Tag Archives: PTSD

What does recovery look like after traumatic experiences


After trauma, what does recovery look like? Is it possible to “move on?” How can you when you can never unsee or unremember what happened to you? 

Is it possible to experience joy rather than emotional pain when remembering past or ongoing hurts? If so, just what does that look and feel like for the victim? What can be expected if I am “healed”? Can I be free from the typical experience of trauma (e.g., Hopelessness, despair, anxiety, confusion, shame, anger, loss of identity, feeling stuck but the demand to act as if the trauma did not take place, and spiritual angst over the goodness and love of God)?

As Diane Langberg has so aptly reminded us, “Trauma is the mission field of this century.” Around the world there is much openness to talk about the impact of trauma and to use spiritual practices as part of the recovery process. In Christian language, we talk about healing the wounds of the heart and one of the best programs out there is the Trauma Healing Institute’s, Healing the Wounds of Trauma. This program is based on the strong Christian belief that God, through the work of the Holy Spirit and the Scriptures,  is in the business of healing wounded hearts. At the heart of this belief sits two important passages:

Isa 61:1-4 The Spirit of the Lord Yahweh is upon me, because Yahweh has anointed me, he has sent me to bring good news to the oppressed, to bind up the brokenhearted, to proclaim release to the captives and liberation to those who are bound, to proclaim the year of Yahweh’s favor, and our God’s day of vengeance, to comfort all those in mourning, to give for those in mourning in Zion, to give them a head wrap instead of ashes, the oil of joy instead of mourning, a garment of praise instead of a faint spirit. 

2 Cor 4: 16-18 Therefore we do not lose heart, but even if our outer person is being destroyed, yet our inner person is being renewed day after day. For our momentary light affliction is producing in us an eternal weight of glory beyond all measure and proportion, because we are not looking at what is seen, but what is not seen. For what is seen is temporary, but what is not seen is eternal.  

These two beautiful passages present a picture of recovery. Good news, release, favor, comfort, joy and beauty in place of mourning and oppression. Renewal in the face of affliction. But what does this mean in real life? Does a “double portion” instead of shame feel like to a victim of sexual trauma? What does renewal and release feel like after a natural disaster? 

Prognosis for Complete Recovery?

If you suffer a serious knee injury requiring surgery, you will need time for rehabilitation. But rehab does not necessarily mean you will recover the full range of motion you once had, or that  your knee will be entirely pain free when you are finished with physical therapy. Your prognosis for recovery depends on many factors such as age, extent of injury, physical health prior to the accident, and availability of quality care. Even with the best care provided to top athletes, recovery may not lead to return to top form. For example, an Olympic skier may be able to ski again but not at a quality that allows for competitive skiing. 

What about the prognosis for spiritual and emotional recovery? Of course, just as in the knee injury example, the answer must be “it depends.” Still, considering the two passages above, words like liberation, joy, release, and renewal shape our imagination for recovery. Do we imagine complete recovery to top spiritual and emotional form, without pain and limitation? It appears to me that we sometimes imagine emotional and spiritual healing without taking consideration the reality of broken bodies and a fallen world. We are not guaranteed a pain free life or faith without distressing questions. In fact, Paul’s beautiful words in 2 Corinthians bear this out. afflicted in every way, persecuted, perplexed, persecuted, struck down, always carrying around death, burdened, groaning and more. Yes, he also says not crushed, not despairing, not destroyed, but alive. But both must be considered together at the same time if we are indeed to imagine our prognosis. Recovery means comfort and lament, joy in mourning, perplexed while trusting, dying yet alive. 

Sprouts of Justice and Recovery?

Isaiah describes sprouts of justice and righteousness beginning in the recovery of the oppressed (Isa 61:11). As a gardener, I see sprouts as the beginning of hope. After planting seeds, the tiny sprouts give me hope for a later harvest but that hope is still tempered with the knowledge of the challenge of getting sprouts to develop into fruited plants. I have to be vigilant about bugs, weeds, and drought. I need to cultivate and fertilize or my sprouts will not turn into much. And even if I do everything right, the seed may be weak or the weather may mean I only have spindly or stunted plants that cannot bear much fruit. Yet, the sight of sprouts brings the hope that empowers us to keep at the gardening work. 

