Adverse Childhood Experiences, Attachment and Resiliency

When talking about trauma, I am frequently asked about the effects of trauma on children, and if the damage can be reversed. The answer is not simple and a lot of factors contribute both to the effects of complex trauma on the child and to the ability to recover.

One of the first studies to address the effects of childhood trauma is the ACE – Adverse Childhood Experiences – study began in the 1980s and continues to this day. “The ACE Study is an ongoing collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente. Led by Co-principal Investigators Robert F. Anda, MD, MS, and Vincent J. Felitti, MD, the ACE Study is perhaps the largest scientific research study of its kind, analyzing the relationship between multiple categories of childhood trauma (ACEs), and health and behavioral outcomes later in life.” (http://www.acestudy.org/).

The study was initially begun to study obesity and weight loss. However, after finding many people regaining weight after a significant loss, the researchers began to search for clues into the reasons people began to use food, alcohol and drugs as coping mechanisms long after the weight issues were address. The researchers compiled a list of nine adverse childhood experiences and developed a point system which related to a person’s likelihood of having serious difficulties in adulthood. The nine ACEs are

1. Recurrent physical abuse
2. Recurrent emotional abuse
3. Contact sexual abuse
4. An alcohol and/or drug abuser in the household
5. An incarcerated household member
6. Someone who is chronically depressed, mentally ill, institutionalized, or suicidal
7. Mother is treated violently
8. One or no parents
9. Emotional or physical neglect

The more exposure to an ACE before the age of 18, the greater the likelihood of adverse affects as an adult. The research subjects were primarily from working class families and members of a HMO. In another ACE study that focused on childhood exposure to domestic violence, the authors found that individuals exposed to domestic violence in childhood had a two to six times greater chance of having experienced other childhood adversities. In addition, exposure to domestic violence in childhood was associated with a higher risk for self-reported alcoholism, illicit drug use, IV drug use and depression as an adult. (Felitti et al 1998, Dube et al 2001)

In addition to the extent of the history of trauma, another factor in resiliency and recovery is support and validation. This is best illustrated in the following stories:

Anna and her friend, Bridget, are seven years old, and playing outside after school one spring afternoon. Suddenly a car swerves around the corner and a gang of young men in the car start shooting at another group of men on the corner. One of the bullets hits Bridget and she is killed on the spot in front of Anna.

Anna’s family and community respond to the violence by supporting her and offering her additional counseling as needed. Her family recognizes her need for additional support and continues to check in with her on a regular basis. In addition, the community takes measure to ensure the safety of children in the neighborhood.

Sarah, also seven years old, walks five blocks to school each morning. Most mornings she is followed by a group of sixth graders who throw rocks at her, call her names, and grab at her clothing and backpack. When she tells her parents they call her a “baby’ and tell her to “toughen up” and “get over it.” The abuse continues for the full school year.

Of these two children, even given the severity of the incident, Anna is more likely to recover and have fewer symptoms of PTSD in the future. Sarah, however, will likely develop some symptoms and seek ways to escape from the emotions and fears that continue to plague her.

If the situations were reversed and Anna was not receiving validation and support, she may continue to experience nightmares and other repercussions of witnessing a traumatic death. If Sarah received support, validation, and advocacy from her parents, she may be able to recover from the effects of the abuse.

The brain is significantly affected by neglect and trauma in childhood. The following picture shows a brain of a normal three year old as compared to another three year old that has experienced extreme neglect. The brain development has been significantly impaired. The good news is that the brain has resiliency and can make positive gains once the child is placed in a home where he/she is validated, supported, and given the chance to develop positive attachments.

This relationship provides an enduring emotional bond and determines future relationships and self-regulation. It is a secure “container” that provides for basic needs and safety, and gives the freedom to explore and learn as opposed to being unavailable, lacking in safety and security. This relationship increases the child’s ability to develop trusting relationships and coping skills.

Studies on brain development have also revealed that the ability to dissociate during times of stress develops during childhood. Dissociation is the ability to psychically leave the situation and lose memory of the even. This may be due to the brain not having developed enough of the pre-frontal cortex (thinking brain) to be able to develop other skills. Dissociation may continue into adulthood.

