As helpers, caregivers, and counsellors, there are times when we need support to be able to help the people we are working with. Hearing from others in similar roles is a key way of finding inspiration and guidance. This book offers practical strategies for supporting people of all ages who have a variety of issues, whether psychological (anxiety, trauma, depression), based on life circumstances (loss and grief, oppressive societal attitudes), or due to harmful ways of coping with these or other life stressors (self-injury, substance use, suicidality). Each chapter begins with an examination of a different psychological issue or situation. Case examples of both youth and adults are included for each topic to illustrate both the impact of the issue and the helping process. Authors share insights they have gained from research, counselling experiences, and the unique wisdom of the people they have encountered. This book is written not only for clinical counsellors, but also for the multitude of frontline helpers who work to support those seeking help and guidance. It is a resource for anyone who identifies as a care provider, including those in the social service, health, education, spiritual care, and social work roles.
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About the Author
Vicki Enns (Editor) is the Clinical Director of the Crisis & Trauma Resource Institute (CTRI). Each author, in addition to being a counselor, social worker, or therapist, is a trainer with CTRI. Contributing Authors: Marion Brown, AnnMarie Churchill, Sheri Coburn, Vicki Enns, Michelle Gibson, John Koop Harder, Trish Harper, Tricia Klassen, Amber McKenzie
Read an Excerpt
By Vicki Enns
It is possible that every human being has been touched by trauma in some way, whether through personal experience, the suffering of a loved one, or the effect of shared fears communicated through world news or community events. It has become increasingly apparent that being impacted by a traumatic experience is extremely common throughout the lifespan (Larkin, Shields, & Anda, 2012). Some people go on to develop post-traumatic stress disorder, with lingering symptoms that affect many areas of their lives, while others are able to live with the impacts affecting their lives less often or less severely (Schalinski et al., 2016). Regardless of the direct impact, a person who has experienced trauma becomes more vulnerable to other life stresses and is more likely to develop other health concerns (Lanius, Vermetten, & Pain, 2010).
Trauma can be defined in many ways, and the same experiences will not have the same impact on every person. For an experience to be traumatic, it involves an overwhelming sense of powerlessness or horror, or a sense of threat to one's well-being that causes a person to feel their emotional or physical survival is at stake.
A traumatic experience sets off deep instincts in a human being to survive, which can lay down a pattern of emotions, beliefs, and behaviors that continue long past the originating experience (van der Kolk, 2014). These patterns often contribute to the development of other struggles, such as anxiety, depression, suicidality, and substance use, so the themes of traumatic impact will show up across many chapters in this book. Understanding the mechanics of trauma, and the basics of how to acknowledge and support those who carry trauma in their bodies and memories, will allow helpers to approach these other struggles more effectively.
Trauma can occur in many different situations. It may be the lasting effect of an isolated experience (see the chapter on Situational Trauma in this book), or it may result from many accumulated experiences over time. When the originating experience (or experiences) occurs in the early years of life, the trauma can have unique and profound impacts on the ongoing development of a person. This is called developmental trauma.
Traumatic experiences during childhood and adolescent development can have a distinct shaping influence on the rest of one's life. Not every bump and bruise will have an impact, and many events will be completely forgotten. However, overwhelming or threatening experiences may yield a traumatic impact and weave themselves into the ongoing development of a person's body and mind.
The word trauma usually evokes images of threatening or devastating events, such as near-death accidents, assaults, wars, or natural disasters. More common, and sometimes overlooked, are the experiences that involve persistent doses of fear and helplessness within the daily relationships or environments of a person's life.
In her 14 years, Inez has moved 10 times. She occasionally sees members of her biological family, but she has lived under the roofs of foster families since her toddler years. Inez keeps a suitcase under her bed packed with her favorite clothes and keepsakes, as she never believes she is staying anywhere long. She is sure that it is a question of when, not if, she'll be made to leave again. Inez longs for a permanent home but has come to believe she is too damaged to really fit in anywhere. She is well aware of how challenging others find her quick emotional swings, her flaring temper, her sudden patterns of disconnection when she refuses to engage, and her face in a vacant stare.
In my office, Inez sits taut, perched at the edge of the couch like she's ready to flee at any moment. Her fingers jump across her phone's screen as she squeezes in one last text before looking at me. She starts describing a battle of wills over the last three days as she has intentionally disengaged at home. Inez recounts details of how her foster family tried to "trick" her into doing activities with them. Suddenly dropping her phone down beside her, she slumps back looking totally deflated.
"I don't understand why they try so hard. Why do they even care about whether I spend time with them? It's like they pretend to love me, but they don't really know me."
At the age of 53, Bud is a muscular, looming man with a tall frame. As the oldest and biggest brother of four siblings, he has always lived his life protecting others. Bud was the loud kid who could sometimes get their raging drunk father to back off and give them some peace to sleep. When they were all younger, he made sure he and his siblings got to school every day. At the age of 17, Bud fought his way out of the family home and created a life for himself with a steady job. Now, as an adult, he has devoted the last 10 years to supporting his one daughter, who is a single parent to his only grandson.
