Posttraumatic Play: Towards Acceptance and Resolution

Many children who experience trauma demonstrate it through posttraumatic play (PTP). This type of play is seen by professionals as a repetitive reenactment of the traumatic event within the child’s play. Reliving the event in this way may serve to retraumatize the child and lead to other psychiatric or behavioral problems. This article examines the issues surrounding childhood trauma and PTP. It uses a case study to illustrate the phases of a play therapy approach that incorporates Ericksonian principles, in order for the child to achieve resolution and acceptance. The countertransference issues that a clinician may encounter also are discussed. Editor's Note: This article is the recipient of the Judith Mishne Memorial Award for Excellence in Clinical Social Work Theory and Practice.     

Supervisors’ Perception of Vicarious Trauma and Growth in Australian Refugee Trauma Counsellors

ABSTRACT

Vicarious trauma is a well-accepted phenomenon supported by more than 20 years of research, yet the body of research on the positive impact, known as vicarious post-traumatic growth, is relatively small. Based on a metasynthesis of qualitative peer-reviewed vicarious trauma studies, Cohen and Collens propose a model of the co-occurrence of vicarious trauma and vicarious post-traumatic growth. This model was examined through a qualitative study involving 11 interviews with supervisors of refugee trauma counsellors working in Forum of Australian Services for Survivors of Torture and Trauma (FASSTT) member agencies. This research project both reviewed the model from the perspective of experienced supervisors and illuminated what occurred within the supervision process to manage vicarious trauma and encourage vicarious post-traumatic growth. While the research project affirmed aspects of the model, the failure of the model to consider socio-political factors limited its applicability to FASSTT agencies.

IMPLICATIONS

• FASSTT clinical supervisors engage in supervision in a manner that may assist counsellors to process how their clients’ trauma disclosures impact on their levels of stress and change their perception of self, their role, and their worldview.

• Including recognition of the influence of the socio-political context of refugee trauma and trauma recovery may be an important additional component of supervision practice.

     

Knowing Terrible Things: Engaging Survivors of Extreme Violence in Treatment

Survivors of extreme violence can be difficult to engage in treatment. Often this is caused by a sense of isolation drawn from the belief that no one who has not shared their experience can comprehend it. The only others who know what they know are those who have died of the violence, fellow survivors and the perpetrators. The clinician attempting to treat such patients may be placed in a dilemma: how to convey the capacity to know terrible things without being destroyed by the survivor, while at the same time not conveying that one is dangerous oneself. This paper suggests a method of utilizing unconscious aggressive fantasy to access the capacity to convey to the survivor that it is possible to hear, understand and contain violent experience. Case illustrations indicate how such capacity might be conveyed, so that a treatment alliance can begin.

Staying put in the Closet: Examining Clinical Practice and Countertransference Issues in Work with Gay Men Married to Heterosexual Women

Gay men married to heterosexual women seek psychotherapy for numerous reasons, not only to find a way out of their marriages. Therapists must identify their countertransference reactions to avoid pushing the patient either to commit to his marriage or leave it. The patient’s underlying problems should be addressed before the patient can explore the fate of his marriage. Therapists also need to be understanding of the patient’s attachment to his wife. In addition, therapists must be aware of the societal implications of homophobia on gay patients. This article discusses motivations for heterosexual marriage among gay men, examines two clinical cases, and addresses practice and countertransference issues. A version of this article was presented at the tenth national conference of the National Membership Committee on Psychoanalysis in Clinical Social Work on March 10, 2007.     

