SOCIAL JUSTICE

Some thoughts on trauma-specific training

What social workers bring to the therapy table

BY JACKIE BARKLEY, RSW

Our college has recently determined the need for improved and accountable skill levels regarding trauma to be assessed for private therapists. Why now, what does this reflect, how do we assess the issue overall, and what are the challenges social work therapists need to consider?

First, trauma has become the new buzzword in the field of mental health, with expectations that service delivery should reflect the need for specialized education in this area. I suggest this can be traced, at least in part, to the increasingly intense political struggles of the past two years. The Truth and Reconciliation report exposed Canadian colonialism and the genocidal history settler Canadians have been unwilling to begin addressing until now. And the death of George Floyd, followed by the powerful resistance to anti Black racism has also exposed another brutal underbelly of our (white settler persons) assumptions of Canadian “goodness” and exceptionalism compared to the UK and the US with regard to white supremacy and the impact of enslavement.

Surprisingly, but positively, these movements have truly begun to pressure and have an impact on the day-to-day direct delivery of mental health counselling. Institutions such as child welfare, the Canadian military, the so called “justice” systems, the public and private mental health agencies, employee assistance programs – to name but a few – are actually being forced to assess their capacity to provide service to the increasing numbers of persons self-describing their trauma. All this added to the ongoing struggle of women experiencing sexual assault and domestic violence, and persons identifying as gender non-conforming to obtain appropriate psychological supports for their suffering means the word “trauma” (mostly appropriately – though its overuse is potentially dangerous and the subject of more discussion) is on the radar of mental health practitioners. And then we must add to this, the chronic relentless anxiety and pain experienced by persons in poverty, homeless persons and those refugees coming to Nova Scotia from war-torn countries.

This is a truly enormous surge of need for... what exactly? A crucial question, requiring critical examination in depth. We need to assess how to provide competent therapy, but simultaneously, not medicalize or individualize the causes of trauma I’ve listed above. In a time of “evidence based” treatment, commodification of mental health counselling, and an increased idolatry of “scientific” methods of service delivery (see the endless alphabetized names of packaged treatment programs purchased by the public mental health systems and the military) it is ever crucial for our profession to not simply follow a trend that will ignore the politics of trauma.

I want to put forward that unless we locate trauma in a philosophical and political discussion, we will not be able to train ourselves to be competent trauma therapists.

Both the Centre for Addiction and Mental Health (Ontario’s vast public mental health service provider) and the American Psychological Association provide descriptions of trauma as largely particular, individual experiences of shock and suffering following events. This way of conceptualizing trauma locates the individual in the event – most often an accident or natural disaster – dislocated from context, disconnected from any social forces or relationships of power and oppression.

Of course, there are people who every day go through random, awful experiences that cause deep and profound reactions. There are persons with severe psychiatric illnesses requiring specialized treatment. There are persons with unique psychological states who need the science and need the medication when appropriate. And it is very important that those of us who provide public and private mental health service be as knowledgeable as possible in the best techniques and research that inform how to treat all mentally ill and struggling persons.

But the majority of traumatic experiences can be located in injustice: racial trauma, war trauma, sexual assault trauma, trauma from genocidal acts, and hate crimes. So many persons experiencing trauma are locked in mental spaces requiring a treatment intervention that includes ideas of liberation, techniques for seeking justice, and validation. If we only “train” people in treating the psychological state of trauma, with little or no education in the injustices our clients are experiencing, then we are merely engaging in self-serving well-paid exercises in molding persons to adapt to and accommodate injustice.

Does that mean we should all become community organizers instead of therapists? No. Individual people ask for and need treatment for the self-defeating thoughts and behaviours that have been the only tools we’ve all been groomed to use under capitalism. But the individual treatment needs location in the larger social forces that have created and replicate the suffering.

The training we need is how to link the world of mental health, to the world of politics. Too often, in social work in particular, especially in social work education, the choice is either/or. We either mobilize, or work in non-profit advocacy organizations where we can be “allies” or work in the mental health professional institutions where we are forced to accept simplistic medical models and learn to condescend to our “patients” by never either challenging them or defending them. In the former, we sometimes think of ourselves as paid-to-be-radical. In the latter, we become the professionalswith-status, who are dramatically better paid. In both these locations, we need to have skills, not sentiment, and solidarity, not condescension. This will mean politicizing the content of trauma-informed health counselling, and increasing the understanding of severe mental illness and related skills among agency and community workers who provide direct services.

All of us need to be allies in the content of our trauma understanding, but also after work in our role as citizens. If we actually do begin to ground trauma training in issues of power and justice, then we are also required to do so in our lives and actions outside of work; else we must suffer the lack of credibility our clients will perceive in us, and the contempt they will heap upon us for saying one thing and acting another.

JACKIE BARKLEY, RSW, is a social worker and community organizer who lives in Halifax. Her decades of experience encompass direct delivery of mental health services and counselling in multiple settings, child welfare, geriatric assessment and corrections. She has a particular interest in cultural competence and intersectional anti-racism work.