crisis & trauma intervention final exam

Relational foundation (chapter 9: developmental, transitional, and situational crises throughout the life span)

• Mutual Empathy – demonstrates our understanding of a person in their context

  • Client's welfare comes first

• Identity in Context – a person's pain, confusion and anxieties make sense in their context

• Perspectives on Loss – looking at during and after loss

  • Dual process model highlights the untidiness of change

  • Normalizes and validates the chaotic feelings

  • Not a linear process

• Mobilizing Resources - staying aware of community resources and networking with partners in the community who offer specialized services

  • Develop resources and explore groups that provide different types of support and assistance

childhood & developmental stressors in a family context

• •Frequently, children who struggle with mental health issues do not receive adequate services

  •The cumulative impact of early adverse childhood experiences often leads traumatized children to be diagnosed with multiple and often inaccurate diagnoses

  •Researchers and clinicians sought to include developmental trauma disorder (DTD) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed)

  oDSM review team rejected the proposal for inclusion

  oThe move to include DTD as a diagnostic category represents a shift in the view of trauma-related disorders to a social malady rather than a dysfunction within a person

  oDTD would be drastically reduced by the elimination of social contexts that foster child abuse, assault, chronic maltreatment, poverty, bullying, and the many faces of neglect

  oDevelopmental traumas can influence a person’s growth by limiting their experience of nurturing relationships and growth-oriented relational bonds

parenting children with disabilities: a new “normal”

• •The added demands of raising a child with a disability is a source of significant stress and can shift the foundation of the whole family

  •May experience increased stress adapting to their new and unexpected roles

  oAdjustments include coping with disappointment, guilt, uncertainty, and grief

  •Grief can be triggered by both internal and external factors

  oTriggers are often related to developmental milestones

  •Before addressing psychoeducation and skills training, we build trusting relationships with the parents

Parenting children with disabilities (parent education & skills training)

• Parent Education

  • Offer specific information about parenting a child with specific needs

  • Validate and normalize the adjustment process; Offer linkages to resources

  • Empowering language; Person first language

  • The disability is only 1 aspect of a person's identity

• skills training

  • Stepping Stones Triple P (Positive Parenting Program) educates parents on how to:

  • A) adopt an assertive approach to discipline

  • B) adapt to the reality of their child’s disability

  • C) establish realistic expectations about the development of their child

  • D) link children in in a shared community

  • E) practice effective self-care

parenting children with disabilities (parent environmental and social support, and parent well-being)

• parent environmental and social support

  • Parental well-being and family adaptation is tied to social connections, in which individuals in the network offer emotional support and provide experiences and solutions about various problems

  • Connection; Not alone

• parent well-being

  • Parents who share in a community of support gain access to helpful information and services and often experience higher levels of overall well-being

  • Practical efforts and social connections reduce systemic distress and can support the family and child as they navigate developmental milestones and potential behavioral issues; these connections also provide parents with meaningful support

additional stressors during parenthood

• •Adjusting to Parenthood

  •Traumatic Childbirth

  •Disconnection After Childbirth

stress and loss in the workplace (sexual harassment & job loss)

• sexual harassment

  • Title VII of the Civil Rights Act of 1964 (U.S. Equal Employment Opportunity Commission [EEOC], 2019b) -- any unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature constitute sexual harassment when this conduct explicitly or implicitly affects an individual’s employment, unreasonably interferes with anindividual’s work performance, or creates an intimidating, hostile, or offensive work environment.

  • Quid Pro Quo

  • Counselors offer education, support, and advocacy

• job loss

  • Negatively affects life satisfaction, mental health, and life domains (i.e., financial and relationship strain, poorer health and quality of life, diminished identity and self-esteem)

  • Counselors help people develop positive daily routines, explore past coping and resilience strategies

  • Counselors nurture and explore a person’s strengths and curiosity in their new and potentially unstable life

  • Counselors would refer out to career counseling, job help, etc.

physical challenges and rehabilitation (children)

• Young children, people living with developmental disabilities, and those with medical needs may be more susceptible during sudden destabilizations

• People with a disability are more likely to experience sexual assaults

• Adjustment to a disability is an essential part of the rehabilitation counseling process (it is nonlinea)

• Strategies to strengthen self-compassion can include meditation as well as practicing compassion and self-compassion

• It is recommended that counselors should

  oA) assist with the exploration of the personal meaning of their condition (i.e., processing feelings of loss and grief)

  oB) provide relevant medical information (i.e., prognosis; functional and vocational implications),

  oC) encourage supportive family and group services (i.e., educational, psychotherapeutic, coping skills training groups)

  oD) teach adaptive coping strategies for community functioning (i.e., assertiveness; interpersonal, decision-making)

transitions & stressors in later adulthood (empty nest & retirement)

• empty nest

  • A time of crisis when the absence of their child creates a vacuum of interactions, responsibilities, and routines

  • Caregivers may feel directionless, lonely, and lost as they adjust to their new way of life

  • Marital discord may arise (child may have been acting as buffer)

  • Counselors should assist with self-discovery, reconnection through developing shared meaning, and intimacy

• retirement

  • Career or work generally becomes part of our identity

  • Loss of income, social contact, status, routine, and purposeful activity can create a social and vocational vacuum

  • Mixed research findings

  • Counselors should assist with establishing meaningful activities, interests, and recreations that replace the void of work

  • Would be helpful to create a plan BEFORE retirement

connections and disconnections (couples/families)

