applying trauma principles contents

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Applying Trauma Principles

Welcome ........................................................................................................................... XIHistory ............................................................................................................................................xiOngoing Professional Development .........................................................................................xiTraining Processes ..................................................................................................................... xiiAwareness and Understanding ............................................................................................... xiiiInformation, Concepts, Approaches, Principles and Skills (ICAPS) ............................... xivGround Rules .............................................................................................................................. xivReading Assignments .................................................................................................................xvTraining Design ...........................................................................................................................xvHomework ................................................................................................................................... xviCertifi cates .................................................................................................................................. xviRefl ective Sharing ..................................................................................................................... xviiBook Discussion .......................................................................................................................xviiiBrain Breaks and Fidgets ........................................................................................................xviiiResearch.....................................................................................................................................xviiiWhen, Where, and How to Use Training ............................................................................. xixFour Broad Goals .........................................................................................................................xxOur Invitation to You................................................................................................................ xxi

SESSION 1 .............................................................................................................................................1Focus for Today’s Session .............................................................................................................2Predictions, Acknowledgments, and Disclaimers (PADs) .....................................................2Specifi c Goals for Th is Course ....................................................................................................3Focus is on Application ................................................................................................................3Responsibilities of Trauma-Competent Professionals ...........................................................4Unfair Responsibilities for Trauma-Competent Professionals.............................................4Power and Importance of Hope ..................................................................................................5Design of Th is Course...................................................................................................................5

Contents

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Overview of This Course..............................................................................................................6Participant-Led Activities ............................................................................................................7Certified Trauma-Competent Professional ..............................................................................7Requirements to Become a Certified Trauma-Competent Professional ............................7Review of Personal Self-Care Plan .............................................................................................8LATE and ACTing .........................................................................................................................9Maintaining Broad Perspectives About the Nature of Trauma .........................................10Closing Thoughts .........................................................................................................................10Trauma-Responsive Tools ..........................................................................................................11

SESSION 2 ...........................................................................................................................................15Session One Review .....................................................................................................................15Focus for Today’s Session ...........................................................................................................16Predictions, Acknowledgments, and Disclaimers (PADs) ...................................................16Trauma Tool Chest Image .........................................................................................................16Creating a Trauma Tool Chest ..................................................................................................17Images and Stories .......................................................................................................................20Clips................................................................................................................................................21The Two Divisions in Trauma Tool Chests ............................................................................23The T and E of LATE ..................................................................................................................23Therapy Versus Education .........................................................................................................23Cognitive Behavioral Therapy ...................................................................................................26Closing Thoughts .........................................................................................................................31Trauma-Response Tools .............................................................................................................32

SESSION 3 ...........................................................................................................................................35Session Two Review .....................................................................................................................35Focus for Today’s Session ...........................................................................................................36Predictions, Acknowledgments, and Disclaimers (PADs) ...................................................36Not What’s Wrong with You? Rather What’s Happened to You? .......................................36The ACT Approach .....................................................................................................................37ICAPS Review ...............................................................................................................................38Defining Active Listening ..........................................................................................................42The Five Images of Active Listening ....................................................................................... 44RESSQ—Five Non-Listening Responses .................................................................................50Concluding Thoughts ................................................................................................................ 54Trauma-Responsive Tools ..........................................................................................................55

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SESSION 4 ...........................................................................................................................................61Session Three Review ..................................................................................................................61Focus for Today’s Session ...........................................................................................................61Predictions, Acknowledgments, and Disclaimers (PADs) ...................................................62Narratives ......................................................................................................................................63Impact of Incoherent Narratives ............................................................................................. 64Life Narratives ............................................................................................................................. 64Creating Narratives .....................................................................................................................67Active Listening Application .....................................................................................................67Concluding Thoughts .................................................................................................................69Trauma-Response Tools .............................................................................................................70

SESSION 5&6 ................................................................................................................................75Session Four Review ....................................................................................................................75Focus for Today’s Session ...........................................................................................................75Predictions, Acknowledgments, and Disclaimers .................................................................75Incorporating Trauma-Sensitivity in All Communications ...............................................76Non-Trauma-Sensitive Statements ..........................................................................................76PADs Create Boundaries ............................................................................................................77Managing Traumatic Reenactment .........................................................................................78Concluding Thoughts .................................................................................................................83Trauma-Response Tools .............................................................................................................83

SESSION 7 ...........................................................................................................................................87Sessions Five and Six Review .....................................................................................................87Focus for Today’s Session ...........................................................................................................87Predictions, Acknowledgments, and Disclaimers (PADs) ...................................................88The A of LATE: Skill of Affirming ...........................................................................................88Basic Definition of Affirmations ...............................................................................................89General Categories of Affirmations .........................................................................................89Affirming a Person Impacted by Trauma ...............................................................................89Specific Affirmations/Sentence Starters: ............................................................................... 90Four Concept Categories to Apply When Using LATE .......................................................91Blending Four Core Concepts with E of LATE .....................................................................93Four Conditions Necessary for an Event to be Encoded as a Traumatic Memory ........94Reflecting on our Journey—The Steps of Growth .................................................................96Concluding Thoughts .................................................................................................................97Trauma-Response Tools .............................................................................................................97

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SESSION 8 .........................................................................................................................................103Session Seven Review ................................................................................................................103Focus for Today’s Session .........................................................................................................103Predictions, Acknowledgments, and Disclaimers (PADs) ................................................ 104Five Continuums Describing People Types ......................................................................... 104Descriptions of Five Continuums .......................................................................................... 105Interactive Processes .................................................................................................................110Concluding Thoughts ...............................................................................................................112Trauma-Response Tools ...........................................................................................................113

SESSION 9 ......................................................................................................................................... 119Session Eight Review .................................................................................................................119Focus for Today’s Session ........................................................................................................ 120Predictions, Acknowledgments, and Disclaimers (PADs) ................................................ 120Therapy Versus Education ...................................................................................................... 120Learning About One’s Past ......................................................................................................121PADing and Establishing Boundaries ...................................................................................121Questions When Exploring One’s Past ................................................................................ 122Explaining How the Hippocampus and Amygdala Differ With Regard

to Memories .......................................................................................................................... 124Helping a Person Understand and Manage Flashbacks From a Neurobiological

Perspective ............................................................................................................................ 125Concluding Thoughts .............................................................................................................. 127Trauma-Response Tools .......................................................................................................... 128

SESSION 10 .....................................................................................................................................131Session Nine Review .................................................................................................................131Focus for Today’s Session .........................................................................................................131Power and Impact of Relationships/Invisible Nature of Relationships .......................... 132Relational Principles ................................................................................................................. 133Invisible Forces within Relationships ................................................................................... 133The Ethical Dimension of Relationships .............................................................................. 134Predictions, Acknowledgments and Disclaimers (PADs) ................................................. 134Rationale—Ethical Dimension ............................................................................................... 135The Four Levels of All Relationships .................................................................................... 136Entitlement ................................................................................................................................ 137An Example Describing the Four Levels/Impact

of Giving and Receiving ...................................................................................................... 137What Do Fairness and Fair Giving Mean? .......................................................................... 138

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The Story about Two Babies ................................................................................................... 138Concluding Thoughts ...............................................................................................................142Trauma-Response Tools ...........................................................................................................143

SESSION 11 .....................................................................................................................................147Session Ten Review ...................................................................................................................147Focus for Today’s Session .........................................................................................................147Predictions, Acknowledgements, and Disclaimers (PADs) ...............................................148Interactive Processes and Relational Forces .........................................................................148Impact of Specific Sensory Messages, Body Language

and Non-Verbal Messages ...................................................................................................149Sensory Messages ......................................................................................................................149Non-Verbal Messages ................................................................................................................151Nonverbal Messages a Trauma-Competent Professional May Want

to Intentionally Transmit ....................................................................................................151Sensory Triggers May Shift Brain States ..............................................................................152Assertive Care ............................................................................................................................152Self-Care for the Professional ................................................................................................. 153Concluding Thoughts .............................................................................................................. 154Trauma-Response Tools .......................................................................................................... 154

SESSION 12 .....................................................................................................................................159Predictions, Acknowledgments and Disclaimers (PADs) ..................................................160Universal Messages ...................................................................................................................160Be Fair and Reasonable with Regard to Your Responsibilities .........................................160Messages to Communicate to Yourself .................................................................................161The Power of Neurobiological Metacognition .....................................................................163Bruce Perry’s Neurosequential Model of Therapeutics......................................................163Appreciating our Journey........................................................................................................ 164Images and Stories .....................................................................................................................168Clips..............................................................................................................................................168Closing Thoughts .......................................................................................................................172Trauma-Response Tools ...........................................................................................................173

Resources .....................................................................................................................179Certification Checklist for Trauma-Competent Professional ..........................................179Template for Presenting a Teachable Moment ....................................................................181Guidelines for 10-Minute Topic Presentation .....................................................................183Case Study ...................................................................................................................................187Homework Grid ........................................................................................................................ 195

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EVALUATION 1 .................................................................................................................................197

EVALUATION 2 .................................................................................................................................199

EVALUATION 3 .................................................................................................................................201

EVALUATION 4 .................................................................................................................................203

EVALUATION 5 .................................................................................................................................205

EVALUATION 6 .................................................................................................................................207

EVALUATION 7 .................................................................................................................................209

EVALUATION 8 ................................................................................................................................. 211

EVALUATION 9 .................................................................................................................................213

EVALUATION 10 ..............................................................................................................................215

EVALUATION 11 .............................................................................................................................. 217

EVALUATION 12 ..............................................................................................................................219

FINAL EVALUATION .............................................................................................................................221

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HistoryIn 2003 in an on-going eff ort to decrease child abuse, neglect and delinquency, the Philadelphia Department of Human Services established a goal to provide city-wide parenting education and support for parents/caregivers. In 2006 United Way of Greater Philadelphia and Southern New Jersey became a co-sponsor in this on-going eff ort. Th e objective of community-based parenting education and support programs is to enhance parent-child relationships by reinforcing healthy behaviors of parents/caregivers. Th rough these programs, parents/caregivers are encouraged to:

J Develop their parenting skillsJ Improve their understanding of child developmentJ Try a variety of healthy approaches to child-rearingJ Learn techniques that reduce stressJ Improve parental eff ectiveness

Over time, the Institute for Family Professionals (IFP) evolved into off ering quality, on-go-ing professional development training to professionals in the greater Philadelphia region who infl uence, directly or indirectly, children and families. We provide courses for organizations such as the School District of Philadelphia and the Behavioral Alliance of Rural Pennsylvania. Additionally, trauma courses are off ered at Philadelphia University where students can earn a trauma minor. IFP has more recently expanded to off er trainings globally via streaming and broadcast mediums. Th is expansion has welcomed a change to our name and we are now Lake-side Global Institute (LGI).

Ongoing Professional DevelopmentTh e responsibility for meeting the complex needs of children, parents/caregivers and other adults is often placed on professionals. Professionals include:

J Case and Social WorkersJ Supervisors and Agency Directors

Welcome

xii Welcome | Applying Trauma Principles

J Counselors J Therapists/Clinicians J Educators (infancy through high school) J Support Staff J Criminal Justice System

Professionals are often over-extended and lack many of the resources required to nurture and support children, adults and families. Recognizing this, Lakeside Global Institute (LGI) provides extensive and comprehensive professional development through courses designed to support professionals.

In 2006, IFP was invited to partner with United Way of Greater Philadelphia and Southern New Jersey to support and expand the reach of IFP throughout the region. It is our partnership with United Way that allows us to offer a wide variety of courses. As a result of this partnership, as well as continued support by DHS, we are able to serve professionals every year who touch the lives of children and families.

LGI’s training approach is designed to incorporate current research in effective transfer of training with an interactive and dynamic format. The materials embrace a broad range of ap-proaches that promote emotional and relational health. Professionals are invited to explore a va-riety of information, concepts, approaches, principles and skills (ICAPS) that enhance and enrich:

J Emotional and relational health J Critical thinking to determine best practices J Skills J Confidence to nurture and support families

LGI provides a place where professionals are allowed to process struggles and discoveries in dealing with children and adults. As a result of the training offered, professionals are empow-ered to become effective in their various roles.

Training courses are evaluated and researched to measure the effectiveness of the training and ensure that the Institute consistently produces measurable outcomes.

Training ProcessesThe following information provides an overall description of training processes.

Professionals can expect that in each session we will:

J Discuss books and curriculum J Share and process ways professionals are applying the information J Present a variety of ICAPS J Practice recognizing, generating and applying ICAPS through interactive exercises

Professionals are asked to complete and submit an evaluation at the end of each session.

Awareness and Understanding xiii

We use this design to better ensure transfer of training so that it is meaningful, practical and inspirational.

We ask professionals to note when and how they are applying concepts and any observations and feedback they believe might be beneficial in helping us meet our shared goals of:

1. Nurturing the nurturers2. Enhancing and enriching professionals’ knowledge and skills3. Promoting connections among colleagues4. Creating a shared foundation and philosophy of ICAPS

We invite professionals to become aware of the impact LGI training has on them personally and professionally. Specifically, we invite professionals to notice ways they are becoming more:

J Aware J Clear J Compassionate J Patient J Tolerant J Hopeful J Respectful

For each of these, we encourage professionals to notice the impact on themselves and others.As professionals are impacted through experiencing LGI training, there can be some pre-

dictable outcomes. These include:

J Enhanced emotional health J Enhanced relational health J Changes in beliefs and behaviors J Increased understanding and abilities to nurture and empower J Increased openness to new learning J Enhanced abilities to accurately apply the LGI ACTing process (Assess themselves and

those with whom they are interacting, recognize the wide range of Choices that exist when interacting and to effectively Take Action for the specific Choice made).

Overall we invite professionals to become more aware of an increase in their abilities to in-tentionally nurture and empower themselves and those with whom they interact.

Awareness and UnderstandingWe invite professionals to become aware of the degrees to which they are able to intentionally build, maintain and repair relational bridges.

We invite professionals to become aware and appreciative of the ways they can develop in-tentional processes that can lead to powerful, positive outcomes. We encourage professionals

xiv Welcome | Applying Trauma Principles

to experience enhanced abilities to effectively deal with clients’ unresolved issues, helping them embrace their innate strengths and abilities to succeed in life.

We invite professionals to celebrate positive experiences that result from participating in this training, and to join in celebrating the positive experiences of their colleagues as they move through these processes.

Information, Concepts, Approaches, Principles and Skills (ICAPS)We frequently share that we will be providing information, concepts, approaches, principles and skills. It has become easier to recall this whole list by developing the acronym ICAPS. Using ICAPS may help guide professionals as they move through these processes as a result of participating in the courses.

Ground RulesThe following are the LGI Ground Rules we re-quest everyone follow:

J Participation

C Everyone is welcome to participate. C Everyone has the right to pass.

J Respect as a Group

C We acknowledge that there are many individual perspectives and values; we agree to respect the opinions of others. We agree not to inflict beliefs and values on each other.

C Everyone agrees to include all members of the group, to nurture the emotional health of everyone present.

C Each person is responsible for letting the group know if they have something to share. C Group members practice question sensitivity toward each other. C Confidentiality outside the group is preserved. C Everyone fairly shares the air space. Group members take responsibility for provid-

ing time for all members to share. C Group members agree to minimize side conversations. C Group members agree to limit the use of cell phones (including text messaging or

social media) or any other technology/activities that prevent full participation.

In addition to the standard LGI Ground Rules, we request that everyone also embraces the following:

J Respect for Self C Each person is open to new information, new perspectives and approaches to

healthy educational processes. C Each person assumes responsibility for themselves. C Members whose needs are not fully met in this group agree to seek other resources. C Each person works to be a critical thinker and thoughtful consumer.

Reading Assignments xv

J Approach

C We are process, not solution, oriented. The ultimate decision for handling a situa-tion or problem belongs with that particular group member. No one tells another how to solve a problem or issue.

C We promote authoritative (Backbone) leadership. C We focus on joy, new awareness and successes, not just problems, struggles and

frustrations. C Group members are encouraged to share triumphs and joys as well as problems.

Ground Rules If Children are Present J Children are expected to act like children. J We recognize that children are at various developmental stages and abilities. J Everyone works to preserve the self-esteem and the physical safety of each child. J If a child is in a difficult stage, such as hitting, biting or pushing, the adults in charge are

expected to protect all of the children.

We ask that professionals uphold the LGI Ground Rules to ensure that groups consistently provide safe opportunities for learning, sharing and processing for all members.

Reading AssignmentsIt is important to keep up with reading assignments to prepare for book discussions.

The information contained in the LGI Curriculum provides background information on the subjects being presented at each session.

Training DesignEach session is designed to include time for personal sharing and reflection, book discussion and presentations of relevant ICAPS along with related interactive exercises to maximize the probability that:

J Classes are stimulating, interesting and valuable J Professionals feel nurtured J Professionals have opportunities to connect with other members J ICAPS transfer into meaningful applications J Professionals experience positive growth and professional development J Professionals collectively influence the language, approaches and skills of agencies and

professionals who serve families

Agencies include discussion groups or workshops as a mechanism for offering services. We are in a unique position to model leadership approaches for facilitating sharing and processing in a group setting as well as effective, interactive methods for presenting ICAPS.

xvi Welcome | Applying Trauma Principles

Each group establishes its own entity with unique dynamics. We also have the opportunity to study and learn from each group’s development and processes to become aware and have understanding of the subject of group process.

HomeworkThere are reading assignments for each session that provide more detail on the subjects presented in class.

Professionals are invited to write a reflective comment on as-signed readings and to submit those to the trainers each session. Research has demonstrated that transfer of training is positively impacted when there are reading assignments and when profes-sionals are expected to relate and apply information to their own situations. We contribute to promoting effective transfer of training through having assigned readings, discussions around readings and when professionals take the time to put their reflections in writing.

Trainers read and briefly comment on each professional’s homework and return it the fol-lowing session.

Comments can be as short or long as professionals determine will be beneficial to their learn-ing process. Some professionals may write a few concise sentences, others may choose to elabo-rate, sharing ways they are personally or professionally relating to and applying ICAPS.

Completing written reflection homework is optional. We see and treat professionals as adult learners. We encourage written homework because research shows the benefits to profession-als for sharing stories, thoughts, reflections and reactions to reading. Writing:

J Provides an outlet to debrief from the experience of reading that is intense, emotional and powerful at times

J Can help professionals focus on what they are experiencing and reinforce what they are learning and the ways they are applying principles

J Can provide a level of discipline to professionals who would benefit from this kind of focused activity

J Promotes an increase in the stickiness of the information J Provides a way to share in a more private way J Affirms individuals

While professionals have commented that it can be challenging to find the time to complete the reading and written assignments, the vast majority have commented favorably on the im-pact the homework has on learning and growth.

CertificatesWe acknowledge the level of participation by group members in the certificate we present at the end of each course. A Certificate of Attendance is awarded to acknowledge professionals who have met the following attendance requirements by attending a minimum of:

Reflective Sharing xvii

J Four sessions (six session courses) J Six sessions (nine session courses) J Seven sessions (10 session courses) J Nine sessions (12 session courses)

Additional attendance information:

J Chronic lateness or leaving sessions early impacts attendance status. J Anyone who misses the first session and does not notify LGI in advance is automatically

withdrawn from the course so those on a waiting list can be invited to attend. J Anyone who misses more sessions than required for minimum attendance is withdrawn

from the course and can: C Return unmarked books and Curriculum C Retake the course in full C Request permission to make-up missed sessions C Submit payment in full for books and return Curriculum

The funding sources sponsoring this training are provided data that details information re-garding attendance.

Reflective SharingResearch indicates that professionals benefit from opportunities to engage with colleagues in re-flecting on awareness, experiences and concerns. Time is allotted in each session for professionals to share observations, experiences or insights related to what is presented. Professionals can share on a professional or personal level.

The following sentence starters can be used during Reflective Sharing:“As I consider the ICAPS presented in previous sessions . . .

J I have observed . . . J I am more aware of . . . J I understand . . . in a new way . . . J I have applied . . . by . . . J The apparent impact . . . has had on me is . . . J The apparent impact . . . has had on those with whom I work is . . .”

By providing time in each session for group members to share and process we:

J Enhance the probability that effective transfer of training will occur J Model ways to create and maintain the climate of an effective group process J Provide opportunities for professionals to debrief, be listened to and affirmed J Provide opportunities for professionals to connect with one another J Provide opportunities for professionals to inspire others to apply ICAPS in real-life

situations J Enhance awareness and understanding of group processes

xviii Welcome | Applying Trauma Principles

Book DiscussionBook discussions provide opportunities for professionals to share thoughts, comments and in-sights with other members of the group. Discussions also provide opportunities for profession-als to highlight specific ICAPS from the readings.

As a result of engaging in this process, we believe professionals gain new insights and con-nect with each other as colleagues with shared missions and values.

There is a designated time each session for book discussion. Trainers will facilitate the pro-cess, clarifying how much time should be spent on each book.

Professionals are asked to bring books to class that had assigned reading.Professionals highlight key points in each reading selection so they can easily identify ICAPS

they wish to discuss. Professionals may wish to refer to their written homework during this discussion time.

Questions to guide the process: J What are key points and principles to highlight in this reading? J What concepts, principles, ideas or opinions made a positive impression? Why? J How and where might you apply something you read? J Is there anything you disagreed with, thought should be modified or was not clear?

Brain Breaks and FidgetsResearch indicates that people involved in training benefit from regu-lar brain breaks. Trainers will periodically invite professionals to stop more cognitive activities to give their brain a break and engage in something that is somatosensory in nature. Each brain break takes 1 to 3 minutes and trainers will use a variety of them.

Professionals are encouraged to take an opportunity to take a personal brain break in which they notice body sensa-tions and intentionally stretch, move around, take deep breaths and mentally promote inner calmness.

Fidgets are sensory objects with which people can fidget. Fidgets are tools that help people focus and also help relieve stress. Fidgets are provided at each training session.

We hope brain breaks and fidgets inspire professionals to care for themselves and to consider ways they might care for others.

ResearchAn important component of the LGI training process is research that demonstrates the degrees to which we are effectively transferring training and therefore impacting the knowledge and skill bases of professionals.

LGI has specific goals mandated by funders. In some training cycles, professionals complete an initial research survey or questionnaire at the first session to provide a base for measuring

When, Where, and How to Use Training xix

growth. This survey or questionnaire is based on specific aspects of our training and our im-pact, not on measuring the overall knowledge of professionals.

As we proceed through various levels of training, we ask professionals to complete post-sur-veys or questionnaires, expecting that, over time, we will demonstrate that professionals are absorbing and integrating basic ICAPS and that our training is having impact.

We believe that as we demonstrate that awareness, understanding and skill levels are being raised, funders will continue to be appreciative of the collective efforts and successes of profes-sionals and LGI in achieving stated goals of the training.

We also expect that professionals are incorporating ICAPS in their work with others and are observing the positive impact of applying them.

We hope professionals will credit themselves for their hard work and openness to learning, growing and changing.

When, Where, and How to Use TrainingProfessionals are invited to consider and apply the information provided in this course profes-sionally and personally.

Professionally you are invited to: J Re-examine, explore and become aware of the beliefs, values, knowledge and skills that

define your professional integrity J Intentionally apply awareness and understanding to your work with others J Consider when and how to present ICAPS to others

Personally you are invited to: J Explore and become aware of your beliefs, values, knowledge and skills for enhancing

the health of your personal life J Intentionally apply awareness and understanding in your personal relationships

We have learned that when professionals apply ICAPS in their personal and professional life, there are several positive results:

J Greater appreciation for the potential and actual value of ICAPS. As these are under-stood and embraced in one’s personal life, they become very real and their value is more deeply embedded.

J The ways to apply ICAPS becomes clearer. Challenges or possible areas of confusion or struggle that others might face become clearer as well.

J Through repeated practice applying ICAPS, professionals become clearer about some of the details and nuances of each and are better able to use them.

J Trust and safety levels are enhanced between professionals and those with whom they interact as a result of professionals integrating ICAPS into their own personal lives. Levels of confidence and relational strength with others often increase because profes-sionals become clearer and more appreciative of the ICAPS they are using personally.

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Four Broad GoalsWe commit to meeting four broad goals:

J Nurturing the nurturers by recognizing, appreciating and crediting professionals who work diligently to nurture others.Rationale: Research has shown that burnout is most likely to occur when people with high stress jobs do not have opportunities to be appreciated, nurtured and renewed.Potential Impact: As a result of feeling safe, appreciated and respected, we find pro-fessionals more engaged in discussions and interactive activities, thereby learning more and experiencing increased understanding of the ICAPS being shared.

As we model what it means to create and maintain a safe and caring environment, we find professionals become clearer about ways to become better equipped to nurture clients in their own situations.

Experiencing this level of nurture also prevents or lessens burnout and can revitalize and renew professionals’ energy for their work.Potential Outcomes: As a result of being impacted in these ways, professionals are better equipped to nurture others which in turn can lead to those individuals to become more emotionally and relationally healthy. This ultimately can impact the emotional and relational health of children and families.

Because the exposure to regular nurture can prevent or lessen burnout and can revi-talize and renew professionals’ energy for their work, there can be less turn-over, saving organizations the money required to train new employees.

J Enhancing and enriching: C What professionals already know C Broadening perspectives C Providing new information and skills or new ways to apply information and skills C Providing opportunities to become clearer about ways to promote emotionally and

relationally healthy practices C Discover effective ways to assess and practice leadership skills C Give each other feedback that invites greater awareness and promotes personal and

professional growthRationale: Each professional can be aware of the benefit of receiving new information, from having opportunities to refresh and review current practices, discover new ways to apply information and raise awareness, understanding and skill levels.Potential Impact: As a result of receiving new information and having opportunities to refresh and review current practices, professionals become clearer and better prepared to interact in healthy and effective ways.Potential Outcome: As professionals become clearer and better prepared to interact in healthy and effective ways with others, those individuals become emotionally and relationally healthy and therefore better equipped to nurture and empower others.

Our Invitation to You xxi

J Promoting connections between and among colleagues, providing opportunities for representatives from many agencies to connect with one another, collaborate, partner, mentor and support each other, which in turn fosters a spirit of teamwork and shared values.Rationale: By providing opportunities for colleagues to connect with each other, the LGI training process encourages a spirit of cooperation and collaboration, which can strengthen the overall mission and goals throughout a region to effectively nurture and educate others.Potential Impact: As a result of professionals connecting with colleagues, sharing val-ues, struggles and expectations, they:

C Gain clarity with regard to their roles and responsibilities C Respect struggles and successes C Grow in compassion, patience, tolerance and hope C Experience the benefits of being connected in safe and caring relationships

Potential Outcome: Each of these impacts can be passed on to the individuals and groups with whom they interact, raising their knowledge and skill levels that promote emotional and relational health.

J Create a shared foundation and philosophy of ICAPS, encouraging the adoption of measurable standards that lead to core competencies and predictable outcomes, which raise the overall quality, professionalism and predictability of those who serve others.Rationale: By engaging in a region-wide process that promotes a unified philosophy, value system and common language, each professional and agency becomes clearer, intentional and effective in interactions with others. Over time these individuals benefit from receiving consistent, meaningful and healthy ICAPS.Potential Impact: As a result of a unified philosophy, values system and common lan-guage throughout the region, there will be momentum generated to continue enhancing the ways that professionals interact with and promote emotional and relational health in others. Approaches that are punitive in nature will greatly decrease as challenging behaviors will be appreciated and understood as having underlying reasons, often relat-ed to family legacies or extreme, toxic stress.Potential Outcomes: As the region-wide, unified philosophy and common language impacts individuals and systems, the various healthy ICAPS can now be passed along to individuals and systems, impacting them and having the ripple effect of enhanced outcomes on others.

Our Invitation to YouWe invite you to use these sessions to promote your own emotional health and to help you become more aware. We invite you to have increased understanding of and more ways to inten-tionally apply relevant ICAPS that nurture and empower you and those with whom you work.

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Lakeside Global Institute welcomes you to Applying Trauma Principles. We are excited that you have joined us to explore the complex and fascinating subject of trauma and to discover ways you can eff ectively use the ICAPS provided.

By attending this course you are demonstrating a willingness to participate in an advanced exploration of the subject of trauma and the many ways it can impact people. You are commit-ting to the practical application of the ICAPS that were covered in Enhancing Trauma Aware-ness, and Deepening Trauma Awareness by completing this course.

LGI courses focus on discovering ways to develop, maintain and improve the emotional and relational health layers of each person’s iceberg. We know that the traumatized iceberg may take our understanding of the sadness and injustice of deep wounding in those underlying lay-ers to a whole new level. We appreciate each participant’s willingness to continue this journey. We credit our participants for courage, dedication, and passion for taking responsibility to be-come trauma-competent in their approach to working with individuals and families.

As we become more knowledgeable, we can anticipate gaining more respect for the power and price of trauma. Th is course will allow us to advance as agents of hope and healing.

As with other LGI courses, we are confi dent you will gain new awareness and insight that will enrich your life personally and professionally. We encourage you to be self-aware as you move through this course, especially with regard to how it is enriching your awareness and ability to use and share the information with others.

1SESSION

2 Session 1 | Applying Trauma Principles

Focus for Today’s SessionWe will be taking time to explore the subject of applying trauma principles and participants can expect to be introduced or re-introduced to:

J Goals for Applying Trauma Principles J Specifics of the design for this course, including ways participants will be invited to

interact and present information and case studies J PADs J The use of a Personal Self-Care Plan J Information about becoming a Certified Trauma-Competent Professional J Consideration of some of the broad perspectives about the nature of trauma that partic-

ipants are invited to appreciate

Predictions, Acknowledgments, and Disclaimers (PADs)

1. We predict that there is excitement about reentering the world of trauma exploration on the part of participants. We may feel excitement and an eagerness to learn more about trauma and ways to apply trauma principles.

2. There may be intense or emotional reactions as we continue enhancing and enriching core knowledge with regard to the properties and principles of trauma. We acknowledge that the intensity of any of these kinds of reactions may reflect personal experiences and wounds. As we have in the past, we encourage participants who find aspects of this training to be personally troubling to consider seeking outside help on resolving trauma issues.

3. Participants have a variety of backgrounds and experiences that can contribute to assim-ilating and integrating information and skills. Each participant will find specific areas to focus on and become competent in order to be prepared to use the knowledge and skills in specific settings.

4. We have experienced that it can be a bit overwhelming to begin actively applying principles in real-life situations. Dr. Bruce Perry and Dr. Sandra Bloom, and the myriad of others who are psychiatrists and neurobiologists have inspired each of us to be agents of change.

5. We acknowledge that because this course will emphasize a way to explore and practice applying trauma principles, the overall quality and success of the course is more depen-dent on that participation than in other LGI courses.

6. We are not claiming to be capable of preparing our participants to be as competent or take on the kinds of responsibilities trauma-trained clinicians assume. Our roles are pri-marily educational and nurturing in nature, with a very mindful approach to maintaining boundaries.

7. Some participants attending this course may not necessarily seek or receive confirmation as a Certified Trauma-Competent Professional; participants may attend in order to ad-vance their own knowledge bases and skill levels and attendance does not automatically mean someone receives LGI’s certification.

8. Becoming a Certified Trauma-Competent Professional is more of a process than an event. It can be challenging to commit to ongoing participation in the process of maintaining high

Specific Goals for This Course 3

levels of competency around the subject of trauma. We hope that the status of this title will contribute to promoting and maintaining high standards within individuals who receive it.

We hope that the PADs address some of the possible concerns participants might be experi-encing. We believe it is important to be aware of the possible impact our training might have on participants and to proactively identify possible needs, expectations and concerns.

Specific Goals for This CourseWe anticipate that participants will have the opportunity to:

J Review contents and materials from Enhancing Trauma Awareness and Deepening Trauma Awareness

J Prioritize ICAPS needed to effectively apply trauma principles (using ACTing) J Explore choices trauma-competent professionals have in order to modify ways of com-

municating with people impacted by trauma J Integrate some of the basic principles and approaches for understanding relational health

and being sensitive to the possible relational needs of individuals impacted by trauma J Provide multiple opportunities for practicing application of key concepts, approaches

and skills J Define expectations, responsibilities and requirements for LGI’s certification as a Trau-

ma-Competent Professional J Promote confidence and competency in participants who apply to become Certified

Trauma-Competent Professionals

Focus is on ApplicationIt is clear that most people attending and participating in LGI trauma courses have received a fairly comprehensive education with regard to the basic nature of trauma, its impact and po-tential aftermath.

Most of us have attended informative trainings throughout our careers. As inspired and informed as we are by the information or skills, over time they dissipate and may no longer be as meaningful as when they were first presented to us. We may not retain what was presented unless we use it.

Applying Trauma Principles is a 12-session course that focuses on providing participants with meaningful opportunities to apply the information, research, principles, and concepts included in Enhancing Trauma Awareness and Deepening Trauma Awareness. Through this course, we can share in discovering and reinforcing specific ways to incorporate what we have learned into practical, usable strategies and approaches. This course is intended to:

J Re-engage participants in discussions about trauma J Strengthen and reinforce the ICAPS covered in the Enhancing Trauma and Deepening

Trauma J Enhance and enrich our awareness, sensitivities and understanding and translate theory

into practice


In this course the individuals that are committed to being effective in their work with people impacted by trauma benefit enormously from connecting with colleagues who can nurture, support and encourage them. By working together, we can create a strong group dynamic in which we partner with each other to promote the values and standards that can ensure our ef-forts to address trauma-related issues or needs.

Responsibilities of Trauma-Competent ProfessionalsIt is important for professionals to be clear about what re-sponsibilities they should assume. For example:

J Do no harm by intentionally or inadvertently exacer-bating someone’s trauma, by triggering flashbacks, or compromising a person’s sense of safety and control.

J If harm is done by inappropriate or unhealthy interactions, immediately take steps to respond and repair that damage, including consulting with someone qualified to pro-vide advice or intervention.

J Create and maintain emotional and relational safety throughout all interactions. J Maintain boundaries between education and therapy. J Appreciate the power trauma can have to deeply wound a person, understanding that

resolving, repairing, reconciling, recovering, restoring, and healing all take time. J Carefully assess a person’s situation, needs, feelings and behaviors. J Consider the choices that might be appropriate and eliminating those choices that may

not be effective or harmful. J Apply researched, approved ICAPS in carefully executed ways. J Be intentional about how to Listen, Affirm and/or Teach Effectively in trauma-sensitive ways. J Project messages and attitudes of respect, compassion, tolerance, patience and hope. J Facilitate the normalization of the thoughts, feelings, beliefs and behaviors that often

are symptomatic of trauma. J Process intense, challenging interactions with a third party qualified to help consider

the appropriateness and possible impact of those interactions. J Continue to grow in awareness, understanding and trauma-sensitive skills and approaches.

Unfair Responsibilities for Trauma-Competent ProfessionalsIt would be unfair for a professional to assume or someone else to project any of the following responsibilities on a trauma-competent professional:

J Diagnose a person’s possible traumatic experience. J Absolute certainty which principle, concept, approach or skill will be effective in treat-

ing people impacted by trauma. J For the outcome of interactions. J Pain, losses and injustices perpetrated by others that have caused or are exacerbating a

child or adult’s trauma.

Power and Importance of Hope 5

With trauma, it is important to keep the boundaries of responsibility in mind and not con-fuse feelings of compassion, worry, concern or love with responsibility.

Trauma-competent professionals are encouraged to remember that one of the most profound-ly unfair expectations which can be imposed on a professional (or anyone) is to have responsibility for someone or something and not have the power to impact that person or situation.

Power and Importance of HopeInherent in our focus is an emphasis on the power and importance of hope. We believe that everyone involved in becoming trauma-competent benefits from knowing they are agents of healing, change and hope. The emerging research on trauma continues to demonstrate the power and possibility for individ-uals impacted by trauma to experience healing. We believe that with careful training and practice, we promote hope and healing for many individuals impacted by trauma.

There is evidence that educational processes can have powerful impact on promoting heal-ing. Our approach is education, and therefore it seems essential that we continue to teach pro-fessionals to maintain boundaries with regards to therapy and education. Just as there can be an educational component to any therapeutic process, we know that certain educational processes can promote hope and healing.

Also, inherent in our focus is the continuation of our emphasis on the power of healthy re-lationships as an essential bridge from pain and despair, to the freedom that comes when these are lessened and resolved. Throughout this course, we will introduce relational concepts that are powerful and important for professionals to understand, appreciate and incorporate in their strategies for working with people, systems and communities impacted by trauma.

Design of This CourseThis course features many of the same design components as other LGI courses, such as spend-ing time at the beginning of each session reflecting on how participants are using the informa-tion, book discussions and presentations of key concepts combined with interactive activities.

There will be some distinct differences between this course and other LGI courses. While we will continue our exploration of the subject of trauma, time will be devoted to allowing each participant to share specific strategies and approaches they are using professionally. The rationale for this approach is that each of us can learn from sharing stories and experiences around similar values, beliefs and information. We know that typically people cannot sustain new ICAPS unless the information and skills are sufficiently reinforced.

By having participants share in reviewing topics covered in the previous courses, partic-ipants can be reminded of the powerful principles and messages that were informative and inspirational in the first 18 sessions of exploring the subject of trauma. Participants benefit from reviewing the material and being able to teach it back to each other. This review pro-cess demonstrates trauma-competency and reinforces participants’ ability to teach the trauma concepts to others outside of LGI, including colleagues, clients and others who may benefit from receiving the information.


Being able to share specific ways participants are presenting information to individuals out-side the course can provide opportunities to practice presenting information to others. This can reinforce the value in educating as many individuals as possible with regard to the power, prevalence and price trauma imposes on individuals, families, communities, systems and soci-ety in general.

By inviting participants to share case studies in which they explain specific principles and strategies they incorporated, participants can benefit from becoming clearer and knowledge-able with regard to their roles and responsibilities as professionals. By receiving feedback from trainers and colleagues, we can enhance each other’s confidence and competence and help maintain our goal of nurturing nurturers.

Overview of This CourseWe will be emphasizing the third circle in LGI’s Three-Part Diagram. The first circle represents the facts, information, and research on the subject of trauma, and the second circle represents extrapolating principles from the first circle. The third circle represents converting principles into responsibilities. We will continue to explore the first two circles, especially with the addi-tion of new reading materials, however the primary focus will be on the third circle.

In addition to the education that will take place from the outside reading assignments, in this course we will focus on reviewing key concepts and principles from Enhancing Trauma Awareness and Deepening Trauma Awareness with the goal of exploring specific ways we can apply these in real-life situations.

We will:

J Use ACTing processes which involve the intentional processes of Assessing, Choos-ing and Taking Action, as a foundation for being intentional about applying trauma principles

J Focus on relational health and dynamics, especially as they relate to trauma and its aftermath

J Introduce the Ethical Dimension of Relationships J Encourage participants to keep in mind the RH Factors (repair, restore, reconcile, re-

solve, recover and heal) J Invite participants to recall some of the processes of being respectful, compassionate

and hopeful whenever interacting with a person impacted by trauma J Invite participants to remember the importance of remaining humble about their role

in caring for someone who is or may be impacted by trauma J Be taking time to consider ways to modify and practice the skills of Listening, Affirm-

ing, Teaching and Exploring (LATE), knowing that people impacted by trauma need professionals to be highly aware of the possible impact their communication might be having

J Spend time inviting participants to share specific stories of experiences when they have applied trauma principles in real-life situations

Participant-Led Activities 7

Participant-Led ActivitiesEach participant will be invited to share each of the following with colleagues in class:

J Teach one of the topics included from Enhancing Trauma Awareness or Deepening Trauma Awareness

J A teachable moment: one or more descriptions of specific ways they have presented infor-mation to someone outside the course, and their assessment of the impact of that process

J Create a case study in which they identify a person impacted by trauma and use the ACT process to demonstrate specific ways they applied trauma ICAPS in interactions with that person.

Certified Trauma-Competent ProfessionalParticipants in this training have an opportunity to earn LGI’s title of Certified Trauma-Com-petent Professional. Participants who desire this certification must complete the requirements of Enhancing Trauma Awareness, Deepening Trauma Awareness and Applying Trauma Princi-ples. As we move through this course, each participant will become clearer about the responsi-bilities, standards and expectations associated with this title.

