Stress, Trauma and Self-care 2 - Amazon S3...Stress, Trauma and Self-care 2.0 Light University 5 Light University • Established in 1999 under the leadership of Dr. Tim Clinton—has

Stress,TraumaandSelf-care2.0

P.O.Box739•Forest,VA24551•1-800-526-8673•www.AACC.net


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WelcometoLightUniversityandthe“Stress,TraumaandSelf-care2.0”programofstudy.Our prayer is that you will be blessed by your studies and increase your effectiveness inreaching out to others. We believe you will find this program to be academically sound,clinicallyexcellentandbiblically-based.Our faculty represents some of the best in their field – including professors, counselors andministers who provide students with current, practical instruction relevant to the needs oftoday’sgenerations.We have alsoworked hard to provide youwith a program that is convenient and flexible –givingyoutheadvantageof“classroominstruction”onlineandallowingyoutocompleteyourtrainingonyourowntimeandscheduleinthecomfortofyourhomeoroffice.Thetestmaterialcanbefoundatwww.lightuniversity.comandmaybetakenopenbook.Onceyouhavesuccessfullycompletedthetest,whichcoverstheunitswithinthiscourse,youwillbeawardedacertificateofcompletionsignifyingyouhavecompletedthisprogramofstudy.Thank you for your interest in this program of study. Our prayer is that you will grow inknowledge,discernment,andpeople-skillsthroughoutthiscourseofstudy.Sincerely,

RonHawkinsDean,LightUniversity


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TheAmericanAssociationofChristianCounselors

• Represents the largestorganizedmembership (nearly50,000)ofChristian counselorsandcaregiversintheworld,havingjustcelebratedits25thanniversaryin2011.

• Known for its top-tier publications (Christian Counseling Today, the Christian CounselingConnectionandChristianCoachingToday),professionalcredentialingopportunitiesofferedthroughtheInternationalBoardofChristianCare(IBCC),excellenceinChristiancounselingeducation, an arrayof broad-based conferences and live training events, radioprograms,regulatoryandadvocacyeffortsonbehalfofChristianprofessionals,apeer-reviewedEthicsCode, and collaborative partnerships such as Compassion International, the NationalHispanic Christian Leadership Conference and Care Net (to name a few), the AACC hasbecomethefaceofChristiancounselingtoday.

• With the needed vision and practical support necessary, the AACC helped launch the

International Christian Coaching Association (ICCA) in 2011, which now represents thelargest Christian life coaching organization in the world with over 2,000 members andgrowing.

OurMission

The AACC is committed to assisting Christian counselors, the entire “community of care,”licensedprofessionals,pastors,and laychurchmemberswith littleorno formal training. It isourintentiontoequipclinical,pastoral,andlaycaregiverswithbiblicaltruthandpsychosocialinsights that minister to hurting persons and helps them move to personal wholeness,interpersonalcompetence,mentalstability,andspiritualmaturity.


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OurVision

TheAACC’svisionhastwocriticaldimensions:First,wedesiretoservetheworldwideChristianChurch by helping foster maturity in Christ. Secondly, we aim to serve, educate, and equip1,000,000 professional clinicians, pastoral counselors, and lay helpers throughout the nextdecade.WearecommittedtohelpingtheChurchequipGod’speopletoloveandcareforoneanother.We recognize Christian counseling as a unique form of Christian discipleship, assisting thechurch in its call to bring believers to maturity in the lifelong process of sanctification—ofgrowingtomaturityinChristandexperiencingabundantlife.Werecognizesomearegiftedtodosointhecontextofaclinical,professionaland/orpastoralmanner.Wealsobelieveselected laypeoplearecalledtocareforothersandthattheyneedtheappropriatetrainingandmentoringtodoso.WebelievetheroleofthehelpingministryintheChurchmustbesupportedbythreestrongcords:thepastor,thelayhelper,andtheclinicalprofessional.ItistothesethreerolesthattheAACCisdedicatedtoserve(Ephesians4:11-13).

OurCoreValues

InthenameofChrist,theAmericanAssociationofChristianCounselorsabidesbythefollowingvalues:

VALUE1:OURSOURCEWearecommittedtohonorJesusChristandglorifyGod,remainingflexibleandresponsivetotheHolySpiritinallthatHehascalledustobeanddo.VALUE2:OURSTRENGTHWearecommittedtobiblicaltruths,andtoclinicalexcellenceandunityinthedeliveryofallourresources,services,trainingandbenefits.VALUE3:OURSERVICEWeare committed toeffectivelyandcompetently serve the communityof careworldwide—bothourmembership and the churchat large—withexcellenceand timeliness, andbyover-deliveryonourpromises.VALUE4:OURSTAFFWearecommittedtovalueandinvestinourpeopleaspartnersinourmissiontohelpotherseffectivelyprovideChrist-centeredcounselingandsoulcareforhurtingpeople.VALUE5:OURSTEWARDSHIPWe are committed to profitably steward the resourcesGod gives to us in order to continueservingtheneedsofhurtingpeople.


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LightUniversity• Establishedin1999undertheleadershipofDr.TimClinton—hasnowseennearly200,000

students from around the world (including lay caregivers, pastors and chaplains, crisisresponders,lifecoaches,andlicensedmentalhealthpractitioners)enrollincoursesthataredelivered via multiple formats (live conference and webinar presentations, video-basedcertificationtraining,andastate-of-theartonlinedistanceteachingplatform).

• Thesepresentations,courses,andcertificateanddiplomaprograms,offeroneofthemostcomprehensive orientations to Christian counseling anywhere. The strength of LightUniversity is partially determined by its world-class faculty—over 150 of the leadingChristianeducators,authors,mentalhealthcliniciansandlifecoachingexpertsintheUnitedStates. This core groupof facultymembers represents a literal “Who’sWho” inChristiancounseling. No other university in the world has pulled together such a diverse andcomprehensivegroupofprofessionals.

• Educational and training materials cover over 40 relevant core areas in Christian—

counseling, lifecoaching,mediation,andcrisis response—equippingcompetentcaregiversand ministry leaders who are making a difference in their churches, communities, andorganizations.

OurMissionStatement

TotrainonemillionBiblicalCounselors,ChristianLifeCoaches,andChristianCrisisRespondersbyeducating,equipping,andservingtoday’sChristianleaders.

AcademicallySound•ClinicallyExcellent•DistinctivelyChristian


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Video-basedCurriculum

• UtilizesDVDpresentations that incorporateover 150 of the leading Christian educators,authors,mentalhealthclinicians,andlifecoachingexpertsintheUnitedStates.

• Eachpresentationisapproximately50-60minutesinlengthandmostareaccompaniedbyacorrespondingtext(inoutlineformat)anda10-questionexaminationtomeasurelearningoutcomes.Therearenearly1,000uniquepresentationsthatareavailableandorganizedinvariouscourseofferings.

• Learning is self-directed and pacing is determined according to the individual time

parameters/scheduleofeachparticipant.• With the successful completion of each program course, participants receive an official

Certificate of Completion. In addition to the normal Certificate of Completion that eachparticipant receives, Regular and Advanced Diplomas in Biblical Counseling are alsoavailable.

Ø TheRegularDiploma isawardedbytakingCaringForPeopleGod’sWay,BreakingFreeandoneadditionalElectiveamongtheavailableCoreCourses.

Ø TheAdvancedDiplomaisawardedbytakingCaringForPeopleGod’sWay,BreakingFree,andanythreeElectivesamongtheavailableCoreCourses.

Credentialing

• LightUniversitycourses,programs,certificatesanddiplomasarerecognizedandendorsedbytheInternationalBoardofChristianCare(IBCC)anditsthreeaffiliateBoards:theBoardofChristianProfessional&PastoralCounselors(BCPPC);theBoardofChristianLifeCoaching(BCLC);andtheBoardofChristianCrisis&TraumaResponse(BCCTR).

• Credentialing is a separateprocess from certificate or diploma completion.However, theIBCC accepts Light University and Light University Online programs as meeting theacademic requirements for credentialing purposes. Graduates are eligible to apply forcredentialinginmostcases.

Ø Credentialinginvolvesanapplication,attestation,andpersonalreferences.

Ø CredentialrenewalsincludeContinuingEducationrequirements,re-attestation,andoccureitherannuallyorbienniallydependingonthespecificBoard.


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OnlineTesting

TheURLfortakingallquizzesforthiscourseis:http://www.lightuniversity.com/my-account/.

• TOLOGINTOYOURACCOUNT

Ø You should have received an email upon checkout that included your username,password,andalinktologintoyouraccountonline.

• MYDASHBOARDPAGE

Ø Once registered, youwill see theMyDVD Course Dashboard link by placing yourmousepointerovertheMyAccountmenuinthetopbarofthewebsite.Thispagewill includestudentPROFILE informationand theREGISTEREDCOURSES forwhichyouareregistered.TheLOG-OUTandMYDASHBOARDtabswillbeinthetoprightofeachscreen.Clickingonthe>nexttothecoursewilltakeyoutothecoursepagecontainingthequizzes.

