This is getting comical. But never fear! I think this is pretty much it. Next Tuesday, I'll be posting at YA Highway, a kind of summary about things to consider when writing traumatic events and characters exhibiting PTSD symptoms.
Up to now:
Part 1: General facts
Part 2: Types of trama
Part 3: Aspects of trauma that make it more or less likely to have lingering psychological effects
Part 4: Individual factors that make it more or less likely a person will develop PTSD after a trauma
Part 5 A and B: Developmental trauma (some thoughts on Nobody But Us by Kristin Halbrook) and an interview with Kristin herself
Part 5 A and B: Developmental trauma (some thoughts on Nobody But Us by Kristin Halbrook) and an interview with Kristin herself
Part 6: Intrusive Recollection
Part 7: Understanding Triggers
Part 8: Avoidance and Numbing
Part 9: Hyper-arousal
Okay ... so you have a traumatized character, and you want to depict him/her going to treatment. This post is for you.
It is widely accepted that treatment for trauma really can't begin until the person is safe--you can't recover from trauma if you're still IN that trauma. Of course, there's a lot of debate about what "safety" means, and whether we're just talking about physical safety (e.g., not still living in the home with an abuser) or both physical and psychological safety (e.g., is living with a temporary foster family a psychologically safe place to deal with traumatic memories?). We have to use our best judgment and keep doing research on that one.
I'm going to describe prolonged exposure therapy in VERY general terms (that often apply to other research-supported treatment approaches as well, such as EMDR). PE is one of the most well-researched and effective treatments for PTSD in existence. There are other treatments like it, such as trauma-focused cognitive behavioral therapy, which is often used with traumatized children and their parents. These are not the only treatments--but there is SOLID evidence to show they work. And I don't like to waste time talking about stuff that I don't believe has a reasonable chance of working. If you're going to apply another model of therapy, it might be cool to see if there's any research support to show it's effective in treating PTSD.
A two-minute video on prolonged exposure therapy:
Once the person is in a reasonably safe place (i.e., not being re-traumatized), treatment can begin, and it generally includes three phases. If you're writing someone receiving treatment for PTSD, please do not have the person walk right in and start dealing in-depth with what happened to him. Because of those avoidance/numbing symptoms, it's unlikely a person with PTSD would even be willing or able to do that. Also, there's work to be done before you can get to that, because of those hyper-arousal symptoms. You can't dive into the deepest, most dangerous waters before you've given the person a nice lifeboat and a life preserver and a tether to LAND.
What you do first is establish some coping skills. Sure, initially you don't expect a person who's been traumatized to be able to use those coping skills when hyper-aroused, but think of it as planting bulbs in the fall--you don't expect them to sprout until the spring. You work with the person on safety and what's referred to as "grounding" skills. Grounding is all about staying in the present. Examples of grounding techniques include counting (like, bricks in the wall, books on the shelf, tiles on the floor) or focusing on a sensory sensation, like the feel of your butt in the chair and your feet on the floor. Some people use objects to hold them in the here and now, like a paperweight or one of those squeeze balls. There are a variety of means to cope (e.g., breathing exercises), but the goal is to develop a way to "come back" or "stay present" when hyper-aroused, so that you can bring your body and mind back into that comfortable cool zone where logic is possible.
Once those skills are well-established, the person can begin to process and grieve the traumatic memories. Usually, it's good to focus on one event, even if the person is dealing with multiple events. In this phase of treatment, the person is asked to describe, in great, painstaking detail, what happened. The therapist asks questions, but also checks in every few minutes and asks the client to identify her distress level on a kind of scale (subjective units of distress, or SUDS). The client uses grounding techniques to keep herself in the moment, but she continues to discuss the memory and think about it with the guidance of the therapist. She does this over repeated sessions and exposures until she is no longer unduly distressed or impaired by the memory. It usually happens relatively rapidly when done right--this therapy only takes 8-12 sessions in a lot of cases!
Describing the trauma repeatedly (and listening to tapes of that description) is only one part of it--if the trauma has led to avoidance of specific places or situations (e.g., driving at night after a carjacking), the therapist will help the client create a "hierarchy" of feared situations that she will gradually expose herself to, starting with the easiest situation and moving to the hardest.
Symptoms can re-emerge during the processing phase, but the therapist is ready for that and helps the client through it. The final phase is about consolidating those coping skills, increasing positive emotion and social connections, and re-engaging with the world.
