trauma past, trauma present: looking at addiction through a trauma informed lens
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Trauma Past, Trauma Present: Looking at Addiction through a Trauma Informed Lens . Allison Sampson Jackson, PhD, LCSW, LICSW, CSTOP Family Preservation Services of VA Providence Service Corporation . Defining Trauma:. - PowerPoint PPT PresentationTRANSCRIPT
Trauma Past, Trauma Present:Looking at Addiction through a Trauma Informed Lens
Allison Sampson Jackson, PhD, LCSW, LICSW, CSTOPFamily Preservation Services of VA
Providence Service Corporation
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Defining Trauma: a traumatic event, either witnessed or experienced,
representing a fundamental threat to one’s physical integrity or survival
responses involve intense fear, helplessness or horror the meaning of the event may be as important as the
actual physical act/experience what we want to emphasize is that it is an individual's
subjective experience that determines whether an event is or is not traumatic
http://www.lisaferentz.com/
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Key Component of TraumaIs the experience of loss!Loss of: boundaries safety trust power and control innocence protection attachment possessions consistency/predictability sense of self/body image
http://www.lisaferentz.com/
Exposure to Violence in Childhood
46 million of 76 million children are exposed to violence, crime and abuse each
year
Finkelhor, D., et al. (2010). Trends in childhood violence and abuse exposure: evidence from 2 national surveys. Archives of Pediatric and Adolescent Medicine, 164(3), 238–242.
Information and slide part of Dr. Allison Sampson's Trauma
Presentation
Trauma impacts learning and academic outcomes
Decreased IQ and reading ability (Delaney-Black et al., 2003)
Lower grade-point average (Hurt et al., 2001)
More days of school absence (Hurt et al., 2001)
Decreased rates of high school graduation (Grogger, 1997)
Increased expulsions and suspensions (LAUSD Survey)
Impact of being in Child Welfare System for Foster Care Children
• 25% will be incarcerated within first 2 years of aging out of the system
• More than 20% will become homeless • Only 58% will have a High School Diploma• Less than 3% will have a college education by age of
25• Many will re-enter the system as parents • For children under age of 5, increase likelihood of
developmental delays 13-62% compared to 4-10%
1) Conradi, L. (2012) Chadwick Trauma Informed System Project p. 54
2) Leslie et. al. (2005). Developmental and Behavioral Pediatrics 26(3), 177-185
The breakdown per child is:
• $32,648 in childhood health care
costs• $10,530 in adult medical costs
• $144,360 in productivity losses
• $7,728 in child welfare costs
• $6,747 in criminal justice costs
• $7,999 in special education costs
1 year of violence=
124 billion dollars
in recovery costs
223,400,000
317,572,282
223,400,000
ACE SCREEN
• Alcoholism and alcohol abuse• Chronic obstructive pulmonary
disease (COPD)• Depression• Fetal death• Health-related quality of life• Illicit drug use• Ischemic heart disease (IHD)• Liver disease• Risk for intimate partner violence• Multiple sexual partners• Sexually transmitted diseases
(STDs)• Smoking• Suicide attempts• Unintended pregnancies• Early initiation of smoking• Early initiation of sexual activity• Adolescent pregnancy
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Unlocking the Brain
At least for today…3 brain levels-they each speak a different language
Brainstem-housekeeping of the
Body, sleeping, eating, breathing
Limbic-smoke alarm, implicit memories
Cortex-planning, logic, reason, judgment
A Person’s Response to Perceived Danger
Trauma Event
Danger Response
Fight Flight FreezeAggression Run Away Dissociate
Verbal attack Substance Abuse Non-emotionality
Slide from Ellen Williams, LCSWCenter for Child & Family Services
Looking Through The Eyes of a Traumatized Child- How it looks to Us….
Slide from Ellen Williams, LCSWCenter for Child & Family ServicesServices
How it looks to The Traumatized Child
Slide from Ellen Williams, LCSWCenter for Child & Family ServicesServices
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The Hand Model of the Brain
http://www.youtube.com/watch?v=DD-lfP1FBFk
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The Handy Model
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Trauma and the Brain Hippocampus-remembers the facts but
not the emotions.
