Treatment for Trauma, PTSD and, Substance Use Disorders in Women: - - PowerPoint PPT Presentation

Treatment for Trauma, PTSD and, Substance Use Disorders in Women: An Adlerian Based Treatment Approach By Shirley Butcher

INTRODUCTION

WH

WHAT IS IS TRA TRAUMA? UMA?

• An

event

• r

series

• f

events that threaten you, perhaps even with death – that causes physical

• r

emotional harm and/or exploits your body and/or integrity

• Trauma

is pervasive and life-altering

*DSM

DSM-5 5 Def efinit ition ion

• f

PT PTSD

PTSD SD as as exp xposur ure to ac actual al

• r

t threa eaten tened ed de death, th, serio rious us inju jury ry

• r

sexual al violatio tion. n.

• Pays

more attention to the behavioral symptoms 4 Clusters sters:

• re

re-ex exper periencing iencing, ,

• av

avoida dance ce, ,

• nega

gative tive cogniti itions an and mood, d,

• an

and ar arousal al.

Pr

Pres esen enta tation tion Purp urpose

• se
• Post-traumatic

stress disorder (PTSD) and substance abuse (SUD) are commonly co-occurring conditions.

• Both

PTSD and SUD can be conceptualized as disorders with significant experiential avoidance components.

• Adlerian

Individual Psychology, social al inter eres est can be developed through interventions in the integrated treatment setting and in individual therapy.

• To

look at clinical presentations, issues, and treatment

• ptions

*I *Importance

• rtance
• f

Treating ting Traum uma & SUD

• Treatment

is ineffective unless it acknowledges the realities

• f

women’s lives

• f

abuse.

• A

history

• f

being abused increases alcohol and

• ther

drugs

• Without

treating all issues

• fall

through the cracks, and eventually end up in the correctional system

• We

need to address Trauma & SUD at the same time

SIG IGNIF NIFICA ICANCE NCE AND ND PREV REVALANC ALANCE

• Trau

auma has as been een repo port rted by 55 55-99% 99%

• f

femal ale substan stance ce ab abuse sers rs

• 25

25-80 80% %

• f

women en & & 20 20+% +%

• f

men hav ave a histo story ry

• f

sexual al victimiza timizatio tion.

• Girl

rls in high gh income me fam amilies lies ar are at grea eatest test ri risk for inces est

• Women

en who were sexual ually ly ab abuse sed in child ildho hood

• d

ar are more than an twice ce as as likel kely to be re-victim ictimized zed as as ad adults ts

• >40%

0%

• f

w women en

• n

w welfar fare were sexual ally ly ab abuse sed as as child ldren en

• The

he maj ajori rity ty

• f

people le in the cri rimin minal al justice ice sys yste tem were ab abuse sed as as child ldren en

SIG IGNIF NIFICA ICANCE NCE AND ND PREV REVALANC ALANCE

• Trauma

betrays-- beliefs, values, and assumptions

• Trust

– about the world around us

• Trauma

leads to unhealthy behaviors

• An

adaptation not a pathology

*SIGNIF IGNIFICA ICANCE NCE AND ND PREV REVALANC ALANCE

Women in ja jail:

• Have

histories

• f

caregiver violence were 9x as likely to run away as teens;

• Partner

violence were 4x as likely to engage in sex work and 2x 2x as likely to deal drugs;

• Witnessed

violence were 2x 2x as likely to commit property crimes

• r

assaults and 9x 9x as likely to use weapons;

• Substance

use disorder was 7x 7x as likely to get DUIs and 6x as likely to engage in sex work;

• Women

with SMI were more likely to have experienced trauma, to be repeat

• ffenders,

and to have earlier

• nset
• f

substance use and running away.

