1. Judy I. Eidelson, PhD Temple University Beasley School of Law March 8th, 2016 Working With Survivors of Trauma

2.  What is trauma?  How does it affect our clients?  How does it affect representation?  Obstacles to effective communication  Strategies for addressing obstacles  Questions and comments Overview

3. HPA Axis Balances body following stress by releasing of various hormones/chemicals Brain-Body Regions Impacted by Trauma SOURCE: Southwick et al., 2005

4. Brain-Body Regions Impacted by Trauma Catecholomines: Fight or flight response Cortisol: Energy available Opiods: Prevent pain Oxytocin: Promotes good feelings SOURCE: Southwick et al., 2005

5. Hippocampus processes information into memories Encoding = Organizing sensory information Consolidation = Grouping information into memories and storing them Amygdala specializes in the processing of emotional memories (works with the hippocampus) Both structures are VERY sensitive to hormonal fluctuations Memory Processes Impacted by Trauma SOURCE: Southwick et al., 2005

6. Like These... THESE HORMONES IMPAIR MEMORY CONSOLIDATION Catecholomines: Fight or flight response Cortisol: Energy available Opiods: Prevent pain Oxytocin: Promotes good feelings SOURCE: Southwick et al., 2005

7. What Happens During A Sexual Assault Impairs rational thought Cathecholamines Increase Reduces energy Corticosteroids Decrease Causes flat affect Opioids Increase SOURCE: Banks, 2002; Southwick et al., 2005

8. What Happens During A Sexual Assault Amygdala Detects Threat Activates Hypothalamus HPA Axis Kicks In Hormonal Flood SOURCE: Banks, 2002; Southwick et al., 2005 Can Trigger a Complete “Shut Down” in the Body

9. Impact of Trauma: Summary Neurobiological changes can make memory consolidation and recall difficult  Story may come out fragmented or “sketchy”  Misinterpreted as evasiveness or lying  Even when content of the memory is accurate, it may take some time and patience for it to come together SOURCE: Campbell & Patterson, 2011; Koss et al., 1995, 1996

10.  An Experience that is Life-Threatening Triggers Fear that Overwhelms the Brain, causing Symptoms Severe Enough to Interfere with Functioning In Four Areas:  Re-experiencing  Avoidance  Hyperarousal  Negative Cognitions and/or Mood What is PTSD?

11.  Most People Recover From Severe Trauma Within Nine Months but Exacerbating Factors Include:  Severity  Chronicity  Human Cause  Specifically Directed at Victim  Prior History Who Gets PTSD?

12. Trauma affects every stage of the legal process:  Getting the whole story -- PTSD leads to avoidance  Telling the story consistently -- Traumatic memories come and go  Appearing credible -- PTSD makes clients detached, distracted Representing Traumatized Clients

13. PTSD Symptoms Can Include:  Disruptions in memory and concentration  Hopelessness (What’s the point?)  Distrust  Detachment from emotional responses  Re-experiencing while recounting  Shame when recounting Psychological Barriers to Communication

14.  Fear of what we might have to hear  Fear of not knowing how to respond  Fear of losing composure  Our own moral judgments (e.g. disapproval of the clients choices)  Idealization of trauma survivor followed by disillusionment Interviewer Internal Barriers to Communication

15.  Additional challenge of “Betrayal Trauma”  Tendency for survivors to blame themselves  Ambivalence about leaving is often intense, (social and religious pressures to endure, belief that victim needs abuser and/or abuser needs the victim)  Leaving does not solve everything (recovery is a multi-step process) Working with Survivors of Domestic Violence

16.  There is always more.  People often do not act in their own best interests if doing so causes embarassment.  Leave the door open for future disclosure.  Don’t be self-righteous (we all leave things out) Strategies: Have Realistic Expectations for Disclosure

17.  Collaboration: Give the client as much control as possible and help her to anticipate what will happen next. Tell her what you hope to accomplish today.  Transparency: Review goals and rationale, invite questions  Allow time to build rapport and trust  Validate and Normalize reactions: “I know this is difficult”; “Many people feel…”  Provide closure: Discuss experience of interview at the end and anticipate the next step if possible Strategies: Conducting the Interview

18. SOURCE : Russell Strand, 2014

19. Strategy: Try to gently engage by normalizing and providing a feeling of control “Sometimes people have a hard time answering these questions. I know that you have been asked a lot of questions and that you are probably concerned about answering any more. Is there something that you would like me to know before I ask you some of my more specific questions? ” The Withdrawn Client

20. Strategy: Return to rationale for asking detailed questions about particular issues “We really need to convey to the court what you have been through and how much you have suffered. Often times these are the most difficult things to discuss, but they can be the most important things for the Court to understand in order to know the truth about how you were treated.” The Withdrawn Client

21. Key Characteristics:  An overload of information  Intense emotions  Often feels hard to stop or contain The “Flooding” Client

22. Strategy: Try to contain, by providing more structure, suggesting short breaks, apologizing in advance for interrupting, and explaining why you need to focus on certain issues “I can understand how important it is for you to make sure I understand what you are telling me. However, I need to focus our time today…” The “Flooding” Client

23. Strategy: “Join”-- Don’t get defensive  Validate their frustration, remind them of your shared goals  Be transparent  Remind yourself that it’s not only the nice people who deserve representation The Angry or Suspicious Client

24. Strategy: End the interview if necessary  Client is unable to contain emotions at all  Client is incoherent, even after attempts to ask more basic questions  Client becomes aggressive, overtly hostile The Angry or Suspicious Client

25. “You’ve really helped me to understand more about what you have been through. How are you feeling after talking about these things today?.... Do you have any questions for me?... Let me explain to you what the next part of the process is…..” Provide Closure after Completing the Interview

26.  Make the situation as predictable as possible  De-sensitize by rehearsing  If a mental health provider is involved, ask them to focus on specific coping skills  Make a plan with client to take a break if needed  If appropriate, allow support person to be present at hearing Preparation for Court

27.  Can occur in those who work with survivors of severe trauma  Can be a normal reaction to hearing very vivid, distressing narratives.  Manifests itself in distress and symptoms of PTSD (e.g., nightmares, irritability, detachment).  Feelings of demoralization and depression are also frequent  Can make you feel like you are a victim or perpetrator Vicarious Traumatization

28. Strategy: Manage expectations and boundaries  Clarify the limits of your role with your clients—refer for other services  Clarify what you CAN do for your client  Tolerate feelings of guilt and helplessness  Recognize fantasies of rescue and omnipotence  Seek supervision and support from colleagues Vicarious Traumatization Continued

29. A positive effect through interaction with client’s stories of resilience: Witnessing and reflecting on human beings’ immense capacity to heal Reassessing the significance of one’s own problems Developing hope and commitment Articulating personal and professional positions regarding human rights Vicarious Resilience

30. Judy I. Eidelson, PhD judyeidelson@gmail.com