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Ethically Treating PTSD Resulting from Terrorism and other Traumas
Ethically Treating PTSD Resulting from Terroism and other Traumas

Section 6
Grief and Guilt in PTSD

CEU Question 6 | CE Test | Table of Contents | PTSD
Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs

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To further explain PTSD resulting from terrorism and other traumas, let us examine grief, realistic guilt, and briefly look at the Stockholm Syndrome.

Grief and mourning experiences may be very much involved in terrorist victimization. We know that victims of terrorism can be badly beaten or injured, possibly maimed, and suffer the rage I have previously described. This rage may be associated with being knocked down in a dominance hierarchy. By this I mean rage at being made to feel suddenly less powerful. However, as you know, direct or indirect victims can also grieve, and grieve deeply, for the loss of an image of themselves - whether that image was as potent, as in control, or as whole.

This grieving may be accompanied by the depressed feelings that accompany other grief reactions and may also precipitate depressive illnesses in predisposed clients. You may have noticed an exacerbation of symptoms in you Depressive Disordered clients.

After the September 11 terrorist attacks, our entire nation was knocked down in a dominance hierarchy and feeling suddenly less powerful. We had to grieve the loss of our image as a nation as being so potent and in control that terrorism could not happen here. This grieving was accompanied by a national feeling of deep depression, as reported by numerous media coverage programs.

Realistic Guilt
In terrorist incidents, realistic guilt is most likely to become a problem when some hostages have been released before others or when persons with military or law-enforcement backgrounds have not resisted the hostage-takers with force.

Of course, if the victim of terrorism could have what he or she wanted, they would want not to have been a victim of terrorism. This fantasy is all the more poignant in the case of terrorism since there has hardly ever been any real human relationship between the terrorist and his victim before the act that brought them together. In the case of the Twin Towers, victims and their loved ones feel, “If only they had been in a different building that day!” But this wish, of course, cannot be fulfilled other than in fantasy, and it remains to be determined how helpful such fantasies are to victims.

As you know, victims need to adapt to the event that has occurred as best they can, and the desire of family, friends, and professionals is to help them. So realistic guilt is involved, because the victim had placed himself or herself in harm's way, a fate they felt they could have avoided.

Research on the Victims of Terrorism
As you know from undergraduate school, the Stockholm Syndrome has often only been viewed as simply identifying with the terrorist, but that concept does not adequately explain hostage behavior. It seems more useful to see how the hostages’ attempts to relate to those who have first captured and terrified them, and then used them as instruments to obtain their objectives from a third party, have affected their behavior. This is explored in detail in the Course Content Manual that accompanies this Audio Tape.

In summary, the suffering of the victim is the leverage used for negotiations with a third party. Hostages, in their psychologically-traumatized state, never view negotiations for their release as benevolent, because they would immediately give anything for their release. The hostage interprets and experiences any negotiations as endangering them.They, therefore, perceive negotiations, especially extended ones, as evidence of indifference, hostility, and rejection, so that the very people who are negotiating for their release seem to be unloving and life-threatening.This reinforces the pathological transference already developing by prolonged exposure to the terrorist.

Peer-Reviewed Journal Article References:
Finlay, L. D. (2015). Evidence-based trauma treatment: Problems with a cognitive reappraisal of guilt. Journal of Theoretical and Philosophical Psychology, 35(4), 220–229. 

Seirmarco, G., Neria, Y., Insel, B., Kiper, D., Doruk, A., Gross, R., & Litz, B. (2012). Religiosity and mental health: Changes in religious beliefs, complicated grief, posttraumatic stress disorder, and major depression following the September 11, 2001 attacks. Psychology of Religion and Spirituality, 4(1), 10–18. 

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. 

Online Continuing Education QUESTION 6: The hostages perceive negotiations, especially extended ones, as evidence of indifference, hostility, and rejection, so that the very people who are negotiating for their release seem to be what? To select and enter your answer go to CE Test.

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Ethically Treating PTSD Resulting from Terrorism and other Traumas

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