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Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)
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Trauma-Informed Care: Overview of Models of Treatment and Issues in Treatment (session 3 of conference)

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Trauma-Informed Care: Overview of Models and Treatment Issues offers information about many evidence-based models for treating Children, Adults, Families and re-vamping our Organizations to become …

Trauma-Informed Care: Overview of Models and Treatment Issues offers information about many evidence-based models for treating Children, Adults, Families and re-vamping our Organizations to become Trauma-Informed. Treatment issues such as safety, pacing, dissociative behavior and therapeutic anger expression are discussed from Cathy's extensive base of experience.

Invite Cathy to present to your organization: http://www.trauma-informedtraining.com/contact-us.html

Or go to www.trauma-informedtraining.com to gain a Level I Certification by taking the exams for all 5 presentations plus 2 additional exams--a total of over 15 CEUs.

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  • Template Flower Title Slide
  • Example Summary Overview Slide
  • AS WE MAKE THE PARADIGM SHIFT, IT IS IMPORTANT TO KEEP A BALANCE BETWEEN ACCEPTING WHAT WE’RE TOLD VIA RESEARCH, EMPLOYEE MANUALS, EXPERTS AND ENGAGING OUR CRITICAL THINKING, TRUSTING OUR GUT AND “QUESTION AUTHORITY”
  • 3 ELEMENTS:BEST AVAILABLE RESEARCH (REQUIRES US TO KNOW SOMETHING ABOUT WHAT IS VALID RESEARCH?)CLINICAL EXPERTISE (REQUIRES US TO HAVE SOME: PROFESSIONAL DEVELOPMENT IN OUR ORGANIZATIONS, INDIVIDUALLY AND AGAIN, DEVELOPING SOME TRUST IN OURSELVES WITHOUT CLOSING OUR MINDS TO OTHER’S IDEAS)CLIENT/PATIENT CHOICE: LIP-SERVICE OR ARE OUR CLIENTS/PATIENTS RESPECTED AS PARTNERS IN THEIR OWN HEALING AND RECOVERY PROCESS?light of the overwhelming numbers of persons who have experienced trauma and are seeking treatment, being imprisoned or living less than joyful lives, making the paradigm shift to “trauma-informed” thinking is imperative. Do we want to use healthcare dollars and energy wisely? Why wouldn’t we want to prevent so many from living a life of pain, unfulfilled potential or criminal activity leading to incarceration?  Many practitioners, with numerous decades of practice experience, question evidence presented in relation to the study of human behavior. But, in light of the very concrete experience and effects of trauma, it seems right to offer some kind of confidence in the approach and treatment we offer. The dilemma we face when treating humans for human conditions is that we cannot guarantee results; research in the field of humanities is just not able to be manipulated in the same ways as other scientific research. Ethics dictate that we cannot tell one group of parents to “beat your kids daily” and another group “no beating allowed” so that we can accurately measure the difference in parenting styles.
  • EVIDENCE-BASED IS AN ELEMENT OF MAKING THE PARADIGM SHIFT; KEEP YOUR BALANCEWHEN TALKING ABOUT “TREATMENT” WE NEED TO BE AWARE OF WHAT WILL CHANGE WHEN WE MAKE THE SHIFT
  • THESE ARE FOUR AREAS I HAVE NOTICED IN ENVIRONMENTS WHERE NO TICP WAS APPLIED—THESE AREAS CHANGE WHEN TICP IS APPLIED—MY EXPERIENCE IS WITHIN MY OWN PRACTICE AND BY OTHERS WHO HAVE ENGAGED IN TRAINING AND REPORTED TO ME
  • Denial as coping defenseACE questionsWhat is your setting?Pivotal moment(s) for clientsEffects: Affirms, Condemns, UselessGuidance for treatmentLive the labels or framework for recovery
  • To access our clients’ historical information we’ll need clinical expertise, sensitivity and willingness to exploreAND TO REALLY LISTEN TO WHAT WE HEAR (LISTEN OR YOUR TONGUE WILL MAKE YOU DEAF)IF A PERSON HAS NARRATED A LONG LIST OF TRAUMAS IN THEIR BACKGROUND, THEN ANSWERS “NO” WHEN YOU ASK: HAVE YOU BEEN ABUSED?WHAT DO YOU DO WITH THAT?
  • Bipolar IIMajor DepressionAnxietyObsessive Compulsive DisorderBorderline Personality DisorderAvoidant Personality DisorderPost-Traumatic Stress DisorderADHD (childhood)Oppositional Defiant Disorder (childhood)Conduct disorder (childhood)
  • Suicidal thought with increasing intent, self-harm via cutting and bulimic behavior, excessive alcohol use, frequent use of marijuana, chaotic relationships, somatic complaints, poor sleep, nightmares, hears voice that commands self-hurt, describes isolative behavior with periods of depression and anxiety
  • In conversation reveals several siblings were removed from parents’ custody due to parents’ narcotics use; client was physically beaten in foster care setting, father was “schizophrenic” and mother was “bi-polar”. Client had first sexual experience at 14 years old with a 20-year old “boy/girl” friend. Client has had several jobs in the last year, dropped out of college last year, on/off relationships with family members, answers “no” when asked: “have you ever been abused?”
  • What factors do you consider?What do you think about family member’s diagnoses?What do you question about the client’s account?What is the role of “validity” of memories?What do you NOT question?How would you diagnose this person?What diagnosis(es) might you expect from the doctor or prescriber?
  • Can you recognize the re-traumatization that may be occurring?
