CJ 720 Trauma & Crisis Intervention Blog
Workplace Violence in the Emergency Department
Workplace violence (WPV) in the emergency department is entirely too common. Emergency medicine has one of the highest rates of WPV each year (Hartnett & Jasani, n.d.). The movement against WPV in healthcare is geared toward resources for nurses, as they spend the majority of the time with a patient, but it is an important factor for techs, CNAs, doctors, and any healthcare staff present in the midst of an incident. I have worked in the emergency department for about seven or eight months now and I have seen and heard of at least five or six different incidents of WPV, one of them being my own experience. The types of WPV range from tight grips in which a patient refuses to let go (this was the matter in my case) to having bones in the face or hand broken to the point where someone's career is ended. During my orientation on the job, I was informed that the reason we have signs for some patients saying "see patient's nurse before entering room" is because a nurse was killed by a patient when she was not fully informed of the background of a patient.
This leads to primary trauma being prevalent on the job for healthcare workers as well as the already established secondary (vicarious) trauma that is frequently experienced by first responders in the field and in the emergency room. One of the first steps to resolving WPV as a whole is to know how often it is happening, who is perpetrating it, and who is being targeted. One of the main barriers to this is the fact that staff often do not know what acts constitute violence (Stene, Larson, Levy, & Dohlman, 2015). I was surprised that my incident had to be reported as WPV. It was scary, of course, because the guy was like 6'5", 200-something pounds, psychotic, and wouldn't let go of my wrist that he was holding incredibly tightly, but it didn't seem like a particularly violent act (though my wrist was and still is sprained). It wasn't until I had to document the report (because security had to be called) that I was told by a senior nurse that the proper documentation would be listed under WPV.
Most healthcare workers in the emergency room report that they feel that violence is an expected part of their job as a part of the emergency department (Hartnett & Jasani, n.d.) I think that part of this is due to the fact that many times, even when not necessarily indicated, police will bring in patients who are a risk for violence. Then when we try and press charges because we've been assaulted, the police will often want to leave that patient at the hospital because they don't have the resources to deal with them or believe they still have to be treated, even when the doctors have cleared the patient. This also leads to a large number of healthcare workers not pressing charges against those who perpetrate WPV. Even when our employers back us up, this lack of support from the other emergency services that exist for purposes such as responding to WPV leads to a sense of learned helplessness. Asking for help feels like it won't do that much, so people don't ask for help. We just expect this to be a part of the job.
This expectation, primary trauma, and secondary trauma are all significant factors leading to professional burnout and stress disorder symptomology (not to mention the actual physical trauma that often accompanies WPV).
References
Hartnett, E., Jasani, G. (n.d.) Emergency Medicine on the Frontline: Workplace Violence in the Healthcare Setting. AAEM and Student Association. Retrieved from https://www.aaemrsa.org/advocacy/resources/workplace-violence
Stene, J., Larson, E., Levy, M, & Dohlman, M. (2015). Workplace violence in the emergency department:
Giving staff the tools and support to report. The Permanente Journal, 19(2), 113-117. doi: 10.7812/TPP/14-187
SGB Treatment for PTSD
Upon his return to civilian life after having served in Afghanistan and Iraq, Army Sergeant Sean Messett struggled with PTSD. Having tried therapy and medication management with no relief, Sergeant Messett heard another veteran speak on a podcast regarding an injection, or stellate ganglion block (SBG), that he had just received himself. With the help of Hanover's For the Love of a Veteran Inc., Sergeant Messett received this injection, and it has changed his life.
SGB treatment consists of a localized injection of insulin into the individual’s stellate ganglion nerves, which are part of the sympathetic nervous system. This consists of a bundle of nerves that are directly connected to the sympathetic nerve, which triggers the body’s reaction to situations of stress or danger. This in turn causes the amygdala to release hormones that produce the fight or flight response. In the case of an individual whose amygdala and medial prefrontal cortex within the frontal lobe have been dramatically changed by trauma, this person can exhibit extremely emotional, angry, fearful or violent responses and/or reactions. The insulin injection serves to reprogram or restart one’s system, working to return it to normal functioning, pre-trauma.
