Lesson 5 - Trauma Counselling

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What survives?


What is a Trauma?

  • Anything that drastically exceeds the flexibility of the mind

  • The less flexibility you have in your mind, the more your life will be filled with traumas

Any break in [peoples] sense of safety and security, or in their ability to understand and manage their psychological state, seems to provoke severe and damaging adjustments.

Rob Gordon (Psychotherapy, 3 1997)


 

The principle of the subjective meaning

Factors that may impact the way the individual processes a traumatic event:
Be sensitive. Client-appropriate language Is important


A more severe psychological injury may or may not involve physical injury or threatened event occurring, since the greatest determinant is the subjective meaning.

Edited from Rob Gordon Psychotherapy, 3, 1997


 

  • Current personal problems

  • Coping skills and defences past history, ("time bombs*"),

  • Belief systems, and spirituality

  • Work situation

  • Group and community situation (social network etc.)

*A time bomb is a past traumatic event that has not been transformed, but lies buried in the subconscious, so that a new trauma may uncover it.

A trauma may come from

  • Outer events

  • Realisation of most undesirable aspects of own personality

  • Through own unexpected reactions, feed back from others, dreams,etc.)

Examples of Trauma / Crisis/Critical incident:

  • War and terrorism

  • Accident

  • Violence

  • Rape,

  • Sexual abuse,

  • Criminality

  • Disease

  • Death of family or friends

  • Suicide attempts

  • Abortion;

  • Loss of job and money

  • Natural disasters

  • Alcohol and drugs


 

War and terrorism

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Witnessing September 11

What do you do if you are faced with people in acute trauma?


 

Accident

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http://www.vtt.fi/rte/transport/research/traffic_safety/accident.jpg

What do you do if you are faced with people in acute trauma?



Violence
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http://www.labournet.net/docks2/0003/charprev.htm




What do you do if you are faced with people in acute trauma?



Violence
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http://urbanshield.za.net/media.html



What do you do if you are faced with people in acute trauma?

Rape,
Sexual abuse
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http://abyss.hubbe.net/jeremiah/gallery/gfx/covers/jtv/lg/ep/s1/108-rape…
What do you do if you are faced with people in acute trauma?


Criminality
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What do you do if you are faced with people in acute trauma?

Disease
Death of family or friends

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What do you do if you are faced with people in acute trauma?


Suicide attempts
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http://daydreaming.free.fr/dessins/SUICIDE.jpg




What do you do if you are faced with people in acute trauma?


Abortion
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http://www.ltia.org/abortion/aborti6.jpg

What do you do if you are faced with people in acute trauma?


Loss of job and money
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http://tbcc.baynet.net/2002/grabaawr/begging.jpg



What do you do if you are faced with people in acute trauma?


Natural disasters for example fire
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http://www.amos.org.au/sydney/photos/bushfire.jpg

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http://www.tribuneindia.com/2002/20021206/wd4.jpg
What do you do if you are faced with people in acute trauma?





Alcohol and drugs

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http://www.danball.com/images/junkie.jpg




What do you do if you are faced with people in acute trauma?


 





What you can do if you are faced with people in acute trauma


Ask your client to sit down, offer water/tea/coffee etc.,
other than that, do nothing, be there, listen.
Check your grounding


Grounding: Ability to face “what is”
Integrity: Coming from one’s own mind, not from patches of other’s minds
Ability to maintain ones own standpoint without loosing respect for other standpoints

Grounding and integrity - Psychologically speaking

That the individual is able to be present and partake in everyday life with its duties and joys.

Ungrounded Psychologically speaking

Inability able to be present and partake in everyday life

Grounding and integrity Spiritually speaking

Openness for the higher with the integrity of the mind intact

Ungrounded Spiritually speaking

“Do as you please and lament the consequences”
Spiritual and or psychological ungroundedness will also show up as physical ungroundedness, cold feet or hands, Lack of balance.

When you are aware of your own centeredness,
When you can face the description of and impact from the trauma (on your client and yourself), Then and only then are you in a position to help in a psychological sense.

 

Is counselling a game of techniques?
 

Counselling is as effective as the therapist is living effectively […]

If counselling is not a way of life, then it is a game of techniques

Carkhuff and Berenson: Beyond Counselling and Therapy

What is needed is being there, comfort, support, information, advice, directions, assessing needs, practical help, listening, helping clarify experiences and sorting out our emotions.

Rob Gordon in Psychotherapy, 3, 1997


 

If you cannot help in a psychological sense,
see if you can help in a practical sense

Physical

Including aerobic exercise, reducing stimulants such as caffeine and nicotine, balanced diet, adequate rest, relaxation.


Behavioural

Including partaking in enjoyable activities, trying to resume a normal routine, avoiding social isolation.


Emotional

Including accepting the unpleasant emotions as normal, expressing emotions as they arise, using support networks effectively.

Edited after Cotton & Jackson:

Early Intervention & Prevention in Mental Health


 

Basic guidelines for trauma and crisis counselling

Each individual will be affected by a traumatic event differently, and each individual processes the trauma differently, (the principle of the subjective meaning).
This implies that the counsellor has to be non-directive, probing, encouraging the client to express what is important to him or her in the order and way he or she feels is natural.
Questions like "Where will you like to start?" or "How are you?" will generally give more open responses than "What happened? Which might invite a description of the experience in only external terms.

