Presentation on theme: "PRESENTED BY: BEVERLY ENGEL"— Presentation transcript:
1PRESENTED BY: BEVERLY ENGEL TRAUMA INFORMED/TRAUMA SENSITIVE TREATMENT OF VICTIMS OF CHILDHOOD SEXUAL ABUSEPRESENTED BY: BEVERLY ENGEL
2TRAUMA INFORMED/TRAUMA SENSITIVE Trauma-Informed ServicesTrauma-informed services involve understanding, anticipating, and responding to the issues, expectations, and special needs of a person who has been victimized.
3TRAUMA INFORMED/TRAUMA SENSITIVE At a minimum, trauma-informed servicesshould endeavor to do no harm—to avoid re-traumatizing survivors or blaming them fortheir efforts to manage their traumaticreactions.
4TRAUMA INFORMED/TRAUMA SENSITIVE Trauma Specific Trauma specific treatment is based upon empowerment of the survivor and the creation of new connections
5TRAUMA INFORMED/TRAUMA SENSITIVE Instead of isolation, there is a focus on relationships,Instead of coercion, there is a focus on persuasion,Instead of authoritarian control, there is a focus on mutuality.
6TRAUMA INFORMED/TRAUMA SENSITIVE “Trauma-specific” services are designed to treat the actual consequences of trauma.Examples of trauma-sensitive treatment approaches include:Grounding techniques which help trauma survivors manage dissociative symptoms.
7TRAUMA INFORMED/TRAUMA SENSITIVE Desensitization therapies which help to render painful images more tolerable .Behavioral therapies which teach skills for the modulation of powerful emotions.
8TRAUMA INFORMED/TRAUMA SENSITIVE Treatment programs designed specifically for survivors of childhood trauma are consistent on several points:The need for respect, information, connection and hope for clients.
9TRAUMA INFORMED/TRAUMA SENSITIVE The importance of recognizing the adaptive function of “symptoms”.The need to work in a collaborative, empowering way with survivors of abuse
10TRAUMA INFORMED/TRAUMA SENSITIVE It is important to become aware of the dynamics that characterize abusive relationships—in particular:1. Control/domination—feeling powerless2. Hierarchical boundaries—feeling less than3. Isolation/confinement—feeling trapped4. Silence/secrets—questioning reality
11TRAUMA INFORMED/TRAUMA SENSITIVE 5. Being unheard or invalidated—feeling unimportant or invisible.6. The reconstruction of reality— questioning her perceptions or her very sanity.7. Betrayal—feeling unsafe and unable to trust
12TRAUMA INFORMED/TRAUMA SENSITIVE Make certain that the same dynamics are notbeing unwittingly replicated in the helpingrelationship.For example:In a trauma informed setting both partiesare acknowledged for bringing valid sourcesof information and expertise to the
13TRAUMA INFORMED/TRAUMA SENSITIVE Providers have information and expertise tooffer victims, but victims also have information to share with providers.Avoid talking down to the victim or conveying to her in any way that you are more important than she is or that what you have to say is more important than what she has to say.
14TRAUMA INFORMED/TRAUMA SENSITIVE Putting victims in secluded rooms or being in a small room with a victim can re-traumatize victims and may trigger a flashback.
15TRAUMA INFORMED/TRAUMA SENSITIVE It is important to inform the victim about exactly what is going to happen.For example, if you are going to do an intake or take a history on the client, explain to her in advance the nature of the intake, the length of the process and how she can signal you if she is unable to continue the interview.
16TRAUMA INFORMED/TRAUMA SENSITIVE Keeping victims fully informed can help them with their trust issues.Knowing what is going to happen ahead of time helps them to feel safe.Making sure that you do what you say you are going to do will help prevent a victim from feeling betrayed.
17TRAUMA INFORMED/TRAUMA SENSITIVE Make sure that you listen to what the victim is saying and that you take what she is saying seriously, even if it doesn’t seem to make sense.
