Restoring Sanctuary Part 2: Trauma Informed Care

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. Hey everybody and welcome back to part two of our introduction to Restoring Sanctuary. In the second half of the presentation, we're going to learn how to assess the individual and the organization for symptoms of trauma. Now again, remember, this is just an overview and an introduction. So you're not going to learn all the tools that you would get by going reading the book Restoring Sanctuary and or going through the certification process that they offer at the Sanctuary Institute. But this gives you a good idea and gives you some places to start for things that you can do. Because a lot of times it's going to be difficult, if not impossible, to get organizational buy in for the whole sanctuary model. But every step, every change we make in our organization to become more trauma informed is going to make that organization better and going to make it more effective for our clients as well as our staff. Then we're going to move on to identifying the sanctuary commitments. And these are things that it doesn't matter if your whole agency has buy in or not. Your department can decide that they want to embrace the sanctuary commitments. Each therapist can decide that they want to embrace the sanctuary commitments. Does it help if the whole organization does? Oh, yeah, by all means. However, every little bit helps. And then finally we're going to discover how to use the self model for interpreting individual and organizational behavior. And this is just a framework for trying to step back and look objectively at behaviors to understand where they're coming from and how they might be protective of that person or organization. So the first thing we need to do or we're going to do today is assess the organization. And why is that? Well, we know that our clients that are coming in have likely had experiences that have been traumatizing, that have been traumatic. So that's no big surprise to us. What we do overlook is how much our organization is organized around crisis and trauma and inducing what types of things do we do that promote trauma and promote trauma protective behaviors in our staff and in our organization. So the first thing you want to do is think about what evidence do you see of the following things in yourself, in your colleagues and in other providers? You know, you have your colleagues that you work with in your department, but then you might refer out to physicians and things. So I want you to think about anybody that's in this recovery oriented system of care and what evidence you see of biological stress, where they're stressed out all the time, where that HPA axis is activated, where they are run down, where they're burnt out, where they're experiencing hypocortisolism, where they're having sleep difficulties because their HPA axis is always ramped up and they're always stressed out. That's going to start affecting people. When it does, when they start getting burned out, they start getting sicker, they start getting more negative, more irritable, which can lead to negative and irritable interactions with clients. Now, I want you to think about the clients that we work with. You know, I know we're talking about the organization here, but I want you to think about the impact of all of this on the clients that we work with. When they were young, when they were exposed to trauma, what types of things, if you think about the ACEs stuff, study, what types of things were they exposed to? And how are we recreating that inadvertently in our own organization? How are we recreating that? By having people who are emotionally unavailable, by having staff members who are negative and frustrated and just, you know, seething a lot of the time. How are we creating that? By having staff members who are just very obviously stressed out and not taking care of themselves emotionally. Again, think about how you see it in your, in yourself and your colleagues and your organization. How would, how much of a problem do you have with emotional regulation? How often do you or, you know, a colleague or whatever go from 0 to 260? You're just, you're kind of on a hair trigger sort of thing. And there are seemingly increasing numbers of triggers where maybe two years ago, five years ago, you used to be a pretty easygoing person and now you are just, you know, everything makes you grab on and go, oh my gosh, I can't stand that. Or get stressed out by the slightest little thing. Through secondary victimization, which happens especially for people who are in healthcare professions and emergency service professions, especially if they're in an organization that doesn't promote self care and sanctuary. You will start to see people develop additional triggers as a result of that secondary victimization. So, all right, we've got more triggers, more difficulty with emotional regulation, more difficulty sleeping, constant levels, high levels of stress that are just almost palpable, difficulty with grieving and anticipating the future. You know, in these organizations, it's hard to see the forest for the trees. Sometimes you get so caught up just trying to put your head down and get through the moment, which, you know, with mindfulness sounds like a great thing. But we also need to be able to look up and see what is the reason we're doing this. What is the goal we're working towards in crisis oriented organization? We're not working towards a goal, we're just trying to keep our head above water right now. We're going to tread water, but the goal, we can't even envision that because we don't know what's going to happen tomorrow. So think about organizations that you work with where the funding is always changing and there's regular layoffs and you know, those sorts of things. You know, that's one of those situations that can happen in an organization that causes crisis and causes trauma because people can't anticipate the future. They can't say, okay, you know, I really want to work hard at what I'm doing right now because I see myself getting promoted and then, you know, moving to this other department and then getting promoted again. All they can see is I've got a job today and I'm going to try to do my best because I don't know for sure if I'm going to have a job tomorrow that's crisis oriented. Cognitively, when people are emotionally dysphoric, when they are emotionally dysregulating a lot, when they are stressed out a lot, when they're having difficulty sleeping, you can see how, you know what I'm talking about here. We're starting to build on these things. It affects people's attitudes and perceptions. They start to see because they're in a negative mindset, because they're stressed out, because they're on high alert and protection. What is their amygdala, what is their body trying to make sure that they see all the threats. So when you're on that high alert, when that HPA axis is activated, you're going to more likely notice the threats. Then you're going to notice the good things. And when you notice the threats, more often than not, guess what it's going to trigger. Negative perceptions, negative schemas, negative attitudes. And a lot of times it can start erode, eroding that self