Monday, March 29, 2010

Combining Feminist Relational Advocacy with Reflective Practice

Summary of the Feminist Relational Advocacy Model by Lisa A. Goodman et.al.


The following is a summary of the paper Feminist Relational Advocacy: Processes and Outcomes from the Perspective of Low-Income Women with Depression by Lisa Goodman, Catherine Glenn and Angela M. Borges of Boston College, Amanda Bohlig of the University of Wisconsin, Madison, and Victory Banyard of the University of New Hampshire. It will be followed by a brief discussion on how this model can be combined with reflective practice (see blog post of March 15, 2010) to increase advocacy effectiveness.

In the article, Goodman et.al., refer to the woman to whom advocacy is provided as the “partner”. This eliminates any perceived power or control in the advocacy relationship.

Principals of Feminist Relational Advocacy –

1. Valuing the woman’s narrative – By developing a relationship through which the advocate can come to understand and respect the woman’s perspective and the reasons underlying her choices an advocate will be able to recognize the partner’s authority to know and name what she needs, and highlight her strength and autonomy without ignoring the multiple factors that limit her range of choices. This may mean a radical approach on the part of the advocate if the woman is in a position of needing non-traditional assistance. As Goodman et. al. state, “if a woman cannot get out from under her ten bags of laundry, then the most valuable thing an advocate may do is help her devise a better system for doing laundry, or even do her laundry with her.”

2. Honoring mutuality and the development of a genuine relationship – Until it is acknowledged that any actions taken by the advocate or the survivor must occur within the context of a trusting and committed relationship many survivors will not share their real needs. Components of a genuine, healing relationship include authenticity, shared power, mutuality, and openness.

3. Emotional and instrumental support are intertwined and inseparable - Just as individuals with greater levels of emotional wellbeing feel more energized to work towards changes in their external conditions, greater access to resources may well increase individuals’ emotional wellbeing.

4. Attention to external forms of oppression as sources of distress – Instead of imposing diagnostic labels on women’s emotional distress, feminist relational advocates, work to understand its roots in social conditions. The model expresses an understanding that poor women’s distress as a reasonable response to unreasonable situations, or even as an expression of resistance to institutional oppression. “Does the woman take the job that will enable her to leave the welfare rolls, but require that her young children be unsupervised? Does she leave the abusive boyfriend and give up the only secure housing situation she has ever known?”

Combining Feminist Relational Advocacy and Reflective Practice to Transform Advocate/Client Relationships

What is reflective practice? - Reflective practice is a way of being that values and enacts ongoing personal awareness of the advocate’s contribution to the tenor and quality of the interpersonal encounter, while also holding in mind the multiple contributions of the other. This includes the ability to use non-judgmental awareness and to reflect on one’s own and other’s mental states, looking inward while looking outward, and is focused on the autonomic and emotional reactions of the self and other. (Michael Morgan PhD)

What do we know about the person with whom we are engaging? This helps to understand their personal narrative and contributes to informed advocacy. The following list factors that influence the advocates relationship and may open doors to understanding responses that the partner may have when responding within the advocate/partner relationship.

Age
Gender
Race
Cultural Background
History
Trauma History
Children? Relationship with?
Living Situation
Supports and Connections/Relationship Patterns
Education
Cognitive issues? (Traumatic brain injury, developmental disabilities or trauma related cognitive isses)
Medical issues?
Coping skills
How does the above influence the person’s ability to cope?
How does what we know influence our perceptions?
What does she say she needs? How does she ask? Does she ask for specific help or does she use other ways to express her needs?
What can the advocate provide for the survivor? How can this be provided?
What can the advocate do to help make changes to the system in order to help the survivor?
How can the advocate maintain safety and respect in the relationship?
How can the advocate care for her/himself in order to be able to maintain safety and respect?

By exploring the answers to these questions and viewing through the Feminist Relational Advocacy Model you can build the advocate/partner relationship, understand the effects of trauma, and be able to address issues that are blocking the process of advocacy and healing within that relationship. 
The above issues are best reflected upon in a group setting with people who may also have contact with the partner. This provides a wider view of the person and what she brings to the advocate/partner relationship.

Tuesday, March 16, 2010

Trauma Stewardship - A Book Review by Anne Johnson, WISE DVS

Trauma Stewardship by Laura van Dernoot Lipsky with Connie Burk. Las Olas Press. 2007.


