Violence Survivors With Posttraumatic Stress Disorder: Treatment by Integrating Existential and Narrative Therapies

The author proposes the addition of narrative and existential therapies to current empirically based treatments for victims of interpersonal violence who are experiencing posttraumatic stress disorder (PTSD). A brief history of PTSD, current diagnostic criteria, and cultural influences in relation to this disorder are addressed. ********** The breadth of interpersonal violence is continuously expanding. According to Broman-Fulks et al. (2006), epidemiological studies estimated that between 50% and 70% of individuals in the United States have experienced some form of interpersonal violence during their lifetime. Interpersonal violence and trauma are exceedingly complex phenomena that have cultural, social, political, and psychological implications (Carlson, 2005; De Silva, 1993; Goto & Wilson, 2003). One constant commonly associated with interpersonal violence is the prevalence of posttraumatic stress disorder (PTSD) among survivors of such violence (Phillips, Rosen, Zoellner, & Feeny, 2006). The complexity of working with survivors of interpersonal violence who are experiencing PTSD makes it imperative for clinicians to provide holistic treatment that attends to all of these layers. In this article, I propose an integration of existential and narrative therapies with current evidence-supported approaches to treating the aforementioned population. First, I briefly define interpersonal violence, then provide a history and review of the diagnostic criteria for PTSD, which frequently results from such crimes. I then address cultural influences that could have an impact on diagnosis and treatment, followed by current treatments within the mental health field. Finally, I review the essential components of existential and narrative approaches and conclude with a discussion of how a combination of these treatment modalities could be beneficial for counselors in their work with survivors of interpersonal violence. INTERPERSONAL VIOLENCE Interpersonal violence is defined here as an encounter that "threatens or manifests bodily or emotional harm" (Gore-Felton, Gill, Koopman, & Spiegel, 1999, p. 294). There are various forms of interpersonal violence, for example, sexual assault, domestic violence, executions, emotional abuse of children and spouses, terrorist attacks, mass shootings, torture, and other forms of homicide. The diffusion of impact can range from a single victim of assault to thousands affected by a mass shooting. Unfortunately, interpersonal violence is becoming a more common occurrence across the United States (Gore-Felton et al., 1999). In 2002, an estimated 1.6 million people across the globe died from self-inflicted, interpersonal, or communal violence. Of these, one third were homicide victims, and about 170,000 died as a direct result of mass violence (World Health Organization, 2007). The disruptive effects of interpersonal violence can be a determinant of mental health (Satcher, Friel, & Bell, 2007). Because of the growing evidence of such violence, it is important to understand the psychological consequences of it (Gore-Felton et al., 1999). PTSD History PTSD is a relatively new diagnostic category, although pathological responses to stressful events have been acknowledged in various contexts for decades (De Silva, 1993). The study of psychological trauma has been chronically forgotten because it provokes powerful controversy and requires one to encounter the essence of human vulnerability and villainy (J. Herman, 1997). It has been postulated that the conception of this disorder was in the late 19th century and was originally referred to as hysteria. At the time, most physicians considered hysteria to be a "disease proper to women and originating in the uterus" (Sgroi, as cited in J. Herman, 1997, p. 10). French neurologist Jean-Martin Charcot was one of the founding scientists to study the controversial disorder. Through various case studies, Charcot was able to demonstrate that the root of hysterical symptoms was psychological (J. …