Healing Trauma: A Brief Intervention for Women

Part of the One Small Thing initiative www.onesmallthing.org.uk Healing Trauma: A Brief Intervention for Women Stephanie S. Covington, PhD, LCSW Ins...
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Part of the One Small Thing initiative www.onesmallthing.org.uk

Healing Trauma: A Brief 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 92037 USA (858) 454-8528 (858) 454-8598 FAX Email: [email protected] www.stephaniecovington.com www.centerforgenderandjustice.org

United Kingdom September 2015 Afternoon Session

Healing Trauma: A Brief Intervention for Women Stephanie S. Covington, Ph.D., L.C.S.W. Center for Gender and Justice La Jolla, CA USA Part of the One Small Thing initiative www.onesmallthing.org.uk September 2015 Afternoon Session United Kingdom

© S. Covington, Ph.D., 2015

Evolving Treatment Approaches

Source: Grella, 2008.

© S. Covington, Ph.D., 2015

Gender-Responsive Treatment •  Creating an environment through: •  site selection •  staff selection •  program development •  content and material •  that reflects an understanding of the realities of the lives of women and girls, and •  addresses and responds to their strengths and challenges. Source: Covington, S.S., & Bloom, B.E. (2006). Gender-responsive treatment and services in correctional settings. In E. Leeder (Ed.), Inside and out: Women, prison, and therapy. Binghamton, NY: Haworth.

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Histories of Abuse ● 

Over 50% have experienced emotional, physical or sexual abuse

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50% histories of domestic violence

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50% observed violence as a child

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33% have experienced sexual assault

© S. Covington, Ph.D., 2015

Trauma History Among Criminal Justiceinvolved 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 behaviours, sex work, and physical and mental health disorders among women in criminal justice settings •  Prison is also a re-traumatising experience © S. Covington, Ph.D., 2015

Process of Trauma Traumatic Event Overwhelms the physical and psychological coping skills

Response to Trauma Fight, Flight or Freeze Altered state of consciousness, Body sensations, Numbing, Hyper-vigilance, Hyper-arousal, Collapse

Sensitised Nervous System Changes in the Brain Brain–Body Connection Psychological and Physical Distress Current stressors, Reminders of trauma (triggers) Sensations, Images, Behaviour, Affect, Memory

Emotional and/or Physical Responses Retreat

Harmful Behaviour to Self

Harmful Behaviour to Others

Physical Health Issues

Isolation Dissociation Depression Anxiety

Substance use disorders Eating disorders Deliberate self-harm Suicidal actions

Aggression Violence Rages Threats

Lung disease Heart disease Autoimmune disorders Obesity

Source: Adapted from Covington, S., Beyond Trauma: A Healing Journey for Women© and Levine. P., In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness.

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Trauma Informed vs. Trauma Specific

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Trauma-Informed Services • 

Take the trauma into account.

• 

Avoid triggering trauma reactions.

• 

Adjust organisation so that trauma survivors can access and benefit from services.

Source: Harris & Fallot

© S. Covington, Ph.D., 2015

Core Values of Trauma-Informed Care •  Safety (physical and emotional) •  Trustworthiness •  Choice •  Collaboration •  Empowerment Source: Fallot & Harris, 2006

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Trauma-Specific Materials for Women ●  Beyond Trauma (Stephanie S. Covington)

●  Healing Trauma (Stephanie S. Covington)

●  Trauma Recovery and Empowerment Model (TREM - Maxine Harris)

© S. Covington, Ph.D., 2015

Beyond Trauma:

Healing Trauma:

A Healing Journey for Women

Strategies for Abused Women

11 sessions

5 sessions

© S. Covington, Ph.D., 2015

Beyond Trauma Evidence-Base • 

Researched in •  Residential treatment •  Women’s prison •  Drug court

• 

Listed on NREPP

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Healing Trauma Study Pre and Post Treatment Changes in Symptoms of Figure  4 Changes  in  Symptoms   epression  and  PTSD,  CWC   IPV  Project,   Depression andof  DPosttraumatic Stress October  1,  2012  through  September  30,  2013  (N=53)   27

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Score Score

23

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Depression Symptomsdf=52, (.000) CESD (t=4.79, p=.000)

PCL (t=2.96, Posttraumatic Stressdf=52, p=.005) Symptoms (.005) 19

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Pre-Test Pre Test

Post-Test Post-Test

Source: [September] 2013 Annual Report: The Interpersonal Violence Project, Josephine M. Hawke, PhD

© S. Covington, Ph.D., 2015

Beyond Trauma: A Healing Journey for Women Trauma Theory Sandra Bloom, M.D. Judith Herman, M.D. Peter Levine, Ph.D. Integrates cognitive-behavioral, expressive arts, guided imagery, and relational therapy. © S. Covington, Ph.D., 2015

Treatment Strategies •  •  •  •  • 

Cognitive-behavioral Guided imagery Relational therapy Mindfulness Eye Movement Desensitization and Reprocessing (EMDR) •  Emotional Freedom Technique (EFT) •  Expressive arts •  Mind-body (yoga) © S. Covington, Ph.D., 2015

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Beyond Trauma & Healing Trauma Themes •  Safety •  Empowerment •  Connection (Aloneness) •  Normal reactions (Shame) •  Mind-body connection •  Substance abuse •  Woman-centered