Studies have shown that success rates range from 80-90%, results are immediate and can last from months to years dependent upon the patient’s needs and response to the injection. While SGB is not a cure, it greatly assists with talk therapy, as it allows patients to be able to think clearer and slow down their mind which was previously always on high alert. Individuals report being able to rest, decrease anger, stress and anxiety, and to reconnect with loved ones.
Quincy Kasper is another veteran who has benefited from the SGB injection. As an advocate for veterans with Post-Traumatic Stress Disorder, he states: ““The only way we’re going to be able to continue to help people and continue to move forward with this is to be talking about it. Because, again, mental health has such a stigma.” (Kasper, Q., 2022). With the overall successfulness of SGB treatment, perhaps more individuals will feel less stigmatized and feel more comfortable in seeking the help they may need.
References:
Escalante, A. (2021). Helping PTSD With A Shot: The New Treatments That Are Changing Lives. Forbes. Retrieved from: https://www.forbes.com/sites/alisonescalante/2021/02/02/curing-ptsd-with-a-shot-the-new-treatments-that-are-changing-lives/?sh=55ff1ed06912
Mediak, G. (2022). Injection helping veterans manage PTSD symptoms. Fox43. Retrierved from: https://www.fox43.com/article/features/sbg-insulin-injection-veterans-ptsd-stellate-ganglion-block/521-49967b48-9e4c-42a1-a2ff-2bdfbed02b46
Rousseau, D. (2022). Neurobiology of Trauma. Module 3. Boston University Metropolitan College.
SGB for Vets (2022). Treatment for PTSD. Retrieved from: https://www.sgbforvets.com
Sutherland, D. (2022). Veteran gets effective PTSD relief through injections. 7WSAW-TV. Retrieved from: https://www.wsaw.com/2022/11/19/veteran-gets-effective-ptsd-relief-through-injections/
Van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, NY: Viking.
Trauma’s Effect On the Brain
Trauma impacts an individual’s body physically, mentally, and emotionally. Whether someone has experienced abuse, war, accidents, natural disasters, any violence, etc., the body creates imprints of these memories on the brain and body causing major changes. While these changes and reactions are detrimental to someone’s health, there are ways to heal from traumas and help individuals keep living their lives. Due to the impact on the brain and body, a person’s life can be flipped around without much understanding of why. Sometimes, the hardest element to consider for someone affected by trauma is understanding the neurological aspect of what has happened to them, what it means in terms of their lives, why it affects them the way it does, and how healing is possible with these unchanging effects.
Before turning to criminal justice, I began as a psychology undergrad. In this time, a main component we learned of was the “3-part brain” or the Triune Brain model (also mentioned in Rousseau’s Module 3). In this model, it is said that there are three parts that make up the brain: the brain stem (reptilian), the limbic/midbrain (mammalian), and the cortex/forebrain (neommalian). The Reptilian is responsible for survival instincts and automatic body functions, the mammalian is responsible for emotions and sensory input, and the neommalian is responsible for decision-making, learning, and memory. All three components are impacted during a traumatic experience, some more than others. The reptilian brain (survival instinct) takes over during a trauma triggering fight or flight and turning off all non-essential bodily functions. Typically, after a traumatic experience has ended, the body is able to switch back to homeostasis- reducing the fight or flight hormones and returning the non-essential bodily functions. For those individuals who end up developing PTSD, however, this switch back to homeostasis never happens. The reptilian brain never returns function to the rest of the other brain areas, leaving them in a continuous state of reactive mode. This reactive mode leaves individuals with symptoms that they don’t understand (PTSD symptoms like mood swings, being easily startled/triggered, having undesirable memories, etc.). This leaves people feeling a loss of control over their own thoughts, decisions, and functions.
