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Trauma-Informed Self-Care
A Handy Guide for the Every-Day Warrior 2016 FMHCA Conference Merging the Old With the New Louise Sutherland-Hoyt, LMHC, CCMHC, NCC
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BenchmarK Counseling, Consulting, Education
Praeteritum ~ Praesens ~ Futurum
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Take a Moment Self-Assess.
Complete the Childhood Experience Assessment (Appendix A). Complete Resilience Scale (Appendix B). When complete, set aside.
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Purpose /Background Trauma-informed care has been integrated into systems and agencies that provide MH services. Many of our clients’ struggles rooted in traumatic experiences. A structure of trauma-informed principles around which to build self-care practices is needed.
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Goals Renewed enthusiasm for your work.
Acquire skills to retool your well-DOing program as you grow and develop in your work. Motivation to move toward mental and physical fitness.
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Objectives Familiarization with current terms associated with
Co-processing of Trauma. Awareness of signs. Application of key principles in Self Care.
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Tasks Personal Assessment. Interactive presentation.
A.C.E.S. Resilience Measure. Interactive presentation. Development of personal plan of Well-Doing.
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Wars Change, Warriors do Not
The Every-Day Warrior Wars Change, Warriors do Not We Are All Warriors Every-Day The Story of Chiron
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Chiron: Sacred Warrior, Wounded Healer
Born out of Rape Rejected First Wound Mentored by Gods Safety Connectedness Keeping his Cool Wounded Knee Second Wound Wounded Healer Mentor of Warriors Self-Sacrifice
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“The Spartans do not ask how many are the enemy
Chiron’s Example Our mental health is not superior to that of our clients. Enduring and holding another’s pain requires us to identify and confront our own inner battles. We facilitate others’ healing through our own example of self examination and reflection. “The Spartans do not ask how many are the enemy but where are they.”
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Our Own Professional (Warrior) Ethos
Codes of Ethics. What is Their Purpose? How do we compare the two? Thinking on a meta scale, are we on the same page as Every-Day Warriors?
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Pause. Take a breath. Reflect.
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Increasing # of Studies
Co-relationship between MH providers and adverse childhood experiences Look at Your ACES score. Where are your enemies?
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What is YOUR Score? One of several studies MH providers (Esaki & Larkin, 2013). 64% scored 1 or more. 53% scored 2 or more. 15% scored 4 or more.
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Family History as Indicative
Substance Abuse the most common. 34%: A family member with Depression/other mental illness. Looking at your own ACE. Mine replete with SA and Depression. If you grew up in a substance using environment, had a family mbr afflicted with depression or other MH D/O you are likely affected.
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Personality Traits/Coping Styles
Know yourself. Look at your Resilience Score. How resilient are you? Where are Your Strengths?
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It is Fair to Conclude As a group, we are vulnerable to negative effects of working with traumatized population. Especially through Agency and/or Residential setting.
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“BIG-T” Trauma and “Little-T” Trauma
Let’s differentiate. BIG-T Trauma. Catastrophic. Natural or Human-Made Disaster. Combat. Rape. Assault. Little-T Trauma. Accumulation of effects of abuse and neglect. Sometimes referred to as “Complex Trauma”. Does your ACES score reflect some level of complex trauma?
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Terms and Definitions Compassion Fatigue aka Burnout.
Secondary Traumatic Stress. Vicarious Trauma.
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Compassion Fatigue/Burnout
Featured in literature; a generalized term. Investment of empathy in work with sufferers of trauma. Cumulative. Observable. You find yourself processing feelings of unworthiness with your supervisor when an adoring client brings you a gift. Just Kidding!
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Seriously Late for appointments.
Relieved when a client or clients cancel. Over self-disclosure. Blaming the client. Labeling the client. Becoming lax in keeping up with the latest.
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Secondary Traumatic Stress
Knowing about clients’ traumatizing event. Helping and/or wanting to help the client. Symptoms/signs similar to Compassion Fatigue/Burnout. Personal history childhood trauma increases vulnerability. Effect can be offset by supportive peers and supervisors.
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Vicarious Trauma Exposure to traumatic imagery actually alters core beliefs/world view of therapist. Therapeutic boundaries compromised. Anger toward clients for not responding to idealized outcomes to therapy. Either avoidant of or intrusive into discussion of clients’ traumatic experiences. Pressures clients to identify or confront perpetrators before client is ready.
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Bear In Mind! Absence of instrument to measure VT.
Most fail to meet VT Criteria. Whether it’s Burnout, Compassion Fatigue, Secondary Trauma, or Vicarious Trauma… The point is…………….
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We Can Manage How we reconnoiter the inherent risks of our work.
How we keep the “enemy” at bay. What we do to be well in Body, Mind, and Spirit.
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This Requires Knowledge of our enemy’s whereabouts.
Understanding the nature of our enemy. Development of a strategy grounded in logistics Implemented with self-knowledge.
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Let’s Get Started Taking Charge of YOU. Maximize this knowledge!
