From the recent ABS Community of Practice: my talk on resilience to trauma healing specialists.
<p><a href=”http://vimeo.com/90045325″>Philip G. Monroe – COP 2014</a> from <a href=”http://vimeo.com/americanbible”>American Bible Society</a> on <a href=”https://vimeo.com”>Vimeo</a>.</p>
On April 23, 2014, I will be the keynote speaker for the 8th annual Faith & Spiritual Affairs Conference put on the Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS). The conference theme: Trauma and Healing: Faith Communities Respond. My particular talk is geared to illustrate the necessity of engaging the faith community in trauma recovery efforts. Trauma almost always challenges a person’s faith and when mental health professionals do not pay attention to spiritual matters, treatment will likely stall. I will highlight several faith founded trauma recovery interventions being used today in church settings.
The conference is free to all who register. But registrations are limited. Held at the Philadelphia Convention center. The breakout speakers list includes the Director of Place of Refuge, Dr. Elizabeth Hernandez.
To register click here. NOTE: enter fsac2014 as the redemption code to get into the conference website. CEs provided for SW and PC. Biblical Seminary, an NBCC approved provider, is the co-sponsor to offer counseling CEs. Other CE providers offering CEs as well.
Our Global Trauma Recovery Institute is featured in the most recent issue of the EMCAPP Journal for Christian Psychology Around the World. Pages 172-211 include an overview of GTRI, two essays by Diane Langberg (The Role of Christ in Psychology; Living to Trauma Memories) and one by me (Telling Trauma Stories: What Helps, What Hurts).
The journal also contains an essay by Edward Welch (www.ccef.org) where he muses his development as a biblical counselor, explores the matter of emotions and some of the stereotypes of biblical counseling. The journal also includes a large number of essays about Paul Vitz as well as a number about the Society of christian Psychology.
Take a look!
As a member of International Society of Traumatic Stress Studies (ISTSS), I am able to offer you a link to a free issue of their journal, Journal of Traumatic Stress.
Click this link for the February issue page with links to download individual articles. Several essays relate to PTSD treatment for veterans, at least one essay re: child maltreatment in Uganda.
In October I represented Biblical Seminary’s Global Trauma Recovery Institute at a conference co-hosted by the World Reformed Fellowship and North West University in Potchefstroom, South Africa. Previously I posted the accompanying slides here. Now, WRF has made available the video for this presentation. Presentation runs about 30 minutes plus a Q and A at the end with another speaker.
Main objectives of the video?
Link to video here.
If you read much about matters of politics and the military, you are well aware of the significant problem of PTSD in returning veterans of Iraq and Afghanistan. While only 20-30% meet criteria for PTSD, all have been forever impacted. Rightly so, the military and traumatology researchers are expending oodles of money and time trying to understand (a) ways to reduce trauma symptoms and (b) improve resilience. Thankfully, we are seeing some helpful interventions being developed. However, there is much work to be done in perfecting treatments (finding ways other than just medicating vets into a stupor), ensuring that practitioners are competent, and improving societal acceptance of PTSD as a real disorder and not just something someone can just decide not to have.
And yet, these wounded and changed warriors have something to teach us about how we see ourselves and our world. Sometimes, it takes a life-changing experience to recognize serious blind spots. Even if you haven’t served in a combat setting, you can understand a bit if you’ve gone on a mission trip and returned with a different perspective and a sense you could no longer go about life the same way.
This article is a worthy read to consider what we can learn from those who were willing to sacrifice their lives, their futures for our safety. If you are indeed thankful for a vet’s service, take a minute to read it.
Filed under Post-Traumatic Stress Disorder
Over the last year or so I have been doing some thinking about those experiencing ongoing trauma. We talk of PTSD, Post-traumatic Stress Disorder, as a set of symptoms experienced after a traumatic event or time. But some people continue to live in ongoing trauma. I’m reading James Fergusson’s The World’s Most Dangerous Place: Inside the Outlaw State of Somalia. Early in the book, he talks of seeing “Sister Mary, a warm-hearted big-bosomed Ugandan in combat fatigues, dispensing medicines from a table in the ruins of the villa’s kitchen.” (p. 45). Sister Mary explains that there are two medical problems she sees. The one she treats most often is diarrhea. But, she says, the other problem she could not treat,
The people here are stressed, she explained. They are traumatized. They do not know where to turn.
You talk a lot in the West about PTSD-Post-Traumatic Stress Disorder…but for these people there is no “post”. The trauma never ends.
What can people do when trauma isn’t post? Do they have to wait until the traumatic experience is in the past in order to deal with it? What can we do for others who remain in precarious and life-threatening situations? A friend raised this question when working with a group of refugees in a UN temporary camp. Some of the suggestions that were given this friend
1. Helping refugees find some way to hang on to small measures of empowerment: set up classes for children, build huts for those who are just arriving, develop “positions” for adults to fill so the camp runs smoothly and has a modicum of safety.
2. Reinstate religious and cultural traditions where possible
3. Practice corporate lament along with other worship activities
4. Allow people to tell as much story as they wish, whether by voice or artistic rendering
Notice that these are finding ways to cope by (a) making the moment better and (b) bearing witness, even if they can do nothing about the crisis. When a person feels some level of ability to respond to a difficult situation, that person often experiences less trauma than those who are unable to express any agency. Further, when they feel that they matter to others (someone listened to whatever they had to say), they tend to have less long-lasting PTSD symptoms.
