Unlimited CEUs for $59 at AllCEUs.com this episode was pre-recorded
as part of a live continuing education webinar on demand CEUs are
still available at AllCEUs.com/Trauma-CEU hi everybody I'm dr. Donnelly Snipes and I'd
like to welcome you to today's presentation on trauma-informed interventions now I had
originally planned to do this based on a book called 101 trauma-informed interventions and
I got the book and I really didn't like it it has a lot of great activities for grounding and
it has a fair amount of activities if there's family related or attachment related trauma but
it was very general in its presentation it really didn't talk about trauma-informed so much it
just said you can do Taichi or you can do Chi Kong or you can do this activity and didn't
draw it in so what we're gonna try to do in this presentation is draw together some activities
and some principles that we need to consider when we're doing activities in order to ensure they're
trauma-informed and many activities that we do many interventions group activities etc can be
trauma-informed if they help us accomplish a few predetermined goals if you will and we'll
talk about those so we're going to review the components of trauma-informed care so we
understand what kind of interventions were really looking for and what the goal of those
interventions hopefully will be we'll identify a variety of interventions and considerations
for the provision of trauma-informed care so the principles of trauma-informed care and this
is a review for some of you so I apologize we'll go through it real quick safety this is
first and foremost people who've been exposed to trauma really need to feel safe they need to
feel emotionally safe like you're not going to push them too far where they can't come back they
need to feel cognitively safe like their thoughts and their opinions are valid and they can state
them without fear of repercussions and they need to feel physically safe and that goes without
saying but there are some things you can look around your office and go looks perfectly
safe to me I don't see what the problem is but something as simple as shutting the door
and locking it if you do that for some reason could be very traumatic to somebody who'd been
in a situation where they've been confined with their abuser before so we do want to consider
safety we want to make sure that clients feel physically safe that there's nothing in our office
that is exceptionally triggering to them and if there is then we need to figure out what to do
about that we need to develop trustworthiness and transparency do what we say say what we mean
and tell clients with trauma-informed care it is so much more important and since most people have
experienced trauma I think this should just kind of be a standard but we need to be transparent we
need to do more than just this informed consent thing at the beginning of treatment ago well
this is kind of what we're gonna do and these are the benefits potential drawbacks and risks
and options but of being signed the paper let's get moving well yes we've got to do that at the
beginning but with people who've experienced trauma we need to help them understand where it is
feasible to what we're getting ready to ask them to do if we want them to do a cognitive interview
for example I was watching a show yesterday that was one of those police procedural shows I don't
remember which one but the police officer told the victim okay I want you to close your eyes and
you could see her just tense up which really good acting there because she's like okay why in the
hell am I gonna close my eyes I don't know you from Adams housecat so it's important if we're
going to ask clients to do something that we explain to them okay this is what we're gonna do
this is why we're gonna do it I'm going to first ask you to close your eyes and this is the reason
if the person is not comfortable closing their eyes but for some reason it's necessary which is
rarely necessary but if it is necessary what can I do to help you feel safe while your eyes are
closed and working with the person before you launch into the act vd or intervention whatever
it is is so important and this is true even with things that seem very benign like meditation many
people who've been exposed to trauma have a lot of difficulty obviously hyper vid with hyper
vigilance so they want to be aware of what's going on they don't want to be closing their
eyes because they don't feel safe yet as your relationship with that client develops and they
begin to trust you they are going to be able to be more vulnerable in your presence so you may
get to a point where they're willing to you know without question close their eyes before in order
to go into an activity but that's not something we can necessarily expect and certainly not demand
from the get-go trauma-informed care provides peer support and mutual self-help we want people to
be able to connect with others who've experienced similar things who've experienced traumas who are
experiencing PTSD who have come through and are in remission or recovered from PTSD we want people
to be able to connect with others not just us as the therapist so it's important to encourage them
to engage in support groups and mutual self-help where appropriate and this is really true well
it's true across the board but when you're working with groups such as clergy counselors doctors law
enforcement firefighters people who typically are there for people they're responsive for people
and they feel somewhat responsible for people and may not want to talk about this trauma for
some reason military's another one because for fear of reprisal in some way shape or form I've
worked with a lot of counselors and I mean work illegally collegially with a lot of counselors
who recognize that they have been experiencing secondary traumatization but they don't want to
go to counseling because they're afraid that it would come back to the board and then the board
would start instituting excessive supervision or something so even clinicians despite the fact
that we know what we know can be hesitant about seeking help so it's important to encourage
people to seek help but it's also important for people to seek help from like others because
what clinicians experience is very different than what cops experience and law enforcement
as a profession tends to be somewhat isolated if you will they like to keep it within the law
enforcement family if you will so it's helpful if they can find support within their occupational
community that's what we'll call it occupational community okay so number four is collaboration
and yuechu ality we're not doing things to the client this is what happened whenever the
trauma happened something happened to the client whether it was an act of God whether it was
an abusive parent whatever happened the client had no control over it so we want to make sure that we
are asking what do you need to do what has worked before what do you think is the best outcome