You know your risks. (ACES) You know your assets. (Resilience) Maximize this knowledge!
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Out of Chaos Comes Clarity
A flurry of research since 2003. We conclude that effects of co-processing of trauma experiences occur on a continuum based upon: Trauma History. Longevity in the Field. Personality Traits. Levels of Resilience.
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We Also Know Self Care has been advocated since the beginning of the profession. Self Care has a definition. But what does it look like?
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Self-Care Defined We Have a Model
‘Self-Care is what people do for themselves to establish and maintain health, and to prevent and deal with illness. It is a broad concept encompassing hygiene, nutrition, lifestyle (activity), environmental factors, socio-economic factors and self-medication.’ World Health Organization We Have a Model Physical self care, healthy activities, surroundings, financial security, self soothing skills.
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Trauma-Informed Self-Care
Three Pillars of Trauma Informed Care (Bath, 2008). Safety Connectedness Manage Emotions Chiron’s Model We can correlate these with our Wounded Healer Archetype.
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Four Elements of Direction
Donald Meichenbaum’s (2007) elements of self care. Increase Your Self-observations. Use Your Cognitive Abilities Engage in Emotional Self-care Behaviors Medina (2008) and Louise add: Become Physically Fit. Including healthy nutrition.
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Well-Being results from Well-DOing.
It’s About Behavior! Locating the enemy through… What we DO. It’s the logic behind moving from “self-care” or “well-being”, which are passive terms… Charting your course toward Well-Doing. The words imply action. Action implies change. Change is constant and necessary for survival. Well-Being results from Well-DOing. Think about your treatment plans. Goals, Objectives, Tasks.
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Today Plotting a course. A ‘treatment plan’ for yourself.
Goals Objectives. Tasks. Dynamic in nature. Allows for adjustment.
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An Rx of Old & New Concepts
Adopting Well-Doing Behaviors. EMDR/Trauma Informed. Good, sound Cognitive Principles. Elements of William Glasser. A Dose of Zen. Archetypes. A Heaping of John Medina. A Five Point Structure
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Five Principles : The Every-Day Warrior
1. The Past is Always Present. 2. The Past is subject to change. 3. We experience people and events not as they are, but as we are. 4. Mindfulness of the present is your pathway to the future. 5. Fitness of Mind and Body is foundational to higher functioning.
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The Past is Always Present
Principle # 1 The Past is Always Present “We can actually reconstruct our past by examining what we think, say, feel, expect, believe, and do in an intimate relationship now” (Richo, 2008).
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Discuss How aware are you of how this principle unfolds in the relationships you have with your clients, your peers, your supervisor? What “Internal Messages” are aroused in the course of your work and relationships? See Appendix C. At what point do these messages begin to mutiny and sabotage your ability to feel good about your work? In terms of transference, counter-transference, etc.
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Management Versus Prevention
We cannot stop the enemies of our past from being present. We CAN learn to reshape our histories. Which leads us to Principle #2…
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The Past is Subject to Change
Principle # 2 The Past is Subject to Change “Nothing changes more constantly than the past; for the past that influences our lives does not consist of what actually happened, but of what [we] believe happened.” Gerald W. Johnson
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Your High School Reunion
The more I attend, the more healing the stories. Reshaping occurs on different levels. Developmental Fluid Dynamic Facilitated through feedback and connectedness with others In terms of human and professional development. Connectedness softens retrospect.
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We See Things Not As They Are,
Principle #3 We See Things Not As They Are, But As WE Are. Each of us tends to think we see things as they are, that we are objective. Not Really When we open our mouths to describe what we see, we in effect describe ourselves, our perceptions, our paradigms. Stephen Covey: The 7 Habits of Highly Successful People
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When Empathy Becomes Contempt
We must engage in self reflective practices that: Require us to understand another’s point of view. In terms of THEIR basic needs, and ours (Glasser, 1998) . Safety Belonging Love Freedom Fun Preserve their dignity and our own. Working around personal feelings of contempt. Working with a drug using client, a sexual predator, a spouse abuser….
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Mindfulness of the Present is Your
Principle # 4 Mindfulness of the Present is Your Pathway to the Future. Pain, suffering, and anger fall on the heels of giving in to signs of emotional and physical distress which, with practice, can be rerouted through skilled and solid mindfulness . Louise Sutherland-Hoyt (2015) Best practices demand we facilitate self-regulation through mindfulness/presence.
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What is Mindfulness Maintaining non-judgmental awareness of our Inner Landscape. Thoughts. Emotions. Bodily Sensations. Their origins (sub-personalities) When we are mindful we: Establish inner leadership. Manage roles of subpersonalities. Restore executive functioning.
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Principle # 5 Fitness of Body and Mind is Foundational to Higher Functioning.
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Westerners Haven’t Quite Bought Into The Interconnectedness of Mind/Body Fitness
But we’re getting there. Validation through research of mind/spirit-body interconnectedness. What we think. Emotional state. The physical state. 35% Adults in America are obese. ( Studies suggest link between Childhood Traumatic Stress, and Adult Obesity (Lanius, etc., 2010)
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Trauma Informed-Fitness
Some thoughts from John Medina (2008). The human brain evolved under conditions of almost constant motion.
