Understanding Trauma, Grief, PTSD, and Crisis: What Therapy Can Help You Make Sense Of

Trauma and grief do not affect everyone in the same way.

After a disaster, sudden loss, frightening event, or other major crisis, one person may cry constantly while another feels strangely numb. Someone may have trouble sleeping, withdraw from friends, become irritable, or find themselves replaying what happened over and over. Others may initially appear to function relatively well and struggle more weeks or months later.

These differences do not necessarily mean one person is coping “better” than another.

Part of crisis counseling involves understanding the different ways people can respond to overwhelming events and helping them regain a sense of stability, safety, and connection.

The concepts below are drawn from Crisis Assessment, Intervention, and Prevention by Jackson-Cherry and Erford (2014).

Your Response to a Crisis Can Change Over Time

People often think of trauma as producing one immediate emotional reaction.

In reality, responses can evolve.

During and immediately after a disaster, people may experience shock, fear, panic, helplessness, denial, or a strong instinct toward self-preservation. In the hours afterward, anger, grief, heightened emotion, rumination, and bursts of activity may also emerge (Jackson-Cherry & Erford, 2014).

Later, the emotional landscape may change again.

Some people begin to recover.

Others experience setbacks.

Someone who talked constantly about the event initially may eventually stop discussing it. Another person may continue thinking about it repeatedly.

Months later, some people may experience fatigue, disappointment, anxiety, panic symptoms, or other more persistent psychological difficulties (Jackson-Cherry & Erford, 2014).

This is one reason therapists pay attention not only to what someone is experiencing, but also when those reactions developed.

Trauma Can Affect Your Behavior, Thoughts, Emotions, and Body

A major crisis can affect almost every area of functioning.

Behavioral reactions may include:

• difficulty eating

• difficulty sleeping

• restlessness

• withdrawal

• conflicts with other people

• reduced interest in social activities

• increased alcohol or drug use

Emotional reactions may include anxiety, irritability, grief, fear, guilt, anger, helplessness, panic, or feeling overwhelmed.

Cognitive reactions may include intrusive thoughts, rumination, nightmares, poor concentration, memory difficulties, uncertainty, and difficulty solving problems.

Physical responses can include symptoms such as increased heart rate, dizziness, tremors, fatigue, sweating, headaches, rapid breathing, weakness, or changes in sexual interest (Jackson-Cherry & Erford, 2014).

This can be confusing for clients.

Someone may come to therapy saying:

"I don't know why I can't sleep anymore."

"I keep snapping at people."

"I can't focus at work."

"I don't want to see anyone."

Sometimes these symptoms make more sense once we understand what happened before they began.

Crisis Counseling Often Focuses on Restoring Stability

In the aftermath of a crisis, therapy does not necessarily need to immediately become an intensive exploration of everything that happened.

Crisis counseling can initially focus on helping someone regain a level of functioning that existed before the event.

Jackson-Cherry and Erford (2014) describe a crisis counseling approach that includes:

• assessing strengths

• restoring pre-crisis functioning

• acknowledging the reality of the situation

• validating the person's experience

• providing psychoeducation

This means therapy may begin with very practical questions.

What resources do you already have?

Who can support you?

What parts of daily life have become difficult?

What would help you sleep, eat, work, or reconnect with others?

What reactions are understandable after what you experienced?

Psychoeducation can also help someone realize that their reactions are not occurring in isolation.

Understanding why your mind or body may be responding differently after trauma can sometimes make those symptoms feel less frightening.

Grief Is More Than Feeling Sad

Grief can involve sadness, but it can also include anger, guilt, numbness, disbelief, longing, anxiety, or even periods in which someone feels relatively normal.

Research and grief models discussed by Jackson-Cherry and Erford (2014) suggest that several factors may help someone come to terms with death, including feeling that they have lived meaningfully, having relatively few regrets, being able to speak openly about terminal illness, maintaining close relationships, caring about loved ones, and, for some people, holding beliefs about life after death.

The well-known death-awareness framework associated with Kübler-Ross also describes experiences such as denial, anger, bargaining, depression, and acceptance (Jackson-Cherry & Erford, 2014).

These stages should not be interpreted as a rigid emotional checklist.

Grief is rarely that orderly.

People may move between different emotions, revisit old feelings, and experience grief differently depending on the circumstances of the loss.

Grieving Can Involve Active Tasks

Another useful way to understand grief comes from Worden's Task Model.

Rather than viewing grief as something that simply happens to us, this model emphasizes processes that bereaved people gradually work through.

According to the framework discussed by Jackson-Cherry and Erford (2014), these tasks include:

1. Accepting the reality of the loss.

2. Experiencing the pain associated with grief.

3. Adjusting to an environment in which the person who died is no longer present.

4. Reinvesting emotional energy into other relationships and parts of life.

The second task can be especially difficult.

People sometimes cope with grief by staying constantly busy.

They work longer hours.

They clean.

They organize.

They distract themselves.

Activity is not inherently unhealthy, but sometimes constant activity keeps someone from acknowledging how much pain they are carrying.

Therapy can provide a place where grief does not need to be rushed or avoided.

Moving Forward Does Not Mean Forgetting

The idea of “moving on” can sound harsh after someone important dies.

It can sound as though healing requires leaving the person behind.

A more useful way to think about it may be learning how to continue living while maintaining the significance of the relationship.

Reinvesting emotional energy does not require replacing the person who died.

It may mean reconnecting with family members.

Returning to friendships.

Finding meaning in work.

Beginning activities again.

Developing new goals.

The loss remains part of your life story, but it does not have to prevent every future chapter from being written.

Therapists Need to Understand Their Own Relationship With Loss

Therapists are human beings too.

They have experienced grief, fear, family relationships, and loss.

