WHAT WILL BE PRESENTED TODAY - Reach Counseling ... Treating Trauma and Traumatic Grief in Children

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Transcript of WHAT WILL BE PRESENTED TODAY - Reach Counseling ... Treating Trauma and Traumatic Grief in Children

  • WHAT WILL BE PRESENTED TODAY

    How to challenge our viewpoints and perspectives to be

    more trauma focused

    Tools we can use to become more trauma informed and

    effective

    Resources we can use to help support our teens

  • THE ABC’S TO BEING TRAUMA INFORMED

    Awareness

    knowledge or perception of a situation or

    fact.

    Belief

    an acceptance that a statement is true or

    that something exists

    Capacity

    the ability or power to do, experience, or

    understand something

  • MASLOW

  • MASLOWS HIERARCHY OF NEEDS

    1) Physiological needs: the person who is starving and dehydrated wants nothing more than water and food.

    2) Once this need is satisfied, s/he desires safety and security – somewhere to live without being threatened or

    harassed.

    3) Once safety is achieved, s/he wants to obtain a sense of belonging, of being accepted and loved, and also seeks

    healthy relationships.

    4) After the above goals are satisfied, the next need, according to Maslow, is to develop a sense of self – esteem.

    5) The final need, Maslow informs us, is to achieve the highly elusive state of self-actualization. By self-

    actualization, he meant creatively reaching one’s potential and finding meaning and purpose in life. Maslow

    also states that this need is only satisfied by individuals extremely rarely.

    WHAT DO PEOPLE TAKE FOR GRANTED WHEN THEIR NEEDS ARE MET?

  • THE EFFECTS OF CHILDHOOD TRAUMA ON OUR ABILITY TO

    ASCEND MASLOW’S PYRAMID OF NEEDS:

    The Effects Of Childhood Trauma On Our Ability To Ascend Maslow’s Pyramid Of Needs:

    Childhood trauma can drastically impinge upon our ability to reach these goals. For example:

    – a highly neglectful parent may not feed his/her child properly, meaning that that child’s physiological needs are

    not met

    – a child who lives with a parent who abuses him/her, or lives in a household in which domestic violence exists will

    live in an atmosphere of fear and, therefore, will not have his/her needs for safety and security met

    – the child who is rejected by his/her patents will not have his/her need to belong satisfied nor is s/he likely to

    develop a solid sense of self-esteem

  • FAULTY TRAUMA ASSUMPTIONS

    -Teens are grateful for help

    -You are the reason for their actions or lack of

    -Your approach to them is non threatening

    -They have the ability at this time to process or take in information given

    -Tools given are able to be useful outside of your safe environment

  • EVERYONE HAS EM……

    What are some experiences that have formed your beliefs?

    What are some ways these beliefs affect how we see others?

    How are these ideas changed if we see things from a survival perspective?

  • THE EFFECTS OF TOXIC STRESS AND TRAUMA ON

    DEVELOPMENT AND WELL‐BEING It may be harder to forge a trusting relationship, because the young person has not experienced adults as

    consistently safe.

    Parents and teachers may describe the youth as easily upset, easily provoked, or highly reactive.

    The youth may display what others consider inappropriate emotions and behavior.

    The young person may be triggered by traumatic reminders.

    The youth may be diagnosed as hyperactive, or oppositional, or conduct disordered.

    The teen may appear inattentive, but he is actually hyper- attentive to “danger signals” of which adults are not

    aware.

    common post-traumatic presentation is dissociation. This may be reported as “lying” – which actually represents a

    confabulated reality produced to replace actual events difficult to recall - or “zoning out” – which has proven

    adaptive during traumatic moments.

  • ACTING OUT

    What if we see behaviors as the sign that a person might be dealing with trauma?

  • OUR INTERACTIONS CAN BE HEALING . . . OR CAN

    RE‐TRAUMATIZE Many who have experienced trauma have a harder time distinguishing between healthy and unhealthy

    relationships. Therefore, the issue of trust and betrayed trust will be a major, on-going issue.

    Relationships worthy of trust are the foundation of progress.

