Have you ever gone to an online news source to suddenly, surprisingly encounter a gut-wrenching headline or photo? Did it make you feel sucker-punched in the stomach?

Now, don’t get me wrong: I think as citizens we have an obligation to know about certain events that may be tragic, hurtful, sad, distressful or disturbing. I’m not saying that horrible events shouldn’t be reported. However, as a psychologist, I would argue that as a society we should have somewhat ‘safe spaces’ in which we can receive news without the proverbial punch in the stomach, if we know, at least in that moment, that we just simply can’t handle it.

As a psychologist, I work with veterans, many with PTSD. Sometimes, they, like many of us, log onto online content to feel more socially connected. Like a self-therapeutic gesture, we do this to sometimes feel more soothed, or distracted from dark or lonely feelings as we delve into novel online content.

Typically, when looking for that sense of connection, or delight, or enrichment, one may turn to news of recent politics, world news, sports scores, entertainment news, comedy sites, book reviews, health & science news, pictures of natural wonders, and so on. However, for many seeking engagement with the news in such a way, they may instead find that their initial encounter will be overshadowed by abrupt headlines detailing deaths, deaths of children, or tortured children on the front page of a particular news site. Even if one is Internet-savvy enough to skip to the front page of these news sites and go straight to their section of interest, horrific headlines and pictures of death and torture will await them on the sidebars. These are non-sequiturs popping up on the same page as articles devoted to meditation, real estate, sports, comedy, and parenting.

Not being able to control encounters with this type of devastating news can be psychologically problematic. It’s not just a problem with combat veterans, or those with PTSD. In fact, I repeatedly hear about this problem from people from many walks of life. Combat veterans and parents of young children are particularly vocal about it. I believe this phenomena causes something that I’ve coined as “news blues.” News blues causes distress when one is not expecting it or prepared for it. It often causes the reader to disengage in that moment from reading the news altogether.

As an avid online news reader, I too have personally felt the news blues. There has been the sting of an unexpected photo, the headline of atrocities to children when I am expecting to read something more benign at night, such as sustainable architecture awards.

Yes, I listen to horrible stories of atrocities for a living. I am able to listen fully, in the right context. For me, there is a large difference between learning about tragedy and atrocities when one feels empowered to help in some way, as a psychologist helps a patient, and then reading about it passively from a new source, with no way to help. The other piece of this is the element of surprise. It is easier to cope with news of such events when it is expected. This allows people to then prepare for such news and work to be emotionally ready for it.

We are rapidly losing control over when and how we are exposed to devastatingly detailed headlines and their accompanying graphic photos.

Some news sites are better able to provide content of all types without the surprise gut-wrenching punch from the headline itself. Although they don’t have a perfect track record, the New York Times often is able to report on crimes important to the nation and world without giving the reader panic attacks or news blues from the headline.

In contrast, the Huffington Post and the Daily Beast -– ironically, two of my favorite news aggregator sites — do so less well. Recently, both sites had headlines on their front page announcing the murder of children in Afghanistan, accompanied by an actual photo of the corpses of these dead children. There was no warning label obscuring the view. There was no “click here” for those who were willing to see. In other words, the visitor on the front page/home page of these sites had no choice but to see this.

What can happen from not being able to control what one sees? For those adults with anxiety and mood disorders, this can set off a whole slew of anxious and harmful sequelae. For those adults without mental health issues, I contend that this can cause news blues. A common emotional response is difficulty in processing the surprise graphic encounter with a horrible atrocity and tragic image, followed by a decision to shut off the news site all together, and ending, at least for the time being, seeking out news.

My concern, apart from the emotional health of readers, is that news blues has the potential to contribute to a civic crisis. When adults stop reading the news, our responsibility as a populace to be informed is eroded. Everyone may not be experiencing news blues. Yet, many report they are becoming desensitized, and this is also problematic. We need to be informed and maintain compassion for other humans.

The social norms of what can be shared in the U.S media have shifted. Where are the honest-but-gently-worded headlines that beckon readers to read more about an important tragedy within the content of the article, instead of disclosing the most disturbing aspects within the headline? Where are the online hyperlinks that can protectively place graphic and upsetting photos behind further ‘clicks’ for the intrepid, willing, and prepared adult readers? Where are the warnings that inform and caution the reader that “some of the following photos may contain graphic content” ?

If, while reading online, we want to know what the “7 Foods We Shouldn’t Live Without Are” or where the “Happiest Cities in the World” are, we have to get there by a dozen clicks and endure slow-loading slide shows. Yes, I know that’s how these sites gauge our engagement which they then use to earn money from advertisers. But why hide this benign information behind a multitude of clicks and slow-loads and then put images of the corpses of dead children openly on the front page and openly on the side-bars of every news page?

Such was the case for Christal Presley, author ofThirty Days with My Father: Finding Peace from Wartime PTSD. Presley’s book chronicles the 30 days in 2009 that she spent talking with her father in an attempt to heal and recover their relationship, years after her grueling childhood. Her memoir gives not only a detailed account of the ripple effects of PTSD on children, but also an inside look at the recovery of a father and grown daughter.

Delmer Presley served during the Vietnam War and returned home a changed man. Riddled with nightmares, flashbacks, and suicidal thoughts, he was often an unpredictable father. Christal Presley writes that bad memories of her father’s outbursts taint her thoughts of childhood. She has many memories of her father grabbing his gun and leaving the house. Presley describes the upsetting experience:  “A man on a mission, his rifle cradled against his chest like an infant and his pupils so dilated you could hardly see the whites of his eyes, he would march back through the house and out the door, but not before uttering a single sentence: ‘I’m going to the river to kill myself.’”

The author’s mother was of little comfort to her. She would tell Presley that if she prayed and was good, god would help them. Over time, Presley began to resent her mother and build up a hatred toward her father. No one outside of their family knew what was going on, though—Presley became very skilled at acting happy and putting a smile on her face, especially when they were at church. But her father’s behavior was damaging.

Presley left home at 18, and spoke to her father very infrequently over the following 13 years. Then, in 2009, while Presley was at a writing workshop, a speaker asked, “What if you wrote about the thing you fear most?” After Presley had struggled with her own happiness for years, never quite dealing with her childhood or father, she thought that perhaps getting to know her dad and learning more about his experience in the war would help her. And she decides to embark on a 30-day, therapeutic conversation.

Toward the beginning of the book, Presley conveys her strong apprehension and anxiety. On the first day of what is supposed to be the 30-day period, her father retracts his agreement to participate in the project. Presley hangs up on him. This is not likely the way she wanted to start the process.

In day seven, Presley has an interesting revelation during a conversation with her therapist. She says that she is conducting the project to get to know her father, and her therapist responds, “There are many ways to get to know a person. And many ways to forgive him.” Although Presley thought she had already forgiven her father, she writes, she begins to question whether she truly had.

Over the course of the 30 days, happier memories begin to break through the surface as Presley and her father trudge along together. They begin to realize how many things they have in common, aside from both experiencing PTSD. For instance, Delmer relates to his daughter that his guitar is his main therapeutic tool. Playing the instrument calms his nerves, makes him feel at peace, and makes him feel good about himself, he tells her. Presley’s tool, meanwhile, is her writing, which makes her feel the same things that her father feels when he plays guitar.

On the last day of the project, the author returns to her parents’ home for Christmas. Rather than being struck with flashbacks as she was accustomed to, she recalls a memory from when she was five: being in a school play and running and leaping into her father’s arms at the end. She recalls how happy she was and how proud she was that he was her dad. “There was a time before, a time I thought I’d lost,” she writes. “It’s coming back.”

Presley has a wonderful written voice. She is articulate, emotional without being overly dramatic, and insightful. She weaves her story with such clarity that it is easy to get lost in her rhythm and words. I found myself wanting to cheer for her and her father as their relationship progressed. She also shares stories of talking with veterans at VA hospitals, which are at times both heartwarming and heartbreaking. They carry a strong message, too: that veterans continue to need support. As for Presley’s own journey, I wish only that she had continued the story a bit longer, just so I could know how her relationship with her father is today.

Thirty Days With My Father: Finding Peace from Wartime PTSD
Health Communications, Inc., November, 2012
Paperback, 264 pages
$14.95 

Other factors, including cultural context and faith, play an enormous role in implementing crisis interventions. This paper will compare and contrast some of these elements and models to examine how crisis interventions can be best handled now and in the future.

Crisis Intervention

Crisis management after a natural disaster is critical. Going about it properly is key to the success of crisis aversion.

There are many elements to examine when looking at a natural disaster. These include: disaster type; disaster zone environment; available resources; and delivery of resources to the area in which the disaster occurred.

Psychological First Aid

It is important to consider psychological first aid when talking about crisis management for natural disasters. This model examines the needs of the first responders and those involved with crisis recovery and management. Such people can include rescue workers, police officers, firefighters, humanitarian relief workers and any others who are in a position to help out during a natural disaster. This model includes key aspects such as education, providing support of peers, speedy recovery, mental health accessibility and a continuum of care (Castellano & Plionis, 2006).

As Castellano and Plionis (2006) discuss, first responders view themselves as having to be strong for others. Showing emotion is considered a type of weakness. This often develops into a hesitancy to seek help, which ican lead to worsening mental health. This creates a domino effect. The first responder needs to be psychologically and physically healthy enough to assist others. However, if their own physical and psychological health is ignored, the person in need may not be taken care of either (Kronenberg, Osofsky, Osofsky, Many, Hardy, & Arey, 2008).

