Crisis Trauma PTSD Final Exam

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Dr. Maloney

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42 Terms

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Mandated reporting
danger to self, danger to others (duty to warn), child, elder, and disabled adult abuse, waiver signed to breach confidentiality, Patriot Act, client sues
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Learned helplessness
Opportunity does not equal freedom, secreted stress hormones long after trauma has passed, seek refuge in the familiar even if it’s not safe
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Addiction to trauma and how it presents
The pain of pleasure and the pleasure of pain, re-experiencing trauma, stress makes us feel better because it is “normal”

They seek out experiences that would repel most of us

The compulsion to repeat

Attracted to dangerous and painful situations

Craving the activity and experience withdrawal when it's not available (even terrible ones)

People become preoccupied with the pain of withdrawal

Fear and aversion can be transformed into pleasure

Many traumatized people who have a re-exposure to stress might be provided with a somewhat relief from anxiety.
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How victims function during an emergency crisis
?
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How often does date rape occur
Peak rates of victimization occur between 16- and 24-year-olds.

Nearly 13% of the women surveyed reported being the victim of date rape and 35% are the victims of attempted rape while on a date

90% of college women surveyed reported their attacker was someone they knew
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Legal aspects of date rape
It is a felony, but still extremely common
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Roles of a crisis worker
to increase functioning
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How psychological problems manifest in the body
loss of self, numbing, reorganization of perception, stuck in trauma
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Loss of self
Difficult to engage in intimate relationships

Hard to trust yourself or anyone else.

Learning to trust = goal \[trust self-determination & self\]

SHAME- objective or misguided, difficulty to confront and address
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Numbing
Limited repertoire of emotions

A sense of being disconnected

For many, only able to feel intense emotions, so often seek to avoid those situations or triggers.
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Reorganization of perception
Trauma is superimposed on everything

Leads to difficulty discerning what is going on

Loose “mental flexibility” & access to imagination -lose of future orientation – hop

Pulled back into the past
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Stuck in trauma
Question where to belong

Those who know \[get it; lived it\] and those who don’t

Results in social alienation

Event becomes both the source of pain and the sole source of meaning (identity)

Fundamentally reorganizes the way the mind and brain manages perceptions.

How we think and what we think about, as well as our very capacity to think

In the midst of sharing, unless addressed, the body remains hyper-vigilant
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What experiences can cause trauma
Molestation, abuse, war, alcoholic relatives, etc.
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Influences on a person’s response to trauma
Material, personal and social resources
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Suggestions from a crisis worker for persons suffering from loss
Acknowledge the loss

Take your feelings seriously

Talk to others

Make necessary accommodations

Be patient

Find your own way to memorialize the loss

Don’t forget
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Worden’s Four Tasks of Mourning
Accepting the reality of the loss

Experiencing the pain of grief

Adjusting to an environment form which the deceased is missing

Withdrawing emotional energy from the deceased and reinvesting it in another relationship or cause
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Crisis-prone person
No help when in crisis

Uses ego strength to defend rather than manage reality

Unprepared to manage future stresses and enters crisis states frequently and easily

Personality disorders are created, chronic depression, lowered functioning
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Countertransference
professional's unresolved past issues are projected onto the client and interfere with the objective and appropriate care of a client
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Dual relationship
counselor has a relationship with the client outside of the professional setting
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Basic attending skills
fundamental listening skills - includes attending, questions, encouragers, paraphrasing, reflection of feelings, and summarization through straightforward, step-by-step process

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Eye contact, body language, soothing calm voice, overall empathy
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What are some common effects of sexual assault and rape?
Depression: prolonged sadness, feeling hopeless, unexplained crying, loss of appetite and energy, and loss of interest and pleasure in activities previously enjoyed. Feelings of hopelessness and suicidal thoughts

PTSD: flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the event.

Dissociation: feeling like one is "checked out" or is not present. Some may daydream. May impair ability to function in the real world.

