Treating the effects of immediate trauma can be quite daunting. Often the emotions have not quite coagulated because the experience is so new and the client may still be in considerable shock. Research suggests, however, that the earlier the trauma is addressed and treated the more resilient the patient is likely to be and the less likely it will be that the patient will experience the lingering effects of the trauma.
I had one such experience recently with one of my patients who experienced a trauma while in treatment with me. She was physically caught in the middle of a physical altercation between two older girls. This new trauma was compounded by earlier traumas she experienced which in fact brought her into treatment.
After witnessing the trauma my patient was visibly distraught. She was tearful, screamed and was to her own admission: "terrified". She said to me that she expected to have nightmares that night (which in fact she did). Her grandmother later reported to me that she had nightmares the whole weekend and catastrophized (my word) the experience - thinking that the victim of the altercation had in fact died. My patient, who we will call "Gina" was tearful, hypersensitive and struggled with her interpersonal relationships all weekend.
The next Monday when she returned to therapy I was prepared to work with her at her own pace. I was certain that she would want to talk about it as a part of the group therapy experience, but I was not certain that she would want to share it publicly so soon. She surprised me. Not only was she interested in sharing the experience with her peers, but she was also interested in working dramatically with me.
Using the dramatic process creates a good amount of distance between the patient and the trauma thereby allowing them the ability to access their emotions safely. For Gina, she wanted to use the drama of the "Broadcaster". It is not unusual for victims of trauma to want to "broadcast" the experience. It gives them an opportunity to tell and re-tell the story. It empowers them by giving them a voice where during the trauma they may have felt silenced.
As the "Broadcaster" Gina asked me to scribe what she spoke , and I did so dutifully. She then performed it for me. The script read: "Nina punched Hope in the face. That's all we have for now. Stay tuned for more on Chanel 5 Fox 5 News".
The next day, Gina went through the routine again - each of us assuming our previous roles. The script read the same, but this time, sensing that Gina might be willing to be pushed a little (and myself falling victim to the pitfalls of short term therapy and insurance companies), I interjected, "I think we have a clip of that". And she silently agreed to watch it with me on our imaginary screen. As soon as the violent perpetrator made physical contact with the victim, Gina pushed the imaginary "off" button and immediately switched it to a clip about kittens and puppies. She would talk about how sweet and cute they were and at one point even asked if I had the clip of "Little House on the Prairie". I was shocked that she knew anything about Little House on the Prairie seeing as how she is only 6. But naturally I obliged. Gina commented on how beautiful Laura is and then inevitably something would happen to Laura or one of the kittens or the puppies. They would get kidnapped or hurt or tangled or even sometimes killed. I sensed by her act of sabotage that she was not quite ready to be pushed. So, I regressed her back to the more safe words - releasing images for which she was not quite ready.
Later during the same session the group was engaged in round robin storytelling - fantasy story. Gina's offering to each newly created story was always a sad offering. If one patient revived a character who died in the story, Gina would kill it. She even titled the story "The boy who kept dying". Gina's title seems to suggest that she may feel victimized and re-victimized over and over again - compounded trauma. After the story was complete she asked if she could tell the story of what happened the week before - her trauma. I obliged though attempted to create some distance for her by employing the "Once Upon a Time" technique. But Gina was not willing to let me hijack the time and setting of the story. She wanted to tell a REAL story, not an imaginary one. In drama therapyspeak we would say that Gina was underdistanced. No sooner than I started the story with "Once Upon a Time in a land far, far away", did she cut me off abruptly and said, "No. Friday at Willowbrooke". I was immediately aware that she was too close to the trauma and not ready to move away from it, and that our work would become creating appropriate therapeutic distance between herself and the trauma. At this time she had become too identified with the trauma to let it go.
Over the next few weeks, we were working less and less with the specific trauma and including it as a part of our overall work together. Eventually Gina was able to tell the story of what happened - or reference what happened with an appropriate emotional response. Her story referencing lessened over time and her trauma symptoms waned including - fewer to no nightmares - improved peer relations- fewer to no emotional outbursts - and no catastrophizing. And for me, the best sign of progress was listening to Gina tell a story - a fantasy story - where she did not feel the need to sabotage and where death was not a recurrent theme.
