Module 7

DOMESTIC VIOLENCE AND TRAUMA

Many women accessing the services of domestic violence shelters experienced trauma as a result of the abuse that they suffered. Experiences of trauma can affect all areas of women’s lives. As a front-line counsellor, it is important that you have a basic understanding of trauma and the impact it has on women who experience abuse. Although your involvement with women is typically brief, you are in a position to provide “first stage trauma intervention,” and initiate the healing process for many women (Haskell, 2003).

LEARNING OBJECTIVES:

- To gain understanding of the relationship between domestic violence and trauma.

- To gain awareness of symptoms of trauma.

- To be able to educate women about the impacts of trauma.

- To be able to teach women skills so that they are able to ground themselves, contain their emotions and self-soothe.

TRAUMA DEFINED

The DSM-IV–TR defines trauma as, “involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm or threat of death or injury experienced by a family member or other close associate. The person’s response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behaviour)” (American Psychiatric Association, 2000, 463).“The word trauma is used both to describe an event and to describe a reaction or response to an event” (Covington, 2003, p. 5).

THE PROCESS OF TRAUMA

Trauma begins with an event or experience that overwhelms an individual’s normal coping mechanisms.

When threatened, an individual’s first response is either fight or flight. The brain sends a signal to the body to be on alert.

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Physiological changes include an increased heart rate, an increase in blood pressure and muscle tension, dilation of the eyes, shallow breathing, flushed skin, tunnel vision, an adrenaline rush and the release of certain chemicals from the brain into the body. The physiological and psychological reactions in response to the event include hyperarousal, altered consciousness and numbing. These are normal reactions to an abnormal experience.

There are changes in the brain, and the nervous system becomes sensitized and vulnerable to any future stressors. Individuals may experience triggers, nightmares and flashbacks, resulting in painful emotional states (Covington, 2003; Matsakis, 1996; Herman, 1997).

Behaviours that occur as a result of trauma can be placed into three categories – retreat, self-destructive and destructive. Retreating behaviours include isolation, dissociation, depression and anxiety. Self-destructive behaviours include substance abuse, eating disorders, self-harm and suicidal behaviours. Destructive behaviours include aggression, violence and rages. Women are more likely to internalize their feelings and therefore retreat or be self-destructive, rather than be violent and aggressive (Covington, 2003).

Women who experienced traumatic events describe feelings of intense fear, helplessness, or horror. Many things influence how a woman responds to a traumatic event, including age, history with other trauma, family dynamics and support systems.

For some women who have had a traumatic experience, the fight or flight mechanism can begin to function poorly or not at all. For example, a woman may be overly sensitive to a mildly stressful event, or she may shut down and become numb. Some women dissociate and disconnect from their bodies. Many women re-experience the traumatic incident in their memories, thoughts and dreams. These re-experienced traumas can be so intense that it feels as though the event is happening all over again. When this is happening, some women find it hard to concentrate and keep their minds on a task. This can contribute to their feeling of being out of control. Some women experience depression, a sense of isolation and sadness. Some may withdraw and isolate themselves. Fear and anxiety may become a daily occurrence. Lives may become limited due to fear of harm.

Exposure to trauma can have long lasting effects on the endocrine, autonomic and central nervous systems. Studies have found complex changes in both the function and the structure of specific areas of the brain (van der Kolk, 1996). Brain chemistry responses to trauma can predispose

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women to alcohol and drug abuse, eating disorders, self-harming behaviour and other mental health challenges (Covington, 2003).

Researchers have found that a history of family violence may be the single most significant risk factor for substance abuse by both women and men (American Psychological Association, 1996).

THE TRAUMA PROCESS:

A traumatic event occurs. The amygdala activates the fight or flight response and physiological and psychological changes occur. When an event exceeds an individual’s capacity to adapt effectively, there is a traumatic stress response. The traumatic event overwhelms an individual so that the normative fight or flight response becomes deregulated and the individual’s capacity to return to a state of homeostasis is impaired.

