Monday, April 14, 2014

Moving Beyond Being Trauma-Informed

I have never really felt comfortable with the term “trauma-informed.”  It seems passive and too open to interpretation.  Anyone can pick up a book, read an article, or even a blog post and become informed about trauma.  At its most basic, it implies some knowledge of what trauma is and what it does.  It can also be expanded to be a philosophical underpinning of the work that we do to assist victim/survivors of domestic and sexual violence, an understanding that the effects of trauma are because of what was done to a person rather than there being something wrong with her/him.  However, what we really want to be is “trauma-responsive.”  This moves our programs from the basic understanding of trauma to not only having knowledge of the effects of trauma, but also incorporating activities, policies, and interactions that value the experience of the survivor, assist in finding ways to mitigate the impact of trauma, and reduce the possibility of triggering or re-victimizing.
In order to have a definition of trauma-informed services that addresses the needs of domestic violence survivors, the National Center on Domestic Violence, Trauma and Mental Health created the following working definition of “trauma-informed” that moves beyond passive knowledge to a genuine active response. 
”A trauma-informed program, organization, system, or community is one that has undergone a transformation in awareness about the traumatic effects of abuse and violence and incorporates that understanding into every aspect of its practice or program. In such settings, understanding about trauma is reflected in the knowledge, attitudes, and skills of individuals as well as in organizational structures such as policies, procedures, language, and supports for staff.  This includes attending to culturally specific experiences of trauma and providing culturally relevant and linguistically appropriate services. Any person, system, or setting can be trauma-informed. A DV program that is trauma-informed recognizes that survivors, staff, and others they interact with may be affected by trauma they have experienced at some point in their lives. Central to this perspective is viewing trauma-related responses from the vantage point of “what happened to you” rather than “what’s wrong with you,” recognizing these responses as survival strategies, and focusing on survivors’ individual and collective strengths. Trauma-informed programs are welcoming and inclusive and based on principles of respect, dignity, inclusiveness, trustworthiness, empowerment, choice, connection, and hope. They are designed to attend to both physical and emotional safety, to avoid retraumatizing those who seek assistance, to support healing and recovery, and to facilitate meaningful participation of survivors in the design, implementation, and evaluation of services. Supervision and support for staff to safely reflect on and attend to their own responses and to learn and grow from their experiences is another critical aspect of trauma-informed work.” (Training the Trainers Curriculum, NCDVTMH, 2011)
If your program meets this definition, then it is meeting the needs of survivors in a more active, responsive way.


Monday, March 24, 2014

Practicing Non-Violence Toward Self - an excerpt from a piece by Phillip Moffitt

I read this  over the weekend and thought I would share portions of it with you as part of my short series on self-care.  The full piece can be found at http://dharmawisdom.org/teachings/articles/practicing-nonviolence-toward-self

