Acknowledging Race-based Trauma

As advocates working with diverse populations, it has become more important to develop an awareness of the additional trauma that survivors may experience due to their ethnic or racial backgrounds.  According to Robert Carter PhD in his 2006 article Race Based Traumatic Stress (http://www.psychiatrictimes.com/display/article/10168/51536), race-based traumatic stress injury can be a consequence of emotional pain that a person may feel after encounters with racism.  These can be understood in terms of specific types of acts such as racial harassment or hostility, racial discrimination or avoidance and/or discriminatory harassment, and aversive hostility. How encounters with racism are experienced depends on many factors associated with an individual's background, health, and cognitive processing. Thus, the person who interprets and appraises his racial encounter as extremely negative (emotionally painful), sudden, and uncontrollable, may exhibit signs and symptoms associated with the stress and possible trauma of racism.

I worked at a shelter program in Norfolk, Virginia for many years and, having grown up in northern Wisconsin, I was admittedly unaware of how generations of racism could affect people of color. I had an encounter with a young woman of color who was bright and doing extremely well in school in spite of being relocated from her home due to domestic violence.  We were having a discussion regarding her possible educational and career options.  I mentioned to her that I thought she could be anything that she wanted to be.  She looked at me with disgust and said “no, I can’t.  I’m black and I’m a girl.”  At twelve years old she had experienced enough sexism and racism for her to develop a limited viewpoint of her options even though her abilities were far above average.  I regret that I don’t know where she is now, but I hope that she found someone to nurture her strengths and resiliency in the face of diversity and that she was able to create dreams in spite of real and perceived limitations. 

There was a woman of color in the shelter around that same time who was about my age and had a son the same age as mine.  I remember thinking one night about our similarities when it suddenly struck me.  Even though we were both women and had teenage sons, our experiences of motherhood were completely different.  Yes, both of our sons were getting into all sorts of trouble and were sometimes engaging in risky behaviors.  However, the consequences for a young black man were much greater than what could possibly happen to my son just because of the differences in the color of their skin.  Her worries were greater and more real than mine. 

I also eventually grew to realize that even though we were both women, I could walk through a shopping mall without being followed by store clerks who were checking to make sure that I wasn’t stealing.  I could apply for a job without worry that my resume would be removed from a pile because my name sounded too ethnic or because I had attended a school that had a high black student population.  I also realized that if I did well or if I did badly, my race would not be considered a factor. 

As white advocates working with women of color it is very important that we be aware of their difference of experience and the effects of insidious and implicit and explicit racism.  In the same way that domestic and sexual assault, childhood abuse, and other forms of violence create a trauma response in the brain, exposure to racism can also create lack of trust, poor self-esteem, hyper-vigilance for fear of further abuse, a sense of despair over one’s future, and a fear of re-victimization.

In the same way that we believe and validate the traumatic experiences of the assaults on survivors, it is important that we validate and believe the experiences of racism and understand the effects this could have on their ability to engage and move forward.  Also, in the same way that we focus on strength, resiliency and empowerment to help victims of gender-based trauma, we can also assist survivors of race-based trauma in finding their great strength and resiliency by acknowledging and honoring their experiences rather than being afraid to address the underlying effects of racism. 

Vicarious Trauma and Advocate Responsibility

Vicarious trauma is real and can lead to poor morale and health in advocates who are regularly exposed to the trauma of others.  The effects of vicarious trauma can mirror the reactions that we see in victims of domestic violence and sexual assault – depression, difficulty planning and making decision, and problems following through with a course of action.  An advocate may become hyper-vigilant and have difficulty sleeping. 

In order to keep on providing good advocacy services, there is a high level of responsibility on the part of the advocate to manage her/his own trauma effects.  Hopefully, an advocate is working as a part of an organization that promotes good self-care but the mission of domestic violence or sexual assault organization cannot be fulfilled if it is spending all of its time managing the trauma of its advocates.  Advocates need to consider self-care a responsibility to themselves, their organizations, and to the victim/survivors who are seeking services.  Given that an advocate is expected to perform his/her duties and provide support as a part of employment, it is imperative that self-care be done pro-actively rather than be used as an excuse not to be available to a victim/survivor.

