Trauma-Sensitive Presence Manual

TRAUMASENSITIVE PRESENCE PREPARED BY

ROY F. ELLIS MDIV MED CSCP RCT-C

TRAUMA & CRISIS RESPONSE

GRIEF & LOSS INTERVENTION

TRAIN THE TRAINER PROGRAM

TOOLS FOR HELPING AND HEALING HeartWrench brand human service interventions are developed by Roy F. Ellis for healthcare professionals, frontline workers, and direct human service workers.

HeartWrench tools equip healthcare professionals, caregivers and soft-human service workers to meet and manage the many modern challenges that arise inside of trauma and loss saturated work environments.

HeartWrench trainings and workshops provide state-of-the-art teaching in the area of trauma, grief&loss, compassion fatigue, psychological safety, burnout, and team wellbeing.

HeartWrench facilitators are trauma-informed and can guide your staff in sharing sessions that promote team reflection, closeness and wellbeing.

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CONTENTS

INTRODUCTION: WORKPLACE HAZARDS For frontline workers, trauma, crisis and grief are part of the everyday experience. There are invisible and visible dangers that put frontline workers at risk and have a powerful impact on wellbeing. How can we help?

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GRIEF, STRESS & TRAUMA

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In this chapter, you’ll come to understand and define grief, stress and trauma and gain a good grasp on how they impact people.

ELEMENTS OF PRESENCE Trauma sensitivity is a new idea with very old roots. In this chapter, you’ll learn the essential components of trauma sensitive presence.

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THE TSP METHOD

THE TOOLS

Here you’ll find various tools that can help make you a great listener. Read and practice these, and you will find your communication skills blossoming and growing.

Chapter five guides you through the process of practicing trauma sensitive presence with a person in crisis.

ROY F. ELLIS © 2024

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TRAUMA SENSITIVE PRESENCE

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CONTENTS

REGULATION SKILLS Helping ourselves and others get emotionally regulated is essential to providing a safe relational experience.

RESOURCES & READINGS

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Helpful offerings for reading and watching that will enrich your understanding of trauma response.

BIO & DEETS

Some information about the author, his education and work history.

ROY F. ELLIS © 2024

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TRAUMA SENSITIVE PRESENCE

INTRODUCTION HUMAN CARE IN THE MIDST OF CHAOS

In the last twenty years, frontline care research has helped us understand the relational healing power and communitybuilding potential of caring street-level work.

Homeless individuals experience multiple traumas, stemming from turbulent life events both before, and as a result of, becoming homeless. Their complex histories are often full of trauma, abuse, violence, addictions and/or mental health issues (Hopper et al. 2009).

Building and maintaining healthy relationships with homeless and street-involved people, even when those relationships have boundaries and imperfections, can bring powerful meaning and a sense of hope into their lives.

There are, of course, many barriers to care and many system challenges that block our best efforts. But every time we are truly and authentically present to people, it creates opportunities for relationship --- allowing them to feel fully seen. This is a great gift for people who feel invisible and underappreciated. Being seen without judgment is good food for the soul. It can heal broken hearts. It can sustain weary travellers.

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INTRODUCTION

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Caring for people whose lives swirl with oppression, crisis, stigma and trauma comes with a cost. We now know of the invisible dangers and visible hazards that are inevitable and inescapable as we meet struggling and suffering people where they are.

“According to multiple studies, exposure to high-trauma work environments has been associated with negative experiences and ongoing problems for individuals and organizations.” (Kellner et al., 2019).

Working with trauma-related problems can lead to a series of negative reactions including trauma, vicarious traumatization, compassion fatigue, and burnout (Waegemakers Schiff & Lane, 2019).

Without support, frontline workers are at risk of mental health challenges such as depression, anxiety, high-risk alcohol and drug use, and post-traumatic stress disorder. Studies show that support for frontline employees can buffer and protect against these and many more mental health problems (Grant et al., 2008; Huizink et al., 2006; Izutsu et al., 2004).

RKPLACE HAZAR DS!

INTRODUCTION

CAUTION INVISIB LE WORKPLACE HAZARDS!

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CAUTION INVISIB LE WORKPLACE

WORKPLACE HAZARDS In construction work, there are plenty of signs alerting us to the dangers on the job site.

In all workplaces, occupational health and safety is taken very seriously. Laws and policies have been created to help ensure that workers remain safe as they do tasks in hazardous areas.

RKPLACE HAZAR DS!

INTRODUCTION

CAUTION INVISIB LE WORKPLACE HAZARDS!

CAUTION INVISIB LE WORKPLACE

WORKPLACE HAZARDS Very few laws, policies and warning signs assist frontline human care workers to remain safe during their duties. The risks and hazards are there, but we don’t always acknowledge how dangerous they are to our sense of wellbeing and safety. Often, workers are not trained, or explicitly encouraged to be aware of the risks on the worksite.

Imagine what it might feel like to see a sign like this as you enter your workplace...

TRAUMA

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INTRODUCTION There are many forms of support that can be offered to a frontline worker in need, but in an acute crisis or traumatic incident, what is immediately called for is a non-judgemental listening presence.

