Post-Traumatic Stress Disorder



 (The following is a chapter from Dillard, J. Ending Nightmares for Good)

Anyone who proposes a quick and easy cure to post-traumatic stress disorder (PTSD) needs to be regarded with considerable suspicion and skepticism. PTSD is a complicated and difficult disorder; many excellent minds have put entire careers into reducing its impact. The most common treatment approaches today for this highly disabling condition are cognitive behavioral therapy, which basically teaches objectivity from the overwhelming emotions of PTSD, different forms of anxiety therapy, which essentially involve desensitization to fearful images and emotions, and talking therapy, which generally relies on external support, teaching, and validation to problem-solve life issues associated with PTSD.

PTSD is complicated and difficult to treat because it is so pervasive. If you can imagine having a repeated, gripping, horrifying nightmare that intrudes into your waking life you can start to get a sense of what these people are up against. All the fight-or-flight reactions of Hans Selye’s General Adaptation Syndrome are activated, not only at night during nightmares, but throughout the day, depleting the resources that the body and mind need to both repel and recuperate from distress.

PTSD does not readily respond to rational interventions because it is fundamentally a physiological and emotional, and therefore pre-rational, reaction to perceived stressors. It does not matter whether those stressors are real or imaginary, and pointing out to a person with PTSD that the threat no longer exists is futile. If you have ever been in a car accident and experienced shock that lasted for days afterward you know that no amount of talking, reasoning, or reassurance made much difference. Think of PTSD as a hypervigilant defense mechanism that is self-perpetuating. That defense exists because the contemplation of its absence is a state of vulnerability and threat too horrible to sustain.

Based on preliminary anecdotal evidence, Integral Deep Listening may offer significant support to both therapists treating PTSD and to those who are having to deal with its symptoms. Integral Deep Listening is a phenomenologically-based dream character and life issue interviewing methodology developed by Joseph Dillard, who has worked with a broad range of psychological disorders, including PTSD, for almost forty years. Both types of “characters” interviewed in the Integral Deep Listening methodology are called “emerging potentials,” because that is how they function: to wake you up to emerging perspectives that can broaden, integrate, and transform your own. Three examples of how Integral Deep Listening has helped those with PTSD are provided below, followed by a short explanation of how it does so. While it is not unusual for only one Integral Deep Listening interview to stop the recurrence of life-long nightmares, more interviewing is necessary to deal with the unrelenting fear that typifies PTSD.

“Y,” a woman living in Israel, wrote the following:

“I want to thank you! I was in a terror attack 9 years ago, and since then I suffer from PTSD. For 8 years I had nightmares every night. Usually I had at least 4 or 5 nightmares per night. I hardly slept and I felt horrible. I read your Ending Nightmares for Good. For 2 months I interviewed a dream every night. The nightmares stopped. Then for a while they would come back every few weeks, so I interviewed dreams only when I had a nightmare. In the past four months I had no nightmares at all! In fact I sleep well, have normal dreams, and wake up refreshed. After so many years of horrible nights, it feels like heaven! It’s just amazing.”

The implication of “Y’s” experience is that Integral Deep Listening may not only be effective for the reduction of PTSD, but more specifically, for healing significant aftereffects of terrorist attacks. Note that Y did not need therapeutic intervention. Because she was highly self-motivated, she was able to do bibliotherapy (read Ending Nightmares for Good) and follow the instructions therein, and eliminate her symptoms herself. Others have reported similar results. Y does not mention symptomatic interference with waking life other than the effects of not getting enough sleep, so it could be argued that she does not meet the diagnostic criteria for PTSD, even though she believes that she had it. However, this next example certainly meets the diagnostic criteria for PTSD.

