Monday, July 21, 2014

Posttraumatic Growth

There has been some new research coming about on something called posttraumatic growth.  During a presentation last week I mentioned this and very few people in the audience knew about it.  It is primarily a result of resiliency studies in people who have been able to recover from traumatic incidents or even from long term interpersonal trauma.  In order to educate readers about this I have taken the following directly from the University of North Carolina, Charlotte, website.  http://ptgi.uncc.edu/what-is-ptg/

After you read this,  I am sure that you will know of people with whom you have worked who have experienced posttraumatic growth.   In fact, you may also have experienced posttraumatic growth. 

What is PTG?

What is posttraumatic growth? It is positive change experienced as a result of the struggle with a major life crisis or a traumatic event. Although we coined the term posttraumatic growth, the idea that human beings can be changed by their encounters with life challenges, sometimes in radically positive ways, is not new. The theme is present in ancient spiritual and religious traditions, literature, and philosophy. What is reasonably new is the systematic study of this phenomenon by psychologists, social workers, counselors, and scholars in other traditions of clinical practice and scientific investigation.

What forms does posttraumatic growth take? Posttraumatic growth tends to occur in five general areas. Sometimes people who must face major life crises develop a sense that new opportunities have emerged from the struggle, opening up possibilities that were not present before. A second area is a change in relationships with others. Some people experience closer relationships with some specific people, and they can also experience an increased sense of connection to others who suffer. A third area of possible change is an increased sense of one’s own strength – “if I lived through that, I can face anything”. A fourth aspect of posttraumatic growth experienced by some people is a greater appreciation for life in general. The fifth area involves the spiritual or religious domain. Some individuals experience a deepening of their spiritual lives,however, this deepening can also involve a significant change in one’s belief system.


Some Clarifications

Most of us, when we face very difficult losses or great suffering, will have a variety of highly distressing psychological reactions. Just because individuals experience growth does not mean that they will not suffer. Distress is typical when we face traumatic events.

We most definitely are not implying that traumatic events are good – they are not. But for many of us, life crises are inevitable and we are not given the choice between suffering and growth on the one hand, and no suffering and no change, on the other.
Posttraumatic growth is not universal. It is not uncommon, but neither does everybody who faces a traumatic event experience growth.


Our hope is that you never face a major loss or crisis, but most of us eventually do, and perhaps you may also experience an encounter with posttraumatic growth.

Here are some links to other articles on posttraumatic growth:




Monday, July 14, 2014

Teens, Trauma and Relationships

Adolescence is a scary period but even more so for teens who are trauma survivors.    Trauma can make it difficult to parse out what could be normal adolescent development, with all the angst and struggles to separate and mature, versus what impact the history of trauma may be having on the teen.  However, I am going to try and provide some insight into what may be going on and how it impacts teens’ ability to develop healthy relationships. 
Development
In his recent book, Brainstorm: the power and purpose of the teenage brain, Dr. Daniel Siegel describes the overall movement of the teen’s brain to becoming more integrated.  Integration means that more areas of the brain are becoming specialized and interconnected to one another in more effective ways.  This specialization takes place through a process of pruning.  Pruning is the remodeling of the brain, letting go of connections in the brain that are not needed or haven’t been used.  From a trauma perspective, this means that neural pathways that have been strengthened to manage safety or that have been developed as a response to trauma will remain while other pathways that have been ignored due to trauma will be pruned away. 
Dr. Siegel explains that if there is any vulnerability in the brain’s makeup during childhood, adolescence can reveal those brain differences because of the pruning down of the existing but insufficient number of neurons and their connections.  The impact of adverse childhood experiences such as abuse and neglect may become more noticeable because the pruning is unmasking the vulnerabilities that have been lying being the surface.  This also is why major psychiatric disorders (which may be responses to trauma) may express themselves for the first time in adolescence.
Trauma Responses
When the flight, fight or freeze responses engage in adolescents it can lead to long term difficulties.  The fight response is a teen’s struggle to gain or hold onto power, especially when they feel they are being coerced.  The flight response can be seen when a teen disengages, runs away and/or checks out emotionally. The freeze response occurs when a youth gives into those in positions of power and does not or is unable to speak up (Adolescent Health Working Group, 2013, www.ahwg.net).
Teens living in households with ongoing abuse and neglect have probably not been able to learn effective ways to manage their outward emotions and their internal responses.  They may blame themselves for the abuse and feel ashamed about what they have experienced.  They may engage in behaviors to manage their trauma responses in unhealthful and dangerous ways such as with alcohol and drug abuse, self-harm, unhealthy relationships, isolation, and high-risk actions.
Their school performance may be impacted by either under-performing, conflict with school personnel, or skipping classes.  The ability to complete tasks or understand school work can be greatly affected by learning disabilities or impairments that cannot be explained by anything other than the impact of witnessing or experiencing trauma.  Being unable to relate to peers and not feeling able to perform adequately in a school environment can lead to feels of shame and isolation.
Impact on Relationships
As you can well imagine, the above trauma responses would influence relationships that a teen may have during adolescence. There may be ongoing conflict with family members or detachment and isolation in order to avoid more conflict.   They may isolate from their peers because of the shame and guilt they feel about their circumstances and also affiliate with persons who reinforce the bad feelings they have about themselves and/or who are also engaging alcohol/drug use and other risky behaviors in order to validate their own sense of loss, shame and isolation.  Relationships may be modeled after what they have seen in their lives and lead to further abuse.
Interventions
The good news is that strong sustained attachments to safe and nurturing adults and peers can improve a teen’s life.  Within these relationships an adolescent can learn the skills necessary for identifying, expressing, and modulating feelings that arise when he/she is triggered or trying to manage the developmental tasks common to this age group having to do with identity and roles in society.  In addition, teens need to feel competent and be able to plan for and have feelings of control about the future.  Engaging in positive activities that help them discover and nurture latent talents can help increase resiliency and lead to a healthy adulthood.

For more information go to :  http://www.ahwg.net/

Monday, June 23, 2014

It’s All About Feeling Safe

I am often asked about how to help a survivor manage their mental health issues.  The advocate is usually feeling that the “symptoms” are possibly unrelated to domestic violence or sexual assault and the advocate does not feel qualified to address what is happening. 
Yes, there may be instances, such as when a survivor is suicidal or psychotic when an immediate mental health intervention is necessary.  However, the skills that advocates have can be used to help reduce the reactions a person may be having because she does not feel safe in her environment or her body.
Being trauma-informed includes having the understanding that the behaviors that an advocate sees may be directly or indirectly related to the trauma the person has experienced over their lifetime.  These behaviors can range from anxiety to depression, anger to paranoia.  What is important to remember is that what the person probably wants more than anything is to feel safe even when they are yelling at you, refusing to get out of bed, or having difficulty making a decision.  We don’t even have to know what caused the behavior.  We can just start the conversation with “what would help you to feel safe at this moment?” and work from there.
Here are a couple of examples:
A woman is having difficulty going to social services to fill out paperwork.  She gets angry when she is reminded that she needs to do this and she starts avoiding staff rather than following through with the plan.   When sitting with an advocate she may become agitated when she feels the conversation moving toward talking about taking the trip to social services.
The advocate can either remind her that it is necessary that she do this and if she does not follow through she will be reprimanded or the advocate can ask the following questions:
1.        Is there something about the social services office that is stressful for you?
2.       Do you feel safe going to and from the office?
3.       Is there any additional assistance that you need in order to fill out the paperwork?  (She may not feel safe talking about literacy issues and asking for help.)
4.       Do you feel like you aren’t ready to take this step?  (She may be considering returning to her abuser and is afraid to talk to you about it.)
5.       Would you like to do a safety plan around making the trip or do you need a volunteer or staff to accompany you?
There are a number of reasons why she may not be taking the trip to social services but more than likely she does not feel physically or emotionally safe doing so.  She may also be fearful that failure to follow through may mean not being able to receive further services from your program.
A survivor is placed in a hotel room for a few nights due to lack of shelter beds.  She is taken to a local grocery for some food that can be kept in the hotel room refrigerator.  However, she keeps calling the crisis line and staff asking for someone to take her out for a hot meal or more groceries.  Some staff may feel inconvenienced or that the person is trying to get as much free food as possible.  However, the person may be using the frequent calls to staff as a way to touch base with another person.  Hotel rooms can be lonely and the person may be afraid to ask to have her needs met.  She may also need to talk about how she feels about leaving her partner, may not feel safe with her emotions or be fearful of being seen.  It all comes down to wanting to feel safe but not knowing how to ask for it. In many survivors’ lives, asking to get needs met put them at risk of harm.
Even events of extreme paranoia or delusion can be calmed by helping the person find a way to feel safe.  If someone is feeling  they are being watched or that a tracking device has been put on their clothing, it helps to ask a few more questions including “what can I do to help you feel safe?”  It may mean making a couple of changes to the environment in order to help the person feel heard and safer.  More than likely the paranoia and delusion can be traced to some recent or long ago trauma but it is usually evident that the person is not feeling safe in their body or environment. 

