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A Dissertation Submitted to the Faculty of the California Institute of Integral Studies in Partial Fulfilment of the Requirements for the Degree of Doctor of Psychology in Clinical Psychology ...

A Dissertation Submitted to the Faculty of the California Institute of Integral Studies in Partial Fulfilment of the Requirements for the Degree of Doctor of Psychology in Clinical Psychology California Institute of Integral Studies San Francisco, CA 2012 - Jennifer Mullan-Gonzalez, Psy.D Psychologist/ Peers Educating Peers (PEP) Coordinator & Adjunct Professor of Psychology

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SLAVERY AND THE INTERGENERATIONAL TRANSMISSION OF TRAUMA IN INNER CITY AFRICAN AMERICAN MALE YOUTH: SLAVERY AND THE INTERGENERATIONAL TRANSMISSION OF TRAUMA IN INNER CITY AFRICAN AMERICAN MALE YOUTH: Document Transcript

  • SLAVERY AND THE INTERGENERATIONAL TRANSMISSION OF TRAUMA IN INNER CITY AFRICAN AMERICAN MALE YOUTH: A MODEL PROGRAM—FROM THE COTTON FIELDS TO THE CONCRETE JUNGLE by Jennifer Mullan-Gonzalez 220 Meadow Lane #B32 Secaucus, NJ 07094 (201) 210-2745 Jennyjennm@gmail.com A Dissertation Submitted to the Faculty of the California Institute of Integral Studies in Partial Fulfilment of the Requirements for the Degree of Doctor of Psychology in Clinical Psychology California Institute of Integral Studies San Francisco, CA 2012
  • CERTIFICATE OF APPROVAL I certify that I have read SLAVERY AND THE INTERGENERATIONAL TRANSMISSION OF TRAUMA IN INNER CITY AFRICAN AMERICAN MALE YOUTH: A MODEL PROGRAM—FROM THE COTTON FIELDS TO THE CONCRETE JUNGLE by Jennifer Mullan- Gonzalez and that in my opinion this work meets the criteria for approving a dissertation submitted in partial fulfilment of the requirements for the Doctor of Psychology in Clinical Psychology at the California Institute of Integral Studies. _____________________________________ Tanya Wilkinson, Ph.D., Chair Core Faculty, Clinical Psychology _____________________________________ Robert Morgan, Ph.D External Reviewer
  • © 2012 Jennifer Mullan-Gonzalez View slide
  • Jennifer Mullan-Gonzalez California Institute of Integral Studies, 2012 Tanya Wilkinson Ph.D., Committee Chair SLAVERY AND THE INTERGENERATIONAL TRANSMISSION OF TRAUMA IN INNER CITY AFRICAN AMERICAN MALE YOUTH: A MODEL PROGRAM—FROM THE COTTON FIELDS TO THE CONCRETE JUNGLE ABSTRACT This theoretical study investigated trauma associated with the intergenerational transmission of slavery—not as an institution or an experience, but as a collective memory grounded in the identity formation of a people, particularly Black Africans in the United States. Current U.S. programs either do not acknowledge slavery or the intergenerational transmission of trauma as goals for treatment; rather individuals are treated with treatment for Posttraumatic Stress Disorder (PTSD) or complex trauma. Such treatments are insufficient at treating the transmission of the trauma of chattel slavery in urban African American male adolescents because those youth may have already experienced complex trauma, including racial oppression and inner city violence. This study examined the intergenerational transmission of trauma through a synthesis of literature on the effect of chattel slavery on the culture, identity, and souls of African American male youth from the inner city. Results indicate that, along with learned dysfunctional patterns, the trauma iv View slide
  • of chattel slavery can indeed be transmitted intergenerationally through indirect and direct methods that can impact daily functioning. Also, many programs for African American male adolescents are focused on external behaviors and designed to address the behavioural elements associated with PTSD; greater success may be achieved by treating the underlying causes. A sizeable body of literature supports the notion that slavery as a form of intergenerational trauma is evidenced in the psychological development of African American adolescent males residing in the inner city. Terms include Posttraumatic Slave Syndrome (Leary, 2005) or Post Traumatic Slavery Disorder (Mims et al., 2005). Untreated intergenerational trauma from chattel slavery has resulted in nonbeneficial symptoms in the enslaved Africans’ offspring that need to be honoured and healed for current Black male youth. This is crucial information for psychologists, clinicians, educators, and the criminal justice system working with African American male adolescents residing in the inner city regarding how externalizing behaviours are treated, conceptualized, interpreted, prevented, and addressed. A new model program is proposed to identify and reassess treatment goals, add symptoms (e.g., vacant esteem, ever present anger, racist socialization), and provide a culturally sensitive model of healing for African American adolescents who reside in urban areas. v
  • ACKNOWLEDGMENTS Creator and all my relations Mom and Dad Eliu Lin & Obe Gayle Karina Gabby Dr. Tanya Wilkinson Anna Fitzpatrick PEP External Supporters: Natty, Sara, KT, Priya, Ivonne, Sharifa, Erin, Cyndy, Juan Counseling center team, PEP, Dr. John Sherry, Dr. Allan DeFina, Dr. Susan Esquilin, Dr. Nelson, Dr. A. LaMar, Secaucus Library vi
  • DEDICATION For all of my “sons” past, present & future Para mi Abuelito, Benigno Mark For my Father, James P. Mullan For my Partner, Eliu Gonzalez For ALL MY RELATIONS. The lessons have been visceral and healing. For this and more I thank you. vii
  • TABLE OF CONTENTS Acknowledgments..................................................................................................vi Acknowledgments..................................................................................................vi Chapter 1: Introduction............................................................................................1 Chapter 1: Introduction............................................................................................1 Overview of the Study.................................................................................9 Overview of the Study.............................................................................................9 Purpose of the Study ................................................................................11 Purpose of the Study ............................................................................................11 Chapter 2: Review of the Literature ......................................................................12 Chapter 2: Review of the Literature ......................................................................12 What is Trauma? ......................................................................................12 What is Trauma? ..................................................................................................12 Complex Trauma ..........................................................................17 Complex Trauma ..................................................................................................17 Trauma and African American Male Youth..................................20 Trauma and African American Male Youth..........................................................20 Resilience.......................................................................................25 Resilience...............................................................................................................25 Community as Family....................................................................28 Community as Family............................................................................................28 Racial Oppression, Racial Identity, and Complex Trauma............29 Racial Oppression, Racial Identity, and Complex Trauma....................................29 viii
  • Racial Oppression..............................................................29 Racial Oppression..................................................................................................29 Racial Identity....................................................................33 Racial Identity........................................................................................................33 Racial Oppression as Complex Trauma.............................37 Racial Oppression as Complex Trauma.................................................................37 What Is Trauma Transmission?.................................................................40 What Is Trauma Transmission?.............................................................................40 .......................................................................................................40 ...............................................................................................................................40 Modes of Transmission .................................................................40 Modes of Transmission .........................................................................................40 Mechanisms of Trauma Transmission...........................................42 Mechanisms of Trauma Transmission...................................................................42 Biological Mechanisms......................................................44 Biological Mechanisms..........................................................................................44 Intrapsychic Mechanisms...................................................45 Intrapsychic Mechanisms.......................................................................................45 Attachment Mechanisms....................................................47 Attachment Mechanisms........................................................................................47 Social Learning Mechanisms.............................................53 Social Learning Mechanisms.................................................................................53 The Family Systems Perspective ......................................55 The Family Systems Perspective ..........................................................................55 Indigenous Perspectives on Trauma..............................................57 ix
  • Indigenous Perspectives on Trauma......................................................................57 Chapter 3: Intergenerational Transmission of Trauma and Trauma Treatment......................60 Chapter 3: Intergenerational Transmission of Trauma and Trauma Treatment......................60 Research on Intergenerational Trauma .....................................................63 Research on Intergenerational Trauma .................................................................63 Posttraumatic Slave Syndrome..................................................................72 Posttraumatic Slave Syndrome..............................................................................72 Vacant Esteem...............................................................................73 Vacant Esteem.......................................................................................................73 Ever Present Anger........................................................................74 Ever Present Anger................................................................................................74 Racist Socialization........................................................................78 Racist Socialization................................................................................................78 Trauma Treatments....................................................................................81 Trauma Treatments................................................................................................81 Cognitive-Behavioral Therapy.......................................................83 Cognitive-Behavioral Therapy...............................................................................83 Eye Movement Desensitization Reprocessing (EMDR)................84 Eye Movement Desensitization Reprocessing (EMDR)........................................84 Trauma-Focused Cognitive Behavioral Therapy (TF-CBT).........86 Trauma-Focused Cognitive Behavioral Therapy (TF-CBT).................................86 Dialectical Behavior Therapy (DBT) ............................................87 Dialectical Behavior Therapy (DBT) ....................................................................87 Process-Oriented Group Therapy..................................................92 x
  • Process-Oriented Group Therapy..........................................................................92 Peter Levine’s Theory of Charging Frozen Energy.......................97 Peter Levine’s Theory of Charging Frozen Energy...............................................97 Mindfulness Interventions of Integrated Treatment of Complex Trauma for Adolescents (ITCT-A)................................................99 Mindfulness Interventions of Integrated Treatment of Complex Trauma for Adolescents (ITCT-A)...........................................................................................99 Intergenerational Trauma Treatment Model (ITTM) ...................99 Intergenerational Trauma Treatment Model (ITTM) ...........................................99 Post-Traumatic Slavery Disorder Treatment Model (PTSlaveryD) ......................................................................................................101 Post-Traumatic Slavery Disorder Treatment Model (PTSlaveryD)....................101 .....................................................................................................102 .............................................................................................................................102 The premise of the PTSlaveryD model is that many mental health professionals are taught traditional Eurocentric paradigms and approaches in regard to mental health treatment and conceptualization. Mims et al. (2005) firmly believe that in order to provide effective mental health treatment to the descendents of the “African Holocaust,” it is first important that mental health professionals are provided with the history of the issues, such as displacement and the post-Jim Crow era effects, so they can better assist their clients in healing current day troubles. The model focuses on issues such as the psychological impact of losing cultural history, the mental suicide and homicide that the authors have termed Mentalcide, and the loss of collective spirit and identity as a race and a people (Mims et al., 2005). ...................102 The premise of the PTSlaveryD model is that many mental health professionals are taught traditional Eurocentric paradigms and approaches in regard to mental health treatment and conceptualization. Mims et al. (2005) firmly believe that in order to provide effective mental health treatment to the descendents of the “African Holocaust,” it is first important that mental health professionals are provided with the history of the issues, such as displacement and the post-Jim Crow era effects, so they can better assist their clients in healing current day troubles. The model focuses on issues such as the psychological impact of losing cultural history, the mental suicide and homicide that the authors have termed xi
  • Mentalcide, and the loss of collective spirit and identity as a race and a people (Mims et al., 2005). ............................................................................................102 Much like the work of sociologist Joy DeGruy Leary and Post- Traumatic Slave Syndrome (PTSS) described and synthesized above, Mims et al. (2005) delineate PTSD from the African Holocaust and PTSlaveryD, clarifying that PTSD stems from a traumatic event while PTSlaveryD was a massive traumatic event with cumulative effects on individuals and the community. PTSlaveryD treats symptoms such as avoidance of the event of slavery, adoption of a victim identity, impaired interpersonal relationships, emotional numbing particularly with Black men, isolation of affect, anger, and psychotic disorders (Mims et al., 2005). Mims et al. (2005) also specify that the DSM-IV does not reflect cultural differences and that there appears to be no correlation or credence given to pathologies or disorders associated with the effects of racism. The PTSlaveryD model provides various steps and stages through which an individual can engage in the process of “recovery from Mentalcide” (p. 67).....................103 Much like the work of sociologist Joy DeGruy Leary and Post-Traumatic Slave Syndrome (PTSS) described and synthesized above, Mims et al. (2005) delineate PTSD from the African Holocaust and PTSlaveryD, clarifying that PTSD stems from a traumatic event while PTSlaveryD was a massive traumatic event with cumulative effects on individuals and the community. PTSlaveryD treats symptoms such as avoidance of the event of slavery, adoption of a victim identity, impaired interpersonal relationships, emotional numbing particularly with Black men, isolation of affect, anger, and psychotic disorders (Mims et al., 2005). Mims et al. (2005) also specify that the DSM-IV does not reflect cultural differences and that there appears to be no correlation or credence given to pathologies or disorders associated with the effects of racism. The PTSlaveryD model provides various steps and stages through which an individual can engage in the process of “recovery from Mentalcide” (p. 67).....................................................................103 PTSlaveryD is an impressive model that includes a vast amount of knowledge from anthropological, sociological, and psychological levels; at the same time, some limitations of the model involve the enormous scope of each section. There are modules related to economics, various stages of recovery, relapse, relationships, school, the criminal justice system, toxicity in foods and eating healthy, as well as prevention in the community. The modules and various lessons are immense, and constitute lifelong commitments in multiple arenas of an individual’s life. Overall, the PTSlaveryD model is not specifically designed to target the psychological processes of the intergenerational transmission of trauma in African American adolescent youth from the inner city. ............103 xii
  • PTSlaveryD is an impressive model that includes a vast amount of knowledge from anthropological, sociological, and psychological levels; at the same time, some limitations of the model involve the enormous scope of each section. There are modules related to economics, various stages of recovery, relapse, relationships, school, the criminal justice system, toxicity in foods and eating healthy, as well as prevention in the community. The modules and various lessons are immense, and constitute lifelong commitments in multiple arenas of an individual’s life. Overall, the PTSlaveryD model is not specifically designed to target the psychological processes of the intergenerational transmission of trauma in African American adolescent youth from the inner city. ...................103 Indigenous Theories.....................................................................104 Indigenous Theories.............................................................................................104 Summary......................................................................................106 Summary..............................................................................................................106 Summary of Review of Literature...............................................107 Summary of Review of Literature.......................................................................107 Chapter 4: Methodology......................................................................................119 Chapter 4: Methodology......................................................................................119 “Isolation is a favored weapon of psychological terrorists.” –bell hooks (year, p. XX)...........................................................119 Overview of Sections...............................................................................120 Overview of Sections...........................................................................................120 Process.....................................................................................................123 Process.................................................................................................................123 Approach..................................................................................................125 Approach..............................................................................................................125 Selection and Orientation of Reviewers..................................................125 Selection and Orientation of Reviewers..............................................................125 References............................................................................................................245 References............................................................................................................245 xiii
  • Hesdorffer, Dale C.; Ghajar, Jamshid. Marked Improvement in Adherence to Traumatic Brain Injury Guidelines in United States Trauma Centers Journal of Trauma-Injury Infection & Critical Care. 63(4):841-848, October 2007. doi: 10.1097/TA.0b013e318123fc21.......254 xiv
  • CHAPTER 1: INTRODUCTION “So we stand here On the edge of hell In Harlem And look out on the world And wonder What we’re gonna do In the face of what We remember.” -Langston Hughes (2001, p. 140) “The opposite of love is not hate, it’s indifference. The opposite of art is not ugliness, it’s indifference. The opposite of faith is not heresy, it’s indifference. And the opposite of life is not death, it’s indifference.” –Ellie Weisel (1992, p. ) African American adolescent males living in urban communities are presented with unique and often difficult dilemmas in Western society today, and the experiences of young African American men differ in many ways from those young men of other racial and ethnic groups. Over the past decade, the psychological community has expended a minimal amount of attention on African Americans (Bell & Jenkins, 1993; Eyerman, 2001). Some paradigms have even chosen to ignore the impact that U.S. history has had on the contemporary culture, mental health, and self-identity of African Americans (Eyerman, 2004; Hacker, 1992; Utsey et al., 2000). This theoretical and program model investigated the affects of slavery as a form of intergenerational trauma on the culture, identity and soul's of African American male youth from the inner city. The writer developed a theoretical hypothesis regarding the impact of the intergenerational transmission of trauma on African American male adolescents based on the synthesis of the literature and proposed a new model program based on the literature. 1
  • Background and Context African Americans comprise a significant portion of the U.S. population, about 13.5% overall (Blackdemographics.com, 2008; U.S. Census Bureau, 2007, p.17), or 41.1 million individuals (U.S. Census Bureau, 2008, p.9). In 2005, the 4.5 million Black men ages 15 to 29 currently living in the United States represented 14% of the U.S. male population of that age and 12% of all African Americans in the country (Bureau of Journal Statistics, 2005, p. 5). Slavery’s legacy continues to have a strong effect in the African American community. Through the Transatlantic Slave Trade, lasting from the 16th to 19th centuries (Horton & Horton, 2005), many Africans were sold into slavery and experienced horrific physical, psychological, and emotional harm due to separation from family, language(s), customs, beliefs, rituals, and values (Abdullah, 1994; Akbar, 1996; Horton & Horton, 2005; Mims, Higginbottom, & Reid, 1996). Enslaved Africans in the “new world” experienced despicable work conditions, forced eradication of language and culture, loss of the family and village, and complete subjugation for the gain of the slaveholder and the United States economy, as well as a loss of cultural foundation (Akbar, 1996; Ginzburg, 1998; Horton & Horton, 2005). For the African American community, a collective identity has emerged through an equally collective memory, that of African enslavement in the Americas (DeGruy Leary, 2005; Eyerman, 2001). Some historians argue that the timeline of U.S. enslavement of Africans consisted of 246 years of slave conditioning, from 1619–1865, 100 years of Jim Crow and the violence involved in ending the legalization of slavery that enslaved Africans, 2
  • and 37 years of inclusion of enslaved Africans in democracy (Mims, Higginbottom, & Reid, 1996). In the post-slavery years, a disproportionate number of African males were—and continue to be—incarcerated. Hightower (2004) concluded that during the post-slavery era, free African Americans threatened the security of Whites, and incarceration was a solution for reducing the fears of White U.S. society. Historically, a large percentage of African American males have been incarcerated: in 2001 nearly 49% of black men lived in the prison system (Carten, 2007; Mims, Higginbottom, & Reid, 1996; Petersilia, 2002; Pouissant & Alexander, 2000), and studies estimate that nearly 15% of African American males are incarcerated daily (Petersilia, 2002; Rich & Gray, 2005). Young African American men represent over 40% of the prison population, nearly three times that of Hispanic men and nearly seven times that of White men (Harrison & Beck, 2005). Numerous scholars have concurred that because of the pervasive racism and oppression within U.S. institutions and communities, African American men struggle not only to thrive but also to survive (DeGruy Leary, 2005; Eyerman, 2001; Hicks-Ray, 2004). The average life expectancy of African American men remains lower than their White counterparts at 70 and 76 years respectively (Center for Disease Control [CDC], 2008). In addition to higher homicide rates (Hicks-Ray, 2004; Hines & Boyd-Franklin, 1996; Leary, 2005), African American males also have elevated rates of diabetes, heart disease, and smoking- related illnesses (Arias, 2007; CDC, 2007). 3
