Counselling for trauma
Please see attached information with video link and preferred models to write about along with sources to be cited.
HSCS 478 – Trauma Counselling – Assignment 2 Marking Criteria
Must Complete: Yes
Weighting (%): 50
Assessment Notes: Written Assignment
No. Words: 3000
Relates to Learning Outcomes: ULO3, ULO4, ULO5
3. demonstrate an advanced knowledge of suicide risk assessment and management;
4. select and apply strategies for the development of resilience in the face of adversity; and
5. devise ways of minimising the risk of vicarious traumatisation.
Due Date: Is displayed at the bottom of this page
You must have read Modules 4 and 5 before completing this assignment.
TASK:
In light of this video clip, imagine that ‘Lyndsey’ has just been released from hospital and referred to you for counselling.
Part A:
Choose an evidence-based approach to working with trauma that current literature suggests would be appropriate to use in Lyndsey’s case.
(i) Provide a brief overview of this approach and provide a rationale for why this might be an appropriate approach to use with Lyndsey. As part of this discussion, critically analyse the approach’s strengths and weaknesses in relation to the specifics of Lyndsey’s case. Please provide specific examples and include references to the literature. (15 marks)
(ii) Do you think Lyndsey is at risk of suicide? Please provide specific examples and include references to the literature. (10 marks)
Part B:
How might you develop Lyndsey’s resilience? Provide at least one evidence-based example of how you would facilitate this. Please provide specific examples and include references to the literature. (10 marks)
Part C:
Describe the ways in which you, as Lyndsey’s counsellor, would minimise your risk of experiencing vicarious traumatisation whilst working with Lyndsey and the specifics of her case. Please provide specific examples and include references to the literature. (10 marks)
* Academic writing style (5 marks)
HSCS 478 – Trauma Counselling – Assignment 2 Marking Criteria
F (0-49)
P (50-64)
C (65-74)
D (75-84)
HD (85-100)
Mark
Part A:
(i)Choose an approach to working with trauma that current literature suggests would be appropriate to use in Lyndsey’s case. Provide a brief overview of this approach and the main processes involved. As part of this discussion, critically analyse the approach’s strengths and weaknesses in relation to the specifics of Lyndsey’s case.
Please provide specific examples and include references to the literature.
Theoretical underpinnings/main processes of approach inadequately described.
Inadequate rationale for why the approach is appropriate for use with Lyndsay, including its strengths and weaknesses
Specific examples and references to literature are not adequately identified and discussed.
Theoretical underpinnings/main processes of approach identified and described
Rationale for why the approach is appropriate for use with Lyndsay, including its strengths and weaknesses identified and described
Specific examples and references to literature are identified and described.
Theoretical underpinnings/main processes of approach identified and discussed.
Rationale for why the approach is appropriate for use with Lyndsay, including its strengths and weaknesses identified and discussed.
Specific examples and references to literature are identified and discussed.
Theoretical underpinnings/main processes of approach identified, discussed and analysed.
Rationale for why the approach is appropriate for use with Lyndsay, including its strengths and weaknesses identified, discussed and analysed.
Specific examples and references to literature are identified, discussed and analysed.
Theoretical underpinnings/main processes of approach comprehensively discussed and analysed.
Comprehensive rationale for why the approach is appropriate for use with Lyndsay, including its strengths and weaknesses comprehensively discussed and analysed.
Specific examples and references to literature are comprehensively identified, discussed and analysed.
/15
(ii) Do you think Lyndsey is at risk of suicide? Provide a rationale for your answer.
Please provide specific examples and include references to the literature.
Lyndsey’s risk of suicide inadequately identified and described.
Specific examples and references to literature are not adequately identified and discussed.
Lyndsey’s risk of suicide identified and described.
Specific examples and references to literature are identified and described.
Lyndsey’s risk of suicide identified and discussed.
Specific examples and references to literature are identified and discussed.
Lyndsey’s risk of suicide identified, discussed and analysed.
Specific examples and references to literature are identified, discussed and analysed.
Lyndsey’s risk of suicide comprehensively discussed and analysed.
Specific examples and references to literature are comprehensively identified, discussed and analysed.
/10
Part B:
How might you develop Lyndsey’s resilience? Provide at least one evidence-based example of how you would facilitate this.
