Posttraumatic Stress Disorder Assessment and Systemic Treatment

The Coping Strategy Environment

The coping strategies supported by the interpersonal environment have the most direct impact on recovery and serve as the best measure of the functionality of the environment. Dysfunctional interpersonal environments support unhealthy forms of coping, but functional environments support relational forms of coping that help keep relational stressors to a minimum. Highly cohesive support systems often organize around the needs of the most vulnerable members, as when a family forms a trauma membrane around the survivor and protects him or her from acute stressors.

In their classic studies of families coping with major stressors, Charles R. Figley and Hamilton McCubbin found clear divisions between families that coped effectively and those that did not. Some coping strategies were obviously unhealthy, such as relying on violence or drugs, but other aspects of the coping environment also influence recovery.

Other forms of dysfunctional coping include failing to identify stressors that need to be addressed and focusing excessively on assigning blame instead of being solution-oriented. Dysfunctional families are frequently ineffective at using resources; they are often overwhelmed by minor stressors. Excessively rigid structures also can develop, reflected in the rules that define the system and the roles that members assume. Rigid rules and roles interfere with a family's need to adaptively deal with new demands and challenges.

Families and groups that have difficulty operating as a unit usually lack cohesion and tend to view problems as centered in the individual rather than in the family or group. Consequently, the unique resources of the group are not brought to bear on the problem.

The Relational Environment

A common effect of individual traumatization is that the survivor grows increasingly distrustful of his or her own perceptions, emotions, and judgment. Trauma survivors typically need greater validation from others—they need to know whether what they are feeling and perceiving makes sense to other people, or whether there is something defective in their mental processes. If survivors do not feel understood and supported within their interpersonal environments, a relational rupture can develop, in which survivors lose their sense of connection—of being part of the social fabric—and come to feel that they are fundamentally defective and different from others.

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