This is becoming increasingly important as agencies are expected to do more with less.  It is not fair to the agency, co-workers, and victims if an advocate decides that the effects of vicarious trauma are so bad that she cannot provide advocacy for an afternoon or a day.  In the same way that first responders and emergency personnel are expected to work through the stress, advocates may need to find a way to continue to provide support and perform work tasks even while dealing with the effects of trauma.  Yes, we expect our agencies to be trauma informed/responsive and have an understanding of the trauma that advocates experience. However, it is the advocate’s responsibility to create a plan to manage the effects of trauma during both work and off-work hours. 

Supervision can be used to discuss the effects of vicarious trauma and can also be used to determine whether or not an advocate is truly dealing with the effects of VT or is experiencing burnout or compassion fatigue.  It may be a time to explore boundary issues, grapple with organizational skills and managing workload, or re-define success or expectations.

For some people who continue to grapple with the stress of providing advocacy to victims of abuse, it may be necessary to self-reflect on whether this particular choice of occupation is a good fit.  Sometimes it is important to admit that it is time to move on and make other choices rather than continue to work in a job that affects your health and well-being and makes it difficult for you to fulfill the expectations and mission of the organization and the victims who seek help.  This does not mean that one has failed. It just means that there was not a good fit.  There are many jobs which I have not applied for because it would not be a good fit and a few jobs in which I worked that I eventually left because it was not a good fit.  By learning what fit and what didn’t I was able to make better career decisions that fulfilled me and used my talents.  I also know, however, that I am responsible for my own self care.

The following information is from The Headington Institute.  It is an outline for managing vicarious trauma for advocates and managers. 

Make a vicarious action plan

You probably wouldn’t set out to help the people you serve without a plan. Why not give yourself the benefit of that same approach? This exercise can be completed in 15 minutes, or you can spend more time on it. We strongly recommend that you repeat it at least every couple of months.

As you complete the exercise, you might like to refer back to the text of this module. For each question we’ve included links back to the relevant section. You can also follow this link to download a list of all the “Think about” questions in this module. If you have been taking notes in response to these questions, those notes will help you complete this exercise. 

1.     List your important risk factors for vicarious trauma. These are things that get in the way of you helping others. They come from three main areas:

a.     From personal factors (e.g., past and current stress in your life)

b.     From your situation (e.g., work-related factors)

c.     From the cultural context (e.g., discrimination and attitudes of intolerance)

2.     List any signs or symptoms of vicarious trauma that you are experiencing. Think about the following areas:

 .      Physical

a.     Psychological

b.     Behavior and relationships

c.     Worldview or frame of reference (spirituality, identity, and beliefs)

3.     What are things that you can do to cope better with these symptoms? (Hint: Think about how you can counteract your risk factors, and remember that good coping strategies for vicarious trauma are things that help you take care of yourself – especially things that help you escape, rest, and play.) How can you take care of yourself in the following areas:

 .      Physical

a.     Mental and emotional

b.     Behavior and relationships

c.     At work

4.     What steps can you take that can help you transform your vicarious trauma on a deeper level? (Hint: remember that transforming vicarious trauma means identifying ways to nurture a sense of meaning and hope).

 .      Outside work

a.     During work

5.     Pick two things you have listed in response to questions 3 or 4, and think about how you will put those into practice this week. Set two specific, realistic, goals by completing the sentence below (Hint: think about how, when, and where you achieve these goals and put that in your answer too):

This week I will ______________________ to help prevent or manage vicarious trauma. 

6.     What obstacles might get in the way of you doing the two things you identified in item 5, above?

7.     What might you to do overcome the obstacles listed above? What will support you in accomplishing your goals (Hint: think about people who can support you and how they might encourage you.

