855 – Grady Fall 2008
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The University of North Carolina at Chapel Hill
School of Social Work
Course Number:
Course Title:
Times:
Instructor:
Office Hours:
Course Website:
SOWO 855
Treatment of Trauma and Violence
Tuesdays 9-11:50 pm, Fall Semester 2008
Melissa D. Grady, Ph.D., L.C.S.W.
TTK 563-H; 919-843-0063
mgrady@email.unc.edu
Mondays 11:30-1:30 and Tuesdays 12:30-1:30 pm and by appointment
is available through http://blackboard.unc.edu
Course Description:
Course reviews explanatory models of trauma and violence within the social context. Students will learn
beginning skills for intervening in a variety of direct practice settings with diverse client populations.
Course Objectives:
1. Critical Understanding of Theory for Practice: Students will demonstrate a critical
understanding of the primary explanatory theories of violence (e.g. feminist, socio-cultural) as
well as a capacity to explain how these theories inform and guide social work practice decisions.
2. Comprehensive Assessment: Students will demonstrate the ability to assess clients for trauma
histories, understand risk and resiliency issues for this population and formulate a case using CBT.
3. Knowledge of and Skills in Best Practices: Students will be able to use their assessment skills to
develop a comprehensive treatment plan based on evidence, client needs/issues and the students’
knowledge of theory to adequately address the issues facing clients. Students will demonstrate
knowledge of and skill in best practices for trauma survivors and perpetrators of sexual abuse
(based on current empirical knowledge and theories) as well as an understanding of the importance
of simultaneously intervening with frequently co-occurring problems (e.g. mental health and
substance abuse problems).
4. Understanding impact of Diversity: Students will assess and evaluate how current assessment
instruments and treatment practices effectively address issues related to diversity, considering age,
class, color, culture, disability, ethnicity, family structure, gender, marital status, national origin,
race, religion, spiritual development, sex, and sexual orientation, and populations at risk.
5. Values, Ethics and Self-Awareness: Using professional ethics and values as guidelines, students
will demonstrate a capacity to manage their own personal values and feelings related to violence
and trauma.
Expanded Course Description:
Building on foundation practice skill knowledge, this course aims to build and extend students’ capacity
to assess and intervene in the area of trauma and violence. This course will cover issues related to the
assessment and treatment of multiple forms of trauma (e.g. combat, sexual abuse, domestic violence)
using primarily trauma theory and cognitive-behavioral lenses. In addition, other evidence-based models
designed to treat survivors of trauma will be presented and evaluated. Since interpersonal trauma could
not occur without the perpetrator, this course will discuss information on the perpetrators of violence and
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abuse, including the skills needed to treat this population. Trauma and violence can significantly impact
providers, therefore, there will also be focus on self-care and vicarious traumatization for the worker.
Social work practice in the area of trauma can present unique challenges for social justice, the interaction
between policy and direct practice, and self-awareness of personal values and feelings. Building on
students’ foundation knowledge of social justice, policy and professional values and ethics, this course
aims to extend students’ capacity to 1) attend to issues of social justice specific to trauma and violence; 2)
recognize how policy shapes and can determine interventions for individuals and family systems; 3)
manage personal feelings and values that may affect their ability to practice social work in the area of
trauma.
Required Texts:
Taylor, S. (2006). Clinician’s guide to PTSD: A cognitive-behavioral approach. New York, NY: The
Guilford Press.
Zayfert, C. & Becker, C.B. (2007). Cognitive-behavioral therapy for PTSD: A case formulation
approach. New York, NY: The Guilford Press.
Recommended Text:
Follette, V.M. & Ruzek, J.I. (Eds.). (2006). Cognitive-behavioral therapies for trauma (2nd ed.). New
York, NY: The Guilford Press.
Other Readings:
All other readings will be on the Blackboard website for the course.
Class Assignments:
There are three required papers for this course. Please see the appendices of the syllabus for a thorough
description of the assignments and the grading criteria that will be used to evaluate the contents of the
papers.
Please put your PID ONLY on the papers – NOT your name – on any written work or assignments that
you turn into the instructor.
Class Participation:
It is expected that students will be active members of the class. Therefore, the following grading rubric
will be used for class participation.
94-100 is for to those students who have consistently attended and have been active regularly in class.
90-93 is for students who have missed one class, but who regularly participate.
85-89 is for students who have either attended regularly, but do not participate often, or for students who
participate, but do not have very regular attendance (miss 2 classes).
80-84 is for students who have do not participate actively, but may have fairly regular attendance (2
classes).
Under 80 means that the student has irregular attendance (3 or more classes), and has demonstrated
through class discussions that s/he has not done the readings or actively disengages with class activities.
855 – Grady Fall 2008
Policy on Incompletes and Late Assignments:
It is expected that assignments will be completed at times noted in the syllabus. If you have a situation
arise that may prohibit you from completing the assignment on time, any request for delay of an
assignment/exam must be done in advance of the due date (at least 24 hours) on an assignment/exam.
Approved delays will not affect the grade. Any unapproved delays or assignments completed after an
approved delay date will begin to accrue a 10% reduction every 24 hours that the assignment is late.
Papers are due at the start of class. Papers that are handed in after the beginning of class will be
considered late and there is a 10% deduction for every 24 period past the due date/time of the paper. In
other words, if the paper is due at 2:00, and turned in at 11:00 pm that night, there will be a 10%
deduction. The clock begins at the start of class.
If the student meets unavoidable obstacles to meeting the time frame, the student should discuss the
circumstances with the instructor to determine if an initial grade of incomplete (INC) would be
appropriate. I prefer not to give an incomplete grade and will give incompletes only in compliance with
University policy.
Distribution of assignments for course grade
Case Formulation Assignment – 25%
Treatment/Intervention Plan Assignment – 35%
Evidence-Based Practice Paper – 30%
Class Participation – 10%
Grading
All grades are converted to the following scale:
94 and above
H
80-93
P
70-79
L
69 and below
F
In order to be as objective as possible in my grading of your assignments,
use your student PID number. DO NOT USE YOUR NAME.
You will lose 5 points if your name is included.
Policy on Academic Dishonesty
Please refer to the APA Style Guide, The SSW Manual, and the SSW Writing Guide for information on
attribution of quotes, plagiarism and appropriate use of assistance in preparing assignments. All written
assignments should contain a signed pledge from you stating that, "I have not given or received
unauthorized aid in preparing this written work". In keeping with the UNC Honor Code, if reason exists
to believe that academic dishonesty has occurred, a referral will be made to the Office of the Student
Attorney General for investigation and further action as required.
Policy on Accommodations for Students with Disabilities:
Students with disabilities which affect their participation in the course may notify the instructor if they
wish to have special accommodations in instructional format, examination format, etc. Please contact the
University’s Disability office to request the paperwork necessary for approved accommodations.
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855 – Grady Fall 2008
Use of Laptops or other electronic devices
No laptops or other electronic devices are permitted in the classroom, unless you have a specific
documented learning disability. Please turn off all cell phones or other devices that would disrupt the
learning environment of the classroom.
APA Formatting
It is an expectation of this course that you will correctly cite all of your material following the 5th ed. of
the APA manual. If you are not familiar with this style, please refer to the manual, the study guide on the
school’s website or see Diane Wyant, the School’s editor at dwyant@email.unc.edu
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855 – Grady Fall 2008
Course Schedule:
August 19
Class 1 - Introductions
August 26
Class 2 – Explanatory theories of violence
September 2 Class 3 – Impact of trauma
September 9 Class 4 – Intro to Trauma theory and CBT
September 16 Class 5 – Case Formulation
September 23 Class 6 – CBT Interventions: Cognitive
September 30 Class 7 – CBT Interventions: Behavioral
Case Formulation Paper Due in Class
October 7
Class 8 – Treatment Planning/Creating a treatment plan
October 14
Class 9 - Exposure Therapy
October 21
Class 10 – Trauma-focused CBT with Children
October 28
Class 11 – Interpersonal Violence
November 4
Class 12 – EMDR and guided imagery
Treatment Plan/InterventionPaper Due
November 11 Class 13 – DBT and trauma treatment
November 18 Class 14 – Perpetrators of sexual violence
November 25 Class 15 – Application of CBT with other disorders
December 2
Class 16 – Self-care/Vicarious traumatization and course wrap-up
Evidence-Based Practice Paper
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Course Outline:
Session 1: Introduction
• Student/Instructor introductions
• Overview of course
• Discussion of self-care and vicarious traumatization
• Duty to warn – ethics of working within trauma
Session 2: Explanatory theories of Trauma and Violence
• Review of theories of the origins of trauma
• Focus on how these models of violence impact direct practice intervention strategies, as well as
policies related to survivors and perpetrators
Readings:
Gilligan, J. (1996). Shame: The emotions and morality of violence. In Violence: Reflections on a national
epidemic (pp. 103-136). New York, NY: Vintage Books.
Malik, N.M., & Lindahl, K.M. (1998). Aggression and dominance: The roles of power and culture in
domestic violence. Clinical Psychology: Science and Practice, 5(4), 409-423.
Johnson, R. (2004). Theories of violence and their influence on the practice of counseling. Psychotherapy
in Australia, 10(4), 40-44.
Van Soest, D., & Bryant, S. (1995). Violence reconceptualized for social work: The urban dilemma.
Social Work, 40(4), 549-557.
Session 3: Impact of Trauma and Violence on Physical and Mental Health
• Consequences/Symptomatology of trauma
• Normal responses to trauma vs. PTSD (Types I and II)
• Who needs treatment?
• Assessment strategies for victims/survivors
Readings:
Taylor text – Chapters 1, 2 and 6
Courtois, C. A. (2004). Complex trauma, complex reactions: Assessment and treatment. Psychotherapy:
Theory, Research, Practice, Training, 41(4), 412-425.
855 – Grady Fall 2008
Pratt, E.M., Brief, D.J., & Keane, T.M. (2006). Recent advances in psychological assessment of adults
with posttraumatic stress disorder. In V.M. Follette & J.I. Ruzek (Eds.) Cognitive-behavioral
therapies for trauma (2nd ed.) (pp. 34-61). New York, NY: The Guilford Press.
Stamm, B.H., & Friedman, M.J. (2000). Cultural diversity in the appraisal and expression of trauma. In
A.Y. Shalev, R. Yehuda, & A.C. McFarlane (Eds.) International handbook of human response to
trauma (pp. 69-85). New York, NY: Kluwer Academic/Plenum Publishers.
Session 4: Introduction to CBT and trauma theory
• Overview of CBT: tenets, understanding cycles
• Overview of trauma theory: stages of recovery, role of worker in each stage
• Impact of policies on delivery of services
• How access of services/power/discrimination limits availability of services
Readings:
Zayfert & Becker – Chapter 1
Lebowitz, L., Harvey, M., & Herman, J. (1993). A stage-by-stage dimension model of
recovery from sexual trauma. Journal of Interpersonal Violence, 8(3), 378-391.
Wright, J.H., Basco, M.R., & Thase, M.E. (2006). Basic principles of cognitive-behavioral therapy. In
Learning cognitive-behavioral therapy: An illustrated guide (pp. 1-26). Washington D.C.:
American Psychiatric Press.
Session 5: Developing a Case Formulation
• How does CBT explain PTSD symptoms?
• Develop a case formulation based on CBT concepts
• Practice with cases
Readings:
Zayfert & Becker – Chapters 2 and 3
Taylor – Chapter 8
Wright, J.H., Basco, M.R., & Thase, M.E. (2006). Assessment and formulation. In Learning cognitivebehavioral therapy: An illustrated guide (pp. 45-63). Washington D.C.: American Psychiatric
Press.
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Session 6: CBT Interventions: Cognitive Interventions
• Increase application of CBT model to treatment process
• Practice types of interventions used with CBT
• Cognitive Restructuring
Readings:
Zayfert & Black – Chapters 5 and 8
Taylor – Chapters 10 and 11
Session 7: CBT Interventions: Behavioral Interventions
• Increase application of CBT model to treatment process
• Practice types of interventions used with CBT
• Behavioral Techniques
Readings:
Taylor – Chapter 9
Wright, J.H., Basco, M.R., & Thase, M.E. (2006). Behavioral methods I. In Learning cognitivebehavioral therapy: An illustrated guide (pp. 123-150). Washington D.C.: American Psychiatric
Press.