  • The risks are particularly significant for young African American males— while the death rate drops for men ages 25 to 29 for most groups, it continues to rise among African American males (Stoops, 2004). Homicide or violent injury is the leading cause of death for adolescent and young adult Black males between the ages of 15 and 24 years in the United States (National Adolescent Health Information Center, 2007, as cited by Smith, Fry, Morabito & Organ, 1992), with a 5% to 45% chance of re-injury over the next five years (Cooper, Eslinger, Nash, al-Zawahri, & Stolley, 2000; Goins, Thompson & Simpkins, 1992). Risk factors for re-injury or homicide include alcohol and substance use, failure at school, possession of a weapon, poverty, disorganization in the neighborhood, male gender, Black race, exposure to television violence, and gang involvement (Sims, Bivins, Obeid, Horst, Sorensen, & Fath, 1989). The greater risks or burdens carried by African American men also extend to education and employment. Young African American men are less likely to graduate from high school than whites and Asians (CDC, 2007, p.7), and they graduate from college at a rate that is 47% of the graduation rate for whites and 22% of the rate for Asians (CDC, 2007, p.8). In 2002 at every educational level, African Americans with the same education made less than Caucasian individuals. The unemployment rate for young African American men is over twice the rate for young white, Hispanic, and Asian men, and over 20% of young African American men live in poverty compared to 18% of Hispanic, 12% of Asian, and 10% of white men (U.S. Census Bureau, 2007, p. 5). 4
  • Population Approximately 12% or roughly 35 million of all Americans racially identified as of African descent (Cassidy & Grieco, 2000). Africans have migrated to the United States from many countries for over four centuries (Boyd- Franklin & Hines, 1996). However, the largest populations of Africans in America are those with ancestors who were brought into the United States against their will and sold into American chattel slavery (Coleman & Cressey, 1996). At one time African American males were considered chattel, and at another slaves. Leary (2005) contends that enslaved Africans who were brought to America have been called many names, such as: indentured servants, sharecroppers, colored, black, Afro-American, Negroes, and most recently African Americans. Each designation has a historical link that carries with it perceptions of oneself and of an ethnic group. What research has evidenced is that who or what a person perceives themselves to be is influenced first by those in our immediate environment that confirm and reinforce for us their perspectives (Leary, 2005). African people arrived to the shores of North American and labored here for more than 200 years as chattel slaves. Once in America, African people were relentlessly and irreparably stripped of their cultural identity. They would be beaten and/or killed for talking their own language, practicing their own religion, and using their own names. The very life of an African was legally declared as less valuable than that of a human being. This is documented in article 1, section 2, and paragraph 3 of the US Constitution (Legal Information Institute, n.d.). 5
  • Africans were denied the right to have claim over their own body, marry, to travel read and write, come together and worship in their own manner. Overall, African people were wholly denied the right of self-determination and were completely, physically, emotionally, intellectually, socially, politically, and legally oppressed. This history is etched in the memories of Caucasian and Black Americans alike. For Black Americans, however, the psychological distress associated with the reality of this history is believed to be triggered and re-experienced through present day encounters with racist oppression. African Americans are diverse in terms of religious affiliation; skin color, socioeconomic status, acculturation, geographic origin, and the coping strategies they employ to deal with numerous forms of oppression and racism (Boyd- Franklin & Hines, 1996). The Black community is divided between a growing middle class and the desperately poor. The research tends to focus on primarily poor African American adults. However, The impact of PTSD may be especially relevant during adolescence because this developmental stage is commonly recognized as a particularly stressful period. This stress is often linked to adolescent developmental stages involving puberty and sexuality, social role redefinition, cognitive development, school changes, and the struggle between separation and individuation (Eccles et al., 1993; Harris, 1991). When these developmental stressors are compounded by trauma, teen adjustment will likely be very challenging. 6
  • Trauma, Intergenerational Trauma, and African American Youth In general, adolescents in high-conflict, inner city communities frequently experience violence in their neighborhood, homes, and schools; a sizeable majority of youth affected by community violence are African American (U.S. Census Bureau, 2007; CDC, 2007). Inner-city youth, particularly African Americans, experience a distressingly high rate of trauma (Silva et al., 2000). According to the Comprehensive Textbook of Psychiatry (Kaplan & Sadock, 2000), the common denominator of psychological trauma is a feeling of “intense fear, helplessness, loss of control, and a threat of annihilation (p. 134).” In a similar vein, Herman (1997) has stated “psychological trauma is an affliction of the powerless, which overwhelms the ordinary systems of care that allow people to have a sense of control, connection, and meaning (p. 33).” Although the majority of inner city African American youth display symptoms of trauma as a result of their experiences (Wright-Berton & Stabb, 1996; Silva et al., 2000), many do not fit the criteria for PTSD or Post-Traumatic Stress Disorder (APA, 1994). Instead, their trauma symptoms are often treated as externalizing behaviors or punished by sentencing within the prison and juvenile justice systems. In either instance, research indicates that PTSD symptoms affect African Americans who experience direct or indirect traumas, in an insidious and aggressive manner compared to other children and adolescents with similar experiences (Silva et al., 2000). As Herman (1992) wrote, “Those individuals (Holocaust survivors) who were able to survive the prolonged practices of dehumanization and brutality were subjected to trauma that was classified as 7
  • some of the most severe and damaging in human history due to its chronic and repeated exposure.” African American children and adolescents live in communities where racial prejudice is palpable, and this discrimination is communicated subtlety in treatment programs that have the reduction of externalized aggressive behaviors as the sole goal (Ferrell, 2001). The difficulty experienced by urban youths of all ethnicities affects African American youths more strongly and has both historical and contemporary roots. The enslavement of Africans in the Americas and the subsequent emotional, physical, and psychological harm that ensued—a genocide that spanned generations—is still remembered and mourned by many African Americans today, according to many psychologists and sociologists (Eyerman, 2001; Latif & Latif, 1994; Hicks-Ray, 2004; Horton & Horton, 2001; Leary, 2005). In addition, unrelenting experiences with prejudice and barriers to success produce disillusionment and frustration among many African American males (Abdullah, 1994; Akbar, 1996; Eyerman, 2001; Hines & Boyd-Franklin, 1996). Such psychological strain, joined with the unresolved traumas of chattel slavery and daily inner-city violence, has prompted many African American males to resort to the externalization of their pain (Abdullah, 1994; Akbar, 1996; Hines & Boyd-Franklin, 1996; Leary, 2005; Mims, Higginbottom & Reid, 1996). Viewed from a racial identity perspective, high rates of incarceration, homicide, and other externalizing and aggressive behaviors can be seen as a way of regaining a sense of power and esteem (Akbar, 1996; Cross, 1971, 1995; Leary, 2005). 8
  • The intergenerational transmission of dysfunctional patterns has been explored by a number of scholars for cultures including Native Americans (Duran & Duran, 1995), survivors of the Jewish holocaust (Danieli, 1998; Kellerman, 2001b; Weingarten, 2003), and Japanese Americans in the United States during World War II (Nagata, 2003). As discussed in Chapter 2, these studies on intergenerational trauma may help to explain the African American male struggle to flourish and survive. Overview of the Study Given the risks and challenges within the Black male population as discussed above, it may be time re-evaluate the treatment goal of psychological programs for African American youth. If the symptoms of a disease return, the underlying cause has not been treated; a treatment program that addresses the underlying cause of externalizing behaviors for this population would logically have a greater likelihood of success. With the exception of Duran’s intergenerational approach with Native Americans (Duran, 2006), current psychological programs designed for treating PTSD do not (to my knowledge) address intergenerational trauma as part of the treatment (DHS, 2005; Duran, 2006; Leary, 2005; Miller & Townsend, 2005). This study seeks to further understand the African American adolescent male experience in the inner city by working to (a) define the population of adolescent African American males who reside in the inner city, (b) identify the present day psychological symptoms most frequently being displayed, (c) identify key theories for the manifestation of the displayed symptomatology, and (d) 9
  • provide a culturally sensitive model of healing for African American adolescents. In particular, the intergenerational transmission of trauma is hypothesized to be one of the underlying contributing factors of African American adolescent male death, incarceration, and soaring diagnoses of posttraumatic stress (PTSD), oppositional defiant (ODD), and conduct disorders (CD). This endeavor proposes to design a treatment program that addresses symptoms associated with the intergenerational transmission of trauma in African American adolescent males who reside in the inner cities of the United States. The model program addresses three key areas. First, it addresses the transmission of intergenerational trauma through both direct and indirect methods by addressing the behaviors and beliefs that perpetuate it. Second, through addressing externalizing behaviors as a symptom of intergenerational trauma, the model program offers a treatment approach that frames acting-out behaviors as a psychological issue as well as a reflection of biological and spiritual imbalance. Third, the element of societal discrimination against African American men is addressed (as recommended by Hardy [1993], Leary [2005], and Steele [1993]). 10
  • Purpose of the Study The purpose of this study is twofold. The first aim of this dissertation is to examine the cultural, historical and intergenerational trauma of slavery through synthesis of the literature on the effect of chattel slavery on the culture, identity and soul's of African American male youth from the inner city. The writer will be developing a theoretical hypothesis regarding the impact of the intergenerational transmission of trauma on African American male adolescents based on the synthesis of the literature on relevant topics. The second goal is to propose a new model program based on the theoretical tenets that emerge from the synthesis of the literature related to: perspectives on intergenerational trauma, the research on contemporary psychological issues affecting inner city African American males, and current psychological trends in trauma treatment. The purpose of this dissertation is to understand the functional and dysfunctional attitudes and behaviors that have been transmitted to African American adolescent males, to place them in a productive psychological context, and to propose treatment options based on this new understanding. 11
  • CHAPTER 2: REVIEW OF THE LITERATURE Being a Negro In America Means Trying To Smile When You Want To Cry, It Means Trying To Hold On To Physical Life Amid Psychological Death. It Means The Pain Of Watching Your Children Grow Up With Clouds Of Inferiority In Their Mental Skies. It Means Having Your Legs Cut Off, And Then Being Condemned For Being A Cripple. It Means Seeing Your Mother And Father Spiritually Murdered By The Slings And Arrows Of Daily Exploitation, And Then Being Hated For Being An Orphan. –Martin Luther King, 1967, This chapter will provide an overview of the literature relevant to posttraumatic stress disorder, complex trauma, trauma and African American youth, resilience, community as family, racial oppression, racial identity and complex trauma, as well as indigenous perspectives on trauma. Additionally, the Biological, Intrapsychic, Attachment, Social Learning and Family Systems theories will be explored in order to explain transmission mechanisms of trauma. Furthermore, research, which supports the premise of the role of spirituality and the soul wound, will be explained in this section. What is Trauma? In 1980, the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition [DSM-III] introduced a new diagnostic category entitled posttraumatic stress disorder (PTSD) in order to account for the wide range of individual and chronic events which were believed to lie outside the range of usual human experience (American Psychiatric Association, 1980). The Diagnostic and Statistical Manual, 4th Edition [DSM-IV] (American Psychiatric Association [APA], 1994) defines trauma as: Exposure to an extreme stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to physical integrity of another person; or learning about 12
  • unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close association. (p. 494) Carlson (1997) provides a very straightforward explanation of PTSD responses that are categorized into main modes, symptoms of re-experiencing and symptoms of avoidance. They are listed below: • Cognitive Mode: intrusive thoughts and images; amnesia of trauma and depersonalization; • Affective Modes: anxiety and anger; emotional numbing and isolation affect; • Behavioral Mode: increased activity and aggression; avoidance of trauma related situations; • Multiple Modes: FINISH Carlson (1997) also points to secondary responses to trauma. Secondary and Associated Responses: • Depression • Aggression • Low Self-Esteem • Identity Crisis • Problems with Interpersonal Relationships • Guilt and Shame The effects of exposure to trauma vary by individual, but symptoms often include the following: re-experiencing the trauma through nightmares and/or flashbacks, avoidance of things associated with the trauma, psychic numbing, and symptoms of increased arousal such as hyper-vigilance, anxiety or irritability 13
  • (APA, 1994). According to the APA (1994) roughly 30% of individuals exposed to potentially traumatic experiences will develop Post-Traumatic Stress Disorder (PTSD) in which multiple symptoms persist and impair functioning in a variety of areas including interpersonal, emotional, cognitive, and behavioral. PTSD was first recognized as a diagnostic category in psychological communities in relation to World War I and II veterans and was known at the time as “shell shock” (Danieli, 1998). War-related trauma received a considerable amount of clinical attention, which resulted in several investigations of the lasting psychological injuries experienced by combat veterans (Finger, 2006). Trauma situations suffered at the hands of humans were found to be experienced as more personal and purposeful, therefore threatening “a victim’s basic sense of attachment to others and safety in the world” (Diller, 2003), this is unlike many aforementioned trauma situations which more commonly involved acts of nature. In the past decade the field of trauma has come to greater focus for researchers and practitioners. Clinicians and theorists have attempted to capture the psychological and behavioral states of individuals’ suffering from trauma with DSM-IV-TR. The American Psychiatric Association (DSM-IV-TR) categorized three main dysfunctional effects of a traumatic experience (2000). The first criterion identifies the inability to escape the powerful memories of the traumatic experience. Re-experiencing the trauma can lead to recollection of images, thoughts and perceptions, through internal or external cues. This may occur through nightmares or flashback in the waking state. 14
  • The second symptom cluster refers to the individual’s futile attempts to deal with continued traumatic occurrence influences. The individual may make strong attempts to avoid any thoughts, feelings or interactions associated with the trauma. These efforts may lead to the avoidance of persons, places and objects that trigger the memory, as well as an inability to recall the details of the trauma. The traumatic experience can also lead to emotional numbing and feelings of detachment, restricted affect, and a sense of a foreshortened future. The final symptom cluster deals with how traumatized individuals cope with heightened arousal levels that result from an intense traumatic experience. Individualized who have been traumatized may manifest symptoms such as disturbed sleep, emotional lability, hyper-vigilance, poor concentration, and a heightened startle response. Traumatic events have an effect on millions of children and adults worldwide each year, and can occur in many forms. Individual experiences of trauma may result from sexual, physical, and emotional abuse, as well as from neglect and unexpected loss. Collective and individual traumatization can take place after natural disasters, war, genocide, and terrorists acts, to name a few examples. The effects of trauma on individuals have been extensively studied and include impairment in biological, cognitive, emotional, and interpersonal functioning (APA, 1994). Many individuals experience serious and lasting harm in response to traumatic events and subsequently develop PTSD. Judith Herman (1992) describes trauma as an experience in which an individual is directly involved in or witness to an event, which evokes feelings of 15
  • a loss of safety, helplessness, fear, horror, and a threat of annihilation. Having built on Herman’s work, Diller (2003) develops the understanding of trauma by distinguishing four major symptom-groups associated with it: 1. Hyperarousal, in which the internal biology of self-preservation goes on permanent alert; 2. Intrusion, in which traumatized people relive the event as if it were recurring in the present; 3. Constriction and numbing, which involve a psychic deadening or dissociation from reality; 4. Disconnection, which involves a shattering of the self, its attachment to others, and the meaning of human experience. Many youth today experience some form, if not multiple levels, of trauma (van der Kolk et al., 2005). Studies show that the percentage of youth diagnosed with PTSD does not coincide with those that have experienced trauma and who are experiencing serious emotional and behavioral dysfunctions (Dale et al., 2007). Clinicians and theorists continue to maximize their understanding of why this discrepancy occurs and how to identify trauma’s impact on treatment without the youths exhibiting the criteria for PTSD. The origins of PTSD began in order to diagnose and treat adult victims of trauma. However, many clinicians focus on how children and adolescents experience and express trauma differently than adults. Some theorists contend that a major diagnostic issue derives from a need for more awareness and sensitivity around developmental factors affecting how various children and 16
  • adolescents exhibit trauma differently (Saywitz et al., 2000). Chemtob et al. (1997) and Atlas et al. (1991) shared that although anger and aggressive behavior are common symptoms of PTSD in youth, such behaviors are practically indistinguishable from those behaviors exhibited by youth diagnosed with Conduct Disorder (CD). Clinicians have come to learn more about the increased effects of youths’ experiencing multiple levels of trauma, while learning about the effects of trauma. Complex Trauma Complex trauma is something that occurs repeatedly and escalates over the course of its duration (Courtois, 2004). In complex trauma, the victim is caged and conditioned in a multitude of ways, particularly in families’ where domestic violence and child abuse are prevalent (Courtois, 2004). The experience of complex or repeated trauma affects victims differently than single events may (Renn, 2002; Van der kolk et al., 2005). There is a qualitative difference in the manifestation of symptoms that result from acute trauma as compared to chronic trauma. Courtois (2004) contends, individuals exposed to trauma over a variety of time spans and developmental periods suffered from a variety of psychological problems not included in the diagnosis of PTSD, including depression, anxiety, self- hatred, dissociation, substance abuse, self-destructive and risk-taking behaviors, revictimization, problems with interpersonal and intimate relationships (including parenting), medical and somatic concerns, and despair (Diagnostic conceptualization of complex trauma). In this study single event acute trauma symptoms will be referred to as type I trauma, whereas repeat exposure to multiple traumas or to non-traumatic 17
  • stressors over a prolonged period of time, will be referred to as type II trauma, complex trauma, or complicated trauma. Although there is a great deal of overlap between the symptom presentation of acute and chronic trauma, many researchers and clinicians feel that the qualitative differences are considerable enough to justify complex trauma as having a distinct and separate category in the DSM nosology. Faust and Katchen (2004) suggested that, most notably in children, there are frequent misdiagnoses in the form of conduct disorder, depressive disorder, and attention deficit disorder, which are actually chronic stress reactions related to complex trauma. Symptoms that develop out of multiple traumatic experiences may take the appearance of symptoms that do not fall under the DSM IV-TR diagnosis of PTSD. In order to better encompass the symptoms and effects of recurring trauma, Dr. Judith Herman (1992), one of the leading proponents of the effort to construct a complex trauma disorder category in the DSM, proposed the diagnosis of Complex Posttraumatic Stress Disorder. Having examined the effects of complex trauma, she observed that beyond the presence of traditional type I trauma symptoms of PTSD, complex trauma, as she calls it, causes alterations in several areas of functioning such as affect regulation, consciousness, self- perception, and interpersonal relations (Faust & Katchen, 2004). Herman (1992) developed seven different problem areas associated with early repeated trauma. (a) Traumatic experiences changes how people regulative their affective impulses, which often appear as problems in controlling anger and 18
  • self-destructiveness. In victims of repeated trauma symptoms noted were: mood lability, relational instability, and impulsivity. (b) Complex trauma results in an altered consciousness and attention that can lead to dissociation, depersonalization, or amnesia. The aforementioned states are a survival technique to cope with emotionally difficult situations, however in the future the behaviors can become dysfunctional coping mechanisms when exhibited as responses to traumatic triggers (Brier & Eliott, 2000). (c) Individuals who were victims of long-term abuse often deal with altered perceptions of the self, chronic shame, and guilt. Often the victim will blame themselves, feel hopeless and helpless, and even overestimate the dangers in the world leading to feelings of anger, abandonment, and self-loathing (Foa et al., 1999). (d) Victims who spend extended periods of time with their perpetrators can end up taking on some of the beliefs of the perpetrator, as evidenced in homes of children who grow up with antisocial parents may take on their parent’s antisocial behaviors (Garbarino, 1999). (e) Victims of interpersonal trauma can have a limited sense of trust and comfort in others, making intimacy difficult and even nonexistent. (f) Victims frequently experience medical issues or somatizations, as a result of attempts to cope with the complex trauma. Bodily distress and dysfunction is quite common in victims of complex trauma (Briere & Spinazolla, 2005). (g) Finally, as victims deal with hopelessness in finding people to identify with their suffering and pain, they may experience an altered system of meaning with the trauma and the world around them. 19
