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crisis
An immediate, unpredictable event that occurs in people’s lives that can overwhelm the ways that they naturally cope (miscarriage, divorce)
Can be experienced as a group, as a community, or as an individual
Compromise feelings of safety
Includes feelings of fear, sadness, and devastation
trauma
Involves an emotional, mental, and physical response to a powerfully negative experience or series of situations in which people perceived that they or a loved one experienced serious psychological, physical, or emotional harm
Can be result of an isolated event or a series of events (violence, sexual assault, abuse, neglect) (betrayal, loss, rejection)
A: repetitive or prolonged
B: involve harm or abandonment by caregivers/adults
C: occurs at developmentally vulnerable times
may upend the emotional, physical, and relational landscapes of communities, resulting in generational trauma
conceptualizing
Most experience a crisis
Not every crisis results in trauma
Crises tend to resolve over time
Trauma can continue/linger
Trauma can result in patterns of anxiety, depression, and eventual PTSD (can impact sleep, relationships, behavior, function, nutrition)
trauma-informed care (TIC)
Trauma assessment, treatment, and recovery are primary goals
All parties involved recognize the role of trauma in a person’s life and understand that people use diverse coping mechanisms to deal with trauma
working with the whole of a person
takes trauma history into account always
considers a person’s coping mechanisms
impacts a person’s daily responses to events
horse to water example
relational foundation
The power of connection that can be formed during crisis/trauma work
An intentional focus on safeguarding a person’s dignity
The relational, societal, political, and cultural contexts that affect a person’s experience of crisis and trauma
The various contexts in which crises and trauma arise
The diverse means by which a counselor can intervene and support
relational-cultural theory (RCT)
The importance of growth through connection
The societal and cultural influences that affect people’s responses to life and to one another
The role of power and privilege
The means by which these factors affect a person’s response to trauma and resilience
growth in connection (relational principles?)
The nature of a person’s relationships deeply influences one’s psychological development across the lifespan
Mutually rewarding social connections facilitate emotional growth and a desire for continued connection
People need one another
authenticity: Recognizes the courage and strength involved in authenticity
context: Reconceptualizing client concerns from a strength-based, rational lens provides clients with an opportunity to face their crisis or revisit trauma with self-compassion and a perspective that can support growth
power: Power with vs power over
central relational paradox: Yearning for connection, Engaging in a way that is disconnected but still mimics a connection
strategy for disconnection and strategy for survival: Recognize that these strategies for disconnection ARE strategies for survival
condemned isolation: Chronic disconnection; when people are alone in their experience without support
relational resilience: Connection and mutuality are invaluable resources
relational ethics: Steadfast commitment to the well-being of the client, “What should I do?” VS. “what should I be?”, Focus is placed on the actor rather than the action, Holistic, mutual, intuitive, compassionate, personal, and contextual
counselor’s compassion
A way to develop kindness, support, and encouragement, to promote the courage needed to take action, to promote the flourishing and well-being of ourselves and others
Involves connecting with another’s experience, feeling it, and wishing to make a difference in the experience
compassion = suffering with
counselor responsiveness
Involves a mutual interplay in which counselors use their emotional response to promote the well-being and growth of clients
Notice, care, and solicit feedback
counselor anticipatory empathy
Anticipate and consider how our responses may affect our clients
Takes into account trauma’s impact on the brain
Consider the needs of all who are involved (friends, family, etc.)
