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Counseling Post-Traumatic Stress Disorder

Counseling someone who wrestles with the symptoms of Post-Traumatic Stress can be a long process. It is not a sprint or even a marathon. It is more like an orienteering or land navigation race. These races involve teams who are given a map and a compass and must reach certain checkpoints delineated on the map. There is no set course and the checkpoints do not have to be reached in any particular order. Determining your team’s course is part of the challenge. Before a team embarks on the race, they need to review the map in order to familiarize themselves with the terrain, discern possible routes, locate the checkpoints, and most importantly identify the finish line. They need to understand where they are headed and how they are going to get there before the journey begins. 

This essay will use the analogy of an orienteering race to identify key elements that should be included when counseling someone who has been diagnosed with Post-Traumatic Stress Disorder (PTSD). First, we will identify the “finish line” or the goal of counseling. Second, we will set our bearings by helping the counselor and counselee understand the nature of PTSD. Third, we will examine particular “checkpoints” that are necessary elements of the process. These checkpoints include demonstrating 1 Corinthians 10:13, reinterpretation, and reengaging on a new mission. As in orienteering races, these “checkpoints” do not necessarily occur in sequential order but are all important elements of the counseling process. Finally, we will show how prior preparation can help prevent PTSD. 

The Finish Line: The Goal of Counseling Someone Wrestling with PTSD 

To understand the goal of counseling, we must first understand what the goal is not. Those who come in for counseling often have unrealistic and unbiblical goals for the counseling process. Those suffering with a diagnosis of PTSD are no different. Some come hoping that all their memories will be wiped away and they will be able to forget all the trauma they have endured. As one veteran stated rather plainly, it would take a lobotomy to make the memories go away.1 [1]Anonymous Veteran 1, Personal Conversation One, April 8, 2015.  While there is hope that God can help remove or minimize the occurrence of unwanted memories, we should not set this up as a primary goal of counseling. The primary goal in counseling is to help someone glorify God by walking in a manner worthy of the call they have been called to (1 Cor. 10:31; Eph. 4:1). We want to help them to move along in the process of becoming more like Jesus. I like to use the concept of moving them from Post-Traumatic Stress to Post-Traumatic Sanctification. 

Since we have firmly established the finish line, it is important to set our bearings so we can move onto the checkpoints. 

Setting Bearings: Taking the D out of PTSD 

In orienteering, after a team has reviewed the map and determined the final destination, it is important for them to set their bearings so they can navigate to the checkpoints along the course. Setting bearings means determining your current location in relation to the geographical context. It involves identifying where you are on the map and on the ground. Using a compass or some other means, you need to identify true north and orient your map accordingly. Identifying key landmarks in your vision and on the map help pinpoint where you are standing. If you set off on your trek with improper bearings, you will end up lost. Similarly, you need to have the proper bearings when counseling someone who struggles with symptoms of PTSD. Understanding the nature of the battle you are facing is essential before setting off on the counseling journey. 

Up to this point I have been using the term Post-Traumatic Stress Disorder. This is the diagnosis used in the mental health field to describe someone who exhibits certain symptoms and behaviors one month or longer after experiencing a potentially traumatic event or a series of potentially traumatic events.2 [1]American Psychiatric Association and DSM-5 Task Force, Diagnostic and Statistical Manual of Mental Disorders: DSM-5. (Washington, DC: American Psychiatric Association, 2013), 271–72; Frank W. Weathers and Terence M. Keane, “The Criterion A Problem Revisited: Controversies and Challenges in Defining and Measuring Psychological Trauma,” Journal of Traumatic Stress 20, no. 2 (April 2007): 111.  Potentially traumatic events are those that threaten death, serious injury, or sexual violation. Within the Diagnostic and Statistical Manual of Mental Disorder (DSM-5), PTSD symptoms are grouped around four different categories: intrusion symptoms, avoidance symptoms, negative alterations in cognition or mood, and alterations in arousal reactivity.3 [1]DSM-5., 271-272.  The DSM-5 description of PTSD can provide helpful reflections of the struggles that often confront people who have faced some of the most horrific suffering this fallen world has to offer. However, while these observations demonstrate that there is some phenomenon that afflicts many who face intense suffering, the description offered is wholly inadequate in itself and can prove to be harmful in many ways. 