Understanding Violence

Whenever I introduce the topic of violence against self in a Dharma talk, almost everyone squirms. No one wants to hear it. I will directly ask the question: Are you, in an obvious manner or in a series of subtle, covert actions, being violent with yourself? Usually people want to assure me that while they may work too hard at times, stay in an unhealthy relationship, eat too much, or sleep too little, they would not characterize their behavior as violent toward themselves. Yet, person after person, once they've closely examined their lives, experiences a moment of self-recognition that at first can be painful and embarrassing. This initial discomfort is often followed by a sense of liberation as new possibilities arise in their imaginations for how to live more peacefully.
Most people perpetrate this violence against self through mistakenly identifying with various thoughts that arise due to impersonal conditions coming together. The body and mind's well-being are the innocent victims. Each individual has a unique pattern, but the common ground is that you relate to yourself in a manner that results in your life being more emotionally or physically violent than it need be.
You may have limited your understanding of self-violence to physical abuse or other blatant self-destructive behavior that calls for a 12-step program. The word "violence" may sound too harsh to you, but its dictionary meaning is "an exertion of extreme force to cause injury or abuse in the form of distortion or infringement." The extreme force can be a mental act that then shows up in the body or an act that is done repeatedly to an extreme.
You can think of violence as any highly energetic form of relating to a person, including yourself, that is jarring, turbulent, and distorting. Can you identify any times in the last few days in which you treated yourself in a discordant, abrupt, or distorting manner?
The Trappist monk and spiritual author Thomas Merton once said, "To allow oneself to be carried away by a multitude of conflicting concerns, to surrender to too many demands, to commit to too many projects, to want to help everyone in everything is itself to succumb to the violence of our times." Obviously Merton wasn't speaking about pathologically self-destructive behavior. Instead he was drawing our attention to the shadow side of normative, even seemingly positive, culturally approved behavior. He was referring to how we do great violence to ourselves simply in the manner in which we go about arranging our lives.
Gradually I've come to realize that violence against oneself is one of the great denials of our time. People are very willing to talk about the violence that the world does to them, but they're much less willing to own the violence that they do to themselves. Violence against self can most easily be recognized in your experience of the body in daily life. You already know the general health problems that come about because of stress, sleep deprivation, and constant strain. You may not identify them as examples of violence to self, but anytime you make yourself sick or dysfunctional, it is an act of violence for which you need to take responsibility. We all know people who are overworked or have too much stress, which causes problems with the digestive system, heart, or other parts of the body, but who never label their behavior as violence to the self. But is there any description that is more apt?
One of the yamas, or moral restraints, in Patanjali's Yoga Sutra is ahimsa, the practice of nonviolence, and this includes nonviolence toward yourself. Of course, you may well want something in your life so much that you are willing to take a chance of hurting your body by driving it too hard. But usually a conscious, short-term exertion to reach a goal is not what causes violence to self. More often it is a matter of long-term disregard of the signals of imbalance. This disregard comes from repeatedly getting so caught in wanting or fearful mind-states that you're unable to reflect on your own behavior. You may have a surface-level awareness of the distress you are feeling in your body, but you don't sincerely respond to the discomfort. In such instances you are in a driven state, controlled by your mind's imaginary creations rather than your inner values.
Inner development and maturity come from acknowledging to yourself that you are being violent with a human being; the fact that you happen to be the human being who is being hurt does not change the truth of the violence. From a spiritual perspective, it is never right to hurt any human being; including yourself; for selfish reasons or because of sloppy attention to the consequences of your actions. Understanding this is your first step in practicing ahimsa toward yourself.

Taking Time Out

As the Thomas Merton quote points out, if you abuse your time, you are participating in violence against self. This may be in the form of overscheduling to the point that you rob yourself of the experience of being alive. Or it may be in the form of allocating your time in a manner that doesn't reflect your inner priorities. Both create a distortion or infringement of self through strain and turbulence. When you treat your time as though you are a machine; a doing machine; you are committing violence against the sacredness of life itself. Whenever I do Life Balance work with organizational leaders, I have them make a list of their values and prioritize them, then compare their priorities with how they actually spend their time. The disparity is usually shocking.
Another abuse of time that disturbs your well-being occurs if you succumb to the modern-day compulsion to avoid boredom at all costs. In our stimulation-based culture, there is near hysteria around constantly seeking fulfillment through activity, which leaves no time for the quietness of simply being present with yourself. Do you allow yourself time each day, or even weekly, to exist without an external purpose and without even background music or television? Empty time is vital to your well-being, and to deny yourself this nourishment is an act of violence.
You may ask why you continue to abuse your time and your body when you have the option to live more peacefully. Or you may say that you feel as though you have no choice but to be harsh toward yourself because your life situation is such a struggle. Under either circumstance you push the body and strain the mind violently because you are filled with the tension that comes with the feeling that there's not enough of something in your life, whether it's money, love, adventure, or confidence.
Feelings of inadequacy, vulnerability, longing, or not having enough are an inevitable part of the human experience. If you, like most people, have not found spiritual freedom, you cannot stop them from arising. But you can stop such feelings from controlling your life by changing how you perceive them. If you refuse to identify with these feelings, disown them as being neither you nor yours, thus seeing them simply as emotional states of mind that come and go, you will discover there is the possibility for some inner harmony even under difficult circumstances.
For instance, let's assume you cannot change your work schedule, and it seems so overwhelming to you that you regularly get very tense and anxious about it. You can experience the schedule as much less violent by not thinking about it in its entirety except when you are in planning mode. The rest of the time you just do what the plan calls for, concentrating on the task in front of you without adding the thought, "Here I am with all this work and so much more to do this week."
Said another way, don't make a panoramic movie out of your difficult schedule such that you are constantly seeing yourself doing all that has to be done, as if it were going to be done all at once. Instead just do what has to be done right now, for that's all you can do. It may sound like a simple thing to do, but it is very subtle and difficult, yet so liberating!
Another method you can use to cope with overscheduling is to notice each time you experience fear or wanting while thinking about all you have to do. Consciously label these feelings as fear and wanting in your mind and then see for yourself that they originate as impersonal mind-states, the way a storm forms due to weather conditions. The land that receives the storm does not own it, and the storm is not the land; it's just a storm, which due to its own characteristics can cause damage. So it is with the stormy situations in your life where there is a tendency to both deny and take ownership of fear or wanting. This misperception leads you to believe you should be able to control them, which in turn causes the physical contractions and the mental anguish that constitute violence to self.