It records the time-frame of significant events, the start, the middle, the end of an event and sends the facts to the cortex-the thinking part of the brain (logic, reason, common sense).
Chasing BehaviorsAgitation
T
Traumatic EventDepressio
n
Intrusive Memories
Nightmares
Hopelessness
Numbing
Insomnia
Shame & Self-Hatred
Panic Attacks
Substance Abuse
Somatic Symptoms
Eating Disorder
s
Self-Destructiv
e Behavior
Dissociation
Poor Impulse Control
Defiance
Withdrawal
Slide by Trish Mullen, Chesterfield CSB
We must ……
Respond to the need ….
Not react to the behavior
Resilience Trumps Aces
From Trish Mullen, Chesterfield Community services Board
TRAUMA AND ATTACHMENT
ATTACHMENT
INFORMATION AND SLIDE PART OF DR. ALLISON SAMPSON'S TRAUMA PRESENTATION
Many argue that these early relationships (experiences) shape neuronal circuits which regulate emotional and social functioning
ATTACHMENT’S PURPOSESIEGEL, 1999
INFORMATION AND SLIDE PART OF DR. ALLISON SAMPSON'S TRAUMA PRESENTATION
Evolutionary Level – biological Infant Survival (Bowlby)
Mind Level – biological and social • Caregiver’s brain helps child’s brain to organize regulation• Caregiver’s brain teaches child self-soothing • Child experience of safety allows for exploration
ATTACHMENT’S PURPOSE
INFORMATION AND SLIDE PART OF DR. ALLISON SAMPSON'S TRAUMA PRESENTATION
Experience of safety is encoded in child’s implicit memory and provides secure base from which to grow and access higher levels of information processing
TRAUMA AND THE BRAIN
UNDERSTANDING “WHY” …
INFORMATION AND SLIDE PART OF DR. ALLISON SAMPSON'S TRAUMA PRESENTATION
• http://www.childwelfare.gov/pubs/issue_briefs/brain_development/effects.cfm
BRAIN AND STRESS
INFORMATION AND SLIDE PART OF DR. ALLISON SAMPSON'S TRAUMA PRESENTATION
• When stress is predictable and moderate, stress can facilitate resiliency and enhance memory
• When stress is unpredictable and severe, stress can create vulnerability and memory impairment
• Severe and chronic stress in childhood via multiple traumas from caregivers can impact affect regulation, interpersonal relationship skills, and states become traits (fight/flight/freeze… disassociation or hyper arousal)
TYPES OF STRESS
INFORMATION AND SLIDE PART OF HARRIS (2013) BUZZ ON BRAIN AND BABIES PRESENTATION
Positive Stress Tolerable Stress Toxic Stress
Normal and essential part of healthy development
Body’s alert systems activated to a greater degree
Occurs with strong, frequent or prolonged adversity
Brief increases in heart rate and blood pressure
Activation is time limited and buffered by caring adult
Disrupts brain architecture and other organ systems
Mild elevations in hormonal levels Brain and organs recover Increased risk of stress-related disease and cognitive impairment
Example: Tough test at school or a playoff game
Example: Death of a loved one, divorce, natural disaster
Example: abuse, neglect, caregiver substance dependence or mental illness
Unaddressed RepeatedProlongedIntense
Effective Intervention Early Detection Parental Resilience Social –emotional buffering
THREE PARTS OF THE BRAIN …
INFORMATION AND SLIDE PART OF DR. ALLISON SAMPSON'S TRAUMA PRESENTATION
• Brain Stem• Limbic Brain
• Cerebral Cortex
STRESS AND THE BRAIN
Sensory Thalamus Amygdala
“The Guard Dog”
Emotional Stimuli Emotional Response
Sensory Cortex
“Wise Old Owl”
LOW ROAD
Smoke Detector Activated
SUD SCALE 3 to 6
Smoke Detector Off
SUD Scale 6 to 3
Self- Regulation
THE CALM PERSON
HIPPOCAMPUS
Working
Model adapted by Allison Sampson from Ledoux (1996, page 164) and utilizing terms from van der Kolk’s work and Goldie Hawn’s Book (2011) 10 Mindful Minutes
Sensory Thalamus Amygdala
“ The Guard Dog”
Emotional Stimuli Emotional Response
HIGH ROAD
Sensory Cortex
“Wise Old Owl”
LOW ROAD
Smoke Detector Activated
SUD SCALE 6 to 10
Smoke Detector Misfires
SUD Scale stays at 8
Lack of Regulation
THE TERRIFIED PERSON
Hippocampus
Shrunken
Model adapted by Allison Sampson from Ledoux (1996, page 164) and utilizing terms from van der Kolk’s work and Goldie Hawn’s Book (2011) 10 Mindful Minutes
VULNERABILITY MOUNTAIN
INFORMATION AND SLIDE PART OF DR. ALLISON SAMPSON'S TRAUMA PRESENTATION
What does this mean for children who have experienced trauma?
