Risking Connection 3 Day Basic Training Day 2

Introduction © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute

Healing Attachment: Power of the Therapeutic Alliance © 2006 Sidran Institute. Risking Connection® is

RC® Trauma Framework Childhood Traumatic Events/ACEs Disrupted Development Attachment Body and brain Self capacities: Inner Connection Current Stressor Worthy of Life gs n i l e e F e tolerabl In Feelings Management Acts to Relieve Feelings Retreats, hurts self, or hurts others © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute Adaptive: Helps in the moment, hurts in the long run 113

Therapeutic Alliance The positive connection between the treater and the client. The alliance is your major healing tool. Your interaction can be healing, whether the contact is one time or long-term, frequent or infrequent. Without an alliance, techniques will not work. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 114

Why is a therapeutic alliance so important? It contradicts traumatized clients’ basic assumptions about relationships. It re-sculpts brain pathways. It decreases a client’s sense of isolation. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 115

Why is a therapeutic alliance so important? (2) Clients learn that the present is different from the past. Clients learn there are inevitable breaks in relationships that can be repaired. It is the treater’s most important source of influence with clients. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 116

A RICH Relationship: The Key to Healing ® These four components define a relationship that is healing, whether it lasts five minutes or five years: Respect Information Connection Hope © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 117

Video: RICH in Action Teacher Barry White Jr: https: //www. youtube. com/watch? v=Vcta. UNJp.

Exercise RICH relationships Respect Information Connection Hope © 2006 Sidran Institute. Risking Connection® is

What makes it hard to own our mistakes? Belief that mistakes imply we are inferior professionals or bad people, or that others will think this of us. Fear of our clients’ anger or our bosses’ censure. Fear of losing face or appearing incompetent. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 120

What makes it hard to own our mistakes? Belief that we should have known better or been able to avoid mistakes. Lack of support/acknowledgement for the challenge of the work. Acknowledging mistakes actually creates greater respect, safety, and trust, not less. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 121

Frame and Boundaries © 2006 Sidran Institute. Risking Connection® is a registered trademark of

What is the frame? It includes: The frame describes the conditions within which the treater and client will work together. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute Roles Rules Guidelines Boundaries 123

Importance of Frame to Clients Suffering ACEs/Trauma The essence of interpersonal abuse is violation of boundaries. Therefore, traumatized clients often have little sense of what appropriate boundaries are. Abused clients often expect to have their boundaries violated, especially by authority figures. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 124

Frame and Boundary Dilemmas For many boundary issues, there’s no agreement in the field. Crossing boundaries often arise from good intentions of staff. Clients are used to boundary violations. They expect them and may even seek them out. No boundary policy can cover all situations that arise. Must think of good of the client and good of the group. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 125

Importance of the Frame Being clear about the frame in a therapeutic relationship is part of creating safety and showing respect. When in doubt about a boundary decision, TALK ABOUT IT with your team! © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 126

Break © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute

Strengthening Self Capacities (Feelings Skills) © 2006 Sidran Institute. Risking Connection® is a registered

Risking Connection® Framework Childhood Traumatic Events/ACEs Disrupted Development Attachments Body and brain Self capacities: Inner Connection Current Stressor Worthy of Life gs n i l e e F e tolerabl In Feelings Management Acts to Relieve Feelings Retreats, hurts self, or hurts others © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute Adaptive: Helps in the moment, hurts in the long run 129

Strengthening Self-Capacities (Feelings Skills) Premise: The MORE a client is able to: Feel connected to caring others when they are not present (Inner connection to others) Feel deserving of life, love, and attachment (Worthy of life) Manage seemingly intolerable feelings (Feelings Management) © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 130

Strengthening Self-Capacities (Feelings Skills) … the LESS they will depend on extreme behaviors to cope and …the MORE they will be able to manage life and relationships. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 131

#1: Inner Connection to Positive Others Because: Clients with histories of ACEs and trauma tend not to have internalized a sense of loving others. And: They often experience separation (even brief) as desolation and abandonment. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 132

Inner Connection to Others Our goals are: To provide a safe therapeutic relationship that the client can internalize over time. To help the client practice holding onto connection with caring others when they are not there. To use concrete transitional objects to symbolize the connection. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 133

