Healing Trauma: An Intervention for Women. Stephanie S. Covington, PhD, LCSW

Transcription

1 Healing Trauma: An Intervention for Women Stephanie S. Covington, PhD, LCSW Institute for Relational Development Center for Gender and Justice 7946 Ivanhoe Ave., Suite 201B La Jolla, CA (858) (858) FAX May 14, 2014 Workshop Colorado Collaborative Justice Conference Westminster, CO

2 Healing Trauma: An Intervention for Women Stephanie S. Covington, Ph.D., L.C.S.W. Center for Gender and Justice Institute for Relational Development La Jolla, CA May 14, 2014 Workshop Colorado Collaborative Justice Conference Westminster, CO U.S. Incarcerates more Women than any other Country 201,200 United States (almost 1/3 rd of female prisoners worldwide) 84,600 China 59,200 Russian Federation 29,175 Thailand 4,060 England & Wales 449 Scotland 44 Northern Ireland Source: Walmsley (2012). World Female Imprisonment List, 2 nd Edition. London, United Kingdom: International Centre for Prison Studies. Pathways Perspective Women s crimes embedded in the conditions of their lives Examines the specific life course events that place women at risk for offending Triple jeopardy: The impact of race, class & gender (Bloom) Multiple marginality: From families, school, work (Owen) Trauma & addiction (Covington) Healing Trauma Workshop, May 14, 2014 Colorado 1

3 Women and Girls in the CJ System Compared with men and boys, they have More severe histories of sexual/physical abuse Higher prevalence of mental and physical health problems Patterns of drug abuse that are more socially embedded revolving around their interpersonal relationships Women and Girls in the CJ System (cont.) Compared with men and boys, they Are typically y primary caregivers for minor children Have limited education and employment histories Respond differently to treatment and CJ supervision Commit fewer violent crimes Trauma History Among Criminal Justice-involved involved Women Women in the criminal justice system have much higher rates of childhood and adult trauma exposure than women in the general population Trauma history is associated with alcohol and drug dependence, high-risk behaviors, sex work, and physical and mental health disorders among women in criminal justice settings Prison is also a re-traumatizing experience Healing Trauma Workshop, May 14, 2014 Colorado 2

4 Beyond Trauma: A Healing Journey for Women 11 sessions Healing Trauma: Strategies for Abused Women 5 sessions Beyond Trauma Evidence-Base Researched in Residential treatment Women s prison Drug court Listed on NREPP Pre and Post Treatment Changes in Symptoms of Depression and Posttraumatic Stress 27 Healing Trauma Study Score Score Depression CESD (t=4.79, Symptoms df=52, (.000) p Posttraumatic PCL (t=2.96, Stress df=52, p= Symptoms (.005) Pre-Test Post-Test Source: [September] 2013 Annual Report: The Interpersonal Violence Project, Josephine M. Hawke, PhD Healing Trauma Workshop, May 14, 2014 Colorado 3

5 Beyond Trauma & Healing Trauma Themes Safety Empowerment Connection (Aloneness) Normal reactions (Shame) Mind-body connection Substance abuse Woman-centered Healing Trauma Facilitator s Guide Participant Workbook (English and Spanish) CD-Rom Implementation Closed groups 8 12 women Healing Trauma Workshop, May 14, 2014 Colorado 4

6 Healing Trauma Adaption of Beyond Trauma (11 sessions) Five 90 minute sessions List of materials Language for facilitation in bold Format Quiet time, check in Information Interactive exercises Grounding, self-soothing exercises Reflection What Makes a Good Facilitator? The following qualities in a facilitator will help to ensure a positive group experience: Trustworthy Credible Available Reliable, consistent Hopeful Warm, compassionate Emotionally mature Healing Trauma Workshop, May 14, 2014 Colorado 5

7 What Makes a Good Facilitator? (cont.) Energetic Healthy boundaries, respects confidentiality Committed to and interested in women s issues Multi-cultural sensitivity and responsiveness Appropriate gender - a female should facilitate the all-female groups What Makes A Good Facilitator? (cont.) If trauma survivor, she needs to feel confident that she is at a place in her own recovery that will allow for healthy and positive outcomes for herself and the women in the group. Content expertise, if possible Skills as a facilitator Role of the Facilitator Begin and end on time Maintain structure of the group Move the group through the content of each session Lead by example by having appropriate boundaries and containing your feelings Allow each woman to have her own experience of the group Healing Trauma Workshop, May 14, 2014 Colorado 6

