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Trauma Sensitive WorkTrauma Sensitive Workwithwith
Domestic ViolenceDomestic ViolenceSurvivorsSurvivors
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PTSDPTSD(Post-Traumatic Stress(Post-Traumatic Stress
Disorder)Disorder)
A potentially disabling condition thatA potentially disabling condition that
many people experience aftermany people experience after
enduring a traumatic event in whichenduring a traumatic event in which
they:they:
are threatened with serious injury orare threatened with serious injury or
deathdeath andand
feel a sense of intense fear, helplessness,feel a sense of intense fear, helplessness,or horroror horror
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PTSD SYMPTOMSPTSD SYMPTOMS
1.1. Intrusive Re-experiencingIntrusive Re-exp
eriencing
Repeatedly re-experiencing the traumaRepeatedly re-experiencing the trauma
in the form of flashbacks, memories,in the form of flashbacks, memories,
nightmares, or frightening thoughts.nightmares, or frightening thoughts. Experiences occur unexpectedly and mayExperiences occur unexpectedly and may
be so intense that the person feels asbe so intense that the person feels as
though the trauma is occurring again.though the trauma is occurring again.
This may cause the person to react in waysThis may cause the person to react in waysthey did when the trauma originally occurred.they did when the trauma originally occurred.
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PTSD SYMPTOMS (cont)PTSD SYMPTOMS (cont)
2.2. AvoidanceAvoidance -- Also referred to asAlso referred to as
dissociation.dissociation. Individual has numbed theirIndividual has numbed their
emotions to avoid painful,emotions to avoid painful,overwhelming feelings.overwhelming feelings.
May attempt to:May attempt to:
avoid all reminders of the traumaticavoid all reminders of the traumaticevent,event,
feel emotionally detached,feel emotionally detached,
withdraw from friends, family, andwithdraw from friends, family, and
everyday activities.everyday activities.
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PTSD SYMPTOMS (cont)PTSD SYMPTOMS (cont)
HyperarousalHy
perarousal
Being constantly on guard,Being constantly on guard,
easily startled or jumpyeasily startled or jumpy Difficulty to concentrating orDifficulty to concentrating or
remembering informationremembering information
May have sleep disturbances orMay have sleep disturbances orpanic attackspanic attacks..
COMPLEX PTSD
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COMPLEX PTSDCOMPLEX PTSDDr. Judith Herman of HarvardDr. Judith Herman of Harvard
UniversityUniversity1.1. The individual experienced a prolongedThe individual experienced a prolongedperiod (months to years) of total control byperiod (months to years) of total control byanother.another.
2.2. Symptoms that tend to result from chronicSymptoms that tend to result from chronic
victimization. Those symptoms include:victimization. Those symptoms include: Alterations in emotional regulationAlterations in emotional reg
ulation, which may, which mayinclude symptoms such as persistent sadness,include symptoms such as persistent sadness,suicidal thoughts, explosive anger, or inhibitedsuicidal thoughts, explosive anger, or inhibitedangeranger
Alterations in consciousneAlterations in consciousness, such as forgettingss, such as forgettingtraumatic events, reliving traumatic events, ortraumatic events, reliving traumatic events, orhaving episodes in which one feels detachedhaving episodes in which one feels detachedfrom one'sfrom one's mental processes or bodymental p
rocesses or body
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COMPLEX PTSD (cont)COMPLEX PTSD (cont) Alterations in self-perceptionAlterations in self-perception, which may include a, which may include a
sense of helplessness, shame, guilt, stigma, and asense of helplessness, shame, guilt, stigma, and asense of being completely different than othersense of being completely different than otherhuman beingshuman beings
Alterations in the perception of the perpetratorAlterations in the perception of the perpetrator,,such as attributing total power to the perpetrator orsuch as attributing total power to the perpetrator or
becoming preoccupied with the relationship to thebecoming preoccupied with the relationship to theperpetrator, including a preoccupation with revengeperpetrator, including a preoccupation with revenge
Alterations in relations with othersAlterations in relations with others, including, includingisolation, distrust, or a repeated search for a rescuerisolation, distrust, or a repeated search for a rescuer
Alterations in one's system of meaningsAlterations in one's system of meanings, which may, which may
include a loss of sustaining faith or a sense ofinclude a loss of sustaining faith or a sense ofhopelessness and despairhopelessness and despair
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COMPLEX PTSD (cont)COMPLEX PTSD (cont)
3.3. Other difficulties of complex PTSDOther difficulties of complex PTSDsurvivors:survivors: May avoid thinking and talking aboutMay avoid thinking and talking about
trauma-related topics because the feelingstrauma-related topics because the feelingsassociated with the trauma are oftenassociated with the trauma are often
overwhelming.overwhelming.
