Repeating Your Trauma Story

Q: Dear Frank, A Facebook contributor asked this question. Some Doctors are telling PTSD patient’s that to continue to repeat the story can cause more trauma. It would be interesting to know which is correct, speak out to many or work with your counselor and leave it there?

A: Dear reader, There is evidence that in the immediate aftermath of a traumatic event it may be harmful to encourage people to attend debriefing sessions in which people must listen to multiple accounts of the trauma. Decades ago there was a Critical Incident Stress Debriefing organization that promoted this practice. Responding to a powerful body of research, they have abandoned their formula and now practice “psychological first aid.” The details are well summarized in this peer-reviewed article:

When you go through a trauma and you listen to many other accounts of the same trauma you may feel validated and believe you have been helped, but research proves that most who do this are then at higher risk for PTSD. They have overdosed on trauma images — their own and everybody else’s.

But when it comes to talking about your own experience as a survivor, you might be in the category of those who do well by ventilating — or you might be one who would much rather avoid talking. Some friends, relatives, co-workers and therapists are of the mistaken opinion that it is ALWAYS beneficial to “get it off your chest.”

Research leads us in a different direction. It is generally best to honor the coping style of the individual with “different strokes for different folks.” Let the ones who would rather not talk keep their own counsel. Let those who want to ventilate tell their story until they have no more to say. This may be awkward in families where some members have heard enough and others want to hear more – or to say more. Couples therapy may be necessary to preserve a marriage when one partner (often male but not always) would rather avoid hearing or telling details and the other is garrulous or curious and needs more post-traumatic conversation.

A good therapist knows how to listen sensitively and actively, getting the right amount of “trauma story” told at the right time in post-traumatic recovery. Some survivors want to talk, but can’t find words. Some are living in the details of their trauma and need help moving on. The therapist and the client should be a team, collaborating on the issue of re-telling the story or letting time and distance separate us from a painful past. I pay very close attention to my patient’s symptoms. If they are still having unwanted memories or nightmares or flashbacks, I know more work needs to be done – including the use of Ochberg’s Counting Method:

The job of the therapist is to help turn the symptom of traumatic memory into autobiographical memory. That means you can remember a terrifying time without being terrified. You get there in different ways, depending upon your own personality and biology. A skilled therapist is supposed to know how to work with different people and help each find her or his own best path.