8 Healing Trauma Session 1 Welcome, Group Agreements and Introduction Table of Contents Session 1 Welcome Why We Are Here Group Agreements Personal Goal Sheet Art Activity: Decorate Your Cover/Folder Participant Introductions Sharing Goals Grounding Exercise: Five Senses Reflection This Group will Help You: Learn more about abuse and how widespread it is in women s lives Become aware of the strengths you already have Increase the skills you need for healing Learn exercises and techniques that can help you feel more grounded and safe Healing Trauma Workshop, May 14, 2014 Colorado 7

9 Common Concerns Why did this happen to me? What did I do wrong? Why do I feel so ashamed? Why did people hurt me? Why is life such a struggle? What do I do now? Trauma One definition of trauma says that trauma occurs when a threatening event overwhelms a person s normal coping skills. In other words, trauma is any stressor that occurs in a sudden and forceful way and is experienced as overwhelming. For some women, the trauma is not a onetime event but is a threat that builds over time. Inner Self & Outer Self Impacts Inner Self It can impact our inner life our thoughts, feelings, beliefs, values. For example, some women believe that you can t trust anyone, and the world is a very unsafe place. Healing Trauma Workshop, May 14, 2014 Colorado 8

10 Inner Self & Outer Self (cont.) Impacts Outer Self It can impact our outer life our outer life consists of our relationships and our behavior. Many women who have experienced trauma struggle with their relationships families, friends, sexual relationships. Art Activity: Decorate Your Cover Grounding Exercise: Five Senses Healing Trauma Workshop, May 14, 2014 Colorado 9

11 Five Senses Reflection Page This is a place where you can write or draw about your experience in the group. Maybe you d like to write about what was most meaningful for you in session 1 Healing Trauma Session 2 Power & Abuse Healing Trauma Workshop, May 14, 2014 Colorado 10

12 Table of Contents Session 2 Quiet Time, Check-In and Review of Last Session Traumatic Events Gender Expectations The Connection between Power & Abuse The Power and Control Wheel Characteristics of Batterers Soothing Visualization Reflection Traumatic Events Trauma can take many forms: Emotional, sexual or physical abuse, Extremely painful and frightening medical procedures Catastrophic injuries and illnesses Rape or assault Muggings Domestic violence Burglary Traumatic Events (cont.) Witnessing murder Automobile accidents Immigration Natural disasters (hurricanes, earthquakes, tornadoes, fires, floods, volcanoes) Abandonment (especially for small children) Terrorism such as September 11, 2001 Witnessing violence such as a parent harming another parent Healing Trauma Workshop, May 14, 2014 Colorado 11

13 Traumatic Events (cont.) Loss of a loved one and severe bereavements (even of a pet) Combat/war Torture Kidnapping Intergenerational (cultural) trauma Of all these forms of trauma, women are at greater risk of interpersonal abuse than men. Gender Expectations: Social Messages Focus Questions How are boys and girls treated differently? What does it mean to act like a woman? What does it mean to act like a man? What would it be like if our roles and the messages were reversed? Healing Trauma Workshop, May 14, 2014 Colorado 12

14 The Connection Between Power & Abuse Here are some ways in which power and abuse are connected: The abuser uses power over the victim. The abuser takes power away from the victim. The victim feels powerless against the abuser and in many aspects of her life. The victim feels trapped or locked in a role. The victim feels isolated, so there is no strength or power from others who could help. 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 Characteristics of Batterers Behavior as Clues: Jealousy Controlling behavior Quick involvement Unrealistic expectations Isolation Blaming others for problems Blaming others for feelings Hypersensitivity Healing Trauma Workshop, May 14, 2014 Colorado 13

15 Characteristics of Batterers (cont.) Cruelty to animals and/or children Playful use of force in sex Verbal abuse Rigid sex roles Dr. Jekyll and Mr. Hyde Past battering Threats of violence Hitting or breaking objects Use of force during an argument Guided Imagery: Safe Place Healing Trauma Session 3 The Process of Trauma and Self Care Healing Trauma Workshop, May 14, 2014 Colorado 14

