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How Victims Learn to Cope: Clinical Strategies for Traumatic Pleasure and Traumatic Repetition Presented by: Rokelle Lerner email@example.com Innerpathretreats.com. The 14th Annual Counseling Skills Conference, October 4 2008 Las Vegas, NV. Disorders Related to Trauma. PTSD
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How Victims Learn to Cope:Clinical Strategies for Traumatic Pleasure and Traumatic Repetition
Presented by:Rokelle Lerner
The 14th Annual Counseling Skills Conference, October 4 2008Las Vegas, NV
So we get rid of sights, sounds by dissociation, repression or addiction.
Sense of Order:
We want to complete or resolve the experience
TraumaticShame: self-hatred rooted in a traumatic experience
TraumaticRepetition: repeating behaviors by seeking situations or persons who can re-create the traumatic experience
Traumatic Pleasure: High risk behaviors to mask pain and emptiness
TraumaBonds: Attachments that occur in the presence of danger, shame or exploitationHow Trauma Victims Cope
Deny basic needs
Avoid sexual pleasure
No interest in eating for periods of time
Sabotage success opportunities
Assess for Axis I disorders: anorexia, sexual aversion disorder, agoraphobia and other phobic responses
Incremental use strategies
Connect relapse with trauma issues
Learning to play as well as relaxation techniques
CBT: confronting disabling beliefs non-deserving
Clinical StrategiesSymptoms ofTraumatic Abstinence
Enduring physical or emotional pain most people would not accept
Avoiding mistakes at any cost
Suicidal ideation, threats or attempts
Numbing of emotions and inability to experience love, joy or sadness
Visualization and affirmation
Intense family of origin work
CBT to restructure faulty or shaming belief
Shame reduction strategies:
Familiarity with the shame cycleSymptoms of Traumatic Shame:
Inability to stop a childhood pattern
Compulsively victimizing others in a similar way that patient was victimized
Provoking others: allows the patient to re-live the victim experience
Assessment for OCD
Cognitive restructuring of key experiences and beliefs about those experiences
Abreaction: re-creation of experience (through visualization or psychodrama) to reduce the power of original experience, bring resolution and make it conscious
ClinicalStrategiesSymptoms ofTraumatic Repetition
Only feeling ‘alive’ when dealing with crisis or huge risk.
Difficulty sleeping, being with their families or maintaining friendships
High risk sex, compulsive gambling, white collar theft, affairs
Stimulation and pleasure are compensating for pain and emptiness. Focus on self soothing, empathic connection and triggers for relapse
Do a history of how excitement and shame are linked to traumatic past.
Debrief the costs and dangers over time.
First Step and relapse prevention plan regarding how powerful this is in their life.
Clinical StrategiesSymptoms ofTraumatic Pleasure
Disorders related to PTSD
Depression, Anxiety, Panic disorder,
Phobias, Substance abuse, Physical
Bessell van der Kolk Ph.D
Our challenge is to re-program the emotional brain so that it adapts to the present rather than continuing to respond as if the past is the present!Trauma
Judith Herman Ph.D
Stage of Recovery
Format for Setting Boundaries
Stephanie Covington PhD
“When an individual can tell a coherent story,
about their past they are well on the way to integration” Mary Main, PhD