CORE SKILLS CURRICULUM
Understanding the Complexity of Traumatic Experience(s):
Gateway to Intervention
The Complexity of Traumatic Experience(s):
The Gateway to Intervention
• Objectives:
– Enhance understanding of the complex components of child and
adolescent traumatic experiences.
– Increase capacity to listen, using a systematic framework
– Increase recognition of omissions and difficult moments
– Enhance clinical confidence to engage children in trauma narrative
work
– Appreciate the capacity and courage of children in meeting the
challenge of trauma narrative work
Danger Apparatus
• Traumatic experiences need to understood within a broader context of
danger.
• The human brain and body are geared to recognize and respond to
dangers.
• Danger takes a priority over normal activities of daily functioning.
• There is a developmental ontogenesis of danger and response.
• Culture helps define appraisal of threat and possible responses.
• Experience molds expectations of danger and selections of
interventions.
Danger Apparatus
• Appraisal of the Magnitude of External and Internal Danger.
• Emotional and Physiological Activation: Valence, Intensity,
Acceleration.
• Efforts at Emotional Regulation, including Suppression or
Override of Inhibitions.
• Estimation and Efficacy of Protective Intervention by
Self/Others/Social Agents.
Danger
• Secondary Appraisal of the Magnitude of External and
Internal Danger (Actualized threats, near misses and false
alarms).
• Secondary Efforts at Emotional Regulation.
• Reconsiderations of Preventive and Protective Intervention by
Self/Others and Social Agents.
When Danger Becomes Trauma:
• Failure of the danger apparatus to prevent an injurious
outcome.
• Moment(s) of true physical helplessness.
• Convergence of external and internal dangers.
The Complexity of Traumatic Experiences
I.
Context
II.
Multiple traumatic moments occur, even within a relatively
circumscribed situation.
III.
Changes foci of attention or concern.
IV.
Radical shift in attention or concern when physical integrity is
violated.
V.
Additional traumatic moments after cessation of violence or threat.
VI.
Additional dimensions to traumatic experiences.
VII.
Disturbances in evolving developmental expectations regarding
danger.
.
Pynoos, Steinberg & Aronson, 1997
The Complexity of Traumatic Experiences
I.
CONTEXT:
A. Circumstances
B. Affective state
C. Cognitive preoccupations
D. Developmental concerns
Pynoos, Steinberg & Aronson, 1997.
The Complexity of Traumatic Experiences
II.
MULTIPLE TRAUMATIC MOMENTS: Even within a relatively
circumscribed situation.
A.
Moment-to-moment perceptual, kinesthetic and
somatic registration.
The Complexity of Traumatic Experiences
II.
MULTIPLE TRAUMATIC MOMENTS: Even within a relatively
circumscribed situation.
B. Ongoing appraisal of external & internal threats.
The Failure Of Developmental Expectations
•
•
•
•
•
•
•
•
•
Alarm Reactions
Social Referencing
Searching
Protective Shield
Resistance to Coercive Violation
Basic Affiliative Assumptions
Emerging Catastrophic Emotions
Socially Modulated World
Surrender – Moment of Unavoidable Danger
The Complexity of Traumatic Experiences
II.
MULTIPLE TRAUMATIC MOMENTS: Even within a relatively
circumscribed situation.
C. Ongoing efforts to address the situation in behavior,
thought and fantasy
The Complexity of Traumatic Experiences
II.
MULTIPLE TRAUMATIC MOMENTS: Even within a relatively
circumscribed situation.
D. Continuous efforts to manage emotional and
physiological reactions.
The Complexity of Traumatic Experiences
III.
CHANGES IN FOCI OF ATTENTION OR CONCERN:
A.
B.
C.
D.
Attention drawn away from one’s own safety out of concern for
danger or injury to other.
Moment of estrangement from others when immediate threat or
injury to self.
Sudden preoccupation with concerns about severity of injury.
Rescue or repair after injury to self or other.
Inhibition of wishes to intervene or suppression of retaliatory
impulses from fear of provoking counter-retaliatory behavior.
Pynoos, Steinberg & Aronson, 1997.
The Complexity of Traumatic Experiences
IV.
RADICAL SHIFT IN ATTENTION OR CONCERN WHEN PHYSICAL
INTEGRITY IS VIOLATED:
A.
Attention directed towards fears/fantasies about nature/extent
of psychic/physical harm.
B.
Engagement of self-protective mechanisms to meet internal
threats and pain (including ‘Dissociative’ physiological
responses and fantasies).
C.
Efforts to invoke or disclaim of affiliative needs/desires in
order to mitigate fear or ward off sense of active participation.
Pynoos, Steinberg & Aronson, 1997.
The Complexity of Traumatic Experiences
V.
ADDITIONAL TRAUMATIC MOMENTS AFTER CESSATION OF
VIOLENCE OR THREAT:
A.
Efforts to aid injured or attend to dead family members or
friends.
B.
Efforts to seek outside help (e.g., police, paramedics).
C.
Experiences during acute medical or surgical care.
D.
Acute separation from significant others, including injured
or dead family members or peers.
Pynoos, Steinberg & Aronson, 1997.
The Complexity of Traumatic Experiences
V.
ADDITIONAL DIMENSIONS TO TRAUMATIC EXPERIENCES:
A.
B.
C.
Worry about safety of significant others whose well-being is
unknown.
Reactivation of previous danger/fear/anxieties from prior
experiences.
Acute grief reactions to witnessing death or destruction even
while threat to self continues.
Pynoos, Steinberg & Aronson, 1997.
A "Worst" Moment:
The Convergence of External and Internal Threats
(Layne, Saltzman, Pynoos)
External Threat:
(An objective catastrophe takes place OUTSIDE of me)
Direct threat to my life, physical safety, or physical integrity
Witnessing the death, injury, or physical violation of others
Learning of the death, injury, or physical violation of loved ones
Efforts by the individual and/or others to take
protective action fail, including attempts to
 Prevent/avoid the trauma before it occurs,
 Protect/defend oneself and/or others during the
trauma,
 Repair or reverse injury/damage/loss after it has
been inflicted.
This leads to the subjective experience of
defenselessness, vulnerability, & helplessness.
{
Individual efforts or
ability to take
protective action fail
Other’s efforts or
ability to take
protective action fail
Internal Threat:
(A subjective catastrophe takes place INSIDE of me)
Catastrophic Thought Reactions
Catastrophic Emotional Reactions (including Bodily Sensations)
Behavioral Distress Reactions
WEAKENED VERSION
•
Proximity to the Violence
•
Lethality of the Instrument
•
Intentionality
•
Object of Violence
•
Seriousness of Injury
Intervention Fantasies
•To
Alter the Precipitating Events
•
To interrupt The Traumatic Action
•
To Reverse The Lethal or Injurious Consequences
•
To Gain Safe Retaliation (Fantasies of Revenge)
•
To Prevent Future Trauma
Pynoos, Steinberg & Aronson, 1997.
National Child Traumatic Stress Network
(NCTSN)
WEBSITE:
www.NCTSNet.org