covington one - healing trauma · “building lives beyond trauma” healing trauma for women...

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8th Annual Evidence-Based Practices Symposium“Building Lives Beyond Trauma”

HEALING TRAUMA FOR WOMENEXPLORING TRAUMA FOR MENEVIDENCE-BASED BRIEF INTERVENTIONS

Presented by :Carol Ackley, LADC

April 6, 2018Sacramento, CA

Curriculum Written by:Stephanie S. Covington, PhD, LCSW

Center for Gender and JusticeLa Jolla, CA

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Healing Trauma2nd Edition

© S. Covington, 2016

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Critical and Interrelated Issues

• Addiction• Mental Health• Trauma• Physical Health• Crime


4© S. Covington, 2016

CHANGES IN UNDERSTANDING:THE CENTRALITY OF TRAUMA

HomelessnessImprisonment

Addiction Mental Health Problems

Violence andTrauma


GENDER-RESPONSIVE TREATMENT

• Creating an environment through:• site selection• staff selection• program development• content and material

• that reflects an understanding of the realities of the lives of women (and now, men), and

• addresses and responds to their strengths and challenges.

(Covington, S.S., & Bloom, B.E. (2006). Gender-responsive treatment and services in correctional settings. In E. Leeder(Ed.), Inside and out: Women, prison, and therapy. Binghamton, NY: Haworth.)

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Trauma Informed

Trauma Responsive

Trauma Specific


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Core Principlesof Trauma-Informed Care

• Safety (physical and emotional)

• Trustworthiness

• Choice

• Collaboration

• Empowerment

© S. Covington, 2016 (Fallot & Harris, 2008)

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Trauma-Informed Services

• Adjust the behavior of counselors, other staff, and the organization to support each person’s coping capacity.

• Allow survivors to manage their trauma symptoms successfully so that they are able to access, retain, and benefit from services.

© S. Covington, 2016 (Harris & Fallot, 2001)

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TRAUMA INFORMED

• Knowing:

• Training

• Understanding


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Trauma-Responsive Services

Doing:• Take into account the impact of trauma on

a person’s thinking, feelings, and behaviors.

• Avoid triggering trauma reactions and/or re-traumatizing an individual.

© S. Covington, 2016 (Harris & Fallot, 2001)

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Trauma-Specific Interventions

Services designed specifically:

• To address violence, trauma, and related

symptoms and reactions; and

• To facilitate recovery and healing.


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Healing Trauma:A Brief Intervention for Women

6 sessions

Exploring Trauma:A Brief Intervention for Men

6 sessions


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Beyond Trauma: A Healing Journey for Women

Trauma TheorySandra Bloom, M.D.Judith Herman, M.D.Peter Levine, Ph.D.Daniel Siegel, MD

Integrates cognitive-behavioral, expressive arts, guided imagery, and relational therapy.


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Beyond Trauma & Healing TraumaThemes

• Safety

• Empowerment

• Connection (Aloneness)

• Normal reactions (Shame)

• Mind-body connection

• Substance abuse

• Women-centered


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Healing Trauma 2nd EditionA Brief Intervention for Women6 Sessions on CD-Rom

• 6 sessions• 2 hours each• 8 – 10 women per group• Facilitator’s guide and Participant’s

workbook are on a CD-ROM allowing for easy duplication

• Participant’s workbook may be printed in English or Spanish


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INTRODUCTION

Part 1

• The World Women Live In

• Trauma

• The Therapeutic Environment

• The Program

• Design of Facilitator Guide

• Facilitation


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SESSIONS

Part 2


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Healing Trauma 2nd EditionA Brief Intervention for Women6 Sessions on CD-Rom

Session 1: Welcome and IntroductionSession 2: Power and AbuseSession 3: The Process of Trauma and Self-CareSession 4: The ACE Survey and AngerSession 5: Healthy RelationshipsSession 6: Love, Endings, and Certificates

