Healing Neen and Being a Drop in the Bucket

A few weeks ago I attended a conference held by the National Association for Infant Mental Health. One of the keynote speakers was Tonier Cain. Her story was inspiring and hopeful. It was also a testimony to the need for trauma responsive services for women.


Tonier spent nineteen years on the streets of Baltimore, using drugs, prostituting, being rape and abused, and going in and out of the correctional system. She had a total of 83 arrests and 66 convictions. She lost five children to the system because of her inability to stay clean and sober and out of jail. It wasn’t until she was able to enter a trauma-responsive treatment program for female offenders that she was able to change her life. She was pregnant and determined not to lose custody of another child and begged a judge to keep her in jail for a few more months so that she would qualify for the program. Once she entered the program she was asked “Tony, what happened to you?” and when she told her life story someone let her know that she was not responsible for all of the bad things that happened to her as a child and she believed them.

Tonier was the oldest child of a drug addict and alcoholic. When she was nine years old her mother had parties and once her mother passed out, her mother’s “guests” would go to the children’s room. Tonier would block the doorway in order to protect her brothers and sisters, sacrificing her safety for theirs. When she was a teenager, her mother signed papers for her to be married to a man who was nine years older than Tonia and who beat her if the house was not as clean as he wanted it to be. She learned that if she used cocaine she was able to find the energy to clean, but was not able to stop the beatings.

Tonier Cain is now a nationally recognized speaker with seven years clean and sober. She is a dynamic advocate for trauma-informed services and is heart wrenchingly honest when speaking about her life.

Tonier’s story is available at http://www.healingneen.org/. The 54 minute DVD is free of charge to anyone desiring a copy. I highly recommend this video as a means of learning how valuable understanding the impact of childhood trauma on a woman’s future can be and knowing that many of the women we work with are responding to the trauma. Also included in the video is a short discussion with Dr. Vincent Filletti M.D., chief researcher of the Adverse Childhood Experiences Study.

As I viewed this video today, I was reminded of a statement made by Patti Bland of the Alaska Network on Domestic Violence and Substance Abuse at a meeting I attended in late September. She stated that “each time we look for reasons not to provide shelter to a battered woman we are colluding with the abuser.” Tonier Cain does not mention it in her video or in her speech, but I can imagine a similar woman seeking services at a domestic violence program and being refused shelter because of her drug use or mental health issues. How often has an abuser used his partner’s drug use or mental illness as a means of control by saying “No one will help you. You’re just a druggie.” “No one is going to take you in. You’re crazy.” And how often is he right? Through the Open Doors to Safety program, this is certainly happening less and less here in New Hampshire. However, there are often other reasons that a woman may not be accepted into shelter that validate the messages that she has been receiving from her current or past abuser. “You’re not worth anything.” “No one will want you.” “You will never get away from me.”

If you work at a shelter program, I invite you to think about Patti Bland’s statement and consider how you can provide services that respond to the trauma that she has experienced through her life and that do not traumatize her further. If you do watch Tonia Cain’s movie, Healing Neen, take time to discuss how you could possible assist a woman who comes to you with a similar story while she is still in active addiction. What community contacts/collaborations do you have in place to assist your program in providing services?

Stephanie Covington, http://www.stephaniecovington.com/ who spoke at the Healing the Wounds of Abuse conference in Manchester and Plymouth NH last month, talked about how we are all drops in the bucket of a woman’s life. She may come and go from our services and we may feel we have failed her. However, we don’t know which drop in the bucket we are, one of the first or one of the many that follow, but eventually, hopefully, there will be enough safety, support, and information provided so that she can make changes in her life. I hope we don’t pass up chances to be a drop in a survivor’s bucket.

