Barriers to Leaving – Looking in the Mirror at Domestic Violence Programs

I have spent a large portion of my career working with domestic violence programs both from within and as a part of the community.  There have been a lot of changes over the years that have increased access to domestic violence programs that have made big differences in the lives of survivors who seek a safe environment in which to focus on the next steps in they want to take in order to be free of abuse.

In the past, many domestic violence programs were guilty of restricting access to survivors who were using drugs or alcohol or who had a mental illness.  I remember talking to one program many years ago that had a policy that a person who had used alcohol or drugs in the past thirty days would not be allowed into shelter until she had thirty days clean and sober.  I informed them that I knew that half their staff would not be able to get into shelter if needed.  Eventually, programs realized that expecting a survivor to get clean and sober who was self- medicating the effects of trauma or living with an abuser who used drugs or alcohol as a means of control was unrealistic and was, as Patti Bland of the National Center on DV, Trauma and Mental Health puts it “actually placing the program in the position of colluding with the abuser.”

Another positive step we have taken is the realization that even though domestic violence programs are not (and should never be) clinical programs, we can provide support services to survivors who are experiencing effects of trauma that have often been seen as mental health issues.  Programs no longer ask about medications as a means of determining if a person has a mental health issue and then using that as an excuse to screen someone out of shelter.  It can’t be done and, fortunately, is not being done. 

However, I feel that some programs, after all of these positive changes, forget that we still need to be diligent in looking at the things that may still be happening that set up barriers and decrease the probability that a survivor will seek services from a domestic violence program.  Programs are often so overwhelmed by the ongoing failures and barriers within their community and society that they become complacent and forget to focus on the barriers that may be generated by the domestic violence program.  Here are a few areas that need to be considered in order to truly reduce barriers and provide victim-center services:

Comprehensive Safety Planning vs. Refusing to House Survivors Who Live in the Same Town/City as the Shelter:  Whenever a program says that they cannot house a survivor and her children because she and her abuser live in the same town as the shelter they are setting up a barrier.  The program is forcing a victim to choose between her job/home and her and her children’s local support and safety.  We are saying that in order to receive services she needs to give up even more than she already has to at the hands of the abuser.  Solutions to this issue would be to investigate the “open shelter” concept in which the community is well aware of the location of the shelter, thus encouraging neighbors to report suspicious activity, and making safety planning a high priority in order to be able to assist the survivor in being able to access local resources and maintain employment while still living in the same community as her abuser.  This will reduce transportation issues for court and visitation also.  Yes, there are times when a victim needs to leave the area for her safety, but this should be her choice.

Case Management vs. Support Services:  I am concerned about the concept of “case management.”  As the executive director of a community mental health program I once worked for said “people are not ‘cases’ to be managed.  They are to be supported.”  If we start looking at victims as cases we are in danger of limiting the services we provide to a menu rather than taking a victim-centered approach to supporting the person in the decisions she makes for her future.  We are also in danger of moving to a more clinical approach that looks at symptoms and issues rather than coping skills, victim needs, and systems of oppression and barriers in the community.

Modeling DV Programs’ Services After Homeless Programs:  When we start to provide services in the manner of homeless services we are in danger of forgetting about the issues of domestic violence and trauma.  I have seen program staff become too eager to move the survivor to housing while not addressing the issues of domestic violence and trauma.  Programs need to go back to their mission statement and review the primary purpose of the organization.

The best way to look at services in a program and determine whether or not the services are a barrier to survivors seeking safety is for staff to put themselves in the shoes of the victim.  We often do an exercise called “In Her Shoes” to point out the barriers and difficulties in the community, but we also need to do the same for our programs.  Ask yourself, “If I was a woman in danger, would this program meet my needs for safety, connection, and stability?”

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.

Looking Through the Trauma Lens with Self- Reflection

Understanding trauma and its impact on survivors of domestic violence and sexual assault is not only a theoretical approach but has become an important component of the way we work.  When looking at our work through the trauma lens it is critical that we look both ways.

A lot of work has been done on understanding the impact of trauma on the survivor.  We know that trauma is going to affect her willingness to reach out and engage when trust has been broken on many levels.  We also have become aware of how concentration and focus can be negatively impacted, reducing her ability to make productive decisions and use resources effectively.  Trauma responses may make it difficult for her to follow-through with appointments or she may avoid circumstances that trigger her or make her feel disempowered.  

It is also important to look through the trauma lens at ourselves and understand how trauma impacts the way that we do our work.  If we are unaware of our own responses to trauma, our own personal experiences and our responses to others’ trauma, we may find ourselves being less than who we wish to be in our interactions with survivors.  Being judgmental and critical of the choices of others, distancing ourselves, or trying to fix rather than support may be signs that we are not managing our own feelings that have arisen due to the impact of trauma. 

As advocates, we have to work with staying present and supportive of survivors even when we feel uncomfortable with their way of being in the world.  It may also be necessary to step back at times to self-reflect on what we bring to the relationship.  Even though we are encouraged to maintain boundaries in our work with survivors, we are also developing a relationship with a survivor that can either help or hinder their healing process.  The following questions from Carole Warshaw at the National Center on Domestic Violence, Trauma and Mental Health can be used in supervision or as a self-tool in order to stretch ourselves and engage more fully in our relationship with the survivor. 

What is particularly challenging for you about this person or interaction? i.e. she never shows up, she is sarcastic, she may be lying to me, I don’t like the way she makes me feel.

What are you aware of feeling?  I get angry, I try to avoid contact with her, I find I want to take her and her child home with me, I feel manipulated, and I am overwhelmed

What are you feeling underneath? i.e. I feel incompetent, I am not a good advocate, I don’t like being angry, I feel special, I feel like I am being set up

What do you think she might be feeling? Is she trying to protect herself? Is she being triggered? Are there feelings coming up in our interactions that she is having trouble tolerating?

