The Impact of Trauma and Crisis on Human Development

1. The Impact of Trauma and Crisis on Human Development Dr. Cyndi Matthews Counseling 5470D

2. Trauma Video • Types of Situations • Feelings/Symptoms/Behaviors • Ways People Try to Cope • Ways Therapists Can Help • Ways Clients Have Found They Can Heal Trauma in Adults

3. What is Trauma?

4. Greek word meaning wound or injury • Horrific events that cause psychological wounds • An injury that can do as much harm, if not more, than a serious physical wound • An assault on the self • “Existential injury that can damage, distort, or even destroy our sense of self… undermines our sense of existence .. Shattering our frameworks of meaning, our spiritual and existential foundations.” What is Trauma?

5. Examples of Trauma?

6. Soul pain – “losing sense of rootedness in everyday normality” • Spiritual pain – “losing our sense of transcendence – leaving us dispirited, joyless, and hopeless” • Take away our confidence, sense of identity • Shock, denial • Anger, irritability • Sad, guilt, shame, hopeless • Confusion, anxiety, withdrawing • Insomnia, nightmares, aches & pains • Withdrawing, feeling disconnected What are the Effects of Trauma?

7. Why or Why Not? Do All Individuals Respond the Same to Trauma?

8. What is PTSD?Understanding PTSD

9. What are the Signs/Symptoms of PTSD?

10. Childhood trauma • Serious illness • Unstable or unsafe environment • Separation from a parent (death or otherwise) • Sexual, physical, or verbal abuse • Domestic violence • Neglect • Bullying What Predisposes One to PTSD?

11. Exposure to an extreme traumatic stressor (Criterion A) • involving direct personalexperienceof an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; • witnessingan event; • learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate; • repeated exposure to aversive details of an event(does not include movies, media, pictures) • The characteristic symptoms resulting from the exposure to the extreme trauma include persistent re-experiencing of the traumatic event(Criterion B) • recurrent, involuntary memories, nightmares, dissociative reactions, prolonged distress, and physiologic reactivity • Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (1) (Criterion C) What is Post Traumatic Stress Disorder – according to DSM V?

12. Negative alternations in cognitions and mood (2) (Criterion D) • Inability to recall event; Persistent negative beliefs about oneself or world; Persistent distorted blame of others; Fear, horror, guilt, anger, shame; feeling alienated from others; inability to experience positive emotions • Persistent symptoms of increased arousal (Criterion E) • aggressive, irritable, reckless, hyper-vigilance, startle response, lack of concentration, sleep disturbance • The full symptom picture must be present for more than 1 month (Criterion F), • Must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion G). • Disturbance cannot be due to meditation, substance abuse or other illness (Criterion H) DSM-V PTSD

13. Crisis Intervention

14. “A stressful life event overwhelms an individual’s ability to cope effectively in the face of a perceived challenge or threat” – precipitating event • Psychological homeostasis disrupted – emotional/psychological disequilibrium • Coping mechanisms failed • Functional impairment What is Crisis?ABC Model 0 – 8:45

15. Psychological First Aid • Make contact • Provide safety • Stabilize affect • Remain calm and composed yourself • Nondirective listening, nonjudgmental • Address needs and concerns • Provide practical assistance • Facilitate connections with social supports • Facilitate coping – “you might experience …” • Referrals and Collaborative services What is Crisis Intervention?ABC Model8:45 – 13:30

16. Case Studies

17. Child Abuse, Child Neglect, &Childhood Traumatic Grief

18. What is Child Abuse? • Child abuse is the physical or psychological mistreatment of a child. • Abused children may experience serious problems in school in terms of both disruptive behavior, social problems, and academic achievement. • Child abuse is usually categorized as • physical abuse • physical neglect • sexual abuse • emotional abuse • What is a teacher’s or professional’s responsibility when they suspect or know about abuse? • It is the responsibility of each teacher to report known or suspected cases of child abuse (to authorities, CPS, management, administration, etc.)

19. Physical Abuse?What are the Effects?Clues & Indicators?

20. Sexual Abuse and its effects? Clues?

21. Emotional Abuse and effects? Clues?

22. (A) Mental/Emotional injury to child that impairs growth, development, or psychological functioning • (B) Causing or permitting a child to be in a situation which causes mental/emotional injury which impairs child • (C)Physical injury that results in substantial harm or genuine threat of substantial harm to the child. • (D) Failure to make reasonable action to prevent injury to child • (E) Sexual conduct harmful to a child’s emotional, mental, and physical health • (F) Failure to prevent harmful sexual conduct • (G) Compelling or encouraging sexual conduct of a child • (H) Causing, permitting, encouraging, engaging in, or allowing the recording of a child in material that is obscene in nature • (I) Current use of illicit substances that results in emotional/mental/physical harm to a child • (J) Causing, permitting, or encouraging the use of illicit substances by a child. • (K) Causing, permitting, or encouraging the sexual performance of a child. Definitions of Child Abuse According to Family Code Chp. 261

