Read Chapter 1 The textbook will focus on relational aspects of crisis and trauma. What key principles have you learn on this topic from chapter 1? (1 Full Page)Chapter1Introductionto

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CHAPTER 1

Introduction to Crisis and Trauma Counseling

Thelma Duffey and Shane Haberstroh

There are critical incidences and traumatic events that occur daily in the lives of unsuspecting people. Every day, women, men, and children are in the midst of living their lives when, much to their horror, crises arise in their

homes, schools, workplaces, and communities. Illnesses, accidents, job layoffs, and sudden deaths occur, seemingly out of nowhere, and people are plunged into crisis. Far too often, communities and the larger world experience critical events and tragedies of significant proportions. When these calamities occur, the media instantaneously broadcasts images of mass murders, war, and acts of terrorism and violence. These tragedies create unimaginable images in the psyches of contemporary society.

Introduction to Key Terms and Philosophies

Crisis

By definition, a crisis is often an immediate, unpredictable event that occurs in peo- ple’s lives—such as receiving a threatening medical diagnosis, experiencing a mis- carriage, or undergoing a divorce—that can overwhelm the ways that they naturally cope. People can experience crises individually or as part of a group, community, or other connected system (James & Gilliland, 2013; Myer & Moore, 2006). Crisis experiences often compromise people’s feelings of safety and can induce feelings of fear, sadness, and even a sense of devastation. Crises can also interfere with a person’s ability to function in the world by negatively affecting several life domains, such as work, family, and social connections. Crises can aggravate existing emo-

Introduction to Crisis and Trauma Counseling, edited by Thelma Duffey, and Shane Haberstroh, American Counseling Association, 2020. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/amridge/detail.action?docID=6173695. Created from amridge on 2024-01-09 01:52:34.

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tional injuries, further obstructing a person’s ability to respond to the incident. This aggravation can lead to a person’s sense of hypervigilance following a painful and unexpected violation of trust and safety. This violation can increase the intensity of a person’s feelings, resulting in a deepened experience of anger, anxiety, guilt, and grief. Furthermore, the “intensity, duration, and suddenness” (James & Gilliland, 2013, p. 8) of an experience may result in a person’s experience of trauma.

Trauma

Trauma involves an emotional, mental, and physical response to a powerfully neg- ative experience or series of situations in which people perceived that they or a loved one experienced serious psychological, physical, or emotional harm (Sub- stance Abuse and Mental Health Services Administration [SAMHSA], 2014). Trau- ma can result from an event or a series of events that subsequently causes intense physical and psychological stress reactions (SAMHSA, 2014). These experiences can include violence, sexual assault, abuse, neglect, disaster, terrorism, and war. Chronic abuse, abandonment, a tragic loss of a loved one, or war experiences, for example, can all result in trauma that can be both enduring and complex. In those cases in which complex trauma exists, a person experiences serious stressors that “(a) are repetitive or prolonged, (b) involve harm or abandonment by caregivers or other ostensibly responsible adults, and (c) occur at developmentally vulnerable times” (Ford & Courtois, 2009, p. 13).

These stressors can also involve complex interpersonal traumatic experiences such as betrayal, loss, rejection, and relational violence. People suffer trauma indi- vidually and within their communities. These tragedies, and the trauma that ensues, may upend the emotional, physical, and relational landscapes of communities, re- sulting in generational trauma—at times altering the fabric of that community for years to come (Dupré, Dawe, & Barling, 2014). In fact, history has shown how trau- mas and crises have helped shape the values of nations, diverse cultural groups, and generations throughout the years (Martz, 2010). As a result, these societal, cultural, and familial messages often guide an individual’s response to crises and trauma and can either derail or facilitate healing (Duffey, 2005; Hartling & Lindner, 2016). Every day, professional counselors assist people as they navigate life crises and the im- mediate and acute aspects of traumatic events and loss (McAdams & Keener, 2008).

Conceptualizing Crisis and Trauma One of the purposes of this text is to practically identify the many faces of crisis, the ways in which crises can occur, and the relational processes that counselors can use when working through crises and traumatic injuries. We also explore impor- tant distinctions between crises and trauma because, although these terms are at times used interchangeably, there are clear differences that distinguish one from the other. Recognizing and understanding these differences is important to the work of counseling.

