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PTSD and communication



See also: Communication with rape victims

Some therapists who work with trauma patients are working on "integrating both verbal and nonverbal therapy with a client with severe anxiety and depression." (McNamee, 2004) The reason for this is the way the brain works. The right brain works with images and the left brain works with logic and words. PTSD victims temporarily loose functioning (essentially) in the left side of the brain. The creative, image oriented side has to take over those functions. That makes logic more difficult. This is due to the passage between the two sides (corpus callosum) being damaged by PTSD. (Villarreal, G. et.al., 2004) , (Seritan, 2005). There is also new evidence that PTSD patients actually store traumatic memories in image form in a different part of the brain than normal memories. (Turner, 2004)


Online resources


PTSD and Relationships


"Trauma survivors with PTSD often experience problems in their intimate and family relationships or close friendships. PTSD involves symptoms that interfere with trust, emotional closeness, communication, responsible assertiveness, and effective problem solving"

Journal articles


Norman, Judith. (2000). CONSTRUCTIVE NARRATIVE IN ARRESTING THE IMPACT OF POST-TRAUMATIC STRESS DISORDER. By: Clinical Social Work Journal. 28 (3). p303-319, 17p. link


Research and clinical practice in social work have historically recognized a strengths perspective. More recently, the role of a constructivist perspective has been discussed in social work education and practice. Narrative construction for the stress disordered client reflects both perspectives. Social workers can listen for and, with clients, identify strengths, survivorship, and resilience as the stories of trauma and victimization are told. Attending to the language of strength and survivorship can actually yield realistic treatment goals. A model of collaborative conceptualization of the problem and target goals is presented with the intended focus of this paper being to encourage the telling and adaptive retelling of the story of trauma. The author shares examples of language and communication given by clients in the adaptive description of traumatic experiences which form the foundation of ongoing healing.


Does writing reduce posttraumatic stress disorder symptoms? Deters, Pamela B.; Range, Lillian M.; Violence and Victims, Vol 18(5), Oct 2003. pp. 569-580. link


To see if writing about their trauma lessened PTSD and related symptoms, 57 undergraduates, previously screened for traumatic experiences, wrote for 15 minutes on 4 days across 2 weeks about either their trauma or a trivial topic. They reported PTSD, impact, suicide ideas, dissociation, and depression pre-, post-, and at 6-week follow-up testing. Trauma and trivial writers were not different. Surprisingly, at follow-up everyone reported less severe PTSD symptoms, impact, and dissociation, and fewer health visits, but about the same suicidal ideation and depression. On PTSD symptoms and impact, the pattern of improvement was different: Those writing about trauma got worse at posttesting, but improved to better than their initial state by follow-up. Those writing about a trivial topic got better by posttesting, and held that position at follow-up. In this project, writing seemed to reduce PTSD symptoms regardless of whether it concerned the trauma or what they ate for lunch. (PsycINFO Database Record (c) 2005 APA, all rights reserved)(journal abstract)


Felmingham, Kim L.; Bryant, Richard A.; Gordon, . (2003). Evian Processing angry and neutral faces in post-traumatic stress disorder: An event-related potentials study. Neuroreport: For Rapid Communication of Neuroscience Research. 14(5). pp. 777-780. link


Examined evoked response potentials (ERPs) to angry and neutral faces in 15 individuals with post-traumatic stress disorder (PTSD; mean age 35.8 yrs) and 15 age and sex-matched controls (mean age 26.2 yrs) over temporal (T5,T6) and occipital (O1,O2) regions. 20 faces with an angry expression were alternated with 20 faces with a neutral emotional expression. There were significantly larger early negative (N110) and late negative (N650) ERP components in controls to the angry compared to the neutral faces. The PTSD group did not display ERP differences between angry and neutral faces, and the amplitude of their negative waveforms were reduced relative to controls. It is concluded that these findings may reflect adaptive, rapid responding to potential threat in the controls, and a reduced capacity to discriminate between non-threat and generalized threat stimuli in PTSD.


