Social Work Practice and Post-Traumatic Growth Podcast

Editor's note: This text-based course is a transcript of the Social Work Practice and Post-Traumatic Growth Podcast, presented by Samantha Silverman, MSW, LCSW, and Benjamin T. Bencomo, DSW LISW, LCSW.

Learning Outcomes

After this course, participants will be able to: 

• • Explain the difference between post-traumatic stress disorder (PTSD) and post-traumatic growth (PTG).
  • Identify symptoms of PTSD and signs of PTG.
  • Identify evidence based interventions for achieving post-traumatic growth (PTG).

Podcast Discussion

Ben: Hello, everyone, and welcome to the Continued Social Work Podcast. I am very excited to have our guest today and learn from her personal and professional experiences related to post-traumatic growth, specifically post-traumatic stress disorder, and post-traumatic growth.

Our guest today is Samantha Silverman. Samantha is a licensed clinical social worker and the owner of Silver Linings Counseling, a group practice located in Denver, Colorado. Prior to Silver Linings Counseling. Samantha worked extensively with Holocaust survivors at a nonprofit agency. Samantha also used to work at the World Trade Center and is a survivor of the terrorist attacks on 9/11. Due to both her personal and professional experiences, Samantha undertook her own journey towards growth in the aftermath of trauma through her current professional practice, which includes psychoeducation and counseling interventions. Samantha hopes to help others achieve their own post-traumatic growth. Samantha, welcome. Thank you so much for joining us today.

Samantha: Thank you so much for having me.

Ben:  Samantha, can you tell me a little bit about your path to social work? How did social work find you and maybe a bit about your social work education background?

Samantha: Sure, absolutely. My path to social work is actually directly correlated to post-traumatic growth. I am going to reference my own personal experience frequently on this podcast. But basically prior to pursuing my master's degree, I worked in the marketing department for a well-known financial firm on Wall Street that was actually located in the World Trade Center. During this time, I had recently graduated college, I was already kind of questioning my career path, and it felt like I wanted to be in a more humanistic field. In the aftermath of 9/11, I began my own path of self-discovery, and I learned more about myself than at any other point in my life. Due to my PTSD symptoms and working in the World Trade Center, I became eligible for free mental health assistance in the state of New York.

During that time period, I sought out many mental health practitioners in New York City. I tried cognitive behavioral therapy, or CBT, hypnosis, and psychoanalysis. And I even joined a sleep study when I developed insomnia. The field of mental health really saved my life in the aftermath of 9/11. And the practitioners that I met during that time were crucial in paving the way for my future. And I also wanted to enter a field that was fulfilling and in which I could be of service to others. So I went back to school and pursued my master's degree in social work at Hunter College in New York City and therefore obtained my master's degree in social work.

Ben: Wow, that is interesting. So it is always interesting to me how social work finds us at different points in our lives and a lot of times due to the experiences that we're living through. So I am glad that those healing experiences that you had with mental health professionals were something that really spoke to you, and what an exciting thing to be able to now serve in that capacity for others as well. So I'm sure I speak on behalf of many clients when I say we're glad that you found, or that social work found you and that you found your way to this.

Samantha: Yes, I appreciate that, Ben. Yes, I feel like it was a two-way street, social work found me, but I was also looking for social work.

Ben:  Samantha, can you tell me a little bit about what led you, you already mentioned briefly your experience during 9/11, but can you tell me a bit about what led you to be especially interested in the field of post-traumatic growth, especially?

Samantha: Sure, absolutely. I'm going to divide this podcast up kind of into two components. I want to delve into the educational aspect of the podcast, but I also want to reference my own personal experience and parts of my own personal story, just because they are both relevant in obtaining post-traumatic growth. Basically, as I mentioned before, on September 11th, 2001, I worked in the World Trade Center for a well-known Wall Street financial firm. On that morning, I witnessed absolutely horrible atrocities, as many of you might imagine. I'm not going to go into the details about what that personal experience was like for me, as I don't think it's relevant to this podcast. However, what I will say is what I saw and experienced had such a profound effect on both my physical and mental health.

