Week 1 Homework Assignment (Trauma-Informed Care)

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  • #4740
    Patricia Burke
    Keymaster

    Please Note
    If you have experienced trauma in your life and the homework exercises activate a stress response or you think they might, please stop what you are doing and engage in whatever self-care activities help you get centered, grounded, and calm your central nervous system.

    Homework Exercises

    Exercise 1
    Watch the short documentary video Important Souls and jot down your thoughts to this statement from the video: “Truth lies in a person’s story, not in their symptoms.”

    Exercise 2

    Think about a person you know who has experienced trauma (it could be a character from a book or film, a client/consumer, a family member or friend). Make two columns on a piece of paper. In one column jot down some behaviors or expressions that might be considered “symptoms” of pathology. Then in the other column jot down some ideas about how those behaviors or expressions might be viewed as resilient attempts to manage or cope with his/her experience of trauma.

    Homework Questions

    Question 1

    What are your general reactions and responses to Anna Jennings’ story of re-traumatization in the documentary Important Souls? What are your reactions to the statements, “Symptoms are adaptations to distress,” and “Truth lies in a person’s story, not in their symptoms?”

    Question 2

    What are your thoughts on Harris and Fallot’s paradigm shift in focus from the traditional approach to behavioral health treatment which asks, “How do I understand this problem?” to a trauma-informed approach to treatment which asks, “How do I understand this person?” Pick a behavior from your list of someone who has experienced trauma that would be considered a pathological symptom in the traditional approach and describe how you might view that behavior as a coping strategy from the trauma-informed care approach. Be specific.

    Question 3
    Review the 10 Key Principles of a Trauma-Informed Approach from this lesson. Describe how the organization, agency, or setting you work in (including private practice) applies some of these principles to its work with people with histories of trauma. Which of these principles actively inform policies and procedures, treatment approaches, and the general atmosphere? How could your organization improve in order to become more fully trauma-informed?

    Please Note
    While answering the homework questions please only share personal information or specific responses to the homework exercises you feel comfortable sharing. It is up to you to decide how much or how little to disclose. Please respect the privacy and confidentiality of consumers/clients and other class participants in your sharing.

    To post your assignment, please reply to this topic below.

    Click here to go back to the course.

    #30813
    Alan Algee
    Participant

    Question 1
    It is not uncommon to have 7 minutes to meet with a psychiatrist for medication—and that may be the only treatment obtained. This model certainly means that it is strictly symptom management. And a psychiatrist cannot require a person to go to counseling as a condition of medication. I do notice that PCPs today are more actively encouraging patients to invest in counseling where their stories may actually have a forum.

    Question 2
    I remember watching black and white clips of treatment at AMHI which contributed to the 1990 AMHI Consent Decree which “required the State to establish and maintain a comprehensive mental health system responsive to individual needs.” So I think that that decree created a huge step toward the principles advocated for in this course. There’s much more to do, but there are also dramatic gains to recognize in the past 30 years.

    Question 3

    I have learned to not take notes when counseling. I personally have concluded that note-taking in a session may be code for “I won’t remember your story” or “now I have some material on you” . . . . I worry that note taking could contribute to re-traumatization.

    I strongly encourage my supervisees to follow my example of how I complete an Assessment. Our form has 12 pages and dozens of very sensitive questions. I never have my computer open and I do not interview the client nor ask hardly any questions. I listen and listen. I can complete a very good Assessment because the client almost always will tell me everything that I need to for CPSA. And if something gets missed, I might gently inquire in a later session. But I have seen some providers actually proceed with an interrogation which I think is not best practice for trauma survivors.

    #30826
    Danielle Cimino
    Participant

    Question1:
    General reactions are sadness to Anna’s story. It is clear that she had been re-traumatized over and over again by staff the system as a whole without any effort to address the underlying trauma. In addition, her outburst were likely seen as aggressive and non-compliant, making providers further pathologize her. I like the emphasis on the quote “the truth lies in a person’s story not their symptoms” because it reminds me that all clients are only human. It is easy to get caught up in what the insurance companies/DSM/agencies would like us to see when the reality is putting people inside a criteria drive box can be detrimental to their overall care.

    Question 2:
    I agree with the paradigm shift in full. Historically clinicians have been quick to pick apart behaviors to find a dx instead of looking at the behavior as a symptoms of traumatic experience. For example, some individuals who exhibit social with drawl, ridged routines, distaste for change, and reactivity to touch could end up with an ASD dx instead of something related to a trauma and/or stressor.

