While addressing cognitive distortions about the event and what it means to the
client, the clinician also may encounter distortions the client has formed regarding the
meaning of symptoms he or she is experiencing. In general, these involve beliefs that the intrusive-reliving, numbing/avoidance, and hyperarousal symptoms of traumatic stress
represent loss of control or major psychopathology. In the style outlined above for trauma-
related cognitions, the therapist can facilitate cognitive reconsideration of these perceptions or beliefs—especially after some level of psychoeducation has transpired—by asking the adolescent about •
what might be a non-pathologizing explanation for the symptom (e.g., the
survival value of hypervigilance, or the self-medicating aspects of substance
use/abuse), •
whether the symptom(s) actually indicate psychosis or mental illness (e.g.,
whether flashbacks are the same thing as hallucinations, or whether it is really
“paranoid” to be fearful about trauma-reminiscent situations, especially if trauma
is still possible), and •
whether it is better to actively experience posttraumatic stress (especially
reexperiencing) than to “shut down” or otherwise avoid trauma memories (Briere & Scott, 2012).
These and other questions may stimulate lively, clinically useful conversations, the
goal of which is not for the clinician’s view to prevail, but for the client to explore the basis for (and meaning of) his or her internal experience.
Development of a Coherent Narrative In addition to the cognitive processing of traumatic memories, therapy can provide
broader meaning and context. Client descriptions of past traumatic events often become more detailed, organized, and causally structured as they are repeatedly discussed and
explored in therapy—including during cognitive reconsideration. Increased narrative coherence is often associated with reduced posttraumatic symptoms (Foa, Molnar, &
Cashman, 1995; Siegel, 1999). As the client is increasingly able to describe chronologically
and analytically what happened, and to place it in a larger context, he or she may experience Chapter 9: Cognitive Processing
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