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Coping with Trauma is a concise, readable and practical book about the nature of traumatic experiences and their impact on both victim and helper. With contributions from some of Australia’s leading trauma specialists, Coping with Trauma provides a unique and systematic analysis of trauma reactions in individuals suffering directly from the experience. As well as the professionals who render assistance to them. This book outlines major principles of assessment and intervention based on contemporary research and experience, and provides vivid, real-life case histories. Coping with Trauma is a well-referenced and valuable resource text for any person who finds themselves working in the area of trauma.



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Published 01 December 1994
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EAN13 9781875378852
Language English
Document size 5 MB

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EDITED BY & Rod Watts David J de L Horne
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© 2000 Australian Academic Press Pty. Ltd. ACN 29 009 894 062
First published in1994 by Australian Academic Press 32 Jeays Street, Bowen Hills, Brisbane QLD 4006, Australia
Copyright © R Watts and D J de L Horne 1994
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publishers.
National Library of Australia Cataloguing-in-Publication data:
Coping with trauma: The victim and the helper Bibliography. Includes index.
ebook ISBN 9781875378852 1. Post-traumatic stress disorder — Australia — Case Studies. I. Watts, Rod. II. Horne, David J. de L. 616.8521
Designed and typeset in Garamond 10/11 by Australian Academic Press, Brisbane Cover design by Elke Ploetz Printed by Shortrun Books, Melbourne
a(er.tigc.Illryohalncsseidiffonnalsjourbadoohdraw,esuaumrailch,hclopyslatgocitaserensofpect-igoalrindaectolhnsisaetsr,niudtsfare,torture,d N the last 25 years the field of traumatic stress studies has seen an unparalleled growth of knowledge such that today there are over 5000 cal accidents, etc.) as well as scores of books and a newJournal of Traumatic Stress. More recently, the firstInternational Handbook on Traumatic Stress Syndromeswas published (Wilson & Raphael, 1993) which reflects the inter-ests of researchers, clinicians, trauma specialists, and others throughout the world in building a common source of reference as well as international cooperation to aid victims of trauma. Further, in the United States there are now five National Centers for the study and treatment of Posttraumatic Stress Disorders (PTSDs). This type of national commitment strongly suggests the importance of addressing the adverse effects of traumatisation. Further, the International Society for Traumatic Stress Studies (ISTSS) and the more recent establishment of an Australian counterpart (ASTSS) within the auspices of the parent organisation, indicate that the scientific study of trauma and victimisation is now mainstream in many disciplines such as psychiatry, psychology, social work, neuroscience, childhood development, and gerontology as well as the medical sciences. The present volume is another important contribution to the field of traumatic stress studies. The nine chapters and appendix that comprise the volume cover both sides of the coin: the victim and the helper. In Chapter one, Beverley Raphael and Lenore Meldrum present a conceptual overview of trauma, bereavement through traumatic loss, and
the Posttraumatic Stress Disorder (PTSD). Additionally, models of care are reviewed with specific recommendations for preventive assessment and management of ‘at risk’ persons and groups (which includes, of course, trauma specialists). In Chapter two, Rod Watts presents a discussion of a multi-fatality road accident which killed 11 people when a motor coach rolled off a cliff. Twenty-nine passengers survived and were immersed in a scene of chaos, death, and injury. Many, if not all, of the survivors displayed symptoms of PTSD. The psychological care and follow-up of the survivors are described in this chapter. Especially noteworthy is the proactive nature of the aftercare in which counsellors sought out survivors who were highly likely to have been traumatised to make available supportive care by specialists knowledge-able in PTSD. In Chapter three, Mark Creamer discusses some of the central issues which mental health professionals face when organising a program of inter-vention following a disaster. In this chapter, the disaster described is the Queen Street shooting in the Australia Post building during which a deranged gunman terrorised employees working in the building in a brutal and sadistic manner, killing eight people and wounding may others. Later, the gunman committed suicide by jumping from a window of the building and falling to his death on the street below. Throughout the ordeal, the gunman moved to different floors of the building and generated terror and horror in nearly all of the workers there. As would be expected, many of the threatened workers developed symptoms of PTSD and sought out support-ive counselling. The program developed to aid the distressed workers was unique because it was purposely designed to occur in the workplace with the endorsement of management and staff. Through the cooperation of several mental health agencies, the intervention strategy ranged from the immediate intervention to longer-term services. However, the mutual cooperation between the mental health specialists and the management staff afforded opportunities for the traumatised workers to come to grips with the post-traumatic psychological consequences of the shooting disaster. Perhaps what is most fascinating about the intervention program was that it was creatively adapted to assist workers in the location where the trauma occurred. This nontraditional approach to treatment is interesting and underscores how the treatment of PTSD may require innovative outreach efforts. Chapters four and five both contain discussions about the impact of trauma on professionals who work with victims of disaster and trauma. In Chapter four, Michael Stewart and Peter Hodgkinson detail common psychological reactions among rescue workers to such catastrophes as the Hyatt Regency Hotel skywalk collapse, the Mount Erebus DC 10 airplane crash, and the football stadium fire in Bradford in the United Kingdom. The authors discuss a number of common difficulties for rescue workers, including performance guilt, acute anxiety states, increased states of irritabil-
