Empowerment 101: Understanding
and Treating Trauma
Misty McIntyre Goodsell, LCSW
Chris Adams Hill, LCSW
South Valley Therapy
www.southvalleytherapy.com
Objectives
• Increase awareness of Large T and little t
trauma
• Increase awareness of symptoms of PTSD
• Tools and techniques for working with
survivors
• Increase tools and understanding for
building empowerment
South Valley Therapy
www.southvalleytherapy.com
Empowering the Therapist
South Valley Therapy
www.southvalleytherapy.com
PTSD: Prevalence
• 7%-8% of US population will have PTSD at
some point in their lives
• Combat soldier and assault victims have
rates as high as 60%
• About 5.2 million adults have PTSD during a
given year
• Women are more likely than men to develop
PTSD: 10% vs. 5% during their lifetimes
www.ptsd.va.gov
South Valley Therapy
www.southvalleytherapy.com
Stages of Recovery
South Valley Therapy
www.southvalleytherapy.com
Pre-Step: Disclosure
• Education
South Valley Therapy
www.southvalleytherapy.com
Stage 1
• Establishing Safety and
Security
• Assess Risk
• Assessing Strengths
• Installation of Hope
• Symptom Reduction
• Skill Building
• Mindfulness
South Valley Therapy
www.southvalleytherapy.com
• Assess Impact of
Trauma
• Identify Trauma-Based
Beliefs
Stage 2
•
•
•
•
Reprocessing Trauma
Work Through Grief / Mourning
Challenging Trauma-Based Beliefs
Replace trauma-based beliefs with positive
reality-based beliefs and/or affirmations =
EMPOWERMENT
South Valley Therapy
www.southvalleytherapy.com
Stage 3
• Build Resiliency
– Increase the support system
– Increase sense of self-worth
– Increase sense of self-efficacy
– Self-Care
– Build/Strengthen spiritual self
– Build / Participate in community
South Valley Therapy
www.southvalleytherapy.com
BIG T or little t
South Valley Therapy
www.southvalleytherapy.com
BIG T
• DSM criteria for PTSD
South Valley Therapy
www.southvalleytherapy.com
Small t
• They don’t meet
criteria for PTSD
– Usually not lifethreatening
– Terror and fear
– PTSD symptoms less
than 5 of the criteria
South Valley Therapy
www.southvalleytherapy.com
• Examples
–
–
–
–
–
–
–
Divorce
Bullying
Neglect
Car Accident
Loss of a pet
Medical Crisis
Verbal Abuse
PTSD: Signs and Symptoms
• Intrusive thoughts about the event
• Nightmares or distressing dreams
• Acting or feeling as if the event is
reoccurring
– Illusions, hallucinations, flashbacks
• Intense psychological distress at exposure to
internal or external triggers
– Physiological reactivity to triggers
South Valley Therapy
www.southvalleytherapy.com
PTSD: Signs and Symptoms
• Persistent avoidance of stimuli associated
with the trauma
• Persistent symptoms of increased arousal
(not present before the trauma)
– Difficulty falling or staying asleep
– Irritability or outbursts or anger
– Difficulty concentrating
– Hyper-Vigilance
– Exaggerated startle response
South Valley Therapy
www.southvalleytherapy.com
• Event factors
PTSD Risk
– Intensity and duration of exposure to the event
– Extent of brutality
– Sense of betrayal
– Threat of dying: not actual threat, perceived
threat
– Degree of unpredictability
– Injury
– Being trapped
– Cultural Context
Naparstak, B (2000) “ invisible Heroes, Survivors of Trauma and How They Heal”
South Valley Therapy
www.southvalleytherapy.com
More likely to develop PTSD if:
• ACES
• Struggle with other
mental health issues
• Have family members
with mental health
issues
• Environmental
•
•
•
•
– Few friends or support •
network
• Recently
loss of a
South Valley Therapy
www.southvalleytherapy.com
loved one (grief and
loss)
Recent stressful life
changes
Heavy Drinker
Are a woman
Poorly educated
Younger
Survivor Response
• Shame
– Shame is a painful feeling about oneself as a
person
• Guilt
– Guilt is a painful feeling of regret and responsibility
for one’s actions
• Fear
– PTSD Responses
South Valley Therapy
www.southvalleytherapy.com
THE BUNNY RABBIT
South Valley Therapy
www.southvalleytherapy.com
Secondary Survivor Response
Common Reactions
• Helplessness
• Fear
• Confusion
• Desire for Revenge
• Self Blame
• Overprotection
South Valley Therapy
www.southvalleytherapy.com
• Loss of routine and
intimacy
• Shame
• Frustration
• Guilt
• Distraction
• Code of Silence
Empowering The Survivor
South Valley Therapy
www.southvalleytherapy.com
Empowerment
• Listen and believe
• Focus on the survivor’s reactions and
feelings
• Assist the survivor in regaining a sense of
control over their life
• Act as an advocate when dealing with police,
medical or legal systems
• Avoid projecting your feelings
South Valley Therapy
www.southvalleytherapy.com
Empowerment Phrases
• “You’ve been through so much AND you are
here”
• “You’ve accessed your strengths (example)
and talents (example). Look how resourceful
you are”
• “You’ve already survived it. The work we are
going to do is about acknowledging your
feelings and taking away the power and
changing the meaning”
• “You are safe in this room” (if true)
South Valley Therapy
www.southvalleytherapy.com
Role of Power and Control
• Main issue in trauma
– Diagnostic criteria
• Healing is allowing the survivor to have as
much control as they can in a healthy way
• They have the power to choose/change the
meaning they make of their traumatic
experience
South Valley Therapy
www.southvalleytherapy.com
LANGUAGE MATTERS
South Valley Therapy
www.southvalleytherapy.com
Do NOT Say Things Like
•
•
•
•
•
•
•
•
I understand…
I’m glad you can share those feelings
You are lucky that…
Don’t worry, it’s going to be alright
It’ll take some time, but you’ll get over it
I can imagine how you feel
Calm down and try to relax
Try to be strong for your children
South Valley Therapy
www.southvalleytherapy.com
Do Say Things Like
•
•
•
•
•
•
•
•
You are safe now (if true)
I’m sorry this happened
I’m glad you are talking to me now
I’m glad you are here with me now
It’s not your fault
Your reaction is common
You’re not going crazy
Things may never be the same, but they can get
better
• I’m here to support you through this
South Valley Therapy
www.southvalleytherapy.com
Working With Secondary Survivors
• Help them to predict what to expect
emotionally for the survivor
• Help them place blame on the assailant or
situation not themselves or the survivor
• Explore positive coping mechanisms
• Model crisis intervention and empowerment
• If they are also survivors, assess their need
for counseling
South Valley Therapy
www.southvalleytherapy.com
Self-Care
• How do you care for yourselves?
South Valley Therapy
www.southvalleytherapy.com
Q&A
South Valley Therapy
www.southvalleytherapy.com