3338823 Trauma Sensitive Work With Domestic Violence Victims[1]

8/14/2019 3338823 Trauma Sensitive Work With Domestic Violence Victims[1]

1/39

Trauma Sensitive WorkTrauma Sensitive Workwithwith

Domestic ViolenceDomestic ViolenceSurvivorsSurvivors


2/39

PTSDPTSD(Post-Traumatic Stress(Post-Traumatic Stress

Disorder)Disorder)

A potentially disabling condition thatA potentially disabling condition that

many people experience aftermany people experience after

enduring a traumatic event in whichenduring a traumatic event in which

they:they:

are threatened with serious injury orare threatened with serious injury or

deathdeath andand

feel a sense of intense fear, helplessness,feel a sense of intense fear, helplessness,or horroror horror


3/39

PTSD SYMPTOMSPTSD SYMPTOMS

1.1. Intrusive Re-experiencingIntrusive Re-exp

eriencing

Repeatedly re-experiencing the traumaRepeatedly re-experiencing the trauma

in the form of flashbacks, memories,in the form of flashbacks, memories,

nightmares, or frightening thoughts.nightmares, or frightening thoughts. Experiences occur unexpectedly and mayExperiences occur unexpectedly and may

be so intense that the person feels asbe so intense that the person feels as

though the trauma is occurring again.though the trauma is occurring again.

This may cause the person to react in waysThis may cause the person to react in waysthey did when the trauma originally occurred.they did when the trauma originally occurred.


4/39

PTSD SYMPTOMS (cont)PTSD SYMPTOMS (cont)

2.2. AvoidanceAvoidance -- Also referred to asAlso referred to as

dissociation.dissociation. Individual has numbed theirIndividual has numbed their

emotions to avoid painful,emotions to avoid painful,overwhelming feelings.overwhelming feelings.

May attempt to:May attempt to:

avoid all reminders of the traumaticavoid all reminders of the traumaticevent,event,

feel emotionally detached,feel emotionally detached,

withdraw from friends, family, andwithdraw from friends, family, and

everyday activities.everyday activities.


5/39

PTSD SYMPTOMS (cont)PTSD SYMPTOMS (cont)

HyperarousalHy

perarousal

Being constantly on guard,Being constantly on guard,

easily startled or jumpyeasily startled or jumpy Difficulty to concentrating orDifficulty to concentrating or

remembering informationremembering information

May have sleep disturbances orMay have sleep disturbances orpanic attackspanic attacks..

COMPLEX PTSD


6/39

COMPLEX PTSDCOMPLEX PTSDDr. Judith Herman of HarvardDr. Judith Herman of Harvard

UniversityUniversity1.1. The individual experienced a prolongedThe individual experienced a prolongedperiod (months to years) of total control byperiod (months to years) of total control byanother.another.

2.2. Symptoms that tend to result from chronicSymptoms that tend to result from chronic

victimization. Those symptoms include:victimization. Those symptoms include: Alterations in emotional regulationAlterations in emotional reg

ulation, which may, which mayinclude symptoms such as persistent sadness,include symptoms such as persistent sadness,suicidal thoughts, explosive anger, or inhibitedsuicidal thoughts, explosive anger, or inhibitedangeranger

Alterations in consciousneAlterations in consciousness, such as forgettingss, such as forgettingtraumatic events, reliving traumatic events, ortraumatic events, reliving traumatic events, orhaving episodes in which one feels detachedhaving episodes in which one feels detachedfrom one'sfrom one's mental processes or bodymental p

rocesses or body


7/39

COMPLEX PTSD (cont)COMPLEX PTSD (cont) Alterations in self-perceptionAlterations in self-perception, which may include a, which may include a

sense of helplessness, shame, guilt, stigma, and asense of helplessness, shame, guilt, stigma, and asense of being completely different than othersense of being completely different than otherhuman beingshuman beings

Alterations in the perception of the perpetratorAlterations in the perception of the perpetrator,,such as attributing total power to the perpetrator orsuch as attributing total power to the perpetrator or

becoming preoccupied with the relationship to thebecoming preoccupied with the relationship to theperpetrator, including a preoccupation with revengeperpetrator, including a preoccupation with revenge