Receiving the PTSD label can be devastating. For some it will mean the end of a career. For others there is a feeling of helplessness and hopelessness once they hear the news that there is no cure for the disorder. For most the term “disorder” signals to them that they are weak or irreparably damaged. Early on in the counseling process you will want to help them understand that what they are experiencing is not an abnormal reaction to normal circumstances of life, but a very common reaction to extreme situations.4 [1]David Powlison, “Gripping Fears” (The Gospel & Mental Illness, Sun Valley, CA: Association of Certified Biblical Counselors, 2014); Christopher B. Adsit, The Combat Trauma Healing Manual: Christ-Centered Solutions for Combat Trauma (Newport News, VA: Military Ministry Press, 2008), Loc 832; Barrett Craig, Help! I’ve Been Traumatized by Combat (Wapwallopen, PA: Shepherd Press, 2015), 4–5; Brian Fleming and Chad Robichaux Ph.D, Redeployed: How Combat Veterans Can Fight the Battle Within and Win the War at Home (Dallas: Frisco House Publishing, 2013), 63–64; Chad M. Robichaux and Jeremy M Stalnecker, The Truth About PTSD (Manassas, VA: Making Life Better Publishing, 2017), 33–35. 

It can be extremely helpful to describe the physiological impact trauma can have. Some of the symptoms of PTSD can occur because our God-given security system, the sympathetic nervous system, often called the fight or flight system, is negatively impacted.5 [1]The purpose of this essay is not to discuss the technical aspects of neurological impact of PTSD. Briefly, studies have shown that the brains of those who are diagnosed with PTSD show decreased volume in the prefrontal cortex or PFC (the part of the brain where high level executive function occurs) as well as structural changes in limbic system, especially with the amygdala and hippocampus (parts of the brain associated with stress response). In normal function the PFC interacts with the limbic system to analyze threats and control the fight or flight response. In people diagnosed with PTSD the PFC does not engage correctly with the limbic system to diminish fear responses. Amy F.T. Arnsten et al., “The Effects of Stress Exposure on Prefrontal Cortex: Translating Basic Research into Successful Treatments for Post-Traumatic Stress Disorder,” Neurobiology of Stress 1 (October 27, 2014): 89–91; H. Barbas et al., “Relationship of Prefrontal Connections to Inhibitory Systems in Superior Temporal Areas in the Rhesus Monkey,” Cerebral Cortex 15, no. 9 (September 1, 2005): 1368; Einat Levy-Gigi et al., “Association among Clinical Response, Hippocampal Volume, and FKBP5 Gene Expression in Individuals with Posttraumatic Stress Disorder Receiving Cognitive Behavioral Therapy,” Biological Psychiatry 74, no. 11 (December 1, 2013): 793–800; Emily B. Ansell et al., “Cumulative Adversity and Smaller Gray Matter Volume in Medial Prefrontal, Anterior Cingulate, and Insula Regions,” Biological Psychiatry 72, no. 1 (July 1, 2012): 57, 62.  This can occur in cases of severe trauma or prolonged exposure to repeated trauma or high stress situations. Giving someone a basic understanding of how that God-given security system is supposed to work and how it was damaged can alleviate much of the fear caused by uncertainty.6 [1]Robichaux and Stalnecker, The Truth About PTSD, 57–66. 

Consider offering the following two ways in which the fight or flight system functions inappropriately in the person who is struggling with PTSD. First, the fight or flight system engages at the wrong time because it is misinterpreting a non-threatening situation as threatening. We see this happen with people who attack a loved one who shakes them awake at night. Another example is the veteran who begins to have a panic attack when he sees a garbage bag on the side of the road, which engages that fight or flight system because it recalls the data from the IED attack he survived in Iraq. Neither of these situations are actually dangerous, but the brain that has been impacted by trauma responds to them as though they are life threatening. Second, the traumatized brain will sometimes leave the fight or flight system engaged longer than it should. This is often called hypervigilance. The person lives life at the level of vigilance appropriate in a theater of combat even when returning to “normal” suburban life. 

One of the most important things to keep in mind is that it is natural to struggle in the aftermath of the horrors that this life can unleash. It might be an indication of worse problems if one did not demonstrate some level of distress after facing violence, death, or near-death experiences.7 [1]Richard Baxter, The Practical Works of the Rev. Richard Baxter, ed. William Orme, vol. 11 (London: James Duncan, 1830), 409.  People find great comfort in the realization that they, and their responses, are normal. Helping people understand what is going on physiologically helps remove some of the difficulties associated with the term disorder. Counselors can also encourage those diagnosed with PTSD that research demonstrates that it is possible for these negative alterations in the brain to be reversed with Cognitive Behavioral Therapy (CBT).8 [1]Levy-Gigi et al., “Association among Clinical Response, Hippocampal Volume, and FKBP5 Gene Expression in Individuals with Posttraumatic Stress Disorder Receiving Cognitive Behavioral Therapy,” 496–797.  Biblical counselors have even greater reason to rejoice because we recognize that CBT employs biblical principles of taking thoughts captive (2 Cor. 10:5) and thinking about what is true (Phil. 4:8), but is truncated because it does not avail itself of the whole counsel of God, nor does it rely on the Holy Spirit, or depend on a vital relationship with Jesus Christ.9 [1]Nate Brooks, “If Christian Cognitive Behavioral Therapy Works, Then Why Isn’t It an Ally?,” Biblical Counseling Coalition, November 6, 2017, http://www.biblicalcounselingcoalition.org/2017/11/06/if-christian- cognitive-behavioral-therapy-works-then-why-isnt-it-an-ally/.  PTSD is not merely a physiological phenomenon. One of the significant problems with the DSM description is it comes from a materialistic anthropology and thus does not incorporate the spiritual element of human existence. Because of the inadequacy of the DSM description and the unhelpful nature of the word disorder, the term Post-Traumatic Stress is preferable.10 [1]Others have used similar variations like Post Traumatic Distress, Paul Randolph, “Post-Traumatic Distress,” The Journal of Biblical Counseling 25, no. 3 (Summer 2007).  Dr. Charles Hodges and I have developed the following description of the phenomenon I call PTS:

Post-Traumatic Stress is a whole person response to traumatic events that encompasses the physical, mental, emotional, behavioral and spiritual being of those affected. It often results in significant disruption of life at home, work, school, and church. It draws on anger, fear, sadness, shame, and guilt to disrupt family relationships, friendships, careers, and Christian service. Those affected will compensate the best they can, sometimes in ways that may compound the struggle they face. 

Gaining a more biblical perspective of the struggle helps to set the bearings for the counseling process—for both the counselor and the counselee. It helps the counselor understand that the label of PTSD is not something to be intimidated by. The proper perspective also helps the counselee understand that his struggle is not abnormal. 

Checkpoint One: Demonstrating 1 Corinthians 10:13 

First Corinthians 10:13 provides similar comfort that we are never alone in our trials and temptations because all temptations are common to man. 

As you develop a genuine relationship with the person you are counseling you will want to begin to demonstrate the truth of 1 Corinthians 10:13. This includes the reality that the counselee’s suffering is not unique and she is not alone in her suffering. Others have been through similar suffering and God is with them in their trials. These truths offer great hope and comfort for those who accept them, but they are often very difficult to believe for someone wrestling with PTS. Putting flesh onto these truths and demonstrating their reality rather than just stating them is a helpful aspect of the counseling process. 

Ministering Faithfully 

If you have suffered some particular trauma then you have a connection to others that is real and impossible to replicate in the life of someone who has not. It will feel more natural for you to speak truth into the life of someone who has suffered greatly because the defensive wall of, “You don’t know what I’ve been through” is not insurmountable and may come down entirely when you share your own struggle. It is hard to describe the immediate connection that occurs between those who have a shared trial. For those who have been spared the horrors of potentially traumatic events, do not worry, you can and do have something to say to sufferers of trauma. Remember the words of 2 Corinthians 1:3-4, 

Blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and God of all comfort, who comforts us in all our affliction so that we will be able to comfort those who are in any affliction with the comfort with which we ourselves are comforted by God. You may never have been in combat, raped, abused, assaulted, or survived a natural disaster, but if you have lived long on this earth you have suffered. As a Christian who has faced suffering you have also been comforted by God in that affliction. The same comforts you received from Him can be extended to those who suffer in other ways. 

In addition, remember that you are not alone in this battle. As I mentioned in the introduction, counseling someone struggling with PTS is a team effort. You want to include your pastor, the sympathetic family members, close friends of the same gender, and a community group. Also, try to recruit a maturing trauma sufferer into the team. This person doesn’t need to be someone who has the spiritual maturity of a leader in the church, but someone who can serve as a living example of how God can work in the life of someone who has suffered greatly. The truth that the trial and temptation of trauma is “common to man” is much easier to believe if one can see it instead of only hearing about it. 

Connecting Personally 

One of the most important components to the process of counseling someone struggling with PTS is to connect with them and gain trust. The experience of trauma often adds an additional layer of mistrust and suspicion atop all the normal barriers to deep interpersonal connection. Many have been betrayed or violated by people they trust—clear examples are those who have been assaulted or abused by family, employers, coaches, or pastors. Others have blamed various authorities or even God as a source of their trauma or at least culpable for not intervening (e.g. military commanders for ordering certain operations or not providing requested support). This can create another barrier if you, as a counselor, are perceived as a type of authority figure. The need for Christ-like humility and love is heightened in these relationships. 

