Shock (acute) Trauma Therapy

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

Injury occurs when a person is exposed to the system of the universe and its representatives in a one-way order. Trauma is an intrusion, violence against a person when he is in a weak position and is not able to react and defend himself. Therefore, it is inhuman

There is no sense in the trauma itself, and it is useless to look for it there. But there is a lot of life-affirming meaning in the efforts to get out of an acute stress state.

The goal of working with shock trauma is to NORMALIZE FEELINGS, restore the dignity and meaning of life, and integrate a new experience of HEALING INJURY into the general coherent narrative of a person's life.

Shock trauma can be extended over time, for example, in a situation of hostilities. Its characteristic feature is that it has a local character, i.e. is not inscribed in a person's previous experience and is not related to his personal characteristics. Of course, one can always find distant associations with earlier events in a person's life, but such a search is not therapeutic, IMHO.

Crisis therapy Shock trauma is fundamentally different from developmental trauma therapy. Relatively speaking, an acute stress reaction is a state close to psychotic, it is a likely rollback from a depressive to a paranoid-schizoid position. It is important to take into account that this is a temporary rollback, which means that a person has potential resources for integration and does not need to be treated as psychotic organized (to correct and deepen his picture of the world), although the main style of therapy is supportive.

The temporary transition of the injured person to the primary defenses is accompanied by intense pain that increases with each activity. Therefore, the therapy of a person in this state is a passage along the blade of a knife: a step to the left, a step to the right - pain and aggression. A person who does not believe in himself, an exhausted person may fear the therapist, but at the same time place huge, sometimes inhuman hopes on him, idealizing his capabilities. Failure of crisis therapy is another crushing of the client's hope and injury.

In my opinion, it is equally unreasonable to use crisis therapy methods to heal developmental trauma, although sometimes oh, how difficult it is to draw the exact line between the one and the other.

The immediate in time transition from crisis therapy to the usual one, which involves a certain degree of regression, is contraindicated. The experience of healing trauma must be learned, it must be "infused". Otherwise, there is a possibility that a person, instead of reconciling with loss and damage, searching for and gaining his own existential meanings, will find the meaning of existence in the continuous process of therapy. The client may also be persuaded to do so by an incompletely restored identity, since then he may be dominated by the illusion that the remaining cracks in his own narcissistic core can be filled at the expense of the therapist (spare ego) in the process of identification with him (archaic identity of subject and object).

And then it is possible for him to retreat into a state of enchantment with trauma.

In addition to extreme vulnerability, vulnerability of a person, when working with a victim, it is important to take into account also:

- his heightened feelings of guilt and shame, - inability to trust, on the one hand, and exposure to risk, on the other, - self-doubt, self-depreciation, - a feeling of powerlessness and helplessness, - a feeling of abandonment, rejection, "no one can understand me", - hopelessness, melancholy, despair, - anger, rage - sometimes restrained, then breaking out, - fears, suspicion, instability of mood.

This list - not the personal characteristics of the client, but the characteristics of the characteristics of his current state, which can gain a foothold in the case of his fixation on the injury.

In crisis therapy, especially important, in my opinion, is the confirmation of the abnormality, injustice, unnaturalness of what happened. Here we are talking about the legal and moral aspect of the trauma, designed to restore the dignity of the victim. Sometimes, this is implied by itself and does not require clarification. And sometimes such explanations have a very healing effect.

A rapist has no right to be a rapistalthough they are, terrorists have no right to torture, but they do it, a scumbag has no right to persecute, but persecutes, the Nazis have no right to arrange a holocaust, but they perpetrated reprisals - and this is a fact of history, God should not turn away from the righteous or sinner, but, alas, sometimes it leaves him …

Trauma is recognized as trauma, rapist - rapist. Atrocity must be called evil. When the motivation is somehow understandable, it is worth voicing the fact that the rapist is a psychopath, a moral monster, a drug addict, a religious fan, money-grubber, etc. This frees a person from responsibility for what happened and gives him the opportunity to feel the naturalness, validity and legitimacy of his anger, hatred, unhappiness, other feelings - that is the essence of the current state. The person's acceptance of their feelings promotes the reintegration of their narcissistic core.

The logically implied consequence of this is recognition of a person as a victim of circumstances and his non-omnipotence. If this does not offend the person's pride, he may be called out loud as a victim. This is not humiliating, it is just a sad fact. After that, the person is faced with the task of reconciling with their limitations and grieving.

