PTSD Healing: It’s a Matter of Perspective, Or: Seeing It Their Way

I can’t help myself, today is just a 2-post day because I’m sitting here with 4 really great perspectives from the other side and as you begin to consider reaching out to friends and family it’s good to know what kind of compassion you can hope to receive and also, what’s on their minds:

1 – Tawnya Torres writes the blog, The Life Of A PTSD’s Spouse. Her husband deployed to Iraq and came back a different man. While Tawnya continues to raise 4 children, she also has to accept and make peace with the fact that her marriage is not the way it was before. She wrote a really great piece this past Saturday about the two ways she’s dealing with that.

2 – Ever wonder how PTSD and vet disabilities are interpreted by and affect kids? Tawnya sent me this Sesame Street promo clip for a show on this topic that airs on April 1st. Hosted by Queen Latifah with an appearance by John Mayer, the show seems to be a very poignant and positive look at bridging the gap between children and their vet parents when the family reunites at home. For further reading, here’s the press release for the show.

3 – My friend Alicia Sparks writes a mental health blog called Celebrity Psychings. In that wonderful way synchronicity works, today she began the series ‘Don’t Avert Your Eyes’ about how to approach someone who needs help; might just be a good resource to turn your friends and family onto so they can learn the etiquette of communicating with you.

4 – My friend Deb Vaughn runs a group on Facebook: I Love Someone With PTSD and I’m not Alone. In her description of the group Deb writes, In addition to those affected by this condition, there are those of us who love and support someone with PTSD. At times it can be lonely and you don't know where to turn. I am starting this group to give loved ones a place to go. It's a great resource for your friends and family so that they can explore their own experience with and outside of you.

I asked Deb to write about what it’s like to watch a loved one struggle with PTSD and still manage to maintain a close and loving relationship. She’s been really great about sharing her perspective. Here’s what she says,

Over the last few years in my journey with my partner and her struggles overcoming her trauma, I’ve learned many lessons. Some of the most important lessons have been about patience, patience with her and with me.

You see, I’m a fixer by nature. I always want to fix things, help people and make things right. PTSD isn’t that simple. There is no quick fix. There is also no simple way to learn and understand what the person you love is going through.

It’s heartbreaking to watch them struggle and to be in pain. Each day is different. You have no idea from one hour to the next what things will be like. It’s hard not to take their moods or outbursts personally. You have to keep reminding yourself that it’s part of the PTSD.

She tells me she doesn’t know how I put up with it all. I do it all because I love her and I will only be satisfied when she is better. It’s a long process. In many cases it can take years. That’s also hard to grasp. Patience is not one of my strongest traits, but somehow I’ve found it deep within myself. I’ve come to realize that it grows out of love.

Here is what I would tell her if she asked me the top 10 things I’d like her to know about my approach to helping her heal from PTSD:

1) You are not a burden. I love you and wouldn’t be with you if I couldn’t handle things or you.

2) Please bear with me, too. I’m still learning and need you to understand that I don’t always do the right thing.

3) Always be honest with me. I can handle it.

4) Sometimes when I react badly it’s because of my own past and not because of you. I have my own demons.

5) I try so hard to understand what you are going through and it’s hard to admit that no matter how much I learn, I’ll never really know what it’s like.

6) I hate to watch you suffer and it breaks my heart.

7) Communication is so important. I need you to tell me what you need or what you need me to help you with. I don’t always know what to do.

8) Sometimes I feel selfish when I want to do something for myself or ask you to do something with me that I know you don’t feel like doing.

9) It’s hard not to take your bursts of anger personally.

10) My love for you is unconditional.

(Photo: DavidDMuir)

Children & PTSD, Part 2: What's the Best Treatment?

Today, Part 2 of my Children & PTSD interview with William Krill...

When should a parent consider getting treatment for a child who exhibits PTSD symptoms?

