Professional PTSD Counselling Diploma Course

Professional
Post-Traumatic Stress
Disorder
Counselling Course
The KEW Training Academy

Professional PTSD Counselling Course
Copyright
Copyright © 2016 by: The KEW Training Academy
Cover and internal design ©2016 The KEW Training Academy
All rights reserved. No part of this course may be reproduced in any form or by any electronic or
mechanical means including information storage and retrieval systems – except in the case of
brief quotations in articles or reviews – without the permission in writing from its publisher, The
KEW Training Academy.
All brand names and product names used in this course are trademarks, registered trademarks, or
trade names of their respective holders. We are not associated with any product or vendor in this
course.
Table of Contents
Contents
Professional ................................................................................................................................. 1
Post-Traumatic Stress Disorder ...................................................................................................... 1
Counselling Course ..................................................................................................................... 1
The KEW Training Academy ..................................................................................................... 1
Professional PTSD Counselling Course ..................................................................................... 2
Copyright ........................................................................................................................................ 3
Table of Contents ............................................................................................................................ 4
Introduction ..................................................................................................................................... 6
Module One .................................................................................................................................... 8
What is PTSD?............................................................................................................................ 8
Module One .................................................................................................................................. 14
Self-Assessment Tasks.............................................................................................................. 14
Module Two .................................................................................................................................. 15
The Effects of PTSD ................................................................................................................. 15
Module Two .................................................................................................................................. 29
Self-Assessment Task ............................................................................................................... 29
Module Three ................................................................................................................................ 30
Clues ......................................................................................................................................... 30
Module Three ................................................................................................................................ 45
Module Four.................................................................................................................................. 47
Children and Teenagers ............................................................................................................ 47
Module Four.................................................................................................................................. 53
Module Five .................................................................................................................................. 54
Identify and PTSD .................................................................................................................... 54
Module Five .................................................................................................................................. 61
Module Six .................................................................................................................................... 62
Medication ................................................................................................................................ 62
Module Six .................................................................................................................................... 70
Module Seven ............................................................................................................................... 71
Mind and Body ......................................................................................................................... 71
Module Seven ............................................................................................................................... 81
Module Eight ................................................................................................................................ 83
Recovery Journey...................................................................................................................... 83
Module Eight ................................................................................................................................ 88
Final Assessment .......................................................................................................................... 89
About............................................................................................................................................. 91
Additional Courses........................................................................................................................ 92
Professional ................................................................................................................................... 97
Post-Traumatic Stress Disorder .................................................................................................... 97
Counselling Course ....................................................................................................................... 97
Introduction
Thank you for purchasing this professional Post Traumatic Stress Disorder Counselling Course.
This course should be studied alongside a professional counselling qualification or, as an add-on
for those who already hold a qualification in counselling.
PTSD is such an emotive subject. It can happen to anyone. Treatment and support may be varied
and extensive.
We all experience the unpredictability of life, having to overcome obstacles as they occur,
progressing in the best way that we know how. But for some, life is more than unpredictable, it
becomes traumatic. Traumas affect people differently and, do not automatically cause PTSD,
there are a number of variables, but for those who do experience Post-Traumatic Stress Disorder,
the effects can be considerable; fear, recurring nightmares, memory lapses, flashbacks and they
will often feel very isolated withdrawing from even those closest to them. Severe trauma has the
power to alter the individual’s feelings about themselves and how they view the world around
them. They may lose a grasp on their own identity and struggle to maintain normal life.
For any individuals with PTSD, the world becomes a terrifying place. They understandably feel
scared and lost, but they may also feel saddened by the loss of their former lives. In addition,
they may feel anger. Often traumatic life events are completely outside of their control, and as a
result, their once comfortable environment turns into a reality that they do not recognise.
If you have already qualified as a counsellor, you may be used to seeing clients with varying
degree of stress and sadness but those with PTSD will take this to a new level because often, fear
governs their every move in life and they are unable to break free from past traumas. With care
and with varying counselling techniques, most of those with PTSD can recover and at the very
least, regain some normality of life. It is not always an easy journey to make however, there is
always hope even if their PTSD is severe.
This course takes into consideration the basics of this disorder, what it is, the techniques that can
help someone to heal, as well as being able to offer advice or guidance to family members or
friends of the sufferer who are often alienated as a result of this condition. If you are undertaking
this course because you are a sufferer of PTSD, know that it will help if you practice the
techniques within, it will also help you to realise that you are not alone and why you feel the way
that you do.
If you studying so to add this qualification to your skills, know that you will be able to help those
who have experienced and survived the traumatic events which have shaped them often beyond
recognition. Importantly, it provides options for recovery and enables those who are prepared to
move towards recovery, to do so.
At the end of each of the modules, you will find self-assessment tasks which help you to test
your knowledge of the information gleaned within each module. It is important that you take the
time to do so and if any of the tasks are difficult, take the time to go back through the module
again until you feel ready to try out the assessments. These tasks will help you to prepare for the
final assessment at the end of the course.
If you are ready, let’s turn to Module One.

Module One
What is PTSD?
We have all heard of PTSD and perhaps have encountered someone who has been diagnosed
with it. It may have been someone close to you or even an individual who lives locally, they may
have changed in their persona, acting out of character or even strangely, but this is only the tip of
the iceberg in PTSD terms.
Post-Traumatic Stress Disorder is a very real and damaging condition. It has a far-reaching
impact on those who experience it and although many people associate it with military personnel
and the horrors of war, PTSD can be experienced by people from all walks of life. Often these
are individuals who feel terribly isolated and who re-live the scenario of their personal traumas
over and over as if a waking nightmare. Their emotions may be extreme – deep sadness,
depression or extreme anger. The individual may suddenly find their mind whipped away from
the present and dragged unwittingly back into the trauma.
Although this condition creates feelings of isolation and the individual may feel as if they are the
only one suffering from PTSD symptoms, the true reality is that there are probably millions of
people all around the globe who suffer from this.
PTSD is serious.
If you have it or know someone who appears to have any of the various symptoms, they need
treatment. There is no way around this. Internally, their lives become disordered and out of
control although to an outsider, they may seem to be coping. Their reality is far from this
however, as inwardly, they fight against symptoms that can easily overwhelm. If these symptoms
are left untreated, they can become so overpowering that the individual struggles to sustain a
relationship, or even to hold down a job.
PTSD causes the individual’s nervous system to be constantly on the alert, and by contrast, they
may feel totally detached from real life. Often sufferers face conditions such as depression and
may even develop substance abuse as a coping mechanism. There are those who develop
complex PTSD and may have multiple traumas to face, recovery is harder and there is also the
possibility of dangerous or self-destructive behaviours.
It doesn’t matter how strong minded an individual or how much they feel they can get better on
their own, treatment for this disorder is absolutely vital because it will not alleviate until they do.
These are not simple or temporary stressors, in fact, this disorder instigates deep psychological
and biochemical changes within. This means that those dreadful memories of the offending
trauma will not fade, leaving the individual trapped within their own personal hell.
Unfortunately, without treatment, there is a cycle of damage; i.e. the loss of a job, no money, and
broken relationships.
Fortunately, PTSD is treatable and as a counsellor, it can be very rewarding to help those who
have become confined within this disabling disorder.
PTSD is not new but we may just hear it discussed more broadly these days. Although the term
itself may be relatively new, if we turn our attention back throughout history, we see that those
who were involved in war and who have faced violence, have often experienced deeply
traumatic symptoms. In World War I, it was called ‘shellshock.’ In World War II, soldiers
experienced what was known as ‘battle fatigue’ and then, if we look at the Korean War, it was
known as ‘gross stress reaction.’
PTSD is invisible. It affects the mind and not the body so it is hard for others to understand.
People have often considered PTSD to indicate weakness although this is far from the truth.
Anyone who survives a serious traumatic event can develop this disorder.
Tip:
There is no recovery without treatment and

for this, an accurate diagnosis must take
place.
There is still much research taking place but fortunately, there are treatments and therapies that
can help the majority of sufferers. Although people are often ignorant of this disorder, many
people have suffered in silence because they were not aware that they were suffering from it.
This is why it is important to help others become aware of the symptoms and to certainly help
families and friends of those affected to recognise and understand the effects of it. Otherwise, the
sufferer will slip deeper and further into depression and isolated without understanding why.
While PTSD understandably affects soldiers, it is abundantly clear that anyone can experience it.
This means your colleagues, your doctor, your librarian, or even your hairdresser could fall foul
to this life-changing condition. Statistics show that women tend to develop PTSD more than men
and also, people within African-American or Hispanic groups will also have higher rates of
PTSD, but this may also be relevant to the amount of violence experienced in those areas.
Sadly, even children can and do develop PTSD. Every parent wishes to protect their child from
traumatic incidents, but it is impossible to do so. You only have to consider terrorism, road
accidents or natural disasters such as earthquakes to know that the lives of children can be
completely shattered as a result.
PTSD occurs as a result of an experience that is horrifying or terrifying. It can be absolutely

anything. It affects people on an individual level. One person may become a broken individual
while another who experiences similar is able to make a full recovery.
Just consider the number of people who may be affected having experienced:
Fires
Earthquakes
Hurricanes
Tornadoes
Tsunamis
Natural disasters are huge causes of PTSD because they have an impact on so many people. If
you consider that a hurricane can destroy so many people’s homes and leave them without food
and water or even, without money, it’s not surprising that a great many of these people will
experience some aspect of PTSD. It doesn’t just affect those who have experienced the disaster
first-hand. Consider the large number of responders who help in the aftermath of a disaster, they
often witness horrifying scenes and many will experience what is known as secondary traumas.
PTSD doesn’t always occur as a result of a dramatic event. Anyone can do so when facing an
event that is traumatic for them on a personal level. A death of a loved one or someone battling a
life-threatening condition could still experience some aspect of PTSD. In addition, anyone who
has suffered from abuse or some sort of violence in their lifetime, could experience this
condition.
In the main, the highest risk for traumas often include the following:
Rape or sexual abuse in adulthood