However, psychological first aid is not applicable only to the first responder. It also is a model of how the first responder is able to help those in need. Providing compassionate engagement is key to helping those who are faced with a natural disaster, as well as allowing those in need to know that the first responder’s purpose is to provide safety and emotional comfort (Vernberg, Steinberg, Jacobs, Brymer, Watson, Osofsky, et al., 2008).

The first responder also must be able to collect information pertinent to disaster victims’ immediate needs. The first responder must be clear-headed enough to recognize the population’s needs and resources available to meet those needs. This requires the first responder to maintain psychological steadiness (Vernberg, Steinberg, Jacobs, Brymer, Watson, Osofsky, et al., 2008).

Stabilization is another key to psychological first aid. A first responder must be able to calm those who are in crisis due to a recently experienced trauma. This is applicable to those who are helping the first responders as well. However, the level and immediacy of stabilization may be different according to the different scenarios and to the needs of a crisis victim vs. those of a first responder. (Vernberg, Steinberg, Jacobs, Brymer, Watson, Osofsky, et al., 2008).

Cultural Considerations

As with most other topics, cultural considerations come into play when looking at crisis management for natural disasters. For instance, within an Asian setting, emphasis may be placed in different areas of a crisis intervention model than it would in a Western one (Udomratn, 2008).

In India, the Nitte Rural Psychiatric Project was adapted for those with limited access to resources. This project offers free care. Its goal is to overcome the stigma of mental health care by utilizing respected community members of, such as religious leaders and local doctors. Education, lectures and awareness are components to mental health care and crisis management. (Akiyama, Chandra, Chen, Ganesan, Koyama, Kua et al., 2008).

However, in another part of Asia, Senior Peer Counseling may be viewed as important in crisis intervention. In Singapore, the respect given to elders may play a valuable role in developing models of overcoming crises after a natural disaster (Akiyama, Chandra, Chen, Ganesan, Koyam, Ku., et al., 2008). In Korea, the Seoul Mental Health 2020 project offers a review of key components of the community mental health resources available to those in the area. This includes looking at adequate coverage, diversifying services in particular areas and also an integration of services. This model is looks at the overall structure of mental health and crisis intervention and aims to improve it (Akiyama, Chandra, Chen, Ganesan, Koyam, Ku., et al., 2008).

Holistic support also may be an important consideration in crisis intervention needs within an Asian population, as discussed in the Yuli psychiatric rehabilitation model for Taiwan.

Faith-based Interventions

Faith-based models also may be considered when dealing with crisis intervention following natural disasters. One model in particular, called the Camp Noah model, focuses mainly on children who have been affected by natural disasters. It is a week-long camp that allows children to express their trauma and be in an environment that supports their faith. It also relies on fun activities to provide therapeutic relief of trauma for these children (Zotti, Graham, Whitt, Anand, & Replogle, 2006).

The Camp Noah model is similar to some of the culturally-based Asian models in that it takes the context of the individual and community to heart. However, its format differs. It does not take on the viewpoint of therapy, but of a therapeutic means of expression. The Camp Noah model is more of a strategy, whereas the Asian-based models are more of an implementation. The Camp Noah model utilizes Bible study, therapist consultation, music, games and crafts. It also has the elements of low participant ratios for quality care and highly trained staff to provide adequate care for children (Zotti, Graham, Whitt, Anand, & Replogle, 2006).

Camp Noah seeks to improve disaster trauma processing and coping skills related to natural disasters. Most of the Asian-based models focus on reducing the stigma of seeking mental health care when a natural disaster does occur. There also are similarities between these models: the community setting is taken into account, and the community and its available resources are included.

Integrative Reviews

An examination of the purpose, sample, method, procedure and results of differing models is a good means of conducting an integrative review for crisis intervention models. Walsh (2009) examined different means of cultural crisis interventions for relief workers after natural disasters had occurred. A cross-cultural sample was examined in-depth to see what governmental and non-governmental agencies could do to intervene.

Walsh (2009) focused primarily on the incidence of reducing post-traumatic stress disorder and how each model worked within the context of cultures such as New Zealand, Germany, the United States, Australia, Turkey, Taiwan, Israel and Iran. Walsh found that three key elements in the data reduction model were relevant to each culture. These three elements included: debriefing, team building and preparation. These elements were different according to the cultural context; however, each proved effective in each of the cultures (Walsh, 2009). Walsh notes that long-term effects on relief workers should be further researched for future crisis intervention models (Walsh, 2009).

Conclusion

Crisis intervention has many elements in the context of a natural disaster. There are the considerations toward the population involved in the natural disaster and the aftercare of not only this population, but the relief workers as well. Models based on cultural contexts are necessary to provide effective intervention and treatment to particular populations. There is also the element of faith when developing crisis intervention models, so as to look at ways of coping with and overcoming trauma. And finally, there is the relevance of examining a model within the cross-cultural context that integrates key elements so as to be globally applicable and efficient in reducing such traumas as post-traumatic stress disorder and other mental health concerns.

References

Akiyama, T., Chandra, N., Chen, C., Ganesan, M., Koyama, A., Kua, E., et al. (2008). Asian models of excellence in psychiatric care and rehabilitation. International Review of Psychiatry, 20(5), 445-451. doi:10.1080/09540260802397537.

Castellano, Cherie, and Elizabeth Plionis. 2006. “Comparative analysis of three crisis intervention models applied to law enforcement first responders during 9/11 and Hurricane Katrina.” Brief Treatment and Crisis Intervention 6, no. 4: 326-336. PsycINFO, EBSCOhost.

Kronenberg, M., Osofsky, H., Osofsky, J., Many, M., Hardy, M., & Arey, J. (2008). First responder culture: Implications for mental health professionals providing services following a natural disaster. Psychiatric Annals, 38(2), 114-118. doi:10.3928/00485713-20080201-05.

Udomratn, P. (2008). Mental health and the psychosocial consequences of natural disasters in Asia. International Review of Psychiatry, 20(5), 441-444. doi:10.1080/09540260802397487.

Vernberg, E., Steinberg, A., Jacobs, A., Brymer, M., Watson, P., Osofsky, J., et al. (2008). Innovations in disaster mental health: Psychological first aid. Professional Psychology: Research and Practice, 39(4), 381-388. doi:10.1037/a0012663.

Walsh, D. (2009). Interventions to reduce psychosocial disturbance following humanitarian relief efforts involving natural disasters: An integrative review. International Journal of Nursing Practice, 15(4), 231-240. doi:10.1111/j.1440-172X.2009.01766.x.

Zotti, M., Graham, J., Whitt, A., Anand, S., & Replogle, W. (2006). Evaluation of a Multistate Faith-based Program for Children Affected by Natural Disaster. Public Health Nursing, 23(5), 400-409. doi:10.1111/j.1525-1446.2006.00579.x.

In The Attachment Therapy Companion: Key Practices for Treating Children & Families, attachment experts Arthur Becker-Weidman, Lois Ehrmann, and Denise H. LeBow seek to create a foundational text. Though they suggest that the book might be useful for caregivers as well, it is designed as a manual for clinicians, outlining the existing best practices in attachment therapy and organizing the field for the way forward. The text has an unfortunate tendency to repeat itself and some of the later chapters feel insubstantial; still, the authors have crafted a strong case for attachment therapy as an exciting theory deserving of further research.

Attachment therapy is new enough that it does not yet have a fixed terminology, so the authors wisely begin with a discussion of key definitions and concepts. The book is careful to distinguish what it terms “attachment-focused therapy” from more heavily “touch-reliant” techniques, explaining that, though touch may be involved in some successful attachment-focused strategies, the focus of the therapy is building an emotional understanding and trust between the child and caregiver. There is also an emphasis on the importance of reciprocity: The child must not only feel the effects of the caregiver’s love and support but also feel that the caregiver is affected by the child in turn. A major theme is that the caregiver’s place in the therapeutic process is equally significant to the child’s, whereas the clinician “takes more of a coaching or consultant role.”

The book argues that attachment is already the basis for many trauma-focused therapies, though it may not always be explicitly labeled. By making attachment the specific target of therapy for children who have experienced lasting trauma, the authors believe that clinicians will be able to avoid frequently used but insufficient diagnoses such as PTSD or bipolar disorder. The authors devote significant time to discussing the particular difficulties of diagnosing and treating children, and claim that attachment-focused therapy is especially suited to the developing minds of the young. They emphasize the necessity of a flexible, individualized treatment plan and rely more on case studies and examples to guide readers in working with their own clients than on step-by-step methodologies.

The Attachment Therapy Companion seems to do a fine job of consolidating current knowledge in the field and paving the way for future developments. The chosen examples are presented in a dialogue format that effectively demonstrates ways in which the clinician can strengthen the child-caregiver relationship. The emphasis on careful listening and avoiding blame for disruptive behavior, with the clinician playing the role of facilitator, provides a convincing image; it is easy to picture the children in the chosen examples making significant progress.

However, it is a bit difficult to imagine a clinician reading this book and successfully implementing its ideas without significant further research, as the text tends to be vague on the beginning stages of the therapy. The book states that a prerequisite for these techniques is a comprehensive assessment of the suitability of both child and caregiver, including “an assessment of the child and the caregiver’s capacity to be insightful, responsive, sensitive, reflective, and committed, and their state of mind with respect to attachment.” Yet it does not offer advice on how to locate and enlist such a qualified caregiver. The book addresses the fact that many traumatized children have difficult family situations when discussing behavior management and treatment logistics but does not address the seemingly larger question of how an attachment therapist would find a suitable caregiver in the lives of these children. As the book argues that attachment-focused therapy is the best way to treat these children and that the role of the caregiver is essential, the lack of strategies offered to find such a caregiver is glaring.