Stopping the Violence

In seeking freedom from violence to self, practice noticing over and over again that you are constantly, and usually unconsciously, wanting things to be different than the way they are. You become a little dictator to yourself, sitting on a throne, arms crossed, pouting and demanding that things you like should stay the way they are forever and what you do not like should disappear immediately. This craving to hold on to what you like and to get rid of what you find difficult is considered the source of suffering in life and the origin of violence against self. By practicing living with things as they are, you will discover that while life may not be less painful, your experience of it is immeasurably better. Also, fully accepting what is true in the moment is the only firm place to begin to make changes in your life. Living in the moment is not a one-time commitment but something that has to be done again and again.
Nonviolence to self is a lifetime practice of which there are ever more subtle levels to discover. The more you are able to be with yourself in a nonviolent way, the less harm you will do to another. Be gentle with the body and mind; refuse to get caught in believing that things have to be a certain way in order for you to be happy.

Friday, March 14, 2014

Why Is Self-Care So Hard?

I was talking to another advocate the other day about the importance of self-care and came to a few realizations.    Those of us working in domestic violence and sexual assault field are impacted every day by the stories that we hear and we need to have downtime in order to recover from the effects of vicarious trauma.  But many of us seldom take the time.  When asked “why not?” many will just shrug their shoulders and say “I don’t have the time.”  I think that for many people it really goes deeper than that.  I think that if a person asks herself why she can’t find the time, the answer reflects more about the person’s regard for herself than it does time constraints. 
1.        “I am not important enough.”  This reflects an attitude that the advocate feels that the problems of others are more important than her own and that she just needs to buck up and not impose on others in order to take care of herself.  She doesn’t see herself as having any value.  The important thing to remember is that if you don’t take care of yourself, you can’t take care of anyone else. 
2.       Imposter syndrome – This has been written about in different places.  It basically is the innate belief a person has that she is hiding her basic unworthiness from the world and that it is only time before every one finds out what a fraud she is.  Staying busy and refraining from self-care is a way of proving one’s value to the world and/or keeping people from finding out the secret.
3.       The depression that comes from vicarious trauma makes it difficult to do any more than what is asked for and taking the extra steps for self-care seem overwhelming.  Depression also makes a person lose touch with the things she used to love to do.  It always amazes me when an advocate can list the contents of a whole tool box of self-care items for a survivor but fails to open that box for herself. 
4.       Trying to stay ahead of the effects of trauma – Many advocates have their own trauma history and are regularly triggered by the stories they hear.  Staying busy is a way to keep from facing one’s own past, but it can often lead to complete burn out and collapse.  It also contributes to being ineffective as an advocate. 
It may take a few tries to find  activities to alleviate the effects of vicarious trauma.  It may be helpful to think about what you used to do that lifted your spirits and find new ways to enjoy them.  Did you enjoy singing – how about joining an acapella group?  Have you always wanted to play music?  Then take lessons or join a drumming group.  Sports?  I know advocates who have joined roller derby teams and love it.  Outdoors?  Check out www.meetup.com to find out what activities are going on in your area or just grab a friend for a hike in the woods.
If you find you are hesitating or it is difficult to engage in activities that you enjoy or you refrain from spending time with family and friends, then the effects of the vicarious trauma may be deeper.  Seriously consider looking for a good therapist in your area to talk to about what you are experiencing.  It could be the best thing you could do for yourself and for the people with whom you come in contact.



