The next level of IATP training!
Certified Expert Trauma Professional (CETP)
Coming July 2013
For more information contact
Sex Offender Treatment Professional Certification
Presented by Mike Dubi, Thom Glaza, Harry Morgan
When: May 2 - 3, 2013
Where: Child Protection Center
720 South Orange Ave
Sarasota, FL 34236
Time: 8:30 - 5 PM
Contact: Mike Dubi firstname.lastname@example.org
Sex Offender Treatment Professional Certification
Presented by Mike Dubi
When: June 24 - 25, 2013
Where: Kean University, Union NJ
Time: 8:30 - 5 PM
Clinical Trauma Professional Training
Presented by Mike Dubi
When: August 22 - 23, 2013
Where: Child Protection Center
720 South Orange Ave
Sarasota, FL 34236
Time: 8:30 - 5 PM
Contact: Mike Dubi
CONGRATULATIONS NEW CERTIFIED PROFESSIONALS
|Members of March 2013 |
CCTP Training Class, Sarasota, FL
William C. Bartholomew
Heath Jordan Brightman
Gail A. Byers
Richard T. Connelly
John R. DeCarlis
Roberta De Oleo
John L. Dotson
Jackie Grimesy Szarka
Zubeyde Seda Gulvas
Phebee V. Henderson
Julie Marie Holly
Leigh Anne Johnson
Terry L. Livengood
Vanessa L. Mayor
Shirley A. Newcomb
Mary Kate O'Brien
Susan K. Roehrich
Nicholas M. Stanco
Edith von Weltin
Mary Kay Young
Trauma Practice: Tools for Stablization and Recovery
Anna Baranowski, Ph.D.
J. Eric Gentry, Ph.D.
Franklin D. Schultz, Ph.D.
Trauma Competency and EMDR: 3 DVD Set
Linda Curran, BCPC, LPC, CACD, CCDP-D
Mike Dubi, Ed.D, LMHC, President
J. Eric Gentry, Ph.D, LMHC.
Lee Norton, Ph.D., MSW, LCSW,
International Association of Trauma Professionals (IATP)
5104 N. Lockwood Ridge Rd.
Sarasota, FL 34234
The International Association of Trauma Professionals is pleased to announce the next level of of IATP training, the Certified Expert Trauma Professional (CETP). This new credential is a web-based experiential learning opportunity that features working in cohorts. Participants will engage in a 24-week long program that will provide both didactic training and clinical supervision with IATP faculty. Class sizes will be small and there will be ample opportunity to engage with faculty and other cohort members. For more details, contact Mike Dubi at email@example.com.
We are also pleased to announce a new addition to our Board of Directors, Dr. Lee Norton. She has worked with trauma and dissociation for over twenty years. She studied with trauma pioneer Charles Figley, Ph.D., and has taught traumatology at the graduate level at both
|Dr. Lee Norton |
Florida State University and the University of Tennessee. She owns and is director of the Center for Trauma Therapy (CTT), with offices in Franklin, TN and Satellite Beach, Florida. CTT provides a multidisciplinary approach to the treatment of trauma and dissociation. Services include trauma-based psychiatry, intensive outpatient trauma resolution, and trauma-based marriage and family therapy. Dr. Norton has taught extensively on the topic of traumatic stress and dissociation in the US and abroad. Additionally she has applied this knowledge in capital cases, where she has been appointed as an expert witness in the field of social work and the effects of trauma on perception, judgment, and behavior.
We are thrilled and honored that Dr. Norton has joined our team. Her expertise adds a new dimension to our ability to serve our IATP members. See her article below.
Mike Dubi, President
If you would like to submit an article for this newsletter for our consideration, please contact
firstname.lastname@example.org. Please include your complete contact information. Of course, we reserve editorial license.
Dissociation: What Every Therapist Should Know
Dr. Lee Norton
What is it? Dissociation is a phenomenon that erodes the neurological and psychological "glue" that bind together thoughts, feelings, bodily sensations, time, volition, and identity. Mild dissociation is common and is characterized by short bouts of "spacing out." We drive our regular route to work so often that some days we may not be able to recall exactly how we got from point A to point B. Persistent and pronounced dissociation is an automatic, unconscious device used to protect an individual from overwhelming experiences and memories of those experiences. The mind becomes tightly compartmentalized, relegating various categories of information to different aspects of the personality. In extreme cases, the boundaries between cells of awareness become so thick and rigid that the individual may have little or no recall for long periods of time, including what was done, where, and with whom.