efficacy, eroding your thought that you can do anything to change. Again, go back to your organization. I remember working in community mental health and sometimes, you know, when we're struggling, when we're just trying to get through, when we're trying to tread water and hold our head above water and everything and clients relapse, you know, we had a client and then they went out and they were good for a month and then it relapsed and they came back through and it feels like a revolving door. This can start to erode efficacy because what we're seeing is failure. What we see is the client came back, we didn't fix the client. So it starts to make us feel like we're not functioning, we're not able to do this job, and it starts making us question, you know, our purpose. Another way you could see it, because I don't want to get too negative here. If you are not in that negative feedback loop, you can see a client who completed treatment, which is a good thing, they went out and they stayed clean, or they stayed asymptomatic for a month, that's a good thing. That may be a month longer than they'd done before. And they came back so they knew they needed help, they didn't commit suicide, they didn't stay out on the street. They came back and they said, I missed something, so help me figure out what I missed so I can stay clean, sober and happy longer. So every relapse is an opportunity to learn it's not a failure. So anyway, that kind of helps you see how just changing your perception of things can relieve some of the crisis and help promote self efficacy. And socially, when you're under stress, when you are emotionally unhappy, dysphoric, angry, anxious, depressed, whatever it is, when you can't grieve, when you can't see the purpose for what you're doing and anticipate the future, when you look around and everything you see is negative and you anticipate the worst all the time, it is hard to have empathy. It is hard to trust yourself or to trust other people because it seems like everything's out of your control. It starts to feel very disempowering. Communication starts to shut down because maybe you tried to communicate in the beginning and it certainly didn't do any good. When you're in that crisis state, your brain is not going, okay, let's see how we can problem solve and let's use all of our higher order human cognitive abilities. No, your brain is going, let me survive. So communication and problem solving start to go down when that starts to go down and social relationships start to dissipate. When they start to dissipate, we lose social support. We also lose that teamwork that's happening. You begin to have difficulty with boundaries and difficulty with authority. Well, that makes sense if you're under stress, if you're in crisis, if everything seems like it's going haywire, then those who are in authority, the Perception might be that, well, they're clearly not doing what they need to do to hold things together. So I am going to do what I need to do to protect myself. That whole cover your butt sort of philosophy that I've experienced and I've heard from a lot of different people in a lot of different professions where they don't trust that the organization has their back, they don't trust anybody else to do the job right. So it comes down to I have to cover my own. But in the moment, you know, everybody else be damned. How is this situation, how are these situations like the family situations in which our clients grew up? In many cases they're very similar. In many cases, this situation may be very similar to the situations in which our colleagues and our staff members grew up. Because so many of us have been exposed to trauma at times in our life. You know, we don't want to say that, you know, everybody working for us is just a picture of health and mental health. It's not true. You know, in any given period of time, about 47% of people in a year period will struggle with an addiction and about 28% of people will struggle with some sort of mental health disorder. So, you know, you add Those up, that's two out of every three. Basically, people will struggle with one or the other in a 12 month period. That's not just our clients. That's, you know, the broad swath of the American population. So when you go to work, the other two clinicians that you work with, both of them may struggle with something if you don't in a 12 month period. Now that doesn't mean that there's anything wrong with them, that they can't provide their services or anything. But it does mean we need to be aware of our own stuff, take care of it, so we don't project it and recreate it in the therapeutic environment. So I want you to really think about the ways in which these symptoms compound stress or recreate trauma for people who have been traumatized. If you're walking around, maybe you as a clinician came from a household where, you know, someone was, had an addiction and someone had borderline personality traits. And you were always walking on eggshells. And every time somebody was stressed, you just kind of held on with dear life to try to avoid making that person upset. And then you come to this work environment and one of your supervisors is the same way. How does that recreate that family of origin and in what ways does that retrigger your childhood trauma? Thinking about these things if you've got staff members who are regularly being re traumatized and triggered, they're going to be probably defaulting to some of their trauma protective behaviors. Well, that makes sense. You know, we want people to protect themselves. Unfortunately, in many cases they may not realize that some of their behaviors, like we talked about in part one, they may not realize that some of their behaviors are the result of learned ways of responding to trauma. So they bring all this stuff to the organization, they bring all this stuff to a place that's supposed to be safe for clients and they actually recreate a trauma dynamic that can negatively influence clients outcomes. It can lead to turnover, it can lead to burnout, it leads to poor productivity, and it leads to poor service delivery. So we really need to make sure that if nowhere else is safe, our organization is a safe place for people to go where they don't have to fear re traumatization. The organizational evaluation. What evidence do you see of these things in your organization? So backing up not in you, but not in your colleagues, but in your organization, the culture of your organization. Loss of basic safety and trust. Do you trust your supervisor? Do you trust your colleagues to do what they need to do? Do you trust that you're going to have a job? Do you trust senior management? Do you feel safe that you have a job? Do you feel physically safe in the environment? Do you feel emotionally safe to state your needs if something is not going well? Or do you feel like you're being told that you need to shut up? Is there loss of emotional management? And this is where you have organizations where you walk into that organization and the stress and the misery and the unhappiness is just palpable. It doesn't look like anybody is happy to be there. They're just kind of going through the motions. This is that loss of emotional management. There's no happiness. We're