16 Table of Contents Session 3 Quiet Time, Check-In and Review of Last Session The Process of Trauma What Does It Mean to Feel Grounded? Grounding Exercises Self-Soothing Chart Relaxation Exercise Developing Personal Boundaries Reflection Process of Trauma TRAUMATIC EVENT Overwhelms the Physical & Psychological Systems Intense Fear, Helplessness or Horror RESPONSE TO TRAUMA Fight or Flight, Freeze, Altered State of Consciousness, Body Sensations, Numbing, Hyper-vigilance, Hyper-arousal SENSITIZED NERVOUS SYSTEM CHANGES IN BRAIN CURRENT STRESS Reminders of Trauma, Life Events, Lifestyle PAINFUL EMOTIONAL STATE RETREAT HARM TO SELF HARM TO OTHERS ISOLATION DISSOCIATION DEPRESSION ANXIETY SUBSTANCE ABUSE EATING DISORDER DELIBERATE SELF-HARM SUICIDAL ACTIONS AGGRESSION VIOLENCE RAGES Grounding Grounding techniques are strategies to help a person who is dissociating ( losing time, emotionally absent) come back into current reality and feelings. Grounding techniques can help women realize that they are in the here and now and that what they are experiencing is in the past and it is not happening now. Healing Trauma Workshop, May 14, 2014 Colorado 15

17 Grounding Physical Mental Grounding Exercises Self - Soothing Alone With Others Daytime Night Time Healing Trauma Workshop, May 14, 2014 Colorado 16

18 Developing Boundaries Healing Trauma Session 4 Healthy Relationships Table of Contents Session 4 Grounding Exercise, Check-In and Review of Last Session Defining a Healthy Relationship & the Relationship Wheel Aspects of a Healthy Relationship The Relationship Wheel & the Power & Control Wheel Activity: The Relationship Wheel What is Love? Reflection and Grounding Exercise Healing Trauma Workshop, May 14, 2014 Colorado 17

19 Relationship Wheel Respect, Mutuality, Compassion Respect Respect is the appreciation of someone s values and it begins to happen when we see their integrity. it We often earn respect when we are willing to do the right thing or take the right action, particularly when the choice is difficult. Respect, Mutuality, Compassion Mutuality Mutuality means there is an equal investment in the relationship. Each person has a willingness and desire to see the other, as well as being seen; to hear the other, as well as being heard; and to be vulnerable, as well as respecting the other s vulnerability. Mutuality also means that there is an awareness of the we, not a sole focus on two I s. Healing Trauma Workshop, May 14, 2014 Colorado 18

20 Respect, Mutuality, Compassion Compassion Compassion is similar to empathy but it occurs on a deeper level. Empathy is understanding another s feeling and being able to feel with them. Compassion means that we go a step further and join with them in their struggle or pain. When we are compassionate we lend our selves to another s process we give of ourselves in order to be with them emotionally. Aspects of a Healthy 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 (Covington & Beckett, 1998) 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 Healing Trauma Workshop, May 14, 2014 Colorado 19

21 Relationship Wheel Wheel of Love Healing Trauma Session 5 Love, Endings & Certificates Healing Trauma Workshop, May 14, 2014 Colorado 20

22 Table of Contents Session 5 Grounding Exercise, Check-In and Review of Last Session Bringing Ourselves to Relationships Love Collage How to End a Relationship Appreciation Activity Upward Spiral of Healing Goal Sheets and Evaluations Certificates of Completion Bringing Ourselves to Relationships Do you remember what you were like before the abuse? Do you want to find that person again? If so, what qualities do you need to find or develop in yourself? If not, what kind of person do you want to be? What qualities do you need to find or develop in yourself? What makes you feel safe? Bringing Ourselves to Relationships (cont.) What brings you joy? What kinds of relationships do you want to have with others from now on? What do you want to offer or give in those relationships? How do you want to be and feel in your relationships? What qualities do you bring to relationships? Healing Trauma Workshop, May 14, 2014 Colorado 21

23 Love Collage Endings Appreciation What I appreciate about the other women in the group. What I appreciate about the group. Healing Trauma Workshop, May 14, 2014 Colorado 22

24 Upward Spiral Transformation Trauma (constriction) Healing (expansion) What makes a difference? Creating a safe environment Listening to her story Empathy Sanctuary Healing Trauma Workshop, May 14, 2014 Colorado 23