Protecting Children

Abstract

In this study, difficulties that women with alcohol problems and victimization experiences might have protecting their children from victimization were investigated. Mothers of children (ages 3-17) were recruited from a longitudinal study of women, alcohol problems, and victimization; women came from alcohol treatment programs, battered women's shelters, mental health clinics, drinking and driving programs, and a random household sample. Hypothetical parenting scenarios were constructed to assess mothers' ability to protect their children from victimization trauma. Women's responses to the scenarios were analyzed thematically and coded. Next, coded responses were analyzed quantitatively to identify significant differences among women with past alcohol and other drug (AOD) problems, current AOD problems, and no AOD problems. Women with current AOD problems were more likely than women with no AOD problems and women with past AOD problems to provide aggressive responses to scenarios. Women with past AOD problems were more likely than their non-addicted counterparts to perceive sexual abuse as a possibility, to attribute responsibility for the problem to the other participant only (seeing no role for their child), and to seek information about what happened from the other participant only. Findings suggest that some interpersonal problem-solving difficulties resolve when women become sober while others persist into recovery, potentially affecting women's ability to protect their children.     

A Pilot Investigation of Media Multitasking and Trauma Symptoms Among Adolescents

Effective prevention and intervention for trauma symptoms are still needed, particularly for adolescents, in whom high-risk behavior is common. This pilot study examines how media multitasking may be related to trauma symptoms in a sample of adolescent college students (N = 55). Results indicate that higher media multitasking is uniquely and independently associated with higher trauma symptoms. These results hold even after controlling for alcohol intoxication, which is commonly associated with trauma symptoms. Adolescents may be more forthcoming in revealing information about media multitasking than other behaviors commonly associated with trauma symptoms, such as alcohol and drug use. The present study provides the first evidence that media multitasking could be an additional tool for clinicians treating adolescents with trauma symptoms.     

“Kids and Fires Are No Match”: Fire and Trauma Prevention for Teen Parents

The purpose of this work was to adapt findings from current research into a clinical intervention. A structured, prevention oriented presentation/discussion was developed along with a brief pre and post test measurement tool. The intervention goal was to help teen parents (N = 124), from high schools and job training centers, focus on the preventive issues of fire safety and trauma prevention for themselves and their children after a difficult life event. Findings included a significant increase (<.001) from pre to post test on intent to make their homes fire safe and to understand the importance of emotional support for themselves and their children at differing developmental ages. Unexpectedly, the comparison group of 81 adults from community programs, though starting with higher scores (p < .01) also showed significant improvement (p < .001) on these measures. It is important for social workers to adapt clinical research findings for dissemination.     

The Convergent Validity of the Trauma Symptom Checklist for Young Children for a Sample of Sexually Abused Outpatients

ABSTRACT

The convergent validity of the Trauma Symptom Checklist for Young Children (TSCYC) was examined with a sample of 172 sexually abused outpatient treatment-seeking children and their caregivers. The TSCYC evidenced good convergent validity with other parent ratings (e.g., the Child Behavior Checklist, Child Sexual Behavior Inventory, and the University of California at Los Angeles Post-Traumatic Stress Disorder Reaction Index [UCLA PTSD Index]). The convergent validity of the TSCYC and the Trauma Symptom Checklist for Children was weak, perhaps illustrating the lack of agreement often found between children and caregivers and illustrating the need for a multi-informant approach to screening and assessment of sexually abused children. The TSCYC seems to hold promise based on the emerging evidence for its convergent validity.     

The Effects of the September 11 Terrorist Attacks on Russian Immigrants

ABSTRACT

The terrorist attacks of September 11, 2001 changed the course of American history. Because of the scope and proportion of the disaster, its impact on witnesses was unprecedented both with regard to the numbers of people who were psychologically affected as well as the intensity of individual reactions. To better understand how different groups of people witnessing the events through the mass media were impacted, we conducted a qualitative study of a sample of Russian immigrants. The data illustrate the emotional and cognitive reactions of the participants and their coping with the traumatic effect of the events. Possible links between the properties of Russian immigrants as a group and their responses to this traumatic effect are discussed.     

The Role of Affect Regulation in a Case of Attempted Maternal-Filicide Suicide: Commentary on an Act of Despair

A case of attempted maternal-filial suicide is discussed from the perspective of trauma, emotional regulation and defense mechanisms. Case details which include childhood sexual abuse, observed parental violence and emotional neglect allow for an illustration of the impact of childhood family experiences on adult intimacy and coping patterns. Domestic violence and the perception of protection are also explored. Emotional regulation in the experience of despair is approached from an object relations perspective. Based on this, implications for prevention and treatment are presented.