I think with children it is important to have a professional do an initial assessment and keep tabs on them for say, six months after a known traumatic event. I would educate the parent on what to watch for, and if symptoms reach the criteria for the diagnosis, begin to treat. But if a child does not develop Acute Stress signs within a few weeks after the trauma, it’s not too likely that full blown PTSD will develop. If the child clearly has Acute Stress, the sooner the treatment the better.

What treatments are available for children?

Most treatments for children are based on the treatment modalities for adults with PTSD. Early in my work with PTSD children, I tried using these methods, and tried to modify them the best I could to use them with children. I became quite frustrated because the methods were awkward when used with children, and with very young children, where insight and mature understandings of the trauma facts are used in adult treatment, children clearly did not have these capabilities.

In addition, one of the usual methods for adults, that of multiple detailed reviews of the trauma until the person becomes desensitized to the facts, was just far too brutal for a child. The ‘flooding’ method was developed for soldiers with PTSD…people who presumably had a very strong ego before their trauma. For a child who may have been abused his whole life and thus has a very damaged ego, repeating the details of the trauma over and over is just ridiculous.

I started to study PTSD in children and have been developing my own Gentling process for about twelve years. During the past six years or so, I have taught the method to many foster parents and other treatment professionals, and they have all had good success with it, where other approaches have not helped the child to make progress.

What I have developed with Gentling makes use of general cognitive-behavioral techniques, but with the addition of some very specific techniques and a loose structure course of treatment. Basically, Gentling 1) strives to help the child feel safe in all environments, 2) sensitizes him to his own symptoms (since he has lived with them his whole life, he does not recognize them as disordered), 3) educates him on how PTSD works in his body and mind, 4) teaches him how to interrupt his own stress episodes to be more comfortable, and finally, 5) helps him to become less reactive to cues and triggers. This is all done at the pace the child dictates, and all work is done with an exceedingly gentle approach.


How should a parent prepare to understand, treat and heal PTSD in her child?

Getting parents or foster parents on board the treatment plan is very important. I spend a great deal of time educating adults around the child (including teachers, extended family members, fellow professionals, even judges) in first fully understanding how PTSD works in children, and then in the Gentling techniques of healing.


One final question: Why do you choose to work with children?

I don’t fully understand my passion for helping abused children to heal, but it might be summed up by one little boy I treated. He had been beaten and thrown in a closet by his stepfather (who knew the boy was frightened of the dark), then the stepfather screwed the door shut. His mother found him hours later, when she came home from work. He was terrorized, and he had torn all of his fingernails off in trying to get the door open. After he related this story to me, he hugged me and said: “When I talk to you Mr. Bill, the hurt goes away.”

For more information on William Krill, or to view his really excellent resources, parenting articles and PTSD information, visit his site.

(photo: TiZi042)

Children & PTSD, Part 1: Who's At Risk?

As we begin this new year tackling our grown up PTSD problems, let’s not forget the little people! Since my experience with PTSD began on the cusp of adolescence (and went undiagnosed until over 25 years later), I don’t pay much attention to the ways in which children suffer from PTSD. But I’ve been thinking about them lately, those little people who seem resilient but are often as affected by trauma as adults. My friend, Maria, for example, has a son, Ian, who is now 6 years old. A year ago Ian suffered from the same illness I did. Today, he’s experiencing the same PTSD symptoms as the rest of us and Maria is doing a really terrific job finding and getting Ian the help he immediately needs so he does not spend years lost in the PTSD maze.

Watching her tireless and inspiring advocacy for her child got me thinking: What is specific to children with PTSD? Which made me think of this Licensed Professional Counselor I’m acquainted with, William Krill. I first discovered him in one of the online PTSD support groups I’m in; his voice was the sagest, wisest, most educated in the group. You’ll see why when you read our interview below.

Krill has been kind enough to shed some light on the topic of children and PTSD. The cool thing about his interview is that it’s so educational. Even for those of us who don’t have this situation in our lives, maybe we will one day. Or, maybe we’ll meet someone for whom the info we pass along will be critical. And if that doesn’t happen, we can spread the word that children need special attention after crises because they can develop very adult psychological complications.

