Integration of Care – Brown Bag w/ Shomari Harris 4/29/22


Unedited audio transcript (below video) courtesy of Zoom

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Shomari M. Harris: Good good to hear alright so i’m going to share my screen here, and then we can go ahead, well, are you ready to start.

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Melanie she/her: yeah I think I think some people are still going to be coming in, so um maybe maybe just do a quick introduction and then we launched in and as people come in i’ll just let them in okay yeah and you’re The co host now, so you can you should have all the privileges.

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Shomari M. Harris: All right, so everybody can see the screen trauma post traumatic stress disorder yeah okay all right, well, thank you Melanie.

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Shomari M. Harris: Alright, so For those of you that have not met me, my name is show Mari em Harris, I am a.

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Shomari M. Harris: trainer in the team chat program that’s the training and technical assistance program that is housed in the euro of hepatitis HIV in St.

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Shomari M. Harris: eyes and i’m also a clinical social worker by training and I have a private practice so today i’m going to be talking to you all about post traumatic stress disorder hey Kim.

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Shomari M. Harris: good to see you well good to know that you’re here.

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Shomari M. Harris: Alright, so let me know when you want me to go ahead and start.

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Melanie she/her: I think you have a lot of content um, so I think we should go ahead and get started, and I just want to say thank you so much for making yourself available to do this.

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Shomari M. Harris: Well, thank you for having me and I appreciate the opportunity to be here to talk about this, because you know this is as part of the reason why I got into mental health and became a therapist because.

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Shomari M. Harris: I wanted to work with men and boys who have been through the experience of childhood sexual trauma and so ptsd is a big part of that and so anytime I get the opportunity to have conversations like this, and I am very excited because that means somebody is going to increase their awareness.

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Shomari M. Harris: So I appreciate.

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Shomari M. Harris: Alright, so i’m going to go ahead and start and what we can do is i’m going to have my chat window here so monitor that as.

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Shomari M. Harris: i’m speaking so I mean we got a pretty manageable size group here today, so if you have questions feel free to go ahead and.

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Shomari M. Harris: put those in the chat and then i’ll try to answer them as they’re coming in with whatever questions I don’t get to as.

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Shomari M. Harris: movement through the presentation and i’ll come back and answer at the end, and then, if there’s something there’s just absolutely pressing and burning can go ahead and unmute yourselves, and you can interrupt and ask a question that way, if you alright.

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Shomari M. Harris: Alright, so let’s go ahead and look at the overview alright so we’re going to talk about what is trauma.

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Shomari M. Harris: We will define it and we’ll talk about different types of trauma acute trauma current trauma, which is relevant because when we talk about ptsd and complex ptsd, that is the main.

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Shomari M. Harris: difference between the two of them, so we’re going to talk about ptsd and complex ptsd move into healing ptsd related trauma so we’re talking about trauma informed care.

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Shomari M. Harris: of which the role of safety is very important we’ll talk about some screening and diagnostic tools and some evidence based practices that are used in psychotherapy to help.

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Shomari M. Harris: manage or heal trauma and then we’ll briefly talk about stigma and mental health all right alright, so what is trauma.

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Shomari M. Harris: into it so medical settings trauma comment refers to severe physical injuries that require immediate emergency response, however.

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Shomari M. Harris: when applied to trauma informed care it encompasses a wide range of physical, emotional and psychological events and effects across all domains of human function so and medical and medical terms trauma.

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Shomari M. Harris: emergent or physical harm trauma care zooms it for a more global and holistic view of the individual, the group or the system.

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Shomari M. Harris: And so, in the literature, we differentiate between Type one and Type two trauma so Type one is what we call acute trauma.

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Shomari M. Harris: which results from a single exposure to a single overwhelm overwhelming event so is one event, a single exposure that is acute travel.

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Shomari M. Harris: To or chronic trauma a developmental relational or complex trauma results from extended exposure to traumatizing situations.

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Shomari M. Harris: Over time, so the main difference here is that acute trauma is a one time single exposure event, whereas Type two or chronic trauma is something that happens over an extended period of time.

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Shomari M. Harris: And we talked about individual trauma so when we talk about individual channel we’re basically talking about.

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Shomari M. Harris: The experience that happens to an individual so, even if there is let’s say a natural disaster that impacts an entire community of people.

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Shomari M. Harris: Each individual within that community is going to have a different experience of that event for some people.

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Shomari M. Harris: You know, it may not even register as trauma for others it may be because of other mental health conditions or other experiences that they have in their past, it may be, it may register as a more traumatic.

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Shomari M. Harris: event for them, because of those extenuating circumstances so individual trauma results from an event series of events or a set of circumstances.

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Shomari M. Harris: That is experienced by an individual as life threatening, and that has lasting adverse effects on the individuals functioning and mental physical social emotional and spiritual well being.

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Shomari M. Harris: Alright, so here again we’re looking at Type one and Type two Type one is acute singular episodic in nature.

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Shomari M. Harris: Type two is chronic repetitive and happens over time, but can I like this quote here because he kind of encapsulates what the difference is between the two.

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Shomari M. Harris: So, in terms of both experience and exposure to complex inter personal trauma is qualitatively distinct from acute trauma and we say qualitatively because.

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Shomari M. Harris: it’s relative.

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Shomari M. Harris: is very subjective so here we’re highlighting the differences again just like acute one time experiences of tropical.

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Shomari M. Harris: versus the chronic ongoing long term trauma experienced by an individual and we’ll talk more about the types of experiences that can rise to the level of trauma.

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Shomari M. Harris: momentarily However, it is worth noting that.

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Shomari M. Harris: As we’ve talked about trauma is subjective, so what one person experiences as traumatic may not even register as an inconvenience to another so trauma is both relative and subjective and two elements that can make a traumatic experience even more insidious.

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Shomari M. Harris: check in chat here.

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Shomari M. Harris: Alright, so when we think about complex trauma we’re talking about.

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Shomari M. Harris: we’re describing exposure to multiple traumas it also refers to the impact of that trauma is usually interpersonal and the interpersonal aspect is key here, because the interpersonal means that.

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Shomari M. Harris: It happens within the context of an interaction between two or more people for which.

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Shomari M. Harris: That speaks to the chronic nature of the complex trauma and then also the impact is important because we are talking about subjectivity and relativity again.

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Shomari M. Harris: And the nature of trauma so two people can witness or live through the same event.

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Shomari M. Harris: But the impact can be vastly different things like their personal history family environment mental health history, etc, all play a role and that response.

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Shomari M. Harris: So, going back to the list here complex trauma involves being or feeling trapped often planned extreme and gone to ongoing ever repeated and evolve challenges with shame trust self esteem identity and regulating emotions which we’ll talk a bit a bit more about.

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Shomari M. Harris: In a little bit.

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Shomari M. Harris: Alright, so again acute trauma single exposure one off event commonly associated with ptsd or post traumatic stress disorder, which is what we are here to talk about today.

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Shomari M. Harris: And then, in terms of other types of trauma we have cultural trauma historical trauma and multi generational trauma.

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Shomari M. Harris: So when we talk about cultural trauma we’re talking about socially mediated processes that occur when groups and door.

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Shomari M. Harris: horrific events there forever changed their consciousness and identity, so in the image here, you see a group of Jewish people.

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Shomari M. Harris: During the Holocaust, and I think we’re all pretty familiar with the Holocaust and what happened there and how that is a cultural trauma that was experienced by that particular group.

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Shomari M. Harris: of people, they also have historical trauma, which is the cumulative multigenerational collective experience of emotional and psychological injury in communities.

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Shomari M. Harris: And in descendants, and so we have picture of their native Americans or indigenous people as a representation of historical problem.

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Shomari M. Harris: And then you have multi generational trauma your transmission of historical oppression and it’s negative consequences across.

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Shomari M. Harris: Generations, and this is a photo of emmett till so this speaks to the Multi generational trauma most multi generational aspects of trauma that have been experienced by the black American Community.

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Shomari M. Harris: Now it is important to note that historical trauma is multi generational trauma experienced by specific.

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Shomari M. Harris: Cultural racial or ethnic group, and it is related to major events that oppressed particular group of people because of their status as oppressed.

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Shomari M. Harris: such as slavery, the Holocaust forced migration and the colonization of native Americans, so this includes people like black Americans and indigenous people Jewish people.

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Shomari M. Harris: And in the examples, they were listening here, the experience of black Americans, for example, could be used as an example for all three types of trauma because it’s.

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Shomari M. Harris: Its cultural, historical and multigenerational in nation alright so we’re going to get into ptsd So if you ever heard this term before.