For example, although most people experience crises in their lives (e.g., rela- tionship loss, acute illness, job loss, academic disappointments), not every crisis is followed by trauma. In other words, crises, in and of themselves, do not constitute a trauma, and they do not always lead to traumatic responses. In contrast, trauma

Introduction to Crisis and Trauma Counseling, edited by Thelma Duffey, and Shane Haberstroh, American Counseling Association, 2020. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/amridge/detail.action?docID=6173695. Created from amridge on 2024-01-09 01:52:34.

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can be seen as a profound and often overwhelming response to a critical loss or injury, such as accidents, deaths, and acts of violence.

Although crises tend to resolve over time, people undergoing trauma may con- tinually experience flashbacks and other debilitating symptoms, such as night- mares, as well as physical, emotional, spiritual, and social concerns. Trauma can also result in a pattern of acute anxiety, depression, and posttraumatic stress. Like many loss situations, traumatic injuries can affect a person’s personal relation- ships; behavioral, sleep, and nutritional patterns; and ability to function in life. Empathic, informed, relational, and skilled professional counseling can support people undergoing periods of crises and experiences of trauma.

Trauma-Informed Care (TIC) TIC is a model used by counselors and institutions to place trauma assessment, treatment, and recovery as a primary goal for counseling. SAMHSA, an agency within the U.S. Department of Health and Human Services, discussed how TIC involves using every person within an organization—from the president or chief executive officer of a company to the maintenance person, and everyone in be- tween—in the service of health and healing. All parties involved recognize the role of trauma in a person’s life and understand that people use diverse coping mechanisms to deal with trauma. TIC also involves working with the whole being of a person, taking trauma history into account and considering the person’s cop- ing mechanisms. TIC recognizes that trauma can affect a person’s interpersonal functioning, including interaction with others, work performance, and sleep pat- terns (SAMHSA, 2014).

This model considers the way that trauma can influence a person’s daily re- sponses to events, potentially including isolation, anxiety, substance misuse, and over- or undereating that can increase health risks (SAMHSA, 2014). A person’s functioning and emotional, physical, social, and spiritual health can be affected. SAMHSA described how a person’s mind and body can be stuck in a state of threat when experiencing trauma because the brain is unable to filter information tem- porally and contextually. This condition can result in an impaired sense of self and disconnection, not only from one’s body but also from others. Disconnection can lead to a person’s distressing reactions to a traumatic event, including intrusive memories, images, thoughts, and dreams as well as a sense of feeling numb and dissociated. When faced with cues or triggers that mirror the trauma event, a per- son may react as if the trauma is happening in that moment. This experience can be perpetually devastating. As a result, a counselor’s compassion, responsiveness, and resourcefulness can bring needed support and relief.

The Relational Foundation for Crisis and Trauma Counseling Numerous theories related to crisis and trauma counseling support counselors in this important work, and we offer a description and applications of the more pre- vailing theories in the following chapters. We also discuss outstanding resources in subsequent chapters, such as the American Red Cross, the American Counsel- ing Association (ACA), and the National Child Traumatic Stress Network. In this chapter, however, we introduce the works of the Jean Baker Miller Training Insti-

Introduction to Crisis and Trauma Counseling, edited by Thelma Duffey, and Shane Haberstroh, American Counseling Association, 2020. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/amridge/detail.action?docID=6173695. Created from amridge on 2024-01-09 01:52:34.

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tute and the Human Dignity and Humiliation Studies (HumanDHS); moreover, we identify these works and SAMHSA’s TIC model as foundational to this text.

This book is structured to provide counselors and mental health professionals with current essential information and examples of practical application to cri- sis and trauma counseling. Relationally framed, we emphasize (a) the power of the connections counselors form with people in crisis and as they work through traumatic experiences; (b) an intentional focus on safeguarding a person’s dignity throughout the work; (c) the relational, societal, political, and cultural contexts that affect a person’s experience of crisis and trauma; (d) the various contexts in which crises and trauma arise; and (e) the diverse means by which counselors can intervene and support people who face them.

We invited scholars and practitioners experienced in working with crisis and trauma situations to contribute to this book, and together, we draw on our prac- tices and research as we discuss the many dynamics of crisis and trauma and strat- egies to promote hope and healing. With the exception of publicly documented crises addressed in this text, the case examples we use throughout the book are compilations of actual client stories, de-identified to protect confidentiality. Our goal is to provide you with guiding theories and interventions for working with crisis and trauma situations while underscoring the role of humane connection as a most salient feature of crisis and trauma counseling.

