I. Tips for working with trauma survivors
At the trauma site:
Traumatized individuals often feel overwhelmed, bewildered, shocked, and helpless.
At this point, a crisis intervention model should be followed. This means providing information, comfort, and practical help.
Priority is given to ensuring the physical safety of trauma survivors, reuniting them with their families and/or gathering information about their loved ones, if they were present at the trauma.
Normalize people’s emotional responses, reassuring them that their thoughts and feelings are legitimate and expected.
Find out what is particularly distressing to the individual and focus your intervention on relieving the subjective experience of distress.
In acute aftermath of a traumatic event (the first month or so):
Normalize people’s emotional and physiological responses. Validate their feelings and reassure them that they are not weak or crazy for feeling angry, sad, fearful, guilty, or any other feeling they may experience. Powerful emotional responses are normal reactions to overwhelming and out of the ordinary situations. Respect and encourage people’s natural healing processes.
Encourage trauma survivors to make the most of their natural support systems – family and friends are invaluable resources in the recovery process. Discourage isolation.
After a traumatic event, people often feel shocked, confused, disoriented, and/or helpless. Confusion, disorientation, and impaired memory functioning can last for several weeks after a trauma. Be actively involved in the process of helping people to find strategies for coping with the sudden upheaval and chaos they might experience. Do not take a distant stance – your clients often need your help in coping with concrete details of everyday life until they are able to regain a sense of control and return to their daily routines.
Encourage empowering activities and problem solving. Discourage dependence and passivity. Help trauma survivors return to activities which they find meaningful and which bolster their sense of competence and control, such as work, school, or other productive activities. Together with your client, make an inventory of his or her internal (psychological) and external (e.g. family, friends, work, community) resources and focus upon how these resources can be used for broadening the use of adaptive coping skills.
Don’t be afraid of the physiological responses of trauma survivors, and don’t try to stop them. Help people to understand that the following reactions are normal and expected, and will diminish over time…
Increased heart rate
Rise in blood pressure
Tight feeling in the stomach
…These are the body’s natural ways of releasing excess energy and regaining equilibrium.
Let your client set the pace. It is crucial for trauma survivors to regain a sense of control. Therefore, do not push a trauma survivor to describe what they experienced prematurely. Wait until he or she is ready to tell about the traumatic event without feeling retraumatized by the telling. Allow the client to decide what is important for him or her to tell you without forcing your agenda upon him or her.
Be on the lookout for potential risk factors for post-traumatic stress disorder (PTSD):
Prior history of trauma exposure.
Early traumatic experiences, e.g. childhood sexual or physical abuse
Prior mental illness
Lack of adequate social support
Less adaptive coping mechanisms, e.g. avoidance, denial, dissociation, and somatization
Be aware of indicators that an individual might be on the road to developing PTSD:
Use of less effective defenses such as
Prolonged avoidance of returning to work or school
Somatization, such as unexplained aches and pains
Reliving of the trauma
Ruminative or obsessive telling of the traumatic event (versus healthy processing and creating meaning through retelling)
Marked avoidance of places, people, sights, and sounds associated with the trauma
Excessive hypervigilance or irritability
Keep in mind, that in addition to PTSD, some people react to trauma with depression, anxiety, and somatization. These phenomena can impair their functioning as well. Yet, be careful not to confuse the effects of head trauma with psychologically based responses, such as headaches, memory loss, concentration difficulties, dizziness, and sudden emotional outbursts. Make sure individuals who have suffered a head injury are properly assessed for neurological difficulties.
Be aware of the use of peritraumatic (at the time of the trauma) dissociation and its possible long-term effects. Peritraumatic dissociation has been identified as an early predictor of PTSD in some trauma survivors. People might use dissociation as a protective mechanism at the time of the trauma because physical flight from the traumatic situation may not be possible. Dissociation allows one to flee the scene emotionally and cognitively by altering consciousness, possibly leading to the emotional numbing and detachment that characterize the avoidance symptoms of PTSD.
Dissociation can occur in several forms: dissociative amnesia, a sense of depersonalization-derealization, or experiences of absorption-imaginative involvement. After a traumatic event, you might observe signs of peritraumatic dissociation such as the trauma survivor behaving as if he or she is in a fog. The trauma survivor may be unable to remember what happened, especially at the most overwhelming and frightening moments. It might seem as there is a black hole in the person’s memory at the moment of impact in the case of a car accident, when actually being physically attacked by an assailant, or at the moment when the blast occurred in the case of a terrorist attack. People might describe their experience of depersonalization-derealization in different ways, such as: “I felt like it was happening to somebody else.” Or, “It was as if I was looking on from outside of myself.” Or, “I just felt numb.”
Treating chronic PTSD:
After about six months, if the PTSD symptoms have not subsided, a trauma survivor is likely to be on the course to chronic PTSD. The successful treatment of chronic PTSD requires knowledge of effective and directive treatment methods, such as Cognitive-Behavioral Therapy, Somatic Experiencing and EMDR. For therapists interested in learning about these treatment methods, we offer several training courses. If you have diagnosed a client with PTSD and are unsure of how to treat the disorder, refer the client to a therapist trained in post-trauma treatment methods or contact us at the Israel Center for the Treatment of Psychotrauma.
II. Training courses offered by The Israel Center for the Treatment of Psychotrauma
As part of our efforts to establish a National Trauma Treatment Network in Israel, we are offering a number of training courses. Each course is designed to inform therapists and train them in the skills and techniques used for brief, focused, and highly effective therapy approaches. These therapy approaches are recommended for the treatment of both acute and chronic post-traumatic stress disorder.
The Ministry of Health has asked the Center to conduct part of a national training program for mental health professionals. The Center is already conducting several training programs, ranging from 3-hour workshops to 112-hour courses.
Training courses include the following topics: the principles of psychotrauma and healthy coping processes, psychological and biological aspects of PTSD, assessment and diagnosis of PTSD, dissociative disorders, Cognitive-Behavioral Therapy, Exposure Therapy, pharmacotherapy for PTSD, and therapist stress reactions.
What is Somatic Experiencing?
The Center offers the only training courses in Israel in the Somatic Experiencing method for trauma treatment. In the last two years, several trainers have come to Israel to conduct 4 or 6 day training sessions. The upcoming course is the first one to be held in Hebrew and will be conducted by Gina Ross from Los Angeles.
To obtain more information or register for a training course, please contact us.