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Shomari M. Harris: Really quickly if you could just put one thing that comes to mind when you hear the words post traumatic stress disorder and the chat I like to see like to hear what you all think of when you hear ptsd or post traumatic stress disorder.

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Shomari M. Harris: What comes to mind.

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Shomari M. Harris: veterans dissociation repeats itself long term mental health distress yes war combat yes, so a lot of what we’re saying here is a lot of what people think of immediately think of when.

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Shomari M. Harris: They hear the words post traumatic stress disorder or ptsd and you’re absolutely right, the term first came to fruition, we were talking about veterans, however.

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Shomari M. Harris: There are other groups of people, for which ptsd is a very common response to traumatic events so let’s play a quick video here, where you get a.

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Shomari M. Harris: overview of what ptsd is how it impacts, the body, the different systems at play here, the psychological and emotional responses impacts of any gets into a little bit about how to treat it i’m going to start it here, and then you all can tell me if you can hear it.

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Shomari M. Harris: And you are here okay.

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Shomari M. Harris: Yes, okay.

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Shomari M. Harris: Many of us will experience some kind of trauma during our lifetime, sometimes we escaped with no long term effects, but for millions of US those experiences linger.

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Shomari M. Harris: causing symptoms like flashbacks nightmares and negative thoughts that interfere with everyday life.

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Shomari M. Harris: This phenomenon called post traumatic stress disorder or ptsd isn’t a personal failing rather it’s a treatable malfunction of certain biological mechanisms that allow us to cope with dangerous experiences.

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iPhone: To understand ptsd we first need to understand how the brain processes, a wide range of ordeals, including the death of a loved one domestic violence.

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iPhone: injury or illness abuse, rape war car accidents and natural disasters, these events can bring on feelings of danger and helplessness which activate the brains alarm system known as the fight flight freeze response.

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iPhone: When this alarm sounds the hypothalamus pituitary and adrenal systems, known as the HPA axis what together to send signals to the autonomic nervous system.

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iPhone: that’s the network that communicates with adrenal glands and internal organs to help regulate functions like heart rate digestion and respiration.

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iPhone: The signal started chemical cascade that floods, the body with several different stress hormones, causing physiological changes that prepare the body to defend itself.

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iPhone: Our heart rate speeds up breathing quickens and muscles tense.

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iPhone: Even after a crisis is over escalated levels of stress hormones may last for days, contributing to jittery feelings nightmares and other symptoms.

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iPhone: For most people these experiences disappear within a few days to two weeks as the human level stabilized but a small percentage of those who experienced trauma have persistent problems.

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iPhone: Sometimes vanishing temporarily only to resurface months later.

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iPhone: We don’t completely understand what’s happening in the brain, but one theory is that the stress hormone cortisol may be continuously activating the fight flight freeze response, while reducing overall brain functioning, leading to a number of negative symptoms.

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iPhone: These symptoms often fall into four categories intrusive thoughts like dreams and flashbacks avoiding reminders of the trauma negative thoughts and feelings like fear anger and guilt and reactive symptoms like irritability and difficulty sleeping.

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Not everyone has all these symptoms or experiences them to the same extent and intensity when problems last more than a month ptsd is often diagnosed.

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genetics ongoing overwhelming stress and many risk factors like pre existing mental illnesses, or lack of emotional support likely play a role in determining who will experience ptsd but the underlying cause is still a medical mystery.

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A major challenge of coping with ptsd is sensitivity to triggers physical and emotional stimuli that the brain associates with the original trauma.

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These can be everyday sensations that are inherently dangerous but prompt powerful physical and emotional reactions.

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For example, the smell of a campfire could evoke the memory of being trapped in a burning house.

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For someone with ptsd that memory activates the same neurochemical cascade as the original event that then stirs up the same feelings of panic and helplessness, as if they’re experiencing the trauma all over again.

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Trying to avoid these triggers which is sometimes unpredictable can lead to isolation that can leave people feeling invalidated ignored or misunderstood.

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Like a pause button has been pushed on their lives, while the rest of the world continues around them.

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But there are options, if you think you might be suffering from ptsd The first step is an evaluation, with a mental health professional who can direct you towards the many resources available.

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psychotherapy can be very effective for ptsd helping patients better understand their triggers and certain medications can make symptoms more manageable.

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As consult care practices like mindfulness and regular exercise, what if you notice signs of ptsd and a friend or family member.

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social support acceptance and empathy are key to helping and recovery, let them know you believe their account of what they’re experiencing.

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And that you don’t blame them for their reactions if they’re open to it, encourage them to seek evaluation and treatment ptsd has been called the hidden wound because it comes without outward physical signs, but even if it is an invisible disorder it doesn’t have to be a silent one.

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Mental health conditions impact millions.

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Shomari M. Harris: Alright, so.

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Shomari M. Harris: Some takeaways from just go back yeah some takeaways here are the fight flight or freeze response and sometimes we add another F, which is failing.

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Shomari M. Harris: Which means to feign death, so an instance where a person is experiencing a traumatic event, they might feel the need to fight or.

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Shomari M. Harris: flee or to phrase to freeze or sometimes even feign death in order to avoid the the trauma to avoid the negative experience.

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Shomari M. Harris: Also, that is a treatable malfunction of certain biological mechanisms, which is a nice way of conceptualizing ptsd in a way that doesn’t.

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Shomari M. Harris: Make it sound as though it is something that you’re going to have to deal with, for the rest of your life or that, for which there is no.

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Shomari M. Harris: No treatment that there is a bright light at the end of the tunnel and so some of the types of responses include the avoidant response reactive.

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Shomari M. Harris: Negative thoughts and intrusive thoughts and we’ll get more into some of those symptoms in a minute.

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Shomari M. Harris: And, as described in the video The major challenge here is managing a person’s sensitivity to triggers, which is why.

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Shomari M. Harris: The evidence based practices that we’re going to discuss a little bit later on, have proven effective in treating ptsd because.

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Shomari M. Harris: They can help a person learn to manage the sensitivity and respond and healthier ways when they are stimulated.

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Shomari M. Harris: So again, just a quick review what is ptsd it’s a mental health disorder that’s triggered by a terrifying event either experiencing it or witnessing it.

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Shomari M. Harris: Most people who go through traumatic events may have temporary difficulty adjusting and coping but.

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Shomari M. Harris: The time of self care they usually give better, however, if the symptoms get worse last four months or even years and interfere with day to day functioning than one might have ptsd.

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Shomari M. Harris: And this is just a little infographic that kind of breaks down how the name of the disorder describes exactly what happens in ptsd so ptsd can occur post.

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Shomari M. Harris: or after a traumatic event for which an individual is as an emotionally psychologically mentally or physiologically distressful response that sometimes rises to the level of a disorder.

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Shomari M. Harris: Alright, so let’s take a look at prevalence of ptsd in the US population ptsd will affect approximately 3.5% of adults in the US every year.

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Shomari M. Harris: there’s an estimated one and 11 people will be diagnosed with ptsd in their lifetime, women are twice as likely as men to be impacted by ptsd and.

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Shomari M. Harris: ethnic groups, such as black Americans Latinos and Native Americans are disproportionately affected and have higher rates of ptsd than non white Latinos.

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Shomari M. Harris: Alright, so let’s get into some of the symptoms, they already went into some of this in the videos, I just wanted to kind of give you a.

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Shomari M. Harris: Another look at it and how to conceptualize it so avoiding thinking about the trauma and we’ll also look at this in terms of.

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Shomari M. Harris: The four different groups, so you have intrusive memories recurrent unwanted distressing memories flashbacks which means reliving the event is if it’s happening to you again.

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Shomari M. Harris: there’s upsetting dreams and nightmares severe emotional distress of physical reactions that sometimes remind people of the traumatic event.

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Shomari M. Harris: There are the avoidance sometimes where people try to avoid thinking or talking about the event, they tried to avoid places activities or people that remind them of the event.

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Shomari M. Harris: There are also be reactive symptoms so negative changes in banking and move so negative thoughts about yourself or other people or the world.

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Shomari M. Harris: hopelessness about the future memory problems, including not even remembering important aspects of the traumatic event.

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Shomari M. Harris: difficulty maintaining close relationships feeling detached from family and friends, a lack of interest in activities that we want us to enjoy.

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Shomari M. Harris: difficulty experiencing positive emotions and feeling emotionally know.

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Shomari M. Harris: And then there are also the changes in physical and emotional reactions, such as being easily startled or frightened.

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Shomari M. Harris: Is hyper vigilance, which is a feeling of always being on guard on guard for danger always being on the lookout self destructive behaviors such as drinking too much or driving too fast.

