healer identity - pca arizonaemotions people create narratives ... together, pop a valium before a...

HEALER IDENTITY

Director of Community Relations at Arizona Trauma InstituteTrainer and Consultant at Arizona Trauma InstitutePromoter of Social Justice at Arizona Trauma InstituteTrainer at International Association of Trauma ProfessionalsPsyD Doctoral Candidate at California Southern University

Areas of Interest: Public Health System Reform; Foster and Adoptive Advocacy and Education; Residential and Group Home Standardization of Care; Relationship Focused Therapy; Traumagenic Family Dynamics; Child & Family Trauma; Paraprofessional Trauma Informed Care; Empowerment and Resiliency Treatment Structure; Childhood Adverse Experience (ACE) Study implication and applications

Arizona Trauma Institute49 S. Sycamore Dr. Ste. 2 Mesa, AZ [email protected]

Arizona Trauma Institute

Assumptions■ People have control

– Intentional, conscious choices

are being made

– Thoughts, behaviors,

emotions

■ People create narratives

– Organize sequence of events

■ People know what coping

skills are acceptable and not

acceptable

■ People learn primarily from

action/consequence

■ People need to identify

emotion change behaviorArizona Trauma Institute

Trauma or TraumagenesisAny environment that promotes Hot System dominance

“anything that interrupts or

interferes with normal

social, emotional,

psychological, cognitive,

spiritual, or physical

developmental processes

– or –

interferes/interrupts secure

attachment can be a threat

to the individual and

considered traumatic” 1

Arizona Trauma Institute 4

Traditional Types of Trauma

■ Natural disasters

■ Mass interpersonal violence

■ Domestic fires

■ Motor vehicle accidents

■ Rape & Sexual assault

■ Physical assault

■ Partner/Family battery

■ Torture

■ War

■ Child Abuse

■ Emergency worker exposure


Intensity■ Witnessing and experiencing DV

■ Sexual assault

■ Physical abuse & neglect

■ Witnessing or being a victim of

■ violent crime

■ Participating in war or military action

■ Accidents and bad injuries


High Frequency■ Chaotic environments

■ Aggressive environments

■ Punitive environments

■ Inconsistent environments

■ Basic Needs not being met

■ Instability in the family:

– Financially

– Emotionally

– Residentially


High Duration■Historical Trauma:

Grandparent(s) don’t know how

amazing they are

Parent(s) don’t know how

awesome they are

Client(s) may have never learned

how amazing they are

■Systemic Oppression

■Marginalization

■Prejudice


None of these ARE Trauma


None of these ARE trauma

■ None of these are really the cause of trauma, all of

them impact the Central Nervous System (CNS)

■ When the CNS gets out of balance, we see

symptoms.


How Humans Operate…

Balance System(Autonomic Nervous System)

• Regulates body processes• Works automatically • When hot symptom dominant,

adaptions or mitigations occur• When balanced, moves from

hot to cool appropriately

**Trauma symptoms result from the over-use of the threat/stress response system (TRS/SNS)**


Symptoms of Activation

Parasympathetic/Cool:

Promote digestion Intestinal motility Fuel storage (increases insulin

activity) Resistance to infection Circulation to non-vital organs Release endorphins Decreases heart rate, blood

pressure and body temperature

Sympathetic/Hot:

Accelerate the heart rate Constrict blood vessels Raise blood pressure,

muscle tension, physical sensation amplification.

Inhibition of insulin production to maximize fuel availability


What is the nature of the Sympathetic

Nervous System (SNS)?


Nature of the Sympathetic System■ Immediate

■ No future

■ Impulsive

■ Irrational/illogical

■ Non planned outside of the

immediate activity

■ Little self reflection

■ Little evaluation


Absolutely correct behavior!!!!

HOW DOES TRAUMA

GET CREATED?


Activation of the hot system creates….

■ Adaptation is the action or process of adapting or being adapted… (examples --- jumping out of the way when someone takes a swing at you, running from the room when someone threatens you).

■ Mitigation is the action of reducing the severity, seriousness, or painfulness of some aspect of the situation (this could be provoking a fight, before the tension gets too high, take a few drinks or some drugs before you walk into a family get together, pop a valium before a big presentation).


