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1: I would first look into boundary issues and client engagement. Boundaries, in the sense that the program will need to look at what her boundaries are and then ensure they are respected. Given her traumatic hx with males, a male dominated group may not be the best setting for her and alternative options should be explored so that she feels safe and able to engage. Her engagement would be concerning as well, it would be important for her clinician to review triggers that could dysregulate her during sessions (group and individual) in order to minimize traumatization as much as possible.
2: To start I would seek out consultation with someone who was more aligned with the culture and would be able to teach me pertinent information about Susto. From there, I would want to collaborate with both the consultant and the client in order to ensure that I am not doing any harm to the culture/ideologies/beliefs during treatment. From there using treatment modalities that align with Susto and its symptoms as the relate to PTSD would likely be the most respectful option.
3: I believe that the seeking safety group would be an appropriate referral for her. Should information come up once she is involved that she needs something different at that time a new referral could be made. Given that this would be a women’s group it would likely be a good place to start in order to observe her engagement.
4: Two of my biggest takeaways from this course are the impacts that trauma can have from a cultural aspect, in addition to the weight of the role staff can play in re-traumatization/screening. The cultural piece reminded me that if there is something unfamiliar to myself or my team we need to seek consultation not only to educate ourselves but also to ensure that we are no retraumatizing the client, or being disrespectful to their ideologies and beliefs. When it comes to screening, early screening is important and that is something that can get lost in translation during an admission. Continuing to remain consistent with all clients screening will be helpful for both clients and the program as a whole.
1: Generally this story was frustrating and saddening to watch. She was retraumatized over and over again by a system who traumatized and stigmatized her in the first place. She needed someone to point out her strengths and utilize them in moving her forward instead of labeling them as “wrong” or bad”. Christina showed resilience by enrolling herself in therapy and continuing to maintain social connections that encouraged her to move towards her goals. In addition she discussed that she took control of her own recovery which is an example of her taking action and maintaining a hopeful outlook. If I was her counselor, I would continue playing on the strengths that she has, in addition to exploring new ones. I would encourage her to continue maintaining a daily routine, attending her support groups, in addition to work with her on perspective taking. Lastly, I would encourage her to continue working with a medication manager that she trusts, so to empower her confidence in saying no if she does not want to take something.
2. I would use both the life events and ACE’s screening tool with my clients. They are both comprehensive, direct, and non bias. These surveys would give a clinician a picture of what things may be helpful to discuss, and what an appropriate manner to discuss those topics would be. The down side to these screeners, or any other screener is that it leaves space for the clients to be dishonest out of fear, discomfort, anger etc. This can leave the door open for clinicians to misinterpret, or lose sight of providing trauma informed care when speaking with clients.
3. If I was working with Selena, I would first focus on establishing safety, normalizing symptoms, and addressing sleep disturbances. Safety and sleeping are two of our most basic needs as humans, if those are not in check it will be really difficult for Selene to dig into any real work as she will not be physically and mentally healthy enough. With normalizing symptoms, there is also psychoeducation. Providing Selena with factual information about his trauma responses it will allow her to have a clearer picture of why she reacts the way she does. Once she accepts that, it is more likely that she will be able to work to find ways to combat some of those symptoms.
The agency I work with make an active effort to continue interviewing consumers, their families, additional providers and referents in order gain insight into what we could change to make treatment better for clients. In addition we have consumers fill out anonymous treatment effectiveness surveys in to provide them with space to be honest about how their clinicians can improve.
I feel my team and I are very person centered when it comes to competencies. We try to individualize reach treatment continuum for clients in an attempt to reach their best possibly outcome. We work with clients to create their own plans in order to give them a sense of control over their own future and well being.
Larry’s interaction with the client in group seemed misplaced. He was utilizing his personal experience as a form of clinical intervention instead of offering a shared experience. By not holding space for the client and her discomfort towards the idea of an AA meeting with all men, he not only could have damaged the therapeutic relationship between them, and created group fracture, but he could have also re-traumatized her. This is not in line with TIC, which Larry’s clinical supervisor realized. If I was his clinical supervisor, I may have also suggested that Larry do his own individual work in order to keep his mental and emotional well being in check, so it will not spill into his clinical work with clients.
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.Hi All. I am a primary therapist at Foundation House. An extended sober living located in southern Maine. I primarily work with male adolescents and emerging adults with substance use and mental health disorders. My hopes for this course are to remain trauma informed and continue using best practice with my clients.