18TRAUMA INFORMED/TRAUMA SENSITIVE The more they feel heard and their experiences validated they will calm down.Victims are accustomed to having what they say minimized, discredited or ignored so active listening can be a corrective experience for them.
19TRAUMA INFORMED/TRAUMA SENSITIVE TREATMENT OF VICTIMS OF CHILDHOOD SEXUAL ABUSE Trust what the victim tells you—especially when she tells you about her abuse experiences. Even if it seems unlikely that it happened or that it happened in the way she is describing it, it very well may be true.
20TRAUMA INFORMED/TRAUMA SENSITIVE There may be some distortion in what she is saying—we all have different perceptions of things that happen--but on the other hand, some of the most extreme and outrageous experiences described by victims often turn out to be true.
21TRAUMA INFORMED/TRAUMA SENSITIVE Key Elements in Trauma Informed/Trauma Sensitive Treatment
22TRAUMA INFORMED/TRAUMA SENSITIVE CollaborationEducationAdaptiveSafety FocusedEmpowerment focusedInterpersonal skills development
24TRAUMA INFORMED/TRAUMA SENSITIVE Trauma-Informed Systems are based on collaboration between the victim and the service provider.Instead of assuming you know what is best for the victim, ask her what she wants and what would help her to feel comfortable and safe. This helps her to begin to establish trust in you.
25TRAUMA INFORMED/TRAUMA SENSITIVE A victim knows her own responses, needs and history better than anyone else. By respecting her knowledge and insights about what she needs in order to bring order and healing to her life, the provider allows for a truly collaborative partnership.As much as possible, consumers need to be offered options and choices rather than be directed or told what to do.
26TRAUMA INFORMED/TRAUMA SENSITIVE Service providers need to work on adopting a collaborative tone versus an authoritarian one. It is important to stress that you and the client are working together. You are not the expert, you are not the one in control.
28TRAUMA INFORMED/TRAUMA SENSITIVE The impact of trauma narrows the person’s life, constricting choices, undermining self-esteem, taking away control, and creating a sense of hopelessness and helplessness.Trauma-Informed Systems stress the importance of service providers being educated about the effects of trauma on an individual’s emotional development and behavior.
29TRAUMA INFORMED/TRAUMA SENSITIVE This education enables service providers to re-frame their basic assumptions about the behavior of consumers who were trauma victims and helps them to begin to treat victims with more dignity, respect and compassion.
30TRAUMA INFORMED/TRAUMA SENSITIVE Making the important connection between a trauma victim’s behavior and their trauma experience will help service providers become more compassionate and less impatient, judgmental and angry at their behavior.
31TRAUMA INFORMED/TRAUMA SENSITIVE For example, understanding that often behaviors initially perceived as combative and/or reflecting a lack of motivation can actually be reactions to fear can help advocates to respond differently, which in turn allows the traumatic reactions to subside.
32TRAUMA INFORMED/TRAUMA SENSITIVE AN ADAPTIVE MODEL
33TRAUMA INFORMED/TRAUMA SENSITIVE In trauma-informed settings, symptoms are seen as adaptations rather than pathology.Every symptom helped a survivor in the past and continues to help in the present—in some way.
34TRAUMA INFORMED/TRAUMA SENSITIVE An adaptation model emphasizes resiliency in human responses to stress. It helps survivors recognize their own strengths and inner resources, rather than defining themselves by weakness and failure.
35TRAUMA INFORMED/TRAUMA SENSITIVE TRAUMA-INFORMED SERVICES ASSUME THAT PEOPLE ARE DOING THE BEST THEY CAN AT ANY GIVEN TIME TO COPE WITH THE LIFE-ALTERING AND FREQUENTLY SHATTERING EFFECTS OF TRAUMA.
37TRAUMA INFORMED/TRAUMA SENSITIVE Safety is of the utmost importance in trauma-informed, trauma sensitive programs. It is the basis from which all “rules” should be created.Creating safety includes such things as allowing participants to set their own pace in groups and to determine when and how they share their trauma stories.
