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Trauma Stabilization

Jamie Marich, Ph.D, LPCC-S, LICDC-CS

Rehab

Trauma Stabilization
Jamie Marich, Ph.D, LPCC-S, LICDC-CS

Rehab

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MATERIALS PROVIDED BY

Jamie Marichs friends and colleagues describe her as a renaissance


woman. A dancer, musician, performer, writer, recovery
ambassador, and clinical counselor, Marich unites these elements
of her experience to achieve an ultimate mission: bringing the
art and joy of healing to others. Marich travels internationally
speaking on topics related to EMDR, trauma, addiction, and
mindfulness while maintaining a private practice (Mindful Ohio)
in her home base of Warren, OH. She is the developer of the
Dancing Mindfulness practice (www.dancingmindfulness.com)
and regularly trains facilitators to take this unique practice into
both clinical and community settings. Jamie Marich is the author
of EMDR Made Simple: 4 Approaches for Using EMDR with
Every Client (2011), Trauma and the Twelve Steps: A Complete
Guide for Recovery Enhancement (2012), and Trauma Made
Simple: Competencies in Assessment, Treatment, and Working with
Survivors. Her new book, Dancing Mindfulness: A Creative Path
to Healing and Transformation is scheduled for release in 2015
with Skylight Paths Press. Marich is also a certified rational living
hypnotherapist and completed the Street Yoga trauma-informed
yoga teacher training program. In 2015, she had the privilege of
delivering a TEDx talk on trauma (available on YouTube), and she
made her first appearance on the popular Recovery 2.0 Conference
with Tommy Rosen.

Speaker Disclosure:
Financial: Jamie Marich is the Founder/Director of Mindful Ohio and The Institute for Creative
Mindfulness. She receives royalties as an author for PESI Publishing and Media. Dr. Marich
receives a speaking honorarium from PESI, Inc.
Nonfinancial: Jamie Marich has no relevant nonfinancial relationship to disclose.

2-DAY TRAUMA INFORMED


TREATMENT CONFERENCE
DAY 1: TRAUMA STABILIZATION
Jamie Marich, Ph.D., LPCC-S, LICDC-CS
Founder & Director, Mindful Ohio & The Institute for Creative Mindfulness

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ABOUT YOUR PRESENTER


Licensed Supervising Professional Clinical Counselor
Licensed Independent Chemical Dependency Counselor
14 years of experience working in social services and counseling; includes three years
in civilian humanitarian (Bosnia-Hercegovina)
Specialist in addictions, trauma, EMDR, dissociation, performance enhancement,
grief/loss, mindfulness, and pastoral counseling
Author of EMDR Made Simple, Trauma and the Twelve Steps, and Trauma Made
Simple (forthcoming)
Creator of the Dancing Mindfulness practice

WHAT LED YOU TO THIS CONFERENCE?

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OBJECTIVES
To define trauma from several perspectives (e.g., etymological, clinical/psychological/
neurobiological/diagnostic)
To explain the impact of unhealed trauma on human behavior and societal systems (e.g., the
family, education, etc.)
To describe the similarities between working with trauma and addressing grief/loss and
mourning
To describe the Triphasic/consensus model of trauma treatment and explain its origins
To explain the role of the therapeutic relationship and boundary setting in effective trauma
treatment
To develop a plan of stabilization/affect regulation for a client impacted by trauma
To implement no fewer than five trauma-informed stabilization skills with clients presenting in
human services settings
To discuss qualities of an effective trauma therapies, including the ability to assess ones own
capacity for working with trauma in clients

DEFINING TRAUMA

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ONCE YOUVE BEEN BITTEN BY A SNAKE, YOURE


AFRAID EVEN OF A PIECE OF ROPE.

-CHINESE PROVERB

What does the word trauma mean?

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Trauma comes from the Greek word


meaning wound
What do we know about physical
wounds and how they heal?

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Appreciating the wound metaphor is the heart


of understanding emotional trauma and how to
treat it.

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TRAUMA
POST-TRAUMATIC STRESS DISORDER
ADVERSE LIFE EXPERIENCES
COMPLEX TRAUMA

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DSM-5:
TRAUMA & STRESSOR-RELATED DISORDERS

Reactive Attachment Disorder


Disinhibited Social Engagement Disorder
Acute Stress Disorder
Posttraumatic Stress Disorder
Adjustment Disorders
Other Specified Trauma-and-Stressor Related Disorder
Unclassified Trauma-and-Stressor Related Disorder

DSM-5 NUTSHELL DEFINITION OF PTSD


POSTTRAUMATIC STRESS DISORDER
(APA, 2013)
Exposure to actual or threatened a) death, b) serious injury, or c) sexual violation:
direct experiencing, witnessing
Intrusion symptoms
Avoidance of stimuli associated with the trauma
Cognitions and Mood: negative alterations
Arousal and reactivity symptoms
Duration of symptoms longer than 1 month
Functional impairment due to disturbances

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TRAUMA: SMALL-T
Adverse life experiences
Not necessarily life threatening, but definitely life-altering
Examples include grief/loss, divorce, verbal abuse/bullying, and just about
everything else
The trauma itself isnt the problemrather, does the trauma get addressed? Is the
wound given a chance to heal?
If it was traumatic to the person, then its traumatic.
According to the adaptive information processing model, these adverse life
experiences can be just as valid and just as clinically significant as PTSD-eligible
traumas (Shapiro, 2014)

COMPLEX TRAUMA/PTSD
Term originally coined by Dr. Judith Herman in 1992
The diagnosis and related constructs (i.e., developmental trauma disorder)
not accepted for DSM-5
Many of the fields leading trauma professional emphasis the importance of
thinking beyond the DSM-5

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COMPLEX TRAUMA/PTSD
Repetitive or prolonged
Involve direct harm and/or neglect or abandonment by caregivers or
ostensibly responsible adults
Occur at developmentally vulnerable times in the victims life, such as early
childhood
Have great potential to compromise severely a childs development.

Courtois & Ford, 2009

ACE STUDY DATA (CDC, 2013)


The Ten ACEs Measured in the Study
Emotional abuse
Physical abuse
Sexual abuse
Emotional neglect
Physical neglect
Witnessing a mother being abused
Household substance abuse
Household mental illness
Losing a parent to separation or divorce
Incarcerated household member

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ACE STUDY DATA (CDC, 2013)


Connection established between the number of adverse childhood experiences and
the likelihood of these health conditions developing in young adulthood and later
adulthood:
Alcoholism and alcohol abuse
Chronic obstructive pulmonary disease (COPD)
Depression
Fetal death
Health-related quality of life
Illicit drug use
Ischemic heart disease (IHD)
Liver disease

ACE STUDY DATA (CDC, 2013)


Risk for intimate partner violence
Multiple sexual partners
Sexually transmitted diseases (STDs)
Smoking
Suicide attempts
Unintended pregnancies
Early initiation of smoking
Early initiation of sexual activity
Adolescent pregnancy

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ACE STUDY DATA (CDC, 2013)


FOR FURTHER READING
http://acestudy.org
http://acestoohigh.com

GEORGE ENGEL, M.D. (1961)


Loss of a loved one is psychologically traumatic to
the same extent that being severely wounded or
burned is physiologically traumatic.
The process of mourning is parallel to the process of
physical healing.

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A CLIENTS PERSPECTIVE:
LILY BURANA (2009)
PTSD means, in talking over beer terms, that youve got some
crossed wires in your brain due to the traumatic event. The overload
of stress makes your panic button touchier than most peoples, so
certain things trigger a stress reaction- or more candidly- an overreaction. Sometimes, the panic button gets stuck altogether and
youre in a state of constant alert, buzzing and twitchy and
aggressive.

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A CLIENTS PERSPECTIVE:
LILY BURANA (2009)
Your amygdala- the instinctive flight, fight, or freeze part of your
brain- reacts to a trigger before your rational mind can deter it. You
can tell yourself, its okay, but your wily brain is already ten steps
ahead of the game, registering danger and sounding the alarm. So
you might say once again, in a calm, reasoned cognitive-behavioraltherapy kind of way, Brain, its okay

A CLIENTS PERSPECTIVE:
LILY BURANA (2009)
But your brain yells back, Bullshit kid, how dumb do you think I
am? Im not falling for that one again. By then, youre hiding in
the closet, hiding in a bottle, and/or hiding from life, crying,
raging, or ignoring the phone and watching the counter on the
answering machine go up, up, up, and up. You cant relax, and
you cant concentrate because the demons are still pulling at your
strings.

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A CLIENTS PERSPECTIVE:
LILY BURANA (2009)
The

long-range result is that the peace of mind you


deserve in the present is held hostage by the terror of
your past.

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AN ENGLISH TEACHERS GUIDE TO


TRAUMA NEUROBIOLOGY
Cognitive-behavioral, talk therapies primarily target the prefrontal regions of the brain (e.g.,
thinking, judgment, and willpower).
However, when a person gets activated or triggered by traumatic memories or other visceral
experiences, the prefrontal cortex is likely to shut down and the limbic brain (e.g., emotional
brain) takes over.
Just talking can activate the emotional, limbic brain, but just talking isnt very likely to calm it
back down.
What does not seem to change with traditional talk therapy is that uncomfortable experience
of being triggered at a visceral level.

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RECOMMENDED READING FOR


MORE DEPTH ON NEUROSCIENCE

Van Der Kolk, B. (2014). The body keeps the score: Brain,
mind, and body in the healing of trauma. New York, Viking.

PSYCHOMETRICS
Catalogue of Resources on the National Center for PTSD Website
http://www.ptsd.va.gov/
Primary Care PTSD Screen
The PTSD Checklist

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When we honestly ask ourselves which person in our lives means the
most to us, we often find that it is those who, instead of giving advice,
solutions, or cures, have chosen rather to share our pain and touch our
wounds with a warm and tender hand.
-Henri Nouwen

BEST PRACTICES FOR ASSESSING &


BUILDING THERAPEUTIC ALLIANCE
Do not re-traumatize!
Do make use of open-ended questions
Do consider the role of shame in addiction, trauma, and griefthere is power in treating
people with dignity
Do not use the you need to language
Do not attempt to talk reason when someone is in crisis
Do be genuine, see every interaction as a chance to build rapport
Do be non-judgmental
Do review stop sign protocol
Do assure the client/student that they may not be alone in their experiences (if appropriate)
Do have closure strategies ready

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NOW ITS YOUR TURN


Write up a brief case synopsis:
An actual student or client (using a pseudonym)
A composite student or client
A famous example (presenting for clinical attention)
A fictitious case
Be sure to identify one of their driving negative themes (i.e., Im not good enough, Im
defective, Im in danger, etc.)

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Discussion:
Your Reactions and Experiences

PRINCIPLES OF TRAUMA-INFORMED CARE


(SAMHSA, 2014)
Promote trauma awareness and understanding
Recognized that trauma-related symptoms and behaviors originate from adapting to
traumatic experiences
View trauma in the context of individuals environments
Minimize the risk of retraumatization or replicating prior trauma dynamics
Create a safe environment

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PRINCIPLES OF TRAUMA-INFORMED CARE


(SAMHSA, 2014)
Identify recovery from trauma as a primary goal
Support control, choice, and autonomy
Create collaborative relationships and participation opportunities
Familiarize the client with trauma-informed services
Incorporate universal routine screenings for trauma
View trauma through a socio-cultural lens
Use a strengths-based perspective: Promote resilience

PRINCIPLES OF TRAUMA-INFORMED CARE


(SAMHSA, 2014)
Foster trauma-resistant skills
Demonstrate organizational and administrative commitment to trauma-informed care
Develop strategies to address secondary trauma and promote self-care
Provide hoperecovery is possible

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Read the entire SAMHSA Treatment Improvement Protocol:


Substance Abuse and Mental Health Services Administration (2014). A treatment
improvement protocol: Trauma-informed care in behavioral health services.
Washington, DC: Author.
Available online: http://www.ncbi.nlm.nih.gov/books/NBK207201/

Please Return by 1:00pm

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FROM DR. BESSEL VAN DER KOLK

The purpose of trauma treatment is to help a


person feel safe in his or her own body.
-from the documentary
Trauma Treatment for the 21st Century (Premier, 2012)

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GENERAL CONSENSUS MODEL OF TRAUMA


TREATMENT (ISTSS TASK FORCE, 2012)

PHASE I: Stabilization
PHASE II: Processing of Trauma
PHASE III: Reintegration

www.traumamadesimple.com/videos

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WHAT TYPES OF COPING SKILLS WORK BEST???


Muscle relaxation
Breath work
Pressure Points/Tapping
Yoga
Imagery/Multisensory Soothing
Anything that incorporates the body in a positive, adaptive way!!!


PROGRESSIVE MUSCLE RELAXATION

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BREATHING BASICS
The mind controls the body, but the breath controls
the mind.


B.K.S. Iyengar

BREATHING BASICS



Teaching breathing exercises to your client is like teaching a


teenager when to accelerate and when to brake the car.
Amy Weintraub

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PRACTICING AWARENESS OF BREATH

BREATHING BASICS
Diaphragmatic breathing
Complete breathing
Ujjayi breathing
Lion breathing

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BREATHING BASICS
Clients who are easily activated may not feel comfortable closing their eyes
during breath work. Reiterate that it is not necessary to close the eyes during
these exercises.
Start slowlyif a client is not used to breathing deliberately, dont overwhelm
him. Starting with a few simple breaths, and encouraging repetition as a
homework assignment, is fine.
Use counting or other sensory/grounding strategies if needed.
If a client has a history of respiratory difficulties, make sure to obtain a release
to speak with her medical provider before proceeding.

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OTHER IMPLICATIONS FROM YOGA

YOGA & TRAUMA/MENTAL HEALTH


Compared women with PTSD in 2 groups: psychotherapy only and
psychotherapy + yoga
Yoga significantly reduced PTSD symptomatology, with effect sizes
comparable to well-researched psychotherapeutic and
psychopharmacologic approaches; Yoga may improve the
functioning of traumatized individuals by helping them to tolerate
physical and sensory experiences associated with fear and
helplessness and to increase emotional awareness and affect
tolerance (van der Kolk, Stone, West, et al. 2014).

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YOGA
Recommendation:

www.yogafordepression.com

PRESSURE POINTS
uSea of Tranquility
uLetting Go/Butterfly Hug
uGates of Consciousness
uThird Eye (and variations)
uKarate Chop

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GUIDED IMAGERY
The purpose of guided imagery as a stabilization coping exercise is
to provide the client with a safe, healthy mental escape that he/she
can access when needed
If you do not feel comfortable to develop your own guided
imageries, there are many free scripts available online, use with
caution to context
Avoid place guided imageries until you see how a client is going
to respond

VARIATIONS OTHER THAN IMAGERY


Sound
Smell
Touch/Tactile
Taste

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MINDFULNESS
Mindfulness means paying attention in a particular way: on purpose,
in the presence of the moment, and non-judgmentally.
-Jon Kabat-Zinn (2011)

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MINDFULNESS IN EVERYTHING
Walking
Moving/gentle stretching
Playing
Dancing
Daily household tasks

RECOMMENDATIONS

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MOTIVATIONAL INTERVIEWING:
4 PRINCIPLES (MILLER & ROLLNICK, 2012)
Express Empathy
Develop Discrepancy
Roll with Resistance
Support Self-efficacy

BEUTLER, ET AL. (2005)

ON THE CONNECTION BETWEEN THERAPIST TRAITS & CLIENT OUTCOMES


Effective therapists are interested in people as individuals
Have insight into their own personality characteristics
Have concern for others
Intelligent
Sensitive to the complexities of human motivation
Tolerant
Able to establish warm and effective relationships with others

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CHARMAN (2005)

mindful
not having an agenda
having concern for others
intelligent
flexible in personality
intuitive
self-aware
knows own issues
able to take care of self
open
patient
creative

QUALITIES OF A GOOD EMDR/TRAUMA THERAPIST


MARICH (2012)
caring
trustworthy
intuitive
natural
connected
comfortable with trauma work
skilled
accommodating
magical
wonderful

good common sense


smart
consoling
validating
gentle
nurturing
facilitating

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QUALITIES OF AN INEFFECTIVE TRAUMA/EMDR


THERAPIST (MARICH, 2012)
rigid
scripted
detached
anxious
unclear
uncomfortable with trauma

INTENSE AFFECT & ABREACTION


The therapeutic process of bringing forgotten or inhibited material (i.e.,
experiences, memories) from the unconscious into consciousness, with concurrent
emotional release and discharge of tension and anxiety.
APA Dictionary of Psychology (2007)

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MINDFULNESS & SELF CARE


Promoting mindfulness in psychotherapists-in-training could positively
influence the therapeutic course and treatment results in patients
(randomized, double-blind controlled study; Grepmair, Mitterlehner, Loew, et
al, 2007)
Health care professionals participating in a mindfulness-based stress
reduction program (MBSR) were able to more fully identify their own themes
of perfectionism, the automaticity of other focus, and their tendencies to
always enter fixer mode; this recognition led to numerous changes along
personal and professional domains (grounded theory; Irving, Park-Saltzman,
Fitzpatrick, et al., 2014); a similar study that exclusively studied nurses yielded
similar findings (Frisvold, Lindquist, McAlpine, 2012)

MINDFULNESS & SELF CARE


In an extensive mixed methods research study with working psychotherapists
from a variety of theoretical backgrounds, Keane (2013) concluded that
personal mindfulness practice can enhance key therapist abilities (e.g.,
attention) and qualities (e.g., empathy) that have a positive influence on
therapeutic training.
Mindfulness practice could provide a useful adjunct to psychotherapy
training and be an important resource in the continuing professional
development of therapists across modalities.

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FOR CONTINUED DEVELOPMENT


How many of the qualities on these lists do I possess?
How do I handle intense affect and abreaction?
What are my personal barriers with trauma?
What factors may inhibit me from being effective with someone struggling with trauma?

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REFERENCES & READING


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D. C.:
Author.
Beutler, L., Malik, M., Alimohamed, S., Harwood, T., et al. (2005). Therapist variables. In M. Lambert (ed.). Bergin and Garfields
Handbook of Psychotherapy and Behavior Change (5th ed.,pp. 227306). New York: Wiley.
Centers for Disease Control. (2013). Major findings, In Adverse Childhood Experiences (ACEs) Study. Updated January 18, 2013,
Retrieved from http://www.cdc.gov/ace/findings.html
Charman, D. (2005). What makes for a good therapist? A review. Psychotherapy in Australia, 11(3), 6872.
Courtis, C. A., & Ford, J. D. (2009). Treating complex traumatic stress disorders: An evidence-based guide. New York: The Guilford
Press.
Engel, G. L. (1961). Is grief a disease?: A challenge for medical research. Psychosomatic Medicine, 23, 1822.
Frisvold, M. H., Lindquist, R., & McAlpine, C. P. (2012). Living life in balance at midlife: Lessons learned from mindfulness. Western
Journal of Nursing Research, 34, 265-278.
Grepmair, L., Mitterlehner, F., Loew, T., Bachler, E., Rother, W., & Nickel, M. (2007). Promoting mindfulness in psychotherapists in
training influences the treatment results of their patients: A randomized, double-blind controlled study. Psychotherapy and
Psychosomatics, 76, 332-338.
Herman, J. (1992). Trauma and recovery. New York: Basic Books.
Irving, J.A., Park-Saltzman, J., Fitzpatrick, M., Dobkin, P.L., Chen, A., & Hutchinson, T. (2014). Experiences of health care
professionals enrolled in mindfulness-based medical practice: A grounded theory model. Mindfulness, 5, 60-71.
ISTSS Task Force: Cloitre, M., Courtois, C. A., Ford, J. D., Green, B. L., Alexander, P., Briere, J., van der Hart, O. (2012). The ISTSS
Expert Consensus Treatment Guidelines for Complex PTSD in Adults. . Retrieved from
http://www.istss.org/AM/Template.cfm?Section=ISTSS_Complex_PTSD_Treatment_Guidelines&Template=/CM/
ContentDisplay.cfm&ContentID=5185.
Kabat-Zinn, J. (2011). Mindfulness for beginners. Boulder, CO: SoundsTrue Books.

REFERENCES & READING

Keane, A. (2013). The influence of therapist mindfulness practice on psychotherapeutic work: A mixed-methods study. Mindfulness. DOI:
10.1007/s12671-013-0223-9.

Kilpatrick, D., Resnick, H.S., Milanak, S.E., et al. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV
and DSM-5 criteria. Journal of Traumatic Stress, 26(5), 537-547.

Marich, J. (2012). What makes a good EMDR therapist?: Exploratory clients from client-centered inquiry. Journal of Humanistic Psychology,
52(4), 401422.

Miller, W., & Rollnick, S. (2012). Motivational interviewing: Helping people change. (3rd edition). New York: The Guilford Press.

Pease Bannit, S. (2012). The trauma toolkit: Healing PTSD from the inside out. Wheaton, IL: Quest Books.

Reiger, D.A., Narrow, W.E., Clarke, D.E., et al. (2013). DSM-5 field trials in the United States and Canada, Part II: Test-Retest reliability of
selected categorical diagnoses.

Resick, P.A., Bovin, M.J., Calloway, A.L, et al. (2012). A critical evaluation of the complex PTSD literature: Implications for DSM-5. Journal of
Traumatic Stress, 25(3), 241-251

Shapiro, F. (2014). The Role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: Addressing the psychological
and physical symptoms stemming from adverse life experiences. Permanente Journal, 18(1), 71-77.

Substance Abuse and Mental Health Services Administration (2014). A treatment improvement protocol: Trauma-informed care in behavioral
health services. Washington, DC: Author.

Van Der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York, Viking.

Van Der Kolk, B., Stone, L., West, J., Rhodes, A., Emerson, D., Suvak, M., Spinazolla, J. (2014). Yoga as an adjunctive treatment for posttraumatic stress disorder: A randomized clinical trial. Journal of Clinical Psychiatry, 75(0), e1-e7.

Weintraub, A. (2012). Yoga skills for therapists: Effective practices for mood management. New York: W. W. Norton.

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To contact todays presenter:


Jamie Marich, Ph.D., LPCC-S, LICDC-CS
Mindful Ohio
jamie@jamiemarich.com
www.mindfulohio.com
www.jamiemarich.com
www.drjamiemarich.com
www.dancingmindfulness.com
www.TraumaTwelve.com
www.TraumaMadeSimple.com
Phone: 330-881-2944

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Instructions on how to use The Greatest Hits List Tools


- Give the client the respective list (you may send them home
with it or have them do it in your office, your discretion)
- Advise the client to read through the negative list and to check
off any belief that he/she still considers a problem. Assure the
client that there are no wrong answers: one item, ten items, or
all items may be checked.
- If more than one item is checked, ask the client to rank the 2-3
most problematic beliefs.
- Go through each of the top 2-3 items and ask the client:
Whens the first time you ever remember getting that message about
yourself?
Whens the worst time you ever remember getting that message about
yourself?
Whens the most recent time that you received that message about
yourself?

- Applications for grief/loss concerns:


What role did your loss play in giving you this message?
Does this message pre-date the loss in any way?

- Other notes:

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The Greatest Hits List of Problematic Beliefs


(May be duplicated for use in clinical settings)

Responsibility

Value

I should have known better.

I am not good enough.

I should have done something.

I am a bad person.

