The Need for Universal Trauma Training in Counselor Education

Trauma training is not currently a universal requirement in counselor education programs, which puts both untrained counselors and their clients in harm’s way; this is an ethical breach that can be closed by providing all counseling students with adequate trauma training, sensitizing them to the skillful assessment of trauma, principles of culturally-responsive client-centered trauma resolution, and the need for relevant continuing education and self-care to avoid counselor impairment and client harm.

This article will address the need for universal trauma training in counselor education, explore the difference between “recovery” and “resilience”, and begin listing common factors in fostering recovery and resilience from trauma for client and counselor wellness. The aim of this article is three-fold: 1) to begin establishing the common factors of adequate trauma training for counselor education curriculum development, 2) to begin developing national standards for counselor education trauma training, and 3) to continue reducing health disparities for marginalized popu-lations who do not readily have access to specialized services outside of community mental health outreach.

Trauma has been described as the body’s natural response to an overwhelming situation (Levine, 1997, 2008, 2010). Due to neurochemical cascades that occur during overwhelming experiences, there are physical, mental, and emotional effects that need to be addressed appropriately and adequately in order for the body to release stored survival energy and return to baseline functioning (Berceli, 2003; https://www.pnirs.org/; Levine, 1997, 2008, 2010; Schore, 1994, 2003), such that the trauma survivor can return attention to developmental tasks across the lifespan. Trauma that resolves without professional intervention often does so in part because the survivor’s social support system provided the necessary empathy and support for that individual’s body to release the stored survival energy in good timing, such that the individual was able to resume attention to developmental tasks rather than get “stuck” in survival mode (Dobson & Perry, 2010; Harvey, 1996; Porges, 2004). Such individuals may be described as “resilient”, often without recognition the role of sufficient social support plays to help them bounce back from a threatening situation (Doidge, 2007).

Resilience has been defined as a “set of qualities that foster a process of successful adaptation and transformation despite risk and adversity” (Benard, 1995), whereas recovery “connotes a trajectory in which normal functioning temporarily gives way to threshold…usually for a period of at least several months, and then gradually returns to pre-event levels” (Bonanno, 2008). Resili-ence to like-kind trauma is more often noted in individuals with a secure attachment history; those who have in-utero substance exposure, an insecure attachment history, and/or score highly on the Adverse Childhood Experiences Scale tend to have a lower threshold for more extreme response to subsequent trauma, with a longer recovery period and more pronounced mental health impacts (Anda, Edwards, Felitti & Holden, 2003; Anson, Chasnoff, Hatcher, Iaukea, Randolph & Stenson 1998; Baker, Blakely, Perry, Pollard & Vigilante, 1995; Blaustein & Kinninburgh, 2010; Bowlby, 1988; Chasnoff, Schmidt, Dchwartz, Telford & Wells, 2012; Cloitre, Cohen, & Koenen, 2006; Cohen, Deblinger, & Mannarino, 2012; Dobson & Perry, 2013; Gold, 2000; Gil, 2006; Heller & La Pierre, 2012; Karen, 1998; Perry, 1997, 1999; Raider & Steele, 2001; Schore, 1994, 2003; Seigel, 1999).