Wright, J.H., Basco, M.R., & Thase, M.E. (2006). Behavioral methods II. In Learning cognitivebehavioral therapy: An illustrated guide (pp. 151-172). Washington D.C.: American Psychiatric
Press.
Session 8: Treatment Planning/Creating a Treatment Plan
• Role Plays of cases
• Creation of treatment plans for cases in class
• Complex issues in treatment
Readings:
Zayfert & Becker – Chapters 4, 9 and 10
Jaycox, L.H., Zoellner, L., & Foa, E.B. (2002). Cognitive-behavioral therapy for PTSD in rape survivors.
Journal of Clinical Psychology, 58(8), 891-906.
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Session 9: Exposure Therapy
• Principles of exposure therapy
• Use of exposure therapy with war veterans
Readings:
Zayfert & Becker – Chapters 6 and 7
Riggs, D.S., Cahill, S.P., & Foa, E.B. (2006). Prolonged exposure treatment of posttraumatic stress
disorder. In V.M. Follette & J.I. Ruzek (Eds.) Cognitive-behavioral therapies for trauma (2nd ed.)
(pp. 65-95). New York, NY: The Guilford Press.
Session 10: Trauma-Focused CBT with Children
• Application of CBT principles to children
• Differences in use with children
Readings:
Cohen, J. A., Mannarino, A.P., Berliner, L., & Deblinger, E. (2000). Trauma-focused cognitive behavioral
therapy for children and adolescents: An empirical update. Journal of Interpersonal Violence,
15(11), 1202-1223.
Deblinger, E., Thakkar-Kolar, R., & Ryan, E. (2006). Trauma in childhood. In V.M. Follette & J.I. Ruzek
(Eds.) Cognitive-behavioral therapies for trauma (2nd ed.) (pp. 405-432). New York, NY: The
Guilford Press.
Ronen, T. (2007). Cognitive behavior therapy with children and adolescents. In T. Ronen, & A. Freeman
(Eds.), Cognitive behavior therapy in clinical social work practice (189-211). New York, NY:
Springer Publishing Company.
Session 11: Interpersonal Violence
• Specific needs for this population regarding intervention and assessment
• Safety planning
• Social justice issues – impact of acculturation, immigration, cultural norms, discrimination within
larger society
Readings:
Bograd, M. (1999). Strengthening domestic violence theories: Intersections of race, class, sexual
orientation, and gender. Journal of Marital and Family Therapy, 25(3), 275-289.
Kubany, E.S., & Watson, S.B. (2002). Cognitive trauma therapy for formerly battered women with
PTSD: Conceptual bases and treatment outlines. Cognitive and Behavioral Practice, 9, 111-127.
Roberts, A. R. (2002). Myths, facts, and realities regarding battered women and their children: An
overview. In A.R. Roberts (Ed.) Handbook of domestic violence intervention strategies: Policies,
programs, and legal remedies (pp. 2-22).
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Session 12: EMDR and Guided Imagery
• Principles of EMDR
• Application of EMDR to trauma survivors
• Guided Imagery
Readings:
Edmond, T., Sloan, L., & McCarty, D. (2004). Sexual abuse survivors’ perceptions of the effectiveness of
EMDR and eclectic therapy. Research on Social Work Practice, 14(4), 259-272.
Naparstek, B. (2004). How and why imagery heals trauma. In Invisible heroes: Survivors of trauma and
how they heal (pp. 149-179). New York, NY: Bantam Dell.
Shapiro, F., & Maxfield, L. (2002). Eye movement desensitization and reprocessing (EMDR):
Information processing in the treatment of trauma. Psychotherapy in Practice, 58(8), 933-946.
Session 13: DBT and trauma
• Application of DBT to trauma population
• Basic principles of DBT
Readings:
Lynch, T.R., Chapman, A.L., Rosenthal, M.Z., Kuo, J.R., & Linehan, M.M. (2006). Mechanisms of
change in Dialectical Behavioral Therapy: Theoretical and empirical observations. Journal of
Clinical Psychology, 62(4), 459-480.
Wagner, A.W., & Linehan, M.M. (2006). Applications of dialectical behavior therapy to posttraumatic
stress disorder and related problems. In V.M. Follette & J.I. Ruzek (Eds.) Cognitive-behavioral
therapies for trauma (2nd ed.) (pp. 117-145). New York, NY: The Guilford Press.
