In a recent article written by one of my mentors Dr. Odeyla Kraybill titled, 'I May Not Be The Therapist For You', she touches on a reality that resonates with my lived experience:
"Find if you can, a therapist that uses a trauma approach, not a modality."
What Dr. Kraybill suggests here is, there is no one trauma treatment modality that can act in treatment circles as applicable to all who've suffered trauma in our lives. We are each unique individuals. Our sources of traumatization are as unique as we are an individual. There is no one-size-fits-all treatment modality that can be generically applied to fit all-comers.
The negative mental health outcomes of traumatization, however: this is common-ground.
Post Traumatic Stress Disorder, Depression, and Substance/Alcohol Use Disorders (I focus on these as I've lived them all): All of these conditions have pretty much the same clinical presentation. There may be subtle expressions of symptoms that only a trained-eye can see as part of the exhibition of symptoms not listed in common, clinical references to the conditions, but for the most part if we have any of these traumatic stress induced issues, our symptoms over-all will be pretty much the same, and will be specific to the manifestation of each.
To review signs and symptoms related to the above conditions, please follow this link to Here To Help BC.
I suffered trauma as a paramedic, learning over time that I brought to the table when I entered the work not only a naive understanding about how psychologically/physiologically dangerous the work can be: I also know today that I came into the work with unresolved trauma from childhood in the form of the Adverse Child-hood Experience of intense bullying across my developmental years in life.
I'd suffered periods of depression off-and-on as an outcome of this experience. Prior to my ambulance career, however, I'd worked to resolve my childhood issues and issues in my family of origin following the death of my father to cancer which pushed me towards asking myself the right questions.
Too common are adverse childhood experiences to Canadians on the whole. Even with some of these potentially traumatizing child-hood events in our lives, some who experience such things will develop mental health issues. Others will not. As stated earlier we are, each one, a unique human being, and we've developed resiliency skills in varying degrees across our life-span.
Did this bullying prior to the work confuse my response to the traumas I personally experienced in the work that continue to haunt me?
I'd argue perhaps: Most certainly this prior bullying experience set me up to mistrust others, and it certainly left behind a response to stress in my life that is all-about 'fight' rather than 'freezing' or 'fleeing' or 'submitting' to anything that might resemble bullying to me as an adult.
Regardless: I, along with many others, were, in fact, bullied out of employment by our employers, peers, and workers compensation systems. Systems love to find any pre-existing conditions or issues that systems can then use to skirt their own responsibilities for worker safety.
Responses to trauma, I argue, are as unpredictable as the traumas themselves. We may carry with us a variety of snakes from our past in a bag. That doesn't change much when due to unexpected traumatization we find ourselves struggling to rebound from the experience.
With trauma issues being for too long in Canada a misunderstood, frightening, and underrated-destructive-force in the society, my own generation of public safety workers were not even warned about the potential for mental health issues developing in us due to traumatic stress injuries, let alone were we provided with the compassionate care and treatment the issues demanded once we were stricken.
In policing and in the military, these servants to the rest of us carry the daily, very-real threat of losing their lives, or may face circumstances where they are required to take the life of another in defense of themselves. Across public safety there is danger of accident and physical death. We experience the levels of actual threat to self in varying degrees, but that threat is there from the moment we put on a uniform to serve each day across career or military deployment that puts us in harm's way.
That said, I've learned that no matter how prepared we think we may be in such profession to face the pain and suffering of others without becoming attached to the pain these others express, the potential for sensitive, perhaps more-highly empathetic individuals to vicariously experience the suffering of a fellow-human-being is actually quite high.
It's my view that this empathetic sensing of the pain or death of a fellow-human-being that can produce in the body and brain traumatic stress injuries that lead to negative outcomes in terms of our mental and physical health.
With this potential being high, many in roles as paramedics, fire-fighters, dispatchers and a variety of other care providers will be traumatized in the work. In this line of work, traumatic experience is a fact of work-life.