38TRAUMA INFORMED/TRAUMA SENSITIVE Safety also includes anticipating crises. For example, many victims of child sexual abuse are frequently flooded with painful memories and many are self-destructive in some way.
40TRAUMA INFORMED/TRAUMA SENSITIVE Empowering victims is one of the major goals of trauma sensitive treatment. This occurs by counselors focusing on client’s strengths versus “problems.”It also occurs by working collaboratively with clients, encouraging them to create their own goals, treating them with respect and the understanding that the client knows what she needs.
41TRAUMA INFORMED/TRAUMA SENSITIVE Empowerment is also accomplished by providing clients with psycho-educational material that will help them to learn to regulate their emotions, self-soothe, and create healthier relationships
43TRAUMA INFORMED/TRAUMA SENSITIVE Focusing on interpersonal skills can help clients increase their self-knowledge, self esteem, self trust, expression of needs and desires, clear communication, limit setting, accurate perceptions of others and honest labeling, establishment of safe boundaries and mutuality and reciprocity.
44TRAUMA INFORMED/TRAUMA SENSITIVE AN INTEGRATIVE APPROACH
45TRAUMA INFORMED/TRAUMA SENSITIVE It is assumed that trauma, substance abuse, and mental health interact within a single individual.Therefore approaches to recovery must be holistic approaches.
46TRAUMA INFORMED/TRAUMA SENSITIVE Integrative explanations include:Primary trauma is a stressor that may trigger substance use and the development of psychiatric symptoms.Trauma symptoms such as flashbacks or nightmares are stressors that may trigger substance use or result in a psychiatric diagnosis.
47TRAUMA INFORMED/TRAUMA SENSITIVE Substance use and certain psychiatric symptoms may have evolved as coping strategies at a time when options were limited.
48TRAUMA INFORMED/TRAUMA SENSITIVE STRENGTH BASED APPROACH
49TRAUMA INFORMED/TRAUMA SENSITIVE The trauma-informed system values a strengths-based approach to assessment and intervention that highlights the assets of the survivor.Instead of being defined by her problems, the consumer is described as having capacities and abilities.
50TRAUMA INFORMED/TRAUMA SENSITIVE Understanding that strengths can be invisible or even undermined if they are not acknowledged and supported, counselors and advocates point out the strengths they see in the survivor, thus helping her to gain more of a sense of well-being, competence, and self-esteem.
51TRAUMA INFORMED/TRAUMA SENSITIVE The experience of having a sense of competence sets in motion a further change, helping survivors to appreciate their own abilities.For example, it can be enormously beneficial to have a survivor develop an inventory of her positive qualities.
53TRAUMA INFORMED/TRAUMA SENSITIVE Instead of presenting yourself as the “expert,” it can be empowering to share information in a psycho-educational program that is both interactive and flexible enough to accommodate what the survivor thinks is important.
54TRAUMA INFORMED/TRAUMA SENSITIVE In such an educational program, past abuses are linked to current coping strategies, and current symptoms are reframed as attempts to cope with past abuses.Psychoeducational programs are most effective in group settings where consumers can learn from each other as well as staff, and staff can learn from the survivor’s perspective.
55TRAUMA INFORMED/TRAUMA SENSITIVE A group-based psycho-educational program also helps survivors trust their own perceptions of reality and receive validation for correct perceptions.
57TRAUMA INFORMED/TRAUMA SENSITIVE In spite of the fact that a majority of individuals receiving mental health, substance abuse and abuse recovery services have a history of trauma, many do not report their trauma experiences to counselors or intake workers.
58TRAUMA INFORMED/TRAUMA SENSITIVE Reasons for this omission can include:Fear of being disbelieved or blamed.Shame at being victimized and attendant vulnerability.Childhood experiences of abuse may not be readily remembered.
60TRAUMA INFORMED/TRAUMA SENSITIVE Because of both under-reporting and under-recognition, trauma-informed service systems have adopted universal screening, asking all consumers about trauma as part of the initial intake or assessment process.
