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PTSD Questions & Answers
Joyce Boaz & Dr. Frank Ochberg, M.D.

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Telling your Trauma Story to your Therapist

Q: Dear Frank, Many trauma survivors have said that they are nervous about telling their story to their counselor. The first visit seems to bring the most fear. And some survivors say they freeze in support groups. All of a sudden physical symptoms arise like tight throats or stomachs. How can a survivor overcome this?

A: Dear Joyce, It isn't easy to tell a trauma story and it shouldn't be. Part of the definition of PTSD is avoidance of reminders, including a reluctance to tell details. People who do not understand the "invisible injury" assume that survivors want to share, want to be among caring people, and "just need to get over it." But that is simply not true. The invisible injury of PTSD makes it physically difficult to put details into words. Some brain studies show that the speech center isn't fully on-line. It has lower blood flow and less ability to act efficiently. When a person is "scared speechless" they, literally, have lost the power to form language in the speech center, Broca's Area, of the brain.

They may also have difficulty breathing. You can't speak easily and coherently when your breath comes in gasps because your level of arousal is so high. But there may be other reasons to find it very difficult to "open up" to a counselor or a support group. Can they take it? Will they be overwhelmed by the images that still haunt you? Although this thought may not be explicit in your mind, you would be in good company if you found yourself holding back because you didn't want to hurt a person by exposing them to a terrible ordeal that you managed to survive. Many combat veterans, many law enforcement officers, many sexual assault survivors hold back for just that reason. It isn't that they are full of shame or guilt.

They do not want to bring pain and terror to someone else. Also, they may not be sure that the listener can listen and will listen, absorbing and understanding the meaning of grave trauma. Survivors have usually told parts of their stories before coming to a therapist or a peer-support group. So they have some experience with others who, perhaps, try to be helpful but don't really know how. And that creates "the second wound." I first heard the term, second wound, from Dr. Marty Symonds. He was a police officer before he was a psychiatrist and he knew that many trauma survivors were interrogated in harsh ways by family members, lawyers, insurance agents, police and health professionals, making matters worse, not better. Often, the second wound was more painful that the first because it felt like a humiliating betrayal. You expected help and compassion and you were cross-examined as though you were to blame. So there are many, many good reasons to be nervous about telling your story to someone who has not earned your trust.

Assuming that the listener will turn out to be trust-worthy, here are some things to consider in telling details:

First, you do not have to tell the whole story all at once. You can tell a piece of it, and see if your counselor or group of peers is attentive and kind. If you do not feel like continuing, you can say so. You should be respected and allowed to set your own pace.

Second, you can ask a therapist what he or she is most concerned about learning. And you can ask a therapist to talk about herself or himself. That makes it more of a conversation and less of an inquisition. Some therapists are very reluctant to talk about themselves, but they should let you know about their education, their professional experience and their interest in working with survivors. I teach young doctors and residents to do this, since survivors of trauma are normal people who encountered abnormally terrible events. They should not be assumed to need psychoanalysis. They need a partnership as they overcome the impact of a trauma injury.

But finally, you should consider what a professional therapist and what a compassionate peer is looking for, as you tell your story. They want to know how you hurt. They want to know what you have done to overcome the pain. They want to know what you were like before being hurt, and what you aspire to be like once your injury, your stress injury, has healed.

So you are not just telling a trauma story - a "war story." You are telling your story. Your life story. And there is a lot more to your life, past, present and future, than the trauma that brought you to therapy.

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Page created on 30 July 2014
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