Ultimately, the book seems a useful resource for clinicians interested in working with child victims of lasting trauma—but it is not quite the foundational text it seeks to be. It is by no means comprehensive, and its weaknesses call out for further research and further writings. Considering the integral role of the caregiver and the significant emotional qualifications required of him or her, it seems like the logical next book would be a primer for the caregivers themselves. (Attachment-focused therapy puts an uncommon amount of responsibility on the parent figure, so he or she deserves to be provided with an uncommon amount of clinical information.) What The Attachment Therapy Companion does, however, is outline a new therapeutic model that requires more psychological knowledge from the client. Though it does not solve all of the problems of such a model, it proves the worth of its field.

The Attachment Therapy Companion: Key Practices for Treating Children & Families
W. W. Norton & Company, September, 2012
Paperback: 240 pages
$27.95

Blind Devotion: Survival on the Front Lines of Post-Traumatic Stress Disorder and Addiction gives a taste of the Prinsen’s gutsiness at the outset, as she begins by acknowledging that she herself has played a part in her family’s difficulties. In this, her first book, the author tells the searingly honest and remarkably brave story of her family’s battles with mental illness, charting the ongoing chaos they’ve faced following Sean’s service in Bosnia.

After his discharge, Prinsen tells us, her husband returns home to the States and is given a prescription for narcotic pain medication to help him cope with the pain of a neck injury he suffered during military training. It is here that things begin to quickly spiral out of control, as Sean becomes addicted to his pills and begins to self-medicate with additional over-the-counter medications and alcohol. His behavior throws the entire family into disarray.

“Alcoholism is an enigma,” Prinsen writes, “— as complex as it is puzzling. It follows no rules and has no boundaries. Like a giant vacuum, alcoholism goes after everything and everyone in its path. It is a family disease — everyone in the family gets sick.”

Because Sean is reluctant to speak about the trauma he experienced in the military, or to share the truth about his depression with anyone, Prinsen assumes that her husband is simply suffering from addiction. It takes many years for her to understand and recognize the nature of PTSD and to connect the dots between the trauma Sean experienced in Bosnia and his subsequent depression and substance use.

“For so long, in the early stages of Sean’s addiction, I didn’t understand the destructive interplay between Sean’s PTSD, his depression, and his substance abuse,” she writes, explaining:

… Only he understood the desperate need to escape from the crippling flashbacks and the intrusive thoughts that blindsides him without warning, bringing with them the full force of the emotions that he felt in the original traumas. Only he understood the exhausting anxiety that kept him on high alert for ‘danger’ 24/7 and the need for something — anything — to keep that anxiety at bay. Only he understood how the pills helped him get through a night that would otherwise be plagued by the alternating horrors of nightmares or insomnia.

Sean’s PTSD continues to go undiagnosed, until he finally reaches crisis point. One night, in 2007, Sean suffers a complete breakdown and attempts what is known as “police-assisted suicide.” He becomes threatening and aggressive, arms himself with a loaded weapon, and calls the police to the house, almost as a challenge.

Prinsen recalls the horrific events of this evening, as she and her two young children are forced to witness Sean’s breakdown and frightening behavior, fearing not only for his life, but for their own. Sean survives, is arrested, and is subsequently jailed. Then, incredibly, after his release, the same thing happens again exactly a year later, as he suffers a repeat breakdown and once again challenges the police to come and get him, putting his family’s lives at risk in the process. By this point you’d be easily forgiven for wondering why on earth Prinsen doesn’t just leave, but it’s here that the relevance of the book’s title becomes clear. Prinsen adopts the military philosophy of “No One Gets Left Behind” and refuses to abandon Sean, no matter what anyone else tries to convince her, or how tempting it might sometimes seem. Looking back, she realizes that she plays a codependent role in the relationship, too.

But Prinsen doesn’t let her husband off the hook lightly, either, and always holds him fully accountable for his actions. “It took me many more years to fully grasp the reality that abuse isn’t just physical,” she writes. “Sean was a master at manipulating my emotions to get just what he wanted, and as difficult as it is even today to say the words — that is abuse.” Sean also used threats of suicide and self-harm to keep her from leaving or setting healthy boundaries, she tells us, recognizing it as a form of abuse. His “screaming, the holes in the wall, the slammed doors, and the broken objects” are also “definitely abuse.”

Later, Prinsen recounts, with brutal honesty, how she at times longed for her husband’s demise:

Sean stayed in our home, but I was finally starting to understand that Sean would never get help until he hit rock bottom. He needed to fall hard if he was ever going to get up again. I did something then that I’ve since found out is common behavior for the loved ones of addicts: I began to systematically pray for my husband’s downfall. I didn’t want him to get hurt. I didn’t want him to injure someone else and live with the regret. I didn’t want him to suffer lifelong consequences. I just wanted him to suffer enough to want to get help for himself.

It is rare to find these sorts of frank admissions in a personal memoir, let alone a first book, and it is this fearless honesty that makes Prinsen’s story so powerful. One can only imagine how difficult it must have been for her to put all of this into writing, knowing that her husband, friends, and family would all be able to read it. At one point in the story she finds herself wondering, “What will people think when they see this in the newspaper?”

In addition to sharing her own raw experiences, Prinsen also follows every section of the book with a short factsheet, providing the reader with a brief summary of the fundamental topics covered and links to further resources. These factsheets might easily have seemed disruptive or out of place, but Prinsen keeps them concise and informative.

The author also raises some vital ethical and political issues, questioning the morality of a government that puts soldiers in situations that destabilize their mental health, then prosecutes them as criminals. “How can we expect our veterans to come back to their homes and be ‘normal’ again after they have seen humanity at its worst?” Prisen recalls thinking angrily as she and Sean walked out of court one day. She feels sick when considering that Sean, who had never had any trouble with the law before he was deployed to Bosnia, was now a twice-convinced criminal. “What kind of a country is this to condemn and shame its own soul-wounded soldiers in such a way?” she asks. “Why don’t we just help them?”

Blind Devotion lives up to its name as a remarkable testament to the unquestioning power of love against all other odds, including the most destructive forms of mental illness. This is a story of survival, with protagonists who are determined to conquer their personal demons and triumph, no matter what. Prinsen’s writing will appeal to every reader, regardless of whether or not they’ve had to deal with PTSD. For the hundreds of thousands, if not millions, of military families who can relate to her experiences firsthand, hearing Prinsen speak about them so openly and shamelessly will surely be a relief.

Blind Devotion: Survival on the Front Lines of Post-Traumatic Stress Disorder and Addiction
Hazelden, September, 2012
Paperback, 348 pages
$14.95

After his discharge, Sean returns home to the US and is given a prescription for narcotic pain medication to help him cope with the pain of a neck injury he suffered during his military training. It is here that things begin to quickly spiral out of control, as Sean becomes addicted to his pills and begins to self-medicate with additional over-the-counter medications and alcohol, throwing the entire family into disarray:

“Alcoholism is an enigma — as complex as it is puzzling. It follows no rules and has no boundaries. Like a giant vacuum, alcoholism goes after everything and everyone in its path. It is a family disease – everyone in the family gets sick.”

Sean is reluctant to speak about the trauma he experienced, or to share the truth about his mental illness with anyone – even his wife.  So, Prinsen assumes that her husband is simply suffering from addiction and she’s unable to connect the dots between the trauma he experienced in Bosnia to his subsequent depression and substance use. It takes many years for her to understand and recognize the nature of PTSD:

“For so long, in the early stages of Sean’s addiction, I didn’t understand the destructive interplay between Sean’s PTSD, his depression, and his substance abuse. That powerful trio of mental health issues would confound me for years… Only he understood the desperate need to escape from the crippling flashbacks and the intrusive thoughts that blindsided him without warning, bringing with them the full force of the emotions that he felt in the original traumas. Only he understood the exhausting anxiety that kept him on high alert for ‘danger’ 24/7 and the need for something – anything – to keep that anxiety at bay. Only he understood how the pills helped him get through a night that would otherwise be plagued by the alternating horrors of nightmares or insomnia.”

Sean’s PTSD continues to go undiagnosed until he finally reaches crisis point. One night, in 2007, Sean suffers a complete breakdown and attempts what is known as “police-assisted suicide,” becoming threatening and aggressive, arming himself with a loaded weapon, and then calling the police to the house, almost as a challenge.

Prinsen recalls the horrific events of this evening, as she and her two young children are forced to witness Sean’s breakdown and frightening behavior, fearing not only for his life, but for their own lives, too. Sean survives, and is arrested, and subsequently jailed. Then, incredibly, after his release, the same thing happens again exactly a year later, as he suffers a repeat breakdown and once again challenges the police to come and get him, putting his family’s lives at risk in the process. By this point you’d be easily forgiven for wondering why on earth Prinsen doesn’t just leave, but it’s here that the relevance of the book’s title becomes clear, as Prinsen adopts the military philosophy, ‘No One Gets Left Behind,’ and refuses to abandon Sean, no matter what anyone else tries to convince her, or how tempting it might sometimes seem.

It would have been easy for Prinsen to portray herself as a heroic martyr in this book, or else as an innocent, one-dimensional victim, with her husband as the evil aggressor. But she never strays into such simplistic territory and always paints herself and the other characters in her story as truly complex individuals. Indeed, her gutsyness is displayed from the outset, as she begins the book by acknowledging her own role in this chaos. She takes ownership of the fact that she too played a part in her family’s difficulties and recognizes herself as a codependent:

“I spent most of my life trying to shake crippling feelings of inadequacy that I believe stemmed from the chaotic home in which we were raised… I couldn’t wait to get to college and escape. Yet by the time I arrived there, my self-esteem and confidence in my ability to control my own world were completely shattered… Melody Beattie, the writer credited with popularizing that term, describes codependents as those who become so obsessed with other people’s feelings and behaviors that they lose sight of what they themselves are feeling or how they themselves are acting.”