What do you find yourself wanting to say?  What is that inner voice saying that you would not want to hear yourself say aloud?

What could you say that might be more helpful?  What would be more a more empathic or empowering, trauma-responsive approach? 

What if this is not signed up for? This may mean that you need more self-care and supervision in order to determine what steps you need to take for yourself.

Taking a look at ourselves through the trauma lens may be difficult at first, but can lead to more meaningful interactions with survivors and others in our lives.  

Shock and Shame: The Legacy of "My Rebellious Years"

In honor of Domestic Violence Awareness month I have a guest blogger.  When I read this story by a survivor and victim advocate I asked if I could share it on the Open Doors to Safety blog and she graciously accepted.  Thank you, so much.  

Warning:  This story gives explicit details of abuse.  You may be triggered.  Please be sure to take care of yourself if this happens.  You can reach out to your local crisis center or national DV hotline for support.

 Recently, I went to court with a young girl.  Beautiful girl—delicately-featured, flawless pale skin—until I looked a little closer.  A hint of a bruise was emerging from her carefully made-up forehead, and a glance at her arms betrayed tracks of purpled fingerprints and handprints from wrists to biceps.  In the process of filling out a restraining order, she had to tell me about the hours-long assault that she endured. 

          She was trying to go to sleep—separately on the sofa, because he was yelling and screaming at her.  He ripped her off the sofa by her hair, grasped her arms, and pulled her along the hallway until he lost his grip.  She tried to crawl back into the living room, but he yanked her back by her hair or her arms—whatever he could gets his hands on—again and again.  She knew he intended to “have sex” with her, and she did not want to go into the bedroom; she kicked and screamed for him to stop.  He shoved her down to the floor, and kneeled on her neck, until—gasping for breath—she agreed to let him have “his way.”  When he let her up and she went running for the front door, he grabbed her again.  “My head smashed some mirrors in the house,” and he pushed her onto the bed…

          "Wait!  Can you back up a minute?  What did you say?!”

          "What?”

          “Do you mean that you ran your own head into mirrors in the house, or that he threw you head-first into mirrors in the house?  How many?”

           She had a vacant look about her, as if I should know the answer.  I thought I did, but I had to be sure.  “He chucked me into the hall mirror, and then I grabbed the bathroom door handle…he yanked my hands off, and pushed me into the bathroom sink, and I fell forward and hit my head on that mirror and it shattered, too.  I started feeling dizzy, and queasy, and I just couldn’t stop him.  He somehow managed to push and lift and shove me into the bedroom, and I fell into that mirror, too.  The mirror at the head of the bed.  I was screaming and crying for him to stop—I didn’t feel well—and he picked up a pillow and pushed it down over my face.  I tried to kick him off me, but he was too strong.  He said he wouldn’t take it off my face until I stopped screaming.  I felt vomit coming up my throat.  I think I passed out.  The last thing I remember was hearing my baby crying.”

          She was so matter-of-fact about all of this.  About the fact that he hadn’t taken her to the hospital, despite her symptoms of a concussion; about how he called his mother and asked for advice; about how he stood over her and made her call out of work for 24 hours, so that her injuries would have a chance to go away and he wouldn’t get “in trouble” if the police were called (in New Hampshire, the police can make an arrest without a warrant for domestic assault for up to 12 hours after the incident).  About how he took her car keys, her cell phone, then ripped the house phone from the wall so she couldn’t call for help.  The more this girl opened her mouth, the more nauseated I became.

          Her mother couldn’t understand the choices she made to keep going back.  She was frustrated.  She “couldn’t deal with this anymore,” and this better be her last time.

          This girl was about the same age as I was when I left “him,” under very similar circumstances.  My head didn’t break any mirrors that night, but the other similarities were too haunting.  And for the first time, I had a blinding flash of insight into my parent's despair as they watched me, time and time again, go back into a relationship with a less-than-manly louse who repeatedly put my life on the line.  They must have been frightened out of their minds.

          I called Mom to process this, and our conversation took us back to my sister’s wedding day, so many years ago, while I was still in high school.  My sister’s “thank-you” gift to her bridesmaids, including me, was a dainty string of pearls to wear with our gowns.  To any other woman, that gift would have been a welcome affirmation of a treasured friendship; to me, it represented danger.  “He” had given me a mizpah coin necklace for Valentine’s Day that year, with very strict instructions that if I ever took the necklace off, it would prove that I didn’t love him.  I was not to take it off.  Ever.

          My sister, on the other hand, was quite insistent that I wear her pearl string.  It was her wedding day; she had every right to expect that I would—as her bridesmaid—do as she wished.  But if you look closely at the wedding photo, there I am with the only solution I could fathom—wearing both.  After an entire morning of being bullied by “him” (because he saw me without the coin) and cajoled by her, the stress of “damned if I do, damned if I don’t” was emblazoned on my face.  A Mona Lisa smile was the best I could muster.

          After causing the morning’s drama, “he” was ordered to stay away from the wedding reception—and still he managed to ruin that day.  He parked outside the reception site, and garnered other wedding guests to retrieve me so that I could cater to his continuing demands.  Was I really going to let him go hungry while he waited outside for me?  Was I really going to dance, when he was outside miserable because he couldn’t be with me?  Was I really going to choose my family over him?  He reminded me there would be consequences to that—serious consequences.  I did the best I could to maintain a celebratory face for my sister and family, but I was close to cracking.