Three weeks ago, an accident at the manufacturing plant where Bud works resulted in his co-worker's arm getting caught in the machinery. Bud worked next to the man and rushed over to hit the emergency brake, but he was unable to stop the crushing force that did permanent damage to his friend's arm. Bud has been unable to return to work since the accident, because he is experiencing high anxiety, trouble sleeping, flashbacks, and exhaustion. Bud comments that he used to be the "rock" to his friends, unwavering and strong. Now he's completely confused and demoralized by his inability to stop his tears or to tolerate the noise of his grandson's weekly soccer practice.
Shuffling into my office, Bud notes how his whole body aches. As he slowly lowers himself into the chair, he says, "I don't know why I'm back here ... it's a mystery why I'm so different since that stupid accident. You can't change what happened. I'm just broken."
With bags under his eyes, a deep slump in his shoulders, and his voice shaking, he describes another night of little sleep. He sighs and turns to the window. With tears brimming, jaw and fists clenched, he declares quietly, "I should be put down. Can you help me with that?"
Bud and Inez each have a unique blend of life experiences, genetic temperament, and cultural contexts that shape their current struggles. However, they both share a common background of developmental trauma that affects how they cope with life.
Any traumatic experience is a violation of one's sense of safety, evoking survival responses to eliminate or avoid the threat. There are predictable symptoms that show up when something wakes up the memory of these experiences: high anxiety, troubling memories that disrupt sleep, and a quick temper that flares unexpectedly.
Symptoms become more complicated in cases where the genesis of these experiences was during infancy, childhood, or adolescence. There may also be a whole range of events that have contributed to setting up this cascade of fear and defense. People who have experienced childhood trauma may not have clear memories to provide an explanation for their symptoms, but they may have built a life of coping with the persistent feeling that something is wrong.
The experience of developmental trauma leaves a distinct impact on the growing individual that is the result of two interweaving factors:
* The direct hit of an experience of helplessness and terror due to a real or perceived threat to one's well-being. This may be a single event or an ongoing accumulation of many experiences.
* The inherent vulnerability of the still-developing physical, intellectual, emotional, and social capacities of a young person. These capacities predict a person's ability to cope and are continually shaped by their environment, so they are partially formed by the trauma.
Living in an unpredictable or frightening environment during these developmental years can result in a baseline of sensitivity and anticipation of recurring threat. Research shows that people with these experiences become highly stressed more quickly, which then informs their mental and emotional understanding of everyday life (Schore, 2003; Siegel & Bryson, 2011; van der Kolk, 2005). Persistent neglect or repeated misattunement from caregivers builds an expectation of not getting one's needs met. As a child grows into adulthood, this background noise can continue to shape how they see themselves, their environment, and every relationship they enter.
INSIGHTS AND GUIDING PRINCIPLES FOR COUNSELING
The prevalence of developmental trauma means that counselors will regularly encounter people living with a complex array of symptoms. Common post-traumatic impacts reflect survival stances of flight (anxiety, avoidance, and urges to withdraw), fight (urges to lash out, rage, and control situations), and freeze (numbness, disorientation, and urges to shut down). Developmental trauma may add layers of impact affecting subsequent relationships to self, others, and the world in general. Examples include
* chronic and persistent fears and worries that spill into everyday life;
* an inability to trust others or develop any form of intimacy;
* general passivity and a struggle to form opinions or make decisions;
* confusion, lack of motivation, and a sense of futility;
* struggles with setting or recognizing boundaries;
* physical struggles, body aches, pains, and dis-ease that are not easily linked to a source;
* profound negativity toward oneself and persistent feelings of guilt and shame;
* chronic dissociation, fogginess, and a sense of disconnection from the rest of the world.
Just as Inez sees every potential caregiver through the lens of her original loss of family, a person may be reliving parts of their trauma history through their present daily life. There may be additional situational trauma that brings fragments of these memories to the surface, as Bud experienced when he suffered the shock of seeing his friend hurt.
There are three main developmental patterns that are particularly shaped by the legacy of developmental trauma: attachment, self-regulation, and self-perspective (Gil, 1996; Siegel, 2012; van der Kolk, 2014).
Attachment patterns affect how a person reaches for and lets in connections with other people. Inez's attachment history makes it difficult for her to trust anyone enough to let them try to care for her. As her counselor, I want to help her risk feeling cared about and express her needs clearly.
Self-regulation patterns affect how a person manages their physical and emotional responses to stresses in daily life. Both Inez and Bud experience their emotions and physical energy swinging quickly from intense agitation to a collapsing feeling of shutting down. One of the goals in our counseling work is for both of them to be better able to adjust the intensity of whatever emotion they are feeling, so they can stay connected to life without fearing it.
