Essential Trauma Informed Interventions for Trauma Recovery & Healing

This episode was pre recorded as part of a live continuing education webinar on demand. CEUs are still available for this presentation through all CEUs register@allceus.com counselortoolbox. Hi everybody, I'm Dr. Donnelly Snipes and I'd like to welcome you to today's presentation on trauma informed interventions. Now I had originally planned to do this based on a book called 101 Trauma Informed Interventions. And I got the book and I really didn't like has a lot of great activities for grounding and it has a fair amount of activities if there's family related or attachment related trauma. But it was general in its presentation. It really didn't talk about trauma informed so much. It just said you can do Tai Chi or you can do Qigong or you can do this activity. And didn't draw it in. So what we're going to try to do in this presentation is draw together some activities and some principles that we need to consider when we're doing activities in order to ensure they're trauma informed. And many activities that we do, many interventions, group activities, et cetera, can be trauma informed if they help us accomplish a few predetermined goals, if you will. And we'll talk about those. So we're going to review the components of trauma informed care so we understand what kind of interventions we're really looking for and what the goal of those interventions hopefully will be. We'll identify a variety of interventions and considerations for the provision of trauma informed care. So the principles of trauma informed care. And this is a review for some of you. So I apologize, we'll go through it real quick. Safety. This is first and foremost, people who've been exposed to trauma really need to feel safe. They need to feel emotionally safe, like you're not going to push them too far where they can't come back. They need to feel cognitively safe, like their thoughts and their opinions are valid and they can state them without fear of repercussions. And they need to feel physically safe. And that goes without saying. But there are some things you can look around your office and go, looks perfectly safe to me. I don't see what the problem is. But something as simple as shutting the door and locking it, if you do that for some reason could be very traumatic to somebody who'd been in a situation where they'd been confined with their abuser before. So we do want to consider safety. We want to make sure that clients feel physically safe, that there's nothing in our office that is exceptionally triggering to them. And if there is, then we need to figure out what to do about that. We need to develop trustworthiness and transparency, do what we say, say what we mean, and tell clients with trauma informed care, it is so much more important. And since most people have experienced trauma, I think this should just kind of be a standard. But we need to be transparent. We need to do more than just this informed consent thing at the beginning of treatment and go, well, this is kind of what we're going to do. And these are the benefits, potential drawbacks and risks and options. Bada bing, sign the paper, let's get moving. Well, yes, we've got to do that at the beginning. But with people who've experienced trauma, we need to help them understand where it is feasible to what we're getting ready to ask them to do if we want them to do a cognitive interview. For example, I was watching a show yesterday that was one of those police procedural shows. I don't remember which one, but the police officer told the victim, okay, I want you to close your eyes. And you could see her just tense up, which really good acting there because she's like, okay, why in the hell am I going to close my eyes? I don't know you from Adam's house cat. So it's important if we're going to ask clients to do something that we explain to them, okay, this is what we're going to do, this is why we're going to do it. I'm going to first ask you to close your eyes. And this is the reason if the person is not comfortable closing their eyes, but for some reason it's necessary, which is rarely necessary. But if it is necessary, what can I do to help you feel safe while your eyes are closed? And working with the person before you launch into the activity or intervention, whatever it is, is so important. And this is true even with things that seem very benign, like meditation, Many people who've been exposed to trauma have a lot of difficulty obviously with hyper vigilance. So they want to be aware of what's going on. They don't want to be closing their eyes because they don't feel safe. Yet as your relationship with that client develops and they begin to trust you, they are going to be able to be more vulnerable in your presence. So you may get to a point where they're willing to, you know, without question close their eyes in order to go into an activity. But that's not something we can necessarily expect and certainly not demand from the get go trauma Informed care provides peer Support and mutual self help. We want people to be able to connect with others who've experienced similar things, who've experienced traumas, who are experiencing ptsd, who have come through and are in remission or recovered from ptsd. We want people to be able to connect with others, not just us as the therapist. So it's important to encourage them to engage in support groups and mutual self help where appropriate. And this is really true. Well, it's true across the board, but when you're working with groups such as clergy, counselors, doctors, law enforcement, firefighters, people who typically are there for people, they're responsive for people, and they feel somewhat responsible for people and may not want to talk about this trauma for some reason. Military is another one, because for fear of reprisal in some way, shape or form. I've worked with a lot of counselors, and I mean work collegially with a lot of counselors who recognize that they have been experiencing secondary traumatization, but they don't want to go to counseling because they're afraid that it would come back to the board and then the board would start instituting excessive supervision or something. So even clinicians, despite the fact that we know what we know, can be hesitant about seeking help. So it's important to encourage people to seek help, but it's also important for