Violence Against Women: Fact Sheet 2014

January 12, 2015

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Intimate partner and sexual violence against women
Fact sheet N-239
Updated November 2014
http://www.who.int/mediacentre/factsheets/fs239/en/

Key facts:

Violence against women – particularly intimate partner violence and sexual violence against women – are major public health problems and violations of women’s human rights.

Recent global prevalence figures indicate that 35% of women worldwide have experienced either intimate partner violence or non-partner sexual violence in their lifetime.

On average, 30% of women who have been in a relationship report that they have experienced some form of physical or sexual violence by their partner.

Globally, as many as 38% of murders of women are committed by an intimate partner.

Violence can result in physical, mental, sexual, reproductive health and other health problems, and may increase vulnerability to HIV.

Risk factors for being a perpetrator include low education, exposure to child maltreatment or witnessing violence in the family, harmful use of alcohol, attitudes accepting of violence and gender inequality.

Risk factors for being a victim of intimate partner and sexual violence include low education, witnessing violence between parents, exposure to abuse during childhood and attitudes accepting violence and gender inequality.

In high-income settings, school-based programmes to prevent relationship violence among young people (or dating violence) are supported by some evidence of effectiveness.

In low-income settings, other primary prevention strategies, such as microfinance combined with gender equality training and community-based initiatives that address gender inequality and communication and relationship skills, hold promise.

Situations of conflict, post conflict and displacement may exacerbate existing violence and present additional forms of violence against women.
Introduction

Defining Violence Against Women

The United Nations defines violence against women as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.”

Intimate partner violence refers to behaviour by an intimate partner or ex-partner that causes physical, sexual or psychological harm, including physical aggression, sexual coercion, psychological abuse and controlling behaviours.

Sexual violence is any sexual act, attempt to obtain a sexual act, or other act directed against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting. It includes rape, defined as the physically forced or otherwise coerced penetration of the vulva or anus with a penis, other body part or object.

Scope of the problem

Population-level surveys based on reports from victims provide the most accurate estimates of the prevalence of intimate partner violence and sexual violence in non-conflict settings. The first report of the “WHO Multi-country study on women’s health and domestic violence against women” (2005) in 10 mainly low- and middle-income countries found that, among women aged 15-49:

– Between 15% of women in Japan and 71% of women in Ethiopia reported physical and/or sexual violence by an intimate partner in their lifetime;

– Between 0.3–11.5% of women reported experiencing sexual violence by someone other than a partner since the age of 15 years;

– The first sexual experience for many women was reported as forced – 17% of women in rural Tanzania, 24% in rural Peru, and 30% in rural Bangladesh reported that their first sexual experience was forced.
A more recent analysis of WHO with the London School of Hygiene and Tropical Medicine and the Medical Research Council, based on existing data from over 80 countries, found that globally 35% of women have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence. Most of this violence is intimate partner violence.

– Worldwide, almost one third (30%) of all women who have been in a relationship have experienced physical and/or sexual violence by their intimate partner, in some regions this is much higher. Globally as many as 38% of all murders of women are committed by intimate partners.

– Intimate partner and sexual violence are mostly perpetrated by men against women and child sexual abuse affects both boys and girls. International studies reveal that approximately 20% of women and 5–10% of men report being victims of sexual violence as children. Violence among young people, including dating violence, is also a major problem.

Risk factors

Factors found to be associated with intimate partner and sexual violence occur within individuals, families and communities and wider society. Some factors are associated with being a perpetrator of violence, some are associated with experiencing violence and some are associated with both.

Risk factors for both intimate partner and sexual violence include:

– Lower levels of education (perpetration of sexual violence and experience of sexual violence);

– Exposure to child maltreatment (perpetration and experience);
witnessing family violence (perpetration and experience);

– Antisocial personality disorder (perpetration);

– Harmful use of alcohol (perpetration and experience);v

– Having multiple partners or suspected by their partners of infidelity (perpetration); and
attitudes that are accepting of violence and gender inequality (perpetration and experience).

Factors specifically associated with intimate partner violence include:

– Past history of violence;
marital discord and dissatisfaction;

– Difficulties in communicating between partners.

Factors specifically associated with sexual violence perpetration include:

– Beliefs in family honour and sexual purity;
– Ideologies of male sexual entitlement; and
– Weak legal sanctions for sexual violence.

The unequal position of women relative to men and the normative use of violence to resolve conflict are strongly associated with both intimate partner violence and non-partner sexual violence.

Health consequences

Intimate partner and sexual violence have serious short- and long-term physical, mental, sexual and reproductive health problems for survivors and for their children, and lead to high social and economic costs.

Violence against women can have fatal results like homicide or suicide.
It can lead to injuries, with 42% of women who experience intimate partner reporting an injury as a consequences of this violence.

Intimate partner violence and sexual violence can lead to unintended pregnancies, induced abortions, gynaecological problems, and sexually transmitted infections, including HIV.

The 2013 analysis found that women who had been physically or sexually abused were 1.5 times more likely to have a sexually transmitted infection and, in some regions, HIV, compared to women who had not experienced partner violence. They are also twice as likely to have an abortion.
Intimate partner violence in pregnancy also increases the likelihood of miscarriage, stillbirth, pre-term delivery and low birth weight babies.

