Arizona Trauma Institute 49 S. Sycamore Dr. Ste. 2 Mesa, AZ

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1 HEALER IDENTITY

2 Arizona Trauma Institute 49 S. Sycamore Dr. Ste. 2 Mesa, AZ andi.fetzner@aztrauma.org Arizona Trauma Institute Director of Community Relations at Arizona Trauma Institute Trainer and Consultant at Arizona Trauma Institute Promoter of Social Justice at Arizona Trauma Institute Trainer at International Association of Trauma Professionals PsyD Doctoral Candidate at California Southern University Areas of Interest: Public Health System Reform; Foster and Adoptive Advocacy and Education; Residential and Group Home Standardization of Care; Relationship Focused Therapy; Traumagenic Family Dynamics; Child & Family Trauma; Paraprofessional Trauma Informed Care; Empowerment and Resiliency Treatment Structure; Childhood Adverse Experience (ACE) Study implication and applications

3 People have control Intentional, conscious choices are being made Thoughts, behaviors, emotions People create narratives Organize sequence of events People know what coping skills are acceptable and not acceptable People learn primarily from action/consequence Assumptions People need to identify emotion change behavior Arizona Trauma Institute

4 Trauma or Traumagenesis Any environment that promotes Hot System dominance anything that interrupts or interferes with normal social, emotional, psychological, cognitive, spiritual, or physical developmental processes or interferes/interrupts secure attachment can be a threat to the individual and considered traumatic 1 Arizona Trauma Institute 4

5 Traditional Types of Trauma Natural disasters Mass interpersonal violence Domestic fires Motor vehicle accidents Rape & Sexual assault Physical assault Partner/Family battery Torture War Child Abuse Emergency worker exposure Arizona Trauma Institute

6 Intensity Witnessing and experiencing DV Sexual assault Physical abuse & neglect Witnessing or being a victim of violent crime Participating in war or military action Accidents and bad injuries Arizona Trauma Institute

7 High Frequency Chaotic environments Aggressive environments Punitive environments Inconsistent environments Basic Needs not being met Instability in the family: Financially Emotionally Residentially Arizona Trauma Institute

8 High Duration Historical Trauma: Grandparent(s) don t know how amazing they are Parent(s) don t know how awesome they are Client(s) may have never learned how amazing they are Systemic Oppression Marginalization Prejudice Arizona Trauma Institute

9 None of these ARE Trauma Arizona Trauma Institute

10 None of these ARE trauma None of these are really the cause of trauma, all of them impact the Central Nervous System (CNS) When the CNS gets out of balance, we see symptoms. Arizona Trauma Institute

11 How Humans Operate

12 Balance System (Autonomic Nervous System) Regulates body processes Works automatically When hot symptom dominant, adaptions or mitigations occur When balanced, moves from hot to cool appropriately **Trauma symptoms result from the over-use of the threat/stress response system (TRS/SNS)** Arizona Trauma Institute

13 Symptoms of Activation Sympathetic/Hot: Accelerate the heart rate Constrict blood vessels Raise blood pressure, muscle tension, physical sensation amplification. Inhibition of insulin production to maximize fuel availability Parasympathetic/Cool: Promote digestion Intestinal motility Fuel storage (increases insulin activity) Resistance to infection Circulation to non-vital organs Release endorphins Decreases heart rate, blood pressure and body temperature Arizona Trauma Institute

14 What is the nature of the Sympathetic Nervous System (SNS)? Arizona Trauma Institute

15 Nature of the Sympathetic System Immediate No future Impulsive Irrational/illogical Non planned outside of the immediate activity Little self reflection Little evaluation Absolutely correct behavior!!!! Arizona Trauma Institute

16 HOW DOES TRAUMA GET CREATED? Arizona Trauma Institute

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20 Activation of the hot system creates. Adaptation is the action or process of adapting or being adapted (examples --- jumping out of the way when someone takes a swing at you, running from the room when someone threatens you). Mitigation is the action of reducing the severity, seriousness, or painfulness of some aspect of the situation (this could be provoking a fight, before the tension gets too high, take a few drinks or some drugs before you walk into a family get together, pop a valium before a big presentation). Arizona Trauma Institute 20

21 Mitigative Activation (Internalized distancing behavior) Freezing, Stuck, Paralysis of Action Dissociation Emotional Numbing Distraction Self-Soothing Reactive Impulsive Emotional and Psychological Distancing Self-Centeredness Sad Withdrawn Whining Crying Sulking Clingy Reluctance to Explore the World Addictive Behavior Obsessiveness Arizona Trauma Institute 21