          With the wedding festivities over and my sister safely off on her honeymoon, somehow my parents conceded to letting “him” take me home.  The conversation in the car included his threats of killing my family, killing me, killing himself, because I chose them over him.  I cried so hard, retching, begging him to understand that it was my sister’s wedding day, and I had to be there for her.  He shoved a piece of paper into my hands and pushed me out of the car.  Utterly overwhelmed, I escaped from the pan into the fire; my parents were waiting inside to express their disgust at “his” behavior, my “rebelliousness,” the whole day’s events; and then they said the fateful words:

         “We’re done, Kath.  It’s time to choose—it’s ****, or us.  It’s him, or your family.”

          Stunned, emotionally eviscerated, I fled upstairs, stuffed what I could into whatever bag I could find, and trudged back down like a convict sentenced to death.  The note—unread—had dropped to my bedroom floor.  Grandma Grape stopped me at the bottom of the stairs.  “Ooh, but honey, where ya’ goin’?”  I choked out that I was staying with a friend, and, in her naiveté, she said, “Oh, fer neat!  See ya’ tomorrow!”  I hugged her tightly, and ran out the door, afraid of what would happen if I didn’t.  I left home, caught between a rock and a hard place, because my parents had forced me to make a choice, had given me an ultimatum.

          Never give a victim an ultimatum.  Not because they will make the “opposite” choice, but because you may not fully understand the implications of the choices she has to make.  My mother still calls this “my rebellious years.”  What she doesn’t understand is that I made a choice to save her life.

          I learned for the first time in our conversation this week what was in that note.  After I left our home on Orchard Street, never to return, my mother packed up the remainder of my belongings.  On the floor she found the note from “him,” a raging, ranting tirade about my selfishness and betrayal.  And a promise that if I didn’t shape up, someone was bound to die.  Maybe me, maybe him.  Or maybe my mom and dad.  But the only way to keep everyone safe was to choose him next time.

          The contents of the note are not surprising; those words were “his” theme song, really.  But what is utterly shocking to me was my mom’s response to that note:  she described hiding it under my mattress.  She said didn’t know what else to do with it.  And a few days later, when a family friend came over to finish helping Mom pack up my things, her friend found the note.  Matter-of-factly, my mom said to me, “and thank God she did.  She burned it.  I wouldn’t have wanted anyone else to see it.  Thank God she did that, she knew what to do with it.” 

          I was stunned.  It was clear that my mom had not even given a single thought to bringing that note to the police.  How could she not have?  And even now, I don’t even know if she showed my father or told him about it.  Was she afraid of what Dad would do if he found out?  Is that why she didn’t tell?  Or was it something deeper, bigger than that?  My mother disclosed to me many years ago that she witnessed my grandfather assault Grandma Grape, and I am sure that the expected response at that time was to sweep it under the rug, keep it quiet, that it was just “a family matter.”  But what is more astonishing to me is that, even though she KNOWS the choice I was faced with that night, she still believes I was acting out of rebellion, not love.   I felt that, rather than being frightened, my mother felt shame.  Right now, I don’t know what to do with that.

          But if you have a daughter whom you love, you NEED to know what to do.  The “symptoms” of a young girl experiencing dating violence are very similar to the symptoms of a teen who has chosen to use alcohol or drugs: 1) a change in personality, 2) becoming more secretive, 3) losing interest in friends or activities that used to be important, 4) slipping grades.  These signs are cries for help—DO NOT IGNORE THEM.  If you suspect that your child is in a relationship with a violent partner, tell her you love her, and are concerned about the changes you’re seeing.  Tell her if she does not feel safe, that you are here to help (and not judge or make decisions for her).  Give her the phone number for your local domestic violence or sexual assault crisis program so she has someone to talk to in confidence.  DO NOT GIVE HER AN ULTIMATUM.  Let her know you have every confidence in her ability to make good choices for herself, and you will be “there” for her when she is ready.  And then love her, unconditionally. 

          And if you find a @#$%^ note with specific threats to hurt her or someone she loves, take it to the police.  The years of pain you save may be hers—or your own. 

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.

Generational Poverty and Trauma

  NOTE: Please be aware that for the sake of creating an understanding of some of the issues that pertain to trauma survivors who have grown up in poverty, I will be making some generalized statements. It is very important to know the survivor as an individual with specific issues that may be due to growing up in a specific culture and may not necessarily meet all the characteristics of that culture.


Many of the survivors who seek shelter from domestic violence programs have grown up in generational poverty. Ruby Payne, author of “A Framework for Understanding Poverty” defines generational poverty as families who have lived in poverty for at least two generations, meaning children of parents in poverty grow up to live in poverty themselves. By contrast, families in situational poverty have fallen into poverty because of a traumatic event such as illness or divorce. She writes that families in generational poverty form their own culture with different values, habits and lifestyles from families in the middle class.

Persons who grow up in generational poverty have different values regarding money, different communication styles, and perceive the world based on their own experience. Someone who has grown up in pervasive poverty may not have had resources available with which to develop skills with which they could move out of poverty. These resources include financial means and support systems that can assist the person in moving out of poverty. Trauma also impacts the ability of a person to move out of poverty. Those skills which are necessary in order to maintain safety and survive in a culture of poverty and trauma are primary, while other developmental milestones or skills may not be nurtured and enhanced.

In the following chart I present information based on Ruby Payne’s work but also add in the component of growing up with trauma. It shows the values involved in decision making, conflict resolution, financial decision, and meeting new people and describes the world view of people who have grown up in generation poverty, middle class, wealth, and/or a culture of trauma.

Generational Poverty
Decision Making - Decisions made based on needs of entertainment and relationships


Conflict Resolution - Ability to fight or have someone who is willing to fight for you.

Money - Money is for entertainment and relationships.

World View - The world is what is locally around you.

Meeting New People - Comments are usually made about you before you are introduced to others.