After 9/11, I developed hypervigilant behavior, which included insomnia, and fear of leaving my apartment. I also developed a chronic upper respiratory disease, which I continue to deal with to this day and will continue to deal with for the rest of my life. I lost half of my hearing and will need to wear hearing devices for the remainder of my life as well. Again, in the aftermath, I sought the help of so many mental health experts who all played a role in righting my course in life. During that time period, I truly experienced an existential crisis. I experienced survivor's guilt, and I questioned why I was alive while others were not. I wondered who I was and what my purpose was in life.

I questioned my career path again, I was then a marketing associate, and I questioned whether I was making a difference in the world with that career path. I viewed all of my interpersonal relationships differently, and I began to develop insight into my relationship with myself. I always tell people when I talk about my 9/11 experience that a part of me died on 9/11, but another part of me was reborn; again, that is when I decided to go back to school, pursue a master's degree in social work, that allowed me to help others. And then, after receiving my master's degree, I moved back to my hometown of Fort Lauderdale, Florida. When I moved back to Florida, I fell into a really interesting position where I worked for a decade with Holocaust survivors.

During that time, I heard equally horrifying and completely mesmerizing stories about individual rebirth. I learned about the immense strength of humankind and resilience and how we can all learn and grow from our personal experiences. So, yeah, I hope that my personal story serves as a catalyst and inspiration to help you and your clients achieve post-traumatic growth.

Ben: Thank you for sharing that. I cannot imagine how much work you have put into your own personal post-traumatic growth. I have worked with survivors of trauma before, but I do not think I have ever heard it put quite that way. The fact that a part of you died that day, and also a new part of you was born. And I have no doubt that maybe many of our listeners who have also experienced trauma in the past can probably relate to that sentiment and that feeling and something that I am sure many of your clients do as well. Thank you for sharing that with us.

Samantha: Absolutely.

Ben: If I could, before we delve a little bit deeper into this, I want to make sure that our listeners understand the difference between the terms that we are using; we are social workers, right? So we often speak in acronyms. My family often reminds me to say the entire word because I fall into this social work lingo of saying acronyms, but people working in this field, obviously know PTSD, it stands for post-traumatic stress disorder, and many may know PTG, but many may not, post-traumatic growth. I wonder if you could explain to us, what is the difference between post-traumatic stress disorder, or PTSD, and post-traumatic growth, or PTG?

Samantha: Sure, absolutely. And yes, I think that is very important before we get into PTG or post-traumatic growth. I definitely want to just take a minute and review post-traumatic stress disorder or PTSD. According to the DSM, the definition of post-traumatic stress disorder is exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways: directly experiencing the traumatic event, witnessing in person the event as it occurred to others, learning that the traumatic events occur to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the events must have been violent or accidental, experiencing repeated or extreme exposure to aversive details of the traumatic events, for example, first responders and police officers.

And I think another important caveat to mention when we talk about PTSD is something called vicarious trauma, which many social workers will encounter when they are hearing traumatic stories from their clients. But basically, what I just read is the definition of PTSD from the DSM. Of course, PTSD is very broad, and I think there are so many other symptoms and incidents where PTSD can be applied to an individual. But to talk about PTG or post-traumatic growth, PTG is actually a relatively new term. It was actually coined in the 1990s by two psychologists, and those psychologists' names were Richard Tedeschi and Lauren Calhoun. And Tedeschi and Calhoun are both trauma experts. And in creating and coining the term post-traumatic growth, I will be referring to it as PTG.

They basically posit that PTG tends to occur in five general areas. Those five areas are an appreciation of life, improved relationships with others, new possibilities in life, personal strength, and spiritual change. Tedeschi and Calhoun actually took those five factors, and they created something known as the post-traumatic growth inventory. That's basically a 21-item assessment tool that can determine an individual's progress in reconstructing their perceptions of self, others, and the meaning of events while they're coping with the aftermath of trauma. Again, it's important to note that PTG does not discount those who struggle with post-traumatic stress. What PTG can do is offer a new lens through which the individual can explore themselves in the shadows or in the aftermath of a traumatic situation.