The first thing to do is simply let the person know you love them and that you are available. Verbalize these truths but also demonstrate them. Be available to help in other ways besides “counseling.” Connect over shared interests and activities, establishing a genuine relationship with the person. The instruction to be “tender-hearted” in Ephesians 4:32 speaks of compassion, the idea that when we enter into another’s suffering, we feel what they feel. Paul lays out important instructions in Romans 12 for building loving relationships. He encourages us to “weep with those who weep and rejoice with those who rejoice” (Rom. 12:15). In order for us to do so, we must be invested and involved in the lives of those people we are going to be weeping with and rejoicing with. The immediate context of the passage instructs us to “be devoted to one another in brotherly love,” “practicing hospitality,” and “contributing to the needs of the saints.” This passage, among many others, describes the Christian walk as an intimate, life-on-life experience. We need to encourage and exemplify this in our counseling with people who are often tempted to isolation. 

Getting to Know Their Struggle 

When you do connect, ask good questions and listen well. Be quick to listen and slow to speak (James 1:19). Investigate what is actually bothering them and don’t assume anything (Proverbs 18:13). Each person’s experience with trauma will be unique and what bothers them about the trauma will vary. For instance one veteran shared that the first time he killed someone in combat he was conflicted because he was going against a lifetime of teaching that “thou shall not kill.”11 [1]Cuevas, Honoring the Code: Warriors and Moral Injury. 

Whereas another veteran said, “It’s never about the killing.”12 [1]The Mighty Oaks Warrior Program, “Interview: USN Seal Lt. Mark L. Donald (Ret.),” 56:00, accessed July 14, 2017, http://www.mightyoaksprograms.org/mighty-oaks-podcast-show-003/.  Again, don’t assume, ask good questions, and listen well. 

You may want to explore issues related to the different symptom clusters associated with a PTSD diagnosis. This would include any intrusion symptoms (e.g. thoughts, dreams, memories, dissociative episodes including reliving flashbacks, or complete loss of memory). Do they have any of these? What is the content of the memories or dreams? If it is from the trauma, is it reliving the experience or certain components of the trauma manifesting in other ways? Have they ever acted out the flashback? This would also include avoidance symptoms. Have they been able to identify particular triggers? What do they do when they identify a trigger? How many friends do they have? How often do they gather with others? Who do they have in their life they can talk to? Are there specific places or people they try to avoid? Cognitive and mood impairment is another symptom to explore. Do they have difficulty remembering things? Do they have any other gaps in their memory? What is their general outlook on life and others? Lastly, you may want to explore any alterations in arousal activity (e.g. hyper-vigilance, exaggerated startle response, outbursts of anger, trouble sleeping). How much sleep are they getting? Do they always feel on edge? Are there particular things that set them off ? What do they enjoy doing? Are there things they used to enjoy that they no longer want to be involved with? You will notice the questions around each of these categories are intended to find out how the person is responding to the symptoms physically, emotionally, cognitively, spiritually and relationally. 

Another way you can develop a relationship with your counselee is to approach them with a humble heart that is ready to learn from them. In one sense, they may have a better understanding of the world than those who have never experienced suffering to the degree that they have. They have insight into the truly horrific depth of sin, evil, and depravity. They no longer live with the illusion that clouds most of our minds that we are somehow in control of our lives and what happens to us. Combat veterans often love to read the Bible tactically, recognizing and studying elements of military strategy encapsulated in the pages of Scripture, and can more easily connect with biblical people and with cultures that experienced warfare as a regular feature of life. 

Of course, the most important aspect of this phase of the journey is attempting to discern your counselee’s relationship with Christ. We should never neglect to emphasize the importance of a genuine relationship with Christ to any counseling issue—and PTS is no different. You are not just trying to discern whether the person is a believer or not, but also trying to assess how they view God and how that view has been influenced by their traumatic experiences. You want to explore how they viewed God prior to their trauma, what view they have of God’s role in the trauma, and what their view of God is now. Assessing this relationship early is helpful and may be a significant portion of helping the person to reinterpret their present situation, which is the next checkpoint I’ll recommend on this orienteering course.

Checkpoint Two: Reinterpretation 

Dr. Greg Gifford points out that PTS largely results from how one interprets reality.13 [1]Greg E Gifford, Helping Your Family through PTSD. (Eugene: Wipf and Stock Publishers, 2017), 21.  Our interpretation of events is influenced by a vast array of factors. The context of an event can radically change how we respond to very similar stimuli. The surgeon who cuts open the chest cavity is going to have a very different reaction than the man who was haunted by the act of mutilation he inflicted on a the corpse of a dead Viet Cong solider when he cut open his chest partly out of malice and partly because he wanted “to see what his lungs looked like.”14 [1]Jonathan Shay, Achilles in Vietnam: Combat Trauma and the Undoing of Character (New York: Scribner, 2003), 117. 

We have already seen how deeply held beliefs from our past can radically impact how we interpret scenarios. Other factors that weigh on our interpretation include: our perception of ourselves and our own actions, beliefs about God and His activity or inactivity in circumstances, and our perception of others (including their actions and motives). Paul encourages believers to think about what is true as they fight to overcome anxiety (Phil. 4:8). We can help people do this by taking false thoughts captive in obedience to Christ who is the way, the truth, and the life (2 Cor. 10:5; Jn. 14:6). As we progress through the course of counseling, we will help people reinterpret their lives—past, present, and future—through the truth of God’s Word. 