just holding on with white knuckles to try to get through the day. Inability to deal with loss. You know, does the organization flail if there is a somebody who quits, does the organization just completely flail and can they not adapt if they lose funding somewhere? Is there inability to resolve or integrate experiences for a growth opportunity. And again, this is, you know, think about, I can't even think of it right now. Risk management. When you do, after a critical incident, you look back over what happened and you try to figure out, you know, what went wrong. How can we learn from this? How can we integrate it to improve our programs? How can we look at our dashboard data and you know, where we're not meeting our dashboards, how can we figure out how to change? How can we evaluate what's causing us to miss our targets? And root cause analysis, that was the word I was thinking of. But how can we look at the data that we've got that's telling us who we're seeing, how successful we are, yada yada, if we're not meeting our goals, how can we integrate that and create a growth opportunity? And I'll give you a hint here. Rapid cycle change is really helpful, but that's, you know, a different class. Problems with cognition, problems with thinking, perceiving and problem solving. Now again, we're talking about the organization, the culture of the organization. If there's a problem in the organization, how hard is it to fix it? You know, is it, can you go tell your supervisor? And your supervisor says, okay, give me a plan, let's look at it and let's, you know, run it by risk management and then we can make it happen. Or if there's a problem, does every, does everything just come to a screeching halt because your organization is so unable to even think differently, unable to think outside of the box, unable to perceive anything other than the current crisis and unable to problem solve because again, they're not in that higher order functioning. Even the senior management is just trying to keep the lid on the box for right now. In your organization, are there communication issues? Can you freely communicate with your supervisor? Can you freely get supervision when you need it? When you have an issue with something going on, is there a method for communication about a problem that exists? Or does the higher ups just not want to hear about it? They don't. In one organization I worked with, the CEO finally admitted in one of our meetings, which not sure whether it was the brightest move or not, but whatever she did that the reason that most of the vice presidents and above were never on campus was because they didn't want to actually be exposed to what was going on on a day to day basis because then they'd have to deal with it. They wanted us to try to figure out how to solve our own problems and they didn't want to have anything to do with it because it was too overwhelming for them. They had their stuff they needed to do and they couldn't be bothered with the downline stuff. So, you know, and this is where we talk, start talking about communication issues because then, you know, there were a lot of problems that in a way it was okay because us middle managers who were always on scene were able to work with line staff. And if you were lucky enough to have a good supervisor of your middle manager, then sometimes things got done. But most of the time, the senior management, vice presidents and above would kind of plug their ears and they would not want to hear about it. And they would do everything they could to avoid giving you an opportunity to communicate problems with authority. Well, you know, if you don't feel like anybody listens, if you don't feel like anybody takes into consideration what's going on for you, the, the staff or for your patients, the whole reason you're there, you know, it can be frustrating. And when senior management comes down and says, all right, we had funding cuts, so this is what we're going to do. We're going to chop this, we're going to chop this and we're going to change this. And you're sitting there going, whoa, whoa, whoa, whoa, whoa, wait a minute, wait a minute. What just happened here? We can't do this. And senior management goes, you're going to, I don't care how you do it, but you're going to make it happen. This is that problem with authority where there's no communication. And then line staff often start to rebel and they start to form cliques for lack of a better reason that are self protective. They're like, okay, we're going to bond together as a department and we're going to be the resistance because we've got to protect our clients as much as possible. Which leads to that confused sense of justice in the organization's view. In higher management's view, justice may be keeping the doors open. In line staff's view and in the view of the clients, justice may be making sure that everybody gets high quality care. Now you can keep the doors open without having high quality care. So understanding what is the best decision for the organization as a whole is important. Understanding the impact of decisions that you make. If I remember when one of our programs was cut, it was devastating because it was a wildly helpful program. It wasn't overly, you know, profitable, but it always broke even. But it was wasn't overly profitable, so they cut it in order to put in a more profitable program. Unfortunately, that led a lot of our clients to being discharged three months sooner than they would have and ended up leading to a lot of relapses and recidivism. So, you know, yes, we created a higher earning program that allowed us to hire a couple more people, but we kind of, in my opinion, did a disservice to the clients that we already had. So those Are all things you want to think about in terms of an organization that's trauma organized. If it's organized around trauma, if it's organized around crisis, in what ways does that manifest itself and in what ways does that recreate situations that are similar to traumatic situations from the past that our staff, ourselves or our clients have been exposed to. So crisis driven organizations sacrifice communication. They sacrifice feedback loops because they don't want the feedback. It's overwhelming. They're like, no, can't do it. I always think of the three little monkeys. See no evil, hear no evil, speak no evil. Well, crisis driven organizations, they don't want feedback so they're going to block it out. Participatory decision making and complex problem solving go into the crapper due to chronic stress because again, nobody is thinking big picture. It's a crisis. It's like, okay, our revenue is down 3% this month and we're going to start freaking out instead of thinking, okay, our revenue is down 3% this month, we need to figure out how to fix that. And getting into our quote, wise mind as an organization and thinking what was the change, how that prompted this revenue drop or whatever it was, and what are some alternatives that we have used in the past when our revenue has dropped to bring it back up? Oh my gosh, solution focused. How about that? In crisis driven organizations, there's a shift to an increasingly hierarchical top down control structure that discourages creativity, innovation and risk