25 Creating a protected space where survivors can speak their truth is an act of liberation; bearing witness is an act of solidarity. For many of us, there can be no greater honor. Herman, J. (1997) Trauma and Recovery. New York: Basic Books. Contact Information Stephanie S. Covington, PhD, LCSW 7946 Ivanhoe Ave., Suite 201B La Jolla, CA (858) (858) FAX sc@stephaniecovington.com Healing Trauma Workshop, May 14, 2014 Colorado 24

26 About your presenter. Dr. Stephanie S. Covington is a nationally recognized clinician, author, organizational consultant, and lecturer. She is a pioneer in the field of women s issues, addiction, and recovery. She has developed an innovative, gender-responsive, and trauma-informed approach to the treatment needs of women and girls that results in effective services in public, private, and institutional settings. Her presentations, staffdevelopment seminars, and technical assistance focus on systems change and the development of caring, compassionate, and empowering therapeutic environments. They provide professionals an opportunity to learn new skills for dealing with personal, institutional, and societal changes and are always in demand, both nationally and internationally. Dr. Covington s clients include the Betty Ford Treatment Center, the United Nations Office on Drugs and Crime, the Center for Substance Abuse Treatment in Washington, D.C., the Michigan Department of Corrections, and numerous other treatment and correctional settings. Dr. Covington was a workshop chair for the women s treatment improvement protocol (TIP) and the trauma TIP (published by CSAT) and is the co-author of a three-year research project, Gender-Responsive Strategies: Research, Practice, and Guiding Principles for Women Offenders, for the National Institute of Corrections. This publication received the University of Cincinnati Award for its outstanding contribution to the field of corrections in the U.S. and Canada. She was selected to be the featured therapist on the Oprah Winfrey Network docu-reality show Breaking Down the Bars: Rockville. Educated at Columbia University and the Union Institute, Dr. Covington has served on the faculties of the University of Southern California, San Diego State University, and the California School of Professional Psychology, and she is a former chair of the Women's Committee of the International Council on Alcoholism and Addiction. She is a board-certified Diplomate of the National Association of Social Workers and the American Board of Sexology and is a member of the American Association of Marriage and Family Therapy and the American Psychological Association. She also served on the Advisory Council for Women s Services for the federal agency SAMHSA. Dr. Covington is based in La Jolla, California, where she is co-director of the Institute for Relational Development and the Center for Gender and Justice, which seeks to expand gender-responsive policies and practices for females who are under criminal justice supervision. Among the many articles and books written by Dr. Covington are: Women and Addiction: A Gender-Responsive Approach Awakening Your Sexuality: A Guide for Recovering Women Leaving the Enchanted Forest: The Path from Relationship Addiction to Intimacy She also has program materials to help meet the needs of women and girls. The following curricula include training manuals for professionals and complementary materials for participants: Helping Women Recover: A Program for Treating Addiction (with special edition for the criminal justice system) Beyond Trauma: A Healing Journey for Women Healing Trauma: Strategies for Abused Women Voices: A Program of Self-Discovery and Empowerment for Girls A Woman s Way through The Twelve Steps Beyond Anger and Violence: A Program for Women (with special edition for the criminal justice system) Becoming Trauma Informed: A Training Program for Correctional Professionals (USA and Canadian) For a list of Dr. Covington s recent articles, and descriptions of her current seminars for professionals, visit: and About Your Presenter March 2013

27 STEPHANIE S. COVINGTON, PhD, LCSW Institute for Relational Development / Center for Gender and Justice, 7946 Ivanhoe Avenue, Suite 201 B, La Jolla, California Phone: (858) Fax: (858) info@stephaniecovington.com BOOK ORDER FORM PROGRAM DEVELOPMENT GUIDE PRICE QTY. TOTAL PRICE CLINICAL INNOVATOR SERIES WOMEN AND ADDICTION: A Gender-Responsive Approach Manual/DVD/CE Test $ $ Manual & CE Test $ $ MANUALIZED, TRAUMA-INFORMED TREATMENT CURRICULA TWELVE STEP MATERIALS A WOMAN S WAY THROUGH THE TWELVE STEPS Complete Set (10 books, 10 workbooks, 1 FG, 1 DVD) $ $ DVD $ $ 1 Facilitator s Guide, 10 workbooks $ $ Facilitator s Guide $ $ Set (1 Book, 1 Workbook in English) $ $ A Woman s Way through the Twelve Steps (Book in English) $ $ La Mujer Y Su Práctica de los Doce Pasos (Book in Spanish) $ $ Workbook (English) $ $ Libro de Ejercicios (Spanish) $ $ BEYOND TRAUMA: A Healing Journey for Women An 11-session trauma-specific curriculum Complete Set (FG, 10 workbooks, 3 DVDs) $ $ Two-volume Facilitator s DVD Set $ $ Client DVD $99.00 $ Facilitator s Guide & 10 workbooks $ $ Facilitator s Guide $ $ Workbooks (pack of 10) $ $ Workbook $ $ HEALING TRAUMA: Strategies for Abused Women CD-Rom $ $ VOICES: A Program of Self-Discovery and Empowerment for Girls Facilitator s Guide (includes 1 journal) $ $ Journal $ 9.15 $ Book Order Form, November 2013 Page 1 of 3 Stephanie S. Covington

