Communication-Focused Therapy (CFT) for PTSD
Dr. Christian Jonathan Haverkampf, M.D.
Posttraumatic Stress Disorder (PTSD) is a relatively common disorder resulting from very different traumatic events or situations. A trauma represents information which cannot be processed by the organism in a way that is fully self-healing in the short term. It causes a disturbance to internal communication systems which affects the internal communication patterns a person uses. These changes in communication patterns can lead to various symptoms if they are maladaptive. Communication-Focused Therapy (CFT) is a psychotherapy developed by the author, which can be applied to several mental health conditions, including post-traumatic stress disorder (PTSD).
Keywords: PTSD, post-traumatic stress disorder, communication-focused therapy, CFT, communication, psychotherapy, treatment
Table of Contents
Post-traumatic stress disorder (PTSD) is the result of an event that is not supposed to occur, whether a tropical storm or a rape. A trauma needs to take one outside the usual human experience, although it may be more than rare. The link between the person and the world seems to be severed by the trauma, resulting in internal and, as a consequence, external disconnects, emotionally and cognitively. The subjective perception of relatively changes, and this divergence between old and new reality can lead to anxiety, a loss of direction and dissociation. The trauma has thus brought a change to the entire system. The change it causes to the internal and external information flows are what causes the symptoms and their resistance to treatment.
Communication is not only the process that prolongs the symptoms but also the instrument with which it can be resolved. Communication-focused treatment is not instant, but a gradual process which helps to resolve the core problem and significantly reduce the symptoms. As the patient becomes more confident in using and experimenting with own communication patterns and sees more stability in the world, the symptoms from the PTSD fade away.
The most significant consequence of a trauma is how it affects the communication with oneself and with others. From negative thoughts about oneself to anxiety when talking to others, a trauma impairs the most global and most important mechanisms of any living organism, the exchange of information. It is through communication that we perceive, feel and change our environment, and disturbances in it lowers these abilities and an individual’s confidence and sense of efficacy in the world.
Where physical trauma causes damage to physical structures, psychological trauma causes damage to the communication systems of an individual. Autoregulatory healing processes set in as in the case of a physical trauma. However, the trauma often causes changes in the communication system which existing communication patterns cannot handle, particularly if they are already maladaptive in everyday life.
Traumas do not have to be caused by other people, however, the most devastating ones often are. A trauma makes the world a less predictable and less safe place. Trust in the world, and by extension in oneself, is shattered by the effect the trauma has on how one estimates risk, but most importantly on the emotional signals it triggers. They are information which needs to be communicated, because otherwise they can persist and, if unresolved, lead to secondary phenomena, such as anxiety. Communication-Focused Therapy (CFT) aims at facilitating the communication of this information internally, and if needed, externally.
Communication space describes the space across which communication can take place in a given moment. If someone in Europe is on the phone with a relative in Australia, then communication space extends to this person in Australia, but probably not to the next-door neighbor if their door is closed. Communication space changes as one becomes receptive to messages from different sources and can send messages to different people. Communication can change over time, such as when a person hangs up the phone, for example. However, in the body and in the outside world it needs to extent to those sources and recipients of potential messages which offer a benefit to the individual but do not create inefficiency.
Trauma often brings with it social withdrawal, a shrinking of the communication space. This is originally a protective mechanism, as the organism tries to avoid further hurt, but it also reduces the available spectrum to communicate with oneself and the environment emotional and other important messages, which could help against the symptoms of the trauma. The vicious cycle of less communication leading even to a further decline in communication often causes patients to get stuck in PTSD. It is when autoregulatory communication processes fail because they have also been compromised by the trauma. The way to get ‘unstuck’ is to develop insight into what is going on and develop the skills to escape from it through communication. This usually requires being able to take a step back, which can be practiced in the therapeutic process.
A trauma often does not cause direct physical harm, but it has an effect on the organism through the changes it triggers in it. Someone who gets hit by a sudden trauma or is exposed to traumatic experiences over a long period of time becomes confronted with emotions and thoughts that are directed at avoiding another trauma and helping the organism to adjust to the world after the trauma. Since the scope of traumatic situations in the modern world shifts faster than evolution could follow, the ingenuity and innovativeness of the higher brain functions needs to be activated. Unlike the emotions, it can adapt to changing situations quickly, if the required openness exists and anxiety is not too high. There can be a conflict, however, between an emotional reaction that tries to protect the organism and an emotional and cognitive reaction that wants to communicate and ‘solve’ the trauma.
