“My people are destroyed for lack of knowledge.” – Hosea 4:6
It Is Not The Victim’s Fault: A Trauma Therapist As Psychological First-Aid!
The Covid-19 pandemic was an unprecedented and significantly disruptive situation. Across the world, this health crisis impacted our daily lives and our mental health in many ways. Most of us had encountered the word trauma before, but the seriousness of the problem and how it affected everyone gave more of us a renewed sense of the word trauma – in ways we probably never thought before.
This pandemic may have lasting effects, and in the long term, trauma clinicians will have a crucial role to play in order to help millions around the world cope.
We recently met with California based Social Worker, Behavioral Health Specialist and Trauma Therapist Jonathan M. Wicks to discuss trauma. Jonathan’s practice questions behavioral health in relation to issues of social and economic equality. He earned his undergraduate degree in Cognitive Science with a research focus on cognitive neuroscience, and his graduate degree in Social Work; with a clinical focus on trauma.
Healing from trauma may take different forms and Jonathan M. Wicks shares some of them with us. He is used to guiding patients through traumatic events; and has developed this tool called the Trauma Wheel in order to help better understand trauma. In the end, the key is in your hands.
1. Let’s start by identifying the word trauma. How do you assess and classify trauma?
This answer is not as straightforward as one may think. For starters, trauma is a subjective experience so what may be traumatic for me, may not be traumatic for you.
There is the clinical definition of trauma which frames trauma as an experience that is life threatening to self or a loved one (e.g., domestic violence, armed robbery), or witnessing an incident that is life threatening or fatal (e.g., community violence, combat trauma, witnessing a fatal car crash), or even being informed about an incident that is life-threatening or fatal (e.g. receiving a phone call about the death of a loved one).
There is also a recent addition to the clinical space that extends trauma to include work experiences that repeatedly expose a person to traumatic content (e.g., a forensic specialist, medical examiner, coroner, etc.).
Beyond that clinical framework of trauma, the Substance Abuse and Mental Health Service Administration (SAMHSA, 2014) has their definition of trauma, which focuses on the Three E’s: an Event, that someone Experiences, that leaves an adverse Effect on the person. One last description of trauma is – too much, too fast, for too long.
Addressing Trauma during a pandemic : To What Degree Does The Pandemic Affect Us All?
The pandemic has created many new challenges. It has devastated families and communities with death and debilitating illness. It has drastically changed the way we interact with the ones we love, forcing us to distance ourselves and make sacrifices for the greater good. Maintaining employment and productivity while working remotely has created strength yet exposed organizational weakness at the same time.
For students and school personnel, the stability of the classroom and school campus routine has been shattered, and many are still recovering from the impact of the many disruptions of COVID-19. Physically, psychologically, emotionally, spiritually, and financially the pandemic has been a proving ground of resiliency. Many have fainted in this day of adversity, but many more have risen to the occasion to fight the good fight. Thinking back to the different definitions of trauma stated above – COVID-19 and the pandemic fit the mold.
2. There are some clear behavioral consequences associated with trauma. On the continuum of consequences (from minimal behavior change to suicide), what is your role in improving wellbeing. What are the long-term side effect of trauma? How are they addressed from a clinician’s perspective?
Again, trauma is subjective as each person will process and cope with situations differently.
If 5 people are in a car crash, perhaps one passenger will be traumatized, but the other 4 involved may not be traumatized by the experience. This is true of all causes of trauma (e.g., accidents, domestic violence, natural disasters, racism, medical diagnosis, military combat, etc.). What is traumatic for you, may not be traumatic for me. When interacting with a traumatized person, because of the subjective nature of trauma, it is important to understand that whatever a person was exposed to, it is their experience to share (or not).
Allowing space for a person to speak about their trauma (if they want to) is great -but forcing a person to talk about it or putting words into their mouth about how it has impacted them, or how it makes them feel, or how they behave etc. is not always helpful towards healing trauma wounds. There is no timeline to healing, and everyone processes their trauma in their own time.
