The PTSD Workbook

(Complex PTSD Category 7)

We have said many times in many different ways throughout this workbook that traumatic events have the ability to change anyone who experiences them. You have been changed in some or many ways by your experiences of prolonged, repeated trauma, and those changes may be soul-deep. Still, if you are to heal, it is important for you to find some sense of meaning from what has happened to you. If your basic psychological needs for safety, trust, power or control, esteem, and intimacy cannot be met adequately by yourself, the world, or others, then finding that meaning may be a difficult task. You also may believe that you are destined to live a very short life and that you will never live long enough to find peace or joy. This is called belief in a foreshortened future, and it is one of the benchmark symptoms of PTSD and complex PTSD.

Working Through a Traumatic Event

The person who works through a history of trauma and comes out the other side as a (somewhat) whole person, has certain character traits and abilities that can be learned or developed by using many of the exercises in this workbook (the appropriate chapter number is listed after each ability). That person has the ability to:

tolerate or lessen the intensity of painful feelings (chapters 5, 6, and 8)
recognize self-blame and shame and then counter it (chapter 7)
stay connected with persons who are both present and absent (chapter 13)
be alone without being lonely (chapter 8)
self-soothe when upset (chapter 2)
anticipate consequences of actions and events (chapter 11)
set and maintain appropriate physical and emotional interpersonal boundaries (chapters 8 and 13)
provide mutual self-support with supportive others (chapters 11 and 13)
have willpower (chapter 11)
take initiative (chapter 11)
have empathy for others (chapter 13)
have a sense of humor (chapter 13)

Which of these do you have? Which do you want to develop?

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You may also want to try to develop what Covey (1999) lists as the “seven habits of highly effective people.” Those habits are:

Be proactive—decide what you want to do and do it. This is personal vision.
Begin with an end in mind (your legacy) and then make every decision and take every action with that final legacy in mind. This is personal leadership.
Put first things first and concentrate on what is important, though not always urgent, to do. This is personal management.
Think win-win. Seek solutions to problems that benefit everyone involved. This is interpersonal leadership.
Seek first to understand and then to be understood. Listen to others with the goal of understanding them and their position. This is empathic communication.
Synergize through teamwork. This is creative cooperation.
Commit to improving yourself constantly. This is balanced self-renewal.

The key to implementing these seven habits is to make a choice each day to try to live by them. Choosing to do so with awareness means you have that end result in mind. As you choose, look at the results of each choice you make. If you like those results, then keep up your good work. If you do not like the results, then learn from your mistakes and try again (Power 1992a).

Continuing to Heal

Healing from trauma occurs when you are able to have at least some level of power or authority over your memories, when you can manage any emotions connected with those memories, and when you can manage intrusive and avoidant PTSD or complex PTSD–related symptoms. Healing occurs also when you are able to control your own behavioral responses (e.g., choosing when and how to express anger). To be healed means you are able to take care of yourself emotionally, physically, interpersonally, and spiritually. It also means that you respect yourself and have relationships with yourself and others that are safe (Matsakis 1998).

We have given you many suggestions and provided many exercises that will help with this healing. We have shown you how to deal with your own messages about what happened to you as well as the messages others instilled within you (your introjects). We have given you strategies to deal with your deserved and undeserved guilt. We have helped you learn self-care and gain boundaries (Matsakis 1999). It is our expectation that your healing will continue long after you finish this workbook, even if you come back to it on occasion for a brushup. Challenging and even possibly changing some of your beliefs about those five basic needs has given you strength to continue to grow. You also have given voice to what happened to you consciously, with the intent of healing and bringing any intrusive memories, thoughts, or nightmares under more control. You have learned to set boundaries and are better able now to keep your traumatic experiences contained, letting out what happened to you only to those who need to know. You have developed strategies to resolve your grief and deal with your losses. Also, you have learned to be satisfied with taking small steps toward healing and are learning to accept yourself as you really are (Schiraldi 2000).