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Shomari M. Harris: trouble sleeping trouble concentrating irritability angry outbursts aggressive behaviors overwhelming guilt and shame and then, when we talk about children.

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Shomari M. Harris: Presentation can be a little bit different depending on the age, so they may have nightmares and they have fearfulness.

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Shomari M. Harris: They may have loss of appetite or difficulty concentrating in school, some may even experiment with jobs, like tobacco or marijuana or even isolate themselves from friends and peers and then, when children under six.

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Shomari M. Harris: Some of the things they may do maybe reenacting the traumatic event during aspects or aspects of the event during play or once again having frightening dreams that may or may not include aspects of the traumatic event, so that is.

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Shomari M. Harris: You mentioned young and what about kids young.

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Shomari M. Harris: Okay, so does that john does that cover your question.

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John S ( Just Me): yeah i’m sorry I jumped the gun when you’re an excellent.

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John S ( Just Me): How about the percentage stuff because you said, like.

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John S ( Just Me): You said 3.5 of the.

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John S ( Just Me): Number like the percentage of here with with the kids.

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Shomari M. Harris: I don’t know right.

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John S ( Just Me): adults and things like that.

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Shomari M. Harris: kids, but I can find out for you.

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John S ( Just Me): I just just curious you know you took the time to do the adults but not, and you mentioned kids here and young adults but didn’t put the percentage value in.

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Shomari M. Harris: You know I mean the oversight on my part, but I can find find out before we get done here and give you that information that okay.

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Shomari M. Harris: And let’s see christina’s and ptsd centers listed appear to combine cognitive processes and behavioral outcomes.

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Shomari M. Harris: These behaviors are often thought of as coping and post a symptoms, how do you differentiate between ptsd system symptoms and coping.

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Shomari M. Harris: behaviors Okay, so this is a good question a lot of times the coping behaviors.

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Shomari M. Harris: are related to the traumatic event, and so, in a few moments we’re going to talk about more about how to diagnose ptsd and this actually leads us into.

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Shomari M. Harris: The conversation about complex ptsd So what we just got through talking about was ptsd that is the result of an acute trauma or a one time event.

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Shomari M. Harris: But when we’re talking about complex ptsd we’re talking about complex trauma that has happened over a period of time and usually for young people were talking about.

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Shomari M. Harris: The period between birth and about 15 years old and so i’m going to play another clip for you all, and then this should start to kind of.

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Shomari M. Harris: jail for you a little bit in terms of differentiating between ptsd and complex ptsd which addresses more of the coping as opposed to behavioral outcome well symptoms and.

00:25:24.540 –> 00:25:26.370
Shomari M. Harris: Those who have been diagnosed.

00:25:27.510 –> 00:25:27.960
Shomari M. Harris: All right.

00:25:35.070 –> 00:25:50.520
Shomari M. Harris: ptsd stands for post traumatic stress disorder, a condition officially recognized in 1982 describe exposure to a relatively brief but devastating event typically a war, a rape an accident or a terrorist incident.

00:25:51.180 –> 00:26:08.580
Shomari M. Harris: Complex ptsd recognized in 1994 describes exposure to something equally devastating, but over a very long time, normally the first 15 years of life emotional neglect humiliation bullying disrupted attachment violence and anger.

00:26:09.240 –> 00:26:16.890
Shomari M. Harris: A lot of us as many as 20% are wondering, the world as undiagnosed sufferers of complex ptsd.

00:26:17.520 –> 00:26:33.060
Shomari M. Harris: We know that all isn’t well, but we don’t have a term to capture the problem we don’t connect up our ailments and we have no clue who to seek out or what sort of treatment might help so here are 12 leading symptoms of complex ptsd.

00:26:33.540 –> 00:26:40.920
Shomari M. Harris: We might think about which ones, if any, apply to us and more than seven might be a warning sign worth listening to.

00:26:41.940 –> 00:26:51.810
Firstly, a feeling that nothing is safe, wherever we are, we have an apprehension that something awful is about to happen, we are in a state of hyper vigilance.

00:26:52.110 –> 00:27:04.770
The catastrophe, we expect often involves a sudden fall from grace, we will be hauled away from current circumstances and humiliated perhaps put in prison and denied all access to anything kind of positive.

00:27:05.310 –> 00:27:15.720
We weren’t necessarily be killed, but to all intense our life will be over people may try to reassure us through logic that reality won’t ever be that bad.

00:27:16.110 –> 00:27:21.630
But logic doesn’t help we’re in the grip of an illness, we aren’t just a bit confused.

00:27:22.380 –> 00:27:33.030
Secondly, we can never relax This shows up in our body we’re permanently tense or rigid we have trouble with being touched, perhaps in particular areas of the body.

00:27:33.390 –> 00:27:45.660
The idea of doing yoga or meditation or breathing exercises these things aren’t just not appealing they may be positively revolting we make all the hippie with a sneer and deeper down, they are of course terrifying.

00:27:46.290 –> 00:27:52.230
Probably our bowels are troubled to our anxiety as a direct link to our digestive system.

00:27:52.860 –> 00:28:04.920
Thirdly, we can’t ever really sleep and we wake up very early generally in a state of high alarm, as though during rest we’ve let down our guard and are now in even greater danger than usual.

00:28:05.820 –> 00:28:23.970
Fourthly, we have deep in ourselves and appalling self image we hate, who we are, we think we’re ugly monstrous repulsive we think we’re awful possibly the most awful person in the world, our sexuality is especially perturbed we feel predatory sickening shameful.

00:28:24.990 –> 00:28:36.210
50 we’re often drawn to highly unavailable people we tell ourselves, we hate needy people, but what we really hate are people who might be too available for us.

00:28:36.630 –> 00:28:46.170
We make a beeline for people who are disengaged won’t want want from us and who might be struggling with their own undiagnosed issues around avoidance.

00:28:47.070 –> 00:28:54.900
Secondly, we are sickened by people who want to be cozy with us, we call these people puppyish revolting or desperate.

00:28:55.680 –> 00:29:02.580
Seventh, we are prone to losing our temper very badly, sometimes with other people more often just with ourselves.

00:29:02.970 –> 00:29:15.930
We aren’t so much angry as very, very worried worried that everything is about to become very awful again we are shouting because we’re terrified we look mean we are in fact defenseless.

00:29:17.100 –> 00:29:30.870
Eighth, we are highly paranoid it’s not that we expect other people will poison us or follow us down the street, we just suspect that other people will be hostile to us and we’ll be looking out for opportunities to crush and humiliate us.

00:29:31.290 –> 00:29:40.680
We can be mesmeric Lee drawn to examples of this happening on social media, the unkindest and most arbitrary environment which anyone with complex ptsd.

00:29:40.950 –> 00:29:48.390
easily confuses with the whole world, chiefly because it operates like their world randomly and very meanly.

00:29:49.260 –> 00:30:05.130
Ninth we find other people so dangerous and worrying that being alone has huge attractions, we might like to go and live under a rock forever in some moods we associate a bliss with not having to see anyone again ever.

00:30:06.390 –> 00:30:19.080
10th we don’t register to ourselves as suicidal but the truth is that we find living so exhausting and often so unpleasant we do sometimes long not to have to exist anymore.

00:30:20.100 –> 00:30:32.880
11 we can’t afford to show much spontaneity we’re rigid about our routines everything may need to be exactly so as an attempt to ward off looming chaos we make clean a lot.

00:30:33.330 –> 00:30:37.890
sudden changes of plan can feel indistinguishable from the ultimate downfall we dread.

00:30:38.880 –> 00:30:47.070
12 in a bit to try to find safety we may throw ourselves into work amassing money fame on a prestige.

00:30:47.580 –> 00:30:56.310
But, of course, this never works, the sense of danger and self disgust is coming from so deep within we can never reach a sense of safety externally.

00:30:56.580 –> 00:31:11.970
A million people can be cheering but one year will be enough once again to evoke the self disgust, we have left unaddressed inside breaks from work can feel especially worrying retirement and holidays create unique difficulties.

00:31:13.410 –> 00:31:19.920
Those are the symptoms, so what is the cure for all these arduous symptoms of complex ptsd.

00:31:20.670 –> 00:31:31.440
Partly, we need to courageously realize that we have come through something terrible that we haven’t until now properly digested because we haven’t had a kind stable environment in which to do so.

00:31:32.340 –> 00:31:42.900
We are a little wonky because long ago, the situation was genuinely awful when we were small someone made us feel extremely unsafe, even though they might have been our parent.