Reinterpreting the Present 

It may seem out of order to address the present before one addresses the past. However, it will often be easier to start with the present and then move backward in time. Jumping right to one’s troubled past and the trauma that instigated much of their current struggle would be challenging at the least and entirely impossible in some cases. The work you have done taking the D out of PTSD is one of the first steps in this process. If you have done this well, then the person will already have shifted the interpretation of his or her present significantly. 

Another step in the process of reinterpreting the present is to distinguish things in life that are a result of the trauma they experienced versus what is a consequence of their own choices or actions. Blaming sinful behavior on one’s psychiatric diagnosis is quite common. While PTS may incline one to outbursts of anger, yelling at your wife and kids because they “made you late for an appointment” is not the result of PTS. Helping someone take responsibility for the thoughts, feelings and behaviors they have control over is challenging but very freeing and rewarding. 

The most important component of any person’s present is their relationship to God. Early on in the process, investigate the counselee’s faith and commitment to Christ. Our standing before God is a primary, defining factor to our identity. Identity questions are key for people struggling with PTS. Many people feel robbed of a previous identity (no matter how misplaced that identity was). The Marine whose identity was a Marine, was altered when he was medically discharged. The single woman who was raped no longer sees herself as a pure, wholesome young woman, saving herself for marriage but as a used, dirty, and discarded “thing.” Trauma survivor, or even PTSD, becomes central to how many perceive themselves. Helping someone shift the focus of their identity from what has happened to them to who they are in Christ is essential and will provide great hope and strength, healing, and new direction for the future. For believers, the experience of trauma can come as a major challenge to their faith. Reminding them of who they are in Christ and what they mean to our Heavenly Father can help reorient them to a proper and biblical view of themselves. 

Reinforcing biblical teaching about suffering and how God uses suffering to make us stronger and more like Jesus is essential. Walking a sufferer through the life of Joseph is helpful, so they can see the trauma inflicted on Joseph and how he was impacted but not identified by it. Point them to Genesis 50:20 and the truth that God takes evil and uses it for good—this can help a sufferer reinterpret their present reality. 

For those counselees who do not know Christ this is an excellent opportunity to introduce them to Him. They likely have false impressions about Jesus and what His life was like, so share with them the suffering Jesus went through in His earthly life. Show them the truth that He was a man of sorrows and acquainted with much grief (Isaiah 53:3). Talk about His family mocking Him, His betrayal by close friends, the unjust arrest and torture He faced and then His eventual murderous execution. Something in Jesus’ life will connect with their own suffering. Then tell them that He voluntarily endured that to save them. 

Show both the believer and the unbeliever the reality of Hebrews 4:15, that Jesus truly knows their suffering not as a distant spectator, but as an innocent victim to the worst trauma that was ever inflicted upon a human being. Then invite them to commune with Him in the eternal life and love bought by that suffering. All the rest of the counsel you will offer flows out of or is built upon this key relationship. Invite your counselee to know Him and then to grow in Him. 

Putting the Past in its Place 

For those who are faced with intrusive symptoms—from nightmares all the way to dissociative episodes—one helpful truth to hold fast to is that the past is in the past. Equip them to take hold of those thoughts and pray to God thanking Him that they are here now and not actually reliving the events of the past. Giving them tools to do so is extremely powerful. Two resources I have found particularly helpful in this regard are Putting Your Past In Its Place by Dr. Steve Viars15 [1]Stephen Viars, Putting Your Past in Its Place (Eugene: Harvest House Publishers, 2011).  and “Distinguishing Between Guilt and Guilt” by Dr. Bob Jones.16 [1]Robert Jones, “Distinguishing Between Guilt and Guilt,” Biblical Counseling Coalition (blog), July 18, 2017, http://biblicalcounselingcoalition.org/2017/07/18/distinguishing-between-guilt-and-guilt/. 

At some point during the counseling sessions it can be helpful to have someone talk through the trauma they have experienced while couching the discussion in prayer and reminders of the truth. For most people talking through the event can be quite scary. It may invoke physiological changes associated with fear including shortness of breath, sweating, and the sense of panic. When someone begins to manifest these remind them that this is a memory, that they are in a safe room with loving people, and there is nothing to fear in that moment. Doing this in the safety of the counseling session can help equip them to recognize these responses and to refocus their thoughts on what is true and lay their burdens before the Lord. As the person is able to share with you about the trauma it will open up the opportunity for you to help them reinterpret their past, including the traumatic events they have experienced. As you do this you will want to investigate thoughts and beliefs the person held or currently holds relating primarily to themselves, others, and God. 

