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Friday, June 20, 2014

The right attitude Day 20 of National PTSD Awareness month.

Some people have the right attitude for helping people with PTSD. They are effective.
The right attitude consists of respect, an understanding of human nature, the ability to listen and hear what is being said as well as what is not being said. They teach you skills that will help you have a better life if you use them, as opposed to "I can fix you." Willingness to use a wide variety of techniques is required because people are different and need different things. Acceptance of people where they are while encouraging change is another requirement.
What is not required is a Ph.D. and an attitude of I can fix you if you just do what I say.
People with PTSD have very sensitive control detectors. They also need to find what heals them, not follow directions that may or may not work. History shows that people with PTSD can get better, but also that PTSD symptoms come back with further trauma whether it is a new war, the losses of old age, or huge reminders, like 50th Anniversary celebrations which threw so many stoic WWII vets into the arms of the VA.
So any program that claims to "cure" PTSD is suspect from the beginning. Does it have 50 year follow-ups? I think not.
It is fair to say is we can help you with your symptoms and if they come back, we will help you again. I have seen people who seemed to be cured by one technique or another, but I have not seen fifty year followups.
Human nature means if someone is told they are cured and symptoms come back, that person is going to think they are defective, not that the cure isn't a cure, and they are unlikely to go for more help.
I have also met veterans who have been told that we have done all that can be done for you and you aren't going to get any better. I do not know of any VA Hospital or clinic that even uses all of the forms of therapy I mentioned yesterday. (It was not a complete list, just off the top of my head.) I did not mention all the available forms, and new ones are developed every day, so that is an outright lie.
Here is a quote from the Transcend Program's manual (a joint PTSD and Substance Abuse program which was so effective that the VA cancelled it) "developing a therapeutic alliance that gives responsibility to the client for change and to the therapist for guiding and supporting that change. Basic to this is developing in the client a feeling that taking responsibility for change will be worthwhile. The concept of self efficacy guides much of our general thinking....We work at instilling in clients the benefits of self-exploration, interpretation, and reframing of life experiences. Gentle tenacity is sometimes needed here in the face of resistance. However, we see resistance not solely as a client based problem, but also as an inability of the therapist to frame the issues and benefits of self-exploration in a way that can help the client overcome his fears."
Now that is the right attitude! They go on to say, "there is no real change without behavior change... We see our position as therapists not simply as facilitators of change, but promoters of a certain way to change. Teaching new skills, emphasizing the need to act on newly learned behaviors, assisting clients in generalizing other situations, and helping them maintain new skills by providing reinforcement... and also teaching them self-reinforcement skills..."
Most of what I mentioned yesterday was also developed by people with the right attitudes. I used to go to the International Society For Traumatic Stress Annual Meetings and go to the workshops, looking for people with the right attitudes. Many of the free Post-Traumatic Gazettes on my web page have reports on that. More tomorrow. 

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