Download 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

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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








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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