You Can't Be Trauma-Informed If You Can't See the Trauma

Thank you for this...it is so very true.  I seem to rant every other day that being ttrauma-informed is not enough; it isn’t a tool to carry around in a toolkit.  It has to become part of what we see and how we respond every single day to folks we encounter personally and professionally.

Wonderful post, Louise.  Thanks for being so real.  This isn't easy and we all need compassion, since, as you say, we're all in it together. 

Every behavior carries a message and that is as true for us in the helping professions as it is for those we work with.  Thanks for the reminder always to stop, take a breath, and listen to our own body and emotions.

What a great post! It reminds me of one of my favorite quotes, by the surgeon Sherwin Nuland, who also wrote the fabulous books How We Die and How We Live:

"When you recognize that pain — and response to pain — is a universal thing, it helps explain so many things about others, just as it explains so much about yourself. It teaches you forbearance. It teaches you a moderation in your responses to other people’s behavior. It teaches you a sort of understanding. It essentially tells you what everybody needs. You know what everybody needs? You want to put it in a single word?

Everybody needs to be understood.

And out of that comes every form of love.

If someone truly feels that you understand them, an awful lot of neurotic behavior just disappears — disappears on your part, disappears on their part."

I've seen this firsthand with the homeless youth with which I work (certainly a traumatized group). Thanks for sharing Louise! Jill

Louise Godbold posted:

Hi Mary!

 

That's a good question. Just because we empathize doesn't mean that its okay for someone else to act in a way that is harmful to us or others. At Echo, we talk about setting limits with empathy.

For example, with the mother who was yelling at me down the phone. I made sympathetic noises and offered her empathy ("I would feel the same way too!") and gave her some space to tell her story. After it became obvious she was not going to slow down, I told her in a prosodic voice that I really wanted to hear what she had to say but it was hard when she was yelling at me. I would repeat that each time she got amped up. When she veered off into a rant I would say, "I have an idea. Do you want to hear it?" Then she would stop and listen to me. At one point, I did actually say that being yelled and cussed at didn't feel good and that it was beginning to feel abusive. 

That's where accountability comes in - letting the trauma survivor know that their actions are hurting someone else and that's not okay.

We prefer to talk about 'setting limits with empathy' because some people bandy about the word accountability and they don't mean that at all - they mean the trauma survivor should darn well get a clue and quit acting that way!

 

Hi Louise,  thanks for your responding to my comment.  I love how you balance seeing through a trauma informed lens with asking to share your ideas for solutions, as well as speaking your truth about the clients behavior as feeling abusive, and then setting healthy boundaries with empathy.  Great example.  Thanks for sharing. Mary

 I've been reading these comments to this great blog post (thanks Louise for posting!).  In  reading the last thread, it reminded me of lovingkindness meditations which I am working on in my practice.  Love for ourselves (setting boundaries, etc) is as much a part of the practice as love for other beings and often so hard to remember to prioritize!

Aw, Cissy! I wish you lived in CA too! 

I love your art project idea. I hope other people take that and run with it. What a marvelous visual reminder. 

I often quote you: "Nothing about us without us." It is why we take a survivor-driven approach. And let's be real - most of us are survivors. 67% of us have at least one ACE and that rises to 83% if you are from a community of color. I would hazard a guess it's more like 100% in the 'caring' professions! However, you'd never know it from clinical trainings. I get it - it's nice and safe behind the clinical language and pretending it's all about 'those people over there.' 

It takes courage to speak from your personal experience and you are out there doing just that, Cissy. The more we speak from a survivor perspective the more we can remove stigma and judgment, and the more we can coax people to come out of their hidey holes of shame to find healing. 

Hi Mary!

That's a good question. Just because we empathize doesn't mean that its okay for someone else to act in a way that is harmful to us or others. At Echo, we talk about setting limits with empathy.

For example, with the mother who was yelling at me down the phone. I made sympathetic noises and offered her empathy ("I would feel the same way too!") and gave her some space to tell her story. After it became obvious she was not going to slow down, I told her in a prosodic voice that I really wanted to hear what she had to say but it was hard when she was yelling at me. I would repeat that each time she got amped up. When she veered off into a rant I would say, "I have an idea. Do you want to hear it?" Then she would stop and listen to me. At one point, I did actually say that being yelled and cussed at didn't feel good and that it was beginning to feel abusive. 

