When Being Trauma-Informed Is Not Enough

 

Trauma-informed care is the new gold standard. For the last several years, Echo has been providing professional development in trauma-informed care but we’re beginning to notice a worrying aspect of the new push to train staff and transform systems. Some human service professionals are seeing ‘trauma-informed care’ as another skill to add to their resume or a box to check off on a grant proposal. But if the information stays with the professionals and is not used to empower survivors, then haven’t we missed the point?

This has led us to conclude that as important as it is for service professionals to learn about trauma and resilience it is even more important that this information gets directly into the hands of survivors.

SURVIVOR EMPOWERMENT starts when we learn:

  • How trauma has impacted our brain and nervous system and how to reverse those changes
  • The quirks and tics in our behavior are not because we are crazy, broken or irreconcilably different but that these are normal responses to abnormal circumstances
  • What is abnormal is the pain, betrayal and shame of abuse
  • There is hope presented by neuroplasticity, the ability to regulate our emotions, form new mental habits and release trauma stored in our bodies, and when we rediscover trust through safe, stable nurturing relationships
  • How purpose and meaning contributes to post-traumatic growth
  • Advocating for ourselves releases us from silence, shame, and the lack of power and control we experienced during the trauma and continues to cast us as victims

The irony is that many service professionals are survivors themselves.

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Once we remove the ‘us’ and ‘them’ of trauma survivor vs. service professional we can talk more honestly about how ubiquitous trauma is in the human experience, how it shapes our behavior and our institutions, our whole society.

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We need survivor wisdom and perspective to shape a trauma-informed world. If you are a service professional who is lucky enough not to have experienced a lot of trauma in your life please make space for those who can talk from direct experience.
 
SURVIVOR WISDOM means that  we can use our stories to bring the science to life and illustrate for survivors, supporters and service professionals alike how trauma and resilience shows up in our daily lives. It means we have compassion and insight that has been acquired at great cost and is not available in a book.
 
SURVIVOR PERSPECTIVE says we are not the sum of our deficits, we are actually incredibly brave, adaptive people. By very definition we are resilient or WE WOULD NOT BE HERE. By ‘othering’ us, you add to the shame and stigma. Even the term trauma-informed ‘care’ suggests professionals have the resources to help us and we have none. If professionals advocate for us instead of empowering us and elevating our voices, understand that once again we suffer the loss of power and control we experienced during trauma.
 

At Echo, our focus is on empowering survivors.
After all, if it is not putting survivors’ interests first then
what is the point of being trauma-informed?


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“No one can ‘treat’ a war, or abuse, rape, molestation, or any other horrendous event, for that matter; what has happened cannot be undone. But what can be dealt with are the imprints of the trauma on body, mind, and soul: the crushing sensations in your chest that you label as anxiety or depression; the fear of losing control; always being on alert for danger or rejection; the self-loathing; the nightmares and flashbacks; the fog that keeps you from staying on task and from engaging fully in what you are doing; being unable to fully open your heart to another human being.


Neuroscience research shows that the only way we can change the way we feel is by becoming aware of our inner experience and learning to befriend what is going on inside ourselves.”

–Bessel Van Der Kolk,The Body Keeps the Score
 
(click image to download)
 

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I cannot agree more with this perspective. As a and educator and survivor I am passionate about helping other educators understand how trauma can affect learning in the classroom, but how do we empower these little survivors (especially if they haven't shared their story)? I really would love to see the day when survivors young and old can connect. We have school assemblies and presentations on mindfulness, stranger danger, drugs and bullying...but what about a presentation on teaching our students what trauma does to the brain where actual survivors can reach out and talk and give hope and possibly encourage our youngsters who are suffering in silence to come forward and seek help. Especially during times like we are seeing now, where media does a good job at silencing and even berating people who come out and talk about their internal battle with shame and loss of certain memories due to trauma. What kind of message are we sending to our young people if they don't witness this world lifting one another up.  I'd give anything to see more commercials about giving survivors hope, validation and a voice...than the next commercial about an anxiety or depression and how happy it can make you. We are at a crucial breaking point in society where drug addiction, hurting & shooting others (because hurt people hurt others), and suicide has reached unbelievable levels. No amount of equipping people with guns and/or drugs to band-aid the underlying problem of the effects of trauma are going to solve this. We need to CONNECT and SEE each other in a world of such disconnect. We need to give each other hope, lift one another up and validate the pain we are all feeling. Otherwise, we are at a stand still....just watching lives gets ruined and end on the daily news because we are too darn afraid to face the underlying problems head on and openly TALK about it.