  • Regardless of the form of trauma, the role of communication in trauma transmission is crucial to understanding and treating symptoms of complex trauma and PTSD (Baranowsky, 1998; Abrams, 1999). When parents have symptoms of complex trauma and PTSD, there is a statistically higher prevalence of PTSD in their children following a traumatic event. MacFarlane (1987) found that trauma in youth was highly correlated with the prevalence of parental trauma in a longitudinal study following a natural disaster in Australia. Research maintains that complex trauma and PTSD are often transmitted from parent to child, or from grandparent to parent to child, most frequently through direct and indirect ways (Solkoff, 1992; Auerhahn & Laub, 1998). Trauma and African American Male Youth Your children are not your children. They are the sons and daughters of life’s longing for itself. You can give them your love, but not your thoughts. They have their own thoughts. You can strive to be like them, but you cannot make them just like you. You can house their bodies, but not their souls, for their souls dwell in the house of tomorrow, that you cannot visit, not even in your dreams. They come through you but they are not from you And though they are with you they belong not to you. -Sweet Honey in the Rock, On Children Recent changes in American society may exacerbate normal adolescent developmental stress. These changes includes: familial separation due to divorce and single parent families, chronic stress due to growing rates of poverty and homelessness, increased risk-taking behaviors such as substance abuse, gang violence and initiations (Berton & Stabb, 1996). Traumatic events, such as witnessing violence and experiencing abuse are common occurrences in the United States (Kilpatrick, Saunders, & Smith, 2003), 20
  • and this is especially true for adolescents and residents of urban neighborhoods (U.S. Department of Justice, 2004). In a study of middle school students, Campbell and Schwarz (1996) found that two-thirds of urban youth and 40% of suburban youth reported being victims of violence (i.e., being beaten up, robbed, stabbed, or shot) and even greater numbers of youth reported witnessing others being injured. Kilpatrick et al. (2003) also reported that 8.8 million youths have seen someone else seriously injured by violence, sexually assaulted, and/ or threatened with a weapon. The authors further suggested that the emotional consequences of such trauma could take many forms, including psychological disorders, substance use/abuse, and delinquency. The alarming rate of youth exposure to violence is of particular concern to trauma researchers. Both direct and indirect exposure to violence has been linked to PTSD symptomatology (Bell & Jenkins, 1991). Data from the Center of Disease Control (CDC) (2010), as well as other investigations indicate that violence and exposure to violence is widespread in the United States and is the second leading cause of death for young people between the ages of 10 and 24. The CDC (2010) reports that 5,764 young people age 10 to 24 were murdered, an average of 16 each day, in 2007 (p. 33). Over 656,000 physical assault injuries in young people age 10 to 24; were treated in U.S. emergency rooms in 2008 (p. 25). In a 2009, in a nationwide survey, about 32% of high school students reported being in a physical fight in the 12 months before the survey. Nearly 6% of high school students in 2009 reported taking a gun, knife, or club to school in the 30 21
  • days before the survey. Additionally, an estimated 20% of high school students reported being bullied on school property in 2009. Researchers (Bell & Jenkins, 1995; Jarrett, 1995) have postulated that a significant number of youth express depression and heightened arousal symptoms of PTSD by perpetrating violent crimes, acting out in class or simply complaining of physical ailments. African American male youth, particularly those living in inner city neighborhoods, are at risk of experiencing many stressors, including exposure to community violence (Pyroos & Nader, 1993; Osofsky, Wewers, Hann & Fick, 1993; Tolan & Henry, 1996). This exposure is linked with negative psychological health outcomes for children of all ethnicities (Horowitz, McKay, & Marshall, 2005). Children residing in urban inner city neighborhoods are more likely to express symptoms congruent with PTSD. In particular, research contends that African American male youth are often misdiagnosed as having behavioral problems, such as oppositional defiance disorder or conduct disorder, when these problems could be a manifestation of PTSD (Abdullah, 1994; Yehuda et al., 2001). For many of these youth, no diagnosis is ever given and they do not receive the proper therapy for this disorder. Statistics do display that the majority of African American youth with externalizing behaviors, such as fighting, truancy and verbal aggression, are largely placed within the juvenile justice system (Fitzgerald & Boldizar, 1992; Abdullah, 1994; Miller & Townsend, 2005). Many African American youth diagnosed with PTSD have been witness to extreme violence or have experienced it themselves (Miller & Townsend, 2005). A number of factors can increase the risk of a youth engaging in violence. 22
  • However, the presence of these factors does not always mean that a young person will become an offender. Risk factors for youth violence include: Prior history of violence; Drug, alcohol, or tobacco use; Association with delinquent peers; poor family functioning; poor grades in school; Poverty in the community and exposure to prior trauma (CDC, 2010). Youth who experience repeated exposures to high risk factors such as violence, unhealthy family environments, inner-city environments, etc., may fit the criteria for complex trauma (Courtois, 2004; van der Kolk et al., 2005). Exposure of youth to trauma and victimization is pervasive in America (Finkelhor, Turner, Ormrod, Hamby, & Kracke, 2009). Youth, once thought of as a time in life where one is protected from trauma, is too often the time when exposure to violence and trauma first occurs. Urban adolescents, particularly African Americans, and those of lower socioeconomic status (SES) status are especially at high risk for exposure to trauma (Hammack, Richards, Luo, Edlynn, & Roy, 2004; Stein, Jaycox, Kataoka, Rhodes, & Vestal, 2003). An alarming number of urban African American children and adolescents have reported at least one exposure to trauma/violence before they reach adulthood (Buka, Stichick, Birdthistle, & Earls, 2001; Stein, Jaycox, Katoaka, Rhodes, & Vestal, 2003). Exposure to trauma is not necessarily a one-time occurrence, and youth who are exposed to a single trauma are at far greater risk of experiencing multiple exposures of trauma and violence (Finkelhor, Turner, Ormrod, Hamby, & Kracke, 2009). Multiple exposures to trauma over one’s life, a frequent occurrence in 23
  • urban and low SES settings, are defined as cumulative trauma (CT). CT has greater negative consequences on health and mental health than single trauma exposures (Kira, Lewandowski, Templin, Ramaswamy, Ozkan, & Mohanesh, 2008). Many victims of trauma or abuse may flee their homes and encounter situations (e.g., gang involvement, prostitution, etc.) on the streets that lead them to the justice system (Veysey, 2003). In a relevant longitudinal study, Widom and Maxfield (2001) examined the link between abuse and criminality, by comparing arrest records for youth with and without a history of abuse and/or neglect. Their results indicated that, “childhood abuse and neglect increased the odds of future delinquency and adult criminality by 29%” (p. 3.). Many African American males are discussed or seen as “at-risk.” A range of unfavorable life events contributes to school failures, increased chances of incarceration, homicide rates, and dropout rates. These events seem to relate to an individual’s degree of vulnerability. Rutter (1980) and Hawkins, Catalano, and Miller (1992) asserted that drug abuse, inappropriate social behavior, delinquency, and premature death are associated with negative risk factors. Canada (1998) stated that too many at-risk African American male adolescents characterize the image of a strong man as violent and promiscuous. Canada further emphasized that, in the eyes of these youth, a true man is daring and audacious, and an unfavorable man is intelligent. Canada stressed that some in society view intelligent young men as arrogant and attempting to fit in with the 24
  • Caucasian culture. According to Reese (2004), many African American male adolescents liken academic achievement as a feminine characteristic. Canada (1998) outlined the plight of the at-risk African American boy. His insights are indispensable for developing an accurate perspective regarding the psychological trauma some African American young men face and are able to conquer, and others yield. According to Canada (1998), African American male adolescents 1. Are killed by violence more often than other racial groups in America; 2. Are arrested more frequently than members of other racial groups; 3. Drop out of school more frequently than members of other racial groups; 4. Attend college in lower numbers than those of other racial groups and; 5. Abandon their paternal responsibilities more than members of other racial groups. Canada’s (1998) summary of the dilemma of African American male youth exemplifies how their environment often molds children. Some children are able to avoid the abovementioned high-risk behaviors without repercussion, while others need support locating the trail towards a healthy existence coupled with achievement. Resilience Children placed in stressful environments may develop behavioral and psychological problems (Luthar & Zigler, 1991). However, some African American children seem to have an innate ability to overcome extreme obstacles and embrace life’s transitions without apparent effort. They seem to demonstrate 25
  • healthy coping skills, positive social interactions, and possibly academic achievement, in spite of social challenges. These children exhibit resilience. Resilience describes an individual’s ability to overcome obstacles related to vulnerability. The concept of resilience relates to an individual’s ability to safely navigate life’s terrain and obtain balance, general mental and physical health. Werner and Smith (1988) conducted a longitudinal study on over 600 participants in Kauai, Hawaii. The focus of the study compared the reaction of children subjected to adverse conditions. Werner and Smith suggested that a majority of the children in the study were able to thrive when exposed to adverse conditions. Illustrating this point, Rutter (1983, 1987) described a 10-year study of a group of children with mentally ill parents. This study revealed that many of the children developed normally and did not exhibit maladaptive behavior. Furthermore, Rutter indicated that these children were examples of how resilience served as a positive response to trauma and misfortune. Similarly, Garmezy (1991, 1994) and Garmezy, Masten, and Tellegen (1984) studied students that lived in poverty to determine their level of competence. Teachers, peers, and school records deemed a percentage of the students studied were competent. Garmezy (1991) suggested that the competence illustrated by these students stemmed from protective factors that foster resilience. Rutter (1987) and Garmezy (1985, 1994) referenced protective factors to describe resilience. Rutter (1990) asserted that protective factors are less important than the mechanisms that employ them. Rutter (1990) further emphasized that these mechanisms moderate risk factors on four different levels. 26
  • These levels include (a) those that decrease the affect of exposure to risk, (b) those that deescalate the impact of multiple negative events, (c) those that foster self-esteem and self-efficacy through experiencing success, and (d) those that, through positive interactions and vital resources, perpetuate hope and individual desire to improve their status. Garmezy (1974) and Masten, Best, and Garmezy (1990) indicated that a sect of at-risk children survive regardless of their status. Garmezy (1991) described resilience as the ability to regain stability and adaptive behavior following calamity. Masten, Best, and Garmezy (1990) described resilience as a shift to the positive side of adversity. Werner (1995) focused on children born into poverty and hostile living conditions. In this study, one-third of the children studied had the ability to sustain a high level of competence despite stressful situations. Masten (1999, 2001) highlighted a group of children that were at risk due to their family structure, the mental state of their parents, and impoverished socioeconomic status. These children exhibited unusual levels of perseverance. Garmezy (1991) and Masten (1994) referred to resilience as a developmental psychopathology derived from the understanding of adaptations and maladaptions in human behavior in adverse situations. Kunjufu (2006) emphasized that the complex cultural environment shapes children. He further stated that gender has an impact on the manner in which exposed children handle stress. Kunjufu (2007) contended that African American male adolescents are heavily impacted by circumstances that cause them to fail academically. 27
  • Undoubtedly, there are factors related to how African American male adolescents internalize conflicts as they attempt to navigate rugged academic and social terrain that may inform educators. This information could influence the development of intervention strategies. The results of viable intervention methods could serve as a guide for those who assist African America boys chose an academic path that leads to health and optimal success. Community as Family The characteristics of African American culture that work to construct resilience may also appear as treatment issues in clinical settings. The role of family for many African Americans is significant and serves to provide strength, support, a sense of community and a foundation of respect in the face of adversity and discrimination. “Family” may refer to non blood-relatives, close family friends, clergy and congregation, as well as aunts, uncles, boyfriends, girlfriends, siblings, and grandparents. Kinship bonds may broaden to people who live in and out of the home of where the individual lives (Hines & Boyd-Franklin, 1996). Extended family members frequently reside in close proximity and can be expected to rely on one another in times of need, as well as on a daily basis. African American male clients may need implicit or explicit support from family members in order to continue in treatment and often for treatment to be successful (Hines & Boyd-Franklin, 1996). The role of religion and spirituality are closely connected to the African American family and is often the foundation. Hines and Boyd-Franklin (1996) discuss religion and religious communities ad groups as necessary outlets before 28
  • the abolition of slavery for African Americans to express their feelings of rage, pain, and humiliation. Today, religion may serve a similar role for African American communities today who may not be formally enslaved, but struggle with oppression in covert, yet extremely destructive ways (Kaden, 2009). Religious communities provide opportunities to communicate and discharge some of the accumulated emotions that affect people who have experienced continuing and pervasive oppression. Many spiritual communities still exist within the Black community, as well as within the family system, formally and non-formally. Religion and spiritually may still hold religious doctrine in their core value system (Hines & Boyd-Franklin, 1996; Akbar, 1996). Clinicians may benefit from being aware of the religious or spiritual background of African American adolescent male clients, as these belief and support systems are crucial when formulating cases, diagnosis and treatment. The role of religion and spirituality may be significant in building resilience and healing in African American adolescent males struggling with trauma, specifically the intergenerational effects of trauma. Racial Oppression, Racial Identity, and Complex Trauma The slave family existed only to serve the master, and in order to survive physically, psychologically, and socially the slave family had to develop a system which made survival possible under degrading circumstances. The slave society prepared the young to accept exploitation and abuse, to ignore the absence of dignity and respect for themselves as blacks. The social, emotional and psychological price of this adjustment is well known. –Akbar, 1996 Racial Oppression There is no doubt that the degradation of Black people, as chattel slaves, is appalling and repugnant; however, one cannot comprehensively verbalize of the 29
  • egregious burdens of slavery without the mention of the psychological wounding that resulted. Although the initial traumatic impact came from the vicissitudes of chattel slavery, the intensification of the psychological trauma produced from the purposeful and strategically calculated, conspiracy to psychologically subjugate and control African people. Africans, who were captured and brought into slavery, were ripped away from their heritage, religion, and sense of community, traditions, culture, and languages. As a collective people, the captured Africans were often brutally snatched, moving from place to place and removed from their families, intensifying the feelings of not belonging. There is a well-recognized and documented account of this conspiracy that is crucial to comprehending the perpetual intergenerational transmission of the trauma of slavery and the psychological state of Black people at present. History reports a description of the methodology of a White slave owner named Willie Lynch (name utilized to describe the lynching and hanging of Africans from their necks by trees), who created a scientific plan and method for the creating and maintaining of a slave. The purpose of this scientific methodology was for the production and reduction of economic losses for White slaveholders. It is important to note that many aspects of The Willie Lynch Letters and the Making of a Slave (1712, 1999) have caused much debate over the past ten years, as to the credibility of the document. However, what is evident is the insight and viewpoint of Southern plantation owners regarding slavery. The Willie Lynch letter provides a manifesto concerning the brutal and inhumane 30
  • psychology behind the African slave trade and displays the materialism, cross- breeding, raping, mental conditioning, murdering and subjugating of an African slave for the next four hundred plus years (1999). The main points of the Willie Lynch Letters of 1712 were the following: We lay down the following principles for the long range comprehensive economic planning: 1) Both horse and niggers are no good to the economy in the wild of natural state. 2) Both must be broken and tied together for orderly production. 3) For orderly futures, special and particular attention must be paid to the female. 4) Both must be crossbred to produce a variety and division of labour. 5) Both must be taught to respond to a peculiar new language. 6) Psychological and physical instruction of containment must be created for both. We hold the above six cardinals as truths to be self-evident, based upon the following discourse concerning the economics of breaking and tying the horse and the nigger together... all-inclusive of the six principles laid down above. NOTE: Neither principle alone will suffice for good economics (Lynch, 1712). The slave masters engaged in a systematic process of dismantling all the mechanisms that preserved the continuity of the African people, from language, religion, rites of passage rituals to storytelling (Akbar, 1996). The Willy Lynch letter of 1712, whether constructed in the 20th or 18th century, depicts the sadism and calculated destruction involved in the soul wounding of Africans enslaved in the United States. Slavery, systematically, provided a grand illusion of freedom, liberation, and self-determination, while tenaciously holding one’s mind in subjugation (Akbar, 1996; Hicks-Ray, 2004). Willie Lynch was a slave owner from the West Indies during the 1800s. He was most infamous for the directions he provided for slave owners on “How to 31
  • Break a Slave.” In 1712, on the bank of the James River in Virgina, Willie Lynch gave a speech where he stated: In my bag, I have a foolproof method for controlling your slaves. I guarantee every one of you that if installed it will control the slaves for at least three hundred years. My method is simple, any member of your family or any overseer can use it. I have outlined a number of differences among the slaves, and I take these differences and make them bigger. I use fear, distrust, and envy for control purposes…On the top of my list is “age” but it is only there because it starts with an “A”; the second is “color” or shade; there is intelligence, size, sex, size of plantation, attitude of owner…Now that you have a list of differences, I shall give you an outline of action- but before that, I assure you that distrust is stronger than trust and envy is stronger than adulation, respect or admiration… Gentleman, these kits are your keys to control, use them. Never miss an opportunity. My plan is guaranteed, and the good thing about this plan is that if used intensely for one year the slave will remain perpetually distrustful (Lynch, 1712). The premise of the Willie Lynch tutorial was that when successfully put into practice the slaves would unconsciously be “trained and could train other slaves.” One of the main premises of the manifesto is the psychological and physical regime of “beating” African males into submission. Mr. Lynch suggested that female slaves would be forced into a position of dominance in their race, creating submissive males, as long as the slave owners could adequately convince and frighten the females into thinking that their males must be “submissive and controlled enough,” or they would be murdered by the White slaveholder. Therefore, the females felt the need to discipline and “beat the disrespect” out of their male counterparts. This aspect continues to plague black racial identity for young males through present day, creating a schism between African American males and females (Akbar, 1996). The Lynch letters created a “formula” and a point of reference forcing African women to “beat and scare” their African boys into 32
  • submission and splitting Africans in the United States as a whole. The effects of this trend is currently seen today in gang violence, domestic violence, “black-on- black” crime, child abuse rates and incarcerated African American males in the United States (Akbar, 1996). We reversed nature by burning and pulling a civilized nigger apart and bullwhipping the other to the point of death, all in her presence. By her being left alone, unprotected, with the male image destroyed, the ordeal caused her to move from her psychologically dependent state to a frozen, independent state. In this frozen, psychological state of independence, she will raise her male and female offspring in reversed roles. For fear of the young male’s life, she will psychologically train him to be mentally weak and dependent, but physically strong. Because she has become psychologically independent, she will train her female offspring to be psychologically independent. What have you got? You’ve got the nigger woman out front and the nigger man behind and scared. This is a perfect situation of sound sleep and economics (Lynch, 1712). Although this methodology for inculcating a slave mentality was invoked into practice 300 years ago, as predicted, it was quite successful at perpetuating a mentality of psychological inferiority, mistrust, disunity, and self-hatred in Black people today. Racial Identity As cruel and physically destructive as chattel slavery was in America, it would appear that the slavery that has imprisoned the minds, perceptions, motivations, aspirations, identity, and spirits, is more cruel than the shackles on the wrists and ankles of Africans (Akbar, 1996). W. E. B. DuBois (1897) described “double consciousness,” both African and American in the racial identity of enslaved Africans in America. However there is also the double consciousness of loyalty to a nation, but not necessarily to its dominant culture or way of life. As Grace Hale (1998) eloquently contends, 33
  • “A traumatic tear evokes the need to ‘narrate new foundations,’ which includes reinterpreting the past as a means of reconciling present and future needs” (p. 6). Hale (1998), Akbar (1996), Leary (2005), Reid et al. (2005), and many other theorists support the discourse around slavery and the intergenerational soul wounding that has been inflicted on the psyches of slaves as a process of mediation involving alternative strategies and alternative voices. In an attempt to trace the effects of slavery on contemporary African American behavior patterns and self-identity, Orlando Patterson (1998) writes: Another feature of slave childhood was the added psychological trauma of witnessing the daily degradation of their parents at the hand of slaveholders…the trauma of observing their parents’ humiliation was later added that of being sexually exploited by Euro-Americans on and off the estate, as the children grew. The occurrence of psychological trauma becomes perpetuated because, as research shows, consecutive traumas amplify one’s susceptibility to, and the severity of, one’s response to each successive trauma. Kira (2001) stated, “accumulating or additive effects of such cascading unremitting rapidly unfolding successive non-traumatic stressors can produce effects remarkably similar to other types of trauma and eventuate PTSD-like symptoms” (p. 78). This suggests that previous victimization is an identifiable risk factor to the severity and chronicity of trauma reactions. The impact of the stigma placed on African American male youth is manifested in different ways. Often, the results for African American male adolescents, as evidenced in the research in this dissertation, is a poor self-image and anger, then leading to a downward spiral socially and academically. William Cross developed the nigrescence model, which illustrates the complexity of Black 34