In a future blog, I will address how cultural influences can shape a person’s viewpoint and ability to recover from complex trauma.

Domestic Violence, Trauma and Mental Health Conference Overview

On June 24, 2010 in Nashua, NH and June 25, 2010 in Meredith, NH, close to 250 members of the mental health professions and advocates from New Hampshire domestic violence and sexual assault programs met for the Mental Health, Trauma & Domestic Conference. Sponsored as a part of the Open Doors to Safety project of the NH Coalition Against Domestic and Sexual Violence, the goals of the conference included enhancing services of both mental health and DV/SA agencies to survivors with mental health issues, build a bridge between the two disciplines by using trauma theory as a common language, and start a collaborative process between existing services.

 Terri Pease, Linda Douglas, Carole Warshaw and Grace Mattern

Carole Warshaw M.D. and Terri Pease Ph.D. of the Domestic Violence and Mental Health Policy Initiative and the National Center on Domestic Violence, Trauma and Mental Health were the primary speakers for the conference and were sponsored by the National Network to End Domestic Violence (see links to the left). The following is my attempt to outline some of the topics that were discussed.

Why Address the Issues of Domestic Violence, Trauma and Mental Health?

• Domestic violence can have serious mental health consequences and abuse and violence play a significant role in the development and exacerbation of existing mental health disorders. 
• Through the Adverse Childhood Experiences Study (Felitti et. al. 1998) it has been found that the great number of risks (physical, sexual, psychological abuse; witnessing violence toward parent, household members with substance abuse, suicide attempts or incarceration) encountered in childhood, the greater the likelihood of experiencing poor health, alcohol or drug abuse, or mental illness as an adult.  
• Batterer’s use MH issues to control their partners by control meds and/or treatment and undermining sanity. Often, since symptoms of trauma are misdiagnosed as mental illness, the batterer is able to use the symptoms against the victim by way of stigma, poverty, discrimination and institutionalization.

Issues of Collaboration: Concerns of DV Programs and Survivors

• Availability and Accessibility –  
• Linguistic and cultural appropriateness 
• Priorities, time and Cost 
• Transportation and Childcare 
• Abuser Control of Insurance 
• Service Quality 
• Choice of provider 
• Providers knowledge of DV 
• Trauma informed vs. trauma competent 
• Need for gender specific services 

Trauma Theory

Trauma theory normalizes the responses that humans experience when exposed to traumatic events. It reframes many symptoms of PTSD and borderline personality disorder as adaptations and survival strategies necessary for survival in a life of complex (ongoing) trauma. Trauma theory also integrates developmental, biological, emotional, cognitive, spiritual and relational domains and challenges both DV and MH providers to expand their skill base and build a broader response to survivors of trauma.

Carole Warshaw M.D. also presented information based on research in the field of neuroscience to explain how the brain and body reacts when experiencing trauma or reminders of the trauma. Similar information is presented in previous blog postings so I will not cover it here.

In order to increase the mental health clinicians’ knowledge of what domestic violence and sexual assault advocates do, I, Linda Douglas, gave a short presentation outlining the aspects of empowerment, advocacy and privilege. As advocacy and empowerment are discussed in other blog postings I will not review here. The issue of privilege and how it pertains to the survivors confidentiality will be covered at another time.

Carole and Terri provided a forum to discuss clinical implications for mental health clinicians. Issues regarding documentation, safety planning and the dynamics of power and control were discussed along with the counter transference, transference and the parallel process that occurs in the therapeutic relationship.

On both days a case was presented and participants were asked to work together to determine what services would be needed for a survivor who is experiencing domestic violence currently and has adaptive behaviors due to complex childhood trauma. It was during this time that domestic violence advocates and mental health clinicians were able to discuss what they can do in the context of their programs and also began to identify gaps in services in their area. Hopefully, steps were taken to continue to discuss collaboration within their communities, with mental health clinicians recognizing that DV/SA advocates are doing trauma informed work with survivors and that mental health services would be valuable in providing assistance to survivors who are dealing with the affects of complex trauma.