22 Adaptive Activation (externalized acting out behaviors) Angry Aggressive Defensive Reactive Impulsive Hostile Irrational Self-centered Poor focus Inattention Sleep disturbances Coercive Bossy Tantrums Name calling Hitting Fidgety Hyperactive Anxiety Irritability Delays in reaching physical language or other milestones Arizona Trauma Institute 22

23 When people are in survival mode they are not looking at the scenery Arizona Trauma Institute

24 No matter the reality of the view Arizona Trauma Institute

25 At the activation point No future focus consequences are meaningless and not related to action. Everything is about this moment in time! All nonessential systems are turned down (suppressed) Arizona Trauma Institute

26 The Adverse Childhood Experience Study 6

27 Stress is Cumulative With low Intensity/High frequency activation the cocktail is smaller, but it accumulates. Depending on you health and body function, the cocktail level in you blood and tissues) may take hours to reach the baseline again Arizona Trauma Institute what happens if the next activation occurs before that can happen?

28 Arizona Statistics in Children (2011/2012 National Survey of Children s 42.5%- Zero ACEs 26.4%- One ACE 31.1%- 2 or more ACEs Health) National Average- 22.6%- 2 or note ACE s

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30 Arizona ACEs and Outcomes

31 Aces questionnaire 1.Did a parent or other adult in the household often or very often Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt? 2.Did a parent or other adult in the household often or very often Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured? 3.Did an adult or person at least 5 years older than you ever Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you? 4.Did you often or very often feel that No one in your family loved you or thought you were important or special? or Your family didn t look out for each other, feel close to each other, or support each other? 5.Did you often or very often feel that You didn t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

32 Aces questionnaire continued. 6. Were your parents ever separated or divorced? Was your mother or stepmother: 7. Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife? 8. Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs? 9. Was a household member depressed or mentally ill, or did a household member attempt suicide? 10. Did a household member go to prison?

33 RESILIENCY SCALE DEFINITELY TRUE PROBABLY TRUE NOT SURE PROBABLY NOT TRUE DEFINITELY NOT TRUE 1. I believe that my mother loved me when I was little. 2. I believe that my father loved me when I was little. 3. When I was little, other people helped my mother and father take care of me and they seemed to love me. 4. I ve heard that when I was an infant someone in my family enjoyed playing with me, and I enjoyed it, too. 5. When I was a child, there were relatives in my family who made me feel better if I was sad or worried. 6. When I was a child, neighbors or my friends parents seemed to like me. 7. When I was a child, teachers, coaches, youth leaders or ministers were there to help me.

34 RESILIENCY SCALE DEFINITELY TRUE PROBABLY TRUE NOT SURE PROBABLY NOT TRUE DEFINITELY NOT TRUE 8. Someone in my family cared about how I was doing in school. 9. My family, neighbors and friends talked often about making our lives better. 10. We had rules in our house and were expected to keep them. 11. When I felt really bad, I could almost always find someone I trusted to talk to. 12. As a youth, people noticed that I was capable and could get things done. 13. I was independent and a go-getter. 14. I believed that life is what you make it.

35 ACEs in Service Providers Psychosocial trauma in childhood of social work students influenced their choice of a social work career 2,4 Social work students reported a significantly higher frequency of early life family trauma when compared with a sample of business students 3

36 Participating workers in child-serving agency 5 70% reported at least one of the ACE categories 54% reported two or more ACE categories 16% reported four or more ACE categories

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39 We are all Human!!! We ALL have biases Past experience and observation can identify groups of people as threats If we perceive people as threats, even without our awareness, it can have an effect upon how we treat these people. It is not the task of the healer to become bias-free but instead to become aware and monitor self

40 What are humans capable of in Cool & Hot Systems? Cool System Responses 1. Bodily Regulation and coordination of physiological responses 2. Attuned Communications 3. Emotional balance and regulation 4. Flexibility in response 5. Pause before reacting 6. Empathy 7. Insight/discernment/judgment 8. Moral awareness 9. Intuition/spiritual feelings 10. Identity Hot System Reactions 1. FIGHTING or aggression to control/overcome threat 2. FLIGHTING or increasing muscle tension to avoid threat 3. FREEZING or Shutting down the body, paralyzing any action Arizona Trauma Institute 40

