1. James K. Boehnlein, MD Professor of Psychiatry Oregon Health and Science University Associate Director for Education VA Northwest Network Mental Illness Research, Education and Clinical Center (MIRECC)

3. Questions After Trauma Unpredictability of life and death Loss Moral Complexities

4. Religion Across Cultures Explanation of how universe began, how life is maintained, what happens when life ceases to exist Explanation of life’s meaning and rationale for suffering Symbols, beliefs, values Relationship between the self and the world

5. Spirituality Bridges religion and science Insightful relationship between self and others Personal values Meaningful purpose for life Connectedness between self and the natural/supernatural

6. Explanatory Frameworks Pain, suffering, atonement, forgiveness Judaism – Restoration of relationship with God through atonement Christianity – Repentance, forgiveness and rebirth Buddhism – Acceptance of suffering; reincarnation Islam – Death divinely ordained – impact on survivor guilt Hinduism – Suffering a result of conflict/tension

7. Core Assumptions Altered by Trauma Belief in personal invulnerability Perception of an understandable world Trust in self and others

8. Healing After Trauma: Psychotherapeutic Themes Trust Security Acceptance Identity and Self-Worth Social Connectedness Grief and mourning Anger and Revenge Control Meaning

9. Barriers to Treatment- Beliefs and Values Avoidance Pride in self-reliance Loss of control/autonomy Treatment is for those who are weak, “crazy” Provider will not understand or believe trauma Societal rejection

10. Factors in Religious / Spiritual Healing Telling the story honestly Ending isolation Moral inventory Forgiveness Helping others Giving and receiving love

11. Clinician Reactions Sadness Anger Vulnerability Fatigue Intolerance of other patients Intolerance/avoidance of violence images Indifference vs. overinvolvement

12. Ethical Principles in Treatment Creation of trust, predictability Cause no harm Respect for personal boundaries Primacy of reducing suffering and promoting health Respect for patient autonomy, independence, and creativity Promotion of justice