Healing Trauma With Tenderness Dr. Hannibal Silver, LPC.

Healing Trauma With Tenderness

Dr. Hannibal Silver, LPCDr. Hannibal Silver, LPC

Psychological Stages of

Response to Disaster and terror attacks

Psychological Stages of

Response to Disaster and terror attacks

Heroic community role - Time: at impact

Magic healing - Time: 3 to 6 months after

Disillusionment - Time: 1-2 years after

Acceptance / redirection - Time: 2 to 3 years

Heroic community role - Time: at impact

Magic healing - Time: 3 to 6 months after

Disillusionment - Time: 1-2 years after

Acceptance / redirection - Time: 2 to 3 years

Self Care for Leaders & Health Professionals

Self Care for Leaders & Health ProfessionalsThe following principles of self-care will protect support leaders

from Compassion Fatigue. Consider the following facts.

A disaster/ Terror attacks creates demands beyond normal community or individual resources.

A disaster may generate a cluster of conflicting responses, such as guilt, anger, gratitude, depression, anxiety, and inconsolable grief. These conflicting emotions need processing or will create emotional fragmentation.

Physical symptoms may include: fatigue, headaches, nausea, muscle pain, dizziness.

Cognitive symptoms include: problems concentrating, problems making decisions, disoriented thinking.

The following principles of self-care will protect support leaders from Compassion Fatigue. Consider the following facts.

A disaster/ Terror attacks creates demands beyond normal community or individual resources.

A disaster may generate a cluster of conflicting responses, such as guilt, anger, gratitude, depression, anxiety, and inconsolable grief. These conflicting emotions need processing or will create emotional fragmentation.

Physical symptoms may include: fatigue, headaches, nausea, muscle pain, dizziness.

Cognitive symptoms include: problems concentrating, problems making decisions, disoriented thinking.



Behavioral Symptoms include: insomnia; crying easily; such

addictions as nicotine, caffeine, and alcohol; and obsessive

behaviors including sexual acting out and addictions.

Facing a tragedy intensifies and magnifies preexistent

bleeding wounds conditions.

Understanding personal limits and appropriate role is

important.(love within limits)

Monitor your own reactions to other’s pain.

Group support and individual counseling may be needed.

emotional emergency resources are limited.

Behavioral Symptoms include: insomnia; crying easily; such

addictions as nicotine, caffeine, and alcohol; and obsessive

behaviors including sexual acting out and addictions.

Facing a tragedy intensifies and magnifies preexistent

bleeding wounds conditions.

Understanding personal limits and appropriate role is

important.(love within limits)

Monitor your own reactions to other’s pain.

Group support and individual counseling may be needed.

emotional emergency resources are limited.

Preventing Compassion Fatigue

Preventing Compassion Fatigue

Set healthy limits for your family and friends: Learn how to say NO Find rewarding professional activities Avoiding exposure to chaotic or stressful situations or

relationships which trigger unregulated emotions Balanced cycle of rest, work, spiritual and recreational

activities. Goodness is stronger than evil Eating good balanced meals Develop realistic expectations about the rewards and

hazards of helping people Share responsibilities with others

Set healthy limits for your family and friends: Learn how to say NO Find rewarding professional activities Avoiding exposure to chaotic or stressful situations or

relationships which trigger unregulated emotions Balanced cycle of rest, work, spiritual and recreational

activities. Goodness is stronger than evil Eating good balanced meals Develop realistic expectations about the rewards and

hazards of helping people Share responsibilities with others

Points to Consider in Grief Recovery

Points to Consider in Grief Recovery

Unresolved grief later surfaces as psychological disorders, impulsive / Compulsive behavior, and addictions

Grief recovery requires intentional work “We grieve alone but we heal in community” (Dr. Ed

Creagan) Witnessing an attack (TV viewing included) may result

in Post Traumatic Stress Disorder.

*Psychologists predict that 25% of the population is expected to develop PTSD in the wake of the World Trade Center, Iraqi, Madrid, and London attacks

Unresolved grief later surfaces as psychological disorders, impulsive / Compulsive behavior, and addictions

Grief recovery requires intentional work “We grieve alone but we heal in community” (Dr. Ed

Creagan) Witnessing an attack (TV viewing included) may result

in Post Traumatic Stress Disorder.

