1. CORE SKILLS CURRICULUM Understanding the Complexity of Traumatic Experience(s): Gateway to Intervention

2. The Complexity of Traumatic Experience(s): The Gateway to Intervention Objectives: –Enhance understanding of the complex components of child and adolescent traumatic experiences. –Increase capacity to listen, using a systematic framework –Increase recognition of omissions and difficult moments –Enhance clinical confidence to engage children in trauma narrative work –Appreciate the capacity and courage of children in meeting the challenge of trauma narrative work

3. Danger Apparatus Traumatic experiences need to understood within a broader context of danger. The human brain and body are geared to recognize and respond to dangers. Danger takes a priority over normal activities of daily functioning. There is a developmental ontogenesis of danger and response. Culture helps define appraisal of threat and possible responses. Experience molds expectations of danger and selections of interventions.

4. Danger Apparatus Appraisal of the Magnitude of External and Internal Danger. Emotional and Physiological Activation: Valence, Intensity, Acceleration. Efforts at Emotional Regulation, including Suppression or Override of Inhibitions. Estimation and Efficacy of Protective Intervention by Self/Others/Social Agents.

5. Danger Secondary Appraisal of the Magnitude of External and Internal Danger (Actualized threats, near misses and false alarms). Secondary Efforts at Emotional Regulation. Reconsiderations of Preventive and Protective Intervention by Self/Others and Social Agents.

6. When Danger Becomes Trauma: Failure of the danger apparatus to prevent an injurious outcome. Moment(s) of true physical helplessness. Convergence of external and internal dangers.

7. The Complexity of Traumatic Experiences I.Context II.Multiple traumatic moments occur, even within a relatively circumscribed situation. III.Changes foci of attention or concern. IV.Radical shift in attention or concern when physical integrity is violated. V.Additional traumatic moments after cessation of violence or threat. VI.Additional dimensions to traumatic experiences. VII.Disturbances in evolving developmental expectations regarding danger.. Pynoos, Steinberg & Aronson, 1997

8. The Complexity of Traumatic Experiences I. CONTEXT: A. Circumstances B. Affective state C. Cognitive preoccupations D. Developmental concerns Pynoos, Steinberg & Aronson, 1997.

9. The Complexity of Traumatic Experiences II.MULTIPLE TRAUMATIC MOMENTS: Even within a relatively circumscribed situation. A.Moment-to-moment perceptual, kinesthetic and somatic registration.

10. The Complexity of Traumatic Experiences II.MULTIPLE TRAUMATIC MOMENTS: Even within a relatively circumscribed situation. B. Ongoing appraisal of external & internal threats.

11. The Failure Of Developmental Expectations Alarm Reactions Social Referencing Searching Protective Shield Resistance to Coercive Violation Basic Affiliative Assumptions Emerging Catastrophic Emotions Socially Modulated World Surrender – Moment of Unavoidable Danger

12. The Complexity of Traumatic Experiences II.MULTIPLE TRAUMATIC MOMENTS: Even within a relatively circumscribed situation. C. Ongoing efforts to address the situation in behavior, thought and fantasy

13. The Complexity of Traumatic Experiences II.MULTIPLE TRAUMATIC MOMENTS: Even within a relatively circumscribed situation. D. Continuous efforts to manage emotional and physiological reactions.

14. The Complexity of Traumatic Experiences III.CHANGES IN FOCI OF ATTENTION OR CONCERN: A.Attention drawn away from one’s own safety out of concern for danger or injury to other. B.Moment of estrangement from others when immediate threat or injury to self. C.Sudden preoccupation with concerns about severity of injury. Rescue or repair after injury to self or other. D.Inhibition of wishes to intervene or suppression of retaliatory impulses from fear of provoking counter-retaliatory behavior. Pynoos, Steinberg & Aronson, 1997.

15. The Complexity of Traumatic Experiences IV.RADICAL SHIFT IN ATTENTION OR CONCERN WHEN PHYSICAL INTEGRITY IS VIOLATED: A.Attention directed towards fears/fantasies about nature/extent of psychic/physical harm. B.Engagement of self-protective mechanisms to meet internal threats and pain (including ‘Dissociative’ physiological responses and fantasies). C.Efforts to invoke or disclaim of affiliative needs/desires in order to mitigate fear or ward off sense of active participation. Pynoos, Steinberg & Aronson, 1997.

16. The Complexity of Traumatic Experiences V.ADDITIONAL TRAUMATIC MOMENTS AFTER CESSATION OF VIOLENCE OR THREAT: A.Efforts to aid injured or attend to dead family members or friends. B.Efforts to seek outside help (e.g., police, paramedics). C.Experiences during acute medical or surgical care. D.Acute separation from significant others, including injured or dead family members or peers. Pynoos, Steinberg & Aronson, 1997.

17. The Complexity of Traumatic Experiences V.ADDITIONAL DIMENSIONS TO TRAUMATIC EXPERIENCES: A.Worry about safety of significant others whose well-being is unknown. B.Reactivation of previous danger/fear/anxieties from prior experiences. C.Acute grief reactions to witnessing death or destruction even while threat to self continues. Pynoos, Steinberg & Aronson, 1997.

18. Individual efforts or ability to take protective action fail Efforts by the individual and/or others to take protective action fail, including attempts to  Prevent/avoid the trauma before it occurs,  Protect/defend oneself and/or others during the trauma,  Repair or reverse injury/damage/loss after it has been inflicted. This leads to the subjective experience of defenselessness, vulnerability, & helplessness. Other’s efforts or ability to take protective action fail A "Worst" Moment: The Convergence of External and Internal Threats (Layne, Saltzman, Pynoos) External Threat: (An objective catastrophe takes place OUTSIDE of me)  Direct threat to my life, physical safety, or physical integrity  Witnessing the death, injury, or physical violation of others  Learning of the death, injury, or physical violation of loved ones { Internal Threat: (A subjective catastrophe takes place INSIDE of me)  Catastrophic Thought Reactions  Catastrophic Emotional Reactions (including Bodily Sensations)  Behavioral Distress Reactions

19. WEAKENED VERSION Proximity to the Violence Lethality of the Instrument Intentionality Object of Violence Seriousness of Injury

20. Intervention Fantasies To Alter the Precipitating Events To interrupt The Traumatic Action To Reverse The Lethal or Injurious Consequences To Gain Safe Retaliation (Fantasies of Revenge) To Prevent Future Trauma Pynoos, Steinberg & Aronson, 1997.

21. National Child Traumatic Stress Network (NCTSN) WEBSITE: www.NCTSNet.org