"When Professional Boundaries Are Breached - How This Woman Overcame the Trauma of a Violent Attack"

Psycho-therapeutic Evaluation

Client: - JB Sex: - Female Age: - 45

Indication: - Paranoid of people being deceitful and scheming behind her back along with anxiety.  Stems from being physically attacked during a 7 year relationship. Bed sweats and bad dreams. Evidence of PTSD

Date Referred: - 5th March 2011

Date of Evaluation: - 18th March 2011

An experiential approach by a Neuro-Linguistic psychotherapist to PTSD with the use of Metaphors of Movement & Motion

Part I aims to give a generalised understanding to Post Traumatic Stress Disorder and part II will give a concise description of the approach to remove symptoms related to the disorder using Metaphors of Movement & Motion (1)

So What Is PTSD Exactly?

The exact causes of PTSD are varied although predominantly will relate to some kind of traumatic event in the past.  This anxiety disorder is a reaction to an event that induced intense fear, horror or a sense of hopelessness that if you were to put an amplitude measure to the intensity out of 10 with 10 being the strongest it would measure 11.

During such extreme trauma there is no doubt a sensory overload that leaves a distinct emotional imprint on the mind.  Neurologically there a 3 significant areas of brain activity between the pre-frontal cortex, amygdala and the hippocampus that would be firing rapidly neuro-receptors processing the ‘experience’ whilst at the same time attempting to calculate a solution to the event..  

Such extreme stress would leave a very vivid visual imprint in the hippocampus which is responsible for episodic memory and closely tied with stimulation of negative emotions through the amygdala. That is why one of the ingredients for diagnosing PTSD is noting the ‘flashbacks’ that seem to repeat themselves over and over, torturing the victim whilst the brain innocently attempts to look for that specific bit of the event that will allow it to understand. I am sure once these victims know that someone else understands what they have been through then there would be an ignition of recovery.

According to the National Institute of Mental Health, there are about 8 million Americans who are suffering from Post-Traumatic Stress Disorder. Most of them are 18 years old and above although the median seems to be 23 years old. Some of the people involved in this statistic are war veterans – those who fought in Vietnam and in Afghanistan. In fact, studies show that 19 percent of the soldiers who were deployed in Vietnam suffered from PTSD at some time after they have been called back and sent home to their family.

It is not just soldiers in combat who suffer from PTSD.  Think about it. The trauma can relate to anyone who has been on the receiving end of a group attack, been involved in a major car accident or been the poor victim of a violent rape incident. Even the recent succession of natural disasters can leave horrible emotional imprints to those who have survived.

What are the signs and symptoms of PTSD?  Is it obvious to see? Well it was not in my client.  After 1st meeting her at a coaching seminar, she was a well groomed women who looked distinguished and assertive.  

Or in hindsight was this a very powerful self-generated defence mechanism that would not leak a single iota of information to the outside world.  Why would they, the world would just not understand anyway.

The manifestations of the severe trauma are grouped into 3 – intrusive memories, avoidance of people and the numbing of emotions, and emotional arousal or hyper-arousal. More often than not, these symptoms show up 3 months after the traumatic event. There are instances though wherein it takes years for these symptoms to manifest themselves.

The symptom of intrusive memory includes flashbacks of the traumatic event while you are awake. For a minute or even for days, you seem to be reliving the horrors that you encountered and you find it incredibly difficult to snap out of it. Through conscious effort you are able to control these memories when you are awake, although our conscious attention is not functioning 24/7; sometimes they haunt you in your dreams. Your subconscious does not have the barriers that your conscious mind has and so you might get nightmares frequently.

Sufferers of PTSD can detach themselves from society or at least to the kinds of people who were involved in the original event.  This avoidance is a coping mechanism due to the emotional scarring the event caused. This may go as far as the people that they care for.  

When I ask PTSD sufferers ‘how can I help? They will invariably say ‘if I tell you, you just won’t understand’.  I’ll always respond by saying ‘that’s right I don’t understand’. Too many therapist’s attempt to give off that air of authority and omnipotence claiming that they know exactly what the client has and how to deal with it.  This is a gross error and complete disrespect for the client, because unless you were that person or at least witnesses to the incident how can you hold a position of comprehension.

If you are a PTSD sufferer there tends to be little dialogue especially if the topic relates to the incident.  Have you noticed those war heroes who survived the war and when pressed by their grand children about what it was like back then they become quiet and distant?  That is enough of an answer to tell you how horrific it was to live during the war.

There is a tendency to have no aspirations and excitement about the future and may even suffer partial memory loss.  The ability to focus tends to become impaired and the family relationships around them gradually disintegrate because it hurts too much to be close to someone.  

There is an array of negative emotions that is experienced such at agitation and anxiety and being overly emotional.  Combine this with underlying anger and mood swings you have got someone who pretty much disengages from society completely.  

