Trauma-Informed Care
Trauma Awareness
Instructor: Dr. Dawn-Elise Snipes, PhD, LPC-MHSP
Podcast Host: Counselor Toolbox and Happiness Isnât Brain Surgery
Objectives
~ Define and differentiate between the different types of trauma (individual, group, mass, natural or human caused)
~ Explore how trauma effects communities and cultures
~ Identify staff and agency issues that could cause retraumatization
~ Explore the objective and subjective characteristics of trauma and their biopsychosocial impact.
~ Identify characteristics that nurture resilience among individuals from diverse groups.
Types of Trauma
~ Individual
~ An individual trauma occurs to one person.
~ It can be a single event or multiple or prolonged events (e.g., a life-threatening illness, multiple sexual assaults, first responders, war).
~ Although the trauma directly affects just one individual, others who know the person and/or are aware of the trauma will likely experience emotional repercussions
~ Survivors of individual trauma may not receive the environmental support and concern that members of collectively traumatized groups and communities receive.
~ They are less likely to reveal their traumas or to receive validation of their experiences.
~ Shame distorts their perception of responsibility for the trauma.
~ They struggle with issues of causation
~ They feel isolated by the trauma
Types of Trauma
~ In working with clients who have histories of individual trauma, counselors should consider that:
~ Empathy, or putting oneself in the shoes of another, is more potent than sympathy (expressing a feeling of sorrow for another person).
~ Some clients need to briefly describe the trauma(s) they have experienced, particularly in the early stages of recovery.
~ Intensive exploration should wait until the client is more prepared
~ Understanding the trauma should begin with educating the client about and normalizing trauma-related symptoms, creating a sense of safety within the treatment environment, and addressing how trauma symptoms may interfere with the clientâs life in the present.
~ It is helpful to examine how the trauma affects opportunities to recover(e.g., by limiting oneâs willingness to share in in group).
~ Identifying and exploring strengths in the clientâs history can help the client apply those strengths to his or her ability to function in the present.
Types of Trauma
~ Group
~ âGroup traumaâ refers to traumatic experiences that affect a particular group of people
~ Groups often share a common identity and history, as well as similar activities and concerns. (vocational groups who specialize in managing traumas or who routinely place themselves in harmâs way)
~ examples of group trauma include crews and their families who lose members from a commercial fishing accident, a gang whose members experience multiple deaths and injuries, teams of firefighters who lose members in a roof collapse, responders who attempt to save flood victims, and military service members in a specific theater of operation.
~ Group members who have had traumatic experiences in the past may not actively support traumatized colleagues for fear that acknowledging the trauma will increase the risk of repressed trauma-related emotions surfacing.
Types of Trauma
~ Group
~ Survivors of group trauma can have different experiences and responses than survivors of individual or mass traumas.
~ Likely to experience repeated trauma.
~ Tend to keep the trauma experiences within the group, feeling that others outside the group will not understand
~ Members may encourage others in the group to shut down emotionally and repress their traumatic
~ Group members may not want to seek help and may discourage others from doing so out of fear that it may shame the entire group.
~ Members may see it as a violation of group confidentiality when a member seeks assistance outside the group, such as by going to a counselor.
Types of Trauma
~ Community and Cultural Trauma
~ Trauma that affects communities and cultures covers a broad range of violence and atrocities that erode the sense of safety within a given community, including neighborhoods, schools, towns, and reservations.
~ It may involve violence in the form of physical or sexual assaults, hate crimes, robberies, workplace or gang-related violence, threats, shootings, or stabbings
~ It also includes actions that attempt to dismantle systemic cultural practices, resources, and identities, such as making boarding school attendance mandatory for Native American children.
~ Cultural and/or community-based trauma can also occur via indifference or limited responsiveness to specific communities or cultures that are facing a potential catastrophe.
Types of Trauma
~ Community and Cultural Trauma
~ Cultural traumas are events that, whether intentionally or not, erode the heritage of a cultureâas with prejudice, disenfranchisement, and health inequities
~ Historical trauma, known also as generational trauma, refers to events that are so widespread as to influence generations of the culture beyond those who experienced them directly.
~ The enslavement, torture, and lynching of African Americans
~ Forced assimilation and relocation of American Indians onto reservations
~ Extermination of millions of Jews and others in Europe during World War II
~ Genocidal policies of the Hutus in Rwanda and the Khmer Rouge in Cambodia
Types of Trauma
~ Mass Trauma
~ Include large-scale intentional and unintentional natural and human-caused disasters.
~ Involve significant loss of property and lives as well as the widespread disruption of normal routines and services.
~ Require extensive resources that exceed the community capacity
~ The initial event causes considerable destruction and spawn additional traumas and other stressful events that lead to more difficulties among survivors, first responders, and relief agencies
~ Create an immediate sense of commonality and rally of supportâremoving much of the isolation
~ People acknowledge their difficulties and receive support from strangers.
~ It is easier to ask for help because blame is often externalized
~ Survivors often encounter an initial rally of support followed by quickly diminishing services and dwindling care.
Types of Trauma
~ Natural traumatic experiences often referred to as âacts of God,â are typically unavoidable.
~ Survivors of natural trauma response to the experience depends on:
~ The degree of devastation
~ The extent of individual and community losses
~ The amount of time it takes to reestablish daily routines, and services
~ The amount, accessibility, and duration of relief services can significantly influence the duration of the recovery process.