  • identity. Cross (1978) devised the nigrescence model in order to shed light on the process of African American personality development. The nigrescence model delineates the psychological metamorphosis that African American encounter as they make an effort to accept their racial reality. Cross (1978) coined this phenomenon the process of “becoming Black.” Cross (1995) outlined five stages of racial identity. The nigrescence model consists of five major stages. Each stage is related to the individual’s level of socialization with members of other racial groups (Cross, 1991). The stages are pre- encounter /conformity, post-encounter/dissonance, immersion-emersion, internalization, and internalization-commitment (Cross, 1991). Racial identity is based on the premise that African Americans are socialized into the Western culture through stages (Thompson, 1992). Cross’s study (1971) served as a unique investigation into the profundity of Black identity. Other researchers have modified the nigrescence model. Evans, Forney, and Guido-Dibrito (1998) defined racial identity as “a sense of group or collective identity based on one’s perception that he or she shares with a certain racial group.” Cross (1971, 1991, 1995) described a psychological model of racial identity that he referred to as “nigrescence” (Cross, 1991, p. 157). Helms (1995) proposed that each stage of socialization is marked by varying degrees of pride, acceptance, and awareness. The pre encounter/conformity stage is illustrated by internalization of traditional White belief’s regarding race and racism. The post encounter/dissonance stage is depicted by complete racial confusion concerning 35
  • one’s own group. The immersion-emersion stage of racial identity is portrayed by inclusive praise of one’s socio-racial group and rejection of Caucasian values and institutions (Helms, 1995). The internalization status stage of racial identity is represented by praise of one’s own culture and the ability to work jointly objectively with members of the Caucasian groups (Helms, 1995). Internalization- commitment is the final stage of the nigrescence model. During this stage, the individual translates issues related to their identity into meaningful activities associated with challenges faced by African Americans and other oppressed races. The first stage of this model, pre-encounter /conformity, depicts a Black individual who criticizes their own race and echoes racially prejudiced attitudes toward Blacks. The second stage of this model, post-encounter/dissonance, occurs due to an occurrence that causes a relevant association with Black culture. The third stage outlined in this model, immersion-emersion, is characterized by tremendous Black awareness. This sort of awareness facilitates involvement with pro-Black groups and the expansion of an anti-White agenda. The fourth stage of this model, internalization, is exhibited through the development of a positive Black identity paired with an appreciation for other cultures. Finally, the internalization- commitment stage is portrayed when individuals become engulfed in the obtainment of impartiality for all oppressed. Cross (1995) later revised his 1971 model to include subdividing pre encounter /conformity into stages referred to as “miseducation and assimilation.” The miseducation stage focuses on the experiences of Black students that become dismayed because of exposure to an educational system that values Western 36
  • cultural aspects and downplays the merit of Black history. Because of this educational emphasis, some Black students develop a Eurocentric cultural perspective. The pre-encounter/conformity assimilation stage occurs when Blacks envision themselves as Americans without having a consciousness of their Blackness. Additionally, Cross (1995) revisited the internalization stage of the Black identity model. Cross separated this stage into two distinct segments: Afrocentric nationalist and Bicultural identities. The Afrocentric perspective focuses on an African culture worldview. The bicultural vantage point embraces social justice and advocates the annihilation of all forms of oppression and racism. Racial Oppression as Complex Trauma Complex trauma is the psychological injury that results from the experience of having endured multiple, traumas or chronic sub-acute stressors over a prolonged period of time. Racism is defined by Better (2008) as, “an individual act or an institutional practice that perpetuates inequality, based on racial membership” (p.10). Is it possible for experiences of racial oppression to produce complex trauma? Dion (2002) decisively posited perceived acts of racial prejudice and discrimination as a “psychosocial stressor”. He writes, “…it elicits cognitive appraisals of threat, such that victims impute stable, malevolent motives and intentions to the antagonists and see themselves as a deliberate target of nasty attitudes and behavior by the antagonist(s).” Dion (2002) further asserted that the unpredictable nature of perceived prejudice and discrimination adds an adaptation 37
  • cost factor that far exceeds that of a predictable or controllable stressor. In this manner, racism carries the potential for relentless levels psychological damage. Dion’s (2002) assertion of racial prejudice and discrimination as a psychosocial stressor is valid; however, to establish an experience as traumatic further suggests that to some extent it produces psychological injury. Research by Williams and Williams-Morris (2000) identified three ways that racism compromises the mental health of Black people in the US. First is the recognition that institutional racism impacts the mental health of Black people via constraints on socioeconomic advancement, limited access to resources, and impoverished living conditions. Secondly, they note that racism induces physiological and psychological reactions that, themselves, can have deleterious effects on mental health. Lastly, they specify that negative self-evaluations that impact mental health are the product from the tolerance of stereotypes in race conscious societies, such as the US. A leading specialist on the health impact of racism and research director of Social Determinants of Health for the CDC, Dr. Camara P. Jones, conducted a survey that revealed that while Whites rarely reflect upon their race throughout the course of the day, 22% of Blacks constantly think about their race on a daily basis and 50% of Blacks think about it, at least once, daily (Healthplace.com, 2003). This statistic highlights the degree of hyper-awareness of being Black that is common in the Black community. In a recent study, precipitated by the high profile arrest of Henry Gates, a Black man who is a respected scholar at Harvard University, Shapiro, Ackerman, 38
  • Neuberg, Becker, and Kenrick (2009) conducted a study to conclude whether the facial expressions of Black men were more likely to be perceived by Whites as threatening. The results documented a prevalence of over-perception of intimidation to the faces of Black males. Winters and DeBose (2002) advanced what they referred to as the “assimilation model,” which proposed that “members of American society who start out disadvantaged can pull themselves up by their bootstraps by taking advantage of the educational and economic opportunities in American society, resulting in even more successful assimilation” (p.133). In this respect, assimilation is considered predictable and advantageous. It is further noted in this study that cultural assimilation is postponed under two circumstances: (a) that the minority group is spatially isolated or segregated, and (b) when discrimination deprives the minority group of educational and occupational opportunities. Here we see that education and socioeconomic status are documented factors of assimilation. When assimilation is thwarted, as is often the case with individuals with low levels of education and income, it would stand to reason that the lack of assimilation would create un-alikeness resulting in greater perceptions of racism and racist attitudes, thus strengthening the relationship between trauma and oppression in this sub-group. The literature presented here builds a distressing foundation for the existence of a relationship connecting perceptions of oppression and trauma. The synthesis of the effects of racial oppression on Africans in America today appears to shed further clarity on the ubiquitous nature of racial oppression that is experienced by the vast majority of African American people today. 39
  • Research indicates that racial oppression may actually further bind, reinforce and exacerbate existing vicarious trauma. Understanding this critical dynamic is essential to understanding how psychologically lethal present experiences of racial oppression are on African American people today. What Is Trauma Transmission? Modes of Transmission “Repetition is the mute language of the abused child.” -Richard Rhodes There is no question that the modes of trauma transmission are complex, multiple, and meditated by numerous variables. Many children pick up on the defensive structures of traumatized parents. Additionally, the children intuitively absorb the repressed, dissociated and warded off trauma that lurks behind the aggressive overtones found in many adults’ parenting styles (Auerhahn & Laub, 1998). PTSD literature embraces and accepts that therapists working with victims of trauma will suffer vicarious traumatization (Pearlman, 1995). Yet the belief that a child who cannot differentiate her boundaries from those of a parent who cares for and lives with her would pick up on the traumatized parent’s traumatized and dissociated self, and be impacted by this identification is still arguable (Solkoff, 1992). Auerhahn and Laub (1998) have researched indirect and direct forms of trauma transmission and they contend that parents who are survivors of the Holocaust often convey themes in nonverbal ways. They maintain that children of survivors are witnesses to the Holocaust and can become chained to parents’ 40
  • versions of reality. In this matrix within which normal development should occur, conflict takes place. Auerhahn and Laub (1998) note that while all parents want to nurture and raise their children, they also wish to have the children out of their way. Survivor’s children’s normal expressions of aggression and hate resonate in traumatized parents with their own overwhelming and repressed rage. At the same time, the survivor’s children conjure up the rage of the perpetrator whose victims they came to be. Furthermore, children of survivors, like all children, must organize their own instinctual lives (Solkoff, 1992), and the stories of the atrocities and massive traumas to which they have been exposed. The parent’s stories of violence, fused with their own aggression and rage, as well have become screens onto which this aggression is projected (Auerhahn & Laub, 1998). Thus, infantile aggression and sexuality, stimulated by parental care, can become fused with Holocaust content if Holocaust imagery and affect are evoked in that relationship. (Auerhahn & Laub, 1998). Children of survivors may sense that their very developmental milestones may reactivate the trauma of the parents. This in turn, supports the children’s identification with victimizers by making them feel that their feelings are murdering the parents (Danieli, 1985; Peskin et al., 1997). Auerhahn & Laub (1998) contend that children’s normative developmental needs and conflicts may reactivate parent’s traumatic histories. An adolescent’s individuation and differentiation can be experienced by a parent as a devastating abandonment from which the parent cannot imagine recovering (Auerhahn & Laub, 1998). Children and grandchildren can thus serve as reactivators of trauma even while they also 41
  • serve (and offer themselves) as opportunities (and second chances) for healing (Danieli, 1994). As long as multiple generations do not distinguish that their life experiences and expectations are diminished by trauma, they remain in the grip of that event(s). Auerhahn & Laube (1998) and Danieli (1998) communicate the vital point that “generational continuity may be the most poignant and consequential casualty of this chronic inattention.” Within the past ten years, the focus in psychological communities around trauma discourse have expanded from individual to the generational impact of trauma on the detrimental impact of trauma on the family system, and previous generations. This process of vicarious retraumatization has been given countless names, including intergenerational, transgenerational, multigenerational, historical, collective trauma and the soul wound (Danieli, 1998; Yellowhorse, 2000; Eyerman, 2001; Duran, 2005). For the purposes of this dissertation the term intergenerational trauma will be utilized to encompass forms of transmitted trauma throughout the generations. The next section will address theories regarding how transmission occurs. Mechanisms of Trauma Transmission Over time, the experience of repeated traumatic stressors become normalized and incorporated into the cultural expression and expectations of successive generations. While trauma manifesting as culturally prevalent will not be necessarily and readily identifiable as a specific or individual disorder. Many 42
  • hypotheses regarding how trauma is transmitted between generations have been suggested. Trauma transmission is often conceptualized into two mechanisms: Direct and indirect (Baronowky, et al., 1998; Kellerman, 2001b; Lichtman, 1984; Rowland-Klein & Dunlop, 2001; Weis & Weis, 2000). Direct and indirect mechanisms of trauma have been used in reference to symptom development, transmission content and communication (Hyland, 2007). Direct transmission of symptom development refers to children acquiring symptoms similar to those of their traumatized parents (Felson, 1998; Kellerman, 2001b; Weis & Weis, 2000). Indirect transmission refers to a child’s development of symptoms as a result of living with a traumatized parent (Hyland, 2007). Direct transmission refers to the traumatized parents’ overt discussion of their traumatic experiences with their children (Baronowsky et al., 1998; Kellerman, 2001b; Rowland-Klein & Dunlop, 2001). In this context, indirect transmission refers to covert, non-verbal communication to the child about the parent’s traumatic experiences. Direct and indirect transmission can take place within the same family (Weis & Weis, 2000). There are various theories of transmission of trauma that involve biological (Yehuda et al, 1998); Yehuda et al, 2000; Yehuda, Halligan & Grossman, 2001), intrapsychic (Gardner, 1999; Kellerman, 2001b; Rowland- Klein & Dunlop, 2001; Walker, 1999; Weis & Weis, 2000), behavioral (Maker & Buttenheim, 2000; Kellerman, 2001b), and familial and social transmission 43
  • mechanisms (Lichtman, 1984; Weingarten, 2003, 2004). Different theories regarding the various types of transmission mechanisms are discussed below. Biological Mechanisms Biological theories of trauma transmission address physiological vulnerabilities for the development of psychological disorders that are passed from one generation to the next (Kellerman, 2001b; Weingarten, 2003, 2004; Yehuda et al., 1998; Yehuda et al., 2000; Yehuda et al., 2001). There is room to believe that there is a direct and specific genetic link for the passing of vulnerability to PTSD from traumatized parent to offspring (Watson et al., 1995). There is evidence that children of traumatized parents are more likely to develop symptoms of PTSD after exposure to trauma, than are children whose parents do not have a trauma history (Solomon et al., 1998). Watson et al. (1995) and Yehuda et al. (1998a) have found that children of parents diagnosed with PTSD are more likely to develop symptoms of PTSD after exposure to trauma, as opposed to children whose parents do not have a known trauma history (Solomon et al., 1998). Research has indicated that children of parents diagnosed with PTSD are significantly more likely to develop PTSD in response to traumatic experiences (Watson et al., 1995; Yehuda et al., 1998a). Offspring of traumatized parents have been shown to exhibit trauma-related biochemical abnormalities (Yehda et al., 1998a; Yehuda et al., 2000; Yehuda et al., 2001). Therefore, it appears that research on the biological transmission of trauma, which occurs predominantly in 44
  • direct and indirect forms; provide an explanation for the intergenerational transmission of trauma. Intrapsychic Mechanisms For the traumatized child, intrapsychic mechanisms of trauma transmission have also been proposed as unavailable for internalization (Baranowsky et al., 1998; Gardner, 1999; Kellerman, 2001b; Kohout & Brainin, 2004; Rowland-Klein & Dunlop, 1998; Walker, 1999). Consequently, the child may become overwhelmed and symptomatology may develop. Maker and Buttenheim (2000), Gardner (1999), Rowland-Klein and Dunlop (1998), Walker (1999) and Watanabe (2002), have all proposed that the psychodynamic concept of projective-identification explains trauma transmission. Roland-Klein and Dunlop (1998) state that this process involves the projection of one’s own denied internal experiences onto another in such a way that the other person actually assumes the feelings and behaviors projected onto her. For example, a parent who experienced abuse as a child may be unable to accept and integrate the traumatic experiences. Therefore, her inability to tolerate feelings of anger and sadness related to her abuse is impaired. As a result of this impairment, she projects those disavowed feelings onto her child. The child then adopts those feelings as her own in an effort to connect with and understand her mother. The child then displays symptoms of anger and sadness, as if she herself had been abused, despite having no actual direct experience of the trauma. The child then becomes a vehicle for expression of the emotional experiences that the parent finds unbearable (Gardner, 1999; Maker & Buttenheim, 2000; Rowlan-Klein & 45
  • Dunlop, 1998; Weingarten, 2004). Projective identification is hypothesized to be an indirect transmission mechanism occurring at an unconscious level, without explicit communication about traumatic experiences. Green (1998), Maker & Buttenheim (2000), and Kohout (2004) identify repetition compulsion as another psychodynamic conceptualization of how trauma is transmitted. Repetition compulsion refers to the unconscious patterns that a person reenacts with an intimate other(s) in their lives’ (Kohout, 2004). Unresolved conflict is compulsively repeated as a means of mastery over traumatic events (Green, 1998). Hence, traumatic experiences are also subject to repetition compulsions (Green, 1998; Maker & Buttenhein, 2000). For example, a father who has a history of abuse by his own father may be hesitant to set limits on his son because he is uncomfortable with the potential for aggression in his discipline. The son, then without limits, begins acting out in controlling and aggressive ways towards his father. Therefore, the father feels victimized by his son in ways that are reminiscent of the abuse he suffered by his father. In this way, trauma is indirectly transmitted and happens because the child’s developmental needs are overshadowed by the father’s traumatic past. Maker & Buttenheim (2000) theorize that the father is unable to provide all of the vital psychological needs that the son requires and negative interactional fields are created. Additionally, the process of projective identification can be used in individuals’ repetitions. The repetitions may also be carried out through unconscious choice to engage with others similar to the original perpetrator (Maker & Buttenheim, 2000). 46
  • Attachment Mechanisms The intergenerational transmission of attachment patterns and the influence of these patterns on the transmission of trauma have also been widely studied (Bar-On et al., 1998; Watanabe, 2002). John Bowlby first developed the concept of attachment, which refers to the “reciprocal, enduring, emotional, and physical affiliation between a child and a caregiver” (James, 1998). Attachment has been conceptualized as a process, which begins in infancy and childhood but continues into adulthood (Johnson, 2003). It is through the attachment relationship that the child develops the capacity to regulate emotion, cope with stress, and navigate interpersonal relationships (James, 1998; Johnson, 2003). Problems in the attachment relationship are often cited as influential in the intergenerational transmission of trauma literature (Bar-On et al., 1998; Sagi-Schwartz et al., 2003). In particular, several authors suggest that the transmission of trauma attachment pattern may be responsible for intergenerational patterns of child maltreatment (Dixon et al., 2005b; Green, 1998; Kretchmar & Jacobvitz, 2002; Newcomb & Locke, 2001; Zeanah & Zeanah, 1989). There are four main types of secure attachment: secure, insecure-resistant, insecure-avoidant, and insecure-disorganized (James, 1998; Johnson, 2003; Macfie et al., 2005; Weingarten, 2003; Zeanah & Zeanah, 1989). Patterns of relating in both children and parents have been identified for each type of attachment (James, 1998; Johnson, 2003). A myriad of theorists agree that attachment style forms as a result of the interactional process between child and 47
  • caregiver (James, 1998; Johnson, 2003; Dixon et al., 2005b). It is hypothesized that styles of attachment are created based on the responsiveness of the parent to the particular physiological, emotional, and social needs of the child. Also, the temperamental match between parent and child will influence the development of a particular attachment style. Children will use attachment relationships as a “secure base” from which that can venture out and explore their environment (James, 1994; Zeanah & Zeanah, 1989). The characteristics of the four attachment styles are described below. Secure attachment is marked by the child’s assurance in caregivers to supply needed comfort and nurturance (Byng-Hall, 2002; James, 1998). Secure attachment supports the advancement of autonomy while maintaining appropriate relational dependence (Johnson, 2003). Development is enhanced by secure attachment in that children are able to explore their environment unencumbered by any significant amount of fear and worry (James, 1989). Securely attached individuals learn to modulate emotional experiences and successfully use relationships as a tool for emotional regulation (Carlson, 1998; Byng-Hall, 2002; Johnson, 2003). Such support is accessed without posing any threat to identity integrity, and an autonomous sense of self is maintained during this process (Johnson, 2003). Secure attachment is facilitated by consistent, reasonably accurate responsiveness by caregivers to the needs of the child (James, 1998; Levy & Orlans, 2006). Parents of securely attached children are attuned and sensitive to their children’s signals and needs most of the time (Levy & Orlans, 2006). They 48
  • can usually provide clear and consistent structure and loving discipline. Additionally, they are effective communicators. Secure attachment may act as a buffer against the development of psychopathology after exposure to trauma (James, 1998; Weingarten, 2003). Additionally, development of secure attachments may assist in interrupting cycles of maltreatment in families (Dixon et al., 2005). Insecure attachment, in contrast, is marked by uncertainty about the availability of nurturance and comfort (James, 1998). Inconsistent, ineffective responsiveness by caregivers is related to resistant attachment in particular (Kretchmar & Jacobovitz, 2002; Zeanah & Zeana, 1989). These children are often observed to be in a constant state of Hyperarousal. It is hypothesized that this is an unconscious adaptive strategies employed to obtain desired reassurance and nurturance from unreliable caregivers (Zeahnah & Zeahah, 1989). Elevated arousal frequently takes the form of anger. Increased levels of anger can be effective in motivating caregivers into action; it can also simultaneously interfere with the child’s acceptance of the caregiver’s response. A parent of avoidantly-attached children can often be observed to be rejecting by means of their infants (Zeanah & Zeanah, 1989). Rejection is not necessarily overt and cruel, but often relate to more subtle behaviors by parents, such as averting their stare or turning away from the infant during exchanges in which the child is seeking comfort. It is hypothesized that, over time, these children begin to discover that their dependency needs will be rejected, and consequently reject desires for attachment and spurn connection. 49