These forms of violence can lead to depression, post-traumatic stress disorder, sleep difficulties, eating disorders, emotional distress and suicide attempts.

The same study found that women who have experienced intimate partner violence were almost twice as likely to experience depression and problem drinking. The rate was even higher for women who had experienced non partner sexual violence.

Health effects can also include headaches, back pain, abdominal pain, fibromyalgia, gastrointestinal disorders, limited mobility and poor overall health.

Sexual violence, particularly during childhood, can lead to increased smoking, drug and alcohol misuse, and risky sexual behaviours in later life. It is also associated with perpetration of violence (for males) and being a victim of violence (for females).

Effect On Children

Children who grow up in families where there is violence may suffer a range of behavioural and emotional disturbances. These can also be associated with perpetrating or experiencing violence later in life.
Intimate partner violence has also been associated with higher rates of infant and child mortality and morbidity (e.g. diarrhoeal disease, malnutrition).

Social and economic costs

The social and economic costs of intimate partner and sexual violence are enormous and have ripple effects throughout society. Women may suffer isolation, inability to work, loss of wages, lack of participation in regular activities and limited ability to care for themselves and their children.

Prevention and response

Currently, there are few interventions whose effectiveness has been proven through well designed studies. More resources are needed to strengthen the prevention of intimate partner and sexual violence, including primary prevention, i.e. stopping it from happening in the first place.

Regarding primary prevention, there is some evidence from high-income countries that school-based programmes to prevent violence within dating relationships have shown effectiveness. However, these have yet to be assessed for use in resource-poor settings. Several other primary prevention strategies: those that combine microfinance with gender equality training; that promote communication and relationship skills within couples and communities; that reduce access to, and harmful use of alcohol; and that change cultural gender norms, have shown some promise but need to be evaluated further.

To achieve lasting change, it is important to enact legislation and develop policies that:

– Address discrimination against women;
– Promote gender equality;
support women; and
– Help to move towards more peaceful cultural norms.

An appropriate response from the health sector can play an important role in the prevention of violence.
Sensitization and education of health and other service providers is therefore another important strategy.

To address fully the consequences of violence and the needs of victims/survivors requires a multi-sectoral response.

WHO actions

WHO, in collaboration with a number of partners, is:

– building the evidence base on the size and nature of violence against women in different settings and supporting countries’ efforts to document and measure this violence and its consequences.

This is central to understanding the magnitude and nature of the problem at a global level and to initiating action in countries;

– Strengthening research and research capacity to assess interventions to address partner violence
developing technical guidance for evidence-based intimate partner and sexual violence prevention and for strengthening the health sector responses to such violence;

– Disseminating information and supporting national efforts to advance women’s rights and the prevention of and response to violence against women; and

– Collaborating with international agencies and organizations to reduce/eliminate violence globally.

http://www.who.int/mediacentre/factsheets/fs239/en/

Gorski Books


Marti MacGibbon Tells Her Story

January 16, 2014
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Marti MacGibbon
Author and Motivational Speaker

By Marti MacGibbon

My name is Marti MacGibbon and I am an addiction treatment professional, award-winning author, a professional humorous, and an inspirational speaker. I specialize in addiction, trauma resolution, recovery, resilience, and all forms of inspiration.  I am also a person in long-term recovery from addiction, with 18 years chemical-free. I entered treatment for Chronic Post Traumatic Stress Disorder (PTSD) when the symptoms became unbearable in sobriety.

I am writing this blog for two reasons:

– To summarize my story of personal recovery which I told in detail in the book Never Give Into Fear, and
– To express my gratitude to Terence T. (Terry) Gorski for his life work.

Terry has dedicated his life to creating practical systems of recovery that are describe step-by-step skills that can be learned and used. He presents these skills in clear, easy-to understand, and no-nonsense language. He has always put recovering people and their families first. His primary goal has to help people to live sober and responsible. His methods have always fostered a movement from dependence, to independence, and then to interdependence. His methods are always collaborative and respectful. He believes in rational thinking and sober responsible living.

Terry Gorski has dedicated his life
to helping addicted people and their families
to learn effective skills
for helping themselves to recover.

My Story Encapsulated

In my active addiction, I might have been described as one of the hopeless cases, and looking back now, I know that both childhood sexual abuse (first instance at 14 years old) by authority figures, and the extreme trauma I survived in adulthood fueled my addiction. Knowledge is power, and this is especially true in recovery.  Organized knowledge is even better. The more I learn about the disease, the stronger my recovery grows, and the more positive action I can take to build a better, more enjoyable lifestyle and share experience, strength, and hope with others.

Knowledge is power.
Organized knowledge is even better.
~ Terence T. Gorski ~

In 1984, I was a successful standup comic (check out part of my act on YouTube), with a scheduled appearance on The Tonight Show with Johnny Carson, but I struggled with addiction. I’d been a heavy drinker in an attempt to cope with emotional pain and self-loathing, but couldn’t perform well on stage under the influence of alcohol, so I’d begun experimenting with stimulants.  That’s when I discovered methamphetamine, specifically crystal meth, and it was “game on!”

In the manner described in Gorski’s book, Straight Talk About Addiction, when I used meth I had an addictive brain response that released the brain chemistry of self-confidence. I felt more in control on meth, and I felt excited at the prospect of a new drug of choice that seemed to benefit me. I met a man¾a handsome criminal with lots of contacts in the drug world. The relationship went downhill fast, morphing into a classic abusive relationship. My downward spiral became a power dive, resulting in my being trafficked to Tokyo and held prisoner by Japanese organized crime figures. I endured rape and physical abuse, and lived under threat of death, but someone helped me to escape, and I returned to the U.S.