An emotion is information, a signal that gets communicated in a message. As the name “e-motion” suggests, their purpose is to bring about some movement or change. Emotions are aggregates of large amounts of information from internal and external sources. As such they are very important to help the individual adapt to the environment and shape the environment in ways that help to satisfy own needs and meet own values and aspirations. Resulting from the impact a trauma has on a person’s communication patterns, it can get more difficult to receive and identify these emotional signals, to extract meaning from them and to use internal and external communication to make adaptive and innovative changes.
The goal of communication-focused therapy (CFT) is to make internal and external communication patterns work better, which then improves the effectiveness of the communication systems as a whole. (Haverkampf, 2010b, 2010a, 2017c, 2017a). This allows not only the autoregulatory processes to work better, but also provides the foundation for conscious insight into these communication patterns, which can then help the patient to use them to meet the own needs, values and aspirations. In cases of PTSD, this regaining of meaningful control over oneself and one’s life helps to draw healthy boundaries and close the psychological wound cast by the trauma. This leads to a better integrated sense of self and raises self-confidence and the motivation to engage with the world in relevant and meaningful ways.
Communicating an emotion helps to resolve it as its information gets passed on. This usually leads to some external action, but it can also mean talking about it, or even writing about it. To the brain it makes little difference whether one carries bricks for a bridge or draws a plan for a bridge. The important step is that an internal communication takes place. Just becoming aware of an emotional signal is already in itself quite powerful to resolve the emotion. However, this should not mean a retraumatization. Rather, it should be allowing the information to move on, which is essentially a constructive process, since it generates new meaning.
After a trauma, it s not easy to get a patient to move from what seems to him or her like self-protection to communication. Crucial is to engage with the patient and make him or her feel safe in the process. This also includes reflecting on the communication between patient and therapist, on what it means, and how the patient generates, sends, identifies, interprets, processes and responds to meaningful messages.
The goal is to reconnect with oneself and with the world. The tool to accomplish this is through meaningful in the context of a facilitating relationship, such as in a patient-therapist interaction. To be meaningful it requires that there is a genuine willingness to understand and empathy on the therapist’s side and an interest for the process on the patient side. Part of the therapeutic process is educating a patient on how this can be accomplished, from recalling situations or thoughts and identifying associated emotions to reflecting on how one feels in the moment. The important element is, however, that the patient has a sense that the therapist understands what he or she is experiencing. This understanding helps the patient to feel safer and willing to embark on a therapeutic process because it communicates that there is a commonality, a process shared by humans in general, which is understandable and predictable.
Reconnecting with one’s emotions happens through the ability to identify emotions and decode their meaning. In other words, reconnecting is about being able to see and understand the information and its meaning, whether emotional, cognitive or of another quality. This can be practiced in a therapeutic setting and transferred to the patient’s everyday life, where it becomes over time a habit integrated into the internal and external communication patterns. For a patient with PTSD, reconnecting can activate fears. However, overcoming them not only leads to a better connection with oneself, but as a consequence also to a clearer perceivable and more detailed, and thus more integrated and stronger sense of self. Several CFT techniques to work with these fears are described by the author elsewhere (Haverkampf, 2010b, 2017a, 2017c, 2018b).
A trauma is not supposed to happen in the world. Some traumas can be a learning experience and prevent greater damage in the future, but the more interconnected and open the world is to meaningful information, the easier learning should become without pain and suffering. The vast majority of traumatic experiences, however, seem pointless. Often, a person may just be in the wrong place at the wrong time, such as in the event of a crime or a natural disaster. No one plans for that, nor should one if the risks of it happening are very low and self-protection from it not feasible or very costly in terms of discomfort, time and money. In clinical experience, it often helps to do what many shy away from, to see it as a lottery which is unrelated to the behavior, interactions, intentions, personality and intelligence of the patient. More and better internal and external communication, rather than less, can help the patient to make sense of this apparent paradox. Knowing more about oneself and the world can make a trauma manageable by integrating it into a much larger tapestry of life and help a person feel the own resources and strengths again, which also helps to deemphasize the power the trauma has over him or her.
