Variations on a scream: A journey through post-traumatic stress disorder

Abstract

This article describes therapeutic work undertaken with an ex-residential social worker who was unable to return to her work following an assault and subsequent development of post-traumatic stress disorder (PTSD). The client's name has been changed. Work began with the client 16 months after the assault and continued over the next 20 months for 30 sessions. The deeply intrusive influence of PTSD is illustrated, as is the need for a flexible therapeutic response to problems raised by the experience of this condition. The importance of the therapeutic structure and process are highlighted. The pervasive influence of fear in general and fears of annihilation and separation in particular are highlighted throughout from both casework and theoretical perspectives. Munch's painting 'The Scream' is described and ways in which this painting conveys much of value to those working with PTSD are suggested. The article concludes with the contention that therapists and counsellors need to tread the thin line of being sufficiently open to and influenced by their clients' fears to recognise and begin to understand them but also to remain sufficiently apart from these fears so as not to be overwhelmed by them.