May use alcohol and substance abuse as aMay use alcohol and substance abuse as away to avoid and numb feelings andway to avoid and numb feelings andthoughts related to the trauma.thoughts related to the trauma.
Survivors may also engage in self-Survivors may also engage in self-mutilation and other forms of self-harmmutilation and other forms of self-harm
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TRAUMATIC MEMORIESTRAUMATIC MEMORIES
Traumatic events areTraumatic events are rememberedremembered
by some individuals while inby some individuals while in
other individuals the memoriesother individuals the memoriesareare dissociateddissociated..
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Factors influencing aFactors influencing a
continuous memorycontinuous memory
include:include: experiencing a single traumaticexperiencing a single traumatic
event naturally or accidentallyevent naturally or accidentallycaused,caused,
being an adult at the time ofbeing an adult at the time of
the trauma, andthe trauma, and receiving validation andreceiving validation and
support.support.
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Factors influencingFactors influencing
dissociationdissociation oror amnesia:amnesia:
experiencing the trauma repetitivelyexperiencing the trauma repetitively
trauma deliberately caused bytrauma deliberately caused by
another personanother person
trauma related to betrayal of trust bytrauma related to betrayal of trust by
a significant person in ones lifea significant person in ones life
being a child at the time of thebeing a child at the time of the
traumatrauma
living in an atmosphere of secrecyliving in an atmosphere of secrecy
and denialand denial
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WHO IS AT RISK?WHO IS AT RISK?
People who are at thePeople who are at the greatest riskgreatest riskforfor
developing PTSD are:developing PTSD are:
Survivors of violent assaults (domesticSurvivors of violent assaults (domestic
violence, rape, sexual assault/or abuse,violence, rape, sexual assault/or abuse,physical assault such as a mugging orphysical assault such as a mugging or
carjacking)carjacking)
Children who have been neglected, orChildren who have been neglected, orsexually, physically or verbally abused,sexually, physically or verbally abused,
and adults who were abused as children)and adults who were abused as children)
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HELPING TRAUMA SURVIVORSHELPING TRAUMA SURVIVORS
HEALHEAL
Trauma Theory:Trauma Theory:
Sickness/Badness vs. Injury ModelSickness/Badness vs. Injury Model Changing the fundamental questionChanging the fundamental question
from:from:
What's wrong with you?"What's wrong with you?"
toto
"What's happened to you?""What's happened to you?"
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MOVING FROMMOVING FROMSICKNESS/BADNESSSICKNESS/BADNESS toto INJUREDINJURED
Our understanding of the impact of trauma alters ourOur understanding of the impact of trauma alters ourfundamental explanations for human dysfunction.fundamental explanations for human dysfunction.
At present, there are basically three widely acceptedAt present, there are basically three widely acceptedreasons for why people do deviant things:reasons for why people do deviant things:
The person is sick.The person is sick.The person is bad.The person is bad.
The person is both sick and badThe person is both sick and bad
Trauma theory implies that it is far more usefulTrauma theory implies that it is far more useful
to assume that a person has been injuredto assume that a person has been injured
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Sickness:Sickness:
The cause of the problem lies withinThe cause of the problem lies withinthe sufferer, unconnected in anythe sufferer, unconnected in anymeaningful way with the outside world.meaningful way with the outside world.
Implies a basic weakness, malfunctionImplies a basic weakness, malfunctionor defect that medical science can hopeor defect that medical science can hopeto stabilize or cure.to stabilize or cure.