When something has happened, which is not supposed to happen, it seems a formidable task to get the patient used to the fact that what happened has been a statistical outlier, something that usually does not happen in this world. More connectedness with the own person and others can strengthen the insight that the traumatic experience was truly a statistical outlier. Often, it requires also connecting with the anger, hurt, pain, frustration, sadness, loneliness and other emotions which seem to separate the own person from the world. Better communication with oneself and others can take down this wall of separation. Work on individual and specific communication patterns which have been maladaptive or can be potentially helpful and adaptive is very valuable here.
Some of the most severe traumata happen on the interpersonal level, and one may even go so far to say that severe chronic forms of PTSD in most cases had an interpersonal traumatization as their origin. Communication is thus the instrument how the trauma was delivered, which adds to the fear of engaging in communication with others, and as a consequence also with oneself. The victim withdraws into nowhere, since the own inner world often does not offer that much more safety. Internal and external worlds require communication to uphold them and interact with them. If there is no place left where the wounded self can withdraw to, an existential dilemma results, which can lead to dissociation from the world and oneself and a loss of perceived meaning in both. Cognitive and emotional numbness and the typical PTSD symptoms are manifestations of this internal purgatory. Working with communication by a gradual focus on internal and external communication patterns can get autoregulatory processes running again. Through an exchange of meaningful messages an awareness of meaning can again be recreated, bringing with it individual perspectives, values and needs, which helps rebuild trust in oneself and others, since both are closely interlinked.
It is difficult to see meaning in the devastation brought on by hurricanes, wars and serious crime, and one is not supposed to. The meaning is in the response. It may be impossible to decode the meaning conveyed by a hurricane, but it is conveyed by how people respond to it. Life continues through the communication processes that pervade it. If life can become safer and broader in the future, then this represents meaning. In therapy, it is does important to shift from the traumatic event to the response, which usually happens naturally if a communication focused approach is used. The communication of emotions elicited by the trauma is then simply a part of the larger response. One should keep in mind though that the information that is communicated, and the meaning that is created as part of this process, are more than a ‘response’, they are the evolution of something new, which reflects on the individuals basic parameters, the needs, values and aspirations. The process is thus highly individual, while adhering to rules that are universal.
Both of these therapies have shown effectiveness in the treatment of PTSD. Both have theories about why they help. The former sees learning processes about certain thought processes as central, the latter psychodynamic processes that bring about a change. However, they both neglect the communication process and changes in how people communicate as what ultimately helps. The difference to interpersonal psychotherapy is that the latter focuses more on the interpersonal setting than the actual communication processes.
The tool that helps in the end is the communication between therapist and patient which can bring about change through the meaningful messages that are exchange in it. This is why focusing on communication in the first place, can help bring about deeper and lasting change. Communication is this sense consists of the communication patterns and the way information is processed and meaning extracted from the information. Most psychotherapeutic approaches focus on specific content or how thoughts and emotions are processed, rather on the underlying process, which is the information processing.
Communication-Focused Therapy (CFT) was developed by the author to focus more specifically on the communication process between patient and therapist. (Haverkampf, 2010b, 2017a, 2018a) The central piece is that the sending and receiving of meaningful messages is at the heart of any change process. CBT, psychodynamic psychotherapy and IPT help because they define a format in which communication processes take place that can bring about change. However, thy do not work directly with the communication processes. CFT attempts to do so.
We engage constantly in communication. The cells in our bodies do so with each other using electrical current, molecules, vibrations or even electromagnetic waves. People communicate with each other also through a multitude of channels, which may on several technologies and intermediaries. It does not have to be an email. Spoken communication requires multiple signal translations from electrical and chemical transmission in the nervous system to mechanical transmission as the muscles and the air stream determine the motions of the vocal chords and then as sound waves travelling through the air, followed by various translations on the receiving end. At each end, in the sender and in the receiver, there is also a processing of information which relies on the highly complex networks of the nervous system. Communication, in short, happens everywhere all the time. It is an integral part of life. Certain communication patterns can, however, also contribute to experiencing anxiety and panic attacks.
Communication is an autoregulatory mechanism. It ensures that living organisms, including people, can adapt to their environment and live a life according to their interests, desires, values, and aspirations. This does not only require communicating with a salesperson, writing an exam paper or watching a movie, but also finding out more about oneself, psychologically and physically. Whether measuring one’s strength at the gym or engaging in self-talk, this self-exploration requires flows of relevant and meaningful information. Communication allows us to have a sense of self and a grasp of who we are and what we need and want in the world, but it has to be learned similar to our communication with other people.