which direction do you want to go from here and what role do you want to play some clients
want to be much more active in their treatment than others what role does this client want and
as treatment progresses that can change because some some people when they start treatment feel
very disempowered very helpless about the whole situation and they're just exhausted from the
PTSD symptoms or from the trauma symptoms but as they start moving through treatment and
start feeling a little bit better and feeling like there's hope then they start feeling more
empowered and wanting to take more control of the reins and that's awesome that's what I want
so we need to regularly revisit this concept of collaboration and mutuality one of my biggest
pet peeves and I have a few of them is when I would see a clinician writing a treatment plan
for a client and then walking over and giving it to them and going here's your treatment plan and
the client didn't participate in the development of the treatment plan at all maybe a little bit
of discussion in the assessment about well what kind of goals do you have but the client didn't
participate in the development of the objectives of the interventions of the pacing of anything
the clinician did it for the client and even more of a pet peeve is if a clinicians treatment
plans look cookie cutter for PTSD for example or for depression every single person that clinician
treats who has PTSD has the same nearly the same exact treatment plan drives me a little bit batty
that tells me the client did not collaborate did not have a say it wasn't a discussion it was an
edict empowerment voice and choice and this kind of goes with collaboration when we're asking
them to participate to help us understand what works for them what doesn't work for them we
want to empower them to say yes that works and I tell my clients from the beginning whether I
know they've got a history of trauma or not over the time we work together I'm gonna make a lot of
suggestions for different activities you might try to address particular things some of them will
work well for you some of them won't and some of them you're not even gonna want to try I need
to know which category each one falls in because if something doesn't work for you I don't want
to keep suggesting it and if there's something that you're just not even willing to try okay you
know I'm not going to force you to try it but I again I need to know so I I know that you don't
like to think about doing meditation for example if that's something a client says no that's not
something I'm gonna do okay at least for now we're gonna write that off and in the back of my mind I
think I might try reintroducing it in a couple of months if it seems appropriate but I don't want
to disempower the client or make the I feel like I wasn't listening by saying well you really need
to try at least try this you know most of us had to sit through something similar and obviously
wasn't traumatic but when we were little and your parents put something like Brussels sprouts
on your plate and you're looking at it going that smells disgusting sorry not a fan of Brussels
sprouts and but your parents said you have to at least try it and you tried it and you're like that
tastes disgusting I told you I don't want clients to feel like I am handing them Brussels sprouts I
want them to feel like I am listening and giving them options so empowerment voice and choice also
means that we look at strengths and we build on the strengths that the client has how have they
dealt with their trauma until now how have they built their life the good parts of their life
up until now let's build on that because those are the strengths that they have we may need to
sharpen those tools a little bit or switch from a manual tool to a power tool but we're gonna
build on them everybody in the team everybody in the team from the clinician to the doctor to
the support people to the client everybody needs to believe in resilience of the individuals the
organizations and the communities and you might think well that's kind of broad for everything
but we have to believe if we're working with a rape victim or a rape survivor we have to believe
that that person has the ability to work through that trauma and integrate that trauma we have to
believe that the people in different organizations that interfaced with that youth after the trauma
they're going to be impacted by it we have to believe that those people can be resilient the law
enforcement officers the attorneys etc and we have to believe that the communities can be resilient
if you're living in a neighborhood that you feel is safe and you find out that the 13 year old down
the street was assaulted the day before that's gonna shake your whole community because all of a
sudden it doesn't feel safe anymore and people are going to start feeling more uneasy but we have to
believe in a trauma-informed perspective that the individual that was the primary survivor as well
as secondary survivors can recover and we have to believe that that organ is that community can
find a new normal it's never gonna be the same I lived on the University of Florida campus when we
had a serial killer go through unfortunately and that really shook the community of the campus
to its core but we were able to come together as a community and we were able to recover
after a hurricane after Katrina after Harvey you know it shook communities to their core and
that was traumatic for millions of people but the communities were able to come back together
so we need to believe in this resilience if you don't then you want to stop right there because
that will be communicated you need to have that belief in your heart that people can integrate
and I use the word integrate not accept they can integrate that experience into their life we need
to build on what clients staff and communities have to offer rather than responding to perceived
deficits and again this is an unfortunate pattern that we generally have instead of seeing a
person who comes in as a survivor and saying wow let's build off of that strength and that
courage you have a lot of times we see them as a victim and we're trying to ameliorate what's
broken in them it's a semantic shift but we want to build on that strength and that courage that
that person has brought to us we want to build on the strengths of the communities yes the houses
may be devastated yes on that campus you know you didn't know when it was safe than people had
curfew and everything and it was really scary for a while but as a community we bonded together
and started watching out for each other more so there were strengths that were brought out and
we want to respond to cultural historical and gender issues leveraging the healing value of
cultural connections remembering this doesn't just mean ethnicity this can mean religion this
can mean occupation this can mean well I guess for example being a u.s.
