Judy I. Eidelson, PhD Temple University Beasley School of Law - PowerPoint Presentation

1. Judy I. Eidelson, PhDTemple University Beasley School of LawMarch 8th, 2016Working With Survivors of Trauma

2. What is trauma? How does it affect our clients?How does it affect representation?Obstacles to effective communicationStrategies for addressing obstaclesQuestions and commentsOverview

3. HPA AxisBalances body following stress by releasing of various hormones/chemicals Brain-Body Regions Impacted by TraumaSOURCE: Southwick et al., 2005

4. Brain-Body Regions Impacted by TraumaCatecholomines: Fight or flight responseCortisol: Energy availableOpiods: Prevent painOxytocin: Promotes good feelingsSOURCE: Southwick et al., 2005

5. Hippocampus processes information into memories Encoding = Organizing sensory information Consolidation = Grouping information into memories and storing themAmygdala specializes in the processing of emotional memories (works with the hippocampus)Both structures are VERY sensitive to hormonal fluctuations Memory Processes Impacted by TraumaSOURCE: Southwick et al., 2005

6. Like These . . . THESE HORMONES IMPAIR MEMORY CONSOLIDATIONCatecholomines: Fight or flight responseCortisol: Energy availableOpiods: Prevent painOxytocin: Promotes good feelingsSOURCE: Southwick et al., 2005

7. What Happens During A Sexual AssaultSOURCE: Banks, 2002; Southwick et al., 2005

8. What Happens During A Sexual AssaultSOURCE: Banks, 2002; Southwick et al., 2005Can Trigger a Complete “Shut Down” in the Body

9. Impact of Trauma: SummaryNeurobiological changes can make memory consolidation and recall difficultStory may come out fragmented or “sketchy”Misinterpreted as evasiveness or lyingEven when content of the memory is accurate, it may take some time and patience for it to come togetherSOURCE: Campbell & Patterson, 2011; Koss et al., 1995, 1996

10. 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 HyperarousalNegative Cognitions and/or MoodWhat is PTSD?

11. Most People Recover From Severe Trauma Within Nine Months but Exacerbating Factors Include:Severity ChronicityHuman CauseSpecifically Directed at VictimPrior HistoryWho Gets PTSD?

12. Trauma affects every stage of the legal process:Getting the whole story -- PTSD leads to avoidanceTelling the story consistently -- Traumatic memories come and goAppearing credible -- PTSD makes clients detached, distractedRepresenting Traumatized Clients

13. PTSD Symptoms Can Include:Disruptions in memory and concentrationHopelessness (What’s the point?)Distrust Detachment from emotional responsesRe-experiencing while recountingShame when recounting Psychological Barriers to Communication

14. Fear of what we might have to hearFear of not knowing how to respondFear of losing composureOur own moral judgments (e.g. disapproval of the clients choices)Idealization of trauma survivor followed by disillusionmentInterviewer Internal Barriers to Communication

15. Additional challenge of “Betrayal Trauma”Tendency for survivors to blame themselvesAmbivalence 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)Working with Survivors of Domestic Violence

16. 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: Have Realistic Expectations for Disclosure

17. 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 questionsAllow time to build rapport and trustValidate 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 possibleStrategies: Conducting the Interview

18. SOURCE: Russell Strand, 2014

19. 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

20. 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 Withdrawn Client

21. Key Characteristics:An overload of informationIntense emotions Often feels hard to stop or containThe “Flooding” Client

22. 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 “Flooding” Client

23. Strategy: “Join”-- Don’t get defensive Validate their frustration, remind them of your shared goalsBe transparentRemind yourself that it’s not only the nice people who deserve representation The Angry or Suspicious Client

24. Strategy: End the interview if necessaryClient is unable to contain emotions at allClient is incoherent, even after attempts to ask more basic questionsClient becomes aggressive, overtly hostileThe Angry or Suspicious Client

25. “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…..” Provide Closure after Completing the Interview

26. Make the situation as predictable as possibleDe-sensitize by rehearsing If a mental health provider is involved, ask them to focus on specific coping skillsMake a plan with client to take a break if neededIf appropriate, allow support person to be present at hearingPreparation for Court

27. 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 perpetratorVicarious Traumatization

28. Strategy: Manage expectations and boundariesClarify the limits of your role with your clients—refer for other servicesClarify what you CAN do for your clientTolerate feelings of guilt and helplessness Recognize fantasies of rescue and omnipotence Seek supervision and support from colleagues Vicarious Traumatization Continued

29. A positive effect through interaction with client’s stories of resilience:Witnessing and reflecting on human beings’ immense capacity to healReassessing the significance of one’s own problemsDeveloping hope and commitmentArticulating personal and professional positions regarding human rightsVicarious Resilience

30. Judy I. Eidelson, PhD judyeidelson@gmail.com