• We are hardwired to desire connection with others and to feel a sense of belonging in our groups 

• Often, our deepest connections can be found within our family systems 

• Families are human systems 

• Home can be love and connection, and at other times, despair and disconnection 

• Crises and traumatic events occur within family systems and intimate relationships 

• When these events occur, they can powerfully affect the fiber of our worlds

domestic violence/IPV (coupled/families)

• Domestic violence, also known as intimate partner violence (IPV) 

• IPV is both complex and terrifying 

  • Name-calling, chastising, throwing objects, hitting walls, hitting a partner, and sexual coercion 

• Power, control, insecurities, impulse control, and failure to manage emotions and stress are core features of IPV 

• When a person (or people) imposes dominance over a partner, child, or other family member and creates chaos and mayhem 

• This form of violence is not only abusive in a literal sense, but it also cuts at the fundamental layer of the recipient’s sense of being 

• It can destroy a person’s sense of trust and threaten a person’s ability to sustain trust in others 

• People who experience IPV not only suffer the injuries of the abuse, but they also suffer a profound sense of betrayal

intimate partner violence (couples/families)

• IPV is described by the World Health Organization (2010) as “behavior within an intimate relationship that causes physical, sexual, or psychological harm, including acts of physical aggression, sexual coercion, psychological abuse and controlling behaviors.” 

  • Women are subjected to IPV at disproportionately higher rates than men 

  • Higher risk for sustaining injury and even death 

  • LGBTQ+ individuals experience proportionately greater instances of IPV 

• IPV can create a wound so profound it leaves the receiving partner in shock, bewildered, and sometimes immobilized, distorting a person’s perception of worth, sense of control, and logistical options

counseling ipv (couples/families) (SHORT ANSWER)

• Counselors:

  • recognize the crises these experiences bring and the often traumatic consequences to such violations 

  • use their position to advocate for each person’s safety while navigating the disconnections and relational expectations or images each carries 

  • attend to building connection while helping both individuals and the couple engage in the challenging work of mutual understanding and eliminating IPV behaviors 

  • are clear in articulating that abuse is never acceptable 

  • clearly identify the accountability factors that must be in place for IPV to cease and for couples to move toward shared honor and respect 

  • recognize a person’s right to be free of injury within a relationship and use a direct yet relational frame for conceptualizing abuse 

• Relationally competent counselors use the power of the relationship to support injured clients while offering a valuable connection to the perpetrating partner

• Counselors support clients in developing: 

  • Emotional regulation skills 

  • Effective communication patterns 

  • Compassion for self and others 

  • Recognizing that sociopolitical, environmental, fiscal, and entrenched patterns  contribute to the preponderance of assaults committed every day

Infidelity (couples/families)

• Can trigger intense and traumatic grief reactions

• Spouse and any children who may be aware of the circumstances often become immersed in shock, despair, disbelief, and a profound sense of abandonment

• Creates crisis points in marriages, and families are often thrust into an orbit of personal agony and, at times, public scrutiny

counseling infidelity (couples/families) (SHORT ANSWER)

• Counselor should recognize that multiple systems are affected by the situation we hope the counselor will remain aware of some of the potential pitfalls of the systemic approach 

  • Systems approach assumes that symptoms are an expression of how the family system functions and are serving a purpose for the family

  • Could inadvertently suggest that the faithful spouse is partially responsible for the infidelity, which could further victimize him and convolute the crisis

• Relationally competent counselors look at power dynamics within the couple relationship and the experiences of connection-disconnection-reconnection

• RCT would consider whether chronic disconnections exist, leading to experiences of condemned isolation

• RCT counselors would support and encourage respectful, authentic dialogue, recognizing the many disconnections that can exist

• RCT counselors would reject assuming a neutral or protective distance in counseling because that would invite disconnection

Incest (couples/families)

• Children have an inherent right to believe that the people entrusted with their care will have their best interests at heart 

  • When this trust is violated by sexual abuse, the damage can be profound 

  • Some failures retreat to secrecy or denial because they fear litigation or public shame, and because they do not truly trust that counseling can help 

  • When children are not believed, the child suffers not only the abuse of the perpetrating parent, but also the betrayal of both parents 

• Perpetrators of family incest often “groom” a child to prepare them for incest 

  • They invest in creating a distinctive bond with the child, perhaps bringing special gifts, sharing personal information more appropriately shared with an adult, estranging them from other peop[le, and builidnf a secret society of sorts between the two 

  • This perceived closeness can elicit a sense of confusion and protectiveness within the child toward the abusing person 

• Over time, children try to make sense of what is happening and can come to believe the perpetrator’s reality at the expense of their own

  • May feel emotionally torn between desiring the familiar attachment and detesting the abuse

counseling incest (couples/families)

• Research indicates that children often experience multiple traumas of sexual abuse before reaching out for help 

  • Sexual abuse can be repetitive and prolonged 

  • Given the developmentally vulnerable age of the child, sexual abuse can deeply affect the child’s future relationships 

  • Sibling-to-sibling abuse can occur 

• Individual counseling for the child and psychoeducation or family counseling 

  • Provide emotional support 

• Counselors can help nonoffending caregivers heal from potential vicarious trauma, and they can encourage consistent and nurturing care and protection for the children 

• Counselors can also help families examine any multigenerational patterns of abuse while using the power of the therapeutic relationship to support family healing

• questions to ask: what does the family know/doesn’t know, has it been reported, where are they/where are they located, etc.

divorce

• Divorce is a crisis that over the past several decades, has come to affect more and more families 