Within the meaningful interactions of therapist and patients, or in any other relevant setting, if it s working well, relevant messages are generated which have the power to bring about change. Messages can bring about change if the recipient regards it as relevant and it contains some new information. The processing of this new information adds something to the recipient, even if the content is rejected as false. In other words, every meaningful interaction gets us further, helps us develop insight into ourselves and the world.
Especially in the case of PTSD, this insight is relevant because it makes the world predictable again. One may not understand why the hurricane hit this specific village or why a parent was abusive, but to realize that how such horrible experiences are processes has a certain course and is predictable, makes the world a better place again.
The therapeutic setting should also make it easier to determine in a safe environment that the person with issues is not the victim, but the perpetrator, if there is one. Insight into certain disasters or catastrophes helps, because it helps shifts the focus to where the issue is, rather than oneself.
At a later stage, communication should be seen as a tool to integrate all the information into one’s perspective of the world. A patient needs to be able to integrate the information from the trauma to an extent that it no longer feels as an alien object or emotion in the mental landscape. To get there may require a new perspective on communication and new ways of working with it, which can be learned and trained in the therapeutic session.
Integration means not necessarily seeing meaning in the traumatic event, but in how one reacts, thinks and feels about it. This should correlate with one’s needs, wants, aspirations and values. One cannot choose a traumatic event, but one can choose how to react to it, and this goes a long way to feeling whole and well. It needs to make sense in the context of one’s sense of oneself.
The trauma is highly personal. Some people may interpret something as a trauma, which others do not. Much depends on one’s outlook on life and one’s past experiences. It is highly subjective. However, in many extreme situations, it is unlikely that there is no traumatization in even the most resilient person. Rape or torture in the vast majority of cases cause symptoms of PTSD, sometimes with a substantial delay of years or even decades.
PTSD is subjective because it is generated from the interaction between one’s basic parameters, view of the world and oneself, basic needs, aspirations and values, and the trauma, which is roughly equivalent to saying how the information about the trauma is processed by oneself. Since information transmission and communication plays such an important role in trauma, these are also the processes that can be used to treat it.
Trauma does not require physical harm or wounds. Rape, for example, does not have to leave physical scars, but it usually does leave psychological ones. To understand trauma, one needs to understand that physical integrity is usually complimented by psychological integrity, a sense of self and person which is a whole and deserves respect as such. Communication can be used as a weapon to inflict great psychological harm.
Often, there are already maladaptive communication patterns before, that cause the problems in the relationship or interpersonal interactions. These patterns can be analyzed and changed. In the processing of the trauma the patterns of communication with oneself and others play a significant role. Since the communication on the inside and on the outside are at least in some respects partial reflections of each other, changing one, can help influence the other. This is why developing insight and skills through the communication processes in the therapeutic setting also have a beneficial influence on the communication a patient has with himself or herself. The blurring between internal and external communication, however, can also maintain the trauma. Since information does not carry a tag about its source, fears can seem real and reality be willed with representations of emotions and thoughts which have remained unresolved from the trauma.
A trauma is a blow to the representation of the world and the self. Just reconstructing everything as it was before is usually not an option, since this would require unmaking the trauma also in the real world. Denial and repression may try to accomplish this, but at some point they will break down as patients diverge increasingly from the fabric of reality in their thoughts, behaviors and decisions. Only by finding ways to get back to the shared reality, rather than farther away from it, can feelings of belonging and efficacy in the world through interactions with others, and oneself, be reestablished. Thus, focusing on how individuals suffering from PTSD communicate with themselves and others to steer their life according to their values, needs and desires is important to reconnect them with a reality that can meet their needs.
In life, one has to live with uncertainty. Uncertainty just means that there is no manual in the beginning and there are still unknowns which leave room for excitement and exploration. Life is a learning experience. An individual suffering from anxiety may have areas in life where she thrives on excitement, and other areas where images of worst case scenarios cause her to freeze when she just considers a change in action or any action at all. Uncertainty to someone suffering from anxiety seems to be bearable in some areas and avoided in others. Often, the areas where it is not tolerated feel meaningful only to the person suffering from anxiety.