*Commonly

• nly

Overloo erlooke ked Traum umatic tic Ev Events nts

–Falls

• r

sports injuries –Surgery (especially in the first 3 years

• f

life) –Sudden death

• f

someone close –A car accident –Breakup

• f

a significant relationship –A humiliating

• r

deeply disappointing experience –Discovery

• f

a life-threatening illness

• r

disabling condition

*Commonly mmonly Ov Overlooked rlooked Trauma umatic tic Ev Events ts

Histor torical cal Trauma auma-

• Multig

igener erati tional

• nal

trau auma ma exper perien ienced ced by a s speci ecific fic cultur ural al grou

• up is

cumulative tive an and collec lective tive Examp amples les-

• Immigr

igran ants ts

• Inter

ergener eneratio tional al Pov

• vert

rty

• Peop
• ple
• f
• f

Col

• lor
• r
• American

rican Indians/F s/First irst Natio tions Peop

• ples

les

TR TRAUM AUMA TH THROUGH OUGH TH THE LEG EGAL AL SYSTEM STEM

• Handcuffs

ndcuffs

• Manda

date ted medi dication tion

• Secl

clusion usion & rest strai aint nt typ ype pr procedur cedures es

*SCOPE PE OF THE HE PROBLEM BLEM

• As

many as 90 90% of women seeking SUD treatment report histories

• f

sexual and physical assault

• Among

substance abusers, rates

• f

PTSD range from 14 14-60 60%

• Among

PTSD populations, co-occurring substance use disorders may

• ccur

in 60 60-80% 80% of individuals

*Am *Among

• ng

Women men in Resi sidentia dential Drug ug and nd Al Alco cohol hol Treatment tment Cente ters rs:

• 57

57% report rt emotio

• tional

al ab abuse se

• 49%

report rt phys ysical ical ab abuse se

• 40%

report rt sexual ual ab abuse se

• 73

73%

• f

women en report rted ed a histo story ry

• f

rap ape

• 45

45% repo port rted repe peated ted rap ape exp xper erie iences ces

• Man

any hav ave multip tiple le issues ues

MEN EN WITH CO-OCC OCCURRIN URRING DISOR SORDE DERS RS

• Men

with co-oc

• ccurring

curring di diso sorders ders frequently quently have trauma uma

• Studi

udies es su suggest est 12-15% 5% have PTS TSD and SUD

• Men

report port crime victi timi miza zation, tion, di disa saster, ster, and comba bat more

• fte

ten than an child ldhood hood abuse use

IMPO PORTANC ANCE

• f

the AC ACE STU TUDY DY to TR TRAU AUMA & SUD

• 90%

0%

• f

pu public lic mental tal heal alth clien ients ts hav ave been en exp xposed sed to, an and most hav ave ac actual ally ly exper erienced, ienced, multiple tiple exposu sures es

• f

t trau auma ma

• ACE

(Adv dver erse se Childho ildhood Experi rience ences) s) Study dy

• Almost
• st

2/3

• f

the study udy par articipa ticipant nts report rted at leas ast

• ne

ad adverse se childh dhood

• od

experien ence ce

• f

phys ysica ical

• r

sexual al ab abuse, e, neglect ct,

• r

fam amily ly dysfu function nction

• More

than

• ne

in five reported rted three

• r

more such ch experi rien ence ces

• (ACE

TEST)

ACE

STUDY

TR TRAUMA RI RISK

• Ri

Risk sks

• f

an an Eve Event bei eing Trau aumatic ic

• It

happ ppened ened un unexpect xpectedly. edly.

• You

were un unpr prepar epared ed for it.

• You

felt lt po powerless erless to pr prev event ent it.

• It

happ ppened ened repe peate tedly. dly.

• Someone

eone was intentionall ntionally crue uel. l.

• It

happ ppened ened in ch child ldhood. hood.

• You

are too

• se

sensiti nsitive. ve.