Ben:  Yeah, wow, thank you for sharing that. I do not think maybe a lot of people are aware that we in the field often will say it is relatively recent, but really this is something that experts in the field have been talking about for at least a couple of decades. And so, I am glad that we are having this conversation on the podcast, and I hope that it spurs others, people listening, to try and learn more about it because it is incredibly complex. And when we try and narrow down PTG, even PTSD, to just the DSM diagnosis, we understand that PTSD can manifest in many different ways, but also when we look at post-trauma, and we look at growth and we look at healing, and we look at the journey that many survivors are going through, I think that all of that can be incredibly helpful. Thank you for sharing that.

Samantha: Oh, absolutely.

Ben:  I want to ask you more specific questions related to post-traumatic growth, but before we do that, I wonder if you could share any information related to statistics? PTSD, as we know, unfortunately, is incredibly prominent, even more so today than probably ever before; in many areas where social workers are interacting with clients, we know that many social workers are working alongside law enforcement, and EMS. And so they are seeing, they are present in those very early stages of a traumatic experience, but we also know whether they're working in child welfare or working with adults in the area of mental health, addictions, obviously any social workers that are working with veterans in that area.

But probably almost any area where social workers interact with clients, we are going to see people who have lived through trauma, maybe not to the extent of a PTSD diagnosis, but definitely people who are living with trauma. And so, with that, I wonder if you can share any information or any recent statistics that you have related to PTSD and prominence.

Samantha: Sure, absolutely, and that is a very good point, Ben. PTSD is so prominent in so many different avenues of social work. And I would even estimate that the majority of clients that we see in our practice have some form of PTSD, but in order to provide you with some statistics, I did take some time and I did look up some present statistics on PTSD. So roughly currently, about 8 million adults in the United States have PTSD during any given year. PTSD affects more than twice as many women as men. That source is from the US Department of Veteran Affairs. It is estimated that 70% of adults in the United States will experience at least one traumatic event in their lifetime. So 70% of adults, that is the majority of us, that leaves only 30% of the US population who do not or will not experience a traumatic event in their lifetime.

Ben: Wow, when we think about it that way, this is something that social workers, not only social workers, who specifically are specializing in working with clients diagnosed with PTSD, but really all social workers should have a general knowledge and understanding of how to support people post-trauma, right? So can you talk about some symptoms maybe that would lead a person to believe that maybe they could be suffering from PTSD? What are some things to look out for?

Samantha: Sure. I am going to talk about some symptoms, and I also might talk about some of my personal experiences and symptoms after 9/11 as well. But basically, there are so many symptoms; any different or strange, erratic change in behavior can also be a symptom of PTSD. Some of the more widely known symptoms are changes in physical and emotional reactions, and those can be being easily startled or frightened, always being on guard, or perceiving there is danger lurking, even when there is not; it can also be self-destructive behavior such as drinking too much or driving too fast. One can also experience trouble sleeping or trouble concentrating. Also, irritability, angry outbursts, and aggressive behavior. Other symptoms can be overwhelming guilt or shame.

Also, people can have flashbacks or dreams. Also, physical reactions, such as feeling ill. Someone can also have denial of the event actually happening, or somebody can startle easily, have a shortened sense of the future, or have an overwhelming sense of sadness and hopelessness. Basically, there are so many vast symptoms associated with PTSD, but I think the root of it is an individual acting in an ego-dystonic way. Ego dystonic refers to somebody acting erratically or differently than they would ordinarily. After I went through 9/11, I experienced a vehement shift in my behavior, myself identity, and even my mood. I stopped sleeping. I developed insomnia, and I developed horrible anxiety and depression. I still lived in New York City, and whenever I rode the subway, I was afraid that a bomb would go off when I was in a crowded place, which is quite common in New York City; as most places are crowded, I wanted to flee.

I developed hypervigilance in locating the nearest exit or evacuation route whenever I felt confined. When I couldn't sleep at night, I would walk through the streets in the city at all hours. For some reason, walking and movement was the only way that I could relax and put my mind at ease and find solace. I also developed survivor's guilt. I frequently ruminated on all the people that had died, and I actually felt guilty and even punitive that I was still alive.

Ben: Thank you for sharing that. We appreciate your bravery and your ability to share some of those very personal experiences with us today. When we talk about trauma and living through trauma and how that changed you, it changed your behavior; it changed how you reacted to different situations, to different stimuli. I think that in that moment of change, right, that's when we're looking at, well, where do we go from here? So based on what you were talking about in regard to how the trauma caused changes for you, what would you say is the first step that needs to be taken in healing trauma?

