Trauma Past, Trauma Present* Relevance of Trauma to ALL

Report
Trauma Past, Trauma Present:
Looking at Addiction through a Trauma Informed Lens
Allison Sampson Jackson, PhD, LCSW, LICSW, CSTOP
Family Preservation Services of VA
Providence Service Corporation
Defining Trauma:

a traumatic event, either witnessed or experienced,
representing a fundamental threat to one’s physical
integrity or survival
 responses involve intense fear, helplessness or horror
 the meaning of the event may be as important as the
actual physical act/experience
 what we want to emphasize is that it is an individual's
subjective experience that determines whether an
event is or is not traumatic
http://www.lisaferentz.com/3
Key Component of Trauma
Is the experience of loss!
Loss of:
 boundaries
 safety
 trust
 power and control
 innocence
 protection
 attachment
 possessions
 consistency/predictability
 sense of self/body image
http://www.lisaferentz.com/
4
Exposure to Violence in
Childhood
46 million of 76 million children
are exposed to violence, crime and abuse
each year

Finkelhor, D., et al. (2010). Trends in childhood violence and abuse exposure:
evidence from 2 national surveys. Archives of Pediatric and Adolescent
Medicine, 164(3), 238–242.
Information and slide part of Dr.
Allison Sampson's Trauma
Presentation
Trauma impacts
learning and academic outcomes

Decreased IQ and reading ability
(Delaney-Black et al., 2003)

Lower grade-point average (Hurt et al., 2001)

More days of school absence (Hurt et al., 2001)

Decreased rates of high school graduation
(Grogger, 1997)