When John was 19 he was the first to arrive at work one morning. Someone had failed to secure the night guard dogs, both of whom immediately attacked him, knocked him down, and began tearing at his neck and leg. John was sure that he was going to die. Thereafter he not only had vivid nightmares reliving the event, which were so upsetting that he hated to go to sleep, leaving him sleep-deprived during the day. This same nightmare would intrude into his waking mind, rendering him unable to go outside for fear of meeting any dog, even though he had always had dogs before. He was constantly vigilant, with an exaggerated startle reflex, emotionally reactive, impulsive, with poor concentration and disruption of both his short-term and long-term memory. John was immobilized by his fear, living in a constant state of traumatic shock, which refused to diminish over time.

John’s treatment focused on interviewing characters from his life nightmare. These included the attacking dogs, their cage, and the store where he worked. Interviews occurred three times a week until the symptoms started diminishing, after two weeks. After a month John was down to one interview a week; after two months, John’s nightmares and symptoms of PTSD were gone and he was put on a self-maintenance program of self-directed interviewing once a week.

It may be that John’s response was faster than “Y’s” because he was working with a trained Integral Deep Listening practitioner. However, I do not believe this is a requirement for the process to work. “Y’s” experience demonstrates that it can be self-directed.

An important part of the Integral Deep Listening treatment protocol is the application of recommendations from the interviews that meet the criteria of “triangulation.”  That is, if a recommendation makes sense to respected objective authority (such as the therapist), as well as to one or more interviewed dream character, and also makes sense to the client, then the recommendation is operationally defined and used as a treatment tool. It also serves as a way to test the method itself in order to build its credibility in the mind of the client. For example, after John’s third interview he remembered a dream of a dog he had during his childhood. In the dream it was walking with him, protecting him from other dogs. That John was having a positive dream containing a dog is in itself a significant indicator of positive change for someone with PTSD due to an attack by dogs. When the childhood dog was interviewed it recommended that John relive this new, healthy dream in his mind before going to sleep. A simple operationalizing of this recommendation involved John checking off in the morning whether he remembered to do this visualization before he went to sleep or not. This recommendation served as a pre-sleep suggestion or “incubation” that provided a visual and metaphorical antidote to John’s sleeping fears. The assumption is that setting such an intention by visualizing the dream before sleep would positively affect not only John’s dreams, but his sleep and his waking anxiety level.

It is also helpful but not necessary to give clients one of the various PTSD questionnaires that can be found on line. These will provide an objective measurement of change both for the clinician and the client, although PTSD is so disruptive and palpable that it is quite easy to see if you are getting anywhere or not. Are the nightmares decreasing? Is there less intrusion of nightmares into waking life? Is the client reporting that they are sleeping better? Are they more or less anxious? Are they able to resume normal waking activities? Do they become less dependent on substances and activities designed to mask or avoid their anxiety?

One woman, Sarah, a US military veteran, had sustained a closed head trauma and brain injury when the vehicle she was riding in while on duty in Iraq hit a mine. Since that time, over a year previously, she had suffered from PTSD, including explosive outbursts toward her two children, which had led to the involvement of child protective services. She was afraid of getting into vehicles. She had been receiving treatment both from the US Veteran’s Administration and from a speech-language pathologist whose practice focused on the treatment of head injury. However, Sarah was resistant. She did not want to believe that she was not “normal” and that she really did have significant long-term damage to her memory, reasoning, impulse control, and her ability to concentrate. For her first Integral Deep Listening interview we chose to have Sarah become the explosion itself, the precipitating factor for her ongoing dreams of explosions and her waking vigilance against them. The explosion said that it personified Sarah’s destructive, explosive self. Simply getting in touch with the source of her fear at the depth provided by an Integral Deep Listening interview generated important and lasting changes. Both she and her therapists reported that her angry outbursts at her children diminished significantly.

In a second interview her hatred at the fact that she was no longer the way she used to be because of the accident took the form of a candy heart in the back of her head. It said that it was “hiding out there” and was the reason her life was so difficult. It said, “I’m there because Sarah didn’t know that I was the reason things were going on her life the way they were.  When she can’t remember when she’s talking to people or forgets to pick up her kids from school, it’s because I’m here.”

Sarah equated her hatred with her head injury and located both in the back of her head, where they were out of sight, out of reach, and out of understanding. People cannot see inside the backs of their heads. A heart is an unexpected metaphor for anger, but this heart is not authentic; it’s phony, just a candy heart that can’t even serve as candy.

The head injury and her hatred were both basically invisible to Sarah, but neither stayed invisible. They would “jump out” in ways that took her off guard, astonished, and dismayed her. She was being told that they showed up in her behavior, such as when her memory failed her. “What I like best about myself is jumping out and surprising Sarah.  I like that because it’s so easy to do.”  Sarah started to cry. She clearly felt surprised and overwhelmed by the lack of control she experienced when her hatred/head injury showed themselves.  Heart said, “The jumping out and memory failures are because of the accident. Sarah tries to explain without getting sidetracked about what she’s trying to say, but she can’t!”

The heart has an adversarial role. It maintains power by remaining hidden and conducting “sneak attacks.”  “I’m worried that when Sarah sees her brain-injury therapist her memory will get better.  That will make my job harder, which is to make it hard for her to remember and to communicate.”

Here is the personification of a life issue (the candy heart personifies Sarah’s hatred) that is clearly in an adversarial role, as, dream monsters are, for instance. We see this further when the heart says, “If I were confident all the time her memory loss would be a lot worse and her concentration would be a lot worse and it would be a lot harder for her to communicate than it is now. I’m accepting myself but I’m very self-critical of others.  If I were completely accepting of Sarah the way she is, with her head injury, I guess I wouldn’t live here in her head.  I wouldn’t be here.  If I were completely accepting now I wouldn’t make things so hard for her about everything.  If I accepted her I wouldn’t make it as hard to accept and explain what has happened to her since the accident.  I would make it a little easier for her to deal with the results of the accident. I wouldn’t jump out and surprise her every chance I got. I would accept that she needs to get better.  But I’m there to make things difficult.”

“If I were completely accepting I would prefer to help her rather than hurt her.  I would realize that she was a part of me and that to hurt her would be to hurt myself.  I would be in the front of her head where I could help her.”

Look at the evolving awareness and shifting of roles that occurs for Sarah as she lets Candy Heart speak. Recognizing that to hurt another is to hurt the part of oneself that they represent is a sophisticated level of ethical and moral development that many highly educated people who have no head injuries lack. Look at the shift in Sarah’s willingness to be seen, to be known, to be helpful rather than adversarial. This is a basic, powerful, and immensely important shift in awareness that is awakening within Sarah, not because of the therapist, but because Sarah is practicing deep listening to a potential for healing that wants to emerge.

It continues, as Sarah actually experiences a shift of the heart to the front of her head: “I am now in the front of Sarah’s head.  It’s clearer.  I can see what she sees.  It is easier to help her.” Before the heart had no interest in helping Sarah. Now it is not only interested; it is interested in its help being easier.

“In the back of her head I couldn’t see until I would jump out, but I could still hear.  Now that I am in the front of her head I am not so mean because I can see as well as hear.  When you see things you see people’s actions.  Actions are louder than words.  Now I don’t have to be so tough on her and other people.  Because I can see people’s actions, now I see them for who they are and therefore I am more accepting and patient of them.”

Wow! Sarah is giving herself reasons to not only help others, but to help herself. She is giving herself reasons to accept both her head injury and to stop being so angry about it or so critical of herself and her limitations, as well as others. It is not important that the therapist understand or agree with any of this. The Candy Heart is not a symbol to interpret but an emerging potential to deeply listen to and to develop a trusting relationship with through the application of its recommendations in Sarah’s daily life. While the interviewer can ask clarifying questions, their job is not to interpret Sarah’s experience but to help her hear what she is saying to herself. This is not about the therapist’s knowledge, experience, or interpretations; it is about the client accessing emerging potentials that access patterns of healing more quickly and effectively than can either the conscious mind of the client or the therapist.

‘Regarding having peace of mind, now that I am in the front of Sarah’s mind I can see how things really are and see the truth of the character of others through their actions. I have peace because I understand why people act out the way that they do.” “Being located in the front of Sarah’s head, I am more the witness.  It gives me cause to think before I react.”  Sarah is giving herself more reasons to not rage, to not let her anger be in control.