College student would
be sort of a an occupation because as Gators at that point in time we needed to come together to
support one another and we recognize and address historical trauma in in people okay so those are
the principles and and I'm gonna summarize it for you in just a couple of slides so don't think
oh my gosh how am I gonna remember all that you got it the events the three E's of trauma
the event is what happened objectively was there was somebody victimized there was a tornado
there was a car crash whatever it was this is the event now every person who goes through an event
experiences it differently based on how old they are you know kids are gonna experience things
very differently than 20-somethings who are going to probably experience it very differently
than sixty somethings okay experiences can be affected by people's developmental age their
prior history with something like that if they've had prior traumas if they have had a prior
experience with something similar if the incident occurs close to what's considered their safe
space if the incident if they're not a primary victim if the incident reminds them of somebody
that's close to them there are a lot of things variations or variables that can go in to making
an experience much more traumatic for one person than the other even though the quote objective
experience is exactly the same the third thing that affects experiences is available resources
when it happened does that person have support within the first two to four hours did that person
have support within the first 24 hours within the first 72 hours after we get out of 72 hours people
have started to really compartmentalize and try to stuff it down because it's just so overwhelming
so important for people to have social support as well as necessary resources in that first
period if a house burns down the red cross goes out there and makes sure that people have
somewhere to stay they have clothes they have a toothbrush they have the things they need and that
happens not instantaneously but it happens within a couple of hours so those available restore says
get forgetting basic needs met think of Maslow's triangle Maslow's hierarchy those happen and that
tends to make help the person feel a semblance of normality a little bit sooner and I'll have a
little bit more of a sense of control so that can make the traumatic experience a little less
traumatic or help the person with their resiliency and the third E is effects so you have the event
the experience and then you have the effects of it what happened to the person is going to affect
them emotionally is going to affect them mentally in the way they understand the world and perceive
things and maybe their outlook for a while it will probably when people are in trauma it will
probably affect their memory because when you're in trauma you're not your memories not good always
just put it that way so if somebody is in acute in an acute state of trauma making sure that they're
told it's okay you're gonna feel kind of scattered for a while write things down keep it simple if
it's been awhile since the trauma you're probably looking at cognitive distortions and cognitive
restructuring that took place as a result of the trauma physical effects because of the emotional
effects there can be physical effects such as not getting in being able to get enough sleep
hyper vigilance increased arousal those sorts of things there can also be physical effects
from the trauma if you're in a car accident and you break your hip it's a physical effect of the
trauma so we need to look at that social effects of the trauma a lot of things go into this the
trustworthiness of other people the reliability and dependability of the people you thought you
were your supports your willingness to engage in interpersonal relationship some people try to
withdraw after a trauma because it's just too overwhelming to deal with other people so there
are social effects spiritual effects as we've talked about in our spiritual steps to happiness
after a trauma people's understanding of how the world works and make the way they make meaning
out of things is often shaken up a little bit so we need to help people work through that and
then the environmental effects of trauma it can be as obvious as the destruction of a house or
car or something like that – something that is a little less obvious for example someone who
is the survivor of a home invasion robbery may start putting bars on their windows and triple
lock their doors and their environment becomes more like a prison than a inviting place to live
so we do want to look at the effects of the trauma when we're helping people work through their
trauma these are all potential treatment plan goals when we're addressing trauma and we have
to let the client guide us at their pace on what they're willing to or able to address it's also
important with trauma to help clients understand and in the trauma-informed care certification
tract there's a class on the neurobiology of trauma but our brains are kind of cool and one
thing that people learn in that track is that during an intensely traumatic event the brain
actually secretes certain chemicals in order to prevent the formation of memories because the
brains going oh dude I don't want to remember that ever which is why sometimes people can't remember
the details of a trauma their brain was protecting them yes it is frustrating it is so frustrating
for somebody who felt so out of control to still feel out of control because they have these blank
spots and we can work with them on that helping people understand that that's a normal part of
the trauma and that some of those memories may come back when and I make the analogy if you will
that when your brain thinks you're strong enough to handle it when the brain thinks you're ready
to and all that tidbit of information you might get it back when I do autobiographies with my
clients I have them write their autobiography on a sheet of paper and every sheet of paper is a