That's where accountability comes in - letting the trauma survivor know that their actions are hurting someone else and that's not okay.

We prefer to talk about 'setting limits with empathy' because some people bandy about the word accountability and they don't mean that at all - they mean the trauma survivor should darn well get a clue and quit acting that way!

Oh Louise:

I LOVE reading your posts and learning from you! Thank you for being so real and honest. This part about how trauma shows up is often missing. The clinical stuff may be described but the actual ways it shows up are often not that. 

That is why a large part of Echo’s trauma trainings is dedicated to ‘how trauma shows up.’ We have so many labels, biases, and reactions stemming from our own trauma histories, that we slap on other people’s behavior and miss the trauma. Passive aggressive? Control freak? Trauma. Lack of hygiene? Emotional manipulation? Trauma. Defensiveness? Punitive? Trauma.

Also, the glasses remind me that an art teacher and I did an interactive art installation and asked trauma survivors to SHOW how trauma feels and in what ways to show what trauma looks like to the one behind the glasses and seeing the world through trauma (and maybe also a trauma-informed lens). 

Some talked dissociation and some talked feeling shattered, some felt like all they could see was fear and others talked about how they could see so little at all because they were shut down. It was SO COOL and the unexpected part was those without trauma TRIED ON the glasses and for a moment, got to see the world others did. Some glasses were covered in dirt. Some were painted. Some were cracked. Some had wonky prescriptions and words like RAGE all over them. I wish I had more pictures to share and that someone would run with it and do it again. 

It was cool because it was a way to show how those living trauma feel it and too often that piece of education is missing. How people think about trauma and understand research is important. How people live, feel and experience the world, is not always a direct line up as you know. I wish I lived in CA so I could go to every workshop AND meet you in person!
Cis

Hi Louise, I think you put it so well when you said that providers should always assume that someone has experienced trauma. Those are great questions/tips you provided about what to think about if someone is reactive in an encounter. A webinar acesconnection presented earlier this week shows how peers can help providers and health sciences students understand the ACEs and trauma they've experienced through role playing. Here's a link to the blog post about it, which includes links to the video recording. 

Hi Louise, Great post on seeing through a trauma informed lens!   Question: once you pause, reflect that the person in front of you acting out of trauma, and that you then approach them with compassion and understanding, if the person still continues to be disruptive and or abusive to you or others, how or when do you suggest setting appropriate boundaries?

Wonderful reminder to take pause and remind myself that I have not traveled another's journey. Thank you for your honesty. 

Peace,

Teri

www.teriwellbrock.com

Thank you for this oh-so-real peek at the challenges of interacting with people who "push our buttons." Even the most skillful among us can wind up in conversations that become unpleasant and unproductive. Clearly, the first and most important step toward interrupting that cycle is self-awareness and reflection. Next, come specific skills for reframing the situation, tapping compassion and conveying empathy. The Institute for Healthcare Communication has created a communication skills development workshop, THE EMPATHY EFFECT: COUNTERING BIAS TO IMPROVE HEALTH OUTCOMES, to bolster these essential skills, and make them more universally applied. For information about bringing THE EMPATHY EFFECT to your organization, please see: http://healthcarecomm.org/trai...ove-health-outcomes/ or call us, toll-free: Tel: (800) 800-5907. 

Great post! I did a workshop on ACEs and Trauma-Informed Care for home health professionals yesterday and just forwarded this as a follow-up. Thank you for your ongoing important work; we are all learning, growing, and healing!

This was very helpful. Thank you  so much for sharing this.

Wonderful article. Louise. Love how you have put it across

Once our indignation or any other parts of our wounded selves come into play, that usually goes out of the window unless you have been conditioned to wear a trauma-informed lens.

The importance of developing a compassionate heart.

When we stop reacting and instead act with wisdom and understanding.

Every moment of our day can be a practice of 'Loving Kindness Meditation.'

Thanks for posting this, Lou. Being able to hesitate, take a breath and respond kindly is a muscle that needs to be exercised often. And even then, we slip. At least I'm at the point where I know almost right away that "I shouldn't have said that!" But I'm still not at the point where I don't slip. Maybe that's just part of being human.

Excellent article and great reminder for me to remember to wear those lenses every day. The awareness that ACES has brought to me personally and my work has been a real gift. Keep it coming!