Increased expulsions and suspensions (LAUSD
Survey)
Impact of being in Child Welfare System
for Foster Care Children
•
•
•
•
•
•
25% will be incarcerated within first 2 years of aging
out of the system
More than 20% will become homeless
Only 58% will have a High School Diploma
Less than 3% will have a college education by age of
25
Many will re-enter the system as parents
For children under age of 5, increase likelihood of
developmental delays 13-62% compared to 4-10%
1) Conradi, L. (2012) Chadwick Trauma Informed System Project p. 54
2) Leslie et. al. (2005). Developmental and Behavioral Pediatrics 26(3),
177-185
223,400,000
ACE SCREEN
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Alcoholism and alcohol abuse
Chronic obstructive pulmonary
disease (COPD)
Depression
Fetal death
Health-related quality of life
Illicit drug use
Ischemic heart disease (IHD)
Liver disease
Risk for intimate partner
violence
Multiple sexual partners
Sexually transmitted diseases
(STDs)
Smoking
Suicide attempts
Unintended pregnancies
Early initiation of smoking
Early initiation of sexual activity
Adolescent pregnancy
Unlocking the Brain
At least for today…3 brain levels-they
each speak a different language
Brainstem-housekeeping of the
Body, sleeping, eating, breathing
Limbic-smoke alarm, implicit memories
Cortex-planning, logic, reason, judgment
14
A Person’s Response to Perceived
Danger
Trauma Event
Danger Response
Fight
Aggression
Verbal attack
Flight
Run Away
Substance Abuse
Freeze
Dissociate
Non-emotionality
Slide from Ellen Williams, LCSW
Slide from Ellen Williams, LCSW
Center for Child & Family ServicesServices
Slide from Ellen Williams, LCSW
Center for Child & Family ServicesServices
The Hand Model of the Brain
http://www.youtube.com/watch?v=DD-lfP1FBFk
18
The Handy Model
19
Trauma and the Brain
 Hippocampus-remembers the facts but
not the emotions.
 It records the time-frame of significant
events, the start, the middle, the end of an
event and sends the facts to the cortex-the
thinking part of the brain (logic, reason,
common sense).
20
Chasing Behaviors
Agitation
Hopelessness
Defiance
Insomnia
Numbing
Withdrawal
Substance Abuse
Slide by Trish Mullen, Chesterfield CSB
Poor Impulse
Control
Shame & SelfHatred
Depression
Panic Attacks
Intrusive Memories
Nightmares
Dissociation
Eating
Disorders
T
Somatic Symptoms
SelfDestructive
Behavior
We must ……
Respond to the need ….
Not react to the behavior
Resilience Trumps Aces
From Trish Mullen, Chesterfield
Community services Board
TRAUMA AND ATTACHMENT
ATTACHMENT
Many argue that these early relationships
(experiences) shape neuronal circuits which
regulate emotional and social functioning
INFORMATION AND SLIDE PART OF DR.
ALLISON SAMPSON'S TRAUMA
PRESENTATION
ATTACHMENT’S PURPOSE
SIEGEL, 1999
Evolutionary Level – biological
Infant Survival (Bowlby)
Mind Level – biological and social
• Caregiver’s brain helps child’s brain to organize regulation
• Caregiver’s brain teaches child self-soothing
• Child experience of safety allows for exploration
INFORMATION AND SLIDE PART OF DR.
ALLISON SAMPSON'S TRAUMA
PRESENTATION
ATTACHMENT’S PURPOSE
Experience of safety is encoded in child’s
implicit memory and provides secure base from
which to grow and access higher levels of
information processing
INFORMATION AND SLIDE PART OF DR.
ALLISON SAMPSON'S TRAUMA
PRESENTATION
TRAUMA AND THE BRAIN
UNDERSTANDING “WHY” …
•
http://www.childwelfare.gov/pubs/issue_briefs/brain_development/effects.cfm
INFORMATION AND SLIDE PART OF DR.
ALLISON SAMPSON'S TRAUMA PRESENTATION
BRAIN AND STRESS
• When stress is predictable and moderate, stress can
facilitate resiliency and enhance memory
• When stress is unpredictable and severe, stress can
create vulnerability and memory impairment
• Severe and chronic stress in childhood via multiple
traumas from caregivers can impact affect regulation,
interpersonal relationship skills, and states become
traits (fight/flight/freeze… disassociation or hyper
arousal)
INFORMATION AND SLIDE PART OF DR.
ALLISON SAMPSON'S TRAUMA PRESENTATION
TYPES OF STRESS
Positive Stress
Tolerable Stress
Toxic Stress
Normal and essential part of healthy
development
Body’s alert systems activated to a
greater degree
Occurs with strong, frequent or prolonged
adversity
Brief increases in heart rate and blood
pressure
Activation is time limited and buffered by
caring adult
Disrupts brain architecture and other
organ systems
Mild elevations in hormonal levels
Brain and organs recover
Increased risk of stress-related disease
and cognitive impairment
Example: Tough test at school or a playoff Example: Death of a loved one, divorce,
game
natural disaster
Social –emotional
buffering
Parental Resilience
Intense
INFORMATION AND SLIDE PART OF HARRIS
(2013) BUZZ ON BRAIN AND BABIES
PRESENTATION
Prolonged