~ Alongside the disruption of daily routines, the presence of community members or outsiders in affected areas may add significant stress
~ Examples include the threat of others stealing, restrictions access to property or living quarters, lack of privacy in shelters, media attention, and subsequent exposure to repetitive images reflecting the devastation.
Types of Trauma
~ Human-caused traumas are caused by
~ Human failure (e.g., technological catastrophes, accidents)
~ Survivors of an unintentionally human-caused traumatic event may feel angry and frustrated because of the lack of protection or care offered by the responsible party or government, particularly if there has been a perceived act of omission.
~ Human design/intention (e.g., war).
~ Traumas perceived as intentionally harmful often make the event more traumatic for people and communities.
~ After intentional human-caused acts, survivors often struggle to understand the motives for performing the act, the calculated or random nature of the act, and the psychological makeup of the perpetrator(s).
Retraumitization
~ Staff and agency issues that can cause retraumatization include:
~ Challenging or discounting reports of abuse or other traumatic events.
~ Using isolation or physical restraints.
~ Using experiential exercises that humiliate the individual.
~ Endorsing a confrontational approach in counseling.
~ Allowing the abusive behavior of one client toward another to continue
~ Labeling behavior/feelings as pathological.
~ Failing to provide adequate security and safety within the program.
~ Limiting participation of the client in treatment decisions and planning processes.
~ Minimizing, discrediting, or ignoring client responses.
~ Disrupting counselorâclient relationships by changing counselorsâ schedules and assignments.
~ Inconsistently enforcing rules and allowing chaos in the treatment environment.
~ Imposing agency policies without exceptions or an opportunity for clients to question them.
Addressing Retraumatization
~ Anticipate and be sensitive to the needs of clients who have experienced trauma
~ Attend to clientsâ behavioral and emotional reactions to decrease them.
~ Develop an individual coping plan in anticipation of triggers
~ Routinely rehearse the coping strategies highlighted in the coping plan
~ Recognize that clinical and programmatic efforts to control or contain behavior in treatment can cause traumatic stress reactions
~ Listen for the specific trigger that seems to be driving the clientâs reaction to understand the behavior and normalize the traumatic stress reactions.
~ Do not shame the trauma survivor for his or her behavior
~ Respond with consistency
Characteristics Impacting Trauma Reaction
~ Single, repeated, or sustained trauma
~ âCascading trauma,â occurs when multiple traumas happen in a pattern that does not allow an individual to heal from one traumatic event before another occurs
~ Number of losses caused by the trauma (Interpersonal, status, self-esteem, financial, tangible, occupational, physicalâŚ)
~ It is helpful to access and discuss the losses associated with the initial trauma.
~ The number of losses greatly influences an individualâs ability to bounce back from the tragedy.
Characteristics Impacting Trauma Reaction
~ Were the traumaâs effects on the personâs life isolated or pervasive?
~ People who remain in the vicinity of the trauma may encounter greater challenges in recovery. The traumatic event intertwines with various aspects of the personâs daily activities and interactions, thus increasing the possibility of being triggered by surrounding cues.
~ Another way to view this potential dilemma for the client is to reframe it as an opportunityâthe repetitive exposure to trauma-related cues may provide vital guidance as to when and which treatment and coping techniques to use in the delivery of trauma-informed and trauma-specific behavioral health services.
Characteristics Impacting Trauma Reaction
~ Was the trauma expected or unexpected?
~ Who was responsible for the trauma and was the act intentional?
~ When terrible things happen, it is human nature to assign blame.
~ Trauma survivors can become heavily invested in assigning blame or finding out who was at fault to make sense of, give meaning to, the trauma and reestablish a sense of predictability, control, and safety
~ It is far easier to accept that someone, including oneself, is at fault than it is to accept the fact that one was simply in the wrong place at the wrong time.
~ For some trauma survivors, needing to find out why a trauma occurred or who is at fault can become a significant block to growth when the individual would be better served by asking, âWhat do I need to do to heal?â
Characteristics Impacting Trauma Reaction
~ Was the trauma experienced directly or indirectly?
~ What happened since the trauma?
~ Psychological meaning of trauma
~ Disruption of core assumptions and beliefs
~ Cultural meaning of a trauma. How do cultural interpretations, cultural support, and cultural responses affect the experience of trauma?
~ History of prior trauma, stressors, mental illness
~ History of resilience
~ Sociodemographic variables (occupation, income, ethnicity, education, genderâŚ)
Resilience
~ Resilience among individuals from diverse cultural, racial, and ethnic groups:
~ Strong kinship bonds
~ Respect for elders and the importance of extended family
~ Spirituality and religious practices
~ Value in friendships and warm personal relationships
~ Expression of humor and creativity
~ Instilling a sense of history, heritage, and historical traditions
~ Community orientation, activities, and socialization
~ Strong work ethic
~ Philosophies and beliefs about life, suffering, and perseverance
Summary
~ Trauma can impact individuals, groups or communities (masses)
~ Each type of trauma presents different issues with garnering support and achieving recovery.
~ Traumas can be caused intentionally or unintentionally by man or nature.
~ The way an individual responds to trauma depends on
~ Their culture, gender, age and other sociodemographic characteristics
~ Whether it was expected
~ How pervasive the trauma is and the number of losses associated with it.