The brain itself goes through a biological change after trauma. Several things happen that wouldn’t happen to a brain that has not experienced trauma. A major piece of the brain (and my personal favorite to talk about) is the amygdala. This small formation located close to the center of the brain is responsible for processing threatening stimuli and activating the appropriate response. It also connects emotions to certain memories. In a traumatic situation, the amygdala becomes overstimulated and starts processing everything as a threat. Another crucial piece of the brain is the hippocampus. This part of the brain oversees learning and memory. To create memories, the hippocampus must make synaptic connections (between neurons, as noted in Rousseau’s Module 3) letting the body know that something is in the past and not happening currently- a memory. When the hormones from the fight or flight response are flooding through the body, they kill the cells that carry out these synaptic connections, making it challenging to let the body know that a traumatic event is over and in the past. This leaves the body in a continuous state of reactive mode. Lastly, the SNS (or sympathetic nervous system) manages that fight or flight mode; it releases epinephrine (adrenaline) into the bloodstream. With everything happening with the amygdala and the hippocampus, the SNS is constantly elevated and stressed unable to regulate or pass off to the parasympathetic nervous system, which would restore the body back to normal function and keep it from overworking. The combination of the three function dysregulations alters someone’s mind and body.
These changes, if left untreated can be detrimental. Thankfully, with what we know today about healing and PTSD, we know that healing is possible. All three brain areas can be restored to normal function, reducing the effects of trauma and sometimes eradicating PTSD symptoms fully. Individuals’ healing processes are all different and need to be treated as such in order to help create change.
References
Smith, I. (2021, September 22). How does trauma affect the brain? - and what it means for you. Whole Wellness Therapy. Retrieved December 2022, from https://www.wholewellnesstherapy.com/post/trauma-and-the-brain
Rousseau, D. (2022). Module 1: Introduction to Trauma. Boston University.
Rousseau, D. (2022). Module 2: Childhood Trauma. Boston University.
Rousseau, D. (2022). Module 3: Neurobiology of Trauma. Boston University.
Rousseau, D. (2022). Module 4: Pathways to Recovery: Understanding Approaches to Trauma Treatment. Boston University.
The Neurobiology of Trauma. The Science Behind Trauma.
It is important to understand the neurobiology of trauma because it is important for people to understand how their brain effects their body. The University of Northern Colorado states that "the neurobiology of trauma--essentially the effects of trauma on the brain--is important to understand because it helps break down common misconceptions and victim-blaming about gender-based violence and it helps survivors to understand their experience and the aftermath in a new way" (University of Northern Colorado, 2022). Understanding the various ways in which trauma impacts the body allows people to victims to fully grasp their trauma, and can help guide them on their path of healing. Also understanding the ways in which the mind and body are connected may allow the victim to fully understand and comprehend their trauma. It allows them to understand why they may have acted/or not reacted the way they did in a situation. A substantial part of someone's trauma may stem from the way they acted during the traumatic event. Often times people can become so locked into what they did or did not during that time. By understanding the neurobiology of trauma it can be a huge stepping stone in the healing process for a trauma victim. "Decades of research into the neurobiology of trauma tells us that there are three responses humans (and many mammals) have to terrifying situations: fight, flight, AND freeze" (University of Northern Colorado, 2022). Copious amounts of research in Neurobiology has lead to the progression of trauma treatment and has had a significant impact on the field of psychology and the way that professionals conduct treatment.
Neurobiology plays a powerful role in ameliorating the impact of trauma. Understanding the neurobiology of trauma debunks and breaks down the myths from the facts in terms of trauma. It dismantles the common misconceptions that are often associated with trauma. It also breaks down stigmas that are often associated with individuals that suffer from trauma. Far too often stigma, rudeness and meanness from others is due to a lack of understanding. By teaching professionals working the world about the neurobiology behind trauma, as well as people out in the world, we might be able to dismantle myths and stigmatization surround trauma. Overall, understanding the various ways in which the mind effects the body is key in trauma treatment.
Sources:
University of Northern Colorado. (2022). Neurobiology of trauma. Retrieved Nov. 16, 2022.
