It’s All About Feeling Safe

I am often asked about how to help a survivor manage their mental health issues.  The advocate is usually feeling that the “symptoms” are possibly unrelated to domestic violence or sexual assault and the advocate does not feel qualified to address what is happening. 

Yes, there may be instances, such as when a survivor is suicidal or psychotic when an immediate mental health intervention is necessary.  However, the skills that advocates have can be used to help reduce the reactions a person may be having because she does not feel safe in her environment or her body.

Being trauma-informed includes having the understanding that the behaviors that an advocate sees may be directly or indirectly related to the trauma the person has experienced over their lifetime.  These behaviors can range from anxiety to depression, anger to paranoia.  What is important to remember is that what the person probably wants more than anything is to feel safe even when they are yelling at you, refusing to get out of bed, or having difficulty making a decision.  We don’t even have to know what caused the behavior.  We can just start the conversation with “what would help you to feel safe at this moment?” and work from there.

Here are a couple of examples:

A woman is having difficulty going to social services to fill out paperwork.  She gets angry when she is reminded that she needs to do this and she starts avoiding staff rather than following through with the plan.   When sitting with an advocate she may become agitated when she feels the conversation moving toward talking about taking the trip to social services.

The advocate can either remind her that it is necessary that she do this and if she does not follow through she will be reprimanded or the advocate can ask the following questions:

1.        Is there something about the social services office that is stressful for you?

2.       Do you feel safe going to and from the office?

3.       Is there any additional assistance that you need in order to fill out the paperwork?  (She may not feel safe talking about literacy issues and asking for help.)

4.       Do you feel like you aren’t ready to take this step?  (She may be considering returning to her abuser and is afraid to talk to you about it.)

5.       Would you like to do a safety plan around making the trip or do you need a volunteer or staff to accompany you?

There are a number of reasons why she may not be taking the trip to social services but more than likely she does not feel physically or emotionally safe doing so.  She may also be fearful that failure to follow through may mean not being able to receive further services from your program.

A survivor is placed in a hotel room for a few nights due to lack of shelter beds.  She is taken to a local grocery for some food that can be kept in the hotel room refrigerator.  However, she keeps calling the crisis line and staff asking for someone to take her out for a hot meal or more groceries.  Some staff may feel inconvenienced or that the person is trying to get as much free food as possible.  However, the person may be using the frequent calls to staff as a way to touch base with another person.  Hotel rooms can be lonely and the person may be afraid to ask to have her needs met.  She may also need to talk about how she feels about leaving her partner, may not feel safe with her emotions or be fearful of being seen.  It all comes down to wanting to feel safe but not knowing how to ask for it. In many survivors’ lives, asking to get needs met put them at risk of harm.

Even events of extreme paranoia or delusion can be calmed by helping the person find a way to feel safe.  If someone is feeling  they are being watched or that a tracking device has been put on their clothing, it helps to ask a few more questions including “what can I do to help you feel safe?”  It may mean making a couple of changes to the environment in order to help the person feel heard and safer.  More than likely the paranoia and delusion can be traced to some recent or long ago trauma but it is usually evident that the person is not feeling safe in their body or environment. 

Start with what you know and domestic violence and sexual assault advocates know about talking about safety.

As Long As You Are Mobilized You Can’t Shut Down

I went to the 25^th Annual Psychological Trauma conference put on by the Trauma Justice Institute in Boston two weeks ago.  I wish I could report on everything that was presented but that would be impossible.  There were a lot of neuroscientists and chemists showing graphs and reading statistics and by the end of the second day of the three day conference a number of us were shuffling around looking brain dead.  It is a good thing we were still walking, though, because one of the important points I wrote down was “as long as you are mobilized, you can’t shut down.”

Stephen Porges said this when he was talking about the polyvagal response ( you can go here for a fairly clear explanation) and I was really struck by the statement.  He was trying to make clear the imperative for movement in times of stress in order to decrease the risk of dissociation (from zoning out to full blown shut down).  Biologically, our bodies need to move in order to regulate.  According to Dr. Porges, our system is constantly monitoring the environment to determine whether or not it is safe (more so for trauma survivors) and when the system is overwhelmed it shuts down.  Movement helps keep the system regulated.

As someone who has been diagnosed with Fibromyalgia and who has developed an understanding of the effects of trauma on the body, I had developed a theory that the nervous system’s response to trauma was the cause of the fibromyalgia.  This theory was validated at the conference by Dr. Porges and there seems to now be more evidence being published.

According to Richard Boyd at http://www.energeticsinstitute.com.au/page/fibromyalgia.html “ Pain studies have shown that incomplete pain signals in the body can cause them to be re-sent and even amplified. Fibromyalgia sufferers appear to have a pain signaling problem that is of this nature. The Vagus nerves have been shown to have “communication problems” when traumatised. This is conjecture but a possible framework under which Fibromyalgia exists without showing causes and origins. It may turn out to be a nervous system “network” problem.”

So why am I bringing this to your attention?  As advocates we meet a lot of survivors who complain of pain issues and who also dissociate at various levels.  They are often highly medicated  and/or finding ways to retreat from the psychological and emotional pain that are non-productive and reduce physical movement.  The findings that I mention above bring home the point that any opportunity we can provide as domestic violence shelter advocates or as facilitators of support groups to get people up and moving can only increase survivors ability to manage their own trauma responses.  Yoga, tai chi, walking, bicycling, dancing, and swimming are just a few of the ways to help reduce the effects of stress.  If someone is in a lot of physical pain they may need to do gentle yoga or slow walking, but it is still movement. 

I would also, if you are able, take the opportunity to provide support while on a walk.  Is there someplace safe and quiet where you can meet a survivor where you can walk and talk at the same time?  When trying to help someone do an emotional safety plan for the weekend or after a court hearing, recommend movement even if it is just going home where it is safe and putting on some loud music and dancing around the house.

And finally, as advocates we are under a lot of stress.  We don’t even have to be meeting with survivors in order to be influenced by the trauma that they experience.  After attending sessions on child abuse and neglect and human trafficking at last week’s Attorney General’s conference, I needed to be outdoors and moving in order to rid myself of the after effects.  A walk in the woods or bicycling usually helps.  Movement has to be a part of our self care plan as well.