Requires attunement with the community and available resources
secondary and vicarious trauma
We run the risk of developing our own impairments and decrease our opportunities to productively connect with our clients
We need balance to be successful
virtual reality
Creates environment where clients can gain mastery over stressful events in real time
Can create more vivid experiences than memory alone
Helps to facilitate exposure therapies
mind-body approaches
Acupuncture, emotional freedom technique, mantra-based meditation, and yoga
brief and targeted approaches
Accelerated response therapy, written exposure therapy
RCT philosophy
Framework for conceptualizing how relationships develop
Normalizes the role of disconnections in relationships
Describes the often-traumatic consequences of chronic disconnection
Views resilience as relationally driven rather than as an indication of singular accomplishment
Growth through relationships
Self is viewed in relation to others
Considers the role of culture and context
Focuses on the role of power and privilege
Multicultural and ethical considerations are at the core of RCT
five good things (RCT philosophy)
1. Clarity
2. zest/energy
3. Increased sense of worth
4. Productivity
5. Desire for more connection
acute disconnection
When one person does not understand the other or does not care about the other’s feelings
Power differential plays a role
Can lead to a person’s sense of being cut off or excluded
The pain of exclusion impacts the brain the same as physical pain
traumatic disconnections
Arise when a person experiences physical, sexual, verbal, or emotional abuse
Complex situations, exacerbated by power and control factors, and larger systemic issues
strategies for disconnection: Behaving in a way that is not congruent with the self
strategies for survival: Behaving in a way that is not congruent with the self because it does not feel safe to behave otherwise
relational images
Ideas people create about who they are and how others respond or will respond to them based on their experiences
Consider someone who suffered neglect or abuse and received no support
Consider someone who suffered neglect or abuse and is now in a position of power
controlling images: Ideas about who and how we are as people; are communicated by culture
research evidence for the power of the counseling relationship
Evidence-based practice are not considered effective WITHOUT a productive therapeutic relationship
Alliance
Cohesion
Connection
Taking client feedback (INTEGRAL)
Empathy
relational competence
Having the capacity to listen to others, listen to oneself, represent personal experiences authentically, and allow for a shared vulnerability that can transform experiences
Leads to potential for greater connection
chronic disconnection
Developed over time and by reinforcement from the environment
Isolation, is a sense of being cut off, others, outside the community
Feel disempowered, heightened anxiety, depression
Additional level of trauma from the system
relating and connecting
client:
Fear-based relating as a result of trauma/crisis
Twisting self to fit into a relationship that does not support growth
Strategies of disconnection/strategies of survival
counselor:
May feel off-balance or “deskilled”
Try to uphold an image of continuing to move forward toward connection and safety
Be aware of concepts like shame, unworthiness, isolation, feeling unlovable
the dance of connection and disconnection (relational responsiveness)
Therapeutic authenticity
Anticipatory empathy
Mutual empathy
By receiving an authentic response from a counselor, seeing that they have an impact on them - the individual can then feel they matter
counselor should:
Become comfortable with the unknown or uncertain
Be fully present
Use ethical listening
Be aware of power dynamics
Know how/when to self-disclose
Guide client in making sense of old relational images
Guide client in finding images that challenge the certainty of the old
Be respectful of the wisdom of the client’s original movements
relational creativity
creativity in counseling (CIC):
A shared counseling process involving growth-promoting shifts that occur from an intentional focus on the therapeutic relationship and the inherent human creative capacity to affect change
Fosters compassion
Creates space for the process to unfold
empathy and responsiveness
Responsiveness > reactivity
Empathic failure will occur
Let the client know you want to understand
Observe
“Sit with it”
Follow the client’s lead
Calming or grounding techniques
Reestablish safety and then keep going
Remain present
Address and talk about it
relational resilience (crises in connectedness)
relational resilience: The capacity to use relationships to realign and move toward growth through empathic responsiveness
Pathways are built up by support and responsiveness
Pathways are broken and eroded by trauma/crisis
We are connected via empathy and compassion
We thrive in connection, not in separation
dilemma: We are hardwired for connection, but society values independence, autonomy, and building a strong separate self
