A psychodynamic treatment for PTSD shows promise for soldiers
While cognitive-behavioral therapy
remains the most well-researched
treatment for post-traumatic stress
disorder, it doesn’t help all patients.
That’s especially true for service
members who have been perpetrators
as well as victims of violence, says
Russell B. Carr, MD, an Army
“It’s a much more complicated
experience, and they often feel a lot of
shame in addition to the usual PTSD
symptoms,” he says.
For the past six years, Carr has
been working with soldiers who
haven’t responded to cognitive-behavioral therapy, and he’s
developed a new treatment rooted
in intersubjective systems theory.
This modern take on psychoanalysis
pioneered by Robert Stolorow, PhD,
posits that the heart of trauma is
shame and isolation.
Carr’s therapy, described in the
October 2011 issue of Psychoanalytic
Psychology, has shown promise
helping soldiers who haven’t
responded to CBT by addressing
the existential dread dredged up by
trauma, and the feeling that their
entire world has lost meaning.
Though Carr’s goals are ambitious,
his intervention is relatively short —
requiring twice-weekly sessions for
up to three months. As a result, the
therapist must clearly define goals, keep conversations on track
and quickly establish rapport with clients, Carr found.
Short-term therapy — which is typical of CBT, but less
common with psychoanalytic approaches — is often the only
option in military settings, he says.
“In the military, there is frequently the situation where a
patient or therapist is leaving soon,” says Carr. “It’s a transient
population, and it limits the length of time we have to work
A key part of intersubjective therapy is helping clients put
their feelings around traumatic experiences into words. These
feelings aren’t always negative. One patient described in the
article found he enjoyed the smell of burning human flesh,
and was later horrified and ashamed of his initial reaction. By
expressing empathy and not rejecting the soldier, Carr helped
the soldier process the experience and reconnect with the