Example: abuse, neglect, caregiver
substance dependence or mental illness
Early Detection
Repeated
Effective Intervention
Unaddressed
THREE PARTS OF THE BRAIN …
• Brain Stem
• Limbic Brain
• Cerebral Cortex
INFORMATION AND SLIDE PART OF DR.
ALLISON SAMPSON'S TRAUMA PRESENTATION
STRESS AND THE BRAIN
THE CALM PERSON
HIPPOCAMPUS
Sensory Cortex
Working
Smoke Detector Off
Smoke Detector
Activated
“Wise Old Owl”
SUD Scale 6 to 3
Self- Regulation
SUD SCALE 3 to 6
Amygdala
Sensory Thalamus
LOW ROAD
Emotional Stimuli
“The Guard Dog”
Emotional Response
Model adapted by Allison Sampson from Ledoux (1996, page 164) and utilizing terms from
van der Kolk’s work and Goldie Hawn’s Book (2011) 10 Mindful Minutes
THE TERRIFIED PERSON
HIGH ROAD
Hippocampus
Shrunken
Sensory Cortex
Smoke Detector
Activated
“Wise Old Owl”
Smoke Detector
Misfires
SUD Scale stays at 8
SUD SCALE 6 to 10
Lack of Regulation
Amygdala
Sensory Thalamus
LOW ROAD
Emotional Stimuli
“ The Guard Dog”
Emotional Response
Model adapted by Allison Sampson from Ledoux (1996, page 164) and utilizing terms
from van der Kolk’s work and Goldie Hawn’s Book (2011) 10 Mindful Minutes
VULNERABILITY MOUNTAIN
INFORMATION AND SLIDE PART OF DR.
ALLISON SAMPSON'S TRAUMA PRESENTATION
What does this mean for children who have experienced trauma?
EXPERIENTIAL EXERCISE
ATTACHMENT AND BRAIN
… WHAT WE ALREADY KNOW
• Review of the exercise … what did you notice about
caregiver touch between the two sets of pictures …
• What do you think the implicit memories are about
caregiving relationships ? About authority figures?
About their ability to be safe ?
INFORMATION AND SLIDE PART OF DR.
ALLISON SAMPSON'S TRAUMA PRESENTATION
The needs of the adults and caregivers with trauma ….
are no different
CROSS-GENERATIONAL TRAUMA
HENDRICKS (2012) CHAPTER 12 OF CREATING TRAUMA INFORMED CHILD WELFARE SYSTEMS
USING TRAUMA INFORMED SERVICES TO INCREASE PARENTAL PROTECTIVE FACTORS
Women who have experienced trauma are more likely to self- medicate with a
substance (55-99%) (1)
Intergenerational transmission of trauma (Depression, PTSD) (2)
Unresolved childhood trauma can lead to reenactments with partners in adult
relationships and/or with their children (3)
Unresolved childhood trauma can lead to difficulty forming secure attachments
with their children (4)
Childhood trauma can result in parenting styles that include threats & violence
(2)
Childhood sexual abuse survivors can miss “red flags” of sexual abuse with their
own children due to avoidance of trauma memories themselves (2)
1)
2)
3)
4)
Najavits, Weiss, & Shaw (1997) The American Journal on Addiction, 6 (4), 273-283
Hendricks, A. (2012). Using Trauma-Informed Services to Increase Parental Factors (pp. 89-91)
Walker (2007) Journal of Social Work Practice, 21 (1), 77-87.
Main & Hess (1990) In M. Greenberg, D. Cicchetti, & E. Cummings (Eds.), Attachment in the preschool years: Theory,
research, and intervention (pp. 121-160)
BIG PICTURE WITH CAREGIVERS
• Often the caregivers … are the kids we as a system “missed”
• They come to us with their own trauma histories
• Successful outcomes with our clients means successful work with the family
• Screening all caregivers and finding them services is critical to the
prevention/treatment/reduction of recidivism for children entering the juvenile
justice system
CROSS-GENERATIONAL TRAUMA
HENDRICKS (2012) CHAPTER 12 OF CREATING TRAUMA INFORMED CHILD WELFARE
SYSTEMS
USING TRAUMA INFORMED SERVICES TO INCREASE PARENTAL PROTECTIVE FACTORS
Caregiver functioning following a child’s exposure to trauma is a
major predictor of child’s functioning (1 & 2)
If we want to improve a child’s outcome, we must address parent’s
trauma history … failure to do so can result in (2) …
- Failure to engage in treatment services
- An increase in symptoms
- An increase in management problems
- Retraumatization
- An increase in relapse
- Withdrawal from service relationship
- Poor treatment outcomes
1) Linares et al (2001) Child Development, 72, 639-652
2) Liberman, Van Horn, & Ozer (2005) Development and Psychopathology, 17, 385-396
3) Hendricks, A. (2012) pp. 91
A PERSON’S RESPONSE TO PERCEIVED
DANGER
Trauma Event
Danger Response
Fight
Aggression
Verbal attack
Flight
Freeze
Run Away
Substance Abuse
Dissociate
Non-emotionality
Slide from Ellen Williams, LCSW
CHASING BEHAVIORS
Agitation
Defiance
Hopelessness
Insomnia
Numbing
Withdrawal
Substance Abuse
T
Poor Impulse
Control
Shame & SelfHatred
Depression
Panic Attacks
Intrusive Memories
Nightmares
Dissociation
Eating
Disorders
Slide by Trish Mullens, Chesterfield CSB
Somatic Symptoms
SelfDestructive
Behavior
WE MUST ……
Respond to the need ….
Not react to the behavior
PARADIGM SHIFT
What does TIC look like?
Core areas of focus in Complex Trauma
Courtois, C. & Ford, J. (2009), Introduction (p.2)
 Self-Regulation



