Archive for the ‘Trauma’ Category

Post-Traumatic Growth (PTG): A Means for Healing

Wednesday, May 1st, 2013

One of the more hopeful and optimistic paradigms in our field comes from Positive Psychology. The concept of Post-Traumatic Growth, based on the work of Tedeschi and Calhout, teaches us that despite the fact that pain, loss, and suffering are associated with traumatic events, as we process and reflect upon the experience we can begin to gain wisdom, insight and resiliency. Through optimism, extroversion, positive affect and a willingness to stay open to experiences, we can manifest post-traumatic growth in arenas including: interpersonal relationships; the belief in new possibilities; personal strength; spiritual and religious growth; and a deeper appreciation for life.

I love the idea of Post-Traumatic Growth (PTG) because we tend to get caught up in the negative side effects of trauma, while overlooking the fact that life-changing experiences can ultimately mean life changing for the better. We should never minimize the impact that trauma has, but as we process our pain we should also begin to assess for the emergence of PTG. We should look for the capacity to change our priorities about what is important in life as we slowly develop a greater appreciation for life itself. PTG can lead to new interests and endeavors, as we are more likely to change what needs to be changed in our life, and take the healthy risks we might not have tried before. The positive by-product of trauma can lead to greater self-reliance and the belief that we can handle difficulties, as we realize that we are stronger than we thought.

When we experience PTG there is an increase in our spiritual faith or a deepening of religious beliefs. Surviving a traumatic event can create a willingness to count on others and be more accepting of them. We can feel a greater sense of closeness to people, and a belief in their inherent goodness. We will put more energy and effort into our relationships, become more willing to express our emotions, and have a greater acceptance that things will actually work out. Post-Traumatic Growth gives us more appreciation for every day, more gratitude, and greater self-compassion. It is my hope and prayer that everyone whose lives have been touched by trauma and pain, can emerge from their sorrow and suffering and reach a place of Post-Traumatic Growth; a place of true healing.

Please share your experiences in guiding clients towards Post-Traumatic Growth.

The Boston Marathon Bombing

Wednesday, April 17th, 2013

by Lisa Ferentz, LCSW-C, DAPA

Again we are forced to contend with extraordinary trauma. Again we are left with feelings of profound grief, fear, and anger. We have to try to wrap our brains around the reality that a person or group of people could be so lacking in empathy, common decency, and a respect for the preciousness of life that they could plant bombs designed to inflict as much physical maiming and emotional terror as possible. We have to grapple with the terrifying reality that we are so potentially vulnerable in environments and at events that are supposed to be safe, joyful, and opportunities to celebrate the strengths of the human spirit. I’d like to suggest, without in any way minimizing the horror of what has happened, that we try to focus on the extraordinary acts of courage and humanity that played out as this nightmare unfolded.

Within seconds of the bomb blasts, videotape shows police, medics, nurses, marathon volunteers, and everyday people rallying to help the physically wounded and emotionally traumatized. Despite a biological instinct to run away from the source of threat, people ran towards the chaos, smoke, broken glass, and blood to offer their help. This is an amazing testimony to the inherent goodness that rests within the majority of human beings. Strangers carrying the injured to safety, running in with wheelchairs, applying pressure to wounds, comforting each other with soothing words of reassurance. Doctors and nurses working, without sleep, doing everything in their power to save lives and limbs. People who were at the scene submitting their pictures and video clips, while thousands call in to tip lines to assist police and intelligence services in their effort to find the clues that will lead to arrests and justice. Already, thousands of people have volunteered to give blood at the hospitals where victims are being treated.

And once again, a horrible but important opportunity to be grateful for what we do have: for 2 more bombs that didn’t explode, for lives that were spared, for families who reached out to and were reunited with one another in the midst of such tragedy. A marathon runner who was one mile shy of finishing the race when the bombs went off, echoed this idea when she said, “I didn’t cross the finish line, but I have never been so ecstatic at the end of a race because I was reunited with my family. And they were all safe.”

There are no answers yet. Who did this? And why? How long will it take to bring them to justice? Why didn’t intelligence catch the “chatter” that usually precedes an act of terror? While we wait for those critical answers, be careful not to vicariously re-traumatize yourself by overdosing on media coverage and images of the event. Try to focus on the overwhelming goodness that still exists in the world, and the countless acts of kindness that we automatically engage in when threatened. And send all of your thoughts and prayers to the families who were directly and indirectly affected by this cowardly and despicable act of terrorism.