This post can in no way cover all the important aspects of this conference. If you desire any more information, please feel free to email me with your questions or make comments below. In addition, I have provided the following bibliography for your use.

•  Warshaw, C. Domestic Violence, Trauma and Mental Health. Encyclopedia on Interpersonal Violence. (C. Renzetti and J. Edleson (eds.). Sage. Thousand Oaks, CA. 2008
•  Warshaw, C., Brashler, P., and Gill, J. Mental health consequences of intimate partner violence. In C. Mitchell and D. Anglin (Eds.), Intimate partner violence: A health based perspective. New York:
• Oxford University Press (2009)
•  Warshaw, C., Brashler P. Mental Health Treatment for Survivors of Domestic Violence. In C. Mitchell and D. Anglin (Eds.), Intimate partner violence: A health based perspective. New York: Oxford University Press (2009)
•  Herman, JL. Trauma and recovery: The aftermath of violence: domestic abuse to political terror. New York: Basic Books; 1992.
•  Davies J, Lyon E, Monti-Catania D. Safety planning with battered women: Complex lives/Difficult choices. Thousand Oaks: Sage; 1998.
•  Markham DW. Mental illness and domestic violence: Implications for family law litigation. Journal of Poverty Law and Policy. 2003;May-June:23-35.
•   Clark C, Young MS, Jackson E, et al. Consumer perceptions of integrated trauma-informed services among women with co-occurring disorders. J Behav Health Serv Res. Jan 2008;35(1):71-90.

The Brain Talk II - Traumatic Memories

I have been doing a lot of reading lately on how the brain stores memories. Most of the information is written by scientists and psychologists/psychiatrists in the field of neuroscience and is not written for the lay person. In order to understand it myself, I have translated the information into metaphors and hope that this helps my readers understand how the brain handles traumatic memories.




There are two types of memory – explicit and implicit. Explicit memory is related to events that are easily related using language. It involves facts, descriptions, concepts and ideas. It is explicit memory that enables us to tell our life story, narrate events, put experiences into words, construct a chronology and extract a meaning (Rothschild

2000, 28-29). It is easily stored into the language centers of our brain and is easily recalled. It is as if we take the memory of the event and place it tidily in one file folder, in one file drawer, into one file cabinet.

Implicit memory involves automatic states within the brain and operates unconsciously. It is implicit memory that we use when we do something we have done many times before and we no longer need to think about the action it takes, such as walking, brushing our teeth, or riding a bicycle. There may be a bridge between the two types of memory if there is a need to make sense of the unconscious action, such as trying to identify why a certain body response occurs when a person is triggered by a reminder (conscious or unconscious) of a traumatic event.

Explicit memory is also dependent on when the event occurred in a person’s development. If the brain has not developed full language and narrative abilities it may only store the event in the areas of the brain responsible for the body’s responses to the trauma.

Here is my example – When I was a year and a half old I was toddling in my grandmother’s kitchen. Someone had placed a freshly brewed (boiled/percolated) cup of coffee within my reach on the kitchen counter. I caught my finger in the handle of the cup and the hot coffee spilled down my neck and chest, resulting in third degree burns. My throat started to close up and by the time we arrived at the hospital I need to have a breathing tube. I had numerous surgeries to repair that damage which required that I be wrapped up in bandages for about six months.

I have no explicit memory of the event. The language areas of my brain were not developed. I have no visual memory of the event. All I know of that day is what my mother told me. As an adult, she was able to store the event in an area of her brain that allowed her to develop a narrative.

I have implicit memories of the event. When I was five, my mother tried to get me to wear a red hooded sweatshirt that had a tight neck. I had a complete meltdown. She tried this twice over a period of a week and then connected that I was reacting to the sensations of feeling out of control and having something over my face. As I developed, I was able to make meaning of the body memories (implicit) and have reduced the effects. I no longer have intense responses to having something over my face and around my neck. I find it uncomfortable but am able to adjust accordingly.