So, what are these sprouts of justice and recovery that victims of trauma may first see that encourage hope and further empowerment? Consider some of these: 

  • Capacity to Name Truth and Justice

Recovery begins when oppressed people find words to name injustices done to self and other. For example, a victim of domestic violence may become well aware of the subtle signs of verbal and emotional coercion, long before any physical violence. They become the canary in the mine, aware of poison that others may not yet sense. 

As this capacity grows beyond a mere sprout, the person may be able to speak the truth aloud, even with courage to say it to leaders. 

As naming capacity grows, it moves from awareness of personal risk to capacity to notice and care for the injustices others experience

  • Accepting weaknesses without hopelessness

Part of recovery requires honest reflection of the damage done. Signs of recovery include the ability to recognize limitations and working within capacity without self-hatred (though there may be lament for losses of previously held abilities). When we truly accept the “new normal” we then can stop evaluating daily life from the perspective of who we used to be

As we accept our limits, we can then begin to see the opportunities we do have even within our limitations

  • Identify resilience and new capacities in the midst of struggle

There may be new capacities we never observed before (e.g., the capacity to speak up to power, the ability to withstand rejection, increased empathy for the pain of others). We now notice these resiliences and growth as they stand on their own

Though we will not call the suffering good, we will be able to identify blessings that we have received in spite of and as a result of the trauma experienced 

Be Careful Not to Damage the Sprouts

For those who are not attempting the impossible, to “move on” from trauma and abuse, it is good to remember that sprouts are tender and can be easily damaged with too much interference. You may need to leave a few weeds you see near the fledgling plants so as not to disturb their roots or bruise the green shoots. How do we do this to the sprouts of recovery? We may unintentional limit growth by questioning why the person learning to speak the truth isn’t doing it in a even-tempered manner. Sadly, too often those in domestically violent marriages are told to stop being so dramatic and to calm down when they begin to speak about the truth of the violence they have experienced. Or, we can point out the sins of the victim as if somehow their responsive sins eliminate their right to speak up about the trauma they experienced. Or, we can hear someone accepting brokenness and accuse them of not trusting God for complete healing. 

Nurture recovery as you would a tender plant. It is a scandalous act of grace! By paying attention to safety needs, by bearing witness to trauma, by being willing to lament and to stay connected, we provide a greenhouse for such plants to grow into levels of recovery never before dreamed of. 

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Filed under Abuse, biblical counseling, christian counseling, christian psychology, Christianity, counseling skills, pastors and pastoring, Post-Traumatic Stress Disorder, ptsd

Making the Church a Safe Place For Victims of Trauma


Free resource available here (filmed October 2013). (Overlook that maniacal looking pose from the image below)

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PTSD “A Disease of Time”


David Davies, part of the staff of “Fresh Air” on NPR, has conducted an 35 minute interview with David Morris, a journalist who was embedded in a unit in Iraq and who suffers from PTSD resulting from an explosion he survived. David has written a book, The Evil Hours: A Biography Of Post-Traumatic Stress Disorder. If you want to better understand the experience of PTSD and its impact on a person, you should listen to this show (or read the transcript). For therapists, Morris discusses his experiences with Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). He also describes the use of propranolol when repeating trauma stories.

Here’s a couple of my take-aways:

  • PTSD is a disease of time.

“…in some ways, PTSD is a disease of time. And a lot of people – PTSD is many things, but one of the things it is a failure to live fully in the present. And I think what happens a lot of times with traumatic – survivors of trauma is they have these compulsive returns to awful events, and they are unable to live in the now.”

