SASS Counselling Model RELATIONSHIPS

Transcription

1 SASS Counselling Model RELATIONSHIPS THE ROLE OF THE COUNSELLOR PSYCHOEDUCATION EMOTIONAL REGULATION PROCESSING TRAUMA BUILDING SELF ESTEEM, RESILIENCE, & CAPACITY SAFETY ADVOCACY ATTACHMENT Sexual Assault Support Service Inc 1

2 SASS COUNSELLING MODEL Sexual assault is an extreme form of interpersonal trauma that attacks the personhood of the individual. The effect on the brain and the body of such interpersonal trauma leaves the person feeling powerless; provokes fight, flight and freeze responses in them; and, has a profound effect on their relationships. Understanding the experience of the client and the impact that sexual assault has had on them is the beginning point of providing an effective counselling intervention. Sexual Assault Support Service Inc 2

3 Relationships Psycho-education Emotional Regulation Processing Trauma Building Self-Esteem, Resilience and Capacity Normalizing the client s experience by providing information Establishing the congruence of the client s response to their experience of sexual assault Identifying client responsivity factors Actively working to engage the client Establishing interactivity as a core underpinning to the therapeutic relationship Using facilitative selfdisclosure on behalf of the counsellor to engage the client Providing immediacy of response Modelling respectful relationships Building rapport with the client and their families, carers or support people Sharing information about age/stage appropriate Providing a safe place Providing linkages between the safe counselling site and other places such as home or school through the use of transitional objects (e.g. providing give aways / take aways such as stress balls, books or star bags) Using ritual (e.g. sharing a cup of tea or coffee) Using creativity to establish connections to the client s story Establishing relationship based learning - tailoring counselling style to client learning style (e.g. sensory, auditory, visual) Identifying individual client triggers and contracting to use them in an agreed strategy Using co-regulation to model self-regulation teaching techniques such as bio- Listening to and understanding the client s story Explaining what trauma is in order to normalize the client s and their family s, carer s and supporter s understanding of their situation Creating congruence and proportionality in the trauma narrative Establishing a mutually respectful relationship Understanding what is therapeutic/countertherapeutic for each client Identifying and acknowledging each client s window of tolerance Enabling the development of client agency within the therapeutic relationship Recognizing the impact of interventions on the client s boundaries determining the Providing a pleasant welcoming physical environment with good quality resources Establishing object permanence in order to develop attachment to symbols and place creating a place of safety. Validating the individual and regarding the client as worthwhile Providing acceptance Establishing mutual regard Noticing and acknowledging client s talents and strengths Understanding and explaining the relationship between stress and capacity (client tolerance) Maintaining hope and establishing a sense of predictability that the future might hold goods things Using unpredictable events to strengthen resilience - Sexual Assault Support Service Inc 3

4 responses with the client and their families, carers and support people Developing awareness and educating about attachment feedback Modifying the physical environment (e.g. teachers use of time-out room) speed, scope and depth of interventions within a safe framework Modelling boundaries with the client Linking stimuli to responses for the client helping them map their journey Teaching and modelling mood regulation techniques Responding to the client s sensitivities, boundaries, and capacity to cope Monitoring the emotional engagement between the counsellor and the client and the client and their significant others Confronting cognitive distortion exploring exceptions through narrative therapy Recognizing and reinforcing the motivation and strength of the client to engage in change Witnessing and validating change Issuing challenges Tapping creativity through the use of art, dance, music Sharing fun and good times Breaking down isolation Sexual Assault Support Service Inc 4

5 Safety Advocacy Psycho-education Emotional Regulation Processing Trauma Building Self-Esteem, Providing multi-system interventions at individual, family and community level Providing community education and information programs to increase community understanding of the issues associated with sexual assault Providing professional training and development programs to enhance the capacity of other services to work more effectively with victims of sexual assault Providing information to family, school, child protection etc in order to locate/normalize the client s behaviour and response to sexual assault Providing information and statistical data placing the incident in an ecological framework Connecting the client with their internal responses response mapping Identifying triggers and danger helping the client to understand their own arousal patterns Providing reality testing Providing an understanding of the stress escalation context of emotional regulation and supporting significant others to implement de-escalation strategies with the client - attune, validate, contain, sooth Facilitating awareness in families of other family members arousal patterns Supporting schools and families in developing and implementing arousal management strategies Developing individualized behaviour management plans Providing resources such as Establishing safety Understanding what is a safe pace for the individual to process trauma Using external resources to help normalize the situation (e.g. the use of library books - bibliotherapy) Offering supportive services (c.f. therapeutic services) Responding with immediacy - grounding Providing consistency, constancy, and continuity Identifying the client s capacity to explore and make choices about interventions and actions Understanding client s approach/avoidance behaviour Understanding different life stages and their impact on the client s capacity to process trauma Honouring what is happening Resilience and Capacity Ensuring that the client knows that their situation is not their fault Distinguish between guilt and shame Respecting and honouring the client s choice to deal with their issues validating Using a strengths focus building on resilience and hope Not judging client s coping mechanisms providing deep acceptance Reframing symptoms as coping mechanisms providing unconditional positive regard Instead of focussing on what is wrong with you, focus on what is right with you Identifying safe place strategies for clients to use when facing their challenges Engaging in capacity building Sexual Assault Support Service Inc 5