Middle Class

Decision Making - Decisions are made related to work and achievement.


Conflict Resolution - Able to use words as tools to negotiate conflict.

Money - Money is for security and is saved. .

World View - The world is your own nation.

Meeting New People - You introduce yourself to others.

Wealth

Decision Making - Ramifications of the financial, social, and political connections are important to decision making.


Money - Money is for security and is usually invested.

World View - The world is international.

Meeting New People - Someone in the group formally introduces you.

Trauma

Decision Making - Decisions are based on safety


Conflict Resolution - Fight, flight or freeze

Money - The future is improbable. Much has been lost in the past and it is anticipated that loss will occur again. Spending decisions are based on anticipated loss.

World View - The world is unpredictable and limited.

Meeting New People - If I don’t trust you, I won’t talk to you unless I need something from you.



When working with someone who has experienced trauma and poverty it is important not to judge them or have the expectation that they will make decisions the same way that you would if you have not grown up in poverty or with trauma. For example, given that a person has grown up in poverty and trauma she may make a decision to spend an income tax return on entertainment or items needed at this moment rather than saving for the future. For a trauma survivor, given that so much has been lost in the past and that the victim has often felt she is living on borrowed time, saving for a future that may not occur is not considered. By imposing our values on the person we are at risk of alienating her.  It is best to recognize the difference in values and understand that as a domestic violence advocate you need to work within the values of the person for whom you are advocating.

I invite you to have discussions at your workplace that take into consideration the impact of generational poverty and trauma and work toward a greater understanding of the dynamics that occur in the decision making process and communication styles for persons who have not had the resources to be able to move beyond poverty and trauma.

Combining Feminist Relational Advocacy with Reflective Practice

Summary of the Feminist Relational Advocacy Model by Lisa A. Goodman et.al.


The following is a summary of the paper Feminist Relational Advocacy: Processes and Outcomes from the Perspective of Low-Income Women with Depression by Lisa Goodman, Catherine Glenn and Angela M. Borges of Boston College, Amanda Bohlig of the University of Wisconsin, Madison, and Victory Banyard of the University of New Hampshire. It will be followed by a brief discussion on how this model can be combined with reflective practice (see blog post of March 15, 2010) to increase advocacy effectiveness.

In the article, Goodman et.al., refer to the woman to whom advocacy is provided as the “partner”. This eliminates any perceived power or control in the advocacy relationship.

Principals of Feminist Relational Advocacy –

1. Valuing the woman’s narrative – By developing a relationship through which the advocate can come to understand and respect the woman’s perspective and the reasons underlying her choices an advocate will be able to recognize the partner’s authority to know and name what she needs, and highlight her strength and autonomy without ignoring the multiple factors that limit her range of choices. This may mean a radical approach on the part of the advocate if the woman is in a position of needing non-traditional assistance. As Goodman et. al. state, “if a woman cannot get out from under her ten bags of laundry, then the most valuable thing an advocate may do is help her devise a better system for doing laundry, or even do her laundry with her.”

2. Honoring mutuality and the development of a genuine relationship – Until it is acknowledged that any actions taken by the advocate or the survivor must occur within the context of a trusting and committed relationship many survivors will not share their real needs. Components of a genuine, healing relationship include authenticity, shared power, mutuality, and openness.

3. Emotional and instrumental support are intertwined and inseparable - Just as individuals with greater levels of emotional wellbeing feel more energized to work towards changes in their external conditions, greater access to resources may well increase individuals’ emotional wellbeing.

4. Attention to external forms of oppression as sources of distress – Instead of imposing diagnostic labels on women’s emotional distress, feminist relational advocates, work to understand its roots in social conditions. The model expresses an understanding that poor women’s distress as a reasonable response to unreasonable situations, or even as an expression of resistance to institutional oppression. “Does the woman take the job that will enable her to leave the welfare rolls, but require that her young children be unsupervised? Does she leave the abusive boyfriend and give up the only secure housing situation she has ever known?”

Combining Feminist Relational Advocacy and Reflective Practice to Transform Advocate/Client Relationships

What is reflective practice? - Reflective practice is a way of being that values and enacts ongoing personal awareness of the advocate’s contribution to the tenor and quality of the interpersonal encounter, while also holding in mind the multiple contributions of the other. This includes the ability to use non-judgmental awareness and to reflect on one’s own and other’s mental states, looking inward while looking outward, and is focused on the autonomic and emotional reactions of the self and other. (Michael Morgan PhD)

What do we know about the person with whom we are engaging? This helps to understand their personal narrative and contributes to informed advocacy. The following list factors that influence the advocates relationship and may open doors to understanding responses that the partner may have when responding within the advocate/partner relationship.

Age
Gender
Race
Cultural Background
History
Trauma History
Children? Relationship with?
Living Situation
Supports and Connections/Relationship Patterns
Education
Cognitive issues? (Traumatic brain injury, developmental disabilities or trauma related cognitive isses)
Medical issues?
Coping skills
How does the above influence the person’s ability to cope?
How does what we know influence our perceptions?
What does she say she needs? How does she ask? Does she ask for specific help or does she use other ways to express her needs?
What can the advocate provide for the survivor? How can this be provided?
What can the advocate do to help make changes to the system in order to help the survivor?
How can the advocate maintain safety and respect in the relationship?
How can the advocate care for her/himself in order to be able to maintain safety and respect?

By exploring the answers to these questions and viewing through the Feminist Relational Advocacy Model you can build the advocate/partner relationship, understand the effects of trauma, and be able to address issues that are blocking the process of advocacy and healing within that relationship. 
The above issues are best reflected upon in a group setting with people who may also have contact with the partner. This provides a wider view of the person and what she brings to the advocate/partner relationship.