Start with what you know and domestic violence and sexual assault advocates know about talking about safety.

Monday, June 9, 2014

As Long As You Are Mobilized You Can’t Shut Down

I went to the 25th Annual Psychological Trauma conference put on by the Trauma Justice Institute in Boston two weeks ago.  I wish I could report on everything that was presented but that would be impossible.  There were a lot of neuroscientists and chemists showing graphs and reading statistics and by the end of the second day of the three day conference a number of us were shuffling around looking brain dead.  It is a good thing we were still walking, though, because one of the important points I wrote down was “as long as you are mobilized, you can’t shut down.”
Stephen Porges said this when he was talking about the polyvagal response ( you can go here for a fairly clear explanation) and I was really struck by the statement.  He was trying to make clear the imperative for movement in times of stress in order to decrease the risk of dissociation (from zoning out to full blown shut down).  Biologically, our bodies need to move in order to regulate.  According to Dr. Porges, our system is constantly monitoring the environment to determine whether or not it is safe (more so for trauma survivors) and when the system is overwhelmed it shuts down.  Movement helps keep the system regulated.
As someone who has been diagnosed with Fibromyalgia and who has developed an understanding of the effects of trauma on the body, I had developed a theory that the nervous system’s response to trauma was the cause of the fibromyalgia.  This theory was validated at the conference by Dr. Porges and there seems to now be more evidence being published.
According to Richard Boyd at http://www.energeticsinstitute.com.au/page/fibromyalgia.htmlPain studies have shown that incomplete pain signals in the body can cause them to be re-sent and even amplified. Fibromyalgia sufferers appear to have a pain signaling problem that is of this nature. The Vagus nerves have been shown to have “communication problems” when traumatised. This is conjecture but a possible framework under which Fibromyalgia exists without showing causes and origins. It may turn out to be a nervous system “network” problem.
So why am I bringing this to your attention?  As advocates we meet a lot of survivors who complain of pain issues and who also dissociate at various levels.  They are often highly medicated  and/or finding ways to retreat from the psychological and emotional pain that are non-productive and reduce physical movement.  The findings that I mention above bring home the point that any opportunity we can provide as domestic violence shelter advocates or as facilitators of support groups to get people up and moving can only increase survivors ability to manage their own trauma responses.  Yoga, tai chi, walking, bicycling, dancing, and swimming are just a few of the ways to help reduce the effects of stress.  If someone is in a lot of physical pain they may need to do gentle yoga or slow walking, but it is still movement. 
I would also, if you are able, take the opportunity to provide support while on a walk.  Is there someplace safe and quiet where you can meet a survivor where you can walk and talk at the same time?  When trying to help someone do an emotional safety plan for the weekend or after a court hearing, recommend movement even if it is just going home where it is safe and putting on some loud music and dancing around the house.