There’s a good reason
not to get intimately involved with a criminals.
That reason is … Ummm?
Well, the reason is they’re criminals.
As a general rule criminals can’t be trusted!
~ Terence T. Gorski ~

At that point, I began using my drug of choice as a means of coping with the trauma I’d experienced, and, as many trauma victims do, I returned to the abusive boyfriend. He beat me up and almost killed me. After that, I spent a year and a half homeless, sleeping under bridges and in abandoned houses. I lived in terror of reprisal from the traffickers I’d escaped. I suffered from nightmares. I didn’t realize it at the time, but I was suffering from PTSD.  (See Gorski’s Approach To PTSD)

Eventually, I met the man who is my husband today. We’ve been together for 26 years, and although we experienced active addiction together for several years, we both entered recovery during the 1990s, and we still enjoy strong recovery today. When I got clean, I returned to professional standup comedy for some years, and I know the power of laughter as a healing force! For me, gratitude, laughter and fun are mainstays in my recovery program. As I motivational speaker, I still do standup comedy, I just call myself a humorist and my audiences are sober people who enjoy a message of hope delivered in a way that helps them life at the ironies of life.

I always wanted to be a comedian,
but I lacked one thing – Talent!
So I did the next best thing.
I became a therapist!
~ Terence T. Gorski ~

Recovery Is An Action Plan

Recovery is a plan of action that creates motivation, which in turn creates more positive action. During my first few days clean, I took a look at my daily schedule and saw that my average day in addiction consisted of a series of bad habits, negative thought patterns, and self-defeating behaviors. At that point I instinctively knew I needed to learn more effective skills and practice them in every area of my life until they became habitual. When I was addicted, I was driven by the automatic and unconscious habits involved in getting ready to use, using, and recovering from using so I could start the cycle again. I didn’t have to think about it. It was a habit – and habits don’t require thought.

I managed to put the complex behaviors required to get and use illegal drugs under automatic habitual control – and I did it during a drug war, while I was homeless, suffering from severe PTSD, and surround by dangerous people. I certainly could develop a set of automatic/habitual recovery skills when I had a safe place to live, food to eat and meetings filled with sober and responsible people willing to help me.

So I rolled up my sleeves and got started. I replaced bad habits with good: began an exercise program, focused on a healthy diet, learned about cognitive distortions, began using positive affirmations and mantras, and started building a sober support network. The results came quickly and my success filled me with enthusiasm for my new lifestyle and the healing process. One success built upon another building momentum until I had moments of genuine well-being which I call spiritual experiences. The recovery process was a similar but opposite to the process of addiction. When actively addicted one failure built upon another until hopelessness crushed the soul.

Recovery is a plan of action that creates motivation,
which in turn creates more positive action.
~Marti MacGibbon ~

After ten years in recovery, I entered into therapy. I still had nightmares from the experience in Japan, and the additional trauma during my homeless period on the street.

Therapy has been, and still is, a game changer for me.  The healing is deep and profound. After therapy, I knew I wanted more than standup comedy, so I obtained education and training in addiction treatment. My goal was to be able to carry the message of recovery to others who suffer. During my studies, I discovered the work, of Terry Gorski. I learned about his Relapse Prevention Certification School. After earning my CADC-II, I enrolled in the RPT training and earned the ACRPS. I have worked with special populations, (Women and Homeless Veterans), and in outpatient, inpatient, and transitional housing settings.

Terry Gorski’s books provide education about the disease of addiction. His material is well organized. He presents valuable information for therapists and recovering people in plain language that anyone can understand.  When I read his books Learning to Live Again, and Understanding the Twelve Steps, I knew I’d discovered valuable recovery tools! Terry didn’t really say anything I didn’t know. He did, however, give me a better way to put what I knew intuitively into words so I could explain it more clearly to others.  I’ve purchased the two books for sponsees and friends in 12-Step programs as gifts they can use as additional resources and companions to the Big Book and Twelve and Twelve. The women I have shared these resources with have always been enthusiastic about the results they achieve when they study the books and take action.

While reading many of Gorski’s books, and in my addiction treatment training, I was thrilled to learn that fun and laughter are important to recovery even though the evidence for relationship between humor and health is not as strong as many believe it to be. This idea, however, continues to electrify me. Although I do not currently work as a counselor in a facility, I maintain my certifications and work to carry the message about recovery.

Today I am producer, founder and host of Laff-Aholics Standup Comedy Benefit for Recovery, an annual fundraiser in Indianapolis featuring nationally headlining comedians. The purpose of the show is to provide a fun event for people in recovery, with social connectivity and plenty of healing laughter. Newcomers learn it’s possible to have fun in recovery, that our community comes together for our most vulnerable members, and “old-timers” are refreshed and inspired. 100% of the profits from the show go to facilities that provide transitional housing and access to treatment for those who have little or no financial assets. We prefer to benefit facilities that will take clients who have “only the shirt on their backs,” so to speak.