61TRAUMA INFORMED/TRAUMA SENSITIVE Trauma screening refers to a brief, focused inquiry to determine whether an individual has experienced specific traumatic events.
62TRAUMA INFORMED/TRAUMA SENSITIVE WHY PROVIDERS DO NOT ASK ABOUT TRAUMA
63TRAUMA INFORMED/TRAUMA SENSITIVE Lack of training or uncertainty about how to respond to the informationBelief that it will be “too upsetting” for trauma survivorsFeeling ill equipped to respond helpfully
64TRAUMA INFORMED/TRAUMA SENSITIVE PRIMARY PURPOSES OF SCREENING
65TRAUMA INFORMED/TRAUMA SENSITIVE To determine appropriate follow-up and referral, including urgent responses to imminent danger and trauma-specific services.It communicates to all consumers that the program believes that abuse and violence are significant events and that staff are willing to discuss trauma with survivors.
66TRAUMA INFORMED/TRAUMA SENSITIVE Even if a trauma survivor decides not to talk about such experiences at this early stage, staff have increased the possibility of later disclosure by communicating their recognition of and openness to hearing about painful events.
67TRAUMA INFORMED/TRAUMA SENSITIVE And perhaps most important, by recognizing that a consumer has a history of trauma, staff can better understand the behavior of a survivor
68TRAUMA INFORMED/TRAUMA SENSITIVE YOU CAN CONTRIBUTE TO CLIENT’S SENSE OF CONTROL BY:
69TRAUMA INFORMED/TRAUMA SENSITIVE Maximizing consumer choice and control in the screening process (trauma sensitive). This is especially crucial for individuals whose experiences of powerlessness and lack of choice have been pervasive. You can contribute to the consumer’s sense of control by doing the following:
70TRAUMA INFORMED/TRAUMA SENSITIVE Being clear about the steps, the process and the reasons for the screening (“I would like to ask you some questions about…”); (“We have found that many people who come here for services have been physically or sexually abused at some time in their lives).”
71TRAUMA INFORMED/TRAUMA SENSITIVE Because this can have such important effects on people’s lives, we ask everyone about whether they have ever been a victim of violence or abuse.Give permission to not answer the questions or to delay the interview.
73TRAUMA INFORMED/TRAUMA SENSITIVE TREATMENT OF VICTIMS OF CHILDHOOD SEXUAL ABUSE At any time in your life have you witnessed someone being injured or killed due to an unnatural event such as a shooting, stabbing, or hit-and-run accident?
74TRAUMA INFORMED/TRAUMA SENSITIVE 2. At any time in your life have you witnessed a physical or sexual assault against a family member, friend, or other significant person?3. At any time in your life has someone touched you sexually when you did not want to be touched?4. At any time in your life has anyone forced you to have sex when you did not want to?
75TRAUMA INFORMED/TRAUMA SENSITIVE 5. At any time in your life has anyone slapped, pushed, grabbed, or shoved you? 6. At any time in your life has anyone choked, kicked, bit or punched you?7. At any time in your life has anyone threatened you with, or actually used, a knife, gun or other weapon to scare or hurt you?
76TRAUMA INFORMED/TRAUMA SENSITIVE 8. At any time in your life, have you been afraid that a specific person (whether it was someone you knew well or not) would hurt you physically?
78TRAUMA INFORMED/TRAUMA SENSITIVE A TRAUMA SENSITIVE/INFORMED APPROAH ISCHARACTERIZED BY:1. Safety from physical harm and re-traumatization.2. An understanding of clients and their symptoms in the context of their life experiences and history and culture.
79TRAUMA INFORMED/TRAUMA SENSITIVE 3. Open and genuine collaboration between provider and consumer at all phases of the service delivery.4. An emphasis on skill building and acquisition rather than symptom management.
80TRAUMA INFORMED/TRAUMA SENSITIVE An understanding of symptoms as attempts to cope.A view of trauma as a defining and organizing experience that forms the core of an individual’s identity rather than a single discrete event.A focus on what happened to the person rather than what is wrong with the person.