Overcoming Adversity

Thursday, January 31st, 2013

There have been many times in my life when I’ve been asked, “How can you do the work you do, listening to such upsetting stories about the terrible things that people endure?” My answer is always the same- it is a joy and a privilege to bear witness to someone’s healing journey. I feel so inspired, on a daily basis, by the courage, resiliency, and grace that my clients exhibit. Their goal for treatment is not merely to ‘survive” but rather, to thrive. Like other clinicians, I am sometimes astonished by a client’s determination to overcome seemingly impossible odds and overwhelming difficulties. Traumatized clients often have an additional unfair vulnerability towards subsequent abuse and pain. If they have not yet learned how to listen to and trust their own instincts or don’t know how to use their own voice to self-advocate and self-protect then they are often taken advantage of by toxic people who have radar about their fragility. As a result, these clients have a long list of adverse and life-changing experiences that can create a state of learned helplessness, perpetuating the cycle of being mistreated and misunderstood by others.

And yet, so many of these clients can and do overcome their traumatic experiences and eventually learn to access their own inner wisdom. How do they do it? How do they keep getting back up, even when they’ve been repeatedly knocked down? Although every client is unique, I think there are some common denominators that exist in clients who are able to transcend their painful past experiences. It may be that they inherently have certain positive cognitions and resources for support that can help mitigate the pain. Certainly, the process of being in a safe and trusting therapeutic relationship is key in helping them access those internal and external resources that make healing possible. Along with a remarkable refusal to “not give up,” there are some additional dynamics that help shift clients from surviving to thriving.

Clients who thrive do not let their trauma narratives define them. Painful events are things that have happened to them- not who they are. These kinds of clients are eventually willing and able to get off the “why me?” hamster wheel. They understand that focusing on “why” will keep them perpetually stuck. They shift from “why did this happen to me?” to “what can I choose to do with it?” Doing something with it and finding meaning in it are key concepts in healing work. Clients who thrive actually do find meaning in their pain, and that can lead to eventually paying it forward and inspiring someone else in their healing journey. In fact, for many survivors, the true definition of “thriving” is being a role model and source of hope for someone else. Clients who thrive don’t look at their trauma as “proof” that people are bad or the world is unsafe. They understand that there is still goodness and kindness in the world, and they seek it out and practice it in their own lives. Ultimately, survivors who thrive have a deeply held sense of gratitude and an appreciation for whatever coping strategies they needed to use to survive. They move beyond self-recriminations, marvel at their own resiliency, and use their anger to create positive changes in themselves and in the world. They don’t allow adversity to put a glass ceiling on new possibilities: an admirable and powerful lesson for us all!

Please share your inspiring examples of clients who’ve overcome adversity in their lives.

The Sandy Hook Tragedy

Tuesday, December 18th, 2012

Like most of you, I have shed many tears over the recent tragedy in Newtown, Connecticut. I grapple with the overwhelming senselessness of it all. I can barely process the unspeakable pain that will haunt the families who have lost their cherished, innocent children, mothers, daughters or siblings. I have only an intellectual understanding of the trauma that will haunt the survivors who witnessed the massacre, as well as the lasting impact it will have on their entire community. As images of funerals, tiny coffins, and grieving loved ones infiltrate the media, the tears resurface and I continually shake my head in disbelief.

As a clinician who has an expertise in trauma, many colleagues have asked me for guidance in handling this horrific event with clients. When tragedy strikes, I think we are hardwired to immediately ask “why?” It is untenable to not have an answer. Not having answers increases our sense of helplessness about a situation that has already left us feeling vulnerable and disempowered. In this case, asking “why” could lead to important conversations about mental illness, lax gun control laws and the frightening accessibility of assault weapons and bullets, the impact of dysfunctional family dynamics, missed red flags that were indicative of sociopathy or untreated trauma, etc. But in the end, there is an inherent senselessness to these tragedies, and no answer ever really satisfies.

