Reflections on Trust and Trauma
Reflections on the Relationship of Trust to Trauma Treatment
Posted April 25, 2011
Reflections on Trust and Trauma
by Frederick Woolverton, Ph.D.
If you are a person who suffers a traumatic event or a prolonged traumatic experience, there is a conventional treatment to help with the terrible experience you have endured. A mental health professional ‘debriefs' you; a therapist gets you, the patient, to describe, sometimes over and over again, the traumatic event that you have experienced until, presumably, the telling of these events removes the power they have over your traumatized psyche.
Theoretically, this ‘cure' is accomplished because, by describing the traumatic event, the traumatized patient gains a sense of ‘mastery' over the it, and the ‘monster' is brought back into the realm of experience that can be described and survived, rather than remaining an unspeakable experience that haunts and waits to attack again.
In explaining the conventional treatment of trauma, therapists sometimes use the analogy of a soda bottle (the psyche) that has been shaken up (traumatized) until it is ready to explode (Posttraumatic Stress Syndrome - PTSD). The patient's recounting the traumatic event is compared to slowly releasing the pressure in a soda bottle until, after retelling the event sufficiently, the internal pressure has been relieved so that the traumatic event has lost its power over the individual's psychology.
The problem with this conventional treatment of trauma is that, more often than not, it doesn't work. Why? In this particular method of treating trauma, the emphasis on what cures has been placed on the wrong thing. Most treatments for trauma emphasize the actual TALKING ABOUT the trauma as the means of recovery, rather than emphasizing the RELATIONSHIP between therapist and traumatized patient INTO WHICH THE PATIENT SPEAKS about the traumatic experience.
I first questioned the effectiveness of the conventional approaches to PTSD shortly after the tragic events of 9/11 when so many thousands of people - civilians, police, fireman, military - suffered trauma of devastating proportions. I saw with my own eyes how mental health professionals, using conventional trauma treatment, failed to help - and in fact, sometimes even hurt and re-traumatized - these individuals who were directly effected by the events of 9/11. Since that day, I have worked on quite a different approach to the treatment of trauma.
For years leading up to 9/11, I lived with my family about 2 blocks from the World Trade Center. Our residence was damaged by the explosions that occurred that day, and my family had to evacuate our home so quickly that everything - including shoes, wallets, papers and my four year old daughter's precious blanket - had to be left behind.
The terrible circumstances of that day that left my daughter and wife severely traumatized. My four year old, for example, was so traumatized by the five hours she spent in the mayhem of that day that she was left unable to speak, to sleep, and believed that she was going to die at any moment. In her state of severe trauma, I determined that one of my highest priorities in the days after 9/11 was retrieving her blanket from our damaged residence and bringing her at least that one source of comfort.
Concentric circles, or rings, had been formed around Ground Zero, and each ring had been secured and cordoned off by the military, the FBI, the NYC police and other government agencies. Civilians were absolutely barred from entering within those rings. However, my friend Tom, who was a New York City police detective and a member of the anti-terrorist task force, agreed to try to get me through the secure rings around Ground Zero and into my residence, which was inside the inner-most ring, where I could retrieve my daughter's blanket. On Friday 9/14, Tom and I set out on our mission. Without Tom's help, I never would have made it near my home.
Tom got me through one secure ring after another until we were inside the inner-ring, standing one block from my home, right next to Ground Zero. The remains of the World Trade Center continued to burn, billowing smoke and ash where the towers once stood, the smoke swallowing up the police and fireman who were working continuously, steadfastly looking for bodies, body parts, anything they could ‘rescue'. When we had passed through the last line of security, we met a group of police who were taking a break between thankless shifts amidst the rubble, the fires and the destruction. They were filthy, exhausted, and battle-weary. Tom went up to the policemen, many of whom he recognized and knew, and said: "Hey guys, this is my friend Fred. He's a shrink."
The reaction to me was instantaneous, angry, bitter and openly hostile.
"Get him the hell out of here, Tom! Shrinks are out!" They stood up and approached me menacingly. "Get the hell out of here! We don't need you shrinks. Go away!"
I was taken aback, and I imagined that they were about to go for their guns when, in an effort to defend myself and defuse this unexpected situation, I said, "Hold on guys, I'm not here as a shrink. I LIVE here. My four year old daughter got caught in the explosions and she's in bad shape. Tom brought me here so I can get her blanket from my house. She left it behind when she ran for her life. Please, all I want is to get her that blanket. She needs it desperately, it's the only thing that I can think of right now that might bring her some peace and comfort."
The cops relaxed somewhat after that and asked questions about my four year old. What had she gone through? Was she injured? How badly damaged was my home? They softened and realized that I was there on a mission for a little girl who had been hurt. With this realization, they wanted to help. "Okay, okay" they said. "Go get your daughter's blanket. Tom, get him to his home, his daughter needs her blanket!"
"Thank you," I acknowledged gratefully. "My daughter jumped into a police boat with her babysitter on Tuesday after breathing that deadly smoke for hours, and the police brought her across the river to New Jersey. Some of you guys probably saved her life. Literally."