We believe that by conferring this title on participants who successfully complete LGI’s re-quirements we can work to advance levels of respect and appreciation for the complex nature of trauma and the importance of addressing trauma-related issues in ways that are well-re-searched as effective, healthy and safe.

Requirements to Become a Certified Trauma-Competent ProfessionalIn order to become a Certified Trauma-Competent Professional each candidate must success-fully complete the following:

J Attendance at Enhancing Trauma Awareness, Deepening Trauma Awareness and Applying Trauma Principles. If sessions were missed, a candidate must write a description of the content of any missed sessions, based on the information contained in the curriculum. This demonstrates that they are familiar with the concepts from these courses. Participants are responsible for contacting LGI administration to determine individual attendance records.

J Confirmation that all reading from the three courses has been completed. J Successful completion of the participant activities in Applying Trauma Principles J Presenting a case study for determining trauma-competency including submission of a

written description of the case study. J Passing an open-book take-home exam based on the information contained in all three

courses. J Signing and submitting a certification agreement to adhere to the standards, values and

expectations of an LGI Certified Trauma-Competent Professional.


Review of Personal Self-Care PlanParticipants are invited to recall that we invited each person to create a Personal Self-Care Plan to activate if and when anything might potentially trigger or exacerbate someone’s issues around feeling safe. This was based on knowing that exploring the subject of trauma can be traumatic for some people. People may come into a course with their own trauma issues that may or may not have been resolved and may not have been uncovered yet.

We encourage professionals to use this concept whenever working in situations needing safety by first explaining the importance of creating an environment of safety and empowering others with their own plan for creating safety. We invite participants to create a Personal Self-Care Plan and invite them to use it when they are feeling anxious or unsafe.

Participants are invited to either use the Personal Self-Care Plan previously created or to re-create one for this course. There may be somewhat less intensity in this course as compared to the other two courses because the focus is on applying principles.

The following are suggestions participants might use as they create personal Self-Care plans.

Note: There is no universal self-care plan. Each person needs to consider what con-tributes to feeling safe. Each person is encouraged to be aware of potential triggers in order to better determine the use of their self-care plan.

Sample ways people can create an internal sense of safety:

J Acknowledge your power to find ways to maintain your safety. J List your options for protecting yourself if something scary or dangerous happens, if

you feel triggered. J Picture a safe and peaceful spot. J Think about what you are saying to yourself and correct over-reactive, untrue thoughts. J Consider if you are reacting so strongly because of something that happened to you in

the past. Change your thoughts to be more realistic. “I can feel myself getting panicky or overwhelmed by what is being shared right now. I am feeling this way because I have a trauma history and can be triggered by things like this. It is completely understandable that I am reacting this way and I can take charge, interrupt the process and regain my sense of calm.”

J Breathe slowly and deeply, notice how your belly or stomach expands and contracts with each breath.

J Create a personal mantra or statement of assurance you can repeat mentally, verbally or in writing. “I am not in danger. I am safe. I have the power to care for myself.”

J Relax your body, one body part at a time. J Pray for yourself or others. J Zone out and decide not to pay attention. J Note your physical sensations and remind yourself that sensations are not dangerous.

LATE and ACTing 9

J Mentally focus on the fact that you are in the present and not in the past (i.e., intention-ally feel your feet on the floor, hands on your lap, remind yourself of the date and exact time and that you are present and safe).

Sample ways people can create an external sense of safety:

J Note where exits are. J Sit near a door. J Sit in the room where you feel safest. J Look around to note that other people seem safe. J Refuse to speak. J Be prepared to leave the room, decide a safe place to go (bathroom, outside the room or

building, into another room that is vacant). J Sit near someone you feel safe being close to, someone who might protect you or at

least accepts the ways you promote safety for yourself. J Tell someone you trust if you start to feel unsafe. J Distract yourself by doodling, taking notes, studying things in the room, thinking about

what you want to have for dinner, softly tapping a pen on the back of your hand, softly drumming your fingers, rocking, sucking on a piece of candy.

J Drink cold water. J Close your eyes for a few minutes. J Leave the room.

LATE and ACTingProfessionals are invited to practice some of the essential communication skills in which we believe all professionals should have sophisticated levels of proficiency (LATE):

J Active Listening J Affirmations J Teaching J Problem Exploration

Professionals are invited to begin their own consideration of the importance of and ways we can intentionally ACT situations (Assess, Choose and Take Action) in which trauma is a prob-able factor. As we move through this course, we invite professionals to enhance their under-standing of methods for Assessing, Choosing, and having the skills to effectively Take Action with healthy, appropriate Choices. These individually and collectively can become part of each person’s Trauma Tool Chest.

These two concepts, being LATE and intentionally ACTing situations, will provide a strong framework from which we can enhance our abilities to effectively apply trauma principles.


Maintaining Broad Perspectives About the Nature of TraumaAs we begin exploring ways to apply trauma principles to real-life situations in order to gain clarity and confidence with regard to be-coming trauma-competent, professionals are encouraged to keep the following broad perspectives about the nature of trauma in mind:

J Trauma and its impact are not scientifically measurable, easily diagnosed or completely understood by either the person experiencing symptoms or those who are offering help. Because trauma is stored in various parts of the brain, we need to maintain a deep respect for its complexity and unique manifestation in each individual person.

J Not every traumatic event leaves serious emotional wounds that require the atten-tion of trauma-competent practitioners or anything more than supportive family and friends. This is especially true with emotionally healthy adults who experience traumat-ic events. There are children who have high levels of resiliency as well and the safety of relationships may assist in their healing.

J We cannot accept responsibility for a the healing processes of a person impacted by trau-ma. It is important to appreciate that we are facilitators of those processes. Our responsi-bilities lie in maintaining the values and boundaries of a trauma-competent professional and the privilege of helping trauma-impact people gain clarity and experience hope.

J Just as we cannot visibly see someone’s traumatic injuries, we cannot see the degrees to which healing is occurring within that person. We are only privy to the outward behav-iors and can only take our best guess at what lies beneath the surface of those outward behaviors. Sometimes recovery and healing is occurring and is obvious to the individual and the professional.

J We need to maintain respect for the phrase “over time.” While being traumatized some-times occurs in a single moment or extremely short period of time, the recovery pro-cess often involves time. Sometimes it is enough that another human takes the time to appreciate and accept a person impacted by trauma’s experiences and struggles.

Closing ThoughtsAs we begin the third course on exploring trauma, its aftermath, impact and ways to effectively address trauma-related issues, each professional is invited to take credit for the willingness to engage in processes that are profound in nature and may be challenging to consider.

In some ways, this course may be more satisfying than our previous two courses that were about becoming aware and then gaining a greater understanding of the dynamics and nuances of trauma.

This is a course that invites us to explore ways to bring hope to those who have been im-pacted by trauma because we will become empowered and competent to effectively apply the myriad of trauma principles in real time.

Trauma-Responsive Tools 11

Trauma-Responsive ToolsTrauma-competence is defined by LGI as a participant’s abilities to actively and intentionally ap-ply relevant ICAPS to situations in which trauma is a possible or definite factor in someone’s life.

Notice your impact on others and your quality of relationships as you become more trauma-competent.

Use the following Trauma Response Tools to enhance your awareness, understanding and abilities to apply specific ICAPS in real-life situations from this session:

1. Possible Unfair Responsibilities of Trauma-Competent Professionals

Record feelings you might have if you assumed one or more of these responsibilities: J I should be able to diagnose possible traumatic experiences in people with whom I

interact

J I should know with absolute certainty which ICAP will be effective when I interact with a person impacted by trauma

J I am solely responsible for the outcome of interactions with a person impacted by trau-ma whom I work with.


Select one of these unfair responsibilities and rewrite it to reflect a fair and healthy responsibility for yourself.

2. The Power and Importance of Hope

Draw an image of what hope looks like to you.

Around your image write words that come to mind when you think of hope.

Notice the feelings and sensations you experience as you focus on the idea of the power and importance of hope. Write some words that describe those feelings and sensations. of these around your image to remind you of how powerful and important having hope can be.

These words can remind you of how powerful and important having hope can impact you and those you are working with.


3. Personal Self-Care Plans

Think about a time and place when you felt extremely safe. Draw a picture of that place or write a short description of it. Consider why it was a safe place for you.

Think about someone in your life with whom you are extremely safe. List three things about that person that explains why you may have felt safe in their presence.

If you cannot recall a safe place or person, imagine somewhere or someone who could provide you with safety. Write down some of the qualities necessary for that place and/or person to help make you feel safe.

Notice how these words and images of safety make you feel.

Use these images to create or add to your Personal Self-Care Plan.

15


We are hopeful that you are anticipating ways we can intentionally apply trauma prin-ciples and approaches that will encourage you to feel trauma-competent and excited about becoming certifi ed as trauma-competent professionals.

We are using these 12 sessions to take a systematic look at ways we, as professionals, can apply trauma principles in real-life situations. We hope to slow things down enough to provide participants with opportunities to discuss ICAPS in more detail and to practice ways to apply the information. We will continue to add to each participants’ trauma tool chest with additional information about key concepts.

Session One ReviewIn Session One, through in-class presentations, discussions and the informa-tion contained in the curriculum we:

J Introduced goals for this courseJ Presented specifi cs of the design for the course, including ways par-

ticipants will be invited to interact and present information and case studiesJ Discussed PADsJ Reviewed Personal Self-Care PlansJ Provided information about becoming a Certifi ed Trauma-Competent ProfessionalJ Considered some of the broad perspectives about the nature of trauma

2SESSION

1


Focus for Today’s Session J Introduce the image of the Trauma Tool Chest, including the trauma tool belt and spe-

cialized tools to help when interacting with a specific person or situation. J Highlighted the differences between therapy and education J Explore ways to teach effectively as one of the essential tools for responding in situa-

tions where trauma might be a factor (the TE of LATE). J Become more Question Sensitive J Provide opportunities for participants to discuss and practice applying ICAPS


1. We acknowledge that there will be participants who are not seeking the certification as an LGI Trauma-Competent Professional. We invite these participants to appreciate that some of the information is specific to the certification and acknowledge that it is not rel-evant to those participants not seeking certification.

2. Each person will have their own journey through this course integrating the material and applying the information in unique ways.

3. Even though 30 sessions of training can seem very comprehensive, in many ways it may feel as if we have just begun. We encourage participants to continue their journey of gain-ing new awareness, understanding and skills and to anticipate that being trauma-compe-tent is an ongoing process of learning.

4. As we invite participants to present a topic, create a case study and share experiences of applying trauma principles, there may be a certain amount of anxiety. We ask everyone to be affirming and appreciative of each person’s contributions.

Trauma Tool Chest ImageWe each need to create a specialized tool chest for responding ef-fectively. We call this our Trauma Tool Chest. Professionals collect and store tools that have the potential to be useful in situations in which trauma may exist. Many of these tools can be effective in pro-moting and maintaining emotional and relational health, and can be used in all situations involving the need to nurture and empower.

We expand on this image of a Trauma Tool Chest, by identifying certain tools that are specific to responding to trauma. These may be specialty tools that are more sophisticated than the general tools for pro-moting emotional and relational health. Specialty skills may be based in trauma-specific research, and may require professionals to receive more training and practice in order to effectively use them.

In addition to having this rather extensive number of tools stored in our trauma tool chest, we need to have a tool belt in which we select the tools that are more appropriate to use in spe-cific situations. What one professional might place in the tool belt may be different than what another professional may choose.

Creating a Trauma Tool Chest 17

As professionals identify and collect tools specifi c to caring for people impacted by trauma, they are encouraged to accept responsibility for learning when and how to use them, gaining greater competency in selecting and eff ectively using these tools.

Trauma-competent professionals are encouraged to connect with, and share tools and ap-proaches with one another. Trauma-competent professionals may serve as mentors and coach-es for other professionals as a way to help them gain stronger abilities.

We often think about teaching as a formal process of creating and then delivering some kind of presentation in a way that promotes learning. In fact, in several LGI courses we include our Teaching/Learning Sequence as a way to provide a structured approach to creating and delivering workshops and other formal educational processes. Certainly there are times when professionals can benefi t from intentional processes of creating and delivering information and skills related to trauma as a way to enhance and increase trauma-awareness, trauma-sensitivity and trauma-competence.

At the same time, it is important to appreciate that often teaching comes in the form of teachable moments. Th ese are the informal interactions in which a professional provides rel-evant ICAPS that directly relate to something the person impacted by trauma is processing. Teachable moments are not as much about providing a skill, but rather providing information that brings awareness and understanding for the person impacted by trauma. It can also be valuable to informally teach trauma ICAPS to others who have some kind of relationship or interactions with tperson impacted by trauma.

By having a trauma tool chest fi lled with a variety of tools, professionals have a large selec-tion of options from which to draw if and when they decide that it would be helpful to teach something to a person impacted by trauma, either in a more formal way or when a teachable moment occurs.

Creating a Trauma Tool ChestIn order to begin the process of creating one’s personal tool chest, professionals are invited to review the concepts and images presented in Enhancing Trauma Awareness and Deepening Trauma Awareness to determine which tools should be a part of that trauma tool chest.

Th e tools that are placed in one’s trauma tool chest are not limited to skills. Information, principles, attitudes and beliefs are all important aspects of being trauma-competent.

Participants are invited to look back over the ICAPS used in Enhancing Trauma Awarenessand Deepening Trauma Awareness in order to fully appreciate the personal and professional progress made during our journey.

In these courses we have addressed the following topics:J Th e importance of becoming Students of Trauma throughout the process of enhancing

and enriching knowledge bases and skill levels.J Th e concepts of becoming more trauma-aware, trauma-sensitive, trauma-informed and

trauma-competent.J Th e defi nitions of trauma and related concepts such as traumatic stress, posttraumatic

stress, and posttraumatic stress disorder.


J The types of trauma, including acute or single episode traumas, chronic trauma and complex trauma.

J The power, pervasiveness, prevalence and price of trauma. J The critical importance of creating safety and providing opportunities to claim power

whenever interacting with anyone who might be impacted by trauma. J Specifics of brain growth, development and functioning:

C key brain parts and what each does C principles that describe the nature of the brain, including the differences in mallea-

bility and plasticity of the higher and lower parts and brain wiring C the mechanical, electrical and chemical ways the brain functions and responds to

the world, especially when impacted by trauma C the concept of brain states from calm, aroused/alert to alarmed to fearful to

terrorized C how a person impacted by trauma often operates in and quickly moves to more

aroused brain states and requires more time and gentle, safe interactions to gradual-ly recover and move to calmer states

C the ways the brain impacts the physiology of the rest of the body in areas such as heart rate and blood pressure

C the two key behavioral responses to being impacted by trauma: dissociation and hyper-vigilance

C neurobiological facts regarding the ways the brain responds to the behaviors and messages conveyed by others through processes such as mirroring neurons

J The dynamics of memory:

C different types of memory (implicit and explicit) C various ways memory can be stored (cognitive, emotional, motor and state

memories) C connections between and among associations, interpretations, generalizations

(AIGs), beliefs, sensations, attitudes and feelings, which often have their origins in the lower parts of the brain and that result from experiences that begin with implic-it memories

J Trauma is a sensory and not cognitive experience. J The differences between trauma and posttraumatic stress and posttraumatic stress dis-

order (PTSD). J Trauma and its aftermath of posttraumatic stress and PTSD are often characterized by

flashbacks that can cause a person to re-experience the original sensations as if they were happening again.

J A person impacted by trauma can be triggered to re-experience many of the sensations that occurred during the original traumatic experience.

J People impacted by trauma are often trapped in a trauma vortex that causes them to re-enact critical aspects of the original trauma.

J Appreciations of the risk factors and protective factors of trauma and ways to promote resilience in both children and adults.

Creating a Trauma Tool Chest 19

J There is an innate power the majority of adults have to recover naturally when trau-matized, without therapeutic interventions but often with the support and care from family and friends.

J Forced debriefing may interrupt natural healing processes. J The younger the child, the greater the impact of trauma. J The importance of recognizing and meeting the needs of the person impacted by

trauma. J Vicarious and secondary traumatization as well as compassion fatigue and the im-

portance of self-care and nurturance from caring colleagues are areas that need to be recognized and supported.

J The critical importance of early attachment between infants and a primary caregiver. J The impact of inadequate attachment, including the development of Reactive Attach-

ment Disorder. J Considerations of perpetrators of trauma: who they often are, including sociopaths and

those who perpetuate trauma from generation to generation through domestic violence and child abuse.

J Fear and how fear typically manifests in people impacted by trauma, the fact that un-certainty produces anxieties while predictability often reduces those anxieties.

J The nature of shame and its connection to trauma; that shame can contribute to trau-matization and how trauma can shame.

J The LGI Steps of Growth J The ways commonly accepted parenting practices such as allowing babies to cry it

out and the use of harsh, shaming disciplining, toilet training and the management of school issues that may result in traumatization of children.

J The typical stages through which a traumatized person moves in order to achieve some degree of recovery:

C Stage I: the creation of an environment of safety and trust in which a person can eventually explore traumatic experience(s) and its impact

C Stage II: remembrance and mourning in which the person is able to retell and if necessary relive essential aspects of the traumatic experience while simultaneously grieving the losses associated with being traumatized

C Stage III: moving into recovery and reconnection with a healthy, normalized life.

J The connections between grief and trauma. Grieving a loss is typically associated with sadness while grieving a loss through the veil of trauma often results in terror.

J The dynamics, power and importance of forgiveness and an awareness that decisional forgiveness differs from emotional forgiveness. Emotional forgiveness tends to have more healing potential but is not always possible to achieve.

J The mind/brain connections and the power the mind has to change the brain. J The use of oases, anchors, and safe places to help a person pause when the exploration

of trauma becomes too intense. J A wide variety of theories and approaches to respond/treat person impacted by trauma

C The value of being LATE: Listening, Affirming and Teaching Effectively.


C Approaches that use cognitive brain functioning through psychoeducational pro-cesses or therapies focused on activating the cortex, such as Trauma-Focused Cog-nitive Behavioral Therapy.

C The use of metaphorical story-telling as a safe way to allow processing to occur. C The use of sensory-based approaches, such as EMDR, tapping therapies, yoga and

relaxation breathing. C The importance and impact of calmness, of rhythmic activities that may mimic pre-

natal experiences around hearing the mother’s heartbeat and being rocked within the womb and appropriate touch.

C The importance and potential impact of consistently being respectful, clear, com-passionate, tolerant, patient and hopeful.

J The importance of and strategies for each using our list of 10 P’s: passion; promotion; prevention; being proactive; providing protection; being prepared; knowing when and how to present information; knowing when and how to process with another; being equipped to provide meaningful information, comfort and compassion; and seeing the possibilities

The following sentence captures and condenses the 10 “P’s”:With passion, be prepared to present information designed to prevent harm and provide pro-tection while promoting possibilities through proactive processes. (Robin Jones)

J The power of relationships and the power of love to promote resiliency, protection and healing.

Images and StoriesThe following are the images we invited professionals to use in order to increase their trauma-awareness and trauma-sensitivity:

J Trauma lenses J The Trauma Iceberg J The three-part diagram:

C the first circle with its research and facts C the second circle of principles that evolve from that

research and those facts C the third circle that contains the responsibilities and ways to apply

the research, facts and principles in meaningful, effective ways

J The Trauma Shroud that covers and underlines so many life dynamics for the person impacted by trauma

J The Miguel story when children in the swimming pool were expected to jump off a block and swim in water over their heads

J The two bars of taffy that responded differently when tapped by a hammer because one had been frozen illustrating the power of memories

J The two bottles of clear liquid that looked the same until both were shaken and opened: the seltzer water bubbled up while the plain water did not

Clips 21

J The importance to encourage the creation and use of personal Self-Care Plans J The story of Sammy and Pooh bear illustrating therapeutic play J The tragic stories of incorrect theories used in hospitals, orphanages and families that

deprived infants and young children of the touch of loving caregivers J Creating and using a First Aid for Trauma: An Intentional Response Strategy to provide

effective first responses when children (or adults) are traumatized J The importance of schools and other institutions having an intervention strategy in

place to respond if and when potentially traumatizing events occur

ClipsThroughout our courses we frequently used clips to emphasize concepts and provide opportunities for assessment and discussion. Included were:

J Several clips from the movie I Am a Promise, including the following scenes:

C Two boys coming into the principal’s office because they were fighting on the playground and were chastised by the principal for not being calm enough to come to her

C The scene in which Cornelius hovered defiantly in the corner of the principal’s office saying that he wanted to stay there. Later his mother is called in and reacts very harshly.

C Mr. Coates’ first-grade class of boys already labeled as underachievers who, as a result of his caring, trauma-sensitive behaviors, responded and blossomed.

J The episode “Noel” from the TV series The West Wing in which Josh experiences PTSD and needs to be guided through the process of discovery in order to understand that music was interpreted by his brain as the sound of gunshot.

J Neurons and What They Do J Trauma, Healing and Relationships: Helping Children Heal: Bruce Perry, Daniel Segel and

other experts spoke about trauma, attachment and the impact on the developing brain J The Role of Attachment in Infancy: Drs. Leslie Atkinson and Judith Andersen discuss

stress and early attachment, infant attunement to parents, biological responses of in-fants, insecure attachment

J RAD and Homework: Casey (diagnosed with reactive attachment disorder) has an out-burst and exchange with her mother about homework

J Helping RAD through Horses at Hoofbeats to Healing: Jody Beans talks about her daughter, Victoria, who has been diagnosed with RAD. Clip describes behaviors and the form of therapy using horses used to help her.

J Through Our Eyes: Examples of people impacted by trauma and how perpetrators im-pacted them

J Sociopaths: DNews Psychopath or Sociopath What’s the Difference?


J Room: Clips of Jack playing with Legos, helping his grandmother in the kitchen, meet-ing Seamus (dog), scenes of Jack thinking and talking to his grandmother about cutting his hair. Tells his grandmother he loves her.

J EMDR: Dr. Francine Shapiro, originator and developer of EMDR, describes the thera-peutic technique

J Play Therapy Works: Introduces and promotes the value of play therapy, credentialed play therapists and membership in Association for Play Therapy

J Baby and Me: Evian water ad shown as a way to incorporate play J Mission Impossible 2: Showed how fear impacts people in different ways and allowed

some participants to experience the sensations of fear for a few seconds J Good Will Hunting: Scene showing how therapist leads Will to a place where shame can

be expressed J Brené Brown on Empathy: Animated short reminding us of the importance of empathy

as the antidote to shame J Mad About You in which Jamie and Paul let their baby cry while they counted minutes

outside the bedroom door. J Dr. Sears’ Top Baby Sleep Tips: American Pediatrician shares his tips for getting baby to

go to sleep and stay asleep. J Benjamin Allen Spaces: Discusses the principles of how grief and grieving can manifest

in a person’s life J Benjamin Allen Waves: Discusses the phenomenon of how grief comes in unexpected

waves J Bindi and Derek: 17-year-old is triggered by a distant memory and given an opportunity

to share part of her narrative. Illustrates her strength and the impact of her great loss. Dance demonstrates a somatic approach to healing.

J “Power of Forgiveness”: Performance demonstrating the power of forgiveness in a wordless exchange between a son and his imprisoned father

J Stephen Post: Principles and health benefits of forgiveness

We have experienced a very sophisticated journey of interwoven ICAPS intended to enhance and enrich trauma-awareness, trauma-sensitivity and trauma-competency. Professionals are invited to celebrate they have learned and are encouraged to continue broadening and expand-ing their knowledge base and skills.

Professionals are reminded that they can revisit the tools they decide to place in their person-al Trauma Tool Chest and/or to modify the importance they place on each tool. Professionals can consider which tools work best with other tools. In each session, we hope to add more tools to each person’s trauma tool chest, and provide opportunities for participants to practice effective methods for using these tools. Professionals are encouraged to continue to add to their Trauma Tool Belts as they become aware of important ICAPS that would enhance their abilities to become more trauma-competent.

The Two Divisions in Trauma Tool Chests 23

The Two Divisions in Trauma Tool ChestsRemember that trauma tool chests have two major divisions: one is the collection of all the in-formation, awareness, and understanding that trauma-competent professionals internally need to own. The second division contains various skills and approaches to interact effectively where trauma is involved.

The T and E of LATEIn today’s session we will focus on the specifics of teaching effectively, the T and E of our ac-ronym LATE. We will look at some of the differences and similarities between therapy and education, and some of the differences and similarities between teaching and Trauma Focused Cognitive Behavioral Therapy (TFCBT). Professionals will be invited to explore sensitive and effective approaches for using questions as part of the teaching process. We will have opportu-nities to discuss and practice designing strategies for planned as well as spontaneous teaching.

Therapy Versus EducationOur approach to teaching about trauma is educational. While we look at a wide variety of information on trauma, we want to be clear that we are not prepar-ing individuals to become clinicians or therapists as a result of this training. It is a responsibility for trauma-competent professionals to recognize and maintain the boundaries that separate education from therapy. Professionals benefit from knowing the differences between educa-tion and therapy to assist them in pro-viding appropriate educational interac-tive processes, while avoiding crossing the line to becoming inappropriately therapeutic. Having techniques to encourage individuals to find the help they need, allows pro-fessionals to be in the position of being facilitators of health and healing without accepting the inappropriate responsibility of being therapists.

We believe that all trauma-competent professionals can facilitate some or all of the Rh fac-tors we have described in previous sessions: facilitating processes of recovery, repair, reconcil-iation, resolution, restoration and healing. Many of these processes are related to therapeutic interventions. The following chart provides a framework for discussing some of the differences between therapy and education as well as some of the places where there is crossover.


Education Versus Therapy

Therapy (There is a wide range of therapies

and not all do everything listed here.)

LGI’s Educational Approach

Focus on past and present Focus on current situations

Emphasis on an intentional problem-solving process that leads to healing

Emphasis on education that sometimes leads to healing

Delves into blind window SharedBoth involve a process that:

◾ Is intentional ◾ Is based on clear stan-

dards and competencies ◾ Nurtures ◾ Promotes trust and

connection ◾ Empowers ◾ Builds confidence ◾ Provides insights ◾ Teaches new and health-

ier responses to life situations

◾ Raises awareness ◾ Promotes growth and

understanding of one’s belief system

◾ Teaches healthy messag-es about children, par-ents, and relationships

◾ Increases a person’s emotional health in the present and for the future

◾ Promotes relational health

Protects blind window

Instructive, directed listening: questions

Listening, affirming, and teaching

Therapists make interpretations Educator does not interpret

Solution oriented Process oriented

Goals: ◾ Healing ◾ Closure

Goals: ◾ Learning ◾ Facilitating connection with

others

Obligation/pressure to share as means for working on deeper issues, areas of pain, and trauma

Invitation to share; education approach to areas of pain and trauma; what is shared is applied to group

Therapist is more directive and structured:

◾ Increased degree of chal-lenging and questioning

◾ Threat level less of a concern

Educator is less directive, less structured, less questioning:

◾ Does not challenge ◾ Threat level kept low

Greater responsibility to deeply assess person’s underlying needs and reasons for issues, to encourage change, decision-making

Responsibility to lead, provide information, encourage new understanding, no pressure to change or make make decisions

Therapist is not self-revealing: maintains high degree of personal privacy

Educator is somewhat self-revealing, can allow a personal relationship

Therapy Versus Education 25

There are goals that are shared between both therapy and education. For example, each strives to:

J Empower J Nurture J Build self-esteem J Provide insights, awareness, perspectives, skills J Teach new and healthier responses J Promote understanding of personal belief systems, and encourage modifications that

reflect emotionally healthy attitudes J Teach ICAPS that can empower someone who has trauma-related issues and needs J Provide support to someone impacted by trauma

In Leadership Guide to Self-Esteem: A Family Affair, author Jean Illsley Clarke shares the principle that there can often be therapy in education, as well as education in therapy. When interacting with someone around trauma-related issues and needs, it becomes likely that there are therapeutic components in the educational processes in which a professional might engage. Professionals may provide a sort of therapeutic educational process when interacting with in-dividuals impacted by trauma.

Author Ronald A. Ruden in his book When the Past is Always Present: Emotional Traumatiza-tion, Causes, and Cures states, “Research reveals that the quality of the relationship between the therapist and the client has a greater influence on client outcomes than the specific type of thera-py used by the therapist.” He lists some of the types of therapy in which people might get involved:

J Cognitive behavioral J Person centered J Psychodynamic J Psychoanalytic J Rational/emotive J Systemic (family therapy)

Within the realm of therapy, the impact the therapy has on an individual comes from the quality of the relationship.

While relationships are key to the quality of therapy and the impact of therapeutic inter-vention, they are also key to the impact of teaching/learning and educational processes. As we consider the importance of effective teaching as an important tool that is used by trauma-com-petent professionals, it is important to keep in mind that boundaries should exist between approaches that might cross in the realm of therapy. Trauma-competent professionals can con-sider whether it may be necessary to use teaching, or one of the other tools, such as Active Lis-tening or affirming. We appreciate that encouraging or demanding a person to relive emotional traumatic moments is an inappropriate expectation on the part of a professional.

Every brain is different. And so must be every course of therapy.—Wendy Walker


Cognitive Behavioral TherapyAs we explore teaching effectively as part of a trauma-competent professional’s repertoire of tools, it can be helpful to appreciate that there are some connections between teaching and the therapeutic processes of cognitive behavioral therapy.

In the field of cognitive behavioral therapy (CBT) there has been a sub-field that specializes in addressing trauma issues called trauma-focused cognitive behavioral therapy (TF-CBT).

According to MedicineNet.com cognitive therapy can be described as follows: A relatively short-term form of psychotherapy based on the concept that the way we think about things affects how we feel emotionally. Cognitive therapy focuses on present thinking, behavior, and commu-nication rather than on past experiences and is oriented toward problem solving. Cognitive therapy has been applied to a broad range of problems including depression, anxiety, panic, fears, eating disorders, substance abuse, and personality problems.

Cognitive therapy is sometimes called cognitive behavioral therapy because it aims to help people in the ways they think: the cognitive and in the ways they act: the behavior. Cognitive therapy has, for instance, been used to help cocaine-dependent individuals become abstinent from cocaine and other substances. The underlying assumption is that learning processes play an important role in the development and continuation of cocaine abuse and dependence. These same learning processes can be used to help individuals reduce their drug use.”

TFCBT is a cognitive behavioral therapy approach used to focus on issues around trauma. It incorporates some of the trauma-awareness and sensitivities therapists need to have as part of their processes of promoting cognitive awareness and abilities to use cognition to address and resolve trauma-related issues.

Professionals interested in hearing a description of trauma focused cognitive behavioral ther-apy can listen to the 20-minute presentation by Dr. Kliethermes available on YouTube (www.youtube.com/watch?v=FQlfc-cz5yk).

QUESTION SENSITIVITY

Professionals are encouraged to consider if, when, why, what, and how they might present something to a person impacted by trauma. Asking these questions is part of assessing a per-son situation or experience. It is an important part of LGI’s process known as ACTing (Assessing, Choosing, and Taking Action). This process will be explored in greater depth in later sessions.

Questions a professional might ask include:

◾ What is my reason for teaching this to this person? Helping to raise this person’s awareness and understanding Normalizing a behavior, thought, feeling or belief Equip the individual with effective strategies to respond to trauma-related issues and needs

◾ When in our interaction is a good time to teach ICAPS? It is less appropriate to teach something if the individual is in a more emotional

Closing Thoughts 27

state, or if the person needs to have opportunities to share and express thoughts and feelings. Consider the brain state. Is the person in a lower brain state, or functioning more from the cortex?

◾ What might be helpful to share in this moment? Consider what ICAPS might be relevant and meaningful to this person. What information might be less threatening. By assessing the apparent needs of the person, it can be easier to make appropriate choices about what to share.

◾ How might I share this in a way that is meaningful, clear, relevant and helpful? Professionals should take time to consider the possible impact of receiving the ICAPS and maintain safety. Professionals need to communicate clearly so that the person on the receiving end understands the information, and why it might be helpful.

Often in the process of teaching, it is appropriate to include questions as a way to guide the learning process.

Professionals are encouraged to appreciate the nature of questions and especially how questions might impact someone.

Questions often have an underlying theme of pressure that people may not have consid-ered. Maintaining safety is the number one focus of any interaction with someone who has trauma-related issues. It is essential for professionals to appreciate that some questions can jeopardize feelings of safety.

When too many questions are asked, there can be both positive and negative responses.

Positive Responses: ◾ Feeling cared for ◾ Other person is interested ◾ Someone wants to help ◾ An invitation to share ◾ Feeling appreciated ◾ Someone else is willing to be involved

Negative Responses: ◾ Backed into a corner ◾ Intimidated ◾ Challenged ◾ Threatened ◾ Unsure ◾ Awkward ◾ Caught off guard ◾ Suspicious ◾ Attacked ◾ Manipulated


◾ Misunderstood ◾ Blame ◾ Shame ◾ Intimidate ◾ Accuse ◾ Create Power Struggles ◾ Attack ◾ Stop Healthy Dialogue ◾ Betray Confidence ◾ Lower Self-Esteem ◾ Intimidate ◾ Limit

When questions are appropriate, they can:

◾ Clarify ◾ Challenge ◾ Focus ◾ Help people process information ◾ Communicate interest, caring, and involvement

If a professional asks an occasional question, it is much less threatening than when a professional asks many questions. The threat levels can go up sometimes in direct correla-tion with the numbers of questions asked. If the person on the receiving end feels intimidat-ed or challenged, chances may be there are too many questions in the conversation.

Considerations When Questioning

Below is a list of considerations a person can use to become clear when deciding if and how to use a question.

The Purpose of the Question ◾ Questions are healthier when they are requests for information that are free of

assumptions and hidden agendas.Sometimes people are very uncomfortable with silences and can use questions to stimulate conversation, to fill the air space, invite, or even coerce others to talk. We encourage educators to become more comfortable with silences that allow people the freedom to choose whether or not they wish to share.

◾ Questions can be used as distractions, ways to avoid real dialogue.A person who is questioning is often taking the lead in the conversation and can hide behind those questions as a way of preventing any self-disclosure. Also by asking many questions that maintain a certain level of superficiality, discussing real issues, feelings and needs are often avoided because the questions keep the focus on more mundane descriptions or opinions.

Closing Thoughts 29

Questions that Intimidate ◾ Sometimes either the question or the questioner can intimidate, depending on the

power structure of the relationship.The concept of power and the concept of being one up, one down or on an equal playing field in a relationship can relate to questions.

◾ If the power structure is unequal or even perceived as unequal, questions intend-ed for clarification can be intimidating.

Questions that Accuse ◾ Many questions assume blame and can carry an accusation or motive ascription

such as, “Did you start this fight on purpose?”A person can feel blamed by a question and the intention of the asker may or may not mean to blame the person. If a person can make a statement rather than a question, there may be less potential for blaming and accusing.By being aware of the potential fragility of the power structure, a person might choose not to use a question because it might have the effect of causing the receiver to feel one upped or accused.

Questions that Advise ◾ Sometimes questions are really ways of telling people what to do. “Have you

considered trying to do it this way?”Questions can seem innocent and an attempt to be helpful when they may be dis-guised efforts to tell someone how to do something. The person receiving these dis-guised advice-giving questions often feels challenged and accountable for either tak-ing up the person’s suggestion or defending their position.

Questions that are Rhetorical ◾ Rhetorical questions are more statements pretending to be questions with no

expectation for or possibility of a legitimate response. “Are you trying to drive me crazy by acting like this?” “How do you think I feel when you . . . ?”Rhetorical questions almost always have hidden messages that blame and accuse or give the questioner a platform for making a statement. If a person says, “Don’t you think children today get away with murder because there are so many loopholes in the educational system?” may be an opinion other than one that affirms the question most likely doesn’t want to be heard.

◾ Rhetorical questions can be a set-up for defensive and hostile responses.Rhetorical questions are disguised statements and therefore not legitimate questions. Rhetorical questions may shame a person into submission, or cause them to respond with another rhetorical question. For example, “Are you trying to drive me crazy by acting like this?” might provoke the question, “Have you ever thought that maybe the way you treat me is why I behave the way I do?”


Questions that are Open-Ended

Healthier ways that questions can be phrased:

◾ “Would you like to tell me about it?” is more inviting than, “Exactly why did you say that?”

◾ Broad questions give the other person the chance to decide what is important and to share as much as they want. “Is there anything more you would like to say about that?”

Broad questions can be less threatening because the power is still with the responder.

Questions that require a Yes or No answer often get only that. For example, “Did you have a good time at school today?” requires only a “Yes” or “No” versus the question, “How was your day today?” which allows for more dialoguing. Of course, sometimes children or adults will answer the second question with, “Fine,” however they were given more of a choice with the second type of question than the first. If a person says, “Tell me about your day,” which is not a question, there is more potential for dialogue. Again the person could respond with, “My day was fine,” which may mean they are not wanting to share any more than that.

Professionals might consider that using third person questions can lower threat levels because it is not so direct and potentially challenging to the receiver of the questions.

For example, a person might change the question, “What do you think you need right now?” to “What do you think someone experiencing some of what has happened to you might need right now?” The shift to inviting someone to think about how some-thing might impact another person can create a subtle shift away from the person. It often is much easier and safer to consider another person then to focus on oneself.

We encourage you to appreciate that the person with possible trauma issues or needs is much more vulnerable to feeling threatened or unsafe when asked questions. Questions can represent power on the part of the questioner and a major issue for people with trauma issues in that they may have lost control as well as safety and power.

Trauma-Arrogance

As we move through this training process, we encourage you to consider that the poten-tial exists for any of us to become trauma-arrogant, as opposed to remaining appreciative of the complex nature of trauma. There can be a tendency to become overly confident in our abilities to know and understand a person’s experience and their needs around trauma. This can lead to trauma-arrogance. We want participants in our training to gain an appropriate level of confidence in their abilities to understand and appreciate the nature of trauma and its aftermath, and to be able to apply this understanding to real-life situations.

It is important for professionals to remain humble and highly aware that we are not in a position to diagnose or treat someone’s trauma-related issues. We need to remember not to respond in a cavalier manner when interacting with an individual impacted by trauma.

Closing Thoughts 31

Closing ThoughtsIn today’s session, professionals were invited to create a specialized tool chest for respond-ing effectively to a person impacted by trauma and to consider the importance of recognizing boundaries with regards to therapy versus education.

Professionals were encouraged to be highly aware and sensitive to teaching processes, wheth-er they are more formal or more occurring in teachable moments, and to be highly question sensitive, emphasizing safety.

We encourage everyone to celebrate new awareness and sensitivity, especially as they in-crease their ability to apply trauma principles to interactions with people who have trauma-re-lated issues and needs.

We encourage professionals to remain humble. We need to be clear about boundaries, re-maining tentative and curious, rather than believing that we fully understand the nature and implications of trauma and its impact.

Professionals are encouraged to put their confidence in the theories, research, accepted approaches and skills that appear to be helpful.

A True Story of a Professional’s Overconfidence

In the late 1980s and early 1990s there was a resurgence of interest in the diagnosis of Multiple Personality Disorder (MPD), now called Dissociative Identity Disorder (DID). This disorder is frequently the result of severe trauma occurring in early childhood. A lead re-searcher in the field of MPD attended a conference and shared that he felt extremely confi-dent in his abilities to recognize and diagnose people suffering from this disorder.

In order to impress the audience with how important it is to remain humble, he described a patient with whom he had worked for seven years. He had primarily treated this patient for issues related to anxiety and depression. One day the client came into his office, sat down, and said, “I decided you can meet me. I’ve been coming here for seven years with [the name of the patient the doctor had been treating] and only now feel like I’m ready to talk with you.” This expert said that the little hairs on the back of his neck stood up as he realized that for all these years his patient had multiple personalities and he completely missed it. He admonished all of us to appreciate that even experts do not know it all and can miss opportunities to better understand someone if arrogance gets in the way.


Trauma-Response Tools1. Personal Trauma Tool Chest

Sketch an image of a tool chest. (Drawing a plain rectangle will be sufficient)

Utilizing the review list of ICAPS from our previous courses ETA and DTA, use three differ-ent colored pencils, write down those items that you feel are essential to use as you become trauma-competent. Use green to indicate you feel highly competent, yellow to indicate you are moving in the direction of becoming competent and red to indicate you need to spend time learning more about this ICAP to effectively use it.