Monday, March 3, 2014

PTSD, Chris Brown and Violence Against Women

According to an article in Rolling Stone, the rehab facility where Chris Brown is receiving treatment for substance abuse reports his actions (including assaults against Rihanna) may be attributable to PTSD and bipolar disorder.  "Mr. Brown will… require close supervision by his treating physician in order to ensure his bipolar mental health condition remains stable," the letter says. "It is not uncommon for patients with Post Traumatic Stress Disorder and Bipolar II to use substances to self-medicate their biochemical mood swings and trauma triggers. . . . Mr. Brown became aggressive and acted out physically due to his untreated mental health disorder, severe sleep deprivation, inappropriate self-medicating and untreated PTSD."

First of all, I find it very interesting that the facility appears to engage with Mr. Brown’s publicist in trying to do damage control by releasing information to the public that excuses his behavior.  Secondly, let’s not fall into the trap of believing that every abuser’s actions are due to PTSD or some other mental health disorder.  I don’t know what in Chris Brown’s personal history may have led to the diagnoses of PTSD.  However, I do know that Chris Brown has lived in a culture that endorses violence against women and by blaming it on PTSD this culture ends up minimizing the impact of other causes of violence.



Violence against women is not caused by mental illness, substance abuse, anger, loss of control, anxiety, problems in the relationship, or the actions of the victim.  It is caused by a need for power and control and a disregard for women as individuals with their own rights.  There is usually a pattern of coercive control that accompanies or leads to the violence.  If the violence was due to any of the above, then the violence would be directed beyond just women. 

It is my hope that any treatment for PTSD and bipolar disorder for someone with Chris Brown’s history would also include a focused long-term batterer’s intervention program that addresses the culture of violence of against women, stops the violence and prevents the reoccurrence of future violence while ensuring victim’s  safety by:  identifying abusive behaviors, teaching alternatives to violence, exploring the impact of violence and abusive behavior on intimate partners, children and others, and assisting the individual in examining the beliefs they hold about the violence


Thursday, February 27, 2014

Tonic Immobility: Fight, flight, or . . . freeze? Yes. Freeze.

This is a re-post of an article on tonic immobility and sexual assault by Dr. Rebecca Campbell from the University of Michigan.  This was found on http://www.joyfulheartfoundation.org/

