Real Stories of Attachment from This American Life

I was listening to a podcast of This American Life called Unconditional Love this weekend and thought these stories might be of interest to those of you who are interested in attachment theory. The prologue of the episode talks about the history of attachment theory. Act one, Love is a Battlefield, tells the story of a couple and the son they adopted from a Romanian orphanage.  Act two, Hit Me With Your Best Shot, is about a family with an autistic child.  Both stories are very compelling.

The Neuroanatomical Transformation of the Teenage Brain: Jill Bolte Taylor

I love checking out other people's brain talks.  Jill Bolte Taylor, author of My Stroke of Insight, gave this talk on the development of the adolescent brain as a TED talk.  I think it is the best brain talk I have heard to date.  It describes what is happening in the developing brain, why teenagers are the way they are and the hope for us all if they tend their brains well and if we don't kill them before they are 25.

Book Review – Restoring Hope and Trust, An Illustrated Guide to Mastering Trauma by Lisa Lewis, Ph.D., et.al.

I ordered Restoring Hope and Trust after an advocate asked me if I had heard of it and wanted to know what I thought.  I am very grateful that she did.  I am often asked if I know of a good book about trauma that would be helpful to survivors.  This may be the one.  Other books are either too technical or clinical.  Restoring Hope and Trust is only 130 pages but is still full of information about the impact of trauma and how to manage its effects. 

Each chapter beings with a mindfulness exercise and then moves into discussions about the many ways trauma impacts a survivor’s life including the physiological and emotional.  The authors pull the best information from many experts in the trauma field including Judith Herman.  The explanations include illustrations and examples of people’s experiences.  At the end of each chapter are self-study questions for journaling. 

What I found the most helpful was how empowering and supportive the authors are in their descriptions of the cycles of behaviors and emotions that survivors often find themselves involved.  The book also includes chapters on compassion fatigue and the treatment of trauma. 

Restoring Hope and Trust is published by the Sidran Institute, an advocacy and education program specifically for survivors of trauma and people who work with them.  The book can be found here  

Some Brain/DNA Geek Info That Shows How Our Grandparents' Trauma May Affect Us

I have been reading about epigenetics lately and then came across some great videos.Rather than trying to define it,  I thought I would share the following for those of you who may get as excited about this kind of thing as I do.   Epigenetics helps us understand how the effects of trauma can be transmitted from one generation to another.  It may cause a sense of hopelessness to realize that our DNA is impacted by the experiences of our ancestors and that our experiences impact our children and grandchildren, but if you read through the article Grandma's Experiences Leave Epigenetic Mark on Your Genes | DiscoverMagazine.com, you will see that there is still a strong case to be made for the power of strong attachment and caregiving.

The video, The Ghost in Your Genes, is a PBS Nova presentation of about 50 minutes from 2007 that can be viewed in its entirety on the ACES Connection website.  About half way through it starts to discuss how trauma impacts our genes.

And then we have this somewhat amusing but fast moving video below that gives a brief overview of what epigenetics is.

Advice About What Good Trauma Therapy Can Do

As a way of introducing you to the ACES Too High website I am encouraging you to read this post by Laura K. Kerr PhD. on what beginnings and endings in trauma therapy should look like and the importance of acceptance.  After you read it, take a look around at the rest of the website.  There is a lot of great information.  Just click on the title and it will take you there.

Take that leap of faith: advice about beginnings, endings in trauma therapy

Basic Assumptions for Working with Traumatized Family Members with Attachment Problems

Last week I attended the New Hampshire Infant Mental Health Conference.  The primary focus of the conference was evaluating for and treating trauma in children.  Cassie Yackley, Psy.D. of the Dartmouth Trauma Intervention Research Center adapted and presented the following from Dan Hughes’ Basic Assumptions for Parenting and Treating Traumatized, Attachment-Resistant Children.  I thought it would be valuable to post here.

Whenever you are working with a parent or child who has suffered trauma remember:

1.      They are doing the best they can.

2.      They want to improve.

3.      Their life, as it is not, is “a living hell.”

4.      They try to be safe by controlling everything in their environment.

5.      They try to be safe by avoiding everything that is stressful and painful.

6.      Their “attacks” reflect a fear of your motives for the nurturing and support you provide.

7.      Poor affect regulation, fragment thinking, a pervasive sense of shame, inability to trust, and lack of behavioral controls inhibit them from being able to have the relationships they desire.

8.      For them to change, they will need you to accept, comfort, and teach them.

9.      You will need to validate their sense of self (and family) while teaching them important developmental skills.

10.  You will need to understand their developmental stage and adjust your expectations to match so that they will have success, not failure.  Your physical and psychological presence are the foundation of your comforting and teaching them.

11.  Under stressful emotional conditions, they will regress and revert to basic, solitary defenses that they have used to survive.

12.  They will have to work hard to learn how to live well.  You cannot do the work for them, nor can you save them. You can comfort and teach them.

13.  You will need support and consultation from trusted others if you are to be able to successfully comfort and teach them.  You will make mistakes and will need to face these, learn from them, and continue.

