Athena H. Phillips: The Externalization of Trauma: A View of PTSD Symptoms as Healthy

In this recent post from GoodTherapy.org, Athena H. Phillips argues from a narrative psychotherapy stance that "externalizing" the trauma is a way to disidentify with the symptoms, to see it as an object of awareness rather than being the trauma. I would agree - if one can "wear" the symptoms rather the BE the symptoms, healing becomes much more possible.

The Externalization of Trauma: A View of PTSD Symptoms as Healthy

December 7th, 2011
By Athena H. Phillips, MSW, LCSW, Post Traumatic Stress / Trauma Topic Expert Contributor

Trauma symptoms are often experienced and viewed as invasive and malevolent.  Helplessness, hopelessness, confusion and a condemnation of self for their existence also appear thematic.  The initial layer of trauma treatment is frequently the unraveling of self-loathing for the expression of symptoms themselves; survivor and therapist collude in their endorsement of them as being inherently destructive and are to be eradicated.  A divergent perspective could be that symptoms are an expression of health versus illness.  Viewing the manifestation of PTSD (Post-traumatic stress disorder) as having utility may offer an alternative understanding of the client’s presentation as offering direction to treatment, internal compassion, decreasing fear of symptoms and can foster a relationship between survivor, therapist and Trauma.  Additionally, the externalization and personification of Trauma may illuminate the individual functions of client presentation while offering precise direction for treatment.

In the embodiment of Trauma we view it as something that has characteristics and ways of being in the world that are consistent over time and place (and in this case it’s interaction with people).  Defining PTSD according the DSM IV is a means of detecting  its’ presence in the life of a survivor while establishing a foundation for this discussion. According to the DSM IV(American Psychiatric Association (1994). Diagnostic and statistical manual of mental health disorders (4th ed). Washington DC: Author), diagnostic criteria include intrusive memories, thoughts, or dreams of an event, a sense of reliving it,  and intense distress in response to both internal and external cues that resemble an event(s).  Individuals may thus become avoidance of triggers or cues, increase isolation, may have a sense of waiting for the other shoe to drop (a foreshortened future) and of being detached.  Sleep difficulties are common; mood labiality, and hyper vigilance are also common (American Psychiatric Association (1994). Diagnostic and statistical manual of mental health disorders (4th ed). Washington DC: Author).

Drawing from the concepts of narrative therapy and the externalization of a problem (the person is not the problem the problem is the problem) allows us to develop a relationship with Trauma and to begin to evaluate its’motivations (Playful approaches to serious problems: Narrative therapy with children and their families. Freeman, Jennifer C.; Epston, David; Lobovits, Dean New York, NY, US: W W Norton & Co. (1997). xvii, 321 pp.).  Symptoms could be conceptualized as tools utilized by Trauma on our behalf in order to protect us, remind us of our core values, and to ensure that what happened before won’t happen again. It could be argued that the trauma response corresponds to the level of violation on self and values; a profoundly disturbing event calls for a profoundly disturbing response (from Trauma’s perspective).  Analogous to the concept of stuck points in Trauma-Focused Cognitive Behavior Therapy (Akin-Little, Angeleque (Ed); Little, Steven G. (Ed); Bray, Melissa A. (Ed); Kehle, Thomas J. (Ed), (2009). Behavioral interventions in schools: Evidence-based positive strategies, School Psychology (pp. 325-333). Washington, DC, US: American Psychological Association, xi, 350 pp.) flashbacks, dreams, invasive thoughts and triggers provide specific information about the violation the client’s event(s) infringed upon them.

Read the whole article.