Lange, Alfred; Schoutrop, Mirjam; Schrieken, Bart; (2002). Interapy: A model for therapeutic writing through the Internet. In: The writing cure: How expressive writing promotes health and emotional well-being. Lepore, Stephen J.; Smyth, Joshua M.; Washington, DC, US: American Psychological Association, 2002. pp. 215-238. link


(from the chapter) This chapter provides a detailed discussion of an ongoing program of research, the Amsterdam Writing Project, which includes clinical trials of expressive writing interventions and a novel Internet-based approach ("Interapy") for delivering mental health services that was born out of these trials. After describing this approach to using structured writing assignments in clinical practice, the authors describe experiments that evaluate the outcome of writing assignments for posttraumatic stress disorder (PTSD) patients and the role of habituation vs cognitive reappraisal in the process of overcoming trauma and grief. One study permitted the authors to investigate the importance of social sharing. The third part of the study describes how the authors translated the face-to-face protocol into an interactive format for writing therapy through the Internet.


Brown, Elissa J.; Heimberg, Richard G. (2001). Effects of writing about rape: Evaluating Pennebaker's paradigm with a severe trauma. ; Journal of Traumatic Stress. 14(4). pp. 781-790. link


Examined the effect of disclosing to others an attempted or completed rape, using Pennebaker's disclosure paradigm. 85 undergraduate women who acknowledged attempted or completed rape wrote about their experience and read their narratives. In a 2 × 2 design, the value of writing only factual information versus factual plus emotional information, and reading to oneself versus reading aloud to another woman was examined. Before and 1-mo after the task, symptoms of dysphoria, social anxiety, and posttraumatic stress disorder were assessed. Greater detail and a moderate level of personalization in the description of the trauma were associated with decreased symptoms of dysphoria and social anxiety. Neither the nature of the writing task nor the presence of another woman predicted degree of symptom reduction.


Mallay, Jane Neily, StressArt Services, Sarnia.(2002). Art therapy, an effective outreach intervention with traumatized children with suspected acquired brain injury. Arts in Psychotherapy. 29(3) link


Discusses the use of art therapy in treating children with posttraumatic stress disorder (PTSD), and present a case study. PTSD is a relatively new diagnosis for children, with responses including depression, anxiety, fearfulness, sleep-eating disturbances, and cognitions of self-blame and feeling damaged. Goals of therapy with PTSD children include reestablishing boundaries, feelings of safety, control, and body integrity, working on emotion ranges, removing self-blame, and putting the event and system involvement in context. Art psychotherapy is appropriate in these cases, with its capabilities to assist with expression and provide verbal support in a psychotherapeutic style. The case of a male (aged 10 yrs) who experienced trauma related to being hit by an automobile shows the value of art psychotherapy in cases of pediatric PTSD.



Fass, Margot L.; Brown, Daniel. (1990). Writing assignments and hypnosis in the treatment of traumatic memories. van der Hart, Onno; Boon, Suzette; van Everdingen, Ghisaine B.; In: Creative mastery in hypnosis and hypnoanalysis: A Festschrift for Erika Fromm. Hillsdale, NJ, England: Lawrence Erlbaum Associates, Inc, pp. 231-253. link


(from the book) interested in extending our understanding methods [hypnoanalytic methods] for use with PTSD [post-traumatic stress disorder] patients makes a distinction between nonhypnotic techniques, specific writing assignments, and the kind of hypnotic techniques described by Brown and Fromm (1986) in "Hypnotherapy and Hypnoanalysis" for use with PTSD patients discusses various ways clinicians can structure therapeutic writing assignments to help the patient translate traumatic memories into a personal narrative also reviews a variety of hypnoanalytic methods that can be used with such patients includes a valuable discussion about criteria for deciding when to use either writing assignments or hypnotherapy techniques with traumatized patients / writing assignments are useful for patients who have some degree of awareness of their trauma history and can see a connection between their past experience and present symptoms