Tri riune une Brain

Ne

Neur urob

• biological

iological Ch Changes es

• Limbic

System

• Hippocampus

and Amygdala

• Neurotransmitters

and Peptides

• Numbing

and Depression

• Changes

in Hormonal System

• HPA

axis > Arousal

*TRAUMA AND THE BRAIN

Brain Responses to Fear

TRAUMA AND THE BRAIN

Trauma auma Re Rela lated ted Brain ain Ch Chan anges es

• Chang

anges in brai ain functio tioning ing an and de developm lopment nt

• Affect

ect the way ay the he brai ain copes es with stres ess

• Suicid

cidal al ide deatio tion/a n/attempts ttempts

• Self

lf-destru destructive ctive beh ehavio aviors rs-cu cutting tting

• Increase

ease ri risk for de depres essio sion, n, an anxiet ety

• Borde

derl rline ine pe pers rsonality ality di disorder der

• Increase

ease ri risk for par aran anoia, a, hal allu lucina cinatio tions ns

• Anger

er problems, ems, poor attent entio ion, n, an and concen entr tratio tion

Clinical linical Cha halleng llenges es in the he Trea eatment tment

• Abstinence

may not resolve comorbid trauma-related disorders – for some PTSD may worsen

• Confrontational

approaches typical in addictions settings frequently exacerbate mood and anxiety disorders

• 12-Step

Models

• ften

do not acknowledge the need for pharmacologic interventions

• Treatments

for PTSD

• nly

may not be advisable to treat women with addictions

• r

may be marked by complications

• Improve

less , Worse coping, Greater distress

• More

positive views

• f

substance use (understandably)

SELF

ELF MED EDICA ICATION TION

• Surv

rvivors rs

• f

ear arly childho ldhood sexual ual ab abuse se use dr drugs an and al alcohol

• l

to cope with th phys ysica ical an and emotio

• tional

al pai ain, memor mories ies an and

• ther

er sym ympto ptoms ms

• f

pas ast trau auma. a.

PTS TSD sy sympt ptoms ms

• fte

ten become

• me

worse se with initia ial abst stinence nence.

TR TREA EATI TING NG CO CO-OCCURRING OCCURRING PT PTSD & SUD SUD

Wom

• men

with PTS TSD an and SUD hav ave par articula cularly rly severe levels ls

• f

s symptoms co compared to wo women with

• nly

PTSD

• More

co-occu curr rring ing di diag agnoses ses

• More

medica dical pr proble lems

• High

gh rate

• f

suicide ide atte tempts mpts (78.6% .6%)

• More

cognitive itive di disto tort rtions

• Lo

Lower complian liance ce with th af after erca care

• Lo

Lower motiv ivatio tion for treatm tment ent

• More

inpa patie ient nt ad admissio ssions ns

WOM OMEN EN WITH TH CO-OCCURRI OCCURRING NG DISORDER ORDERS STI TIGMA MA

• Ne

Need saf afety to discl clos

• se

ch chemi mical cal use

• May

beco come disru rupti ptive ve when trauma history ry beco comes evident nt

• Face

ce tremend ndous us stigma

• Oft

ften most need these serv rvice ces

• Leas

ast likely ely to seek/ k/rece eceive ive serv rvices ces

• Violence
• ften

seen as a “natural” part

• f

life

Lisa Najavits defines PTSD as: “PTSD means being stuck in the trauma, unable to successfully face the emotional pain, cope with it, and go

• n with normal life.”

COS OST OF OF U UNTRE TREATED TED PTS TSD & SUD IN WOM OMEN EN

• In

Incr creased ed need and rate

• f

u use

• f

E ER and cr crisis serv rvic ices es

• Repeated

ted treatment nt due to r relapse se

• Total

co cost

• f

t treatment ent for me mental al illness ss and SUD per year >$ >$300 billio ion. n.

• 75

75% ma may b be attri ributa butable ble to ch childho hood

• d

trau auma ma

• In

Incr creased ed jail co costs

WH

WHEN EN TR TREA EATM TMEN ENT FA FAIL ILS

• Dual

ally ly di diag agnoses

• ses

pe peopl ple may ay inter ernalize alize a s sense nse

• f

fai ailur ure

• May

ay feel el they ey ar are craz azy, y, laz azy, y,

• r

b bad ad

• Sense

se that somet ethi hing ng is terr rrib ibly ly wrong

• Dem

emoral aliza izatio tion

• Self

lf-blame lame

• Social

al isolatio tion

• Increase

ease in Self lf Inter eres est

WH

WHAT TREATMEN MENTS TS WO WORK? K?