Instead, I’d like to offer some things to keep in mind when processing these kinds of events, particularly with our clients. Many people who have prior histories of trauma interpret these tragedies as “proof” or “evidence” that the world has been and always will be an unsafe place. This can create a downward spiral of cognitive and emotional distortions, and I think it’s important to help clients maintain a sense of balance or perspective while still giving them the opportunity to express their fear, grief or anger. When we overgeneralize and think “everyone is evil” or “every environment is unsafe,” our lives and relationships get marginalized and we become re-victimized.

It is easy to focus on what we can’t control, and to obsess about how scary that is as we go through our daily lives. The counter-balance is to remind our clients of what they can control and to help them stay pro-active in those arenas. I believe the best responses to acts of evil are acts of kindness. Encourage your clients to do something that honors the memory of those children and keeps alive the notion that there is still goodness in the world. Whether it’s signing a petition to change gun control laws, advocating for the increased availability of mental health resources, donating money or services to help the stricken families and community of New Town, or reading to children who are hospitalized during the holidays, “doing something” is what helps us attach meaning to these kind of senseless crimes. It is also a way to help clients recognize the difference between their past experiences- when they were truly powerless- and the present- when they can respond and make a difference.

As we compassionately help our clients navigate their emotions, remember to help them keep alive feelings of gratitude. Tragedies are opportunities for us to focus on what we do still have, and to reconnect with the people and relationships that are often taken for granted. In the earliest stages of tragedy, it seems impossible to focus on gratitude. Our anger and grief can trump everything else. But when we are ready, there is great healing to be found by re-embracing and acknowledging all that we have to be grateful for in our lives.

Lastly, the issues of faith and spirituality can be sorely tested during these times. Clients can feel legitimately “betrayed” by a higher power that “allowed” something so awful to happen. My belief is that God is not in these heinous acts. He gives us free will and the choice to harm others is a choice that man makes. God is in the aftermath: the grace, resiliency and inner strength we eventually discover in ourselves. He is in the newfound meaning and possibility of healing and growth that can follow in the footsteps of trauma. He is in the “coming together” through beautiful acts of kindness and support that this community and other communities around the country and even the world will discover, in time. Prayer and faith can be great sources of comfort. So even when we are angry with God, we are still connected to God. And that relationship can sustain us even in our darkest times.

Below are links to documents from A Practical Guide for Crisis Response in Our Schools: Sixth Edition and Comprehensive Acute Traumatic Stress Management, both publications of the American Academy of Experts in Traumatic Stress. They include useful information for assisting professionals in addressing the emergent psychological needs of those impacted by this tragic event.

Practical Suggestions for Assisting Children in the Aftermath of a Tragedy

Teacher Guidelines for Crisis Response

Parent Guidelines for Crisis Response

How Do People Respond During Traumatic Exposure?

Helpful Information During and After a Traumatic Event

The Aurora Tragedy

Tuesday, July 31st, 2012

Described as a “loner,” like many sociopaths, it appears he deceived many into believing he was an “upright citizen.”

Much has already been written about the heartbreaking tragedy in Colorado. The killer’s total disregard for human life and safety are impossible for us to process. Many people have asked me, “How can something like this happen? Or “What drives a person to commit such a heinous crime?” I think we ask those questions because when tragic events occur, we want the incomprehensible to some how make sense: it is human nature to want to fill in the blanks. When we don’t have answers, we begin to make assumptions and create potential scenarios in our own minds. It still feels better than not knowing. When we have answers we equate that with a sense of control. For most people, it is untenable to reconcile the fact that things happen in life that are truly not within their control.

Of course, there is much that still needs to be revealed about the killer’s mindset, motivations and intentions, family background, mental health, etc. It is possible that as those things are uncovered and revealed, some of our burning questions will be answered. But at the end of the day, this feels like the act of a sociopath. Consider some of the cardinal features of this frightening diagnosis and how they appear to resonate with what we currently know about the killer.

So far, he appears to have a total lack of remorse, shame or guilt. The calculating way in which he attempted to do the most harm possible speaks to a callous disregard for the distress and pain of others, focusing, instead on a sense of entitlement, rage, and cruelty- hallmark features in a sociopath. This appears to have been an act of premeditation and considerable planning, with the intention of using victims for his own gain, either as a vehicle for the expression of his rage, for notoriety, etc. By all accounts, he is extremely intelligent and was academically successful. Sociopaths tend to be very bright, but use their intellect for nefarious ends. Described as a “loner,” like many sociopaths, it appears he deceived many into believing he was an “upright citizen.” The most distressing feature, a total lack of empathy for the pain he caused in countless others adds even more credence to this possible diagnosis.