© S. Covington, 2016 (workbook in English and Spanish)

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Format All Sessions

• Quiet time—“settling”

• Check-in

• Review of between-sessions activity

• Discussions

• Lectures

• Interactive exercises

• Closing, grounding exercise


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2 ACTIVITIESSession 1

Welcome and Introduction to the Subject of TraumaGoals:

• To begin to establish a group environment that is based on trust, safety, and respect

• To provide an introduction to the subject of trauma


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ACTIVITIES

Session 1

• Decorate Your Cover/Folder

• Five Senses


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Grounding Exercise:Five Senses


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Five Senses


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Power and Abuse

Goals:

• To explore the effects of gender roles on individuals

• To emphasize the connection between power and abuse

• To identify behavioral characteristics of people who abuse others


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ACTIVITIES

Session 2

• Gender Questions

• Power and Control Wheel

• Soothing Visualization


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Gender Expectations

• How are boys and girls treated differently as children?

• Social messages come from family members, communities, teachers, movies, music, and video games. What are the social messages that boys get? How are boys supposed to act?

• What are the social messages that girls get? How are girls supposed to act?


27(From the manual In Our Best Interest: A Process for Personal and Social Change. Available through Domestic Abuse Intervention Project, 206 W. 4th St., Duluth, MN 55806)

POWER AND CONTROL WHEEL


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The Process of Trauma and Self-CareGoals:

• To present the Process of Trauma

• To introduce a variety of grounding and self-soothing activities

• To explore the concept of personal boundaries


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ACTIVITIES

Session 3

• Grounding Activities

• Self-Soothing Chart

• Relaxing Activity


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Process of Trauma


Traumatic EventOverwhelms the physical and psychological coping skills

Response to TraumaFight, flight, or freeze

Altered state of consciousness, Body sensations, Numbing, Hypervigilance, Hyperarousal, Collapse

Sensitized Nervous SystemChanges in the Brain

Brain-Body ConnectionPsychological and Physical Distress

Current stressors, Reminders of trauma (triggers)Sensations, Images, Behavior, Affect (emotions), Memory

Emotional and/or Physical Responses

Retreat

IsolationDissociation

Depressive disordersAnxiety disorders

Harmful Behavior to Self

Substance use disorders

Feeding and eating disorders

Deliberate self-harmSuicidal actions

Harmful Behavior to Others

AggressionViolence

RagesThreats

Physical Health Issues

Lung diseaseHeart diseaseAutoimmune

disordersObesity

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Self - Soothing

Alone With Others

Daytime

Night Time


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The ACE Questionnaireand AngerGoals:

•To connect the women’s childhood traumatic experiences to their present behaviors

•To better understand the feeling of anger and how to manage it in healthy ways

•To revisit the Power and Control Wheel© S. Covington, 2016

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ACTIVITIES

Session 4

• Adverse Childhood Experiences Questionnaire

• Meeting a Feeling

• Anger Funnel

• Anger Triggers

• Palms Down, Palms Up


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ACE Study

Before age 18:

1. Recurrent and severe emotional abuse

2. Recurrent and severe physical abuse

3. Contact sexual abuse

4. Emotional neglect

5. Physical neglect


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ACE Study (cont.)

Growing up in a household with6. Both biological parents not being present

7. Your mother being treated violently

8. An alcoholic or drug user

9. A family member who is mentally ill, chronically depressed, or attempting suicide

10. A family member being imprisoned

(N = 17,000)


3636(R. Fallot, Ph.D.)

Death

Conception

Who

le L

ife P

ersp

ectiv

e

Mechanisms by Which Adverse Childhood Experiences influence Health and Well-being Through the Lifespan.

