The early stages of trauma work often place an emphasis on developing coping strategies for managing symptoms, teaching affect regulation and containment skills, and providing education on posttraumatic stress (PTSD). Normalizing the constellation of symptoms as a normal response to an abnormal situation helps clients consider that perhaps there is nothing wrong with them—that they aren’t broken but are in fact normal. However, trauma work is often difficult and painful; the process itself can be as frightening as events leading someone to pursue therapy. The focus of this article is to take the concept of PTSD as a normal response one step further and begin to consider how symptoms are attempting to be helpful and ways in which they are working on behalf of the individual. In order to facilitate a relationship between clients and their symptoms, I will begin by the identification symptoms as internal characters that exist in all of us in similar ways with similar goals. Determining who the characters are and what they are attempting to accomplish will hopefully set a lighter tone in this approach to challenging work and may decrease anxiety about trauma work itself and provide a more targeted direction for treatment.
Flashbacks and nightmares are frequently described as “in your face,” unavoidable, intense, and overwhelming and can take the survivor off guard. These experiences could be likened to a drill sergeant; an unrelenting and aggressive character whose intent is to prepare you for battle. Drill sergeants are skilled at detecting your failings; anything soft or permeable about you will be identified and illuminated with force. They are thunderous, use big voices, and have a large, inescapable presence. When they are near, life beyond them becomes a soft hum; in their absence energy is consumed by averting further interactions with them. Should you get too comfortable with your skill set or how you are moving along in life, you will likely be reminded that letting your guard down would be in err.
The premise for this relationship as it exists is conflicted and aversive given the means with which the drill sergeant communicates. However, what if the the drill sergeant is protective in nature? Perhaps there is logic to his or her existence and the force with which he interferes with daily life. In preparation for battle, for example, one needs to be equipped emotionally for what is to come, and this preparation is based on a particular knowledge of what can occur within the context of a battlefield. The internal drill sergeant witnessed your wounding and may be working to help ensure that it doesn’t happen again. S/he may be providing specific imagery (i.e. in the form of a flashback or repetitive nightmare) that coincides with why you were injured, what bothers you about it, and how to avoid or confront similar hazards.
This particular character can, however, be debilitating and become so overbearing that survivors become fearful of him or her; the goal becomes avoiding the activation of those images through isolation and withdrawal. The drill sergeant may either respond to this reaction with fervor or may reinforce it by relaxing a bit (because the survivor is considered safe if he or she is isolated). Cultivating a relationship between trauma survivors and their drill sergeant may help shift the course of treatment through understanding, openness, and utilizing what the drill sergeant is showing you (in the form of flashbacks and nightmares) as information. The following list is some ways in which a connection between the survivor and the internal drill sergeant can be developed:
1. Differentiate the self from the internal drill sergeant. Identify the ways in which the drill sergeant exists in all people versus unique traits that are specific to the survivor.
2. Formulate questions for the drill sergeant such as:
- “Why are you talking right now? What is it that you need from me in order to relax a bit?”
- “What do you want me to know?”
“Do you have concerns about the past, present or future that are reflected in the images, feelings or words you are showing/wanting me to hear?”
3. Capitalize on the content of flashbacks or nightmares as a means of providing a guide for therapy. For example:
- The drill sergeant may be repeatedly showing you the most disturbing aspects of a traumatic memory. The fact that this disturbs you illuminates your inherent goodness (something special about you and close to your heart that made this part of the memory upsetting). The drill sergeant is aware of this unique and inherent goodness and this is the precise thing he is trying to protect.
- The timing of a flashback or nightmare may be relevant. Perhaps there is something in your internal or external environment that is reminiscent of the memory.
Flashbacks and nightmares can be a significant disruption in the life of a survivor. Imagery, body memories, sounds, smells, and other components of trauma may be experienced repeatedly and can impair one’s ability to assume a sense of safety in the world. Working with survivors on how they interpret these particular symptoms can help survivors shift the sense of being victim to them to gaining a sense of mastery and trust. The ways in which symptoms organize themselves can illuminate idiosyncratic qualities of the survivor that he or she may not be fully aware of. Acknowledgement of PTSD as adaptive as well as functional can be aided by the externalization of specific symptoms—things that exist outside of the person. This also fosters a relationship between the survivor and his or her internal system while creating space for playfulness, openness, and healing.
© Copyright 2012 GoodTherapy.org. All rights reserved. Permission to publish granted by Athena H. Phillips, MSW, LCSW, therapist in Portland, Oregon
The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.