Suggested Steps in Helping Those in Trauma

1. Begin by developing an atmosphere of safety, trust and exploration. Ensure stability for the person before going further. Build the relationship first. Just talking is more important than techniques. “Tell me your story.”

2. Know the nature of the trauma to this individual: how it is being perceived, how it is felt, and how it is being acted out. There is no effective way to know the impact of the trauma without going inside the individual to find out how the trauma has made its mark. Then adapt your counseling to the person. Don’t expect one intervention to have the same results with two traumatized individuals.

3. Explore trauma memories and associated responses. It is important to fully explore the trauma memories and observe the unique responses the individual has to the memories.

4. Decondition harmful affective responses. This critical step is much easier to state than to accomplish. Help them discover new ways of responding to difficult responses—reframe and reinterpret.

Reframe symptoms as “signs of coping ” and as “protective and healing mechanisms” and “normal” part of the recovery process.

a. Intrusive thoughts are an attempt to make sense of the experience, the brain’s attempt to assimilate the experience. Not just let the experience go, but rather make sense of it; flashbacks/ nightmares are access routes to memory. Flashbacks is a way the brain is attempting to heal itself. It’s the mind’s attempt to make sense of what happened.

b. Denial/numbing are ways that the mind takes a “time out,” as a way of “dosing” or of “pacing” oneself so you only have to deal with so much stress at one time.

c. Dissociation at the time of the event was a potentially useful skill. Speak of the “wisdom of the body,” e.g., “mind is taking time out from overstimulation”’ “denial is one of nature’s small mercies.”

d. Convey that the “survival skills” that the client once used and were adaptive at the time may no longer be appropriate.

e. Commend the counselee for being distressed. The counselor might say something like the following: “Given what you have been through, if you didn’t have stressful reactions, weren’t depressed, had a short fuse at times, dwelled on what happened (use counselee’s symptoms), then I would be really concerned.

f. Indicate that PTSD is definitely responsive to treatment and that healing can be a lifelong process. Convey to the counselee that symptomatology may not go away complete, nor forever.

g. Indicate that it is possible that symptoms “may get worse before they get better” as we discuss and work through what happened and why, as we begin to refocus on the trauma.

h. Finally, “although this may be difficult to believe right now, you may even find that there will be some positive benefits to you and your life as a result of the experiences you have had and your willingness now to face and work through what you must work through.”

5. Reexposure to the trauma is critical, as is how and when the person is reexposed. Research with all trauma survivors indicates a principle that the individual must mentally revisit the traumatic experience again—but with the supportive assistance of someone who can help them through their fear.

6. Restructure the meaning of the trauma by having the person change the ending of the trauma story. As the person is reexposed to traumatic experiences, it is very important to add a component that did not exist the first time around—control. Take the control away from the event or the person. You’ve survived until now. How could this be worse? You told your story. How will you be different next month, next year?

7. Replace problematic behavioral responses with adaptive behaviors. Teach the person how to make positive changes. “Remember you can write the last chapter of your trauma. It hasn’t been written yet.”

8. Build a new internal self-view. Understanding the meaning of past trauma to the individual, which is Step 2, will help you understand what the post trauma self-image is. “Don’t define yourself permanently as a traumatized person. Teach them when to remember the trauma instead of the traumatic memories being in charge.

9. Teach the person specific coping strategies. The person must have a new sense of self and feel more confident about internal abilities to be able to win the battle over the present by keeping the past from taking over. You must have some ability to teach, to model, and to reinforce new adaptations or coping skills. Teach the language of healing.

10. Self-mastery can turn trauma and other stressful situations into experiences producing resilience. The final step is similar to rewriting the ending of the trauma story; the individual can be stronger because they have been to hell and made it back in one piece.

I Thess. 5:14 “…encourage the timid and faint-hearted.” Encourage means “to console, comfort and cheer up.” It refers to the person who “is discouraged and ready to give up.”

Hebrews 10:25, “Let us encourage one another.” It means “to keep someone on their feet, who, if left to himself would collapse.”

© Copyright 2006 H. Norman Wright.