Adverse Childhood Experiences(www.ACEStudy.org)(www.cdc.gov/ace)


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Anger Funnel


HurtSadness

FearInsecurity

AngerRage

Violence

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Meeting a Feeling


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Anger Triggers


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Palms Down, Palms Up


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1 ACTIVITYSession 5

Healthy Relationships

Goals:

• To describe the elements of a healthy relationship

• To introduce the Wheel of Love


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ACTIVITY

Session 5

• Relationship Wheel


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Relationship Wheel


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Relationship Scale1. Similarities

2. Compatible Values

3. Ability to Deal with Change

4. Clear Communication

5. Effective Conflict Resolution


1 2 3 4 5 6 7 8 9 10

1 2 3 4 5 6 7 8 9 10

1 2 3 4 5 6 7 8 9 10

1 2 3 4 5 6 7 8 9 10

1 2 3 4 5 6 7 8 9 10

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Relationship Scale (cont.)

6. Effective Negotiation

7. Firm Personal Boundaries

8. Healthy Sexual Expression

9. Shared Quality Time

10.Friendship


1 2 3 4 5 6 7 8 9 10

1 2 3 4 5 6 7 8 9 10

1 2 3 4 5 6 7 8 9 10

1 2 3 4 5 6 7 8 9 10

1 2 3 4 5 6 7 8 9 10

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Wheel of Love


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Love, Endings, and CertificatesGoals:• To help women understand what

they bring to relationships• To use creative arts to enable each

woman to depict her history of love and how she would like to experience love in the future

• To explore how to end relationships respectfully

• To show appreciation for the group members and the group experience


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ACTIVITIES

Session 6

• Love Collage

• Appreciation


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How To End a Relationship• Find a safe place where you are not alone

if someone has abused you.

• Be direct and honest.

• Speak using “I” statements rather than “you” statements.

• Express the feelings you are experiencing in the present.

• Assume personal responsibility for change.

• Decide on the level of intimacy or contact you want with the person in the future.© S. Covington, 2016

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How To End a Relationship (cont.)

• Act in a timely fashion. Establish and stick to agreed-on timelines by which changes should occur.

• Let the other person know what you appreciate about her or him.

• Let the other person know what you appreciate about the relationship.

• Tell the other person what you wish you’d been able to do differently.


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Love Collage


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Trauma andAddiction

(constriction)

Healing andRecovery

(expansion)

Transformation


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What Makes a Difference?

• Creating a safe environment

• Listening to her story

• Empathy


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HEALING TRAUMAA BRIEF INTERVENTION FOR WOMEN6 SESSIONS ON CD-ROM

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Pre-Test Post-Test

Scor

e

CESD (t=4.79, df=52, pPCL (t=2.96, df=52, p=

PRE AND POST TREATMENT CHANGES IN SYMPTOMS OF DEPRESSION AND POSTTRAUMATIC STRESS

(September 2013 Annual Report: The Interpersonal Violence Project, Josephine M. Hawke, PhD) © S. Covington, 2016

55(Healing Trauma Evaluation Triannual Progress Report, Linda Frisman, July 1, 2015)

HEALING TRAUMAA BRIEF INTERVENTION FOR WOMEN6 SESSIONS ON CD-ROM


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References

• Hawke, J. (2013, September). September 2013 Annual Report: The Interpersonal Violence Project. Prepared for the Connecticut Women’s Consortium.

• Frisman, F. (June 1, 2015). Healing Trauma Evaluation Triannual Progress Report. Connecticut Women's Consortium.


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Exploring Trauma


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Gender-Responsive Treatment

• Creating an environment through:• site selection• staff selection• program development• content and material

• that reflects an understanding of the realities of the lives of women and girls, and

• addresses and responds to their strengths and challenges.


(S. Covington, “Women and Addiction: A Trauma-Informed Approach.” Journal of Psychoactive Drugs, SARC Supplement 5, November 2008, 377-385.)