Affect Regulation
Disassociation (difficulty in being “present”)
Somatic Dysregulation
 Self-Identity


Impaired Self-Concept
Impaired Self-Development
 Co-regulation


Secure working model of caring relationship
Disorganized Attachment Patterns
Information and slide part of Dr. Allison
Sampson's Trauma Presentation
Creating a Culture for TIC
Five Core Values (Fallot, 2009)
1)
2)
3)
4)
5)
Safety
Trustworthiness
Choice (and Voice !!)
Collaboration
Empowerment
We can offer CAPPD to those with work with …
http://www.multiplyingconnections.org/
Information and slide part of Dr. Allison
Sampson's Trauma Presentation
Phase Oriented Care
Understand what good trauma
treatment looks like …

Phase Oriented Treatment “ Gold Standard”
Phase I: Safety and Stabilization
Phase 2: Trauma Reprocessing
Phase 3: Reintegration


Handout on questions to ask Mental Health Providers
Resource
http://www.nctsnet.org/nccts/nav.do?pid=ctr_top_tr
Information and slide part of Dr. Allison
mnt_prom
Sampson's Trauma Presentation
Phase Oriented Treatment for Trauma
(Herman 1992, Janet 1889) from Courtois, C. “Treating
Complex Traumatic Stress Disorders”)
PHASE ONE: Safety and Stabilization
 Personal and Interpersonal Safety Established:
Education/Support/Safety Planning
 Enhance Client’s ability to manage extreme arousal
(hyper/hypo)
 Active engagement in positive/negative experiences (deal
with automatic avoidance behaviors, self awareness of
avoidance, increase coping skills and use of coping skills)
 Education (psychotherapy, trauma, skills to be learned)
 Assess and develop relationship capacity (decrease
avoidance of relationships or negative thoughts about
relationships, build support network, define client’s
Information and slide part of Dr. Allison
attachment network)
Sampson's Trauma Presentation
Phase Oriented Treatment
Phase Oriented Treatment for Trauma
(Herman 1992, Janet 1889) from Courtois, C. “Treating Complex Traumatic
Stress Disorders”
PHASE TWO: Trauma Reprocessing
 Disclosure of traumatic memories, development of an
autobiographical narrative (identify emotions connected
to trauma memories, grieve and mourn losses, resolution of
relationships when appropriate, increased awareness,
increase interpersonal and self-regulation skills)
 Supporting client in maintaining functioning and not getting
lost in memories or seeing themselves as “disabled”, need
to affirm strengths, promote positive self-esteem, and
internal and external resources now available to them
PHASE THREE: Re-Integration
 Growth and period and reengagement in life
 Can be time of client realizing losses, discover of unresolved
developmental deficits, fine tuning of self-regulation skills
Replacing Coping
Behaviors
Phase One Work
Chasing Behaviors
Agitation
Hopelessness
Defiance
Insomnia
Numbing
Withdrawal
Substance Abuse
Poor Impulse
Control
Shame & SelfHatred
Depression
Panic Attacks
Intrusive Memories
Nightmares
Dissociation
Eating
Disorders
Slide by Trish Mullens, Chesterfield CSB
T
Somatic Symptoms
SelfDestructive
Behavior
Respond to the need
Don’t react to the behavior
Post Traumatic Growth
Typically 30-70 percent of survivors say that
they have experienced positive changes of
one form or another
• Construct meaning from
what happened
• Survivor and thriver
stories
• What to do with the
“broken vase” ?
Post Traumatic Growth

http://ptgi.uncc.edu/
Posttraumatic growth tends to occur in five general areas.





