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  

Empowerment and Success

The term “empowerment model” has long been the term used to describe how advocates work with domestic violence survivors.   It is the understanding that only the victim/survivor can be the expert on their life. Advocates provide information, support, resources and education so that victims can make the best choices possible to become safe and self-reliant.  We strongly believe that empowerment is not something we give to the survivor.  Instead, it is something that is intrinsic to the survivor and it is our task to help the person find and expand their personal power.

When a woman comes to a crisis center for assistance in changing her life, she is often unaware that she has any power at all in her life.  Through the use of power and control, the abuser has diminished her belief in herself and her capacity for growth.

If we truly believe that empowerment is something that exists within each person, what then is the role of the advocate?  In the same way that a sapling has the capacity within to become a full grown tree, a survivor contains the capacity to be a strong woman.  However, without proper nourishment and support, that sapling may struggle and be less protected from the elements.  The job of the advocate is to provide the support, resources and education to encourage the growth of the individual into a woman who has power and control over her life. 

Support takes different forms during the progression from being under the power and control of the abuser to being in control of one’s own life.  When we plant a seedling, we may provide ground stakes and support lines to help the tree stand tall until its root system has expanded deep into the soil and taken hold.  Later, we slowly loosen that support as the tree is ready to stand on its own.  Too often we worry about disempowering a woman and remove the support too early or we smother her for fear that she may make a decision that will harm her or her children. 

In many ways, our definition of success has changed over the years.  The definition of success has increasingly been defined by funders so that we are mandated to worry more about moving a person along quickly to find transitional or permanent housing, a job, etc., rather than focusing on Judith Herman’s (see Trauma and Recovery) first stage of recovery from trauma – safety and stabilization.  This is not to say that housing and employment are not valuable and necessary.  However, we tend to lose focus on the need to allow time for the person to feel safe and stable enough to be able to reduce her trauma responses and make informed rational decisions rather than emotional reactive decisions.

Because of the need to provide good outcomes to funders or other interested parties (or for other reasons), we may find ourselves looking at a person who is seeking shelter or other supports and asking “will this person be successful in our program?”  The question we should be asking is “do we have what this person needs to be successful and, if not, can we find the resources to provide it?”  Even if the resources the person may seem to need (i.e. mental health, substance abuse, housing, etc.) are not initially available, are we able to provide the support the person needs in order to feel safe and stable? Assumptions made at the start of a person’s contact with a program about her capacity for success can be self-fulfilling prophecies.  Which outcome would you rather assume?

It also becomes imperative that we take a look at our definition of success.  If success means a linear progression from abuse to safety to independence, we may be setting ourselves up for perceived failure.  Understanding that success may be more of a process of small successes and setbacks rather than a straight shot to a successful event can lessen the pressure we place on a trauma survivor and reduce our own burn out and compassion fatigue. 

When I was first working as a shelter director back in the mid 90’s there was a woman, Bonnie, in the program who had come to us seeking shelter and an opportunity to engage in substance abuse services.  She was 43 years old and had been drinking steadily since the age of 13 and had been victimized as a child and an adult.  She stayed in the shelter for three months and then left on her own.  At first I felt that not only had she failed at maintaining her sobriety and safety, but that we had failed her.  Fortunately, my mentor at that time reminded me that we had given Bonnie three months of safety, sobriety and community that she had never experienced before.  It was not the success I was hoping for, but it was a success none-the-less.  Many people would have looked at Bonnie’s history and judged her as being at risk of failing the program.  However, Bonnie left the program with more information than she had when she came in.  She also knew she could return at any time. 

Trauma survivors are also very tuned into our attitudes and expectations.  If a trauma survivors senses that we are unable to see them as individuals capable of success, they will meet those expectations or fight against them. It is important that we find ways to take care of ourselves and challenge our own assumptions about people so that we can reflect an attitude of support and an expectation of success that supports rather than questions a survivor’s abilities. 

Compassion Fatigue and Our Role as Advocates

As advocates we spend a lot of time discussing vicarious trauma. It is easy to see how hearing other people’s stories of abuse and trauma can negatively effect our beliefs and relationships. However, we often forget that we also are very susceptible to compassion fatigue. Compassion fatigue and vicarious trauma can overlap and often look quite alike. It is almost as if one is the flu and the other is a bad cold. A little hard to tell what is happening at the time, but both seriously affect our ability to be objective and compassion when working with victims of domestic violence and sexual assault.

The website http://www.compassionfatigue.org/ states the following about caregivers who are experiencing compassion fatigue:

“Studies confirm that caregivers play host to a high level of compassion fatigue. Day in, day out, workers struggle to function in care giving environments that constantly present heart wrenching, emotional challenges. Affecting positive change in society, a mission so vital to those passionate about caring for others, is perceived as elusive, if not impossible. This painful reality, coupled with first-hand knowledge of society's flagrant disregard for the safety and well being of the feeble and frail, takes its toll on everyone from full time employees to part time volunteers. Eventually, negative attitudes prevail.”

One side affect of compassion fatigue that often occurs is decreased lack of empathy towards those whom we are working to support. Often I will begin to hear comments about victim/survivors such as “this person doesn’t seem to be trying hard enough,” “she is using too many of our resources,” “she ‘should’ be ____________ (whatever it is the advocate feels that she should be doing, rather than what the victim/survivor feels empowered to do).”

In the article Changing the Script: Thinking about our relationships with shelter residents by Margaret Hobart at the Washington State Coalition Against Domestic Violence http://www.wscadv.org/resourcesAlpha.cfm?aId=D00E1151-C298-58F6-025BBD925C7F8AF8, Ms. Hobart ask us to take a look at the type of relationships we may develop with shelter guests (and other victim/survivors). When we fall into one of the less productive relationships such as parent/child, teacher/student, drill sergeant/recruit, employer/employee, or rescuer/victim it is often because we have become overwhelmed by the needs of the survivor or we have created our own agenda of what we feel should be her focus. We forget about recognizing strengths and helping the person find their inner power and we become directive rather than collaborative in helping the woman move forward. Or, we may able to put our own agenda aside and be collaborative but we still end up being resentful and disappointed because she did not follow through on suggestions we made.

Self care, of course, needs to be a priority and there are many resources that talk about compassion fatigue and vicarious trauma and self care. I would also like to suggest that when you are feeling the effects of compassion fatigue i.e excessive blaming, bottled up emotions, isolation, complaining, compulsive behaviors and poor self care, that you take time for self reflection using Margaret Hobart’s article and determining if your expectations of victim/survivors are based on the role you are playing in their life or on a collaborative/team approach to support and advocacy. Being aware of our own perceptions and triggers is also very important in managing compassion fatigue. Are you having difficulty working with survivors who have mental health or substance abuse issues because of feeling overwhelmed or unequipped? Has your agency lost personnel and you are feeling overwhelmed by your workload and it is impacting your attitude toward victims and co-workers? Or are you spending so much time in a care-taking role that it may be time to look at your professional boundaries and the impact it has on you and your relationship with victim/survivors?

Being aware of how compassion fatigue affects us and the people for whom we advocate is vital to our continuing to be effective in our jobs and the community.