lloveland asked: What does psychotherapy for PTSD look like and how would it look in a teenager?
First, to make sure everyone is on the same page with regards to the definition for Posttraumatic Stress Disorder (PTSD), here is the short version according to the DSM-IV-TR:
Reexperiencing an extremely traumatic event accompanied by symptoms of increased arousal (startle easily, increased heart rate, etc) and avoidance of places, people, things, and emotions associated with the trauma.
If you want the exhaustive list of symptoms, I have it typed up and can email it you, lloveland, or anyone else who asks. I wanted to spend this post answering your question. So here goes.
First, I want to say identifying PTSD in children and teens is tricky. Children don’t have the psychological savvy and verbal skills to express their fears in an easy to understand way. And teens . . . well on a good day they can be emotionally labile and withdrawn. Second, what PTSD looks like in a person depends on the trauma causing event. A rape victim, a war veteran, and a car accident survivor will likely display their symptoms in a unique manner.
That being said, the following is a list of what you may see: emotionally labile, self-destructive (self-injurious behavior, drinking, drugs, promiscuity) and impulsive behaviors, dissociative symptoms (mentally blackout), somatic complaints (i.e., headaches, stomachaches), hopelessness (a red flag for suicidality), feeling damaged, hostility, feeling constantly threatened, lack of interest in things they once enjoyed.
Young children will sometimes experience dreams of the event that change into generalized nightmares with monsters, threats to themselves, or trying to rescue others. You will see the trauma in repetitive play. Some will fixate on the idea that they or a parent or friend will be harmed or die.
Treatment depends on the trauma. However, generally speaking the treatment takes a two part approach. First, the client-therapist alliance MUST be strong. The relationship tends to become strong as the therapist teaches the client relaxation and physiological awareness. Why those skills first? People who suffer from PTSD misread and ignore their fight or flight response. As a result, they often feel out of control or anticipate a threat. Being intune with their body is the first step to reclaiming their power. SO when you expose them to the trauma they know they are in control and they are safe.
Once the person understands their physiological cues they are ready for the next part. This involves exposure (real or mentally) to the traumatic event.
In the case of assault or abuse you have to do a mental exposure. You pair talking about the event with relaxation skills. You want to work with the client to develop a scale from least invasive and safe things to talk about related to the event to the most frightening. In the beginning you may talk about general happening on the day of the event. Each time they talk about an aspect of the event you follow the discussion with relaxation. The head on approach can be tough for teens, so I use a bag of fun techniques. I use art therapy techniques such as giving them a cardboard pencil box in which they decorate the inside with what they don’t show people and the outside is what they show people. I use music A LOT. In fact I have a CD full of songs that have lyrics about abuse, depression, anxiety, etc. All popular songs they would know. Given my love for reading and writing, I am a HUGE fan of storytelling and giving them books to read. The Velveteen Rabbit is great for abuse survivors. I have teens write a letter to the self that was harmed. This is just a sampling of what I and other therapist may do to help a teen reconnect with feelings and take back their power.
If exposure to the event is possible, I gradually expose them to aspects of the scene. Let’s use the example of a person who survived a car crash. In the beginning we may simply talk about cars, and then look at pictures of cars. Next they stand next to a car and then sit in a car, so on and so forth. Maybe you take them to the location of the accident. The exact steps are based on the client’s list you help them make. And just like above, each exposure is paired with relaxation.
Good Examples of PTSD:
Movies: Good Will Hunting shows PTSD related to abuse. I don’t agree with some of the therapy, but Will (Matt Damon) shows the symptoms well.
Ordinary People. An Oscar winning late 70’s/early 80’s movie. The story of a teen who survives a boating accident in which his brother, the star of the family, dies. Depressing as all get out, but incredible. The therapy and PTSD are done well.
Books: Wake by Lisa McMann has a character from an abusive home; he has nightmares
Speak by Laurie Halse Anderson deals with sexual assault. Art therapy is used.
Harry Potter’s response to Sirius’s death is an excellent PTSD example. He is agitated, withdrawn, experiencing guilt.