Aaaand that's pretty much it. Speaking as a psychologist, I guess what I would beg each and every one of you is to do your research if you're writing treatment for PTSD. There are remarkable resources out there, free and available for use and dissemination.
On Monday, I'll do a little wrap-up and answering questions that have come up. If you do have questions that I haven't answered, today would be the day to post them in the comments section!
Part 7: Understanding Triggers
Part 8: Avoidance and Numbing
Part 9: Hyper-arousal
Okay ... so you have a traumatized character, and you want to depict him/her going to treatment. This post is for you.
It is widely accepted that treatment for trauma really can't begin until the person is safe--you can't recover from trauma if you're still IN that trauma. Of course, there's a lot of debate about what "safety" means, and whether we're just talking about physical safety (e.g., not still living in the home with an abuser) or both physical and psychological safety (e.g., is living with a temporary foster family a psychologically safe place to deal with traumatic memories?). We have to use our best judgment and keep doing research on that one.
I'm going to describe prolonged exposure therapy in VERY general terms (that often apply to other research-supported treatment approaches as well, such as EMDR). PE is one of the most well-researched and effective treatments for PTSD in existence. There are other treatments like it, such as trauma-focused cognitive behavioral therapy, which is often used with traumatized children and their parents. These are not the only treatments--but there is SOLID evidence to show they work. And I don't like to waste time talking about stuff that I don't believe has a reasonable chance of working. If you're going to apply another model of therapy, it might be cool to see if there's any research support to show it's effective in treating PTSD.
A two-minute video on prolonged exposure therapy:
Once the person is in a reasonably safe place (i.e., not being re-traumatized), treatment can begin, and it generally includes three phases. If you're writing someone receiving treatment for PTSD, please do not have the person walk right in and start dealing in-depth with what happened to him. Because of those avoidance/numbing symptoms, it's unlikely a person with PTSD would even be willing or able to do that. Also, there's work to be done before you can get to that, because of those hyper-arousal symptoms. You can't dive into the deepest, most dangerous waters before you've given the person a nice lifeboat and a life preserver and a tether to LAND.
What you do first is establish some coping skills. Sure, initially you don't expect a person who's been traumatized to be able to use those coping skills when hyper-aroused, but think of it as planting bulbs in the fall--you don't expect them to sprout until the spring. You work with the person on safety and what's referred to as "grounding" skills. Grounding is all about staying in the present. Examples of grounding techniques include counting (like, bricks in the wall, books on the shelf, tiles on the floor) or focusing on a sensory sensation, like the feel of your butt in the chair and your feet on the floor. Some people use objects to hold them in the here and now, like a paperweight or one of those squeeze balls. There are a variety of means to cope (e.g., breathing exercises), but the goal is to develop a way to "come back" or "stay present" when hyper-aroused, so that you can bring your body and mind back into that comfortable cool zone where logic is possible.
Once those skills are well-established, the person can begin to process and grieve the traumatic memories. Usually, it's good to focus on one event, even if the person is dealing with multiple events. In this phase of treatment, the person is asked to describe, in great, painstaking detail, what happened. The therapist asks questions, but also checks in every few minutes and asks the client to identify her distress level on a kind of scale (subjective units of distress, or SUDS). The client uses grounding techniques to keep herself in the moment, but she continues to discuss the memory and think about it with the guidance of the therapist. She does this over repeated sessions and exposures until she is no longer unduly distressed or impaired by the memory. It usually happens relatively rapidly when done right--this therapy only takes 8-12 sessions in a lot of cases!
Describing the trauma repeatedly (and listening to tapes of that description) is only one part of it--if the trauma has led to avoidance of specific places or situations (e.g., driving at night after a carjacking), the therapist will help the client create a "hierarchy" of feared situations that she will gradually expose herself to, starting with the easiest situation and moving to the hardest.
Symptoms can re-emerge during the processing phase, but the therapist is ready for that and helps the client through it. The final phase is about consolidating those coping skills, increasing positive emotion and social connections, and re-engaging with the world.
Aaaand that's pretty much it. Speaking as a psychologist, I guess what I would beg each and every one of you is to do your research if you're writing treatment for PTSD. There are remarkable resources out there, free and available for use and dissemination.
On Monday, I'll do a little wrap-up and answering questions that have come up. If you do have questions that I haven't answered, today would be the day to post them in the comments section!
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