Michael: I love your line that survivors are Perfectly-Adapted to a Damaged World. And - when I speak publicly I introduce myself as a woman who survived the childhood sexual abuse of incest. In that I'm defining my experience instead of my experience defining me. At the same time - it's a mouthful and I do use the shorthand of "incest survivor" a lot. That's because - my experience is still so hidden in the culture and I want others to see they are not alone in their experience - we were isolated when it was happening and we get isolated by the culture holding us back from saying what we went through. 

Michael Sirbola posted:

Culture is Biological! We need to stop referring to persons suffering from CPTSD, PTSD, Schizo-affective, Borderline & Bipolar Disorders as "SURVIVORS" which implicitly risks victim-blaming them as being damaged and transition to seeing them as being evolutionarily PERFECTLY-ADAPTED to a Damaged World. Onward!

Michael: Interesting! I hear you and think it’s an interesting point. I don’t think of survivors as a damaging or victim bling title though. I feel it’s descriptive. I did survive adversity and that’s not guaranteed. It is adaptive. And I’m a survivor.  For me, both are true. But I appreciate your perspective. It made me pause! And the emphasis on diagnosing problems and root issues rather than symptoms!

Cis 

Culture is Biological! We need to stop referring to persons suffering from CPTSD, PTSD, Schizo-affective, Borderline & Bipolar Disorders as "SURVIVORS" which implicitly risks victim-blaming them as being damaged and transition to seeing them as being evolutionarily PERFECTLY-ADAPTED to a Damaged World. Onward!

Tina:

i can feel how weary you are. I can’t argue that feeling. 

As a survivor, I want to say you were one of the first & loudest survivor advocates who I heard talking about ACEs. It was encouraging. 

I am sorry for the toll of not just ACEs but systems that often do more harm than good and seem to and often actually do retraumatize those with the most pain, ACEs, and challenges. I need people like you, Louise, Rebecca Lewis Pankratz, Renee Boynton Jarrett who do survivor led and co led power with and power sharing. There are in roads and people to learn from and who guide. 

It is still an uphill battle though and the need to rest or pause or re examine how to best serve kids is real. Those are good and horribly hard questions. My hope is we creating what we needed, what we know would have helped and that we ask far more often what people need most. And then listen.  Too often in medical sectors as well as others that question isn’t asked at all me. That, to me, is the most important question. And kids can’t speak for what they need always, but adults who were once kids with ACEs can, and you’re one of the few people who has done that. I’m sorry it’s so hard and there seems so little to do for kids and families WITH kids and families. 

I’m following this thread to learn of others that do it, attempt it, and can speak to how it works. I know Dr. Claudia Gold is also doing great work that’s really huge on listening and empathy and tangible support - not edupuking with referrals. You’re not alone. I hope you Keep sharing what you’re doing, seeing, learning, feeling. Cis

Tina Marie Hahn, MD posted:

This is why I don’t feel like I can be a doctor anymore. 

We take hurting children and tell them that something is wrong with their brain.   We tell them to take these two antipsychotics, this SSRI and this alpha-2 blocker. These are the only tools we have. We have become glorified pill pushers. Yes it is harsh but think about it for a second and you will know I’m saying the truth. 

In doing so we tell a child who has a trauma adapted brain, that it (they) are broken.   

It is no different then when I was given cyproheptadine for my crushing migraines after my grandmother was killed.  That liquid did nothing to end these headaches and my traumatized brain and body became more and more adapted to an insane world and less and less able to cope with sanity.  

I cannot do this to children. I feel like a monster abusing them in this way.   My soul feels like it is breaking. 

I hope you will all forgive me.  I don’t know how we continue in medicine this way? 

Thanks for this write up Louise. I needed to hear someone say what I have been thinking. 

Tina, you are such a bold, truthful advocate for your fellow trauma survivors. We need more of your voice. Silencing survivors is allowing the abusers to win. Not on my watch!  

Hi Tina, just wanted to say that I felt really sad after reading your post - please do not stop being a doctor, you are doing and have done amazing work. And most of all you will continue to have a positive impact on children, families and generations to come. You have influenced  medical colleagues to what is really going on  for traumatised children and families and will continue to do so. We need more people like you, not less. In your life you have been through so much and you have succeeded in turning  your experiences into doing something so good, please don't underestimate your huge contributions to making a real difference to so many. 

And remember to look after you,

Best wishes, thoughts and prayers,

Colette

This is why I don’t feel like I can be a doctor anymore. 