  • The best treatment never removes all symptoms of PTSD

“The best we can do is work to contain the pain. Draw a line around it. Name it. Domesticate it, and try to transform what lays on the other side of that line into a kind of knowledge, a knowledge of the mechanics of loss that might be put to use for future generations.”

  • Honest reflections of the impact of PE and CPT (and why so many dropout from PE treatment)
  • Honest admission about the most common “treatment” of PTSD–alcohol (and evidence why so many end up abusing it!)
  • War traumatizes far too many but rape is 5x more traumatizing

[in discussing how helplessness/lack of control is a significant factor in the development of PTSD] “Yeah, the helplessness is one of the main predictors of who’s going to end up with PTSD and who doesn’t. And the idea that you have absolutely no control over your environment is very hard for people to deal with because, you know, you are basically completely helpless and unable to control your destiny and your survival….and that’s one thing I discovered in the book is I thought – you know, we sort of assume that PTSD is sort of the realm of soldiers and veterans, when in fact, the most common and most toxic form of trauma is rape.

…a soldier may have some control over his or her environment. They have a weapon with them; they can move; they can take cover. But oftentimes in the cases of rape, the victim is completely overwhelmed and trapped and cornered. And from the moment the attack begins, they are rendered almost completely helpless, which is interesting. And you see that in the diagnosable rates of who gets PTSD and who doesn’t. Rape survivors tend to have it almost 50 percent of the time, whereas your average war veteran – particularly for Iraq and Afghanistan veterans – the rate of PTSD diagnosis is more around 10 to 12 percent. So a rape victim – rape is, in a manner of speaking, five times more traumatic than combat.”

 

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Why are Some Trauma Victims More Vulnerable to Re-Victimization


For those who have not suffered a chronic trauma reaction it can sometimes be hard to understand how a victimized person gets situations where re-victimization can happen. Wouldn’t one trauma at the hands of another cause you to be vigilant against any subsequent danger?

You might think so, but here’s how it happens in simplistic terms:

  1. Interpersonal Trauma leads to confusion, self-doubt (and hatred), loss of voice.
  2. Vigilance against one kind of victimization leads to making decisions to give up other values/interests to avoid the trauma
  3. That decision (or impulse) leads to opportunity for exploitation

Still doesn’t make sense? Consider how a societal trauma preps a community or country for re-victimization. Dave Zirin writes about the use of “Shock Doctrine” in his 2014 book, Brazil’s Dance with the Devil: The World Cup, the Olympics, and the Fight for Democracy. Shock doctrine is opportunist moves by governments interested in taking advantage of a traumatized population

Left to their own devices, people tend to vote for things that make their lives better, like sharing wealth and resources and ensuring quality health care and education for all. Nobody wins elections by promising to turn the country into a sweatshop zone. So in order to put neoliberal policies in place, the world’s elite need a strategy—some clever sleight of hand to get what they want before anyone can object. Enter the shock doctrine

The idea is simple: people who are traumatized are more likely to agree to authoritarian measures, to suspending democracy, to doing whatever it takes. The trauma can be unexpected, like a natural disaster or a terrorist attack, or planned, like a massive budget cuts or a military coup—anything that

‘puts the entire population into a state of collective shock. The falling bombs, the bursts of terror, the pounding winds serve to soften up whole societies much as the blaring music and blows in the torture cells soften up prisoners. Like the terrorized prisoner who gives up the names of comrades and renounces his faith, shocked societies often give up the things they would otherwise fiercely protect…’

While people are reeling, trying to figure out how to survive, corporations and the corporationist state walk through the open door and take what they please.” (p 73-4)

Zirin illustrates this by pointing to countries who take privacy rights or freedom of speech from citizens in the name of protecting the people (state) from outside attack. Or corporations who find ways to take land from poor citizens after a natural disaster—to use for their own benefit.

My point is not to attack political ideologies, corporations, or governments. Rather it is to show that trauma sets us up to give up rights and boundaries more easily in order to avoid a terror. That same willingness is more easily exploited by one who sees the vulnerability. The authority will protect us we think. But if the authority is only interested in its own protection, the victim is prone to re-victimization.

