“Sounds like interesting work Tony, do you have a particular way of working with individuals returning from combat?’ (end quote)
I have always been somewhat bemused by the debate about how to treat trauma. I find it quite easy to work with and I think I have been reasonably successful in doing so. My view is that trauma debriefing is a natural human process anyway which makes the counselling process easier and more likely to succeed.
Humans when they have been traumatized in some way will most often spontaneously engage in the reparative process of trauma debriefing. Hence the goal of the therapist is basically to make sure the natural process proceeds as it should. They are kind of just helping the natural process along and are a bit of a bystander in this way, unlike other counselling situations.
Once the shock has subsided and any serious physical damage is made reasonably stable then the person as I said will spontaneously engage in remediating their damaged psyche. The steps basically are.
1. The person enters into the relational. That is they do not isolate self and seek out others to engage in about talking about the traumatic episode. Here the therapist is looking out for things like a Be strong, Don’t trust or Don’t be a child script messages. People with these may falter at this first stage by tending to isolate self and not seek others out to talk about the incident.
2. They talk about what happened and this can be as basic as describing what physically happened in the event. What were their reactions to what happened and so on.
3. Cathartic release. Whilst doing number 2 most people will begin experiencing feelings and then one wants some kind of cathartic release of emotions. Some can falter at this stage because they have a Don’t feel message of some kind.
4. The get a sympathetic response of some kind by the other person they are talking to.
And that is about that. To me it all seems rather simple and uncomplicated. The person will do the same process a number of times over weeks or months and after that the debriefing is usually complete.
As I said before I think this is a natural human process. Watch people after a car accident. Most will automatically seek others out, want to talk about the event, show some emotions and want to get reassuring hugs which covers the four points I mentioned above.
I now regularly use FaceBook and Google Earth with clients usually as a home work exercise. When ever I hear an angry client say they are going to cut up and burn all the photographs of their ex-partner, I usually counsel them to save at least a couple. Such photographs can be used in a therapeutic way later on.
As I have said before I have always used photographs in therapy with clients. They can be most helpful therapeutically. With the proliferation of the internet I now use FaceBook and Google Earth (along with blogs, websites, linkedin, YouTube, TrueLocal and all the other networking sites) almost on a daily basis.
For homework I may suggest a client does a search on FaceBook for a person they have been discussing or suggest they search on Google Earth for a particular place or location. This can form the same therapeutic function as suggesting the client to get some photographs they may have of a person or a place that is psychologically important for them.
These can serve a number of therapeutic functions. Whenever a client says, “I am never going to see him again”, the first thing they need to do is see the person again. One way to do that is through a FaceBook search. Even if the search comes up with nothing, therapeutic gain has been achieved. The person has actively set out to find the feared or disliked other by the very act of doing the search and thus there is psychological impact on their Child ego state.
Why is there a psychological gain? In Gestalt terms it brings the issue to the foreground of the psyche. It makes the person or place front and centre in the persons psychology. Over time people will unconsciously neatly pack away the painful person, event or relationship into a safe place in the psyche. By searching for them and maybe finding them on FaceBook or seeing the place on Google Earth that painful person, event or relationship is unpacked from the psyche and comes to the fore front of the mind.
When this is done the personality is destabilised and the person is primed for psychological change. They are placed into a frame of mind where psychological change is more likely to occur. I have discussed this on YouTube before.
By searching for the person, maybe seeing their picture and even talking to them the Child ego state is destabilised and thus ready for change. By seeing the place (house) where the abuse occurred the Child ego state is destabilised and ready for change.
Secondly, when an event occurs, over time the Adult ego state memory of it fades. When that happens the Child ego state will start to fill in the gaps, but the person will perceive these as Adult facts not Child ego states ‘fill ins’. As the Child ego state fills in the gaps it will structure the memory of the person or event such that it fits the life script and thus problems are solidified by a past memory that isn't even true at least to some degree. FaceBook and Google Earth can allow for an Adult ego state update.
Say the person was bullied by someone at high school. That bully may be remembered 20 years later as a big and overpowering person. To be seen years later on FaceBook the new Adult facts obtained can significantly reduce the Child ego state memory of the over powering person they were.
A person involved in a car accident at a particular intersection. Since then they avoid that intersection by driving other ways to get home. Google Earth is a good way to go and see that intersection again. Thus FaceBook and Google Earth have direct therapeutic uses in the trauma debriefing process.
Related to this it can help in doing goodbye work. In working with a recent client it became apparent that she still had a significant attachment (and love) to the first real love of her life. A teenage 3 year relationship that was semi abusive, where she fell deeply in love with him. In the past I would normally suggest she does a ‘drive by’. That is go and drive by the house where he now lives. However in this instance she did a FaceBook search, found him and became his FaceBook friend.
She saw some old photos that he had on his FaceBook and saw him as he is now. The Child ego state fill ins of her memory were dissolved. After a number of discussions with him she came back to therapy and said, “How did I ever fall in love with him!”. Combining this with 2 chair regressive goodbye work in therapy and that chapter in her life was quickly closed. The attachment was dissolved and she was this more able to attach with her current partner.
This post will not make sense unless you have read the previous two before it.
The previous post on a model for trauma debriefing relates to only one type of trauma. That is either single incident trauma or an ongoing trauma that has since ceased.
Single incident trauma is just that, a single incident. Examples may be an abduction, serious car accident, airline or train accident, an assault or rape, or some life threatening incident such as a terrorist bombing. Usually these are unpredictable, occur quickly and then end in a relatively short space of time. That is they do not continue over weeks or months or years. It is not uncommon to get clients with this type of traumatic experience presenting for treatment.
Indeed the research indicates that it is best to begin the debriefing process within 72 hours of the event occurring, if that can be arranged. If the debriefing does not occur within 6 weeks then it is seen that the personality adjusts and incorporates the traumatic reactions into it. Thus the reactions become ego syntonic and do not remain ego dystonic and thus they are harder to remedy.
The model described below is particularly relevant to this type of trauma . I would suggest however that most trauma is not of this kind. Most often the traumatic event(s) extend over a prolonged period of time and involve a whole series of single traumatic events collected together. So one ends up with not a single traumatic event but a period of time where there was a number of traumatic events collected together.
Examples of this may include ongoing legal battles, marital problems, bullying, imprisonment, difficult pregnancy, protracted life threatening illness, political harassment and can occur in some occupations such as in the military, the police or the ambulance service.
The model described below is relevant for these ongoing trauma periods as long as it is definitely over. For instance the person has left the military, the marriage is over, the baby has been born healthy, or the legal battles or bullying have ended. One can then set about resensitizing the Free Child again using the model described before.
Not uncommonly however a therapist will be dealing with a client who is in the middle of a series of traumatic events and not at the end of it. Such as employees who are sent for counselling because they are on stress leave from work. In such circumstances the therapist is not suggesting trauma debriefing. Even if they did it would not happen because the Free Child of the client simply will not go there. As mentioned before the FC has partitioned itself off and it simply will not even consider coming out of hiding until it sees that the environment is no longer threatening like is has been.
Balancing act
The therapist does not seek to resensitize the Free Child like described before. One does not do trauma debriefing but instead does trauma management and this can require some therapeutic skill at times. One walks that fine line with the client between assisting the Free Child to hide but also wanting the Free Child to be resensitized enough so as to avoid some of the PTSD symptoms that will develop is the Free Child hides too deep for too long.