The shame and guilt is interesting because these are learnt behaviours or emotions so probably stem from experiences before the traumatic event.  The traumatic event however reignites and brings back vividly to the present how to feel this way. These emotions can drive the victim to drink or drug use and in some case dependency.  This is their attempt of a panacea but unfortunately it is abusive behaviour because the act does not fulfil the intent, it just makes it more bearable to deal with whilst slowly killing them.

The victim’s visual representation of the past trauma is so current that it is as if they have lost their future timeline as they replay the event like a broken record.  This is why some victims are so jumpy or startled by the littlest thing. They can even suffer from visual or auditory hallucinations resulting in difficulty to focus and fully engage in conversation or activity.

Naturally what I am describing here is the extremes of PTSD; however some victims develop cute coping mechanisms that enable the person to appear very compos mentis, although inside they’re a bubbling pot of guilt and anger that is so repressed that it makes you wonder if it was as bad as they described it.  Through sheer will some can manage to hide their deep shameful pain.

The Client

My client JB was involved in a relationship with a black man for 7 years and during the relationship she expressed her fear of him at times because he could come across as threating and aggressive.  Before they met she had started her own music company and knew of this particular man for his musical abilities along with strong network of followers.

She also knew of his reputation as a womaniser.  Despite this her drive and enthusiasm to get the company up and successful led her to arrange a business partnership with the individual.  Eventually they developed an intimate relationship that had all the signs of stress and strain from the beginning.

Eventually towards the end of the relationship she was severely attacked by this man where she was hospitalised for several days.  She did not press charges although after this her confidence was shattered and very fearful of this man. When she explained what had happened to the other members of the music company they accused her of lying and basically turned their backs on her and she was forced out of her own company because of ownership rights as well as feelings of betrayal.  To support this article I will inform you the other members of the music company were also black men.

Imagine if you will a time line of a person who seeks assistance through therapy for the symptoms of paranoia and betrayal, fear of black people, underlying anxiety, bed sweats and nightmares.  The physical attack was over 4 years ago. The client requested to be like they were before the event ever happened and I instantly remarked that is impossible because it has happened and you cannot go back in time.  Besides if they do become the person who they were before the event ever happened then the same thing will happen all over again. Bit pointless really.

Points to Consider

1/ Self – This here is all about the person, their beliefs, and description of the events to leading up to the traumatic memory.  In this instance a severe physical attack from a boyfriend of 7 years that left her hospitalised for several days. The attack happened in their home.

2/ Other – This is the concourse of forces that lead up to the attack and it probes into what facts can be remembered, estimated beliefs of this person along with values and thoughts.  It is her general description of the events leading up to the attack from his eyes.

3/ Other – The attack.  This is her detailed description of the attack of what the attacker was doing and saying.  It is again important to get her perceived beliefs, values and thoughts.

4/ Self – The attack.  This is the key point in helping the victim to recover and change their perception of the incidence.  It is a gross error to believe that the actual attack itself is the cause of the victim’s current state of mind and manifestation of negative emotions.  If you chunk down in detail you will invariably find that it is a particular comment or action that they did or did not do that sticks rigidly in their mind that maintains historic representation being repeatedly played in their mind inhibiting forward thinking and movement.  In respects to this particular victim it is her screaming “please don’t kill me!”

5/ Other – Sequelae.  This is a description in detail of exactly what happened after the attack.  He phoned an ambulance and he was arrested, although the victim did not press charges as he was threatening to do it again if she said anything.  The attacker and his supporting circle of the same ethnic origin coerced the victim out of her own company, and threatened to tarnish her name amongst those respected in the music industry leaving her isolated and betrayed.  The attacker himself moved out of the family home although with full ownership rights to the company.

6/ Self – Sequelae.  Our victim received a broken nose, cuts to the face and head along with severe bruising to the arms and back.  She also had 2 broken ribs. After several days in hospital she was released although terrified to go home so she went to convalesce at her mothers.  She explained she was not returning home until he had left her house and she said she did not want to talk to him again until she returned to work. Eventually she did go back to work and when she arrived everyone looked shocked to see her and everyone ignored her presence.  When this was addressed it was revealed that she was a trouble maker and did not feel the business could continue with her as owner.

This exercise enables the victim to put down on paper exactly what happened before, during and after form several different perspectives.  This exercise enabled the client to chunk down and identify the exact point that fused all the other pieces together. To understand finally and for the first time since the event say what it was that was maintaining this traumatic memory and manifesting the negative emotional imprints.  

Dealing with PTSD - A Metaphors of Movement & Motion Approach

Metaphors are laced in our everyday language amongst the other linguistic models of sensory and conceptual.  To help give a distinction of all 3 linguistic models, read the following descriptions: -

Sensory – As I look the keeper in the eye and hear the roar of my team mates, I feel the web of my laces strike the ball in the net.

Conceptual – I take the ball on my chest and go round the defender with a clear shot on goal.

Metaphorical – It’s as if I am a cheetah closing the gap on its prey.

