Coming Home Working from the Trauma-informed Perspective

with the Justice Involved Population PRESENTED BY LAYNE PAVEY, MSW, LIACSW, CPC

& EMDR THERAPY PROVIDER

Poll Question ‣ Which type of setting best describes where you

provide services? a) Community-based organization b) Hospital – outpatient c) Hospital – inpatient d) School/educational facility based program e) Residential facility f) Individual or group private practice g) Government based organizations h) Criminal Justice System i) Other

Poll Question ‣Have you or a family member been impacted

by incarceration? a) Yes b) No c) I don’t know

Poll Question ‣ I have worked with the justice involved

population in these areas: a) Case management b) Probation/Parole c) Public Defender or Prosecutor's office d) Addiction Recovery e) Juvenile f) None g) Other

Professional Work ‣ Founded I Did the Time in 2014

‣ Joined the Smart Justice Spokane Campaign’s Executive Committee

‣ Hired at Spokane Psychology & Neuropsychology after graduation in 2014

• EMDR Therapy Provider

‣ Founded Revive Reentry Services, LLC in 2015

‣ 2016 Cohort Member: JustleadershipUSA

Reentry ‣ Moved into parent’s basement ‣ Had difficulties finding jobs in my

field ‣ Filed Bankruptcy ‣ Family confusion ‣ Panic Attacks & Nightmares ‣ Felt alone ‣ Went back to school for a Masters

of Social Work

Scope of Mass Incarceration ‣ 100 million people with arrest and/or conviction

records • New minority class ‣ USA spends $80 billion per year ‣ 2.4 million still incarcerated • 97% of people return to their communities • Average sentence: 15-24 months ‣ Rate of recidivism remain higher than 50% • #1 factor: Not having a job/income

Poor Social Conditions Drive Crime ‣ A 2009 report by the National Institute of Corrections

found that social conditions within U.S. society are the main contributors to criminogenic pathologies:

• Homelessness • Poverty • Social location • Drug and alcohol addiction • Undiagnosed or untreated mental illness • Dysfunctional family patterns • Underperforming pedagogical institutions

Social Isolation & Marginalization ‣ Ruptured sense of belonging ‣ Shame: “I am bad/broken/unforgivable” ‣ Loneliness ‣ Voiceless ‣ Learned Helplessness ‣ Internalized Oppression ‣ Hypervigilance

Recovery & Restoration ‣ Reintegrating feelings of guilt and healing • I’ve done something harmful, but I’m not bad forever ‣ Restoring: • Sense of dignity • Sense of belonging, social inclusion • Hope • Family Relationships • Consumer to Citizen • Abilities & Opportunities

The Connection Continuum

Shame Empathy

The basic psychological motive, or cause, of violent behavior is the wish to ward off or eliminate the

feelings of shame and humiliation.

Feeling Unworthy Feeling with

Vulnerability

Defining Trauma

‣ Trauma is an emotional response to a terrible event like an accident, sexual assault or natural disaster. During and immediately after the event, shock and denial are typical. Long term reactions include unpredictable emotions, flashbacks, strained relationships and physical symptoms like headaches or nausea.

Research by CDC & Prevention ‣ 1 in 5 Americans was sexually molested as a child

‣ 1 in 4 was beaten by a parent to the point of marks being left on their body

‣ 1 in 3 couples engage in physical violence

‣ 25% of us grew up with alcoholic relatives

‣ 1 in 8 witnessed mother being beaten/hit

Four Types of Trauma 1. What others do to us 2. What we see others do to others 3. What we do to others 4. What we do to ourselves

Foundation is Proper Assessment ‣ Evidence-based assessment tools, scales ‣ “What has happened to you?” vs. “What’s wrong with

you?” ‣ “When you were growing up, who was an adult you

had in your life who you could go to to feel safe and loved?”

‣ “What do you feel were general beliefs about you from adults?”

‣ “Where could you go to feel safe?” ‣ Assess for shame vs. guilt

Graphic Timeline Trauma Narrative

SUD= +10

SUD= -10

DV 6

Little Brother 8

SA 9 Foster Care 9

Moved out 5

Began Drug Use 4

First Robbery 6

Baby Girl 10

Fed Raid 7

Incarceration 5

Sobriety 3

Reentry -9 & +5

DSM-5 Traumatic experiences and more… ‣ Sexual Assault ‣ Physical Assault ‣ Natural Disasters ‣ Torture ‣ Imprisonment /Captivity ‣ War/Combat Zone ‣ Childhood Abuse ‣ Explosions/Fires ‣ Accidents ‣ Witnessing Violence ‣ Victim of Violent Crime ‣ Life Threatening Illness

‣ Neglect ‣ Abandonment ‣ Adoption ‣ Turnover of/Separation from Caregivers

(foster system) ‣ Loss of a Caregiver ‣ Death of loved one ‣ Divorce ‣ Parent incarcerated ‣ Drug Abuse ‣ Racism ‣ Medication Reactions ‣ Public Humiliation ‣ Betrayal ‣ Persuasive Coercion ‣ Gang Involvement/Initiation ‣ Shame from systems (medical, mental

health, criminal justice, education, etc.)