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Guiding Principles for Gender-Responsive Services• Gender

• Environment

• Relationships

• Integrated Services

• Economic & Social Status

• Community


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THE ENVIRONMENT: CORE VALUES OF A TRAUMA-INFORMED SYSTEM OF CARE

• Safety: Ensuring physical and emotional safety

• Trustworthiness: Maximizing trustworthiness, making tasks clear, and maintaining appropriate boundaries

• Choice: Prioritizing consumer choice and control

• Collaboration: Maximizing collaboration and sharing of power with consumers

• Empowerment: Prioritizing consumer empowerment and skill-building

© S. Covington, 2016 Source: Roger Fallot, Ph.D.

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What’s Been Missing?

• Impact of male socialization on recovery

• Relational needs of men

• Abuse and trauma (experienced and perpetuated)


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• 6 sessions• 2 hours each• 8 – 10 men per group• Facilitator’s guide and Participant’s

workbook are on a CD-ROM allowing for easy duplication

• Participant’s workbook, entitled Building Resilience, may be printed in English or Spanish © S. Covington, 2016

Exploring TraumaA Brief Intervention for Men6 Sessions on CD-Rom

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Exploring TraumaA Brief Intervention for Men6 Sessions on CD-Rom

Session 1: Welcome and Introduction

Session 2: Exploring Trauma

Session 3: Thinking, Feeling, and Acting

Session 4: Beyond Guilt, Shame, and Anger

Session 5: Healthy Relationships

Session 6: Love, Endings, and Certificates

© S. Covington, 2016 (workbook in English and Spanish)

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Format Of All Sessions

• Quiet time—“settling”

• Grounding

• Check-in

• Review of between-sessions activity

• Discussions

• Lectures

• Interactive exercises

• Closing, grounding exercise© S. Covington, 2016

65

Session 1

Welcome and Introduction to the Subject of Trauma

Goals:

• To begin to establish a group environment that is based on trust, safety, and respect

• To provide an introduction to the subject of trauma


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ACTIVITIES

Session 1

• Looking at Trauma “out there”

• Introductory Word Cloud

• Five Senses

• Reflection


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Big “T” and little “t” Traumas List

• Not necessarily two distinct columns

• Beginning of process of mutual acceptance for participants

• You will guide this process by honoring men’s responses and exhibiting flexibility


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GROUP AGREEMENTS

• Modeling

• Guiding the process

• Empowering


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Participant IntroductionsWord Cloud


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Word Cloud


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Participant Word Cloud


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Participant Word Cloud


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Tools for Continuous Engagement

• Begin to expose men to the need for self-regulating

• Begin to provide them opportunity and tools for mindfulness practices

• Engage men in a simple exercise in “self-mastery”


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Five Senses


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Session 2

Exploring Trauma

Goals:

• To explore the effect of gender roles on how we view trauma

• To connect our childhood environments and upbringings to our present behaviors

• To emphasize the connections between power, control, abuse, and shame


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ACTIVITIES

Session 2

• Mindfulness Grounding

• ACE Questionnaire

• Power & Control Wheel

• Containment Practice


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ACE Study(Adverse Childhood Experiences)

• Collaboration between

• Centers for Disease Control and Prevention

• Kaiser Permanente HMO in California

• Largest study of its kind ever conducted

• 17,000 adult members participated


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ACE STUDY (CONT)

Before age 18:

1. Recurrent and severe emotional abuse

2. Recurrent and severe physical abuse

3. Contact sexual abuse

4. Emotional neglect

5. Physical neglect


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ACE STUDY(CONT.)

Growing up in a household with

6. Both biological parents not being present

7. Your mother being treated violently

8. An alcoholic or drug user

9. A family member who is mentally ill, chronically depressed, or attempting suicide

10. A family member being imprisoned

(N = 17,000)


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ACE STUDY (CONT.)

Results

ACEs still have a profound effect 50 years later, although now transformed from psychosocial experience into organic disease, social malfunction, and mental illness.

