Becoming Trauma-Informed

Updated: Sep 22

Individual trauma results from an event, series of events, or set of circumstances experienced by an individual as physically or emotionally harmful or life-threatening with lasting adverse effects on the individual's functioning and mental, physical, social, emotional, or spiritual well-being.

-U.S. Substance Abuse and Mental Health Services Administration


When I started in the social service field, I was motivated by a desire to humanize the most dehumanizing systems. I deliberately sought out situations that were not considered ‘good’ places to work, like city shelters, state psychiatric hospitals, jails and prisons. I was interested in the power of environment on a person’s psyche, and believed that creative expression--drama, music, art, poetry--could be a means of infusing life and healing into these institutional settings. But it wasn’t long before I found that the moments of connection and communication paled compared to the oppression perpetuated by the systems that I hoped to transform. I couldn’t stop thinking about the stories of the people I worked with. I spent a lot of time being outraged at the system and my supervisors.


Coping


My response to my demoralization was to hang out with other staff and vent, usually at a bar. That actually worked pretty well--until it didn’t. Eventually my coping mechanisms started to have a negative impact on my life and work. Meanwhile, I’d had zero training on trauma, and what inevitably happens when you live or work around chronic trauma. I couldn’t describe, even to myself, the nature of the distress I was feeling. And because of how involved I was in work, I wasn’t doing my own work of personal healing and growth.


Normalizing


It wasn’t until going to graduate school for Drama Therapy that I was exposed to the concept of psychological trauma and its impact on the brain and body. I learned that empathy--the most essential part of any helping relationship--is a dual-edged sword; at once a gift and a vulnerability. I discovered that the negative impact of the passion I felt for my work was referred to as ‘Vicarious Trauma’, a common phenomenon where the brains and bodies of helping professionals unconsciously mirror the normal fight, flight, or freeze responses of the trauma survivors we empathize with. I was relieved to learn that what I’d been experiencing had a name, and that the causes were well known. Because understanding all this helped me stay in the field, I’ve become something of an evangelist regarding vicarious trauma awareness for helping professionals.

There are extremely high rates of trauma throughout our society. No one, especially a professional focusing on trauma’s effects and outcomes, should have to go to graduate school to learn about it!


9/11 and After


After the attacks of September 11, 2001, there was heightened awareness and concern about the impact of trauma, especially on children. Donations poured in, delivering an infusion of funding to address the crisis. I had the amazing opportunity of starting up a new youth afterschool program on Manhattan’s Lower East Side. We had resources for mental health enhancements that had never been there before, and created a model for non-stigmatizing holistic supports, focusing on the arts. Creative arts therapists would actually “embed” in the classroom, helping to coach students and staff to recognize and manage physiological and emotional responses to stress, so that they could get to the important business of being a child--feeling safe enough to learn and have fun!


Why did it take 9/11?


So many of our children are so deeply impacted by trauma. Families in New York City’s low-income neighborhoods have been demonstrating resilience forever. People touched by social service systems are virtually always trauma survivors, impacted by interlinked circumstances--poverty, interpersonal violence, the generational legacy of slavery, colonization, genocide--that take away one’s sense of control and safety. These are also populations that, due to due to systematic racism and oppression, have been denied the right to name their experiences or tell their own stories. In contrast, 9/11 was a traumatic event experienced by all New Yorkers, including those who have most often controlled the dominant narratives in our society. The experience and articulation of shock and distress by these people demanded response. The positive outcome of 9/11 was that this response began to establish a new official language about trauma.


An Evolving Trauma-Informed Movement


Trauma-informed care is a strengths-based service delivery approach that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment.

-U..S. Substance Abuse and Mental Health Services Administration


Trauma-informed care is now not only a ‘thing’ (0 which 2years ago, it wasn’t) but a thing that is being evolved, enhanced, deconstructed and challenged. The Adverse Childhood Experiences (ACES) movement established the epidemic-level prevalence of childhood trauma and its lasting impact on health outcomes and life expectancy. The growing ACES movement emphasizes the need for community-level response and prevention, and for moving treatment focus away from a narrative around individual ‘events’ and toward changing population-level conditions. ACES has helped name the fact that helping professionals, even with the best of intentions, are often focused on mitigating or managing problems, rather than preventing and healing from problems.


Dr. Nadine Burke Harris’ viral TED talk : How childhood trauma affects health across a lifetime gives a simple and vivid description of this mindset shift:


“If you're a doctor and you see 100 kids that all drink from the same well, and 98 of them develop diarrhea, you can go ahead and write that prescription for dose after dose after dose of antibiotics, or you can walk over and say, "What the hell is in this well?"


Language is never static, and will always reflect the societal conditions from which it emerges. While recognizing the importance of a universalized standard of trauma-informed care, Dr. Shawn Ginwright chronicles the inherent deficit-based narrative in the term 'trauma-informed care' and calls for a new paradigm: healing centered engagement.'


“Healing centered engagement is explicitly political, rather than clinical. Communities, and individuals who experience trauma, are agents in restoring their own well-being. This subtle shift suggests that healing from trauma is found in an awareness and actions that address the conditions that created the trauma in the first place.”


Those closest to the problem are closest to the solution” is an apt mantra for all of us who seek to support healing and affirm the lives of trauma survivors. So how can service systems help, rather than maintain the status quo?


Voice and Choice


For the majority of people impacted by social service system involvement, trauma is not one event, but layers of complex trauma that have had no chance to heal. This leads to an over-sensitized nervous system that is constantly in flight or freeze mode, totally ‘normal’ in terms of physiological responses to threat, but prompting behavior that others have a hard time understanding (like a lightning-quick temper, or extreme irritability, or appearing tuned out or forgetful). Helpers need to understand that the ‘difficult’ client is probably a trauma survivor. The bottom line? People touched by social service systems must have voice and choice in how services are provided. It is literally vital that accessing help itself does not re-traumatize through unchecked power differentials and triggering interactions.