The fragmented and emotionally charged components of the trauma – such as body responses, emotions and the meaning of the event – can be stored in memory without a clear interpretation to help make sense of the experience. As a result of the sloppy storage of the unprocessed emotional material, things that happen in the present may trigger emotional responses associated with the past traumatic experience.

TRAUMA AND BRAIN FUNCTIONING:

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Cerebral cortex - front brain centre for reason and insight; left /right hemispheres; contains the neocortex

Limbic brain – midbrain– filtering of emotions; contains the amygdala, hippocampus, hypothalamus, thalamus

Back brain - Reptilian brain responsible for automatic vital functions; contains the cerebellum

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The brain is comprised of many distinct regions, each responsible for a specific function. Promislow (1998) categorized the major brain regions as the cerebellum (back brain), the limbic brain (mid-brain) and the cerebral cortex (front brain).

Under conditions of trauma, the back brain, the cerebellum, is first to alert the body’s responses to the situation. This region of the brain handles automatic, vital functions such as heart rate and breathing. The back brain is made up of three distinct sections: 1) the brain stem, which is responsible for the basic life functions of digestion, respiration and circulation; 2) the reticular activating system (located at the top of the brain stem), that acts as a transmission and filtering mechanism for incoming brain signals and transmits them to the higher reasoning area of the brain; and 3) the cerebellum (located at the back of the brain stem), which is responsible for complex motor functions such as walking.

The mid-brain, limbic brain, is responsible for vital functions such as body temperature, blood pressure and the filtering of emotions. The mid-brain, a major pathway to the cerebral cortex, is associated with motivation, regulating the fight or flight response, release of hormones, interpretation of emotion and connections for fine motor tasks.

The cerebral cortex is the centre for reason and insight. This part of the brain decodes sensory information, facilitates the formation of complex memories, analyzes information and makes decisions. The cerebral cortex is comprised of the right and left hemispheres. The right hemisphere is responsible for logical thinking while the left brain is responsible for emotional reasoning. Under stress, the communication between these two hemispheres breaks down, allowing individuals to access one or the other, but not both.

When an individual experiences an event, information about this experience is perceived through the senses and processed by the brain. The amygdala is the part of the brain that functions as an emotional scanner, informing us about the significance of an event. The amygdala, located in the limbic brain, acts as an early warning system, sounding the alarm and activating the fight or flight response if the event is frightening. This occurs before the more slowly triggered neocortex (located in the cerebral cortex) has an opportunity to respond to the threat. The neocortex is the part of the brain that assists us to identify, organize and fully process information. When the threat passes, brain functioning returns to a state of homeostasis, or balance and the neocortex can then make sense of the experience. But when the

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regulatory system is overwhelmed by a traumatic event, its functioning can become disrupted.

During a traumatic event, thinking - which helps mediate, make sense of and soothe emotions - gets bypassed. As a result, individuals are not able to fully process the traumatic event. The unprocessed, fragmented and emotionally charged parts of the trauma can become stored in memory without clear interpretation of the event.

(Information summarized from van der Kolk; Miller and Guidry, 2001; and Matsakis, 1996).

EFFECTS OF TRAUMA

Women who have been abused and suffer the impacts of trauma may encounter: depression, self-harm, problems with memory, nightmares, difficulties sleeping, anxiety, panic attacks, substance abuse, eating disorders, suicidal ideation, low self-esteem, feelings of self-loathing and overwhelming feelings of fear (Covington, 2003).

Because trauma can impact the functioning of the brain, it can affect a woman’s emotions, thinking, behaviours and relationships with others.

Trauma can result in a woman feeling out of control. Some women talk about feeling like they are going crazy.

Some women feel emotionally numb or hypervigilant. Many women may not realize that they are reacting to the past abuse and that the abuse they experienced can impact their lives for many years.

Some women who have experienced trauma are diagnosed with specific mental health disorders such as: Post Traumatic Stress Disorder (PTSD), brief reactive psychosis, dissociative identity disorder, dissociative amnesia and antisocial personality disorder.