• Smoking• Alcoholism• Injection of illegal drugs• Obesity

© S. Covington, 2016 (Felitti 2002, 44-47)

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ADVERSE CHILDHOOD EXPERIENCES(WWW.ACESTUDY.ORG)(WWW.CDC.GOV/ACE)


Death

Conception

Who

le L

ife P

ersp

ectiv

e

Mechanisms by Which Adverse Childhood Experiences influence Health and Well-being Through the Lifespan.

(Felitti, V.J., et. al.)

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DECIPHERING MESSAGES ABOUT MANHOOD

• What are we taught about what it means to be a a man?

• What do these messages imply about women? About gay men?

• What do these messages say about anyone who is not “masculine” enough?

• What about privilege, power and control?


83(Duluth Domestic Abuse Intervention Project) © S. Covington, 2016

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POWER-NOT JUST A MATTER OF GENDER

• Have any of you witnessed the maltreatment of children, of women, of persons in minority groups, or of people of different sexual orientation?

• Have you ever seen people of different religious beliefs being mistreated? Have any of you had the experience of someone having power over you? Have any of you been abused as a child or experienced abuse as an adult? Have any of you witnessed discrimination in the workplace?

• Have any of you been discriminated against?


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POWER-NOT JUST A MATTER OF GENDER

• If any of you have felt oppressed or been denied equal treatment, what was it like living in a world where you felt that you had little or no power?

• How did this affect your emotions, your behaviors, and your self-esteem?

• If you haven’t experienced any of these issues, can you try to put yourself in the place of someone who has? What would it feel like?


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ACTIVITIES

Session 3

• Fight, Flight, Freeze

• Process of Trauma

• Breathing

• Calming

• Relaxation


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Session 3

Thinking, Feeling and Acting

Goals

•To explore how a man’s belief systems impact his response to trauma triggers

•To explore the (mal)adaptive behaviors men use to cope with trauma and possible alternatives

•To explore the use of grounding techniques to manage trauma trigger


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Traumatic Events Activity(From “out there” to “oh, that happened to me!”)

Big “T”

“If a boy __________________, he may grow up to think that he is _______________________.

Little“t”

“If a boy __________________, he may grow up to think that he is _______________________.


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Process of Trauma


Traumatic EventOverwhelms the physical and psychological coping skills

Response to TraumaFight, flight, or freeze

Altered state of consciousness, Body sensations, Numbing, Hypervigilance, Hyperarousal, Collapse

Sensitized Nervous SystemChanges in the Brain

Brain-Body ConnectionPsychological and Physical Distress

Current stressors, Reminders of trauma (triggers)Sensations, Images, Behavior, Affect (emotions), Memory

Emotional and/or Physical Responses

Retreat

IsolationDissociationDepression

Anxiety

Harmful Behavior to Self

Substance use disorders

Eating disordersDeliberate self-harm

Suicidal actions

Harmful Behavior to Others

AggressionViolence

RagesThreats

Physical Health Issues

Lung diseaseHeart diseaseAutoimmune

disordersObesity

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The Importance of Grounding

• A way for men to effectively manage triggers

• Creating new pathways in the brain

• Different strokes for different folks

• The connection between grounding, meditation and effective, long-term recovery

• Self-Mastery through teaching others


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Session 4Beyond Guilt, Shame and AngerGoals

• To explore the emotional and physical effects of guilt, shame, anger, and other emotions

• To understand the Spiral of Trauma, Addiction, Recovery, and Healing

• To learn ways to identify and manage emotions that may surface as a result of traumatic experiences


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ACTIVITIES

Session 4

• Review of Belief Systems

• Guilt and Shame

• Anger Funnel

• Spirals

• Trauma and the Body

• Creating Healing Stories


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Session 4: Beyond Guilt, Shame, and Anger

• Participant-Led Grounding Activity

• Working Through Guilt, Shame, and Anger

• Spiral of Trauma, Addiction, Recovery and Healing

• More than Survivors

• Art Activity: Creating Healing Stories •• Trauma and the Body

The Anger Funnel

Source: Helping Men Recover. Copyright 2011 by S. Covington, D. Griffin, & R. Dauer.