Self-perspective patterns describe the quality of one's relationship to self. Living with persistent feelings of fear, shame, and humiliation has left Bud questioning the worth of his existence and has left Inez with no understanding of why anyone would fight for her unless they had ulterior motives to exploit her. Healing this kind of self-perspective is a slow, yet foundational goal for resolving the impact of developmental trauma.
From working with many people like Bud and Inez, I have come to rely on the following four principles to guide how I support change in these patterns:
1) Build a secure relationship foundation
Develop secure, healthy, and nurturing connections.
2) Create developmental bridges
Recover skills from gaps left in developmental capacities.
3) Develop a positive connection to the body
Cultivate a sense of safety and stability in one's own body.
4) Order the story across time
Create a cohesive life story that separates the past from the present and future.
1) BUILD A SECURE RELATIONSHIP FOUNDATION
Children have an amazing capacity to align themselves to their caregivers and stay connected. The human brain is a social organ, and we need relationships to expand our social engagement capacities for ongoing development of the whole nervous system (Schore, 2003; Siegel, 2012; van der Kolk, 2014). The way caregivers respond to a child and to stressors in the environment will directly shape the child's experience. Ideally, children receive secure enough caregiving responses that allow them to recover from stress and experience the necessary nurture to re-establish a sense of the world as good and reliable.
Without such support, a child may develop patterns of anxious, clingy behaviors that reflect the continual search for reassurance, or they may develop patterns of shutting down their awareness of fear, allowing them to survive by believing they don't need support. Underlying such patterns is usually a deep river of disturbance and disconnection, along with feelings of shame, humiliation, and loss. We see this with Bud's experience of putting so much energy into supporting others, yet feeling intense shame that he is now in a position of needing help for himself.
Developmental trauma compromises a person's ability to "read" themselves or other people accurately, making it harder to enter and maintain supportive relationships. When a person feels persistently under threat, their nervous system shifts to rely on pure survival instincts instead of staying connected to others. This leaves them with reduced opportunities to develop skills for "cooperation, nurturing, and the ability to function as a productive member of the clan" (van der Kolk, 2014, p. 349).
When caregivers are the source of threat, a child is presented with an impossible puzzle of both desperately needing and fearing the same source of connection. As the child grows older, these same expectations and coping patterns will often emerge in other relationships when feelings of stress and uncertainty arise.
Whenever Inez spends time with her biological family, she receives messages that she is too much to handle and gets in the way of their needs. Inez expects this response from every caregiver and believes herself to be unlovable. After a short time in a new foster home, she feels the overwhelming urge to protect herself from her greatest fear of inevitably being sent away. She walls up, shuts off communication, and becomes a sullen, combative teenager who can play the "I don't care" card better than most.
The accumulation of unmet needs leaves the person on guard against others, repeating these patterns. Internally, the person is constantly scanning to determine the following:
* "Can I reach them when I need them, or are they absent and hard to make contact with?"
* "How do they respond to me – are they predictable and comforting, or are they confusing and dangerous?"
* "Do I trust them to be there when I need them in a predictable way?"
A common factor for effective counseling work is the quality of the relationship between counselor and client. Building a secure, nurturing, helping relationship becomes the initial task and is the foundation upon which all other ongoing counseling work rests. It's not unusual for much of the time spent with a client who experienced developmental trauma to revolve around building, monitoring, and repairing this foundation. The steps can seem simple, yet they can have a profoundly powerful impact on the quality of your working relationship.
Building this foundation requires focusing on the following tenets of secure attachment:
1) Accessibility that is consistent, non-judgmental, and open
* Be sure that your verbal and nonverbal communication is congruent. Open body language, with eye contact and sensitivity to boundaries for physical space, conveys a message that you are available but not coercive.
* Be certain to offer opportunities for your client to practice making choices. These may be simple things, such as where they sit or what time you meet. Give them a chance to make the choice to engage.
* Be clear and honest about your availability. It is important you say only what you can do and not make promises you can't keep. Having firm and clear limits that you can explain is reparative for clients and key for your own well-being.
* Be clear that there aren't conditions attached to connecting with you, and that they aren't responsible for taking care of you.(Continues…)
Excerpted from "Counseling Insights"
Copyright © 2018 ACHIEVE Publishing.
Excerpted by permission of ACHIEVE Publishing.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Developmental Trauma Vicki Enns, MMFT, RMFT 1
Situational Trauma Michelle Gibson, MSW, RSW 28
Anxiety AnnMarie Churchill, PhD, RSW 58
Depression Sheri Coburn, MSW, RSW 86
Self-Injury Trish Harper, MSW, RSW 118
Suicidality Tricia Klassen, MSW, RSW 150
Substance Use Amber McKenzie, MSc, CPsych 182
LGBT2SQ+ Centered Approaches Marion Brown, PhD, RSW 217
Grief John Koop Harder, MSW, RSW 246
Speaking and Training 319