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Section 25
Helping Family Members of a PTSD Survivors

Question 25 | Test | Table of Contents

The Protective Reaction
This is a natural response when someone you care for has been hurt. This reaction can often feel supportive to the one who was hurt. In fact, sometimes it is exactly what the person wants, and sometimes it is not what is wanted. This is because it can make someone feel helpless, like a child and this is the very way they don’t want to feel again. Lynn Manning struggled to make people under stand that being blind did not mean he was a baby. Your client will need to take your cue from the person they  are trying to protect. If he or she feels supported by and grateful for the protection, tell your client to keep it up! If he or she seems irritated by it, this is probably a message to back off. That doesn’t mean stop supporting the person, it just means stop hovering.

The other thing about the protective reaction is that it is often for the protector. It may seem like it’s for the other person, but often it is to help the family member or friend take care of your fears that have been stirred up by this event. It may be to help him or her feel less helpless. This is a normal reaction. When we hear about the trauma of others, we can’t help but feel shaken and fearful, and feel a need for more protection. The challenge is to direct it in the right way.

The Trying-To-Explain-Why-This-Happened Reaction
This is a common response from those close to the one hurt. It is an effort to make some sense out of the event. We often feel if we could just understand something and fit it into some logical explanation, then we would be more able to deal with it. We do this because it is sometimes easier than dealing with something that is incomprehensible. Of course, what your client will find him or herself hitting up against is that there is no logical explanation. When your client, or your client’s family, can’t find a logical explanation, they may come up with an illogical explanation that they try to make sound logical, like "Because I decided I wanted to stay home from the basketball game, he was in an accident."

Blaming Yourself And Feeling Guilty
This is one of those illogical explanations that your client, or your PTSD client’s family, may find themselves believing. Here are some examples of how it usually goes: • If only I hadn’t had that fight with him this morning, he wouldn’t have gone off by himself. • If only I had secured those windows the way I should have, the robber wouldn’t have been able to enter the house and terrify my wife. • I can’t seem to stop feeling guilty. I just know I could have done something to prevent this, even though I can’t think of anything right now. All of these thoughts are efforts to make sense of the situation and to try to figure out how you could prevent it in the future—that is, how to achieve control over the situation. But, as stated earlier, most traumas are so unpredictable and sudden, little or nothing can be done to prevent them.

Feeling Helpless And Inadequate
Your client was helpless during the trauma. Most likely, he or she wasn’t there, so they could do nothing. If he or she were there, it is likely you were rendered helpless by some outside force. This state of helplessness is a difficult fact to face, but it is an irreversible fact. Just as the person who experienced the trauma, there was nothing your client could do. Recognizing this fact will help them deal with the helplessness and thereby aid in understanding the helplessness of the one for whom they are caring.

Liz told me about her frustration because she was unable to protect her daughter "You spend your life protecting your child You’re right beside them And after all the time in my life I protected her, I couldn’t protect her from that ‘accident’ So all I could do was be a caretaker and that part was easy to do because she was very special."

Not Knowing How to Help
Another type of helplessness that emerges after the trauma is simply a helplessness about what to do. More than likely, your client desperately wants to help. They would like to help by trying to take away what happened. It is upsetting that they can’t. They also want to take away the pain. Your client cannot do that, either. Many things that they would like to do won’t work. As a result, family members of PTSD survivors feel inadequate. It is natural reaction to feeling helpless, but being helpless is not the same as being inadequate.

Role Confusion
Many traumas lead to a change in roles. Your client will feel confused about this sudden role change. For example, if your client’s wife was the one hurt, and he or she takes over the tasks she normally performed, they will experience role confusion. This can be perplexing: • They have to learn unfamiliar skills. • They might worry that taking over someone’s job might offend the person and find it difficult to discuss it with them. • They could be overwhelmed by how much they are having to handle and be confused about the mixed feelings they are experiencing. • If there are children, it may be difficult to explain these changes to them. • The person they care for may have changed.

Anger And Blame
Your client may find him or herself feeling angry, which in turn leads to blaming the person who was traumatized. This is common. They might be embarrassed by this blaming because they feel they shouldn’t feel this way. But they are angry. Who wouldn’t be? Their life has been disrupted. Everything is different. Sometimes these feelings are an effort to deny one’s vulnerability. If you can blame the person traumatized, then you can continue to deny randomness and your own vulnerability. This kind of anger can also be displacement; that is, they become angry with someone or something other than with whom the anger really belongs. In trauma, displacement onto the victim is common because often the perpetrator or the event that caused the trauma is not available to get angry with or to blame. It seems the anger has to go somewhere, so it goes to the next illogical choice, the trauma victim. Uncontrolled anger and blaming can become problematic, and is something for which your client, or your PTSD client’s family, should find help.

