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Palo Alto Online

Publication Date: Wednesday, September 11, 2002

Uncovering the depths of trauma Uncovering the depths of trauma (September 11, 2002)

Palo Alto psychiatrist uses metaphors to help clients recover

by Jocelyn Dong

Dr. Deborah Rose likens it to a nuclear bomb going off inside of a person -- the kind of extreme psychological trauma that leaves people unable to cope.

For some, the terrorist attacks on Sept. 11, 2001, were such an event. For others, it is war, divorce or witnessing a murder.

What happens, the Palo Alto psychiatrist said, is that an out-of-the-ordinary event "unleashes a cascade of symptoms and thoughts and feelings that people are . . . not prepared for." They lack the preparation to understand their reactions.

The good news -- and there is some -- is that people who go through trauma can learn how to deal with it. Rose said her clients use their energy to come to a deeper understanding of who they are as human beings. And they also learn to try new and creative things, as did one client -- a writer -- who published a book about her rape and her recovery. For some, the progress is measured in smaller but still significant steps.

"For someone who hasn't known how to deal with themselves and others, suddenly the words are there," Rose said. "They can protect themselves and assert themselves as they didn't before."

She gives the example of a client whose co-worker was intentionally changing settings on her computer. After some therapy, the client found herself able to confront the co-worker and tell him to leave her alone, rather than continue to feel victimized.

Frequently, people who endure extreme trauma do not have the words to explain or talk about what they've gone through. Veterans of war are one case in point. Sometimes, friends and relatives of the person assume the person simply prefers not to talk about an experience. Rose disagrees.

"It's not that he won't -- it's that he doesn't have the words, and if he tries to talk about it, he is in danger of having a traumatic enactment go on inside of himself. This is a physically life-threatening state," she said.

What Rose does with clients who have this post-traumatic stress disorder (PTSD) is to carefully uncover what is causing their terror. She describes her technique as "decoding nonverbal cues."

"Trauma is not expressed in words, but in bodily sensations, in pre-verbal cues," Rose said. In a session, she and her client work to describe those feelings -- using metaphors like the nuclear bomb, or a series of images, or characters like zombies or Martians. Rose pays attention to those metaphors, which help clients cope with what she calls their "psychological death."

Rose has consulted for the National Center for Post-Traumatic Stress Disorder and also the YWCA Rape Crisis Center. She criticizes some mental-health professionals for using techniques that do not address the depth of their clients' traumas. For example, she said some deal with patients on the strictly interpersonal level, failing to hear what the client is actually trying to say. "I don't want to talk about it" may be a plea to understand the trauma, not an instruction to the therapist to stop asking questions, Rose said.

Although Sept. 11, 2001, brought great trauma to thousands of people, Rose noted that the outlook is positive when talking about human resilience. All of her clients who had gone through their own personal tragedies prior to the attacks -- and thus had learned how to understand their reactions to trauma -- readily coped with the national tragedy.

And new clients who sought help after Sept. 11 are also on the road to recovery. These people typically had unresolved traumas and were barely coping before the attacks, Rose noted. If there is a silver lining, however, it's that by finally getting help, they too are becoming stronger than before. Nancy Venable Raine, Rose's client, wrote the book, "After Silence: Rape and My Journey Back," and dedicated it to Rose. The book is available locally.

E-mail Jocelyn Dong at


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