Samantha: Sure. I would say the first step is the realization that you need to change. And after that realization, you need to take a risk. An individual absolutely needs to take a risk in order to begin the cycle of change. You can't remain stagnant in your trauma and expect to change. If you don't take risks, you're really doing yourself an injustice. Risks, in my opinion, promote strength and resilience. And in regards to that, to taking a risk, to elicit that change, there's actually a very well-known model which speaks to the stages of change. I am going to talk about that as I think it is really important in helping somebody kind of understand the steps and the stages of change, but the model is called the transtheoretical change model.

And the transtheoretical stage model can be broken down into the following steps. The first step is pre-contemplation, which really means that you are not quite ready for change, but you are starting to think about it. The next step is contemplation, which means that you are starting to think a little bit more about change and possibly even getting ready for change and thinking about what to do. The next step is preparation, which means that you are ready for change. In the preparation stage, that could be the stage where you say, okay, I am going to reach out to a therapist. I am going to regain control of my life. And then, after the preparation stage is, the action change. That is when an individual is actively making the room and creating change.

For example, continuing to see a therapist and processing their trauma. And then, after the action stage, the most important one, in my opinion, is the maintenance stage. And that is keeping up with change. Maintenance is very important to achieve because if you do not maintain that change, it is very easy for an individual to fall back into old patterns of behavior. In regard to the stages, I would say that the time for each stage is really variable for each individual. One individual may spend more time in the pre-contemplation stage. Another individual may spend more time in the preparation stage. However, I will say that once an individual reaches the action stage of change, they can actually begin to identify certain triggers and maladaptive behaviors.

And I would say that the action stage of change is usually accomplished in psychotherapy, but it can also happen in other interventions. But I will say that the insight acquired through therapy sessions can really help course correct some of these triggers and these maladaptive behaviors.

Ben: Yeah. And so, as social workers working in these areas, we are not always sure what stage a client is going to be coming in or someone is going to be coming through our doors in. So how can a person use maybe their PTSD diagnosis to start this process, to start moving along these stages of change, to work towards post-traumatic growth specifically?

Samantha: Yes, that is a great question. Again, I am a psychotherapist, and I believe that by acquiring that newly developed insight through therapy, an individual can work towards PTG. However, there are interventions out there. I do not believe that therapy is always the best intervention for somebody to acquire change. But I will say that first and foremost, the individual needs to be well stabilized in their current life situation. If someone is unstable or in a crisis, growth through counseling is very difficult, if not impossible. I actually once had a continuing education instructor say change does not happen in a crisis. That phrase has really stuck with me. And when I first heard this term, I kind of molded over and continued to process it.

But basically, what I have come to determine from that term is that when an individual is in crisis, they are naturally in a fight or flight response. When an individual is in crisis, they have blinders on, which prevents them from forward thinking. When an individual is in crisis, they are usually in survivalistic mode. They are usually untethered, ungrounded, and therefore unable to process necessary change. Also, when someone is in crisis, the therapist needs to utilize more of a supportive and validating approach in order to move the client to a more stable predicament. Crisis procedures need to be followed, and an acute crisis state can consist of a client, maybe even currently reliving the trauma or even having recurrent flashbacks, or even being in a hostile living environment, such as living with an abuser or maybe unstable housing.

So again, the crisis needs to be mitigated before an individual can move along the path for change. And again, I'm just going to reiterate that term change does not happen in a crisis. PTG occurs when an individual has moved out of that acute crisis state and is grounded and stable. And that doesn't necessarily mean that someone needs to be symptom-free of PTSD. An individual can still have nightmares or flashbacks, insomnia, and anxiety. However, they need to be in a relatively stable environment. Because when a client is stable, that's when they can, in turn, acquire new insight, which leads to that change. It is then that a therapist can begin to lay the groundwork for a client to move toward post-traumatic growth.

Ben: So interesting. In your experience, Samantha, do you feel that it is realistic for everyone to achieve post-traumatic growth?