• Cognitive

nitive beha ehavior vior ther erapy apy

• Exposure

ther erapy apy & F Flooding ding

• Eye

ye Movement ment Desen sensitiz sitizati tion (EMDR) DR)

• Group

an and indi dividual idual ap appr proac ache hes

• Streng

engths hs & S Skill lls bas ased ed

• Self

lf-help elp (e.g., g., Courag age to Heal al, Add ddicted ted Brai ain)

• Higher

gher Power bas ased ed (AA, NA, etc.) c.)

• Phar

arma maco coth ther erapy apy

• Somatic

tic Exp xperien riencing cing (TRE) RE)

COMOR MORBID BID TREA EATMENT TMENT AP APPROACHES ROACHES

• Co

Concu curr rrent nt Model : Additional components may be integrated and delivered concurrently

• Sequentia

ntial Model : Initial phase may focus

• n

substance abuse related symptoms in preparation for working

• n

trauma related symptoms later

IMPOR PORTAN ANCE CE OF INTERGRA ERGRATE TED AP APPROACH ROACH

• Less

ss than 20%

• f

s sub ubst stance ance treatmen ent centers ters

• ffer

specialized cialized traum uma related ted services. vices.

• Many

treatment ent center ters have no p process cess

• f

a asses sessing ing for traum uma related ted diso sorde ders. rs.

• Few

treatmen ent provide iders rs have specializ ecialized ed trainin ning in treating ting traum uma related ted diso sorde ders rs and

• ften

miss PTSD diagnoses noses

• r

s symptom

• ms.

s.

• Clients

ts with co-occur

• ccurring

ring PTSD and SUD have worse se

• ut

utcomes than those with eithe her diagn gnosis

• sis

alone. e.

• Recovery

very rates are particul icularly rly low in program ams that fail to a addres ess traum uma related ted issu sues. es.

• SUD

may not b be effectivel ectively managed ed un until traum uma based ed issu sues es are addressed essed

RES

ESEARCH EARCH BAS ASED ED AP APPROA ROACHES CHES

• A

few hav ave been een ri rigorously usly tested: sted: – Tri riffle fleman man et al al: Substan stance ce Dependen pendence ce PTSD SD The herap apy (SDPT) PT)=A =Assis ssisted ed Re Recover very from Trau auma ma an and Substan stances ces – Naj ajav avits its et al al: Seeking eking Saf afet ety – Bac ack, k, Brad ady et al al: Concurr rrent ent Treatm tment ent

• f

PTSD SD an and Cocain aine Depend pendence ence – Assisted isted Re Recover ery from Trau auma an and Substan stances ces (ARTS; S; as as SDPT, Tri rifflema leman et al al 1998 98, 2000 00, 2001) 01) – Man anual alized ized Cognitive nitive-Behavio Behavioral al Trea eatm tment ent with th car aref eful ul attent entio ion to tran ansfe ference ence an and countertr ertran ansfer sference ence issues ues

SOME OME EM EMPIRIC PIRICAL AL RES ESEA EARCH RCH RES ESUL ULTS TS

• Naj

ajav avits its (1996): 96): Ope pen, n, uncontroll lled tri rial al

• f

N=1 =17 treatment tment comple leter ers showed wed de decrease eases in PTSD SD sever verity ity

• Hien

en (2000): 00): N=10 100, compar aring ing See eeking king Saf afet ety an and Cogn gnit itive ive- Behav havio ioral al Coping ing Skill lls Ther erapy apy: equival ivalent ent

• utcomes

mes through ugh 6- month th follow-up; up; return urn to base aseline line at 9 months ths

• Bac

ack, k, Brad ady et al al (2001): 01): uncontr troll lled ed tri rial al, high gh rates

• f

dr drop-out within thin firs rst four weeks ks

• Integr

egrated ted counse seling ling may ay be

• ne
• f

the he key program am featu tures es that impacts acts

• utcomes.

mes.