  • THIS MAY BE ONE OF THE “MIRRORS” WE NEED TO ADDRESS IN OURSELVESADDRESSING TRAUMA DOESN’T RE-TRAUMATIZE, NOT ADDRESSING IT DOESADDRESSING TRAUMA DOESN’T HAVE TO DEMONIZE PARENTS AND CARETAKERS; WITHOUT ADDRESSING IT WE CONTINUE TO CREATE THE SOCIETY THAT PRODUCES PERPETRATORS RATHER THAN DECREASE VIOLENT BEHAVIOR
  • IN OTHER WORDS, IF THE SYMPTOMS OF PTSD ARE THERE BUT THERE IS NO ONE EVENT (DSM CRITERIA)—THAT DOESN’T MEAN THE PERSON DOESN’T HAVE PTSD, IT MEANS THAT PTSD MAY INDEED BE CREATED BY CHRONIC CONDITIONS, NOT JUST ONE CONCRETE EVENT
  • Divorce, bereavementEnd of a romantic or significant relationshipFrequent coming/going of significant adultsSudden death of loved one or significant personExposure to violence: domestic, community, schoolFrequent movesFamily member’s traumatic eventPovertyJob lossOthers?
  • How many have treated adults who describe being forced to go to therapy, in childhood, while mom/dad continued with addictive, neglectful, abusive behavior?WHAT IF THE ‘OPPOSITIONAL’ CHILD IS MERELY DEMONSTRATING DISTRESS—IN A WAY THAT HE/SHE CAN—REMEMBER, OUR BRAINS ARE NOT FULLY DEVELOPED UNTIL 20S, THE CHILD IS SELF-CENTERED (APPROPRIATELY—AND ANNOYINGLY, BY THE TIME THEY ARE A TEEN ‘-)
  • OUR SETTING DETERMINES WHAT REMEDIES WE UTILIZE, BUT IF WE ARE UTILIZED TICP APPROACH, ASSESSMENT IS SIMILAR—IT’S OUR NEXT STEPS THAT ARE DETERMINED BY OUR ORGANIZATIONAL ROLE
  • Asking: “Have you been abused?” is not sufficient.Denying abuse/victimization is a defense to cope with victimizationACE: Ten specific questions to help persons identify traumatic experienceEarly life stressors cause not only mental health problems, they contribute to later life medical health problemsAre you prepared to help your service recipients utilize their answers in a recovery-orient way?
  • In psychiatry, psychology and mental health counseling comorbidity refers to the presence of more than one diagnosis occurring in an individual at the same time. However, in psychiatric classification, comorbidity does not necessarily imply the presence of multiple diseases, but instead can reflect our current inability to supply a single diagnosis that accounts for all symptomsSO WHY DON’T WE QUESTION THIS? IT’S A COMMON, EXPECTED AND ACCEPTED OCCURRENCEONE DOCTOR (I HAVE FOUND TWO WHO WRITE ABOUT IT, SO FAR, THE OTHER IS Miro Jakovljevic: Born on Jan. 27 1954, in Sarajevo (B&H), graduated from the School of Medicine in 1977. Since 1979, he is employed at the Department of Psychiatry, University Hospital Center Zagreb, Croatia.) has addressed this extensively:
  • Colin Ross outlines the major problems with comorbidity, or rather with our professional LACK of QUESTIONING AUTHORITYTHE “ONE DIAGNOSIS” WOULD NEED TO HIGHLIGHT THE EFFECTS OF TRAUMA, PHYSIOLOGICALLY, PSYCHOLOGICALLY AND EMOTIONALLY AND SPIRITUALLY
  • ALLOW FOR DISCUSSION
  • TAKE A MINUTE TO TAKE A BREATH
  • Anti-depressants were originally meant to be used short-term; when people are taught to meditate, address cognitively distorted thinking and beliefs and otherwise attend to emotion regulation and distress tolerance, the judicial use of medication may be helpful. Stability may be established, SO THE WORK CAN BE DONE; however, the industry that has arisen has put forth that medication IS “treatment”—this just is not so and is driven by profit.READ HIGHLIGHTED FROM ARTICLEROBERT WHITAKER Whitaker was a medical writer at the Albany Times Union newspaper in Albany, New York from 1989 to 1994. In 1992, he was a Knight Science Journalism fellow at MIT.[2] Following that, he became director of publications at Harvard Medical School.[3] In 1994, he co-founded a publishing company, CenterWatch, that covered the pharmaceutical clinical trials industry. CenterWatch was acquired by Medical Economics, a division of The Thomson Corporation, in 1998.[4]In 2002, USA Today published an article of Whitaker, Mind drugs may hinder recovery in its Editorial/Opinion section.[5] In 2004, Whitaker published a paper in the non-peer-reviewed journal Medical Hypotheses, titled The case against antipsychotic drugs: a 50-year record of doing more harm than good.[6] In 2005, he published his paper Anatomy of an Epidemic: Psychiatric Drugs and the Astonishing Rise of Mental Illness in America in the Ethical Human Psychology and Psychiatry.[7] In his book Anatomy of an Epidemic, published in 2010, Whitaker continued his work.[8][9][10]
  • WITH TICP, WE’RE USING AN INJURY MODEL: WHAT DOES THIS IMPLY?WITH TICP, WE ALL NEED TO BE A BIT OF A ‘SOCIAL WORKER’—ORIENTED TOWARD ADDITIONAL RESOURCES A PERSON CAN USE IN THEIR RECOVERY, REHABILITATION PROCESS
  • REMEMBER HERMAN’S 3 STAGE MODEL: IT ESTABLISHED SOMETHING OTHER THAN FOCUSING ON “COMPLEXES” FROM A PSYCHOANALYTICAL VIEW
  • Roger D. Fallot, Ph.D. is a clinical psychologist and Director of Research and Evaluation at Community Connections. A graduate of Yale University (B.A., M.S., and Ph.D.), his professional areas of specialization include the development and evaluation of services for trauma survivors and the role of spirituality in recovery.Maxine Harris is CEO and Co-Founder of Community Connections, a private, not-for-profit mental health agency in Washington, DC. She is also the Executive Director of The National Capital Center for Trauma Recovery and Empowerment. 