Samantha: You know, that is another really great question. So I think it is realistic, but I do not know if it is possible. Trauma is very personal and is shaped by a combination of individual experiences, perceptions, and memories. There have actually been studies that speak to two distinct people. It is experiencing the same accident or the same trauma from exactly the same lens or the same vantage point. However, the effect on that trauma would mean very different things to those two individuals. And it can be based on a number of factors. Those two individuals obviously have different body chemistry, different backgrounds, and different childhood and life experiences, but one individual may experience lasting effects of PTSD while the other individual may be more resilient.

When I used to work with Holocaust survivors, actually this phenomenon came up so frequently. I was so perplexed that each survivor's account was so different from the others. Many of the survivors that I met were in the same concentration camp; some even had similar horrific experiences in terms of starving, sleeping on top of one another in the barracks, and even being subjected to really torturous and experimental acts. However, it was really interesting because each individual always had such a different account, a different narrative or story, and an overall different reaction to a very similar experience. After liberation, many Holocaust survivors married. And they went on to have families of their own after the war, who they evolved to as parents, members of society, and colleagues were all vastly different.

Some of the survivors wrote books and honestly talked about and recollected the horrors they encountered during the Holocaust. However, there were other survivors who just wanted to bury their experiences, and they never uttered a word again, not even to their own children. So to answer your question, is it realistic for everyone to achieve post-traumatic growth? I think that it is realistic as long as a client is open to change. PTG can only occur if someone is open to change and not stagnant or stuck in their trauma. If a client is not open to change, meaning if they are not open to processing and talking about their traumatic incident, I do not know if it is possible to obtain post-traumatic growth.

Ben:  Wow, that is so interesting. I know that often we have conversations, and in my class with students, about how people internalize or externalize their experience much differently, even maybe among siblings who grew up in the same household and remember their childhood in vastly different ways and have internalized that in different ways. And thank you for sharing the experience of working with some of your clients who are Holocaust survivors. I mean, I think many of us can't even begin to imagine the trauma that they had to live through, but I think that it helps to illustrate your point very well of how some of those people were able to achieve post-traumatic growth through some of the work that they did and some of the supports that they received and being able to talk about it.

And people may get there at different times in their life to where they are ready; they are ready to start that journey at different points. And so I think that that's important for all of us to understand that it's possible, but it is something that not necessarily everyone automatically is going to achieve that post-traumatic growth in the same way. Thank you for sharing that. I wonder, Samantha, if you'd be willing to share maybe some of the interventions or strategies that you have found especially helpful that you have utilized in your own professional practice with clients who are seeking post-traumatic growth.

Samantha: I feel like, in terms of post-traumatic growth, there are so many different interventions that can be utilized both within counseling and without counseling, but I will speak to some of the interventions that I tend to gravitate more towards with my clients. I feel like I do utilize an eclectic approach to counseling, and what works for one client may not necessarily work for another client. And it is really important to gauge what intervention that client is comfortable with rather than the therapist only utilizing one or two techniques. And some of the interventions that I gravitate towards using are narrative therapy, which is an individual recounting and telling their story and making a narrative out of their experience, journaling, and reminiscence therapy.

And again, narrative therapy allows an individual to look back at their trauma and make sense of it through shaping their life into a story. So they're basically able to intertwine their traumatic experience into their current identity. One of my favorite books, actually, that speaks to this is "Man's Search For Meaning" by Victor Frankel. And when I worked with Holocaust survivors, I extensively read so many books that both my clients had written about the Holocaust as well as very well-known books from the Holocaust. But basically, Frankel's "Man's Search For Meaning" provides a very vivid account of his experience as a prisoner in a Nazi concentration camp. The book really kind of emphasizes and focuses on hope, responsibility, freedom, also nature, and even art as means to help one endure and kind of overcome harrowing experiences.

And to back up a little bit, just a little bit of information on Victor Frankel, he is actually or was actually a psychiatrist before the war. He was a board-certified psychiatrist, practicing psychiatry. And during the war, he endures horrible, horrible experiences. He ultimately ends up surviving the Holocaust. I believe he loses his entire family, but after he is liberated from the concentration camp, he goes, and he writes this book. And one of the statements or messages in his book is he writes that people must have faith that the whys in life have an answer, which is really interesting. And again, with narrative therapy that is utilized as a means to help somebody find the why in life.

