Pastoral Responses to Post Traumatic Stress Injury
The concept of burnout is pretty well known among pastoral counselors but about post traumatic stress injury or post traumatic stress syndrome (PTSS) there is still a lot of ignorance. Because the symptoms between a severe burnout and post traumatic stress injury are somewhat similar the two at times get confused but they are not the same. To use a metaphor, a burnout can be compared to a repetitive strain injury in a ligament while a traumatic injury actually involves actual trauma to the ligament for example in the form of a wound. Post traumatic stress injury is an actual psychological wound and just like in a physical sense wounds can come in various forms and sizes. The deeper the wound, the longer the needed recovery time.
Post traumatic injury, just like any physical wound, can have multiple causes but usually it is a major traumatic event in a person’s life which was experienced as a major threat to his/her very existence as a person and emotionally so overwhelming that he/she got deeply hurt and distressed. Persons who were already emotionally weakened due to other stress factors, including physical and environmental factors, are particularly susceptible to major traumatic stress injury.
A seriously wounded person is usually not in full control of his/her emotions and this is equally true for psychological injury. It is common for people to just express their pain without giving much thought to how this affects people around them. As in the case of a serious physical injury following traumatic psychological injury people may be totally numb, confused and depressed. Silence in such a situation is not a sign of the person being in control but indicates deep grief. The victim may also suddenly cry, scream, shout, fight or express their pain in other ways. It is important not to take this personal. The person is in serious pain and overwhelming distress and not in full control of his/her emotions.
Dealing with people who are emotionally out of control is not easy and requires a lot of patience, compassion and wisdom so we do not worsen matters! To tell them that what they do is wrong or evil is not going to help but will act like throwing salt in the wound. To tell a seriously injured person to stop whining, to keep quiet and to stop complaining is counter-productive. Even worse if we shame and blame the person by telling them to stop playing the victim role in order to get sympathy. This is not just unloving behavior, it is downright cruel! Unfortunately I have personally encountered many pastoral counselors who said such hurtful things. The same applies for apportioning blame by telling the person what he/she should have done or should not have done. Who are we to decide such things, do we know all the facts? To do so is not only unprofessional, it is also a sign of arrogance and pride. By saying such things we suggest that we would have done things better in their situation. Such behavior is a serious violation of the Law of Christ which requires us be humble and gentle and to do unto others as we would like to have done to us.
When a person is suffering, wounded and out of control they need our compassion, comfort and competent assistance. One does not tell a bleeding accident victim to stop crying or complaining or tell that he or she may be to blame for the accident. Even most non-Christians would be shocked by such inhumane behavior. Like ambulance workers and medical professionals we must help all suffering people in their distress and give them the best care possible whether we think they are guilty or not! This includes among other things that we:
1. Make sure the person is in a place of emotional safety (a spiritual sanctuary) and away from being exposed to further (verbal/emotional) abuse.
2. Make sure basic needs are taken care of. For example a homeless person or anyone in an unstable life situation cannot focus on healing as their focus is own basic survival.
3. Shield the person from further injury, including well-meaning but incompetent counselors
4. Help the person talk and show empathy and avoid any form of coercion, condemnation or suggesting blame or culpability.
5. Nurse the person back to full health. It is not your task to play the role of judge, accuser, witness who testifies against the victim or be the executioner of some form of punishment. If you feel you need to play a role in psychological/spiritual law enforcement and accuse people of their wrongs and tell them what to do or what not then you have no place whatsoever in counselling.
6. Help the victim talk about their experiences, their feelings and their concerns. Make sure you communicate compassion and empathy, love and concern.
7. Be very cautious in giving advice as it can easily be experienced as you imposing your view and opinion on the situation which gives victims the idea that you don’t take them serious.
8. Only offer advice when requested and even then do so very gently, avoiding adding insult to injury by blaming or shaming the victim. Stress your love for them and your faith in them. Stress Gods love for them and Gods faith in them that with His help they will get through this, not just as mere survivors but stronger and better as God uses all thing for the good of those who love Him.
9. Take note of self-undermining, self-condemning and other self-defeating thoughts and help victims to be more compassionate, forgiving and understanding towards themselves just as God is very compassionate, forgiving and understanding. Very often psychological injury is compounded by spiritual infections such as a low-self esteem, low-self confidence, lack of proper sense of self-worth and self-condemnation. Often these are the result of old untreated emotional wounds. These issues need to be addressed in a loving, gentle but firm manner because if allowed to fester they will hinder inner healing.
10. If in the counselling process the victims become aware of certain things they could have done better or wrong things they have done then do not downplay these but also do not encourage wallowing in guilt and condemnation. Instead they should be allowed to explain what wrong they think they did (confession) and then be helped to ask and receive Gods forgiveness, and turn away from doing such things again (repentance) and work on this area in their lives so that they can grow stronger (sanctification) which may include bringing to light underlying issues that created the vulnerability or temptation.
11. Bringing to light what traumatic events have actually happened and how the victims have interpreted and experienced it is very important. These things must be acknowledged and validated and not be dismissed as invalid or wrong. We must not conclude too quickly that a person has misread or misunderstood a situation. After all they were there in that situation and we were not. Often it takes time for the whole story to surface and even then some things may be too hard or too painful to express in words. Also victims may still out of a sense of loyalty, fear or concern partially still protect the perpetrators who harmed them. However, even if we become aware beyond any doubt that the victim is misinterpreting some things it is far better to help them reach that same conclusion by asking questions that increase their own insight in the situation than telling them that they are wrong and should adopt our interpretation. From a Christian point of view we better help the person to focus on Jesus and then trust the Holy Spirit to convict people of what is wrong, right, and how to judge/distinguish between these.
These few basic guidelines for pastoral care to victims of post traumatic stress injury are also important for dealing with people who suffer from other psychological (stress) injuries. It is my sincere hope that they will contribute to better and more sensitive pastoral care to wounded people in the church and our community as too many have been left so broken and hurt that they have turned their backs to the church and sometimes even to God who was misrepresented by behavior of the people around them. By providing better pastoral care we may prevent the spiritual death of many.