I wasn't educated to respect this reality. I know far too many from these helping professions from my own generation who were.
I was not granted information prior to the work that prepared me psychologically to face traumatic experiences.
Where in the general population we know that every human-being will experience at least a single traumatizing event across a typical life-span that can go-on to develop issues with mental health, for those in care-professions, public safety professions, and in the military, these individuals will be exposed to an estimated 300-600 potentially traumatizing experiences across the course of career.
I'd argue, as others successfully do, that this potential is actually much higher in the public safety worker community.
Recently completing a survey for a research project in the works by the Canadian Institute for Public Safety Research and Treatment, an initiative of the Collaborative Center for Justice and Safety out of the University of Regina in Canada:
My own answers to the survey reflected that I'd taken in over 1500 potentially traumatizing events across my own sixteen year career in rural service as a British Columbia Paramedic. Of these 1500 potentials, I've identified key traumatic calls that ultimately manifested into the mental health issues I struggle with today.
I'd like folks to agree: There is no way to adequately predict who in the population will be traumatized by experiences in life.
But, we will be traumatized.
Some of us will at least once experience traumatization. Others, by virtue of chosen-roles in vocation, will more frequently experience traumatization in the course of our duties in employment-in paramedicine, social-health-care-worker professions, policing, justice system work, and in the military.
The exposure to traumatic events is higher than for the general population in these demographics in Canada.
This is fact, no longer open to debate.
Therefore, it is to be expected on the part of our medical systems, social services systems, employers in these professions, in family, and across Canadian Society that many living among us are struggling with issues of trauma. I encourage that it's time we all ACCEPT reality, and it's time for society on the whole to get very real:
Human-Beings will be traumatized in life, at least once. Human-Beings who've experienced Adverse Childhood Experiences of trauma will develop mental health issues as an outcome of such experience. Historical and Inter-generational Trauma persists as an outcome of colonization in Canada, impacting Canada's First Nations Peoples at a very deep level.
Many who present as homeless are dealing with unresolved trauma.
Many who are addicted (in fact, I argue along-side Dr. Gabor Mate-all) are dealing with unresolved trauma.
This is a FACT of Canadian life. A fact we can no longer ignore.
So let's get real and let's all work together to structure a cohesive network of collaborative human-beings in this country and let's together create a unified understanding of trauma, PTSD, Depression, Substance-Use Disorder, and other mental-health consequences of traumatic stress injuries.
Let's agree to get busy constructing streams of care that make much more sense that what we're continuing to do today.
We've a number of trauma-and-violence informed care-providers working today in Canada who are in private practice. For any-and-all who wish to improve their relationship with life, at any level, trauma-issues/addictions included, those with resources of affluence are able to access care with as quick an exchange between seeker of help and care-provider that is a single phone-call.
Publicly funded systems of care? Unfortunately, Governments in Canada have ignored issues of mental health for so long, it's only as recently as 2018 that some in governments are waking up to weaknesses evident in public policy.
As Dr. Kraybill in her article rightly suggests: Our Publicly Funded Medical Care System; Workers Compensation Systems; and our Health-Care systems on the whole need treatment approaches (frameworks) that provide a workable guide for treating traumatic stress injury induced brain injury and resulting mental health challenges.
Modalities are very important. Our best treatment providers will have educated themselves in a variety of modalities, accepting that their potential trauma-clients will respond uniquely in treatment.
True, quality, trauma-informed care, however, regardless of a therapists leaning in regards to modality used to assist trauma resolution and integration, maintains always, a 'client-centered' 'client-is-in-charge' approach.
To best serve trauma-issues in the population, and to provide a linear reference point for clients (we all will respond to our own traumas in highly non-linear fashion):
What we can accept and apply in Canada in perhaps a universal way, is to encourage acceptance of a trauma-treatment framework to act as a best-practice guide to therapists, physicians, psychiatrists, other care-providers, individual-clients, and the community care-giver community at large.