Communication and rape victims


Using both sides of the brain: Experiences that integrate art and talk therapy through scribble drawings. McNamee, Carole M.; Art Therapy, Vol 21(3), 2004. pp. 136-142. link

Neuroscience researchers identify a cerebral cortex with two functioning hemispheres: a left hemisphere associated with language and speech and a. right hemisphere associated with visual-motor activities. Additionally, neuroscientists argue that contemporary lifestyles favor the verbal, logical left brain and often ignore the truths that present in the right brain. Psychotherapy techniques range in their use of left-brain verbal discourse and right-brain nonverbal discourse. In a case study, the author describes experiences integrating both verbal and nonverbal therapy with a client with severe anxiety and depression. Nonverbal therapy involved annotated scribble drawings. Images in the drawings became the stimuli for verbal discourse with the client. Other client responses to the annotated scribble drawings are described.



Use of drawing technique to encourage verbalization in adult survivor of sexual abuse. Lev-Wiesel, Rachel; Arts in Psychotherapy, Vol 25(4), 1998. pp. 257-262. link

Demonstrates the effectiveness of drawings (art therapy) in encouraging an adult survivor of childhood sexual abuse to speak about the past traumatic experiences. This ability to speak up not only breaks the conspiracy of family members to keep the secret, but also enables the victim to deal with negative feelings toward himself/herself and his/her parents. The drawing technique is illustrated in 4 therapeutic sessions (out of 24) with an adult female who was sexually abused by her father in childhood.


Holistic Assessment of rape victims. By: Mayer, Rick A.; Ottens, Allen J.. Guidance & Counseling, Mar94, Vol. 9 Issue 4, p24, 4p

This article describes a method for the holistic assessment of rape victims. This method consists of assessing the effect the rape has on the victims'affective, cognitive and behavioural functioning. By assessing the severity of the trauma in these areas counsellors are able to develop appropriate treatment strategies.
"The TAF permits counsellors to assess clients' level of impairment with respect to affective, cognitive and behavioural reactions to a crisis. Space is provided on the TAF for counsellors to make notation of any significant clinical findings. Affective categories are: (a) anger/hostility (may be present as agitation or a desire for possible retaliation); (b) fear/anxiety (may be present as sense of disorientation or jittery tension); and (c) sadness/melancholy (may be present as emotional and/or physical exhaustion accompanied by a sense of hopelessness). Counsellors are asked to identify clients' affective reaction to the crisis event using these categories and also assess the level of impairment. Should more than one affect be present, counsellors must judge which affect is primary, secondary and tertiary."


Art speaks in healing survivors of war: The use of art therapy in treating trauma survivors. Baker, Barbara Ann; Journal of Aggression, Maltreatment & Trauma, Vol 12(1-2), 2006. pp. 183-198.

Mental health clinics can use creative art therapies as a means of reaching out to war refugees in their communities who may not respond to traditional talk therapy. In this case, the use of quilting and other artwork was utilized by the staff at Chicago Health Outreach to assist displaced Bosnians to cope with their war-related trauma and integration into their new environment in the United States. It can be difficult to reach refugee populations within a community whose culture and language are different from the majority, but finding other means of communicating can make a real difference for these individuals as they find safety and understanding by working on and sharing special creative projects.


The healing art: The integration of art therapy into the modern psychoanalytic approach. Sharon, Ruth Velikorsky; Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 65(7-B), 2005. pp. 3724.

In this study I want to illustrate how the production of drawings and written associations of a patient in the psychoanalytic framework can be a springboard for progressive verbalization and communication. It is helpful because it can facilitate the expression of pre-verbal and non-verbal material. Experiences of the patient, before the age of language acquisition, fall into this category. I will do this using a case study approach, by presenting the case of Rachel, a preoedipal patient whom I treated through the use of art in the psychoanalytic framework. Her case will be presented, and the repetitive material which signalled the presence of the resistance and the unconscious material in her art work and written associations to it will be summarized and explored. I will discuss the presence of the transference, countertransference, and resistance in our therapeutic relationship-as present in her work, her actions, and her behavior as treatment progressed. My purpose in doing that is to explore the ways in which the use of art effected those elements. I also hope to open this field for more research in this area.