• Trau

auma-focused cused PTSD SD treatment tment preliminar iminary ap appear ars more effect ective ive in de decreasing easing PTSD SD an and SUD UD sym ympto toms ms than an SUD UD treatment alone, without jeopardizing patient’s safety

• r

treatment rete tenti tion

WHA

HAT WORKS RKS?

• Here

and now focus us

• Skills

ls for self-regula egulation ion

• Increas

eased ed confiden idence ce in abilit lity to self-regul egulate te

• Skills

ls for distr tress ess toleranc nce

• Stress

ss reduc uction tion skills ills

• Inter

erper personal sonal skil ills training ning

• Mind-Bo

Body dy-Spirit pirit Interven ventio tions ns

• Formal

programs (Dialectic ectic Behavio avior Therap apy (DBT): ): Marsha Lineha nehan, , Seeki king ng Safety: ty: Lisa sa Naja javits vits)

• ADLERIA

RIAN THEORY ORY

• Creating

ting meaning, ng, significance gnificance and belongin nging

Cr Crea eating ting a Be Best Practic actice Model del

• Using

ng an an Adl dlerian rian Holist stic ic App pproach ach with th Collabor aboratio tion between etween Sys yste tems ms

• Shar

ared ed lan angu guag age an and concep eptua tual fram amewo ework rk

• Trai

ained ned Provide ders rs using ng integ tegrated ted trea eatment tment

• Treatm

tment ent setting ttings must routinel inely as asses ess for substan stance ce di disorder ders an and psyc ychia hiatr tric ic di disorde ders rs (especia peciall lly trau auma bas ased ed sym ympto toms ms)

• Assisting

isting client ents in creating ting support rt sys yste tems ms, netwo work rks an and groups

• Psyc

ychoso

• socia

cial reha habilita bilitation tion an and coping ng through ugh social al inter eres est

AP APPROA OACH CH SHOULD OULD BE CULTUR TURALL ALLY SPEC ECIFIC FIC

• Interventions

that have been culturally modified may ease barriers and increase the level

• f

engagement.

• Incorporating

culturally appropriate terms.

• Integrating

culturally specific stories and proverbs can increase the comfort level.

Ad Adle lerian ian View

• f

Huma uman Natur ture

• Adler

stressed a positive view

• f

human nature.

• Individuals

can control their fate.

• Help
• thers

(social interest).

• Lifestyle

“Meanings ngs are not determin ined ed by situation ions, but we determine ne

• urselve

lves by the meanings we give to situati tions

• ns.”

Alfred Adler

Ov

Over ervi view ew

• The
• ne

dynamic force behind people’s behavior is the striving for success

• r

superiority

• People’s

subjective perceptions shape their behavior and personality

• Personality

is unified and self-consistent The value

• f

all human activity must be seen from the viewpoint

• f

social al inte terest est

• The

self-consistent personality structure develops into a person’s style

• f

life

• Style
• f

life is molded by people’s creative power

Ad Adle lerian ian Integr egrated ted Th Therapy apy Ap Appr proac

• ach
• Adlerians

attempt to view the world from the client’s subjective frame

• f

reference

• Unconscious

instincts and

• ur

past do not determine

• ur

behavior

– It is not genes – It is not environment – It is not genes and environment – It is how we choos

• ose

to respond

• nd to
• ur

genes and environment

Basi sic Tenets nets

• f

Ad Adleria lerian Base sed Trea eatment tment

Li Life festyl yle

• r

S Style

• f

Li Life fe

• patterns
• f

beliefs

• cognitive

styles

• behaviors

Holi lism sm

• Views

humans as a unit

• A

whole that functions as an

• pen

system

Basic Adlerian Theory Tenets

Fe Feeling ling

• f

Inferiority riority

• Feel

elings ings

• f

inad adeq equacy uacy an and incompet mpetence ence

• serve

rve as as the he bas asis is to stri rive ve for super erio iori rity ty in

• rde

der to

• vercome

me feel elings ings

• f

infer erio iori rity ty.