Shelly, a young mother, was struggling with taking care of her mother after her mother suffered a sudden trauma that resulted in physical disabilities. She feels her mother’s frustration and anger. She also feels angry when her mother says she isn’t being helpful enough. She also feels angry when her mother is being more helpless than necessary. She feels angry at how her previously independent mother has changed. She feels "angry and more angry, pretty much all the time." But, she added later, "If you love a person enough, you have to understand. . . you have to have a lot of understanding because she was normal a moment ago and she’s not anymore." So for this young, overtaxed mother, the anger doesn’t change the inalterable love for the mother who was and the mother who is.

Outrage
Your client may find him or herself feeling outraged at whomever or whatever caused the trauma. This is very often an immediate reaction. They  may feel the impulse to go after the person who caused the trauma and seek revenge. If a corporation was associated with the trauma (as in an air or train disaster), he or she may wish to go after the institution or representative associated with the company. To some extent, this can be a useful reaction as it is accompanied by a feeling of strength. That strength may help them take useful action—for instance, pressing charges or seeking and receiving restitution for lost wages. It could, however, lead to getting involved in wasted action and in focusing energy away from the healing process of the one for whom they care. The usefulness can best be measured by the degree of involvement: If rage-based action takes precedence over everything else, it is probably not helpful. If the action is balanced by attending to other aspects of the aftermath of the trauma (including taking care of him or herself), it is probably helpful.

Invisibility
Your client may feel invisible. Sometimes trauma takes over everything. For those who have children, the occurrence of a trauma is not unlike having a newborn enter the family—each pushes everything else into the background. The after effects of the trauma often dictate every­day actions for some time. This could include trips for medical help, phone calls about legal proceedings, dealing with workers rebuilding after disaster, hand holding— an infinite list of possible after effects that can push aside normal, everyday events. Your client then feels invisible. Their needs, their exhaustion, their strain don’t seem to exist. They may begin to feel like a hungry baby who wants to scream for attention, but there is no one to hear.

Your client  may feel invisible because the person who was traumatized may suddenly be involved with other people who have gone through the same or a similar trauma and you are left out. Rafael Yglesias captures this in his novel Fearless. The two main characters, Max and Carla, were strangers before the plane crash from which they both survived. After the crash they were together, a lot. This was to the dismay and bewilderment of Max’s wife, who suddenly became a backdrop to the incredible bond between Max and Carla. This form of invisibility is very difficult to tolerate and is difficult not to take personally. It isn’t personal, though. It is only because some trauma victims have an insatiable need to be in the company of other trauma victims. It is felt that no one else can understand. And there is some truth in that.

- Hybels-Steer PhD, Mariann; Aftermath: Survive and Overcome Trauma; Simon & Schuster: New York; 1995

Personal Reflection Exercise #11
The preceding section contained information about helping family members and friends deal with a PTSD survivor.  Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Update
Family Involvement in PTSD Treatment: Perspectives from
a Nationwide Sample of Veterans Health Administration Clinicians

- Thompson-Hollands, J., Rando, A. A., Stoycos, S. A., Meis, L. A., & Iverson, K. M. (2022). Family Involvement in PTSD Treatment: Perspectives from a Nationwide Sample of Veterans Health Administration Clinicians. Administration and policy in mental health, 49(6), 1019–1030. https://doi.org/10.1007/s10488-022-01214-1

Peer-Reviewed Journal Article References:
Contractor, A. A., Weiss, N. H., Dolan, M., & Mota, N. (2020). Examination of the structural relations between posttraumatic stress disorder symptoms and reckless/self-destructive behaviors. International Journal of Stress Management, 27(1), 35–44. 

DeCou, C. R., Mahoney, C. T., Kaplan, S. P., & Lynch, S. M. (2019). Coping self-efficacy and trauma-related shame mediate the association between negative social reactions to sexual assault and PTSD symptoms. Psychological Trauma: Theory, Research, Practice, and Policy, 11(1), 51–54.

Khayyat-Abuaita, U., Paivio, S., Pascual-Leone, A., & Harrington, S. (2019). Emotional processing of trauma narratives is a predictor of outcome in emotion-focused therapy for complex trauma. Psychotherapy, 56(4), 526–536. 

QUESTION 25
How can you gauge if a the rage-based action of a PTSD survivor’s family member is useful? To select and enter your answer go to Test.