Relationship is at the core of counseling, as indicated in its definition (Kaplan, Tarvydas, & Gladding, 2014), and research speaks to the primary role of relation- ship in therapeutic success (Norcross & Wampold, 2018). It is therefore essential that counselors explore the means by which healing and compassionate relation- ships are formed, which is particularly salient when working with people follow- ing traumatic losses. We offer leading theoretical constructs focused on crisis and trauma counseling and integrate guiding relational principles throughout this text. Judith V. Jordan—renowned scholar and cofounder of the Jean Baker Miller Training Institute, which is home to relational-cultural theory (RCT)—also pro- vides a detailed description of the role of connection in Chapter 2. We begin our discussion with a brief overview of RCT.

RCT Counseling theories provide frameworks to understand the human experience. At the most fundamental level, our theoretical perspectives guide the questions we ask, the way we relate to our clients, and how we conceptualize the counseling process. RCT is based on the early works of Jean Baker Miller, who recognized that traditional psychological theories largely ignored the emotional needs of women and marginalized groups (Jordan, 2018; Miller, 1976). Miller (1976) discussed how these clinical models emphasized separation from others as key to human devel- opment (Hartling & Sparks, 2008; Jordan, 2017). In response, she documented what she saw as the undervalued, yet indisputable, relational strengths of women in her book, Toward a New Psychology of Women (Miller, 1976).

Her work with other RCT founding scholars at the Stone Center at Wellesley College evolved into a theory that identified the importance of authentic, mutu- al connection as particularly relevant to the experiences of marginalized groups. Since then, scholars have explored the unique challenges facing many men soci-

Introduction to Crisis and Trauma Counseling, edited by Thelma Duffey, and Shane Haberstroh, American Counseling Association, 2020. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/amridge/detail.action?docID=6173695. Created from amridge on 2024-01-09 01:52:34.

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etally and have described RCT in application to counseling men (Duffey & Haber- stroh, 2014). RCT’s focus on (a) the importance of growth through connection, (b) the societal and cultural influences that affect people’s responses to life and to one another, (c) the role of power and privilege, and (d) the means by which these factors affect a person’s response to trauma and resilience make it a progressive theory relevant to working with men, women, and children.

Relational Principles Relational Neuroscience

RCT’s theoretical principles, particularly as they relate to trauma work, are sup- ported by neuroscientific findings showing that human beings are “wired for con- nection” (Banks & Hirschman, 2015). Dr. Amy Banks, director of Advanced Train- ing at the Jean Baker Miller Institute at Wellesley Centers for Women, has referred to this principle as relational neuroscience. Relational neuroscience addresses the impact of interpersonal exchanges on the brain and identifies the impact of trauma on a person’s neurobiological structure and changing brain chemistry. This change can affect the ways that people who experience trauma interact with others.

For some people who have already suffered compounded losses after trauma, recognition of brain change and its potential impact on relationships can be dis- couraging. Fortunately, research has indicated that people’s brains have the ca- pacity to regenerate and heal. Scientists refer to this occurrence as the brain’s neuroplasticity (Banks & Hirschman, 2015). An awareness that growth-fostering connection with others (Jordan, 2018) and relational counseling experiences can promote brain health and influence neuroplasticity (Banks & Hirschman, 2015; Jordan, 2018) brings hope to people with trauma experiences and direction to their counselors. These concepts are addressed in Chapter 4.

Growth in Connection

According to RCT, the nature of a person’s relationships deeply influences one’s psychological development across the life span (Miller, 2008). Furthermore, mu- tually rewarding social connections facilitate emotional growth and a desire for continued connection (Banks, 2006, 2011, 2016; Lenz, 2016). The concept of growth in connection diverges from traditional psychological approaches that purport in- dependence from others as a cornerstone to growth. In a sense, RCT reinforces the idea that people need one another, and it introduces a model that proposes how people indeed grow in relationship. This paradigm is particularly salient given that the United States, as a culture, commonly privileges stoicism and rugged individualism and often views presenting pain or expressing need as weakness (O’Malley, Arbesman, Steiger, Fowler, & Christakis, 2012).