    Question 3:
    The environment that I work in stresses empowerment and collaboration for providers, consumers, and their families in addition to peer support and mutual self help. It is my intention that empowerment of the consumer will allow them to feel open and that they have more control of their situation to make changes than they have in the past. Peer support is also stressed in order to allow clients to feel a sense of universality in what they are going through.

    #30837
    edostie
    Participant

    question 1

    Anna’s artwork so clearly delineated her experiences it is shocking no professional talked to her about them. I have to wonder if there were not any art therapists available at the time to help her.
    The sad tale of her life seems so unnecessary. Certainly listening to her experience would have been critical to helping her find a better way to live. Symptoms in such cases seem to be coping mechanisms, however dangerous and attention seeking mechanisms to try and get help. What she was trying to say stood out in her art work, in her deterioration and finally in her death. That she was also kept silent while screaming for help with her behavior really should have been noticed.

    question 2
    The character I am using is from a book I just finished, Liane Moriarity’s Apples Never Fall (c. 2021 Pan MacMillan)

    Savannah is a young woman who insinuates herself into the main characters’ lives proceeding to lie constantly, scam them in various ways, systematically attempting to ruin their marriage, harm their 4 children and blackmail them, all the while pretending to be their friend by endearing acts of kindness.
    As the story proceeds, more is revealed about who she truly is, she turns out to have legitimate grievances from her childhood against these people. This character’s presentation is a perfect example of using coping mechanisms that derive from childhood incidents of neglect and abuse (her mother starved her so she could be a ballerina, so she developed an eating disorder, for example). Indeed this particular family she is now scamming on one given day in her distant past ignored her, abused her by refusing to give her food, yelled at her and by turning attention only to her brother, the star tennis champion of the story, totally annihilated her sense of self-worth.
    A trauma informed person, indeed, any responsible adult, near this child or now, working with this troubled young adult, who would use an understanding and collaborative approach instead of punishing and confronting her, or convicting her, could have truly helped the chain of events that continued to engulf her way of living. Luckily, in the end, one of the main characters does show her compassion and it makes a difference to her so she can honestly feel love and care from a person she formerly wanted to continue harming in revenge scenarios.

    Question 3
    How my agency utilizes these principles

    PEER SUPPORT AND MUTUAL SELF-HELP; EMPOWERMENT;
    INCLUSIVENESS AND SHARED PURPOSE
    My work takes place in a setting using group therapy with DBT as the major modality employed. Within the group set up, however, each person participates in making an individual treatment plan and follows with an individual therapist at least once a week to assess progress with their individual goals. Time and time again as clients graduate at the end of their time they
    mention peers in the group who have helped them, how they have helped them and how meaningful the mutual support has been. It is wonderful to be part of facilitating these exchanges and to be able to be the bones to support rather than didactically lecturing or pretending to be the “experts.”

    SAFETY, TRUSTWORTHINESS AND TRANSPARENCY
    The program uses a simple, consistent, predictable structure the clients can count on as they come for approximately six weeks with 3 groups a day DBT, Education and Psychotherapy. Various topics are covered during these sessions but a big focus is placed on art therapy and self-care through Yoga, gratitude lists and, in general, Positive Psychology approaches.

    B) How my agency could improve

    EMPOWERMENT and VOICE AND CHOICE
    Our agency could better utilize individual strengths within the group – such as seeking opportunities for talents to be displayed. Once in awhile client’s ability or talent with music has been shown and the group always benefits from this. We have seen this utilized with art directives to great success. Expanding this to include other areas would be a good way to include more of what is good and positive in people.
    ***
    I don’t know what category it would fit under but I know there is still too much repetition of information required from clients – such as when a therapist has to fill in for another person – unavoidable sometimes. Even if you read the chart or evaluations it seems that sometimes you have to cover ground they’ve had to go over before – this is frustrating for clients and definitely does not enhance the therapeutic relationship. At least starting with a disclaimer when talking with the client such as “I promise to only cover the bare minimum of what you’ve already told Ellen” would be affirming.

