TraumaOnline
The newsletter of the
International Trauma Training Institute (ITTI)
Mike Dubi, Ed.D., LMHC, Editor
Jeanne Thomas, MBA, Associate Editor
 
Late Spring 2019, Vol. 2, No. 3
Greetings!

ITTI is proud to announce its new professional journal, The Practitioner Scholar: Journal of the International Trauma Training Institute (PSJITTI). ITTI recently took over The Practitioner Scholar which was founded in August 2011 as an open-access, peer-reviewed, online journal. The advantage of such a journal is that the journal offers revolving publication which often equates to less time from submission to publication. However, the articles are also indexed on EBSCO-host (a premier research indexing tool) annually which greatly expands the readership. Previous journal articles have received approximately 5,000 hits annually through EBSCO with an additional 1,000 hits online.

The Practitioner Scholar will be dedicated to publishing manuscripts concerned with clinical practice, current professional and scientific issues, new techniques and innovative approaches, training, education and research related to counseling, professional and applied psychology, traumatology, and related behavioral sciences. PSJITTI is now the official journal of the International Trauma Training Institute (ITTI). In addition to taking over the management of the journal, ITTI will expand it by adding specialty sections that will only require internal review:

  • Clinicians’ Corner: This section will publish manuscripts between 1-15 pages in length that focus on insights or interventions appropriate for treatment of specific clients or defined issues.
  • Current Events: This section will publish 1-10-page manuscripts articulating strategies to address current events such as a mass shooting, university closure, or natural disaster. 
  • Book & Movie Reviews: This section will publish 1-5-page reviews of books or movies that clinicians have found helpful in assisting themselves or clients with the awareness, knowledge or skills needed to promote recovery or wellness.

It is our hope that through the journal and expanded sections, ITTI can offer quality publications to enhance our members’ and other professionals’ work in the field.
Along with the new journal, ITTI welcomes Dr. Joffrey S. Suprina, the founder of the journal who will remain as editor. In addition to serving as editor of The Practitioner Scholar , he has served as Editor of the Exemplar (Premier publication of CSI), Technical Editor and Managing Editor of The Journal of Individual Psychology , Contributing Editor of The Journal of Trauma Counseling International , as well as editor of several newsletters. Joffrey Suprina has also authored over 30 publications. He looks forward to being a more integrated part of the ITTI family.

The journal is undergoing some website enhancements, so we will send directions for how to get involved in an upcoming notice. There will be many ways for you to participate in this exciting new undertaking. We will be seeking journal members, reviewers, editorial staff and of course authors. We look forward to your participation as we expand the impact of ITTI through a professional journal.

Best wishes to you all,

Mike Dubi, ITTI, President
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ARTICLE

A Review of Judith Herman's Tri-Phasic Model and Its Adaptation into Trauma-Informed Care

by
Dale Lewis, LMHC

In her 1997 seminal work Trauma and Recovery: The aftermath of violence – from domestic abuse to political terror, Judith Herman defines and details her Tri-Phasic Model for the treatment of trauma. It has been adopted by others and integrated into several approaches toward the treatment of trauma. The Tri-Phasic Model, among its other attributes, identifies the importance of creating safety for the client in order to foster an environment where the client can feel secure enough to address their trauma. The model then addresses protocol for remembering and mourning the trauma, and helping clients empower themselves to reconnect with themselves, others and the community. All of this is done to help the client move from trauma victim to trauma survivor. Within mental health agency work, Trauma-Informed Care is becoming standard practice, borrowing from the Tri-Phasic Model of Judith Herman.

Creating safety is of paramount importance. This starts with the therapeutic relationship. Herman (1997) points out that “the core experiences of psychological trauma are disempowerment and disconnection from others. Recovery, therefore, is based upon the empowerment of the survivor and the creation of new connections”(p. 133). The website Traumaline1.com puts it this way:

  • The central task of recovery is safety. People who have experienced trauma often feel betrayed both by what has happened to them as well as their own bodies. Their symptoms become the source of triggers that result in re-traumatization. This can leave the individual feeling both emotionally and physically out of control. Getting the right help to regain internal and external control is a primary focus of this phase. (http://www.traumaline1.com/node/108, Accessed 2/18/19).

At this crucial stage, Herman (1997) warns the therapist against transference, countertransference, and “rescuing” the client, as well as being aware of power and control issues. She further cautions that “the more the therapist accepts the idea that the patient is helpless, the more she perpetuates the traumatic transference and disempowers the patient” (p. 142). Herman further identifies the therapeutic relationship through “The Therapy Contact”, describing the therapeutic relationship not as one of love, or parental in nature, but rather “a relationship of existential engagement in which both partners commit themselves to the task of recovery” (p. 147). 

The client must, of course, trust the therapist in order to begin to feel safe. The traumatized client has a need to know what happens next, the importance of assessment, the reasons for an intervention, that the client has the ability and right to say no, and of the potential consequences of their decisions. Having family and friends that support the client may be helpful in helping create an environment of safety for the traumatized client. Herman (1997) identifies that in times of crisis, the environment can involve a temporary shelter, such as in cases of domestic violence and/or homelessness.

Of completing the first stage of the Tri-Phasic Model, Herman (1997) states that “no single, dramatic event marks the completion of the first stage. The transition is gradual, occurring in fits and starts. Little by little, the traumatized person regains some rudimentary sense of safety, or at least predictability, in her life” (p. 174).  Similarly , Lewis comments, Dana Snedden states in her article In Occupational Therapy Now entitled Trauma-informed practice: An emerging role of occupational therapy   that “During stage one, the primary goal of recovery is to enable the person to make a gradual shift from a state of ‘unpredictable danger’ to a state of ‘reliable safety’, meaning that individuals begin to trust stimuli from the environment and their own reactions” (p. 26).

With regard to the second stage – Remembrance and Mourning – Herman states that “The choice to confront the horrors of the past rests with the survivor” (p. 175). The caution offered here is this: If the client (and therapist) avoid the trauma, the recovery process will stall. If stage one is not completed, then stage two will not only be “fruitless, but has the potential to re-traumatize the client (Herman, 1997, p. 176).

Remembrance and Mourning is focused on the client being able to recount what has happened, and address the parts of the client’s narrative that cause the client distress. Herman (1997) cautions that the goal of psychotherapy is not to remove, delete, or fix the trauma. “The goal of recounting the trauma story is integration, not exorcism” (Herman, 1997, p. 181).

Imagine the mind as a computer. The brain is the hard drive. When the hard drive is fragmented, storing information compartmentally and sectioning it off, the computer does not work as efficiently. By recounting the trauma narrative, one is defragging their hard drive, reintegrating the information that has been sectioned off. 

Techniques, such as Eye Movement Desensitization and Reprocessing (EMDR), Rapid Resolution to Trauma (RRT), Brainspotting, Trauma Focused Cognitive Behavioral Therapy and Hypnosis have been used in an effort to treat trauma during this stage. Herman (1997) places a caveat by stating “whatever the technique, the same basic rules apply: the locus of control remains with the patient, and the timing, pacing, and design of the sessions must be carefully planned so that the uncovering technique is integrated into the architecture of the psychotherapy” (pp. 186-187). Herman also cautions that behavioral based interventions are less effective for “prolonged, repeated traumatic experiences” (p. 187). 

Once safety has been established and the client has undertaken the experience of remembering their trauma, the client enters the third stage of the Tri-Phasic Model: Reconnecting. Herman (1997) states that “helplessness and isolation are the core experiences of psychological trauma. Empowerment and reconnection are the core experiences of recovery” (p. 197). Here, the client learns ways to self-regulate and cope with their fear and anxiety. Herman (1997) puts it thusly:

  • The survivor no longer feels possessed by her traumatic past; she is in possession of herself. She has some understanding of the person she used to be and of the damage done to that person by the traumatic event. Her task now is to become the person she wants to be (p. 202).

The Tri-Phasic Model is looked at as a well-articulated and established model to address the needs of a client who has experienced trauma. Herman carefully addressed acute, chronic, and complex trauma in her work. Various agencies, have adopted the Tri-Phasic Model in idea, and have used it to create the “Three Pillars” of Trauma Informed Care featuring Safety, Connections, and Managing Emotions (Bath, 2008, p. 18). Unfortunately, according to Hopper, Bassuk, & Olivet (2010), “definitions of ‘trauma-informed’ and how these ideas are implemented vary widely. There is generally a lack of specificity in how agencies are defining ‘trauma-informed’, and how this relates to actual practice” (p. 87).