Sessions 14: Perpetrators of Sexual Abuse – Who are they?
• Demographics
• Theories of causation
• Treatment using CBT
Readings:
Grady, M. D. (in press). Sex offenders part I: Theories and models of etiology, assessment and
intervention. Social Work in Mental Health.
Ward, T., Hudson, S.M., & Johnston, L. (1997). Cognitive distortions in sex offenders: An integrative
review. Clinical Psychology Review, 17(5), 479-507.
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Sessions 15: Application of CBT to other mental health issues
• Using CBT to address other mental health issues
• Transferring model to other populations
Readings:
Read 2 of the following that interest you the most.
(Please let me know if there is topic that interests you that is not here and I can try to find it for you.)
Daoud, L., & Tafrate, R.C. (2007). Depression and suicidal behavior: A cognitive behavior therapy
approach for social workers. In T. Ronen, & A. Freeman (Eds.), Cognitive behavior therapy in
clinical social work practice (401-418). New York, NY: Springer Publishing Company.
Himle, J.A. (2007). Cognitive behavior therapy for anxiety disorders. In T. Ronen, & A. Freeman (Eds.),
Cognitive behavior therapy in clinical social work practice (pp. 375-399). New York, NY:
Springer Publishing Company.
Malkinson, R. (2007). Grief and bereavement. In T. Ronen, & A. Freeman (Eds.), Cognitive behavior
therapy in clinical social work practice (521-550). New York, NY: Springer Publishing Company.
Najavits, L.M. (2006). Seeking Safety: Therapy for posttraumatic stress disorder and substance use
disorder. In V.M. Follette & J.I. Ruzek (Eds.) Cognitive-behavioral therapies for trauma (2nd ed.)
(pp. 228-257). New York, NY: The Guilford Press.
Walsh, B.W. (2006). Cognitive treatment. In Treating self-injury: A practical guide. New York, NY:
Guilford Press.
Session 16: Self-Care/Vicarious Traumatization and Course wrap-up
• Self-care techniques
• How to recognize vicarious traumatization
• Changes in personal schemas
Readings:
Bride, B.E. (2007). Prevalence of secondary traumatic stress among social workers. Social Work, 52(1),
63-70.
Ryan, K. (1999). Self-help for the helpers: Preventing vicarious traumatization. In N.B. Webb (Ed.) Play
therapy with children in crisis: Individual, group and family treatment (pp. 471-491). New York,
NY: The Guilford Press.
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Case Formulation Paper
Social Work 855: Treatment of Trauma and Violence
Objective: The purpose of this assignment is to practice and demonstrate the ability to formulate/describe
a clinical case using a CBT framework. The student is to assess the presenting problems of the case and
link their assessment back to the CBT model of assessment.
Description: The student will be given a choice of cases that s/he may choose for this paper. It is always
recommended that the student choose a case that it outside of their previous experience to increase their
learning on this assignment. Once the student has read the case, then s/he should describe the symptoms
and presenting problem using CBT as an explanatory model. Each symptom should be listed, and then an
explanation of why the person has those symptoms should be explained. See Zayfert and Becker pages
30-38 for examples. This process should be done for the presenting problem as well, if it is separate from
the symptoms described in the case. This paper should be approximately 5 pages.
Grading Criteria:
1. Each of the symptoms in the case is listed. (10 pts.)
2. The student has provided a thorough and clear explanation for each of the symptoms in the case.
(25 pts.)
3. The explanation is consistent with the CBT model. (15 pts.)
4. Within the explanation, there is a discussion as to the purpose or functionality of each of the
symptoms. (5 pts.)
5. There is a discussion of social justice issues or other broader issues that might play a role in this
case, such as lack of access to services, or homophobia. (15 pts.)
6. The student has written a formulation summarizing the issues/presenting problem for the case (1-2
paragraphs). (15 pts.)
7. The writing is clear with NO errors. (10 pts.)
8. APA formatting is used to document ideas that are not the student’s. (5 pts.)
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Treatment Plan/Intervention Paper
Social Work 855: Treatment of Trauma and Violence
Objective: The purpose of this paper is to help students develop a thorough and consistent plan for
intervention based on their assessment of a client’s needs.
