Many mental health workers steer clear of taking on clients who have been the victims of severe trauma and/or stress. There are three main reasons for this:
First there’s fear around saying something that might make the person worse. Then there is fear of vicarious trauma. Finally, there is also mistaken belief that there are hundreds of trauma specialists ‘out there’ just waiting for referrals.
The various techniques of the solution-focused (SF) approach for this client group have been field-tested successfully over many years; and, indeed, a sizeable number are evidence-based.
These techniques have proved effective and transferable across many severe trauma and stress areas, including: sudden death, mass shootings, terrorist incidents, natural disasters, combat operational stress injury (COSI), road traffic collisions, rape and near-death experiences.
I run two-day workshops for both professionals and lay workers who are keen to help severe trauma and stress survivors move forward to a life lived well. Yvonne Dolan’s model of victim-survivor-living life well (‘thriver’) is followed closely, as these workshops unfold. Both the content and the process of these workshops follows closely the contents of the book, Beating Combat Stress: 101 Techniques for Recovery.
An important aspect of both the book, the workshops and the 1:1 therapeutic work, is to promote an understanding of ‘victimhood’, ‘survivorhood’ and ‘thriverhood’. As clients move through the first two of these stages, towards thriverhood, they can measure their progress using the 1-10 scale.
Some of the most powerful techniques of this, the solution-focused approach to severe trauma recovery include:
- Let it go… let it go… let it go…
- The Stop! technique and replaying the DVD later
- That was then, this is now
- The rainy-day letter.
In both books and at the workshops, I outline the ways in which workers can look after themselves when doing this important work, to avoid the pitfalls and vicarious trauma that can occur sometimes.
As far as the client or survivor is concerned, there are eight important points to cover, to prevent either re-traumatisation or re-victimisation.
These are: (1) show compassion and deep empathy; (2) as the service user discloses, acknowledge, validate and normalise all feelings and sensations expressed; and, (3) ask strength-based questions, interrupting as appropriate while the client is disclosing, as follows:
- How did you cope at the time?
- What got you through all this?
- What most helped?
- How did you do that?
- How did you know how to do that?
- Looking back on what happened, in what ways has it made you a more determined and/or stronger person?
- Awful though it was, which aspects of surviving it have made you a better person?
- It is important to compliment sincerely, where appropriate, both as the service user is disclosing; and most importantly at the end of the session.4
- Treat the content with care, respect and in a supportive manner
- Value and affirm throughout, both verbally and non-verbally
- Keep your own and your service user’s eyes on the treatment goals
- Stick to the ‘5 o’clock rule’
There is a great need out there for severe trauma and stress recovery work and the expression ‘The harvest is great, but the workers are few’, applies. The SF approach has much to commend it. Typically, 7–9 sessions are required over an 8–10-month period.
Seeing someone make the journey from simply having survived to living a meaningful and purposeful life, in control of trauma symptoms, rather than being controlled by them, is very rewarding indeed.
In both workshops and in 1:1 client work, I introduce a wide range of techniques for dealing with triggers, flashbacks, intrusive thoughts and sleep disturbance. The thread that runs through the work is one of helping survivors move from being controlled by severe trauma symptoms to control, as they make their journey towards thriverhood: living life to the full, living the authentic life.
Image credit: Freepik
Both before and since his NHS career, John Henden has been keenly interested in a range of different psychotherapies.