Trauma and Self Harm – When Hurting Helps the Pain

As domestic violence and sexual assault advocates we often come into contact with situations that we don’t feel equipped to handle.  Even though we understand the dynamics of power and control and receive training and education on providing empowering services that allow for the victims/survivors to make their own choices, we are often taken aback and feel powerless when we meet someone who has scars from injuries that were self-inflicted.  Unless we understand the underlying motivations behind self-harm we are at risk of over-reacting by assuming the injury is a part of a suicidal gesture or we under react by ignoring the evidence of internal pain.

According to Solomon and Farrand (1996) “the assumption is that the alternative to self-injury is ‘acting normally,’ but on the contrary . . .  the alternative to self-injury is total loss of control and possible suicide.  It becomes a forced choice from among limited options.”  In other words, when a person engages in self-injury she/he may be doing so in order to relieve the pain and anxiety and reduce the feelings of wanting to commit suicide.  “A basic understanding is that a person who truly attempts suicide seeks to end all feelings whereas a person who self-mutilates seeks to feel better (Favazza, 1998).”

Another misconception regarding persons who self-injure is that they are “attention seeking.”  Most people who self-harm are trauma survivors and experiencing extreme internal pain and ongoing activation of the flight-fight-freeze response (see my BrainTalk).  Throughout their lives they may not have had this internal pain validated.  In fact, many survivors have been accused of lying and manipulating by those people and systems that were supposed to help them.  When this type of pain is not recognized, an external expression of pain may feel necessary in order to have others see some sort of manifestation of what is happening internally.

According to Bessel Van der Kolk, “neglect [was] the most powerful predictor of self-destructive behavior.  This implies that although childhood trauma contributes heavily to the initiation of self-destructive behavior, lack of secure attachments maintains it.  Those… who could not remember feeling special or loved by anyone as children were least able to control their self-destructive behavior.”  This neglect leads to a person feeling that there are not of value and not worthy of any care or support.

People who self-injure do so in order to feel something or to not feel so much.  If a person is dissociating (feeling disconnected from self or surroundings) she/he may self-injure in order to be able to feel something and be able to feel grounded within the body again.  Some people may be feeling so much, the emotions are so activated, that the self-injuring may be a way to calm down and possibly reach a state where the feelings are less intense,

The following are some guidelines for responding to someone’s self-injuring:

Show that you see and care about the person in pain beyond the injury. 

Show concern for the injury, address safety (is the cut deep, has the person cleaned or treated the injury, etc.) and then move to validating the pain the person must be in to have done the injury. 

Make it clear that it is okay to talk about self-injury and convey your respect for the person’s efforts to survive.  She was doing the best that she could.

Help the person make sense of the self-injury.  When did it start?  What was happening then?  Explore how self-injury has helped the person survive in the past. 

Encourage the person to find safe ways to deal with buried feelings and seek support in order to care for herself.

Acknowledge that is frightening to think about living without self-injury and that reducing how often it occurs can be the first step.  She may need to learn there are other things that work before she can make different choices.

It is important mostly to remember that by validating the pain beneath the injury we are letting the person know that they are of value and recognized as a survivor.

How Children Succeed - Grit, Curiosity, and the Hidden Power of Character by Paul Tough

If you read nothing else but the first chapter of this book, you will have a greater understanding why some kids have such a hard time making it through life.  By discussing childhood trauma through the lens of the ACE Childhood studies and an understanding of how stress impacts learning, Paul Tough makes a strong case for increased focus on building attachment relationships and self-regulation/control in the early years, rather than tests scores.  Learning cannot occur when the child is focused on survival in a world of poverty and violence, but needs to feel safe and believe in a future.
I have to admit that I was not as enamored of the rest of the book as I was that first chapter, but I encourage you to read that first chapter thoroughly and then scan the rest of the book for what may draw your attention.
You can also read more about the book and Paul Tough via this link at NPR or this review at Kirkus.

The Importance of Play in a Child’s Recovery from Trauma

In thinking about the needs of children who have been traumatized, it is important to have a good understanding about how play contributes to healing and resilience.  The following excerpt is from www.lifeisgood.com/playmakers Playmakers, a program in Boston, MA that has worked with Hurricane Katrina survivors by engaging children in transformative, trauma-informed play.

Play is the way in which children form loving, trusting relationships. And the quality of a child’s life (or anyone’s life for that matter) is in direct proportion to the quality of their relationships.

When children are actively engaged, they play with passion and gusto, are curious and inquisitive, move freely and comfortably, and extend this passion and curiosity to many different kinds of activities. Active engagement is the key building block for creativity - when we are actively engaged, our minds are primed and ready for exploration and creation.

INTERNAL CONTROL = Feelings of safety, worth, and competence that support our ability to engage and challenge ourselves.

Using rats as his subjects, Jaak Panskepp found that young rats stop playing the moment a threat is introduced in their environment. Even once the threat is removed, the rats do not return to their pre-threat levels of playfulness. All young mammals, including children, cannot fully engage in play if their basic safety needs are not met. However, once children feel safe, they can develop a sense of freedom and empowerment, enabling them to gain control over their own involvement in an activity and to handle the ups and downs of their emotions. Developing a sense of control, children begin to believe that they can influence their world and meet challenges with success. When children are internally controlled, they have an “I can do it attitude,” they continue trying to meet a challenge even when they feel frustrated, they take initiative when playing with others, and they can switch to different roles comfortably (e.g., from leader to follower). Through feeling safe, competent and empowered, children develop an inner peace that sustains them through life’s challenges.