    #30850
    Jason Antkies
    Participant

    Question 1
    It is disheartening to see that Anna was in systems that did not understand what happened to her. It is sad to see she didn’t get the help she needed so that she could continue to live. My reaction to the first statement is that human beings are trying to survive. Their symptoms are what they are relying on to help them with survival. Most often they haven’t been taught or modeled healthy ways to cope with difficult situations. I think we live in a shame-based society that lacks empathy and compassion and most people don’t feel safe to open up and get support for what happened to them. Symptoms are just the beginning of someone’s truth. It is crucial to understand what has happened to someone so you can really put yourself in their shoes. Having a clear understanding of someone’s truth can allow you to connect with that person on a deeper level, which will build rapport and connection.

    Question 2
    My thought is that people are not problems to be solved, people are people and to really be able to hold space with someone is to be able to understand what has happened to them. There is no better way to understand someone than hearing their truth and for the provider to be in a space that they are fully present, non-judgemental, and compassionately listening. One example that comes to mind is a client who when triggered in a group setting would get up and leave the group. In the old model, one could say this person is not serious about their treatment, they don’t really want to be here. In the trauma-informed model, one would say this person is doing the best they can to cope with a triggering situation. They are practicing resiliency by protecting themselves from more harm.

    Question 3
    Trustworthiness and transparency – Our agency believes transparency is crucial for appropriate care. This starts from the pre-admission process with potential clients and families and throughout their stay in our program. We always want to reduce shock value so being open and honest with everyone is our approach.

    Collaboration and mutuality – We strive to have an environment where everyone is equal. Clinicians do their best to avoid power struggles. We take client’s feedback and opinions into consideration often and we want them to be a part of their process.

    Peer Support and mutual self-help – Our community relies upon senior peers role-modeling for newer residents. Our goal is for the clients to build healthy support systems within the treatment community where they can practice vulnerability, compassion, and empathy. Our belief is that connection is the solution to addiction.

    I think an area of growth would be moving away from a confrontational approach wherein staff may personalize certain behaviors that they label as dishonesty or manipulation. I believe that a trauma-informed approach would encourage staff to understand that these behaviors are the client’s trying to cope with their situations which would help staff have more empathy and compassion and to deal with any of their own countertransference.

    #30865
    Ellen LCSW
    Participant

    Question 1: My first reaction to the video was: “My god, how could no one ask her about her story in such a LONG time?” It strikes me as collective incompetence of immense proportions. My heart breaks for Anna… I view hearing a client’s story as one of the most important things I do, and–as I tell virtually all of them when I invite them to share their stories–What’s shareable is more bearable.

    Question 2: I work with an 18-year-old woman with autism as well as a challenging medical condition. Her first significant statement to me a couple of years ago when we first met was, “I’m terrified of EVERYTHING!” I could have focused only on her SYMPTOMS of anxiety, but instead I listened to her with a different ear that helped me really get to know her as a person. Turns out, her reality is completely denied at home, and every aspect of her life is tightly controlled by her mother. She is really bright, articulate, funny, loves animals, and is NOT who her mother thinks she is (or wants her to be). Therapy is the only place she can speak her truth, be who she is, and work toward the future she wants when she graduates this June. By the way, the only thing that really terrifies her now is the prospect of her mother gaining control of her legally and financially because of her diagnosis.

    Question 3: I can honestly say that most of the Principles of Trauma-Informed Care were part of my training and have been integrated into my personal philosophy and practice with clients. I work really hard to provide emotional safety and convey my own trustworthiness, acceptance without judgment, and desire to collaborate, empower, and promote choice in my work with clients. Actually, that’s wrong. I don’t work that hard at it because it comes fairly naturally to me. After finishing this first lesson, however, I did catch myself rushing a client through their story very recently. They told the story of being traumatized by Child Protective Services with great vehemence five weeks in a row and I responded to the statement: “They destroyed my life–it’s over!” by saying: “Your life is over only if you let it be.” I wanted them to see possibilities for a better future, but now I realize they weren’t done with their story yet (although I did validate it every step of the way), which is something I will rectify next session.

