I subscribe to the Psychotherapy Networker e-newsleter and just read a great article by Nancy Errebo, Psy. D. about using EMDR with a returning vet. (This issue has 3 articles on PTSD.) http://www.psychotherapynetworker.com/index.php?category=magazine&sub_cat=articles&type=article&id=Like%20a%20Ghost&page=1
Two quotes struck me:
"while nightmares and flashbacks are very troublesome and painful, avoidance is by far the most dangerous aspect of PTSD-in fact, it maintains the fear and vigilance and the constant preoccupation with the war. "Avoidance also becomes a way of life," I said and described some veterans I know who'd spent many years avoiding almost everything and everybody in their largely unsuccessful attempts to stay calm. There's no healing without exposure to the memory and the emotions that go with it, I added." [my italics-Patience]
"the brain naturally tries to process trauma by reviewing experience, but the images and emotions are so vivid that nightmares and flashbacks result. So the opposite, also completely natural, tendency kicks in and the brain tries to avoid the pain by numbing the emotions. At this point, the information can't be processed, and the cycle just repeats over and over again-the natural healing process getting caught in a kind of gridlock. EMDR is designed to break the gridlock and keep the information processing system active so that healing can occur."
This article also mentions EFT, Emotionally Focused Therapy for couples, one of the therapies I think is stupendous. Dr. Errebo wrote an article on that: "EMDR and Emotionally Focused Couple Therapy for War Veteran Couples" in the Handbook of EMDR and Family Therapy Processes. I belong to the International Society for Traumatic Stress Studies, and often go to their conferences. I saw Susan Johnson, the developer of EFT, give a workshop on it, and it was simply wonderful.
A lot of VA's do offer EMDR these days, and it works for many people. Processing the trauma may only be the beginning of recovery, however, if you grew up in a home where there was a war between men and women. EFT offers the chance to make your home a sanctuary instead of a battleground. So does applying the principles of Al-anon to life with PTSD and I'm sure there are other effective therapies, but this is the one that I know about.
Another therapy that I attended a workshop on is ACT, Acceptance and Commitment Therapy. I felt that this was another one that I would like to see in every VA. If you Google "Steven C. Hayes" and "Sonja V. Batten" and "Acceptance and Commitment Therapy" you can find out more from the people who developed the concept. I think it pays to be an informed consumer of mental health and to speak up for what you feel would help you.
By the way, none of the devlopers of these therapies think their way is the only way. When a therapist tells you that their therapy should have worked, that's when instead of feeling like a failure, you need to find a new therapist. The failure is not you. It's different if they say "this doesn't seem to have helped you, so lets try and find something that will, perhaps with another therapist." That is honest, because people are best with techniques they know and love, as long as they don't imply that you failed.
Actually, I think I have to qualify that,too. If you try to do therapy while drunk, stoned, in a food coma, etc (all of which may be the PTSD symptom: efforts to avoid thoughts or feelings associated with the trauma) you can prevent your own healing. It is like the healing of any wound. Pain is involved. You went through hell and healing it will hurt. So you heal in small doses with help. But if you don't feel, you won't heal.
I often say it is good to be able to go in and out of the numbing at will, since the numbing is a survivor skill. But healing is something else, something beyond numbing. When you numb pain, you also numb joy...
And if your pain is intolerable, there are programs like Dialectical Behavioral Therapy, which teach you skills in tolerating painful emotions before you try to do trauma work. I don't know of a VA where they do that either, but I hope it will come.