The Trauma-Sensitive Presence (TSP) method of dialogue before, during and after an incident can be a powerful tool to help limit the whole-body impact of trauma, stress, crisis, and grief.

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INTRODUCTION DOWNGRADING TRAUMATIC RESPONSES The main goal of TSP interventions is to downgrade potential traumas and chronic stressors, turning them into bad experiences that can be integrated into our sense of self.

Providing frontline workers and street-involved people with fast and ready supportive conversation after a crisis or trauma has several beneficial effects.

1) The provision of supportive presence lessens the stress and traumatic impact of a negative event.

2) The accumulation of social resources and safe experiences within a social network of care acts as a protective mechanism and leads to improved well-being over time (Kellner et al., 2019).

After a TSP intervention, workers experience increased safety. As a result, the nervous system begins to calm and relax. Over time, these interventions rewire our brains, bodies and hearts to feel less alone, disconnected, and anxious.

When we are met with an attuned presence, we know we are not alone, and that we are going to be okay.

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GRIEF, STRESS & TRAUMA UNDERSTANDING GRIEF HEALTHY GRIEF: Over time, we see

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PROBLEMATIC GRIEF: Over time, we see

management of painful emotions future-oriented aspirations comfortable with memories ability to enjoy the story of loved-one ability to engage with others ability to visit triggering locations

avoidance of painful emotions getting stuck in the past, trapped keeping memories locked away inability to enjoy the story of the person withdrawal, isolation and disconnection innability to visit triggering locations

--- Catherine Shear - The Center for Prolonged Grief

Strobe& Shut’s Dual Process Model of grief reminds us that normal reactions to grief move between periods of hopeless backward backwardlooking loss-filled avoidance and future oriented, identity building growth.

Accepting both states and allowing for free flow between loss-orientatioin and restoration-orientation is crucial for listeners.

GRIEF, STRESS & TRAUMA

STRESS Stress is often described as a feeling of being overloaded, wound-up tight, tense and worried. Our bodies respond to stress by activating the nervous system and releasing hormones such as adrenalin and cortisol. Chronic stress can wreak havoc on your mind and body and mind leading to: Aches and pains Decreased energy Difficulty sleeping Disorganized thinking Fatigue Feeling a loss of control Feelings of helplessness Frequent illnesses and infections Gastrointestinal complaints Headaches Irritability Muscle tension Nervousness and anxiety Trouble concentrating Upset stomach

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GRIEF, STRESS & TRAUMA

STRESS CYCLE STAGES

A stress cycle is a psycho-physiological process of moving through an experience where there is enough relational or physical threat or discomfort to turn on our fight, flight and freeze system. We have many more of these stress cycles occur during a day than we always recognize.

The Trigger stage: The body recognizes a danger in its environment. Our brains don't always distinguish between psychological and physical threats so there can be many things our brain perceives as threats. Our stress cycle gets triggered a lot.

The Response stage: the body activates the sympathetic nervous system (aka. fight, flight, or freeze). Our adrenaline spikes, our heart rate might start racing, etc. We might feel rage, terror or confusion. We may just blank out and get spacey.

The Resolution stage: The body switches from the fight/flight sympathetic to the calming parasympathetic nervous system.

This system comes online when we're feeling safe enough. This is the stage that most of our stress cycles skip, so we need to be more intentional about triggering it.

---- Drs. Emily & Amelia Nagoski

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TRAUMA

GRIEF, STRESS & TRAUMA

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“Trauma is a psychic wound that hardens you psychologically that then interferes with your ability to grow and develop. It pains you and now you’re acting out of pain. It induces fear and now you’re acting out of fear. Trauma is not what happens to you, it’s what happens inside you as a result of what happened to you. Trauma is that scarring that makes you less flexible, more rigid, less feeling and more defended." - Gabor Maté Body

TRAUMA

GRIEF, STRESS & TRAUMA

Trauma is not what happens to us, it is what we hold inside in the absence of an empathic witness --- Dr. Peter Levine

“Traumatized people chronically feel unsafe inside their bodies: the past is alive in the form of gnawing interior discomfort... They often become experts at ignoring their gut feelings and in numbing awareness of what is played out inside.

They learn to hide from their selves.”

---Bessel Van Der Kolk

Trauma is a chronic disruption of connectedness.

--- Dr. Stephen Porges

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TRAUMA

GRIEF, STRESS & TRAUMA

Bonnie Badenoch’s definition of trauma

What makes a potential trauma?

Fearful, terrorizing and/or painful experiences are potential traumas.

What turns potential traumas into traumas?

When these experiences don’t have the support they need (internally or externally) to be digested and integrated into the flow of our experience. We feel alone, scared and overwhelmed. Our bodies are in great discomfort.

The question to ask concerning trauma: Who is with us before, during, and after an experience?