We also are observing an excellent example of the power of asking an interviewed dream character or personification of a life issue how it scores itself, 0-10 in core qualities associated with integration and waking up: confidence, compassion, wisdom, acceptance, inner peace, and witnessing. Clearly, Sarah has not considered either her rage or her head injury from the perspective embodied by these values. When she does, expansion and transformation becomes possible.

“What I like best about myself in the front of Sarah’s mind is that I can see everything that goes on.  Now I can see and hear.  I can see people’s actions.  There’s nothing I dislike about myself here.” Sarah has moved from a fighting, confrontational position of self-sabotage to one of awareness, openness, and helping. Instead of fighting herself and her disability, instead of fighting learning about her head injury, instead of fighting with those who would help her get well, instead of fighting with her boyfriend and her children, Sarah is giving herself permission to shift from a defensive, angry posture to an open, caring one. She is doing so with the help of a simple visual metaphor that tells a story that  describes her predicament in a way that makes sense to her. It doesn’t matter whether it makes sense to you or me; it doesn’t matter if it would work for you or me. It is like a tailor-made, personally designed antidote or medicine which Sarah is administering to herself with the help of the structure of the IDL interviewing format and the interviewer.

“What Sarah could do for me would be to read up about brain injury so she can be more patient about things.  Maybe she will understand how I am going to cause her to react to things.” The heart is now seeking Sarah’s cooperation and help. It is forming a partnership or alliance with Sarah for treatment and getting well.

“It would be helpful for Sarah to be me when she is dealing with her children.  Maybe when she’s dealing with Vince (her boyfriend) she won’t get so annoyed.  It’s not so hard to think about the accident when she becomes me.  It’s easier to cope when she becomes me.  I know that there was an accident.  I know that it wasn’t her fault.  I also know that the accident is what is affecting her mood swings and her speaking habits.  I also know that that if she read up on it she could learn to not react the way she does.  She could calm herself more and not react.  Maybe if she understood me more she wouldn’t be so upset with me and want to fight with me.”

By getting in touch with a perspective that knows these things Sarah is giving herself both reason and permission to know these things too. Previously, she lacked both.

“When I want to fight with her it’s because I’m in the back of her head.  I would prefer to stay in the front of her head.” What was initially an adversarial perspective is now telling Sarah that it would prefer to be an ally.

“What puts me back there, in the back of her head, is when she forgets that she understands.  If I were in charge of Sarah’s life I wouldn’t be so quick to react to some of the things that she does.  I would try to understand why people act the way that they do instead of just reacting.”

A recommendation is presenting itself here. How does one understand why people act the way that they do? By asking questions. Doing so not only provides additional information; it is a healthy substitute for emotional reactivity, inserting a pause between feelings and behavioral response. This recommendation can easily be operationalized. Sarah can check off each evening before she goes to bed, “Did I remember to ask questions when I was confused or upset?”

The heart said, “The type of relationship I would like to have with Sarah going forward is for us to get along and for her to understand and not to hate me so much.  She doesn’t understand why I affect her or what her brain has to do with her moods and her communication skills. She doesn’t understand why her brain has to be in charge of that. She wants to be in charge of that.” Sarah’s hate/brain injury is telling her that instead of attempting to control her moods and communication skills that she get information about her head injury.

Sarah said that it was OK if the heart stayed in the front of her head, meaning that she was in agreement with the proposed changes recommended by the heart. When she was asked to summarize what she heard the heart say, Sarah said,  “I don’t understand why my head injury is affecting my life.  Why can’t I be in control of my life instead of the heart’s affect on my brain?  Maybe I should read up on the accident and how it affected me and what type of brain injury I have.   It made me sad to read about it; that’s why I didn’t do it. But now I understand why I need to.”

The heart said, “If you read about your head injury with me, the heart, in the front of your mind, that will help you deal with your sadness.” This is another specific recommendation that Sarah could put to the test in her daily life.