Play that provides children with opportunities for engagement, empowerment, connection, and joy has the potential to serve as a transformational experience, changing the way a child’s brain, body and spirit develop.

When children are fully and freely engaged in play, they learn new things, develop key social and emotional skills, feel part of a community and take on new challenges. Engaged in transformative play, children build healing relationships with the key people in their lives. This type of play enables children to build resilience in the face of life’s greatest challenges. Denying children access to transformative play experiences does them a great disservice. This is particularly true for children who have been exposed to trauma. Unfortunately, we know that fear destroys playfulness. According to a 1998 study conducted by the US Centers for Disease Control and Prevention, millions of our nation’s children have experienced profound trauma, such as community violence, abuse, neglect, natural disasters, and extreme poverty. Trauma can cripple the development of young children, lead to negative long-term health consequences, and shorten life expectancy. Long-term stress such as community violence, conflict at home, and inadequate resources can undo a child’s sense of safety in the same way that natural disasters (e.g., hurricanes) and manmade disasters (e.g., war) can. And children need to feel safe to play.

Fortunately, children have an incredible ability to bounce back when they receive the support they need from the adults around them.

Empowering, joyful play with sensitive, caring adults can help to restore what trauma violently strips from a child.

If schools, hospitals, and social service agencies put playful engagement on the back burner, children, particularly those suffering from the impact of poverty and trauma, will miss out on essential opportunities to engage in transformative play and build the resilience they need to meet life’s challenges.

In addition to providing opportunities and areas for children to play, it is important for adults to engage with children in meaningful ways to promote competency and resiliency.  The following is from The Urban Child Institute.

·         Respond: Responding to children’s distress and creating an environment of care and support helps children to develop their ability to calm themselves down as they grow older.

·         Create a sense of safety: Children thrive in environments where they know they are safe and supported to explore and learn.

·         Encourage resilience: As much as we would like to protect our children from any hurt they might face, there are benefits to a skinned knee. Learning to overcome mild disappointments and difficulties early in life lays the foundation for being able to overcome greater challenges later. Feeling connected to others, developing self-confidence, experiencing success and helping others overcome challenges are all aspects of resilience.

·         Help others together: Helping others is a good way for children to feel connected to others and builds their self esteem. Helping others as a family is a good way to help children learn and express responsibility and learn that they can make a difference.

·         Grow positive behaviors: Children do better when they have the structure of clear and consistent expectations where they can learn how they are supposed to act. Child behavior experts tell us that positive responses to a behavior from supportive adults will increase the likelihood that the child will repeat that behavior. Catching your child being good by commenting on things they do that you like will help them increase positive behaviors and learn that certain behaviors are valued over others.

·         Help your child find something they do well: It is important for children to know that their actions can lead to good outcomes. Providing them with opportunities to explore different activities. Also providing your children time with other children their age can help them learn that they can make friends and build a support system.

·         Accentuate the positive: Young children tend to personalize the information they get from their caregivers, so it is important to accentuate the positive you see in your child. Every correction or negative comment should be matched throughout the day by five positive comments or encouraging statements.   

Just Some of What I Learned at the Trauma Center Summer Institute

I just got back from the Trauma Center Summer Institute that takes place in Cape Cod every July.  I highly recommend if for anyone who is doing trauma-informed services or treatment.  The faculty from the TraumaCenter at Justice Resource Institute was excellent. 

I will probably incorporate what I learned into some more detailed posts in the future but just wanted to pass on a few snippets of things that I learned or re-learned while there. 

The majority of the impact from childhood trauma is delayed –

When physical or emotional abuse occurs in childhood, the effects of this abuse may take years to show up.  If the abuse occurs during early childhood the effects may not be seen until adolescence.  Trauma that occurs in early childhood and adolescence has a greater impact than if it occurs during the latency period between 6 and 12 years of age.  This is because there is more growth occurring in the brain during these two period of development and therefore the brain is more vulnerable to trauma.

Trauma that occurs during the pre-verbal period of development (ages 0-2) can be recalled and described once language or other means of communication is available – During the week I took part in a sand tray therapy workshop and the facilitator described at least two incidents and showed pictures of the trays in which a 3 or 4 year old was able to recreate a traumatic event in the sand tray that took place when the child was less than one year old.  This does not mean that a sand tray should be used as a way of forcing the child to tell their story.  The story comes out in the natural process of using the sand tray.

Vicarious Trauma is an STD!!!  STD = Sensitivity Transmitted Disease. Basically, if we don’t “care”, we don’t catch it.  However, like a sexually transmitted disease it is:

-      Easy to catch

-      Painful

-      Shameful

-      Hard to get rid of

-      Tends to keep coming back

-      Leads to justified ambivalence about continuing to engage in being sensitive

 How can we be sure to never catch an STD?  Abstinence – live on a mountain top in the Himalayas, quit our jobs, disconnect from the media, minimal contact with the world.  