I had one such experience recently with one of my patients who experienced a trauma while in treatment with me. She was physically caught in the middle of a physical altercation between two older girls. This new trauma was compounded by earlier traumas she experienced which in fact brought her into treatment.
After witnessing the trauma my patient was visibly distraught. She was tearful, screamed and was to her own admission: "terrified". She said to me that she expected to have nightmares that night (which in fact she did). Her grandmother later reported to me that she had nightmares the whole weekend and catastrophized (my word) the experience - thinking that the victim of the altercation had in fact died. My patient, who we will call "Gina" was tearful, hypersensitive and struggled with her interpersonal relationships all weekend.
The next Monday when she returned to therapy I was prepared to work with her at her own pace. I was certain that she would want to talk about it as a part of the group therapy experience, but I was not certain that she would want to share it publicly so soon. She surprised me. Not only was she interested in sharing the experience with her peers, but she was also interested in working dramatically with me.
Using the dramatic process creates a good amount of distance between the patient and the trauma thereby allowing them the ability to access their emotions safely. For Gina, she wanted to use the drama of the "Broadcaster". It is not unusual for victims of trauma to want to "broadcast" the experience. It gives them an opportunity to tell and re-tell the story. It empowers them by giving them a voice where during the trauma they may have felt silenced.
As the "Broadcaster" Gina asked me to scribe what she spoke , and I did so dutifully. She then performed it for me. The script read: "Nina punched Hope in the face. That's all we have for now. Stay tuned for more on Chanel 5 Fox 5 News".
The next day, Gina went through the routine again - each of us assuming our previous roles. The script read the same, but this time, sensing that Gina might be willing to be pushed a little (and myself falling victim to the pitfalls of short term therapy and insurance companies), I interjected, "I think we have a clip of that". And she silently agreed to watch it with me on our imaginary screen. As soon as the violent perpetrator made physical contact with the victim, Gina pushed the imaginary "off" button and immediately switched it to a clip about kittens and puppies. She would talk about how sweet and cute they were and at one point even asked if I had the clip of "Little House on the Prairie". I was shocked that she knew anything about Little House on the Prairie seeing as how she is only 6. But naturally I obliged. Gina commented on how beautiful Laura is and then inevitably something would happen to Laura or one of the kittens or the puppies. They would get kidnapped or hurt or tangled or even sometimes killed. I sensed by her act of sabotage that she was not quite ready to be pushed. So, I regressed her back to the more safe words - releasing images for which she was not quite ready.
Later during the same session the group was engaged in round robin storytelling - fantasy story. Gina's offering to each newly created story was always a sad offering. If one patient revived a character who died in the story, Gina would kill it. She even titled the story "The boy who kept dying". Gina's title seems to suggest that she may feel victimized and re-victimized over and over again - compounded trauma. After the story was complete she asked if she could tell the story of what happened the week before - her trauma. I obliged though attempted to create some distance for her by employing the "Once Upon a Time" technique. But Gina was not willing to let me hijack the time and setting of the story. She wanted to tell a REAL story, not an imaginary one. In drama therapyspeak we would say that Gina was underdistanced. No sooner than I started the story with "Once Upon a Time in a land far, far away", did she cut me off abruptly and said, "No. Friday at Willowbrooke". I was immediately aware that she was too close to the trauma and not ready to move away from it, and that our work would become creating appropriate therapeutic distance between herself and the trauma. At this time she had become too identified with the trauma to let it go.
Over the next few weeks, we were working less and less with the specific trauma and including it as a part of our overall work together. Eventually Gina was able to tell the story of what happened - or reference what happened with an appropriate emotional response. Her story referencing lessened over time and her trauma symptoms waned including - fewer to no nightmares - improved peer relations- fewer to no emotional outbursts - and no catastrophizing. And for me, the best sign of progress was listening to Gina tell a story - a fantasy story - where she did not feel the need to sabotage and where death was not a recurrent theme.
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