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Making the Church a Safe Place for Victims of Trauma


This afternoon I will be speaking at Chelten Church on the topic of “Making the Church A Safe Place for Victims of Trauma.” This 3 hour continuing education seminar (co-sponsored by Biblical Seminary who provides the NBCC approved CEs) will focus primarily on trauma resulting from child sexual abuse. However, other forms of sexual violence and traumas (domestic violence, military trauma) will get a bit of attention as well. If you can’t make it or wish to see what I am talking about, you can download and see the slides: Making the Church A Safe Place For Victims.

Tomorrow, Mary DeMuth will speak on a topic similar to her book. Her talk is entitled, “Unmarked Marriage.”  I suspect the conference organizers will take walk-ins!

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GTRI 2014: Day 11, Muhanga to Butare/Huye


July 11, 2014.

We ended the Community of Practice at noon and said our goodbyes. The morning consisted of a short devotional comparing the good and the false shepherd described in John 10. We explored how helpers may end up becoming “hirelings” due to burn-out and

Community of Practice

Community of Practice

loss of vision. After the devotional, our tables each became case consultations with caregivers discussing their hard cases and receiving encouragement, support, prayer, and a bit of advice. In a number of instances, caregivers brought up the issue of those who have mixed parentage (Hutu/Tutsi) and the struggle to deal with their identity. I and others have noted that this group has been far more vocal talking about the different “tribes” where previous groups have rarely even mentioned these groupings. It makes me wonder whether this is unique to this group or whether there is something going on in the country that makes it okay to discuss identity.

After our goodbyes, we traveled south for 2 hours to the university town of Butare. Butare is the home of the National University. First stop in Butare consisted of an ice cream at Sweet Dreams just down the road from the Shalom Guest house where we are staying (known internationally as the project with the female drumming corp). Our purpose here is to meet with Anglican Bishop Nathan Gasatura and some of the pastors/leaders of his diocese to discuss the trauma recovery needs. Bishop Nathan has been a friend and attended some of our previous training. Diane spoke a bit about “talking, tears, and time” and the process of healing through trauma. We had a good dialogue where one question was raised, how can a Hutu counselor help a Tutsi victim (or vice versa)? I was thankful that Baraka Paulette, the new president of the new Rwandan Association of Christian Counselors, was present as she answered in a very beautiful way, putting all at ease. Though our time was short, we squeezed in a bit of singing and dancing in the cathedral.

Before our meeting, a few of us purchased locally roasted inexpensive Rwandan coffee and an espresso at Café Connexion across the street from the cathedral and guesthouse. This cafe was not something most would venture into in the United States. It contained dingy walls, a couch and a couple of stuffed chairs, a shelf full of brown bags of coffee, a large coffee roaster and the center of the room was a small desk with an espresso machine. Yet, this was possibly the best coffee I tasted on the trip. [the return trip the next morning and bag of coffee brought home and now gone supports this opinion!] After dinner, many of us walked down the dimly lit main street in the dark passing the university. It was good to walk and good to deepen relationships with fellow GTRI mates.

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Brooks on journaling about emotions


Friend Jeff McMullen pointed out a recent David Brooks op ed in the New York Times. (Read it here). While I’m not sure I agree fully with his journaling/not journaling point he says something very important about the timing of writing one’s emotions after a traumatic event. He says,

When people examine themselves from too close, they often end up ruminating or oversimplifying. Rumination is like that middle-of-the-night thinking — when the rest of the world is hidden by darkness and the mind descends into a spiral of endless reaction to itself. People have repetitive thoughts, but don’t take action. Depressed ruminators end up making themselves more depressed.

Then later, this important distinction between immediate processing of emotions and later processing,

We are better self-perceivers if we can create distance and see the general contours of our emergent system selves — rather than trying to unpack constituent parts. This can be done in several ways.