Authenticity In contrast, RCT recognizes the courage and strength involved in authenticity, and it identifies authenticity—the ability to represent oneself fully in relationship—as central to growth (Jordan, 2018). We believe that RCT’s reframing, and a coun- selor’s conceptualization of the client through this lens, provides a source of direc- tion, hopefulness, and relief for people in crisis.

Introduction to Crisis and Trauma Counseling, edited by Thelma Duffey, and Shane Haberstroh, American Counseling Association, 2020. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/amridge/detail.action?docID=6173695. Created from amridge on 2024-01-09 01:52:34.

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Context Professional counselors and mental health clinicians using relationally competent principles consider the life circumstances and contextual factors that affect their cli- ents. Context helps counselors look at all sides of a situation, and it brings perspec- tive to behaviors, attitudes, and feelings that could otherwise be pathologized. For example, far too many women with trauma histories are disproportionately mis- diagnosed with borderline personality disorder (BPD; Cloitre, Garvet, Weiss, Carl- son, & Bryant, 2014; Lewis & Grenyer, 2009). We have worked with several women who held tightly to this BPD diagnosis after receiving it from former mental health professionals. Some of these women may experience “unstable relationships with others, efforts to avoid real or imagined abandonment, identity disturbances, [and other symptomology]” (American Psychiatric Association, 2013, p. 663), which are characteristically seen in BPD. In many of these cases, however, these women also have a history of exploitation, abuse, domination, and other misuses of power. These histories bring context to their diagnoses, and counselors can conceptualize their situations using a trauma-informed (SAMHSA, 2014) and relational lens.

Although diagnoses of BPD can be appropriate, there are several cases in which posttraumatic stress disorder (PTSD) is a more appropriate and realistic diagnosis (Cloitre et al., 2014; Lewis & Grenyer, 2009). For example, there is context to the way these women respond to situations, and their relationships, and focusing on these contexts may help them begin to understand their responses from a perspective that Jordan, Kaplan, Miller, Stiver, and Surrey (1991) described as an “internalized defi- ciency model of women” (p. 26). In these cases, women who internalize these defi- ciencies have difficulty noticing their own strengths and values, and “they end up believing the way they think and feel is unimportant” (Jordan et al., 1991, p. 27). This dynamic can set a woman up to carry a distorted sense of her own value.

Reconceptualizing client concerns from a strength-based, relational lens provides cli- ents with an opportunity to face their crises or revisit their traumatic histories with self- compassion and a perspective that can support posttraumatic growth (Jordan, 2017; Kress, Haiyasoso, Zoldan, & Trepal, 2018), making the contextual aspect of RCT especially rel- evant to crisis and trauma counseling. See Sidebar 1.1 for more information on RCT.

Power RCT examines the difference between power-with and power-over. Power-with re- flects a shared power, whereas power-over involves exploitation, control, or dis- missiveness. These dynamics can be played out within supervisory and personal relationships as well as in exploitive business dealings.

Central Relational Paradox RCT shows that in spite of people’s yearning for connection, they sometimes en- gage in protective, but disconnecting, strategies that prevent their desired con-

Sidebar 1.1 • Relational-Cultural Theory Relational-cultural theory posits that people need healthy and meaningful connections in their lives for growth. Research now shows how the brain is actually wired to desire connection with others and can even grow from healthy connections. With this in mind, how do you instill this hope with your clients?

Introduction to Crisis and Trauma Counseling, edited by Thelma Duffey, and Shane Haberstroh, American Counseling Association, 2020. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/amridge/detail.action?docID=6173695. Created from amridge on 2024-01-09 01:52:34.

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Introduction to Crisis and Trauma Counseling

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nections. People may hide how they feel or think to maintain some semblance of life-giving relationship.

Strategy for Disconnection and Strategy for Survival Given the protective nature of these disconnections, RCT conceptualizes these strategies for disconnection as also being strategies for survival. When people un- dergo chronic disconnection and worry that further attempts to connect will be met with more rejection or loss, they may behave in ways that keep them out of connection, even though connection is what they truly desire. They may act this way because they see themselves as essentially unfit for connection, or they fear being seen as unfit. In these cases, they may hide aspects of themselves that they consider defective, which results in forsaking their true nature to sustain a rela- tionship or connection. Tragically, these efforts can result in continued disconnec- tion and isolation.