I love you and I value the work you do; Read this book. This was the message from my sister when she sent me Trauma Stewardship for my birthday last summer. I didn’t read it right away because I’m rarely interested in “self-help” books. Reading is often an escape for me, and I knew the book would be an invitation to critically explore my experiences. This fall I finally felt ready to open the book. The words and message leapt off the page - I felt understood, validated, heartened, and energized. I am introducing it to you because I think it will speak to many of you at DCYF and DV-SV crisis agencies.

My sister was a student of the author, Laura van Dernoot Lipsky, in the Masters of Social Work Program at the University of Washington in Seattle. My sister is a case manager for homeless AIDS patients, and I am a physician and anti-violence advocate. We find comfort in each other. We commiserate often about our clients and patients and the sorrows of life we experience through them. When we are left raw, disillusioned, or cynical after a particularly hard situation, we often ask larger questions about the sustainability and effectiveness of our work. Is our fight really making the world a better place? Can we see hope? Are we too exhausted to keep going?

Bearing witness to the suffering of others impacts us. This is what Lipsky calls our “trauma exposure response.” Others have pathologized this response by calling it “burnout”, “compassion fatigue,” and “secondary trauma.” We hear many touchy-feely messages about “self-care” and “ways to avoid burnout.” Taking care of ourselves is incredibly important, but many of the suggested coping mechanisms are shallow platitudes or at most, band-aids. They leave us feeling insulted. Taking a bath and drinking tea are really going to help me after I’ve witnessed the effects of horrible violence on innocent children? In contrast, Lipsky’s book offers a whole-life and whole-work method to create insight and resilience as we do our important work. She gives us a framework and language to elucidate how we are inwardly and outwardly affected. She helps us understand ways to honor ourselves and the people we serve rather than vilify our inevitable reaction to seeing and hearing about human suffering. She defines this “Trauma Stewardship” as “the entire conversation about how we come to do this work, how we are impacted by our work, and how we subsequently make sense of and learn from our experiences.”

The first section of Trauma Stewardship explains how the exposure to trauma affects us all on an individual level. I appreciate that the author looks to the newest trauma research and discusses how trauma changes our body and spirit, not just our emotional or cognitive state. She goes further to discuss how organizational culture and societal forces are also sensitive to trauma exposure. The message is again holistic. If we can cultivate awareness of the effects of trauma exposure at all levels of our work, healthy change becomes attainable as well. Not only are we able to nurture ourselves, but our new understanding gives us tools to positively change institutional culture and society as a whole.

In the second section, Lipsky names and explains very recognizable reactions we all have at one time or another as we encounter human trauma. Lipsky respectfully normalizes and validates these responses. She explains the details and reasons for feelings of hopelessness, diminished creativity, numbness, minimization, avoidance behaviors, guilt, and addiction, to name a few. These are not responses to fear and condemn, as if feeling them means we are burned out or weak. Instead, we are encouraged to cultivate a simple awareness in an effort to map our individual (as well as organizational) trauma exposure response. Throughout this process, the author reminds us to have deep compassion and patience for ourselves. She even reaches out to CPSWs especially as bearers of some of the most intense trauma exposure.

In the last section, Lipsky gathers wisdom from a variety of spiritual practices to give us options to care for the many parts of ourselves. Whereas other proponents of “self-care” often focus solely on an individual, “balancing” practice, Lipsky doesn’t assume that there is any one answer for many individuals trying to stay resilient. She recognizes that we need to cultivate passion and understand how we operate within our workplace. Readers will take away their own healing strategies that speak to them at the present moment.

Lipsky peppers the book with hilarious New Yorker cartoons. She recognizes the value of humor and irony in the face of pain and suffering. She also includes a number of 2-3 page first-person accounts of workers’ career paths in the helping professions. These honest confessionals hearten the reader. They send the message that we are not alone and we all go through both difficult and joyful times as we learn to understand ourselves and the systems in which we work.

This is a book to be read straight through or in small doses. It can be read again and again, with new insights at each return. It is supportive and loving. Many times it brought me to tears – tears of relief and thankfulness that someone (both the author and my sister) cares about my work so much that she would give me this gift. So, to all you CPSWs and DVS advocates: I care about you and I value the work you do; Read this book.