If a person decides to reach out for help regarding their exposure to trauma, they can benefit from services from a trauma-informed service provider. Trauma- informed care is a model for how to best engage with a traumatized individual. This is important because not all service providers or agencies are trauma- informed (yet). A trauma-informed provider will aim to cultivate SAMHSA’s six principles of trauma-informed care in their practice setting: physical and emotional safety, transparency to build trust, peer support, collaboration and mutuality, empowerment of the client’s voice and choice, and awareness to cultural, historical, and gender issues. The goal of utilizing these principles is to avoid re-traumatizing a person, and to understand a person’s behavior and cognition within the context of their trauma history.
Regarding the impact of trauma, there are a myriad of responses a person may have after experiencing a traumatic event.
Some of these symptoms may subside after a person is safe, or removed from the threat, but other responses to trauma may last much longer. My role as a clinician in helping a traumatized client often starts with psychoeducation about trauma, including the neurobiological impact of trauma.
Much of the trauma symptoms reported by survivors of trauma can be understood through learning about the interplay of the brain areas impacted by trauma, namely the prefrontal cortex, hippocampus, and amygdala. As a clinician, helping a client gain insight into the changes in the brain can help add context to what (and why) they may be experiencing certain symptoms; especially psychoeducation on the over-activation of the amygdala which can increase threat-perception and drive survival responses.
Aside from that, helping a client develop a toolbox of healthy coping skills to help with self-regulation is critical step when working with a person exposed to trauma. Often after surviving a traumatic event, people will be triggered and go into a trauma-response (e.g., flight, fight, freeze, or fawn). Without self-regulation skills, they may have a very difficult time interacting with the world around them.
Essentially, my role as a clinical social worker is to help them find stability as they heal from the trauma wound.
Lastly, there is ample evidence that shows there can be healing in processing one’s trauma. To say that another way, if a person never addresses the traumatic experiences they have gone through, it can potentially create more distress later in life because of not healing from past wounds. This can be “scary” as some people would rather not open something from the past that has caused so much harm. It is for this reason that finding a trauma-informed clinician is an important step if a person does decide to address their trauma.
Finding a safe space to unpack the challenges the trauma has caused can be liberating, as many people do not disclose their trauma to their family or friends and carry the psychological, physiological, emotional, and spiritual weight alone.
Sometimes, this can be out of shame of what happened to them, or because they know they will not receive non-judgmental support if they do disclose their trauma history.
My role as a trauma-informed clinician is to build rapport with a client and ensure they above all feel safe, and know about the causes of trauma, the neurobiology of trauma, the common responses to trauma, the evidenced-based self-regulation and relaxation techniques (e.g. deep breathing, progressive muscle relaxation (PMR), window of tolerance, etc.), all delivered in a safe space free of judgement where the client is empowered to talk about how the trauma has impacted them; with focus on the use of healthy coping skills to manage the impact of the trauma.
I practice with evidence-based interventions and methods from cognitive behavioral therapy (CBT), trauma-focused cognitive behavioral therapy (TF-CBT), dialectical behavioral therapy (DBT), problem-solving therapy (PST), and motivational interviewing (MI). There are clinical assessment tools to further help pinpoint treatment (e.g., PCL-5, Trauma- Symptoms Inventory, etc.). If necessary, referral to psychiatry or a medical doctor may be apart of the treatment as well.
3. You developed an innovative trauma wheel. Your wheel brings a clear shift in how to address trauma. Can you tell us a bit more about this tool and how it can readily be applicable to different trauma settings?
The Trauma Wheel was created to solve a specific problem I faced in grad school. When I started my final practicum in a domestic violence (DV) crisis shelter, I quickly learned that there was not enough time to ethically treat a person’s trauma the same way I did the year before as a psychotherapist practicum student at a rape crisis center. I was prepared to continue processing trauma as a main treatment goal in the DV program. However, in the DV shelter, with families typically only being there for 45 days or less, it was not going to be the same service model.
From what we know about trauma, 45 days is not enough time to adequately address and treat a person healing from trauma. Due to the potentially complex nature of symptom management, the importance of relaxation skills and healthy coping strategies, a thorough trauma treatment would take more time than the 45-day domestic violence crisis program offered.
