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1 : *.,,,. Herman 3. Terr DSM-5.,.. * (Corresponding Author): / / / Tel: / euna@snu.ac.kr

2 (Society of Clinical Psychology, 2015) (Post-Traumatic Stress Disorder: PTSD)., (Present-Centered Therapy; Schnurr et al., 2003), (Cognitive Processing Therapy, CPT; Resick & Schnicke, 1993), (Seeking Safety; Najavits, 2002), EMDR(Shapiro, 1995), (Debriefing) (Society of Clinical Psychology, 2015). DSM- -TR(APA, 2000) PTSD.,., (Courtois, 2008).,,, /,.,, (Preventive Counseling),, (Bronfenbrenner, 1979),.,, ( ), (psychological healing) (recovery),.,, / / / (safety; Herman, 1997) (reconnection)., DSM- -TR(APA, 2000) PTSD,., (Multiple Trauma),. PTSD,., (multiple trauma), CPTSD(Complex PTSD; Herman, 1992) PTSD (APA, 2013) /, PTSD (Rothschild, 2000)., PTSD, PTSD.,

3 , (67%), PTSD (59%), (31%) (Cloitre et al., 2005)., CPTSD PTSD,.., PTSD.,.,., PTSD,. (Dialectical behavioral therapy, DBT; Linehan, 1993) (Linehan, 1993). DBT PTSD, Linehan /., DBT PTSD,,..,. PTSD (Courtois, 2008)., PTSD, 1 (Type ) (Type )., Type (Rothschild, 2000)., EMDR,,,.,.,,. (critical period), / PTSD., /.,,., %. PTSD (20 50%),

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5 (The polyvagal perspective; Porges, 2007).,,. Herman(1992, 1997) 3 1, 3., (psychoeducation) (advocacy), (referral), PTSD outreach,. (2002).. J. Herman 3 Herman(1992, 1997), (Courtois, 2008). 1. (Safety) / ( / )., /,,,,. 2,,. 3. Herman (2 ) / (1 ) (3 ). 1 3.,,. (3 ) PTSD.. 3, / /. Herman 3,. Herman., Herman 1, 3

6 ,. Terr(1991) (Trauma),., Type 1,, (Everly & Mitchell, 2000). Type, (Siegel, 1999) (Society of Clinical Psychology, 2014)., Type,, 3, (Rothschild, 2000; Schore, 1996). DSM-5(Diagnostic and Statistical Manual of Mental Disorders; APA, 2013). DSM-5, PTSD (Trauma and Stressor Related Disorders),. (Dissociative subtype) CPTSD (Friedman, 2013). 6 PTSD (Preschool subtype)., Type 1 (,, ) PTSD Type / / /,,, :,,

7 .,. (Survival circuits; LeDoux, 2002).,., ; (survival-in-the-moment states; LeDoux, 2002).,.,,, PTSD.,. ( / )., - (tend-and-befriend), /. (General adaptation syndrome) 3 :,,. 3 (,, ).,..,,. (The Polyvagal perspective).,,,., (fight-flight reaction),., Porges(2007) 3 (myelinated vagus),, (nucleus ambiguus: ) (Sympathetic nervous system) ( ) spinal cord (unmyelinated vagus) (immobilization:, ),

8 . 1 (immobilization:, ).,, ( ) ,, ( ) (myelinated vagus) ( 2 ). (immobilization:, ) 1.,,, 1.,,., 2 ( ) 1 ( ) (Ogden, 2009). PTSD (Dissociative Disorder)/ (Dissociated memory disorder) (APA, 2013; Van der Kolk et al., 1996)., (implicit or procedural memory), (dissociated memory) PTSD, (Shapiro, 1995; Levine, 2010; Ogden, 2009). (Window of Tolerance; WT). (WT) / (Siegel, 1999). Siegel, Ogden(2009) (The Window of Affect Tolerance) ( 2)., WT / (, ). WT, WT,

9 WT WT. WT,. (empowerment)., 1 WT. Bromberg(2006) Ogden(2009) WT., WT,,., WT,. WT 2, (Najavits, 2002). ( 3 ). J. Herman 3 (Herman, 1997), Terr(1991) DSM-5.., ( PTSD ), / /.,,.,...,, : (Safety) (Surviving) Herman(1997) 3, (Safety). / /.,., (response) (trauma event),

10 ( ) / / / / / / / / / / / (Stabilization) & ( ) / / (Positive reframing) (Ritual).,. / /,,. (Out reach) & (Advocacy).. 10 (practitioners) (Vera & Speight, 2003)., / /., (, 2015). (,,,, ),., /.,.,, / / 1. (trigger), ( ).