What managers can do

Are you a manager? Managers can take many steps to help lessen the impact of vicarious trauma on staff they are supervising. Here are some of them.

1.     Understand the psychological and spiritual impact of humanitarian work:

a.     Be alert to how the cumulative exposure to stressful and traumatic situations may be affecting staff.

b.     Regularly check in with staff about how they’re coping – do not wait for them to approach you with a problem.

c.     Support staff in seeking counseling or coaching if and when needed.

2.     Set a good example in the way that you care for yourself, including:

 .      Work at a sustainable and reasonable pace over time, and encourage staff you supervise to do the same;

a.     Openly value things and people outside of work (e.g., time spent with your family);

b.     Take allocated leave time;

c.     Acknowledge that humanitarian work can be challenging and that healthy work/life balance takes practice and intentionality.

3.     Especially during times of increased pressure or crises, look for ways to help staff keep current challenges in perspective by:

 .      Reminding staff of the bigger picture of the organization’s mission and purpose, and how this assignment or disaster response fits into that bigger picture; and

a.     Reminding staff of the value the organization places upon them both as people and the organization’s most important resources. Encourage staff to work in sustainable ways. If that does not appear possible in the short-term, encourage them to take extra time after the immediate impact phase is over to rest and regain equilibrium.

4.     Express concern for the general well-being of your staff and not just the quality of the work they are doing.

5.     Make sure that staff suggestions and feedback about their jobs and the organization are heard and valued – even if you are fairly sure they will not result in tangible change in the near future.

6.     Do not say or do things that would stigmatize staff who are struggling with vicarious trauma or other stress or trauma-related issues.

7.     Strive to stay positive, and to praise and acknowledge effort and results whenever possible.

The Neurobiology of Sexual Assault

Please click on the following for an excellent video on the neurobiology of sexual assault.  It describes in length the concept of "tonic immobility" and the implications for investigation and advocacy.  The U.S. Department of Justice has graciously allowed for the dissemination of this information.  It is the best presentation on trauma that I have seen.

The Neurobiology of Sexual Assault: Implications for First Responders in Law Enforcement, Prosecution, and Victim Advocacy NIJ Research for the Real World Seminar December 2012 Rebecca Campbell, Ph.D., Professor of Psychology, Michigan State University

The NH Coalition Against Domestic Violence gratefully acknowledges the U.S. Department of Justice, Office of Justice Programs, National Institute of Justice, for allowing us to reproduce, in part or in whole, the recording [insert title]. The opinions, findings, and conclusions or recommendations expressed in this recording are those of the speaker(s) and do not necessarily represent the official position or policies of the U.S. Department of Justice.

Insidious Trauma – Why Anti-Oppression and Social Justice Work are Critical for Trauma-Informed Programs

While many of us working in the field of domestic violence and sexual assault address the needs of survivors of interpersonal violence and recognize the impact of oppression on the lives of victims, we may, at times, fail to realize the overlapping impact of the insidious trauma that is experienced by many groups, including women, LGBT, disabled persons, and the elderly.  Psychologist Maria Root (in a number of articles) describes insidious trauma as the impact of living in societies where stigma, discrimination, and violence against women are still very much part of the fabric of their everyday lives.  We can expand this definition to include other marginalized populations and imagine the impact on a survivor with whom we may be working.

Those of us who work in ending violence against women are well versed in understanding oppression and social injustice in regards to women.  Let’s take that same construct and move on to recognize the impact that a person’s race and/or ethnic background has on their life experience and how it sets a person up for insidious trauma.  A person of color or a different ethnicity experiencing interpersonal violence is most likely also experiencing insidious trauma that occurs from the awareness that their race/ethnicity makes them a target just by their being present in the world.  This is increased when the person is isolated in the community, separated from family and cultural supports, and recognizes their own vulnerability.  Given the messages they may be receiving from the media regarding hate crimes or how they are being treated in public, they may be experiencing some traumatic effects due to insidious trauma. 