  • In cases where there have been relational forms of trauma, disorganized attachment is often cited (Bar-On et al., 1998; James, 1994). There are numerous ways in which the parents of these infants have been observed to behave in particularly frightened ways (Carlson, 1998; James, 1994). Traumatized parents may conduct themselves in unsuspectingly frightening or frightened ways; and perpetration of abuse by caregivers can also appear frightening to children as well. A caregiver may become traumatically triggered during communication with her/his child, and consequently demonstrate nonverbal expressions that the child, with no framework for this behavior, experiences as horrifying. Caregivers with unresolved grief or trauma are particularly at risk for engaging in this way with their offspring. Avoidantly attached children have developed disorganized ways of approaching attachment relationships (James, 1994; Zeanah & Zeanah, 1989). These children often begin interactions for nurturance with caregivers, however they may then react with panic, retreat or guardedness. There is a deficiency in coherent behavioral organization when connecting to parents and their behavior is often seen as confusing when distressed (Carlson, 1998). The attachment relationship can significantly influence the experience of trauma (James, 1994; Weingarten, 2003). It may serve as a safeguard or heighten the child’s vulnerability to the detrimental effects of trauma. Securely attached children who have a single possibly traumatic encounter may feel adequately comforted and contained by their caregivers. However, children who experience multiple traumas, such as chronic abuse, particularly if perpetrated by a significant attachment figure, may be at greater risk for the development of 50
  • psychopathological symptoms (James, 1994). When children experience neglectful, unpredictable, and frightening responses from caregivers they may become particularly anxious, irritable or withdrawn (James, 1994). Maltreated children are the most commonly classified as having an insecure-disorganized attachment style, out of the three types of insecure attachment (Bar-On et al., 1998; Carlson, 1998; Zeanah & Zeanah, 1989). Attachment theory states that children form “internal working models” of relationships (Bar-On et al., 1998; Weingarten, 2003; Zeanah & Zeanah, 1989). The child’s experiences in relationship to her or his caregiver are internalized and then utilized to facilitate and comprehend future relationships and steer interpersonal behavior. The term “working” refers to opportunity for change in attachment style based on new relational experiences. It is posited that these internal models shape the basis for the adult’s relationship and caregiving behaviors with his or her own child (Bar-On et al., 1998; Green, 1998; Kretchmar & Jacobvitz, 2002; Macfie et al., 2005; Weingarten, 2003). Hence, transmission occurs because early experiences are carried forth to the next generation through these internalized models for relationships. Of particular significance, is abusive patterns frequently referred to as ‘cycles of abuse,” which may be perpetuated through attachment relationships. PTSD often impairs interpersonal functioning, hence interferences in the caregivers’ adult attachment may occur. Parents who are currently affected by trauma-related symptoms may have been noted to have problems in creating 51
  • secure attachments with their children (Bar-On et al., 1998). As a result of the hyperarousal symptoms, parents afflicted with PTSD may behave in frightening or frightened ways with their children, as indicated above, in turn also producing difficulties in attachment. Under-responsiveness can also occur as a possible result of disruptions in attachment styles. Additionally, parents struggling with the symptoms of PTSD may be more focused on their own distress, as opposed to the needs of their children (Bar-On et al., 1998). Issues related to attachment can produce ineffective coping strategies, in that children are unable to utilize relationships effectively in order to get their needs met and consequently develop inadequate strategies for connection and emotional regulation (James, 1998). Insecurely attached children are likely to exhibit maladaptive behaviors and experience heightened psychological distress. Attachment mechanisms of trauma transmission are considered indirect, as effects are a result of living with an impaired parent. It is estimated that about 30% of adults abused as children go on to abuse their own children (Kaufman & Zigler, 1987; Oliver, 1993; Weingarten, 2003; Zeanah & Zeanah, 1989). Another 30% go on to raise their children without perpetuating abuse (Oliver, 1993). Some adults abused as children will unknowingly choose partners who become abusive with their children (Macfie et al., 2005). Oliver (1993) suggests that other life stressors, such as poverty or oppression, or lack thereof, and other factors will determine the behavior of the remaining 40%. 52
  • Cycles of maltreatment have often been observed to skip a generation (Kaufman & Zigler, 1987; Oliver, 1993). It is thought that this may be due to problems in the attachment relationship. In other words, although the majority of parents abused as children do not go on to perpetuate abuse with their own children, their attachment experiences are nevertheless blemished by the abuse they suffered. Additionally, based on the preise that attachment relationships are transmitted, it seems quite likely that their children may also experience difficulties with attachment (Green, 1998; Kretchmar & Jacobvitz, 2002; Zeanah & Zeanah, 1989). Garcia-Prieto & Travis (1985) note that adults raised by impaired parents are often sickened to find that despite their best efforts at good parenting, they have raised children who are just like their own parents. The attachment troubles of the second generation may direct to a recurrence of maltreatment with the third. Social Learning Mechanisms Learning theories hypothesize that children are socialized to behave in particular ways, established on modeling. By observing their caregivers and particularly their parents, children learn behavioral strategies. Macfie et al. (2005), Newcomb and Locke (2001), and Weingarten (2004) have discussed the purpose of social learning theories as explanative mechanisms of intergenerational transmission of trauma. These authors suggest that children may “learn” parents’ trauma related symptoms and begin to exhibit similar behavior. Social learning mechanisms of trauma transmission are, therefore, direct. 53
  • Social learning theory has received significant attention as it relates to cycles of maltreatment (Macfie et al., 2005; Newcomb and Locke, 2001; Solomon et al., 1988; Weingarten, 2004). Roughly a third of maltreated adults will continue to perpetuate, knowingly or unknowingly, the cycle of maltreatment with their own offspring (Macfie et al., 2005; Newcomb & Locke, 2001; Weingarten, 2004). Some authors suggest that parents repeat the parenting strategies the learned or were modeled to them, in their own childhood with their own children (Macfie et al., 2005; Newcomb and Locke, 2001; Solomon et al., 1988; Weingarten, 2004). Therefore, the social learning theory, much like the attachment theory, speculates that the intergenerational transmission of trauma is based on early experiences with caregivers. However, research by Macfie et al. (2005) suggests that social learning theory may be insufficient in explaining the intergenerational transmission of trauma. Macfie and Weingarten et al. (2005) studied the role of intergenerational patterns of parent-child role reversal. They examined 138 non-clinical families and found that men who had experienced role reversal with their mothers tend to marry women who enacted role reversal with their sons. Macfie et al. (2005) additionally referenced other studies by Browne and Finkelhor (1986) suggested that women who had been sexually abused by their fathers are more likely to marry men who sexually abuse their daughters. Based on these findings, the authors suggest that the learning theory only accounts for transmission of same- sex boundary violations. In contrast, the authors propose that internalization of 54
  • the whole family system is better accounted for by the internal working models of attachment theory. Therefore, although social learning theory is criticized as insufficient for explaining the intergenerational transmission processes (Macfie et al., 2005), it appears that there are aspects of this psychological intervention that could be quite helpful. As a direct form of trauma transmission, social learning mechanisms are comparable to biological mechanisms in that they mutually involve the child’s adoption of parental PTSD symptoms. The Family Systems Perspective The intergenerational perspective reveals the impact of trauma, its contagion, and repeated patterns within the family (Danieli, 1995). Boszormenyi- Nagy and Spark (1984) argue that children feel indebted to repay parents for the care and nurturance they received and that for many families, this repayment takes place in the next generation through care provided to children. Kohout (2004) and Boszormenyi-Nagy and Spark (1984) speculates that trauma is passed down from generation to generation in the form of “debts,” “entitlements,” and “legacies.” Maltreatment can hamper with this process and create an imbalance in family relational “ledgers.” These authors also argue that repetitions occur in the form of “invisible loyalties” in hat children are compelled to maintain family connections by recreating that which they received. In the case of collective trauma, Weingarten (2003, 2004) argues that children become imbued with a need to reverse the agony of the previous generations. It appears, that the children assume their parents’ trauma as their 55
  • own and embark on a pursuit for relational connection and truthfulness. Boundaries of ownership can be blurred in such a journey and not only create traumatic repercussions for the second generation, but also perpetuate violence. Boundaries in families with traumatized parents are often noted to take excessive forms in which roles within the family are inappropriate and/ or blurred (Danieli, 1995; Kellerman, 2001b). Roles can become reversed and children may adopt a parental function. The parent, through conscious or unconscious mechanisms, may exert pressure on the child to attend to parental needs. The child may also sense fragility in the parent and adopt a caregiving role. Such a child seeks to preserve the good, nurturing aspects of her or his parent by relieving parental burdens. However, as Kellerman (2001b) states, “they sadly become orphans themselves with unfulfilled dependency needs of their own.” (p. 263). While traumatized parents may appear fragile to their children and in need of protection, the opposite can also be true. Traumatized parents are frequently noted to be overprotective with their children (Felson, 1998; Kellerman, 2001a, 2001b; Weingarten, 2004). Indirect messages regarding safety in the world, or lack thereof, are consequently transmitted indirectly. Children may be left with elevated levels of anxiety and mistrust. Hence, functioning in day-to-day activities and relationships may be impaired. Structural family therapy, founded by Salvador Minuchin, addresses e need to develop and uphold clear and appropriate hierarchical divisions in families (Goldberg & Goldberg, 2004). Structural family therapists emphasize 56
  • that children in families where boundaries are either overly inflexible or overly diffused are at risk for the development of psychological symptoms and may encounter difficulties with identity formation and independence. As previously mentioned, intergenerational trauma transmission is also affected by the parent’s present level of trauma-related impairment (Felson, 1998; Kira, 2003; Weis & Weis, 2000; Yehuda et al., 2001). Having a parent with PTSD significantly increases the risk of trauma transmission. Parents currently suffering from PTSD are likely to be anxious with their own needs and may, as a result, be incapable to fully attend to the needs of their children (Baranowsky et al., 1998; Felson, 1998). Overall, residing with a parent or caregiver who is struggling with PTSD can create a very stressful and anxious home environment. There may be higher levels of familial conflict, which in turn can trigger symptom development in vulnerable children because the effects of a healthy and supportive relationship are lacking (Felson, 1998). Indigenous Perspectives on Trauma Effects of trauma may manifest itself into feelings of fear, anxiety, rage, helplessness, and may potentially result in such maladaptive behaviours as alcoholism, family discord, and high suicide rates (Bryant-Davis, 2007; Duran, 2006). When discussing symptom-oriented problems in communities of color, many indigenous healers and clinicians in psychological communities speak of ideas such as “spiritual injury, soul sickness, soul wounding, and ancestral hurt” (Duran, 2006). Many psychological literature reviews omit or do not conceive of the word soul in connection with providing mental health services. However, 57
  • Eduardo Duran (1995; 1996; 2000; 2006) and Maria Yellow Horse-Braveheart (2000; 2003) have been some of the primary clinicians in the Native American community to introduce the oral traditions and use of the term soul wounding to reflect a spiritual ailment as a collective in the community. Healers of both a psychotherapeutic, indigenous, native and/ or shamanic orientation agree (Duran, 1996; Levine, 1997; Yellowhorse, 2000; Villoldo; 2000; Odigan, 2001; Wangayal; 2002; Foor, 2004) that the symptoms of trauma almost always arise in response to an external stressor or a combination of stressors, most of which are clearly identifiable and severe in nature. Unlike nearly all other mental-health disorders which separate the question of etiology from diagnosis; the first DSM-IV diagnostic criteria for both Posttraumatic Stress Disorder (PTSD) and Acute Stress Disorder (ASD) require that the person was exposed to a traumatic event. Similarly, the contemporary shamanic literature contains long lists of symptoms and causes of soul loss including incest, physical abuse, war, accidents, rape, major illness and surgery, death of a loved one. Both trauma and soul loss imply external stressors. Even in cases where the agent of the psychological distress is understood to be an intrusive spirit, this being is described as having appeared at a time when the person was in a weakened emotional and physical state. Trained psychotherapists and shamans acknowledge varying degrees of severity in complex trauma or soul loss. There are psychological terms for some of the variables that tend to increase stressor magnitude. Therefore, the possible severity of PTSD, complex, or intergenerational trauma response include: sexual 58
  • victimization, intentional acts of violence, degree of unpredictability or uncontrollability, extent of combat exposure, and the grotesqueness of death (Foor, 2004; Villolodo, 2000). Among shamanic healers in North America there are several recurring metaphors or ways to conceptualize sickness and healing that are analogous to what is called “complex trauma” in psychology. Perhaps the most widely used construct is that of “soul loss” (Villolodo, 2000). In an appendix entitled culture- bound syndromes, the DSM-IV acknowledges, “soul loss may be related to Major Depressive Disorder, Posttraumatic Stress Disorder, and Somatoform Disorders” and that the practices and symptom patterns described as soul loss throughout Latin America cultures “are found in many parts of the world” (Villoldo, 2000). In neoshamanic, as well as in many indigenous shamanisms, the idea of soul loss “is that whenever we experience trauma, a part of our vital essence separates from us in order to survive the experience by escaping the full impact of the pain” (Villoldo, 2000; Odigan, 2001). Psychotherapists’ and shamanic healers’ methods agree that the transformation of trauma in individuals is inseparable from healing trauma in the larger socio-cultural matrix. 59
  • CHAPTER 3: INTERGENERATIONAL TRANSMISSION OF TRAUMA AND TRAUMA TREATMENT Intergenerational or multi-generational trauma happens when the effects of trauma are not resolved in one generation. When trauma is ignored and there is no support for dealing with it, the trauma will be passed from one generation to the next. What we learn to see as "normal" when we are children, we pass on to our own children. Children who learn that ... or sexual abuse is "normal,” and who have never dealt with the feelings that come from this, may inflict physical and sexual abuse on their own children. The unhealthy ways of behaving that people use to protect themselves can be passed on to children, without them even knowing they are doing so. This is the legacy of physical and sexual abuse in residential schools (Aboriginal Healing Foundation, 1999). CITE! “The medicine is already within the pain and suffering. You just have to look deeply and quietly. Then you realize it has been there the whole time.” -saying from Native American Oral Tradition The origin of study of intergenerational trauma lies in the exploration and study of the impact of the Holocaust upon the survivors and their children (Abrams, 1999; Baranowsky et al., 1998; Walker, 1999). Such exploration soon sparked further research into other forms of traumas and psychological issues that impacted upon other ethnic groups, as well as others who have faced societal and cultural atrocities. In Baranowsky, Young, Johnson-Douglas, Williams-Keeler & McCarrey’s (1998) review of the literature, the noticed that the effects of trauma can be influentially far-reaching. They noticed that previous research (Edwards, 1995; McCann & Pearlman, 1990) on vicarious traumatization and compassion fatigue displayed that clinicians treating with traumatized clients, they begin to experience traumatization. In their clinical experiences, they were able to trace a parent’s own unresolved traumatic Holocaust experiences to the current serious 60
  • psychological problems of the child. Additionally, they summarize a study in which the staff of the Holocaust Memorial Museum displayed a wide range of stress responses after exposure to private possessions from survivors and victims’ in the museum (Hyland, 2000; McCarroll et al., 1995). They contended: If trauma is so volatile as to leave its mark on a therapist who meets a client for a limited period of time, or museum staff who come into contact with material alone, we must ask what happensto the offspring of trauma victims who interact with these individuals on a daily basis. (p. 249). Within the field of traumatic stress, intergenerational transmission of trauma is a relatively recent focus of mental health. Intergenerational trauma has been reported first observed in 1966, by clinicians alarmed by the number of children survivors of the Nazi Holocaust seeking treatment (Danieli, 1998; Brave Heart, 1995, 2000). The Israeli psychoanalysts were among the first theorists to build upon the classic definition of trauma and were integral in establishing the concept of intergenerational trauma, as an integral part of the field of traumatology (de Graaf, 1998). Danieli (1998) states that the ensuing pioneers in the United States (Axelrod, Schnipper, & Rau, 1980; Barocas & Barocas, 1973, 1979; Danieli, 1980, 1981a; Fogelman & Savran, 1979; Kestenberg, 1972, 1989), and soon after in Israel (Davidson, 1980; Klein, 1971) further expanded upon our understanding of the “second generation syndrome” (van Ijzendoorn et al., 2003). Clinicians began to observe that children of survivors were presenting for treatment with symptoms as if they themselves had lived through the atrocities of the Holocaust (Baranowsky et al., 1998; Rowland-Klein & Dunlop, 2001; Weingarten, 2003). 61
  • Numerous theories regarding the intergenerational transmission of trauma have been proposed (Baranowsky et al., 1998), and the information related to these mechanisms have since increased to encompass multigenerational transmission effects (i.e. on the grandchildren and great-grandchildren of Holocaust survivors) and the children of parents who are survivors of neglect, sexual, emotional and physical abuse (Gardner, 1999; Watanabe, 2002). Shosan’s (1989) studies on Israelis suggest that not only is trauma passed on intergenerationally; but also it is also cumulative. Therefore, there is a process whereby unresolved trauma becomes more severe each time it is passed on to a subsequent generation (Duran, 2006). Once liberated from enslavement or imprisonment, survivors manifested what can be seen as a cluster of PTSD symptoms. These symptoms are often referred to as survivor syndrome this included chronic or recurrent states of anhedonia, dissociation, depression, anxiety, psychosomatic conditions, intense anger, and survivor guilt (Niederland, 1981). In 1980, the descriptions of the “survivor syndrome,” commonly observed in those who lived through the Holocaust, found its way into the Diagnostic Statistical Manual of Mental Disorders (DSM-III), as a separate and valid category: posttraumatic stress disorder (PTSD) (Danieli, 1998). Survivor syndrome was said to include symptoms of emotional detachment, depression, intense anger, anxiety, hypochondriasis, disturbances of cognition and memory, and guilt over having survived when other perished (Niederland, 1964), was being 62
  • passed from parent to child. This process is now more commonly known as the intergenerational transmission of trauma (Danieli, 1998). Trauma transmission has been discussed and studied during the past several years extensively (Abrams, 1999; Baranowsky, Young, Johnson-Douglas, William-Keeler & McCarrey, 1998; Bar-On, 1996; Danieli, 1998; Gardener, 1999; Kellerman, 2001b; Kira, 2003; Kohut & Brainin, 2004; Rosenheck & Fontana, 1998a, 1998b; Salson & Figley. 2003; Solomon, Kotler & Midulincer, 1988; Walker, 1999; Weis & Weis, 2000). Recently, the focus of trauma has expanded from individual impact to the generational impact of trauma (Danieli, 1998; Eyerman, 2001). This transmission of trauma begins at the interpersonal level (i.e., from a parent to their child), and expands to the intergenerational level (i.e., a generation of parents to a generation of children), thus impacting an entire group or culture. Increased interest regarding the effects of trauma on survivors’ children has risen, and there has been an increasing awareness of the detrimental impact of trauma on children and adolescents. As a whole, intergenerational transmission of trauma is largely seen as a phenomena related to various minority and oppressed populations due to the lingering impact of colonization (Cutler, 2001). Research on Intergenerational Trauma Historical examples of intergenerational trauma can be seen in Jewish Holocaust survivors who were forced to endure concentration camps, war survivors who witnessed excessive acts of violence, and Aboriginal people who were victims of “ethnic cleansing” for hundreds of years. 63
  • There is a substantial amount of evidence that demonstrating that the effects of intergenerational exists (Felsen, 1998; Danieli, 1984). In particular, the evidence is abundant in the literature supporting the transmission of intergenerational trauma in children of Holocaust survivors’ (Danieli, 1984). Specifically, in Israeli soldiers whose parents were survivors suffered from a greater number and longer lasting symptoms of Posttraumatic Stress Disorder after returning from combat, when compared to Israeli soldiers whose parents did not go through the Holocaust (Solomon, Kotler, & Mikulincer, 1988). Based on his studies with Israeli soldiers, Solomon (1990) also concluded, that soldiers whose parents were survivors, manifested symptoms after combat that were very similar to their survivor parents; particularly when compared to combat soldiers who parents were not in the Holocaust. Wiseman and Barber (2008) conducted a study using 56 Holocaust Survivor Offspring that were born in Israel between 1946 and 1956. The participants’ parents all emigrated from Eastern Europe prior to 1945, and all were in a Nazi concentration camp. The results supported the concept of intergenerational transmission of trauma in the following ways. First, there was an emotional distance between the Holocaust Survivor Offspring and their parents, as well as a deep need to be validated and cared for by the mother. Secondly, the children of the survivors reported that they sought to protect their parents from negative emotions. Thirdly, the children were also hesitant to ask questions about the Holocaust, despite a deep curiosity to know details of what occurred. Fourthly, the children of survivors’ reported that their parents were in 64
