Trauma Recovery, and Empowerment Model TREM

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Trauma Recovery, and Empowerment ModelTREM

• Gloria D. Jones, PhD, LPC, NCAC II, CCS
• Taunya A. Lowe
• Georgia School of Addiction Studies
• Savannah, Georgia

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Introductions
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Overview- Video Discussion
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History of Trauma Recovery and Empowerment Model
(TREM)

• Development through CSAT grant
• Cooperative with National Center for Trauma
  Recovery and Empowerment Community Connections,
  Washington D.C.
• TREM Manual and Workbook are authored by Maxine
  Harris, and Mary Ellen Copeland
• 33 sessions self help format, facilitated by
  two group leaders
• Can be open or closed group
• Flexibility in delivery of modules

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Components of TREM

• Empowerment Part I 11 Sessions
• Trauma Recovery - Part II - 10 Sessions
• Advanced Recovery Issues 9 Sessions
• Closing Rituals 3 Sessions

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Goals of TREM

• To enhance competencies and skill building as
  women do trauma recovery work
• Establish Group Cohesion and Commonalities Re
  Womanhood

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Trauma Defined

• The exposure to an extreme stressor involving
  personal experience of an event that involves
  actual or threatened death or serious injury, or
  threat to ones physical integrity or witnessing
  an event that involves death, injury, or a threat
  to the physical integrity of another person or
  learning about unexpected or violet death,
  serious harm, or threat of death or injury
  experienced by a family member or other close
  associate. The persons response to the event
  must involve intense fear, helplessness, or
  horror

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Trauma Defined (continued)

• The traumatic event can be experienced in various
  ways recurrent and intrusive recollections of
  the event recurrent and distressing dreams
  during which the event is replayed dissociative
  states intense physiological distress and
  reactivity deliberate efforts to avoid thoughts,
  feelings or conversations about the traumatic
  event diminishing interest or participation in
  previously enjoyed activities feeling detached
  or estranged from others reduced ability to feel
  emotions a sense of a foreshortened future.

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Trauma Defined (symptoms)

• Difficulty Falling or Staying asleep
• Hyper vigilance
• Exaggerated startle response
• Irritability or Outburst of Anger
• Difficulty Concentrating or Completing tasks
• American Psychiatric Association Diagnostic and
  Statistical Manual of Mental Disorders, 4th ed.,
• (Washington, D.C., American Psychiatric
  Association, 1994), p. 424.

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Events of Trauma

• Sexual Abuse
• Severe Neglect
• Physical Abuse
• Domestic Violence
• Gang and Drug Related Violence
• Rape (sexual assault)
• Witnessed Violence and Cruelty to others
• Serious Emotional and Psychological abuse
• Repeated Abandonment or Sudden Loss

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Video Clips
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Feelings of Trauma

• Intense Fear
• Fear of Complete Destruction
• Total Helplessness
• Profound Emptiness
• Loss of Control
• Total Disconnection

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What do Trauma Symptoms Look Like?

• SAD
• low self esteem, shame, feeling of
  isolation, self injury
• MAD
• Compulsions, feeling totally different from
  everyone, paranoia, dissociative episodes/amnesia
• BAD
• Explosive anger ragefulness, prostitution
  and run away truancy in adolescence, drug use and
  sale
• Ive Been Had
• Disrupted relationships,Domestic violence,
  revictimization and distrust, Failure to protect
  oneself to accurately assess dangerousness,

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Close to Home
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Basic Understanding of Sexual and Physical Abuse
of Trauma

• 1. Survivors of childhood physical and sexual
  abuse experience the impact of that abuse
  throughout their lives.
• 2. The impact of abuse can be felt in areas of
  functioning seemingly unrelated to the abuse
  itself.
• 3. Current problematic behaviors and symptoms
  may have originated as legitimate and even
  courageous attempts to cope with or defend
  against trauma.

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Core Elements of Trauma

• 1. Experiences of childhood sexual and physical
  abuse betray a childs core assumptions about
  herself, her family, and her world.
• 2. Abuse severs fundamental connections to
  oneself, ones family and ones community.

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Core Elements of Trauma(continued)

• 3. Experience of abuse and the responses of
  others to that abuse can serve to invalidate
  ones judgment, ones perception, ones sense of
  reality, and ones sense of self-worth.
• 4. Working from a trauma framework
  understanding clients/consumers their life
  experiences, their cultures, and their society is
  the most helpful, respectful and empowering
  clinical model for helping women with histories
  of abuse.

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Effects of Trauma

• People respond to a traumatic event differently.
• The experience shapes a survivors reactions to
  abuse and traumatic stress.
• Trauma that occurs in childhood by a caregiver is
  doubly destructive.
• It destroys the attachment relationship that a
  child would normally need to depend on to manage
  the trauma of abuse.

