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General Population
10% of women and 5% of men are likely
to suffer PTSD
33.3 will have symptoms lasting several
months
Those most vulnerable - inadequate
social support, survivors of child hood
sexual abuse
dependence
PTSD and veterans - 75% met criteria for
alcohol abuse
60% women & 20% men in alcohol recovery
programs sexual abuse as child
80% reporting physical abuse as children - in
above recovery program
understanding D/A
effects
Differentiate D/A, MI
abuse
Devise treatment
plan
Negative
Increase D/A
Increase MI
symptoms
Avoid deal D/A or MI
remains undisclosed
Potential destabilizing factor when kept
a secret
Secret interferes with treatment
Secret maintains a lower level of trust
Treatable condition remains untreated
Core Beliefs
The shame and despair that come from the
powerlessness and unmanageability help crystallize the
core beliefs about personal unworthiness that were part
of the persons initial addictive system:
I am basically a bad, unworthy person
No none would love me as I am
My needs are never going to be met if I have to
depend on others
Sex is my most important need
(Adapted from Carnes, 1989)
Multiple Addictions
Complex Post-Traumatic
Stress Disorder
A history of subjection to totalitarian control
(Herman, 1992)
Assessment Process
You will have to ask questions to assess
If symptoms are resulting from abuse.
This should not be used to dredge up
repressed memories.
Assessment Questions
In the course of the day/night, do you hear
abuse?
Have you ever observed sexual abuse?
Have you ever been the victim of
physical abuse?
Have you ever observed physical
abuse?
(van der Kolk)
Non-traditional Approaches to
Uncovering and Processing
Direct therapeutic exposure
Hypnosis
EMDR
Psychodrama and role play
Creative therapies such as art therapy, music
TREM Model
Trauma, recovery, empowerment
Women with history of:
Serious
mental illness
Substance abuse
Trauma
Homelessness
(Harris, 1998)
response to trauma
Women with early trauma unable to
develop adult coping skills
Trauma severs connections
Women with repeated abuse feel
powerless.
(Harris)
Group Model
10 33 sessions
4 stages in group program
1.
2.
3.
4.
Empowerment
Trauma recovery
Advanced trauma recovery
Closing rituals
(Harris)
therapist
(Harris, 1998)
masking, ritualizing
Psychodrama techniques of grounding in
present explore addiction patterns
Role reversal, doubling, mirroring demonstrate
splitting of self and choice of addiction
Psychodrama can explore denial in client and
therapist to protect beliefs and myths
(Sealy, 1999)
Psychodrama/Addiction/Trauma
Allows the traumatized inner child to come
Traumatic Transference
Therapist may suffer vicarious symptoms that
replicate PTSD
Repeated exposure to stories challenges
therapists basic faith
Heightens sense of personal vulnerability
May share clients experience of helplessness
As defense against helplessness may
assume role of rescuer
May violate boundaries of therapy
sexual arousal
Witness guilt
Existential panic