  • constant fear that another war would erupt. Earlier studies found similar results, revealing that children of Holocaust survivors tended to have stronger feelings of anxiety because of their belief growing up that disaster would incur (Nadler, Kav Venaki, & Gleitman, 1985). Finally, biological approaches to intergenerational trauma transmission has examined the cortisol levels (stress hormone) of a sample of children of survivors. The results indicated that the children of Holocaust survivors’ had lower level of Cortisol compared to people without the Holocaust history background. These results reveal the possibility that individuals who are directly or indirectly exposed to trauma, may present with hypersensitivity to stressful situations. While intergenerational trauma started as exclusively the study of the Holocaust survivors and their offspring, it soon became the catalyst from which to understand the psychological symptoms and treatment infecting other ethnic groups such as Native Americans, Japanese Americans, and Vietnam War veteran’s descendants. New interest in intergenerational transmission for trauma was found in the Vietnam War. A myriad of researchers observed and studied the effects on children of Vietnam veterans and found these affects to be similar to those of the children of Holocaust survivors (Wiseman & Barber, 2008). War has always taken a toll on human lives’. Accounts throughout history tell of nightmares and other emotional problems associated with the horrors of war. Terms like "combat fatigue" and "shell shock" were used in the past to describe some of the effects of combat (APA, 1980). These terms are misleading because they imply that the 65
  • effects of combat are short-term. In the DSM-IV the term "Acute Stress Disorder" is used for a similar syndrome lasting less than 30 days (APA, 1994). Many Vietnam Veterans returned to their home countries at the end of their tour, however many of them could not leave their experiences behind them. The nature of the psychological impact of war service is evident in the prevalence of PTSD (American Psychiatric Association, 1987) in Vietnam War Veterans. The National Vietnam Veterans War Readjustment Study (Kulkas et al., 1990) indicates that nearly 500,000 Vietnams vets have PTSD and that almost 1.7 million veterans will exhibit clinically significant stress reactions in their lifespan (Hendrix & Annelli, 1993). A study conducted by the Center for Disease Control (CDC) found that Vietnam veterans were twice as likely to have enduring psychological problems in contrast with other war veterans (Roberts, 1988). Duran and Duran (1990, 1995, 2006) noted Native American researchers were among the first to utilize the term soul wound to highlight the etiology of the plentiful crises currently being suffered by Native Americans, in their publications. The soul wound is based upon concepts long known to Native American Elders as “spiritual injury, soul sickness, soul wounding, and ancestral hurt” (Duran, 2006). As Duran (2006) notes in Healing the Soul Wound: Counseling with American Indians and Other Native People, some research literature emerged from Israeli studies on posttraumatic stress, while he was seeking further discourse on the soul in trauma studies literature. Knowledge of the soul wound has been present in Indian country for many generations, and according to 66
  • researchers (Duran et al., 1998), contemporary problems in the community were seen with their etiology in traumatic events known as the “soul wound.” Duran’s work suggests that these concepts all present the idea that when trauma is not dealt with in previous generations; it has to be dealt with in subsequent generations (2006). Brave Heart (2004), was another prominent pioneer for the Native American and Native Hawaiian population on intergenerational trauma, and she conceptualizes Duran and Duran’s (1990) model as historical trauma. Dr. Maria Yellow Horse Brave Heart (1996, 2000, 2002, 2003) utilizes the term historical trauma, which differs slightly from Baranowsky et al. (1998) and other prominent theorists within the field of traumatology and intergenerational transmission of trauma. Brave Heart (2004) contends that historical trauma is defined as what happens when an ethnic group is traumatized over an extended period of time. She asserts: Historical trauma is the forced assimilation and cumulative losses across generations involving language, culture and spirituality which contribute to the breakdown of the family kinship networks and social structures. The historical legacy and the current psychosocial conditions contribute to ongoing intergenerational traumas. (p. 4). Historical trauma is the cumulative emotional and psychological wounding over the lifespan and across generations, emanating from massive group trauma (Brave Heart, 2000). Native Americans have, for over 500 years, endured physical, emotional, social, and spiritual genocide from European and American colonialist policy (Duran, 1996; Brave Heart, 2000). According to Brave Heart (1995, 1998, 1999, 2000) historical unresolved grief is the grief that accompanies the trauma. The historical trauma response is a constellation of 67
  • features in reaction to massive group trauma. This response is observed among Lakota and other Native populations, Jewish Holocaust survivors and descendants, Japanese American internment camp survivors and descendants, among other groups (Danieli, 1998; Brave Heart, 1998, 1999, 2000). Brave Heart asserts that the Lakota people, a group of indigenous people from the greater Sioux Native American tribe, suffer from impaired grief as an effect of cumulative massive group trauma associated with tragic events (1996, 1998, 2003). The Wounded Knee Massacre, assassination of Sitting Bull, and the forced removal of Lakota children to boarding schools, are but a few examples of massive group traumas experienced by the Lakota (Brave Heart, 1996). In her subsequent research, Brave Heart asserted that unresolved, disenfranchised grief, brought about by massive group traumas, was the basis for the decline in socio- economic conditions that prevail in the Lakota population and their respective communities. Brave Heart instituted the characteristics of the syndrome known as Human Trauma Response (HTR). HTR has a complex of biological, psychological, and social features, and HTR is differentiated by Maria Yellow Horse Brave Heart (2003) as follows: HTR often includes depression, self-destructive behavior, suicidal thoughts and gestures, anxiety, low self-esteem, anger, and difficulty recognizing and expressing emotions. It may include substance abuse, often an attempt to avoid painful feelings through self-medication. Historical unresolved grief is the associated affect that accompanies HTR; this grief may be considered fixated, impaired, delayed, and/or disenfranchised. (p. 7) Historical unresolved grief is the related affect that accompanies HTR; this grief may be considered fixated, impaired, delayed, and/or disenfranchised. 68
  • Manifesting as behavioral patterns associated with unresolved, disenfranchised grief, HTR is characterized as the litany of concerns typically experienced by First Peoples. Some of the symptoms include depression, self-destructive behavior, suicidal thoughts and gestures, anxiety, low self-esteem, anger, and substance abuse. HTR can be endemic in groups that have experienced unresolved massive group traumas. HTR tends to saturate communities, and at times even entire societies, and may also be transmitted to individuals within those groups who had no direct exposure to the original trauma. HTR is persistent and will pass from one generation to the next until and unless it is acknowledged and resolved in an appropriate manner (Brave Heart, 2003). Brave Heart also hypothesizes that HTR may be more commonly applicable amongst native people and proposes that multigenerational trauma may be present in other populations, including, for example, the children of those imprisoned in internment camps for Japanese Americans in the United States during World War Two (Brave Heart, 1996, 2003). During World War II, Japanese Americans suffered immense historical trauma at the hands of the United States of America government. During the years of 1942-1945, approximately 120,000 Japanese and Japanese American individuals from the West Coast of the United States were forcibly removed from their homes and incarcerated in internment camps due to government fears of treason and espionage (Nagata, 1993). The Japanese, culturally referred to as the Nisei in Japanese, were forced to live in sparse conditions without food or adequate shelter. The Nisei were left to fend for themselves with an experience of 69
  • helplessness, deprivation and health issues (Nagata, 1993). Yet, the major groups of survivors, the Nisei, generally do not confront the implications of the trauma within themselves or with their own children. In many respects, the Nisei have been “permanently altered in their attitudes, both positively and negatively, in regard to their identification with the values of their bicultural heritage; or they remain confused or even injured by the traumatic experience” (Miyoshi, 1978; Nagata, 1993). After the horrific experience of incarceration in the internment camps, the Nisei, brought forth a generation of children, referred to as the Sansei in Japanese. The Sansei were reported to have experienced a pervasive sense of silence in the family having been transmitted the trauma of their parents (Nagata, 1993; Yoshikawa, 2005). The Sansei children were left to struggle and hold the deep historical wounding which was forbidden to discuss. This pervasive sense of silence became a source of resentment towards many of the Sansei’s parents. Research corroborates the conclusions, that much like the children of Holocaust survivors, the Sansei, whose parents had been exposed to a traumatic experience like the internment camps, expresses an elevated level of emotional vulnerability (Nagata, 1993; Yoshikawa, 2005). Since trauma may directly or indirectly affect the children of trauma victims; the multiple pathways of its effects create a variety of consequences. Despite the silence, or perhaps because of it, the Sansei, felt the effects of that experience in numerous ways. Nagata (1993) and Miyoshi (1997), report that many of the Sansei are sad and angry about the injustice and attribute a number of 70
  • negative consequences in their own lives to their parents' internment. These include feelings of low self-esteem, the pressure to assimilate, an accelerated loss of the Japanese culture and language, and experiencing the unexpressed pain of their parents (Miyoshi, 1997). Jensen (1997) writes that long-term health consequences included psychological anguish as well as increased cardiovascular disease. Traumatic stress was buffered by culturally constructed coping mechanisms that were less inculcated in the youngest detainees. It is reported that the Sansei experienced more post-traumatic stress symptoms of unexpected and disturbing flashbacks, than those who were older at the time of incarceration (Jensen, 1997). "Survey information found former internees had a 2.1 greater risk of cardiovascular disease, cardiovascular mortality, and premature death than did a non-interned counterpart (Jensen, 1997). Jensen (1997) contends that California Nisei-age individuals, the proxy for internment, died 1.6 years earlier than Hawaiians who represented non-interned status. Therefore, it was concluded that traumatic stress has life-long consequences even in the presence of efficacious coping strategies. When confronted by personal traumas, the children of the Japanese internment camps were more likely to exhibit severe behaviors such as substance abuse and suicidal ideation (Yoshikawa, 2005). As discussed in this section, historical examples of intergenerational trauma can be seen prominently in the descendents of the Jewish Holocaust survivors, Vietnam veterans, Japanese who were incarcerated in the US internment camps and the Native people who were indigenous to the United 71
  • States of America. Intergenerational trauma is also seen with survivors of the trans-Atlantic slave trade and their children and grandchildren who were enslaved after them. The latter example is an example of intergenerational trauma, and thus will be the focus of this paper. Posttraumatic Slave Syndrome “No man can put a chain about the ankle of his fellow man without at last finding the other end fastened about his own neck.” -Frederick Douglas Perhaps the most essential and poignant question that this dissertation seeks to address is what effect has our history (American chattel slavery) had on the culture and soul of African American male youth? According to Dr. Joy DeGruy Leary (2005), Post Traumatic Slave Syndrome (PTSS) is a condition that exists when a population has experienced multigenerational trauma, resulting from centuries of psychological and emotional enslavement, and continues to experience oppression and institutionalized racism today (p. 125). Immersed in this condition, Dr. Leary suggests that there lies a “belief, whether real or imagined, that the benefits of society in which they live are not accessible to them.” She asserts that PTSS is a syndrome, a pattern of behavior that is caused by various and specified circumstances, (DeGruy Leary, 2005). Therefore, multigenerational trauma, such as the physical and psychological enslavement, passed down from African to African American slave, to future generations of offspring, combined with consistent oppression and microaggressions, wedded 72
  • with the absence of opportunity to access the benefits and rights available in the society; can lead to Post Traumatic Slave Syndrome (DeGruy Leary, 2005). Dr. DeGruy Leary (2005) has identified three categories that are consistent with the behaviors associated with the syndrome of Post Traumatic Slave Syndrome (PTSS): Vacant Esteem, Ever Present Anger, and Racist Socialization. Vacant Esteem DeGruy Leary (2005) describes Vacant Esteem as the state of believing oneself to have little or no worth. Vacant Esteem is often exacerbated by a societal and group pronouncement of inferiority (p. 129). She contends that Vacant Esteem is the result of three aspects of influence: society, community and family (2005). Societies influence people through media, policies, government and institutions. African Americans continue to be disproportionately represented in penal institutions (Leonhardt, 2005; Palast, 2002), charged higher interest rates on homes and auto loans, as well as make it more difficult to obtain small business loans (Bureau of Labor, 2005; Lerman, 1997). Additionally, the media contributes to vacant esteem’s formation by frequently displaying African Americans as criminals, academically deficient, disadvantaged and sexually irresponsible (DeGruy Leary, 2005; Miller & MacIntosh, sc1999; Tatum, 1997); West, 1993). Communities influence people through the establishment of social norms, types of “slang” and language, and other modes of conformity and norms. Finally, families influence people in the manner in which a child is raised and the belief systems that are placed in our psyches. When parents and those in the 73
  • immediate family system believe themselves to have little or no value these behaviors and beliefs can transmit a similar belief in their children, this will be discussed further in the Mechanisms of Trauma section below. There are excessive ways in which families have raise their children in order to ensure that the child is submissive and docile, such as corporal punishment ad verbal abuse. These three influences can promote a limiting sense of identity or a healthy self-concept and important placement in the community and society at large. DeGruy Leary (2005) notes that a disparaging identity to which a youth believes he or she is confined can lead to vacant esteem, because the child beliefs they are worth-less. Vacant esteem is a symptom of PTSS and is transmitted from generation to generation through family, community and society (DeGruy Leary, 2005). Ever Present Anger DeGruy Leary (2005) raises the authentic question much of her audience members and professionals have asked her during conferences, “So why are African Americans so angry?” In order to understand fully understands the anger and rage of African American males; it is first essential to understand the causes of anger. Dr. James R. Samuels (1980) as found in Dr. Leary’s book, explains, “Anger is the normal emotional response to a blocked goal. Often, if a person’s goal remains blocked over a period of time, they will begin to consider the possibility of failure and experience fear, and when we are fearful we also lash out in anger.” Ruth King (2004), author of Healing Rage asserts that “rage isn’t 74
  • going away,” she notes that each human being “embodies a rage inheritance from our parents and ancestors that presents itself as an opportunity to transform personal and generational suffering.” The basic assumption in King’s (2004) work is that unresolved rage from childhood and intergenerational trauma is still locked in individual and collective bodies and minds; which then creates a disguise of rage in adult lives’. Some of the symptoms of rage have become such an ingrained part of an individual’s existence that it is easy to forget the origins of rage and more often recreate the past and perpetuate the suffering the many people attempt to avoid (King, 2004). Therefore, Ever Present Anger may be defined as the anger, rage and frustration that are a symptom of blocked goals, a lack of safety, insurmountable fear and powerlessness. One of the most significant goals that have been consistently blocked by the dominant culture has been of the African American community’s integration into the greater society with equal rights, responsibilities, privileges and membership (DeGruy Leary, 2005). Grier and Cobbs (1968) note that “the history of slavery and the failure of America to successfully integrate its black citizenry into the social and political fabric of America, has led to a very real and lasting rage in African Americans.” African Americans have been told lies about slavery, being free, civil rights, fair housing, adequate healthcare, jobs, security, equality and justice, to name a few (DeGruy Leary, 2005). Hence, if these lies and blocked goals are added to the historical component of slavery, which was an inherently angry, unsafe and violent process, any group would eventually learn the ways of their 75
  • captors. Africans learned that anger and violence were the key ingredients necessary to ensure that their needs were met, and one of the most basic needs of a human being is safety (Akbar, 1990). What is most precarious for Africans in America is the form of internalized oppression that has been created. There are psychological ramifications when a group has been assaulted in a genocidal manner (Duran & Duran, 1995). Duran & Duran (1995) contend that internalized oppression can result in suicide, substance abuse, domestic violence and community violence, among others. Internalized oppression is born when the victim has a complete loss of power, which then turns into despair, thereby ensuring that the psyche reacts by internalizing what appears to be its own genuine power; in reality this is the power of the oppressor (Duran & Duran, 1995). This destructive cycle of assumed power has then created a level of self-hatred in the individual and/or group that can be internalized or externalized (Duran & Duran, 1995). When self- hatred is externalized, such as gang violence and domestic violence, there is violence within the community. Native Americans have the highest rates of violent crimes, homicide and suicide, of any group in the United States (Duran & Duran, 1995; Abbas, 1992; French & 1992). Native Americans in the United States have been subjugated, assimilated, exterminated and oppressed for over 500 years by Europeans (Duran & Duran, 1995). Genocide for Sioux people at Wounded Knee 1890 was similar to Jewish Holocaust: people were attacked for the religious beliefs; they were 76
  • buried in a mass grave. Many historians and scholars believe that America perpetrated its own Holocaust. Lisa Poupart (2001) contends that Indians are now oppressing themselves as evidenced by social ills, such as: Suicide, alcoholism, domestic and child abuse. These social ills have perpetuated a legacy of chronic trauma and unresolved grief originating in the European conquest of the Americas (Yellow Horse, 1995). Poupart (2001) notes that racism, oppression and internalized oppression exacerbate these destructive behaviors. Disease, warfare, displacement, relocation, boarding schools, and other assimilation policies such as Allotment (1887), Citizenship (1924), Termination and Relocation (1950s) have all contributed to the Native American’s internalized oppression that has been resurrected through the silence of colonization and the invisibility and devaluation by dominant culture of the Indian peoples’ pain. It is proposed, that the pain and rage are turned inward, and the rage is enacted on those who are closest to the perpetrator. The individual, collective and historical trauma, colonization, and genocide psychologically and physically disabled Native Americans from communicating or acting out their rage against the dominant culture (Brave Heart, 2004). Therefore, Indians’ silence contributes to the oppression. Aggression serves a dual purpose in both destroying another like himself and feeling momentary catharsis in the moment, as well as destroying a part of himself that he finds helpless and hateful (Duran & Duran, 1995). DeGruy Leary (2005) suggests that Ever Present Anger in today’s youth appears to be a product of hopes and dreams being continuously undermined in United States institutions 77
  • and the racism that permeates society. She also asserts that anger resides just below the surface in many African Americans today, even during periods of happiness and rest. Dr. DeGruy Leary suggests: Even when we’re feeling good, an ever-present anger resides just below our surface. Anger at the violence, degradation and humiliation visited upon ourselves, our ancestors and our children; anger at being relegated to the margins of the society in which we live; anger at the misrepresentation and trivialization of our history and culture; and finally, anger at living in the wealthiest nation in the world and not having equal opportunity and access to its riches (p. 138). Research maintains that the exploration of anger in the African American community is just the foundation and what is infinitely more important are the ways in which anger can be transformed. Yet, it is crucial to gain an understanding as to why anger appears “ever present” in the black experience. This dissertation aims to create a model program that expands upon this principle with the goal of healing the Ever Present Anger in order to promote healthier development and functioning for African American male youth. Racist Socialization Slavery was the commencement of the racist socialization of African Americans throughout American history. This trend continued and was exploited From United States history textbooks to movies, African Americans, and other people of color, have been historically portrayed as dirty, lustful, stupid, immoral, incapable of reasoning and inferior to whites in every way (Akbar, 1990; Degruy Leary, 2005; Hicks-Roy, 2004). Dr. DeGruy Leary (2005) proposes, “African Americans have a unique socialization experience due to centuries of systematic and traumatic programming of inferiority (p. 142). 78
  • Research suggests that it is quite common for people being held captive to take on view and attitudes of their captors (DeGruy Leary, 2005; Hicks-Ray, 2004). It would then make sense to imagine what would occur to a group who had been held captive for generations. As DeGruy Leary (2005) asserts: One of the most insidious and pervasive symptoms of Post Traumatic Slave Syndrome is our adoption of the slave master’s value system. At this value system’s foundation is the belief that whites, and all things associated with whiteness, are superior; and that black, and all things associated with blackness, are inferior. (p. 182) Many African Americans have adopted attitudes and views of white, racist America and observe other African Americans through similar lens (DeGruy Leary, 2005; Hicks-Ray, 2004; Akbar, 1990). This phenomenon has birthed due to centuries of slavery and decades of institutionalized oppression that followed (DeGruy Leary, 2005). It would then appear that African American culture has not assimilated to Euro-American culture. Assimilation is the gradual replacement of a culture’s traits, history and traditions with those of the mainstream culture (Hicks-Ray, 2005). It would appear that African American culture has retained its strength despite the pressures to assimilate into mainstream white culture. Abdullah (1994) asserts that the African experience in America meets the criteria for PTSD. The following are a list of some conditions that may promote the emotional traumas that justify the diagnosis of PTSD (DeGruy Leary, 2005; Abudullah, 1994; APA, 1994): • A serious threat or harm to one’s life or integrity. • A threat or harm to one’s children, spouse or close relative. • Sudden destruction of one’s home or community. 79