Trauma-Response Tools 33

Write about how you feel about the items you identified in each of the colors. Allow yourself to feel proud for all the tools you feel confident to apply and those that will require your time and energies to develop.

2. Therapy versus Education

Imagine that someone with whom you were interacting began to describe a trauma that was observed as a child. Generate two lists: what your responsibilities would be if you were a therapist working with this person and what your responsibilities would be if you were an educator.

C If I was a therapist and this happened, my responsibilities would include . . . .

C If was an educator and this happened my responsibilities would include . . .


Reflect on both education and therapy. What are the differences and possible similari-ties when thinking about your responsibilities? Write about what you want to be careful not to do as an educator.

35


Welcome to our third session of Applying Trauma Principles. We hope that participants are feeling clearer and fairly comfortable with the format and focus of this course, which is primarily on the acquisition and practice of ways to apply the trauma princi-

ples we have been learning.We hope that participants are highlighting their personal understanding and beliefs about

the role of a trauma-competent professional along with ICAPS critical for trauma-competent professionals to have in their trauma tool chests.

Session Two ReviewIn Session Two, through in-class presentations, discussions and the informa-tion contained in the curriculum we:

J Introduced the image of the Trauma Tool Chest, including the trau-ma tool belt and specialized tools to help when interacting with a specifi c person or situation.

J Explored the diff erences between therapy and educationJ Discussed ways to teach eff ectively as one of the essential tools for responding in situa-

tions where trauma has occurred (the TE of LATE).J Become more Question SensitiveJ Provide opportunities for participants to discuss and practice applying ICAPS

3SESSION

2


Focus for Today’s Session J The ACT Approach J Memory Systems J Active Listening


1. As a professional gains new skills to put in their Trauma tool belt, one may feel the re-sponsibility to be effective in trauma-related situations. This may be overwhelming and burdensome to some people.

2. As we move into continuing our exploration of ways to apply trauma principles, profes-sionals may become more mindful to avoid inadvertently exacerbating someone’s trauma wounds when interacting with a child, young person or adult who has trauma-related issues and needs.

3. The difference between therapy and education reminds us to keep boundaries clear for ourselves and those we are assisting.

4. We predict that there will be differences between and among our participants with regard to their levels of confidence and competence. People have their own history of trauma-training and experiences. Each of us has different gifts and talents as well as insights and abilities that contribute to the unique nature of each person’s level of trauma-competence.

5. LGI Trainers are humbled by the opportunities to work with professionals. The enormity and complexity, as well as the importance of the subject of trauma have heightened our awareness and responsibilities as trauma-competent professionals.

6. We acknowledge that ultimately the success of a course is the combined responsibili-ty of the trainers and participants and the ways we discuss, process and assimilate the information.

Not What’s Wrong with You? Rather What’s Happened to You?Imagine a world where everyone had trauma lenses and would consider the possibility that difficult or confusing behaviors of children or adults might be the result of trauma. Imagine if instead of angry or incredulous responses to those behaviors, people immediately wondered “What happened to you that is causing you to behave this way?” instead of the more blaming reaction of “What’s wrong with you?”

Imagine a world where people, especially those with some degree of authority or influence, were intentional about not blaming, shaming or punishing children or adults whose difficult or challenging behaviors need to be addressed and corrected. Imagine if instead there were high levels of respect, appreciation, compassion and patience.

We encourage the professionals attending our three trauma courses to become more aware of the shift from asking, “What’s wrong with you?”, to asking, “What’s happened to you?” For

The ACT Approach 37

those of you who have become fluid in immediately going to the inner thought of “What’s hap-pened to you?” we encourage you to consider ways to help each other make this shift.

The ACT ApproachAs was described in Deepening Trauma Awareness, a professional who is going to interact with a person impacted by trauma can use an approach we call ACTing.

ACTing is an intentional and strategic process that provides a systematic framework of help-ing clarify options and healthy responses that can be made when interacting with a person impacted by trauma

Assessing, Choosing, and Taking Action is an intentional approach for assessing, making choices about possible responses, and taking action on those choices when interacting with someone who has been impacted by trauma. A professional using the ACT approach may be-come intentional in assessing where the boundaries might be between appropriate therapeutic educational processes and actual therapy. By being intentional about a careful assessment, the possible choices become clearer and are more likely to be appropriate.

The first two parts, Assessing and Choosing, involve mental processes that help a profession-al become clearer about the needs and dynamics of a situation. This can lead to considering op-tions that can effectively address and meet those needs and respond to those dynamics. Taking Action is based on the Assessments that led to the Choices.

ACTing is usually not a one-time sequence of events. Once a person has Taken Action, they need to Re-ACT, meaning they need to Re-Assess the situation and the impact of what Action was Taken.

TAKE ACTION CHOOSE

ASSESS

Re-ACT


We suggest that one set of tools that should go into all trauma tool chests includes ways to more accurately Assess situations, as well as having a repertoire of Choices from which to choose and then the knowledge about appropriate ways and skill levels to Take Action with those Choices.

Professionals are encouraged to appreciate that the intentional use of the ACEing process is a way to clarify and simplify the intentional decision-making processes. It can be used virtu-ally all the time assuming there is time to mentally process the situation. In interactions with individuals with trauma-related issues intentional ACTing can be a grounding tool that can promote a sense of confidence.

As with many of the ICAPS professionals put in their trauma tool chests, ACTing is a con-cept that can be useful for individuals impacted by trauma to learn to use as a way to better understand and manage trauma-related thoughts, feelings and behaviors. Professionals are en-couraged to consider how to present this as a tool a individuals impacted by trauma can use to better understand and appreciate trauma-related needs.

ICAPS ReviewTrauma Categories

The following lists the wide range of traumas that people can experience:

SituationalSituational traumas involve traumatic events that are not perpetrated by other people that

the person may know (i.e., car accidents, terrorist attacks, or natural disasters, such as hurri-canes, fires, earthquakes).

RelationalRelational traumas are interpersonal in nature because another person is the perpetrator,

often someone who should be trustworthy or has significant power in the child or adult’s life.

Acute/Single EventThis is a one-time traumatic event.

Adverse Childhood Experiences (ACEs)These are the specific adverse childhood experiences described in the ACEs study and in-

clude those that are being added as researchers determine additional specific adversities that have contributed to long-term negative physical and emotional outcomes.

Allostatic LoadThis is a term that has been coined to describe the impact and emotional weight of ongoing

chronic, toxic stress.

Attachment-Related TraumaTraumas related to the experiences of attachment in early life. Healthy development occurs

when there are secure attachments. A person can be virtually crippled from having meaningful relationships throughout life.

ICAPS Review 39

Chronic TraumaTraumas that occur repeatedly.

Complex TraumaWhen there are a variety of traumas making the overall impact even more difficult to assess

and understand. There are elements of unpredictability and chaos.

Chronic Toxic StressBessel van der Kolk refers to Disorders of Extreme Stress Not Otherwise Specified as DES-

NOS. This is an acknowledgment of the power for chronic, toxic stress to impact a person much like the other traumas.

Cultural/Political TraumaTrauma involving or that occurs as a result of cultural practices and/or political unrest, take-

overs, revolutions, etc.

Developmental TraumaTraumas associated with interrupting normal developmental tasks, such as trust-build-

ing in the early months of life or gaining a sense of autonomy coupled with the ability to be inter-relational.

Immigration TraumaThis is the complete loss of identity and familiarity, often leaving immigrants without the

proper tools or resources to help them cope in a new environment.

Medical TraumaMedical procedures that are very painful, frightening, often involving isolating the child or adult.

Racial TraumaRacial trauma, or race-based traumatic stress (RBTS), refers to the mental and emotional injury

caused by encounters with racial bias and ethnic discrimination, racism, and hate crimes.

Trans-GenerationalThis honors the fact that traumas can be passed from one generation to the next, often im-

pacted by the powerful forces of loyalty to family beliefs and behaviors.

Traumas That Occurred in the Past Versus Currently Being ExperiencedSome children and adults are still in situations or relationships in which trauma is continuing

to happen.

Unprocessed MemoriesMemories that have never been processed for the powerful, negative impact they had. Often

these are experiences that usually would not be considered traumatic, however the person,


usually a child, creates toxic beliefs that are extremely powerful as a result of that experience. These toxic beliefs haunt that person as an adult. (Source: Francine Shapiro, Getting Past your Past.)

Vicarious TraumaA category of traumatization that occurs when someone hears about or witnesses someone

else’s traumatic experience. The person vicariously traumatized can experience the same symp-toms as someone who was directly traumatized.

War TraumaThis can include a person’s physical traumas coupled with the highly stressful, terrifying

traumas that may cause the constant sense of being in danger.

We encourage professionals to consider what the possible underlying trauma issues might be to explain difficult, confusing or challenging behavior. It is important not to see trauma in every behavior. There can certainly be other explanations: sometimes a child or adolescent behaves in difficult or confusing ways as they move through the various developmental tasks of life. The moral, relational, spiritual, physical, intellectual, emotional and social tasks are a part of grow-ing and maturing. Each person’s uniqueness, temperamental variables and situational factors are also important to consider. Adults can exhibit difficult behaviors as the result of factors unrelated to trauma. Trauma is not the only explanation for difficult or confusing behaviors.

Reminder: Little t Versus Big T

Professionals are encouraged to remember that trauma should be considered in terms of its impact, not on what outside observers assume the degree of trauma might or should be. The degree of traumatization can vary from individual to individual.

Parenting or Caregiving Practices

There can be a low level, almost continuous form of traumatization that occurs when parents or caregivers interact with frequent use of threats and anger in order to produce compliant

Degree of Trauma

Little “t”Minor

Big “T”Paralyzing,

Deeply Wounding

Perception of Event

Non-traumatic Traumatic

ICAPS Review 41

children. These children might appear outwardly to be emotionally stable and normal. Bruce Perry describes children from the Davidian compound who seemed to be coping well until someone took their pulses as they slept and found they were far from calm. There are many people who are treated in ways society currently accepts as appropriate discipline that actually are experiencing trauma.

Continuum of Unresolved Versus Resolved Trauma

Many times trauma resolves on its own, and sometimes it will resolve to some degree versus being completely resolved. Resolved traumas are those that a person has experienced and then residual symptoms no longer exist. A trauma may be considered resolved when a person has opportunities to process a traumatic experience, to make sense of it, and to realize that the expe-rience existed in the past, and not in the present. Sometimes traumas simply resolve on their own.

Professionals may need to accept that someone has sufficiently resolved their trauma and is no longer struggling with trauma-related issues and needs. As professionals and not therapists, it is not our place to make therapeutic diagnoses or to judge if and when someone has achieved full resolution of a trauma.

Brain Research and Principles

Professionals are encouraged to maintain a willingness to incorporate brain research and principles in order to understand a situation in which trauma might be a factor. Professionals do not need to know all of the technical information contained in the reading materials we are exploring; rather it is important to have a basic understanding of fundamental brain function-ing and how this relates to traumatic experiences. This can enhance and enrich our awareness of what might be going on for someone and can provide information suitable for teaching them to better understand how their brain might be functioning.

Hippocampal Malfunctioning

In previous sessions and in our reading materials, we have learned a great deal about memo-ry and how it is stored. We have learned that the hippocampus is able to remember facts while the amygdala tends to be involved with the brain’s emotional memory system. According to Babette Rothschild in Eight Keys to Save Trauma Recovery, the amygdala is the part of the brain that tells you how to react in any situation even before you have any conscious thoughts. This is why you might smile when you hear the voice of someone you love even before you have actu-ally mentally recognized the specific person to whom you are responding.

The hippocampus is the part of the brain that remembers facts, but not emotions. It also records the time frame of significant events and can send the facts to the cortex.

However, often during trauma, ultra high levels of stress hormones—necessary for fight, flight, or freeze—stop the hippocampus from functioning properly. When that happens, an accurate time-frame of events does not get logged. The event might be remembered, but in jumbled order or with significantly missing steps. Typical in trauma, without the hippocampus able to carry out its role, it may not register that the trauma is actually ended.


This understanding of hippocampal malfunctioning is an important awareness as we consider processes of helping people with possible trauma-related issues and the need to share their stories.

Implicit Memory Systems

Many times unresolved traumas reside only in implicit memory systems and therefore the person is not able to mentally recall some or all of an experience that was traumatizing. This can make it challenging to process with someone who appears to have trauma-related issues and needs and is not able to describe what happened.

Implicit memory systems are where most if not all of the trauma experience reside. Profes-sionals can be surprised about why it may be difficult or impossible to use skills such as Active Listening to invite someone to become clearer through processes of sharing, because often times people may not have the recall of memories they need.

Emotional Expression

In both education and therapy, struggles and pain need acknowledgment and the people in-volved deserve credit for their losses and efforts. Both educators and therapists need to be able to accept the many expressions of feelings as normal, even welcomed.

With children or adults who have trauma-related issues, interacting in ways that encourage ex-pression of feelings may or may not be advisable. This is one of the areas in which the boundaries between therapy and education can be difficult to determine. When someone has a trauma-histo-ry, they may have developed a number of mechanisms for protection from having to re-experience feelings associated with the trauma. It is inappropriate for a professional to push for or even offer the kinds of responses that might trigger emotional expressions of pain associated with trauma.

It can be helpful to teach people impacted by trauma about the nature of traumatic grief and the importance of having permission to experience that grief. Professionals may find themselves in a position of using an educational path that invites rather than imposes processes of being able to discover and, when appropriate, express feelings of sadness associated with the grieving process.

Defining Active ListeningAs we explore the principles and related skills that are essential for all trauma-competent professionals to have in their trauma tool chests, using the skills of LATE, professionals are encouraged to explore or review the specifics of of Active Listening.

Active Listening is a specific, intentional form of com-munication in which the Listener focuses attention on information being shared by a Speaker and generates responses to what the Speaker says. These responses reflect the content, feelings or possible meaning of what the Speaker is sharing.

While Listening might be considered the process of hearing something someone is saying, Active Listening responses are being able to not only hear but also understand, and then give a

Defining Active Listening 43

statement to the person that reflects what was heard and understood. In LGI we call this giving a HUG (Hearing, Understanding and Giving back) to another person.

Active Listening is one of seven healthy ways of communicating with others and is one of the most important ways of communicating compassion, appreciation and respect. It is also one of the most important skills for trauma-competent professionals to learn and master.

Active Listening to Promote Safety

One of the benefits of using Active Listening with someone who might have trauma-related is-sues and needs is that this is a form of communication that promotes high levels of emotional safe-ty between two people. Active Listening is grounded in acceptance and respect. Promoting safety and power are the two essential first steps of addressing someone who might have trauma-related issues and needs. Active Listening, when practiced sensitively and intentionally can give power to the Speaker, allowing that person to be more “in charge” of the direction of the conversation.

The Goals of Active Listening

The ultimate goals of Active Listening are:

J To build trust in a relationship by conveying understanding and acceptance J To provide the Speaker opportunities to experience the relief, release and healing that

occurs when a person can share, vent, and process with another person who knows how to respond and how not to respond

The A’s of Active Listening

The skill of Active Listening promotes trust and connection in a relationship. There are sev-eral messages, both verbal and non-verbal that we expect professionals to transmit when they are using the skill of Active Listening. We call these messages, the 6“A’s” of Active Listening.

The 6 A’s of Active Listening are listed below, along with the expected messages each typical-ly transmits verbally and non-verbally.

Availability: “I’m here. I will stay with you.”Attending: “I’m now focusing on you.”Awareness: “As you share, I am now aware of your situation and feelings.”Acknowledgment: “ I will show you that I am more aware of you, that I accept what your

experience is.”Appreciation: “ I appreciate the implications of your situation. I can see what it means

to you.”Acceptance: “ I accept your feelings, your perspectives and your perceptions. They

are okay with me, even when I don’t agree with them.”


Acceptance is the Heart and Soul of Active Listening

Of these six A’s, acceptance is the heart and soul of Active Listening. It is important to distin-guish between accepting and agreeing when Active Listening.

I can accept that a person is feeling confused and unsure. I can accept that they perceive a situ-ation in a certain way, but I may not agree with these perceptions or the accompanying behaviors.

There may be times when I cannot understand why someone feels a certain way, but I can still accept these feelings. It may not be completely necessary that I understand why. It may be appropriate for me to express my difference of perception, but as soon as I do, I am no longer wearing the Listening hat. An attitude of acceptance is projected through more than just words; it comes through a relaxed body language that conveys warmth and interest, appropriate eye contact and facial expression.

The Five Images of Active ListeningThe following images may assist you during an Active Listening interchange:

J Movie Ticket: The Listener behaves as though they are watching a movie. They are an attentive observer, responding non-verbally to what is being said, using attentive body language and noting details without giving specific comments back to the receiver.

J Mirror: The Listener acts as a mirror to the person to help them see themselves more clearly. This mirror has the power to telescope to see the bigger picture, and to micro-scope to see things in very fine detail.

J Container: The Listener holds out a container and collects whatever the person wants to unload. To provide a safe place to unload or discharge feelings or simply to relieve what needs expressing.

J Processor: The Listener acts as a processor or organizer helping to sort or arrange pri-orities and identify feelings, issues or expectations.

J Little Book of Wisdom: The Listener states a principle or truth that reflects the receiv-er’s expectations or perspective.

When wearing the Active Listening hat, professionals may use one or more approaches in the process of helping someone express the negative or confused feelings sometimes experi-enced by children and adults. Expression of one emotion may trigger another, allowing many feelings to surface and be articulated and understood by the Active Listener.

We can even Actively Listen to babies, who may not understand the words but can sense the caring, appreciation and acceptance.

Active Listening as a Skill

Active listening is a skill that is useful for processing the everyday experiences that bring intense or important feelings. Some research has indicated that when a person has been trau-matized by an experience, if they have the opportunity to fully effectively address the experi-ence soon after it occurs, it may lessen or eliminate the possibility of that traumatic experience continuing to have a lasting effect.

The Five Images of Active Listening 45

An important perspective from Trauma through a Child’s Eyes is that trauma is less about verbally recalling an experience and more about dealing with the sensory reactions to trauma.

At the same time, there appears to be benefits in inviting someone to share an experience that has had a traumatic impact. They may want to express the experience to someone who can receive the story.

Because Listening is based on appreciation and acknowledgment, the person receives credit which feels freeing. By being permitted to describe their story, a person may be able to grieve for losses of safety or control.

For some, by being able to tell their story the trauma can be seen differently as the person takes charge of it. They can remember it but they do not have to keep re-experiencing it.

Listening can be more than just a useful and interesting process. It can have serious and im-portant implications for providing incredible healing. There is power to effectively prevent or lessen the potential for PTSD.

Active Listening Principles

Many people consider themselves to be “good listeners.” They observe that others come to them to share problems.

They may listen well in terms of assessing the situation and in being attentive, but in the purest sense, true Listening is seldom used as we define it.

We have found that often it is not until people have experienced pure Active Listening without any of the non-listening responses and especially RESS-Qing that they understand just how much skill and sophistication is required to be effective.

Listening is most effective if the Listener is in the right frame of mind to truly Listen to the receiver. The degree to which the Listener has all of these attitudes in place will determine the relative health of the process.

Each of these attitudes is on a continuum and each person needs to make a personal

assessment when deciding to give a Listening response.

◾ Be prepared to accept the feelings of the speaker. ◾ Be objective, yet intuitive. ◾ Have a desire to Listen. ◾ Allow the speaker to be responsible for their own feelings. ◾ Recognize that feelings are often transitory. ◾ Let the speaker lead the conversation. ◾ Be patient and allow the receiver to draw their own conclusions. ◾ Try not to have a specific result in mind. ◾ Sometimes people need information and do not need someone to Listen. ◾ RESSQ (reassure, explain, solve, share, question) can be healthy responses when

people are in need of reassurance, teaching or problem-solving. ◾ Sometimes it can be a challenge to Active Listen when you have strong feelings

on the subject.


Active Listening is about Processing, not Fixing

Active Listening is one of the most important and powerful forms of communication and professionals need to own and respect the importance of the other “hats” of healthy communication. There are times when Ac-tively Listening is not the healthiest response, even when the professional is executing the skill well. Learning our approach to this skill requires an open mind, patience and the development of one’s intuition.

The two goals of Active Listening are:

J Building trust in a relationship by conveying understanding and acceptance J Providing the speaker with opportunities to experience relief and healing that can occur

when a person processes with another person

As we study the many uses for Active Listening, as well as the specific techniques and forms Active Listening can take, it is important to appreciate that Active Listening is a tool for en-couraging the sharing of positive, exciting situations and stories. While professionals often find themselves interacting with children and adults who are facing stresses and struggles, there are times when people are happy and experiencing positive feelings. People may benefit from opportunities to share these feelings and stories with a Listener.

Christopher’s college graduation day was here. He was very excited and impulsively decided to spend one more night on campus with his college friends. He announced this decision to his parents and bid them farewell. Several hours later his mother, Sage, was sitting in her bedroom reading a book. She heard a knock on the door and thought it odd because of the late hour. When she answered the door, surprisingly, Christopher was there. He indicated he had changed his mind about spending one more night at college and Sage proceeded to go back up to bed. Several minutes later there was a knock on her bedroom door. Christopher entered, looked at her and said, “Mom, I can’t believe college is over. I’m really upset. I’m never going to see my friends again.” Sage thought to herself, “Of course you’re upset, now you have to get a job.” Instead of saying what she was thinking, Sage remembered learning about Active Listening in class and thought that this may be an appropriate time to try the newly acquired skill.

Feeling inept about her new skill, she responded with, “Wow! Seems like you’re really surprised at how sad you are about this.” That was it. The emotional floodgates opened as Christopher paced back and forth, very emotional about all the different feelings of college ending: how much he would miss academia, miss his friends and how scared he was about becoming an adult. Sage sat, listened and resisted the urge to reassure, explain, share, solve, or question, as tempting as it was.

As Christopher became clearer about his mixed emotions, he came over, sat on the bed, crawled into his mother’s arms and cried. This moment in time was a relationship connection to cherish as he was becoming an adult. Now Sage needed someone to actively listen to her.

RESSQ—Five Non-Listening Responses 47

Internal Dialogue

Effective, healthy communication involves the internal interactions that are constantly oc-curring for each person. This is known as the internal dialogue.

We each have our own core belief system composed of the myriads of messages received from birth on. We have organized, sorted and categorized these messages into complex be-lief systems. We have our own internal forms of conversing that reflect those belief systems.

People may have a myriad of core beliefs and internal messages that are distortions or unhealthy absolutes that can be triggered by circumstances outside the person. Once triggered, the person may be speaking to themself with messages that promote unhealthy emotional experiences. A few examples of distorted beliefs and internal messages include:

◾ “The world is not safe/filled with pain/crazy . . .” ◾ “People can’t be trusted/are out to get you/don’t get it. . . .” ◾ “ People in positions of authority misuse their power/are one-sided/cannot be

trusted. . . .” ◾ “Men (or women) are clueless/self-centered/insensitive/helpless. . . .” ◾ “Children . . . are a pain in the neck/brats/mess up your life. . . .” ◾ “A person should never. . .” ◾ “Once you . . . you can never . . .” ◾ “There is no way in life to . . .” ◾ “Always be careful to . . .” ◾ “It is not fair that . . .” ◾ “You can’t trust . . .” ◾ “Be careful about . . .”

One of the ways an intentional communicator can become more effective, especially when deciding which hat to put on, and how to respond while wearing that hat, is to con-sider what the internal dialogue might be.

The more a person knows another person, the more likely they are familiar with how that person seems to think and believe. It is in the context of safe and trustworthy relationships that people become confident enough to allow others to facilitate them in new awareness and understanding.

By considering what the inner belief system and internal dialogue might be, a Listener can formulate Listening statements in an attempt to reflect some of those inner beliefs and messages.

The Feeling Vocabulary

As professionals learn about Listening, it can enhance their effectiveness as Listeners to increase their vocabulary.


By increasing their vocabulary, they can be more accurate in responding to the person, making the whole process clearer and more effective.

Adventurous Addicted Amazed Annoyed Anxious AwedAwkward Ambitious Ambivalent Ashamed Abandoned AbsoluteAppreciated Attacked Bothered Burdened Betrayed BlamedBullied Calm Clear Confident Cheated CherishedCertain Co-dependent Condemned Confused Controlled CriticizedClever Cautious Culpable Depressed Discounted DiscouragedDetermined Destroyed Devastated Empowered Energized EmptyExploited Exuberant Exasperated Excited Exposed FearfulFocused Freed Frustrated Friendly Guilty GullibleHelpless Hopeful Hungry Hurt Ignored IndifferentIntimidated Interrogated Inspired Invested Isolated JealousJolted Joyful Justified Judged Lazy LethargicLoved Loyal Lucky Manipulated Mesmerized MotivatedMisunderstood Mocked Nervous Negated Neglected NurturedOpen Overwhelmed Quiet Passionate Pressured ProvokedProdded Perturbed Powerful Puzzled Pulled RageRestless Relieved Refreshed Relaxed Responsible RevoltedStartled Sensitive Sensuous Settled Surprised SnugTentative Thwarted Tortured Transformed Trapped TerrifiedTrusting Trustworthy Trusted Upset Unnatural UnsureUnique Understood Vexed Vicious Vulnerable WiseWorried Wary Yearning Zoned Out Zonked

Continuum Language When Listening

To become more accurate about feeling words, Listeners can consider the continuums on which feelings fall:

Anger Continuum

Degrees of anger might be:Outraged . . . Furious . . . Bitter . . . Mad . . . Frustrated . . . Aggravated . . . Agitated . . . Annoyed

Happiness Continuum

Degrees of happiness might be:Ecstatic . . . Delighted . . . Thrilled . . . Joyous . . . Pleased . . . Contented . . . Satisfied

Concern Continuum

Degrees of concern might be:Panicked . . . Alarmed . . . Anxious . . . Distressed . . . Worried . . . Troubled . . . Concerned

Keeping Needs in Mind

Needs and the vast array of needs that can exist to help generate Listening statements which are reflective of some aspect of one or more needs the receiver seems to be experiencing.


Examples:“You needed your partner to understand you had been caring for a fussy baby for hours and when he seemed to ignore your need for a break you were hurt and disappointed and then became angry at him.” (First person Process response}

“Parents need time to get used to a new stage their children enter, especially when the new behaviors that result are so challenging to manage!” (Third person Little Book of Wisdom response)

“It has been hard for you to figure out what your teenager needs to help him through this difficult time. You are guessing from his outward behaviors that some important emotional or relational need is not being adequately met, but right now it is not clear what that need may be.” (First person Process response)

By stopping to ask yourself: “What needs or principles of needs might apply to the receiver’s situation?” Listeners can often generate meaningful Listening statements.

Getting Acquainted with Your Own Sensations

Excerpted from Trauma Through A Child’s Eyes by Peter A. Levin and Maggie Kline

Note that sensations are different than emotions. They describe the physical way the body feels. Non-verbal children can be invited to point to where in their bodies it might feel shaky, numb or calm or where the owie is, etc.

Expressions Indicating Sensations ◾ Dread in the pit of the stomach ◾ Racing heart ◾ Heart pounding ◾ Tightness in the chest ◾ Lump in the throat ◾ Knot in the stomach or throat ◾ “I don’t have words for it” ◾ “It’s such a cold feeling” ◾ “Like getting the wind knocked out of me” ◾ “I just feel numb” ◾ “My heart wouldn’t stop racing, but I couldn’t move” ◾ After danger has passed: could breathe easier; felt some tingling or vibration

Sensation Vocabulary Box ◾ Cold/warm/hot/chilly ◾ Twitchy/butterflies ◾ Sharp/dull/itchy ◾ Shaky/trembly/tingly


RESSQ—Five Non-Listening ResponsesWe have found that there are five non-listening responses that are common-ly used when a Listening response would be much healthier. We have found that these five responses are among the hardest to stop using when learning to be an effective Active Listener. It is hard to let go of the goal of rescuing the other person. The process of rescuing someone usually interrupts the Lis-tening process and the goals that it can achieve.

We believe that people respond with one or more of these RESSQ responses because they are pulled to help or take care of the person, stop them from feeling or expressing pain, con-fusion or joy.

While each of these five common responses may be appropriate in some situations, NONE is a Listening response. Each is a healthy hat, just not a Listening hat.

The acronym RESSQ was developed by Susannah Spanton Horsey.

J Reassure J Explain J Suggest or Solve J Share J Question

Using this example: a child was pushed down on the playground during recess by some older kids, and comes home from school telling their parent what happened.

◾ Hard/soft/stuck ◾ Jittery/icy/weak ◾ Relaxed/calm/peaceful ◾ Empty/full ◾ Flowing/spreading ◾ Strong/tight/tense ◾ Dizzy/fuzzy/blurry ◾ Numb/prickly/jumpy ◾ Owie/tearful/goose-bumpy ◾ Light/heavy/open ◾ Tickly/cool/silky ◾ Still/clammy/loose


Consider how it might feel to that child if their parent responded in one or more of the fol-lowing ways:

REASSURING: “It’s going to be all right. I’m sure it was an accident. You’re fine. Things like this happen once in awhile.”

This form of communication tends to be a conversation stopper because it sends the mes-sage that the person is fully capable of handling the situation and it suggests it is time to move on. This is a legitimate form of communication; it is the Affirming hat, however it is not the Listening hat.

EXPLAINING: “The reason this happened is . . . Maybe the other children were having a tough morning. Teachers are busy and can’t look after every single child on the playground.”

This form of communication tends to place the focus on the situation, not on the person. It suggests the person consider thinking on an intellectual level rather than a feeling level. It tells the person they should consider why things are this way and to give up their feelings. This is a legitimate form of communicating; it is the Teaching hat, however this is not the Listening hat.

SOLVING, trying to suggest or advise: “A way to handle this is . . . Have you thought about trying to . . . ? When a fight starts, you should . . . If you play next to a teacher, you’ll be safer.”

This form of communication also moves the conversation into an action mode. It denies the importance of venting feelings and sorting. It tells the person they are not capable of handling the situation. This is a legitimate form of communicating; it is part of the Problem Exploration hat, however it is not the Listening hat.

SHARING your own story or your feelings: “I know just how you feel. One time I had the exact same thing happen, let me tell you about it. Oh, you think that’s bad, I know a kid who . . .”

This form of communication shifts the attention from the speaker to the person who was sup-posed to be listening. We often call this story stealing. While the Listener may be trying to say, “See how much I understand,” their sharing shifts the focus onto themselves and changes the flow of the conversation. It can be hard for the speaker to shift back to talking about their story. This is a legitimate form of communicating; it is the Sharing hat, however it is not the Listening hat.

QUESTIONING: “Why did you do that? How do you feel about that? How often does it happen? What happened first?”

This form of communication shifts the control of the conversation from the speaker to the Listener. This can interrupt the process in several ways. It makes the speaker accountable to the Listener. It can change the direction the conversation would have taken if the speaker was following their train of thought. It makes the speaker move from a feeling mode to a thinking mode, causing them to go from their limbic to their cortex. This can be a legitimate form of communication used during Problem Exploration, however, it is not the Listening hat.


Some of the Reason People RESS-Q

RESS-Qing is sometimes done because the receiver’s emotions are troubling to the Listener. The Listener feels better if they can stop the receiver from emoting those feelings.

People have been taught to problem solve and advise as the appropriate response to someone struggling. These are hard habits to break.

RESSQ responses may occur because the Listener is comfortable being in charge of conversations or because they feel compelled to rescue the person from their feelings and struggles. While each may have its place in a healthy conversation because each is a healthy hat.

Using Sentence Starters

The following sentence starters may assist new Listeners in creating appropriate Listening responses. It may be helpful to keep these sentence starters close-at-hand when practicing Listening to give some extra support in the process of learning.

“It sounds like . . .”“It seems . . .”“That makes you feel . . .”“That could make a person feel . . .”“You wish . . .”“You would like to change . . .”“It hurt you . . .”“You need permission to . . .”“You are looking forward to . . .”“When you [describe action of person], what happened was that . . .”“The hard part about this is . . .”“You didn’t expect . . .”“It bothers you that . . .”“You aren’t sure . . .”“You’re worried/concerned that . . .”“You needed/need . . .”“When you aren’t getting/didn’t get what you need(ed), then . . .”“It seems unfair that . . .”“You can’t understand . . .”

Q & A about Listening:

Doesn’t Listening encourage people to wallow in their problems instead of focusing on how to make healthy changes?

Not usually. The receiver’s feelings are real and Listening helps the expression of healthy venting. The receiver may not know how many deeply hidden feelings are inside until they

Concluding Thoughts 53

can be expressed. Often, a myriad of past hurts that are connected to the present situation may come up, or the sadness we may feel when we realize how seldom we feel Listened to. Listening doesn’t create emotions, it reveals them.

Sometimes it seems as if the receiver feels worse after talking about their feelings. How can that be helpful?

The Listener is not creating feelings but rather giving the speaker a way to connect with and express them. When these feelings become “visible,” they can look pretty dramatic and the speaker is then more conscious of them. Being in touch with what may be painful emotions may make the speaker feel “worse.” This process has great healing potential as it also opens the way for the speaker to get in touch with inner resources and encourage the next stages of problem-solving.

Professionals are cautioned to be aware of their own tendencies to want the people they work with to feel better. Often we have been taught to avoid unhappy feelings, get to the happy ones and figure out ways to solve problems as soon as they are perceived. It can be very uncomfortable to sit by and let someone feel pain or sadness, and it takes time to trust that letting a person just be unhappy is actually very healthy. The goal is to learn to trust the speaker’s ability to handle their own situations and feelings.

The speaker doesn’t seem interested in figuring out a way to make things better.Professionals need to be careful of the tendency to jump prematurely into problem-solving sim-

ply because they are uncomfortable with someone’s lack of movement towards making changes. Premature problem solving is ineffective because unexpressed and unresolved feelings will get in the way and will slow or negate the process. Only when the feelings have been sufficiently resolved can the speaker make a shift in attitude and want to pursue ways to change or cope.

If the receiver (especially a child) is doing something wrong and must be stopped before hurting someone or something else, won’t Listening seem like permission to be destructive?

Listening is only one of many healthy and appropriate responses. Certainly it is important to set fair and appropriate limits as needed, even while Listening is taking place: “You are so angry with your sister you would like to find some way to get even. The rule in the family is that we do not hurt one another, but sometimes we can feel so angry that we may wish we could. It can seem like the person deserves to be hurt if they somehow hurt us.”

Listening is about accepting, which is not necessarily agreeing with someone’s values, perspectives or feelings. It is important for a Listener to keep focused on the need for accep-tance and to keep the issue of agreement separate.

When I Listen to people, my funny way of talking seems to make them suspicious.People often expect the standard responses of denying feelings, discounting needs and

receiving unwanted advice. People may not be used to having someone focus on their feel-ings and give them the time to talk. They often feel exposed—even sometimes ignored or mocked because they aren’t being dictated to. An observant Listener will acknowledge those feelings. “You are puzzled by my reaction. You may have expected me to tell you what


Concluding ThoughtsIn today’s session we continued to explore the principles and properties of trauma and ways we as potential trauma-competent professionals need to approach the subject of trauma.

Professionals were also encouraged to be intentional about ACTing situations (Assessing, Choosing, and Taking Action) in order to be clearer in interactions with someone who has possible trauma-related issues or needs.

We introduced and reviewed some of the details of Active Listening in a comprehensive way that incorporates trauma principles in order to enhance the effectiveness of Listening responses.

As we continue exploring ways to intentionally apply the ICAPS necessary for professionals to become trauma-competency, participants can be both enthused and intimidated by the re-sponsibilities as well as the potentials.

Everyone involved in this extensive journey of becoming trauma-competent deserves credit for the courage it takes to venture into unknown and sometimes overwhelming areas. We hope that everyone derives both comfort and satisfaction from knowing we are taking this journey together and that the potential for amazing, positive results make the struggles that sometime occur worthwhile.

to do but instead I seem to be willing to just let you have your feelings. That feels strange to you.” An effective Listener easily moves from the past to the present feelings and needs, even those that are centered on the current conversation with the Listener.

Won’t people become dependent on me to keep being so caring through my Listening?This dependence might occur. If you maintain the attitude that each person is responsible

for their own feelings and their own solutions, you can usually keep the process moving in the direction of independence, not dependence. If someone does seem to be demanding too much time from you, you may need to send I messages to express your own needs and feelings and, if necessary, set appropriate limits for yourself.


Trauma-Responsive Tools1. ACTing Practice

Bring to your mind someone with whom you have recently interacted with who was possibly experiencing some kind of trauma or trauma history.

Assessing:

Describe your relationship with this person.

Write down facts or observations about this person’s experience or situation.

Write down your assessment of the following regarding this person. Appreciate that these are your perceptions and therefore are considered possibilities.

Needs:

Feelings:


Degrees to which the person feels safe:

Expectations:

Goals:

Consider additional areas you might want to include in your Assessment:a. Messages being transmitted non-verballyb. Significant ways high levels of stress or trauma history might have impacted their

experience or situation.c. Beliefs about their experience or situation.d. Ways they have experienced or been denied personal power and rightse. Ways they have experienced and expressed fear, anxiety, terror, or shamef. Their values and whether they were honored or challenged at the time of their ex-

perience are in their situation.g. Ways they may have been impacted in terms of attachment.h. Ways they have experienced trans-generational trauma and/or toxic messagesi. Ways they have experienced traumatic grief and the degrees to which it has been

addressed and/or resolvedj. Ways they might outwardly exhibit symptoms of unresolved trauma: triggers,

flashbacks, dissociation, hyper-vigilance, re-enactmentsk. If and how they are ready to work on any of the Rh processes: Recovery, Repair,

Resolution, Restoration, Reconciliation, and Healing


Write and include additional assessment possibilities:

Choosing:As a result of generating your Assessment, list some of the Choices you have in terms of how you will interact with this person.What are some of my choices to verbally and nonverbally establish myself as a safe per-son? “To make this person feel safe, I will . . . ”

What are some of my choices to verbally and nonverbally communicate that I am trust-worthy? “To promote trust in our relationship, I will . . . ”


What are some of my choices for inviting this person to claim their power to be self-pro-tective, in charge of the conversation, aware of their right to establish and maintain boundaries? “Some of the ways I can invite this person to be self-protective, in charge of the conversation, and in charge of boundaries are . . . ”

What are some of my choices that promote responding in trauma-sensitive ways?

Taking Action:Look at the ways you have Assessed this person’s experience or situation and the vari-ous Choices. Describe how you would Take Action with each choice. Keep in mind how important it is for trauma-competent professionals to use a trauma-sensitive blending of Listening, Affirming, Teaching and Exploring to respond when someone has trauma-relat-ed issues and needs.

2. Active Listening

Think about the person you used in the previous ACTing exercise.If that person needed to be Actively Listened to, write down how the individual would respond (thoughts, feelings, beliefs) to any of the following RESS-Q statements:


“You’re such a smart person and very capable of figuring all this out!”

Thoughts: __________________________________________________________________________________

Feelings: ___________________________________________________________________________________

Beliefs: _____________________________________________________________________________________

“I truly understand what you’re going through. In fact I have had the same experiences as you. What happened to me is . . . ”

Thoughts: __________________________________________________________________________________

Feelings: ___________________________________________________________________________________

Beliefs: _____________________________________________________________________________________

“What were you thinking about when you first experienced that? Does this happen to you frequently? Is it possible you provoked some part of this?”

Thoughts: __________________________________________________________________________________

Feelings: ___________________________________________________________________________________

Beliefs: _____________________________________________________________________________________

Write three Active Listening statements based on the ACTing you did in the previous ex-ercise. Try to use a variety of Listening categories, from Content to Feeling to one or both Process responses.

61


In our previous session we highlighted the importance of responding to diffi cult or confusing behaviors understanding the concept, What’s happened to you? rather than What’s wrong with you? We hope that this image of a person having some kind of wound or injury that

underlies behaviors results in greater appreciation that there is a legitimate reason for these behaviors. It is a goal for all of us that this person can be respected, and attended to in ways that lead to the trauma Rh factors: repair, restoration, resolution, recovery, reconciliation, and healing. In today’s session, the emphasis will be on applying the skill of Active Listening which was presented in the previous session.