Sense that new opportunities have emerged from the struggle,
opening up possibilities that were not present before.
Changes in relationships with others (ex: closer relationships
with some specific people, increased sense of connection to
others who suffer)
Increased sense of one’s own strength – “if I lived through that,
I can face anything”
Greater appreciation for life in general
Experience a deepening of their spiritual lives, however, this
deepening can also involve a significant change in one’s belief
system
Resilience

http://acestoohigh.com/
Resilience Factors (APA website)
 Caring/Supportive Relationships (primary)
 Capacity to make realistic plans and take steps to
carry them out
 A positive view of yourself and confidence in your
strengths and abilities
 Skills in communication and problem solving
 The capacity to manage strong feelings and
impulses
Examples
 Protective
 Families
Factors
who thrive
Targeting Change
One tool …
When in their upstairs brain

Support folks you work with in developing goals
based on their motivation … what do they want for
their life today, what do they hope for, “magic wand
questions”, what is their goal each day !!!

Collaborative Planning with Consumers…




Interviewing for hopes
Brain storm how to get there
Creating a plan where they have a support system and
access to skills that will help them reach their goal
Respecting their boundaries/contracting
LET’ PRACTICE ….
Skill Building
Replacing Coping Skills
Steps to replacing coping
behaviors







Identify current self-regulation strategies
Help consumer make meaning out of why they
chose these strategies (ex: brain, ACE score, etc)
“Magic Wand” question … focus of change
Teach about the skills needed to build selfregulation
Focus work on building resilience and new coping
strategies like a muscle
Track progress with something like the diary card
Frame replacing coping behaviors as a journey, it
will take time
Dialectical Behavioral Therapy
– Informed
DBT was developed in the late 1970s by Dr. Marsha Linehan
and colleagues
Main goals: cope with stress, regulate emotions, improve
relationships with others


Learning new behaviors -- which can be anything a person
thinks, feels or does
Validation – the push for change can feel like it invalidates
the pain that a consumer feels, validation is critical to
helping consumer move forward

i.e. the unhealthy coping strategy makes sense given your
experience, even though it is not the best approach to solve the
problem
Dialectical Behavioral Therapy –
Informed


Dialectics (opposites)
Dialectics makes three basic assumptions:



all things are interconnected
change is constant and inevitable and
opposites can be integrated to form a closer
approximation of the truth
In DBT, the work is focused on resolving
seeming contradictions between selfacceptance and change in order to bring
about positive changes for an individual
DBT – Informed
Skills
-
-
Self Regulation
Mindfulness
Interpersonal Relationship Skills
Distress Tolerance Skills
Accept and Change
Vulnerability Mountain
Self Regulation
Self-Regulation (“sunscreen”)




Relaxation and Grounding Exercises
Bilateral Movement
Attunement Exercises
Guided Imagery


http://www.healthjourneys.com/Store/Products/HealingTrauma-PTS-Health-Journeys/19
Self-Care Plan (daily practice)
Mindfulness – art of being
present in the moment




Mindfulness Scale (MAAS)
Mindfulness Exercise (sheet) – breathing, “one
thing”
Mindfulness Principles
Mindfulness at UCLA http://marc.ucla.edu/
Self Awareness
“knowing your skin”






Educate children and adults about their triggers and trauma responses
o Wise old owl (Hawn Foundation)
o Guard Dog (Hawn Foundation)
o Smoke Detector (Van der kolk)
o Alarm System ( ARC book pp.316-318)
o Light Switch (“Please Explain Anxiety to Me”)
Teach and practice with them identification of feelings and needs
Engage them in “Behavioral Experiments” where the try something
different
Teach about Thought Distortions (“thought distortion box”) so they can
begin to recognize thoughts they tell themselves that take them down
to “Distress Valley”
Supporting beliefs that child or adult deserves “good” things
Recognizing “bumps in the road” don’t mean “a crash”
Teaching About the Brain
 Upstairs/downstairs
practice
brain teaching
 Using
of multiplying connection tools
(amazing brain pamphlets)
 Partnering
with Parents
Now you practice ………
Interpersonal Effectiveness Skills