Condemned Isolation When loss through disconnection becomes chronic, or when people are alone in their experiences without support, they may experience what RCT refers to as condemned isolation, which RCT contends is the “greatest form of human suffering” (Jordan, 2008, 2017; Miller, 1976; Pompeo-Fargnoli, 2017, p. 65).

Relational Resilience In contrast, when genuine relational connections are available and people are able to process their experiences in an environment of safety and respect, they are bet- ter able to experience what RCT refers to as relational resilience (Jordan, Walker, & Hartling, 2004, p. 32). Linda Hartling, former director of the Jean Baker Miller Training Institute and current director of HumanDHS, and Evelin Lindner, the founding president of HumanDHS (Hartling & Lindner, 2016), coauthor Chapter 15, which focuses on this important topic. Resilience is experienced in relation to others; therefore, RCT counselors acknowledge connection and mutuality as in- valuable resources in their work with individuals experiencing crisis and trauma (Banks, 2006, 2016; Kress et al., 2018).

Relational Ethics RCT counselors live out their steadfast commitment to the well-being of the cli- ent, which is at the heart of RCT, by practicing relational ethics. Relational ethics is a relatively new perspective that is less widely known than the mainstream ap- proach called principle ethics, which is rule based and rooted in certain “abso- lute” moral principles. In principle ethics, counselors are taught to ask themselves “what should I do?” when faced with an ethical issue, whereas relational ethicists ask themselves “who should I be?” in this relationship with this client. In relation- al ethics, the focus is on the actor rather than the action (Remley & Herlihy, 2020).

Principle ethics privileges an ethical decision-making process that is linear, pa- ternalistic, dispassionate, universal, and abstract. By contrast, relational ethics val- ues a process that is holistic, mutual, intuitive, compassionate, personal, and con- textual. Rather than searching for answers using a step-by-step, decision-making model, relational ethics instructs counselors to be comfortable with the contextual nuances of ethical decision making and to engage clients in this process (Birrell & Bruns, 2016). Finally, rather than taking a mental and emotional step back as the

Introduction to Crisis and Trauma Counseling, edited by Thelma Duffey, and Shane Haberstroh, American Counseling Association, 2020. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/amridge/detail.action?docID=6173695. Created from amridge on 2024-01-09 01:52:34.

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authority to determine and remedy ethical issues, relational ethics teaches coun- selors to remain fully present in the moment with their clients, engaging them in the process.

This is not to say that counselors applying relational ethics do not follow a logical mind-set or minimize professional standards. On the contrary, counselors follow- ing a relational ethical model respect both logic and mutuality when navigating ethical dilemmas. This approach is in contrast to models that promote searching for a universal principle that can be applied to a generalized “other” (Benhabib, 1987). In some respects, relational ethics makes greater demands on counselors be- cause they cannot find answers by simply applying a model or consulting a code (Birrell & Bruns, 2016). However, this approach helps counselors to better grasp the client’s inner world and create a power-with dynamic that strengthens connec- tion and fosters healing.

Counselor Compassion, Responsiveness, and Resourcefulness in Crisis and Trauma Counseling

Think for a minute to a time when you experienced an event that was outside of your control—an experience that may have felt like a punch to the stomach or an unexpected turn of events that some would consider debilitating. Imagine there was a counselor present. Now consider what that counselor could say or do that would, at least in part, create some sense of safety in that moment. You might imagine be- ing comforted, heard, validated, and supported by your counselor. You might also imagine feeling connected with your counselor as you access and brainstorm your shared resources and strengths. Perhaps you can imagine feeling truly cared for and understood as you sort through the shock and loss of this experience. What could the counselor say or do that would communicate an understanding of your pain? What could the counselor do to communicate care and compassion?

Although people vary in the ways they express and receive compassion during times of injury or distress, they all need it. Counselor compassion, responsiveness, and resourcefulness are all vital to any experience with clients undergoing crises and traumatic experiences. Recognizing their impact is an integral part of serving clients in crisis and trauma situations.

Compassion

The Dalai Lama XIV was quoted as saying, “If you want others to be happy, prac- tice compassion. If you want to be happy, practice compassion” (Dalai Lama & Cutler, 2009, p. 18). Compassion is an experience that can move the hearts of those who feel it and those who receive it. Gilbert and Choden (2013) described a coun- selor’s compassion as b

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