What causes it? Though an organic condition (such as temporal lobe epilepsy) can cause dissociation, it is more commonly associated with early childhood neglect and abuse, especially sexual abuse. The correlation between childhood sexual abuse and dissociation was noted over 100 years ago by French and then German-Austrian scientists. Led by Jean Martin Charcot at the world renowned research hospital, Salpetriere, in Paris, dozens of cases of "hysteria" were assiduously observed and recorded, and a large proportion of these patients were found to have sustained "precocious sexual experiences" (child sexual abuse). Modern data support these findings, and indicate that any form of neglect and abuse that occurs during the formative years, and for which there are not sufficient compensatory factors, instinctually impel children to rely upon dissociation for survival. A key question for mental health practitioners is, How much for how long? When toxic factors exceed a child's mental, physical, and emotional resources, dissociation is the likely outcome.
How do we identify it? Because of its insidious effect on cognitive, emotional and physical development, dissociation is considered the great chameleon of mental health disorders. Symptoms are broad and seemingly unrelated. Dissociative patients report anxiety, mood swings, problems with attention and concentration, sleep and eating disorders, agitation, impulsiveness, and problems in all spheres of relationships. Most dissociative patients bring to therapists a "fat file," filled with diagnoses from numerous types of doctors, including family practitioners, psychiatrists, endocrinologists, orthopedists, urologists, gastroenterolgists, and pain management specialists. Patients lament unvanquished problems with drugs and alcohol, compulsive eating, gambling, spending and self harm. They describe an inability to decide upon and complete goals, and an excruciating and incessant internal voice that berates and criticizes them for everything they do and don't do. Even epic accomplishments do not relieve them of a crippling sense of shame and worthlessness. They suffer from irrational fears and panic attacks that often keep them prisoners in their own home. They speak of how they have been betrayed and victimized by their own bodies, and recount endless lists of physical ailments. Migraines, ulcers, irritable bowel disorder, and chronic back and joint pain are only a few of the physical problems seen in dissociative patients. Many doctors and therapists throw up their hands in dismay.
A complex history of mental and physical problems for which no known cause can be found is the first clue that dissociation may be involved. Other indicators include self harm (especially cutting,) and suicidal ideation or gestures. There always exists the temptation to diagnose borderline personality disorder, but this should be resisted and instead each case should be examined through a lens of trauma and dissociation. To this end, all medical and mental health professionals should take a comprehensive trauma history of each patient. Early childhood illnesses, surgery and hospitalizations are especially important data, for these can inspire the helplessness that causes an instinctual dissociative response. Likewise, any indication of direct or indirect sexual misconduct or assault should be addressed openly and compassionately. Family discord and mental illness, accidents, catastrophic losses, and natural disasters all are relevant to an effective evaluation. Most dissociative patients have suffered multiple types of trauma at different ages and stages of life. All these experiences are important threads in the fabric of the treatment strategy.
Besides examining the patient's history through records and interviews, a number of assessments may be used to collect different kinds of data. The Dissociative Experiences Scale, Symptom Checklist, Structured Clinical Interview for DSM Diagnoses, Toronto Alexithymia Scale, are among the growing body of assessments that can help determine the presence of dissociation.
How do we treat it? Dissociation can be difficult to treat but, as with most problems, strong clinical skills and persistence are the keys to good outcomes. Eric Gentry's simple formula provides the best guide: establish a strong working relationship, reverse the chronic physiological dysregulation inherent in traumatic stress and dissociation, and reprocess the trauma without reliving it. Achieving safety and stabilization may take months. There may be many setbacks. Do not be discouraged. Remain committed to self care, vigilant to counter-transference, and always curious about your patient's inner world. For specific guidance about working with the psychological dynamic of dissociation, see Richard's Schwartz' book Introduction to Internal Family Systems (Published by the Center for Self Leadership, Oak Park, IL, 2001; ISBN: 13:978097248009).
Lee Norton, PhD, MSW, LCSW
Founder/Owner, Center for Trauma Therapy
Board Member, International Association of Trauma Professionals
NOT ALL SEX OFFENDERS
by Thomas Glaza, M.A., Ed.D, LMHC, CAP, CSOTS
The Association for the Treatment of Sexual Abusers (ATSA), the international leader in sex offender and victim research, informs us that 1 in 3 girls and 1 in 6 boys are victims of sexual abuse at some time during their childhood. And that many of these crimes go unreported to law enforcement. ATSA informs us that "sexual abuse" can be depicted on a continuum ranging from the seemingly benign act of frotteurism (rubbing against someone while fully clothed) to rape with violence, with many sex-related acts in between.
Prior to the 1990s, persons convicted of a sex-related offense received jail time, which was occasionally followed up with therapy. More often, the allegations of sex-related crimes - especially those committed against minor females by their fathers, step-fathers, brothers or other males - were largely dismissed as being false. Public awareness increased beginning in the 1990s and federal laws were enacted to punish convicted offenders, monitor their movement when returned to the community and to create commitment facilities for those convicted of the most heinous crimes.
As community awareness grew, there was an exponential increase in the number of adults and youths being identified as "sexual abusers." The increase in offender identification evolved from a new openness involving access to information. This population continues to grow each year.
At the same time, the number of mental health practitioners who seek training in this highly-specialized field is woefully insufficient to treat this growing population. It is a well-known fact that strongly-held biases against sex offenders often inhibit therapists from reaching out to this highly stigmatized population. This is not a new phenomenon. In the not-so-distant past alcoholics, drug addicts, gays, lesbians, transgendered persons, and others were ostracized and denied treatment.
IATP is pleased to announce a two-day training that will lead to attendees earning designation as a Certified Sex Offender Treatment Professional (CSOTS). The course was developed by Mike Dubi, Ed.D, LMHC, CSOTS, Thom Glaza, M.A., M. Ed, LMHC, CAP, CSOTS, and Harry Morgan, Ph.D., LMHC, CCSOTS, all of whom have extensive experience treating sex offenders and are active psychotherapists with offices in southwest Florida.
The inaugural Certified Sex Offender Treatment Provider course will be held at the Child Protection Center in Sarasota, Florida on May 2nd and 3rd, from 9:00AM to 5:00PM (registration is from 8:30 - 9). Participants must attend both sessions in order to earn thirteen (13) Continuing Education Units. The cost is $160. Future courses will be offered as the need arises.
This is a unique opportunity for mental health providers, case managers and supervisors to add a valuable tool to your list of competencies. At the same time you can take pride in being at the forefront of a new wave of providers dedicated to setting the standard for the treatment of adult and youthful sex offenders
At the conclusion of the course, students will be able to verbalize a clear understanding of: Federal and State of Florida laws governing convicted sexual abusers; contact vs. non-contact offenses; the misinformation generated and re-enforced by the media; factors that differentiate between male and female offenders and youthful offenders; the co-morbid mental health conditions prevalent among offenders; the rationale for and the types of risk assessments unique to sex offenders; how to administer and analyze a variety of risk assessments; how to conduct a psycho-sexual evaluation; the most efficacious treatment modalities; and the importance of developing appropriate and achievable client treatment objectives.
Play Therapy as an Intervention for Traumatized Children
by Rebekah R. Pender, Ph.D., Kean University
Introduction to Trauma
Children in today's world face a myriad shocking and disturbing events from war and natural disasters to terrorism and increased school shootings. More personal traumatic events experienced by children include car accidents, physical and sexual abuse, and medical procedures. Therefore, childhood trauma continues to be a growing area of concern for counselors and psychotherapists. Trauma can be defined as "a sudden and extraordinary event that overpowers a child's ability to cope and to manage the reactions that are aroused by the event" (Dripchak, 2007, p. 125).
According to Terr (1991), there are two categories of trauma experienced by children. Type I is a sudden, unpredicted trauma that occurs as a single event in the child's life, such as natural disasters or automobile accidents. Type II is recurrent exposure to trauma which the child learns to fearfully anticipate, such as chronic physical or sexual abuse, or living in a war-torn country. A child who falls under the Type II category may develop symptoms that are more acute and severe than those children who experience Type I trauma (Ogawa, 2004).
A child's ability to respond to trauma is dependent upon the age at which the trauma is experienced and involves multiple, subjective dimensions (Dripchak, 2007, p. 125; Subtance Abuse and Mental Health Services Administration, SAMHSA, 2011). Young children up to the age of six years old have been observed through research to play out the traumatic event by recreating it in their imaginary play or by experiencing nightmares related to the event, in addition to being more likely to aggressively act out (SAMHSA). Older children between the ages of seven and 12 "were most likely to report feelings of re-living the trauma and difficulty with expressing sadness or anger" (SAMHSA, p. 1). Previous research has also shown that adolescents between the ages of 13 and 18were more likely to report feeling isolated, guilty and fearful.