taking, resulting in an inability to manage complexity. Well, yeah, if senior management, who hasn't seen a client in 20 years is making all the decisions, and if senior management is making these, these decisions when they fully admit that they intentionally stay off campus so they don't have to interact with the rank and file, then there's probably going to be some problems with the wonderful ideas they come up with. And if they don't want to hear about and contemplate the impact that it has because they've shut down communication and feedback loops, then people aren't able to respond. And creativity, even creatively responding to what they want, is often discouraged. They want it done by the book. Do what I say, don't think about it, don't question it, just make it happen. And most of us have difficulty working in that environment because our clients are unique. Each individual requires a unique approach. When I was a supervisor, each, each of my staff members required a slightly different approach to being supervised. Some needed more micromanagement, others preferred if I just left them alone to do what they needed to do. Thank you very much. Some people needed a lot of positive feedback, others didn't. They were able to validate themselves. So it's important to recognize the impact when communication and feedback loops and participatory decision making get shut down. Organizations can't manage it because they're not getting feedback about the nitty gritty. That is important. They're operating on a macro level, and they don't understand all the little pieces that go into it. So chronic stress leads to chronic crisis, which leads to lack of safety and basic trust. You know, staff members start going, I don't know if I'm going to have a job tomorrow or in six months. I. I don't feel safe. I don't feel like I can state my own feelings or, you know, advocate for my clients without getting squashed like a bug, which leads to lack of emotional management. Because then people start to get frustrated and they start to feel disempowered and they start to feel just helpless. So communication breaks down, conflict increases, and then we start repeating failed strategies. You know, you're just, you're not allowed to be creative. You're not allowed to get out of that box. So you keep running around in that same box, and there's just, there's still no way out. This leads to learned helplessness, loss of critical thinking, silencing of dissent, increased authoritarianism, unresolved issues, and ultimately an organization where pretty much everybody working there feels demoralized and powerless and which leads to a lot of turnover. And that gets communicated to clients. The enthusiasm that we have when we go into work with them is gone. If you're going in there and you're just completely burnt out and demoralized, clients pick up on this. They may not understand that it's not about them, it's about the organization. They may feel like you're there and you're unhappy to be there because you're unhappy to be with them. So again, how are we recreating their trauma from the past? When we look at behaviors and, you know, I told you we would talk about the self philosophy. When we look at individual behaviors of employees of ourselves or of our clients, we want to ask ourselves in what ways, when this, whenever this thing happened, in what ways did the person not feel safe and how could he or she be helped to feel safe? So if you've got someone who starts withdrawing, who starts yelling, who starts self injuring, you know, we want to look and see, you know, in what ways was the situation recreating a prior trauma or triggering prior trauma protective behaviors? E. What vulnerabilities triggers or reenactment stimuli or skill deficits led to inability to effectively identify emotions in themselves and others and effectively regulate personal emotions and behaviors. That's a lot of stuff under E. So, you know, really, we want to look at what was going on. Why was it in this situation that this person had difficulty reading the situation or managing their own emotions? And it could be they don't have the skills to do it yet. It could be that they had a lot of vulnerabilities, they were sick, they hadn't slept well, and they had had way too much coffee. It could be maybe they came back from a weekend pass, and the weekend was extraordinarily stressful and traumatizing, and they were, you know, still in that mindset, and they were feeling there. They were feeling vulnerable and raw. We don't exactly know what was going on necessarily until we sit down and think about it and we say, what happened? What needs to happen to scaffold emotional management. Now, scaffolding means helping people get from point A to point B. But sometimes people can't make that leap all by themselves. So we need to say, okay, when you get upset, I want you to use these skills and tools. And if the person is unable to do that, which sometimes they are at the beginning, then scaffolding means when we see the person start to get upset, we prompt them to start using those skills and tools. And then they're like, oh, yeah, okay, I know what I need to do. You prompt them to go take a walk. You prompt them to go to start doing their deep breathing exercises, whatever it is for that person, eventually they will get to the point where when they start to get upset, it's second nature to know what to do next. And they will do it and follow all the way through. L. In what ways did this event represent a loss or a recapitulation of a loss? So a lot of things happen that can remind us of the past. You. You know, when you lost a sense of safety, when you maybe somebody from. In their childhood, they were home one day and, you know, going about, watching tv, doing whatever, and their parent came home, slammed the door and had a great big knockdown, drag out. Domestic, violent, domestically violent interaction with the other parent. Well, that's traumatic to that person. So in this particular situation now, fast forward 15 years, you know, Jim Bob comes in and slams the door and is upset about something. This may represent or recapitulate that loss of safety. All of a sudden, the person's feeling like, oh, crap, I'm not safe anymore. In what ways did it represent a loss or recapitulation of a loss of love? You know, when we lose someone important to us, whether it is a friend or a parent or a family member, you know, there are reminders of it. Maybe this person in their. In their past was never able to form a healthy attachment with their primary caregiver. And that leaves a gaping hole for a lot of people. So in the present, if they are engaging in relationships with others, you know, trying to maybe get that fatherly love or motherly love that they never got, and then that relationship ends, that can recapitulate that loss. When they're working with a therapist who has power over them, there is a power dynamic. No matter how much you try to level the playing field, that can often lead to transference reactions that resemble the parent child dynamic. So when it's time to terminate, it can recapitulate the loss that the child had when they were never able to get the approval or keep the love of the parent that they wanted. And F, what does