Why did this happen to me? Why am I feeling like this? And I think that narrative therapy can also create meaning following the trauma of being a survivor. With narrative therapy, an individual can create a new purpose in life, such as retelling their story for others in a similar situation and perhaps even acting as a source of strength and inspiration to others enduring or trying to process a traumatic event.

Ben:  One of my favorite books as well. Interesting that you bring that up. So, Samantha, I know that in the past, when I was working clinically, I would sometimes actually, I do not know if prescribe is the right word, but “prescribe” a book to be read by a client that I felt would be especially helpful. Is that something that you would do with clients, or in your experience and expertise, could that possibly maybe be triggering to clients who have a PTSD diagnosis?

Samantha: That is a really great question. And again, I think that kind of goes back to what we were talking about a few minutes ago about really gauging where an individual is and also gauging where their triggers are. I think that for some, it could be appropriate to prescribe certain reading and certain books. And I mean, me personally, I read Victor Frankel's "Man's Search For Meaning" even before I worked with Holocaust survivors when I was trying to process 9/11. But to others, it could be retraumatizing or triggering. So I think it's really just a matter of being mindful of the client's window of tolerance or level of tolerance.

Ben: Okay, that is helpful. Thank you for that. Now a little bit earlier, you also mentioned journaling. For our listeners, can you explain what is the difference between narrative therapy and journaling?

Samantha:  Sure, they actually sound very similar, but they are quite distinctive. And they can also be used in conjunction with one another. I tend to utilize narrative therapy and journaling in conjunction during my interventions. So basically, while narrative therapy helps an individual make sense of their story and put their story into a narrative per se, journaling helps formulate the story by writing it down or putting it into words or meaning. With journaling, you are, in essence, writing an autobiographical account of your story. And again, just to reference Victor Frankel and his Holocaust memoir, "Man's Search For Meaning," Victor Frankel actually coined a really interesting term in therapy called logo therapy. He actually coined that in his book. Logo therapy has since become a widely utilized intervention in the field of psychotherapy.

But logo therapy speaks to an individual's ability to endure hardship and suffering through a specific search for purpose. So again, logo therapy, narrative therapy, and journaling can all be utilized together to really empower a client, to tell their story, in a productive and meaningful way, of an incident that was devastating or tragic, but also shape them into who they are today. I think that when one can try to understand their hardship in some other way, it can formulate an inner strength or a grit that was not present before. And I also think by experiencing tragedy, we really can become stronger, more empathic, and are able to relate to others who are newly experiencing a hardship. And then just one quick example can be, for example, someone recently diagnosed with cancer, perhaps their immediate family has no basis for comparison, and therefore their family lacks empathy.

However, if that individual who was recently diagnosed with cancer seeks out a cancer support group or even another cancer survivor, they can begin to share their experience and open up that dialogue with another person. Another thing that I like doing is assigning my clients a therapy journal for them to utilize in between our weekly sessions. And again, this is obviously under the category of journaling, but I will encourage them to write down any thoughts, feelings, or observations that may come up during the week so we can discuss them at our next session for processing. And I think that journaling can really be an important way to track one's progress in therapy also as a way of developing new insights and then processing those insights with a trained health professional. The other thing that journaling is really helpful with is that it helps people release their inner ruminations by putting pen to paper.

Ben: Yes, absolutely. Now you mentioned reminiscence therapy also is a tool that you have used in your professional practice and that it can be helpful in obtaining post-traumatic growth. Can you speak a bit more to that term for people who may not be familiar with the term reminiscence therapy?

Samantha: Of course. So the purpose of reminiscence therapy is to evoke memories and stimulate mental activity. So somebody can basically think about a time in their life when something was good or healthy or positive. Reminiscence therapy can take place in a group, or it can also take place in individual therapy. But the end result is often some form of life story or book being created based on somebody's past experiences. I oftentimes use reminiscence therapy with my older adult clients and ask them to talk about different facets of their life that were healthy, positive, and pleasant. Oftentimes you can even engage your client in a conversation or ask them to reminisce about who they were before and who they became after the trauma, in essence, splitting the self into two distinctive individuals.