• QUIZZES

Ø Simplyclickonthefirstquiztobegin.• PRINTCERTIFICATE

Afterallquizzesaresuccessfullycompleted,a“PrintYourCertificate”buttonwillappearnearthetopofthecoursepage.YouwillnowbeabletoprintoutaCertificateofCompletion.Yournameandthecourseinformationarepre-populated.ContinuingEducationThe AACC is approved by the American Psychological Association (APA) to offer continuingeducationforpsychologists.TheAACCisaco-sponsorofthistrainingcurriculumandaNationalBoard of Certified Counselors (NBCC)ApprovedContinuing Education Provider (ACEPTM). TheAACC may award NBCC approved clock hours for events or programs that meet NBCCrequirements.TheAACCmaintainsresponsibilityforthecontentofthistrainingcurriculum.TheAACCalsoofferscontinuingeducationcreditforplaytherapiststhroughtheAssociationforPlayTherapy (APT Approved Provider #14-373), so long as the training element is specificallyapplicabletothepracticeofplaytherapy.It remains the responsibility of each individual to be aware of his/her state licensure andContinuing Education requirements. A letter certifying participation will be mailed to thoseindividuals who submit a Continuing Education request and have successfully completed allcourserequirements.


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PresentersforStress,Traumaand

Self-care2.0


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PresenterBiographiesBarryLord,Psy.D.,isaLicensedPsychotherapistwhohasworkedinthefieldofcounselingforover 20 years. He retired from the San Diego Regional Center as a Senior Social WorkCounselor. Prior to this, hewas theOperationsDirector of the Rehabilitation Center for theSalvationArmyinSanDiego.Dr.LordwasalsotheDeanoftheBehavioralSciencesDepartmentatSouthernCaliforniaSeminaryandcontinues to teachasanadjunctprofessoratSanDiegoChristianCollege,aswellasinthegraduateprogramatSouthernCaliforniaSeminary.Dr.Lordis currently inprivatepracticeand is theDirectorofPastoralCareandCounseling,whereheandhisstaffworkwithover150court-ordereddomesticviolencecases.Heownsacertificationprogram, “DV Counselor Training,” where he and his staff equip and certify clinicians tofacilitate Domestic Violence Recovery Program groups (www.dvcounselortraining.com). Dr.Lordlecturesatnationalandinternationalseminars,WebinarsandradioprogramsthroughouttheUnitedStatesandservesasthechairmanoftheTrainingandInterventionCommitteeoftheSanDiegoDomesticViolenceCouncil.Heather Gingrich, Ph.D., is a professor of counseling at Denver Seminary. Dr. Gingrichspecializes in the treatment of complex trauma, including adult survivors of abuse, and hasdoneresearch,writing,andclinicalworkintheareaofdissociativedisordersandtrauma.Sheisa clinicalmember of the International Society for the Study of Trauma andDissociation, theRockyMountain Trauma and Dissociation Society, and a professional affiliate of Division 56(TraumaPsychology)oftheAmericanPsychologicalAssociation.Dr.GingrichalsoservesasanadvisorforthePhilippineAssociationofChristianCounselorsandthePhilippineSocietyfortheStudyforTraumaandDissociation.Duringher30-plusyearsinthecounselingfield,Dr.Gingrichhasdividedhertimebetweenclinicalworkandteaching.ShehaslivedinCanada,Pakistan,thePhilippines, and the United States. Dr. Gingrich earned a Ph.D. from the University of thePhilippines, an M.A. from Wheaton College Graduate School, and a B.A. from CarletonUniversity in Canada. She recently authored, Restoring the Shattered Self: A ChristianCounselor’sGuidetoComplexTrauma.ArchibaldHart,Ph.D.,isaProfessorofPsychologyandformerDeanoftheGraduateSchoolofPsychology, Fuller Theological Seminary in Pasadena, California. Having trained originally inSouthAfricawherehe is licensedas a clinical psychologist,Dr.Hart first came to theUnitedStates in1971 todoaPost-Doctoral Fellowshipat theGraduate SchoolofPsychology, FullerTheological Seminary, and inMay 1973, he joined the faculty. He is licensed in the state ofCaliforniaasapsychologistandspecializesinpsychotherapyfromaChristianorientation,stressmanagement and the use of biofeedback techniques, neuro-psychodiagnosis and cognitiveapproachestopsychology.Hismajorresearchinterestsareintheareasofvocationalhazardsoftheministryandstressmanagement.


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SylviaHartFrejd,D.Min., isapopularspeaker,author,counselorandlifecoach.Shecurrentlyserves as the Founder andExecutiveDirectorof theNation’s FirstDigitalWellnessCenter atLibertyUniversity inLynchburg,Virginia,whereshe is teachingahealthyuseandtheologyoftechnology.ShehasaMaster’sdegreespecializingincounselingandaDoctoratespecializinginLeadershipandiscertifiedinInternetaddiction.Dr.FrejdisalsoaCertifiedRecoveryCoach,isapresenterattheAmericanAssociationofChristianCounselorsWorldandNationalConferencesand is featured on their Life Coach Training DVD’s. Her newest book co-authored with herfather, Dr. Archibald Hart, is, The Digital Invasion: How Technology is Shaping You and YourRelationships.FocusontheFamilyvotedtheirDigitalInvasionbroadcastwiththetwoauthorstobeoneof theBestof2013.Dr.Frejd ispassionateabouthelpingothersredeemtheir reallivesandrelationships.ShespeaksatconferencesandretreatsworldwideonthetopicsofTheDigitalInvasionandThreeConversationsEveryoneMustHave.


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Stress,TraumaandSelf-care2.0TableofContents:

STSC101:TraumaandtheBrain:TheEffectsonLifespanDevelopment.................................12BarryLord,Psy.D.STSC102:RestoringtheShatteredSelf:TreatmentofComplexTrauma................................31HeatherGingrich,Ph.D.STSC103:MaintainingHealthandWellnessinaStressfulDigitalWorld...............................47ArchibaldHart,Ph.D.andSylviaFrejd,D.Min.


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STSC101:

TraumaandtheBrain:TheEffectsonLifespanDevelopment

BarryLord,Psy.D.


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AbstractSciencehasrevealedthatemotionaltraumachangesbrainfunctioningattheplacewherethe“emotionalbrain”and“survivalbrain”meet.Thispresentationexaminesrecentbrainresearch,emotional trauma in childhood, the effects on the developing person, and long-termpsychological risks. Dr. Lord discusses relevant brain structures and the relationship of earlychildhoodemotionaltraumaonthedevelopingbrain,personalityandrelationships.LearningObjectives

1. Participants will identify brain structures and functions particularly impacted byemotionaltrauma.

2. Participantswillexaminetherelationshipbetweenchildhoodemotionaltraumaandthedevelopingperson.

3. Participantswillbeequippedtoapplytherapeuticstrategiesfortraumarecoveryintheclinicalsetting.


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I. Introduction

A. SpeakerIntroduction

1. Dr.BarryLord

2. Trainerforcounselorsaddressingoffenders

3. DeanofBehavioralSciences(Retired)SouthernCaliforniaSeminary

B. WhatWillBeCovered

1. EmotionalTraumaacrosstheLifespan.

2. Thescopeoftheproblem,complextrauma,theACEstudyasdevelopedbyVincentJ. Felitti,MD,withKaiserPermanenteand theCenters forDiseaseControl andanACEtestthatscoreshowmanytraumaticitemswereinone’schildhood.

3. Traumaasapredictorofhealthandsuccessinrelationships.4. Discusshowwedevelopsecureattachments,theflight/fight/freeze/fornicate/freed

responsesoftheamygdala,themid-brainandthebrainasalearningmachine.

5. Understandingthelimbicsystemandhowemotionsaffectstressandhealth.

C. TheExtentofChildhoodTrauma

1. Currently,thesinglemostimportantpublichealthconcernintheU.S. ischildhoodtrauma.Traumaincludesabuseandneglect.

2. Eachyear,overthreemillionchildrenarereportedtotheauthoritiesforabuseandneglectintheUnitedStates.Ofthisnumber,about1/3(onemillion)areconfirmedaschildabuse.Anunfortunatefactisthatmosttraumasbeginathome.

3. IntheUnitedStates,approximately1200-1400childrenaremurdered intheirownhomeseachyear.

4. Thevastmajorityofchildhoodtrauma(nearly80%)isperpetratedbythechildren’sownparents.


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5. In the United States alone, between 1996 and 1998, there were more than fivemillion children exposed to some form of severe trauma such as physical abuse,domestic violence, community violence, motor vehicle accidents, chronic painfulmedicalprocedures,andnaturaldisasters.

6. Thesekindsofeventscanleaveashatteringimpressiononchildren.• Beginning with Lenore Terr’s landmark work, investigators over the last

twenty years have determined that more than thirty percent of childrenexposed to traumatic events will develop serious and chronicneuropsychiatricproblems.

• Themostcommonarepost-traumaticstressdisorders(PTSD).

II. ImpactofTraumaticChildhoodExperiences

A. Post-TraumaticStressDisorders

1. PTSDhasbeenstudiedprimarilyasanadult,combatveteran’sproblem.

2. TheUnited Stateshas spentbillionsof researchdollarson clinical services for theonemillionveteransfromtheVietnamerawhosufferfromPTSD.

3. In contrast, the twentymillion (ormore) childrenwith PTSD, are among the leastunderstood,understudiedandconsistentlyunderservedgroupintheUnitedStates.