  • Safety: Environment: physical, emotional, psychological spiritualPerson centered: Validates, affirms, listensDidactic: Skills based, practical applicationExperiential: Many activities & ways to learn (respects learning styles), allows for expression of intense emotionRecovery/Discovery oriented: “YES” to dreams & self-improvement; utilizes strengthsRelationships: Utilizes therapeutic relationship, encourages connection to larger communityDevelopmentally fits: age, cognitive ability, emotional maturity
  • These resources served as the basis for my gathering of the models we’re going to look at, briefly—for much, much more, go to their websites
  • Chadwick Center for Children and Families. (2009). Assessment-Based Treatment for Traumatized Children: A Trauma Assessment Pathway (TAP). San Diego, CA: Author. Trauma‑focused cognitive behavioral therapy (TF‑CBT) is an evidence‑based treatment approach shown to help children, adolescents, and their caregivers overcome trauma‑related difficulties. It is designed to reduce negative emotional and behavioral responses following child sexual abuse, domestic violence, traumatic loss, and other traumatic events.The treatment—based on learning and cognitive theories—addresses distorted beliefs and attributions related to the abuse and provides a supportive environment in which children are encouraged to talk about their traumatic experience. TF‑CBT also helps parents who were not abusive to cope effectively with their own emotional distress and develop skills that support their children.DBT for Adolescents: focuses on a synthesis between 2 seemingly opposite treatment strategies: change and acceptance. The change focus is derived from behavioral science, and treatment incorporates standard behavior therapy practices, including chain analysis (described below), skills training, contin-gency management, and exposure. TRAUMA ASSESSMENT PATHWAY: GO TO LINKCBITS At-a-GlanceThe Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program is a school-based, group and individual intervention.  It is designed to reduce symptoms of post-traumatic stress disorder (PTSD), depression, and behavioral problems, and to improve functioning, grades and attendance, peer and parent support, and coping skills.CBITS has been used with students from 5th grade through 12th grade who have witnessed or experienced traumatic life events such as community and school violence, accidents and injuries, physical abuse and domestic violence, and natural and man-made disasters.CBITS uses cognitive-behavioral techniques (e.g., psychoeducation, relaxation, social problem solving, cognitive restructuring, and exposure).TST focuses on the child's emotional and behavioral needs as well as the environments where the child lives (home, school, community). The treatment model includes four components (skill-based psychotherapy, home and community based care, advocacy, and psychopharmacology) that are fully described in a published manual.[2] A clinical trial showed that TST is effective in improving the mental health and well-being of children who have been traumatized.[3] TST has also been successfully replicated.[4]
  • Cognitive Processing Therapy: CPT typically consists of 12 sessions and has been shown to be effective in treating PTSD across a variety of populations, including combat veterans,[2][3][4] sexual assault victims,[5][6][7] and refugees.[8] CPT can be provided in individual and group treatment formats. The theory behind CPT conceptualizes PTSD as a disorder of "non-recovery" in which erroneous beliefs about the causes and consequences of traumatic events produce strong negative emotions and prevent accurate processing of the trauma memory and natural emotions emanating from the event. Prolonged Exposure Therapy http://en.wikipedia.org/wiki/Prolonged_exposure_therapy CPT Cognitive Processing Therapy for Rape Victims, 1993 Patricia Resick, Monica SchnickeProlonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder, characterized by re-experiencing the traumatic event through remembering it and engaging with, rather than avoiding, reminders of the trauma (triggers). Sometimes, this technique is referred to as flooding Acceptance and commitment therapy or ACT (typically pronounced as the word "act") is a form of clinical behavior analysis (CBA)[1] used in psychotherapy. It is an empirically-based psychological intervention that uses acceptance and mindfulness strategies mixed in different ways[2] with commitment and behavior-change strategies, to increase psychological flexibility. The approach was originally called comprehensive distancing.[3] It was developed in the late 1980s[4] by Steven C. Hayes, Kelly G. Wilson, and Kirk StrosahlDBT:developed by Marsha M. Linehan, a psychology researcher at the University of Washington, to treat people with borderline personality disorder (BPD) and chronically suicidal individuals; it is now used in a variety of psychological treatments including treatment for traumatic brain injuries (TBI), eating disorders, and mood disorders.[1][2] Research indicates that DBT is also effective in treating patients who present varied symptoms and behaviors associated with spectrum mood disorders, including self-injury.[3] Recent work also suggests its effectiveness with sexual abuse survivors[4] and chemical dependency.[5]DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness largely derived from Buddhist meditative practiceCRITICAL THINKING QUESTIONS: WHY IS DBT EFFECTIVE? IS IT THE SPECIFIC SKILLS? IS IT THE FACT THAT IT IS TREATMENT FOR THOSE WHO HAVE BEEN TOLD THEY ARE ‘HOPELESS’ AND UNTREATABLE? IS IT GETTING TOGETHER IN A GROUP AND REALIZING “I’M NOT ALONE?” THESE FACTORS NEED TO BE EXAMINEDSeeking Safety is a present-focused treatment for clients with a history of trauma and substance abuse. The treatment was designed for flexible use: group or individual format, male and female clients, and a variety of settings (e.g., outpatient, inpatient, residential). Seeking Safety focuses on coping skills and psychoeducation and has five key principles: (1) safety as the overarching goal (helping clients attain safety in their relationships, thinking, behavior, and emotions); (2) integrated treatment (working on both posttraumatic stress disorder (PTSD) and substance abuse at the same time); (3) a focus on ideals to counteract the loss of ideals in both PTSD and substance abuse; (4) four content areas: cognitive, behavioral, interpersonal, and case management; and (5) attention to clinician processes (helping clinicians work on countertransference, self-care, and other issues)Psychological first aid (PFA) is a technique designed to reduce the occurrence of post-traumatic stress disorder. It was developed by the National Center for Post Traumatic Stress Disorder (NC-PTSD), a section of the United States Department of Veterans Affairs, in 2006. It has been spread by the International Federation of Red Cross and Red Crescent Societies, Community Emergency Response Team (CERT), the American Psychological Association (APA) and many others. It was developed in a two-day intensive collaboration, involving more than 25 disaster mental health researchers, an online survey of the first cohort that used PFA and repeated reviews of the draft.[1] http://www.ptsd.va.gov/professional/manuals/psych-first-aid.asp
  • The basics of cognitive work need to be taught: give the reasons for the “10 Twisted Forms of Thinking”—why don’t they work? Why are they detrimental in trauma work and everyday life, in relationships? TICP APPROACH REQUIRES OUR OWN APPLICATION: WHAT ABOUT OUR OWN THOUGHTS AND SPEECH? IS IT FULL OF “SHOULDS, OUGHT TO, HAVE TO AND MUST”? DO WE ADDRESS OUR OWN EITHER/OR THINKING? DO WE LABEL OTHERS?