And again, I mentioned earlier that I felt like a part of me died, but another part of me was reborn after 9/11. In reminiscing, the two individuals can share common traits, and the same exact upbringing, but somewhere along the line, when the trauma occurs, there's a line of divergence that splits that individual into two separate entities, one before the trauma and one after the trauma.

Ben: Wow. So when we are talking about post-traumatic growth, we are talking about really helping the person understand who they have become following that traumatic experience. Okay. Okay. That is helpful. Thank you. Are there any other interventions that you feel might be helpful for someone to help them achieve post-traumatic growth?

Samantha: Sure, and again, just to reiterate, there are so many interventions, both inside of the psychotherapy world and outside of the psychotherapy world, too many to even list in this podcast. But some of the ones that I tend to gravitate more towards, I do EMDR, which is eye movement desensitization and reprocessing. I also do CBT or cognitive behavioral therapy. Insight-oriented is another one that I do, and also mindfulness and somatic-based practices. And there are, again, so many other forms of interventions that somebody can utilize outside of therapy. And I feel that it's important for me to kind of touch on of what a few of those are. Obviously, there's the medication or pharmaceutical route in which medication can be administered by either a psychiatrist or a nurse practitioner. Medications such as Prozac is the most common one that is an SSRI or specific serotonin reuptake inhibitor.

And SSRIs can help quells some feelings of anxiety and depression. There are also alternative medications that have recently been coming out more and more in the media. Psilocybin is one. Michael Poland actually just wrote a book on the medical and health benefits of psilocybin. Another one that's coming out frequently in Colorado that I've been seeing is ketamine-assisted therapy treatments. I don't know enough about these new modalities to really speak to them, but they are other interventions if somebody is not interested in going through psychotherapy. And then another personal and, I guess, professional strategy that I encourage all of my clients to do is to engage in self-care. I really think that in order for somebody to be truly healthy, well-balanced, and well-stabilized, there needs to be a combination of both mental and physical health and, for some, even spiritual or religious health.

Physical health or sorry, physical exercise, healthy eating and diet are just so important in maintaining good overall health. I find it difficult for somebody to engage in therapy if they are not partaking in self-care. I feel like it's a very important and initial tenant of therapy for somebody to start engaging or to start the process of self-care before they can really tackle any other goals for therapy.

Ben: A little bit earlier, we talked about this idea of achieving post-traumatic growth. And so we're talking about different strategies that you have found helpful, and you have spoken about how really the client's going to guide that process, and you use many different modalities and many different intervention strategies, just whatever works, whatever helps the client move in that direction. So we are working with clients trying to help them seek or achieve that post-traumatic growth, but does that mean that they're cured of their PTSD?

Samantha: That is another very good question and a good point. And again, this is just my personal opinion, but I personally don't think that PTSD can necessarily be cured. However, I think that it can be intertwined or even compartmentalized in a person's life, meaning that I think that the trauma is always still a part of one's identity, but it is not all-consuming, meaning that it doesn't have to be someone's entire identity. I feel like with PTSD, PTSD can be all-consuming and really become somebody's entire identity. However, I feel like with PTG, it's more of a shedding of an individual's old identity and fusing together the past, present, and future. I feel like those with PTSD may still suffer symptoms.

To this day, I continue to have nightmares of being in the World Trade Center, and the Holocaust survivors that I worked with also continue to have symptoms so many years later. I think that symptoms can also diminish over time. And it is possible that the symptoms even reemerge during an acute period of stress. Another thing that I think it's important to mention is that new trauma can trigger old trauma. Any new trauma experienced can elicit similar responses from the past, in turn, even tying the traumas together. That's why I think it is so crucial that each trauma be processed and dealt with in order for somebody to achieve an optimal quality of life. I can not speak for my clients or for others who are on their journey toward PTG.

However, I can speak from my own personal experiences and my observations of others dealt with. I think that when trauma is successfully processed, there is an inner wisdom that emerges that was not there before. This usually takes time and does not happen overnight. An individual must commit themselves to healing and, again, creating that safe space for change. But when it does happen, it is so incredible to witness the resiliency of the human spirit.

Ben: Definitely. So rather than speak to curing PTSD, maybe we are talking more about helping clients to grow in a way that prepares them and equips them to live the next stage of their life and to be prepared for when those, maybe those flashbacks, those nightmares or subsequent trauma might occur, that they are equipped, and they are able to process that in a more healthy way. Would that be a little bit more accurate for what we are looking for in terms of post-traumatic growth, do you think?