There are also some documented misgivings, reservations, and caveats when it comes to delivering Trauma-Informed Care as well. Citing the Chadwick Center for Children and Families (2004) and Chaffin and Friedrich (2004), Ko et al. (2008) state that traumatic stress is often not recognized, and if it is, staff at agencies such as shelters, child welfare programs, and juvenile justice agencies are not sufficiently trained and do not used evidence based interventions to address the client’s trauma. Additionally, Citing Chapman et al., Ko et al. assert that “trauma is widely recognized within the juvenile justice system as a critical factor in the origins and rehabilitation of delinquent youths but also widely feared as a Pandora’s box of problems that may intensify the behavioral and legal challenges of delinquent youths if opened up (p. 400). Hopper, Bassuk, & Olivet (2010) mirrored these concerns, stating the following:

  • Programs attempting to implement TIC have encountered some concerns and resistance on the part of providers. Providers may be afraid that addressing trauma will open a ‘Pandora’s box’ of reactions. They may lack confidence in their ability to manage and address trauma reactions and may be concerned that they will encounter triggers of their own trauma histories [19]. They may also worry that they will not have the resources to adequately respond to the complex needs of survivors (p. 85).

McManus and Thompson (2008), citing Karabanow & Clement (2004) and Hopper, Bassuk, & Olivet (2010), identify there has not been a great deal of research on the subject with regard to homeless populations. What has been done supports the importance of utilizing the three phases of Herman’s model emphasizing Safety, Remembering and Mourning, and Reconnecting with the community (1997) and the “Three Pillars” of Trauma Informed Care of Safety, Connections, and Managing Emotions (Bath, 2008, p. 18). Hopper et al. (2010), Ko et al. (2010) identify the difficulties of translating the Tri-Phasic Model to work with the child welfare system, the juvenile justice system, and homeless populations.

What is recognized by all of these agencies is the consideration that must be afforded to the client who has experienced trauma. Trauma Informed Care is the norm, and is considered best practice for all of the types of agencies identified in this article. These agencies are recognizing the importance of trauma and its effects. What is concerning, however, is the lack of research and cohesion regarding Trauma Informed care when Herman’s Tri-Phasic model has already been so well defined and articulated.

References
Bath, H. The Three Pillars of Trauma Informed Care. Accessed February 18, 2018.

terror (2nd ed.). New York: Basic Books.

Hopper, E, Bassuk, E, & Olivet, J. (2010). Shelter from the Storm: Trauma-Informed Care in
Homelessness Services Settings, The Open Health Services and Policy Journal.

Ko, S., Ford, J. & Kassam-Adams, N. et al. (2008). Creating Trauma-Informed Systems: Child Welfare, Education, First Responders, Health Care, Juvenile Justice. Professional Psychology: Research and Practice. American Psychological Association, Vol. 39, No. 4, 396–404 DOI: 10.1037/0735-7028.39.4.396

McManus, H. and Thompson, S (2008). Trauma Among Unaccompanied Homeless Youth: The Integration of Street Culture into a Model of Intervention. Accessed February 20, 2019 from the National Center For Biotechnology Information website:

Snedden, D. (2012) Trauma-informed practice: An emerging role of occupational therapy
Occupational Therapy Now Vol. 14 (6)
Traumaonline1.com website. Accessed 2/18/19 from  http://www.traumaline1.com/node/108
                                                                                                                     
CALL FOR PRESENTERS
EB-ACA (European Branch - American Counseling Association
Vienna, Austria, Sept 27-28, 2019
Greetings, colleagues and friends!
On behalf of the European Branch of the American Counseling Association (EB-ACA), we are pleased to announce that we are currently accepting presentation proposals for the 60th Annual EB-ACA Conference, which will be held September 27-28, 2019 at Webster University in Vienna, Austria.

This year's conference theme is Counseling Around the World: Reaching Beyond Borders , a reflection of the past, present, and future of international counseling issues and a celebration of the 60th anniversary of EB-ACA. We are accepting proposals for 50-minute content sessions and for student poster presentations. We welcome diverse proposals that address a variety of issues in counseling; however, preference will be given to proposal submissions that reflect this year's conference theme. Each presenter may present up to two sessions. Proposals are due by Friday, April 5th, 2019 by 11:59 p.m. EST. Proposal determination letters will be e-mailed within four weeks of the submission deadline.

Go to https://goo.gl/forms/4geR812MyZ5j4ZrW2 to submit a presentation proposal. Submission deadline: Friday, April 5th, 2019 by 11:59 p.m. EST.
Conference registration will open within the next two weeks. Please stay tuned for more information and do not hesitate to contact us at european.counseling.aca@gmail.com if you have any questions or comments.

We hope you will consider presenting at the 60th Annual EB-ACA Conference in Vienna, Austria!

Best regards,
Elizabeth Crunk, Ph.D.
EB-ACA President-Elect and Conference Coordinator
Assistant Professor of Counseling, The George Washington University

Mercedes Ballbé ter Maat, Ph.D., LPC, ATR-BC
EB-ACA President
Professor, Department of Counseling
Nova Southeastern University
UPCOMING TRAUMA TRAININGS