ecological social conceptualization
ecological-social model:
People relate to each other in intimate relationships, family constellations, local communities, and organizations and within the broader societal strata
Conceptualizing traumatic events among many interwoven social systems that reciprocally influence one another
These relationships also exist in a time that embodies the collective messages about trauma, crisis, abuse, and neglect
think 1964 vs. 2025
overview of cultural influences
culture: the set of distinctive spiritual, material, intellectual, and emotional features of society or a social group (that encompasses not only) art and literature, but lifestyles, ways of living together, value systems, traditions, and beliefs
individualism-collectivism: how people relate within their communities
power distance: how much people believe that power is distributed unevenly, how much latitude people have to disagree with those in power,r and the extent of shared decision-making processes
uncertainty-avoidance: how people respond to ambiguity, tolerate differences within their community, and support rules and a belief in absolutes
standards for competency
national standards:
Developing awareness and acceptance of diverse people
Increasing awareness of cultural values
Deepening understanding and strategies to manage the dynamics of difference
Developing knowledge of various cultures
Learning approaches to adapt in different cultural contexts
1st step: gaining a basic sense of cultural and contextual factors that shape our worldview, recognizing that our cultural contact are often overlapping and varied
cultural awareness
Cultural competence: means recognizing that each of us, by virtue of our culture, has at least some ethnocentric views that are provided by that culture and shaped by our individual interpretation of it
Unaware: easily believe stereotypes about different cultures, may unknowingly violate equality laws, and have difficulty seeing biased behaviors in themselves and others
Traditional: recognize their own biases but engage in subtle discriminatory practices, may make demeaning jokes, and may create toxicity in professional and personal settings
Neutral: strive to be self-aware but do not intervene in discriminatory behaviors by others
Change agents: see their own biases, recognize prejudice in others, and intervene when they see discrimination and abuse of power to help systems and others value the intrinsic worth of diverse individuals
Rebels: highly attuned to discriminatory practices, can result in reverse discrimination
knowledge of cultural differences
certain cultural groups are at risk of experiencing more traumatic events than others
Cultural lenses and within-culture relationships provide meaning-making about traumas and guide recovery practices
Our use of language and labels and appreciation of differences within cultures and within clients can help set the stage for productive counseling
labels, language, and examples
External labels of ethnicity, gender, race, and sexuality, may not match with the identity and identifiers used within their own community
American Indian and Alaskan Native
African American and Black
Asian
Hispanic
LGBTQ+
culturally centered empowerment and advocacy
relational-cultural theory:
How people grow
How people connect to one another
Find their way through relational ruptures to reconnection
Foster resilience through authenticity and mutuality
cultural humility and culturally centered care
Requires research, practice, and adaptability
Being culturally humble - do not assume competence, rather approach with openness
Grow from interactions with diverse people, remaining open to learning and integrating new concepts into practice
Actively strive to address power imbalances and join with groups who advocate for equity and change
relational foundations
Your presence is an essential counseling skill
What happens when a counselor pulls away from a difficult conversation?
Power and privilege are present during the time of and after a crisis
microaggressions
Microassaults: intentional denigrating acts committed against marginalized people
Microinsults: emerge from a counselor’s lack of awareness and can disempower and humiliate others
Microinvalidations: can result when people dismiss and minimize the experiences of others
Power/privilege: a system of unearned advantage gained through another’s disadvantage
Power-over dynamic — exert control
collective trauma experiences
Collective trauma: the broad effects that calamitous forces inflict on social groups of any size
Cultural traumas: embody atrocities committed against a particular cultural group that dramatically shape the collective identity of that group
Historical traumas: events experienced by marginalized groups throughout history, with the effects persisting through generations
Intergenerational trauma: the effects of trauma passed through family lineage
Power-under dynamic: being controlled
Counselors may miss/not attend to details because of fear, privilege, lack of knowledge, etc.
