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Elaine K Hammond, LMSW Psychological trauma is the loss of faith that there is order and continuity in life. Trauma occurs when.

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Presentation on theme: "Elaine K Hammond, LMSW Psychological trauma is the loss of faith that there is order and continuity in life. Trauma occurs when."— Presentation transcript:

1 Elaine K Hammond, LMSW

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3 Psychological trauma is the loss of faith that there is order and continuity in life. Trauma occurs when one losses the sense of having a safe place to retreat within or outside oneself to deal with frightening experiences or emotions. This results in a state of helplessness, a feeling that one ’ s actions have no bearing on the outcome of one ’ s life. Since human life seems to be incompatible with meaninglessness and lack of control, people will attempt to avoid this experience at just about any price, from abject dependency to psychosis (van der Kolk, 1987)

4 What we drag around may impair our ability to move again in community with others

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6 Safety Trustworthiness Choice Collaboration Empowerment Trauma Informed Practice: Will avoid inadvertent retraumatization and will facilitate consumer participation in treatment (Harris & Fallot, 2001)

7 Safety: includes where services are offered; time of day that services are offered; security personnel available, open doors or locked and the affect that each has on consumers; waiting room appearance; are all staff members attentive to signs of consumer discomfort and do they recognize these signs in a trauma informed way. Trustworthiness: includes providing clear information about what will be done, by whom, when, why and under what circumstances; respectful and professional boundaries; is unnecessary consumer disappointment avoided; is informed consent taken seriously on a consistent basis? Choice: includes how much choice consumers have over the services they receive (such as time of day, gender preferences for service providers, etc.); are consumers provided a clear and appropriate message about their rights and responsibilities? Collaboration: includes giving consumers a significant role in planning and evaluating services; consumer preference is given in areas of service planning, goal setting, and developing treatment priorities; cultivating an atmosphere of doing “with” rather than doing “to” or “for”; conveying the message that the consumer is the expert in their own life? Empowerment: includes recognizing consumer strengths and skills; building a realistic sense of hope for the client’s future; provide an atmosphere that allows consumers to feel validated and affirmed with each and every contact at the agency (Fallot & Harris, 2006)

8 Safety: includes where services are offered; time of day that services are offered; security personnel available, open doors or locked and the affect that each has on practitioners; waiting room appearance; are all staff members attentive to signs of practitioner discomfort and do they recognize these signs in a trauma informed way. Trustworthiness: includes providing clear information about what will be done, by whom, when, why and under what circumstances; respectful and professional boundaries; is unnecessary practitioner disappointment avoided; is informed consent taken seriously on a consistent basis? Choice: includes how much choice practitioners have over the services they provide; are practitioners provided a clear and appropriate message about their rights and responsibilities? Collaboration: includes giving practitioners a significant role in planning and evaluating services; practitioner preference is given in areas of organizational planning, goal setting, and developing treatment priorities; cultivating an atmosphere of doing “with” rather than doing “to” or “for”; conveying the message that the practitioner is the expert in their own life? Empowerment: includes recognizing practitioner strengths and skills; building a realistic sense of hope for the practitioner’s future; provide an atmosphere that allows practitioners to feel validated and affirmed with each and every contact at the agency (Fallot & Harris, 2006) * For this discussion, this term includes all staff, clinicians, supervisors and administrators.

9 Sickness Model What’s Wrong With You?! Sickness implies that the cause of the problem is within the sufferer Sickness implies individual weakness or defect and stabilization may be all we can do Sickness implies passivity, helplessness Sickness relies largely on “ expert ” knowledge; patients are expected to be “ compliant ” and are reprimanded if they are not Sickness denies personal and social accountability

10 Injury Model What’s happened to you? Includes physical, psychological, social, and moral forms of injury Includes deprivation, neglect, and developmental insult Implies rehabilitation process that is mutual, long term: Requires active collaborative relationship between helper and injured party Removes stigma and shame Provides understandable shared framework Increase in compassion, increase in expectations

11 Secondary traumatic stress (STS) …the natural, consequent behavior and emotions that result from knowledge about a traumatizing event experienced by another and the stress resulting from helping or wanting to help a traumatized or suffering person. The symptoms are identical to those of PTSD (Catherall, 1995). Think of this in behavioural terms Partly a function of the requirement for constant empathic response and repressed emotion Generally a process, yet may be from a single event

12 Vicarious traumatization (VT …the cumulative transformative effect on the helper of working with survivors of traumatic life events, both positive and negative (McCann & Pearlman, 1990). Can be considered a specific manifestation of countertransference, except the “client” never goes away Think of this in terms of altered world view Repeated exposure to trauma narrative may affect personal sense of safety, trust & control (Newell & MacNeil, 2010).

