Reflections of a Trauma Nurse/Counsellor’s Academic, Research & Clinical Experiences
Introduction to Psychotraumatology
I have decades of reflections I am ready to share concerning my academic, research and clinical experiences as the trauma nurse who became a trauma counsellor. However, a brief introduction into the emerging field of Psychotraumatology, as experienced by myself across North America, but mostly in Canada, is a good place to start.
I presented similar versions of the following brief, introductory material. The first was an in-service in acute psychiatry (Thompson, 2004), and the second was as a topic of interest, Harmony Project: Woman’s Support & Enhancement Group (Thompson, 2005), attended by survivors with diagnosed, Complex, Post-Traumatic Stress Disorder (C-PTSD; Herman, 1972).
From 1985 to 1996, I completed all requirements at-a-distance and obtained a PhD in Psychology. My dissertation was named Psychological Traumatology and a decade passed before the American Psychological Association (APA) founded Division 56 – Trauma Psychology (APA – 2006). In Canada in 1989, when I established a private practice to provide trauma, exit and grief nursing/counselling services, I was perceived as eccentric and fringe, especially when serving client(s) engaged and in the midst of volatile and hostile agendas and the use of coercive persuasion (Lifton, 1961).
The historical roots of Psychotraumatology trace back to a surgical sub-specialty in the field of medicine, the science of traumatology. By definition, traumatology deals with wounds resulting from external force or violence (Miller & Keane, 1972).
During the writing of my dissertation (Thompson, 1996), I stated that the science of traumatology required a second branch to deal with the invisible, non-surgical wounds resulting from traumatic lifetime events as evidenced by the explosion of studies completed in the past decade on survivors of traumatic events.
According to Dr. Mark Lerner (2008), President of the American Academy of Experts in Traumatic Stress, recognizing and addressing traumatic stress is the responsibility of all individuals who are on the front-lines caring for people exposed to traumatic lifetime events. Traumatic events are a part of life and traumatic stress reactions are normal responses experienced by normal people in the face of abnormal events. Professionals who are knowledgeable about traumatic stress understand that the uncomfortable and disturbing symptoms that precipitate diagnostic labels often serve an adaptive function For example, hypervigilance is a state of ‘stress-readiness’ that keeps people alert, watchful and cautious. While individuals feel uncomfortable, nervous and wary, hypervigilance has historically served as a basic mechanism to protect people from further traumatic exposure.
Self-Regulation Therapy (SRT ®) is a non-cathartic mind/body approach aimed at diminishing excess activation in the nervous system created and taught by the founders, Josephs and Zetti. Ed Josephs, PhD and Lynne Zetti, PhD, are great clinical trainers and healers. I remain eternally grateful to them for not only my professional training, but most important was my own healing experience. Dr. E. Josephs and Dr. L. Zetti can be contacted at the Canadian Foundation for Trauma Research & Education, Inc. (CFTRE-2004). http://www.cftre.com.
During my CFTRE experience, I learned and according to Freud that trauma causes a breech in the protective barrier against stimulation leading to overwhelming feelings of helplessness. I also learned and according to Flannery that psychological trauma is a state of severe fright experienced when people are confronted with a sudden, unexpected potentially life threatening event, over which we have no control, and to which we are unable to respond effectively to no matter how hard we try. Traumatic events are deemed extraordinary, not because they rarely occur, but because they overwhelm ordinary human adaptation to life. Internal fear, a sense of a loss of control, threat of annihilation and helplessness are the common denominators of psychological trauma (Herman, 1992).
From 2002 to 2004, the following key trauma response definitions and indicators were revealed during my training in Foundation and Advanced Certificate courses taken at CFTRE. An experience is traumatic when it is sudden, unexpected and non-normative and exceeds the individuals’ perceived ability to meet its demands. The event disrupts the individual’s frame of reference, central psychological needs and schema (McCann – Referenced in CFTRE material).
Types of trauma includes falls, motor vehicle accidents (MVA’s), attack (rape, abuse), medical/dental surgeries and anaesthesia, near-drowning, electrocution, hallucinations, psychosis, high fevers, poisoning, developmental trauma, loss/abandonment, natural disasters including fire, torture and ritual abuse, war, horror and survivor guilt.
Dysregulation is the inability of the sympathetic (SNS) or parasympathetic (PNS) branches of the nervous system to self-regulate which shows itself in many disorders including PTSD, anxiety and mood disorders, phobias, psychotic disorders, alexithymia and personality disorders. The physical symptoms of dysregulation include insomnia, asthma, allergies, migraines, tinnitus, hypercousis, photophobia, neck/back pain, fibromyalgia, chronic fatigue, autoimmune diseases, gastrointestinal difficulties, temporal mandibular joint dysfunction (TMJ), and alcohol and drug abuse.
SNS overactivation symptoms include hypervigilance, exaggerated startle response, panic attacks, rage, insomnia, always on the go and excessive habits (drugs, alcohol, exercise).
PNS overactivation symptoms include depression, disconnection, deadness, numbness, exhaustion and alexithymia. Because the nervous system is out of balance, symptoms may alternate between sympathetic and parasympathetic overactivation. People often feel like they are “’going crazy.’
When trauma happens there is a loss of integrity (cohesive sense of self), resiliency, trust, sense of safety, boundaries, orientation in time and space, control and connection to self, other, the planet and God. When trauma happens there is an experience of overwhelming fear, powerlessness, helplessness, inadequacy, threat of death, exhaustion, contraction, tension patterns (pain) and fixity (frozen-ness).
In 2010, I became aware of a second noteworthy, non-profit organization (np org) in Canada devoted to public/professional crisis/trauma psycho-educational training mandates in addition to the aforementioned CFTRE. The second np-org is the Crisis and Trauma Resource Institute, Inc. (CTRI-2010), who offer a wide variety of services for individuals, communities and organizations across Canada.
Author: Dr. Linda AK Thompson, BGS, MA, CCC, PsyD, FAAETS Owner, Matrix of Trauma (© MOT ™): Research, Advocacy, Healing
Herman, J. L. (1992). Trauma and Recovery: the aftermath of violence – from domestic abuse to political terror. New York: Basic Books.
Lerner, M.D.; Volpe, J.S. & Lindell, B. (2008). A Practical Guide for University Crisis Response. A Publication of the Institute for Traumatic Stress: Melville, NY.
Lifton, R.J. (1961). Thought reform and the psychology of totalism. New York: Norton.
Miller, B.F. & Keane, C.B. (1972). Encyclopedia and Dictionary of Medicine and Nursing. Toronto: W.B. Saunders Co.
Thompson, L.A.K. (1996). The Matrix of Trauma: A thesis – partial fulfilment for the requirements for the degree of doctor of psychological traumatology in psychological assessments and etymology. © Unpublished/Sealed. Summit University of Louisiana, New Orleans: Louisiana.
Thompson, L.A.K. (2004). Introduction to Psychotraumatology: Unpublished In-service.
Thompson, L.A.K. (2005). Harmony Project: Woman’s Support & Enhancement Group: Nursing Counselling Services (NCS 1990-2012), Private Practice. Water Valley, AB.
*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA