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Becoming a Trauma Informed Addictions Counselor using a Source-Focused Model
- 1. Denice Colson, PhD, LPC, MAC. CPCS Trauma Education & Consultation Services, Inc.
- 2. “ ” 65% of Alcoholism is attributable to unhealed, unaddressed childhood trauma. (Anda, ACE Interface, 2013)
- 3. “ ” 78% of IV drug use is attributable to unhealed, unaddressed childhood trauma. (Anda, ACE Interface, 2013)
- 4. “ ” 58% of suicide attempts are attributable to unhealed, unaddressed childhood trauma. (Anda, ACE Interface, 2013)
- 5. “ ” Overall, 61% of men and 51% of women surveyed in the general population report experiencing at least one trauma in their lifetime. (SAMHSA, TIP 57)
- 6. “ ” But of self-reporting addicts, 71% report experiencing at least one trauma in their lifetime. (SAMHSA, TIP 57)
- 7. What percentage of people in substance abuse treatment are working with trauma informed counselors, and more importantly, receiving trauma specific treatment? While research indicates that substance abuse and addiction, depression and anxiety, are frequently the fruit of unaddressed, unresolved childhood abuse and trauma, most programs continue to focus mainly on picking the fruit, cutting the limbs, and trimming the tree, making it prettier, better trained; but the roots remain intact, protected and covered up only to produce more fruit in the future.
- 8. Goals and Objectives Identify the research which indicates links between childhood trauma and adult/adolescent addiction. Identify the differences between source-focused thinking and symptom focused-thinking. Identify the 6 progressive stages for developing a trauma survivor. Identify the 3-phases of trauma recovery. MOST Important Goal: To increase your hope that survivors can heal, to increase your confidence in trauma-informed treatment, to empower you to work more confidently with your addiction clients who probably have childhood and adult onset trauma.
- 9. Levels of Development in Trauma-Care
- 11. Level 1: Being “Trauma Informed” Simply means internally acknowledging the impact that trauma has on your clients, your treatment, and your self. It’s a broad stroke. It’s the “recognition of psychological trauma as a pivotal force that shapes the mental, emotional, and physical well- being of those seeking healing and recovery with the support of mental health and human services.” (SAMHSA) You recognize that many, if not most, of your clients have a history of trauma.
- 12. How Much do I agree with the following statements? Child abuse/neglect damages a whole life, not just a childhood. Trauma is the problem and substance use is the solution; until the solution becomes the problem. Addiction treatment isn’t complete until the underlying trauma has been acknowledged and addressed. Not at all Might Consider it Some Mostly Completely
- 13. Level 2: Adopting a Trauma- Informed Approach Goes beyond recognizing the presence of trauma symptoms and acknowledging the role that trauma has played in their lives, and actively seeks to change your treatment approach from one that asks, "What's wrong with you?" to one that asks, "What has happened to you?” (SAMHSA) Actively shifting your own perspective.
- 14. Shifting MY Paradigm Where am I coming from? What is my history with addiction treatment? What is my personal history? How ready am I to make this shift? Consider the Stages of Change. Precontemplative: I didn’t know there was a paradigm to shift! I am happy with the way I do treatment now and don’t see any reason to change. Contemplative: I’m considering the idea that trauma might be beneath some of my client’s SUD, but I’m not convinced yet. I’m considering it and weighing the research. Preparation: I’m convinced that I need to make some changes, I’m not sure which way to go. Where do I begin? I’m gathering my resources today. Action: I’ve made the paradigm shift internally and am applying the shift in my practice and looking for more ways to make the application. Maintenance: I’m maintaining the paradigm shift and looking to add skills and move up to the expert level of trauma care.
- 15. Change takes place slowly and over time. To start… Stop trying to fix the behavior, and see the behavior as a symptom of a wound. …there’s fire! Make the assumption that, where there’s smoke…
- 16. View symptoms through the lens of trauma.