Session Three ReviewIn Session Th ree, through in-class presentations, discussions and the infor-mation contained in the curriculum we covered the following ICAPS:

J Th e ACT ApproachJ Memory SystemsJ Active Listening

Focus for Today’s SessionJ NarrativesJ Active Listening Application

4SESSION

3


Predictions, Acknowledgments, and Disclaimers (PADs)1. You may be somewhat frustrated or disappointed as you now understand what might

be happening in conversations around you, especially those with whom you have close relationships.

2. When someone is struggling with an unresolved issue, it is very hard not to respond with a RESSQ statement.

3. Active Listening is learned over time and we need to be gentle with ourselves.4. Self-care is encouraged as each professional is on a unique journey in becoming

trauma-competent.5. Listening to someone’s narrative can provide healing for the person and may be difficult

for the professional to hear and process.

Review: RH Factors

It can be helpful to appreciate that the terms recovery, resolution, restoration, repair, recon-ciliation and healing are used, sometimes interchangeably, to describe the process that can occur when trauma and its symptoms are addressed.

RH factor definitions on a continuum:

◾ Recovery: the return to normal health of someone who has been ill or injured ◾ Resolve: to move from dissonance to resonance, a process that allows pain to

subside, for an injury to become less inflamed ◾ Restore: to bring something back to an earlier and better condition, to energize ◾ Reconcile: to bring into agreement or harmony ◾ Repair: to restore or renew by any process of making good, strengthening ◾ Heal: to be completely repaired, restored, recovered, cured ◾ Healing: the process that leads to a state of full (or as complete as possible)

recovery, resolution, restoration, cure

It can be helpful to remember that there can be hippocampal malfunctions during trau-matic episodes that make it hard to put together a coherent life story. When professionals engage in Listening processes that might contribute to some degree of RH factors, they may also be contributing to processes of repairing and re-establishing hippocampal functioning.

Not all traumas can be totally healed. Sometimes trauma-related symptoms can be re-solved and sometimes the best outcome achieved is to gain self-awareness and coping skills that allow a level of management if and when trauma-related symptoms occur. Being able to cope with and manage trauma-related symptoms can be an enormous gift to anyone who has struggled with trauma issues, especially when years have been spent being un-aware, confused and powerless.

Narratives 63

NarrativesIn One Researcher’s Report: The Strongest Predictor of Emotionally Healthy Children we introduced the research of Dr. Daniel Siegel, psychiatrist and researcher. Dr. Siegel stresses that people are bet-ter equipped to move forward in healthy ways in their lives and to parent effectively if they have created and explored their life stories, which he calls a narrative. When a parent can make sense of their life story and can understand how the past affects them, then their children are more likely to thrive.

It is important to note that the phrase “makes sense” refers to a life story that, according to Dr. Siegel (The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are) involves

sequential descriptions of people and events that condense numerous experiences into generalizing and contrasting stories. New experiences are compared to old ones. Similarities are noted in creat-ing generalized rules, and differences are highlighted as memorable exceptions to those rules. The stories are about making sense of events in the mental experiences of the characters. . . . These stories appear to be functioning to create a sense of coherent comprehension of the individual in the world across time. . . . Narratives may at times selectively focus on the minds of others and on external contexts, not on one’s own internal experience. . . . The narrative process . . . attempts to make sense of the world and of one’s own mind in its various states. In some individuals, however, one sees nar-ratives that reflect upon a particular self-state without creating a more global coherence of the mind as a whole. The narrative process is thus a fundamental building block of an integrative mode, but is insufficient by itself to create coherence across self-states through time.

Siegel goes on to state that “making sense” of an experience on one level “ . . . means trying to understand cause–effect relationship—what is happening and why it happened.” He states that “through the life course, individual mind attempts to create a coherent internal, interpersonal, and group experience.” The narrative requires both right and left-brain hemisphere modes of processing information.

The right brain’s perceptually rich, analogic, context-dependent, autonoetic, mentalizing representa-tions create much of the imagery and many of the themes of the narrative process. The logical, linear, “making sense” interpretations of these representations and the communication of narrative details stem from the left hemisphere’s interpretive and linguistic processing of digital representations. On each side of the brain, these processes may reflect a vertical integration of various representational processes. . . . The left hemisphere’s drive to understand cause-effect relationships is a primary motiva-tion of the narrative process. . . . Coherent narratives are created through inter-hemispheric integration.

Siegel states that,

Autobiographical narratives can reveal integration or incoherence. A coherent narrative reveals a blending of left-and right-hemisphere processes. The interpreting left hemisphere is driven to weave a tale of what it knows. When access to the right hemisphere’s representational processes is limited, such detail is incoherent.

When the mentalizing, primary emotional, somatosensory, and autobiographical processes of the right hemisphere can be drawn upon, left brain is able to “make sense” by integrating a coherent life


story. Bilateral integration promotes coherent narratives. . . . Integration allows the mind to experi-ence the mutual co-regulation of energy flow and information processing, which permits adaptive, coordinated functioning. Incoherence derives from the inflexible, maladaptive, unrestricted flow of energy and information within the mind across time.

Siegel is saying that just because a person says they understand themselves, doesn’t make it true. A narrative needs to be an accurate story that is coherent, logical and involves an integra-tion process in which memories are organized in ways that allow a person to sequentially and rationally tell their life story. The decision of whether or not there is genuine integration versus incoherence, of which a person may not be aware, sometimes needs to be determined through objective observation by someone professionally qualified.

Impact of Incoherent NarrativesThere may be areas in people’s lives that do not make sense, that feel unclear, distorted, or inac-cessible. Many times these areas involve unresolved trauma.

When someone has not or cannot make sense of the life experiences, they may function with-out the necessary component that can come from achieving clarity and a sense of cohesion. They may be less able to achieve relational integrity because of these distortions in their own narrative. These areas in which clarity and cohesion have not occurred detract from an ability to function in ways that would be healthy if they had the experience of making sense of their life.

Being able to create a cohesive life story that provides ways to understand and reconcile life events, can provide a person with clarity and the ability to fully embrace the freedom to grow and change in ways that reflect life’s values.

Trauma-competent professionals are encouraged to appreciate that sometimes they have the privilege of facilitating a person’s process of finding new ways to clarify and understand one’s narrative. This can be a part of achieving the Rh factors: repair, restore, recover, resolve, recon-cile and heal for children and adults.

Life NarrativesDr. Daniel Siegel in his book Mindsight: The New Science of Personal Transformation and DVD set The Neurobiology of We, encourages processes that invite people to put stories into words and convey those stories to other people. These stories are called “life narratives,” and they can be very helpful in allowing people to find coherent ac-counts of their past.

Creating a life narrative may help a person impacted by trauma gain clarity in understanding an experience that had a traumatic impact. It may also help the person make sense of some of the ongoing trauma related symptoms and struggles. Professionals may be able to share information about life narratives and consider ways to tell their personal stories. Professionals can carefully guide the process, and affirm the impact of that person’s narrative.

Life Narratives 65

At the same time, for some people impacted by trauma, the process of creating and sharing a life narrative might be better facilitated by trained therapist.

Professionals need to be careful not to re-traumatize or trigger an individual through the process of creating a narrative. Professionals are encouraged to be highly aware of some of the dangers of processing too deeply, or asking questions that probe rather than invite discovery. If professionals can work to remain highly sensitive and intentional about their own processes, it is less likely that they will do harm.

In Th e Neurobiology of We Dr. Daniel Siegel states that the single best predictor of positive out-comes for a child, meaning that child is emotionally healthy and primed to thrive, is not what is often cited. Being raised in a home where children can achieve strong and healthy attachment, or where the parents come from strong and healthy emotional roots are factors. However, the sin-gle most critical factor is the response to the question, “How does this parent make sense of their life?” If in the narrative a parent tells they can make sense of their life story and can understand how the past aff ects them, then the research indicates the children are more likely to thrive.

Th is powerful information is important for trauma-competent professionals. One of the ef-fects of trauma is that a person may have issues involving memory, and making sense of past experiences. In moments of perceived inescapable danger, the lower parts of the brain take over, the hippocampus and cortical areas become limited in their functioning.

Th e information about the importance of a person being able to make sense of their life story and our consideration of providing opportunities to promote healing in a non-therapeutic way bring an essential question to mind: How can we facilitate processes that assist people in mak-ing better sense of their life stories while respecting the line between education and therapy?

Th is is a question we all need to keep in mind as we explore more about inviting those who might have trauma-related issues and needs to share their experiences and stories.

The irony is that we attempt to disown our diff icult sto rie s to appear more whole or more accepta ble, but our wholeness—even our wholeheartedness—actually depends on the integration of all

our experie nces, including the falls.—Brené Brown

Author Babette Rothschild in Eight Keys To Safe Trauma Recovery: Take-Charge Strategies To Empower Your Healing devotes all of Chapter 3 on one of the keys she says is important to re-alize about recovering from trauma: Remembering Is Not Required. In this chapter she refers to Judith Herrman’s seminal classic, Trauma And Recovery, in which Herman describes the three essential phases of trauma recovery:

J Phase 1: establishing safety and stabilization; and she emphasizes that this can take hours, weeks or even years

J Phase 2: processing trauma memoriesJ Phase 3: integrating and applying what was gained from the fi rst two phases into daily life

life?” If in the narrative a parent tells they can make sense of their life story and can understand how the past aff ects them, then the research indicates the children are more likely to thrive.

Th is powerful information is important for trauma-competent professionals. One of the ef-fects of trauma is that a person may have issues involving memory, and making sense of past experiences. In moments of perceived inescapable danger, the lower parts of the brain take over, the hippocampus and cortical areas become limited in their functioning.

Th e information about the importance of a person being able to make sense of their life story and our consideration of providing opportunities to promote healing in a non-therapeutic way bring an essential question to mind: How can we facilitate processes that assist people in mak-ing better sense of their life stories while respecting the line between education and therapy?

Th is is a question we all need to keep in mind as we explore more about inviting those who might have trauma-related issues and needs to share their experiences and stories.

The irony is that we attempt to disown our diff icult sto rie s to appear more whole or more accepta ble, but our wholeness—even our wholeheartedness—actually depends on the integration of all

how the past aff ects them, then the research indicates the children are more likely to thrive.Th is powerful information is important for trauma-competent professionals. One of the ef-

fects of trauma is that a person may have issues involving memory, and making sense of past

is less likely that they will do harm.Th e Neurobiology of We

comes for a child, meaning that child is emotionally healthy and primed to thrive, is not what is often cited. Being raised in a home where children can achieve strong and healthy attachment, or where the parents come from strong and healthy emotional roots are factors. However, the sin-gle most critical factor is the response to the question, “How does this parent make sense of their

process of creating a narrative. Professionals are encouraged to be highly aware of some of the dangers of processing too deeply, or asking questions that probe rather than invite discovery. If professionals can work to remain highly sensitive and intentional about their own processes, it is less likely that they will do harm.

Th e Neurobiology of We comes for a child, meaning that child is emotionally healthy and primed to thrive, is not what is

professionals can work to remain highly sensitive and intentional about their own processes, it is less likely that they will do harm.

Th e Neurobiology of We comes for a child, meaning that child is emotionally healthy and primed to thrive, is not what is often cited. Being raised in a home where children can achieve strong and healthy attachment, or where the parents come from strong and healthy emotional roots are factors. However, the sin-

Professionals need to be careful not to re-traumatize or trigger an individual through the process of creating a narrative. Professionals are encouraged to be highly aware of some of the dangers of processing too deeply, or asking questions that probe rather than invite discovery. If professionals can work to remain highly sensitive and intentional about their own processes, it is less likely that they will do harm.

Th e Neurobiology of We Th e Neurobiology of We comes for a child, meaning that child is emotionally healthy and primed to thrive, is not what is often cited. Being raised in a home where children can achieve strong and healthy attachment, or where the parents come from strong and healthy emotional roots are factors. However, the sin-gle most critical factor is the response to the question, “How does this parent make sense of their life?” If in the narrative a parent tells they can make sense of their life story and can understand how the past aff ects them, then the research indicates the children are more likely to thrive.

dangers of processing too deeply, or asking questions that probe rather than invite discovery. If professionals can work to remain highly sensitive and intentional about their own processes, it is less likely that they will do harm.

Dr. Daniel Siegel states that the single best predictor of positive out-comes for a child, meaning that child is emotionally healthy and primed to thrive, is not what is often cited. Being raised in a home where children can achieve strong and healthy attachment, or

a life narrative might be better facilitated by trained therapist.Professionals need to be careful not to re-traumatize or trigger an individual through the

process of creating a narrative. Professionals are encouraged to be highly aware of some of the dangers of processing too deeply, or asking questions that probe rather than invite discovery. If professionals can work to remain highly sensitive and intentional about their own processes, it is less likely that they will do harm.

dangers of processing too deeply, or asking questions that probe rather than invite discovery. If professionals can work to remain highly sensitive and intentional about their own processes, it

Dr. Daniel Siegel states that the single best predictor of positive out-comes for a child, meaning that child is emotionally healthy and primed to thrive, is not what is

At the same time, for some people impacted by trauma, the process of creating and sharing a life narrative might be better facilitated by trained therapist.

Professionals need to be careful not to re-traumatize or trigger an individual through the process of creating a narrative. Professionals are encouraged to be highly aware of some of the dangers of processing too deeply, or asking questions that probe rather than invite discovery. If professionals can work to remain highly sensitive and intentional about their own processes, it professionals can work to remain highly sensitive and intentional about their own processes, it


Professionals need to be careful not to re-traumatize or trigger an individual through the process of creating a narrative. Professionals are encouraged to be highly aware of some of the dangers of processing too deeply, or asking questions that probe rather than invite discovery. If professionals can work to remain highly sensitive and intentional about their own processes, it

Dr. Daniel Siegel states that the single best predictor of positive out-comes for a child, meaning that child is emotionally healthy and primed to thrive, is not what is often cited. Being raised in a home where children can achieve strong and healthy attachment, or where the parents come from strong and healthy emotional roots are factors. However, the sin-gle most critical factor is the response to the question, “How does this parent make sense of their life?” If in the narrative a parent tells they can make sense of their life story and can understand

Dr. Daniel Siegel states that the single best predictor of positive out-comes for a child, meaning that child is emotionally healthy and primed to thrive, is not what is often cited. Being raised in a home where children can achieve strong and healthy attachment, or where the parents come from strong and healthy emotional roots are factors. However, the sin-

dangers of processing too deeply, or asking questions that probe rather than invite discovery. If professionals can work to remain highly sensitive and intentional about their own processes, it

Dr. Daniel Siegel states that the single best predictor of positive out-

where the parents come from strong and healthy emotional roots are factors. However, the sin-gle most critical factor is the response to the question, “How does this parent make sense of their life?” If in the narrative a parent tells they can make sense of their life story and can understand how the past aff ects them, then the research indicates the children are more likely to thrive.

often cited. Being raised in a home where children can achieve strong and healthy attachment, or where the parents come from strong and healthy emotional roots are factors. However, the sin-gle most critical factor is the response to the question, “How does this parent make sense of their


gle most critical factor is the response to the question, “How does this parent make sense of their life?” If in the narrative a parent tells they can make sense of their life story and can understand how the past aff ects them, then the research indicates the children are more likely to thrive.

Th is powerful information is important for trauma-competent professionals. One of the ef-

comes for a child, meaning that child is emotionally healthy and primed to thrive, is not what is often cited. Being raised in a home where children can achieve strong and healthy attachment, or where the parents come from strong and healthy emotional roots are factors. However, the sin-gle most critical factor is the response to the question, “How does this parent make sense of their


Rothschild notes that therapists sometimes push for the processing of trauma memories way before safety and stabilization has occurred, which would not be a healthy overall process directed towards recovery. Rothschild suggests that a process in which memories must be re-called, probably in detail, and therefore this recalling can often result in re-experiencing the emotional memories associated with the traumatic event. Rothschild suggests that this type of emotional memory recall is not always necessary to complete this phase. Rothschild suggests that there may be a variety of ways for a person to work through Phase 2 that do not necessarily involve the expression of feelings as part of the process of dealing with trauma memories.

She notes that recalling trauma can throw a person off-balance.

For anyone, recalling a traumatic past in an already wobbly state only increases the wobble . . . For those who live with the emotional instability on a daily basis due to their trauma, increasing that instability can land them in deeper trouble.

She states that this is quite different from becoming upset, which can be a natural part of all human expression.

She encourages individuals impacted by trauma to improve their future rather than to pro-cess and reprocess the past, especially when that reprocessing interferes with the quality of life. She acknowledges that for many people processing trauma memories might be an important part of the goal of improving daily life. She suggests there may be other ways to complete this phase of recovery that do not require or trigger emotional memories.

Because her book is directed at the individuals who have experienced trauma rather than therapists, she emphasizes the importance of individuals with trauma issues to decide if, when and how they might process memories. She says the choices are [p. 44]:

J Tackle the memories in detail J Review the memories in general J Leave the memories completely alone J Decide later which of these is appropriate for you

Professionals are encouraged to keep these principles in mind when they interact with people impacted by trauma.

When leaving the actual memories completely alone, a person may use the cognitive knowl-edge to move through this phase by appreciating that trauma memories exist. They may focus on managing and perhaps replacing symptomatic behaviors with healthier ones. Over time this can replace old patterns of behaviors and beliefs that were triggered by underlying implicit memories. This is a subtle, indirect way to acknowledge and deal with traumatic memories and may require more work to accomplish a direct approach. It is a viable option that allows the person who is not able to uncover actual memories or the person who would be re-traumatized by having to go through a process of recall to successfully move through this phase of recovery.

This information can be valuable to teach to someone who is struggling with trauma-related issues. There can be freedom in learning that it is not necessary to re-create the details of a trauma in order to heal from it. There certainly should be time given to becoming safe before thinking about processing memories that can lead to re-experiencing the trauma

Creating Narratives 67

For example, teaching about the power trauma memories can have and the importance of addressing them at the right time can be a very meaningful gift a professional can offer an indi-vidual impacted by trauma.

Offering a variety of general principles of trauma that can affirm a person’s realities without a person having to actually remember in graphic detail the specifics of a traumatizing event can be remarkable. Healing is very possible when understanding somehow gives the brain permis-sion to revise ways it processes associations, interpretations and generalizations.

Creating NarrativesCreating a narrative involves having opportunities to share life stories with others who act as sounding boards, listening to the power and significance of that story. It is in telling stories and having others receive those stories that a person is likely to experience clarification about the meaning and importance of their life experiences. Over time, a person becomes equipped to create a sense of wholeness and clarity, regardless of how many aspects the story involved pain, loss or injustice. The gift of creating the narrative is that one’s life story can be valued with clar-ity and understanding.

One of the effects of trauma is that the person often has issues around memory and making sense of past experiences because it may have been lost or distorted. In moments of perceived inescapable danger, the lower parts of the brain take over the processes and there is limited functioning of the hippocampus and cortical areas. Memories can be fractured or damaged during traumatic events, making it difficult, and sometimes impossible for a person to have an accurate narrative that allows opportunities to make sense of traumatizing life experiences. This is one explanation for why trauma can continue to impose pain and loss in a person’s life. A person may not be able to resolve trauma on their own. It can continue to haunt them and interfere with the ability to function in healthy ways.

Sometimes it is essential for a person to receive therapy in order to explore and resolve trau-ma that continues to negatively impact that person’s life.

We should never underestimate the power of love and compassion to promote recovery and healing from trauma, even from those who have not been formally trained. Dr. Perry shared stories of many caring people who deeply impacted and helped create healing.

When using LATE, a trauma-competent professional can facilitate healing processes, especial-ly in terms of helping a person impacted by trauma share life stories that lead to making sense of one’s narrative and allows experiences to be integrated into the picture of a person’s life.

Active Listening ApplicationAvoid Delving Too Deeply

Trauma-competent professionals are encouraged to be highly aware and sensitive about facilitating an exploration of a situation with a person impacted by trauma. Active Listening often provides these opportunities for the profes-sional to help a person understand their thoughts, feelings and behaviors.


Trauma-competent professionals need to understand that Actively Listening may create a sense of vulnerability or exposure, and therefore may reduce a sense of safety in the relation-ship. To actively listen in a trauma-sensitive way involves considering if a response might evoke feelings of loss, shame or a sense of hopelessness.

Sometimes it is clarifying and even healing for someone to verbally reflect the person’s thoughts and feelings . There are times when a person is not ready and might be hurt by having to consider some of those reflections, especially those that overwhelm or produce feelings of inadequacy, unworthiness or shame .

Responses that might delve too deeply:

J “It sounds like you have no hope for recovering from the pain of this experience.” J “Your experiences have left you broken and incapable of functioning.” J “ The people who were supposed to protect you have abandoned you and it seems like

there is no one in your life who cares for you.” J “ Your patterns of reenacting the tragic situations in your family’s legacies continue to

haunt you.”

While all of these might be true or at least their reflections of what someone is saying, their impact might be damaging rather than empowering or enlightening.

Sometimes it can be healthier to include affirmations and teaching that promotes one or more of our Rh factors and processes. Affirmations can be offered that reflect perspectives that involve negative images, a sense of hopelessness or helplessness.

Healthy Affirmations and Teaching statements include:

J “ You have found creative ways to manage your trauma and I see someone who is strong and capable.”

J “ There is new research that validates the power and devastation trauma can inflict on someone. It sounds like you believe you should somehow magically get over having trauma symptoms. The information from brain research indicates that simply deciding to no longer be afraid or dissociative is an unfair expectation. Let me tell you a little bit about how the amygdala functions and can prevent a person from being able to simply decide not to have trauma symptoms . . .”

J “ I hear you saying that you believe it was partially your fault that you were violated. I understand that that is your perspective. I’d like to share my perspective with you. It was not your fault you were traumatized by someone who should have been protecting you. It is not your fault that you continue to struggle with symptoms from the trauma. I have some important information to share with you that will explain what I am saying in more detail . . .”

The balancing act is to know when to Actively Listen and how deeply to go with that Lis-tening. The caution is to appreciate that it is possible to delve too deeply into someone’s inner self-image and beliefs and to articulate what is discovered in that process. It becomes a judg-ment call on the part of the Listener, and it is important to apply trauma-sensitivity when re-sponding to a person.


It is important for the professional to have strategies in place for stepping back if there seems to be a negative reaction from the person impacted by trauma.

Professionals consider the following options:

J To Actively Listen to the reaction they are seeing in the Speaker: “I think what I just said is having a very strong impact on you and may be making you feel . . .”

J To insert a countering Affirmation, such as, “While you may see yourself this way, I have seen how strong you are as you describe the ways you have coped. While you may feel discouraged right now, I am excited for you because of all you are discovering about yourself, which gives you the power to address issues that maybe you didn’t understand before.”

J Use the Little Book of Wisdom. “It can be hard for someone to realize they have revealed something very private and then to hear another person put words to that.”

J Use a Content Listening response, “Let’s go back to what you said about remembering that walk in the woods. I think you said you remember how bright the sun was that day . . .”

J To apologize for intruding in a private area. “I am sorry I said that to you. I think it was more than you want to hear about yourself and probably want me to know about you. I’m sorry if I made you feel unsafe.”

If the relationship is fairly strong between two people and there is sufficient trust, most peo-ple, when hearing genuine regret or a desire to reestablish safety can feel nurtured and appreci-ated. Being able to strategically and quickly reverse the process of delving too deeply along with some kind of acknowledgment that safety was temporarily breached can be a good strategy for professionals to keep in mind.

To attempt to teach anything to anyone without first establish-ing a real-life connection is practically futile.

—Annette Breaux and Todd Whitaker

Concluding ThoughtsIn today’s session professionals were encouraged to consider the responsibilities that are fair to assume. Getting clearer about these responsibilities in the overall image of becoming a trau-ma-competent professional is an important goal.

The importance of helping someone with trauma-related needs and issues find ways to make sense of the experiences and create a coherent narrative can be revealing, and provide direction and focus for professionals.

By becoming clearer and better equipped to effectively use Active Listening, trauma-competent professionals can elevate their understanding and standards to being sensitive when Listening.

We hope that there is both new respect for the many nuances of being trauma-sensitive and trauma-competent.


Trauma-Response Tools1. Coherent Life Narratives

Think about the last 6 months of your life. Describe this time as a narrative, with a sequen-tial listing of events followed by feelings you associate with these events.

On individual pieces of paper draw sketches or cut images from magazines or coloring books to represent key moments in these six months. Lay your drawings out sequential and tell your story to someone you know, using your sketches to guide your story. Notice the degree to which your story is a coherent narrative.

Notice how you feel and the sensations you experience as you tell your story.

Think about a segment of your childhood, such as your memories of being a child in pre-school or kindergarten or a summer vacation or some kind of adventure that hap-pened over several days, weeks or months. Describe this time as a narrative, with a se-quential listing of events followed by feelings you associate with these events.


On individual pieces of paper draw sketches or cut images from magazines or coloring books to represent key moments in these six months. Lay your drawings out sequential and tell your story to someone you know, using your sketches to guide your story. Notice the degree to which your story is a coherent narrative.

If you struggle to create a narrative from your childhood and you know or suspect you have a trauma history, this last exercise may be very difficult or impossible to do. Remember that Babette Rothchild’s research shows that remembering is not necessary for healing.

Notice how you feel and the sensations you experience as you tell your story.

Draw an image of a head—a plain circle will do. Draw an oval in the upper half of the im-age to represent the brain contained within that head. Draw a line down the middle of the oval and put the letters LH on the left-hand side to represent the left hemisphere and RH on the right-hand side to represent the right hemisphere.

Recall that “making sense” of a life story is essential for it to become a coherent narrative involving an understanding of the cause and effect of relationships. Use one of the stories to record some of the images related to the story, drawing representations of those images in the margins on the RH side of your brain image.

For example, someone remembering a story of a fishing trip might have images of a fishing pole, a boat, the sun, themself in the boat with someone else. Perhaps the facial expression is one of joy or perhaps sadness.

Notice that pulling up these images is making use of the right hemisphere of your brain.

Note the sensations your body experienced in this situation. Write a few words or use symbols to describe those sensations near your images.


On the left-hand side in the margins by the LH, in a sequential order write down some of your interpretations of the images from the RH side.

For example, “I remember the sensations of the wind blowing in my face in the sun shin-ing down on us. I was happy and excited about fishing with my grandfather. He showed to me the correct way to use the pole and put the bait on the hook. I was very proud when he congratulated me for doing a good job.”

Write CC on the line between the left and right hemispheres of your brain image to stand for “corpus callosum.” As you recall this memory using both sides of your brain, draw arrows that show that each side is communicating with the other side.

As you recall the sequence of events using both your right hemisphere and left hemi-sphere and putting your story into a coherent narrative, what are some of your conclu-sions, i.e., how do you make sense of your experience?

For example, “By putting this story into a sequence of events and remembering the details as well as the sensations accompanying them, it makes sense to me how close I feel to my grandfather and how much I associate fishing with him.”

2. Practicing Active Listening

As you look at your diagram, imagine you were offering Active Listening statements to yourself. Write three Listening statements that would reflect the narrative you just creat-ed. Note that this is a good opportunity to practice creating Content responses in which you describe the story back to the person.

For example: “So the story begins when . . . and then . . . .happened.”


Avoiding Delving Too Deeply

Because Listening to someone with trauma-related issues and needs has the potential to overwhelm the recipient of that Listening, it is important to recognize when a trau-ma-competent professional might be delving too deeply.

For each of the following Listening statements that might delve too deeply, write some feelings each might generate in the recipient and re-write the statement to be less intru-sive or overwhelming:

You feel powerless to avoid panic attacks because you are so easily triggered. It is like you are doomed to have these attacks for the rest of your life.

Possible feelings:

A less intense statement that still shows a high degree of awareness and sensitivity:

As you realize all the ways your parents let you down you are struggling to think about staying connected to them.

Possible feelings:



The deep feelings of shame you have experienced as a result of your childhood abuse are like a huge dark cloud of constant pain that won’t go away.

Possible feelings:


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Today’s session is to continue exploring specifi c ways trauma-competent professionals can apply principles of trauma-sensitivity in their communication with people who have trau-ma-related issues. We will also continue our active listening practice and begin our case

study preparation.

Session Four Review

J Continued exploration of Daniel Siegel’s concept of a coherent narrative and ways trauma-competent professionals can use this information when interacting with someone who might have trau-ma-related issues.

J Expanded Active Listening application through role play and recognition exercises

Focus for Today’s Session

J Active Listening Practice/ProcessJ Case Study Preparation

Predictions, Acknowledgments, and Disclaimers

1. Because trauma is complex, sometimes convoluted and sometimes diffi cult to under-stand how it is impacting each unique individual, being able to know which principle to apply can be challenging.

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76 Sessions 5 & 6 | Applying Trauma Principles

2. Professionals may be inspired to encourage others to be aware and to advocate for trauma-competency.

3. Active listening can be both frustrating and rewarding in relationships.4. Practicing trauma-sensitive communication takes time to incorporate into our lives.

Incorporating Trauma-Sensitivity in All CommunicationsAs we continue our exploration of ways to apply trauma principles in interactions with people impacted by trauma, the more intentional we become in our communication.

Trauma-sensitivity involves active, ongoing personal self-assessment before choosing and executing a choice that is based on that assessment (ACTing).

Trauma-competent professionals are encouraged to be trauma-sensitive with regard to their communication. Trauma-sensitive communication maintains safety in relationships and offers people opportunities to experience genuine loving care that does not shame, criticize, intimi-date or isolate the person. Reassuring, Explaining, Suggesting/Solving, Sharing and Questions (RESSQ) is an important aspect to remember, understanding that these communication hats can be experienced negatively when someone needs to share or process.

Non-Trauma-Sensitive StatementsThe following statements and behaviors might be the antithesis of trauma-sensitivity:

J “ Oh, I don’t think you should feel that way. You should be thankful for all that didn’t happen?”

J “You’re making this all about you instead of the person who was actually hurt.” J “You must be getting something out of behaving this way.” J “I am sure if you tried a little harder, you could get better control over yourself.” J “This has gone on long enough. Stop talking about this.” J “ I think most people would have resolved this by now. You seem not to be motivated

enough to make the changes you need to make and move on with your life.” J “ Come on, I’m sure if you just give this a little time, you’ll feel better. After all, time

heals all wounds.” J “ I had an old friend who had the same thing happen to him and after a few sessions of

therapy, he saw things in a whole different way and is back to his old self. You don’t need more than one or two therapy sessions to fix what’s wrong with you.”

J “ How often do you feel like this? I can’t believe it’s all you think about. When’s the last time you thought about something happy?”

There can be forms of communication that damage the safety of the relationship because they imply rather than directly state messages of disapproval, shame and unwillingness to con-tinue interacting unless the person changes to be more acceptable in the eyes of the speaker.

Professionals benefit from appreciating the potential value in acknowledging the possible existence and impact of trauma in a person’s life. Sometimes a person is unaware they have

PADs Create Boundaries 77

been traumatized, and sometimes people do not understand the nature and potential impact trauma can have.

Consider how affirming it might be for someone who had a sibling die when she was a child to learn that some of her irrational fears about her own children’s safety might be a reenactment of her childhood trauma. It could be affirming for her to discover that the fears that have been haunting her may be connected to her unconscious associations, interpretations and general-izations from her childhood experiences.

A professional might blend the communication skills of trauma-sensitive LATE (Listening, Affirming, Teaching, Exploring) by transmitting messages such as:

J “ You may be feeling a sense of foreboding for your own children that seems to prevent you from relaxing and trusting that they are safe and healthy.” [Listening]

J “ You say that your fears are irrational and at the same time you don’t know how to ef-fectively lessen or eliminate them.” [Listening]

J “ When you mentioned to me about losing your brother to an illness when you were both children, I immediately wondered if you had had opportunities to process what might have been traumatizing for you. Sometimes information can give a person a new window of understanding about why they react and feel. Knowing that a person’s past can be very much a part of present life can explain what seemed to be irrational.” [Teaching]

J “ You have worked hard to ensure that your children are always safe. You deserve so much credit for your willingness to consider ways to address your fears and the beliefs from past experiences.” [Affirming]

J “ I’d like to share some of the principles of . . . traumatic grief, PTSD and how the brain creates beliefs based on traumatic experiences.” [Teaching]

PADs Create BoundariesA part of being trauma-sensitive includes knowing when to include PADs to promote a sense of safety and give the person with trauma-related issues permission to take control of creating and maintaining safety.

By predicting and acknowledging what might be involved in interactions and by disclaiming what probably cannot happen, the receiver of this information can feel cared for, respected and safer. By including disclaimers, it becomes clear that there are areas that are unpredictable or that probably cannot be addressed.

Articulating specific limits and boundaries that both people agree to maintain gives the re-ceiver a right to maintain safety, which contributes to the power and balance the professional wants incorporated into interactions with this person.

These are some examples of PADs which help to maintain boundaries:

J “ There is a difference between education and therapy. I am hoping to offer you infor-mation that could help you better understand yourself. Information can lead to healing and sometimes it can lead to other components of the healing process: reconciling,


restoring, recovering, repairing and resolving aspects that might cause you so much fear and anxiety.” [Predicting, Acknowledging, as well as Teaching]

J “ The mind and the brain are amazing and complex. Please understand that I do not know exactly what you experienced and I don’t know exactly what you need right now. It is a process that will take time.” [Disclaiming]

J “ It is important that you feel safe and protected as you talk to me. If at any time our conversation starts to make you feel uncomfortable, please let me know. I want to be a resource to you, not someone who in any way makes you feel unsafe. You can say something as simple as, ‘I don’t feel like talking about that right now,’ and I will imme-diately stop and will be very thankful that you trust me enough to tell me you need that boundary maintained.” [Setting limits and maintain boundaries]

J “ There are legitimate reasons for what you are feeling, even if you cannot completely figure out exactly where they are coming from.” [Predicting, Acknowledging, Disclaim-ing, and Affirming]

Managing Traumatic ReenactmentTraumatizing events typically occur outside relationships. These include accidents, hurricanes, fires and floods, and trauma perpetrated by people unknown to the victim, such as random shootings, robberies, beatings or rape. Traumatizing relationships can be defined as those rela-tionships in which trust is violated because a trusted person once traumatizes the other person, damaging the integrity and safety of the relationship.

By communicating information, through Teaching processes, a trauma-competent profes-sional can add to a person’s understanding of trauma and its impact. This can contribute to facilitating processes in which a person can better understand their life story.

There is a continuum on which we can place traumas in terms of how obvious they are, how aware a person is of having been traumatized and the impact that trauma may still be having.

On one of the trauma continuums are those traumas that are clearly obvious to all concerned and can be documented through factual accounts. The person impacted by trauma remembers significant details and understands the depth and impact of the trauma.

As we move down this continuum, people can be less aware to clueless about the specifics and the reality that trauma has likely caused.

This can be a helpful awareness when applying trauma-sensitive communication skills, es-pecially if the professional believes they have a clear understanding of a person’s trauma and its impact.

Trauma-competent professionals consistently maintain trauma-sensitivity in their commu-nication. Professionals are encouraged to use the skills of LATE to gently invite self discovery, and new levels of awareness and understanding without putting pressure on a person.

This can be challenging to maintain, especially when a professional feels confident to rec-ognize trauma-related symptoms and wants to process them. When self-awareness and self-control are important to exercise as professionals, Teaching can invite self-discovery. As

Managing Traumatic Reenactment 79

professionals we do not want to pressure someone to make connections between symptoms and possible causes if a person might not be ready for becoming more aware.

What lies behind us and what lies before us are tiny matter compared to what lies within us.

—Ralph Waldo EmersonIn Creating Sanctuary, Dr. Bloom describes one of the dilemmas she and her team faced when

working with people who had trauma-related issues and needs, including processes around Man-aging Traumatic Reenactment. People with unresolved trauma are often re-creating previous re-lationships when interacting with others, including professionals who are attempting to Listen, Affirm and Teach Effectively. Sometimes there is a hidden, usually unconscious agenda to re-cre-ate a past relationship in which someone, often the parent, was needed to be caring and support-ive. Being supportive is what Listening, Affirming and Teaching can feel like to the receiver. If that person’s parent/child relationship was a source of trauma and there was and continues to be pain associated with it, there can be attempts to reenact the unsafe dynamics of the relationship. This can put the unsuspecting professional in interchanges that intuitively feel awkward.

For example, in a Listening exchange, if a professional said, “It sounds like you have struggled in many ways to manage your anger when your children break some of the family rules and you wish you could find better ways of responding to them.” In response, the person explodes at the professional and says, “Don’t tell me I don’t manage my anger well! You don’t know how bad my kids are—they defy me, disrespect me, and laugh about it, so of course I have to punish them and yes, I get angry. But they deserve what they are asking for and I give them just that. So don’t tell me I should learn to manage my anger. They should learn not to make me angry!” The per-son might be reenacting how anger was expressed in their life. These could be the very phrases this person’s parent used when angry, and now the professional has symbolically become that critical parent.

If a professional suspects an interaction has become a reenactment, they may decide, if it would not cross the boundaries between therapy and education, to use a reflective Listening statements about what they perceived just happened. Whether to offer some teaching informa-tion about reenactment as a way to invite the person to become more self-aware and self-un-derstanding is a judgment call.

Psychological Debriefing after Trauma

The acclaimed idea of psychological debriefing (PD), first described in 1983 by Mitchell as Critical Incident Stress Debriefing (CISD) has come under greater scrutiny in recent years and that now there are questions about what, if anything, should be offered to individuals following traumatic events.

Originally, the concept of using psychological debriefing involved providing crisis interven-tion after exposure to traumatic situations, opposed to providing psychological treatment.


CISD and other PD models have been recognized as semi structured interventions de-signed to reduce initial distress and to prevent the development of later psychological sequelae, such as PTSD following traumatic events, by promoting emotional process-ing through the ventilation and normalization reactions, and preparation for possible future experiences. . . . It is, however, apparent that many participants in debriefings would have fulfilled the criteria for acute stress disorder or had symptoms of PTSD, anxiety, and depression. Debriefings have been used with survivors/victims, emergen-cy workers, providers of psychological care. The focus of PD is on current reactions of those involved in a trauma rather than earlier life experiences that may shape their individual reactions. . . . The participants are assured that they are normal people who experience an abnormal event.

Typically debriefing involves the following seven steps occurring in one to two sessions within one month of a traumatic event. They are considered to be brief, preventive tech-niques to reduce the likelihood of PTSD:

1. The introduction: the debriefer shares the purpose for the process and explains that it will help the person or people prevent future problems. Ground rules are established.

2. Expectations and facts: participants are encouraged to describe the facts of what happened and their expectations. “Discussion of expectation is believed to focus individuals on their experiences at the time and to help them understand why they reacted the way they did.”

3. Thoughts and impressions: using questions that encourage participants to share their thoughts and impressions, the debriefer attempts to help construct a picture of what happened. The debriefer uses sensory impressions, asking “what did you see, hear, touch, smell, taste?” “The aim is to produce a more realistic reconstruc-tion of the trauma.”

4. Emotional reactions: usually the longest stage in the PD, the debriefer asks ques-tions concerning emotions such as if and when the following were experienced: fear, helplessness, frustration, self-reproach, anger, guilt, anxiety, and depression.

5. Normalization: the debriefer stresses the normality of these reactions and the probability that they are more universally experienced in others who have shared this kind of experience. Common symptoms are also described that might be occurring now or in the future, such as:

◾ intrusive thoughts and images ◾ distress when reminded of what happened ◾ attempts to avoid thoughts, feelings and reminders ◾ detachment from others ◾ loss of interest in things that once gave pleasure ◾ anxiety and depressed mood ◾ sleep disturbance, including nightmares


◾ irritability and anger ◾ shame and guilt ◾ hyper-vigilance ◾ increased startle reactions

6. Future planning/coping: the debriefer offers suggestions for managing symptoms that might arise, which includes letting people know there may be additional support needed in the future.

7. Disengagement: other topics are discussed and participants are advised to seek further help if it appears that they are exhibiting symptoms indicative of more severe reaction or a continuation of reactions to the trauma.

This is just one formula for conducting debriefing. There are others . The goal continues to be to provide opportunities for sharing and processing traumatic experiences as well as receiving information about typical traumatic reactions as a way of lessening the chances for trauma to evolve into posttraumatic stress or PTSD.

The authors also note that the term psychological debriefing has been used in other in-terventions that may involve more, much longer and intensive sessions, such as professional development used for military personnel returning from wars.