Sexual or physical abuse in childhood
Domestic violence
Armed robbery or torture
Violent acts leading to death
Violent acts play a huge part in the in the vast numbers of soldiers who have developed PTSD
but, we also have to include those who are in the police or other service who are often in the
direct line of fire. Not all PTSD is caused through human-related traumas as it can be caused
through traumatic accidents. Certainly anyone who has lived through a terrifying or potentially
deadly event stands a higher risk of getting PTSD.
It is important to note that the cost of PTSD when left untreated is extraordinary high. It’s a
silent killer but in many ways, should also be noted as a public health crisis. Sadly, many
wonderful people are lost each year due to their PTSD being untreated and this is often through
irrational actions or through experiencing suicidal thoughts. In addition, there are high medical
costs and legal issues too as many people lose their ability to look after themselves if the PTSD
had created relationship or work issues. Because this condition makes it difficult to control
emotions or to even handle any pressures at all, is not surprising to know that a great many
sufferers start to experience problems in all areas of their lives. In fact, the divorce rates for those
with untreated PTSD are extremely high.
In addition, another negative side-effect is that any children within the family unit where
untreated PSD is present, are far more likely to develop learning or emotional problems than
other children of the same age.
You may have noticed a common element throughout, that of, being untreated. Once an
individual has been diagnosed and given treatment – be it therapy or medication, the severe risks
reduce dramatically.
You may see many sufferers of PTSD in your counselling practice and setting up a connection
and building rapport with them will be paramount to their success because trust may be an issue.
Therefore, be honest with them and explain how PTSD affects them, that they are not alone in
their recovery but, that it will take some time.
Remember, there is always the hope of full recovery providing they stay the course and attend
therapy and receive a proper medical diagnosis.
Module One
Self-Assessment Tasks
Task:
What does PTSD stand for?
Task:
Who can suffer from PTSD?
Task:
List some of the main causes of PTSD
Please note that these self-assessment tasks are to ensure your understanding of the information
within each module. As such, do not submit them for review with KEW Training Academy.
Module Two
The Effects of PTSD
In everyday terms, we tend to think of our memories as usually being a positive element in our
lives. But memories are not always positive, in fact, they can have a dark edge to them so that
you recall upsetting or hurtful memories leading towards feelings of anger or great sadness.
Sometimes, you may feel embarrassed or humiliated and desperately wish to push these
memories to one side. If you consider this to be true, consider how bad the memories can be for
someone who has PTSD.
The memories recalled usually may be embarrassing or hurtful but in the main, these are minor
incidents which occurred in the past and which will not have a life-changing impact. Consider
instead, the possibility of a traumatic experience, one where you may have narrowly survived.
Or, what it must feel like to have experienced a natural disaster. Although you cannot completely
comprehend the enormity of such a situation, it can help you to identify with someone who has.
Any individual with PTSD who seeks out your counselling services will have experienced a
trauma and will therefore, desperately need your help. The trauma may have affected them on a
physical level and an emotional level. Their thoughts may be jumbled or erratic, their moods
fluctuating and they may feel as if they have no hope left of a future. They may feel weak as an
individual and most certainly, lost. Although most people consider traumas to be an unusual and
somewhat, substantial event that has occurred i.e. an earthquake, it is important to realise that
some traumas are not newsworthy and far from rare.
Consider the following:
An overwhelming event that causes considerable distress. This can be anything from a
natural disaster to an individual suffering from a life-threatening illness.
An event that threatens either life or someone who is close to them. (This does not
include those who are suffering from secondary traumas i.e. rescue teams, police officers
etc.)
An unexpected event which could be a violent assault, a motoring accident or even an
event that happened in nature i.e. lightning.
An event that creates feelings of helplessness, fear or horror.
So from this we can understand that a trauma is something that shakes the very core of the
individual, not just on a physical level but on an emotional level. It makes them terrified, fearful
for their safety or for the safety of others. It has the power to break down any psychological
defences. Going forward, any sense of security that they may have experienced previously is
likely to be shattered.
Often, people may come to you experiencing self-traumas and these could be anything between a
substantial trauma and everyday stressors. We call these sub traumas because they are very real
to the person and depending on the individual, they may indeed need substantial help and support
but these will not be the signs of PTSD.
Day-to-day stressors:
An argument with a loved one
Career changes
Problems at work
Moving house
Commitment i.e. wedding
Although these can all be highly stressful, they are still a part of life and can be dealt with.
Loss of control
When an individual loses control in their lives, they start to question their ability to function, to
make decisions or to even stay safe. If they have had a fall and hurt themselves a little, they may
feel unsettled, physically or emotionally shocked, but after a few minutes, will be able to pick
themselves back up and to start taking control of their lives again, in comparison to the feelings
that they would experience if they were mugged.
When an individual has control of their feelings, they are able to take a break from any anxious
thoughts, distracting themselves by watching a comedy and even be able to laugh, but, by
comparison, someone who has experienced a deep trauma, will not be able to distract themselves
in this way, negative feelings, suicidal thoughts or flashbacks will not go away or stop.
A trauma will change the individual’s world. They may lose belief in others and themselves. In
fact, PTSD can shatter their basic belief systems. They may not be able to trust others or their
own instinct.
Someone suffering from PTSD feels that the world around them is a dangerous place and that
there is little to no hope. Unlike day-to-day stressors which usually pass with time, traumatic
events and subsequent memories and feelings will not. But there are layers to PTSD. Although,
there will be significant damage which is easily determined, there are often secondary wounds.
Financial issues, work issues or relationship problems all add on a secondary level. Even those
closest to the individual will not understand why they have not recovered.
Stress affects us all. Although long-term and unresolved stressors are harmful to health and well-
being, stress can be used in a positive way. To start with, it is life-saving. The fight or flight
instinct that we all have is there to protect us. It can challenge and enable you to exceed all
expectations and to reach difficult goals. But the stress that occurs as a result of any trauma can
be damaging both physically and mentally and all too often, the individual is bombarded with
dark, destructive thoughts and this is why anyone suffering from PTSD must seek professional
help.
In many ways, the trauma and subsequent symptoms that come with PTSD is natural.
We are hardwired to feel a multitude of difficult emotions when we feel stressed or when bad
things happen. It is instinctive. Our brains try to prevent the same things from happening again.
We each deal with these stressors in a unique way. So even two people involved in the same
situation will recover at different speeds and through different methods.
The stress response
We’ve all experienced typical responses to stress generally including; insomnia, headaches or
even palpitations. But stress can have a deep impact on health and well-being including:
Difficulty concentrating
Decision-making impaired
Confusion
Feeling disorientated
Difficulty recalling some aspects of the trauma
But there are emotional effects too:
Guilt
Grief
Feeling helpless
Feeling isolated
Feeling vulnerable
Feeling abandoned
Anger
Irritability
Fear
Physical effects:
Exhaustion
Headaches
Increased heart rate
Feeling startled more frequently
A loss of interest
Relationships:
A loss of libido
Blame
A desire to stay at home
Feeling overprotective
Hostility
Withdrawing from life
These are all very powerful feelings that can last not just days or weeks but even months.
Although these may be typical stress responses, in comparison to the sensation of those who
have PTSD, they are minor in impact. These can and do get better if the individual who feels
stressed makes changes to their life. For someone recovering from a trauma, they may not be
able to make the necessary positive decisions for change.
Acute stress:
When acute stress disorder is present, these are individuals who will not just adjust back to
normal life following the trauma. In fact, as many as one 1/3 of those who have survived trauma
will continue to experience symptoms that impact their lives on a significant level. These
feelings will not fade away in a matter of days or weeks.
Tip:
Often acute stress disorder starts within 4

weeks of a trauma.
The symptoms may last only for only a few days but can continue up to and beyond a four-week
period. Note that if the symptoms continue beyond a four-week period, the diagnosis is then
likely to be PTSD.
PTSD sufferers will experience symptoms that impact their life on such a severe level that they
cannot cope with day-to-day activities. This may sound a relatively easy way to diagnose PTSD,
but in reality, it’s not quite as easy to calculate whether an individual has such serious problems.
Doctors look at the severity of the symptoms and have to consider whether these symptoms are
more severe than if experiencing a normal stress reaction.
As an example:
Disassociation.
This is common and where the individual feels different, they may notice changes within
themselves, their concept of time may be impacted, any memories may be impaired and they feel
or act as if ‘spaced out’. In other words, they live in a daze state. For these individuals, the world
may seem very un-real to them. Even the most familiar of places may seem unrecognisable and
certainly unfamiliar. Even the people around may not seem real. Time can speed up or even slow
down for them. An individual may say that they feel as if they are watching their own life…in
the same way, they view a film. They may also experience sensations within their body which
may frighten them i.e. feeling as if their body parts are disconnected. They may have little
emotions or feel numb. They may have lost a lot of the memories several surrounding the
trauma. Anxiety is also common. They will find it difficult to let anyone close to them. They
cannot bear to connect with anyone who also experienced the trauma or, indeed anything
associated with it.
Post-Traumatic Stress disorder
If we consider the symptoms of Acute Stress Disorder, we can see that they are indeed similar to
those of PTSD. This is because those symptoms, if they do not start to dissipate, will lead to
PTSD (in diagnostic terms). Remember that the symptoms must generally last longer than the
four-week period. But PTSD tends to be a much more powerful and negative response and it
certainly does not go away on its own.
PTSD and Acute Stress Disorder sufferers share three core symptoms:
Being on red alert (hypervigilance)

Intrusive thoughts relating to the trauma
Avoidance
One main difference between Acute Stress Disorder and PTSD is that dissociative symptoms
relative to Acute Stress do not need to be present for a diagnosis of PTSD to be made.
The following may be a little difficult to understand because diagnosis cannot fall into neat
boxes. So although PTSD is likely to be diagnosed if all of the symptoms last for longer than a
four-week period, if you refer to the Diagnostic and Statistical Manual used within psychiatry, it
clearly states that for acute stress disorder to be diagnosed, the individual would need to have
experienced disassociation i.e. to not feel connected to themselves. However, this is not
necessarily relevant for PTSD.
Initially when the symptoms/diagnosis were first defined, it was considered that disassociation
experienced quickly after trauma was experienced thereby predicted PTSD but nowadays
research doesn’t really support this idea. Some doctors do not think disassociation is an essential
element for diagnosis and in fact, may also believe that Acute Stress Disorder need not be
diagnoses, instead, it should fall under the PTSD umbrella.
Although we have clearly stated that when symptoms do not start dissipating after four weeks,
then PTSD is likely, it does not necessarily mean that the symptoms will not continue to improve
thereafter. In fact, some people experience symptoms of stress for several months and then,
suddenly start to feel a little better. Others seem to heal emotionally and physically fairly quickly
but then experience problems later on.
Let’s look at two elements which point to PTSD:
It impacts life. When PTSD is present, even the day-to-day elements of life are affected. The
sufferer may not want to go to work, they may not feel up to shopping, or even to have the
energy to cook a meal. When an individual experiences strong stress reactions, it may be so
powerful and overwhelming, but some people can still continue coping to some degree.
When symptoms last for a long time, although doctors may not wish to diagnose PTSD until at
least four weeks have passed, it is likely to be PTSD when the symptoms do not start to
eradicate.
Simple PTSD
Simple PTSD will often occur where there has been a single traumatic event. The individual may
have been attacked or, perhaps involved in a motor accident although there are a great many
potential causes. Symptoms may be mild or even serious by nature and sufferers may experience
avoidance, always feel hypervigilant and even experience intrusive thoughts. Simple PTSD
responds well to CBT (Cognitive Behavioural Therapy and Counselling treatments).
Complex PTSD
This occurs when people have suffered from repetitive traumas - consider abuse that occurred in
childhood or perhaps vicious and ongoing attacks from a family member. The following are
common causes of complex PTSD:
War-related traumas
Chronic relationship abuse
Urban violence
Childhood sexual or physical abuse
Childhood neglect
These events can change someone on an emotional or physical level and those with complex
PTSD will often experience a greater array of symptoms and traditional methods for recovery
may not help. However, even Complex PTSD is treatable but recover may be slow and the
individual may always experience some symptoms even if greatly reduced.
Doctors have a tendency to divide PTSD into three subcategories based on the timeline of the
symptoms:
Acute Post-Traumatic Stress Disorder - this is a term given when the symptoms have been
present for less than three months
Chronic Post-Traumatic Stress Disorder - this is the term given when the symptoms have lasted
for more than three months
Delayed Post-Traumatic Stress Disorder - this is where the symptoms do not start until six
months or more after the trauma has occurred. Although this is rare, it can be experienced in
some war veterans who have seen the atrocities of combat and in those individuals who were
abused as children.
Individual elements:
We are all unique beings and therefore, on a personal level, our risk for experiencing PTSD is
different from anyone else. Variables include life-history, gender, the brain structure and
genetics.
Age - anyone can develop PTSD but age does play a factor as to whether the individual develops
long-term problems after experiencing trauma. Young children are at risk if their trauma has
separated them from their family unit. Those individuals who are in middle age, age group - 40
and 60 years of age, will often have an increased risk for PTSD after experiencing trauma. This
is often because an individual may have to cope with children and any elderly parents and
therefore, have increased levels of responsibilities to cope with should trauma strike.
The elderly, this group tends to cope fairly well following traumas especially if they are
physically healthy. This may be because they have lived long enough to be able to cope with
obstacles in life and are more emotionally able to deal with difficult situations.
In addition, there are multitude of circumstances in life that need to be considered:
Considerable stress - sometimes an individual will be under severe stress in life, so