In Infe feri riority rity Co Comp mplex

• If

people le ar are

• verw

rwhe helmed lmed by the he feeling lings

• f

i infer erio iori rity

• they

ey de devel elop an an inferior riority ity comple lex. x.

Basic Tenets

• f

Adlerian Based Treatment

Stri riving ing for Superio riority rity

• Refers

to the desire to be better

• The

drive to become superior allows individuals to become skilled, competent, and creative

Superior

riority ity Co Comp mplex

• Is

an exaggerated striving for superiority

• The

individual hides their feelings

• f

inferiority

• Used

as a method

• f

escape from difficulties.

• In

reference to unhealthy

• r

neurotic striving.

Co

Comp mpensa ensati tion

• n
• Ex

Example les: s: Bul ullies lies, , narciss cissist ists

• Ev

Even more su subtle: le: peop

• ple

le who ho hi hide the heir ir fe feeling lings

• f

w wort rthles hlessness sness in the he de delu lusions sions

• f

power aff fforded ded by alc lcoh

• hol
• l

and dru rugs. s.

“The he fe feeling ling

• f

inf nferiority eriority ru rules les the he mental tal li life fe and ca can be cl clearly arly recognized cognized as the he se sense se

• f

incom completen letenes ess and un unfu fulf lfillmen illment ... .. both

• f

individua ividuals ls and

• f

hu humanity nity.”

Alfred Adler

Trea eatmen ent Mu Must st Address ess Tas asks

• f

Li Life fe

• Emphasis
• n

lifestyle (5 life tasks)

• Adler’s

Five basic

• bligations

and

• pportunities:

– Social interaction – Work/Occupation – Love/Sex – Cosmos (Spirituality, Higher Power, Religion) – Self –Self Development

• These

are used to help determine therapeutic goals.

“It is the individual who is not interested in his fellow men who has the greatest difficulties in life and provides the greatest injury to

• thers. It

is from among such individuals that all human failures spring.”

― Alfred Adler, What Life Could Mean to You

Newest est Components mponents

• f

Trauma uma-inf informed

• rmed

Servi vices ces

• Competence

model – sees strengths

• Client’s

worldview is due to trauma

– Distrust, danger, confusion and self-blame are normal

• Sees

how dealing with stresses

• f

trauma causes clients to adopt less healthy ways to behave

• Appreciates

early traumas inform later complex coping skills, continue to develop

• ver

a lifetime

• Understands

trauma informs client’s identity even when not realized

• Grounded

in founding Principles

• f

Trauma-Informed Services

Trauma uma-Inf Infor

• rmed

med Trea eatment tment Serv rvices ices

• Emphasis

is

• n

whole person – how you lead your life.

• “How

can I come to understand this person fully?”

• Focus

not just

• n

functioning

• Agency

message becomes “your behavior makes sense given your circumstances”

• Clients

& staff begin to see clt behaviors as coping & brave, not pathological/unhealthy

• Trauma

seen as complex PTSD resulting from chronic &/or repeated stressors

• Strength-based

approach

• Clients

actively involved in all aspects

• f

tx planning & services

• We

are equal partners

Core Values lues

• f

T Traum uma-inf infor

• rmed

med Care

• Saf

afety ety: Ensuring physical and emotional safety

• Tru

rustwo twort rthines iness: s: Maximizing trustworthiness, making tasks clear, and maintaining appropriate boundaries

• Choice

ice: : Prioritizing consumer choice and control

• Collabo

laboratio tion: n: Maximizing collaboration and sharing

• f

power with consumers

• Empower

wermen ment: t: Prioritizing consumer empowerment and skill- building

Int ntegr egrated ted The herapeutic apeutic Ap Appr proach ach

• View

the world from the client’s subjective frame

• f

refer erenc ence

• Reality

is less important than how the individual perceives and believes life to be

• It

is not the childhood experiences that are crucial ~ It is the present interpretation