We need a shift in public health policy in this country that accepts this over-due stated reality:
"It's not only MORALLY WRONG; It's economically stupid for governments (health-care systems-policy-makers) to NOT place mental health care on the same tiers as physical health care." ~ British MP and Advocate, Norman Lamb
We may not be willing or able to agree on which modalities for trauma-treatment are best-practice.
But we can determine what is best practice APPROACH to addressing what is seeming today to be a rising collective issue: Citizens across this country are living with the negative outcomes of current or prior traumatization in our lives.
I think it's frankly high-time we all started working collaboratively towards accepting this reality, and it's long over-due times for governments and systems of care to respond to what may be the most healing journey this country and citizens could agree together to take: I sincerely believe we are at a cross-roads in Canada historically.
Healing trauma issues in the nation should by now for all of us be considered JOB ONE.
I offer here two trauma-treatment framework models that I've had privilege to learn about from two of my trusted mentors, Dr. Anna Baranowsky and Dr. Odeyla Gertel Kraybill:
Tri-phasic Trauma Treatment: Endorsed by Dr. Baranowsky and the Traumatology Institute, this trauma-treatment model is derived from the pioneering work of Judith Herman.
Expressive Trauma Integration Model: Developed by Dr. Odeyla Gertel Kraybill.
More On Trauma Treatment: The Trauma Recovery Blog
Tools For Self-Assessment-Share These Answers Directly With Your Care-Providers
An Overview of Treatment Modalities: The Trauma Recovery Blog
Tools For Self-Assessment (To Share With Treatment Providers): Canadian Institute for Public Safety Research & Treatment-For Public Safety Workers
Self-Assessment Tools for the General Public (To Share With Treatment Providers): E-Mental Health Canada
Take The Adverse Childhood Experiences Quiz (To Share With Treatment Providers): NPR News Network
"Find if you can, a therapist that uses a trauma approach, not a modality."
What Dr. Kraybill suggests here is, there is no one trauma treatment modality that can act in treatment circles as applicable to all who've suffered trauma in our lives. We are each unique individuals. Our sources of traumatization are as unique as we are an individual. There is no one-size-fits-all treatment modality that can be generically applied to fit all-comers.
The negative mental health outcomes of traumatization, however: this is common-ground.
Post Traumatic Stress Disorder, Depression, and Substance/Alcohol Use Disorders (I focus on these as I've lived them all): All of these conditions have pretty much the same clinical presentation. There may be subtle expressions of symptoms that only a trained-eye can see as part of the exhibition of symptoms not listed in common, clinical references to the conditions, but for the most part if we have any of these traumatic stress induced issues, our symptoms over-all will be pretty much the same, and will be specific to the manifestation of each.
To review signs and symptoms related to the above conditions, please follow this link to Here To Help BC.
I suffered trauma as a paramedic, learning over time that I brought to the table when I entered the work not only a naive understanding about how psychologically/physiologically dangerous the work can be: I also know today that I came into the work with unresolved trauma from childhood in the form of the Adverse Child-hood Experience of intense bullying across my developmental years in life.
I'd suffered periods of depression off-and-on as an outcome of this experience. Prior to my ambulance career, however, I'd worked to resolve my childhood issues and issues in my family of origin following the death of my father to cancer which pushed me towards asking myself the right questions.
Too common are adverse childhood experiences to Canadians on the whole. Even with some of these potentially traumatizing child-hood events in our lives, some who experience such things will develop mental health issues. Others will not. As stated earlier we are, each one, a unique human being, and we've developed resiliency skills in varying degrees across our life-span.
Did this bullying prior to the work confuse my response to the traumas I personally experienced in the work that continue to haunt me?
I'd argue perhaps: Most certainly this prior bullying experience set me up to mistrust others, and it certainly left behind a response to stress in my life that is all-about 'fight' rather than 'freezing' or 'fleeing' or 'submitting' to anything that might resemble bullying to me as an adult.
