Connect with and regularly attend some religious or spiritual services or gatherings. 5. Take regular walks with a loved one or loved ones. 6. Develop a habit of reading aloud to a loved one. It could be a bedtime story, a novel, the Bible, etc.
Transition Rituals examples: 1. Write about the experience of the trauma and aftereffects for a set amount of time each day. When it feels as if you have written everything you have to write, burn the pages and scatter or leave them somewhere significant. 2. Find a picture of you around the time of the trauma. Take a copy of the picture to some place in nature, pray or meditate or grieve about the trauma and then leave the picture at that place by burning it or burying it.
Possibilities, 551 W. Cordova Rd. #715, Santa Fe, NM 87505, Telephone: 800.381.2374, fax 505.983.2761, web site: www.brieftherapy.com
1. 'Uncontrollable disruptions or distortions of attachment bonds precede the development of post-traumatic stress syndromes. People seek increased attachment in the face of danger. Adults, as well as children, may develop strong emotional ties with people who intermittently harass, beat, and, threaten them. The persistence of these attachment bonds leads to confusion of pain and love. Trauma can be repeated on behavioural, emotional, physiologic, and neuroendocriniologic levels. Repetition on these different levels causes a large variety of individual and social suffering.
Anger directed against the self or others is always a central problem in the lives of people who have been violated and this is itself a repetitive re-enactment of real events from the past. Compulsive repetition of the trauma usually is an unconscious process that, although it may provide a temporary sense of mastery or even pleasure, ultimately perpetuates chronic feelings of helplessness and a subjective sense of being bad and out of control. Gaining control over one's current life, rather than repeating trauma in action, mood, or somatic states, is the goal of healing.' Vanderkolk at http://www.cirp.org/library/psych/vanderkolk/
2. 'It seems that Complex PTSD can potentially arise from any prolonged period of negative stress in which certain factors are present, which may include any of captivity, lack of means of escape, entrapment, repeated violation of boundaries, betrayal, rejection, bewilderment, confusion, and - crucially - lack of control, loss of control and dis-empowerment. It is the overwhelming nature of the events and the inability (helplessness, lack of knowledge, lack of support etc) of the person trying to deal with those events that leads to the development of Complex PTSD. Situations which might give rise to Complex PTSD include bullying, harassment, abuse, domestic violence, stalking, long-term caring for a disabled relative, unresolved grief, exam stress over a period of years, mounting debt, contact experience, etc. Those working in regular traumatic situations, eg the emergency services, are also prone to developing Complex PTSD.' from http://www.bullyonline.org/stress/ptsd.htm#PTSD, PDSD and bullying
3. 'Complex Post-Traumatic Stress Disorder (C-PTSD) is a clinically recognized condition that results from prolonged exposure to prolonged social and/or interpersonal trauma, including instances of physical abuse, emotional abuse, sexual abuse, domestic violence, torture, chronic early maltreatment in a care giving relationship, and war. Van der Kolk and Courtois (2005) suggest that C-PTSD better describes the pervasive negative impact of chronic trauma than does Post traumatic stress disorder, as PTSD fails to capture some of the core characteristics of C-PTSD. These include psychological fragmentation, the loss of a sense of safety, trust, and self-worth, as well as the tendency to be revictimized, and, most importantly, the loss of a coherent sense of self. This loss of the coherent sense of self, and the ensuing symptom profile, is what most pointedly differentiates C-PTSD from PTSD.' from http://www.ptsdforum.org/thread5804.html
4. 'Herman (1992) divides recovery from CPTSD into three stages: establishing safety, remembrance and mourning for what was lost, and reconnecting to society. Before this work can begin, a healing relationship must be established; Herman believes recovery can come only within a relationship and only if the survivor is empowered.' from http://suicideandmentalhealthassociationinternational.org/cptsd.html
5. What is Complex PTSD?
'Although there remains debate in the field about the concept of complex PTSD, there are strong proposals for its eventual inclusion as a formal diagnosis in the diagnostic manual. Complex PTSD (Herman, 1992, 1993), also known as Disorders of Extreme Stress Not Otherwise Specified (DESNOS; Ford, 1999; Pelcovitz et al., 1997; Roth, Newman, Pelcovitz, van der Kolk, & Mandel, 1997; van der Kolk et al., 2005), was originally formulated as a disorder caused by prolonged and extreme stress that occurred across years of development. Some authors have used the term “chronic PTSD” when the term “Complex PTSD” is likely more accurate (e.g., Bremner, Southwick, Darnell, & Charney, 1996; Feeny, Zoellner, & Foa, 2002).