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GRIEF, STRESS & TRAUMA

VICARIOUS OR INDIRECT TRAUMA

Vicarious trauma can be seen as an occupational hazard. Working with trauma survivors puts us at risk of developing vicarious trauma. This term refers to ‘the cumulative, trans-formative effect on the provider working with survivors of traumatic life events’ (Saakvitne & Pearlman, 1996) The more traumatic the event or material the provider is aware of, the more likely they are to develop vicarious trauma. This is normal and is completely manageable with strong workplace and social supports. https://www.toronto.ca/wp-content/uploads/2020/07/9029Vicarous-Trauma-Toolkit-2020.pdf

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GRIEF, STRESS & TRAUMA

CLASSIC TRAUMA SYMPTOMS

1. Intrusive Symptoms: thoughts, emotions and physical sensations intrude in a person’s life unexpectantly. Very uncomfortable appearing as nightmares, flashbacks, and painful memories. Adaptive Purpose: Constant reminder of dangerous experiences that we need to make sure don’t happen again.

2. Avoidance Symptoms: People, places, situations and activities that remind us and trigger us back into the trauma space. We structure our lives to avoid these and contract our lives.

Adaptive Purpose: Staying away from things, people, places and situations that have caused irreparable harm can prevent it from happening again.

3. Depressive Symptoms: Low mood and dampened emotions and motivation. Being tired, listless and numb.

Brain fog and cognitive issues are common. Adaptive Purpose: Brain and body check out when there are overwhelming experiences. Slows us down.

4. Reactive Symptoms: Hypervigilance. We are always on the lookout for threats and danger. Jumpy and nervous.

Adaptive Purpose: The brain’s warning system or fire alarm (the amygdala) helps us remain aware of possible dangers, especially right after a crisis.

5. Risk-taking: There is evidence that traumatized people tend to engage in reckless behaviours that put themselves and others at risk. Drinking, sex, fast driving, dangerous activities.

Adaptive Purpose: Distractions from emotional pain.

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GRIEF, STRESS & TRAUMA ALONENESS OF TRAUMA

“The harm of grief, trauma and loss comes if we are not surrounded by loving supportive relationships.

We suffer a double edge of isolation: aloneness with ourselves and aloneness while we are together.

It takes more than one mind to bear difficult experiences.”

--- Diana Fosha PhD

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ELEMENTS OF PRESENCE INTERPERSONAL NEUROBILOGY Interpersonal neurobiology (IPNB) is an interdisciplinary framework developed by psychiatrist Dan Siegel and studied by thousands of researchers and scientists.

IPNB proposes that interpersonal experiences have a substantial impact on brain development early in life. These impacts directly affect how we respond to threats and relational challenges as adults.

Understanding how our brains and nervous systems work when we are stressed helps us know how to intervene and connect. When we truly connect to people and tune into their emotions, they feel accepted and seen, they are allowed to express themselves without judgement. This experience of being held in fullness helps them to relax in the safety of relationship, leading toward a connected calm.

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ELEMENTS OF PRESENCE

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POLYVAGAL THEORY

Polyvagal theory identifies the social engagement system, a playful mixture of activation and calming that operates out of unique nerve influence - ventral vagal.

ROY F. ELLIS © 2024

T R A UMA SENSI T I V E P R E S E N CE

ELEMENTS OF PRESENCE

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Here is a great video about the polyvagal theory. https://www.youtube.com/watch?v=SlhFrBoEnxU Here is a good explanation of the polyvagal theory. https://www.polyvagalinstitute.org/whatispolyvagaltheory

ELEMENTS OF PRESENCE

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CO-REGULATION Connection starts with Coregulation.

Coregulation lies at the heart of all human relationships. It is the reciprocal sending and receiving of signals of safety.

It is not merely the absence of danger but connection between two nervous systems; each nourishing and regulating the other in the process.

Because it is baked into our evolutionary past, it is not a desire, but a need – one developed to facilitate survival. As humans, we therefore are programmed to seek interpersonal connection: it is a biological imperative.

Cozolino, L. (2006). The neuroscience of human relationships: Attachment and the developing brain. New York: W. W. Norton & Co.

ELEMENTS OF PRESENCE TRUE CONNECTION & RECEPTIVITY

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“The most untapped reservoir of resource we have on the planet is people not knowing how to connect with themselves and not knowing how to connect with others.”

Dan Siegel

“I define connection as the energy that exists between people when they feel seen, heard, and valued; when they can give and receive without judgment; and when they derive sustenance and strength from the relationship.”

Brene Brown “Being receptive means overcoming insecurities and self-preoccupation and opening yourself up to the experience of another. It means you resist the urge to project your own viewpoint; you do not ask, “How would I feel if I were in your shoes?”

Instead, you are patiently ready for what the other person is offering.

David Brooks

ELEMENTS OF PRESENCE

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WHAT ABOUT SELF-REGULATION?

Self-regulation cannot exist without first experiencing a lot of co-regulation.

Regulation circuits are built inside of safe relationships.

We borrow this safety, we experience it, and integrate it such that it becomes our own.-

ELEMENTS OF PRESENCE ATTUNEMENT

“The ability for attuned communication…rests on our capacity to accurately sense someone else’s state and communicate, nonverbally (most important) and verbally (less important), our felt understanding of their emotional experience."

— Bonnie Badenoch, Being a Brain-Wise Therapist “Attunement means we are willing to be present to each other and meet each other exactly where we are.”

- Thomas Hubl

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ELEMENTS OF PRESENCE

ATTENDING TO THE OTHER AS SACRED DUTY “If you consider that each person has a soul, you will be aware that each person has some transcendent spark inside them.