Regardless: I, along with many others, were, in fact, bullied out of employment by our employers, peers, and workers compensation systems. Systems love to find any pre-existing conditions or issues that systems can then use to skirt their own responsibilities for worker safety.
Responses to trauma, I argue, are as unpredictable as the traumas themselves. We may carry with us a variety of snakes from our past in a bag. That doesn't change much when due to unexpected traumatization we find ourselves struggling to rebound from the experience.
With trauma issues being for too long in Canada a misunderstood, frightening, and underrated-destructive-force in the society, my own generation of public safety workers were not even warned about the potential for mental health issues developing in us due to traumatic stress injuries, let alone were we provided with the compassionate care and treatment the issues demanded once we were stricken.
In policing and in the military, these servants to the rest of us carry the daily, very-real threat of losing their lives, or may face circumstances where they are required to take the life of another in defense of themselves. Across public safety there is danger of accident and physical death. We experience the levels of actual threat to self in varying degrees, but that threat is there from the moment we put on a uniform to serve each day across career or military deployment that puts us in harm's way.
That said, I've learned that no matter how prepared we think we may be in such profession to face the pain and suffering of others without becoming attached to the pain these others express, the potential for sensitive, perhaps more-highly empathetic individuals to vicariously experience the suffering of a fellow-human-being is actually quite high.
It's my view that this empathetic sensing of the pain or death of a fellow-human-being that can produce in the body and brain traumatic stress injuries that lead to negative outcomes in terms of our mental and physical health.
With this potential being high, many in roles as paramedics, fire-fighters, dispatchers and a variety of other care providers will be traumatized in the work. In this line of work, traumatic experience is a fact of work-life.
I wasn't educated to respect this reality. I know far too many from these helping professions from my own generation who were.
I was not granted information prior to the work that prepared me psychologically to face traumatic experiences.
Where in the general population we know that every human-being will experience at least a single traumatizing event across a typical life-span that can go-on to develop issues with mental health, for those in care-professions, public safety professions, and in the military, these individuals will be exposed to an estimated 300-600 potentially traumatizing experiences across the course of career.
I'd argue, as others successfully do, that this potential is actually much higher in the public safety worker community.
Recently completing a survey for a research project in the works by the Canadian Institute for Public Safety Research and Treatment, an initiative of the Collaborative Center for Justice and Safety out of the University of Regina in Canada:
My own answers to the survey reflected that I'd taken in over 1500 potentially traumatizing events across my own sixteen year career in rural service as a British Columbia Paramedic. Of these 1500 potentials, I've identified key traumatic calls that ultimately manifested into the mental health issues I struggle with today.
I'd like folks to agree: There is no way to adequately predict who in the population will be traumatized by experiences in life.
But, we will be traumatized.
Some of us will at least once experience traumatization. Others, by virtue of chosen-roles in vocation, will more frequently experience traumatization in the course of our duties in employment-in paramedicine, social-health-care-worker professions, policing, justice system work, and in the military.
The exposure to traumatic events is higher than for the general population in these demographics in Canada.
This is fact, no longer open to debate.
Therefore, it is to be expected on the part of our medical systems, social services systems, employers in these professions, in family, and across Canadian Society that many living among us are struggling with issues of trauma. I encourage that it's time we all ACCEPT reality, and it's time for society on the whole to get very real:
Human-Beings will be traumatized in life, at least once. Human-Beings who've experienced Adverse Childhood Experiences of trauma will develop mental health issues as an outcome of such experience. Historical and Inter-generational Trauma persists as an outcome of colonization in Canada, impacting Canada's First Nations Peoples at a very deep level.
Many who present as homeless are dealing with unresolved trauma.
Many who are addicted (in fact, I argue along-side Dr. Gabor Mate-all) are dealing with unresolved trauma.
This is a FACT of Canadian life. A fact we can no longer ignore.
So let's get real and let's all work together to structure a cohesive network of collaborative human-beings in this country and let's together create a unified understanding of trauma, PTSD, Depression, Substance-Use Disorder, and other mental-health consequences of traumatic stress injuries.
