Treating Clients After A Traumatic Experience: Case Discussions · 2017. 12. 23. · TREATMENT...
Transcript of Treating Clients After A Traumatic Experience: Case Discussions · 2017. 12. 23. · TREATMENT...
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.