Possibly the most important thing to realise about counselling for Trauma or Post Traumatic Stress Disorder (PTSD – distress caused by trauma that hasn’t resolved within 4-6 weeks) is that you can be trusted to know what’s best for you and therefore the pace at which you feel comfortable. It’s not necessary to work directly with the traumatising event by reliving it. It’s more helpful to work with the effects of the trauma that are being experienced in the present.
Trauma is caused by a highly stressful and/or life-threatening event (either one’s own life or someone else’s). Our usually integrated system of physical feelings, emotions and thoughts separates (dissociation) as a last defense when our usual fight/flight/freeze response hasn’t worked or been available. It’s a survival strategy as the event is too overwhelming. Trauma work involves reconnecting these elements of the self within the trust and safety that exists in the counselling room.
Often people perceive Trauma/PTSD as a personal weakness or failure. It’s neither of these, it’s a survival response when a person’s trusting relationship with the world has been destroyed. A person’s sense of power and control (personal authority) is compromised and needs to be restored. It is normal also for a person’s identity to be challenged and healing inevitably involves some re-evaluation of the concept of self. It’s common to ponder questions such as “Am I good or bad?”, “Who am I?”, “Why do bad things happen to good people?” and “Does my life have meaning?”. This existential questioning is a movement away from roles and towards a more authentic self. Trauma counselling is not about the removal of symptoms, it’s about understanding and acceptance of the person as a whole. Exploration of losses such as the loss of the sense of being the “strong person”, loss of trust, loss of hope etc. is at the heart of the work.
Trauma is often described in a self-defining way e.g. “before” the event or “after” the event. It can re-stimulate past traumas and often isn’t identified as Trauma as the person doesn’t recognise the symptoms. So what are the symptoms?
Symptoms are experienced individually but fall into three categories:
Re-experiencing the traumatic event
- flashbacks/intrusive thoughts or images
- re-experiencing feelings that happened during the event
- emotional distress when reminded by triggers
Avoidance and numbing
- avoiding reminders of the event
- forgetfulness/memory loss
- loss of interest in activities or life in general
- feeling numb/detached
- sense of a limited future (dread)
- use of alcohol/drugs
- being tearful
- sleep disturbance
- hyper-vigilance (being on red alert)
- feeling jumpy and startling easily
- moments of intense bodily heat
Other feelings that are common are guilt, shame, feelings of mistrust or betrayal, a sense of hopelessness or helplessness and feeling alone. It’s not uncommon to experience suicidal thoughts, difficulty concentrating (brain fog) and physical aches and pains.
It’s important to realise that PTSD can be caused by an accumulation of ongoing experiences (such as childhood abuse or domestic violence) as well as a singular event. The sooner PTSD is addressed the easier it is to overcome. If you are worried that you may have PTSD it’s important to visit your GP to discuss medical and psychological treatments that are available. An experienced counsellor can help to normalise the effects of the trauma, help to put it into a context and be alongside someone so that they don’t feel so alone in facing it.