Tom Kavanaugh raised an interesting question in response to viewing the streaming videos on SteveAndreasPTSDTraining.com.

He wrote:

“None of the processes and protocols I’ve studied has provided any information about what to do with someone once they have released the effects and symptoms of PTSD.  It’s my opinion that up to 80% of a person’s life may be spent coping with the symptoms they experience. So when those symptoms are released, there is a huge gap in their life because they don’t know what to do, where to go, or who to be with. In other words, there’s no real direction for them to follow to get on with their life. Have you considered this perspective in your work; and, if so, what conclusions or suggestions would you make?”

Steve Andreas replies…

Your question is an excellent one, pointing out a significant omission in what I had time to present in the four-day training. Here are my thoughts:

If someone experiences PTSD later in life, they have probably already developed many interests, abilities, habits, and activities. Then when much of their life becomes preoccupied with coping with the symptoms of PTSD, that interrupts their normal activities, but doesn’t erase them. When their PTSD is resolved, they can easily return to their previous life and interests.

John, in our book Heart of the Mind (chapter 7, pp. 61-63) is a good example of this. Despite 13 years of coping with PTSD, he had no difficulty adjusting to its resolution. This was also true of Tara, the Iraq vet I saw recently. (Streaming video of the entire 4-session treatment is now available online at: http://releasingptsd.com/.) Both John and Tara were already employed, and functioning well, despite the considerable difficulties caused by their PTSD. When someone has gone through a major life challenge and resolved it, they may do even more than just return to their previous life. They are likely to participate in things that always interested in them, but with additional depth and perspective.

It is good to keep in mind that many people who experience terrifying events either experience no PTSD at all, or their disturbance is very short-lived, and they quickly return to their previous life, even without any therapy or treatment.

In contrast to this, if a person suffering from PTSD has been sitting on the couch in front of the TV for years, withdrawn from most of the world, sometimes in an alcohol or drug induced “self-medication” stupor, perhaps scraping by on disability payments, the situation is very different. Their adjustment to having their PTSD resolved will probably be much more challenging.

If someone experiences PTSD fairly early in life (or has had a very sheltered and limited life) they may never have had the opportunity to develop satisfying interests, abilities and activities. Or their development of these interests may have only been peripheral and in the service of their coping with PTSD. Then when the PTSD is resolved, they may indeed feel lost, and not know what to do, and require additional help.

Yet another variable is the extent to which PTSD has become a part of someone’s identity. Some people have PTSD, in the same way that people have a car, a habit, a disease, or a problem with alcohol. It is simply something that they have to cope with, but it isn’t part of their identity. For others PTSD becomes something that is a key part of who they are (in contrast to what they have) and they may have arranged much of their behavior around that core identity, and the activities that are involved in it. The same is true of people who have used drugs or alcohol for some time.

When someone with PTSD has been on disability payments for some time, they are faced with the possible loss of this income if they resolve their PTSD. If they have been out of the job market for many years, it may be very difficult to get a job that pays as well. If they continue to receive disability payments, while knowing that they no longer have PTSD, they have to find a way to make that congruent with how they think of themselves. “Am I a person who is willing to accept money for being disabled, when I know that I am no longer disabled? Is that OK? I do need a way to get by. Is it OK to accept disability payments until I can get a job?” One of the useful functions of identity is to provide a stable and durable foundation for our behavior and our direction in life. When something negates that identity, it also negates the stability and direction that it provided.

Whenever someone is uncertain about their interests and direction in life, it is very useful to help them discover what is interesting and important to them, and explore the opportunities that are available to them to actualize these interests. This might include what is sometimes called “values clarification,” “life coaching,” “career counseling” or “discovering one’s mission in life.” Many people try to figure out their life path on the inside — by just thinking about it. However, it usually works much better to learn what we like and how we want to contribute by taking action in the world. This is how it happens naturally for people. As children and young adults, we do lots of different activities and notice what we like and don’t like. We also notice what others seem to appreciate from us. Many careers are discovered this way, and this process of exploring and getting feedback never stops for someone engaged in the world. So giving a client tasks to do a range of different activities is a way to further this process. Ask your client to explore activities that s/he knows little about, or give a task to volunteer for some kind of community service, or some other activity that takes them into contact with activities and people whom they otherwise wouldn’t get to know.

Keep in mind that many people who have never experienced PTSD can also make good use of this kind of exploration, so it can also be useful for many other clients as well. If someone has passively “gone along with the crowd” and never really chosen their life path, then when that path is disrupted by a significant change — loss of a job, retirement, loss of a spouse through death or divorce, serious injury or disease — they may also feel very lost, and need help in finding a new life path that is in alignment with who they are now in their changed circumstances. This often occurs in what has been called a “mid-life crisis,” but of course it can happen at any point in someone’s life.

So Tom’s question is a good one that goes far beyond PTSD, to whenever someone makes a significant change. Rehearsing the change in several future contexts to find out how well the change works will usually indicate when further work is necessary.