194770-bw-Thomaes.pdf [ 1 ], page 165 @ Preflight

1 12 | introduction and outline introduction Working with people who experience severe psychological trauma leaves the therapist sometimes shocked about their horrifying, almost unbelievable histories and about the scars this may have caused, and at the same time intrigued by the way people were able to survive. In my daily practice, listening to details of a history of child abuse from a patient sometimes produces a film like image in my head for a while, which only represents a tiny proportion of the ongoing intrusions patients may suffer themselves. The way people cope with abuse histories is various, but most have missed a lot of opportunities in education, work experience and relationships in the past, because of the disturbed homes or environment they came from. For the therapist it is a challenge to support these people in their way to accept and take their past (" Vroeger ") seriously in the way it influenced their lives, emotions and bodies and at the same time go beyond (" Verder ") in order to optimally develop given the circumstances they came from. A case history in short: In 2006 Nina came by the acute psychiatric services with panic attacks and depressive complaints after ending a long-lasting relationship. She visited a psychiatrist a couple of years who prescribed medication for a recurrent depressive disorder, but symptoms resisted. Three years later, when she was confronted with domestic violence at the neighbors and could not convince her psychiatrist from her distress, she deregulated in such a way that acute psychiatric service referred her to a part-time inpatient psychiatric ward where antidepressant medication has been prescribed again. She told that, years before she had discovered that she had repeatedly been sexually abused as a child by an employee of her father. Disclosing her history, she never received approval or support from her parents, who also demonstrated ambivalent behavior in her upbringing. Confronted with domestic violence in her neighborhood , she had been overwhelmed by emotions and intrusive memories of the sexual abuse. She was diagnosed next to the recurrent depressive disorder with a posttraumatic stress disorder and a vulnerable personality structure with fear for rejection and excessive need to control and esteem in DSM-IV terms, which refers to Complex PTSD. As background, she has a university degree and worked as office manager for years. However, she left different jobs and contracts were not prolonged, which …