people to seek help from like others. Because what clinicians experience is very different than what cops experience. And law enforcement as a profession tends to be somewhat isolated, if you will. They like to keep it within the. The law enforcement family, if you will. So it's helpful if they can find support within their occupational community. That's what we'll call it, occupational community. Okay, so number four is collaboration and mutuality. We're not doing things to the client. This is what happened. Whenever the trauma happened, something happened to the client. Whether it was an act of God, whether it was an abusive parent, whatever happened, the client had no control over it. So we want to make sure that we are asking, what do you need to do? What has worked before? What do you think is the best outcome? Which direction do you want to go from here, and what role do you want to play? Some clients want to be much more active in their treatment than others. What role does this client want? And as treatment progresses, that can change because some people, when they start treatment, feel very disempowered, very helpless about the whole situation. And they're just exhausted from the PTSD symptoms or from the trauma symptoms. But as they start moving through treatment and start feeling a Little bit better and feeling like there's hope. Then they start feeling more empowered and wanting to take more control of the reins. And that's awesome. That's what I want. So we need to regularly revisit this concept of collaboration and mutuality. One of my biggest pet peeves, and I have a few of them, is when I would see a clinician writing a treatment plan for a client and then walking over and giving it to them and going, here's your treatment plan. And the client didn't participate in the development of the treatment plan at all. Maybe a little bit of discussion in the assessment about, well, what kind of goals do you have? But the client didn't participate in the development of the objectives of the interventions, of the pacing of anything. The clinician did it for the client. And even more of a pet peeve is if a clinician's treatment plans look cookie cutter for ptsd, for example, or for depression. Every single person that clinician treats who has PTSD has the same, nearly the same exact treatment plan drives me a little bit batty. That tells me the client did not collaborate, did not have a say. It wasn't a discussion, it was an edict. Empowerment, voice and choice. And this kind of goes with collaboration. When we're asking them to participate to help us understand what works for them, what doesn't work for them, we want to empower them to say, yes, that works. And I tell my clients from the beginning, whether I know they've got a history of trauma or not, over the time we work together, I'm going to make a lot of suggestions for different activities you might try to address particular things. Some of them will work well for you, some of them won't, and some of them you're not even going to want to try. I need to know which category each one falls in. Because if something doesn't work for you, I don't want to keep suggesting it. And if there's something that you're just not even willing to try, okay, I'm not going to force you to try it. But again, I need to know. So I know that you don't like to think about doing meditation, for example, if that's something a client says, no, that's not something I'm going to do. Okay. At least for now, we're going to write that off. And in the back of my mind, I think I might try reintroducing it in a couple of months if it seems appropriate. But I don't want to disempower the client or make the client feel like I wasn't listening by saying, well, you really need to try, at least try this. You know, most of us had to sit through something similar and it obviously wasn't traumatic, but when we were little and your parents put something like Brussels sprouts on your plate and you're looking at it going, that smells disgusting. Sorry, not a fan of Brussels sprouts. But your parents said, you have to at least try it. And you tried it and you're like, that tastes disgusting. I told you. I don't want clients to feel like I am handing them Brussels sprouts. I want them to feel like I am listening and giving them options. So empowerment, voice and choice also means that we look at strengths and we build on the strengths that the client has. How have they dealt with their trauma until now? How have they built their life, the good parts of their life up until now? Let's build on that because those are the strengths that they have. We may need to sharpen those tools a little bit or switch from a manual tool to a power tool, but we're going to build on them. Everybody in the team, everybody in the team, from the clinician to the doctor, to the support people to the client, everybody needs to believe in resilience of the individuals, the organizations and the communities. And you might think, well, that's kind of broad for everything. But we have to believe if we're working with a rape victim or a rape survivor, we have to believe that that person has the ability to work through that trauma and integrate that trauma. We have to believe that the people in different organizations that interfaced with that youth after the trauma, they're going to be impacted by it. We have to believe that those people can be resilient. The law enforcement officers, the attorneys, etc. And we have to believe that the communities can be resilient. If you're living in a neighborhood that you feel is safe and you find out that the 13 year old down the street was assaulted the day before, that's going to shake your whole community because all of a sudden it doesn't feel safe anymore and people are going to start feeling more uneasy. But we have to believe in a trauma informed perspective that the individual that was the primary survivor as well as secondary survivors can recover. And we have to believe that community can find a new normal. It's never going to be the same. I lived on the University of Florida campus when we had a serial killer go through, unfortunately, and that really shook the community of the campus to its core. But we were able to come together as a community and we were able to recover after a hurricane, after Katrina, after Harvey, you know, it shook communities to their core and that was traumatic