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ContentContent
I. Foundations
II. Development
III. Effects
IV. Treatment Approaches
Presented by Sharada on June 14, 2014Presented by Sharada on June 14, 2014
for ACCfor ACC –– Level 2 Training ProgramLevel 2 Training Program
Trauma: Working with &
Understanding & Helping Clients
2
I.I. Foundations:Foundations:
1. Terminolgy Basics1. Terminolgy Basics¹¹
Stress :Stress : the responseresponse of any organism to a
stressorstressor, a demand – Hans Selye, “The Stress of
Life(1956)
Traumatic stress : streesTraumatic stress : strees resulting from a
traumatic event (three main categories: 1.natural
events, 2.accidents, 3.person to person)
Posttraumatic stress disorderPosttraumatic stress disorder (PTSD):(PTSD): a
cronically high stress levelcronically high stress level as a result of the
disorder.disorder.
categorized with the anxiety disordersthe anxiety disorders in the
DSM (DSM-V, 2013, acc. to www.dsm5.org)
100% event dependent.
Symptoms must be present for at least 1 month.at least 1 month.
Acute :Acute : symptoms continue for up to 3 monthsup to 3 months
Cronic:Cronic: symptoms persıst longer than 3 monthslonger than 3 months
DelayedDelayed--onset:onset: symptoms emerge at least 6at least 6
months following an eventmonths following an event (APA, 2000).
DelayedDelayed--onset:onset: iincludes disturbances first arisingfirst arising
in adulthoodin adulthood that have roots in childhoodroots in childhood
trauma.trauma.
Acute stress disorderAcute stress disorder (ASD):(ASD): a cronicallycronically
high stress levelhigh stress level as a result of the disorder.disorder.
has thehas the same origins and symptomssame origins and symptoms as PTSD.
PTSD & ASD are the samesame disorder in differentdifferent
phasesphases.
isis short lived;short lived; symptoms resolve within a month.within a month.
Only 20Only 20--25% of people25% of people who experience
traumatic incidents develop PTSD.PTSD.
It depends on the eventevent and the personperson
Men experience moreexperience more traumatic events
WomenWomen are more likelymore likely to develop PTSD
(After a traumatic event, 20% of women & 8%
of men get PTSD.)
3
I. Foundations:
2. Types¹
A. SingleA. Single--Blow vBlow versusersus RepeatedRepeated
1.1. Natural disesters:Natural disesters:
❑❑ the communitythe community pulls togetherpulls together around naturalaround natural
disestars; people help, support each other.disestars; people help, support each other.
Examples:Examples: earthquakes, tornados,earthquakes, tornados, avalanches,avalanches,
fires, floods, hurricanes and volcanic eruptionsfires, floods, hurricanes and volcanic eruptions..
22. Technological disestars. Technological disestars
❑❑ tend to be more sociallytend to be more socially divisivedivisive,, because muchbecause much
attention is diverted to finding fault and fixingattention is diverted to finding fault and fixing
blame.blame.
Examples:Examples: dam breaks, building collapses, planedam breaks, building collapses, plane
crashes, chemical spills and nuclear reactorcrashes, chemical spills and nuclear reactor
failure.failure.
33.. Criminal ViolenceCriminal Violence
❑❑ DirectDirect impact on victims,impact on victims, indirectindirect effect oneffect on
thosethose whowho witnesswitness them, on those whosethem, on those whose lovedloved
onesones are injured or killedare injured or killed..
Examples:Examples: bbuurglarglary, robbery, aggravated assault,ry, robbery, aggravated assault,
rape, and homiciderape, and homicide..
❑❑ Traumatic experiences areTraumatic experiences are prolongedprolonged, &, &
repeatedrepeated , sometimes, sometimes extending overextending over
many yearsmany years..
B. Natural versus ManB. Natural versus Man--madeTraumamadeTrauma
1.1. War and political violenceWar and political violence
❑❑ Severe, repeated and prolonged.Severe, repeated and prolonged.
❑❑ Being the passive victim of violence,Being the passive victim of violence,
❑❑ Being active participant: the injuring &Being active participant: the injuring &
killing=violence to onekilling=violence to one’’s identitys identity
2.2. Criminal violCriminal violeencence
❑❑ RapeRape
❑❑ Domestic violanceDomestic violance
❑❑ Child abuse:Child abuse:
physical,physical,
emotional,emotional,
sexualsexual
by parents, siblings,by parents, siblings, otherother relatives,relatives,
neighboneighbouursrs
4
I.I. Foundations:Foundations:
3. Severity and Symptoms3. Severity and Symptoms²²
The higherhigher the “dosedose” of trauma, the
more potentially damaging its effect.
The greatorgreator the stressorstressor, the more the
likelihood of developing PTSD.
The typetype and contextcontext of the trauma are
also extremely important factors.
The effectseffects are likely to be most severemost severe is
the trauma (characteristics) is
man-made
repeated
unpredictable
inflicted with sadhistic or malevont intent
undergone in childhood
perpetrated by a caregiver
Symptoms include:
re-experiencing symptoms
(for example, flashbacks, nightmares)
avoidance of people or situations
associated with the event
emotional numbing
hyperarousal.
5
II. Development:
1.Trauma & Nervous System³
Stress & traumaStress & trauma are primarily nonare primarily non--
cognitive phenomenon:cognitive phenomenon:
nonnon--primitive,primitive,
nonnon--conscious,conscious,
nonnon--cognitive,cognitive,
nonnon--verbalverbal
area of the mind, namely in Autonomicarea of the mind, namely in Autonomic
Nervous System (ANS).Nervous System (ANS).
Autonomic Nervous SystemAutonomic Nervous System controlscontrols
thousands of physiological functionsthousands of physiological functions
includingincluding: heart rate, body temperature,
pupil dilation, breathing, oxygen in blood,
digestion, hormones
ANS deeply influencesANS deeply influences
Body sensations,
Emotional state,
Sense of Self,
Sense of others,
Sense of world
Stress & trauma symptoms areStress & trauma symptoms are
adaptive survival responsesadaptive survival responses toto threat.threat.
TheThe greater the threat,greater the threat, the greaterthe greater
the reactionthe reaction in ANSin ANS..
Even when the treat has passetreat has passedd the
ANS can retain activationretain activation. This is due
to attractor statesattractor states or “troughs” built
into the ANS.
When a treat passes, we are more
into an activated state, but we
typically interrupt the processinterrupt the process.