Alterations in relations with othersAlterations in relations with others, including, includingisolation, distrust, or a repeated search for a rescuerisolation, distrust, or a repeated search for a rescuer

Alterations in one's system of meaningsAlterations in one's system of meanings, which may, which may

include a loss of sustaining faith or a sense ofinclude a loss of sustaining faith or a sense ofhopelessness and despairhopelessness and despair


8/39

COMPLEX PTSD (cont)COMPLEX PTSD (cont)

3.3. Other difficulties of complex PTSDOther difficulties of complex PTSDsurvivors:survivors: May avoid thinking and talking aboutMay avoid thinking and talking about

trauma-related topics because the feelingstrauma-related topics because the feelingsassociated with the trauma are oftenassociated with the trauma are often

overwhelming.overwhelming.

May use alcohol and substance abuse as aMay use alcohol and substance abuse as away to avoid and numb feelings andway to avoid and numb feelings andthoughts related to the trauma.thoughts related to the trauma.

Survivors may also engage in self-Survivors may also engage in self-mutilation and other forms of self-harmmutilation and other forms of self-harm


9/39

TRAUMATIC MEMORIESTRAUMATIC MEMORIES

Traumatic events areTraumatic events are rememberedremembered

by some individuals while inby some individuals while in

other individuals the memoriesother individuals the memoriesareare dissociateddissociated..


10/39

Factors influencing aFactors influencing a

continuous memorycontinuous memory

include:include: experiencing a single traumaticexperiencing a single traumatic

event naturally or accidentallyevent naturally or accidentallycaused,caused,

being an adult at the time ofbeing an adult at the time of

the trauma, andthe trauma, and receiving validation andreceiving validation and

support.support.


11/39

Factors influencingFactors influencing

dissociationdissociation oror amnesia:amnesia:

experiencing the trauma repetitivelyexperiencing the trauma repetitively

trauma deliberately caused bytrauma deliberately caused by

another personanother person

trauma related to betrayal of trust bytrauma related to betrayal of trust by

a significant person in ones lifea significant person in ones life

being a child at the time of thebeing a child at the time of the

traumatrauma

living in an atmosphere of secrecyliving in an atmosphere of secrecy

and denialand denial


12/39

WHO IS AT RISK?WHO IS AT RISK?

People who are at thePeople who are at the greatest riskgreatest riskforfor

developing PTSD are:developing PTSD are:

Survivors of violent assaults (domesticSurvivors of violent assaults (domestic

violence, rape, sexual assault/or abuse,violence, rape, sexual assault/or abuse,physical assault such as a mugging orphysical assault such as a mugging or

carjacking)carjacking)

Children who have been neglected, orChildren who have been neglected, orsexually, physically or verbally abused,sexually, physically or verbally abused,

and adults who were abused as children)and adults who were abused as children)


13/39

HELPING TRAUMA SURVIVORSHELPING TRAUMA SURVIVORS

HEALHEAL

Trauma Theory:Trauma Theory:

Sickness/Badness vs. Injury ModelSickness/Badness vs. Injury Model Changing the fundamental questionChanging the fundamental question

from:from:

What's wrong with you?"What's wrong with you?"

toto

"What's happened to you?""What's happened to you?"


14/39

MOVING FROMMOVING FROMSICKNESS/BADNESSSICKNESS/BADNESS toto INJUREDINJURED

Our understanding of the impact of trauma alters ourOur understanding of the impact of trauma alters ourfundamental explanations for human dysfunction.fundamental explanations for human dysfunction.

At present, there are basically three widely acceptedAt present, there are basically three widely acceptedreasons for why people do deviant things:reasons for why people do deviant things:

The person is sick.The person is sick.The person is bad.The person is bad.

The person is both sick and badThe person is both sick and bad

Trauma theory implies that it is far more usefulTrauma theory implies that it is far more useful

to assume that a person has been injuredto assume that a person has been injured


15/39

Sickness:Sickness:

The cause of the problem lies withinThe cause of the problem lies withinthe sufferer, unconnected in anythe sufferer, unconnected in anymeaningful way with the outside world.meaningful way with the outside world.

Implies a basic weakness, malfunctionImplies a basic weakness, malfunctionor defect that medical science can hopeor defect that medical science can hopeto stabilize or cure.to stabilize or cure.

Holds an expectation of passivity onHolds an expectation of passivity on

the part of the suffererthe part of the sufferer

Denies both personal and socialDenies both personal and socialaccountability for the course of theaccountability for the course of thesickness.sickness.


16/39

Badness:Badness: Connected to the concept of sin.Connected to the concept of sin.

Implies a basic defect and little hopeImplies a basic defect and little hopethat anyone can correctthat anyone can correct

But we can, and should, punish it.But we can, and should, punish it.

Requires self- corrective action -Requires self- corrective action -totally on the part of the bad persontotally on the part of the bad person

TheThe bad personbad person is wholly responsibleis wholly responsiblefor their deviant actionsfor their deviant actions

should stop the misbehavior- regardlessshould stop the misbehavior- regardlessof its origin orof its origin or

accept the consequences (punishment).accept the consequences (punishment).


17/39

Injury:Injury:

Implies a cause that is obviousImplies a cause that is obviousor discoverableor discoverable connects the sufferer to the socialconnects the sufferer to the social

environment that allowed or failedenvironment that allowed or failedto prevent the injury.to prevent the injury.

Implies a process ofImplies a process ofrecoveryrecoveryandand rehabilitationrehabilitation the sufferer must learn how to copethe sufferer must learn how to cope

with a semi-permanent or evenwith a semi-permanent or evenpermanent disability.permanent disability.


18/39

Injury (cont):Injury (cont):

Implies a cause that is obvious orImplies a cause that is obvious or

discoverablediscoverable connects the sufferer to the socialconnects the sufferer to the social

environment that allowed or failed toenvironment that allowed or failed toprevent the injury.prevent the injury.

Implies a process ofImplies a process ofrecoveryrecoveryandand

rehabilitationrehabilitation the sufferer must learn how to cope withthe sufferer must learn how to cope with

a semi-permanent or even permanenta semi-permanent or even permanent

disability.disability.


19/39


RequiresRequires active participation by theactive participation by the

sufferersuffererin the process of recoveryin the process of recovery helpers are morehelpers are more consultantsconsultants andand

catalyzing agentscatalyzing agents of change thanof change than healers.healers.

Requires assumption of bothRequires assumption of both individual responsibilityindividual responsibilityon the part of theon the part of the

sufferer, andsufferer, and social responsibilitysocial responsibilityon the part of theon the part of the

larger social group.larger social group.


20/39


TheThe

injuredinjured

individualindividual

must look at the waysmust look at the ways

he or shehe or she contributed to the injurycontributed to the injuryin orderin ordertoto

ensure properensure proper risk managementrisk managementininthe future,the future, andand

must take necessary steps to ensuremust take necessary steps to ensurerecoveryrecoveryandand future risk preventionfuture risk prevention..

The largerThe larger social groupsocial group represented by represented byfamily, school, workplace, or the communityfamily, school, workplace, or the community

as a whole - must come to terms with theas a whole - must come to terms with therole the society played inrole the society played in failing to preventfailing to preventthe injurythe injury providing the contexts within whichproviding the contexts within which

individual healing can occur.individual healing can occur.


21/39

TRAUMA INFORMED ADDICTIONTRAUMA INFORMED ADDICTION

TREATMENTTREATMENTMaxine Harris, Roger FallotMaxine Harris, Roger Fallot

CORE TREATMENT ELEMENTS:CORE TREATMENT ELEMENTS:

1.1. Teach integrative and contextualTeach integrative and contextual

explanationsexplanations NOT EXCUSESNOT EXCUSES

1.1. Place substance use in thePlace substance use in the

context of clients life,context of clients life,relationships and trauma historyrelationships and trauma history


22/39

CORE TREATMENT ELEMENTS (cont)CORE TREATMENT ELEMENTS (cont)

3.3. INCLUDE ACCESS TOINCLUDE ACCESS TO

ANCILLARY SERVICES:ANCILLARY SERVICES:

VOCATIONAL PARENTING SAFE HOUSING

EDUCATIONAL LIFE SKILLS LEGAL SERVICES

HEALTHCARE


23/39

CORE TREATMENT ELEMENTS (cont)CORE TREATMENT ELEMENTS (cont)

SELF-KNOWLEDGESELF-KNOWLEDGE

CLEAR COMMUNICATIONCLEAR COMMUNICATION

SELF-REGULATIONSELF-REGULATION

ACCURATE PERCEPTION OFACCURATE PERCEPTION OF

OTHERS ANDOTHERS AND

SELF-SOOTHINGSELF-SOOTHING

HONEST LABELINGHONEST LABELING

SELF TRUSTSELF TRUST

APPRECIATING MUTUALITYAPPRECIATING MUTUALITY

AND RECEPROCITYAND RECEPROCITY

LIMIT SETTINGLIMIT SETTING

CLEAR EXPRESSION OFCLEAR EXPRESSION OF

NEEDS AND DESIRESNEEDS AND DESIRES

4.4.TEACHTEACH CROSSOVER SKILLSCROSSOVER SKILLS FORFORRECOVERY FROM TRAUMARECOVERY FROM TRAUMA ANDANDADDICTION:ADDICTION:


24/39

KEY COMPONENTS OF TRAUMAKEY COMPONENTS OF TRAUMA

SENSITIVE SERVICESSENSITIVE SERVICES

Most trauma informed interventionsMost trauma informed interventionscover three primary areas:cover three primary areas:

1.1. Identifying the nature and extent ofIdentifying the nature and extent of

the trauma, including:the trauma, including: symptom development;symptom development;

strengths used for survival;strengths used for survival;

distortion of feelings and behavior duedistortion of feelings and behavior due

to trauma;to trauma; how ongoing symptom experienceshow ongoing symptom experiences

(dissociation, substance abuse) may(dissociation, substance abuse) mayfunction to numb the pain of abusefunction to numb the pain of abuse

history.history.


25/39

KEY COMPONENTS OFKEY COMPONENTS OF

TRAUMA SENSITIVE SERVICES (cont)TRAUMA SENSITIVE SERVICES (cont)

2.2. The creation of a safe haven.The creation of a safe haven.Certain basic rules help toCertain basic rules help to

establish this environment,establish this environment,

including:including: confidentiality;confidentiality;

opportunity to speak or pass;opportunity to speak or pass;

a group norm disallowing advice-a group norm disallowing advice-giving, criticism, or confrontationgiving, criticism, or confrontation


26/39

Safe Haven (cont)Safe Haven (cont)

Common responses among victimsCommon responses among victimsexperiencing such anexperiencing such anenvironment include:environment include:

increased self esteem at knowingincreased self esteem at knowingwhat they have to say is heardwhat they have to say is heardand valued,and valued,

relief at finding they are notrelief at finding they are not

alone or crazy or badalone or crazy or badbecause of their experiencesbecause of their experiences

increased empowermentincreased empowerment


27/39

KEY COMPONENTS OFKEY COMPONENTS OF

TRAUMA SENSITIVE SERVICES (cont)TRAUMA SENSITIVE SERVICES (cont)

3.3. Survivors are encouraged to developSurvivors are encouraged to develop

skills needed to recover from traumaticskills needed to recover from traumatic

experiences and build healthy lives.experiences and build healthy lives.

These include learning:These include learning: cognitive- behavioral re-thinkingcognitive- behavioral re-thinking

strategies,strategies,

problem-solving skills,problem-solving skills,

relaxation techniques,relaxation techniques, stress coping,stress coping,

relapse prevention andrelapse prevention and

short- and long-term safety planning skills.short- and long-term safety planning skills.


