Tag Archives: Therapy

Understanding Trauma

Trauma. It’s the latest trend in therapy, right? Yes, yet it’s more than a trend. If we look at how trauma has been perceived historically, it’s easy to see how this focus on trauma could be considered a trend. However, when we look at what recent research has to say about trauma, it changes our understanding of why we need to focus on trauma. When all of this comes together, then we can better understand what we need to do to address the trauma in our lives and in the lives of our loved ones who may be continuing to use substances to cope.

Brief History of Trauma

Historically, people think about trauma as something that happens to veterans in war. Shell shock, battle fatigue, soldier’s heart, and combat stress reaction are all names that have, over the years, been employed in attempts to describe what we now call Post Traumatic Stress Disorder. Experts did recognize trauma as a possibility outside of a wartime scenario but believed these incidents to be limited. Therefore, these instances outside of wartime trauma exposure were not looked at much. So, when you look at trauma from this lens, it’s easy to see how limiting our understanding of trauma can be.

Current Understanding of Trauma


Image by John Hain from Pixabay 

Now days, though, researchers have done quite a bit of work around trauma in other settings. We understand PTSD can stem from things like abusive situations, bad car accidents, witnessing things that can be seen as life threatening, and more. And, thanks to researchers in the last few years, we also know how challenges and difficulties in the home environment that disrupt attachment can affect development. In fact, many researchers, therapists, and specialists are advocating for a new DSM-5 diagnosis of Developmental Trauma Disorder as a result. This is because research has found that symptoms of PTSD and symptoms of trauma stemming from developmental trauma are distinct, even though they do have some overlap.

In sum, this shift to focus on trauma is not just a trend. It’s a broadening of our understanding of what symptoms of trauma look like and what trauma means. In fact, for most clients who struggle to maintain recovery and who struggle with mental health symptoms, underlying trauma is likely part of the problem.

Supporting Someone with Trauma

So, then, what do we do about it? How do we support someone with underlying trauma in their lives? There are a few key things to remember. First, we must keep in mind, people with a history of trauma are living their lives hyperalert to everything around them. They are constantly keyed into anything that could be conceived of as a threat. This hyperarousal is also exhausting. Which means not only is the person scanning for danger all the time, they are exhausted on top of it. Put those two things together and it’s clear they’re not going to be thinking things through as clearly as someone not in this position would be.


Image by John Hain from Pixabay 

Also, keep in mind they cannot control this. Just because the rational brain can understand the threat is not there, doesn’t mean the emotional part of the brain believes it. A classic example is the idea of walking through a parking ramp late at night all alone. Men tend not to be as alert in this scenario when compared to women. Why? Because most women have been taught situations like this are dangerous. In general, men have not had this same lesson. It doesn’t matter if it’s a parking ramp a woman knows like the back of her hand, she’ll still most likely be on high alert for any danger if she’s there late at night and all alone regardless of what ration and reason may tell her.

Once we establish this understanding that the part of the brain controlling the traumatic stress reactions doesn’t respond to ration and logic, it becomes clearer we need to tap into the emotional part of the brain to calm that stress reaction. That’s mainly a role for therapists and specialists. As a support person for someone with trauma challenges, we can remember to honor as many of their requests as possible while still ensuring we are caring for ourselves. For example, if your loved one feels like they need to sit in a specific place and there’s no obvious reason not to honor it, let them. Also remember their anger is not about you despite what it may feel like. Accompany them to therapy appointments when appropriate and when possible. Learn what you can from the experts to help you support your loved one. And keep those healthy boundaries we’ve talked about in the previous articles here and here.

Trauma and Yoga

A final thought for you on how to support a loved one who’s struggling with trauma. Encourage yoga. Research from The Trauma Center, a leading training and research institute on trauma, shows the use of yoga in people with trauma can be a very effective tool in being able to rebuild the mind-body connection that can be broken with trauma. But go slow and be prepared for it to trigger trauma reactions. Make sure if you choose to offer this as a support to your loved one, you’re working with their therapist.


Image by Mary Pahlke from Pixabay 

Trauma is not just a trend in the therapy world. It’s a very real part of what clients in substance abuse treatment programs, mental health programs, jails, prisons, and more deal with. It can be an underlying reason why they struggle to remain stable in the community for long. Caring for a loved one requires lots of understanding, patience, and insight. And healthy boundaries.

Stacy Overby, MS, LADC, CCTP is the program director. She has been a licensed drug and alcohol counselor since 2010 and a certified clinical trauma professional since 2017.

Life with the Wright Family

This is a great activity for working on active listening skills with teenagers. It was originally found on the CDC’s website.

Materials:

  • The Wright Family Story found here.
  • One playing card, paper clip, pen, or other small item for each person in the group.