EXPERIENTIAL EXERCISE
ATTACHMENT AND BRAIN … WHAT WE ALREADY KNOW
INFORMATION AND SLIDE PART OF DR. ALLISON SAMPSON'S TRAUMA PRESENTATION
• Review of the exercise … what did you notice about caregiver touch between the two sets of pictures …
• What do you think the implicit memories are about caregiving relationships ? About authority figures? About their ability to be safe ?
The needs of the adults and caregivers with trauma ….
are no different
CROSS-GENERATIONAL TRAUMA HENDRICKS (2012) CHAPTER 12 OF CREATING TRAUMA INFORMED CHILD WELFARE SYSTEMSUSING TRAUMA INFORMED SERVICES TO INCREASE PARENTAL PROTECTIVE FACTORS
Women who have experienced trauma are more likely to self- medicate with a substance (55-99%) (1)
Intergenerational transmission of trauma (Depression, PTSD) (2)
Unresolved childhood trauma can lead to reenactments with partners in adult relationships and/or with their children (3)
Unresolved childhood trauma can lead to difficulty forming secure attachments with their children (4)
Childhood trauma can result in parenting styles that include threats & violence (2)
Childhood sexual abuse survivors can miss “red flags” of sexual abuse with their own children due to avoidance of trauma memories themselves (2)
1) Najavits, Weiss, & Shaw (1997) The American Journal on Addiction, 6 (4), 273-2832) Hendricks, A. (2012). Using Trauma-Informed Services to Increase Parental Factors (pp. 89-91)3) Walker (2007) Journal of Social Work Practice, 21 (1), 77-87. 4) Main & Hess (1990) In M. Greenberg, D. Cicchetti, & E. Cummings (Eds.), Attachment in the preschool
years: Theory, research, and intervention (pp. 121-160)
BIG PICTURE WITH CAREGIVERS
• Often the caregivers … are the kids we as a system “missed”
• They come to us with their own trauma histories
• Successful outcomes with our clients means successful work with the family
• Screening all caregivers and finding them services is critical to the prevention/treatment/reduction of recidivism for children entering the juvenile justice system
CROSS-GENERATIONAL TRAUMA HENDRICKS (2012) CHAPTER 12 OF CREATING TRAUMA INFORMED CHILD WELFARE SYSTEMSUSING TRAUMA INFORMED SERVICES TO INCREASE PARENTAL PROTECTIVE FACTORS
Caregiver functioning following a child’s exposure to trauma is a major predictor of child’s functioning (1 & 2)
If we want to improve a child’s outcome, we must address parent’s trauma history … failure to do so can result in (2) …
- Failure to engage in treatment services - An increase in symptoms - An increase in management problems - Retraumatization - An increase in relapse - Withdrawal from service relationship - Poor treatment outcomes
1) Linares et al (2001) Child Development, 72, 639-6522) Liberman, Van Horn, & Ozer (2005) Development and Psychopathology, 17,
385-396 3) Hendricks, A. (2012) pp. 91
A PERSON’S RESPONSE TO PERCEIVED DANGERTrauma Event
Danger Response
Fight Flight FreezeAggression Run Away Dissociate
Verbal attack Substance Abuse Non-emotionality
Slide from Ellen Williams, LCSWCenter for Child & Family Services
CHASING BEHAVIORS
T
Agitation
Traumatic EventDepressio
n
Intrusive Memories
Nightmares
Hopelessness
Numbing
Insomnia
Shame & Self-Hatred
Panic Attacks
Substance Abuse
Somatic Symptoms
Eating Disorder
s
Self-Destructiv
e Behavior
Dissociation
Poor Impulse Control
Defiance
Withdrawal
Slide by Trish Mullens, Chesterfield CSB
WE MUST ……
Respond to the need ….
