New Content Added: To update the content we have added Child Abuse and PTSD information found at the end of the Table of Contents.
On this track, I will present a few ways to identify the way trauma affects a client: the extent of the trauma, anger, and guilt. We
will also present two techniques: The Trauma Questionnaire and Benefits
The Extent of the Trauma
In treating PTSD, I believe it is necessary to identify what type of trauma
a client or group of clients have experienced. I feel that
the extent of the trauma is more relevant to the effect of PTSD on the client
than the client’s past or present psychological state. As you
know, there are some traumatic events that would affect anyone exposed,
such as the recent rise in PTSD after 9/11.
Michael, a teenage
client of mine, was referred to me by his high school guidance counselor
who said that he had been fighting with the teachers and
classmates at school, and that his grades had been plummeting. Michael
had been shipped from foster home to foster home his whole life, and had
finally settled in a permanent residence.
His guidance counselor believed
that something at his new home had happened to cause the
change in his grades, but Michael refused to talk with her. Once he
was referred to me, I witnessed the same behavior that Michael had shown
to the school counselor --- silence. The only thing he would say angrily
is, "I don’t want to talk about it." I believed that
Michael could be exhibiting symptoms of PTSD and perhaps was trying
to repress the memories that kept trying to push their way out.
Technique: Trauma Questionnaire
To help Michael begin to talk about the event without having to take the first
leap of "talking about it," I asked him to fill out a seven question "Trauma
Questionnaire". I requested Michael to answer the questionnaire
in a journal and to quietly read it back to himself. When he said again, "I
don’t want to talk about it," I responded, "But you’re
not talking about it. You’re writing and reading about it." He
seemed to be receptive.
The questions I gave to Michael included the following. Although
many questions may not apply to Michael, I felt the general nature of the
questionnaire would be beneficial.
- Have you ever been in a natural catastrophe, such as an earthquake, fire,
- Were you ever sexually or physically assaulted, either by a stranger, a
group of teenagers, a family member, or anyone else?
- As a child, were you physically maltreated with excessive beatings or
a parent’s or caretakers disciplinary measures sadistic?
- Have you ever witnessed the death, torture, rape, or beating of another
person? Have you ever seen someone die or be badly injured in a car,
airplane, or other accident? Have you ever been injured in such
- Has anyone in your family or a close friend been murdered?
- As a child, did you ever witness the beating, rape, murder, torture, or
suicide of a parent, caretaker, or friend?
- Have you ever been in a situation in which you felt that you or a member
of your family would be harmed or killed? Even if your life or the
lives of your family members were not directly threatened, did you distinctly
fear that you or they were in serious danger?
The next session, Michael had written in his journal about an incident that
had taken place about a month ago. He said that while he was walking
home, he saw someone robbing a gas station. Michael watched the perpetrators
run out of the station and hijack a car and also witnessed them beat the owner
of the car even though she had already let them take the vehicle.
told me that he had feared for his life and had hidden behind a trash bin so
that the perpetrators could not see him. Now that he had related this
incident to me, I could now see where Michael’s anxiety was coming from.
Next, we will briefly discuss anger as a reaction to a trauma.
One of Michael’s principle symptoms of his PTSD was, obviously, his anger
as exhibited by his angry tone of voice in therapy and fights at school. He
frequently lashed out at his teachers and his classmates. This was a
new behavior for Michael. I feel that Michael’s anger was his attempt
to control the environment around him. When he witnessed the robbery,
Michael described feeling scared and ashamed for having to hide behind a dumpster.
now wishes he could have helped the driver of the car that had been beaten,
but instead he ran away. To cope with this feeling of helplessness, Michael
used his anger to manipulate his surroundings. Think about your client
who chronically displays anger.
Could that client have been the survivor
of a traumatic event, childhood abuse perhaps? We will discuss anger
in detail on a later track.
Technique: Benefits and Costs
To help Michael control his anger which I believe he used to cope with this
feeling of helplessness, by manipulating his surroundings, I asked
him to try the "Benefits and Costs" technique.
asked Michael to take a piece of paper and draw a line down the middle of
it longways. On one side, I asked him to write "BENEFITS" in
capital letters and then write, "The good things about my anger are…". Then, on the other side of the paper, I asked him
to write, "COSTS" in capital letters and then
to write, "The bad things about my anger are…". Next,
I told Michael to list on the "Benefits" side, the things he
gains from displaying anger and on the "Costs" side what he
loses from displaying anger.
Under the "Benefits", Michael
"I feel that people will do what I say when I’m
"If I don’t show that I’m angry,
I feel like I’ll explode";
"My anger can protect me
from people who want to hurt me."
"My friends are afraid of me now";
get so mad at my teachers that I don’t want to learn anything"; and
feel embarrassed that I hurt everyone else’s feelings."
that Michael has identified that anger can have negative results, he could
more easily be aware of his motives for becoming angry.
Another manifestation of PTSD is a feeling of guilt or shame. Some
trauma survivors in trying to fight their feelings of helplessness blame themselves
for not doing anything. This was the case with Michael. When he
hid behind the dumpster, he felt that he was being a coward in not helping
the woman who was badly beaten by the carjackers. Michael felt ashamed
that he was the one who could hide and she couldn’t.
then addressed these feelings in a format I like to call "If
I could do it over" technique. First, I asked Michael, "What
would you have done to help the woman?" Michael
replied, "I could have tried to fight them." I
then said, "Michael, did they have guns?" He stated that
yes, they did have guns. I asked, "How many were there?" Michael
said, "At least three." I then asked, "Michael, what
do you think would have happened had you tried to play the hero?"
responded, "I guess they might have shot me and then probably have shot
the lady." As you can see, by examining in detail the
result of his fantasy "hero" actions, Michael
could finally realize his helplessness and begin to accept it as an unavoidable
consequence of trauma.
On this track, we presented a few ways to identify how trauma can affect a
client: analyzing the extent of the trauma, anger, and guilt. We
also presented two techniques: The Trauma Questionnaire and Benefits and Costs.
On the next track, we will examine the three ways clients re-experience a traumatic events: sleep
disturbances; flashbacks; and emotional recall. We will also include
a technique to help you identify what type of trauma re-experience your client
Online Continuing Education QUESTION
What are three ways to identify how trauma can affect a client?
To select and enter your answer go to .