And finally, as advocates we are under a lot of stress.  We don’t even have to be meeting with survivors in order to be influenced by the trauma that they experience.  After attending sessions on child abuse and neglect and human trafficking at last week’s Attorney General’s conference, I needed to be outdoors and moving in order to rid myself of the after effects.  A walk in the woods or bicycling usually helps.  Movement has to be a part of our self care plan as well.

Tuesday, April 29, 2014

Coping with Grief and Loss after Trauma

When someone loses a loved one to death it is recognized that the person will go through a grieving process that is considered acceptable by family and society.  Not only is it accepted but there are rituals to assist the person in mourning the loss and family and friends provide support and companionship at various levels after the death of the loved one. 
Unfortunately the grief that one feels after trauma or the end of an abusive relationship is often not recognized and validated for the one who has experienced the trauma.  In fact, the person who has experienced the loss may not even recognize the grief and loss involved until she has begun the healing process.
Significant traumatic events, particularly interpersonal trauma, extreme physical trauma, and the trauma of war, change the life of person who has experienced it.  The change can actually create a new life in which the person feels the loss of who he or she might have been.  In the loss of a relationship, even one in which the person was abused, she may be mourning the loss of the relationship she was hoping to have rather than the actual one she no longer has.   This grief is rarely recognized or addressed, even though many of the feelings occurring post-trauma can be traced back to grief.
Validation of this loss can provide an opportunity for the person to begin to recognize what she may be feeling.  I have heard people rebel against being called a “victim” or a “survivor” because they did not like the new identity and instead wanted to go back to who they were.  This anger is a part of the grieving process. 

In order to assist a person through this process it may be helpful to ask about personal and culturally appropriate rituals that are used to help and spend some time talking about the loss.  After this loss has been recognized the person may then be willing to look at who they have become since the trauma and the strength and resilience that they carry that has helped them get through both the trauma and the loss.

Monday, April 14, 2014

Moving Beyond Being Trauma-Informed

I have never really felt comfortable with the term “trauma-informed.”  It seems passive and too open to interpretation.  Anyone can pick up a book, read an article, or even a blog post and become informed about trauma.  At its most basic, it implies some knowledge of what trauma is and what it does.  It can also be expanded to be a philosophical underpinning of the work that we do to assist victim/survivors of domestic and sexual violence, an understanding that the effects of trauma are because of what was done to a person rather than there being something wrong with her/him.  However, what we really want to be is “trauma-responsive.”  This moves our programs from the basic understanding of trauma to not only having knowledge of the effects of trauma, but also incorporating activities, policies, and interactions that value the experience of the survivor, assist in finding ways to mitigate the impact of trauma, and reduce the possibility of triggering or re-victimizing.
In order to have a definition of trauma-informed services that addresses the needs of domestic violence survivors, the National Center on Domestic Violence, Trauma and Mental Health created the following working definition of “trauma-informed” that moves beyond passive knowledge to a genuine active response. 
”A trauma-informed program, organization, system, or community is one that has undergone a transformation in awareness about the traumatic effects of abuse and violence and incorporates that understanding into every aspect of its practice or program. In such settings, understanding about trauma is reflected in the knowledge, attitudes, and skills of individuals as well as in organizational structures such as policies, procedures, language, and supports for staff.  This includes attending to culturally specific experiences of trauma and providing culturally relevant and linguistically appropriate services. Any person, system, or setting can be trauma-informed. A DV program that is trauma-informed recognizes that survivors, staff, and others they interact with may be affected by trauma they have experienced at some point in their lives. Central to this perspective is viewing trauma-related responses from the vantage point of “what happened to you” rather than “what’s wrong with you,” recognizing these responses as survival strategies, and focusing on survivors’ individual and collective strengths. Trauma-informed programs are welcoming and inclusive and based on principles of respect, dignity, inclusiveness, trustworthiness, empowerment, choice, connection, and hope. They are designed to attend to both physical and emotional safety, to avoid retraumatizing those who seek assistance, to support healing and recovery, and to facilitate meaningful participation of survivors in the design, implementation, and evaluation of services. Supervision and support for staff to safely reflect on and attend to their own responses and to learn and grow from their experiences is another critical aspect of trauma-informed work.” (Training the Trainers Curriculum, NCDVTMH, 2011)
If your program meets this definition, then it is meeting the needs of survivors in a more active, responsive way.