Traumatic stress is a virus – contagious, can lay dormant, and we can build immunity to it.  It is transmitted physically, through our auditory senses, emotionally and cognitively.  If we don’t build up our immune system through good self care, we can catch vicarious trauma and then spread it to others with whom we are working.  It can become an epidemic and eventually a pandemic – infecting the whole agency.

Polyvagal Theory explains the freeze response. Click here for more information. 

This is just a sample of what I learned!!

Respond to the Emotions Beneath the Behaviors

I recently completed a webinar presented by the Florida Council Against Sexual Violence called  Trauma Informed Care for Foster and Adoptive Parents of Sexually Abused Children. The training was produced by Laurens Kids, Inc. and Florida Council Against Sexual Violence for the State of Florida, Department of Children and Families, Office of Child Welfare.  You can find the 3-hour webinar here .

There were three things that stood out for me in the webinar. 

First of all, it included a 20 minute video by the National Child Traumatic Stress Network called The Promise (of Trauma Informed Care).  This video outlines the three major components of providing trauma informed treatment for children who have been sexually assaulted:  parental involvement, coping skills and the traumatic narrative.  The video made the point that putting a child into counseling alone without the parent(s) being included can make the child feel as if there is something wrong with him/her and that the family somehow blames him.  Coping skills should be taught within the sessions which can then be reinforced and used by the parents at home.  Through the combination of parental support and coping skills, the child will then be able to unravel the traumatic narrative, be able to tell the story of the assault in small stages and receive valuable feedback that the assault was not her fault.

Secondly, I was moved by the focus on teaching the parent rather than changing the child.  When the focus is on teaching the parent to engage with the child in a positive, strength based and supportive approach the relationship between parent and child will eventually change, resulting in changes in the child’s behavior.  Often parents (and some teachers) feel that the focus needs to be on the child’s behavior.  Children cannot regulate their emotions without support and care from the adults in their lives.  I encourage you to check out the Circle of Security program for more information on how focusing on the parents’ responses to the child impacts the parent/child relationship leading to a more emotionally regulated child.

Finally, when I heard this statement I wrote it down and have been thinking about it ever since, “respond to the emotions beneath the behavior.”

The webinar had a panel of foster parents discussing some of the behaviors that were present in the children they were fostering or adopting.  They had been watching a role play of a teenager who had stayed out past curfew and was being confronted by her foster mother.  In the first role play, the mother was angry and the teen became defensive.  In the second role play, the mother focused on the feelings of fear of abandonment the teen was feeling and was able to join with the teen in trying to work through the problems that they were facing together.  The foster parents who viewed the video were struck by how focusing on the teen’s underlying emotions changed the energy of the conversation.

I think that as advocates we can also remember this statement when we are working with adults.  Often we have our own internal responses to the behaviors of people with whom we are working, but when we seek to understand the underlying emotions and take the focus off of the behaviors (which may just be skills they are using to manage their trauma response) we may be able to start a new healthier and more productive relationship.  It takes practice and an ability to be able to calm our own internal responses but it is well worth it in the long run.

How to Tell if a Therapist is Trauma-Informed

The growing knowledge of the effects of trauma on people's lives has increased the need for trauma-informed services.  In addition, a number of treatment models have arisen that address the needs of trauma survivors.  In response to this increased need a number of therapists have started identifying themselves as trauma-informed or providing trauma treatment when they are basing this solely on the fact that they have a number of clients who have identified themselves as trauma survivors.  It is important to be able to sort out which therapist are actually trauma-informed and are knowledgeable in treatment modes that meet the needs of survivors and do not inflict further re-victimization.

The Sidran Institute at http://www.sidran.org/  as excellent information on what to look for in a therapist and the type of questions you should ask a therapist before engaging in therapy.  Clink here to access their web page on What to Look For and How to Choose a Therapist.

The Pennsylvania Coalition Against Rape  has an excellent document on locating a trauma therapist.

For a list of current treatment models click here.

Book Review

Parenting from the Inside Out – How a deeper self-understanding can help you raise children who thrive  by Daniel J. Siegel, M.D., and Mary Hartzell, M.Ed.

Over the years I have heard many parents say to me “I can only give what I got” as a response to questions about their parenting.  They were stating that the parenting they received as children impacted their parenting as adults and they were not able to do any better as a result.  This is only half true. 

In Dr. Dan Siegel and Mary Hartzell’s book, Parenting from the Inside Out, the reader is given an understanding of how our childhoods impact how we parent and what we can do to change some of those patterns in order to enhance and repair our relationships with our children and increase their resiliency.

The book is laid out in a way that is easily accessible.  There is information on brain science that is presented in terms that are understandable but is also as an addendum to each chapter so that it can be scanned over and reviewed later.  There are also exercises/questions for parents to use to go deeper in examining old patterns and making changes.

Dr. Siegel http://drdansiegel.com/about/biography/ is a clinical psychiatrist at the UCLA School of Medicine and has a done a number of TED talks on neurobiology that are easy to grasp for those of us who are not scientists.  Mary Hartzell is a child development specialist and parent educator http://maryhartzell.com/Welcome.html  Together they bring together an understanding of attachment theory, compassion and mindsight in a way that is non-blaming and empowering for parents who truly want to raise children who thrive.

