Trauma: Treatment and Transformation

By Dr. Muriel Warren

In this post-9/11 world, therapists need to expand their toolboxes to deal with trauma and its effects. This book provides a new way of dealing with the devastating emotional residue of a traumatic event. It centers on the innovative application of hypnotherapy to help trauma victims "self-actualize," regain their lives, and move forward again. This book outlines the effects of trauma on mind and body and provides comprehensive systems and treatment plans for the mental disorders caused or exacerbated by trauma. Many people are familiar with the famous "fight" or "flight" responses to trauma, but few now about the "freeze" response. "Freeze" is the most dangerous of the trio since it inhibits any reaction and leaves he victim immobile. It can lead directly to Post-traumatic Stress Disorder. Also included is a brief survey of brain research and its implications. Dr. Warren takes readers on a brief journey of self-discovery to unlock their full self-potential and raise it to a new level.

• Language: English
• Publisher: iUniverse
• Release date: Jan 7, 2004
• ISBN: 9780595752041

Dr. Muriel Warren

Dr. Muriel Prince Warren,D.S.W., is a psychotherapist, educator, and author trained in solution-focused therapy, hypnotherapy, and psychoanalytic psychotherapy. Former director of the Psychoanalytic Center for Communicative Education and past president of the International Society for Psychoanalytic Psychotherapy, she is a member of the Society of Clinical and Experimental Hypnosis and a Diplomat of the American Academy of Experts in Traumatic Stress. She is the author of several books on behavioral management and mnainains a private practice in Rockland County, NY.

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eserved © 2003 by Dr. Muriel Prince Warren

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To my favorite people: Howard, Jenny, George, Joel,

Ashleigh, Kristina, Louis, Taylor, and Kate

"When one door of happiness closes,

another opens; but often we look so long

at the closed door that we do not see the

one which has opened for us."

—Helen Keller

Contents

Tables and Figures

Foreword

by Daniel Araoz

Introduction

Chapter 1 - CHANGE AND THE PROCESS OF HEALING

Change and Anxiety

Trauma and Immobility

The Mind of a Terrorist

Through the Eyes of a Bystander

Two Types of Trauma

Children’s Responses to Death and Trauma

After the Crash

Escaping the Double-Bind

Chapter 2 - DEALING WITH TRAUMA IN AN AGE OF CHRONIC STRESS

The National Trauma Syndrome

Use of the Telephone

Demobilization, Defusing, and Debriefing

Transformation

Developmental Models of Growth

Summary

Chapter 3 - MAJOR DISORDERS RELATED TO TRAUMA

Compassion Fatigue

Critical Incident Stress Disorder

Acute Stress Disorder

Posttraumatic Stress Disorder

Bereavement

Chapter 4 - EXISTING DISORDERS AFFECTED BY TRAUMA

Anxiety Disorders

Panic Disorder

Specific Phobia

Social Phobia

Generalized Anxiety Disorder

Obsessive-Compulsive Disorder

Separation Anxiety Disorder

Depression

Major Depressive Disorder

Dysthymic Disorder

Dissociative Disorders

Substance Abuse and Eating Disorders

Anorexia Nervosa

Bulimia Nervosa

Chapter 5 - BEHAVIORAL TECHNIQUES

Belly Breathing

Change

Family Sculpturing

Hypnosis

Trauma Release Technique

Hypnotic Induction

Hypnosis with Children

Mindfulness

Practical Steps for Dealing with Terror

Personal Power Chart

Chapter 6 - THERAPEUTIC GAMES

Chapter 7 - BIBLIOTHERAPY

Self-Help Books

Chapter 8 - RESOURCES FOR PROVIDERS

Books

Catalogs

Videotapes

References

Related Websites

Tables and Figures

Tables

1   Response to Trauma

2   Four Waves of Assistance

3   The CISD Process

4   Maslow’s Hierarchy of Needs

5   Jozefowski’s Phoenix Model

6   A Model of Compassion Stress

7   A Model of Compassion Fatigue

Figures

1   Maslow Vs. Jozefowski

Acknowledgments

I wish to thank the many people who have supported and encouraged me during this project. Special thanks go to my husband for his research and editorial skills, and Dr. Daniel Araoz for writing the foreword to this book. I would also like to acknowledge Norma Pomerantz for her meticulous editorial work.

Foreword

It is rare that anyone goes to a lecture to hear the lecturer being introduced. In books, the foreword is that introduction. Get it out of the way quickly because what comes after is a real treat. Abe Lincoln is supposed to have stated, Most folks are about as happy as they choose to be. Dr. Warren gives us a comprehensive treatise on trauma in its many manifestations, focusing lovingly on the tragedy suffered by our country on 9/11. One of the main points she emphasizes throughout the book is that we—yes, all of us—can learn to choose the thoughts that will free us from the trauma we have suffered. The effects of a horrible tragedy like that suffered by our country in 2001 do not have to victimize us forever. With care and compassion, especially for those who, in helping, suffer secondary stress disorders, she proposes many methods to free us from the remnants of trauma after the painful event that affected our memory, feelings, and behavior, often for a long time after the tragedy.

This is a book of liberation—transformation—in Warren’s positive language. She uses the Phoenix metaphor to encourage us—clinicians and patients alike—to look at trauma in a less negative way. Trauma comes from a horrible experience we suffered, but we can transform ourselves for the better because of it. To prove her point, she brings up many heroic examples of people who went through the excruciating suffering of 9/11 at close range, either physically or emotionally.

