Trauma-Informed Care: Is Your Eye on the Thread or the Jewel?
by Pat Shelly
“Knowing that human beings are multiple in our identities, and that those identities are intersectional is foundational to cultural competence [but] not sufficient. Why is this? Because this only speaks to intellectual competence and I would argue that cultural competence is emotional competence. How do we hold the ambiguity of our own and our clients’ identities [and how they inform one another]? …trauma-informed and culturally competent care means good quality, compassionate, empathic, and attuned care.”
– excerpt from keynote address, Trauma Talks 2012: Advancing the Dialogue on Trauma-Informed Care,
by Laura S. Brown, Ph.D.
The above quote from the 2012 Trauma Talks conference and this article about a keynote from the 2014 conference demonstrate how trauma-informed care is continually developing to provide greater sensitivity while addressing complexities in treatment.
Cécile Rousseau, MD, gave a keynote at Trauma Talks 2014: Advancing Cultural Understandings in Trauma-Informed Care, entitled “Culture, trauma transmission and posttraumatic reconstruction.” Dr. Rousseau is the director of the Transcultural Child Psychiatry Clinic at Montreal Children’s Hospital, and a faculty member at McGill University. She works with children who are refugees, immigrants, and trauma survivors, and publishes widely on issues affecting these populations.
Offering brief case studies, reviews of research on empathy and trauma transmission, while raising issues for clinical practice, this keynote gave me new perspectives regarding trauma-informed practice.
Trauma-informed practice encompasses principles of safety/trustworthiness, choice/collaboration/empowerment, and a strengths-based approach. It “emphasizes physical, psychological, and emotional safety for both providers and survivors…[it] creates opportunities for survivors to rebuild a sense of control and empowerment.”
(Hopper, Bassuk & Olivet, 2010, pg. 82)
In the keynote, Dr. Rousseau spoke of the ‘gift’ (the story or account of the trauma) that the therapist receives, and the privilege of engaging, offering acceptance, and paying careful attention to the power relations between individuals and therapists.
She gave examples of trauma transmission, such as the institutional abuse of power by those who deal with refugees in other settings. A judge in an asylum hearing may be so overwhelmed by the extent of violence and injury suffered by the refugee that the reaction is one of disbelief – or even anger – at the refugee. For the refugee, by “causing” the (unacknowledged) discomfort or pain, the consequence may be denial of asylum and deportation.
A therapist may feel overwhelmed as well, and become an unreliable partner in therapy by withdrawing from the pain caused by hearing the story of the trauma.
Rousseau described some cultural aspects of a Western / individualized / medical model approach that is often present in trauma-informed practice in North America, and the mismatch that can result when a person is from a non-Western society (i.e., not of the European or North American dominant culture).
Individuals who come from the latter type of society – in which health care is based on wellness and resiliency, where everything is interconnected and community is an essential consideration for recovery from trauma – need a very different approach to healing.
In one of the most poetic parts of her presentation, Rousseau commented that often standard (Western) trauma-informed care could be likened to jewelry: the focus is on the ‘jewel’ – the traumatic event – and the belief that healing can start only once the jewel is revealed and the story is told. Therapy then progresses toward a beginning of finding meaning and reconciliation.
With a non-Western approach, the process can be seen as embroidery, with the trauma being just one thread among many in life’s fabric, comprised of self, family, community, ancestors, place, land, water, sky, and more.
The focus then may be on survival, not trauma – especially in situations where war, mass rape, torture and other dislocations require that the more immediate concerns of safety, shelter, or providing for one’s family are addressed. Sometimes, the therapist may have to collude, she said, in avoidance of the specifics of the trauma in order for the person to to assert priorities of physical security or other basic needs over healing.
Having worked with many families from Guatemala, Rousseau spoke of how the Maya people have survived massacres by Spanish colonizers and then 20th century juntas perpetrating wide-spread acts of state-sponsored violence.
The Maya know they will continue to survive. By seeing the treatment of such trauma as a strand in the embroidery of this historical truth, the therapist can acknowledge the perserverance of culture, language, and strong identity that can support healing.
In teaching and implementing trauma-informed practices, it is important to remember to look beyond that jewel that is so attractive and brilliant. We must remember the embroideries that are woven of many experiences, encompassing survival, stability and growth, pain, loss, and destruction, as well as times of joy and peace. As with a community, so too with the individual.
How do you define cultural competency in therapy? What examples could you add to Rousseau’s examples of institutional transmission of trauma or that inflicted by therapists? Tell us your thoughts!
Hopper, E.K., Bassuk E.L. & Olivet J. (2010). Shelter from the Storm: Trauma-Informed Care in Homelessness Services Settings. The Open Health Services and Policy Journal, 3(2):80-100.
Trauma-Informed Social Work Practice: What is It and Why Should We Care? by Nancy J. Smyth
Culturally Competent Supervision podcast with Hilary Weaver, DSW
Cécile Rousseau bio & publications
Slides from Laura S. Brown’s 2012 keynote presentation on Cultural Competency in Treating Trauma
Slides from the second keynote at Trauma Talks 2014 by Suzanne L. Stewart, PhD “Intergenerational Trauma:Indigenous Perspectives on Healing and Healthcare”