Please provide specific examples and include references to the literature.
Inadequate explanation of how Lyndsey’s resilience might be developed, including at least one example of how this would be facilitated.
Specific examples and references to literature are not adequately identified and discussed.
Explanation of how Lyndsey’s resilience might be developed, including at least one example of how this would be facilitated identified and described.
Specific examples and references to literature are identified and described.
Explanation of how Lyndsey’s resilience might be developed, including at least one example of how this would be facilitated identified and discussed.
Specific examples and references to literature are identified and discussed.
Explanation of how Lyndsey’s resilience might be developed, including at least one example of how this would be facilitated identified, discussed and analysed.
Specific examples and references to literature are identified, discussed and analysed.
Explanation of how Lyndsey’s resilience might be developed, including at least one example of how this would be facilitated comprehensively discussed and analysed.
Specific examples and references to literature are comprehensively identified, discussed and analysed.
/10
Part C: As Lyndsey’s counsellor, reflect on ways in which you would minimise your risk of experiencing vicarious traumatisation whilst working with Lyndsey and the specifics of her case.
Please provide specific examples and include references to the literature.
Inadequate refection of ways of minimizing risk of vicarious trauma whilst working with Lyndsey.
Specific examples and references to literature are not adequately identified and discussed.
Ways of minimizing risk of vicarious trauma whilst working with Lyndsey identified and described.
Specific examples and references to literature are identified and described.
Ways of minimizing risk of vicarious trauma whilst working with Lyndsey identified and discussed.
Specific examples and references to literature are identified and discussed.
Ways of minimizing risk of vicarious trauma whilst working with Lyndsey identified, discussed and analysed.
Specific examples and references to literature are identified, discussed and analysed.
Ways of minimizing risk of vicarious trauma whilst working with Lyndsey comprehensively discussed and analysed.
Specific examples and references to literature are comprehensively identified, discussed and analysed.
/10
Academic writing and referencing
Structure, referencing style, use of peer-reviewed references, spelling, grammar, punctuation, word length.
Paper format is poorly used or absent. Introduction, and conclusion are poorly constructed or absent, lack of logical order and overall narrative.
Errors in spelling, grammar and punctuation which detract from readability and clarity of meaning. Word count is not within the 10% prescribed limit (excluding references).
Less than 20 or more references and/or drawn from subject reading materials and/poor quality sources.
APA7 refencing style not used or poorly and inconsistently applied
Discussion paper format used that includes an introduction, conclusion and recommendations.
Spelling, grammar and punctuation are adequate to ensure readability and clarity of meaning.
Word count is within 10% of prescribed limit (excluding references).
References (20 or more) have been largely drawn from the subject reading material.
APA7 referencing style has been used throughout the assessment.
Discussion paper format has been clearly used; includes an introduction that clearly outlines the intended structure, all paragraphs with 4 sentences or more, a conclusion and recommendations.
Spelling grammar and punctuation are consistently applied to promote readability and clarity of meaning.
Word count is within 10% of prescribed limit (excluding references).
References (20 or more) have been drawn from subject reading material and also provide evidence of research from other sources.
APA7 referencing style used consistently throughout assessment.
Discussion paper format has been closely adhered to and clearly used to logically develop a coherent narrative/argument throughout the paper.
Spelling, grammar and punctuation demonstrate attention to detail that does not detract from readability and clarity of meaning.
Word count is within the prescribed limit (excluding references).
References (20 or more) have been drawn from high quality sources and indicate research beyond the subject reading material.
APA7 used throughout the assignment with clear attention to detail.
Discussion paper format has been closely adhered to and clearly used to logically develop a coherent narrative/argument throughout the paper.
Spelling, grammar and punctuation demonstrate attention to detail that does not detract from readability and clarity of meaning.
Word count is within the prescribed limit (excluding references).
References (20 or more) have been drawn from high quality sources and indicate research beyond the subject reading material.
APA7 used throughout the assignment with clear attention to detail.
