Over the last few months I’ve focused on some new connections I’ve been making in how Post-Traumatic Stress Disorder (PTSD) might manifest differently for those who have been internationally mobile. Many Third Culture Kids, and other global nomads, have absorbed a variety of cultural approaches to health and illness, and stress. As we can see in writings that explore culture-bound syndromes, the cultures we most identify with have a role in impacting our experience of health and illness.
As TCKs identify with multiple cultures, they could find themselves presenting symptoms of stress or distress unfamiliar in their national culture. It follows that for those TCKs suffering with PTSD, access to diagnose or support could be complicated by such cultural variances in their identifying culture and their treatment culture.
In light of my previous posts on this topic, PTSD and Cultural Variance: Implications for Third Culture Kids and TCKs and PTSD continued: West African culture-bound syndromes, I wanted to speak to some therapists who are more experienced than I in this field. My hope is that my interviews with them will both inform and encourage any Third Culture Kids to feel better equipped in understanding their stress responses, and actively seek help if needed. There are wonderful practioners out there – and it’s an important investment in our mental health to reach out to them.
First, let me introduce Robbie Thain.
Robbie is based in Lincolnshire, England, an ex-serviceman, and a member of the British Association of Counselling and Psychotherapy. Robbie works especially with Post Traumatic Stress Disorders (PTSD) and is also trained to use Integral Eye Movement Therapy (IEMT) which can be extremely effective for phobias and trauma. I asked him:
- Why do you work with ex-service men and women, and with sufferers of PTSD especially?
Being an ex-serviceman myself I want to help the people who I already have an affinity with. Usually service people have a similar outlook on life and sense of humour so it`s a lot easier to connect with them. PTSD is not exclusive to service people, but if the two go together then empathy is a lot easier.
- What are the most common presenting symptoms of PTSD you identify in your clients?
They can be many and varied – if the memories are very violent then nightmares, nightsweats and moodswings are common, but they can be very similar to a nervous breakdown with crying for no reason, fatigue and lack of interest in life being common.
- Are there ‘mental blocks’ that interfere or complicate the treatment and recovery from PTSD, that are shared by your clients?
Sometimes memories can be a little vague if they have not been “processed” properly, so recall may be difficult.
- What factors seem to be most helpful in your clients’ recovery?
Every client is different, so reliving the memories can be beneficial, whereas using IEMT (Integral Eye Movement Therapy), (where the client does need to vocally share the experience), can be very effective.
- Are there specific processes or treatments that you’d recommend in the treatment of PTSD, that your clients find especially effective?
IEMT (Integral Eye Movement Therapy) seems to be the most effective.
Now, let me introduce you to Vivian Chiona, Psychologist and founder/director of Expat Nest, an online counselling service with expatriates specifically in mind.
I asked Vivian:
1) What are the most common presenting symptoms of PTSD you identify in your clients?
Common presenting symptoms of PTSD that I identify in my clients are clients re-experiencing the traumatic event. For example, they experience panic attacks and overwhelming physical reactions due to flashbacks or reminders (triggers) of the event. Clients often experience distressing nightmares and experience feelings of depression or anxiety as a result of these symptoms. Other symptoms that have been presented within my clients with PTSD are self-blame, shame, guilt, self-hatred or low self-esteem, and substance abuse.
3) Are there ‘mental blocks’ that interfere or complicate the treatment and recovery from PTSD, that are shared by your clients?
It’s extremely distressing for clients to expose themselves to feelings and situations that remind them of their trauma. I have noticed that some of my clients lack social support. It’s important, not only that the client feels safe with the therapist/counselor, but also that they have social support from others for example, from family and friends.
It is possible that internationals have friends located in countries all over the world, rather than in the location that they are currently placed, meaning that communicating online (via Internet) is something that they are used to. Online therapy suits this specific mobile lifestyle, as no matter their location, the therapist is easily accessible.
Another ‘mental block’ could be that they feel as if they would never recover from their trauma; they project their current feelings into the future, a dark future. This doesn’t have to occur and a big part of our work is to challenge and shift this ‘mental block.’
4) What factors seem to be most helpful in your clients’ recovery?
A good therapeutic relationship between the client and myself is key as I want the client to feel safe when our sessions are taking place. Additionally, if reprocessing a certain emotion or situation causes the client distress, I focus on being able to reduce this distress by using stress management techniques. Furthermore, trauma-focused cognitive-behavioral therapy seems to be highly effective when working with PTSD online.
Motivation is an important factor in the client being able to work effectively on their issues. If the client is not motivated to do so, it is our role to help them with this by using specific techniques ie motivational interviewing.
It’s also helpful to focus on the client’s beliefs about himself or herself, their current situation, and their future. Having the right counselor for the client makes all the difference; a counselor who is specialized and has experience in helping clients with this diagnosis.
5) Are there specific processes or treatments that you’d recommend in the treatment of PTSD, that your clients find especially effective?
Our ideal clients love online counseling as they find it convenient, accessible, and reliable wherever they may be located. We are mindful that in some countries, clients don’t have access to expat specialized mental services. Online therapy enables us to travel to them. Over the years, I have found that Trauma-focused cognitive-behavioral therapy is especially effective when working with PTSD. It not only focuses on the client exposing themselves to feelings and situations that remind them of the trauma, but it also focuses on replacing distorted thoughts about the trauma to a more balanced one.
Additionally, the use of stress management techniques is extremely helpful to help the client remain calm when processing their traumatic experience. We recommend our clients with PTSD to regularly do some trauma releasing exercises and other ‘homework’ as a way of releasing the trauma when the sessions are not taking place.
6) I understand you are willing to work online (Via Internet) with clients all over the world. How do you find this interacts with working with PTSD?
We need to be gentle as it is like scratching an old wound that is bleeding every time we scratch it. Once a good and safe therapeutic relationship has been established, with the incorporation of stress management techniques, trauma focused therapy and a variety of other techniques, working with PTSD is definitely successful online (via Internet).
As a non-PTSD specialist, I’m very grateful to both Robbie and Vivian for giving me a glimpse into how PTSD therapy works for them and their clients. I hope any readers will feel encouraged to explore the range of specialist support there is out there in the big wide world. There is increasing awareness of PTSD as touching a variety of lives and experiences, and a broad range of therapies exist to support those suffering from this disorder.
No matter the experiences that have touched your life,
there is always hope… and help.