Many people have heard of "fight or flight," which is a way our bodies respond to very threatening, stressful situations. It's a biological response in mammals, including humans, that involves gearing up the body to either fight back against the threat or flee from the threatening situation. When the mind recognizes a situation as very threatening to the physical well-being, emotional well-being or even the very survival of the organism, the brain triggers the body to release adrenal hormones, sometimes referred to as "stress hormones." These hormones are what give the body the energy and wherewithal to fight back or get away to safety.
But sometimes, the sudden release of high levels of stress hormones triggers an entirely different reaction: freeze. When this happens, the body can't move and won't move, arms and legs don't fight back and they don't carry the body away to safety.
Why? Why would the body freeze in a threatening situation?
Good question.
Research studies with animals have documented that sometimes the best way to protect the body is to freeze, to play dead, fighting back or fleeing would only prolong the threat and endanger the body even worse (maybe even risk death). In other words, sometimes the safest solution isn't fight-or-flight. The safest option is to freeze and so the brain and body work together?to hold the organism still until the threat has passed.
So, which one? When will the body fight? Flight? Freeze?
Researchers have not yet determined why animals or humans respond with which strategy—in which situation. What is clear is that all three are normal, biological responses to threatening encounters. Researchers have determined that these responses are autonomic, which means they happen automatically without conscious thought or decision making. In other words, we don't get to pause and think about these three different options; the brain picks one quickly and goes with it. It's not something we get to decide. It's not something we get to choose. Thinking it over?weighing the pros and cons might take too long?and that could endanger the survival of the organism, so the brain is hard-wired to make a decision and go with it.
The technical term for the "freeze response" is tonic immobility (TI).
During an episode of tonic immobility, a person enters into a temporary state of paralysis. Typically, this means that the individual can't move his/her arms, legs, hands, feet, etc. The person is frozen and may appear to be dead. Tonic immobility may last for only few moments, or for several minutes, or for much longer periods of time. During the episode, the person may be aware of what's happening to them and may also understand that he/she cannot move.
Recently, researchers discovered that some rape and sexual assault victims experience tonic immobility during the attack. Tonic Immobility can happen whether the assailant is a stranger to the victim, or whether it is someone she/he knows. Victims who experience tonic immobility during the assault freeze. They can't move, they can't fight back, they can't flee. And after the trauma, a person can have difficulty remembering specific details of the event, especially when they freeze while it's happening.
It's important to remember that tonic immobility is an autonomic response, victims don't decide to do this; it's an automatic response of the brain and body, working together to try to protect the survival of the organism.
Tonic immobility can be extremely frightening and confusing to rape and sexual assault victims. Why did I freeze? Why couldn't I move? Why couldn't I scream? Why didn't I fight back? Why was I just stuck there? It's not uncommon for victims to blame themselves for this response, often because they don't understand why they did what they did. And often, not remembering the details of how things happened can bring up feelings of shame, especially when questioned by others. Most people don't know about the "freeze response." Most people don't know that research now tells us that "fight or flight" is actually "fight, flight or freeze." The freeze response, also called called tonic immobility, has been documented in many research studies with sexual assault victims. It is very real, it is very normal, it is completely biological and it is not something victims can control. Nor is their fault.
In my career as a research psychologist, I have had an opportunity to interview many rape survivors who experienced tonic immobility during the assault. None of them ever knew why they froze and because of that, they carried within them tremendous guilt and confusion. When I've told them that what they experienced sounds like tonic immobility, and when I've described to them what tonic immobility is, they are astounded. Some survivors cry in relief, some have jumped up and hugged me, some have sat there in disbelief, asking me to explain it over and over again, just to be sure. To know that this is something normal—something that happens to many survivors and it's not their fault—is incredibly freeing and healing. It can help make one part of a terrible—traumatic crime a bit more understandable.
I have also had the opportunity to talk with police officers, detectives, nurses, doctors, and rape victim advocates about these issues. Many of these professionals are not aware of "fight-flight-or-freeze" or if they are, they don't know that research now shows that some rape and sexual assault victims experience the "freeze response" during the attack. Unfortunately, there are still too many instances where our helping professionals blame victims for tonic immobility and add to victims'shame, guilt, and self-blame. However, as legal and medical system personnel learn about Tonic Immobility, they are able to help victims understand what has happened to them and help them along their journey of healing.
Dr. Rebecca Campbell is a professor of community psychology and program evaluation at Michigan State University. Her research focuses on violence against women—specifically sexual assault and how the legal, medical, and mental systems respond to the needs of rape survivors. She is the author of Emotionally Involved: The Impact of Researching Rape (2002, Routledge), which won the 2002 Distinguished Publication Award from the Association for Women in Psychology. Dr. Campbell has been active in the anti-violence social movement since 1989 and has spent 10 years working as a volunteer rape victim advocate in hospital emergency departments.
- See more at: http://www.joyfulheartfoundation.org/blog/talking-about-tonic-immobility-tonights-svu#sthash.b3bDYmBM.dpuf

Monday, February 24, 2014

A Few Resources on Vicarious Trauma

I was going to write a new post about vicarious trauma but there is a lot of good stuff out there already so I thought I would just provide the links:

Compassion Fatigue Solutions

National Society for the Prevention of Cruelty to Children in the United Kingdom has a lot of good information on vicarious trauma in addition to information on child abuse.