Now I am launching a talk show on a recovery radio network called Pure Motive Radio. The show is on Blog Talk Radio, and it’s called, Kickass Personal Transformation with Marti MacGibbon. The purpose of the show is to provide entertainment, education, and tips on personal development in recovery. I’m booking comedians, authors who write about recovery, and thought leaders in the addiction treatment field. I enjoyed the two guest appearances that Terry Gorski made on my show. I am excited because he has agreed to do more in the future! My listening audience will be fascinated, educated, and enthralled!

Terry’s generosity to the recovering community is extensive. His many books, lectures, and the services of The CENAPS® Corporation provide a wealth of resources for those of us who suffer from the disease of addiction. He’s a brilliant clinician with a keen sense of humor and his contribution to recovery has made it possible for countless lives to be saved, healed and improved.  Terry Gorski Rocks! ~ Marti MacGibbon

C2953-MacGibbon Cover-Mini

Mari MacGibbon’s inspiring story of recovery.

Marti’s MacGibbon’s Website:
http://martimacgibbon.com/

Marti’s MacGibbon’s Blog:
http://martimacgibbon.com/blog/


PTSD and Addiction: A Cognitive Restructuring Approach

January 11, 2014
By Terence T. Gorski, Author
June 22, 2013
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Recovery Is Possible With
Cognitive Restructuring

 WHEN  TREATING PTSD AND ADDICTION, I don’t use a single approach – I use a consistent set of principles and practices. I strive to be sensitive and adaptive to the emerging needs of patients in the moment. The key seems to be a balance of flexibility and consistency.  Everyone responds in a uniquely personal way in learning to understand and manage PTSD. I like the idea that and the PTSD recovery process results in Post Traumatic Growth. People don’t just overcome their symptoms. They grow and change in positive ways.

PTSD ASSESSSMENT – A CRITICAL FIRST STEP

First I do a comprehensive assessment of PTSD. This includes an analysis of presenting problems, a life history, and a history of treatment and recovery. I include efforts at self-help to be important. Most people try everything they know to get a handle on their PTSD before seeking any formal or professional help.

ADDICTION ASSESSMENT – NOT A LUXURY, A NECESSITY

If the assessment provides confirmation of active PTSD symptoms, I do a comprehensive addiction assessment because addiction is so common in patients with PTSD. If the addiction is not identified and treated concurrently, the PTSD treatment can make the addiction symptoms worse, and the addiction symptoms can prevent patients from benefiting from the treatment/recovery of PTSD.

PSYCHO-EDUCATION – TEACHING A LANGUAGE OF RECOVERY

Then I use psycho-education to give people a new cognitive frame of reference about PTSD. This is extremely important because, although most people are familiar with the general idea of PTSD, most lack accurate information or a useful way of understanding the symptoms and the pathways to recovery.

SURVIVORS – NOT VICTIMS

The most important thing I want to teach is that patients are trauma survivors, not trauma victims. I also want to be sure that the trauma is over. You work differently with PTSD if the trauma is still ongoing It makes a difference if: a soldier needs to return to combat or is home from the war; if a battered child is still living under the control of violent parent and will have to go home; if the abused spouse is out of the marriage or still involved due to children or financial issues; if the person is in prison and going back to the cell block or if they have been released. If they are actively involved in an ongoing trauma teach survival and coping skills, safety plans, and ways to responsible get out and get safe.

GET PATIENTS SOME INITIAL RELIEF FROM PAIN

The first goal is to provide relief for the most painful mediate symptoms. This often involves referral for EMDR. I am not skilled with this method, but many patients find it helpful. This also involves basic training in relaxation, diet, and exercise as a part of overall stress management.

THE LIFE AND SYMPTOMS HISTORY – A COLLABORATIVE APPROACH

Then I do a guided life and symptom history so people can see how symptoms have affected their life negatively through pain, problems, and losses; and positively through a process of making decisions that lead to positive change, growth, and development. This is a positive psychology intervention called Post Traumatic Growth (PSG).

THE COMPREHENSIVE SYMPTOM LIST

I develop a comprehensive list of the PTSD symptoms that patients are struggling with. This often involves showing them a list of symptoms because they lack the words or language to describe what they are experiencing. It is easy for me to forget how important it is to give patients a language of recovery so they can identify and communicate their experiences.

Once I have a comprehensive symptom list, I ask patients to evaluate the frequency (how often) and severity (how disruptive) the symptoms tend to be.  Then explore each symptom. First I want them to tell me real-life stories about what happened when they experienced each symptoms. I like to get at least two stories about each – one story in which they managed it pretty well, and one story in which they managed it poorly. This helps them to take ownership of their symptoms and get a feel for the new language they are learning. I get stress enough how important I feel this process by relating symptoms to actual lived experiences is for most patients.

I look for patterns of symptoms. Many symptoms appear in clusters that are activated by the same trigger event and once they appear, they mutual reinforce and intensify each other. I treat these symptom clusters as a single symptom and help patients to find a meaningful name it.

STRENGTH-BASED – WHAT ARE YOU DOING RIGHT

I make it a point to discuss how patients have managed to survive up to this point. I want to find periods of time when they have successfully managed their symptoms or been symptoms free. What were they doing at those times. What was going on or not going in their lives. What thoughts, feelings, behaviors, and social styles are associated with successfully coping with the symptoms?

