Acute Shock Trauma. Residence. Help

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Acute Shock Trauma. Residence. Help
Acute Shock Trauma. Residence. Help
Anonim

Start here Acute trauma

Shock (acute) trauma is a state (experience) accompanied by a feeling of chaos, loss, bitterness of betrayal and pain of disintegration.

The division of the described stages of recovery from shock trauma is rather arbitrary.

Since shock trauma is a non-experienced situation of undischarged stress of survival, the release can be sudden for the victim and his helper without being tied to the stage.

A person always has the hypostasis of the Inner Healer, therefore it is recommended to rely primarily on it, and only in special circumstances - when unfolding pathological reactions, identification with loss - to seek help from a specialist. Moreover, this is not always a psychologist (since the likelihood of retraumatization is high), sometimes it is more environmentally friendly to turn to a psychiatrist first

Once again, I emphasize that crisis therapeutic work with trauma is advisable after a person's natural resources have been exhausted.

The first, and often sufficient an ambulance for an injured person is HOLDING, support. A "good enough" mother, according to Winnicott, establishes a relationship with the child, called "holding" (from the English hold - to support) - this is a state when all the child's needs are met, he is protected. It is the care and devotion of the mother, who is sensitive to all the needs of the child, who understands his desires and fears, that is the leading factor in the development of relationships. The mother does this naturally and simply: she literally supports the baby's environment, taking care that the world does not "collapse" on him too much. In the relations of the holding, primary identification develops.

This metaphor is relevant for the healing of any person in trouble, regardless of their age: after all, a person really splits and temporarily loses a sense of his identity and security as a baby.

The main tasks for the traumatized person are to restore the integrity of the narcissistic core (identity), natural habitual psychological defenses (adaptive capabilities) and the gradual return of the ability to bear responsibility and make decisions.

Best of all copes with the tasks of the holding natural surroundings victim: family, friends, relatives, colleagues.

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The Jewish funeral rite is remarkable in this respect. The grieving person is freed from troubles and all work, from reading prayers, and does not leave the house. All relatives and neighbors get together for this period. Personal grief, tears are experienced openly. The grieving person is "turned off" from the whole cycle of life, he is "inactive" and focused on the experience of grief. He should concentrate on suffering, grief and memories of the deceased and, if possible, not be distracted from this. In order for the grieving person to read the memorial prayer, it is customary to gather at least ten men in the grieving person's house. This is an opportunity to show your respect and sympathy to his loved ones, to provide tremendous support, not to let them bend in trouble. However, the intensity of mourning gradually decreases, and at the end the person returns to a more normal life.

Consoling the bereaved is a mitzvah of mercy. Entering and leaving the house of the bereaved, they do not say "shalom", do not embrace, they sit silently until the bereaved person begins to speak. They sit on the ground in which their loved one has just been buried, trying, as it were, to approach him, which also corresponds to the "humiliated" state of mind of the suffering. This is one way to express the longing and despair that gripped the orphaned. Those who come to the house silently enter the door, usually ajar, and, without attracting attention to themselves, quietly sit down to share the grief of their neighbor. They try to support morally, calm down and reconcile with the decision of Heaven. Rising before leaving, they say to him: "The Almighty will comfort you along with the rest of the mourners of Zion and Jerusalem."

It is interesting that Judaism's approach to the problem of mourning - dividing it into periods during which the intensity of mourning gradually decreases, the grieving person gradually copes with his grief and returns to normal life - is in good agreement with the concepts of modern psychology.

I would especially like to note that at the first stage, the feelings of the victim are not contained, but are experienced in their entirety openly. And the loved ones present at the same time are, as it were, a confirmation of their "correctness", appropriateness and the fact that the worst will not happen now and here. Psychology, using modern scientific methods and experiments, unexpectedly came to the conclusion that the ancient Jewish structure of dealing with feelings, with grief, is most favorable for a person experiencing trauma.

Recommendations to relatives of the victim

- do not leave him alone, - pay him, if possible and necessary, full attention, or be in his field of vision, - listening without interrupting and maintaining eye contact, - be direct and frank, - to approve of reactions, including aggressive statements, swearing, - show a sincere interest and offer help in everyday matters,

- help maintain control over the situation and make simple decisions, - avoid general phrases, speak essentially in simple sentences, - keep promises (from Finnish-speaking sources)

Second. Therapy of acute trauma with the help of a specialist is not always indicated: a person in this state is supra-vulnerable, the wounds bleed, so it is better to wait until the family's psychological defenses are at least to some extent mobilized in a natural way.

If a natural, normal way, for example, social holding, is not possible, then the task of a specialist is simply provide comfort to the victim, allay their annihilation anxiety and ease the horror of losing control: to hear complaints and lamentations, the content of premonitions, dreams, let cry, hold out a napkin or sit silently with sympathetic attention, making it clear that a person is not alone in his trouble. This is a signal to a person that the universe understands and supports him. The very live presence of a specialist can have a healing effect - it is a message to a person that it is possible to be, a signal that there is someone who is not afraid of such confusion of feelings.

One of the types of consolation is informational support of a person - an explanation of how trauma factors work / affect a person's state, for example, the factor of surprise, natural lack of readiness, lack of moral and physical strength to prevent, special cruelty from the outside, repetition of what happened, etc.

You can talk about ways of solving everyday issues, about those who are around the victim, about his environment, about pressing matters - this grounded a person, returns him to reality.

When a person is traumatized, time for him collapses, perspective is lost, feelings acquire a totally fatal, all-consuming character. Therefore, it may not be superfluous to remind him that this state is not forever, that over time it will change and become easier.