B. CommonandSignificant

1. Research has shown that Traumatic Childhood experiences are not onlytremendouslycommon,theyalsohaveanintenseinfluenceonmanydifferentareasofaperson’sdevelopmentthroughouthis/herlife.

2. Children exposed to alcoholic parents or domestic violence rarely have securechildhoods.

3. Theirsymptomatologytendstobemostlyinevitableandmultidimensional.

4. It is likely to include depression, various medical illnesses, as well as variety of

impulsiveandself-destructivebehaviors.


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III. TheACEStudy

A. Overview1. The term “Complex Trauma” describes the experience ofmultiple and/or chronic

andprolongeddevelopmentallyadversetraumaticeventsinchildren’slives.2. In the Adverse Childhood Experiences (ACE) study by Kaiser Permanente and the

Centers for Disease Control, 17,337 adults and HMO members responded to aquestionnaire about adverse childhood experiences, including childhood abuse,neglectandfamilydysfunction.

B. ResultsoftheACEstudy

1. 11.0%ofindividualsreportedhavingbeenemotionallyabusedasachild

2. 30.1%reportedphysicalabuse

3. 19.9%reportedsexualabuse

4. 23.5%reportedbeingexposedtofamilyalcoholabuse

5. 18.8%reportedafamilymemberwithmentalillness


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6. 12.5%witnessedtheirmothersbeingbattered

7. 4.9%reportedfamilydrugabuse(VanderKolk,2005,p.3)

8. TheACEstudyshowedthatadversechildhoodexperiencesarevastlymorecommonthanpreviouslyrecognizedandacknowledgedandthattheyhavepowerfulrelationtoadulthealthahalf-centurylater(Felitti,1998).

C. ContextoftheACEStudy

1. Thereare10typesofchildhoodtraumameasuredintheACEStudy.

2. Fivearepersonalandaboutwhathappenedtothetesttakerasachild—physicalabuse,verbalabuse,sexualabuse,physicalneglectandemotionalneglect.

3. Fivearerelatedtootherfamilymembers:• aparentwhoisanalcoholic• amotherwhoisavictimofdomesticviolence• afamilymemberinjailoronediagnosedwithamentalillness• thedisappearanceofaparentthroughdivorce,deathorabandonment


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4. Eachtypeof traumacountsasone.Soapersonwhohasbeenphysicallyabused,withonealcoholicparentandamotherwhowasbeatenup,hasanACEscoreofthree.

D. QuestionsontheACEStudy

1. Did a parent or other adult in the household often or very often…swear at you,insultyou,putyoudown,orhumiliateyou?orAct inawaythatmadeyouafraidthatyoumightbephysicallyhurt?

No___IfYes,enter1___

2. Didaparentorotheradultinthehouseholdoftenorveryoften…push,grab,slap,or throw somethingat you?or Everhit you sohard that youhadmarksorwereinjured?


3. Didanadultorpersonatleastfiveyearsolderthanyouever…touchorfondleyouorhaveyoutouchhis/herbodyinasexualway?orAttemptoractuallyhaveoral,analorvaginalintercoursewithyou?


4. Didyouoftenorveryoftenfeel that…noone inyourfamily lovedyouorthought youwereimportantorspecial?orYourfamilydidn’tlookoutforeachother,feelclosetoeachotherorsupporteachother?


5. Didyouoftenorveryoftenfeelthat…youdidn’thaveenoughtoeat,hadtoweardirty clothes andhadnoone toprotect you?or Yourparentswere toodrunkorhightotakecareofyouortakeyoutothedoctorifyouneededit?


6. Was a biological parent ever lost to you throughdivorce, abandonment or otherreason?


7. Wasyourmotherorstepmother…oftenorveryoftenpushed,grabbed,slapped,orhadsomething thrownather?orSometimes,often,orveryoften,kicked,bitten,hitwithafistorhitwithsomethinghard?orEverrepeatedlyhitoveratleastafewminutesorthreatenedwithagunorknife?



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8. Did you live with anyone who was a problem drinker or alcoholic, or who usedstreetdrugs?


9. Was a householdmember depressed ormentally ill or did a householdmemberattemptsuicide?


10. Didahouseholdmembergotoprison?


E. Scoring

1. Nowaddupyour“Yes”answers:_____

2. ThisisyourACEScore

F. FurtherContextoftheACEStudy

1. The study’s researchers came upwith an ACE score to explain a person’s risk forchronicdiseaselateroninlife.

2. Thinkofitasa“cholesterol”scoreforchildhoodtoxicstress.Yougetonepointforeachtypeoftrauma.ThehigheryourACEscore,thehigheryourriskofhealthandsocialproblems.(Ofcourse,othertypesoftraumaexistthatcouldcontributetoanACE score, so it is conceivable that people couldhaveACE scores higher than10;however,theACEStudymeasuredonly10types(Fellitti,1998)

3. Abuseinchildhoodislinkedwithadultobesity.

4. Itisalsorelatedtodiabetesandotherhealthproblems.

5. If it is indeed causal, then preventing child abuse may modestly decrease adultobesity.

6. Treatment of obese adults abused as childrenmay benefit from identification of

mechanismsthatleadtomaintenanceofadultobesity(Williamson,2002).


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7. Allexperienceschangethebrain–yetnotallexperienceshaveequalimpactonthebrain.

8. Because thebrain isorganizingat suchanexplosive rate in the first yearsof life,experiences during this period have more potential to influence the brain – inpositiveandnegativeways.

IV. TraumaFromCaregivers

A. Children learntocontrol theirbehaviorsbyattendingtotheirparents’andcaregivers’responsestothem(Schore,1994).

B. A child’s internalworkingmodels are defined by the internalization of the emotionalandcognitivefeaturesoftheirprimarycontacts.

C. Because early experiences occur in the setting of a developing brain, neuraldevelopmentandsocialinteractionsarecomplicatedlyinterwoven.

D. AccordingtoresearcherDonTucker:

1. (p.199), “For the human brain, the most important information for successfuldevelopment is conveyed by the social rather than the physical environment.”

2. Hewent on to say that the baby’s brainmust begin efficient involvement in theprocessofsocial informationandthetransmissionof informationthatoffersentryinto the child’s culture. In other words, the social is more important than thephysical.

E. Attachment-Earlypatternsofattachmentformthequalityofinformationprocessingthroughoutlife(Critenden,1992,pp.575-602).

1.SecurelyAttachedChildren• Secure infants learntotrustbothwhattheyfeelandhowtheyunderstandthe

world.


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• This allows them to rely both on their emotions and thoughts to react to anygivensituation.

• Theirexperienceoffeelingunderstoodprovidesthemwiththeconfidencethattheyarecapableofmakinggoodthingshappenandtheknowledgethatiftheydonotknowhowtodealwithdifficultsituations,theycanfindpeoplewhocanhelpthemfindasolution.

• Securechildrenlearnacomplexvocabularytodescribetheiremotions(suchaslove,hate,pleasure,disgustandanger).Thisallowsthemtocommunicatehowtheyfeelandtoformulateefficientresponsestrategies.

• Secure children spendmore time describing bodily states such as hunger and

thirst,aswellasemotionalstates,thandomaltreatedchildren(Cicchetti,1990).

• Integrationofthoughtsandemotionsiscrucial.

• Undermostconditions,parentsareabletohelptheirdistressedchildrenrestoreasenseofsafetyandcontrol.

• Thesecurityoftheattachmentbondhelpsto insulatethechildagainsttraumainducedterror.

• Whentraumaoccursinthepresenceofasupportive,buthelpless,caregiver,thechild’sresponseislikelytomimicthatoftheparent–themoredisorganizedtheparent,themoredisorganizedthechild(Brown,1986).

2. DissociativeChildren

• When the caregivers themselves are the source of the distress, children areunabletocontroltheirownarousal.

• Thiscausesabreakdownintheircapacitytoprocess,mixandcategorizewhatishappening.

• Emotions–atthecoreofthetraumaticstressisabreakdowninthecapacitytoregulateinternalstates.

• Detach/Disconnect–ifthedistressdoesnotletup,childrencandissociate.

• The appropriate sensations are dissociated into sensory fragments and as aresult,thesechildrencannotcomprehendwhatishappeningtothem.

• Dissociativechildrencannotdeviseandexecuteappropriateplansofaction(van

derKolk,1995).


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• When children are unable to achieve a sense of control and stability, theybecomehelpless.

• Iftheyareunabletograspwhatisgoingonandunabletodoanythingaboutittochangeit,theygoimmediatelyfrom(fearful)stimulusto(fight/flight/freeze)responsewithoutbeingabletolearnfromtheexperience.

• Unlike adults, children do not have the option to report, move away orotherwise protect themselves. They depend on their caregivers for their verysurvival.

• Indomesticviolence,ifsomeoneisabusivetotheirspouseorpartner,itismorethanlikelythatchildabuseisoccurringinthehouseholdaswell.

V. HelpingTraumatizedChildren

A. Understand theBrain-Tohelp traumatizedchildren,weneedtounderstandhowthebrainrespondstothreats,howitstorestraumaticmemoriesandhowitisalteredbythetraumaticexperience.