THE IDEA OF PTSD SYMPTOM EPISODES

I also like to introduce the concept of PTSD symptoms episodes – moments in time when the symptoms get turned on by triggers and turned off by things like rest and safe environments. The idea is that the symptoms are not always there. Most patients believe that they are, but they are usually wrong. The symptoms are usually turned on some of the time and turned off at other times. Once a symptoms episode is activated by a trigger, it starts, runs a cycle, and then ends or significantly diminishes in intensity. Know that it will end gives strength in facing the symptoms. Naming the symptoms identifies the enemies or the monsters to be dealt with. At the very least, at some times the symptoms are less severe and more manageable than at other times.

SYMPTOM SELF-MONITORING

I encourage patients to do conscious self-monitoring o their symptoms at least four times per day (breakfast, lunch, dinner, and before bed) and note the specific symptoms experienced, how severe the symptom is, what is happening that is making it more severe, and what could be done to make it a little bit less severe. This starts patients on a journey of Post Traumatic Growth by showing them they are not totally at the mercy of these symptoms — that they can choose to do things to make their symptoms a little bit better or a little worse.

FLASHBACKS – TEACHING PATIENT TO GET OUT SAFELY

I find that many patients are fearful of the flashback and dissociative states that they get into that are often a part of PTSD. They fear that if they get into these states they will fall into a bottomless black pit and never be able to crawl out again. This is why a believe so many people are afraid to start talking about past experiences or the triggers that activate symptoms. They are afraid that once the symptoms start they won’t stop.

FINDING A SAFE PLACE INSIDE YOURSELF

To counter this, I like to have patients find a safe-memory or fantasy that they can go to and practice going there when they are feeling pretty good. I want them to learn and practice relaxation exercises that work for them. I give them a smorgasbord of relaxation methods to choose from. Giving choices, it seems, reduces resistance. I also avoid “one size fits all” methods of relaxation — but no methods really do work for everyone. I avoid using guided imagery at first because I find it unpredictable. Once patients relax and engage their imagery processes, they often are vulnerable to intrusive thoughts, feelings, and flashbacks.

IMMEDIATE RELAXATION METHODS – CHOICE AND SAFETY

I like to teach centering, deep-breathing, and mindful (detached) awareness, I want to be sure that patients learn how to get back into the here and now and stop intrusive symptoms as soon as they start.

I avoid what I call “big bang catharsis techniques” which take the patients quickly into deeply re-experiencing the memories of trauma. I have just had too many b ad experiences with patients regressing and getting worse as a result of these techniques. I personally don’t find using them worth the risk.

I would rather take patients into the memories as they emerge in the assessment and recovery skills training process. I want to be sure that patients have the ability to stop and crawl out of the experience and get back into a tight anchor with here-and-now-reality.

SUPPORT NETWORKS 0 CRITICALLY IMPORTANT

I also focus on building support networks of people, places, and things that can be used when things get tough. Simple things like: Who can you call if you need to talk? Who should you avoid if your symptoms are bad in the moment? What can you do that will help? What should you avoid doing because it will make things worse? I am especially concerned about having a support systems that can be used during the night. This is when the symptoms tend to be more intense and the support less available.

COGNITIVE RESTRUCTURING – TFUAR MANAGEMENT

The general structure I wrap these general principles of cognitive restructuring. I use the word cognitive to mean total information processing with the brain and the mind. This involves Thoughts (T), Feelings (F), Urges (U), actions (A), and relationships. It also involves subtle intuitions and openness to spiritual experiences which seem to be very common in people who survive trauma. using a cognitive restructuring process. I ask patients to complete these sentence stems, or I turn them into open-ended questions. Using active listing is critical. Patients must feel listened to, understood, taken seriously and affirmed as a person. This process turns a sterile and “objective” assessment into a highly personalized and collaborative self-assessment.

COGNITIVE RESTRUCTURING FOR PTSD

Here is a general structure for the process:

1.  The symptom that I am experiencing is …

2.  When I experience this symptom I tend to think …

  • A more helpful way of thinking might be ….

3.   When I experience this symptom I tend to feel …

  • A more helpful way of managing those feelings might be ….

4.  When I experience this symptom I tend to manage it by doing the following things …

  • A more helpful behavioral strategy for managing this symptom might be ….

5.  When I experience this symptom what I do to try to get help from other important people in my life is …

  • A more helpful strategy for getting the help and support if others in managing this symptom might be ….

6.   he overall daily plan I have for managing my PTSD recovery is …

  • Some ways of making my recovery plan more helpful for me might be …

A SIMPLISTIC SKELETON OF A COMPLEX PROCESS 

This is a simplistic skeleton of the basic principles and practices of a cognitive restructuring approach for PTSD. This sketch, of course, just covers some of the steps on the critical path to recovery and relapse prevention. It also presents my preferences as a therapist based upon my past experiences with clients. I am sharing this as a personal report on lessons learned.

 Gorski Books


Dark Thoughts: Personal and Collective

January 8, 2014
1508552_705489946150179_333021707_nBy Terence T. Gorski, Author
January 8, 2014

Dark thoughts can envelop our soul. We create some of these thoughts from personal experience, but not all of them.  Real but hidden threats cause some of these thoughts. Historical memory of devastating wars, poverty, and disease are the source of others. Many dark thoughts come from the collective unconscious of the group mind reflected in the deep rumblings of  the core violence of human culture.