Mitigative Activation (Internalized distancing behavior)

■ Freezing, Stuck, Paralysis of Action

■ Dissociation■ Emotional Numbing■ Distraction■ Self-Soothing■ Reactive■ Impulsive■ Emotional and Psychological

Distancing■ Self-Centeredness

■ Sad■ Withdrawn■ Whining■ Crying■ Sulking■ Clingy■ Reluctance to Explore the World

■ Addictive Behavior■ Obsessiveness


Adaptive Activation (externalized acting out behaviors)

■ Angry■ Aggressive■ Defensive■ Reactive■ Impulsive■ Hostile■ Irrational■ Self-centered■ Poor focus■ Inattention■ Sleep disturbances

■ Coercive■ Bossy■ Tantrums■ Name calling■ Hitting■ Fidgety■ Hyperactive ■ Anxiety ■ Irritability■ Delays in reaching physical

language or other milestones


When people are in survival mode they are not looking at the scenery


No matter the reality of the view


At the activation point

■ No future focus…consequences are meaningless and not

related to action.

■ Everything is about this moment in time!

■ All nonessential systems are turned down (suppressed)


The Adverse Childhood Experience Study6


Stress is Cumulative• With low Intensity/High

frequency activation the

cocktail is smaller, but it

accumulates.

• Depending on you health and

body function, the cocktail

level in you blood and tissues)

may take hours to reach the

baseline again

…what happens if the next

activation occurs before that can

happen?

■42.5%- Zero ACEs

■26.4%- One ACE

■31.1%- 2 or more ACEs

National Average-

22.6%- 2 or note ACE’s

Arizona Statistics in Children(2011/2012 National Survey of Children’s

Health)

Arizona ACEs and Outcomes

Aces questionnaire

1.Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?

2.Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?

3.Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?

4.Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?

5.Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

Aces questionnaire continued….

6. Were your parents ever separated or divorced?

Was your mother or stepmother:7. Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?

8. Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?

9. Was a household member depressed or mentally ill, or did a household member attempt suicide?

10. Did a household member go to prison?

1. I believe that my mother loved me when I was little.

2. I believe that my father loved me when I was little.

3. When I was little, other people helped my mother and father take care of me and they seemed to love me.

4. I’ve heard that when I was an infant someone in my family enjoyed playing with me, and I enjoyed it, too.

5. When I was a child, there were relatives in my family who made me feel better if I was sad or worried.

6. When I was a child, neighbors or my friends’ parents seemed to like me.

7. When I was a child, teachers, coaches, youth leaders or ministers were there to help me.

RESILIENCY SCALE

DEFINITELY TRUE PROBABLY TRUE NOT SURE PROBABLY NOT TRUE DEFINITELY NOT TRUE

8. Someone in my family cared about how I was doing in school.

9. My family, neighbors and friends talked often about making our lives better.

10. We had rules in our house and were expected to keep them.

11. When I felt really bad, I could almost always find someone I trusted to talk to.

12. As a youth, people noticed that I was capable and could get things done.

13. I was independent and a go-getter.

14. I believed that life is what you make it.

RESILIENCY SCALE

DEFINITELY TRUE PROBABLY TRUE NOT SURE PROBABLY NOT TRUE DEFINITELY NOT TRUE

ACEs in Service Providers

■ Psychosocial trauma in childhood of social work

students influenced their choice of a social work

career2,4

■ Social work students reported a significantly higher

frequency of early life family trauma when

compared with a sample of business students3

Participating workers in child-serving agency5

■ 70% reported at least one of the ACE categories

■ 54% reported two or more ACE categories

■ 16% reported four or more ACE categories

■ We ALL have biases

■ Past experience and

observation can identify

groups of people as

threats

■ If we perceive people as

threats, even without our

awareness, it can have an

effect upon how we treat

these people.

■ It is not the task of the

healer to become bias-free

but instead to become

aware and monitor self

We are all Human!!!

What are humans capable of in Cool & Hot Systems?

Hot System Reactions1. FIGHTING or aggression to

control/overcome threat

2. FLIGHTING or increasing

muscle tension to avoid threat

3. FREEZING or Shutting down

the body, paralyzing any action

Cool System Responses1. Bodily Regulation and

coordination of physiological

responses

2. Attuned Communications

3. Emotional balance and

regulation

4. Flexibility in response

5. Pause before reacting

6. Empathy

7. Insight/discernment/judgment

8. Moral awareness

9. Intuition/spiritual feelings

10. Identity


What are we capable of in Cool & Hot Systems?

