Treating Clients After A Traumatic Experience: Case

Discussions

Paul Granello, Ph.D, LPCC-S

Lisa Longo, MA, LPC

CJ Potter, MA, LPC

Ohio State University

SESSION OVERVIEW

• Brief overview of trauma and trauma

methods

• Case study 1: Small and Large group

discussion

• Case study 2: Small and Large group

discussion

WHAT IS TRAUMA?

• Exposure to actual or threatened death,

serious injury, or sexual violence ( APA, 2013).

• Any event that is extremely upsetting and at

least temporarily overwhelms internal

resources (Briere & Scott, 2006).

STATISTICS

• 50% of US adults have experienced at least

one major traumatic stressor (Briere & Scott, 2006).

• 94% will develop psychological symptoms

immediately following (Bauman, 2008).

• 20-30% of people exposed to a traumatic

event will develop PTSD (Seligman & Reichenberg, 2012).

POSTRAUMTIC RESPONSES

• Posttraumatic Stress Disorder (PTSD)

• Acute Stress Disorder (ASD)

• Depression

• Anxiety

• Substance Abuse

• Dissociation

• Psychosis

POSTTRAUMTIC RESPONSES

… are more severe and persist longer when:

• The event involves a human cause

• The event is sudden or unexpected

• The individual has poor coping skills

• The individual assumes responsibility for the event

• The traumatic event involves others who did not

survive

PTSD SYMPTOMOLOGY

• Painful re-experiencing of the event

• Avoidance and emotional numbing

• Marked alterations in arousal and reactivity

• Negative alterations in cognitions and mood

ASSESSMENT • Up to 50% of actual cases of PTSD are missed

during clinical interviews

• May not report unless specifically asked

• Symptoms might resemble another disorder

• Clinicians may lack training

• Lack of time during intake

ASSESSMENT

• Ensure safety and basic survival resources

• Ensure that there is no current abuse or victimization

• Screen for suicidality and substance abuse

• Measure client’s level of functioning

• Assess for support, coping skills, strengths, and

resilience

THERAPEUTIC APPROACH • Establish safe and secure environment

• Provide support

• Encourage discussion of the event

• Validate the experience

• Instill hope

• Provide psychoeducation

• Reduce stigma

TREATMENT GOALS • Access and process the trauma

• Expression of feelings

• Increase coping skills

• Reduce cognitive distortions and self-blame

• Restore self-concept and previous level of

functioning

TRAUMA FOCUSED THERAPIES

• Prolonged Exposure (PE)

• Cognitive Processing Therapy (CPT)

• Eye Movement Desensitization Reprocessing

(EMDR)

PROLONGED EXPOSURE

• Regarded as most effective treatment

• Extended exposure to trauma memory

• Visual imagery

• In vivo experience based on fear hierarchy

• New information is incompatible with fear

COGNITIVE PROCESSING THREAPY

• Modified version of CBT

• Goal is to make meaning of trauma

• Cognitive restructuring to address distorted beliefs

• Exposure in the form of writing

• “Stuck points” – conflicting beliefs or blind

assumptions

EYE MOVEMENT DESSENSITIZATION REPROCESSING

• Pairs motor function with activation of

traumatic memory

• Side to side eye movements

• Positive belief

• Believed to disrupt stored memory

CASE STUDY #1 BARRIERS

• Privacy

• Delayed Treatment

• Volunteer Force

• Alternative Career Paths

• 2nd Amendment Rights

• Minorities

CASE STUDY #1 PROBLEM AREAS

• Symptomology

– Anxiety

– Mood

– PTSD/Trauma

• Jargon

• Role of the Parents

CASE STUDY #1 GOALS

CASE STUDY #1 INTERVENTIONS

CASE STUDY #2 PROBLEM AREAS

CASE STUDY #2 GOALS

CASE STUDY #2 INTERVENTIONS

REFERENCES

• American Psychological Association. (2013). Diagnostic and statistical

manual of mental disorders. (5th ed.). Washington, DC: Author.

• Briere, J. and Scott, M. (2006). Principles of trauma therapy: A guide to

symptoms, evaluation, and treatment. Thousand Oaks, CA: Sage

Publications.

• Sadock, B.J. and Sadock, V.A. (2007). Kaplan and Sadock’s synopsis of

psychiatry. Philadelphia, PA: Lippincott Williams & Wilkins.

• Seligman, L. and Reichenberg, L. (2012). Selecting effective treatments: A

compressive, systematic guide to treating mental disorders. Hoboken, NJ:

John Wiley & Sons, Inc.