I first became aware of Trauma Informed Care (TIC) at a breakout presentation during the National Conference on Addiction Disorder (NCAD) a few years back. Upon return to my practice is when I began to more clearly appreciate the extent of trauma in the histories of the clients I was treating. I sought out more formal training on this topic, which lead me to create my own presentations on TIC for healthcare providers in the Metro Detroit area.
According to SAMSHA, “A program, organization, or system that is trauma-informed realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist re-traumatization.” (SAMHSA Tip 57. 2014).
Since that first breakout session years ago, I incorporated what I learned about TIC into my practice—specifically the concepts of re-traumatization and safety. TIC is about treating the effects of trauma on the client while not treating the trauma itself. In my opinion, this is one reason why TIC is such a powerful tool in treating what I refer to as “unhealed trauma,” especially in individuals struggling with aspects of out of control substance use and other behavior addictions.
TIC’s main premise is to prevent re-traumatizing the client and also the clinician and other staff members. In addition, according to SAMHSA, it is understood that TIC should be incorporated in all policies and procedures for any organization, hospital or clinic, so that re-traumatization can be prevented.
A critical component of TIC is to educate the client about the impact of trauma—this includes possible PTSD symptoms, the effects of trauma on the brain, and ultimately to instill hope that the client can heal. There is a long list of symptoms, but one powerful symptom of PTSD is this hypersensitivity of the need to “feel safe.” Beginning with education regarding the effects of trauma (or possibly PTSD), this allows the client to reframe their history, and begin to feel more in control of their reactions. This reframing helps the client to improve their overall emotional stability and can lessen the hypersensitivity to feeling safe.
Let’s first define what we recognize as trauma. Healthcare Providers recognize two important types of trauma today:
Acute Trauma: According to the National Institute on Mental Health (NIH), acute trauma is often connected with short-term post-traumatic stress disorder. It reflects intense distress in the immediate aftermath of a one-time event. Complex (or chronic) Trauma: According to the NIH, complex trauma is not attached to one specific event in the past, and can arise from harmful event that are repeated or prolonged. This may include the effects from prolonged Adverse Childhood Experiences (ACEs), such as neglect, and physical and sexual abuse.
TIC begins with recognizing that most individuals have some sort of acute or complex trauma in their past, what I have referred to as unhealed trauma. When a client presents with unhealed trauma at intake, the most likely diagnosis would be PTSD. Currently, the DSM 5 recognizes PTSD as a diagnosable disorder, where a certain set of criteria needs to be met. However, that set of criteria is being more closely scrutinized presently, as healthcare professionals gain a clearer understanding of the effects of trauma on an individual; e.g., the emerging evidence of the difference in PTSD and Complex PTSD.
With this knowledge base, I was struggling to accurately diagnosis my LGBTQ+ clients who were still navigating the impact of their unhealed trauma, which often included other aspects not generally recognized as being “traumatic.” For example, emerging evidence shows that growing up LGBTQ+ is a form of childhood trauma. (See the NIH Sexual & Gender Minority Research Office study “Sexual & Gender Minority Health Disparities Research Framework.)
Because I specialize in Substance Use Disorder (SUD) and the LGBTQ+ population, I struggled with how to frame the harm from past spiritual or religion abuse on this population. This is how I became familiar with what is now being referred to as “Spiritual Abuse.”
On a personal level, I was fascinated by this concept, as someone who was raised in the Roman Catholic Church, attended services with my family as a child, and was an altar boy for a few years. I have many memories of messages from the church that being gay is a sin, I was going to burn in hell for who I loved, and I had no place in the church, nor in my family for that matter, as I was considered an “abomination.”
Spiritual Abuse is quickly becoming a recognized form of complex trauma, or sometimes called Spiritual Trauma. According to the book “Affirmative Counseling with LGBTQI+ People (Ginicola, Smith, and Filmore. 2017. American Counseling Association), spiritual abuse is “the coercion and control of one individual by another in a spiritual contest. The target experiences Spiritual Abuse (SA) as a deeply emotional personal attack.”
This abuse may include, but not limited to:
- Manipulation and exploitation.
- Enforced accountability.
- Censorship of decision-making.
- Requirements for secrecy and silence.
- Pressure to conform.
- Misuse of scripture or the pulpit to control behavior.
- Requirement of obedience to the abuser.
It’s important to contextualize that spiritual abuse is situated in a cultural context, usually with a surrounding culture supporting the power imbalance between the offender and the victim (Gincola et al). For LGBTQ+ people, this is especially damaging in that parents, family and friends may also be the “perpetrator” or offender in many circumstances.
Often, in a spiritual abuse scenario, the offender is unaware of the impact of the abuse, as the offender is being motivated that they are ‘doing good; morally and ethically,’ with the stinging statement, “I’m doing this to help you.” In not recognizing the power differential coupled with the feeling for the victim of being “trapped,” this frames the “best intentions” of the offender on doing the most harm to the victim; in this case, most LGBTQ+ individuals. My intent is not to attack any particular spiritual belief. This is bringing into focus the need to understand one’s own motivation and message being sent. Even with our best intentions, as humans, we need to recognize today that our language or behavior may be “biased” in nature. In being more honest and aware, the idea here is that the message can change, be reframed, and have less of an impact on the receiver’s mental health.
I believe, especially with our LGBTQ+ clients, we need to begin talking more about the abuse of power held in the name of any Higher Power (aka God, Allah, etc.); especially when that power is invoked and wielded as a weapon against the individual’s authentic self. Our LGBTQ+ clients have already developed a core belief that they are unlovable and outcast from their families. Now they perceive that they are being “rejected” from what should be a safe and comforting institution.
As Addiction Counselors, we should task ourselves to be more versed in TIC, culturally competent approaches to addiction and specialty populations, and the importance of religious or spiritual beliefs during the treatment process. As people who treat LGBTQ+ clients, I hope we can begin to recognize the importance of treating spiritual abuse–just like any other form of complex trauma—so that our clients can begin to truly heal forming the foundations for a recovery which leads to a happy, joyous, and free existence.