- 17. …and consider the context… Raised by a single mother Arrested for DUI at 23 Mother was verbally and physically abusive. Bullied in School Started drinking at 13 to feel like he fit in at school, smoking pot at 14 to deal with anxiety. Abandoned by father at 5.
- 18. A Trauma-Informed Approach Can be implemented in any type of service setting or organization: Private practice office, group practice, treatment center; church, synagogue, temple or mosque; day- care, elementary, middle or high school. Realizes the widespread impact of trauma and understands potential paths for recovery; Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and Resists re-traumatization. Meaning, institute policies that promote…
- 19. SAMHSA’s Six Key Principles Safety: avoid activities that may reenact traumatic experiences. Promote Trustworthiness and Transparency- be honest about what you are doing and why you are doing it. Offer opportunities for peer support Approach treatment with collaboration and mutuality Provide Empowerment by giving clients a voice and giving them choices about their treatment. Always be sensitive to Cultural, Historical, and Gender Issues recognizing generational and historical trauma.
- 20. Rather than only evaluating the surface… Begin by: Assume there is a root, and make an attempt to evaluate for the root.
- 21. Typical Evaluation… What brought you here today? What symptoms are you having? What changes do you want to make? What diagnosis will I give? …What’s wrong with you?
- 22. Trauma Informed Evaluation… Also ask questions like, When did this start? What was going on in your life that led you to make this decision? What kinds of stress did you have? …What happened to you?
- 23. EFFECT OF Trauma-Oriented Evaluations on Doctor Office Visits Benefits of Incorporating a Trauma-oriented Approach Biomedical evaluation: 11% reduction in DOVs (Control group) in subsequent year. (700 patient sample) Biopsychosocial evaluation: 35% reduction in DOVs (Trauma-oriented approach) in subsequent year. (>120,000 patient sample)
- 24. Use Screening Instruments Family Health History Questionnaire Health Appraisal Questionnaire (http://www.cdc.gov/ace/questionnaires.htm) Also: Trauma Symptom Inventory (Briere, 1995) PTSD-8 (Hansen, et al., 2010) Primary Care PTSD Screen (PC-PTSD) (Prins, et al., 2003).
- 25. Others ACE Score http://acestudy.org/yahoo_site_admin/assets/docs /ACE_Calculator-English.127143712.pdf Simple Trauma Source Assessment (by Denice Colson)
- 26. Simple Trauma-Source Assessment© 2 sections: child/adult. Simple questions. Check-list. A few scaling questions. Provides for discussion, not “diagnosis”. Sign-up for my newsletter and receive this by email to use in your center. You can put your own heading on it as long as you keep it like it is written (don’t add or take anything out without contacting me and getting written permission) and keep my copyright on the bottom.
- 27. Use Handouts Trauma Source Score Handout Adverse Childhood Experiences and Health and Well-Being Over the Life- span Develop your own. Visit ACESConnection.com for more help.
- 28. “Important Souls” THE STORY OF ANNA CAROLINE JENNINGS- A TRAUMA SURVIVOR WHO DIDN’T GET TRAUMA INFORMED CARE AND WHOSE STORY HELPED TO LAUNCH THE CURRENT TRAUMA INFORMED CARE MOVEMENT
- 30. Breath… What are your feelings and thoughts about this video? Perhaps you have responded in a like minded manner as a treatment provider in the past. What can you do about that now? Ask for forgiveness, and move forward to change your approach. You can’t know what you don’t know. You can’t treat what you don’t understand. You can move up the pyramid!
- 31. Level 3: SAMHSA Guidelines for Trauma-Specific Interventions Any trauma specific intervention that you learn and adopt should meet the following guidelines: Survivor's need to be respected, informed, connected, and hopeful regarding their own recovery. The interrelation between trauma and symptoms of trauma such as substance abuse, eating disorders, depression, and anxiety need to be understood, anticipated, and addressed through education and information. Providers need to work in a collaborative way with survivors, family and friends of the survivor, and other human services agencies in a manner that will empower survivors and consumers
- 32. Key Thought: a trauma- specific intervention will focus on the source, not just the symptoms.
- 33. Trauma Trauma Trauma Trauma Trauma Trauma Trauma Trauma Trauma Trauma Trauma Trauma Source-focused thinking means that I begin to look past the fruit, past the surface, and attempt to identify and address the roots of addiction, depression and anxiety. Source-focused thinking vs. Symptom-focused-thinking I don’t want to just remove the part of the tree I can see, I want to dig deeper, do the best I can to get to the roots.
- 34. Links between childhood trauma and adult/adolescent addiction. THE ACE STUDY AND BEYOND
- 35. ACEs and Population Attributable Risks Anda, ACE Interface© 2013
- 36. ACE and Adult Alcoholism A 500% increase in adult alcoholism is directly related to adverse childhood experiences.
- 37. ACE and Adult Alcoholism 0 2 4 6 8 10 12 14 16 18%Alcoholic ACE Score0 1 2 3 4+
- 38. ACE Leads to Early Alcohol Initiation •As the number of ACE increase, the more likely a person is to begin drinking before 14, or between 15-17 and the less likely they are to begin drinking at 18 or at 21 (the legal age).
- 39. 2/3rds experienced physical and/or sexual abuse 75% of the women - sexually abused. (SAMHSA/CSAT, 2000; SAMHSA, 1994 ) Men and women in SA treatment…
- 40. 6 to 12 times more likely to have been physically abused. 18 to 21 times more likely to have been sexually abused. (Clark et al, 1997) Teenagers with alcohol and drug problems
- 41. 86% report physical abuse histories, 69% sexual abuse histories. Of those with sexual abuse histories 96.7% physically abused . 96% of both (sa, pa) emotionally abused. (Saylors, 2003; 2004) Of American Indian/American Native women in SA treatment
- 42. ACE and Obesity 66% reported one or more type of abuse. Physical abuse and verbal abuse were most strongly associated with body weight and obesity. (the abuse types strongly co- occurred) International Journal of Obesity (2002) 26, 1075 – 1082. doi:10.1038=sj.ijo.0802038
- 43. ACE and Smoking A child with 6 or more categories of adverse childhood experiences is 250% more likely to become an adult smoker
- 44. ACE and IV Drug Use A male child with an ACE score of 6 has a 4,600% increase in the likelihood that he will become an IV drug user later in life
- 45. Dose-Response Relationship Higher ACE Score Reliably Predicts Prevalence of Disease, Addiction, Death Higher ACE Score Responsegetsbigger The size of the “dose”— the number of ACE categories Drives the “response”— the occurrence of disease, addiction, and death.
- 46. Social, emotional, and cognitive impairment Adoption of health risk behaviors Disability, Diseases, social problems Early Death ACEConversion 46 ACE Pyramid
- 47. How Strong is the Study? Replicated in 5 US states and Puerto Rico as well as Canada, China, Jordan, Norway, the Philippines and the United Kingdom. 61 Publications by principles and their associations on CDC.gov Same results, some show a stronger curve and increased percentages of trauma in the general population.
- 48. Not Yet Replicated in Georgia! Visit my Facebook page: https://www.facebook.com/pages/The-Georgia- Adverse-Childhood-Experiences-ACE-Awareness- Project/327902950723640 LIKE
- 49. Social, emotional, and cognitive impairment Adoption of health risk behaviors Disability, Diseases, social problems Early Death ACE Conversion 49 ACE Pyramid Research gaps http://youtu.be/rVwFkcOZHJw
- 50. Social, emotional, and cognitive impairment Adoption of health risk behaviors Disability, Diseases, social problems Early Death ACEConversion 50 ACE Pyramid Research gaps
- 51. Strategic Trauma and Abuse Recovery©: A Source-Focused Model for Healing DISSERTATION: TOWARD A MORE COMPREHENSIVE, BIBLICALLY-INTEGRATED, THEORY AND TREATMENT OF PTSD, SUBSTANCE ABUSE, AND OTHER TRAUMA RELATED DISORDERS
- 52. The 6 progressive stages for developing a trauma survivor. If you are a horticulturist, a person who studies the science and art of growing fruits, vegetables, flowers, and ornamental plants, it’s important to know the plant stages of development. If you are going to be a trauma-informed or addictions counselor, it’s important to know the stages of development for a trauma survivor.
- 53. “Trauma” Derived from the Greek word that means an injury or wound.
- 54. Wound to the identity rather than a wound to the body. Creates contradictions to expectations which results in tangible and intangible losses. Creates a demand for action. An experience that causes psychological injury or wound. Pain is pain. 54 Psychological trauma
- 55. Personal experiences 55 Personal Identity Personal expectations, values, beliefs, and needs. Genetics
- 56. How the Damage to Identity Happens: The Still-Face Experiment https://www.youtube.com/watch?v=apzXGEbZht0
- 58. 58 REBT Basic Human Behavior A. Activating Event Emotions C. Behavior B. Beliefs, values, expectations, needs Information passes through the brain.
- 59. Blueprint for building a Trauma Survivor Theory: Six Stages in Development of a Trauma Survivor Identity
- 60. 2. Triggers Limbic System (Fight/Flight) of the Brain. You experience Losses. 1. Event Outside of conscious control contradicts expectations/ beliefs. 3.Grief Response begins and is resolved. Stops here. 3. Grief Response begins and is NOT resolved; information is stored, and the cycle moves forward. Trauma Survivor Blueprint© (Adapted from Collins & Carson., 1989. The Integrated Trauma Management System)
- 61. Trauma Survivor Blueprint© Part 2 4. Brain rallies to survive: activating (new) survival responses 5. Own responses are compared to expectations/beliefs. 6. If they contradict, triggers Limbic system again creating more emotion associated with loss. (Adapted from Collins & Carson., 1989. The Integrated Trauma Management System)
- 62. Ongoing, unresolved trauma: Survivors keep cycling through this loop, developing more survival responses. As the cycle moves the person further away from awareness of this connection
- 63. 4. Brain rallies to survive: activating (new) survival responses 5. Own responses are compared to expectations/beliefs. 6. If they contradict, triggers Limbic system again creating more emotion associated with loss. (Adapted from Collins & Carson., 1989. The Integrated Trauma Management System)
- 64. As the cycle moves the person further away from awareness of this connection… Perception of self and others changes. Personal identity changes. People adopt a “survivor identity”.
- 65. Self-Perception= I’m a tough guy! Perception by others= He’s an angry violent person!
- 66. Example of Development in a Family You are treating a new client, Sue Crenshaw. She is 35 years old, divorced twice, and has 3 children who don’t live with her. She has come to you for… a drug and alcohol evaluation for a DUI, or for ASAM I treatment, or because she has sever anxiety, Her history reveals that she started drinking when she was 13. Started using pot at 15. Has tried various drugs including cocaine, ecstasy, and meth, but has an aversion to needles so assures you she has never used heroin or “hard drugs”. Currently she mostly drinks alcohol and smokes pot.
- 67. Treatment Approach Typical symptom focused treatment would involve what steps?
- 68. Trauma-Informed Treatment Approach Trauma informed interventions look beneath the surface to ask, “What has happened to you?” and attempts to address not only the fruit (addiction/substance use disorder) but also the roots. In fact, source-focused treatment assumes that something did happen and assumes that there is a root beyond self- destructive behavior; we just have to find it. Assumes the person is trying to solve a problem, not make one. Assumes that the SUD developed because of resiliency. So, how did Sue Crenshaw get here? How did this “Substance Use Disorder” develop and what are the roots?
- 69. Sue Crenshaw is 10 years old and in the 5th grade. She has been an A/B student since she started school. John is 8 years old and in the 3rd grade. He has been an A/B student since he started school. Meet the Crenshaws: A typical family Bob Crenshaw: •35 Years old •Father •Manager in an oil company •Drinking beer since 18 years old •Never addicted. Mary Crenshaw •33 years old •Mother •Works part time from home as a computer programmer. •Drinking beer since she was 18 years old •Never been addicted. For the sake of the role-play, no previous trauma of any kind. Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014
- 70. Choose which family member you want to represent in this discussion based role-play. Choose between mom and one of the two children. Dad will be role-played by the trainer. As we walk through this role-play, you will be asked to respond, putting yourself in this person’s place. We will be demonstrating the 6 stages in the development of a trauma survivor but in a family system. 70 Instructions
- 71. The family is at a restaurant with two other neighborhood families celebrating New Year’s Eve. Sue is sitting with her friends all together at a separate, but nearby table, while the adults are sitting men with men and women with women at their table. Dad had a couple of beers at home before coming to the restaurant and has had several more while at the restaurant. Sue notices that Dad seems to be laughing louder and louder. She hears a loud crash and turns to see her father covered with spaghetti sauce and his plate on the floor. Apparently he has dumped his entire plate on himself. As mom jumps up to help him he growls at her, “I can take care of myself, stupid!” He stands, very wobbly, and heads to the men’s room. As everyone watches, he walks toward the door, showing uncertainty in his steps. He is obviously drunk and not walking straight. 71 Incident #1:
- 72. Stage 1: Event outside of your control contradicts expectations, values, beliefs. Does it contradict your expectations? What expectations are contradicted? Incident #1: The first incident. Crenshaw Family Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014 Mom Sue John
- 73. Stage 2: Triggers Limbic System (Fight/Flight) of the Brain. You experience Losses. What did you feel when it happened? What did you lose? Incident #1: The first incident. Crenshaw Family Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014 Mom Sue John
- 74. Stage 3: Grief Response begins and is resolved. Stops here or Grief Response begins and is NOT resolved; information is stored, and the cycle moves forward. Is it resolved? Does it move forward if it isn’t? Incident #1: The first incident. Crenshaw Family Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014 Mom Sue John
- 75. Stage 4: Brain rallies to survive: activating (new) survival responses What might you do in response? Incident #1: The first incident. Crenshaw Family Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014 Mom Sue John
- 76. Stage 5: Own responses are compared to expectations/beliefs. As you think about your responses, do any of them contradict your expectations of your own behavior, thoughts, or attitudes? What might you feel? Incident #1: The first incident. Crenshaw Family Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014 Mom Sue John
- 77. Stage 6: If they contradict, triggers Limbic system again, creating more losses and more emotion associated with loss. What might you lose? Incident #1: The first incident. Crenshaw Family Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014 Mom Sue John
- 78. The individuals are beginning to develop “masks” over their true identities. Sue is developing a mask over her true identity. Incident #1: After the first incident Crenshaw Family Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014 Mom Sue John
- 79. Incident #1: What about the father? Family Identity Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014 Mom Sue John Dad 1. Does his drunk behavior contradict his own expectations? 2. What might he feel when it happened? What will he lose? 3. Is it resolved? Does it move forward if it isn’t? 4. What might he do in response? 5. Do any of them contradict his expectations of his own behavior, thoughts, or attitudes? What might he feel? 6. What might he lose?
- 80. Incident #1: After the first incident…the father. Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014 Mom Daughter Son Dad Crenshaw Family
- 81. Its been 3 years and there have been at least 5 more incidents. Sue is now 13 and has heard her mom and dad fight many times. This time, she’s in her room and she hears dad come home. He’s loud when he comes in the door and she peeks out to see what he’s doing. He looks obviously drunk and appears to have been in a fight. Shortly after he gets into the house, police pull up into the driveway with sirens blaring and lights flashing. Mom runs up to dad and asks what happened. Sue and John come out to see but then run and hide in their rooms. The police knock on the door and announce themselves. They arrest Dad for driving drunk and leaving the scene of an accident. Mom starts crying and yelling. Dad throws up in the front room while handcuffed. 81 Incident #7:
- 82. Stage 1: Event outside of your control contradicts expectations, values, beliefs. Does it contradict your expectations? What expectations are contradicted? Incident #7 Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014 MomCrenshaw Family Sue John
- 83. Stage 2: Triggers Limbic System (Fight/Flight) of the Brain. You experience Losses. What did you feel when it happened? What did you lose? Incident #7 Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014 MomCrenshaw Family Sue John
- 84. Stage 3: Grief Response begins and is resolved. Stops here or Grief Response begins and is NOT resolved; information is stored, and the cycle moves forward. Is it resolved? Does it move forward if it isn’t? Incident #7 Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014 MomCrenshaw Family JohnSue
- 85. Stage 4: Brain rallies to survive: activating (new) survival responses What might you do in response? Incident #7 Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014 MomCrenshaw Family JohnSue
- 86. Stage 5: Own responses are compared to expectations/b eliefs. As you think about your responses, do any of them contradict your expectations of your own behavior, thoughts, or attitudes? What might you feel? Incident #7 Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014 MomCrenshaw Family Sue John
- 87. Stage 6: If they contradict, triggers Limbic system again, creating more losses and more emotion associated with loss. What might you lose? Incident #7 Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014 Mom Sue Crenshaw Family John
- 88. Incident #7: …the individuals have continued to develop “masks” over their true identities. Incident #7 Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014 Mom Sue John Crenshaw Family
- 89. Incident #2What about the father? Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014 Mom Sue John Dad 1. Does his drunk behavior contradict his own expectations? 2. What might he feel when it happened? What will he lose? 3. Is it resolved? Does it move forward if it isn’t? 4. What might he do in response? 5. Do any of them contradict his expectations of his own behavior, thoughts, or attitudes? What might he feel? 6. What might he lose? Crenshaw Family
- 90. Incident #7: …the father Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014 MomDad Crenshaw Family JohnSue
- 91. Boundary Erosion and Enmeshment:. Eventually… Family Identit y Family Identity Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014
- 92. Our Client-Sue Crenshaw What She Presents Her TRUE Identity
- 93. Father gets drunk in restaurant Dad gets DUI Parents argue louder Mom starts talking about dad Mother slaps father Mother hiding from father Yells at mom in front of friends Dad gets drunk more often Dad withdraws further Mom shouts at kids Father curses at mother Dad gets arrested at home GOING FROM ROOT TO FRUIT
- 94. Unfortunately, many of these symptoms are viewed by the survivor-brain as solutions. They temporarily work to reduce the pain and/or internal conflict and safeguard the personal identity. Meaning, the brain doesn’t want to let go of them! Most treatment is symptom focused—focus on reducing unwanted or risky symptoms. 94 Treatment
- 95. Dr. Felitti’s redefinition of addiction informed by the ACE Study: Addiction is the unconscious, compulsive use of psychoactive materials or agents in an attempt to deal with a problem. “It’s hard to get enough of something that almost works.” Considers addiction (SUD) as evidence of another problem. Felitti, V. (2011) Adverse Childhood Experiences and The Origins of Addiction. Neuroscience of Addiction. Presentation to the Alberta Family Wellness Center. Retrieved from http://www.albertafamilywellness.org/resources/video/origins-addiction
- 96. Paradoxical Relationship with the Substance Adapted from Collins, J., (1990) Presenters Handbook, TRT Institute, Angel Fire, New Mexico Flip-side of the same coin. Professional Trauma Survivor
- 97. Its this paradox that we as addiction counselors have to try to overcome. Being source-focused helps to go around the paradox. Avoiding it and not taking it on directly.