11 / (Psychoeducation). (LeDoux, 2002; Porges, 2007),., (dependence),., / / /.,., ( ). (Phoenix, 2007)., ( ; Society of Clinical Psychology, 2015). (Psychoeducation)., 1) (,, ), 2) ( / ), 3). 1,, (stabilization).,.,.. Type, / (,, EMDR, )., WT (Siegel, 1999).,, (, Grounding) (Najavits, 2002).. EMDR (Levine, 2010; Odgen, 2009)., EMDR,, (Shapiro, 1995).. PTSD (Abnormal Stimulus) (Normal Reaction).

12 .,., (survival-in-the-moment states; LeDoux, 2002), (Phoenix, 2007). ( ) (set)., 1. (referral),.,.,.,,, PTSD., (,, ) (Rothschild, 2010)., (Sharpless & Barber, 2011). WT,, (SNRI) / / (Society of Clinical Psychology, 2015). : :.., Type,. Type,, (Herman, 1992)., (Trauma Re-enactment; Herman, 1992) (Linehan, 1993).. (, SE, SP ) (, 2015; Levine, 2010; Ogden, 2009).. 2 : 2, /., (distancing). 2 1.,., PTSD

13 .,...,,,., ( ;, 2015). (SE, SP) (Levine, 2010). (Freeze) ( ). / (Ogden, 2009). Type, / ( ) ( ). - ( ), ( - - ) (Odgen, 2009). MBSR, MBCT, (, SE, SP) (, 2015; Linehan, 1993; Levine, 2010; Ogden, 2009). (Stabilization) : / /., 2 WT..,,., / / (Schore, 1996; Rothschild, 2000, Najavits, 2002). -. Type /, (Rothschild, 2000).. ( ) (Rothschild, 2010).,,,.,

14 ,,,.,,, (Skills Training in Affect and Interpersonal Regulation: STAIR, Cloitre et al., 2002), Narrative Story Telling(NST).. (Prolonged Exposure; PE; Foa, 1997).,,. (CPT). 3 MBCT(Mindfulness Based Cognitive Therapy; Segal, Williams, & Teasdale, 2002), (Acceptance Commitment Therapy; ACT; Hayes, Strosahl, & Wilson, 1999), (Dialectic Behavior Therapy; DBT; Linehan, 1993). / ( ) (Mindfulness) (Linehan, 1993).,. CPTSD (Ford & Courtois, 2014; Linehan, 1993; Van der Kolk, 2002). (Battered Wife s Syndrome). Type (Becker, & Zayfert, 2001). Brainspotting(Grand, 2013), OEI (Observed and Experiential Integration; Bradshaw, Cook, & McDonald, 2011), EMDR(Eye Movement Desensitization and Reprocessing; Shapiro, 1995). (Esterling, L'Abate, & Murray, 1999)., (Pennebaker & Francis, 1996) ( ) ( ).,.. 2 ( ). 2.,,, /,. Type, /., (ritual),,..,

15 ,. 3 : (reconnection), (Ford & Courtois, 2014)..,,. (trigger).,.,,. :..,..,. Frankl(1962),., (Herman, 1997).,. (Ritual):. Frankl... (ritual),, (, ), /., /.., /. / /.

16 (empowerment). (empowerment).,.. (empowerment),,..,.,.,... (positive reframing;, 2002),,..,,,,. 2,. /.,.,.,.., 1, 3. Herman 3, Herman 1, 3. 1, 3.,. /.,., 1 2, 3.,.