Samantha: That is a very accurate description, Ben. Yes, you phrased it beautifully, yes.

Ben: Thank you. Samantha, we are almost out of time. We have got a little bit more time, though. And I am wondering if any of our listeners are interested in learning more about PTSD or post-traumatic growth; where can they go to obtain more information?

Samantha: Sure. So it really depends on what somebody is looking for, or I guess how much time they want to develop to learn about PTSD or post-traumatic growth. Just for very brief online reading, I would recommend the APA, which is the American Psychological Association. There are many articles on their website on PTG and, of course, PTSD. Also Psychology Today, which is a very popular publication for mental health practitioners. Psychology Today has both a print publication as well as online articles on PTG. In terms of reading books. I know I mentioned I love Victor Frankel's "Man's Search For Meaning," that's one of my absolute favorite books ever. There's also "The Body Keeps The Score," which is a really excellent book in terms of tying in PTG to somatic work.

In terms of trainings, there are also various trainings for different modalities focused on PTG. I had a really wonderful experience of becoming certified in EMDR at the May Burger Institute in Boulder. So much of EMDR is really focused on healing from trauma. There are also somatic interventions so many different workshops. I know Peter Levine has a focus on somatic work and also polyvagal theory. But yeah, there are so many resources out there depending on how much you want to commit.

Ben:  Right, thank you. You also reminded me I have on my shelf "The Body Keeps The Score." It was a recommendation from one of my students about a year ago and I have not read it yet. So this is a good reminder that I need to pull that off the shelf and make the time to read that.

Samantha: Yes, you have to read it, it is excellent. It is very dense, and it will take a while to read, but if you break it up into segments and read maybe a couple of chapters a day, it is excellent.

Ben: Good homework. All right, before we end the podcast, this is a question that I often ask podcast guests, but I think it is especially important, given our conversation today. You spoke earlier in the podcast about, or you mentioned, vicarious trauma. And since many of our listeners are likely to be social workers and likely to be working professionally with clients, vicarious trauma is absolutely something to be aware of, to be cognizant of. Given your experience of both pretty extreme traumatic events that you have lived through personally and also the work that you do, I can imagine that vicarious trauma is something that you are often cognizant of and thinking about.

So Samantha, what do you do to take care of yourself? What do you do for your own continued self-care, to be your best personal self, and also to put your best professional self forward for your clients in your practice?

Samantha: Yes. So I think that vicarious trauma is absolutely a phenomenon to expect and to anticipate when providing counseling services. And I feel like it is really important for a therapist to have a high degree of self-awareness and insight. So they are able to identify any triggers that may arise from that vicarious trauma. And again, I went through my own experience in psychotherapy before I pursued my master's degree. I went through years and years of therapy. And I really think that was so beneficial for formulating who I am today as both an individual and a therapist, able to provide care to my clients. But basically, a therapist needs to have helped themselves before they can help any of their clients.

Again, you have to expect vicarious trauma because so many of our clients seek therapy for trauma-related incidents. It's just so important in this field or for any mental health practitioner to really follow exemplary mental health themselves, or else it is difficult to practice what you preach. I know you asked about me personally, Ben and personally, I do consider myself to be a very hard worker and sometimes even a workaholic. However, I guarantee that I carve out time for myself and my family every single day. I have to exercise like four or five days a week. Exercise just really helps my physical and mental health so much. I really try to encourage all of my clients to formulate some kind of exercise routine that works for them, but I carve that time out almost every morning.

I also eat healthily and try to take care of myself. I make sure that I get adequate sleep at night. I try to have a regular sleep schedule and a routine. And I feel that by incorporating all of those facets, I am the best version of myself, and I, therefore, can be the best therapist to serve my clients.

Ben: That is great, thank you, thank you for sharing that. Samantha, I want to thank you for joining us today and for sharing so much of yourself personally and so much of your expertise professionally with us and with our listeners. I know that I have learned so much in this past hour from you, and I am sure that our listeners have as well. Thank you so much for joining us today, and thank you for your continued work.

Samantha: Thank you for having me.

References

Available in the handout.