Before I go any further, I would like to state that there is a lot of research conducted on the effectiveness of CBT for PTSD treatment. Research has shown repeatedly that CBT is indeed effective in the treatment of PTSD. In a particularly good research study done by Nilamadhab Kar (2011), a meta-analysis conducted using thirty-one randomized control studies, the “gold standard” of psychological research, showed that CBT had successfully reduced trauma-related symptoms in people who were victims of terrorism, combat, sexual assault, refugees, and motor vehicle accidents, as well as disaster survivors.17 So far, so good, right? Another meta-analysis of fifty-five studies of empirically supported treatments for PTSD found that nonresponse and dropout rates were as high as 50 percent.18 This meant even odds, or the flip of a coin on whether or not you’d get better or drop out of treatment, or not very good chances, to my mind, and as I’ll explain later, I think there is a reason for this. Yet CBT is still a major contributor to my theory on how you can heal from trauma.
Freudian Theory
I’ve never been a Freudian, not even a little bit. I never liked his theories on psychosexual development and especially disliked his (over)emphasis on sex, aggression, and the unconscious. But admittedly, I have been profoundly influenced by Freud in two ways, especially as it relates to my theory on healing from a pain in the past.
First, I think Freud’s writings on defense mechanisms were pure genius. The defenses he described are still widely accepted today by most practitioners because they are highly useful and spot-on, including denial, minimization, rationalization, and displacement.19 But when it comes to treating trauma survivors, the defense mechanism that stands out above the others to me is repression. It is well-documented that horrific trauma can be so overwhelming that the only possible mode of survival is to block even the memory of the experience from the delicate mind. It really happened, and it is stored in the brain (in complete detail and living color for future recall), but for now, there is a free pass to survive without the ugly movie in your head. The mind, it appears, is attempting to block the images, the way your mom put her hands over your eyes during the naughty parts of the movie. The memory is frozen, presumably in your hippocampus, only to be triggered some time in the future by an otherwise benign event. Whatever was frozen is now defrosted and fresh, as if it had just happened. Good therapy requires that it (finally) be dealt with and put away successfully in order to return the stress switch back to the “off” position.
Similarly, Freud postulated that the goal of good therapy (psychoanalysis) was to make the unconscious conscious.20 In other words, in order to heal, the trauma must be processed on a conscious level. Hence, the material that has never been allowed to surface (and is thus neither remembered, felt, nor expressed) cannot be released to allow the client to heal. From all indications, Freud, it turns out, was exactly right. That is, no healing will occur until you consciously process and release your traumatic memory.
Gestalt Therapy
The great German theorist and psychologist Fritz Perls is one of the most underrated and underappreciated contributors to modern psychology and especially to psychotherapy. If I asked twenty recent doctoral residents in psychology the question of who are the top five greatest contributors to their style of practice, I don’t know if I I’d hear the name Fritz Perls mentioned even once.
So why do I deem him to be so influential and necessary in successful recovery from trauma? His Gestalt (the German word for the whole picture, entity, or enchilada) theory emphasizes closure, or completion of unfinished business.21 Who do you know that mows 90 percent of their lawn? Makes half the bed? Shaves one leg? We have a need to complete things, to put things away or find a better place for them psychologically. It’s a phenomenon I observe every day in my office. Someone presents feeling stressed and overwhelmed because of their perception of a given situation in their lives. By the end of the session they feel dramatically relieved and better—not because the world has changed, but because they perceive an opportunity to place something painful, scary, or threatening in a better place where it loses its power to upset them. With unresolved trauma, clients cannot seem to let go of their horror because it is unfinished for them. Whether it is blocked partially or completely from their memory (repression), repeats endlessly on a loop, or recurs every night in a nightmarish dream, it is only because it is unfinished.
Jim needed to “finish” his trauma by saying goodbye to his sons and forgiving himself for his perception of his having allowed them to die. He also needed to forgive God22 for “taking his sons away from him.” Finally, he had to believe that he had a life where he could find happiness.
Religion and Forgiveness
Pick a religion, any religion. With the exception of perhaps Satanism, virtually all religion teaches the necessity of forgiveness for living a godly life and achieving peace, wholeness, and connection with the divine. In Buddhism, forgiveness is about removing unhealthy emotions that would otherwise cause harm to the non-forgiving person. Likewise, Sikhism describes forgiveness as the remedy to anger, especially when the forgiving person is aroused by compassion. Judaism requires forgiveness after a sincere apology, but even in its absence, forgiveness is considered a pious act. Islam is a term derived from a Semitic word meaning peace. Forgiveness is thought to be a prerequisite for achieving peace.23
In Christianity, Jesus taught his followers to pray to God the father, “Forgive us our debts, as we forgive our debtors” (Matthew 6:12, King James Version). Note that he already assumes that we ought to be forgiving others, as it is essential to improve our own status with God. Jesus went on to say, “but if ye forgive not men their trespasses, neither will your Father forgive your trespasses.” (Matthew 6:15, King James Version.)
Perhaps it is fair to conclude that forgiveness is that which lets the afflicted off the hook, as much or more than the offender. How is that so? Because the opposite of forgiveness, resentment or hatred, is known to be a toxin for the grudge holder. A twentieth-century Buddha, Mark Twain, quipped, “Anger is an acid that can do more harm to the vessel in which it is stored them to anything on which it is poured.”24 Research has confirmed that resentment contributes to numerous conditions, including depression, heart disease, and premature death.25
But what exactly is forgiveness? Let’s begin with what it isn’t. Psychologist Syd Simon taught that forgiveness is not forgetting; it is not revenge, nor does it condone the offense. Forgiveness, in the simplest sense of the word, means to let go.26
This translates into two types of forgiveness: forgiveness without reconciliation and forgiveness with reconciliation. They both allow for letting go of the offense, but one restores the relationship to the place or position held prior to the perceived offense, while the other does not. (Think of this as “Mounds Bar” and “Almond Joy;” they are both the same candy, but one has nuts, and the other doesn’t.)
For example, I once employed an office manager who admitted to embezzling funds from the practice. She was terminated on the spot. Several weeks later, I was completely over any hurt, anger, resentment, and sense of betrayal. But I did not rehire her. I forgave, but without reconciliation.
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