28/39

How Trauma Affects PeoplesHow Trauma Affects Peoples

Lives:Lives:

Trauma interferes withTrauma interferes with Knowing how to feel safe and how to keep self/familyKnowing how to feel safe and how to keep self/family

safesafe

Feeling understood by and able to connect emotionallyFeeling understood by and able to connect emotionally

with other personswith other persons Knowing how to feel in control and how to be organizedKnowing how to feel in control and how to be organized

and goal-directedand goal-directed

Feeling like a person worthy of respect, support, andFeeling like a person worthy of respect, support, and

compassion (versus damaged/bad)compassion (versus damaged/bad)

Knowing how (and when, and whom) to trustKnowing how (and when, and whom) to trust

Knowing how to help and show caring to others withoutKnowing how to help and show caring to others without

being exploited or controllingbeing exploited or controlling

Knowing how to contain intense emotions andKnowing how to contain intense emotions and

impulses, and how to soothe/calm oneselfimpulses, and how to soothe/calm oneself


29/39

What Intervention Can Do:What Intervention Can Do:

Provide modeling/guided experience in:Provide modeling/guided experience in: Identifying life experiences that may haveIdentifying life experiences that may have

been traumatic and feelings, problems, andbeen traumatic and feelings, problems, and

coping styles that may result from traumacoping styles that may result from trauma

Identifying dangers/problems and takingIdentifying dangers/problems and takingpractical steps to be safe and feel safepractical steps to be safe and feel safe

Identifying intense emotions/impulses,Identifying intense emotions/impulses,

understanding how they make sense, andunderstanding how they make sense, and

how to self-soothe, problem solve, and behow to self-soothe, problem solve, and besoothed and guided by trustworthy otherssoothed and guided by trustworthy others

Recognizing the worth and value of one'sRecognizing the worth and value of one's

own actions and intentionsown actions and intentions


30/39

What Intervention Can Do (cont):What Intervention Can Do (cont):

Provide modeling/guided experience in:Provide modeling/guided experience in:

Organizing complicated problems into smallOrganizing complicated problems into smallpractical steps toward solutionspractical steps toward solutions

Engaging in a non-coercive, non-abandoningEngaging in a non-coercive, non-abandoning

relationship based on mutual respect,relationship based on mutual respect,responsibility, and learningresponsibility, and learning

Recognizing attempts to maintain and repairRecognizing attempts to maintain and repairrelationships despite despair/fear/angerrelationships despite despair/fear/anger

Recognizing attempts to deal with intenseRecognizing attempts to deal with intenseemotions and impulses despite lapsesemotions and impulses despite lapses

Recognizing attempts to maintain or regainRecognizing attempts to maintain or regainpersonal control/autonomy and safetypersonal control/autonomy and safety


31/39

What Intervention can achieveWhat Intervention can achieve

Trauma sensitivity adds value to allTrauma sensitivity adds value to alltypes of services by:types of services by: Enhancing the clients safety (including ability toEnhancing the clients safety (including ability to

identify and practically manage dangers)identify and practically manage dangers)

Enhancing the clients autonomous self-controlEnhancing the clients autonomous self-control(including identifying and making choices)(including identifying and making choices)

Directly demonstrating respect, compassion, andDirectly demonstrating respect, compassion, and

confidence in the client as an adult/parentconfidence in the client as an adult/parent

Showing the client how relationships can beShowing the client how relationships can be

personal without violating her personal space andpersonal without violating her personal space and

boundaries, trustworthy without being perfect, andboundaries, trustworthy without being perfect, and

satisfying without any exploitationsatisfying without any exploitation

Helping the client directly face problems withoutHelping the client directly face problems without

avoidance, blame, secrecy, or dishonestyavoidance, blame, secrecy, or dishonesty


32/39

What Intervention can achieveWhat Intervention can achieve

(cont):(cont):

Trauma sensitivity adds value to allTrauma sensitivity adds value to all

types of services by:types of services by: Enhancing the clients understandingEnhancing the clients understanding inin

non-stigmatizing termsnon-stigmatizing terms of how she learnedof how she learnedto cope with trauma and why these types ofto cope with trauma and why these types of

coping made sense for dealing with hercoping made sense for dealing with her

traumatrauma

Enhancing the clients understanding ofEnhancing the clients understanding ofhow post-traumatic symptoms are anhow post-traumatic symptoms are an

attempt to regain a sense of safety, self-attempt to regain a sense of safety, self-

