I do research and see adult clients at a center that specializes in trauma. As I have developed relationships with my clients, I have noticed that the initial trauma incidents that many of my clients come into treatment for are in the past. Of course, because trauma is in the past does not mean it has healed! However, treating the initial trauma in therapy has been challenging because some of my clients are continually being abused. Many of my clients’ trauma has evolved from being about the abuse incident to being about “the system.” Time and time again, I hear from my clients that they feel abused and violated by systems. The child protective system is supposed to protect the abused child, yet treats abuse victims as suspects and perpetrators as innocents. The family court system somehow believes the domestic violence perpetrator due to their narcissism and ability to lie effectively in court. The Department of Social Service system fails them time and time again when they are at their worst physically and mentally. The criminal justice system racially profiles individuals who did nothing wrong and sometimes neglects to provide justice to victims of continual lawbreakers. The school system sometimes administratively turns a blind eye to bullying or safety issues for my clients’ children.
Sadly, some of my clients, who had trauma symptoms initiated by trauma events, are transferring these symptoms to systemic trauma. I have one client who feels hopeless and numb because their ex is still stalking them after years; they have tried everything to be protected via the court systems, and nothing has worked. I have another client who has had to fight in family court for over a decade against contact with an ex-partner who continues to show signs of a severe personality disorder. Yet, the court has not put together information about the signs over time to see the pattern of behavior. I have a client who, because of the person’s race and gender, has been traumatized by family court; they lost custody of their child when they were the most stable parent. Some clients have resigned themselves to protect themselves the best way they know how because they have realized that the court systems have not protected them.
What do we do as therapists when we are taught specific interventions in school, but those interventions do not apply to systemic trauma? We know that it is best practice for therapists to use evidence-based interventions to treat our clients, which are primarily geared toward an identified patient and are individualistic in nature. But some clients face pain from systemic problems, and these therapeutic interventions do not address this. Instead of a diagnosable disorder, some clients are experiencing a normal response (sadness, anger, frustration, fear) to a very abnormal or toxic situation. For example, anyone would have a problem if they were in the situations our clients face: constant court problems, inability to be hired, no childcare so they can work, racial injustice—the list goes on. I have many clients who were traumatized more by the child protective services, family court, medical, or criminal justice systems than they were by their own families. Systemic problems occur more frequently for clients from marginalized populations.
This personal/systemic conflict is crucial for us to consider. Applying interventions for individual problems to systemic issues is like fitting a square peg into a round hole. It is vital to avoid “blaming the victim” by pathologizing our clients for systemic problems. Yet, when therapists focus on clients’ internal struggles while ignoring the systemic issues that affect them, we blame the victim. Strategies for tackling individual problems are not the same as systemic ones. Knowing when a case is personal or systemic is vital for both therapists and the clients they serve.
Jennifer Shepard Payne, PhD, LCSW, is founder and owner of DTG Counseling and Consulting, a private practice where she provides acceptance and commitment therapy (ACT) counseling and coaching primarily to African Americans of faith suffering from anxiety or trauma. She is research faculty at Kennedy Krieger Institute, and assistant professor at Johns Hopkins University.