*Psychologists predict that 25% of the population is expected to develop PTSD in the wake of the World Trade Center, Iraqi, Madrid, and London attacks

Self - Defeating Strategies Self - Defeating Strategies

Letting Fate define your life

Letting Fear run your life

Letting the past rule your life

Letting others guide your life

Letting Fate define your life

Letting Fear run your life

Letting the past rule your life

Letting others guide your life

ABCs of Crisis Intervention ABCs of Crisis Intervention

Warning: Crisis intervention can be intrusive and

harmful if not properly done.

Warning: Crisis intervention can be intrusive and

harmful if not properly done.

Approach

Basic Agenda

Coping Skills

Coping Suggestions

Approach

Basic Agenda

Coping Skills

Coping Suggestions


ApproachApproach

Time for description, not for prescription

Time for understanding, not for advice

Time for personalized assessment, not for generalized care

Time for empowering affirmation, not for conveying pity

Time for description, not for prescription

Time for understanding, not for advice

Time for personalized assessment, not for generalized care

Time for empowering affirmation, not for conveying pity


Basic AgendaBasic Agenda

Listen to the personal stories of tsunami victims

Understand their religious world view

Identity most pressing needs and problems

Review and clarify the trauma experience

Focus on the human ability to re-bounce and renewal

Listen to the personal stories of tsunami victims

Understand their religious world view

Identity most pressing needs and problems

Review and clarify the trauma experience

Focus on the human ability to re-bounce and renewal


Coping SkillsCoping Skills

Cultivate a new plan for living within the new scenario.

Develop redemptive responses to evil

Reaffirm the goodness of a new life

Explore translating pain into words

Silence can be deadly

Cultivate a new plan for living within the new scenario.

Develop redemptive responses to evil

Reaffirm the goodness of a new life

Explore translating pain into words

Silence can be deadly


Coping Suggestions Part 1


Give yourself permission and time to grieve

Focus on your neglected dreams and goals.

Redefine your priorities, and focus your energy and resources on those priorities

Ask for support and help from mosque - synagogue - church, or other community resources.

Learn how to develop M*A*S*H caring communities (contact GCC counselors about that)

Give yourself permission and time to grieve

Focus on your neglected dreams and goals.

Redefine your priorities, and focus your energy and resources on those priorities

Ask for support and help from mosque - synagogue - church, or other community resources.

Learn how to develop M*A*S*H caring communities (contact GCC counselors about that)




Eat healthy meals, and exercise

Set small, realistic goals to help tackle obstacles. For

example, reestablish daily routines for yourself and for your

friends

Get enough rest to increase your reserve strength

Acknowledge unresolved issues, and use the hurt and pain

as motivators to make necessary changes to heal

Eat healthy meals, and exercise

Set small, realistic goals to help tackle obstacles. For

example, reestablish daily routines for yourself and for your

friends

Get enough rest to increase your reserve strength

Acknowledge unresolved issues, and use the hurt and pain

as motivators to make necessary changes to heal




Continue to educate yourself and your friends

and relatives about normal reactions to disaster

Talk to your children. Be supportive. Set an

example by expressing your feelings and by

showing problem solving skills in dealing with

emotional troubles

Remember that you are not alone

Continue to educate yourself and your friends

and relatives about normal reactions to disaster

Talk to your children. Be supportive. Set an

example by expressing your feelings and by

showing problem solving skills in dealing with

emotional troubles

Remember that you are not alone

Healing StrategiesHealing Strategies

Realize your trauma (avoid denial and fake self-confidence)

Listen to your heart, and talk to it.

Translate your pain into words

Know, respect, and express your limits. (Help people understand you)

Use pain as a gift - develop growth strategies

Face the here and now through a wisdom perspective

Realize your trauma (avoid denial and fake self-confidence)

Listen to your heart, and talk to it.

Translate your pain into words

Know, respect, and express your limits. (Help people understand you)

Use pain as a gift - develop growth strategies

Face the here and now through a wisdom perspective

Wisdom PerspectiveWisdom Perspective

The True Self is the combination of one’s thoughts and

emotions

Thoughts and emotions are not a reliable source of

wisdom

Thoughts and emotions cannot be ignored

Mental Health is the harmonious integration of thoughts,

emotions according each person original design.

The True Self is the combination of one’s thoughts and

emotions

Thoughts and emotions are not a reliable source of

wisdom

Thoughts and emotions cannot be ignored

Mental Health is the harmonious integration of thoughts,

emotions according each person original design.

Strategies of FlightStrategies of Flight

Victimization (Flight from Responsibility)

Anger (Flight from compassion)

Pride (Flight from being Vulnerable)

Addiction (Flight from Pain)

Dissociation (Flight from Power)

Self-Pity (Flight from Joy)

Self-Absorption (Flight from Freedom)

Victimization (Flight from Responsibility)

Anger (Flight from compassion)

Pride (Flight from being Vulnerable)

Addiction (Flight from Pain)

Dissociation (Flight from Power)

Self-Pity (Flight from Joy)

Self-Absorption (Flight from Freedom)

Family Coping StrategiesPart 1

Family Coping StrategiesPart 1

Talk about the event

Encourage group or community members to describe

their emotional pictures of the disaster

Facilitate interaction and a supportive environment

Avoid blaming or rescuing god

Share how the disaster has changed your views of life,

meaning and priorities

Talk about the event

Encourage group or community members to describe

their emotional pictures of the disaster

Facilitate interaction and a supportive environment

Avoid blaming or rescuing god

Share how the disaster has changed your views of life,

meaning and priorities

Coping StrategiesPart 2

Coping StrategiesPart 2

Explore how tragedy reveals human endurance and

solidarity

Allow individual healing to take place

Express appropriate physical expression of care

Silence is gold

Express your sorrow

Respect space for private grief

Accept the unfairness of life

Explore how tragedy reveals human endurance and

solidarity

Allow individual healing to take place

Express appropriate physical expression of care

Silence is gold

Express your sorrow



Helping Kids to CopePart 1


Explore how tragedy reveals human strength and

companionship

Allow individual recovery to take place

Express appropriate physical touch

Avoid explaining suffering

Express your sorrow



Explore how tragedy reveals human strength and

companionship

Allow individual recovery to take place

Express appropriate physical touch

Avoid explaining suffering

Express your sorrow





Empathetic communication

Talk to kids about a “beautiful day”

Talk to kids about good and evil

Talk about the triumph of goodness over evil

Evil cannot be explained

Bono: people without works of love are fiction

Empathetic communication

Talk to kids about a “beautiful day”

Talk to kids about good and evil

Talk about the triumph of goodness over evil

Evil cannot be explained

Bono: people without works of love are fiction



Spend extra bedtime with your kids

Listen to them

Pray with them

Reassure them of your love

Bless them

Celebrate their lives

Spend extra bedtime with your kids

Listen to them

Pray with them

Reassure them of your love

Bless them

Celebrate their lives

Communication Strategies with Kids

Communication Strategies with Kids

Toddlers - Avoid creating an environment of sadness around

them

Preschoolers - Respond according to their desire for

information

School age - Discuss their concerns and questions

Toddlers - Avoid creating an environment of sadness around

them

Preschoolers - Respond according to their desire for

information

School age - Discuss their concerns and questions

APA RecommendationsPart 1


Spend more time with children and let them be more

dependent on you during the months following the trauma.

Allow your child to cling to you more than usual. Physical

affection comforts children who’ve experienced trauma.

Provide play experiences to help relieve tension. Younger

children in particular may find it easier to share their ideas

and feelings about the event through non-verbal activities

such as drawing.

Spend more time with children and let them be more

dependent on you during the months following the trauma.

Allow your child to cling to you more than usual. Physical

affection comforts children who’ve experienced trauma.

Provide play experiences to help relieve tension. Younger

children in particular may find it easier to share their ideas

and feelings about the event through non-verbal activities

such as drawing.



Encourage older children to speak with you, and with one

another, about their thoughts and feelings. This helps reduce

their confusion and anxiety related to the trauma. Reassure

them repeatedly that you care about them and that you

understand their fears and concerns.

Keep regular schedules for activities such as eating, playing

and going to bed to help restore a sense of security and

normalcy

Encourage older children to speak with you, and with one

another, about their thoughts and feelings. This helps reduce

their confusion and anxiety related to the trauma. Reassure

them repeatedly that you care about them and that you

understand their fears and concerns.

Keep regular schedules for activities such as eating, playing

and going to bed to help restore a sense of security and

normalcy

APA RecommendationsWhen to Seek Professional Help

APA RecommendationsWhen to Seek Professional Help

Unusual Separation Anxiety

Unreasonable fear and morbidity

Sleep Disorders

Loss of Concentration

Behavioral Problems

Isolation from friends and enjoyable activities

Physical Symptoms

Unusual Separation Anxiety

Unreasonable fear and morbidity

Sleep Disorders

Loss of Concentration

Behavioral Problems

Isolation from friends and enjoyable activities

Physical Symptoms

Post-Traumatic Stress DisorderPost-Traumatic Stress Disorder

Post-Traumatic Stress Disorder is a debilitating condition

that follows a terrifying event. Often people with PTSD

have persistent, frightening flashbacks, thoughts and

memories of their ordeal, and they feel emotionally numb.

Post-Traumatic Stress Disorder is a debilitating condition

that follows a terrifying event. Often people with PTSD

have persistent, frightening flashbacks, thoughts and

memories of their ordeal, and they feel emotionally numb.


People with PTSD repeatedly re-live their trauma in the form

of nightmares and disturbing day-time recollections

They may also experience sleep problems, depression,

feelings of detachment or numbness, and they may be easily

startled

They may lose interest in things they once enjoyed, and they

might have trouble feeling affectionate

People with PTSD repeatedly re-live their trauma in the form

of nightmares and disturbing day-time recollections

They may also experience sleep problems, depression,

feelings of detachment or numbness, and they may be easily

startled

They may lose interest in things they once enjoyed, and they

might have trouble feeling affectionate


They may feel irritable, more aggressive or even violent

Seeing things that remind them of the incident may be very

distressing which could lead them to avoid places or

situations that bring back those memories

Anniversaries of the event are often extremely difficult

They may feel irritable, more aggressive or even violent

Seeing things that remind them of the incident may be very

distressing which could lead them to avoid places or

situations that bring back those memories

Anniversaries of the event are often extremely difficult

Specific Symptoms of PTSDPart 1


Recurrent and intrusive distressing recollections of the event,

including images, thoughts, or perceptions

Recurrent distressing dreams of the event

Acting or feeling as though the traumatic event were recurring

Intense psychological distress at exposure to internal or external

cues that symbolize or resemble an aspect of the traumatic event

Physiological reactivity upon exposure to internal or external cues

that symbolize or resemble an aspect of the traumatic event

Recurrent and intrusive distressing recollections of the event,

including images, thoughts, or perceptions

Recurrent distressing dreams of the event

Acting or feeling as though the traumatic event were recurring

Intense psychological distress at exposure to internal or external

cues that symbolize or resemble an aspect of the traumatic event

Physiological reactivity upon exposure to internal or external cues

that symbolize or resemble an aspect of the traumatic event



Efforts to avoid thoughts, feelings or conversations associated

with the trauma

Efforts to avoid activities, places or people that arouse

recollections of the trauma

Inability to recall an important aspect of the trauma

Markedly diminished interest or participation in significant

activities

Feeling of detachment or estrangement from others

Restricted range of affect (e.g. unable to have loving feelings)

Sense of a foreshortened future (e.g. does not expect to have a

career, marriage, children, or a normal life span)

Efforts to avoid thoughts, feelings or conversations associated

with the trauma

Efforts to avoid activities, places or people that arouse

recollections of the trauma

Inability to recall an important aspect of the trauma

Markedly diminished interest or participation in significant

activities

Feeling of detachment or estrangement from others

Restricted range of affect (e.g. unable to have loving feelings)

Sense of a foreshortened future (e.g. does not expect to have a

career, marriage, children, or a normal life span)



Difficulty falling or staying asleep

Irritability or outbursts of anger

Difficulty concentrating

Hyper-vigilance

Exaggerated startle response

Fear for our own safety and future

Difficulty falling or staying asleep

Irritability or outbursts of anger

Difficulty concentrating

Hyper-vigilance

Exaggerated startle response

Fear for our own safety and future

Martha’s Diagnosis & Treatment Plan

PTSD Case Study


PTSD Case Study

Initial Intake Martha is a 58-year-old married woman She has 3adult children and 2 grandchildren Due to Martha’s condition, she and her

husband are only marginally involved in the church (in the past, she was fairly independent and was involved in a number of religious activities)