But Prinsen doesn’t let her husband off the hook lightly, either, and always holds him fully accountable for his actions:

“It took me many more years to fully grasp the reality that abuse isn’t just physical. Sean was a master at manipulating my emotions to get just what he wanted, and as difficult as it is even today to say the words – that is abuse. Throughout our dark years, Sean also used threats of suicide and self-harm to keep me from leaving or setting healthy boundaries – and that, too, is abusive behavior. And most importantly, there were his raging behaviors – his screaming, the holes in the wall, the slammed doors, and the broken objects. Definitely abuse.”

One can only imagine how difficult it must have been for Prinsen to put all of this into writing, knowing that her husband, friends, and family would all be able to read it. At one point in the story, Prinsen finds herself wondering “What will people think when they see this in the newspaper?”, worrying about the local community’s reaction to her husband’s exploits. It’s even more impressive, then, to see her publish this book, and to lay her soul bare so bravely for all to see.

Later, Prinsen even recounts, with brutal honesty, how she at times longed for her husband to crash:

“Sean stayed in our home, but I was finally starting to understand that Sean would never get help until he hit rock bottom. He needed to fall hard if he was ever going to get up again. I did something then that I’ve since found out is common behavior for the loved ones of addicts: I began to systematically pray for my husband’s downfall. I didn’t want him to get hurt. I didn’t want him to injure someone else and live with the regret. I didn’t want him to suffer lifelong consequences. I just wanted him to suffer enough to want to get help for himself.  I needed my husband to crash, and I prayed for it every day until it finally happened.”

It is rare to find these sorts of frank admissions in a personal memoir, let alone a first book, and it is this fearless honesty which makes Prinsen’s book so powerful. There are doubtless hundreds of thousands, if not millions, of families that will be able to relate to Prinsen’s experiences, and to hear her speak about them so openly and shamelessly will surely be a relief. Prinsen’s voice is a powerful one, and she is an inspirational advocate for anyone who has ever had to deal with PTSD and its effects.

Beyond her husband’s trauma, Prinsen also frequently considers the effects these experiences have had on both her and her family, and offers a detailed explanation of secondary traumatic stress and how it should be treated:

“My precious little boy was suffering – an unwitting victim of the horrors that his father had brought home with him from Bosnia. I couldn’t stop myself from wondering, ‘Why, God? How many more people have to get hurt because of some stupid conflict in some faraway land? How many more innocent children will become ’casualties of war?’”

In addition to sharing her own experiences here, Prinsen also follows every section of the book with a short factsheet, providing the reader with a brief summary of the fundamental topics covered, and links to further resources. All these topics are also indexed at the back of the book, so that they can be easily accessed when necessary. These factsheets might easily have seemed disruptive or out of place, but Prinsen keeps them concise and informative, and her advice and research are first class, putting many professional self-help books to shame.

The book also raises some vital ethical and political issues as Prinsen questions the morality of a system which treats its military veterans in this way:

“I was relieved that Sean’s legal troubles were now behind him, but I still felt sick to my stomach as I considered how Sean – who had never had any trouble with the police before he was deployed to Bosnia – was now a twice-convinced criminal. ‘So this is the ‘freedom’ for which people like my husband risk their lives every day?’ I thought in anger as we walked out of the courthouse. ‘What kind of a country is this to condemn and shame its own soul-wounded soldiers in such a way? Why don’t we just help them?… How can we expect our veterans to come back to their homes and be ‘normal’ again after they have seen humanity at its worst?.. Why do we do so little to help them?’”

Prinsen doesn’t dwell too long on this debate, and doesn’t presume to be able to fix the system or offer any answers, but her bravery once again stands out in simply asking such powerful questions and bringing these issues to the fore.

Blind Devotion lives up to its name as a remarkable testament to the unquestioning power of love against all other odds, including the most destructive mental illness. Prinsen writes that she “originally thought this book would be the story of my husband’s struggles and redemption – but it was destined to be about my redemption as well.” This is a story of survival, with protagonists who are determined to conquer their personal demons and triumph, no matter what. Prinsen’s writing constantly draws you deeper into the book, and her narration of the story is so engaging and thought-provoking that this will appeal to every reader, regardless of their experiences with PTSD. An inspirational book by an exciting new author: both Sharlene and Sean have much to be proud of.

Blind Devotion: Survival on the Front Lines of Post-Traumatic Stress Disorder and Addiction
By Sharlene Prinsen
Hazelden Foundation:  2012
Paperback
333 pages

Anyway. I am writing to share some things I have learned in the last 10 years of therapy. I can only hope it may help one person. If it shortens his or her journey by even one long, painful, depressingly suicidal day it would be well worth it.

The first step for me was realizing everything is not as it could or should be upstairs! This may be glaring and painfully obvious to you all day every day. Take pride in that because you are actually ahead. I was practicing a lot of really reckless behaviors and endangering my life and health almost daily, but thinking that I was “fine.” Realizing this sort of behavior was probably not coming off a basis of any sort of concern or care for my welfare was the start of identifying my poor self-esteem (understatement).

It took some time and therapy but this realization grew and grew until my therapist and I started to see the depths of my problems. It wasn’t just poor self-esteem, it was utter self-hate and loathing. It was cruel and critical, cold and unrelenting, vicious and violent and nothing could halt its path. This voice operated twenty-four hours a day on full acceleration. It was a raging beast and interfered with every second of my days and nights.

At this stage some work was done to intellectually provide me with an infrastructure for another way of thinking. The theory that all of these beliefs about myself were incorrect was introduced to the raging beast. The beast thrashed through this new talk and reduced it to splinters every time it was raised. The only way I could even intellectually entertain the idea that I was not innately bad, evil, filthy, genetically wrong and hideous beyond comprehension literally was to talk about another person. I would never ever treat another person this cruelly. No matter what one of my friends had done in the past, I would never think they were remotely bad. I would want them to love themselves as I loved them. That was a starting point for me.

If you also have this raging beast in your head, you are probably one of those people feels mildly irritated when complimented or does not give it a millisecond to sink in because it’s just plain ridiculous, nearly irrelevant. You can have glaringly obvious talents, but you either have absolutely no awareness or belief in them or think that that one positive is outweighed by 600,000 negative and evil horrible parts.

The next significant step was adding some other types of therapy to open up and expose this secret, dark, raging beast. I had to feel it and express it. I used primal therapy, inner child work and art therapy both to expose the beast and to start to allow my more vulnerable and kinder parts a voice. This was a fairly lengthy process, but I believe it was probably a lot quicker than talking about it because the beast listens to no one. It wasn’t until I felt the feelings that I “got it.”

For example, someone told me that because I was only a child, being sexually abused wasn’t my fault and I wasn’t dirty or bad because of it. Using the process so far as an example I went from denial (“yeah whatever, of course it’s not the child’s fault, I don’t think I’m dirty and I don’t care so shut up”) to “If I thought of my friend/sister/a child on the street it would absolutely never ever be their fault that they were abused and it should never ever happen to anyone and they should never ever have to carry that burden” to feeling the humiliation, powerlessness, degradation, shame, and physical pain of that sexual abuse. This step allowed the beast to start letting in the tiniest momentary, usually temporary rays of compassion.

The other important aspect of this was just exposing the beast, lying on the floor and telling a benevolent witness (therapist) everything this voice was saying. After 10 minutes of emptying the latest derogatory diatribe that was on repeat in my mind, it seemed to have lost so much of its power. It did seem almost childish whereas 10 minutes previously I was a slave to its mastery and perceived wisdom.

Among and throughout these varying stages were periods of crisis, either deadly depression (in bed, staring comatose at the wall, with no will to do anything) or suicidal fantasies and active self-harm. Crisis management became really important. There was no management initially as the beast ruled. There was no sharing of decisions with anyone more mature, compassionate, caring or even sensible. It was what the beast — all the negative thought processes and critical cruel voices — says goes. There can be no other way.

So the first step was becoming aware that there was always something else to do, that these were just feelings and that I was not only made of my negative feelings. At first it was a lot about just stalling action. If I felt tempted to cut or burn myself, instead I would draw the cutting and burning, or I would call a friend, or book a session with my therapist, or get a drink or have a shower. Often in the heat of the moment you think the feeling is forever and so painful and horrible that it could never be stalled. Often, though, it can reduce in a short period of time with a distraction or by expressing those feelings through art or a feeling session or even just moving your body and energy to somewhere or someone else.

Now I have the crises more under control and don’t feel like a danger to myself so much anymore. I am building on this self-love thing. If you search for love with the Google search engine, you’ll find numerous definitions. I particularly like the Wikipedia one: “Love is an emotion of a strong affection and personal attachment. Love is also a virtue representing all of human kindness, compassion, and affection —”the unselfish loyal and benevolent concern for the good of another. Love may describe actions towards others or oneself based on compassion or affection.”

Now that’s a definition I can start to relate to.

Feeling my suffering as a child when I was intellectually and physically unable to defend myself has led to a compassion for myself and an affection of sorts for the wild ways I tried to deal with that pain and the courage I have shown to move through the impasse that seemed so impossible. I’m no Martha Stewart bumblebee now but the beast is more balanced and I think probably relieved that its job is over.