Filed under Abuse, Psychology, Uncategorized
I am reading Christine Courtois and Julian Ford’s, Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach (Guilford Press, 2013). I won’t be blogging through each chapter but I do recommend it for those working with adult survivors of child sexual abuse, especially those who are new to “complex trauma.”
The first two chapters give an overview of complex trauma reactions and diagnoses. If you want to know more about complex trauma, see this post about another edited book by these two authors. Chapter three, “Preparing for Treatment of Complex Trauma” begins the meat of the book. In this chapter they take up the ever important issue of empathy, safety, and respect as foundation to therapy. They emphasize the need for,
safety within the therapeutic relationship with a therapist who is empathic and respectful yet is emotionally regulated with appropriate and defined boundaries and limitations. (54)
This empathy and trust relationship is both foundation and method of treatment (59). But while the therapist is responsible to see that at safe therapeutic relationship has been built, it requires the client to be involved in building such an environment. The truth is that the client’s role in building safety in the counseling office is by passive and active testing of limits. Most counselors tolerate suspicious questions the first or second time. But, it is important for counselors to,
being prepared to patiently and empathically respond to active or passive tests or challenges to trustworthiness as legitimate and meaningful communication that deserves a respectful reply in action as well as in words. (60, emphasis mine)
If the therapist understands and does not take mistrust as a personal affront, the therapeutic relationship can evolve gradually. The client can begin to recognize that the therapist actually “gets” why he or she is initially skeptical, self-protective, or “realistically paranoid” and does not pressure the client to be a “happy camper” but instead works to earn trust by being honorable, reliable, and consistent. This also implies a view of the client’s initial mistrust as expectable in light of the client’s history–that is, as a strength rather than as a deficiency or pathology. (63)
Sometimes clients can present in an opposite way–to be entirely deferential and affirming the counselor before a track record can be developed. Therapists with these clients need also to be prepared to encourage a healthy level of distrust.
What is not helpful is “artificial neutrality or passive and intellectualized detachment on the part of the therapist…” (64). It is my sense that we usually do this when we are afraid of the client. Not so much afraid of being injured, but afraid of failing or being consumed by the trauma. Or, we get consumed by our own history. A healthy therapist must stay emotionally present yet aware of own internal machinations. A healthy therapist must be able to predict some of the angst that arises in treatment of complex trauma and able to prepare self and client for this inevitable distress.
[What is below was shared with Rwandan caregivers and counselors. It is written in simpler English and has no footnotes. Academically oriented readers will recognize the interventions come from narrative exposure therapy models for children].
Counselors invite others to tell their stories of pain, heartache, fears, and traumas so that they can find relief from their troubles. However, not every way of talking about past problems is helpful and some ways of talking can actually harm the person. So, it is important that all caregivers and counselors understand how to help others tell their difficult stories in ways that invite recovery and do not harm.
Good Storytelling Practices
Counselors who do the following can encourage healthy and safe storytelling of difficult events:
Unhelpful Practices
Here are some things that we should avoid doing when helping another tell a difficult story
**Trigger Warning: rape, threatened violence
A Case Study With 2 Storytelling Interventions
Patience, a 13 year old girl, suffered a rape on her way to school last month. The rapist’s family paid a visit to the girl’s family and offered money as a token of penance. The girl’s father accepted the money because, “nothing can make the rape go away so we will take the money for now.” Patience was told by some family members to not tell anyone about the rape and to just act as if it never happened. However, Patience is suffering from nightmares, refuses to go to school, and sometimes falls down when she catches a glimpse of the rapist in town. Her father has threatened to beat her if she doesn’t return to school or help out with the chores at home. Her favorite aunt, a counselor/caregiver, learns about the rape and asks her to come for a visit in a nearby city.
[Warning: these two interventions are not designed to rid a person immediately of all trauma symptoms. In addition, these interventions must be used only after a counselor has formed a trusting relationship with the client.]
Filed under Abuse, counseling, counseling science, counseling skills
A former student (HT Armando!) sent me this link today about a woman who experienced PTSD like symptoms after receiving an out-of-the-blue text from her husband telling her he was leaving and divorcing her.
She experienced flashbacks, nightmares, became hyper-alert to dangers, unable to sleep and other such symptoms that are common to PTSD. She did not have an actual or perceived threat on her life–a necessary requirement for the current diagnosis of PTSD. However, she did seem to respond to the surprising evidence that her husband had deceived her for some time as having been “sleeping with the enemy.”
This question for you is whether you think it harms those who suffer classic PTSD (i.e., those who do experience a threat on their life) to lump them together with those who have similar symptoms from non-life threatening trauma. Yes? No?
I have observed pastors in significant conflict with church leaders exhibit PTSD like symptoms. I have observed individuals who learn in late adolescence or adulthood that their parents were actually adoptive parents. It appears that some of the same symptoms exhibited by those who experienced rapes, car crashes, or war trauma show up in some individuals whose world is turned upside down by another’s deception and duplicity.
So I ask the question again: What is gained or lost by expanding PTSD diagnosis to include those with similar symptoms but without the threat of physical injury or death?
Here’s one gain and loss for someone having this kind of divorce reaction. Those who have the symptoms without the physical threats may find some comfort in knowing their reactions are had by many others. However, I would imagine that most of these same people may find their symptoms abate more quickly than that of those who see actual death and destruction. Thus, a diagnosis of PTSD may end up hurting them due to an over-estimation of recovery time needed.
Filed under counseling science, Post-Traumatic Stress Disorder, Psychology
Musings on Faith and Psychology 