Self Help Tools

http://www.dbtselfhelp.com/html/interpersonal_effectiveness_ha.ht
ml
EX: Cheerleading statements (connected to building positive selfidentity)
“Cheerleading statements are statements that people make to themselves in
order to give themselves permission to ask for what they need or want, to
say no, and to act effectively”
ACTIVITY
Can you build some cheerleading statements with your neighbor ??
DISTRESS
TOLERANCE
Distress tolerance skills
(taken from the Accepts skills … DBT informed)
o Activities (physical and mental) – mental vacation, bi-lateral movement (walking), temperature change
o Contributing – helping others gets you out of yourself and your stress (smiling, give compliment, invite someone to coffee,
hold a door, do a favor)
o Comparisons – Bringing perspective to current situation, what skills have helped you cope before (have helped your children
cope before) … validate yourself
o Emotions – Seek out activities that create feelings that are OPPOSITE from the painful ones you are experiencing (listen to
music, favorite movie, work on a project --- favorite hobby)
o Push Away – Put away distressing memories in a “lock box” or in the “parking lot” for a little while … can do this in writing or
mentally
o Thoughts – distract your thoughts with “one-thing” exercises, read something inspiring, “just worrying exercise”
o Sensations – Any physically vigorous activity or actively awakening senses (brisk walk, cold bath/hot bath, splash cold water
on face, lotions on your wrist, strong taste, bold colors (Mandela), music)
Pederson, L. (2012). The Expanded Dialectical Behavioral Therapy Skills Training Manual . Eau Claire: CMI Education Institute, Inc.
pp. 45-50
PRACTICE
Using
the ACCEPTS Model …
turn to your neighbor and think
through activities that will fall
under 2 of these categories
that you could use with
consumers you work with …
Skill building resilience starts
with you …
 Who
is taking care of you ??
Information and slide part of Dr.
Allison Sampson's Trauma
Presentation
Mirror Neurons
Impact of Working with Victims of Trauma
• Trauma experienced while working in the role of helper has
been described as:
– Compassion fatigue
– Countertransference
– Secondary traumatic stress (STS)
– Vicarious traumatization
• Unlike other forms of job “burnout,” STS is precipitated not
by work load and institutional stress but by exposure to
clients’ trauma.
• STS can disrupt child welfare, police and juvenile justice
workers’ lives, feelings, personal relationships, and overall
view of the world.
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Healing the hero
https://www.youtube.com/watch?v=FdaJYEr
aGG0&feature=em-upload_owner
Produced by Trish Mullen, LPC
Chesterfield CSB
Impact of Chronic Stress
http://www.helpguide.org/mental/stress_signs.htm










raise blood pressure
suppress immune system
increase the risk of heart attack and stroke
contribute to infertility
speed up the aging process (life expectancy)
create vulnerability for anxiety and depression
obesity
skin conditions (ex: eczema)
sleep problems
digestive problems
Information and slide part of Dr.
Allison Sampson's Trauma
Presentation
Vicarious Trauma’s Impact
Personally
(Yassen, 1995)

Emotional



Roller coaster
Overwhelmed
Depleted

Cognitive




Behavioral




Negative coping mechanism
Difficulty sleeping
Absent- mindedness
Information and slide part of Dr.
Allison Sampson's Trauma
Presentation
Spaciness
Apathy
Perfectionism
Minimization
Personal Impact … (Yassen, 1995)
 Spiritual


 Interpersonal
Hopelessness
Anger at a Higher Power



 Physical




Aches and pains
Impaired immune system
Breathing difficulties
Information and slide part of Dr.
Allison Sampson's Trauma
Presentation
Withdrawn
Intolerance
Loneliness
Projection of anger
and blame
Professional Impact (Yassen, 1995)
 Performance
of Job
Tasks
 Morale




Decrease in quality
and quantity
Increase in mistakes
Avoidance of job
tasks


Information and slide part of Dr.
Allison Sampson's Trauma
Presentation
Dissatisfaction
Negative attitude
Detachment
Professional Impact (Yassen, 1995)
 Interpersonal




 Behavioral
Withdrawn from
colleagues
Impatience
Poor communication
Staff conflicts



