and its Aftermath
by Peter Goetz, MFT
events are those experiences that are intrusive, sudden, non-normative
and exceeding of an individuals capacity to meet the defense
demands of the encountered event. The essence of trauma is repetition
and the reexperience of the event through mental imagery, physical/emotional
arousal or numbing and other symptom formation now, in present
time. Trauma overwhelms our usual frame of reference of how the
world operates - or should operate - and the individual
The range of trauma is as wide as human experience. Examples come from every
realm of life and could include:
all have coping strategies to help deal with intrusion, attack, physical
or emotional overwhelm, but what happens when these strategies fail?
When our orienting and defensive responses dont keep harm or
chaos at bay, how does the individual respond, not just to the intrusion
itself but the ensuing shock and disruption to self worth, to an
emotional life gone chaotic, to having ones sense of self and
place in the world shaken. The events, in the past, come to feel they
are being lived in the present. Trauma becomes imprinted on lives
in ways that appear to define them.
attack through assault, rape, animal attack, physical/sexual
abuse,or emotional abuse.
or natural disaster such as war, floods, cultural genocide,
earthquake,fire, social dislocation.
or inside injury such as childhood surgery, bike or auto accidents,
burns, sporting accidents, chronic disease or health failure,
sanctioned trauma such as war, prison, ritual abuse, religious
or developmental trauma such as childhood neglect, severe loss.
trauma, that is, being witness to or bystander to others traumatization.
The lingering impact of trauma, the intrusion of it and its persistence bring
people to psychotherapy. They seek relief, resolution and better management of
the activation and freezing responses triggered by memories and reenactments
of trauma. The reexperiencing shapes us on all levels on which we process information:
cognitively, somatically, emotionally, biochemically, neurologically, relationally
and, of course, spiritually.
The degree to which trauma symptoms develop or cause impairment hinge on what
personal resources an individual has at hand, now and at the time of the event.
Other variables at influence include the duration and severity of the trauma,
what meaning (or lack of) was given to the traumatic event, as well as the kinds
of supportive and reassuring presence provided (or not) by community, family
or friendship network.
The more prolonged traumas are those that intrude into life so that the trauma
itself becomes a limiting descriptor of identity. Post Traumatic Stress Disorder
(PTSD) is the psychiatric diagnostic category that captures within its definition
a range of prolonged traumatic response (over 1 month). The category of Acute
Stress Response applies to acute responses of less than 1 month. The American
Psychiatric Associations diagnostic manual (DSM IV) lists specific behavioral
and experiential criteria for this condition. Included, in summary:
on trauma (van der Kolk, Herman) have looked beyond these symptom
and behavioral descriptions to a deeper level of human experience
with the fully dimensional ways in which people respond to and reexperience
trauma. The term Complex PTSD has been coined to capture how
personality, views of self and other and perception itself is shaped
and altered by trauma. Complex PTSD can include:
individual has been exposed to event(s) where they have experienced,witnessed
or confronted an event where actual or threatened death, serious
injuryor threat to the integrity of the self was involved.
The response to this can
include fear, helplessness, terror.
traumatic event is reexperienced by recurrent and intrusive
mental images andfeelings (thoughts, dreams, nightmares, illusions,
hallucinations, flashbacks, vivid recalls).
and somatic distress and reactivity to cues that symbolize
or resemble aspects of the traumatic event.
avoidance of stimuli associated with the trauma and numbing
of general responsiveness (avoiding certain thoughts, feelings,
range of feelings, diminished interest in usual activities
or association with people or places associated with the event.
symptoms of arousal such as difficulty falling or staying asleep,
anger outbursts, hypervigilance, exaggerated startle response,
is resolved by working with all of the resources one has at hand now,
in present time. Resources are everywhere: they can be internal or
external, they can include special people, a sense of solidity or
presence in ones own body, personal mastery, sustaining or
nurturing beliefs, spirituality, financial stability, nature, art,
color or ritual. Consideration of what effective resources are available
is as necessary as reviewing what behaviors or personal stances keep
the symptom picture intact, stuck or reenacted now.
in regulation of affect and impulses, such as difficulty in
managing feelings, self destructive urges or engaging in risk
taking or dangerous behavior.
in attention or consciousness, such as dissociation, selective
memory loss and time distortion for discrete periods of the
complaints such as chronic pain, digestive problems, cardiopulmonary
symptoms, sexual problems.
in self-perception such as an individuals beliefs that
theyre permanently damaged; shame and aloneness in the
sense that no one could understand are prominently felt.
in the perception of the perpetrator such as preoccupations
with hurting the perpetrator, idealizing them, or holding very
distorted views about them. Thoughts may minimize or rationalize
in relation with others such as difficulty trusting, victimizing
others (do as has been done to) or reenactment of trauma from
the past in overt or covert ways.
in meaning of life, of previously held sustaining beliefs.
Despair, hopelessness, or emptiness may be accompanying feeling
states, or generally feeling ineffective in ones life.
Trauma held in its undigested state will remain active or, if left unattended,
will settle into shape in personality structure in the form of traits, maladaptive
behaviors, relational habits or attitudes. Traits can become habit, habits become
ingrained, efforts are made to keep a steady state of coping and maintaining
The work of resolution involves sequencing or working though traumatic events
on all levels of experience:
attention to and working with physical sensations stimulated
by trauma or its reenactment (somatic).
through self limiting beliefs about self, others and ones
place in the world (cognitive).
pharmaceutical interventions when needed (biochemical).
effective regulation and flow of feeling states; working through
highly charged responses gripped in memory (emotion).
arousal patterns and information processing systems (neurological).
and forming — maybe for the first time — supportive,
loving, responsive social lives; forming effective and flexible
boundaries with others (relational).
a new order of connection with something bigger than ourselves,
be that nature, a greater realm of mind or God (spiritual).
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