Psychological trauma can have effects in many ways

PSYCHOLOGICAL trauma is often a focus of assessment and intervention in personal injury claims and as such it is helpful to consider the range and complexity of difficulties that might arise as a result of some form of traumatic event. ‘Trauma’ has become part of everyday language, so it may be helpful to define what is meant by the term.

In formal diagnostic terms, in order that an event be considered to be traumatic it requires the person to either experience or witness something (or things) that involve actual or threatened death or serious injury, or threat to the integrity of self or others, and that the person experienced fear, helplessness or horror (American Psychiatric Association 1994).

The consequences of traumatic events can be wide ranging and recovery is often hampered by complications. One way of understanding that is via the ‘ripple effect’ described by Helen Kennerley and Deborah Lee of the Oxford Cognitive Therapy Centre. This identifies the potential impacts that trauma can have:

• On the brain – presenting problems in relation to arousal and the effects of this on memory, sensitisation to stress and the ability to contextualise experiences (ie to put them in the past).
• On the sense of self – difficulties experienced at a brain level clearly have an impact on the person’s view of themselves; for example, seeing themselves as damaged, vulnerable, weak etc.
• At an interpersonal level – the changed sense of self can in turn influence the way they relate to others. The impact of the effects of trauma can be that the person becomes introverted, easily angered, hopeless with a lack of interest in life and a future, and unable to express positive To the social system in which they exist – the issues described above can lead to disruptions in relationships and feelings of isolation. That can be compounded by perceived cultural views of how people ‘should’ be.

The effects of a traumatic event can be complicated by a number of factors. People can be more profoundly affected by events that have a human cause rather than by natural events. That is especially the case if they are the victim of acts of violence.

The person’s previous experience of traumatic events may affect how they respond to the recent trauma, as will their previous life experience generally, eg whether they have developed coping resources; as can a lack of a supportive social network.

The person’s response to the effects of the trauma has an important part to play, for example whether they have learnt to deal with their distress by avoiding situations, either physically or by using drugs and alcohol, or by acts of self harm. In addition, other effects of the trauma may present further challenges to the client. Those may include physical damage sustained as part of the traumatic event and the constant presence of pain. People can find themselves unable to work and struggling financially. Importantly, the legal process can also be a prompt for distress often over a considerable period of time.

Key to a cognitive behavioural approach to working with someone who is suffering following a traumatic event is to understand in what way those issues are affecting that particular person. That leads to an understanding formed with the client regarding the interactions of their views of themselves, others and the world, their attempts to cope with or avoid distress and their family and social environment.

This formulation allows the therapist to understand risks and to tailor evidence-based interventions to meet the specific needs of the client. Vital to the process is the forming of a therapeutic relationship, since much of what is required of the client can feel counter-intuitive and requires at least a degree of trust. That is especially the case when asking the person actively to think about the traumatic event, knowing that it will probably cause that person distress.

Very often clients feel more distress in the early stages of therapy. Being open and honest at the outset is vital, as is ensuring that the client has a sense of genuine collaboration. That requires that the therapist has the relevant knowledge and experience to convey hope and compassion while encouraging the client to engage actively in their treatment, knowing that it will be difficult at times. It is all too easy for client and therapist to find themselves dealing with high levels of distress and if neither is fully prepared for this it can be damaging for both.