Speeding Up Healing

Power lists a number of ways to speed up healing without retraumatizing yourself (1992a, 92, 104). You may:

become more and more aware of each choice you make
choose to work for a “common good” that gives you a sense of meaning
utilize self-management techniques to control or minimize the impact of flashbacks
implement ways to be more functional on a daily basis
look for what makes you resistant to doing your work, and then do something to modify that resistance
manage your pain in constructive ways (exercise a “normal” amount, not to the point of injury or exhaustion, for example)
remind yourself consistently that you survived “the worst”—your original traumas— and that you now exist in this present time
learn the names of your feelings, find out what those feelings feel like, and practice them
practice turning the volume up and down on various feelings
seek out positive experiences and enjoy them and the positive emotions that accompany them

Exercise: The Ladder

Another way to look for meaning in your healing is use the ladder exercise developed by Busuttil et al (2002). The aim of this exercise is to identify short- and long-term goals that can be presented to others. In your journal, draw a ladder with several rungs. On the top rung, write in your long-term goal for healing or finding meaning. On the bottom rung, write in the lowest point of your life. On the intervening rungs, fill in the steps you want or need to take in order to achieve your ultimate goal. You will want to include many life dimensions as you climb the ladder, such as your marriage or other long-term relationships, social activities, spiritual endeavors, occupational and financial goals or pursuits, and your values. If you seek feedback from important persons in your life, you may change what you have put on your rungs.

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Thoughts about Finding Meaning

How do you find meaning in life? One way is to pursue some type of activity or project that grows out of your traumatic experiences. Mothers who have lost children to drunk drivers often become active in MADD. Family members of those lost in major airline disasters have formed support groups and have advocated for changes in airline regulation. Through this process, you will again recognize your abilities and your limitations. You may become a mentor to others or start your own organization or project. You may write poetry or throw pottery or draw. You may decide to enter a helping profession (once you are healed enough that your baggage does not influence how you practice your professional skills). Through these or similar activities, you give something back to the world.

You may also find meaning by developing your own self further or by enjoying some of the beauty and pleasures of the world (Schiraldi 2000). You may become a photographer of nature. You may develop a new loving, intimate relationship or foster the relationship you presently have. You may develop friendships or you may commit to personal growth that helps you to understand yourself and others.

It is quite possible that you will never know exactly why you were a victim; on the other hand, you may have some knowledge about what lay behind your abuse, torture, or trauma. Bad things do happen to good people (Kushner 1981). At times, growth comes from suffering. How have you grown as you have done the work in this workbook? Have you changed?

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It is possible to grow through trauma. If you have been responsible to any degree, through negligence or intent, for the event or events that happened to you or around you, and you own up to your responsibility, you have grown. When you realized and accepted that you were betrayed, violated, victimized, and abused and that what happened to you was due to the actions of others and was not of your own doing or causing, you have grown. If you no longer blame yourself for what was not your responsibility, you have grown. When events were due to chance and you can accept just that—that you were a victim of a random act of trauma—you have grown. As Tedeschi, Park, and Calhoun (1998) recognize, you grow when your trauma is no longer an incomprehensible present but becomes, instead, a comprehensible part of your past.

Spiritual Development

One way many person find meaning is through pursuing some form of spiritual development. Developing spirituality can be a lifelong pursuit as you learn to ask questions about how you view a Higher Being, Creator, God. Perhaps you may decide that you want to learn to pray or you want to use prayer more. Prayer can be a way to get understanding and clarity if you open up to whatever “comes in” as you pray. Through prayer, you have a tool to give voice to your pain and listen in the present to what messages are given to you. Do you pray for answers? For relief? Or do you pray for specific interventions or material goods? It is important to decide just what you are praying for.

Brussat and Brussat (2000) discuss many prescriptions for spiritual practice in their book Spiritual Rx. One prescription is to search for beauty; beauty is truly everywhere around you, but noticing it can be difficult when trauma and traumatic symptoms overshadow your ability to see. They also examine the prescription of faith, stating that “faith [is] not something you have but…something you are in—a relationship. It involves an awareness of and an attunement to God’s presence in your everyday experiences” (81). When you have faith, you can choose and then remain true to a vision or an aspiration, e.g., the vision of yourself as healed from your traumatic past. In order to follow that vision, you need some level of trust (one of the five psychological needs) in yourself, in Providence, and in others. If you pray and have a conversational relationship with a Higher Power, you can ask for guidance in following that vision.

We have spoken of forgiveness in chapter 12. One aspect of a spiritual journey is to examine forgiveness in three contexts: forgiveness of self, allowing release of guilt and shame; forgiveness of others (to the extent that is possible); and forgiveness of God, which you may seek depending on your spiritual practices. Through your spiritual quest, if you choose that route to try to find meaning in what happened to you, you may look at what you want to do to forgive yourself and others or to seek God’s forgiveness if you believe that is essential to your growth.