ity, forms of re-enactment, decreased occupational interest, and symptoms of PTSD. These common and expectable post-disaster reactions are further discussed by Robyn Robinson in Chapter five who reviews the different types of programs that have been developed for emergency service providers. They include: critical incident stress debriefing, group counselling, family support, de-fusings, demobilisations, and one-to-one counselling services. The rationale for these different approaches is explained and points to the reality that despite professional training, emergency responders continue to be at risk for powerful impacts to their sense of well-being and therefore need the implementation of specialised programs to care for those exposed to trauma in the line of duty. In Chapter six, the psychology of working with victims of traumatic accidents is discussed. David Horne outlines a number of very practical clinical guidelines in this chapter. These guidelines begin by describing the nature and extent of problems confronting the professional working in a medical setting when a patient enters the system for treatment. Clearly, the team responsible for care must assess both the nature of physical injury and psychological impact, especially PTSD and co-morbid conditions. Differential diagnosis is especially important since the absence of hard medical findings on head injury, for example, should not preclude careful follow-up on symptoms of PTSD which may be similar to those of ‘soft’ neurological signs. For this reason, Horne recommends that extensive psychological assessment be performed prior to psychotherapy. To illustrate the complex interplay of factors that confront mental health professionals in case management, Horne presents a discussion of a case which involved PTSD, anger, and phobia following a motorcycle accident. The patient not only had disrupted psychosocial functioning but was violent and abusive to his spouse and children. The report of this successful treat-ment illustrates the need to understand how the cyclical tendencies of hyperaroused affective states and psychic numbing get expressed in behav-ioural forms of coping and ego-defence. Chapters seven and eight concern traumatic impacts on children. In her chapter, Ruth Wraith discusses a broad range of topics associated with child-hood trauma, including some common myths that have existed for many years in the mental health community (for example, ‘children are resilient and will naturally recover from any effects by forgetting the experience, getting over it, or growing out of it’). The author explores the various ways that trauma impacts on children in terms of the damaged inner-self, devel-opmental stages, cognitive capacities, interpersonal functioning, and family dynamics. Further, the management and treatment of children’s responses is discussed, including practical clinical recommendations on how to protect the child’s vulnerability throughout the recovery process. In Chapter eight, Denise Brunt focuses on the long-term consequences of sex abuse in childhood. To begin, the author lists a number of basic questions prior to a discussion of how sexual abuse causes damage to the
self. And since the primary blow of childhood sexual abuse is a loss of trust and feelings of boundary violation, there are typically many thematic issues which carry forth throughout psychosocial development such as feelings of low self-esteem, the need for power and control, conflicted gender identity, and the capacity for intimacy. The chapter presents models of intervention and notes that mental health specialists might be especially prone to countertransference reactions when working with children who relive the pain of their violation by those whose role it was to nurture them. In Chapter nine, the role of culture in the treatment of PTSD is explored. Harry Minas and Steven Klimidis note that because of its history, Australia has a rich and diverse cultural heritage. In recent years the influx of refugees to Australia from Asian countries has resulted in a significant sub-culture of people who have endured the ravages of war trauma, civil violence, mass genocide, and political oppression. Predictably, immigrants who have survived traumatic events will have PTSD and other psychiatric disorders. Of particular interest in this chapter is the special concerns with the cross-cultural assessment and treatment of PTSD. The clinician needs to be aware of their own circumscribed belief system and how it might vary from that of clients from different cultural and religious backgrounds. The need for interpreters skilled in bridging gaps between cultures to facilitate disclosure of trauma is particularly important in the treatment process. The appendix to this volume concerns the understanding and manage-ment of the deceased. Priscilla Nelson-Feaver and Ian Warren begin by discussing cultural needs and how different religions view death and the conception of the afterworld. This conceptual overview is useful and creates a foundation for the discussion that follows in regards to: (i) viewing the body of the deceased, (ii) the funeral and its alternatives, (iii) procedures for exhibiting the deceased, and (iv) legal considerations. In conclusion, this book by some of the leading researchers in Australia, offers the reader a concise and practical text on traumatic stress reactions that is readable, well-referenced, and a valuable source for students and professionals alike.
PROFESSORJOHNP.WILSON Department of Psychology Cleveland State University Cleveland, OH, USA Past President, International Society for Traumatic Stress Studies
CHAPTER ONE Helping People Cope with Trauma Beverley Raphael and Lenore Meldrum
CHAPTER TWO Follow-up to Survivors of Large-Scale Road Accidents Rod Watts
CHAPTER THREE Community Recovery from Trauma Mark Creamer
Post-Traumatic Stress Reactions in the Professional
Michael Stewart and Peter Hodgkinson
Developing Psychological Support Programs in Emergency Service Agencies
Robyn Robinson
The Psychology of Working with Victims of Traumatic Accidents David J. de L. Horne
CHAPTER SEVEN The Impact of Major Events on Children Ruth Wraith
Long-Term Repercussions of the Trauma of Sex Abuse in Childhood
Denise Brunt