It took some hard reflection for Bill Stephens Jr. to see himself beyond the looking glass.
For years, this Carlisle native and former Army sergeant has grappled with the lingering effects of post-traumatic stress disorder.
With help, Stephens has taken charge, letting the insight flow out onto the page as verse — poetry he hopes to someday publish as a book titled “The Mirror.”
“It’s a coping mechanism for people with all types of PTSD,” said the 47-year-old combat veteran. He goes to counseling every month and takes medication.
Telling his story helps the healing by shedding light on a condition that contributes to the suicide of up to 22 veterans every day in the U.S.
Stephens wants people to know there is reason for hope and that it starts with public awareness and leaving behind the stigma that can weigh down himself and others with PTSD.
His path to coping started in 2007 when Stephens entered a warriors’ transition unit at the Walter Reed Medical Center. He was in with a group of 10 other men and one woman undergoing therapy.
“There were colonels and majors, chaplains and privates, a sergeant first class and a Marine Corps staff sergeant,” Stephens recalled. The common thread was shared techniques and experiences designed to get a handle on the trauma and to regain control.
Group members were asked one day to illustrate a picture describing themselves and their emotions. “The infantry guys always drew everything in red,” Stephens said. “The people in red. The guns in red. Later on, they used black markers to describe what they were doing.”
Another time, they were asked to clip images from magazines to create a collage of their impressions of an emotion. But their choice of magazines was limited to journals like Better Homes and Garden. The group was also under instructions to log-on every night and blog about their feelings and how their day went.
Lori Moskel, a Carlisle-area therapist, uses a method called cognitive processing to help those diagnosed with PTSD. “It’s very systematic,” she said. “It starts with education about trauma.”
Cognitive processing uses a series of steps where the client is challenged to gradually put into words their thoughts on the reasons for the trauma and their physical and emotional reactions.
By writing it down, they are mapping it out using the words as a reference to a progression. The trauma becomes something real and tangible, allowing the client to pinpoint exactly where their thinking is not helpful and their perspective is skewed.
“Just reading it out loud really helps them to expose it in a way that they can process their feelings,” Moskel said. “Why am I stuck here and caught up in this vicious cycle? How can I get control of my life?
“Some people have a hard time completing this therapy because of the avoidance,” she said, referring to the tendency of those with PTSD to shy away from whatever reminds them of the trauma.
Exposure is a common therapy used in the treatment of PTSD, said Valerie Domenici, a licensed clinical psychologist in Carlisle. “The basic idea is ‘Let’s not run away. Let’s look at what happened here.’”
To illustrate her point, she used a swimming metaphor: “When you first jump into a cold pool, it’s pretty shocking, but if you stay in, the body starts to warm up. You don’t feel quite as cold. You get used to it. You adjust to it,” Domenici said.
Those with PTSD jump into water, but quickly climb out and run away so their bodies never calm down and desensitize the physiological response to the trauma.
Exposure therapy uses a series of steps designed to gradually change this response to triggers and to the memory of the traumatic event.
“I am very careful with exposure therapy,” Domenici said. “I don’t want to re-traumatize the person.”
For example, she may have the client say one sentence about what happened and then back away to do a relaxation technique. She would then come back and ask the client to say two sentences before returning to a relaxation technique.
The goal of therapy is to not completely remove the physiological response, but to recalibrate the body so that it is responding appropriately to danger. Domenici compared it to a household warning device.
“You have to retrain the fire alarm,” she said. “You don’t want it to be overly sensitive. You don’t want to take the batteries out of it either. Sometimes exposure is not even necessary. People can be trained to relax their bodies without necessarily having to come out with the story of everything that happened to them.”
Many of her clients are adult female survivors of childhood trauma. While exposure therapy is appropriate in some cases, there have been plenty of clients who are coping well enough with PTSD symptoms without having to recall the nitty gritty details of the abuse they had experienced.
“Why go there if it’s not necessary?” Domenici said. “A lot of times it’s the meaning of the events that are getting at people. What does it mean about me? What does it mean about the world? We can work on those sorts of questions without getting into the specifics of the trauma itself.”
As with any therapy, she has to be aware of whether the client is putting up a front. There are people who come in with the notion that they alone can pull themselves up by the bootstraps.
“There is an undercurrent of something,” Domenici said. “You have to be able to tell the difference between those who are really ready and those who are trying to convince themselves.”