The reason the authors of this book raise significant questions about the efficacy of PD is that new research indicates that not all PD is effective. In fact, some have negative results. [Of the 10 studies that compared individual PD with no intervention, two were positive, five were neutral, and three were negative.] They state that other randomized controlled trials have consistent results to these 10 studies. In their conclusion they state that,

Their findings support and strengthen the original conclusion that no evidence sug-gested that PD is effective in the prevention of PTSD symptoms shortly after a trau-matic event or in the prevention of longer-term psychological sequelae.

The authors conclude that,

it is important to remember that the usual reaction following a traumatic event is a normal one that leads to recovery. We should not disrupt this process, but it may be helpful to consider five recent recommendations, the first two by Bisson and col-leagues and the final three by Watson:

1. Shortly after a traumatic event, it is important that those affected should be provided, in an empathetic manner, with practical pragmatic psychological support. Individuals should be provided with information about possible reactions; what they can do to help themselves (coping strategies); accessing support from those around them (particularly families and community); and how, where, and when to access further help.

2. It is important for appropriate early support of individuals following a traumat-ic event. Any early intervention approach should be based on an accurate and


current assessment of need prior to intervention. People cope with stress in differ-ing ways. No formal intervention should be mandated for all exposed to trauma.

3. Strive to make interventions culturally sensitive, developmentally appropriate, and related to the local formulation of problems and ways of coping.

4. Lack of distress and/or rapid recovery may not be a desired outcome. Ethnic, political, cultural, and economic factors may contribute to differing goals for functioning and identity, and providers should be sensitive to the particular motivations of each survivor.

5. Because of the dearth of evidence in early interventions, as much as possible, strive to evaluate whether early interventions are effective in ameliorating specific outcomes, or whether new interventions should be designed to ac-complish such objectives.

The bottom line for trauma-competent professionals is to appreciate that psychological debriefing is no longer considered necessary or recommended as a normal response to trau-matic events. Respect should be given for natural recovery processes from traumatic events.

Elena, a trauma-sensitive therapist, was processing some aspects of Tara’s adverse childhood experiences and their impact on her life today as a young mother. Tara shared how deeply she was impacted when a family friend abused her while their parents were socializing down-stairs. Tara shared she had never told anyone about the incident. She was about 10 years old. “Even though your parents were nearby, somehow they were not able to keep you safe,” Elena responded. Tara’s face reflected her sense of despair and Elena noticed Tara put her hands on her abdomen. “It looks like you’re having some sensations as you remember what happened.” Tara replied, “Yes, just thinking about it makes me feel tight in my gut.” Elena realized that to continue to help Tara feel safe and empowered, it would be important to continue to use the skill of Listening. “It seems like your body is remembering how you felt then.” It can be import-ant to honor those sensations and acknowledge them.” Elena noticed Tara taking a deep sigh, which Elena realized can sometimes be a reflection of letting go.

Elena continued, “It sounds like you never told your parents about this because you were scared.” Elena’s comment seemed to puzzle Tara. “It never occurred to me that I should tell them.” Tara paused and contemplated what she just said. “I guess I just knew that they really didn’t care what happened to me as long as I behaved properly around their friends. I knew I couldn’t tell them because they would be embarrassed that somehow it was my fault.” Elena replied, “So there you were as a child feeling isolated and shamed. That can be overwhelming for any child. It seems like you’re realizing that this all gets carried into the core beliefs you have as an adult.” Tara continued, “I just never realized that kids should tell their parents when something bad happens to them. I always thought I just had to deal with things that happened to me and not tell anyone about them. Maybe that’s why it’s so hard for me to tell my husband or anyone else when I’m feeling scared or hurt.”


Concluding ThoughtsThe journey to become more trauma-competent involves enhancing and enriching trauma-sen-sitivities, especially with regard to the specific ways a professional interacts with a person im-pacted by trauma.

Professionals are encouraged to hone their awareness, sensitivities and skills with regard to ways to communicate effectively with someone who has trauma-related issues and needs. This includes the awareness that trauma might be impacting how this person interacts with a pro-fessional and with others. Recognizing that trauma continues to impact current relationships and how well one can connect, communicate and achieve emotional intimacy, all can add to a professional’s awareness and overall effectiveness in their application of skills.

By continuing to build on ICAPS of trauma-sensitive communication, professionals become confident they are enhancing their trauma-competency levels and abilities to positively impact those who have trauma-related issues and needs.

Trauma-Response Tools1. Non-Trauma-Sensitive Statements

For each of the following statements that are non-trauma sensitive, write some of the internal messages you think the person could be saying to themself.

For example, when hearing “Oh, I don’t think you should feel that way. You should be thankful for all that didn’t happen?” the person might have the following internal mes-sages, “ I need to feel thankful and yet that isn’t what I really feel. I guess I’ll hide my real feelings to make this person approve of me.”

Elena and Tara went on to process more about the impact of her adverse childhood expe-riences. Tara was able to become clearer that the isolation and shame were more powerful than the actual abuse. Tara realized that if she had been able to process immediately and have her feelings acknowledged, it probably would not have had profound negative conse-quences in her life. Elena’s goal in interacting with Tara was to:

◾ Remain deeply respectful of Tara and her narrative ◾ Appreciate the power of Trauma-Sensitive Listening ◾ Maintain Tara’s safety each step of the way ◾ Free Tara to make her own discoveries about the meaning of this traumatic

moment


C “You’re making this all about you instead of the person who was actually hurt.”

C “This has gone on long enough. Stop talking about this.”

C “I think most people would have resolved this by now. You seem not to be motivat-ed enough to make the changes you need to make and move on with your life.”

C “Come on, I’m sure if you just give this a little time, you’ll feel better. After all, time heals all wounds.”


C “I had an old friend who had the same thing happen to him and after a few sessions of therapy, he saw things in a whole different way and is back to his old self. You don’t need more than one or two therapy sessions to fix what’s wrong with you.”

C “How often do you feel like this? I can’t believe it’s all you think about. When’s the last time you thought about something happy?”

2. Practice Using LATE

Write four sentences that show each of the communication skills we have been practicing that are trauma-sensitive: Listening, Affirming, Teaching and Exploring in response to a person impacted by trauma saying, “I’m afraid to go to sleep at night because I never know when I am going to have a dream about my trauma. It makes it seem like it is happening for real, even when I wake up.”

Be aware of incorporating the principles of being trauma-sensitive with each response.

L _______________________________________________________________________________________________

A _______________________________________________________________________________________________

T _______________________________________________________________________________________________

E _______________________________________________________________________________________________

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In today’s session, professionals will begin presenting case studies. As we move into the sec-ond half of this course, participants may fi nd themselves becoming confi dent about their abilities to be more competent. Participants may also feel they are becoming intentional in

guiding a person through meaningful and safe processes.We will:

J Explore four concept categories that professionals should keep in mind when interact-ing with a person impacted by trauma

J Continue our application of active listening and discuss the A of LATE to broaden ways a professional might choose to interact with someone with trauma-related issues

J Review the LGI Steps of Growth, inviting professionals to recognize their own ascen-sion up the steps

Sessions Five and Six ReviewIn Sessions Five and Six, through in-class presentations, discussions and the information contained in the curriculum we covered the following ICAPS:

J Active ListeningJ Case Study Preparation

Focus for Today’s SessionJ Affi rmationsJ Four Concept Categories

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J Reflecting on Own Steps of Growth J Case Studies

Predictions, Acknowledgments, and Disclaimers (PADs) J Professionals may continue to find the information contained in the reading materials

and in our classes fascinating, at times intimidating, but also the source of increased confidence.

J Professionals may find themselves feeling clear and perhaps more responsible with regard to effectively applying trauma principles. Growing more confident in the appli-cation of LATE and the process of ACT.

J We are each gaining an ability to effectively address trauma-related issues and needs which can help soothe some of the despairing feelings that are associated with trauma.

The A of LATE: Skill of AffirmingProfessionals are encouraged to understand the principles of affirming and the categories of affirmations.

The challenge of using affirmations effectively is to recognize that an affirmation given before a person is ready to receive it can feel like a discount. The person transmitting the affirmation may not really understand how distressed, confused or emotionally-impacted the person is. Premature affirmations can interrupt processes of exploring the thoughts and feelings of some-one’s story.

Affirmations have the power to build someone up because the affirming person is saying in a positive way how they see the person. The hope is that these reflections strengthen and empow-er the person, give another perspective, especially when one trusts that the person transmitting the affirmation is someone to be respected.

When determining if an affirmation might be helpful to a person, assess where that person is on their journey and the extent to which hearing a positive belief/perspective might reassure that person. This means the professional needs to be assessing before, during and after the pro-cess of choosing to offer an affirmation.

Dr. Bruce Perry of the Child Trauma Academy has research that indicates that children who live in families where there are serious levels of abuse and neglect resulting in trauma also re-ceive fewer affirmations than children in families where children show no indications of being traumatized.

It becomes very clear that affirming children (and adults as well) is an extremely important form of communication that can promote resiliency.

In LGI we regularly encourage professionals to intentionally affirm children and adults in ways that support and encourage them to gain positive self-images, self-confidence and to grow and learn in healthy ways.

Basic Definition of Affirmations 89

Affirmations are our mental vitamins, providing the supplemen-tary positive thoughts we need to balance the barrage of negative

events and thoughts we experience daily.—Tia Walker

Basic Definition of Affirmations

1. Affirmations are:

C One person’s favorable opinion of something another person did or might do C Something about who that person is or can be C Messages that validate, approve and encourage

2. People often think of affirming mostly as giving statements about how wonderful some-one is or how well they have done something. These are the two most common categories of affirming: affirming for an accomplishment or for a trait or characteristic. It may sur-prise professionals to learn that there are at least 10 other areas in which someone could affirm a child or adult.

3. Professionals are encouraged to use Developmental Affirmations that are based on spe-cific developmental stages that occur in each age and stage of life.

General Categories of Affirmations J Accomplishment J Potential J Quality or Trait J Struggle or Effort J Intention J Growth or Change J Positive Impact J Reality J Value or Priority J Right and/or Responsibility J Connection J Process

Affirming a Person Impacted by TraumaProfessionals are encouraged to be more sensitive and clearer when offering affirmations that focus on some aspect of the trauma and its impact.

Such affirmations can focus on strengthening or increasing the person’s: J self-confidence J self-esteem


J rights and responsibilities J abilities to be self-sufficient J gifts and talents J abilities to create, succeed, communicate J growth and change J Rights to:

C have meaningful relationships C be safe C have a healthy degree of power C meet needs

J Abilities to:

C survive struggles C contribute in meaningful ways C control himself or herself C impact others C be sensitive C make healthy and appropriate decisions C process

Specific Affirmations/Sentence Starters:

J To build and affirm self-confidence: “You are gaining in self-confidence every day.” “One of the ways I see you becoming more self-confident is when you . . .”

J To promote self-esteem: “You have the right to appreciate the wonderful qualities that exist in you, such as . . . “You are/have the right to be connected with . . .” “You are unique in the following way . . .”

J General rights and responsibilities: “It was your right to . . .” “You took responsibility for . . . when you . . .”

J Abilities to be self-sufficient: “You are capable of doing that on your own.” J Gifts and talents: “You are very gifted in the area of . . .” “You clearly have the ability to . . .” J Abilities to think, create, succeed, communicate: “I am impressed by how well you

can think things through, create new approaches, communicate clearly . . .” J Growth and change: “Over the last few days (weeks, months, years) I have seen a big

change in you.” “You seem to be so much better at . . .” J The abilities to have meaningful relationships: “You are fully capable of creating and

maintaining meaningful relationships with important people in your life.” J The right to be safe: “You have the right to feel safe.” “It isn’t fair if you constantly feel

like you are in danger.” J A healthy degree of power: “You can take charge of . . .” J To meet needs: “You deserve to decide what you need and how to meet those needs.”

“You are able to get your needs met in healthy and legitimate ways.” J Abilities to contribute in meaningful ways: “You have a lot to offer. For example . . .”

Four Concept Categories to Apply When Using LATE 91

J To be sensitive: “You seem to be able to deeply empathize and understand how others are feeling.”

J To make healthy and appropriate decisions: “You have/you are able to think about things and then come up with healthy and appropriate decisions.”

J To process: “You are processing that well.” “Being able to . . . is going to take time and patience.”

These are just some suggestions for offering specific affirmations. Professionals are encouraged to use these as examples and springboards for the creation of their own affirmations.

Four Concept Categories to Apply When Using LATEWhenever trauma-competent professionals are applying their abilities to Listen, Affirm, Teach and Explore (LATE), it can be helpful to keep the following four concept categories in mind as possible areas on which to focus Listening, affirming, and teaching:

Categories:

J Grief: The strong probability that some form of grief is associated with a person’s trau-ma and its aftermath because most traumas involve some form of loss.

J Stress: The probable impact the stress of experiencing the trauma has had at both a psychological and a neurobiological level.

J Fear: The high probability the traumatic event evoked high fear responses with a loss of power or control.

J Shame: Often a person experiences some degree of shame associated with the trauma, immediate and continued, that impacts the person’s response to trauma.

A trauma-competent professional might offer one or more of the following Listening state-ments that incorporate these four concept categories [A Listening statement occurs when the Listener puts words to what the Listener thinks the speaker is thinking, believing or feeling and how an experience might be impacting the person]:

Active Listening Statements:

J Grief: “You seem to be grieving deeply for the many things you have lost as a result of what happened to you.”

J Stress: “It seems that this event has put a lot of stress on you which is keeping you in a place of hyper-vigilance; you may feel like you are constantly in a state of alarm even when you logically know you are safe.”

J Fear: “It sounds like you were overwhelmed with terror and unable to do anything. You felt as if you had no choices and were just frozen with fear.”

J Shame: “You seem to somehow feel responsible for not being able to stop that from happening and when you look back on it you might feel ashamed that you could not find a way to do that.”


A trauma-competent professional might offer one or more of the following Affirming state-ments that incorporate these four concept categories [An affirmation occurs when a person shares positive and nurturing beliefs about the other person]:

Affirming Statements:

J Grief: “I hope you can hear how important it is for you to have permission to grieve what you lost. You have the right to grieve.”

J Stress: “It is okay for you to find ways to reduce your stress, including therapy and oth-er ways of self-care.”

J Fear: “I can see how strong you are and how capable. I think those qualities will go a long way in helping you understand and deal with the fears you are experiencing.”

J Shame: “I think it is unfair for you to blame yourself for something you are unable to stop. You can reframe this experience to better understand it. It is not your fault and therefore allowing your shame to be released is so important.”

A trauma-competent professional can share relevant information about each of these sub-jects with a person impacted by trauma as a way to increase knowledge and understanding of what might be happening (the T of LATE).

All four of these responses: Listening, Affirming, Teaching, and Exploring can contribute to helping a person makes sense of the experiences and therefore build a more coherent narrative. This in turn can lead to one or more of our Rh factors: resolving, repairing, reconciling, restor-ing, recovering and healing.

The E of LATE

A trauma-competent professional may be able to create opportunities for a person im-pacted by trauma to Explore their story through a guided process, gently asking questions. This may be a way to help a person impacted by trauma regain more accurate memories, and may help bring greater clarity to their narrative.

In LGI trainings, professionals are generally cautioned about the misuse of questions because of the potential that exists for questions to be intimidating, threatening, and dis-empowering. Questions can also threaten the safety of a relationship because they shift the power in the relational dynamic, placing the questioner in charge of the conversation.

At the same time, when questions are framed as an invitation to guide a person towards greater self-awareness and self-discovery, the receiver of the questions can feel nurtured and relieved that someone is becoming a stronger guide to processes which can lead to enhanced awareness, understanding and clarity.

A guided process that involves intentional questions invites a safe exploration blend-ed with Listening, Affirming, and Teaching. A professional is well-equipped to nurture and share in the the journey of a person impacted by trauma.

As professionals become more trauma-competent, they can become more confident in their abilities to create questions that can guide processes of exploration and are less

Blending Four Core Concepts with E of LATE 93

Blending Four Core Concepts with E of LATEProfessionals can also consider ways to generate questions to guide a process of incorporat-

ing the four concept categories described earlier: grief, stress, fear and shame. In addition to in-corporating these core concepts in Listening, Affirming, and Teaching processes, professionals might generate questions that invite the person impacted by trauma to explore the trauma-re-lated issues and needs.

If focusing on grief, a professional might ask, “Considering that you have experienced many losses as part of this traumatic experience, what might some of those losses be?” “How have they impacted your life?” “To what extent have you grieved these losses?”

If focusing on stress, a professional might ask, “How do you think the stress you have expe-rienced has impacted you?” “What kinds of stress do you think this trauma may have caused?”

If focusing on fear, a professional might ask, “Can you put into words specifically what you fear at this point?” “In what ways do you feel helpless?”

likely to intimidate or threaten.Trauma-sensitive questions invite the person impacted by trauma to recall facts, sequenc-

es of events, and the meaning or impact these seem to have had. All questions should feel gentle in nature to the receiver and the individual should always have the option of saying comfortably, “I don’t know” or “I really do not want to talk about that.”

Before engaging in processes of exploring a person’s story, the professional should ex-plain the process. It is important to build in the safety and control the person impacted by trauma needs by stating that the person does not have to answer any questions, or share any aspect of the experience. The professional can provide appropriate PADs about the process. For example,

You might find responding to my questions helpful and it is also possible one or more of the questions might feel intimidating. Questions can do that, even when my inten-tions are to gently guide you. I may not realize a question could be making you un-comfortable. So at any point, I ask that you communicate with me by directly saying, “I’m not comfortable answering that.”

Questions that request who, what, when, and where information are typically less threaten-ing than questions that ask how or why. “How did that make you feel?” might be a welcome invitation to sharing feelings or it could feel intrusive. “Why do you think that happened?” or “Why did you respond that way?” are questions that have a greater potential to put a person on the spot and they also invite the person to explore underlying feelings or thoughts.

Professionals are encouraged to gently incorporate guided processes that include questions as a way to invite a person impacted by trauma to explore the experience. Professionals are asked to simultaneously ACT/Re-ACT the process, Assessing what seems to be going on, Choosing to either continue with the guided process or switch back to Listening, Affirming, or Teaching.


If focusing on shame, a professional might ask, “What do you think makes you believe this was your fault?” “You seem to think you had the power to stop this from happening. Can you tell me what it is you think you were capable of doing?”

Guided processing questions is a helpful addition to the processes of Listening, Affirming, Teaching and Exploring (LATE).

Four Conditions Necessary for an Event to be Encoded as a Traumatic Memory

In his book When the Past is Always Present, author Ronald Ruden postulates the following:

There are four conditions that need to be met for an event to be encoded as a traumatic memory. First, one needs an emotional-producing event. Second, the event must have meaning for the in-dividual. Third, the brain’s neurochemical landscape at the time of the event must be suitable, and fourth, the event must be perceived as inescapable. If these are present, then, through the intermedi-acy of the amygdala, an enduring imprint of the moment and its associated components is synapticly encoded. The event has been traumatized.

He describes in more detail each of these four conditions, noting that whether or not a per-son is traumatized by a traumatic event has more to do with the degrees to which emotions are triggered, even in those situations when the traumatization is more vicarious than a firsthand experience. He notes that an emotional event “. . . must cause norepinephrine and cortisol to rise to high levels to meet this requirement for traumatization.” He explains that,

Norepinephrine prepares our mind for quick action and increases our ability to process, associate, and store information. Norepinephrine also activates an amygdala-prefrontal pathway, preventing the prefrontal cortex from inhibiting the amygdala. Cortisol enhances norepinephrine’s actions. Do-pamine is also elevated at this time, causing the content and context of the event to become more salient.

Ruden notes that when there are significant losses, including things like loss of stature, loss of youth, loss of self-esteem, and any other loss, they are considered meaningful events. He connects meaning with our innate need for attachment coupled with previous experiences. We can be attached to nonliving things, such as our home so losing or fearing the loss of our home which can have enormous meaning.

He defines landscape as the brain’s neurochemical state and lists five neurochemicals be-lieved to be necessary for traumatization. These are a blend of neuromodulators as well as neurotransmitters. Individually and collectively they can affect mood and the way that infor-mation is processed. They heighten arousal and prepare the brain to store incoming sensory information. A person’s neurochemical landscape becomes more vulnerable if there has been prior stressful events, which can change perception for a current event.

He uses the example that,

Preschoolers who witnessed the September 11 attack on the World Trade Center were at high risk for developing lingering emotional and behavioral problems only if they had had a previous frightening

Four Conditions Necessary for an Event to be Encoded as a Traumatic Memory 95

experience, like seeing a parent fall ill. . . . It was found that 40% of those who had such sequential traumas suffered from depression, emotional outbursts, and poor sleep three years later. By contrast, children who had no such earlier trauma showed few, if any, psychological scars. What is remarkable is that the previous traumatic events could be anything from a dog bite to a serious accident.

He adds that,

Vulnerability is increased by overly empathetic abilities, low self-esteem, and difficulty in regulating the level of emotional response. Personality traits such as obsessive-compulsive disorders, anxiety, introversion, and substance abuse also increase risk. The stressors caused by poverty and low educa-tion levels independently increase the risk for traumatization.

He states that inescapability means that a person perceives the inability to move or hide. Even momentary sensations of inescapability can activate the neurochemicals of terror that in turn can lead to a traumatic memory. He gives examples such as being in a car accident, the act of falling down, crossing a bridge or the first few moments when someone is told they have cancer.

He describes that in order to erase a traumatically encoded memory,

We must first have a common language with which to speak. We define traumatization at the neural level as the process that permanently encodes and synaptically consolidates linkages between the emotional, cognitive, autonomic, and somatosensory components present during the traumatizing event. Any one of the components recalled either consciously or subconsciously, activates the amyg-dala and causes the release of stress neurochemicals. For each reactivation, we experience some or all of the components as if they were happening for the first time.

We can use this information to further understand why a person can have unresolved trauma that continues to cause emotional and relational pain.

This is information that also might be shared with someone in order to help work on the construction of a narrative. This is important for helping someone make sense of traumatic experiences.

Professionals are encouraged to appreciate that when they can effectively help process a person’s trauma, they often are simultaneously interrupting the path of that aftermath. If left unchecked, the posttraumatic symptoms of experiencing flashbacks and having triggers can in-stantaneously set off a sequence of electrical and chemical reactions in the brain that re-create many of the trauma symptoms. A smaller, lower case “t” level of trauma can gradually increase in size and, because of these triggers and flashbacks, they can be interrupted through processes that help a person become more aware and understand their trauma symptoms and neurobio-logical responses.

There is a lot of science to suggest that past trauma changes the way we perceive the world. When you have trauma at a young age, the memory

warps your brain circuits. Affirmations help you change the wiring.—Louise Hey


Reflecting on our Journey—The Steps of GrowthOne of the ways we invite participants in our LGI trainings to understand their own process of learning, growing and changing is to use the image of the Steps of Growth. In this image, before a person begins the process of learning, growing and changing, the person is in a lower state of unawareness, sometimes what we call being in the basement, not realizing that somewhere there are stairs that lead upstairs.

When a person begins to learn, grow, and change, the first Step is moving from Unawareness to Awareness. There is recognition that there are needs that are not being met, information that has not been received or processed, changes that need to be made. Sometimes a part of going from Unaware to Aware involves experiencing the hurt that has occurred because of this lack of Awareness. This is often an emotionally-charged step; one that probably impacts more of the limbic system of the brain than the cortex.

After sufficient time is spent on the step of Awareness, and after the emotional reactions have somewhat resolved, a person is in a place to begin Understanding the needs and dynamics of a situation. On this step, a person gains information, learns principles, and has greater clarity with regard to the overall situation. This is a more cortical process and can be very satisfying because of the clarity it often brings.

After gaining sufficient Understanding, a person is ready to move to the Action Step, in which one makes and executes plans, ACTing a situation, now equipped with what is needed to do so effectively.

While we know that people often become impatient when they become Aware to start to take Action, we know that the step of Understanding is what brings clarity so that when taking Action, a person does so equipped with key principles and information.

We hope the ATP course is providing professionals with multiple opportunities to consider ways to take Action, to intentionally apply the Awareness and Understanding that has occurred over our last two courses.

We acknowledge that there continues to be moments of new Awareness and the need for more Understanding, even as we work on applying trauma principles on the Action Steps.

As professionals continue exploring ways to apply trauma principles in their interactions with people, we invite them to mentally reflect on the journey from being possibly Unaware of the principles of trauma to becoming more Aware as emphasized in Enhancing Trauma Aware-ness. In Deepening Trauma Awareness, professionals were invited to move to the Understand-ing Step of Growth, to become clearer and therefore better able to appreciate the issues, needs and ICAPS related to understanding trauma.

Professionals are encouraged to recall that individuals move up the Steps of Growth at their own pace and are entitled to take as much time as needed to adequately complete each step be-fore moving to the next one. We also encourage professionals to be aware not only of their own progress, but also the progress of others, being respectful and encouraging as each individual experiences each step.


Concluding ThoughtsAs we enter into the second half of our ATP course, we are engaging in a process to clarify the many ICAPS we have been exposed to over Enhancing Trauma Awareness, Deepening Trauma Awareness and Applying Trauma Principles. We hope the journey is enhancing and enriching knowledge and skill bases as well as provided an overall confidence in the processes that can positively impact a person impacted by trauma.

While there is no one exact approach or even set of approaches each professional should use, certainly there are essential principles, such as incorporating Judith Herman’s phases of establishing safety and control, going through processes of remembrance and grief and rees-tablishing one’s life.

Professionals are encouraged to appreciate the many ways they have ascended the Steps of Growth with regard to trauma, the many times they have and will apply trauma principles. The awareness and understanding of trauma and the application of principles can change the outcome of a person’s life, give them hope, and lessen the power trauma has to damage and destroy lives.

Trauma-Response Tools1. LATE

Imagine you are having a conversation with the person for whom you just created a Trau-ma Shroud.

Actively Listening

J Write down 2–3 Listening statements you could make in response to this person:

J Write down some of the ways you think receiving these Listening messages might im-pact the beliefs of this person:


J Write down some of the ways providing Listening responses might impact your rela-tionship with this person:

Affirming

J Write down 2–3 Affirming statements you could make to this person:

J Write down some of the ways you think receiving these Affirming messages might im-pact the beliefs of this person:

J Write down some of the ways providing Affirming messages might impact your rela-tionship with this person:


Teaching

Think about all the ICAPS you know about the brain, how it functions and about the im-pact of trauma.

J Write down something from those ICAPS that that might help this person.

J Write down how you think learning this might impact the thoughts, feelings, behaviors and/or beliefs of this person:

J Write down some of the ways Teaching this might impact your relationship with them:

ExploringRemember that a trauma-sensitive professional only explores with someone when confi-dent that person feels safe enough to dig deeper into their experiences and the impact of those experiences.


J Write down 2–3 questions you might pose to invite this person to explore their trau-matic experience and its impact:

J Write down the ways you think Exploring their trauma might clarify their beliefs and explained some of their behaviors:

J Write down the ways Exploring their trauma might impact your relationship with this person:

J Notice your ability to use each part of LATE when interacting with someone with trau-ma-related issues and needs. Put a check next to each of the feelings and beliefs listed below that you experienced as a result of this exercise:

□ Clearer about when and how to communicate.□ Empowered to make a difference in this person’s life.□ Empowered to impact the relationship in a positive way.□ Overwhelmed by the responsibility of being a trauma-sensitive communicator.□ Excited to use newfound awareness and skills to have a positive impact.□ Hopeful that using each of these forms of trauma-sensitive communication can

make a difference.


J Others:

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In today’s session, professionals continue their case study presentations and will be invited to continue the process of modifying and assessing their strategic plan.

Professionals are encouraged to add more principles and concepts from today’s session to their personal tool chest for people impacted by trauma.

Session Seven ReviewIn Session Seven, through in-class presentations, discussions and the infor-mation contained in the curriculum we covered the following ICAPS:

J Affi rmationsJ Four Concept CategoriesJ Refl ecting on Own Steps of Growth


J Continuums of Five People Groups.J Additional Processes in Application of LATE).

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1. Professionals may feel clearer about developing a case study and stll have many questions to consider.

2. Each case study provides opportunities for healing and growth. 3. Professionals are encouraged to continue learning new ICAPS and integrating additional

information in ways that promote healthy change. Change takes place in the context of healthy relationships over time.

Five Continuums Describing People TypesTrauma-competent professionals who are ACTing a situation might find it beneficial to incor-porate the following continuums to help them Assess what might be true about each specific person. The continuums may provide greater clarity in the assessment process, and guide the Choices and Execution of those choices.

A PAD for these continuums:

J We are not recommending that professionals label people in a rigid or judgmental ways. Use these continuums as a guide to assist in making better choices with regard to how to effectively respond to someone.

J It can be difficult to determine where on each continuum a person might be, because we may only see the outward behaviors from which we make our assessments.

J Understanding these continuums may help a person impacted by trauma recognize and generate a self-assessment as well as aid in understanding their own narrative and healing processes.

There are five continuums professionals are invited to use to describe someone who has trau-ma-related issues and needs:

How Self-Aware

Clueless Highly AwareHighly Unaware

How Knowledgeable

No Knowledge Well Read Misinformation Healthy Information

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Descriptions of Five Continuums 105

How Open to Processing/Learning

Closed, Blocked Very Open, Receptive

How Dominant/Assertive

Too Much /Demanding or Appropriate, Too Little/Passive or submissive Sensitive

How Hopeful

Hopeless, feels powerless Appropriately hopeful Unrealistic expectations

Descriptions of Five ContinuumsAs we consider each of the continuums on which people impacted by trauma may fall, it is im-portant to understand that people can be at different places along each continuum and on any given day that position might change. Other people may be more consistent and predictable in their behaviors.

Interacting with people who are predominately on the far right hand side of the first four continuums and in the middle of the fifth one are usually people who:

J Are somewhat too highly self-aware and may realize they have trauma-related issues and needs.

J Have some degree of knowledge about the nature of trauma and its impact. J Are reasonably receptive to processing their situations and dealing with their issues,

feelings and beliefs. J Are appropriate with regard to how assertive or insistent they are about exploring their

trauma-related issues, as well as about setting and maintaining boundaries. J Have reasonable and realistic degrees of hope.

Interacting with people who are predominately on the far left-hand side of the first four continuums and on either end of the fifth one can be challenging for trauma-competent profes-sionals. They require more specialized responses that incorporate sensitivity. These are people who usually:

J Have little or virtually no self-awareness. They may not realize they have trauma-related issues and needs. They may not appreciate the impact those trauma-related issues and needs might be having on them and on the people around them.

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3

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J Have either little or no knowledge about the subject of trauma or the knowledge they have is inadequate or incorrect.

J Are apathetic or to some degree resistant about learning, changing, or to processes that might be helpful.

J May be openly aggressive, passively aggressive, overly confident or domineering that they prevent the professional from engaging in meaningful processes.

J Are lacking in hope for themselves and their abilities to resolve, repair, reconcile, re-store or recover. Their expectations may be unreasonable and unreachable. This may be due to an unrealistic timeframe for change to occur.

People can be in different places on each of these continuums. There are a varieties of con-figurations of people types which require sensitivity on the part of the trauma-competent pro-fessional. This can be especially true when Assessing, then Choosing based on that assessment. Responses that are more likely to be helpful and healthy, and then considering specifically how to appropriately Take Action with those Choices is critical.

People often move up and down each of these continuums during the overall process of ex-ploring some aspect of their trauma-related issues and needs.

Understanding the varieties of configurations that exist can help the trauma-competent profes-sional feel more comfortable and competent with regard to the processes and expectations one has.

We will look at each of these five extreme end points, remembering that people can fluc-tuate on the continuums and may be on various points of each. If someone is at more than one extreme negative end, their behavior may be more difficult to manage.

Awareness is like the sun. When it shines on things, they are transformed.

—Thieh Nhat Hahn

Awareness Continuum

Highly aware people tend to be/have:

◾ More emotionally and relationally mature ◾ Higher levels of clarity with regard to their own inner selves ◾ More tuned in and sensitive to their own needs as well as the needs of others

Less aware people can appear to be less aware of their own needs or that others have needs.In relation to the Steps of Growth, highly unaware people may be less aware of how

unaware they are.

Interactive Processes 107

When people know that they do not know there usually are fewer challenges because these people are often open to becoming more aware. It is the people who do not know that they do not know who may be more challenging.

Sometimes highly unaware people have not had opportunities to learn to be more aware and sensitive. Sometimes whatever their trauma-related issues are, they have also experi-enced a great deal of shame and messages about maintaining secrets. Some may have such fragmented memories and therefore they are not fully capable of having a coherent narrative.

Response Ideas ◾ Listening, Affirming, Teaching, and Exploring can gradually invite the person who

is more unaware to gain greater awareness. ◾ Professionals need to be aware that gaining awareness can be a very painful step

of growth. Professionals should not push for recognition of something but facili-tate a journey of self-discovery.

◾ This is a time for trauma-competent professionals to be gentle, compassionate and respectful of the importance of maintaining emotional safety.

Knowledge Continuum

Sometimes people are well read or have attended classes in which sound, well-researched information has been provided and seem to have assimilated that knowledge well.

Other people may have little or no information on the subject of trauma.Some people may have information, however it may be inaccurate, outdated, misinter-

preted, unhealthy or inadequate.Usually it is easier to respond to people with little knowledge than people with misinfor-

mation, especially when these people are open to growing and learning.Sometimes people will say or show that they have no interest in gaining knowledge or

see no value in it. People may believe they are incapable of growing and changing, or may not have had opportunities to learn about trauma.

People may have been told or given information that is old, one-sided or someone’s un-substantiated opinions stated as facts. These can be especially powerful if whoever shared the information is influential in the person’s life or the information is connected to family legacies or loyalties. If someone has believed in something based on misinformation and feels pressured to now change those beliefs, feelings of guilt and shame may become pres-ent possibly resulting in challenging outward behaviors.

Response Ideas ◾ Provide information in ways that are non-threatening and easily understood,

which can help people impacted by trauma become more open to learning. ◾ Provide sources, providing lists with references, clearly stating the researched

information. Sometimes displaying a variety of books and articles on a subject can help raise peoples’ receptivity to new information.


◾ When people have apparent misinformation and are adamantly stating it as the truth, professionals need to be respectful and non-defensive. Responding in a car-ing compassionate way invites people to step back and reconsider their materials, especially as they grow in their trust that the professional is knowledgeable.

Openness Continuum

People vary in how open or receptive they are to learning, to participating in exploration processes, sharing and being vulnerable.

The more closed type may seem disassociated, disinterested, unwilling to engage in a meaningful dialogue, and convey with body language the desire not to be present.

People may act closed but are not hostile or negative. They may seem to be disinterested but perhaps are more overwhelmed or shy about sharing experiences that are painful or shameful.

People express their lack of openness as hostility, resentment or resistance.People may have had previous negative experiences when they risked sharing more

openly and they bring those memories and associated beliefs about how safe other people are into the current situation.

There can be fear that by being too self-revealing, they will be judged harshly by the professional.

Sometimes a person has been coerced into engaging in some kind of conversation with the professional, creating feelings of resentment.

When someone is feeling vulnerable and being or acting distant, it may be a way to control the situation.

People may be naturally shy, private and reserved. This could be the way this person re-lates in a new situation and over time will warm up as trust levels rise.

At times people may not trust easily, so may outwardly appear either hostile or shut down.

Response Ideas ◾ Concentrate on being warm, inviting, respectful and sensitive to the needs of

each person. ◾ Do not pressure the person impacted by trauma. Over time when not pressured to

be more open, many people find themselves willing to risk being a little vulner-able because they find themselves having more trust in the professional and the process.

◾ Gently invite the person to participate. “If and when you would like to share something with me, you are most welcome to do so. In the meantime, I’d like to share some information with you I think you might find helpful in understanding the nature of trauma.”

◾ Professionals offer an acknowledgment to let the individual know silence is ac-cepted: “Not everyone chooses to share in a process like this or to share anything that might feel too personal. That’s fine.”


The Domineering and/or Overly Talkative Type

A person may be very enthusiastic, but the dominance or talking excessively detracts from the process of exploring trauma-related issues and needs.

This person may have a tendency to interrupt and then proceed with information or de-scriptions of situations that are not relevant to processing around trauma. Sometimes they might will go on and on, sharing every detail of a story, many of which are insignificant or irrelevant.

This may be a very needy person who only feels important if the center of attention or be a self-focused type who wants to be admired by the professional. Exuberant, outgoing people may become passionate when given a chance to talk.

Some people want to control the professional and are only happy when directing a conversation.

People who feel equal or better than the professional and dominate might be used to demonstrating how capable and knowledgeable they are.

Response Ideas ◾ Set up clear goals, descriptions of the process and expectations. ◾ Interrupt a monologue by saying, “Thanks for sharing that. To your

point, it may be helpful to understand . . . ” ◾ In some cases, professionals may have to become very tolerant of this particular

style, and can apply Listening, Affirming, Teaching and Exploring effectively.

Hope Continuum

Professionals can gradually grow in their awareness of how hopeful the person impacted by trauma appears to be.

The levels of hope can range from no hope that any of the RH Factors are possible to a belief in an instant or quick fix solution.

The healthiest place on this continuum is more in the middle, where there are realistic levels of hope that combined with a willingness to work through the necessary processes to achieve healing.

There are some people with low self-esteem who cannot believe they are capable or deserve recovery and healing.

People who have tried in other venues to work on trauma-related issues and needs may have been treated disrespectfully. Perhaps have been more harmed than helped, blamed and shamed and therefore have little or no hope that they will now be treated with com-passion, patience, and respect.

Response Ideas ◾ Actively Listen to where on the Hope continuum a person appears to be. Use

Active Listening to put words to previous experiences and beliefs, even when they are on either side of the healthier points of this continuum.


Interactive ProcessesWe have described the processes of restoration, reconciliation, repair, recovery, resolution and healing (RH Factors).

Th ere are other processes which we encourage trauma-competent professionals to incorpo-rate into their awareness and application of LATE.

Th ese include:

J Calming, stabilizingJ NormalizingJ Providing comfortJ Celebrating victories and successesJ Inspiring and motivatingJ Responding to the impact the process of exploring trauma-related issues and needs

appears to be having

Focusing on one or more of these processes will further enhance the overall processes a profes-sional uses when interacting with a person impacted by trauma.

Calming and Stabilizing

It can be helpful for the professional to respect and encourage processes of calming and stabilizing the person impacted by trauma. Using a gentle and confi dent voice tone, speaking about the benefi ts of becoming calmer, teaching about the neurobiology of stress and the ability to achieve some degree of calmness and stability is important.

An example of Listening and Affi rming to promote calming and stabilizing: “You seem to be feeling frustrated right now and I am observing you being a little calmer and more focused. I am confi dent that once you let yourself focus on your ability, you will be successful. [Note that the professional’s body language and voice tones need to also promote calming and stabilize, need to be gentle and relaxed.] Let’s start with a brain break that helps focus on our breath called square breathing . . . ”

Professionals could provide information about brain states, principles and techniques for stress reduction, and any other information that might promote calming and stabilization.

◾ Be Affi rming, sharing a sense of hope for a person as well as helping the person impacted by trauma to understand the need.

◾ Use the information provided when Teaching to create new awareness and under-standing that increases hope and helps promote more realistic beliefs.

◾ Professionals trust the power of their own positive attitudes to promote changes in levels of hope.


Normalizing

It can be extremely comforting for individuals to learn that their symptoms, experiences, fears and needs are normal, expected, and typical. There can be great relief to find out thoughts, beliefs and behaviors are logical, neurobiologically based, and are not the result of the person being crazy or melodramatic.

Professionals may find they have many opportunities to use LATE to promote this process of normalizing. Promoting this process can contribute to our RH Factors.

An example of Listening and Affirming around processes of normalizing: “You seem unsure about whether or not the ways you are feeling right now are normal. You are wondering if they are reasonable and if others think you are being crazy or melodramatic. I think as I teach you more about the nature of trauma and some of the ways it can impact someone, you will discover and then feel more confident that the ways you are behaving are reasonable and normal, given what has happened to you.”

Teaching more about the nature of trauma and the ways that can help a person discover how thoughts, beliefs and behaviors may, especially in light of how trauma impacts lower areas of the brain, involve less conscious thoughts is very helpful.