There are bigger currents of humanity that move through our minds – a collective current that touches us all but is acknowledged by few. Our troubled violent history and current problems disturb us to the core of our being. It is easier to deny, to self-medicate, to distract with destructive pursuits. To look away is tempting. Denial, however, does not work very well in changing reality.

Human civilization is dark and violent. Human beings have a long history of collective and personal violence. War and violent crime have plagued humanity since before the beginning of written history.  The first recorded war occurred over 5,000 years ago and human beings have been systematically slaughtering each other with the best available technology ever since. War is the primary driver of technology and economic development.

Violence may have created and certainly sustains human culture. Read the Bible or the Koran and take note of the wide-spread murders, wars, plundering of cities, the women raped and murdered, and children put to the sword. Much of this slaughter was done in the name of God. It was also done to get new lands and steal the wealth of others. It is too often rationalized as the will of god.

The violence that permeates culture creates chronic pain called ANGST – the universal pain of the human condition. Living with the conscious knowledge that we will die causes us fear. To know that we need to love and the violence causes more violence causes shame and guilt when we live a world where life must feed upon life in order to survive. Addiction may well be a universal cross-cultural mechanism for managing this primal fear. There seems to be a strong relationship between fear of violence and both addiction and mental health problems. There is strong evidence that primitive religion emerged as a result of ritual practices to stop collective mob violence in primitive communities.

As long as we deny the violence all around us and pretend that it doesn’t exist, we ware part of the problem. We silently enable the violence and refuse to see what we are doing. The dark thoughts that we push deep into our mind, however, haunt us and often emerge at unexpected times. We are all guilty of perpetrated or enabling violence.

While hanging on the cross Jesus said: “Father, forgive them for they know not what they do.” This statement tells us why we are all culpable for the violence that surrounds us. If we don’t continue to improve our violence control mechanisms based on human empathy, individual societies and the world can lapse again into world war and domestic riots.

Tremendous resources are invested in national and international violence control mechanisms. War is expensive. So is crime.  Many of us prefer to deny this fact. It is easier to pretend that civilization is based upon a foundation of peace and love. It’s not! History has taught us that denial of violence does not work. Denial results in more violence. The social processing of violence, in a peaceful way, is necessary to establish any solid foundation for future peace.

It is hard to accept the truth and then stand for something better – a higher truth that we are also a part if something better. The problem is that power structure of the world has a solid foundation and a need for perpetual violence. To develop a peacetime economy that is not preparation for war is a goal that has yet to be achieved.

LIVE SOBER – BE RESPONSIBLE – LIVE FREE

GORSKI BOOKS GORSKI TRAINING/CONSULTATION


The Wolf and the Lamb

December 13, 2013

Terence T. Gorski, Author
A Personal comment and passing on
the Aesop Fable and The Moral of the Story

Wolf_and_Lamb_01

The Wolf and the Lamb
When Hunger Drives Conflict
Who Wins?

“A tyrant will always find a pretext for his tyranny. So it is useless for the innocent to seek justice through reasoning when the oppressor intends to be unjust.” ~ Aesop

The Wolf and the Lamb is the fable that Illustrates this moral. It was written by Aesop and used to educate millions of children into the realities of life. The popularity of Aesop Fables faded as political correctness began replacing reality with the art of lying about the nature of life to avoid offending others.

Jesus taught in the New Testament that the day would come when the world and the world and the lamb can lie down in peace together. I wish that were true. I must simply say perhaps some day, but not in this lifetime. When both the wolf and sheep start getting hungry and all that is left for food is each other – that’s when the trouble starts. In this battle, who do you think will win?

We were created by a loving God.  We we were cast into a world where life must feed upon life in order to survive.  We are told by God Incarnate or the prophets of God to love one another. All of these original messengers were violently and horrible killed by the political  wolves of their day. So my humble message, which may be wrong, is love one another and beware of the big bad wolf. Trust God and lock your car.

I do acknowledge that when wolves and dogs are well fed they can be peaceful. When hunger laws at their bellies they form into packs and go searching for food. That’s canine version of a human mob. They hunt and kill relentlessly and without mercy. So I guess my revised opinion, which also may be wrong, is this: we need to beware the big bad wolf and also beware the human mobs.

I really want George or wells vision of tyranny toe be wrong. I just know that in a battle between a wold and lamb, the world usually wins. There is no reasoning with a hungry monster when they come to visit. Out core survival responses urge to fight, run, or freeze and hide.

THE WOLF AND THE LAMB

An Aesop Fable

While lapping water at the head of a running brook, a wolf noticed a stray lamb some distance down the stream. Once he made up his mind to attack her, he began thinking of a plausible excuse for making her his prey.

“Scoundrel!”, he cried, running up to her. “How dare you muddle the water that I am drinking!”

“Please forgive me,” replied the lamb meekly, “but I don’t see how I could have done anything to the water since it runs from you to me, not from me to you.”

“Be that as it may,” the wolf retorted, “but you know it was only a year ago that you called me many bad names behind my back.”

“Oh, sir,” said the lamb, “I wasn’t even born a year ago.”

“Well,” the wolf asserted, “if it wasn’t you, it was your mother, and that’s all the same to me. Anyway, it’s no use trying to argue me out of my supper.”

And without another word, he fell upon the poor helpless lamb and tore her to pieces.

