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