overwhelming that they feel they cannot cope. The slightest trigger thereafter can increase their
abilities significantly.
Mental health disorder - if an individual is already experiencing psychiatric issues prior to the
trauma, the effects will be considerably worse.
Parental considerations - being a parent can also add to the risk of long-term symptoms because
there is additional responsibility in respect of caring for children.
Financial issues - money problems can certainly increase the traumatic effects of any situation as
they add an extra element of stress.
Personality traits - although anyone can experience PTSD, those individuals who naturally tend
to have optimistic personalities may have a reduced risk of developing the condition whereas
those who are naturally negative are more at risk.
Gender - women are more than twice as likely to develop PTSD if the trauma involved a
physical or sexual assault. Research indicates that women often react more strongly to natural
disasters.
Although it is not known for sure why gender plays such a key role in the risk of PTSD, the
following may be potential reasons:
Women are physically smaller and therefore, may be more vulnerable, a crisis threatens their
safety and in respect of rape, this affects more women than it does men.
Women will react more strongly if the crisis also involves children.
Women tend to be less aggressive than men and so may feel that they have little control over a
situation.
Women may be more empathic towards the suffering of others and this may also increase the
risk of PTSD
Women display symptoms of stress more readily than men. This makes it easier to identify and
women will seek medical help sooner, facing up to their symptoms more than men generally.
Although genes may well play a role within PTSD there is no single gene responsible. Therefore,
scientists conclude that a variety of genes and possibly, in varying combinations will increase or
decrease the risk for PTSD.
Research indicates that an individual who suffers with individual may also have stress reactions
that won’t turn off. Again, scientists are unable to identify a single chemical responsible for this
but there are indications that natural body chemicals, at abnormally high levels may be a greater
risk. It is possible that adrenaline and cortisol may create feedback loops where related chemicals
(out of control) are sent out and add to this to the combinations of life experiences, gender and
genes etc. and you can see why PTSD is very much an individually related condition.
The brain
Research indicates that people who have PTSD tend to have a smaller than average
hippocampus. There are two in the brain, one on the left side and one on the right and this region
relates to memories. Unfortunately, it is susceptible to stress. What is not known currently is
whether the stress of the trauma causes the hippocampus to shrink or whether those who have
experienced PTSD have a reduced hippocampus initially.
Where there is chronic elevation of cortisol levels (stress-related hormone) this can certainly lead
to brain cells being damaged and, result in a smaller hippocampus. Studies have also indicated
that there may be differences in size or even function of other brain areas in those people who
have PTSD as an example, the amygdala – responsible for creating alerts when danger occurs.
We do know that the symptoms of PTSD do correlate with abnormalities in these areas of the
brain. As a classic example, some people with PTSD will have memory problems which
seamlessly connect with abnormalities in the structural function of the amygdala or with an
impaired hippocampal function.
The type of trauma
The types of trauma may vary as will the reactions of those involved:
The severity of the trauma - this can be a trauma that dissipates quickly without anyone being
injured or killed.
The cause of the trauma - traumatic events that is out of the individual’s control. It may have a
long lasting impact but perhaps not as much as would a traumatic event caused by another
person.
The surprise factor - those traumas that occur with little warning will often give the individual no
chance to prepare.
The violation of personal boundaries - when physical abuse or rape has occurred and which has
breached personal boundaries
The number of traumas suffered - if someone has survived one trauma, they are likely to have a
far greater risk for developing PTS again.
Post-Traumatic Stress Disorder can really impact the individual’s memory. Short-term memory
including any chronological order of the traumatic events may become jumbled. Undoubtedly,
one of the worse aspects of PTSD is when difficult memories continuously rise to the surface as
a constant reminder of an event that is both painful and harrowing. It’s true to say that the most
traumatic of memories often lie dormant for weeks or months but can resurface if a trigger
occurs.
The trigger could be anything at all, a comment, an object, or an actual place but it must be
linked in some way to the original event. When it occurs, it can create a multitude of emotional
and physical responses leading to the individual experiencing the sheer horror of the trauma all
over again.
In counselling terms, this is known as traumatic coupling. It is so powerfully connected to the

original trauma, that the trigger creates the same response. Sometimes it can be very easy to
detect a trigger. If someone as experienced a traumatic event i.e. they nearly drowned when a
boat sunk, the trigger could be a new report on TV, or an image of a boat or shipwreck. This
alone could be sufficient to trigger off unhealthy anxiety levels. Other triggers may be much
harder to detect.
There are:
Sensory triggers - these are very powerful and often bring back a multitude of other
memories. They include sounds, sights, tastes, odours and sensations.
Painful physical experiences - as an example the sight of blood could trigger off bad
memories. Dates could trigger off the memory of the anniversary of the trauma or, relate
to an individual who may have died in the event.
Emotions connected to the trauma - when terror has been experienced or any other type
of fear can trigger a flashback
Legal proceedings - where legal proceedings are involved after the trauma, this can
repeatedly create triggers.
Intimacy - contact with another person in an intimate way can trigger off a PTSD
response especially if the original trauma was sexual or physical abuse.
Milestones - a milestone can create many emotions and act as a trigger leading toward
difficult memories re-surging.
Module Two
Self-Assessment Task
Task:
Find a volunteer (even if someone is prepared to act out the role) and then create a case study of
treatment depending on the information given to you. Note down the traumatic event, their
reactions, symptoms etc. Although this is not as good as if speaking to someone who has or who
had PTSD, it will help you to learn the best questions to ask, to feel comfortable doing so and to
learn how to create case studies. Please note that these case studies form an important part of
your final paper.
Module Three
Clues
Medical diagnosis of PTSD is essential. A client may come to you for counselling before any
diagnosis has been made. Assure them that you are prepared to help however, to be sure of
treating in the most relevant and useful way, they must speak to a medical doctor first. Once they
do, the doctor is likely to ask the following:
Whether a particular event created the symptoms

How long the symptoms have been occurring
The severity of the symptoms
These questions are important because PTSD will only occur following a traumatic event and the
duration as previously stated will help the doctor to make the right diagnosis rather than to
diagnose a normal stress reaction, Acute Stress Reaction or PTSD. The severity of the symptoms
would also indicate whether they are life-threatening or impact every aspect of life. The doctor
will also look at the mental and physical aspects which may not be part of any core diagnosis
but, often go hand-in-hand.
Three core symptoms:
To be able to make an accurate diagnosis, the doctor has to follow a pattern of symptoms and
then, plan a treatment approach. In respect of PTSD, there are three specific symptoms such as:
Intrusive thoughts
Hyperarousal
Avoidance
Recurring intrusive thoughts
Intrusive thoughts experienced by someone suffering from PTSD almost always cause a strong
emotional response i.e. fear, anger or, humiliation. Even when the individual is asleep, these
fears manifest as nightmares. During the day, they also pull the individual out of the present
time, keeping them locked in a nightmare past and may impact behaviour in ways that do not
make sense to close family members and friends.
Not everyone suffers with flashbacks in PTSD although, it is perhaps one of the more well-
known symptoms. Simply, a flashback is a memory stored in the brain from the traumatic event
which make the individual feel that they are back in that moment. Flashbacks may contain
sounds, odour and colours, therefore, the flashbacks can be random with almost unfathomable
bits of information rather than the individual experiencing the memory as a whole. This can
make it incredibly hard for them to step away from the past or to gain control over the
flashbacks. This is why they need therapy.
Because flashbacks are often so vivid even if jumbled, it’s easy to see why a veteran soldier
could be very easily transported back to the time when they were in the midst of a battle. On a
sensory level, this can be overwhelming. But not all intrusive thoughts lead to sensory
flashbacks. But negative thoughts are very common, so much so that anyone with PTSD may
feel they have little hope in life or paranoid, in that they believe people are trying to hurt them.
Although there is a greater understanding of PTSD nowadays, where diagnosis is not present, the
individual may gain very little understanding or support from others because their actions,
thoughts, feelings and behaviours’ are out of the norm and therefore, not understood. Diagnosis
can help others to have greater empathy and, through reading up on PTSD, it is possible for them
to offer a great deal more support and understanding as a result. But in the main, people
generally do not understand that a PTSD sufferer is affected not just in terms of their mind but
their whole body too. If they experience of flashbacks that brings terrifying memories surging to
the fore, they experience heightened levels of anxiety, the heart beats faster and they often start
to sweat profusely. In other words, this individual doesn’t just think about the past trauma, they
are back living it all over again.
Avoidance and numbing
Sadly, once PTSD is present, these unpleasant emotions do not just dissipate and this is why it is
so important that they seek a professional diagnosis, counselling treatment or therapy such as
CBT. If left, emotions, far from dissipating, will simply grow stronger over a period of time and
this leads to even greater distress. As such, the individual will try to block out these memories or
avoid experiencing the bad feelings. This also leads to their changing their behaviours’ and as an
example: they may avoid activities relative to the trauma.
They may block out core parts of the traumatic events i.e. psychogenic amnesia
They may avoid going to the scene of the trauma or to anywhere that resembles it
They may resist taking legal action relative to the trauma in case the feelings rise to the surface
They may not wish to watch any television programs or films in case they witness scenes that
remind them of the trauma
They may be worried about going to sleep because they are scared that their nightmares recur.
Some clients will develop emotional distancing which prevents them from being able to feel the
emotions but this creates the following issues:
It damages relationships
It detracts from the pleasures in life
As a result, this makes it much harder for the individual to bring forth warm emotions or to
create enthusiasm about their own future. Instead of embracing the positive in life, they may start
to think negative thoughts i.e. who cares what I do in the future? I may not even be here.
There is a term for this kind of thinking process -foreshortening and it simply means that the
individual has difficulty planning ahead. It’s important to be able to detect signs of
foreshortening in your sessions:
Short-circuited goals - this is where an individual abandons their once sought-after career plans
but settles for anything as long as it pays the day-to-day bills. You may see an individual
focusing only on short-term gains and this can include romantic attachments, which are
temporary and possibly unsatisfying, rather than their investing in and developing long-term
deep and meaningful relationships.
A lack of interest in their health – this occurs because the individual is unable to imagine
themselves still being alive in 10 or 20 years, so, as a result, they stop eating well, and may even
develop alcohol or substance abuse.
Hyperarousal - in hyperarousal, the individual’s nervous systems remain constantly on red alert.
This means they are unable to relax and let down the barriers around them. Understandably, this
can create a variety of problems which will most certainly affect their ability to forge or sustain
strong relationship with others. It will also impact general well-being including:
Quick to anger
Chronic irritability
An inability to relax – just in case something bad happens
Exhaustion
Physical symptoms - heart palpitations
Insomnia
Panic attacks
Lightheadedness
Shallow breathing
Tingling
Nausea
Feeling the need to scream
Feeling the need to run away
A fear of dying
Panic attacks are often experienced with PTSD and can be very cruel. They can occur at any time
– day or night, even when the individual is not thinking about the trauma or, indeed, anything
negative. Because of this, it can make the individual scared to go anywhere where a panic attack
has occurred or could occur. If not dealt with, it can lead to severe cases such as agoraphobia.
Symptoms of Complex PTSD
Any individual who has survived either multiple traumas or prolonged physical or sexual abuse,
may develop a condition known as complex PTSD. Although the symptoms can be
overwhelming, the symptoms may also be the reason that the individual survived. Disassociation
is common in those who have experienced child sex abuse as being able to detach from their
body made it easier to cope with the abuse.
From a counselling perspective, it is certainly harder to help a client who has Complex PTSD
because the damage goes much deeper affecting what they think, who they are, what they believe
in and even how they feel about themselves. Sufferers with complex PTSD may experience
severe mood swings.
This condition can certainly create emotions that are out of control and the individual is then
unable to regulate them. They may experience mood swings, experience deep depression,
anxiety and even suicidal thoughts. Their behaviours’ may seem to be out of control i.e. having
one off sexual encounters with strangers, gambling, shoplifting, spending too much money etc.
Disassociation - this is where the individual feels totally detached from their body almost as if
their life is happening to someone else. It is actually a very common feature in a condition
known as Acute Stress Disorder and as previously mentioned, it can also occur in Simple PTSD.
Disassociation however, is far more common when complex PTSD is experienced. Although it is
a way of the individual protecting themselves, the downside is that it makes them feel much less
of a person as a result.
Damaging emotions - as with Complex PTSD, sufferers will often experience deep and negative
feelings of guilt, self-disgust, shame or feel helpless and vulnerable. Sadly, this can lead toward
eating disorders or even self-harming.
Distorted feelings - One comment aspect of Complex PTSD is Stockholm Syndrome where the
individual may begin to identify emotionally with the person who traumatised them. Although,
on a rational level, this may sound difficult to understand, it can lead to the individual even
defending the person’s actions. Consider that a child has grown up being sexually abused by
their parents, they begin to justify these actions and even protect the parent responsible.
Altered feelings - the individual may be distrustful, needy, jealous or afraid to let other people
into their life.
Loss of meaning - this can leave the individual feeling hopeless of any future and to be in the
depths of despair.
For any individual to overcome Complex PTSD, they need the help of a professional team. They
also need to be able to believe that they can get better and see each step towards recovery as a
positive.
Body language
Surprisingly, PTSD can often be diagnosed when the individual is seeking medical help for
another condition. This could be as simple as the individual reporting severe digestive problems
or even, heart palpitations and this happens because PTSD causes chemical changes within the
body, creating symptoms of change.
Physical symptoms include:
Panic attacks
Increased heartbeat
Hyperventilation
Trembling
Sweating
Light-headed
Some diseases or health conditions are often linked to PTSD although reasons as to why this
might be is largely unproven. Research indicates that PTSD can increase the risk of
cardiovascular disease but it may be that the disease was already occurring and it simply worsens
or, symptoms become exaggerated. Although this is not the case in all individuals who suffer
from PTSD, the following conditions are linked and occur fairly frequently:
Chronic pain i.e. headaches, fibromyalgia etc. (Even though many PTSD sufferers
experience a reduced sense of pain)
Irritable bowel syndrome-heartburn, chronic diarrhoea, constipation or stomach pain

