This chapter describes key steps, with scripts, for the phases of therapy with a dissociative identity disorder (DID) client, and for an eye movement desensitization and reprocessing (EMDR) session with a DID client. In brief, the method employs the artful use of EMDR and ego state therapy for association and acceleration, and of hypnosis, imagery, and ego state therapy for distancing and deceleration within the context of a trusting therapeutic relationship. It is also endeavoring to stay close to the treatment guidelines as promulgated by the International Society for the Study of Trauma and Dissociation. The acronym ACT-AS-IF describes the phases of therapy; the acronym ARCHITECTS describes the steps in an EMDR intervention. Dual attention awareness is key in part because it keeps the ventral vagal nervous system engaged sufficiently to empower the client to sustain the painful processing of dorsal vagal states and sympathetic arousal states.
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- Go to chapter: ACT-AS-IF and ARCHITECTS Approaches to EMDR Treatment of Dissociative Identity Disorder (DID)
The important elements of the Eye Movement Desensitization and Reprocessing (EMDR) and Phantom Pain Research Protocol are client history taking and relationship building, targeting the trauma of the experience, and targeting the pain. This protocol is set up to follow the eight phases of the 11-Step Standard Procedure. This chapter presents a case series with phantom limb patients obtained a few before and after EMDR magnetoencephalograms (MEGs) at the University of Tübingen, Germany on arm amputees that show the presence of phantom limb pain (PLP) in the brain images before EMDR and the absence of it after EMDR. In these case series, it is found that PLP in leg amputations is much easier to treat than arm amputations, likely due to the much more extensive and complex arm and hand representation in the sensory-motor cortex compared to the leg and foot representation.
- Go to chapter: Chronic Brain Impairment: A Reason to Withdraw Patients From Long-Term Exposure to Psychiatric Medications
Chronic Brain Impairment: A Reason to Withdraw Patients From Long-Term Exposure to Psychiatric Medications
The syndrome of chronic brain impairment (CBI) can be caused by any trauma to the brain, including months or years of exposure to one or more psychiatric medications. Although all psychiatric drugs have specific initial biochemical effects, over time other neurotransmitter systems then react to the initial drug effects and, as a result, broader changes begin to take place in the brain and in mental functioning. Psychiatric drug CBI, like all CBI, is associated with generalized brain dysfunction and/or damage, and therefore manifests itself in an overall compromise of mental function. The concept of CBI also resembles the concept of organic brain syndrome (OBS). The only effective treatment for CBI is a carefully conducted withdrawal from all psychiatric drugs, as well as all other psychoactive substances. A variety of stressors and trauma can cause chronic brain impairment or CBI. Long-term exposure to psychiatric drugs frequently results in CBI.
The EMDR Accelerated Information Resourcing Protocol (EMDR-AIR Protocol®) is designed to look for that learned generational reaction to trauma that the client is currently using to cope with the current situation while, at the same time, tapping into the historical strengths and resources that enabled survival. These resources are found through the rapid accessing of client history by using Multi-Tiered Trans-Generational Genogram (MTTG). The MTTG seeks to look at family history, birth dates, cultural information, transgenerational behavioral patterns, lifestyle, untold secrets, multi-tiered transgenerational trauma and sexual history, belief systems, historical events, and styles of celebration. The main objectives for the EMDR-AIR Protocol are to recognize potential stuck components in the EMDR processing that are related to trans-generationally transmitted behavioral and emotional patterns and to enable the client to step away from the crisis so as to begin the process of reprocessing with EMDR, with the chronologically most relevant Touchstone Event.
Protocol for excessive grief is to be used when there is a high level of suffering, self-denigration, and lack of remediation over time concerning the loss of a loved one. Eye Movement Desensitization and Reprocessing (EMDR) does not eliminate healthy appropriate emotions, including grief. The protocol is similar to the Standard EMDR Protocol for trauma. The goal of this work is to have clinicians’ client accept the loss and think back on aspects of life with the loved one with a wide range of feelings, including an appreciation for the positive experiences they shared. Francine Shapiro often brings up the issue: How long does one have to grieve? She asks us to not place our limitations on our clients as this would be antithetical to the notion of the ecological validity of the client’s self-healing process.
- Go to chapter: Life Course Systems Power Analysis: Understanding Health and Justice Disparities for Forensic Assessment and Intervention
Life Course Systems Power Analysis: Understanding Health and Justice Disparities for Forensic Assessment and Intervention
This chapter describes the life course pathways of cumulative health and justice disparities experienced by historical and emerging diverse groups, which is often found among forensic populations. It helps readers articulate a life course systems power analysis strategy for use with forensic populations and in forensic settings. The chapter demonstrates how a data-driven and evidence-based assessment and intervention plan can be used to address clinical and legal issues using case examples of an aging prison population. It uses older people in prison to illustrate the complex life course of health and social structural barriers and needs of incarcerated people who have histories of victimization and criminal convictions. Information about trauma and justice, especially related to the trauma of incarceration, which in itself is often a form of abuse, especially when frail elders are involved and they are at increased risk for victimization, medical neglect, and “resource” exploitation is presented.