Initial Intake Martha is a 58-year-old married woman She has 3adult children and 2 grandchildren Due to Martha’s condition, she and her

husband are only marginally involved in the church (in the past, she was fairly independent and was involved in a number of religious activities)


PTSD Case Study


PTSD Case Study

Symptoms

A pervasive sense of “fear” (most days)

A vague sense of dread (most days)

Jumpy at work (at times)

Difficulty concentrating at her job

Symptoms

A pervasive sense of “fear” (most days)

A vague sense of dread (most days)

Jumpy at work (at times)

Difficulty concentrating at her job


PTSD Case Study


PTSD Case Study

Initial Interview

Martha discloses that she was robbed in a supermarket parking lot 2 years

ago

As she begins to describe details of the mugging, she becomes extremely

agitated, starts to shake, and has difficulty talking

Martha’s breathing becomes very rapid and she begins to hyperventilate

This sort of thing occurs several times a day (usually when she is at home)

At times she feels like she is going crazy (she can’t understand why this

occurs)

Initial Interview

Martha discloses that she was robbed in a supermarket parking lot 2 years

ago

As she begins to describe details of the mugging, she becomes extremely

agitated, starts to shake, and has difficulty talking

Martha’s breathing becomes very rapid and she begins to hyperventilate

This sort of thing occurs several times a day (usually when she is at home)

At times she feels like she is going crazy (she can’t understand why this

occurs)


PTSD Case Study


PTSD Case Study

Description of Trauma

One day, late afternoon, she decided to purchase a few things at the

grocery store. As she was in the parking lot a car drove close to her and

a man leaned out and grabbed her purse, which she was carrying over

her shoulder. The car then continued to drive off; however, Martha held

on to her purse and was dragged several hundred yards before she

finally let go

In addition to cuts and bruises from being dragged, Martha suffered

severe injuries to her arm and had to have surgery. When she came for

counseling, she was still undergoing physical therapy

Description of Trauma

One day, late afternoon, she decided to purchase a few things at the

grocery store. As she was in the parking lot a car drove close to her and

a man leaned out and grabbed her purse, which she was carrying over

her shoulder. The car then continued to drive off; however, Martha held

on to her purse and was dragged several hundred yards before she

finally let go

In addition to cuts and bruises from being dragged, Martha suffered

severe injuries to her arm and had to have surgery. When she came for

counseling, she was still undergoing physical therapy


PTSD Case Study


PTSD Case Study

Current Conditions

She is isolated and only interacts with her immediate family and co-

workers (at her job)

Every time she was anywhere near the site of the robbery, she began to

cry uncontrollably. (She has moved to another state)

Martha is reluctant to go anywhere that is unfamiliar to her

Overall, Martha is very reluctant to drive; her husband must driver her

to any new place

Current Conditions

She is isolated and only interacts with her immediate family and co-

workers (at her job)

Every time she was anywhere near the site of the robbery, she began to

cry uncontrollably. (She has moved to another state)

Martha is reluctant to go anywhere that is unfamiliar to her

Overall, Martha is very reluctant to drive; her husband must driver her

to any new place


PTSD Case Study


PTSD Case StudyLegal Matters

Martha has a lawsuit pending against the grocery store in whose

parking lot the robbery took place. She is claiming the store

could have provided security protection for its customers

because it is in a known crime area. According to her lawyer,

Martha is likely to receive some settlement from her suit

Legal Matters

Martha has a lawsuit pending against the grocery store in whose

parking lot the robbery took place. She is claiming the store

could have provided security protection for its customers

because it is in a known crime area. According to her lawyer,

Martha is likely to receive some settlement from her suit

Evaluation of Martha Part 1


.

◊ There must be severe trauma. Martha’s robbery experience with

severe injuries fulfills the important feature of the diagnosis: the

stressor must be unusually traumatic

◊ The Stress must be relieved in some way. Martha’s uncontrollable

crying anywhere near the site of the robbery, as well as her

distress and physiological symptoms in recollection of the event

during the session and at home, fulfills this second criteria

.

