Honoring One Patients Journey: PTSD and the Power of Healing.

She asked me for paper and pen and drew three circles.

Understanding PTSD: A Widespread but Often Silent Struggle

According to the National Center for PTSD, About 6 out of every 100 people (or 6% of the U.S. population) will have PTSD at any point in their lives. In 2020, about 13 million Americans had PTSD. Women are more likely to develop PTSD than men. About 8 of every 100 women will have PTSD at some point in their life partly due to a higher prevalence of sexual assault compared to men. Veterans are more likely to have PTSD, and the statistics increase if they were deployed to a war zone.

June 27th, PTSD Awareness Day

As a psychiatric nurse practitioner working with individuals who have experienced trauma—whether acute, chronic, or complex—I’m often moved by the strength and resilience of the human spirit. Each year on June 27th, we observe PTSD Awareness Day, and for many years my thoughts return to one woman in particular. Her story is one of pain, survival, and ultimately, transformation. It continues to shape the way I approach my work.

A Lesson in Courage

Each patient leaves an impression with me, however some patients have had a significant impact on my practice.

It was just another day at work, with a new patient on my schedule. I reviewed the intake forms that documented a long history of repeated trauma beginning in adolescence. Sadly, her story is not uncommon for me, but her presence in the room that day was unforgettable.

She walked in without making eye contact and sat with her gaze fixed on her feet. The air in the room was heavy. I could feel her pain in my chest. She spoke very softly, often offering just one or two word responses. At some point, I stopped trying to ask questions, or take notes and wheeled my chair around the desk. I leaned forward and told her that she didn't have to talk about anything, "we can just sit here and let it be.” And we did.

Building Trust

Over the next few appointments, she slowly began to meet my gaze for a few seconds at a time and respond to my assessments. After around six months of encouragement, she agreed to consider therapy. With her consent, I coordinated with a trauma therapist at the clinic where I worked, and invited them into our next appointment. For the next two and a half years, she engaged in individual therapy and even started attending group therapy. In total, we worked together for three years, during which I witnessed her incredible journey of healing. She showed up consistently, with courage and resilience, trusted her therapist's guidance and made real progress.

The Three Circles (see picture above)

At our final appointment, I asked her if she remembered our first meeting. She said "yes" and asked me for a pen and a piece of paper. She drew three circles (see my rendition above) and explained them like this:

• Circle One: An open, empty circle.“This is who I was as a child, open to the world". She was trusting, and had hopes and dreams of becoming a Veterinarian.

• Circle Two: A circle almost completely filled in black.“This is what trauma did to me. It almost filled up every part of me". She lived in constant fear, often experiencing severe anxiety, panic attacks, depression, insomnia, nightmares and suicidal thoughts. She told me that the night before our first appointment she considered ending her life.

• Circle Three: A circle with a small black dot in the center. She pointed to the black dot and said, "this is where the memories live now". She then pointed to the white space around the dot, “this is me now." She told me that rather than living in fear of the pain from her past experiences, she was choosing to live with confidence for who she is now, and hope for who she could be in the future, "it will always be part of me, but I've built a life around it.".

  
  

I asked her what she does when the memories come calling, and she laughed a little and said, "I ask them what they want, thank them for stopping by and tell them they have to go!" Despite the humor, I didn't get the impression that she was being dismissive of the episodic pain that still occurred when triggered. In fact, she seemed accepting of the probability that there could still be dark times ahead, but she was also determined not to give up the life she had made waiting for them to occur. She wasn't going to stop going to the gym, or socializing with friends, or hiking with her dog in order to return to sitting for hours in a dark room, crippled with apprehension and fear.

I don't know where her "Three Circles" came from. An adaptation of Paul Gilbert, PhDs "3 Circles Model of Emotion" is my best guess. I do know that just as she left an imprint on the first day I met her, she left another on the last. This confident, young woman was strikingly different from the one that sat across from me three years earlier! On that day, we cried together (you try keeping dry eyes through that), laughed together, and finally embraced one another, and she left my office for the final time (I was leaving and she was transitioning to a new provider). Her story is a testimony to the power of asking for help, showing up for yourself, and with assistance from a skilled Trauma-Informed Therapist, taking the steps everyday that leads to sustained healing.

If You’re Struggling, Please Reach Out

I’ve often shared a brief version of the three-circles with my patients when discussing trauma. I share it in detail, on this platform because someone out there may need to hear that what they experienced, and the subsequent effects of trauma aren't "who" they are. One or more traumatic events can lead to psychological reaction and severe symptoms that can stay for years even after the event(s). Traumatic events whether caused by a person/people, situation(s), accident, medical event, or otherwise are not who you are, they are what happened to you and the collateral emotional damage that resulted. Asking for professional help, and talking to someone isn't easy, but healing is possible. There are compassionate, skilled professionals that specialize in evidence-based treatments for PTSD. There are crisis numbers available on this website, and 365 days-a-year 24/7 by calling 988 from anywhere in the U.S.

Thank you for sharing just one of the amazing peoples stories I've witnessed with me. Remember that even in the darkest places there is a pinprick of light.

Take care,

Clarissa Juarez, CNP PMHNP

Founder, Veteran & Psychiatric Nurse Practitioner

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