ACES TOO HIGH

This excellent blog was brought to my attention.  It discusses Adverse Childhood Experiences (ACES) and how to reduce them.  

ACES TOO HIGH

Self-Reflection Puts Trauma Informed Advocacy First

In order to fully embed trauma-informed services philosophy at member domestic violence and sexual assault programs here in New Hampshire we formed a cohort of advocates representing eight different programs who share their experiences and knowledge about building trauma-informed programs and using the principles when working with survivors.  This is the first in a series (I hope) of posts written by members of the cohort.  Thank you, Tina E.!

Self-Reflection Puts Trauma Informed Advocacy First

As a shelter manager for a domestic violence agency, I recently had a very difficult experience turn into a learning opportunity for clients, an intern, as well as for me.  As we know, working on such an intimate level with women in crisis can be challenging, painful, and even rewarding, but ultimately it tests our ability to practice what we preach, trauma informed advocacy.

A recent change in our household dynamics shifted our shelter from a fairly peaceful environment of two families supporting each other, both far along in their journey of establishing safety and independence, to a contentious and somewhat unsafe situation.  A new resident arrived with her children and began confronting others in an aggressive manner and discussing inappropriate topics with teens in the house.  This was upsetting and definitively a trigger to our current residents.  Her mannerisms and demeanor were offsetting even to staff, putting us in a place of carefully promoting discussions of safety and healthy conflict resolution while tempering feelings of distrust or frustration. 

In our house meetings a conscious effort was made to encourage the more intimidated client to share her concerns and requests regarding her children.  We discussed the type of households families may come from and the fear and domination victims face when wanting to be heard, but emphasized that this was a safe opportunity to build positive communication skills.  Although the one resident was able to show a marked change in her ability to display healthy boundaries for herself, the newer resident appeared impassive, somewhat arrogant and claimed no responsibility for any of the actions described by the other residents.  Despite the lack of resolution, it provided a format for practicing appropriate assertiveness for clients and even a chance for staff to role-model this when the client pointedly confronted staff.

The teachable moment came at a subsequent house meeting, at which I will own my mindset with regards to our residents.  I was impressed with the client who was speaking up for herself and was concerned the aggressive resident was displaying power and control behaviors.  Honestly, I felt protective of the one client and expected more negativity from the other.  Although I truly believe I remained professional, I know that this preconceived notion did not take into consideration the “whys” for the behaviors in the first place.  During this next meeting I recognized an increased confidence in the client standing up for herself, but noticed that the tone of the meeting had become accusatory.  With five adults in the meeting and the power in the room shifting, I carefully looked at things from our new resident’s perspective and wondered if I was at all being led by any biases.  After one resident became more vocal, displaying her frustration, I took the opportunity to ask everyone to consider some things.   I requested first that rather than taking someone else’s behavior personally, we assume that the actions are not intended to be hurtful.  Secondly, we can recognize that our new resident came into an already established household.  Most importantly, I stressed that we really knew nothing about her story, her fears, her concerns and where she was in that moment of her journey.  We ended up discussing how coping mechanisms to trauma may include having control over her own life in whatever way a victim can and one person’s survival skills may look very different than another’s.

This conversation opened up some amazing dialogue and the fact that our residents found some common ground was a positive moment for all.  However, I know the most fundamental aspect of this was truly modeling the trauma informed perspective.  My acknowledgement that no matter how compassionate I believe I am, putting aside my presumptions to see each client as an individual victim of trauma is the key to the best practice of advocacy and that there is always room to grow.

                                                

Transforming Early Life Trauma by Christine Claire Reed

Please click on the link below and take time to read this excellent blog on how creative arts has helped a trauma survivor.  The more that we can offer our survivors as means of managing the effects, the more empowered they will feel.

Transforming Early Life Trauma

Taking a Different View - Trauma-Informed Services

Working with survivors of domestic violence can sometimes be challenging.  At times it seems as if they are working against us and sabotaging our efforts to help.  They don’t always fit the ideal description of a victim.  We may expect them to be timid, dis-empowered, fearful, and willing to accept any help we offer them to feel safe.  When they don’t respond to us in the way that we would like we may even feel manipulated, attacked, used, or we may even begin to doubt their stories or label their actions as symptoms of a mental illness.

When working with survivors of domestic or sexual assault who are challenging it is very important that we stand back and take a different point of view.  Instead of talking about a person’s behaviors or symptoms that are getting in the way of her being able to move forward, it is more helpful to ask “how are the effects of trauma impacting her ability to make changes, engage in services and move forward and how can we help to alleviate effects?”  In addition, it is helpful to ask ourselves what we are doing that may be re-victimizing or increasing the impact of trauma triggers.  This is the goal of being a trauma-informed organization.

One definition of trauma-informed services is:

When a program is trauma-informed, every part of its organization, management and service delivery system is assessed and potentially modified to include a basic understanding of how trauma impacts the life of an individual who is seeking services.  Trauma-informed organizations are based on an understanding of the vulnerabilities or triggers of trauma survivors that traditional service delivery approaches may exacerbate, so that their services and programs can be more supportive and avoid re-traumatization.