Not react to the behavior
PARADIGM SHIFT
What does TIC look like?
Information and slide part of Dr. Allison Sampson's Trauma Presentation
Core areas of focus in Complex TraumaCourtois, C. & Ford, J. (2009), Introduction (p.2)
Self-Regulation Affect Regulation Disassociation (difficulty in being “present”) Somatic Dysregulation
Self-Identity Impaired Self-Concept Impaired Self-Development
Co-regulation Secure working model of caring relationship Disorganized Attachment Patterns
Creating a Culture for TICFive Core Values (Fallot, 2009)
1) Safety2) Trustworthiness3) Choice (and Voice !!) 4) Collaboration5) Empowerment
We can offer CAPPD to those with work with … http://www.multiplyingconnections.org/
Information and slide part of Dr. Allison Sampson's Trauma Presentation
Phase Oriented Care
Information and slide part of Dr. Allison Sampson's Trauma Presentation
Understand what good trauma treatment looks like …
Phase Oriented Treatment “ Gold Standard”
Phase I: Safety and Stabilization Phase 2: Trauma ReprocessingPhase 3: Reintegration
Handout on questions to ask Mental Health Providers
Resource http://www.nctsnet.org/nccts/nav.do?pid=ctr_top_trmnt_prom
Information and slide part of Dr. Allison Sampson's Trauma Presentation
Phase Oriented Treatment for Trauma (Herman 1992, Janet 1889) from Courtois, C. “Treating Complex Traumatic Stress Disorders”)PHASE ONE: Safety and Stabilization
Personal and Interpersonal Safety Established: Education/Support/Safety Planning
Enhance Client’s ability to manage extreme arousal (hyper/hypo)
Active engagement in positive/negative experiences (deal with automatic avoidance behaviors, self awareness of avoidance, increase coping skills and use of coping skills)
Education (psychotherapy, trauma, skills to be learned) Assess and develop relationship capacity (decrease
avoidance of relationships or negative thoughts about relationships, build support network, define client’s attachment network)
Phase Oriented Treatment Phase Oriented Treatment for Trauma (Herman 1992, Janet 1889) from Courtois, C. “Treating Complex Traumatic Stress Disorders”PHASE TWO: Trauma Reprocessing Disclosure of traumatic memories, development of an
autobiographical narrative (identify emotions connected to trauma memories, grieve and mourn losses, resolution of relationships when appropriate, increased awareness, increase interpersonal and self-regulation skills)
Supporting client in maintaining functioning and not getting lost in memories or seeing themselves as “disabled”, need to affirm strengths, promote positive self-esteem, and internal and external resources now available to them
PHASE THREE: Re-Integration Growth and period and reengagement in life Can be time of client realizing losses, discover of unresolved
developmental deficits, fine tuning of self-regulation skills
Replacing Coping Behaviors Phase One Work
Chasing BehaviorsAgitation
T
Traumatic EventDepressio
n
Intrusive Memories
Nightmares
Hopelessness
Numbing
Insomnia
Shame & Self-Hatred
Panic Attacks
Substance Abuse
Somatic Symptoms
Eating Disorder
s
Self-Destructiv
e Behavior
Dissociation
Poor Impulse Control
Defiance
Withdrawal
Slide by Trish Mullens, Chesterfield CSB
Respond to the needDon’t react to the behavior
Post Traumatic Growth Typically 30-70 percent of survivors say that they have experienced positive changes of one form or another
• Construct meaning from what happened
• Survivor and thriver stories
• What to do with the “broken vase” ?
