When an event or experience in one’s life becomes so painful that it is unendurable, it is called traumatic. Sometimes a single event can be traumatising and sometimes trauma is the result of a group of difficult experiences. The symptoms of trauma can begin immediately following a traumatic experience or arise much later. Causes of psychological and emotional trauma include experiencing violence, childhood abuse, living through catastrophic events (like war or natural disasters), and accidents. The death (or loss) of a person can be traumatic for some people. Life transitions like moving home or leaving one’s culture can have a traumatic impact on some people’s lives. Throughout life, there are many experiences that some people find traumatic. PTSD is a special type of trauma that requires specialised treatment. The types of treatment I provide are called Narrative Exposure Therapy (NET) and Prolonged Exposure Therapy (PE).
IN THE REGION OF TRAUMA, ALL DURATION OR STRETCHING ALONG COLLAPSES; PAST BECOMES PRESENT, AND FUTURE LOSES ALL MEANING OTHER THAN ENDLESS REPETITION.
[ROBERT STOLOROW, PHD.]
Intensive Therapy for PTSD, Multiple, and Complex Trauma
Narrative Exposure Therapy (NET)
I am an experienced practitioner of Prolonged Exposure Therapy (PE), and one of only a handful of private practitioners in London who offer NET. Narrative Exposure Therapy is a brief, evidenced-based, manualised treatment for complex and multiple trauma. It is favoured by human rights organisations as a first-line treatment for refugees, victims of sex trafficking, and other victims. Numerous studies have shown that NET significantly reduces the symptoms associated with complex and multiple trauma.
With my help, a client identifies a chronological narrative of his or her life, focusing mainly on their traumatic experiences, but also incorporating positive events. This process contextualises the network of cognitive, affective and sensory memories of a patient’s trauma. By expressing the narrative, the client fills in details of fragmentary memories and develops a coherent autobiographical story. In so doing, the memory of a traumatic episode is refined and understood in context.
I ask my client to describe his or her emotions, thoughts, sensory information and physiological responses in detail. He or she is then asked to narrate the traumatic experience and relive the emotions experienced without losing connection to the present moment. When NET treatment ends, a documented autobiography that has been created by me is presented to my client.
By engaging in narrating their whole life story, my client does not need to choose one particular traumatic occurrence from numerous ones experienced across the lifespan. Rather, NET grants my client the freedom to reflect on their entire life, cultivating a feeling of personal identity. Going over the biography helps to highlight understanding of experiences and contextualise interrelated emotional responses, which facilitates integration and comprehension of behavioral patterns and schemas that emerged during development.
NET is distinct from other treatments in its explicit focus on recognising and creating an account or testament of what happened, in a way that serves to recapture the patient’s self-respect and acknowledges their human rights.
Prolonged Exposure Therapy (PE)
I am an experienced practitioner of Prolonged Exposure Therapy (PE), and one of only a handful of practitioners in London who offer PE. Prolonged Exposure Therapy is considered by the United States Veterans Association to be the gold standard in evidenced-based, manualised treatment for posttraumatic stress disorder (PTSD). Numerous well-controlled studies over the past two decades have shown that PE significantly reduces the symptoms of PTSD as well as co-morbid symptoms of depression, anger, and anxiety. In addition to reducing symptoms, PE also instills confidence and a sense of mastery. Clients become more able to discriminate safe and unsafe situations, and experience improvement in many areas of everyday functioning.
PE is based in Emotional Processing Theory, which posits that PTSD symptoms arise as a result of cognitive and behavioural avoidance of trauma-related thoughts, reminders, activities and situations. PE helps the client interrupt and reverse this process by blocking cognitive and behavioural avoidance, introducing corrective information, and facilitating organisation and processing of the trauma memory and associated thoughts and beliefs. This is accomplished through in vivo and imaginal exposure.
Imaginal exposure involves repeatedly revisiting the traumatic experience in memory by describing the event aloud in detail. The narrative is recorded and the client listens to the recording between sessions to maximise therapeutic value. Revisiting the event in this way helps processing of the traumatic memory by activating the thoughts and emotions associated with the trauma in a safe context. Imaginal exposure also helps the client realise he or she can cope with the distress associated with the memory.
In Vivo Exposure
In vivo exposure involves repeatedly engaging in activities, situations, or behaviours that are avoided because of the trauma, but which are not really dangerous. Over time, In vivo exposure lessens fear, and other distressing emotions, and helps with the recognition that the avoided situations are not overly dangerous, and that the client can cope effectively even when distressed.
Why Prolonged Exposure Therapy?
- PE has the largest number of studies advocating its efficacy and effectiveness.
- PE has been found effective with the widest range of trauma populations.
- PE has been found effective in co-morbid populations (substance use disorders, BPD, psychosis, etc.).
There is great hope for PTSD and Complex Trauma sufferers.
Narrative Exposure Therapy and Prolonged Exposure Therapy can help untangle the complex emotions and fears that trauma survivors feel.
Controlled studies have shown that Prolonged exposure produces clinically significant improvement in about 80% of patients with chronic PTSD.
Although Narrative Exposure Therapy is a relatively new treatment, it is overtaking other forms of treatment as the gold standard therapy for human rights victims and has been shown to have greater effects than other forms of treatment for human rights victims.
Treatment lasts for 10 sessions for PE and for 6-8 sessions for NET with each session lasting 90 minutes. For best results, sessions should be scheduled once to twice weekly. A course of sessions, or individual 90-minute sessions, may be scheduled and paid for directly through my website, or please feel free to email me with questions.