00:31:43.350 –> 00:31:53.520
We were made to think that nothing about who we were was acceptable in the name of being brave, we have to enjoy some very difficult separations perhaps repeated over years.

00:31:53.940 –> 00:31:58.740
No one reassured us of our worth we were judged with intolerable harshness.

00:31:59.400 –> 00:32:06.450
The damage may have been very obvious but more typically it might have unfolded in objectively innocent circumstances.

00:32:06.810 –> 00:32:13.950
A casual visitor might never have noticed, there might have been a narrative which lingers still that we were part of a happy family.

00:32:14.700 –> 00:32:27.150
One of the great discoveries of researchers in complex ptsd is that emotional neglect within outwardly high achieving families can be as damaging as active violence in obviously deprived ones.

00:32:27.810 –> 00:32:38.160
If any of this rings bells we should stop being brave, we should allow ourselves to feel compassion for who we were that might not be easy, given how hard we tend to be with ourselves.

00:32:38.670 –> 00:32:44.610
The next step is to try to identify a therapist or counselor trained and how to handle complex ptsd.

00:32:45.180 –> 00:32:53.340
That may well be someone trained, specifically in dealing with trauma, which involves directing enormous amounts of compassion towards one’s younger self.

00:32:53.700 –> 00:33:03.780
In order to have the courage to face the trauma and recognize its impact on one’s life rather touchingly and simply the root cause of complex ptsd.

00:33:04.320 –> 00:33:18.030
Is an absence of love and the cure for it follows the same path we need to really learn to love someone, we very unfairly hate beyond measure ourselves.

00:33:22.260 –> 00:33:34.440
Shomari M. Harris: Alright, so I think going back to this was christina’s question about how do you differentiate between the symptoms and the coping behaviors a lot of times the coping behaviors are the symptoms.

00:33:34.950 –> 00:33:41.490
Shomari M. Harris: Of ptsd and there’s one of the ways that you know that a person or you’re able to diagnose, a person with.

00:33:42.420 –> 00:33:55.530
Shomari M. Harris: Complex ptsd as opposed to regular ptsd so what you have on the slide now is a symptom well the complex ptsd symptom clusters, so you have things like.

00:33:55.770 –> 00:34:01.620
Shomari M. Harris: Problems will affect regulation problems with safety and impulse control problems with attention and.

00:34:02.010 –> 00:34:19.140
Shomari M. Harris: attention and state stability and dissociation problems with identity and self perception problems with body image and some Madison ization and problems with systems, meaning problems with relationships and attachments and so i’m not sure how many of you are familiar with.

00:34:20.220 –> 00:34:28.110
Shomari M. Harris: personality disorders, but one of the personality disorders that frequently is associated with or come confused but.

00:34:28.770 –> 00:34:36.510
Shomari M. Harris: In many instances we’re trying to move away from this diagnosis and diagnose people with either complex trauma disorder or complex ptsd.

00:34:36.750 –> 00:34:47.670
Shomari M. Harris: Because the symptoms have such a large overlap, but borderline personality disorder is a mental health disorder that impacts, the way you think and feel about yourself and others.

00:34:47.940 –> 00:34:57.000
Shomari M. Harris: causing problems with functioning and everyday life, and it includes self image issues difficulty managing emotions and behavior and a pattern of.

00:34:57.240 –> 00:35:06.900
Shomari M. Harris: unstable relationships and borderline is a highly stigmatized in order to do to the perceived difficulties and treatment and the level of relational dysfunction with which.

00:35:07.200 –> 00:35:11.970
Shomari M. Harris: Patients often present now one of the reasons why we are moving toward.

00:35:12.330 –> 00:35:20.790
Shomari M. Harris: A diagnosis of complex ptsd or complex trauma disorder, as opposed to borderline personality disorders, because of the stigma.

00:35:21.060 –> 00:35:29.040
Shomari M. Harris: But also the extreme overlap in the symptoms, if you weren’t if I would have borderline personality something’s up here right next to.

00:35:29.280 –> 00:35:38.340
Shomari M. Harris: Complex ptsd symptoms, the only difference between the two is that with borderline personality disorder that there is a fear of abandonment.

00:35:38.820 –> 00:35:50.550
Shomari M. Harris: But all of the other symptoms look exactly the same, but if you mentioned complex ptsd or complex trauma disorder and a medical or mental health setting.

00:35:50.940 –> 00:36:00.990
Shomari M. Harris: Nobody BATs an eye, but if you say that a person has borderline personality disorder, all of a sudden, all the red flags and the alarms go off and there’s already a stigmatized.

00:36:01.500 –> 00:36:13.320
Shomari M. Harris: view of this person and what their treatment or the potential for their treatment is going to look like so frequently there’s overlap between the symptomatology of CT sd which is complex.

00:36:14.070 –> 00:36:24.600
Shomari M. Harris: Post traumatic stress disorder and other mood and anxiety disorders such as major depressive disorder generalized anxiety bipolar disorder and panic disorder and with.

00:36:25.230 –> 00:36:37.320
Shomari M. Harris: personality disorders, like we talked about with borderline personality disorder so in many instances, the ptsd is the root cause for and or exaggerates a pre existing condition.

00:36:38.280 –> 00:36:52.200
Shomari M. Harris: Alright, so we’ll keep moving here so again, the differences between ptsd and cpt see ptsd is that ptsd is caused by a single event is recognized and the DSM five as an official diagnosis.

00:36:52.500 –> 00:37:05.670
Shomari M. Harris: Whereas cpt see ptsd is caused by long lasting trauma that continues or repeats for months or even years is typically the result of some sort of childhood trauma and is not yet recognize and the DSM.

00:37:06.090 –> 00:37:15.120
Shomari M. Harris: Typically, someone with C ptsd or complex trauma disorder will be diagnosed as having borderline personality disorder.

00:37:15.690 –> 00:37:25.560
Shomari M. Harris: So some of the leading causes of ptsd childhood trauma and one of the major causes of see ptsd is childhood sexual abuse.

00:37:26.010 –> 00:37:33.990
Shomari M. Harris: And then there’s also repetitive abuse so complex trauma disorder is caused by repetitive abuse which could be physical, emotional or.

00:37:34.260 –> 00:37:42.540
Shomari M. Harris: Sexual so a child who is sexually abused, particularly when victimized by more than one relative or family member begins to see the world as.

00:37:42.840 –> 00:37:47.190
Shomari M. Harris: Difficult and unsafe place and they feel like there is no hope or no escape.

00:37:47.520 –> 00:37:58.770
Shomari M. Harris: From the danger and they feel like they have absolutely no control over the situation and continue to feel unsafe, even when the danger is gone and so going back to what.

00:37:59.280 –> 00:38:07.200
Shomari M. Harris: Christina was talking about earlier about coping children learn to cope, and a lot of the ways that children cope when they are younger and dealing with trauma.

00:38:07.860 –> 00:38:17.940
Shomari M. Harris: Those same coping skills don’t necessarily translate into adulthood, and so that’s when you’ll see for particularly for a lot of people who go through childhood sexual abuse.

00:38:18.480 –> 00:38:31.350
Shomari M. Harris: Long about late 20s early 30s is when some of those systems or coping mechanisms began to break down and that’s when either they see severe negative or adverse.

00:38:31.980 –> 00:38:43.890
Shomari M. Harris: consequences in their life or that’s what prompts them to go into therapy or to seek treatment so in terms of childhood sexual abuse the prevalence of it.

00:38:45.180 –> 00:38:52.980
Shomari M. Harris: One of every 10 children will either experience either has experienced abuse is experienced with us, or will experience abused.

00:38:53.250 –> 00:39:00.840
Shomari M. Harris: By the time that they are 18 years old, and so you may have heard the statistics about one in four girls and one in six boys.

00:39:01.170 –> 00:39:09.540
Shomari M. Harris: will experience sexually abused by their 18th birthday and this particular figure one in 10 was derived from a study done by a.

00:39:09.900 –> 00:39:15.240
Shomari M. Harris: group called darkness to light, which is a nonprofit that fights against sexual child sexual abuse.

00:39:15.510 –> 00:39:23.640
Shomari M. Harris: And the study was conducted in 2014 as a analytical review of all the available literature at that time on, childhood sexual abuse.

00:39:24.000 –> 00:39:34.740
Shomari M. Harris: And the study found that the figure of one in 10 for all children was a more accurate representation of childhood sexual abuse prevalence with an American society.

00:39:37.350 –> 00:39:39.750
Shomari M. Harris: Alright check chat here okay.

00:39:41.130 –> 00:39:43.020
Shomari M. Harris: All right, so how do we heal ptsd.