Autoimmune disorders i.e. asthma or arthritis.
Obesity
Pregnancy complications i.e. extreme nausea, miscarriage etc.
It is true to say that those people who have PTSD have difficulty surviving in the present and
therefore, they become despondent about their have the opportunity to have any sort of future.
They develop poor habits of care which can lead towards significant health issues. In addition,
the chemicals that affect the brain will often affect the digestive system too and so these
chemical changes can upset both the mind and the body.
There are often co-existing psychiatric problems in those with PTSD, in some ways, this is
unsurprising:
If a client already has a mental disorder, they will be more vulnerable to decision making,
protecting themselves or being hurt. In addition, this makes it very easy for a trauma to lead
towards PTSD.
Understandably, some disorders of the mind will lead to impaired brain function which can make
it harder for the individual to process the memories relating to the trauma logically, again, this is
likely to increase the risk for them to develop PTSD.
There’s also the potential to trigger disorders such as depression or eating disorders even if these
were non-existing problems prior to the trauma.
Tip:
Varying psychological issues require

different treatments.
So identification and diagnosis of all of the symptoms is paramount to success. It may be that all
of the symptoms experienced occur as a result of PTSD but not necessarily so. Either way, a
medical team will have to come up with inventive ways of dealing with not just the symptoms
but the core issues. Fortunately, whether it is the PTSD that is treated or any co-existing
disorders, it usually leads towards some improvement.
Depression:
Up to 50% of those with PTSD will also suffer from depression. There are two main reasons as
to why this may happen:
PTSD may change the biochemistry and structure of the brain leading towards depression
PTSD can make life unbearable for the individual and as such, have a detrimental effect
on both careers and personal relationships. Failure in either of these areas could easily
lead towards depression.
Understandably, it can be difficult to identify the symptoms experienced between PTSD and
depression but once established, it can lead towards a more effective treatment.
Symptoms of depression include:
A lack of interest in life

Suicidal thoughts
Suicidal behaviour
Feeling worthless
Feeling hopeless
Apathy
A lack of concentration
Insomnia
Oversleeping
When someone is in the midst of any mental health issue, it can be difficult for them to have
clarity of mind and to fully grasp how the condition is affecting them and why. It may be as a
part of your role, that you help clarify the situation for clients and to explain treatments that the
doctors may have recommended. Often, treatments for depression are the same or similar to
those for PTSD. But for some individuals, they may be different. Understanding why can do
much to help ease the confusion and panic associated with PTSD.
Anxiety
Anxiety Disorder Symptoms - this will closely resemble the symptoms of PTSD but sometimes,
they will be allocated a specific category or may have occurred prior to the trauma.
Agoraphobia - some clients will find it very difficult to leave their home environment even for a
short distance and therefore, agoraphobia may be listed as a secondary diagnosis.
Generalised Anxiety - where there are a multitude of anxieties about a wide range of topics and
these anxieties impact on life and disable the ability to function normally, then this diagnosis
may be used.
Panic Disorder - this condition may be diagnosed if the individual has high levels of fear and
disabling panic attacks. They may believe that they are losing their mind or feel as if they’re
going to die.
Social Phobia - this condition may be diagnosed when an individual has an extreme fear of
socializing or of spending time with others.
Obsessive Compulsive Disorder - OCD symptoms include the constant checking of day to day
elements and may include the implementation of self-made rituals. It may be diagnosed when an
individual displays symptoms of intrusive negative thoughts, has a need to touch or count objects
or, has an obsession with germs.
It’s true to say that some doctors may view these types of problems as being completely separate
from PTSD but if the latter is present, others may consider all conditions to be a part of it.
Alcohol and substance abuse
Sadly, many people suffering with PTSD will turn to alcohol or drug use as a method of coping.
While it is unsurprising as alcohol or drug use may help to alleviate some of the anxieties or pain
associated with PTSD, it can very quickly lead to further problems later on.
The individual does not need to have taken drugs or alcohol previously for it to become a
problem in the present. Those individuals who have experienced violent traumas have the greater
risk of developing a dependency on drugs or alcohol. This will include war veterans, victims of
rape or physical assault and, anyone who survived the atrocity of childhood abuse. Perhaps
surprisingly, only about 10% of those who have been traumatised by natural disasters will
develop a dependency on drug or alcohol.
Certainly, those individuals who experience severe PTSD symptoms will have a greater risk of
developing substance abuse issues than those who have mild PTSD. This clearly indicates that
substances are used as a way of medicating pain and anxieties. Statistics indicate that
approximately 60 to 80% of veterans from the Vietnam War who sought treatment for their
PTSD condition, had also developed alcohol problems. In addition, between 30 and 60% of those
individuals who sought treatment for substance abuse problems, were then diagnosed with
PTSD.
When you are counselling your clients, it’s important to be nonjudgmental and to understand
why PTSD sufferers often fall into the substance-abuse trap. It is not a sign of weakness but a
method of coping. Because individuals with PTSD often feel out of place, isolated and uneasy in
social situations, by drinking or using drugs, it helps them to ease the severity of their symptoms,
allowing them to relax a little or to fit in with others.
Often people suffering with PTSD will turn to alcohol or drugs to combat their insomnia or, if
they have been experiencing terrible nightmares, to help alleviate this. Certainly drinking or
drugs may soothe the pain on a temporary basis although does not provide a long-term or healthy
solution. It does of course help to numb feelings of fear, anxieties or even quell anger in some
people.
Even the bravest of people i.e. those on the front line of trauma recovery could fall into the
substance abuse trap.
Borderline personality disorder
This is quite a common diagnosis for anyone suffering with complex PTSD. Although it can be
difficult to diagnose as a separate condition and perhaps is quite controversial, diagnosis may be
made if the individual has five or more of the following symptoms:
Unsustainable relationships
Intense relationships
Disturbing self-image
Impulsive behaviour
Repeat suicidal threats or behaviour
Mood swings - real or imaginary
Abandonment
Extreme anger
Paranoia
There can be many similarities between Borderline Personality Disorder and Complex PTSD, so
in diagnosis, it will require the doctor to make a judgement call on this. To treat BPD, the doctor
may suggest a therapy known as Dialectical Behaviour Therapy as this helps to treat any self-
destructive behaviour, emotional regulation and distress tolerance. The individual may also be
given medication to help reduce some of the symptoms. Sometimes, a client may feel confused
about whether they have BPD rather than PTSD because they may also be treated with
Dialectical Behavioural Therapy and similar medication.
Self-harm
Sadly, some individuals who have developed PTSD may also develop a behaviour known as
self-harm, self-injury or self-mutilation. As such, they may cut or burn parts of their body. While
family members may be understandably concerned believing this to be suicidal behavior, many
specialists believe the opposite. They feel that it is actually a cry for help. Individuals with PTSD
may be more likely to injure themselves if:
They have suffered prolonged physical or sexual abuse during their childhood
They are female
They have eating disorders
They have substance abuse problems.
In your counselling practice, you will no doubt see people who have varying degrees of mental
health problems. A client who has been self-harming may feel deep shame, guilt and is often
isolated. They may feel that they are going mad but actually, the mind is conjuring up an escape
route for them. In other words, it is their way of dealing with pain when they can see no other
way of coping with it. It’s important to try to understand how the mind works when an individual
is suffering from these symptoms as to the client it means:
That they are alive - this is especially for those people who have disconnected from the world
around them and who are displaying avoidance or numbing symptoms.
It helps them forget the core pain - by self-harming, they feel the pain caused through this which
acts as a counterbalance against the pain caused through dark memories.
It affords some control - the act of self-harming may make the individual feel that they have
control over themselves. This is often as a response against those feeling vulnerable or
powerless.
It affords an emotional high - it may be surprising, but by injuring themselves, endorphins are
released which helps them to feel better as the chemicals reduce emotional pain and help
alleviate tension and anxiety.
It punishes guilt – there will be some clients with PTSD clients who have suffered childhood
abuse, and they may feel they need to be punished, self-harming is a way of achieving this.
It’s a cry for help - when an individual has been abused, they are often bullied into keeping it a
secret. Often, individuals find it too difficult to talk about this act even when the opportunity
presents itself. As these buried traumas rise to the surface, self-harming becomes the cry for help.
Needs love - anyone who has been abused throughout childhood has not received the love and
kindness needed. As such, self-harming may be a way of being able to love and care for
themselves afterwards.
Triggers - self-harming may act as a trigger for disassociated behaviour where the individual
disconnects mentally from parts of the body or from the mind. This affords them temporary
escape from their reality.
From a logical and rational perspective, it’s all too easy to see that self-harming can only bring a
temporary relief to the individual. It also sadly increases the feelings of shame and secrecy
associated with it and so a cycle of self-abuse is formed.
Eating disorders:
Although eating disorders needs specific care all of its own, it is possible to counsel clients with
PTSD and to realise that they have also developed an eating disorder, the root of which may be
emotional, genetic or cultural. But PTSD may form an additional trigger. Research, (although not
fully clear) indicates that there is a connection between PTSD and an eating disorder. However,
some traumas and in particular, sexual abuse or rape will certainly increase the risk of a woman
developing an eating disorder. The eating disorder that is linked most strongly to PTSD is
bulimia nervosa, however, you may also see clients with compulsive eating disorders or who
have anorexia nervosa. Although it may seem strange that trauma affects an individual in this
way, there may be good reasons as to why it occurs:
Offers distraction – those with PTSD often turn to avoidance as a coping mechanism. When it
comes to eating disorders, there is little time to consider the past, the memories, any present fears
or even worries about the future. The mind switches to food. So, on a temporary level, as with
self-harming, an eating disorder can make difficult problems dissipate for a while.
Distancing - anyone who has experienced a severe trauma in connection with physical or sexual
abuse, may wish to drastically reduce their potential to experience any similar event again. So,
by gaining large amounts of weight or, losing large amounts of weight, they feel they will make
themselves less attractive and will not be considered sexually.
A false sense of control - anyone who is able to control their weight through starvation, through
purging or bingeing may feel that they are in control of this one particular aspect of their life.
Because they have a poor association with food and with health generally due to the PTSD, they
will not consider the action as dangerous.
Module Three
Task:
Explain the connection between self-harming and PTSD
Task:
Explain how an individual may develop PTSD and an eating disorder
Task:
What is social phobia?
Task:
What are the symptoms of Borderline Personality Disorder?