  • High-profile divorces; family disruptions due to abuse, neglect, infidelity, and financial problems; as well as other issues, are crisis points for some families 

  • Some families regroup during these times and seek support 

  • Others are simply too preoccupied and can leave children feeling especially vulnerable and alone

• Although divorce can create a crisis within the family, the way that both spouses manage the divorce and treat one another in the process directly affects how children view relationships and respond to their own relationships

counseling divorce

• Supportive counseling services and psychoeducation related to the mediation and divorce process are useful resources for family members undergoing high-conflict divorce 

  • Families with high-conflict patterns generally engage in legal custody battles that potentially wreak havoc on at least some of its members, particularly the children

• Using RCT principles – such as counselor authenticity, honoring of disconnections while fostering connection, and moving toward a power-with position – can help couples and their children cope with these often-chaotic times more authentically and can enhance the potential for each person’s healing and growth toward connection

suicide of a family member

• Suicide is often described as a permanent solution to a temporary problem

• Although strong connections between family members may serve as protective factors against suicidal behaviors, this outcome is not always the case 

• These losses are devastating to those who are left to make sense of the tragedy 

• What if? Should I have…. Could have…. What did I miss? 

• Death by suicide destabilizes the family in profound ways, and it alters the way family members live their daily lives 

• Surviving children assume various roles following a suicide, such as caretaker, peacemaker, or rebel, and whereas some seek closeness, others withdraw 

• Still others escape into substances and other self-destructive behaviors 

• Some children feel a need to talk about the loss, whereas others do not 

• Sometimes they wish they could talk to their parents but do no want to burden them, so they keep their feelings, fears, and pain inside 

• Parents whose children commit suicide experience a unique form of grief that is complex and often clouded with guilt, remorse, and despair

counseling suicide of a family member

• Counselors can guide parents in understanding the diversity of ways that children grieve and the developmental factors that influence their children’s grief 

• Parents whose children commit suicide experience a unique form of grief that is complex and often clouded with guilt, remorse, and despair 

• Counselors can assist with finding purpose 

• Counselors can help clients to explore new ways to establish legacy

childhood illness and death

• Anticipatory grief: feelings of grief that occur before an impending loss 

• Dynamics in play before the diagnosis are often exacerbated, and parents’ responses will vary depending on their own personalities and life histories 

  • Denial 

  • Detachment 

  • Feeling spread too thin 

  • Overprotective 

  • Caretaker role 

  • Increased fear

addiction and mental health

• Addiction is a disease of disconnection 

• Disconnection from the family, a spouse, children, a job, and from oneself 

• Addiction creates the illusion that drugs truly are a best friend or, in some cases, a supportive relative 

• Families with addiction experience the heartbreak of many kinds

  • Some feel shame, guilt, and regret 

  • At other times, they feel resentment, anger, and embarrassment 

  • They may blame themselves and each other, and many feel isolated and alone 

• Creating and maintaining safety is challenging for families entrenched in addiction, long after treatment ends

relational-cultural response (working with people in crisis)

• When counselors work with people in crisis, who they are with their clients is as important as what they do 

• Counselors consider any power dynamics that could exacerbate the impact of the crisis, and they reflect on how they can use their power well 

  • RCT would refer to this process as sharing “power-with” another person 

  • Counselors would also consider what relational images the family bringes to the counseling session 

• Relationally competent counselors are aware that people in crisis need relationships they can trust, and they strive to create authentic and empowering connections with them

• They recognize the challenge of caring for a loved one in their suffering and of fighting alongside them

• They understand that when the fight is unsuccessful and the medical treatment questionable or traumatic, a family’s grief can become a medical trauma

motivational interviewing (couples/families)

• OARS: 

  • Open-ended questions: 

    • To explore concerns, promote collaboration, and understand the client’s perspective 

  • Affirmations: 

    • To support strengths, convey respect 

  • Reflective listening: 

    • To explore deeper, convey understanding, deflect discord, elicit change talk 

  • Summarize: 

    • To organize discussion, clarify motivation, provide contrast, focus the session and highlight change talk

cognitive behavioral therapy (couples/families)

• 3 Cs of Cognitive Restructuring: 

  • Catch it 

    • Mindfulness of self 

  • Check it 

    • Reality testing, checking the facts, and finding evidence 

  • Change it 

    • Reframing thoughts to be more adaptive

dialectical behavior therapy (couples/families)

• 4 modules of DBT: 

  • Mindfulness: 

    • Becoming more aware of self and others, while focusing on improving an individual’s ability to accept and be present in the current moment 

  • Distress Tolerance: 

    • Tolerating and surviving crises while learning to accept oneself and the current situation 

  • Emotion regulation 

    • Strategies and tools to help manage and change intense emotions that are causing problems in a person’s life 

  • Interpersonal effectiveness: 

    • Techniques allowing a person to communicate with others in a way that is effective and assertive while maintaining self-respect and strengthening relationships

FEMA guidelines

• FEMA’s disaster planning model follows 7 core principles to follow when developing disaster response plans and designing community recovery efforts: 

1. Individual and family empowerment 

2. Leadership and local primacy 

3. Predisaster recovery planning 

4. Engaged partnerships and inclusiveness 

5. Unity of effort

6. Timeliness and flexibility 

7. Resilience and sustainability and 

8. Psychological and emotional recovery

experiential incongruence (community trauma and grief)

• Experiential incongruence occurs when disasters strike unexpectedly, out of context, or with incomprehensible magnitude 

