Crisis Work With Acute Trauma

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Life is what happens to you just when you have other plans.

Milan Kundera

Here I share my vision and tools for crisis management of acute trauma, mainly the trauma of violence.

Although some things work in long-term therapy.

"The third extra" is a symbol of exclusion from the therapeutic relationship of the diabolical presence of the rapist, leaving room for the light side.

The meaning of crisis work with hot trauma is the propaedeutics of the development of the "heavy tail" effect, when the victim's comprehension of the meaning of the event that has occurred leads to difficult experiences, fixation on the pathological response and its radiating into all aspects of the victim's life.

In shock trauma, the feeling of catastrophe gives a special acuteness to affects, i.e. irrevocable loss of all vital meanings, value orientations and supports. The living space seems to collapse, and nothing but losses is felt. The overturning of the familiar picture of the world can torment the painful experience of wastedness, the futility of a past life, frailty and hopelessness.

In countertransference, there is hopelessness, helplessness, depression.

Sometimes a person just needs time to make sure, to make sure of the safety of his main personal "baggage" and capabilities. And sometimes it can help inventory of the remaining assets, what is expensive and important, and opportunities with a discussion of their significance for the victim.

There are situations when, due to emotional stress, the client is still unable to talk about what happened, he is thrown into a stupor and numbness, or, on the contrary, he is in such an agitated state that he can only operate with interjections and exclamations. If assistance in verbalization is unsuccessful, then referring to a resource episode can sometimes help, although it can be annoying with inappropriateness and incomprehensibility. Also, everyday questions about everyday life help, which make it possible to recreate the microsocial sphere and to ground. Questions about bodily sensations, is it comfortable in the office, is it hot, is it blowing, is it comfortable to sit, about the state in general, about sleep, dreams, nutrition and other symptoms of post-trauma, allow you to reverse the client's attention to himself, to the fact of his existence, on the fact of continuation of life.

It is important to create conditions for a person to have a chance to feel their right to be in this room, that they are expected and taken care of.

"Light step" the therapist means his willingness to quickly retreat from his comments and understanding, if they turned out to be inaccurate, inappropriate, premature, seemed wrong to the client. Prof. activity can be flexibly varied depending on the condition and needs of the victim: for some, verbal support, assessment and explanations are extremely important, for others it is much more important to be able to speak out, for others - to sit in silence, but everyone needs kindness and non-verbal support.

Silent freezing in a non-contact state, numbness signals the client's immersion in the transitional space. Such immersion can also occur with unemotional, monotonous retelling - muttering. “In the center of every person is an element of incommunicado, which is sacred and protected like the apple of an eye” (Winnicott).

If at such moments "mom" does not come for a long time, then the person seems to cease to exist. Therefore, it is important to remind of your presence - by changing your posture, coughing, interjections, simple questions.

By itself, protective inhibition as a decrease in functional lability is the prevention of transcendental exhaustion.

Excessive activity, assertiveness, impatience, in turn, can be perceived by the client as intrusion, destruction, disrespect for space and rights. An obvious picture of what happened to the therapist, voiced prematurely, when the person is not yet able to comprehend the whole meaning of what happened, can intensify splitting and lead to retraumatization with the transfer of the abuser image to the therapist.

I am a supporter of very slow progress, based simply on building a safe space, since fast progress is fraught for the client with the fact that the split-off pieces of the soul can remain hostage to the abuser and, on the contrary, the clothes of the tearing and poisonous rage, the brutal energy of the enemy can inadvertently find shelter in the soul victim.

I mean acute, not multiple early trauma, where the situation is more complicated.

The complication can also arise from the person's feeling that they had alternative behaviors. This is the illusory basis of a person's desire to replay a catastrophic event. It is based on ignoring, forgetting the fact of one's own helplessness and being cut off from resources at the time of injury. It is impossible to admit one's own defeat at once.

Conventionally, with an injury, the time line breaks at the point of impact, and the line of the future turns out to be directed backward, coinciding with the past. Therefore, perspective can feel like a seemingly safer past, which symbolizes regression. There is a hesitation between despair and an insane hope that all of this was not.

The truth is that at the time of the injury, there were NO other opportunities besides those used by the client. For one reason or another, physical or psychological, there were none. These reasons are discussed in therapy as natural, as a given, limited by circumstances. Their analysis can expand behavioral possibilities in the future. But the specific past was limited by the conditions that were available at the time of the injury.

At first, in crisis work, the prevailing distance and counterdependence in relation to the specialist. Extreme alertness up to paranoid syndrome is possible. Paranoia here is an inversion of the feeling of one's depravity and unworthiness. Inadequacy is not emphasized or discussed in any way, or adjusting to fear and recognizing it as a natural reaction to trauma, or / and switching, works.

I consider withdrawal to obsessive rationalization and obsessive reflection as a manifestation of the need to understand, comprehend what has happened, "embrace" and retain affects. Then I bring my simple explanation or description, support doubts and questions. Moralizing is a symptom of losing the sense of one's correctness and confusing one's morality with the immorality of the aggressor. Diffusion of the enemy figure is almost inevitable. Prevention - indignation and anger, with confirmation of the illegality of the other side, lawlessness.

All terminology and analogies with the inanimate world are avoided whenever possible. By virtue of magical thinking, they can be perceived as a seal and a sentence, a confirmation of defectiveness, and resonate with a traumatic sense of hopelessness. The vocabulary is simple, sentences and questions are short, unambiguous and clear.

A certain difficulty in work is created by the fact that if the victim is not in the cocoon of his experiences and contacts the therapist, he often involuntarily tries to control and limit the actions, words and countertransference of the therapist. As a natural trail from the crash and the experience of fear of colliding with unpredictable reality. In countertransference, there is an extremely oppressive influence and tension, causing irritation and a possible desire to show who is the boss here. On the other hand, benevolent attitude and compassion is read by a person without words and is the basis of trust.

Increased the client's need to control the therapy situation and regain the "flight control center" - the natural echo of trauma.

Questions about well-being and the designation of a person's freedom of choice and the exclusive voluntariness of therapy help to get away from this exaggerated need, without the initial requirement of a rigid setting on a schedule, so that the client gets in touch with his own desires and needs, the ability to make decisions. In the beginning, there are breaks in collaboration, when the client does not ask for a new meeting, but says that he needs time to think - fluctuations between trust and fear of getting involved in something dangerous.

The call to learn a lesson from trauma when the person is disorganized is useless. But as a coherent identity and a sense of boundaries are restored, the client has an opportunity for a clearer understanding and a finer assessment of the situation, and therefore building up his personal experience.

At first, if necessary, I bend the lower time limit of the session so that the client does not collide head-on with her (my) inexorable rigidity.

For a situation of a more serious condition, closer to obsessive-compulsive syndrome or reactive psychosis in a hypo- or hyperkinetic form, I propose a clearer and more frequent mode of meetings.

It is very difficult to combine softness, as a symbol of non-violence, with the creation of a feeling of firm support in acute trauma: wherever you throw, there are mines everywhere.

Due to a feeling of inner emasculation and an extreme lack of resources, the client may be steered by the idea of his financial bankruptcy and poverty. This is under discussion.

Thanks to the client for trust and payment "hints" to him that he is recognized as valuable and full.