Another spiritual prescription involves keeping hope. The Brussats believe that hope can be learned and that it is the major ingredient of optimism. What does the word hope mean to you? Do you have hope in your future—that you will be healed as much as you can be? Do you have hope now, in the present, in your ability to heal?

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Do you have any or all of the following three attitudes that help you to have hope?

patience—the ability to accept that healing takes time, and often occurs on a time line other than your own
courage to pursue healing without knowing what lies ahead, particularly if you still have memories that you have not faced
persistence—the ability to keep going on with your healing, even after you finish this workbook

Another spiritual practice involves seeking joy or allowing yourself to have feelings of happiness and pleasure. You may find that you find joy by doing for others, as you try to find meaning in your life. When and where do you feel joy? How can you share joy with others or help others find joy?

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According to the Brussats, “many people…define spirituality as the search for meaning and purpose…(that) involves both seeking and making” (2000, 172). Think of a time when you suddenly changed what you were going to do and as a result met someone you needed to meet or were presented with a new opportunity. There are many possible paths open to you at all times. Is finding a purpose a difficult task for you? How do you show yourself that your life really does matter—to yourself, if not to others?

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You alone know whether you view your God or Higher Power as anthropomorphic (having human qualities) or beyond human in attributes, and where you see God. You alone know if your connection to that Higher Power or God is personal or distant. Bourne (1998) notes that you may see God in:

natural beauty
deep insights or truth
creative inspiration
love given or received
premonitions
miracles
synchronicities (coincidences that are not coincidences)
other visionary experiences

Exercise: Ways to Improve Your Spirituality

Bourne (1998) suggests a variety of ways to improve your spirituality. If you answer these questions, try not to do so merely with “yes” or “no,” but write about when you use each way to improve your spirituality, if you do.

Do you pray as a way to communicate with your Higher Power or to request something from him or her?
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Do you turn over problems to that Higher Power for solutions?
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Do you meditate in order to get in touch with deeper parts of your self through quieting your mind?
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Do you read literature that is spiritual in nature? This might include the Bible or other works.
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Do you meet with others in a “spiritual fellowship” whether through church attendance, vision quests, workshops, or other activities?
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Do you do some type of compassionate service for others?
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If you are seeking what Bourne describes as “a more optimistic and tolerant view of life” (1998, 282), you may use some of the following suggestions and revelations to guide your quest.

Life is a school with the primary purpose of growth in consciousness and wisdom and the capacity to love.
Adversity and difficult situations are lessons designed for growth rather than random, capricious acts of fate. In the larger scheme of things, everything happens for a purpose. This may be difficult to accept but, if you have used your experiences to find your life purpose, you may have helped many others in many ways. Through your experiences, you have hopefully learned compassion and empathy.
Your personal limitations (including disabilities and illnesses) can point up the lessons you have to learn in life and can be challenges to be used for growth.
Your life has a creative purpose and mission, something that you must do in order to feel complete.
You have a higher source of support and guidance available to you in your Higher Power if you ask.
You can contact your Higher Power directly through your personal experience.
The power of intention can promote what Bourne calls “miraculous consequences” if your intention is for the highest good.
Evil is the misuse of your creative power.
Love is stronger than fear and can overcome fear.
Death is a transition. Some part of your being transcends and survives beyond death.

Do you believe any of these principles? If so, which ones:

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Are there other statements or principles you can turn to that will help you on your healing path?

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What did you learn about yourself by completing these exercises about developing spirituality?

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Connecting with Nature

Another way to seek meaning and purpose is to connect with nature. Eitner (2001), president of the Masters Group (a group focused on developing expanded consciousness) and a Reiki master, has used and taught various methods to achieve advanced states of consciousness that shift and change old trauma-bound patterns, fears, and defenses. She has found that healing of trauma and related negative addictive behavior patterns can be done effectively in nature. Project Nature Connect, also called “the natural systems thinking process or reconnecting with nature,” provides safe, easy, and supportive experiences to restore the senses wounded by traumatic experiences. Through the use of these exercises, persons who have been traumatized can become part of and build connections to the “web of life” or supportive natural community. Project Nature Connect, in a series of interactions experienced in nature, restores these connections and senses to their natural state. The exercises she uses in her work emphasize natural attractions, positive feelings, and appreciation, building a framework for you, as a survivor, to become connected to what is specifically positive and supportive for you. You can obtain more information about Project Nature Connect from the Web site, www.ecopsych.com, or from Project Nature Connect, P.O. Box 1605, Friday Harbor, WA 98250.

