PTSD, Post-Traumatic Growth, and PFA
A Post-Traumatic Stress Disorder (PTSD) diagnosis and post-traumatic growth are not mutually exclusive events. Nor is the opportunity for post-traumatic growth null in the event of a PTSD diagnosis. The fundamental difference between these two events is the reaction of the individual and their support system, or lack thereof, after the trauma has occurred. Society has been conditioned to believe that trauma is a rare occurrence and not that the “trauma response is a normal response to an abnormal situation” (Rousseau, 2017). Due to this conditioning, many individuals who experience trauma are overwhelmed with a sense of shame due to their actions or inactions in the face of a traumatic event (Van der Kolk, 2014).
One of the hardest aspects of recovery for trauma survivors is the fact that “people can never get better without knowing what they know and feeling what they feel” (Van der Kolk, 2014, p. 27). It takes a tremendous amount of trust and courage for a survivor to allow themselves to remember (Van der Kolk, 2014), but that can be the key difference between suffering with PTSD and engaging post-traumatic growth. With the proper social connections, a survivor can develop the necessary physical, mental, emotional, and social resilience to positively impact their sense of self, social interactions, and philosophy of life (Rousseau, 2017).
A key transition point in determining whether post-traumatic growth would be successful could be directly, or shortly, after the event itself. Psychological First Aid (PFA) could provide the necessary support and encouragement that makes the difference between a lone-PTSD diagnosis that someone struggles with and their ability for post-traumatic growth. PFA is a strength-based model of support and intervention designed for immediate use after a traumatic experience. PFA can be implemented by almost anyone in the presence of someone who has experienced trauma or distress: mental health workers, disaster responders, emergency workers, law enforcement officers, crisis counselors, or even a parent with their child. PFA should occur in a natural setting where the survivor will be most comfortable and least influenced by stressors (2011a). Two of the most important things to remember when implementing PFA is to ensure that “what [providers] do does no harm” (2011a), and that disaster and other trauma survivors are having a “normal reaction to an abnormal situation” (2011a; 2011b).
The goals of PFA include establishing a calm environment, human connection, and trust, providing practical assistance, safety and comfort, and promoting adaptive coping while ensuring the survivor’s immediate needs are being met and that they are being linked with necessary services (2011a). To achieve these goals, providers are encouraged to observe the survivor without intruding, model healthy responses, maintain confidentiality, and acknowledge the survivor’s successes to encourage strengths-based healing (2011a). It’s important that providers working with survivors are direct, do not speculate, and are willing to admit that they don’t have the answers to some of the questions that may be posed by the survivor (2011b).
The immediate moments after a trauma has occurred can become extremely sensitive for the survivors. Van der Kolk (2014) asserts that “after trauma the world becomes sharply divided between those who know and those who don’t. People who have not shared the traumatic experience cannot be trusted, because they can’t understand it” (p. 18). This is parallel to the assertion of the presenters in Psychological First Aid (2011a) that providing PFA to survivors is a careful balancing act to establish trust, largely due to this assertion that those who have not survived trauma cannot understand what their clients are going through. It can be extremely triggering for a survivor to receive support from a provider who claims to understand how they are feeling; one of the presenters in Psychological First Aid (2011b) expressly warns the audience to avoiding using such terms as “understand” when supporting individuals because of this risk.
I strongly believe that training in PFA for individuals who are at the forefront of trauma- and first-response would be the best practice for trauma survivors. It is the responsibility of the community and the organizations who are trusted to care for these individuals to provide the best options for treatment and growth after a traumatic event has occurred. The social mindset surrounding trauma and the regularity of appropriate treatments have much room for growth, however with the appropriate education and advocacy, we as growing professionals can ensure this best practice is achieved.
References:
Cavalcade Productions (Producer). (2011a). Psychological first aid I: Goals and guidelines [Documentary]. Available from http://bu.kanopystreaming.com.ezproxy.bu.edu/video/psychological-first-aid-i-goals-and-guidelines
Cavalcade Productions (Producer). (2011b). Psychological first aid II: Caring and coping strategies [Documentary]. Available from http://bu.kanopystreaming.com.ezproxy.bu.edu/video/psychological-first-aid-ii-caring-and-coping-strategies
Rousseau, D. (2017). MET CJ 720 Trauma and Crisis Intervention – Module 1: Introduction to Trauma
Van der Kolk, B. A. (2014). The body keeps the score : Brain, mind, and body in the healing of trauma. New York: Viking.