I did something wrong.

I am permanently damaged.

I am to blame.

I am defective.

I cannot be trusted.

I am terrible.

Safety

I am worthless/inadequate.

I cannot trust myself.

I am insignificant.

I cannot trust anyone.

I am not important.

I am in danger.

I deserve to die.

I am not safe.

I deserve only bad things.

I cannot show my emotions.

I am stupid.

Power

I do not belong.

I am not in control.

I am different.

I am powerless/helpless.

I am a failure

I am weak.

I am ugly.

I am trapped.

My body is ugly.

I have no options.

I am alone.

I cannot get what I want.

I have to be perfect.

I cannot succeed.

I have to please everyone.

I cannot stand up for myself.


I cannot let it out.

Others Not Listed:

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The Greatest Hits List of Addiction-Specific Beliefs


(May be duplicated for use in clinical settings)

I cannot cope without alcohol.

I am nothing without my addiction.

I cannot cope without drugs.

I have no identity without my addiction.

I cannot cope without cigarettes.

I have no identity if I cant act out.

I cannot cope without acting out violently.

My addiction is my security.

I cannot cope without victimizing others.

I must use alcohol to cope with my past.

I cannot cope with emotions without eating.

I must use drugs to cope with my past.

I cannot live without sex.

I must have sex to cope with my past.

Sex is my most important need.

I must eat to cope with my past.

Escaping reality is my most important need.

I must act out violently to cope with my past.

I cannot survive without a partner/relationship.

I must victimize others to cope with my past.

I am not capable of dealing with my feelings.

I must smoke to cope with my past.

I am not capable of dealing with my life.


I cannot accept/deal with reality.
I must gamble to be in control.

Other Beliefs Not Listed:

I must drink alcohol to be in control.


I must use drugs to be in control.
I must smoke cigarettes to be in control.
I must eat to be in control.
I must act out violently to be in control.
I must victimize others to be in control.
I must be in a relationship to be in control.
I must have sex to be in control.
I am incapable of being social without alcohol.
I am incapable of being social without drugs.
I am incapable of being social without cigarettes.

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Adverse Childhood Experiences (ACE) Score


Prior to your 18th birthday:
1 Did a parent or other adult in the household often or very often
Swear at you, insult you, put you down, or humiliate you? or Act
in a way that made you afraid that you might be physically hurt?
No___
If Yes, enter 1 __
2 Did a parent or other adult in the household often or very often
Push, grab, slap, or throw something at you? or Ever hit you so
hard that you had marks or were injured?
No___
If Yes, enter 1 __
3 Did an adult or person at least 5 years older than you ever Touch
or fondle you or have you touch their body in a sexual way? or
Attempt or actually have oral, anal, or vaginal intercourse with
you?
No___
If Yes, enter 1 __
4 Did you often or very often feel that No one in your family loved
you or thought you were important or special? or Your family
didnt look out for each other, feel close to each other, or
support each other?
No___
If Yes, enter 1 __
5 Did you often or very often feel that You didnt have enough to
eat, had to wear dirty clothes, and had no one to protect you? or
Your parents were too drunk or high to take care of you or take
you to the doctor if you needed it?
No___
If Yes, enter 1 __
6 Was a biological parent ever lost to you through divorce,
abandonment, or other reason?
No___
If Yes, enter 1 __

44

7 Was your mother or stepmother often or very often pushed,


grabbed, slapped, or had something thrown at her? or
Sometimes, often, or very often kicked, bitten, hit with a fist, or
hit with something hard? or Ever repeatedly hit over at least a
few minutes or threatened with a gun or knife?
No___
If Yes, enter 1 __
8 Did you live with anyone who was a problem drinker or alcoholic, or
who used street drugs?
No___
If Yes, enter 1 __
9 Was a household member depressed or mentally ill, or did a
household member attempt suicide?
No___
If Yes, enter 1 __
10

Did a household member go to prison?


No___
If Yes, enter 1 __

Now add up your Yes answers: ________


This is your ACE Score

45

NOTES

NOTES