Play Therapy to Treat Childhood Trauma
Contingent upon the developmental level of the child being served, children do not possess the requisite verbal and reasoning skills to internally examine and then share their experience verbally; therefore, those who provide trauma counseling must look for other ways to assist the child with communicating their trauma. One such way to do this is with play therapy, which recognizes that play is a child's natural form of communication and concedes that play is the most characteristic manner in which a child may process the traumatic event. Children who have experienced a traumatic event will spontaneously and repeatedly play out the traumatic event with trauma-related play themes referred to by Terr (1990) as "traumatic play" or "posttraumatic play" (Cohen, Chazan, Lerner, & Maimon, 2010). Terr reported that this type of play was noticed in both Type I and Type II trauma.
Play therapy allows the child to express deeply emotional concerns in a safe manner in a secure setting. The Association for Play Therapy
(2012) defines play therapy as "the systematic use of a theoretical model to establish an interpersonal process wherein trained play therapists use the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development" (para. 3). In general, the most prevalent theories (Gestalt, Cognitive Behavioral, Psychoanalytic, Person-Centered, etc.) utilized in the treatment of adults also have theories adapted to play therapy (Schaefer, 2003). The two main types of play therapy are directive and non-directive.
There are a few common modalities for treating children who have experienced trauma, such as creative arts and psychoanalytic, though only trauma-focused Cognitive-Behavioral Therapy has been empirically researched (Cohen, Mannarino, & Rogal, 2001). The theories compared here are Release Play Therapy (RPT), Structured Play Therapy (SPT) and Child-Centered Play Therapy (CCPT). RPT and SPT are directive approaches that utilize toys and objects most specific to the child's experience of trauma in an effort to encourage the child to process the experience through play (Ogawa,2004). According to Ogawa, the therapist may, in an effort to prompt expression of the traumatic experience, recreate the experience with the child. The therapist directs the session to first break down the child's defenses in order to provide the opportunity for the child to master their play, express deleterious emotions, and have successful play outcomes (Ryan & Needham, 2001; Schaefer, 1994).
In CCPT, the therapist is non-directive and thus therapy relies on the child's natural ability to cope and process the traumatic event on their own (Ryan & Needham, 2001). The child is in control of the session, the type of play utilized in the session (symbolic or realistic) and in control of the degree to which emotional distance is experienced, which prevents the child from becoming overwhelmed by emotions associated with the trauma (Ogawa, 2004). The therapist provides unconditional positive regard, empathy, and congruence to the child and allows the child freedom to simply "be" in the session as they wish (Ryan & Needham). While Child-Centered Play therapists attest to the effectiveness of CCPT with children who have experienced traumatic events, there are very few clinical examples in the literature (Ryan & Needham).
In conclusion, children need a safe place to express themselves regarding a single traumatic event or one that has recurred frequently. Directive and non-directive styles of play therapy allow the child to freely and safely explore the intense emotions surrounding their perceptions which they are unable to express verbally. More research is needed to explore the effectiveness of both styles of play therapy for use with children who have experienced traumatic events with special attention given to single traumatic events versus recurring traumatic experiences.
Association for Play Therapy. (2012). Play therapy. Retrieved from http://www.a4pt.org/ps.playtherapy.cfm
Cohen, E., Chazan, S., Lerner, M., & Maimon, E. (2010). Posttraumatic play in young children exposed to terrorism: An empirical study. Infant Mental Health Journal, 31(2), 158-181.
Cohen, J. A., Mannarino, A. P., & Rogal, S. (2001). Treatment practices for childhood posttraumatic stress disorder. Child Abuse & Neglect, 25, 123-135.
Dripchak, V. L. (2007). Posttraumatic play: Towards acceptance and resolution. Clinical Social Work Journal, 35, 125-134.
Ogawa, Y. (2004). Childhood trauma and play therapy intervention for traumatized children. Journal of Professional Counseling, Practice, Theory, and Research, 32(1), 19-29.
Ronen, T. (2002). Difficulties in assessing traumatic reactions in children. Journal of Loss and Trauma, 7, 87-106.
Schaefer, C. E. (1994). Play therapy for psychic trauma in children. In K. J. O'Connor & C. E. Schaefer (Eds.), Handbook of play therapy, (Vol. 2, pp. 297-318). Chichester, UK: Wiley.
Schaefer, C. E. (Ed.). (2003). Foundations of play therapy. Hoboken, NJ: John Wiley & Sons, Inc.
Substance Abuse and Mental Health Services Administration. (2011). Helping children and youth who have experienced traumatic events. HHS Publication No. SMA-11-4642. Retrieved from http://www.samhsa.gov/children/samhsa_short_report_2011.pdf
Terr, L. C. (1990). Too scared to cry. New York: Harper & Row.
Terr, L. C. (1991). Childhood traumas: An outline and overview. American Journal of Psychiatry, 148, 10-19.