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Dr. Dror Green
The present treatment for post-trauma
When I talk to experts in psychotherapy, they almost always admit that there is no efficient treatment for post-trauma, but they recommend a combination of psychiatric medication and psychotherapy, in order to reduce the symptoms. Nevertheless, I am often approached by therapists, professional or ‘spiritual’, who ask me to help them introduce a new magical method that may release all PTSD symptoms.
I do not oppose to both points of view. In my interactions with hundreds of PTSD victims, I have never met one who had a positive experience with a therapeutic method that cured his symptoms, but many of them met therapists who helped them feel a little better. This helped me to learn something about the disadvantages of psychotherapy and about the simple needs of PTSD victims.
The reason for the gap between the many researches concerning PTSD and the lack of effective therapeutic methods is that most researchers and therapists wrongly believe that PTSD is an illness that can be cured.
PTSD victims at the beginning of the 21st century are treated as women were treated at the beginning of the 20th century, when Freud and his colleagues believed that independent and assertive women that rebelled against the patriarchal dominance were hysterical (an illness that disappeared when women gained equal rights).
The many researches concerning PTSD and the therapeutic approaches that were consequently developed are based on the false assumption that trauma is a curable illness. This assumption causes the professional and supporting administrations to ignore the needs of PTSD victims by patronizing and devaluating them. I will present shortly the main approaches and their assumptions concerning PTSD victims.
Psychiatry
Psychiatry provides medications that meant to relieve the symptoms. Even in cases of mental illness psychiatric medications are not based on scientific data but on ‘trial and error’. Sometimes medications improve patients’ lives. Medications can also help PTSD victims cope with anxiety and anger attacks.
Medication is not different than any other kind of drug, like alcohol or Marijuana, and it supplies an easy way to appease the pain. Frequently medications have side effects that diminish their advantages. Some medications cause overweight and others cause numbness and dizziness. Medications do not cure the traumatic pain but relieve the symptoms temporarily.
Medication is not recommended as the only treatment, and it is more effective while integrated with cognitive psychotherapy, since it help PTSD victims cooperate with their therapists.
Medications can also be dangerous, as it happened in the case of Pentothal. After the war of 1973 between Israel and Egypt and Syria many PTSD victims were hospitalized and forced to receive Pentothal injections, that made them reconstruct and re-experience the traumatic events. Some of them lost their sanity, and they are still hospitalized. Some of the therapists and psychiatrists that participated in this experiment suffer from PTSD symptoms.
One cannot ignore the advantages of psychiatric medications that provide temporary relief and enable PTSD victims to communicate with others and approach for help. But constant use of medications creates dependency and addiction that contradict the basic need of PTSD victims to return their own control of their lives.
Psychoanalysis and dynamic psychotherapy
When Freud created the first talking therapy, psychoanalysis, he tried to create a corresponding model to the medical model to which he was accustomed as a physician. He believed that the mind, an abstract concept that has no agreed-upon definition even nowadays, is similar to the physical system, which can be treated and healed when it is wounded. His healing method, psychoanalysis, was based on the medical model, and he tried to heal his patients through manipulation. He believed that if the patients would be aware of the source of their trauma, the symptoms would disappear.
If Freud’s assumptions and techniques were proved, psychoanalysis would have become the main road to mental health and integrated in the medical profession. But in spite of the beauty of psychoanalysis one cannot find in Freud’s case studies successes than testify on its reliability. This explains why hundreds of other therapeutic approaches had developed after Freud. These approaches are based on different and sometimes contradicted assumptions, but there is no way to prove which of them is more effective.
Many of the new approaches to psychotherapy are based on psychoanalytic assumptions, and they are called ‘dynamic psychotherapy’. They were designated to reconstruct patients’ preliminary traumas, which were erased from memory, in order to reveal the source of the trauma and by that to relieve the symptoms.
These assumptions contradict the definition of post-trauma, since they are based on the belief that trauma is an illness that can be healed. They ignore the possibility that trauma is an injury that cannot be fixed or reconstruct. Relating to PTSD victims as ‘patients’ and as sick does not help rehabilitating them, since it makes them feel like victims and strengthens their inclination to blame others (or themselves) and by that it weakens their sense of control.