You will be aware that at the deepest level we are all equals.

We’re not equal in might, intelligence, or wealth, but we are all equal on the level of our souls. If you see the people you meet as precious souls, you’ll probably wind up treating them well.

If you can attend to people in this way, you won’t be merely observing them or scrutinizing them. You’ll be illuminating them with a gaze that is warm, respectful, and admiring. You’ll be offering a gaze that says, “I’m going to trust you, before you trust me.”

---- David Brooks, How to Know a Person

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THE TOOLS

THE TOOLS Non-judgemental acceptance No agenda Not knowing Make room for silence Empathy & compassion Resonant felt-sense presence Active listening Face/voice/heart connection Calm vs. regulated Follow feelings Safe, seen, soothed, secure Attunement tips

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THE TOOLS

NON-JUDGEMENTAL ACCEPTANCE We prepare our hearts and our minds by committing to a conversation where we will suspend our judgements, and endeavour to meet the person exactly where they are. This doesn’t mean we don’t have judgments inside, only that we are careful to keep them contained while we create a welcoming, accepting space.

Be cautious: We all tend to encourage the positive and diminish the negative. Sometimes our endless positivity can be a silent judgement against the negative and problematic. We may mistakenly encourage joy or gratitude while working to dissolve away rage, despair and bitterness. People know when we’re working against some feeling tone or idea they are presenting.

The quiet message we are sending is that some aspect of how they are being or what they are doing is NOT WELCOME. They may not consciously know this, but their nervous system will let them know that they are not entirely safe with us.

Aim in all your connecting and sharing to embrace people completely as they are. We don’t come to CHANGE THEM but to BE WITH THEM. To help them feel safe. We do this by encouraging their free and open expression and meeting it always with embrace and soft concern.

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THE TOOLS

NO AGENDA Having no agenda frees you up to leave your figuring, fixing and analyzing behind. Without an agenda, you can just be there to see what arises in the conversation. There is nothing you need to say, no wise words you need to bring forth, no comfort you need to offer other than your presence. No agenda is a state of relaxation that attends fully.

It is important to try and enter the shared space as empty as possible of goals, agendas, plans and expectations. Caregiver goals only cloud the skies between us. Enjoy the fact that you are off the hook for anything but your presence! Instead, be open to what they are bringing into the shared space.

Our people may come with their own goals, and that’s great. We can help them move toward their goals, but our work is to be a SAFE (ventral vagal) experience. To connect!

Sometimes, our person will come with goals that sound unproductive or problematic. They may say they “don’t want to feel.” They may want to “go back to how I was.” In these cases, we can gently welcome these defensive goals and slowly help them begin to understand what is driving these agendas---usually they want to be free of anxiety, fear and terror. We can affirm how important it is for them to feel safe.

We never work against the movement of the person. We flow with their concerns, ideas, thoughts, feelings and behaviours. If, for any reason, you feel unsafe with them, let them know. You are also allowed to feel safe, and can terminate at any time.

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THE TOOLS

NOT KNOWING To provide amazing trauma-sensitive care, you don’t have to understand what’s happening or be an expert at trauma or grief.

We can get caught up in thinking we need to have a bunch of education, competency and learned theories so that we can say we are working knowledgeably. We like getting our left brain in gear, figuring out how to help, what to do, and what is the best way forward.

Makes sense.

But being in a figuring-out mode when we are in the presence of a crisis diminishes our right brain presence. We end up back inside our brains doing gymnastics and analysis. Meanwhile the person in pain is right in front of us needing to feel felt by us.

As we attempt TSP, it will always be better to err on the side of emotional and physical attunement. There is nothing wrong with using our brains to determine pathways to practical help, but I encourage you after a crisis to try and remain focused on presence, and not on understanding.

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THE TOOLS

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MAKE ROOM FOR SILENCE We often think that talking is the way to help people with their discomforts, fears and troubles.

Talking to help is like running when you are lost. When you are lost, you need to stop and get very still. One needs to reorient to the place that feels the most foreign. As we come to know where we are in our lostness, we begin to get our bearings.

When we are trying to connect and attune, talking, advice and questions are often an escape from the uncertainty of the moment. We are with someone in a place of pain and we would like to talk our way out.

Instead, let silence live between you. Become comfortable with the spaciousness of listening presence. Let silence be easy, full and welcoming. You don’t have to know the way. Feel the goodness of that.

Remember that our silence isn’t used to provoke the other into speaking. We aren’t trying to leverage the other person by withholding ourselves or our voices.

Rather we are fully with them, but non-verbally. We are clearing a space in the relational woods for the other person to approach and settle in. Try saying something like this... but use your own words.

“During our time together, let’s make room for silence. I’m here listening, but there is lots of time and space for you. I’ll sit here and if you have something to share, I’ll listen.”

After someone shares, let there be a pause before you respond. Let them feel you holding the power of their experience.

THE TOOLS

EMPATHY & COMPASSION Empathy is our capacity to imagine what it is to be in the mental/emotional life of the other. We do this by leaning into their experience... asking good questions and following where they lead.