Activity Instructions:

  1. Have the entire group stand in a circle, shoulder to shoulder.
  2. Give each person in the circle the small item that can easily be passed from hand to hand.
  3. Explain you will read them a story. Every time they hear any word that sounds like right, they are to pass their object to the person on their right. And, every time they hear the word left, they are to pass the object to the person on their left.
  4. Start reading the story slowly to give clients a chance to follow what you want them to do. After a few passes of the objects, stop and check in with the clients. Make sure they all have an item in their hands as it is normal for some clients to have several items and others to have none.
  5. Redistribute the items as needed and continue with the story. Speed up your reading a little as you go. Pay attention to how the clients are doing. Stop, check in, and redistribute items as needed throughout the rest of the story.
  6. After the story is done, collect the items and process the experience with the clients. Follow up questions can include:
    1. What does this activity tell us about communication?
    2. What does this activity tell us about teamwork?
    3. What does this activity tell us about listening skills in particular?
    4. What was your experience participating in this activity?
    5. How much of the story can you remember?

What’s Most Important

Purpose: To become aware of values and priorities.

Materials: One copy for each participant of the handout, “What’s Most Important” handout; scissors; tape or glue; one piece of blank paper for each participant; one business envelope for each participant; whiteboard and markers or chalkboard and chalk

Time: 40-50 minutes

Planning Notes:

  • Read the handout and add values statements of your own, if you wish, before duplicating the handout.
  • Cut the individual handouts into strips. Place each set of strips in an envelope, creating a packet for each participant.
  • Create a poster of prioritized values for Step 3, one for each value statement. The priorities should read from MOST IMPORTANT to SECOND MOST IMPORTANT and so on, down to LEAST IMPORTANT.

Procedure:

  1. Review the concept of values. Talk about choosing from a series of coins/bills and how the largest value is the one we pick first and so on.
  2. Explain that for, this activity, the participants will choose among several intangible items, rating which they value most, second most, all the way to which they value least.
  3. Go over instructions for the activity
    1. I will give each of you an envelope containing 20 strips of paper. Each strip has the name of something intangible written on it. Arrange these strips so that what is of most value to you is on top and what is of least value is on the bottom. (Display the illustration you have drawn.)
    1. Move the strips around until the ranking matches how you really value them. Then tape or glue your strips in the correct order to the piece of blank paper I will also give you.
    1. This may be somewhat frustrating because you can have only one top priority. Sometimes, we have conflicting priorities. You must just do the best you can.
  4. Distribute one envelope and one piece of blank paper to each participant. Ask participants to begin. Circulate, offering help if anyone who is having trouble understanding what it is you asked. Caution the adolescents to work slowly and think carefully about each item.
  5. When all or most of the participants are finished, call time. Conclude the activity using the discussion points below.

Discussion Points:

  1. What were your top three or four values?
  2. Was it easier to choose the things you value the most or the least? Why?
  3. Were there items on the list that that you had never really thought about before? Which ones?
  4. Were you surprised by your completed list of values? Why or why not?
  5. How do you think your ranking of values would compare to your parents’ ranking?
  6. How might you stand up for your top three values?

Recovery Dice Group Activity

Goals: 

  • Teach the participants the importance of Coping Skills and Sober Resources, by utilizing their creativity.   
  • Assist participants in identifying various coping skills and community resources they have available to them to assist them in improving their relapse prevention skills and knowledge.  
  • Encourage creativity in this hands on recovery activity.  

Materials:  

  • 12 Sided Dice Template (2 for each client) linked below
  • Scissors 
  • Markers/Writing Utensils
  • Clear Tape 

Introduction: Start at discussion with participants regarding what they should do when experiencing cravings or triggers.  Encourage them to brainstorm various options including different coping skills and community resources.  Assist and provide additional examples if needed. 

Procedure:

Explain to participants that they will be creating their own Recovery Dice.  The idea for the dice is to have as a resource when struggling with finding the right coping skill or resource to use in a particular situation.  They will each create one Coping Skill Dice, and one Resource Dice. They may not repeat any resources or coping skills on their recovery dice.   

Discussion: 

  • Have participants share their finished projects, explaining which coping skills and resources they put on their Recovery Dice.  
  • Have the participants come up with various situations or triggers in which a coping skill or resource would be necessary.   
  • Each individual will take turns using their recovery dice for the scenarios discussed as a group.  
  • Closing: Discuss/reiterate the importance of effective coping skills and knowledge of community resources in and effective relapse prevention plan.  Assist clients in identifying additional resources they may not have come up with on their own.  

A Centering Exercise

Often clients come into sessions agitated and unable to focus. Sometimes it’s walking into a group setting that can trigger this. Centering exercises are designed to calm the mind of racing thoughts and relax the body. While there are many options out there, here’s an easy one to try.

Have the clients sit comfortably in a chair, with their feet on the floor. Instruct them to close their eyes and breathe slowly in through the nose, hold the breath for a moment, then breathe out through the mouth until their lungs are empty. Ask them to notice any thoughts that come into their mind. Remind them, all they need to do is acknowledge and then let go of the thoughts that come to mind. Have them continue breathing in the same pattern for several minutes, just observing the thoughts coming and going. Then, when they are ready, have the clients open their eyes. Ask the clients if anyone wants to volunteer their observations on the thoughts they noticed, but don’t require it of clients when completing a centering exercise. Allow time to discuss any thoughts or observations should clients choose to do so.

And there you have it. A quick and easy centering exercise. Remember the main goal of this exercise–peace and calm. Dealing with those thoughts and feelings are for another time.