University of Northern Colorado. (2022). Neurbiology of trauma: Dismantling common misconceptions and victim blaming statements about sexual violence. Retrieved Nov 16, 2022.
https://www.unco.edu/assault-survivors-advocacy-program/pdf/neurobio_trauma.pdf
A Private War: Why PTSD Is Still Overlooked
Why PTSD is still overlooked: I came across a very interesting article in the New York Times that was published by Dani Blum, but was information from Van der Kolk and other very prominent researchers and experts. I wanted to address one of the comments by one of the expert that mention: "Some experts say this pervasiveness has diluted the meaning of PTSD. The disorder stems from severe trauma, said John Tully, a clinical associate professor in forensic psychiatry at the University of Nottingham in England. “We’re talking life-threatening or close,” he said. The term loses its meaning when people apply it too broadly, he said — and PTSD means more than wrestling with the aftermath of an upsetting event." This comment struck me because in the beginning of the article it mentions that 70 percent of adults in the United States experience one traumatic event and about only 6 percent will develop PTSD the bulk being women. I feel a lot of PTSD in women can stem from childbirth as mentioned a women was diagnosed with PTSD after she delivered a stillborn baby, she expressed after leaving the hospital forgetting how to even get home and feeling like she had arrived from mars. I feel that not only is PTSD being overlooked but it is also being overlooked in women who have given birth. The rewarding opportunity to bring life into the world is such an honor as a mom but in that same sentence can be so difficult especially for new moms. An article from the The Atlantic expressed the misdiagnosis of postpartum depression with postpartum PTSD which differ in the since that postpartum depression is commonly associated with sadness, trouble concentrating, and having a hard time finding happiness in activities versus postpartum PTSD is associated with flashback and intrusive memories. For mothers this traumatic experience can come before or during pregnancy and can be associated with severe morning sickness, bad reactions to fertility etc or when your baby has medical problems during labor.
Based on these articles and how much postpartum PTSD, I know of mothers who experienced things that these exact women experienced during giving birth and how it has had such a long term effect on them. At the time I did not consider their symptoms to be associated with PTSD but I know how it made them feel, even looking at some women who can't produce milk for their children through their whole pregnancy and it makes them feel like a failure of a mother and as if they aren't able to provide for their child. For some women this is such a traumatic event, especially as a mom. Which makes some women afraid to have more children because of some of the complication they experienced with their first kid.
Overall, my purpose of this article was to just to shed light on how PTSD is being overlooked in many different aspects. And so many people go without getting help because you have experts that make comments like the one above not wanting to dilute the word PTSD and neglecting the many that suffer. What may not be considered a life-threatening traumatic event to some" can seem like the end of the world to many.
References:
Blum, D. (2022, April 4). A private war: Why PTSD is still overlooked. The New York Times. Retrieved May 1, 2022, from https://www.nytimes.com/2022/04/04/well/mind/ptsd-trauma-symptoms.html
Strauss, I. E. (2015, October 2). The mothers who can't escape the trauma of childbirth. The Atlantic. Retrieved May 1, 2022, from https://www.theatlantic.com/health/archive/2015/10/the-mothers-who-cant-escape-the-trauma-of-childbirth/408589/
Indigenous Generational Trauma
The concept of trauma and its aftereffects have long been little understood. People deal with traumatic situations differently and what may not affect some can scar others for life. Its complexities are still not entirely understood and the aftereffects of trauma, even less so. Post-traumatic stress disorder (PTSD) and other disorders that develop as a result of experiencing a traumatic event are at the forefront of this class. I chose to delve into the effects of intergenerational trauma in individuals. Specifically, looking into the effects of intergenerational trauma on indigenous groups piqued my interests. My mother is Ecuadorian and natively indigenous to that country, so many of the experiences of Canadian Native Americans and are similar to hers and that of her family. Trauma, in this context, is not an isolated event or incident. Rather, it spans decades and even centuries starting with distant ancestors and accumulating to the experiences of the individual today. It’s a tragic inheritance and the cyclical nature of it means that generational trauma is one of the most devastating results of racism and colonialism present today.
In class, we learned about genocide and the devastating effects on individuals who have lived through genocides of their people, along with the effects that this is bound to have in their lives after survival. The Holocaust was a recent infamous example of this and the way it has shaped the Jewish population throughout the world is profound. Another form of genocide that has more recently been accepted is cultural genocide, which, according to the European University Institute, is “the systematic destruction of traditions, values, language, and other elements that make one group of people distinct from another” (Novic, 1970). Indigenous peoples across the world, and specifically in the Americas, have experienced both traditional genocide and cultural for centuries. Across generations, they have had to deal with the attempted erasure of their very selves, their culture, their traditions and what makes them a distinct race. The very fabric of their generational beings has been threatened and abused. Native Americans deal with psychological issues, including “depression, substance abuse, collective trauma exposure, interpersonal losses and unresolved grief and related problems within the lifespans and across generations, along with having higher health disparities than any other racial group in the United States (Brave Heart et. al, 2011, pg. 282). Substance abuse and suicide rates are also significantly higher among indigenous populations than any other, with the suicide rates being a shocking 50% higher than the national average (Brave Heart et. al, 2011, pg. 283). The effects of generational trauma, including forced assimilation and genocide, are more devastating and pertinent for this ethnic group than perhaps any others in the Americas.