Post Traumatic Growth http://ptgi.uncc.edu/
Posttraumatic growth tends to occur in five general areas.
Sense that new opportunities have emerged from the struggle, opening up possibilities that were not present before.
Changes in relationships with others (ex: closer relationships with some specific people, increased sense of connection to others who suffer)
Increased sense of one’s own strength – “if I lived through that, I can face anything”
Greater appreciation for life in general Experience a deepening of their spiritual lives, however,
this deepening can also involve a significant change in one’s belief system
Resilience http://acestoohigh.com/
Resilience Factors (APA website) Caring/Supportive Relationships (primary) Capacity to make realistic plans and take steps to
carry them out A positive view of yourself and confidence in your
strengths and abilities Skills in communication and problem solving The capacity to manage strong feelings and impulses
Examples Protective Factors
Families who thrive
Targeting Change One tool …
When in their upstairs brain Support folks you work with in developing goals based on
their motivation … what do they want for their life today, what do they hope for, “magic wand questions”, what is their goal each day !!!
Collaborative Planning with Consumers… Interviewing for hopes Brain storm how to get there Creating a plan where they have a support system and access
to skills that will help them reach their goal Respecting their boundaries/contracting
LET’ PRACTICE ….
Skill Building
Replacing Coping Skills
Steps to replacing coping behaviors Identify current self-regulation strategies Help consumer make meaning out of why they chose
these strategies (ex: brain, ACE score, etc) “Magic Wand” question … focus of change Teach about the skills needed to build self-regulation Focus work on building resilience and new coping
strategies like a muscle Track progress with something like the diary card Frame replacing coping behaviors as a journey, it
will take time
Dialectical Behavioral Therapy – Informed DBT was developed in the late 1970s by Dr. Marsha Linehan and colleagues
Main goals: cope with stress, regulate emotions, improve relationships with others
Learning new behaviors -- which can be anything a person thinks, feels or does
Validation – the push for change can feel like it invalidates the pain that a consumer feels, validation is critical to helping consumer move forward i.e. the unhealthy coping strategy makes sense given your
experience, even though it is not the best approach to solve the problem
Dialectical Behavioral Therapy – Informed Dialectics (opposites) Dialectics makes three basic assumptions:
all things are interconnected change is constant and inevitable and opposites can be integrated to form a closer
approximation of the truth In DBT, the work is focused on resolving seeming contradictions between self-acceptance and change in order to bring about positive changes for an individual
DBT – Informed Skills
- Self Regulation - Mindfulness- Interpersonal Relationship Skills- Distress Tolerance Skills
Accept and Change
Vulnerability Mountain
Self Regulation Self-Regulation (“sunscreen”) Relaxation and Grounding Exercises Bilateral Movement Attunement Exercises Guided Imagery
http://www.healthjourneys.com/Store/Products/Healing-Trauma-PTS-Health-Journeys/19
Self-Care Plan (daily practice)
Mindfulness – art of being present in the moment Mindfulness Scale (MAAS) Mindfulness Exercise (sheet) – breathing, “one thi
ng”
Mindfulness Principles Mindfulness at UCLA http://marc.ucla.edu/
Self Awareness “knowing your skin” Educate children and adults about their triggers and trauma responses
o Wise old owl (Hawn Foundation)o Guard Dog (Hawn Foundation)o Smoke Detector (Van der kolk)o Alarm System ( ARC book pp.316-318)o Light Switch (“Please Explain Anxiety to Me”)
Teach and practice with them identification of feelings and needs Engage them in “Behavioral Experiments” where the try something different Teach about Thought Distortions (“thought distortion box”) so they can
begin to recognize thoughts they tell themselves that take them down to “Distress Valley”
Supporting beliefs that child or adult deserves “good” things Recognizing “bumps in the road” don’t mean “a crash”
Teaching About the Brain Upstairs/downstairs brain teaching practice
Using of multiplying connection tools (amazing brain pamphlets)
Partnering with Parents
Now you practice ………
Interpersonal Effectiveness Skills Self Help Tools
http://www.dbtselfhelp.com/html/interpersonal_effectiveness_ha.html
EX: Cheerleading statements (connected to building positive self-identity)
“Cheerleading statements are statements that people make to themselves in order to give themselves permission to ask for what they need or want, to say no, and to act effectively”
ACTIVITY Can you build some cheerleading statements with your neighbor ??
