Trauma Addictions Mental Health and Recovery (TAMAR)
Total Page：16
File Type：pdf, Size：1020Kb
FACILITATOR’S MANUAL TAMAR Acknowledgements Trauma, Addictions, Mental health, And Recovery (TAMAR) was originally developed in 1999 as part of a Substance Abuse and Mental Health Services Administration (SAMHSA) Women and Violence project site in Maryland. This version was adapted from the original TAMAR model as a collaboration National Association of State Mental Health Program Directors (NASMHPD) Center for Innovation in Trauma-Informed Approaches and Advocates for Human Potential, Inc. (AHP) by Leah Harris, M.A. (NASMHPD); Kay Peavey, B.A. (AHP); Joan Gillece, Ph.D. (NASMHPD); and Pam Rainer, M.S.W. (AHP). TAMAR TAMAR Contents INTRODUCTION .............................................................................................................................. 1 Welcome ......................................................................................................................................... 1 Rationale ......................................................................................................................................... 1 TAMAR Background ........................................................................................................................ 1 Background for Facilitators ............................................................................................................. 1 Shame and Forgiveness .................................................................................................................. 2 Creative Expression ......................................................................................................................... 3 Mind-body Skills Practice ................................................................................................................ 3 TAMAR Intake/Assessment............................................................................................................. 4 Contents .......................................................................................................................................... 4 Creating a Trauma-informed Learning Environment ...................................................................... 6 Time Management .......................................................................................................................... 6 Module 1: Introduction to TAMAR ................................................................................................. 7 Module 2: The Effects of Trauma ................................................................................................. 20 Module 3: Trauma Reminders ...................................................................................................... 30 Module 4: Self-soothing ............................................................................................................... 37 Module 5: Tolerating Distress ...................................................................................................... 43 Module 6: Containment I ............................................................................................................. 55 Module 7: Containment II ............................................................................................................ 68 Module 8: Physical and Emotional Abuse .................................................................................... 82 Module 9: Sexual Abuse (Females) .............................................................................................. 89 Module 9: Sexual Abuse (Males) .................................................................................................. 92 Module 10: Trauma and Addiction ............................................................................................. 100 Module 11: Boundaries and Safety ............................................................................................ 106 Module 12: Intimacy and Trust .................................................................................................. 116 Module 13: Sexual Communication, Negotiation, and Consent ................................................ 123 Module 14: Parenting ................................................................................................................. 131 Module 15: Closing Ritual ........................................................................................................... 133 TAMAR TAMAR INTRODUCTION Welcome Congratulations! By becoming a facilitator of Trauma, Addictions, Mental health, And Recovery (TAMAR), you will play an essential role in helping justice-involved individuals understand the impact of trauma on their lives, their families, and their communities, which will help them develop vital skills for life within and outside of the correctional facility. Recognizing trauma as a major factor in behavior can also help make your job duties easier, the correctional facility safer, and programming more effective. This manual provides everything you need to facilitate successful TAMAR groups. Rationale For many people involved in the justice system, trauma has shaped their experience of the world in devastating and persistent ways. Research indicates that at least two-thirds of men and almost all women who are presently or formerly incarcerated have experienced some form of trauma, including adverse childhood experiences; emotional, physical, and/or sexual abuse; domestic violence; extreme poverty; and loss of friends and loved ones due to community violence. Scientific literature indicates that early exposure to trauma and violence results in changes to the brain that can severely impact behavior. It is also important to recognize that incarceration, in and of itself, can be a highly stressful and potentially traumatic experience. TAMAR Background TAMAR was developed in the late 1990s as part of a federally funded, gender-specific program for incarcerated women in Maryland. It has since been implemented in multiple justice and behavioral health systems across the country. The original TAMAR intervention was updated in 2019 to create a clinical intervention that combines psychoeducation about trauma and its impact with concrete techniques designed to help participants of any gender identify their triggers and learn and practice skills for self-regulating trauma symptoms. Background for Facilitators None of us is protected from misfortune, be it a one-time catastrophic event or a long-term hardship. We may be directly involved with illness, violent crime, natural disaster, divorce, accidents, abuse, domestic violence, or war. We might also encounter these events secondhand. Whether directly or indirectly experienced, these types of incidents can be traumatic. TAMAR 1 What is traumatic for one person may be only stressful for another. Many factors contribute to the impact of trauma: age, social and cultural influences, history of previous trauma, physical and psychological health, and quality of coping skills. Support systems available at the time of the trauma and afterwards play a substantial role in how we cope. To deny pain in our lives is to walk a dangerous path that can lead to lifelong dysfunction. The aftereffects of trauma are both psychological and physiological. Feelings of helplessness and hopelessness contribute to changes in self-image and contaminate interpersonal relationships. Emotional flooding and numbing, chaotic and conflicted thought processes, and maladaptive behaviors are symptoms related to being overwhelmed by trauma. Sleep disturbances, phobias, flashbacks, memory impairment, hypervigilance, physical pain, and addictions are other debilitating symptoms that can be related to post-traumatic stress. Regardless of the cause or origin of the trauma, adults are responsible for developing the necessary coping skills to move forward. With careful thought and daily practice, most people can recover a sense of safety and purpose in their lives; some will achieve even more effective and beneficial ways of functioning in the world than those they used before the trauma. To overcome the impact of traumatic stress one needs to restore, or develop, healthy ways to tolerate distress and pain, to exhibit compassion and respect for oneself, to interact with others without compromising personal values and beliefs, and to make changes that allow for purpose and meaning in life. Creativity, a natural human function, plays an important role in the development of these abilities. TAMAR offers an opportunity to everyone, regardless of previous experience or artistic talent, to manage symptoms of traumatic stress in a creative, life-affirming way. Shame and Forgiveness Shame is often a core feature of trauma. With no awareness of how trauma impacts the mind and body, survivors may not understand why they react the way they do in the face of stressful or triggering events. They may feel great shame afterwards for their reactions, or they may feel “out of control” or “crazy.” TAMAR modules de-stigmatize and de-pathologize the trauma response by explaining to participants how their brains and bodies respond to stress and trauma, helping them identify and understand their own unique ways of reacting under stressful or traumatic circumstances, and emphasizing the possibility of change through self- regulation strategies. With this approach, participants can understand why they responded as they did while still accepting responsibility for their actions. They can begin to forgive themselves and can gain more of a sense of control