Elaine K Hammond, LMSW

ehammond@buffalo.edu

Self-care in the Trauma Informed Environment:

A mindful approach

Introduction

Psychological trauma is the loss of faith that there is order and continuity in life. Trauma occurs when one losses the sense of having a safe place to retreat within or outside oneself to deal with frightening experiences or emotions. This results in a state of helplessness, a feeling that one’s actions have no bearing on the outcome of one’s life. Since human life seems to be incompatible with meaninglessness and lack of control, people will attempt to avoid this experience at just about any price, from abject dependency to psychosis (van der Kolk, 1987)

What we drag around may impair our ability to move again in community with others

Part I: The trauma informed

environment for practitioners

5 Pillars of Trauma Informed PracticeSafetyTrustworthinessChoiceCollaborationEmpowerment

Trauma Informed Practice:Will avoid inadvertent retraumatization and will facilitate consumer participation in treatment (Harris & Fallot, 2001)

Safety: includes where services are offered; time of day that services are offered; security personnel available, open doors or locked and the affect that each has on consumers; waiting room appearance; are all staff members attentive to signs of consumer discomfort and do they recognize these signs in a trauma informed way.

Trustworthiness: includes providing clear information about what will be done, by whom, when, why and under what circumstances; respectful and professional boundaries; is unnecessary consumer disappointment avoided; is informed consent taken seriously on a consistent basis?

Choice: includes how much choice consumers have over the services they receive (such as time of day, gender preferences for service providers, etc.); are consumers provided a clear and appropriate message about their rights and responsibilities?

Collaboration: includes giving consumers a significant role in planning and evaluating services; consumer preference is given in areas of service planning, goal setting, and developing treatment priorities; cultivating an atmosphere of doing “with” rather than doing “to” or “for”; conveying the message that the consumer is the expert in their own life?

Empowerment: includes recognizing consumer strengths and skills; building a realistic sense of hope for the client’s future; provide an atmosphere that allows consumers to feel validated and affirmed with each and every contact at the agency

(Fallot & Harris, 2006)

The five pillars of trauma informed care

Safety: includes where services are offered; time of day that services are offered; security personnel available, open doors or locked and the affect that each has on practitioners; waiting room appearance; are all staff members attentive to signs of practitioner discomfort and do they recognize these signs in a trauma informed way.

Trustworthiness: includes providing clear information about what will be done, by whom, when, why and under what circumstances; respectful and professional boundaries; is unnecessary practitioner disappointment avoided; is informed consent taken seriously on a consistent basis?

Choice: includes how much choice practitioners have over the services they provide; are practitioners provided a clear and appropriate message about their rights and responsibilities?

Collaboration: includes giving practitioners a significant role in planning and evaluating services; practitioner preference is given in areas of organizational planning, goal setting, and developing treatment priorities; cultivating an atmosphere of doing “with” rather than doing “to” or “for”; conveying the message that the practitioner is the expert in their own life?

Empowerment: includes recognizing practitioner strengths and skills; building a realistic sense of hope for the practitioner’s future; provide an atmosphere that allows practitioners to feel validated and affirmed with each and every contact at the agency

(Fallot & Harris, 2006)

* For this discussion, this term includes all staff, clinicians, supervisors and administrators.

The five pillars of trauma informed care for practitioners*

Sickness ModelWhat’s Wrong With You?!

Sickness implies that the cause of the problem is within the sufferer Sickness implies individual weakness or defect and stabilization may be all we can doSickness implies passivity, helplessnessSickness relies largely on “expert” knowledge; patients are expected to be “compliant” and are reprimanded if they are notSickness denies personal and social accountability

We stop asking: “What is wrong with this person?” and begin asking…. “What has happened to this person?”

Injury ModelWhat’s happened to you?Includes physical, psychological, social, and moral forms of injuryIncludes deprivation, neglect, and developmental insultImplies rehabilitation process that is mutual, long term: Requires active collaborative relationship between helper and injured partyRemoves stigma and shameProvides understandable shared frameworkIncrease in compassion, increase in expectations

Secondary traumatic stress (STS)…the natural, consequent behavior and

emotions that result from knowledge about a traumatizing event experienced by another and the stress resulting from helping or wanting to help a traumatized or suffering person. The symptoms are identical to those of PTSD (Catherall, 1995).Think of this in behavioural termsPartly a function of the requirement for constant

empathic response and repressed emotionGenerally a process, yet may be from a single event

So, what’s the worst that could happen?

Vicarious traumatization (VT…the cumulative transformative effect on the

helper of working with survivors of traumatic life events, both positive and negative (McCann & Pearlman, 1990).Can be considered a specific manifestation of

countertransference, except the “client” never goes away

Think of this in terms of altered world viewRepeated exposure to trauma narrative may affect

personal sense of safety, trust & control (Newell & MacNeil, 2010).

And…

Compassion fatigue (CF)…the natural, predictable, treatable, and

preventable unwanted consequence of working with suffering people (Figley, 1995). Also cumulativeNot specific to trauma work

And/or

In other words: Parallel ProcessIn organizations like ours, parallel process

means a complex interaction among traumatized clients, stressed staff, pressured organizations, and difficult systems.

