The Medical Recovery Period

It is not uncommon for the emotional sequellae of a traumatic event to lie dormant during the medical recovery period, such as when an injured person is convalescing in a hospital. There can be several reasons for this, for example:

• 1. The trauma survivor is in a sheltered environment, that is, the hospital.
• 2. The person, in many cases, is totally focused on his or her physical recovery and is reacting to medical procedures.
• 3. The survivor does not have to cope with demands of day-to-day life, nor is it likely that he or she will face triggers to memory of the traumatic event.
• 4. In cases in which the event was caused by another person, the survivor may not have to encounter unfriendly strangers while being cared for either in the hospital or at home.

Another reason for delay in the trauma response may be that those who are close to a traumatized person are more attentive, sympathetic, and protective while the person is physically disabled. Because many support people are not as comfortable with or aware of the invisible psychological wounds of trauma, their support may rapidly fade when the physical injuries heal. Often these support people want to forget, to go on with their lives, and to put their own terrible memories of the event behind them. This can occur just when the traumatized person has begun to recover physically. So, these people may mistakenly expect the survivor to be fine and get on with his or her life, now that the physical wounds have healed.

The clinician should take note if a seriously injured traumatized person is unable to acknowledge emotional or psychological issues during this physical recovery period. But, by no means should psychotherapy be postponed until after medical treatment is completed. It is important that the survivor view therapy as a part of the fabric of trauma care, not as an indication of a weakness or pathology. Even though it is quite logical to expect that psychological symptoms may not always become apparent until after medical treatment is completed, many trauma clients are profoundly startled by the onset of such symptoms. Many were so relieved to survive the event that, during physical recovery, they did not think about what returning to their day-to-day lives might entail. Hence, if the treatment process begins during the physical recovery period, the clinician will have an opportunity to prepare the client for the struggle that lies ahead. Initially, it may take the form of supportive therapy and education of the survivor and his or her family, because the survivor may not be willing or able to work toward treating symptoms directly in this phase.