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Healing Trauma •  Facilitator’s Guide •  Participant Workbook •  (English and Spanish) •  CD-Rom

© S. Covington, Ph.D., 2015

Implementation

•  Closed groups •  8 – 12 women

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Healing Trauma •  •  •  • 

Adaption of Beyond Trauma (11 sessions) Five 90 minute sessions List of materials Language for facilitation in bold

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Format •  •  •  •  • 

Quiet time, check in Information Interactive exercises Grounding, self-soothing exercises Reflection

© S. Covington, Ph.D., 2015

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 © S. Covington, Ph.D., 2015

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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 allfemale groups

© S. Covington, Ph.D., 2015

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

© S. Covington, Ph.D., 2015

Healing Trauma Session 1 Welcome, Group Agreements and Introduction

© S. Covington, Ph.D., 2015

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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

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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

© S. Covington, Ph.D., 2015

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?

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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.

© S. Covington, Ph.D., 2015

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.”

© S. Covington, Ph.D., 2015

Inner Self & Outer Self (cont.) •  Impacts Outer Self – It can impact our outer life… our outer life consists of our relationships and our behaviour. Many women who have experienced trauma struggle with their relationships – families, friends, sexual relationships.

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Art Activity: Decorate Your Cover

© S. Covington, Ph.D., 2015

Grounding Exercise: Five Senses

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Five Senses

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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

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Healing Trauma Session 2 Power & Abuse

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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 Visualisation Reflection © S. Covington, Ph.D., 2015

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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

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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 © S. Covington, Ph.D., 2015

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. © S. Covington, Ph.D., 2015

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Gender and Abuse •  As children, boys and girls suffer similar rates of abuse •  Girls - sexually abused •  Boys - emotional neglect or physical abuse. •  In adolescence, boys are at greater risk if they are gay, young men of color, or gang members. •  Young men - people who dislike or hate them. •  Young women – relationships; from the person to whom she is saying, “I love you.” •  Adulthood •  Man - combat or being a victim of crime •  Woman – relationship; the person “I love you.” © S. Covington, Ph.D., 2015

Gender Expectations: Social Messages

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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?

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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. © S. Covington, Ph.D., 2015

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 55806 © S. Covington, Ph.D., 2015

Characteristics of Batterers Behaviour as Clues: •  Jealousy •  Controlling behaviour •  Quick involvement •  Unrealistic expectations •  Isolation •  Blaming others for problems •  Blaming others for feelings •  Hypersensitivity © S. Covington, Ph.D., 2015

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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 © S. Covington, Ph.D., 2015

Guided Imagery: Safe Place

© S. Covington, Ph.D., 2015

Healing Trauma Session 3 The Process of Trauma and Self Care

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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 © S. Covington, Ph.D., 2015

Process of Trauma TRAUMATIC EVENT Overwhelms the Physical & Psychological Systems

RESPONSE TO TRAUMA Fight or Flight, Freeze, Altered State of Consciousness, Body Sensations, Numbing, Hypervigilance, 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

Source: Covington, S., Beyond Trauma: A Healing Journey for Women© and Healing Trauma: Strategies for Abused Women CD-Rom©.

© S. Covington, Ph.D., 2015

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 realise that they are in the here and now and that what they are experiencing is in the past and it is not happening now.

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Grounding

•  Physical •  Mental

© S. Covington, Ph.D., 2015

Grounding Exercises

© S. Covington, Ph.D., 2015

Self - Soothing Alone

With Others

Daytime

Night Time

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Developing Boundaries

© S. Covington, Ph.D., 2015

Healing Trauma Session 4 Healthy Relationships

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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 © S. Covington, Ph.D., 2015

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Relationship Wheel

© S. Covington, Ph.D., 2015

Respect, Mutuality, Compassion Respect Respect is the appreciation of someone’s values and it begins to happen when we see their integrity. We often earn respect when we are willing to do the right thing or take the “right action,” particularly when the choice is difficult.

© S. Covington, Ph.D., 2015

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.

© S. Covington, Ph.D., 2015

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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.

© S. Covington, Ph.D., 2015

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)

© S. Covington, Ph.D., 2015

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 55806 © S. Covington, Ph.D., 2015

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Relationship Wheel

© S. Covington, Ph.D., 2015

Wheel of Love

© S. Covington, Ph.D., 2015

Healing Trauma Session 5 Love, Endings & Certificates

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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

© S. Covington, Ph.D., 2015

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?

© S. Covington, Ph.D., 2015

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?

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Love Collage

© S. Covington, Ph.D., 2015

Endings

© S. Covington, Ph.D., 2015

Appreciation •  What I appreciate about the other women in the group. •  What I appreciate about the group.

© S. Covington, Ph.D., 2015

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Upward Spiral Transformation

Healing (expansion)

Trauma (constriction)

© S. Covington, Ph.D., 2015

What makes a difference? •  Creating a safe environment •  Listening to her story •  Empathy

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Sanctuary

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What makes a difference? •  Creating a safe environment •  Listening to her story •  Empathy

© S. Covington, Ph.D., 2015

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.

© S. Covington, Ph.D., 2015

Contact Information Stephanie S. Covington, PhD, LCSW 7946 Ivanhoe Ave., Suite 201B La Jolla, CA 92037 USA (858) 454-8528 (858) 454-8598 FAX

www.stephaniecovington.com www.centerforgenderandjustice.org [email protected] © S. Covington, Ph.D., 2015

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