Areas which people often feel anxious about are where there has been an issue with their interpersonal interactions in the past. Early traumata, like a disappearing or abusive parent, stay unresolved. For example, if a parent feels fearful and angry with himself and this is picked up by a child, the latter may decode these messages correctly in that the parent is angry, but since the parent may not be conscious about it, the child does not pick up on the second important half of the message, that the parent has a problem with himself and his issue is unrelated to the child. Of course, one can learn to pick up on the self-blame and frustration of the parent, and therapists should become experts at reading between the lines in this fashion, but it requires experience, reflection and insight into transference and counter-transference phenomena, for example, to use the psychoanalytic terms.
Anxiety can lead to avoidance, which in turn can attach even more anxiety to the situations or behaviors which are being avoided. In social situations, not interacting with others deprives the person of continuously updating and honing the skills and confidence of interacting with others. Avoidance can thus lead to an increase rather than a decrease in anxiety in the long-run.
Individuals suffering from anxiety and panic attacks often see less meaning in the things they do. In therapy an important part is to rediscover meaning, and find it in the things that are relevant to the patient. Relevant is anything that is close to his or her values, basic interests, aspirations, wants, wishes and desires.
An important step in therapy thus to make the person aware of how anxiety affects one’s thinking. Individuals from anxiety often focus differently from other individuals. There is often a focus on worst outcomes and strong fears which are caused by it. Underlying this are often strong emotions or conflicts which need to be defended against. The danger and uncertainty is quite frequently inside oneself, rather than on the outside. An individual with a fear of flying may be more afraid of not containing oneself and not being able to leave the plain than anything else. Anxiety is the fear of crashing oneself and the feelings of a dreaded uncertainty about oneself and one’s emotional states.
A traumatic event is communicated, relevant and has the potential to bring about a change in the recipient, if that individual is ready to receive and identify a message in it. It is therefore meaningful. However, more interesting and helpful is the meaning one can identify in the response to the trauma, which may be the real meaning of the trauma. Often in traumatic situations, once the aftermath has been dealt with, to the extent this is possible, things may become clearer, and if a patient uses communication in a helpful way, the emotions and thoughts triggered by the trauma can be reflected upon.
Traumata can get processes moving that have been stuck or bring misplaced information closer to awareness. This is not to say that a trauma is good, or even therapeutic, but that a trauma can generate a significant amount of meaning which would not have been produced otherwise. The responses to trauma contain information which is often not available to consciousness, whether because it never seemed relevant, even though it is, has been repressed or a relevant association between it and something else has never been made. In any case, most of the meaning can be found in the response to the trauma rather than in the trauma itself. This is then also the starting point for the therapeutic process, where communication is used to give the patient the tools to distill meaning from his or her response to the trauma.
The important next step is to integrate the effect it has on the individual into the individual’s sense of self. In the case of the hurricane, it may be that one is sad and angry about the loss of a loved one, but that hurricanes, storms, and the changing weather itself, is a part of a dynamic changing world in which one lives as a human being. Identifying the emotions and one’s response, as well as the needs, aspirations and values that seem relevant in the context of the trauma and the response to it, provides the information needed to identify meaning and integrate the trauma into the sense of self.
Integrating a traumatic event into the self means that some change in interacting with oneself and others will result, even if a person’s basic needs and wants remain the same. Since the self is a product of observing communication flows, the sense of self will be affected by the trauma, although this can be in a positive rather than in a negative way. The sense of self evolves over time throughout life, as information flows change, it can become better defined and feel stronger, since over time there is more experience about communication with oneself and others and the effects of changing flows of meaningful information and the responses to them.
To break through the vicious cycle of anxiety, in which emotions like fear and anxiety cause safety thoughts and behaviors, which in turn reinforce feelings of fear, loneliness, sadness, and so forth, it is helpful to focus on identifying what is meaningful and having more of it in life. Communication helps in identifying and finding meaning, either communication with oneself or with others. The exchange of messages is like a learning process in which meaning can be identified, found and accumulated. Through meaningful interactions one accumulates more meaning, more connectedness with oneself and the world and reduces the need for thoughts and behaviors which are triggered by fears, guilt, self-blame and other negative emotions. This also helps against depression and anxiety.
Perceiving more meaning also makes interacting with others and oneself more meaningful. This has a positive effect on one’s interaction patterns, how and in which one ways one relates to one’s environment and exchanges messages with it. Knowing more sharpens and strengthens the sense of self, which is particularly helpful in patients suffering from PTSD.
