Eight Guides to Trauma Treatment

Eight Guides to Trauma Treatment John Sargent, M.D.

Learning Objectives • 1) Learn about the features associated with traumatic stress in children and adolescents. • 2) Learn an approach to integrating and staging treatment of traumatic stress in children and adolescents.

This presenter has no conflicts to declare

The presenter has no conflicts of interest to declare.

Characterizations of Trauma Significant Danger Unexpected and unpredictable Uncontrollable - inducing helplessness

Potentially leading to CNS changes • Alterations in arousal and shut off • Alterations in memory formation (disconnected, highly visual)

Dissociation and numbing are common • Trauma always includes loss

Trauma responses vary • Based upon previous traumatic experiences or psychiatric disorder • Based upon temperament, attachment relationships and potentially upon genetic endowment

Based upon parental experience with PTSD • Based upon degree of social support and community attributions about the trauma

Based upon degree of dissociation and the presence of substance abuse and depression • Based upon experiences with modeled violence • Based upon degree of personal responsibility, guilt and shame associated with the trauma

Aspects of the traumatic event(s) also influence trauma responses • Single vs multiple events • Impersonal - Natural Disasters

Interpersonal • Attachment Trauma

Combination - e.g. Accidents, War • Coupled with subsequent disruptive events • Loss of important relationship

Loss of community safety • War • Torture • Community Violence • Refugee Experience • Domestic Violence

Loss of health • Invasive medical procedures

Key variables • Predictability • Control

Meaning and context • Protection

Stability • Opportunity to reestablish day-to-day routines and competency

Continuity and connection • Forgiveness and reconciliation vs. rage and retribution • Chronic difference vs. recovery • Community memorialization

Guides to Treatment - Often Intersect and Interact Safety usually includes heroic and courageous actions

Usually connects individuals to agents of community - police, health care system, legal system, social service and mental health system

Basic Needs food, clothing, shelter Often involves charity, victim status, unequal hierarchy and acceptance of need and need for help

Knowledge not only information but a relationship within which necessary information is asked for and provided

Behavioral Routines oriented toward recovery - build competency and reorient victims toward life after trauma

Emotional Expression, Labeling and Support identifying separate important affects and renders them comprehensible and allows expression and modulation within attachment relationships

Embedding Support within a Network of Support rebuilds a community responding to affect and united in supporting each other

Narrative Creation builds coherence, context and a sense of groundedness. The trauma victim is the author. The story distances the author from the story and displaces dissociation with understanding and continuity, role of psychotherapy

Justice opportunities for accountability acceptance of blame, apology, forgiveness, and reconciliation

Examples: Survivor mission, altruism, truth and reconciliation experiences. Reparations and advocacy for human rights and community efforts toward integrity and a just society, memorialization and artistic expressions, journals and recollections

Eight Guides to Trauma Treatment