Post-traumatic Stress Disorder

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

This article examines the genesis and clinical phenomenology of post-traumatic stress disorder, as well as the features of therapy for clients with PTSD. A model of psychological assistance to people suffering from post-traumatic stress disorder is proposed

Z., a 35-year-old woman who was experiencing multiple difficulties in her life: extremely expressed anxiety, at times deep depression (which was the reason for the appeal), insomnia, nightmares, applied for help.

One of Z.'s most disturbing symptoms was the constant memories of her father, whom she dreamed almost every day and who died 8 years ago. According to Z., she survived her father's death rather quickly, trying “not to think about it”. In the course of therapy, it became clear that Z. had a markedly expressed ambivalence towards his father. On the one hand, she was a close and dear person, on the other, she hated him for the cruelty he showed towards her.

Before his death, Z. was unable to address her feelings by placing them in a relationship, but after death the situation did not simplify [1], but was simply ignored by Z.

She still couldn't say, "Daddy, I love you," because she hated him with every fiber of her soul. On the other hand, she also could not confess to hate her father, because she loved him very much. Stuck between hatred, rage for her father and love for him, Z. had no opportunity to survive the grief. In a blocked form, the process of experiencing still exists, defining the clinical phenomenology of Z.

After a long and difficult therapeutic work, the focus of which was the possibility of accepting ambivalent feelings, the process of experiencing could be restored.

Experiencing the traumatogenic event underlying PTSD without special help has no prospects in its implementation, since it is blocked by the secondary framework in the form of the following mechanisms:

1) constantly repeating reproduction of a traumatic event in chronic patterns of violation of creative adaptation;

2) sustained avoidance of any stimuli associated with the traumatic event;

3) dulling of the general reactivity, which was absent before the injury;

4) persistent symptoms of increased excitability, etc. [1, 2, 3].

I., 47, a veteran of the war in Afghanistan, asked for help because of the symptoms that had bothered him for the past few years: anxiety, suspicion, irritability, insomnia, vegetative dystonia. Family relations worsened, and the wife filed for divorce. Outwardly, I. looked cold, detached, his face lifeless, as if in a grimace of disgust. Feelings were in some way an atavism in his life.

I. treated therapy not as a space for experiencing, but as a place where one person, the therapist, does something with another, the client, so “to make it easier for the client”. Needless to say, with such an attitude towards therapy, our work was not easy. However, after a while, hints of emotions began to appear in our contact, or rather, the possibility for I. to notice and be aware of them.

It seemed to me that as if he had become more sensitive and vulnerable, some events in his life began to impress I. to a greater extent and evoke different feelings. It was a pleasant moment in the therapeutic process with a sense of some kind of breakthrough. This time, however, did not last long. After 1, 5-2 months I. began to experience very strong anxiety, several times even canceled the session, not being able to leave the house, referring to strong anxiety and a vague sense of threat. A month later, memories of the past war, in which he participated, appeared.

Horror, pain, guilt, despair mixed together, forcing I. to experience intense anguish. According to him, "before the therapy, he did not feel so excruciatingly bad."

This was one of the most difficult periods of our collaboration. The illusions that the client becomes better and easier in the course of therapy have disappeared irrevocably, and not only for the client, but also for me.

Nevertheless, this was the period of the most productive therapeutic work, high-quality contact and closeness, intimacy, or something. More differentiated feelings began to appear behind the memories of the events of the past war: horror and fear for my life, shame for the situations in which I experienced weakness, guilt for the death of a friend …

But at that moment, our relationship with I. was strong and stable enough that these feelings could be not only recognized and realized, but also "bearable and endured" in contact. So, many years later, blocked for obvious reasons ("war is not a place for weakness and weakness"), the process of difficult experience was again released. The therapy lasted several years and led to a significant improvement in the quality of I.'s life, the restoration of family relations, and, most importantly, to his reconciliation with himself and some harmony.

In work with post-traumatic stress disorder, it is common practice for the client to seek therapeutic help for an issue that apparently has nothing to do with trauma.

Moreover, the therapeutic request put forward is not guile or a form of resistance. At this moment, the client is really worried about various problems and difficulties in life, with health, in relations with people, united by a single etiological line, unrecognized by a person. And this axial etiological feature is related to trauma, i.e. the once blocked process of experience.

In the course of therapy, which focuses on disturbing symptoms as the client's way of organizing contact in the field, sooner or later chronic patterns, frustrated in the therapist-client or client-group contact, lose their former power. It would seem that therapy is coming to an end. But this is not so - it is just beginning.

In the therapeutic field, phenomena appear that are still blocked by trauma, which are preceded by often unbearable mental pain. These phenomena, as it is already becoming clear, are directly related to trauma as a blocked experience process. If pain can be placed on the “therapist-client” contact, the process of experiencing has a chance to be restored [4, 5].

In a sense, the process of psychotherapy for post-traumatic stress disorder presupposes the inevitability of the actualization of the trauma. In other words, a relevant therapeutic challenge for PTSD is the need to transform a chronic trauma into an acute one, i.e. actualize it in the therapeutic process. However, it should be noted that this process cannot and should not be forced. Trying to speed up the process of transformation and actualization of traumatic experiences, we, perhaps, unwittingly, block the process of experiencing. It is impossible to simultaneously fulfill the task of helping the client "surrender" to the process of experience and try to control it on our part.

Ignoring this contradiction always leads to a halt in the therapeutic process.

We psychotherapists are specialists in contact, which is the very essence of the process of psychotherapy.

Therefore, the main task in working with post-traumatic stress disorder is to release the natural course of the process and accompany it in continuous mental dynamics.

Literature:

1. Kolodzin B. How to live after mental equanimity. - M., 1992.-- 95p.

2. Reshetnikov M. M. Mental trauma / M. M. Reshetnikov. - SPb.: East European Institute of Psychoanalysis, 2006 - 322p.

3. Kaplan G. I., Sadok B. J. Clinical psychiatry. In 2 volumes. Per from English. - M.: Medicine, 1994.

4. Pogodin I. A. Phenomenology and dynamics of early emotional manifestations / Journal of a practical psychologist (Special issue of the Belarusian Institute of Gestalt). - No. 1. - 2008, S. 61-80.

5. Pogodin I. A. Proximity as a relationship on the border of contact / Bulletin of gestalt therapy. - Issue 6. - Minsk, 2007. - S. 42-51.

[1] I think that our parents are immortal beings in the sense that feelings for them remain in us for life. After the physical death of parents, feelings do not lose their relevance.