00:39:44.070 –> 00:39:48.720
Shomari M. Harris: Strong going back to some informed care, which is what we talked a little bit about at the top.

00:39:48.990 –> 00:39:57.930
Shomari M. Harris: So trauma informed care is a movement from what is wrong with you to what happened to you, this is a shift in the thinking that we as providers must have and.

00:39:58.260 –> 00:40:08.520
Shomari M. Harris: Not there’s something wrong with the client, but something happened to them that is creating the circumstances and the reactions and the behaviors that they are exhibiting and today.

00:40:09.180 –> 00:40:19.170
Shomari M. Harris: So trauma informed care can be seen as a universal design for serving trauma survivors and the entire system is used as a vehicle for the intervention.

00:40:19.470 –> 00:40:29.340
Shomari M. Harris: And it is a strengths based framework that is grounded and an understanding of and responsiveness to the impact of trauma that emphasizes physical.

00:40:29.970 –> 00:40:43.140
Shomari M. Harris: psychological and emotional safety for both providers and survivors and it creates opportunities for survivors to rebuild a sense of control and empowerment.

00:40:44.250 –> 00:40:50.910
Shomari M. Harris: The original pillars three pillars safety connections and managing emotions and.

00:40:51.810 –> 00:40:59.820
Shomari M. Harris: Not so long ago, and that was updated to include trauma knowledge safety choice empowerment and cultural.

00:41:00.210 –> 00:41:08.280
Shomari M. Harris: Competence, and so, for the purposes of today, let us talk a little bit more about the role of safety so.

00:41:08.730 –> 00:41:18.810
Shomari M. Harris: Again requirements of trauma informed care organization wide commitment to translate principles into concrete practice across all programming so in terms of the role of safety.

00:41:19.560 –> 00:41:28.350
Shomari M. Harris: Their psychological and emotional elements consistency predictability compassion empathy empowerment through education so with consistency.

00:41:28.740 –> 00:41:39.240
Shomari M. Harris: You know, do what you say you will do be a stable calming presence in presence in the lives of your clients predictability it fosters reliability safety managers expectations.

00:41:39.570 –> 00:41:51.930
Shomari M. Harris: position staff as result reliable collaborators and the patient’s care and creates predictable schedules and scheduling compassionate looks like having cultural humility and cultural curiosity empathy.

00:41:52.530 –> 00:42:01.350
Shomari M. Harris: learn to identify and articulate your understanding of the feelings and emotions your clients are experiencing and one of the things I always share with people is that.

00:42:02.100 –> 00:42:06.450
Shomari M. Harris: Even though you may not understand or have the similar experience as your client.

00:42:07.140 –> 00:42:15.210
Shomari M. Harris: experiences are unique but emotions are universal, we all know what it means to be happy, we all know what it means to be sad, we all know what it is to be.

00:42:15.570 –> 00:42:21.000
Shomari M. Harris: Anxious So even if someone is presenting who you with an experience that is foreign to you.

00:42:21.600 –> 00:42:31.260
Shomari M. Harris: Trying to access and understand the emotional experience will go a long way and creating a safe environment and then with the empowerment through education knowledge is power.

00:42:31.800 –> 00:42:38.820
Shomari M. Harris: trusted your clients can make their own meaning of information and we’ll ask for assistance when necessary.

00:42:39.120 –> 00:42:47.550
Shomari M. Harris: And then, safety and trustworthiness can be established through such practices as empowering intake procedures kind and respectful interactions.

00:42:47.850 –> 00:43:05.010
Shomari M. Harris: Having the ability to control some aspect of the physical space providing clear information about the programming ensuring informed consent, creating safety plans and demonstrating predictable expectations and then in terms of the physical and environmental elements.

00:43:06.750 –> 00:43:12.450
Shomari M. Harris: You want to create car, the one you want there to be a balance between Community and individual spaces.

00:43:12.870 –> 00:43:19.140
Shomari M. Harris: And you want to create trigger fee free spaces that avoid damn lighting that avoid chemical spells that.

00:43:19.530 –> 00:43:27.270
Shomari M. Harris: avoid disruptive behavior they incorporate natural lighting so things like the design of the waiting room, creating a welcome space.

00:43:27.690 –> 00:43:34.560
Shomari M. Harris: Soft colors relaxing music artwork those things are important considering dedicated spaces and entrances so.

00:43:35.160 –> 00:43:40.800
Shomari M. Harris: Consider having different interests for or waiting options for individuals may not feel safe around.

00:43:41.160 –> 00:43:51.360
Shomari M. Harris: Other people in this can include spaces, particularly for children for women for families or individuals who need personal waiting spaces to care for their mental health.

00:43:51.720 –> 00:43:56.010
Shomari M. Harris: And then, make sure that you’re holding conversations about incorporating security barriers.

00:43:56.370 –> 00:44:03.660
Shomari M. Harris: At your facility so this could include having cameras screenings at the door, based on the needs and the desires of the.

00:44:03.990 –> 00:44:12.270
Shomari M. Harris: Community make sure that you posting information, ensure that there’s a list of patient rights and responsibilities that are posted around your clinic so that.

00:44:12.600 –> 00:44:27.030
Shomari M. Harris: People can understand the expectations of themselves and the staff and then reflect on the area around your clinic so consider if that space has any barriers to client safely accessing your your Center or.

00:44:27.540 –> 00:44:44.460
Shomari M. Harris: The place where they’re going to be coming to receiving care Are there things that are preventing them from entering so if so have these conversations develop conversations with clients and staff about how to resolve those barriers and implement recommendations.

00:44:45.750 –> 00:44:55.680
Shomari M. Harris: Alright, so in terms of diagnosing ptsd the current diagnostic criteria include there being an exposure to a traumatic stress in.

00:44:56.400 –> 00:45:06.480
Shomari M. Harris: The development of the characteristics syndrome that involves re experiencing avoidance numbing and hyper arousal symptoms and things that we’ve talked about in the video and reviewed, a little bit earlier.

00:45:06.840 –> 00:45:23.040
Shomari M. Harris: And it should last or in order to rise to the level of having a diagnosis of ptsd for at least one month, and they should be clinically significant distress or impairment in social or occupational functioning.

00:45:23.640 –> 00:45:30.780
Shomari M. Harris: So, in order to have a comprehensive assessment of ptsd, we need to make sure that we are evaluating all the diagnostic criteria.

00:45:31.080 –> 00:45:45.900
Shomari M. Harris: That we assess the associated features assess the call more bit disorders and it’s again is going back to what Christina was talking about when you’re assessing associated features and assessing co morbid disorders So is there a depression was a previous.

00:45:46.590 –> 00:45:54.300
Shomari M. Harris: diagnosis of anxiety if you’re dealing with someone who is maybe having a mood disorder like bipolar disorder.

00:45:54.720 –> 00:46:04.920
Shomari M. Harris: Are there aspects of the bipolar disorder that are informing the coping or the behaviors that might be representative of ptsd diagnosis.

00:46:05.190 –> 00:46:14.430
Shomari M. Harris: And we do all this, so that we can establish a differential diagnosis, which means that we’ve considered all the possible diagnoses and landed on ptsd.

00:46:14.850 –> 00:46:22.380
Shomari M. Harris: As the final diagnosis, based on the evidence that is presented in front of us by the client.

00:46:23.250 –> 00:46:29.820
Shomari M. Harris: So here are a few screening tools they’re literally several dozen screening tools that you can use for ptsd.

00:46:30.180 –> 00:46:37.170
Shomari M. Harris: Many of them are self reports and meaning that you can give the form to a client and they can check it off for themselves and score themselves.

00:46:37.410 –> 00:46:46.620
Shomari M. Harris: And then you as a provider can take a look at that and begin to decide whether or not or determine whether or not there needs to be further evaluation so.

00:46:47.190 –> 00:46:55.080
Shomari M. Harris: Here, the primary care of ptsd screen so it’s a five items sprain or this done by a mental health professional or provider.

00:46:55.380 –> 00:47:07.350
Shomari M. Harris: You have the span, which is four items for questions, which is a shortened version of a longer 10 question or 10 items screen called the Davison trauma scale, this is also a self report.

00:47:07.740 –> 00:47:17.040
Shomari M. Harris: The short post traumatic stress disorder rating interview or sprint is an eight items self report and then there’s the trauma screen questionnaire, which is a 10.

00:47:17.400 –> 00:47:27.570
Shomari M. Harris: Item screen that is done by a mental health professional or a doctor in a clinical setting and then in terms of treating ptsd.

00:47:28.020 –> 00:47:36.120
Shomari M. Harris: Here are some of the evidence based practices that work best with ptsd and part of the reason why these particular.