SPIRAL OF ADDICTION AND TRAUMA

Addiction & Trauma(constriction)

Recovery & Healing(expansion)

Downward Spiral Upward Spiral

Adapted from HWR, Covington, S. 1999

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Creating Healing Stories

• Emphasize the power of visualization

• Explore the power of creation

• Help men begin to visualize a different future

• Help men share their vision with others


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Participant Healing Masks


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Participant Healing Mask


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CREATING YOUR HEALING MASK• The front represents our Outer Self: Our actions,

relationships, behaviors.

• Draw a vertical line down the front, forming two equal halves.

• The left side represents your outer self in the past, while under the grips of your addiction.

• The right represents what you want your outer self to be in the future.

• Use words, symbols, drawings to describe what you want to represent on either half.


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CREATING YOUR HEALING MASK

• The back represents your Inner self: Your thoughts, beliefs and emotions.

• Draw a vertical line down the back, forming two equal halves.

• The left side represents your Inner self in the past, while under the grips of your addiction.

• The right represents what you want your Inner self to be in the future.

• Use words, symbols, drawings to describe what you want to represent on either half.


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ACTIVITIES

Session 5

• Boundaries

• Healthy Relationships

• Relationship Wheel

• STARE


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Session 5

Healthy Relationships

Goals

• To describe the elements of a healthy relationship

• To introduce the qualities of love, boundaries, and other aspects of healthy relationships

• To introduce a model for conflict resolution


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BOUNDARIES

• Physical boundaries activity

• Psychological boundaries

• Intellectual boundaries

• Emotional boundaries

• Connection between our boundaries and those of others


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DEFINITION OF A HEALTHY RELATIONSHIP

• Feel a greater sense of zest, vitality, and energy.• Empowers you to act, and you feel free to take

action in your life.• Each person has a more accurate perception of

herself and the other person. • Each person feels a greater sense of self-worth. • Each person feels more connected to the other

person and feels a greater motivation for connection with other people beyond those in this specific relationship.

© S. Covington, 2016 (Miller 1986, 1990)

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RELATIONAL NEUROSCIENCE

When we are cut off from others, our brains suffer. Can result in chronic irritability and

anger, depression, addiction, and chronic physical illness.

© S. Covington, 2016 (Banks 2015)

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CHARACTERISTICS OF AHEALTHY RELATIONSHIP

• Similarities• Ability to deal with

change• Compatible values• Effective, open

communication• Effective conflict/

anger resolution• Effective

negotiation• Firm personal

boundaries• Healthy sexual

expression• Shared quality time• Friendship

© S. Covington, 2016 (Covington and Beckett 1988)

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S.T.A.R.ECONFLICT RESOLUTION MODEL

• Start positive.

• Tell the person how you are feeling about the EVENT not about them personally. (No Blaming, Judging, Attacking, or Labeling)

• Ask for a solution.

• Review solution.

• End positive.© S. Covington, 2016

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Session 6

Love, Endings, and CertificatesGoals

• To use creative arts to enable each man to depict his history of love and how he would like to experience love in the future

• To explore how to end relationships respectfully

• To show appreciation for the group members and the group experience


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ACTIVITIES

Session 6

• Love Collage

• Appreciation


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Love Collage• Create your own Love collage, or think of a

male client of yours, and make one for him.

• On the left side, use words, pictures from a magazine, or symbols to describe your experience with love while addicted.

• On the right side, use words, pictures from a magazine, or symbols to describe how you would like to experience love in the future.

• Share with another person at your table.


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Certificates and Appreciation

• Please go around your table and share one thing you have learned from each other and one thing you admire about each other.