Using Right Brain Activity to Build Resilience and Assist Recovery from Trauma

I went to a conference this past week and was reading Sandra Bloom’s book, Creating Sanctuary – Toward the Evolution of Sane Societies, on the plane and became a little discouraged as I was reading her chapter on Trauma Theory. I was particularly impacted by the following paragraph on pages 28 and 29:


“Evidence also exists that the massive secretion of neurohormones at the time of the trauma may deeply imprint the traumatic memory (Van der Kolk 1994, 1996c). The neuroscientist Le Doux (1992) has termed this ‘emotional memory.’ In studying the influence of fear in particular, he has shown that emotional memory appears to be permanent and quite difficult, if not impossible, to eliminate although it can be suppressed by higher centers in the brain (Le Doux 1992; 1994). This ‘engraving’ of trauma has been noted by many researchers studying various survivors (Van der Kolk 1994; Van der Kolt and Van der Hart 19931).”

This imprinting of the traumatic memory and the flooding of chemicals into the amygdale (doing center of the brain) appears to make it almost impossible for a survivor of trauma to be able regulate their emotions and they will continue to respond to life events and relationships as if the trauma is ongoing. If this is so, how can advocates possibly hope to be able to work with and assist survivors in making positive changes in their life?

Fortunately, the Self and Family Conference provided some answers so that I was able to return feeling less discouraged and more empowered.


Using Right Brain Activity

There were a number of speakers, including Stephanie Covington, Judy Crane of the Refuge, and Cardwell Nuckols who spoke on using right brain activities to calm down the spin cycle of the amygdale, move away from the constant interpretive cycle of the left brain, and empower the survivor by engaging them in activities in which they can gain some competence and make meaning out of their experience.

The left brain is responsible for trying to make sense of the world and the perception of self. For trauma survivors, trying to make sense out of trauma can keep them in a cycle of constantly responding to the world as if the trauma is ongoing. By engaging in right brain activities, i.e. art work (collages, painting, drawing), music (drumming, dancing), exercise (yoga, Tai Chi or Qi Gong) and writing (poetry and short stories), a person is able to engage the brain in other activities that generate competency, slow down the left brain activity that keeps them in constant hyperarousal.

Judy Crane of the Refuge (see links to the left) gave a couple of dramatic examples. She told the story of a woman who had been severely sexually abused by her grandmother when she was three years old. This woman was given the materials and support to create a figure out of soda cans and Marlboro cigarette packs (her grandmother smoked Marlboros and drank a lot of diet coke). The woman put pieces of paper in the cans that described how she felt. She was given permission to show her work and then she used Judy’s golf cart to flatten the cans. The work that went into the can sculpture enabled her to be able to create, move out of the left brain, and feel empowered.


Another client of Judy’s was using self cutting as a coping mechanism. She was given red and black paint and was encouraged to use this as a way to focus her pain rather than causing self injury as the self harm was disrupting to the other inpatients. Within a few weeks, the client had gone from cutting herself to creating significant art that showed her progression from hurting to healing.

There is a lot of research out there about the calming effects of yoga, Tai Chi, and even aromatherapy. I was also given information on Soul Collages (see link to the left) and integrative medicine (I hope to expand on this in the future).


The Healing Relationship

There is more and more evidence in the mental health field that the primary catalyst for healing in trauma survivors has little to do with the mode of treatment. It is the “therapeutic relationship.” In domestic violence and sexual assault work we can refer to it as the “healing relationship.” Being as genuine, empathic, and knowledgeable of the impact of trauma on survivors as we can, we can assist them in beginning the road to recovery. This is difficult to do in situations when the survivor is still being impacted by the activities of the abuser, but can open the gateway to slowing down the hyper activity in the left brain and increases their sense of safety and trust in the advocate.

Another note: Anyone Can Provide Trauma Informed Services

Stephanie Covington, PhD. was quick to discuss how any provider can be trauma informed. In addition to speaking around the country about her programs for women, trauma and recovery, she also has talked to other providers about how to be trauma informed. She has even met with her dentist’s office to discuss how they can be more trauma informed i.e. explaining to the patient in advance each move and being responsive to how the weight of the apron worn during x-rays could be triggering. The dental office changed their procedures to be more trauma informed and uses these procedures for everyone so there is no need to question patients about their trauma history.



The conference was very informative and I hope to write more over the next few weeks about what I learned from experts in the areas of trauma, substance abuse, and mental health.

Finding “A Woman’s Way Through the Twelve Steps”

When I first started working with survivors of intimate partner violence who were self medicating the pain of the violence there was a lot of criticism in the domestic violence community of the traditional 12 Step programs. This has continued over the years due to survivors continuing to be victimized within the 12 Step programs and the traditional approach maintained by substance abuse therapists who promote the 12 Step model. The empowerment model of domestic violence seems at odds with some of the steps which require a person taking a look at their “character defects” in order to take responsibility for their actions. Also, within the rooms of AA and NA, members can become emphatic in regards to beliefs that a person must be torn down before they can be built back up again. As we well know, survivors of violence have experienced that tearing down within their relationships and may find some interpretations of the 12 Steps to be another means of external forces exerting power and control in the life of the person using substances to cope.

The traditional approach to substance abuse treatment requires that the “addict” admit to having a disease, be willing to admit that they are powerless, take responsibility for their part of the problem and make sobriety a priority. In the trauma informed, empowerment model based approach, the advocate supports the survivor in making safety a priority and recognizing that the trauma the person has experienced has contributed to the increased use of substances or processes that mask the symptoms of the trauma. The survivor is also supported in knowing that they are not responsible for the trauma which led to the substance use.

Oftentimes, DV advocates are reluctant to address issues of substance abuse due to seeing the use as the person’s choice and her way of coping with her life. However, many times survivors see this as the only choice and an advocate can be of assistance in educating her as to other ways she can manage her life, increasing her self confidence and possibly leading her to the point where she can eventually see that there are other choices besides drinking or using drugs. It is not the role of the advocate to judge a survivor’s use of the substance, but be able to assist the survivor in maintaining safety and becoming personally empowered by having new choices available.

Another reason that DV advocates may be reluctant to address issues of substance use has to do with the lack of resources available to women to maintain their safety and sobriety and the fear of having a women revictimized within the recovery community. There are a few things that can be done to increase safety and make the 12 Step model more empowering for survivors. There are a number of different types of peer support programs for women in recovery but none are as prevalent and available as the 12 Step program. We have a number of women currently involved in the program coming into our agencies and it is valuable for us to have an understand of the model in order to converse with them about how recovery can be empowering.

First of all, in order to educate a woman about safety issues in regards to attending 12 Step meetings the following recommendations can be made:

1) Do not disclose where you staying to anyone in the group or reveal the name of your abuser.
2) If you go to a group and someone there knows the abuser, leave immediately and do not return to that meeting.
3) Try not to be predictable in which meetings are attended every week. A stalker may use a local meeting schedule as a way to follow a woman from meeting to meeting.
4) Do not accept rides from people you do not know or be the only passenger.
5) Attend “women’s only” groups as much as possible.


In A Woman’s Way Through the Twelve Steps, Stephanie S. Covington Ph.D. takes each of the 12 Steps and interprets them in a way that can be very valuable in working with survivors of trauma who are trying to find a way to manage their sobriety through the use of the support a 12 Step program can provide. In addition to the text, A Woman’s Way Through the Twelve Step, there is a workbook that can be used by someone working her way through the steps. See www.stephaniecovington.com for more resources.

Here is a very brief review of the steps and how they can be interpreted and used within the empowerment model I encourage you to read the book yourself since I cannot possibly cover all of the points here. . It is important to note that the steps are a process that can take years and should not be rushed. It is often recommended that the first three steps take a year or more and that the remaining steps be done as the person is ready. By using a workbook and a facilitated group, however, the steps can be done in a shorter period of time and then done more comprehensively at a later date.

