SHATTERED ASSUMPTIONS..

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SHATTERED ASSUMPTIONS.. BROKEN LIVES
UNDERSTANDING AND MANAGING TRAUMA
by
Andrew Davies
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Aims.

• To facilitate a greater understanding of Trauma
  and its impact on individuals and organisations
• To facilitate a greater understanding of how
  individuals and organisations can manage and
  recover from the trauma of critical incidents
• To emphasize that traumas cannot always be
  prevented but can be contained and managed once
  they have occurred if efficient and effective
  policies and practices are adopted.

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Our Context
(Living and working in an unsafe world)
Every day in Africa an impala wakes up. It must
run faster than the fastest lion or it will be
killed.
Every morning a lion wakes up and knows it must
outrun the slowest impala or it will starve to
death.
It doesnt matter whether you are a lion or an
impala when the sun comes up you had better
start running.
Anonymous
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Our Context.

• South African life has been characterized by
  violence and crime both before and after the
  revocation of the apartheid system.
• In some ways, trauma (whether realized or
  anticipated) has become part and parcel of the
  South African psyche.
• The burden of overwhelming trauma and its
  consequences has been experienced by South
  African trauma counsellors for many years.

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Our Context
(The trauma of everyday life)

• Amongst the highest violent crime rates in the
  world (including murder, car-jacking, and
  violence in schools). Homicide accounts for 44.5
  of deaths.
• The highest rates of rape, child abuse, and
  family violence in the world.
• Rampant HIV/AIDS infection rate.
• Large disparity between rich and poor.
• Limited and inadequate community resources.
• SA employees are at risk for exposure to
  incidents of traumatic stress.

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Definition of Trauma.

• A sudden, unexpected (unprepared for) event that
• is outside the range of normal human experience
• involves actual or threatened death or serious
  injury or a threat to the physical integrity of
  self or others
• and would be markedly distressing to anyone

• The event is so unpleasant and shocking that the
  human mind and body react in an autonomic
  defensive manner.

• The traumatisation is caused by the event, not
  because of some failing or weakness in the
  person.

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Critical Incident Defined.
A critical incident is an event that causes
disruption to an organisation, creates
significant danger or risk and traumatically
affects individuals within the organisation

• These are events with circumstances that are
  unusual or distressing and typically produce
  immediate and/or delayed emotional reactions that
  surpass the individuals normal coping mechanisms
  and have the potential to interfere with usual
  functioning

• Examples include explosions, accidents, civil
  unrest, assaults, fire, terror attacks, etc.

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The Psychological Impact of Trauma
Stress is a reaction to an event or situation
that places pressure upon a person. When demands
become extremely threatening, overwhelming, or
severe, they provide a heightened state of
physical, cognitive, behavioural and emotional
arousal commonly called traumatic stress
Stress
Traumatic Stress
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Shattered Assumptions (Janoff-Bullman)

• The experience of trauma shatters two basic
  assumptions about the self and the world
• The belief in personal invulnerability or
  immortality
• The belief that the world is a meaningful and
  orderly place, and that events happen for a
  reason
• Violence, shatters a third belief the trust
  that other human beings are fundamentally benign.
• These 3 assumptions (or illusions) allow people
  to function effectively to relate to others.
  After trauma, individuals are left feeling
  vulnerable, helpless and out of control in a
  world that is no longer predictable.

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The Psychological Impact of Trauma
OVERWHELMED
OUTCRY Fear, sadness, rage
PANIC OR EXHAUSTION
DENIAL Refusing to face memory of incident
EXTREME AVOIDANCE
INTRUSION Unbidden thoughts of the event
FLOODED STATES
WORKING THROUGH Facing the reality of what has
happened
PTSD
COMPLETION Going on with life
PHASES IN THE REACTIONS TO TRAUMA
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The signs symptoms of PTSD
People often respond to a stressful or traumatic
experience with very strong feelings. They start
saying, feeling and doing things that they did
not do before
The following reactions commonly occur in
response to trauma (the response involves intense
fear, helplessness or horror)

• Re-experiencing the trauma (recollections,
  physical reactivity)
• Avoidance or numbing (detachment, estrangement,
  forgetting)
• Increased arousal (startle response,
  irritability, sleep problems)
• Other symptoms (depression, guilt, cognitive
  problems)

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Rescue recovery personnel (fire, police
ambulance etc)
Third level
Grieving relatives, friends and colleagues of
first level individuals
Second level
Individuals directly experiencing the event who
may or may not be physically injured
First level
4th level casualties     The community/organisati
on as a whole  
The Ripple Effect
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Definitions
Vicarious traumatization The transmission of
traumatic stress by observation and/or bearing
witness to the stories of traumatic events.
Secondary traumatization The overwhelming
traumatic effect resulting from exposure to the
trauma of the victim.
Continuous traumatic stress A term used in place
of PTS when trauma is so pervasive and
unremitting that it falls within the range of
normal human experience.
Burnout A state of physical, emotional, and
mental exhaustion caused by a depletion of
ability to cope.
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A Duty of Care

• Creating and maintaining an effective,
  well-tested Critical Incident Management Plan is
  perhaps the surest way to limit damages and
  hasten recovery while keeping the individual
  functional and the company operational.
• A planned and structured model of crisis
  management will not only enhance an organisation
  ability to recover from financial losses and
  return more efficiently to full productivity, but
  will also assist the company to fulfil its moral
  responsibility to protect employees.
• Responding to the needs of employees in a
  compassionate, sensitive and helpful manner in
  the event of trauma affirms the value of
  employees to the company.

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Guidelines for Responding to Trauma Victims
Trauma defusing and debriefing services are
vital in assisting individuals to process the
traumatic experience through an integrated,
appropriate and effective method of intervention
These services also facilitate the normalisation
of personal experience
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A Note on Caring
. relieving the emotional suffering of clients
automatically includes absorbing information that
is about suffering. Often it includes
absorbing that suffering as well
(Figley, 1995)
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Defusing
Defusing is the ventilation of thoughts and
emotions associated with the crisis event, and
should be provided as soon as possible after the
initial impact of the critical event to mitigate
the effects of the trauma and promote recovery

• PHASES
• Introductory Phase
• Exploration Phase
• Information Phase
• Dos donts
• Cross cultural considerations

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Debriefing
Psychological debriefing is an established
multi-phase group crisis intervention process to
help individuals work through their thoughts,
reactions, symptoms followed by training in
coping techniques. It is not therapy but Involves

• Education about stress reactions
• Emotional ventilation
• The promotion of cognitive reassurance that the
  stress response . is controllable and that
  recovery is likely
• Mobilisation of resources within outside the
  individual or group
• Preparation for future
• Intervention to assist in recovery from
  traumatic stress
• Screening for people who need additional support

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Healers must understand that caring does not
only mean caring for others it also means caring
for oneself. We must be aware of our limits and
know when it is necessary to nurture ourselves
No one can heal without being healed
(Elizabeth Kubler-Ross)
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We are not invulnerable, but if we maintain a
strong sense of community among ourselves, we can
be resilient
(Catherall, 2001)
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Thank you