Can Understanding Trauma Help Advocates Feel A Little Less “Manipulated”?

Let’s face it. Everyone once is a while we work with a survivor who manages to pushes our buttons, argues every point, doesn’t show up on time or at all and accuses you of not helping her, has burned bridges at a few agencies in town, and has not always told you the truth. Sometimes before, after or during the time you are with her you get this little feeling in your gut that you are being used, manipulated or just plain jerked around and you confide to a co-worker that you really dread going to court with this person. You may even use the label “borderline” when describing the person. All of this ends up making you feel like a horrible advocate and you start to wonder whether or not it is time to get that job in the florist shop (You know the job I am talking about – the person in the back who gets to make all the arrangements but doesn’t have to relate with the public at all. Yes, that job. The job that is all peaceful and pretty without all the drama and hair pulling.) .

The first thing I want to let you know is that no matter how bad it gets, it helps to remember that it is harder to be her than it is to work with her and all of the emotion and drama that you see on the outside is just a small percentage of what is happening inside her head. Most of that chaos can be explained by understanding how she has developed skills and behaviors in response to trauma and that the trauma may be more complex than she has been willing or able to divulge to you or anyone else.

Before I break this down into the top complaints that advocates, mental health and substance abuse clinicians, and case managers have had over the years and provide an explanation as to why the action may be occurring let me give you a brief review of what trauma does to the brain.

When the brain experiences a traumatic event the “doing” center of the brain, the amygdale, is activated into fight, flight or freeze mode. The pre-frontal cortex or frontal lobe, the “thinking center” assesses the danger and will tell the “doing” center to back down and resume normal activity. However, after many traumatic incidents (complex trauma) the “thinking” area of the brain will stop assessing, assumes the person is always under attack, and will not stop the “doing” center from going into fight, flight or freeze. Therefore, the person is in a heightened state of anxiety and hyper vigilance most of the time and develops strategies to manage that state that would seem foreign and/or maladaptive to the rest of us.

Keeping that information in mind, let’s take a look at some of the things that we often see as barriers to working with a person.

1. Not showing up, showing up late, or canceling at the last minute.

There are a couple of reasons related to trauma that this may happen on an ongoing basis. First of all, if a person has been subject to complex trauma over the course of his/her life, it is highly likely that the focus has been on personal safety and survival rather than learning skills that we often take for granted, such as keeping calendars or managing multiple appointments. We often assume that the person we are working with has the skills necessary to follow through when they may not. Their skills have to do with how to survive a potential threat, not making an appointment.

Secondly, meeting with a provider of services can be a trigger. If the reason the person is meeting with you is somehow related to a traumatic experience, then the thought of the appointment can be a reminder of the event and increase her anxiety. Other triggers could be present. She may have to drive or walk near a place an incident occurred. She may be in danger of seeing his perpetrator in the neighborhood near your office. She may not even be aware of the trigger, she just knows that meeting with you is very anxiety provoking and the appointment becomes something to be avoided. In addition, not being able to articulate why this is happening is probably why you do not receive the call. Avoidance of triggers is a survival skill.


2. Lying, telling half-truths, withholding information
The more I learn about the trauma done by perpetrators, the effects of trauma on the lives of survivors and how they are often re-victimized by bureaucratic systems and overworked, burned out staff, the more I realize that lying and withholding information is a learned skill that comes of out of self protection. If my safety depended on my ability to tell a good lie, I would become a great liar. If my basics needs and my children’s lives were dependent upon my withholding some information about my substance abuse or the whereabouts of my abuser, then I would withhold that information. If my perpetrator told me that if I told anyone about what happened then I or someone I love would be harmed, I would not tell.

Where we, as advocates, become frustrated is when we know that we are here to help and that we do not necessarily present a threat to the person and she continues to lie. Remember, in order to remain safe she has had to stop “thinking” about whether or not telling the truth is an option. She remains in “doing” mode and her survival skill is lying.

3. Accuses you of not helping.

After years of complex trauma, the survivor continues to live in survival mode. She is not able to process whether today is much better than yesterday. She wants things better now and she also doesn’t believe it will ever happen. She has been promised change by her abuser, her caretakers (often the same people), and other agencies and providers. After all of this, things are not getting better. She is still in pain. She is still frightened, hyper vigilant, and struggling to live in a world in which she does not feel safe. She feels that she has no reason to trust you or anyone else and she doesn’t trust life when it does seem to be improving.

Getting help, feeling better, making positive changes and living a new life can be terrifying to a trauma survivor who has lost a lot. The further she moves toward goals the more anxious and frightened she may become, because now she has more to lose. Safety in home, body and relationships is not something to be trusted in the mind of some trauma survivors. This takes time and an ongoing atmosphere of safety and trust in relationships.

Keeping you at a distance and not trusting you to help are survival skills.

So what do we do when working with survivors who are very committed to using their survival skills? We remember that trauma occurred in relationships and that recovery will need to take place in relationships. We can’t expect the survivor to manage recovery all on her own and we cannot take her use of survival skills personally – even when she accuses us of being the problem. Not taking it personally does not mean that we do not use appropriate boundaries to keep from being abused by the survivor. This is our opportunity to model setting boundaries, maintaining equanimity, use our basic advocacy skills, and letting the person know that we understand why they are in survival mode. We may not see immediate change in the person’s behavior, but we may find ourselves responding in ways that cause us less distress and the survivor may find herself following our lead. And, hopefully, we can put off that flower shop job a little longer.

The Fallacy of Co-Dependency and Addiction in Regards to Seeking Safety

I was having a conversation with a program director yesterday and it was brought up that there is still language in the mental health community in regards to intimate partner violence survivors being labeled as “addicted” to their abusers. This led to a discussion regarding co-dependency, addiction and being a person living with an abusive partner in her life.