Holds an expectation of passivity onHolds an expectation of passivity on
the part of the suffererthe part of the sufferer
Denies both personal and socialDenies both personal and socialaccountability for the course of theaccountability for the course of thesickness.sickness.
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Badness:Badness: Connected to the concept of sin.Connected to the concept of sin.
Implies a basic defect and little hopeImplies a basic defect and little hopethat anyone can correctthat anyone can correct
But we can, and should, punish it.But we can, and should, punish it.
Requires self- corrective action -Requires self- corrective action -totally on the part of the bad persontotally on the part of the bad person
TheThe bad personbad person is wholly responsibleis wholly responsiblefor their deviant actionsfor their deviant actions
should stop the misbehavior- regardlessshould stop the misbehavior- regardlessof its origin orof its origin or
accept the consequences (punishment).accept the consequences (punishment).
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Injury:Injury:
Implies a cause that is obviousImplies a cause that is obviousor discoverableor discoverable connects the sufferer to the socialconnects the sufferer to the social
environment that allowed or failedenvironment that allowed or failedto prevent the injury.to prevent the injury.
Implies a process ofImplies a process ofrecoveryrecoveryandand rehabilitationrehabilitation the sufferer must learn how to copethe sufferer must learn how to cope
with a semi-permanent or evenwith a semi-permanent or evenpermanent disability.permanent disability.
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Injury (cont):Injury (cont):
Implies a cause that is obvious orImplies a cause that is obvious or
discoverablediscoverable connects the sufferer to the socialconnects the sufferer to the social
environment that allowed or failed toenvironment that allowed or failed toprevent the injury.prevent the injury.
Implies a process ofImplies a process ofrecoveryrecoveryandand
rehabilitationrehabilitation the sufferer must learn how to cope withthe sufferer must learn how to cope with
a semi-permanent or even permanenta semi-permanent or even permanent
disability.disability.
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Injury (cont):Injury (cont):
RequiresRequires active participation by theactive participation by the
sufferersuffererin the process of recoveryin the process of recovery helpers are morehelpers are more consultantsconsultants andand
catalyzing agentscatalyzing agents of change thanof change than healers.healers.
Requires assumption of bothRequires assumption of both individual responsibilityindividual responsibilityon the part of theon the part of the
sufferer, andsufferer, and social responsibilitysocial responsibilityon the part of theon the part of the
larger social group.larger social group.
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Injury (cont):Injury (cont):
TheThe
injuredinjured
individualindividual
must look at the waysmust look at the ways
he or shehe or she contributed to the injurycontributed to the injuryin orderin ordertoto
ensure properensure proper risk managementrisk managementininthe future,the future, andand
must take necessary steps to ensuremust take necessary steps to ensurerecoveryrecoveryandand future risk preventionfuture risk prevention..
The largerThe larger social groupsocial group represented by represented byfamily, school, workplace, or the communityfamily, school, workplace, or the community
as a whole - must come to terms with theas a whole - must come to terms with therole the society played inrole the society played in failing to preventfailing to preventthe injurythe injury providing the contexts within whichproviding the contexts within which
individual healing can occur.individual healing can occur.