*Developmental Trauma D/O

Trauma & Attachment ‣ Trauma: Bad things that happened that shouldn’t have ‣ Attachment: Good things that should have happened

that didn’t

‣ Traumas that occur within relationships are more difficult to heal

‣ Most common traumas in women & children occur at the hands of their parents or intimate partners

Trauma (continued) ‣ Trauma is a natural response to an event that

challenges your basic assumptions about how the world and people work

‣ Trauma causes physiological changes in brain functioning and the autonomic nervous system

‣ Reprocessing and integrating the brain’s stored responses to trauma is part of the recovery process

‣ Psycho-ed is cognitive restructuring

The Job of the Trauma-informed Therapist

1. Normalize trauma adaptations through psycho-ed 2. Teach self-regulation to help Cts realize they can

calm themselves down 3. Help to lay traumatic memories and reenactments to

rest (EMDR, CPT, PE) 4. Reconnect Cts with their fellow men and women

(community building) 5. Advocate on behalf of Cts to keep them in the

recovery process ‣ Allow your Cts to teach you something

Top Down regulation involves strengthening the capacity of the watchtower to monitor your body’s sensations.

Two Main Responses ‣ Flight or Fight

‣ Freeze or Faint

(Feigned Death)

Autonomic Nervous System Sympathetic ‣ Emergency ‣ Arousal ‣ Fight or Flight ‣ Increased HR ‣ Increased BP ‣ Increased Breathing ‣ Increased muscle tension ‣ Increase compulsivity ‣ Decrease Neo Cortical Fx ‣ Decrease Frontal Lobe Activity

(emotion regulation) ‣ Decreased Temporal Lobe

Activity (language) ‣ Unessential Areas Off

Parasympathetic ‣ Low Stress ‣ Calm/Relaxed ‣ Renew and Repair ‣ HR normal ‣ BP normal ‣ Breath measured ‣ Long-term functions On

Interrupting Trauma Recovery ‣ Traumas of Agency or Shame • Agency: Perpetuated by people ◦ Mugging

• Shame: Where the victim is made to feel the blame ◦ Rape ◦ Childhood abuse ◦ Prison

Interrupting Trauma Recovery ‣ Shame blocks access to the context that is necessary

for recovery ‣ We stay numb (dissociated) and re-experience

traumatic events through the retelling of the traumatic story

• Drug Abuse • Recidivism • Self-harm • Abandoning others ‣ “Shame erodes the part of us that makes us believe we

can change.” ~Brene Brown

Pain that is not Transformed is Transferred

‣ “Much of the violence that plagues humanity is a direct or indirect result of unresolved trauma that is acted out in repeated unsuccessful attempts to re-establish a sense of empowerment.” ~Peter Levine

‣ In order for clients to cease violence they must be treated non-violently

Trauma & Behavior ‣ What is right action when I’m perceiving threat whether it’s an

actual threat or when there is no threat? ***Relax your body ‣ Every single breach of integrity you’ve ever committed in your

life is a fight or flight behavior ‣ Therapists can help Cts to identify personal values, principles and

missions so Cts become able to stay true to their integrity, to a principle-based life

‣ Relaxing the body helps us live and act intentionally ‣ Put your energy in what you can control (not outside of you, i.e.

Probation Officer) ‣ Teach people the ability to relax muscles in the context of daily

living

Therapeutic Relationship ‣ Traumatized human beings recover in the context of

relationships ‣ Role of relationship is to provide physical and

emotional safety including safety from feeling ashamed or judged, and to bolster the courage to face what’s happened

‣ Being the Anchor: Holding space so your client can listen to the painful messages from their emotional brains that have been kept secret for so long

‣ Being the guide who is not afraid of another’s terror as they explore

Therapeutic Relationship ‣ Ego States are “stuck” at the ages we were when we

were traumatized and not comforted ‣ Frightened adults respond to the same comforts as

terrified children • Gentle holding or rocking and the assurance that

someone bigger and stronger is taking care of things so we can safely go to sleep

• We need to know it is safe to let go ‣ Our attachment bonds are our greatest protection

against threat ‣ At first the therapist provides the safe, secure,

nurturing and protective relationship *Developmental Needs Meeting Strategies

Recovering with Community ‣ There is nothing one cannot heal from within the space

of an accepting, non-judgmental community ‣ Community transforms trauma by accepting trauma

survivors and supporting them in the healing process ‣ When victims and offenders of crime are denied

healing within the context of community, recovery is interrupted or postponed

Belonging ‣ “A deep sense of love and belonging is an irreducible

need of all people. We are biologically, cognitively, physically, and spiritually wired to love, to be loved, and to belong. When those needs are not met, we don't function as we were meant to. We break. We fall apart. We numb. We ache. We hurt others. We get sick.” ~Brene Brown