6
II. Development:
2.Stress & Trauma Symtoms³
Even when a threat passes, we move into activated state, butEven when a threat passes, we move into activated state, but
we typically interrupt the process, butwe typically interrupt the process, but the emotional reactionsthe emotional reactions
can becan be kept alivekept alive long after the original trauma is past.long after the original trauma is past.
vision
changes:
clouded
or tunnel
feelings of
unreality
complete dissociation
feeling
disconnected
blank affect,
numbness,
State 4: Trauma
❑❑❑❑ Absence of State
1 and State 2
symptoms
slow
thoughts
sensation of
heavy weight,
nausea
collapsed posture,
fogginess/dissociatio
n, lessening muscle
tension
feeling cold
lethargy,
sleepiness,
heaviness,
confusion,
hopelessness
State 3: Moderate
TraumaAt overwhelm
point where
fight--or- flight
isn't enough, a
massieve
parasympatheti
c response
emerges.
very fast
thoughts
maximum
activation &
performance
overall body tension:
muscle contracting
hyperventilation,
sweating, shaking,
trembling
panic,
rage,
terror
State 2: High
Stress
❑❑❑❑ short-duration
❑❑❑❑ semi-stable
speedy
thoughts
restlesness or
feeling fidgety,
feeling nervous
somatic tension: tight
muscles, headache or
other pain, sensations
of heat
increased heart
rate,
breath speed,
insomnia
fear,
anxiety,
anger,
excitement,
irritability,
annoyance
State 1: Mild StressThe
brain(mind)
detects a treat,
activates the
sympathetic
nervous system
to be prepared
to fight or flee.
7
III. EIII. Effectsffects
11.. AAttachmentttachment²²
Attachment theoryAttachment theory is indispensableindispensable for
understanding traumatic experiences.
AttachmentAttachment is theis the basis ofbasis of ourour sense ofsense of
safety and securitysafety and security in the world. Securein the world. Secure
attachments canattachments can make trauma moremake trauma more
bearablebearable by restoring a sense ofby restoring a sense of
security. Because attachments aresecurity. Because attachments are
healing, establishing or reestablishing ahealing, establishing or reestablishing a
sense of secure attachment.sense of secure attachment.
Bowlby’s idea of secure basesecure base provides aa
feeling of securityfeeling of security. It is a home base
from which the youngster feels
confident to exploreconfident to explore the world. When
traumatrauma impinges on this sense of
security, exploration, initiative, &exploration, initiative, &
autonomyautonomy are underminedundermined.
A secure attachmentA secure attachment at theat the
first 12 monthsfirst 12 months portends,portends, GoodGood
adjustmentadjustment in laterin later whichwhich
includes good coping skills, goodincludes good coping skills, good
peer relationships, and reducedpeer relationships, and reduced
risk of psychiatric disturbance.risk of psychiatric disturbance.
8
III. EIII. Effectsffects
2. The2. The SelfSelf²²
Self-dependence
SelfSelf--continuitycontinuity :
developmental achievement
1.cohesiveness 2.unity
3.integrity 4.wholeness
5.identity ((TraumaTrauma→→SevereSevere
internalinternal cconflictonflict→→PowerlesnessPowerlesness))
Self-experience
ATTACHMENTATTACHMENTAUTONOMYAUTONOMY
Self in relationsSelf in solitude
Public Self ❑❑❑❑ the basis of your
sense of ''me'' that is reflected from
others ❑❑❑❑ the outer surface of the
self
Private self ❑the inner core ❑❑❑❑
beyond being covered up, never
shared ❑❑❑❑ an independent agent ❑❑❑❑
the source of authonomy
'Me' – Objective self
❑❑❑❑ Reflected on your ‘self-concept’
❑❑❑❑ how your self thinks about itself
❑❑❑❑ associated with a feeling of
positive self-esteem, derived partly
from caring and affirming
relationships ❑❑❑❑ Depends on how
others view, respond to & treat you
'I' – Subjective self
❑ your active self in choosing,
initiating, organizing &
interpreting ❑❑❑❑ a feeling of being
myself that is stable across time
& space: a sense of continuitya sense of continuity
9
III. Effects
3.Vulnerable Identities4 and
The Four types of Aversive Emotions²
Traumatic events have the power not just to make us have negative thoughtsnegative thoughts but
wounds the selfwounds the self and sense of competencesense of competence and masterymastery. 4”
Shame and GuiltShame and Guilt
1.1. inability to protectinability to protect himself from illness,
violence, or abuse
2.2. invalidatinginvalidating positive identitypositive identity indicating a
total surrender of the combat veterans,
captivity, traumatic injuries, burns or grief
DepressionDepression
3. Loss of identityLoss of identity indicating a total surrender
of the combat veterans, captivity, traumatic
injuries, burns or debilitating disease
Anger and AgressionAnger and Agression
4.4. The feelings of estrangementestrangement & isolationisolation
accompanied by angeranger
5. NotNot being valuedbeing valued && treated withtreated with
considerationconsideration is another source ofis another source of angeranger
Anxiety, Fear, and PanicAnxiety, Fear, and Panic
6.6. a paranoid attitudea paranoid attitude to the world and ato the world and a
comprehensivecomprehensive destruction of social trustdestruction of social trust..
Positive change and growthPositive change and growth
7.7. An incompetent selfincompetent self being supplanted by a
competent onecompetent one
1.1. The Self as Powerless :The Self as Powerless : “I felt like I was
observer watching what was happening to me.”
2. Experiencing the Self as Inferior:2. Experiencing the Self as Inferior:
“It’s been months since the attack, and I’m still not
over it-what’s wrong with me?”
3.3. Experiencing the Self as Nonexistent orExperiencing the Self as Nonexistent or
FuturelessFutureless:: “Now I just live day to day.”
“I died in Vietnam.”
4.4. Experiencing the Other as AbandoningExperiencing the Other as Abandoning::
“I couldn’t bear the thought that I would never see my
family again.”
55.. Experiencing the Other as HostileExperiencing the Other as Hostile
“I just felt he hated me and wanted me to suffer.”
6. Experiencing the Other as Betraying6. Experiencing the Other as Betraying::
“He was the only person I thought I could rely on.”
77.. Experiencing the Self More PositivelyExperiencing the Self More Positively::
“Every day I wake up feeling grateful I’m alive.”
10
III. EIII. Effects:ffects:
44.. RelationshipsRelationships²²
TTraumatic bonding:raumatic bonding: “The more one is abused and terrorized, the harder one
clings to the abuser.” – compulsion to repeat the earlier destructive pattern (Freud)
Problematic ModelsProblematic Models
Isolation
Yearning
Fearfulness
Dependency
Vulnerability to harm: “the failure of self-protection”
Extreme Needs for Control
Internalization of Aggressive Models
Developing new modelsnew models in the group:,
Benign Models for “secure attachmentsecure attachment”, “intimacyintimacy”, “making connectionmaking connection”,
“cooperetioncooperetion”, and “resolving controversyresolving controversy” can be learned, generalized, old
models supplanted.