  • ALTERNATIVES FOR FAMILIES: Target Population: Caregivers who are emotionally or physically aggressive or abusive with their children, children who experience behavioral dysfunction, especially aggression, or trauma-related symptoms secondary to their as exposure to physical discipline/abuse, and high conflict families who are at-risk for these problemsCHILD/ADULT RELATIONSHIP ENHANCEMENT: GO TO LINKChild and Family Traumatic Stress Intervention (CFTSI) is an early intervention and secondary prevention model that aims to reduce traumatic stress reactions and posttraumatic stress disorder (PTSD). It is delivered to children aged 7–18 years, together with their parent or caregiver, after the child has experienced a potentially traumatic event (PTE).Trauma Adapted Family Connections (TA-FC) is a manualized, trauma-focused practice rooted in the principles of Family Connections (FC). It employs a multiphased approach to increase the safety, well-being, stability, and health of children and families who have experienced multigenerational trauma and/or complex trauma. Each phase encompasses elements drawn from theories of attachment, neglect, trauma, family interaction, and community-based frameworks to uniquely respond to the needs of individual family members as well as the unit as a whole
  • GO TO LINK:What is the Sanctuary Model? The Sanctuary Model® represents a theory-based, trauma-informed, evidence-supported, whole culture approach that has a clear and structured methodology for creating or changing an organizational culture.In the early years of developing and applying the Sanctuary Model to the original population – adults who had been abused as children – in acute care, inpatient settings, research wasn’t even on the “radar” screen…AS A LIVING PHILOSOPHY: The process of “Creating Sanctuary” begins with getting everyone on the same page – surfacing, sharing, arguing about, and finally agreeing on the basic values, beliefs, guiding principles and philosophical principles that are to guide our decisions, decision-making processes, conflict resolution skills and behavior. There are no shortcuts here. Trauma-informed change requires a change in the basic mental models upon which thought and action is based and without such change, treatment is bound to fall unnecessarily short of full recovery or fail entirely. This change in mental models must occur on the part of the clients, their families, the staff, and the leaders of the organization. Mental models exist at the level of very basic assumptions, far below conscious awareness and everyday function and yet they guide and determine what we can and cannot think about and act upon.What would change?The impact of adopting the Sanctuary Model should be observable and measurable. The outcomes we should expect to see include:Less violence including physical, verbal, emotional forms of violence. Systemic understanding of complex biopsychosocial and developmental impact of trauma and abuse with implications for response. Less victim-blaming; less punitive and judgmental responses. Clearer more consistent boundaries, higher expectations, linked rights and responsibilities. Earlier identification of and confrontation with perpetrator behavior. Better ability to articulate goals, create strategies for change, justify need for holistic approach. Understanding of reenactment behavior and resistance to change. More democratic environment at all levels. Better outcomes for clients, staff, and organization 
  • Less violence including physical, verbal, emotional forms of violenceSystemic understanding of complex biopsychosocial and developmental impact of trauma and abuse with implications for responseLess victim-blaming; less punitive and judgmental responsesClearer more consistent boundaries, higher expectations, linked rights and responsibilitiesEarlier identification of and confrontation with perpetrator behaviorBetter ability to articulate goals, create strategies for change, justify need for holistic approachUnderstanding of reenactment behavior and resistance to changeMore democratic environment at all levelsBetter outcomes for clients, staff, and organizationDO WE THINK THIS IS IMPOSSIBLE/PIE IN THE SKY THINKING?WHAT DO WE EXPECT OF OUR CLIENTS/PATIENTS? WE ASK THEM TO TAKE THE FIRST STEPS, ENGAGE SUPPORT AND MOVE FORWARD…NO LESS THAN WHAT WE NEED TO DO
  • HERE’S AN EXAMPLE OF VIDEO I USE TO DEMONSTRATE WAY TO REGULATE EMOTION AND ENGAGE IN SELF-MANAGEMENT
  • Intake/build rapport/get the story/outline your approach, ask about preferences FOR LEARNINGAssess (observe, discuss, educate): addictions, dissociative response, anxiety, depression, Post-Traumatic Stress responseEducation: IBS & AAI, Self-Management concept, Trauma Responses (triggers—including somatic, “body” responses), brain and body effects of traumaDemonstrate and explain: Coping Skills: Breathing, Containment, Reality Checks, Pacing, specifics of Grounding, Emotion Regulation and Distress Tolerance
  • EDUCATE SERVICE RECIPIENTS, TO SOME EXTENT (DEPENDS ON YOUR SETTING) ABOUT BRAIN PROCESSESWHAT DO YOU THINK THIS ACCOMPLISHES?