The next stage of help is therapyif it is necessary, the STOP rule is introduced.

The actual therapy begins with containment, discussing what happened in a safe environment.

Traumatic experiences are structured in a special way. When a person gets into a critical situation, stress hormones are released in the body, which enhance the process of memorization by the ancient limbic system of the brain (even if they are repressed). And these memorized experiences are mainly outside the semantic structure of a person: visual, olfactory, sound, kinesthetic. For these alienated mental states to become contradictory objects of self-reflection, they must first of all become linguistically "thinkable". In fact, it is only thanks to the therapist's ability to tolerate such states that they become coherent and "thinkable" for both participants. The therapist's ability to remain witness to the client's retelling of their tragedy is a vital, albeit difficult, first step in making this experience an object of awareness. Thus, containment makes it possible to "translate" the experiences of traumatic events into human language, the language of comprehension, understanding, and digestion of what happened. When using art therapy techniques, drawings are also discussed whenever possible.

When a person gets into trauma, a lot of instinctive energy is released - rage, horror, panic, etc. Even with the best container received from loving parents, a person may not be able to withstand the heat of such a high level of internal energy, and the container stops working: "The container reacts to the intrusion by becoming rigid and refusing to respond to what has entered it, as a result its contents lose their form and meaning" (Bion).

In psychotherapy, the therapist provides a container and helps the client to strengthen their inner ability to handle feelings as if they were an alternative parent, for example, it can be a sympathetic statement from the therapist at the right moment, which shows that the therapist knows and understands deep feelings and suffering. a client that he has experienced, or who are waiting to be experienced. So the therapist gives the client's experiences a kind of temporary shelter in his soul, modulates their severity to an acceptable level, shares verbal or non-verbal feedback.

Dealing with trauma requires extreme care, gentleness, and sensitivity. If in doubt about the appropriateness of the comments, it is best to remain silent. Formal, meaningless phrases can hurt.

The experience of caring for oneself, simultaneously with the feeling of a loving other, also causes a feeling of oneself as a loved one. In the opposite case (with rejection, coldness on the part of the other), the experience of oneself as "bad" arises.

An important point of this stage is the retention of the cause (traumatic event) and effect (the victim's condition) togetherbecause, due to dissociation, a person can repress, lose sight of the cause and be horrified by his own reactions, increasingly fencing himself off from reality and focusing on himself. In this case, he may feel inadequate, even paralyzed by the fear of insanity.

As for evil, such work for a specialist can be accompanied by a dissociative withdrawal into oneself or inattention to the client's material, so it is important here to mobilize your ability to maintain contact with the client and maintain your vitality.

The body, like the soul, is a natural container of a person, therefore body-oriented and bioenergetic therapy is a very successful form of shock trauma therapy.

Fourth stage - with symptoms of PTSD - after the restoration of the client's natural defenses - gradual discharge of blocked energy and integration

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Its goal is to overcome mental suffering, ideas of self-blame, absorption in the image of loss and identification with it in order to return to reality. Acceptance of loss, damage does not exclude that reproaches of conscience, guilt and melancholy can be prolonged. The expected result of such work is the transition to grief and depressive grief and the gradual transformation of experiences into memories, a way out of the victim's position (possibly already outside of therapy).

The client can be explained that experiencing pain and grief is the key to mental integration and express confidence that he will cope with it.

When dealing with trauma, both the client and the therapist must be in a resourceful state. The therapist should be able to withstand the client's strong energies, without extinguishing or shaking them, listening carefully to intonation, understanding semantic, emotionally loaded accents.

In other words, the therapist must be able to touch his own pain in order to be sensitive enough to the client's pain, while remaining in a resourceful state. If the client does not show tears and pain, it means that he unconsciously feels the limitations of the container of the therapist, which is used by that to hold on to his own pain. If the therapist's own human pain is encapsulated, then his psychic energy is spent on maintaining the integrity of this capsule, so as not to splash a single drop of pain on the client, and this may manifest his concern, but contact with the client's pain becomes impossible. In such a situation, the client experiences a rejection of his feelings, and this hurts again, the trust in the therapist collapses. According to the law of symmetry, the client's pain is also encapsulated, which does not mean that the trauma has been healed.

Nevertheless, the encapsulation of traumatic experiences (and their splitting off) is also a psychological defense, archaic, allowing one to postpone the experience of unbearable feelings until "better" times. It is a way to protect and preserve the spirit of life.

Additional difficulty in dealing with feelings can create an overwhelming sensation for the client. premeditated traumatic events. It's about the traumatized person's age-old question For what?! “It implies a special malignancy of the design of the“devil,”the rapist, his non-random choice of the victim. In such a situation, it can be explained that violence, trauma has its own“unconscious”logic, inaccessible to human understanding, which has nothing to do with the victim himself. Or, the reasons for what happened. at least in the first approximation can be named through the designation of the specifics of the offender (drug addict, psychopath, religious fan). As a result, the client should develop an understanding accidentshitting him with a poisonous satanic arrow.

An emotionally rich and exhaustive story about what happened, heard, understood and actively accepted by the therapist, brings the client a feeling of relief, release and some completeness. Affects that have arisen in a traumatic situation and provoked a dissociative reaction should be identified and named. It also notes the moments in which the client maintained contact with the resources in order to integrate them into the reconstructed identity. Then the client will not have an obsessive desire to return to the retelling of what happened again and again.

At the end of crisis therapy, it can be effective to work with parables or fairy tales with themes of trials and healings to restore contact with the spirituality.

Published on the author's website www.annanterapia.fi

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