/5
Total
/50
Assessment Notes – Counselling
Part A
There are many approaches in the literature for working with trauma and most of these are complex and divided into several stages or phases. As we cannot possibly cover every approach within this module, we have provided a ‘taste’ of a number of approaches for working with clients who have experienced trauma, and would encourage you to conduct further research in this area. Of course, irrespective of the approach to trauma counselling taken, it is vital that the client be involved in the creation of the treatment plan and is invited to work collaboratively with the practitioner to decide what the goals of therapy are and how these will be achieved. Remember that the treatment plan is an evolving document and may need to be changed as therapy progresses. At a minimum, a treatment plan should always include client-agreed goals for treatment and some specific interventions that are planned to help the client to achieve these goals. It should also include some suggestion of a desired outcome. This is so that both the client and the therapist know whether or not the goals have been achieved.
The approaches that we will consider below have been divided into two different categories. The first category includes approaches that are offered immediately (or very shortly) after the traumatic event has occurred and are short-term in nature. These are Crisis Intervention, the MANERS model of psychological first aid and Critical Incident Stress Debriefing (CISD). The second category includes approaches that provide support over a longer-term (and may be offered once the immediate crisis has been addressed, perhaps after using one of the immediate/short-term approaches mentioned previously).
Immediate Responses to Crisis and Trauma- Option 1 Immediate
We begin this section by looking at three short-term responses that focus upon providing support immediately (or very shortly) after the traumatic event/crisis has occurred – Crisis Intervention, the MANERS model of psychological first aid and Critical Incident Stress Debriefing (CISD).
Crisis intervention
According to Kanel (2014, p. 2), a ‘crisis’ has three essential components:
“(1) a precipitating event
(2) a perception of the event that causes subjective distress
(3) the failure of a person’s usual coping methods, which causes a person experiencing the precipitating event to function at a lower level than before the event.”
Whilst this definition might suggest that a ‘crisis’ relates only to the event itself, it actually encompasses much more than this. The fact that the same situation might be defined as a ‘crisis’ by one person but not by another illustrates the subjective nature of the experience. Furthermore, as an individual’s perceptions and coping strategies may change over time, an event that was perceived to be a crisis at one point in their development may be viewed quite differently at another.
As we have seen in earlier modules, there are numerous violent or traumatic events which may cause a client to enter into a state of crisis. The fact that the upheaval created by such events destabilises an individual’s level of functioning across all arenas (physical, emotional, behavioural and cognitive) means that, as counsellors and mental health practitioners, we need to be able to offer some immediate, active form of intervention that moves the person from their current state of chaos to a place in which a greater sense of control and manageability is experienced.
Kanel (2014) offers the following ABC Model of Crisis Intervention. She states that, “the focus of the ABC model is to identify the precipitating event, the client’s cognitions about the precipitating event, subjective distress, failed coping mechanisms and impaired function. The goal is to help the client integrate the precipitating event into his or her daily functioning and return to pre-crisis levels of emotional, occupational, and interpersonal functioning.” (p. 26)
A. Phase One: Developing and maintaining contact
Build rapport with basic attending skills
Provide an empathic, non-judgemental and genuine presence
Increase the client’s level of trust
2. Phase Two: Identifying the problem and therapeutic interaction
Focus on delineating the problem
Identify perspective, subjective distress, and current and previous functioning
Collect information to understand the nature of the crisis so that new ways for the client to think about, preceive and cognitively process the situation can be provided
3. Phase Three: Coping
Explore new coping methods
Assist the client to examine ways of coping
Provide other suggestions
Follow-up (p. 26 – 27). [This may involve referral for longer-term therapy]
The following video presentation provides an in-depth discussion and demonstration of this model by Kanel herself.
Kanel, K. (2008, January 1). [Streaming video]. Crisis counseling: The ABC model and live demonstration with two PTSD clients. Microtraining Associates.