  • Challenges worldview 

  • Can destabilize a sense of safety and security 

  • Can complicate reactions 

  • Especially challenging for children

counseling communal trauma and grief (SHORT ANSWER)

• Counselors should avoid pathologizing these experiences 

• Counselors should provide an accepting space for clients to move through their grief at their own pace and understand that healing has its own timeframe 

• Counselors also recognize that behaviors that may appear maladaptive are serving as strategies for survival 

  • If supported, these strategies can transform into relational bonds that have the power to transcend the original trauma bond 

• Counselor provides on-the-ground support immediately after a disaster 

• Counselor should approach disaster response systemically, so they can appreciate that powerful traditions still drive many interactions, despite shattered infrastructures 

community violence

• When a person is murdered, the effects ripple through a community 

  • The effects of these losses can range from the devastation felt by close friends and family to widespread reactions when many people experience unexpected violence 

  • Most people who have experience a violent crime have developed social and economic patterns 

    • Thus, the toll that is violence takes on a community cand be profound and the recovery process following a communal trauma must address long-term goals 

• Barron (2013) - we must adequately brace the support structures in „the community that support the children in the community: Families, First Responders, Health Care Providers, Educators, Clergy, Arts and Recreation.”

• „Data suggests that many people suffer privately and/or alone

relational foundation (community violence and community trauma)

• Separates people from others 

• Shatters sense of safety

• Limits much much-needed resources 

• Shodks  pool in  isolation 

• Freezes communication 

• Further complicated (if counselors are survivors themselves)

existential trauma

• shattering of an individual’s fundamental sense of  meaning, purpose, and identity due to a traumatic experience

shared trauma

• When a therapist and client both experience the same traumatic event, either directly or vicariously

primary trauma

• initial injury sustained by an individual during a traumatic event, whether physical or psychological

secondary and vicarious trauma

• emotional distress experienced when someone hears about or witnesses the trauma of another person, even if they weren’t directly involved in the traumatic event

traumatic grief

• a type of grief where the experience of loss is compounded by trauma, often due to the circumstances surrounding the death or loss

complicated grief

• when grief persists for a prolonged period (typically beyond a year and significantly impacts daily living

neurobiological responses (community violence/community trauma)

• Autonomic nervous system is activated 

  • Flight, fight, freeze (fawn is more of a learned behavior) 

• Broca’s area: controls language processing

  • When deactivated - people experience traumatic memories in somatic form 

• Neuroception: subconscious process where your body, without conscious thought, assesses whether a person, place, or situation is safe or dangerous 

  • Mirror neurons 

• Stress contagion: the phenomenon where observing or experiencing the stress of others can lead to an increased stress response in oneself

timing and type of interventions (community violence/community trauma)

• Immediate phase: the response to a community-based tragedy or natural disaster 

  • Disaster mental health: encompassess the psychololgical and emotional impact of disasters on individuals, families, and communities we all as the provision of services to support recovery 

  • Psychological first aid 

• Intermediate phase: the creation of organized strategies and plans for individual and community recovery begins to take place

  • Involves identifying affected individuals and groups 

  • Targeting services 

  • Building resources 

  • Enhancing the clinical capacity of existing organizations 

  • And instituting trauma-informed training

Sutherland Springs example (community violence/community trauma)

• A: meeting with the community to learn more about how to help 

• B: building with infrastructure for this service 

• C: collaborating with many sectors of the city and region 

• D: navigating the necessary administrative and legal offices 

• E: working to secure the location and create structure 

• F: identifying personnel to lead the effort onsite 

• G: working with organizations during the development and opening 

• H: participating in ongoing events, including regular meetings in community

community counseling strategies (community violence/community trauma) (SHORT ANSWER)

• Community interventions encourage connection and creativity 

• Assess community needs 

  • Identify gaps in current services 

• Community-wide education on all aspects of trauma is needed 

  • Public psychoeducation should be delivered as early as possible, repeatedly, and through a variety of delivery methods 

  • Collaborating with religious leaders in helpful in delivering information to individuals without access to technology 

• Sensitivity to the needs of the community, as well as recognizing the fracturing between and among groups that can arise, is vital 

  • Provide workshops, programs, resources, public forums, and panel discussions to clinicians, leaders, and residents of the community 

• Provide ongoing communication and information

relational foundation of the military

• Collectivism: 

  • Paramount and inescapable within military culture 

  • Initial training: placed in situations that facilitate the development of a “bond that transcends all others, even the marriage and family bonds we forge in civilian life” 

• Hierarchy: 

  • The “rigid hierarchical system based on dominance and subordination” is designed to promote the superlative functioning of the military system 

  • No room for disobedience or disrespect 

• Masks and compartmentalization 

  • The masks are methods by which service members disconnect from others 

  • The mission is more important than the self 

  • Compartmentalization is necessary because personal issues could compromise the mission

the masks of the military (SHORT ANSWER)

• Secrecy: 

  • The separation of work and home life and involves keeping problems in each area from overflowing into other areas of life 

• Stoicism: 

  • Maintaining an outward appearance of stability at all times 

  • Critical component to combat survival 

  • The stress of constantly preparing for change can induce emotional havoc for service members and their families 

• Denial:

  • Involves hiding fear and anxiety from others and themselves 

  • This mask involves the complete rejection of stressors that could become problematic during combat to allow for full focus on the mission at hand 

  • Using denial to cope (after it is safe to explore the stressor) can cause problems to arise

the deployment cycle

• Predeployment: 