Monday, March 24, 2014

Practicing Non-Violence Toward Self - an excerpt from a piece by Phillip Moffitt

I read this  over the weekend and thought I would share portions of it with you as part of my short series on self-care.  The full piece can be found at http://dharmawisdom.org/teachings/articles/practicing-nonviolence-toward-self

Understanding Violence

Whenever I introduce the topic of violence against self in a Dharma talk, almost everyone squirms. No one wants to hear it. I will directly ask the question: Are you, in an obvious manner or in a series of subtle, covert actions, being violent with yourself? Usually people want to assure me that while they may work too hard at times, stay in an unhealthy relationship, eat too much, or sleep too little, they would not characterize their behavior as violent toward themselves. Yet, person after person, once they've closely examined their lives, experiences a moment of self-recognition that at first can be painful and embarrassing. This initial discomfort is often followed by a sense of liberation as new possibilities arise in their imaginations for how to live more peacefully.
Most people perpetrate this violence against self through mistakenly identifying with various thoughts that arise due to impersonal conditions coming together. The body and mind's well-being are the innocent victims. Each individual has a unique pattern, but the common ground is that you relate to yourself in a manner that results in your life being more emotionally or physically violent than it need be.
You may have limited your understanding of self-violence to physical abuse or other blatant self-destructive behavior that calls for a 12-step program. The word "violence" may sound too harsh to you, but its dictionary meaning is "an exertion of extreme force to cause injury or abuse in the form of distortion or infringement." The extreme force can be a mental act that then shows up in the body or an act that is done repeatedly to an extreme.
You can think of violence as any highly energetic form of relating to a person, including yourself, that is jarring, turbulent, and distorting. Can you identify any times in the last few days in which you treated yourself in a discordant, abrupt, or distorting manner?
The Trappist monk and spiritual author Thomas Merton once said, "To allow oneself to be carried away by a multitude of conflicting concerns, to surrender to too many demands, to commit to too many projects, to want to help everyone in everything is itself to succumb to the violence of our times." Obviously Merton wasn't speaking about pathologically self-destructive behavior. Instead he was drawing our attention to the shadow side of normative, even seemingly positive, culturally approved behavior. He was referring to how we do great violence to ourselves simply in the manner in which we go about arranging our lives.
Gradually I've come to realize that violence against oneself is one of the great denials of our time. People are very willing to talk about the violence that the world does to them, but they're much less willing to own the violence that they do to themselves. Violence against self can most easily be recognized in your experience of the body in daily life. You already know the general health problems that come about because of stress, sleep deprivation, and constant strain. You may not identify them as examples of violence to self, but anytime you make yourself sick or dysfunctional, it is an act of violence for which you need to take responsibility. We all know people who are overworked or have too much stress, which causes problems with the digestive system, heart, or other parts of the body, but who never label their behavior as violence to the self. But is there any description that is more apt?
One of the yamas, or moral restraints, in Patanjali's Yoga Sutra is ahimsa, the practice of nonviolence, and this includes nonviolence toward yourself. Of course, you may well want something in your life so much that you are willing to take a chance of hurting your body by driving it too hard. But usually a conscious, short-term exertion to reach a goal is not what causes violence to self. More often it is a matter of long-term disregard of the signals of imbalance. This disregard comes from repeatedly getting so caught in wanting or fearful mind-states that you're unable to reflect on your own behavior. You may have a surface-level awareness of the distress you are feeling in your body, but you don't sincerely respond to the discomfort. In such instances you are in a driven state, controlled by your mind's imaginary creations rather than your inner values.
Inner development and maturity come from acknowledging to yourself that you are being violent with a human being; the fact that you happen to be the human being who is being hurt does not change the truth of the violence. From a spiritual perspective, it is never right to hurt any human being; including yourself; for selfish reasons or because of sloppy attention to the consequences of your actions. Understanding this is your first step in practicing ahimsa toward yourself.

