Vivian B. Brown, Ph.D. - Women, Children, & Families
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Transcript Vivian B. Brown, Ph.D. - Women, Children, & Families
Creating a Safe
Community and a
Clinical Home
CENTERS FOR INNOVATION IN
HEALTH, MENTAL HEALTH AND
SOCIAL SERVICES
Vivian B. Brown, Ph.D.
Major Paradigm Shifts
Substance
abuse treatment
establishes women and children’s
programs and adopts gender-sensitive
programming
Mental Health adopts a recovery
perspective
Trauma moves into foreground and
becomes a unifying and central
concept for both fields
What are our Clinical Shifts?
Trauma
as a key component
Assessment needs to include
trauma/PTSD
Services designed to assist women
in understanding links between
trauma, substance abuse, and
emotional disorders
Concept of peers is expanded
Fears of providers
Trauma
treatment means “opening
up” trauma memories, and that
leads to disaster
Stages of Recovery*
Stage One: ESTABLISHING SAFETY
Treatment aims:
• Securing safety
• Stabilizing symptoms
• Fostering self-care
Stage Two: REMEMBRANCE AND MOURNING
Treatment aims:
• Reconstructing the trauma
• Transforming traumatic memory
Stage Three: RECONNECTION
Treatment aims:
• Reconciliation with self
• Reconnection with others
• Resolving the trauma
*Judith L. Herman, 1992
Stage 1 Recovery
Focus
upon establishing both
physical and psychological safety
Increasing understanding of links
between trauma and substance
abuse
Teaching coping skills
Stage 1 helps providers as well as
clients
Paradox of
Countertransference*
Each disorder appears to evoke opposite
countertransference reactions
PTSD/trauma tends to evoke identification
with women’s vulnerability
If taken too far, may lead to excessive support at
the expense of growth
Substance abuse tends to evoke anxiety
about the women’s AOD
If taken too far, can become harsh judgment and
control
*Najavits, 2003
Empowerment Model
Essential
to recovery from an
experience of helplessness,
powerlessness, and overwhelming
fear is empowerment
To increase one’s power in personal,
interpersonal, and/or political spheres
Allowing the woman choice and
control moves recovery further
Culture
Understanding
the influence of
women’s cultures is essential to
making an effective therapeutic
alliance
Trauma-specific Models
Utilized
in Women with Co-Occurring
Disorders and Histories of Violence Study
Atrium
Seeking Safety
Trauma Recovery and Empowerment
(TREM)
TRIAD
Another
model utilized in women’s
substance abuse treatment
Helping Women Recover
Common Features
Stage
1
Cognitive-behavioral
Teach coping skills
Group curricula, but could be utilized
in individual sessions
Can be co-facilitated by a
professional and a peer
Some Important Coping Skills
Grounding
Self-soothing
Establishing
boundaries
Emotional self-regulation
Coping with triggers
Other Treatment Services
Trauma-informed
parenting training
Trauma-informed vocational services
Procedures or Situations That May Trigger
Prior Experiences of Trauma Include
Lack of control-powerlessness
Threat or use of physical force
Observing threats, assaults,
others engaged in self-harm
Isolation
Being in a locked room or
space
Physical restraints - handcuffs,
shackles
Interacting with authority
figures
Interacting with men, in
general
Lack of privacy
Removal of clothing – strip
searches, medical exams
Being touched – pat downs
Being watched – suicide
watch
Loud noises
Fear based on lack of
information
Darkness
Intrusive or personal
questions