Helping Victims Deal With Trauma

1. Helping Victims Deal With Trauma Anna M. Whalley, LCSW Shelby County Crime Victims Center 901.545.4357

2. Trauma “Traumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptations to life.” Judith Herman Trauma and Recovery 1993

3. Individual Trauma “ a blow to the psyche that breaks through one’s defenses so suddenly and with such force that one cannot respond effectively.” Kia Erickson In the Wake of a Flood 1979

4. Maslow’s Hierarchy of Human Needs Survival Needs Oxygen Food Water Shelter Rest

5. Hierarchy… Safety and Security Lack of threats Law Community stability

6. Hierarchy… Cognitive Functioning Maintain every day life Establish daily goals Plan

7. Hierarchy… Self Esteem and Meaning Internal values Cultural norms Belongingness Adequacy

8. Hierarchy… Self Actualization Peak performance Episodic “Bliss”

9. Elements of Trauma Earth

10. Elements Air

11. Elements Fire

12. Elements Water

13. Elements People

14. External Factors Visual perceptions are critical to the formation of a narrative.

15. External Factors Proximity to the trauma effects memory

16. Chronology of Event Vital to integration of the experience

17. Low Point Traumas Clear ending to the traumatic event.

18. No Low Point Trauma Victimization may be ongoing.

19. Physical Crisis Response Frozen Fright

20. Physical Mobilization

21. Physical Exhaustion

22. The Mind’s Response Shock Disbelief Denial

23. Mind… Regression

24. Mind… Cataclysm of Emotion

25. Emotions Fear and Terror

26. Emotions Anger, Fury and Outrage

27. Emotions Confusion and Frustration

28. Emotions Guilt or Self Blame

29. Emotions Shame or Humiliation

30. Emotions Grief or Sorrow

31. Emotions Disenfranchised Grief

32. Emotions Reconstruction of Equilibrium

33. DSM-IV- Substance Dependence Maladaptive pattern of substance use with Tolerance Withdrawal Uses more than intended

34. Substance Dependence Desire to stop Interferes with life Physical or Psychological problem made worse by using the substance

35. DSM-IV- Substance Abuse Maladaptive use with Use leading to a failure to fulfill obligations Use in hazardous situations Recurrent legal problems related to use Continued use in spite of social or interpersonal problems

36. Substance Abuse- Pre-victimization Women- Twice as likely to experience an assault A&D users are 1 ½ times as likely to experience traumas ER patients with violence related injuries at least twice as likely to have been drinking

37. Women and Substance Use/Abuse “It is worse for a woman to get drunk…” May exclude victims from DV services Women take a shorter period of time to go from occasional use to abuse

38. Men and Substance Abuse Myths Alcohol use causes men to batter. Alcohol treatment will address the abuse. Battered women are co-dependent so partially to blame.

39. Substance Abuse- Post-Victimization 9 out of 10 alcoholic women were abused as children. Women who have been assaulted are twice as likely to use or abuse substances. Alcohol abusers report 3 times as much trauma as nondrinkers. Drug and alcohol abuse is strongly associated with PTSD.

40. A Play in One Short Act

41. Secondary Victimization Law Enforcement Prosecutor Victim/Witness

42. Secondary Victimization Family and Friends

43. Secondary Victimization Media

44. Survival Strategies “Survival strategies are specific stress responses which include specific adaptive and maladaptive biological, psychological and social constituents.”

45. Survival Strategies Rescuing Attaching Asserting Adapting Fighting Fleeing Competing Cooperating Valent, Paul. “From Survival to Fulfillment: a framework for the life-trauma dialectic”

46. Rescuing… Must rescue others.

47. Attaching… Must be rescued by others.

48. Asserting… Must achieve goals.

49. Adapting… Must surrender goals.

50. Fighting… Must remove danger.

51. Fleeing Must move from danger.

52. Competing… Must obtain scarce essentials.

53. Cooperating… Must create scarce essentials.

54. Warning Signs of Trauma-Related Stress Recurring thoughts or nightmares about the event. Having trouble sleeping or changes in appetite.

55. Warning Signs… Being on edge, being easily startled, or becoming overly alert. Feeling depressed, sad and having low energy.

56. Warning Signs… Memory problems. Feeling scattered and unable to focus. Having difficulty making decisions. Feeling irritable, angry or resentful.

57. Warning Signs… Feeling numb and disconnected from others. Feeling a sense of despair and hopelessness.

58. Warning Signs… Feeling extremely protective of, or fearful for the safety of loved ones. Not being able to face certain aspects of the trauma.

59. Warning Signs… Physical Eating disturbance Sleep disturbance Sexual dysfunction Low Energy Chronic, unexplained pain

60. Warning Signs… Numbing Amnesia Detachment Altered sense of time Avoidance of situations related to the trauma

61. What Is Counseling? Friendly, but not a friendship. Instructive, but not a class. Intense, but not intimate. Helpful, but not care-taking. Important, but not magic.

62. Principles of Counseling Mutual respect and commitment Client Centered Ethically Sound Proven Effective

63. Post-trauma Counseling Education Experience Energy

64. Post-trauma Counseling Rehearsal Reassurance Referral

65. Post-trauma Counseling Activism Advocacy Actualization

66. What Crime Victims Need… To feel relatively safe Edward L.Smookler, PhD

67. What They Need… To know that you will respect their boundaries

68. What They Need… To know that they can leave if they want to

69. What They Need… To know that they will not be touched if they do not want to be touched

70. What They Need… To talk and be listened to

71. What They Need… To be left alone

72. Procedures and Processes Begin simply.

73. Procedures… Let the victim lead.

74. Procedures… With permission, ask questions.

75. Procedures… Create space for discussion.

76. Beware- The Silencing Response This will hurt the client or me. This cannot be true. If this happened to you, it could happen to me. Anna Baranowsky, 1997

77. Goals of Post-trauma Counseling Reduce Stress Identification of feelings and reactions Integrating trauma into life story Relieve stress symptoms

78. Goals… Enhance adaptive capacity Daily functioning Healthy lifestyle Social support systems Growth opportunities

79. Resilience- What is it? Insight- Asking tough questions and giving honest answers. Ability to read others’ signals. 2002 National Victims Assistance Academy- Text

80. Resilience Independence- the right to safe boundaries, emotional and physical

81. Resilience Relationships- Intimate and fulfilling ties to others. Ability to select and maintain healthy relationships.

82. Resilience Initiative- Determination to master ones self and environment. Creative problem solving and constructive activities.

83. Resilience Creativity and Humor- Used to forget pain and express emotion. Reduces tension to make a bad situation better.

84. Resilience Morality- Knowing what is right and wrong. Standing up for one’s beliefs. Taking joy in helping others.