- 98. With S.T.A.R., Source Focused means: Each stage of The Trauma Survivor Blueprint is addressed in order. Evaluation, testing, and treatment are all focused on the source of the problem, not just the symptoms. Symptoms are bypassed when at all possible and allowed to resolve on their own as the “wound” is healing.
- 99. Why is bypassing symptoms important? • Asking a person to let go of their survival responses before the pain heals for which they are using the survival responses is like asking someone to let go of the ledge they are holding on to so that they can float in mid air until the rescue helicopter gets to them!
- 100. Let’s launch you in to the air!
- 101. I’m sure you can fly!
- 102. 102 How do we fight this paradox? We don’t! We give people something to hold on to.
- 103. 3 Widely Accepted Phases of Trauma Recovery Safety, Grieving, Reconnecting
- 104. 3 Progressive Phases of Trauma and Abuse Recovery 1. Establishing Safety and Stabilization 3. Reconnecting and Integrating 2. Reprocessing and Grieving
- 105. Phases Very broad and undefined. The heart of recovery is Reprocessing and Grieving. Remaining in Establishing Safety and Stabilization won’t complete the healing- this is like cutting off the limbs of the tree down to a stump and hoping it doesn’t grow back. Have to get to the Reprocessing phase.
- 106. In order to navigate these three very broad phases, I’ve broken them down into 12 Strategic Stages Safety and Stabilization: 4 stages Reprocessing and Grieving: 6 stages Reconnecting and Reintegrating: 2 stages
- 107. Phase One-Safety and Stabilization: Characterized by Feeding Your FAITH 1. I admit that I am wounded by a traumatic event or series of events and I am accepting that I am powerless over the wound, the wounding, and the one creating the wound. 2. I have decided to give up trying to fix myself and will humbly seek healing through a Higher Power (God), fully understanding that healing will require my participation. 3. I am accepting that I have to grieve in order to heal and I’m determined to give up any substance use that results in numbing my grief and I will allow myself to feel as I move through the healing process even though it will be painful and scary at times. 4. I am forming a partnership with at least one other person (counselor or recovery coach) as I prepare to boldly identify in a focused and structured manner the people or events that wounded me.
- 108. Phase Two- Reprocessing and Grieving: Characterized by Snowballing your HOPE 1. I am courageously choosing to tell my story using structure and detail to my counselor/recovery coach, and, when possible my fellow burden bearers. 2. I am identifying the beliefs that have grown out of the hurtful events; beliefs about me, life, others, and God (spirituality, religion, or church) along with my initial responses. 3. I am humbly identifying and admitting to myself, my partner or group, my own survival responses even when they contradict my own expectations of myself.
- 109. Phase Two- Reprocessing and Grieving: (Con’t) 4. I am embracing and grieving all of the losses I experienced during this source of trauma; those the offender caused me, and those caused by my own survival responses. 5. After completing this thorough inventory of my experiences, contradicted expectations, losses, survival behaviors and the losses these caused me, I humbly and courageously choose forgiveness; forgiving my perpetrator for robbing me and forgiving myself (as I have been forgiven) for my responses. 6. I understand that healing is an ongoing process from the inside-out, and I humbly acknowledge where I’ve come from and those who have contributed (including my Higher Power) to my healing and will make a spiritual or personal marker to represent where I have traveled on my path of healing with this source of trauma.
- 110. Phase Three: Reconnecting and Integrating: Characterized by Activating Your LOVE 1. I am remaining open to identifying other wounds in my life that need to be healed, without attempting to heal them myself, while maintaining a willing attitude to work through these steps again if necessary, or to assist someone else who needs to work through these steps to healing. 2. I am beginning to intentionally move toward reconnecting with myself, with my Higher Power (God as I understand Him), and with others.
