[Alan Algee]

Question 1:

Is Jacinta in “treatment” or is she in “trauma milieu”? Reading her case, it just didn’t sound like that she was in actual treatment. She is forced into a program syllabus and is highly symptomatic. I cannot hear Jacinta at all. She is being judged a lot. There is no mention of any of her strengths. Is she ready for IOP group? Did she complete a “group readiness” intervention. Anyway . . . I would probably start out with the grounding strategies.

Question 2:

Is it believed that Susto can be reversed in the course of healing? I might take one or two symptoms and ask her to monitor it to see if she can notice improvement. Maybe have her use a fitbit to monitor her sleeping patterns—assuming that she is interested in tracking sleep. Of course there’s a risk that her symptom could become worse before better. So I would want to make really sure that she chooses what she would like to track.

Question 3:

I probably would not actually “refer” her only because that verb seems a little bit “directive”. I would help her to self-refer to a program that she chooses. I would make sure that we reviewed all of the options available and support whatever direction she takes. I also think that Jacinta really needs a skillful individual counselor with whom she forges a strong and lasting therapeutic alliance. I would also coach her on how to find a support group. It would be hard for me to refer her to a manualized treatment group (e.g. DBT) because she already has little control over herself. I would want her to be in treatment that allows her to be whoever she needs to be for that session—as far from judgement as possible.

Question 4:

My big take-away is remembering that humans are very complex and no two people are alike. We must use the trauma informed strategies to learn how to really get to know our clients as best as we can. The theories and content of this course gave me some new tools that I hope will let me better describe the very wide bandwidth of my clients experiences.

[Alan Algee]

QUESTION 1
Able to talk about it with apparent ease and objectively. Good command of language. Researches her options for recovery and then engages after she choses a recovery option. Strong philosophical values. Able to develop a vision for herself. Puts accomplishments on the record which is positive and self-inspiring. Realizes that an internal locus of control is very powerful when in recovery.

QUESTION 2
LEC-5
Pros: thorough, fidelity to DSM 5, could foster talk for follow through
Cons: of the 17 questions, it might take only one event to cause the PTSD but the client may feel that 1/17 might not mean very much, it’s hard to gauge the severity of an event, just because it “happened” or was “witnessed” does not mean much diagnostically

Adverse Childhood Effects Calculator
Pros: I like the fact that this narrows down to a phase of life; ACEs are very serious and this assessment is important to understanding who we might be
Cons: like most instruments, this might feel invasive; should be used judicially and skillfully—not routinely

QUESTION 3
Establish Safety: ask her to try to recognize “in the moment” safety (assuming that, in fact, she is in a safe place).

Address Sleep Disturbances; this would be critical. We would explore all available resources to try to get good sleep (there’s lots out there; sleep study?)

Support Empowerment; she already is working on her recovery so we would build on her current strengths and coping strategies while on the hunt for others that she may find helpful

[Alan Algee]

Question One

Every two years, the leadership uses the “Guide to Trauma-Informed Organizational Development” which is a very well developed grid in which new TIC goals for the agency are developed and detailed accountability is established. This is done in two parts. The first is to assess how the goals in the last two-year cycle were performed. The second is to develop new goals for the new cycle. Goals are never duplicated from cycle to cycle to assure ongoing development (unless one of the previous goals was not developed which, we hope, is rare). This leads to confidence that we really are making progress in TIC.

Question Two

Every year we require all employees to have 4 hours of training in trauma per year (more than that is encouraged). We do not require any specific training (Providers may choose their own topics in trauma). Each provider has a Professional Development Plan which is reviewed with their supervisor. This way Providers and their supervisors can visit their PDP and decide on which counselor competencies would be best to work on. This, we hope, reflects the systematic and on-going model of training rather than specific event training.

Question Three

I would say that Larry really doesn’t need any more training in the 12-step approach. He probably is something of an expert in that model. I would have Larry re-visit Carl Roger’s “Six Core Conditions” which would hopefully give Larry some specific skill sets to really work on. I would emphasize these skill over all of the counselor competencies (which can be over-whelming) and really hone in on developing skills to set those conditions which are essential if there is going to be any movement for his clients.

[Alan Algee]

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.

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