Eight Guides to Trauma Treatment

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Eight Guides to Trauma Treatment

• John Sargent, M.D.

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Learning Objectives

• 1) Learn about the features associated with
  traumatic stress in children and adolescents.
• 2) Learn an approach to integrating and staging
  treatment of traumatic stress in children and
  adolescents.

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• This presenter has no conflicts to declare

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• The presenter has no conflicts of interest to
  declare.

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Characterizations of Trauma

• Significant Danger
• Unexpected and unpredictable
• Uncontrollable - inducing helplessness

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• Potentially leading to CNS changes
• Alterations in arousal and shut off
• Alterations in memory formation (disconnected,
  highly visual)

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• Dissociation and numbing are common
• Trauma always includes loss

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Trauma responses vary

• Based upon previous traumatic experiences or
  psychiatric disorder
• Based upon temperament, attachment relationships
  and potentially upon genetic endowment

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• Based upon parental experience with PTSD
• Based upon degree of social support and community
  attributions about the trauma

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• Based upon degree of dissociation and the
  presence of substance abuse and depression
• Based upon experiences with modeled violence
• Based upon degree of personal responsibility,
  guilt and shame associated with the trauma

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Aspects of the traumatic event(s) also influence
trauma responses

• Single vs multiple events
• Impersonal - Natural Disasters

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• Interpersonal
• Attachment Trauma

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• Combination - e.g. Accidents, War
• Coupled with subsequent disruptive events
• Loss of important relationship

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• Loss of community safety
• War
• Torture
• Community Violence
• Refugee Experience
• Domestic Violence

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• Loss of health
• Invasive medical procedures

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Key variables

• Predictability
• Control

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• Meaning and context
• Protection

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• Stability
• Opportunity to reestablish day-to-day routines
  and competency

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• Continuity and connection
• Forgiveness and reconciliation vs. rage and
  retribution
• Chronic difference vs. recovery
• Community memorialization

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Guides to Treatment - Often Intersect and Interact

• Safety
• usually includes heroic and courageous
• actions

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• Usually connects individuals to agents of
  community - police, health care system, legal
  system, social service and mental health system

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• Basic Needs
• food, clothing, shelter
• Often involves charity, victim status, unequal
  hierarchy and acceptance of need and need for help

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• Knowledge
• not only information but a relationship within
  which necessary information is asked for and
  provided

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• Behavioral Routines
• oriented toward recovery - build competency and
  reorient victims toward life after trauma

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• Emotional Expression, Labeling and Support
• identifying separate important affects and
  renders them comprehensible and allows expression
  and modulation within attachment relationships

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• Embedding Support within a Network of Support
• rebuilds a community responding to affect and
  united in supporting each other

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• Narrative Creation
• builds coherence, context and a sense of
  groundedness. The trauma victim is the author.
  The story distances the author from the story and
  displaces dissociation with understanding and
  continuity, role of psychotherapy

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• Justice
• opportunities for accountability acceptance of
  blame, apology, forgiveness, and reconciliation

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• Examples
• Survivor mission, altruism, truth and
  reconciliation experiences. Reparations and
  advocacy for human rights and community efforts
  toward integrity and a just society,
  memorialization and artistic expressions,
  journals and recollections