CORE SKILLS CURRICULUM

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 • Context • Multiple traumatic moments occur, even within a relatively circumscribed situation. • Changes foci of attention or concern. • Radical shift in attention or concern when physical integrity is violated. • Additional traumatic moments after cessation of violence or threat. • Additional dimensions to traumatic experiences. • Disturbances in evolving developmental expectations regarding danger. • . Pynoos, Steinberg & Aronson, 1997

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

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

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

14. The Complexity of Traumatic Experiences • CHANGES IN FOCI OF ATTENTION OR CONCERN: • Attention drawn away from one’s own safety out of concern for danger or injury to other. • Moment of estrangement from others when immediate threat or injury to self. • Sudden preoccupation with concerns about severity of injury. Rescue or repair after injury to self or other. • 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 • RADICAL SHIFT IN ATTENTION OR CONCERN WHEN PHYSICAL INTEGRITY IS VIOLATED: • Attention directed towards fears/fantasies about nature/extent of psychic/physical harm. • Engagement of self-protective mechanisms to meet internal threats and pain (including ‘Dissociative’ physiological responses and fantasies). • 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 • ADDITIONAL TRAUMATIC MOMENTS AFTER CESSATION OF VIOLENCE OR THREAT: • Efforts to aid injured or attend to dead family members or friends. • Efforts to seek outside help (e.g., police, paramedics). • Experiences during acute medical or surgical care. • 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: • Worry about safety of significant others whose well-being is unknown. • Reactivation of previous danger/fear/anxieties from prior experiences. • Acute grief reactions to witnessing death or destruction even while threat to self continues. Pynoos, Steinberg & Aronson, 1997.

18. A "Worst" Moment: The Convergence of External and Internal Threats (Layne, Saltzman, Pynoos) { • 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. Individual efforts or ability to take protective action fail Other’s efforts or ability to take protective action fail

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