  • GO TO LINKS AS TIME ALLOWS
  • READ FROM ARTICLE
  • Not all must be done in THERAPY setting; many persons engage in activities outside of therapy that can be validated as “therapeutic”: sports, dance, Cognitive: addresses leftover “magical thinking” reflected in IBS, depression anxiety, Post-Trauma Stress responsesExpressive: art (Soul Collage), music, anger, movement Skills-based: Dialectical Behavior Therapy-DBT, Acceptance and Commitment Therapy-ACT, CBT: Feeling Good The New Mood TherapyGroup: Therapy and support groupsCreative writing: gives opportunity to tell one’s story, build self-esteemSpiritual: meditation, group attendance, nature connection
  • Introduce: Three areas of grief: The Childhood the client did haveThe Childhood the client did not haveThe Childhood the client can never haveAnger work is important and can be done safely, in outpatient settings. Contact Cathy for training.Ways to express anger: list
  • IF CLIENTS HAVE NO WAY OR PERMISSION TO PHYSICALLY, SAFELY EXPRESS ANGER, WHAT CAN HAPPEN? WHAT DOES THIS SAY TO THEM?‘WHO’ WILL YOU REALLY BE WORKING WITH?
  • Client is able to participate in somatic therapy work, if he/she choosesClient begins to develop compassion for self and othersClient begins to take steps to reach life goals: education, employment, relationshipsClient begins to “be my own therapist”
  • ANOTHER WAY TO DEPICT ‘RECOVERY’ PROCESS FOR CLIENTS
  • Knowledge and understanding about IBS and AAIClient’s current life circumstances/ageTherapist’s awareness re: Countertransference/Personal mirrorsMemoriesAbreactive workAwareness of dissociative symptomsConsultation/Supervision
  • I WOULD ADD: HAVE A CLEAR, CONCISE CONSENT FOR TREATMENT/SERVICES—READ ALOUD WITH CLIENTSBE VERY CLEAR ON FINANCIAL ARRANGEMENTS: FUZZY ARRANGEMENTS, EXCEPTIONS CAN LEAD TO THERAPEUTIC ISSUES FOR CLIENT AND THERAPIST
  • THESE THOUGHTS CANNOT BE OVER-STRESSED:The complex symptomatology of patients who have survived profound childhood abuse, particularly the severedissociative and post-traumatic symptoms of patients with multiplepersonality disorder (MPD), may predispose therapists to engage in poorly considered psychotherapeutic practices.”
  • And I would add, those who are not at a point of resolve and awareness about their own use of dissociation can become dangerous or at best, ineffective“Therapists should be careful to keep a rational clinical perspective, and not to be distracted by patients' unusual and dramatic clinical presentation…Therapists who do not respect traditional psychotherapeutic principles risk becoming out of control and detrimental…excessive fascination or preoccupation with MPD phenomenology can also have a number of untoward effects…”
  • EyesBreathingBody languageVoice Changes
  • FLOODING: WHAT’S YOUR SKILL LEVEL?TRUST= IS NOT “ALL/NOTHING” AND GOES BOTH WAYS
  • the trauma therapist needs to be flexible, trained in several different treatment modalities and theoretical bases… If the therapist is only trained in one model or method then clients have to adapt to that model or method. If the client can’t do that or if it doesn’t appeal, it can end up with the client feeling wrong or a failure…”
  • STT=Somatic Trauma therapy: Babette Rothschilde SE= Somatic ExperiencingThis is just a sampling of the current, primary approaches (EFT http://www.huffingtonpost.com/serina-deen-md-mph/eft_b_1536431.html3 Principles (Karla H) We are all born with the innate wisdom and power to create well-being in our lives. Trauma can create an enormous barrier to accessing that wisdom. Gaining an understanding of the principles of Mind, Thought and Consciousness melts that barrier and relieves human suffering. When we begin to realize that it is our own thoughts that create our experience moment to moment, we put others' actions or circumstances back into perspective and return to a state of health. The more we allow this wisdom to guide our thoughts instead of straying into experiences from the past or worrying about the future based on our past framework, the more we settle into and enjoy our own best life.
  • WHAT ABOUT OTHER SETTINGS? WE WILL CONTINUE WITH SESSION 4 TO LOOK AT SEVERAL
  • Transcript

    • 1. TRAUMA-INFORMED CARE PERSPECTIVE TREATMENT THAT WORKS overview of issues and models Going Mainstream Series: Level I Cathy S Harris, MSW, LCSW www.trauma-informedtraining.com
    • 2. SUMMARY OVERVIEW – TREATMENT • What is the role of “evidence-based”? • How will the paradigm shift affect treatment? assessment & diagnosis/comorbidity/medication/professional relationships • Criteria for a useful model • Overview of models • Application of TICP concepts in treatment • Treatment Issues
    • 3. “… not everything that can be counted counts, and not everything that counts can be counted” (William Bruce Cameron, Informal Sociology: A Casual Introduction to Sociological Thinking 1963, p. 13).
