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"PTSD: Therapy should focus first on stability then the trauma" The Sentinel news article

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Joseph Cress - The Sentinel

Trauma is like taking a walk after stepping on broken glass.

The shard digs in deeper with every footfall, making it harder to heal.

“To get it out is going to be pretty uncomfortable,” Carlisle therapist Lori Moskel said. “People don’t want to go through that uncomfortable process.”

She was using the metaphor to describe the avoidance behavior prevalent among many sufferers of post-traumatic stress disorder. The behavior is a common barrier to seeking counseling.

“How do you remove trauma?” Moskel asked. “You talk about it. You process it. You analyze your thoughts about it.

If you don’t do that, you remain in pain. People who have PTSD do not want to seek treatment because it’s painful to talk about it.”

Yet they run the risk that the wound may fester, leading some to self-medicate with drugs and alcohol and others to suffer from depression and thoughts of suicide.

Gentle persuasion

The first step in healing is to realize that trauma is treatable with measured steps that can begin with a friend or relative gently coaxing the person to get help.

In expressing concern, the friend or relative should avoid language like “I think there’s something wrong with you” because individuals with PTSD often harbor feelings of guilt and shame about what happened to them, said Valerie Domenici, a licensed clinical psychologist in Carlisle.

To reduce fear and anxiety, she suggests a caring nonjudgmental approach with words like “I have noticed that you seem unhappy, that you seem to be struggling. I care about you and want you to feel better.”

Moskel recommends leaving information at a place where the person is bound to find it. That way they can see that you are thinking about their welfare. “It goes a long way,” Moskel said.

Any diagnosis should be left to professionals. A person who suffered a trauma may not be suffering from PTSD and even if it is present, there may be more pressing issues to address.

Moods and motives

Often clients coming in for the first appointment describe mood-related or interpersonal symptoms that could apply to any number of mental health issues, Domenici said. Examples include “I feel sad,” “I don’t like myself,” and “I’m scared of people.”

It is rare for anyone suffering from PTSD to come and say, “I’m here because I was sexually abused when I was five.”

But by asking the right questions at the right time, therapists can gauge how comfortable a client is with counseling and spot the red flags that may indicate a possible PTSD diagnosis.

There must be a careful measured approach for therapy to be effective to set the client at ease and to build a level of trust and confidence in the process.

“Good treatment does not require re-victimization or re-traumatization,” Domenici said. “You are with the wrong provider if you go in and there is no attention paid to the possibility of the work triggering or destabilizing a person’s position. You want to be sensitive to that.”

She recommended the client sets the rules by bringing up possible triggers. The steps in the process vary from individual to individual. Some clients had prior counseling and are ready to open up more about what the issues are while others are new to therapy and need to get a better handle on what they are feeling and how a provider can help.

Stability first

Because PTSD often involves avoidance, work to resolve the trauma should proceed with caution and only when the therapist and client are comfortable with the idea, Domenici said. “A lot of trauma work is trying separate what is happening now from what was happening then. The past and present collide and a lot of that is trying to disentangle the two.”

That’s why it’s important to focus first on the issues creating immediate chaos for the person before going deep into the root cause of the PTSD if that’s truly necessary, Domenici said. “Is your life stable enough to do any trauma work right now? Let’s stabilize your life and get you in a position where you feel secure enough that your current life is not falling apart. Let’s talk about breathing. Let’s talk about bringing your heart rate down. Let’s try some relaxation techniques.”

She refers people with drug and alcohol addictions to treatment professionals because she knows they are better qualified to help that type of client. “I don’t want to stir up trauma stuff with someone who can’t cope with daily life without using something,” Domenici said.

For any therapy to be effective, she needs to do a risk assessment to determine if the person has suicidal or homicidal thoughts. “Anybody on the verge of hurting themselves or someone else does not need to be talking about the nitty gritty details of their trauma,” she said. “There needs to be basic stabilization work first.”

Email Joseph Cress at

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