To help in a way that is not re-traumatizing, social service staff need to be 100% present and committed to self-reflection. This requires ongoing access to resources for managing vicarious trauma, and for healing from their own primary trauma. Staff need support networks that do not feel subject to ‘performance evaluation,’ and, organizations need to get the conditions for success in place for courageous conversations about how the organization’s culture, structures, and norms may consciously or unconsciously reflect inequity and traumatization.


The Deep Roots of Structural Trauma


We have collective discomfort about naming the trauma that is at the foundation of our country, and we can’t talk about this trauma without addressing the structural racism in our society. At this writing, the horrific policy-imposed separation of families at the United States’ southern border has sparked collective moral outrage and resistance actions, and people are effectively mobilizing to do what they can to stop and reverse this travesty. “This is not my America,” some say. But, our racial justice leaders remind us that forced family separations due to slavery, colonization, and genocide are deeply American. Our political foundation itself is traumatizing; the legacy of intergenerational trauma is so embedded into our everyday lives that it has come to be seen as normal--when it is not.


Right now, survivors are reminding and teaching about things that they really shouldn’t have to. A helping system that is truly healing is only possible when there is a shared acknowledgment of the root causes of today’s endemic poverty and trauma. Healing systems depend on organizations being able to get comfortable with the discomfort of talking about race, racism and the intersecting isms, not only ‘out there’ but also in terms of how organizations themselves reflect and perpetuate the same things.


Case Study: Hard Questions about Helping


Along with asking how we provide services we also have to be willing to see--and undo--coded messages about who “deserves” services. Systemic change is about big change and small change, at the same time. In organizations, we have to find the small sparks and then systematically follow them through, so they can reverberate. The field of victim services is one area where important questions about access and inclusiveness are being addressed through a racial justice lens.


As Senior Director of Training at Safe Horizon (the nation’s largest victim assistance organization, responding for over 30 years to the most difficult examples of interpersonal violence), I had the opportunity to work with dedicated advocates to fan the sparks of change. The organization and its staff had recognized that sometimes, inadvertently, the services provided to domestic violence survivors and crime victims didn’t take into account individual situations. People have ways of managing risk and violence that may not be in line with what staff think of as safety. Continuing to live with an abusive partner in order to keep your children out of the shelter system is a good example. For staff, especially when vicarious trauma is added to the mix, acknowledging this complexity can feel demoralizing and often leads to help’ that is not really helpful, impeding authentic collaboration with clients.


Safe Horizon’s growth and evolution as a leader in victim assistance has hinged on realizing that a huge proportion of people impacted by violent crime are overlooked because of biases and assumptions--most significantly, young men of color. Organizational questions emerged such as: “How can we put trauma knowledge in the hands of everybody? How can we help our clients voice why they move through the world as they do? How can we assist them in naming why their feelings--of rage, distrust of authority, belief they won’t be heard--make sense?” This kind of organizational approach facilitates crime victims to work with, rather than be re-traumatized by, their normal human coping responses.


As Dr. Kenneth Hardy says:


“Rechanneled rage can be a powerful energy source helping youth of color to discover and cultivate what is great in and about them. It drives them to stand again after they have been knocked down, to try again after not succeeding, and to believe in themselves when all others around them fail to do so. These are the positive outcomes of healing the hidden wounds of racial oppression.”


Being Trauma-Responsive is a Risk Management Strategy


Every social service organization that wants to be fully effective has to manage the never-ending impact of running towards the fire of trauma. It’s basic to organizational sustainability, and I think just as important an any other element in a cohesive risk management plan. So, what would a proactive ‘trauma management plan’ entail?


Public trainings: Build the field and create career support systems beyond one’s own organization. Threading a baseline of knowledge across the field of action we are all trying to address is a great way to both reinforce internal trainings and bring fresh ideas and thinking to the organization.


Organization-based learning experiences: Enable courageous conversations between staff from multiple levels and diverse perspectives. Help build a common language and define your unique context, culture, work and identity.


Space to reflect, process and plan. In the hustle and bustle of daily work and ongoing crisis it can be hard to take time out. Allow clear space for ideas to percolate and new possibilities to arise.


To Stamp Our Feet with New Power


Everything I’ve described in this article requires courage and commitment. We are in a field that is breaking new ground. We need to listen and learn, and we need to support each other in expanding resilience and possibility. We truly don’t want status quo ‘band aid’ solutions. We do want tectonic structural shifts.


Early in my career, when I was struggling and didn’t have any of this context around trauma, a colleague mailed a poem to me: "Escape," by D.H. Lawrence. It made me feel seen and heard, and I share it here because it helped reconnect me to my purpose:


When we get out of the glass bottles of our ego, and when we escape like squirrels turning in the cages of our personality and get into the forests again, we shall shiver with cold and fright but things will happen to us so that we don't know ourselves. Cool, unlying life will rush in, and passion will make our bodies taut with power, we shall stamp our feet with new power and old things will fall down, we shall laugh, and institutions will curl up like burnt paper.


As a community of helping professionals, we have the opportunity each day to, in the words of Dr. Clarissa PInkola Estes, “stretch out to mend the part of the world that is within our reach.”

How will we transform systems and institutions together, while sustaining ourselves for the marathon? How can we activate a healing, non-oppressive power that we might not yet even be able to envision?

source: Pixabay

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