The psychoanalytic and psychodynamic technique is even more dangerous, since it confronts PTSD victims with the traumatic experience. Unfortunately, each encounter with the trauma or with a new trauma, enforces the traumatic experience and increases the damage. The psychoanalytic-dynamic therapy is based on the reconstruction of the traumatic experience, and it endangers the post-traumatic patients and may increase their pain.
Many therapists are aware of the dangers in psychoanalytic-psychodynamic therapy for PTSD victims, and they recommend other kinds of therapy.
Yet there is a special aspect of psychoanalysis that may create a sense of security in PTSD victims, a sense they cannot find in any other place. Freud’s main contribution to psychotherapy was his definition of ground rules, concerning the special relationships between analysts and patients, which create a safe place in the therapeutic session. Sometimes PTSD victims can find in psychoanalysts’ clinics the safe place, which they cannot find in any other place. This means that in spite of the dangers in the dynamic technique they can find a model for relationship that is based on trust, with their therapists.
Humanistic psychotherapy
There are many humanistic approaches to psychotherapy that are based on different assumptions than the psychoanalytic theories. According to humanistic psychotherapy clients are not ‘patients’, since they are not sick, and they do not pretend to cure them. Humanistic therapists treat their clients as equal, and do not claim to have secret knowledge that is not accessible to clients. Instead of cure or healing they provide a supporting environment, in which their clients can grow and rehabilitate their injured emotions.
Humanistic psychotherapy rejects the idea that human beings are motivated and dominated by unconscious powers that are based on childhood trauma. The humanistic therapy focuses on the ‘here-and-now’ and is based on the optimistic idea that human beings can always realize their potential.
These approaches, including the existential therapies, Rogerian therapy, Gestalt or Victor Frankl’s Logotherapy, wish to strengthen the clients, help them understand themselves, re-define their value systems and find a meaning in their lives.
Humanistic psychotherapy is humane, and it provides a supporting environment to clients who can take responsibility for their lives and improve them. But this warm and humane relationship, and the therapeutic setting which is not so clear and firm like the psychoanalytic setting, is suitable for those who can trust others, and may provoke suspicion in PTSD victims who need such supporting environment but afraid to trust it.
Humanistic psychotherapy is based on clients’ potential to heal themselves but it does not suggest a method to cope with the trauma. Many humanistic therapists would address trauma as a starting point for a positive change.
Despite the positive and optimistic approaches of Humanistic psychotherapy, it does not respond to the needs of PTSD victims, who lack the inner power and the belief in their human potential and cannot trust others. PTSD victims find it difficult to trust optimistic ideas, since they lack the emotional skill of being optimistic and creating trust.
Humanistic psychotherapy has many advantages, but unfortunately PTSD victims cannot benefit from them, since they lack the preconditions for such therapy.
Cognitive-behavioral therapy
For some reason it is conventional to include cognitive-behavioral therapy in the field of psychotherapy, although it is basically focused on behavioral changes and does not relate to ‘psychic’ or emotional aspects. From this point of view cognitive-behavioral therapy is similar to psychiatry that relates only to the physical aspect of the emotional difficulty.
Cognitive-behavioral therapy ignores the causes of the problem and focuses on removing the disturbing symptoms and solving problems by changing thinking patterns and habits.
Cognitive-behavioral therapy provides tools for solving problems by learning, practicing and creating new conditionings. Thus, for instance, elevators’ anxiety can be treated by relaxation and breathing technics and by guided imagination to reduce anxiety and learn how to use the elevator again. It is a practical way to remove difficulties that interfere with everyday life.
It is almost the only treatment that can help PTSD victims cope and overcome everyday difficulties. It helps them reduce the level of anxiety and identify stimulations that may harm them.
The advantages of cognitive-behavioral therapy are also its disadvantages, since it focuses only on symptoms and does not relate to the emotional process that is their source. This means that cognitive-behavioral therapy, that solves specific difficulties, also creates dependency with the therapist and does not strengthen independent and self-control, which is so important for PTSD victims.
Techniques and ‘magic’
There are effective techniques that can help PTSD victims cope with everyday life and improve their interaction with others. Such techniques are relaxation, hypnosis, autosuggestion and guided imagination. Each of these techniques may help PTSD victims in difficult situations.
