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PTSD Questions & Answers
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Joyce Boaz & Dr. Frank Ochberg, M.D.

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Recovery: Improving a damaged self-concept.

Q: Dear Frank, I received this interesting email inquiry from a website viewer. Michele asks: How would Dr. Ochberg suggest that PTSD sufferers bridge the gap between one self and the other? I know how I achieved it (through a lot of trial and error and that included reading a lot of Erickson), but I'm wondering if Dr. Ochberg would suggest a definable path, or a developmental perspective, or an organized process that would ease and encourage this evolution. If that's too broad, I wonder if Dr. Ochberg has defined one single act on the part of the victim that would encourage the evolution of the integrity he mentions.If it's possible for Dr. Ochberg to comment on how survivors might resolve this issue, I'd be so interested to know his opinion.

A: Dear Joyce:

Michele's questions are perceptive and challenging. Obviously, she knows that trauma, profound trauma, affects the sense of self we had before being knocked off our foundation, and she knows that PTSD is more than a menu of symptoms. Serious trauma and disabling post-traumatic stress changes our view of past, present and future. But even more disturbing, our sense of self is altered for the worse. We are diminished, fragmented, isolated and disliked--by ourselves. My job as a therapist is to help a survivor regain the ability to perceive personalities with some degree of accuracy, and then to perceive his or her own persona with respect. So often, PTSD is closely linked to depression. Flashbacks, numbing and arousal are half the story. My patients are self-critical. They punish themselves mercilessly for their inability to work, to play and to meet the needs of others. If they have a demanding and demeaning parent--who may, in fact, be long dead--they talk to themselves in that parent's voice about their failures. So I find myself doing everything I can to understand my patient's values, beliefs and pre-traumatic strengths. I know that there is a "self" in there somewhere that cared enough to find me and that wants to recover hope, connection and esteem. I search for the source of self-deflating comments. When I find it, I try to teach my patient to hear that voice from the past and set it aside. Send it to the back of the room. Trump it with a message from some previous friend or family member who was kinder, gentler and more perceptive. I've written elsewhere of the "Board of Directors" that constitutes our conscience. This Board need not be dominated by one loud voice, even if that voice is a powerful parent. Usually, a traumatized self is vulnerable to psychological self-condemnation, and, too often, the instrument of that psychological abuse is a ghost from the past.

So when Michele asks about bridging the gap between one self and the other, I believe she is asking for a path from a disparaged self to a respected self. And we are talking now about self-disparagement and self-respect. (It isn't always a matter of changing the self-concept. Some victims are surrounded by abusive others. They need to move. Or they need to say, "No," to requests and demands for contact with poisonous relatives. Never easy.) But when the path from a degraded self to a worthwhile self is blocked by obstacles from the mind, it takes mental retraining to clear that path.

The form of therapy that works best is called CBT- cognitive behavioral therapy. The therapist coaches the client in ways to recognize and change self-degrading thoughts. Ultimately, a better self-concept emerges.

Michele, the best single way to make this transition is to help others. Nothing is as nurturing to the self-image as the gratification that comes from being of benefit to other human beings. In some ways, these acts of caring are proof of progress, coming after recovery from disabling PTSD symptoms. But they are also avenues to recovery, restoring sensations of competence, worthiness and meaning.

I don't want to suggest that any of this is easy, or that one size fits all. Every individual has a route to integrity that is as personal as a fingerprint. We are unique. But the common impediment to a reasonable, rational perception of "the whole me" is a mindset that is far too critical. Changing that mindset is often accomplished with coaching on hearing and then overcoming negative messages from the past.

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