And the Australian National Sexual Assault folks have a some great info on their website.

And if you want to read a good book click on the links below to reviews that have been done on this blog:

Trauma Stewardship by Laura van Dernoot Lipsky

Fried: Why You Burn Out and How to Revive by Joan Borysenko Ph. D.

If you are into social networking here is a  of Facebook group you may be interested in:

Self Care for Advocates

Remember to use your supports and to find activities to nurture you in mind, body and spirit.  I suggest finding a reason to dance!


Tuesday, February 4, 2014

Addiction to Trauma and the Piranha Theory

Victims who return to their abuser or who do not leave a dangerous situation are often referred to as being “addicted to their abuser” or “addicted to trauma.”  The concern with using this statement is that given the stigma connected with addiction to substances this description of a survivor of abuse can appear to be victim blaming.  The victim is seen as seeking out the abuse as a means of feeding some sort of need rather than placing the blame on the perpetrator or perpetrators who have significantly impacted the brain chemistry of the victim in a way that resembles the addiction process.
According to Bessel van der Kolk quoted in Sandra Bloom’s article Trauma Theory Abbreviated,one hypothesis is that people can become ‘addicted”’ to their own internal endorphins and as a result only feel calm when they are under stress while feeling fearful, irritable and hyperaroused when the stress is relieved, much like someone who is withdrawing from heroin.  This has been called ‘addiction to trauma.’”
The important distinction to make is that this “addiction” is a physiological response caused by the actions of another individual as a means of power and control.  The victim does not seek out the pain.  Instead the victim is seeking relief from the tension that builds when an atmosphere is calm.  In fact, it may be important to recognize that calm and safe surroundings can feel threatening to a trauma survivor and this creates a greater risk of returning to the abuser.
Although the addiction hypothesis explains the physiological origins of the behavior, it may also be helpful to look at what is happening emotionally and psychologically.  Admittedly, this is becoming harder to differentiate as we learn more about the brain, but it can be helpful to our understanding of victim/survivors.
The Piranha Theory - When a person grows up in an environment that is dangerous physically and/or emotionally, it results in the physiological responses noted above.  In addition, skills are learned in order to cope with the environment.  These may include the physiological response of dissociation and other responses such as lying, manipulation, running away, withdrawal and isolation, or over achieving and enhanced competence.  In other words, when a person grows up in fish bowl of piranhas a great number of responses are developed in order to stay safe in that environment.
Now imagine that a person with the skills to manage piranhas is moved to safety.  Rather than feeling safe, the person is going to be looking for the hidden piranhas.  She/he does not believe that there are no piranhas so she may feel ambivalent about giving up the behaviors that controlled the environment in the past.  The survivor may be looking for danger at every corner because that is what she is used to.  This is causing and is caused by a physiological response that is a reaction to perceived danger, real and imagined, and experienced previously. 
Being trauma responsive in our work with survivors includes providing safety and stabilization in addition to refraining from actions that could re-victimize the person.   Physiological stability cannot be achieved as long as the person is on an emotional roller coaster of stimulus and response (Bloom, 1999).   Once a person feels stable physiologically, she can then start the work of changing behaviors that correspond to the new environment.  This takes work and giving up old behaviors when there is constant fear and worry that the perpetrator is still around the corner.  Our acknowledgment of this struggle and assistance with stabilization is infinitely more productive than labeling a person with an “addiction to trauma.”