Elaine K Hammond, LMSW
ehammond@buffalo.edu
 Psychological trauma is the loss of faith that there
is order and continuity in life. Trauma occurs
when one losses the sense of having a safe place to
retreat within or outside oneself to deal with
frightening experiences or emotions. This results
in a state of helplessness, a feeling that one’s
actions have no bearing on the outcome of one’s
life. Since human life seems to be incompatible
with meaninglessness and lack of control, people
will attempt to avoid this experience at just about
any price, from abject dependency to psychosis (van
der Kolk, 1987)
What we drag
around may
impair our
ability to
move again
in community
with others
Trauma Informed Practice:
Will avoid inadvertent retraumatization and will
facilitate consumer participation in treatment (Harris & Fallot,
2001)
 Safety
 Trustworthiness
 Choice
 Collaboration
 Empowerment
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Safety: includes where services are offered; time of day that services are offered; security
personnel available, open doors or locked and the affect that each has on consumers;
waiting room appearance; are all staff members attentive to signs of consumer discomfort
and do they recognize these signs in a trauma informed way.
Trustworthiness: includes providing clear information about what will be done, by
whom, when, why and under what circumstances; respectful and professional
boundaries; is unnecessary consumer disappointment avoided; is informed consent
taken seriously on a consistent basis?
Choice: includes how much choice consumers have over the services they receive (such as
time of day, gender preferences for service providers, etc.); are consumers provided a
clear and appropriate message about their rights and responsibilities?
Collaboration: includes giving consumers a significant role in planning and evaluating
services; consumer preference is given in areas of service planning, goal setting, and
developing treatment priorities; cultivating an atmosphere of doing “with” rather than
doing “to” or “for”; conveying the message that the consumer is the expert in their own
life?
Empowerment: includes recognizing consumer strengths and skills; building a realistic
sense of hope for the client’s future; provide an atmosphere that allows consumers to feel
validated and affirmed with each and every contact at the agency
(Fallot & Harris, 2006)
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Safety: includes where services are offered; time of day that services are offered; security
personnel available, open doors or locked and the affect that each has on practitioners; waiting
room appearance; are all staff members attentive to signs of practitioner discomfort and do
they recognize these signs in a trauma informed way.
Trustworthiness: includes providing clear information about what will be done, by whom,
when, why and under what circumstances; respectful and professional boundaries; is
unnecessary practitioner disappointment avoided; is informed consent taken seriously on a
consistent basis?
Choice: includes how much choice practitioners have over the services they provide; are
practitioners provided a clear and appropriate message about their rights and responsibilities?
Collaboration: includes giving practitioners a significant role in planning and evaluating
services; practitioner preference is given in areas of organizational planning, goal setting, and
developing treatment priorities; cultivating an atmosphere of doing “with” rather than doing
“to” or “for”; conveying the message that the practitioner is the expert in their own life?
Empowerment: includes recognizing practitioner strengths and skills; building a realistic sense
of hope for the practitioner’s future; provide an atmosphere that allows practitioners to feel
validated and affirmed with each and every contact at the agency
(Fallot & Harris, 2006)
 * For this discussion, this term includes all staff, clinicians,
supervisors and administrators.
Sickness Model
What’s Wrong With You?!
Sickness implies that the cause of the problem is within the sufferer
Sickness implies individual weakness or defect and stabilization
may be all we can do
Sickness implies passivity, helplessness
Sickness relies largely on “expert” knowledge; patients are expected
to be “compliant” and are reprimanded if they are not
Sickness denies personal and social accountability
Injury Model
What’s happened to you?
Includes physical, psychological, social,
and moral forms of injury
Includes deprivation, neglect, and developmental
insult
Implies rehabilitation process that is mutual, long
term: Requires active collaborative relationship
between helper and injured party
Removes stigma and shame
Provides understandable shared framework
Increase in compassion, increase in expectations
 Secondary traumatic stress (STS)
 …the natural, consequent behavior and emotions that
result from knowledge about a traumatizing event
experienced by another and the stress resulting from
helping or wanting to help a traumatized or suffering
person. The symptoms are identical to those of PTSD
(Catherall, 1995).
 Think of this in behavioural terms
 Partly a function of the requirement for constant empathic
response and repressed emotion
 Generally a process, yet may be from a single event
 Vicarious traumatization (VT
 …the cumulative transformative effect on the helper of
working with survivors of traumatic life events, both
positive and negative (McCann & Pearlman, 1990).
 Can be considered a specific manifestation of
countertransference, except the “client” never goes away
 Think of this in terms of altered world view
 Repeated exposure to trauma narrative may affect personal
sense of safety, trust & control (Newell & MacNeil, 2010).