As the professional invites a person impacted by trauma to Explore situations and experienc-es, the blending of that exploration with Listening, Affirming and Teaching can contribute to the process of normalizing.

Providing Comfort

In the process of exploring trauma, a person not only needs to be affirmed, a person may need reassurance, gentle words and appropriate touch providing comfort, messages of warmth, caring and affiliation. It involves predicting that things will get better, that there will be relief as a result of working through many of the processes necessary.

An example of Listening and Affirming around providing comfort, “You wish somebody would just let you know that it’s going to be okay and you are on the right track. I see someone who is becoming much clearer and more in charge.”

Teaching about the importance of receiving and accepting the comfort of others as well as Exploring specific ways to become more receptive to comfort is essential.

Celebrating Victories and Successes

By seeking victories and successes, the person impacted by trauma can gain greater self-aware-ness and self-confidence. Being intentional and mindful about opportunities to celebrate victo-ries and successes the person with whom they are working is experiencing, even those that may seem small in light of the bigger picture can be very healing.

An example, “You seem to be aware that you have made some important new discoveries and have been successful the last few times you tried . . . I think it is so important for you to take a few minutes to celebrate.”


Inspiring and Motivating

Inspiring and motivating involves projecting high levels of enthusiasm and encouragement that invites a person to take risks. Inviting individuals to step out of their comfort zone, and become creative and capable of becoming more in charge of their processes of recovery and healing is essential.

Focus on inspiring and motivating with statements such as, “You sound enthusiastic about the potentials you are beginning to recognize for your own recovery and healing. You are strong enough to take a few risks with what you have learned about how your brain functions.”

Teach about the nature of a positive attitude and outlook, about allowing oneself to accept new challenges with enthusiasm and then Explore specific steps a person might take in order to become more inspired and motivated.

Responding to the Impact the Processing of Trauma-Related Issues and Needs Appears to be Having

Be aware and appreciative of the reactions a person might be having during interactions of processing trauma-related issues and needs. The process of exploring aspects of trauma can trigger flashbacks and can cause a person to dissociate or become hyper-vigilant. The person may change brain states and show signs of arousal, fear or terror. Enthusiastic professionals who are caught up in their process of exploring someone’s trauma-related story might inadvertently miss cues that the person is reacting negatively to some aspect of the process. It is important for professionals to immediately stop and regroup, focusing on these reactions or changing their strategy if the focus might be overwhelming or embarrassing to the person.

An example of Listening and Affirming is, “It seems like as we talk about this part of your sto-ry, you are having feelings and sensations right here and it might even feel hard to stay present with me. I believe you have the potential to use your thinking abilities to help you understand what these processes are evoking and to set some limits.”

When Teaching and Exploring, this may provide information about the possibility of a per-son having reactions to processing and can explore ways for a person to self-care.

By integrating an awareness and appreciation of each of these processes and the ability to incorporate this information, one can enhance the scope and sophistication of a trauma-com-petent professional’s interactive abilities.

Concluding ThoughtsProfessionals may find themselves more aware of how various ICAPS are becoming clearer, and therefore more useful.

We invited professionals to consider the five continuums that can help the trauma-compe-tent professional be better equipped to adapt a plan for specific individuals.

We also considered additional processes that professionals are encouraged to incorporate into their interactions with people impacted by trauma.


Trauma-Response Tools1. People Types

Bring to mind someone with whom you have recently interacted.

On a scale of 1 to 10, with ten equaling very much so and one equaling not much at all, describe this person in terms of:

C Self-aware C Knowledgeable C Open to processing and learning C Dominant, assertive, passive, submissive or sensitive C Hopeful

As you look at this description, think about how the combination of these traits impacts your relationship.

Write your responses to the following being aware of yourself.

Using the same 1 to 10 scale, to what extent do you think you were:

C Self-aware C Knowledgeable C Open to processing and learning C Dominant, assertive, passive, submissive or sensitive C Hopeful

Consider how each of these impacted that interaction.


Finish the following sentences for each category, first circling the word that describes the degree to which you see yourself on the continuum:

How Self-Aware

Very Somewhat Not at all

As a result of being self-aware, the other person most likely felt . . .

This probably impacted our overall interaction in the following ways . . .

How Knowledgeable


As a result of being knowledgeable, the person most likely felt . . .


How Open to Processing and Learning


As a result of being open to processing, the other person most likely felt . . .


How Dominant/Assertive


As a result of being dominant, demanding, passive or sensitive, the other person most likely felt . . .



How Hopeful


As a result of being hopeful, the other person most likely felt . . .


How do these images help you better understand the other person, yourself and some of the dynamics of your relationship?

2. Interactive Processes

Incorporating each of the interactive processes described in the curriculum into inter-actions with individuals impacted by trauma can enhance the potential to strengthen the sense of safety and trust. This also allows you to focus on something other than that person’s trauma experience.Imagine a thirteen-year-old child you are familiar with. Her father has been in jail for many years. Her mother has had to move from homeless shelter to homeless shelter and often spends nights with her three children sleeping on the street. You know she has been abused over the years and is trying hard to be a good student. While she has experienced significant trauma in her life, incorporating one or more of the processes can be beneficial and helpful.


For each of the categories that expand the ways you can interact with someone, write a Lis-tening or Affirming sentence that focuses on each category. Complete these sentence starters:A way I could focus on promoting calming and stabilizing is to say . . .

This might help her think or believe . . .

Calming, Stabilizing

L _______________________________________________________________________________________________

A _______________________________________________________________________________________________

Normalizing

L _______________________________________________________________________________________________

A _______________________________________________________________________________________________

Providing Comfort

L _______________________________________________________________________________________________

A _______________________________________________________________________________________________

Celebrating Victories and Successes

L _______________________________________________________________________________________________

A _______________________________________________________________________________________________

Inspiring and Motivating

L _______________________________________________________________________________________________

A _______________________________________________________________________________________________

Responding to the Impact of Processing Trauma-Related Issues and Needs

L _______________________________________________________________________________________________

A _______________________________________________________________________________________________

Consider the degrees to which focusing on these interactive processes might promote a stronger connection between you and this individual. Also consider the potential down-side of focusing on these in ways that might discount her traumatic experiences and there-fore potentially diminish her trust in you.


What are some things that might help you determine whether you are promoting her emotional health and the integrity of your relationship?

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In today’s session, professionals will be invited to continue to add ICAPS into their trauma tool chest to become a Trauma-Certifi ed Professional. Trauma-Competent Professionals can:

J Incorporate processes of sensitively using questions to invite a person to share aspects of life experiences, helping a person impacted by trauma to explore their own personal narrative. Questions are sensitively used to help a person make sense of current trau-ma-related issues and needs.

J Incorporate information about brain functioning into processes of interacting with people who have trauma-related issues and needs. Th is information helps the profes-sional understand the dynamics of the interactions.

J Present Rothschild’s Flashback Protocol for interrupting and/or managing fl ashbacks to individuals with whom they are interacting.

Session Eight ReviewIn Session Seven, through in-class presentations, discussions and the infor-mation contained in the curriculum we covered the following ICAPS:

J Continuums Describing People TypesJ Additional Processes in Application of LATE

9SESSION

8



J PADs and Establishing Boundaries J Exploring the Narrative of a Person Impacted by Trauma


1. We are encouraging participants to consider ways trauma-competent professionals might invite a person impacted by trauma to share facts and descriptions of their narrative.

2. We are not suggesting that professionals engage in therapeutic history-taking. This can be done by a professional who serves specifically in the role of a trauma-competent therapist.

3. Our focus in this session is to inspire professionals to consider how they can generate specific questions that will help a person explore their background or story.

4. Each trauma-competent professional may feel different levels of comfort in all the pro-cesses of this experience.

5. Because memories can be so fragmented as a result of traumatic experiences, inviting someone to recall experiences has the potential to be traumatizing.

Therapy Versus EducationProfessional settings where individuals are invited to share aspects of their personal history, family and medical history are common practices. Some professionals including therapists, nurses, medical practioners, and social workers are trained in various methods of screening and history-taking.

There are standard questions therapists ask in initial sessions in order to take a client’s his-tory. Specific information is often requested with regard to family dynamics, childhood events, ways of disciplining and significant life events. Clinicians use this information to design a strat-egy for working with each client. Professionals who take histories as part of their job or practice also have their own standard set of questions to help them understand the person coming to receive services.

Trauma-competent professionals can use some of these approaches, but need to be mindful that there are limits and differences that separate therapy from education. These differences have been discussed in detail in previous sessions.

When a trauma-competent professional begins interacting with someone who has possible trauma-related issues, it may be appropriate to engage in a process with the person and invite them to share specific facts and life experiences to better understand the person in general. This is part of the E of Exploring we have invited professionals to add to LATE (Listening, Affirming, Teaching and Exploring Effectively). By gathering data with regard to a person’s life facts and past experiences, a professional becomes clearer and better equipped to ACT the situation.

Learning About One’s Past 121

The important thing is not to stop questioning. Curiosity has its own reasons for existing.

—Albert Einstein

Learning About One’s PastThe primary goal of engaging in a discussion around the facts and experiences in one’s past is to help the person impacted by trauma understand the nature and impact of traumatic experienc-es. When a person is guided through a process of sharing, it can help both the professional and the person. The professional becomes clearer, and therefore able to understand and assess that person’s situation. The professional gains insight into some possible explanations for issues, needs and behaviors. The person impacted by trauma also gains some clarity, an essential step for a person’s recovery and healing process.

This guided exploration often presents opportunities for the trauma-competent professional to Listen, Affirm, Teach, and Explore (LATE). This can nurture and empower the person im-pacted by trauma, which often leads to Rh processes of resolution, reconciliation, repair, resto-ration, recovery and healing.

By having pre-planned questions that invite a person to share descriptions and facts about experiences related to current issues and needs, the trauma-competent professional can be more focused and gain greater clarity. A guided process of exploring a person’s background can be clarifying for the professional, and helpful to the person impacted by trauma. Sometimes it is helpful to know if there are gaps in one’s memory, as this may give some indication as to how a trauma might have impacted one’s abilities to make logical sense of the sequence of events around a traumatic experience.

PADing and Establishing BoundariesProfessionals need to be aware that the process of exploring someone’s past has the potential to be stressful, and even possibly trigger a stress response. As memories are activated, the person might also experience flashbacks of trau-matic events.

In order to prevent or respond effectively, professionals are encouraged to offer PADs and encourage the person impacted by trauma to establish and maintain boundaries that can promote safety. The person impacted by trauma can be invited to share descriptions or stories that they are comfortable sharing. Professionals should never coerce or force a person impacted by trauma to share beyond their comfort. Safety is a priority in any interaction.

Trauma-competent professionals can be very open and upfront about the potential that ex-ists for them to be uncomfortable. Professionals state that they do not wish to cause unhealthy levels of distress, and that the person has the freedom to stop the process at any time.

Emphasize that safety is the number one priority in all interactions. Teach the person to signal or state that they do not want to respond to a question. The professional can predict and


provide hand signals that the person impacted by trauma could use, such as shaking of the head or waving a hand in a gesture of saying, “I don’t want to go there.” The professional instructs the person to make the statement, “I don’t want to talk about that,” or “I don’t want to answer that question.” The professional shares with the person impacted by trauma that not only is safety a priority in all interactions between them, it is also important to have the power to determine when a boundary needs to be set and maintained.

Even as we are discussing the possible value of inviting a tperson impacted by trauma to explore experiences of the past, it is important for trauma-competent professionals to understand that it is not always necessary for someone to revisit traumatic memories. Babette Rothschild says that some people can become much worse from attempting to gain full recall of one or more traumatic memories. [From the chapter Key Three: Remembering Is Not Required.] She notes that a person has options with regard to how vividly a traumatic experience needs to be remembered. She states that such recall could occur now or later or not at all and provides the following four options:

J Tackle your memories in detail J Review them in general J Leave them alone entirely J Table this decision until a later time

By being aware that remembering is not required, professionals are mindful not to push a person with regard to fully remembering details of a traumatic experience. In fact, one should leave decisions around such recall to a trained therapist.

As trauma-sensitive professionals, the fundamental question is to ask ourselves, “When do I use questions if safety is my

#1 priority in all interactions?”—Michelle Machado

Questions When Exploring One’s PastThe following section provides some ideas and types of questions for professionals to consider and employ when exploring one’s past.

There also are references in this section to other resources, including recommendations in the read-only sections and/or the attachments at the end of this session’s notes.

When developing questions, first determine if a situation involves a circumstantial or a rela-tional trauma.

If it is a circumstantial trauma, the professional creates questions around who, what, when, where, how and possibly why the trauma (s) occurred.

J To whom did this trauma occur? J What is each person’s relationship to the other people involved?

Questions When Exploring One’s Past 123

J The details that describe what happened? J Where and how did this happen? J The possible causes? J What seems to be the impact on each person involved? J What are some:

C Outward behaviors? C Immediate concerns? C Concerns for the future? C Resources available? C Needs?

J What has already happened with regard to providing some kind of intervention? J What else might help adequately meet some of these needs?

Many of the questions might also apply to relational traumas.Each professional uses information about the nature of trauma, its causes, symptoms, pro-

tective and risk factors, and principles of trauma, to generate questions.For example, the professional might list some of these factors and then invite the person im-

pacted by trauma to consider to what degree each is a part of the traumatic experience.

When you read this list of risk factors, does anything in your past experiences or stories come to mind? What are some of the specific ways these risk factors might have impacted you?

Are there factors on this list that help you see times when you and/or your children had protection? How might these have provided protection?

If the trauma somehow impacted a child, questions around parenting styles might be asked. They might consider how healthy and strong the child’s attachment appears to be, based on the four categories of attachment: secure, avoidant, ambivalent or disorganized.

For example, the professional might ask,

When you look at the characteristics of families in which one or both parents were primarily authori-tarian, what specifically resonates with you? Can you think of a story or example? Can you guess how that might have impacted you and possibly related to your trauma issues?

If the trauma is relational, the professional might want to begin by asking questions that would help determine if it is a one-time acute trauma, chronic or complex trauma.

If the trauma involved more than one person, such as traumas that impact an entire family or a subsystem of the family, questions around the impact to that system might include:

J “ What are some of the changes in behaviors you have observed with regard to your family?”

J “ Have you noticed any changes in the levels of intensity of emotions family members express with each other?”


J “ To what extent does the family appear to be stronger and more unified or weaker and less unified?”

J “What are some of the ways this family has attempted to cope with the trauma?”

Being aware of the possible brain states of the person impacted by trauma can be highly important.The professional might ask: “How calm does this person appear to be? Does he or she seem to

be in more of an alert, aroused, fearful or even terrorized state? What is indicating this?” The pro-fessional needs to be very cautious in making such an Assessment because a person’s brain state is not always obvious based on outward behaviors. By considering the possibility that the person is in a lower brain state can be helpful to the interaction and how information is shared. The lower the brain state a person is in, the more that person can benefit from receiving calming messages, often communicated through Listening and Affirming. This can become an opportunity to en-courage the person to learn more about how the brain functions.

A trauma-competent professional can understand and teach the person with trauma-related issues about some of the common somatic symptoms that often accompany post-traumatic experiences. Babette Rothschild in Eight Keys to Safe Trauma Recovery states that,

Somatic symptoms have something very important in common: they are the result of a nervous sys-tem that continues to behave as if the traumatic event is about to occur again.

She quotes Peter Levine, in his book Waking the Tiger in which he describes how:

J The physical sensations of trauma continue to activate the mind’s fear response, J Which in turn activates the physical response to danger, J Which is the root of the physical sensations of trauma.

All of these create a vicious cycle in which the mind and the body continue to act as if the trauma is occurring over and over. Rothschild notes that, “A key element of breaking this cycle involves updating the mind to recognize that the trauma concluded and that the event lies in the past.” By explaining this phenomenon to a person impacted by trauma, it can help the per-son have a better sense of what is going on neurobiologically. The hope is that it can contribute to helping that person gradually gain control over the ways the brain is operating when physical sensations of trauma occur.

Explaining How the Hippocampus and Amygdala Differ With Regard to MemoriesThe many principles of the brain’s operation, especially around memory sys-tems and the differences between how the amygdala and hippocampus record memories can be helpful to understand. As we have learned and as Rothschild says in Eight Keys to Safe Trauma Recovery,

The amygdala directs the brain’s emotional response system. It tells you how to react to any situation, usually before you have any conscious thought involved. . . . It remembers the feeling of those events,

Helping a Person Understand and Manage Flashbacks From a Neurobiological Perspective 125

not the facts. . . . The amygdala is central in recording and reactivating somatic markers. . . . The other brain area, the hippocampus, remembers facts but not emotions, such as the name of the person at the other end of the phone, and when or where something happened. It records the timeframe of significant events, the start, the middle, and the end. When needed, it sends these facts on to the cortex, the thinking part of the brain, the structure responsible for conscious thought. However, often during trauma, ultra-high levels of stress hormones—necessary for the survival responses of flight, flight, or freeze—stop the hippocampus from functioning properly. When that happens, an accurate timeframe of events does not get logged. The event might be remembered, but in a jumbled order or with significant missing stats. Typical of trauma, without the hippocampus able to carry out its role, it may not register that the trauma actually ended. PTSD is often the result of just such hippocampal failure.

Rothschild states that one of the ways to help someone who has had these kinds of hippo-campal interruptions is to recognize that they survived, because they exist in this space and time. She states that, “living and dealing with your past trauma will become easier if you help yourself to grasp that simple truth.”

Helping a Person Understand and Manage Flashbacks From a Neurobiological PerspectiveRothschild (in her chapter “Stop Flashbacks” from her book Eight Keys to Safe Trauma Recov-ery) provides what she calls the Flashback Protocol that can be used to stop or reduce the im-pact of a flashback. As preparation when approaching a situation where the person anticipates a flashback might be triggered, and as a way of practicing to prepare for flashbacks so that this protocol becomes a more automatic response is a powerful tool for healing.The eight steps are [and she notes that if a person becomes more distressed when sensing their body, they should skip the first step and start with the second step]:

1. Pay attention to your internal senses, naming one or more sensations you have, such as heart rate, changes in respiration, dizziness, sweaty palms, shaky legs, cold hands, or butterflies in your stomach.

2. Identify what you are feeling emotionally; for example, “I am afraid.”3. State clearly to yourself that these symptoms are in reaction to a memory. You may give

the flashback a title if you want, but make sure the title is no more than three words: “I am having the symptoms because I am remembering The Assault.”

4. Shift attention to your external senses and name at least three things you can see, hear, or smell: “I could hear the lawnmower next-door.” “I see the sun shining through the front window.” “I smell cinnamon from the bread in the toaster.”

5. Affirm today’s date, including the year, month, and day.6. Based on the information from the last two steps, evaluate the situation you are in now

as safe or dangerous.7. If you are actually safe, in spite of having a flashback, you can then tell yourself, “I am hav-

ing a flashback and I am not in any danger,” or “[the title of the trauma] is not happening now (or anymore).”

8. If you are not in safe circumstances, seek safety.


This process helps a person focus on sensations. It helps a person differentiate between past experiences that the brain is flashing back to, making the person think they are presently back in time. By focusing on things like today’s date and specific external senses, it helps to bring a person back into the present and more cognitive state.

The following describes one researcher’s opinion for what constitutes routine and univer-sal trauma screenings and assessments for children and adolescents. It may be helpful for professionals to read, and consider ways they might incorporate some of the principles into their beliefs and practices.

TRAUMA SCREENING AND ASSESSMENT FOR CHILDREN AND ADOLESCENTS: “ROUTINE AND UNIVERSAL”

Compiled by Ann Jennings, PhD

Questions about trauma in routine mental health intake of children, with parallel questions posed to the child’s parent or legal guardian need to be integrated

Screening and assessment for trauma need to be in juvenile justice and out-of-home child protection settings as well

Assessment for trauma exposure and impact should be a routine part of psychiatric and psychological evaluations, and of all assessments that are face to face. [Hodas 2004]

Approaches to Assessment of Trauma

Three basic approaches to assessment of trauma and post-traumatic sequelae in children through tools and instruments:

Roland knows that his anxiety can cause negative thoughts to be magnified and catastro-phized and has recently discovered mindfulness is a tool he can use to help take control of his thoughts. Through mindfulness, he believes he can honor any fearful thoughts that may be causing anxiety, but keep them in perspective, not allowing them to control how his body responds. By noticing the sensations in his body when he becomes anxious, including sweaty palms and lower back pain, he is able to employ mindfulness tools early in the anx-iety building process and it seems much easier to control.

When Roland begins to feel anxious, he has created a few statements to intentionally become aware of his specific body sensations. One tool he often refers to is a “body scan” of what he is feeling in his body and he creates a story in his mind of calming thoughts. Since he has learned that feeling anxious can distort his thoughts, he purposely tries to “stay in the cortex area of the brain” when anxious feelings arise.

Through mindfulness training, Roland incorporated the practice of using calm breathing pat-terns to “picture” and “feel” the calmness entering his body and the negative feelings leaving. He feels very strongly from many successful experiences that these tools allow an attunement to his body sensations and they can change the experience from alarming to calming.


Concluding ThoughtsProfessionals were invited to consider some of the specific kinds of guided questions they might incorporate into more formal processes.

We encouraged professionals to incorporate their understanding of neurobiology when in-teracting with people impacted by trauma, including some of the neurobiological information they might want to share as part of the teaching aspect of their interactions.

We invited professionals to become familiar with Rothschild’s Flashback Protocol, which involves eight steps a person might use to stop and/or manage flashbacks.

◾ Instruments that directly measure traumatic experiences or reactions ◾ Broadly based diagnostic instruments that include PTSD subscales ◾ Instruments that assess symptoms not trauma specific but commonly associated

symptoms of trauma [Wolpaw & Ford]

Use of de-escalation preference surveys, a secondary prevention intervention, represents an indirect method of finding out about trauma exposure. For example, in indicating a desire not to be touched, a child may be reflecting past sexual abuse.

In institutional settings, use of a risk assessment tool to determine potential contraindica-tions to use coercive measures requires that information on past abuse be obtained [Hodas].

Guidelines

Determine if a child is still living in a dangerous environment. This must be addressed and stress-related symptoms in the face of real danger may be appropriate and life-saving.

Provide the child a genuinely safe setting and inform him/her about the nature, and lim-itations, of confidentiality.

Seek multiple perspectives about trauma (e.g., child, parents, legal guardians)Use combination of self-report and assessor-directed questionsRecognize potential impact of both culture and developmental level while obtaining

trauma information from children. [Wolpow & Ford]Trauma comes in many different forms for children of varying ages, gender, and cultures,

there is no simple, universal, highly accurate screening measure.Screening approaches should identify risk factors such as poverty, homelessness, multiple

births during adolescence, and other environmental vulnerabilities of trauma-related symp-toms and behavior problems associated with trauma histories, PTSD symptoms (which vary with age), behavioral symptoms associated with trauma [Hodas]

Parents, guardians or other involved adults would have to participate in screenings of younger children

Older children and adolescents could complete a self-report measurePositive screens will require a more comprehensive follow-up evaluation conducted by a

professional familiar with manifestations of childhood trauma [Hodas]


Trauma-competent professionals are encouraged to continue the process of incorporating and integrating the various ICAPS into their process of intentionally applying trauma princi-ples into their interactions with those who may have trauma-related issues. Professionals are invited to continue the process of designing, modifying and adding to their Personal Trauma Response Guides as a way to have a more concrete approach to intentionally applying trauma principles to real-life situations.

Trauma-Response Tools1. Questions when inviting a person impacted by trauma to explore their past

Imagine you are working with someone with serious unresolved traumas that involve pos-sible abuse, neglect and/or betrayal.Consider how each of the following questions might impact this person in terms of how safe one might feel and how much each question invites the individual to explore OR feel unsafe and possibly threatening.After each question, write two or more words that describe your reaction to each and then rate the question on a continuum with 1 indicating inappropriate/unsafe questions and 10 indicating acceptable/healthy exploration questions. [Note: There are no right or wrong reactions. This is about encouraging greater awareness to trauma-sensitive questions pro-fessionals might ask.]

1 (threatening/unsafe) 10 (acceptable/healthy)

How do you think the ways your relative traumatized you has impacted your relationship with other family members?

What are some of the feelings you have when you reflect on the experiences you shared with me?

Do you think these traumas occurred because you seemed unable to defend yourself?

When you consider the protective factors I just shared with you, are there any that jump out to you as something you have experienced?


What are some ways you are learning to claim your power when you experience trau-ma-based reactions in your day-to-day life?

What are some of your most challenging symptoms when you find yourself being triggered?

Write three questions you think would show high levels of trauma-sensitivity when interact-ing with a person impacted by trauma. Consider why each would be highly trauma-sensi-tive.

1. _______________________________________________________________________________________________

2. _______________________________________________________________________________________________

3. _______________________________________________________________________________________________

2. Flashbacks from a Neurobiological Perspective

When working with individuals impacted by trauma, professionals need to be prepared to use Rothschild’s Flashback Protocol when someone appears to be experiencing a flashback. It is important to practice guiding someone through the steps so that you can become intentional and comfortable facilitating this guided process.

Begin by first practicing using the steps with yourself. Recall a time when you experi-enced something distressing that left you feeling shaken and disoriented, which is similar to the sensations of a flashback.

A. As you go back in your memory and re-create the experience, notice your internal senses. Name one or more of the sensations you experience: your heart rate, any changes in your breathing, sensations of dizziness, shakiness, cold hands and/or butterflies in your stomach.

B. Name your feelings.C. Mentally acknowledge that your sensations and feelings are in reaction to the mem-

ory. Give the memory a name or label to describe it: The time I . . . D. Shift to becoming attuned to your external world in the here and now. Name at least

three things you can see, hear or smell in your current environment.E. State today’s date, including the year, month and day.F. Note that you are currently in a safe situation.

G. Tell yourself that you are experiencing a kind of flashback because you have chosen to go back in time to revisit a painful memory. Simultaneously note that you are cur-rently safe.

H. If you had decided you were not safe, it would be important to immediately take steps to create safety for yourself.


After going through the Flashback Protocol, notice any sensations the process has stim-ulated. Primarily notice how you could use these steps to help yourself return to reality after choosing to move back in time to an overwhelming experience.Invite someone to go through the same process and act as their guide. Be careful not to ask someone with a serious trauma history to force themselves to experience a painful flashback. This practice needs to be done with great sensitivity! At the same time, it can be valuable to practice with someone else after experiencing it personally. These are ways to deeply encode the Flashback Protocol in your memory bank so you and others can easily recall this Flashback Protocol when needed.

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Welcome to the tenth session of Applying Trauma Principles. Professionals will fi nd themselves refl ecting on their 30-session journey of enhancing and deepening trauma awareness, combined with discovering ways to apply trauma principles. We hope that

our participants are feeling more confi dent and competent with regard to all they have gained from the powerful and complex subject of trauma. Th e more professionals intentionally apply ICAPS in their day-to-day interactions, the stronger their awareness, understanding, and abil-ities will become.

Session Nine ReviewIn Session Nine, through in-class presentations, discussions and the infor-mation contained in the curriculum we covered the following ICAPS:

J PADs and Establishing BoundariesJ Exploring Narrative of a Person Impacted by Trauma


J Consider the power and potential impact of relationshipsJ Review or learn Nagy’s Ethical Dimension of Relationships and how its principles apply

to trauma-related issues and needs

10SE

SS

IO

N

9


Power and Impact of Relationships/Invisible Nature of RelationshipsThroughout our trauma courses, there has been an emphasis on the power and potential im-pact of relationships.

According to Neurons to Neighborhoods, “Human relationships, and the effects of relation-ships on relationships, are the building blocks of healthy development.”

As Cozolino points out in The Neuroscience of Human Relationships,

Learning anything positive, including love, requires freedom from fear. . . . If we learn not to fear in early relationships, we will enter subsequent relationships assuming that others are trustworthy, caring, and dependable. . . . The most important aspect of early attachment relationships is the estab-lishment of a sense of safety. In the same way, establishing and maintaining trust is the first and most important order of business in a therapeutic or teacher-student relationship.

Professionals are encouraged to maintain and appreciate these powers and potentials as they create, maintain and, when necessary, repair their relationships with people experiencing trau-ma-related issues.

As we have learned, relationships, by nature, are intangible, abstract and invisible and yet have definite properties and powers that impact the emotional and relational health within each relationship.

Relationships are the invisible bridge that connects two or more people. Like tangible bridg-es, relational bridges can be new or old, more or less safe, trustworthy and strong, or more or less dangerous. Some relational bridges are longer than others, have areas reflecting a break that occurred at some point in the construction or may have no guard rails to provide bound-aries and protection.

Human beings build relational bridges from conception on. These bridges are built through the myriad of interactions that occur. People learn how to build, maintain and repair relational bridges based on their own experiences. Therefore the relative health, safety and strength of the bridges being built are the reflections of the experiences and the observations made about how to interact.

Professionals are encouraged to be intentional when creating, maintaining and repairing the relational bridges between themselves and the people with whom they are interacting.

The following questions can be considered:

J How strong and safe does this relationship appear to be? J What has contributed to building, maintaining and repairing safety? J How healthy are the various interactions? What contributes to the overall health of

these interactions? J What contributes to the safety or lack of safety? What else could be added to make this

relationship safer? J In addition to promoting physical and emotional safety, what are the ways “universal

principles of healthy relationships” can be nurtured?

C Safety C Trust

Relational Principles 133

C Respect C Fairness C Openness C Authenticity C Attentiveness C Responsiveness C Empower C Compassion C Empathy

This needs to be done through the transmission of accurate, well-researched ICAPS.Research indicates that relationships are the cornerstone of promoting emotional health in

children and adults. Even in psychotherapy, the one factor that predicts positive outcomes is the quality of the relationships, regardless of which type of psychotherapy is being used [When the Past is Always Present, Ruden].

Relational PrinciplesProfessionals are encouraged to consider relationships as living entities to which they contrib-ute ingredients that promote safety, trust, respect, fairness, openness and authenticity.

Professionals can appreciate that it takes time to build strong and healthy relationships. It takes effort to intentionally maintain them and the potential exists for any relationship to experi-ence wounding. This can jeopardize the health of one or both of the participants in that relation-ship. Whenever one or even both of the people in a relationship are simultaneously dealing with underlying trauma-related issues and needs, the relationships that are formed and maintained may be impacted to some degree. This can be seen on a continuum from very mild to very seri-ous, by the related issues and needs the trauma experiences have created.

We have found that the use of healthy, effective and appropriate communication skills that focus on maintaining healthy interactive processes are what can build, maintain and repair rela-tionships, including those in which trauma is a factor. Becoming more aware, having increased understanding for the power of relationships and then intentionally using effective forms of com-munication can build, maintain and when necessary repair relationships. These can be key in-gredients for professionals to be successful in whatever the goals and purposes are for their in-teractions. The potential exists within each relationship for the person or people involved to be nurtured, to experience growth and to recover and heal from emotional and relational wounding.

Invisible Forces within RelationshipsProfessionals are invited to think about the forces that exist within relationships and the nature of these forces.

Consider two magnets held far part from each other. If we slowly bring the magnets closer and closer to each other, at some point we could feel how they pull to try to connect as the


magnetic force is activated between them. Even before they touch each other, there is an invis-ible connection that has the power to pull one magnet towards the other one and eventually they come together.

Just as there is the invisible force of magnetism that exists between two magnets, there are in-visible forces between people that influence how each person thinks, feels, and behaves. These forces influence how healthy or how unhealthy relationships are.

Most people understand that none of us can exist without relationships. Every person has relationships with their parents or caregivers. While some people can live fairly isolated lives, it is human nature to be drawn to be in relationships with others. In addition, we have relation-ships with ourselves.

Most people would say they would want their relationships to be healthy. People are some-times aware that they are in relationships that are unhealthy to some degree. These are the kinds of relationships where people might physically or emotionally hurt each other, where one person may take advantage of another person, where there is fear, resentment, unhealthy competition, and other negative ways of interacting. Other relationships are somewhat healthy to very healthy. These are relationships in which people nurture and support each other, treat each other fairly and genuinely love and respect each other.

By learning more about the invisible forces that exist in relationships, people become more in charge. They are able to use this information to help them understand the dynamics and im-pact of relational forces that contribute to narratives, especially when trauma is involved.

Dr. Ivan Nagy put the ethical dimensions of relationships—trust, loyalty, fairness—at the center of the therapeutic process.

—Marlene F. Watson

The Ethical Dimension of RelationshipsOne theory of relationships that is extremely helpful to understand is the Ethical Dimension of Relationships created in the 1960s by Dr. Ivan Boszormenyi-Nagy, a psychiatrist from Hungary. This theory is part of Contextual Therapy, and is used by many therapists to help understand why people act as they do, and to consider what can help them change unhealthy behaviors. Nagy trained many therapists in Philadelphia for decades, and left a legacy of therapists, clini-cians and pioneers in the field who practice Contextual Therapy using his model and theory as a basis for their treatment approaches.

Predictions, Acknowledgments and Disclaimers (PADs)

1. The Ethical Dimension of Relationships is both complex and sophisticated. There are en-tire courses devoted to exploring the Ethical Dimension of Relationships and therapists spend years learning to apply the concepts and principles in their work with clients. We

Rationale—Ethical Dimension 135

offer a brief description of this concept, highlighting key ICAPS that will be helpful in one’s understanding of relationships and trauma.

2. The Ethical Dimension of Relationships is presented in other LGI courses. For those who are new to Nagy’s Ethical Dimension of Relationships, it can take some time to grasp this profound, abstract way of understanding.

3. The Ethical Dimension teachings might make a person feel sad and angry because it explains why it may have been virtually impossible for someone to avoid behaving in destructive ways.

4. This information contributes to our understanding of the power trauma can have to cause many unfair losses in people’s lives. Professionals will appreciate their role in ap-plying key principles of the Ethical Dimension of Relationships in the work they do with children and adults.

5. This information is not provided as a way to excuse unhealthy or unethical behaviors. It provides explanations for behaviors and the deep relational needs each of us can experience.

Nagy’s Ethical Dimension of Relationships provides a way to describe invisible forces within each of us. This is based on how, during our lifetime, we were given to in fair or unfair ways, and the impact that has had on our abilities to give to ourselves and others.

Ethical, according to Nagy, means the fairness in regard to giving and receiving. It is not about whether something is morally right or wrong.

For example, it may be morally wrong to steal from somebody. At an ethical level, it may be a legitimate behavior because of the experience of destructive entitlement.

Rationale—Ethical Dimension

J We become clearer and more aware about why parents/caregivers, children, adults, colleagues and family members behave as we do.

J We have a theory that explains virtually all behaviors, can reduce or eliminate the ten-dency to blame others, and is highly empowering in providing answers and approaches to promote emotional and relational health.

J When we appreciate the properties, principles and impact of the forces of the Ethical Dimension of Relationships, we better understand and explain why we should all lessen and eliminate the use of punishment. Punishment by its nature earns children and adults more destructive entitlement.

J We better understand why people are sometimes unable to give fairly, be trustworthy, care for children and others in ways that logically make sense. The Ethical Dimension provides a valid explanation of even the most reprehensible behavior, such as child abuse or neglect. At Nagy’s ethical level, parents who are unable to give fairly to their children somehow earned the right to this form of destructive entitlement.

J By including the Ethical Dimension in our LGI training, we are able to offer individuals a profound and sophisticated concept taken from Contextual Family Therapy in a form that can be understood and effectively applied in real life situations. By becoming aware


that this fourth dimension is in operation in all of our lives and by understanding some of how it functions, we are in a position to be more accepting and tolerant of the be-liefs and behaviors of others, even if those behaviors are destructive. We appreciate the incredible importance of helping ourselves and others reverse the spiral downward that Nagy calls destructive entitlement and intentionally work to create an upward move-ment toward constructive entitlement.

The Four Levels of All RelationshipsIn his theory, Dr. Nagy says that in all relationships there are four levels or dimensions that are simultaneously occurring.

Level One

Th e facts of the relationship. Th is encompasses the:

J agesJ sexJ relationshipJ length of time people have known one anotherJ the factual descriptions of words and actions

Th ese can be objectively described. Th ese are the outward, identifi able behaviors of the LGI Iceberg.

Level Two

Th e psychology of the people in the relationship. Th is includes each person’s:

J self-esteemJ underlying issuesJ historyJ emotional statusJ past historiesJ ego strengthJ needs

It is the Emotional Health layer of our LGI Iceberg.

Level Three

Th e systemic nature of the relationship. Th is includes how people in the relationship relate and impact one another. Th e concepts found in systems theory and approaches such as Trans-actional Analysis fi t under this category. Th is layer describes how people are behaving from a systems perspective.

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J Who is more powerful and how is that power used? J Does one person become childlike when around a specific other person? J How clear is the communication? J Are people talking in their own coded language that has many hidden meanings and

messages?

This is a part of the Relational Health layer of our LGI Iceberg.

Level Four

The ethical dimension within the relationship. This involves considering the balance of giving and receiving based on the degrees of fairness and how much trustworthiness has existed in the relationship. It describes the impact of the processes of giving and receiving over time in terms of the rights the person earns to behave, or not behave. It helps to explain why people can or cannot give or receive fairly, and where they may be blocked from healthy giving and receiving. This also is a part of the Relational Layer of our LGI Iceberg that explains the forces behind the behaviors related to the other layers.

EntitlementWhen we think about giving, a first image may be of something material: a birthday gift, a pay-check, flowers, a book.

Giving to others in relationships involves less about offering a tangible item and more about the degree to which safety, trust, love, respect, appreciation and other emotional and relational aspects are offered. As human beings, we offer these to each other and conversely can be on the receiving end of each.

Because we are relational beings we not only want to give and receive from each other, we need to be given to and to give to others.

When the giving and receiving processes are fair and just, we measure the giving and receiv-ing by considering:

An Example Describing the Four Levels/Impact of Giving and ReceivingThe Facts

Example: John calls Mary every day just to say hello and ask if there is anything he can do to help her and she in turn asks him the same question. Each does at least one or two kind and loving things for the other person each day.

The Psychological Impact

Example: John and Mary’s individual self-esteem is promoted as a result of being cared for and being able to offer caring messages.


The Systemic Nature

Example: Power is shared and respectfully treated in John and Mary’s relationship. Neither seems to be playing games to put the other person in a one-down or one-up position.

The Ethical Dimension of the Relationship

Example: Assuming both John and Mary have been on the giving and receiving end of fair-ness and giving in early, pivotal relationships in their childhood experiences, each has earned the right to freely and openly give and receive love and caring without needing to somehow diminish, dominate or deprive the other person.

What Do Fairness and Fair Giving Mean?When Dr. Nagy talks about fairness, he is describing what a person is owed in life and the de-grees to which that person receives what they deserve. He is not talking about how people feel with regard to what they deserve. For Nagy, fairness and fair giving are forces in relationships that have nothing to do with feelings.

Fairness is about what a person deserves in terms of being treated justly, in having opportu-nities to both give and receive from others in ways that are trustworthy and respectful.

Think about what a newborn baby is owed. Without having any way to pay back one’s parents or caregivers, a baby deserves to be treated in loving and nurturing ways, just because that baby exists in the world. Babies cannot pay for what caregivers need to give to them.

The Story about Two BabiesThe following story about two babies may help clarify some of the principles of earning de-structive and constructive entitlement. Note: in the story, the babies are referred to as boys. This theory can be applied to looking at both male and female, or other gender identities.

The First Baby

Imagine two children are born on the same day. One child is born into a family where the parents are emotionally and relationally strong and healthy. They are people who were given to in loving and fair ways from the time they were babies. When their baby is born, it is easy and natural for these parents to immediately provide what the child needs, from physical care to emotional care. As this child grows in this circle of love, he is on the receiving end of what Dr. Nagy would call fair giving.

Eventually, as the baby gets older, he begins to smile and coo at his parents. Delighted in re-ceiving the baby’s happy expressions of joy, caring for the baby becomes even more of a pleasure for the parents. The back-and-forth dances of love and affection provide a process of giving and receiving. The child continues to grow. The parents provide a safe and healthy home life. They encourage their child to give back to the family in ways that are helpful to others. In this pro-cess, the child earns what Dr. Nagy calls constructive entitlement.

