Information
Editors
PerttiHakkarainen
AaroMäkelä
How to Approach Maltreatment Victims and Provide Psychological Support
Essentials
- Mental trauma arises in a situation that is exceptionally upsetting or catastrophic or threatens vital functions.
- At the shock stage, patients will distance themselves from the event and be matter-of-fact and unfeeling. At the reaction stage, they start facing what happened, and strong emotions may surface.
- When approaching the patient, the aim should be to create a safe and calm atmosphere with as little feeling of hurry as possible.
- See that the patient is discharged to his or her family or a friend, as necessary, and is capable of immediate coping in everyday life.
- Agree on further contacts and treatment.
The experience of being physically assaulted
- A traumatizing event may be any threatening situation an individual faces that causes unusually strong reactions disturbing normal life.
- Mental trauma arises in a situation that is exceptionally upsetting or catastrophic or threatens vital functions.
- Being physically assaulted often represents such a situation, and a person who has recently faced violence will experience acute traumatic stress - suffer what is called a traumatic crisis.
- Treatment is typically sought at the first two stages of traumatic crisis (shock and reaction stages).
- At the shock stage, the person will keep reality mentally distant. At the doctor's office, for example, they may be highly matter-of-fact, rather unfeeling and dispassionate.
- At the reaction stage, they will start facing what has happened and may develop very strong emotions as a result.
- Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) have three typical symptoms often presented by people who have experienced violence:
- Intrusive re-experience of the event, i.e. flashbacks
- Avoiding things reminding of the event, i.e. avoidance
- Hyperarousal associated with increased physical alertness
- Patients should be informed about such symptoms, as far as possible, in order to help them understand their own reactions. This can reinforce the experience of being in control even if symptoms persist.
Treatment
- A primary principle in approaching people who have experienced violence is that the approach should not (even in the abstract sense) repeat traumatizing elements of the violent situation - insecurity, danger or uncontrollability.
- The approach should thus be particularly safe and human, the professional should be predictable and reliable, and the patient should be allowed to experience a clear feeling of being in control (this is called trauma-informed approach).
- A good approach consists of
- understanding the patient's mental reactions and state and their association with the experienced traumatic situation
- not complicating the patient's situation or producing another traumatic experience
- guiding the patient to receive support for recovery.
- At best, the approach during the examination, for instance, will promote recovery from the traumatic experience.
- Patients typically present in one of the following four stages.
- Shock stage, where the event has not yet been mentally assimilated
- Various levels of dissociation, denial and rejection are typical and can be seen as loss of emotional connection or being dispassionate.
- Treatment: stabilize the situation by means of a safe and caring approach and environment.
- Reaction stage, where the person gradually faces the changed mental reality
- Typically symptoms of re-experience, avoidance and physical hypo- or hyperarousal that complicate life
- Treatment: Continued stabilization by helping patients recognize their symptoms and by providing support and help to cope with everyday life despite the symptoms. Treatment of symptoms/consequences.
- Processing and reorientation stages occur later.
- Patients process what they have experienced and accept it as part of their view of the world. Their belief system becomes more trusting again.
- This often requires active psychosocial treatment and support.
- The symptoms will subside within a few days.
- Being repeatedly subject to violence may make the symptoms more varied and severe; see also Domestic violence Domestic Violence.
- Benzodiazepines should be avoided.
- If necessary, give the patient a small dose to take with them but don't prescribe these.
- Alcohol should be avoided.
- Make the next appointment according to local practice.
- Some patients will have symptoms for a longer time and require actual psychological processing.
- See also Acute stress reaction and post-traumatic stress disorder Antisocial Personality Disorder.
Practical instructions for approach
- When you first see such a patient, you should offer
- a calm, human and non-intrusive contact
- Listen actively but without interrupting, i.e. nod or look the patient in the eyes.
- Give the patient the opportunity to speak and to say the worst things aloud.
- Accept the patient's reactions.
- Speak clearly and simply, avoiding empty phrases.
- immediate, continuous security through taking care of basic physical and mental needs
- Try to calm down the victim's emotional outburst and overload.
- Respond to the patient's immediate needs and worries with practical advice.
- Help them to maintain control and take care of coping in everyday life, of their children, routines.
- Ensure contact with their near ones, family, social support network.
- Tell them about the stress reaction.
- Ensure contact with available support services also with regard to any further treatment needed; the victim must not be left alone.
- Offer help actively, and support the patient's coping methods.
- Keep your promises.
- A calm approach will tell patients that:
- they are safe, also mentally
- they can trust the professional
- the situation is under control.
- At the same time, you can communicate a hope that such experiences are not something ultimately intolerable.
- To permit professional calm, there should be sufficient time available, peaceful working conditions, clear instructions and procedures.
References
- [Posttraumatic stress disorder]. A Current Care Guideline. Working group appointed by the Finnish Medical Society Duodecim, the Finnish Psychiatric Association, and the Finnish Society for Child and Adolescent Psychiatry. Helsinki: the Finnish Medical Society Duodecim, 2022 (accessed 15.6.2023). Available in Finnish at http://www.kaypahoito.fi/hoi50080/.