Chloe* walked into the room, attractive, articulate and vivacious. I was her psychologist and this was our first session together. It soon became apparent however that despite her bright nature Chloe was emotionally very unstable. She would be sobbing one minute, angry the next and then completely cold the next. Chloe described feeling chronically anxious and she was having trouble coping with everyday life.
It was clear that Chloe was suffering from the effects of trauma but it wasn’t until the next session that she was able to reveal what was troubling her. She had been in a car accident 10 years ago where her father had been killed.
After trying to ignore it for years, encouraged by her family to be strong and just get on with things, it was only now – a decade later – that the pain was beginning to surface.
What is trauma?
In the dreams we have for our life we never include our house being destroyed by fire, getting assaulted while on an outing or seeing someone killed in a car accident. All of these events are horrific and shocking. We expect to see them on the nightly news but not in our own lives.
Psychologist Suzanne Phillips and social worker Diane Kane worked extensively with traumatised couples in the aftermath of 9/11. In their book Healing Together, they describe a traumatic event as “an unimaginable event out of the range of what you (would ever) expect to handle”.
Philips and Kane say that trauma “violates your belief in yourself, your judgement, your body, other people, even higher powers”. They go on to say: “… it deprives you – suddenly and even violently – of what you had. It destroys the sense of safety, predictability and justice that you assumed and expected in your life”.
There are two main aspects that characterise a traumatic event. Firstly the event is life threatening or leads to serious injury for someone. Secondly it creates feelings of intense fear, helplessness or horror.
Many of us will recover in time after a trauma but others will not. They will be left with nightmares, flashbacks and anxiety. If they do not recover from the trauma they may be experiencing what is called post-traumatic stress disorder (PTSD).
One of the foremost authorities on the disorder is the Australian Centre for Post Traumatic Mental Health (ACPMH). They estimate that up to 65 per cent of Australians have experienced at least one traumatic event and around five per cent of Australians have had PTSD at some point in their lives.
PTSD is diagnosed if the person still cannot cope with everyday life a month after the event. They may experience the following symptoms:
• Re-experiencing. Flashbacks, nightmares or symptoms such as panic or heart palpitations when confronted with a reminder of the trauma.
• Avoidance and numbing. Avoidance of anything related to the event, feeling flat, loss of interest in normal activities, a feeling of detachment.
• Being wound up. Difficulty sleeping and concentrating, irritability, hyper-vigilance, being easily startled.
Janet* is a senior trauma specialist with 28 years experience of working with PTSD. She says that people with PTSD may not seem themselves even weeks after the event. There may be a change in their mood or behaviour in some way.
Janet emphasises that avoidance is a big indicator of PTSD. “It is one of the biggest problems,” she says. “People will do anything not to face the trauma.” Examples of avoidance may include drinking more, working longer hours or getting angry a lot. All are ways of avoiding the pain.
When something happens that doesn’t fit the way we know and understand the world, we have to try and make sense of it. Sometimes we do this in unhealthy ways. We might have thoughts such as, “It was all my fault. I should have reacted differently.” We might overgeneralise and think, “No one in the world can be trusted” or “The world is a dangerous place”. Alternatively, we might try to forget that it happened by burying it in the unconscious.
Each of these reactions hampers recovery from the trauma. PTSD is actually not an illness as such; it is a problem with recovery. Treatment is about getting the recovery process back on track.
Janet recommends Cognitive Processing Therapy for treating PTSD. She describes it as a “graded exposure therapy”. This means that the person must be “exposed” to the trauma again by talking through their experience of the event.
“You need to examine all the stuck points, all the ‘shoulds’ that prevent people from healing,” says Janet. For example, someone might think, “I can’t be happy while others have lost everything”. Thoughts like this are bound to keep them stuck.
Janet describes a war veteran who felt that he was weak because he froze during action when a mate was killed next to him. Unconsciously the self-blame provided him with an explanation for an event that he may otherwise have found impossible to make sense of but the self-blame “kept him in the past”.
In therapy sessions, Janet helps the client look at previous life experiences and beliefs and how they were disrupted by the event. Issues that are covered include safety, trust, power/control, self-esteem and intimacy. Together with the client she uses this understanding to integrate the event into the client’s life and change any unhealthy behaviour.
While treatment for PTSD may be relatively straightforward and only require 12 sessions, complicating factors such as grief, anxiety, depression or substance abuse make treatment longer and more complex. It is highly recommended by most practitioners that psychological treatment be sought before considering the use of medication.
How you can help ?
If you have a loved one who has been through a trauma, try to keep life as normal as possible after the initial period of acute distress. It generates a feeling of psychological safety if there is a routine to “hold” the person.
In the book Post Traumatic Stress, trauma experts Stephen Regel and Stephen Joseph say, “There is overwhelming evidence that has shown that social support is a major protective factor following exposure to traumatic events”.
You might show your support by making their favourite food, putting on their favourite music or making a cup of tea and just sitting together. You could take up the slack for them if they are having trouble focusing by, for example, paying the bills, checking the children’s homework or keeping the daily running of the house on track.
Encourage your loved one to take care of themselves and to share meals with you. Support them in getting back to work. Encourage and affirm any positive changes, saying things such as, “That’s great you went out with your friends” or “You look really refreshed after your walk”.
Listening is really important. It can be hard to know the right thing to say but actually there is no right thing. Just listen intently without interrupting. Let them know you are trying to understand.
You can affirm that you understand by saying things like, “This is really awful. It must be so hard going through something like this” or “It must seem overwhelming at times. It must be hard to feel like you will ever get through it”.
Don’t say things like, “I know how you feel” or “It’s all going to be okay” or “You just need to get on with things”. You don’t know these things. Also, avoid giving examples from your own life. Keep the focus on them.
Remember that you don’t have to fix it for them or make the pain go away. If you pressure someone to feel better they will feel like you can’t tolerate their pain or that there is something wrong with them so they will stop talking to you and may push their feelings away or pretend that all is okay when it is actually not. This will make healing even more difficult.
Be prepared for them to get upset as they talk. This is okay. Don’t let it make you feel you have done the wrong thing by talking to them. They are just processing the event.
Your loved one may seem disinterested or distant after the event. This is not a rejection of you and does not indicate a loss of interest in the relationship. They are just trying to avoid pain by shutting down and withdrawing.
If the person is angry you do not have to put up with this. Anger doesn’t help them work through things. Anger is a high-energy state and people unconsciously use this to avoid the lower energy state of vulnerability or pain.
By putting up with their anger, you’re actually helping them hide the problem. Instead, let them know the way they are speaking to you is not okay. Say, “Let’s continue this discussion when you’re feeling a bit calmer. I’m going to leave and let you calm down and we’ll have a chat about it again later.”
My client Chloe, took many months to heal. She had grief to deal with as well as the PTSD. But she was training as a veterinary technician and her passion for her work made her determined not to let the past trauma prevent her from reaching her future goals.
How to help yourself after a trauma:
1. Recognise and acknowledge that you have been through something traumatic. Don’t minimise it.
2. Take more care than usual since you are more prone to accidents and illness after a trauma.
3. Avoid stimulants such as coffee and cigarettes; you are stimulated enough.
4. Don’t use substances such as alcohol to numb the pain.
5. Plan your days to give structure around the inner chaos.
6. Don’t isolate yourself; spend time with other people.
7. Avoid making big life decisions at this time.
8. Get support. Talk to your GP or contact Lifeline on 13 11 14.