Nonetheless, clients in the DV shelter wanted to talk about their trauma. For many of the clients, their services in the program were the first time they ever sat with a mental health professional so quite naturally, their trauma history would be discussed.
The Trauma Wheel was created so that if a client did present with a desire to address their trauma, I could at least validate their experience, and offer psychoeducation on trauma in general. What I learned, was that even though a person would not have the opportunity to directly unpack their subjective trauma and dive deep into the long-term healing process, the fact that they learned about the common impact of trauma and the different symptoms of trauma exposure helped normalized what they were experiencing. Many clients would think they were “crazy” when in reality they were traumatized. The Trauma Wheel helped put words to what many people experience after being exposed to trauma.
The Trauma Wheel consist of six slices which each give an overview of the most common responses after surviving a traumatic event: hyperarousal, startle response, sleep disturbance, difficulty with memory and concentration, intrusive thoughts, and avoidance. The Trauma Wheel has 20 other responses that are also very common after trauma exposure (e.g., fear, self-harm, inflated ego, physical ailments, guilt, chronic exhaustion, addiction, etc.).
Helping individuals put a name to what they have been feeling in their body and mind can be transformative. It does not remove a person’s history, or make the hurt immediately go away – but it does create a clearer path towards healing. The language of trauma leads to better understanding trauma, which often times can lead towards targeted work to increase or decrease specific behaviors and thoughts related to certain symptoms of trauma exposure.
The Trauma Wheel has helped clients identify what they struggle with, which not only validates their trauma exposure, but also psycho-educates them about the impact trauma can have without requiring a client to open and disclose their direct trauma experience. Essentially, the Trauma Wheel helps to address a client’s trauma in the short-term setting – it can be a very useful tool.
To learn more about the trauma wheel, visit this website: Traumawheel
4. In 2020, during the global pandemic, a critical incidence involving a black man being murdered was recorded live. This sad event exposed racism to many; and in a traumatic way. In dealing with the psychological aftermath of this incident, many wanted sustainable changes. How to support everyone going through this transition?
As we all adjust to this transition out of the lens of white supremacy, it can be helpful to do some self-discovery by tapping into history; tapping into your own history, to be specific.
Many of African descent have holes in their family’s history, and much of the healing that can take place is attached to uncovering that hidden history. If a melanated person does not discover their own identity, society has surely offered its preference. Through the media (i.e., music, film, literature, etc.), much of the trauma of Blacks have endured has been packaged into stereotypical characters that, if not defeated through a personal journey of knowledge of self, will keep a person reliving the past hurt and embodying these types of character traits.
Developing healthy coping skills and a self-care regimen is a great way to stop societal views from becoming your own perception of self. Aside from that, having a safe space to talk about how these vicarious experiences have impacted us is important. Whether it’s with family, a friend, support group, or therapist, having a safe space to talk about all that has happened can make a big difference on wellbeing. Rather than hold all the emotions inside – find a healthy way to release them little by little, with someone who is safe. Some day soon, someone should create a 24/7 hotline that is available for those that have been impacted by systemic oppression. It can be a safe space to talk, but also to be connected to supportive services.
One of the main principles of trauma-informed care deals with historical and cultural oppression. Melanated men, women, and children have endured centuries of systemic oppression all over the planet, and due to what we know about epigenetics and how environmental stressors can cause change on the molecular level, there is still great healing work to be done within communities of color because of past trauma (Muligan, 2021).
Black folks have received some of the cruelest, harshest, and long-lasting oppression, but not much healing has ever been documented outside of the church serving – and now that most people walk around with a mobile phone that can record in high definition, much of the documented injustice has caused a global shift in the response of hate towards melanated bodies.
There is tangible evidence that things have changed, as several guilty verdicts have recently come out, which in the past may not have happened without social media (e.g., the killers of George Floyd, Ahmaud Arbery, and Daunte Wright have all been found guilty). Nevertheless, it must be stated that all this exposure to black death can be traumatizing. It is wise to take breaks from consuming this type of media content, as again, environmental stressors can impact our wellbeing in many ways, down to the subconscious level.