year so they start with their earliest memory and then whatever age they were so six will say they
answer a bunch of questions about what was going on when they were six as best as they can then on
the next sheet of paper is when they were seven next sheet of papers when they were eight and
sometimes people can't remember the age so I say when you were in first grade second grade third
grade whatever it is that helps them cognitively connect with that age why do I have them do
waste so much paper if you will because as we go through therapy people often remember things
they're like you know I forgot that when I was six I used to do this or when I was six this was
going on well we can add it to the autobiography now so they're able to start filling in some of
those gaps and it feels helps them feel a little bit more complete if you will in some ways okay
so the four R's we need to help clients realize the event what happened recognize the experience
help them come to terms or understand how they experienced that event and the effects of that
experience so if somebody experienced a trauma when they were 4 or 5 you know cognitively
children are thinking dichotomously at that point in time they don't have much of a point of
reference they are dependent wholly dependent on their adult caregivers so their experience
and the effects of that trauma and their reaction could be very different then well if
they experienced the same thing heaven forbid when they are 26 we want to help them see that
they may be reacting they may have those memories stuck for lack of a better term right now kind of
stuck in their amygdala from when they were 4 or 6 this happened and they're still feeling when
they're exposed to those triggers they're still feeling like that terrified child to help them
understand why they're reacting the way they're reacting we want to help we want to respond
to help people live a high-quality life and acceptance and commitment therapy for trauma
is one approach cognitive behavioral therapy for trauma is another approach or trauma focused
cognitive behavioral therapy cognitive processing therapy is another one there's also exposure and
desensitization type approaches there's a lot of different approaches that people can use EMDR is
yet another one we need to educate clients about the options that are out there so they can most
effectively choose what's gonna they feel will work for them and then we need to ensure you
know sort of that above all do no harm thing we need to ensure that we are doing everything
possible to resist rhe traumatising the client we want to make sure we're not taking their power
we want to make sure we are not recapitulating that event and if something happens that starts
to do that we need to be able to help them stop and take action so they don't feel like they're
immersed in it again unless you know obviously unless you're doing exposure therapy or something
and even then exposure therapy needs to be done by a trained professional somebody who's trained
in exposure therapy you don't want to just pull that out of your hat and go hey you're terrified
of spiders so let me bring a spider in and see if you want to work with it please don't do
that okay so summary of the intention of the interventions we're getting to the interventions
in just a second you want to create safety and develop trust with clients through the use of
cultural resources peer support transparency collaboration and empowerment so you're getting
this whole support system together you're you're gathering up the resources and and sort of
stocking the fort if you will so this person feels like they are totally support it and protect
it and cocooned if if you want to use that term we do this in order to help clients get to the place
where they can explore events the experiences and the effects of those those events and respond in a
way that will help them live a rich and meaningful life without feeling like they are being regularly
retraumatization happens when people feel a lack of control can we make these memories go away no
can we help them develop a different relationship with those feelings reactions and memories yes
where they feel like they have more control where they feel like they can live a rich and meaningful
life yes we can so create safety these are some of the activities that can be kind of fun encourage
people to develop a nurturing voice and we talk in group a lot about what a nurturing voice means
because some people are like them what what would you tell a six-year-old what would you tell
a small child what would you tell your best friend if they so again back with my stack of
index cards that I have when people have trials tribulations and troubles in their life I have a
whole stack of cards that I have developed that of issues that often come up and I'll pull a card
out and I will say okay if you got fired from your job what might you tell yourself what might you if
you were using a nurturing voice what what would you tell yourself and if they kind of look at me
like I all know what would you want a nurturing parent to tell you you want to develop the voice
of a nurturing parent in your head instead of a critical heckler so we'll go through those cards
for the better part of group and then we'll talk about how it would feel and how it felt switching
from a critical voice to a nurturing voice we also talked about experiencing trauma so if somebody
goes into a shopping mall for example and they whenever they're around crowds it triggers their
PTSD the critical heckling voice can say you are so weak you are so broken you're no good to
anybody the nurturing voice can say I don't blame you for being stressed out and anxious right
now what can we do what tools do you have to help you get through this moment so we talked about
symptoms of PTSD and situations that trigger PTSD symptoms for people we talk about what
they tell themselves and then we talk about what an alternate nurturing voice in their head