Clearly then, compared to long-term counselling, crisis intervention is more active and directive, involves short-term contact which focuses on the ‘here-and-now’ situation (in an effort to minimise the victim’s feelings of panic, chaos and disorientation) and deals with the practical steps and coping strategies required to help the individual regain a sense of control in the immediate aftermath of the crisis. These differences are highlighted in the following table by Jackson-Cherry and Erford (2010, p.15-16):
Or Option 2- Long Term
Trauma and Narrative Therapy
The final therapeutic approach that we will consider in this module is Narrative Therapy. A word of caution here though – Narrative Therapy (a therapeutic approach that can be used to work with a client who has experienced trauma) is not the same as a ‘trauma narrative’ (which refers to the story or account that a client provides in relation to their experience of trauma). In Narrative Therapy we will certainly hear ‘trauma narratives’ but we will also hear ‘trauma narratives’ when using Trauma-Focused CBT, Somatic Therapy or Survivor Therapy for example.
https://dulwichcentre.com.au/wp-content/uploads/2015/06/Beginning-to-Use-a-Narrative-Approach-in-Therapy.pdf
for those of you interested in learning more about the use of Narrative Therapy when working with trauma, we have included a presentation by Michael White, one of the leading names in relation to this approach. Given the length of the presentation (approximately an hour) it is completely optional as to whether or not you choose to watch it.
Trauma and Narrative Therapy – Michael White
Michael White presented an all day workshop on his narrative therapy approach to working with trauma survivors at the International Trauma Studies Program
in New York City on April 1, 2007.
PART B
Developing and increasing resilience
A different way to look at people’s experiences of trauma is in terms of resilience. Resilient people are those who have experienced trauma but, due to a combination of personal, family and socio-ecological protective factors, continue to function well despite their adversity. The concept of resilience has become very popular with therapists using a strength-based approach. In the next reading, Iacoviello and Charney (2014, p.1) explore the psychosocial elements of resilience, in particular, “optimism, cognitive flexibility, active coping skills, maintaining a supportive social network, attending to one’s physical well-being, and embracing a personal moral compass.” In addition to considering ways in which resilience can be promoted within the individual, they discuss the development of community resilience.
Iacoviello and Charneys’ (2014) article is followed by one from Ungar (2013). Ungar (2013, p. 255) argues that adopting a social ecological stance (rather than one based upon an individual’s personal attributes such as personal mastery and temperament) is imperative as, “resilience is less a reflection of the individual’s capacity to overcome life challenges as it is of their informal and formal social networks to facilitate positive development under stress.” Ungar (2013, p. 255) cautions, however, that we need to be clear about the fact that resilience is not the same as the suppression of symptoms associated with poor mental health, rather, it reflects, “the positive adaptations that individuals, families and communities make regardless of the the presence of disordered thoughts, feelings, and behaviours.” In presenting his argument, Ungar (2013, pp. 258 – 260) proposes three principles to explain the influence of environment on resilience:
Principle 1: Nurture trumps Nature when coping with trauma.
Principle 2: Differential impact of Environment on resilience.
Principle 3: Cultural variation to what is ‘meaningful’.
Iacoviello, B. M., & Charney, D. S. (2014). Psychosocial facets of resilience: Implications for preventing posttrauma psychopathology, treating trauma survivors, and enhancing community resilience. European Journal of Psychotraumatology, 5(1), 23970–23980. https://doi.org/10.3402/ejpt.v5.23970
EISSN: 2000-8066
Ungar, M. (2013). Resilience, trauma, context, and culture. Trauma, Violence & Abuse, 14(3), 255–266. https://doi.org/10.1177/1524838013487805
ISSN: 1524-8380, EISSN: 1552-8324
Neria, Y., & Watson, P. (2013). Understanding and fostering resilience in persons exposed to trauma. The Psychiatric Times, 30(5), 20, 39–45.
ISSN: 0893-2905
Jackson-Cherry, L.R. & Erford,B.T. (2010). Crisis intervention and prevention, Pearson Education.
Kanel, K. (2011). A Guide to Crisis Intervention, Cengage Publishers, USA.
Pender, D.A. & Pritchard, K.K. (2009). ASGW Best Practice Guidelines as a Research Tool: A Comprehensive Examination of the Critical Incident Stress Debriefing, The Journal for Specialists in Group Work, vol. 34, June, pp. 175 – 192.
PART C
To date, we have been exploring the impact that violence and trauma have on the individual, or group of individuals, who directly experience it. In this final module, we turn our attention to the impact that working with the traumatised can have upon the health and wellbeing of the counsellor. As you will soon discover, like CISD, there is contention surrounding the existence (or otherwise) of secondary trauma-related phenomena. Firstly though, the next reading by Bell and Robinson (2013) introduces the concept of “shared trauma” in counselling and explores the implications for counsellors, including the risk of vicarious traumatisation. The video that follows it explores the experience of countertransference in trauma work.
