Psychotherapy at TRAUMATYS
The treatment provided at TRAUMATYS is described in details in a chapter (Gaston, 1995) of the book entitled "Dynamic Therapies for Psychiatric Disorders" (Axis I), edited by J. Barber and P. Crits-Cristoph (1995). This treatment model represents a state-of-the-art approach to treating PTSD.
 | Goals |
The goals of psychotherapy are to eradicate PTSD and co-morbidity symptoms, to resume normal psychosocial functioning, and to prevent relapse. When an individual needs to cease working temporarily because symptomatology is interfering with psychosocial functioning, or when there is a crisis situation, psychotherapy is provided twice a week. Otherwise, psychotherapy is provided once a week.
In order to reach these goals, the objectives of the psychotherapeutic process are to assist the individual to recognize and accept one's traumatized self and, in parallel, to regain control over one's outer and inner worlds. Subsequently, psychotherapy aims at integrating the traumatic information, both cognitively and emotionally, through an experiential revision of the traumatic event and through accommodating one's psychological structure to the newly assessed traumatic information. Finally, psychotherapy aims at practicing the newly adopted skills and attitudes, and at fostering a new sense of self.
| Phases |
The first phase aims at establishing the conditions to develop an alliance, at completing the psychological history, and at reviewing the details of the traumatic event along with its circumstances. In order for the individual to be able to fully explore one's traumatic experience, it is necessary to first work on the consequences of the chronicity of the psychological condition, if any, to reinforce appropriate adaptive strategies, to ensure that anxiety is not overwhelming, to encourage the obtention of valuable social support, to help resolve situational problems which contribute in maintaining the psychological condition, if possible, and to address the individual's avoidance mechanisms and their functions in order to bring them to a non defensive level.
The second phase consists of experientially revisiting the traumatic event, identifying the defense mechanisms interfering with its revision, and addressing the conflicts or structural deficits which were reactivated by the traumatic event. This review takes place in the usual waking state and/or under therapeutic hypnosis. Within this context, identifying associated emotions and meanings, tackling damaged schemas of oneself and others, revising these schemas in a reality-based framework, and modifying the defensive and interpersonal patterns occurs. Having completed this process, the information associated with the traumatic event should be integrated within the individual's psychological structure. If this second phase cannot be dealt with or completed given structural difficulties encountered within the individual, reinforcing the psychological structure is undertaken in order to help contain the overwhelming emotions associated with PTSD. Unfortunately, this latter approach can neither eradicate PTSD symptomatology, nor can it foster a full recovery of functional capacities or prevent relapse.
In order to ensure that the psychotherapeutic gains are sustained over time and prevent relapse, the third phase strives at encouraging the individual to practice the newly acquired cognitive, behavioral and interpersonal patterns. A novel attitude toward adversity is also addressed, unless it has emerged spontaneously, so that the individual can consider life's obstacles as challenges rather than threats, and realistically assess the possibility of life's dangers. Termination of psychotherapy is discussed. Gains are recognized, while the individual's active participation in them is emphasized.
| Techniques -
The basic techniques are the following :
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Within this specialized approach, it is essential to help the individual regain control at all times, restore and preserve the individual's self-esteem as much as possible, and encourage an experiential review of the traumatic event. It is also important to proceed gradually, in tolerable doses, starting with peripheral reactions and heading toward the heart of the psychological wound.