 Compassion fatigue (CF)
 …the natural, predictable, treatable, and preventable
unwanted consequence of working with suffering people
(Figley, 1995).
 Also cumulative
 Not specific to trauma work
 In organizations like ours, parallel process means a
complex interaction among traumatized clients,
stressed staff, pressured organizations, and
difficult systems.
“What happens here affects us too….If we don’t spend the time
dealing with that, we burn out, we aren’t as effective, and ultimately
we can’t do as good a job.” Staff member, Baker Victory Services
• Self care
• Training
• Supervision
• Choice of interventions
• Experience
Professional
Resources
Personal
Resources
• Personal history
• Relationships
• World View
• Mindfulness
• Self Care
Compounding/Confounding
traits:
Surviving or Thriving
 Safety
Trustworthiness
Choice
Collaboration
Empowerment
 How are you feeling?
What is your goal?
Who can help you?
 How might TI praxis inform your daily work?
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Acknowledge that the work affects us all.
Seek – and offer - support
Don’t quit too soon.
Acknowledge when things go well.
 Neurohormonal Effects
 Lower serotonin (impulsivity, sleep problems,
aggression)
 High levels of endogenous opioids (numbing, interferes
w/memory)
 High levels of catecholamines (epinephrine &
norepinephrine: anxiety, panic, interferes w/memory)
 Chronic stress: depletion of endogenous opioids
 SNS: (Sympathetic nervous system)
 Prepare for Threat
 Adrenal glands: hormones to prepare for fight, flight or
freeze.
 Epinephrine and norepinephrine
 PNS: Reestablish Homeostasis (Parasympathetic
Nervous System)
 Pituitary & Adrenal Glands hormones to bring body
back to normal (rest/recovery)
 Cortisol, glucocorticoids (endogenous opioids)
 Extreme autonomic arousal (e.g., heart rate, blood
pressure) to stimuli reminiscent of the trauma
 Hyperarousal to intense, but neutral stimuli (loss of
stimulus discrimination)
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GI issues:
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Headache
Back Pain
Limb pain/numbness
Tightness in chest
Heart racing/palpitations
Body heaviness – sense of slow motion
Tingling sensations
Muscle tension:
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Upset stomach, Butterflies, Nausea, Diarrhea/constipation
Brow, jaw, fists, shoulders, abdomen, thighs, toes
Sweating
Difficulty swallowing/lump in throat
Sore throat/dry mouth
Watering eyes/tearing/loss of peripheral vision/tunnel vision/”going dark”
Ringing in the ears, temporary loss of hearing
Feeling faint
Feeling “frozen”
Changes in breathing
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Shortness of breath, shallow breath/quickened breath
Pre-Frontal Cortex
Five Senses
Integration and
Planning
Thalmus
Hippocampus
Cognitive Map
Amygdala
Emotional
Significance
 Sleep
“Sleep like a baby”
or in this case, like Putnam…
 Nutrition
 Movement
 Challenges to breathing that supports the nervous
system
 First: acknowledge the challenges
 Softening the abdomen
 Prohibitions for this for both men and women
 May hold body memory of physical trauma
 Find private space, such as your car, private stall bathrooms
 Words
 May be triggers to past trauma
 Both ‘breathe’ and ‘relax’ can sound dismissive
 Try ‘rest’, ‘soothe’ or ‘comfort’
 Prepare/contract for the word ‘breathe’ ahead of time
 “A core aspect of the mind can be defined as an embodied and
relational process that regulates the flow of energy and
information.” Dan Siegel
 1: the element or complex of elements in an individual that feels,
perceives, thinks, wills, and especially reasons
 2: the conscious mental events and capabilities in an organism
 3: the organized conscious and unconscious adaptive mental
activity of an organism Mirriam-webster.com
 the element of a person that enables them to be aware of the
world and their experiences, to think, and to feel; the faculty of
consciousness and thought. Oxforddictionaries.com
 Psychological trauma is the loss of faith that there
is order and continuity in life. Trauma occurs
when one losses the sense of having a safe place to
retreat within or outside oneself to deal with
frightening experiences or emotions. This results
in a state of helplessness, a feeling that one’s
actions have no bearing on the outcome of one’s
life. Since human life seems to be incompatible
with meaninglessness and lack of control, people
will attempt to avoid this experience at just about
any price, from abject dependency to psychosis (van
der Kolk, 1987)
 How can we assess attributes of life meaning?
 What do you find beautiful?
 What do you look forward to about growing older?
 What do you think happens to us when the body dies?
 What is one thing you would like people to remember
you for?