Empathy leads to compassion writes Gabor Mate. “Compassion means feeling with the other.” In compassion, we move from imagining to feeling with the person.

We are focused enough and connected enough to resonate with their emotional state and show it on our faces, in our bodies, and through our breathing. We resonate with our whole being as we connect.

According to John Bowlby, an attachment researcher, the responder regulates their behaviour so that it meshes with the person in crisis... “We let them call the tune”.

“We do not obtain the most precious gifts by going in search of them but by waiting for them,” writes philosopher Simone Weil.

This is attunement.

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THE TOOLS

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RESONANT FELT-SENSE PRESENCE Felt-sense presence means we are emotionally engaged, and that our bodies are not switched-off.

We are so focused on the other, that our feelings are in sync with the person we are with. They can feel us feeling them, and this connects us deeply.

It’s telling the other “I feel with you,” not “I feel bad for you.”

Felt sense will be experienced within you, as sensation and emotion and will be visible on your face, in your eyes, in the pace of your breathing etc. Think of any time you felt strongly with someone and how powerful that experience was.

We are not asked to get lost in the felt-sense, only to be engaged enough with the other to be resonant with them.

THE TOOLS

THE TOOLS: ACTIVE LISTENING Active listening involves six skills: Paying attention - attending wholly and giving the gift of our presence Suspending judgment - showing we are accepting of their experience Reflecting - making statements that mirror back their words Clarifying - seeking deeper insight and being curious Summarizing - distilling their thoughts to show you are listening Sharing - offering thoughts, feelings and resonance

"Listening is the oldest and perhaps the most powerful tool of healing. It is often through the quality of our listening and not the wisdom of our words that we are able to effect the most profound changes in the people around us.

When we listen, we offer with our attention an opportunity for wholeness.”

Rachel Naomi Remen: Kitchen Table Wisdom

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THE TOOLS ACTIVE LISTENING Many of us have the idea that listening is passive---the information enters our ears and flows into our brains. But the psychologist Carl Rogers insisted that listening was active; a way of truly entering the experience of the other. Rogers spent his career developing a kind of listening which is beneficial for both listener and speaker. According to Rogers, “when people are listened to sensitively, they tend to listen to themselves with more care and to make clear exactly what they are feeling and thinking.”

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THE TOOLS FACE, VOICE, HEART CONNECTION

We are neurologically wired to wear our heart on our face.

When we are in our social engagement system, our voice is full of prosody (variation), our facial muscles are mobilized and expressive, our eyes are twinkly and attentive, and our hearts are full of warmth and affection for the other.

For most of us, seeing a controlled neutral face and a hearing monotone voice makes us feel unsafe... .

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THE TOOLS

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CALM VS. REGULATED Calm is not the same as regulated. We can be regulated and still be confused, angry, overwhelmed, sad and afraid. People must see we are not bypassing our feelings while we are with them. If we are pushing down our emotions, or masking them, people will sense this, and feel less safe with us. They may then mask their own feelings, and we will not truly meet them in their situation.

The difference with regulated feelings is that we are aware and mindful of how we are feeling inside. We can look at the other person and say, “this really makes me sad” or “that’s a scary thought.”

We mirror authenticity, but we are not flying out into space.

We may be overwhelmed but we are not crumbling.

They see that we can be deeply ok in the face of really hard feelings.

Calm happens on the far side of coregulation...

THE TOOLS

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FOLLOW FEELINGS People often suppress feelings. This is a natural adaptation to hurt.

People need to feel safe to show feelings. The gift that we can give people is to notice the tiny little emotional expressions that appear in micro-moments. Pay attention to even the smallest indication or glimmer; a wet eye, a huff, a sigh, a white knuckle, a pinched face for a second, a flash of sadness or fear, or a blank-out. Notice these and lean in.. Try not to tell them what you saw but instead ask them: “I’m wondering what just happened. I thought I saw an emotion ‘cross your face. Were you aware that something just happened?”

If they can’t name the feeling, offer a little help.

“I think I’m seeing sadness in your eyes. I’m really curious about what you're feeling? Can we spend a moment with this?”

If they are having trouble touching in on the feeling try this: “I’m wondering if we can just sit in this feeling for a moment.

Notice what it feels like inside and where you feel it. Can we make room for the feeling and just let it be there?”

Just remember that we’re paying attention and gently nudging a feeling if it shows up. We’re not trying to wring out the emotional sponge. If you see something, notice it. If you don’t see anything, hold space and presence and remain attuned.

THE TOOLS SAFE, SEEN, SOOTHED, SECURE

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Neurobiologist Dan Siegel outlines four components that make the other feel we are “really there”. To be truly connected people need to feel:

SAFE Responders have two primary jobs when it comes to making people feel safe: protect them from harm, and avoid becoming a source of fear and threat.

SEEN Truly seeing people demands that we do three things: (1) attune to their internal mental state on a profound and meaningful level; (2) come to understand their inner life; and (3) respond to what we see in a timely and effective manner. This three-­step process helps people “feel felt.”

SOOTHED When a person is in distress, that state can be shifted by an interaction with a caregiver who cares for her. She might still suffer, but at least she won’t be alone in her pain. Based on this responderdirected “inter-­soothing,” she’ll learn to provide “inner soothing” for herself.