could tell them instead another activity you can do and I really strongly recommend this at the
beginning of treatment like when you're doing the treatment plan develop a crisis plan help the
person develop a crisis plan so they can identify signs of impending crisis and they can also this
is also goes along with their advance directives they can identify where they want to go if they
have to be hospitalized who they want involved in their care etc they can also identify what's the
most helpful thing thing or things that people can do and what's the least helpful or potentially
damaging things that people can do you want to have that in a plan and then in a post crisis
plan we generally forget this part after the person goes through the crisis after the person
gets stabilized and you know they've gotten gotten grounded again what is it that they need to do
because after a crisis whether it's a three or four hour thing or a three or four month thing
you know it doesn't matter after a crisis people tend to be exhausted which means they're more
vulnerable to dysphoric emotions and reactions so in this post crisis period what is that going
to look like how can they start taking care of themselves again or continue to take care of who
do they want involved and at what point can those supports do they feel like those supports can
step away from them a little bit mindfulness activities our third group of things people can
do because we want people to have an awareness of self in order to feel safe we need to be aware
of what's going on within us and around us not hyper-vigilant but if we are mindful and we notice
you know what I'm feeling really uneasy here for some reason we can intervene before it becomes
a full-out anxiety attack if we are mindful of what's going on we can explore with curiosity you
know I'm feeling really uneasy I wonder where this is coming from and develop a greater awareness
so then we can identify ways to deal with that so we're not having to close things out we're not
having to escape or leave we're able to identify triggers reminders etc and develop a plan for how
to handle those so we feel safe we feel like we've got control we feel like we have the ability to
be empowered in our life grounding techniques awareness of the present when people start having
flashbacks if they've been exposed to trauma it's not uncommon for people to have flashbacks when
they start having flashbacks or feel like they're getting ready to have a flashback it's important
for them to be able to ground themselves and I have a variety of grounding techniques that we go
through one of my favorite is the 4 3 2 1 I have people identify for things they see in the present
moment 3 things that they hear 2 things that they smell and one thing that they can feel and that
just helps them really focus on the moment and staying in the present instead of going back there
because remember PTSD pulls our mind to the past about what happened and could happen again and
pulls our mind to the future worrying that the worst is going to happen we want to encourage
people to stay in the present what's going on they're grounding techniques can be as simple as
calling a friend and you know but the hands-free phone if you're in the car and and just talking
and staying focused in the present one of the things I do and it's not trauma related so to
speak it's more to my own weird phobias but I have this unreasonable fear of bridges so whenever
I go over a bridge I sing songs whether it is the ABCs or mary had a little lamb' it's usually some
kind of little kids song that I can just sing over and over and over again until I get across the
bridge it helps me stay grounded and focused on what I'm singing instead of looking around going
oh my gosh encourage clients to brainstorm how have they grounded themselves before when they've
had flashbacks how have they gotten react limited to the present if they've woken up from a
night terror how can they get reground a– dand reoriented unhooking we've talked about this
in other classes helping people unhook from their emotions when we feel like we're hooked to it
imagine going fishing and you are just out there you're cruising along and suddenly this 12-foot
great white shark and yeah you've got really strong fishing line 12-foot great white shark
takes your line and starts pulling you and you're afraid it's gonna pull you right off the boat
and gobble you up that's the way our feelings can feel in the middle of an anxiety attack or in the
middle of PTSD so encouraging people to understand that they can cut that line they can see that
great white shark out there they can notice that great white shark out there and they can cut that
line and go you know what I ain't going overboard today Pandora's box is another one that I really
like doing with clients because it starts to give them a sense of control and we practice this when
we start talking about the trauma and the effects of the trauma and all that stuff this is one of
the early exercises we do and we talk about how when there to something that reminds them of the
trauma it opens up Pandora's box and most people know that that's this box that's filled with all
these emotions and there's lots of other stories that go along with it but we talked about how
it's this box that's filled with emotions when they open it some people are afraid that if they
open it everything is going to come pouring out and they will never get the lid shut back so they
they're afraid to go there so we start talking about Pandora's Box we look at it and if it's
somebody who's more visual I even have some boxes that I've gotten at the craft store that are like
treasure chests that are locked and we look at the box and I we talk about what it feels like to
look at that box that might be filled with their emotions what does it feel like to think about
taking the lock off of that box what does it feel like to and we gradually step to the place where
