An Adlerian View of PTSD and ....

Marco,

(For Dan Bollinger) Post-traumatic Stress Disorder (PTSD) is described in DSM-IV (309.31) as the reaction of a person who has been exposed to a serious traumatic event, within which they experienced intense fear, helplessness, or horror. That event may be persistently re-experienced as memories, images, thoughts, dreams, illusions, hallucinations, or flash backs. They may also persistently avoid any stimuli associated with the trauma and have persistent symptoms of increased arousal (not present before the trauma).

An Adlerian perspective of this disorder acknowledges the comprehensive description of symptoms and the apparent history of the disorder, but goes much further diagnostically by exploring the internal and social purposes of the persistent symtomology. If debilitating symptoms persist, there is a high probability that a "neurotic disposition" existed before the "traumatic event." The choice of symptoms is interesting but not as important as the awareness of the responsibilities that are being avoided. Adler believed that many symptoms are extensions of early childhood "weapons" against the parents, and are retained in adulthood to continue serving the unconscious final goal. Clients may combine or change symptoms, yet retain the same underlying goal. If you want to read more about this, look at "The Unity and Diversity of Disorders" in The Individual Psychology of Alfred Adler, edited by Heinz and Rowena Ansbacher.

Although it is possible for anyone to have a terrible experience and be deeply distressed by it, the ability to digest it and move on depends, in part, on the "style of life" that existed before the experience. Certainly, the empathy, insight, and encouragement of a skilled therapist can help dissolve any residual pain, fear, and bitterness--but only if the client cooperates in the process of changing the core fictional final goal and style of life that may be capitalizing on the retention of symptoms. Treatment planning in Classical Adlerian psychotherapy is not focused on the type of disorder or particular symptoms; it targets the mistaken style of life and fictional final goal (the fire under the smoke).

Regarding dissociative disorder: amnesia, fuge, MPD, and depersonalization; a Classical Adlerian approach would be to first rule out organic etiology or substance abuse; often, a complete psychological/neurological test battery is essential. We would explore which life tasks are being avoided by the symptoms, and what tendencies in early childhood provided the "prototype" that could provide a foundation for the later development of the symptoms. Once again, we do not target the symptoms, but the style of life and fictional final goal beneath them. The treatment plan for any client does not grow out of "disorder categorizations"--it is based on a creative invention that penetrates his unique style of life. For an overview of the therapeutic process, read "The Stages of Classical Adlerian Psychotherapy" at http://ourworld.compuserve.com/homepages/hstein/stages2.htm .

Dr. Stein

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