To everyone out there drowning in suffering, depression, suicidal despair and fear and loathing in Las Vegas, hang in there. Try some feeling and expressive therapies, use any tricks you can to ease the self-hate. I know you won’t believe me but you deserve to get better and it really is possible! Hang in there comrades!

Oxford Handbooks offer up-to-date, critical reviews of original research by leading figures in the discipline. Despite the comprehensive and highly academic nature of “The Oxford Handbook of Traumatic Stress Disorders,” it is well organized to make it easy to locate key findings, summaries and abstracts. An extensive index and references are included, and it is all searchable online.

The tome aimed at professionals dealing with the diagnosis and treatment of traumatic stress disorders provides an extremely thorough and detailed look at all aspects and issues surrounding the disorders.

In “Defining Traumatic Events: Research Findings and Controversies,” the editors examine the history of the controversy over “Criterion A,” the trigger for post-traumatic stress disorder. It has significant clinical and legal implications.

Criterion A defines those stresses that may be considered a potentially traumatic event:

• The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
• The person’s response involved intense fear, helplessness, or horror.

A major aspect of the controversy is over whether the definition is too broad or too narrow. Too broad of a definition would dilute it and could lead clinicians to misidentify normal reaction to stressful events. Too narrow a definition leaves out those deserving eligible care. Revisions to criterion A are proposed the upcoming edition of the primary “Manual of Mental Disorders.”

Currently, a diagnosis of acute stress disorder requires criterion A, plus clinically significant functional impairment as well as at least three of five dissociative symptoms.

In a later chapter, proposed changes to the acute stress disorder diagnosis and future directions for research into early predictors of post-traumatic stress disorder are discussed.

Chapter 4, “Classification of Posttraumatic Stress Disorder,” reviews the current criteria of PTSD. It examines the symptoms and their overlap with symptoms for other disorders.

The authors observe, “Although many traumas do involve the acute experience of intense fear, helplessness, or horror, events evoking primary emotions of anger or shame can also generate PTSD.”

Later the handbook addresses modifications to the definition of PTSD and proposed changes for the DSM-5 manual. Authors of this chapter note, “The precise factor structure of PTSD has been addressed by many research teams over the past 15 years. The structure of the construct as described in the DSM-IV is that PTSD consists of three symptom clusters: Re-experiencing, Avoidance/ numbing, and Hyper-arousal. Utilizing confirmatory factor analysis strategies, studies tested whether the three symptom clusters of DSM-IV provide the best model for the latent structure of PTSD. In short, the overwhelming majority of studies support a four-factor model.” and, “Among these four-factor models, re-experiencing, avoidance, and hyper-arousal have emerged as distinct clusters in all of these studies.” Rationale for the addition of new symptoms is examined and future research is suggested.

Chapter 7, which is called “Epidemiology of Posttraumatic Stress Disorder in Adults,” summarizes information on the prevalence of PTSD in U.S. veterans of the Vietnam War as well as the soldiers returning home more recently from deployment in Iraq and Afghanistan. It gives an overview of PTSD research, risk factors, and the risk for other post trauma disorders. Some of the concluding results are:

• There is a direct relationship between the intensity of conflict and risk of PTSD.
• At least 80 percent of residents in the United States qualify for the diagnosis of PTSD.
• Only a small proportion of those exposed to traumatic events actually develop PTSD.
• Exposure to a violent assault is more likely to result in PTSD than other types of traumatic events.
• Women are at higher risk for PTSD than men.

The chapter reaches the conclusion, “The most important impact of the extensive epidemiological literature of PTSD has been a sharp shift away from the original model in DSM-III that PTSD was a normal response to an abnormal stressor. The idea that traumatic events would cause PTSD in most victims, regardless of preexisting vulnerabilities, has been refuted. PTSD is seen as a pathological response by a minority of persons.”

Another section examines populations of people with psychiatric, behavioral, cognitive, or physical disabilities who have a higher than normal likelihood to be exposed to psychological trauma.  “Individuals with severe psychiatric disorders, substance abuse disorders, developmental disabilities, and persons who are incarcerated are more likely to experience trauma throughout their lives, especially interpersonal victimization, and are more likely to develop posttraumatic stress disorder (PTSD),”according to the book.

“Contributions from Theory,” the fourth section of the extensive handbook, looks at the current research in genetics and genomics of PTSD, related biological issues, learning models and family models of PTSD.

The next section of the book covers assessment. The most widely used assessment tools for PTSD are described, including structured interviews, self-reports, and psychophysiological methods. Key PTSD issues are discussed, including identifying an index traumatic event, the linking of symptoms, detecting malingering and reporting false or exaggerated symptoms. Psychophysiological measurements vary, but often include recordings of heart rate, skin conductance, musculature contraction/relaxation and electrocortical measures such as EEG. While psychophysiological procedures provide more evidence for PTSD, these tests have limitations. Roughly 40 percent of people with PTSD show little or no physiologic reactivity. The authors conclude that an approach using one or more of each type of measurement is the best way to go.

Overall, The Oxford Handbook of Traumatic Stress Disorders is an invaluable, comprehensive guide for clinical psychologists, psychiatrists and social workers who care for those with traumatic stress disorders.

J. Gayle Beck and Denise M. Sloan have prepared an extremely detailed gem that I highly recommend for graduate students, scholars and practitioners in psychology and related fields.

The Oxford Handbook of Traumatic Stress Disorders
Edited by J. Gayle Beck, Denise M. Sloan
Oxford University Press, Inc., February, 2012
Hardcover, 576 pages
$150

Rosenthal shares her battle with Stevens-Johnson Syndrome (SJS), leading us from her diagnosis at age 13 through 24 subsequent years of psychological repercussions. Rosenthal recounts the story of how she fought for years to overcome her PTSD, and managed to slowly climb her way out of a serious case of depression and anxiety, experiencing a rebirth along the way. Ultimately this results in a remarkable tale of personal strength and post-traumatic growth.

The book is divided into four sections: ‘Shock;’ ‘Confusion;’ ‘Clarity;’ and ‘Healing,’ with each of these representing a different stage in Rosenthal’s journey. The first, ‘Shock,’ describes Rosenthal’s life ‘before the world intruded’ – the innocent childhood cut short by the onset of her terrible illness. ‘Confusion’ and ‘Clarity’ cover her emotional journey in coming to terms with this trauma, and ‘Healing’ describes her eventual recovery and return to happiness.

Not only is Johnson one of the 0.5 people per million to suffer from SJS, but in her case it also develops into its most extreme, life-threatening form, Toxic Epidermal Necrolysis Syndrome (TENS).The symptoms of this are a form of blistering so serious that Rosenthal has to be treated in a hospital burn unit. She recounts the condition’s sudden onset with such excruciating accuracy and vivid attention to detail that you may find yourself wincing as you read about the unbelievable pain she had to endure. Rosenthal recalls meeting the hospital psychiatrist, and being unable to put her experience into words at the time:

I did not tell her how drastically I felt changed. I did not say out loud that I was trying to suppress the memory of a pain so intense it defied words. I could not explain that I was struggling not to be overwhelmed by a staggering number of new fears and feelings, nor even the latest fear: that I had survived the physical onslaught only to be outdone by the emotions in its wake.

Indeed, it is these subsequent emotions which later cause Rosenthal to become disconnected from the rest of the world. She survives a near-death experience, and then sinks into a state of deep depression, anxiety, insomnia, and eating disorders.

Rosenthal shares the following quote from Dr. David Biro’s memoir One Hundred Days: My Unexpected Journey from Doctor to Patient:

Doctors love a good zebra. Patients with rare, exotic diseases. We crowd around to see them, touch them, photograph them. We put them on display at conferences. We write their stories in journals. We do all this, I suspect, because they reawaken the spirit that first pushed us into medicine: a fascination with the human body, its incredible achievements and its terrifying failings.

It is this idea of an “exciting zebra” for the medical community that Rosenthal most strongly identifies with throughout her struggle. She reluctantly adopts this as her identity, labeling herself as a “medical anomaly, alone, a freak.”

Eventually, 16 years after her initial diagnosis, and following countless fruitless attempts at a cure by her doctors, Rosenthal decides to seek a different kind of help. She arranges to see a psychotherapist, named Greg. It is this work with Greg, and an introduction to transcendental meditation, that signals a change for Rosenthal: She talks about her experiences for the first time and begins to discover her true voice, escaping the fearful clutches of her Ego voice. Remembering her college days, Rosenthal writes that “[W]riting was good for me. It gave me a focus outside my physical discomfort and limitation. It gave me something in which to bury the emotional angst I carried and also a place to explore how and when and why to find language and choose words.”

As her sessions with Greg evolve, Rosenthal recalls that:

I became more of a full self: I defined boundaries, learned how to communicate, and started more consciously mulling the question, ‘What do I want?’… I made a list of twenty-two things I was afraid of. At the top of the list: ‘I am afraid of myself.’ And yet, I wanted more and more to become myself. Writing seemed to be the path to that connection.

She begins to make significant progress, and to feel in control of her life, so Rosenthal terminates the sessions with Greg. But another onset of the illness sparks a relapse into her depressed state, as she is once again forced to resign herself to the role of patient, or ‘zebra.’ It is this relapse which finally triggers the turning point for Rosenthal, as she fully acknowledges the fear she has lived with – and denied – for so long. She decides once and for all to “reclaim myself,” with Greg’s help:

We break through the fear to a point where I begin to imagine for myself a different life than the invalid one I am used to. This happens oh, so slowly, but I hear the machinery grinding in my head. I fantasize I could be her, the girl of such vast energy I glimpsed for just a moment in the hospital. I imagine myself strong and free and vibrant and healthy and able to succeed without enduring the pitfalls of illness. One day, walking along the beach I feel myself as I would like to be: happy, unafraid, able to live without looking back, a strong source of joyful vitality.