17 ,, 3. /.,. (mass trauma),., PTSD,., 3 PTSD PTSD.,,.,.,., 1. 2 ( ),.. (2015), (1 ),.,.., (couch therapy).,.., 2 PTSD., PTSD.,., PTSD, (mass trauma),

18 ., (critical period),. PTSD (Foa, Keane, Friedman, & Cohen, 2008),,.., PTSD.. Herman,.,.,, , 2 (PTSD ),,,.,.,., 2,.,..,,. 1).,,,,. 2),,,,., CYS-net,...,,,,...., PTSD 3.

19 .,., 2 PTSD :,,.,., 1, 3,. 1, 3., Herman 3,,..,. (2002). (2015).. (2015).. American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th-TR Edition). American Psychiatric Association, Washington. D.C. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th Edition). American Psychiatric Association, Washington. D.C. Becker, C. B., & Zayfert, C. (2001). Integrating DBT-based techniques and concepts to facilitate exposure treatment for PTSD. Cognitive and Behavioral Practice, 8(2), Bradshaw, R. A., Cook, A., & McDonald, M. J. (2011). Observed & experiential integration (OEI): Discovery and development of a new set of trauma therapy techniques. Journal of Psychotherapy Integration, 21(2), 104. Bromberg, P. M. (2006). Awakening the dreamer: Clinical journeys. Mahwah, NJ: Analytic Press. Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press. Cloitre, M., Koenen, K. C., Cohen, L. R., & Han, H. (2002). Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse. Journal of Consulting and Clinical Psychology, 70(5), Cloitre, M., Miranda, R., Stovall-McClough, K. C., & Han, H. (2005). Beyond PTSD: Emotion regulation and interpersonal problems as predictors of functional impairment in survivors of childhood abuse. Behavior Therapy, 36(2), Courtois, C. A. (2008). Complex trauma, complex reactions: Assessment and treatment.

20 Esterling, B. A., L Abate, L., Murray, E. J., & Pennebaker, J. W. (1999). Empirical foundations for writing in prevention and psychotherapy: Mental and physical health outcomes. Clinical psychology review, 19(1), Everly, G. S., & Mitchell, J. T. (2000). The debriefing" controversy" and crisis intervention: a review of lexical and substantive issues. International Journal of Emergency Mental Health, 2(4), Foa, E. B. (1997). Psychological processes related to recovery from a trauma and an effective treatment for PTSD. Annals of the New York Academy of Sciences. Foa, E. B., Keane, T. M., Friedman, M. J., & Cohen, J. A. (2008). Effective treatments for PTSD: practice guidelines from the International Society for Traumatic Stress Studies. Guilford Press. Ford, J. D., & Courtois, C. A. (2014). Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation, 1(9). Frankl, V. E. (1962). Man's Search for Meaning: An Introduction to Logotherapy. Beacon Press. Grand, D. (2013). Brainspotting: The revolutionary new therapy for rapid and effective change. Sounds True. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press. Hendrix, H., Hannah, M. T., Luquet, W., Hunt, H. L., & Mason, R. C. (2005). Imago relationship therapy: Perspectives on theory (Vol. 1). Jossey-Bass Inc Pub. Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5, Herman, J. L. (1997). Trauma and Recovery: The Aftermath of Violence from Domestic Abuse to Political Terror. New York: Basic Books. Karle, W., Corriere, R., & Hart, J. (1973). Psychophysiological changes in abreactive therapy: I. Primal therapy. Psychotherapy: Theory, Research & Practice, 10(2), 117. LeDoux, J. (2002). Synaptic self: how our brains become who we are. New York: Viking. Levine, P. A. (2010). In an unspoken voice: How the body releases trauma and restores goodness. Berkley, CA: North Atlantic Books. Levine, P. A., & Frederick, A. (1997). Waking the Tiger. Berkeley, CA: North Atlantic Books. Linehan, M. M. (1993) Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press. Mindell, A. (2012). Quantum Mind: The Edge Between Physics and Psychology. Portland: Lao Tse Press. Najavits, L. M. (2002). Seeking Safety: A Treatment Manual for PTSD and Substance Abuse. New York: Guilford Press. Ogden, P. (2009). Emotion, mindfulness and movement: Expanding the regulatory boundaries of the window of tolerance. In D. Fosha, D. Siegal & M. Solomon (Eds.), The healing power of emotion: Perspectives from affective neuroscience and clinical practice (pp ). New York: W.W. Norton. Pennebaker, J. W., & Francis, M. E. (1996). Cognitive, emotional, and language processes in disclosure. Cognition & Emotion, 10(6), Phoenix, B. J. (2007). Psychoeducation for survivors of