00:47:36.840 –> 00:47:55.620
Shomari M. Harris: work well with ptsd particularly with complex ptsd or complex trauma disorder is because they work on managing the behavioral symptoms and the identity symptoms so cognitive behavioral therapy, which is one that is pretty common that people.

00:47:57.450 –> 00:48:04.470
Shomari M. Harris: People use or are have gone through it, the guiding principle for that one is changed the way one thinks, you can change the way one.

00:48:04.830 –> 00:48:10.140
Shomari M. Harris: behaves and then there’s cognitive processing therapy, so the guiding principle, there is that.

00:48:10.560 –> 00:48:23.070
Shomari M. Harris: you’re trying to learn to evaluate and change the upsetting thoughts that you have about the trauma you’re able to process your failings process your responses in a way that helps you to manage and mitigate them.

00:48:23.520 –> 00:48:38.460
Shomari M. Harris: there’s also DDT which is dialectical behavioral therapy the guiding principle here is that if you can identify help one to identify their strengths and negative patterns of thinking, then you can boost their confidence and self efficacy, this goes back to.

00:48:39.630 –> 00:48:52.320
Shomari M. Harris: The feelings of the identity issues and having an inconsistent sense of self, and also as one of the videos mentioned about the Inter personal struggles that people have.

00:48:52.920 –> 00:49:06.420
Shomari M. Harris: DVD and transfer transference focus psychotherapy really help with that the guiding principle for tfp is integrating once disparate images of self into one consolidated whoa.

00:49:08.640 –> 00:49:18.540
Shomari M. Harris: Okay, so Christina San Diego and recommendations for which going to use in a typical setting where people were HIV services, so the just go back here.

00:49:19.440 –> 00:49:29.610
Shomari M. Harris: So the show any of these short form screenings like the span, which is a self report or the sprint, which is also a self report would be.

00:49:29.940 –> 00:49:36.900
Shomari M. Harris: A good screeners have used because it’s something that you can give a person, while they are maybe waiting to be seen by the provider.

00:49:37.200 –> 00:49:45.240
Shomari M. Harris: Or if you give it to them, while you’re actually in the session with them and they can fill it out there, and you can begin to actually ask them questions that they have them.

00:49:45.750 –> 00:49:57.840
Shomari M. Harris: and any of the self reports can also be done by the provider and sometimes what I like to do if I suspect that the client has ptsd is even if I do a self report with them, I give them the option of.

00:49:58.290 –> 00:50:08.430
Shomari M. Harris: either going through it item by item with them or giving them the opportunity to do it by themselves, and again that goes back to you know how we create a collaborative.

00:50:08.670 –> 00:50:18.510
Shomari M. Harris: Experience for the clients and create a sense of agency, because we’re giving them choice and we’re letting them make decisions about their own care all right.

00:50:20.640 –> 00:50:32.490
Shomari M. Harris: Then briefly with stigma stigma around mental health stigma the perception that certain attributes make a person unacceptable the different from others, leading to prejudice and discrimination against them.

00:50:32.940 –> 00:50:44.670
Shomari M. Harris: For several types of stigma public systemic and self public self Stigma is also called interpersonal segments, so this is discrimination and evaluation by others systemic or.

00:50:45.360 –> 00:51:02.220
Shomari M. Harris: structural or institutional Stigma is reduce access to care and resources to do to policies and then their self or internalized stigma which is an internalization of negative stereotypes about ones self so.

00:51:02.850 –> 00:51:08.820
Shomari M. Harris: Looking here, and you know we have public or into personal self and internalized institutional and structural.

00:51:09.150 –> 00:51:20.910
Shomari M. Harris: So stereotypes and prejudices for public stigma would be people with mental illness are dangerous and competent to blame for their disorder even unpredictable and how does that manifest and discrimination.

00:51:21.480 –> 00:51:27.570
Shomari M. Harris: And what employers may not hire them landlords may not rent them the healthcare system may offer a lower standard of care.

00:51:28.170 –> 00:51:36.480
Shomari M. Harris: Then there is the internalize those stereotypes and prejudices might be for sound like i’m dangerous and competent or i’m to blame.

00:51:36.900 –> 00:51:49.290
Shomari M. Harris: And the discrimination might look like having thoughts that lead to lower self esteem and self efficacy or thinking why try someone like me is not worthy of good health and then institutionally.

00:51:49.770 –> 00:52:00.660
Shomari M. Harris: Stereotypes might be embodied in laws and other institutions, and then the discrimination either intended or unintended is a loss of opportunity.

00:52:02.640 –> 00:52:07.590
Shomari M. Harris: And this graphic here just gives you an example, what Sigma Sigma Sigma can.

00:52:07.890 –> 00:52:16.770
Shomari M. Harris: sound like so here are a lot of things that you know people, you may have heard in your own life or you may have actually said about someone or your clients may have said to you.

00:52:17.190 –> 00:52:27.030
Shomari M. Harris: that people have said about them, so you shouldn’t have kids you pass on your issues and so selfish should be you everyone has anxiety, some people are just stronger than you are.

00:52:27.360 –> 00:52:33.060
Shomari M. Harris: therapy and medications I just scan so you don’t need all that all women are a bit bipolar.

00:52:33.360 –> 00:52:42.810
Shomari M. Harris: Mental illness is just an excuse to live off of benefits and not contribute to society so These are the things that sometimes people do and say.

00:52:43.080 –> 00:52:52.080
Shomari M. Harris: That creates stigma around mental health, so how can we combat these things well here are a few things we can do we can talk openly.

00:52:52.380 –> 00:53:04.710
Shomari M. Harris: About mental health, we can be conscious of the language that we are using and remind people that words matter, we can choose empowerment over shane educate ourselves and others and will respond to.

00:53:05.070 –> 00:53:18.840
Shomari M. Harris: The misconceptions or the negative comments by sharing facts and experiences we can encourage quality equality between physical and mental illness draw comparisons to how they would treat someone with cancer or diabetes.

00:53:19.170 –> 00:53:29.880
Shomari M. Harris: be honest about treatment normalized mental health treatment, just like we, like other health care, treatment and show compassion for folks with mental illness.

00:53:30.540 –> 00:53:46.440
Shomari M. Harris: Alright, so I know that that was a lot and try to get through it as quickly as possible, but be thorough and now it’s on you what questions do you all have comments considerations musings pondering reflections.

00:53:48.210 –> 00:53:51.720
Shomari M. Harris: Things that you’d like more information about you can unmute yourself, where you can put it in the chat.

00:53:55.560 –> 00:53:57.330
Marcelo Maia’s iPhone: yeah may I ask the question.

00:53:57.810 –> 00:54:02.730
Marcelo Maia’s iPhone: Sure, when you add to that substance use.

00:54:04.260 –> 00:54:17.100
Marcelo Maia’s iPhone: Any New York City there’s an epidemic from that means what I heard very often is methamphetamine would affect how people feel or can express their feelings can you use a little bit.

00:54:18.000 –> 00:54:22.350
Shomari M. Harris: Or how methamphetamine for substance use can impact the way people feel.

00:54:23.370 –> 00:54:26.370
Marcelo Maia’s iPhone: And how that affects people with ptsd.

00:54:27.300 –> 00:54:42.450
Shomari M. Harris: Okay okay so, particularly with methamphetamine if that’s an interesting the substance, because part of what happens with methamphetamine is that it could be boring sensations in people.

00:54:44.220 –> 00:54:53.700
Shomari M. Harris: make people are sexual and particularly in New York City, a lot of men and the gay community or MSM is.

00:54:55.200 –> 00:54:55.650
Shomari M. Harris: websites.

00:54:56.670 –> 00:55:05.400
Shomari M. Harris: Part of the reason why it’s become so popular in the communities, because it does allow one to kind of numb themselves from the emotional and psychological distress.

00:55:05.640 –> 00:55:17.460
Shomari M. Harris: That they may be experiencing it heightens the sexual experience and the sex drive and it creates a space where people feel uninhibited and free to maybe.

00:55:18.210 –> 00:55:32.160
Shomari M. Harris: Think do and act in ways that they may feel more restricted when they are not under the influence and so the simple answer to your question is particularly with methamphetamines it can be.

00:55:32.910 –> 00:55:40.980
Shomari M. Harris: It can be something that is numbing for a person, but at the same time activating it can know all those negative thoughts, it can know all those.

00:55:41.250 –> 00:55:58.110
Shomari M. Harris: Those a bad feelings, but then it can also activate a person in ways that they may not have access to when they are sober but also the interesting thing about methamphetamine is that that particular high.