I realize I am now attempting to fill in the missing pieces as well, but considering the possibility that this is the work of a sociopath can actually help to shed some light on this tragedy. The respected literature on sociopathy maintains that between 1%-4% of the population in the United States meets criteria for this frightening diagnosis. That translates to between 3 and 12 million people. Most are not in jail, they live and often appear to thrive among us, and we are vulnerable to their manipulative ways. To learn more about socipathy, I highly recommend two excellent books on the subject, Martha Stout’s, The Sociopath Next Door, and Robert Hare’s, Without Conscience.

Regardless of what made this killer act, may every person whose life was touched and affected by this horrible crime find the comfort and support they deserve. And may the memories of every person whose life was senselessly and prematurely taken always be cherished and honored.

Turning Tragedy into Opportunity: Resilience of the human spirit

Wednesday, July 25th, 2012

…extraordinarily traumatic events actually led to rebirth, recovery, and rebuilding.

I am writing this after returning from a wonderful and rejuvenating family vacation with my husband and our three grown sons. For many, many summers now, we have realized our goal of showing our boys the beauty of North America. We have walked countless magnificent trails and climbed incredible mountains in most of our National Parks, marveled at the pristine splendor of Alaska, and explored almost all of the majesty and charm of Canada. This summer, we wanted a more urban experience, so we spent time in wonderful downtown Chicago, and then fell in love with the amazing jazz of New Orleans. On the surface, these seem like disparate places to visit, but I soon discovered a fascinating and moving connection between our Mid-Western and Southern destinations.

Maybe the fact that I specialize in trauma and healing means that I see most of the world through a particular lens. But I was so struck by a theme that emerged both in the cities of Chicago and New Orleans. In both places, profound disasters threatened the very existence of the city and nearly led to their complete annihilation. The Great Chicago Fire of 1871 was one of the largest disasters of the 19th century, killing hundreds and destroying the very fabric of the city: the business district, hotels, department stores, City Hall, churches, the printing plants, theatres, and the opera house.

In 2005, Hurricane Katrina wrecked havoc on New Orleans and other neighboring states in the South. It was one of the five deadliest hurricanes and the costliest natural disaster in the history of the United States. Over 1800 people died, with total property damage estimated at $81 billion dollars. In New Orleans, 80% of the city and nearby parishes were flooded. Visiting the 9th Ward is a moving and sobering experience- the only way to begin to appreciate the depth of destruction and loss.

And yet, in both cities, these extraordinarily traumatic events actually led to rebirth, recovery, and rebuilding. Even with the magnitude of destruction, Chicago went on to become one of America’s most economically important cities. And as New Orleans continues to rebuild, the palpable feeling of resiliency and gratitude is remarkable. Wherever we went, we were met with friendly, welcoming faces, and we were repeatedly thanked for supporting the city with our presence and much needed tourist dollars.

In both cities, I was moved by this idea of turning tragedy into an opportunity for regrowth. It made me think about our clients and the amazing courage and resiliency of the human spirit. It was a great reminder about our inherent capacity to heal, even in the face of devastating life events. I felt humbled and hopeful, and was again reminded of what a privilege it is to bear witness to this process when we help our clients in their healing journeys.

Resources for Resiliency

Positive Psychology Resources – Centre for Confidence and Well-being
Reivich, K and Shatte, A, The Resilience Factor: 7 Keys to Finding Your Inner Strength and Overcoming Life’s Hurdles ,Three Rivers Press, 2003
Ginsberg, K , Building Resilience in Children and Teens: Giving Kids Roots and Wings, American Academy of Pediatrics, 2011
Neenan, M, Developing Resilience: A Cognitive-Behavioural Approach, 2009 Routledge

Living in a Virtual War Zone: The Children and Adolescents of Domestic Violence

Wednesday, April 25th, 2012

Written by, Denise Tordella, M.A., LPC

A 2006 survey of American households revealed that nearly 30% of children, many of whom are very young, live in homes where there is some form of intimate partner/domestic violence. Children and adolescents who witness or experience trauma, including domestic violence, display increases in stress hormones comparable to those displayed in combat veterans. This research finding makes sense from the perspective that these children and adolescents are living in a virtual war zone! Children and adolescents may experience long term effects from chronic exposure to domestic violence which may include: impaired academic performance; reduced levels of motor and social skills; behavior problems; substance abuse; self-harming behaviors; changes in brain physiology and function; and emotional difficulties including depression, anxiety disorders and post-traumatic stress disorder.