Taking Time Out

As the Thomas Merton quote points out, if you abuse your time, you are participating in violence against self. This may be in the form of overscheduling to the point that you rob yourself of the experience of being alive. Or it may be in the form of allocating your time in a manner that doesn't reflect your inner priorities. Both create a distortion or infringement of self through strain and turbulence. When you treat your time as though you are a machine; a doing machine; you are committing violence against the sacredness of life itself. Whenever I do Life Balance work with organizational leaders, I have them make a list of their values and prioritize them, then compare their priorities with how they actually spend their time. The disparity is usually shocking.
Another abuse of time that disturbs your well-being occurs if you succumb to the modern-day compulsion to avoid boredom at all costs. In our stimulation-based culture, there is near hysteria around constantly seeking fulfillment through activity, which leaves no time for the quietness of simply being present with yourself. Do you allow yourself time each day, or even weekly, to exist without an external purpose and without even background music or television? Empty time is vital to your well-being, and to deny yourself this nourishment is an act of violence.
You may ask why you continue to abuse your time and your body when you have the option to live more peacefully. Or you may say that you feel as though you have no choice but to be harsh toward yourself because your life situation is such a struggle. Under either circumstance you push the body and strain the mind violently because you are filled with the tension that comes with the feeling that there's not enough of something in your life, whether it's money, love, adventure, or confidence.
Feelings of inadequacy, vulnerability, longing, or not having enough are an inevitable part of the human experience. If you, like most people, have not found spiritual freedom, you cannot stop them from arising. But you can stop such feelings from controlling your life by changing how you perceive them. If you refuse to identify with these feelings, disown them as being neither you nor yours, thus seeing them simply as emotional states of mind that come and go, you will discover there is the possibility for some inner harmony even under difficult circumstances.
For instance, let's assume you cannot change your work schedule, and it seems so overwhelming to you that you regularly get very tense and anxious about it. You can experience the schedule as much less violent by not thinking about it in its entirety except when you are in planning mode. The rest of the time you just do what the plan calls for, concentrating on the task in front of you without adding the thought, "Here I am with all this work and so much more to do this week."
Said another way, don't make a panoramic movie out of your difficult schedule such that you are constantly seeing yourself doing all that has to be done, as if it were going to be done all at once. Instead just do what has to be done right now, for that's all you can do. It may sound like a simple thing to do, but it is very subtle and difficult, yet so liberating!
Another method you can use to cope with overscheduling is to notice each time you experience fear or wanting while thinking about all you have to do. Consciously label these feelings as fear and wanting in your mind and then see for yourself that they originate as impersonal mind-states, the way a storm forms due to weather conditions. The land that receives the storm does not own it, and the storm is not the land; it's just a storm, which due to its own characteristics can cause damage. So it is with the stormy situations in your life where there is a tendency to both deny and take ownership of fear or wanting. This misperception leads you to believe you should be able to control them, which in turn causes the physical contractions and the mental anguish that constitute violence to self.

Stopping the Violence

In seeking freedom from violence to self, practice noticing over and over again that you are constantly, and usually unconsciously, wanting things to be different than the way they are. You become a little dictator to yourself, sitting on a throne, arms crossed, pouting and demanding that things you like should stay the way they are forever and what you do not like should disappear immediately. This craving to hold on to what you like and to get rid of what you find difficult is considered the source of suffering in life and the origin of violence against self. By practicing living with things as they are, you will discover that while life may not be less painful, your experience of it is immeasurably better. Also, fully accepting what is true in the moment is the only firm place to begin to make changes in your life. Living in the moment is not a one-time commitment but something that has to be done again and again.
Nonviolence to self is a lifetime practice of which there are ever more subtle levels to discover. The more you are able to be with yourself in a nonviolent way, the less harm you will do to another. Be gentle with the body and mind; refuse to get caught in believing that things have to be a certain way in order for you to be happy.