Resolving Trauma
Without Drama
Bill O’Hanlon, M.S., LMFT
Possibilities
Santa Fe, NM USA
Bill@billohanlon.com
www.billohanlon.com
Good News about PTSD
We are finally
recognizing it
Bad News about PTSD
We have mainly one
idea and approach to it
and some prevalent
myths
Myths and misconceptions
about trauma and treatment
1
All people who suffer
trauma develop PTSD
Trauma doesn’t necessarily lead to PTSD
• 60.7% of men; 51.2% of women in the
U.S. have experienced at least one
traumatic event meeting DSM criteria
• In Detroit, nearly 90% of residents have
been exposed to traumatic events
• But the general lifetime prevalence of
PTSD is about 7.8% and Detroit residents
is 9.2%.
Kessler, R.C.; Sonnega, A.; Bromet, E.; Hughes, M.; and Nelson, C.B. (1995). “Trauma and
Posttraumatic stress disorder in the National Comorbidity Survey,” Archive of General
Psychiatry, 52(12):1048-1060.
Breslau, N.; Kessler, R.; Chilcoat, H.; Schultz, L.; Davis, G.; and Andreski, P. (1998). “Trauma and
posttraumatic stress disorder in the community: The 1996 Detroit Area Survey of Trauma,”
Myths and misconceptions
about trauma and treatment
2
People who develop
PTSD only resolve it
through therapy
PTSD often resolves without treatment,
but treatment can help resolve it faster
• There was a steep decline in the
prevalence of PTSD over the first 12
months after it developed, followed by
a gradual decline for 6 years.
• But treatment seekers had about half
the duration as non-treatment
seekers.
Kessler, R.C.; Sonnega, A.; Bromet, E.; Hughes, M.; and Nelson, C.B. (1995).
People are often more resilient than
we therapists give them credit for
Expected rates of PTSD following 9/11 didn’t materialize
“Resilience is often the most commonly
observed outcome trajectory following
exposure to a potentially traumatic event.”
There is a whole literature on Post-traumatic Growth and Resilience
G. A. Bonanno, C. Rennicke and S. Dekel, (2005) “Self-enhancement among high-exposure
survivors of the September 11th Terrorist Attack: Resilience or Social Maladjustment?” Journal
of Personality and Social Psychology, 88:984-988.
Bonanno, G.A. et. al, (2002) “Resilience to Loss and Chronic Grief: A prospective study from
preloss to 18-months postloss,” Journal of Social Issues, 83:1150-64.
Tedeschi, R. G. and Calhoun, I.G. (2004) “Posttraumatic Growth: Conceptual foundations and
empirical evidence,” Psychological Inquiry, 15:1-18.
Linley, P.A. and Joseph, S. (2004) “Positive Change Following Trauma and Adversity: A review,”
Journal of Traumatic Stress, 17:11-21.
Carver, C.S. (1998) “Resilience and Thriving: Issues, models and linkages,” Journal of Social
Issues, 54:245-266.
Example of natural resolution
of PTSD (post-Katrina)
911 operator in Katrina disaster
Myths and misconceptions
about trauma and treatment
1. All people who suffer trauma develop
PTSD
2. People who develop PTSD only
resolve it through therapy
3. Long-term, abreactive therapy that
helps people relive and assimilate the
trauma is the most effective approach
4. There are only negative effects from
trauma
trauma:
A lesson from Cambodia
approaches
1
Future pull
approaches
2
Inclusion
approaches
3
Pattern
Change
approaches
4
Re-Connection
Resolving Trauma
Without Drama
Future-oriented
interventions for
resolving trauma
Resolving Trauma
Without Drama
“All pasts are like
poems; you can derive
a thousand things, but
you can’t live in them.”
–John Fowles
FUTURE PULL:
Connecting with a
Future with
Possibilities and in
which the Post-Trauma
is Resolved
FUTURE PULL:
The Victor Frankl
Strategy
Howard Lutnick, CEO Cantor Fitzgerald
Lost his brother, his best friend and 658 of his employees
in the 9/11 attacks
We always thought we’d fall apart at some
point. I’d tell people it was like surfing in front
of a very large wave and as long as I kept
going forward as fast as I possibly could, the
wave would never get me. But if I ever
stopped, and took a moment to look back . .
.Whoosh, the wave would crash over me,
and I’d get crushed. But if I kept moving
forward, the wave would get smaller and
smaller, and that’s what happened. (Fall
Elspeth McAdam-Future Pull
. . . A young girl I was working with had
experienced abuse. She walked into my office
as a very large girl with shaved hair, tattoos on
her head, and I don't think she had showered in
a week. I had been asked to see her because
she was so angry. She clearly didn't want to
come and see an expletive expletive shrink.