Community & Belonging ‣ Community is about the experience of belonging ‣ We are in community each time we find a place were we belong ‣ To belong is to be related to and part of something ‣ Belonging can also be thought of as longing to be—to find a

deeper purpose in all we do together

‣ The opposite of belong is to feel isolated and in all ways always on the margin, an outsider

Belonging & Ownership ‣ Belonging also means to be an owner: Something

belongs to me ‣ Being a co-creator of what I own—to build and nurture

it ‣ Knowing that our safety and success are dependent

on the success of all others ‣ We chose to come together to produce a desired future

Attunement & Neglect ‣ Attunement: The experience of sensing another’s

subjective state ‣ “A study or criminals who had committed the cruelest

and most violent crimes found that they had life histories that suggest emotional neglect and little opportunity for attunement.” ~Daniel Goldman

‣ Hurt people, hurt people

Restorative Justice ‣ “A process to involve, to the extent possible, those

who have a stake in a specific offence and to collectively identify harms, needs and obligations, in order to heal and put things as right as possible.” —Howard Zehr

‣ Restorative Justice reduces recidivism if the offender feels s/he was not made to feel like a bad person in the process

Hayes (2011) Reoffending and Restorative Justice.

Love & Home ‣ Love: The security produced by experiencing

nurturing acceptance and guidance toward autonomous development

‣ “The ache for home lives in all of us. The safe place where we can go as we are and not be questioned.” ― Maya Angelou, All God's Children Need Traveling Shoes

‣ “Perhaps home is not a place but simply an irrevocable condition.” ― James Baldwin, Giovanni's Room

References ‣ Block, P. (2008). Community: The Structure of Belonging. San Francisco,

CA: Berrett-Koehler. ‣ Kolk, B. (2014). The Body Keeps Score: Brain, Mind and Body in the

Healing of Trauma. New York, NY: The Penguin Group. ‣ Schmidt, S.J. (2009). The Developmental Needs Meeting Strategy (DNMS):

An Ego State Therapy for Healing Adults with Childhood Trauma and Attachment Wounds. San Antonio, TX: DNMS Institute, LLC.

‣ Shapiro, F. (2013). Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy. New York, NY: Rodale, Inc.

‣ Siegel, D.J. (2010) Mindsight: The New Science of Personal Transformation. New York, NY: Random House, Inc.

‣ Information on Development Trauma Disorder: http://www.traumacenter.org/research/DTD_Field_Trial.php

‣ Trauma Assessment Tools: http://www.ptsd.va.gov/ “For Professionals”

Q&A?

Contact Information

Contact us at ctac.info@nyu.edu

Upcoming Webinars Beyond Speaking Spanish: Cultural Competency with

Spanish-Speaking Communities July 13th

12:00PM – 1:00PM

Trauma Informed Collaboration July 27th

12:00PM – 1:00PM

Trauma-informed Therapists ‣ Emphasize relationship ‣ Assess for trauma ‣ Psycho-ed as cognitive restructuring (normalizing

reactions) ‣ Communicate clearly • Let people know what you are doing and why

‣ Use structure (session treatment plan) ‣ Anticipate emotion dysregulation and embrace conflict ‣ Keep promises & appointments ‣ Check in on emotional states before starting session ‣ Encourage story sharing in the context of what was

learned/gained (strengths)

Trauma Response

What makes an event traumatic? The instinctual trauma response.

‣ Startle ‣ Thwarted Intention (fight or flight) ‣ Freeze (no win situation) ‣ Altered State (peri-traumatic dissociation) ‣ Body Memory: Automatic obedience ‣ No Resolution/Integration

Common Symptoms ‣ PTSD

• Re-experiencing ◦ Flashbacks ◦ Nightmares ◦ Fragmented images/feelings

• Avoidance • Hyperarousal • Hypervigilance • Negative Mood & Self-schemas • Depersonalization • Derealization • Dissociation • Catatonia

‣ Childhood Abuse/Neglect • SNS Dominance • Insomnia • Leg Pistoning • Dissociative Amnesia • Psychogenic Seizures • Chronic (& Somatic) Pain • Chronic Health Issues • Autoimmune D/Os • Social Anxiety • Positive Affect Intolerance • Memory Loss/Inability to Retain • Impaired focus/concentration • Impulsiveness • Drug Abuse • Sensitivity to light and sound • IBS & Stomach Problems

Sympathetic Nervous System Activation GOOD/Dominance BAD

SNS Activation ‣ Increased acuity/focus ‣ Increased skill/performance ‣ Increased energy/strength ‣ Excitement/fun ‣ Anticipation ‣ Joy/Ecstasy

SNS Dominance ‣ Decreased

concentration/attention deficit ‣ Diminished functioning

(cognitive & motor) ‣ Increased muscle tension ‣ Lose 30 % of speed and agility

and strength ‣ Fatigue/Burnout ‣ Avoidance ‣ Dis-ease ‣ Self-destructive attempts to

soother discomfort (addiction)