Dozens of therapists in Connecticut and New York are—or in the near future will be—working with children and families deeply affected by the extreme violence and loss that occurred at Sandy Hook Elementary School. They know that the effects of such a massive psychological trauma take the form of a wide variety of emotional, psychological, and behavioral stress reactions in the first few weeks. They also know that compassionate listening and dependable availability are the best way to support each individual’s unique way of gradually coming to terms with the shock, confusion, and sense of loss and betrayal that are expectable.
They also know that watchful waiting involves careful observation of the signs that a child or adult may be developing PTSD, but that it is too early to make that diagnosis. Helping children and families restore their normal structure and routines is the best way to help them manage specific symptoms in this acute period—and the best way to prevent PTSD.
As we think ahead to the next several weeks and months, therapists need to know how best to provide treatment if PTSD does develop. Because the violence also involved a terrible loss of innocent lives, therapists must be prepared not only to treat PTSD, but also traumatic grief, and to do so with therapies that have a strong evidence-base specifically for these difficult problems.
But we also must be careful to guide and not prescribe—to help each child and adult find the way to re-focus on what and whom they most love and value, without pressing them to do it “our way” or making it so complicated that they just shut down.
Before any evidence-based treatment model is chosen and offered, therapists should step back and remember that each effective approach to trauma psychotherapy is based on helping children and adults to make the one essential change that is necessary in order to recover from both PTSD and traumatic grief.
That change is re-engaging the brain’s capacity to re-set its own inner alarm system. This can be done in as many ways as there are models of psychotherapy, but at the essence it is the act of focusing the mind and body on one and only one thing: whatever is most important, precious, and life-affirming to that person at this moment in their life.
Every effective approach to trauma therapy provides a path that enables each client to take three essential steps: SOS.
This is why play and drawing can be healing for traumatized children, because their creative acts re-orient them to what they most care about. It is why cognitive behavior therapies help kids and adults to shift from thoughts of despair to thoughts that provide hope and affirmation. It’s also why facing the pain and re-telling the story of exactly what happened in a traumatic experience, instead of trying to bury or forget the terrible memories, can lead to a renewed sense of confidence, trust, and hope. It’s why finding ways to honor the memory and preserve the emotional and spiritual connection to lost loved ones can enable those who are shocked and bereaved to continue to mourn the loss without being tortured by traumatic grief.
This is only a first step in the long journey toward healing, but as therapists we need to know how to help children and adults who have been traumatized by violence and loss to take the right first steps for themselves—they depend upon us for that.