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Filtering in PTSD Clients
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let's look at how mental filters by your client may predispose them to PTSD. These
mental filters bring forth some major ethical areas for concern. I use filtering
to refer to the mental mechanisms which helps us to individually sort through
our world and integrate information. We have found in times of national trauma,
due to terrorist attacks, that we can somewhat predict which of our clients will
react extremely to the situation based upon what I will call their Filtering Style.
Ive divided filtering into six categories. Lets look at the first
category of positive versus negative filters.
6 Filtering Style Categories
Filter #1 - Positive
The first we call the Positive/Negative Filtering is an
orientation towards focusing on circumstances that are either positive or negative.
Clients unconsciously choose the positive or negative experiences while rarely
considering the opposite in their memories of the past and the orientation to
the future. Some clients seem to be only able to concentrate on things that are
positive while others appear to focus on negative issues.
Regardless of how the
client tries to change this filtering style, it appears to be extremely resistant
to modification. Its been my experience that clients experience more severe
PTSD if their filtering mechanism is more negative than positive. What filter
do you use?
♦ Filter #2 - Global
A second filtering mechanism is that of a global filter
versus filtering out details. This perspective is oriented toward focusing on
details that either involve large or small components. Some clients are only able
to see the forest while others cant see the forest for
the trees. However, many people seem to be quite flexible and sort of both
Im wondering if you have found, like we have, that PTSD clients
who see the world from a more global view are able to more easily put events into
perspective. Are you global or a details person?
Filter #3 - Time
Third is a perspective on time which orients toward focusing on details predominantly
from the past, present, or future. Some clients cant seem to get out of
the past. They will base present and future decisions on successes or failures
in the past. Others choose to ignore both the past and the future adopting a live
for today attitude. Still others embrace a future-oriented life disregarding
past and present requirements. Those who may be too singularly focused on the
past appear to experience more severe PTSD. Where is your focus? Past? Present?
Filter #4 - The
Fourth is a same and different perspective.
This is a personal focusing preference oriented towards identifying things which
are similar or different. Some people choose to highlight those circumstances
which they can account for as similar to other conditions in their lives. Contradictory
to these clients are those who choose to identify situations and adjust so the
resulting circumstances are dissimilar.
My colleagues and I have found PTSD clients
appear to focus more on present events similar to past stressors, as opposed to
events that differ from the past. What is your focus on, similarities or differences?
♦ Filter #5 - The
Switch Referential Index
Fifth, the Switch Referential Perspective filtering
is a preference which involves an ability to switch from the clients own
reference point to that of someone else. This perspective can have a number of
facets. A client can switch from how I feel to how he
or she feels or how they feel. The client can suppose
what happened to another happened to themselves. The object of the referential
switch perspective is to equate the clients sensory perception to that of
another or others. As you know, the ability to switch perspective is an important
factor in achieving intimacy and understanding. It is also a valuable asset for
those who would aid trauma victims.
Do you notice a pattern with your PTSD clients
regarding I feel versus they feel? What is your referential
Filter #6 - Authority Perspective
Finally, the Authority Perspective filter is an unconscious sorting preference
oriented toward identifying ones personal source of authority. Such sources
can include I, you, us, family, God (religion), culture, ethnicity, and others.
Ones sentence structure can identify ones source for authority. We
indicate our authority source when we say I feel..., Do you
think..., We should..., His word..., etc. As you
know, Vietnam veterans who suffer from PTSD usually have a resentment towards
authority. However, regarding their perspective concerning authority as lying
inside or outside of themselves, I have not noticed a pattern. What is your authority
Code of Ethics states that we must show acceptance and be non-judgmental. However, when we experience someone who has the same perspective or filtering
system as we do, we have a positive sense of commonality and security in communication.
You may experience a feeling of understanding, connecting, and being on the same
wavelength with your client. His state of rapport creates an awareness
of harmony and unity in the treatment session.
However, when rapport is either
broken or not established (as in a conflict of perspectives or filters), you may
encounter a negative sense of detachment and discomfort in communication in the
session. This negative sense can lead you to consider the client as being wrong.
3 Questions to Increase Your Self-Awareness
♦ To increase your self-awareness regarding your filtering or perspective consider
the following three questions:
-- 1. Try to determine the perspectives of
PTSD clients with whom you communicate on a regular basis.
-- 2. Can you identify
their perspectives or filters that are the same or different from yours?
-- 3. Can you identify barriers to your communication due to the PTSD clients
Lastly, Id like to talk about the problem in working with
PTSD clients related to the intrusive imagery. According to Brett & Ostroff,
certainly intrusive imagery is a hallmark of PTSD. However, through your work
with survivors, therapists may also experience intrusive imagery. Often images
of those scenes, that survivor clients have described vividly, are ones which
connect in some way with your own psychology. The self-care strategy that is most
helpful here is for the therapist to identify his or her own prominent theme in
the images (which may differ from the clients).
For example, the therapist
may reexperience intrusive images. While for the client, this memory may represent
primarily a disruption in her sense of safety; to the therapist what is prominent
may be the sense of betrayal, which is related to trust. Once the therapist has
identified this theme, it can be connected to other issues, for example related
to trust disruptions in the therapists life. This allows the therapist to
begin to work with and, over time, to integrate the images; it can then cease
to be intrusive for the therapist.
type of disruption most notably experienced by all taking this home study course
is the visualization of the destruction of the Twin Towers. Many of my colleagues
reported having visceral reactions when they would see tall buildings on television
immediately following the attack.
summary, we have talked about victims of terrorism experiencing a loss of invulnerability,
loss of an orderly world, loss of positive self-image, and loss of trust.
We also discussed the role that prior experience and training make in the predisposition
to PTSD. The psychodynamics of hostage victims including pathological transference
and psychological infantilism were also discussed.
The importance of ventilating
feelings and realistic guilt were discussed along with the psychopathology of
being held hostage. The factors of feelings of helplessness, existential fear,
and sensory input overload were also discussed as they related to psychological
anchors and transference regarding the mutual fate bond, six filtering perspectives,
and Code of Ethics issues.
is hoped that this portion of the home study course has provided you with a broader
knowledge base regarding the ethical treatment of PTSD resulting from terrorism
and other traumas. This is Tracy Catherine Appleton with the Healthcare Training
Institute. Thank you for selecting us to be a vehicle for you to earn your Continuing
Education credits. I look forward to talking with you in another home study course.
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.
Hyland, P., Karatzias, T., Shevlin, M., McElroy, E., Ben-Ezra, M., Cloitre, M., & Brewin, C. R. (2021). Does requiring trauma exposure affect rates of ICD-11 PTSD and complex PTSD? Implications for DSM–5. Psychological Trauma: Theory, Research, Practice, and Policy, 13(2), 133–141.
Macdonald, A., Pukay-Martin, N. D., Wagner, A. C., Fredman, S. J., & Monson, C. M. (2016). Cognitive–behavioral conjoint therapy for PTSD improves various PTSD symptoms and trauma-related cognitions: Results from a randomized controlled trial. Journal of Family Psychology, 30(1), 157–162.
Robison, M. K., Miller, A. L., & Unsworth, N. (2018). Individual differences in working memory capacity and filtering. Journal of Experimental Psychology: Human Perception and Performance, 44(7), 1038–1053.
Wendt, M., Luna-Rodriguez, A., & Jacobsen, T. (2012). Conflict-induced perceptual filtering. Journal of Experimental Psychology: Human Perception and Performance, 38(3), 675–686.
The Code of Ethics states that we must show acceptance and be non-judgmental.
What are three self-awareness questions? To select and enter your answer go to