This book offers a unique benefit. Warren’s innovative charts of behavioral goals for trauma therapy with children, adolescents, adults and families, are similar to the ones she gave us in 1999 in her Behavior Management Guide. Besides these practical aids for the clinician, Warren has spent much time in designing treatment plans, like the one for Acute Stress Disorder. I consider these charts a creative contribution that will benefit all of us who deal with people in a clinical setting.

The ultimate goal of Dr.Warren’s efforts is the person’s reintegration, as she explains in the lucid section on hypnosis. She depowers trauma and empowers the individual who has gone through the trauma in order for him or her to reconnect with life. She leads the reader to a new space of optimism and happiness. It is as if she is saying that nothing, not even the most horrible experience of destruction and death, has the power to diminish us unless we consent to it.

Trauma: Treatment and Transformation is a very useful tome for clinicians in this country where we are living with chronic stress, as Warren says, and where every psychotherapist will encounter patients suffering from traumatic events. But it is equally beneficial for people in general. Dr. Warren’s style is uncomplicated, clear, and to the point. Unlike others who want to sound scientific, she writes to be understood; she offers practical, useful, techniques and methods to enjoy life after trauma. She gives enough help for both the emergency situations that cause unbearable stress and for a lifestyle without stress—with emphasis on mindfulness—in spite of any and all the negative surprises that life gives us. We are lucky that the English language provides us with the solution to STRESS in the very word, summarizing what this great book teaches: S-T-R is a reminder to STOP, THINK, and RELAX in emergency stress situations; E-S-S encourages us to ESTABLISH SELF SECURITY, which is a matter of attitude and inner strength, the ultimate goal of mindfulness as taught by Dr. Warren.

Now that you’ve read the foreword, don’t forget Lincoln’s statement, and rush to assimilate the contents of the book in order to find out how to be happy in spite of life’s tragedies.

Daniel Araoz, Ed. D., ABPP, ABPH

Professor, C. W. Post Campus

Long Island University, New York

Introduction

America may never be the same. Before 9/11, wars had always been fought on foreign soil, never here at home. But all of that changed with the collapse of the World Trade Center. We are at war against terrorism by fanatics within our borders as well as throughout the world. It is virtually impossible to predict and prevent every possible terrorist attack, even in our own backyard. As a result, we must learn to live under the constant threat of disaster.

That threat can give rise to emotions ranging from mild anxiety to sheer terror. Most people (Bracken 2002, pp.1, 2) manage to push it aside to get ready for the hustle and bustle of our everyday lives. However, some people just can’t shed the anxiety and must live out their lives with a constant feeling of dread. Their lives are not shaped by a taken-for-granted order, but are endlessly threatened by the quicksand of meaninglessness."

No one escapes a disaster without some degree of impairment that flows like a wave over the family, work group, and the community. In its wake, it leaves the seeds of severe and debilitating physical and psychological disorders. In reaction to the emotional shock wave that spread from Ground Zero, many people slipped into altered states of consciousness. Hospital emergency rooms were jammed with frightened people suffering from a variety of somatic reactions. My physician tells me that later, after the first signs of the biochemical attack, patients were begging him for antibiotics in case of anthrax exposure. A male patient I treated for depression and suicidal ideations is still, to this day, hoarding medication to combat anthrax.

One of the most difficult problems of disaster is dealing with the death of a loved one. Jozefowski (2001, p.15), outlines the stages of coping with death in her book, The Phoenix Phenomenon. The death of a loved one, she explains, forever changes the normal flow and rhythm of life, dividing it into before and after. In this sense, 9/11 has changed the normal flow of life in the world.

America is now on high alert. President Bush warned that we must quickly return to normalcy or become our own worst enemies. He tells us to be on high alert, but to remain calm. How is that possible? Incongruent messages such as those double-bind people, create innumerable psychological and physical problems, and generally drive the American public crazy. Kalb (2003, pp.42-53) explains that living with fear will affect both the mind and the body.

As of this writing, one wonders how our troops will return from Iraq and what pathological consequences their psyches will suffer. There will definitely be a tremendous need for therapists who are trained to deal with trauma and its residues.

This book will deal with trauma, its psychological and biological effects on mind and body, the psychology of terrorism, and treatment plans that deal with the resulting problems and transform them into growth.

1

Change and the Process of Healing

CHANGE AND ANXIETY

Change is being forced on us, and the human psyche’s protective response is to fight to avoid anxiety that always accompanies change. Paraphrasing Kierkegaard, Becker (1973) points out that:

Man (is) lulled by the daily routines of his society, content with the satisfactions that it (life) offers him. In today’s world, the car, the shopping center, the two-week summer vacation. Man is protected by the secure and limited alternatives his society offers him, and if he does not look up from his path, he can live out his life in a certain dull security. [p. 74]

For Kierkegaard, there were three kinds of people: Normal man (or woman), who lives a life of quiet desperation to avoid or deny death anxiety; Schizophrenic man, who is crazy; and Creative man, who lives in a garden of anxiety. Becker explains that as long as man is an ambiguous creature, he can never banish anxiety. What he can do instead is to use anxiety as an internal spring for growth into new dimensions of thought and trust (p. 92).

The year 2003 presents us with a new imperative. Man can no longer be lulled into a life of quiet desperation while terrorists confront us daily. We must learn to live with death anxiety. In this way, catastrophe can be used as a garden for growth.

Recently, I asked myself how I have changed since 9/11. I found myself working exhaustingly long hours trying to help my patients work through their individual traumatic reactions to the terrorism. I felt like I was really doing something to help others, and found the effort healing, not only for my patients, but for myself. Many weeks later I also found that