There is a high level of comorbidity in women between post–traumatic stress and other disorders, including depression, anxiety, panic disorder, phobic disorder, substance abuse and physical disorders (Najavits, Weiss and Shaw, 1997).

POST TRAUMATIC STRESS DISORDER (PTSD)

In order for an individual to be diagnosed as having Post Traumatic Stress Disorder, the following conditions and symptoms must be found, as specified in the DSM-IV-TR:

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1. The individual must have been exposed to a trauma in which he or she was confronted with an event that involved actual or threatened death, serious injury, or a threat to self or others’ physical well-being.

2. The individual persistently re-experiences the traumatic event in at least one of the following ways:

- Recurrent and intrusive distressing recollections of the event.- Recurrent nightmares of the event.- Flashback episodes. - Intense psychological distress on exposure to internal or external cures that resemble the original event.- Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

3. The person persistently avoids such stimuli in at least three of the following ways:

- Attempts to avoid thoughts or feelings associated with the event.- Tries to avoid activities, places, or people that arouse recollections of the trauma.- Has an inability to recall an important aspect of the trauma.- Has marked diminished interest or participation in significant activities. - Feels detached and estrangement from others.- Has a restricted range of affect.- Has a sense of foreshortened future.

4. The person has persistent symptoms of increased nervous system arousal that were not present before the trauma, as indicated by at least two of the following difficulties:

- Difficulty falling or staying asleep.- Irritability or outbursts of anger.- Difficulty concentrating on tasks.- Constantly being on watch for real or imagined threats.- Exaggerated startle response.

5. The disturbance causes significant clinical distress or impairment in social, occupational, or other critical areas of living. The duration of these symptoms must be for more than one month (American Psychiatric Association, 2000).

PTSD is a normal reaction when an individual has experienced a severe stress typically considered to be outside the range of usual human experience that

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would be extremely distressing to almost anyone. Abuse is a traumatic experience and usually involves actual fear of physical or emotional injury. The traumatic events can shake the foundation of a person’s life and may interfere with developing a solid sense of self. Individuals do not develop PTSD because of any weakness in personality, but the traumatic experience may alter one’s sense of self (Matasakis, 1996).

SIMPLE AND COMPLEX POST-TRAUMATIC STRESSSimple post-traumatic stress, which results from a one-time incident, such as a rape or a car accident, is very different from the complex responses that follow chronic, ongoing traumatic events. Events, such as chronic childhood abuse or prolonged experiences of violence in an intimate relationship, result in an individual feeling captive and powerless (Herman, 1997). Complex PTSD is a new diagnosis and has not been officially documented in the DSM-IV, but is currently summarized under the DSM-IV category of “Disorders of Extreme Stress Not Otherwise Specified” (Haskell, 2001).

Herman (1997) outlines three ways that Complex PTSD differs from PTSD. Firstly, the effects of Complex PTSD are more widespread and persistent than those of PTSD. Secondly, the kinds of character personality changes are more pronounced, in that individuals have difficulties establishing relationships with others and struggle with their own identity issues. Thirdly, individuals have an increased vulnerability for further victimization from others, as well as self-harming behaviours.

Haskell (2001) describes research results indicating that individuals who had been subjected to ongoing abuse or numerous traumas experienced the effects of simple Post Traumatic Stress but they also exhibited a variety of other psychological problems that are characteristic of Complex Post Traumatic Stress. Some of these additional difficulties include:

depression and self-hatred; significant difficulties dealing with emotions and impulses

(also known as affect dysregulation), including aggression against themselves;

dissociative responses (such as depersonalization);

self-destructive behaviour (substance use problems, eating disorders);

inability to develop and maintain satisfying personal relationships; and

loss of meaning and hope.

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Women seeking refuge in a shelter often have experienced on-going trauma resulting from intimate partner abuse and therefore may present with symptoms of complex Post Traumatic Stress. Some women’s experiences of abuse are short term and they exhibit symptoms closely described by simple PTSD. Others may present with varying degrees of trauma symptoms.