The Story about Two Babies 139

Constructive Entitlement

The earning of constructive entitlement is a process in which a person is given to fairly and as a result is able to give to himself and others in fair and healthy ways. This in turn promotes a sense of inner joy, peace and satisfaction that contributes to that person’s ability to continue to give fairly. Throughout this person’s life, as he has earned constructive entitlement, the spiral of fair giving and receiving repeats itself in other relationships. This person will eventually freely give to his children more than they can give to him. What was given to him allows him to give to his children from that inner constructive entitlement he earned during his lifetime.

The Second Baby

Now imagine that second child born into a family that is very different from the first family just described. In this family, both parents were treated unfairly, were not given what they de-served in terms of appropriate physical or emotional care. They did not receive significant de-grees of nurturing, love, protection, and opportunities to grow up in healthy ways. Because the parents were not given to fairly, they are less able to give what their baby is owed and therefore this child is deprived from receiving the loving care all babies deserve. This is the child whose parents might be neglectful or abusive. This child’s parents are unable to recognize, appreciate or meet his needs.

As this child grows, he cannot receive positive affirmations or appreciation for attempts to be caring in the family because his family members do not have the ability to give these things to their children. He might be mocked, ignored, criticized or punished for efforts to offer some-thing into the family. Sometimes the child is asked or forced to give more than is fair to his fam-ily. Often he may be expected to care for siblings because the parents are unable or unwilling to. Children may be forced to keep family secrets, which is unfair and a huge burden that causes children high degrees of inner pain. Children are sometimes pressured to learn or behave in ways they are not yet capable of, and then subject to punishment or humiliation by others who have placed unfair demands on them.

Destructive Entitlement

Because a child is not being given to fairly and cannot give back fairly, this child has earned what Dr. Nagy calls destructive entitlement. This is a spiral that is the opposite of the construc-tive entitlement spiral of fair giving and receiving. In this downward spiral, a person is not given to fairly those things that he deserves. Therefore he cannot give back fairly. The spiral goes back and forth in a downward way with the person now earning the right to not give fairly in rela-tionships with others, and even with the relationship he has within himself. This is the person who may behave in self-destructive ways that impact the ability to maintain physical, emotion-al, and relational health. This person may treat others unfairly without remorse because deep down the person has earned the right to be unfair through this destructive entitlement. They can be untrustworthy and have earned the right to be untrustworthy. This person may abuse or neglect others. The forces of destructive entitlement are often the reason behind unhealthy, unfair behaviors.


Constructive and destructive entitlement are often trans-generational. This means that much like the ways family members pass physical characteristics down through the generations through genes, parents also pass constructive or destructive entitlement to their children, who in turn may pass it on to their children. This is called the trans-generational nature of families.

If someone does not interrupt the transfer of destructive entitlement to children, this de-structive entitlement will be passed on from generation to generation, with each new set of children being deprived of their right to be in spirals of constructive entitlement.

Sometimes people earn destructive entitlement because of the unfairness that occurs in life. If someone is the victim of a random drive-by shooting, the person earns some degree of de-structive entitlement. If someone gets a debilitating disease or experiences a horrific accident, the individual earns some degree of destructive entitlement. If that person doesn’t have an op-portunity to shift the destructive entitlement to constructive entitlement, they will be less able to give fairly to themselves or others.

When someone is offered and is able to accept the gift of unconditional, unmerited love, mercy or grace, constructive entitlement is earned. If and when a person is able to give to some-one or some cause and then receives credit for his or her efforts and accomplishments, it is very likely that constructive entitlement is earned.

On the other hand, when someone experiences a traumatic event and therefore is wounded to some degree and experiences losses, destructive entitlement is earned as a result. These may be literal losses or losses of things such as a sense of safety or security attachment. Through the experience of trauma, a person can earn destructive entitlement.

Relational traumas that occur when family members wound each other are especially dev-astating. When traumas are perpetrated from parent to child, the child earns destructive en-titlement. Children are born owed the fair giving and nurturing that occurs through the ways parents provide love and protection as well as safety and structure. Relational trauma damages the processes of this fair giving and nurturing, and therefore can earn that person destructive entitlement. The person then has the ethical right to not give or receive fairly to others or themselves.

The potential to restore, repair, reconcile, resolve, recover and heal occurs through the re-lational dynamics created, maintained and enhanced through the intentional application of trauma principles related to relationships.

When someone has experienced wounding as a result of injustices and unfairness, and has built up destructive entitlement, there are two essential components for shifting that spiral of destructive entitlement to the spiral of constructive entitlement.

It is in the safety of a trustworthy relationship that someone can explore ways to restore hope, belief in one’s self and abilities to live a more meaningful, satisfying life. It is in the safety of a trustworthy relationship that someone can repair the damage that has been done as a result of experiencing significant trauma.

Someone can reconcile the images versus the realities of life, especially when those realities have perpetrated traumas.

People may resolve fears, beliefs, and expectations, coming to a place of greater understand-ing and peace in healthy relationships.

The Story about Two Babies 141

People can recover the self that existed before the trauma and the potential for being an emo-tionally and relationally healthy, confident and competent person.

People heal from the wounds that trauma inflicts, and can move on in their life no longer a victim of trauma triggers, flashbacks or reenactments when safety and trust are experienced.

When professionals apply the principles of the Ethical Dimension of Relationships the first essential step that promotes the healing process, is to create sufficient credit for the unfairness or injustices. Credit occurs when there is sufficient appreciation for the unfairness, injustice and loss associated with being treated unfairly, either through abuse, neglect or variations of trauma. Credit occurs when the unfairness is adequately addressed and corrected along with an acknowledgment of what was lost, regardless of the fact that a correction has occurred.

Receiving adequate credit for unfairness or injustices perpetrated against a person decreases their destructive entitlement. When unfairness is acknowledged and appreciated, a person may be able to let go of some of the anger and hurt. Through the process of being given to, over time, the person gains the skills to care for others. The person who has been forced to over give can now assume the right to set limits on giving.

Being able to create and share a narrative is a way for a person to understand and appreci-ate their own story. It is a way to receive credit from the person who Listens with acceptance, and who does not judge or criticize. In this way, professionals see how the skill of Active Lis-tening is a tool for effectively addressing destructive entitlement and promoting constructive entitlement.

The second essential step for a person who has earned destructive entitlement is the need to experience opportunities to give back in fair and trustworthy ways. It is through fair giving that they can begin to reverse the spiral of destructive entitlement.

Sometimes this giving back needs to be in the form of making amends to those who have been hurt by the person with the destructive entitlement. When they are able to adequately both apologize and somehow offer meaningful contributions to the other person’s healing, both people are earning constructive entitlement. The first person does this by giving fairly into a relationship, and the person on the receiving end is getting credit for the unfairness of the injustices.

For example, the parents who are less abusive of their children than their parents were when they were children deserve credit for being better parents and giving more to their children than was given to them. In Dr. Nagy’s Ethical Dimension, they deserve credit for giving more than what was given to them. When these parents are supported and encouraged to give in ad-ditional ways without being blamed or criticized for things they cannot do, the healing process begins and some of the destructive entitlement is reversed.

Depending on the severity of the destructive entitlement, the healing process could take years, and may involve extensive therapy. However, all who appreciate the principles of Dr. Nagy can be empowered with the knowledge that allows them to better understand human behavior and recognize the potential that exists to reverse the spiral of destructive entitlement and convert it to the spiral of constructive entitlement.


Concluding ThoughtsIt is extremely important for professionals who are applying trauma principles to include an awareness, understanding and appreciation of the nature and power of the various invisible forces that operate in the relational dynamics of interactions and connections.

Every human being has forces within and around them that can be described in terms of the Ethical Dimension of Relationships. The Ethical Dimension of Relationships is a powerful concept that can explain many of the underlying reasons behind destructive behaviors and in-abilities to change those behaviors. It provides an explanation for why people can be unfair and untrustworthy with themselves and others. It is a theory that helps us make more sense of who we are and why we behave in the ways we do.

Brent was a naturally compassionate person and exhibited many leadership capabilities from a young age. While in high school and then college, these attributes continued to be displayed and he had many opportunities to use his multiple talents by being elected, or selected, to positions of service and influence. He was highly respected by his peers and community. Brent was well-liked, seemed wise beyond his years and was able to communicate clearly and effec-tively. During college breaks he used his time to travel overseas and teach students impacted by trauma. After college his hope to live overseas and continue teaching did not materialize.

During a basketball game, Wes approached Brent, telling him that his brother was in prison. Wes indicated that his brother rarely had visitors and asked Brent if he would consider going. As Brent attempted to visit Gary (the brother), he was not at all interested. Brent was gently persistent. As Brent continued to visit, he became familiar with Gary’s narrative, allowing Gary to tell his story and giving him credit for his losses. Over time they developed a relationship of trust and Gary understood Brent’s desire to help when he was released from prison.

As Gary’s release date drew closer, Brent was making contacts to prepare for his release and the needed employment. Brent asked an uncle who owned a construction business if he would consider hiring Gary. Having heard Gary’s narrative, Brent was confident that Gary would take a new employment opportunity seriously and be grateful. Brent’s persua-sion was effective and upon release Gary was hired. Gary proved himself a worthy invest-ment, working hard and going above and beyond job requirements. Eventually, Gary gained enough confidence and believed in himself enough to leave the job and begin his own company. Tivoli Roofing and Siding became highly successful.

Because Gary had been given to so generously by Brent, their relationship was now built on loyalty and trust. Even though as years went by their paths grew to be very different, they kept in touch occasionally. When Gary heard of Brent’s hardships in his career and family, he immediately offered him a position in Tivoli Roofing and Siding without hesitation. Brent graciously accepted. Having been familiar with the teachings of the Ethical Dimension, he realized that he was contributing to the two main principles: giving Gary credit and allowing Gary to give back in return. (A testimony to the Ethical Dimension of Relationships.)


As trauma-competent professionals, being intentional about applying the principles of the Ethical Dimension of Relationships impacts the relational dynamics and degrees of safety and health in creating positive and meaningful interactions.

An understanding of the Ethical Dimension of Relationships gives professionals the opportu-nities to change downward spirals of destructive entitlement to the upward spirals of construc-tive entitlement. Applying this knowledge helps people impacted by trauma heal from the pain of being treated unfairly and unjustly and frees them from treating others unfairly. Those who have earned destructive entitlement need sufficient credit for what they did not receive and the losses that occurred as a result of their traumatic experiences.

Trauma-Response Tools1. Ethical Dimension

The Ethical Dimension is a powerful, invisible force that influences the choices we and others make in everyday life based on the power of earned entitlement.

The person impacted by trauma may earn Destructive Entitlement because trauma, by its very nature, is an imposed injustice on a person’s right to feel and be safe, to experience the joys of healthy relationships and secure attachment.

To practice recognizing the forces of both Constructive and Destructive Entitlement, it can be helpful to analyze these invisible dynamics in the context of movies or televi-sion shows. In shows like Criminal Minds and Law and Order, Students of Trauma can practice assessing how some level of earned Destructive Entitlement is often behind the behaviors of perpetrators. 12 Years a Slave is a powerful movie with many examples of Constructive and Destructive Entltlement or for a more lighthearted movie, watch Over-board, starring Goldie Hawn.

There are many movies that can be viewed through the lenses of the Ethical Dimension. The 2005 Oscar award-winning movie Crash is filled with examples of both earned De-structive Entitlement and Construct of Entitlement. The movie focuses on issues around racism.

Specifically, you can watch the four minute YouTube clip from Crash titled Shaniqua John-son-Crash (https://www.youtube.com/watch?v=uAHRs3XBt_s).

For practice recognizing the forces of the Ethical Dimension, view this clip or some other movie that has underlying issues that most likely are representative of Constructive or Destructive Entitlement.

Brief description: an agitated son comes to a doctor’s office after having a negative expe-rience with the phone receptionist, Shaniqua Johnson, with whom he then interacts in an unhealthy, racially-charged way. She in turn responds in ways that are indicative of the entitlement she has earned. Warning: this clip from Crash contains profanity.

When viewing this clip, or any other clips from other movies in which there are imbalanc-es in fair giving and receiving:


Record as many life experiences that each character has in terms of its ethical fairness

How has each of these earned entitlements impacted the character’s behaviors.Note how each character’s earned entitlement influences that character’s behaviors which often earns another character some degree of Constructive or Destructive Entitlement.

After viewing this clip, write down some of your conclusions about the Ethical Dimension.


Think about someone you know who has experienced significant relational trauma. Write down the ways this person has earned Destructive Entitlement and how this person’s enti-tlement has impacted their decisions and behaviors.

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Welcome to the eleventh session of Applying Trauma Principles. Professionals are in-vited to appreciate the power and potential each has gained to prevent as well as respond when someone has experienced trauma and its aftermath. We encourage

Trauma-Competent Professionals to be advocates for all individuals and organizations who are involved in the lives of children and families to become trauma-aware, trauma-sensitive, trauma-informed and trauma-competent.

Session Ten ReviewIn Session Ten, through in-class presentations, discussions and the informa-tion contained in the curriculum we covered the following ICAPS:

J Th e power and potential impact of relationshipsJ Nagy’s Ethical Dimension of Relationships and how its principles apply

to some trauma-related issues and needs

Focus for Today’s SessionJ Impact of Sensory Messages and Body LanguageJ Attending BehaviorsJ Assertive Care—Self-Care

Our focus today will be on the relational forces that can be impacted by interactive processes between trauma-competent professionals and people impacted by trauma.

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Predictions, Acknowledgements, and Disclaimers (PADs)

1. We predict that reviewing the information about sensory messages and body language may increase participants’ sensitivity when interacting with people impacted by trauma.

2. When completing the open-book exam we encourage participants to ask for support from LGI administration if needed.

3. The ongoing journey of implementing the teachings of the ethical dimension can create high levels of self-awareness.

Interactive Processes and Relational ForcesTrauma-competent professionals are encouraged to be aware of the impact that processing traumatic experiences might have on the person who is trauma impacted. It is important to understand that the person with whom they are having an interaction may have various trauma triggers and traumatic memories that can be activated at any time.

We encourage professionals to become aware and sensitive to the impact of discussing some-thing related to a person’s trauma experiences as memories may be triggered. This could lead to flashbacks or some kind of reenactment through an association, interpretation or generaliza-tion. In the instant that a sensory cue triggers some kind of flashback, there can be an instanta-neous cascading chain reactions.

Attending behaviors are those specific behaviors that transmit messages. Carl Rogers referred to this as unconditional positive regard. These are messages that invite a person to experience a safe, respectful and authentic relational interaction that in turn contributes to strengthening the relational bridge between a professional and the person impacted by trauma.

We encourage professionals to be aware and intentional with regard to projecting attending behaviors that enhance messages of safety, trust and a genuine interest and desire to connect.

The potential exists when interacting with someone with trauma-related issues to inadver-tently trigger unconscious, implicit trauma memory. Understanding sensory cues and body language and their potential to communicate nonverbal, indirect messages may trigger some aspect of a traumatic memory. This enhances the potential for effective, safe interactions be-tween a professional and someone who is impacted by trauma.

Sensory and body language cues involve subtle messages that are transmitted and received at an unconscious level. It is possible that neither person realizes nor recognizes some kind of sensory triggering is occurring. Knowing that the potential exists and being open to consid-ering that this underlying dynamic may be contributing to the effectiveness and safety of an interaction can be a powerful awareness.

Impact of Specific Sensory Messages, Body Language and Non-Verbal Messages 149

Impact of Specific Sensory Messages, Body Language and Non-Verbal MessagesAs part of this process of becoming more intentional about exhibiting attending behaviors, we encourage professionals to increase their awareness in regard to the importance of the impact body language and sensory messages can have on interactions.

Research has shown that as much as 80% of the messages communicated between people involve not what is verbally shared, but rather involves the interpretation, often done uncon-sciously, of body language. All individuals are continually interpreting and assessing the body language of others in our interactions, deciding not only what is being directly communicated, but also what is being communicated nonverbally.

Sensory MessagesIndividuals can be more or less aware of and receptive to sensory messages being transmitted and interpreted during interactions with another person. Sensory messages are transmitted through each of the five senses:

J Sight

C Visual cues C Various forms of body language: the way the professional sits, walks, gestures, main-

tains or changes distance or position with the person impacted by trauma C Visual cues in the environment: pictures on the wall, mirrors, items on a shelf or

desk, whether or not the door is open or closed, other people in the room

J Sound

C What is heard beyond actual words C Tone of voice C Speed with which each person speaks C How soft or loud C Interruptions by one or both people C How balanced the airspace time is C Auditory cues or any other sounds occurring during an interaction, such as the tick-

ing of a clock, voices or sounds outside the room

J Smell

C The professional’s perfume or aftershave could be a sensory cue C The smells of food or candles, smells from cleaning products or musty books or

alcohol products


J TouchAny way the professional uses touch with the person impacted by trauma during an interaction including:

C A handshake or fist bump C Pat on the back C Holding a person’s hand C Hug C Holding a crying person C The way the fabric on a sofa or chair feels to the person impacted by trauma C How the rug, tiles or hardwood floors feel as the person walks across them C Temperature and humidity in the room C Open or closed windows

J TasteItems involving taste that is a part of an interaction between a professional and a person impacted by trauma:

C Piece of hard candy taken from a candy dish on a desk C A cup of tea or coffee C Anything a person eats or drinks that can be sensory cues of a traumatic experience

Any sensory cue might trigger sensory memories that in turn can impact the beliefs and feel-ings of the person on the receiving end of an interaction. Professionals are encouraged to be highly sensitive to the possibility of triggering some kind of trauma-related memory as a result of one or more sensory cues present during an interaction.

Sometimes this can happen unintentionally and we encourage professionals to be gentle with themselves when this occurs.

Body language can also be a sensory cue, so it can be im-portant for trauma-competent professionals to consider some of the specifics:

J Proximity

C Close proximity may feel threatening if it crosses the invisible boundary of safety each person perceives

C Too distant, creating feelings of being disconnected, isolated or unimportant

J Eye contact

C Steady versus intermittent C Warm and engaging versus piercing and penetrating C Degrees to which a person has permission to look away or look down

J Facial expression

C To the extent a person’s expressions are clear and easy to read, or the person is dis-tant and avoiding

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C Whether there are appropriate smiles and healthy expressions or a person looks puzzled or confused

C Whether the facial expression is warm and encouraging versus cold or hostile

J Body positioning

C Sitting or standing, whether one person sits and the other stands C Placement of the hands C Head gestures such as shifting the head to one side or turning from side to side,

gestures that indicate boredom or restlessness, such as wiggling, tapping, wringing of the hands, or how relaxed versus how tense a person’s body appears to be

Each aspect of a person’s body language contributes to the overall messages of how safe, warm, encouraging and open each person is to building and maintaining a relational bridge.

Cultures transmit different messages with similar body language behaviors. For example, in some cultures making eye contact is considered rude and perhaps a threat whereas in other cul-tures not making eye contact is considered disrespectful. Cultures also dictate how close or far away people stand from each other as the acceptable distance. In America, the comfort distance is approximately 18 inches apart whereas in some European countries, it is 12 inches apart. In America, if someone is 12 inches away from another person and begins communicating, the other person may feel intimidated, challenged or simply uncomfortable because the person seems to be too close for comfort.

Non-Verbal MessagesHow a person interprets sensory cues, including the body language of another per-son depends to a large extent on previous experiences and interpretations made about them. From infancy on, life experiences create filters through which messag-es pass. These filters interpret and translate the underlying meanings of messages.

A child who learned every time his father squinted his eyes that he was about to be slapped could very easily have a visceral reaction in a conversation if someone squints their eyes in a similar way. Most likely the person squinting their eyes in the current moment has no idea that a child or perhaps the now grown adult would interpret that body language as a precursor to a violent act. It is, however, the translation made by the filter when the person instantaneously remembers what that body language means that can set off a triggered response.

All of these factors contribute to the overall set of messages that are transmitted and received within the context of interactions and impact the degrees to which the emotional and relational health are being enhanced, maintained or diminished.

Nonverbal Messages a Trauma-Competent Professional May Want to Intentionally TransmitConsider some of the specific ways professionals might use body language to communicate the following messages:


J I am a safe person who will work to maintain your sense of consistent, predictable safety.J I do not demand that you trust me; I know trust needs to be earned and I am eager to

gently earn your trust.J Take your time deciding if, when and how to communicate with me.J I am focused only on you right now.J If you want to share something, I want to hear it.J I care about what has happened to you.J You can rely on me to just listen without judging or advising you.J Feel free to tell me what you need.J I am honored that you are willing to trust me.J What you think, feel, believe and value are important to me.J Your experiences, needs and perspectives matter to me.J You can be yourself with me.J Count on me not to give you my opinion, advice or to share my own experiences with

you during this time.J I care about you.J I want to be available to you.

Sensory Triggers May Shift Brain StatesWhen a person is triggered (i.e., has an amygdala hijacking, experiences fl ashbacks or some other trauma-related response) most likely the individual will shift from a calmer or aroused brain state to a state of alarm, fear or terror.

As part of the process of shifting into the lower brain state, a person moves to being more dissociative, hyper-aroused and/or hyper-vigilant. When becoming dissociated, a person might seem to no longer be attentive, may stare off into space, may mumble and be less able to re-spond to questions or comments. If the person shifts to a state of hyper-arousal or vigilance, the person might seem more agitated, rigid, frustrated or angry and less able to think clearly.

When a professional believes that a person’s brain state is shifting they need to be intentional about focusing on re-creating the sense of safety that has been jeopardized because a trigger was activated. If appropriate, a professional might share what was observed with regard to the apparent shift in brain states and communicate the process to reestablish a sense of safety. Th is provides a valuable teaching opportunity that could enhance a person’s understanding and im-pact of triggers.

By intentionally exhibiting attending behaviors and being tuned into potential trauma-trig-gering sensory cues, professionals enhance the probability that their interactions are perceived and received as safe and nurturing exchanges.

Assertive CareBecause the possibility exists for a person impacted by trauma to be triggered, professionals may need to shift from supportive care to assertive care. Jean Illsley Clarke, author of Growing

Self-Care for the Professional 153

Up Again, defines supportive care as nurturing that is gentle and directed by the person in care. Assertive care is when the person decides for the other person that the individual is incapable of adequate self-care and needs someone to be more directive in what that person is able to do or not do. Described in the books Primal Leadership by Goleman and Resonant Leadership by Boyatzis and McKee, this is the leadership style called commanding and is used when a person or group is incapable of effective and healthy forward movement.

When deciding to shift from being supportive to being assertive, the professional will need to shift from being in a following position to being in a leading position, directing the person to create or reestablish safety. It might involve saying things like, “Right now it seems that you are having a hard time deciding what to do next. I need you to call your friend on the phone who I know has offered to stay with you and tell her that you need her. I would like you to make that call now.”

In most situations, professionals should not put themselves in a highly directive position in their interactions with a person impacted by trauma, but being assertive when a person is floundering to care for one’s self may be the more responsible response. Professionals need to be mindful not to set up a relationship in which the person impacted by trauma could become somehow codependent. However, there are times when someone goes into such a downward spiral and truly needs to borrow the other person’s cortex for a little while.

Professionals may need to provide outside resources and therapists who are better equipped to manage a crisis situation in which a person has become unable to provide adequate self-care.

Daring to set boundaries is about having the courage to love our-selves even when we risk disappointing others.

—Brené Brown

Self-Care for the ProfessionalAs with the sensory cues described earlier in this session, professionals are encouraged to be aware that they too might have sensory triggers which, when activated, may result in having a surge of their own flashbacks.

If and when such surges occur, professionals need to apply the same trauma principles to themselves as we are encouraging them to apply when interacting with others. The key is to be aware that triggers, flashbacks and possibly reenactments could be stimulated as a result of the processes occurring within an interaction. This is especially true if there has been any kind of similar trauma history. A professional can be more mindful of how to respond to internal pro-cesses and mindful of possible changes in one’s own brain state. Having a set of internal mes-sages that address possible episodes of being triggered provides a professional with a personal set of tools.


Concluding ThoughtsIn today’s session, professionals were invited to become more aware of some of the nuances that occur during interactive processes they might have with a person impacted by trauma. Someone with trauma-related issues and needs is susceptible to sensory cues and may be sensi-tive to body language that has the potential to trigger implicit memories related to a traumatic experience. By understanding this information a trauma-competent professional can make in-tentional shifts in interactions in order to reestablish safety.

Professionals are encouraged to be aware of the need to possibly shift from providing Sup-portive Care to providing Assertive Care, based on the needs of those with whom they are interacting. Having permission to make this shift when it is necessary for the preservation of a person’s safety and well-being adds another tool to a trauma-competent professionals ev-er-growing tool chest.

Trauma-Response Tools1. Impact of Sensory Messages, Body Language and Non-Verbal Messages

The next time you are out in public, observe some of the sensory messages others are transmitting to you, noticing the ways they are transmitting these messages through their body language and non-verbal messaging.

Record some of the specific messages you received and how each was transmitted. For ex-ample: The prominent message I received when entering a store was, “ I hope you will buy some of the items we have on sale.” The message was transmitted through:

J Strong eye contact J Warm smile J Outstretched hand

In terms of sensory messages I could:

J See products attractively displayed J Smell fruity smells as people tried various perfumes and hand creams J Hear classical music being softly played J Hear conversations by other customers J Feel creamy and slightly cool lotion I rubbed on my hand from the tester-container

The impact of this experience was that I felt:

J Subtly pressured to engage in a conversation with the salesperson. J Like immediately leaving to avoid pressure to purchase something. J Curious and wanted to at least try one or two of the hand lotions on display.

Your experience

Place: ____________________________________________________________________________________________


Message transmitted: ___________________________________________________________________________

___________________________________________________________________________________________________

Sensory messages: ______________________________________________________________________________

___________________________________________________________________________________________________

Impact of experience: ___________________________________________________________________________

___________________________________________________________________________________________________

2. Assertive Care versus Supportive Care

Write down the name of someone you know who would benefit from receiving your Sup-portive Care.

List three characteristics of this person that lead you to believe they would benefit from receiving your Supportive Care as opposed to receiving your Assertive Care.

List three ways you might offer that Supportive Care.

Write down the name of someone you know would benefit from receiving your Assertive Care.

List three characteristics of this person that lead you to believe they would benefit from receiving your Assertive Care as opposed to receiving your Supportive Care.


List three ways you might offer that Assertive Care.

3. Self-Care

Draw a vertical line down the middle of the blank space below.

On the left side, write a list of what has been stressful for you over the last twenty-four hours.

On the right side, write a list of the ways you have cared for yourself in order to balance some of the stresses.

For those items for which you have not cared for yourself, use a different colored pen or pencil and write down ways you can provide self-care.

Keep in mind that self-care is not always an external action. It can also be caring for your-self in a mindful way, Actively Listening to your own inner dialogue and affirming yourself for things you have done, who you are, your potentials, your intentions, and any other affirmations that are realistic, self-caring and self-soothing.


Notice and write about how it makes you feel to consider caring for yourself.

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As we complete our 30-session journey of Enhancing Trauma Awareness, Deepening Trauma Awareness, and Applying Trauma Principles, we have gained a sophisticated level of knowledge of the key principles and properties of trauma and its impact. In our

12 sessions of ATP we have specifi cally explored ways to apply trauma principles.By completing all the reading, attending classes, and participating in the discussions, activities

and participant-led presentations, each professional has become competent and confi dent in un-derstanding the nature and principles of trauma and the application of eff ective approaches.

Th is journey has been humbling for most of us as we became clearer and more aware of the complex aspects of trauma and how it can powerfully impact children, families, communities, and entire systems. We understand that some traumas can resolve on their own, especially for adults, when there is a strong and healthy support system in place. On the other hand, the many ways trauma can permeate the brains and minds of children and adults deserves the utmost respect.

As each of us experience the journey, we may fi nd ourselves deeply touched and perhaps forever changed as our appreciation for the power, prevalence and pervasive nature of trauma increases as well as our sense of re-sponsibility for applying trauma principles.

We believe successfully completing this jour-ney qualifi es our participants to embrace the title of trau-ma-competent professionals.

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Predictions, Acknowledgments and Disclaimers (PADs)

1. Trauma-competent professionals are encouraged to keep themselves, and the person im-pacted by trauma they are working with, focused on hope.

2. It is important that the hope is realistic and does not minimize the process needed to gradually address the trauma.

3. We acknowledge that we did not cover every aspect of trauma. It is important to contin-ue your journey of expanding your knowledge and skill bases.

When the mind is thinking, it is ta lking to itself.—Plato

Universal MessagesTrauma-competent professionals are encouraged to create a list of Universal messages to trans-mit in interactions with people impacted by trauma. A list provides the trauma-competent professional ways to focus discussions, maintain calmness, clarity and an overall sensitivity to what constitutes a healthy process when interacting with a person impacted by trauma.

J I am available to process the issues, needs or feelings that are related to your trauma.J While I cannot completely understand every aspect of your experience, I am equipped

to facilitate processes around understanding trauma, it’s impact, and approaches for healing.

J I want to make sure you are feeling safe. You can ask me to stop at any time, set limits reestablish your sense of safety and control of our processes.

J What happened that has caused traumatic memories was not your fault. Your struggles make sense.

J As painful as it can be to explore some of the underlying reasons for your trauma-relat-ed symptoms, together we can fi nd ways to help you understand and be able to remem-ber without having to re-experience the pain. It may not be necessary for you to specifi -cally remember all the detail. We can fi gure that out together.

J I encourage you to be prepared and patient about this process. I know that healing as well as learning, growing and changing are all processes that take place over time. Th ere are other important processes such as grieving, addressing issues around shame, fear, helplessness and stress. Th ere is no set timeline or deadline; we need to honor your unique process of healing.

Trauma-competent professionals are encouraged to add to this list of universal messages in order to personalize and enhance its depth, breadth and scope.

Be Fair and Reasonable with Regard to Your ResponsibilitiesPart of being trauma-competent involves maintaining the following perspectives:

Messages to Communicate to Yourself 161

J Have trust in the natural processes of healing. Even a severe traumatic event does not necessarily result in long-term debilitation.

J Be mindful of not taking on the responsibility for the ultimate outcome. This is an un-realistic and unfair expectation for any trauma-competent professional. Have a strategy for maintaining healthy boundaries.

J Your main role is to facilitate processes of creating and maintaining health, trust, and safety in the relationship, and then to trust that over time and in the context of safe and healthy relationships, growth, change and healing occurs.

J There are important differences between feeling compassionate and being responsible for a person’s Rh Factors (repair, reconciliation, restoration, resolution, recovery and healing). Compassion is a healthy response in the process. Feeling or believing you are responsible for a person’s Rh Factors is not.

J Often trauma-competent professionals grieve for the losses they become aware have happened to children and adults. Allow yourself the freedom to grieve in healthy ways.

J Trauma-competent professionals may experience fear, anxieties, and stress around effective applications. They may have concerns for how children and adults have been impacted by trauma. It is important to recognize and facilitate your own processes, resolving your own fear, stress and anxiety reactions.

J Regularly check your levels of self-confidence and maintain fair and reasonable expec-tations of yourself. Take responsibility for striving to effectively apply trauma principles without expecting that you will always be clear, correct and able to fully ACT every situation.

J As important as it is to wear trauma lenses to continue the process of becoming clear and more focused, it is just as important to be able to remove them, creating boundaries and self-care as a trauma-competent professional.

Messages to Communicate to Yourself

J I need to trust, honor and respect the process by remembering that healing takes place in the context of safe, healthy relationships over time.

C It is important for trauma-competent professionals when they are interacting with someone who has trauma-related issues and needs to trust, honor and respect the process through which healing occurs.

C This means that the trauma-competent professional remains calm and patient, even when it appears that a person is stuck in a place of pain, grief, confusion, fear or is experiencing other sensations and emotions.

C The trauma-competent professional appreciates that trauma wounds can be deep. Traumatic memories are stored in many places throughout the brain and body. We appreciate how pervasive trauma is, not only in society but within a per-son’s inner self.

C Trauma-competent professionals do not put unfair pressure, to rush the process, to set a deadline for when healing should take place. This pressure should not be on one’s self or on the person impacted by trauma.


J Maintain respect for the power, pervasiveness, prevalence, and price of trauma throughout the facilitation of different processes.

C It is important for trauma-competent professionals to appreciate how powerfully trauma can wound someone. Even when that person has learned about the trauma, has worked hard to identify the sources of the pain and creates an accurate nar-rative, trauma still has a profound impact. When a person has experienced some degree of healing they can still can be blindsided by a trigger that sets off a cascade of flashbacks and leaves the person feeling vulnerable and defeated. This does not mean that the person impacted by trauma has not done the necessary work, nor does it mean that the trauma-competent professional missed something. At times trauma can override the logic and rational thinking a person has worked so hard to achieve in order to manage trauma-symptoms. There are times when those trau-ma-memories will prevail: this is one of the internal prices of trauma.

C It is important for trauma-competent professionals to maintain a perspective that the person impacted by trauma may always have certain vulnerabilities. This does not mean there has not been healing. Rather, it can mean that certain memories will remain, even though they may be dormant. Both the trauma-competent profession-al and the person impacted by trauma need to respect the nature and attributes of traumatic memories that include how dormant memories can be re-activated.

J Trust, honor and respect the power of healing.

C We have been exploring many processes and approaches that may have great power and potential to overcome trauma. While there are no guarantees for all situations, it is important for trauma-competent professionals to appreciate the sophisticat-ed knowledge each has processed and integrated, the abilities to apply the skills of ACTing situations with an emphasis on Listening, Affirming, Teaching, and Exploring.

J Create a sense of personal satisfaction when given the opportunity to walk with some-one who is processing traumatic memories.

C Give yourself permission to experience a strong sense of personal satisfaction when-ever the opportunity to apply the trauma principles we have studied in our three courses as well as any other valuable, principles learned from other venues. While it may be hard to walk with somebody as they address their wounds, there can be a feeling of gratitude for the privilege of sharing the journey. The privilege that we can experience when someone puts trust and faith in our ability to keep them safe, while guiding them, is a powerful and meaningful process.

Our ability to observe our stream of consciousness, revisit memories, and think about our thinking, which occurs

in the pre-frontal cortex, is called metacognition.—Diane Wagenhals

The Power of Neurobiological Metacognition 163

The Power of Neurobiological MetacognitionAs we refl ect upon the neurobiological aspects of trauma and its impact, trauma-competent professionals are invited to refl ect on how this information helps them understand what might be going on neurobiologically for a person with trauma-related issues and needs.

By being able to teach individuals about how their brain may have been impacted, it gives them the understanding of neurobiological processes.

Th e individual now has the ability and knowledge about the brain and may be able to over-ride some of the ways trauma has been impacting neurobiological processes. Th is could be called neurobiological metacognition meaning the process of thinking about one’s process of reacting neurobiologically.

Bruce Perry’s Neurosequential Model of TherapeuticsOne of the newer and promising approaches to treating trauma based on neurobiological wounding is Bruce Perry’s Neurosequential Model of Th erapeutics (NMT).

Dr. Perry and his staff have designed a process for creating brain maps of children who have experienced trauma that identify specifi c areas where the brain has not been adequately nur-tured and may have been wounded. Once each segment of the map is coded and those areas in need of somatosensory attention have been identifi ed, the therapy involves systematically engaging each brain area with appropriate sensory activities. Th e process begins with the areas deepest and lowest in the brain’s hierarchy in order to promote recovery and healing. A team approach is used in which clinicians take a neurosequential trauma history in order to create a map for a child.

The following has been excerpted from the Child Trauma website. Professionals are encour-aged to go to this website to get more information about the nature of NMT.

What is the Neurosequential Model of Therapeutics?(www.childtrauma.org)

The Neurosequential Model of Therapeutics (NMT) is a developmentally-informed, biolog-ically-respectful approach to working with at-risk children. The NMT is not a specifi c ther-apeutic technique or intervention; it is a way to organize the child’s history and current functioning to optimally inform the therapeutic process. The NMT integrates several core principles of neurodevelopment and traumatology into a comprehensive approach to the child, family and their broader community. The NMT process helps match the nature and timing of specifi c therapeutic techniques to the developmental stage of the child, and to the brain region and neural networks that are likely mediating the neuropsychiatric problems. The goal of this approach is to structure assessment of the child, the articulation of the pri-mary problems, identifi cation of key strengths and the application of interventions (educa-tional, enrichment and therapeutic) in a way that will help family, educators, therapists and


NMT has many benefits. It is specific in terms of the neurobiology and addresses the most primitive brain issues first, and sequentially moves up the brain to address each new area in need of repair. While clinicians are involved in the most serious cases and in designing specific strategies for an individual child, the general theories of NMT prove beneficial to many profes-sionals and caregivers who interact with children.

Trauma-competent professionals are encouraged to explore the many varied approaches of addressing trauma-related issues and needs to enhance and enrich their understanding of the therapeutic processes that may hold answers and hope for effectively addressing trauma-relat-ed issues. Trauma-competent professionals can strategically, intentionally, and effectively ad-dress these needs, in partnership with such therapies and approaches.

Appreciating our JourneyParticipants are invited to look back over the ICAPS used in Enhancing Trauma Awareness, Deepening Trauma Awareness and Applying Trauma Principles in or-der to fully appreciate the personal and professional progress made during our journey.

In these courses we have addressed the following topics:

J The importance of becoming Students of Trauma throughout the process of enhancing and enriching knowledge bases and skill levels.

J The concepts of becoming more trauma-aware, trauma-sensitive, trauma-informed and trauma-competent.

J The definitions of trauma and related concepts such as traumatic stress, posttraumatic stress, and posttraumatic stress disorder.

J The types of trauma, including acute or single episode traumas, chronic trauma and complex trauma.

J The power, pervasiveness, prevalence and price of trauma. J The critical importance of creating safety and providing opportunities to claim power

whenever interacting with a person impacted by trauma.

related professionals best meet the needs of the child. Active participation of caregivers and other adults in the child’s life is important to the success of the NMT; indeed, by weaving various activities throughout the child’s various relationships and environments, the major-ity of “therapeutic” experiences are provided outside of the actual context of conventional therapy. The model has three key components—assessment, staffing/training and the array of recommended therapeutic, educational and enrichment activities (see Perry, 2006; Perry and Hambrick, 2008; Perry, 2009). A related approach, the Neurosequential Approach to Caregiving (NAC) incorporates the same principles but the practical application informs parenting, early childhood education, education and a range of other settings where focus of the work is not specifically “clinical” in nature. This application of neurodevelopmental principles, the NAC, is a powerful complement to the use of NMT in clinical populations.

Appreciating our Journey 165

J Specifics of brain growth, development and functioning:

C key brain parts and what each does C principles that describe the nature of the brain, including the differences in mallea-

bility and plasticity of the higher and lower parts and brain wiring C the mechanical, electrical and chemical ways the brain functions and responds to

the world, especially when impacted by trauma C the concept of brain states from calm, aroused/alert to alarmed to fearful to

terrorized C how a person who is impacted by trauma often operates in and quickly moves to

more aroused brain states and requires more time and gentle, safe interactions to gradually recover and move to calmer states

C the ways the brain impacts the physiology of the rest of the body in areas such as heart rate and blood pressure

C the two key behavioral responses to being a person impacted by trauma: dissocia-tion and hyper-vigilance

C neurobiological facts regarding the ways the brain responds to the behaviors and messages conveyed by others through processes such as mirroring neurons

J The dynamics of memory:

C different types of memory (implicit and explicit) C various ways memory can be stored (cognitive, emotional, motor and state

memories) C connections between and among associations, interpretations, generalizations

(AIGs), beliefs, sensations, attitudes and feelings, which often have their origins in the lower parts of the brain and that result from experiences that begin with implic-it memories

J Trauma is a sensory and not cognitive experience. J The differences between trauma and posttraumatic stress and posttraumatic stress dis-

order (PTSD). J Trauma and its aftermath of posttraumatic stress and PTSD are often characterized by

flashbacks that can cause a person to re-experience the original sensations as if they were happening again.

J A person impacted by trauma can be triggered to re-experience many of the sensations that occurred during the original traumatic experience.

J People impacted by trauma are often trapped in a trauma vortex that causes them to re-enact critical aspects of the original trauma.

J Appreciations of the risk factors and protective factors of trauma and ways to promote resilience in both children and adults.

J There is an innate power the majority of adults have to recover naturally when trauma-tized, without therapeutic interventions but with the support and care from family and friends.

J Forced debriefing may interrupt natural healing processes. J The younger the child, the greater the impact of trauma.