SECURE The fourth “S” results from the first three. We give people a secure base when we show them that they are safe, that there’s someone who sees them and cares for them, and that we will soothe them in distress. They then learn to keep themselves safe, to see themselves as worthy, to soothe themselves when things go wrong.

THE TOOLS ATTUNEMENT TIPS

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AN INFINITY OF MORE As you talk, stay curious about what is coming next! Imagine there is an infinity of more! Try saying something like this...

“Thanks so much for sharing that. I’m wondering, though, whether there might be more you want to say about that?”

WELCOME AWKWARDNESS, NOVELTY, SUSPICION In the middle of crisis, grief and trauma, the brain responds to danger by following old familiar neural pathways. These are very familiar. You might experience your person going back to the same line of reasoning, or landing in their usual fight, flight or freeze position. They will feel immobilized and stuck in their feelings. But that response is an old friend to them.

However, as we help people back to safety by becoming their sheltering haven, they may find themselves in NEW territory.

The early experience of safety can feel awkward, foreign, weird, novel and untrustworthy. People will defend against this new feeling with skepticism and healthy caution. They may fear stepping toward safety only to be abandoned again. Welcome all these feelings and statements.

THE TOOLS ATTUNEMENT TIPS

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RIGHT-BRAIN PRESENCE AND FLOW Right-brain focus means we are remaining relational, embodied, and oriented to the present. We are not getting caught up trying to solve the problem. We are not getting fixated on what we need to say or do. We are just present in the moment, wide open and curious. Relax, feel, relate, resonate, connect.

KEEP PEOPLE IN TOUCH WITH THEIR BODY 80% of neurological information comes up from the body to the brain and only 20% goes from brain to body. People are nonetheless not likely to bring information about their sensing body into helping conversations.

We get our body in tune (co-regulating) with theirs by helping them start to value and be interested in how their body is feeling inside. We can invite people into body awareness by asking them where the feelings are in their bodies. Ask them how intense the feeling is... is it tolerable? What does it feel like?

Let these questions flow naturally after you see feeling in them, or they show feeling. Just direct them back to their body. “Where are you feeling that right now?”

THE TSP METHOD

THE SEQUENCE TSP SEQUENCE Self-assessment Environment & nourishment Sitting down and connecting Setting time & discussing confidentiality Assesssment Crisis Colours Window of Tolerance Narrative Story - what happened Thoughts, feelings, sensations What it means Next steps Gratitude and ending Follow-up

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THE TSP METHOD

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PREPARATION: SELF ASSESSMENT AND AWARENESS Before you begin, take a few minutes to do a thorough scan of your body, being and state of mind. Be sure you’re ready to connect from a regulated state...

Sensing tissue: Are you comfortable in your skin right now? Aware of the room, the temperature, the feel of things.

Heart-rate: How is your heart responding as you prepare?

Respiration: Notice the pace and depth of your breathing.

Temperature: Hot or cold, sweating or dry, warming or cooling?

Energy: Fidgety or restless? Dampened, neutral, flat? High or low?

Facial mobility: Is it expressive and alive or neutral and flat?

Eyes: Keep eyes soft and receptive.

Throat/airway: Any tightness? Choking off, phlegm? Open and breathe deeply and easily.

Voice: Watch your vocal prosody. Natural, flowing rising and falling tone, volume, warmth.

Hands and feet: Any tension or toe-tapping, fidgeting or loose energy?

Head Brain: Are you in left brain figuring-it-out mode or the hereand-now right brain?

Heart Brain: Do you feel connected, close, warm or cautious, guarded and ambivalent? Ready to be relational?

Belly Brain: What’s your gut tell you about this coming connection? What about this conversation, moment or connection is uncomfortable? Get in touch!!!

Thoughts: Is your mind doing too much work? Are you getting ahead of the moment?

Spiritual Presence: Are you grounded and light, or floaty, heavy or chaotic?

Safety Check: Guarded, braced, afraid, too open, too porous and pleasing?

THE TSP METHOD

PREPARATION: ENVIRONMENT & NOURISHMENT Choose a place to speak that is safe (away from ongoing risks and the noises associated with the danger/issue).

Is the space quiet?

Seek to make the space comfortable (if possible).

Move two chairs about four feet apart. Try not to meet across a table or desk.

Best if both chairs are sideways to exits, so no one has their back to the door.

Do not lock the doors.

Provide water and a glass.

If the person is hungry try and access food or snacks.

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THE TSP METHOD

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THE PROCESS: SITTING & CONNECTING When moving together into the chosen space, ask the person which chair they would like. Be hospitable, even if you know the person well. You are engaging in a different kind of encounter and conversation.

As you sit together, take a moment to pause: quietly notice their body, breathing, facial expression, energy level, overt /covert signals, dress and voice levels, eye contact etc.

As you take them in, really tune into their emotional state. Receive them. Listen with your whole body.

Make room for the CONNECTION between to emerge.

From this safer place, the inherent wisdom of between you can begin to flow naturally. Focus on developing comfort in that shared space where connection and presence live.