  • Service member is notified of and training for an impending deployment 

  • Family is preparing for the separation 

• Deployment: 

  • First month of physical absence 

  • Family and service member adjust to their new roles and routines 

• Sustainment: 

  • Family and service member have adjusted to their new lifestyles and expectations 

  • Lasts until the final month of the deployment 

• Redeployment: 

  • Service members and families prepare for the service members’ return home 

• Postdeployment: 

  • Service member reintegrates; the routines, roles, and responsibilities established during sustainment are often renegotiated (lasts 3-6 months)

reentry into civilian life (military)

• Redeployment: 

  • Service member prepares to return home from a deployed status 

  • May be anxiety-provoking for many service members 

  • There may be a sense of disconnection or detachment from family and friends 

• Postdeployment: 

  • Begins after the service member returns home 

  • Period of redefining, reestablishing, and renegotiating 

  • This period is often a time of ambiguous presence, during which the service member is physically present but psychologically absent 

  • Spouses may express irritation that the service member wants to spend time with other returning troops rather than spending free time at home 

  • Hall (2016) reported that service members may benefit emotionally from processing combat experiences with individuals with whom they served

involuntary vs. voluntary separation (military)

• Involuntary separation: 

  • Service member did not want to leave service but was required to do so because of a medical reason or injury (physical or psychological), or because of disciplinary actions 

  • Disciplinary actions resulting in a general or dishonorable discharge, limiting or eliminating post-service benefits such as medical coverage 

  • Involuntary separation can be traumatic, leaving some individuals struggling to find meaning and purpose in a civilian community 

• Voluntary separation: 

  • Service member chooses to leave service before being eligible for retirement 

  • Not uncommon for service members to feel disconnected, alienated, and misunderstood by their civilian counterparts 

  • Priorities and perceptions of what matter are inevitably altered; not uncommon for a service member to become irritated with a civilian for complaining about something they see as trivial

suicide and substance use (military)

• At any point during reintegration to the civilian world, suicide risk may be elevated

• Disconnection may feel insurmountable, which can lead to the possibility for suicidality

• Use and abuse of substances are common to numb chronic physical pain from injuries, as well as feelings of fear, depression, and posttraumatic stress or other trauma symptoms

• Substance use issues may cause conflict with family and friends, and the service member may believe that their loved ones are better off without them

losing a family member (military)

• The military lifestyle is one of constant transition, which means loss occurs frequently 

• Grieving the death of a parent, child, or sibling who dies in combat may produce feelings of ambiguous loss for those who are left behind 

• Ambiguous loss defies resolution or closure, and it often results in a prolonged state of confusion about the loss 

• Young children may exhibit jealousy or resentment toward other youth whose military parent returned safely, and they may show heightened concern for the safety and well-being of the remaining parent 

• Young children may also struggle to understand the permanence of death and express a desire for the deceased parent to come home 

• Older children may develop intense separation anxiety, mitigated by reunification fantasies

• Death of a spouse or parent not only brings immediate grief for individuals but also has long-lasting ramifications for the family unit

• The loss of the service member means that the family may lose their military identity when they must move away from the support of their military community

the effect of traumatic injuries (military)

• PTSD: 

  • Military service members play a uniquely active part in their own trauma, thought to account for elevated arousal symptoms such as anger, aggression, and hostility 

  • With combat stress at the heart of war, “it is hard for warriors not to perceive stress symptoms of any kind of evidence of personal weakness and failure” because this is at the core of their identity and what they have been called on to do 

  • Family members are at risk for developing secondary traumatic stress 

• Moral injury:  (SHORT ANSWER)

  • Trauma that occurs when a service member must go against a deeply embedded moral belief or ideal, usually because of military orders or the environmental context 

  • They may feel intense guilt or shame, and they often replay the scene in their head, wondering what could have been done differently 

  • Moral injury is believed to “impair and sometimes destroy the capacity for trust. When social trust is destroyed, it is replaced by the settled expectancy of harm, exploitation, and humiliation from others.”

military sexual trauma

• The military system creates a uniquely oppressive context for sexual trauma survivors in which 

  • (A) The assault occurs where the survivor lives and works, and where they will continue to have to live and work, usually with ongoing contact with the perpetrator; and 

  • (B) The survivor may feel unable to speak out about the assault because the perpetrator may be in a position of power over them, and also because reporting the assault could damage the group cohesion necessary for successful unit functioning 

• PTSD symptoms are 9x more likely in female service member survivors of sexual trauma 

• MST is known to heighten the risk of suicide attempts and completion 

• Physical touch and sexual intimacy may be difficult for these service members, creating barriers within their relationships

military domestic violence

• The cultural values of hypermasculinity, aggression, group cohesion, hierarchy, and authoritarianism may converge to create a perfect storm when they are used abusively 

• Military training necessarily prepares service members to be comfortable with violence and killing, and harnesses aggression and anger to be used within combat 

• In the military, work and home often converge, and this aggression and violence may permeate the family system 

• Additionally, the arousal symptoms of PTSD, crippling mistrust due to moral injury, and inhibitions lowered by substance abuse-often used to avoid trauma memories - can augment the risk of domestic violence 

• The context for abuse is so deeply embedded within the necessary military training and structure that it is extremely challenging to eradicate this issue

counseling strategies (military)

• Cognitive behavioral therapy 

• Solution-focused brief therapy 

• Relational-cultural theory 

• Cognitive processing therapy 

• EMDR 

• Somatic therapy 

Counseling strategies: 