SelfSelf--DependenceDependence : “balancing autonomy and attachment” (Joseph Lichtenber-Psychoanalist)
a healthy balance b/w Selfa healthy balance b/w Self--development and relationshipsdevelopment and relationships with others, which
requires to have a sense of continuitya sense of continuity in the relationships.
11
IV.IV. Treatment Approaches to Help ClientsTreatment Approaches to Help Clients
1.1. A spectrum ofA spectrum of the Most Readily Visiblethe Most Readily Visible
Trauma Therapy MethodsTrauma Therapy Methods¹¹
❑❑❑❑ Feldenkrais
❑❑❑❑ Pilates
❑❑❑❑ Alexander
Strengtening
Training
Relaxation
training
MindfulnessYoga &
Meditation
VVII. Non. Non--
psychologicalpsychological
Body TherapiesBody Therapies
❑❑❑❑ Play Therapy
❑❑❑❑ Sandplay
therapy
Poetry
Therapy &
bibliotherapy
Drama Therapy
❑❑❑❑ Music Therapy
❑❑❑❑ Dance &
Movement
Therapy
Art Therapy
V. ExpressiveV. Expressive
TherapiesTherapies
Hypnosis
Equine-
Assisted
Psychotherapy
Transactional
Analysis
Psychoanalysis
Psychodynamic
P.
IV. AdditionalIV. Additional
PsychotherpiesPsychotherpies
Traumatic
Incident
Reduction
Energy
Therapies:
❑❑❑❑Thought Field
Therapy
❑❑❑❑ Emotional
Friedom
Technique(EFT)
Eye Movement
Desensitization
& Reprocessing
(EMDR)
Neurolinguistic
Programming
III. SpecializedIII. Specialized
TraumaTrauma
TherapiesTherapies
(Power Therapies)(Power Therapies)
Somatic
Trauma
Therapy (STT)
Bodynamic
Analysis (BA)
Sensorimotor
Psychotherapy
Somatic
Experiencing
II. SomaticII. Somatic
PsychotherapiesPsychotherapies
Dialectic
Behavior
Therapy(DBT)
Prolonged
Exposure
(flooding)
Cognitive-
Behavioral
Therapy
I. CognitiveI. Cognitive
TherapiesTherapies
12
IV.IV. Treatment Approaches to Help ClientsTreatment Approaches to Help Clients
2.2. Common & Different Components of Trauma TherapiesCommon & Different Components of Trauma Therapies¹¹,,¹º¹º
CommonalitiesCommonalities
Only goalOnly goal is improvingis improving the quality ofthe quality of
lifelife ― on a dayon a day--toto--day basisday basis ― of theof the
traumatized individual.traumatized individual.
Central Aim of the processCentral Aim of the process is
regainingregaining a feeling of personal controlcontrol
& integrityintegrity .
Major componentMajor component is ccontactontact & ssupportupport
with a helping professional & the client's
network.
ShameShame & GuiltGuilt are necessary
components of the ultimateultimate
integrationintegration.
DifferencesDifferences
Working with or withoutWorking with or without processingprocessing
trauma memoriestrauma memories (Power Ts)
The bodyThe body’’s responses to emotions &s responses to emotions &
thought processthought process as being the
foundation (Somatic Ps)
Helping clients to change intrusivechange intrusive
sensory imagessensory images & increaseincrease control overcontrol over
symptomssymptoms (Power & Cognitive Ts)
emphasis on therapeutic relationshiptherapeutic relationship
b/w therapist & the CIb/w therapist & the CI and targeting
attachment issues (Additional Ps)
Working withWorking with creative expressioncreative expression &&
nnonon--psychologicalpsychological bbodyody trainingstrainings
A threeA three--phased approachphased approach (Pierre Janet)(Pierre Janet)
Phase1:Phase1: Stabilization & safetyStabilization & safety
(a) Education (b) Identification of feelings through(a) Education (b) Identification of feelings through
verbalizing somatic statesverbalizing somatic states
Phase2:Phase2: Remembering & processingRemembering & processing
trauma memoriestrauma memories (deconditioning)(deconditioning)
Phase3:Phase3: Integration with family & culture,Integration with family & culture,
and normal daily lifeand normal daily life (restructuring of(restructuring of
traumatic personal schemes)traumatic personal schemes)
(a) Reestablishment of secure social connections &(a) Reestablishment of secure social connections &
interpersonal efficacy (b) Accumulation ofinterpersonal efficacy (b) Accumulation of
restitutive emotional experiencesrestitutive emotional experiences
13
IV.IV. Treatment Approaches to Help ClientsTreatment Approaches to Help Clients
3.3. PersonPerson--Centered Expressive Arts TherapyCentered Expressive Arts Therapy⁵⁵⁵⁵⁵⁵⁵⁵,,⁶⁶⁶⁶⁶⁶⁶⁶
A multimodal approachA multimodal approach iintegratingntegrating
mind, body, emotions, & spiritual innermind, body, emotions, & spiritual inner
resources through the use of various artresources through the use of various art
forms.forms.
Natalie Roger’s method’s of expressive
art therapy are based on the humanisticbased on the humanistic
principlesprinciples :
All people have an innate ability to
create.
The creative processThe creative process is healing.
Personal growt & higher states ofPersonal growt & higher states of
consciousness are achieved throughconsciousness are achieved through selfself--
awareness, selfawareness, self--understanding, andunderstanding, and
insight.insight.
Self-awareness, self-understanding, and
insight are achievedachieved by delving into ourour
emotions.emotions.
Our feelings and emotions are an energyan energy
source.source. That energy can be channeledchanneled
intointo the expressive arts to be released &to be released &
transformed.transformed.
When used alone and/or with otheralone and/or with other
formsforms of healthcare practices, art
therapy cancan healheal stress disorders,
traumatic events, and cognitive
disorientations .
14
IV.IV. Treatment Approaches to Help ClientsTreatment Approaches to Help Clients
44.. NonNon--psychological Body Therapies:psychological Body Therapies:
YogaYoga  and Meditationand Meditation⁷⁷⁷⁷⁷⁷⁷⁷,,⁹⁹⁹⁹⁹⁹⁹⁹
The word “yogayoga” means “unity,
harmony”. Yoga can help throughYoga can help through
Harmonization of body, mind & soul,
Unification with the true-self,
Reawakening of dormant skills
Yoga is practised in 8 steps for
entightenment on selfentightenment on self--realizationrealization.