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Effects of Trauma

• Childhood trauma can potentially effect ALL
  aspects of the self.
• Specific impact on a child can influence
• 1. Childs genetic makeup
• 2. Developmental stages at the time of abuse
• 3. Relationship with perpetrators
• 4. Attachment qualities to caregivers
• 5. Social and cultural context in which she grows
  up

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Coping Mechanisms of Survivors

• Disruptions in Identity
• Attachments
• Relationships
• Dissociation
• Substance Abuse and Addictions
• Impairments in work,love and play
• Self-harming behavior

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Adaptations

• People are adaptive. A trauma model that frames
  survivors symptoms as adaptations, rather than
  as pathology.
• Every symptom helped a survivor in the past and
  continues to help in the present-in some way.
• An adaptation model emphasizes resiliency in
  human responses to stress. It helps survivors
  recognize their own strengths and inner
  resources, rather than defining themselves by
  weakness and failure.

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Adaptations

• Reduction of Shame
• Engenders hope for client and providers.
• It helps reinforce a framework in which
  everything is part of an whole.

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Goals of Part IEmpowerment

• Develop a shared sense of the experience of being
  a women.
• To gain knowledge about her body and bodily
  functions.
• To understand her own space (physically and
  emotionally) how to set limits and say No!

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Goals of Part I continued

• To develop an understanding of how the abuse in
  her life has impacted her self -esteem and sense
  of worth.
• To develop healthier strategies to comfort
  oneself.
• To lean the differences between intimate and
  sexual relationships.
• To examine what she wants and How to ask for it
  in a sexual relationship.

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Empowerment Part I( 11 sessions )

• Introductory Session
• What it Means to Be a Woman
• What do you know and How do you Feel about Your
  Body?
• Physical Boundaries
• Emotional Boundaries Setting Limits Asking for
  What You Want

• Self-Esteem
• Self-SoothingDeveloping Ways to Feel Better
• Intimacy and Trust
• Female Sexuality
• Sex with a Partner
• Transitional Session from Empowerment to Trauma
  Recovery

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Mock Group

• Topic 2
• What it Means to be a Woman

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Leader Techniques (1-4)
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Experiential Exercise

• Physical Boundaries

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Goals of Part IITrauma Recovery

• To gain an understanding of what is meant by
  trauma and the role of power and control in
  abusive relationships
• To understand the connections between current
  physical pain and previous abuse
• To learn to accurately label her experiences of
  sexual, physical, and emotional abuse and the
  impact it has had on her life

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Goals of Part II continued

• To understand that currently labeled symptoms and
  behaviors may have developed as creative coping
  strategies
• To learn the connection between addictive
  compulsive behaviors and her history of abuse
• To understand how past abuses may be related to
  current interpersonal patterns that are hurtful
  and abusive

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Trauma Recovery Part II10 Sessions

• What is Emotional Abuse
• Institutional Abuse
• Abuse and Psychological and Emotional Symptoms
• Trauma and Addictive or Compulsive Behavior
• Abuse and Relationships

• Gaining an Understanding of Trauma
• The Body Remembers what the mind forgets
• What is Physical Abuse
• What is Sexual Abuse
• Physical Safety

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Care of the Clinician

• Experiential Exercise
• Comfort Book

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24 Session TREM

• 24 vs 33 sessions
• Open vs. Closed Groups
• Needs, Obstacles, Solutions to conducting TREM
  Groups

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TREM Exercises
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Topic 19Abuse and Psychological Emotional Systems
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Leader Techniques (5-9)
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Goals of Part III

• To understand both current and past family
  dynamics
• To begin to assess the process by which she makes
  decision and understand the factors which
  interfered with proactive decision-making
• To identify problematic communication styles and
  to develop more effective styles

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Goals of Part III Continued

• To explore the concepts of blame, responsibility,
  acceptance and forgiveness and their roles in
  healing and recovery
• To develop ways to modulate emotional storms
• To understand stages of relationship development
  and develop problem-solving strategies for
  negotiating issues in relationships
• To develop an understanding of the personal
  process of recovery

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Advanced Trauma Issues Part III (9 Sessions)

• Blame, Acceptance and Forgiveness
• Feeling Out of Control
• Relationships
• Personal Healing

• Truths, and Myths about Abuse
• What it Means to Be a Woman
• (3)Closing Rituals

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Blame, Acceptance, and Forgiveness

• Discussion

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Questions
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TREM Exercises

• Tree Exercise
• Autobiography in Five Chapters

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Grounding Techniques
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Discussion of Implementation Issues and Challenges
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Closing Rituals Goals Part IV

• To solidify a more reality based perception of
  what abuse is and is not
• To evaluate knowledge and skills gained during
  the group experience and how her attitudes and
  behaviors have changed
• To recognize personal accomplishments and
  identify plans for any further recovery work
• To celebrate the completion of the group in a
  meaningful manner so that saying good-bye does
  not feel like an abandonment

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Closing Rituals Goals Part IV (3
Sessions)

• Truths and Myths About Abuse
• What it Means to Be a Woman
• Closing Sessions

• Washing of the Stone
• Medicine Bag
• Demonstration of Closing Rituals

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Evaluation