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Ethically Treating PTSD Resulting from Terroism and other Traumas

Section 12
Identifying Trust Issues with Victims of Terrorism
by Aphrodite Matsakis

Question 12 | Test | Table of Contents

Identifying Trust Issues in the Present
Are there any connections between the ways you were betrayed before or during your trauma and the difficulties you have trusting others in the present? Can you identify any relationships in the present where you have trust issues that originated in the trauma or in secondary world experiences?

Use the following sentence as a model:
Because I was betrayed by the U.S. military, who did not protect New York City, I now distrust my safety and have strong reactions when I hear sirens.

Exercise: Assessing Trustworthiness
In a previous exercise, you identified three persons who betrayed you in the past and the ways in which those three betrayals affected your current relationships. In the following exercise, you are asked to do something more complicated: to assess the trustworthiness of three persons from your present-day life, given the information you currently have.

Consider the following questions:
Do you mistrust this person totally, or do you trust him/or her in some areas, but not others?
What evidence do you have that it is safe to trust the person in these areas?
What evidence do you have to the contrary?
What else would you need to know to put your trust in this person in the areas you specified?
Is it possible to find out this information?
For example, are there other people you can talk to about this person?
Are there written records you can examine?
Are there questions you can ask this person?
Is there a safe way to “test” whether your evaluation of this person is accurate?

Your writings about each relationship should address each of the following categories:

Initial Impressions

Check and complete as many items as apply:
I do not trust _____ in the following areas _____.
I do trust _____ in the following areas _____.
I don’t trust _____ in any way.
I trust _____ totally.

Assessing Trustworthiness: Analyzing Initial Impressions and Information
I have seen, heard, and sensed the following about this person. In the past, this person has _____, _____, and _____.
At this point in time, the following information indicates this person might be trustworthy because _____.
At this point in time, the following information indicates this person is not trustworthy because _____.
At this point in time, most of the information suggests _____ about this person’s trustworthiness.
I trust this person in the areas of _____ and _____ and _____ because _____.
In order to be more certain about my trust, I need to find out _____.
I do not trust this person in the following areas _____.
The reasons I don’t trust this person in these areas is because I have seen, heard, and sensed the following about this person _____.
In the past this person has _____.

Obtaining Additional Information and Checking Out Reality
With whom can I talk to obtain more information about this person?
Is there someone whose opinion I respect with whom I can check my perceptions and who can help me sort out the information I do have about this person?

Hypothesis Testing: Devising Experiments to Test Someone: Taking Small Manageable Chances to Find Out More Information
Is there a safe, doable experiment I can devise to test whether this person is caring and trustworthy or to test other thoughts I have about him/her?
Is there some smaller step I can take toward trusting that person that will not be too costly to me and that will help me to judge that person’s trustworthiness?
What small step might that be?
What’s the worst thing that might happen?
If taking this small step seems extremely risky, then why am I contemplating it?

Revising Your Hypotheses Or Thoughts About Someone
Assuming you have taken that small chance and observed that person’s reaction, what did you learn about him/her? How does this change your previous evaluation of this person?
Can you take another small step toward trusting him/her, or did the information you obtained show you that you need to be cautious?
If this person disappointed you, does this mean that he/she is not to be trusted at all or that there are additional areas where this person isn’t to be trusted?
If so, what are these areas?
If you learned that this person could be trusted just a little more, does it make sense to take another small step toward trusting him/her a little more and see what happens?
With whom can you talk to help you analyze and sort out what you learned about this person?

Revised Current Impressions
Check and complete as many items as apply. Then, compare your current assessment of the person under consideration with your initial assessment. Congratulations on having taken the time and effort to think through issues of trust with this relationship. How do you feel having completed all of this work? Hopefully, you will feel that you now have a little more control of the relationship.
I do not trust _____ in the following areas _____.
I do trust _____ in the following areas _____.
I don’t trust _____ in any way.
I trust _____ totally.
I am still uncertain about the following with respect to this person _____. I still need to find out _____.
The steps I need to take to find out what I need to know are _____, _____, and _____.

Areas of Uncertainty
I am not sure whether or not to trust _____ in the following areas _____, ______, _____, and _____.
The reasons I might not trust are _____.
The reason I have to be cautious are _____.
What I need to know to make a good decision is _____.
I can find out some of what I need to know by taking the following steps: _____.
Some areas I might never be sure about are _____.

Post-traumatic stress disorder in children

- Kaminer, D., Seedat, S., & Stein, D. J. (2005). Post-traumatic stress disorder in children. World psychiatry : official journal of the World Psychiatric Association (WPA), 4(2), 121–125.

Personal Reflection Exercise #3
The preceding section contained worksheets for client self-assessment. Write two case study examples regarding possible applications of these assessments.

Peer-Reviewed Journal Article References:
Himmerich, S. J., Ellis, R. A., & Orcutt, H. K. (2020). Application of PTSD alcohol expectancy symptom clusters to the four-dimensional model of PTSD: Support from moderations of the association between symptoms of posttraumatic stress and alcohol use. Psychological Trauma: Theory, Research, Practice, and Policy, 12(4), 347–355.

Saltzman, L. Y. (2019). It’s about time: Reconceptualizing the role of time in loss and trauma. Psychological Trauma: Theory, Research, Practice, and Policy, 11(6), 663–670.

Taylor, S., Charura, D., Williams, G., Shaw, M., Allan, J., Cohen, E., Meth, F., & O'Dwyer, L. (2020). Loss, grief, and growth: An interpretative phenomenological analysis of experiences of trauma in asylum seekers and refugees. Traumatology. Advance online publication. 

PTSD victims of terrorism and other traumas may have problems with trust. What is a question you might have the client use for "checking out reality?" To select and enter your answer go to Test.

Section 13
Table of Contents