B. Yes,Altered.Tohelptraumatizedchildren,weneedtounderstand:

1. Howthebrainrespondstothreats.

2. Howitstorestraumaticmemories.

3. Howitisalteredbythetraumaticexperience.

C. Thisissobecause:

1. The brain is designed to change in response to patterned, repetitive stimulation.

2. The stimulation associated with fear and trauma changes the brain almostimmediately.


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D. TheBrainisaLearningMachine

1. ThediagrambelowbuildsupontheABCModel–Action,BehaviorandConsequence

VI. EmotionalTraumaThroughtheLifeSpan

A. Child abuse is 15 timesmore likely to occur in familieswhere domestic violence ispresent(Stacy,W.andShupe,A.TheFamilySecret.Boston,MA.BeaconPress,1983).

B. 77% of all the childrenwho died from abuse and neglectwere younger than fouryears of age (U.S. Department of Health and Human Services, Administration forChildrenandFamilies,2002).

Event Self-Talk Schema Emotions Choices Behaviors Consequences

AnythingNeithergoodnorbad

Stinkin-thinkinAwfulizingCatastophizingInappropriateforthecircumstances

Lensforviewingourindividualizedworld

Feelings(mad, glad,sad)Oftenlearnedfromrelationshipwithourprimarycaregivers

SurvivaltechniquesLearnedcopingskills

MaybeHelpfulortragic

AnEvent

http://www.google.com/url?sa=i&rct=j&q=children+who+died+from+abuse+and+neglect+were+younger+than+4&source=images&cd=&cad=rja&docid=Y-ONiUVdD3ylSM&tbnid=hmDL3uKkDBSiDM:&ved=0CAUQjRw&url=http://www.childhelp.org/pages/statistics&ei=iw1iUe2wD4Hn2AX6xIHwCQ&bvm=bv.44770516,d.b2I&psig=AFQjCNFyspbufEYyBmeK-QQcDk3rkcsAng&ust=1365466883268493


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C. Beingabusedorneglectedasachildincreasesthelikelihoodofarrestasajuvenileby53percentandofarrestforaviolentcrimeasanadultby38percent(AnUpdateontheCycleofViolence,February2001).

D. Childrenwhowitnessviolenceathomedisplayemotionalandbehavioraldisturbancesasdiverseaswithdrawal, lowself-esteem,nightmares,andaggressionagainstpeers,familymembers and property (Peled, E., Jaffe, P.G.&Edleson, J.L. (Eds.)Ending theCycle of Violence: Community Responses to Children of Battered Women. ThousandOaks,California:SagePublications,1995).

VII. Stress:YourBrainandBody

A. AngryOutbursts

1. Wheneverangryoutburstsoccurandpeopledrop their “angernades”onandhurtothers,itisgenerallyduetotheneedtoreleasestress.Itisrarethatpeopleexplodebecauseofaparticularoranisolatedincident.

2. Itisrarethatpeopleexplodebecauseofaparticularorisolatedincident.B. TheSeatoftheEmotions:TheAmygdala

TheAmygdala isanalmond-shapedneuro-structure involved inarousalproducingandrespondingtononverbalsignsofanger,avoidance,defensivenessandfear.1. ControlsAutonomicResponsesAssociatedwith:

• Fear• EmotionalResponses• HormonalSecretions

2. Theamygdalacanbethoughtofasthebrain’s“alarmsystem.”

3. Stimulate one region and you feel fear and panic,making youwant to flee fromdanger.

4. Stimulateanotherandyougetaburstofragethatmakesyoureadytofight.


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5. Fightandflightreactionsarenotalwayshelpfulinthemodernworld.

6. Peoplehavebeendesignedwitha superbmechanismtoensurewehave thebestpossiblechanceofsurvivalwhenfacedwithalife-threateningsituation.

7. Thismechanismdoes not know the difference between fact or fiction. It believeswhateveryoutellit.

C. MemoryandtheHippocampus

1. Thehippocampusfilesawaymemories.

2. It connects memories with other related memories and gives the memoriesmeaning.

3. Inotherwords,thehippocampusmightbeconnectingthememoryofyourfirstdayat school with information about the physical surroundings, the smells and thesoundsofthatevent.

4. Experiences are destined for your long-term memory and stored in yourhippocampusforafewyears.

5. Duringthistime,experiencesarerelayedagainandagainintoyourbrain’scortex.

6. Eventually,thesememoriesbecomepermanentlyetchedontoyourcortexas long-termmemories.


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D. YourBrainandEmotions

1. Your amygdala is responsible for generating negative emotions such as sadness,anger,fearanddisgust.

2. Workonnon-emotionalmental tasks inhibits theamygdala,which iswhy keepingyourselfbusycancheeryouupwhenyouarefeelingdown.

3. Wecannotchoosewhetherornotwegetangry.Allwecandoischoosewhattodowiththatanger.

4. Atthesubconsciouslevel,youwillpickupcuesandthecoreofyourbrainandthebrain stemwork togetherwith theamygdala (and theHippocampus) in the limbicsystem,todetermineifangeristherightresponse.

5. Remember,thisisnotthehighlyrefinedneo-corticalpartofyourbrain.

6. Thedecisiontobecomeangryisnotadelicate,deliberateandrationaldecision.

7. Thedecisiontogetangryisthrowinganemergencyswitch.Itspurposeistogetyoureadyforafight,literally.Ithappensinafewmilliseconds.

8. The reptilian brain does not believe there is time for a debate about appropriateresponse,sothereisnorationalizationofthesituationatthispoint.

9. What theamygdaladoes is an instantaneous shuffling throughpast experience toseeifwehaveencounteredanythingsimilarinthepast.Itislikeaflashcarddeckofemotionallychargedmemories.

10. Ifwefindamatch,evenarudimentaryone,itisgoodenoughfortheamygdala.

11. Weinstantlyusethatasourplanofaction,andtheruleofthumbis:theamygdalaoverreacts.


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12. Survival istheobjectiveandnotappropriatesocial interaction,soitcalls inthebigguns.

E. YourBody’sResponse

1. NerveSignals• Once your brain has decided there is a danger, it sends immediate nerve

signalsdownyour spinal cord toyouradrenal glands telling them to releasethehormone,adrenaline.

• Once released, adrenaline increases the amount of sugar in your blood,increasesyourheartrateandraisesyourbloodpressure(andhasmanyotheractions).

2. CortisolLevels• Without cortisol, youwould die – but toomuch of it is not a good thing. It

seems itmakesyourbrainmorevulnerabletodamagesuchasstrokes,agingandstressfulevents.

• Stressexcitesbraincellstodeath.

• In the short-term, cortisol presumably helps the brain to copewith the life-threatening situation.However, if neuronsbecomeoverloadedwith calcium,theyfiretoofrequentlyanddie–theyareliterallyexcitedtodeath.

3. FightorFlight• Basically,ourbodiesoperateonthepremiseof,“Shootfirstandaskquestions

later.”

• Thisprimingthebodyforfightorflighthappensliterallyintheblinkofaneye.Thealarmhasbeensoundedandangerhasbeenunleashed.

• Basically, our bodies operate on the premise of “shoot first, ask questionslater.”

• Forrightnow,atleast,thereptileinusisinfullcontrol.

• Stresshastodowithadaptingtoathreatoradaptingtoachallenge.


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• Whenpeopleviewaneventasathreat,theyexperiencedistress.

• Whenpeopleoverinterpretastressorasathreat,itcanaffecttheirhealth.

• Stressisasustainedfightorflightresponse.

VIII. Emotions,StressandHealth

A. Emotions

1. Emotions often have their roots in thewaywe appraise our environment and ourreactionstoit.

2. Peopleoftencometoappraisethingsasthreatstotheirsurvival,wheninfactthingsarenotthreats.

3. Theflight-flightresponseisactivated.

4. Peoplealsoseelargeportionsoftheenvironmentsuchasjobsandneighborhoodsasthreats(Page-237).

B. Stress

1. ChronicStress• Chronicstresscandamagenervecellsintissuesandorgans.• Particularlyvulnerable,isthehippocampussectionofthebrain.• Thinkingandmemoryare likelytobecomeimpaired,withatendencytoward

anxietyanddepression.

2. Anxiety• Anxiety Disorders are characterized by unrealistic, unfounded fear and

anxiety.• Worrycanberealorimagined.• AnxietyDisordersappeartohavebiologicalcauses• Anxietyisacomplexblendofunpleasantemotionsandcognitions(thoughts),

moreorientedtothefutureandmuchmorediffusethanfear.• Anxietydisordersallhaveunrealistic, irrational fearsoranxietiesofdisabling

intensityastheirprincipalandmostobviousmanifestations.


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C. Distressvs.Eustress

1. Eustress• Beingworriedaboutrealthingsperformsaneededfunctioninourlives.• Itcanleadtoactionandpositiveresultsandgivesusahigh.• Thisiscalledeustress.

2. Distress• Needlessworryisoftenharmful,addingunwantedstressandevenhealthrisks

toourlives.• Unnecessaryworry(anxiety)hurts.• Itiscumulative.• Itbuildsupinourbodiesandisstoredasstress.• Thetrickisknowingonefromtheotherandlearningtodealwithboth.• 95%ofwhatweworryaboutneverhappens.