A statewide introduction of trauma-informed care in a child welfare system

Most children in the care of the child welfare system have been exposed to multiple traumas in addition to the stressor of being removed from their home. Because the risk for mental health problems following exposure to trauma is high, a critical need exists to introduce trauma-informed practices into the child welfare system. The purpose of this study is to evaluate initial stages of a trauma-informed training program for the Arkansas Division of Child and Family Services (DCFS). In Phase 1, 102 (75%) of DCFS area directors and supervisors participated in 10 regional, two-day workshops modeled after the National Child and Traumatic Stress Network (NCTSN) trauma-informed training for child welfare. Pre- and post-training evaluations demonstrated significant improvements in participants' knowledge of trauma-informed practices. A three-month follow-up with directors and supervisors indicated that use of trauma-informed practices increased significantly and that such changes were correlated with pre- versus post-training improvement in knowledge. Most participants were able to partially implement action steps established at the time of training; however, a number of barriers were cited as preventing full implementation, including time constraints, heavy caseloads, lack of staff, and limited resources. Results are discussed in light of plans under way for Phase II training for all DCFS front-line staff.     

Chapter 10. Care Needs of Older Adults Following a Traumatic or Disastrous Event

SUMMARY

This chapter addresses biopsychosocial and spiritual needs of older adults following a traumatic or disastrous event. It assumes that most older adults have established a pattern of positive adaptation over the life course as they encountered acute stress or chronic adversities. The importance of social supports and mutual aid is also described.     

Integrating Human Rights and Trauma Frameworks in Social Work with People from Refugee Backgrounds

Abstract

Social work practice informed by human rights and trauma frameworks can be empowering and enabling. While both frameworks are complex and contested, their implementation “from below” via praxis can maximise benefits for social work with people who have experienced trauma and human rights abuses, such as those from refugee backgrounds. This article presents an exploration of this practice approach through the presentation of the story of Zillah and Amman, a fictionalised composite of many real refugee experiences. Taking as examples the education and child protection systems, the discussion highlights how theory to practice integration requires cross-cultural engagement, critical reflection, dialogue, and an understanding of human rights “from below”.     

Responding to the needs of youth who are homeless: Calling for politicized trauma-informed intervention

Trauma in the lives of youth who are homeless is a pervasive reality. In this article, a politicized understanding of trauma is taken up to explore the complex psychological, relational, and social/political challenges experienced by many young persons facing homelessness. Their needs are contrasted with the dominant framework for assessing and addressing homelessness among youth, which fails to adequately account for the effects of trauma in their lives. The authors argue for therapeutic approaches to address the negative effects of trauma; development of community services that adequately respond to the consequences of traumatic life experiences; and socially responsible policies that ensure provision of adequate services and also aim to address root causes of youth homelessness. While current conceptualizations of trauma-informed services go some distance toward achieving these goals, the authors argue that it is only by taking up a more radical understanding of trauma that interventions will be employed to better achieve these targets. Toward this end, the authors introduce a framework that integrates the SPECs model (Evans & Prilleltensky, 2007; Prilleltensky, 2005) with trauma-informed service provision, thereby infusing a social and political analysis to guide more effective trauma-informed solution building in response to the issue of youth homelessness.     

Exploring the professor and student relationship after a life-threatening trauma

ABSTRACT

A professor shares his account of recovering from a near fatal bicycle accident in this article. The authors explore the professor/student relationship after this life-threatening accident. Using qualitative research methods, a purpose sample of students from a mid-size undergraduate social work program described their experiences of interacting with the professor after he returned to work. All the students in the sample took a course from the professor before the accident. All the students in the sample also knew about the severity of his injuries after the accident. Important themes of trauma emerged interwoven in the relationship between students and the professor. There are also important concepts mentioned in the article that look at the healing process that occurs between the students and the professor, where significant trauma has occurred in the life of a professor. Existing studies examine the professional/student relationship when the student experienced trauma. Administrators need to consider these important themes of trauma when a professor returns to work after a life-threatening accident.     