respect, and empowermentrespect, and empowerment

d ki


33/39

Integrated Treatment:Integrated Treatment: SeekingSeeking

SafetySafetyTHE FOUR KEY PRINCIPLES OF SEEKING SAFETY TREATMENTTHE FOUR KEY PRINCIPLES OF SEEKING SAFETY TREATMENT

1.1. Safety as the priority of this first stage of treatmentSafety as the priority of this first stage of treatmentThe basic philosophy of the treatment is that, when a person hasThe basic philosophy of the treatment is that, when a person has

both active substance abuse and PTSD, the most urgent clinicalboth active substance abuse and PTSD, the most urgent clinical

need is to establish safety. "Safety" is an umbrella term thatneed is to establish safety. "Safety" is an umbrella term that

signifies various elements including:signifies various elements including:

discontinuing substance use,discontinuing substance use, reducing suicidality,reducing suicidality,

minimizing exposure to HIV risk,minimizing exposure to HIV risk,

letting go of dangerous relationships (such asletting go of dangerous relationships (such as

domestic abuse and drug-using "friends"),domestic abuse and drug-using "friends"),

gaining control over extreme symptoms (such asgaining control over extreme symptoms (such as

dissociation), anddissociation), and

stopping self-harm behaviors (such as cutting).stopping self-harm behaviors (such as cutting).


34/39

"Seeking safety""Seeking safety" refers to helping clients freerefers to helping clients freethemselves from such negative behaviors and, in sothemselves from such negative behaviors and, in so

doing, to move toward freeing themselves fromdoing, to move toward freeing themselves from

trauma at a deep emotional level.trauma at a deep emotional level.

This treatment attempts to teach life-This treatment attempts to teach life-

enhancing skills that promote safety:enhancing skills that promote safety: learning to ask for help from safe people,learning to ask for help from safe people,

utilizing community resources,utilizing community resources,

exploring "recovery thinking,exploring "recovery thinking,

taking good care of one's body,taking good care of one's body,

rehearsing honesty and compassion,rehearsing honesty and compassion,

increasing self-nurturing activities, and so on.increasing self-nurturing activities, and so on.

Safety as the priority of this first stage treatment(cont)


35/39

THE FOUR KEY PRINCIPLES OF SEEKING SAFETY TREATMENTTHE FOUR KEY PRINCIPLES OF SEEKING SAFETY TREATMENT

2.2. Integrated Treatment Of PTSD And Substance AbuseIntegrated Treatment Of PTSD And Substance Abuse

attention to both disorders at the same time in the presentattention to both disorders at the same time in the present

Each topic can be applied to both PTSD and substance abuse.Each topic can be applied to both PTSD and substance abuse.

Integration is goal for clients: to "own" both disorders.Integration is goal for clients: to "own" both disorders.

Treatment content is focused on helping clients to:Treatment content is focused on helping clients to:

learn what the two disorders are and why they co-occur;learn what the two disorders are and why they co-occur;

exploring their interrelationship in the present (e.g.,exploring their interrelationship in the present (e.g.,using crack last week to cope with PTSD flashbacks);using crack last week to cope with PTSD flashbacks);

understanding the course of the disorders in recoveryunderstanding the course of the disorders in recovery(e.g., with abstinence, PTSD may feel worse before it(e.g., with abstinence, PTSD may feel worse before itfeels better);feels better);

increasing compassion by viewing substance abuse asincreasing compassion by viewing substance abuse asan attempt to cope with the pain of trauma; andan attempt to cope with the pain of trauma; and

teaching safe coping skills that apply to both.teaching safe coping skills that apply to both.


36/39

THE FIVE KEY PRINCIPLES OF SEEKING SAFETYTHE FIVE KEY PRINCIPLES OF SEEKING SAFETY

TREATMENTTREATMENT

3.3. A Focus on IdealsA Focus on IdealsAddiction and trauma (individually, and especially inAddiction and trauma (individually, and especially in

combination,) lead to demoralization and loss of idealscombination,) lead to demoralization and loss of ideals

Trauma - "shattered assumptions":Trauma - "shattered assumptions":Many clients reportMany clients reportfeeling more upset about a loss of ideals, such as trust, thanfeeling more upset about a loss of ideals, such as trust, thanabout particular external conditions, such as poverty or lackabout particular external conditions, such as poverty or lackof a job.of a job.

