Using Stories, Art, and Play in Trauma-Informed Treatment: Case Examples and Applications Across the Lifespan

230 Pages·2018·9.58 MB·English

by  Pat Pernicano

Using Stories, Art, and Play in
Trauma-Informed Treatment
This book shows new and experienced therapists how to use meaningful therapeutic material in art, stories and play to
facilitate shifts in outlook and behavior. Using a wide variety of case studies, Dr. Pernicano lays out a framework for problem
clarification, conceptualization, trauma-informed intervention and positive therapeutic outcome with clients across the
lifespan. Case examples include working with clients suffering from dissociation, depression, anxiety, mood dysregulation,
adjustment to life change, grief and loss, and/or panic attacks. Replete with client-generated illustrations as well as practical
tips and strategies, U sing Stories, Art, and Play in Trauma-Informed Treatment teaches therapists how to think conceptually, plan
systemically and intervene flexibly to improve treatment outcomes for diverse clients.
Pat Pernicano, PsyD, has provided supervision, training and trauma-informed treatment in outpatient, residential, geriatric,
substance abuse, school, VA and private practice settings. In 2017, she and her husband were jointly honored by the Kentucky
Psychological Association as Lifetime Career Psychologists of the year. More information about her work can be found at
www.pernicanoplaycreations.com .