(Image of Indigenous people from Bolivia https://southamericamission.org/donate/ministries/indigenous-rural-outreach/)
I think the profound trauma inflicted on indigenous groups is something that needs to get far more mainstream attention than I feel it does. Indigenous peoples are such a high-risk group that more programs and the like need to be directed toward them. They carry the weight of ancestors’ traumas that cannot truly be put into words. The burden must be astronomical, and the horrifying part is that it’s not over. This isn’t simply past trauma that they must cope with, but ongoing. Ideally, I would like to see more scholarly work done on the topic in the future and particularly, on South American indigenous populations. Throughout my preliminary search on the topic, it quickly became clear that there is far less material available and beneficial infrastructure for South American indigenous population as compared to their North American counterparts.
References:
Brave Heart, M. Y., Chase, J., Elkins, J., & Altschul, D. B. (2011). Historical trauma among indigenous peoples of the americas: Concepts, research, and clinical considerations. Journal of Psychoactive Drugs, 43(4), 282–290. https://doi.org/10.1080/02791072.2011.628913
Novic, E. (1970, January 1). The concept of cultural genocide : An international law perspective. Cadmus Home. https://cadmus.eui.eu/handle/1814/43864
Erasing the mental health stigma for law enforcement
Therapy is often seen as taboo, especially in certain job fields. Police officers are perhaps one of the most important groups that should be seeking support, but the stigma surrounding therapy stops them. Many departments, however, are trying to defeat this stigma. In Washington D.C., a grant of $7 million dollars was created. The Law Enforcement Mental Health and Wellness Act would be used for access to better mental health care for law enforcement (Justice Department Announces Funding to Promote Law Enforcement Mental Health and Wellness, 2021). The funding would allow training, demonstration projects, new practices related to peer mentoring, mental health, wellness, and sucicide prevention programs (2021).
This isn’t the first act, and it definitely won’t be the last act, that aims to provide mental health resources to law enforcement. The more acts/grants that are created, the more the stigma around mental health will be erased for this field and others. Law enforcement professionals have hard jobs. They handle danger, pressure, and the responsibility of protecting the public. This alone creates a lot of stress on them. The global pandemic had only increased the amount of stress and worry on officers, nurses, etc. Now more than ever, we as a society should be focused on promoting mental health, not stigmatizing it in a negative way. Seeking therapy should be no different than going to the doctor for an illness. We need to be mentally healthy just as much as we do physically, especially when carrying out a job like police officers do.