Traumatologists posit that trauma is a fact of life, as is resilience, and are investigating thera-peutic interventions to develop evidence-based practices for recovery addressing single-incident shock trauma (e.g., car accidents); developmental and relational trauma (e.g., in-utero substance exposure, neglect, abuse, betrayal, domestic violence, and oppression); and complex trauma (e.g., violence, war, migration, and natural disasters) across the lifespan, around the world (Albuquerque, Mercante, Nasello, Newberg, Peres, Peres, & Sima, 2007; Ayala & Groves, 2015; Bates, Brown, Money & Moore, 2011; Berceli, 2003, 2010; Blaustein & Kinniburgh, 2010; Briere & Scott, 2012; Briere, F, H. R & Rome, 2015; Beutler, Levant & Norcross, 2005; Chard, Monson & Resnick, 2008; Cohen, Deblinger, & Mannarino, 2012; Fosha, 2000; Freyd, 1996; Gamble, Lev, Perlman & Saakvitne, 2000; Gil, 2006; Heller & LaPierre, 2012; Herman, 1997; Kline & Levine, 2008; Levine, 1997, 2010; MacFarlane, van der Kolk & Weisaeth, 1996; MacKinnon, 2012; Newberg, 2007, 2009, 2012; Ogden, 2015; Rothschild, 2000; Schnur & Sori, 2013; Siegel, 2012; Siegel & Solomon, 2003; Weaver, 2010; http://www.aaets.org/index.htm). Counselors serving a broad spectrum of populations can expect to be assessing and treating trauma survivors throughout their careers, to aid recovery and foster resilience for long-term wellness.

Vicarious trauma, also known as secondary trauma or trauma exposure response, appears to be a leading cause in counselor burn-out and compassion fatigue (Aconson & Pines, 1988; Adams, Boscarino, & Figley, 2004; Burk & van Dernoot Lipsky, 2009; Figley, 1993; Figley, 1995; Panos, 2007; Perry, 2014). The risks for vicarious trauma are highest among practitioners with the least training in trauma resolution (Figley, 1995; Herman, 1997; Perry, 2014; http://www.aaets.org/index.htm). Some indicators of the unresolved trauma exposure response are: feeling helpless and hopeless; a sense one can never do enough; hypervigilance; diminished creativity; inability to embrace complexity; minimizing; chronic exhaustion; somatic complaints; inability to listen; dissociative moments; sense of persecution; guilt; fear; anger and cynicism; inability to empathize/numbing; addictions; and grandiosity (Burk & van Dernoot Lipsky, 2009). Any subset of these concerns could result in counselor impairment, and thus merit an organized plan for protection of client and counselor.

Counselor education could develop and adopt standards for student training that would introduce all counselors-in-training to the common factors of both trauma, and trauma resolution, thus laying the foundation for safe entry into a career of serving traumatized clients to foster recovery and resilience while protecting practitioners from vicarious trauma. The highest quality education would include: an overview of trauma research from conception -not birth- (Chasnoff, et. al., 1993, 1998, 2002; 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2012; Karen, 1994; Kelly and Verny, 1981; Perry, 1995, 1997, 2004; Porges, 2004; Schore, 2003; Stern, 1985) to death; discussion of the compounded multicultural implications of trauma (Brown, 2014; Chard, Monson, Resick, 2008; Chasnoff, Messer, Schmidt, Telford & Wells, 2009; Chasnoff, Farina & Leifer, 2004; Chester, Goldman & Robin, 1996; Comas-Diaz, 2006; Harvey, 1996); a survey of intervention modalities (including video examples) to inspire continuing education; and skills practice to assess counselor integration and capacity prior to program advancement.

As the field of traumatology coalesces in response to advances in neuroscience, imaging tech-nology, attachment research, and epigenetics, counseling practices may also enhance efficacy by integrating trauma resolution training in continuing education for licensed counselors (http://www.aaets.org/index.htm; Brown, 2014). Trauma is now recognized to be part of the hu-man condition, and thus is widely-experienced in varying degrees by a majority of counseling clients, but most significantly among the most marginalized. This author postulates that the es-sential common factors derived from various trauma resolution techniques can be integrated into current counseling practices by most counselors with appropriate supervision, thus improving client outcomes and quality of life, as well as reducing relapse rates for many presenting problems, while increasing counselor protection from the work-related hazard of vicarious trauma.

A beginning list of common factors in trauma includes:

1. the universal nature of overwhelm occurring unexpectedly throughout our development;
2. the unjust fact of trauma occurring more in systematic oppression of marginalized popula-tions;
3. the body-based experience of overwhelm impacting brain and emotional development and functioning, especially when left unresolved;
4. the depletion of positive affect and felt safety in relationships;
5. relational trauma being harder to resolve due to broken trust in needed others, therefore re-quiring that counselors be trauma-trained in order to do no harm and increase efficacy of treatment.