“God is not in Afghanistan,” was one veteran’s response to his wife when she told him she was praying for him. Many who have walked through the darkest experiences of life have difficulty reconciling those with the concept of an almighty, all-loving, all-knowing God. You may never be able to address every one of their questions nor resolve the ever-present problem of evil, but replacing unbiblical thoughts about God with biblical truth will aid the healing process. 

Issues of guilt and shame are also common among people wrestling with Post-Traumatic Stress. Helping them investigate this component of their story can be very helpful and transformative. First, you will need to determine if guilt and shame are part of the struggle this person faces. If so, you will need to help them parse out why they have these feelings and whether or not they are legitimate. For some, the legitimate guilt of sins they committed is a heavy burden they have been carrying, which has weighed down their soul. Finding forgiveness in Christ will be tremendously freeing. For others, guilt and shame come from things beyond their control. Survivor’s guilt is common among combat veterans. They often question why they came home when so many people, especially close friends, did not. A particular form of survivor’s guilt is acutely felt when the survivor traded places with another service member who died in their place. Some victims of rape will feel guilty, believing they were somehow responsible. This is compounded if they were engaged in inappropriate behavior leading up to the attack. This is a delicate and difficult discussion to have and takes great wisdom and care. 

As you help someone parse out his past you will likely identify individuals who have sinned against him. Guiding them to a biblical understanding of forgiveness is going to be deeply helpful in the transformation process. Placing the events of the past in their proper eternal perspective can also be helpful. The Apostle Paul was no stranger to extreme suffering, and while he in no way minimized the suffering he faced (2 Cor. 1:8), he says it was “light and momentary” compared to the “eternal weight of glory” that would later be revealed to him (Rom. 8:18). Reinterpreting one’s past and present should naturally lead to a reinterpretation of one’s future. Clearly, we want them to be encouraged and to think to their eternal future, but we also want to help them reinterpret the life they still are called to live here on the earth. 

Reinterpreting the Future 

PTSD has become something of an identity for many who have received this diagnosis. They have been told they have this disorder and there is no known cure for it. They are pointed to a myriad of options which may or may not alleviate some of the symptoms. Yoga, equine therapy, service dogs, EMDR, and of course pharmacotherapy are all held out as potential sources of relief. But this future is bleak. Many, even in the secular community, are now promoting the concept of post traumatic growth. The idea that one can move past trauma and the distress it has caused, and move forward and grow after the trauma.

As biblical counselors we do not just hold open the possibility for growth after trauma, we encourage victims of trauma that they can actually be stronger because of their trauma, not in spite of it (James 1:2-4). If God truly is sovereign and He uses all things for our good by transforming us into the image of Jesus, and the trauma we have faced is included in “all things,” then we can hold forth the promise of Post Traumatic Sanctification. The hope that God is using the trials of this life to improve us, and mold us to be the men and women He wants us to be. With a reinterpreted biblical understanding of one’s past, present, and future, a third checkpoint to reach is reengaging them in a new mission. 

Checkpoint Three: Reengage in a New Mission 

Everyone desires to be a part of something bigger than themselves. Combat veterans know this feeling keenly. Many joined the military to serve and be a part of something that offered them a chance to change the world. No matter the nature of the trauma, each person will benefit from being assigned a new mission. Help them learn to see their trauma as a stewardship that God has entrusted to them. Their experience can be used to help so many other people. Few things inspire others more than seeing someone overcoming adversity. Peter encourages his readers to always be ready to give a reason for the hope that is in them (1 Pet. 3:15). The reason people were asking about this hope was due to the dark suffering backdrop which made the hope shine so brightly. Joni Eareckson Tada’s testimony would not have impacted so many if she had not broken her neck and been paralyzed over 5 decades ago. Paying-it-forward, taking what you have been given, and using it to help others, is a popular concept these days but it is rooted in the timeless truths of Scripture. Teach your counselee to take the comfort that the God of all comforts has comforted them with and use it to comfort others (2 Cor. 1:2-4). 

This new identity in Christ combined with a new mission gives those who seemingly had no hope and no purpose renewed meaning for their futures. A renewed identity, purpose, and mission that is directed to the ultimate aim of brining glory to God. As they walk in this mission, they can bear the image of a God who takes ashes and makes beauty (Isaiah 61:3). He takes evil intention and uses it for good (Gen. 50:20). Their lives will then point to the greatest truth, the best news, the gospel of Jesus Christ (Matt. 5:16). An event at the center of human history, where God used the most horrific trauma any human has ever inflicted on another to accomplish the greatest good (Is. 53:10; 2 Cor. 5:21; Rom. 8:28). 

