1. Empowerment 101: Understanding and Treating Trauma Misty McIntyre Goodsell, LCSW Chris Adams Hill, LCSW www.southvalleytherapy.com South Valley Therapy

2. Objectives Increase awareness of Large T and little t trauma Increase awareness of symptoms of PTSD Tools and techniques for working with survivors Increase tools and understanding for building empowerment South Valley Therapy www.southvalleytherapy.com

3. Empowering the Therapist South Valley Therapy www.southvalleytherapy.com

4. PTSD: Prevalence 7%-8% of US population will have PTSD at some point in their lives Combat soldier and assault victims have rates as high as 60% About 5.2 million adults have PTSD during a given year Women are more likely than men to develop PTSD: 10% vs. 5% during their lifetimes www.ptsd.va.gov South Valley Therapy www.southvalleytherapy.com

5. Stages of Recovery South Valley Therapy www.southvalleytherapy.com

6. Pre-Step: Disclosure Education South Valley Therapy www.southvalleytherapy.com

7. Stage 1 Establishing Safety and Security Assess Risk Assessing Strengths Installation of Hope Symptom Reduction Skill Building Mindfulness Assess Impact of Trauma Identify Trauma-Based Beliefs South Valley Therapy www.southvalleytherapy.com

8. Stage 2 Reprocessing Trauma Work Through Grief / Mourning Challenging Trauma-Based Beliefs Replace trauma-based beliefs with positive reality-based beliefs and/or affirmations = EMPOWERMENT South Valley Therapy www.southvalleytherapy.com

9. Stage 3 Build Resiliency – Increase the support system – Increase sense of self-worth – Increase sense of self-efficacy – Self-Care – Build/Strengthen spiritual self – Build / Participate in community South Valley Therapy www.southvalleytherapy.com

10. BIG T or little t South Valley Therapy www.southvalleytherapy.com

11. BIG T DSM criteria for PTSD South Valley Therapy www.southvalleytherapy.com

12. Small t They don’t meet criteria for PTSD – Usually not life- threatening – Terror and fear – PTSD symptoms less than 5 of the criteria Examples – Divorce – Bullying – Neglect – Car Accident – Loss of a pet – Medical Crisis – Verbal Abuse South Valley Therapy www.southvalleytherapy.com

13. PTSD: Signs and Symptoms Intrusive thoughts about the event Nightmares or distressing dreams Acting or feeling as if the event is reoccurring – Illusions, hallucinations, flashbacks Intense psychological distress at exposure to internal or external triggers – Physiological reactivity to triggers South Valley Therapy www.southvalleytherapy.com

14. PTSD: Signs and Symptoms Persistent avoidance of stimuli associated with the trauma Persistent symptoms of increased arousal (not present before the trauma) – Difficulty falling or staying asleep – Irritability or outbursts or anger – Difficulty concentrating – Hyper-Vigilance – Exaggerated startle response South Valley Therapy www.southvalleytherapy.com

15. PTSD Risk Event factors – Intensity and duration of exposure to the event – Extent of brutality – Sense of betrayal – Threat of dying: not actual threat, perceived threat – Degree of unpredictability – Injury – Being trapped – Cultural Context Naparstak, B (2000) “ invisible Heroes, Survivors of Trauma and How They Heal” South Valley Therapy www.southvalleytherapy.com

16. More likely to develop PTSD if: ACES Struggle with other mental health issues Have family members with mental health issues Environmental – Few friends or support network Recently loss of a loved one (grief and loss) Recent stressful life changes Heavy Drinker Are a woman Poorly educated Younger South Valley Therapy www.southvalleytherapy.com

17. Survivor Response Shame – Shame is a painful feeling about oneself as a person Guilt – Guilt is a painful feeling of regret and responsibility for one’s actions Fear – PTSD Responses South Valley Therapy www.southvalleytherapy.com

18. THE BUNNY RABBIT South Valley Therapy www.southvalleytherapy.com

19. Secondary Survivor Response Common Reactions Helplessness Fear Confusion Desire for Revenge Self Blame Overprotection Loss of routine and intimacy Shame Frustration Guilt Distraction Code of Silence South Valley Therapy www.southvalleytherapy.com

20. Empowering The Survivor South Valley Therapy www.southvalleytherapy.com

21. Empowerment Listen and believe Focus on the survivor’s reactions and feelings Assist the survivor in regaining a sense of control over their life Act as an advocate when dealing with police, medical or legal systems Avoid projecting your feelings South Valley Therapy www.southvalleytherapy.com

22. Empowerment Phrases “You’ve been through so much AND you are here” “You’ve accessed your strengths (example) and talents (example). Look how resourceful you are” “You’ve already survived it. The work we are going to do is about acknowledging your feelings and taking away the power and changing the meaning” “You are safe in this room” (if true) South Valley Therapy www.southvalleytherapy.com

23. Role of Power and Control Main issue in trauma – Diagnostic criteria Healing is allowing the survivor to have as much control as they can in a healthy way They have the power to choose/change the meaning they make of their traumatic experience South Valley Therapy www.southvalleytherapy.com

24. LANGUAGE MATTERS South Valley Therapy www.southvalleytherapy.com

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

26. Do Say Things Like You are safe now (if true) I’m sorry this happened I’m glad you are talking to me now I’m glad you are here with me now It’s not your fault Your reaction is common You’re not going crazy Things may never be the same, but they can get better I’m here to support you through this South Valley Therapy www.southvalleytherapy.com

27. Working With Secondary Survivors Help them to predict what to expect emotionally for the survivor Help them place blame on the assailant or situation not themselves or the survivor Explore positive coping mechanisms Model crisis intervention and empowerment If they are also survivors, assess their need for counseling South Valley Therapy www.southvalleytherapy.com

28. Self-Care How do you care for yourselves? South Valley Therapy www.southvalleytherapy.com

29. Q&A South Valley Therapy www.southvalleytherapy.com