D. DealingwithStress

1. Afirststepisrecognizingthatworriescomefromthingsbothrealandimaginary.

2. Imagination can litter our internal environment with every manner of fearfulpossibility,manyofwhichdonotexistoutsideofourfertileimaginations.

3. Nonetheless, they trigger the same damaging chemical and physical changes as a

genuineemergency.

4. It hasbeenwell documentedover the years that anxiety andanger are linkedandonecanaffecttheincidenceandpresenceoftheotherveryeasily.

5. Generallyspeaking,stressistheaccumulationofanxiety.

6. Resiliency is the capacity to manage and survive one’s life events (stress).

E. TheAccumulationofStress

1. Stressmaynotbenecessarilytraumatic,butitcancompriseacombinationoffactorsthat build up over time, gradually eroding our resilience and productivity.

2. Prolonged exposure without adequate rest or relaxation can eventually havedevastatingresults.


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3. Manypeopleendupinextremedifficultybecausetheyfailtospottheaccumulatingwarningsignsatanearlystage.

F. TheKeytoManagingStress

1. Thatwhichwepushdownoutofourawareness,wemagnify.2. Thekeytomanagingstressistobecomeawareofit.

3. Practicehealthycopingstrategies.

4. Ourreactiontostressfuleventsisdeterminedbyahostofdifferentfactors,including:

• Thescaleoftheeventsthemselves(Weretheylifethreatening?).• Thecircumstancesofourliveswhentheyoccurred(Wereyoualreadystressed

byotherfactors?).• Perhaps themost crucial indicatorofhowwedealwith stressand trauma is

thequalityofourcopingstrategies.• Themoreeffectivelyweareabletorespondtostressandminimizetheanxiety

thatcomesalongwithit,themoreresilientwewillbecome.

5. Both cumulative and acute stress have the capacity to undermine our ability tofunction.• Traumacanputastoptoeverything.• Thewayswefindtocopecanhaveacritical impactonourability torecover

andreturntoaproductive,functioninglife.

6. Itisalmostimpossibletopredicthowonepersonwillrespondtostressandtraumaatanyparticulartime.• Somepeoplearecapableofdealingwith tremendouspressureandcaneven

thriveonit.• Others, however, will find themselves overwhelmed by apparently trivial

developments• Themostcrucialindicatorofhowwedealwithstressandtraumaisthequality

ofourcopingstrategies• Themoreeffectivelyweareabletorespondtostressandminimizetheanxiety

thatcomesalongwithit,themoreresilientwewillbecomeinthelongterm

7. Both cumulative and acute stress have the capacity to undermine our ability tofunction.Traumacanputastoptoeverything.Thewayswefindtocope,however,will have a critical impact on our ability to recover and return to productive,functioninglives.


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STSC102:

RestoringtheShatteredSelf:TreatmentofComplexTrauma

HeatherGingrich,Ph.D.


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AbstractComplex trauma survivors (e.g., adult survivors of child abuse, intimate partner violence,torture,kidnapping,sextraffickingvictims)presentuniquecounselingchallenges.Intrusive,re-experiencing post-traumatic symptoms, such as flashbacks, nightmares, and terrifyingemotions, can be overwhelming not only for counselees, but also for their counselors. Theprimaryfocusofthispresentationwillbehowsuchpost-traumaticsymptomscanbestabilizedwhendealingwithcomplex,relationaltrauma,bothintheinitialphaseofcounseling,aswellasthetraumaprocessingphase.Theconceptofdissociationisexaminedinordertoexplainboththepsychologicalmechanismbywhichsuchintrusivesymptomsdevelop,andhowtheycanbecontained.Howandwhentouseexplicitspiritualresourcesarealsobeexamined.LearningObjectives

1. Participants will identify intrusive post-traumatic symptoms and explain how theydevelop.

2. Participantswilldescribehowtostabilizeintrusivepost-traumaticsymptoms,includingflashbacks,nightmares,terror,memorygaps,andphysicalpain.

3. Participants will recognize how to use spiritual resources appropriately with complextraumasurvivors.


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I. Introduction

A. Based on Restoring the Shattered Self: A Christian Counselor’s Guide to ComplexTrauma

B. OutlineofThePresentation1. BackgroundtoHeatherGingrich’sApproach

2. DifferencebetweenPTSDandCTSD

3. DissociationanditsRelevance

• Definition• Useasadefensemechanism• Howthecapacitytodissociatedevelops• BASKmodelofdissociation

C. ThreePhasesofTreatmentforCTSD

D. HowtheChurchcanHelp

II. BackgroundtoHeatherGingrich’sApproach

A. SexualAbuseSurvivors

B. DissociativeDisorders

C. OtherTraumaSurvivors(seeGingrich,2002)

D. ResearchonDissociationandTraumainthePhilippines

1. Livedthereforeightyears

2. Taughtataseminary

3. DidPh.D.researchontraumaanddissociation


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E. RecognitionofOverlapinTreatmentTechniques

III. DifferencebetweenPTSDandCTSD

A. PosttraumaticStressDisorder

1. EvenSingleExposure• Naturaldisasters• Rapeincidents• Witnessingviolence• Combatveterans

2. PrimarilyCognitive-BehavioralTreatments

3. InternationalSocietyforTraumaticStressStudies(ISTSS)

B. ComplexTraumaticStressDisorder(DisordersofExtremeStress)

1. Literature currently using “Complex Stress Disorder,” but in the past, sometimesreferredtoas“DisordersofExtremeStress.”

2. MultipleExposures

• Incestsurvivors• Childabuseandrape• Oftenovermanyyears

3. ComplexTraumaticStressDisorderStillNotanOfficialDiagnosis

4. Multi-facetedTreatmentApproaches

5. InternationalSocietyfortheStudyofTraumaandDissociation(ISSTD)


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C. DSM-5–ChangeinCriteriaAforaPTSD

1. SexualAssaultListedasaPossibleTraumaticEvent

2. ResponseofFear,Helplessness,orHorrorNoLongerIncluded

D. DSM-5–AdditionalSymptomCluster

1. NegativeThoughtsandMoodorFeelings• Apersistentanddistortedsenseofblameofselforothers• Estrangementfromothersormarkedlydiminishedinterestinactivities• Aninabilitytorememberkeyaspectsoftheevent

E. DSM–5–DissociativeSubtype

1. ChosenwhenPTSDisSeenwithProminentDissociativeSymptoms• Depersonalization(experiencesoffeelingdetachedfromone’sownmindor

body)

• Derealization (experiences in which the world seems unreal, dreamlike ordistorted)

F. ImportanceofSubjectiveEvaluationofEvent

1. Someonewhohasbeenthroughaclassically traumaticeventmaynotnecessarilyhavePTSD.

2. Whatistraumaticforoneindividualisnotnecessarilyexperiencedastraumaticforanother• AnApparently“BigT”traumamaynotbe• ASeeminglyMinorEventmaybe

IV. DissociationanditsRelevance

1. WhyTalkAboutDissociation?

1. UsedbyVictimsofallkindsofTrauma


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2. There is a well-documented association between trauma and posttraumaticdissociation.

3. DSM-5nowlistsadissociativesubtype.

2. Definition

1. DSM-V–DefinitionofDissociation:• Disruption of and/or discontinuity in the normal integration of

consciousness,memory,identity,emotion,perception,bodyrepresentation,motorcontrolandbehavior.

2. SimplyPut:• Dissociationiscompartmentalizationordisconnectionamongaspectsofself

andexperience–bothpsychologicalandphysical.

3. Normalvs.PathologicalDissociation

1. Normal• Automatisms(example-brushingyourteeth).• Absorption(soinvolvedinaprojectyoulosetrackoftime).• Imaginative involvement (can almost imagine yourself as one of the

charactersinthebookormovie).

2. Pathological:DissociativeSymptomsandDisordersWillBeDescribedLater• Especiallyaconsiderationincross-culturalresearch.• Whatisconsideredpathologicalinonecultureisnotnecessarilypathological

inanother.• This considerationwas one of the reasons for includingObjective 2 in this

study.


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4. ContinuumofDissociation

5. DevelopingtheCapacitytoDissociate

1. WeAreBornUnintegrated(i.e.,dissociated)• Forexample,whenanewbornishungryortheirdiaperneedstobechanged,

theywillcry,andassoonastheyreceivewhattheyneed,thereisanalmostinstantaneouschange

2. HealthyAttachmentLeadstoIntegrationofBehavioralStates• Forexample,ayoungchildmaybeabletowaittoeatwhenpromisedbya

parentthatamealiscominginasetamountoftime.

• Asparentsareteachingchildrenthesethingsthroughtheirrelationship,thisbringsaboutintegration.

3. ImpactofChildAbuse• Ininstancesofchildabuse,dissociationismorelikely.


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4. DissociationasaDefense• For example, an incest survivor who is regularly abused at the same time

each day may mentally check out and immediately forget what hashappened.

• Achildcanappeartoliveanormallifeasifeverythingisokay.

