IN THE COMMUNITY

Social work & clinical treatment of trauma

A caution

BY ROBERT S. WRIGHT, MSW, RSW, & JAMES OWEN DUBÉ, MSW, RSW

As social workers take up more and more space in clinical settings and have our clinical expertise recognized and expanded in institutional and community settings, it is important that we not stray from our roots as advocates for the most oppressed and marginalized members of our society. We must be clinicians who bring our social justice orientation and prerogative to all aspects of practice. It is important that we critique clinical practice models to ensure that they are not perpetuating or expanding the marginalization of certain populations from accessing and benefiting from mental health services. It is important that poor, fragilely housed, racialized and Indigenous persons’ needs and considerations are centred in all our practices. We cannot abandon our primary clients as our profession becomes more privileged among health practitioners.

As conceptualizations of trauma become more central to our understanding of mental health, it is important that we consider the social justice imperative in our exploration of trauma. Most would agree that trauma is complex. When we add to our understanding of trauma other lenses such as critical race theory, anti-oppressive practice, and socio-cultural intersection, the complexity explodes into a kaleidoscope of considerations that social workers must address as we work with clients.

An example of where concerns exist about trauma as a sociocultural phenomenon needing a critical race/anti-oppressive practice approach is in relation to Black male sexual victimization. Images in popular media and even reputable news media perpetuate ideas about Black men that are rooted in the history of enslavement. Though most are aware that African women were often sold into sexual slavery or regularly sexually abused by their captors, few realize that the same was true for African men. Foster (2011) described it well: “The sexual exploitation of enslaved black men took place within a cultural context that fixated on black male bodies with both desire and horror.” Foster goes on to describe graphically how African men were sexually victimized by both their male and female captors. This sexual victimization, exploitation, fetishization and demonization continued after emancipation and shaped the ideas that continue to oppress and problematize Black male sexuality to this day. This creates a barrier to Black men seeking help for their victimization and other forms of trauma.

That Black men continue to suffer as victims of sexual violence and other forms of trauma should be understood, but it is widely under-reported and poorly addressed.

We can connect the dots, however. We know, for example, that the American Centers for Disease Control and Prevention (CDC) recently amended their estimate of male, lifetime sexual assault victimization from 1 in 6 to 1 in 4 (CDC, 2021). We also know that the incidence of such traumas is dramatically higher among marginalized, criminalized, and clinical populations. With Black men disproportionately experiencing poverty, academic underachievement, and incarceration, and given the history of Black male sexual victimization, it is not a hard sell to believe they experience sexual victimization at a rate greater than 1 in 4. Yet, the clinical needs, and specifically the trauma treatment needs, of Black men are underserved.

Consequently, it is our view that the “needs” of Black men go unaddressed, and society reacts to the symptoms of Black male trauma, or the “idioms of distress” (Brown & Courtois, 2019) through a criminal justice response. That Black men are dramatically and disproportionately targeted by police and overrepresented in Canadian federal correctional institutions is well documented in Scot Wortley’s (2019) report on street checks in Halifax, and the Office of the Correctional Investigator’s (2013) special report on diversity in corrections.

Meanwhile mainstream service providers and clinical researchers provide no alternative. These largely white, middle class, university-educated women with very little exposure, let alone intimate knowledge, of Black communities (Williams et al., 2021), have shaped our understanding of what trauma is and what constitutes effective trauma treatment. Brown & Courtois (2019), as editors of companion issues of two journals, Psychotherapy and Practice Innovations, write a powerful introductory article critiquing the narrow construction of our current understanding of Post-Traumatic Stress Disorder and its treatment. They warned that “It is essential that the field of trauma treatment not prematurely foreclose around [the] limited range of treatments [described in the American Psychological Assessment Clinical Practice Guideline for the Treatment of PTSD]”. They go on to say that “We must take culture, context, and our clients’ intersectional identities into account in understanding the meaning of their trauma and their idioms of distress rather than attempt to squeeze people, particularly those from marginalized groups, into a one-size-fits-all paradigm.”

We argue that social workers are in danger of accepting a set of definitions of trauma and its effective treatments which have been marketed rather than developed as a specialist form of clinical knowledge. What are considered effective treatments have been identified by methods that conform to university models of research that are steeped in colonization and the hegemony of western scientific practice. This has also resulted in most of our modalities of trauma treatment being entirely focused on individualist, neoliberal ideas about healing, growth, and change. To suggest that this perpetuates ideas of white supremacy may seem extreme, but it is not unwarranted. This is compounded by a lack of appreciation for and intimate knowledge of the lives of Black clients. Knowledge is discounted if it is held by community elders or practitioners who have developed effective treatments for their clients but have little connection to the academy since their pre-service education.

Issues like Black male sexual victimization are clinical phenomena that can only be understood through a deep understanding of the tragic history of enslavement, the generational experience of racial trauma, and the structural anti- Black racism that causes Blacks to be overrepresented by control agencies rather than helping agencies. We argue that culturally relevant trauma treatment must incorporate eco-structural and anti-oppressive practice techniques. It must respond to the complexity of sociocultural aspects of traumatic experiences.

It is necessary to have a critical race/socio-cultural model for understanding trauma and for understanding how trauma should be treated. We have found that this is best accomplished by moving away from specific modalities and towards a clinical model based on culturally competent psychosocial assessment and intervention. This kind of advanced social work practice allows for far more complex work than more narrow, westernized modalities of trauma processing so commonly favoured by mainstream practitioners.

ROBERT WRIGHT, MSW RSW, is an African Nova Scotian social worker who has worked extensively in trauma and antiracism. Robert is also well known for creating Impact of Race and Culture Assessments, a specialized, clinical, presentence report for African Canadians.

JAMES DUBÉ, MSW, RSW, is a white social worker who has been mentored by Robert and other Black social workers for the past six years. He has been a substantial contributor to developing culturally accessible services at The Peoples’ Counselling Clinic.

The authors are co-founders of The Peoples’ Counselling Clinic, which provides direct services and public education focused on issues of trauma, race, sex and gender. They work with under-served populations, including those who have experienced trauma.

REFERENCES:

Annual Report of the Office of the Correctional Investigator 2012-2013. (2013). Office of the Correctional Investigator.

Brown, L. & Courtois, C. (2019). Trauma treatment: The Need for Ongoing Innovation. Practice Innovations, 4(3), 133-138.

Centers for Disease Control and Prevention. (2021, April 19).Sexual violence is preventable. Centers for Disease Controland Prevention. Retrieved January 3, 2022, from https://www.cdc.gov/injury/features/sexual-violence/index.html

Foster, T. (2011). The Sexual Abuse of Black Men under American Slavery. Journal of the History of Sexuality, 20(3), 445-464.

Williams, M. T., Osman, M., Gran-Ruaz, S., & Lopez, J. (2021). Intersection of racism and PTSD: Assessment and treatment of Racial Stress and Trauma. Current Treatment Options inPsychiatry. https://doi.org/10.1007/s40501-021-00250-2

Wortley, S., & Nova Scotia Human Rights Commission. (2019).Halifax, Nova Scotia: Street checks report. Toronto, Ont.: S. Wortley