The first two of the three exercises below for connecting with nature were designed by Dr. Michael Cohen, an educator and environmental psychologist. The third of these was initially designed by Christina Brittain and has been modified by Eitner.

Exercise: Gaining Permission

This exercise begins to set the pattern to help you ask for and receive permission to interact with nature. You will also be able to begin distinguishing between what is naturally attractive and welcoming and what is not. As you complete this exercise, you will begin to notice differences in your interactions with other people as well as with nature.

Go to an attractive natural place like a wood, park or backyard, or even to an indoor plant. The key factors are that the area should be natural, attractive, and safe.
You will find that something in this natural place will stand out and look very attractive, and you will be drawn to it.
Ask permission of that plant, tree, bush, or whatever to interact with it. This is generally done nonverbally and always respectfully.
Obtain its permission in some way. If you receive that permission, you will find yourself feeling acknowledged and connected. This will be a positive experience.
If you don’t receive this permission, identify another attractive something, and obtain permission to interact with it.
Sense the connection; feel what gift this natural attraction has for you.
When you are finished with the experience, thank the natural attraction for interacting with you.

I tried this exercise when I:

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The results of my trying this exercise in nature were:

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Exercise: Establishing Trust

This closed-eye experience begins to establish your trust in the person you choose to lead you and in nature itself through using your senses.

Ask someone you like and trust and with whom you feel comfortable to be your nature guide. Go with that nature guide to an attractive natural place like a backyard, wood, or park.
Ask the area for permission to interact, as described above.
Take your guide’s hand, close your eyes, and explore the area. Be open and receptive to gathering information through your other senses. Walk along and ask your guide to place your hand on natural things, like a tree, rock, or leaf. As you touch it, be receptive, noticing what you feel, smell, sense, or hear. Do you notice changes in temperature, hear more sensitively, feel more distinctly? Are you comfortable with the connections?
After interacting with each leaf, tree, rock, etc., thank it for sharing itself with you. Thank your guide for leading you.

I tried this exercise when I:

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My experiences with this exercise were:

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Exercise: Sharing Your Troubles with Nature

Sometimes, when nothing feels safe, you still need to tell your troubles to someone or something. Nature can provides connection and comfort and a place where you can share (and look for) meaning.

Go to a natural attractive place like a backyard, park, or wood. An indoor plant will do if needed.
Ask the place for permission to visit. Nature welcomes you when you see or feel something that attracts you. Sit down beside it, or where you can easily see and interact with it.
Now think about what is troubling you.
Tell the attractive part of nature what is troubling you.
Feel nature sharing your troubles; this sharing can make them easier to bear.
Continue to sit still and feel nature sharing your troubles with you.
When you feel your troubles getting lighter, express your appreciation to nature. Nature is always there to comfort you.

As you share with nature, you may find that you see beauty around you and feel connected with something greater than yourself. Perhaps your Higher Power is some type of connection with nature. Allow yourself to take in whatever nature offers you.

I completed this exercise by:

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What it taught me about letting go of my troubles (and traumas) was:

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Exercise: Affirming Positive Qualities

Go to an attractive natural place like a backyard, park, or wood, or to an indoor plant.
Find something that is attractive to you, and ask for permission to interact with it.
When you receive permission, identify what it is about the natural attraction that you like. (For instance, “I like that flower because it is pretty and graceful.”)
Recognize that you have those same (or similar) qualities and say to yourself, “I like myself because I am pretty and graceful.” Be sure to choose realistic qualities of both nature and, potentially, of yourself.
Continue the same process with other attractions.
It might be helpful to ask another person to assist you to discover things you like about yourself (particularly if you have not worked through your self-esteem or psychological need issues).

I completed this exercise by:

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What I learned through completing this exercise was:

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How did it feel to you to try to connect with nature in this way? Remember to check out the Web site for more information about the program.

This chapter has looked at ways to find meaning in your life. Finding meaning for what you endured and survived can be a very difficult task. Keep the three attitudes in mind as you do so—keep your courage, try to be patient, and persist as you keep in mind that healing is possible.

If you are able to let go of those aspects of trauma that are not positive in your life, if you are optimistic, if you are a self-starter and are hardy, you will have a better chance to grow. We will discuss the concept of resilience in more detail in the final chapter of this workbook. Before you go to that chapter, what have you learned about yourself in this one? How have you let go of what happened to you? How have you grown? How do you reach out to others who are hurting? When and how do you show your appreciation of life? Have you bonded with other survivors? Have you joined any support groups or created a new group? How have you used your personal energy to survive?

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