Monday, March 15, 2010

Transforming Advocacy through Reflective Practice

The other day I was participating in a webinar presented by the Domestic Violence and Mental Health Policy Initiative and was encouraged to contemplate on the use of “reflective practice” in our work with people who have been affected by trauma. This appears to be a vital component in providing trauma informed services. In this blog post I am going to talk about how we can apply reflective practice to our daily work, how it may help us increase our effectiveness as advocates and how it may also help ease some of the effects of vicarious trauma. I will be applying information from the webinar and from a presentation by Michael Morgan, Ph.D., LMFT of the University of Wyoming called Transforming Counselor Education Through Reflective Practice given at the ACES Annual conference in October 2009.


What is reflective practice?

Reflective practice is a way of being that values and enacts ongoing personal awareness of the advocate to the tenor and quality of the interpersonal encounter, while also holding in mind the history and contributions of the other person. According to Michael Morgan this includes a “moment to moment non-judgmental awareness and the ability to reflect on one’s own and the other’s mental states and have the ability to look inward while also looking outward.”

By being mindfully reflective we take a step back from a situation and consider as much as we can before taking further action. This would include being aware of our own and the other’s relationship patterns, life experiences and unmet needs, cultural norms and personal values, coping skills, and preferred way of being. We may not be aware of all that the other person is managing in a particular moment, but, as advocates, we are aware that most, if not all, of the survivors we are working with are dealing with the effects of trauma in their lives. How they are managing these effects are determined by their life history, cultural background, current health and living situation, their stage of development, and current supports.

“How you are is as important as what you do.” Dr. Jeree Pawl

Advocates want to be helpful and empowering in the work that we do. Reflective practice emphasizes the “being” of our work. Being helpful depends, in part, on our awareness and regulation of our own processes as well as our being able to perceive what is happening in the mind of another.

Example: Heather is an advocate who has been working with a survivor, Mary, and preparing her for a protective order hearing. Mary has been focused on being able to retain custody of her children and her place of residence. She appears to be disorganized at times. A day before the hearing Mary admits that she has been involved with the local DCYF (a referral was not made by them) and is currently under investigation for neglect due to Mary’s drug use. Mary admits to occasional drug use.

Through reflective practice, Heather is able to be mindful of her own beliefs and attitudes regarding substance abuse and is able to recognize what about Mary’s drug use may trigger Heather’s own issues. The advocate is also able to recognize that Mary’s withholding of this information may be due to her trauma history (told not to tell family secrets), her fear of losing the advocate’s help (has been abandoned in the past by caretakers) and her fear of losing her children. Heather uses reflective practice to be able understand her role in the relationship as the advocate and is able to put aside feelings of frustration due to Mary’s withholding of important information. Heather is able to not take the issue personally and maintain a good relationship. By being nonjudgmental and able to reflect on her own attitudes and beliefs, Heather is able to help Mary with the immediate crisis and eventually be available to work with Mary in regards to finding help for her substance abuse issues.


“Do unto others as you would have them do unto others.”

It is vital to reflective practice that it be incorporated into the culture of the programs in which we work. When supervisors and agency directors provide a safe place and relationships that promote safety, respect and the ability to be vulnerable then advocates are  free to do the same for shelter guests and clients. Being given the time and space to engage in reflection can decrease the effects of vicarious trauma and promote an atmosphere of empowerment that then encompasses the survivors with whom we work.

A reflective culture in our programs can be done as follows:

Ongoing awareness work (values, experience, patterns, preferences)

• Along: mindfulness practices, journaling, holistic wellness, body scan

• With others: personal counseling, reflective supervision



In reflecting upon on our work with others the following questions may be helpful:

How do you feel related to the other (likes, dislikes)?

When have you felt/responded similarly? Who do they remind you of? What personal experiences come to mind?

What do you bring to your work with this client (currently, historically)? How can this be an asset or liability?

What does it feel like to be in this person’s body? What is meaningful to this person? Why?

What does she need?

We have a baseline of understanding based on our knowledge of trauma and how that affects a person behaviorally and cognitively By applying reflective practice to our work we are more able to act rather be reactionary.

In closing, remember that no matter how difficult it is to work with a survivor, it is more difficult to be them. Through reflective practice we will be able to be more mindful and be able to engage in healing relationships.

Monday, March 8, 2010

Book Review - Violent Partners by Linda G. Mills, J.D., PhD.,

Linda Mills’ biography states that she is a lawyer and social worker and the founder of the Center on Violence and Recovery at New York University. She admits that she grew up in privileged, attending Beverly Hills High School in California.