Most individuals with Complex PTSD experienced chronic interpersonal traumatization as children which damages the development of their sense of themselves and of others. Because they experience others, often caregivers who are attachment figures, as causing them physical and emotional pain, or neglecting their needs for comfort and security, these individuals are at risk for developing a sense that they are bad and that others cannot be relied upon (Bremner et al., 1993; Breslau et al., 1999; Donovan et al., 1996; Ford, 1999; Roth et al., 1997; Zlotnick et al., 1996) They have serious dissociative symptoms (Dickinson, DeGruy, Dickinson, & Candib, 1998; Pelcovitz et al., 1997; Zlotnick et al., 1996; van der Hart et al., 2004, 2005). This belief that they are bad and unlovable, and that others are untrustworthy becomes pervasive in how they related to others later in life, and is called insecure attachment. Currently the DSM dissociative disorder diagnoses and PTSD do not address insecure attachment which is so pervasive in people with Complex PTSD. In addition to symptoms of PTSD (Ford, 1999), patients with Complex PTSD have enduring personality disturbances and a high risk of revictimization (Herman, 1992; Ide & Paez, 2000).
Criteria have been proposed for Complex PTSD, and include the following symptom clusters: (1) alterations in regulation of affect and impulses; (2) alterations in attention or consciousness; (3) alterations in self-perception; (4) alterations in relations with others; (5) somatization; and (6) alterations in systems of meaning (Pelcovitz et al., 1997; Roth et al., 1997; van der Kolk et al., 1993, 2005).
Bremner, J.D., Southwick, S.M., Johnson, D.R., Yehuda, R., & Charney, D. (1993). Childhood physical abuse in combat-related posttraumatic stress disorder. American Journal of Psychiatry, 150, 235-239. (a)
Bremner, J., Southwick, S., Darnell, A., & Charney, D. (1996). Chronic PTSD in Vietnam combat veterans: Course of illness and substance abuse. American Journal of Psychiatry, 153, 369-1079.
Dickinson, L.M., DeGruy, F.V., Dickinson, P., & Candib, L. (1999). Health-related quality of life and symptom profiles of female survivors of sexual abuse. Archives of Family Medicine, 8, 35-43.
Donovan, B.S., Padin-Rivera, E., Dowd, T., & Blake, D.D. (1996). Childhood factors and war zone stress in chronic PTSD. Journal of Traumatic Stress, 9, 361-368.
Feeny, N.C., Zoellner, L.A., & Foa, E.B. (2002). Treatment outcome for chronic PTSD among female assault victims with borderline personality characteristics: A preliminary examination. Journal of Personality Disorders, 16, 30-40.
Ford, J. (1999). Disorder of extreme stress following war-zone military trauma: Associated features of posttraumatic stress disorder or comorbid but distinct syndromes? Journal of Consulting and Clinical Psychology, 67, 3-12.
Herman, J.L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress 5, 377-392.
Herman, J.L. (1992). Trauma and recovery. New York: BasicBooks.
Ide, N., & Paez, A. (2000). Complex PTSD: A review of current issues. International Journal of Emergency Mental Health, 2, 43-49.
Pelcovitz, D., van der Kolk, B.A., Roth, S., Mandel, F., Kaplan, S., & Resick, P. (1997). Development of a criteria set and a structured interview for the disorders of extreme stress (SIDES). Journal of Traumatic Stress, 10, 3-16.
Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F.S. (1997). Complex PTSD in victims exposed to sexual and physical abuse: Results from the DSM-IV Field Trial for Posttraumatic Stress Disorder. Journal of Traumatic Stress 10, 539-556.
van der Hart, O., Nijenhuis, E.R.S., & Steele, K. (2005). Dissociation: An under-recognized feature of complex PTSD. Journal of Traumatic Stress, 18 , 413-424.
van der Kolk, B.A., Pelcovitz, D., Roth, S., Mandel, F. S., McFarlane, A.C., & Herman, J. L. (1996). Dissociation, somatization, and affect dysregulation: the complexity of adaptation of trauma. American Journal of Psychiatry, 153(FestschriftSuppl), 83-93.
van der Kolk, B.A., Roth, S., Pelcovitz, D., & Mandel, F. (1993). Complex PTSD: Results of the PTSD field trials for DSM-IV. Washington, DC: American Psychiatric Association.
van der Kolk, B.A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders ofextreme stress: The empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress, 18, 389-399.
Zlotnick, C., Zakriski, A.L., Shea, M.T., Costello, E., Begin, A., Pearlstein, T., & Simpson, E. (1996). The long-term sequelae of sexual abuse: Support for a complex posttraumatic stress disorder. Journal of Traumatic Stress, 9, 195-20. '
Retrieved from http://www.isst-d.org/education/faq-trauma.htm#Complex