This interview is an excellent example of how deeply listening to emerging potentials in an integral way can help even those with significant impairments of cognitive function who also have PTSD. Sarah’s angry outbursts decreased significantly. She stopped raging at her children and her boyfriend. Her therapists reported that she was finally cooperating with treatment. Was this just a coincidence or did Integral Deep Listening play an important part in these changes for Sarah?  It may be that Integral Deep Listening is effective with such people because it is reflective of innate perspectives that resonate powerfully for people. It is disarming in its innocence and non-threatening in its presentation. The power and meaning of imagery is a pre-personal, pre-rational developmental competency that is innate, even in small children. It seems to be hard-wired into mammals prior to linguistic competencies and shows up as a metaphorical and experiential language in our dreams. Therefore, when executive and rational functions are impaired, individuals are still likely to possess and understand “metaphorical reasoning” that says things like, “your cognitive impairments are like a candy heart in the back of your head; your hate is also there, wrapped up in your feelings toward your cognitive impairments.” A person with a head injury may be unable to express such a statement, but the visual imagery still provides relevant analogies in a powerful and understandable way. That this occurs implies that there is an underlying integrative consciousness that is persistently, consistently working to heal, balance, and transform all people in all situations, regardless of their deficits or their cultural, and ideological filters. Amplifying their ability to deeply listen to that consciousness is a short-cut to development. At the same time it gives those who have PTSD with head injury new and effective ways to see not only their deep inner beauty but to frame words and treatment interventions in ways that are most likely to speak to the unique needs of each individual.

When we get scared we externalize or objectify the perceived threat so we can defend ourselves from it. We see this in dreams when we create monsters that scare us that are the personification of our fears. The more scared we are, the more parts of our experience are not only objectified as “other,” and “not self,” but as threats. Both PTSD and agoraphobia are extreme examples of this process. Everything and everyone can become a threat and a signal for heightened vigilance, resistance, reactivity, and anxiety. Integral Deep Listening assumes that every “threat” can best be treated as if it were a wake-up call. That is, John’s attacking dogs, although a literal waking event, keep coming back to be listened to, to be heard, but because they are so threatening, instead of listening to them, John goes into panic and avoidant behavior. Integral Deep Listening is “deep” because it does not simply listen to what John’s attacking dogs have to say to him; it is deep because it asks him to become what he fears, in a process that is considerably more than desensitization. By doing so, John incorporates into himself perspectives that are not afraid and are self-confident. As a result, John becomes less afraid and more self-confident. His sense of self expands to include that which previously was perceived to be a threat. The more that he interviews both threatening and non-threatening dream characters such as the attacking dogs, the cage, his work, and his childhood dog, the more he identifies with perspectives that not only do not have PTSD but which offer authentic, practical, and personally relevant solutions to his anxiety and his sense of perceived threat. This expansion of self does not ignore or repress fear; it incorporates it into a context that can not only accept it but use it productively for further life growth. We see that with Sarah when she uses her candy heart to move to a healthier attitude both toward treatment of her head injury and toward her children.

In addition to the many children who have PTSD due to abuse there are many  more who have  subclinical PTSD but who have adapted to their fear in such a way that they can work, learn, and grow. How much easier would the path ahead be for both groups if they no longer had to fight with or adapt to their fears, but could instead expand their sense of who they are in ways that used their fears to grow? Children naturally take to the pretend world of Integral Deep Listening and its metaphorical way of explaining their predicament in ways that innately feel true for them. How much childhood suffering and lifelong scarring could be avoided if children learned to interview their own emerging potentials and test their recommendations in their lives? Because Integral Deep Listening is an empirical methodology, it is falsifiable. That means that like “Y” you can follow the instructions in Ending Nightmares for Good and at IntegralDeepListening.Com and draw your own conclusions as you work first with yourself and then with the children in your world. We invite both your feedback and your questions. For information about coaching, counseling, classes and seminars, contact Joseph.Dillard@Gmail.Com. Join us on “Friends of IDL” on Facebook.

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