THE MORAL OF THIS STORY IS:
“A tyrant will always find a pretext for his tyranny. So it is useless for the innocent to seek justice through reasoning when the oppressor intends to be unjust.” ~ Aesop


The Righteous Warrior

December 13, 2013

By Terence T. Gorski
December 13, 2013

warrior-priestI am in favor of peace. I pray for peace everyday. I don’t believe that world peace can be achieved until every person alive chooses nonviolent ways to resolve their conflicts over violence. I don’t expect that to happen in my lifetime. All I can do is pass on the dream.

Until the world is filled with people committed to nonviolent solutions, there will be ongoing violent struggle. Some call it the battle between good and evil.

Violence is the scourge of humanity since before the dawn of recorded human history. So until the time of a universal (100%) commitment of individuals to peaceful resolutions becomes a reality, we have to rely on a court system. For courts to work there must be enforcement. The need for enforcement means there must be warriors. Within the USA this means a police force. Internationally it means the military. When fighting natural and man-made disasters, it means emergency first responders of all disciplines.

I was always taken with the idea of the warrior priest — the righteous warrior, the warrior monks. The image is one of the spiritually and morally enlightened being willing and able to fight for good against evil. This mythology has been and is still a powerful force driving human consciousness in all cultures.

The righteous warrior fighting against evil – fighting in the name of good. A great idea. I am too much of a realist, however, to believe all of our wars are just or all of are warriors are righteous. I do know that warriors need to be highly trained and held to a higher standard. A higher standard is needed because they are endowed with the social sanction, the training, and the weapons they need to take human life when required to protect the common good.

Yes, there is a broad swatch of a grey between good and evil and who puts what into each category. Politicians and religious leaders of all kinds can paint the most unspeakable horrors of violence as righteous, moral and just. Think about the inquisition, or the crusades, or the plundering and murder reported as the will of God in the Old Testament and the Koran. Murder entered the old testament in the first three pages.

True evil, however, cannot be missed no matter how it is painted. The Nazi Concentration Camps, the killing fields of Cambodia, the millions of lives taken by slave owners in all cultures and all countries since the beginning of recorded history.  Tragically the list of horrors man has perpetrated upon man could go on for pages. This tendency toward violence and the loss of empathy for the victims of violence is, in my mind, at the root of the idea of evil. Organized violence embodied in war and mob rule is the most horrific violence of war.

Evil must be fought. To ignore evil is to condone it. Evil should not be sanctioned as good by religious leaders in the service of those holding political power. Ayn Rand talks about the alliance between political and spiritual leaders in the service of violence.  She calls it an alliance between Attila and the Witch Doctor. Righteous warriors are destroyed, body and soul, by this unholy alliance.

Attila and the Witch Doctor represent two figures – the man of faith and the man of force. They are philosophical archetypes, psychological symbols and historical reality. As philosophical archetypes, they embody two variants of a certain view of man and of existence. As psychological symbols, they represent the basic motivation of a great many men who exist in any era, culture or society. As historical reality, they are the actual rulers of most of mankind’s societies, who rise to power whenever men abandon reason.” [Rand, FNI, p. 14.]

Warriors are at their best when they act calmly and with the righteous knowledge that to kill a murderer to protect the lives of good people is in fact a virtuous act. Answer this question in your own mind:

If a psychopath had a knife at the throat of your child and was ready to start slashing, would it be right for the sniper to grant mercy to the psychopath and allow the child to die a horrific death?  Or would it be right for the sniper to calmly line up the head of the psychopath in his sites, exhale, and squeeze the trigger saving the child’s life. Which of these would be right? Which would represent the good?

For the sniper to kill the psychopath is an act that is both righteous and necessary. No guilt is appropriate on the part of the warrior for he or she stopped evil dead in its path to save an innocent life. All civilized people need to be willing to do the same. Most warriors, however, pay a heavy price for the taking of life even when it is a righteous act.

“Killing is supposed to be hard.
If you found it, easy I’d be worried about you.”
~ Leroy Jethro Gibbs, NCIS ~

We need our warriors. We need them trained, equipped and held to a high moral standard. We need them to work in the service of the good. In order for that to happen, we must each know what the good is. WE must know the values that are worth dying for. My father was a World War II combat veteran. His memory, and that of  my mother, weigh heavily on my mind. The order I get, the smarter i realize my parents were.

“We sleep safe in our beds because rough men stand ready in the night
to visit violence on those who would do us harm.” – George Orwell

My mother and father told me of a song that was popular during World War II. It was entitled: “Praise the Lord AND Pass the Ammunition. Sometimes good people must pick up weapons and do harm to those who destroy the lives of peaceful people in the night. Let’s work for the day, however, where all humanity will embrace the need for nonviolent resolution of human conflicts. Each one of counts. Each of our children count. You count.

“If there must be trouble, let it be in my day,
that my children may know peace.”
~ Edmund Burke ~


School Violence – Managing The Epidemic

December 6, 2013

By Terence T. Gorski, Author ,
April, 2013

imagesI was a member of my High School Debate team. I learned that false arguments need to be unmasked or they are assumed to be true. One powerful false argument that is frequently used, especially by public media, is the PLEA TO EMOTION. This is an argument presented in a way that creates strong emotions. The hidden message is that if thinking about this makes you feel bad, it must be bad. If it makes you feel good, it must be good. No thinking required. The message is clear:  intense feelings prove that the argument must right. Unfortunately, just because the argument of a speaker raises strong feelings, it does not mean the argument is correct. In cognitive therapy this is a thinking error called emotional reasoning. People try to think with their gut instead of their minds.