My interview with Krill breaks down into two parts, the first defining the problem, the second exploring the solution.

Today we’ll tackle Part One, Children & PTSD – Who’s at Risk?:

Define the age category 'child' encompasses.

Generally, children are considered under the age of thirteen. It’s not uncommon for emotional development to be halted at the age of the first trauma. Interpersonal trauma treatment (i.e. PTSD) does need to be tailored not only to the age of the survivor, but also tailored to the individual. Adult treatment approaches do not work with children. Unfortunately, there is not a lot of material out there for survivors of interpersonal trauma in general, let alone materials specific to age. I’m currently working on a book outlining the treatment approach I have developed for working with children. It’s called Gentling: A Clinician’s Guide to Treating PTSD in Abused Children.

What types of situations induce PTSD in children?

Just about any situation can create PTSD, from natural disasters to direct physical and sexual abuse to neglect. In addition, there is research to show that children can develop PTSD in domestic abuse situations where they witness their mother (or other close relative) suffering abuse. We don’t yet fully understand why some individuals develop PTSD while others do not, even though they have experienced the same level of trauma. Recent research indicates that there may be a difference in people’s brain chemistry that accounts for a pre-disposition to PTSD.

About how long after a trauma does PTSD usually emerge in children?

Not everyone is effected long-term by a trauma. While it is likely that with enough intense trauma, everyone would develop PTSD symptoms eventually, all PTSD starts with the diagnosis of ‘Acute Trauma Disorder’. Acute Trauma is essentially the same as PTSD, but it may in fact end in a relatively brief period of time. It’s only after Acute Trauma does not ease that the diagnosis of PTSD is assigned.

In most cases, there will be identifiable signs of either of the stress disorders if there is a close enough observation of the child. The problem is that many of the signs of PTSD in children often look like a different diagnosis, like ADHD or ODD. It is not uncommon for these children to be misdiagnosed as Bi-Polar. In addition, most PTSD victims, especially children, tend to work hard at covering their symptoms and do not share the fact of experiences. So, a child could go for years, even decades, before anyone recognizes the behaviors seen and labeled as PTSD.

What symptoms should a parent look for in terms of recognizing PTSD in his child?

For me the key has been to start with any known traumatic events, such as abuse events. When difficult behaviors symptoms develop, a connection with the trauma(s) needs to be considered carefully. PTSD in children does not express the way that it does with adults. While there are general similarities, I have found that children tend to have unique expressions, like a high incidence of nighttime enuresis (bed wetting) that does not respond to medicine or behavioral interventions. In addition, many boys also have encopresis (fecal soiling after successful toilet training).

By far the biggest marker is that the child will have rapid mood changes from relative calm and happy to highly agitated. I describe this as being like a ‘light switch’. And just as quickly as the agitation starts, it can end. Often, the child cannot tell you what it was that they were upset about. The upsets are often accompanied by regressions in speech, and the child may begin to speak in baby-talk, cry uncontrollably, and refuse to be comforted or touched. This all may be accompanied by facial and chest flushing, body tenseness, pacing or looking panicked, and one very reliable sign: pupil dilation.

Often, parents describe these upsets as ‘tantrums’, but these are not really tantrums because they are far more intense than tantrums; tantrums are usually about manipulating to get something. Rather, these upsets are more accurately called ‘stress episodes’.

What is the best way to prevent PTSD from occurring in children?

There is a great deal of controversy over the idea of rapid response to trauma to prevent eventual PTSD. There is research on both sides that indicate it is effective or ineffective. There is even some research that demonstrates that ‘critical incident de-briefing’ can actually induce PTSD. So the jury is still out on the best time to begin treatment. In my opinion, the most important thing is to place the treatment time and speed into the hands of the person with the PTSD. “Forcing” someone to talk about their trauma before they are ready would likely not be effective. A trauma victim has already been forced during the trauma, I wouldn’t suggest repeating that situation to help them!

(Part 2 of this interview will post on Thursday, 1/8/09.)

(photo: **LYN**)