Developing a network

1. Developing a network • Needs to be realistic and safe • Into this you can build a series safety circles • Needs to be accessible and available • Eg number in phone or access to phone card or address) • Needs to be regularly reviewed • We all need a network!

3. What if sessions • The purpose to establish strategies for staying safe, protecting privacy (especially when done with a group of people) and sharing information • Gives some perspective on danger; especially good for groups of peers or families but also possible with an individual

6. Examples of “what if” or “let’s suppose” discussions about risk • Let’s suppose you were scared because you couldn’t find Daddy when you went shopping? • Let’s suppose you were on your way home from school and someone asked you to get in a car? or go to see their kittens? or go to the beach? • What if a stranger came to pick you up from sport or school? (Always make sure kids know who will collect them) • What if you were at a sleep over and didn’t feel safe? • What if the baby sitter did something you didn’t like?

7. Go away Make a fuss Distract the grown ups Show you don’t like it Tell them you don’t like it Get help from the network Eat and avoid Throw something Do nothing Be gross Fight back Be invisible Borrow protection Later… Later tell someone Review network Check early warning sign The kinds of responses you will see… or could encourage

8. What if discussions with parents • What if you found out your children’s computer use was worrying you ? • Do your young people know about safety on the internet. • What if you found pornography in the home?

9. Books and Stories • Eg Uncle Willy’s Tickles • Sometimes it’s OK to tell secrets • See http://www.feministbookshop.com/ for more titles • 7 steps to safety http://www.nt.gov.au/health/facs/sevensteps.shtlm • Bravehearts Dittos Keep Safe Adventure • Protective Behaviours, Peg Flandreau West • Counselling Children, Kathryn Geldard and David Geldard

10. Supporting safer sexual behaviourand sexual identity • Psycho-education • Increasing sense of self and entitlement and self determination in sexual activity • Sensing safe progress • Problem solving in risk situations What if • Exercise - Am I ready • Exercise - Sex rules my rules

11. *Addressing Cognitive Distortions: Assumptions • Successful resolution of trauma involves cognitive processing of the experience. • Maladaptive thoughts about an experience prohibit resolution of that experience. • Thinking errors occur with limited awareness and information. • When inaccurate or maladaptive attributions are challenged and replaced with accurate and beneficial thoughts, feelings, and behaviors can become more positive and adaptive.

12. *Addressing Cognitive Distortions: Tasks • Identify thinking distortions • Re-define attributions • Identify linkage between thoughts, feelings, and behaviors • Process guilt and self-blame • Identify link between behaviors and personal experiences (includes triggers) • Enhance understanding that client has control over choices – self-power

13. Typical maltreatment maladaptive cognitions • Self-blame (e.g. what did/did not do) • Shame (e.g., overall negative self) • Over accommodation (e.g., no one trustworthy, it’s a dangerous world) • Assimilation (e.g., helplessness, why not be risky) • Overestimation of danger

14. Improving Cognitive Coping • Explain the connection between thoughts feelings behaviors • Focus on the positive instead of the negative aspects • Positive self-talk • Recognizing how one is coping well

15. Eliciting alternative attributions regret vs responsibility • Best friend role what would you say to your best friend • Glass half full • No Excuses exercise

16. *System Dynamics: Assumptions • Children need their family system members to keep them safe and to provide support and nurturance throughout trauma treatment • Including caretakers in treatment reinforces children’s learned coping skills, behavioral management, and challenges inaccurate cognitive attributions about their responsibility regarding the trauma. • Children and their family members have a great impact on each other. • Addressing system dynamics helps move a closed system to an open system by teaching communication and problems solving skills.

17. *System Dynamics: Tasks • Share trauma integration with appropriate system people • Share resources for caretakers • Develop parenting skills • Implementing and maintaining appropriate boundaries • Improving communication and understanding of developmental and emotional needs of child

18. Parent/Caretaker Involvement • Essential and critical to effectiveness of therapy with children • Reduce distress • Promote ability to support the child in a safe environment • Provide information • Prepare for joint exposure/trauma narrative sessions • Teach behavior management skills

19. What a parent needs to knowafter sexual abuse • Indicators of trauma and how to respond • Sexual development red flags • Family guidelines for safety and privacy • Comfort levels with touch • Caution with playful touch • Triggers • Teach privacy and respect • Keep adult sexuality private

20. *Trauma Integration: Assumptions • Creating a Trauma Narrative helps change cognitive misattributions and decreases intensity of reminders and negative emotions such as terror, horror, helplessness, & rage • Exposure to traumatic details and related feelings allows for greater control, learning new coping skills, understanding of the traumatic event and their reactions to the event. • Making sense of the trauma allows for a more positive view of themselves, their future, and the community in which they live.

21. *Trauma Integration: Tasks • Re-tell the traumatic story through various mediums • Poems, Letters to the abuser • My journey Creative Therapy Adolescents overcoming CSA Ollier and Hobday • I have reclaimed my life Creative Therapy Adolescents overcoming CSA Ollier and Hobday • Integrate traumatic experience into cognitive schema • Experience full range of emotions associated with trauma • Corrective emotional re-working of the trauma • Reduce emotional charge related to trauma • Process grief and loss associated with trauma • Identify physical reactions to traumatic experience and process

22. *Heuristics of Using theClinical Pathway • One skill builds upon another. • All spokes of the Trauma Wheel will be addressed at some point during treatment. • The length of time and intervention type depend upon the unique client picture. • The wheel is fluid – you move back and forth between spokes of the wheel.

23. *On-going Re-assessment • Weekly interviews/updated goals • Progress notes • Supervision • Follow-up standardized measures • Must use the same measures for each time period (to measure change over time) • Can add measures over time (once added must continue to administer added measure to assess change over time).

24. Symptom Change Over Time

25. COW Strategies ( crisis of the week)Lucy Berliner, M.S.W. Director of the Harborview Center for S AClinical Associate Professor at the University of WashingtonSchool of Social Work and Department of Psychiatry and Behavioral Sciences. • Acknowledge identified COW. How?? • Address COW briefly and then return to treatment goal, or…… • Address COW through components-based intervention (problem solving, cognitive coping, emotional regulation…)

26. Resources • www.ChadwickCenter.org (Chadwick) • www.nctsn.net (National Child Traumatic Stress Network) • www.musc.edu/cvc/ (TF-CBT on-line and OVC guidelines) • www.cachildwelfareclearinghouse.org • John Briere www.johnbriere.com • Eliana Gil Helping Abused and Traumatised Children Integrating Directive and Non Directive approaches