  • • Seeing another person injured or killed as a result of an accident or violence. • Learning about a serious threat to a relative or close friend being kidnapped, tortured or killed. • Stressor is experienced with intense fear, terror and helplessness. • Stressor and disorder is considered to be more serious and will last longer when the stressor is from another human being. Considering that the American Psychological Association (APA, 1994) considers any one of the above stressors enough to cause PTSD, one can imagine the embedded levels of trauma for slaves who survived the Middle Passage from Africa, as well as those Africans who survived the atrocity of American chattel slavery. Therefore, we can extrapolate the innumerable amount of PTSD symptomatology evident in those Africans who survived a lifetime of slavery. There were no counseling services readily available to freed slaves after the Civil War (DeGruy Leary, 2005; Gutman, 1976; Ginzburg, 1988; Pinderhughes, 1989) and most traumas were never addressed, nor did the traumas cease. Slaves experienced daily physical assault, however equally impactful and concerning was the daily psychological assault brought upon their psyches and souls (DeGruy Leary, 2005; Danieli, 1998; Abdullah, 1994). Abudullah (1994) has asserted that Africans in America have faced four distinct periods of trauma, including the European conquest of Africa established in 1442, the physical enslavement period (1619-1865), the post-physical enslavement period (1865-1954), and the period in which the US Federal government and private sectors responded to modern African American movements, such as Jim Crow and the Black Power Movement (1954-1995). Research points to the fact that African Americans continue to bear the scars of 80
  • each of these historical and cultural traumas (DeGruy Leary, 2005; Eyerman, 2004; Abdullah, 1994; Akbar, 1990). Historical experiences have had grave implications on the current day psychological development of Black people as a group (Leary, 2005). Leary (2005) described the PTSS condition as the consequence of multigenerational oppression of Black people due to centuries of chattel slavery, which were then reinforced by institutional racism, which continues to perpetuate injury with no apparent healing period. Leary (2005) termed these trauma responses, “adaptive survival behaviors”. Reid et al. (2005) also emphasized the cumulative result of intergenerational transmission of trauma symptoms, they coined the term as Post Traumatic Slavery Disorder . They present several case studies that precisely demonstrate the mechanism by which the intergenerational transmission of symptoms occurs. They classify symptoms such as: avoidance, a corrupted sense of identity, impaired interpersonal relationships, emotional numbing, anger and even psychoticism, as markers of PTSS that stem from the oppression of racism and discrimination. Trauma Treatments This section focuses on empirically supported treatments and dominant psychological models for addressing the psychological effects of trauma, particularly PTSD. As empirically validated treatments specifically for intergenerational trauma are lacking, treatment for PTSD was chosen as the most applicable, well studied approach. Aside from the Intergenerational Transmission of Trauma Model (ITTM) created and facilitated by Valerie Copping, Psy.D of 81
  • Ontario, Canada (discussed later in this section), the majority of treatments and theories are designed to treat PTSD and Complex PTSD, as an umbrella for the myriad forms of trauma. In this section, existing programs are described and critiqued for their goals and effectiveness in treating trauma symptoms. To delimit the discussion, I chose to present treatments that have been highly utilized, researched, and validated in this field. There is no widely uniform theory of PTSD treatment planning or intervention, so a clinician can determine under which circumstances specific PTSD approaches will most effectively serve a client (Shalev et al., 2000). Specifically, this section presents treatments that attempt to rebalance deficits in arousal and affect regulation; treatments that address symptoms of intrusion, avoidance, and anxiety; interventions that address interpersonal deficits related to PTSD; and theories regarding intervening and working with individuals with traumatized experiences of self. In this section, I explore and synthesize trauma treatments within the field of psychology that are more traditional and empirically validated as efficacious. The discussion includes the following: cognitive therapy approaches (Mendelsohn et al., 2011; Novaco, 1996), psychodynamic psychotherapy (Horowitz, 2001), process-oriented group psychotherapy (Makler, Salvatore, Sigal, & Mircea, 1990; Yalom, 1995), Eye Movement Desensitization Reprocessing (EMDR; Shapiro, 2000), Dialectical Behavior Therapy (DBT; McCain & Korman, 2001), Bessel Van der Kolk’s (2001) theory of affect deregulation and increased arousal, Peter Levine’s (1997) theory of charging frozen energy, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT; Cohen et al., 2004), Mindfulness Interventions of 82
  • Integrated Treatment of Complex Trauma for Adolescents (ITCT-A; Briere & Lanktree, 2008). In addition, some less conventional methods of trauma treatment specific to the intergenerational transmission of trauma were investigated and synthesized, such as the promising Intergenerational Trauma Treatment Model (ITTM; Scott & Copping, 1996, 2001), the Post-traumatic Traumatic Slavery Disorder treatment model (Mims, Higginbottom, & Reid, 2005), and some of the interventions, benefits, and perspectives of Indigenous perspectives of healing (Duran & Duran, 1989, 1995; Braveheart, 1996, 2002, 2003). Add a paragraph on the section flow and logic for choosing the order. Group sub-sections- maybe 3-4 main subsections each with 2-3 sub-sections? Cognitive-Behavioral Therapy Cognitive models of PTSD theorize that the individual’s inability to process trauma produces distress when the individual is confronted with internal and external cues, and produces avoidance of trauma reminders (Mendelsohn et al., 2011; Novaco, 1996). Originally developed for women who were survivors of rape and experiencing PTSD symptoms, cognitive therapy is a combination of exposure therapy, cognitive processing therapy, and cognitive behavioral therapy (Resnick & Schnicke, 1993). Cognitive therapies help the client begin to find coping skills in order to better deal with the traumatic memories and associated negative thoughts and expectations (Tucker & Trautman, 2000). Cognitive therapies generally target five schemas by addressing key cognitive distortions 83
  • associated with the traumatic event: safety, power, trust, control, self-esteem, and intimacy (Resick, 2001). Additionally, Cognitive Behavioral Therapy (CBT) is an intervention found to effectively reduce many strong emotions that affect interpersonal relationships in individuals with PTSD, particularly anger (Novaco, 1996). CBT interventions focus on monitoring anger frequency, intensity, and triggers. Individuals in treatment are taught to restructure cognitions relating to anger by altering their attention and focus. Communication and assertiveness skills are often taught and practiced through role-plays. Finally, clients are introduced to relaxation techniques including progressive muscle relaxation, breathing-focused relaxation, and guided imagery (Novaco, 1996). From a clinical practice perspective, when working with youth who have been traumatized, CBT is the cognitive therapy treatment of choice with the most evidence for efficacy to date. One of the most effective forms of cognitive therapy is described in the next section. Eye Movement Desensitization Reprocessing (EMDR) Eye Movement Desensitization Reprocessing (EMDR) is an intervention developed by Francine Shapiro (2000) in which clients are taught to focus upon traumatic memories while tracking a therapist’s lateral hand movements. According to Shapiro (2000), the use of rhythmic stimuli in the lateral or vertical hand movements allows a client to activate the “information processing system, (p. 45)” which has an intrinsic capacity to heal the brain by metabolizing the 84
  • trauma and the associated thoughts and feelings. During EMDR, clients focus on the most disturbing element of a trauma while describing what comes to mind; the therapist then encourages the client to verbalize the cognitive or emotional associations using structured questions created to target the triggered traumatic memory (Shapiro, 2000). EMDR is distinguished from other types of exposure therapies and interventions because during EMDR immersion the traumatic memory is continually being interrupted by alternating stimuli and by the associations to the trauma that arise in response to the stimuli (Shapiro, 2000). EMDR asserts that intermittent exposure to feared stimuli will decrease anxiety associated with the stimuli, in contradiction to the underlying principle of exposure therapy, which asserts that intermittent exposure feared stimuli will increase anxiety (Shapiro, 2000). Research on EMDR has been extensive and has a considerable body of literature supporting the effectiveness of EMDR in reducing PTSD symptoms, although it does not appear to read as more effective than other exposure-based treatments, and the eye movements do not appear to integral to the treatment (Davidson & Parker, 2001; Zoellner et al., 2001). Research investigating the effectiveness of EMDR in the treatment of Vietnam veterans found that it was successful in reducing intrusion, avoidance, and trait anxiety (Carlson et al., 1998). There have been a number of anecdotal descriptions of the application of EMDR to complexly traumatized clients (e.g., Twombly, 2000; Korn & Leeds, 2002). (Trauma tx book) 85
  • Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) addresses the negative effects of traumatic events by integrating several therapeutic approaches and treating both the child and parent in a comprehensive manner (Child Welfare Information Gateway, 2007, p. 2). Based on learning and cognitive theories, the treatment addresses distorted beliefs, provides a supportive environment in which the traumatic experience is discussed, and utilizes the attributions related to the trauma (Cohen et al., 2004). The general goals of TF-CBT are to correct maladaptive behavior patterns or thoughts related to the trauma; to provide support and skills to help caregivers cope effectively with their emotional stress (Child Welfare Information Gateway, 2007, p. 4); and to reduce the child’s or adolescent’s negative and emotional behavioral responses to the abuse (Child Welfare Information Gateway, 2007, p. 4; Cohen et al., 2004). A strong body of evidence established by TF-CBT’s developers and replicated by independent investigators supports the efficacy of this approach in treating traumatized and abused children (Saxe et al., 2007; Silverman et al., 2008). Although TF-CBT provides strong evidence for its uses, it is essential to note its limitations. First, the model is best suited to treat children who have endured one specific trauma and who are currently living under safe conditions (Ford, et al., 2005). The vast majority of the literature supports effective treatment for sexual abuse. Secondly, TF-CBT fails to address the social–environmental 86
  • instabilities that contribute to and perpetuate pathology, as well as the sociocultural effects (Saxe, Ellis & Kaplow, 2007). Dialectical Behavior Therapy (DBT) Dialectical Behavior Therapy (DBT) is a comprehensive intervention strategy originally created for the treatment of individuals diagnosed with Borderline Personality Disorder (BPD). Prominent researchers, among them Van der Kolk (2001) and Johnson (2002), contend that BPD is more accurately conceptualized as Complex PTSD resulting from childhood trauma. Hence, the skill-building component of DBT has begun to be used with the affect- deregulation aspect of childhood trauma. The focus of DBT is to establish mastery of conflicting dialects: (a) vulnerability versus invalidation, (b) active passivity versus apparent competence, and (c) unremitting crises versus inhibited grief (Linehan, 1993). DBT integrates cognitive behavioral interventions with Zen Buddhist principles of acceptance and compassion. The main tenant of DBT treatment is the attempt to create a “dialectical balance” with clients between focusing on change and accepting what is. Through DBT, individuals are taught to balance these dialects by developing mindfulness, interpersonal effectiveness, distress tolerance, and emotional regulation (Linehan, 1993). This intervention consists mainly of individual and group psychotherapy, skills training, and telephone consultation as needed (McCain & Korman, 2001). The skill-building component of DBT involves group work on identifying and labeling feelings, anger 87
  • management, distress tolerance, acceptance of feelings, and increasing the experience and communication of positive emotions (Cloitre et al., 2002). Support for the efficacy of DBT in the treatment of affect regulation in Complex PTSD has begun to amplify. Zlotnick et al. (1997) compared the effectiveness of a DBT-informed affect regulation group to a wait list control condition in a sample of 48 female survivors of childhood sexual abuse; treatment showed a reduction in PTSD and dissociative symptoms. Cloitre et al. (2002) compared the efficacy of an intervention that incorporated group skills training in affect and interpersonal regulation in 58 women with PTSD related to childhood sexual abuse. The affect-regulation components of the interventions were informed by DBT principles, such as group topics including labeling of feelings, emotional regulation and management, acceptance of feelings, and an enhanced sense of positive emotions. The treatment resulted in a significant reduction in affect-deregulation symptomatology (Cloitre et al., 2002). Psychodynamic and Psychoanalytic Psychotherapy Psychodynamic or psychoanalytic psychotherapy has traditionally placed a strong emphasis on working with a person’s experience of self. Psychoanalytic treatment attempts to foster self-esteem by providing a person with the opportunity to engage in self-disclosure and to reveal the entirety and humanness of their experience of self with the therapist (McWilliams, 1999). The psychoanalytic perspective notes that while traumatic events can affect an individual’s conscious beliefs about the self, they also simultaneously affect one’s unconscious sense of self (Marshall et al., 2000) 88
  • Psychodynamic psychotherapy for PTSD is pluralistic, in that it offers copious perspectives of etiology and treatment; however, a common theme in psychodynamic approaches is examination of the personal meaning of the traumatic event. Strong emphasis is placed on exploring the trauma and how it affects an individual’s worldview of self and others. Significant attention is given to the way in which a person utilizes defense mechanisms in order to avoid overwhelming feelings, meanings, emotions, and memories attached to the trauma(s). Often, transference, which is defined as the parts of the patient’s experienced relationship with the therapist that may be projected aspects of past or current relationships and experiences, is examined in order to better understand the client’s developmental experiences (Marshall et al., 2000). The classic psychodynamic view asserted that traumatic symptoms are a resurgence of developmental conflicts; therefore, little emphasis was placed on exploring the nature of the traumatic events in treatment. However, current psychodynamic theory views PTSD symptomatology as the result of a loss of control, meaning, and connection, and a sense of helplessness in the individual (Marshall et al., 2000). Marshall et al. (2000) further concurs that self-protection or defenses are fragmented by the overwhelming traumatic experience, resulting in a failure to integrate traumatic memories verbally. During the treatment of trauma survivors, the psychodynamic therapist continually attempts to track both the conscious and unconscious thoughts and themes in which the traumatized self emerges, particularly in the transference relationship (McWilliams, 1999). Theorists assert that traumatic events often 89
  • create a split in one’s self-continuity, causing the traumatized person to feel alienated creating a “post-trauma-self” that may be defended against unconscious efforts to replace it with a “narcissistic self” or “omnipotent self” (Lindy & Wilson, 2001). Horowitz (2001) developed a model of brief psychodynamic psychotherapy for PTSD. This treatment incorporates traditional psychodynamic concepts where conflicts are brought into consciousness; the therapist and client analyze how threatening thoughts, feelings, and impulses are kept from awareness; and transference is used to develop insight into relational dynamics. In this model, particular attention is placed on exploring maladaptive interpersonal patterns that have developed as a result of the trauma. There may be a specific link between childhood relational events, interpersonal patterns emerging in the transference, and the client’s interpersonal manner of coping with the trauma (Krupnick, 1997). Donald Winnicott (1971) proposed that early traumatic experiences in a person’s life produce changes in the structure of self-experience. According to Winnicott, all infants initially view others as their own creation, and over time they come to experience the world as filled with separate and different people. However, according to this developmental perspective, if a child experiences too much trauma at an early developmental age, this milestone will not be reached. The child will alternatively come to experience others as his own creation due to the immense fear that if others are separate, they will abuse him. Although this process is on an unconscious level, the traumatized person will maintain the 90
  • illusion that he creates the world. Winnicott maintains that this person will not benefit from psychoanalytic interpretation because interpretation is based on the belief that the client has the capacity to internalize an idea from a separate, other person. Alternatively, Winnicott asserts, the therapist must create a climate in which the client may “destroy him [the abuser]” by unleashing the rage that was not permitted by caregivers. This approach allows the client to transcend this experience of self and begin to see the world as composed of separate others (Winnicott, 1971). Psychologists investigated the efficacy of countless psychodynamic and psychoanalytic interventions in terms of (a) inducing personality change involving self-perception (Lindy et al., 1998), (b) engaging a sense of acceptance of rageful and aggressive feelings (King, 2004), and (c) alleviating guilt with female trauma survivors (Herman, 1992). The research strongly correlates with a reduction of interpersonal symptoms, guilt, and rage, as well as changes in the perception of the traumatized self (Foa et al., 2000; Lindy et al., 1988). Therefore, it appears possible that the treatments studied by the aforementioned researchers changed the individual’s experiences of self. Friedrich (1990) assessed both the effectiveness and limitations of individual psychotherapy for children and adolescents who were traumatized. He found that psychotherapy was overall more effective when the following criteria were met: (a) the child felt safe and the child was protected against further victimization; (b) the child was supported continually by parents or caregiver; (c) the non-abusing parent or caregiver was in regular contact with the therapist to 91
  • facilitate systematic changes; and (d) the youth was able to communicate about the experience and handle the anxiety evoked by the therapy process. Further, he found that although the psychodynamic field has moved toward a more systemic treatment focus, it still has major limitations. These limitations include (a) a strong child-focused only approach, that is, not involving the social context that may have contributed to the abuse and may continue to perpetuate symptoms; (b) long duration of treatment, which is not cost-effective and does not extinguishing unpleasant symptoms early in treatment; and (c) lack of focus on the maladaptive behaviors developed by the abused youth as a result of their trauma (Friedrich, 1990). Process-Oriented Group Therapy Process-oriented group therapy gives clients with PTSD the prospect of focusing upon the interpersonal patterns that emerge within the context of the group process (Makler, Salvatore, Sigal, & Mircea, 1990). Interpersonal themes that may arise and be addressed during a group process with individuals who have been traumatized include aggression, relationships with family members, sexual intimacy, and interpersonal guilt (Makler et al., 1990). A therapist’s interpretation of the interpersonal dynamics that emerge during group interactions can assist themes in emerging from the group members’ accounts of current life experiences. Through the group process, clients may gain insight into their relational experience while experimenting with more adaptive and communicative patterns (Makler et al., 1990). The curative factors of the group in process- 92
  • oriented psychotherapy include hope, altruism, catharsis, universality, imitative behavior, and existential awareness (Yalom, 1995). Research shows that group process-oriented psychotherapy is an efficacious PTSD intervention (Foy et al., 2000). A recent review of clinical trials of group therapy (Foy et al., 2001) found that all empirically validated methods of group psychotherapy were associated with reductions in the symptoms of PTSD, distress, dissociation, depression, fear, and self-esteem. Carver et al. (as cited in Foy et al., 2000) found increased social behavior in 29 victims of childhood sexual abuse, from a 10-15 session process-group psychotherapy. Walsh (2006) supported group therapy as a treatment type to reduce self-injury and increase positive, alternative ways to cope. Regardless of theoretical perspective, Foy, Eriksson, and Trice (2001) found that all groups, whether cognitive behavioral, psychodynamic, and supportive therapy, demonstrated empirical support for the group process and reduced distress among trauma survivors. van der Kolk (1996) described the group intervention as a mechanism capable of addressing some of the trauma-related concepts of self, commonly destructive in the experience of traumatized individuals, which relate to identification of needs, emphasis on self- care, and the ability to have empathy for other trauma survivors. Van der Kolk (1996) noted that the resolution of these can be accomplished in a group setting (p. 432) and he suggested that the focus of group therapy should be on emotional attachment in the process of healing. Psychodynamic Theory and Creativity 93
  • Psychodynamic theories explore the unconscious and defensive formation of the traumatized individual. According to psychodynamic theory, the unconscious can be brought to the physical world in many ways, one of which is projection, which in turn can be processed through artwork (Rosso, 1997). Rosso (1997) described many Kleinian psychoanalytic perspectives on art. Klein was one of the first psychoanalysts to recognize the significance of using art in therapy. From a Kleinien perspec 94
  • From a Kleinian perspective, the earliest danger situation for an infant is an attack by the mother; the act creates a loss of the love-object and the resulting feeling is that of meaninglessness. This experience of emptiness gets described by the artist as the empty space on the wall. The space is later filled with art, and this art acts as reparation for the early infantile situation. According to Segal (1952), object relations theory views art as the creation of a world of its own, apart from the external world; it serves as a recreation of one's “destroyed” internal world. Thus, creative expression can be a type of therapy as one works through to the depressive position, or the position from which one can think symbolically about one’s own experiences. Segal (1952) explained that the process of art reparation is the full expression of the conflict between life and death instincts. Milner (1955) described the role of symbol formation as the development of transitioning from the internal world to the external world. Methods of symbolism were noted as particularly important to individuals who were forced to endure in the external world without having the liberty for their internal world to be articulated (Milner, 1955). According to this perspective, play serves the same principle as words in talk therapy; both are symbols for communicating or bridging the inner world to the external world. Winnicott (1971) explained that a primary task for the therapist is to teach individuals to play, and that play behaviors can alter trauma- related implicit memories. This transformation helps to improve affect regulation. The use of play and art has been suggested as a way of bringing the internal world to the external world in a less threatening manner than a more direct or directive approach. The foundation appears to be the success of the psychodynamic art- 95
  • oriented or play-based interventions in non-verbal actions from an experiential, hands-on, rather than intellectual. Van der Kolk’s Treatment Van der Kolk (2001) asserted that self-regulation is based on the ability to experience the nuances of physical sensations, organize this experience, attach emotional meaning to it, and take action if necessary. Van der Kolk’s treatment of affect deregulation and increased arousal in Complex PTSD focuses upon a body-oriented approach, which includes the act of tracking and labeling physical sensations and emotional states. However, traumatized children and adolescents often fail to develop these abilities due to the arousal that is often disorganizing during trauma, as well as a lack of awareness and attunement from caregivers; both self-organization and caregiver attunement are necessary for the development of a child’s ability to self-regulate. Hence, physical sensations become disorganizing, and disorgnization then becomes a chronic state of increased arousal (Van der Kolk, 2001). The inability to effectively connect emotional meaning to bodily sensations further contributes to affect deregulation and prevents effective processing of environmental stimuli (Van der Kolk, 2001). Van der Kolk (2001) asserts that the treatment of increased arousal and affect regulation must focus upon the development of the ability to identify, label, and verbalize bodily sensations and emotional states. Consciously becoming aware of bodily sensations is beneficial as the traumatized youth learns to stay focused and organized in the presence of increased arousal, stressors, and numbing. This consciousness can in turn lead to more appropriate identification 96