Sources:
Justice Department Announces Funding to Promote Law Enforcement Mental Health and Wellness (2021, October 14). In Department of Justice. Retrieved from https://www.justice.gov/opa/pr/justice-department-announces-funding-promote-law-enforcement-mental-health-and-wellness
Person-Centered, Trauma Informed Care for Holocaust Survivors
All “Holocaust survivors have endured trauma” according to Kavod, a journal dedicated to survivors (2018). Results of their trauma are physical, neurological, psychological, social, and cultural impacts. Physical impacts include, but are not limited to poor dental care and diabetes, and if the Holocaust survivor lived in the Former Soviet Union near Chernobyl, they faced all kinds of problems due to the radiation (benign tumors, heart disease, pulmonary disease, etc.). Neurological impacts include Dementia and Alzheimers. Psychological impacts include, but are not limited to hoarding (afraid of not having enough because they had nothing during the war), PTSD, anxiety, and depression. Social impacts include, but are not limited to trust issues, 2nd and 3rd generation intergenerational trauma, living below the poverty line, etc.. And the cultural impacts of the trauma mostly have an effect on religion. Some Holocaust survivors become culturally religious because they feel as though God have saved them, while others become anti-religious because they question “why did God allow this tragedy to happen?” With all of these impacts of their trauma in-mind, the Jewish Federations of North America (JFNA) knew that Holocaust survivors needed more than regular trauma-informed care. So in 2015, JFNA came up with Person-Centered Trauma-Informed Care (PCTI) that would address all the needs of survivors that are not just limited to therapy. PCTI is a “holistic approach to providing services. It would promote dignity, strength, and empowerment of trauma victims by incorporating knowledge about trauma in victims’ lives into agency programs, policies and procedures” (ACL 2021). In addition to therapy, other services will be provided that focus on mental, cognitive, and physical health, education and training to caregivers and people who will routinely interact with the survivor, socialization with support groups, and support for families of survivors and their caregivers. JFNA awarded over 80 plus sub-grants to nonprofit organizations like Jewish Family & Children Services. The goals and services of the program include: “reduce social isolation among survivors; improve the physical, emotional, mental, and cognitive health of survivors; increase survivors’ access to supportive, legal, and financial services; and train and educate professional staff, family caregivers, and volunteers about caring for survivors in a PCTI way” (Kavod 2018).
Person-Centered Trauma-Informed Care is unique in the sense that all services are catered toward the patient, meaning that no treatment plan or interaction is the same. The environment will adjust in accordance to the patient’s needs and their triggers. Services are meant to be given in a safe, non-threatening, and non-traumatizing manner. Yesterday, I was able to interview a social worker from Jewish Children & Family Services who offered me an example of how the environment adjusted to her client. One of her clients, a Holocaust survivor, was a widower who had trouble sharing his story and had a lot of anxiety coming into the office. She asked him, “what makes you relaxed before going to bed?” He described that listening to classical music and dancing relieved his anxiety. So for every meeting with him, she would play classical music when he walked in and danced in the room for 5 minutes with the door open. Once that idea had occurred, the following session he was able to share his story. In a typical therapy session, it is unusual to do this, but in PCTI, everything is based on the individual’s comfort in their environment and the people they surround. Jewish Children & Family Services also train staff, volunteers, caregivers, and family members how to interact with the survivor and how to recognize signs of post-traumatic stress. In one year of the program, 98% of trained participants of PCTI felt that “they can now identify potentially traumatizing situations that may impact survivors” while 94% felt that “they are competent in creating a trauma-informed environment for Holocaust survivors” (Kavod 2018).
Overall, the recently established PCTI care program has been proven effective, and according to the social worker I had interviewed, she sees a great deal of improvement in her patients, many of whom turn their trauma into a positive thing by sharing their stories to others.
Works Cited
Person-centered, trauma-informed service. ACL Administration for Community Living. (2021, November 8). Retrieved from https://acl.gov/programs/strengthening-aging-and-disability-networks/advancing-care-holocaust-survivors-older
Teaching about trauma: Models for training service providers in person-centered, trauma-informed care. Kavod. (2018, February 27). Retrieved from http://kavod.claimscon.org/2018/02/teaching-about-trauma-models-for-training-service-providers-in-person-centered-trauma-informed-care/
Trauma Theater: Real Therapy or Fun Fiction…
Before I begin explaining my understanding of Trauma Theater, I must first begin with a little history on how I learned of trauma theater. I recently learned of a trauma-based therapy that utilized theater as a means of coping with trauma. In the book, “The Body Keeps the Score” (van der Kolk, 2014) Dr. Van Der Kolk discusses his positive experiences with theater-based trauma therapy and even discusses how it helped his son following a mysterious illness.
There is little information about exactly when this form of therapy started or who pioneered it, but one thing I found to be certain was that this therapy method is alive and well. It seems to be consistently used with troubled adolescents and veterans suffering from PTSD but can also be applied to others suffering from a traumatic incident. Historically speaking it may date as far back as Shakespeare and his utilization of trauma to create while writing his plays. Dr. Van Der Kolk discusses in his book that he learned about it from a group of veterans he had been treating for PTSD and how he discovered that the theatrical production was a part of the recent positive changes he observed during therapy with these veterans.