Helping someone fight the challenges of PTS is difficult. How they respond to counseling and how they mature in Christ will depend a great deal on various elements of life before they faced trauma. Preparation for trauma and the ability to resist or recover from the effects of trauma is often called resiliency. The final section of this essay will describe the importance of preparing to face suffering in this world and the vital role the church and biblical counseling can play in this preparation. 

Pre-Counseling as Preparation to Prevent PTS 

Anyone who has ever competed in any event, including orienteering races, knows that how you finish the race depends a great deal your preparation before the race begins. If someone has no idea how to read a map, he is going to have tremendous difficulty reaching a single checkpoint. Similarly, how one responds to trauma and its aftermath is greatly influenced by a one’s preparation. There are innumerable influences that shape someone’s life prior to potentially traumatic events, and the influence of these factors is ultimately incalculable. However, it is clear from life and research that pre-traumatic factors are important in developing resiliency. 

Why is this important to biblical counselors? Because some of the most significant pre-traumatic factors involve one’s personal beliefs and values. What someone believes about God, moral reasoning, and her perspective on the nature and purpose of life are extremely influential in how she responds to trauma when it comes. 

Families and the church have an important role to play in addressing PTS in a preventative fashion. To illustrate let me share a brief segment of the testimony of Captain Matt Myer who served as Company Commander over “Chosen Company” during the battle of Wanat, one of the worst days of combat in U.S. Army history. To give you some context, Jason Hovater was a strong Christian who encouraged the faith of his fellow soldiers and kept his entire unit laughing with antics and impersonations. His life was cut short a month from his twenty-fifth birthday when an enemy round deflected off the night vision mount on his helmet and into the center of his face.

Matt Myer saw the foundations of his belief in God and Christianity shaken to the core after the horrors of Wanat. He had been raised with the faith that Jesus died for everyone’s sins and believing in Him was an avenue to paradise. There was a contract with God which held that a good person doing good deeds would see blessing and favor. But he knew that Jason Hovater lived this kind of life, and Myer could not forget the image of that young soldier’s destruction. It would be years of thought and contemplation, part of that time spent working with an Army chaplain, before Myer began to reconcile those religious contradictions. He found solace in the book When God Weeps, by Joni Eareckson Tada, a woman confined for decades to a wheelchair who discusses how a loving God allows suffering and the opportunity to appreciate unexpected blessings.17 [1]Gregg Zoroya, The Chosen Few (Boston, MA: Da Capo, 2017), 349. 

When one’s core or deeply held beliefs comes into conflict with perceived reality it results in a great amount of distress to one’s soul. There is a tension that threatens to tear one apart and the seeming solution is to abandon either the centrally held belief or abandon reality—or at least one’s perceived reality. One significant, pre-traumatic factor that played a role in Myer’s life was his faulty view of the Christian life. Had he been raised to understand the world through a more biblical lens, his faith might not have been so shaken. 

General Preparation for Suffering 

Teaching a robust theology of suffering is a way churches can help prepare people to face potentially traumatic events. Jesus warns His followers that they will be hated by the world and face persecution (Jn. 15:18-20). Peter reminds Christians that they are called to suffer, and Jesus has given them an example to follow in suffering (1 Peter 2:21). Suffering is a component of the Christian walk that should come as no surprise to the followers of Jesus. It is important that suffering be a part of our biblical theology. Suffering is inevitable and truths from Scripture can greatly impact how people respond to trials. Richard Baxter was no stranger to suffering18 [1]Baxter lived in a time of human history where trauma was plentiful. Baxter lived to see the Great Plague of London, the burning of London, the Thirty-Years War, and the English Civil War. He served as a chaplain during the English Civil War and lost close friends to combat. Richard Baxter, The Crucifying of the World by the Cross of Christ in The Practical Works of the Rev. Richard Baxter, ed. William Orme, vol. 9 (London: James Duncan, 1830), 484; Richard Baxter, Obedient Patience in The Practical Works of the Rev. Richard Baxter, ed. William Orme, vol. 11 (London: James Duncan, 1830), 502-504.Richard Baxter, J. M. Lloyd Thomas, and N. H. Keeble, The Autobiography of Richard Baxter (Totowa, N.J: Dent; Rowman & Littlefield, 1974), 57; Doris L. Bergen, ed., The Sword of the Lord: Military Chaplains from the First to the Twenty-First Century (Notre Dame: University of Notre Dame Press, 2004), 95.  and he encourages Christians to draw on Scriptural truths in preparation for suffering so that we might suffer well to the glory of God. Baxter encouraged Christians to pray that God would give them the strength to endure suffering well. He also challenged them not to be surprised by suffering when it comes but to expect it and recognize that it is an intrinsic component (Acts 14:22) of the Christian life that God uses to shape people into the image of Christ (Rom. 8:16-17; 28-30).19 [1]Richard Baxter, The Practical Works of the Rev. Richard Baxter, ed. William Orme, vol. 7 (London: James Duncan, 1830), 459; Richard Baxter, The Practical Works of the Rev. Richard Baxter, ed. William Orme, vol. 8 (London: James Duncan, 1830), 430; Richard Baxter, The Practical Works of the Rev. Richard Baxter, ed. William Orme, vol. 12 (London: James Duncan, 1830), 313; Richard Baxter, The Practical Works of the Rev. Richard Baxter, ed. William Orme, vol. 3 (London: James Duncan, 1830).  Believing that the world is chaotic, out of control, and completely random adds to the sense of helplessness that afflicts those who have been through traumatic experiences.20 [1]Dr. Powlison noted the almost universal experience among trauma survivors of feeling completely helpless and out of control. Powlison, “Gripping Fears.” The sovereignty of God places firm grounding under the feet of those who have been faced with the realization that they are not in control of their own lives. Comfort can be found in acknowledging that God maintains absolute control over our suffering. As Richard Baxter wrote when referencing Amos 3:6, “‘Remember that nothing can be amiss which is done by God:’ for where there is perfection of power, and wisdom, and goodness, no actions can be bad. And there is nothing done by any of your afflicters, which is not governed by the will of God: “Shall there be evil in a city, and the Lord hath not done it?”21 [1]Richard Baxter, The Life of Faith in The Practical Works of the Rev. Richard Baxter, ed. William Orme, vol. 12 (London: James Duncan, 1830), 485.

