What’s Necessary For Effective Treatment Of PTSD

Many models of Post-traumatic Stress treatment are offered to the clients today. EMDR, exposure therapy, Narrative therapy etc. Clients may feel lost and unsure which approach would suit them, and sometimes it takes a while for a therapy selection process to bear fruits.

When I am asked how I work and what it is that I do in my sessions, I generally respond that I am a psychodynamic existential psychotherapist. Confusing heh? How an unsophisticated client is supposed to know what that means? So recently I took time and wrote a more elaborate description on my website describing in few more details what and how we approach in sessions with the clients. I also attempted to say a few words on some focuses in therapy that benefit trauma survivors on their journey of recovery from trauma.

Here are fundamental areas in our treatment that we focus on.

Existential Approach.

In our assessment and focus in treatment we keep in mind our existential needs as humans. It is important for each human to be connected with others, to have meaning in life and to feel independent and free to make choices. Often PTSD strips people off these. People who suffer from PTSD will inevitably experience difficulties in the most or in all of these aspects. Post traumatic stress often causes a person to mistrust others (and their therapists included), and feel loss of control over their lives.

In therapy we explore what makes life meaningful for a trauma survivor and work towards removing the barriers to achieving a meaningful living experience. We also look at making connections with others, overcoming fear of rejection and disappointment in relationships.

Attachment Work.

Insecure attachment is often present for those who suffered from abuse and neglect in childhood. As a result people are trying to protect  themselves by ensuring they won’t get too attached to anyone too much anymore. Frequently the clients don’t even want to bring this issue and discuss it in sessions. I recently responded to a post on a PTSD survivor forum questioning the need to explore an avoidant attachment style in therapy. I said this part of work in sessions was very important because it addressed one of the fundamental tasks for recovery. The forum participant disagreed with me stating that she or he doesn’t see any value in discussing attachment with a “paid stranger”. I wasn’t surprised at such comment. Often the survivor of trauma does want to reduce the therapist to a merely paid professional and nothing more. And it is true, that the therapist is a paid professional. But the need to keep a distance is very strong and needs to be explored. Therapeutic relationship is a good place for that.

Psychodynamic Approach.

Psychodynamic approach is basically analytical work, where therapist and the client analyze feelings and thoughts arising from the situations clients find themselves in. PTSD reactions are very strong and volatile leading people to react with “black or white” strong volatile senses. While our emotional system is impacted by trauma, everything might be interpreted as a need to fight or flee. Sitting down in a moment of discomfort and discussing why something causes a strong reaction  helps a person to shift into more “grey” areas and making sense of things rather than being overwhelmed by them.

Inviting Questions And Feedback.

As a trauma survivor myself I have been in therapy for a few years and it not only has helped me to recover from my own trauma but also taught me how to be a better therapist for my clients. From time to time I visit the PTSD survivors forum to provide peer support and to find inspiration for my blog. I often read people writing about issues in their therapy that I have experienced myself. People writing about feeling misunderstood, judged or angry at their therapists. They also experience so much fear and mistrust in sessions that raising these issues becomes very difficult. They go back to the sessions hoping that the therapist would notice that something is wrong and invite an open conversation. Some of them leave therapy prematurely for being unable to move past an issue and not being able to address it. Frequently clients fear that should they voice something their therapist doesn’t want to hear, the therapist will be mad at them. It is not surprising considering that PTSD symptoms make you vulnerable and afraid.

I always invite questions and feedback from clients. I believe that only good and positive feelings cannot be experienced in therapy.

Inevitably a client will at times feel uncomfortable about the way a session goes, should it be my comments or any non-verbal communication. Inviting an honest feedback doesn’t always encourage people to proceed with it, and I respect that. However it does leave the door open when there is a need and a wish to do that.

If A Particular Form Of Therapy Isn’t Working For You – Move On.

A person suffering from PTSD if often in a vulnerable place and in desperate wish to be supported. Hence why when something in therapy doesn’t feel right people tend to wait it out, and have hope that a relief will come later on. I would encourage all survivors out there to speak up and address your concerns early on. It is much harder (and more confusing) to find an exist out of unhelpful therapy course after some years later than if you do it within the assessment stage. From your first session, ask questions, voice your doubts and uncertainties. See how your therapist responds to these. Does he/she get uncomfortable (or, worse, defensive)? Do you get evasive answers that confuse you more? How safe does it feel to proceed?

Having open conversations within first couple of sessions is vital not only for establishing whether a particular form of therapy is right for you, but also taking steps to take control over your life after traumatic experiences. And it actually feels good!



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