Judith Herman's Model of Trauma Therapy
Judith Herman, a psychiatric researcher, states in her book, Trauma and Recovery, “the conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma.” (Herman 1) She captures the two main schools of thought existing regarding the treatment of Post-Traumatic Stress Disorder (PTSD). Some advocate the act of recounting the traumatic events, while others do not consider this to have therapeutic benefits. This divide was seen in World War 1 and the treatment of shell shock patients and is still seen today. In this paper, the presence of storytelling and lack thereof in traumatic shock treatment from WWI onward will be observed. Lewis Yealland was a Canadian doctor working in England during the first World War. He is well known for his work with shellshock patients.
Recovery is the primary goal for people who have experienced trauma, their families, and their care providers. Recovery does not necessarily mean complete freedom from post-traumatic affects. Recovery is an individual experience and will be and look different for everyone. In general recovery is the ability to live in the present without being overwhelmed by the thoughts and feelings of the past. Central to the experience of trauma is helplessness, isolation and the loss of power and control. The guiding principles of trauma recovery are the restoration of safety and empowerment. Recovery does not necessarily mean complete freedom from post traumatic affects but generally it is the ability to live in the present without being overwhelmed by the thoughts and feelings of the past. There is a vigorous debate in the field of traumatic stress as to whether revisiting traumatic memories is necessary for healing or whether it may in fact even be harmful. Obviously this is an individual matter; many may find it beneficial to tell and retell their experiences of trauma where others may find that destructive to their well being.Trauma recovery is best to be looked upon as a process that is worked on over time and in intentional stages. The re-establishing of safety is the first and most central step in recovery separate and apart from whether the details of the trauma are ever spoken of or not.
The core experiences of psychological trauma are disempowerment and disconnection from others. Recovery therefore is based upon empowerment of the survivor and the creation of new connections. Recovery can take place only within the context of relationships; it cannot occur in isolation. In renewed connections with other people, the survivor recreates the psychological faculties that were damaged or deformed by the traumatic experience. These include the basic capacities for trust, autonomy, initiative, competence, identity, and intimacy. Just as these capabilities are originally formed, they must be re‐formed in relationships with other people (Chu J., 1988). Trauma robs the victim of a sense of power and control over her own life; therefore, the guiding principle of recovery is to restore power and control to the survivor. She must be the author and arbiter of her own recovery. Others may offer advice, support, assistance, affection, and care, but not cure. Many benevolent and well‐intentioned attempts to assist the survivor founder because this fundamental principle of empowerment is not observed. No intervention that takes power away from the survivor can possibly foster her recovery, no matter how much it appears to be in her immediate best interest (McCann L & Pearlman L., 1990). Caregivers schooled in a medical model of treatment often have difficulty grasping this fundamental principle and putting it into practice. With trauma survivors, the therapeutic alliance cannot be taken for granted but must be painstakingly built.
To sum up, sadly, many people who suffer from the impact of trauma also begin to struggle with substance dependence. In many cases, women who are dealing with trauma begin to drink or use another drug in order to find relief from the mental and emotional effects of trauma. As a result of this substance use and dependence, many trauma patients develop drug or alcohol dependence problems. They may struggle to end this problem in their lives. Eventually, the issue worsens, causing problems in the individuals’ daily lives. Alcohol and drugs provide people with an escape from the world around them. When a person drinks excessively, she can become unconscious to the things that are going on in her life. An extreme dose of a strong drug can cause a person to get “high”, providing her with an escape from reality. However, these substances only offer temporary freedom from the negative impact of trauma.
Herman JL. Trauma and Recovery . Basic, New York, 1992.
Erikson E. Childhood and Society . Norton, New York, 1963.
Kardiner A & Spiegel A. War, Stress, and Neurotic Illness . Hoeber, New York, 1947.
Chu J. Ten traps for therapists in the treatment of trauma survivors. Dissociation 1988; 1: 24 32.
Lister E. Forced silence: A neglected dimension of trauma. Am. J. Psychiatry 1982; 139: 872 876.
McCann L & Pearlman L. Vicarious traumatization: A framework for understanding the psychological effects of working with victims. J. Traumatic Stress 1990; 3: 131 150.