This chapter serves as a one-stop resource where therapists can access a wide range of word-for-word scripted protocols for Eye Movement Desensitization and Reprocessing (EMDR) practice, including the past, present, and future templates. These scripts are conveniently outlined in an easy-to-use, manual style template for therapists, allowing them to have a reliable, consistent form and procedure when using EMDR with clients. There is a self-awareness questionnaire to assist clinicians in identifying potential problems that often arise in treatment, allowing for strategies to deal with them. Some clients may be able to talk about their trauma; however, the thought of processing it with the Standard EMDR Protocol may seem too overwhelming. In cases such as these, having the client develop a resource to address the “fear of the fear” may reduce the anxiety of reprocessing the traumatic memory.
The purpose of remembering trauma is to help us get free from the past. The amygdala is a small part of the brain that aids in processing highly charged emotional memories. Trauma memories seem to be encoded differently than regular memories. Memory is a complex topic with many ongoing controversies in the scientific field. Sexual trauma makes an imprint on the psyche that can permeate one’s very being. Holographic reprocessing (HR) involves discovering and exploring personal holograms by working to identify the patterns in our life. These experiences form the basis of limiting or negative beliefs, as well as protective behaviors or coping strategies. Experiential hologram refers to a theme of experiences that emerge and are reenacted in people’s relationships. Trigger is an anxiety response or the activation of the fight, flight, or freeze system in order to mobilize the person to get out of danger.
Eye Movement Desensitization and Reprocessing (EMDR) Scripted Protocols: Basics and Special Situations
Scripting is a way to inform and remind the Eye Movement Desensitization and Reprocessing (EMDR) practitioner of the component parts, sequence, and language used to create an effective outcome. As EMDR is a fairly complicated process, this book provides step-by-step scripts that will enable beginning practitioners to enhance their expertise more quickly. The book is separated into nine parts. The Client History part represents the first of the eight phases of EMDR treatment. The ability to gather, formulate, and then use the material in the intake part of treatment is crucial to an optimal outcome in any therapist’s work. Part II includes an important element of the Preparation Phase that addresses ways to introduce and explain EMDR, trauma, and the adaptive information processing (AIP) model. The importance of teaching clients how to create personal resources is the topic of Part III. Here, an essential element of the Preparation/Second Phase of EMDR work is addressed to ensure clients’ abilities to contain their affect and remain stable as they move through the EMDR process. Part IV shows how to work with clients concerning the targeting of their presenting problems when the usual ways do not work such as usage of drawings to concretize clients’ conceptualization of their issues and usage of an alternative initial targeting method. Part V includes protocols that have been scripted based on the material that appears in Francine Shapiro’s EMDR textbook. Parts VI and VII address EMDR and early intervention procedures for man-made and natural catastrophes for individuals and groups. Performance enhancement and clinician’s self-care are dealt with in the final two parts of the book.
- Go to chapter: Introducing Adaptive Information Processing (AIP) and EMDR: Affect Management and Self-Mastery of Triggers
Introducing Adaptive Information Processing (AIP) and EMDR: Affect Management and Self-Mastery of Triggers
It is helpful to introduce the concept of Adaptive Information Processing, to help Eye Movement Desensitization and Reprocessing (EMDR) clients understand the nature of how our brains work. The second phase of EMDR is called the Preparation Phase. When EMDR first started, practitioners often went from Phase 1-Client History Taking to Phase 3-Assessment Phase with just a brief moment to introduce the client to the specifics such as the mechanics of EMDR, including bilateral stimulation (BLS), sitting position, and stop signals. For some clients, this has worked well, however, as time went on, practitioners often reported that something more was needed before beginning desensitization and reprocessing. The idea of tapping into the client’s natural resources began within the Standard EMDR Protocol itself. In the face of man-made or natural catastrophes, practitioners have found that building resources are essential aspects of working with recent trauma, especially for children.
- Go to chapter: The Wreathing Protocol: The Imbrication of Hypnosis and EMDR in the Treatment of Dissociative Identity Disorder, Dissociative Disorder Not Otherwise Specified, and Post-Traumatic Stress Disorder
The Wreathing Protocol: The Imbrication of Hypnosis and EMDR in the Treatment of Dissociative Identity Disorder, Dissociative Disorder Not Otherwise Specified, and Post-Traumatic Stress Disorder
The Wreathing Protocol has been designed as a thorough, planful, and parsimonious way to protect trauma patients from decompensation during the middle phase of trauma. It presumes sophistication and fluency on the part of the clinician who ought to be skilled in advanced hypnosis techniques, ego state therapy, and controlled fractionated abreactions without the use of formal hypnosis or eye movement desensitization and reprocessing (EMDR). To best illustrate the discrete interventions amidst the complexity of dissociative responses, the operationalized EMDR protocols will be exemplified in the paradigmatic dissociative disorder, dissociative identity disorder (DID); however, they also apply for lesser dissociative disorders, dissociative disorder not otherwise specified (DDNOS) and post-traumatic conditions particularly when using an ego state model as an organizing principle in the treatment. Wreathing Protocol represents a skeletal structure around which complex dissociated elements of personality can regroup, blend, and integrate after detoxification and transformation of the traumatic material.
