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TRAUMA 101

TRAUMA 101. TRAUMA INFORMED PRACTICE Feb. 11, 2013 Kathy Savicki, LCSW, Mid-Valley Behavioral Care Network. WHAT DO WE MEAN BY TRAUMA? . “ Traumatization occurs when both internal and external resources are inadequate to cope with the external threat.” Van der Kolk.

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TRAUMA 101

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  1. TRAUMA 101 TRAUMA INFORMED PRACTICE Feb. 11, 2013 Kathy Savicki, LCSW, Mid-Valley Behavioral Care Network

  2. WHAT DO WE MEAN BY TRAUMA?.“Traumatization occurs when both internal and external resources are inadequate to cope with the external threat.” Van der Kolk Critical role of environmental support Link with abuse and neglect – toxic stress for children Fear + disrupted attachment

  3. Limitations of the Diagnostic System • Acute Stress Disorder – 1st month after event • PTSD • 1st described Vietnam vets and rape victims • Poor fit for children and youth • DSM V will change criteria • Proposed but rejected by APA: • Developmental Trauma Disorder • Complex Trauma/Disorders of Extreme Stress

  4. Generational Trauma Parental trauma responses affect their children • Parental problems and crises impact kids • Parental coping tools and relational styles are passed down • Children can learn a ‘trauma response’ to life

  5. Trauma in Our Lives • Up to 70% of American adults experience at least one traumatic event • At any time 5% of Americans have active PTSD • 8% of us will experience PTSD in our lifetime • Approx. 25% experience multiple traumas • Prevalence in women is 2x that in men

  6. Ability to Cope with Trauma Depends on: • Single vs. repeated trauma • Age when trauma occurred or began • Agent – natural vs. human • Nature of the trauma – accidental vs. purposeful • Innate resilience

  7. Select Traumatic Events and Risk for PTSD Source: Breslau, 1996 Detroit Area Survey of Trauma

  8. Neurobiology of Trauma What happens in our brains? These slides are available on the BCN website at http://www.mvbcn.org/home/mv1/smartlist_176/trauma-sensitive_services.html

  9. Trauma and the Brain • Thalamus (temporal lobe) receives sensory signals • Amygdala sorts for immediate danger - Shuts down ‘thinking brain’ - Diverts energy to physical response • Hippocampus stores episodic long term memory • Reactivation of this pathway strengthens it

  10. In the Traumatized Brain

  11. In the Traumatized Brain

  12. Intervention Strategies

  13. Memory & Perception A memory includes: • Narrative, verbal • Visual imagery • Sensory, somatic • Affective, feeling • Interpersonal, behavioral Traumatic memories are encoded or “remembered” in a different way from normal, everyday events.

  14. Traumatic Memory • Sensory • Linked with intense arousal • Fragmented • ‘Body’ rather than verbal memory Role of psychotherapy is to develop the use of the frontal cortex to make sense of and manage reactivity

  15. PTSD Symptom Clusters (DSM IV)

  16. Developmental Trauma Disorder Exposed to over a year of interpersonal violence, with significant disruptions of protective caregiving Affective and Physiological Dysregulation Attentional and Behavioral Dysregulation Self and Relational Dysregulation PTSD Symptoms Functional Impairment

  17. Complex PTSD, also called Disorders of Extreme Stress Proposed for DSM-IVR by trauma treatment experts, but not adopted Superb clinical description of adults who experienced on-going child abuse and neglect and multiple or pro-longed trauma Better way of understanding many people otherwise labeled with personality disorders

  18. Generational Trauma Parental trauma responses affect their children • Parental problems and crises impact kids • Parental coping tools and relational styles are passed down • Children can learn a ‘trauma response’ to life

  19. Systems Trauma Simply put, systems trauma is the trauma that people experience or re-experience as a direct result of their interaction with a powerful system Although it may be connected to a single trauma, more often it is part of complex trauma