Crucially, through her ongoing therapy sessions, and by reading two life-changing books – Joan Didion’s ‘The Year of Magical Thinking’ (a parent’s perspective of a child’s grave illness) and Elizabeth Wurtzel’s ‘More, Now, Again: A Memoir Of Addiction’ – Rosenthal realizes just how important her writing is to her, and how it can offer her a solution to her problems:

Socrates wrote that language is ‘an activity that moves the soul towards definition.’ Words can deliver us from our solitude, or deepen it. They are our most specific form of translating what exists in a heart through the landscape of a mind. I have always used language as a fence, as a guardrail against truth, definition, and exposure. So often my words have cloaked my self in disguises designed to ensure anonymity. Or, the lack of words has kept me separate from even myself. Recently, however, I sense the ability to use language in another way. I begin writing poetry again, starker poems and more to the point, writing more directly than ever about the aftereffects of illness and its consequence on identity… I begin to feel safe… I understand the problem has been that I never acknowledged my past and then came back to the present. Instead, I have lived in the trauma and run away from myself in every moment. It is time to sit still.

This will certainly sound familiar to anyone who has ever studied the concepts of Narrative Therapy, and it is ultimately — through her writing, a discovered love of music and dance, and a new identity – that Rosenthal finally overcomes the trauma of her illness and truly achieves happiness. At the end of the book she states that:

I can describe myself as if TENS never happened: I am a dancer, I am a writer, a creator, a lover, a partner, a daughter, a sister, a friend. I am a dog owner, a Floridian, a beachwalker, a homeowner. I am a joy seeker. I am a believer in my self. I have conquered the past. Now, I am creating my future as a woman who is connected, strong, and free.

Notably, Rosenthal is many things, but she is no longer a ‘zebra’.

Today Rosenthal works as a post-trauma coach, using the wisdom gained from her own experiences to help others, and employing the philosophy that “we can’t always find meaning in our trauma, but we can learn to make meaning come out of it.”

This is an honest, triumphant story of personal courage in the face of adversity, and will undoubtedly help anyone who has ever dealt with the effects of trauma or illness. At one point in the book, Rosenthal states that “Writing seems like the only thing that can save me,” and I am grateful that it has. Rosenthal is a survivor, and hopefully her story will help many other victims of PTSD work toward their own recovery and post-traumatic growth, finding happiness and a new sense of identity along the way.

Before the World Intruded: Conquering the Past and Creating the Future, A Memoir
By Michele Rosenthal
Your Life After Trauma, LLC: April 9, 2012
Paperback, 230 pages
$14.95

This is often because they demand themselves to be 100% successful 100% of the time, even when they cannot control 100% of the situation. You may have problems that stem from this kind of internal pressure as well. If you are a first responder, a veteran or the family member or friend of one, this section may have special meaning for you. If you are not in any of those categories, then this case may help you have a better understanding of — and compassion for — what our first responders and combat veterans are going through. In addition, if you have any of the symptoms listed here, it can help you learn something more about yourself.

Trauma can cause many physical disturbances and once it takes root, it usually doesn’t clear up on Its own. For people who have PTSD because they have chosen to serve their country in combat or as frontline responders, life can be especially hard, because they often develop feelings of failure. Most often, their symptoms aren’t being caused by fear for themselves, but because of the people they might have hurt — or who they couldn’t save. While the experiences that occur in war could be enough to have a negative impact on anyone, there can be additional reasons for breaching the emotional defenses of even the strongest warrior. The following example can give you an idea of how much suffering our combat veterans are experiencing — and how intricately woven our memory networks can be.

Hal Walters is a 37-year-old married, combat-decorated Marine Corps Staff Sergeant (SSCT E-6) with more than 11 years of active-duty service. His military primary care physician referred him for treatment due to postdeployment PTSD and major depression disorder symptoms. SSCT Walters related that within a week of returning home from his second and most recent combat tour in Iraq two years ago, he began to experience progressively worsening problems, along with daily intrusive recollections of combat-related events triggered by a wide range of common stimuli­ — such as the sight of older women, children, and crowded places.

His symptoms included insomnia, anxiety-related nightmares, inter­mittent crying jags, irritable and depressive moods, stomach problems, chronic fatigue, problems with concentration and memory, feeling socially disconnected, frequent headaches, periods of emotional numbing alternating with intense anger outbursts or seemingly unprovoked crying spells, hypervigilance (feeling tense and on guard), exaggerated startle (jumping at sudden noises), loss of appetite, feelings of exhaustion and profound guilt in relation to multiple war-related memories. All of these are symptoms — alone or in combination — that affect thousands of our warriors. Millions have been affected dating back to earliest recorded time.

Hal had a number of memories that needed to be processed, but one had extra special significance. He was on guard duty and his platoon was forced to open fire when a car barreled down on them. The disabled, smoke-filled, bullet-riddled car rolled to a stop. A few occupants slowly attempted to open the passenger doors. Exiting the rear door was an elderly Iraqi woman, who was mortally wounded and bleeding profusely. She cried out in obvious anguish and pain, as he and his men watched her collapse in spasms. As he told his therapist, other vehicle occupants were all badly shot-up and lay either dead or quietly dying. However, regulations did not permit the soldiers to approach until the explosive and ordnance disposal people had had a chance to inspect the car and ensure it was not a suicide bomb. The elderly Iraqi woman writhed on the ground and moaned loudly for what he reported seemed like hours, but lasted possibly only minutes until she eventually bled to death.

Hal’s facial and emotional expression changed dramatically while retelling the horrific incident. He lowered and shook his head in his trembling hands, as he tearfully recollected the ordeal that he reported reliving several times a day (and at night). Although he denied active suicidal thoughts, intense shame and guilt led him to question why he should continue to live. He frequently made references to the elderly nature of the female victim, so his therapist asked him whether she reminded him of anyone else he knew before. He appeared to carefully consider the question and initially answered “No.”

Then he quickly changed his mind, stating, “Come to think of it, she reminded me of my grandmother.” When asked how so, he replied, “My grandmother was from Nigeria, but lived with us for a few years when I was around eight.”

He paused and then continued. “But she and my mom constantly argued, I mean really argued. Then I remember one day my grandma told me she couldn’t live here anymore and was going to return to Africa.”

Those suffering from major traumas such as sexual or physical assault, combat experiences, accidents or the sudden death of a loved one can be diagnosed with post-traumatic stress disorder (PTSD) if certain symptoms exist. These include intrusive thoughts of the event; nightmares or flashbacks; avoidance of reminders of the incident and increased arousal, which can include problems such as sleep difficulties; angry outbursts; being easily startled or having difficulty concentrating.

Research has also indicated that medically unexplained physical symptoms, including fatigue, gastrointestinal problems and pain can also go along with this disorder. Anyone suffering from PTSD can benefit from EMDR therapy.

In order to be officially diagnosed with PTSD it is necessary to have experienced a major trauma. However, recent research has also revealed that other, less dramatic life experiences can cause even more symptoms of PTSD than major traumas. Many of these disturbing life experiences take place throughout childhood and can include hurtful experiences with parents or peers. The negative impact on the person’s sense of self takes place since, just as with diagnosed PTSD, “unprocessed memories” are running the show.

This happens because the experience was so disturbing that it disrupted the information processing system of the brain. One of the functions of this system is to take disturbing experiences to mental adaptation. So if something happens to us that is disturbing, the processing system “digests” the experience and the appropriate connections are made, while the reactions that are no longer useful — such as the negative self-talk, emotions and physical sensations — are let go.

However, if an experience is too disturbing, it disrupts the system, causing the memory to be stored with the negative emotions, physical sensations and beliefs. Current experiences must link with the memory networks in our brain to be interpreted. If there is an unprocessed memory, the negative emotions and sensations can emerge and color our perception of this current situation. In short, the past is present.

That’s where EMDR therapy can help. While EMDR cannot remove a problem caused by genetics or organic injury, the research indicates that even in these cases negative life experiences can exacerbate problems. When a person is held back from doing things he or she would like to do by feelings of insecurity, anxiety, fear, or unremitting sadness, or is pushed into doing things that are not useful — such as overreacting to people or situations — the reason can generally be found in the memory networks. Many times the problems are unprocessed memories from the past that are poisoning the present.

In my new book, Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy, I provide numerous procedures that will allow the reader to identify the earlier memories that are at the root of their problems, and ways to change their emotions, physical sensations and negative thoughts. There are also techniques to help achieve desired goals in work and social relationships. These self-control techniques can make life more manageable, and understanding why we are doing things that don’t serve us can often help to bring things into perspective.

But if the techniques aren’t sufficient to give you a good feeling about your life, or you feel better for awhile but the old feelings continue to come back, then it would be useful to read the stories in the book that illustrate why different kinds of problems emerge, and decide if EMDR therapy would be a good choice for you.

Part of that evaluation involves taking stock of both your personal and professional relationships. Do you feel happy and fulfilled? Do you have a good support system? Or do you feel frustrated and troubled by disturbing thoughts and emotions?

Generally, there are three categories of negative feelings and beliefs that can emerge. These are the feelings of not being good enough, not being safe, or not being in control. If we often feel insecure, fearful or anxious — or notice that these feelings arise intensely in certain situations — we have the tendency to blame ourselves. Friends aren’t able to reassure us no matter how hard they try, because the problem is generally caused by the unprocessed memories associated with the negative emotions, physical sensations and beliefs.

