Diamonds in the Rough: Multifaceted Women’s Treatment: Practicing Gender-Responsive, Trauma-Informed Treatment - PowerPoint PPT Presentation


PPT – Diamonds in the Rough: Multifaceted Women’s Treatment: Practicing Gender-Responsive, Trauma-Informed Treatment PowerPoint presentation | free to download - id: 3bed0d-YjJkY


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation

Diamonds in the Rough: Multifaceted Women’s Treatment: Practicing Gender-Responsive, Trauma-Informed Treatment


Diamonds in the Rough: Multifaceted Women s Treatment: Practicing Gender-Responsive, Trauma-Informed Treatment Presented by Dee-Dee Stout, MA, CADC II; member of MINT – PowerPoint PPT presentation

Number of Views:92
Avg rating:3.0/5.0
Slides: 49
Provided by: responsibl7


Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Diamonds in the Rough: Multifaceted Women’s Treatment: Practicing Gender-Responsive, Trauma-Informed Treatment

Diamonds in the Rough Multifaceted Womens
Treatment Practicing Gender-Responsive,
Trauma-Informed Treatment
  • Presented by Dee-Dee Stout, MA, CADC II member
    of MINT
  • or
  • (P) 510-919-9678

Walk Away Skill 1
  • We should be humbled
  • in the presence of our clients
  • for they are the heroes
  • of their lives.
  • ----Scott Miller, PhD

Before we get started
  • Safety
  • IPV v DV Intimate Partner Violence v Domestic
  • Privileged Leaving
  • Binary talking/thinking
  • Empowerment
  • Cannot be given
  • Includes failures achievements

  • Defined as keeping you safe from the outside
    world, not from each other
  • Women supporting other women
  • Staff can model this behavior
  • Involve residents with curricula
  • planning rules

  • Trauma-informed (TI) does not equal
  • Being TI means to be committed to providing
    services in a welcoming survivor-friendly
  • Accommodates vulnerabilities (think, ADA)
  • Allows for services to be delivered in a
    collaborative treatment setting
  • Appreciates that trauma/PTSD is a mental health

  • Means the agency/clinician understands the role
    violence and victimization play in the lives of
    our clts
  • Means the agency/management understands trauma
    drives the treatment
  • Acknowledges drug use/other less than healthy
    behaviors are likely results of trauma not vice

  • Gender-responsive does not mean women only
  • Acknowledges and treats genders differently
  • 1970s began female-focused research treatment
  • Began to decline in 1980s and re-emerged in
    1990s (though Federal funding streams still

What is gender-responsive, trauma-informed
  • First, some history statistics

Why Womens Treatment?
  • Stigma still great
  • Further study needed
  • Need to encourage gender-specific treatment (both
    men women)

Womens Treatment
  • 59 of tx facilities who treat women have no
    special programs for women they serve why?
  • 19 offer child care
  • 45 transportation
  • 40 housing asst
  • Facilities that do not offer gender-specific
  • 4 child care
  • 28 transportation
  • 24 housing asst

Consequences to Women
  • Women more vulnerable physiologically,
    psychologically, socially
  • Women perceive their quality of life as less than
    men w/SUD
  • Health, sleep, nutrition, work, self-esteem,
    autonomy, love, stress, mood/affect, security,
    social nurturance, public support, environment,
    outlook and more

Risk factors to Women
  • Possible reciprocal relationship between negative
    consequences and risk factors, leading to a
    vicious cycle
  • Sex assault initially related to AOD misuse,
    prompts her to use more to ameliorate pain of
    assault (Kaysen et al, 2006 cited in Helping
    Substance-Abusing Women of Vulnerable
    Populations by An-Pyng Sun)
  • Conflict btwn woman partner triggers a relapse,
    making the strain worse (Sun, 2007)

Physiological/Health Conseqs
  • The telescoping effect
  • ETOH more body fat/less water leads to higher
  • Womens lower ADH (alcohol dehydragenase) in GI
    tract (stabilizes during lifetime) more research
  • Health-related problems occur early in drinking
    more liver,heart, brain trouble in spite of mens
    drinking more breast cancer, reproductive
    dysfunction, babies w/complications HIV/AIDS
    STD/STIs much higher mortality rate than male

Psychosocial Consequences
  • AOD use puts women at higher risk of sexual and
    non-sexual victimization
  • Women hold double standard for womens AOD
  • Women seen as weak willed being sexually
    promiscuous, and irresponsible in giving birth
    to/caring for children (often numerous)
  • Leads to rejection, isolation, depression, guilt,
    lower self-esteem(Finkelstein, 1994)

Psychosocial Consequences
  • Intoxication of any kind can impair cognitive
    function and motor ability
  • Men often see women under-the-influence as
    targets for assault (neither tends to call it
  • Women with SUD more likely to lose kids than
    non-SUD woman in child welfare system
  • Rates of parents/caretakers w/SUD 40/50-80

What is Trauma?
  • An event or series of events that threaten you -
    perhaps even with death that causes physical or
    emotional harm and/or exploits your body and/or
  • Trauma is pervasive and life-altering
  • Trauma has been reported by 55-99 of female
    substance abusers (Najavits et al, 1998)

PTSD Symptoms - simplified
  • Re-experience
  • Recurrent and intrusive recollections of and/or
    nightmares about the event
  • Flashbacks, hallucinations, or other vivid
    feelings of the event happening again
  • Great psychological or physiological distress
    when certain things (objects, situations, etc.)
    remind them of the event.
  • Avoidance
  • Persistently avoiding things that remind them of
    the traumatic event
  • Including thoughts, feelings, or conversations
    associated with the incident to activities,
    places, or people that cause them to recall the

PTSD Symptoms (cont)
  • General lack of responsiveness signaled by an
    inability to recall aspects of the trauma
  • Decreased interest in formerly important
  • Feeling of detachment from others, a limited
    range of emotion, and/or feelings of hopelessness
    about the future
  • Increased arousal
  • Includes difficulty falling or staying asleep,
    irritability or outbursts of anger, difficulty
    concentrating, becoming very alert or watchful,
    and/or jumpiness or being easily startled
  • Note Folks w/PTSD are at increased risk for

More on Trauma
  • Trauma betrays our beliefs, values, and
    assumptions trust about the world around us
    wound of the soul
  • Trauma can result in engaging in less healthy
    behaviors, aids us through our reactions to
    events. Behaviors
  • Are an adaptation not a pathology
  • What kept us alive to get you to us!

Possible Responses to Trauma
  • Intense fear hypervigilance
  • Feelings of helplessness
  • Anxiety
  • Excessive worry
  • Intrusive thoughts memories
  • Flashbacks
  • Depression

More Possible Responses to Trauma
  • Anger or rage
  • Nightmares Night Terrors
  • Detachment Dissociation
  • Substance Use Misuse/Abuse
  • Unusual sexual behavior
  • Difficulty with relationships
  • Others

Post-trauma, women w/SUDs
  • Improve less
  • Worse coping abilities
  • Greater distress
  • More positive views of substance use
  • PTSD does not go away with abstinence it gets

Connections between SUD Trauma
  • Witnessing/experiencing childhood family violence
  • Childhood physical emotional abuse
  • Women in chemical recovery
  • Typically have history of violent trauma
  • Substances used to numb or dissociate - medicinal
  • Violence often seen as natural part of life
  • Coping mechanism for frustration and anger

Dissociation (complete numbing)
  • Not mentioned in DSM-IV as symptom of PTSD though
    sx of acute stress d/o
  • PTSD actually is a dissociative disorder not
    anxiety d/o?
  • Crucial to understand process most severe
    consequence of PTSD/trauma

Womens Treatment Getting Started
  • Increase clients feelings of well-being
  • Different RP
  • Help them learn to anticipate, recognize, and
    effectively cope w/conflict situations negative
    emotions (opposite of men)
  • Cope with stress!
  • Screen for childhood abuse
  • Screen for COD

Womens Treatment Nuts Bolts
  • Incorporate healthy eating, nutrition, and
    healthy weight control
  • Eating disorders including dissatisfaction w/body
  • Smokers young or overweight need extra attention
    due to higher risk

Womens TreatmentNuts Bolts
  • To help reduce stigma, AOD family
    hx/dysfunctional family of origin discussions are
  • Doesnt ignore personal responsibility
  • Heredity factors unclear in women

Womens Treatment Nuts Bolts
  • Womens only programs seem more beneficial than
  • Easier discussing personal experiences re sex,
  • Reduced sexual harassment
  • Reduced early drop out rates w/men met at
  • Lesbians, women with young kids, and women
    w/childhood hx of sex abuse tend to participate
    more in female-only programs

Features of Good Womens Treatment
  • Case Management
  • One-Stop Shopping Model
  • Supportive Staff/Individual Counseling
  • Counselor's genuine concern
  • Respect for/ trust in client
  • Supportive, nonjudgmental attitude

Trauma-Informed Services
  • Asks Are our policies and procedures, program,
    hiring practices, etc. all in line with
    preventing the re-traumatization of clients?
  • OR
  • Are we letting our rules defined as the need
    for safety - actually mimic any dynamics of a
    trauma/abusive relationship?