21 trauma. Perspectives in Psychiatric care, 43(3), Porges, S. W. (2007) The polyvagal perspective. Biological Psychology, 74(2), Resick, P. A., & Schnicke, M. K. (1993). Cognitive processing therapy for sexual assault victims: A treatment manual. Newbury Park CA: Sage Publications. Rothschild, B. (2000). The Body Remembers. New York: WW Norton & Company. Rothschild, B. (2010). Treatment Essentials: the go-to guide. New York: W.W. Norton. Schnurr, P. P., Friedman, M. J., Foy, D. W., Shea, M. T., Hsieh, F. Y., Lavori, P. W.,... & Bernardy, N. C. (2003). Randomized trial of trauma-focused group therapy for posttraumatic stress disorder: Results from a Department of Veterans Affairs cooperative study. Archives of General Psychiatry, 60(5), Schore, A. N. (1996). The experience-dependent maturation of a regulatory system in the orbital prefrontal cortex and the origin of developmental psychopathology. Development and Psychopathology, 8, Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to relapse prevention. New York: Guilford. Shapiro, F. (1995). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures. New York: Guilford Press. Sharpless, B. A., & Barber, J. P. (2011). A clinician's guide to PTSD treatments for returning veterans. Professional Psychology: Research and Practice, 42(1), 8. Siegel, D. J. (1999). The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are. New York: Guilford Press. Society of Clinical Psychology (2015). Post-Traumatic Stress Disorder. Retrieved from div12.org/psychologicaltreatments/disorders/ptsd_ main.php. Stuart, G. L., Moore, T. M., Gordon, K. C., Ramsey, S. E., & Kahler, C. W. (2006). Psychopathology in women arrested for domestic violence. Journal of Interpersonal Violence, 21(3), Terr, L. (1991). Childhood traumas: an outline and overview. American Journal of Psychiatry, 148, Van der Kolk, B. A. (2002). Assessment and treatment of Complex PTSD. In R. Yehuda, (Ed.), Treating trauma survivors with PTSD (pp ). Washington, DC: American Psychiatric Association. Van der Kolk, B. A., Pelcovitz, D., Roth, S., Mandel, F. S., McFarlane, A., & Herman, J. L. (1996). Dissociation, somatization, and affect dysregulation: The complexity of adaptation to trauma. American Journal of Psychiatry, 153(7), Vera, E. M., & Speight, S. L. (2003). Multicultural competence, social justice, and counseling psychology: Expanding our roles. The Counseling Psychologist, 31(3), : : :

22 Trauma Counseling Model: Recovery Mechanisms and Techniques in Three Stages Kyungil University This study focused on effective and tangible trauma counseling techniques from the perspectives of growth and extension in counselogy and reviewed the recovery mechanism on three stages of trauma. As the frames to analyse recovery mechanisms, the types of trauma events, neurophysiological studies of trauma response, the principles of affect arousal were reviewed. Specifically, the trauma theory by Herman was used for identifying core techniques in three stages. The classification of trauma events by Terr and DSM-5 diagnostic criteria were used to define the trauma response and main counseling task in stages. In order to explain trauma response in a neurophysiological scope and find the implication of recovery mechanisms and tangibility of techniques, Survival Circuits, General Adaptation Syndrome, The polyvagal perspective, and Window of Tolerance were examined. Based on the analysis, the model of trauma counseling was suggested. Key words : trauma, safety, reconnection, recovery mechanism, counseling technique, counselogy, PTSD

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<31392EC0CCC1F6B9CE2CC8ABC3A2C8F12E687770> 한국심리학회지 : 상담 및 심리치료 The Korean Journal of Counseling and Psychotherapy 2008, Vol. 20 No. 2, 553-580 성매매 여성들의 복합 외상 후 스트레스 장애 * 이 지 민 홍 창 희 부산대학교 본 연구에서는 자료수집이 힘든 성매매집결지의 여성들을 대상으로 장기간 반복적인 외상이 주는 정신병리적인