they unlock it take the lock out and gradually open it up just a peek just a peep just a little
bit and then start opening it a little bit more we talk about what their fears are if they open that
box too much we talk about strategies for closing that box again if it starts to open and when we
start processing trauma issues or talking about something that might trigger intense emotions they
have the key word that I need to shut the box and that's my clue and that's their clue that okay you
know this is getting too intense for me right now instead of running from it or changing the topic
I need to shut the box and we may be able to open it again in 15 minutes but right now I need
to shut the box and we work on that with each client each week help clients develop boundaries
depending on the trauma they may have had their boundaries violated in one or more different ways
so help them learn about boundaries sometimes when people are in a traumatic experience other
people are so well-meaning that they want to comfort they come up and they want to give hugs
and they want to touch and people who've been traumatized sometimes don't want to be touched
they're like personal space you know this is my bubble encouraging people to develop the skills
to know what's a comfortable personal space and the assertiveness skills to be able to kindly
articulate you know I need this kind of space I'm not a hugger I'm I just don't do well with that
it's nothing personal I'm just not me emotional boundaries encouraging people to be able to set
those emotional boundaries and say I feel how I feel it's not right or wrong it's just how I feel
if you feel differently that's okay doesn't mean anything's wrong with me and cognitive my thoughts
are my thoughts and I can choose to hold them or I can choose to change them but it's my choice and
that's my boundary I have this is all my stuff in my little bubble and I can choose what I do
with it in there and our bubbles can connect with other people's bubbles but it doesn't mean they
necessarily it doesn't mean they have to intersect you know they can touch and connect without
having somebody else's bubble gobble yours up transparency like I said earlier always
explain the rationale behind activities encourage clients to improve communication and
this is goes to their transparency we talked earlier about informed consent but we also want to
encourage clients to be more transparent they need to stop mind-reading and how does that relate
to transparency well if I'm in a relationship with somebody and I expect them to do something
or get me a present or something and they don't do it and I get angry and then I get frustrated
with them and I give them the cold shoulder for the next two days they're probably sitting there
going what the heck if we encourage people to stop mind-reading and stop assuming that they know
other people are thinking or wanting or needing than this open communication which can feel
very threatening for a lot of people this open communication will help them garner support if we
are mind-reading if we are assuming that somebody has ill-will towards us for some reason if we're
assuming somebody has not nice motivations for what they're doing then it can make us feel
like we're less safe it can make us feel more in danger many times we are mind-reading and and
having transference reactions based on past trauma so encouraging people to stop mind-reading to
communicate openly will reduce stress reduce hyper vigilance and increase a feeling of
connection and support finally encourage clients to start using I statements this helps
improve communication and transparency because they're saying I feel this way when this happens
they're not saying you did this you did this you did this they are communicating their wants needs
and feelings so other people understand and can meet their needs or try to meet their needs and
encourage people to develop an awareness of the motivations behind their thoughts feelings and
urges so this mind-reading act activity we do I ask people to think about times when they have
read people's mind or thought they were reading people's mind and felt like that person meant
something not nice towards them for whatever reason and it hurt their relationship or
it negatively impacted them in some way and then I asked them how did they know that and
do they know that for sure do they have facts to support it how could they have addressed it in a
way that may have prevented some of the distress that it caused and then obviously we practice
using I statements and identifying what they need and I'll go around the room and I'll have
everybody say I feel however they're feeling at the moment and I need and you know if you do this
too close to the end of group they're like I feel exhausted and I need to go have a smoke break
or something a lot of people will say that but it gets people starting to use I statements and
empowers them to start getting their needs met collaboration and empowerment multi multi sensory
guided imagery can be empowering because it gives people the ability to transport themselves to
a different place for a moment to take a mini mental vacation sometimes it's very stressful
sometimes you're just in the middle of something that's traumatic I've used the example of getting
shots before when you go to the doctor and you're getting ready to get a shot it's not a pleasant
thing if you can transport yourself for a second that can be helpful now this can be less than
helpful with clients who have a history of dissociating as in a response to trauma I don't
want to encourage dissociation I wouldn't want to encourage intentional vacationing values
identification helping people recognize what is important in their life and empowering them
to take steps towards that and we talked a lot about that in acceptance and commitment therapy
for trauma we also talked a lot about living in the and and this is very empowering have clients
identify times in their life where they've been scared to do something but they did it anyway