Metaphors are vessels of complex information that are used to help us interpret our experience of the world, others and ourselves.  Our metaphors can be limiting or empowering and until our awareness is raised on what these complex symbols are will carry on without the faintest idea of what they mean to us.  

Exploration of our metaphor landscape is a nourishing process that allows the subconscious mind find attunes itself of not only what our metaphors are but the relationship and organisation of each of them in relation to each other.  Having this awareness reorganises our landscape order and patterns, creating new strategies and thus new movement and behaviour.

Just to give a clear distinction Metaphors of Movement & Motion is not clean language. Clean language explores several different metaphors in a client’s landscape where MoM tends to look at the problematic metaphor and the current strategies to try and deal with it. Keeping clear focus on the client’s destination, distance speed and mode, the approach of MoM will in contrary to Clean Language you always describe what the client’s metaphor is not.  

This is done on the premise that clients are very good at describing what their experience is not because invariably people do not know what they want.  Telling them what it is not their level of attention and awareness is raised and their automatic correction mechanism comes into play telling what it is.  A neat trick that is very powerful.

Using various voice tones of disbelief and sympathy the client suddenly becomes ‘awake’ for the first time in years, finally being able to comprehend the order of what’s in their subconscious mind.

When I first asked my PTSD client what was the problem there was lots of frontal lobe explanations in sensory and conceptual language listing classic descriptions of suffering such as I “I feel ashamed” and “I just cannot trust anyone anymore”.

The transition from sensory and conceptual linguistics when she said “I just feel scared all the time”.

And then it came “And this feeling of scared, and that is like what?”

“I feels like I am on unstable ground and I am sinking”.

JB stated the view was that she has of herself  from the right hand side was as if she watching herself from the sea and she was on dry golden sand and she was stepping forward with her left foot and just sliding back with an overwhelming feeling of just staying where she was.

The beach carried on ahead of her leading eventually to a big bustling city full of busy people.  Behind again was lots of beach although she could not see what was beyond that. I asked her to describe what there was to her left and she said there was lots of sand and up on the horizon there was sand dunes with Chinese people playing with a ball and they were happy and having fun.  

Beyond the sand dunes was the big bustling city she described before although it was just very big and not very appealing because she felt insignificant.

I then established how JB constructed time and she had a linear time line from front to back.  

I then asked what footwear she was wearing and she said she had big clumpy walking boots that sunk in the sand.  This was what was stopping her from getting out from the sand. Her general experience of this was tiring and frustrating and her current strategy for dealing with this was just to stay there and feel shameful and guilty.

Provoking her creative side to generate new solutions she said she could take her boots off and just run.  This felt very invigorating for her running in bear feet although she felt unsure when she got close to the Chinese people on the sand dunes because she felt as if she did not belong.   She had this feeling because those Chinese people were care free and she knew that was a part of her she did not have.

I asked her to create 3 new strategies of dealing with this feeling and she said she could just accept everyone was different and also just live in the moment and also just get in there and start trusting again.  Attempting to choose one of the 3 new behaviours she decided to blend all 3 and when it was trialled she had a wonderful feeling of acceptance and fun although she then after a while she felt as if she should leave them to have fun on their own.  

I got JB to future pace this new strategy to a situation coming up and whilst doing this she had a wonderful insight in remembering that when she was a little girl she was the one who was always playing the piano and rehearsing when all the other kids were playing and that in her adult life the conflict of not fitting in is because she has always been a leader and never one to follow and that she is equally satisfied being the facilitator for others to have fun and when she sees this it is just as satisfying for her knowing she is the one who created it.  

For homework I asked her to draw her metaphor and be aware of any new sensations, insights and behaviours in relation to her previous problems.

One week later I asked her to answer some simple questions and here is her response: -

Hi Steve

I am delighted to say that I've been feeling great since our last session!

In answer to your specific questions:

What have you noticed in comparison to before we started the Metaphor work? I'm feeling much more relaxed in myself and have lost the feeling of anxiety that I had.

What have you noticed in regards to your feelings? I'm feeling more confident, happier, more positive about the future and my ability to cope with it.

What have you noticed in regards to your general thoughts? I feel stronger in myself.  The sessions made me realise that I'm absolutely fed up with feeling scared and anxious about the future.  It reminded me that I have a choice.  I can choose to stay where I am or I can embrace my life again and enjoy it!

What have you noticed in regards to your sleeping pattern? Since the last session I've been sleeping deeply with no dreams that I can remember.

What have you noticed in regards to other people? I've made a conscious effort to connect with people in my everyday life and I have had a positive response back.  I had become quite scared of initiating contact with people but I am definitely gaining my confidence again.

 What kind of insights have you had? I understand why I've struggled so much since the events of 4 years ago.  I lost trust in people and that made me become insular.  The more insular I became, the more I cut off emotionally, and the harder it became to connect with people. The world seems friendlier now and I feel much more hopeful about my future. Thank you!

A Traumatic Event Analysed from a Neuro Linguistic Perspective

I thank the most excellent Neuro Linguist Andrew T Austin for the following descriptive model for PTSD