Early group Eye Movement Desensitization and Reprocessing (EMDR) intervention following trauma may facilitate adaptive processing of traumatic event(s) and help prevent consolidation of traumatic memories following large-scale natural or man-made disaster. Group EMDR may also be usefully applied with homogenous groups, and where professionals are exposed to high levels of work-related stress. Writing is a useful clinical tool in narrative therapy, bibliotherapy and writing therapy. Written journaling to monitor behavior is commonly practiced between sessions of cognitive behavioral therapy. The Written Workbook Protocol allows close adherence to the EMDR Standard 3-Pronged Protocol at all steps until the end of the processing phase, when constraints of the group format come more dramatically into play. Cognitive interweaves necessary to clear potential blocks to processing are more difficult to tailor and implement in group. The potential power of “group cognitive interweaves” emerged spontaneously during multifamily group EMDR with tsunami survivors in Thailand.
Since people with dissociative disorders (DD) rely on autohypnotic defenses, this version of Safe Space Imagery (SSI) uses hypnotic language to teach the client to block out intrusive thoughts and feelings and learn how to get their body to a state of deep relaxation. Regular practice of SSI supports the client’s stability and becomes a coping skill used for self-soothing, symptom management, and eventually as an integral part of trauma processing. The SSI method is different from the Safe Place Protocol that is routinely taught in the eye movement desensitization and reprocessing (EMDR) Institute Basic Training. The SSI protocol is useful for many clients with trauma histories and for those with DDs. In SSI exercise one part volunteers to go first while the others watch. This approach works well when one want to teach a client SSI and there are protective or suspicious parts that need to stay hypervigilan.
Clients with dissociative disorders (DD) or complex post-traumatic stress disorder (C-PTSD) often have issues concerning the “therapist’s trustworthiness, inherent dangerousness and potential abusiveness”. Goals of this exercise are the following: Increase cooperation between the therapist and the dissociative system by communicating knowledge about the therapist, the office, and experience in treatment to all parts of the system; and maintaining the client’s dual awareness while processing information concerning trauma in the past. It is essential for these clients to maintain their connection to the therapist and the present. Dual attention stimulation (DAS) is used to install and communicate the information. Examples of things to notice are the following: pictures on walls, the carpet, a stuffed animal, the wallpaper, where therapist sits, where client sits, typical sounds, and any things in therapist’s office that indicate it’s not the past. Safety-oriented information is also important.
Clients who have experienced severe trauma often feel that there is a lack of safety in their lives. Therefore, it is helpful to have an uncontaminated place where it is possible for the client to meet and get acquainted with the ego states and a place where they can meet with each other and work together. The use of the Workplace for stabilization activities promotes awareness of the ego states or parts and also develops coconsciousness between the parts. Client and ego states’ reactions to these ideas that support communication and connection range across the affective spectrum from surprise to relief, feelings of normalcy, disapproval, disgust, revulsion, somatic reactions, or all of the above. Many types of workplaces or conference rooms are suggested in the literature in which the client sits at an oval table and invites ego states to sit in the empty chairs around the table.
This chapter serves as a one-stop resource where therapists can access a wide range of word-for-word scripted protocols for Eye Movement Desensitization and Reprocessing (EMDR) practice, including the past, present, and future templates. These scripts are conveniently outlined in an easy-to-use, manual style template for therapists, allowing them to have a reliable, consistent form and procedure when using EMDR with clients. When a client seems too overwhelmed by the trauma and cannot focus on anything else, having them focus on positive things in their lives may help them regain a more appropriate and positive perspective. Once stabilized, clients may be ready to address the trauma with the Standard EMDR Protocol. If the client brings up a negative thought, redirect to the last positive thought and continue focusing on more positives. Repeat this process until the client feels strong enough to begin addressing the traumatic issue. This may take several sessions.
This graduate-level, introductory textbook provides instructors and students with a comprehensive overview of the profession of clinical mental health counseling (
CMHC). Designed to cover the Council for the Accreditation of Counseling and Related Educational Programs ( CACREP) 2016 Standards and to provide an inclusive overview of the work of professional counselors, the book offers an in-depth exploration of the professional knowledge, skills, current issues, and dynamic trends in professional counseling that are essential parts of the educational journey of emerging clinicians. It provides readers with practical, applicable, real-world information upon which they can build through-out their programs of study and practice. Issues such as strength-based approaches, the various settings in which clinical mental health counselors may practice, record keeping and documentation, advocacy, professional roles, third-party payers and managed care, and self-care and professional development are vitally important to new counselors, and these subjects often are glanced over in an information-packed curriculum. In addition, the book covers the topics of crisis, disaster, and trauma, which constitute relatively new areas of emphasis within the CACREPStandards. Conceptually, it book looks at the history, roles, functions, settings, and contemporary issues of counseling through the lens of human ecological and integrated systems-of-care approaches. Unique to this particular textbook, and in juxtaposition to an ecological perspective of the individual, a focus on integrated systems of care in clinical mental health endeavors provides students with knowledge and skills that can help them to move seamlessly into the current world of work as clinical mental health counselors. The textbook is comprised of five sections, spanning the following clusters of CMHC-relevant information: (a) Introduction to Professional Counseling and Clinical Mental Health Counseling, (b) Working With Clients, (c) Practice Issues, (d) Working Within Systems, and (e) Client-Care and Self-Care Practices.