A descriptive study: Selection and use of art mediums by sexually abused adults: Implications in counseling and art psychotherapy. Clukey, Frances Harlow; Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 64(4-B), 2003. pp. 1679.

This research was designed to explore what happens in the process of therapy when clients, having persisting symptoms of sexual abuse and having disclosed that abuse, have access to a wide variety of art materials to select and use in treatment. A blend of qualitative and quantitative research in design, the study is an initial step towards a greater understanding of the potentially transformative experience of art making and the role of art mediums in the practice of therapy. Treatment for abuse is a long, complex and arduous process. Persistent aspects of abusive experience remain deeply buried within the body and cause periodic, cyclical, somatic and psychological problems in an individual's life. Clients often feel words are too immediate and too explicit to describe the experience and the resulting emotional response generated by sexual abuse. Created within the context of what psychiatrist Winnicott (1971) described as the "good enough" therapeutic relationship, artwork may be viewed as more concrete and symbolic, or less immediately explicit and therefore safer than verbal communications. Sensory-based therapies such as art therapy are, therefore, particularly useful in accessing traumatic memories and transforming the experience to a less damaging state. For this study, the author set up private practice to work as therapist with eight individuals for eight fifty-five minute sessions in a traditional art therapy studio. Each session was documented on videotape. Artwork was photographed. Videotapes, artwork, intake histories and the researcher/therapist's notes were analyzed. Brief case studies were developed. Data were considered by frequencies and ordinal comparisons for immerging patterns. The data described art mediums as accessing cognitive, symbolic, emotional, perceptual, kinesthetic and sensory levels of understanding. A spiral model facilitated understanding the process. The potential to pace the process of therapy by direction and selection of more or less mediated, fluid and controllable art mediums was shown to exist. Through the spatial and kinesthetic processes of art making in art therapy, the individual controls recollection, comprehension, integration and resolution of trauma. Art mediums are central in art therapy as they safely provide the means of expression and reflection to transform trauma in the bodymind.

Three art assessments: The Silver Drawing Test of cognition and emotion; draw a story: Screening for depression; and stimulus drawings and techniques. Silver, Rawley; New York, NY, US: Brunner-Routledge, 2002. xxiv, 315 pp.

(from the jacket) Art can be an invaluable means of communication. It can bypass language and hearing impairment and become a means of communicating thoughts or feelings too difficult to express with words. This book uses three original art assessments that use stimulus drawings to elicit response drawings that provide access to a patient's emotions and attitudes toward themselves and others while testing for the ability to solve problems and convey ideas. Each assessment includes studies of reliability, validity, and normative data, drawing on international research in the field and on the author's own body of work spanning more than forty years. Stimulus drawings are provided as well as drawing from imagination tasks, and rating scales to assess emotional and cognitive content.

Arts as language: Access to thoughts and feelings through stimulus drawings. Silver, Rawley; New York, NY, US: Brunner-Routledge, 2001. xix, 187 pp.

(from the cover) Discusses the use of the visual medium as a linguistic parallel to verbal or written communication. While recognizing that language expands and facilitates thought, the author illustrates the existence of high-level thinking in its absence and demonstrates the usefulness of drawing as an expressional tool for patients who are unable, or unwilling, to express themselves through the conventional use of language. Covering areas such as cognition, creativity, and emotion, this book provides the reader with an introduction to and explanation of stimulus drawing assessment. In this approach, drawings serve as the principal channel for the exchange of ideas. Stimulus drawings are provided to the patient to evoke a response drawing. These response drawings allow patients to sketch their fantasies, thus allowing some sort of gratification. The drawings may also serve as a means of acceptably expressing feelings the patient deems inappropriate, such as fear or anger. Reviews of qualitative and quantitative studies follow the introduction. By reviewing studies of children, adolescents, and adults suffering form various impairments and injuries, the author shows the broad applicability of stimulus drawing assessments.