When certain things happen in the present — even minor ones, like the expression on someone’s face — the memories can get triggered and the emotions, beliefs and accompanying sensations (like a tightness in stomach or chest) surface. We don’t get an image that goes along with it, so we don’t realize it’s really the “old stuff.” Then, since our distress can debilitate us, we may have problems interacting with people in the present, causing new memories of “failures” to be stored and thus increase the problem. That’s how depressions can also increase: our new negative experiences just dig the hole more deeply.

So, the bottom line is that we deserve to have happiness and fulfilling relationships. Problems involving negative thoughts and emotions are generally the result of negative past experiences that are improperly stored in our brains. The negative feelings may appear to be true to us, but they are actually the result of physiologically stored memories. This makes it not a “mental problem,” but rather a physical problem that can be remedied. If you break your leg, you would not just hobble along. You’d have no question about going to a doctor to align your bones properly so that healing can take place.

Likewise, if you go to an EMDR therapist for assistance, a good history will be taken and you will be prepared for memory processing. Then the memory will be accessed and aligned in a certain way, while the information processing system of the brain is stimulated so the memory can be transformed into an adaptive learning experience. The negative emotions, physical sensations and beliefs can be discarded and a positive sense of self can emerge.

EMDR therapy is not limited to simply taking symptoms away. It addresses the past, present and future. The goal is to allow the person to achieve a complete state of emotional health. It has also been used to help athletes, performers and executives to achieve a state of “peak performance.”

If you feel stuck personally, or in your relationships, and the self-help techniques provided in Getting Past Your Past are not sufficient, then consider fully addressing the problem with EMDR therapy. Ultimately, the goal is to liberate you from the confines of the past into a happy and productive present and a fulfilling future.

Today, EMDR is recognized by the US Department of Defense and the American Psychiatric Association as an effective treatment for post-traumatic stress disorder (PTSD).

Traumatic memories come in many types. While some may involve violence or physical abuse, others involve everyday life experiences, such as relationship problems or unemployment, according to Shapiro in her recently published book, Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy. These everyday experiences also can produce symptoms of PTSD.

In our interview, Shapiro talks more about the book and reveals how she discovered EMDR along with the inner workings of the treatment, its effectiveness for PTSD and much more.

1. How did you discover EMDR?

I discovered the effects of the eye movements that are now used in EMDR therapy one day as I was taking a walk. I noticed that disturbing thoughts I had been having had disappeared and when I brought them back they didn’t have the same “charge.” I was puzzled since I hadn’t done anything deliberately to deal with them.

So I started paying careful attention and noticed that when that kind of thought came up, my eyes started moving rapidly in a certain way and the thoughts shifted out of consciousness. When I brought them back they were less bothersome.

So, I started doing it deliberately and found the same results. Then I experimented with about 70 people. During that time I developed additional procedures to achieve consistent effects.

I tested the procedures in a randomized study that was published in the Journal of Traumatic Stress in 1989. Then I continued the development of the procedures and published a textbook on EMDR therapy in 1995.


2. Can you give us a glimpse into an EMDR session with a client with PTSD?

EMDR therapy is an eight-phase approach. It begins with a history-taking phase that identifies the current problems and the earlier experiences that have set the foundation for the different symptoms, and what is needed for a fulfilling future.

Then a preparation phase prepares the client for memory processing. The memory is accessed in a certain way and processing proceeds with the client attending briefly to different parts of the memory while the information processing system of the brain is stimulated.

Brief sets of eye movements, taps or tones are used (for approximately 30 seconds) during which time the brain makes the needed connections that transform the “stuck memory” into a learning experience and take it to an adaptive resolution. New emotions, thoughts and memories can emerge.

What is useful is learned, and what is now useless (the negative reactions, emotions and thoughts) is discarded. A rape victim, for example, may begin with feelings of shame and fear, but at the end of the session report: “The shame is his, not mine. I’m a strong resilient woman.” 




3. EMDR helps clients process their experiences, but they don’t necessarily have to discuss the details or relive them. So how does EMDR help clients process problematic experiences?

There are very few research-supported trauma treatments. The other two besides EMDR that are best known ask the client to describe the memory in detail because it is necessary for the therapy procedures that are used.

In one of these (Prolonged Exposure therapy), the clients are asked to describe the memory in detail 2-3 times during the session as if reliving it. The rationale for this treatment is that “avoidance” is causing the problem to persist and the clients need to learn that they can experience the disturbance without going crazy or being overwhelmed. For the same reasons, they are also asked to listen to recordings of the event for homework and visit places they previously avoided in order to allow the disturbance to abate.

The other form of treatment (Cognitive Processing Therapy) asks clients for details of the event in order to determine what negative beliefs they hold so they can be challenged and changed. This is done during sessions and with homework.

In EMDR therapy, the emphasis is on allowing the information processing system of the brain to make the internal connections needed to resolve the disturbance. So, the person only needs to focus briefly on the disturbing memory as the internal associations are made.
A Harvard researcher has published a couple of articles detailing how the eye movements in EMDR therapy seem to link into the same processes that occur during rapid eye movement (REM) sleep. This is the time that dreams take place and the brain processes survival information.

According to the theory, the memory is then transferred from episodic memory, which holds the emotions, physical sensations and beliefs that were stored at the time of the original event, into semantic memory networks, where the person has “digested” the experience so that the accurate personal meaning of the life event has been extracted and those negative visceral reactions no longer exist.

In an EMDR session you can observe these connections being made as learning rapidly takes place through the internal connections.



4. Is there an explanation why trying to reproduce REM responses helps people recover from PTSD? In other words, do we understand the underlying mechanism any better yet?

There are now about a dozen randomized studies that have examined the effects of the eye movement component in the context of the REM hypotheses. They have found supportive results such as decreases in physiological arousal, increases in episodic associations and increased recognition of true information.

Another dozen studies have shown that the eye movements serve to disrupt working memory.

About another dozen studies using brain scans have observed significant neurophysiological pre-post EMDR therapy changes, including an increase in hippocampal volume.

However, there are still more questions to be answered. In fact, there is no definitive neurobiological understanding as to why any form of therapy, as well as most pharmaceuticals, works.





5. Since EMDR therapy is done by a trained professional, what kinds of self-help techniques do you discuss in the book that take from the EMDR world of techniques and theory? (Please give an example or two of specific techniques mentioned in the book).

I’ve included a wide range of self-help techniques that will allow people to (a) manage stress, (b) change their emotions, physical sensations and negative thoughts in the present, (c) help get rid of negative intrusive images, (d) identify situations that trigger these kinds of reactions and help prepare for them in advance, and (e) identify the unprocessed memories that are causing the negative reactions.

Additional techniques include ones taught to Olympic athletes to achieve peak performance. These can also help people prepare for future challenges such as presentations, job interviews and social situations.

The book is targeted toward mental health professionals but has information that parents or caregivers of child trauma survivors could benefit from as well. Steel and Malchiodi fill the book with illustrations and case studies, giving the book a more powerful and effective edge.

Trauma-informed practice is a term readily defined and supported in the first chapter as well as throughout the book. The authors state that “it [trauma informed practice] means that trauma is predominately a sensory process for many children and adolescents.” The authors go on to say that trauma is an experience that cannot be changed by cognitive therapy alone. They suggest that instead, clinicians must reorganize our current understanding of trauma therapy. Therapists should begin to incorporate different therapeutic techniques that address the sensory process of traumatic stress, not just the cognitive process.

In Chapter One, the authors discuss children’s and adolescents’ unique response to trauma and uses current neuroscience research to back up their explanations. This chapter also solidifies the difference between trauma and grief reactions and helps clinicians understand the different ways to identify and treat them.

Chapter Two discusses assessment, stressing that trauma-informed assessment must “address the importance and validity of evaluating children’s reactions, behaviors and thought patterns that preceded the traumatic events.” The authors also suggest a multidisciplinary approach to assessment; clinicians should strive to find positive characteristics within the child that helped them survive and overcome the trauma. This chapter provides several models of assessment with thorough explanations, helping the clinician find what would work best for each individual client they might work with.

Chapter Three talks more about assessment, but instead of highlighting standardized methods, it discusses sensory-based assessment practices. Many survivors may hesitate to verbalize their experiences, making standardized assessment difficult. Although less well-established, sensory-based assessment uses play and art techniques to “help better understand a child’s preferences for self-expression and disclosure.” The chapter goes on to discuss many specific art- and play-related assessment techniques for a clinician to add their assessment arsenal.

Chapter Four seems to me to be the most important. It focuses on establishing safety through self-regulation, something survivors of trauma, especially children, struggle greatly with. This chapter is based on the idea that our physical bodies remember trauma and ingrain those memories in a sensory-oriented way, inaccessible through word-based therapy. The authors even go so far as to suggest that focusing solely on word-based accounts of the trauma can keep therapy at a surface level, never allowing full integration of the trauma experience.

This chapter also identifies techniques such as mindfulness and self-expression interventions as tools in helping children and adolescents regain their sense of personal safety. Another powerful part of this chapter is the chart provided on key elements of a safe intervention. This clearly defines, for a clinician, what is considered a safe and unsafe intervention.

Chapters Five and Six focus on relationships. The authors explain how to design and implement a trauma-informed environment, one that helps establish feelings of safety and fosters resilience and independence.

Chapter Seven focuses on building resilience in child survivors. By first discussing resilience characteristics, readers get an extensive understanding of what it means and what it looks like to see resilience in a child. Then the authors give age-specific guidelines for promoting those same resilience characteristics in therapists’ clients. There is a final section on post-traumatic growth and what the transition from victim to survivor to thriver looks like.