In able to provide trauma-informed services, advocates may sometimes need to take a breath and recognize their own trauma responses in order to be able to respond in a trauma informed way.  By thoughtfully working with someone to recognize when she has become activated emotionally and then assisting her in reducing her responses we are of more value as an advocate than if we become resistant or activated in return. 

This may be particularly challenging in working with shelter guests.  A guest can feel powerless in the face of living in a strange place with people she doesn’t know and feeling controlled by staff or other systems.  This will increase trauma responses and a domino effect may occur among the shelter guests, one or more guests’ actions creating a possible activating situation.  Ongoing discussion amongst staff and guests about the effects of trauma and regular activities to relieve stress are vital in being able to help everyone feel emotionally safe.

It can also be helpful to take time out from looking at the non-productive behaviors (trauma responses) that you may see in a survivor and start to actively seek and point out any positive actions the person may make.  We can often fall into the habit of focusing only on the negative and fail to recognize the efforts and strength it takes for a woman to move forward after years of abuse.  Each time we point out something someone does wrong only validates what she may have heard from an abuser or parent.  We can help change patterns by focusing our efforts on a person’s strengths.

How Childhood Trauma May Make the Brain Vulnerable to Addiction, Depression

Please click on the link below for an interesting article on how the brain is changed by childhood trauma and contributes to addiction and depression.


How Childhood Trauma May Make the Brain Vulnerable to Addiction, Depression

Acknowledging Race-based Trauma

As advocates working with diverse populations, it has become more important to develop an awareness of the additional trauma that survivors may experience due to their ethnic or racial backgrounds.  According to Robert Carter PhD in his 2006 article Race Based Traumatic Stress (http://www.psychiatrictimes.com/display/article/10168/51536), race-based traumatic stress injury can be a consequence of emotional pain that a person may feel after encounters with racism.  These can be understood in terms of specific types of acts such as racial harassment or hostility, racial discrimination or avoidance and/or discriminatory harassment, and aversive hostility. How encounters with racism are experienced depends on many factors associated with an individual's background, health, and cognitive processing. Thus, the person who interprets and appraises his racial encounter as extremely negative (emotionally painful), sudden, and uncontrollable, may exhibit signs and symptoms associated with the stress and possible trauma of racism.

I worked at a shelter program in Norfolk, Virginia for many years and, having grown up in northern Wisconsin, I was admittedly unaware of how generations of racism could affect people of color. I had an encounter with a young woman of color who was bright and doing extremely well in school in spite of being relocated from her home due to domestic violence.  We were having a discussion regarding her possible educational and career options.  I mentioned to her that I thought she could be anything that she wanted to be.  She looked at me with disgust and said “no, I can’t.  I’m black and I’m a girl.”  At twelve years old she had experienced enough sexism and racism for her to develop a limited viewpoint of her options even though her abilities were far above average.  I regret that I don’t know where she is now, but I hope that she found someone to nurture her strengths and resiliency in the face of diversity and that she was able to create dreams in spite of real and perceived limitations. 

There was a woman of color in the shelter around that same time who was about my age and had a son the same age as mine.  I remember thinking one night about our similarities when it suddenly struck me.  Even though we were both women and had teenage sons, our experiences of motherhood were completely different.  Yes, both of our sons were getting into all sorts of trouble and were sometimes engaging in risky behaviors.  However, the consequences for a young black man were much greater than what could possibly happen to my son just because of the differences in the color of their skin.  Her worries were greater and more real than mine. 

I also eventually grew to realize that even though we were both women, I could walk through a shopping mall without being followed by store clerks who were checking to make sure that I wasn’t stealing.  I could apply for a job without worry that my resume would be removed from a pile because my name sounded too ethnic or because I had attended a school that had a high black student population.  I also realized that if I did well or if I did badly, my race would not be considered a factor. 

As white advocates working with women of color it is very important that we be aware of their difference of experience and the effects of insidious and implicit and explicit racism.  In the same way that domestic and sexual assault, childhood abuse, and other forms of violence create a trauma response in the brain, exposure to racism can also create lack of trust, poor self-esteem, hyper-vigilance for fear of further abuse, a sense of despair over one’s future, and a fear of re-victimization.

In the same way that we believe and validate the traumatic experiences of the assaults on survivors, it is important that we validate and believe the experiences of racism and understand the effects this could have on their ability to engage and move forward.  Also, in the same way that we focus on strength, resiliency and empowerment to help victims of gender-based trauma, we can also assist survivors of race-based trauma in finding their great strength and resiliency by acknowledging and honoring their experiences rather than being afraid to address the underlying effects of racism. 

Vicarious Trauma and Advocate Responsibility

Vicarious trauma is real and can lead to poor morale and health in advocates who are regularly exposed to the trauma of others.  The effects of vicarious trauma can mirror the reactions that we see in victims of domestic violence and sexual assault – depression, difficulty planning and making decision, and problems following through with a course of action.  An advocate may become hyper-vigilant and have difficulty sleeping. 

In order to keep on providing good advocacy services, there is a high level of responsibility on the part of the advocate to manage her/his own trauma effects.  Hopefully, an advocate is working as a part of an organization that promotes good self-care but the mission of domestic violence or sexual assault organization cannot be fulfilled if it is spending all of its time managing the trauma of its advocates.  Advocates need to consider self-care a responsibility to themselves, their organizations, and to the victim/survivors who are seeking services.  Given that an advocate is expected to perform his/her duties and provide support as a part of employment, it is imperative that self-care be done pro-actively rather than be used as an excuse not to be available to a victim/survivor.