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TRAUMA INFORMED ADDICTIONTRAUMA INFORMED ADDICTION
TREATMENTTREATMENTMaxine Harris, Roger FallotMaxine Harris, Roger Fallot
CORE TREATMENT ELEMENTS:CORE TREATMENT ELEMENTS:
1.1. Teach integrative and contextualTeach integrative and contextual
explanationsexplanations NOT EXCUSESNOT EXCUSES
1.1. Place substance use in thePlace substance use in the
context of clients life,context of clients life,relationships and trauma historyrelationships and trauma history
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CORE TREATMENT ELEMENTS (cont)CORE TREATMENT ELEMENTS (cont)
3.3. INCLUDE ACCESS TOINCLUDE ACCESS TO
ANCILLARY SERVICES:ANCILLARY SERVICES:
VOCATIONAL PARENTING SAFE HOUSING
EDUCATIONAL LIFE SKILLS LEGAL SERVICES
HEALTHCARE
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CORE TREATMENT ELEMENTS (cont)CORE TREATMENT ELEMENTS (cont)
SELF-KNOWLEDGESELF-KNOWLEDGE
CLEAR COMMUNICATIONCLEAR COMMUNICATION
SELF-REGULATIONSELF-REGULATION
ACCURATE PERCEPTION OFACCURATE PERCEPTION OF
OTHERS ANDOTHERS AND
SELF-SOOTHINGSELF-SOOTHING
HONEST LABELINGHONEST LABELING
SELF TRUSTSELF TRUST
APPRECIATING MUTUALITYAPPRECIATING MUTUALITY
AND RECEPROCITYAND RECEPROCITY
LIMIT SETTINGLIMIT SETTING
CLEAR EXPRESSION OFCLEAR EXPRESSION OF
NEEDS AND DESIRESNEEDS AND DESIRES
4.4.TEACHTEACH CROSSOVER SKILLSCROSSOVER SKILLS FORFORRECOVERY FROM TRAUMARECOVERY FROM TRAUMA ANDANDADDICTION:ADDICTION:
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KEY COMPONENTS OF TRAUMAKEY COMPONENTS OF TRAUMA
SENSITIVE SERVICESSENSITIVE SERVICES
Most trauma informed interventionsMost trauma informed interventionscover three primary areas:cover three primary areas:
1.1. Identifying the nature and extent ofIdentifying the nature and extent of
the trauma, including:the trauma, including: symptom development;symptom development;
strengths used for survival;strengths used for survival;
distortion of feelings and behavior duedistortion of feelings and behavior due
to trauma;to trauma; how ongoing symptom experienceshow ongoing symptom experiences
(dissociation, substance abuse) may(dissociation, substance abuse) mayfunction to numb the pain of abusefunction to numb the pain of abuse
history.history.
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KEY COMPONENTS OFKEY COMPONENTS OF
TRAUMA SENSITIVE SERVICES (cont)TRAUMA SENSITIVE SERVICES (cont)
2.2. The creation of a safe haven.The creation of a safe haven.Certain basic rules help toCertain basic rules help to
establish this environment,establish this environment,
including:including: confidentiality;confidentiality;
opportunity to speak or pass;opportunity to speak or pass;
a group norm disallowing advice-a group norm disallowing advice-giving, criticism, or confrontationgiving, criticism, or confrontation
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Safe Haven (cont)Safe Haven (cont)
Common responses among victimsCommon responses among victimsexperiencing such anexperiencing such anenvironment include:environment include:
increased self esteem at knowingincreased self esteem at knowingwhat they have to say is heardwhat they have to say is heardand valued,and valued,
relief at finding they are notrelief at finding they are not
alone or crazy or badalone or crazy or badbecause of their experiencesbecause of their experiences
increased empowermentincreased empowerment
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KEY COMPONENTS OFKEY COMPONENTS OF
TRAUMA SENSITIVE SERVICES (cont)TRAUMA SENSITIVE SERVICES (cont)
3.3. Survivors are encouraged to developSurvivors are encouraged to develop
skills needed to recover from traumaticskills needed to recover from traumatic
experiences and build healthy lives.experiences and build healthy lives.
These include learning:These include learning: cognitive- behavioral re-thinkingcognitive- behavioral re-thinking
strategies,strategies,
problem-solving skills,problem-solving skills,
relaxation techniques,relaxation techniques, stress coping,stress coping,
relapse prevention andrelapse prevention and
short- and long-term safety planning skills.short- and long-term safety planning skills.
