This chapter discusses comprehensive school crisis interventions, identifies the characteristics that define a crisis, finds ways to assess for the level of traumatic impact, and determines what interventions can be provided to help with response and recovery. It highlights the PREPaRE Model of crisis prevention and intervention. There are six general categories of crises: acts of war and/or terrorism; violent and/or unexpected deaths; threatened death and/or injury; human-caused disasters; natural disasters; and severe illness or injury. Children are a vulnerable population and in the absence of quality crisis interventions, there can be negative short- and long-term implications on learning, cognitive development, and mental health. Evidence-based interventions focusing on physical and psychological safety may be implemented to prevent a crisis from occurring or mitigate the traumatic impact of a crisis event by building resiliency in students. Crisis risk factors are variables that predict whether a person becomes a psychological trauma victim.
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This chapter talks about the presession preparation for Phase V which is the final phase of treatment in the family systems trauma (FST) model. There are two important core strategies within this presession preparation step. First, the FST therapist uses a tool developed within the FST model called the decision tree checklist. This tool will help the FST therapist and family determine the next treatment steps within five different options. Second, the FST therapist will use another tool developed in the FST model called a red flags checklist. The checklist contains the top “red flags” or most likely early warning signs for relapse for a particular family. To accomplish these goals, there are four mini-steps. These are as follows: (a) type and laminate final playbooks and troubleshooting countermoves checklist; (b) proactively initiate any check-ins as needed; (c) create a decision tree handout; and (d) create a red flags checklist.
Trauma-Informed Approaches to Eating Disorders is clearly a much needed and long overdue book about treatment, written by a diverse group of clinicians and carefully edited to focus on the needs and strengths of clinicians. The complexities and challenges that undergird, surround, and even haunt the nature, diagnosis, treatment, management, and understanding of eating disorders (EDs)-in-relation-to-trauma are so great, even for veteran clinicians, that they can leave practitioners at any level of experience feeling helpless and exhausted. This book, in a way that would be appreciated by practitioners of acceptance and commitment therapy, accepts the reality of those feelings and is committed to improving treatment, understanding, and compassion. The book is designed to foster respect for complexity and link it to humility in the presence of tragedy, tribulations, and suffering, framed all too often by our own shortcomings as healers. EDs are dangerous, ubiquitous, usually chronic in nature, and difficult to treat. Anorexia nervosa (AN) has the highest fatality rate (4%) of any mental illness. Bulimia nervosa reveals a fatality rate of 3.9%. EDs offer an enormous challenge to therapists because of their complexity, which includes severe medical risk, co-occurring anxiety, depression and personality disorders, an addiction component, and body image distortion—all of this within a mediadriven culture of thinness in which starving and purging can for some become lifestyle choices. This complexity is further exacerbated by the presence of painful life experiences or trauma. The book elucidates the connection between trauma and EDs by offering a trauma-informed phase model, as well as chapters describing the ways in which various therapeutic models address each of those phases. It offers an in-depth exposition of a fourphase model of trauma treatment.
This chapter talks about Phase I of the family systems trauma (FST) treatment model: Identify Symptoms (Stressors) and Set the Goals for Therapy. The main goals and objectives of Phase I are to (a) identify the child’s or adolescent’s problem symptom through an FST technique known as a stress/symptom chart; (b) use what is called a seed/tree diagram to illustrate the causes of the child’s or adolescent’s symptoms through what are called unhealthy undercurrents and four toxic seeds (c) ask all family members to pick their top problem symptoms and toxic seeds that they want to address with rationale; and (d) set the goals of therapy. The chapter provides case example illustrating six key mini-steps in Phase I: the symptom/stress chart; the seed/tree diagram; the top seed and symptom selections; the choice between stabilization and direct trauma work first; setting the goals of therapy; and consolidate gains using ethnographic interviews.
This chapter deals with structural dissociation in the treatment of trauma and eating disorders. Dissociation is the inability to stay present when intolerable feelings and mental contents are activated. It is a way of making the overwhelming less overwhelming. A dissociative process is an unconscious attempt to sequester the intolerable away into the recesses of the mind, never to be contacted again. The chapter uses structural dissociation theory of the personality. Structural dissociation theory distinguishes two action systems that govern human behavior. The first action system is daily life and second action system is defense. The theory defines three levels of dissociation, primary dissociation, secondary dissociation, tertiary dissociation. Treating dissociation is a phase-oriented approach. The first phase is stabilization and preparation for trauma reprocessing. This is where the dissociation is treated. The second phase is reprocessing the painful memories. The third phase is full consolidation and integration.
