[Greta Garvey]

Question 1.
In working with Jacinta, I would focus on engagement and exploring her mental health symptoms. Moving Jacinta to a female only group would be beneficial, due to her past sexual abuse with a male. She shares that she doesn’t relate her childhood experiences to her current substance use. At the agency where I work, we provide substance use counseling and mental health counseling. It would be helpful to meet Jacinta where she is and focus on her mental health symptoms. If this could not be done due to the court mandated substance use treatment, mental health counseling should be offered additionally. Individual counseling may be more appropriate, especially initially in treatment. Creating a safe environment would be imperative in creating a therapeutic alliance with Jacinta.

Question 2.
Practicing cultural competencies in trauma informed care will be vital in working with Jacinta. Creating an understanding and safe environment for Jacinta to explore her feelings regarding Susto will assist in meeting the client’s individual needs, and differentiating between cultural beliefs/norms, and mental health symptoms. In working with Jacinta, I would explore her statement that she thinks that Susto which she heard about from her parents, may be causing her feelings of unhappiness and anxiety. The following was listed in our lesson this week and would be helpful regarding this client’s needs; “Has knowledge of how to differentiate PTSD, trauma-related symptoms, substance-use related symptoms and other mental disorders in that particular culture and the culturally-specific meanings of those symptoms and behaviors.” (SAMHSA, 2014, pp.131–135)

Question 3
In working with Jacinta, I would discuss the benefits and risks of the seeking safety group. At this point in treatment, it may be overwhelming for her to be involved with two groups and individual counseling. Before I make any referrals I discuss what the group will entail, and what expectations there will be in attending the group. If I were to make a referral, I would make the referral within the agency, so that she would not have to start the process again with another provider. Seeking safety may be helpful in addressing Jacinta’s needs if she is ready to attend a group. It would be imperative to ensure the group was female only.
Question 4
Truthfully, this has been one of the most informative, relevant, and inspiring trainings I have taken. I can see myself using the information that I learned within these lessons on a daily basis with my client’s. Screening and assessing for trauma, trauma-informed addiction services, and learning more about cultural competencies in trauma informed care are areas that I learned more about in taking this course. Really meeting my clients “where they are” is what has stood out to me over this course. Everyone has different experiences and will experience trauma in an individual manner.
Thank you so much for this wonderful training. I look forward to using the knowledge I learned here in my daily practice.

[Greta Garvey]

1. It saddens me to hear of Christina’s experience of hospitalization as a child. She was sexually abused by her babysitter, confided in her parents, and then was punished at the hospital by being put in isolation, and by being medicated. No one took the time to listen to Christina’s experience. She wasn’t given the opportunity to have a voice. Listening to Christina speak about taking her recovery into her own hands was empowering. She shares that she started doing research online to learn about alternative options for treatment. Being medicated was not helping her to get better. She shares that her diagnosis and behaviors were viewed as a weakness and not a strength. She learned about the benefits of cognitive behavioral therapy, and started attending a group. She shares that peer support was helpful. Christina started going to school and got a job as a Medical Assistant. If I were working with Christina, I would utilize Strategy #7 encouraging participation in 12 step, peer support, and other mutual-help programs. (SAMHSA, 2014, p.121) I would also focus on person centered approach, and encourage Christina’s self-advocacy.

2. The Brief Trauma Questionnaire is a screening tool that I would use in my practice. In reviewing this tool, a positive would be that client’s, especially new clients would be able to share if they had experienced a traumatic event without verbalizing their experience. A negative may be that questionnaires can be triggering. It would be helpful to discuss the possibility for a reaction to the questions being asked. The PTSD Checklist is another screening tool that I would use. This would be a helpful tool in assessing my clients for PTSD symptoms. Many of the client’s that I meet with have previously been diagnosed with PTSD. This would be a tool that would allow my clients to assess the symptoms they are experiencing. The limitation with this tool is it applies to the last month of the client’s life. This would be a limiting factor in diagnosing, and with past trauma.

