Doctors came to see her singly and in consultation, talked much in French, German, and Latin, blamed one another, and prescribed a great variety of medicines for all the diseases known to them, but the simple idea never occurred to any of them that they could not know the disease Natasha was suffering from, as no disease suffered by a live man can be known, for every living person has his own peculiarities and always has his own peculiar, personal, novel, complicated disease, unknown to medicine. - Leo Tolstoy
This section includes charts to help clarify life history, traumatic events, childhood experiences, and therapeutic writing. It overlaps with some of the handouts given in the linked "PTSD assessment, images, memories & information" section . I use "therapeutic" writing as a general term covering all types of writing that have been shown to be helpful & "therapeutic". When describing the form of therapeutic writing, developed by Jamie Pennebaker and other researchers, that focuses particularly on writing one's "deepest thoughts & feelings" about life traumas & difficulties, I tend to use the term "expressive" writing (to distinguish it, for example, from other forms of therapeutic writing focusing on diverse topics such as "best possible selves", "intensely positive experiences", "self-affirmation" and so on). In general terms many of these handouts, charts and questionnaires can be helpful in exploring the way we are affected by our pasts.
Chart, early years (0 to 13) - this is the first of six charts that I sometimes use to get an outline of the basic facts of a person's life history. The charts take a good deal of time and effort to fill in. I give them to the client I'm seeing as 'homework'. I typically only use these charts when I'm involved in longer term work with someone. They can be useful in many overlapping ways. They can clarify the time pattern of chronic and recurrent disorders, they can highlight and order sections of a person's life that have been particularly traumatic, they can pinpoint particular events that may benefit from emotional processing (and by helping organize the memories, start the work of processing itself), and they can be useful sheets to refer back to when reminding oneself of previous work that has been done. This 'early years' chart can helpfully be combined with the ACE questionnaire (see below).
Chart, adolescence & adulthood (14 to 34)
Chart, maturity (35 to 55)
Chart, getting older (56 to 76) - I don't have a further chart covering age 77 to 97, but you're welcome to adapt an existing sheet if you want to produce a 'getting even older' chart!
Chart, six year & three year details - these two sheet are used when it seems helpful to put a particulary important section of someone's life under more of a spotlight. Particularly over times of trauma, memory can become disorganized and over-generalized. Putting events into a narrative sequence can paradoxically sometimes be an important part of putting events 'behind you'. An image for this is of a messy cupboard. Painful memories have been shoved into the 'cupboard' in a messy, disorganized way - partly because the memories themselves are so upsetting. Unfortunately they've been shoved into the cupboard so haphazardly that one can't properly shut the door. Every so often the door of the memory cupboard swings open (probably triggered by some linked event occurring in one's current life). Out spills the painful memories and one trips over them. Part of the work of using these charts is to take the memories out of the cupboard and restack them in a more organized way, so that they don't keep falling out so often!
Self-concealment scale & background information - this is a questionnaire to measure "the tendency to conceal from others personal information that one perceives as distressing or negative". Quoting the original research paper "Self-concealment significantly correlated with self-report measures of anxiety, depression, and bodily symptoms and accounted for a significant incremental percentage of the variance in physical and psychological symptoms even after controlling for occurrence of trauma, trauma distress, disclosure of the trauma, social support, social network, and self-disclosure." The background information sheet gives further examples of research showing the problems associated with excessive self-concealment.
Monitoring & understanding our reactions - when people have excessive or inappropriate reactions to current experiences, this is often because their responses are being coloured by unhelpful learning from the past. This questionnaire can help in understanding these links.
Note, I have written a series of blog posts on therapeutic writing (also downloadable as handouts) that begins with the post "Writing (& speaking) for resilience & wellbeing 1: introduction".
Power of words 1 - this sequence of 6 Powerpoint slides can be printed out as a (6 miniatures to a page) handout introducing some background to expressive writing as developed by Jamie Pennebaker. This and the next half dozen slides (below) are from a talk I gave back in 2003. Subsequent research further backs up the potential value of this approach. See too the further handouts on Expressive writing (below).