DISTRESS TOLERANCE
Distress tolerance skills (taken from the Accepts skills … DBT informed)o Activities (physical and mental) – mental vacation, bi-lateral movement (walking), temperature change
o Contributing – helping others gets you out of yourself and your stress (smiling, give compliment, invite someone to coffee, hold a door, do a favor)
o Comparisons – Bringing perspective to current situation, what skills have helped you cope before (have helped your children cope before) … validate yourself
o Emotions – Seek out activities that create feelings that are OPPOSITE from the painful ones you are experiencing (listen to music, favorite movie, work on a project --- favorite hobby)
o Push Away – Put away distressing memories in a “lock box” or in the “parking lot” for a little while … can do this in writing or mentally
o Thoughts – distract your thoughts with “one-thing” exercises, read something inspiring, “just worrying exercise”
o Sensations – Any physically vigorous activity or actively awakening senses (brisk walk, cold bath/hot bath, splash cold water on face, lotions on your wrist, strong taste, bold colors (Mandela), music)
Pederson, L. (2012). The Expanded Dialectical Behavioral Therapy Skills Training Manual . Eau Claire: CMI Education Institute, Inc. pp. 45-50
PRACTICE Using the ACCEPTS Model …
turn to your neighbor and think through activities that will fall under 2 of these categories that you could use with consumers you work with …
Skill building resilience starts with you …
Who is taking care of you ??
Information and slide part of Dr. Allison Sampson's Trauma
Presentation
Mirror Neurons
106
Impact of Working with Victims of Trauma
106
• Trauma experienced while working in the role of helper has been described as:– Compassion fatigue– Countertransference– Secondary traumatic stress (STS)– Vicarious traumatization
• Unlike other forms of job “burnout,” STS is precipitated not by work load and institutional stress but by exposure to clients’ trauma.
• STS can disrupt child welfare, police and juvenile justice workers’ lives, feelings, personal relationships, and overall view of the world.
Healing the hero
https://www.youtube.com/watch?v=FdaJYEraGG0&feature=em-upload_owner
Produced by Trish Mullen, LPCChesterfield CSB
Impact of Chronic Stresshttp://www.helpguide.org/mental/stress_signs.htm
raise blood pressure suppress immune system increase the risk of heart attack and stroke contribute to infertility speed up the aging process (life expectancy) create vulnerability for anxiety and depression obesity skin conditions (ex: eczema) sleep problems digestive problems
Information and slide part of Dr. Allison Sampson's Trauma
Presentation
Vicarious Trauma’s Impact Personally(Yassen, 1995)
Emotional Roller coaster Overwhelmed Depleted
Behavioral Negative coping mechanism Difficulty sleeping Absent- mindedness
Information and slide part of Dr. Allison Sampson's Trauma
Presentation
Cognitive Spaciness Apathy Perfectionism Minimization
Personal Impact … (Yassen, 1995)
Spiritual Hopelessness Anger at a Higher Power
Physical Aches and pains Impaired immune system Breathing difficulties
Information and slide part of Dr. Allison Sampson's Trauma
Presentation
Interpersonal Withdrawn Intolerance Loneliness Projection of anger
and blame
Professional Impact (Yassen, 1995)
Performance of Job Tasks
Decrease in quality and quantity
Increase in mistakes Avoidance of job
tasks
Information and slide part of Dr. Allison Sampson's Trauma
Presentation
Morale
Dissatisfaction Negative attitude Detachment
Professional Impact (Yassen, 1995)
Interpersonal Withdrawn from
colleagues Impatience Poor communication Staff conflicts
Information and slide part of Dr. Allison Sampson's Trauma
Presentation
Behavioral Tardiness Absenteeism Faulty Judgement
107
Managing Stress
• Request and expect regular supervision and supportive consultation.
• Utilize peer support.
