Colonialist co-opting at the trauma-informed care conference
My work recently sent me and a hundred or so other colleagues to a day-long conference on trauma-informed care (TIC), to be presented by two bigwigs in the field who have implemented this approach at their agency in Washington, D.C. What is TIC, you ask? Well, it’s exactly what it sounds like, because social science researchers are not very creative when it comes to naming treatment modalities or theories. It’s essentially a no-brainer for a room full of social workers aggravated at being pulled away from work for an entire day and forced to wear name tags with smiley faces: simply put, TIC is a framework for understanding poverty, homelessness, mental illness, substance abuse, and so forth. At the center of many of the above problems is a history of abuse, violence, and rape; therefore, it makes sense to provide services using that lens.
We were put through a grueling lecture by the keynote speaker, who talked about his agency (a community mental health center in D.C.) and the multiple ways in which they have implemented trauma-informed strategies with not only their consumers but with staff members as well (”retraumatization” was bandied around a lot). A psychologist, he gave multiple examples of his earlier practice and all of the gaffes he had made during assessments, medication reviews and other therapeutic office visits with individuals who, as it turns out, were survivors or victims of trauma. It wasn’t until TIC as a modality was published in 2001 by another psychologist that he realized he could incorporate this lens into his practice by shifting around some agency protocol in order to make the office more client-centered. And boy, what a realization: “I was taught that, for privacy reasons, you should always shut the door after a client walks in your office,” he said. “Then one day I shut the door behind a woman and she began screaming in terror. I didn’t know what to do. Of course, it was revealed later that she had a long history of childhood sexual abuse, and to her, shutting the door and being alone in a room with a man was upsetting.”
Wow. I mean, just wow. Are you as amazed as I am that this guy has been practicing since the 60s and makes a shit-ton of money traveling around doing speaking engagements to enlighten us poor social workers who don’t have as much education? But this was the actual example he gave to illustrate his point that agency protocol should be secondary to the needs of the traumatized client, and if that means opening your door during a session, well, HIPAA be damned. Another pearl of wisdom he laid at our feet was a long story that involved him consulting his supervisor about a problem he was having with a certain client, yet another woman who had been sexually abused as an adolescent and whose life had been demolished because of it. “This woman is so hopeless, and I don’t know what to do,” he said to his supervisor. The supervisor replied, “You’ll have to lend her some of your hope.” “But how?” “Well,” said the supervisor, “you lend her some of your hope, and then I will lend you some of mine.”
At this point I burst out laughing and tried to disguise it as a coughing fit so I could go to the bathroom and laugh some more–after I puked up all that sacchirine nonsense.
However, as the day wore on there was something that began to bug the hell out of me. Through all the examples, through all the evidence-based research cited, through all the treatment approaches discussed, through all the larger societal issues dissected, I did not hear ONE mention of the fact that domestic violence sheltershave been doing these things for years. In fact, TIC may just as well be called the battered women’s movement, a grassroots campaign forged out of all that 1970s feminist awareness in which survivors of domestic violence and rape opened their homes to other victims of domestic violence and rape. Gradually, these survivors founded shelters by scraping together funds and pooling their resources, where consciousness-raising groups took place and classes in self-defense and feminist theory (a deadly combination) were taught. The hierarchal model of capitalism/patriachy was discarded in favor of collectivism and decision reached through consensus–a much lengthier and messier process, but that’s how democracy works. As I sat in this lecture hall listening to Mr. Psychologist sing the praises of consensus-based decisions, streamlining bureaucracy through collapsing or diminishing the agency hierarchy, and offering ongoing education to staff members on the ways domestic violence and rape impacts peoples’ lives, I felt myself growing more and more indignant. I could have given this fucking lecture, along with probably any number of former colleagues of mine from the domestic violence field. “Forming community partnerships with the police, with faith-based organizations, with landlords, with people in the area who can volunteer their services for wellness and self-care are things your agency may want to think about when implementing TIC strategies,” he said, like it was some kind of revelation. You think, buddy?
Of course, domestic violence shelters look a lot different today than they did in the 1970s, for better and worse. The passage of laws protecting women ultimately led to funding requirements from the government–local, state and federal–that the shelters “professionalize” by hiring educated staff and conforming to an apolitical, feel-good mission. “Smash the state” was out, “caring hands for your journey to healing” was in. (For a great and more in-depth history of this shift in the domestic violence field, the journal Feminism Psychologycontinually publishes articles, editorials and community-based research on this issue.) Still, it’s an undeniable fact that most shelters staff women and train their hotline crisis counselors, advocates and social workers to use TIC, rooted in feminist theory, even if these words are not used explicitly. Now, because some (male) researchers figured it out and gave it a sexy name, it’s become suddenly viable, a hot new treatment approach, worthy of note. Just another example of the disconnect between policy and practice, and I think it’s pretty clear which side benefits more.
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April 2nd, 2009 at 1:23 pm
I feel I should speak up for TIC, as its implementation in group homes for children and youth helps pull staff out of the dark ages. A lot of the TIC trainings I sat through in that environment focused on, say, the radical notion that helping a displaced kid feel safe was going to do her/him more good than manipulating her/him into talking about their shitty, shitty childhoods. Novel.
So much of social work just turns into a whack-off therapy session for the workers. Faced with the horror of what residents/clients/consumers have seen, it is often the worker who needs to talk about it. The worker needs to process the appalling injustices their r/c/cs’ experiences reveal. Misguidedly, workers (Jesus, at least this former worker) set about trying to meet this need to process by badgering the client about it. So in a youth context, I think the aim of TIC is to move the focus back to the needs of the kid.
Yet I agree with your nausea of beginner insights masquerading as practice-changing information. It’s horrifying that he or she with the most letters behind his or her name gets to stand up and announce such fucking pedestrian information and collect a speaker’s fee. But it’s more horrifying still how much of social work practice is conducted without said pedestrian info. (J.R., what does Paul say about whining for meat when you still need milk?)