00:55:59.550 –> 00:56:05.520
Shomari M. Harris: Is kind of like you’ve heard the phrase you know chasing the high well as we do it more and more.

00:56:06.030 –> 00:56:18.930
Shomari M. Harris: there’s less of that feeling less of that good feeling, and so it can exacerbate the already present mental health challenges, whether it’s depression or anxiety, a lot of times people on.

00:56:19.590 –> 00:56:36.690
Shomari M. Harris: methamphetamine or crystal meth will experience extreme bouts of paranoia and if you’re already someone who was experiencing ptsd or even complex ptsd is going to exaggerate all of those already present symptoms and behaviors and also create.

00:56:37.740 –> 00:56:53.490
Shomari M. Harris: potentially create a circumstance, where the person can’t even access the resources that are available to help them because of the ways that it has distorted the way they view the world and the people in it and the people that are available to help them.

00:56:55.320 –> 00:56:58.950
Shomari M. Harris: Deborah is saying can’t adults develop complex trauma yes.

00:56:59.610 –> 00:57:05.220
Shomari M. Harris: Yes, if you have an adult who’s in a situation where they let’s say a person is in.

00:57:05.490 –> 00:57:19.800
Shomari M. Harris: A relationship or intimate partner, violence and they’ve been married for a married or you know partner for about 10 years and let’s say five years of that you know they were experiencing physical abuse emotional abuse psychological abuse.

00:57:20.700 –> 00:57:26.910
Shomari M. Harris: very likely the person who is an adult can experience or develop complex trauma disorder.

00:57:29.490 –> 00:57:33.210
Shomari M. Harris: Oh backup one slide okay let’s see here.

00:57:39.990 –> 00:57:43.020
Shomari M. Harris: What other questions comments reflections.

00:57:44.340 –> 00:57:54.960
Shomari M. Harris: I will, I have a question for you all, if Lucy Kimberly saying hasn’t been evidence of high marijuana use someone people who met so evidence of high marijuana use or the efficacy of marijuana yes.

00:57:57.120 –> 00:58:03.780
Shomari M. Harris: i’m going to say that, instead of saying hi marijuana use, because that would be a little more stigmatized, especially because here in New York City.

00:58:04.020 –> 00:58:21.870
Shomari M. Harris: marijuana is legal now, but is marijuana something that can help to relieve some symptoms of ptsd and complex ptsd very much so, and it is one of the ways that people are able to self medicate even before the legalization of.

00:58:22.470 –> 00:58:24.360
Shomari M. Harris: Because, if you think about what marijuana does.

00:58:24.750 –> 00:58:31.950
Shomari M. Harris: And many people marijuana is going to act as either a stimulant or depressant depending on what is happening in their environment.

00:58:32.190 –> 00:58:42.660
Shomari M. Harris: So if you have a person who is already experiencing symptoms of hyper vigilance and hyper arousal and even if they’re not around other people that they want to calm down, just to be able to.

00:58:42.900 –> 00:58:54.750
Shomari M. Harris: sleep, because one of the things that we talked about with ptsd and with complex ptsd is an inability to sleep and when people don’t sleep, the whole host of other challenges that can happen and so.

00:58:55.200 –> 00:59:02.370
Shomari M. Harris: part of what can happen to a person with ptsd or complex ptsd is they can develop a dependence on.

00:59:02.970 –> 00:59:25.410
Shomari M. Harris: A substance like marijuana or tobacco or alcohol or other substances that initially start off as a coping tool or mechanism that allows them to be able to manage a particular one particular symptom but ends up being something that they become dependent on and let’s see.

00:59:27.300 –> 00:59:39.060
Shomari M. Harris: In the chat medical marijuana what is that for a person who seeks therapy yet lives in a toxic environment is constantly reminded of the traumatic experiences that brought them to their current situation.

00:59:39.840 –> 00:59:47.490
Shomari M. Harris: So this is this is interesting because this one of the challenges that we sometimes face as mental health providers is.

00:59:48.180 –> 00:59:58.860
Shomari M. Harris: You are faced with a client who has been traumatized or severely traumatized by a particular experience or particular person or group of people that they.

00:59:59.400 –> 01:00:06.300
Shomari M. Harris: have to either live or engage on a regular basis, and so the challenge there if.

01:00:07.200 –> 01:00:15.330
Shomari M. Harris: If you can’t if the person cannot remove themselves from that situation like ultimately that will be what we want to happen is, we will want to remove the person from.

01:00:15.630 –> 01:00:25.830
Shomari M. Harris: That situation let’s say, for example, you know we’re talking about a young person who doesn’t have the ability to just move out on their own well let’s say that we’re talking about someone who is.

01:00:26.160 –> 01:00:41.340
Shomari M. Harris: In messick partnership, where you know, maybe they don’t have the resources or the financial stability, to be able to move out on their own, so it then becomes about how to manage the situation that they are currently and.

01:00:42.690 –> 01:00:50.400
Shomari M. Harris: i’m working with a client and therapy and our maybe we’re doing DVD or maybe we’re doing cvt are doing.

01:00:52.230 –> 01:01:07.620
Shomari M. Harris: Focus cycle therapy then we’re helping them to manage their responses and or learn to manage their responses in that situation or to that situation, with the goal of trying to figure out a way to.

01:01:08.730 –> 01:01:23.760
Shomari M. Harris: Stop the abuse from occurring or to remove them from that situation, but that is a very it’s a very complex situation to deal with because in a lot of instances, you will be dealing with people that are still in the traumatic environment let’s see.

01:01:25.200 –> 01:01:37.980
Shomari M. Harris: let’s see Marcel also heard about magic mushrooms, yes, that is one of the things that people have used to treat ptsd billy is saying what is john for personal six therapy oh yeah we got that one.

01:01:40.170 –> 01:01:43.290
Melanie she/her: yeah so john has his hand up, and I think that.

01:01:44.940 –> 01:01:49.470
Melanie she/her: way, but I think that’s the last question um.

01:01:51.150 –> 01:01:51.480
Melanie she/her: john.

01:01:52.680 –> 01:01:55.980
Melanie she/her: Hannah okay so john and then Kimberly you’re going to close this out okay.

01:01:56.220 –> 01:01:58.920
John S ( Just Me): Yes, thank you, Dr How is this is really, really great.

01:02:00.540 –> 01:02:02.100
Shomari M. Harris: Clinical social worker mountain doctor.

01:02:03.060 –> 01:02:04.770
John S ( Just Me): Okay, you said you had your own.

01:02:07.410 –> 01:02:19.800
John S ( Just Me): i’m curious how often does this get bts gets misdiagnosed mean you know if i’m a drug addict and you know my do a lot of suicidal things and things like that there.

01:02:20.820 –> 01:02:26.010
John S ( Just Me): You know i’m classified as one thing, but yet if I were to fill out the self evaluation.

01:02:27.030 –> 01:02:35.370
John S ( Just Me): And there’s six questions on there, how many of those questions that I take that would just say automatically that I was ptsd without even knowing ptsd.

01:02:36.060 –> 01:02:46.290
Shomari M. Harris: So this is where having a detailed history of your client becomes really, really important, because you can have people present with depression, you can have people.

01:02:46.710 –> 01:02:55.740
Shomari M. Harris: With anxiety, you can have people present with symptoms of ptsd you can have people present with symptoms of substance use or.

01:02:56.400 –> 01:03:09.780
Shomari M. Harris: or even abuse and those symptoms can overlap and this kind of goes back to what we’re talking about and assessing all of the comorbidities so that we can make a differential diagnosis, so if I have someone presenting in front of me.

01:03:10.080 –> 01:03:14.820
Shomari M. Harris: who may be experiencing a depression, but it’s also exhibiting.

01:03:15.450 –> 01:03:26.190
Shomari M. Harris: Anxious symptoms that may look like they are part of a constellation of symptoms that could lead to a diagnosis of ptsd where i’m going was i’m going to delve.

01:03:26.460 –> 01:03:35.400
Shomari M. Harris: or inquire more fully about what their experience has been because for people, particularly with complex.

01:03:35.910 –> 01:03:46.710
Shomari M. Harris: trauma disorder or even that have a diagnosis of borderline personality disorder in many instances they’re very high correlations between childhood sexual trauma.

01:03:47.130 –> 01:04:03.690
Shomari M. Harris: And those two diagnoses, so if a person is coming to me, and they already have a diagnosis from another provider of borderline personality disorder they already, let me know that there’s the potential for childhood sexual trauma and the thing about childhood sexual trauma is that.