    #30870
    Russell Kohrs
    Participant

    I was born in 1960 like Anna, my recovery from alcohol started 1993, the yeas after her passing, at times I view post 1993 as a different lifetime, the early picture of Anne to me suggests she is already hurting, the drawings are mesmerizing, the symbols dramatic. The negative self perception in her words remain heavy to this reader.
    I need to improve awareness and remain present when witnessing symptoms being an adaptations of distress, the transition in real time from the what is the behavior to the why of the behavior is challenging.
    I believe in the power of storytelling,

    My thoughts on the paradigm shift, person centered focus, excellent goal with consistency challenges,
    Two examples of Men’s verbal responses, both, non stop, topic to topic to topic, as a listener the challenge is to not get stuck focusing on topic one, he’s on topic four, his grievances’, his opinions, and his story in the stream of information. allowing the information stream to continue within a time limit, giving the person a chance to be heard in their communication skill survival strategy that has developed through I believe incarceration and isolation, respond to both men with awareness and understanding, review details of their story with no shame, steer both men to breathing and communication strategies, pausing and or breathing between topics, initiate a discussion on identifying triggers. Discuss grounding exercises.

    As an agency we are encouraged to focus on improving people centered care, understanding and implementing trauma informed care has been a priority, ACE’S screening has been enlightening, most of our clients have a high ACE’S score. The behavior and emotional reaction continue to be a real time challenge. To continue to communicate and support team members, help increase awareness to these needs.
    Encourage team members to treat everyone with dignity and respect,

    #30884
    Alicia Fredericksen
    Participant

    Question 1

    It’s so sad that the mental health system failed Ms. Jennings. The story reminded me of the power of narrative therapy, which has always been one of my favorite modalities. There is power and healing in being able to retell a story, reclaim it, and/or reinterpret it. In my work, I have definitely seen how “symptoms are adaptations to distress”, as clients reenact unhealthy relationship dynamics from their childhood or prior romantic partners. It feels like a familiar role to them, one where they know what is expected of them, and so they return to the same patterns and behaviors because they know how to act/react in that dynamic. This story also made me think about the healing power of relationships, and how that is where the real therapy happens. You develop a relationship with someone by getting to know them—which you do by hearing their story. I think one of the most powerful things we can do is to let someone tell their authentic story.

    Question 2

    I love this paradigm shift. Some of the most challenging clients we work with are those suffering from Borderline Personality Disorder. It can be so easy to dismiss them as “oh, she’s a borderline”. Instead, I was told by a supervisor long ago that “when you see borderline, think trauma”. It immediately helps me have more compassion for this person, as I see their maladaptive traits as coping skills for the immense trauma they have (almost always) suffered. I think particularly of when clients get angry and push you away/reject you—and how it is their way of rejecting someone who appears to care about them before they get rejected themselves. This is likely born out of their own history of neglect or rejection by pivotal figures/caretakers in their lives.

    Question 3

    Safety—This is one we’ve struggled with recently, particularly as it relates to psychological safety. We had a leader who was punitive, reactive, frequently changed moods without warning, and you had to constantly walk on eggshells around (I’m refraining from giving her a diagnosis… ). It took some time, but eventually the leadership above her recognized the damage she was doing to the organization, and had her removed. We are now reinvested in a culture of psychological safety, and taking steps to make people feel comfortable and able to speak up again.

    Peer Support and Mutual Self-Help—My organization does a great job of this. People are able to come together to problem-solve, decompress/debrief, and validate/encourage each other. There are almost no egos, and people look for opportunities to learn from each other.

    Resilience and Strengths-Based—I think this is another area where we do well. Especially in the field of substance use disorders, where there is so much stigma and judgment, it is so important to approach things from a strengths-based perspective. We hold hope for the clients and empower them to believe in their own ability to get better. Many clients have given feedback that they are surprised at how much compassionate and nonjudgmental care they receive, as they are so used to the opposite approach in most other areas of their lives.

    #30886
    Kellie Westberry
    Participant

    Answer 1

    The saddest part of watching video’s like this for me is, that change is not happening fast enough. Accountability is not being enforced. Why? Because there are too many rules, regulations, laws etc., that stand in the way of true progress. We spend more time completing paperwork, then we do meeting with our Clients and actually listening to them. I’m not saying this is the only barrier; however, it does play its part. I will say that the rules, regulations and laws that govern funding of programs, does make a difference; however, more has to happen. There is a lack of hands on training. We can read, watch videos and say we know what we are talking about; however, do we really? Remember that time when you were sitting with your client, listening to their story and all of a sudden, you realized, you had no business being in that room. Maybe you did, maybe you didn’t… either way, it takes time to learn, it takes time to practice… just like it takes time to heal. We adapt to things every day… our truth lies within us and if you are fortunately enough to hear our story, “You should Listen”.