  20. Systems Trauma The experience of powerlessness is key to retraumatization, especially when people have experienced authority figures as cruel. People are often retraumatized when they experience being treated in a way that is similar to past traumas. The more trauma a person has experienced, the more vulnerable they are to retraumatization If you have a negative sense of self, feeling judged can be powerfully retraumatizing

  21. When Under Stress………. We all tend to use our more primitive defensive brain Use of that part of the brain curtails the use of the more-highly organized, intelligent part of the brain We become more tuned in to immediate survival, and less tuned in to the abstract future We opt for simple and swift as opposed to complex and thoughtful reactions

  22. Retraumatization: Feeling States Being retraumatized often invokes intense feelings • Hopelessness • Helplessness • Extreme vulnerability • Intense desires to die, disappear or run • Pervasive shame • Anger or rage • Terror • Self-hatred/condemnation

  23. Retraumatization: Common responses • Strong negative emotions that may be difficult for the person to explain, and expressed in ways that we might not understand (or appreciate) • Defensive or angry verbalizations/avoidance • Withdrawing emotionally/shutting down/self-sabotage • Telling people “in authority” what they think the person wants to hear/overly “compliant” • Disengaging from services/leaving

  24. Systems WHICH FREQUENTLY RE-TRAUMATIZE • Law Enforcement • Criminal Justice • Child Welfare • Hospitals and related medical systems • Mental Health • Substance Abuse Treatment

  25. Many Parents Encountering Child Welfare • Have experienced abuse as children • Have experienced multiple life traumas and developmental interruptions • Have not had the natural and therapeutic supports needed to initiate their own recovery • Have had little or no experience, training or support in being a parent • Have multiple life stressors and limited resources

  26. Child Welfare Parents experience Child Welfare staff as extremely powerful Parents who encountered the Child Welfare System as children know that power What’s at stake is the primary attachment to one’s child Actual and perceived negative experiences create difficulties in building a relationship

  27. Child Welfare The Child Protective Services System works with a legal system that can feel adversarial Fact-based reports can feel accusatory, triggering intense feelings of guilt Parents often experience this process as frightening, unfair, humiliating and painful

  28. Potentially traumatizing experiences Not being informed of or understanding the plan for the children when they have been taken into custody, not knowing the process Having – or feeling that - important decisions are made about them or their children without their knowledge, participation or consent Multiple conflicting priorities without the resources or support to accomplish them Negative evaluations of their character or value as parents

  29. Potentially traumatizing experiences Judgments and stereotypes related to the parent’s addiction, mental health, or family history Being treated as hopeless or as if their past history dooms them to failure Fear of their children having negative experiences (big or little) in foster care Loss of contact with child or termination of rights

  30. Basic Skills: Trust and Respect Kindness, courtesy, politeness Reliability Attentive listening – open ended questions Emphasize choice Owning our mistakes Assume symptoms (including lies) have a positive intent and an adaptive function

  31. Reconsidering Our Words • Frequent flyer • Perjorative label reflecting our helplessness/frustration • Manipulation • An indirect method of achieving a goal when being direct isn’t see as an option or likely to succeed • Secondary Gain • Reflects a primary need not met in other ways • Attention Seeking • Why do people have to work so hard to get our attention? • Borderline • Person with an attachment disorder

  32. We Have to Believe in Recovery Stay strengths-based and respectful • Remember that change is terrifying • Know that the person is doing their best to survive in the moment • If they rage at you, assume you’ve reactivated previous traumatic relationships and don’t over-react yourself • Peer supports are invaluable to help people feel truly understood and hopeful about change

  33. We Have to Believe in Recovery Stay grounded in Recovery Principles • Recovery is not linear, but marked by growth, setbacks and learning from experience • Honoring attempts that don’t work • Moving from destructive to healthy coping involves daily choices for health and safety • The process can be laborious • Small steps need to be recognized and valued • Beware when you feel “Here we go again” • Holding on to hope

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