where they didn't think they could do something but they tried and they did it anyway or maybe
they failed but they tried encouraging them to explore how they have embraced or walked with
fear and dysphoria at times will help them see that they can continue to do it have them explore
how they're different now than they were when the trauma occurred this can mean exploring how
they are stronger how they have grown up how they have more supports how they have they're in
a healthier environment whatever it is so they can recognize how they're safe now and how they have
survived until this point and then encourage them to identify and enhance strengths for coping with
PTSD or trauma symptoms you know my favorite flip charts all around the room one for irritability
one for hyper vigilance sleep disturbances flashbacks numbing and withdrawal having clients
go around to each one of those and identify ways that they cope with those specific symptoms can
and then we bring it all together and I put it together in a handout for them that I give them
the following week but this helps clients identify some new techniques that may work for some of
their colleagues or whatever you want to call them group mates and helps them start exploring
new tools that they might have have them create meaning and this needs to be approached delicately
creating meaning from what happened yes it isn't unfortunate whatever it was it was traumatic and
it stinks that you had to go through that how can you create meaning from it how did you grow how
did you become stronger what can you get out of it play it out is another empowerment tool that
we use sometimes with clients who start having extreme reactions to certain situations they're
afraid to go into public because they're afraid that something Bad's going to happen and so
we asked okay what what do you what are you afraid is going to happen and then what and then
what and then what so we have them play it all out and then we talk about the likelihood of that
event happening in the and and generally it comes out that it's pretty unlikely that it's going to
happen but in the unlikely event that it should happen you know is there do they want to create
some sort of plan of approach encourage people to identify triggers and modify them whenever
possible if going into super crowded places is a trigger for you well then don't go shopping at
the mall on Christmas Eve you know that may be one of those things that you just choose to avoid
there are some things you can't avoid I've told you about my my friend who was a law enforcement
officer who was involved in a particularly nasty car accident well he went back to duty he couldn't
avoid driving he couldn't avoid the interstates but he knew the interstate was a trigger for him
so he had to figure out a way that he was able to deal with that being those sights and smells
even a smell of exhaust fumes was would start triggering flashbacks for him so encouraging him
to be aware of those things and he knew that if he got on the interstate you know at least at first
until he desensitized to doing that he would have a plan in place for what he would do obviously
this was back before before he went back on patrol duty and then once he got to the place where he
realized you know what I've been able to go on to the interstate and there hasn't been a problem
and it's not so bad anymore then he was able to progress back to to full duty how people use
red flags and green flags red flag warning means that they're feeling triggered or they're feeling
anxious it they may not be able to identify why but if they know that they're feeling stressed
out that day that's a red flag day kind of like when there's a riptide at the beach knowing that
there's red-flag what do you do differently that day and how do you need the people closest to you
to behave differently that day I know in my red flag days I cannot take a lot of sudden loud
noises they just make me jump out of my skin I recognize them and they still happen we've got
four dogs we're not gonna have a quiet household however I recognize that when I'm having a
red-flag day sometimes I need to go in a different part of the house from the dogs because if they're
barking too much it really grates on my every nerve and that's okay systematic desensitization
is another way we can empower clients to be exposed to trauma reminders to trauma triggers and
have those triggers not elicit the same emotional response narrative therapy written or charted
depending on your clients some people love to write some people hate it so if they want to write
a narrative I say okay your life is a television series and you are in season 15 right now season
15 is coming to a close now tell me about season 16 what is it gonna be like and just like when
you watch a show like ER or something that's gone on for many many many many seasons you develop
emotional attachments to particular characters and when they go away it's like oh you know that's
you have this little little mini grief thing going on however you don't forget that they were there
when there's a traumatic event that happens one season you don't forget that that happened but
how do the writers write that in to make meaning from it obviously they put it in the script for
a reason how does it play out and how can you make it play out in season 17 in a way that is
meaningful and positive if somebody doesn't want to narrate that much they don't want to write a
prose story that's fine chart it out do it mine you know this is what happened then this is what
happened then this is what happened last week and this is what's gonna happen next week next month
next year you can do the broken pot activity which you take a big terracotta pot you want to get one
of the bigger ones and you don't want to smash it into a million pieces so breaking it is a little
bit dicey until you get the hang of it you want to break it into large pieces I've found the