41 Cool System Responses 1. Bodily Regulation and coordination of physiological responses 2. Attuned Communications 3. Emotional balance and regulation 4. Flexibility in response 5. Pause before reacting 6. Empathy What are we capable of in Cool & Hot Systems? 7. Insight/discernment/judgment 8. Moral awareness 9. Intuition/spiritual feelings Hot System Reactions 1. FIGHTING or aggression to control/overcome threat 2. FLIGHT or increasing muscle tension to avoid threat 3. FREEZE or Shut down the body, paralyzing any action 10. Identity Arizona Trauma Institute 41

42 Traits of Effective Healers7

43 Therapeutic Alliance & Empathy 80% of the positive outcomes 8-9 Warmth Empathy Respect for the client Attunement 10 Patience (2-4 sessions) 11

44 Traits of Effective Healers7

45 Goal Consensus & Collaboration Connect around Strengths Feedback Informed Treatment Open process of communication

46 Traits of Effective Healers7

47 Positive Regard & Affirmation Awareness of Biases Connect around Strengths Feedback Informed Treatment Communication Skills Hope and Optimism Conflict Resolution

48 Traits of Effective Healers7

49 Congruence & Genuineness Awareness of Biases Deliberate & Intentional Non-avoidant Verbal & Non-verbal 18

50 Professional Development: Progress not Perfection.. In 2014, there were over 41,000 peer reviewed journal articles on trauma alone (how many did you read??) You are consistently reading new research based books You are courageous and willing to apply what you are learning into action You set aside time everyday for learning something new that will improve your skills as a healer

51 Resources 1. Anda, R. & Felitti, V.J. The Adverse Childhood Experiences Study, andhttp:// both Accessed on January 25, Rompf, E. L., & Royse, D. (1994). Choice of social work as a career: Possible influences. Journal of Social Work Education, 30(2), Black, P. N., Jeffreys, D., & Hartley, E. K. (1993). Personal history of psychosocial trauma in the early life of social work and business students. Journal of Social Work Education, 29(2), Lyter, S. C. (2008). Woundedness and social workers: Strategies for supervision of practicum students. Arete, 32(1), Esaki, N., & Larkin, H. (2013). Prevalence of adverse childhood experiences (ACEs) among child service providers. Families in Society: The Journal of Contemporary Social Services, 94(1), Center for Disease Control, Source: Sharpley, C.F., Jeffrey, A.M., & Mcmah, T. (2006). Counsellor facial expression and client-perceived rapport. Counselling Psychology Quarterly, 19(4), Hersoug, A., Hogland, P., Monsen, J., & Havik, O. (2001). Quality of working alliance in psychotherapy therapist variables and patient/therapist similarity as predictors. The Journal of Psychotherapy Practice and Research, 10,

52 Resources 10.Erskine, R.G. (1998). Attunement and involvement: Therapeutic responses to relational needs. International Journal of Psychotherapy, 3(3). 11. Risking Connection : A Training Curriculum for Working with Survivors of Abuse, by K.W. Saakvitne, L.A. Pearlman, S.J. Gamble, and Beth Tabor Lev (Sidran Institute Press, 2000), p Summers, R. F., & Barber, J.P. (2003). Therapeutic alliance as a measurable psychotherapy skill. Academic Psychiatry, 27(3). 13. Duncan, Miller, Hubble, & Wampold, 2010; Duncan, B., Miller, S. D., Hubble, M., & Wampold, B. E. (Eds.). (2010). The heart and soul of change: Delivering what works (2nd ed.). Washington DC: American Psychological Association 14. Lambert, Harmon, Slade, Whipple, & Hawkins, 2005; Lambert, M. J., Harmon, C., Slade, K., Whipple, J. L., & Hawkins, E. J. (2005). Providing feedback to psychotherapists on their patients' progress: Clinical results and practice suggestions. Journal of Clinical Psychology, 61, Norcross, 2011; Norcross, J. C. (Ed.). (2011). Psychotherapy relationships that work (2nd ed.). New York: Oxford University Press. 16. Baldwin, Wampold, & Imel, 2007; Baldwin, S. A., Wampold, B. E., & Imel, Z. E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75, Anderson, Ogles, Patterson, Lambert, & Vermeersch, 2009; Anderson, T., Ogles, B. M., Patterson, C. L., Lambert, M. J., & Vermeersch, D. A. (2009). Therapist effects: Facilitative interpersonal skills as a predictor of therapist success. Journal of Clinical Psychology, 65,