If the victim is somehow not recognized as a victim, an innocently injured party, then it is possible to get stuck in an injury due to the splitting of the nucleus into 2 parts - the suffering (victim) and the revengeful, punishing (pursuer, executioner). Further, the person splits off the "victim", identifying with a sadist, a tyrant.

Then one can often observe a chain reaction of evil - a person acting out his pain on others.

When these parts are looped back, a person will punish himself additionally for his own suffering and pain. To implement this punishment, he will find a "bad enough object", for example, an incompetent specialist, with the help of which, in particular, thanks to the mechanism of projective identification, he will inflict new pain on himself.

If the specialist is not able to contain enough, he unconsciously distances himself from the client, skips his material, then the latter has a feeling that the therapist is not working with him, but with some idea, image, illusion about the client - as if he had already decided everything and understood about the client long ago., and he has no use for redundant information.

If the client feels that the therapist does not understand him, pulls him somewhere into "his own steppe", then he automatically turns into a "executioner" for the client. The same thing happens if the therapist sees in a person a "next complainant" and does not see his pain and despair behind the complaints, reproaches and accusations. In general, the quintessence of any therapy is to understand what a person's soul hurts about.

If the therapist is not ready to face the energetically powerful experiences of the client, it makes sense to let him know that he is understood, to show attention, sympathy and respect for his emotions. It is important for the client to feel and know that the therapist is on his side, that he is an ally against the rapist, then therapy will not turn into opposition and continuous confrontation, which is not useful in crisis work up to the stage of victim recognition. Feeling cared for and accepted by the therapist restores mental balance.

Due to the violation of boundaries and the dominance of the irrational, the client in an unsuccessful therapy can also become a hostage to the therapist's personal pain, introjecting it as an additional "bonus" to his own. In other words, regression and hypersensitivity of the traumatized person to non-verbal communication can provoke him to fall into the projective identifications (and traumatic funnel) of the therapist himself.

As a complication, inside or outside therapy, a correlated, hate-filled relationship between the rapist and the victim can arise, and the inner "criminal" overflowing with sadism seeks to destroy the inner powerless object-victim, cause him suffering and inflict reprisals on him. The existence of such an unconscious dyadic structure is one of the main problems in working with clients, since it manifests itself in transference / countertransference, and it is not easy for even an experienced specialist to get out of this cycle. But this is no longer a question of crisis therapy.

This is how the traumatic's sentence to self-punishment can work.

Its other form is psychopathologization, withdrawal into illness.

Errors in crisis work with shock trauma at the initial stage:

a) any kind of assessment of experience and feelings, incl. disguised as care. The meaning of the trauma is an absolutely subjective matter, the idea of the degree of catastrophe can be obtained exclusively from the client. The therapist should refrain from emotional assessment of what happened, even with the help of intonations and interjections, b) search for a connection between trauma and distant events in a person's life. Such an approach gives the client the impression of the inevitability and "deservedness" of the injury, and, consequently, of his own badness and incorrectness, c) supporting the client in finding reasons for inaction in a critical situation, since such an approach loads him with guilt and creates a feeling in a person that if he was more circumspect, faster, smarter, then injury could have been avoided,

d) not following the client, switching his attention to the details of the event that are insignificant for him - creates in the client a feeling of the therapist's incomprehensibility of the essence of what happened, e) the therapist's unwillingness to clarify, following the client, the nuances of feelings and circumstances that are important to him, as well as the details of the violation of mutual understanding with him, to speak openly about his "missing" in the client's semantic field, f) attempts to correct the client's picture of the world, which is already fragmented. This creates in him a feeling of his inadequacy: "if I see incorrectly, then I am abnormal." The picture of the world is restored in the process of an inevitable collision with reality and a gradual expansion of the client's field of perception, g) the verbal description of the client as good, glorious, kind, intelligent - this is

can feel like a (re) intrusion and also block his ability to share his anger. He can receive these signals only non-verbally through a sense of acceptance, g) analysis and interpretation of the traumatic situation, behavior and feelings of the client - he only needs an understanding of what happened and a feeling of being heard, h) from Sudarikova Tatyana Yuryevna: the therapist should not call the client's situation "this", that is, impersonally, because there is a certain taboo on naming events in his own words, thus excluding behavior and perception is provoked. It is very unhelpful and "rape" should be called rape. A frozen pregnancy is a frozen pregnancy.

If the client has identified the event, named the trauma and said the definition, then the therapist follows it and calls it an echo in the same way. There is an expression "The enemy is recognized. The enemy is named. The enemy has no power."