• Power: 

  • Power-over: unilateral  (save this for when you really need to protect the client) 

  • Power-with: collaborative (use this a lot so that you can build trust) 

• Connection and disconnection: 

  • Central relational paradox: individuals desire connection and will hide parts of themselves that they believe are unacceptable in an attempt to avoid rejection 

  • Relational competence: the belief that one is able to engage competently in and bring value to various relationships

barriers to care (military) (SHORT ANSWER)

relational foundation of resilience

• We are living in a time where trauma is becoming more and more commonplace 

• We speak of resilience in ways that hold hope for a light at the end of the tunnel – for meaning in life after adversity or loss 

• We question why it is that some people find their way through trauma, whereas others do not 

• We consider the protective factors that support a person’s resilience and the relational dynamics that support resilience

traditional resilience models

• Resilience is traditionally viewed as a function of some innate, internal quality or constellation of qualities that will somehow see people through the darkness 

• Biological, environmental, and personal factors - such as temperament, intelligence, self-esteem, internal locus of control, mastery, and social support – are common characteristics cited as important in the resilience literature 

• Sehgal (2015) has suggested, the popular notion of resilience is a convenient catchword, placing the focus on a person’s individual character while distracting them from critically examining social conditions that isolate and oppress

• Idealizing individual resilience can be a subtle, but effective, way to silence those whom society might deem insufficiently resilient because they protest hardships induced by social injustice, inequality, and discrimination

relational resilience (SHORT ANSWER)

• Jordan (2018) proposed that resilience develops and is strengthened through relationships; specifically, relationships that cultivate the mutual growth and development of all involved

• Counselors attuned to the systemic and shared nature of dysfunction and healing see how resilience makes sense in context and the ways that helping professionals have collective power to enact social change

  • We work to heal the forest

• Jordan (2018) defined a relational view of resilience as “the capacity to move back into connection after disconnection, and the capacity to reach out for help”

• When people reach out in times of distress and are supported, they nourish and build their capacity for resilience

courage and relational resilience

• Trauma can disconnect people from their core sense of dignity as a human being

• With an appreciation for the strategies people use to survive traumatic disconnection, we walk with them throughout their journey to reconnect with themselves and others

• Our potential for healing and resilience can be strengthened through the connections we form and through the support and care we offer one another during times of crisis and loss

roots of resilience: dignity

• Dignity - the state or quality of being worthy of honor or respect

  • Dignity is at the root of resilience

  • Dignity is the seed that generates the creativity needed for positive change

• One of the most promising paths to fostering resilience is actively and consistently recognizing the dignity of all people

• HumanDHS - (a global network) strives to fully understand the dynamics of dignity as well as its violation through many forms of humiliation

humiliation (resilience)

• Humiliation - the experience of being deeply devalued, demeaned, denigrated, or dehumanized, a sense of violation involving being cruelly or brutally “put down”

  • “The strongest force that creates rifts between people and breaks down relationships”

relational equality in dignity (resilience)

•  emphasizes that everyone is born with inherent worth and that dignity is enhanced through positive interactions and respect for others

relational ecology (resilience)

• a framework that emphasizes the interconnectedness and relationships between humans and their environment

  • Strive to decouple our sense of worth and dignity from material forms of wealth, status, and power

relational dialogue (resilience)

• a type of dialogue where the relationship between the participants is the focus, not just the information being exchanged

  • "Waging good conflict"

creativity in counseling (resilience) (SHORT ANSWER)

• Entropy - gradual decline into disorder

• Creativity in Counseling - “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”

  • Opposing force to entropy

  • Can be used destructively or positively

  • Counselors can express creativity by creating safe spaces to strengthen the dignity and resilience of clients, supporting their psychological growth and their increasingly healthy sense of belonging

creativity in action (resilience)

• Counselors use of the full range of human expression, resourcefulness, and imagination to facilitate growth

• Offer reframes, have brainstorming sessions, and seek novel solutions

• Creativity drives best practice and revision

• Resourcefulness - quick, clever, think outside of the box

• Divergent Thinking - explore many different solutions and possibilities

• Creativity can spark change within a system, strengthen resilience and dignity, and reduce risk of further isolation and dehumanization

relational bridge building (resilience)

• As counselors, we become advocates for our communities and each other

• Putting the quality of our relationships—with people and the planet—at the center of our concern

• This is opposed to the “me-versus-you” language and thinking that generate ruthless competitive achievement and separate entities vying for limited power and resources

• Resilience is often offered during times of adversity and great loss, yet the pathways to resilience are often unclear

• Recognizing our pain; acknowledging our right to grieve; and understanding the systemic, societal, and cultural influences that either support us in our healing or heighten our pain and feelings of humiliation are important variables in our ability to build

the toll of violence (K-12 schools)

• Acts of violence in schools carry a heavy cost, and the traumatizing nature of such acts presents risks for students’ mental health concerns 

• Heightened levels of anxiety, posttraumatic stress, acute stress disorder, complex trauma, secondary trauma stress, mood changes, prolonged grief, and depression 

• Violence in or related to the school environment affects students’ cognitive, social, and emotional development; learning potential; and school attendance, as well as their engagement in career development 

• In anticipation of a crisis, schools ideally create a thorough and collaborative crisis plan that allows the various personnel to understand potential risks and to implement a plan of action should a crisis occur 

• Without a well-vetted safety plan, a tumultuous situation can devolve into even more chaos 