In order to establish her expertise in the area of interpersonal violence, Linda Mills tells her tales of intimate partner violence in high school and college. She considers her family’s “high tolerance” for her maternal grandfather’s verbal abuse as part of the reason she stayed in one of her relationships past the point she feels she would have otherwise.


In Violent Partners, Linda Mills is very critical of the domestic violence movement and states specifically that in her experience and in the experience of others that domestic violence advocates see their primary goal as convincing the victim (most likely a woman) to leave her abuser. She relates the history of the domestic violence movement and a few case histories in order to make her point that the domestic violence movement is not meeting the needs of the partners in intimate partner violence. Indeed, she explicitly works to make the case that both the abuser and the victim are active participants in the ongoing abuse and by not addressing the needs of the abuser and encouraging the victim to leave the domestic violence movement has failed in its endeavors to end intimate partner violence.

Dr. Mills also relates a number of cases and research in order to support her premise that women are just as violent as men. One case history is about Brenda Aris, a woman who killed her husband after fifteen years of abuse. Dr. Mills states that the fact that Mrs. Aris appeared to premeditate the murder of her husband (she was at a neighbor’s home, saw the gun, stole it and then shot her husband multiple times after a period of intense abuse on his part) is sufficient evidence to show that Mrs. Aris was as much of an abuser as her husband. Dr. Mills does not speak to the trauma of the victim or its effects on the children. She goes on to speak about the daughter of Brenda Aris and her violent behavior as an adult as another indicator of the violence of women.

Dr. Mills cites extensive research done my Murray Strauss, an UNH researcher known for his tendency to use data without context to further the belief that women are just as violent as men. She also states (pg. 33) “As anyone who regularly watches the reality show Cops can tell you, the police often arrive on the scene to discover a drunk and mutually combative couple yelling at each other, shoving each other, and hotly declaring that the other person started it.” She also cites the increase in arrests of women since mandatory or preferred arrest policies have been adopted as further proof that women are just as violent as men.

In her chapter, The New Grassroots Movement, Linda Mills appears to promote the work of SAFE (Stop Abuse for Everyone), founded by Jade Rubic to serve “those who typically fall between the cracks of domestic violence services: straight men, gays and lesbians, teens, and the elderly”; SAFE New Hampshire founded by Lee Newman who specifically states he feels like “a watchdog” to ensure that domestic violence advocates in New Hampshire are doing their job; and Violence Anonymous, a program that uses the 12 Step model of Alcoholics Anonymous, and encourages the attendance of couples.


Dr. Mills also encourages couples counseling (long considered risky for survivors by the domestic violence movement) and other group programs including peacemaking and healing circles for anyone involved in a violence relationship.

Linda Mills denies that she blames the victims, but states the following (pg. 204) “the problem is: that batters as adults were usually victims as children, we teach men to become abusive – they aren’t born that way; and that all of us, men and women, are responsible for making people violent. I also started to recognize that many of us were far more complicit that we realized in contributing somehow to a violent dynamic – that mothers and wives, as often as fathers and husbands, could do an enormous amount to reduce violence if we were willing to understand how we all played a role in it.”

Amidst her criticism of the domestic violence movement, her promotion of alternative “new grassroots movements” and her own healing/peacemaking circles, Linda Mills does an injustice to the many victims who have been empowered and led to the road of recovery by the advocates in domestic violence programs throughout the country. She does not appear to encourage dialogue with the domestic violence programs and she is strongly supported by many of the father and men’s rights groups throughout the country.

There may be a place for the type of information she is providing but she appears to be making broad generalizations based on one-sided (and sometimes shoddy anecdotal i.e. Cops) research in order to justify the abuse that occurred in her own life. It is concerning that she is receiving so much press and media coverage (she has appeared on Oprah and the O’Reilly Factor) without representation by the domestic violence movement.

Monday, March 1, 2010

Creating Emotional Safety for Trauma Survivors with Mental Health Issues

One of the most frequently asked questions I receive when providing training on trauma informed services for survivors of domestic and sexual violence is “What can we do as advocates to help people feel safe?”

The National Center on Domestic Violence, Trauma and Mental Health (see Valuable Links to the left) has provided some excellent information on creating a sense of safety for trauma survivors with mental health issues that I have paraphrased and combined with a few tips of my own to assist advocates. At the end of this post I will be providing more information about an upcoming training provided by the NCDVTMH.

What is emotional safety?

Emotional safety has been defined as “a feeling that your inner most thoughts, feelings and experiences are, and will be, honored as one honors themselves. You need not prove, nor impress; you just simply are. When it is present you feel open, even at ease, and fluid with the spontaneity of a healthy child.”