A beginning list of common factors in trauma resolution counseling may include:

1. skillfully assessing and accessing client-specific capacity for recovery and resilience in re-sponse to overwhelm via trust-based therapeutic rapport (Ayala & Groves, 2015; Benard, 1995; Blaustein & Kinniburgh, 2010; Cloitre, Cohen & Koenen, 2006; Fosha, 2000; Heller & LaPierre, 2012; Levine, 2010; Najavits & Strupp, 1994; Rothschild, 2000; Seigel & Solomon, 2003; Weaver, 2010);
2. awareness of the neurodevelopmental impacts of in-utero and early childhood trauma (Chasnoff, et.al., 2002, 2004, 2006, 2007, 2008, 2009, 2010, 2012; Perry, et. al., 1999, 2010, 2012, 2013; Schore,1994, 2003);
3. leveraging interpersonal neurobiology to co-regulate the client’s nervous system (Amini, Lannon, and Lewis, 2001) through left-eye to left-eye contact (Schore, 2003);
4. following the client/s pacing unless the client/s accelerate into distress, which is re-traumatizing (Levine, 2003, 2010; Raider & Steele, 2001; Rothschild, 2000; Schore, 2003);
5. slowing the client and session down when trauma is being processed (Levine, 2003, 2010; Rothschild, 2000; Weaver, 2010);
6. referencing the client/s body as a resource for soothing, regulating, and discharging over-whelm as part of the corrective emotional experience (Bates, Brown, Money & Moore, 2011; Berceli, 2010; Fosha, 2000; Levine, 2003, 2010; Rothschild 2000; Weaver, 2010).
7. following the body’s cues for discharge of stored survival energy as evidenced by trembling, especially in the legs as the fight/flight/freeze response is released from the body (Berceli, 2010; Levine, 2003, 2010; Rothschild; 2000; Weaver, 2010);
   h) following the body’s cues for discharge of emotional overwhelm as evidenced by patterns in movement, (e.g. protective and defensive postures, attempts to regain balance and control, changes in breath; micorexpressions of shock, terror) (Berceli, 2010; Levine, 2003, 2010; Rothschild, 2000; Weaver, 2010);
8. reducing verbal processing to minimum, concrete, here-and-now awareness, talking “through” pain, not “about” pain (Levine, 2008; Weaver, 2010);
9. the value of accurate empathy and normalization in supporting the body’s natural discharge of overwhelm (Farber & Lane, 2002; Najavits & Strupp, 1994).

As peer-reviewed research of trauma interventions expands, counselors will be able to implement appropriate interventions for the developmental needs of their clients in their settings, thus aiding clients in recovery and fostering their long-term resilience to the highest degree possible, while protecting the counselor from the trauma exposure response.

Some trauma resolution models in mental health practice today are: Accelerated Experiential-Dynamic Psychotherapy; Accelerated Recovery Program; Acceptance and Commitment Thera-py; Dialectical Behavioral Therapy; Emotion-Focused Therapy; Eye Movement Desensitization and Reprogramming; Hakomi; Mindfulness-Based Stress Reduction, NeuroAffective Relational Model; Neurogenic Yoga; Neurosequential Model of Therapeutics; Occupational Therapy; Sen-sory Awareness; Somatic Experiencing; Theraplay; Trauma-Focused CBT; and Trauma Releas-ing Exercises. Given the variance in evidence collected to date on this short list, counselors are cautioned from getting minimum training and supervision while expanding scope of competence; over-eager application of a technique without proper theoretical understanding and skills integration can do more harm than good.

