Sam Balla is an LISW from Ohio specializing in the treatment of trauma, primarily working with veterans. He served as an infantry squad leader in the United States Marine Corps, and is an Iraq combat veteran. From 2012 to 2015, he served as president and chairman of the Board of Veterans First Foundation Inc. — a charity that provides essential items to veterans in need. He also held the title of program manager at Columbus’ Southeast Inc, where he managed a $1.7-million budget and two residential treatment facilities for those experiencing severe mental health conditions, like addiction and PTSD. Currently, he works in outpatient counseling, handling a wide range of outpatient mental health conditions. His treatment approaches include Cognitive Behavioral Therapy (CBT), Solution-Focused Brief Therapy (SFBT), Eclectic Therapy, Motivational Interviewing, and Trauma-Focused care.
Here, Sam shares his insights on treating trauma across populations and offers skills to help clinicians build rapport with clients who have experienced trauma.
Q: Have you observed any differences in treating trauma across different populations and treating trauma for active duty service members and veterans?
A: I wouldn't say necessarily that there are significant differences between populations;. Except if you consider the veteran population versus civilians. I think the majority of the difference has to be with what has been made available to and/or offered to victims of trauma, after the fact. Especially over the past 15 to 20 years, veterans tend to have a greater understanding of [...] therapy for trauma and post-traumatic stress disorder (PTSD). When it comes to civilians who have experienced trauma, it really seems to be almost nonexistent that they had been introduced to the concept of PTSD, and the availability of resources to help them cope with the experience. Many of my civilian clients have been living with PTSD for many years before finally engaging in services. Veterans tend to be introduced to the concept very quickly. That makes a difference in where the client is at in recovery when I begin work with him or her.
Q: What is most challenging for you in treating trauma as compared to other clinical concerns?
A: Of course, trauma recovery looks different for each person. But for some of them, the biggest challenge is working with clients about being able to feel safe in ordinary situations. For instance, I have had several clients that didn't even feel safe in their own homes. And this includes all of the actions they may take to try to secure their homes. I have one client in particular who lives alone and has described setting up several security cameras, motion lights, alarms and several arms placed around his home. Despite this extensive effort, he sleeps very poorly due to hyper vigilance. He has frequently cited being concerned about not having someone on watch when he is trying to sleep. Unfortunately, this gentleman experienced a home invasion a few years ago, which only served to reinforce his PTSD after serving in Desert Storm. PTSD -thinking has a tendency to distort the impact of logic. Clients can tell themselves that events are very unlikely to occur, but can't get away from how severe the results may be if another experience happens, despite the extreme unlikeliness of it. It's virtually an imbalance of logic. Which in and of itself is distressing. It tends to shake the foundations of understanding of the world in the trauma survivor.
Q: What are some of the best treatment modalities to address trauma that you are familiar with? Is there one you are interested in learning more about?
A: Personally, I tend to be very eclectic. I've heard a few clients in the past extoll the virtues of some programs such as prolonged exposure therapy and EMDR. \The biggest thing that has been helpful for me in working with trauma survivors is the establishment of trust. Once a client can verbalize trusting me, it makes it a lot easier to suggest any number of efforts the client may make to attempt improvement. This action alone, the attempt, usually brings at least mild to moderate benefit and relief to the client. Especially when I point out the measure of control that a client has over making those attempts. Trust and control are huge issues for trauma survivors. After making some attempts, and hopefully continuing to trust me, it makes it easier to assist clients with developing acceptance of things that are out of their control.
Q: Can you name 3 characteristics or soft skills that can help clinicians be more successful in building rapport and working with clients who have experienced/ survived trauma?
A: I certainly avoid telling trauma survivors that I know how they feel. Indeed, I tend to do almost the opposite by explaining how different people experience trauma differently, even people who were present for the same event. I believe this helps connect the client with his or her belief that what he or she is experiencing is unique.
The second thing would follow right along afterward, by explaining to the client that though his or her experience is fairly unique, there should be hope. This hope will come in the form of working together to find a solution by trying out different coping skills and me being there to support that effort.
An additionally important item that I'm not sure would be considered a soft skill is the teaching of grounding techniques. I utilize a handful of grounding techniques, mostly focusing on the five senses. I encourage clients practicing and honing these skills outside of when they might especially need them. I make sure to explain the physiological reasons they can be effective. I've noticed that most clients appreciate being offered some skill that is more tangible than an abstract idea related to changing thought patterns. Of course, that doesn't mean I completely discard those approaches, it just seems that early on a more visceral recommendation seems to connect before clients can really approach more philosophical concepts.
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