Power of words 2 - a further 6 slides that can also be printed out as a (6 miniatures to a page) handout.
Expressive writing, written by me - as it says 'on the tin'! This is a two page Word doc format "how to" handout on expressive writing about life traumas & difficulties as explored by Jamie Pennebaker and other researchers. Here is a PDF file of the same material.
Therapeutic writing & speaking: inspiration from values - this post explains how one can benefit from writing about other topics - such as life goals or intensely positive experiences - as well as one can by writing about trauma and life upheavals.
Therapeutic writing combining expression & reappraisal - see the post "An intriguing and encouraging development in therapeutic writing".
Importance of traumatic memories 1 - this sequence of 6 Powerpoint slides can be printed out as a (6 miniatures to a page) handout introducing the potential importance of working on traumatic memories in many cases of anxiety or depression - as well as with PTSD. If you're using it as a handout, you can toggle Powerpoint to show the slides in black & white or in colour.
Importance of traumatic memories 2 - this second set of 6 slides gives further general explanation and details of research on trauma memories in depression and in social anxiety.
Importance of traumatic memories 3 - this third set of 6 slides extends the research details to cover agoraphobia, OCD, eating disorders, and other difficulties. The sequence of 18 slides is taken from a lecture I gave in early 2006. Subsequent research has added further weight to the probable value of emotional processing as a potential part of the treatment for many psychological difficulties.
Healing traumatic memories - these 2 slides can be printed out as a (2 miniatures to a page/full pages) handout explaining the nuts & bolts of the Ehlers & Clark cognitive model for processing trauma memories.
The Ehlers & Clark model for cognitive therapy treatment of PTSD involves particular focus on the trauma memory itself and on trauma-associated beliefs. Work on the trauma memory typically involves four methods - imaginal "reliving" or "revisiting", a written account, a "site visit", and discriminating triggers. See April 2012 blog posts for more on this. There is a detailed blog post on reliving/revisiting, a handout making suggestions on how to complete the written account downloadable both as a Word doc and as a PDF file, and more detailed descriptions of site visits & discrimination training.
Written exposure therapy - there are a couple of blog posts about this exciting development in writing treatment for PTSD - "One of the most exciting therapeutic writing studies for years" and "Written exposure therapy: how do you do it?". A handout giving background and describing how to use this form of expressive writing is available both as a PDF file and as a Word doc. I tend to use this handout in conjunction with the excellent one derived from the Ehlers & Clark model (see above). Fascinatingly, this approach is likely to be relevant for work with difficult memories associated with other disorders than formal PTSD e.g. may well be useful for depression, social anxiety disorder, etc.
Adverse childhood experiences (ACE) questionnaire & background information - this questionnaire is adapted from the major Adverse Childhood Experiences Study (see www.cdc.gov/nccdphp/ace), one of the largest investigations ever conducted on the links between childhood maltreatment and later-life health and well-being. Over 17,000 people have been followed since enrolment in the mid 1990's. To date (2008), over 30 scientific articles have been published and over 100 conference and workshop presentations have been made about this work. The ACE Study findings suggest that these experiences are major risk factors for the leading causes of illness and death as well as poor quality of life in the United States. Progress in preventing and recovering from the nation's worst health and social problems is likely to benefit from the understanding that many of these problems arise as a consequence of adverse childhood experiences.
Life events, genetics & depression onset 1 - these 2 Powerpoint slides (and a further 2 below) can be printed out as a (2 miniatures to a page) handout explaining how genetic risk and difficult life events interact in precipitating depression. The probably severity of different types of life event is also highlighted. If you're producing a handout from these slides, you can toggle Powerpoint to show them in black & white or in colour.
Life events, genetics & depression onset 2 - see above. These 2 slides extend the relevance of negative life events to triggering other psychological problems besides depression ... and discusses too issues about coping abilities.
Life events questionnaire - a classic life events questionnaire.