    Answer 2

    I work in a MAT program. Our facilities dosing operations are from 5:00 am to 11:00 am. Every day of the week, we have at least one or two individuals who are three to four minutes late arriving to receive their daily dose of medication. The nurses, “Follow the rules to the letter.” They will lock the door, at 11:00 am sharp and no one is permitted to enter the facility to dose. The reaction from our Patients varies from name calling, yelling and screaming, to throwing objects at the windows and making verbal threats. Rarely, do we have a Patient accept the fact that they were late and go back to their vehicle and drive away without getting upset. I’m using this as an example because many if not all of our Patients have experienced trauma in some way, shape or form. When they are late to dosing, and are not allowed into the building, and no one goes out to talk to them. The Patient is reacting to the circumstances. We do not know if these circumstances are “Re-Traumatizing” our Patients or not. He/she could feel as if they are being punished, ignored or set up for failure. They could be terrified of relapsing. They could be afraid of going through withdrawal. Some of our Patients will say and/or do whatever it takes, including, threatening others to get their dose. And what do we do…

    Answer 3

    When I sit with a Client, I do not take notes. I listen, validate and when appropriate, use open ended questions to learn more. I’ve been fortunate enough to have had amazing supervisors throughout my career… however, my best teacher, was my childhood therapist. I never liked going to his office because he never looked at me… he was too busy writing in his note pad. I feared he was writing stuff down to tell my parents. When he greeted me, it was with a smile, but I never felt like I could trust him. These key principals are practiced in the agency I work for. When I meet with my Clients, my intention is to provide a safe environment for them to share their story. If you want honesty you need to practice it. If you want to empower, you need to foster it.

    #30889
    Rose Ryan
    Participant

    Question 1
    My general reactions to the story are sadness and anger. There were so many times when Anna could have been helped that were missed. “Symptoms are adaptations to distress” seems to me to be a very true statement. As a sexual abuse trauma victim, I know that I exhibit behaviors (depression/anxiety) that others consider a mental illness and providers just want to throw medication at it rather than listen to the story of what happened or how it affected me. I was not believed by most people when I told my story and yet that is where the truth of the situation is. It is in the story that only I can tell.

    Question 2
    The traditional approach focuses on the problem rather than the person. As if all people who are experiencing something have come to it the same way and require the same treatment to “be rid of the problem” A trauma informed approach looks at how a person got to where they are and what they specifically need to heal. I have a young man as a client whose parents often left him and his siblings alone. There did not have the care they needed and many times food money went drugs. This young man was stealing food from his school cafeteria and other children. Without knowing his history, you would not see that he was just trying to care for himself and his four siblings when their parents would not. s

    Question 3
    1. Safety: One of the key policies of our agency is to assume that everyone has a trauma history. We are careful to provide safe spaces and do our best not to re-traumatize with our settings, our actions or our words.
    2. Collaboration: My whole approach when working with families is that we are a team. The family is part of that team and we bring in others as they allow. I offer solutions and ideas, I do not tell people what to do. Decisions are made using discussion and information.
    3. Empowerment: Very key in our organization. We are asked to identify client strengths and also to help clients to identify their own strengths.
    4. Peer Support and mutual help: We have a peer support team and if the client wishes to work with a peer support, they are an invaluable resource of support for the client. We also encourage clients to look for natural supports in their life that can be a resource and help with their healing.
    All of these principles are adhered to at all levels of our organization. No matter who you talk to or interact with they are going to be supportive and meet you were you are. There is no judging or blaming. I think that education is the key to improving a trauma informed approach. I also believe that listening to clients and hearing what they have to say and using that to inform your policies is very important. ssssssssss

    #30890
    Jamie Williams
    Participant

    Question 1: My reaction to Anna’s story is deep sorrow for her. She was begging for help and trying to find any way/behavior to get her needs met and no one gave her an opportunity to heal. As we know, pain shared is pain lessened. She never had safety or was provided a safe place to heal and grow. Our behaviors are results of our life experiences. It reminds me to leave my biases out of interactions with clients or others in the community and to allow space for myself to believe other’s stories as they see it and not as I interpret it.

    Question 2:I feel the paradigm shift is so important. When we can view others as what they have been through and not how they are presenting. We can focus on treating all parts of them and not just behavior modification. When a client gets up to leave group with anxiety, a traditional approach may be to provide them with an anxiety medication and send them back to group where as a trauma informed approach may be for a staff member to sit down with the client, walk them through grounding techniques and coping skills and get curious with them about where the anxiety is coming from instead of masking it.