• Crisis planning in school settings is a major undertaking and involves buy-in from all levels, clear channels of communication, and investment from the community and administration

key elements (violence K-12 schools)

• (A) creating a planning team to identify and rank potential threats and 

• (B) outlining strategies and resources to address potential crises 

• After the plan is developed, the team provides regular ongoing training to staff and evaluates the plan on a regular basis 

• Planning teams consider practical elements such as identifying evacuation procedures, establishing annexes to provide physical safety, and developing communication strategies to mitigate the spread of misinformation

relational foundation (K-12 schools)

• School personnel should create environments to help students thrive using “developmental, strength-based, contextually-focused, and wellness perspectives 

• Counselors consider the contextual factors that affect students’ ability to fully participate in the school community 

• An emphasis on growth-fostering relationships is an important relational-cultural theory (RCT) tenet inherent in the work of professional school counselors 

• Effective school counselors invest in relationships that empower students to develop accurate perceptions of themselves and their worth, as well as the interpersonal skills that support meaningful connections with others 

• RCT suggests that youth may engage in inauthenticity to survive a system that does not embrace or allow it 

• When a school community faces violence and loss, healing grows when the people involved, and those outside the system, support one another in the immediate aftermath and maintain an ongoing connection 

• Counselors respond with anticipatory empathy and nurture relational resilienc,e shown when students reach out

bullying (K-12 schools) (SHORT ANSWER)

• Can erupt from unequal balances of power and influence 

• Nearly ⅓ of all students ages 12-18 reported having been bullied at some point 

• Individual bullying: When one individual or a group bullies another person 

• Pack bullying: bullying carried out by groups 

  • Most prevalent in high schools 

• Physical bullying: includes physical abuse, threats of physical harm, and attempts to force individuals to act in ways against their judgment and values 

• Emotional bullying: includes attempts to demean, ostracize, or minimize others 

  • Most prevalent 

• Relational bullying: involves the manipulation of social status or reputation 

  • Most prevalent among girls

motivation behind school shootings

• 71% of school shooting offenders experienced depression and suicidal thoughts and made suicidal threats, gestures, or attempts before committing the offense 

• 54% of youth who bully had been victims of bullying, abuse, or neglect and had a history of violence 

• Students who bully experienced or perceived rejection from individuals or organizations 

types of school shooters

• Traumatized shooter: dysfunctional and traumatic past, history of abuse and instability 

• Psychopathic shooter: lack of empathy, sense of superiority, takes pleasure in causing pain 

• Psychotic shooter: hallucinations or delusions stemming from a mental health disorder 

prevention/intervention K-12 schools

• Comprehensive school counseling services support the domains of academic, career, personal, and social development 

• School counselors provide interventions and support through…. 

  • Guidance curricula help students acquire growth-supportive, age-appropriate competencies 

  • Individual planning focuses on individual students’ goal setting and planning in major life and academic domains

  • Responsive services target students whose personal concerns and problems may affect their development

    • This responsive services team addresses any preventive, remedial, or crisis intervention issues in a student’s life

  • System support services focus on the enhancing processes and systems that support students’ success at institutional

prevention for K-12 schools

• Guidance and classroom activities: 

  • Students receive skills training to develop a repertoire of skills and knowledge to help them cope during potential crises and stressful situations 

  • Involves developing communication and problem-solving skills to build and sustain relationships 

  • Counselors deliver age-level interactions focused on helping youth gain personal awareness and develop strategies to relate well with others in the school context 

• Small groups 

  • Youth who experienced loss/abuse/mental health issues can find more intimate and tailored support 

  • Caring relationships seem to be the most powerful ingredient for helping pupils develop empathy, self-worth, and empowerment through authentic connections with others

Intervention for K-12 schools

• Through individual and group counseling, students may begin to experience authentic relationships and develop mindsets and skills necessary to address the stressors and problems in their lives 

• School counselors develop consultative relationships with parents, teachers, and support staff who can advocate for students as they make sense of traumatic incidents 

• Cognitive behavioral intervention for trauma in schools 

  • Provides psychoeducational modules, individual counseling, and skills training to mitigate the effects of trauma 

• Coalition for Grieving Students 

  • Offers strategies to work compasstionately and authentically with students who experienced loss

relational foundation for higher education

• RCT discusses the importance of authentic connection, recognizing that relationships continuously shift between connection and disconnection 

• College students can be particularly susceptible to feelings of disconnection as they attempt to create new friendships and social networks in their new setting

• This sense of disconnection may contribute to loneliness, homesickness, and isolation

bullying in higher education (SHORT ANSWER)

• Overt bullying: physical, verbal, or social 

• Covert bullying: subtle acts of aggression or intimidation 

• Direct bullying: intimidation that occurs directly between the aggressor and the target 

• Indirect bullying: intimidation between the aggressor and the target, but involving others in the process 

• On-ground bullying: involves subtle or overt acts that occur in-person 

• **Physical bullying: involves acts of violence toward another person 

• **Psychological (verbal) bullying: name calling, threatening remarks 

• **Relational (social) bullying: attempts to harm someone’s reputation

cyberbullying in higher education

• Posting comments or rumors about someone online that are mean, hurtful, or embarrassing 

• Threatening to hurt someone or telling them to kill themselves 

• Posting a mean or hurtful picture or video 

• Pretending to be someone else online to solicit or post personal or false information about someone else 

• Posting mean or hateful names, comments, or content about any race, religion, ethnicity, or other personal characteristics online 