1. Yama:1. Yama: ethicalethical rulesrules forfor social lifesocial life..
2. Niyama:2. Niyama: ethicalethical rules forrules for private lifeprivate life..
3. Asana3. Asana(( postureposture)) controlcontrol over theover the bodybody
4. Pranayama:4. Pranayama: controlcontrol over theover the breath
5. Pratyahara:5. Pratyahara: controlcontrol over theover the sensessenses..
6.Dharana:6.Dharana: concentrationconcentration on oneon one objectobject..
7. Dhyana:7. Dhyana: meditationmeditation onon oneone objectobject forfor sometimesometime
8. Samadhi:8. Samadhi: enlightenmentenlightenment..
A key finding from these brain scans isA key finding from these brain scans is
that during traumatic stress,that during traumatic stress, the speechthe speech
center shutscenter shuts downdown.. ““This is whyThis is why talktalk
therapy is limited in helpingtherapy is limited in helping someonesomeone
recover from or heal fromrecover from or heal from
overwhelming stressoverwhelming stress..””
Since 2006 traumaSince 2006 trauma--sensitive yogasensitive yoga is used
to heal trauma survivors & people with
PTSD in the Trauma Center in Brookline,
Massachussets.
Head of Center , Dr. Bessel van der Kolk,
who is the recognized authority on PTSD,
uses yoga asyoga as an adjunct to talk therapyan adjunct to talk therapy toto
heal bodyheal body--mind disconnectedness.mind disconnectedness.
The Trauma CenterThe Trauma Center’’s research hass research has
shown thatshown that a 10 week session of traumaa 10 week session of trauma
sensitive yogasensitive yoga producesproduces measurablemeasurable
resultsresults..
15
IV.IV. Treatment Approaches to Help ClientsTreatment Approaches to Help Clients
44.. NonNon--psychological Body Therapies:psychological Body Therapies:
MindfulnessMindfulness¹¹,,⁷⁷⁷⁷⁷⁷⁷⁷,,⁸⁸⁸⁸⁸⁸⁸⁸
BothBoth mindfulnessmindfulness && meditationmeditation isis thethe
oldest in the East and the newest in theoldest in the East and the newest in the
West as treatment optionsWest as treatment options
Somatic psychotherapiesSomatic psychotherapies have been applying
the secular aspects of mindfulness for more
than 100 years.
The cognitive therapiesThe cognitive therapies have reinvented &have reinvented &
embraced mindfulness as one of their ownembraced mindfulness as one of their own
in the 21in the 21stst Century.Century.
Since 1979Since 1979,, Jon KabatJon Kabat--ZinnZinn havehave
pioneeredpioneered
the integration ofthe integration of mindfulnessmindfulness
meditationmeditation && otherother mindfulnessmindfulness--basedbased
approachesapproaches inin mainstream medicine &mainstream medicine &
healthcare.healthcare.
Mindfulness means paying attentionpaying attention in a
particular way; on purposeon purpose, in the presentin the present
momentmoment, and nonnon judgmentallyjudgmentally.
AttituteAttitute is based on: 1.non-judging,
2.Patience, 3.Beginner’s mind, 4.Trust
5.Non-striving, 6.Acceptance 7. Letting go
PracticePractice requires commitmentcommitment, selfself--disciplinediscipline,
and intentinalityintentinality.
❑❑❑❑ 4 main aspects4 main aspects of mindfulness in
resolving traumatic stress & PTSD:
1. body awarenessbody awareness
2.2. attentivenessattentiveness to the quality of howto the quality of how
an emotionan emotion feels infeels in the bodythe body
3.3. attention to the mindattention to the mind
4.4. spiritual facetspiritual facet: the identification of: the identification of
sufferings as a guidance in living ansufferings as a guidance in living an
ethical life.ethical life.
16
IV.IV. Treatment Approaches to Help ClientsTreatment Approaches to Help Clients
10 Foundations of Safe Trauma Therapy10 Foundations of Safe Trauma Therapy ¹¹
1. First task of recovery:1. First task of recovery: Establish the survivor’s safetysafety within
& outside the therapy (suicide and homicide prevention) .
2. Prerequisite:2. Prerequisite: developdevelop therapeutic alliancetherapeutic alliance before youbefore you
address traumatic memories.address traumatic memories.
3. Apply the brakes before accelerator:3. Apply the brakes before accelerator: work slowly with an
emphasis on containment.
4. Don4. Don’’t forget the accompanying mechanismst forget the accompanying mechanisms . Identify &
build on the client’s internal & external resources.
5. Regard defenses as resources.5. Regard defenses as resources. Never get rid of coping
strategies or defenses; instead, create more choices.
6. View trauma as a pressure cooker.6. View trauma as a pressure cooker. Always work to reduce –
never to increase- the pressure.
7. Adapt the therapy to the client,7. Adapt the therapy to the client, rather than expecting the
client to adapt to the therapy.
8. A good grounding in theory8. A good grounding in theory makes not only for a better
informedinformed therapist but also a more creativecreative & flexibleflexible one.
9. Regard the client9. Regard the client’’s individual differences.s individual differences. Never expect one
intervention to have the same result with two clients.
10. Be prepared at times10. Be prepared at times – or even for a whole course of
therapy – to put aside all techniquesto put aside all techniques && just be togetherjust be together
talkingtalking oror just sitting quietly.just sitting quietly.
Suicide rate amongst Veterans is estimated to
be 22 SUICIDES PER DAY! PTSD and TBI are
mentally and physically debilitating conditions.
We provide task trained service dogs at no cost.
17
Reference Sources:Reference Sources:
1. Trauma Essentials: The Go-To Guide, Babette Rothschild, W.W.Norton & Compant, Inc., ISBN-13:978-0-393-
70620.
2. Coping with Trauma, A Guide to Self-Understanding, Jon G. Allen, Ph.D., American Psychiatric Press,
ISBN-13:978-0-88048-996-0.
3. “Lecture: Mapping the Authonomic Nervous System”, Online Videos, http://www.loveandtrauma.com/videos.
4. The Post-Traumatic Stress Disorder: Malady or Myth?, Chris R. Brewin, Yale University Press,
ISBN-13:978-0-300-12374-6.
5. “Person-Centered Expressive Arts in Groups”, p.275-279, Theory and Practise of Group Counselling, Gerald
Corey, Brooks/Cole, Cengage Learning, ISBN-13:978-0-8400-3389-5.
6. “Art Therapy”, http://www.sjcshk.com/Art%20Therapy.html
7. “Mind-Body Practices from Recovery from Sexual Trauma”, p.199-216, Patricia L. Gerbarg and Richard P.Brown,
Surviving Sexual Violence: A Guide to Recovery & Empowerment, ed. Thema Bryant-Davis , Rowman &
Littlefield Publishers, Inc., ISBN-13:978-1-4422-0639-7.
8. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to face Stress, Pain, and Illness,
John Kabat-Zinn, Ph.D., Delta Trade, ISBN-13:978-0-385-30312-5.
9. “More than 30 years International Distinction”, University of Massachusettes Medical School, Center for
Mindfulness in Medicine, Health Care, and Society, http://www.umassmed.edu/Content.aspx?id=41252
10.Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body & society, Ed. Bessel A. Van
der Kolk, The Guilford Press, ISBN: 1-57230-088-4.

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Trauma 14June2014 Sharada_DAY9

  • 1. 1 ContentContent I. Foundations II. Development III. Effects IV. Treatment Approaches Presented by Sharada on June 14, 2014Presented by Sharada on June 14, 2014 for ACCfor ACC –– Level 2 Training ProgramLevel 2 Training Program Trauma: Working with & Understanding & Helping Clients
  • 2. 2 I.I. Foundations:Foundations: 1. Terminolgy Basics1. Terminolgy Basics¹¹ Stress :Stress : the responseresponse of any organism to a stressorstressor, a demand – Hans Selye, “The Stress of Life(1956) Traumatic stress : streesTraumatic stress : strees resulting from a traumatic event (three main categories: 1.natural events, 2.accidents, 3.person to person) Posttraumatic stress disorderPosttraumatic stress disorder (PTSD):(PTSD): a cronically high stress levelcronically high stress level as a result of the disorder.disorder. categorized with the anxiety disordersthe anxiety disorders in the DSM (DSM-V, 2013, acc. to www.dsm5.org) 100% event dependent. Symptoms must be present for at least 1 month.at least 1 month. Acute :Acute : symptoms continue for up to 3 monthsup to 3 months Cronic:Cronic: symptoms persıst longer than 3 monthslonger than 3 months DelayedDelayed--onset:onset: symptoms emerge at least 6at least 6 months following an eventmonths following an event (APA, 2000). DelayedDelayed--onset:onset: iincludes disturbances first arisingfirst arising in adulthoodin adulthood that have roots in childhoodroots in childhood trauma.trauma. Acute stress disorderAcute stress disorder (ASD):(ASD): a cronicallycronically high stress levelhigh stress level as a result of the disorder.disorder. has thehas the same origins and symptomssame origins and symptoms as PTSD. PTSD & ASD are the samesame disorder in differentdifferent phasesphases. isis short lived;short lived; symptoms resolve within a month.within a month. Only 20Only 20--25% of people25% of people who experience traumatic incidents develop PTSD.PTSD. It depends on the eventevent and the personperson Men experience moreexperience more traumatic events WomenWomen are more likelymore likely to develop PTSD (After a traumatic event, 20% of women & 8% of men get PTSD.)
  • 3. 3 I. Foundations: 2. Types¹ A. SingleA. Single--Blow vBlow versusersus RepeatedRepeated 1.1. Natural disesters:Natural disesters: ❑❑ the communitythe community pulls togetherpulls together around naturalaround natural disestars; people help, support each other.disestars; people help, support each other. Examples:Examples: earthquakes, tornados,earthquakes, tornados, avalanches,avalanches, fires, floods, hurricanes and volcanic eruptionsfires, floods, hurricanes and volcanic eruptions.. 22. Technological disestars. Technological disestars ❑❑ tend to be more sociallytend to be more socially divisivedivisive,, because muchbecause much attention is diverted to finding fault and fixingattention is diverted to finding fault and fixing blame.blame. Examples:Examples: dam breaks, building collapses, planedam breaks, building collapses, plane crashes, chemical spills and nuclear reactorcrashes, chemical spills and nuclear reactor failure.failure. 33.. Criminal ViolenceCriminal Violence ❑❑ DirectDirect impact on victims,impact on victims, indirectindirect effect oneffect on thosethose whowho witnesswitness them, on those whosethem, on those whose lovedloved onesones are injured or killedare injured or killed.. Examples:Examples: bbuurglarglary, robbery, aggravated assault,ry, robbery, aggravated assault, rape, and homiciderape, and homicide.. ❑❑ Traumatic experiences areTraumatic experiences are prolongedprolonged, &, & repeatedrepeated , sometimes, sometimes extending overextending over many yearsmany years.. B. Natural versus ManB. Natural versus Man--madeTraumamadeTrauma 1.1. War and political violenceWar and political violence ❑❑ Severe, repeated and prolonged.Severe, repeated and prolonged. ❑❑ Being the passive victim of violence,Being the passive victim of violence, ❑❑ Being active participant: the injuring &Being active participant: the injuring & killing=violence to onekilling=violence to one’’s identitys identity 2.2. Criminal violCriminal violeencence ❑❑ RapeRape ❑❑ Domestic violanceDomestic violance ❑❑ Child abuse:Child abuse: physical,physical, emotional,emotional, sexualsexual by parents, siblings,by parents, siblings, otherother relatives,relatives, neighboneighbouursrs
  • 4. 4 I.I. Foundations:Foundations: 3. Severity and Symptoms3. Severity and Symptoms²² The higherhigher the “dosedose” of trauma, the more potentially damaging its effect. The greatorgreator the stressorstressor, the more the likelihood of developing PTSD. The typetype and contextcontext of the trauma are also extremely important factors. The effectseffects are likely to be most severemost severe is the trauma (characteristics) is man-made repeated unpredictable inflicted with sadhistic or malevont intent undergone in childhood perpetrated by a caregiver Symptoms include: re-experiencing symptoms (for example, flashbacks, nightmares) avoidance of people or situations associated with the event emotional numbing hyperarousal.
  • 5. 5 II. Development: 1.Trauma & Nervous System³ Stress & traumaStress & trauma are primarily nonare primarily non-- cognitive phenomenon:cognitive phenomenon: nonnon--primitive,primitive, nonnon--conscious,conscious, nonnon--cognitive,cognitive, nonnon--verbalverbal area of the mind, namely in Autonomicarea of the mind, namely in Autonomic Nervous System (ANS).Nervous System (ANS). Autonomic Nervous SystemAutonomic Nervous System controlscontrols thousands of physiological functionsthousands of physiological functions includingincluding: heart rate, body temperature, pupil dilation, breathing, oxygen in blood, digestion, hormones ANS deeply influencesANS deeply influences Body sensations, Emotional state, Sense of Self, Sense of others, Sense of world Stress & trauma symptoms areStress & trauma symptoms are adaptive survival responsesadaptive survival responses toto threat.threat. TheThe greater the threat,greater the threat, the greaterthe greater the reactionthe reaction in ANSin ANS.. Even when the treat has passetreat has passedd the ANS can retain activationretain activation. This is due to attractor statesattractor states or “troughs” built into the ANS. When a treat passes, we are more into an activated state, but we typically interrupt the processinterrupt the process.