A trauma has the power to change how one experiences the world, even though no one wishes for this change. However, one has a choice over the flavor of this change, whether it changes the meaning one gives to aspects of the world. In the best-case scenario, one may even see more in the world, more meaning, than before. At a minimum, therapy should make it possible to exchange information about the meaning aspects of the trauma have to the person, and be understood by the therapist. If the therapist does not understand a particular piece, he or she should ask to get at least a good sense for it to be able to engage in the process which ultimately creates new meaning through the exchange of meaningful messages.
Often, individuals suffering from PTSD lose track what is really important to them and the fit between these values and interests and their current life situation. This then leads not only to various psychiatric symptoms, but also to life decisions which may be too risk-averse or too risk-seeking, for example.
When patients learn to reconnect with themselves and get a better insight into their values, needs and aspirations, it helps to make better decisions but also to use interactions with others to find one’s needs, aspirations and values met. Since communication with oneself and others is the mechanism by which this will be accomplished, and they are reflected in one’s communication and interaction patterns, there is a strong link between the self-image and the use of communication. They are closely linked.
The conception of the self and the view of the own personality attributes together make up how one sees oneself. Values, basic interests and aspirations play a major role are basic parameters that must align with the self-image. If the self-image does not align with them, there is a weakness in the self-image which can cause problems in stressful situations, under high expectations or after traumatic events. Since no one prepares for a traumatic event, the alignment of self and basic parameters plays a role mostly in the post-event therapeutic process.
A trauma shatters the self-image because it raises the question if it is true. A working self-image, which is itself the result of internal and external communication processes, has as a purpose and holds the promise that it facilitates and in a sense guarantees a better life, one that is content, satisfied, relatively happy and most importantly stable and safe. Even if one thrives on adventure and change, one is looking for stability and safety through change, adventure and risk, namely stability in being oneself and the safety to be able to be oneself. A trauma puts all that in question, particularly when the sense of being able to influence and control the external environment and as a result the perceived influence over the internal world have been shattered as well.
Since the self-image is essentially the perception of one’s internal communication history, it can be changed in a helpful direction by developing more adaptive and better suited internal communication patterns. Since internal and external communication patterns are to a large extent reflections of each other, working with the communication patterns in a therapeutic setting or reflecting on the experienced communication patterns elsewhere helps to form and shape a better self-image over time. (Haverkampf, 2012, 2016, 2017c, 2017b, 2017d) However, since in this approach, the patient does the formative work himself or herself, aided by the more effective communication patterns, the modifications in self-image are really his or hers individually, which makes them endure longer and be more permanent into the future. This can in turn lead to a greater feeling of stability and safety, which is of significant help to a patient suffering from PTSD.
Developing the values, needs and aspirations further means getting more detailed information about them. Insight and skills n the communication process play here an important role, because it is through communication with oneself and others that the basic parameters can be identified in greater detail. Especially after a traumatic situation, a more detailed knowledge of them can give a greater sense of stability and help to connect with them.
Greater insight is a way to develop the basic parameters further, but it is also through the experimentation in the communication processes one has with oneself and others that they can be extended into new areas. If one has no knowledge or exposure to a specific event, one’s values, needs and aspirations can not reflect it. However, often a value in a more specific situation can be deduced from a more basic value, if one become aware of the specific situation or event. Still, deduction alone is not enough, because the more specific value or need, and possible conflicts between more basic values and needs, could not be specified without awareness of the existence of the event or situation. Communication is the mechanism which delivers this information, and through which one can become of specific situations and events, and thus of more detailed knowledge about one’s basic parameters.
Communication is the vehicle of change. The instruments are meaningful messages which are generated and received by the people who take part in these interactions. In a therapeutic setting, keeping the mutual flow of information relevant and meaningful brings change in both people who take part in this process. The learning curve for the patient may be steeper in certain respects because he or she spends less time in this interaction style than a therapist.
The process through which change can occur in many cases runs automatically, since communication processes are inherently autoregulatory, if one lets them run their course. However, in a number of cases people get stuck in PTSD. Change requires meaningful communication, and if a patient becomes afraid of the process or loses faith in it, constructive and dynamic communication can effectively shut down. Communicating about the trauma and the emotions that are associated with it can cause fears, which over time are also best addressed with communication.