Finally, Chapter Eight closes with a small section on trauma integration. This section helps the reader understand when therapy has been successful and when it is advisable to end therapy due to full and proper integration of the traumatic experiences.

Overall, Trauma-Informed Practices with Children and Adolescents is a book that I would highly recommend to all mental health professionals. This book is thorough in its explanations and reasoning and makes excellent support for the newer and perhaps, less conventional ideas that it presents. Child and adolescent trauma survivors need special intervention due to the unique ways young people process and integrate traumatic stress. This book helps open the lines of conversation for clinicians to explore different and new ways of treating trauma.

Trauma-Informed Practices with Children and Adolescents
By William Steel and Cathy A. Malchiodi
Routledge: October 27, 2011
Paperback, 279 pages
$39.95

Dr. Ann Masten from the University of Minnesota wrote in the journal American Psychologist (2001) about resilience as “ordinary magic.” That is, given normal protective factors, most children will be able to cope, recover, and be fine after witnessing or experiencing a traumatic event.

Some children and adolescents may develop symptoms following a disaster, especially if they have experienced traumatic events earlier such as losses or other difficult situations. The symptoms related to trauma may appear as difficult behaviors or emotions shown at home or school. It is important for parents to know that children’s behaviors and emotions can become dysregulated, where they demonstrate more aggressive or withdrawn behaviors such as sadness or anger, and even “numbing” or little emotion as a way of coping with trauma.

Some of the “red flag” behaviors of concern when seen in children of different ages include:

• For children under 5 years of age: returning to earlier behaviors such as thumbsucking, bedwetting, fear of darkness, separation anxiety or excessive clinging
• For 6-11-year-olds: disruptive behaviors, extreme withdrawal, inability to pay attention, sleep problems and nightmares, school problems, psychosomatic complaints
  including stomachaches and headaches or changes in usual behaviors
• For 12-17-year-olds: sleep problems and nightmares, school problems including changes in performance and truancy, risk-taking behavior, problems with peers, changes in usual behaviors, psychosomatic complaints including stomachaches and headaches, depression or suicidal thoughts

Parents need to be able to recognize these “red flag” behaviors and identify when their child may be experiencing so much distress that he needs help. Parents may also need help in providing support to their child after traumatic events that may also traumatize the parents. Brief support and being able to talk to someone who can be more objective may be helpful to both parents and child after a traumatic event.

When they experience traumatic events, children can be protected most by support from their parents or trusted caregivers, being able to talk to them and have them listen, and if they are younger, being able to play freely. Younger children often play out what they have seen or experienced which, at times, may be difficult and upsetting for parents to observe but is important in helping the child recover from the event.

Returning to routines is also very important for children after they’ve experienced trauma, even if the routines are different from what they experienced before the traumatic event. If the children are older, then being able to go to school and be with friends will help in their recovery. Life needs to be predictable for children (and adults) and traumatic experiences disrupt that predictability. Reinstating routines help make life predictable again.

Guidelines for Parents to Help Their Child Cope with Trauma Include

1. Offer to listen to your child and help her, but don’t overwhelm her if she is not ready to talk. Don’t pressure your child to think or talk about what has happened beyond her willingness and readiness to do so. Children need answers to their questions that are age-appropriate and truthful, but it is not in their best interest to be flooded with more information than they ask for or need.

2. Talk about what has happened or is happening but in tolerable doses. It is wise to respect your child’s need to break off the discussion and to respect his wish to not talk further about the trauma for a while. He or you can ask to talk again at another time.

3. Do not underestimate a young child’s awareness or understanding of what has happened or may be happening. Answer your young child’s questions about injury or death truthfully, but in language she can understand without offering her
more than is necessary for her to hear.

Different age groups have different needs. For example, very young children need to be protected from exposure to too much television or other media; they are likely to have either seen or heard too much already.

Children need to be helped not only with their anxiety and confusion, but also with their anger. They may react to the traumatic event with anger and need to learn ways to express their feelings in healthy ways. Here are a few age-appropriate, healthy ways to help children express their confusion or anger about a traumatic event:

• It is often helpful for young children to have the opportunity to draw pictures of what has happened, perhaps depending on the traumatic event, including rescue vehicles coming to aid. Children who are a little older may want to play out the event with toys.

• Older children may find it helpful to use heroic action figures for their play or toy soldiers or military equipment to show danger as well as rescue.
• School-age children may want to use these less verbal forms of expression but they also might be able to be more direct and verbal about their feelings and concerns; they are more likely to also talk to teachers, relatives, and other adults in addition to parents.
• Teenagers may find it helpful to talk as part of a small group of peers their own age rather than talk by themselves. After disasters, teenagers can play a major role in helping others in recovery work at school and in their community and also help younger children. It is important to recognize and support prosocial activities for teenagers, which can also decrease the likelihood of higher-risk behaviors.

As I shared with one parent whose young child was very upset after experiencing a traumatic event that would impact both of their lives for some time, “Life will return to normal, however, after trauma, it may be a ‘new normal.’”

Flipped car photo available from Shutterstock

Dr. Jung starts out by explaining the vast impact of sexual trauma.  He states that about “20-25% of girls and 10-15% of boys experience some form of sexual trauma before the age of 18.”  This is quite a large number if you stop to think about it.  In addition, we must consider the ripple effect of sexual trauma; the victim is unlikely to go on with life in the same manner so the people they associate with may be affected as well.  An interesting point is the financial aspect of these numbers.  He quotes a study performed by the National Institute of Health that shows a strong correlation between PTSD and sexual trauma.  Given the correlation, the study states that PTSD is associated with almost the highest rate of service use and may be the highest per-capita cost of all mental illnesses.

Dr. Jung’s discussion of historical and cultural figures and the impact sexual trauma had on their lives is quite interesting.  Overcoming such an obstacle, many were able to build an empire, so to speak.  Oprah Winfrey is one of the examples that he uses.  She has become an international icon over the years, reaching out to people with her television show, magazine, website, and now, her own TV network.  Even though she experienced sexual trauma as a child and had a very troubling past growing up, she was able to overcome her challenges and create a life of entrepreneurial endeavors, inspiration, and creativity.  His use of these famous characters is to provide an illustration of what he believes is the “astounding creativity and tremendous sensitivity” that victims may gain from the experience of sexual trauma.

The anecdotes of his own patients are a more personal approach to the face of a sexual trauma victim.  Jung describes the variety of symptoms that his patients suffered, typically providing one story for each of the forms of PTSD that he discusses.  The stories can get graphic as the patients relive the trauma they endured.  He couples the stories with letters written by patients, which give a direct view into the mind of the victim.  For instance, one letter was written by a patient that was molested by a priest.  The letter describes the emotional turmoil that the patient experienced.  The letter recounts the molestation, explains how he does not trust anyone, and harbors anger toward his ex-wife.  He goes on to say, “Somebody has to pay.  The smell, the texture, the taste in my mouth that has haunted my life…  I need to be vindicated.”  This is just one of the many stories shared by Dr. Jung.

After building this foundation for understanding the victim, Dr. Jung begins the arduous task of explaining the therapeutic process for victims.  From the crisis intervention to reliving their trauma, the healing process for a victim is often a bumpy road.  He explains the patience and understanding required of a therapist to assist a victim along the way.  He states:

It is important to recognize that there is no one word of wisdom, one magical advice or one great medication that will cure this vast, complex, human condition, for it is from the violation of one of the most personal, sacred and vulnerable foundations of human existence.

An important note that Dr. Jung addresses is that there is no complete resolution of sexual trauma; he likens this to how there is no perfect person.  This is something certainly that must be discussed between therapist and patient to assure that the expectations of the outcomes are realistic.  He continues this discussion in Chapter 5, which focuses more on the various medications, which may help patients deal with various symptoms of PTSD.

Finally, Dr. Jung rounds out Sexual Trauma with a section filled with advice to physicians, therapists, patients and parents.  He does make note that every patient is different; therefore, the advice is not a textbook manual for every case.  They are merely suggestions, which can be used to “acquire some sense of direction and to work through the challenges of the therapy process.”

Sexual Trauma is undeniably a strong text, which outlines a promising therapeutic approach to sexual trauma and PTSD.  I believe that it is a great resource for therapists and physicians.  For victims of sexual trauma, it may provide comfort and give them hope that there is a path to recovery. 

However, I do believe there are two drawbacks to the book that need mentioning.  First, I feel as though much of the focus is on the story telling of patients and famous sexual trauma victims rather than the actual therapeutic process.  Perhaps more explanations or descriptions of the steps involved in his process could have made this section more enlightening.  For instance, when discussing the process of transference, it is unclear how Dr. Jung would resolve this part of the therapy.  Rather, he merely gives examples of transference that he has experienced with patients and advises therapists to “be very giving, and generous of his or her time, attention and self, to allow the transference to occur unimpeded.”

Second, I regretfully must admit that the text is difficult to get through.  The content of Dr. Jung’s book is useful, informative, and interesting.  However, it is painfully obvious that the book was not edited well, or even at all.  There are errors throughout the text and grammar, spelling and style errors.  Specifically, the section on Marilyn Monroe was so atrocious I had to put the book away because of my frustration.  At times, the writing was so poor that I had to ponder the message that Dr. Jung was attempting to deliver.  It is truly a shame his message is so poorly delivered.

Sexual Trauma: A Challenge Not Insanity
By K. Elan Jung, MD
Hudson Press: 2010
Hardcover, 660 pages
$19.99