Download Working With Survivors of Trauma

Working With Survivors of Trauma
Judy I. Eidelson, PhD
Temple University Beasley School of Law
March 8th, 2016
Overview
 What is trauma?
 How does it affect our clients?
 How does it affect representation?
 Obstacles to effective communication
 Strategies for addressing obstacles
 Questions and comments
Brain-Body Regions Impacted by Trauma
HPA Axis
Balances body
following stress by
releasing of various
hormones/chemicals
SOURCE: Southwick et al., 2005
Brain-Body Regions Impacted by Trauma
Catecholomines: Fight
or flight response
Cortisol: Energy
available
Opiods: Prevent pain
Oxytocin: Promotes
good feelings
SOURCE: Southwick et al., 2005
Memory Processes Impacted by Trauma
Hippocampus processes information into memories
Encoding = Organizing sensory information
Consolidation = Grouping information into
memories and storing them
Amygdala specializes in the processing of emotional
memories (works with the hippocampus)
Both structures are VERY sensitive to
hormonal fluctuations
SOURCE: Southwick et al., 2005
Like These . . .
Catecholomines: Fight
or flight response
Cortisol: Energy
available
Opiods: Prevent pain
Oxytocin: Promotes
good feelings
THESE HORMONES IMPAIR MEMORY CONSOLIDATION
SOURCE: Southwick et al., 2005
What Happens During A Sexual
Assault
Cathecholamines
• Impairs rational thought
Increase
Opioids
Increase
• Causes flat affect
Corticosteroids
Decrease
• Reduces energy
SOURCE: Banks, 2002; Southwick et al., 2005
What Happens During A Sexual
Assault
Amygdala
Detects Threat
Activates
Hypothalamus
HPA Axis Kicks
In
Hormonal Flood
Can Trigger a
Complete “Shut
Down”
in the Body
SOURCE: Banks, 2002; Southwick et al.,
Impact of Trauma: Summary
 Neurobiological changes can make memory
consolidation and recall difficult
 Story may come out fragmented or “sketchy”
 Misinterpreted as evasiveness or lying
 Even when content of the memory is accurate, it
may take some time and patience for it to come
together
SOURCE: Campbell & Patterson, 2011; Koss et al., 1995, 1996
What is PTSD?
 An Experience that is Life-Threatening Triggers
Fear that Overwhelms the Brain, causing
Symptoms Severe Enough to Interfere with
Functioning In Four Areas:
 Re-experiencing
 Avoidance
 Hyperarousal
 Negative Cognitions and/or Mood
Who Gets PTSD?
 Most People Recover From Severe Trauma
Within Nine Months but Exacerbating Factors
Include:
 Severity
 Chronicity
 Human Cause
 Specifically Directed at Victim
 Prior History
Representing Traumatized Clients
Trauma affects every stage of the legal process:
 Getting the whole story -- PTSD leads to avoidance
 Telling the story consistently -- Traumatic memories
come and go
 Appearing credible -- PTSD makes clients detached,
distracted
Psychological Barriers to Communication
PTSD Symptoms Can Include:
 Disruptions in memory and concentration
 Hopelessness (What’s the point?)
 Distrust
 Detachment from emotional responses
 Re-experiencing while recounting
 Shame when recounting
Interviewer Internal Barriers to
Communication
 Fear of what we might have to hear
 Fear of not knowing how to respond
 Fear of losing composure
 Our own moral judgments (e.g. disapproval of the
clients choices)
 Idealization of trauma survivor followed by
disillusionment
Working with Survivors of Domestic
Violence
 Additional challenge of “Betrayal Trauma”
 Tendency for survivors to blame themselves
 Ambivalence about leaving is often intense,
(social and religious pressures to endure,
belief that victim needs abuser and/or abuser
needs the victim)
 Leaving does not solve everything (recovery is
a multi-step process)
Strategies: Have Realistic
Expectations for Disclosure
 There is always more.
 People often do not act in their own best
interests if doing so causes embarassment.
 Leave the door open for future disclosure.
 Don’t be self-righteous (we all leave things
out)
Strategies: Conducting the Interview
 Collaboration: Give the client as much control as
possible and help her to anticipate what will happen
next. Tell her what you hope to accomplish today.
 Transparency: Review goals and rationale, invite
questions
 Allow time to build rapport and trust
 Validate and Normalize reactions: “I know this is
difficult”; “Many people feel…”
 Provide closure: Discuss experience of interview at the
end and anticipate the next step if possible
SOURCE: Russell Strand, 2014
The Withdrawn Client
Strategy: Try to gently engage by normalizing and
providing a feeling of control
“Sometimes people have a hard time answering these
questions. I know that you have been asked a lot of
questions and that you are probably concerned about
answering any more. Is there something that you would
like me to know before I ask you some of my more
specific questions?”
The Withdrawn Client
Strategy: Return to rationale for asking detailed
questions about particular issues
“We really need to convey to the court what you
have been through and how much you have suffered.
Often times these are the most difficult things to
discuss, but they can be the most important things
for the Court to understand in order to know the truth
about how you were treated.”
The “Flooding” Client
Key Characteristics:
 An overload of information
 Intense emotions
 Often feels hard to stop or contain
The “Flooding” Client
Strategy: Try to contain, by providing more
structure, suggesting short breaks, apologizing in
advance for interrupting, and explaining why you
need to focus on certain issues
“I can understand how important it is for you to
make sure I understand what you are telling me.
However, I need to focus our time today…”
The Angry or Suspicious Client
Strategy: “Join”-- Don’t get defensive
 Validate their frustration, remind them of
your shared goals
 Be transparent
 Remind yourself that it’s not only the nice
people who deserve representation
The Angry or Suspicious Client
Strategy: End the interview if necessary
 Client is unable to contain emotions at all
 Client is incoherent, even after attempts to
ask more basic questions
 Client becomes aggressive, overtly hostile
Provide Closure after Completing
the Interview
“You’ve really helped me to understand more
about what you have been through. How are you
feeling after talking about these things today?....
Do you have any questions for me?... Let me
explain to you what the next part of the process
is…..”
Preparation for Court
 Make the situation as predictable as possible
 De-sensitize by rehearsing
 If a mental health provider is involved, ask them to
focus on specific coping skills
 Make a plan with client to take a break if needed
 If appropriate, allow support person to be present at
hearing
Vicarious Traumatization
 Can occur in those who work with survivors of severe
trauma
 Can be a normal reaction to hearing very vivid, distressing
narratives.
 Manifests itself in distress and symptoms of PTSD (e.g.,
nightmares, irritability, detachment).
 Feelings of demoralization and depression are also
frequent
 Can make you feel like you are a victim or perpetrator
Vicarious Traumatization Continued
Strategy: Manage expectations and boundaries
Clarify the limits of your role with your clients—refer
for other services
Clarify what you CAN do for your client
Tolerate feelings of guilt and helplessness
Recognize fantasies of rescue and omnipotence
Seek supervision and support from colleagues
Vicarious Resilience
A positive effect through interaction with client’s
stories of resilience:
• Witnessing and reflecting on human beings’
immense capacity to heal
• Reassessing the significance of one’s own
problems
• Developing hope and commitment
• Articulating personal and professional positions
regarding human rights
Judy I. Eidelson, PhD
[email protected]