The thought of engaging in communication about emotions or thoughts that are close to one’s sense of self can invoke fears. Underlying those fears are often other emotions, such as anger, resentment or guilt or self-blame.
The reason of communicating emotions is uncertainty about and a disconnect from them. However, to reconnect, communicating with oneself is necessary, which is difficult because one’s image of the self may not correlate with the attributes retrieved from one’s emotions and thoughts. Regardless of whether an individual has suffered from a trauma, discovering attributes of one’s self and personality is a continuous process. To overcome the fear of self-discovery, it important to realize that changes to one’s concept of the self are made throughout one’s life. Since information flows overall are largely determined by biology, which can be plastic, but mostly remains relatively constant, a pre-determined basic sense of self exists relatively constant over time. One may say, that throughout one’s life the concept of the self approaches increasingly this basic self.
A therapist should provide a setting that feels safe enough to engage in the process, but be inquisitive and active enough to move the process along if there are resistance points coming up, whether in the patient or the therapist. In any instance, the therapist should be alert, thoughtful, reflecting, be able to take a view from a distance, and be empathetic. The approach the therapist takes to communicating with the patient largely determines how safe the letter can feel in a therapeutic session and the success of the therapy.
In a safe space the patient can experiment with different communication patterns and approaches to the interaction with the therapist and others, which not only helps reconnecting with the world around, but also with oneself. This then builds the confidence to become more inquisitive in the communication process, and to acquire the skills to use it to one’s advantage.
The construction of new meaning and the integration of this into one’s sense of self is one of the primary goals of the therapy of PTSD. This also includes addressing, resolving and integrating emotions into the self in a meaningful way. The end result should make the trauma an event in the past, whose story is integrated into the much larger story of the individual.
The individual narrative is a series of interactions with others and oneself. It is important because it injects life events with additional meaning in relation to one’s personality and sense of self. Humans have a need for a well-rounded narrative or life story, because it makes it easier to decide in the present and makes the future seem more predictable.
A trauma has an impact on one’s life story. However, one needs to separate the events from the responses it triggers, one’s thoughts, emotions and behaviors in the face of and after the traumatic event. It is less the actual event of the trauma than the individual response to it, which needs to be integrate in one’s life story. However, doing this requires the reconnection with oneself, one’s thoughts and emotions as already described above. If one’s response does not fit the image has about oneself, either the response has to be change in the future or one’s image of self needs to change.
This may seem like a stark choice, but it is at the heart of how to manage trauma. The trauma is not one’s choosing, so it does no reflect of one’s self or personality. The response, however, is of one’s choosing, and it will reflect on how one sees oneself. Of course, it is important not to forget that a traumatic event is a special situation, which may elicit unusual responses, but even the fear of a response is a response and will form part of how the individual sees himself or herself in the future.
Reconnecting with oneself and discovering more about one’s values, needs and aspirations as well as one’s emotions and personality traits helps to create responses that are more in tune with oneself, and the blow to the self from a trauma in future will be lower, because the divergence between conceived self and basic self is smaller.
In the long-run, the more one’s image of oneself and the basic sense of self are closer aligned the easier is it to manage traumatic situations. The basic sense of self is, as described above, how one perceives the information flows inside oneself and also with the respect to the environment. ‘Alignment’ does not mean that they have to be identical, but that the conceived self extends the basic self in a valuable way. In the treatment of trauma, patients need to rediscover attributes of their basic self and have the courage to experiment with extensions to it. This set of attributes then helps in the face of adverse life events.
Communication with oneself and others also has the purpose to integrate flows of information and meaningful messages into a coherent sense of oneself. A trauma usually shatters a coherent sense of self, or at least pushes strongly against it, which leads to greater vulnerability and many of the post-traumatic symptoms. To make the sense feel more whole and coherent again requires a shift in perspective, a change in how one sees oneself and the world, which is facilitated by having a good connection with oneself and the world around. Learning to observe communication, the exchange of meaningful messages, and developing the skills to shape it in a way that makes change, adaptation and healing possible, is a central piece of therapy.
Dr Jonathan Haverkampf, M.D. MLA (Harvard) LL.M. trained in medicine, psychiatry and psychotherapy and works in private practice for psychotherapy, counselling and psychiatric medication in Dublin, Ireland. The author can be reached by email at jo****************@gm***.com or on the websites www.jonathanhaverkampf.com and www.jonathanhaverkampf.ie.
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