Let's agree to get busy constructing streams of care that make much more sense that what we're continuing to do today.
We've a number of trauma-and-violence informed care-providers working today in Canada who are in private practice. For any-and-all who wish to improve their relationship with life, at any level, trauma-issues/addictions included, those with resources of affluence are able to access care with as quick an exchange between seeker of help and care-provider that is a single phone-call.
Publicly funded systems of care? Unfortunately, Governments in Canada have ignored issues of mental health for so long, it's only as recently as 2018 that some in governments are waking up to weaknesses evident in public policy.
As Dr. Kraybill in her article rightly suggests: Our Publicly Funded Medical Care System; Workers Compensation Systems; and our Health-Care systems on the whole need treatment approaches (frameworks) that provide a workable guide for treating traumatic stress injury induced brain injury and resulting mental health challenges.
Modalities are very important. Our best treatment providers will have educated themselves in a variety of modalities, accepting that their potential trauma-clients will respond uniquely in treatment.
True, quality, trauma-informed care, however, regardless of a therapists leaning in regards to modality used to assist trauma resolution and integration, maintains always, a 'client-centered' 'client-is-in-charge' approach.
To best serve trauma-issues in the population, and to provide a linear reference point for clients (we all will respond to our own traumas in highly non-linear fashion):
What we can accept and apply in Canada in perhaps a universal way, is to encourage acceptance of a trauma-treatment framework to act as a best-practice guide to therapists, physicians, psychiatrists, other care-providers, individual-clients, and the community care-giver community at large.
We need a shift in public health policy in this country that accepts this over-due stated reality:
"It's not only MORALLY WRONG; It's economically stupid for governments (health-care systems-policy-makers) to NOT place mental health care on the same tiers as physical health care." ~ British MP and Advocate, Norman Lamb
We may not be willing or able to agree on which modalities for trauma-treatment are best-practice.
But we can determine what is best practice APPROACH to addressing what is seeming today to be a rising collective issue: Citizens across this country are living with the negative outcomes of current or prior traumatization in our lives.
I think it's frankly high-time we all started working collaboratively towards accepting this reality, and it's long over-due times for governments and systems of care to respond to what may be the most healing journey this country and citizens could agree together to take: I sincerely believe we are at a cross-roads in Canada historically.
Healing trauma issues in the nation should by now for all of us be considered JOB ONE.
I offer here two trauma-treatment framework models that I've had privilege to learn about from two of my trusted mentors, Dr. Anna Baranowsky and Dr. Odeyla Gertel Kraybill:
Tri-phasic Trauma Treatment: Endorsed by Dr. Baranowsky and the Traumatology Institute, this trauma-treatment model is derived from the pioneering work of Judith Herman.
Expressive Trauma Integration Model: Developed by Dr. Odeyla Gertel Kraybill.
More On Trauma Treatment: The Trauma Recovery Blog
Tools For Self-Assessment-Share These Answers Directly With Your Care-Providers
An Overview of Treatment Modalities: The Trauma Recovery Blog
Tools For Self-Assessment (To Share With Treatment Providers): Canadian Institute for Public Safety Research & Treatment-For Public Safety Workers
Self-Assessment Tools for the General Public (To Share With Treatment Providers): E-Mental Health Canada
Take The Adverse Childhood Experiences Quiz (To Share With Treatment Providers): NPR News Network
"A man knows that he has stumbled upon the truth. When morality and reason unite in the ecstasy of neutrality. When all inner conflict comes to cease, resting within upon the subject in peace."
~ Unknown
~ Unknown
Disclaimer: These materials and resources are presented for educational purposes only. They are not a substitute for informed medical advice or training. Do not use this information to diagnose or treat a health problem without consulting a qualified health or mental health care provider. If you have concerns, contact your health care provider, mental health professional, or your community health centre.
Darren Gregory © 2018: All Rights Reserved