13 Compassion fatigue (CF) …the natural, predictable, treatable, and preventable unwanted consequence of working with suffering people (Figley, 1995). Also cumulative Not specific to trauma work

14 In organizations like ours, parallel process means a complex interaction among traumatized clients, stressed staff, pressured organizations, and difficult systems. “What happens here affects us too….If we don’t spend the time dealing with that, we burn out, we aren’t as effective, and ultimately we can’t do as good a job.” Staff member, Baker Victory Services

15 Compounding/Confounding traits: Surviving or Thriving Personal Resources Personal history Relationships World View Mindfulness Self Care Professional Resources Self care Training Supervision Choice of interventions Experience

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17 Safety Trustworthiness Choice Collaboration Empowerment How are you feeling? What is your goal? Who can help you? How might TI praxis inform your daily work? Acknowledge that the work affects us all. Seek – and offer - support Don’t quit too soon. Acknowledge when things go well.

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21 Neurohormonal Effects Lower serotonin (impulsivity, sleep problems, aggression) High levels of endogenous opioids (numbing, interferes w/memory) High levels of catecholamines (epinephrine & norepinephrine: anxiety, panic, interferes w/memory) Chronic stress: depletion of endogenous opioids

22 SNS: (Sympathetic nervous system) Prepare for Threat Adrenal glands: hormones to prepare for fight, flight or freeze. Epinephrine and norepinephrine PNS: Reestablish Homeostasis (Parasympathetic Nervous System) Pituitary & Adrenal Glands  hormones to bring body back to normal (rest/recovery) Cortisol, glucocorticoids (endogenous opioids)

23 Extreme autonomic arousal (e.g., heart rate, blood pressure) to stimuli reminiscent of the trauma Hyperarousal to intense, but neutral stimuli (loss of stimulus discrimination)

24 GI issues: Upset stomach, Butterflies, Nausea, Diarrhea/constipation Headache Back Pain Limb pain/numbness Tightness in chest Heart racing/palpitations Body heaviness – sense of slow motion Tingling sensations Muscle tension: Brow, jaw, fists, shoulders, abdomen, thighs, toes Sweating Difficulty swallowing/lump in throat Sore throat/dry mouth Watering eyes/tearing/loss of peripheral vision/tunnel vision/”going dark” Ringing in the ears, temporary loss of hearing Feeling faint Feeling “frozen” Changes in breathing Shortness of breath, shallow breath/quickened breath

25 Hippocampus Cognitive Map Pre-Frontal Cortex Integration and Planning Thalmus Amygdala Emotional Significance Five Senses

26 Sleep “Sleep like a baby” or in this case, like Putnam… Nutrition Movement

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28 Challenges to breathing that supports the nervous system First: acknowledge the challenges Softening the abdomen Prohibitions for this for both men and women May hold body memory of physical trauma Find private space, such as your car, private stall bathrooms Words May be triggers to past trauma Both ‘breathe’ and ‘relax’ can sound dismissive Try ‘rest’, ‘soothe’ or ‘comfort’ Prepare/contract for the word ‘breathe’ ahead of time

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31 “A core aspect of the mind can be defined as an embodied and relational process that regulates the flow of energy and information.” Dan Siegel 1: the element or complex of elements in an individual that feels, perceives, thinks, wills, and especially reasons 2: the conscious mental events and capabilities in an organism 3: the organized conscious and unconscious adaptive mental activity of an organism Mirriam-webster.com the element of a person that enables them to be aware of the world and their experiences, to think, and to feel; the faculty of consciousness and thought. Oxforddictionaries.com

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35 Psychological trauma is the loss of faith that there is order and continuity in life. Trauma occurs when one losses the sense of having a safe place to retreat within or outside oneself to deal with frightening experiences or emotions. This results in a state of helplessness, a feeling that one ’ s actions have no bearing on the outcome of one ’ s life. Since human life seems to be incompatible with meaninglessness and lack of control, people will attempt to avoid this experience at just about any price, from abject dependency to psychosis (van der Kolk, 1987)

36 How can we assess attributes of life meaning? What do you find beautiful? What do you look forward to about growing older? What do you think happens to us when the body dies? What is one thing you would like people to remember you for?

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