    Question 3:The environment I work in has the following principles: Safety, empowerment, voice and choice, peer support and mutual self-help. We build off of client and staff strengths, in a home like setting that is comfy and cozy. Clients participate in their plans for treatment and aftercare planning. Clients are encouraged to advocate for their needs and ask for help. We also help to integrate them into the 12 step community.

    #30900
    Greta Garvey
    Participant

    Question 1

    My initial reaction to Anna Jennings experience, is that it is a tragedy. She did not receive the care and treatment to allow her to share her trauma story. Her artwork was a cry for help. It illustrated the trauma she had endured throughout her life, and was an expression of her feelings. “Symptoms are adaptations to distress”, it may be better understood that symptoms are a manner of survival. Symptoms can present as coping skills, as a way for someone to get through each day. Although the coping skills may be maladaptive, they have served the individuals ability to survive. “Truth lies in a person’s story, not in their symptoms?” This statement leads me to think of person first language and its importance in treatment. Anna was a person who had PTSD, her symptoms were not inherently who she was, they were a part of her. Allowing someone to tell their story can be a powerful and healing experience. If Anna would have been able to tell her Trauma Story with her artwork, this may have been an opportunity for her to experience healing and connection.

    Question 2
    It is important for me to treat each person I meet with as an individual. If I focus solely on the problem, then I am not treating the person as a whole. Building rapport and focusing on the collaborative relationship with the client is important in working with client’s who have experienced trauma. This allows the client to have a voice in their treatment .
    Currently, I am meeting with a female client in their 30’s who presents each week with visible signs of irritation and verbal physical aggression. Each week my client presents with frustrations about their relationship with their mother-in-law. She shares about being irritated with her mother-in-law, feelings of anger towards her, and shares about the negative impact her interactions have on the relationship with her partner. My client has experienced the loss of her own Mother as a teenager. My client’s presenting symptoms are irritation and anger. These symptoms, or strengths, have acted as her survival, or coping skills throughout her life. She has struggled with feeling close to others, and usually falls into the role of scapegoat. Being verbally aggressive is a way for my client to express her feelings of repression, abuse, and loss. She has found her voice, and has learned to set limits and boundaries with those in her life who may be harmful to her.

    Question 3
    At our agency we emphasis the importance of a Trauma-Informed Approach. In reviewing the list of principles our agency emphasizes safety, trustworthiness and transparency, and peer support and mutual self-help. In regards to safety we use Covid-19 screeners, create crisis plans as needed, and use assessments to identify the potential risks for safety for the client. In regards to trustworthiness and transparency we ensure that we have releases in place before talking to anyone regarding the client, respect confidentiality within the limitations, and make reports with our clients to child services when needed (as long as there is not a safety risk to the Provider, then it may be done without the client present). Our agency has a wonderful peer support specialist who has run groups in the past to help increase self help and advocacy among our client’s. One area our agency could improve is the principle of inclusiveness and shared purpose. Providing trainings and opportunities for the non-therapeutic staff would help to increase the therapeutic needs of our client’s. There are instances when client’s call or come in upset, agitated, or aggravated, and it would be helpful for the front office staff to have more training to understand the person who is upset, and not focus on their symptoms.

    #30934
    Janice Black
    Participant

    Question 1
    Left with strong feelings of sadness and loss of such a gifted and tormented woman who was never understood. Thoughts of how our culture wants to ‘fix’ everything and fix it quickly. What are the symptoms, where do they fit in the DSM…with Anthem re-imburse and how many sessions do we have with this client still prevail unfortunately. TIC flies in the face of these questions. May her memory be a blessing. thank you for sharing it.

    Question 2
    Fortunately there has been a paradigm shift in the way we view people as people and not as a collection of symptoms. I am reminded of actually my best friend here in Maine. A highly successful professional, great mom and loving wife; however, also a survivor of German Nazi ritual abuse. As a friend she has an inordinate need to be in control (of everything), she has gained a large amount of weight since adolescence, has a need for two sound machines in her bedroom, and sleeps with a baseball bat at her door. Many of her friends certainly worry about her weight and the health issues that have arisen and
    humorously accommodate to her need to set times, schedules, invitations, menus etc and simply think and joke about the bat as her security system for her fancy home. I’ve known this woman for decades and am one of the few people outside of her family who know her past experiences with horrific abuse both here in the US as well as in Germany. I clearly see her “symptoms” as her story….her way to process, self protect and accommodate to a world that has only started to feel safe. All in all she is simply my friend “…..” not an anxious, over weight over achieving and controlling woman.