Many times the question that people ask is, “Why doesn’t she just leave?” By the time the family reaches the point where this question is being asked, the family is deeply entrenched in the cycle of violence and abuse. The mother and children are living in a constant state of fear and anxiety and they are dominated by responses of flight, fight or freeze. The neurobiological impact of trauma and the emotional, cognitive and behavioral adaptations that the family makes impacts their ability to makes decisions, develop safety and exit plans, and to fundamentally believe in their own ability to find safety. The ability “to leave” is profoundly trumped by the need “to survive”.

The coping strategies that families develop may help them survive the abuse and violence in their lives and those strategies will often go on to create patterns that wreak havoc on the rest of their lives.

On June 1st, at my workshop at the Institute entitled, “The Impact of Domestic Violence on Children and Families,” we will identify maladaptive coping strategies that families develop to manage their reactions to abuse and violence. We will identify interventions that reinforce positive and nurturing parenting skills and explore stress reduction strategies to address the neurobiological, emotional, somatic, and cognitive aspects of traumatic stress they have experienced. We will focus on enhancing self-regulation skills and skills that support social and peer group competence. We will focus on collaborating with families in their healing from domestic violence by supporting secure attachment between children/adolescents and their non-abusive parent as we enhance their safety and stability.

The Impact of Sandusky on Clinicians and Clients

Wednesday, December 21st, 2011

I can only imagine how the Sandusky scandal has impacted your practices. For my clients it has been profoundly triggering. The ongoing reality that children continue to be betrayed and violated while adults look away- minimizing, rationalizing, and denying the unimaginable horrors that someone with power can inflict on innocent lives –has opened healed wounds and caused new ones. My clients get angry all over again, and re-connect with the grief, despair, and helplessness they experienced in childhood. For them, the onslaught of new disclosures and the tepid empathy shown towards the victims reinforces the relentlessness of their own experiences, and the lack of protection and compassion they felt from others whenever they did find the courage to come forward with their trauma narratives.

As clinicians we have a difficult task ahead of us. It is unclear how this story will play out in the media and the courtroom. How vocal and articulate will Sandusky’s supporters be? How much “blaming the victim” will be woven into the story? Will his attorneys attempt to distort the truth, downplaying the seriousness of his offenses or the long-term adverse effects on his victims? Will Sandusky take any responsibility for his actions or be held sufficiently accountable in a court of law? And what will be the short and long-term effects on our clients?

As is often the case, I find myself confronted with the reality that there are many things that happen in this world that are not within our control. And there are some things that are- including the meaning we choose to attach to events, the extent to which we learn and grow from them, and what we do with them once they have occurred.

I encourage my colleagues to use this very difficult event as an opportunity to continue educating both clients and the community at large about the dynamics of abuse and victimization. Focus on the innocence of children and the need to proactively protect them from predators. Let it be known that “looking the other way” makes you an accessory, and is an unacceptable and unconscionable response. Challenge the media when they use the word “relationship” to describe “rape.” Empower survivors of sexual abuse to find the courage to share their experiences, ending generational cycles of secrecy and denial. Educate anyone who downplays the severity of what was done to these children. Keep the discussion alive- it not only validates experiences, it gives survivors a voice and communicates to them that we care, deeply, about their pain and believe, deeply, in their capacity to transcend it and heal.

Remembering 9/11

Sunday, September 11th, 2011

At this time of year, I always reflect upon the trauma and tragedy of 9-11. Like so many of you, the details of that day are forever etched in my mind, proving, in part, how vividly we can retain the emotional and somatic memories of something that profoundly affects us. I cannot tell you what I ate for breakfast three days ago, but I can tell you, in exquisite detail, all about that Tuesday morning, 10 years ago. And so can anyone I talk to about that day.

