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Healing Trauma:A Brief Intervention for WomenHealing TraumaHEALING TRAUMA:A BRIEF INTERVENTION FOR WOMEN2nd EditionBy Stephanie. S. Covington, PhD and Eileen M. Russo, MAPresented byTwyla Wilson, L.C.S.WDurham, NCWritten byStephanie S. Covington, Ph.D., L.C.S.W.Center for Gender and JusticeLa Jolla, CA USAUTAH STATE DIVISION OF MENTAL HEALTH AND SUBSTANCE ABUSEFEBRUARY 20-21, 2018 SALT LAKE CITY, UT1Healing Trauma:Healing Trauma 2Exploring Trauma:A Brief Intervention for Women6 sessions S. Covington, 2017A Brief Intervention for Men6 sessionsnd2EditionA Brief Intervention for Women6 Sessions on CD-Rom 6 sessions 1.5 hours each (2 hours optional) 8 – 10 women per group Facilitator’s guide and Participant’sworkbook are on a CD-ROM allowing foreasy duplication Participant’s workbook may be printed inEnglish or Spanish S. Covington, 20173HEALING TRAUMA S. Covington, 20174 S. Covington, 20176HEALING TRAUMAA BRIEF INTERVENTION FOR WOMEN6 SESSIONS ON CD-ROMA BRIEF INTERVENTION FOR WOMEN6 SESSIONS ON CD-ROMPRE AND POST TREATMENT FigureCHANGESIN SYMPTOMS OF4Changes in Symptoms of Depression and PTSD, CWC IPV Project,DEPRESSIONAND POSTTRAUMATIC STRESSOctober 1, 2012 through September 30, 2013 (N 53)2725Score2321CESD (t 4.79, df 52, p .000)PCL (t 2.96, df 52, p .005)191715Pre-TestPost-Test(September 2013 Annual Report: The Interpersonal Violence Project,Josephine M. Hawke, PhD) S. Covington, 20175(Healing Trauma Evaluation Triannual Progress Report,Linda Frisman, July 1, 2015)UTAH STATE DIVISION OF MENTAL HEALTH AND SUBSTANCE ABUSEFEBRUARY 20-21, 2018 SALT LAKE CITY, UT1

Healing Trauma:A Brief Intervention for WomenWhat Makes a Good Facilitator? (cont.)Part 1INTRODUCTION The World Women Live InBE PREPARED! Trauma The Therapeutic Environment The Program Design of Facilitator Guide Facilitation S. Covington, 20177Role of the FacilitatorPart 2 Begin and end on timeSESSIONS S. Covington, 20178 S. Covington, 201710 Maintain structure of the group Move the group through the contents ofeach session Lead by example by having appropriateboundaries and containing your feelings Allow each woman to have her ownexperience of the group S. Covington, 2017Healing Trauma 2nd9Format All SessionsEditionA Brief Intervention for Women6 Sessions on CD-Rom Quiet time—“settling” Check-inSession 1: Welcome and IntroductionSession 2: Power and Abuse Review of between-sessions activitySession 3: The Process of Trauma and Self-Care DiscussionsSession 4: The ACE Survey and Anger LecturesSession 5: Healthy Relationships Interactive exercisesSession 6: Love, Endings, and Certificates(workbook in English and Spanish) S. Covington, 2017 Closing, grounding exercise11UTAH STATE DIVISION OF MENTAL HEALTH AND SUBSTANCE ABUSEFEBRUARY 20-21, 2018 SALT LAKE CITY, UT S. Covington, 2017122

Healing Trauma:A Brief Intervention for WomenSession 1Session 1 - Overview2 ACTIVITIESWelcome and Introduction tothe Subject of Trauma Goals: To begin to establish a groupenvironment that is based on trust,safety, and respect To provide an introduction to thesubject of trauma S. Covington, 2017Welcome, Facilitator Introductions, and Goals forthe GroupWhy We Are Here: Information about TraumaGroup AgreementsPersonal Goal Sheet (and Optional InformationSurvey)Art Activity: Decorate Your Cover/FolderParticipant IntroductionsSharing GoalsGrounding Activity: Five SensesReflection, Between-Sessions Activity, and Close13 S. Covington, 2017Session 1This Group will Help YouACTIVITIES Learn more about trauma and howwidespread it is in women’s lives Decorate Your Cover/Folder14 Become aware of the strengths you alreadyhave that can help you recover Five Senses Increase the skills you need for healing Learn exercises and techniques that canhelp you feel more grounded and safe S. Covington, 201715 S. Covington, 2017Inner Self & Outer SelfInner Self & Outer Self (cont.) Impacts Inner Self – It can impact our innerlife our thoughts, feelings, beliefs, values.For example, some women believe that“you can’t trust anyone”, and “the world isvery unsafe place.” Impacts Outer Self – It can impact our outerlife our outer life consists of ourrelationships and our behavior. Manywomen who have experienced traumastruggle with their relationships – families,friends, secual relationships. S. Covington, 201717UTAH STATE DIVISION OF MENTAL HEALTH AND SUBSTANCE ABUSEFEBRUARY 20-21, 2018 SALT LAKE CITY, UT S. Covington, 201716183

Healing Trauma:A Brief Intervention for WomenFive SensesGrounding Exercise:Five Senses S. Covington, 201719 S. Covington, 201720Session 2Reflection Page2 ACTIVITIESThis is a place where you can write or drawabout your experience in the group. Maybeyou’d like to write about what was mostmeaningful to you in Session 1.Power and AbuseGoals: To explore the effects of genderroles on individuals To emphasize the connectionbetween power and abuse To identify behavioralcharacteristics of people whoabuse others S. Covington, 201721 S. Covington, 201722Session 2Session 2 - OverviewACTIVITIES Quiet TimeCheck-InReview of Last Session and the Between-SessionsActivityTraumatic EventsGender ExpectationsThe Connection between Power and AbuseThe Power and Control WheelCharacteristics of People Who Abuse OthersSoothing VisualizationReflection, Between-Sessions Activity, and Close[Optional: Yoga Pose] S. Covington, 2017 Power and Control Wheel Soothing Visualization23UTAH STATE DIVISION OF MENTAL HEALTH AND SUBSTANCE ABUSEFEBRUARY 20-21, 2018 SALT LAKE CITY, UT S. Covington, 2017244

Healing Trauma:A Brief Intervention for WomenGender Expectations How are boys and girls treated differently aschildren?Gender Expectations:Social Messages Social messages come from familymembers, communities, teachers, movies,music, and video games. What are thesocial messages that boys get? How areboys supposed to act? What are the social messages that girls get?How are girls supposed to act? S. Covington, 201725Focus Questions S. Covington, 201726The Connection BetweenPower and Abuse How are boys and girls treated differently? What does it mean to “act like a woman”?Here are some ways in which power and abuseare connected: What does it mean to “act like a man”? The abuser uses power over the victim. What would it be like if our roles and themessages were reversed? The abuser takes power away from the victim. The victim feels powerless against the abuserand in many aspects of her life. The victim feels trapped or locked in a role. The victim feels isolated, so there is no strengthor power from others who could help. S. Covington, 201727POWER AND CONTROL WHEEL S. Covington, 201728Characteristics of BatterersBehavior as Clues: Jealousy Controlling behavior Quick involvement Unrealistic expectations Isolation Blaming others for problems Blaming others for feelings Hypersensitivity(From the manual In Our Best Interest: A Process for Personal and Social Change. Availablethrough Domestic Abuse Intervention Project, 206 W. 4th St., Duluth, MN 55806) S. Covington, 201729UTAH STATE DIVISION OF MENTAL HEALTH AND SUBSTANCE ABUSEFEBRUARY 20-21, 2018 SALT LAKE CITY, UT S. Covington, 2017305

Healing Trauma:A Brief Intervention for WomenCharacteristics of Batterers (cont.) Cruelty to animals and/or childrenGuided Imagery:Safe Place “Playful” use of force in sex Verbal abuse Rigid sex roles Dr. Jekyll and Mr. Hyde Past battering Threats of violence Hitting or breaking objects Use of force during an argument S. Covington, 201731 S. Covington, 2017Session 332Session 3 - Overview3 ACTIVITIESThe Process of Trauma and SelfCare Goals: To present the Process of Trauma To introduce a variety of groundingand self-soothing activities To explore the concept of personalboundaries S. Covington, 201733Quiet TimeCheck-InReview of Last Session and the Between-SessionsActivityThe Process of TraumaWhat Does It Mean to Feel “Grounded”?Grounding ActivitiesSelf-Soothing ChartRelaxation ActivityDeveloping Personal BoundariesReflection, Between-Sessions Activity, and Close[Optional: Yoga Pose] S. Covington, 201734Session 3ACTIVITIESPersonal Boundaries Grounding Activities Self-Soothing Chart Relaxing Activity S. Covington, 201735UTAH STATE DIVISION OF MENTAL HEALTH AND SUBSTANCE ABUSEFEBRUARY 20-21, 2018 SALT LAKE CITY, UT S. Covington, 2017366

Healing Trauma:A Brief Intervention for WomenProcess of TraumaGroundingTraumatic EventOverwhelms the physical and psychological coping skillsGrounding techniques are strategies to help aperson who is dissociating (“losing time,”emotionally absent) “come back” into currentreality and feelings.Response to TraumaFight, flight, or freezeAltered state of consciousness, Body sensations, Numbing,Hypervigilance, Hyperarousal, CollapseSensitized Nervous SystemChanges in the BrainBrain-Body ConnectionPsychological and Physical DistressCurrent stressors, Reminders of trauma (triggers)Sensations, Images, Behavior, Affect (emotions), MemoryGrounding techniques can help womenrealize that they are in the here and now andthat what they are experiencing is in the pastand it is not happening now.Emotional and/or Physical ResponsesRetreatHarmfulBehavior to SelfHarmfulBehavior to OthersPhysicalHealth IssuesIsolationDissociationDepressive disordersAnxiety disordersSubstance usedisordersFeeding and eatingdisordersDeliberate self-harmSuicidal actionsAggressionViolenceRagesThreatsLung diseaseHeart diseaseAutoimmunedisordersObesity S. Covington, 201737Grounding S. Covington, 201738Self - Soothing PhysicalAloneWith Others MentalDaytimeNight Time S. Covington, 201739Relaxation Exercise S. Covington, 2017 S. Covington, 201740Developing Boundaries41UTAH STATE DIVISION OF MENTAL HEALTH AND SUBSTANCE ABUSEFEBRUARY 20-21, 2018 SALT LAKE CITY, UT S. Covington, 2017427

Healing Trauma:A Brief Intervention for WomenSession 4Session 4 - Overview5 ACTIVITIESThe ACE Questionnaireand AngerQuiet TimeCheck-InReview of Last Session and the Between-SessionsActivityThe Adverse Childhood Experiences QuestionnaireThe ACE StudyAngerWords for AngerMeeting a FeelingThe Anger Funnel Goals: To connect the women’s childhoodtraumatic experiences to their presentbehaviors To better understand the feeling ofanger and how to manage it in healthyways To revisit the Power and Control Wheel S. Covington, 201743 S. Covington, 201744Session 4Session 4 – Overview (cont.)ACTIVITIES Activity: The Anger FunnelActivity: Anger TriggersActivity: Palms Down, Palms UpReflection, Between-Sessions Activity, and Close Adverse Childhood ExperiencesQuestionnaire Meeting a Feeling Anger Funnel Anger Triggers Palms Down, Palms Up S. Covington, 201745 S. Covington, 2017ACE StudyACE Study (cont.)Before age 18:Growing up in a household with1.Recurrent and severe emotional abuse2.Recurrent and severe physical abuse3.Contact sexual abuse4.Emotional neglect5.Physical neglect6.Both biological parents not being present7.Your mother being treated violently8.An alcoholic or drug user9.A family member who is mentally ill,chronically depressed, or attempting suicide4610. A family member being imprisoned(N 17,000) S. Covington, 201747UTAH STATE DIVISION OF MENTAL HEALTH AND SUBSTANCE ABUSEFEBRUARY 20-21, 2018 SALT LAKE CITY, UT S. Covington, 2017488