First, you can distance yourself by time. A program called Critical Incident Stress Debriefing had victims of trauma write down their emotions right after the event. (The idea was they shouldn’t bottle up their feelings.) But people who did so suffered more post-traumatic stress and were more depressed in the ensuing weeks. Their intimate reflections impeded healing and froze the pain. But people who write about trauma later on can place a broader perspective on things. Their lives are improved by the exercise.

David points to some research that exists that suggest CISD is unhelpful for some participants. Some are made worse. Yet, narrating one’s trauma in the broader context of a life tend to see a reduction of symptoms. The difference seems to be whether the focus in on life or mostly on the trauma. Trauma in perspective is the goal. Just reviewing trauma may in fact strengthen the traumatic reaction rather than weaken it.

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GTRI 2014: Day 8 Kigali


July 8, 2014

Tuesday. Yesterday was a deep dive into Rwanda for GTRI students. They heard directly from Rwandan caregivers and spent time trying to weigh the genocide and its ongoing impact. Today we begin meeting and interacting with trauma healing and recovery caregivers in a conference setting. At a local hotel about 100 Rwandans gathered to kick off the Bible Society’s trauma healing community of practice and the inauguration of the Rwandan Association of Christian Counselors. The purpose of this meeting was to introduce both projects to the public and to invite the media and dignitaries to be present. The Rev. Emmanuel Kayijuka game some opening remarks and an Anglican Bishop offered a brief bible study of John 4:1-3, the woman at the well. He pointed out that she was likely a prostitute and an DSC_0233abused woman, abused by men, by society and desperate. Why else gather water at noon. He also pointed out that after her healing, she became a woman on a mission of healing, seeking social contact for the purpose of evangelism. After these reflections, Dr. Jean Mutabaruka presented a paper looking at the relationship between trauma, PTSD, and complicated grief. He pointed to 12 types of trauma in Rwanda, including sexual/physical/emotional abuse, witnessing violence, discrimination, poverty, etc. At the end, he raised a few general questions regarding the management of the mourning period/process each year.

After the professor finished, both Diane Langberg and I made a few brief remarks in response. Dr. Harriet Hill presented an overview of trauma healing project, in Rwanda and around the world. She showed the latest trailer of a documentary (much about the Congo project) about bible based trauma healing slated to be aired on ABC network this fall. Fun to see people I know in this trailer. David from the Rwandan Bible Society reviewed the progress to date: 2,918 trained people using Healing Wounds of Trauma material. Many of these are able to train others while the rest are better able to care for themselves.

New President: Baraka Credit: Heather Evans

The second half of the day included a presentation by Baraka Paulette Unwingeneye about the efforts thus far to form the Rwandan Association of Christian Counselors. This group of counselors and caregivers have been meeting with us since 2011 and are ready to be birthed. As Baraka said it, it may be like an elephant’s gestation, but now we are near the final month. We had presentations from Narcisse about the needed documents to be filed to make the association official, myself about the benefits and processes to form an associations. Then, those in attendance voted in a president, vice-president, secretary, treasurer, advisors, and conflict managers. This may not sound very moving, but I assure it was!

Fun too

While we come to Rwanda for serious matters, not everything has to be intense. As our day was ending, we quickly changed from our conference clothes to go out for a bit of shopping: the Simba market for coffee and tea, and another market selling typical Rwandan traditional items (clothes, woven bowls, banana leaf art. I looked and looked for a blue African traditional shirt but came up empty.

This marks our last night at Solace. Tomorrow we move on to the conference proper about 50 minutes or so south in Muhanga (Southern Province). Though we are about to begin the training in earnest, I think I am beginning to relax. A year’s worth of planning is now well under way. Despite a few surprises and schedule changes, most everything is working as planned. No problems with transportation, food, water, housing. Meetings planned have more or less happened.