for millions of people. But the communities were able to come back together. So we need to believe in this resilience. If you don't, then you want to stop right there because that will be communicated. You need to have that belief in your heart that people can integrate, and I use the word integrate, not accept they can integrate that experience into their life. We need to build on what clients, staff and communities have to offer rather than responding to perceived deficits. And again, this isn't unfortunate pattern that we generally have. Instead of seeing a person who comes in as a survivor and saying, wow, let's build off of that strength and that courage you have. A lot of times we see them as a victim and we're trying to ameliorate what's broken in them. It's a semantic shift, but we want to build on that strength and that courage that that person has brought to us. We want to build on the strengths of the communities. Yes, the houses may be devastated. Yes. On that campus, you know, you didn't know when it was safe and people had curfews and everything. And it was really scary for a while. But as a community, we bonded together and started watching out for each other more. So there were strengths that were brought out and we want to respond to cultural, historical and gender issues. Leveraging the healing value of cultural connections. Remembering this doesn't just mean ethnicity. This can mean religion. This can mean occupation. This can mean. Well, I guess, for example, being a UF college student would be sort of an occupation, because as gators, at that point in time, we needed to come together to support one another and we recognize and address historical trauma in people. Okay, so those are the principles and I'm going to summarize it for you in just a couple of slides. So don't think, oh my gosh, how am I going to remember all that? You got it. The events, the three E's of trauma. The event is what happened objectively. There was somebody victimized, there was a tornado, there was a car crash, whatever it was, this is the event. Now, every person who goes through an event experiences it differently based on how old they are. You know, kids are going to experience things very differently than 20 somethings who are going to probably experience it very differently than 60 somethings. Okay? Experiences can be affected by people's developmental age, their prior history with something like that. If they've had prior traumas, if they have had a prior experience with something similar, if the incident occurs close to what's considered their safe space, if the incident, if they're not a primary victim, if the incident reminds them of somebody that's close to them. There are a lot of things, variations or variables that can go into making an experience or much more traumatic for one person than the other, even though the objective experience is exactly the same. The third thing that affects experiences is available resources. When it happened, did that person have support within the first two to four hours? Did that person have support within the first 24 hours? Within the first 72 hours. After we get out of 72 hours, people have started to really compartmentalize and try to stuff it down because it's just so overwhelming, so important for people to have social support as well as necessary resources in that first period. If a house burns down, the Red Cross goes out there and makes sure that people have somewhere to stay. They have clothes, they have a toothbrush, they have the things they need. And that happens not instantaneously, but it happens within a couple of hours. So those available resources for getting basic needs met. Think of Maslow's triangle, Maslow's hierarchy. Those happen, and that tends to make help the person feel a semblance of normality a little bit sooner and have a little bit more of a sense of control. So that can make the traumatic experience a little less traumatic or help the person with their resiliency. And the third e is effects. So you have the event, the experience, and then you have the effects of it. What happened to the person is going to affect them emotionally, it's going to affect them mentally and the way they understand the world and perceive things and maybe their outlook for a while. It will probably. When people are in trauma, it will probably affect their memory. Because when you're in trauma, you're not. Your memory's not good, just put it that way. So if somebody is in an acute state of trauma, making sure that they're told it's okay, you're going to feel kind of scattered for a while. Write things down. Keep it simple. If it's been a while since the trauma, you're probably looking at cognitive distortions and cognitive restructuring that took place as a result of the trauma. Physical effects. Because of the emotional effects, there can be physical effects such as not being able to get enough sleep, hyper vigilance, increased arousal, those sorts of things. There can also be physical effects from the trauma. If you're in a car accident and you Break your hip. It's a physical effect of the trauma. So we need to look at that. Social effects of the trauma. A lot of things go into this. The trustworthiness of other people, the reliability and dependability of the people you thought were your supports, your willingness to engage in interpersonal relationships. Some people try to withdraw after a trauma because it's just too overwhelming to deal with other people. So there are social effects, spiritual effects, as we've talked about in our spiritual steps to happiness after a trauma. People's understanding of how the world works and the way they make meaning out of things is often shaken up a little bit. So we need to help people work through that. And then the environmental effects of trauma. It can be as obvious as the destruction of a house or car or something like that to something that is a little less obvious. For example, someone who is the survivor of a home invasion robbery may start putting bars on their windows and triple lock their doors, and their environment becomes more like a prison than a inviting place to live. So we do want to look at the effects of the trauma when we're helping people work through their trauma. These are all potential treatment plan goals when we're addressing trauma. And we have to let the client guide us at their pace on what they're willing