• Consider therapy for unresolved trauma, which your work may be activating.
• Practice stress management through meditation, prayer, conscious relaxation, deep breathing, and exercise.
• Develop a written plan focused on maintaining work–life balance.
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Perry and Cost of Caring http://childtraumaacademy.com/cost_of_caring/index.html
Lesson 3: Self-Care Strategies for Combating Secondary Trauma
http://www.childtraumaacademy.com/cost_of_caring/lesson03/page03.html
Self-Care Strategies for Combating Secondary Trauma: An overview
Below, please find a few of the possible, positive ways you can address stress. Jot down the things you do (or will begin making a point to do) in order to better care for yourself. List additional items within each column.
Physical Psychological Emotional Workplace
Sleep well
Eat well
Exercise
Walk/Jog
Dance
Others:
Self-reflect
Read for pleasure
Say "No"!
Smile
Solitude
Others:
See friends
Cry
Laugh
Praise yourself
Meditate
Others:
Take breaks
Set limits
Get peer support
Get supervision
Use vacations
Others:
Information and slide part of Dr. Allison Sampson's Trauma
Presentation
Self-Care
“Whether you and I and a few others will renewthe world some day remains to be seen.
But within ourselves we must renew it each day.”
—Hermann Hesse
91
Self-care Strategieshttp://www.compassionfatigue.org/pages/Top12SelfCareTips.pdf
92
The best strategy to address compassion fatigue is to develop excellent self care
strategies, as well as an early warning system that lets you know that you are moving into the
caution zone of Compassion Fatigue.
Self Care: Need Options
Time and Connection: 10 second exercises 2 minute exercises 5-10 minute exercises 20-30 minute GI, Walking Meditation http://www.healthjourneys.com/default.asp (Belleruth Naparstek)
Trish Mullen, LPC
93
Brain Gym 94
0-10 0-10
Before Brain Gym After Brain Gym
Practice Figure 8 with whole right arm/left armFigure 8 with both armsCross crawl (opposite right hand to bent left knee, then left hand to bent right knee)
Self Care Apps Provider Resilience GPS for the Soul Mediation Oasis Apps Mindfulness Training System IChill App (Peter Levine) Narrative Therapy Questions (Narrative Q’s) Brain Wave http://socialwork.buffalo.edu/resources/self-care-starter-kit.html Flipagram (example) http://flipagram.com/f/nGbakYX6B5
NCTSN Self Care Inventory
Pocket TM … by Trish Mullen, LPC
Challenge:
Working with children who are in their downstairs brain and getting them back up to their upstairs brain … when we all use primarily upstairs techniques in our work …
Self care targeted to the right brain and lower brain …
HAPPY PLACE
http://youtu.be/up_WSAYmn-s
Caring For Yourself
98
Creating Internal Awareness
99
Creating Awaresness
100
Window of Tolerance
Pat Ogden101
Using Grounding Techniques to Stay in the Window of Tolerance
Mental GroundingPhysical GroundingSoothing GroundingSomatic Grounding
Najavitis, L.M. (2002). Seeking safety: A treatment manual for PTSD and substance abuse. NY: Guilford.
102
Practice Examples Distress Tolerance
“Down Stairs Brain” Temperature Change Grounding by looking up Bi-lateral movement Butterfly taps Compassion Hold
“Dig where the ground is soft” Chinese proverb
Conclusion: “Dig where the ground is soft” Chinese proverb
Instead of picking your trickiest area, pick the issue that you can most easily visualize improving on. (e.g.: “making a commitment to going for a walk every lunch time vs. getting rid of my difficult supervisor”).
You may not notice it right away, but making one small change to your daily routine can have tremendous results in the long term. Imagine if you started walking up two flights a stairs per day instead of using the elevator, what might happen after three months?
104
Together we can make a difference
Becoming Trauma Informed is a process …
https://www.youtube.com/watch?v=7wK2io3Z2KM&feature=em-upload_owner
105
THANK YOU ……
Dr. Allison Sampson-Jackson
Family Preservation Services, Inc
804-432-0056
http://www.vscsw.org/continuing_education/