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Association of Traumatic Stress Specialists

Archive for December 2009

Prevention: An Emerging Frontier in Mental Health

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 Major strides have been taken to predetermine which individuals are more susceptible to post-traumatic stress. Unfortunately, mental health professionals, like Dr. Robert Heinssen of the National Institute of Mental Health (NIMH), will reluctantly tell you that they don’t quite have stress risk predictions completely figured out. 

The NIMH has dedicated years to researching traumatic stress reactions, as well as ways to determine which individuals may be more susceptible to long-term mental health issues stemming from traumatic stress.

In June of 2008, the United States military reached out to the NIMH to help them expand their suicide prevention program. It has been well-documented, especially as of late, that military suicide has risen dramatically. To the military’s credit, they have taken this problem very seriously, said Dr. Heinssen.

Recent military efforts to curb soldier suicide have been structured to put just as much emphasis on a soldier’s mental health as their physical strength. The Comprehensive Soldier Fitness program has been designed to develop both strong minds and strong bodies.

While the NIMH’s goal is to learn stress risk predictions for the entire population, they feel adamantly that what they have, and what they will continue to, learn from the military experience will help them serve everyone better over the long run. Dr. Heinssen says the hundreds of thousands of soldiers that have participated in the NIMH’s research on stress risk predictions, have created a “platform” which has substantially highlighted “risk and protective factors.”

The dimensions of conflict that these soldiers are facing – the volunteer nature of their work, multiple deployments, battle, etc. – all bring about different levels and reactions to traumatic experiences, which have in turn helped researchers to develop innovative risk prediction tools and strategies.

I really encourage everyone to watch the “Speaking of Science Series — Discussion on PTSD” video from the NIMH. It’s only about 11 minutes long, but both Dr. Robert Heinssen and Dr. Farris Tuma of the NIMH explain how the emergence of prevention has greatly served to increase their industry’s fight, especially within the U.S. military, against traumatic reactions to stress.

Readers: In what other ways have you seen prevention used in the spectrum of mental health?

Written by traumalines

December 31, 2009 at 2:49 am

“Notes from the Field”

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Just as technology has evolved from typewriters to laptops, from high-frequency radios to cell phones, so have the mental health resources made available to international relief workers.

“Notes from the Field,” written by Francois de la Roche, is a first-hand story of how one certified traumatic responder’s career progressed right alongside his industry’s care for their members:

In the early 1980’s, when I started international relief work, we were still accepting hand-written reports, unless you brought along a portable typewriter as part of your personal kit. Cellular telephones didn’t exist, so if you were in an isolated field post, you depended on your high-frequency radio for contact with head quarters and the outside world. Living conditions varied widely, in most cases, where the work needed to be done, living conditions could be primitive, or as I recall with fondness “rustic.” We lived, ate and shared the life of the local population — including local problems as well as larger geo-political challenges affecting the communities we were serving.

 As part of our lives as international relief workers, there was an image of the rugged individual that we were suppose to maintain; and as part of that image, we were also expected to be able to “tough it out” in rough situations. It was one thing to be evacuated because an exotic disease or worse, but it was totally different if you were evacuated because you couldn’t “hack it.”

Being evacuated for stress induced or psycho-traumatic reasons usually meant the end of your international relief career. However, change came in the 1990’s when major international relief/development organizations started including a visit to the psychologist as part of the standard mission briefing and then at the end of mission during the debriefing. The purpose for these psychological reviews at the start and end of assignments was a targeted attempt to stanch the loss of qualified personnel after one or two assignments where stress was indicated as the reason for leaving.

Over the years, more emphasis was put on staff care in the international relief agency community. The added focus was based on models being used within the military, emergency response agencies — such as fire and police departments — and with large not-for-profits like the American Red Cross, where staff care specialists were imbedded within emergency response operations to deal with post-crisis trauma of personnel. 

Some international organizations (IO) and non-governmental organizations (NGO) started copying these systems and developed staff care specialists – those individuals who were trained in stress management and post-crisis trauma support at headquarter and regional levels. Still, some NGOs started training country level staff in stress management and post crisis trauma support, thus pushing down to the closest level to a crisis situation help for the NGO responders in need. 

The build-up of support systems to keep IO and NGO staff going, and to provide them with safe outlets and skills for stress management, and also to provide post-crisis support didn’t come because the job was tough. The world of the IO and NGO was changing.

In 1984, when I first went on an international assignment, there were maybe 200 or so NGOs — the main responders were still the United Nations (UN) and the Red Cross. By the mid-‘90s, it was not uncommon to have maybe 250 NGO’s plus the Red Cross and the UN operating in a single country.  Additionally, it was becoming more dangerous for NGO and IO workers in the field as emergencies and conflicts started getting more complex, and the work of the NGO or IO was being seen through different lenses by the various actors in an emergency or conflict.

Danger lurked everywhere for the NGO and IO worker, it was (and still is) common to read in the news wires about NGO and IO workers being kidnapped or killed by one side of an issue or the other, being injured or worse in vehicle accidents and of course you heard of the periodic suicide of a colleague.

When Iraq and Afghanistan were invaded, the perception that NGO and IO workers were extensions of their respective governments, along with military units getting involved in relief and development work, further blurred the world of the NGO and IO worker. 

All this complexity, blurring of roles, and life in general, having to take long breaks between assignments in difficult environments, it was no wonder that international relief and development workers got stressed out so easily, or worse, burned out and ended up changing their life styles and work objectives.

It was in April 2008 that I was invited by World Vision International to take courses in Critical Incident and Stress Management (CISM). I thought that was pretty cool, yet, I didn’t think that I would, within the next month, start practicing what I learned!

Upon my return from my post in Herat, Afghanistan, I ended up doing an individual intervention for one of my stressed out colleagues. In July, there came an opportunity to conduct a group debrief (CIGD) after three of my colleagues were near an improvised explosive device (IED) when it exploded. While it didn’t harm them physically, it did cause them some great stress.

Over the next months, would do several crisis management debriefings (CMB) and another individual crisis intervention (ICI). As part of my personal goals post-training, I set up a staff care plan for the World Vision (WV) Afghanistan Team, and ensured that staff care procedures, as well as CISM intervention requirements, were written into the WV-Afghanistan Security Plan — which included the hostage management and line of duty injury/death response plans.

In January 2009, I was again invited to attend further CISM training, this time it was for advance courses which included pastoral care, suicide intervention, along with CISM planning and administration. Whilst at the training, my trainer, Dr. Michael Hegenauer, Director of Staff Care for World Vision International, mentioned that it would be neat if World Vision could get one of its staff to apply to the ATSS for certification as a certified traumatic responder (CTR). True to my nature, I volunteered to apply for my CTR.

This was quite an experience collecting those materials to put into my CTR application — with my certificates both with me in Afghanistan and at home in Cincinnati, and my references being somewhere else in the world. But I did it, and after getting my sponsor, it took only about another sixty days before I got my letter from the ATSS saying that I had been approved for my CTR.

May 2009 was the start of a new period for me. I was actively being recruited for work in Sudan…which when I told this to my wife, she was ecstatic at the thought that I’d no longer be in Afghanistan.  She was also really happy when many years before I called her to let her know that I was no longer in Vietnam…so based on this experience I continued with the change process.

By the end of May, I was offered my new job in Sudan as the Country Director for International Relief and Development (IRD). Prior to my departure, one thing that I wanted to do was to help a WV colleague of mine to get her CTR. She was not sure that as a German Citizen she could be certified by the ATSS. Lo and behold in July, and after some really fun search processes for her CISM training certificates, she got her CTR! It made me feel really good about what I did for her, since she wanted to use this newly acquired skill set to help other colleagues through critical incidents and high stress situations.

Well, here I am in Torit, Sudan, writing this short piece on my experience in dealing with critical incidents and stress in the old days, as I wait to start a field assessment at first light tomorrow morning. When I first got to Sudan, I let the NGO Security Consortium know that I was an ATSS CTR and offered my services. Sure enough I would get plenty of opportunities in these first months of my assignment to practice my skills. So far I’ve done three individual critical interventions internally for my staff, and have done a group debrief for another NGO which experienced having some of its staff arbitrarily arrested and thrown into jail (something you do not want to happen to you in Sudan). I’ve been contacted by colleagues several times to provide them with individual interventions when they have been stressed to the breaking point. So, yeah, it’s been busy, but good busy. Oh, I do all this on my own time after work and on the weekends…

The way I see it now, there is no excuse why NGOs should not have a staff care plan that includes the ability by a member of the NGO team to be able to conduct CISM interventions as needed by the respective team. With so much need in very rough places in this world, the international NGO community cannot afford to have its staff burn out because the INGO community is not able to provide the needed immediate and medium-term crisis intervention that is so necessary to keeping its staff healthy. Maybe the ATSS would do well to seek out INGOs and invite interested international relief and development workers to train in CISM, get their CTRs and provide these services to a community in want of this type of help.  Could this be the wave of the future — keeping the members of the INGO community on the job longer, happier in their work and living a less stressful life…hmmm?

About the author:

Francois joined IRD as the Country Director for IRD’s Sudan operations on June 15th, 2009, after serving 31 years with the American Red Cross, CARE and World Vision in US based and international relief and development operations.

He has served in various leadership posts in Latin America, Africa, Europe and Central Asia, responding to complex emergencies which include the Sahel Famine Relief Operation, the Armenia Earthquake Response, the Sudan Emergency Operations, the Liberian, Sierra Leonean and Angolan civil war refugee operations, and the Hurricane Mitch Emergency Response.

After the September 11, 2001, Francois was named by the American Red Cross to lead the America’s Fund for Afghan Children, established by George W. and Laura Bush. He would again serve in Afghanistan in 2007 through 2009, and is now on his second tour of duty in Sudan. 

In 2008, Francois started his CISM training and work as Peer Support Provider.  He was certified as a Trauma Responder by the ATSS in April 2009. Prior to becoming an international humanitarian specialist, Francois grew up in Guatemala and France, learning to speak in this order – Spanish, French and English. He graduated from California State Polytechnic University, Pomona in 1973 with a B.A. in History and served 6 years as a Commissioned Officer of United States Marines during which time he participated in combat operations in Southeast Asia. He’s married, and happily so to his wife of 36 years, Bonnie and has two daughters, Aimee, mother of their grandchildren Damian and Sara; and daughter, Marie. Francois and family are based out of West Chester, OH.

Written by traumalines

December 29, 2009 at 2:45 pm

“A Father’s Journey from a Daughter’s Perspective”

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Deborah Donnelly despises the word “closure.”

“I think that this is a term over-utilized by people who are uncomfortable with someone’s strong feelings after any type of traumatic event,” writes Donnelly in her article titled “A Father’s Journey from a Daughter’s Perspective.”

‘A Father’s Journey’ is the story of a Holocaust survivor’s “never ending road of healing” told through his daughter’s eyes. Deborah Donnelly, a social worker of nearly 28 years, was honored to walk alongside her father as he came to terms with the trauma he spent so many years ignoring.

A Father’s Journey from a Daughter’s Perspective:

There is a name for who I am: a “2G.”  A “2G” means that my parents are Holocaust survivors. It was an eye opening experience for me when I found out that there was a label that both describes and has come to define a significant aspect of my belief system. It has become my passion to strive to accept people for who they are, and never tolerate, but fight against genocide, ethnic cleansing and the like.

I am going to focus on my father and his journey, through my own perspective. I will not be discussing the portion of his life that was spent in Nazi-occupied Poland, or his horrific experiences in a variety of concentration camps, however, I will reflect on how I view his life afterwards — in his own unique journey in becoming who he is today.

The earlier experiences of my life with my father are embedded in my memories. It is only in recent years that I have seen a major shift in my father’s actions and demeanor. I feel blessed to bear witness that he seems to be more at peace now than he ever was in the past.

As a child there was a sense of doom and gloom in my home. The earliest memory I have of seeing my father  with a sadness that I can not even begin to describe — he was almost at a lack of words — was when I came home from school one day, and inquired as to why I only had one set of grandparents. “Where were my other grandparents?” 

I could not have been more then six or seven years of age. My father told me that something terrible had happened, and that I was too young to understand. I am a lot older now and I still don’t understand.

When I learned of the Holocaust I asked my father questions from time to time. Whenever I did so, one of two things happened — he would answer a few questions and then yell “I don’t know, stop asking me,” (the questions were typically around the characteristics and qualities of his family) or my mother would come running from another room and tell me to leave my father alone, “don’t upset him,” she would say.

I can’t begin to share the amount of guilt I carried for upsetting my father. To this day, my father has not shared with my sister or me his experiences during the war. However, in recent years, he has been more willing and open in responding to specific questions that I may pose.

There has been a multitude of studies conducted on the impact of trauma on survivors of the Holocaust.  There has also been a great deal of research dedicated to “transgenerational trauma,” or how the Holocaust  survivor’s experiences impact their offspring throughout their own life span. I find it almost impossible to understand how any human being — including my father — survived the daily torture, dehumanization, inability to protect a loved one and bearing witness to the demise of a friend or family member. Even as a social worker with an expertise in the field of trauma, I still cannot comprehend this. Then again, perhaps I chose not to in an effort to shield myself.

Recently, my father accompanied a group of adolescents to the Holocaust Museum in Washington D.C. As part of this trip, he had to share his own story of life in the death camps, and the events preceding his imprisonment. Afterwards, my father shared with me that this particular speaking session was one of the roughest he’d experienced since he began to share his story with others. We chatted, and through exploration, one of the exhibits in the museum upset him severely. This was the same exhibit that brought me to my knees, sobbing uncontrollably, during my first visit to the Holocaust Museum.

I have to also offer some additional information on my father. He has always operated with feelings of hope in a many situations.  He can be somewhat optimistic, and has always been encouraging of me with my various endeavors. He also operates with a sense of denial; however the other side of denial is hope. If you lose hope then you lose it all. This was most evident when my mother was terminally ill.  He declined to share that tidbit of information with me that she was going to die.  When I told him that a nurse informed me that “mom was dying, he expressed that as long as there was breath in her body, a miracle can occur.  I also think he was trying to shield me from the inevitable for as long as he could. 

My father never stereotyped people. He never spouted hateful remarks towards the German or Polish people. “There is good and bad in all groups of people,” he would frequently tell me. I always told people that if my father said something bad about someone, it must be true. He has a tendency to find and focus on the positive traits in people, rather than the negative.

Like many families of survivors, there was this proverbial elephant in the room that no one wanted to address. Bringing up the topic of the Holocaust would upset my father.  My mother would also echo the same sentiments. “Stop talking about it, your father won’t sleep, you are upsetting him.”

We could be watching television and something sad or happy would happen and my father, rather than cry, would stuff his feelings — he was practically bursting in an effort to hold in his emotions. If I confronted him about it, he would deny that he was feeling anything.  So, we went through life pretty much like that.

Very seldom would my father agree to speak to a group on the Holocaust. If he did speak, there was a significant change in his mood in the days before and after the educational lecture.

Almost four years ago, my father decided to relocate.  He left the comfort and familiarity of the North East. This was the beginning of as I see his transformation, and as William Shakespeare said, “Giving sorrow words.”

As a trauma specialist, I studied a variety of therapeutic modalities to treat the effects of psychological trauma. In looking at the modalities, essentially the clinician needs to be a supportive entity and a guide through the healing process. I also believe that as human beings we have a wonderful ability within us to gather all of our resources so that we can create emotional healing. We have the capacity to change. If necessary, we are drawn to find that special someone who may help us in facilitating the healing process.

There is one treatment modality that I have found to be the most useful, Eye Movement Desensitization Reprocessing (EMDR). EMDR was developed by Francine Shapiro, PhD. I was most fortunate in studying Part I of the EMDR Institute with her. Something she stated at the training has resonated with me: “You are just the facilitator or the guide for an individual to do the work. Support them and get out their way.” Of course, inherent in all approaches are to establish a strong, caring, relationship where an individual gains a sense of trust, safety and security.