Bell, C. H., & Robinson, E. H., III. (2013). Shared trauma in counseling: Information and implications for counselors. Journal of Mental Health Counseling, 35(4), 310–323. https://doi.org/10.17744/mehc.35.4.7v33258020948502
ISSN: 1040-2861, EISSN: 2163-5749
What is vicarious traumatisation?
The provision of support and treatment to those experiencing trauma is demanding, confronting, exhausting, upsetting and at times, harrowing. The distress experienced by those indirectly affected by the pain and trauma of others is known by various names such as vicarious trauma, secondary traumatic stress, compassion fatigue, traumatic countertransference, contact victimisation and burnout.
Corey and Corey (2011, p. 316 – 317) describe burnout as:
“A state of physical, emotional, and mental exhaustion that results from constant or repeated emotional pressure associated with an intense, long-term invovlement with people. It is characterised by feelings of helplessness and hopelssness and by a negative view of self and negative attitudes to work, life and other people…In addition, helping professionals who observe and work with people who have experienced traumatic events may suffer from compassion fatigue, a stress-related syndrome that results from the cumulative drain on the helper’s capacity to care for others.”
These authors provide the following list in relation to some of the risks of burnout:
Doing the same type of work with little variation
Giving a great deal personally and not getting back much in the way of appreciation or other positive responses
Lacking a sense of accomplishment and meaning in your work
Being under constant and strong pressure to produce, perform, and meet deadlines – many of which may be unrealistic
Working with a difficult population, such as highly resistant clients, involuntary clients, or those who show very little progress or change
Continuing conflict and tension among staff; an absence of support from colleagues and an abundance of criticism
Lacking trusting relationships between supervisors and workers, creating conflict rather than teamwork towards commonly valued goals
Lacking opportunities for personal expression or for taking initiative in trying new approaches; a situation in which experimentation, change and innovations not only are not rewarded but are actively discouraged
Continuing dissatisfaction with agency goals and few opportunities to create new goals
Providing substandard services to clients
Having unrealistic demands on your time and energy
Having personally and professionally taxing work without much opportunity for supervision, continuing education, or other forms of in-service training
Experiencing unresolved personal conflicts beyond the job situation, such as marital tensions or chronic health or financial problems.
(Corey & Corey, 2011, p.318-319)
2. Sign and symptoms
Signs and Symptoms
According to Corey, Corey and Callanan (2011, p. 70), burnout ‘comes at the end of a long process of “therapist decay”, which is identified by the following signs:
An absence of boundaries with clients
Excessive preoccupation with money and being successful
Taking on clients that exceed one’s level of professional competence
Poor health habits in the areas of nutrition and exercise
The absence of camaraderie with friends and colleagues
Living in isolated ways, both personally and professionally
Failing to recognise the personal impact of client’s struggles
Resisting personal therapy when experiencing personal distress.”
With regard to the construct of ‘vicarious traumatisation’, Caringi and Pearlman (2009 cited in Ford 2009, p. 376 – 377) offer the following viewpoint:
“Supporting the recovery of people who have been affected by severe, prolonged or early violence, neglect or abuse is an honour and a challenge. It is an honour because it requires earning the trust of those whose trust has been compromised in other relationships. It is also a challenge because it requires the therapist to maintain self-awareness and attention to emotional reactions and behaviours while remaining attuned to the client’s needs. The empathic engagement necessary for truly therapeutic relationships with [the persons suffering from PTSD] often has transformative negative personal repercussions for the therapist…When the helper opens himself or herself to another’s pain, s/he may experience personal distress [arising] from imagining personally experiencing the traumatic event, resulting in negative feelings [and changes in personal outlook, because] empathy arises from imagining what the client experienced…”
The result of vicarious trauma, according to Coutois (2008b cited in Ford, 2009, p. 377), is that the counsellor is likely to under- or over-respond to his or her traumatised clients:
“Over-response can result in ‘rescuing’ of the client that, in turn, can result in a failure to maintain appropriate boundaries and the development of dual relationships. For example, a therapist might meet the client on a daily basis, have numerous phonecalls between appointments, give the client advice on how to handle personal problems, or in more extreme cases, provide practical or financial help to the client, arrange meetings outside of the office setting, or in general, do a variety of special things for the client that could be as egregious as having sexual contact with the client.
