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It is essential that anyone
who wishes to treat people experiencing Post-Traumatic Stress Disorder (PTSD)
be properly trained or experienced to do so. In some cases, it has
become apparent that previous training as a therapist or counsellor can
serve as a disadvantage. This is because of the unique place that PTSD
occupies among clinically defined mental health conditions. PTSD is
cause specific, i.e. linked directly with a known cause. As such, the
treatment of the condition can be approached in a much more direct
manner that would be the case with many other conditions.
Anyone undertaking to treat someone experiencing PTSD should ideally
ensure that the following minimum criteria have been met prior to
commencing a course of therapy:
1. That PTSD has been properly diagnosed.
2. That a client undergoing therapy for PTSD has previously undergone a
Critical Incident Stress Debriefing (CISD) process under the supervision
of a trauma cognisant therapist/mental health worker trained and
experienced to carry out that task. (Clinical guidelines suggest that
such debrief be carried out if more than 24 hours and less than 1 month
post incident: however a traumatised individual can benefit from such a
process even years after the original incident)
3. The therapist must be clear whether they are dealing with a single,
compounded, multiple, ‘simple’ or ‘complicated’ incident/s of
trauma.
4. That the client understands the concept of PTSD and has it explained
where this is not the case. The successful treatment of PTSD often
involves an emphasis on educating people about their condition.
5. Where possible and desirable involve immediate family in the process.
Whether or not they should be present during treatment sessions is an
individual decision. Where any doubt exists they should be excluded.
Studies of Vietnam veterans exposed to trauma suggested that those in
the high-symptom group were more hypnotisable that those in the
low-symptom group. Other studies showed a similar result . Control
studies among groups experiencing more generalised anxiety disorders
found that they scored about half as well as PTSD groups on hypnotic
induction scales. This would indicate that there are advantages to the
PTSD sufferer in seeking the assistance of a hypnotherapist. From the
therapist’s point of view, a highly hypnotisable subject coupled with
a known cause affords them a choice of several direct treatment options.
The symptom that is most characteristic of PTSD is the repeat occurrence
of intrusive imagery. This can and does take many forms, the most
commonly recognised of these is the ‘flashback’. In general, a
flashback accompanied by some form of ‘acting out’ is an extreme
response and should lead to the sufferer being classified as being in
the high symptom group. This is NOT to be confused with the abreaction
that most clinical hypnotherapists are familiar with. A flashback does
not generally lead to the emotional release associated with a properly
handled abreactive experience. In high-symptom cases where this kind of
experience is more common, additional training in trauma management is
strongly advised. Other health care workers as an adjunct to their own
work, as well as a direct treatment, can use clinical hypnosis as an
option. In reviewing some textbooks on PTSD, the suggested applications
of clinical hypnosis or hypnotherapy in relation to PTSD are suggested
as:
1. As a stress and anxiety management tool. It is ideal for lowering
initially high stress levels to the point the client can begin to
benefit from other treatment options.
2. As a method for dealing safely with the directed release of
suppressed and pent up emotion.
3. As a method for dealing with the abreactive experience.
4. As a method for dealing with dissociation, spiritual malaise etc.
As an experienced hypnotherapist with over a decade's experience in
working with traumatised people I find these recommendations heartening.
It was not so long ago that Hypno-analytic techniques were considered an
important treatment for 'shell shock' in the aftermath of the so-called
Great War when the sheer volume of sufferers overwhelmed the available
medical services.
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