to or able to address. It's also important with trauma to help clients understand. And in the Trauma Informed Care certification track, there's a class on the neurobiology of trauma. But our brains are kind of cool. And one thing that people learn in that track is that during an intensely traumatic event, the brain actually secretes certain chemicals in order to prevent the formation of memories, because the brain's going, oh, dude, I don't want to remember that ever. Which is why sometimes people can't remember the details of a trauma. Their brain was protecting them. Yes, it is frustrating. It is so frustrating for somebody who felt so out of control to still feel out of control because they have these blank spots. And we can work with them on that, helping people understand that that's a normal part of the trauma and that some of those memories may come back when, and I make the analogy, if you will, that when your brain thinks you're strong enough to handle it, when the brain thinks you're ready to handle that tidbit of information, you might get it back. When I do autobiographies with my clients, I have them write their autobiography on a sheet of paper, and every sheet of paper is a year. So they start with their earliest memory and then whatever age they Were so six, we'll say they answer a bunch of questions about what was going on when they were six as best as they can. Then on the next sheet of paper is when they were seven, next sheet of paper is when they were eight. And sometimes people can't remember the age. So I say when you were in first grade, second grade, third grade, whatever it is that helps them cognitively connect with that age. Why do I have them do waste so much paper, if you will? Because as we go through therapy, people often remember things. They're like, you know, I forgot that when I was six I used to do this, or when I was six this was going on. Well, we can add it to the autobiography now so they're able to start filling in some of those gaps. And it feels, helps them feel a little bit more complete, if you will, in some ways. Okay, so the four Rs we need to help clients realize the event, what happened, recognize the experience, help them come to terms or understand how they experienced that event and the effects of that experience. So if somebody experienced a trauma when they were four or five, you know, cognitively, children are thinking dichotomously at that point in time. They don't have much of a point of reference. They are dependent, wholly dependent on their adult caregivers. So their experience and the effects of that trauma and their reaction could be very different than what if they experience the same thing, heaven forbid, when they are 26, we want to help them see that they may be reacting, they may have those memories stuck, for lack of a better term right now, kind of stuck in their amygdala from when they were four or six, whenever this happened. And they're still feeling, when they're exposed to those triggers, they're still feeling like that terrified child. To help them understand why they're reacting the way they're reacting, we want to help, we want to respond to help people live a high quality life and acceptance and commitment. Therapy for trauma is one approach. Cognitive behavioral therapy for trauma is another approach or trauma focused. Cognitive behavioral therapy, Cognitive processing therapy is another one. There's also exposure and desensitization type approaches. There's a lot of different approaches that people EMDR is yet another one. We need to educate clients about the options that are out there so they can most effectively choose what's going to, they feel will work for them. And then we need to ensure, you know, sort of that above all, do no harm thing. We need to ensure that we are doing everything possible to resist re traumatizing the client we want to make sure we're not taking their power. We want to make sure we are not recapitulating that event. Something happens that starts to do that. We need to be able to help them stop and take action so they don't feel like they're immersed in it again. Unless, you know, obviously, unless you're doing exposure therapy or something. And even then, exposure therapy needs to be done by a trained professional, somebody who's trained in exposure therapy. You don't want to just pull that out of your hat and go, hey, you're terrified of spiders, so let me bring a spider in and see if you want to work with it. Please don't do that. Okay, so, summary of the intention of the interventions. We're getting to the interventions in just a second. You want to create safety and develop trust with clients through the use of cultural resources, peer support, transparency, collaboration and empowerment. So you're getting this whole support system together. You're gathering up the resources and sort of stocking the fort, if you will. So this person feels like they are totally supported and protected and cocooned, if you want to use that term. We do this in order to help clients get to the place where they can explore events, the experiences and the effects of those events, and respond in a way that will help them live a rich and meaningful life without feeling like they are being regularly re traumatized. Traumatization happens when people feel a lack of control. Can we make these memories go away? No. Can we help them develop a different relationship with those feelings, reactions and memories? Yes. Where they feel like they have more control. Where they feel like they can live a rich and meaningful life. Yes, we can. So create safety. These are some of the activities that can be kind of fun. Encourage people to develop a nurturing voice. And we talk in group a lot about what a nurturing voice means because some people are like, what? What would you tell a six year old? What would you tell a small child? What would you tell your best friend if they. So again, back with my stack of index cards that I have. When people have trials, tribulations and troubles in their life, I have a whole stack of cards that I have developed of issues that often come up. And I'll pull a card out and I will say, okay, if you got fired from your job, what might you tell yourself? What might you. If you were using a nurturing voice, what would you tell yourself? And if they kind of look at me like, I don't know, what would you want a nurturing