trauma work

[Adam Blatner]

Yes, and of course not only the sequelae, that which happens after the trauma, but many other variables all make a difference, for which reason I question many categories in psychiatry and psychotherapy as overgeneralized. 
     The co-morbidity problem for may people with PTSD may be as complex and difficult to unravel as the PTSD itself in some cases; in others, so many aspects of what compounds or complicates a scary experience... etc. 
    
     Back to the problem of really evaluating the person, what Karl Menninger called "the vital balance." 
  ----- Original Message ----- 
  From: thana ag 
  To: jenny at blennerhassett.gen.nz ; adam blatner 
  Cc: list at grouptalkweb.org 
  Sent: Wednesday, December 02, 2009 7:05 PM
  Subject: RE: trauma work


  I think it is a very important distinction.Plus makes us alert to the nuanses of being aware of the person,and the situation the person presents 
  anath garber

  > Date: Thu, 3 Dec 2009 13:37:11 +1300
  > From: jenny at blennerhassett.gen.nz
  > Subject: Re: trauma work
  > To: adam at blatner.com
  > CC: list at grouptalkweb.org
  > 
  > Hi
  > I find it is more helpful to think about attending to (maybe treating)
  > the sequelae of trauma rather that the trauma itself. what is traumatic
  > to one person may not be traumatic to another. In many potentially
  > truamatic situations it is the response of others that can be remarkably
  > healing or contribute to further problems. A simple "I don't believe
  > you"- while not in itself traumatic, magnifies the effect of an assault;
  > where a silent but heartfelt caring and holding might generate a very
  > different outcome in the longer term - leading to a very different
  > experience of meaning, trust in the world and others etc.
  > 
  > Practically speaking that means I may offer therapy for the sequalae of
  > sexual abuse rather than therapy for sexual abuse. It may seem a bit
  > semantic but to me the distinction seems important.
  > 
  > regards
  > Jenny
  > 
  > 
  > Adam Blatner wrote:
  > > Hello, All,
  > > 
  > > I've been corresponding with someone not in the psychodrama community
  > > about trauma and thinking about the issues, and it occurs to me that the
  > > word has become fashionable and overgeneralized. I'm not sure that when
  > > some folks talk about trauma they don't include stress, affliction,
  > > difficulty, and so forth. What are the boundaries among these
  > > experiences? When does a stress become traumatic? And then of course
  > > there may well be degrees of trauma; and the problem of accumulated
  > > trauma and what that implies.
  > > 
  > > (I think a stress becomes trauma when it undercuts the person's
  > > defensive system and basic beliefs about self, others, or the world. For
  > > many people, events that are traumatic for others are certainly
  > > unpleasant, but not traumatic. Many people are able to incorporate
  > > horrendous experiences within their life schema and defensive system. It
  > > may harden them, but doesn't generate deep faults.
  > > I wonder also if doubts in the social environment cannot turn an
  > > experience that had been assimilated into a trauma---i.e., if what was
  > > thought of as a just and necessary action in wartime is called into
  > > question.)
  > > 
  > > (A recent article on physical trauma---to the brain---in
  > > football--- in the New Yorker magazine--- is fascinating as a social
  > > phenomena: How much danger do we expose our modern-day gladiators to and
  > > what risk do we tolerate. The author dares to use the Michal Vick
  > > scandal about dog fighting to present an interesting moral problem: Is a
  > > sport that may involve some danger different from a sport that almost
  > > for-certain entails injury? And if that injury shows up decades later,
  > > does that lessen its moral implications?)
  > > 
  > > Back to psychological trauma: Then there is another question:
  > > I don't think that what most people experience as depression is a
  > > primary condition. Some of it is, or near primary; but often what this
  > > syndrome involves is sustained demoralization and disappointment due to
  > > an accumulation of stresses plus an admixture of a deficit of resilience
  > > or health-promoting factors. (Analogy: People with significant vitamin
  > > deficiencies are far more susceptible to infections.)
  > > 
  > > Point being that treatment must take into consideration
  > > recognition of individuality and complexity of problem. Some depression,
  > > for example, mirrors the culture's lack of clear purpose (for each
  > > individual), multiple competing and often unrealistic demands (or so it
  > > seems), and other factors promoting socio-cultural alienation. These are
  > > more common among teens who are diagnosed with "depression."
  > > Some depression results from suffering which results from
  > > the consequences of being fired, abandoned, and otherwise losing that is
  > > in turn due to having engaged in self-defeating behaviors, addiction,
  > > and acts that drove supports away---parents, partners, dates, employers,
  > > etc. Yet the focus on trauma may reinforce the illusion of victimization
  > > when in fact the person has created his or her own negative situation. 
  > > I wonder whether therapists look for and diagnose these predisposing
  > > patterns.
  > > 
  > > Some depression results from the come-down from a period of
  > > over-stimulation---certainly from pharmacological agents such as cocaine
  > > or amphetamines. Again, I think some patients may not tell their
  > > therapists this and for therapists a fair degree of suspicion is
  > > appropriate.
  > > 
  > > Some depression is part of a histrionic life style, a role of
  > > victim, and some of these come to different therapists and to
  > > psychodrama groups and dominate the group with their manipulations.
  > > 
  > > And so forth. All of which suggests that taking an individual
  > > who presents at a psychodrama conference or in other short-term contexts
  > > and attempting to treat the trauma may be fine if the director gets a
  > > relatively healthy protagonist with a relatively limited symptom-complex
  > > and a relatively strong network for follow-up and other coping
  > > avenues---which sometimes happens; but there's also a risk of getting a
  > > protagonist without those resilience factors.
  > > 
  > > So to build on Marcia Karp's quoting of Zerka's line that
  > > psychodrama is a tool, like a hammer. It can be used in different ways,
  > > and also you can hurt people with it. I love the concept of tool and
  > > think that there are a goodly number of tools created by Moreno that can
  > > be used in different ways. But also---using the metaphor of
  > > carpentry---there are other functions that require skill and judgment.
  > > In carpentry they include measuring, planning, stuff like that; in
  > > psychotherapy they include adequate diagnosis.
  > > 
  > > (Diagnosis doesn't mean pinning a label on someone. I despair of
  > > the idea that such labels have much meaning. More often, especially for
  > > depression, anxiety, and trauma, these are very large categories---akin
  > > to "belly-ache" in medicine---that could in turn have scores of
  > > different causes, some minor, some with desperate prognoses. So
  > > diagnosis for me means finding out what is going on, what the strengths
  > > are, what resources are available, what other conditions might be making
  > > it worse, etc.---some of which is acknowledged in the diagnostic manual,
  > > but these elements are rarely used.)
  > > 
  > > Warmly, Adam
  > > Adam Blatner, M.D.
  > > website: www.blatner.com/adam/ <http://www.blatner.com/adam/> 
  > > 
  > > 
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