5. MentalDisorder• Dissociativedisorder/otherdisorderwithdissociativesymptoms.

6. BASKModelofDissociation

1. Behavior,Affect(Emotions),Sensation(Physical),Knowledge• Full,integratedmemoryincludesallfourre-associatedcomponents.

2. BASK–Knowledge• Thecognitiveknowledgeofanexperience.• Traumasurvivorhasfullorpartialcognitiveknowledgeoftraumaticevent.• Cognitiveknowledgeof thetrauma isdissociatedfrombehavior,affectand

sensation.• Generallywhatpeoplemeanwhentheysay,“Iremember.”

3. BASK–Behavior• Behaviorisdissociatedfromotheraspectsofmemory.• Individualsactinacertainmannerwithoutknowingwhy.• Examples:

Ø AvoidingintimaterelationshipsØ VomitingaftersexualintercourseØ Dislikeofparticularfoods

4. BASK–Affect• Affectisdissociatedfromotheraspectsofmemory• Example:

Ø Feelingfearfornoapparentreason

• TherearenofeelingsattachedtothecognitiveknowledgeofthememoryØ FlataffectØ Matter-of-facttoneofvoice


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Ø E.G.Cantalkaboutbeingrapedas thoughdiscussing theheatof thecomingsummer

5. BASK–Sensation• Physicalsensationisdissociatedfromotheraspectsofmemory

• Individualmayhavecognitiveknowledgeofthetraumaticevent,beawareofrelatedaffect,andunderstandsomebehavior,butnotrememberthepainorpleasureassociatedwiththetrauma

• Examples:Ø BodyMemories- physical symptoms such as bleeding or severe pain

occurinthepresentbutareunexplainedØ SexualExcitement

7. BASKMODEL

V. ThreePhasesofTreatmentforCTSD

A. RationaleforPhase-OrientedModel

1. PrematureTraumaProcessingCanLeadtoDestabilization• Hospitalization• InabilitytoFunctioninJob• DifficultyParenting• BasicCopingCapacitiesCanbeOverwhelmed

Behavior Affect

Sensation Knowledge


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B. PhaseI–SafetyandStabilization

1. SafetywithintheTherapeuticRelationship• DevelopingRapport

Ø Facilitativeconditions

• BecomingaSafePersonØ RememberthateveryclientisuniqueØ KnowyourlimitationsØ DonotpromiseanythingyoucannotdeliverØ Give advance warning of events such as going out of town for a

conferenceorchangingoffices

• RemainingaSafePersonØ KeepappropriatetherapeuticboundariesØ ThisisvitallyimportantØ ConsultØ ProtectconfidentialityØ Forexample,PTSDcanbeaverylongtermprocess

2. SafetyfromOthers• Identifyinghealthyvs.unhealthyrelationships• Helpingclientsfindphysicalsafety

3. SafetyfromThemselves

4. MakingSenseofSymptoms• Symptomsasattemptsatcoping• Warningsignals• Canbeviewedasinvitationstoheal

5. TherapeuticuseofDissociation• Potentiallyassessuseofdissociation

Ø SomatoformDissociationQuestionnaire(SDQ-5orSDQ-20)(Nijenhuis,1999)

Ø DissociativeExperiencesScale-II(DES-II)(Putnam,1997)Ø StructuredClinicalInterviewforDSM-IVDissociativeDisorders-Revised

(SCID-D-R)(Steinberg,1993)

• Use“PartsofSelf”languageØ Askallpartsofthemtolistenin


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• ContractingØ SymptommanagementØ Day-to-dayactivitiesØ SuicideØ Symptomscanbecontainedandcontrolledtemporarily

• Ideomotorsignaling

C. PhaseII–ProcessingofTraumaticMemories

1. ReadinessforPhaseIIWork

2. MemoryWork• Natureofmemory

• AccessingdissociatedmemoriesØ DecidingwheretostartØ Whenspecificmemoriesdonotsurface

• IsMemoryRecoverytheGoal?

• FacilitatingtheIntegrationofExperiencesØ TheimportanceofdetailsØ TitratingtheprocessØ Extenttowhichre-experiencingisnecessaryØ GroundingtechniquesØ CheckinginØ MemorycontainmentØ Structuringthesessionandcounselingrelationship

3. WhyDwellOnThePast?• Nehemiah2:11-18• ManyyearsaftertheJewishexileinBabylon,Nehemiahisgivenpermission

gobackandre-buildthewallsofJerusalem.• Beforebeginningtheproject,Nehemiahgoesfromgatetogateviewingthat

whichwasbrokenanddestroyed.• Afterwards,hegatheredthementogetherandsharedhisvisionandplanfor

rebuilding.• One has to know the extent of the damage before knowing how to best

makerepairs


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4. FacilitatingIntegrationofSelfandIdentity

5. WorkingthroughIntenseEmotions• GeneralPrinciples• UnderstandingandDealingwithSpecificEmotions

Ø Mourning:Denial,angeranddepressionØ Guilt,shameandself-hatredØ FearofabandonmentØ Anxiety,terrorandfear

6. RoadblocksforCounselors

7. KeepingPerspective

8. ExampleofTamar

• 2Samuel13:1-19tellsthebiblicalaccountoftheincestualrapeofTamarbyherhalf-brotherAmnon.

• Whensherealizesheintendstorapeher,Tamar’sshameisapparentasshebegshim,“Don’tdothiswickedthing.Whataboutme?WherecouldIgetridofmydisgrace”(vs.13).

• Herdepressionanddespairareapparent invs.19whereTamarputsashesonherhead, toreher robeand, “wentaway,weepingaloudas shewent,”andinvs.22wherewearetoldshe,“livedinherbrotherAbsalom’shouse,adesolatewoman.”

Behavior Affect

Sensation Knowledge


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9. LevelsofIntegrationofSelf

NoIntegrationPartialIntegrationFullIntegration

10. IntegrationofSelfandExperience

11. DealingwithSpiritualIssues• Allphases,butparticularlyPhasesIIandIII.• Gradual,oftendifficultprocess.• Allowclienttosetpace.• Thereareoftenquestionsre:whyGoddidnotprotectfromthetrauma.• Intime,clientscanoftenseethatGodwasthereandiscurrentlyinvolvedin

theirhealingprocess.• Inhighlydissociativeclients,somepartsofselfmayhavearelationshipwith

Christ,whileothersmaynot.Ø (e.g.,internalBiblestudy)

• Distinguishbetweenpartsofselfanddemonic

Ø UltimatelygiftofdiscernmentnecessaryØ PotentiallyVERYdestructivetoattemptdeliveranceministry


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• Ifanykindofdeliverance/exorcismritualisdecidedupon,makesurethatthefollowingfactorsareincorporated(Bull,Ellason&Ross,1998):

Ø PermissionoftheindividualØ Non-coercionØ ActiveparticipationbytheindividualØ UnderstandingofDIDdynamicsbythoseinchargeØ Implementationoftheprocedurewithinthecontextofpsychotherapy

• See“NotAllVoicesareDemonic”(Gingrich,2005b)

D. PhaseIII–ConsolidationandRestoration

1. ConsolidatingChanges

2. DevelopmentofNewCopingStrategies

3. LearningtoLiveasanIntegratedWhole

4. NavigatingChangingRelationships• MarriageandParenting• Friendships• RelationshiptoGodandChurchCongregations• Community• FamilyofOrigin

5. Employment

6. ConfrontingthePerpetrator

7. Forgiveness

VI. HowtheChurchcanHelp

A. EducatingaboutCTSD


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B. ProvidingEmotionalandSpiritualSupport

C. ChurchesandChristianMentalHealthProfessionalsinPartnership

D. SpecificSuggestions

1. Determineyourrole(i.e.,counselor,friend,supportperson,prayerpartner,etc.).

2. Decideonyourlevelofinvolvement.

3. LISTEN!

4. Beavailable,butsetlimits.

5. Pray,encourage,casuallyvisit(ifnotthecounselor).

6. Point them toother resources (books, therapists, supportgroups, crisisnumbers,etc.)

E. DoNot…1. Preach

2. Givepatanswers

3. Makedecisionsfortheperson

4. Judge

5. Touchwithoutpermission

6. Expecttoomuchtoosoon!


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VII. References

AmericanPsychiatricAssociation(2000).Diagnosticandstatisticalmanualofmentaldisorders(textrevision).Washington,DC:Author.

AmericanPsychiatricAssociation(2013).Diagnosticandstatisticalmanualofmentaldisorders,(5thed).Washington,DC:Author.

Braun(1988).TheBASKmodelofdissociation:Clinicalapplications.Dissociation,1(2),16-23.

Bull, D., Ellason, J., & Ross, C. (1998). Exorcism revisited: Some positive outcomes withdissociativeidentitydisorder.JournalofPsychologyandTheology,26,188-196.

Carlson,E.(1997).Traumaassessments:Aclinician’sguide.NewYork,NY:GuilfordPress.

Gingrich,H.D.(2002).StalkedbyDeath:Cross-culturalTraumaWorkwithaTribalMissionary.JournalofPsychologyandChristianity,21(3),262-265.

Gingrich,H.D.(2005a).TraumaanddissociationinthePhilippines.InG.F.Rhoades,Jr.andV.Sar (2005), Trauma and dissociation in a cross-cultural perspective: Not just a NorthAmericanphenomenon.NewYork,NY:HaworthPress.

Gingrich, H. (2005b). Not all voices are demonic. Phronesis, (Asian TheologicalSeminary/AllianceGraduateSchool,Philippines)12,81-104.

