Tuesday, July 25, 2017

The Best Way to Treat Trauma

How should therapists treat trauma victims? Should they provide emotional support? Should they offer up dollops of empathy? Should they feel the pain?

Israeli professor Moshe Farchi says No to all of it. Drawing on his experience in the Israeli military Farchi has developed a technique that he calls “mental first aid.” He teaches people to provide it to trauma victims, explaining, though not in so many words, that standard therapy, the kind that wants you to feel your feelings, is counterproductive.

Longtime readers of this blog will notice that Farchi’s approach has much in common with mine.

A story from Agence France Presse (via Maggie's Farm) outlines the Farchi method:

They are employed in the immediate aftermath of a traumatic event such as an attack, serving as mental first-aid.

"One thinks that a person in distress should be contained, held," he told AFP.

But providing emotional support activates the recipient's emotional part of the brain at the expense of the area responsible for the ability to think and make decisions, he said.

Note this well. If a therapist appeals to the patient’s emotions, he will activate the emotional part of the brain. But this will diminish the patient’s ability to access the rational part of the brain, the part that allows him to think and to make decisions. It leaves him in the trauma. It does not help him to remove himself from the trauma.

The point is of vital importance.

Farchi continues that you cannot undo the trauma. He wants to mitigate the sense of helplessness trauma victims feel. He might have introduced some cognitive exercises to override the sense of helplessness, but he prefers to help the trauma victim to take effective actions. The solution to helplessness is action. The solution to the sense that you cannot do anything is to do something.

How does he help the person to take action? First, by reorienting him in the world. How do you do that? Simply, by asking questions that involve concrete and objective facts. You do not ask what the victim is feeling. You do not want him to get in touch with his feelings. You ask him where he is, what he is doing. And you ask him to describe in detail what happened… as though he were an outside observer.

The AFP story continues:

Thinking and making decisions are what the person needs to do in order to be freed of a "sense of helplessness."

"The given is that we can't stop the threat -- the rocket has hit, the event has taken place," he said. "What we can do is stop the helplessness."

"The opposite of helplessness is effective action. That's why first of all we need to activate the person, to diminish the helplessness," Farchi said.

Activating the person includes asking concrete and factual questions, giving him or her the ability to make decisions -- initially easy ones, such as if they want to drink a glass of water or take a break.

This mental first aid was developed in the military, in situations where soldiers need to bounce back quickly from traumatic events, where they cannot wallow in their self-pity or their empathy.


Ares Olympus said...
This comment has been removed by a blog administrator.
Stuart Schneiderman said...

This was too long... a comment should be a few well-chosen sentences. Otherwise I will delete it.

Ares Olympus said...

Stuart: How does he help the person to take action? First, by reorienting him in the world. How do you do that? Simply, by asking questions that involve concrete and objective facts. You do not ask what the victim is feeling.

This is consistent with what my men's group. They used a device called an "awareness wheel": first observation, verifiable facts, second evaluation or interpretation, and third is feelings that are generated from the interpretations.

So by clarifying each level separately, we can take more control over our reactions. We can see that feelings are not based on facts, but interpretations, and interpretations are often preconceived, based on imagined patterns that add to previous events, and interpretations and feelings.

But a final point, psychological trauma (as well as "victim") are about interpretations and reactions, not objective facts like physical trauma. Identifying feelings isn't a bad thing, but the more important question is what inner narratives are generating the feelings. And the "Trauma" part perhaps comes where interpretations can't be questioned.

James said...

Sort of on the subject: