“Most people have no imagination. If they could imagine the sufferings of others, they would not make them suffer so.” ― Anna Funder, All That I Am
Personal Punching Bag
The majority of clients and families I have worked with have experienced a trauma of one form or another. Existentially, the experience of trauma is nearly universal. Almost everyone has at least one threatening experience. These traumas may be physical, psychological, or emotional. While the DSM 5 leaves little room for emotional trauma to be considered when diagnosing posttraumatic stress disorder (PTSD). I would argue, however, that if a PTSD diagnosis is based on symptomalogy rather than etiology, there is ample evidence for emotional PTSD (ePTSD*).
Families can systemically experience emotional traumas. These traumas, whether inflicted internally (by family members) or externally (outside circumstances or individuals), are usually highly interpersonal (rather than impersonal) and compound (occurring frequently in various settings). Here is a great article on the variations in the etiology of PTSD. Again, this information can be very beneficial in predicting and preventing trauma, but it is of little use to the existential therapist who seeks to facilitate authentic healing from traumatic experiences. To minimize the impact of emotional trauma, in favor of more visible trauma like physical and sociological, can inhibit the ability of a therapist to successfully identify, and treat, systemic trauma.
The symptoms of PTSD can also be found in ePTSD. Just as physical trauma usually reflected in physical symptoms, emotional trauma will usually result in emotional reactions. I will use traditional PTSD symptoms and suggest their emotional parallels with potential existential responses. To explore the symptomatic parallels, let’s use this hypothetical situation:
A newly married could comes to your office complaining of a lack of emotional intimacy. Spouse X states their trouble began when X had briefly mentioned a family friend had an affair or was involved in an open/poly-amorous relationship. Spouse Y claims to have a history of being cheated on, including coming from a home where one parent was unfaithful to the other which resulted in a turbulent divorce.
At intake, the couple described a sense of all the air being sucked out of the room. X’s offhanded comment had resulted in an emotionally cold and distant response from Y. Y looked directly at X and, with absolute conviction, stated, “I knew you’d do this. I just didn’t think it’d be so soon.” X was flabbergasted! Clarification was requested, but Y walked out of the house without stating an intended destination or time of return. X, alone in the house, chose to watch some TV, clean a bit, but more than anything, functioned in a fog. It wasn’t until late that evening when Y returned home; still cold and aloof. X gave Y some space, hoping this would offer some appeasement. After a long and silent dinner, as bedtime approached, there seemed to be no relief in the tension. As the couple drifted off into the fitful sleep only emotional exhaustion can foster, Y began to shout and cry while sleeping. Y flailed out with their arms, then drifted back into silent sleep. Naturally, this had upset X, who also slept in small spurts, punctuated by the sounds and movements of Y.
The next morning, though tired, the gravity of the situation had seemed to reduce. Y was in a better mood, had smiled at and even hugged X, and had left for work as normal. X breathed a sigh of relief and returned to a regular routine. Things seemed to be getting better, but over the next few weeks X noticed Y was working longer hours, often not returning home until late at night, well after their usual bedtime. Physical intimacy decreased to zero and, when questioned by X, Y become very hostile and angry. X attempted to clarify the concern regarding their intimacy. Y responded defensively citing exhaustion from an increased work-load, accused X of not appreciating how hard Y was working, and would often disappear for several hours after these discussions.
During the interview, Y regularly looked surprised as X recounted many of their interactions. Y claimed to remember fewer than half of these discussions and sat through the majority of the session avoiding eye contact, with closed body posture, and minimal participation. X was the primary agonist for pursuing therapy and was the most verbal historian at intake.
At intake, the couple described a sense of all the air being sucked out of the room. X’s offhanded comment had resulted in an emotionally cold and distant response from Y. Y looked directly at X and, with absolute conviction, stated, “I knew you’d do this. I just didn’t think it’d be so soon.” X was flabbergasted! Clarification was requested, but Y walked out of the house without stating an intended destination or time of return. X, alone in the house, chose to watch some TV, clean a bit, but more than anything, functioned in a fog. It wasn’t until late that evening when Y returned home; still cold and aloof. X gave Y some space, hoping this would offer some appeasement. After a long and silent dinner, as bedtime approached, there seemed to be no relief in the tension. As the couple drifted off into the fitful sleep only emotional exhaustion can foster, Y began to shout and cry while sleeping. Y flailed out with their arms, then drifted back into silent sleep. Naturally, this had upset X, who also slept in small spurts, punctuated by the sounds and movements of Y.
The next morning, though tired, the gravity of the situation had seemed to reduce. Y was in a better mood, had smiled at and even hugged X, and had left for work as normal. X breathed a sigh of relief and returned to a regular routine. Things seemed to be getting better, but over the next few weeks X noticed Y was working longer hours, often not returning home until late at night, well after their usual bedtime. Physical intimacy decreased to zero and, when questioned by X, Y become very hostile and angry. X attempted to clarify the concern regarding their intimacy. Y responded defensively citing exhaustion from an increased work-load, accused X of not appreciating how hard Y was working, and would often disappear for several hours after these discussions.
During the interview, Y regularly looked surprised as X recounted many of their interactions. Y claimed to remember fewer than half of these discussions and sat through the majority of the session avoiding eye contact, with closed body posture, and minimal participation. X was the primary agonist for pursuing therapy and was the most verbal historian at intake.
Now let’s explore how the potential ePTSD reactions could be expressed (1-4) and a few interventions (responses) the existential therapist may use to encourage meaningful healing. Many of these symptoms may overlap at various points. This is common in working with families and individuals dealing with trauma.
*ePTSD is not a diagnosis recognized in the DSM 5. It is my term for the an aspect of trauma many therapists already recognize and treat, without having specific verbiage.