    • 4. QUESTION AUTHORITY Cathy S Harris, MSW, LCSW copyright 2011
    • 5. EVIDENCE-BASED: WHAT IS IT? • Evidence-based practice is the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences (patient choice). American Psychological Association • Evidence-Based and Promising Practices: Elizabeth Cannata, Michael Williams
    • 6. what’s wrong with you? what happened to you? Cathy S Harris, MSW, LCSW copyright 2011
    • 7. ? WHAT WILL CHANGE IN TREATMENT Cathy S Harris, MSW, LCSW copyright 2011
    • 8. ASSESSMENT DIAGNOSIS COMORBIDITY MEDICATION PROFESSIONAL RELATIONSHIPS
    • 9. ASSESSMENT DIAGNOSIS • Denial as coping defense • ACE questions • What is your setting? • Pivotal moment(s) for clients • Effects: Affirms, Condemns, Useless • Guidance for treatment • Live the labels or framework for recovery
    • 10. Denial of victimization is a COPING DEFENSE for victimization
    • 11. • Bipolar II • Major Depression • Anxiety • Obsessive Compulsive Disorder • Borderline Personality Disorder • Avoidant Personality Disorder • Post-Traumatic Stress Disorder • Childhood: ADHD, Oppositional Defiant Disorder, Conduct disorder CASE EXAMPLE MDD: MULTIPLE DIAGNOSIS DISORDER
    • 12. • suicidal thought with increasing intent, • self-harm via cutting and bulimic behavior, • excessive alcohol use, frequent use of marijuana, • chaotic relationships, • somatic complaints: headaches, poor sleep, nightmares, • hears voice that commands self-hurt, • isolative behavior • periods of depression and anxiety CASE EXAMPLE THIS CLIENT REPORTS
    • 13. In conversation reveals several siblings were removed from parents’ custody due to parents’ narcotics use; client was physically beaten in foster care setting, father was “schizophrenic” and mother was “bi-polar”. Client had first sexual experience at 14 years old with a 20-year old “boy/girl” friend. Client has had several jobs in the last year, dropped out of college last year, on/off relationships with family members, answers “no” when asked: “have you ever been abused?” CASE EXAMPLE - DETAIL
    • 14. • What factors do you consider? • What do you think about family member’s diagnoses? • What do you question about the client’s account? • What is the role of “validity” of memories? • What do you NOT question? • How would you diagnose this person? • What diagnosis(es) might you expect from the doctor or prescriber? WHAT DO YOU SAY?
    • 15. copyright © 2011 Cathy S Harris, LCSW DIAGNOSIS & TREATMENT: PERPETUATING CYCLE Oppositional Defiant Disorder, Conduct Disorder, Borderline, Anti-Social, etc. No One Asks about environment thus defense: self-blame “I’m Bad” Medication, counseling focus on child as PROBLEM Adult rejects treatment, passes on pain to offspring Child “acts out” Cathy S Harris, MSW, LCSW copyright 2011
    • 16. copyright © 2011 Cathy S Harris, LCSW IT’S NOT ABOUT…. Cathy S Harris, MSW, LCSW copyright 2011
    • 17. The definition of Post-Traumatic Stress Disorder should change with the next revision (of the DSM)… “Does presence of a PTSD syndrome automatically imply exposure to severe trauma? That is true only if PTSD can arise as a specific response to severe trauma… However, if there are cases where PTSD develops in absence of severe trauma, it is not a valid assumption…it does not have to be a severe, A1-level trauma to qualify for PTSD.” DR. MICHAEL FIRST, NEW YORK STATE PSYCHIATRIC INSTITUTE Clinical Psychiatry News, November, 2007 Cathy S Harris, MSW, LCSW copyright 2011
    • 18. SUB-THRESHOLD EVENTS Cathy S Harris, MSW, LCSW copyright 2011 the stuff of injured (“dysfunctional”) families Divorce, bereavement Death of a significant person End of significant relationship Frequent coming/going of significant adults Exposure to violence: domestic, community, school Frequent moves Family member’s traumatic event Poverty, Job Loss OTHERS?
    • 19. WHAT CHANGES IF WE UNDERSTAND “SUB-THRESHOLD” EVENTS? • Leads to a new framework for understanding “oppositional” behavior • The presence of many STE conditions in a child’s family life may indicate non-nurturing, ‘not’ child-centered parenting and can result in early life stressors that may cause adult depression, anxiety and even Post- Traumatic Stress Disorder (Nemeroff: Link Between Childhood Trauma & Depression) (The Link Between Childhood Trauma and Mental Illness)
    • 20. WHAT CHANGES IF WE UNDERSTAND SUB-THRESHOLD EVENTS (CONT.) • This alternative way of viewing children’s behavior can lead to a different treatment approach that includes family systems work versus targeting the child as “the problem” and primarily utilizing medication to manage “the problem” (Systemic Treatment of Families Who Abuse: Eliana Gil)
    • 21. Assessment tools: PTSD Checklist Beck Inventories SI Alcohol, Drugs, Medications ACE Genogram History/Timeline: Social, Employment, Relationships Past Treatment: Useful/Not useful Treatment plan: Education, Skills, Processing Discharge plan: Supports, Goals WHAT IS YOUR SETTING? Assessment tools: PTSD checklist Beck Inventories ACE SI Alcohol, Drugs, Medications History: brief social Supports: formal informal Treatment plan: immediate needs SAMHSA-Self-help for trauma referrals Follow up: 1-3 days OUTPATIENT PSYCHOTHERAPY CRISIS CENTER Cathy S Harris, MSW, LCSW copyright 2011
    • 22. • Asking: “Have you been abused?” is not sufficient. • Denying abuse/victimization is a defense to cope with victimization • ACE: Ten specific questions to help persons identify traumatic experience • Early life stressors cause not only mental health problems, they contribute to later life medical health problems • Are you prepared to help your service recipients utilize their answers in a recovery-oriented way? ADVERSE CHILDHOOD EXPERIENCES STUDY: ACE Cathy S Harris LCSW copyright 2011
    • 23. • What is it? • What’s the problem? • Question authority COMORBIDITY
    • 24. WHAT IS COMORBIDITY? Wikipedia “Mental Health” In psychiatry, psychology and mental health counseling comorbidity refers to the presence of more than one diagnosis occurring in an individual at the same time. However, in psychiatric classification, comorbidity does not necessarily imply the presence of multiple diseases, but instead can reflect our current inability to supply a single diagnosis that accounts for all symptoms
    • 25. • “Multiple symptoms expressed as multiple diagnoses” • Common thread? (trauma) • Confusing for clients • Ignores/minimizes effects of social history • May contribute to over-use of medication • Mathematically impossible to meet multiple criteria per DSM .