parent to tell you? You want to develop the voice of a nurturing parent in your head instead of a critical heckler. So we'll go through those cards for the better part of group and then we'll talk about how it would feel and how it felt to switching from a critical voice to a nurturing voice. We also talk about experiencing trauma. So if somebody goes into a shopping mall, for example, and they whenever they're around crowds, it triggers their ptsd. The critical heckling voice can say, you are so weak, you are so broken, you're no good to anybody. The nurturing voice can say, I don't blame you for being stressed out and anxious right now. What can we do? What tools do you have to help you get through this moment? So we talk about symptoms of PTSD and situations that trigger PTSD symptoms for people. We talk about what they tell themselves and then we talk about what an alternate nurturing voice in their head could tell them instead. Another activity you can do, and I really strongly recommend this at the beginning of treatment, like when you're doing the treatment plan. Develop a crisis plan. Help the person develop a crisis plan so they can identify signs of impending crisis. And they can also, this is also goes along with their advance directives. They can identify where they want to go, if they have to be hospitalized, who they want involved in their care, etc. They can also identify what's the most helpful thing or things that people can do and what's the least helpful or potentially damaging things that people can do. You want to have that in a plan. And then in a post crisis plan, we generally forget this part. After the person goes through the crisis, after the person get stabilized and you know, they've gotten, gotten grounded again, what is it that they need to do? Because after a crisis, whether it's a three or four hour thing or a three or four month thing, you know, it doesn't matter. After a crisis, people tend to be exhausted, which means they're more vulnerable to dysphoric emotions and reactions. So in this post crisis period, what is that going to look like? How can they start taking care of themselves again or continue to take care of themselves? Who do they want involved? And at what point can those supports, do they feel like those supports can step away from them a little bit? Mindfulness activities are a third group of things people can do. Because we want people to have an awareness of self in order to feel safe. We need to be aware of what's going on within us and around us. Not hyper vigilant, but if we are mindful and we notice. You know what, I'm feeling really uneasy here for some reason. We can intervene before it becomes a full out anxiety attack. If we are mindful of what's going on, we can explore with curiosity. You know, I'm feeling really uneasy. I wonder where this is coming from. And develop a greater awareness so then we can identify ways to deal with that so we're not having to close things out, we're not having to escape or leave. We're able to identify triggers, reminders, etc. And develop a plan for how to handle those so we feel safe, we feel like we've got control. We feel like we have the ability to be empowered in our life. Grounding techniques Awareness of the present when people start having flashbacks if they've been exposed to trauma, it's not uncommon for people to have flashbacks. When they start having flashbacks or feel like they're getting ready to have a flashback, it's important for them to be able to ground themselves. And I have a variety of grounding techniques that we go through. One of my favorite is the 4, 3, 2, 1. I have people identify four things they see in the present moment, three things that they hear, two things that they smell, and one thing that they can feel and that just helps them really focus on the moment and staying in the present instead of going back there. Because remember, PTSD pulls our mind to the past about what happened and could happen again and pulls our mind to the future or worrying that the worst is going to happen. We want to encourage people to stay in the present. What's going on? Other grounding techniques can be as simple as calling a friend and you know, with a hands free phone if you're in the car and just talking and staying focused in the present. One of the things I do and it's not trauma related so to speak, it's more my own weird phobias. But I have this irrational fear of bridges. So whenever I go over a bridge, I sing songs. Whether it is the ABCs or Mary had a Little Lamb. It's usually some kind of little kid song that I can just sing over and over and over again until I get across the bridge. It helps me stay grounded and focused on what I'm singing instead of looking around going oh my gosh. Encourage clients to brainstorm how have they grounded themselves before when they've had flashbacks? How have they gotten re acclimated to the present if they've woken up from a night terror? How can they get regrounded and reoriented unhooking We've talked about this in other classes, helping people unhook from their emotions when we feel like we're hooked to it. Imagine going fishing, you are just out there, you're cruising along and suddenly this 12 foot great white shark. And yeah, you've got really strong fishing line. 12 foot great white shark takes your line and starts pulling you and you're afraid it's going to pull you right off the boat and gobble you up. That's the way our feelings can feel in the middle of an anxiety attack or in the middle of ptsd. So encouraging people to understand that they can cut that line, they can see that great white shark out there, they can notice that great white shark out there and they can cut that line and go, you know what, I ain't going overboard today. Pandora's box is another one that I really like doing with clients because it starts to give them a sense of control. And we practice this when we start talking about the trauma and the effects of the trauma and all that stuff. This is one of the early exercises we do. And we talk about how when they're exposed to something that reminds them of the trauma, it opens up Pandora's box. And most people know that that's this box that's filled with all these emotions. And there's lots of other stories that go along with it. But we talk about how it's this box that's filled with emotions when they open it. Some people are afraid that if