Substance Use and Misuse of alcohol: temporary relief experienced but can result in severe harm or death.

Other emotional & psychological effectst: anger, distrust, and feeling unsafe if someone they knew. May experience shock, self-blame, loss of control, numbness.

Physical effects- possible bruising, bleeding, difficulty walking, soreness, STIs, broken or dislocated bones, or pregnancy. Chronic fatigue, shortness of breath. Full physical exam by a physician may be warranted. 5% of rapes result in pregnancy.
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Cognitive key
The perception a person has of the precipitating events that lead to emotional distress
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Client confidentiality
All disclosures by clients are private and professionals may not share information with anyone except supervisors

the legal counterpart is called Privileged Communication, and the client owns it in the court
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Goal of crisis counseling
to increase client's functioning
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Support groups for grieving parents
95% chance of parents who attend will remain married. It is very important this comes first before individual counseling
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What parents often experience with death of a child
Parental relationship usually weakened

Many parents lose their jobs

Concentration is greatly affected

Support groups are important
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Reasons people stay in a battered relationship
Afraid he’ll kill her, the pets, children, her family

Religious beliefs

Pro-family values

Economically dependent

No resources

Children need both parents

No support from family

Hopes he’ll change Believes it is her fault

Sees no other option

Feels insecure and unable to take care of self
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Interventions for battered victims
Let them know help is available

Give specific information about resources

Document the battering with accurate medical records

Acknowledge experiences in a supportive manner

Respect their right to make own decisions
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Facts about abusive parents
Shows little concern for child’s problems

Takes an unusual amount of time to seek health care for child

Does not adequately explain an injury

Gives different explanations for the same injury

Complains about irrelevant problems unrelated to the injury

Blames a third party

Reluctant to share information about the child

Uses alcohol or drugs

Has no friends or relatives to turn to in crises

Very strict disciplinarians

Were abused as children

Goes to different doctors and clinics

Antagonistic and hostile
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Facts about people who are violent/batter
Intimidation

Isolation

Emotional abuse

Economic abuse

Sexual abuse

Using children

Threats

Using male privilege

Physical abuse
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Secondary trauma
From helping the traumatized victims

Demanding caseloads and long hours

Dealing with trauma daily

Absorbing the trauma from victims

Vulnerability due to listening to others speak of traumatizing events
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PTSD symptoms
Intrusion, negative mood, dissociative symptoms, avoidance symptoms, arousal symptoms, impairment in functioning
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Acute stress disorder symptoms
Intrusion, negative mood, dissociative symptoms, avoidance symptoms, arousal symptoms, impairment in functioning
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Intial responses to trauma
trying to push away memories and act like nothing happened

right after the event may have trouble describing what happened due to the deactivation of Broca's area

shock, disbelief, distress, and panic
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Impact of trauma on brain
Re-calibration of the alarm system, elevated stress hormones, relevant and irrelevant information processor messed up. Right brain reacts as if the traumatic event were happening in the present. Left brain impacts capacity to organize experiences in logical sequences and translates shifting feelings and perceptions into words, person may not be aware they’re re-experiencing the past
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Impact of trauma on body
short: deactivation of Broca's area, deactivation of the left side of the brain (capacity to organize experiences into logical feelings and translating feelings and perceptions into words) \n long: there is a loss of self making it difficult to engage in intimate relationships, stuck in fight or flight, constant state of stress where body can't differentiate between overwhelmed and danger
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Benefits of experiencing crisis
Opportunity-With help: growth, insight, better coping skills, higher levels of functioning and better prepared for the future stresses. Strengthened and gained relationships, recognized personal strength, new support options, and better empathy

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Danger: No help: lower level of functioning via defense ,mechanisms, or not functioning

i.e suicide, homicide, psychosis
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Does all significant stress lead to a crisis
No
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Educational statment
Providing factual information
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Empowerment statement
Presenting the client with choices
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Validation statement
Telling the client their feelings are natural and that there is hope that things will get better
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Refreaming statement
Defining the situation differently