6 Working with the client to develop an understanding of their responses to trauma (hopelessness, grief, loss, and anger) Developing the client s self protection capacity Teaching and modelling respectful and pro-social behaviour Identifying and responding to functional and dysfunctional coping mechanisms such as substance abuse, hyperarousal, dissociation, risktaking, and self harm bio-feedback systems to assist in mood regulation Fostering increased understanding of behaviour in order to increase tolerance Identifying and validating client s changes and improvements Delivering parenting skills programs for the client Working to extend the window of tolerance activities and games - giving positive reinforcement (e.g. dance program) Facilitating access to good quality resources and services Honouring the extended family in order to support parents or carers to build resilience in their child Giving permission to the client to recognize achievements and have a go Sexual Assault Support Service Inc 6

7 Attachment Psycho-education Emotional Regulation Processing Trauma Building Self-Esteem, Resilience and Capacity Providing information about the concept of attachment and explaining how trauma impacts on attachment Grounding the client s behaviour in theory Acknowledging developmental changes over time Teaching behaviour modelling techniques to parents Teaching parents to play and engage with their children Observing and providing feed back about family interactions Providing advocacy in schools Identifying the client s environmental or system contexts and establishing consistency of messages (e.g. across family and school) Skilling and supporting parents to assist their children with emotional regulation Teaching appropriate attachment behaviour including when certain behaviours are not OK Working with whole family systems on establishing appropriate boundaries Using reality therapy in families with members who have complex problems providing systems advocacy on behalf of family members Honouring the client s original attachments Creating a soothing environment Modelling positive and Grounding the client by relating their behaviour to trauma Helping to articulate an alternative story using narrative therapy Acknowledging that disclosure can dislocate other attachment relationships (e.g. extended family) helping the client to process and manage this Acknowledging the significance of attachment figures and dealing with relationship ambivalence Identifying family system patterns that involve adult codependency and scapegoating Using client-centred approach to guide the phasing of interventions Protecting and developing attachment at key points in the therapeutic relationship Using attachment to the counsellor to offer self-esteem support to the client Using trust in the counselling relationship to ground normalization and support the client when facing challenges Extending the capacity of the client through promoting their success Modelling positive competitive behaviour Supporting the client in recovering from failure Helping them to hold onto their tale of a positive journey strengths focus Articulating choice and acknowledging the client s power to make choices Building broader family resilience through engaging them positively with other services Managing service exiting in a Sexual Assault Support Service Inc 7

8 effective attachment styles in the therapeutic relationship Establishing consistency the counsellor needs to display empathy but not mood or affect escalate with the client Modelling the repair of dislocated relationships Modelling sustaining a relationship over time sharing new breakthroughs of understanding with parents and supporters in order to support a positive response to the client from them Mobilizing trust in the therapeutic relationship in order to use desensitization strategies Using resources including transitional objects to help clients process trauma Balancing the victim s contact with the perpetrator by taking into account attachment, trauma and safety issues advocacy role positive way (e.g. graduation ritual) acknowledging that the client has the capacity to take the next step for themselves Sexual Assault Support Service Inc 8

9 The Role of the Counsellor Psycho-education Emotional Regulation Processing Trauma Building Self-Esteem, Build rapport as a pre- cursor to psycho-education Link interventions to assessment - recognising that assessment involves client centred cognitions which identify barriers and potentials Use theory to inform assessment and synthesize practice Use developmental and trauma check lists to assist in the design of interventions choose tools that are client specific Use a range of interventions including cognitive and creative methods that are age appropriate and take into account the neurobiology of the brain Use symbols to establish an age appropriate shared language with the client Introduce normalization Use the client s language of choice to establish a shared language and facilitate insight Provide a non-threatening and non-clinical counselling environment which honours and validates the client Use interpersonal and symbolic congruence in the counselling relationship and environment Use auditory, visual, kinaesthetic, and cognitive tools to integrate the client s understanding of meaning Assess the impact of trauma on the client s capacity to selfregulate provide them with the opportunity to learn selfsoothing Apply an understanding of the nature of trauma and intervention sequencing build on an understanding of the impact of trauma on the Recognize that the client s capacity to process and integrate fluctuates Recognize that the counselling process doesn t necessarily have to work directly on the trauma Recognize that trauma will be processed in different ways at different stages of life use expressive and other relevant therapies Support the client to feel the pain of the trauma while being held in a safe counselling relationship Identify and extend the therapeutic window without overstretching the client s tolerance Acknowledge and respect the client s approach-avoidance behaviours Recognize that it may be necessary to reprocess the Resilience and Capacity Reinforce that the client is not to blame and distinguish between guilt and shame Break the client s isolation by linking them to others who have had similar experiences - use group work as an intervention where appropriate Take a holistic approach by working with the client in the context of their family and community Provide community information programs about sexual assault and related issues Use counsellor behaviour modelling strategies Sexual Assault Support Service Inc 9

10 techniques at the front end of the therapeutic relationship Engage in the here and now being mindful of future options and goals Create safety Recognize that a client s grasp of a concept can form a stage or finalization of part or whole of the therapeutic relationship validation, integration, consolidation Recognize the impact of trauma on developmental issues understand the fit for each client Apply an understanding of the neuro-sequential development of the brain Apply an understanding of the impact of sexual assault Provide education and information programs to facilitate normalization of the client context brain match interventions to the age at the trauma injury Locate the intervention response in an appropriate cultural context Deliver client centred practice same issue at various different developmental stages of the client journey to recovery Sexual Assault Support Service Inc 10