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How Trauma Affects PeoplesHow Trauma Affects Peoples
Lives:Lives:
Trauma interferes withTrauma interferes with Knowing how to feel safe and how to keep self/familyKnowing how to feel safe and how to keep self/family
safesafe
Feeling understood by and able to connect emotionallyFeeling understood by and able to connect emotionally
with other personswith other persons Knowing how to feel in control and how to be organizedKnowing how to feel in control and how to be organized
and goal-directedand goal-directed
Feeling like a person worthy of respect, support, andFeeling like a person worthy of respect, support, and
compassion (versus damaged/bad)compassion (versus damaged/bad)
Knowing how (and when, and whom) to trustKnowing how (and when, and whom) to trust
Knowing how to help and show caring to others withoutKnowing how to help and show caring to others without
being exploited or controllingbeing exploited or controlling
Knowing how to contain intense emotions andKnowing how to contain intense emotions and
impulses, and how to soothe/calm oneselfimpulses, and how to soothe/calm oneself
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What Intervention Can Do:What Intervention Can Do:
Provide modeling/guided experience in:Provide modeling/guided experience in: Identifying life experiences that may haveIdentifying life experiences that may have
been traumatic and feelings, problems, andbeen traumatic and feelings, problems, and
coping styles that may result from traumacoping styles that may result from trauma
Identifying dangers/problems and takingIdentifying dangers/problems and takingpractical steps to be safe and feel safepractical steps to be safe and feel safe
Identifying intense emotions/impulses,Identifying intense emotions/impulses,
understanding how they make sense, andunderstanding how they make sense, and
how to self-soothe, problem solve, and behow to self-soothe, problem solve, and besoothed and guided by trustworthy otherssoothed and guided by trustworthy others
Recognizing the worth and value of one'sRecognizing the worth and value of one's
own actions and intentionsown actions and intentions
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What Intervention Can Do (cont):What Intervention Can Do (cont):
Provide modeling/guided experience in:Provide modeling/guided experience in:
Organizing complicated problems into smallOrganizing complicated problems into smallpractical steps toward solutionspractical steps toward solutions
Engaging in a non-coercive, non-abandoningEngaging in a non-coercive, non-abandoning
relationship based on mutual respect,relationship based on mutual respect,responsibility, and learningresponsibility, and learning
Recognizing attempts to maintain and repairRecognizing attempts to maintain and repairrelationships despite despair/fear/angerrelationships despite despair/fear/anger
Recognizing attempts to deal with intenseRecognizing attempts to deal with intenseemotions and impulses despite lapsesemotions and impulses despite lapses
Recognizing attempts to maintain or regainRecognizing attempts to maintain or regainpersonal control/autonomy and safetypersonal control/autonomy and safety
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What Intervention can achieveWhat Intervention can achieve
Trauma sensitivity adds value to allTrauma sensitivity adds value to alltypes of services by:types of services by: Enhancing the clients safety (including ability toEnhancing the clients safety (including ability to
identify and practically manage dangers)identify and practically manage dangers)
Enhancing the clients autonomous self-controlEnhancing the clients autonomous self-control(including identifying and making choices)(including identifying and making choices)
Directly demonstrating respect, compassion, andDirectly demonstrating respect, compassion, and
confidence in the client as an adult/parentconfidence in the client as an adult/parent
Showing the client how relationships can beShowing the client how relationships can be
personal without violating her personal space andpersonal without violating her personal space and
boundaries, trustworthy without being perfect, andboundaries, trustworthy without being perfect, and
satisfying without any exploitationsatisfying without any exploitation
Helping the client directly face problems withoutHelping the client directly face problems without
avoidance, blame, secrecy, or dishonestyavoidance, blame, secrecy, or dishonesty
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What Intervention can achieveWhat Intervention can achieve
(cont):(cont):
Trauma sensitivity adds value to allTrauma sensitivity adds value to all
types of services by:types of services by: Enhancing the clients understandingEnhancing the clients understanding inin
non-stigmatizing termsnon-stigmatizing terms of how she learnedof how she learnedto cope with trauma and why these types ofto cope with trauma and why these types of
coping made sense for dealing with hercoping made sense for dealing with her
traumatrauma
Enhancing the clients understanding ofEnhancing the clients understanding ofhow post-traumatic symptoms are anhow post-traumatic symptoms are an
attempt to regain a sense of safety, self-attempt to regain a sense of safety, self-
respect, and empowermentrespect, and empowerment
d ki
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Integrated Treatment:Integrated Treatment: SeekingSeeking
SafetySafetyTHE FOUR KEY PRINCIPLES OF SEEKING SAFETY TREATMENTTHE FOUR KEY PRINCIPLES OF SEEKING SAFETY TREATMENT
1.1. Safety as the priority of this first stage of treatmentSafety as the priority of this first stage of treatmentThe basic philosophy of the treatment is that, when a person hasThe basic philosophy of the treatment is that, when a person has
both active substance abuse and PTSD, the most urgent clinicalboth active substance abuse and PTSD, the most urgent clinical
need is to establish safety. "Safety" is an umbrella term thatneed is to establish safety. "Safety" is an umbrella term that
signifies various elements including:signifies various elements including:
discontinuing substance use,discontinuing substance use, reducing suicidality,reducing suicidality,
minimizing exposure to HIV risk,minimizing exposure to HIV risk,
letting go of dangerous relationships (such asletting go of dangerous relationships (such as
domestic abuse and drug-using "friends"),domestic abuse and drug-using "friends"),
gaining control over extreme symptoms (such asgaining control over extreme symptoms (such as
dissociation), anddissociation), and
stopping self-harm behaviors (such as cutting).stopping self-harm behaviors (such as cutting).
