In recent years the mental health community has become increasingly
sensitized to a promising new development in the theory and treatment
of emotional illness. The central role of trauma---physical,
emotional and sexual abuse, and neglect---in the generation of a wide variety of
symptomatic behavior and emotional distress is more and more apparent.
Many people who previously were diagnosed with severe personality disorders or psychotic disorders were considered to have a poor prognosis, and others with milder but significant distress and dysfunction have found a path to understanding and recovery previously unavailable to them.
Dr. Colin Ross has developed a clinical treatment program based on his Trauma Model. His goals are to offer high quality and effective treatment to people with trauma-related disorders, to assist in treatment planning with referring therapists, and to engage in clinical research to help further refine key elements of diagnosis and treatment in this new and exciting area of mental health care.
The Effects of Trauma
Trauma can lead to many symptoms including depression, anxiety, substance abuse, psychosis and dissociation. An enduring pattern of numerous complex symptoms can devastate a person's emotional and cognitive development, causing severe dysfunction and distress in adulthood. Trauma's various manifestations include chronic
depression, lack of coherent self image, low self esteem, repetitive self defeating and self destructive behaviors, unstable mood, and hallucinations.
At times the traumatic origins of an individual's problems may be difficult to ascertain. At the Ross Institute, an experienced staff of clinicians provides psychiatric, psychometric and gehavioral evaluation to ascertain the presence of trauma-related problems as well as determining the presence of other treatable medical or psychiatric disorders.
The treatment of trauma disorder patients requires special care and presents special challenges. Often these patients have a wide range of deficits that impair their ability to form healing relationships or make informed treatment decisions on their own
behalf. A wide range of treatment modalities is offered to address these deficits.
A variety of cognitive therapies is offered to assist patients in correcting their general cognitive deficits as well as specific cognitive distortions related to anger, shame, identity, sexuality and relationships.
In addition, a variety of experiential treatment modalities are offered to assist in development of an integrated sense of self. These activities also are helpful in developing socialization skills, reality testing, and affect tolerance and regulation.
Special attention is given to anger expression as trauma disorder patients typically have difficulty tolerating their anger, expressing it constructively, and overcoming their fear of retaliation.
A didactic approach is also utilized to educate the patient as to the cause and form of his or her difficulties, solicit the patient's intellectual capacity for involvement in treatment and recovery, and demystify and de-stigmatize the patient's perception of his or her problems and diagnoses.
A therapeutic milieu is fostered so that patients may gain support and encouragement from one another. The milieu is also utilized as a model social community through which patients may gain an understanding of their responsibility for both themselves and their community.
Therapeutic journaling is also utilized to develop self awareness and self validation, and to diminish personality fragmentation.
Additionally, psychotropic medication is prescribed as appropriate to facilitate the regulation of feelings and the treatment of medication-responsive psychiatric disorders.
Overall, we follow the treatment principles described in Dr. Ross' book, The Trauma Model.
Types of Patients Treated
Due to our wide ranging clinical treatment modalities, we are equipped to treat a variety of patients and problems. Almost all patients are admitted emergently for safety and stabilization. Some require significant assistance in developing internal self regulation and life management skills in order to return to living independently.
Clinical Teaching and Consultation
We endeavor to provide comprehensive treatment. We work with a referring therapist in the community who continues to work with his or her patient in the hospital, and also accept out of area referrals. In these circumstances we solicit the treatment experience of the referring therapist and help formulate an ongoing treatment plan for use upon referral back to outpatient care. We see this as an excellent opportunity to learn from other therapists' experiences and also as an opportunity to provide clinical teaching and consultation for the less experienced therapist.
Commitment to Research
With the assistance and enduring commitment of Dr. Colin Ross, we expect to engage in significant research in the diagnosis and treatment of trauma-related disorders. By no means do we expect to have all the answers. However, we do make the commitment to contribute as much as possible to the dialogue and growing body of knowledge in this field.
The Problem of False Memories
Our position at the Ross Institute is that patients need to be responsible for their own thoughts, feelings, behavior, and memories. It is not our task to either "validate" memories or conclude that they are not real. We work with the patient to help him or her sort out the reality of the past as best as possible. The content of the memories is not our primary focus; the healing elements of the treatment are in the process and structure, not in the content.
NURSING INTERVENTIONS FOR TRAUMA PATIENTS
Individuals with trauma-related disorders should be treated first and foremost as troubled human beings, not as diagnoses. Most general rules and expectations
for any adult psychiatric unit apply to a trauma unit. Often the correct nursing intervention is the same as for any inpatient with a given behavior or symptom.
It is important to be both rigid and flexible at the same time, which can be difficult. Clinical judgment is required to strike a balance between rigidity and excessive flexibility.
Personnel working regularly on a Trauma Program should read Dr. Ross' book, The Trauma Model.
Unit Problems Requiring Nursing Interventions
Individual nurses may develop a special interest in therapy skills and seek training, supervision and experience in therapy techniques in order to make their nursing interventions more effective. However, the following is directed at general nursing
skills for a trauma unit.
The first step is to identify the problem which is the current immediate nursing problem. Knowledge of the trauma model helps to plan the nursing intervention.
Usually the problem is behavioral or involves severe symptoms. Generally the person will be angry, noisy, frightened, abreacting, acting childishly, or refusing to comply with ward routine; or being assaultive, threatening or self-destructive. The nursing
task is to modify the behavior or the symptoms, which may require specific interventions.
General Nursing Interventions
Medication, limit-setting, support, conversation, reassurance, calling the therapist or doctor, and educating the patient.
The role of nursing is to create a safe, calm, therapeutic milieu. This involves all nursing skills. Although the role of the nurse is not to be the primary therapist, many nursing interventions are healing and therapeutic.
Usually the goal of nursing interventions is not therapy as such but keeping the individual and the unit as stable as possible. A controlled, orderly unit is healthy for the patients, reduces regression and acting out, and reduces staff burnout.
Equally, it is important to be reasonable and flexible within defined limits.