Out Of The Tower And Into The Fray: Examples Of Integrating Trauma Advocacy Into Research And Practice

The majority of individuals worldwide have experienced some form of trauma, violence, or abuse across their lifespan (Benjet et al., 2016). A substantial proportion who experience these harms will develop associated mental and physical health consequences, as well as related social and occupational impairments. As trauma psychologists, we recognize that oppression underlies, contributes to, and complicates a person’s recovery from myriad forms of trauma and harm. Understandings of trauma are intricately tied to real-world social issues and movements, and trauma research can be used to inform activism and advocacy. To further promote research in this area, this special issue of the Journal of Trauma & Dissociation is focused on the scientific study and real-world practice of trauma advocacy and its impact in helping mitigate the negative consequences of trauma.

Advocacy in psychology, both as the authors in the special issue and as we note below, can take many forms: from writing for a public audience to working with policymakers to directly disseminate research to the communities we study. Some have argued that advocacy is a crucial element in a responsive mental health system (Stylianos & Kehyayan, 2012). As trauma mental health experts, we agree. We also strongly believe that psychologists can go beyond promoting healing and resilience at the individual level. To do so – to engage in advocacy behaviors, however – requires the difficult and daunting task of stepping outside our traditional offices with 50-minute treatment hours as well as our university classrooms.

Many of us feel comfortable and are well-positioned to work directly with traumatized individuals and families. And, of course, it is imperative that psychologists and other mental health providers empower the trauma survivors with whom they work to tap into their power to create change and to exercise choice and control in their own treatment and life choices. It is also important that mental health advocates continue to investigate and document the complex injustices, betrayals, and traumas that people experience as well as their negative consequences. To go beyond the typical way of helping heal the world, psychologists must consider the difference between, and the role they want to play, in “helping a person forced to stand in the rain attempt to dry off with a towel versus providing her with a raincoat, while investigating access to raincoats and advocating policies that produce their more equitable distribution” (Mallinckrodt et al., 2014, p. 304).

The importance of advocacy in the trauma and dissociation field cannot be underestimated. At times, with the weight of our work, it can feel like the world is filled with oppressive social, political, and economic conditions that not only impede people’s growth and development but saddles them with major mental and physical health problems. These repressive circumstances are not equitably distributed. Certain groups of individuals and communities have higher rates of traumatic exposure, unjust distribution of resources and opportunities, and greater barriers to healing. To address these systems-level issues, many trauma experts have expanded their work into communities and institutions, with the goal of positively impacting social structures, ideologies, and policies.

One form of advocacy that psychologists and other mental health advocates can engage in is sharing our clinical experiences and research findings with people who make public policy. Indeed, the American Psychological Association has had a long-standing commitment to educating policymakers about how psychological research findings can inform federal policy (Garrison et al., 2017). Advocates can share information about the nature and impact of trauma and mental illness, as well as underscore the importance of adequate funding for mental health research and for mental health parity legislation. These efforts may include arranging meetings with elected state and federal officials, facilitating coalition building to promote legislation, and developing evidence-based position papers.

Mental health advocates can also create constructive dialogues and experiential learnings, such as teaching a designated course or facilitating field-based learning opportunities (Pearrow & Fallon, 2019). As trauma psychologists, we can do as Gomez and Yassen (2007) have and work to understand and positively affect change among the many and complex systems with which trauma survivors come into contact. Trauma psychologists and other mental health professionals can help facilitate access to resources, address language and social isolation and cultural displacement, and reduce feelings of helplessness and hopelessness. And, they can disseminate trauma science and stories to a wider audience through speaking with journalists, writing op-eds or longer narratives, and speaking to traditional media or podcast-based interviewers (Cook, 2018).

This type of advocacy and action involves continual self-reflection, sharing power, building on resilience, and empowering individuals with means to promote positive social advancement (Goodman et al., 2004). A recent article by Hailes et al. (2020) outlined how practitioners can implement these ideals in practice, as well as ethical dilemmas to be mindful of when working from an advocacy and social-justice paradigm. Some psychology and counseling programs across the United States are integrating advocacy training into their curricula. In fact, there are now training models and materials that can provide a template for others to help colleges and universities in describing processes and procedures of the advocacy relationship, supervision, and community collaboration (Goodman et al., 2018).

The challenges to such work are many, and the pathways to overcoming them are not always clear. It is likely that mental health -advocates do not fully possess all the knowledge, awareness, skills, resources, and opportunities entirely necessary for advocacy. Trauma advocacy and action may also not feel or actually be viewed as valuable during the promotion process, especially if we are employed at academic institutions. In addition, institutional barriers in the form of prohibitions or limitations based on concerns about an institutions’ non-profit/501(c)(3) status may impede our engagement (Holland, 2016; Wright et al., 2020).