Even after the language and meaning making centers of the brain are developed, when traumatic events occur, our brain is flooded with large amounts of chemicals. This chemical overload will shut down the areas of the brain responsible for the explicit memories and the memories are then stored in the areas that govern sight, smell, hearing, and other body sensations. These memories are fragmented and stored in multiple areas as if the memory was torn into hundreds of puzzle pieces, placed in multiple file folders, and tucked in various file drawers. The result is that the person is unable to recall the memory in chronological order and may even mix up memories from different events, much like finding unconnected puzzle pieces and Legos in the Monopoly and Clue game boxes. It is very difficult for the person to figure out where the piece actually belongs.

What results is a survivor who cannot tell her story in a way that makes sense to the police, court or advocate. The survivor may mix up different events, be unable to relate when the incident happened, who was there, or even have blocked out certain parts of the event. For law enforcement and lawyers, who require a cohesive, sequential narrative, this can be frustrating. This may even result in a survivor being re-victimized by a system that does not understand trauma.

As advocates our job becomes assisting the person in putting together the pieces of the puzzle. Being triggered by the telling of the event is a common occurrence. It helps if the advocate can find a safe, quiet place before a court hearing where the victim can tell her story as it comes to her. Once most of the pieces are the table, then both the victim and the advocate can attempt to put them in order. Trying to have the person tell the person in chronological order right at the start would be like trying to put a puzzle together starting at the upper left corner and moving to the right and then back to the left piece by piece. The process may actually take sorting, putting a group of pieces together, discarding the pieces from another puzzle, and then trying to put the picture together. There may still be some holes when all is done but the story is there.

Finding a way to explain this process to a survivor is also helpful. You can try to find your own metaphors and make this information more accessible. Trauma survivors are often frustrated and re-traumatized by the difficulties they experience when trying to remember and make meaning out of their experiences. By understanding what is happening and having a tool box of skills to use to manage the emotions and body sensations that arise out of being triggered a victim can move to being a survivor and will be more empowered as she is able to manage and make sense out of her memories.

The following are some suggestions from the Bristol Crisis Services for Women (UK) for managing triggers or body memories of trauma –

Grounding:
• stamp your feet, grind them around on the floor to remind yourself where you are now
• look around the room, noticing the colors, the people, the shapes of things
• listen to the sounds around you: the traffic, voices, the washing machine, etc.
• feel your body, the boundary of your skin, your clothes, the chair or floor supporting you
• have an elastic band to hand - you can 'ping' it against your wrist and feel it on your skin
• tell yourself that feeling is in the now, the things you are re-experiencing were in the past.


Take care of your breathing: breathe deeply down to your diaphragm; put your hand there (just above your navel) and breathe so that your hand gets pushed up and down.

Count slowly to 5 as you breathe. When we get scared we breathe too quickly and
shallowly and our body panics. This causes dizziness, shakiness and more panic.
Breathing slowly and deeply will stop the panic.

If you have lost a sense of where you end and the rest of the world begins, rub your body so you can feel its edges, the boundary of you. Wrap yourself in a blanket, feel it around you.

My Brain Talk

This is a short version of my “brain talk” that is part of most presentations I give on trauma.

The brain is an amazing organ. Every time I get ready to present about what happens within the brain during a trauma event I am in awe of how the brain really works to try and protect us from harm. However, when exposed to chronic trauma the brain eventually goes into overdrive and ends up wearing down both the brain mechanisms that are meant to protect and the physical body.

Imagine that you are driving through a residential neighborhood on a beautiful spring day. Suddenly, you see a soccer ball bounce into the middle of the street just a few car lengths ahead of you. What is the first thing that you do? I hope that you answered “I slam on the brake!”

Did you think about slamming on the brake? Did you consciously think to yourself “Hmmm, there is a ball. There may be a child somewhere behind it. I should put on the brake. Yes, I will put on the brake.” NO – you probably just slammed on the brake and thought about it afterward. That was your amygdale engaging.