Counselor self-care is a common topic of discussion in counselor education, staff meetings and conferences, and yet many practitioners underestimate the importance of following through with a comprehensive plan at effective intervals to foster their own resilience and therefore protect themselves and their clients from the effects of vicarious traumatization. This author is investi-gating common factors for counselor care to effectively process and resolve the clinical presen-tation of trauma in a variety of settings and populations. The field of Somatic Psychology, with governing bodies such as the United States Association of Body Psychotherapists, publishes research on the body-based effects of trauma work and how to discharge the negative effects for counselor well-being. From this lens, a beginning list for ongoing holistic self-care to protect counselors from trauma exposure response would include:

a) ongoing, preventative personal therapy with a qualified role model who integrates trauma resolution in practice (http://usabp.org/), rather than waiting for negative effects to begin;
b) an ongoing psychospiritual embodiment practice to regulate physiology and reduce inflam-mation from stress (Berceli, 2010; http://usabp.org/; Newberg; 2009; https://www.pnirs.org/);
c) ongoing sufficient healthy social support to meet needs for mutuality, connection, ease and joy (Herman, 1997; Newberg, 2009);
d) beneficial nutritional habits to maintain healthy baseline (Newberg, 2009; https://www.pnirs.org/);
e) ongoing access to nature to regulate physiology (http://www.ecopsychology.org/);
f) application of daily mindfulness for self-monitoring and numinous renewal (Newberg, 2009);
g) continuing education and networking with trauma experts to ethically expand scope of competence (http://www.aaets.org/index.htm).

This author is concerned with the rates of compassion fatigue, vicarious traumatization, and lim-ited reflexive self-awareness regarding lack of preventative self-care evident in mental health agency settings and their practitioners. Such tendencies may occur in part because counselor education does not sufficiently prepare and train students for the amount and variety of traumas they will be helping clients process over the course of their careers, and clinical supervision training does not adequately prepare supervisors to empathically and ethically monitor their su-pervisees with regard to trauma resolution. Without sufficient focus on the self of the practitioner and the effects of trauma exposure, counselors are ill-prepared for what they experience in the field, and often wait until they are unhealthy, if at all, to begin integrating self-care in a meaningful way. Not only does this detract from the counselor’s well-being, but it necessarily detracts from the human services that impaired clinician can render. In an age of managed care, when high caseloads and mass trauma effect so many communities, we must organize to take care of those who aim to take care of others, and be embodied role models for those we serve.

References

Adams, R. E., Boscarino, J. A., & Figley, C. R. (2004). Evidence of Compassion Fatigue follow-ing the September 11 Terrorist Attacks: A Study of Secondary Trauma among Social Workers in New York. International Journal of Emergency Mental Health, 6:2, 98-108.

Albuquerque, V.E., Mercante, J., Nasello, A., Newberg, A., Peres, J., Peres, M., Sima, M. (2007). Cerebral blood flow changes during retrieval of traumatic memories before and after
psychotherapy: a SPECT study. Psychological Medicine, 2007, 37, 1481–1491. f 2007 Cam-bridge University Press. doi:10.1017/S003329170700997X

Aigbogun, N., Alim, T., Alonso, A., Charney, D., Doucette, J., Feder A., Graves, R., Lawson, W., Mellman, T., Smith, B.,Wang, Y., Weaver, J., & Westphal, M. (2006). Trauma, Resilience, and Recovery in a High-Risk African-American Population. http://dx.doi.org/10.1176/appi.ajp.2008.07121939.

Amini, F., Lannon, R., & Lewis., T. (2000). A General Theory of Love. Random House. NY, NY.

Anda, R.F., Edwards, V.J., Felliti, V.J., & Holden, G.W. (2003). Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study. Am J Psychiatry. 2003 Aug;160(8):1453-60.

Anderson, J.F., Boyd-Franklin, N., & Kelly, S. (2006). Racism and Invisibility: Race-related stress, emotional abuse, and psychological trauma for people of color. Journal of Emotional Abuse: Vol. 6, Issue 2-3.

Anson, A., Chasnoff, I.J.,Hatcher, R., Iaukea, K., and Randolph, L., Stenson, H. (1998). Prenatal exposure to cocaine and other drugs: Outcome at four to six years. In: Harvey, J.A. and Kosofsky, B.E., eds. Cocaine Effects On the Developing Brain. New York, NY: Annals of the New York Academy of Science, 1998:314-328.

