Trauma Informed Care
Seeking Safety Part 1
Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs.com
Podcast Host: Counselor Toolbox
Objectives
~ Review five central ideas:
~ Safety as the priority of this first-stage treatment;
~ Integrated treatment of PTSD and substance abuse
~ A focus on ideals
~ Content areas: cognitive, behavioral, interpersonal, and case management
~ Attention to therapist processes.
Safety as the Priority of the First Stage
~ People with PTSD often also struggle with depression, addiction and eating disorders
~ The most urgent clinical need is to establish safety.
~ “Safety” is an umbrella term that signifies various elements:
~ discontinuing addictive behaviors
~ reducing suicidality
~ minimizing exposure high-risk situations
~ letting go of dangerous relationships
~ gaining control over extreme symptoms (such as dissociation)
~ stopping self-harm behaviors (such as cutting).
Safety as the Priority of the First Stage
~ Even though the trauma may have occurred long ago, patients have typically been abused and are now abusing themselves
~ treating themselves in ways that repeat it
~ ignoring their needs
~ perpetuating pain (albeit sometimes in the guise of trying to satisfy short-term impulses).
~ This represents a meaningful connection between their disorders
~ Recovery requires that the patient establish safety, grieve and reconnect
Safety as the Priority of the First Stage
~ Safety is addressed in numerous ways, including
~ The safe coping sheet
~ The list of safe coping skills
~ The safety plan
~ The safety contract
~ Other methods
~ Emotional safety
~ Physical safety
~ Interpersonal safety
~ Environmental Safety
Integrated Treatment
~ “Integration” means attention to both disorders at the same time in the present.
~ It is not asking patients to talk in detail about the past
~ Helping patients
~ Learn what the disorders are and why they cooccur
~ Explore their interrelationship in the present (e.g., bingeing and purging when they felt rejected)
~ Understand the course of the disorders in recovery (e.g. with abstinence, PTSD may feel worse before it feels better)
~ Increase compassion by viewing unhelpful behaviors as an attempt to cope with the pain of trauma
~ Learn safe coping skills that apply to both.
~ Patients are encouraged to see that healing from each disorder requires attention to both disorders
Integrated Treatment
~ Integration is ultimately an intrapsychic goal for patients as well as a systems goal:
~ to “own” both disorders, to recognize their interrelationship, and to fall prey less often to each disorder triggering the other.
~ This treatment provides opportunities for patients to discover
~ Connections between the two disorders in their lives
~ In what order they arose and why
~ How each affects healing from the other
~ Their relationship to other life problems
Integrated Treatment
~ Integration is created by fluid movement among the four target areas of the treatment
~ Cognitive
~ Behavioral
~ Interpersonal
~ case management
~ To help patients recognize the links among their thoughts, actions, and relationships, and between their internal experience and their functioning in the external world.
A Focus an Ideals
~ This treatment explicitly seeks to restore ideals that have been lost.
~ The title of each topic is framed as a positive ideal—one that is the opposite of some pathological characteristic
~ Honesty combats denial, lying, and the “false self.”
~ Commitment is the opposite of irresponsibility and impulsivity.
~ Taking Good Care of Yourself