She was very angry at being there. I just said to
her, 'You've talked to everybody about your
past. Let's talk about your dreams for the
future.' And her whole face just lit up when she
said her dream was to become a princess. In
my mind I could not think of two more opposite
visions–but I took her very seriously. I asked
Elspeth McAdam-Future Pull
She started talking about being a people's princess who
would do things for other people, who would be caring
and generous and a beautiful ambassador. She
described a princess who was slender and well
dressed. Over the next few months, we started talking
about what this princess would be doing. I discovered
that, while this girl was 14 and hadn't been attending
school for a long time, the princess was a social
worker. I said, 'Okay it is now ten year's time and you
have trained as a social worker. What university did
you go to?' She mentioned one in the north of
England. I asked, 'What did you read [study] there?'
She said, 'I don't know, psychology and sociology and
a few other things like that.' Then I said, 'Do you
Elspeth McAdam-Future Pull
She said, 'I had this psychiatrist who helped me.'
I said, 'How did she help you?' And she started
talking about how we made a phone call to the
school. I said, "Who spoke? Did you or her?'
She replied, 'The psychiatrist spoke but she
arranged a meeting for us to go to the school.' I
said, 'Do you remember how you shook hands
with the head teacher when you went in? And
how you looked and what you wore?' We went
into these minute details about what that
particular meeting was like–looking from the
future back. And she was able to describe the
conversations we had had, how confident she
had been, how well she had spoken, and the
Pull
About a month after this conversation
she said to me, 'I think it's about time
we went to the school, don't you? Can
you ring and make an appointment?' I
asked if she needed to talk about it
anymore and she said no, that she
knew how to behave. When we went
into the school she was just brilliant. I
first met that girl ten years ago. Now
she is a qualified social worker. She
fulfilled her dream–although she didn't
Future Pull
“There is a reason the rearview
mirror is smaller than the
windhield.” –Sign on a church in
Winnipeg
Problems into Preferences
Rephrase from what is unwanted to
what is desired
Redirect from the past to the future
Mention the presence of something
rather than the absence of
something
Suggest small increments rather
than big leaps
Expectancy Talk
Yet, so far
Before
After
When
How quickly?
Letter From Your Future
 Write a letter from your future self to




your current self
From five years from now
Describe where you are, what you are
doing, what you have gone through to
get there, and so on
Tell yourself the crucial things you
realized or did to get there
Give yourself some sage and
compassionate advice from the future
Letter From Your Future
Use these questions to guide their letter writing:
 What have you learned and gained perspective on since back in
[fill in the present date/year]?
 What things were you worried or frightened about in those days
that seem trivial or far away for you today?
 What problems seemed overwhelming or insurmountable in
those days that you did eventually resolve or overcome?
 What sage advice would your future self give to that present
self?
 What comfort or reassurance would your future self give to your
present self?
 Who were you troubled by, frightened by or concerned with that
now doesn’t matter as much?
Future Pull
"You have to go fetch the
future. It's not coming
towards you, it's running
away." –Zulu proverb
• What is your sense of a future you
would prefer (vs. problem-determined or
problem-continued future)?
• What would you do or focus on or think
in the near future if you were committed
to or moving toward that future?
•Could you do any small part of that right
now or in the near future?
The Miracle Question
 Say: “Imagine that as you were asleep tonight, a
miracle occurred and the problem or concern that
brought you to therapy was resolved.” Make
certain that the client is experientially involved in
the scenario.
 Ask: “When you first open your eyes, what the first
thing you will notice that will let you know that this
miracle has occurred?”
 Ask: “How would other people know the miracle
had occurred? What would they notice that is
different about you or what you are doing?”
 Keep tracking the changes through the day, the
Other Future Metaphors
Crystal ball
Time machine
Other Future Metaphors
Rainbow bridge
Future Pull
“The future enters into us, in
order to transform itself into
us, long before it happens.”