Scripture provides the incredible hope that suffering is not a result of God’s abandonment. Instead, He is with His followers in the midst of their trials and promises never to leave them or forsake them (Isaiah 43:1-3, 1 Cor. 10:13, 1 Pet. 4:14). 

Specific Pre-Counseling 

Having a solid theology of suffering is vitally important for every Christian, but we can also offer specific counsel for those who are at a higher risk of facing the intense suffering that often leads to PTS. There are certain careers, locations, and particular situations where trauma is more likely to occur. For instance, if there is a young man in your church who serves in combat related MOS (Military Occupational Specialty, the military term for career field) who is preparing to deploy to an active theater of operation, he is much more likely to face trauma related to combat. 

One way I like to prepare men for such a deployment is to warn them of some of the particular dangers involved in combat and the peculiar temptations they will face that can dramatically impact their lives. Vengeance killing is one of those temptations that is more prevalent in a combat zone than in most other places. Many military members who have lost a close friend in combat can lash out in anger seeking to exact vengeance for their loss. The Bible gives us very clear instruction on this type of scenario. Romans 12:19 is clear that we are not to take revenge but leave all justice to the Lord. But the story of David’s first encounter with Abigail in 1 Samuel 25 is also very insightful. In verses 26 and 31 Abigail warns David about shedding blood to avenge his own name. Her words make it clear that there would be severe consequences for David’s soul if he acts with vengeful motives, “And when the LORD does for my lord according to all the good that He has spoken concerning you, and appoints you ruler over Israel, this will not cause grief or a troubled heart to my lord, both by having shed blood without cause and by my lord having avenged himself ” (1 Sam. 25:30-31). Abigail does not condemn the taking of life, she actually commends David’s military accomplishments and acknowledges the Lord’s work in granting David victory over his enemies (vs. 29). What results in internal turmoil is killing for the wrong motive. Warn young men headed into combat to guard their hearts against these temptations and earnestly pray the Lord will deliver them in the midst of these trials perhaps by recalling the counsel you have lovingly given them. This is just one example of the kind of specific counsel that can be offered to help prepare people and prevent the potential struggle with PTS. 


Post-Traumatic Stress Disorder is a diagnosis that has gained prominence in our culture in recent decades. While PTSD is not only a military issue, the ongoing war in Afghanistan and the soldiers, sailors, airman and marines returning home with the invisible wounds of war have brought greater attention to the problem. As biblical counselors we need to be prepared to help those who have suffered in the aftermath of life-altering and sometimes life-ending affliction. This essay has described how pre-counseling about sin and suffering can prepare individuals to face traumatic events and buffer the effects of that suffering. When counseling is necessary for those who have already faced intense suffering it is important to begin with a proper understanding of the nature of Post-Traumatic Stress and then move onto counsel that includes a demonstration of 1 Corinthians 10:13, a reinterpretation of the life of the sufferer, and moves to reengage them on a new and better mission. All of this preparation and all these checkpoints are steps along a course that is aimed at a finish line. That finish line is the glory of God through the transformation of the sufferer to the image of Christ. My hope is that this essay will help you move those who are struggling with Post-Traumatic Stress to Post Traumatic Sanctification.