Manual Writing: Learning As You Go William R. Saltzman, Ph.D. The National Center for Child Traumatic Stress & Miller’s Child Abuse and Violence Intervention Center

Distinct bodies of knowledge

Development of the UCLA Trauma- Grief Manualized Program

Tuzla, Bosnia

Sarajevo, Bosnia

Multiple iterations

Accentuate the positive… eliminate the negative

Module I (6 sessions) Module II (4-8 sessions) Module III (8 sessions) Module IV (2-4 sessions) Group PhaseOpeningWorking ThroughTermination Module Title Group Cohesion, Psychoeducation, and Basic Coping Skills Working Through Traumatic Experiences Coping with Traumatic Loss and Grief Re-Focusing on the Present and Looking to the Future Thera-peutic Tasks  1: Welcome and introduction (program overview, barriers, group contract, posttraumatic stress, depression, and grief reactions)  2: Learning about trauma and loss reminders (how I react to, and cope with, reminders)  3: Learning coping skills  4: The event-thought- feeling link  5: Identifying and challenging distressing thoughts (“Three Steps to Taking Charge of Your Feelings”)  6: Support seeking (“Five Steps to Getting Support”)  First: Preparing for trauma narrative work (constructing the group narrative, constructing my personal trauma timeline)  Middle: Constructing the trauma narrative (prolonged therapeutic exposure; develop a vocabulary for communicating about the trauma)  Final: Exploring the worst moments (prolonged therapeutic exposure; using trauma reminders to understand the nature and personal meaning of traumatic experiences; cognitive restructuring cognitions associated with guilt and shame; exploring intervention fantasies)  1: Learning about grief (grief reactions, loss reminders, and grief processes / tasks)  2: Understanding grief reactions: Focus on anger  3: Understanding grief reactions: Focus on guilt  4: Remembering and reminiscing  5: Guided imagery: Retrieving a non- traumatic image of the deceased  6: Adjusting to a world in which the deceased is absent  7: Planning for difficult days (relapse prevention)  8: Saying goodbye in a good way  1: Resuming developmental progression  2: Problem-solving current life (“Three Steps to Solving a Problem”)  3: Dealing with problems that are not my job to fix  4: Saying goodbye in a good way

Columbine High School

Santana High School

World Trade Center

Pasadena, Trauma Group

VIII.Practice Exercise G0ALS: To introduce the necessity for practicing skills outside of group. To describe practice task for this week. · Underscore the importance of practicing the assigned skills during the week. Meeting once a week for an hour is not enough to effect change in our life. Research has shown that the on- going practice is critical. Assignments · Distribute copies of the Practice Sheet. · During the week, members are to pay attention to post-traumatic feelings and reactions that they might experience during the week. Draw upon simple examples from the earlier discussion to remind group members what to look for. As a rule of thumb, you might suggest that they simply keep track of downward shifts in their mood or feelings or to the presence of strong emotions such as anger, sadness, guilt, or fear, which may be related to trauma or loss themes. These are possible signs that they may be in a trauma/loss reactive mode.

Discuss Note TOPIC #7Practice Exercise · Pay attention to post-traumatic feelings and reactions—like those we’ve just talked about · Use your worksheets in your workbook (or journal?)-- track strong emotions such as anger, sadness, guilt, or fear, or negative shifts in emotion and mood. · Remember to focus on what is happening outside of you, and what is happening inside of you. S how them where it is, and tell them how to use it— show them where the instructions are on the worksheet itself as you cover them.. Help them translate an example from the session to the worksheet. TOPIC #8Transitional Activity / Close (Worksheet: Monitoring Changes in My Mood / Feelings)

UCLA Program Core Components Trauma–loss psychoeducation Normalizing and validating reactions Enhancing emotional awareness Identifying personal trauma / loss reminders Developing effective coping skills Accessing appropriate support Trauma narrative reconstruction Cognitive restructuring

Promising Practices Take it one step at a time Team up Manuals come in different shapes and sizes Build in flexibility and support Expand and formalize parent / family components Keep your voice