- 111. How S.T.A.R. Works Phase 1 This can be done in individual or group/class setting of as many people as you like. Phase 1 can be done using “Inside-Out Recovery: Let the Healing Begin!” a specifically Christian-integrated class with 13 lessons that can be lengthened or shortened as needed. Psychoeducational in nature, open to public, has a starting and stopping point. Clients can work the stages using handouts and discussion. They can go back through as many times as they like until they are ready to move on to Phase 2. If you don’t want a specifically Christian program, you can modify it and remove the parts that are too much.
- 112. How S.T.A.R. Works Phase 2 Can be done individually or in a group of up to 8 people. Each stage has a set of handouts and involves structured writing and structured processing (reading out loud and processing feelings). Each stage is different and goes from telling the story, to identifying the impact of the trauma on current life in a strategic and measured manner.
- 113. How S.T.A.R. Works Phase 2 One source of trauma is addressed at a time-not one incident—one source. Most sources are people or relationships. For example, Sue Crenshaw has at least 3 sources, probably. Her father, her mother, and alcohol. Treats addiction as a source of trauma. “Trauma is the problem and substance use is the solution; until the solution becomes the problem.” She would move through the 6 stages on alcohol, then her father, and then her mother. Then she would go on to Phase 3.
- 115. How S.T.A.R. Works Phase 3 Can be done individually, in marriage counseling or family counseling, and, optionally the participant returns to a Phase 1 group to help with others and provide encouragement and give back. Identifies areas that have been strengthened, healed, or restored. Completes a “Relationship Map” and a “Life Map” Ending point is determined by participant and Counselor/Recovery Coach.
- 116. How S.T.A.R. Works Elements of STAR are evidence informed, and strategically arranged and integrated in a uniquely structured way, building a pathway through the healing process. STAR assumes resiliency in people. People are resilient and surviving the best they can. Many of the behaviors like addiction, depression, and anxiety, are adaptations intended for survival. To the survivor, they almost work. STAR assumes the resiliency of the brain. Neuroplasticity- based treatment is gaining momentum in behavioral health care. Trauma impacts and changes the brain. Treatment using the STAR modalities intends to impact and rewire the brain naturally. The brain can heal!
- 117. Summary and Conclusion A SUCCESSFUL TRAUMA THERAPY IS ABOUT MORE THAN JUST NOT HAVING SYMPTOMS. IT’S REALLY ABOUT HAVING A LIFE…A LIFE THAT’S ABOUT PURSUING DREAMS, PURSUING HAPPINESS. BUT ESPECIALLY IT’S ABOUT THE RIGHT TO HAVE A PRESENT AND A FUTURE THAT ARE NOT COMPLETELY DOMINATED AND DICTATED BY THE PAST. (SAAKVITNE, 2000)
- 118. “ ” 65% of Alcoholism is attributable to unhealed, unaddressed childhood trauma. (Anda, ACE Interface, 2013)
- 119. “ ” 78% of IV drug use is attributable to unhealed, unaddressed childhood trauma. (Anda, ACE Interface, 2013)
- 120. “ ” 58% of suicide attempts are attributable to unhealed, unaddressed childhood trauma.(Anda, ACE Interface, 2013)
- 121. “ ” Of self-reporting addicts, 71% report experiencing at least one trauma in their lifetime. (SAMHSA, TIP 57)
- 122. What percentage of counselors are providing trauma informed treatment, and more importantly, trauma specific treatment? My hope is, that after today, you will make it one more.
- 123. Trauma wounds, but people can heal. I BELIEVE THIS IS ONE OF THE MOST IMPORTANT THINGS WE CAN DO. WE CAN BEGIN TO ADDRESS THIS GENERATIONAL TRANSFERENCE OF TRAUMA AND THE IMPACT OF TRAUMA IN PEOPLE’S LIVES.
- 124. Thanks for coming! Denice Colson, PhD, LPC, MAC, CPCS www.TraumaEducation.com Be sure you have signed up to receive the assessments and tools by email!