The definition of addiction, “the state of being enslaved to a habit or practice or to something that is psychologically or physically habit-forming, as narcotics, to such an extent that its cessation causes severe trauma,” does a disservice to the survivors for whom we advocate and does not address the cycle of violence and the desire for the woman to manage her life in a way that keeps her and her children safe. According to the definition of addiction, separation from the habit causes trauma due to the loss and the physical effects of separation. Certain habits, skills, and coping mechanisms may be developed in a relationship in order to attempt to manage the abuser and the violence but these are in no way a sign that the person is addicted to the abuser. If anything, she is addicted to maintaining her safety and is hyper vigilant of the abuser’s activities in order to maintain that safety. This hyper vigilance is a result of complex trauma, not of an addiction.

The term “co-dependency” over the years has evolved and is often used when describing a victim of intimate partner violence who remains living within the cycle of abuse. As a movement, domestic violence advocates work hard to keep from labeling victims with descriptors that blame the victim. The original concept of codependency was developed to acknowledge the responses and behaviors people develop from living with an alcoholic or substance abuser. Like the term “addiction” however, “co-dependency” does not take into consideration the hyper vigilant behavior that arises from the complex trauma of abuse. Someone who is labeled co-dependent is attempting to control another person’s behavior in order to feeling in control and may blur boundaries in order for that to occur. However, a victim of violence has had her boundaries violated by another and has developed behaviors in order to maintain her safety. Again, these behaviors are not due to co-dependency but are survival skills developed while experiencing trauma.

When we think about what trauma does to the brain we understand a little more about how addiction and co-dependency differ. When the brain experiences a traumatic event the “doing” center of the brain, the amygdale, is activated into fight, flight or freeze mode. The pre-frontal cortex or frontal lobe, the “thinking center” assesses the danger and will tell the “doing” center to back down and resume normal activity. However, after many traumatic incidents (complex trauma) the “thinking” area of the brain will stop assessing, assumes the person is always under attack, and will not stop the “doing” center from going into fight, flight or freeze. Therefore, the person is in a heightened state of anxiety and hyper vigilance most of the time and develops strategies to manage that state that would seem foreign and/or maladaptive to the rest of us. To the victim, these strategies feel like the only way to maintain safety. This is not about being co-dependent or addicted it is about wanting to be safe.

While the trauma is occurring and the survivor is developing her skills to maintain safety she may be unable to focus on skills and behaviors for daily living. As stated above, the “thinking” area of the brain has allowed the “doing” center to take over. What we see as manipulative, co-dependent, or addictive behaviors are actually necessary skills to maintain safety and until the chemicals that have flooded the “doing” center of the brain find a healthy way to release and the “thinking” brain can function normally again, these skills will remain as the primary method of maintaining safety. This work cannot occur while trauma is still occurring and requires safe, healthy relationships with advocates and therapists who understand what is happening from a trauma-informed viewpoint. There are many modes of treatment that work to return the brain and body to balance and I recommend that you search out therapists in your area who understand trauma and trauma treatment.

Current Treatment Modalities for Complex Trauma’

Summarized by Linda Douglas
December 15, 2009

Treatment models are presented in alphabetical order with resource information given. Some of the websites have a “Provider Search” in order to be able to find therapists in your area. This list does not recommend any particular approach nor is it comprehensive. New treatment modalities are being developed each year and no approach meets the needs of everyone. The list is intended to be used as a guide to learning more about trauma treatment methods.


Accelerated Experiential Dynamic Psychotherapy
AEDP is a transformation-based, healing-oriented model of therapy. Developed by Dr. Diana Fosha, author of The Transforming Power of Affect it has roots in and resonances with many disciplines amongst them attachment theory, affective neuroscience, body-focused approaches, and transformational studies.
AEDP fosters the emergence of new and healing experiences through the in-depth processing of difficult emotional and relational experiences. Key to this experiential enterprise is the establishment of the therapeutic relationship as secure base, which is sought from the get-go.
http://www.aedpinstitute.com/

Attachment, Self-regulation, & Competency (ARC)
ARC is a framework for intervention with youth and families who have experienced multiple and/or prolonged traumatic stress. ARC identifies three core domains that are frequently impacted among traumatized youth, and which are relevant to future resiliency. ARC provides a theoretical framework, core principles of intervention, and a guiding structure for providers working with these children and their caregivers, while recognizing that a one-size-model does not fit all. ARC is designed for youth from early childhood to adolescence and their caregivers or caregiving systems.
http://www.traumacenter.org/research/ascot.php

Contextual Therapy

Contextual Therapy is based on Judith Herman’s three phase model of psychotherapy in which Phase I helps survivors firmly establish conditions of safety and a sense of interpersonal security before proceeding to direct trauma work in the second phase of therapy, followed by a third phase of integration and reconnection. The capacities gained in Phase I and III – safety, and a sense of security, integration and connection – are usually being developed by survivors of prolonged child abuse for the first time and are the priority in this type of therapy.