We take hurting children and tell them that something is wrong with their brain.   We tell them to take these two antipsychotics, this SSRI and this alpha-2 blocker. These are the only tools we have. We have become glorified pill pushers. Yes it is harsh but think about it for a second and you will know I’m saying the truth. 

In doing so we tell a child who has a trauma adapted brain, that it (they) are broken.   

It is no different then when I was given cyproheptadine for my crushing migraines after my grandmother was killed.  That liquid did nothing to end these headaches and my traumatized brain and body became more and more adapted to an insane world and less and less able to cope with sanity.  

I cannot do this to children. I feel like a monster abusing them in this way.   My soul feels like it is breaking. 

I hope you will all forgive me.  I don’t know how we continue in medicine this way? 

Thanks for this write up Louise. I needed to hear someone say what I have been thinking. 

Tawyna Hughes posted:

How can you go about getting trained in this topic?  My agency is upstate NY and we have been working on being trauma informed, but now we want to take the next step of empowering the families we work with.  Does anyone have training leads for us?  We are a not for profit community action agency so there is not much funding, but we are a passionate crew!

Hi Tawyna!

We are a training agency - happy to talk to you about how we can help. Ask for Jenny or Sofia at 213-484-6676. The infographic is free to download on our website. As you can tell, we are pretty passionate too and we love to bring this information to the families we work with so that they can be the experts on their own lives. 

Louise

Tawyna Hughes posted:

How can you go about getting trained in this topic?  My agency is upstate NY and we have been working on being trauma informed, but now we want to take the next step of empowering the families we work with.  Does anyone have training leads for us?  We are a not for profit community action agency so there is not much funding, but we are a passionate crew!

Hi Tawyna, Please check with these folks and feel free to use my name:

MHEP, INC – Mental Health Empowerment Project - https://mhepinc.org/

Director - Amy Colesante - mhepinc@aol.com

NYAPRS - https://www.nyaprs.org/  - The New York Association of Psychiatric Rehabilitation Services

Harvey Rosenthal - Director - HarveyR@nyaprs.org

Eileen Crosby - Office Mgr. - EileenC@nyaprs.org

MHEP, does a Trauma Informed training and one for peers also. NYAPRS has several options. If no luck, please let me know and I can direct you to some others.

I also present a Trauma Informed Care/practice for organizations and peer support, but there is $$$ involved. The NY agencies may have funding to allow them to come in to your organization. Same for some others based nationwide, if you can obtain funding/grant, etc.

Take care, Michael

 

How can you go about getting trained in this topic?  My agency is upstate NY and we have been working on being trauma informed, but now we want to take the next step of empowering the families we work with.  Does anyone have training leads for us?  We are a not for profit community action agency so there is not much funding, but we are a passionate crew!

Well said Louise!! Thank you!! I am grateful for the inroads that have been made in trauma informed and trauma PRACTICING care. But for the most part, it is the same old, same old for too many, and I speak from personal and professional experience as one who has presented around this country on TIC. Tomorrow finds me presenting at a conference here in NH for TIC to medical and behavioral health practitioners; I'm to share of my own experiences on the above...it still digs up hurts and the ever-present knowledge that for many practitioners, it still is business as usual.

Take care, Michael Skinner

Thank you Louise for this great posting and bravo to you and your organization. As an incest survivor activist it does my heart so much good to read your perspective. I lead writing and mindfulness workshops for sexual abuse survivors working in the field and so many say they still can't be "out" in their organizations. What you're promoting and how you promote it is helping to pry open our institutional closet doors.

THANK YOU!

Donna

Louise:
YOU KNOW I LOVE you and all Echo does. Thanks for keeping the focus where it belongs and for reminding us all that survivors matter, that survivor wisdom and survivor perspective are actually required, and that we can't forget the point of becoming trauma-informed -

to transform all of us - and our systems.

THANK YOU!!!!!!!!!!!!!!!!!!!!!!!!! Thank you! Thank you!

Cissy

P.S. I hope either of the Trauma Centers in Boston (which now has a .org and and a .net) will have outpatient services available to survivors soon and center survivor wisdom, voices, and perspectives in however they run, going forward.

This article encompasses much of what I have been thinking about and studying lately. Excellent post, with much food for thought. As a nurse, I find it fascinating that there are many of us with high ACEs, but this has not been studied nearly enough. This line makes so much sense:

The irony is that many service professionals are survivors themselves.

Thank you for breaking down the barriers between us and them because it really seems like it is a big WE.

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