◊ There must be severe trauma. Martha’s robbery experience with

severe injuries fulfills the important feature of the diagnosis: the

stressor must be unusually traumatic

◊ The Stress must be relieved in some way. Martha’s uncontrollable

crying anywhere near the site of the robbery, as well as her

distress and physiological symptoms in recollection of the event

during the session and at home, fulfills this second criteria



3. The patient must attempt (willingly or unwillingly) to achieve emotional

distance from the stressful event. Martha was moved to another state,

she is reluctant to go anyplace with which she is not familiar, and she

is reluctant to drive unless there is an absolute necessity to do so.

Distancing can also be accomplished by a general numbing of

emotional responsiveness (isolation from others, inability to love).

Martha also meets this criteria through isolation: she only interacts

with her immediate family, or with co-workers at her job

3. The patient must attempt (willingly or unwillingly) to achieve emotional

distance from the stressful event. Martha was moved to another state,

she is reluctant to go anyplace with which she is not familiar, and she

is reluctant to drive unless there is an absolute necessity to do so.

Distancing can also be accomplished by a general numbing of

emotional responsiveness (isolation from others, inability to love).

Martha also meets this criteria through isolation: she only interacts

with her immediate family, or with co-workers at her job



4. PTSD patients must have symptoms of increased arousal. Martha suffers

from poor concentration, excessive fear and dread, and recurrent

panic attacks. Martha’s panic attacks have a clear relationship to a

particular stimulus (the trauma). Such attacks are said to be cued or

situationally bound. Martha’s attacks appear to be also invariably,

becomes panic-stricken when confronted by the stimulus.

4. PTSD patients must have symptoms of increased arousal. Martha suffers

from poor concentration, excessive fear and dread, and recurrent

panic attacks. Martha’s panic attacks have a clear relationship to a

particular stimulus (the trauma). Such attacks are said to be cued or

situationally bound. Martha’s attacks appear to be also invariably,

becomes panic-stricken when confronted by the stimulus.

Evaluation of Martha Evaluation of Martha

◊ Adjustment Disorder

◊ Acute Stress Disorder

◊ Obsessive-Compulsive-

Disorder

◊ Adjustment Disorder

◊ Acute Stress Disorder

◊ Obsessive-Compulsive-

Disorder

◊ Generalized Anxiety Disorder

◊ Agoraphobia

◊ Specific Phobia

◊ Social Phobia

◊ Generalized Anxiety Disorder

◊ Agoraphobia

◊ Specific Phobia

◊ Social Phobia

Differential DiagnosisDifferential Diagnosis


1. Exposure to a life-threatening event that caused serious

physical and psychological injury, and which resulted in an

intense emotional response of pervasive fear and dread

2. Intense distress when exposed to reminders of the traumatic

event, composed of physiological reactivity when exposed to

internal or external cues that symbolize the traumatic event

1. Exposure to a life-threatening event that caused serious

physical and psychological injury, and which resulted in an

intense emotional response of pervasive fear and dread

2. Intense distress when exposed to reminders of the traumatic

event, composed of physiological reactivity when exposed to

internal or external cues that symbolize the traumatic event

Martha’s Treatment Plan Behavioral Definitions



3. Lack of interest and participation in significant activities and

relationships

4. Family dynamics become more disrupted, to the point where

specific roles of family members are changed

3. Lack of interest and participation in significant activities and

relationships

4. Family dynamics become more disrupted, to the point where

specific roles of family members are changed




1. Pull together and develop ways to function more cohesively in

the face of the major life event

2. Develop and implement effective coping skills to carry out

normal responsibilities, and participate constructively in

relationships

1. Pull together and develop ways to function more cohesively in

the face of the major life event

2. Develop and implement effective coping skills to carry out

normal responsibilities, and participate constructively in

relationships

Long-Term Goals Long-Term Goals


1. Identify the symptoms of PTSD that have caused distress and have

impaired functioning

2. Consider referral of Martha for medical treatment and possible

medication

3. Identify how PTSD symptoms have affected marital and family

relationships functioning at work or church, social, and recreational

life

1. Identify the symptoms of PTSD that have caused distress and have

impaired functioning

2. Consider referral of Martha for medical treatment and possible

medication

3. Identify how PTSD symptoms have affected marital and family

relationships functioning at work or church, social, and recreational

life

Short-Term Objectives Short-Term Objectives


4. Assist Martha in finding a community support system for the

development of coping skills

5. Report increased comfort and ability to talk or think about the traumatic

incident without emotional turmoil

6. Participate in conjoint and/or family therapy sessions. Engage in group

activities as a family unit to build cohesiveness.