they open it, everything is going to come pouring out and they will never get the lid shut back. So they're afraid to go there. So we start talking about Pandora's box. We look at it and if it's somebody who's more visual, I even have some boxes that I've gotten at the craft store that are like treasure chests that are locked. And we look at the box and I, we talk about what it feels like to look at that box that might be filled with their emotions. What does it feel like to think about taking the lock off of that box? What does it feel like to. And we gradually step to the place where they unlock it, take the lock out and gradually open it up just a peep, just a peep, just a little bit. And then start opening it a little bit more. We talk about what their fears are if they open that box too much. We talk about strategies for closing that box again if it starts to open. And when we start processing trauma issues or talking about something that might trigger intense emotions, they have the keyword That I need to shut the box. And that's my clue. And that's their clue that, okay, you know, this is getting too intense for me right now. Instead of running from it or changing the topic, I need to shut the box. And we may be able to open it again in 15 minutes, but right now, I need to shut the box. And we work on that with each client each week. Help clients develop boundaries. Depending on the trauma, they may have had their boundaries violated in one or more different ways. So help them learn about boundaries. Sometimes when people are in a traumatic experience, other people are so well meaning that they want to comfort. They come up and they want to give hugs and they want to touch. And people who've been traumatized sometimes don't want to be touched. They're like, personal space. You know, this is my bubble. Encouraging people to develop the skills to know what's a comfortable personal space and the assertiveness skills to be able to kindly articulate. I need this kind of space. I'm not a hugger. I just don't do well with that. It's nothing personal. I'm just not me. Emotional boundaries. Encouraging people to be able to set those emotional boundaries and say, I feel how I feel. It's not right or wrong, it's just how I feel. If you feel differently, that's okay. It doesn't mean anything's wrong with me. And cognitive, my thoughts are my thoughts, and I can choose to hold them or I can choose to change them, but it's my choice, and that's my boundary. I have. This is all my stuff in my little bubble, and I can choose what I do with it in there. And our bubbles can connect with other people's bubbles, but it doesn't mean they necessarily. It doesn't mean they have to intersect. You know, they can touch and connect without having somebody else's bubble gobble yours up. Transparency, like I said earlier, always explain the rationale behind activities. Encourage clients to improve communication, and this goes to their transparency. We talked earlier about informed consent, but we also want to encourage clients to be more transparent. They need to stop mind reading. How does that relate to transparency? Well, if I'm in a relationship with somebody and I expect them to do something or get me a present or something, and they don't do it, and I get angry, and then I get frustrated with them, and I give them the cold shoulder for the next two days, they're probably sitting there going, what the heck? If we encourage people to stop mind reading, stop assuming that they know what Other people are thinking or wanting or needing, then this open communication, which can feel very threatening. For a lot of people, this open communication will help them garner support. If we are mind reading, if we are assuming that somebody has ill will towards us for some reason, if we're assuming somebody has not nice motivations for what they're doing, then it can make us feel like we're less safe, it can make us feel more in danger. Many times we are mind reading and having transference reactions based on past trauma. So encouraging people to stop mind reading to communicate openly will reduce stress, reduce hyper vigilance and increase a feeling of connection and support. Finally, encourage clients to start using I statements. This helps improve communication and transparency. Because they're saying I feel this way when this happens, they're not saying you did this, you did this, you did this. They are communicating their wants, needs and feelings so other people understand and can meet their needs or try to meet their needs and encourage people to develop an awareness of the motivations behind their thoughts, feelings and urges. So this mind reading activity we do, I ask people to think about times when they have read people's mind or thought they were reading people's mind and felt like that person meant something not nice towards them for whatever reason and it hurt their relationship or it negatively impacted them in some way. And then I asked them how did they know that and do they know that for sure? Do they have facts to support it? How could they have addressed it in a way that may have prevented some of the distress that it caused? And then obviously we practice using I statements and identifying what they need. And I'll go around the room and I'll have everybody say I feel however they're feeling at the moment and I need. And you know, if you do this too close to the end of group, they're like, I feel exhausted and I need to go have a smoke break or something. A lot of people will say that, but it gets people starting to use I statements and empowers them to start getting their needs met. Collaboration and empowerment. Multi sensory guided imagery can be empowering because it gives people the ability to transport themselves to a different place for a moment to take a mini mental vacation. Sometimes it's very stressful, sometimes you're just in the middle of something that's traumatic. I've used the example of getting shots before. When you go to the doctor and you're getting ready to get a shot, it's not a pleasant thing. If you can transport yourself for a second, that can be helpful. Now this can be less than helpful. With clients who have a history of dissociating in a response to trauma. I don't want to encourage dissociation. I want to encourage intentional vacationing, values identification, Helping people recognize what is important