• Creating a mean or hurtful webpage about someone 

• Doxing: an abbreviated form of the word documents, destroys the privacy of individuals by making their personal information public, including addresses, social security, credit card, and phone numbers, links to social media accounts, etc.

consequences of bullying for higher education students

• may include low academic motivation and success, feelings of anxiety and depression, relational difficulties, alcohol and drug abuse, aggressiveness, nonsuicidal self-injury, and suicidal thoughts and behaviors 

• Employees of color and sexual minorities may be particularly vulnerable to persistent acts of harassment, intimidation, and threats

  • It is not always someone IN power against someone with LESS power

  • These may be overt acts, or covert acts, such as microaggressions

• In higher education settings, instructors may be less attuned to classroom management issues, particularly interpersonal dynamics between and among students

• For some students, it is the first time they have been away from home for an extended period of time

  • They may have fewer supports and opportunities to nurture their relational resilience

• When bullied by a roommate, people may feel trapped in an abusive relational living situation

sexual harassment (higher education)

• The toxicity of sexual harassment can sap relational and cognitive reserves and lead to impaired academic performance, isolation, and increases in the use of alcohol and other substances

• Staff can also be targets of sexual harassment, which can create an unsafe and hostile work environment, resulting in lower work satisfaction, decreased productivity, increased distress, and higher employee turnover

• Inappropriate or negligent responses by institutions relative to sexual harassment claims also may have legal and accreditation ramifications

• Quid pro quo - harassed individuals receive pressure from an individual with evaluative powers over them to engage in sexual behaviors in exchange for some benefit

• The hierarchical nature of higher education may also create an environment in which sexual harassment can thrive

reasons given for not reporting sexual violence

• in order of most frequent, include undisclosed reasons, the belief that the event was a personal matter, fear of retaliation, the belief that the event was not sufficiently significant as to warrant a report, not wanting the perpetrator to get in trouble, the belief that police are unwilling or unable to be helpful, and the report was given but not to law enforcement

Title IX (sexual assault)

• established as part of the Education Amendments of 1972, requires that all educational institutions that receive federal funding respond to and correct all forms of discrimination in educational settings, which includes sexual offenses

Clery Act of 1990 (sexual assault)

• aimed at promoting awareness of campus crimes by requiring higher education settings to report crime statistics on campus, alert members of the campus community about potential dangers, and publish annually a campus security report that is to be shared with current and prospective students as well as employees of the university

Campus SaVE, 2013 (sexual assault)

• higher education institutions must keep records of dating violence, sexual assault, domestic violence, and stalking on campus; must ensure that victims of violence receive appropriate protections and accommodations

violence in higher education settings (SHORT ANSWER)

• Interpersonal violence/IPV 

  • More common among college couples than with any other group 

  • Psychological effects of IPV may include depression, anxiety, PTSD, and attachment issues 

  • May engage in self-injury, withdraw from others, adn experience suicidal thoughts 

  • May also engage in smoking, risky alcohol behavior, using drugs, and risky sexual behaviors 

  • People with few peer supports are more likely to remain in unhealthy relationships 

• ***Mass shootings: 

  • An incident in which 4 or more people are killed during one event or in multiple places that are in close proximity of each other 

  • Rampage shootings: take place on school premises (or functions connected with a school) and are carried out by a current or former student or employee 

    • Shooters target specific students, staff, or faculty members because of some type of symbolic significance these individuals have to the shooters

• Strategies — Mass Shootings 

  • Prevention – it is important that university faculty and staff be trained in recognizing signs that people are in crisis and ways to compassionately respond to them

  • Active Shooting – it is important that individuals consider safety options, such as knowing where exits are in their classrooms or buildings s well as determining appropriate steps such as fleeing, hiding, or fighting

Leakage (K-12 schools, conducting threat assessments, violence, etc.)

• Involve other entities as needed, and determine immediate and short-term safety issues

• Leakage – the client may share plans to hurt others while in session

• Determining the lethality and potential of a threatening comment, or indirect behavior, can seem elusive

• Language, tone, etc. is different for everyone – can feel very difficult to assess

Van Brunt’s pathway to violence

• Van Brunt (2015) has outlined the pathway to violence that perpetrators often take:

  • Beginning with a perceived grievance and ideation

  • After a person has convinced themselves of the need to act out, they begin to plan and prep for their retribution

  • Perpetrators may attempt to circumvent procedures and physical contexts that keep people safe

  • They may seek out vulnerable spaces 

emergency operations in higher education

• Develop a threat assessment team composed of representatives from various departments and programs within the institution. (Emergency may include destabilization related to academic, legal, psychosocial, public health, infrastructure, transportation, and housing)

• Once assembled, this team develops a comprehensive plan to assess potential threats, risks, and annexes for campus community members to shelter in place or receive care; the team then develops lockdown protocols and plans to maintain communications and operations and to account for community members

• Next, the collaborative planning team develops training protocols to disseminate this information to relevant stakeholders

• Once implemented, the campus safety and emergency response team follows up and modifies the campus safety plans as new hazards emerge or become prioritized

• The team also reviews processes used during drills and actual crisis and emergency situations

crises of identity development (SHORT ANSWER)

• •The work of counselors is to appreciate clients’ multifaceted intersections and contexts

• To integrate our knowledge into crisis response care; 

• And work to dismantle forms of oppression at the individual, community, and societal level

• All of the transitions and situations we highlight in this chapter speak to life and role stressors that entangle themselves in role expectations and personal and social identities, potentially leading to feelings of isolation and chronic anguish