28 STEPHANIE S. COVINGTON, PhD, LCSW Institute for Relational Development / Center for Gender and Justice, 7946 Ivanhoe Avenue, Suite 201 B, La Jolla, California Phone: (858) Fax: (858) info@stephaniecovington.com BOOK ORDER FORM (continued) MANUALIZED, TRAUMA-INFORMED TREATMENT CURRICULA (continued) HELPING WOMEN RECOVER: A Program for Treating Addiction A 17-session program for treating women with addictive disorders Facilitator s Guide (includes 1 journal) $ $ Participant s Journal $ $ Special Edition for use in the criminal justice system Facilitator s Guide (includes 1 journal) $ $ Participant s Journal $ $ BEYOND VIOLENCE: A Prevention Program for Criminal Justice-Involved Women Special Edition for use in the criminal justice system Facilitator s Guide (includes 1 workbook and DVD) $ $ Participant s Workbook $ $ HELPING MEN RECOVER: A Program for Treating Addiction A 18-session program for treating men with addictive disorders Facilitator s Guide (includes 1 workbook) $ $ Participant s Workbook $ $ Special Edition for use in the criminal justice system Facilitator s Guide (includes 1 workbook) $ $ Participant s Workbook $ $ ALCOHOL AND DRUG EDUCATION WOMEN IN RECOVERY: Understanding Addiction English version $ 6.85 $ Spanish version $ 6.85 $ BOOKS AWAKENING YOUR SEXUALITY: $ $ A Guide for Recovering Women LEAVING THE ENCHANTED FOREST: $ $ The Path from Relationship Addiction to Intimacy Book Order Form, November 2013 Page 2 of 3 Stephanie S. Covington

29 STEPHANIE S. COVINGTON, PhD, LCSW Institute for Relational Development / Center for Gender and Justice, 7946 Ivanhoe Avenue, Suite 201 B, La Jolla, California Phone: (858) Fax: (858) info@stephaniecovington.com BOOK ORDER FORM (continued) SUBTOTAL (from previous pages): U.S. Shipping & Handling Add 10% before tax: Outside U.S. Shipping & Handling Add 25% before tax 1 : California Sales Tax Add 8% before shipping for California residents only 2 : TOTAL 3 : $ $ $ $ $ 1 International order payments by check/money order must be in U.S. currency and drawn from a U.S. affiliated bank 2 Only residents of California need to add California sales tax 3 Review the bottom of this page for processing options to place your order BILLING ADDRESS Name of Organization: Contact Name: Address: City: State: Zip: Country: Phone: Tax Exempt Number: Your Internal Order #: SHIPPING ADDRESS (please note, we are unable to ship to P.O. Box addresses) Same as Billing Address (check box): Name of Organization: Contact Name: Address: City: State: Zip: Country: Phone: ADDITIONAL INSTRUCTIONS: PLEASE ALLOW DAYS FOR DELIVERY PLEASE CHOOSE ONE OF THE FOLLOWING METHODS TO SUBMIT YOUR ORDER: Mail completed form with check/money order payable to Dr. Stephanie Covington to the La Jolla, California address Fax or completed form with purchase order (obtained from your accounting department) to or info@stephaniecovington.com. We will process your order immediately and bill you under Net 30 terms. Credit cards may only be accepted via our online shopping cart and checking out via Paypal. We are unable to take credit cards over the phone. Visit and select Books and Curricula. Book Order Form, November 2013 Page 3 of 3 Stephanie S. Covington