—Rainer Maria Rilke
Future Pull
“The best thing about the
future is that comes only one
day at a time.” –Abraham
Lincoln
Future Pull
Methods
Problems into preferences

Letter from the future
Positive expectancy talk
 Miracle question/time
machine/crystal ball/rainbow bridge
Acknowledgment and
Possibility
Transitioning between past, problem
and possibilities
Carl Rogers with a twist
3 methods
Reflecting in the past tense
Reflecting from total to partial
Reflecting from truth/reality claims
to validating perceptions
Letter from Abraham Lincoln to Fanny McCullough
Dear Fanny
It is with deep grief that I learn of the death of your
kind and brave Father; and, especially, that it is
affecting your young heart beyond what is common in
such cases. In this sad world of ours, sorrow comes to
all; and, to the young, it comes with bitterest agony,
because it takes them unawares. The older have
learned to ever expect it. I am anxious to afford some
alleviation of your present distress. Perfect relief is not
possible, except with time. You can not now realize
that you will ever feel better. Is this not so? And yet it is
a mistake. You are sure to be happy again. To know
this, which is certainly true, will make you some less
miserable now. I have had experience enough to know
what I say; and you need only believe it to feel better
Resolving Trauma
Without Drama
Validating/inclusive
interventions for
resolving trauma
Undifferentiated
self
Undifferentiated
self
Shaming/devalui
ng
Sexual/physical intrusi
Undifferentiated
self
Attribution of experience
Leads to
3-D
effect
Unowned/”bad” feelings,
thoughts, sensations,
memories, fantasies, desires,
aspects of self
Aspects of
experience with
which the person
Devalued aspect is either
inhibited, suppressed and
numbed or becomes
intrusive, dominant or
compulsive
AKA “The Missing Roommate”
Inclusion Level 1
Permission #1
To
You can
It’s okay
You’re okay if
Inclusion Level 1
Permission #2
Not to have to
 You don’t have
to
 It’s okay if you
don’t
 You’re okay if
you don’t
Inclusion Level 2
Inclusion of
seeming
opposites
You can and not
 Opposite
polarities
 Previously
incompatible
Inclusion
“Do I contradict myself? Very
well, then I contradict
myself. I am large, I contain
multitudes.”
–Walt Whitman
Inclusion
“In logic, no two things can
occupy the same point at the
same time, and in poetry that
happens all the time. This is
almost what poetry is for, to be
able to embody contrary
feelings in the same motion.”
Inclusion
“Anger and tenderness–my selves.
And now I can believe they breathe in
me as angels and not as polarities.
Anger and tenderness–the spider’s
genius. To spin and weave in one
moment anywhere. Even from a
broken web.”
—Adrienne Rich
OXYMORONS
Awfully nice
Found missing
Almost exactly
“Now, then ...”
Terribly pleased
Definite maybe
Exact estimate
Same difference
Sweet sorrow
Working vacation
Tight slacks
Pretty ugly
Inclusion Level 3
Exceptions
That’s the way it is,
except when it’s
not
 Moments of
exception
 Including the
opposite
possibility
 Recognizing
Nature
Future selves
Spirituality
Resources
Alternative
Stories
Exceptions
Influenced by alien
voices
(society’s/others)
Devalued
Identified Self
(Identity Story)
aspects
(Disidentified
Self)
Community
Previou
s
solution
s
Polarities
(Non-identified self)
Where to Apply Inclusion
Injunctions
 Restraining - Can't, shouldn't,
won't
 Compelling - Have to, should,
will, must
 Be, think, feel, know, notice,
do, talk about

Undoing Injunctions
Determine the injunction
Sex is bad.
It's not okay to get angry.
I have to relax or stop obsessing.
Use any or all of the inclusive methods to
undo injunctions
"It's okay to be connected and sexual."
"You don't have to relax. If the obsessions are
there, you can just let them be there."
Review: Levels of
Inclusion
3 Levels of Inclusion
Permission
• To
• Not to have to
Inclusion of (seeming)
opposites
Exceptions
Resolving Trauma
Without Drama
Pattern
changing/breaking
interventions for
resolving trauma
Patterns as problems
John Cage:
“I can’t understand why
some people are
frightened of new
ideas. I’m frightened of
the old ones.”
Patterns as problems
Emile Chartier:
“There’s nothing as
dangerous as an idea
when it’s the only
one you have!”
Patterns as problems
12-step saying
Insanity is doing the
same thing over and
over and expecting
different results.
