Treating PTSD: Creating a “Safe Space”

By
Virginia M. Spaulding, Ph.D
Deployment Health Psychologist

Over the past eight years, I have worked with service members from all branches of service who are experiencing various symptoms of Post-Traumatic Stress. What makes this condition a disorder or not has to do with the degree and intensity of the symptoms experienced. These symptoms include re-experiencing the emotional and cognitive reactions related to fear, avoidance of people and places where the person feels unsafe or threatened, being irritable and having negative beliefs about themselves as moral human beings and the world as fair and kind place, and finally starling easily and being overly reactive in physical sense to sounds and crowded spaces where control over the environment is not easy. The other condition that contributes significantly is feeling part of a “tribe” which consists of people who know and understand the shared experiences of the person experiencing the trauma. Social support is a key factor in what makes the experience of an event a crisis moving the traumatic events form a shared experience that can be resolved to a disorder in which the person is walled off and isolated. Those returning war vets who can stay with their units consistently do better than those who are assigned as an Individual Augmentee (IA) and return to units that do not share the individual’s experiences.

The Department of Defense endorses several treatment options including Cognitive Processing Therapy, Prolonged Exposure, Eye Movement Desensitization Reprocessing, and more recently Somatic Therapies, and Virtual Reality Therapies. These are all good and useful treatments but without the creation of the “Safe Space”, where the service member feels accepted and non-judged as a human being, these treatments have less than optimal effectiveness. In my experience, it is really the creation of the “Safe Space” within the community of those who have had similar experiences that helps get the person to the place where the treatment factors can be most effective. This concept of the “Tribe” was brilliantly illustrated in Sebastian Junger’s book by that name where he discusses PTSD in the United States and how the isolation of experience leads to a much greater probability of remaining symptomatic.

So what does all this mean for us as friends and spouses of service members returning from war, or others who have experienced different types of trauma? People need an accepting witness to their experiences and people with any kind of trauma need to feel safe first before they can move on to a positive resolution of their traumas. So what is it that makes for a “Safe Space”? One condition is respect for the immensity of upheaval that your valued friend, or spouse, has undergone. This means offering a space to talk when it feels right but respecting privacy when it is requested. This will mean a great deal in helping them to talk about their experiences when they are ready. Understanding that traumatized people often pass judgment on themselves for behavior that they believe to be amoral, wrong or bad, isn’t an important factor. Creating the space where the experience can be revealed in its full unpleasant detail without judgment is incredibly important. it is really like a spiritual connection in which the traumatized person can feel fully accepted in spite of the scars they carry. It is in this “Safe Space” that the ugliness of the experiences can be revealed and the healing connection of witnessing car be shared.

And finally, it is important to understand that healing from a traumatic experience may take some time. many service members do not experience the symptoms of chronic post-traumatic stress until some years after the event. it may be at the time of retirement or when the member leaves the service that they begin to truly process their experiences. So continuing to “know” on the one hand that the person has experienced a traumatic event and continuing to provide a “Safe Space” for them to talk without judgment about time frames, is significant. Statements like “haven’t you gotten over this yet?” or “that was five years ago” are non-helpful statements that will send the traumatized person back into hiding. So in a large way, a “Safe Space” is for the long term.

As the partner or friend of the traumatized veteran, it is also important to have one’s own expectations, feelings, and thoughts. You are in a relationship and I have found that being honest about how some of the behaviors affect you is very important. The traumatized person knows they are not OK and that their behavior is off. So take away the layer of guilt that keeps them separated and let them know it is difficult but that you are willing to hang in there. Talking about how you’re affected is very different from judging the person for their experience. in the end, the traumatized person often believes that keeping the traumatic experiences away from friends and family is a way of protecting them from the horrors of what they have experienced and have done. Let them know that even though you were not there and have likely not experienced what they did, that you are still with them and that included who they are because of their experiences, all of them. Remember that you are the tribe and by creating that all important “Safe Space” that honors both you and the service member, you can make the biggest difference in their professional treatment whatever methods are used.