This is becoming increasingly important as agencies are expected to do more with less.  It is not fair to the agency, co-workers, and victims if an advocate decides that the effects of vicarious trauma are so bad that she cannot provide advocacy for an afternoon or a day.  In the same way that first responders and emergency personnel are expected to work through the stress, advocates may need to find a way to continue to provide support and perform work tasks even while dealing with the effects of trauma.  Yes, we expect our agencies to be trauma informed/responsive and have an understanding of the trauma that advocates experience. However, it is the advocate’s responsibility to create a plan to manage the effects of trauma during both work and off-work hours. 

Supervision can be used to discuss the effects of vicarious trauma and can also be used to determine whether or not an advocate is truly dealing with the effects of VT or is experiencing burnout or compassion fatigue.  It may be a time to explore boundary issues, grapple with organizational skills and managing workload, or re-define success or expectations.

For some people who continue to grapple with the stress of providing advocacy to victims of abuse, it may be necessary to self-reflect on whether this particular choice of occupation is a good fit.  Sometimes it is important to admit that it is time to move on and make other choices rather than continue to work in a job that affects your health and well-being and makes it difficult for you to fulfill the expectations and mission of the organization and the victims who seek help.  This does not mean that one has failed. It just means that there was not a good fit.  There are many jobs which I have not applied for because it would not be a good fit and a few jobs in which I worked that I eventually left because it was not a good fit.  By learning what fit and what didn’t I was able to make better career decisions that fulfilled me and used my talents.  I also know, however, that I am responsible for my own self care.

The following information is from The Headington Institute.  It is an outline for managing vicarious trauma for advocates and managers. 

Make a vicarious action plan

You probably wouldn’t set out to help the people you serve without a plan. Why not give yourself the benefit of that same approach? This exercise can be completed in 15 minutes, or you can spend more time on it. We strongly recommend that you repeat it at least every couple of months.

As you complete the exercise, you might like to refer back to the text of this module. For each question we’ve included links back to the relevant section. You can also follow this link to download a list of all the “Think about” questions in this module. If you have been taking notes in response to these questions, those notes will help you complete this exercise. 

1.     List your important risk factors for vicarious trauma. These are things that get in the way of you helping others. They come from three main areas:

a.     From personal factors (e.g., past and current stress in your life)

b.     From your situation (e.g., work-related factors)

c.     From the cultural context (e.g., discrimination and attitudes of intolerance)

2.     List any signs or symptoms of vicarious trauma that you are experiencing. Think about the following areas:

 .      Physical

a.     Psychological

b.     Behavior and relationships

c.     Worldview or frame of reference (spirituality, identity, and beliefs)

3.     What are things that you can do to cope better with these symptoms? (Hint: Think about how you can counteract your risk factors, and remember that good coping strategies for vicarious trauma are things that help you take care of yourself – especially things that help you escape, rest, and play.) How can you take care of yourself in the following areas:

 .      Physical

a.     Mental and emotional

b.     Behavior and relationships

c.     At work

4.     What steps can you take that can help you transform your vicarious trauma on a deeper level? (Hint: remember that transforming vicarious trauma means identifying ways to nurture a sense of meaning and hope).

 .      Outside work

a.     During work

5.     Pick two things you have listed in response to questions 3 or 4, and think about how you will put those into practice this week. Set two specific, realistic, goals by completing the sentence below (Hint: think about how, when, and where you achieve these goals and put that in your answer too):

This week I will ______________________ to help prevent or manage vicarious trauma. 

6.     What obstacles might get in the way of you doing the two things you identified in item 5, above?

7.     What might you to do overcome the obstacles listed above? What will support you in accomplishing your goals (Hint: think about people who can support you and how they might encourage you.

What managers can do

Are you a manager? Managers can take many steps to help lessen the impact of vicarious trauma on staff they are supervising. Here are some of them.

1.     Understand the psychological and spiritual impact of humanitarian work:

a.     Be alert to how the cumulative exposure to stressful and traumatic situations may be affecting staff.

b.     Regularly check in with staff about how they’re coping – do not wait for them to approach you with a problem.

c.     Support staff in seeking counseling or coaching if and when needed.

2.     Set a good example in the way that you care for yourself, including:

 .      Work at a sustainable and reasonable pace over time, and encourage staff you supervise to do the same;

a.     Openly value things and people outside of work (e.g., time spent with your family);

b.     Take allocated leave time;

c.     Acknowledge that humanitarian work can be challenging and that healthy work/life balance takes practice and intentionality.

3.     Especially during times of increased pressure or crises, look for ways to help staff keep current challenges in perspective by:

 .      Reminding staff of the bigger picture of the organization’s mission and purpose, and how this assignment or disaster response fits into that bigger picture; and

a.     Reminding staff of the value the organization places upon them both as people and the organization’s most important resources. Encourage staff to work in sustainable ways. If that does not appear possible in the short-term, encourage them to take extra time after the immediate impact phase is over to rest and regain equilibrium.