cultural traumas
“When members of a collective feel they have been subjected to a horrendous event that leaves indelible marks on their group consciousness, marking their memories forever and changing their future identity in fundamental and irrevocable ways”
Collective memories: how people see themselves in the context of current social structures and can fuel advocacy efforts or lead to cultural meaning-making
Shootings of Black People and Routine Injustice
Forced Migration, Human Smuggling, and Human Trafficking
Hurricanes Katrina and Maria
#MeToo Movement
Pulse Nightclub
Racially, Religiously, and Ethnically Motivated Church Shootings
historical traumas
“Trauma that is (a) experienced collectively among individuals who share a common identity, (b) spans generations, (c)and is remembered through images and stories that may transmit intergenerationally as negative health and psychological effects”
Slavery
The Holocaust
Subjugation, Forced Relocation, and Massacres of Indigenous and Native American People
applying these concepts in practice
Continually develop your own cultural and personal awareness; integrate feedback
Recognize your power and privilege; use your powers for good
Recognize that different traumatic events may carry different nuanced meanings for different people
Explore and discover as much information as possible related to the community and cultural factors present within your client’s social networks
Appreciate the social and cultural contexts of trauma
Recognize and respect how people identify themselves within their social and cultural worlds
Engage in mutually empathic ways, showing your compassion and humanness
Stay connected with the people and groups that nourish your well-being
relational neuroscience
The same system that we rely on when in crisis could make life more difficult for a trauma survivor
adaptive vs. maladaptive
basis in RCT: Jean Baker miller, Women suffering from a lack of supportive relationships, Resulted in negative relational images - relationally deficient
adaptive versus maladaptive
adaptive: fight-flight-freeze, avoidance, distraction, disassociation, humor, isolation, and reliving/remembering (the lesson)
maladaptive: stuck-fatigue, no longer in danger, no longer in danger, no tethers reality, inappropriate, no connection/internalizing, stuck (no longer conscious)
the relational brain
The mind is an emergent property of the body and relationships
Mental life emerges from the flow of energy between the mind (brain) and its experiential environment (relationships)
Newer research views the brain to be essentially relational
Relationship between infant and caretaker
Mirroring neural pathways uses more mature brain
social synapses
Interpersonal verbal and nonverbal communication can be understood as operating as part of the same network as their own neurons, albeit at a different structural level
“Just as the neurons within a single brain form overlapping and interrelated webs of excitatory and inhibitory stimulation to create something greater than the sum of its parts, so do we as individual brains form an emergent social system through our networks of communication."
mirror neurons
active from birth (language development, emotional regulation, autobiographical memory, and empathic attunement)
mirror neurons: allow an observer to experience the intentional action of another individual or to feel another person’s brain through a kind of internal simulation
amygdala
Center of body’s stress response
Research - fear conditioning
Linked to positive learning
Receives sensory information from the various sensory systems and processes it as either threatening or non-threatening
medial prefrontal cortex
Reduced prefrontal cortex activation during the presentation of negative emotional stimuli or performance of learning and memory tasks under conditions of emotional interference
PTSD linked to reduced frontal cortex volumes
MPC is involved in regulating the amygdala’s response
Suggest a reciprocal relationship between them
More research about these interactions needed
HPA Axis
Plays an important role in the fight-flight-freeze response
When the amygdala is triggered, starts a coordinated response, including the HPA Axis
cortisol
Stress hormone leads to wide-ranging systemic effects on glucose metabolism, cardiovascular function, inflammation, arousal, learning, and memory
Research shows correlation but no causation
autonomic nervous system
Activated in a stress response (fight, flight, freeze)
Dilated pupils, increased heart-rate, blood vessels, GI tract, bronchodilation
PTSD – baseline autonomic hyperarousal
Smart vagus - vagus nerve
Communicates with SNS and PNS to inhibit activity during times of safety
Neuroception: describes how neural circuits distinguish whether situations or people are safe, dangerous, or life-threatening
Mirror neurons help with this alert system
hippocampus
Memory consolidation, spatial contextualization, and learning
Trauma stress can directly impact recall and encoding
Smaller hippocampal volume in those with PTSD
More likely to overgeneralize negative context
This could help to explain why trauma survivors struggle to differentiate between safe and unsafe
Correlation does not mean causation
ventrolateral periaqueductal gray
PTSD type with more dissociative, blunting, or submissive responses
Corresponds to freeze response
Conserves energy, avoids predators, reduces blood volume in extremities
Right hemispheric connections in session can help move away from detachment
relational effects of trauma
Amygdala hijack – heightened anger, impulsivity, and fear
Difficulty discerning safe from unsafe
Fragmented memories, flashbacks
Fight-flight-freeze (and fawn)
These traumatic experiences can lead to an unreliable sense of self
Anxiety about social interactions
Difficulty participating fully in the moment
neurology of compassion and connection