Information and slide part of Dr.
Allison Sampson's Trauma
Presentation
Tardiness
Absenteeism
Faulty Judgement
Managing Stress
•
Request and expect regular supervision and supportive
consultation.
•
Utilize peer support.
•
Consider therapy for unresolved trauma, which your
work may be activating.
•
Practice stress management through meditation, prayer,
conscious relaxation, deep breathing, and exercise.
•
Develop a written plan focused on maintaining work–life
balance.
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Perry and Cost of Caring
http://childtraumaacademy.com/cost_of_caring/index.html
Lesson 3: Self-Care Strategies for Combating Secondary Trauma
http://www.childtraumaacademy.com/cost_of_caring/lesson03/page03.html
Self-Care Strategies for Combating Secondary Trauma: An overview
Below, please find a few of the possible, positive ways you can address stress. Jot down the things you do (or will begin making a point to do) in
order to better care for yourself. List additional items within each column.
Physical
Psychological
Emotional
Workplace
Sleep well
Self-reflect
See friends
Take breaks
Eat well
Read for pleasure
Cry
Set limits
Exercise
Say "No"!
Laugh
Get peer support
Walk/Jog
Smile
Praise yourself
Get supervision
Dance
Solitude
Meditate
Use vacations
Others:
Others:
Others:
Others:
Information and slide part of Dr.
Allison Sampson's Trauma
Presentation
Self-Care
“Whether you and I and a few others will renew
the world some day remains to be seen.
But within ourselves we must renew it each day.”
—Hermann Hesse
91
Self-care Strategies
http://www.compassionfatigue.org/pages/Top12SelfCareTips.pdf
The best strategy to address compassion
fatigue is to develop excellent self care
strategies, as well as an early warning system
that lets you know that you are moving into the
caution zone of Compassion Fatigue.
92
Self Care: Need Options
Time and Connection:
 10 second exercises
 2 minute exercises
 5-10 minute exercises
 20-30 minute GI, Walking Meditation

http://www.healthjourneys.com/default.asp (Belleruth Naparstek)
Trish Mullen, LPC
93
94
Brain Gym
0-10
Before Brain Gym
0-10
After Brain Gym
Practice
Figure 8 with whole right arm/left arm
Figure 8 with both arms
Cross crawl (opposite right hand to bent left knee, then left
hand to bent right knee)
Self Care Apps

Provider Resilience
GPS for the Soul
Mediation Oasis Apps
Mindfulness Training System
IChill App (Peter Levine)
Narrative Therapy Questions (Narrative Q’s)
Brain Wave
http://socialwork.buffalo.edu/resources/self-care-starter-kit.html
Flipagram (example) http://flipagram.com/f/nGbakYX6B5

NCTSN Self Care Inventory








Pocket TM …
by Trish Mullen, LPC
Challenge:
Working with children who are in their downstairs brain and
getting them back up to their upstairs brain … when we all use
primarily upstairs techniques in our work …
Self care targeted to the right brain and lower brain …
HAPPY PLACE
http://youtu.be/up_WSAYmn-s
Caring For Yourself
98
Creating Internal Awareness
99
Creating Awaresness
100
Window of Tolerance
101
Using Grounding Techniques to
Stay in the Window of Tolerance
Mental
Grounding
Physical Grounding
Soothing Grounding
Somatic Grounding
Najavitis, L.M. (2002). Seeking safety: A treatment manual for PTSD
and substance abuse. NY: Guilford.
102
Practice Examples
Distress Tolerance
“Down Stairs Brain”
 Temperature
Change
 Grounding by looking up
 Bi-lateral movement
 Butterfly taps
 Compassion Hold
“Dig where the ground is soft”
Chinese proverb
Conclusion: “Dig where the ground is soft” Chinese proverb
Instead of picking your trickiest area, pick the issue that you can
most easily visualize improving on. (e.g.: “making a commitment to
going for a walk every lunch time vs. getting rid of my difficult
supervisor”).
You may not notice it right away, but making one small change to
your daily routine can have tremendous results in the long term.
Imagine if you started walking up two flights a stairs per day instead
of using the elevator, what might happen after three months?
104
Together we can make a
difference
Becoming Trauma Informed is a process …
https://www.youtube.com/watch?v=7wK2io3
Z2KM&feature=em-upload_owner
105
THANK YOU ……
Dr. Allison Sampson-Jackson
Family Preservation Services, Inc
804-432-0056
[email protected]
http://www.vscsw.org/continuing_education/

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