Saturday, November 04, 2006
For the few or none that have read this blog, I will continue writing more on psychological safety. This is more for my own benefit as I have a lot of thoughts on this matter that are manically running through my mind. Let's start with a definition of general safety. "The condition of being safe from undergoing or causing hurt, injury, or loss" according to webster's online dictionary. As is the case with many individuals who have experienced any type of psycholgical trauma, feeling safe is an ongoing problem. As is the nature of PTSD symptoms, many have a sense of insecurity, fear of the unknown, and at times paranoia of being harmed again. It can lead to compensatory behaviors such as avoidance. Therefore, does it not seem pivotal to to establish a sense of safety in treatment before attempting any trauma resolution? What can be done if just the thought of the traumatic incident causes severe fear even in therapy? How can the trauma be resolved? How can the client achieve emotional relief? It seems only obvious that the treatment regime must be planned to meet the client's needs in the way that they are able. Therefore, it seems only logical that the therapist/counselor be trained in several treatment modalities ranging from the traditional (i.e. CBT, REBT, talk therapies in general) to the non-traditional (i.e. play therapies, sand-tray, EMD/R, art, music, thought field therapy, experiential therapy) approaches. Thus, the client's needs can be assessed and resolution can be made by implementing an effective treatment that promotes safety. The goal, once safety is established and maintained is to decrease the negative symptoms and effects of PTSD sufficiently so that retraumatization is less likely to occur. One problem that I have run into with clients is retraumatization--not in the therapeutic setting, but in their normal environment and social interaction. They are still subjecting themselves or being subjected to situations that are associated to the past traumas. Therefore, the focus of the treatment changes from trauma resolution to establishing safety for their situation. This may mean that the battered woman must be empowered to refuge resources to avoid continued harm. It could also mean that the adult male or female who was abused by a parent avoid speaking or having contact with them as they are completing treatment. Essentially, safety is cornerstone in the trauma treatment.
I have also found that safety comes in levels and it can change throughout the treatment. There may be times when safety has been established with one step of the treatment and must be modified later on. Therefore, treatment progress seems to ride on safety.
Thus far I have talked about safety being established in trauma situations to avoid continued traumatization. Now, I will explain an even more difficult situation regarding safety. With many traumas, the source of it is an isolated event or series of events that occur over time. It is as if they "leave a mark" on the individual's psyche. I will compare traumatization to a rotten buffet. An individual is forced to go to a buffet and is forcefed rotten moldy food against their will. They do not know when the feeding will occur or for how long they will be forced to eat. Therefore, it is a pain that is caused to them against their will. (One type of trauma in this case would be parental abuse which I will use during this part of the blog). How does neglect come into play in trauma? Neglect, if it were compared to a buffet would have a different aspect to it. Rather than being fed rotten moldy food, the individual is being denied basic foods and water that they need to survive. They are being starved rather than forcefed. Neglect, on its lowest level stunts psychological development, such as starvation would cause failure to thrive in small children. Maslow's heirarchy of needs explains it well. The lowest level of the needs pyramid is physiological needs--shelter, food, water, medical needs, etc. As that is established the next need is safety. Let's assume that an individual is safe from physical harm, but is not given the needed structure, nurturing, love, and attention that they need. They are left to learn for themselves and to develop without help. How can safety truly be established when their emotional, mental, and psychological foundation is not being cultured? It only seems logical that the individual is being denied basic needs. Without it, self-actualization is not possible and will not be possible until that foundation is built. It seems to me, thus far in my limited career, that building a foundation with someone who has attempted to self-actualize without it is much more difficult than resolving trauma. It is like trying to place a foundation under an already built home. Therefore, trauma resolution does not seem possible as that foundation must be built.
Thus far I have discussed briefly the concerns of safety in trauma treatment. This is only the surface of safety and I expect to continue more safety concerns, as well as possible explanations of how it can be established.
This is for anybody and nobody and is my first attempt to publish blogs. The focus will obviously be on issues of mental and emotional health. Yes, I do have an idea of what I am talking about. Much of it will involve the speciality that I work in--psychological trauma, much of which is manifested in posttraumatic stress disorder or like symptoms. As an initial blog I'll explain, to no one, that trauma is any event or situation that someone is a victim or witness of that causes a sense of hopelessness, helplessness, fear, and vulnerability. It can be physical or emotional in nature; and you don't even have to be the actual victim. You can be watching it, such as children witnessing domestic violence. Although I will not go into the full Diagnostic and Statistical Manual definition of PTSD, I will state that it can have long-term emotional, mental, relational, and behavioral effects. It can, at times, appear to be depression, anxiety, sleep, addiction, or behavioral disorders (among a few). If the trauma occurs many times and continues over several years (depending on the age and development of the individual) it can also result in dissociative symptoms; even to the point of dissociative identity disorder (formerly known as multiple personality disorders). Now, trauma-related disorders can be treated and there are many different modalities that are effective and beneficial. Every professional therapist or counselor will have their favorites. The important part is that it be done in a safe environment where the client will not be retraumatized during the treatment. It is possible to be retraumatized by focusing on the frightening images, feelings, or sensations that the person experienced during the actual event(s). Thus, if you know a person who purposely avoids talking about something traumatic, there is a strong reason for it. Safety, therefore, is the first step in the treatment. The second is trauma resolution--in other words, decreasing the emotional upheaval that is associated with the event/incident. Finally, once that is achieved the individual would benefit from reconnection to their family, friends, and society as trauma can result in personal isolation. So as not to continue babbling I will end this introduction now. Further blogs will include my thoughts and other professional's thoughts on therapeutic approaches with trauma as their targeted population--and some.