Hot System Reactions1. FIGHTING or aggression to

control/overcome threat

2. FLIGHT or increasing muscle

tension to avoid threat

3. FREEZE or Shut down the

body, paralyzing any action

Cool System Responses1. Bodily Regulation and

coordination of physiological

responses

2. Attuned Communications

3. Emotional balance and

regulation

4. Flexibility in response

5. Pause before reacting

6. Empathy

7. Insight/discernment/judgment

8. Moral awareness

9. Intuition/spiritual feelings

10. IdentityArizona Trauma Institute 41

Traits of Effective Healers7

Therapeutic Alliance & Empathy

■ 80% of the positive outcomes 8-9

– Warmth

– Empathy

– Respect for the client

– Attunement10

– Patience (2-4 sessions)11

Goal Consensus & Collaboration

■ Connect around Strengths

■ Feedback Informed Treatment12-15

■ Open process of communication

Positive Regard & Affirmation

■ Awareness of Biases

■ Connect around Strengths

■ Feedback Informed Treatment12-15

■ Communication Skills16-17

– Hope and Optimism

– Conflict Resolution

Congruence & Genuineness

■ Awareness of Biases

■ Deliberate & Intentional

■ Non-avoidant

■ Verbal & Non-verbal18

Professional Development:Progress not Perfection……..

■ In 2014, there were over 41,000 peer

reviewed journal articles on trauma alone

(how many did you read??)

■ You are consistently reading new research

based books

■ You are courageous and willing to apply

what you are learning into action

■ You set aside time everyday for learning

something new that will improve your

skills as a healer

Resources1. Anda, R. & Felitti, V.J. The Adverse Childhood Experiences

Study, www.acestudy.org andhttp://www.cdc.gov/ace/findings.htm both Accessed on January 25, 2014.

2. Rompf, E. L., & Royse, D. (1994). Choice of social work as a career: Possible influences. Journal of Social Work Education, 30(2), 163–171.

3. Black, P. N., Jeffreys, D., & Hartley, E. K. (1993). Personal history of psychosocial trauma in the early life of social work and business students. Journal of Social Work Education, 29(2), 171.

4. Lyter, S. C. (2008). Woundedness and social workers: Strategies for supervision of practicum students. Arete, 32(1), 20–37.

5. Esaki, N., & Larkin, H. (2013). Prevalence of adverse childhood experiences (ACEs) among child service providers. Families in Society: The Journal of Contemporary Social Services, 94(1), 31-37.

6. Center for Disease Control, Source: http://www.cdc.gov/ace/prevalence.htm

7. http://www.scottdmiller.com/feedback-informed-treatment-fit/becoming-a-more-effective-therapist-three-evidence-based-clues-from-research-on-the-fields-most-effective-practitioners/

8. Sharpley, C.F., Jeffrey, A.M., & Mcmah, T. (2006). Counsellor facial expression and client-perceived rapport. Counselling Psychology Quarterly, 19(4), 343-356.

9. Hersoug, A., Hogland, P., Monsen, J., & Havik, O. (2001). Quality of working alliance in psychotherapy therapist variables and patient/therapist similarity as predictors. The Journal of Psychotherapy Practice and Research, 10, 205-216.

http://www.acestudy.org/

http://www.cdc.gov/ace/findings.htm

http://www.cdc.gov/ace/prevalence.htm

http://www.scottdmiller.com/feedback-informed-treatment-fit/becoming-a-more-effective-therapist-three-evidence-based-clues-from-research-on-the-fields-most-effective-practitioners/

Resources10.Erskine, R.G. (1998). Attunement and involvement: Therapeutic responses to relational needs. International Journal of Psychotherapy, 3(3).

11. Risking Connection®: A Training Curriculum for Working with Survivors of Abuse, by K.W. Saakvitne, L.A. Pearlman, S.J. Gamble, and Beth Tabor Lev (Sidran Institute Press, 2000), p. 13.

12. Summers, R. F., & Barber, J.P. (2003). Therapeutic alliance as a measurable psychotherapy skill. Academic Psychiatry, 27(3).

13. Duncan, Miller, Hubble, & Wampold, 2010; Duncan, B., Miller, S. D., Hubble, M., & Wampold, B. E. (Eds.). (2010). The heart and soul of change: Delivering what works (2nd ed.). Washington DC: American Psychological Association

14. Lambert, Harmon, Slade, Whipple, & Hawkins, 2005; Lambert, M. J., Harmon, C., Slade, K., Whipple, J. L., & Hawkins, E. J. (2005). Providing feedback to psychotherapists on their patients' progress: Clinical results and practice suggestions. Journal of Clinical Psychology, 61, 165-174.

15. Norcross, 2011; Norcross, J. C. (Ed.). (2011). Psychotherapy relationships that work (2nd ed.). New York: Oxford University Press.

16. Baldwin, Wampold, & Imel, 2007; Baldwin, S. A., Wampold, B. E., & Imel, Z. E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75, 842-852.

17. Anderson, Ogles, Patterson, Lambert, & Vermeersch, 2009; Anderson, T., Ogles, B. M., Patterson, C. L., Lambert, M. J., & Vermeersch, D. A. (2009). Therapist effects: Facilitative interpersonal skills as a predictor of therapist success. Journal of Clinical Psychology, 65, 755-768.

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