Counseling Techniques
Given the prevalence of individuals who suffer with both SUDs and PTSD as a result of trauma, counselors really need to be able to address trauma-related issues. Therefore, counselors look to other therapeutic techniques that are useful in treating trauma. Two techniques, that have been found helpful for PTSD are clinical hypnosis (Kluft, 2016; Platoni, 2013; Poon, 2009) and Eye Movement Desensitization Response (EMDR) (Shapiro, 1989a, 1989b, 1995; Harford, 2010) have been used extensively to help individuals contain the impact of their traumatic symptoms. Clinical hypnosis has been employed in the treatment of various types of trauma for quite some time. Unfortunately, both clinical hypnosis and EMDR require extensive specialized training; however, many SUD counselors can be more easily trained in utilizing techniques such as diaphragmatic breathing, guided imagery and progressive muscle relaxation, which can be mastered more quickly. Eye Movement Desensitization Response (EMDR) treatment, has been found to be an effective technique when used to treat traumatized clients. Also, EMDR has no contraindications for those experiencing SUD. Similarly, clinical hypnosis can also be utilized to treat traumatized individuals. EMDR and clinical hypnosis do not entirely rid a person of traumatic recollections but both approaches do allow the client to gain control over these often debilitating symptoms (Harford, 2010).
In addition, there is a therapeutic approach to managing trauma or what SAMHSA (Substance Abuse & Mental Health Services Administration, 2015) refers to as a trauma-informed approach. A program, organization or treatment is considered to be “trauma-informed” when it addresses the following (often referred to as the “4 Rs”):
- (1) realizes the widespread impact of trauma and understands the potential paths for recovery
- (2) recognizes the signs and symptoms of trauma in clients, families, staff and others involved with the system
- (3) responds by fully integrating knowledge about trauma into policies, procedures, and practices ... and
- (4) seeks to actively resist re-traumatization of the client
It’s important to explain what’s meant by “actively resisting re-traumatization of the client.” Here, counselors need to take their lead from where the client is and not force the client to re-live traumatic memories at times when he or she is not prepared to or willing to do so. An example would be instances where combat veterans were essentially forced to re-experience traumatic combat experiences in order to do extinction training (this is a behavioral technique derived from classical conditioning models, in which a client is asked to “re-live” a traumatic memory either by having them describe the traumatic incident in great detail or watching videos that would simulate the traumatic memory). When the client is not prepared or willing to re-live these traumatic memories it can bere-traumatizing. As counselors, it’s important to work collaboratively with our clients to bring about change and not force them to re-live traumatic experiences when he or she feels unprepared to do so (see Boxed Item 2.3).
There are also six key principles to the trauma-informed therapeutic approach.
- (1) safety
- (2) trustworthiness and transparency
- (3) peer support
- (4) collaboration and mutuality
- (5) empowerment, voice and choice
- (6) cultural, historical and gender issues
Safety refers to the notion that trauma-informed counseling always provides a safe atmosphere for the client and his or her family. Counseling sessions become a safe place for the client and/or family to share their fears, concerns, difficulties and any other areas they wish to explore. Trustworthiness and transparency are essential in any counseling relationship. Counselors must be conscientious in explaining the counseling process to clients and to be faithful in keeping commitments. Trust is built upon consistency. There’s an old saying, “People we trust are those who say what they do and they do what they say,” such that actions and words are consistent. In terms of transparency it’s important that counselors let clients know well in advance when they may be taking time off or may be unable to meet with their client. It’s also important for counselors to be transparent about their own reactions and feelings and to provide clients with regular feedback.There are many support groups for people who have experienced trauma. Peer support groups are often an essential component of trauma-recovery just as 12-Step and other addiction support groups (e.g. SMART recovery) are essential to SUD recovery. But here’s the key thing. In referring someone to a support group it’s best when the group is composed of individuals who have experienced similar trauma. For example, it’s helpful to have a group made up of combat veterans; though generally it’s not helpful to mixViet Nam veterans with Operation Iraqi Freedom veterans, just as it’s not as helpful to mix Operation Desert Storm veterans with Operation Enduring Freedom (Afghanistan) veterans. Similarly, we would not mix sexual assault survivors with incest survivors.
The SAMHSA website (2015) also provides links to trauma-informed care treatment models such as ATRIUM (Addiction & Trauma Recovery & Integration Model), Seeking Safety and TAMAR (Trauma, Addiction and Mental Health Recovery), which are helpful models that provide counselors with ways to address both substance use disorder and trauma.
In addition, “collaboration and mutuality” refer to the need to work collaboratively when addressing trauma-related issues, while “empowerment, voice and choice” addresses the need for trauma survivors to be able to tell their story and to begin to express to trusted others what they have gone through in an effort to gain better understanding and support. Finally, it is important for counselors and others working with trauma survivors to take culture, history and gender issues into account when working with trauma survivors. For example, gender issues are
Psychoanalytic Theory 35 of the utmost importance in the description of Kim’s trauma and the responsibility she felt as the only female Marine in her unit and as part of her helicopter crew.