Aronson, E. & Pines, A. (1988). Career burnout: Causes and cures. New York: Free Press.

Ayala, K. & Groves, T. (2015). Implementing the Neurosequential Model of Therapeutics. Foster Family-based Treatment Association, 21:2 pp 1-4.

Azuma S.D., and Chasnoff, I.J. (1993). Outcome of Children Prenatally Exposed to Cocaine and Other Drugs: A Path Analysis of Three-Year Data. Pediatrics, Vol 92, pp. 396-402, 1993.

Bailey, G., Bertrand, J., Chasnoff, I.J., Coles, C.D., Dent ,D., Floyd, R.L., Frankel, F., Kable, J., O’Connor, M.J., Paley, B., Taddeo, E., Wells A. (2009). Interventions for children with fetal al-cohol spectrum disorders (FASDs): Overview of findings for five innovative research projects. Research in Developmental Disabilities, 30:986–1006.

Bailey, G.W., Chasnoff, I.J., Jandasek, B., Telford, E., & Schmidt, C. Wells, A.M., (in press). Mental Health Disorders Among Foster and Adopted Children with FAS and ARND. Illinois Child Welfare.

Bailey, G.F., Chasnoff, I.J, McGourty, R.F. (2005). Commentary: Screening as a tool for en-gagement. Journal of Perinatology, June 2005.

Bailey, L., Chasnoff, I.J., McGourty, R.F.,& Wells, A.M. (2007). Validation of the 4P’s Plus© Screen for Substance Use in Pregnancy. Journal of Perinatology: Official journal of the California Perinatal Association, 27, 744-748.

Baker, W., Blakely, T., Perry, B., Pollard, R., Vigilante, D. (1995). Childhood Trauma, the neuro-biology of adaptation and ‘use-dependent’ development of the brain: how ‘states’ become ‘traits’. Infant Mental Health Journal, Vol. 16, no. 4: 271-291.

Bates, M., Brown, D., Money, N., Moore, M. (2011). Mind-Body Skills for Regulating the
Autonomic Nervous System. Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. Version 2.

Belcher, H., Hunt, K., Martens, P. (2011). Risky Business: Trauma Exposure and Rate of
Posttraumatic Stress Disorder in African American Children and Adolescents.
Journal of Traumatic Stress, Vol. 24, No. 3, June 2011, pp. 365–369.

Benard, B. (1995). Fostering Resilience in Children. Educational Resources Information Center.

Berceli, D. (2008). Transcend Your Toughest Times. Namaste Publishing, Berkeley, CA.

Beutler, L. E., Levant, R. F., & Norcross, J. C.(Eds.). (2005). Evidence-based practice in mental health: Debate and dialogue on the fundamental questions. Washington DC: American Psycho-logical Association.

Blausetein, M., & Kinniburgh, K. (2010). Treating Traumatic Stress in Children and Adolescents. Guilford Press. NY, NY.

Bonanno, G. (2008). Loss, Trauma, and Human Resilience: Have We Underestimated the Hu-man Capacity to Thrive After Extremely Aversive Effects? Psychological Trauma: Theory, Prac-tice, and Policy, Vol.S, No.1, 101-113.

Bowlby, J. (1988). A Secure Base. Basic Books. London, UK.

Briere, J. & Scott, C. (2012). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment, Second Edition. Sage Publications, Thousand Oaks, CA.

Briere, J., Follette, V.M., Hopper, J.W., Rome, D.I., & Rozelle, D. (Eds.). (2015). Mindfulness-Oriented Interventions for Trauma. Guilford, NY, NY.

Brown, L. (2014). Treating Trauma: Basic Skills and Specific Treatments. www.continuingedcourses.net/active/courses/course073.php

Burk, C. & van Dernoot-Lipsky, L. (2009). Trauma Stewardship. Berrett-Koehler. SF, CA.