This chapter presents the conceptual framework for understanding eye movement desensitization and reprocessing (
EMDR) therapy. It begins with a review of selected aspects of four models of psychotherapy that historically most directly support understanding the evolution of EMDR therapy. The early history and evolution of EMDR therapy in turn have been strongly associated with the search to understand and treat the relationship between trauma and dissociation. Classical behavior therapy views posttraumatic stress disorder (PTSD) through the lens of conditioning in which a powerful conditioned association is formed between specific cues were present at the time of adverse or traumatic experiences and the intense state of alarm evoked by the experience. In EMDR therapy, various strategies can be employed to support the goals of stabilization and symptom reduction. Some stabilization strategies commonly used in EMDR therapy were developed in other traditions such as progressive relaxation, self-hypnosis, biofeedback, and meditation.
This book provides a comprehensive model for effectively blending the two main postmodern brief therapy approaches: solution focused and narrative therapies. It harnesses the power of both models the strengths-based, problem-solving approach of solution focused therapy (SFT) and the value-honoring and re-descriptive approach of narrative therapy to offer brief, effective help to clients that builds on their strengths and abilities to envision and craft preferred outcomes. The book provides an overview of the history of both models and outlines their differences, similarities, limitations, and strengths. It then demonstrates how to blend these two approaches in working with such issues as trauma, addictions, grief, relationship issues, family therapy, and mood issues. Each concern is illustrated using a case study from practice that focuses on individual adults, adolescents, children, or families. Sample client dialogues and forms are included to help the clinician guide clients in practice. SFT has provided therapists with new tools for working with clients who are dealing with substance abuse. The book provides a summary of research findings that have shown the effectiveness of the solution focused approach over the problem-focused approach. The narrative model invites clients to construct a new presentation in a problematic story (narrative) and develop a script for a preferred future (solution focused), with a newly crafted character, instigating new strategies for actions (solution focused), based on exceptions.
Today’s practitioners of the healing arts have the challenge of restoring faith and hope in communities and cultures that have been ravaged by naturally occurring and person-made events. There is a psychological and emotional cost to those at the epicenter of trauma and disaster; it is a wounded soul. Professional helpers at all levels of service have the task of bringing balance back to the mind, body, and spirit of individuals, groups, and communities affected by trauma and disaster. Thus, taking care of the soul or being conscious of our spiritual health is critical to personal survival. Miller suggests that mental health professionals must first be comfortable with exploring their own spirituality before delving into their clients’ existential and spiritual experiences of loss, grief, life-threatening illness, and trauma. Disaster mental health professionals can play a key role in the challenge of promoting faith and hope for trauma and disaster survivors.
Stories get constructed through experiences of life. The author discusses how clients who experience trauma can write new stories so that their values are honored as they distance themselves from the event. She shares Yvonne Dolan’s conversation about her work with sexual abuse survivors and saying to all of us who attended. Dolan’s work, along with narrative therapy’s externalizing of the problem ideas, equipped the author with new ways of reaching clients so that the relationship with the intruding problem was changed. The author researched structures of novels and combined some ideas from narrative therapy and solution focused therapy into an exercise that she explains in the chapter. The exercise is designed to help readers develop insight into their own coping strategies, so they can see how the therapy performs.
This chapter discusses the psychosocial influences of environmental and natural disasters on individuals and communities. Environmental and natural disasters are envirobiopsychosocial by nature. Many times there are contributing factors involving substantial interaction effects between the person and the environment with which he or she lives. Thus, it is of paramount importance for mental health professionals to recognize that disaster survivors do in fact have some degree of control and responsibility over their internal and external environment for healing traumatic experiences. The chapter addresses commonly occurring environmental and natural disasters and offers disaster mental health counselor’s important issues for consideration based on the typology of each disaster. Four major events are discussed: earthquakes, floods, hurricanes, and tornadoes. Mental health counselors may best serve clients involved in environmental and natural disasters by being culturally attuned.