FRONT-LINE COUNSELLORS AND TRAUMA INTERVENTIONS

It is likely that you will work with women experiencing a range of symptoms associated with the traumatic experience of being abused. Trauma means wounding. Just as the body can be traumatized, so can the psyche. On the psychological and mental levels, trauma refers to the wounding of one’s emotions, spirit, will to live and beliefs about one’s self and the world. One’s dignity is questioned as well as one’s sense of security (Matsakis, 1996).

There are often far-reaching impacts of abuse. Specific behaviours that individual women may exhibit while residents in your shelter may be related to the trauma they experienced. It can be very comforting to women who are experiencing trauma symptoms to understand that these symptoms are normal responses to abnormal situations.

Herman (1997) outlined a three stage model of trauma recovery – safety, remembrance and mourning and reconnection. Your role as a front-line counsellor focuses largely on assisting women to work on achieving safety in their lives. Front-line counsellors have a significant role to play in first stage trauma recovery (Haskell, 1997).

A THREAD FOR YOUR TAPESTRY OF INTERVENTIONS

The following are recommendations for front-line counsellors in shelters that have been adapted from the work of Haskell:

- Address safety issues in women’s lives. This involves recognizing and understanding the impacts of social inequity on women and assisting them to obtain basic needs such as housing and food. All women need to be supported to develop a safety plan specific to their individual situations. This also refers to maintaining a sense of safety within the shelter environment.

- Learn to recognize and identify trauma reactions.

- Do not probe women’s trauma memories or explore them any further than is required to screen for a history of trauma.

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- If a woman does disclose details of her abuse experience, allow her to talk. Validate her experience.

- Re-frame “symptoms” as “coping strategies” to trauma in order to de-stigmatize women’s experiences.

- Explain trauma as a normal response to an abnormal event. Support women to understand that their responses are attempts to cope with the impacts of the trauma they experienced. Provide information on the effects of violence.

- Help women recognize that their lives are profoundly shaped by the contexts within which they live. This includes an understanding of prejudices based on gender, race, class, ethnicity, sexual identity, age, and disabilities, which can contribute to the difficulties women experience.

- Increase clients’ sense of control over their lives by familiarizing them with post-traumatic responses and the reasons for these adaptations.

- Educate women about triggers and support women to identify their own triggers. Triggers are cues that activate or retrieve traumatic memory. Triggers can become associated with the original memory and can be experienced as intrusive thoughts, flashbacks, anxiety, or overwhelming rage. When women do not have an understanding of what triggers their trauma memories, they can become hyperaroused, numb, or afraid. When these triggers interfere with everyday life, women often begin to organize their lives by avoiding anything that they believe will result in uncomfortable feelings.

- Be knowledgeable of resources in the community that provide therapy for women experiencing trauma.

- Teach women strategies to manage their trauma reactions. Examples include grounding activities, containment exercises, safe place exercise, journaling and self-soothing activities.

STRATEGIES TO TEACH WOMEN TO MANAGE THEIR TRAUMA REACTIONS

GROUNDING ACTIVITIES help women connect to the present and detach from emotional pain. Distraction works by focusing outwardly on the external world, rather than inward toward the self. Grounding provides a means for individuals to regain control over their emotions and to stay safe. Grounding anchors individuals to the present and to reality (Najavits, 2002).

The following guidelines are recommended for leading individuals through

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grounding exercises (Najavits, 2002).

- Women can learn to do grounding on their own. Grounding can be done anytime, anyplace, anywhere.

- Grounding can be used when individuals are faced with a trigger, having a flashback, dissociating, having a substance craving, or when emotional pain becomes distressing.

- Eyes should stay open and keep scanning the room and lights should remain on.

- Individuals should rate their mood before and after the grounding exercises to monitor how well the grounding worked (using a 10 point scale – 10 means extreme pain).

- There should be no talk about negative feelings or journal writing.