• Step One – We admitted were powerless over alcohol – that our lives had become unmanageable.
This step is primary about becoming aware of how life has become unmanageable due to the use of the substances. We know as advocates that trauma may be the source of the unmanageability and we want to remind survivors that they are not responsible for the abuse in their lives. By acknowledging their lack of power in some areas of their lives (i.e. the actions of their abuser) they can then become free to act in areas where they do have power.

• Step Two – Came to believe that a power greater than ourselves could restore us to sanity.•
Step Three – Made a decision to turn our will and our lives over to the care of God as we understood Him.
These two steps generate a lot of resistance for survivors and advocates alike due to the suggestion that life will be better if we just had over power and control to another outside entity, This can raise fear and trepidation for someone who wants to regain power and control over her own life, especially when religion has been used as an excuse to perpetrate ongoing abuse.


Stephanie Covington encourages us to consider the use of the group as a higher power, particularly a group of women who have had the same struggles and who have found their way to empowerment, safety and sobriety. She also encourages women to find their own definition of God/Goddess/Higher Power and recognize that we do not need to be held to the constraints of a childhood religion that does not empower women.

• Step Four – Made a searching and fearless moral inventory of ourselves.
This step has been a block for most persons involved in 12 Step programs due to the fear of facing some of the demons of the past. The main points to remember are that this inventory is a process and not an event. It takes as long as it takes and not everything needs to be addressed in the first inventory. Also, Stephanie Covington encourages women to do an inventory of “Assets and Strengths” and “Challenges and Limitations” rather than the traditional inventory of “character defects.”

• Step Five – Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
Done with an empowering approach this step can provide what many of our survivor support groups do. It helps the person put an end to secrecy, helps them find that other people feel the same, assists with self-acceptance and self forgiveness and starts the survivor on the road to celebration and gratitude for their assets and strengths and the support they receive from a community of women.

• Step Six – Were entirely ready to have God remove these defects of character.
This step provides the opportunity for a survivor to use “letting go” rituals to release some of the challenges and limitations she may believe about her life. By this time she may have learned enough about how the trauma has affected her that she will be able to release some of the coping skills that are no longer needed due to the development of new strategies.

• Step Seven – Humbly asked Him to remove our shortcomings.
This step is about relinquishing those former coping skills and recognizing how there is strength available to move forward. The word ‘humbly” often gets confused with humiliation. However, in this step humility means having a strong sense of who we are, realizing our limitations and acknowledging our strengths.

• Step Eight – Made a list of all persons we had harmed and became willing to make amends to them all.
This step is about relationships and the power of being able to recognize what we are responsible for and what others are responsible for. It is helpful to have a sponsor or therapist work with the survivor on this step as it is very easy to get off balance and start taking responsibility for the actions of others.

• Step Nine – Made direct amends to such people wherever possible except when to do so would injure them or others.
Personal responsibility can be a key to empowerment. The 12 Step program encourages direct and honest amends and this can only be done after the strong, balance approach in Step Eight. It is also mentioned that amends can be “living amends,” treating some with more respect or kindness than in the past. It also requires a willingness to accept whatever the person’s reaction may be to the amends. This about making amends, not necessarily about receiving forgiveness.

• Step Ten – Continued to take personal inventory and when we were wrong promptly admitted.
This step encourages staying present in the moment. As in Step Four, it is recommended to use the balanced approach of making an inventory of “Challenges and Limitations” and “Strengths and Assets.”

• Step Eleven – Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
– “Prayer is an act of either reaching out to a Higher Power or going inward to a deeper knowing. Just as we described God our own way in Step Three, we can also come to prayer however we like.” Stephanie Covington

• Step Twelve – Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all of our affairs.”
This step is an invitation to continue practicing the principles of the 12 Step program and inviting others to explore the support of the program.

This review is not necessarily a recommendation of the 12 Step program but is more of a means to help advocates be more informed about the model. Given how it is often the only type of support a survivor has for her recovery from substance use, it is valuable to be able to talk to survivors about how it can be used in an empowering way.