Prefrontal cortex: responsible for emotional regulation, remains neuroplastic across the lifespan
Early experiences are incredibly important, but not set in stone
Allan N. Shore:
Emphasized the importance of affective enactments in the process of therapy
Emotional transactions between client and counselor create the opportunity for both parties to grow and integrate a greater level of self-awareness
Discomfort can also be part of therapeutic rewiring
Safety and presence MUST be established
factors, approaches, and interventions that foster healing and resiliency
Nonverbal communication – how we learn, initially
Gestural communication – precedes speech
When message and body language conflict – most people believe the body language
trauma and the body
Described the trauma survivor as having subjectively “lost their way in the world,” and the work of healing from trauma involves a return to self, world, and relationship
Start small
Mindfulness meditation
Trauma-informed yoga
Somatic path to healing
Mental and emotional integration are important – so is physical
the nature of crisis
A crisis is a shock to internal and external systems
Perception or experiencing of an event or situation as an intolerable difficulty that exceeds the person’s current resources and coping mechanisms
Events can be natural disasters such as hurricanes, earthquakes, or fires
Human-driven catastrophes can include examples such as accidental gun shootings, oil spills, building collapses, and train derailments
Terrorism, sexual assault, abuse, genocide, robberies, and school violence are exemplars of intentional acts committed to hurt others
perception, proximity, and intentionality
perception: Both of the client and the counselor
proximity: Can be seen as physical and/or rational
intentional vs. unintentional: unintentional minimization; these concepts impact HOW people respond to a crisis or trauma
crises and emergencies
crisis: a time of intense difficulty
emergency: usually involves medical or law enforcement personnel (self-injurious behavior vs. suicidality)
not all crises are emergencies
situational crises versus developmental crises
situational crises: episodes that take people by surprise. and tax their resources
developmental crises: include life events and common struggles that people endure (puberty, death, living alone)
moments of crisis can flare from simmering stress levels and situational crisis can strike at any time
relational reciprocity
resilience grows from the act of reaching out for help
work together for mutual benefit and shared obligation
internally focused cognitive and coping models
cognitive model (based on CBT):
Focuses on how people develop and sustain irrational beliefs that serve as perceptual filters during times of crisis
Negative thinking spirals can lead people away from constructive problem-solving and objective perspective-taking before, during, and after a destabilizing event
Probing, expanding, exploring, and thought work can be challenging during times following a crisis
Short-term vs. long-term?
equilibrium approach:
A person maintains a repertoire of coping responses that become challenged – as a result, people enter a state of disequilibrium, and the tensions they feel overpower their natural capacities to cope
Goal is to help restore people to their previous homeostatic functioning through problem-solving and developing new coping strategies
psychological mobility: the option to make decisions and work toward solutions
biopsychosocial approach
Highlights interactions among personal, genetic, and demographic factors with psychological and social influences – each domain impacts another
At the genetic level, studies of hereditable predisposition find that many addictive and mental health disorders share genetic backgrounds
Keep in mind that people’s identity occurs within the context of social and cultural systems that can either hinder or support recovery
systemic and ecological approaches
Systemic and ecological approaches explore the dynamics, roles, and normative functions within small systems and larger organizations and communities
Systems theory:
Helps us understand the interactional patterns, normative emotional expressions, role adherence, and boundaries within a group, community, or family system
Homeostasis: posits that people in systems will gravitate toward familiar ways of acting and responding to each other, even when these styles appear harmful and counterproductive to an outside observer
A destabilizing event shatters familiar interactional and behavioral patterns, a crisis can serve as a touchpoint for a group, community, or family to evaluate how ways of coping and supporting one another can change
grief model and processes
Ambiguous loss: no definite answer, often without a clear end
Disenfranchised loss: arises when people cope with losses that are not socially sanctioned and bear the weight of stigma
The dual process model
Recognized that grief involves maintaining a connection to memories, and lost hopes, and accounts for many of these dynamics from a personal process model
Explores how people move between their new life (restoration) and living with their experience of loss
Meaning making:
Constructivist theory focuses on creating meaning from loss by engaging in validation, honest storytelling, exploring metaphors, creativity, and eclecticism o
Especially important that clients see that their stories are heard, received, and validated
Companioning With – your presence during tumultuous events
crisis counseling skills and approaches
preparation
PREPaRE Model
Predispositioning – the idea that certain factors in a person's life or background can make them more likely to experience a crisis, and US MORE LIKELY TO RESPOND EFFECTIVELY
1. Review and gain clarity about policy
2. Create your office space so that you have a means to escape
3. Develop resource materials that include suicide and violence screening instruments, safety plans, verified resources, etc.
