Tuesday 28 January 2014

Pilot Study on the Treatment of PTSD with Transactional Analysis Psychotherapy


Having recently watched the harrowing 'Broken by Battle' edition of Panorama following the plight of several army veterans living with post-traumatic stress disorder (PTSD), I was moved to compose a few thoughts in response to the programme- and, also, to highlight the research I'm presently conducting into the effectiveness of transactional analysis psychotherapy for the treatment of PTSD.

Sadly, I have to report that many of the trenchant criticisms levelled at the authorities by the veterans and their families mirror similar observations made by the individuals I work with. Hopefully, though, the mass exposure to these issues afforded by this compelling programme will serve to focus minds in the Ministry of Defence and relevant health and social care services with a view to dramatically improving the care and treatment of those who have risked everything at the behest of our political and military leadership.

Among the most pressing concerns raised by my work is the apparent irony that, too often, the care and treatment of veterans is brief, intermittent and fragmentary and, as such, only serves to reinforce the fragmentation of self and experience brought about by the experience of trauma. Individuals tend to be seen by different practitioners at successive appointments, or receive a confusing plethora of short-term treatments using different approaches. Consequently, progress is limited and, crucially, the veterans are unable to build a mutually trusting therapeutic relationship and can find themselves re-traumatised by having to recount their history over and over again.

I have heard, too, of individuals being disbelieved and accused of lying, or exaggerating their experiences, because their stories are conflicted, or lack a coherent time line. This, despite the fact that conflated, or contradictory narratives are a common symptom of the traumatised brain, where memories are laid down as dissociated fragments in haphazard fashion under the auspices of the limbic system's 'fight-flight-freeze' response, rather than the orderly, complete and easily retrievable explicit memories stored when a person is calm and the neocortex is in control.

Veterans also spoke of breathing exercises being prescribed without any explanation as to the neurological purpose of these simple, yet effective techniques- which shift executive control of the brain back from the limbic system to the neocortex and, thereby, allow an individual to treat their own panic and anxiety symptoms. Simply put, why would anyone stick to an exercise they are advised to carry out when nobody fully explains what it's for and how it works? What is needed here is clear and concise, non-patronising information. Indeed, the very act of giving a patient a way of understanding the impact of trauma on their mind and body through a mixture of spoken and written language and simple diagrams in itself stimulates the neocortex and helps them acquire the sense of autonomy and efficacy they need to regain control over their fight-flight-freeze mechanisms.

For many individuals- based on both my clinical experiences and the testimony of several clients- it is the safety, consistency and affective containment provided by one-to-one, long-term psychotherapy that is most effective in the effective treatment of PTSD- especially when backed up by carefully-monitored psychiatric medication and person-centred social care. Furthermore, all such treatment should be provided with the informed consent of the patient concerned, obtained in advance, so as to maintain confidentiality and fully include them in their treatment.

It is with the intention of finding solid evidence for these initial observations that I have embarked on an extensive programme of research into the effectiveness of TA psychotherapy, in particular, for the treatment of PTSD; commencing with a pilot study based on a sample of six clients. This brief survey can be read and/or downloaded by clicking on the following link and registering free of charge for online access to the International Journal of Transactional Analysis Research (IJTAR):

TA Psychotherapy for Armed Forces Veterans Presenting with PTSD - David Harford 2013

As alluded to in the pilot, a full-scale study is presently nearing completion employing a larger sample of clients and a wider range of quantitative and qualitative outcome measures, which, all being well, will provide strong corroboration for my working hypothesis that 'transactional analysis psychotherapy is an effective treatment for post-traumatic stress disorder (PTSD)'.

However, this more substantial body of research may also need to give consideration to the impact of ATOS benefits assessments on veterans presenting with PTSD, as my initial results seem to suggest that the government's publicly-stated drive to reduce the number of benefit claimants using a private company and, by all accounts, poorly-trained, or unduly-influenced assessors, is extremely damaging to the health and welfare of this very vulnerable group of people.

On this last point- and by way of echoing the core message of 'Broken by Battle'- these remarkable men and women have risked their lives and experienced appalling horrors in the course of their duties; often, with terrible consequences for their physical and mental health and well-being. You would think, therefore, that they would receive the very best of ongoing care and support from those who sent them into danger. In reality, the picture is decidedly mixed and, sometimes, shockingly neglectful.

David Harford www.harfordtherapy.com

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