The Collaborative Approach to Clients with PTSD
Post-traumatic stress disorder (PTSD), a syndrome often associated with soldiers returning from war, is brought on by exposure to physically or mentally threatening situations. PTSD is the most commonly diagnosed syndrome in people that have been exposed to trauma, especially in people with long histories of exposure to physical or emotional harm. Survivors of child abuse are therefore at exceptional risk for developing the disorder (Breslau, 2009, p. 205). The manifold effects of PTSD on mental and physical function include avoidance, numbing, depression, and aggression towards oneself and others. The disorder has also been associated with multiple comorbidities, including substance abuse, major depression, and borderline personality disorder (Kreidler & Kurzawa, 2009, p. 28). The task of establishing a therapeutic relationship with a client suffering from PTSD is paramount, as the nature of PTSD can interfere with both the seeking of and adherence to therapy (Trusz, Wagner, Russo, Love, & Zatzik, 2011, p. 208). Applying four of the essential ingredients of the collaborative partnership –sharing power, being open and respectful, being nonjudgmental and accepting, and living with ambiguity- from The Collaborative Approach to Care (Gottlieb & Feeley, 2006), this paper will focus on Kara Thrace (Appendix A) from the television show Battlestar Galactica (Saunders & de Segonzac, 2006) as a case study to determine the limits and benefits of implementing this model to establish a therapeutic relationship with a client suffering from PTSD.
In Kara’s case, the nurse must be aware of the impact of the Kara's childhood trauma in order to begin to establish a therapeutic bond with her. Harris and Fallot (2001) base trauma informed care on the principle that the client’s unique experience with trauma defines the role that victimization has played in his or her life, shaping lifelong responses and coping strategies that he or she exhibits (p. 12). The model emphasizes empowerment as a means of recovery by focusing on the person’s strengths, building skills, and respecting the person's ultimate responsibility to choose treatment (Chandler, 2008, p. 364; Wiechelt, Miller, & Smith, 2011, p. 194). Kara’s PTSD diagnosis, evident in her aggression, inability to maintain healthy relationships, numbing behaviour with alcohol abuse, and the blame that she internalizes as a consequence of these behaviours, originates in her childhood victimization and progresses in her subsequent retraumatization as a fighter pilot (Breslau, 2009, p. 205). Gottlieb and Feeley (2006) emphasize individualized, holistic care as a prerequisite for establishing a collaborative partnership between the nurse and the client (p. 8), but in Kara’s case, the nurse must go further by approaching her care with the specific understanding that her problems are rooted deeply in her identity as a survivor of trauma and a sufferer of PTSD.
The primary component of the collaborative partnership is the sharing of power, which Gottlieb and Freely (2006) describe as the ability of both the client and the nurse to collaborate and share in the decision-making regarding his or her care (p. 28). The abuse Kara has suffered at the hands of her mother has stripped her power away. The nurse must therefore be especially aware of his or her inherent power advantage within the healthcare system in order to avoid recreating the feelings of helplessness Kara experienced as a child (Harner & Burgess, 2011, p. 473). Knowledge forms the basis of power within the relationship, including both the nurse's professional knowledge and Kara’s individual knowledge of herself and her experiences (Gottlieb & Feeley, 2006, p. 31). One of the key strategies for enhancing Kara’s perception of her own power within the relationship is thus the sharing of knowledge of her mental illness, PTSD, with the aim of reducing her internalized stigma associated with her