- Go to chapter: Trauma and Spirituality: Implications for Counselor Educators, Supervisors, and Practitioners
Integrating spirituality within trauma and disaster mental health counseling emerges as one of the most challenging, yet misunderstood, areas in counselor education and professional practice. The search for personal meaning in one’s chronic illness, disability, or traumatic experience is thought to be an existential and spiritual pursuit. This chapter explores the implications of infusing the client’s spirituality into counseling practice with the intention to bring some level of meaning to extraordinary stressful and traumatic events. It offers guidelines for mental health counselors, counselor educators, and clinical supervisors for integrating spirituality into disaster mental health services. Spirituality within the multicultural-centered perspective enhances other cultural attributes such as race, ethnicity, gender, disability, and sexual orientation, and it is vital for understanding the holistic needs of the individual. Advancing the theories and practice of spiritual integration, particularly for clients with chronic medical/physical/mental illnesses and disabilities, is essential for healing trauma.
This chapter offers an overview of the dynamic process of psychosocial adjustment and adaptation to chronic illnesses and disabilities (CIDs) and the key variables in coping and resiliency with such chronic and persistent mental and physical health conditions. It describes recommended treatment interventions to assist mental health counselors in helping others adjust in post disaster recovery and the rehabilitation process. There are a number of stage models offered in the literature regarding psychosocial adaptation to disability, trauma, crisis, grief, and loss. The overall intent and purpose of stage models of disability are to assist mental health practitioners with a conceptual clinical perspective of how the individual perceives the consequences of his or her CID and where he/she is at in terms of adjustment, response, and adaptation. It can also assist mental health practitioners in treatment planning and deciding what course of action needs to be facilitated through the rehabilitation process.
The instructions for Resource Development and Installation (RDI) with children/teens need to be adapted in developmentally appropriate language. RDI should only be used when the child/teen does not appear to have adequate tolerance to use eye movement desensitization reprocessing (
EMDR) therapy. Bilateral stimulation (BLS) is used to install the resource. The BLS is stopped if the child/teen associates to negative material. The therapist may want to encourage the child/teen to set aside the negative material in an imaginal container before proceeding. In addition, the therapist may choose to use very short sets to decrease the possibility of activating negative material. During trauma-focused EMDR therapy desensitization, the therapist may use previously installed resources as interweaves to address blocked responses to treatment. The therapist should be aware that if he or she chooses to use RDI during desensitization, processing of traumatic material has stopped.
In the eye movement desensitization and reprocessing (
EMDR) community the issue of dissociation is the only topic that seems to stir up even more misunderstanding and controversy than addiction. This chapter shares some of the best practices for demystifying dissociation and working with it responsibly in EMDRtherapy as a normal phenomenon that accompanies trauma, especially complex trauma. This chapter discusses the practice of mindfulness necessary for the work and notes the imperative of teaching mindfulness, or the art of returning to the present moment, to clients who struggle with addiction. It also explores specific exercises for how one can guide clients through this process of validation followed by action, wherever they are in the phases of EMDRtherapy. The chapter presents a case that begins to further connect the dots about how this material about dissociation is relevant to working with addiction.
- Go to chapter: EMDR Therapy Case Conceptualization: DSM-5 and ICD-10 Diagnoses Specific to Infants Through Adolescents
EMDR Therapy Case Conceptualization: DSM-5 and ICD-10 Diagnoses Specific to Infants Through Adolescents
With case conceptualization organized through diagnoses specific to infants through adolescents, this chapter explores the advanced application of Eye Movement Desensitization and Reprocessing (EMDR) therapy to other clinical, emotional, developmental, and behavioral issues. The chapter provides an overview of using EMDR therapy when working with children who have symptoms of specific mental health disorders, trauma, stressful life experiences, and educational issues. It also provides information on working with children with sexually reactive or trauma-reactive behaviors. Children with cognitive challenges can benefit immensely from EMDR therapy. In fact, it is one author’s assessment that EMDR therapy is the treatment of choice for children with cognitive challenges because the therapy does not require the client to have advanced verbal skills. Children with attention deficit hyperactivity disorder (ADHD) are potentially challenging in therapy, and it is important for the therapist to be aware of his or her own responses to the child.
The goals of the Preparation Phase are to explain Eye Movement Desensitization and Reprocessing (EMDR) therapy to children and caregivers, assess the client’s resources to prepare for trauma reprocessing, and to teach the "mechanics" of EMDR therapy. This chapter addresses how presenting EMDR therapy to children and teenagers may vary. Therapists can assess children’s resources and skills through direct questioning, interactional activities, and observation. The child’s responses from Phase 1 can be incorporated and expanded during the Preparation Phase. Professionals working in the child welfare system have an opportunity to work with attachment issues and model healthy adult-child interactions. Explaining the mechanics of EMDR therapy entails describing and demonstrating bilateral stimulation (BLS), establishing the client’s Safe/Calm Place for use during the Desensitization Phase, and teaching emotional literacy. Also, the therapist educates the client with self-soothing/calming techniques, the Stop Signal, the Distancing Metaphors, containers, and resources during the Preparation Phase.