J The importance of recognizing and meeting the needs of the person impacted by trauma. J Vicarious and secondary traumatization as well as compassion fatigue and the im-

portance of self-care and nurturance from caring colleagues are areas that need to be recognized and supported.

J The critical processes of early attachment between infants and a primary caregiver. J The impact of inadequate attachment, including the development of Reactive Attach-

ment Disorder. J Considerations of perpetrators of trauma: who they often are, including sociopaths and

those who perpetuate trauma from generation to generation through domestic violence and child abuse.

J Fear and how fear typically manifests in people impacted by trauma, the fact that un-certainty produces anxieties while predictability often reduces those anxieties.

J The nature of shame and its connection to trauma; that shame can contribute to trau-matization and how trauma can shame.

J The LGI Steps of Growth J The ways commonly accepted parenting practices such as allowing babies to cry it

out and the use of harsh, shaming disciplining, toilet training and the management of school issues may result in traumatization for children.

J The typical stages through which a traumatized person moves in order to achieve some degree of recovery:

C Stage I: the creation of an environment of safety and trust in which a person can eventually explore his or her traumatic experience(s) and its impact

C Stage II: remembrance and mourning in which the person is able to retell and if necessary relive essential aspects of the traumatic experience while simultaneously grieving for the losses associated with being traumatized

C Stage III: moving into recovery and reconnection with a healthy, normalized life.

J The connections between grief and trauma. Grieving a loss is typically associated with sadness while grieving a loss through the veil of trauma often results in terror.

J The dynamics, power and importance of forgiveness and an awareness that decisional forgiveness differs from emotional forgiveness. Emotional forgiveness tends to have more healing potential but is not always possible to achieve.

J The mind/brain connections and the power the mind has to change the brain. J The use of oases, anchors, and safe places to help a person pause when the exploration

of trauma becomes too intense. J A wide variety of theories and approaches to respond/treat people impacted by trauma

C The value of being LATE: Listening, Affirming and Teaching Effectively. C Approaches that use cognitive brain functioning through psychoeducational pro-

cesses or therapies focused on activating the cortex, such as Trauma-Focused Cog-nitive Behavioral Therapy.

C The use of metaphorical story-telling as a safe way to allow processing to occur. C The use of sensory-based approaches, such as EMDR, tapping therapies, yoga and

relaxation breathing.

Appreciating our Journey 167

C The importance and impact of calmness, of rhythmic activities that may mimic pre-natal experiences around hearing the mother’s heartbeat and being rocked within the womb and of appropriate touch.

C The importance and potential impact of consistently being respectful, clear, com-passionate, tolerant, patient and hopeful.

J The importance of and strategies for each using our list of 10 P’s: passion; promotion; prevention; being proactive; providing protection; being prepared; knowing when and how to present information; knowing when and how to process with another; being equipped to provide meaningful information, comfort and compassion; and seeing the possibilities

The following sentence was created by Robin Glasco Jones (one of our trainers). It cap-tures and condenses the 10 “P’s”:

With passion, be prepared to present information designed to prevent harm and provide protec-tion while promoting possibilities through proactive processes.

J The power of relationships and the power of love to promote resiliency, protection and healing.

J Continue to encourage participants to add tools to their trauma tool chests and consid-er if, when and how to use them sensitively and appropriately.

J Explore the differences between therapy and education and how trauma-competent family professionals need to appreciate the boundaries as well as the similarities.

J Explore ways to teach effectively as one of the essential tools for responding in situa-tions where trauma might be a factor (TE of LATE).

J Become more Question Sensitive, especially when interacting with someone who might have trauma-related issues.

J Provide opportunities for participants to discuss and practice applying the information and principles included in today’s session.

J The Assess, Choose, Take Action (ACT) Approach J Memory Systems J Life Narratives J Active Listening Application J Case Study Preparation and Presentations J Affirmations J Reflecting on Own Steps of Growth J Continuums that describe different people types J Application of LATE J PADs and Establishing Boundaries J Exploring a the Narrative of a Person Impacted by Trauma J The power and potential impact of relationships J Nagy’s Ethical Dimension of Relationships and how its principles can apply to trauma-

related issues and needs J Impact of Sensory Messages and Body Language


J Attending Behaviors J Assertive Care—Self-Care J Universal Messages J Fair and Reasonable Responsibilities J Neurobiological Metacognition J Bruce Perry’s Neurosequential Model of Therapeutics

Images and StoriesThe following are the images we invited professionals to use in order to increase their trau-ma-awareness and trauma-sensitivity:

J Trauma lenses J The Trauma Iceberg J The three-part diagram:

C the first circle with its research and facts C the second circle of principles that evolve from that research and those facts C the third circle that contains the responsibilities and ways to apply the research,

facts and principles in meaningful, effective ways

J The Trauma Shroud that covers and underlines so many life dynamics for the person impacted by trauma

J The Miguel story when children in the swimming pool were expected to jump off a block and swim in water over their heads

J The two bars of taffy that responded differently when tapped by a hammer because one had been frozen illustrating the power of memories

J The two bottles of clear liquid that looked the same until both were shaken and opened: the seltzer water bubbled up while the plain water did not

J The importance to encourage the creation and use of personal Self-Care Plans J The story of Sammy and Pooh bear illustrating therapeutic play J Creating and using a First Aid for Trauma: An Intentional Response Strategy to provide

effective first responses when children (or adults) are traumatized J The importance of schools and other institutions having an intervention strategy in

place to respond if and when potentially traumatizing events occur

ClipsThroughout our courses we frequently used clips to emphasize concepts and provide opportu-nities for assessment and discussion. Included were:

J Several clips from the movie I Am a Promise, including the following scenes:

C Two boys coming into the principal’s office because they were fighting on the play-ground and were chastised by the principal for not being calm enough to come to her

Clips 169

C The scene in which Cornelius hovered in the corner of the principal’s office saying that he wanted to stay there. Later his mother is called in and reacts very harshly towards him.

C Mr. Coates’ first-grade class of boys already labeled as underachievers who, as a result of his caring, trauma-sensitive behaviors, responded and blossomed.

J The episode “Noel” from the TV series The West Wing in which Josh experiences PTSD and needs to be guided through the process of discovery in order to understand that music was interpreted by his brain as the sound of gunshot.

J Neurons and What They Do J Trauma, Healing and Relationships: Helping Children Heal: Bruce Perry, Daniel Segel and

other experts spoke about trauma, attachment and the impact on the developing brain J The Role of Attachment in Infancy: Drs. Leslie Atkinson and Judith Andersen discuss

stress and early attachment, infant attunement to parents, biological responses of in-fants, insecure attachment

J RAD and Homework: Casey (diagnosed with reactive attachment disorder) has an out-burst and exchange with her mother about homework

J Helping RAD through Horses at Hoofbeats to Healing: Jody Beans talks about her daughter, Victoria, who has been diagnosed with RAD. Clip describes behaviors and the form of therapy using horses used to help her.

J Through Our Eyes: Examples of people impacted by trauma and how perpetrators im-pacted them

J Sociopaths: DNews Psychopath vs. Sociopath What’s the Difference? J Room: Clips of Jack playing with Legos, helping his grandmother in the kitchen, meet-

ing Seamus (dog), scenes of Jack thinking and talking to his grandmother about cutting his hair. Tells his grandmother he loves her.

J EMDR: Dr. Francine Shapiro, originator and developer of EMDR, describes the thera-peutic technique

J Play Therapy Works: Introduces and promotes the value of play therapy, credentialed play therapists and membership in Association for Play Therapy

J Baby and Me: Evian water ad shown as a way to incorporate play J Mission Impossible 2: Showed how fear impacts people in different ways and allowed

some participants to experience the sensations of fear for a few seconds J Good Will Hunting: Scene showing how therapist leads Will to a place where shame can

be expressed J Brené Brown on Empathy: Animated short reminding us of the importance of empathy

as the antidote to shame J Mad About You in which Jamie and Paul let their baby cry while they counted minutes

outside the bedroom door. J Dr. Sears’ Top Baby Sleep Tips: American Pediatrician shares his tips for getting baby to

go to sleep and stay asleep. J Benjamin Allen Spaces: Discusses the principles of how grief and grieving can manifest

in a person’s life


J Benjamin Allen Waves: Discusses the phenomenon of how grief comes in unexpected waves

J Bindi and Derek: 17-year-old is triggered by a distant memory and given an opportunity to share part of her narrative. Illustrates her strength and the impact of her great loss. Dance demonstrates a somatic approach to healing.

J “Power of Forgiveness”: Performance demonstrating the power of forgiveness in a wordless exchange between a son and his imprisoned father

J Stephen Post: Principles and health benefits of forgiveness J The Path to Recovering from PTSD: focused specifically on the experience of veterans J Children, Violence and Trauma—A Call to Action: Office for Victims of Crime inviting

viewers to consider what they can do to help a child in need J Everybody Loves Raymond: Active Listening J Big Bang Theory: Active Listening J Helping Children Heal: Relationship-Induced Trauma J Bryan Stevenson TEDTalk: Ethical Dimension

We have experienced a very sophisticated journey of interwoven ICAPS intended to enhance and enrich trauma-awareness, trauma-sensitivity and trauma-competency. Professionals are invited to celebrate all that they have learned and are encouraged to continue broadening and expanding their knowledge bases and skills.

On occasion, we encounter individuals who have lives so impacted by trauma that there seems to be little hope for change and healing. Such was the case for Carson. He walked into my office on the recommendation of a friend. With a great deal of emotional pain, he verbally painted a tragic picture of his intense traumatic childhood and ensuing life. Now, at the age of 65, he felt that there was little or no hope for anything to change. His life was replete with therapeutic interventions and diagnosis. He had a personal history of anxious behavior which included diagnoses of bipolar, alcoholic, obsessive-compulsive, depression. This created significant shame, high-risk acting out and dysfunction. He had attempted sui-cide twice, was institutionalized twice and had been in therapy with 4 different psychiatrists who medicated him with different psychotropic drugs. He was skeptical and felt that he may never live a normal life! He demonstrated such a strong desire to overcome his life ob-stacles, that I became convinced that he deserved an approach that was both creative and trauma-informed. All the traditional approaches had not worked for him.

We entered a counseling/mentoring relationship. He was articulate about his childhood, with vivid memories of countless situations where the messages and abuse that shaped his life were destructive and filled with shame. He was re-enacting traumatic childhood events regularly. He was left in insurmountable double-binds where there was no way for him to gain the approval of his parents. As a child he desperately tried to escape the abuse, neglect and de-structive messages by going to his grandparents’ home. The messages of incapability, shame, fear and never being good enough permeated his home life and relationships. Eventually the impact of such pounding messages began to impact his emotional and relational health. He

Closing Thoughts 171

began to drink excessively, act out and his private world was in complete disarray.The realities of the impact of his trauma seemed endless and permeating. Yet he was willing

to explore the impact of all he had experienced. He processed it openly and emotionally. In the context of his current retired life, we worked through what it would look like to change. We reviewed the steps of growth and set that as a template for change. He had never heard of any scenario like that in any of his previous counseling. We worked through brain states and what triggers he was encountering that left him dysregulated, feeling hopeless and out of control. We talked through his coping mechanisms and how he was using them to handle the destruc-tive messages triggering him to obsess, become angry, experience depression or act out.

We talked thoroughly about transgenerational legacies and their cumulative impact on his capacity to cope. The discussions were detailed, nuancing each traumatic event and articulat-ing its impact to almost every aspect of his life. There were tears, oppressive guilt, anger and significant battles, literally fighting back the urge to act out. We worked diligently on strategies for brain regulation. We acknowledged that so much of what he experienced was not his fault but was passed to him through messages and actions of severe criticism and abusive control.

Slowly he began to understand his family core beliefs and where they came from. He was able to release the guilt and shame of his past. He actively engaged in the process of brain regulation, discrediting the toxic messages, replacing them with new truths and coping mechanisms. He looked at himself and others around him with new lenses, allowing him to go into the observer’s role and create boundaries of relational integrity and trust with those he encountered. He identified his hyper-vigilance and his responses to stress as well as his impact on others. He began to realize that taking his power back was a new potential regulating mechanism. For the first time he experienced the reality that he was no longer a victim of trauma, even though he was impacted by trauma.

Carson is a man of courage to encounter such extreme trauma. He was relentless to find coping strategies and regulating behaviors that would intervene in his tendencies to react in the extreme. He gradually gave up his obsessive behavior as a coping mechanism. He would observe how others were taking advantage of him and learned how to communicate authentic I-messages. He fought the internal demons of acting out and replaced them with more positive ways of processing stress and addressing the real issues. He worked on his relationships with a perspective of objective processing and was very intentional about identifying which triggers left him in a high threat brain state and how to regulate his brain to a more cognitive place. He actually wrote a book of our sessions which left him with new messages and strategies that allowed him to live in emotional and relational health and freedom. He regularly wept over his victories and new capacities to overcome the impact of trauma. Finally, he could set a course of life that was stable, resonant and filled with meaningful relationships.

Now Carson is pursuing his interests. He recognizes that he is a gifted artist and interior decorator. He is seeking volunteer opportunities that will energize him through the use of his strengths and uniqueness. He is working to make his relationships with his spouse and friends to be authentic, whether in confrontation or affirmation in a fair give and take di-mension of relationships. He has changed his perspective from a hopeless and powerless ex-istence to a new potential where he is capable to live a purposeful and meaningful life filled


Closing ThoughtsWe know that participants have been invested and engaged in all three of our trauma courses. It is our hope that each participant has been positively impacted and has deepened both their un-derstanding, and beliefs about trauma and it’s impact on individuals, families, and systems. We are confident that through this course, professionals will be more equipped when responding to people impacted by trauma. We hope that each participant will not underestimate the incredi-ble power that exists within the relational dynamics that is intentionally created and sustained over time. Ultimately this can be the catalyst to open the channels for healing to take place.

We encourage participants to take the time needed for self-care, rest, and reflection, follow-ing this intensive course. We encourage professionals to continue the journey of gaining new information, insights, and perspectives as research emerges and new theories and approaches provide more effective avenues for understanding and healing.

We are advocates for promoting a much greater level of trauma-awareness, trauma-sensi-tivity and trauma-competency within all systems that touch the lives of children and adults. We can promote the kinds of healthy processes that prevent trauma from occurring in the first place and are equipped to effectively address traumatic experiences to prevent them from be-coming posttraumatic stress or PTSD.

We hope each participant comes away from this course appreciating the power that exists in healthy, loving relationships that provide effective ways for attending to the wounds traumatiz-ing experiences cause.

In conclusion, we want to offer a word of hope. We know that there are many ways that we can effectively address trauma’s negative impact. We believe that when it comes to trauma, we contribute to promoting hope, and healing! As a result of attending these three courses, we believe we each carry a spark of hope that says our enhanced levels of trauma-awareness, trau-ma-understanding, trauma-sensitivity and trauma-competence have prepared us to be lead-ers and facilitators of healing processes that change lives. Trauma has the power to devastate and wound; trauma-competent professionals have the power to effectively apply skills and ap-proaches to lift the human spirit to help overcome trauma’s impact. Together we are creating a global movement of healing!

Healing yourself is connected with healing others and

Healing others is connected with healing yourself.—Yoko Ono

with optimism and personal empowerment. He learned that even a life filled with trauma can create hope for change, growth and a fully-functioning life. As he undertook a powerful journey of overcoming a lifetime of trauma he realized that, with safety and relationship, change and healing is possible at age of 65!


Trauma-Response Tools1. Neurobiological Metacognition

Write the name of someone you know well who may have unresolved trauma-related issues and needs.

The possible brain states this person experiences regularly:

How you think this person’s amygdala reacts to everyday experiences:

What do you think might be the messages this person thinks about themself, others and their world, and life in general for each of the following categories?

How:Valuable I am:

Safe I am:

Safe I am being with people in my family:

Well I can cover-up my feelings:

Clear I am about my right to share my thoughts, feelings and stories with others:

What are my feelings:


What:I expect of family members or other people in my life:

I think family members or others expect of me:

Kinds of hopes and dreams I have about my future:

By generating the possible thoughts of this person, you are practicing neurobiological metacognition.As you interact with people impacted by trauma, practice using your abilities to consider:

C What might be going on in their minds C What might biologically be happening with their brain and nervous system C How this impacts their emotional and relational health

Use this information to inform the ways you interact with this person.

2. Invitation to Reflect on Your Trauma-Informed Journey

Create a timeline that reflects your journey of becoming trauma-informed and trauma- competent.

Start on the far left-hand side with the approximate date you first became a Student of Trauma.

Using the bulleted list in the curriculum, highlight those items that were powerful in influ-encing your growing trauma-awareness, trauma-sensitivity and abilities to apply trauma principles in a trauma-competent way.


Record the most important items on your timeline.

For example, learned brain states placed early on your timeline and later on the timeline, regularly recognizing brain states in others.

Include any notable moments in time that were powerful to you on your journey.

Write one or two words to remind you of a specific experience in which you were applying one or more ICAPS.

Use your timeline to reflect on your journey to becoming a trauma-competent professional.


Write a list of the ICAPS you recognize as:

C Essential for you to continue using C Those that you want to go back and review C Personal reflections that are powerful or meaningful to you C Reflections that have enhanced your awareness, understanding and abilities to in-

teract in trauma-sensitive ways

Finish the following sentences:

As a result of participating in this course and applying principles in real-life situations, I am now more aware that . . .

The most important new understandings I have gained are . . .

The skills I have acquired that allow me to take action are . . .

I am aware of the importance of reflecting on my journey as a professional as well as on my personal journey because . . .

I am clear that it is essential for myself and others to continue growing and learning about trauma and its impact because . . .


With regard to being an agent of change who can:

C Influence Prevention of trauma C Be sensitive about Avoiding exacerbating or triggering someone’s unresolved trau-

ma issues C Be intentional about Responding to those who are experiencing flashbacks or other-

wise are triggered by their traumas C Offer Therapeutic interventions or in some other way promote recovery and healing

I recognize that this journey has afforded me the right and honor to consider myself trau-ma-competent, knowing that this competency is an ongoing continuum of learning and growth.

Some reflections on this journey are:

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Lakeside Global InstituteApplying Trauma Principles

Certifi cation Checklist for Trauma-Competent Professional

Name: __________________________________________________________________________

Attendance

□ Enhancing Trauma Awareness (ETA) Sessions 1–6□ Deepening Trauma Awareness (DTA) Sessions 1–12□ Applying Trauma Principles (ATP) Sessions 1–12

Participants must submit a written summary of the curriculum for each session missed. Partic-ipants who wish to check their attendance, can contact LGI administrators.

Homework□ Confi rmation that assigned homework readings from all three courses have been complet-

ed. Th is is not written homework, it is assigned readings.

Presentations (as outlined in hand outs for ATP)□ Topic Presentation □ Teachable Moment □ Case Study

Certifi cation

180 Certification | Applying Trauma Principles

Additional Assignments□ Completion of a Self-POET (Performance Outcome Evaluation Tool). □ Submission of completed open-book take-home exam. □ Submission of signed Certification Agreement to adhere to the standards, values and expec-

tations of a Certified Trauma-Competent Professional.

Trainer Recommendation□ Trainer agrees that participant has adequately met the in-class requirements.

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Template for Presenting a Teachable Moment

Participants use the following guided for their presentation to the group. You do not have to answer all of these questions; rather use this as a guide for designing what you would like to present.

1. How would you describe the person to whom you provided LGI trauma-related information?

2. What specifi c concepts, facts or principles did you teach?

3. What are some of the ways you taught this?

4. In what ways were you question sensitive?

5. What inspired you to teach this? What did you know or suspect might be his or her trau-ma-related needs? What were you hoping to achieve?

6. Describe the specifi c LGI topic or concepts you used and what feedback and/or observa-tions did you receive as a result of this interaction?

7. What is your overall assessment of your process of teaching? What else might you have done? Is there anything you would have done diff erently?

8. Please comment on the how process impacted the person and /or yourself?

Template

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Guidelines for 10-Minute Topic Presentation

General Description: Each participant signs up to provide a review for his or her class-mates of some of the ICAPS [Information, Concepts, Approaches, Principles, Skills] of a specifi c concept located in the Participants’ Binder Notes.

Important Notes:

� Participants should not include any outside research on the concept they have chosen. Th is is not an exercise in which we want participants to expound on topics; rather this is an opportunity for participants to highlight key ICAPS from a previous LGI trauma course so that other participants have the opportunity to recall and reinforce those ICAPS. (Participants are always welcome and encouraged to do their own research on trauma topics however the purpose and design of this exercise does not involve sharing that research during this exercise.)

� Participants will not have the time to highlight every signifi cant piece of information in the materials they sign up to review. Participants should select a limited number of key points and allot a minute or less to describe each key point.

� Participants can look for key ICAPS they believe are important for Trauma-Com-petent Professionals to incorporate into their tool chests and possibly their Personal Trauma Maps. Participants may want to state a reason why they think one or more of these key points is signifi cant to them without sharing longer stories of personal application.

Topic Presentation

184 Topic Presentation | Applying Trauma Principles

Purposes Served by Reviewing ConceptsReviews by participants of concepts from Enhancing Trauma Awareness and Deepening Trau-ma Awareness allow each participant providing the review and his or her classmates to recall ICAPS and possibly be better equipped now after receiving so much information to incorpo-rate these ICAPS more powerfully in his or her mental trauma tool chest and perhaps on his or her Personal Trauma Map.

By having to highlight and summarize powerful concepts, participants have the opportunity to practice this process; a skill needed by Trauma-Competent Family Professionals when shar-ing ICAPS with others as part of wearing the Teaching hat.

Encouragement to be Warm and EngagingBecause two of the purposes of having participants provide concept reviews are

1. to give them the opportunity to practice consolidating lengthy information into key points and then

2. to practice teaching some ICAPS,

participants are encouraged to be warm, personable and engaging as they highlight some meaty, powerful ICAPS. Participants can think about the impact they might be having as they share these ICAPS, including how to impress and inspire people as well as to inform them. This often is done through projecting warmth, making eye contact, and using voice tone to show enthusiasm.

Responsibilities of Participants Hearing Topic PresentationsParticipants who are listening to a fellow colleague share his or her Concept Review can note the specific ICAPS being shared and the significance of each of these to him or her.

After each participant finishes his or her Concept Review, participants will be invited to note the specific ICAPS they heard in that review.

A sample of part of a review from ETA Session 2 around the review of Active Listening and Affirming:

I am going to highlight some principles around the responsibility we all have when providing healthy and appropriate responses when trauma is an issue. This section was a good reminder of that need to take responsibility for being very intentional about our communication.

As I looked through this section, I found the following ICAPS important for me, and I think all trauma-competent family professionals, to incorporate into their interactions with anyone with possible unresolved trauma-based issues.

I thought one key principle was that it is important for trauma-competent family professionals to know that someone with unresolved trauma might not have good boundaries or abilities to

Responsibilities of Participants Hearing Topic Presentations 185

set limits with regard to how much to disclose. The idea is that the trauma-competent family professional needs to be skilled at Active Listening which can be a great tool someone shares his or her story/narrative but needs to do it in a trauma-sensitive way. This means keeping in mind the importance of protecting a person who is sharing his or her story so as to not re-trig-ger him or her.

I liked being reminded that the simple way to remember what Active Listening is all about is to use the acronym “HUG” which stands for Hearing, Understanding and Giving that back in a statement.

The key point for all of us to remember about Active Listening is that we do not have to agree in order to accept, and sometimes the perspectives of a person impacted by trauma may be a little off in our opinions; Active Listening is not about inserting those opinions.

It also seems very important to keep RESS-Q in mind—to not Reassure, Explain, Solve/Sug-gest, or Share when doing Active Listening because each of these can take away from the pro-cess. I think we all have probably struggled with one or more of these when learning about Active Listening!

I think trauma-competent family professionals can be really helped by periodically reviewing the sentence starters listed on pages 46 and 47 to help them have more varied ways of provid-ing Active Listening responses.

In the section on affirming a adult or child impacted by trauma, I thought it was important to note that Bruce Perry’s research says that a lot of children in families where there’s serious levels of abuse and neglect resulting in trauma also receive many fewer affirmations than chil-dren in families where children are not being traumatized. I think that means for all of us that we need to encourage those we work with to think about how often they affirm children and adults, especially when they might have trauma-related issues and needs.

I thought it was important to stress that there are some specific affirmations for children or adults impacted by trauma listed on page 49. I think it can be really helpful to have a variety of ways to focus on positive attributes and successes or potential and children or adults who have been wounded by trauma.

The list starts on page 51 and here are a few of the bulleted items: . . .

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Guidelines

Generating and presenting a case study to colleagues provides an opportunity for each participant to share how they are integrating trauma information into interactions with others. Professionals are able to listen to each case study and gain understanding while

becoming more sophisticated when interacting with others by incorporating key trauma ICAPS into interactions.

After utilizing the Trauma Profi le Recognition Checklist, use the following template as a guide for creating your case study presentation. You do not have to respond to each item:Choose from the following questions/statements to provide a description for your case. Please remember you have up to ten (10) minutes.

Utilize Trauma Profi le checklist:

1. General description of the person with whom you interacted: include basic facts about this person and what your relationship is (only 2 minutes of presentation).

2. Share aspects of the person’s history as it relates to possible trauma issues. Th is could include:

a. Categories of traumab. Specifi c description of traumac. Apparent impact of trauma: behaviorallyd. Observed outward behaviors (hyper-vigilant, dissociative, lack of self-regulation)

3. Which trauma ICAPS from your trauma tool chest did you apply?4. With regard to possible trauma-related needs:

a. What are some needs this person has? b. What specifi c recommendations do you have for meeting the needs associated

with this person’s trauma-related issues?c. What was important to say or do with regard to helping to meet these needs? d. In terms of needs, where on the steps of growth is the person and how did you

assist in meeting these needs?

Case Study

188 Case Study | Applying Trauma Principles

5. Considering the list of areas in which a trauma shroud might impact someone, which specific areas appear to have been impacted in this person’s life? How did you provide hope?

6. What specific brain information helped you describe and understand this person?7. What are the possible AIGs the person has? Is it clear where there might be differences

between implicit and explicit memories?8. To what extent are you and/or this person aware of underlying associations, interpreta-

tions, generalizations, sensory triggers, flashbacks and reenactments? Describe any of these that might be impacting this person.

9. With regard to life narratives:a. Which aspects seem clear to this person?b. Which may need attention and/or clarification?

10. When you consider our list of Rh factors (repairing, restoring, recovering, reconciling, resolving and healing), which might be important to address and emphasize? Why?

11. How did you show compassion, patience, tolerance, respect, clarity and hope?

During your interaction or interactions with this person:

J What did you do to create, build and maintain safety? J What PADs did you include to create safety and maintain boundaries? J How did you balance education versus therapy? J In what ways did you Assess, Choose and Take Action with those choices throughout

your interaction? J Describe ways you used LATE? What was the apparent impact for each? J Overall how would you describe your process with this person? What do you believe

was the overall impact?

With regard to yourself in this process:

J How would you describe your attitudes, beliefs, thoughts, feelings and behaviors throughout this process?

J Describe your relational connections before, during and after your interaction. J How did exploring this person’s situation impact you? J What new insights, awareness, understanding and our sensitivities did you gain as a

result of this case study?

Sample Case Study 189

Sample Case StudyCase Study: Amelia

General description of the person with whom you interacted: include basic facts such as who this person is, facts about him or her and your relationship with him or her.

Amelia is a 63 year old woman. Amelia lives with a roommate. Her children are grown. She lives in New Jersey and has resided there for over 25 years. Amelia was originally from Northern VT, and moved to South Jersey as a single parent to raise her sons in a quiet community. She began a career at the casinos. She has two grown sons and several grandchildren who she adores.

Amelia’s parents divorced when she was twelve and her mother remarried while she was still in her teen years. Her stepfather and mother eventually moved to Cape May, NJ, along with several other family members, who relocated there, including: some of her aunts and uncles, as well as father. As family relocated to the same area, in time they created a strong family net-work. Amelia was a pivotal member of this family.

Amelia has always been a strong and loving mother and provided amazing opportunities for her boys. They are successful men and fathers today. Amelia’s parents were very involved assisting in the lives of her children in healthy ways over the years. Over the past few months it appears Amelia’s adult sons have been very concerned because they have witnessed increased depression, isolation, and what appears to be a dangerous level of alcohol consumption. These behaviors are affecting her relationship with her sons especially the oldest who tends to be very judgmental.

My relationship to Amelia is that she is my dear friend. We are close in age, and have been very relationally close since childhood. Our relationship is mutual in that we have been able to be there for each other during both times of celebration, and also difficult times in life.

Share whatever aspects of this person’s history relates to possible trauma issues. This could include:

Type or types of trauma J Illness from cancer J The loss of her best friend at age 47 due to illness and unexpected death J Recent job loss after 26 years which includes a major law suit J Both parents died within one year

Specific description of trauma or traumas

Amelia suffered from a form of cancer, about 12 years ago and she was treated and has been cancer free ever since. This was a very traumatizing experience for her.Earlier this year, within six months of each other, both Amelia’s mother and father passed away. Amelia was very close with both parents, and served as their caretaker.


Amelia was terminated from her job as a cocktail waitress at a casino after many years of ser-vice. She was told that the casino was re-structuring to a ‘Roaring Twenties’ theme, and re-quired servers to wear new uniforms that were very seductive in design. Being terminated was a devastating situation for many reasons.

Apparent impact of trauma or traumas: behaviorally (evidence of being dissociative and/or hyper vigilant/hyper aroused), apparent emotional health, relational health, including the health of your relationship with him or her.

Dissociative behavior may describe what the family is seeing lately in Amelia’s behavior.She has been spending more and more time in isolation.

The more alcohol consumption the more embarrassed she has become and avoids many family situations.

Her emotional health was suffering shown by immense sadness, easily triggered anger, low energy, and high anxiety.

Which trauma facts and/or principles from your trauma tool chest did you apply to enhance your understanding of possible trauma-related issues?

J The trauma glasses allowed me to see more clearly what might be the possible cause of some of the unhealthy behaviors.

J The brain information J The differences between grief and trauma J The trauma iceberg J LATE has been a very important tool throughout my experience of working with Amelia J Protective factors and ways to promote resilience

Considering the list of areas in which a “trauma shroud” might impact someone, which specific areas appear to have been impacted in this person’s life? How would you describe the impact in each area?

J Self Esteem has been lowered significantly J Family Connections are suffering J Social Situations tend to be awkward J Issues around Shame J Career issues J Relationships

To what extent do you see evidence of triggers? Is this person experiencing flashbacks and/or reenactments?

Amelia seems to be triggered by anything sad. Also when someone talks about their parents in loving ways, she seems to have an emotional reaction.

Her crying happens often and is easily triggered.Reenactment is not something I have witnessed.


Is it clear where there might be differences between implicit and explicit memories?

Amelia was a vulnerable adolescent when she experienced her parents divorce therefore the trauma memories are most likely in her implicit memories. Amelia did not realize the con-nection between the trauma of the divorce and the loss of her parents through death until we began our sessions together. As she moved up the steps of growth she became highly aware of the deep unresolved issues from earlier in her life related to her parents divorce. When she was finally able to talk about feelings she had buried for nearly 50 years, she earned the constructive entitlement she deserved.

What brain information has helped you better describe and better understand this person?

J Basic brain information has been very beneficial in understanding the impact of trauma on a young teen and the impact that has had on the current loss of her parents.

J I would imagine that her brain neural pathways were affected at a time when the cortex is growing to its full capability and size.

J Explaining to Amelia the role of the limbic system and emotions vs. the cortex was very easy for her to understand and allowed some understanding for her.

With regard to life narratives: Which aspects seem clear to this person?

I was aware of the impact of many hours of listening, and conversation with Amelia. In one of our sessions we looked at many of her family from years ago. It seemed like this process of telling her story allowed to gain some powerful self-awareness related to her own life narrative. process. We spoke authentically about how her parents’ divorce really impacted her as a young teen. She was able to make sense of some important personal feelings she had at that time and how they often trigger her.

Which aspects may need attention and/or clarification?

As Amelia continues to work on herself she will need to take better care of her own develop-mental needs, including her physical, intellectual, emotional, social, and spiritual health. While Amelia had been using alcohol as a copying mechanism, it seems like it may not be as extensive-ly as her family believes. I suggested Amelia continue to work on building healthy coping skills, to increase the number of tools she can turn to as she feels lonely and overwhelmed. She agreed to this. The need for physical exercise and a new passion in life are her areas of focus right now.

With regard to possible trauma-related needs: What are some possible needs this person has?

I think Amelia has needed and continues to need credit for her many traumatic losses. Amelia needs to take the skills she has used to care for others and utilize them for herself. She needs support from a supportive circle of friends or family. There is a lot of judgment about her be-havior and it is causing more shame not healing.


How well have these needs been met?

Amelia needs are being met slowly and to some degree. The challenge is most family members are intolerant and have little compassion or understanding.

What are some specific recommendations you have for meeting those needs associated with this person’s trauma-related issues?

I recommend to Amelia to participate in a weekend retreat for women. The weekend is de-signed to help women feel supported by other women and have a chance to heal something in their life. After some very creative fund-raising and encouragement, Amelia decide to go. The weekend was a very empowering and emotional experience for her. She made strong connec-tions with a large group of women all along the east coast.

How did you show compassion, patience, tolerance, respect, clarity and hope? How did these appear to impact this person?

This part of the process created a strong impact for Amelia and I.Listening without judgment created feelings of compassion, respect, clarity and hope on many levels for Amelia.

During your interaction or interactions with this person:What did you do to create, build and maintain safety?

I defined and used some PADS and chose our time in private uninterrupted.I let Amelia take the lead and used question sensitivity.I was committed to stay connected through texting and phone calls throughout the processes.

In what ways did you use Listening, Affirming, Teaching Effectively? / What was the apparent impact for each?

There have been both in person and phone conversations with Amelia, and in the beginning listening was my primary tool. In the midst of our working together I sent her an affirming card. This made such a strong impact; she called and said, “It means so much to me that you think of me when we are not together. Thank you so much!”

Teaching came in the form of teachable moments as the opportunity arose throughout our conversations.

What else do you think this person would benefit from receiving?I think Amelia would benefit from seeing a life coach to assist and work with her as she con-

siders her next steps around employment. She may also benefit from seeing a therapist to sup-port her as she continues the grieving/healing process. Therapy may help her continued efforts to build and maintain healthy family relationships. I also encourage her to incorporate exercise, as I believe it is so important to help both care for her physical body, and clear her mind from anxious thoughts.


How would you describe your attitudes, beliefs, thoughts, feelings and behaviors throughout this process?

I felt good that I was able to rely on my listening skills so that Amelia could experience less judgment and shame.

How would you describe your relational connections before, during and after your interaction?Although we are close something changed in our relationship. We grew in respect for each

other in ways we had not had an opportunity to do before. Amelia was very touched by the level of listening and affirming she received from me.

How did exploring this person’s situation impact you?I believe that exploring this situation has impacted me in surprising ways. I learned so much

and I was grateful to serve the needs of someone hurting so deeply.

What new insights, awareness’, understanding and other sensitivities did you gain as a result of this process? What, if anything, do you wish you had done differently?

I gained a new appreciation for the inter-connected nature of trauma.I am more aware of how early trauma can connect to current losses for someone. I wish I

could help the process move more quickly but I know those choices are Amelia’s.

What else would you like to do?I will continue to be available and check in with Amelia as an emotional coach as I know time

is needed for healing.

195


Homework Grid

Session Due

Destroying Sanctuary

Neuroscience of

Psychotherapy

Trauma Through a

Child’s Eyes CurriculumAdditional Paperwork

2 Chapters 1, 2 & 3 Chapters 1 & 2 Session 1Session 2

3 Chapters 4, 5 & 6 Chapters 3 & 4 Session 3

4 Introduction & Chapter 1 Chapters 7 & 8 Chapter 5 Session 4

5 Chapter 2 Chapters 9 & 10 Chapter 6 Session 5

6 Chapters 3 & 4 Chapters 11 & 12 Chapter 7 Session 6

7 Chapters 5 & 6 Chapters 13 & 14 Session 7

8 Chapter 7 Chapters 15 & 16 Chapters 8 & 9 Session 8

9 Chapters 8 & 9 Chapters 17 & 18 Session 9

10 Chapter 10 Chapters 19 & 20 Chapters 10 & 11 Session 10

11 Chapter 11 Chapters 12 & 13 Session 11

12 Chapter 12 Chapters 21 & 22 Session 12 Final Evaluation

Th e books you receive are a gift to enhance the training process and to provide additional re-sources to achieve our shared goals. We will schedule a time each session for discussions of the reading assignments to process and reinforce the information contained in the reading. We have a goal of providing a safe, predictable venue for professionals to participate in an on-going supportive process that emphasizes nurturance and appreciation and we will allot time to share insights and opinions.

Homework Grid

196 Resources | Applying Trauma Principles

If for some reason you fall behind in reading assignments, we request that you catch up with the readings as quickly as possible so that you may contribute to the discussions in class.

Read each session’s assignments before coming to class. Typically this will involve reading 3–6 chapters every two weeks.

Highlight concepts you find interesting or relevant so that you can share with your group members during the book discussion.

Bring the books that had assigned reading with you to class.

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Name (optional): __________________________________________________________________________________

Date: ________________________ □ Morning □ Afternoon □ Evening

Using the following scale, please rate the extent to which you agree with each of the state-ments listed below:5 = Strongly Agree 4 = Agree 3 = Undecided 2 = Disagree 1 = Strongly Disagree

______ Th e overall goals for this session were clearly presented.

______ Th e facilitators were knowledgeable and clear.

______ Th e facilitators were respectful and responsive.

______ Th ere were opportunities to interact and connect with other participants.

______ Overall, this session met or exceeded my expectations.

______ Technology was implemented to assist in the transfer of training in today’s session.

______ Th e assigned readings were relevant to today’s session.

______ Th e varied presentation approaches kept me engaged.

What did you fi nd most helpful?

Evaluation 1SESSION

198 Evaluation Session 1 | Applying Trauma Principles

How have the information, concepts, approaches, principles and skills (ICAPS) presented today impacted you professionally?

Other Notes or Comments:

Thank you for your feedback.

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Evaluation 2SESSION

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Evaluation 3SESSION

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Evaluation 4SESSION

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Evaluation 5SESSION

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Evaluation 6SESSION

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Evaluation 7SESSION

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Evaluation 8SESSION

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Evaluation 9SESSION

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Evaluation 10SE

SS

ION

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Evaluation 11SE

SS

ION

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Evaluation 12SE

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ION

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Name (optional): __________________________________________________________________

Group Number: __________________________________ Date: ________________________

On a scale of 0 to 5 with 5 being the highest, to what extent has this training met the broad LGI goals for all training ion each of the following:

______ Nurture the nurturers

______ Promote a common language, philosophy, set of values and general approaches educa-tion among agencies throughout the city

______ Enhance and enrich the knowledge and skill bases of participants

______ Create a shared foundation and philosophy of ICAPS

______ On a scale of 0 to 5 with 5 being the highest to what extent are you clearer and more confi dent with regard to the subject of trauma?

In what specifi c areas and ways are you clearer and more confi dent?

Final Evaluation

222 Final Evaluation | Applying Trauma Principles

______ On a scale of 0 to 5 with 5 being the highest to what extent do you believe you are better equipped with skills that allow you to apply the ICAPS learned in all three courses (Enhancing Trauma Awareness, Deepening Trauma Awareness, and Applying Trauma Principles)?

What are some of the specific skills you now are equipped to use?

______ On a scale of 0 to 5 with 5 being the highest to what extent are you applying ICAPS in real-life situations?

Specifically, where have you and do you expect to use the ICAPS you received in this training?

What would you like to say with regard to:The IFP training process, especially as it results in transfer of training:

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The trainers:

The books:

The curriculum:

224 Final Evaluation | Applying Trauma Principles

Other handouts, exercises, or materials:

The certification process:

The overall impact this training has had on you, ways you have changed, or any other com-ments you would like to make:

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What suggestions and recommendations would you like to share?

If you are unable to submit your completed final evaluation during the last session,please mail it to:

Lakeside / Institute for Family Professionals1350 Welsh Road, Suite 400

North Wales, PA 19454

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