Trauma Treatment Manual

Albany, CA
(510) 524-3654

Copyright, 1996
First Written 3/93
Last revised 09/01

Author's Introductory Note:This manual was originally written for people working in the field with women survivors of rape in Bosnia, but it can be used more broadly as a guide for helping anyone of either gender who has survived any kind of trauma. Since it is written from afar and based on experiences similar to but not the same as the ones you are dealing with, please use what is useful or helpful and ignore what is irrelevant or wrong for your circumstances, trusting more in your judgment and intuition than in anything contained herein. Also, please be aware that some of the suggestions and conversations suggested here may not fit the cultural context you will be working in. It is best to ask local people about what can be discussed in private or in public with any group you are dealing with. For example, some people in the former Yugoslavia may be unwilling to discuss rape with anyone. It may be necessary to talk "around" such subjects rather than directly. Some groups may not be willing to discuss feelings at all. When in doubt, follow rather than lead.

For anyone working with survivors of trauma from Kossovo, I have been sent a translation of this manual into Albanian by Dr. Dimocritos Sarantidis, President of the Medical Rehabilitation Centre for Torture Victims and General Secretary of the Balkan Network of Rehabilitation Centres for Torture Victims.

For anyone working with survivors of the earthquake in Taiwan or any other trauma in China, this manual is now available also in Chinese. Been-Fun, Liaw, a graduate of Department of Counseling, National Changhua University of Education in Taiwan, Republic of China, has kindly provided me with a translation in Chinese.

This manual may be adapted for any purpose the reader feels is appropriate in helping survivors of trauma or those helping them. It is primarily intended for treating adults. The manual may be freely distributed. I'd appreciate it if my name is kept on it. My wish is for this to be a living document, kept alive and changing by the feedback I get from those who use it. Please let me know what works, what doesn't, what you'd like to see changed, removed, or added. I would also be willing to adapt this manual for different purposes, if there are requests and there is time. Please respond to me at:

To read a book I have written about recovery from the trauma of the attacks on the World Trade Center and Pentagon and about the sources of global trauma, go to Recovery 9-1-1.

Trauma Treatment Manual

General Guidelines

When people have experienced things they cannot stand, ordinary people can often give them what they need to help them begin to heal. This section gives general guidelines for working with people who have been catastrophically violated.

What they are suffering

The people you will be working with have experienced events that have permanently changed their lives. But they can heal. People who have been raped, who have seen their loved ones killed -- their lives will never be the same again. Yet no matter how great the horror people have experienced, they may recover emotional functioning, so that they are not feeling pain, terror, shame, fear, or horror all the time. Rape and murder may have robbed them of a sense of integrity and wholeness, but in time and with your help, they may be able to resume life with their sense of self restored.

People who have experienced rape or torture or who have witnessed murders of loved ones usually suffer from Post Traumatic Stress Disorder, a psychological disorder that occurs when people have experienced life-threatening, shocking events. It has symptoms that are often the same for different people, regardless of the specific events they suffered.

With Post Traumatic Stress Disorder (PTSD), many normal processes are more intense, while many are deadened. People whose normal lives have been drastically changed by the sudden intrusion of horrifying and destructive events are experiencing more than they can integrate, and their sense of security and safety is shattered. In PTSD, some of people's responses are greatly heightened. The blow of a severe event has told them that the world is not the safe place they imagined. So they become ready for danger at all times: they have hyper-vigilance -- greater readiness to flee or fight. They live in emergency mode, and they have learned not to trust. At the same time as having heightened responses, they also shut down a great deal, so that many of their normal responses to life and to other people are not accessible to them. As a result, these are some of the symptoms you might see:

What they need

Most of all people need to feel relatively safe. Anyone who has been extremely hurt by other people, especially when they have been systematically tortured has learned not to trust anyone. This is how they survived. They will not trust you at first, not for a long time, maybe never. Moreover, in areas of the world in which brutality, horror, and extreme danger have become commonplace, talking about safety can seem absurd or even offensive. But you still can help people to feel relatively safer. All of us know how to do that with people; we just need to be reminded how: we may begin simply by performing simple acts of kindness, by letting people alone when they want to be let alone, by treating other people as if you cared about them. Most important for survivors of extreme abuse is that they need to know these things:

What you can do to help: Your Characteristics

What you can do to help: Procedures and Processes

Final Word

Your feedback will help this page grow. Please let me know what works for you and what doesn't. If you have questions, please feel free to ask, and I'll do what I can to answer. If you wish consultation on any of your work with trauma, please ask me, and I'll try to help. E-mail me at the addess above.

To read a book I have written about recovery from the trauma of the attacks on the World Trade Center and Pentagon and about the sources of global trauma, go to Recovery 9-1-1.