Courtois, C.A., Ford, Judith; Treating Complex Traumatic Stress Disorders,
2009, The Guildford Press, pgs. 227-242

Contextual Behavior Trauma Therapy
Using behavior analysis and acceptance and commitment therapy, CBTT interventions identify and modify stimulus-response changes underlying traumatic stress disorder symptoms with a foal of enhancing mindfulness, acceptance, and the therapeutic relationship. The term contextual indicates a focus on the function of behavior rather than the form and incorporates radical acceptance and behavioral activation as primary mechanisms for changing trauma-related patterns of avoidance. It includes components of Acceptance and Commitment Therapy, Dialectical Behavior Therapy, and Functional Analytic Psychotherapy. Brief descriptions of ACT and FAP follow and DBT is described in another section.
Acceptance and commitment therapy emphasizes the enhancement of acceptance, willingness, psychological flexibility, and “valued living” as a mean of challenging and reducing avoidance of experiences.
Functional analytic psychotherapy emphasizes clinically relevant behaviors that occur within the therapy relationship that functionally parallel problematic behaviors occurring outside of the session.
Courtois, C.A., Ford, Judith; Treating Complex Traumatic Stress Disorders,
2009, The Guildford Press, pgs. 264-285


Cognitive Behavioral Therapy (Trauma Focused)

CBT seeks to improve functioning and emotional well-being by identifying the beliefs, feelings, and behaviors associated with psychological disturbance and revising them through critical analysis and experiential exploration to be consistent with desired outcomes and positive life goals. It expresses an optimism about human nature, holding the belief that new ways of thinking, behaving, and feeling are possible and that the client can effect change. It incorporates psychoeducation about how the symptoms that a client experiences have evolved from trauma and engenders a sense of hope by educating about how skills training can result in change and mastery. Client and therapist are seen as co-investigators in identifying the goals of therapy.
Currently seen as treatment of choice for children and adolescents.

Courtois, C.A., Ford, Judith; Treating Complex Traumatic Stress Disorders,
2009, The Guildford Press, pgs. 243-263

http://tfcbt.musc.edu/index.php

http://www.goodtherapy.org/trauma-focused-cognitive-behavioral-therapy.html

http://www.nctsn.org/nccts/nav.do?pid=hom_main

Dialectic Behavior Therapy

DBT is a broad-based psychosocial treatment model primarily developed by Marsha Linehan primarily as a treatment for persons diagnosed with Borderline Personality Disorder. It incorporates psychotherapy in individual sessions and skills training done in group sessions. Skills training incorporates many elements of mindfulness and emotional regulation in order to assist clients in being able to manage extreme emotional dysregulation due to triggers of trauma and intense feelings of abandonment and invalidation.

Cognitive Behavioral Therapy for Borderline Personality Disorder, Marsha Linehan, 1993

http://behavioraltech.org


EFT – Emotional Freedom Technique
EFT combines the two well established sciences of Mind Body Medicine and Acupuncture/Acupressure.
It is an emotional version of acupuncture wherein meridian points are stimulated by tapping on them with fingertips. This addresses a new cause for emotional issues (unbalanced energy meridians). Proponents claim that when properly done, this frequently reduces the therapeutic process from months or years down to hours or minutes. And, since emotional stress can contribute to pain, disease and physical ailments, EFT users claim it provides physical relief. EFT practitioners teach clients about the meridian points and encourage them to use the tapping techniques at times of emotional distress in order to decrease anxiety and emotional dysregulation.
www.emofree.com
Energy Treatments
There are a number of “Energy Medicine” modalities out there that lay claim to providing relief from emotional stress. There is a lot of anecdotal evidence in regards to the effectiveness of these various modalities and more research is showing positive results. It is recommended that practitioners of these models be researched in regards to their education and training. Two schools of energy medicine that have long histories and good reputations are the Donna Eden Energy Medicine Program http://www.energymed.org and the Barbara Brennan School of Healing http://www.barbarabrennan.com/


Experiential and Emotion Focused Therapy

EEFT is related to AEDP (see above) as an experiential approach that offers a systematic template for understanding and achieving renewed emotional experiencing in the wake of psychological trauma. Both AEDP and EEFT work to enhance client’s abilities to access and explore emotional experience within an affirming empathy-based therapeutic relationship. Adaptive processing of intense emotions in the context of a safe relationship is a foundation for enlarging the trauma survivor’s perspective from preoccupation with danger and damage to a full experiencing of oneself as alive and of one’s life and relationships as having fundamental worth and meaning.

Courtois, C.A., Ford, Judith; Treating Complex Traumatic Stress Disorders,
2009, The Guildford Press, pgs. 286-311.

Eye Movement Desensitization and Reprocessing (EMDR)
Eye Movement Desensitization and Reprocessing (EMDR)1 is a comprehensive, integrative psychotherapy approach. It contains elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2.

EMDR is an information processing therapy and uses an eight phase approach to address the experiential contributors of a wide range of pathologies. It attends to the past experiences that have set the groundwork for pathology, the current situations that trigger dysfunctional emotions, beliefs and sensations, and the positive experience needed to enhance future adaptive behaviors and mental health.
During treatment various procedures and protocols are used to address the entire clinical picture. One of the procedural elements is "dual stimulation" using either bilateral eye movements, tones or taps. During the reprocessing phases the client attends momentarily to past memories, present triggers, or anticipated future experiences while simultaneously focusing on a set of external stimulus. During that time, clients generally experience the emergence of insight, changes in memories, or new associations. The clinician assists the client to focus on appropriate material before initiation of each subsequent set.
http://www.emdr.com
Gentle Reprocessing
Gentle Reprocessing™ is a complete therapy made up of a unique integration of guided imagery, inner child work, cognitive therapy and EMDR components, among other proven therapies. It is designed to gently and rapidly dissolve trauma symptoms that prevent clients from living fully. Gentle Reprocessing™ reduces symptoms of PTSD, Anxiety, Depression, OCD, phobias, abuse, and Dissociation. Gentle Reprocessing™ has also been used with success for Performance Enhancement and Anger Control.
During the development of Gentle Reprocessing™ an external and an internal approach were developed. The internal approach worked well for most adults to release traumas and mental health symptoms. The external approach was developed for children as young as 2 ½ and has been proven to work well with fragile adult clients. – from the website http://www.gentlereprocessing.com/Welcome.html

Hypnotherapy

Given that many traumatic memories are stored in the subconscious or at a cellular level, it is believed that hypnotherapy can access these memories and bring them back to the conscious so that the negative belief systems associated with the trauma can be disabled. Not all hypnotherapies are educated in trauma and possible hypnotherapies should be interviewed as to their ability to provide trauma informed services.