in their life and empowering them to take steps towards that. And we talked a lot about that in acceptance and commitment therapy for trauma. We also talked a lot about living in the and. And this is very empowering. Have clients identify times in their life where they've been scared to do something, but they did it anyway. Where they didn't think they could do something, but they tried and they did it anyway. Or maybe they failed, but they tried. Encouraging them to explore how they have embraced or walked with fear and dysphoria at times will help them see that they can continue to do it. Have them explore how they're different now than they were when the trauma occurred. This can mean exploring how they are stronger, how they have grown up, how they have more supports, how they have. They're in a healthier environment, whatever it is, so they can recognize how they're safe now and how they have survived until this point. And then encourage them to identify and enhance strengths for coping with PTSD or trauma symptoms. You know, my favorite flip charts all around the room. One for irritability, one for hyper vigilance, sleep disturbances, flashbacks, numbing and withdrawal. Having clients go around to each one of those and identify ways that they cope with those specific symptoms. And then we bring it all together, and I put it together in a handout for them that I give them the following week. But this helps clients identify some new techniques that may work for some of their colleagues, or whatever you want to call them, groupmates, and helps them start exploring new tools that they might have have them create meaning. And this needs to be approached delicately. Creating meaning from what happened you. Yes, it is unfortunate. Whatever it was, it was traumatic, and it stinks that you had to go through that. How can you create meaning from it? How did you grow? How did you become stronger? What can you get out of it? Play it out is another empowerment tool that we use sometimes with clients who start having extreme reactions to certain situations. They're afraid to go into public because they're afraid that something bad's gonna happen. And so we ask, okay, what. What do you. What are you afraid is going to happen? And then what? And then what? And then what? So we have them play it all out, and then we talk about the likelihood of that event happening in the. And generally it comes out that Pretty unlikely that it's going to happen, but in the unlikely event that it should happen, you know, is there. Do they want to create some sort of plan of approach, Encourage people to identify triggers and modify them whenever possible? If going into super crowded places is a trigger for you, well, then don't go shopping at the mall on Christmas Eve. You know, that may be one of those things that you just choose to avoid. There are some things you can't avoid. I've told you about my friend who was a law enforcement officer who was involved in a particularly nasty car accident. Well, he went back to duty. He couldn't avoid driving, he couldn't avoid the interstates. But he knew the interstate was a trigger for him. So he had to figure out a way that he was able to deal with that being those sights and smells. Even the smell of exhaust fumes would start triggering flashbacks for him, so encouraging him to be aware of those things. And he knew that if he got on the interstate, at least at first, until he desensitized to doing that, he would have a plan in place for what he would do. Obviously this was back before he went back on patrol duty. And then once he got to the place where he realized, you know what? I've been able to go on to the interstate and there hasn't been a problem and it's not so bad anymore, then he was able to progress back to full duty. Have people use red flags and green flags. Red flag warning means that they're feeling triggered or they're feeling anxious. They may not be able to identify why, but if they know that they're feeling stressed out that day, that's a red flag day. Kind of like when there's a riptide at the beach. Knowing that there's a red flag. What do you do differently that day? And how do you need the people closest to you to behave differently that day? I know on my red flag days I cannot take a lot of sudden loud noises. They just make me jump out of my skin. I recognize them and they still happen. We've got four dogs. We're not going to have a quiet household. However, I recognize that when I'm having a red flag day, sometimes I need to go in a different part of the house from the dogs because if they're barking too much, it really grates on my every nerve, and that's okay. Systematic desensitization is another way we can empower clients to be exposed to, to trauma reminders, to trauma triggers, and have those triggers not elicit the same Emotional response Narrative therapy. Written or charted, depending on your clients. Some people love to write, some people hate it. So if they want to write a narrative, I say, okay, your life is a television series, and you are in season 15 right now. Season 15 is coming to a close. Now tell me about season 16. What is it gonna be like? And just like, when you watch a show like ER or something that's gone on for many, many, many, many seasons, you develop emotional attachments to particular characters. And when they go away, it's like, oh, you know, that's. You have this little mini grief thing going on. However, you don't forget that they were there. When there's a traumatic event that happens one season, you don't forget that that happened. But how do the writers write that in to make meaning from it? Obviously, they put it in the script for a reason. How does it play out? And how can you make it play out in season 17 in a way that is meaningful and positive? If somebody doesn't want to narrate that much, they don't want to write a prose story, that's fine. Chart it out. Do a timeline. You know, this is what happened then. This is what happened then. This is what happened last week, and this is what's going to happen next week, next month, next year. You can do the broken pot activity, which you take a big terracotta pot, you want to get one of the bigger ones, and you don't want to smash it into a million pieces. So breaking it is a little bit dicey. Until you get the hang of it, you want to break it into large pieces. I found the easiest way to do