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EVIDENCE OF EFFECTIVENESS

• Evaluated in a community-based setting with mixed populations (substance use treatment and correctional)

• Evaluated in a prison setting with men serving long sentences for serious offenses

• Could change really be measured after just six sessions?


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EXPLORING TRAUMA: A BRIEF INTERVENTION FOR MEN(COMMUNITY)

Pre- to Post-Intervention OutcomesKnowledge/Skill Stress Anger Depression Anxiety

All improvements were statistically significant


(Linda Frisman & Aili Cordova Arisco. (2016, September 30). Evaluation Report: Exploring Trauma. Connecticut Women's Consortium.)

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EXPLORING TRAUMAMEN IN PRISON – FACILITATORS

Facilitators N = 13Age 40.2Age of 1st arrest 16.2Number of lifetime arrests 10.8Lifetime years of incarceration 21.0


(Messina & Burdon, 2017)

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EXPLORING TRAUMAMEN IN PRISON – FACILITATORS (CONT.)

Some high school education 39%

High school/GED46%

Some college 15%

© S. Covington, 2016 (Messina & Burdon, 2017)

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EXPLORING TRAUMAMEN IN PRISON – FACILITATORS (CONT.)

Ever spent time in SHU Yes = 85%Number of times in SHU M = 2.6 timesLifetime years spent in SHU M = 6.1 years

Murder/manslaughter offense 54%Attempted murder offense 23%Theft/robbery offense 15%Drugs offense 8



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EXPLORING TRAUMAMEN IN PRISON – PARTICIPANTS

Age 38.0Age of 1st arrest 14.2

Number of lifetime arrests 9.8Lifetime years of incarceration 18.2



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EXPLORING TRAUMAMEN IN PRISON – PARTICIPANTS (CONT.)

No high school education 5%Some high school education 32%High school/GED 40%Vocation certificate 20%Some college 20%College degree 1%


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EXPLORING TRAUMAMEN IN PRISON – PARTICIPANTS (CONT.)

Ever spent time in SHU Yes = 63.2%Number of times in SHU M = 1.6 timesLifetime years spent in SHU M = 5.5 yearsMurder/manslaughter offense 32%Attempted murder offense 20%Assault/rape offense 14%Theft/robbery offense 14%Other offense 20%



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EXPLORING TRAUMA-MEN IN PRISON

Patient Health Questionnaire

Presence of anxiety disorder ★

Depression subscale

Short Screen Scale: DSM-IV PTSD

K6 Brief Mental Health Screen

•Legend•★ Change (no statistical test of significance performed)• Significant Change• No Significant Change


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EXPLORING TRAUMAMEN IN PRISON –QUESTIONNAIRES

Buss-Warren Aggression Questionnaire

Physical aggression

Verbal aggression

Anger

Hostility

Indirect aggression

Legend★ Change (no statistical test of significance performed) Significant Change No Significant Change

(Messina & Burdon, 2017) © S. Covington, 2016

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EXPLORING TRAUMAMEN IN PRISON – QUESTIONNAIRES

Trauma Symptoms Checklist (TSC-40)

Dissociation Anxiety Depression Sexual abuse trauma index Sleep disturbance Sexual problems TSC-40 total score

Legend★ Change (no statistical test of significance performed) Significant Change No Significant Change(Messina & Burdon, 2017) © S. Covington, 2016

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WHAT MAKES A DIFFERENCE?

• Creating a safe environment

• Listening to his story

• Empathy



UPWARD SPIRAL

Addiction & Trauma(constriction)

Recovery & Healing(expansion)

Transformation

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FOR MORE INFORMATION• Carol Ackley• Phone: 612-961-3344• Email: [email protected]

Stephanie S. Covington, PhD, LCSWCenter for Gender and JusticeInstitute for Relational DevelopmentPhone: (858) 454-8528• Email: sc@stephaniecovington.comwww.stephaniecovington.comwww.centerforgenderandjustice.org


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