Internal Family Systems

The IFS Model views a person as containing an ecology of relatively discrete minds, each of which has valuable qualities and each of which is designed for, and wants to play a valuable role in the life of the person. The model evolved on the premise that the parts were forced into extreme and sometimes destructive roles when a person’s family of origin values and interactional patterns created internal polarizations that escalated over time and played out in other relationships. In therapy, the parts are recognized for their value in assisting the patient in being functional and safe. Through treatment, the Self is revealed at the center of all of the parts and is eventually able to assume leadership through negotiation with the other parts.
http://www.selfleadership.org/



Mindfulness Meditation

More of a skill rather than a treatment mode, the number of practitioners incorporating mindfulness meditation into their practice is expanding. Mindfulness meditation is body center in that the person remains completely present and focused on their body and surroundings, assessing all body sensation and emotions in a nonjudgmental manner. Research is expanding on the usefulness of mindfulness meditation on relieving symptoms of complex trauma and more information is becoming available.

http://www.umassmed.edu/Content.aspx?id=41252

Movement Therapies including Dance and Yoga
Exercise can be an important part of treatment of symptoms related to trauma. Often those experiencing difficulty with anxiety can benefit from regular cardiovascular exercise (including dance) which allows the opportunity for the body to learn recovery from arousal. On the other hand, yoga has been researched as a treatment for PTSD, or post-traumatic stress disorder. In two studies, the PTSD sufferers that were taught and practiced yoga experienced greater symptom reduction than those that were only a part of more traditional treatment.
Yoga is used as a relaxation technique because it focuses the mind and slows down the body. Simply learning to control your own breathing can allow you to feel more in control of yourself. PTSD can leave a person with constant anxiety. Those that feel they must be prepared at all times to prevent future trauma often have difficulty controlling their thoughts and focusing on the present moment. A coping skill for dealing with certain types of trauma can be disconnection from one’s own body. Although protective in certain situations, it is not generally very functional. Perhaps more than other forms of exercise, yoga encourages body awareness and connection. All of these aspects of yoga can be very healing.
http://www.yogajournal.com/health/2532

Neurofeedback
In a neurofeedback session, a computer records EEG activity (brain wave patterns) using electrodes pasted on the scalp surface. This non-invasive "listening" device is painless and comfortable. In conventional NF, an assessment of the EEG activity is done. This allows the neurotherapist to determine the pattern of training that will be most beneficial for the individual. The computer is then adjusted so that it creates a musical tone as the person begins to generate more of the desirable brain rhythms. This “neuro-feed-back” literally guides the person to a more and more calm state. Clients begin to feel a tremendous sense of empowerment as they take back what they were deprived of by the trauma — a good night’s sleep, feelings of calm and confidence, and a general sense of well-being.
The results of controlled studies, as well as clinical experience with this therapy have been tremendously encouraging. People who have been suffering from PTSD for ten and twenty years are often completely relieved of their symptoms. Follow-up testing has shown that the person becomes markedly less anxious, depression is reduced or eliminated, and the person is generally more comfortable and relaxed. The power of the traumatic incident is removed, reducing an all-consuming experience to a simpler factual memory.
http://www.traumacenter.org/clients/neurofeedback.php

Sensorimotor Psychotherapy
Most human behavior is driven by procedural memory -memory for process and function-and is reflected in automatic responses and well-learned action patterns: movements, postures, gestures, and autonomic arousal patterns, which in turn both influence and sustain emotional biases and meaning making. The emerging understanding from neurobiology about the impact of both trauma and early attachment dynamics underscore the importance of physical action to initiate new ways of perceiving reality and promote new behavior patterns. Simple actions, such as pushing away, reaching out, grasping, holding on, grounding, containment, self-touch, and orienting, correspond to psychological functions. When clients experience and practice actions specifically related to a psychological symptom or issue, the issue can be brought into present moment experience, and adaptive functioning can be positively affected. For example, exploring the physical act of reaching out can stimulate emotional pain and early memories related to reaching out, and/or fortify confidence in the possibility of asking for help and increasing social contact; experiencing the physical capacity to define one's personal space by executing the action of pushing away can strengthen the ability to secure boundaries and lessen helplessness, but might also evoke memories and feelings of boundaries not being respected or accepted in the past. – from a training announcement for the Cape Cod Institute promoting a Sensorimotor Training by Pat Odgen, the found of Sensorimotor Psychotherapy.
http://www.sensorimotorpsychotherapy.org/home/index.html
http://www.traumaresources.org/article_ogden1.htm


Somatic Experiencing

Somatic Experiencing® is a body-awareness approach to trauma being taught throughout the world. It is the result of over forty years of observation, research, and hands-on development by Dr. Levine. Based upon the realization that human beings have an innate ability to overcome the effects of trauma, Somatic Experiencing has touched the lives of many thousands. SE® restores self-regulation, and returns a sense of aliveness, relaxation and wholeness to traumatized individuals who have had these precious gifts taken away. Peter has applied his work to combat veterans, rape survivors, Holocaust survivors, auto accident and post surgical trauma, chronic pain sufferers, and even to infants after suffering traumatic births. – from the website

Also see information on Sensorimotor Psychotherapy.

http://www.traumahealing.com/

Yoga Nidra

Yoga Nidra is another form of mindfulness meditation that incorporates breathing techniques with awareness of the body. There are techniques that visualize a scan of the body to increase relaxation and lessen anxiety.

http://irest.us
http://www.swamij.com/yoga-nidra.htm