CHANGE THE DOING
CHANGE THE VIEWING
CHANGE THE
CONTEXT/SETTING
Changing the Pattern
1. DE-PATTERNING
 Find and alter repetitive patterns
of action and interaction that are
involved with the problem
2. RE-PATTERNING
 Help clients establish a new
pattern in place of the old one
 Find and use solution patterns
of action and interaction
Patterns/Processes
Thoughts
Beliefs
Stories
Internal
experience
Behavior
Actions
Neurolog
y
External
sensory
perception
External
environment
Pattern Intervention
Interventi
on
New views
Neurology
External
Lead out of the
sensory
old repeating
Internal
perception
experience patterns
Behavior
External
environment
Breaking the post-traumatic
pattern
 Find any regularity in the post-traumatic experience
 Neurological/physiological
 Perceptual
 Behavioral
 Interpersonal
 Frame of reference
 Focus of attention
 Find any place to make a small or dramatic change in
the pattern that is under your or their influence
 Find the exception/solution pattern
 Find a substitute that wouldn’t be so harmful or
upsetting
Resolving Trauma
Without Drama
Neurological
interventions for
resolving trauma:
The fast track out of
Neurology works
rapidly
Recent trauma
treatments
EMDR
TFT/EFT
Controversial but
Websites for further info
Thought Field Therapy
www.tftrx.com
Emotional Freedom Technique
www.emofree.com
EMDR
Websites for more information:
www.emdr.com
www.emdria.org
Francine says: GET SOME
TRAINING!
Resolving Trauma
Without Drama
Perceptual
interventions for
resolving trauma
Breaking the post-traumatic
pattern
 Find any regularity in the post-traumatic experience
 Neurological/physiological
 Perceptual
 Behavioral
 Interpersonal
 Frame of reference
 Focus of attention
 Find any place to make a small or dramatic change in
the pattern that is under your or their influence
 Find the exception/solution pattern
 Find a substitute that wouldn’t be so harmful or
upsetting
Externalizing
Move the post-traumatic pattern
outside the person’s body
Raggedy Anne
Slash painting
The Writing Ritual
Write about the trauma for as little as
3 days in a row
Write for about 15 minutes or so
Keep the writing private
Be honest and write freely without
editing or worrying about getting it
exactly right
Consider burning it, burying it,
throwing it away or some such ritual
Resolving Trauma
Without Drama
Reconnecting
interventions for
resolving trauma
Trauma can disrupt
connections
•Initial disconnection is normal
•But if it persists, then PTSD often
ensues
•Discover natural places or ways of
connection
•Help people reconnect or connect in
places or ways they haven’t before
Connection can help reduce PTSD
• Being with someone else during an
earthquake is protective against PTSD
Armenian, H. et. Al. (2000). “Loss as a determinant of PTSD in a cohort of adult
survivors of the 1998 earthquake in Armenia: Implications for policy,” Acta Psychiatr.
Scand., 102(1):58-64.
• Post-traumatic stress disorder sufferers in
group treatment recovered at a
significantly higher rate (88.3%) than those
in individual treatment (31.3%).
Beck, J. et.al. (2009).“Group Cognitive Behavior Therapy for Chronic Posttraumatic
Stress Disorder: An Initial Randomized Pilot Study,” Behavior Therapy, 40(1):82-92.
Maryann Burns, Cantor Fitzgerald
Missed her train the morning of 9/11
The only place I felt like myself was
work. I needed to be around other
people who’d been where I’d been. I
didn’t want to have to explain myself.
In groups of other people I often felt
detached, you know?
Work made me feel sane. I wanted to
Pathways to Connection
Soul/spirit/core self/intuition
Body/sensory experience
Another being
Community/groups
Nature
Art
God/universe/higher power/bigger
picture, meaning and purpose
Discover the natural
connections people have
 Help them reconnect
where they have
disconnected
 Help them find and
create new connections

Connective Rituals
Regularly repeated
activities
Reconnect one to self,
others or something
beyond
Give one a sense of
continuity
Resolving Trauma
Without Drama
Post-Traumatic
Success:
How trauma can
contribute to a person’s
Positive Disintegration
Psychiatrist Kazimierz Dabrowski first
posited a theory of “Positive
Disintegration” in 1964 (Dabrowski, K.
Positive Disintegration. Boston: Little,
Brown & Co.), suggesting that
overwhelming crises are necessary
and natural elements that help people
move from one developmental stage
to the next.
Success
Success
“Dear Mom and
Dad: Thanks
for the happy
childhood.
You’ve ruined
any chance I
had of
Resilience is learnable
“We do know there are factors that make
some people resilient. There are genetic
components to it, but there’s a huge
learning component. People can train
themselves to be more resilient.” –Dr. Steven
Southwick, himself a veteran of the Vietnam War,
deputy director of the Clinical Neurosciences Division
of the National Center for PTSD
“Facing Combat Without Stress? Researchers Examine Most Resilient
Soldiers,” VA (Veterans Administration) News Flash, August 26, 2007,
http://www.vawatchdog.org/07/nf07/ nfAUG07/nf082607-7.htm
Post-Traumatic Growth
Inventory
 Posttraumatic Growth Inventory, a 21-item
scale for assessing positive outcomes
reported by people who have experienced
traumatic events, is described.
