In addition to making life more joyful, intimacy is important in PTSD recovery. People who actively connect with others following a traumatic event seem to fare better. For example, Holocaust survivors who made an effort to get involved with others had better mental health than those who did not. These people formed social groups with friends, family, and neighbors. They self-disclosed or confided what was happening in their lives—their pains, concerns, even finances. They used the telephone, visits, and letters to stay in touch, and provided support for their comrades. They also accepted support from others. The researchers concluded that staying isolated is bad for your health. A positive finding in this research was that survivors were more likely to help out family and friends than those who did not endure trauma.
Unfortunately, PTSD survivors seem to have more relationship difficulties such as divorce and avoidance of intimacy Some appear to marry in hopes of recreating their pre-trauma life or escaping difficult circumstances before sufficient healing has taken place. For some, fear of intimacy interferes with connectedness. As one survivor said, "I heard that love casts our fear, but in my case fear cast out love." Sheehan has identified five fears that interfere with intimacy and which must be neutralized in order for intimacy to grow. Otherwise, survivors will sabotage intimacy in ways that include workaholism, picking fights, abandoning their partner, or drinking. As you’ll see, these fears make perfect sense for one who has survived trauma, so be encourage your client to be understanding toward him or herself. The fears are:
1. Loss of control. In intimacy, we open ourselves up emotionally. This means that we are prone to emotional intrusions of unresolved memories. This can lead to avoidance or anger to prevent loss of control. It is logical, then, to sufficiently heal so that intimacy might progress. In some cases, survivors fear being controlled by their partner. This follows logically from trauma where choice and control were taken away, especially when it was another human wresting control from the victim. The antidote is to find a trustworthy person(s) who can be viewed as an ally and teammate. In such a relationship, we gradually learn to relinquish or share some control.
2. Abandonment. We manifest this fear by never loving again, engaging in casual sex without emotional involvement, being distant or revengeful in relationships, or overreacting with clinging, jealous insecurity. This follows from being left by significant people, or by their failure to protect the victim.
3. Rejection. To protect against this fear the survivor might not let herself be fully known, or will reject the other person first. This fear arises from the feeling of being damaged and unlovable, and by the perception that people would reject her if they knew her secret.
4. Attack. In close relationships, people are more vulnerable to put-downs, teasing, or other abusive acts. Such behaviors seem like a betrayal of the unspoken pledge to support and protect one’s loved one. One who has become sensitized to danger will have an even greater need for safety. Because of this vulnerability, survivors are likely to feel threatened by even small disagreements. A "you are with me or against me" mindset might develop which makes communication difficult.
5. One’s own tendency to hurt others. Survivors may not see their anger, disappointment, or hurt as normal feelings that can be constructively dealt with, or they may lack the skills to do so.
Intimacy is more likely to flourish if survivors:
1. Accept the fears. View them as normal, understandable consequences of trauma without judging yourself. Normalizing fears is one way to neutralize them.
2. Replace ideas that block intimacy:
• All men/women are no good. This idea would lead one to either avoid all intimacy, or to permit someone untrustworthy to enter one’s boundaries, since there is apparently no hope of finding someone decent. In truth, some people do not reject, abandon, attack, or take advantage of others weaknesses. Some people respect and honor others, even with their imperfections. This is the essence of love.
• Nobody has gone through the terrible things I have gone through. Nobody can relate to me. Even among young, apparently healthy college students you will typically find a wide range of severe traumas. No matter what you j have gone through, many others have experienced similar traumatic events. People exist who will relate to you with compassion. Some people have learned this compassion through the things they have suffered, while others have learned compassion by being raised in loving homes.
• Nobody could accept me if they knew what I’ve been through. Some people may not. When trusted with secrets, however, some people will accept and respect the survivor more.
• It is demeaning to be flawed, and foolish to reveal vulnerabilities. Everyone is flawed, and sharing our true feelings is the essence of wholesome intimacy.
• I can’t burden others with my problems. If people care about you, they will want to know about the bad times as well as the good. People in high-quality relationships create time for humor, play, and affection. And when discussion of difficult emotions is needed, they make time for that, too.
3. Develop communication skills. Encourage your client to visit the library. There are many, many effective skills for resolving differences peacefully, expressing affection verbally and nonverbally, expressing negative feelings constructively, complimenting, and standing up for yourself.
4. Gradually risk and discern. Help your client to, as wisely as possible, involve trusted people in their life. Allow them to help to meet his or her needs. With the right person, disclosing your true self can be pleasantly surprising. Hiding your true self creates barriers. As fears are permitted expression and are respected, trust builds. The climate of safety that develops also fosters the expression of positive emotions. It is possible to be known emotionally without disclosing details that are too uncomfortable to discuss. Test the waters and discern how the other person responds. Caution may indeed be wise if the other person is too defensive to reciprocate, is judgmental or abusive, or will not keep confidences. Heed those warnings. When you discern, however, that the other person is safe, begin to accept nurturing in the form of emotional support, listening, and compliments.
5. Notice how conflicts are handled. Conflict in relationships is normal and to be expected. However, it is the way conflict is handled, and not the presence of conflict, that has been found to predict marital success. Attacking verbally or physically, withdrawing, sulking, threatening, criticizing, raising the voice, manipulating, dishonesty, and jealousy are styles that create interpersonal distance. Approaches that favor intimacy include good listening skills, sticking to issues, kind humor, patience, calmness, emotional openness, sharing control, complimenting, empathy, and willingness to tolerate differences.
6. Consider picking up where they left off before the trauma. This could mean building the type of healthy relationships that were enjoyed before the trauma, or cultivating better ones. Ask your client to ponder the kind of relationship that he or she would enjoy, and to try to create a vision of what it would be like.
- Schiraldi PhD, Glenn R.; The Post-Traumatic Stress Disorder Sourcebook; Lowell House: California; 2000
The Veterans Health Administration’s Treatment of PTSD and
Traumatic Brain Injury Among Recent Combat Veterans
- Terrio, Heidi, others, Traumatic Brain Injury Screening: Preliminary Findings in a U.S. Army Brigade Combat Team, Journal of Head Trauma Rehabilitation, vol. 24, no. 1., pp. 14–23., January -February 2009.
Reflection Exercise #9
The preceding section contained information
about five fears that interfere with intimacy in PTSD survivors. Write
three case study examples regarding how you might use the content of this section
in your practice.
QUESTION 11 According to Schiraldi, what are the five fears that interfere with intimacy in PTSD survivors? Record the letter of the correct answer