Crisis Trauma PTSD Final Exam

Dr. Maloney

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

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

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.

How victims function during an emergency crisis

?

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

Legal aspects of date rape

It is a felony, but still extremely common

Roles of a crisis worker

to increase functioning

How psychological problems manifest in the body

loss of self, numbing, reorganization of perception, stuck in trauma

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

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.

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

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

What experiences can cause trauma

Molestation, abuse, war, alcoholic relatives, etc.

Influences on a person’s response to trauma

Material, personal and social resources

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

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

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

Countertransference

professional's unresolved past issues are projected onto the client and interfere with the objective and appropriate care of a client

Dual relationship

counselor has a relationship with the client outside of the professional setting

Basic attending skills

fundamental listening skills - includes attending, questions, encouragers, paraphrasing, reflection of feelings, and summarization through straightforward, step-by-step process

Eye contact, body language, soothing calm voice, overall empathy

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.

Cognitive key

The perception a person has of the precipitating events that lead to emotional distress

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

Goal of crisis counseling

to increase client's functioning

Support groups for grieving parents

95% chance of parents who attend will remain married. It is very important this comes first before individual counseling

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

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

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

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

Facts about people who are violent/batter

Intimidation

Isolation

Emotional abuse

Economic abuse

Sexual abuse

Using children

Threats

Using male privilege

Physical abuse

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

PTSD symptoms

Intrusion, negative mood, dissociative symptoms, avoidance symptoms, arousal symptoms, impairment in functioning

Acute stress disorder symptoms

Intrusion, negative mood, dissociative symptoms, avoidance symptoms, arousal symptoms, impairment in functioning

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

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

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

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

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

i.e suicide, homicide, psychosis

Does all significant stress lead to a crisis

No

Educational statment

Providing factual information

Empowerment statement

Presenting the client with choices

Validation statement

Telling the client their feelings are natural and that there is hope that things will get better

Refreaming statement

Defining the situation differently