Finding ways to complete Phase 1 of the eye movement desensitization and reprocessing protocol, history and treatment planning, presents unique challenges when working with children. The therapist often has many other sources of information about the child's trauma history; still, developing a shared understanding of the trauma and the impact of trauma is just as important in child therapy as it is in the adult protocol. This chapter presents an option for using storytelling, props, and metaphor to elicit trauma history from a child in a way that is sensitive to their age and their window of tolerance for distress. Gathering trauma history from the child early on in treatment in a play-based and developmentally informed way creates an opportunity to obtain some of the painful information while keeping the child feeling emotionally grounded and safe.
TraumaPlay is a flexible, sequential, play therapy model designed for treating traumatized and attachment-disturbed children and teens. An integration of TraumaPlay and eye movement desensitization and reprocessing (
EMDR) functions as a one–two power punch combination as the power of play is recognized as the child's most natural form of adaptive information processing and encourages the full-body somatic experiencing of new neurophysiological states while desensitizing and reprocessing hard things. The overarching goals of TraumaPlay include leaching the emotional toxicity out of clients' traumatic experiences, creating a more coherent narrative of these life events, and deepening relational resources. Getting through the child client's layers of protection requires developmental sensitivity, titration, and creativity. Unlocking a traumatized child's healing may take more than one key, so pairing TraumaPlay and EMDRtogether can maximize the effectiveness of each. TraumaPlay therapists enhance safety and security through both nondirective play therapy methods and directive play therapy interventions.
- Go to chapter: EMDR and Expressive Arts Therapy: How Expressive Arts Therapy Can Extend the Reach of EMDR With Complex Clients
EMDR and Expressive Arts Therapy: How Expressive Arts Therapy Can Extend the Reach of EMDR With Complex Clients
The utilization of eye movement desensitization and reprocessing (
EMDR) therapy alone, as Francine Shapiro has discussed, presents challenges when working with children, particularly with complex relational trauma. Limits for the effectiveness of EMDRinclude the developmental immaturity of the child and missing adaptive information, the impact of trauma on skill development, and lack of trust due to the impact of relational trauma. This chapter explores how creative arts therapy holds the potential as a special form of mentalization therapy that can support and strengthen the skills required for success in EMDRin Phase 4 processing. This approach emphasizes how the expressive arts, when used strategically, can extend the reach of EMDRby utilizing the indirect dyadic process of art making within a therapeutic relationship increasing trust, building metacognitive functioning, elevating concrete thinking through experiential learning, and taking a curious, open, and playful stance that helps grow self-reflective capacity.
This chapter talks about Phase III of the family systems trauma (FST) treatment model: Co-create Playbooks. The primary goals for Phase III are to (a) ask the family to present their top technique findings from their homework lead sheet; (b) show wound and/or safety playbook recommendations from pre-session preparation; (c) co-create the wound and/or safety playbook(s) together (FST therapist, child, and family); and (d) predict relapse if the family tries to implement the contract before troubleshooting and dress rehearsals are completed in the next session. Phase III has an average length of stay of one to two 2-hour sessions or two to three 1-hour sessions. The four mini-steps of this phase show how to co-create a finalized playbook(s) that will be ready for testing through role-plays and troubleshooting. There can be more than one playbook co-created depending on family or when using a two-track process (safety and wound playbook side-by-side).
In the three decades since Francine Shapiro introduced the model, adaptive information processing (
AIP) and eye movement desensitization and reprocessing ( EMDR) have provided mental health clinicians with a method for conceptualizing clients' responses to traumas as adaptive and protective without diminishing the pain that comes from holding stored trauma. For those working with child clients, the goal of healing emotional and relational wounds becomes substantially more attainable when caregivers also come to view children's trauma responses as adaptive and protective, all the while developing increasing capacity for being with their children's woundedness. EMDRtherapists who provide family-based play therapy need ways to establish and monitor safety within family systems in order for the integration of these modalities to offer their full power. This chapter aims to offer sandtray as a modality that allows for this integration. Sandtray offers a common language for all who engage.