My father did not enter therapy, but he did meet a wonderful person, Rabbi Fred Gutman. Rabbi Gutman took the time to get to know my father, gained his trust and confidence, and as Dr. Shapiro said, he got out of my father’s way. He was the beacon of light that my father needed to begin to look within him, and begin the ongoing journey to some level of healing.

My father began to share his life story. With the support and encouragement of the Rabbi, my father spoke to groups all over his geographical area. At Rabbi Gutman’s invitation, he went on March of the Living three times.

The energies were open. On the 61st anniversary of his liberation by the Americans, we found his brother’s children. My father was led to believe that his brother was mortally wounded in the Russian Army.

 I despise the word closure. I think that this is a term over-utilized by people who are uncomfortable with someone’s strong feelings after any type of traumatic event. It is a great privilege to walk alongside someone and bare witness as a survivor strived towards the healing process. Closure is also a great term for clinicians to use in setting up treatment plans, as well as justifying continued therapy to insurance companies.

The best that we can hope for is that a person becomes less symptomatic, and can define, in their own words, what the event has done or means in their own lives in the present. My father will now open up a bit more with my sister and I. When I ask him some questions, he will direct me to his video tapes. I can not get past one point in his history when I listen or watch one of his documentations. During a recent visit with my father, I asked him, “During the time of the Holocaust, was there one memory that stands out as being the worst for you?” He said “yes,” and that is the one point in the video or tapes that I sense and feel his pain so intensely that I turn it off.

My father has not had an easy life. His own father died of an industrial accident when he was an infant. Due to his mother’s impoverished life, he could not live with her until he was 13 years old. Despite all of his hardships, he was and is a wonderful father. He never had a role model growing up, yet he did a great job at being a father.  I have wonderful memories of all the things my sister and I did with my father on Saturdays while my mother worked.

Has my dad had closure? No, there is no such thing. He has done a lot of work to give the events of that horrific time a place in his life. My father is on the never ending road of healing. He has chosen how he attributes meaning and what he wants to do at this crossroad.

It was at this crossroad that my father also had unexpected meeting. He was at an event at his temple, when he saw the Rabbi pointing him out to an elderly man. They were introduced, and this man was an American Soldier who liberated two concentration camps. One of the two concentration camps was Ebensee. My father looked at this man, and said, “You liberated me.” Ebensee was the last Camp of my father’s persecution.

Rabbi Gutman was the catalyst in helping my father share his experiences and journey to a better place. Overall, my father appears less constrictive, and will allow himself to experience the great pain as well as the wonderful joy he has in his life. He continues to laugh and cry when appropriate. There is less stuffing of the unpleasant feelings. I am so proud that my father is telling his story. The ending has changed, as he now knows he was not the only survivor. My father has endless energy in a variety of aspects in his life.  He is determined to share his story so we will never forget.

Thanks dad for being you!!

About the author:

Deborah Donnelly has written this article to honor her father Hank Brodt.

Deborah has been a social worker for over 27 years. Her credentials include a CTS, CAS (Certified Addiction Specialist), ACSW (Academy of Certified Social Workers), BCSCR (Board Certified School Crisis Response — formerly from AETS) and a Certified School Social Worker Specialist. She is a member of NASW, NJEA, NEA, ATSS, and AETS. She has been employed as a Social Worker with Fair Lawn Public Schools since 1992, and has typically done additional part time clinical work.

She is passionate about the Holocaust and Genocide education. As a “2G” she feels that her responsibility is to never let the world forget all who were murdered during that time — Jewish and non Jewish. Deborah feels that it is also important to fight against what is happening today with ethnic cleansing/Genocide and human trafficking.  

Her husband Dan is a Police Lieutenant.

Written by traumalines

December 24, 2009 at 2:50 am

Welcome to ATSS’s Blog!

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Welcome to TraumaLines.wordpress.com! We’re just getting this blog off the ground so please be patient.

Thanks,

ATSS

Written by traumalines

December 7, 2009 at 11:52 pm

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