23. Neglect and its Effects? Clues?

24. (A)  the leaving of a child in a situation where the child would be exposed to a substantial risk of physical or mental harm, without arranging for necessary care for the child, and the demonstration of an intent not to return by a parent, guardian, or managing or possessory conservator of the child; • (B)  the following acts or omissions by a person: • (i)  placing a child in or failing to remove a child from a situation that a reasonable person would realize requires judgment or actions beyond the child's level of maturity, physical condition, or mental abilities and that results in bodily injury or a substantial risk of immediate harm to the child; • (ii)  failing to seek, obtain, or follow through with medical care for a child, with the failure resulting in or presenting a substantial risk of death, disfigurement, or bodily injury or with the failure resulting in an observable and material impairment to the growth, development, or functioning of the child; • (iii)  the failure to provide a child with food, clothing, or shelter necessary to sustain the life or health of the child, excluding failure caused primarily by financial inability unless relief services had been offered and refused; • (iv)  placing a child in or failing to remove the child from a situation in which the child would be exposed to a substantial risk of sexual conduct harmful to the child; or • (v)  placing a child in or failing to remove the child from a situation in which the child would be exposed to acts or omissions that constitute abuse under Subdivision (1)(E), (F), (G), (H), or (K) committed against another child; or • (C)  the failure by the person responsible for a child's care, custody, or welfare to permit the child to return to the child's home without arranging for the necessary care for the child after the child has been absent from the home for any reason, including having been in residential placement or having run away. Definitions of Child Neglect as Defined by Texas Family Code 261

25. Self-Injurious Behavior • Does not indicate suicidal intent • Way of relieving stress, emotional pain & anxiety • Eating Disorders • Eating disorders have been found to be associated with locus of control - perfectionistic • Some theorists postulate that restricting food may serve as a way to hide feminine features to fend off unwanted sexual advances • Depression • Related to locus of control and self-concept • Theorist postulate that the more well-developed self-concept is the better the prognosis for the abused adolescent. • Alcohol/Drug Abuse • A form of self-medication • Exacerbated by potentially low-self-concept • Potential to recreate cycle of abuse/maltreatment depending on involvement in drug culture. Results of Abuse/Trauma on Adolescents?

26. Format of treatment correlates to cognitive development • Young Children: • Play Therapy for Trauma Dr. Baggerly • Trauma Help for Children • Children: Play Therapy, Expressive Arts, Music • Teen: Arts, Activity Therapy, Talk Therapy, Music • Documentation! • Adjunct services: • Parent Consultation • Consulting with CPS • Interacting with the Legal System • Consent Booklet on Blackboard Treatment Issues for Children & Teens who have been Abused?

27. Childhood Traumatic Grief • Deal with both trauma and grief • Bereavement • State of having lost a love one • Grief • Person’s reaction to the loss • Mourning • Family religious, and cultural rituals which bereavement and grief are expressed • Uncomplicated bereavement • Typical grieving of coping with loss of a loved one • Complicated bereavement • Condition in which bereavement is complicated by separation distress and trauma symptoms • Childhood traumatic grief What is Childhood Traumatic Grief (CTG)?

28. Talking about death • Games, Books • Mourning the loss • Things I will miss, acrostic name • Addressing ambivalent feelings • Things I will not miss • Preserving positive memories • scrapbook, memory box • Redefine the relationship • Interaction is one of memory • Commit to new and present relationships • Address concerns • Make meaning of loss • How has this changed you? • What would you tell other children? • Joint Parent Child Sessions Ways of Working with Grief?

29. Affective Expression Skills • Emotional bingo, color your life, feeling masks, songs • Stress Management • Muscles relaxation, deep breathing, relax, unwind in the way they enjoy • Problem solving/social skills • Triangle of thoughts, feelings, behaviors • Create child’s trauma narrative • Read books • Create own narrative, read to you, then parents • Cognitive Processing • overgeneralization, • best friend role play • Joint Parent-Child sessions Ways of Working with Trauma?

30. Counseling with Adults

31. Low Self-esteem • Poor Social Skills • Poor Conflict Resolution Skills • Depression • Hopelessness • Parenting issues: • Overprotective • Projecting onto their child • Fear • Lack of resolution What about Adults? Symptoms of Childhood Abuse?

32. Educational Components • Abuse, Self-medicating, effects • Pacing the healing process • Retelling the Story • Finding the mistakes they tell themselves • Finding Self-Power, Assertiveness • Empty chair, reliving assertively • Coping techniques/Pain management • Good Books & Workbooks: • Courage to Heal & Workbook • Women Survivors of Childhood Sexual Abuse • Surviving Childhood Sexual Abuse Workbook • Codependent No More & Workbook What Do We Do Now in Therapy with Adults?

33. Helping Clients Tell their Story of Trauma4:25-20:18 • Open Ended Questions - Listening- Paraphrasing – Encouraging - Summarizing • Look for: • What helped? • Pacing? • What didn’t help? • What surprised you? • What good does it do to tell the story? Video – Telling the Story

34. Confronting traumatic memories • Condensing traumatic events • Resolving states of confusion over memories • Resolving issues with unconditional acceptance • Concentrating on enhancing daily functioning. • Achieving control over spontaneous recall. (Chase & Yalom, 1995) What are the Goals of Trauma Therapy?

35. Domestic Violence

36. What is Domestic Violence?What are ways individuals are harmed?

37. What is the Cycle of Violence?

38. Learn to recognize abuse • Yelling, hitting, slapping, shaming, blaming, keeping you at home, stalking or spying, possessive (emotional often turns into physical • Make a safety plan • Many on internet – domestic violence safety plan • Protect yourself when they attack • Give your kids a code word • Tell your neighbors • Stay away from bathrooms & kitchen • Plan an escape route • Choose 2 safe places • Do not use your home or cell phone • Make a checklist of important papers • Call the police/shelters • Do not go home • Don’t contact your partner • Get an order of protection Domestic Violence – Safety PlanCase Study

39. Working with Suicide

41. What are the Signs Someone is Suicidal?

42. What are Ways of Asking if Someone is Suicidal?

43. Ideation? • Plan? • Method? • Access? • Where? When? • Suicide Risk Assessment Tool • Call? • Supervisor • Colleague • Emergency Room/Police • 1-800-273-TALK • 1-800-SUICIDE Suicide Risk Assessment Questions?

44. Suicide Risk Assessment?Assessment Tool on Blackboard