Chard, K., Monson, C., & Resick, P.A. (2008). Cognitive processing therapy: Veteran/military version. Therapist and patient materials manual. Washington DC: United States Department of Veterans' Affairs.

Chasnoff, I.J. (1998). Silent violence: Is prevention a moral obligation? Pediatrics. 1998,102:145-148.

Chasnoff, I.J. (2002). Psychosocial Issues in Pregnancy: Guidelines for the Obstetrician. Ameri-can College of Obstetrics and Gynecology.

Chasnoff, I.J. (2007). Drugs and Alcohol in Pregnancy and the Affected Child. In: Lessenger, J.E. and Roper, G.F. (ed). Drug Courts: A New Approach to Treatment and Rehabilitation. Springer Publishing.

Chasnoff, I.J. (2008). Management of the Newborn Exposed to Maternal Substances of Abuse. In: Textbook of Neonatology.

Chasnoff, I.J. (2010). Substance Abuse: Effects on the Child. In: Shweder RA. The Child: An Encyclopedic Companion. University of Chicago Press, Chicago.

Chasnoff I.J. , Farina L., & Leifer M., (2004). Attachment and behavioural difficulties in interna-tionally adopted Russian orphans. Adoption and Fostering; 28:38-48.

Chasnoff, I.J., Messer, G., Telford, E., Schmidt, C., & Wells, A. M. (2010). Neurodevelopmental functioning in children in FAS, pFAS and ARND. Journal of Developmental and Behavioral Pe-diatrics, 31,192-201.

Chasnoff, I.J., McCurties, S. McGourty, R., & Wells, A.M.(2008). Perinatal substance use screening in California: Screening and Assessment with the 4Ps Plus© Screen for Substance Use in Pregnancy. Chicago, IL: NTI Upstream.

Chasnoff, I.J., & McGourty, R.F. (2006). Screening as a Tool for Engagement. Journal of Peri-natology 26:261.

Chasnoff, I.J., Schmidt, C.A., Schwartz, L., Telford, E., & Wells, A.M., (2012). Neurocognitive habilitation therapy for children with fetal alcohol spectrum disorders: An adaptation of the Alert Program®. American Journal of Occupational Therapy, 66, 24-34.

Chester, B., Goldman, D. & Robin, R. W., (1996). Cumulative trauma and PTSD in American Indian Communities. In A. J. Marsella, M. J. Friedman, E. T. Gerrity & R. M. Scurfield, (Eds.). Ethnocultual aspects of posttraumatic stress disorder (pp. 239-254). Washington DC: American Psychological Association.

Cloitre, M., Cohen, L.R. & Koenen, K.C. (2006). Treating survivors of childhood abuse: Psycho-therapy for the interrupted life. Guilford Press, NY, NY.

Cohen, J.A., Deblinger, E., Mannarino, A.P. (eds). (2012). Trauma-Focused CBT for Children and Adolescents. Guilford Press. NY, NY.

Comas-Diaz, L. (2006) Latino healing: The integration of ethnic psychology into psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 43, 436-453.

Dobson, C., & Perry, B.D. (2010). The role of healthy relational interactions in buffering the im-pact of childhood trauma. In (Gil, E., Ed) Working with Children to Heal Interpersonal Trauma: The Power of Play. Guilford Press, NY, NY.

Dobson, C. & Perry, B.D. (2013). The Neurosequential Model (NMT) in maltreated children. In (J. Ford & C. Courtois, Eds). Treating Complex Traumatic Stress Disorders in Children and Ado-lescents, pp 249-260. Guilford Press, New York.

Doidge, N. (2007). The Brain that Changes Itself. Penguin. London, UK.

Farber, B.A. & Lane, J.S. (2002). Positive regard. In J. Norcross (Ed.). Psychotherapy relation-ships that work: Therapist contributions and responsiveness to patients (pp. 175-194). Oxford University Press, NY, NY.