    Question 3
    It is my sincere hope that my small practice reflects a Trauma Informed approach to care and growth. I started out working with a local psychiatrist clearly reflecting a medical model of treatment. We had clear intake forms to complete, were not allowed to have any contact with patients (not clients!!) outside the clinic (if we see them in Shaws….go the other way), all treatment in the room…no walks, no rides home in terrible weather etc. In my own practice now I write the intake assessment after two sometimes three sessions, I need a DSM dx but often use an adjustment reaction rather than anything more pathological, the office is warm, comfortable, I have coffeee, tea and hot chocolate always available. On lovely days I am not aversed to simply sitting outside or going for a walk. My clients know who I am as an imperfect person. Silences don’t bother me nor does pain. The privilege of being in my 7th decade allows me a warm acceptance of the slings and arrows of outrageous fortunes.

    #31014
    Tanya Haley
    Participant

    Question 1
    My initial reaction to the short video was that unfortunately this is only one story of many. It is that her cries both verbal and expressed through art went unanswered. The system failed Anna and her family and countless others who have been pushed through the system. Only applying a Band-Aid to a bullet wound. In order to heal past trauma one must be able to look past the symptoms in order to see the personal to understand the best way to treat. As an example: You have two people who are obese and diabetic. Patient A has experience many years of early childhood trauma. Obesity and diabetes is a result over emotionally eating and using weight as a protection from abuse. Patient B is a product of their upbringing of unhealthy eating habits and lower education levels in the home. Both have the same “symptoms” but different etiology. Here is where “Truth lies in a person’s story, not in their symptoms.”

    Question 2
    As I stated above the traditional model of medicine is like putting a Band-Aid on a bullet hole. Focusing solely on symptom treatment does not take into account the story behind the symptoms and many times the story is needed to understand the root of the issue. We know that trauma, especially in early childhood increase risk factor for unhealthy behaviors and long term chronic health outcomes. Address trauma and the treating the person is one step in improving overall health outcomes for the individual. Not to mention the potential to reduce the financial burden of extended health care cost. To go back to Anna, she was in the system for 19 years. Countless healthcare dollars were spent on treating her symptoms. Which was not successful and ultimately lead to her untimely death. Should Anna have been treated as whole person, the outcome most certainly would have been different.

    There are so many “symptoms” that could easily be considered pathologically, but really are protective strategies adapted to survive the experience of trauma. Obesity can be seen as a problem unhealthy eating patterns, but in reality could be a coping skill to avoid being traumatized/abused. Whether they want to reduce their physical appearance to protect themselves or are eating to cope with the pain they feel inside. Many traditional models of medicine may treat this as simply a behavior problem and not a mental health issue.

    Question 3
    While our agency does not inquire about trauma histories. We do practice Collaboration and Mutuality, Empowerment, Voice and Choice. Our practice uses motivational interviewing skills to help elicit the clients engagement in the process. Using these skills to work with a client where they are at and encourage them to have a sense of autonomy. Putting them in the driver’s seat so to speak. Letting them have a sense of control in the situation. Recently our team has received Mental Health First Aide training to assist in our day to day interactions with clients.

    #31015
    Janice LaraHewey
    Participant

    Question 1
    How sad and familiar Anna’a story is. I have seen changes over the years but it has been a agonizingly slow process. It is still common for professionals to look for the “easy” stuff that may respond to a relatively quick fix. There are reasons people are who they are and do what they do. Are professionals trying to heal the injuries or simply numb things?

    Question 2
    Yelling when bothered/upset about something. This behavior could be the result of childhood trauma where the individual was ignored/ neglected. His needs were not tended to any adults around him and people would only listen to him when he yelled loud enough to get their attention. So to be noticed, he had to yell. Carried into adulthood, the person may continue to yell in order to be heard.

    Question 3
    In the agency I work for, we work to create a safe, respectful environment that respects and promotes individual choice. I think to become a more trauma informed agency, I think more training/ education about trauma and it’s long term impacts (not just diagnosis information) would help spread information across the agency to other programs which don’t necessarily provide counseling services.

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