  • 6. 6 II. Development: 2.Stress & Trauma Symtoms³ Even when a threat passes, we move into activated state, butEven when a threat passes, we move into activated state, but we typically interrupt the process, butwe typically interrupt the process, but the emotional reactionsthe emotional reactions can becan be kept alivekept alive long after the original trauma is past.long after the original trauma is past. vision changes: clouded or tunnel feelings of unreality complete dissociation feeling disconnected blank affect, numbness, State 4: Trauma ❑❑❑❑ Absence of State 1 and State 2 symptoms slow thoughts sensation of heavy weight, nausea collapsed posture, fogginess/dissociatio n, lessening muscle tension feeling cold lethargy, sleepiness, heaviness, confusion, hopelessness State 3: Moderate TraumaAt overwhelm point where fight--or- flight isn't enough, a massieve parasympatheti c response emerges. very fast thoughts maximum activation & performance overall body tension: muscle contracting hyperventilation, sweating, shaking, trembling panic, rage, terror State 2: High Stress ❑❑❑❑ short-duration ❑❑❑❑ semi-stable speedy thoughts restlesness or feeling fidgety, feeling nervous somatic tension: tight muscles, headache or other pain, sensations of heat increased heart rate, breath speed, insomnia fear, anxiety, anger, excitement, irritability, annoyance State 1: Mild StressThe brain(mind) detects a treat, activates the sympathetic nervous system to be prepared to fight or flee.
  • 7. 7 III. EIII. Effectsffects 11.. AAttachmentttachment²² Attachment theoryAttachment theory is indispensableindispensable for understanding traumatic experiences. AttachmentAttachment is theis the basis ofbasis of ourour sense ofsense of safety and securitysafety and security in the world. Securein the world. Secure attachments canattachments can make trauma moremake trauma more bearablebearable by restoring a sense ofby restoring a sense of security. Because attachments aresecurity. Because attachments are healing, establishing or reestablishing ahealing, establishing or reestablishing a sense of secure attachment.sense of secure attachment. Bowlby’s idea of secure basesecure base provides aa feeling of securityfeeling of security. It is a home base from which the youngster feels confident to exploreconfident to explore the world. When traumatrauma impinges on this sense of security, exploration, initiative, &exploration, initiative, & autonomyautonomy are underminedundermined. A secure attachmentA secure attachment at theat the first 12 monthsfirst 12 months portends,portends, GoodGood adjustmentadjustment in laterin later whichwhich includes good coping skills, goodincludes good coping skills, good peer relationships, and reducedpeer relationships, and reduced risk of psychiatric disturbance.risk of psychiatric disturbance.
  • 8. 8 III. EIII. Effectsffects 2. The2. The SelfSelf²² Self-dependence SelfSelf--continuitycontinuity : developmental achievement 1.cohesiveness 2.unity 3.integrity 4.wholeness 5.identity ((TraumaTrauma→→SevereSevere internalinternal cconflictonflict→→PowerlesnessPowerlesness)) Self-experience ATTACHMENTATTACHMENTAUTONOMYAUTONOMY Self in relationsSelf in solitude Public Self ❑❑❑❑ the basis of your sense of ''me'' that is reflected from others ❑❑❑❑ the outer surface of the self Private self ❑the inner core ❑❑❑❑ beyond being covered up, never shared ❑❑❑❑ an independent agent ❑❑❑❑ the source of authonomy 'Me' – Objective self ❑❑❑❑ Reflected on your ‘self-concept’ ❑❑❑❑ how your self thinks about itself ❑❑❑❑ associated with a feeling of positive self-esteem, derived partly from caring and affirming relationships ❑❑❑❑ Depends on how others view, respond to & treat you 'I' – Subjective self ❑ your active self in choosing, initiating, organizing & interpreting ❑❑❑❑ a feeling of being myself that is stable across time & space: a sense of continuitya sense of continuity
  • 9. 9 III. Effects 3.Vulnerable Identities4 and The Four types of Aversive Emotions² Traumatic events have the power not just to make us have negative thoughtsnegative thoughts but wounds the selfwounds the self and sense of competencesense of competence and masterymastery. 4” Shame and GuiltShame and Guilt 1.1. inability to protectinability to protect himself from illness, violence, or abuse 2.2. invalidatinginvalidating positive identitypositive identity indicating a total surrender of the combat veterans, captivity, traumatic injuries, burns or grief DepressionDepression 3. Loss of identityLoss of identity indicating a total surrender of the combat veterans, captivity, traumatic injuries, burns or debilitating disease Anger and AgressionAnger and Agression 4.4. The feelings of estrangementestrangement & isolationisolation accompanied by angeranger 5. NotNot being valuedbeing valued && treated withtreated with considerationconsideration is another source ofis another source of angeranger Anxiety, Fear, and PanicAnxiety, Fear, and Panic 6.6. a paranoid attitudea paranoid attitude to the world and ato the world and a comprehensivecomprehensive destruction of social trustdestruction of social trust.. Positive change and growthPositive change and growth 7.7. An incompetent selfincompetent self being supplanted by a competent onecompetent one 1.1. The Self as Powerless :The Self as Powerless : “I felt like I was observer watching what was happening to me.” 2. Experiencing the Self as Inferior:2. Experiencing the Self as Inferior: “It’s been months since the attack, and I’m still not over it-what’s wrong with me?” 3.3. Experiencing the Self as Nonexistent orExperiencing the Self as Nonexistent or FuturelessFutureless:: “Now I just live day to day.” “I died in Vietnam.” 4.4. Experiencing the Other as AbandoningExperiencing the Other as Abandoning:: “I couldn’t bear the thought that I would never see my family again.” 55.. Experiencing the Other as HostileExperiencing the Other as Hostile “I just felt he hated me and wanted me to suffer.” 6. Experiencing the Other as Betraying6. Experiencing the Other as Betraying:: “He was the only person I thought I could rely on.” 77.. Experiencing the Self More PositivelyExperiencing the Self More Positively:: “Every day I wake up feeling grateful I’m alive.”
  • 10. 10 III. EIII. Effects:ffects: 44.. RelationshipsRelationships²² TTraumatic bonding:raumatic bonding: “The more one is abused and terrorized, the harder one clings to the abuser.” – compulsion to repeat the earlier destructive pattern (Freud) Problematic ModelsProblematic Models Isolation Yearning Fearfulness Dependency Vulnerability to harm: “the failure of self-protection” Extreme Needs for Control Internalization of Aggressive Models Developing new modelsnew models in the group:, Benign Models for “secure attachmentsecure attachment”, “intimacyintimacy”, “making connectionmaking connection”, “cooperetioncooperetion”, and “resolving controversyresolving controversy” can be learned, generalized, old models supplanted. SelfSelf--DependenceDependence : “balancing autonomy and attachment” (Joseph Lichtenber-Psychoanalist) a healthy balance b/w Selfa healthy balance b/w Self--development and relationshipsdevelopment and relationships with others, which requires to have a sense of continuitya sense of continuity in the relationships.