The amygdale (the doing center of the brain) is a small kidney shaped piece inside of your brain that becomes flooded with cortisol and norepinephrine during times of extreme stress. The message is sent down the brain stem and spinal cord to whichever part of the body needs to act and completely bypasses the thinking part of the brain (the frontal cortex or forebrain). In lesser amounts cortisol improves cognition and attention and stimulates the front cortex (the part of the brain behind your forehead and above your eyes). However, in large amounts, the cortisol causes the frontal cortex to shut down and the amygdale does all the work. Once the danger is over (someone has held back the children and removed the ball from the street) the frontal cortex and the amygdale can go back to a normal state.

EMTs, military personnel, and other people talk about times when they didn’t think about how to respond but just went into automatic mode during times of danger and extreme stress. This is what happens to persons who are experiencing trauma in their lives and when the danger is chronic. The frontal cortex basically stops and says “I am not even going to stop and think about things any more because this person needs to be on constant alert and ready to act.”

This explains why survivors of trauma appear to always be on guard, hyper-vigilant, ready to fight or flee, and appear to be constantly afraid. This also is the reason why some people are not able to engage in a relationship with a provider. The person’s brain has gone into a default mode of constantly being prepared for danger. The survivor has probably had few experiences of being engaged in safe relationships and may not have grown up in an environment that leads to the ability to make choices other than those needed for survival. In fact, perpetrators were probably caretakers and had said that they were only doing what was good for the person or that they were just trying to help.

Another important point to know is that if the survivor grew up in an unsafe or hostile atmosphere he/she did not have the opportunity develop normally. Most or all of development was focused on maintaining safety and survival in the environment in which he/she grew up. Some of the behaviors we may observe may seem strange or counter-productive in a safe environment. However, in their environment, these behaviors were skills to maintain safety.

Here are two examples:

In the book, The Cellist of Sarajevo by Steven Galloway, the author describes how during the siege of Sarajevo in 1992, people in the city of Sarajevo had to change how they traveled about the city. There were snipers in the mountains around the city who were shooting at people as they crossed streets on their way to get water or bread. People would congregate on street corners to decide whether or not it was safe to cross. They would cross in large groups or one by one. They would often run in a zig-zag pattern in order to be a harder target to hit. If someone who grew up or lived in a war zone such as this for a long period of time, even when they moved to a safe place, they may continue to cross the street in the same manner. For them it is an ingrained survival skill. For observers it may seem strange or a means of attracting attention.

Another story is of a personal nature. When I was in sixth grade I was bullied by a boy in my class who was two years older than the rest of us. He always waited until the math teacher came into the class as he appeared to sense that she was timid and would not stop him. He would get out of his desk and roam around the room during the math hour. At some point, sometimes once a week and sometimes not for a week or so, he would come up behind me and drive the point of his elbow into the middle of my back. I eventually was able to talk to a school counselor and it stopped. The repercussions did not end there. When I went into seventh grade I was placed in a remedial math class.

Because I had been focused on the boy and his whereabouts and was in fear of his attack, I had not learned sixth grade math. Fortunately, because I was in a nurturing environment, had my feelings regarding the bullying validated, and the abuse had stopped I was eventually able to move quickly back up to a higher level math class within the first semester of seventh grade.

The other part of the story is what I know about the boy. He came from a family of about eight children and his parents were alcoholics and known to be violent. Since he was two years older than the rest of us it is evident that he had been held back and had difficulties learning. This was more than likely because he was focused on survival at home and not on learning at school. He did not graduate from high school. I can only speculate on what the rest of his life has been like.

This story took place forty years ago. These days he probably would have been diagnosed with some sort of conduct disorder and possibly attention deficit disorder. Underneath it all, though, was the ongoing trauma in his life and that he was probably in a default mode of survival which made it difficult for him to learn anything else. This is why we may know people who have street smarts, can read faces and emotions, and have difficulties in new environments because they are looking for danger and how to manage (usually considered “manipulation”) the systems in which they are involved.

I hope this helps explain what is happening in the brain of persons who have had ongoing trauma. In future posts, I will write about how attachment and nurturing can have an impact on children who have experienced trauma and also how culture can affect a person’s response to traumatic events.

