Differentiating intervention strategies for primary and secondary trauma in post-traumatic stress disorder: The example of Vietnam veterans

A model of treatment of PTSD is presented. Two central psychological issues are addressed: (1) the conflict between ego forces oriented toward recalling and assimilating the traumatic material (thereby achieving ego integration) versus ego forces oriented toward repressing and avoiding the reexperience of the trauma (thereby defending against ego disintegration); and (2) the loss of self-cohesion which results from the breakdown between the trauma survivor's self and his social milieu. Clinicians are advised to use two different theoretical orientations (ego psychological and self psychological) in treating these two basic issues. The concepts of primary and secondary trauma refer to the initial traumatic experience and the subsequent breakdown in the relationship between the survivor and his social environment and are offered as tools for distinguishing which issue is uppermost in the patient's material at any given time.