  • 11. 11 IV.IV. Treatment Approaches to Help ClientsTreatment Approaches to Help Clients 1.1. A spectrum ofA spectrum of the Most Readily Visiblethe Most Readily Visible Trauma Therapy MethodsTrauma Therapy Methods¹¹ ❑❑❑❑ Feldenkrais ❑❑❑❑ Pilates ❑❑❑❑ Alexander Strengtening Training Relaxation training MindfulnessYoga & Meditation VVII. Non. Non-- psychologicalpsychological Body TherapiesBody Therapies ❑❑❑❑ Play Therapy ❑❑❑❑ Sandplay therapy Poetry Therapy & bibliotherapy Drama Therapy ❑❑❑❑ Music Therapy ❑❑❑❑ Dance & Movement Therapy Art Therapy V. ExpressiveV. Expressive TherapiesTherapies Hypnosis Equine- Assisted Psychotherapy Transactional Analysis Psychoanalysis Psychodynamic P. IV. AdditionalIV. Additional PsychotherpiesPsychotherpies Traumatic Incident Reduction Energy Therapies: ❑❑❑❑Thought Field Therapy ❑❑❑❑ Emotional Friedom Technique(EFT) Eye Movement Desensitization & Reprocessing (EMDR) Neurolinguistic Programming III. SpecializedIII. Specialized TraumaTrauma TherapiesTherapies (Power Therapies)(Power Therapies) Somatic Trauma Therapy (STT) Bodynamic Analysis (BA) Sensorimotor Psychotherapy Somatic Experiencing II. SomaticII. Somatic PsychotherapiesPsychotherapies Dialectic Behavior Therapy(DBT) Prolonged Exposure (flooding) Cognitive- Behavioral Therapy I. CognitiveI. Cognitive TherapiesTherapies
  • 12. 12 IV.IV. Treatment Approaches to Help ClientsTreatment Approaches to Help Clients 2.2. Common & Different Components of Trauma TherapiesCommon & Different Components of Trauma Therapies¹¹,,¹º¹º CommonalitiesCommonalities Only goalOnly goal is improvingis improving the quality ofthe quality of lifelife ― on a dayon a day--toto--day basisday basis ― of theof the traumatized individual.traumatized individual. Central Aim of the processCentral Aim of the process is regainingregaining a feeling of personal controlcontrol & integrityintegrity . Major componentMajor component is ccontactontact & ssupportupport with a helping professional & the client's network. ShameShame & GuiltGuilt are necessary components of the ultimateultimate integrationintegration. DifferencesDifferences Working with or withoutWorking with or without processingprocessing trauma memoriestrauma memories (Power Ts) The bodyThe body’’s responses to emotions &s responses to emotions & thought processthought process as being the foundation (Somatic Ps) Helping clients to change intrusivechange intrusive sensory imagessensory images & increaseincrease control overcontrol over symptomssymptoms (Power & Cognitive Ts) emphasis on therapeutic relationshiptherapeutic relationship b/w therapist & the CIb/w therapist & the CI and targeting attachment issues (Additional Ps) Working withWorking with creative expressioncreative expression && nnonon--psychologicalpsychological bbodyody trainingstrainings A threeA three--phased approachphased approach (Pierre Janet)(Pierre Janet) Phase1:Phase1: Stabilization & safetyStabilization & safety (a) Education (b) Identification of feelings through(a) Education (b) Identification of feelings through verbalizing somatic statesverbalizing somatic states Phase2:Phase2: Remembering & processingRemembering & processing trauma memoriestrauma memories (deconditioning)(deconditioning) Phase3:Phase3: Integration with family & culture,Integration with family & culture, and normal daily lifeand normal daily life (restructuring of(restructuring of traumatic personal schemes)traumatic personal schemes) (a) Reestablishment of secure social connections &(a) Reestablishment of secure social connections & interpersonal efficacy (b) Accumulation ofinterpersonal efficacy (b) Accumulation of restitutive emotional experiencesrestitutive emotional experiences
  • 13. 13 IV.IV. Treatment Approaches to Help ClientsTreatment Approaches to Help Clients 3.3. PersonPerson--Centered Expressive Arts TherapyCentered Expressive Arts Therapy⁵⁵⁵⁵⁵⁵⁵⁵,,⁶⁶⁶⁶⁶⁶⁶⁶ A multimodal approachA multimodal approach iintegratingntegrating mind, body, emotions, & spiritual innermind, body, emotions, & spiritual inner resources through the use of various artresources through the use of various art forms.forms. Natalie Roger’s method’s of expressive art therapy are based on the humanisticbased on the humanistic principlesprinciples : All people have an innate ability to create. The creative processThe creative process is healing. Personal growt & higher states ofPersonal growt & higher states of consciousness are achieved throughconsciousness are achieved through selfself-- awareness, selfawareness, self--understanding, andunderstanding, and insight.insight. Self-awareness, self-understanding, and insight are achievedachieved by delving into ourour emotions.emotions. Our feelings and emotions are an energyan energy source.source. That energy can be channeledchanneled intointo the expressive arts to be released &to be released & transformed.transformed. When used alone and/or with otheralone and/or with other formsforms of healthcare practices, art therapy cancan healheal stress disorders, traumatic events, and cognitive disorientations .