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Some thoughts on international trauma training


In just a few days I will be off to Uganda and then on to Rwanda to do some training with trauma healing workers in both country’s bible societies. In addition, a group of students from our Global Trauma Recovery Institute will join me in Rwanda to learn more about how to help without hurting. In light of this trip, I penned a few thoughts for those who have a heart to do something about the massive trauma needs around the world. Here’s a preview:

Trauma is a hot topic these days. We live in a world where we are aware of terrible traumas happening around the globe in real time. We hear and see tsunamis unfolding, towns being flooded when dikes are breached, mass shootings, bodies strewn about due to ethnic conflict, houses destroyed by errant bombs, and gender violence in almost every corner of the world. While humanitarian efforts to respond to the physical needs of those in trouble are not new, there is a recent push to have charity workers become “trauma informed” so they can also address spiritual and psychological distress.

Trauma is a hot topic not just because we have more evidence of it happening in real time. It is hot because we have better information about the impact of violence and abuse on the human brain, on human interactions, and on the fabric of a society (Mollica, 2006).

Christian counselors, many of whom want to provide cups of cold water to the hurting masses, undoubtedly wish to use their skills to bring hope, healing and recovery to traumatized peoples around the world. But just where should they start?

You can read the rest of my thoughts over at our faculty blog site.

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Traumatic Nightmares? Two Treatment Possibilities


Many who suffer from PTSD or other traumatic reactions also experience chronic nightmares. It is bad enough to have to deal with intrusive memories and triggers during the day but being robbed of peaceful sleep can send you over the edge, both in terms of physical and emotional health. Christian counselors may be tempted to ignore these nightmares (how can you stop something you have little control over?) or overly spiritualize the content of the dream.

But we ought not neglect the problem of nightmares. It is well-known that reductions in quality of sleep make all mental illnesses worse. Nightmare sufferers understandably avoid sleep but of course this creates a vicious cycle of insomnia, anxiety, and increased avoidance strategies.

There are two intervention options (among many) that appear to have fairly robust positive data indicating helpfulness. (For detailed descriptions of these two and others including the analyses of value, see this pdf): Prazosin (medication) and Imagery Rehearsal Therapy (IRT).

Prazosin is an anti-hypertensive (alpha blocker) that may work on the problem of too much norepinephrine in PTSD patients. It seems to improve sleep length and REM time. Interestingly, beta blockers have been found to increase nightmares rather than reduce them. I am no physician and so cannot evaluate the value of this medication for clients but would encourage clients with chronic, severe and re-occurring nightmares to talk with their doctor about whether Prazosin might work for them. The studies I have reviewed primarily examined the value of this medication for veterans with extreme nightmare problems. The most significant downside to medication treatment is that it only works when the medication is taken. Stop the medication, the nightmares may come back. However, some relief may be beneficial and thus the medication then has value.

Imagery Rehearsal Therapy (IRT) is a short-term therapy that does not work on the actual content of the traumatic experience or attempt to treat PTSD. Instead, it treats nightmares as a primary sleep disorder problem. There are variations on IRT but most versions last between 4 and 6 sessions and may be delivered in individual or group formats. Sessions include education about the nature of nightmares, sleep hygiene protocols, and the imagery replacement protocol. While some of the IR protocols are done imaginally, others ask nightmare sufferers to (a) write down the details of the distressing nightmare, and (b) write a new ending to the nightmare. As Bret Moore and Barry Krakow describe, the therapist does not dictate the new outcome of the revised dream but encourage the sufferer to “change the nightmare anyway you wish” (Psychological Trauma, v. 2, 2010). The nightmare sufferer then rehearses (multiple times) the new ending and is instructed to ignore the old nightmare.

Sound goofy? How is it that a person can just decide to have a different dream? However, the evidence that this therapy works is quite robust. Numerous studies with veterans and civilians indicates it is effective in reducing unwanted nightmares. Most treatment protocols suggest starting with nightmares with content unrelated to actual traumatic events.

Thus, Christian counselors ought to review these two treatments and consider learning the IRT protocol to bring relief to chronic nightmare sufferers.

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