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"Seeking safety""Seeking safety" refers to helping clients freerefers to helping clients freethemselves from such negative behaviors and, in sothemselves from such negative behaviors and, in so
doing, to move toward freeing themselves fromdoing, to move toward freeing themselves from
trauma at a deep emotional level.trauma at a deep emotional level.
This treatment attempts to teach life-This treatment attempts to teach life-
enhancing skills that promote safety:enhancing skills that promote safety: learning to ask for help from safe people,learning to ask for help from safe people,
utilizing community resources,utilizing community resources,
exploring "recovery thinking,exploring "recovery thinking,
taking good care of one's body,taking good care of one's body,
rehearsing honesty and compassion,rehearsing honesty and compassion,
increasing self-nurturing activities, and so on.increasing self-nurturing activities, and so on.
Safety as the priority of this first stage treatment(cont)
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THE FOUR KEY PRINCIPLES OF SEEKING SAFETY TREATMENTTHE FOUR KEY PRINCIPLES OF SEEKING SAFETY TREATMENT
2.2. Integrated Treatment Of PTSD And Substance AbuseIntegrated Treatment Of PTSD And Substance Abuse
attention to both disorders at the same time in the presentattention to both disorders at the same time in the present
Each topic can be applied to both PTSD and substance abuse.Each topic can be applied to both PTSD and substance abuse.
Integration is goal for clients: to "own" both disorders.Integration is goal for clients: to "own" both disorders.
Treatment content is focused on helping clients to:Treatment content is focused on helping clients to:
learn what the two disorders are and why they co-occur;learn what the two disorders are and why they co-occur;
exploring their interrelationship in the present (e.g.,exploring their interrelationship in the present (e.g.,using crack last week to cope with PTSD flashbacks);using crack last week to cope with PTSD flashbacks);
understanding the course of the disorders in recoveryunderstanding the course of the disorders in recovery(e.g., with abstinence, PTSD may feel worse before it(e.g., with abstinence, PTSD may feel worse before itfeels better);feels better);
increasing compassion by viewing substance abuse asincreasing compassion by viewing substance abuse asan attempt to cope with the pain of trauma; andan attempt to cope with the pain of trauma; and
teaching safe coping skills that apply to both.teaching safe coping skills that apply to both.
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THE FIVE KEY PRINCIPLES OF SEEKING SAFETYTHE FIVE KEY PRINCIPLES OF SEEKING SAFETY
TREATMENTTREATMENT
3.3. A Focus on IdealsA Focus on IdealsAddiction and trauma (individually, and especially inAddiction and trauma (individually, and especially in
combination,) lead to demoralization and loss of idealscombination,) lead to demoralization and loss of ideals
Trauma - "shattered assumptions":Trauma - "shattered assumptions":Many clients reportMany clients reportfeeling more upset about a loss of ideals, such as trust, thanfeeling more upset about a loss of ideals, such as trust, thanabout particular external conditions, such as poverty or lackabout particular external conditions, such as poverty or lackof a job.of a job.