4. Develop plans for your own self-care and strategies to mitigate compassion fatigue
relational approach
Person-centered theory (Rogers)
Relational-cultural theory (Miller & Stiver)
Infusing these approaches helps to form a solid relational foundation
Like the nondirective play therapy approach
Therapeutic relationship remains the most important
empathy and mutual empathy
“Empathy fuels connection. Sympathy drives disconnection” – Dr.Brene Brown
Making the effort to understand the client’s experience through their lens of core beliefs, values, relationships, and life experiences
Counselor serves as a witness to their pain and their recovery
Empathy should be reciprocal
Mutual empathy
Allows the client to know they have an impact on others
trauma counseling
The expanded definition of trauma includes physical threat of harm or death to self or others
Includes events “that are extremely upsetting, at least temporarily overwhelming the individual’s internal resources, and producing lasting psychological symptoms”
Bring the client’s experience to the foreground
Encourages counselors to focus on the lived experience of the clients
Accounts for the client’s relationship to the traumatic event
types of trauma
Primary trauma:
Direct trauma exposure and firsthand experience of the trauma
Secondary trauma:
Indirect exposure through being a part of a trauma-affected community or group
Vicarious trauma:
Beliefs and values begin to change as a result of working with trauma survivors
Results from an empathic connection with a client
Shared trauma:
Entire group experiences the same trauma at the same time (ex: natural disaster, terrorism)
PTSD versus ASD versus CPTSD
PTSD:
Event
Re-experiencing
Flashbacks
Nightmares
Avoidance
Hypervigilance
diagnose when symptoms persist beyond 1 month
ASD:
ASD can turn into PTSD over time
3 days of these symptoms to one month
common signs: dissociation, depersonalization, sleep disruption
symptoms: intrusion, negative mood, dissociation, avoidance, arousal (car accidents, natural disasters)
complex trauma
multiple traumas over time
often interpersonal and early-life
may lead to dissociation, somatic issues, poor boundaries, self-regulation difficulties
smaller in intensity
sense of self
5 keys assessment
Biopsychosocial
5 Key Areas:
Most immediate presenting concern(s)
Current functioning
Risk assessment
Current social support
Past and current coping skills
ACEs Questionnaire
Adverse childhood experiences
Posttraumatic Growth Inventory
COPE Inventory, Coping Responses Inventory
Good to help with tracking progress for the client
PCL-C
PTSD checklist civilian version
cognitive-processing therapy
12-week protocol with 4 main goals:
Psychoeducation about the information processing model of trauma
Increasing awareness of thoughts and feelings and their connections
Training in specific skills to challenge distorted thoughts and beliefs
Understanding subsequent changes in beliefs and worldview
2 core skill sets:
Cognitive processing
Exposure to traumatic material through reflection and writing
“Stuck points” - incomplete processing
Examine and deconstruct
Socratic questioning, worksheets, homework, self-statements, journaling
exposure therapy
Avoidance - defense mechanism used to cushion the impact of trauma
Prolonged avoidance blocks processing and integration
Highly structured, deliberate process
Deliberate rumination vs. intrusive rumination
Prolonged exposure (8-15 sessions):
Structured exposure approach, using in vivo and imaginal exposure
Exposure is paired with deep breathing and self-regulatory skills
Systemic Desensitization:
Briefer periods of exposure
Utilizes memory recall
trauma-focused CBT
Children, adolescents, and families
Emphasizes a set of central skills designed to build a child’s coping strengths, and it facilitates the processing of the trauma with an emphasis on family involvement
PRACTICE:
Psychoeducation and parenting strategies
Relaxation techniques
Affective expression and regulation
Cognitive coping strategies
Trauma narrative and processing
In vivo exposure
Conjoint parent-child sessions
Enhancing personal safety and future growth
eye movement desensitization and reprocessing
Bilateral stimulation - repeated sensory stimulation that alternates between the left and right sides of the brain and body
Catalyzes cognitive and emotional processing and aids in resetting physiological and neurological rhythms that are disrupted by trauma
Helps desensitize while expediting the reprocessing of the memory
8 phases:
History and treatment planning
Start off like you would for any other client
Preparation
Make sure they have the support they need for trauma work
The skills they need, the resources
Assessment
Assess where your baseline is
Desensitization
Eye movements