“The environment we create communicates our beliefs about the people we serve. When DV programs work to increase access for women with psychiatric disabilities or who experience the mental health effects of trauma, the way we offer services and the environment that we create can have a great impact.”

Validation

One of the most important things that we can provide to a survivor is validation of her experience. By providing information about trauma, triggers and trauma responses we may be able to create a sense of safety. A lot of childhood trauma survivors have been told that they were not hurt, were crazy, needed to get over it, caused it, or made it up. To have someone communicate to them that they have been hurt and are dealing with the effects of the trauma can be a first step in the healing process.

“Many people who have gone through such frightening experiences have trouble turning their minds away from what happened. It makes sense that you would feel jumpy and preoccupied, that you might still be trying to work on making things turn out better.”

“Sharing what we know about trauma, about triggers and about how people respond to trauma increases the sense of control and autonomy that survivors in our programs may feel.”

Creating a welcoming environment

The arrangement of the physical environment in both the shelter and the crisis center can have a calming or disrupting effect on the survivor. A lot of clutter or activity can increase anxiety and make it very difficult for the person to focus. By having areas which accommodate a variety of feelings, interactions and behaviors we can make our programs more accessible.

“We have different kinds of spaces here in the shelter – a room where people can sit quietly to collect their thoughts, safe spaces outside to work off some energy, and materials for people who want to draw or paint to express themselves.”

Providing choices within the environment can also assist in establishing a sense of safety. When meeting with someone in the crisis center, court waiting room, or a public place a sense of safety can be provided by merely providing the person with a choice of where to sit. Some survivors find it very important to sit where they can see any entrances, others are more concerned about their personal space and do not want to sit too close to other people, and some may want to sit where they can’t be seen by anyone coming through the doorway.

In a shelter these choices may be limited at times, but if you are able to reduce restrictions and rules and increase personal choice a survivor may respond in a positive way and be able to continue to make empowering choices. Some choices may be as simple as which bed they want to sleep in to how they choose to contribute to work with others to make a safe and caring environment. This can be difficult when shelters have guests who have experienced a lot of complex trauma. Staff sometimes may fall into the pitfall of trying to control rather than support. It is also staff’s responsibility to model ethical communication and communicate with each other regularly so that shelter guests know that they are being supported by all staff.

Note: Please see the Washington State Coalition website to the left for more information in their resources section on how to move from the use of rules to an empowerment based model of rights and responsibilities.

It is also important to give survivors as much information as possible so that may feel more in control. There is a fine line, however, between enough information and information overload. Try to provide information both verbally and in written form. Know that you may have to repeat yourself as the trauma may affect how a person processes information.

  • “Make sure you say your name, perhaps writing it down in case she has trouble remembering it.
  • Speak clearly – your normal way of speaking may sound like an ‘accent’ to someone else, even though you sound completely normal to yourself.
  • Be sure to check back with her. Some people may be embarrassed to admit that they don’t understand all that you have said. Saying something like ‘I hope I said that clearly. Was there anything I said that didn’t quite make sense?’ can ease that embarrassment. It shows that you understand that it is the advocates’ responsibility to offer support and information in ways that survivors can use.
  • Avoid secrets and surprises. Being transparent about our work means telling people what we are going to do, letting them know who makes decisions and how our program operates. By staying on track as advocates we continue to use the skills, caring and commitment that we offer to any survivor, whatever the symptoms or struggles of the survivor living with the symptoms of trauma and/or mental illness. It is easier for advocates to do this when they (and their supervisors) are clear in understanding that the survivor’s response is not personal.”
To better meet the needs of survivors with mental health issues, it is important to assist them in reaching out to local mental health programs and peer support providers. Collaborative efforts can increase a sense of safety for the survivors when they realize that DV/SA programs and mental health providers are knowledgeable of each other’s services and ensure that none of us are trying to do everything.

On June 24, 2010 in Nashua, NH and on June 25, 2010 in Meredith, NH, Carole Warshaw and Terri Pease from the NCDVTMH will be providing trainings to mental health providers on meeting the needs of survivors with mental health issues. This conference is open to all mental health therapists, clinicians, and psychologists working with domestic violence survivors. Domestic violence advocates will be present all or part of the day in order to participate in discussions regarding enhancing community collaboration. The conference is free and includes lunch and CEUs. For more information please contact me at linda@nhcadsv.org