Gingrich, H. D. (2013).Restoring the shattered self: A Christian counselor’s guide to complextrauma.DownersGrove,IL:InterVarsityPress

McFarlane,A.&Girolamo,G.(1996).Thenatureoftraumaticstressorsandtheepidemiologyofposttraumatic reactions. In B. A. van der Kolk, A. C.McFarlane,& L.Weisaeth (Eds.),Traumatic stress: The effects of overwhelming experience onmind, body, and society.NewYork,NY:GuilfordPress.

Nijenhuis,E.R.S.(1999).Somatoformdissociation:Phenomena,measurement,andtheoreticalissues.Assen,TheNetherlands:VanGorcum.

Putnam, F.W. (1997).Dissociation in childrenandadolescents:A developmental perspective.NewYork,NY:GuilfordPress.

Steinberg,M. (1993). Structured clinical interview for DSM-IV dissociative disorders (SCID-D).Washington,DC:AmericanPsychiatricPress.

vanderKolk,B.A.,Weisaeth,L.,&vanderHart,O.(1996).Historyoftraumainpsychiatry.InB.A.vanderKolk,A.C.McFarlane,&L.Weisaeth(Eds.),Traumaticstress:Theeffectsofoverwhelmingexperienceonmind,body,andsociety.NewYork:GuilfordPress.


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STSC103:

MaintainingHealthandWellnessinaStressfulDigitalWorld

ArchibaldHart,Ph.D.

andSylviaFrejd,D.Min.


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AbstractThe digital age is shaping our lives and relationships in striking newways.We believemostpeople are not getting any form of coaching or teaching on how to manage their or theirchildren’s use of digital technology to become good stewards of their virtual lives. Nor arecounselorsbeingtrainedtodealwiththemanysevereconsequencesdigitalover-use.Wearenowexperiencinganepidemicofdigital addictions, includinggaming,gambling,pornographyandcybersex.Thispresentationhelpsyouassessyourrelationshipwithtechnologyandreclaimwhatithasstolenfromyourreallife.Itofferspracticalhelptoparents,counselors,educators,andpastorsonhowtomanagethedigitalworldresponsibly.LearningObjectives

1. Participantswillexplorehowourbrainsarebeingrewiredbydigitaltechnologythroughwhatneuroscienceresearchisexposing.

2. Participantswill identifytheeffectsofsocialmediaonourintimacy,empathysystems,andmarriagesandunderstandwhyweexpectmorefromtechnologyandlessfromeachother.

3. Participantswill studykeyways toestablishdigitalboundaries inorder tohelpclientssuccessfullymanagestressandthrive.


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I. OpeningStatements

A. DigitalTechnology’sImpact

1. Thisisadigitalinvasion.

2. Digitaltechnologyisexpandingandchanginglife.

3. Manyprofessionsarechangingaswell.

B. We ALL Need to Stay Informed about the Health and Emotional Risks of theDigital/TechnologicalWorld

C. ThePurposeofthisLectureisNottoCriticizeTechnology

1. Technologyitselfisawonderfulthingwithmanybenefits.

2. Ourpresenterhasalonghistoryofpromotinghealthytechnologyuseandenjoyingtechnology.

3. Theproblemathandishowweusetechnology.

D. The Way We are Using Technology Today is Negatively Impacting Our Lives, OurLearning,OurHealthandOurChildren

1. Example: a recent reporthas identifieddigital dementia–dementia appearing inteenagerswhoareoverlyinvolvedinthedigitalworld.

2. Thishasbeenidentifiedinothercountries,butitisonlyamatteroftimebeforeweseethesepathologieshereintheU.S.

E. TheGoalistoBeInformedabouttheDigitalWorld


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1. The digital world is not going anywhere – digital technology is expandingexponentially.

2. Wehaveonlyjustbegun.• Conversations have already taken place in the scientific community about

how todo things such as plant implants intohuman’s brains tohelp themenactwithtechnology

II. TheImpactoftheDigitalInvasion

“Theoveruseofinternetanddigitaltechnologyisnowoneoftheprimarycausesof physical problems, mental problems, learning problems and [more].” (Dr.ArchibaldHart)

A. TechnologyUseAffectsOurRelationships

B. TechnologyOveruseImpactsOurAbilitytobePresent

1. Example–Pastorsseecongregantsutilizingsmartphonesinsteadoflisteningtothesermon.

2. In previous years, without a smart phone, the sermon would not have beeninterruptedtonearlythesamelevel.

C. AnxietyandDepression

1. Thereisstrongevidencethatthefloodofanxietyproblemsthatweseetodaycanlargelybetracedbackdirectlytotheoveruseofdigitalgadgets.

2. Thisiscomingintoourhomesandimpactingthewholefamily.• Frombabytograndma,weareimpactedbytechnology

D. ImpactonSleep

1. Thisisoftenoverlooked.


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2. Sleepisveryimportant.

3. Studiesshowthatmanypeople,aftergoingtobed,engageinthedigitalworld.

4. Sleephasarelationshipwithlearning.

5. Sleepisessentialanddeservesattentiondespitethedenialofsomethatitisso.III. MythsAboutTechnology

A. ThereisaStrongResistancetotheTruthaboutTechnology

1. Thisislikelyduetotheprevalenceofaddiction.• Inanaddiction,wedonotwanttohearthat thesourceofouraddiction is

wrong.

B. Individualswanttoconvincethemselvesthattheirtechnologyusage isnotaproblem.

C. Myth1:TheMythofMultitasking

1. Thisisaveryprevalentmyth.• Example–Dr.Harthasheardteachersataprofessionalconferenceworking

togetheronhowto

2. Theideathatthehumanbrainisbuiltformultitaskingisalie.

3. Studies have shown that the best and brightest students perceive that they areperformingbetterwhenmultitasking,butresultsaretothecontrary.

4. Weneedtosequentiallytask.• Finishatask,thenmovetothenextoneandfinishit• This does not go so far as to say that you cannot listen to music while

driving, but texting and driving is a bad (and in some places, illegal) idea


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D. Myth2:TheBrainCanWorkFaster

1. Weusedtobelievewewereonlyusingafractionofourbrain.

2. Expertsclaimednumberssuchas5%ofthebrainistypicallyused.

3. Thebrainactuallyfunctionsbestwhenitisslowest.

4. Manyaddictivebehaviorsareaproblembecausetheyspeedupapartofthebraincalledthewhitematter.• Alladdictionsincreasethewhitematterinthebrain.• Thegreymatterinthebrainiswhatcompleteshighorderfunctions.• Whenthewhitematterincreases,thegreymatterdecreases.• Mostteenagerstodayhaveadeficiencyingreymatter.

5. Scientistsaresayingwearere-wiringthebrainanddiminishingitscapacity• Wecannotlearnaswellorempathizeaswell.

• Brainscansareshowinga10-20%decrease in theprefrontalcortexpartofthebrainthatdevelopsempathyandemotionalintelligence.

• This is a very important piece to remember when working with clients –thoseover-engaginginthedigitalworldarereducingtheirE.Q.

• Many experts believe thatwe have having an empathy epidemic – peoplewillneedtobere-taughttohaveconversations,eye-contact,empathy,etc.

• ThisextendstoattachmentcapabilityØ The brain is designed to attach, but we are changing the brain

structure.Ø Somepeoplecannotexpressthemselvesemotionallyintermsoflove

andaffection.

E. Myth3:WeCanUseDrugstoImprovetheFunctionofOurBrains1. Manycollegesanduniversitiesseeahighpercentageofstudentswhoaretryingto

getAttentionDeficitmedicationssuchasAdderallandRitalin.


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2. Students who do not have an Attention Deficit Disorder, but take thesemedications,willscorehigherontests-10-20%higher.

3. The problem is that students taking Adderall and Ritalin in this way are notcommittingthelearningtolong-termmemory.• Theyarenotlearningtogainknowledge

F. Myth4:WeCanUseDigitalTechnologytoOurAdvantageIfWeGiveOurselvesOvertotheTechnology

1. Thismythisparticularlydangeroustothechurch.

2. Therearesomethingsthatthedigitalworldcanofferthatareveryuseful.

3. Thereisagoodsideandabadside.• We need to pay very close attention to both sides sowe are clear in our

usageofthegoodsidewhileblockingthebadside.

• Example: ManypeopleuseSmartphonesduringasermon. TheymayhavetheBibledownloadedonanapp.However, theymayalsobedistractedordistractingothers.

G. We Need a Wakeup Call. There is a Good Side and a Bad Side to Technology.

IV. Psychopathologies

A. TimemagazinefeaturedacoverstoryonhowSmartphonesaremakingpeople“crazy”andbringingaboutdisorders

B. OneCommonIssueTodayisFacebookDepression


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C. TheWorldofSocialMediaisaClimatethatBreedsFearandAnxiety

D. PeopleFeelaSenseofLossWhenTheySeeThingsthatOthersHave,butTheyDoNot

E. InternetUsageisCorrelatedwithDepression

F. TheBest Strategy for CombatingDigital TechnologyRelatedPsychopathologies is toLogoff–NoMorethanOneHourPerDayisRecommended

G. TechnologyHasaPlace,butaGoodRuleofThumbisthatYouShouldLogOffwhenYouRealizeitisPullingYouDown

V. MakeaDigitalWellnessPlan

A. ItStartswithaWakeupCall

B. We All Have a Relationship with Technology in the Way that We All Have aRelationshipwithFood

1. Considerwhattherelationshipwithtechnologymaybetakingawayfromyou

C. WeNeedtoLookforSignsthatSomeoneisEnjoyingDigitalLifeandLosingtheThingsTheyEnjoyedintheRealLife

D. TheDigitalWorldisDisengagingUsfromNature

1. Thisimpactsourwellbeing.


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2. Thereisgreatconcernaboutthelackofnaturalconnection-beinginnaturehasaspecialimpactonphysicalandmentalhealth.