- No judgments are to be used – just descriptions.

- Focus on the present.

Najavits (2002) describes three ways of grounding – mental, physical and soothing. Mental grounding refers to focusing one’s mind; physical grounding focuses on one’s senses – touch, sound, smell; and soothing means talking to one’s self in a kind, gentle manner.

EXAMPLES OF MENTAL GROUNDING (Adapted from the work of Najavits).

- Ask the woman to describe the physical environment that she is in, using all senses. You can use this strategy when you are working with a woman in person or with someone on the telephone.

- Ask the woman to count backwards from 10.

- Invite a woman to recite a safety statement – My name is _________, I am safe right now. I am in the present, not the past. I am present here _______________.

- Ask the woman to read something. For example, have affirmation cards or books, such as The Woman’s Book of Courage, available in the counselling space and ask her to choose one to read.

EXAMPLES OF PHYSICAL GROUNDING (Adapted from the work of Najavits).

- Give the woman a glass of water to drink.

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- Invite the woman to take off her shoes and tap her feet, or dig her heels into the ground; have her focus on the feeling of becoming grounded.

- Have grounding objects in the counselling space for women to hold; for example, rocks, soft stress balls, beads, pieces of cloth and so on.

- Focus on breathing. Have her breathe with you; count with her while encouraging her to breathe deeply.

SOOTHING GROUNDING (Adapted from the work of Najavits).

- Ask the woman to repeat positive statements.

- Ask her to think of her favourite color, animal, food, TV show, etc.

- Ask her to repeat a coping statement “I can deal with this;” “I know that this feeling will pass.”

CONTAINMENT: Containment is an act of containing painful emotions in order for women to manage overwhelming feelings, and it encourages them to have control over their own healing process. It is different than stuffing or denial, as it is a conscious act and it is temporary. “Containers provide a holding tank for intrusive, painful or disruptive thoughts, images and feelings” (Vermilyea, 2000, p. 60). Invite a woman to imagine a container. Ask her to visualize putting into the container painful thoughts and/or emotions that she has chosen to deal with at a later time. Let her know she is in control of these emotions or thoughts and can choose when to take them out of the container and have a look at them. You could also have a container in the counselling office and have women write down thoughts and emotions that they choose to deal with at a later time and place them in the container.

SELF-SOOTHING: Working with women in the shelter is a wonderful opportunity for you to begin to teach them about self-soothing. Some women may have engaged in unhealthy self-soothing activities as in the use of alcohol and drugs. You can explore other ways of comforting themselves. It can be beneficial to have your counselling space exhibit some self-soothing activities. For example, play relaxation music prior to a counselling session; have drawing materials available; have a basket of affirmation cards in the room; be conscious of the pictures or posters that are on the walls; have a variety of stuffed animals in the room; have a self-care basket and invite women to choose an item at the end of a session. A cozy blanket or shawl can be very soothing to offer a woman who is distressed. Always have a pitcher of fresh water in the room.

JOURNALING: If possible, have a journal for every woman that comes into your shelter. Explain that a journal is an ongoing gift to oneself. A journal is a safe place for drawing, doodling, jotting down things and sorting out your thoughts and emotions. (See Appendix for a handout to give to women about journaling).

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THROUGH HER EYES

Janice came to the shelter on the recommendation of the police who were called to her home by a neighbour. Janice and her partner had been married for just over a year and Janice explained that there had never been any physical violence until that night. She acknowledged that her partner was controlling. He did not want her to go out with her friends and got angry anytime that she contacted a member of her family. She said that on that particular evening, she had gone out with friends after work and although she had called her partner to inform him that she would be late, he was furious when she arrived home. He accused her of having an affair with her boss and when she denied this, Mark, her partner, threw her down the stairs. She went on to explain that he then chased after her and pushed her on to their bed where he violently raped her. Janice sobbed as she said that it felt like the assault went on for hours. She said she was terrified of Mark. During her stay at the shelter, Janice had difficulties sleeping and was easily startled whenever there was a loud noise. The counsellors talked to Janice about the impacts of trauma, normalizing the responses that she was experiencing. Janice was referred to a counsellor in the community experienced in dealing with trauma. The counsellors taught Janice some strategies to keep herself grounded when she became overwhelmed with intrusive thoughts. One of the counsellors led Janice through a safe place exercise which Janice found very useful, and she was eventually able to calm herself by visualizing her safe place.