7. Explore the possibility of using psychological and spiritual resources to

facilitate healing and recovery

4. Assist Martha in finding a community support system for the

development of coping skills

5. Report increased comfort and ability to talk or think about the traumatic

incident without emotional turmoil

6. Participate in conjoint and/or family therapy sessions. Engage in group

activities as a family unit to build cohesiveness.

7. Explore the possibility of using psychological and spiritual resources to

facilitate healing and recovery

Short-Term Objectives Short-Term Objectives


1. Ask the patient to identify how the traumatic event has negatively

affected her life

2. Refer Martha to psychiatric evaluation, and maintain collateral

involvement with the treating professional

3. Conduct family sessions to facilitate the expression of family

members’ feelings, and begin to discuss the differences in

perception of the event and how it has affected each of them

differently. Prompt each family member to describe any emotional,

cognitive, or behavioral changes that have resulted from trauma

1. Ask the patient to identify how the traumatic event has negatively

affected her life

2. Refer Martha to psychiatric evaluation, and maintain collateral

involvement with the treating professional

3. Conduct family sessions to facilitate the expression of family

members’ feelings, and begin to discuss the differences in

perception of the event and how it has affected each of them

differently. Prompt each family member to describe any emotional,

cognitive, or behavioral changes that have resulted from trauma

Counseling Interventions Counseling Interventions


4. Refer patient to group sessions where the focus is on sharing traumatic

events and their effects with other PTSD survivors

5. Apply Solution-Focused Techniques - such as the miracle question, scaling

questions/goals, attention to the exceptions, amplifying positive

changes - in order to empower the patient in dealing with the trauma

6. Enlighten the family as to how various family groups cope differently in

the face of crisis. Explain how the pre-existing conditions such as

previous history of depression or other emotional disorder; physical,

verbal or sexual abuse; history of anxiety; or dysfunctional family

system predisposes them to deal with such events in a particular way

4. Refer patient to group sessions where the focus is on sharing traumatic

events and their effects with other PTSD survivors


questions/goals, attention to the exceptions, amplifying positive

changes - in order to empower the patient in dealing with the trauma







The Signs of Unresolved Trauma

The Signs of Unresolved Trauma

1. Suicidal Ideation

2. A pattern of out-of-control and self-

injurious behavior

3. Self-destructive addictions:

a. Dual Diagnosis

b. Eating Disorders

c. Self Mutilation

d. Sexual Addictions


2. A pattern of out-of-control and self-

injurious behavior


a. Dual Diagnosis

b. Eating Disorders

c. Self Mutilation

d. Sexual Addictions

The Signs of Unresolved TraumaThe Signs of Unresolved Trauma

4. Intrusive thoughts, images feelings and nightmares

5. Flashbacks

6. Extensive comorbidity/multiple diagnoses

7. Inability to tolerate feelings or conflicts

8. Intense self-blame and feeling unworthy

9. Staying stuck in the victim or perpetrator roles

10. Disorganized attachment patterns

11. Black and white thinking and other cognitive distortions

12. Pathological dissociation

4. Intrusive thoughts, images feelings and nightmares

5. Flashbacks








How To Assess For TraumaHow To Assess For Trauma

1. Have you ever experienced emotional abuse? By whom?

2. Have you ever experienced neglect? By whom?

3. Have you ever experienced physical abuse? By whom?

4. Have you ever experienced sexual abuse? By whom?

5. Do you ever have intrusive thoughts or images regarding

the (emotional, neglectful, physical, and or sexual)

experience that you previously mentioned?

6. Do you ever experience flashbacks or feel like the abuse is

still happening?





5. Do you ever have intrusive thoughts or images regarding

the (emotional, neglectful, physical, and or sexual)

experience that you previously mentioned?

6. Do you ever experience flashbacks or feel like the abuse is

still happening?

How To Assess For TraumaHow To Assess For Trauma

7. Are your presenting symptoms (suicidal ideation, homicidal

ideation, inability to function, self injurious behaviors, or

addictions) in any way associated with your past experience?

8. Do you ever lose time?

9. Do you feel you often acting on impulses and don’t have control

over your behaviors?

10. Do you have difficulty managing feelings of anger, sadness,

shame and rage?

11. How did your family express their feelings when you were

growing up?