THE TSP METHOD

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THE PROCESS: SETTING TIME & CONFIDENTIALITY One of the first things we need to do when we sit down with someone for an intervention is to let them know approximately or exactly how much time you have to share with them.

This helps give them a sense of structure and a parameter to the discussion. I find an hour or two sufficient, less if the person is overwhelmed.

Give them a ten or fifteen-minute warning as you close so that you can tie things up.

Confidentiality is essential. However, this is not therapy, and there may be important information that you relay back to others...

Let them know you are here to help and will share only what is necessary to secure their safety and assist them going forward. I always try and let them know what I will be sharing with management so that there are no surprises.

Let them know that If they are suicidal or homicidal, you will have to speak with someone.

THE TSP METHOD

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ASSESSMENT: THE WINDOW OF TOLERANCE When we can find a place to land between sympathetic overwhelm (FIGHT/FLIGHT/FREEZE) and parasympathetic underwhelm (NUMBING, SHUTTING DOWN), we stay within our window of tolerance--- being neither too excited nor too dampened.

Working inside the window of tolerance means that we work together to assess at each moment whether the person is feeling overwhelmed or if the emotions, thoughts and sensation in their body are tolerable.

I like to scale their nervous system activation between 0 and 10.

0 = calm, 10 = panic.

Ask them the highest number they can experience and not go into fight/flight/freeze. That’s the edge of their window of tolerance.

Then ask them what number they are at now. If the number is over their highest number, you need to pause and help them to coregulate with you (SEE REGULATION TOOLS)

THE TSP METHOD

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NARRATIVE: A GUIDELINE FOR COMMUNICATION Although we have stressed over and over that there isn’t anything for you to do, and in a perfect world you would simply create a container and let the person bring whatever they’d like, most people are not comfortable with absolutely no structure.

Therefore, I am offering a very simple process that may help guide your conversation. But it is a guidebook to the terrain, a map, not the territory.

If you feel comfortable moving with the person wherever they need to go, do that. If you sense you can follow where they lead and keep track of their nervous system so that it doesn’t overwhelm them, then go with that.

However, if you need some help, or if they are unable to get talking without some structure, this simple process will get you where you need to go. You focus on: Story Thoughts, feelings, sensations Meaning by touching on all three topics in order, you will help the person to meet themselves, and be seen in their wholeness.

THE TSP METHOD

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NARRATIVE: THE STORY -WHAT HAPPEND When you start, ask the person if they’d like to tell you what happened, but very briefly. You don’t want tons of information or details. Just to get a good sense of what happened.

Explain to them that you don’t want them to re-experience the event, crisis or trauma, so staying away from too much detail is important. You want to make sure their nervous system doesn’t go into fight or flight!

It should only take 3 to 4 minutes for them to share.

If they start going on longer or deeper into the story, or if you see them starting to become triggered or activated, just ask them to pause. Then explain again that you’re trying to stay brief and keep them safe.

Assure them that the story is really important, but that this is not the time to get into the details.

Refocus and invite them to finish the story.

Thank them for sharing.

THE TSP METHOD

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NARRATIVE: THOUGHTS, FEELINGS AND SENSATIONS Once the story is concluded invite the person to describe any feelings, thoughts or sensations that they are experiencing now.

Leave lots of room and space for them to share.

Again, you don’t need to do anything here. Just use the tools; paying attention, suspending judgment, no agenda, reflecting statements, clarifying, summarizing and sharing what’s happening for you as you resonate and attune with them.

You can ask them about each element: Feelings, thoughts and emotions. Sometimes people mistake thoughts for feelings, so listen carefully and let them know if they’re talking about a thought, a feeling or a sensation in their body.

This is where you might see some tears, anger, confusion or fear. Welcome whatever comes and check in to make sure they are not overwhelmed.

Don’t pass them Kleenex or interrupt strong feelings in any way. Just listen and attend. Nothing for you to know or do, right? You’re only needed to witness and attend.

Let them share until there is no more to share.

THE TSP METHOD

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NARRATIVE: WHAT IT MEANS Once they have completed sharing to their satisfaction, you can move on to the meaning of the experience.

Simply ask, “What does this all mean to you?” Put it in your own words.

Asking about meaning drops people into a deep inner place where they rarely go. You may have noticed in your life that people rarely ask us what an event, moment, experience or pain “means” to us. That’s because the question moves people into places of self-reflection and questioning.

People may not know what the event means yet. They may be confused and lost. If that’s the case, just ask “what’s it like being lost for you?” After they answer ask them “why?”

That will move them closer to meaning.

This is tricky stuff and don’t worry if you don’t get there or they can’t get there themselves. Remember there’s nothing for you to do. These are just some cues to help. They are guidelines, not rules.

These practices are challenging to learn. Be patient with yourself. It takes years to get good at this.

THE TSP METHOD

At appropriate moments, especially when they are deep in pain or stress, these statements will help ground you both in presence and safety...

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THE TSP METHOD

NEXT STEPS Once the conversation about the meaning of the event has slowed or ended, you can move on to enquire about next steps.

Ask them what they think the next steps are?

What do they need now?

Where do they need to be for the next few hours?

Who needs to be with them?

What can the organization do?

Do they need to stay around people or would they prefer to be alone?

How can you help?