Monitoring possible red light symptoms is imperative. (See later).

 


"The power spot" or the "core" of the trauma


 

What is it that is too much?

The Core or Power spot is that part of the trauma which is too much"


The Core or Power spot is the most important for the client to be able to contact, locate, define, talk about, and possible to work with.
The core may be hidden in "secondary issues", such as other people’s more or less insensitive reaction to the trauma and other more or less important issues.


 

"The power spot"

The power spot or the core is generally determined by the ways the individual has structured his or her subjective ideas of reality:
These constancy’s may be […] psychological in the forms of ideas of cause and effect, expectations and assumptions; emotional such as security or confidence, self efficacy, trust, or social in expectations of people or places.

Rob Gordon in Psychotherapy, 3 1997


 


Help the client to find her own ”starting point" in her need of gradually organising the traumatic experience in the way that makes sense for her, not necessarily for you.


If the client keep returning to the ‘core issue’, it is a sign of a need of further work and integration of this core.

Repetitive talking always indicates the likely presence of a trauma.


In such a case, be careful and begin to explore whether the client is really motivated and whether he or she has the strength to work through her own defences at this time.
Maybe it is safer to put on a lid and end the counselling for now in agreement with the client, and/or to refer the client on to a psychiatrist or other, more experienced professionals. It is important to emphasise to the client that psychological work with the trauma is essential.
Maybe inform the client about PTSD (see later)

 

Drug and alcohol
Working while on drugs or working while not intoxicated

If you intend to work specifically with people while they are on drugs, helping them to get of the drug, the teaching here is not sufficient!
Detoxification can be a life-threatening process, some drugs deposit themselves in the bones, and detoxing can be prolonged, painful and dangerous (for example from Methadone!).
Good overview over drugs commonly abused:

http://www.thisisull.com/drugs/drugindex.html


Working with people during detox from heavy usage:

You will encounter people in delirium, people that are in the grip of uncontrollable emotions, despair, rage, horror, you will encounter convulsions, vomiting, fainting.
In short, you will encounter situations where a medically trained person must be present, for this to be somewhat acceptable.

If you however want to work with someone that is past the detoxifying faze, or at least not intoxicated while you work with them, you can do that with some precautions and care.

The techniques of working with the psychological reasons for drug and alcohol abuse are no different from what is used on any other client.
At the drug and alcohol clinic, Addcare, we considered it a reasonable success if we had a 10% success rate!

 

Why drugs?

Alcohol: The cause is generally emptiness and escape from lifes’s challenges
Drugs: We found the cause often to relate to emptiness and
misunderstood spiritual longing.

The counsellor’s ability to face the pain, horror and suffering of the client and still stay centred is essential for the outcome of the counselling



There are a number of factors that are relevant to all counselling and healing,
but extra important here:

The physically based craving and the emotional dependency forms a bond that is difficult to untangle, the addict do not know how to cope without the drug, and do not have the stamina to face the pain when the drug is not there.
It is therefore generally speaking easier to help someone that has been on drugs for 10 years, than someone that just started. The pain suffered is a good spur to get off the hook. Until then there is a general tendency to understand well-meant warnings from friends relatives and professionals as the oldies that don’t know what they are missing out on, and who really is a part of the problem since a common reason to be on drugs is despair with the rigidity and unkindness of the world.

 

All these pains lead to a common phenomenon among drug users “
They are often very good liars!

In your consulting room the drug users are open and cooperative, in their own milieu they relapse and use drugs, back at your place, with the cleaner energy there, they feel ashamed etc, but will often, because this is the umpteens time, cover it up and lie.
For this to have any success, you must build up a rapport, so they dare tell the truth.

Caution if you counsel drug users
Take care!

Dirty needles etc means high occurrences of very contagious strand of hepatitis (spread by simple contact) and HIV, which may lead to AIDS (Spread by small amounts of blood sucked into the syringe from previous user

The drug-lifestyle also creates a high risk of sexually transmitted diseases.


On a more subtle level:

Drug use is associated with a lot of breaches of personal integrity,
So drug users often knowingly or unknowingly carry an unpleasant energy with them even if they are friendly and cooperative on the conscious level


Be careful if you are sensitive

And be very careful with hands-on healing


 


The ability to listen:

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Zen monk Thich Nhat Hanh talks about how listening
is the first step towards peace.


Question: If you could speak to Osama bin Laden, what would you say to him? Likewise, if you were to speak to the American people, what would you suggest we do at this point, individually and as a nation?�
Answer: If I were given the opportunity to be face to face with Osama Bin Laden, the first thing I would do is listen.
I would try to understand why he had acted in that cruel way. I would try to understand all of the suffering that had led him to violence. It might not be easy to listen in that way, so I would have to remain calm and lucid. I would need several friends with me, who are strong in the practice of deep listening, listening without reacting, without judging and blaming.
In this way, an atmosphere of support would be created for this person and those connected so that they could share completely, trust that they are really being heard.
After listening for some time, we might need to take a break to allow what has been said to enter into our consciousness. Only when we felt calm and lucid would we respond.
We would respond point by point to what had been said.
We would respond gently but firmly in such a way to help them to discover their own misunderstandings so that they will stop violent acts from their own will.
E-mailed to us, source lost