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What do others think of this response from a Nurse Educator in Mental Health (who says she's not a clinician):

"The information and research used to inform staff includes; SAMHSA’s concept of trauma and guidance for a trauma informed approach. We also have the SAFEWARDS model that has been implemented throughout our in-patient services, and staff are being trained in SPEC (safe practice, effective communication) 4 day training – with emphasis on TIC, patient centred care and recovery -- (MY NOTE: although they've given NO  information about what Qs / responses in the case of specific patient behaviors -- no questions about such things as "exaggerated startle responses" on being woken -- sign of possible PTSD)
I believe the concepts of TIC are included and threaded throughout the training/education being offered as we have fully embraced least restrictive practice and fully endorsed the 6 core strategies (Te Pou), modified from SAMHSA. I believe our services will continue to evolve, and any new information/research utilised to inform best practice for our clients/families and services."

For some bizarre reason there's nothing said about actually asking about experience of trauma / abuse.  I'd have thought that, and several other related questions (prior need for hospitalization etc) would need to be the first questions to be addressed -- especially since there're an increasing number of guides, resources, training materials for precisely that.  Your thoughts?

(especially since I posted that list of references detailing some research showing, in that study that (a) the vast majority of psych inpatients have such traumatic experiences; (b) most never disclose / volunteer that information until asked; (c) only a bare majority (51%) get asked even when it's in place; (d) stereotypes influence who will and won't be asked -- people with Borderline PD get asked if they've suffered sexual abuse more than others.

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Last edited by Russell Wilson
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Hi, Russell -- We posted a link today to this very interesting article that partly addresses your question -- https://blogs.psychcentral.com...al-health-treatment/

Here's an excerpt:

Allow me to explain what I mean by trauma complicating treatment. About 7 years ago I was assigned an older aged client (about 66yrs old) while an intern in a community mental health center. This older male had a long history of chronic abuse and domestic violence from the age of 10yrs old to the age of 50yrs old. That chronic abuse included rape and molestation by men and females he knew and did not know. By the time he got to me, his trauma symptoms worsened and evolved into delusions. The delusions included delusions of grandeur (belief that he could defeat his enemies by just looking at them), delusions of persecution (belief he was being persecuted for being “so talented”), and somatic delusions (belief that he smelled like flowers and fear of what others would think).

What I failed to understand at the time was that his delusions were not so much of a psychotic nature as they were of a trauma-based nature. In other words, his delusions were developed, without his awareness, as a defense against years of trauma he had experienced. His trauma developed into strong beliefs held to be true despite strong evidence to the contrary. Nothing anyone else would tell him made a difference in how he viewed himself. In fact, when he would ask me if I noticed a feminine fragrance on him and I would say “no, not at all,” he would indicate I was lying, telling him what he wanted to hear, or “couldn’t detect it.” He would say “I’m so spiritual and ‘set apart’ that you can’t meet me where I’m at.” He was tormented by these delusions triggered by years of trauma.

Following this experience, I sadly encountered similar situations within the teen and adult population. I then pursued training in trauma-informed care (i.e., knowledge of trauma and how it affects the psyche).

feeling guilt and shame over an addiction. i went to therapy today with a EMDR THERAPIST then  on the way home i "ACTED OUT "   .....SO Frustrated. i say i want to stop,,,but then look what i am doing...feedback is welcomed please.

Rick Herranz Sr. posted:

feeling guilt and shame over an addiction. i went to therapy today with a EMDR THERAPIST then  on the way home i "ACTED OUT "   .....SO Frustrated. i say i want to stop,,,but then look what i am doing...feedback is welcomed please.

Hi Rick, don't know what sort of addiction you're talking about -- nor am I asking to know -- these things are best sorted out in the confidentiality of a professional relationship. But don't feel too bad -- too blaming / self-shaming -- such steps are an expectable / manageable part of recovery, you had difficulty regulating / managing the emotions left over from the session and reverted, temporarily, to an over-learnt / automatic "coping" strategy. Such "self-shaming", and feeling bad for feeling bad, is all wrapped up as part of the shit that's left over from the trauma(s). Such difficulties with emotion regulation are quite common amongst those with addiction issues. They are also one of the defining characteristics of Complex Trauma (at least in what will be in ICD-11, if not in DSM 5). One of the best validated treatment approaches in such circumstances, which you might want to investigate, is Lisa Najavits' "Seeking Safety", which targets both the effects of trauma, and addiction issues, concurrently.

Ideally, you could talk through this event with your therapist, who hopefully does more than just EMDR. Depending on the nature of your problems -- e.g., Trauma vs Complex Trauma, for a start. There are a lot of things which could be looked at, in terms of both assessment ("understanding the problem") and treatment, but rest asssured, in the hands of an adequately trained and proficient, the issues are "hard work", but these days relatively easily understood and dealt with, if not quickly overcome -- but much quicker than the "lifetime" it once took. 

Feel free to PM me if you've got further questions -- but I'm in a different country from you, and this would NOT constitute a professional relationship at any stage.

Jane Stevens posted:

Hi, Russell -- We posted a link today to this very interesting article that partly addresses your question -- https://blogs.psychcentral.com...al-health-treatment/

Here's an excerpt:

Allow me to explain what I mean by trauma complicating treatment. About 7 years ago I was assigned an older aged client (about 66yrs old) while an intern in a community mental health center. This older male had a long history of chronic abuse and domestic violence from the age of 10yrs old to the age of 50yrs old. That chronic abuse included rape and molestation by men and females he knew and did not know. By the time he got to me, his trauma symptoms worsened and evolved into delusions. The delusions included delusions of grandeur (belief that he could defeat his enemies by just looking at them), delusions of persecution (belief he was being persecuted for being “so talented”), and somatic delusions (belief that he smelled like flowers and fear of what others would think).

What I failed to understand at the time was that his delusions were not so much of a psychotic nature as they were of a trauma-based nature. In other words, his delusions were developed, without his awareness, as a defense against years of trauma he had experienced. His trauma developed into strong beliefs held to be true despite strong evidence to the contrary. Nothing anyone else would tell him made a difference in how he viewed himself. In fact, when he would ask me if I noticed a feminine fragrance on him and I would say “no, not at all,” he would indicate I was lying, telling him what he wanted to hear, or “couldn’t detect it.” He would say “I’m so spiritual and ‘set apart’ that you can’t meet me where I’m at.” He was tormented by these delusions triggered by years of trauma.

Following this experience, I sadly encountered similar situations within the teen and adult population. I then pursued training in trauma-informed care (i.e., knowledge of trauma and how it affects the psyche).

Thanks, Jane, I found that valuable.

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