01:04:04.710 –> 01:04:15.780
Shomari M. Harris: For a person to really receive the help that they need, they have to feel really comfortable and safe with their provider so, particularly with men, but this happens with women as well.

01:04:16.230 –> 01:04:20.340
Shomari M. Harris: Particularly with men men will have been in therapy, they will have.

01:04:20.700 –> 01:04:29.700
Shomari M. Harris: You know, a provider or a doctor that they trust or even have respect they feel has their best interests at heart, but they don’t feel safe enough to be able to.

01:04:29.940 –> 01:04:37.530
Shomari M. Harris: Talk about the experience of childhood sexual trauma because of stigma and so a lot of times what will happen is I will have.

01:04:37.860 –> 01:04:45.060
Shomari M. Harris: A young man or you know even adult man in front of me who might be 3040 years old and.

01:04:45.510 –> 01:04:53.220
Shomari M. Harris: it’s just now, for the first time ever, revealing or disclose someone that they haven’t explored childhood sexual trauma.

01:04:53.640 –> 01:05:04.800
Shomari M. Harris: And is a lot of times they’re not even asked, but even when asked they don’t feel safe or comfortable enough to have that level of conversation and to be that vulnerable.

01:05:05.040 –> 01:05:15.870
Shomari M. Harris: With their providing because vulnerability is something that is it’s frightening to them because vulnerability is what made them a survivor in the first place.

01:05:19.020 –> 01:05:20.160
Shomari M. Harris: Is that helpful to you john.

01:05:20.340 –> 01:05:23.520
John S ( Just Me): yeah I got it I got it yep Thank you.

01:05:24.270 –> 01:05:25.440
Shomari M. Harris: Alright, well, thank you.

01:05:27.990 –> 01:05:38.430
Kimbirly Mack: Summer you said somewhere in your talk about the person needing to learn to love or that person who.

01:05:40.650 –> 01:05:41.340
Kimbirly Mack: Really.

01:05:42.870 –> 01:05:45.240
Kimbirly Mack: put them in pain, or something like that can you.

01:05:45.540 –> 01:05:49.950
Shomari M. Harris: Well, not necessarily learning the person who was injurious to them.

01:05:50.970 –> 01:06:02.640
Shomari M. Harris: Re learning to love themselves, even though they have had all these experiences or had experiences with people who made them feel like they were unworthy of love.

01:06:05.400 –> 01:06:07.350
Kimbirly Mack: Okay, and you um.

01:06:08.640 –> 01:06:09.120
Kimbirly Mack: What.

01:06:10.980 –> 01:06:12.840
Kimbirly Mack: How do you help somebody that.

01:06:15.060 –> 01:06:17.010
Kimbirly Mack: Like their family.

01:06:19.140 –> 01:06:20.430
Kimbirly Mack: They weren’t protected.

01:06:23.100 –> 01:06:24.240
Shomari M. Harris: How do you help someone.

01:06:24.510 –> 01:06:27.240
Kimbirly Mack: yeah and it’s yeah.

01:06:28.050 –> 01:06:31.290
Shomari M. Harris: it’s there’s really no simple answer to that question.

01:06:31.290 –> 01:06:44.310
Shomari M. Harris: yeah but one of the the main principles that I tend to practice in my work or sexual trauma survivors is being someone passionate and willing to stand in witness.

01:06:45.180 –> 01:06:54.090
Shomari M. Harris: Because psychoanalysis what we call standing and witness is the beginning of the healing process for trauma and so sometimes.

01:06:54.450 –> 01:07:03.660
Shomari M. Harris: One of the most powerful things that a person can have is someone to listen to them and to validate their experience and that’s what we call standing and witness to.

01:07:04.020 –> 01:07:13.110
Shomari M. Harris: The traumatic experience and then you can take that a step further and actually be someone who is willing to not only stand in witness.

01:07:13.350 –> 01:07:13.740
Shomari M. Harris: But to.

01:07:14.280 –> 01:07:25.410
Shomari M. Harris: Create for this person what we call an emotionally corrective experience, where, if you are someone who is experienced most people in your life is being untrustworthy.

01:07:25.740 –> 01:07:34.110
Shomari M. Harris: Then, that means I need to be trustworthy in this therapeutic relationship and I need to do that consistently so that you can learn that.

01:07:34.440 –> 01:07:44.040
Shomari M. Harris: If that type of experience can happen with me as your provider, that we can then translate that into other relationships that you have in your life and it’s not just.

01:07:44.610 –> 01:07:57.600
Shomari M. Harris: Best not just you know relegated to trustworthiness, but many aspects of what it means to have a relationship with friends and family can be invoked or the.

01:07:57.870 –> 01:08:15.690
Shomari M. Harris: The pathological aspects can be evoked in psychotherapy or even psychoanalysis to help people to really learn those experiences and have that emotion, to correct it experience, yes, the slides Melanie does have the slides and is going to send them out to everyone correct.

01:08:16.170 –> 01:08:21.480
Melanie she/her: Yes, and I did send them the IOC, but if you weren’t on that list you did not get them and so i’m happy to send.

01:08:21.480 –> 01:08:22.200
Marcelo Maia’s iPhone: them students.

01:08:22.770 –> 01:08:29.640
Melanie she/her: In the room right now i’m I don’t have all of your emails because I don’t know who all of you are but.

01:08:30.120 –> 01:08:41.040
Melanie she/her: But anyone who’s in the room, right now, I can make sure that they get a copy and I just want to say thank you so much, yes it’s a lot of information, but um you can also send me questions for sure maury.

01:08:42.720 –> 01:08:43.230
Melanie she/her: yeah.

01:08:43.530 –> 01:08:43.950

01:08:46.320 –> 01:08:47.910
Shomari M. Harris: known in the chat as well.

01:08:48.420 –> 01:08:52.800
Melanie she/her: You can send questions to Mario directly and we’re really.

01:08:54.570 –> 01:08:59.220
Melanie she/her: Really value the contributions that he’s made throughout the process, because.

01:08:59.910 –> 01:09:08.970
Melanie she/her: We actually first heard got a really amazing presentation from you should Mari on during needs assessment which really talks got into.

01:09:09.720 –> 01:09:17.970
Melanie she/her: The importance of trauma informed care, and so we wanted to be sure to make this available as we’re putting together the behavioral health directive so that folks.

01:09:19.050 –> 01:09:34.980
Melanie she/her: If not you know at least had some sort of lens to what is happening among in behavioral health and like things that we need to be thoughtful about when when developing that guidance so big shout out tomorrow Thank you again.

01:09:36.570 –> 01:09:44.940
Shomari M. Harris: This is the work that I like to do so, I appreciate you all, you know being amenable to this and inviting me and because you know and.

01:09:46.500 –> 01:09:54.390
Shomari M. Harris: As we, as we say, this is the hidden one, so this particular ptsd this particular diagnosis and, more specifically, complex.

01:09:56.070 –> 01:10:03.870
Shomari M. Harris: Like yesterday, are one of the things that impact so many people, because you know when we think about one in 10 children experiencing sexual trauma.

01:10:04.320 –> 01:10:13.710
Shomari M. Harris: Those shows, and eventually become adults, and so we have what 16 people right now, so the 15 speaking, that means at least one or two people.

01:10:14.340 –> 01:10:25.170
Shomari M. Harris: On this call, right now, may have that experience and maybe someone who is struggling with ptsd or complex ptsd or complex trauma disorder and maybe don’t even realize it.

01:10:26.430 –> 01:10:30.930
Melanie she/her: Agreed agreed and i’m I would be willing to say that that’s probably an underestimate.

01:10:31.590 –> 01:10:43.230
Melanie she/her: Especially when you start getting into these services, because a lot of people are drawn to this work, because of their experiences, but I just want to tell everybody to have a wonderful weekend and thank you so much for taking time out of your Friday know moving.

01:10:43.440 –> 01:10:43.800
Melanie she/her: Your new.

01:10:44.520 –> 01:10:49.890
Melanie she/her: Meeting, and thanks to everyone who made it from the IOC you guys are my heroes.

01:10:50.010 –> 01:10:52.560
Shomari M. Harris: thanks again tomorrow, thank you.

01:10:53.610 –> 01:10:54.990
Graham Harriman He Him His: Thank you amazing work.

01:10:55.890 –> 01:11:02.460
Shomari M. Harris: Thank you, and feel free to email i’ll put my do he email address there, and also my personal so.

01:11:03.150 –> 01:11:05.220
Shomari M. Harris: feel free to reach out all right.

01:11:05.550 –> 01:11:08.280
Melanie she/her: All right, you guys are going to sign off everyone have a great day.