Description: This paper is to build on the previously completely Case Formulation paper. Students will
take the previously completed assignment and create a treatment plan that is based on their assessment of
the client. The treatment plan should be consistent with the assessment, meaning that the interventions
should address the symptoms that were originally brought up in the assessment, and the types of
interventions (e.g. modality, duration, specific skills) should match up clearly with the problems listed
and causes for those problems, as discussed in the assessment. The treatment plan should be clear, with
clearly written goals, objectives that are measureable, realistic time frames for completion and should be
consistent with the client’s needs as well as his/her cultural background. In addition, the modality or
modalities of treatment (e.g. group, individual, family) should discussed and a rationale given for the
decision for that choice. Included in your plan should also be any other interventions that you feel are also
important to the treatment outside of the CBT model. These could include but are not limited to the
creation of a safety plan, a referral to another agency for additional assistance, advocacy work, addressing
social justice issues on behalf of your client on a policy level, inclusion of a spiritual leader. Think outside
the box here. This paper should be approximately 6-8 pages.
The Case Formulation Paper should also be included when turning in this paper.
Grading Criteria:
1. For each intervention, there is an appropriate goal and 2-3 objectives listed for each issue being
addressed written properly. (15 pts.)
2. For each of the symptoms listed for the client, the student has listed an appropriate intervention to
address the symptoms/problem that is consistent with the stated problem/symptom. (20 pts.)
3. For each intervention, there is an appropriate time-frame provided for when the goal should be
met. (5 pts.)
4. For each intervention, there is an appropriate method of evaluation for how to determine whether
the goals and objectives have been met. (5 pts.)
5. The interventions are consistent with the client’s individual needs in terms of their culture, gender,
sexual orientation, religion, class, language or other issues of diversity. (15 pts.)
6. The appropriate modality or modalities are recommended for treatment (e.g. individual, family,
group). (5 pts.)
7. Other non-CBT/direct therapeutic interventions have been considered that would address the
needs of the client. (15 pts.)
8. All interventions are clearly described and written in client-friendly language. (5 pts.)
9. The paper is clearly written with NO writing errors. (10 pts.)
10. APA formatting is followed. (5 pts.)
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Evidence Based Practice Paper
Social Work 855: Treatment of Trauma and Violence
Objective: A major part of what you will do as a practitioner is to provide a rationale to your clients, your
clients’ family members, or insurance providers for the intervention choices you recommend and carry
out with your clients. This paper is aimed to help you practice gaining the skills to both explain the
reasons for your choices, as well as determine through the available research whether what you are
recommending is appropriate for your client.
Description: In this paper, you are to provide a rationale as to why you feel that the treatment plan you
created for your client in the previous assignment was an appropriate plan or not. Your paper should in
essence explain how well the intervention model you used, namely CBT, fit with the assessment you
completed of the client’s needs. This explanation should include how well the specific interventions
matched up with the needs of the client, both in terms of their symptoms as well as broader needs or
social justice issues. This paper should also include a discussion of the outcome literature regarding CBT
and the treatment of individuals who have suffered from a trauma. What does the research say about the
efficacy of CBT in the treatment of PTSD? In addition, you should provide a rationale for other
interventions that you recommended for your client that were outside of the CBT framework. This paper
should be about 5 pages and a minimum of 5 references should be included that were not assigned
readings for this course.
Grading Criteria:
1. There is a clear rationale provided regarding how well or NOT well, the student feels the CBTbased treatment plan fit with the symptoms of the client. (20 pts.)
2. There is a clear rationale provided regarding the other proposed interventions provided in the
treatment plan. (15 pts.)
3. There is a discussion regarding how well the student feels CBT meets the specific needs of the
client, in terms of their culture, sexual orientation, age, gender, spirituality and other issues of
diversity. (15 pts.)
4. The student summarized relevant literature to support his/her position regarding the choice of CBT
for someone who is diagnosed with PTSD. (20 pts.)
5. At least 5 resources outside of class were used. (10 pts.)
6. The writing was clear with NO errors. (10 pts.)
7. APA formatting was used throughout the paper. (10 pts.)