Module Four
Children and Teenagers
When it comes to symptoms and the diagnosis of PTSD in respect of children and teenagers,
many of the rules for adults apply. The PTSD will have occurred as a result of a specific trauma
or traumas. In addition, to be diagnosed with PTSD, they must have experienced symptoms for a
four-week period or more. Where it differs is that children and teenagers may exhibit alternate
symptoms.
Young children
Parents or carers may bring children to you worried as to their behaviours. They will need
guidance and support if the child in question is suffering from PTSD. In the first instance,
encourage them to seek medical diagnosis to be sure that they are receiving the correct treatment.
Certainly detecting this condition in a toddler is likely to be very difficult and this is because
young children do not act or even think in an adult-like manner. As such, the symptoms
displayed can be misinterpreted. Therefore, it’s important to understand some of the signs that
indicate PTSD in this age range.
Fears - you may find that a young child develops an innate fear of monsters, talking about them
constantly. This may occur because the child is unable to provide a more coherent picture of a
traumatic event – it may be that a person has been threatened, has died, or they have been victim
of a threatening or abusive situation. Although fears may be indicative of a trauma, it is not
necessarily indicative of PTSD.
Intense separation anxiety - separation anxiety is quite normal in that children have to come to
the realisation that their parents can leave them and, will not always be present. However, if a
child has developed PTSD, the fear of separation may have become overwhelming to the point
that the child displays real feelings of terror. This could be as a result of something significant
happening to the parents or parent.
Magical thinking- this is where children believe it was their thoughts, actions or desires that
made the trauma occur. Often, it is totally unrelated to the actual trauma but in magical thinking,
the child believes it is very real. This leads toward irrational self-blame.
Mood changes - a young child with PTSD may begin to display irritability, or aggressive
behaviour or may even start to withdraw socially from others.
An increased startle response - a child with PTSD may start to react in an extreme way when
there are any sudden or unexplained noises around them.
Post-traumatic play - children can sometimes display elements of the trauma experienced if
given dolls or toys to play with. Another way of fathoming how they are feeling, is when they
draw pictures which may depict aspects of the trauma.
Setbacks - some toddlers may start to forget any skills which have been learnt previously. This
can include talking or toilet training.
Preoccupations – young children can become preoccupied by objects which are completely
unrelated to any traumatic event.
Sleep problems – young children with PTSD may suddenly start to develop sleep problems.
Health symptoms - although it’s important to ensure that there are no medical causes for
symptoms such as tummy ache or headaches, children often display these kinds of symptoms
when they have PTSD.
Schoolchildren
Children of school age may also develop PTSD as a result of a trauma. Symptoms include:
Sleep problems
Nightmares
Anger
Unwarranted aggression
Mood swings
Headaches
Tummy ache
They may also display aspects of the trauma when playing or through art. But there are other
signs that should be noted:
Safety fears - this is a very common symptom of PTSD where the child becomes obsessive about
the fear of death or the need to feel safe.
Guilt - children can often believe that a traumatic event was their fault and this is a more mature
version of magical thinking.
Loss of interest - the child may lose interest in playtime activities or stop being friendly with
others. They may withdraw socially and shut themselves away isolating themselves.
Omen - sometimes children who have symptoms of PTSD believe they failed to spot any
warning signs of the traumatic event and so they develop an increased alertness so to ensure the
event will not happen again.
School problems - PTSD children may act out of character in class and even refuse to go to
school. It is common to see their school grades begin to slip.
Time - children with PTSD can also start to develop mixed-up memories about the chronological
order of the traumatic event. In many ways this is similar to adults with PTSD.
PTSD in teenagers
A teenager with PTSD will often reveal the symptoms through their behaviour. This can be
problematic because teenagers are capable of expressing their inner pain and confusion in far
more dangerous ways than young children. As an example, they may turn to drink or, if old
enough to drive, do so erratically without the self-control of an adult.
It is worth looking out for the following signs:
Impulsive behaviour
Rebellion
Sexual behaviour
Aggression
Risk-taking
A teenager may fall a little quiet after a trauma which although naturally can be a pre-curser to
PTSD. Parents may consider this to be a part of the healing process and that they will heal from
the trauma in time, but when a teenager becomes quiet and withdrawn, it does not indicate this at
all.
In addition:
Friendships – the teenager may suddenly stop being friends with others for little or no
reason or, may start to become friendly with those who have a bad reputation
School grades – even those who are usually keen to study and progess may suddenly find
it difficult to concentrate or to sustain their previous academic levels
Violence - they may develop an unhealthy interest in violent activities including
computer games
Depressed – the teenager may seem sad, lethargic or display definitive depressive
symptoms
Sleep – the teenager may find it difficult to sleep or suddenly start sleeping for longer.
They may also experience recurring nightmares
Teenagers often display dramatic and perhaps volatile behaviours so it is not always easy to
diagnose PTSD during this adolescent stage. One way of doing so is to identify behaviours that
are significantly different from the way they may have acted before. As an example, consider a
15-year-old who has always studied intently and never been in trouble and yet, following a
traumatic event, their academic level drops and they refuse to go to school.
PTSD and children of abuse
When a child has been abused either sexually or has experienced violence at the hands of a
parent or carer, this very act of betrayal affects them at core level. Abused children can start to
display some quite severe symptoms including:
Running away
Violence
Self-harming
Stealing
Promiscuity
Turning to prostitution
Using drugs
Using alcohol
Displaying depressive behaviours
Displaying suicidal behaviour
As a counsellor, you may see parents or carers with young children or teenagers and suspect
there has been some abuse. It takes time to be able to recognise and trace the route of this
behaviour. But by developing trust and having patience, it is possible to connect with them and
to help them turn their life around before their symptoms develop, increase and become an
established part of their nature.
Module Four
Task:
Consider how you would counsel a child who displays symptoms of PTSD
Module Five
Identify and PTSD
For anyone experiencing emotional difficulties or mental illness, it is almost impossible to self-
diagnose. Their clarity of mind will be affected and no one symptom can really define the whole
picture. Once an individual has recognised that they need professional help, it is your role to help
them progress through any difficulties, to receive medical support and care and to use the
relevant therapy techniques. Although it is important for all clients to trust in your abilities, when
you have someone with PTSD, it is especially so.
PTSD sufferers find it hard to trust. Remember, they will have often lost sight of their own
identity, actions and decision-making. They will be suspicious as to the intent of others so take it
slowly, be honest with them and make sure they realise that you will support them through the
process for as long as they require it.
As a counsellor, you will be able to help a great many clients towards a successful recovery but it
can and will take time. It is important however that the clients - if they have not already sought
out a medical diagnosis, do so. As we have previously discussed, there are many conditions that
mimic PTSD and this has to be taken into consideration in terms of treatment and medication.
Some PTSD sufferers will have secondary symptoms and sometimes, they will have entirely
separate health issues. Note: as a counsellor, you will not be diagnosing officially but referring
your clients to seek medical attention. You may however receive clients who have been referred
from a local doctor complete with diagnosis and medication (especially once they know you
have studied PTSD) as basic counselling may be all that some require. While other clients need a
support team and various therapies to help them toward recovery, each client will have unique
needs depending on the trauma experienced, their gender, genetics, and age, etc.
It’s useful to run through the following checklist before starting so that you have a full
comprehension as to the extent of the symptoms:
Has the client survived a life-threatening traumatic event?

Did others die during this traumatic event?
If yes, how did that make them feel? Did they feel: horrified, vulnerable, terrified etc.
(Did the client answer yes to the questions?)
Does the client have repetitive memory recall regarding the event?
Does the client experience recurring nightmares in respect of the event?
Does the client feel as if they are reliving the event? Discuss hallucinations, flashbacks etc.
Does the client feel emotionally, mentally or physically distressed when reminded of the
traumatic event?
(Did the client say yes to one or more of the questions?)
Does the client do their best to avoid thinking, feeling or talking about any topic which is relative
to the traumatic event?
Does the client try to avoid people, activities or places that reminds them of their trauma?
If the client tries to recall the traumatic events, is their memory blank?
Does the client have a reduced interest in day-to-day pleasurable activities?
Does the client feel detached from others?
Does the client find it difficult to experience emotions?
Does the client find it difficult to think about the future?
(Did the clients say yes to 3 or more questions?)
Does the client have insomnia or find it difficult to stay asleep?

Does the client feel irritable or display frequent bursts of anger?
Does the client find it difficult to concentrate?
Does the client find it difficult to relax and feels alert always?
Does the client start to react much more strongly to noises?
(Did the client say yes to at least two the questions?)
When did the clients symptoms start i.e. more than one month ago?
Have the symptoms interfered with work relationships or friendships?
(Did the client say yes to both questions?)
The score should then be totalled up and if the client predominantly answered yes to most or all
of the questions, they are more than likely to have PTSD. If they answered no to some of the
questions, they may not have full PTSD. You may need to prompt further and certainly discuss
symptoms. Discuss if they have received medical assistance.
It’s worth noting that if a client experienced a trauma some months previously and have only just
started to experience symptoms, they may have what is termed as delayed PTSD. If the
symptoms started within the four-week period after the trauma, they may have Acute Stress
Disorder.
Although this type of questionnaire does not afford a 100% means of diagnosis, it does enable
you as the counsellor to have a much clearer picture of the individual and to be able to
understand generally just how severe the symptoms are and how badly it affects their life.
The life of a PTSD sufferer can be highly volatile. Like everyone, they will have good and bad
days although the bad days are likely to happen far too frequently. In addition, they may feel that
they have days when everything goes wrong. Gradually this can spiral out of control – they may
lose their job or their relationship. Behaviour can also become erratic.
When PTSD is present, you often see that the client has turned their attention inwards and they
blame themselves. However, it’s important for your clients to start to realise that they are not in
control and this is why they need professional support. Although this realisation can make them
feel vulnerable, it’s important that you work to eradicate feelings of blame.
It can be hard for the client to identify that they have a problem, let alone to discuss it so do keep
this in mind. Life can be so difficult when they are caught up in the emotion of it all. They may
see that their family and friends gradually moving away from them in an emotional sense and
they may deep down realise that their extreme behaviours are the cause, but rather than blaming
the condition, they blame themselves.
In terms of a relationship, PTSD can have a detrimental effect on even the strongest of romantic
connections. Partners of a PTSD sufferer often feel as if they are living with a stranger and in
many ways they are. This is another reason why PTSD must be treated because gradually it can
undermine every single aspect of life.
Make sure your clients feel safe and able to talk to you. Don’t lead them in the discussions, just
prompt them. The more they trust in you, the greater the communications. Although they may
not be able to voice their feelings with clarity, it may be enough for you to gain a fairly accurate
picture of their situation. Certainly, they are likely to be guilty of emotional outbursts or have
extreme reactions to some of the minor stresses in life.
As such, they may start to alienate family and friends or even scare them.
Your client may also do everything they can to avoid going to certain places or to talk to certain
people. They may even wish to avoid objects if they act as a trigger. Finding out about these
triggers enable you to help them overcome them. Those around them may feel that they have
started to become very distant and even uncaring and may have little interest in the present or of
the future. A PTSD sufferer is likely to feel distrustful even to those who are closest to them and
they may well find excuses so to avoid any type of intimacy. Instead, some people avoid sexual
contact with loved ones but may seek out unsafe or even dangerous sexual partnerships.
Without a doubt, PTSD is likely to cause workplace issues. With symptoms including
palpitations, confusion and anger as well as a lack of sleep, flashbacks and increased anxieties, it
is likely that individuals may struggle to sustain their employment. In addition, their behaviour
may become volatile or overly emotional. Unsympathetic employers may make it difficult for
them to remain in the workplace if behaviour becomes too erratic. PTSD also strips back
confidence levels and the individual will start to doubt their own abilities, even the simplest of
jobs may become difficult. They may also appear to have no interest in the job at hand.
Your clients may specify that they experience physical aches and pains and it’s not uncommon
for them to suffer with:
Heart palpitations
Chronic exhaustion
Tension headaches
Chronic pain
Irritable bowel syndrome
Intense fatigue
Sleep problems
In addition to physical symptoms, your client may talk about extreme thoughts including:
Suicidal thoughts
Deep depression
Violent thoughts or actions
Unsafe sexual activity
Eating disorders
Disassociation
Reckless behaviour
Worthlessness
Gradually over several sessions, you may be able to glean sufficient information so to counsel
the client in the right direction.
Tip:
Always refer clients to the doctor if you

suspect they have PTSD and they have
not received a medical diagnosis.
The client must develop some trust in you and to also develop the ability to be able to
communicate openly and honestly, although this may be difficult for the client who is suffering
with the extremes of this condition. This will enable you to help them understand why they feel
this way and to be prepared to face up to their fears, taking the first steps towards healing. Make
no mistake even sharing their thoughts and feelings with you or with a doctor may terrify them.
Many PTSD sufferers really believe they are going mad. They may feel that their world is unsafe
and it is highly volatile. Too often we want those around us to believe that we are strong, capable
or even perfect. Family and friends may see PTSD as a character flaw or that the individual is
weak or worse, putting the symptoms on.
Some of your clients may also have substance abuse issues so it is a case of dealing with these
issues as well. This may be outside of your remit as a counsellor so do refer them to an addiction
therapist where necessary. If they have not yet been to see the doctor, they should write down
every single symptom that they experience which will help them to receive the correct diagnosis.
If possible, they should take a friend or family member along, someone that they can trust. If
your client is in the pre-diagnosis stage, do advise them that doctors will not rush to make a
diagnosis and so it may take some time to ensure all other conditions are ruled out first so that
the correct diagnosis can be made. Because there is no easy way of testing for PTSD, the more
that the individual can share with the doctor, the easier it will be to get to the crux of the
problems.
As an example, the doctor is likely to ask:
The type of trauma.