They had relaxed now after they realized I was virtually one of them. They wanted to know more and more, and soon we were all talking together as if we were the best of friends. I felt comfortable enough to ask them, "What is it about shrinks that provoked such a negative reaction before? Why do you guys hate shrinks so much?"
Their answer was simple. Mental health professionals had visited them at Ground Zero many times already. The ‘shrinks' would talk to them one-on-one, trying to get them to talk about their experiences as they worked in the rubble of the World Trade Center. Almost without exception, they said, every cop or firemen that "succumbed" and talked to the "shrinks" never returned to work after opening up about their experiences working in the burning rubble. Apparently, just talking to the mental health professionals who were coming down to ‘help' them provoked a profoundly negative reaction, or "nervous breakdown" as the cops called it, that made returning to work impossible.
"One by one, we see our buddies talk to shrinks, and one by one we see them fall apart and never return to work." So the police and firefighters learned not to talk to shrinks or to anyone else about the terror that they were enduring, because whoever talked would be the next one to stay home on permanent "sick leave", crippled and emotionally shattered with nothing to turn to except for alcohol and drugs, plagued by depression and crippling anxiety.
I knew that, in keeping with traditional thinking, mental health professionals arrived on the scene at Ground Zero and urged the police and firefighters to TALK about what they were seeing, hearing, smelling, and experiencing. I witnessed firsthand that this approach by the psychological community was not helpful at all; in fact, it was the opposite. It was even more damaging. And I remember thinking, TALKING alone does not help victims of trauma; in fact, it often re-traumatizes the victim.
"Shrinks don't know anything about us. They weren't there. They think talking helps. What do they know? They don't even know what they did to our buddies and what they are continuing to try to do to us."
So I ventured further into asking them more about their experiences at Ground Zero (now that we were all friends). "Is there anything that DOES help you guys?"
"Yes," they answered to my surprise. "The Red Cross brings dogs down here to hang out with us." I watched as others nodded in agreement. "The dogs help a lot. THEY instinctively understand what we're going through. They don't talk. They don't ask stupid questions like all of you shrinks do. They just understand us and understand what we are doing and going through. They understand without talking. They just get us deep down."
Who knew? The dogs were obviously excellent trauma therapists, but why?
First, it was clear that the police and firefighters WANTED to be understood. They emphasized that the most important thing the Red Cross dogs gave them was the feeling that "someone" (the dogs) understood what they were going through. Contrary to conventional trauma therapy, these men did not want to talk. They wanted to feel understood by someone who did not have to ask a lot of questions and who did not require the victims of trauma to speak. They wanted to be understood by someone or some being that made them feel safe, not threatened, and who understood them using empathy and intuition rather than attempting to understand them through a demanding question and answer format. Indeed, I have seen my daughter unable to speak about the events of that day while she was struggling to overcome the devastating effects that 9/11 had on her; I have witnessed my wife fall apart when pressured to describe what she experienced, and watched her beg others not to make her talk. I have seen both my wife and daughter emerge from the most severe effects of trauma without speaking directly about the traumatizing events. And then, subsequently, I have seen each of them WANT to speak about their traumatic experiences, but only after each had established that there was a listener who was prepared to FEEL their experiences, to use his/her intuition and imagination and empathic abilities with which to understand what they went through. It was the BEING UNDERSTOOD that each felt would help, not the talking itself. If talking about their experiences was the means of being understood, then fine. But if talking was just talking to someone who might not understand, then they, like the police at Ground Zero, wanted nothing to do with it.
Indeed, two years after 9/11, I got a telephone call: the same group of policemen who I had met at Ground Zero on September 14 wanted to visit me, as a group, in my office. They wanted to TALK to me about what they had all gone through.
"Talk? Why talk? Why me?" I asked.
"Because you seemed to understand what we were going through when you spoke with us that day, and you went through it too. We think you would understand us now better than anyone else. And we want to talk, to tell someone what we went through, to deal with it".
In this very personal experience, I realized completely that, to have any chance of treating trauma, there has to be an established relationship that is built on understanding and, most of all, trust. This sacred trust between therapist and patient is critical to the successful treatment of trauma. Mental health professionals have learned that trauma affects, and is filed away in, a part of the brain that words alone can't reach, and that traditional cognitive and rational thinking can't grasp and can't comprehend. Therefore, as I explored the treatment of trauma, I realized that the TALKING about the trauma is woefully insufficient to successfully treat PTSD and the devastating effects that traumatic events have on countless individuals. It is the UNDERSTANDING of a person's traumatic experience (the patient) by another person (the therapist) that is central to the effective treatment of trauma. For the patient/therapist relationship to be as understanding, non-judgmental, and trustworthy as the relationship between a dog and a human is difficult to achieve. But this level of understanding is definitely the most vital element in the successful treatment of any trauma. The first hand demonstration of this fact that I received a few days after 9/11 and subsequent knowledge of the importance of the trust relationship between patient and therapist is a therapeutic lesson that I will never forget, both personally and professionally.
(Written in collaboration with Robert W. Bradberry)
Frederick Woolverton, Ph.D., is Director of The Village Institute for Psychotherapy in Manhattan and Fayetteville, Arkansas and is the co-author of the forthcoming book "Unhooked."