Worden identified several issues therapists should monitor when counseling grieving clients, including unresolved losses of their own, fear that something similar could happen in their own lives, and unresolved fears surrounding mortality (Jackson-Cherry & Erford, 2014).

These reactions can contribute to countertransference, meaning the therapist's own experiences or emotions begin influencing the therapy.

A therapist's personal history should not become the client's burden.

Part of professional development involves recognizing these reactions and ensuring that therapy remains centered on the person seeking help.

PTSD Can Be Treated

Post-Traumatic Stress Disorder can develop following exposure to traumatic events.

For some people, symptoms may include intrusive memories, nightmares, avoidance, changes in beliefs about themselves or the world, emotional distress, and heightened alertness.

Jackson-Cherry and Erford (2014) discuss several trauma-focused treatments used for PTSD, particularly within military populations.

These include:

• trauma-focused Cognitive Behavioral Therapy

• exposure-based therapy

• Cognitive Processing Therapy

These treatments differ in their specific techniques, but they share an important goal:

Helping traumatic experiences become more manageable rather than allowing them to continue controlling someone's present life.

What Is Cognitive Processing Therapy?

Cognitive Processing Therapy, commonly called CPT, is a structured treatment used for PTSD.

Jackson-Cherry and Erford (2014) describe CPT as a manualized approach that includes psychoeducation, impact statements, assignments between sessions, and identifying and challenging problematic beliefs associated with trauma.

Trauma can change the conclusions we draw about ourselves.

Someone may think:

"It happened because I'm weak."

"I should have stopped it."

"I can't trust anyone anymore."

"The world is never safe."

"Something is permanently wrong with me."

CPT helps clients examine these beliefs more closely.

The goal is not to pretend something terrible did not happen.

Instead, therapy can help determine whether the conclusions someone developed in response to that experience remain accurate and useful today.

Military Trauma Can Affect the Entire Family

Military service does not affect only the service member.

Spouses and children may also experience stress related to military culture, deployments, expectations, family roles, and concerns about how their behavior may reflect on the service member.

Jackson-Cherry and Erford (2014) discuss how military spouses and children may experience pressure associated with the service member's rank and professional identity.

Mental health stigma can further complicate matters.

Some military families may worry that seeking therapy will be perceived as weakness or create consequences for the service member.

These pressures can create an environment in which people feel they must appear strong even when they are struggling.

Therapy can provide a space where those pressures can be discussed more openly.

Sudden Death Requires Clear and Compassionate Communication

Sometimes crisis work involves telling someone that a loved one has died.

The way that information is communicated matters.

Jackson-Cherry and Erford (2014) emphasize that death notification is ideally conducted in person rather than by phone when circumstances allow.

The purpose is not simply formality.

People may experience overwhelming emotional or physical reactions when receiving unexpected news.

Having another person physically present can provide immediate support and allow someone to assess whether additional help is needed.

When children are involved, the framework discussed by Jackson-Cherry and Erford (2014) recommends initially informing adults privately so they can decide how best to communicate the death to their children.

Accuracy Matters When Delivering Difficult News

When someone has died, families deserve accurate information.

At the same time, unnecessary delays can create additional distress, particularly if loved ones discover the death through social media, news reports, or other people.

Jackson-Cherry and Erford (2014) emphasize both timeliness and accuracy.

Before notifying someone, the death should be verified.

Once that information is confirmed, communication should generally occur promptly.

This balance protects people from two painful possibilities:

Receiving incorrect information or learning about a loved one's death indirectly.

Plain Language Is Often Kinder Than Euphemisms

People sometimes soften language around death because they are trying to protect the person receiving the news.

They may say:

"She passed on."

"We lost him."

"He's gone."

But in moments of shock, ambiguous language can sometimes create confusion.

Jackson-Cherry and Erford (2014) recommend clear, direct communication.

For example:

"I have some very bad news to tell you. Your mother died."

The first statement prepares the person emotionally for what is about to follow.

The second communicates the reality clearly.

The goal is not to sound cold.

It is to combine compassion with clarity.

Graphic or unnecessary details, on the other hand, may intensify distress and are generally not needed simply to communicate that someone has died.

Therapy Can Help Make Overwhelming Experiences More Understandable

One of the common threads across disaster response, grief, PTSD, and crisis counseling is that overwhelming experiences can make life feel unpredictable.

Your body may react differently.

Your thoughts may feel unfamiliar.

Your emotions may seem difficult to control.

Your relationships may change.

Things that once seemed easy can suddenly require enormous effort.

Therapy cannot undo what happened.

But it can help you understand your reactions, regain stability, develop ways of coping with distress, process grief or traumatic memories, and begin reconnecting with parts of life that may have been disrupted.

Sometimes the first therapeutic goal is not profound insight.

It is sleeping again.

Eating regularly.

Getting through work.

Calling a friend.

Feeling safe enough to leave the house.

Being able to think about the future without immediately feeling overwhelmed.

Those steps may seem small from the outside.

After trauma or major loss, they can be significant.

Healing After Trauma and Loss Is Not Linear

People often expect recovery to follow a steady upward trajectory.

It rarely does.

Someone may have several good weeks and then experience an anniversary, reminder, nightmare, or unexpected trigger that brings intense emotions back.

That does not necessarily mean they have returned to the beginning.

Grief and trauma recovery can involve progress, setbacks, adaptation, and renewed progress.

Therapy can provide a consistent place to make sense of those changes.

The ultimate goal is not to erase every painful memory or guarantee that you never experience grief again.

It is to help painful experiences occupy a different place in your life, one where they can be remembered and acknowledged without controlling everything that comes afterward.

Reference

Jackson-Cherry, L. R., & Erford, B. T. (2014). Crisis Assessment, Intervention, and Prevention. Pearson Higher Ed.

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