this person need to be able to restore hope, purpose and empower positive change? So we want them to be able to look at the future. F stands for future. Things are not great. You know, in this moment, you know, there was a trauma situation. For some reason they started being reactive and trying to protect themselves from something that felt unsafe or something that made them feel emotionally vulnerable or triggered a remembrance of a loss. How can we help them from this situation right now? Restore hope that they are safe and envision a positive future and envision handling situations like this, learning what triggered them and how to handle them better, more healthfully in the future. So benefits of sanctuary. If we start creating sanctuary, and one of the first ways to do this is to start getting everybody to buy into the sanctuary commitments, which we're getting to Improved communication. If we are not operating around a crisis constantly, then we are going to be able to take a breath and step back and communicate openly and creatively about what's going on. You know, think about firefighters that are on the scene of a, you know, a multi car pile up. They're not sitting back going, okay, you know, what should we do? We have these three options and yada, yada, yada. No, somebody takes the lead and starts being very authoritarian because that's what they have to do at that moment and says, Jim Bob, you do this. Sally sue, you do that and we're going to make this happen. That's not the kind of communication we need on an ongoing Basis in a crisis, it's sometimes very, very helpful. In a sanctuary in a non crisis environment, not so helpful. Sanctuary improves social skills and relationships because oh my gosh, guess what? We're communicating. We're listening to each other, we're validating each other's opinions and thoughts and feelings, which leads to decreased violence. And you know, when I talk about violence, I'm not just talking about physical violence. I'm talking about decreased emotional violence, including microaggressions. It results in improved judgment and problem solving because we're communicating. And since the social skills and relationships are improving, we're getting more input, so we're getting a more dynamic view of what's going on, which helps us all have more information to better solve the problem. There's fewer symptoms of trauma, those biological symptoms of stress and hypocortisolism and poor sleep and reduced immunity. There's fewer symptoms of trauma cognitively because people are not quite as negative. They are starting to be able to embrace the dialectics. There are fewer emotional symptoms of trauma because we see less emotional dysregulation, because people feel safer and they're not just trying to hold on and they're not just trying to tread water. There's improved job, school or work performance. You know, obviously if it's your organization, your staff is going to have more energy and be more focused and have more future orientation and enthusiasm to see their clients, which is going to result in improved job performance. It can also result in improved, you know, work and school performance for our clients because if they have a safe place to go where they can start dealing with their stuff, then it's going to help them when they're outside of session. And organizationally, sanctuary reduces turnover and improves morale. You know, there's just no two ways about it. It makes it a much, much, much nicer place to work. So the sanctuary perspective steps back and says, what happened to you? Not what's wrong with you? So when somebody acts out or chooses an ineffective behavior or emotionally dysregulates, instead of thinking that something's wrong with them, we say, you know what? Whatever's going on with you is right. This is the way you develop to protect yourself because you want to survive. And you developed it in response to a trauma and it's become an unhealthy habit. Now you haven't developed any new skills, any new healthier skills or ways of reacting yet. So more time is spent focusing on the solution than the problem. So we say, what happened to you? That would trigger a protective Reaction in this situation? And how can we help you feel safe? How can we help you emotionally regulate? And how can we help you see a future that is positive and empowering? See the difference here? We're focusing on the solution. We're not saying, how can I control this client's behavior so they don't do this anymore? We're saying, how can we help the client develop new skills so they can have a healthier life? Because if they're doing that, then they're not going to be doing that behavior anymore. But we're focusing on the solution, not the problem. So the four key interactive aspects from bad experiences. Safety. You know, we already talked about self. Some. We're going to talk about it a little bit more. Maintaining safety and self relationships and the environment. So when something bad happens and a client uses an unhelpful, you know, seemingly unhelpful behavior, we want to say, okay, in what ways is this helpful to this client to allow him or her to self protect? In what ways does this enhance the client's self knowledge? In what ways does this protect the client's self esteem? In what ways does this make the client feel like he or she is in control and has self efficacy? In what ways does this behavior indicate self discipline? You know, we're not always talking about anger and aggression towards someone else. Sometimes self discipline is not helpful. But. And in what ways does this behavior indicate self control? So we want to go back and everything the client does, we want to help them find healthy ways to respond to whatever that trauma situation is that promotes self protection, self knowledge, you know, and awareness, mindfulness of what's going on and what they need. Self esteem, self efficacy, self discipline and self control. These are the things we want to promote. If you promote these, then the things you don't want going on are going to go away. So we want to promote these things. Emotions. We want to help clients identify their feelings. There's a concept there, not just the superficial feeling, but all the feelings and the feelings that are triggered from the past. Where are these feelings coming from? You're feeling these feelings. And we've all had the experience before where we felt the feeling and we felt it at a 10, when whatever the situation was really only deserved like a 3. And we have to step back for a second and go, what in the world is going on here that I'm reacting with a 10 when it's really only a 3. So helping clients become aware of their feelings, the sources of their feelings, whether it's because of something in the present, or whether it's projection and recapitulation of the past. We want to help them learn tools to modulate their affect in response to memories, persons, and events. So when they think about it or when they experience it, or when they smell something that reminds them of that situation, we want them to have tools where they can get grounded in the present and modulate their affect. Something as simple as the cleaner that your housekeeping staff uses may trigger a memory of abuse in the past. So