7. Are your presenting symptoms (suicidal ideation, homicidal

ideation, inability to function, self injurious behaviors, or

addictions) in any way associated with your past experience?


9. Do you feel you often acting on impulses and don’t have control

over your behaviors?

10. Do you have difficulty managing feelings of anger, sadness,

shame and rage?

11. How did your family express their feelings when you were

growing up?


3. Terminate the destructive behaviors that serve to maintain

escape and denial while implementing behaviors that

promote healing, acceptance, and responsible living

4. Recall the traumatic event without becoming overwhelmed

with negative emotions

5. Re-establish healthy and appropriate family role assignments

3. Terminate the destructive behaviors that serve to maintain

escape and denial while implementing behaviors that

promote healing, acceptance, and responsible living

4. Recall the traumatic event without becoming overwhelmed

with negative emotions

5. Re-establish healthy and appropriate family role assignments

Long-Term Goals Long-Term Goals


1. Ask the patient to identify how the traumatic event has negatively affected her

life

2. Refer Martha to psychiatric evaluation, and maintain collateral involvement with

the treating professional

3. Conduct family sessions to facilitate the expression of family members’ feelings,

and begin to discuss the differences in perception of the event and how it has

affected each of them differently. Prompt each family member to describe any

emotional, cognitive, or behavioral changes that have resulted from trauma

1. Ask the patient to identify how the traumatic event has negatively affected her

life

2. Refer Martha to psychiatric evaluation, and maintain collateral involvement with

the treating professional

3. Conduct family sessions to facilitate the expression of family members’ feelings,

and begin to discuss the differences in perception of the event and how it has

affected each of them differently. Prompt each family member to describe any

emotional, cognitive, or behavioral changes that have resulted from trauma




questions/goals, attention to the exceptions, amplifying positive changes

- in order to empower the patient in dealing with trauma







questions/goals, attention to the exceptions, amplifying positive changes

- in order to empower the patient in dealing with trauma







The Signs of Unresolved Trauma The Signs of Unresolved Trauma


2. A pattern of out-of-control and self-injurious behavior


a. Dual Diagnosis

b. Eating Disorders

c. Self Mutilation

d. Sexual addictions

4. Intrusive thoughts, images, feelings and nightmares

5. Flashbacks


2. A pattern of out-of-control and self-injurious behavior


a. Dual Diagnosis

b. Eating Disorders

c. Self Mutilation

d. Sexual addictions

4. Intrusive thoughts, images, feelings and nightmares

5. Flashbacks

The Signs of Unresolved Trauma The Signs of Unresolved Trauma















How to Assess for Trauma How to Assess for Trauma





5. Do you ever have intrusive thoughts or images regarding the

(emotional, neglectful, physical, and or sexual) experience

that you previously mentioned?





5. Do you ever have intrusive thoughts or images regarding the

(emotional, neglectful, physical, and or sexual) experience

that you previously mentioned?

How to Assess for Trauma How to Assess for Trauma 6. Do you ever experience flashbacks or feel like the abuse is still happening?

7. Are your presenting symptoms (suicidal ideation, homicidal ideation,

inability to function, self injurious behaviors, or addictions) in any way

associated with your past experience?


9. Do you feel you often act on impulses and don’t have control over your

behaviors?

10. Do you have difficulty managing feelings of anger, sadness, shame and

rage?

11. How did your family express their feelings when you were growing up?

6. Do you ever experience flashbacks or feel like the abuse is still happening?

7. Are your presenting symptoms (suicidal ideation, homicidal ideation,

inability to function, self injurious behaviors, or addictions) in any way

associated with your past experience?


9. Do you feel you often act on impulses and don’t have control over your

behaviors?

10. Do you have difficulty managing feelings of anger, sadness, shame and

rage?

11. How did your family express their feelings when you were growing up?

Global community counselingGlobal community counseling

Provides free online counseling for victims of natural disasters

and terror attacks and free consultation for helping

personnel

For more information visit our website

www.gccusa.org

Provides free online counseling for victims of natural disasters

and terror attacks and free consultation for helping

personnel

For more information visit our website

www.gccusa.org

Healing Trauma With Tenderness Dr. Hannibal Silver, LPC.

Documents

Transcript of Healing Trauma With Tenderness Dr. Hannibal Silver, LPC.