Figley, C.R. (1993b). Compassion Fatigue and Social Work Practice: Distinguishing Burnout from Secondary Traumatic Stress. Newsletter of the NASW Florida Chapter, June, 1-2.

Figley, C.R. (Ed.) (1995). Compassion Fatigue: Coping with Secondary Traumatic Stress Disor-der in Those Who Treat the Traumatized. An Overview. 1-20. Brunner/Mazel. NY, NY.

Fosha, D. (2000). The Transforming Power of Affect. Basic Books. NY, NY.

Freyd, J. (1996). Betrayal Trauma. Harvard University Press. Cambridge.

Gamble, S.G., Lev, B.T., Pearlman, L.A.,& Saakvitne, K.W.,(2000). Risking connection: A train-ing curriculum for working with survivors of childhood abuse. Lutherville, MD: Sidran Foundation and Press.

Gil, E. (2006). Helping Abused and Traumatized Children. Guilford Press. NY, NY.

Gold, S. N. (2000). Not trauma alone: Therapy for child abuse survivors in family and social con-text. Brunner-Routledge. Philadelphia PA.

Harvey, M. R. (1996). An ecological view of psychological trauma and trauma recovery. Journal of Traumatic Stress, 9, 3-24.

Heller, L., La Pierre, A. (2012). Healing Developmental Trauma. North Atlantic Books. Berkeley, CA.

Herman, J. (1997). Trauma and Recovery. Basic Books. NY, NY.

http://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2008.07121939

http://www.apa.org/monitor/jun02/brightfuture.aspx.

http://attcnetwork.org/regcenters/productDocs/19/FACT%20SHEET-12-11-2013-ENGLISH%20AND%20SPANISH.pdf

https://www.cdph.ca.gov/programs/Documents/African_Am_CRDP_Pop_Rept_FINAL2012.pdf

http://www.centerforyouthwellness.org/adverse-childhood-experiences-aces/.

http://www.chadwickcenter.org/

http://www.choa.org/Childrens-Hospital-Services/Child-Protection-Center/~/media/CHOA/Documents/Services/Child-Protection-Center/Resources/Parents-Caregivers-Professionals/LGBTQ-Trauma.pdf

https://drkathleenyoung.wordpress.com/2010/03/28/kicked-out-homelessness-and-lgbtq-youth/

http://www.ecopsychology.org.

http://www.giftfromwithin.org.

http://globalmigration.web.unc.edu/files/2013/09/Trauma-Informed-Culturally-Relevant-Mental-Health-Care-for-Latino-Adolescents-in-NC.pdf

http://www.greencross.org/

http://www.heinz.org/UserFiles/ImpactOfRacialTraumaOnAfricanAmericans.pdf

http://homeless.samhsa.gov/resource/culture-and-trauma-brief-trauma-among-lesbian-gay-bisexual-transgender-or-questioning-youth-50193.aspx

http://joydegruy.com/resources-2/post-traumatic-slave-syndrome/

http://judythweaver.com/writings/somatic-awarenesssensory-awareness-a-path-of-unraveling-trauma/.

http://www.kennedykrieger.org/sites/kki2.com/files/family-center-trauma-exposure-ptsd-children2011.pdf

http://learn.nctsn.org/course/index.php?categoryid=40

http://www.ncbi.nlm.nih.gov/pubmed/25082744

http://www.nctsn.org/about-us/about-this-web-site.

http://www.nctsn.org/nctsn_assets/pdfs/culture_and_trauma_brief_v2n3_LatinoHispanicChildren.pdf

http://www.new-hope-recovery.com/center/2014/07/03/religious-trauma-lgbt-addiction/

http://www.nrcpfc.org/is/downloads/LGBTQ.Trauma.pdf

https://www.pnirs.org/.

http://psychink.com/ticlearn/sample-page/compassion-fatigue-courses/

http://www.psychology.sunysb.edu/attachment/measures/content/aai_interview.pdf.

http://reclaimingfutures.org/latino-health-context

http://www.slideshare.net/jayembee/trauma-and-health-issues

http://thebreathenetwork.org/trauma-informed-care-for-lgbtq-survivors-of-sexual-violence

https://traumaawareschools.org/articles/9620

http://trelosangeles.com/wp-content/uploads/2013/10/Berceli.2010.pdf.