• f

these events

“seeing with the eyes

• f

another ther, li list stening ening with the he ears rs

• f

anoth ther, er, and fe feeling ling with the heart

• f

another.” ― Alfred

Adler

En

Enco cour urag ageme ement/Di nt/Disco scour urag agemen ement

• En

Enco cour urag agement ement is the he most st power erful ful method available for changing a person’s beliefs liefs

• Disc

scour

• urag

agemen ement is the he basi sic co cond ndition ition tha hat prevents vents people le fr from fu functio ctioning ning

CO COMOR ORBID BID PTS TSD AND ND SU SUD

• Leads

to exa xagg gger erated ted fe feeling ngs

• f
• f

i infe ferio riority rity

• Safe

feguar uardin ding tech chni nique ques

• Exc

xcuses es (yes…but;

• nly

if…)

• Ag

Aggressio sion (to safeguard their exaggerated superiority complex)

• De

Depreci ciation tion (undervalue

• thers

achievements)

• Ac

Accu cusation

• n (blame
• thers

for

• ne’s

failures and to seek revenge)

PTS TSD & SUD: Copi ping ng through

• ugh

Social Inter erest est Soci cial al interest is the “sole criterion

• f

human values” Pur urposed posed increased eased copin ping ther eref efor

• re

reduction duction in recidiv divism sm

One factor that underlies all types

• f

maladjustments in un underdevelo developed ped so socia ial in inte terest est. . Adler

We are

• ur

ur

• wn

architect itects and can bui uild ld either her a us useful ful

• r

a us usele less ss st styl yle

• f

li life.

Adler

Trea

eatmen tment Process cess

Techn chniq iques: ues:

• Phase

1- Establishing relationship

• Phase

2- Explore individual dynamics

• Phase

3- Encourage self-understanding and insight

• Phase

4- Reorientation

Ther erap apeu eutic tic Proces ess: s:

• Goals
• Discover

purposes to behavior

• r

symptoms and basic mistakes associated with coping.

• Correct

faulty assumptions and conclusions.

Treatment Process

Re Rela lation

• nsh

ship ip:

• Cooperation,

trust, respect, confidence, and alignment

• f

goals

• Counselor

models communication and acts in good faith!

• Promoting

so socia ially lly inter erested ested copi ping ng pr preve venti nting ng rela lapse pse

Trea

eatment tment Pr Process cess

Client’s Exp xperien rience: ce:

• Recognize

errors in their thinking (challenge and doubt past decisions)

• Fearful
• f

leaving

• ld

patterns.

• Client’s

explore concepts epts

• f

self lf,

• thers

ers an and life (private logic).

• Feelings

are aligned with thinking and fuel behaviors (We think, feel, act)

• Offer

discouraged client’s encouragement!

“We should be humbled in the presence of our clients for they are the heroes of their lives.”

• -- Scott D. Miller

Similarities ilarities

• f

Trauma uma-in infor

• rmed

med Care and nd Ad Adler lerian ian Pers rspective ective

• f

Treatment tment

Trauma auma-Inf Informed

• rmed

Care: e:

• 1. Establish

a safe environment.

• 2. Use

an empowerment model.

• Always

respect a client’s right to choose

• Focus
• n

client strengths

• Build

client skills Alfred Adler’s Individual Psycho ycholo logy: gy:

• 1. The

therapeutic relationship—a collaborative partnership

• 2. A

subjective approach

• Life

experiences(perception) explanation

• f

human behavior

• Birth
• rder

and sibling relationships

• Encouraging

(empowerment model)

Similarities ilarities

• f

Trauma uma-in infor

• rmed

med Care and nd Ad Adler lerian ian Pers rspective ective

• f

Treatment tment

• 3. Support

the development

• f

healthy relationships

• 4. Build

healthy coping skills.

• Emotional

self-awareness, Grounding, Self-soothing, and Making safe choices

• 5. Provide

access to trauma- specific services.

• 6. Design

holistic services

• 3. Social

interest is stressed (coping, support the development

• f

healthy relationships)

• 4. Basic

mistakes in the client’s private logic

• 5. Therapy

as teaching, informing

• 6. Based
• n

the holistic concept