this is to just leave it out over the winter and it just naturally cracks on. You found that out the hard way. Anyhow. Take the pieces of the terracotta pot, and on the inside of the piece or each piece, write an effect or a result of the trauma that has impacted the person. And then they glue it back together, and on the outside of the pot, they write something that they're grateful for or a support that they have. Involve cultural supports. And this can be faith healers, pastors, or, like I said earlier, colleagues. Sometimes people will feel. And it's true to a certain extent. I don't know what it's like to be an emergency room doctor. I don't know what it's like to be a firefighter. I can empathize, but I haven't been there. I haven't lived in that sort of structure. I haven't been a cop. I have lived with cops and firefighters and soldiers. But I have never been in that situation. I've never been in Afghanistan. So my empathy can only go so far. So sometimes it's helpful to have colleagues that are involved that can use terms and phrases and words that are meaningful to the person that may not be in our vocabulary. Identify peer based resources like specialty groups where people can go without fear, fear of reprisal. Encourage family support and therapy because somebody who has experienced trauma doesn't live in a bubble. And their trauma and the effects of that trauma affect their significant others and their significant others, which is why we have intergenerational trauma. We want to make sure that we're bringing in everybody who has been touched by that trauma in some way so we can break the trauma cycle responding without re traumatizing. And Jessica, I will get to the comment about EMDR in just a second. We want to help people build resiliency and prevent vulnerabilities. So when they are going into a situation and they feel triggered in some way, they feel like it's a dangerous situation, they need to ask themselves. Or they can ask themselves challenging questions. 1 what are the facts for and against my belief that this is a dangerous situation or this is could be a dangerous situation? Looking at the facts, usually when they start feeling that they may be being triggered and using emotional reasoning, this reminds me of a time that was unpleasant and was very traumatic. Therefore, I am anxious about going into a similar situation. That's emotional reasoning. There is no evidence that this situation in the present is going to be traumatic. Is there a high or low probability that your belief is or will be true? Is there a high or low probability that this will be a dangerous situation? Going to your kid's basketball game? What else contributed to the situation that was traumatic in the past and is that present now? You know, a lot of times there are other extenuating factors that are not there in the present. And are you catastrophizing or using all or none, thinking, are you expecting the worst? Or thinking, every time I go into a crowded place something bad happens or I have a panic attack? Those are questions that clients can start asking themselves in order to help them feel more empowered about what they're getting ready to do in order to help them get grounded now when it comes to emdr, yes. I think EMDR is priceless for many people who have experienced trauma. Does it work for everybody? No. You know, I've talked to clients who've gone to EMDR therapists and said, no, it didn't do much for me, but I've also talked to a lot of clients who've gone and said, yeah, it was the best thing that I ever did. I wish I wouldn't have waited so long. So it's something that I feel needs to be presented as an option to clients to help them see if that's something that works for them. Okay, so we need to create safety and develop trust through the use of cultural resources, peer support, transparency, collaboration and empowerment. We want to do this in order to help clients feel safe enough to explore events, the experiences of those events, and the effects of those events, and respond in a way to help them live a rich and meaningful life without retraumatizing themselves. We want them to be able to accept and experience reality without feeling like they are going through the trauma over and over and over again. When you're working with a client, no matter what intervention you're doing, ask yourself if it is in any way disempowering, non transparent, or could be triggering. Whether that is having them hold hands, dimming the lights, lighting a candle, doing something ritualistic, whatever it is, or even ropes courses can be somewhat traumatizing for clients because there's a lot of times on ropes courses where you're often really close and your personal space is kind of invaded. So we do want to recognize those things and be transparent about what's going on. And as I said multiple times, but I'm going to say it once more, inform clients before every intervention of the potential benefits and effects and tell them what they're going to do. You're not doing a psychological study. It's not like you have to have a double blind or something. So let clients know. I'm going to ask you to close your eyes because it will help you visualize what was going on. Or I'm going to ask you to take three deep breaths because it will help you slow down your heart rate and breathing so you can trigger that rest and digest action in your brain. If clients understand, they're a whole lot more likely to go along with it, but they feel empowered because they're able to say, okay, I understand and I'm making a conscious choice to do this. It's not being done to me. Alrighty, everybody, thank you so much for being here the day before Thanksgiving. And I hope you have safe travels and a wonderful wonder, wonderful, wonderful holiday, whatever you're doing, or wonderful, wonderful, unholiday. If you're not participating in the Thanksgiving festivities, it should be gorgeous weather in a lot of the United States. So hopefully maybe you can get out and do something fun. If this podcast helps you help your clients or yourself, please support us by purchasing your ceus@allce.com or getting your agency to sponsor an episode. A direct link to the on demand CEUs for this podcast is@allce.com podcastce that's allce.com podcastce. To sponsor an episode of Counselor Toolbox and reach over 50,000 clinicians per week, go to allce.com sponsor. Thank you.