    We have been taught healthy things whether we knew it or not. We often can expect healthy behaviors without

    realizing these are not things they have ever seen or understand

    Appropriate boundaries are key underpinnings of relationships. Because traumatized youth have so little

    experience with trust, breaking their trust or not following through on a perceived commitment can cause great

    harm.

    Think about the possibility of past adversity as an underlying problem when you are up against something you don’t

    understand. If you cannot understand why someone does or doesn’t do something that seems to be common

    sense, be curious and ask “What happened?”

  • USEFUL TOOLS TO INCREASE OUR KNOWLEDGE

    NATIONAL CHILD TRAUMATIC STRESS NETWORK

    http://www.nctsn.org/sites/default/files/assets/pdfs/tips_for_finding_help.pdf

    http://www.nctsn.org/sites/default/files/assets/pdfs/tips_for_finding_help.pdf http://www.nctsn.org/sites/default/files/assets/pdfs/tips_for_finding_help.pdf

  • ITS OK TO SAY WE ARE

    NOT EQUIPPED AND

    REACH FOR HELP.

    Why is it important for us to know our limitations when it

    comes to trauma ?

  • So we can have the

    capacity

    to do something about it!

  • TF CBT

  • NATIONAL CERTIFICATION

    Tfcbt.org

    Master’s degree & licensure

    Completion of TF-CBT Web Training (http://tfcbt.musc.edu/)

    Minimum 2 days live training with approved trainer or developer

    Follow up consultation/supervision for 6-12 months

    3 completed cases

    Use of standardized instrument to assess progress

    Passing TF-CBT knowledge test.

  • WHAT IS TF-CBT?

    A structured individual and parent trauma-focused model for children and adolescents (3-18 years old) who have

    experienced one or more traumatic events and are experiencing symptoms as a result.

    Includes initial skills-based components followed by more trauma-specific components with gradual exposure

    integrated into each component.

  • CORE VALUES -CRAFTS

    Components Based

    Respectful of cultural values

    Adaptable and Flexible

    Family Focused

    Therapeutic relationship is central

    Self-efficacy is central

  • EVIDENCE BASE

    TF-CBT is the most researched and most supported of all current treatments for childhood Posttraumatic Stress

    Disorder (PTSD) and child trauma, with seven completed randomized controlled trials (RCT), three open (non-

    controlled) studies, and four ongoing RCTs. (www.nctsn.org)

    Evidence base is strong when done in sequence.

  • A TF-CBT THERAPIST…

    Has knowledge about child/adolescent trauma & development.

    Has trauma-specific assessment skills

    Is able to be directive as well as to inhabit a teacher role in session

    Has child and adult therapy skills

    Has resolved personal trauma issues

    Guards against colluding with avoidance

    Seeks consultation with others experienced in using the model

    Is able to resist chasing of COWs

  • PRACTICE COMPONENTS

    Assessment

    Conceptualization

    Psychoeducation & Parent Education

    Relaxation

    Affect Regulation

    Cognitive Coping

    Trauma Narrative

    In vivo exposure

    Conjoint Sessions

    Enhancing Future Safety

  • CAREGIVER INVOLVEMENT

    Caregiver engagement is essential

    1:1 – Parallel child’s progress through components.

    Green light parent:

     Believes child

     Stays child-focused

     Is positive and supportive of child

     Protects child

  • GRADUAL EXPOSURE

    The process through which children and parents undergo incremental desensitization to trauma reminders → relief

    from emotional/physiological distress upon re-exposure.

    This is what makes it Trauma-Focused

    This does NOT refer to the gradual telling of a child’s trauma story.

    As the child progresses through the model, therapist encourages parent and child to implement skills with

    increasing specificity of reminders of the abuse until the details are recounted in narrative compenent.

  • PSYCHOEDUCATION

    Handouts providing trauma specific info (i.e. sexual abuse, witness to DV)

    Common reactions to stress and trauma

    Common parent reactions to child trauma

    Neurobiology of trauma

    Fight, flight, freeze

    Triggers

    A Terrible Thing Happened Holmes et al (2000)

  • PARENTING

    Generic Parenting skills and trauma-specific skills.

    Validate parents’ concerns and take them seriously.

    Functional