This also applies to people with different abilities or the elderly.  In a chapter in Laura S. Brown’s book Cultural Competence in Trauma Therapy – Beyond the Flashback, Dr. Brown tells the story of a young woman with a congenital disorder that had required increased amounts of assistance from others.  This young woman developed the belief that most people who were disabled wished they were dead.  She had developed this from hearing stories of people with disabilities who were seeking physician assistant suicide and finding that there was a pervasive attitude among the non-disabled population that people with disabilities were brave to continue living and felt it was understandable that someone would want to commit suicide.  It is easy to imagine that this attitude by mainstream society could affect a person’s image of his/her self as a valuable member of society. This woman was eventually able to find a movement that protests against this attitude and supports the dignity and affirms the lives of those livings with physical challenges. 

In addition, insidious trauma occurs within the LGBT community as they hear ministers, politicians, and social network trolls make comments about hate crimes or blaming them for natural or manmade disasters such as in Hurricane Sandy or the Sandy Hook school shooting. 

Laura Brown also states that in order to be culturally competent in providing trauma-informed services we should also consider how insidious trauma may be present even if the particular person has not identified having had an experience of overt trauma.  “Everyday racism, sexism, heterosexism, ableism, and other forms of institutionalized oppression may seem so familiar to people as the background noise of their lives that they have no cognitive construct into which to place these encounters; they simply have the post trauma distress and dysfunction arising from doing battle every day against an army of small toxic agents.” Often the historical violence that has been done to a group of people such as Native Americans, Black Americans, Jews, and a large number of immigrant populations has an impact that lasts beyond the generation during which the greatest violation occurred. 

Understanding what we do about complex trauma’s impact on a survivor’s ability to trust and feel safe in the world, we now need to add the understanding that the person we are working with may also be experiencing the effects of insidious trauma.  A person may come into shelter or for other services with lack of trust and an increased sensitivity due to oppression and stigma she may have experienced or seen others of her particular group experiencing.  In the past I have heard people refer to the person as having a chip on her shoulder.  By understanding the effects of insidious trauma, we can now understand that this distrust, hypervigilance, and protective stance are a part of the effects of the trauma experienced by their particular group and should be addressed in the same way we do with other trauma survivors. 

Knowing this, it also calls us to action in regards to addressing oppression and social injustices in society.  We can do this on individual, agency, community, and national levels.  If we are to call ourselves “trauma-informed” we need to also be aware of and address those institutions, attitudes, laws, and beliefs that contribute to insidious trauma.

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.  

Three Quick Book Reviews

It felt like Christmas morning in the Coalition office yesterday when I was handed a pile of books that I had ordered.  I have had a lot of requests for books that would be suitable to recommend to trauma survivors so I had set myself on a quest to meet the need.  Here are three books that would be helpful for anyone trying to understand their own trauma responses and how to move forward toward healing.

No Comfort Zone: Notes on Living with Post Traumatic Stress Disorder by Marla Handy, 2010, Mocassa Press, Madison, WI

No Comfort Zone is a personal story told with great insight and honesty.  Marla grew up with an abusive father and a mentally ill mother.  She suffered childhood abuse and medical trauma.  Ms. Handy is able to intertwine important information about PTSD with actual stories of trauma and healing.  I do have to warn the reader, though.  As in any book that relates stories of interpersonal violence there are descriptions that could be triggering to someone with a trauma history.  However, Marla’s ability to educate via her storytelling can provide a sense of comfort to someone who feels that she is alone in her pain.  If you recommend this to a trauma survivor please let her know who she can contact for support.