Walk Away Skill 2
  • Watching our Language or Some Simple Dos
    Donts in
  • GRTI Treatment

Language is crucial
  • Abstinent, sober, or drug-free
  • Powerful empowered
  • Women united for women
  • Supportive relationships
  • Not clean
  • Not Powerless
  • No Gossiping
  • Not enabling or co-dependency

What shouldnt we do?
  • Dont explore past trauma(s)
  • In general, no psychodynamic work at first
  • No autobiographies until stable
  • Dont ask about the trauma or the triggers
  • Gently guide conversation to present problems
  • Use complex reflections to highlight strengths

  • PTSD affects about 7.7 million American adults
  • Women are more likely to develop PTSD than men
  • Some evidence that susceptibility runs in
  • PTSD is often accompanied by depression,
    substance abuse disorders, or one or more of the
    other anxiety disorders
  • Thanks to NIMH _at_

How to Create a TI Agency
  • Administrative Commitment
  • Universal screening
  • Brief non-threatening
  • Soon after admission
  • Training education
  • RICH
  • Hiring Practices
  • Review PP
  • Review committees need to be vigilent
  • 1 staff min. who understands trauma/abuse how
    its accidentally supported in agencies

Principles Philosophy of TI Treatment
  • Understand Trauma
  • Assume all clients have trauma hx
  • Split of client due to trauma
  • Ripple effect felt throughout life in all areas
    of life
  • Understand the Client Survivor
  • Holistic view to understand their experiences
  • Understand Services
  • Goal is to return autonomy control to clt
  • Fish proverb
  • Understand the Service Relationship
  • We dont have all the answers
  • Trust safety must be earned from the clt
  • Invite the clt to participant
  • Genuineness a must!

5 Core Elements in Trauma-Informed Addiction
  • Program must have a commitment to teaching
    explanations of events that integrate trauma
  • Milieu must promote consumer empowerment
    relationship building as well as healing
  • Each woman must be encouraged to develop certain
    crossover skills that are equally important in
    recovery from trauma SUDs

5 Core Elements in Trauma-Informed Addiction
  • A series of ancillary services help a woman to
    continue her recovery once she leaves a
    structured program
  • The program avoids the use of recovery tactics
    that are contraindicated for women recovering
    from physical and sexual violence

Elements in Building a Program
  • Women-only programs (more needed)
  • Making women-only groups available in all
  • Referring
  • Residential treatment best for women w/few
    resources heightened environmental stress
  • Child care on-site w/other services (case mgmt)
  • Emphasizing non-judgmental, non-confrontational
    approaches for staff
  • 1x1 counseling

Trauma-Informed Treatment
  • Says women their needs must be at center of all
    treatment components
  • Says that tx must not be parallel but
    simultaneous (ie, meds)
  • Says clients are the experts in their lives
  • Says providers must know the hx of past and
    current abuse of clients

Trauma-Informed Treatment
  • Says clients may choose their counselors or
  • Says we must explain to clients why/how we are
    asking them to do something
  • Says the clients needs come first always!

What can we do?
  • 1. Listen more talk less
  • 2. Gently help clients link SUDs PTSD
  • 3. Discuss only current - not past - problems
  • 4. Listen to client behaviors
  • 5. Get training
  • 6. Appreciate that substances do solve PTSD

What more can we do?
  • Be willing to try new things model healthy
    change for clients
  • Believe the client their CSOs are their most
    important resource
  • See opportunities not problems
  • Know we cant know everything be OK with that
  • Build alliances with other disciplines (MDs, AOD,
    other agencies, etc)
  • Be flexible with staff re how they approach
    their job
  • Try walking in the clients shoes
  • Have a great sense of humor!

A few last thoughts
  • Teach clients more about mental illnesses/CODs
  • Add a COD group or coordinate with another agency
    to provide this service
  • Remember clients are customers they can go
    elsewhere or not come to tx at all even if
  • Engage in free trainings
  • Online through NIDA, ATTC, and more
  • Ontrack
  • Host trainings with other agencies

Letting Go
  • If you let go a little, youll have a little
  • If you let go a lot, youll have a lot of peace,
  • If you let go completely, youll have complete
  • peace.
  • How much peace do you want in your professional

  • The Body Remembers The Psychophysiology of
    Trauma Trauma Treatment. Babette Rothschild,
    2000. WW Norton.
  • Trauma Recovery. Judith Herman. 1992. Basic
  • Many Roads, One Journey Moving Beyond the
    12-Steps. Charlotte Kasl, Ph.D. 1992.
  • Seeking Safety A Treatment Manual for PTSD and
    Substance Abuse. Lisa Najavits, Ph.D. 2002.
    Guilford Press.
  • Helping Substance-Abusing Women of Vulnerable
    Populations. An-Pyng Sun. 2009. Columbia
    University Press, NY.

  • Motivational Interviewing, (2nd Ed), Preparing
    People for Change. William R. Miller Stephen
    R. Rollnick, 2002. Guilford Press.
  • Waking the Tiger Healing Trauma The Innate
    Capacity to Transform Overwhelming Experiences by
    Peter Levine Ann Frederick. 1997. North
    Atlantic Books.
  • The Change Book, (2nd Ed), ATTC. 2004.
  • Assessing and Treating Trauma PTSD. Linda
    Schupp. 2004. Pesi, LLC.
  • New Directions for Mental Health Services Using
    Trauma Theory to Design Service Systems, No. 89,
    Spring 2001. Maxine Farris and Roger Fallot.
    2001. Jossey-Bass.

  • Regional training materials
  • developed by
  • Dee-Dee Stout
  • ONTRACK Project Staff
  • Madalynn C. Rucker
  • Peggy Thomas