This can be a challenge, as most people do not choose how they respond when triggered – instead they typically go into an automatic survival response (e.g., flight, fight, freeze, or fawn). With that in mind, it can be beneficial to focus effort on the ability to self-regulate when triggered; whether that be by the NEWS, social media, or real life face-to-face interactions.
5. How to prevent the progression of trauma related to racism in the black community? The black community has been facing race-related trauma for a long time. How to educate other communities who are new to this problem? Can you share a little bit about trans-generational trauma that particularly affects this community?
Trying to engage the average person in a discussion on racism and social justice can be emotionally triggering, and even sometimes physically dangerous. Being able to speak with the right balance of emotion and intellect is a valuable skill to learn; this concept comes out of the DBT (Dialectical behavior therapy) and is referred to as the wise mind. Any worthwhile discussion on societal oppression is going to be both emotional and intellectual.
Keeping this balance in mind can help avoid burnout and further harm from systemic trauma.
All that being said – what is the solution? It’s both an individual solution and systemic solution. If every system was operating with fairness and justice, that would be a good start. However, without each person being upstanding, even with the best systems in place this still would not solve the social problems of corruption and unjust outcomes.
It is when individuals hold themselves to ethical and legal standards and are also able to operate in systems that are fair and just, that we get the best results. So, whether a person wants to focus on the individual work, or systemic work, it will take a combination of patience, emotional intelligence, empathy, and an understanding of history. If a person is willing to admit that systems need change, and they are willing to change their own thinking and behavior, then change is possible.
However, if a person is not willing to change either themselves or the systems around them – they more than likely will consume time and energy that can be better utilized elsewhere. There is no shame in leaving the presence of a fool; no matter how much evidence you have, it will never be enough to persuade a fool. Some of the work relies on knowing who is ready to work, and who is not.
It does not matter what color their skin is – ignorance comes in all shades. Some people will deny, deny, deny that any of this is “real” and that is something to understand and prepare for. Spend your time with the ones who are ready to work on self, and ready to work on changing systems.
6. In conclusion, how can a trauma therapist help restore quality of life? How does someone know they have healed from trauma? In addition to currently available interventions, what role do faith-based, spirituality and religious interventions play in reducing symptoms or stabilizing someone?
Healing from trauma can look different for everyone. Some people break their arm and are able to recover the full function of their arm. Some people can have the same type of injury and never regain the same type of function. Much like with physical recovery, the way a person psychological, physiologically, emotionally, and spiritually heals from trauma can vary.
One way to perceive healing from trauma, is whether the symptoms of trauma are still having a maladaptive impact on the person. Is the avoidance still keeping them in the house? Are they still struggling to concentrate during conversations? Do they still jump at every noise? When these types of symptoms decrease, this can be considered healing for some.
However, these types of things can continue to happen even for someone who has “healed” in other ways. Some of the reality with healing from trauma is the level of intensity with the symptoms and how they impact a person’s daily life. Some people are able to learn skills and techniques to reduce the impact of trauma to a level that is so low, they no longer meet the diagnostic criteria for PTSD.
Even without a formal diagnosis, many people are able to regain stability after a traumatic event by finding a safe environment with social support. As stated, when assessing for if someone has healed from the trauma, this depends on the presence of trauma symptoms, and the impact those symptoms have on their daily function.
In closing, please know that just because a person does not exhibit outward symptoms, this does not mean that they are free of internal struggles. Things like intrusive thoughts (e.g., flashbacks, replay of verbal abuse, etc.) or nightmares may continue in a person’s life long after they have found safety and stability.
There is no timeline on healing, and that is okay. A person may not ever fully “heal” from their trauma – but they more than likely can learn skills to better manage how they live with their trauma history. Through support and resources, some level of healing is possible.
References
Gratz, K. L., Tull, M. T., & Wagner, A. W. (2005). Applying DBT mindfulness skills to the treatment of clients with anxiety disorders. In Acceptance and mindfulness-based approaches to anxiety (pp. 147-161). Springer, Boston, MA.
Mulligan, C., 2021. Systemic racism can get under our skin and into our genes. American Journal of Physical Anthropology. Volume 175, Issue 2. Special Issue: Race reconciled II: Interpreting and communications biological variation and race in 2021.
Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