Putting aside the feelings of terror, the surreal nature of it all, the overwhelming anger and grief- New York is my home, and home to my family- I remember the extraordinary “coming together” that we all experienced for weeks, even months afterwards. When the second tower fell, I think there was a universal sense of vulnerability. And with that vulnerability came our hard-wired, reflexive drive to reach out, protect, and comfort one another as best we could. For an extended period of time after 9-11, we were kinder to one another. We were more patient, more compassionate. It was implicitly understood that every one of us had been shaken to our core and we had become untethered. Reaching out, assisting each other in ways we hadn’t before, even making eye contact and smiling at strangers, helped us to feel moored again. We re-connected with our humanity and were reminded of the importance of “being there” for each other.

My wish, as we acknowledge the 10th anniversary of this tragic time in our history, is for each of us to again remember the importance of reaching out, connecting, supporting, and comforting one another. Trauma is insurmountable when we cannot find any meaning in it. May we continue to find meaning beyond the senselessness of 9-11 and the wisdom to act on the lessons we can learn. Remember the healing power of reaching out to others in gratitude and love. May you find comfort and peace this 9-11.

Adolescent Substance Abuse and Trauma

Monday, August 29th, 2011

by Denise Tordella, MA, LPC

Adolescent Substance Abuse is America’s #1 Public Health Problem, according to the June 2011 study by the National Center for Addiction and Substance Abuse (CASA) at Columbia University (www.casacolumbia.org/upload/2011/20110629adolescentsubstanceuse.pdf). The CASA report states that childhood trauma, including: abuse; neglect; and household dysfunction are significant risk factors for adolescent substance abuse. The CASA study also states that a lack of education and training on this topic leads to failure in addressing it with adolescents. Only 6.4% of adolescents in need of treatment receive it and we all know the impact of untreated substance abuse disorders in our clients.

Substance abuse, like any other self-harming behavior, begins as a survival strategy. It starts out as a way to regulate dysregulated arousal states that may develop as a result of: disorganized attachment issues; emotional, physical and sexual abuse; neglect; co-occurring mental health disorders (e.g., depression, anxiety); and grief and loss. Initially drug and alcohol use seem to alleviate stress, either through the increase in pleasurable sensations and emotions or the avoidance of intense, trauma related emotions and sensations. In the long run, substance abuse takes on a life of its own because more of the psychoactive substance is required to achieve the same effect and, eventually, adolescents need to use psychoactive substances to deal with the symptoms of physical and emotional withdrawal. They do not use to “feel good”; they use to “feel less bad” on so many levels. Substance abuse also puts adolescents at risk for additional trauma (e.g., sexual and physical assault, injury).

Trauma, and its impact on mental health and substance abuse issues, must be addressed concurrently in treatment. We need to validate the adolescents’ creative, albeit maladaptive strategies to self-regulate their arousal system and develop compassion and acceptance to counteract the shame and guilt that is the inevitable result of addiction and trauma. When treating this population, we must address how the use of psychoactive substances has helped the adolescent to cope. We should explore the thoughts, emotions and sensations that are being managed by substance abuse in order to identify the symptoms that will be exacerbated as substance abuse decreases. We should identify interventions specifically targeted to increase the range of coping strategies for adolescents as they begin to “crowd out” substance use as their primary coping strategy. I have had the wonderful opportunity to complete Level 1 of Sensorimotor Psychotherapy training as developed by Pat Ogden and I am currently studying Level 2. It is so important to help adolescents recognize sensations in their bodies. Once they are tuned in to these sensations we can teach them to regulate and manage them so they can remain grounded and centered in their bodies. When this is accomplished, they don’t need to use alcohol and other drugs to regulate these experiences in a maladaptive way.

Join us on Monday, September 19 for the workshop, Making the Connection: Adolescent Substance Abuse & Trauma to learn about assessment and treatment strategies for adolescents impacted by traumatic stress and substance abuse. In this training, we will explore how to provide trauma-specific, integrated treatment strategies and interventions for working with adolescents with substance abuse disorders. All of the aforementioned issues will be explored in the training. Please join us for an opportunity to share your knowledge, expand your education, and to learn trauma-specific approaches to address adolescent substance abuse that you can use with your clients the NEXT DAY!