Children come to psychotherapy for a variety of stressful or traumatic situations that are unique to children. This chapter is designed to help the clinician conceptualize these child-specific situations through all eight phases of Eye Movement Desensitization and Reprocessing (EMDR) therapy. It addresses how to use EMDR therapy with child/teen-specific situations. There are many issues infants, toddlers, children, and adolescents face when their parents divorce. Once the child learns resourcing and containment skills, the therapist can then have the child focus on any anticipatory anxiety about testifying. EMDR therapy works well with infants, toddlers, children, and adolescents in dealing with their sense of loss, safety, power, and control in a divorce situation. An EMDR therapy child/adolescent therapist is encouraged to use and weave together other clinical modalities and techniques within the eight phases of treatment to treat the many common issues that children/teens bring to psychotherapy.
This chapter defines disability in an international context and compares global disability issues in high-resource and low-resource countries. It discusses the relevant disability demographics, constructs, and resources that relate to global perspectives of disability issues and the expanding role of rehabilitation counselors (RCs). According to the UN, comparative examinations of disability-related legislation indicated that “only 45 countries have anti-discrimination and other disability-specific laws” thereby highlighting the urgent need to advocate for disability-friendly policies worldwide. These important issues relate directly to theoretical perspectives on disability, definitions of disability, and the role of RCs. The chapter addresses the awareness of current global contextual factors and other issues affecting disability such as culture, poverty, trauma, crisis, large-scale disaster, HIV and AIDS, and psychosocial issues across the life span. The WHO has published guidelines for community-based rehabilitation (CBR), including a matrix that covers the five components of health, education, livelihood, social dimension, and empowerment.
Social workers, both in the community and within the Veterans Administration (VA), provide a comprehensive range of services to a broad demographic of veterans. Service provision for veterans can address a wide range of issues including aging, homelessness, reintegration, sexual assault, physical and psychological war injuries, and substance abuse. Research-informed practice allows social workers to effectively address the special needs of veterans. This chapter discusses the landscape of social work practice with veterans and the interconnectedness of research, policy, and service delivery. It offers an introduction to working with veterans from a practice, policy, and research perspective. Social workers should have a working knowledge of military culture, the impact of deployment, subsequent redeployments, reintegration, and adjustment to civilian life. It is essential for social workers to have knowledge about the physical and psychological aspects of trauma, particularly war-related trauma.
This chapter discusses the need for the clinician to acquaint herself with the patient’s culture, mores, lore, and metaphors so as to understand the patient within a meaningful context. It describes that successful treatment includes both reprocessing of trauma and the reconstruction of a coherent, meaningful life narrative. Damaged self-esteem, identity, and alienation in second generation offspring of survivors of anti-Semitic atrocities, such as European pogroms and the Holocaust, can be addressed with eye movement desensitization and reprocessing (EMDR) treatment. The EMDR trauma therapist working with one or multiple generations of genocides needs to be familiar with the impact of mass genocide on the psyche, the impact of internalized oppression, and the factors that continue to impact upon offspring’s identity formation. The chapter reviews the clinical case which describes the treatment of a second generation patient whose family survived Ukranian pogroms, World War II, rampant anti-Semitic atrocities, and immigration-related trauma.
This chapter examines five areas of social work that have been primarily developed in more recent social work eras: lesbian, gay, bisexual, transgender, and queer (LGBTQ) rights, ethics, environmental social work, trauma and neuroscience. It provides some basic information on these areas, along with one individual who had contributed to this area of social work. These individuals have been selected as examples of leading areas of social work, but are by no means the only leaders in the field during this new century. It would be impossible to recognize here all of the people who are creating, developing, and inspiring the field of social work today. Social workers are moving into new areas of the field, and are collaborating with professionals from many other areas related to mental health and social justice.
Native Americans are a young and growing population. Poverty, racism, and trauma are common factors in the lives of many Native people, and these provide a context for significant social and health disparities. It is also important to recognize the resilience and tenacity that have allowed Native people to survive as distinct cultural and political groups in spite of centuries of colonization. Helping professionals can play an important role in assisting Native clients to access needed services and nurture their resilience. Professionals can also bring a strong grounding in social justice to combat many of the struggles that affect Indigenous Peoples. This chapter discusses the demographic profile of the Native American population. It also discusses the psychosocial risks and needs of Native Americans. The chapter provides the assessment treatment approaches for social and health problems, although few have been developed or adapted for Native Americans.
It is not uncommon for children, adolescents, and families to seek counselors’ services when they are in crisis. Despite a growing literature base in school crisis prevention, intervention, and preparedness, there is a relatively scant literature base addressing mental health crisis intervention for professional counselors. This chapter addresses elements pertinent to crisis intervention, including mandated reporting, and associated trauma or grief. Children understand and process grief and trauma differently based on developmental and cognitive ability levels. Unfortunately, it is not uncommon for children to experience traumatic events before reaching adulthood. As an example, international studies document that child sexual abuse, physical abuse, or domestic violence affects approximately 25% of children. War, natural disasters, motor vehicle accidents, violence, terrorist acts, and refugee experiences can all contribute to trauma reactions. Regrettably, if left untreated, complications associated with unresolved trauma or grief can last well into adulthood.