REFERENCES

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders. DSM-IV-TR. 4th ed. Washington, D.C.: American Psychiatric Association.

American Psychological Association. (1996). Violence and the Family: Report of the American Psychological Association Presidential Task Force on Violence and the Family. Washington, DC: American Psychological Association.

Capacchione, L. (1979). The Creative Journal: The Art of Finding Yourself. Ohio: Swallow Press Books.

Covington, S. S. (2002). Beyond Trauma: A Healing Journey for Women. Facilitator’s Guide. MN: Hazeldon. 12 17/06/2010

Dolan, Y. (2000). One Small Step: Moving Beyond Trauma and Therapy to a Life of Joy. NE: Authors Choice Press, iUniverse.

Haskell, L. (2001). Bridging Responses: A Front-line Worker’s Guide to Supporting Women who have Post-Traumatic Stress. www.camh.net/Publications/Resources_for_Professionals/Bridging_responses/bridging_responses_acknowledge.html.

Haskell, L. (2003). First Stage Trauma Treatment: A Guide for Mental Health Professionals Working with Women, Centre for Addiction & Mental Health.

Herman, J. (1997). Trauma and Recovery: The Aftermath of Violence - From Domestic Abuse to Political Terror. New York: Perseus Books.

Matsakis, A. (1996). I Can’t Get Over It: A Handbook for Trauma Survivors. 2nd edition. CA: New Harbinger Publications.

Najavits, L. M. (2002). Seeking Safety: A Treatment Manual for PTSD and Substance Abuse. New York: Guilford Press.

Najavits, L., Weiss, R., & Shaw, S. (1997). The Link Between Substance Abuse and Post-Traumatic Stress Disorder in Women: A Research Review. American Journal on Addictions, 6 (4), 273-83.

Patton Thoele, S. (1991). The Woman’s Book of Courage: Meditations for Empowerment & Peace of Mind. CA: Conari Press.

Promislow, S. (1998). Making the Brain-Body Connection. West Vancouver, B.C. Kinetic Publishing.

van der Kolk, B. The Body Keeps The Score: Memory & the Evolving Psychobiology of Post Traumatic Stress - Provided by Trauma Information Pages. www.trauma-pages.com/. Vermilyea, E. G. (2000). Growing Beyond Survival: A Self-Help Toolkit for Managing Traumatic Stress. MD: The Sidran Press.

Walker, L. (1991). PTSD in Women: Diagnosis and Treatment of Battered Women Syndrome. Psychotherapy 28, 21-29.

ADDITIONAL RESOURCES

The following are excellent books in addition to the ones listed under references:

Cohen, B. M., Barnes, M. M., and Rankin, A. B. (1995). Managing Traumatic Stress Through Art: Drawing from the Center. MD: The Sidran Press.

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Louden, J. (1992). The Woman’s Comfort Book: A Self-Nurturing Guide for Restoring Balance in your Life. NY: HarperCollins Publications.

Miller, D. & Guidry, L. (2001). Addictions and Trauma Recovery: Healing the Body, Mind & Spirit. NY: W. W. Norton & Co., Ltd.

Rosenbloom, D. & Williams, M. B. (1999). Life After Trauma: A Workbook for Healing. NY: Guilford Press.

QUESTIONS: MODULE 7

1. How can we understand the relationship between domestic violence and trauma?

2. What are the effects of trauma on women who have been abused?

3. What is the difference between simple and complex post-traumatic stress?

4. How can you help women manage their reactions to trauma?

5. What can you do to help someone whose traumatic experience(s) have been triggered?

6. What are three behaviours that occur as a result of trauma?

7. What is containment and what is its purpose?

8. How can you help a woman self-soothe?

9. Why is journaling important?

10.What resources are available in your community that provide therapy for women experiencing trauma?