Mandala artwork by clients with DID: Clinical observations based on two theoretical models. Cox, Carol Thayer; Cohen, Barry M.; Art Therapy, Vol 17(3), 2000. pp. 195-201.

The authors have explored the compositional patterns and thematic imagery in mandala drawings by a large group of patients diagnosed with multiple personality/dissociative identity disorder (MPD/DID). In approaching this work, they used both the Ten Category Model (G. M. Cohen & C. T. Cox, 1995) and the Great Round of Mandala theory (J. Kellogg, 1978, 1997) looking for parallels between the two systems of analysis to help therapists better understand the nonverbal communications of their clients. Although not a formal research study, the observations based on the synthesis of these two unrelated models are nonetheless consistent with the assessment and treatment literature on DID.

Art psychotherapy groups: Between pictures and words. Skaife, Sally; Huet, Val; Florence, KY, US: Taylor & Frances/Routledge, 1998. x, 209 pp.

(from the cover) Presenting an account of the challenges encountered in art psychotherapy practice, this book explores new theoretical material arising from the merging of art and group psychotherapy. The contributors present in-depth discussion of case studies with client groups such as children, forensic patients, patients on acute psychiatric wards, the cognitively impaired elderly, institutionalized patients moving into the community, and drug and alcohol abusers. A common theme which emerges from the book is that the physical use of art materials and the space of the art room offer a possibility for communication of feelings which is not possible in purely verbal groups. This allows clients with severe mental health problems, and groups who would not normally be considered for purely verbal group therapy, to benefit from a psychodynamic group process.
The book is intended to be a resource for practising and trainee art therapists, and all professionals working psychodynamically with clients who have severe mental health problems.

Therapeutic presence: Bridging expression and form. Robbins, Arthur; Philadelphia, PA, US: Jessica Kingsley Publishers, Ltd., 1998. 280 pp.

(from the cover) In the therapeutic workplace, the interaction between patient and therapist is built upon cognitive, affective and expressive experiences. The contributors to this book explore this interaction, examining the concept of therapeutic presence, and the therapist's ability to maintain it. The theory integrates a creative framework that synthesizes traditional and non-traditional approaches to treatment, and will be of use to all mental health professionals.
The author suggests that, since therapeutic presence calls for an openness and awareness of the intersubjective space between therapist and patient, therapists who become receptive to the subtle cues of sensory perceptual communication, as well as to the playful mirroring and meditative interaction, will achieve more successful and meaningful interactions with patients. Therapeutic presence requires a sensitivity to the temporal characteristics of the therapeutic frame, and an experience of energy that may open, shut down, or disrupt the field of therapeutic contact.
This stance can be applied to therapeutic modalities ranging from psychoanalysis to creative arts therapy, in work with both short term and long term populations. The author suggests that the full use of the therapist's creative energies may provide the only solution to overwhelming therapeutic situations.




Malchiodi, C. (1997). Breaking The Silence: Art Therapy With Children From Violent Homes. NY: Brunner Routledge.


Mary Beth Williams, Soili Poijula. (2002). The PTSD Workbook: Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms. Oakland, Ca., New Harbinger Publications.



CORK Bibliography: Post-Traumatic Stress Disorder (PTSD)


Healing, Therapy, and Psychology



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Related links: Victim blame, Memory and ptsd, Panic attacks, Body memories, Sleeping problems, Dyslexia and PTSD


American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.

Clukey, Frances Harlow. (2003). A descriptive study: Selection and use of art mediums by sexually abused adults: Implications in counseling and art psychotherapy. ; Dissertation Abstracts International: Section B: The Sciences and Engineering, 64(4-B), 2003. pp. 1679.

Villarreal, G. et.al., (2004). Reduced area of the corpus callosum in posttraumatic stress disorder. Psychiatry Research: Neuroimaging Section, 131(3), 227-235. Link

McNamee, Carole M. (2004). Using both sides of the brain: Experiences that integrate art and talk therapy through scribble drawings. Art Therapy. 21(3), 2004. pp. 136-142. link


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