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Treating PTSD: Natural Disasters, Sexual Abuse & Combat
4 CEUs Treating PTSD: Natural Disasters, Sexual Abuse & Combat

Section 7
Empowerment in PTSD Clients

Question 7 | CE Test | Table of Contents | PTSD CEU Courses

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In the last section, we discussed the three levels of grieving losses which include:  grieving specific losses, grieving the realization of powerlessness and grieving mortality.

In this section, we will include exercises to help clients gain a feeling of empowerment:  Taking Inventory, Refinding Yourself, and Accentuating the Positive.  In this section, we will address PTSD related to combat.

Charles had been captured during the Vietnam War and held in a POW camp.  As was common in these camps, the prisoners were tortured, beaten, and starved.  Because of this inhumane treatment, Charles most clearly suffered from a low sense of self-worth. 

Charles stated, "They treated us like dogs, worse than dogs.  There are times when I almost believe they were right.  There has never been any time after that that I felt good about myself because of what they did to me.  They took everything." 

As you can see, as a result of the torture and foul treatment, Charles had lost much of what he believed was his humanity.  To help Charles and clients like him, I will include several techniques, many that you might consider using on your client who is suffering from a lack of self-worth and self-esteem.

3 Techniques to Improve Self-Esteem

♦ Technique #1 - Taking Inventory
The first empowerment technique I used with Charles is "Taking Inventory."  In this exercise, I ask my clients to focus on their progress throughout therapy and how much they have improved over the various months or years. 

I asked Charles to carefully consider and then answer the following questions:

  1. What have you learned about how the conditions of trauma distorted your view of what occurred during the trauma, your role in causing the trauma, or influencing its outcome, your self-esteem, and your view of other people?
  2. What have you learned about yourself emotionally?
  3. Which emotions do you still struggle with?
  4. What are your most trying emotional situations today?
  5. Do you have any unfinished emotional work to do regarding the trauma or secondary wounding experiences?  If so, what?
  6. How did the trauma change your view of the meaning of life?
  7. How did the trauma change your view of human nature?

Charles answered, "I have learned that what the VC did to me was wrong, and that they were not right in torturing me.  I’ve learned that I can be caring emotionally.  I love my wife, and I can be sensitive towards her.  She dearly loves me, and I love her back which doesn’t make me an animal.  I still struggle with my feelings of anger.  I still can’t forgive the VC for what they did, but I suppose I will have to one of these days.  I value my life more after going through those conditions and I know now that there are people who do evil in the world, and people who do good.  From now on, I’ll focus on those who do good." 

As you can clearly see, Charles had finally found the means to recognize his worth through his wife.

♦ Technique #2 - Refinding Yourself
The second empowerment technique I asked Charles to try is the "Refinding Yourself" technique. 

I asked Charles to remember back to a time before the war and answer the following questions about that time:

  1. What did you do for fun?
  2. What were your major worries and anxieties?
  3. What did you like about yourself then?
  4. What didn’t you like about yourself?
  5. Who were your friends?
  6. How were you getting along with your family?
  7. Did you have any religious or spiritual beliefs?  If so, what were they?
  8. Did you have any firm philosophical or existential convictions?  If so, what were they?
  9. What dreams or goals did you have for your life, and what were your interests?
  10. Of the goals and interests you had prior to the trauma, which ones would you like to pursue now in the near future?
  11. Of the pretrauma goals and interests you are still drawn to, which would you realistically be able to pursue?  What obstacle would stand in your way?

During this exercise, Charles digressed into a very long and heartfelt story about his teenage years, "Oh man, what didn’t I like to do when I was young?  I was that smarty-ass kid down the block that got everyone else into trouble while still beating the rap myself.  We’d set off firecrackers under the cop’s car and TP every house on the street. 

"I remember one time, Bobby Carlyle, jumped this guy’s fence whose house we were egging and came face to face with a Doberman.  I’ve never seen a seventeen year old wet his pants before that."  As a result of completing this exercise, Charles could reflect on a time that didn’t involve the war.

♦ Technique #3 - Accentuating the Positive
In addition to Taking Inventory and Refinding Yourself, the third empowerment activity I asked Charles to complete is the "Accentuating the Positive." 

I asked Charles to complete the following steps to help build-up his self-esteem:

  1. Develop a list of ten positive statements about yourself that are meaningful, realistic, and true.
  2. Write these ten statements on a piece of paper. 
  3. Find a place to relax for fifteen to twenty minutes.  Meditate upon one statement and the evidences for its accuracy for a minute or two.  Repeat this for each statement.
  4. Repeat this exercise for ten days, adding an additional statement each day.
  5. Several times each day, look at an item on the list, and for about two minutes meditate on the evidence for its accuracy.

Obviously, this exercise is designed to help Charles emphasize his qualities that he values.

In this section, we presented exercises to help clients gain a feeling of empowerment:  Taking Inventory, Refinding Yourself, and Accentuating the Positive. 

Peer-Reviewed Journal Article References:
Cattaneo, L. B., & Chapman, A. R. (2010). The process of empowerment: A model for use in research and practice. American Psychologist, 65(7), 646–659.

Cattaneo, L. B., & Goodman, L. A. (2015). What is empowerment anyway? A model for domestic violence practice, research, and evaluation. Psychology of Violence, 5(1), 84–94. 

Macdonald, A., Pukay-Martin, N. D., Wagner, A. C., Fredman, S. J., & Monson, C. M. (2016). Cognitive–behavioral conjoint therapy for PTSD improves various PTSD symptoms and trauma-related cognitions: Results from a randomized controlled trial. Journal of Family Psychology, 30(1), 157–162. 

Lehrner, A., & Yehuda, R. (2018). Trauma across generations and paths to adaptation and resilience. Psychological Trauma: Theory, Research, Practice, and Policy, 10(1), 22–29. 

Taylor, S., Charura, D., Williams, G., Shaw, M., Allan, J., Cohen, E., Meth, F., & O'Dwyer, L. (2020). Loss, grief, and growth: An interpretative phenomenological analysis of experiences of trauma in asylum seekers and refugees. Traumatology. Advance online publication.

Tsvieli, N., & Diamond, G. M. (2018). Therapist interventions and emotional processing in attachment-based family therapy for unresolved anger. Psychotherapy, 55(3), 289–297.

What are three exercises to help clients gain a feeling of empowerment? To select and enter your answer go to CE Test.

This course has covered such topics as: identifying how trauma affects a specific client, re-experiencing the trauma, adaptation reactions to trauma, depression and PTSD, client’s emotional comprehension, survivor guilt and self-destructive behaviors, three levels of victimization, triggers, coping with triggers, recalling the trauma, emotional recall, unresolved anger, unresolved grief, and empowerment.

I hope you have found the information to be both practical and beneficial. We appreciate that you've chosen the Healthcare Training Institute as a means for receiving your continuing education credit.

Other Home Study Courses we offer include: Treating Teen Self-Mutilation; Treating Post Holiday Let-Down and Depression; Living with Secrets: Treating Childhood Sexual Trauma; Interventions for Anxiety Disorders with Children and Adults; and Balancing the Power Dynamic in the Therapeutic Relationship. 

I wish you the best of luck in your practice. Thank you.  Please consider us for future home study needs.

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