we want to help clients become aware of what's triggering that, feel empowered to say something about it. And we also want to help them develop tools to modulate their affect in response to that sensory trigger. Because we, you know, let's take Pine Sol, for example. My grandmother's always use pine salt, so that's a happy memory for me. But if it was a bad memory, you know, we can't tell everybody in the world never to use pine salt. So I want clients to be aware that that smell triggers that response, but also to have tools in their toolbox so if they're out somewhere and they smell that smell, they can get regrounded and remind themselves that they're currently safe in the present. And we also want to help them trade actions for words. And this is where distress tolerance activities and urge surfing really come in handy. Because when people start to feel threatened, when they start to feel unsafe, the first thing that we want to do is get safe. The first thing we want to do is give in to those behavioral urges in order to push away the threat, we or to flee from it. So we want to help people learn to identify their feelings, modulate their response, become aware of what's going on, and learn how to communicate and express what's going on in words so they can receive support instead of having to act out and continue to recreate that trauma dynamic. We want to help them learn how to communicate to themselves and to others what's going on and what they need to feel safe. Loss is the third component of things that go wonky because of trauma. Feelings of grief, in dealing with personal losses can be triggered. So we want to help people develop the skills to learn how to grieve, to learn how to say, this really hurts, and I don't know how I can go on without it. Many times there are losses that people have that they've never gotten to acceptance with. They're still very angry about them or very depressed about the loss. And it could be the loss of the childhood that they thought they should have had. It could be the loss of a parent. It could be a loss because they were put in foster care. You know, there are oodles of losses. So we need to help people identify what losses they may still need to grieve. We need to give them the tools to learn how and help them move towards saying goodbye or accepting the loss and integrating it into their life. One of the things that I do with a lot of my clients, and it doesn't work with everyone, obviously, so there are a lot of tools. I talk to them about their life being like a television series. You know, the Simpsons has been on for, you know, 30 years, and it comes back season after season after season. But we pick a television series that they like and we say, okay, this chapter in your life, this season of your television series, it's coming to a close and this storyline is ending. So how do we end this storyline and gracefully transition into the next storyline? You know, it's still going to inform future storylines because, you know, if you've got, you know, two characters that are married in one season, and all of a sudden, you know, one of the characters decides to quit the show, you know, they've got to kill it off. So, you know, the other character goes on in the next season and is now widower or a widow. Well, we still remember that they were married in prior season. So it still informs the future, but the future is not dictated by it. So I encourage them to figure out how they're going to end the season and start the next one. We want to encourage clients to refrain from reenactment. You know, when they had that loss, what did they do? A lot of times we frantically try to prevent the loss or we numb or escape because we can't face the loss. Sleeping, drug use, whatever. Some people just throw themselves into their work. We want to refrain from reenactment. We want to help them figure out, how are you going to move on? Encourage them to feel grief and deal with personal losses as a result of, of that loss. Because very rarely is a loss just a loss. When we lose things, there are usually multiple losses associated with it. You know, if you lose a spouse, for example, you know, you lose your best friend, you lose the person you thought you were going to grow old with. You lose a source of financial support, you lose. You know, you can keep going on with that. You know, if you lose that financial support, you may end up losing the house that the two of you lived in for 30 years. So there can be multiple losses that happen as a result of a Primary loss. And remember, losses can be things like loss of self esteem or loss of hope. And we want to help people identify how to deal with these losses and be able to feel the grief that, you know, this dream is gone. So what do I do now? And the final aspect is the future. Remember, we had safety, emotions, loss and the future. So in this future, we want to encourage people to try out new roles, ways of relating and behaviors as a survivor and in order to ensure personal safety and, and possibly to help others. So what can they do? How do they envision the future? How are they, how could they envision themselves as stronger from this experience? We want them to learn ways of relating and behaving as a survivor to ensure personal safety and help others. And we want to enhance the vision of the future. Now, a lot of these, you're thinking, okay, that all sounds great, how do we do this? Well, obviously there are certain things that you will be doing in session, but it's also vitally important that your staff is modeling all of these things. They're modeling ways of relating as a survivor. They're modeling open communication, they're modeling respect for one another, and they're modeling non violence. Which takes us to the sanctuary commitments. Sanctuary commitments are a set of commitments that were set forth in the book that indicate a commitment to developing an organization, to developing a place that is safe. Now, sanctuary doesn't just have to be in the organization. We want sanctuary to be within ourselves. We want sanctuary to be within our own heads so our own heads are not a dangerous, violent, critical place. We want sanctuary to be within our families. We want sanctuary to be within our schools and within our workplaces. So how do we do this? Oh, and within our communities? First commitment is nonviolence, both physical and verbal, non violence. We are not going to hit, we are not going to use microaggressions, you know, those little snide stares. We are not going to verbally be violent or aggressive or condescending or rude. This helps build safety skills and a commitment to higher goals. If we feel, if we know that this is a safe environment where we're not going to get, you know, just completely degraded for our thoughts or our feelings and we know that we're physically safe, then we start to feel physically and emotionally safe, to get outside of our envelope, to push it past our safety zones and go, maybe I can do this. We want to make sure that people are safe from hostile environments and we want to move from hostility to hospitality. So encouraging environments that are not only physically safe. But physically comfortable, you know, they're non violent, they're inviting