Addiction loss of ideals:Addiction loss of ideals: Life has become narrowed inLife has become narrowed infocus, one is living "at the bottom-surrounded by people whofocus, one is living "at the bottom-surrounded by people whocannot cope, pushing away reality, losing connections tocannot cope, pushing away reality, losing connections tonormal life (job, home, relationships), lying about substancenormal life (job, home, relationships), lying about substanceabuse, unable to face emotional pain.abuse, unable to face emotional pain.

Recovery from both:Recovery from both: The treatment explicitly seeks toThe treatment explicitly seeks torestore ideals that have been lost.restore ideals that have been lost.

The title of each topic is framed as a positive ideal-The title of each topic is framed as a positive ideal-one that is the opposite of some pathologicalone that is the opposite of some pathologicalcharacteristic of PTSD and substance abuse.characteristic of PTSD and substance abuse.

The AA goal of living a life of moral integrity is anThe AA goal of living a life of moral integrity is anantidote to the deterioration of ideals inherent inantidote to the deterioration of ideals inherent insubstance abuse and PTSD.substance abuse and PTSD.


37/39

THE FOUR KEY PRINCIPLES OF SEEKING SAFETYTHE FOUR KEY PRINCIPLES OF SEEKING SAFETY

TREATMENTTREATMENT

4.4. Three Content AreasThree Content Areas; Cognitive, Behavioral; Cognitive, Behavioral

and Interpersonaland Interpersonal

CognitiveCognitive - Present- and problem-- Present- and problem-

oriented, to reduce currentoriented, to reduce current

symptoms.symptoms. Brief, time-limited, and structured, withBrief, time-limited, and structured, with

the goal of strong treatment gains over athe goal of strong treatment gains over a

short time frame.short time frame.

It is educational, with emphasis onIt is educational, with emphasis on

rehearsal of new skills.rehearsal of new skills. It is directive and collaborative, guidingIt is directive and collaborative, guiding

clients (much as a good parent would)clients (much as a good parent would)

while emphasizing their maturewhile emphasizing their mature

contribution to their own treatment.contribution to their own treatment.


38/39

4.4. Three Content Areas; Cognitive, Behavioral andThree Content Areas; Cognitive, Behavioral and

Interpersonal (cont)Interpersonal (cont)

BehavioralBehavioral - The "behavioral bottom line"- The "behavioral bottom line"

is taught: that it is not sufficient to talkis taught: that it is not sufficient to talkabout action, but real action, howeverabout action, but real action, however

small, is essential.small, is essential.

Each session Clients make aEach session Clients make a

commitment to one concrete step tocommitment to one concrete step topromote healingpromote healing

Counselors are encouraged to listen toCounselors are encouraged to listen to

Clients behavior more than their wordsClients behavior more than their words

Clients guided to "own" their actions-Clients guided to "own" their actions-

no matter what happens in their lives.no matter what happens in their lives.


39/39

THE FOUR KEY PRINCIPLES OF SEEKING SAFETYTHE FOUR KEY PRINCIPLES OF SEEKING SAFETY

TREATMENTTREATMENT

4.4. Three Content Areas; Cognitive, Behavioral andThree Content Areas; Cognitive, Behavioral and

Interpersonal (cont)Interpersonal (cont)

InterpersonalInterpersonal - most PTSD arises from trauma- most PTSD arises from traumainflicted by others (in contrast to naturalinflicted by others (in contrast to naturaldisasters or accidentsdisasters or accidents

PTSD survivors:PTSD survivors: distrust of others, confusiondistrust of others, confusion

over what can be expected in relationships,over what can be expected in relationships,

and concern over reenactments of abusiveand concern over reenactments of abusive

power both as victims and as perpetratorspower both as victims and as perpetrators

Substance abusersSubstance abusers:: substance abuse is oftensubstance abuse is often

precipitated and perpetuated by relationshipprecipitated and perpetuated by relationship

issues (substance-abusing family members,issues (substance-abusing family members,substance use as an attempt to gainsubstance use as an attempt to gain

acceptance by others, substance use toacceptance by others, substance use to

manage interpersonal conflict)manage interpersonal conflict)

Documents

3338823 Trauma Sensitive Work With Domestic Violence Victims[1]