While doing the eye movements you’re also moving into the next phase
Installation of positive beliefs
Lessen the stress
Body scan
Sometimes trauma lives in the body instead of the brain
To figure out where they still may be feeling certain parts of the processing in their body
Closure
Closing activity after EMDR before the reevaluation
Reevaluation
After an EMDR session, there’s a reevaluation after
Period of EMDR where you get schedules for reevaluation if you need any more processing done
medication intervention
SSRIs
Mood stabilizers
Benzodiazepines
Prazosin/Minipress - hypertension medication
Risks:
Sedation
Compliance
Sleep disturbances
Impaired memory processing
Medication misuse/abuse
group interventions
Polyvagal Theory:
Socializing and interpersonal connection may be central to the healing process following trauma because they help to bring back “online” parts of the PNS that allow people to know they are no longer in danger
Connection is vital
Therapeutic adjunct:
Strengthens empathy, emotion regulation, and interpersonal attunement
Common to include CBT and PE
Co-occurring groups are common (to also address substance use)
Seeking safety
DBT
family interventions
Attachment theory:
How we learn to seek comfort and safety
How we learn to trust others and ourselves
Treatment approaches:
TF-CBT has family interventions built-in
Systemic Family Model
Emotion Focused Therapy
brief therapies
Psychological first aid
Contact and engagement
Safety and comfort
Stabilization
Information gathering
Practical assistance
Connection with social supports
Information on coping strategies
Linkage with collaborative services
Psychological First Aid Cheat Sheet
Psychological First Aid Field Guide
contraindications (not a therapeutic intervention)
Critical incident stress debriefing:
Designed for first responders and personnel
Has been used successfully
Protocol invites individuals to recall and share details of their experience during trauma response with the goal of normalizing and facilitating cognitive appraisal and emotional processing
Potential to retraumatize through exposure
NOT appropriate for primary survivors (not there in a professional capacity)
Those administering need to be appropriately trained
Structured prevention program NOT a therapeutic approach
warning signs on the safety plan should be…
what the client recognizes about themselves
examples: fatigue, hygiene, losing interest, isolating, repetitive thoughts, negative thinking, reckless/risky behaviors, appetite changes
myths about suicide
once someone is suicidal, he or she will always remain suicidal
talking about suicide is a bad idea and can be interpreted as encouragement
only people with mental disorders are suicidal
most suicides happen suddenly and without warning
someone who is suicidal is determined to die
people who talk about suicide do not mean to do it
suicide nomenclature
recommended terms
suicidal behavior
suicide
suicidal ideation
suicide attempt
suicide survivor
terms to avoid
suicidal threat
suicidal gesture
nonsuicidal self-directed violence?
suicidal self-directed violence?
risk factors of suicide
three domains of risk factors
a. health factors
b. environmental factors (social)
c. historical factors
risk factors: distal variable; presence of a measurable demographic, trait, behavior, or situation
correlation not causation
risk factors: age, sex, psychiatric diagnosis, history
context is key
warning signs of suicide
warning signs: proximal, implies imminent risk, and are particular to the inidividua’s current state of functioning
three domains of warning signs: talk, behavior, mood
warning signs suicide: IS PATH WARM
I: Ideation
S: substance abuse
P: purposelessness
A: anxiety
T: trapped
H: homelessness
W: withdrawal
A: anger
R: recklessness
M: mood change
connecting and working with suicide
foundation
listening deeply
connecting compassionately
offering genuineness
sharing mutual empathy
RCT:
counseling relationship
relationship tools
mutual engagement
competence
mutual empathy
growth-fostering relationships
suicide assessment
suicide assessment: suicide risk factors and lethality assessment
collaborative assessment and management of suicidality - CAMS
A: collaborative assessment of suicidal risk
B: collaborative treatment planning
C: collaborative deconstruction of suicidogenic problems
D: collaborative problem-focused interventions
E: collaborative development of reasons for living
chronic assessment of suicide events - CASE
A: presenting events
B: recent events (past 6-8 weeks)
C: past events
D: immediate events
suicide assessment
Assess risk factors that may increase suicidal behavior
Address protective factors used to provide the client with both internal and external support
Conduct a suicide inquiry by asking, "Are you thinking about killing yourself?"