When the symptoms started and what the symptoms are.
How serious the symptoms.
Whether there are any drug or alcohol related problems.
If there are any eating disorders.
Module Five
Task:
For your case study, practice asking the check-list questions and add the results into your notes.
If you know someone who had suffered previously with PTSD, then this will make it much more
realistic however, if not, use your volunteer and consider how you would progress their recovery.
Module Six
Medication
Although there is medication which can help sufferers of PTSD, doctors will not simply write
out prescriptions for drugs. The reason for this is that although many of the drugs would
undoubtedly alleviate some of the symptoms, it is far more effective usually for the individual to
participate in therapy sessions.
There is no doubt however that for some people, medication can be a lifesaver and at the very
least, it can start the recovery process. The majority of people with PTSD often get better as a
result of regular therapy sessions i.e. counselling, CBT, psychotherapy and rarely take anything
other than traditional painkillers. For some people however, PTSD makes life so difficult that it
is almost impossible for the individual to overcome their feelings and they need extra help. The
doctor will prescribe medication depending on the severity and type of symptoms experienced
and whether the medication is likely to alleviate some of the symptoms which could be
impacting the recovery process during therapy. But these drugs do not offer a cure.
Doctors may recommend medication for the following:

The client has trouble sleeping most nights
The client is so anxious that they are unable to sustain a job or to cope with therapy
The client experiences suicidal thoughts or behaviours
The client has alcohol substance abuse issues
The client has substantial depressive symptoms
Although the family doctor may be the first line support (certainly for the diagnosis and
treatment plan) often individuals are then referred to a psychiatrist as they will know the best
medical treatments for PTSD.
Anyone with PTSD is likely to struggle making wise decisions, unable to weight up the pros and
cons especially when it comes to taking prescribed medicines or not. As a counsellor, you may
be asked for guidance or to explain, although you will not be prescribing medication. It’s good to
be able to understand the client’s fears and anxieties in this case and to ensure they understand
the implications, thereby making the right choice for them:
Certainly if the client is in danger of hurting themselves or others, then medication is

likely to be the best option to help them start gaining control.
Medication works fairly fast. While therapy is often the best option, it is certainly not a
quick fix and for some clients, having something extra which can start alleviating
anxieties will lead towards greater success in therapy.
Some clients will not be able to see a therapist immediately and therefore, medication
may help them to keep on track until they are able to visit a professional therapist.
Medication can be really useful especially for someone who has lost all hope in life and
who is unable to sleep, work or enjoy life at all. Of course medication does not cure or
resolve issues on a long-term basis. However, even if the results are temporary, it can
help the client to move toward therapy which will be longer lasting.
Medication can assist treating any disorders that coexist alongside the PTSD.
It is important to understand that some drugs can actually cause more problems than they help.
Certainly, some of the psychiatric drugs will be habit forming and not recommended if a client is
already trying to overcome problems with alcohol or drug dependency as this would only create
further problems of dependency. There are also side-effects to consider.
Some prescribed drugs can also increase the potential for suicide, heart damage or can trigger
diabetes. It’s important that your client considers all options before taking any medication and
understands the possible side-effects. Sometimes people respond well to a drug very quickly but
then find that it no longer works for them. This is not uncommon and the reason for this is
because the brain can very quickly adapt to any new drug. Drugs may also lead onto denial. As a
result, people can believe that they do not need any further help. So you may wish to specify that
medication provides short-term benefits but not overall solutions.
All of the drugs prescribed by doctors to treat the symptoms of PTSD will affect the nerve cells
in the brain. These cells create and transport messages leading to thinking, feeling and the
utilisation of the senses. Let’s look at this little more closely. Firstly, once the neuron receives a
message, the immediate response is to share the news, sending it electronically from one of the
branches down to the tail (this is known as the axon) and onto the sending end. Chemicals called
neurotransmitters are then projected out landing in a space known as the synapse and this is what
separates the neuron from its neighbours. These chemicals move around in the synapse and then
try to gain permission to attach to a receptor located on the next neuron branches. Once this has
happened, the news is then passed on to the next and so on. When prescribed drugs for PTSD are
taken, the following can occur:
Some medication will act upon the receptors of the neurons which means messages may not be
passed on. This happens because the medication mimics the neurotransmitter, triggering the
usual response from the cell or blocking the neurotransmitter from reaching its target.
Some medication will boost the activity of the neurotransmitter by stopping the sender (the
neuron) from retrieving the message if it is not accepted immediately. The result? More of the
neurotransmitter remains floating around in synapses where it may still find the opportunity to
connect with another neuron and to ultimately pass on its message. There are some drugs that
affect different neurotransmitters at the same time.
The medication prescribed for any individual depends on the symptoms exhibited and of course,
which neurotransmitters will influence those symptoms. This is because different
neurotransmitters will impact different aspects of the brains functionality and this includes
impulse control, arousal, wakefulness, motivation, mood and memory etc. Neurotransmitters also
affect cells in different ways and each neurotransmitter will have multiple effects. Therefore, it is
true to say that different medication will have a very different impact on how they work on the
individual even if the medications are from the same chemical family foundation. So it makes
sense that it can take a while to find the right combination of medication.
So one medication treatment may save someone’s life but be totally ineffective for someone else
and this is why doctors are not quick to prescribe medication for PTSD sufferers unless it is
absolutely essential.
There are options available:
Antidepressants
Antidepressants, while designed to help combat feelings of depression, also help to reduce
anxiety levels. There are different types and they work in a variety of ways:
Selective Serotonin Reuptake Inhibitors
These are the medication of choice currently for PTSD. If we look at the name of the medication
and analyse, we can see how this particular drug works. Selective means that it affects only one
messenger chemical. Serotonin is the messenger chemical for this drug. Serotonin is important
because it impacts mood, aggression, impulsiveness, anxiety levels as well as some physical
processes including all-important sleep. Reuptake is what happens if the neurotransmitter is
unable to link with another neuron. Inhibitor means that this drug blocks this particular process
making the neurotransmitter more effective by enabling it to have an extra chance for connection
with the other neurons. Studies into this drug have indicated that it works well in helping to
reduce PTSD symptoms and some patients respond favourably within only a week or two of
taking these medications. Although it is only a short-term fix, some people seem to take longer -
up to 12 weeks before they start to feel better. Unfortunately, as with all medication, there are
risks and side-effects.
For some, this medication increases depression and thereby, increases suicidal thoughts or
impulses. They can also reduce sex drive and have to be considered carefully when combining
medications. Too much serotonin can cause a condition known as serotonin syndrome which
impacts body temperature and heart function. Although the drug is not addictive, individuals
should be reminded not to stop taking them suddenly as these can cause temporary but
unpleasant withdrawal side-effects.
Serotonin and Norepinephrine Reuptake Inhibitors
This medication increases the power of these two messenger chemicals. Norepinehrine plays an
important part in alertness and arousal. This medication stops the cells that sends the chemicals
out from taking them back again. These are considered an alternative or second line treatment for
PTSD. They can be effective but may also have adverse side effects including: irregular sleep
patterns, weight gain and sexual side-effects.
Tricyclics
These are the oldest antidepressants still in use but because they have far more side-effects i.e.
blurred vision, drowsiness, headaches or confusion than the latest drugs, they are used less and
less. They boost levels of serotonin and norepinephrine but may also increase the levels of
dopamine. Tricyclics also block some cell receptors and this is one reason why side-effects
occur. They may be useful if other drugs do not help.
MAOI Inhibitors
These inhibitors interfere with the neurotransmitters used to transmit messages. They were one
of the first types of anti-depressants but have a wide variety of side-effects including reactions
with certain medications or food so are rarely prescribed now.
Antianxiety Drugs
The most commonly prescribed antianxiety drugs are Benzodiazepines and Buspirone and these
worked in alternative ways. One works fairly quickly but has higher levels of dangerous side-
effects and the other works more slowly but is safer to take.
Benzodiazepines enhance the effect of gamma aminobutyric acid which reduces any excitability
of nerve cells. They work fast and help to ease anxiety and sleep problems in a matter of days.
The downside is that the individual can become dependent upon them very quickly. They may
cause aggression, make the individual feel sleepy, impair coordination and, create memory
problems. They should also never be taken if the individual has substance abuse problems.
Buspirone
These often takes between two and four weeks to work effectively. Fortunately, this medication
has fewer side-effects, helping to alleviate symptoms such as nightmares and intrusive thoughts.
Beta-blockers
These are considered one of the most current and exciting PTSD treatments as they address
traumatic memories. Beta-blockers have long been used for blood pressure and are deemed
relatively safe. They work by blocking the beta receptors on specific cells in the heart, the brain
and other organs too, this keeps adrenaline and noradrenaline from stimulating cells. Clients with
substantial PTSD symptoms have stated that beta-blockers have helped to reduce palpitations,
rapid breathing and other symptoms of stress.
Sleep aids
Doctors often advise individuals to use an over-the-counter sleep aid rather than prescribed
medication to help with mild sleep issues as there is usually less side-effects. Stress to your
clients that they should never attempt to self-medicate as tiredness, feelings of confusion and
panic attacks will not help with decision-making skills.
There are a wide range of drugs are available to treat the many symptoms of PTSD.
Anticonvulsants
Drugs often used to treat seizures may also help people with PTSD particularly if anxiety levels
are high.
Lithium
This is a mood stabilising drug which may help reduce the number of flashbacks and any
irritability experienced with PTSD. There are side-effects however, changes to the thyroid, a loss
of appetite, nausea and it may even impact the kidneys.
Any medication can help an individual to feel better even if in the short-term. Certainly some of
the drugs used for PTSD can really help those experiencing extreme side-effects. Although it can
be difficult for a PTSD sufferer to fully analyse and comprehend the side-effects of any potential
drug, it is important that they do their best to understand and to make the best decision based on
the doctor’s guidance and of course, how they feel.
They should ask:

What the medication does
How long it takes to work
Whether short-term or long-term usage
Side-effects
Some medication can make an individual feel suicidal and if there is any risk of this, it may not
be worth taking the medication. If the individual is taking a multitude of medications, they need
to make the doctor aware that they are doing so because some drugs do not interact well in
combinations.
For anyone who is loath to take medication or where the symptoms are not dangerous or life-
threatening, the best approach is likely to be the non-drug version first. Advise the client to
reduce the amount of caffeine and alcohol consumed, to take more care and consideration with
their food and to try basic relaxation techniques, stress management techniques and meditation as
well as to increase exercise. Within your counselling session, you can talk your client through all
of these options, helping them to feel safer, relaxed and this will increase feelings of well-being
and hope. Relaxation techniques will also help to improve sleep patterns and combat panic
attacks and anxieties. Combined, these can help to alleviate the severity of the PTSD symptoms.
Module Six
Task:
What symptoms need to be present before a doctor is likely to prescribe medication for PTSD?
Task:
How can relaxation techniques help?
Task:
How do the drugs which are prescribed for PTSD work?
Module Seven
Mind and Body
Your clients are likely to respond well to a psychological approach to aid the mind and body and
this can start the healing process. Because everyone is unique, their ability to heal will depend
upon your ability to connect with them, their personal experiences, their personalities and the
actual trauma experienced. As such, the same treatments and therapies and will not work for
everyone.
Cognitive Behavioural Therapy has been proven to aid PTSD recovery although some people
find that it does not work as well on them. Fortunately, there are a great many options available
in respect of treatment. It can be useful to combine these with natural therapies at the same time.
There are two broad categories which provide psychological approaches different from
Cognitive Behavioural Therapy:
Neuro Linguistic Programming