 Women tend to report more benefits than
do men
 People who have experienced traumatic
events report more positive change than
do persons who have not experienced
extraordinary events.
“
Post-traumatic Growth
Reports of posttraumatic growth have been found in people who
have experienced:













Bereavement
Rheumatoid arthritis
HIV infection
Cancer
Bone marrow transplantation
Heart attacks
Coping with the medical problems of children
Transportation accidents
House fires
Sexual assault and sexual abuse
Combat
Refugee experiences
Being taken hostage
Ref: Tedeschi, R. G. and Calhoun, I.G. (2004) “Posttraumatic Growth: Conceptual
foundations and empirical evidence,” Psychological Inquiry, 15:1-18.
Post-traumatic Growth Inventory
Categories are:
New Possibilities
Relating to Others
Personal Strength
Spiritual Change
Appreciation of Life
The American Psychological Association has this
inventory on their website so people can take it:
http://cust-cf.apa.org/ptgi/
Post-traumatic Growth Inventory
Sample statements; rate on a scale of 1-5 how much the
trauma or crisis led to this:
I established a new path for my life.
I know better that I can handle difficulties.
I changed my priorities about what is
important in life.
New opportunities are available which
wouldn't have been otherwise.
I have more compassion for others.
I discovered that I'm stronger than I
thought I was.
Thriving Through Crisis:
Creating Post-Traumatic
Success
Connection
Compassion
Contribution
Creating Post-Traumatic
Success
Compassion/Contribution/Service
Mitzvah therapy



The African Violet Queen
Sol Gordon’s Abuse Victim
M.A.D.D.
When a man is wrapped up in himself, he makes
a pretty small package. –John Ruskin
The Dead Sea (no outlet) vs. The Sea of Galilee
(outlet)
Transforming PTSD into
Post-Traumatic Success
Blissed
or
Dissed
DISSED
Wounded/Cursed
(Disrespected)
or
Righteously Indignant
(Dissatisfied)
The Key
Transforming the
“negative” energy
of anger and hurts
into positive energy
Dissed
Wounded/Cursed
Dissed
Vocal
coach
Patsy
Rodenbe
rg
Dissed
Rock music and
movie critic
Ken Tucker
Dissed
Horror
writer
Stephen
King
Wounded
Leonard Cohen:
There’s a crack in
everything.
That’s how the light gets
Dissed
We all leave childhood with wounds.
In time we may transform our
liabilities into gifts. The faults that
pockmark the psyche may become
the source of a man or a woman’s
beauty. The injuries we have
suffered invite us to assume the
most human of all vocations–to heal
Dissed to Creativity,
Contribution or Career
 Where have you been wounded?
 Where or about what have you
been cursed?
 How can you turn this wound or
disrespect or curse into a
blessing or contribution?
 How could this wound, curse, or
disrespect fuel your creativity or
Resolving Trauma
Compassion
Passion=Feeling
Com=with
Compassion/SelfCompassion
People who are unable to forgive
themselves or others also have an
increased incidence of depression
and callousness toward others.
Pargament, K.L., et al. (1998). Journal of
Scientific Study of Religion, 37:710-724.
Compassion
Find contexts of compassion/selfcompassion (the solution-oriented
approach)
Ask about moments when the
person softened toward themselves
or someone else
Find another context (like being a
friend, a child, or a client) that can
access compassion
Ask the person how they would like
Self-Compassion
Bumper Sticker:
I honor and express all
facets of my being,
regardless of state and
local laws.
Four major approaches to resolving
trauma briefly and respectfully
1. Connect the traumatized person
to a future with possibilities
2. Validate/value and include all
aspects of the person
3. Change the pattern of the posttraumatic problem
4. Reconnect the person in places
where he or she has been
disconnected (from self, others
Plus: Post-Traumatic
Success
1. Connection
With self, others and something
beyond
2. Compassion
 For others and for self
 Forgiveness
3. Contribution
 Letting the wound or the trauma
lead to being of service and
changing the world in a positive way

THANK YOU
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Bill O’Hanlon, M.S., LMFT
Possibilities
223 N. Guadalupe #278
Santa Fe, NM 87501 USA
Bill@billohanlon.com
www.billohanlon.com