This special issue of the Journal of Trauma & Dissociation contains five articles that represent some of the best signs of advocacy in trauma psychology. The goal of the issue is to increase awareness of and interest in advocacy. In addition to the methodological rigor, significance and innovation of these pieces, this work is inspiring. The research and clinical practice we do as trauma specialists can be understandably challenging. These articles are filled with hope, vision, and empowerment. As editors of this special issue, we have confidence that these articles can stimulate conversations that effect change and give us space to learn from one another’s successes and struggles, and to witness real-world endeavors that involve systemic change efforts.

The first paper entitled Community-Engaged Research: A Trauma Specialist’s Tool for Action and Advocacy describes the work of Noami Wright, Julie Olomi, and Anne DePrince (Wright et al., 2020) using community engaged research to aid immigrants to gain access to victim services and legal information. Not only is this a timely and important topic, but this piece contributes greatly to the literature by providing an excellent concrete example of how do this work. This article serves as a great example of how researchers can become more community-engaged, and how they can work to improve college campus policies and practices to encourage faculty to do so.

The second paper Pride in All Who Served: Implementation of a Pilot Health Education Program for LGBT Veterans reports on a small feasibility study conducted by Michelle Hilgeman, Tiffany Lange-Altman, Kaitlin Portz, Vincent Intoccia, and Robert Cramer of an innovative intervention to enhance LGBT veterans’ identity and well-being (Hilgeman et al., 2020). Though this project is focused on the experience of stigma and discrimination, not trauma per se, there are several key points that make it particularly relevant. Chronic discrimination can be emotionally damaging for this marginalized population. The curriculum for the 10-week group was aimed at identity, the coming out process, military culture, affirmative care, family life, and utilizing community resources. Not only does this space seem to build community and pride, but veterans who participated experienced significant important change from pre-post on depression, anxiety, suicidality, resilience, coping, and sexual minority identity. This work also represents an important first step need for community members to become their own advocates within and outside of treatment.

In the third paper Rape Kit Notification: Recommendations and Barriers to Reconnecting with Survivors, Courtney Ahrens, Sherisa Dahlgren, and Rebecca Howard (Ahrens et al., 2020) explored several facets to reconnecting with sexual assault survivors whose forensic evidence is represented in the current rape kit backlog. There were several groups of key stakeholders in the study including police, legal professionals, and survivors. The advanced methodology of doing interviews to inform a survey, and then giving the survey to the same participants, is a major strength of this work, allowing for even stronger research-based recommendations to policies and practices. One of the key findings is that it is less about doing an exact procedure with all survivors, and more about the tone and general approach to victim notification.

Devon Isaacs, Melissa Tehee, Julii Green, Tamara Barrett, and Kee Straits authored the fourth paper When Psychologists Take a Stand: Barriers to Trauma Response Services and Advocacy for Native American Communities in Crisis (Isaacs et al., 2020). The authors are Native psychologists who describe their valiant advocacy efforts over the development of the Dakota Access Pipeline at Standing Rock. Working within U.S. professional psychological organizations as well as on-the-ground, this is a detailed example of crisis and sustained advocacy in indigenous groups. The authors highlight the magnitude of this systemic and unjust discriminatory treatment.

In the fifth paper Communities Healing and Transforming Trauma (CHATT): A Trauma-Informed Speakers’ Bureau for Survivors of Violence, Laurie Fields, Christine Valdez, Carla Richmond, Melissa Murphy, Maura Halloran, Alicia Boccellari, and Martha Shumway (Fields et al., 2020) address the importance of having people with lived experience of trauma involved in educating the public about their traumatic experiences. The authors measure not only the emotional growth of the speakers and facilitators, but present data on the audience members’ reactions.

Of course, the scientific study of trauma advocacy will continue to grow, evolve, and strengthen. As a field, we will continue to increase the methodological rigor and scope of our research, such as investigating if teaching advocacy skills to survivors leads to an actual decrease in their trauma sequalae or the prevention of future trauma. Further research on the intersection of trauma, advocacy, and social movements might include the influence of advocacy in assisting survivors in the process of their recovery; traumatic experiences as motivators for advocacy and activism; advocacy and dissemination of trauma science/research; trauma-related public policy advocacy; the impact of social movements (e.g., #MeToo, #BlackLivesMatter) on trauma survivors’ healing or on public perceptions; how psychologists/mental health professionals engage in trauma advocacy; the effects of advocacy training on health providers’ knowledge, attitudes and participation; and how trauma advocacy can combat stigma and prejudice against survivors.

We invite readers to think about how we, as individuals and as a group, can take the science and practice of trauma and dissociation, and use it to shape government policies (e.g., laws, regulations and mandates), programs, and initiatives to safeguard others’ welfare and promote systemic change. It is our collectivism and a sense of calling that will move mountains in this area (Autin et al., 2017).

We are in awe of and inspired by the work of these authors. We hope that this special issue encourages readers to consider advocacy as an integral part of their professional identity. We can all step outside our traditional comfort zones to use our knowledge and expertise to educate policymakers and the public, change the systems that perpetuate injustice, and to advocate for policies that will ensure inclusion, equity, and fairness. May the scholarship, advocacy and activism of the authors in this special issue be a formative light for us all.