4.     Express concern for the general well-being of your staff and not just the quality of the work they are doing.

5.     Make sure that staff suggestions and feedback about their jobs and the organization are heard and valued – even if you are fairly sure they will not result in tangible change in the near future.

6.     Do not say or do things that would stigmatize staff who are struggling with vicarious trauma or other stress or trauma-related issues.

7.     Strive to stay positive, and to praise and acknowledge effort and results whenever possible.

The Neurobiology of Sexual Assault

Please click on the following for an excellent video on the neurobiology of sexual assault.  It describes in length the concept of "tonic immobility" and the implications for investigation and advocacy.  The U.S. Department of Justice has graciously allowed for the dissemination of this information.  It is the best presentation on trauma that I have seen.

The Neurobiology of Sexual Assault: Implications for First Responders in Law Enforcement, Prosecution, and Victim Advocacy NIJ Research for the Real World Seminar December 2012 Rebecca Campbell, Ph.D., Professor of Psychology, Michigan State University

The NH Coalition Against Domestic Violence gratefully acknowledges the U.S. Department of Justice, Office of Justice Programs, National Institute of Justice, for allowing us to reproduce, in part or in whole, the recording [insert title]. The opinions, findings, and conclusions or recommendations expressed in this recording are those of the speaker(s) and do not necessarily represent the official position or policies of the U.S. Department of Justice.

Insidious Trauma – Why Anti-Oppression and Social Justice Work are Critical for Trauma-Informed Programs

While many of us working in the field of domestic violence and sexual assault address the needs of survivors of interpersonal violence and recognize the impact of oppression on the lives of victims, we may, at times, fail to realize the overlapping impact of the insidious trauma that is experienced by many groups, including women, LGBT, disabled persons, and the elderly.  Psychologist Maria Root (in a number of articles) describes insidious trauma as the impact of living in societies where stigma, discrimination, and violence against women are still very much part of the fabric of their everyday lives.  We can expand this definition to include other marginalized populations and imagine the impact on a survivor with whom we may be working.

Those of us who work in ending violence against women are well versed in understanding oppression and social injustice in regards to women.  Let’s take that same construct and move on to recognize the impact that a person’s race and/or ethnic background has on their life experience and how it sets a person up for insidious trauma.  A person of color or a different ethnicity experiencing interpersonal violence is most likely also experiencing insidious trauma that occurs from the awareness that their race/ethnicity makes them a target just by their being present in the world.  This is increased when the person is isolated in the community, separated from family and cultural supports, and recognizes their own vulnerability.  Given the messages they may be receiving from the media regarding hate crimes or how they are being treated in public, they may be experiencing some traumatic effects due to insidious trauma. 

This also applies to people with different abilities or the elderly.  In a chapter in Laura S. Brown’s book Cultural Competence in Trauma Therapy – Beyond the Flashback, Dr. Brown tells the story of a young woman with a congenital disorder that had required increased amounts of assistance from others.  This young woman developed the belief that most people who were disabled wished they were dead.  She had developed this from hearing stories of people with disabilities who were seeking physician assistant suicide and finding that there was a pervasive attitude among the non-disabled population that people with disabilities were brave to continue living and felt it was understandable that someone would want to commit suicide.  It is easy to imagine that this attitude by mainstream society could affect a person’s image of his/her self as a valuable member of society. This woman was eventually able to find a movement that protests against this attitude and supports the dignity and affirms the lives of those livings with physical challenges. 

In addition, insidious trauma occurs within the LGBT community as they hear ministers, politicians, and social network trolls make comments about hate crimes or blaming them for natural or manmade disasters such as in Hurricane Sandy or the Sandy Hook school shooting. 

Laura Brown also states that in order to be culturally competent in providing trauma-informed services we should also consider how insidious trauma may be present even if the particular person has not identified having had an experience of overt trauma.  “Everyday racism, sexism, heterosexism, ableism, and other forms of institutionalized oppression may seem so familiar to people as the background noise of their lives that they have no cognitive construct into which to place these encounters; they simply have the post trauma distress and dysfunction arising from doing battle every day against an army of small toxic agents.” Often the historical violence that has been done to a group of people such as Native Americans, Black Americans, Jews, and a large number of immigrant populations has an impact that lasts beyond the generation during which the greatest violation occurred. 

Understanding what we do about complex trauma’s impact on a survivor’s ability to trust and feel safe in the world, we now need to add the understanding that the person we are working with may also be experiencing the effects of insidious trauma.  A person may come into shelter or for other services with lack of trust and an increased sensitivity due to oppression and stigma she may have experienced or seen others of her particular group experiencing.  In the past I have heard people refer to the person as having a chip on her shoulder.  By understanding the effects of insidious trauma, we can now understand that this distrust, hypervigilance, and protective stance are a part of the effects of the trauma experienced by their particular group and should be addressed in the same way we do with other trauma survivors. 

Knowing this, it also calls us to action in regards to addressing oppression and social injustices in society.  We can do this on individual, agency, community, and national levels.  If we are to call ourselves “trauma-informed” we need to also be aware of and address those institutions, attitudes, laws, and beliefs that contribute to insidious trauma.