  • 14. 14 IV.IV. Treatment Approaches to Help ClientsTreatment Approaches to Help Clients 44.. NonNon--psychological Body Therapies:psychological Body Therapies: YogaYoga  and Meditationand Meditation⁷⁷⁷⁷⁷⁷⁷⁷,,⁹⁹⁹⁹⁹⁹⁹⁹ The word “yogayoga” means “unity, harmony”. Yoga can help throughYoga can help through Harmonization of body, mind & soul, Unification with the true-self, Reawakening of dormant skills Yoga is practised in 8 steps for entightenment on selfentightenment on self--realizationrealization. 1. Yama:1. Yama: ethicalethical rulesrules forfor social lifesocial life.. 2. Niyama:2. Niyama: ethicalethical rules forrules for private lifeprivate life.. 3. Asana3. Asana(( postureposture)) controlcontrol over theover the bodybody 4. Pranayama:4. Pranayama: controlcontrol over theover the breath 5. Pratyahara:5. Pratyahara: controlcontrol over theover the sensessenses.. 6.Dharana:6.Dharana: concentrationconcentration on oneon one objectobject.. 7. Dhyana:7. Dhyana: meditationmeditation onon oneone objectobject forfor sometimesometime 8. Samadhi:8. Samadhi: enlightenmentenlightenment.. A key finding from these brain scans isA key finding from these brain scans is that during traumatic stress,that during traumatic stress, the speechthe speech center shutscenter shuts downdown.. ““This is whyThis is why talktalk therapy is limited in helpingtherapy is limited in helping someonesomeone recover from or heal fromrecover from or heal from overwhelming stressoverwhelming stress..”” Since 2006 traumaSince 2006 trauma--sensitive yogasensitive yoga is used to heal trauma survivors & people with PTSD in the Trauma Center in Brookline, Massachussets. Head of Center , Dr. Bessel van der Kolk, who is the recognized authority on PTSD, uses yoga asyoga as an adjunct to talk therapyan adjunct to talk therapy toto heal bodyheal body--mind disconnectedness.mind disconnectedness. The Trauma CenterThe Trauma Center’’s research hass research has shown thatshown that a 10 week session of traumaa 10 week session of trauma sensitive yogasensitive yoga producesproduces measurablemeasurable resultsresults..
  • 15. 15 IV.IV. Treatment Approaches to Help ClientsTreatment Approaches to Help Clients 44.. NonNon--psychological Body Therapies:psychological Body Therapies: MindfulnessMindfulness¹¹,,⁷⁷⁷⁷⁷⁷⁷⁷,,⁸⁸⁸⁸⁸⁸⁸⁸ BothBoth mindfulnessmindfulness && meditationmeditation isis thethe oldest in the East and the newest in theoldest in the East and the newest in the West as treatment optionsWest as treatment options Somatic psychotherapiesSomatic psychotherapies have been applying the secular aspects of mindfulness for more than 100 years. The cognitive therapiesThe cognitive therapies have reinvented &have reinvented & embraced mindfulness as one of their ownembraced mindfulness as one of their own in the 21in the 21stst Century.Century. Since 1979Since 1979,, Jon KabatJon Kabat--ZinnZinn havehave pioneeredpioneered the integration ofthe integration of mindfulnessmindfulness meditationmeditation && otherother mindfulnessmindfulness--basedbased approachesapproaches inin mainstream medicine &mainstream medicine & healthcare.healthcare. Mindfulness means paying attentionpaying attention in a particular way; on purposeon purpose, in the presentin the present momentmoment, and nonnon judgmentallyjudgmentally. AttituteAttitute is based on: 1.non-judging, 2.Patience, 3.Beginner’s mind, 4.Trust 5.Non-striving, 6.Acceptance 7. Letting go PracticePractice requires commitmentcommitment, selfself--disciplinediscipline, and intentinalityintentinality. ❑❑❑❑ 4 main aspects4 main aspects of mindfulness in resolving traumatic stress & PTSD: 1. body awarenessbody awareness 2.2. attentivenessattentiveness to the quality of howto the quality of how an emotionan emotion feels infeels in the bodythe body 3.3. attention to the mindattention to the mind 4.4. spiritual facetspiritual facet: the identification of: the identification of sufferings as a guidance in living ansufferings as a guidance in living an ethical life.ethical life.
  • 16. 16 IV.IV. Treatment Approaches to Help ClientsTreatment Approaches to Help Clients 10 Foundations of Safe Trauma Therapy10 Foundations of Safe Trauma Therapy ¹¹ 1. First task of recovery:1. First task of recovery: Establish the survivor’s safetysafety within & outside the therapy (suicide and homicide prevention) . 2. Prerequisite:2. Prerequisite: developdevelop therapeutic alliancetherapeutic alliance before youbefore you address traumatic memories.address traumatic memories. 3. Apply the brakes before accelerator:3. Apply the brakes before accelerator: work slowly with an emphasis on containment. 4. Don4. Don’’t forget the accompanying mechanismst forget the accompanying mechanisms . Identify & build on the client’s internal & external resources. 5. Regard defenses as resources.5. Regard defenses as resources. Never get rid of coping strategies or defenses; instead, create more choices. 6. View trauma as a pressure cooker.6. View trauma as a pressure cooker. Always work to reduce – never to increase- the pressure. 7. Adapt the therapy to the client,7. Adapt the therapy to the client, rather than expecting the client to adapt to the therapy. 8. A good grounding in theory8. A good grounding in theory makes not only for a better informedinformed therapist but also a more creativecreative & flexibleflexible one. 9. Regard the client9. Regard the client’’s individual differences.s individual differences. Never expect one intervention to have the same result with two clients. 10. Be prepared at times10. Be prepared at times – or even for a whole course of therapy – to put aside all techniquesto put aside all techniques && just be togetherjust be together talkingtalking oror just sitting quietly.just sitting quietly. Suicide rate amongst Veterans is estimated to be 22 SUICIDES PER DAY! PTSD and TBI are mentally and physically debilitating conditions. We provide task trained service dogs at no cost.
  • 17. 17 Reference Sources:Reference Sources: 1. Trauma Essentials: The Go-To Guide, Babette Rothschild, W.W.Norton & Compant, Inc., ISBN-13:978-0-393- 70620. 2. Coping with Trauma, A Guide to Self-Understanding, Jon G. Allen, Ph.D., American Psychiatric Press, ISBN-13:978-0-88048-996-0. 3. “Lecture: Mapping the Authonomic Nervous System”, Online Videos, http://www.loveandtrauma.com/videos. 4. The Post-Traumatic Stress Disorder: Malady or Myth?, Chris R. Brewin, Yale University Press, ISBN-13:978-0-300-12374-6. 5. “Person-Centered Expressive Arts in Groups”, p.275-279, Theory and Practise of Group Counselling, Gerald Corey, Brooks/Cole, Cengage Learning, ISBN-13:978-0-8400-3389-5. 6. “Art Therapy”, http://www.sjcshk.com/Art%20Therapy.html 7. “Mind-Body Practices from Recovery from Sexual Trauma”, p.199-216, Patricia L. Gerbarg and Richard P.Brown, Surviving Sexual Violence: A Guide to Recovery & Empowerment, ed. Thema Bryant-Davis , Rowman & Littlefield Publishers, Inc., ISBN-13:978-1-4422-0639-7. 8. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to face Stress, Pain, and Illness, John Kabat-Zinn, Ph.D., Delta Trade, ISBN-13:978-0-385-30312-5. 9. “More than 30 years International Distinction”, University of Massachusettes Medical School, Center for Mindfulness in Medicine, Health Care, and Society, http://www.umassmed.edu/Content.aspx?id=41252 10.Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body & society, Ed. Bessel A. Van der Kolk, The Guilford Press, ISBN: 1-57230-088-4.