    • 26. ? HOW IS COMORBIDITY A PROBLEM FOR YOUR CLIENTS
    • 27. Pause and relax…
    • 28. Cathy S Harris, MSW, LCSW copyright 2011
    • 29. • Errors of Logic in Biological Psychiatry • Mad in America: Bad Science, Bad Medicine, and The Enduring Mistreatment of the Mentally Ill • Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America MEDICATION
    • 30. • Client/Patient as partner • Respects strengths • Systems knowledge • All professionals (resources) Professional Relationships
    • 31. PRINCIPLES OF TREATMENT trauma aware ≠ trauma-informed
    • 32. JUDITH HERMAN: TRAUMA AND RECOVERY 1992: Three stage model 1. Establishing safety 2. Reconstructing the traumatic story 3. Restoring the connection between the survivor and his/her community.
    • 33. Trauma-Informed Care is anchored in principles of SAFETY TRUST CHOICE COLLABORATION EMPOWERMENT harris & fallot 2001 Cathy S Harris, MSW, LCSW copyright 2011
    • 34. CRITERIA FOR A USEFUL MODEL
    • 35. “the treatment of (trauma) must be based on good general principles of psychotherapy.” “BRILLIANTE” Sidran.org “…survivors are..best served by therapists who work from an environmental framework..they are more likely to see clients as experts in their own lives and (as) partners in healing.” COLIN ROSS, MD Dissociative Identity Disorder: Diagnosis, Clinical Features and Treatment, 1997
    • 36. • Safety: Environment: physical, emotional, psychological spiritual • Person centered: Validates, affirms, listens • Didactic: Skills based, practical application • Experiential: Many activities & ways to learn (respects learning styles), allows for expression of intense emotion • Recovery/Discovery oriented: “YES” to dreams & self- improvement; utilizes strengths • Relationships: Utilizes therapeutic relationship, encourages connection to larger community • Developmentally fits: age, cognitive ability, emotional maturity ESSENTIAL ELEMENTS
    • 37. copyright © 2011 Cathy S Harris, LCSW TREAT THE WHOLE PERSON Cathy S Harris, MSW, LCSW copyright 2011
    • 38. MODELS OF TREATMENT what’s in your toolbox?
    • 39. Models for Developing Trauma-Informed Behavioral Health Systems and Trauma Specific Services National Center for PTSD The National Child Traumatic Stress Network SAMHSA’s National Registry of Evidence-Based Programs and Practices Open Doors to Safety David Baldwin’s Trauma Information Pages Jim Hopper, Ph D RESOURCES Cathy S Harris, MSW, LCSW copyright 2011
    • 40. CHILDREN ADULTS FAMILIES ORGANIZATIONS
    • 41. CHILDREN • Trauma-Focused Cognitive Behavioral Therapy • DBT for adolescents • Trauma Assessment Pathway • Cognitive Behavioral Interventions for Trauma in Schools • Trauma Systems Therapy
    • 42. • Cognitive Behavioral Therapy • Cognitive Processing Therapy • Prolonged Exposure Therapy • Acceptance & Commitment Therapy • Dialectical Behavior Therapy • Seeking Safety • Psychological First Aid • Three Principles ADULTS
    • 43. COGNITIVE BEHAVIORAL THERAPY FOUNDATION FOR MANY MODELS Dr. Aaron Beck: Creator of CBT Dr. David Burns
    • 44. • Alternatives for Families • Child/Adult Relationship Enhancement • Child and Family Traumatic Stress Intervention • Trauma Adapted Family Connections FAMILIES
    • 45. • Sanctuary Model • Sandra Bloom MD • Center for Nonviolence and Social Justice ORGANIZATIONS
    • 46. ? What should a certified “Sanctuary Organization” look like? WHAT SHOULD A CERTIFIED “SANCTUARY ORGANIZATION” LOOK LIKE
    • 47. SANCTUARY MODEL: KEY ELEMENTS A Sanctuary program should be a strong, resilient, tolerant, caring, knowledge-seeking, cohesive and nonviolent community where Staff are thriving, people trust each other to do the right thing, and clients are making progress in their own recovery within the context of a truly safe and connected community
    • 48. SANCTUARY MODEL: KEY ELEMENTS CONT. Tangible results of a Sanctuary community include decreased staff turnover, decreased use of coercive measures, decreased critical incidents, staff injuries, and client injuries, greater client and staff satisfaction. Such a community is sufficiently knowledgeable that it fully recognizes the ever present possibility of violence and therefore constantly attends to protecting its social immune system against the spread of violence in any form – physical, psychological, social or moral.
    • 49. SANCTUARY MODEL: KEY ELEMENTS CONT. In such a community, communication is open, direct and honest and people trust that they will find out information that they need to make good decisions. Members of a Sanctuary community are curious about human behavior and do not assume that everyone is motivated in the same way. They are accustomed to listening deeply and to being heard by others
    • 50. EXPECTED OUTCOMES USING SANCTUARY MODEL • Less violence including physical, verbal, emotional forms of violence • Systemic understanding of complex biopsychosocial and developmental impact of trauma and abuse with implications for response • Less victim-blaming; less punitive and judgmental responses • Clearer more consistent boundaries, higher expectations, linked rights and responsibilities
    • 51. ORGANIZATIONS: SANCTUARY MODEL EXPECTED RESULTS (CONT.) • Earlier identification of and confrontation with perpetrator behavior • Better ability to articulate goals, create strategies for change, justify need for holistic approach • Understanding of reenactment behavior and resistance to change • More democratic environment at all levels • Better outcomes for clients, staff, and organization
    • 52. STAGES OF TREATMENT pacing the work
    • 53. Cathy S Harris, MSW, LCSW copyright 2011 https://www.youtube.com/watch?v=gYPZSmW05PY
    • 54. FIRST STAGE OF TREATMENT • Intake/build rapport/get the story/outline your approach, ask about preferences • Assess (observe, discuss, educate): addictions, dissociative response, anxiety, depression, Post-Traumatic Stress response • Education: IBS & AAI, Self-Management concept, Trauma Responses (triggers— including somatic, “body” responses), brain and body effects of trauma • Demonstrate and explain: Coping Skills: Breathing, Containment, Reality Checks, Pacing, specifics of Grounding, Emotion Regulation and Distress Tolerance
    • 55. EFFECTS ON THE BRAIN Cathy S Harris, MSW, LCSW copyright 2011
    • 56. EDUCATE Cathy S Harris, MSW, LCSW copyright 2011
    • 57. What makes the effects of torture linger? Bessel van der Kolk, MD
    • 58. MIDDLE STAGE OF TREATMENT • Cognitive: addresses leftover “magical thinking” reflected in IBS, depression anxiety, Post-Trauma Stress responses • Expressive: art (Soul Collage), music, anger, movement • Skills-based: Dialectical Behavior Therapy-DBT, Acceptance and Commitment Therapy- ACT, CBT: Feeling Good The New Mood Therapy • Group: Therapy and support groups • Creative writing: gives opportunity to tell one’s story, build self-esteem • Spiritual: meditation, group attendance, nature connection
    • 59. BEGIN TO WORK THROUGH IBS & AAI Introduce: Three areas of grief: 1. The Childhood the client did have 2. The Childhood the client did not have 3. The Childhood the client can never have Identify: areas of anger: Who? What? Create some way to allow client to physically express the energy of anger.