Addiction loss of ideals:Addiction loss of ideals: Life has become narrowed inLife has become narrowed infocus, one is living "at the bottom-surrounded by people whofocus, one is living "at the bottom-surrounded by people whocannot cope, pushing away reality, losing connections tocannot cope, pushing away reality, losing connections tonormal life (job, home, relationships), lying about substancenormal life (job, home, relationships), lying about substanceabuse, unable to face emotional pain.abuse, unable to face emotional pain.
Recovery from both:Recovery from both: The treatment explicitly seeks toThe treatment explicitly seeks torestore ideals that have been lost.restore ideals that have been lost.
The title of each topic is framed as a positive ideal-The title of each topic is framed as a positive ideal-one that is the opposite of some pathologicalone that is the opposite of some pathologicalcharacteristic of PTSD and substance abuse.characteristic of PTSD and substance abuse.
The AA goal of living a life of moral integrity is anThe AA goal of living a life of moral integrity is anantidote to the deterioration of ideals inherent inantidote to the deterioration of ideals inherent insubstance abuse and PTSD.substance abuse and PTSD.
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THE FOUR KEY PRINCIPLES OF SEEKING SAFETYTHE FOUR KEY PRINCIPLES OF SEEKING SAFETY
TREATMENTTREATMENT
4.4. Three Content AreasThree Content Areas; Cognitive, Behavioral; Cognitive, Behavioral
and Interpersonaland Interpersonal
CognitiveCognitive - Present- and problem-- Present- and problem-
oriented, to reduce currentoriented, to reduce current
symptoms.symptoms. Brief, time-limited, and structured, withBrief, time-limited, and structured, with
the goal of strong treatment gains over athe goal of strong treatment gains over a
short time frame.short time frame.
It is educational, with emphasis onIt is educational, with emphasis on
rehearsal of new skills.rehearsal of new skills. It is directive and collaborative, guidingIt is directive and collaborative, guiding
clients (much as a good parent would)clients (much as a good parent would)
while emphasizing their maturewhile emphasizing their mature
contribution to their own treatment.contribution to their own treatment.
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4.4. Three Content Areas; Cognitive, Behavioral andThree Content Areas; Cognitive, Behavioral and
Interpersonal (cont)Interpersonal (cont)
BehavioralBehavioral - The "behavioral bottom line"- The "behavioral bottom line"
is taught: that it is not sufficient to talkis taught: that it is not sufficient to talkabout action, but real action, howeverabout action, but real action, however
small, is essential.small, is essential.
Each session Clients make aEach session Clients make a
commitment to one concrete step tocommitment to one concrete step topromote healingpromote healing
Counselors are encouraged to listen toCounselors are encouraged to listen to
Clients behavior more than their wordsClients behavior more than their words
Clients guided to "own" their actions-Clients guided to "own" their actions-
no matter what happens in their lives.no matter what happens in their lives.
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THE FOUR KEY PRINCIPLES OF SEEKING SAFETYTHE FOUR KEY PRINCIPLES OF SEEKING SAFETY
TREATMENTTREATMENT
4.4. Three Content Areas; Cognitive, Behavioral andThree Content Areas; Cognitive, Behavioral and
Interpersonal (cont)Interpersonal (cont)
InterpersonalInterpersonal - most PTSD arises from trauma- most PTSD arises from traumainflicted by others (in contrast to naturalinflicted by others (in contrast to naturaldisasters or accidentsdisasters or accidents
PTSD survivors:PTSD survivors: distrust of others, confusiondistrust of others, confusion
over what can be expected in relationships,over what can be expected in relationships,
and concern over reenactments of abusiveand concern over reenactments of abusive
power both as victims and as perpetratorspower both as victims and as perpetrators
Substance abusersSubstance abusers:: substance abuse is oftensubstance abuse is often
precipitated and perpetuated by relationshipprecipitated and perpetuated by relationship
issues (substance-abusing family members,issues (substance-abusing family members,substance use as an attempt to gainsubstance use as an attempt to gain
acceptance by others, substance use toacceptance by others, substance use to
manage interpersonal conflict)manage interpersonal conflict)