Borderline personality disorder (
BPD) causes significant mental distress and impairment in psychosocial functioning. The condition is marked by emotional dysregulation, unstable personal relationships, impulsivity, chronic anger, and identity disturbances. A person with this condition often engages long-standing patterns of maladaptive coping responses that can include substance use, self-injury, suicidal behavior, aggression, and other reckless behavior. The condition is often comorbid with other psychiatric conditions including mood and anxiety disorders, eating disorders, substance abuse, posttraumatic stress disorder, and other personality disorders. While prolonged impairment in psychosocial functioning and symptom relapses are common, lasting improvement in a wide range of areas can be expected over time. Dialectical behavior therapy ( DBT) is an intensive psychotherapy based on the cognitive behavioral model that uses individual and group sessions to help people with BPDdevelop adaptive coping strategies to manage symptoms and improve functioning. DBThas been widely studied and has been found to be an effective psychotherapeutic approach to treating BPD.
This book describes the foundational elements of counseling and psychotherapy with children and adolescents. It includes updates and expanded material about clients’ affect, trauma, substance abuse, progress monitoring, self-care, referral for medication, and mindfulness. Of particular interest is a series of new elements including elements addressing sexual and gender identity, social media, sexuality and harassment, and rules for use of technology. All of these topics have become increasingly important in counselors’ conceptualization of children and adolescent clients and therapy. The book emphasizes the conditions and processes of creating growth within the child, explicating the process of assisting growth and self-inquiry. There are new sections on grounding feelings in the body, teaching tools for distress tolerance, and highlighting the importance of progress monitoring. The book discusses teaching skills for negotiating social conflict—a substantial stressor for children and adolescents. It provides guidance on cocreating individual and family rules for use of technology. It also addresses frequent misconceptions and mistaken assumptions followed by the discussion on crisis intervention, effective referral skills, cultural competency and mandated reporting. The book then addresses issues such as coming to terms with one’s own childhood and adolescence and the rescue fantasy. There is a succinct introduction to interventions (i.e., including a list of more comprehensive texts on counseling with children and adolescents) and an updated review of techniques often used in work with children and adolescents (e.g., play therapy, brief, solution-focused therapy). For ease of reading the word caregiver will be used to indicate a parent, legal guardian, foster parent, and so on. The book focuses on counselor self-care and provides guidance for setting boundaries, knowing their edge, practicing within competency, and assessing and planning personal self-care. Finally, it closes with a brief overview of how to use the text for transcript analysis in training programs.
Trauma is very common in American society, and it is therefore important for social workers to intentionally engage in trauma-informed practices. This chapter first describes the definitions of trauma, its prevalence, the neurobiology of trauma, and the ways in which trauma can impact people throughout their lives. Then, the principles and components of trauma-informed care (
TIC) are reviewed. Finally, specific suggestions are offered for translating TICprinciples into trauma-responsive social work practices that facilitate trust, safety, collaboration, choice, and empowerment. There is a paradigm shift that occurs when we begin to conceptualize presenting problems as symptoms of trauma and client problems as survival and coping skills that developed in response to traumagenic experiences. TICfits well with the strengths-based bio-psycho-social perspectives of social work. When we understand trauma, we better understand how clients make meaning of their experiences, how that narrative shaped cognitive schemas about themselves and others, and how we can help clients restore a sense of interpersonal safety. A case study illustrates the principles and practices of TIC.
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.
Long-term care involves the financing and delivery of an array of health and social services to the aged and disabled. In contrast to acute care, which is disease based and curative in orientation, the orientation of long-term care is inherently holistic and function based. The scope of long-term care policies and services thus encompasses the aged, the developmentally disabled, the chronically ill, and persons disabled by trauma. Although both the biological and demographic realities of an aging population and principles of intergenerational justice should propel us toward a feasible approach to the long-term care insurance (whether in the form of social insurance, a normative shift toward the broadscale investments in private long-term care insurance that will reduce the growth of Medicaid long-term care expenditures), the political path to a coherent and effective national long-term care financing strategy remains elusive.
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.
This chapter reviews the case studies of Darlene Green, Julie Abner, Michelle Byrom and Kristina Earnest to illustrate false confessions. Confessions are one of the most incriminating forms of evidence. The Reid Interrogation Technique has been used by police departments since the 1960s and is the most commonly utilized method of interrogation in the United States. Gender differences exist in all areas of the criminal justice system. Battered women may also respond like those with a long history of serious mental illness as their mental health issues may lower their ability to withstand the pressure of interrogation. In domestic violence cases, there were the batterer’s threats to harm the children if she did not accept blame usually for his abuse of the children. Women meet all the vulnerabilities that were found in the research with men and others including the impact of the long histories of abuse and trauma.Source:
This chapter presents a flowchart diagram of the family systems trauma (FST) model that includes an overview of the motivational phone call and all five phases of the FST treatment model along with procedural steps and prephase preparation steps: Phase I: Identify Symptoms (Stressors) and Set the Goals for Therapy Pre-session Preparation for Phase II; Phase II: Wound Work Introduction Pre-session Preparation for Phase III; Phase III: Co-Create Playbooks Pre-session Preparation for Phase IV; Phase IV: Troubleshooting and Dress Rehearsals Pre-session Preparation for Phase V; and Phase V: Evaluate Progress and Relapse Prevention. Deeper understanding and competency in the FST model can be enhanced if the reader “zooms out” before “zooming in”. From the flowchart and overview provided in this chapter, it may be evident why it took eight long years to synchronize each phase of FST treatment and provide a step-by-step road map.