    • 60. Cathy S Harris, MSW, LCSW copyright 2011 Without expressive anger work, with whom are you working?
    • 61. LATTER STAGE OF TREATMENT • Client is able to participate in somatic therapy work, if he/she chooses • Client begins to develop compassion for self and others • Client begins to take steps to reach life goals: education, employment, relationships • Client begins to “be my own therapist”
    • 62. cognitive work TRAUMA: IBS/AAI, triangulation in relationships, depression, anxiety, PTSD STABILIZATION: SKILLS/SELF-CARE EXPRESSION/SELF-COMPASSION RESOLVE PAST/HOPE FOR FUTURE FRUITS: EMPLOYMENT EDUCATION RELATIONSHIPS SELF-EXPRESSION COMPASSION: OTHERS MATURITY: YOUR BEST LIFE GROWTH: INTEGRATION: MIND/BODY Cathy S Harris, MSW, LCSW copyright 2011
    • 63. ETHICS safety, pacing, training
    • 64. SAFETY • Knowledge and understanding about IBS and AAI • Client’s current life circumstances/age • Therapist’s awareness re: Countertransference/Personal mirrors • Memories • Abreactive work • Awareness of dissociative symptoms • Consultation/Supervision
    • 65. HOW NOT TO BE SUED “Getting sued is a cost of doing business as a trauma therapist in the United States.” Colin Ross, MD Do not have sex with your client Do not have a personal relationship with your therapy client Do not adopt the rescuer position Keep good boundaries Maintain confidentiality Obtain informed consent Keep thorough records Maintain therapeutic neutrality, especially for memory content Follow the principles and procedures of trauma therapy Obtain written consultation if necessary Stay current with the literature Obtain supervision if necessary The Trauma Model pg 313-318, 2000
    • 66. “The complex symptomatology of patients who have survived profound childhood abuse, particularly the severe dissociative and post-traumatic symptoms of patients with multiple personality disorder (MPD), may predispose therapists to engage in poorly considered psychotherapeutic practices.” James Chu, MD The Rational Treatment of Multiple Personality Disorder, 1995 Cathy S Harris, MSW, LCSW copyright 2011
    • 67. Safety: Be Aware of Dissociation • A normal response to trauma • Not only Dissociative Identity Disorder • Easily missed • “Here and Now” observation
    • 68. “Therapists should be careful to keep a rational clinical perspective, and not to be distracted by patients' unusual and dramatic clinical presentation…Therapists who do not respect traditional psychotherapeutic principles risk becoming out of control and detrimental…excessive fascination or preoccupation with MPD phenomenology can also have a number of untoward effects…” James Chu, MD The Rational Treatment of MPD, 1995 Cathy S Harris, MSW, LCSW copyright 2011
    • 69. BREATHING Holds breath, short of breath BODY LANGUAGE Rigid, sleepy, non-medically based seizures VOICE CHANGES Becomes child-like, deeper, softer, higher EYES Fixated, blinking, fluttering, evasive
    • 70. Safety: Dissociation: Resources Dissociation and Internal Models of Protection, Thomas, 2005 The Rational Treatment of Multiple Personality Disorder, Chu, 1994 Dissociative Identity Disorder, Ross, 1997 Dissociative Identity Disorder Source Book, Haddock, 2001
    • 71. PACING • Functionality • Flooding • Support • Therapeutic relationship • Trust
    • 72. TRAINING • What is my level of expertise? • Addictions • Current research • Supervision • Consultation
    • 73. SOMATIC WORK bringing the body into therapy
    • 74. Cathy S Harris, MSW, LCSW copyright 2011
    • 75. “…the trauma therapist needs to be flexible, trained in several different treatment modalities and theoretical bases… If the therapist is only trained in one model or method then clients have to adapt to that model or method. If the client can’t do that or if it doesn’t appeal, it can end up with the client feeling wrong or a failure…” BABETTE ROTHSCHILD, MSW The Body Remembers: An Interview with Babette Rothschild
    • 76. B r i n g i n g t h e B o d y i n t o T h e r a p y• Eye Movement Desensitization and Reprocessing • Trauma Release Exercises • Somatic Experiencing • Emotional Freedom Technique • Sensorimotor • Hakomi • Expressive Anger • Bioenergetics • Trauma Sensitive Yoga
    • 77. USE YOUR COMPASSION • People are trying to get their needs/perceived needs met • People are doing the best they can AND they need to improve • Explanation but NOT an excuse • “An adult complaining is as a child crying.” (Dr. Robert Mayer)

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