There are also new techniques that pretend to serve as a magical solutions to all post-traumatic symptoms and difficulties.
Prof. Edna Foa developed her technique of Prolonged Exposure Therapy, in which PTSD victims are forced to re-experience the traumatic events. She believes that in ten sessions of two hours each she can reduce the post-traumatic symptoms and change the lives of PTSD victims. This technique is a kind of desensitization, which is a learned process of coping with unbearable feelings.
EMDR claims to help PTSD victims in 3-10 sessions by associating the traumatic memories to a series of eye movements. There is no explanation yet to this strange process, but therapists believe that this is an effective technique, especially when integrated with other therapeutic approaches.
SE, Somatic Experiencing, is based on the idea that a physical experience may help PTSD victims be aware of their physical sensations, and by that release unnecessary survival energies.
EFT proposes an emotional release by fingers tapping on special points of the human body.
There are hundreds of spiritual therapies that pretend to heal the post-traumatic pain by various physical techniques or by autosuggestion.
From my personal experience and my interactions with hundreds of PTSD victims, I learned that any technique or belief that help PTSD victims increase their sense of control in a supported and secure setting is a useful supplement to their surviving toolbox.
The common denomination of these techniques is the false assumption that PTSD is an illness that has to be cured. This assumption ignores the option that PTSD is a kind of disability that needs support and reinforcement, and it also ignores the risk of aggravation by re-experiencing the trauma.
The potential dangers of psychiatry, psychotherapy and alternative approaches
Many approaches to traditional or alternative psychotherapy are based on the assumption that PTSD is an illness that has to be cured. This assumption may be dangerous for PTSD victims who need help and support.
The advantages of psychotherapy and alternative approaches
In my research I tried to find the common denomination of more than 400 therapeutic approaches, and I found that it is the unique situation and special interaction between therapists and their clients. The therapeutic interaction is different than any other interaction, and it is based on special boundaries that create a sense of a safe place. Even when the therapeutic theory has no solid basis or when it is based on mystic assumptions, the therapist’s personality and skills of creating a safe place for his clients create a frame in which clients can improve their emotional skills by themselves.
Thus, any therapeutic intervention by a sensitive therapist that can create such a safe place may be beneficial in some way to PTSD victims. It can be more beneficial when clients learn from the therapist how to create such a safe place by themselves. In this way the therapeutic interaction becomes a simulation for practicing emotional skills for creating a safe place.
Paradoxically, a rigid approach like psychoanalysis, which is not effective for PTSD victims, may provide a safe place due to its clear ground rules, and by that help client to feel secure. Other approaches create the sense of confidentiality by warm human relationship or by supporting and containing that also create conditions for a safe place.
PTSD victims, like other clients, can test the benefit of different therapists by the sense of confidentiality within this interaction. I wrote about it extensively in my book ‘Psychotherapy, consumers’ guide’ (Green, 2003).
Emotional Training
When I found that the sense of a safe place is the main benefit clients may find in any kind of psychotherapy, I decided to research how this sense of security is created in psychotherapy and in other situations.
This led me to define seven categories of emotional skills, with which we create the sense of a safe place, and without which we cannot survive in the world.
Emotional Training is designated to help you PTSD victims identify their special and unique emotional skills, to understand how they use these skills to create a sense of a safe place and to improve them as a continuous process in their lives.
Emotional Training is based on the practice of the seven categories of emotional skills. By simulations and practicing it becomes a simple and practical way of life that serves as an emotional immune system.
Emotional Training is a basic and primary skill for rehabilitating the emotional process, and it can be integrated with any other skills and methods.
Emotional Training is beneficial for PTSD victims, since it does not relate to the trauma as an illness, and since it provide PDSD victims with emotional skills to efficiently cope with the post-traumatic symptoms. It does not pretend to heal or fix the trauma, but it introduces practical tools to cope with the traumatic damage which cannot be healed and to live full and creative life after the trauma.
The post-traumatic damage does not involve only PTSD victims, but also their family members and close relationships. The rehabilitation of PTSD victims needs a supporting environment that has the appropriate tools to cope with the difficult symptoms, and a professional help that will provide the basic safe place in which the emotional skills may be practiced.
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