Effective Treatment for Trauma: Myths &Guidelines

1. Effective Treatment for Trauma: Myths &Guidelines Jonathan Kandell, LCSW, LISAC Senior Therapist, Codac Behavioral Health, Licensed Psychotherapist in Private Practice May 8, 2008 Long Rangers Forum Tucson, AZ

2. Today’s Talk • What is PTSD • Treating PTSD • Guidelines for Professional Help

3. “Although the world is full of suffering, it is also full of the overcoming of it.” Helen Keller, US blind & deaf educator (1880 - 1968)

4. “Trauma” “An extreme stressor... that involves actual or threatened death or serious injury, or other threat to one's physical integrity.” “Produces intense fear, helplessness, or horror.” from the DSM-IV

5. Domestic Violence Sexual Abuse & Rape War & Refugees Suicide Vehicular accidents Genocide Community violence Natural disasters Medical trauma Displacement, slavery, trafficking Causes…

6. Post Traumatic Stress Disorder (PTSD) • Post • Traumatic • Stress • Disorder re-lived trauma anxiety ruins your life

7. PTSD in a nutshell

8. PTSD in a nutshell

9. PTSD Fight Flight Freeze

10. PTSD Hyper-arousal Tuning out Paralysis

12. This is dissociation

14. Dissociation gone awry

15. Dissociation gone awry

16. Compartmentalization

18. Being human makes PTSD worse • Animal aspects: • Fight, flight, freeze • Human aspects: • “Mind Games” • “Analysis Paralysis”

19. Your dog doesn’t do this: I am a terrible dog failure, who must punish myself by refusing the leftover carne asada.

20. PTSD Hyper-arousal Tuning out Immobility

21. Complex PTSD Acting Out Avoidance Helplessness

22. What it feels like inside… • Everything is truly my fault (even though I act like I don’t care). • I can never be forgiven. • Nobody could ever understand me. • Come here, but go away. • Shame-based arrogance. • Surrender is a dirty word but fighting is useless. Jerry Boriskin, PhD

23. What it feels like inside… • I feel nothing at all, except the surges of anger. • Life sucks and anyone who believes otherwise is stupid. • I am a complete cynic, yet everything should be perfect. • I don’t care what anyone says, I am defective, unlovable, and things are hopeless. Jerry Boriskin, PhD

25. Treating PTSD (and associated disorders…)

26. Treatment Myths • You get “cured” • Medication alone will work • All trauma requires treatment • PTSD requires intense “processing” -- and it must happen now

27. Treatment Misconceptions • You get “cured” or “don’t get cured” • All trauma requires treatment • All treatment requires processing.

28. Treatment Misconceptions • You get “cured” or “don’t get cured” • All trauma requires treatment • All treatment requires processing.

29. Expected history of PTSD Traumatic Event 1 month 9 months 3 years Many recover without treatment within months of event (45-80% natural remission at 9 months) Generally 33% remain symptomatic for 3 years or longer with greater risk of secondary problems Usual onset of symptoms

30. Treatment Myths • You get “cured” or “don’t get cured” • All trauma requires treatment • PTSD requires intense “processing” -- and it has to happen now.

31. The problem with jumping right in

37. Stages of Recovery • Safety • Remembrance & Mourning • Reconnection (Judith Herman)

38. Some therapies that work • Seeking Safety (Najavits) • Dialectical Behavior Therapy (Linehan) • Self Trauma Model (Briere) • Eye Movement Desensitization Reprogramming (Shapiro) • Acceptance Commitment Therapy (Hayes) • Schema Therapy (Young) • Emotion-Focused Therapy (Greenberger)

39. Some Key Points for Recovery

40. Trauma will heal spontaneously if the process isn’t blocked

41. Trauma will heal spontaneously if the process isn’t blocked

42. Trauma will heal spontaneously once the process isn’t blocked

43. Trauma will heal spontaneously once the process isn’t blocked

44. Spirituality & Compassion are crucial

45. Guidelines for Seeking Professional Help (and tips for families)

46. Guidelines for Treatment • Don’t make a career of “managing symptoms”. Build a life worth living. • Avoid unlicensed “healers” • Heal in your own way, true to yourself • While recovery can be slow, you should see (and expect) definite improvement over time!

47. Advocate when “the System” itself stifles recovery • Chaos • Lack of communication • Colluding with the disease, not recovery • “Programs” and “fads” instead of relationships

48. Tips for families • Take action: don’t be paralyzed by fear • Advocate for treatment • Be your family member’s “reality check” • Be assertive--not aggressive • Learn about co-dependency • Patience, not passivity. • Maintain positive expectations adapted from Jerry Boriskin

49. “Although the world is full of suffering, it is also full of the overcoming of it.” Helen Keller, US blind & deaf educator (1880 - 1968)

50. Thank you very much for listening with an open mind! Jonathan Kandell, LCSW LISAC 327-4505 x1087 jkandell@sysmatrix.net