Under-response can paradoxically be related to over-response…As the practitioner becomes overwhelmed by the demands of the work and the client, he or she might become angry and detach or blame the client as a result. In some cases, this results in hostility toward the client and abrupt and unplanned endings (abandonment) based on these feelings. Under-response can also be the result of dislike of, and stigmatisation, of the client and his or her psychological trauma history and traumatic stress symptoms. All of these reactions are ethically compromised in that they have the potential to add to the client’s distress and to cause further emotional harm.”
Not everyone subscribes to the belief that trauma work carries with it an almost inherent risk of experiencing vicarious traumatisation. As the following readings illustrate, there is a growing argument that trauma can also act as a catalyst for growth of the practitioner in the therapeutic context.
Pack, M. (2014). Vicarious resilience: A multilayered model of stress and trauma. Affilia, 29(1), 18–29. https://doi.org/10.1177/0886109913510088
ISSN: 0886-1099, EISSN: 1552-3020
Nuttman-Shwartz, O. (2015). Shared resilience in a traumatic reality: A new concept for trauma workers exposed personally and professionally to collective disaster. Trauma, Violence & Abuse, 16(4), 466–475. https://doi.org/10.1177/1524838014557287
ISSN: 1524-8380, EISSN: 1552-8324
Hunter, S. V. (2012). Walking in sacred spaces in the therapeutic bond: Therapists’ experiences of compassion satisfaction coupled with the potential for vicarious traumatization. Family Process, 51(2), 179–192. https://doi.org/10.1111/j.1545-5300.2012.01393.x
ISSN: 0014-7370, EISSN: 1545-5300
Reducing Susceptibility to Vicarious Trauma – the Importance of Self-care
Without a doubt, counsellors and mental health practitioners have an ethical responsibility to both their clients and themselves to be self-aware and to actively develop and implement self-care strategies. Corey and Corey (2011, p. 329) note that, “self-care and self-renewal involve a balanced attention to our physical, emotional, mental, social, and spiritual dimensions.” Furthermore, Corey, Corey and Callanan (2011, p. 71) stress that “self-care is not an indulgence, it is necessary to prevent distress, burnout, impairment, and to maintain a level of psychological and physical wellness. This pursuit of psychological wellness is an ethical imperative.”
In the following series of commentaries edited by Barnett (2011), the challenges to professional competence that those working in dangerous contexts face, and suggestions for how competence might be maintained, are provided.
Johnson, W. B., Johnson, S. J., Sullivan, G. R., Bongar, B., & Miller, L. (2011). Psychology in extremis: Preventing problems of professional competence in dangerous practice settings. Professional Psychology: Research and Practice, 42(1), 94–104. https://doi.org/10.1037/a0022365
EISSN: 1939-1323
Corey, G. & Corey, M. (2011) Becoming a Helper (6th ed), Brooks/Cole, U.S.A.
Corey, G., Corey, M. & Callanan, P. (2011), Issues and Ethics in the Helping Porfessions (8th ed), Brooks/Cole, U.S.A.
Assessment Outline
In light of this video clip, imagine that ‘Lyndsey’ has just been released from hospital and referred to you for counselling.
Part A:
Choose an evidence based approach to working with trauma that current literature suggests would be appropriate to use in Lyndsey’s case.
(i) Provide a brief overview of this approach and provide a rationale for why this might be an appropriate approach to use with Lyndsey. As part of this discussion, critically analyse the approach’s strengths and weaknesses in relation to the specifics of Lyndsey’s case. (15 marks)
(ii) Do you think Lyndsey is at risk of suicide? Provide a rationale for your answer. (10 marks)
Part B:
How might you develop Lyndsey’s resilience? Provide at least one evidence based example of how you would facilitate this. (10 marks)
Part C:
As Lyndsey’s counsellor, reflect on ways you would minimise your risk of experiencing vicarious traumatisation whilst working with Lyndsey and the specifics of her case. (10 marks)