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APPENDIX

PROTECTIVE CONTAINER EXERCISE: (Adapted from Managing Traumatic Stress Through Art and Growing Beyond Survival).

If you have experienced trauma, you may sometimes feel overwhelmed by feelings or thoughts that have the potential to lead to harmful behaviour or leave you feeling in pain. It can be helpful to learn to use containment images to help you feel better. Containment allows you to store overwhelming information, images, and feelings, and allows you to explore them at a later date, without causing you stress in the present. Creating an image of a container to hold your intrusive thoughts and feelings is a way for you to soothe yourself. As you feel more emotionally stable, you can choose to examine some of the overwhelming thoughts and feelings.

DIRECTIONS:

- identify one intrusive thought or feeling that you would like to contain

- think about the features of the container that is designed to safely hold this thought or feeling

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- think about its form, location and use

- the container should have some way to securely close and a way to reopen if/when you choose to do so

- draw a picture of your container

- think about and decide on the steps that you will take to place your intrusive thoughts or feelings into your container

ALTERNATIVE:

- you can make or buy yourself a container. A shoebox works well or you could purchase a small box from a dollar store.

- you can write down or draw your intrusive thoughts or feelings and place them in the container

JOURNALING: (Adapted from Vermilyea, 2000; Dolan, 2000; Louden, 1992; and Capacchione, 1979).

“A journal serves as a road map, a support, and a method of internal communication and self-expression. A journal is also a container. It is a powerful tool for people working on self-understanding and acceptance” (Vermilyea, 2000, p. 66). “A journal is an ongoing gift that you give yourself. Daily entries ensure a continuing dialog with your Authentic Self” (Dolan, 2000, p. 17).

Capacchione (1979) recommends that you find a quiet place where you can be alone with yourself and concentrate on your journaling. She also suggests that you put the date on the first page of each journal entry. By doing this you can go back

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and review what you have written or drawn. You are likely to see changes and growth.

The following is a list of ideas to get you started:

Just write words – just write whatever comes to your mind.

Focus on feelings. What do you feel in this moment? Where do you feel it in your body?

Draw pictures. Draw a picture of your feelings.

Write a letter to someone that has been a support to you.

Write about a dream vacation.

Write about accomplishments that you are proud of.

Draw/write about what a safe place is. Write or draw about your safe place.

Write a letter to yourself affirming who you are.

Write to a higher power.

Write about your strengths.

Write about what being good to yourself means.

Make a list of things that bring you joy.

At the end of the day make a list of everything that you have accomplished that day.

When you need to be comforted and don’t know what to do, close your eyes and doodle. Let your emotions flow out through your pen or pencil.

Draw a comforting scene.

SELF-SOOTHINGFollowing are some ideas to soothe yourself when you are feeling overwhelmed and distressed. Add your own ideas at the end.

Listen to music

Talk to a safe and supportive friend

Hold an object that comforts you (a stuffed animal, a stress ball, a special rock)

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Go for a walk

Breathe deeply

1. COMFORT BOX: (Adapted from Dolan, 2000).

There may be times when you are distressed and you are unable to think of anything that brings you relief. By putting together your own comfort box you can open it when you need to and find your comfort items. Sometimes it is difficult to think about what pleases and soothes us when we are emotionally flooded.

Either purchase a small box from the dollar store or make yourself a box. A shoe box works well. Decorate the outside of the box if you choose to. Inside the box place items that bring you comfort. What nourishes your mind and your spirit?

Here are some ideas for what to include in your comfort box:

Your favourite tea

Bubble bath or bath oil

Candles

A favourite picture, card or photograph

A special book

A stuffed animal

An affirmation book; for example, The Woman’s Book of Courage

A special rock or sea shell

Make your own list of self-soothing activities.

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