3. Parentsshouldmakesurethatchildrenhavetimewithnatureeveryday.

E. PeopleAreForgetting toEnjoyThings forThemselvesBecauseTheyAreSoWorriedaboutPostingThem

F. ReclaimYourRealLifeandRelationships

1. Alotofpeoplecapturethemoment,butmisstheexperience.

2. Bemindfulandinthemoment.

3. “Bewhereyourbuttis.”• Abigpartofbeingpresentintoday’sworldistoletgoof,“Itweet,therefore

Iam”andinsteadfocusonbeinginreality.

G. Get Yourself or Others Who are Struggling with Digital Addiction to EnjoyableActivities

1. EnjoyableactivitiesintherealworldcanhelplessenthegroupofdigitaladdictionVI. DigitalContract

A. PrayaboutWhatYourContractShouldInclude

B. IncludeaGoodTheologyofTechnology


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C. UseDifferentContractsforKids,TeensandFamilies

D. ConsiderIncludingItemsSuchas,“RealPeopleTrumpInternetPeople”

1. Don’tbe“alonetogether”–sittingaroundphysicallytogetherbuteachinyourownworldwithtechnology.

2. DevelopGoodNetiquette.VII. InternetAddiction

A. InternetAddictionisDefinedAs:

1. Excessiveuse,oftenassociatedwithalostsenseoftimeoraneglectofbasicdrives.

2. Withdrawal, including feelings of anger, tension and/or depression when thecomputerisinaccessible.

3. Tolerance, including the need for better computer equipment,more software ormorehoursoftime.

4. Negative repercussions, including arguments, lying, poor achievement, socialisolation,andfatigue.

B. InternetAddictionisOneoftheFastestGrowingAddictionsRightNow

C. TheImpactoftheDigitalWorldisAlmostEqualtoSomeoftheMostPowerfulDrugsasFarastheImpactMadeOntheBrain


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D. TheInternetHasBeenCalled“ElectronicCocaine”

E. Digital Activities Can Have Dopamine Flood the Pleasure Centers of the Brain ThenShutThemDown1. Thiscantakeawaytheabilityofotheractivitiestobringpleasure.

2. Individualscanlosetheirabilitytogainpleasurefromrelationshipsandfamily.

F. OneTechniquetoCombattheImpactofInternetOveruseageorAddictionistheUseofRelaxationCDs/Meditation

G. RecognizingInternetAddiction

1. Spendingmorethan38hours/weekonline.

2. Neglectingworkorschoolresponsibilities.

3. Unsuccessfullytryingtocutbackondigitaluse.

4. Neglectingsleep,dietorexercise.

5. Havingmoreenjoymentindigital/virtuallifethanreallife.

H. StrategiesforCombatingInternet/DigitalAddiction

1. Digitaladdictionisaverytoughaddictiontotreat.

2. Considerusingadigitalusagelog.• Seewheretimeisbeingspent.• Trytocutbackinsmallincrements.


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3. Cognitivebehavioraltherapyisthemostpopulartreatment.

4. Helpmanagestressandanxiety.

5. EnlistanaccountabilitypartnersuchasCovenantEyes.VIII. SpiritualImpact

“SpiritualdisciplineshavebeenpracticedinthelivesofdeeplyintegratedfollowersofGodforoverthreethousandyears.Theyfacilitatetheverythingsneuroscienceand attachment research suggest are reflections of healthy mental states andsecure attachment. Furthermore, thesedisciplines can strengthen theprefrontalcortex.”Dr.CurtThompson

A. TheGreatestThreatisOntheGodRelationship

B. SpiritualPracticesSuchasSilenceandSolitudeCanHealtheBrain

C. GodWantsUstoHaveaFocusedMindandHeWantsUstoRenewOurMind

D. DoNotAllowTechnologytoRobYouorYourClientsofthePlacethatisReservedforGod

E. GodWillGiveUsthePeaceandTranquilitytoCalmOurBrains

F. A Healthy Life Spiritually, Physically and Emotionally is a Life that is Lived inAccordancewiththeConditionsthatGodHasCreatedforUs


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G. ScriptureTellsUsthatWeNeedtoBeStillandKnow

H. WeAreDumbingDownOurBrains–OurBrainsAreNotFunctioningattheSameLevelasinthePast

I. OutofBoredomComesImaginationandCreativity

1. Thebrainiscreativewhenitissloweddown.

2. Creativityislackinginyoungergenerationsduetothedigitalinvasion.

3. Welcomesomeboredom,quietnessandstillness.

4. Thereisabigdifferencebetweenconnectionsandconversation.

5. ItischallengingtogetpeopletogodeeperwithGodandwitheachother,butitisthewayGodhasdesignedus.


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Resources

• Net Nanny:Protects families and helps manage experiences with digital content.Parents, spouses, guardians, and educators are given control to manage the onlineexperience.

• Pure Sight: Has the mission of providinga safe online environment for the world’schildren.

• Aims to help parents protect their children in this world of technology by becominginvolvedintheironlinelives.

• Saavi Accountability: An instant online accountability program that lets you set thestandardsforyourhome,andthenenablesparentsoraccountabilitypartnerstoreceiveinstanttextmessageandorinstantemailnotificationsanytimeyourpersonalstandardshavebeenviolated.

• Safe Eyes:Is Mac, PC, and iOS compatible software that protects your family fromharmfulcontentandotherdangersontheInternet.

• GameTimeLimitsforParents:AppforiPhone,iPodtouch,andiPad.

• X3 Watch:Is a free accountability software program helping with online integrity.WheneveryouaccessaWebsitethatcontains inappropriateorpornographicmaterial,theprogramwill record theWebsite, time anddate the sitewas visited.A personofyourchoice(anaccountabilitypartner)willreceiveanemailcontainingallinappropriatesitesyouhavevisitedthatweek.

• Hooked:ThePitfallsofMedia,TechnologyandSocialNetworkingbyGregoryL.Jantz

• HealingtheWoundsofSexualAddictionbyMarkLaaser

• PureEyes:AMan'sGuidetoSexualIntegrity(XXXChurch.comResource)

• EveryYoungMan’sBattle:StrategiesforVictoryintheRealWorldofSexualTemptationbyStephenArterburn,FredStoekerandMikeYorkey

• TreatingPornographyAddiction:TheEssentialToolsforRecoverybyDr.KevinB.Skinner

• iBrainbyGarySmallM.D.andGigiVorgan

• AloneTogetherbySherryTurkle

• TheShallowsbyNicholasCarr

• TheChurchofFacebookbyJesseRice

• Plugged-InParentingbyBobWaliszewski


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• TheDigitalDietbyDanielSieberg

• HopeandHelpforVideoGame,TV&InternetAddictionsbyMarkE.Shaw

• Porn@Work:ExposingtheOffice’s#1AddictionbyMichaelLeahy

• TheSecretinthePew:PornographyintheLivesofChristianMen–BreakingtheBondageofSexualSinbyDavidA.Blythe

• ThePornographyTrap,2ndEdition:AResourceforMinistryLeadersbyMarkR.LaaserandRalphH.Earle,Jr.

• AnatomyoftheSoulbyCurtThompsonM.D.RecoveryResources

• www.Just1ClickAway.org

• www.techaddiction.com

• www.netaddiction.com

• www.netaddictionrecovery.com

• www.aplaceofhope.com

• www.Cyberbullying.us

• www.Shepherdshillacademy.org


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AppendixARiskFactorsforDigitalAddictions

1. Individualswithother(pastorpresent)addictionssuchasdrugs,food,alcohol,smokingorsex.

2. Individualswithotherpsychologicaldifficultiessuchasanxiety,depression,orlowself-esteem.

3. People with relationship difficulties. These users may be drawn to the more socialaspectsoftheInternet(chatrooms,onlinegaming,Facebook,etc.)

4. Highlyintelligentpeople,individualswhoarenotintellectuallychallengedbytheirjoborschoolwork.

5. Thoselookingtoescapetheirfeelings.

6. People with extended periods of non-structured time. This includes: stay-at-homemoms,universitystudents,andyoungchildrenwith fewafterschoolactivities, retiredindividualsandpeoplewhoworkfromhome.

7. Militarysoldiers.


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AppendixB

GrowingNewAddictions

1. InternetGamingAddiction

2. CompulsiveGambling(online)

3. Pornography(softandvirtual)

4. “Virtual”worldgames(parentsraisedavirtualbaby,whileneglectingrealchild)

5. Constantstimulationaddiction

6. Socialnetworkingaddiction


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