Assess lethality level of means and specificity of suicide plan
Document assessment and recommendations
questions: ideation
"Are you thinking about killing yourself?"
"How long have you been thinking about killing yourself?"
"When is the last time you have thought about killing yourself?"
questions: lethality
"Have you thought about what you would use or do to kill yourself?"
"What ways have you thought about dying?"
"Do you know how to use the means?"
questions: means
"Where are the means?"
"Do you have access to the means and where?"
"Do you have the ability and know where to acquire the means?"
questions: plan
"Do you have a plan for killing yourself?"
"Do you know when you would do it?"
safety planning
always collaborative
goal: to reduce the client’s psychological, emotional, and behavioral isolation
safety planning can help to
recognize warning signs of an impending suicidal crisis
employ internal coping strategies
utilize social contacts as a means of distraction from suicidal thoughts
contact family members or friends who may help to resolve the crisis
contact mental health professionals or agencies
Reduce the potential use of lethal means
intervention Hybrid Model (suicide?)
A: predispositioning/engaging/initiating contact
B: exploring the problem
C: providing support
D: Examining alternatives
E: Making plans
F: obtaining commitment
G: following up
prevention strategies for suicide
universal prevention:
Strategies are designed to reach an entire population to maximize health and minimize suicide risk by removing barriers to care and increasing access to help
selective prevention:
Strategies target vulnerable groups within a population on the basis of characteristics such as age, sex, occupational status, or family history
indicated prevention:
Strategies target specific vulnerable individuals within the population who are displaying early signs of suicidal behavior or who have made a suicide attempt.
developmental trauma disorder
A: exposure to multiple or chronic adverse events
B: affective and psychological dysregulation
C: self and relational-dysregulation
D: experience of some PTSD symptoms
E: impairments in life domains
relational image: our own expectations of how others will treat us/will behave
controlling images: societal expectations based on cultural and social norms
(it’s more clinical intuition)
childhood physical abuse
Physical abuse: nonaccidental physical injury to a child cause by a caregiver, and can include punching, beating, kicking, biting, shaking, throwing, stabbing, choking, hitting, burning or otherwise causing physical harm
Long-term physical, social, and psychological consequences
Any form of abuse during childhood can have long-term effects
childhood sexual abuse
Childhood sexual abuse: any interaction between a child and an adult (or other child) in which the child is used for sexual stimulation of the perpetrator or observer
Can include touching and non-touching behaviors
Traumagenic dynamics model: used to explore and highlight how CSA can shape a person’s experiences of themselves and of the world
Betrayal, powerlessness, traumatic sexuality, and self-blame
childhood emotional abuse and neglect
Regularly deprived of love and support
Child neglect: the failure of a caregiver to provide for a child’s basic needs
a. Failure to attend to medical concerns
b. Failure to provide basic necessities
c. Failure to attend to psychological needs
d. Failure to address educational concerns
Allowing the child to drink alcohol or do drugs while in the home
Abandoning child for periods of time
sexual assault in adulthood and rape culture
Rape Culture – An environment in which rape is prevalent and in which sexual violence against women is normalized and excused in the media and popular culture. Perpetuated through the use of misogynistic language, the objectification of women’s bodies, and the glamorization of sexual violence, thereby creating a society that disregards women’s rights and safety.
gendered myths for men
A. staying tough and strong; real men are not vulnerable
B. they may have enjoyed the act (especially if perpetrated by a female)
C. perpetrators were gay
D. they will go on to perpetrate acts of sexual aggression themselves