Write it all down on a piece of paper (the only notes you take) and give it to them.

Follow-through on anything you have promised.

You don’t have to go too deep into these questions.

You just want to make sure you know a little about what is next to help their nervous system feel safe about what is coming now... they are leaving this safe haven and going back into the world.

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THE TSP METHOD

GRATITUDE & ENDING Express gratitude for their sharing, vulnerability, and willingness to be present with you.

Let them know how meaningful and good it was to be with them. Speak from your heart. Say nothing that you don’t believe. Don’t say nice words to make them feel good. Let them know how grateful you are to see their pain, sadness or fear etc. Be authentic.

Now ask them if they have any final words they want to say to you before you end your time together.

I usually offer the choices of a wave, handshake or hug, depending on both of our comfort levels with contact.

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THE TSP METHOD

FOLLOW-UP Typically there is a brief verbal follow-up with a manager or supervisor. It is crucial that this sharing have the sole purpose of securing the safety and wellbeing of the individual.

The following topics can be discussed: Is the person feeling safe?

What is the level of concern? Is this a trauma or just a bad experience?

Does the person have a plan for the next few hours? What is that plan? Does it involve other people?

What next steps were identified that concern the organization?

Does this person have a plan for taking care of their mental health?

Did the person have thoughts about their presence at work in the near future. Do they want time away or do they wish to return to work.

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REGULATION TOOLS REGULATION: TAPPING

Tapping works with energy/pressure points on the body, and is proven to help people calm when they are stressed or anxious.

If you take the time to learn these pressure points and the simple method, you can teach it to people who are out of their window of tolerance, or who wish to learn regulation tools.

Learn more at: https://healthy.kaiserpermanente.or g/health-wellness/healthencyclopedia/he.emotionalfreedom-technique-eft.acl9225

REGULATION: HAVENING The Havening techniques (c) are simple and effective. These selfcalming touch practices can calm the nervous system and move us from sympathetic (FIGHT/FLIGHT) to calm and oriented.

It isn’t a miracle solution, but it can make a difference quickly. It’s easy to learn and teach. “You can’t reexperience trauma in a calm body. “ - Dr. Eric Gentry Learn more at: https://mindcare.nz/havening.html https://theenlightenco.podia.com/ havening-techniques-informationsheet

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RESOURCES & READINGS

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RESOURCES & READINGS

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Understanding the Impact of Trauma https://www.ncbi.nlm.nih.gov/books/NBK207191/ Do frontline workers know about trauma-informed care? https://www.homelesshub.ca/blog/do-frontline-workers-know-abouttrauma-informed-care Frontline Workers Toolkit https://www.toronto.ca/wp-content/uploads/2020/07/9029-VicarousTrauma-Toolkit-2020.pdf Frontline Workers with Lived Experience and Traumatic Stress In the Homelessness Sector https://yorkspace.library.yorku.ca/server/api/core/bitstreams/10e138d3 -aab6-4bc3-bb7c-2d25f99f2648/content

A qualitative study of work-related distress among service providers to people experiencing homelessness in Canada https://www.sciencedirect.com/science/article/pii/S26665603220010 37 Posttraumatic stress disorder, secondary traumatic stress, and burnout in frontline workers in homelessness services https://www.pure.ed.ac.uk/ws/portalfiles/portal/336701727/Lemieux_ CumberlegeEtal2023JSDHPosttraumaticStressDisorder.pdf

BIO & DEETS

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Originally from Thunder Bay, Ontario, I have always been interested in community-based work and underserved populations. In 1998, I moved to Halifax to work with people with HIV/AIDS and later was hired by the Capital Health Mental Health Program and then Palliative Care. I have a Master of Divinity from Queens University and a Master of Education in Counselling Psychology from Acadia.

As a private consultant, I’ve specialized in working with professionals and volunteers in person-centred organizations where trauma, compassion fatigue and burn-out are workplace hazards.

Speaking, teaching and writing are my lifelong passions. I’m a vibrant communicator who combines a researcher’s interest in accuracy with the wit and colour of a natural storyteller. Because I enjoy people, I excel at living conversations with my participants and prioritize dialogue and discussion over purely didactic engagements.

BIO & DEETS Roy F Ellis Consulting offers a range of interventions, workshops, trainings and opportunities that assist corporations, healthcare institutions and community-based organizations to enhance staff and management well-being in times of trauma, crisis, change and grief.

Roy has helped organizations such as the DND Military Family Resource Centre, Dalhousie Department of Emergency Medicine, Moms Stop the Harm, Shelter Nova Scotia, North End Community Health Association, Department of Justice Victim Services, Metro Community Housing, Mainline Needle Exchange, Direction 180, Mobile Outreach Street Health, Native Alcohol and Drug Abuse Counselling Association of Nova Scotia, Threads of Life Canada, VON, Healing our Nations, AIDS Cape Breton, CUPE, Helpline, and the Newfoundland Labrador Construction Safety Association. Roy co-created Camp Kedooopse, a bereavement camp for grieving children in the Maritimes.

Roy has finished writing a book on grief.

E: roy@royfellis.com C: 902 830 5225 W: royfellis.com Facebook: royellisgrief

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