Empowerment 101: Understanding and Treating Trauma

www.southvalleytherapy.com

Empowerment 101: Understanding and Treating

TraumaMisty McIntyre Goodsell,

LCSWChris Adams Hill, LCSW

South Valley Therapy


Objectives• Increase awareness of Large T and

little t trauma• Increase awareness of symptoms of

PTSD• Tools and techniques for working with

survivors• Increase tools and understanding for

building empowerment South Valley Therapy


Empowering the Therapist



PTSD: Prevalence• 7%-8% of US population will have PTSD at

some point in their lives• Combat soldier and assault victims have

rates as high as 60%• About 5.2 million adults have PTSD during

a given year• Women are more likely than men to

develop PTSD: 10% vs. 5% during their lifetimes

www.ptsd.va.govSouth Valley Therapy


Stages of Recovery



Pre-Step: Disclosure• Education



Stage 1• Establishing Safety

and Security• Assess Risk• Assessing

Strengths• Installation of Hope• Symptom

Reduction• Skill Building • Mindfulness

• Assess Impact of Trauma

• Identify Trauma-Based Beliefs



Stage 2• Reprocessing Trauma• Work Through Grief / Mourning• Challenging Trauma-Based Beliefs• Replace trauma-based beliefs with

positive reality-based beliefs and/or affirmations = EMPOWERMENT



Stage 3• Build Resiliency– Increase the support system– Increase sense of self-worth– Increase sense of self-efficacy– Self-Care– Build/Strengthen spiritual self– Build / Participate in community



BIG T or little t



BIG T• DSM criteria for PTSD



Small t• They don’t meet

criteria for PTSD– Usually not life-

threatening– Terror and fear – PTSD symptoms

less than 5 of the criteria

• Examples– Divorce– Bullying– Neglect– Car Accident– Loss of a pet– Medical Crisis– Verbal Abuse



PTSD: Signs and Symptoms• Intrusive thoughts about the event• Nightmares or distressing dreams• Acting or feeling as if the event is

reoccurring– Illusions, hallucinations, flashbacks

• Intense psychological distress at exposure to internal or external triggers– Physiological reactivity to triggersSouth Valley

Therapy


PTSD: Signs and Symptoms• Persistent avoidance of stimuli

associated with the trauma• Persistent symptoms of increased

arousal (not present before the trauma)– Difficulty falling or staying asleep– Irritability or outbursts or anger– Difficulty concentrating– Hyper-Vigilance– Exaggerated startle response



PTSD Risk• Event factors– Intensity and duration of exposure to the event– Extent of brutality– Sense of betrayal– Threat of dying: not actual threat, perceived

threat– Degree of unpredictability– Injury– Being trapped– Cultural ContextNaparstak, B (2000) “ invisible Heroes, Survivors of Trauma and How They Heal”



More likely to develop PTSD if:

• ACES• Struggle with other

mental health issues• Have family

members with mental health issues

• Environmental – Few friends or

support network

• Recently loss of a loved one (grief and loss)

• Recent stressful life changes

• Heavy Drinker• Are a woman• Poorly educated• Younger



Survivor Response• Shame– Shame is a painful feeling about oneself

as a person• Guilt– Guilt is a painful feeling of regret and

responsibility for one’s actions• Fear– PTSD Responses



THE BUNNY RABBIT



Secondary Survivor Response

Common Reactions• Helplessness• Fear• Confusion• Desire for

Revenge• Self Blame• Overprotection

• Loss of routine and intimacy

• Shame• Frustration• Guilt• Distraction• Code of Silence



Empowering The Survivor



Empowerment• Listen and believe• Focus on the survivor’s reactions and

feelings• Assist the survivor in regaining a

sense of control over their life• Act as an advocate when dealing

with police, medical or legal systems• Avoid projecting your feelings



Empowerment Phrases• “You’ve been through so much AND you

are here”• “You’ve accessed your strengths

(example) and talents (example). Look how resourceful you are”

• “You’ve already survived it. The work we are going to do is about acknowledging your feelings and taking away the power and changing the meaning”

• “You are safe in this room” (if true)South Valley Therapy


Role of Power and Control• Main issue in trauma– Diagnostic criteria

• Healing is allowing the survivor to have as much control as they can in a healthy way

• They have the power to choose/change the meaning they make of their traumatic experience



LANGUAGE MATTERS



Do NOT Say Things Like• I understand…• I’m glad you can share those feelings• You are lucky that…• Don’t worry, it’s going to be alright• It’ll take some time, but you’ll get over it• I can imagine how you feel• Calm down and try to relax• Try to be strong for your children



Do Say Things Like• You are safe now (if true)• I’m sorry this happened• I’m glad you are talking to me now• I’m glad you are here with me now• It’s not your fault• Your reaction is common• You’re not going crazy• Things may never be the same, but they can

get better• I’m here to support you through this



Working With Secondary Survivors

• Help them to predict what to expect emotionally for the survivor

• Help them place blame on the assailant or situation not themselves or the survivor

• Explore positive coping mechanisms• Model crisis intervention and

empowerment• If they are also survivors, assess

their need for counselingSouth Valley Therapy


Self-Care• How do you care for yourselves?



Q&A


Documents

Empowerment 101: Understanding and Treating Trauma