NLP was created back in the 1970’s by linguistics professor John grinder and mathematician
Richard Bandler. They combined what they believed were the most useful aspects of alternate
therapy techniques. They considered that each individual had a unique internal map (the
individual’s perception of their world and the language that they used to translate or express this
perception). For a great many people, the map becomes distorted or limited. Fortunately, the map
can also be changed simply by amending thoughts and behaviours in a positive manner.
They found that when studying successful people, it was possible to model their behaviours and
therefore, an individual through modelling could become more successful. NLP helps individuals
to consider more successful ways of thinking, behaving and, communicating.
NLP practitioners have an arsenal of tools at their disposal and the length of the therapy sessions
although usually short can be highly effective. Several of the techniques which are most relevant
to PTSD include:
Reframing:
This is a technique also used in Cognitive Behavioural Therapy and it helps the individual to
look at a specific event, to reframe it by viewing it in an alternate way and by doing so, it is then
possible to create a different meaning for it. This can be especially useful for someone who has
experienced a deeply traumatic event and who may have done the best that they could within that
situation but who has survivors guilt. Because the human brain often thinks in negative terms
automatically, it is possible using reframing techniques to change the outcome so that the
individual feels better about it.
Squash: this technique enables specific cues which would ultimately lead onto unwanted
behaviours being reconfigured through visualisation. The squash effect requires the individual to
quickly push any undesired image away while pulling a positive visualisation towards them.
Visual squash example:

The client should imagine that their problem is placed in one hand.
They then represent their problem by trying to see, hear, feel, smell or even taste. They try to feel
the weight of the problem, ascertain the texture and temperature as if it was real i.e. ‘I feel scared
to sleep. It looks like a large black hole that I will fall into. It sounds grim, it feels dry and heavy
and it smells like rotten eggs but tastes sharp.’
In the other hand, they then decide on their desired state i.e. I would like to feel sleepy, relaxed
and safe.
Then, make a representation of their desired state. ‘It looks like a fluffy white cloud, starlight
glitters on the edges, I hear distant sounds of the piano and flute. It smells like lavender and
tastes of violet.’
Go back and forth focusing on the problem state and then the desired state several times until the
image of the desired state is set.
Anchoring:
We typically associate emotions with certain stimuli. Anchors become embedded in our
unconscious minds, but in NLP, it is possible to learn how to create and break anchors. Chosen
anchors are always positive, strong or happy and so we learn to associate a memory with a
particular anchor. By touching one knuckle, clapping or clicking fingers, an installed anchor can
quickly take effect working as a trigger.
Memory separation:
This technique is particularly useful for treating PTSD. It helps the individual to separate i.e.
disassociate from a traumatic memory, viewing it as if it was not a part of them. It’s a
visualisation technique which then taps into kinaesthetic techniques so to change how the
individual views their trauma, enabling them to detach and view with a greater perspective. It is
not traumatic disassociation because the person remains in control at all times.
Within your counselling practice, we would strongly suggest that you study and learn some of
the tools and techniques of NLP and CBT so that you can offer greater assistance within the
counselling sessions.
Here’s an example:
Use relaxation techniques i.e. deep breathing techniques and visualisation techniques to help the
client feel relaxed, peaceful and calm. In this relaxed state, ask the client to picture themselves.
They need to imagine that they have a photo of themselves as they were prior to any trauma.
Note that some people will find this difficult initially, but persevere.
Then, ask your client to visualise the trauma as if from the viewpoint of someone else. You can
ask them to imagine that they have stepped out of their own body but moved into a cinema now
and they can watch themselves sitting in one of the seats nearer to the screen. At this point, they
are playing the film of their trauma. Note that by sitting further back and being able to view
themselves watching the recording of the trauma, this helps to create distance between them and
the trauma. As they visualise the trauma, you now encourage them to alter their film in different
ways.
1. They can decide to view their film in black-and-white and then change it to colour. They
can make the sound louder or silent. They can also run the film backward. By repeating
this process as much as is required, they will start to feel a sense of control over their
memory.
2. Ask the client to step back into their body and to consider how they feel about the
experience.
Note: any of your clients who are vulnerable to disassociation i.e. using it as a defence
mechanism should not use this therapy because it could trigger off involuntary dissociation.
Internal Voice Temp Change
Clients’ often have a fast paced internal dialogue which only serves to create, increase and
sustain the intensity of their feelings. This is known as a fast tempo and works to stimulate and to
make the client hyper alert, as such, they find it difficult to reduce the speed or to gain control.
This particular NLP technique is very useful for any client suffering from the symptoms of
PTSD and before starting the technique, ask them whether any part of them has an objection to
experiencing less intensity and more comfortable responses in all situations. This sets the scene
and their approval for progress.
You can use the following dialogue:
Up to this point, you have experienced these intense feelings numerous times. (Plant the seed
that change is possible). Bring just one of these occasions to mind and tell me what you are
thinking or saying yourself.
If a client struggles to tell you i.e. they simply do not know what they are saying, they may be
disassociated from the experience. Another technique to gain insight would be to say…
If I drew a picture of you similar to a cartoon in a comic and created a thought bubble above your
head, what would I write in the bubble to indicate thoughts at this moment?
You can also use the following. If you did know, what might it be? You can even prompt them to
make up something. It is the tempo and not the content that will be changed.
So the sentence you have said to yourself is (note past tense which indicates this will stay in the
past) the car is going to drive off the cliff. When you say this to yourself, are you speaking
normally or are you saying this in a fast tempo?
Notes that the tense changes to the present to bring the client into the experience. Most of your
clients will confirm they are using a fast tempo. If they say they are not, ask them to check it
again.
Now, I will ask you to do three things. The first is to speak the sentence aloud or think the
sentence exactly as you have done so far and to notice how you feel.
Now I am going to say the sentence but slow it down by approximately one third. Once I have
said the sentence, I would like you to say or think this sentence to yourself but at the slowed
down speed and then notice the difference.
Now I’m going to say the same sentence but even slower, and I want you to do the same and
then tell me when you have done so.
Make sure you slow down the tempo, create long pauses between each word and try to match
each word to the client’s exhalation. You will see that your client begins to anticipate when they
will hear the next word and you can say the word even slower than would be anticipated. Pause
even longer between the next to last and the last word of the sentence. This shifts the tempo and
works to deconstruct the meaning of the sentence and it will also change their response.
Now, once you try (setting them up for failure) to think of the sentence as you used to do, what
do you notice that is different?
This technique when practiced sufficiently helps to decrease the tempo and intensity of thoughts.
Spinning feelings
In NLP, there are many tools that can help to change visual and auditory representations
impacting how a person perceives and feels. This is an excellent technique for those clients with
deeply troubled feelings.
Ask the client to close their eyes and to make gestures with their hand or a finger to indicate the
answer:
Where in your body does the feeling start?

Where in the body does the feeling move to?
This indicates the path of the feeling and you can ask whether it is clockwise or anti-clockwise as
the feeling moves along.
Then ask the client to reverse the direction of the feeling and to tell you what is different for
them. You can also make use of colour (they often choose white or blue). This reversal of
direction and adding colour, helps to reduce the intensity of any difficult feelings, sometimes
significantly. It also works well on anger, OCD, panic attacks and phobias etc.
Traumatic incident reduction
In the same way as CBT requires clients to confront their trauma, Traumatic Incident Reduction
has a slightly different method. It is a short-term therapy and the therapist acts as the facilitator
while the client does the work.
To give you an idea:
The client identifies the trauma that he or she needs to confront. It is important to understand that
the clients must want to confront the trauma as they decide the intensity of the experience.
The client then views the trauma as if it’s a film, rewinding it right to the beginning and then
they view the trauma from start to finish. At the end of this, you would ask them to confirm what
happened and feelings experienced. The therapist does not interrupt or evaluate or question.
The client then repeats the process, rewinding and watching the video of the trauma and talks
about the experience afterwards with each separate viewing. These sessions last between one or
two hours usually and can be made up of just one single session or up to twelve or more if a
client has complex PTSD or multiple traumas to deal with. TIR practitioners say that the clients’
experiences vary, but normally, it increases during the first few viewings, but then the emotion
begins to fade, until they have no reaction in a negative sense to the trauma itself.
The whole process continues until the client starts to experience positive emotions or at least has
a significant reduction of emotion. Typically, all clients achieve this state by the end of the
session. It’s a much shorter procedure than within CBT and there is very little input from the
therapist. There is also an emphasis on encouraging the client to seek out any earlier incidents
which may have been traumatic and could have influenced their thoughts and behaviours from
that point. This is known as Thematic TIR. It can be used for anyone experiencing deeply rooted
anger issues. They can use the same film technique as outlined working through incidents until
they start to engage with the anger, working all the way back through each incident until they
find the core anger…the earliest incident.
Psychodynamic therapy
Psychodynamic therapy considers the unconscious dynamics which play a main role in all
emotions. It helps the client to address the unconscious thoughts and conflicts which exist as a
result of the trauma. They may spend time exploring any pre-trauma events which could have
instigated feelings of vulnerability leading towards PTSD. As an example, a psychodynamic
therapist may be concerned with any abandonment issues that the client feels - perhaps as a result
of parental divorce during their childhood and ascertains how those particular feelings could
impact the current potential to PTSD. There is a great deal of communication between the client
and the therapist as they work to break down the unconscious psychological defences.
Hypnotherapy
Hypnotherapy aids clients by helping them to achieve deep feelings of relaxation and to open up
their mind. The client does not lose awareness at any time and the therapist uses soothing
imagery or any number of techniques to aid relaxation, enabling the client to view the trauma.
With time, the client starts to recall parts of the trauma that have been blocked from their
memory. By doing so, they can start to process these memories and come to terms with them. In
addition, the client is able to revisit those times when positive feelings existed which will help
them to put any trauma in context.
Hypnosis has a long history as a treatment and it was used in World War II as a therapy for those
soldiers who were diagnosed with battle fatigue. Often hypnosis is considered a primary
treatment but many have found CBT to be more effective when it comes to PTSD. It is important
to remember however that some treatments will not work as well for some but will have
excellent results when used on others.
Art therapy
Although therapies such as CBT have generally replaced art therapy, some clients still find it
incredibly useful in respect of healing. In particular, those people who find it very difficult to talk
about their traumas. The therapist provides the materials needed and then helps the client to work
through their trauma by asking them to draw a picture of how they perceived their body after the
trauma. Art materials include crayons, watercolours, pencil, charcoal or even sculpting material.
Certain clues may emerge as a result from the artwork. This is a gentle healing therapy ideal for
those with deeply rooted issues and who are unable to express themselves so it does have some
advantages over other therapies:
Importantly, it is a safe way for those clients who are badly traumatised to be able to express
pain.
By using imagery to describe trauma, it helps the clients to understand and to be able to define
meaning to the event. It also gives them a sense of control over it. Art can be very useful to help
aid stress management, to increase mindfulness and, it will enable the brain to take a break. In
addition, it combines negative with positive in that negative emotions can be recalled alongside
the therapeutic process of creation. In this way, it can help with the processing of traumatic
memories.
We certainly know that the mind has a powerful effect on the body but it also works the other
way too, so always remember that the mind and body connection can be utilised to help increase
the healing process.
Relaxation
While relaxation techniques on their own are insufficient to treat PTSD, they can certainly help
to alleviate symptoms and also help to alleviate anxieties and aid the prevention of panic attacks.
In addition, they have no side effects and so are risk-free. You can also introduce yoga or tai chi
to your client’s sessions because this helps to detract the mind from any difficult thoughts and
works on improving health and well-being.
Meditation is gaining considerable scientific support. It may be advisable to talk the client
through the process initially so that they can visualise strong, positive imagery, again to detract
their minds from unpleasant thoughts. Some clients will find it easier than others but do
persevere. You can talk them through breathing exercises also to help them breathe through
anxieties affording them greater control and teach them healing meditations where they can
visualise their body and mind healing. If you are not sure how meditation or visualisation scripts
work, consider buying a guided meditation or listening to a sample online. You will see how
simplistic and yet effective it is.
Module Seven
Task:
Create a script for meditation to help with the healing of anxieties. Imagine yourself talking to
your client as you create the script for maximum effect. It can be short script that focuses on
breathing, you can create a guided visualisation that takes them on a journey (use vibrant
imagery) or create scripts for pure relaxation i.e. progressive muscle relaxation. This will help
you to become used to talking clients into a relaxed state. Note: this works best if you can try this
script on a volunteer or record yourself doing so.
Task:
Practice the techniques given in this module so that you can feel confident applying any of the
techniques to clients.
Module Eight
Recovery Journey
There is no definitive guide to recovery when it comes to PTSD. What works for one person may
not work for another, so you need to take an intuitive and yet measured approach. In comparison
to some of your other clients, a PTSD sufferer will be less trusting, so it is important that you do
all that is possible to strong connections and rapport with your client. Trust will be key to their
successful recovery.
PTSD clients need to understand that even if two people experience the same traumatic situation,
they will not experience the same type of PTSD. Responses are shaped by the event as well as
personal experiences, genetics, gender and even age. So it’s worth noting that the schedule for
healing will vary from one person to the next.
While recovery is more than possible in respect of PTSD, it is very much an individual process.
Firstly, there is no magic formulae to help the individual feel whole again. Consider it a series of
stepping stones leading them from a very dark place to one where they will feel relatively well.
Some people will no longer experience any of the symptoms but others will still experience some
on occasion. Recovery time will also be on an individual level. Although it will not happen
overnight, there will be an improvement throughout the weeks or months as gradually the client
begins to adjust to normal life again. The duration for recovery will depend very much on the
treatment given and the individual’s ability to stay the course. Gradually, your client will realise
that they are improving, will be able to face their memories and this often forms a turning point
as the flashbacks begin to decrease and they experience less overwhelming negative feelings.
Your client may report to you that they were able to finally pass the scene of the trauma or face
up to a negative trigger without losing control. Gradually, the client will re-enter the real world
and will no longer feel as if they are standing on the side-lines of their own life.
You will also discover that your clients are able to form bonds with others. Social occasions will
start to be pleasant as opposed to being harrowing or exhausting. There will be a greater sense of
optimism about the future. It’s only when they can compare the person they were whilst in the
midst of the PTSD with the person that they have become, will they realise that their progression
has been significant.
In addition, through careful practice of the therapy techniques and relaxation techniques,
problems will be less difficult to overcome as they will have greater clarity of mind. Stress will
have a lesser impact on them too. Instead of being overwhelmed by any difficult tasks, they will
be able to face up to the challenge.
When utilising relaxation and meditation techniques, they’ll understand how to offset the
negative aspects of stress and be able to utilise deep breathing techniques to aid their
development and as a part of the counselling process, you can install specific milestones
throughout, these may be short but significant milestones to mark the client’s progress.
Do manage the clients’ expectations. There may always be some evidence of PTSD, especially if
they had Complex PTSD through multiple traumas or, as a result of child abuse. In the same
way, a combat veteran may also experience ongoing – albeit reduced symptoms from time to
time. The most important aspect is that they celebrate each step towards recovery rather than
focusing on the negative symptoms. They need to understand that even as they heal, they will not
forget what happened. Part of the recovery process is not about erasing memories, instead, it is
about helping them to cope with those memories in a safe way. They may still feel terribly sad or
even angry when those memories surged forwards but it is how they deal with them that is
important.
Tip:
Your clients may become frustrated and demotivated at times