physically, they're inviting socially. When somebody walks in the door, one of my pet peeves is when you walk into the door of a provider's office and the receptionist is there behind that glass and they don't even acknowledge you. They don't look up, they don't smile, and they certainly don't move the glass back and go, you know, good morning, so and so. That's not hospitable. So we want to encourage hospitality. We want to encourage hospitality in terms of psychological safety, making sure that whoever walks into our organization feels accepted. We want to have indications that we are accepting of people with trauma, of people from different cultures, of people of different genders, of people of different ages. So we want to have psychological safety and we need to commit to a refusal to retaliate with physical or psychological violence. That means don't retaliate against your colleague or your team member when they do something that you don't like. That means don't retaliate against a client when they do something that you don't like. And you have to model how to handle that kind of behavior. If the client becomes aggressive, you know, obviously within reason and within safety, you know, using skills in order to handle that situation without becoming paradoxically violent back towards them, you know, you don't want to get into this dominance thing. If the client becomes aggressive, standing your ground, hearing them out, using reflective listening and all that stuff we learned in school to de escalate the situation. This is what we need to model. We need to help clients learn a better response to violence than violence. Well, I say clients, we need to help everyone, because I've seen it not only in clients, but in staff members as well. Emotional intelligence. We need to encourage this. We need to encourage people to see patterns and develop really good skills for affect management. We need people to recognize their own emotions and the emotions of others, which means we need to teach our staff mindfulness. We need to teach them to be aware of what's going on with them in the present moment and what's going on with those around them in the present moment. We need to help them discern between different feelings and label them appropriately and their causes. You know, if I'm in a bad mood today, you know, okay, I'm in a bad mood. So I've identified that I'm grumpy. But why? What is the cause of that grumpiness? Is it because of a meeting I've got to go to? Is it because I woke up late or what's the cause of that grumpiness? Too often we can feel angry and that anger can get displaced onto inadvertent targets. And we need to use a certain amount of emotional information to guide thinking. You know, what is going to help people feel safest and happiest. And most supported leaders understand that a key part of their job is to recognize, contain and manage emotions in their organization. Social learning. We want to demonstrate as a staff, as an individual that we're constantly learning and problem solving. We want to learn from one another via observation, imitation and modeling healthy interactions. We want to learn not only from ourselves, but from our clients and our other staff members. Clients do have a lot to teach us. We want to go from top down directing to a living learning environment in which everyone is expected to learn and contribute to the learning of others at all times. So clients can give each other pick me ups. Clients feel free feel able to call out a staff member. If the staff member is, you know, being particularly cranky or seeming unhappy, it's okay for the client to go, you know what, you seem like you're really down today. You know, it doesn't have to turn into, you know, an inappropriate exchange of personal information, but that allows the client to identify what's going on, use that emotional intelligence, model supportive behavior and see what the reaction is. We want to help people become aware of, articulate and unlearn, establish patterns and routines. So think about what are some toxic routines at your agency or that you have, you know, how can we become aware of these, such as, you know, when something happens that you don't like, when you get an edict that comes down from on high, how many times do you end up in the break room with three other people complaining about it and talking about how horrible senior management is, well, that's violence, you know, that's complaining. That is not problem solving, that's focusing on the negative and just stirring up aggression and irritability. So we want to look at these toxic routines. Social learning helps people adapt to changing conditions and values everyone in the learning environment because everyone in the environment has something to contribute and a different perspective on the changing conditions. Open communication maintains a flow of ideas to help people to overcome barriers to healthy communication. It reduces acting out, enhances self protective and self correcting skills, and teaches healthy boundaries. So open communication is when people can talk about how they're feeling, but when other people can also communicate and give a pick me up or say, you know what, I'm noticing that your work Product seems to have gone down significantly lately. Can we talk about what's going on? Organizational and interpersonal transparency. People talk amongst themselves and they know the whys of what's being asked of them. The organization. If they tell you to do something, it's not just because I said so. It's because these are the reasons we made this decision. So it eliminates any ulterior motives for what might be going on. Everyone communicates directly and as much as possible using words to convey what they mean. So really, actually talking, not expecting people to understand. Your closed off nonverbals. Not expecting people to understand or read your mind Using words, Talking now, paraphrasing and clarifying. Leaders not only practice the ability to handle dissent when it occurs, but they actually search for it. They go out and they say, what could we be doing better? You know, we made this change. In what ways do you think it worked and in what ways do you think we fell short? This is, this is how leaders invite people to give feedback. They can invite clients to provide feedback. In parent child relationships. You know, you can do the same thing with your child. You know what's going on, what do you think is working? Is there anything that's making you unhappy right now? Now the kid may say chores are making me unhappy. Well, chores may be a necessary activity. So we go back to the organizational and interpersonal transparency. I'm not having you do chores just because it's less for me to do, although it's a benefit. I'm having you do chores so you can learn how to sweep, to mop, to do your laundry, so you can be an independent person when you get of age and when you have open communication. You also don't have organizational undiscussables. And those undiscussables can be nepotism. Those undiscussables can be the behavior of a particular staff member. Undiscussables can be, you know, a variety of things. And these are the things that you know better than to bring up to your boss because