BOOK REVIEW Creating Sanctuary - Toward the Evolution of Sane Societies by Sandra Bloom

Creating Sanctuary  - Toward the Evolution of Sane Societies  by Sandra Bloom  1997, Routledge Publishing

Creating Sanctuary is an excellent book to have on the shelf at any program providing support to victims of complex trauma.  Sandra Bloom’s book is over ten years old but I found it to be a refreshing look at trauma and how organizations can build and sustain a sanctuary for victims. 

According to her biography on the Drexel University website, Dr. Sandra L. Bloom is a Board-Certified psychiatrist, graduate of Temple University School of Medicine and recently was awarded the Temple University School of Medicine Alumni Achievement Award. In addition to her faculty position at the School of Public Health at Drexel, she is President of CommunityWorks, an organizational consulting firm committed to the development of nonviolent environments. Dr. Bloom currently serves as Distinguished Fellow of the Andrus Children’s Center in Yonkers, NY.
From 1980-2001, Dr. Bloom served as Founder and Executive Director of the Sanctuary programs (see link at left), inpatient psychiatric programs for the treatment of trauma-related emotional disorders. n partnership with Andrus Children’s Center, Dr. Bloom has established a training institute, the Sanctuary Leadership Development Institute, to train a wide variety of programs in the Sanctuary Model®. The Sanctuary Model® is now being applied in residential treatment programs for children, domestic violence shelters, group homes, homeless shelters and is being used in other settings as a method of organizational development.
Dr. Bloom is a Past-President of the International Society for Traumatic Stress Studies and in addition to being the author of Creating Sanctuary: Toward the Evolution of Sane Societies and she is co-author of Bearing Witness: Violence and Collective Responsibility.

This highly readable book is broken down into five sections.  Section one is a comprehensive view of trauma theory that reviews the research done by a number of experts in the field of trauma and neuroscience.  She includes the physical, cognitive, emotional, social, and behavioral responses and discusses the innate need for the survivor to make meaning out of the trauma that has occurred.  By telling the stories of trauma survivors, Dr. Bloom demonstrates how a victim’s life can become completely organized around trauma in their thoughts, feelings, behavior and meaning making.  Section Two responds to the question “if traumatic experience is so damaging, and human history has been so traumatic, how have we survived and thrived?” by explaining how our attachments to each other and our social groups that follow us from cradle to grave help survivors heal from trauma.  Section Three discusses the social in psychiatry and how some treatment milieus and concepts have not served trauma survivors well.  Dr. Bloom speaks to the impact that feminist theory has had on psychiatry and how it facilitated a shift to a more relational and empowerment based model of meeting the needs of trauma survivors.

In sections four and five, Dr. Bloom takes the reader beyond the usual scope of trauma as an interpersonal issue that is healed within one to one relationships and encourages us to examine reconstruction society as a whole within a sanctuary model.  She lists shared assumptions that encourage the reader to look beyond diagnosing and treating to engaging in the creation of healing sanctuaries.  This includes assessing burnout, vicarious trauma, and practices within the organization that may limit the abilities of advocates and others in providing support.  

The last section, “Toward the Evolution of Sane Societies”, documents the significant trauma that occurs within society as a whole and addresses how the world at large contributes to trauma.  This book was written well before September 11, 2001 and it would be interesting to have an update in regards to Dr. Bloom sees the terrorism and the responses of our government as contributing to the traumatization of individuals and societies. According to Dr. Bloom, the globalization of trauma and the effects on individuals needs to be addressed beyond the scope of individual organizations.  It requires social changes, changes in the way we do business, changes in the classroom, recognizing justice as a force for healing trauma, creating an emotionally literate population, and being willing to bear witness and move beyond just being a bystander.

The depth of this book in addressing the issue of trauma can at times be overwhelming and challenging.  However, Dr. Bloom does an excellent job of outlining the issues surrounding traumatized societies and addressing it by creating a model for sanctuary in our organizations, social service agencies, and political institutions.

This book is being added to the NHCADSV library and is also available on Amazon.com or through your local bookseller.

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.

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.