Dr. Van Der Kolk’s book is what first introduced me to this type of therapy and although I found it to be an interesting process, I did notice that a majority of the programs discussed in the book or on the internet reside on the east coast of the U.S. I have no doubt some also exist on the west coast, but since I have mostly lived in Colorado I had never heard of this therapy. Naturally, I was a little skeptical of the process and had difficulty seeing how it would apply to me or anyone I know who has experienced trauma.
In my profession I work a lot with juveniles who have entered the justice system or are frequently contacted by the police. We do not have programs like you see in Boston or New York City. In Colorado the typical approach is what you see in mainstream psychology. There are programs that work with juveniles, but it is more traditional counseling and if they have absent or uninvolved parents it typically does little good because they immediately return to crime and drugs.
This is why I found the “Trauma Drama” program so interesting. In an article I found on Statnews.com, “Trauma Drama is a theater-based therapy program for teenagers with severe emotional and behavioral problems. The idea is that theater can help this group of troubled adolescents regulate their emotions and build skills to cope with trauma” (says, 2016). After reading about these programs, I kept wondering if there was an application in the juvenile justice system as a whole.
Besides its use among troubled adolescents, I found an article in Psychology Today that discussed the work of Renee Emunah and how she was using her “techniques, exercises and methods to bring new life to hospitalized patients experiencing psychosis” (Healing Trauma with Psychodrama, 2018). I am not a psychologist, but to me this sounds like something worth considering just given the evidence of success with veterans, adolescents and people experiencing varying degrees of trauma. So why isn’t this method nationally recognized and used? Even in Van Der Kolk’s book it states “all of these programs share a common foundation of the painful realities of life and symbolic transformation through communal action. Love and hate, aggression and surrender, loyalty and betrayal are the stuff of theater and the stuff of trauma” (van der Kolk, 2014).
I will not argue that theater draws on the same emotions that are often experienced during trauma. The human experience is full of difficult and often painful encounters, so why is this not a more commonly known and utilized therapy? Is it simply because it can only act as a piece of the solution to dealing with trauma or is it because mainstream psychologists stick to what they’ve learned and use what has worked best for them? From my research this seems to be a widely used technique, but there is little information on why or if this form of therapy really works for people.
Do psychologists always have to have the data present to accept a certain method for treating patients? I am not sure if there will ever be a definitive answer until more in-depth research is completed on the success of such a program, but if that were always the case then why are therapies like EMDR so widely used? There are plenty of people on both sides of the fence when it comes to EMDR, yet it is commonly used in trauma-based therapy. I guess as an individual I would have to decide for myself. Maybe a program like this could be introduced in Colorado and could be utilized to aide adolescents in leading meaningful lives or could help veterans process their trauma. Maybe a program like this could even be introduced with first responders who are suffering from PTSD.
Ultimately, there will probably always be those who find drama therapy useful and can see the success while others will undoubtedly find the issues within. Just like many other forms of therapy they do not all work for everyone. We all have certain things that resonate with us better than others or our brains are wired differently which means different approaches are necessary to live successful and meaningful lives. I can not definitively say that trauma theater is fiction and have found that programs exist which utilize drama therapy for treatment. It is not a one stop shop to dealing with trauma, but I can see the benefits it may offer for some people. Trauma theater may allow someone to access their experiences in a safe space, by giving them the opportunity to confront an abusive parent or the offender who assaulted them. There are so many options for therapy out there it is hard to dismiss something with such a large following.
Maybe trauma therapy is here to stay, and we will see more studies done showing the progress of the programs available. This type of therapy seems to be utilized on such a broad spectrum of trauma survivors that there is no reason it shouldn’t continue to be used.