I have strong feelings about violence against children, including the violence of school shootings. These feelings range from anger at the shooter to deep grief for the families and survivors. I also stand in awe at the emergency first responders who entered the school, witnessing the unspeakable horror perpetrated on  the children and teachers who were brutally mutilated by bullets. This includes the police, the paramedics, and the forensic investigators. Many of these responders are traumatized. They did their jobs well and do not deserve the trauma they are certainly suffering.

Over the years I have learned an important lesson: It does not always feel right to do right. Sometimes it hurts to do the right thing. Like it or not, violence has been a part of nature and of humanity since before the beginning of recorded history. It is unlikely that violence will be stamped out in our lifetime. Strong feelings make us reach for quick and easy solutions – ban guns, screen everybody, and lock up anyone who might one day become violent. Then lock down schools and arm school teachers while declaring all schools No-Gun Zones. The list of simple, often contradictory, and most-likely ineffective solutions is long and creative.

Violence will not end until every human being choses to resolve conflicts peacefully
by learning to mange their own mind and emotions. 

Unfortunately there is no fast and easy solution. Violence will not end until every human being choses to resolve conflicts peacefully and learn to mange their own mind and emotions. A great dream, but I will not see  it in my lifetime. No matter what we as a nation do about our epidemic of violence, there will be unintended consequences. Whatever we do, we will need to constantly review and revise our national strategies based on what works and what does not work.

In this paper I am going to present a ten point plan for managing the epidemic of violence. I elected strategies that I believe will make a difference and that can be implemented by involved community members, parents, and professionals. Anyone deeply concerned with developing more effective policies for managing the societal problems related to violence can find something in the list that they can get behind.

I expect that some people will criticize some of the recommendations that I have made here. That’s good. If two people agreed about everything, at least on of them is unnecessary. This is a tough issue with no easy solutions. I encourage people of good will to debate and respectfully disagree about strategies for violence prevention. Let’s be cautious  without falling into the trap of emotional reasoning.

Let’s avoid personal attacks on those who disagree with us and focus on the strategies rather than the personalities. I believe we all want to find an end to the senseless violence that periodically lifts its head in our communities. To accomplish this we must talk, debate disagree, and be willing to change our opinion as we learn new and more compelling information and alternatives. I welcome criticism and constructive alternatives to my ideas. In my opinion, the broad range of factors that need to be addressed are these:

(1) We must have a plan to change our culture of violence which is based on the belief that violence is good, violence is a solution, and violence is an acceptable form of entertainment. This includes changing the sports, entertainment, and video game industries.

(2) We must have programs for improve parenting skills that includes how to monitor and observe children, recognize warning signs of addiction and mental health problems, and how to get help. Currently more training is required to get a driver’s license than to get married or have a child. Note: The rate of child abuse, neglect and child homicide is high. School shootings are so infrequent that they don’t even statistically make the list of major causes of child murders by the FBI.

(3) Reduce the illicit drug trade. Drug dealing is the primary source of income for street gangs. The gangs ran and enforce the multi-billion dollar underground economy by an antisocial drug culture of violence. The drug trade is the primary factor contributing to the proliferation of handguns and other automatic weapons used in violent crimes.

(4) Reduce family and relationship violence. According to the Department of Justice, of all children under age 5 who were murdered from 1976-2005:

◦  31% were killed by fathers
◦  29% were killed by mothers
◦  23% were killed by male acquaintances
◦  7% were killed by other relatives
◦ 3% were killed by strangers

(5) Provide readily available addiction and mental health services for prevention, early intervention, treatment, and relapse prevention. Work hard to reduce the stigma so parents and young people will reach out early for these services.

(6) Stop the media from making mass murderers, whether school/workplace killers or serial killers, instant celebrities by putting their pictures and names on all media. Work instead upon creating victim empathy be letting people know the true human losses.

(7) Take reasonable steps to enforce safety in our schools and places of work by proper policies of preparation and training for BOTH school/workplace leadership and students/employees. This can start by showing all children, parents, and students/employees the Department of Homeland Security five minute video entitled: Surviving an Active Shooting Incident (http://youtube/5VcSwejU2D0) which shows common sense responses (RUN, HIDE, FIGHT) to the unlikely event of a school or workplace shooting.

(8) Support police efforts and other resources in consulting with schools and large workplaces in how to prevent and respond to active shooting events and require compliance the same way that we do with fire code enforcement. Thirty percent of US schools are already protected by armed police officers. Fire drills occur in every school, even though child death in a school fire is exceedingly rare. Practical training in how to respond to an active shooting event and regular drills should be conducted following the same policy procedures as fire drills.

(9) Consistently enforce existing gun laws and pass rational new gun control legislation.

(10) Encourage all people to give up the myth of safety. The world is a dangerous place. People are injured and killed every day.

As a society, we can take reasonable actions to improve safety – no one can guarantee anyone’s safety. We can take steps to reduce violence but nothing can prevent it totally. BE PREPARED.

LIVE  – BE RESPONSIBLE – LIVE FREE 

GORSKI BOOKSGORSKI TRAINING/CONSULTATION 


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