International Society for Traumatic Stress Studies (www.istss.org) or the International Society for the Study of Trauma and Dissociation (www.isst-d.org).

Karen, R. (1998). Becoming Attached. Oxford University Press. NY, NY.

Kline, M. & Levine, P. (2008). Trauma-Proofing Your Kids. North Atlantic Books. Berkeley, CA.

Levine, P. (1997). Waking the Tiger. North Atlantic Books. Berkeley, CA.

Levine, P. (2010). Resolving Trauma in Psychotherapy: A Somatic Approach. psychotherapy.net.

MacFarlane, A.C., van der Kolk, B. A., Weisaeth, L. eds. (1996). Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society. Guildford Press. NY, NY.

MacKinnon, L. (2012). The Neurosequential Model of Therapeutics: An interview with Bruce Perry. The Australian & New Zealand Journal of Family Therapy, 33:3 pp 210-218 doi:10.1017/aft.2012.26.

Najavits, L. M. & Strupp, H. (1994). Differences in the effectiveness of psychodynamic therapists: A process-outcome study. Psychotherapy, 31, 114-123.

Newberg, A., Waldman, M.R. (2009). How God Changes Your Brain. Ballantine. NY, NY.

Newberg, A., Waldman, M.R. (2012). Words Can Change Your Brain. Hudson Street Press. NY, NY.

Ogden, P. (2015). Sensorimotor Psychotherapy. W.W. Norton & Co. NY, NY.

Panos, A. (2007). Promoting resiliency in trauma workers. Poster presented at the 9th World Congress on Stress, Trauma, and Coping, Baltimore, MD.

Perry, B.D. (1997). “Incubated in Terror: Neurodevelopment factors in the cycle of violence” in Children, Youth and Violence: The Search for Solutions, J. Osofsky, ed. Guilford Press. NY, NY.

Perry, B.D. (2014). The cost of caring: Understanding and preventing secondary traumatic stress when working with traumatized and maltreated children. CTA Parent and Caregiver Education Series. ChildTrauma Academy Press: Volume 2: Issue 7.

Perry, B.D. (1999). Bonding and attachment in maltreated children: Consequences of emotional neglect in childhood CTA Parent and Caregiver Education Series. ChildTrauma Academy Press: Volume 1: Issue 3.

Porges, S. (May, 2004). Neuroception: A Subconscious System for Detecting Threats and Safety. Zero to Three Journal, Vol. 24, no. 5: 19-24.

Raider, M. & Steele, W. (2001). Structured Sensory Intervention for Traumatized Children, Ado-lescents and Parents. Vol. 1 of Mellen Studies in Social Work Series. Edwin Mellen Press, Lon-don, UK.

Rothschild, B. (2000). The Body Remembers. W.W. Norton & Co. NY, NY.

Schnur, S. & Sori, C.F. (2013). Integrating a neurosequential approach in the treatment of trau-matized children: An interview with Eliana Gil, Part II.

Schore, A. (2003). Affect Regulation and Disorders of the Self. W.W. Norton & Co. NY, NY.

Schore, A. (1994). Affect Regulation and the Origin of the Self. Lawrence Erlbaum Associates. Hillsdale, NJ.

Schore, A. (2003). Affect Regulation and the Repair of the Self. W.W. Norton & Co. NY, NY.

Seigel, D. (1999). The Developing Mind. Guilford Press. NY, NY.

Siegel, D.J., Solomon, M. (2003). Healing Trauma. W. W. Norton & Co. NY, NY

Weaver, J. (2010). 6th National conference of the United States Association for Body Psycho-therapy, held October, 2010. The theme of the conference was “Unraveling Trauma: Body, Mind and Science.”