easiest way to do this is to just leave it out over the winter and it just naturally cracks on
you found that out the hard way anyhow take the pieces of the terracotta pot and on the inside
of the piece or each piece right and effect or a result of the trauma that has impacted the person
and then they glue it back together and on the outside of the pot they write something that
they're grateful for or support that they have involve cultural supports and this can be faith
healers pastors or like I said earlier colleagues sometimes people will feel and it's true to a
certain extent I don't know what it's like to be an emergency room doctor I don't know what
it's like to be a firefighter I can empathize but I haven't been there I haven't lived in
that sort of structure I haven't been a cop I have lived with cops and firefighters and soldiers
but I have never been in that situation I've never been in Afghanistan so my empathy can only go so
far so sometimes it's helpful to have colleagues that are involved that can use terms and phrases
and words that are meaningful to the person that may not be in our vocabulary identify peer based
resources like specialty groups where people can go without fear fear of reprisal and encourage
family support and therapy because somebody who has experienced trauma doesn't live in a
bubble and their trauma and the effects of that trauma affect their significant others and
their significant others which is why we have intergenerational trauma we want to make sure that
we're bringing in everybody who has been touched by that trauma in some way so we can break the
trauma cycle responding without retraumatization tabat EMDR in just a second we want to help people
build resiliency and prevent vulnerabilities so when they are going into a situation and they
feel triggered in some way they feel like it's a dangerous situation they need to ask themselves or
they can ask themselves challenging questions one what are the facts for and against my belief that
this is a dangerous situation or this is could be a dangerous situation looking at the facts
usually when they start feeling that they may be being triggered and using emotional reasoning
this reminds me of a time that was unpleasant their friend was very traumatic therefore I am
anxious about going into a similar situation that's emotional reasoning reasoning there is
no evidence that this situation in the present is going to be traumatic is there a higher low
probability that your belief is or will be true is there a high or low probability that this
will be a dangerous situation going to your kid's basketball game what else contributed to
the situation that was traumatic in the past and is that present now you know a lot of times
there are other extenuating factors that are not there in the present and are you catastrophizing
or using all-or-none thinking are you expecting the worst or thinking every time I go into a
crowded place something bad happens or I have a panic attack those are questions that clients
can start asking themselves in order to help them feel more empowered about what getting ready to
do in order to help them get grounded now when it comes to EMDR yes I think EMDR is priceless for
many people who have experienced trauma does it work for everybody no you know I've talked to
clients who've gone to MDR therapists and said not didn't do much for me but I've also talked to
a lot of clients who've gone and said yeah it was the best thing that I ever did I wish I wouldn't
have waited so long so it's something that I feel needs to be presented as an option to clients to
help them see if that's something that works for them okay so we need to create safety and develop
trust through the use of cultural resources peer support transparency collaboration and empowerment
we want to do this in order to help clients feel safe enough to explore events the experiences
of those events and the effects of those events and respond in a way to help them live a rich
and meaningful life without reach Ramat izing themselves we want them to be able to accept and
experience reality without feeling like they are going through the trauma over and over and over
again when you're working with a client no matter what intervention you're doing ask yourself if
it is in any way disempowering non-transparent or could be triggering whether that is having
them hold hands dimming the lights lighting a candle doing something ritualistic whatever it is
or even ropes courses can be somewhat traumatizing for clients because there's a lot of times on
ropes courses where you're often really close and your personal space is kind of invaded
so we do want to recognize those things and and be transparent about what's going on and as I
said multiple times but I'm going to say it once more inform clients before every intervention of
the potential benefits and effects and what tell them what they're going to do you're not doing a
psychological study it's not like you have to have a double-blind or something so let clients know
I'm going to ask you to close your eyes because it will help you in visualize what was going
on or I'm going to ask you to take three deep breaths because it will help you slow down your
heart rate and breathing so you can trigger that rest and digest action in your brain if clients
understand they're a whole lot more likely to go along with it but they feel empowered because
they're able to say okay I understand and I'm making a conscious choice to do this it's not
being done to me alrighty everybody thank you so much for being here the day before Thanksgiving
and I hope you have safe travels and a wonder one wonderful wonderful holiday whatever you're
doing or wonderful wonderful unhallowed a if you're not participating in the Thanksgiving
festivities it should be gorgeous weather and a lot of the United States so hopefully
maybe you can get out and do something fun if this podcast helps you help your clients
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