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Medina The best meetings would have us walking at about 1.8 miles per hour. How Come?
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And Still More Medina I love this guy.
The optimal environment for processing information would include motion.
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Exercise positively affects executive functioning, reaction times, and analytical skills.
Problem Solving and Creativity, also. Active muscles protect brain from certain metabolites that cause stress induced changes associated with Depression.
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Improves Cognitive Abilities
Increases oxygen flow into the brain, which reduces brain-bound free radicals (toxic waste). An increase in oxygen causes an uptick in mental sharpness. It increases neurons’ creation, survival, and resistance to damage and stress. Think Neuroplacticity. Exercise facilitates Brain’s ability to readapt and rewire.
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Facilitating by Example
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2008: 200 pounds. Sluggish, depressed, cranky. But put on a good face.
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2011: 67 Pounds Lighter, Age 60 Mt. Whitney Summit
Elevation 15, 508’ MSL 22 Miles Round Trip 18 Hours Quick on feet, focused, creative.
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2013: 3 Therapists @ Whitney Summit.
2012: Half Dome, Yosemite. 2013: 3 Whitney Summit. 15 Hours, 45 minutes, 22 miles round trip. Training objectives buttressed by 3 pillars of trauma informed self-care.
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Exemplify Wellness Follow This Logic.
If I am to facilitate wellness with my clients … It stands to reason that I must be well. In order for me to be well … I must DO the following…….
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Identify Your Core Element
Your Personal Mission Statement. A Constitution. Remains constant amid life changes. Can be amended. Glance at Your Personal Plan of Self-Care Building your wellness plan.
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As Your Plan Takes Shape
Your Mission Statement is Your Constitution. Subject to amendments. Your Objectives Reflect Direction. Your Tasks are Observable and Measurable.
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Our Goals Think: The 3 Pillars Safety. Connectedness.
Affect/Emotional Regulation. .
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Objectives Backbone of the Every-Day Warrior
Four Elements of Direction: Self Observation. Use Cognitive Abilities. Emotional Self Care. Physical Self Care.
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Tasks Are interwoven with 5 Principles Are observable.
You are DOing things. You are experiencing the effect of what you do.
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For Example My Mission Statement: (Goal) .
To have quality relationships (interconnectedness) at home, work, and community by creating a safe and sound environment, and through respectful interactions with all. Objective #1 Be self-observant Orient tasks around 1 or more of 5 principles. Past is Always Present .
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My Personal Plan of Self-Care
Mission Statement: Example To have quality relationships (interconnectedness) at home, work, and community by creating a safe and sound environment, and through respectful interactions with all (affect regulation). .
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Getting Started Early in career and clueless, but, I remember it well!
Objective #1: Be Self Observant. Tasks: Apply Principle #1. Assume that all triggers, positive and negative, are the presence of past experiences. Engage in activities to identify and analyze your triggers. Identify 3 elements of arousal Example Trigger: A client tells me I don’t know what I’m doing. Early in career and clueless, but, I remember it well! Emotional: ______Panic, Fear, Shame, Anxiety Internal Messages: I can’t do anything right, not good enough. I’m stupid. Physiological: My core, my throat, my face, my ears.
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Continuing Reflect on ACES What from my history is being aroused?
Reflect back: How are the 3 elements of your arousal familiar to things that happened in your past? What about those experiences is driving my reactions with clients, peers, others? Perfectionist Hard to take criticism. Have to be right. Defensive
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Continuing On Objective #2: Use Cognitive Skills Tasks.
Apply Principle #2: The Past is Subject to Change Rethink significant, negative and positive impact landmarks Change the internalized message(s). See your own therapist Attend a support group Self-Applied EMDR Getting Past Your Past (Shapiro, 2013) Connect with Peers.
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Objective #2 Continued Apply Principle #3: We See Things not as They Are Projecting arousal of unmet needs, messages, emotions onto client. What kind of tasks to apply #3? _________________ Look at your worksheet for additional suggestions. What have you?
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Continuing With Objectives
Looking ahead. Objectives 3 and 4. Tasks woven into one or more principles. Use your strengths. Use what has worked in the past. Remember! Bite off only what you can chew. It takes at LEAST 6 weeks to create new neuropathways to effect change.
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An Interactive Process
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To Recap: Trauma-based work necessitates Trauma-Informed Self-Care.
Three Pillars. Four Elements of Direction. Five Principles of the Every-Day Warrior All 5 principles are interactive and interdependent. Well-Being is Well-Doing.
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As wounded healers we can rethink
As Spartans We have found the enemy. As wounded healers we can rethink our notion of the enemy.
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Wisdom of the Buddha To love our enemy is impossible.
The moment we understand our enemy, we feel compassion towards him, and he is no longer our enemy. Thich Nhat Hanh
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Questions and Discussion
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Copyright 2015, Louise Sutherland-Hoyt
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