Advice and Treatment for PTSD

 

Pink & fluffy? Not at all!

There are many reactions that I encounter when I tell people what my profession is but the top three tend to be:

• The person moves closer and starts telling me about their (clearly unresolved) experience of trauma
• They run for the hills as they think I can read their minds and will discover deep, dark secrets
• They roll their eyes, say “so, you’re a counsellor?” before dismissing me as a pink and fluffy treehugger

I’m sure readers in the protection industry can relate to being stereotyped!
What I enjoy is when someone has a genuine interest in the human mind and we end up having a proper conversation. I’ll try not to get on my soapbox but really the field of trauma is endlessly fascinating! We’ve all encountered something that could be classed as traumatic, whether in our adult life or childhood, and the way we deal with it can shape our personality, and our lives, both negatively and positively. In previous articles, I’ve talked about our in-built surveillance system and the human survival response. We all have this incredibly sophisticated system and a brain that is constantly being shaped by our experiences. Everyone is unique in their background, skills, experience and beliefs so it’s impossible to get bored when you’re working with people.

I have no issue listening to people’s stories (within limits!) so I can help them make informed choices about what to do. Believe me, I can’t read your mind and have no desire to do that with everyone I meet. However, the pink and fluffy stereotype is the one I particularly take issue with. It’s true that many counsellors and psychotherapists have “a certain approach” and many clients respond to that but trauma is different and trauma specialists are also different!

Years ago when I began working with police firearms officers, a chief inspector told me “don’t worry – they may be ‘roughty toughty’ on the outside but inside they are marshmallow” to which I replied that I may be marshmallow on the outside but I was ‘roughty toughty’ on the inside.

This is true of the majority of trauma professionals. To deal with the aftermath of trauma day in day out, you must have an inner strength especially if you do crisis work. To hear stories of horrific childhood abuse, hateful and mindless violence and lives being changed forever without crumbling requires a certain mindset. That doesn’t mean that we lack compassion and empathy. Far from it, but we need to be able to go into chaos and despair and provide structure, containment and safety. So how do we do that?

• By being focused and having a clear process for recovery: All trauma professionals should be clear about their way of working and provide the rationale behind this. People should be active, informed participants in therapy. It shouldn’t be something that they don’t understand or have any control or say in. We work hard but we expect you to work hard too.
• By giving psycho-education: Strategies for reducing symptoms and empowering people to be active in their own recovery is absolutely fundamental to the work. People should be able to ask questions and be given good explanations about things like the trauma response and why we advise the things we do.
• By providing a safe, structured environment for working with traumatic memories: People should not feel overwhelmed by emotions as this can be detrimental to recovery. Trauma therapists should provide ways that the person can talk about what happened (although not just repeating the same story over and over again) in a tolerable manner. Crying is not mandatory – yes, emotions such as distress or anger may be naturally expressed but the therapist is not there to force it.
• By seeing the strength in people: An experienced trauma therapist won’t judge their client as weak or having failed in some way. It can take a huge amount of strength and courage to live with a serious trauma reaction and even more so to ask for help. We see that.
• By maintaining hope: We know that people can and do recover fully. Often the person cannot believe this will be possible and our job is to carry the hope. However, we need to build trust and credibility first. Choosing a therapist is a very personal matter. I doubt that there’s a therapist in the world, no matter how competent they are, that will be right for everybody. They are trained to make people feel comfortable and at ease so should be informed if this is not the case.

In the UK, the National Institute for Health and Care Excellence (NICE) only recommends treatments for psychological trauma with emphasis on psycho-education for all reactions along with trauma-focused cognitive behavioural therapy and eye movement desensitisation and reprocessing (EMDR) for Post Traumatic Stress Disorder (PTSD). NICE suggests that there is no evidence for supportive counselling (what most people think of as the pink and fluffy kind) being effective. NICE goes so far as to suggest that requests for supportive counselling should be discouraged. Yet many people still end up with this type of support. This is one time when they really do need specialist support and because trauma therapy is focused and directive, it shouldn’t go on for months and months with no observable progress.

Often, the hardest part is overcoming the fear of accessing help. Even though it has been shown that there are effective treatments, even for PTSD, the pink and fluffy “counsellor” or the drug-dispensing medical “shrink” stereotypes will prevent many people from ever getting advice and treatment for PTSD.

Research has consistently shown that those who are affected the most are less likely to be receiving support, with stigma, shame and attitudes towards treatment being important factors in this. Some people will find the decision to seek help impossible. For them, there is too much shame in admitting a problem to themselves let alone in front of a stranger. Other barriers to seeking help for trauma include a lack of trust in mental health professionals, not knowing where to get help from, difficulty in accessing or scheduling appointments or getting time off work, concerns about the impact on their career and lack of confidence in the effectiveness of treatment.

Although NICE highly recommends psycho-education for trauma reactions, very few people actually get a sufficiently high standard of this. Removing the barriers that prevent someone from recovering was the driving force behind the development of our Power to Recover programme. For many people who can’t or won’t access face to face therapy, it’s proved a lifeline. When the first person described it as “life-changing” we felt incredibly proud of what we’d achieved.

It’s a real privilege to do the work we do and be part of someone’s recovery. I take great pride and satisfaction in what I do so if ever we meet, please don’t ask me about trees!

Reference:
National Institute of Clinical Excellence (2005) Post Traumatic Stress Disorder (PTSD) The Management of PTSD in adults and children in primary and secondary care. (Clinical guideline 26) London: NICE.

Dr. Liz Royle is an international speaker and author who specialises in providing psychological trauma consultancy and training for high risk organisations. She was a founder Board member for the UK Psychological Trauma Society and leads the Uniformed Services Task Force on behalf of the European Society for Traumatic Stress Studies.