you're just going to get shut down. You know, it's something that is not open for discussion. Well, in a sanctuary, everything's open for discussion. I remember in one situation I worked in, the organization had decided to start allowing people to come onto the unit who were actively taking benzodiazepines, anti anxiety medication, which in the past we had always prohibited. And they were also allowing people to come on the unit who were actively taking opioid medications. And again in the past we had always prevented that because we were a drug treatment facility. However, you know, it became an issue that we needed to because a population we started serving that was the best course of treatment for them. And they didn't happen to be addicted to those particular medications. So the decision was made, for the benefit of the organization as well as the patients, to allow that particular group of people to be prescribed those medications. But I was able to go to my boss and I was able to say what happened. I'm not cool with this unless you can help me understand why this is happening. And, you know, I stated my case for why I was concerned about it, and he stated his case for why senior management decided it was okay. Did I hundred percent agree? No. But did I understand the rationale? Yes, but that's open communication. There weren't any undiscussables between me and my immediate supervisor. Social responsibility. Everybody has a common goal and focus, whether it's in your family or whether it's in your organization. You want to build social connection skills and establish healthy relationships with the people that you work with. Because theoretically you're all there to do the same thing. Whether it is teach children or provide medical care, or provide mental health care, or have a healthy family. You generally have some sort of unified goal. You want to develop a commitment to balancing individual rights and responsibilities with the rights and responsibilities of the community or the organization or the or the family, instead of the reciprocity rule. So think about it. You know, does Johnny always get his way? Well, no. You know, everybody has the right to get their way sometimes, you know, to choose what you're going to do on a Friday night or choose where you want to go on vacation, but you're going to balance that with the rights and responsibilities of everybody else in the family. The reciprocity rule is when you react as the other person did and expect the other person to do as you did. So, you know, it's expecting people to do unto others as you did unto them, even if what you did unto them was really unpleasant. We want to balance individual rights. This can include distributive justice, how resources are allocated. We want to make sure that everybody in the family or everybody in the organization has equal access to resources. Procedural justice. Principles that govern decision making processes, rewards and punishments. Again, in the family, we want to make sure that everybody is treated as equally as possible. Same thing in the organization. And interactional justice. We want to make sure that everybody treats one another kindly. That doesn't seem like it's that hard, but it actually can be really Hard. So we want to encourage people to really pay attention to how they're treating each other. You know, and if you grew up in a family, you know that families don't always model this. You may have a big brother that picks on a little brother or whatever, and that happens. But interactional justice encourages people to really treat one another as they want to be treated. And social responsibility means shared ethical principles. So y' all are kind of on the same page about what is right and what is wrong. Democracy is not like, you know, in a. Not like voting. It's not like in the political sense. But it means recognizing the importance of each person's contribution, creating the skills of self control, self discipline, and administration of healthy authority. There have to be leaders, but leaders and healthy leaders listen and communicate and are open to feedback loops. They communicate that everybody's participation is a personal responsibility. In a democracy, you know, it is your responsibility to stand up and say something if there's a problem. The tools that we need to help our clients, ourselves and our organization develop for democracy include the ability to effectively and assertively express oneself, the ability to actually listen and deeply listen to others, not just, you know, do lip service to it. Conflict management skills, compromise, self control, self discipline, self respect and respect for other people, and growth and change. In this environment. We want to commit ourselves to this vision of growth, this vision of becoming a sanctuary, this vision of becoming happy and healthy and grounded and emotionally intelligent. We want to restore hope, meaning and purpose and. And empower positive change. So we want to commit to this vision of growth. Not a vision of how can we just keep people from acting out? How can we keep Johnny from making bad decisions at school? We want to go past that and we want to have this vision of how can we help Johnny be the best student that he can be in this classroom? How can we help Johnny be the best person he can be and really realize his potential? And how can we help him feel empowered to make those steps? So trauma takes many forms and represents a sense of loss of safety. Sanctuary can be created in the home, in the community, and in the organization. And I would love to see it everywhere. But let's start with creating sanctuary in our own heads so we're not battling with that critical self. And then maybe in our families and in our immediate work environment, Sanctuary helps people become aware of the function of their behaviors and break unhelpful reenactment cycles. Organizations are susceptible to trauma and can re. Traumatize individuals by creating those same dynamics that the individual experienced in their family of origin or in their past. The Self Model helps people interpret individual and organizational behavior in terms of its impact on safety, emotional regulation, sense of loss, and hope for the future. The implementation of the Sanctuary Model, like I said, is much more in depth than anything we're going to go over in these podcasts, but the book is a really great place to start Restoring Sanctuary if your organization wants to learn more about the Sanctuary model or wants to get certified in it, and I'm not in any way affiliated or sponsored with the Sanctuary Institute, like I said in the first podcast, this is just a philosophy that I stumbled upon and I think it is amazingly fabulous. But anyway, if you want more information, if you want guidance on creating a sanctuary in your organization, Sarah Yannowsi is the Director of the Sanctuary Institute and you can reach her at 914-965-3700 extension 1117 so you can always find her. You can google the Sanctuary Institute. They're located in New York so you can go to their website too. Anyhow, so that's where you would find more information. Thank you for being with me and I will see you next week. 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