The Post-Traumatic Stress Disorder Sourcebook: A guide to healing, recovery, and growth; 2^nd Ed. by Glenn R. Schiraldi, PhD., 2009, McGraw-Hill Books, NY

I would definitely recommend this book to someone who has a lot of questions as to how trauma has impacted his/her life.  The explanations of the PTSD basics including memory and anxiety are easy to understand and could be quite useful to an advocate who is looking for more ways to explain how trauma impacts the brain.  Dr. Schiraldi also discusses the necessary foundations for healing from trauma – stabilization, safety, balance and taking care of one’s health.  There is also an in-depth section on how to manage symptoms (or trauma responses).  At the end of the book he talks about transitioning to a life with less impact from the trauma and more intimacy, meaning, spiritual growth. 

Dr. Ghiraldi also gives an overview of many treatment modes used by therapists in working with trauma survivors.  It is fairly comprehensive in its descriptions of the modalities but I find that he has omitted a number of mind-body therapies.  For a more comprehensive listing of treatment modalities I would recommend ----

Healing from Trauma:  A survivor’s guide to understanding your symptoms and reclaiming your life by Jasmin Lee Cori, M.S. LPC, 2008, Da Capo Press, Cambridge, MA

Jasmin Lee Cori provides most of the information that Dr. Ghiraldi does but in a different format.  I love a chapter that is titled “Shit Happens” while still taking very seriously the impact that certain incidents can have in a person’s life.  She also does an excellent job of describing the impact of trauma on the body using wonderful examples that may be less triggering that some other books.  She also describes the impact of trauma on the body and brain and describes some interventions and tools that can be used to decrease anxiety, flashbacks, and dissociation.  She includes interventions such as trigger point therapies,  somatic therapies, and hands-on therapies. 

I was also impressed that she provided a framework for how to find an appropriate therapist, what is expected, and how to know when a person should change therapists.  She also goes more in-depth into spirituality than the above books and provides a good framework for living a healthy life beyond trauma.

I hope this is helpful as you look to make recommendations or are looking for more information for yourself. 

Book Reviews: Blackout Girl – Growing Up and Drying Out in America and Picking Up the Pieces Without Picking Up

In September of this year I attended the Office of Victims of Crime conference in New Orleans, LA.  Jennifer Storm, Executive Director of the Victim/Witness Assistance Program in Harrisburg, PA was a keynote speaker on the last day.  Ms. Storm told her story of being raped at the age of twelve and her struggles to deal with the family dysfunction, alcoholism and drug addiction that followed.  Her story was inspiring and hopeful, a narrative of resilience and determination that not only tells of recovery against all odds, but gives hope for those young women who are still struggling with the effects of trauma and its aftermath.

In her book, Blackout Girl – Growing Up and Drying Out in America, Jennifer Storm goes into great detail about her experiences.  She describes the rape, the reaction of her parents and brothers, and her subsequent fall into substance abuse.  She spent many years struggling with addiction and continued to be re-victimized in many ways including being raped again and again and experiencing intimate partner violence.  Where her book excels is in her telling of her struggles in her relationships with her mother and brothers, and how she grows into an understanding of her sexuality.  Her story is inspiring and hopeful.

I have one caveat, however.  When I heard Ms. Storm’s story and saw her book, I had hoped that this would be one I could fully recommend.  I can only recommend it with caution.  Ms. Storm tells her story of rape and substance abuse in great detail.  If you are a person with a trauma and/or history of substance use the details in this book could be triggering. I would recommend that it be read only if you are engaged in some form of ongoing support or therapy and are engaging in self-care.  Advocates and survivors often tell me that they are looking for books to read about other women who have struggled with trauma and addiction. 

Jennifer Storm has also written a guidebook for persons in recovery who are working through victimization and the court process.  It is called Picking Up the Pieces Without Picking Up.  This book is about rebuilding one’s life after the impact of trauma.  It provides exercises for dealing with trauma and addiction, using some Twelve Step (of AA) language with a strong understanding of the impact of trauma.  It also includes a chapter on navigating the criminal justice system.  This guidebook would be a great adjunct to ongoing support through a local domestic violence or sexual assault program and/or in partnership with a recovery sponsor who is knowledgeable about trauma and recovery.

You can find out more about Jennifer Storm at www.jenniferstorm.com