Judy I. Eidelson, PhD - PowerPoint Presentation

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Judy I. Eidelson, PhDTemple University Beasley School of LawMarch 8th, 2016

Working With Survivors of TraumaSlide2

What is trauma? How does it affect our clients?How does it affect representation?Obstacles to effective communicationStrategies for addressing obstaclesQuestions and commentsOverviewSlide3

HPA Axis

Balances body following stress by releasing of various hormones/chemicals

Brain-Body Regions Impacted by Trauma

SOURCE: Southwick et al., 2005 Slide4

Brain-Body Regions Impacted by Trauma

Catecholomines:

Fight or flight response

Cortisol: Energy availableOpiods: Prevent painOxytocin: Promotes good feelings

SOURCE: Southwick et al., 2005 Slide5

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 Trauma

SOURCE: Southwick et al., 2005 Slide6

Like These . . .

THESE HORMONES

IMPAIR

MEMORY CONSOLIDATION

Catecholomines: Fight or flight responseCortisol: Energy availableOpiods: Prevent painOxytocin

: Promotes good feelings

SOURCE: Southwick et al., 2005 Slide7

What Happens During A Sexual Assault

SOURCE: Banks, 2002; Southwick et al., 2005Slide8

What Happens During A Sexual Assault

SOURCE: Banks, 2002; Southwick et al., 2005

Can Trigger a Complete

“Shut Down”

in the BodySlide9

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 together

SOURCE: Campbell & Patterson, 2011; Koss et al., 1995, 1996Slide10

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?Slide11

Most People Recover From Severe Trauma Within Nine Months but Exacerbating Factors Include:Severity ChronicityHuman CauseSpecifically Directed at VictimPrior HistoryWho Gets PTSD?Slide12

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, distracted

Representing Traumatized ClientsSlide13

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 CommunicationSlide14

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 CommunicationSlide15

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 ViolenceSlide16

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 DisclosureSlide17

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 possible

Strategies: Conducting the InterviewSlide18

SOURCE: Russell Strand, 2014Slide19

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 ClientSlide20

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 ClientSlide21

Key Characteristics:An overload of informationIntense emotions Often feels hard to stop or containThe “Flooding” ClientSlide22

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

” ClientSlide23

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 ClientSlide24

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 ClientSlide25

“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 InterviewSlide26

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 CourtSlide27

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 TraumatizationSlide28

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 ContinuedSlide29

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 ResilienceSlide30

Judy I. Eidelson, PhD judyeidelson@gmail.com