Strategies to Build Inner Connection to Others Send a quick postcard when on vacation. Hang pictures of loved ones and/or treaters in cleint’s room. Give client a small object (stone, stuffed animal) to help remember you care about her. Tell a client that you will be thinking about him when he faces something difficult. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 134

Strategies to Build Inner Connection to Others Write a note to a client or create something together that she can keep as a transitional object. Make a tape for client that he can play when distressed. Construct a list of people who care about the client and post it on the wall. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 135

#2: Feeling Worthy of Life Because: Clients often feel that they are unworthy, unlovable, or untouchable. And: Connection and empathy diminish shame. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 136

Feeling Worthy of Life Our goals are: To communicate in every way the client is worthy and lovable. To avoid situations the client finds shaming. To encourage sharing what is shameful. To talk directly about the interpersonal relationship between treater and client. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 137

Strategies to Build Feelings of Worthiness Make opportunities for the client to participate in activities he enjoys and does well. Catch him doing things well - even very small things. Set goal of making 5 affirming comments for every limit-setting one. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 138

Strategies to Build Feelings of Worthiness Plan ways for client to get involved helping others. Remind the client of his successes you’ve witnessed. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 139

#3: Feelings Management Because: Clients were never taught about feelings and how to soothe themselves. Their body and brain has a very narrow window of tolerance for strong feelings. They often associate strong feelings with danger. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 140

Feelings Management Our goals are: To teach them strategies for managing and regulating strong feelings. To model managing our own strong feelings. Remember Co-regulation! Clients learn to regulate feelings in the presence of regulated others. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 141

Strategies to Build Feelings Management Skills Feeling Awareness Teach clients the language of body sensation Help clients to identify the body sensations connected to being calm, getting upset, and very upset Help clients to identify sensations attached to particular feeling words. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 142

Strategies to Build Feelings Management Skills Language of Sensation Solid, relaxed, warm, calm, grounded, alive, energized, open, free, unstruck, smooth, settled Tight, dizzy, burning, fuzzy, hot, numb, dull, shaky, nothing, cold, sharp, clammy, sweaty, foggy, nauseous, goose bumpy, blocked, tense, butterflies, wobbly, tired, stuck, thick, itchy, fidgety, suffocated, frozen, breathless, blank, floaty, empty, hollow, deadened, absent, heart pumping © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 143

Worksheet: Catch It Early! What are 3 situations that set you off (trigger you)? 1. _____________________ 2. _____________________ 3. _____________________ 10 8 6 4 2 0 Situation 1 Situation 2 Situation 3 What do you feel in your body when you are more upset? At a 6/7? ________________ What would staff see looking at you when were more upset? At a 6/7? ________________ What strategies help you when you are more upset? At a 6/7? ________________ What do you feel in your body when you are first getting upset? At a 4/5? ________________ What would staff see looking at you when you are first getting upset? At a 4/5? ________________ What strategies help you when you are first getting upset? At a 4/5? ________________ What do you feel in your body when you are calm? At a 1/2? ________________ What would staff see looking at you when you are calm? At a 1/2? ________________ What strategies help you stay calm when you are calm? At a 1/2? ________________ © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 144

Strategies to Build Feelings Management Skills Feeling Identification Help client to learn feeling words and connect them to feelings in her body. Teach client that feelings are different from actions. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 145

Strategies to Build Feelings Management Skills Feelings Modulation: Use sensory objects related to: touch, hearing, seeing, smelling, tasting/chewing. Continually work on strategies to make strong feelings more tolerable (draw feelings, distract oneself, use physical activity, etc. ) Designate a “Chill Room” or “Sensory Room” Help client create a “Calm Down Kit” or “Sensory Kit” Dialectical Behavior Therapy (DBT) skills © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 146

Strategies to Build Feelings Management Skills Feeling Expression Help client to use words, not actions, to express their feelings. Teach client the difference between constructive and destructive expression of feelings. Help clients to use “I” statements. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 147

Exercise Strengthening Self-Capacities © 2006 Sidran Institute. Risking Connection® is a registered trademark of

Video The Client’s Experience of the System Option 1. Multiple Transitions: A Young Child’s Point of View on Foster Care and Adoption (The Infant. Parent Institute, http: //www. infant-parent. com/) Option 2. Re. Moved https: //www. youtube. com/watch? v=l. Oe. QUwd. Aj. E 0 © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 149

Lunch © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute

Using RC Principles for Collaborative Crisis Management © 2006 Sidran Institute. Risking Connection® is

A Collaborative Model for Crisis Management Many of the major failures in treatment of trauma survivors occur in our responses to crises. The client’s participation in, and anticipation of, crisis intervention is essential. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 152

Collaborative Crisis Management What To Do: Before the crisis During the crisis After the crisis Note: The following principles are consistent with existing deescalation and crisis management curriculum such as TCI, CP/I, Mandt, etc. 153 © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute

Before The Crisis © 2006 Sidran Institute. Risking Connection® is a registered trademark of

Before the Crisis 1. Build Self-Capacities When the Iron is Cold The best long-term way to prevent crises is to seize every opportunity to strengthen and/or teach feeling skills. Inner connection Self-worth Feelings management The stronger the self-capacities, the fewer the crises © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 155

Before the Crisis 2. Create Crisis Prevention Plans The more we collaborate with clients to anticipate crises, the less crises take us and clients by surprise. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 156

Before the Crisis 2. Create Crisis Prevention Plans ask: What upsets you? What are the first signs that you’re getting upset? What helps you when you’re upset? What doesn’t help? Crisis Prevention Plans are living documents, continually reviewed and modified with the client. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 157

During the Crisis © 2006 Sidran Institute. Risking Connection® is a registered trademark of

During the Crisis: Four Principles 1. Remember symptoms are adaptations 2. Stay RICH® 3. Stay calm yourself 4. Focus only on calming and grounding © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 159

During the Crisis 1. Remember Symptoms are Adaptations Keep this mindset: If you don’t truly believe that problem behaviors are adaptive, you’re more likely to: Personalize the behavior Engage in avoidable power struggles © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 160

During the Crisis 2. Stay RICH® Respect: Validate the client’s emotional experience of the situation; watch your tone, inflection, posture, eye contact, etc. Information: Inform the client of what is happening, your intentions, what you need from her, what will happen next; offer choices; offer ideas for self-soothing. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 161

During the Crisis 2. Stay RICH® Connection: Assume client feels alone in her distress. Offer yourself as a connection. Bring in others who are connected to the client. Hope: Offer hope that together you and the client can get through this. Remind client of previous success at overcoming similar challenges. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 162

During the Crisis 3. Stay Calm Yourself Use calming techniques (e. g. , deep breathing, count to 10, etc. ) Watch your body language If you can’t stay calm, fake it! If you can’t fake it, get help (i. e. switch out) Remember: Don’t take the behavior personally Clients become regulated in the presence of regulated others. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 163

During the Crisis 4. Focus Only On Calming and Grounding If the client is emotionally or behaviorally upset… Focus on helping the client calm down Validate! (Validation doesn’t necessarily mean agreement) Discuss consequences LATER © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 164

During the Crisis 4. Focus Only On Calming and Grounding If the client is emotionally or behaviorally upset… Don’t hurry resolution Offer choices Be as flexible as possible © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 165

During the Crisis 4. Focus Only on Calming and Grounding If the client is having a ‘flashback’ or difficulty staying present, ground the client in the present. Use 4 “Ws” Who she is, who you are When – day, time, year Where is she now What is happening now Direct client’s attention to immediate physical surroundings, e. g. invite client to squeeze arm of chair, rub coarse rug, press feet against ground, or use sensory objects. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 166

During the Crisis: Role-Play Practicing principles of crisis management during the crisis ------------------------------------ To what extent does the treater display the 4 principles of crisis management? 1. 2. 3. 4. Remember symptoms are adaptations Stay RICH® Stay calm yourself Focus only on calming and grounding © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 167

After the Crisis © 2006 Sidran Institute. Risking Connection® is a registered trademark of

After the Crisis Think (again) about the function of the behavior. How did the behavior help the client in the moment? Ask the “why under the why” The reasons clients act out are generally not intentional or conscious © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 169

After the Crisis Work on replacement behaviors that serve similar needs for the client with fewer negative consequences. If cutting helps to show others inside pain, suggest drawing on the body with a marker. If violent threats help hold other’s attention so client doesn’t feel alone, use transitional objects to help client feel less alone without treater there. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 170

After the Crisis Work to repair the relationship by talking with client about the

After the Crisis: Role-Play Repairing the relationship -after the crisis © 2006 Sidran Institute.

Rethinking “Manipulation” © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran

Rethinking “Manipulation” What distinguishes manipulative behavior from other behavior? Trying to get what you want… In an indirect, deceitful or dishonest way… Without regard for the needs or feelings of the other person. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 175

Rethinking “Manipulation” How do we feel when we have been successfully manipulated- especially if it is public? Angry! Stupid! Foolish! Played! Never again! Who else feels that way much of the time? © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 176

Rethinking “Manipulation” Why is it difficult for our clients to ask directly for what they want? It hasn’t worked in the past. Our programs/systems often say “no” to reasonable, direct requests. It feels vulnerable and weak. You have to trust the other person. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 177

Rethinking “Manipulation” What can we do when we feel manipulated? Talk over our feelings with another adult. What needs was the client trying to meet? Use RICH® to talk with the client. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 178

Exercise: Manipulation How did the client’s behavior make you feel? How might the behavior have solved a problem or met a need for the client? How could you use RICH® to talk with the client about direct and indirect communication? © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 179

Case Example: Sarah Since Sarah’s admission, you have had trouble connecting with her. You are delighted when she asks to speak with you. She tells you that she has been worried about her mother. Her mother has been sick recently and seems more depressed. Sarah is afraid she’s becoming suicidal again. Although Sarah knows she is not allowed visits at this time, she wonders if she could possibly have just a day visit to see if her mother is okay. You feel uneasy about this. If you help her with this, it may build her trust with you and the team. When you present this idea to your team, they are dubious. However, your passion and faith in her convince the others and Sarah leaves on a day pass on Saturday. You get the call at home. Sarah has left her mother’s house half an hour after getting there. Then you get a second call. Sarah and her boyfriend Leon have been picked up by the police and Sarah has been returned to your facility. Staff is eager for you to talk to Sarah first thing Monday morning. They are asking you what her consequences are going to be. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 180

Vicarious Traumatization The Impact of Managing Crisis Holding onto Hope © 2006 Sidran Institute.

The Impact of Managing Crisis on the Treater Contributing Factors: Listening to life stories of our clients. Managing life-threatening crises. Realizing that, at times, the stakes are quite literally life and death. Expectations about our power to control client’s actions. © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 182

Video VT and Compassion Fatigue Portraits of Professional Caregivers. Their Passion. Their Pain. Caregiversfilm. com © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 183

VT: What Gives Us Hope A Map - The RC Trauma Framework Noticing successes Loving your work Listening to and reclaiming your body Recognize the benefits of your work © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 184

Vicarious Transformation The positive growth and transformation of treaters as people, as a result of the work they do. Pearlman, L. A. & Saakvitne, K. W (2012) Compassion Satisfaction “The pleasure you derive from being able to do your work well…to help others through your work…to contribute to the work setting or. . the greater good of society. ” Stamm, B. H. (2009) © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 185

Video Vicarious Transformation and Compassion Satisfaction Portraits of Professional Caregivers. Their Passion. Their Pain. caregiversfilm. com © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 186

Exercise: Vicarious Transformation and Compassion Satisfaction 1. What brings you particular satisfaction about the work you do? 2. Do you think you’ve grown as a person as a result of your work? If so, how? © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 187

Exercise: Success Stories © 2006 Sidran Institute. Risking Connection® is a registered trademark of

Wrap Up and Feedback 1. What worked well about today? What did you like? What kinds of things should we keep? 2. What didn’t work? What kinds of things should we get rid of? 3. What do you need from this training before it ends? © 2006 Sidran Institute. Risking Connection® is a registered trademark of Sidran Institute 189