Using Stories, Art, and Play in
Trauma-Informed Treatment
Case Examples and Applications
Across the Lifespan
Pat Pernicano
First published 2019
by Routledge
52 Vanderbilt Avenue, New York, NY 10017
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2019 Pat Pernicano
The right of Pat Pernicano to be identified as author of this work has been asserted by her in
accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilised in any
form or by any electronic, mechanical, or other means, now known or hereafter invented,
including photocopying and recording, or in any information storage or retrieval system,
without permission in writing from the publishers.
Trademark notice : Product or corporate names may be trademarks or registered trademarks, and
are used only for identification and explanation without intent to infringe.
Library of Congress Cataloging-in-Publication Data
A catalog record for this book has been requested
ISBN: 978-1-138-48468-9 (hbk)
ISBN: 978-1-138-48472-6 (pbk)
ISBN: 978-1-351-00530-2 (ebk)
Typeset in Garamond MT & Futura BT
by Apex CoVantage, LLC
C
ONTENTS
Foreword: Using Stories, Art and Play in Trauma-Focused Therapy x
HELEN BENEDICT
Acknowledgments xi
Introduction A Picture Is More Than a Picture 1
Part I The Tools of the Trade 7
Chapter 1 The Building Blocks of Communication 9
The Salience of Language 9
Non-Verbal Communication 10
Meaning-Making: Integrating Verbal and Non-Verbal Communication 11
Chapter 2 Mining for Gold With Milton Erickson 13
Chapter 3 Constructing With Metaphor and Stories 16
The Nature of Metaphor 16
Symbols in Stories, Art and Play 17
The Nature of Stories 29
Chapter 4 The Blueprint of Trauma-Informed Treatment 31
What It Means to Be “Trauma-Informed” 31
Trauma-Informed Knowledge 32
Grounded in Neurobiology 33
Identifying Blind Spots and Risk Factors 33
Working Within a Developmental Context 34
Using a Systemic Approach 35
A Matter of Good Fit 36
Chapter 5 The Integrative Tool Bag 39
Integrative Psychotherapy 39
The Therapeutic Stance 40
The Tools Themselves 41
Part II Case Examples and Applications 55
Chapter 6 Overview of Case Development 57
Case Organization 58
Case Examples in Trauma-Informed Care 58
Child Cases Using Stories, Art and Play 61
Chapter 7 The Bloodthirsty Bats: A Case of Child Sexual Abuse 63
Case Information and Background 63
The Problems (and Reactions to the Problems) 63
The Conceptualization 65
Interventions and the Trauma Narrative 66
The Shift 67
The Progress and Outcomes 67
Termination Progress and Outcome 70
Questions for Case Discussion 72
Chapter 8 The Alligator Eyes: A Case of Complicated Grief 73
Case Information and Background 73
The Problems (and Reactions to the Problems) 73
Initial Interventions and New Problems 74
The Conceptualization 74
Intervention With a Shift 74
The Trauma Narrative and New Shift 75
Progress and Outcomes 76
Questions for Case Discussion 76
Chapter 9 The Boy Whose Sister Said “Fuck”: A Case of Parental Drug Overdose 77
Case Information and Background 77
The Problems (and Reactions to the Problems) 77
The Conceptualization 78
Interventions and the Trauma Narrative 79
Shift 83
Shift and Trauma Narrative 86
The Progress and Outcomes 89
Questions for Discussion 91
Chapter 10 Feed the Alligator: A Case of Sibling Trauma Intervention 92
Case Information and Background 92
The Problems (and Reactions to the Problems) 92
The Conceptualization 93
Interventions and the Trauma Narrative 93
The Progress and Outcomes 94
The Shift 95
Progress and Outcomes 96
Questions for Discussion 96
Chapter 11 The House With Many Rooms: A Case of Child Dissociation 97
Case Information and Background 97
The Problems (and Reactions to the Problems) 97
vi
The Conceptualization 97
Interventions: Psychoeducation About Trauma 98
Interventions 99
Beginning Trauma Narrative 99
Shift: Sharing the Inner World 100
New Shift and Continued Trauma Intervention 102
Major Shift 103
Continued Trauma Intervention 105
The Progress and Outcomes 108
Questions for Discussion 110
Chapter 12 The Mom of Many Colors: A Case of the Impact of Parental Substance Abuse 111
Case Information and Background 111
The Problems (and Reactions to the Problems) 111
The Conceptualization 112
Interventions 112
Shift and Beginning Trauma Narrative 113
New Shifts 114
Interventions About Parent-Child Issues 115
Interventions: Perceptions of Mom 117
Shift 120
Further Conceptualization 122
The Progress and Outcomes 122
New Shift 124
Stuck on the River 124
Progress and Outcomes 125
Questions for Discussion 125
Chapter 13 The Boy With a Hungry Heart: A Case of Maternal Neglect and Abandonment 126
Case Information and Background 126
The Problems (and Reactions to the Problems) 126
The Conceptualization 127
Interventions and Trauma Narrative 127
The Shift 128
The Hungry Heart 129
The Progress and Outcomes 131
Questions for Discussion 131
Chapter 14 The Wounded Elephant: A Case of Emotional Wounding 132
Case Information and Background 132
Problems (and Response to the Problems) 132
Conceptualization 133
Interventions 133
Shift 135
Progress and Outcomes 136
Questions for Discussion 137
Adolescent Cases Using Stories, Art and Play 139
Chapter 15 “Tell Me Who I Am”: A Case of Grief and Identity 141
Case Information and Background 141
The Problems (and Reactions to the Problems) 141
vii
The Conceptualization 142
Interventions and Trauma Narrative 142
The Shift 143
Progress and Outcomes 147
Questions for Case Discussion 148
Chapter 16 The Zodiac Queen: A Case of Adolescent Dissociation 149
Case Information and Background 149
Problems (and Response to the Problems) 149
Conceptualization 150
More Background 150
Interventions 150
Shifts 151
Intervention: The Zodiac Queen 152
Progress and Outcomes 159
Questions for Discussion 160
Adult Cases Using Stories, Art and Play 161
Chapter 17 The Girl Behind the Brick Wall: A Case of
Anxious Avoidant Attachment 163
Case Information and Background 163
Conceptualization 163
Problems 164
Intervention and Further Conceptualization 164
Shift 168
Trauma Narrative 169
Progress and Outcomes 171
Questions for Case Discussion 171
Chapter 18 The Girl Who Lost Her Voice: A Case of Sexual Trauma 173
Case Information and Background 173
Conceptualization 173
Problems (and Reactions to Problems) 173
Interventions 174
Shift to Employment 174
Progress and Outcomes 177
Questions for Discussion 177
Chapter 19 Grief and the Four Stones: A Case of the Woman
Who Chose To NOT Move on 178
Case Information and Background 178
Problems 178
Conceptualization 179
Intervention 179
Shift (Four Stones) 181
Progress and Outcomes 181
Questions for Discussion 182
Chapter 20 The Mermaid Who Forgot: A Case of Pending Loss 183
Case Information and Background 183
Problems (and Reactions to Problems) 184
viii
Conceptualization 184
Initial Interventions 185
New Interventions and Shift 185
Dive Deep 186
Shift 187
Progress and Outcomes 189
Questions for Discussion 190
Chapter 21 The Woman Who Got Rid of a Leech: A Case of
Relationship Choices 191
Case Information and Background 191
Problems (and Reactions to Problems) 191
Conceptualization 191
Interventions 192
Progress and Outcomes 194
Questions for Discussion 194
Appendix: Resources for Trauma-Informed Care 195
The Unleashed Pain (Pernicano, unpublished manuscript) 195
Pernicano Trauma-Informed Publications 197
Pernicano Techniques 197
Other Resources 200
The Meaning of Color in Client Art 202
References 210
Index 213
ix