Trauma and Origins: Post-Holocaust Genealogists and the Work of Memory

In the 1970s, as children of Holocaust survivors reached adulthood, many began to excavate, piece together, and re-fashion their fractured family histories. This movement achieved momentum in the 1980s and 1990s, as the so-called “second generation” moved into middle age. Drawing from data gleaned from participant observation on a listserv for children of survivors and from interviews, I argue that those who engage in post-Holocaust genealogy are searching for coherent narratives that place their own origin in the context of the families into which they were born. By seeking, borrowing from and selectively appropriating traces of the past, they are using them as raw material in the production of new stories about the past and, by implication, the present.

Trauma Related Critical Incident Debriefing for Adolescents

Events like the tragedy at Columbine High School and the terrorists attacks on New York City in 2001 have highlighted the need for mental health practitioners to become familiar with interventions that are designed to assist young people who have survived extremely stressful events. Mental health professionals often see people who have experienced car accidents, severe abuse, rape, or other victimization, as well as survivors of natural and man-made disasters during the first critical stages of the recovery period. This article describes the process of critical incident de-briefing and provides a step-by-step primer for its application. The process is short-term (four sessions or less) and provides an intervention designed to reduce the frequency and severity of post-traumatic stress symptoms. Adolescents are particularly at risk because of issues surrounding identity formation, self- esteem, and developmental differences in coping mechanisms. Therefore, those who work with an adolescent cohort should be familiar with debriefing methods and how to apply them to the teenager.     

The Experience of Trauma Recovery: A Qualitative Study of Participants in the Women Recovering from Abuse Program (WRAP)

ABSTRACT

The efficacy of intensive group treatment programs for child maltreatment has been established. The aim of this qualitative study was to understand how women with a history of child maltreatment experienced the Women Recovering from Abuse Program (WRAP), an existing intensive group treatment program. Seven women were interviewed following their participation in WRAP. Three themes emerged: Breaking Trauma-Based Patterns, Doing Therapy, and The Healing Journey as a Continuous Process. These findings deepen our understanding about how participants view the recovery process. Theoretical and clinical implications are discussed.     

Child Soldiers in Sierra Leone and the Problems of Demobilisation,Rehabilitation and Reintegration into Society: Some Lessons for Social Workers in War‐torn Societies

Between March 1991 and February 2002 Sierra Leone was engulfed in a bloody and protracted civil war in which tens of thousands of people were killed, many more injured, over half of the population displaced and millions of pounds worth of property destroyed. Much of the violence unleashed, particularly on the civilian population, was the work of child soldiers. The phenomenon of child soldiers raises many issues of children's well‐being, although this phenomenon is not unique to Africa.

In this paper, I briefly analyse the reasons for and the nature of the conflict, in particular the social forces which impelled children to join social movements challenging for state hegemony. I focus on how peripheral capitalism has impacted on the Sierra Leonean family and how the ensuing political and economic crises have left Sierra Leonean children with little security, forcing them to turn to family surrogates (social movements) for protection. I examine the processes of demobilisation, rehabilitation and reintegration of former child combatants and some of the problems and challenges to social work and social workers working with traumatised children from war ravaged communities in African nations. I suggest that Tonnies' dichotomy between ‘Gemeinschaft’ and ‘Gesellschaft’ offers a useful framework for social work education in this context.     

Sifting Through Trauma: Compassion Fatigue and HIV/AIDS

This article explores the compassion fatigue of the author and the graduate students he supervised while conducting psychotherapy with persons living with HIV/AIDS at a counseling center in Atlanta, Georgia. The metaphor of a sifter is suggested to represent the self-care strategies that providers employ to avoid and manage compassion fatigue. Several vignettes are presented and discussed from the perspective of the provider. The vignettes facilitate an examination of the contribution of trauma experienced by persons living with HIV/AIDS to the compassion fatigue of social service providers. The author recommends a renewal of research in the area of compassion fatigue among social service providers working with these clients.