References:
van der Kolk, B. (2014). The Body Keeps the Score: Mind, Brain and Body in the Healing of Trauma. Penguin Books.
says, M. B. (2016, August 23). Teens work through trauma using theater as therapy. STAT. https://www.statnews.com/2016/08/23/theater-trauma-teenagers/#:~:text=Called%20Trauma%20Drama%2C%20it
Healing Trauma with Psychodrama. (2018). Psychology Today. https://www.psychologytoday.com/us/blog/the-new-normal/201804/healing-trauma-psychodrama
(image) Young People Are Using Musical Theater to Heal Their Trauma — and It’s Working. (2019, July 12). NationSwell. https://nationswell.com/news/young-people-musical-theater-trauma/
Trauma on the Job: Post-Traumatic Stress Disorder in Law Enforcement Officers
As we have learned throughout this course, PTSD is prevalent among many people and professions. However, being a law enforcement officer, PTSD is a personal concern because every police officer is one situation or call away from experiencing something stressful and traumatizing that could end up causing them to suffer from PTSD. PTSD can commonly be linked to the inability to sleep, nightmares, intrusive memories that don’t fade in intensity, physical reactions to places or other things associated with the event, the feeling of always being on guard or, by contrast, feeling numb (Lexipol, 2016). Karen Lansing, a licensed psychotherapist and Diplomate of the American Academy of Experts in Traumatic Stress, states “it’s tempting to associate PTSD with a single incident, stressing that it is often caused by exposure to numerous traumatic incidents over several years or, in some cases, an entire career. I typically see what we call cumulative PTSD” (Lexipol, 2016). Additionally, Lansing states “Incidents involving shootings or improvised explosive devices will often open the door. It’s easier for an officer to come in after one of those incidents because everyone understands that they should be talking about it. But the shooting or ‘things that go bang’ are just the latest incident sitting on top of a stack of other traumatic incidents” (Lexipol, 2016).
Dealing with PTSD in law enforcement provides its own challenges and obstacles, but other challenges these officers face are what treatments are available and effective to help law enforcement officers deal with PTSD. Lansing uses a technique called Eye Movement Desensitization and Reprocessing (EMDR), where Lansing acts almost like a Field Training Officer, guiding the officer through a process of reliving the incident, resolving the trauma, and then mining it for any learning points it has to offer that could be important in the future. EMDR allows the brain to reprocess the incident to full resolution in a safe environment. “The officer is in full control, with me riding shotgun should he need some back-up if things get hung up” (Lexipol, 2016). Lansing says she begins the process of EMDR by tending to the most highly triggering event first such as an officer involved shooting. She states that once this memory is neutralized or the officer is at peace with it, she then moves on to what flashback comes next. Lansing continues to knock these memories off one by one until the officer is feeling better.
As important as these therapy sessions are to officers suffering with PTSD, I have argued and as this course has proved, leadership and administration of police departments are just as critical and important in helping officers deal with PTSD. Lansing states that she can take care neutralizing PTSD easily through therapy sessions, however if she encounters trauma after she neutralizes the event due to poor leadership, she might not be able to succeed and help the officer. “In all of the many hundreds she has helped return fully to the job after treating their PTSD, there are nine who Lansing was not able to return, six in one law enforcement agency and three in another. These were very troubled agencies and all nine were lost due to this leadership issue” (Lexipol, 2016) In order to overcome the obstacles of poor leadership, Lansing believes “training first responders as well as ensuring that officers get at least seven hours of sleep and receive early clinical interventions, such as department-wide annual check-ins with a psychotherapist. Since 2008, she’s also focused on the need for better leadership training” (Lexipol, 2016).
This information and study completed by Lansing has really solidified the need in my opinion for all police departments to start early intervention when an officer is exposed to a traumatic event. My department offers peer counselors to any officer who needs someone to talk to if they are having trouble. The issue with this is that most police officers that I know don’t like to be seen as weak and will never admit that they are suffering or need help. As Lansing states, good leadership and training is needed so that everyone in a department is aware of the effects that PTSD can have on a person. Creating a culture that embraces the impact that PTSD has on its officers starts at the top and trickles down through leadership and training. Being able to understand this so that an officer doesn’t feel the need to suppress their feelings, so they aren’t seen as weak or vulnerable by their peers is imperative to combat PTSD. Overall, PTSD is prevalent in law enforcement and through this course, studies, and my own experience, it is nothing to take lightly and finding ways to help those officers suffering from PTSD is a collaborative effort by everyone in a department.
References:
Lexipol (2016). Trauma on the Job: Post-Traumatic Stress Disorder in Law Enforcement Officers. Retrieved April 21, 2022 from https://www.lexipol.com/resources/blog/post-traumatic-stress-disorder-law-enforcement-officers/