This chapter provides brief description on “Pre-session Preparation for Phase III” of the family systems trauma (FST) treatment model. It presents a menu of creative strategic directives along with ways in which these directives can be turned into wound playbooks to restructure the family to answer the “Now what?” question and heal trauma both within the child and the family. It then highlights the benefits of blending structural and strategic family therapy with the “Now what?” question. The FST flowchart indicates that this pre-session preparation for Phase III step occurs immediately after Phase II. The primary goals of this step are to (a) decide on the best strategic directives for the targeted undercurrent(s); and (b) create customized playbooks based on the particular family and goals of therapy. This pre-session preparation step is complete once the FST therapist chooses the technique or directive and creates the associated customized playbook.
Eating disorders (EDs) may be among the most self-destructive and persistent behaviors that emerge in the aftermath of trauma. Researchers are becoming curious about the role of the body, and, in particular, the nervous system, as it relates to ED symptoms and the management of dysregulated affect states. This chapter highlights the psychobiological processes that somatic experiencing (SE) is built upon with regard to working with trauma, with specific considerations for its application when working with the ED population. A natural starting point for understanding the intersection between trauma and EDs involves a brief overview of the effects of trauma on the nervous system. SE treatment goals are accomplished not only by listening to the client’s narrative but also by closely watching the body’s expression of the nervous system to slow the process down and explore the various elements of an experience.
This chapter explores the neurological link between trauma and eating disorders (EDs) by describing one of humans’ basic functions: response to stressors. Adverse life events interact with the genome and developmental processes, leading to biological changes that predispose one to a broad range of psychiatric problems, including EDs. The mechanisms involved include abnormalities in the stress response, changes in appetite, altered reward sensitivity, and increased sensitivity to rejection. Specific genes increase one’s susceptibility to stressful experiences, and stressful experiences have the ability to alter one’s genes (i.e., epigenetics). Epigenetics refers to the way in which environmental exposures have the capacity to influence the genome in a way that affects later gene expression. Findings from epigenetic research and neural-based interventions offer evidence against the long-standing understanding of genes and neurocircuitry as “rigid” structures.
The method of Constant Installation of Present Orientation and Safety (CIPOS) is a procedure that can extend the healing power of eye movement desensitization and reprocessing (EMDR) to a much wider population of clients. It works on the principle that, by expanding and developing an individual’s ability to remain oriented to the safety of the present situation, that person, then, is much more able to safely access and resolve highly disturbing memory material. The CIPOS intervention utilizes short-term memory (STM), which is a particular memory phenomenon that is easily observed and which overlaps substantially with another phenomenon, working memory (WM). The CIPOS procedure is a way of helping clients learn to reduce their own catastrophic expectations regarding access of traumatic memories, while also learning an important skill—the skill of more and more easily coming out of trauma and back to the present.
This chapter discusses what happens in the aftermath of trauma, abuse, and disordered eating. This aftermath includes connection to illness as identity and disconnection from sense of self, spiritual identity, higher power, and significant others. Furthermore, there is disconnection from spirituality, passion, purpose, meaning in life, internalized principles, dreams, and deepest desires. We have also provided a few of the many interventions that we have found valuable in reducing suffering and helping clients to reclaim their identity. It focuses our attention on the processes of assessment and therapeutic intervention, and, by so doing, directly addresses the building and nurturing of self. The chapter attempts to describe the journey from ED and trauma identity to knowing, strengthening, valuing, honoring, and sharing self. It is through this that an individual is able to withdraw trust and faith in illness as a way of dealing with life.
An understanding of dissociation begins with the recognition that human personalities—dissociative and nondissociative—universally have parts. Sometimes, the structure of these parts involves amnesiac separation as well as significant conflicts between parts, and these conflicts, in turn, often cause significant emotional problems. This chapter provides a brief description on treating dissociation within an adaptive information processing model. It is unfortunate that there has been a kind of “sibling rivalry”, between Eye Movement Desensitization and Reprocessing (EMDR)-related methods and cognitive-behavioral methods of treatment for trauma-related conditions, including dissociative disorders. A discussion, between client and therapist, of how cognitive models apply to the individual case, are often important as a preliminary step to prepare that client for the arduous and potentially destabilizing work of trauma processing.