In his sonnet, »Tears of the Homeland 1636«, Andreas Gryphius wrote of the Thirty Years’ War:

Once more we are wholly / still more than wholly, laid waste.
The invaders’ brazen rabble / the braying trumpets’ fury,
Swords greasy with gore / the siege cannons’ thunderous roar
Have all our sweat / and labour / and reserves consumed away. […]
And even then I am silent still on that / which bitter more than death,
Harsher than the plague / and the burning and starvation:
That even the soul’s wealth / from so many too was forced.

People often experience dramatic crises as traumatic, which can cause a variety of mental disorders, the most prominent being post-traumatic stress disorder. Such disorders may be triggered when an individual experiences or observes a traumatic situation themselves or learns that someone close to them has had such an experience. They may even arise if an individual is simply confronted with details of such a situation. The social media giant Facebook recently agreed to pay compensation of 52 million US dollars to content moderators who have experienced mental health issues after viewing huge numbers of disturbing images and videos for the company.

Many factors play a role in the development of post-traumatic stress disorder. For example, it is far more likely to develop when the trauma is caused by other people than when it results from a natural disaster. The key symptom involves involuntarily reliving the experience, which can range from seeing an image flash before the mind’s eye to acting out a longer scenario. For example, there are reports of former child soldiers replaying entire combat scenes. When such intrusions or flashbacks occur, the person loses awareness of their current situation. Often a seemingly insignificant reminder can trigger a flashback, for example the sound of a siren, the sight of a particular street corner or a specific movement. Some people also relive the event in the form of nightmares. What all sufferers have in common is that the experience leads to stress, suffering and avoidance behaviour. Depending on the nature of the traumatic event, some sufferers will refuse to walk down dark streets at night, others will no longer enter a hospital, and still others will attempt to repress all thoughts of the trauma. This is precisely where the key to treatment lies.

Philipp Kanske

Shifting roles in psychotherapy

JAM #27 — Role Changes

> Other Essays

Editorial
Astrid Eichhorn, Michael Saliba, Erik Schilling

Dare to co-design?!
Anna Cord

It is time to rethink the role of leadership (in science) – a polemic
Astrid Eichhorn

Shifting roles at home? Division of labour within families during and after the coronavirus pandemic
Lena Hipp

Pure curiosity? Why the public is interested in science
Lukas Haffert

The art lies in finding the balance
Miriam Akkermann

Shifting roles in psychotherapy
Philipp Kanske

Role Changes – 8 Vignettes
Jan Hennings, Astrid Eichhorn, Garvin Brod, Jessica Burgner-Kahrs, Isabelle Dolezalek, René Orth, Erik Schilling, Lara Keuck and Oliver Rymek

When patients begin psychotherapy, they are asked to shift their perspective on avoiding the memory. While avoidance may help in the short term, it increases the likelihood of new episodes of reliving the trauma down the road. Trauma research has shown that when memories are avoided, the trauma is stored differently than other memories. When you think about an important event in your life, you may recall it in vivid detail, but you are always aware that the event is in the past. Traumatic memories lack this contextual information, which is why therapy involves consciously reliving the traumatic event. This can be approached in a variety of ways. For example, the patient might write a sort of script of the situation and read it with their therapist, allowing it to play out like a film in their mind’s eye. By working through the memory in this way, the patient adds context to the memory, which helps to normalise it.

Another means of shifting perspectives and roles in therapy involves intentionally changing the film script, for example by adding important information about the trauma that helps alter the patient’s perspective: »I survived.« »I wouldn’t be able to remember the situation now if I hadn’t managed to overcome it somehow.« In some cases, it may also be helpful for the patient to actually slip into another role. For example, if the patient was sexually abused as a child, in the imaginary world of the film script, the patient’s adult self can be present and offer comfort to their childhood self. Changing roles in this way serves to alter the way the memory is stored in the brain and help the patient gain control over if and when they choose to recall the trauma.

In recent years, researchers have paid particular attention to the phenomenon of post-traumatic growth. This term refers to the positive developments that the majority of trauma survivors report once enough time has passed since the event. These include a new way of appreciating life, meaningful social relationships or personal strength. Perhaps the crises that our society is currently experiencing can also lead to »post-crisis growth« in the long term. For trauma patients, growth depends on how intensively they engage with the situation and to what extent they are able to shift their perspective. The global community would do well to embrace this sort of flexibility in its thinking – a process that ultimately involves many small shifts in perspective.


Philipp Kanske is a professor of clinical psychology and behavioural neuroscience at the TU Dresden. He was a member of Die Junge Akademie from 2015 to 2020.