3. In my approach with Selena, I would focus on building trust, addressing sleep disturbances, and providing psychoeducation. Building trust will be vital for treatment with Selena. Her trust was violated when she was sexually assaulted by someone that she knew, and thought of as a big brother. Providing a safe and trusting environment will assist in building a strong therapeutic alliance. Selena’s sleep disturbance is severe. She has developed a fear of sleeping, and avoids sleeping until she is exhausted. Assisting Selena in increasing her sleep hygiene and creating a routine before bed, will assist in increasing restful sleep. Providing psychoeducation about PTSD symptoms would be beneficial. Selena appears to be experiencing severe sleep disturbances related to trauma. As she has predominantly been treated for depression, she may be confused about the emotions and symptoms that she is experiencing. Discussing treatment options, coping strategies, and types of therapy will be helpful in assisting Selena choose the right treatment option for her needs.

[Greta Garvey]

Question 1
Services and Interventions are the guideline the agency that I work for is following in using a TIC approach. The assessments we use have a specific section to evaluate for current and past trauma. Providers are encouraged to ask clients to share only what they are comfortable sharing, especially during the assessment period. Clients are referred to Provider’s based on their needs, this includes the preference to work with a male or female provider. We have specific counselors at the agency who have additional training in trauma. As part of our CEU requirement for the agency each year we need to receive 4 hours of training specifically related to trauma. Individual supervision is readily available to all staff members, and group supervision takes place twice a month. The staff members are caring and work as a team to support one another. As the agency offers SUD and Mental Health counseling the ability to collaborate with one another is helpful to our clients, especially when addressing issues related to trauma.
In regards to Training and Workforce development our agency would benefit in offering additional support for providers who are experiencing secondary traumatic stress and who have trauma histories. Self-care is encouraged and suggestions are made during individual and group supervision, but specific trainings and resources would be helpful. Provider’s may not be aware of the negative effects of secondary trauma until they experience it.
Question 2
In reviewing the trauma-informed counselor competencies checklist the following areas are where I feel competent; understanding my client’s need for personal and physical safety, maintaining clear boundaries within the client/counselor relationship, and using a strengths-based approach. Some areas I would like to focus on learning more about is increasing competence in screening and assessment of substance use disorders, identifying training on Secondary Traumatic Stress reactions, and the impact trauma has on diverse cultures. Being able to have additional training and competency in substance use assessments will help me to incorporate integrated treatment for my client’s. In addition to recognizing signs of burnout, it would be helpful to have a better understanding of secondary traumatic stress reactions, and what to do when experiencing this in the moment with a client. Learning more about the different experiences of cultural reactions to trauma, and beliefs about treatment, will be helpful in increasing my ability to provide my clients with person centered, individualized treatment.
Question 3
As a young male clinical social worker Larry may not be taking into account the past trauma the female member of his group has experienced. “In addition, since addiction treatment services have traditionally been designed to address the needs of men, in order for a program to be truly trauma-informed, it must not only adopt an integrated treatment approach but also be re-designed to meet the needs of women survivors of trauma (Harris & Fallot, 2001, p. 57). In this situation the female group member had a negative reaction when she was confronted by a male facilitator. Larry’s approach does not align with a TIC approach which is person centered. Larry’s supervisor has addressed the needs regarding the approach to the group, but has not addressed the need for further training specifically regarding trauma, and a TIC. Larry may be experiencing a secondary traumatic stress reaction as he is comparing his recovery experience to the member in his group. If I were Larry’s supervisor I would focus more on TIC approach to treatment, and offer Larry further education and resources regarding the possibility for STS reactions in treatment. It may also be helpful to have a co-facilitator for the group until Larry has more of an understanding of TIC approach.

[Greta Garvey]

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.

[Greta Garvey]

Hi,
My name is Greta Garvey, LMSW-cc. For the last 3 years I have worked at Dirigo Counseling Clinic LLC as an outpatient counselor. I enjoy working with clients across a broad age range, and work with couples. So many of my client’s have experienced trauma during their lives, and I am looking forward to learning more about trauma informed care, to be better informed to help my client’s in addressing the impacts of trauma on their lives.

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