“What happens here affects us too….If we don’t spend the time dealing with that, we burn out, we aren’t as effective, and ultimately we can’t do as good a job.” Staff member, Baker Victory Services

Compounding/Confounding

traits:Surviving or

Thriving

Personal

Resources• Personal history

• Relationships• World View• Mindfulness• Self Care

Professional

Resources

• Self care• Training• Supervision• Choice of

interventions• Experience

Burnout. Happens.

Maslow (was right…)

SafetyTrustworthinessChoice CollaborationEmpowerment

How are you feeling?What is your goal?Who can help you?

How might TI praxis inform your daily work?Acknowledge that the work affects us all.Seek – and offer - supportDon’t quit too soon.Acknowledge when things go well.

Some considerations going forward:

A basic mindfulness exercise…

Part II: Body

Neurohormonal EffectsLower serotonin (impulsivity, sleep problems,

aggression)High levels of endogenous opioids (numbing,

interferes w/memory)High levels of catecholamines (epinephrine &

norepinephrine: anxiety, panic, interferes w/memory)

Chronic stress: depletion of endogenous opioids

The neurobiology of trauma: Your brain on crisis

SNS: (Sympathetic nervous system)Prepare for ThreatAdrenal glands: hormones to prepare for fight,

flight or freeze.Epinephrine and norepinephrine

PNS: Reestablish Homeostasis (Parasympathetic Nervous System)Pituitary & Adrenal Glands hormones to bring

body back to normal (rest/recovery)Cortisol, glucocorticoids (endogenous opioids)

Hypothalamic-Pituitary-Adrenal (HPA) Axis

Extreme autonomic arousal (e.g., heart rate, blood pressure) to stimuli reminiscent of the trauma

Hyperarousal to intense, but neutral stimuli (loss of stimulus discrimination)

Psychophysiological Effects

GI issues: Upset stomach, Butterflies, Nausea, Diarrhea/constipation

Headache Back Pain Limb pain/numbness Tightness in chest Heart racing/palpitations Body heaviness – sense of slow motion Tingling sensations Muscle tension:

Brow, jaw, fists, shoulders, abdomen, thighs, toes Sweating Difficulty swallowing/lump in throat Sore throat/dry mouth Watering eyes/tearing/loss of peripheral vision/tunnel vision/”going dark” Ringing in the ears, temporary loss of hearing Feeling faint Feeling “frozen” Changes in breathing

Shortness of breath, shallow breath/quickened breath

The body keeps score…

Memory Processes and Trauma

HippocampusCognitive Map

Pre-Frontal CortexIntegration and

Planning

Thalmus

Amygdala

Emotional Significance

Five Senses

Sleep“Sleep like a baby”or in this case, like Putnam…

NutritionMovement

Some body basics

Activating the Parasympathetic Nervous System…

Challenges to breathing that supports the nervous systemFirst: acknowledge the challenges

Softening the abdomenProhibitions for this for both men and womenMay hold body memory of physical trauma

Find private space, such as your car, private stall bathroomsWords

May be triggers to past traumaBoth ‘breathe’ and ‘relax’ can sound dismissive

Try ‘rest’, ‘soothe’ or ‘comfort’ Prepare/contract for the word ‘breathe’ ahead of time

We all breathe…don’t we?

Part III: Mind

“A core aspect of the mind can be defined as an embodied and relational process that regulates the flow of energy and information.” Dan Siegel

1: the element or complex of elements in an individual that feels, perceives, thinks, wills, and especially reasons

2: the conscious mental events and capabilities in an organism

3: the organized conscious and unconscious adaptive mental activity of an organism Mirriam-webster.com

the element of a person that enables them to be aware of the world and their experiences, to think, and to feel; the faculty of consciousness and thought. Oxforddictionaries.com

What is “the mind”?

“You yourself, as much as anybody in the entire universe, deserve your love

and affection.”~Buddha

(5th century BCE)

A loving-kindness exercise…

Part IV: Spirit

Psychological trauma is the loss of faith that there is order and continuity in life. Trauma occurs when one losses the sense of having a safe place to retreat within or outside oneself to deal with frightening experiences or emotions. This results in a state of helplessness, a feeling that one’s actions have no bearing on the outcome of one’s life. Since human life seems to be incompatible with meaninglessness and lack of control, people will attempt to avoid this experience at just about any price, from abject dependency to psychosis (van der Kolk, 1987)

How can we assess attributes of life meaning?What do you find beautiful?What do you look forward to about growing

older?What do you think happens to us when the

body dies?What is one thing you would like people to

remember you for?

Postscript

May you be full of peace and joy; may you be deeply connected to the roots of peace and joy.

May you be at ease, well and thriving in body, in mind, in spirit.

May you be safe from harm.May you be free of suffering; may you be released from

the roots of suffering.May you awaken to your own best self, full of love and light, patience and kindness, gratitude and generosity.

And when you meet the challenge of suffering, and meet it you will, may you greet it with equanimity and

compassion.May you breathe peace….

~