I think the most important element of trauma counselling is to facilitate that person to re-tell, re-live and release their painful memories. This process can take time and should not be forced. The person with PTSD needs to feel able to trust the counsellor, and believe they can handle the horrors that haunt them. If the person can not articulate verbally, writing can help people process and come to terms with their trauma. Writing can be private or used to communicate the unspeakable. In my experience few people can successfully 'seal over' a trauma and never speak of it. People who recover from PTSD tend to have accepted, adjusted and integrated traumatic events.

- In my experience, I also follow their lead. When there is a need for them to talk about their traumatic experiences I would let them do so. However, for those who are not yet ready to re-tell their stories I wait for them to initiate the telling of their traumatic experiences, although, I do inform them initially that it would be beneficial for them to talk about their experiences, but only whenever they are ready.

the decision whether to support or discourage retelling of trauma depends on the "axis II"considerations as well as quality of trauma. In the 80's it was obligatory to invite telling, even if repeated. Lessons were learned via borderlines and MPD patients who became professional storytellers of their trauma and they were "overidentified" with their trauma. It would have been better to help them move on, prohibit retelling and help to "get a life". Now we are much smarter and need to assess the purpose of the telling and watch the results. Talking leading to working through and integration affirms the model. Talking leading to preservation and affective dysregulation suggests it is not smart and that other issues are primary (bipolar, axis II for example).

Having been married to a combat vet for 40 years, and knowing many of them personally, you need to take your cues from them. If they feel they are in a "safe environment"with no judgment, and are given an "opening" it should be up to them to take the lead. No one who has been through a trauma should be made to go at a pace set by someone else.

I, too, believe it's wise to "follow a person's lead". I know, personally, I have found it helpful to tell my story at least once through....if that had been discouraged, I don't feel like I could have fully moved through it. However important it can be to tell one's story, though, it is THEN important to stop "living" in it....For others, perhaps, even the re-telling would be too traumatizing.

The traumatized person needs to tell his/her story enough times that the compulsion to tell it tapers off. It is important to remember that PSTD is still present even if the patient is no longer obsessed with it but do not be surprised that the need to tell can crop up even years after the event itself. This is one of the benefits of having people will to listen be there for the wounded whenever help is needed. Like suicide, PSTD is a condition that keeps on "giving" long after the event occurred.

The ways in which PTSD occur are variable. If it occurs within a backdrop of hyper vigilance (combat and persistent stress), there may many layers to unfold. Does the soldier feel guilt over killing and replay this scenario in multiple ways? Survivors guilt? Did they allow themselves to become unnecessarily violent?
Redirecting the thought processes in this scenario will require knowing how to help the patient reframe the experience.
Other scenarios, those in which an immediate unpredicted trauma occur, may also require a debriefing. Some must be converted to feel empowered, others may feel too responsible.
A forced purging, however, seems futile.
Neuroplasticity, which is damaged to some degree, must be restored. If the patient desires, initiation of psychopharmacology centered around improved sleep and Anxiety can lay the framework which will help build pathways around the loop. If you help a person sleep and feel better, much of the self absorption will improve, laying the foundation of more effective therapy. Once a patient understands the relief they can get medically, they generally become much more optimistic about their prospects and more willing to openly share their experience. I think.