especially if some of the symptoms occur or appear to
worsen. Prepare for this and keep your motivation and
encouragement strong.
Clients may not always be able to focus on the end goals or to realise that sometimes setbacks
occur and are natural.
Anyone with Simple PTSD will have a fairly good chance of recovering either completely or at
least, will be able to control the majority of symptoms going forward. If you have clients who
have Complex PTSD, it is important that they are realistic about the recovery process and to be
patient. Therapy and counselling is certainly going to help them feel much happier, internally
peaceful and more optimistic.
The stages of recovery:
Victim
When the traumas first occur, it can overwhelm them and take over their lives. The clients may
have difficulty in functioning on a day to day basis, feel negative, depressed and even suicidal.
This is the time when they need immediate help. In therapy, we call this the emergence stage.
The first treatments include supporting them on an emotional basis and ensuring that any health
concerns are dealt with, making sure that they have the right treatment to keep them safe. At this
point, the client needs to be educated about the impact of such a trauma so that they are able to
face it in a more positive way. Your client may need medical assistance in respect of medication
but certainly, they should have a firm diagnosis. There is no doubt that someone emerging from a
traumatic event will be very emotional.
Survivor
As your client begins to face up to their fears through therapy, they start to gain greater control
of life. There is no doubt that the traumas will still define life but gradually, they will start to
realise that they have become more in control of those painful memories. Gradually, they start to
feel more optimistic and have less bad days. As the weeks or months go by, the client starts to
grow stronger and to feel more confident. At this point of the recovery process, you will be able
to set long-term goals which can include:
The recognition of and diffusing any toxic emotions

Repairing the damage to any relationships identifying any remaining victim behaviours
and instead, learning new behaviours with enhanced positive beliefs.
Developing positive coping strategies
As the client progresses, this part of the therapy becomes less intense but it is important that you
keep the client motivated and on track. Some clients will feel that they are cured and will wish to
stop the sessions. Sadly, many people start to experience a false recovery and once the therapy
has stopped, they experience a complete relapse.
Thrive
Although your clients will never forget the traumatic experience, with your assistance, they will
have moved from the victim stage, to survivor and then on to thrive. The trauma may still have
some influence over them but, they are no longer controlled by it. They may not need regular
therapy sessions at this point but some top up sessions to ensure that no relapses occur.
There is no definitive time limit for PDF recovery.

Depending on the chosen therapies utilised and of course, your skillset and techniques gained,
Cognitive Behavioural Therapy can take between one month and twelve months. If you are
providing general counselling support and they are taking CBT as well, this may reduce the time
needed for recovery. If a client also has substance abuse issues, then the therapy will be extended
and multi-pronged. In addition, if a client is undergoing difficult life events, this can increase the
number of sessions. For anyone with coexisting mental disorders or complex PTSD, treatment
will be more intense and will take longer to complete.
Module Eight
Task:
Write (or complete ) a case study that utilises many of the techniques given within this course. If
you have volunteers, please practice the techniques on them and record your findings. If this is
not possible, create a made-up case study utilising the techniques to show your understanding of
how you would support and progress a client towards recovery.
Final Assessment
Congratulations on completing this professional study course on PTSD. We hope that you have
found it informative and are ready to embark upon your new career. If you have any difficulties
with the questions, do go back and read through the modules first. Please take time to complete
the Final Assessment in full and then send your answers to: courses@karenEwells.co.uk
hello@kewtraining.com
Please ensure that you do not send your assessment earlier than two months after commencing it.
This is to give you sufficient time to fully understand, process and practise all the information
provided on the course. Your assessment must be typed and sent in the body of your email or
attached as a Word document. Unfortunately, we cannot accept any other form of attachments.
We aim to acknowledge receipt of your assessment within one working day and we will review it
and contact you within 14 working days. Following satisfactory review, you will be awarded a
certificate of competence.
1. What was PTSD known as during the second World War?
2. PTSD can only affect adults – True or False?

3. List some of the main causes of PTSD
4. List three emotions that a sufferer of PTSD might feel
5. What is disassociation?
6. What is complex PTSD?
7. What is meant by triggers?
8. How many weeks would an individual have to experience symptoms before being
diagnosed as PTSD?
9. List three behaviours that a child of abuse might display.
10. Which technique for recovery have you found most useful throughout this course?
11. What is reframing?
12. What is internal voice temp change?
13. Write a short sample script which could be used for relaxation purposes within a session.
14. Provide details of your case study.

About
The KEW Training Academy was established in 2006 by Karen E. Wells to fill a gap in the
market for online courses that make learning fun, educational and easy. The KEW Training
Academy offers easy and effective solutions that work for you either personally or
professionally. Your course has been tailored from years of experience enabling you to achieve
the goals that give you the key to freedom. www.kewtrainingacademy.com
www.kewtraining.com
Additional Courses
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This course is delivered via an E-Learning portal where you work through the course module by
module in your own time. It includes a comprehensive training manual, scripts, inductions, and
consultation forms for your client, a BONUS Ultimate Relaxation Hypnosis MP3 and unlimited
& dedicated support from the tutors via online forums. Everything you need to get you from the
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Life Between Lives was discovered by Dr Michael Newton who was the pioneer for this work.
Michael has now retired but has formed TNI (The Newton Institute) based in the US to carry on
his legacy.
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This Online Training Course is for existing therapists that wish to expand their practice by
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Mindfulness is a state of active, open attention on the present moment. When you are Mindful,
you can observe your thoughts & feelings with judging them good or bad. Instead of life passing
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day and life.
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Online Diploma Training Course - Future Life Progression
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Training for those that have experience in Regression already.
This course is for those who want to expand their practice by using Progression techniques for
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elsewhere anywhere! If you wish to combine Progression with Healing, this is the course for
you.
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The KEW Training Academy

Professional PTSD Counselling Diploma Course

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The KEW Training Academy

If you are ready, let’s turn to Module One.

There is no recovery without treatment and

PTSD occurs as a result of an experience that is horrifying or terrifying. It can be absolutely

Rape or sexual abuse in adulthood

What does PTSD stand for?

Who can suffer from PTSD?

List some of the main causes of PTSD

Consider the following:

The stress response

But there are emotional effects too:

Often acute stress disorder starts within 4

Post-Traumatic Stress disorder

Being on red alert (hypervigilance)

Let’s look at two elements which point to PTSD:

In addition, there are multitude of circumstances in life that need to be considered:

Considerable stress - sometimes an individual will be under severe stress in life, so

The type of trauma

In counselling terms, this is known as traumatic coupling. It is so powerfully connected to the

Whether a particular event created the symptoms

Three core symptoms:

Recurring intrusive thoughts

Avoidance and numbing

Symptoms of Complex PTSD

Physical symptoms include:

Irritable bowel syndrome-heartburn, chronic diarrhoea, constipation or stomach pain

Pregnancy complications i.e. extreme nausea, miscarriage etc.

Varying psychological issues require

Symptoms of depression include:

A lack of interest in life

Alcohol and substance abuse

Borderline personality disorder

Explain the connection between self-harming and PTSD

Explain how an individual may develop PTSD and an eating disorder

What is social phobia?

What are the symptoms of Borderline Personality Disorder?

It is worth looking out for the following signs:

PTSD and children of abuse

Has the client survived a life-threatening traumatic event?

(Did the clients say yes to 3 or more questions?)

Does the client have insomnia or find it difficult to stay asleep?

(Did the client say yes to at least two the questions?)

(Did the client say yes to both questions?)

Always refer clients to the doctor if you

As an example, the doctor is likely to ask:

The type of trauma.

Doctors may recommend medication for the following:

Certainly if the client is in danger of hurting themselves or others, then medication is

There are options available:

Selective Serotonin Reuptake Inhibitors

Serotonin and Norepinephrine Reuptake Inhibitors

They should ask:

How can relaxation techniques help?

How do the drugs which are prescribed for PTSD work?

Neuro Linguistic Programming

Visual squash example:

You can use the following dialogue:

Where in your body does the feeling start?

Traumatic incident reduction

To give you an idea:

Your clients may become frustrated and demotivated at times

The stages of recovery:

The recognition of and diffusing any toxic emotions