  • of emotional meaning that may have previously been pushed out of awareness. This awareness then becomes the act of labeling and tracking emotional states. This skill, according to Van der Kolk (2001) allows traumatized individuals to have an increased capacity to take appropriate action in order to manage their emotional lives, own what they feel, and be in touch with themselves. Peter Levine’s Theory of Charging Frozen Energy Peter A. Levine (1997) contended that elevated arousal levels and constriction in traumatized individuals derive from the inability to effectively discharge the defensive energy assembled during a traumatic event. Levine asserts that when a person is in a dangerous situation, she will react by mobilizing energy to either fight or flight. However, if these responses are prevented due to the severity of the trauma, an individual may become frozen, which in turn leads to a frustration and fight response, and then rage; meanwhile, the frustrated flight response gives way to helplessness. While fighting or fleeing would discharge the mobilized energy, the frozen energy that often results is tightly wound together with the emotional states of helplessness, rage, and terror (Levine, 1997). Levine (1997) argues that in order to treat the arousal associated with PTSD effectively, interventions must facilitate the discharge of frozen energy by guiding clients to become more aware of their felt sense of body sensations through an act called focusing. Eugene Gendlin (1996) coined the term felt sense and identified it as an awareness of implicit bodily experiences, noting that felt sense is an aura encompassing everything an individual feels and knows about a 97
  • given subject at a given time. Gendlin contended that the efficacy of all therapeutic interventions can be enhanced by the act of focusing, in which clients focus their attention on the felt sense (Gendlin, 1996). Levine argues that the felt sense and focusing can be utilized to focus upon the frozen energy created during the traumatic event(s), leading to a natural biological resolution where trauma- based frozen energy is discharged. The release of such energy results in a significant reduction of PTSD symptoms including increased arousal (Levine, 1997). According to Hendricks (2001), 23 studies have demonstrated that focusing is associated with successful therapeutic outcomes. One study compared the efficacy of client-centered therapy that included focusing instructions to client-centered therapy without focusing instructions in a sample of 50 patients diagnosed as neurotic. Individuals who received focusing instructions demonstrated significantly better outcomes on client therapist success ratings than clients who received only therapy (Sachse, as cited in Hendricks, 2001). There has been no research on the efficacy of Levine’s (1997) frozen energy approach in reducing arousal; however, there are numerous studies on the efficacy of the focusing technique supporting this intervention (Gendlin et al., 1968; Gendlin, 1997; Hendricks, 2002). 98
  • Mindfulness Interventions of Integrated Treatment of Complex Trauma for Adolescents (ITCT-A) Mindfulness Interventions of Integrated Treatment of Complex Trauma for Adolescents (ITCT-A) can be delivered in an individual or group therapy format with a specific family therapy component. The treatment model borrows from empirically based interventions such as exposure therapy, cognitive therapy, play therapy, and relational treatment (Briere & Lanktree, 2008). The model works with youth who have complex trauma and parent–child attachment issues. Two school-based studies without control groups and a clinical-based study have shown promising results. The school-based study yielded significant decreases in depression, post-traumatic stress, dissociation, internalizing symptoms, and externalizing symptoms, while the clinical-based study reported significantly reduced symptoms on most trauma-related areas as measured by the Trauma Symptom Child Checklist (Fact Sheet, NCTSN.org, p. 4). Intergenerational Trauma Treatment Model (ITTM) The Intergenerational Trauma Treatment Model (ITTM) is an attachment- based, cognitive behavioral model that begins to resolve the trauma impact history in youth and their caregivers. Created by psychologists Valerie E. Copping and Katreena L. Scott (1996, 2001), the model is based on the premise that chronic or complex childhood trauma is strongly associated with the development of criminal behaviors later in life. Informed by trauma theory, attachment theory, and advanced CBT techniques, the ITTM is a manualized treatment intervention 99
  • model designed to restructure the impact of chronic or complex trauma on children’s development (Copping & Scott, 2001). ITTM is a revolutionary and unique trauma treatment for 3-18 year olds and their adult caregivers. ITTM is a comprehensive, 21-session, manualized program offered in three treatment phases. The ITTM first addresses unresolved trauma impact in the caregiver’s history in group treatment sessions, then works with the caregiver alone in individual sessions (Copping, 1996, 2001), and finally treats the child or adolescent with the active participation of the caregiver(s). The ITTM includes attention to intergenerational patterns of trauma transmission and focuses on parents or caregivers as the key agents of change for their children and adolescents. The ITTM is offered in three distinct phases. Phase A is a sick-week group course for the caregiver(s) entitled “The Trauma Information Sessions.” Phase B involves eight individual caregiver sessions aimed at addressing the impact of the caregiver’s most traumatic childhood experience, improving the caregiver’s capacity to relate to and with the youth, and helping the caregiver(s) contain their child’s trauma. In Phase C, the caregiver and clinician team up together to provide the child with three to eight sessions of trauma treatment (Copping et al., 1996). The strength of the ITTM is that it aligns with many of the recommendations for treating complex trauma in children (Copping et al., 1996). In particular, caregivers are the primary focus of the intervention and recognition and attention are given to the intergenerational nature of the trauma (Copping et 100
  • al., 2001). According to the model, the treatments offered in Phase B are designed to reduce the impact of intergenerational trauma and to provide caregivers with a model for working therapeutically with their child to resolve the child’s trauma in Phase C. Although the ITTM advances the field in terms of its focus on the primacy of parents in children’s change and its direct addressing of the intergenerational nature of trauma, the model does not encompass the pervasive effects of historical events on parents or their children. Additionally, it is not culturally specific in its psychoeducational and cognitive restructuring phases with regard to young Black men dealing with the overt and covert affects of racism, oppression, and the intergenerational transmission of trauma that is slavery. Post-Traumatic Slavery Disorder Treatment Model (PTSlaveryD) Three mental health clinicians, Sekou Mims, Larry Higginbottom, and Omar Reid (2005) created the Post-Traumatic Slavery Disorder curriculum. The PTSlaveryD model was designed with the following purpose in mind: To help social workers and mental health professionals develop a clear understanding of the social, emotional, and economic dynamic that are impairing African American people from the ability to capitalize on their own knowledge, information and learning clearly, coherently and independently on behalf of their own personal development; as well as that of their family and community. (p. 1) 101
  • The premise of the PTSlaveryD model is that many mental health professionals are taught traditional Eurocentric paradigms and approaches in regard to mental health treatment and conceptualization. Mims et al. (2005) firmly believe that in order to provide effective mental health treatment to the descendents of the “African Holocaust,” it is first important that mental health professionals are provided with the history of the issues, such as displacement and the post-Jim Crow era effects, so they can better assist their clients in healing current day troubles. The model focuses on issues such as the psychological impact of losing cultural history, the mental suicide and homicide that the authors have termed Mentalcide, and the loss of collective spirit and identity as a race and a people (Mims et al., 2005). 102
  • Much like the work of sociologist Joy DeGruy Leary and Post-Traumatic Slave Syndrome (PTSS) described and synthesized above, Mims et al. (2005) delineate PTSD from the African Holocaust and PTSlaveryD, clarifying that PTSD stems from a traumatic event while PTSlaveryD was a massive traumatic event with cumulative effects on individuals and the community. PTSlaveryD treats symptoms such as avoidance of the event of slavery, adoption of a victim identity, impaired interpersonal relationships, emotional numbing particularly with Black men, isolation of affect, anger, and psychotic disorders (Mims et al., 2005). Mims et al. (2005) also specify that the DSM-IV does not reflect cultural differences and that there appears to be no correlation or credence given to pathologies or disorders associated with the effects of racism. The PTSlaveryD model provides various steps and stages through which an individual can engage in the process of “recovery from Mentalcide” (p. 67). PTSlaveryD is an impressive model that includes a vast amount of knowledge from anthropological, sociological, and psychological levels; at the same time, some limitations of the model involve the enormous scope of each section. There are modules related to economics, various stages of recovery, relapse, relationships, school, the criminal justice system, toxicity in foods and eating healthy, as well as prevention in the community. The modules and various lessons are immense, and constitute lifelong commitments in multiple arenas of an individual’s life. Overall, the PTSlaveryD model is not specifically designed to target the psychological processes of the intergenerational transmission of trauma in African American adolescent youth from the inner city. 103
  • Indigenous Theories Since the late 1990s, a number of researchers have utilized intergenerational trauma as an explanation for an array of the social conditions that occur across Native and Indigenous communities (Braveheart-Jordan & De Bruyn, 2004). As discussed in Chapter 3, Maria Braveheart (1996, 2002, 2003) described historical and intergenerational trauma as the cumulative effect of emotional and psychological wounding occurring across the lifespan and across generations due to unresolved, disenfranchised grief brought about by massive group trauma. As indicated before, this dissertation will also use the term intergenerational trauma interchangeably with soul wounding. In Indigenous models of healing, both mainstream and Aboriginal mental health practitioners have consistently challenged and are challenging the DSM diagnosis of PTSD (Kirmayer, Brass, & Tait, 2000). Researchers concur that the DSM’s focus on individual trauma does not adequately reflect the Aboriginal and Indian experience. As Waldram (2004) contends “approaching trauma through DSM by and large precludes a meaningful discussion of culture, and virtually excludes notions of history and collective, community or cultural trauma” (p. 235). Kirmayer, Brass, and Tait (2000) suggest that the emphasis on narrating personal trauma in contemporary psychotherapy is problematic for these populations because many forms of violence perpetuated against Indigenous people are implicit and may be difficult to understand through individual perspectives. They contend instead that individual events are part of larger historical formations. 104
  • Perspectives by Native/Aboriginal researchers and mental health clinicians are critical to this study, as they closely mirror the kidnapping, assimilating, and historical grieving of the Africans in the United States today. Root (1992) suggests that racism and discrimination compound the impact of direct or personal trauma by allowing the oppression of a community of peoples. This “insidious trauma” becomes normalized, so the group does not realize how social structures and norms continue to oppress them. Duran and Duran (1995) concur with this assessment in their study of Native Americans in the United States. They contend that many of the problems facing Native people today, such as suicide, alcoholism, and domestic violence, appear to have become part of the Native American heritage due to long decades of forced assimilation and genocidal practices implemented by the U.S. government (Duran & Duran, 1995). Although Native/Indigenous/Aboriginal peoples cannot be “clumped together” and the First Nations in Canada cannot be compared to the Aboriginal people of Australia, a common theme in many indigenous models of healing intergenerational trauma is that of the teachings of the medicine wheel (Foor, 2004). The medicine wheel breaks the main constructs of life into four elements generally referred to as the four directions: east, south, west, and north (Duran, 2006). Harmony and balance between the four elements must be achieved. The Intergenerational Trauma Transmission Model is predicated on the assumption that public policies have disrupted the four element-systems and that the resulting trauma has created negative social conditions for Native/Indian/Aboriginal peoples (Menzies, 2009). 105
  • In Duran’s (1989) manual, Suicide Handbook Prevention and Intervention With Native Americans, he described phases of intervention with Native youth considering suicide. In addition to the aforementioned considerations of the cultural and sociopolitical aspects of the Native experience, he also suggested that mental health workers should (a) understand why the person was suicidal and refer to traditional or mental health providers as appropriate, (b) understand what is causing their depression (i.e. alcoholism, hostile behaviors, hypochondriasis, etc.), and (c) assess their family and community support systems and level of interest and resistance. The various models of indigenous healing all circle back to the greater historical picture. Indigenous peoples see the community as being in pain, and the pain needs to be addressed if the mental health provider is to comprehend and address the etiology of the problem. Duran (1989) contends that the core of Native awareness is the place where the soul wound occurred—the fabric of the soul—and it is from this essence that mythology, dreams, and culture emerge and converge. The manifestations of the wound exemplify the tremendous suffering that the Native peoples have undergone. Summary A search for intergenerationally transmitted trauma treatments for youth and adults, and more specifically for African American adolescent males, reveals that such treatments are only available in very limited contexts: Therapies appear to be exclusively focused on severe trauma and PTSD. It is outside the scope of 106
  • this study to account for all the specific differences and similarities between trauma treatments and more specific intergenerational trauma-promoting therapies, mainly because of the vast ranges of the first and the contrasting absence of the latter. Nevertheless, it is important to differentiate one from the other, as evidenced above. The scarcity of treatment programs specifically for treating and healing of the intergenerational transmission of trauma appears crucial for urban African American youth, given current trends and pathology within the population, as well as the aforementioned soaring rates of homicide, suicide, incarceration, and mental health concerns. The treatments and theories discussed in this section are beneficial for specific types of trauma; however, as a body they fail to address the cumulative intergenerational transmission of trauma and the way that cumulative trauma manifests in many African American male youth living in distressing conditions. A treatment designed for this population must address the sequelae of the intergenerational transmission of trauma in Black males residing in the inner city. Therefore, a treatment model focused on clinically treating the symptoms of intergenerational trauma, specifically created for urban African American male adolescents, is the focus of the remainder of this study. Summary of Review of Literature What can be concluded from this extensive literature review is that the intergenerational transmission of trauma exists in the biology and sociology of 107
  • African American male youth growing up in the United States. The literature supports that the psychological and physical strain of slavery coupled with current daily pressures, that may be internalized as a form of complex trauma, has prompted many African American males to resort to the externalization, as well as the internalization of their pain (Abdullah, 1994; Akbar, 1996; Hines & Boyd- Franklin, 1996). The literature widely supports the premise that the enslavement of Africans in America became a soul wound, and insidious form of trauma that vibrated across generations. Although the research supporting the intergenerational transmission of trauma is present in psychological scholarly journals and texts supporting the dysfunctional patterns within various cultures (Duran & Duran, 1995; Danieli, 1998; Nagata, 2003; Weingarten, 2003), what appears to be sparse in the literature, are the effects of slavery on African American male adolescents growing up in urban areas riddled with violence and racial oppression. The intergenerational transmission of trauma has serious ramifications for our Black male youth, and for the course of mental health treatment with this population. Effective programs and treatment for working with young Black men affected by aftereffects of slavery, is not only beneficial for the youth but for the society that surrounds this youth, due to the decreased possibility of victimization of another individual as well as a reduction of misdiagnosis in this population. Historically intergenerational trauma treatment has essentially been PTSD treatment. This author, and other mental health professionals cited in this dissertation, feel strongly that African American male youth, do require the 108
  • acknowledgement, attention, treatment and interventions that will target this particular form of trauma. The research in this literature review has supported treatment strategies that are culturally sensitive (Duran & Duran, 1998; Mims et al., 1996; Leary, 2005), adapted to the Black adolescent male residing in the inner city, and targets the powerlessness that a person experiences as a primary trait of traumatization (Van der Kolk 2005). The conceptual model program that will be proposed in Chapter 5 was informed by the literature review and the reoccurring theme that culture, historical events related to that culture and mental health should be closely wedded when facilitating the creation of a program targeting the intergenerational transmission of trauma. The trauma treatment section provided specific treatments that continue to be effective in the treatment of individuals living with he manifestations of complex trauma. Of the trauma treatments explored it appears that the exploration of the unconscious, transference, and attachment within the Psychoanalytic frame of therapy would provide for a solid foundation for the conceptualization of the proposed model program. This will allow for the unconscious material related to the indirect and direct methods of intergenerational trauma to be projected onto other group members and processed. Cognitive Behavioral Therapy (CBT) consists of interventions that could effectively reduce strong emotions, as well as negative self-talk that could affect many of the interpersonal relationships in Black adolescent males, particularly anger (Novaco, 1996). The CBT interventions could further assist individuals in 109
  • identifying and expressing their needs in an appropriate manner while focusing on monitoring anger frequency, intensity, and triggers. Treatment for adolescents who are exposed to complex trauma must account for deficits in executive functioning and verbal skills that tend to manifest around pre-verbal trauma. Sensorimotor and bodily focused approaches described in the literature review point to the significance of meeting traumatized individuals at a more primitive level, if need be. Treatment interventions need to focus on how to ground the group participants as to not illicit extreme states of emotional overload that could lead to injurious behaviors, yet the process must also involve some therapeutically appropriate provocative questioning and exercises in order to illicit unconscious projective material, rather than what is often part if traditional talk therapy. While there are limits to the quantitative research on the benefits of sensorimotor and bodily approaches to treatment with African American male adolescents, elements of this therapy appear promising with this population. Additionally, some of the principles of Dialectical Behavior Therapy (DBT) appear to be beneficial and has been utilized in the treatment of severe forms of trauma. Specifically, the interventions related to the principles of acceptance and compassion, as well as the use of labeling feelings, would appear to work very well with this dissertation’s population. Theoretically, creative interventions also appear extremely promising for addressing core issues that maintain vacant or low self-esteem, unconscious rage, and racist socializations. Play and art have been understood as allowing for integration between the internal and eternal world in a less threatening manner, and it can also feel as though it is 110
  • not therapy, which seems of particular importance for a population who is hypersensitive to being pathologized and where respect is crucial. Also, as described above primary experience exists separate from language, and different forms of action approaches such as artistic expression might alter habitual patterns of thinking, feeling and behaving (Wiener, 1999). Art can be both a projective activity and a replacement behavior in the cycle of externalizing behaviors, as well as a coping skill. The Intergenerational Trauma Treatment Model (ITTM) appears to contain many aspects of treatment interventions mentioned throughout the Trauma Treatment Section of Chapter III, that mirrors that of this present model. The use of the psychodynamic theory to work on issues of attachment, trauma theory and CBT techniques, all are utilized in order to heal unresolved trauma. The method of bringing the caregiver into the adolescents’ trauma treatment may prove to be effective for the proposed current model. ITTM gives attention to intergenerational patterns of trauma transmission and focuses on parents as the key agents of change for their children and adolescents. However, the current model will focus on the African American male youth as the key agents of change, specifically because of the mistrust, misdiagnosis, overpathologizing, and racist behaviors inflicted by the mental health field as a whole. Often mature African American men and women see therapy as something for people who are psychotic or severely mentally ill, not for the condition of trauma. Yet the optional request to involve caregivers within the treatment model can provide quite useful as if the adolescents are affected by the affects of slavery, the parents 111
  • or caregivers may also very well be. Furthermore, the Posttraumatic Slavery Disorder Treatment model (PTSlaveryD) and the Indigenous theories and models can provide an excellent foundation of treatment for African American male youth. The PTSlaveryD model provides a cultural paradigm that stresses the importance of a culturally sensitive form of trauma treatment for the impact of slavery on African Americans. The model proposed by this writer will certainly weave the threads of the history and affects of slavery, loss and reclaiming of cultural history, dismantling of victim identity, isolation of affect, anger, impaired personal relationships and the importance of the collective spirit and identity of African Americans. The Indigenous theories described above are grounded in the symptoms of trauma associated with PTSD that has been passed down from generation to generation. These theories challenge the Eurocentric perspective of mental health, particularly diagnosis and the DSM diagnosis of PTSD in many people of color. The theories would be relevant in working with African American male youth in that they look at the individual and individual events as part of a larger historical context, as well as racism and discrimination as having immense impact on the individual and community. This model proposes that the use of the Medicine Wheel, concept of soul wounding, and the 4 directions; would be equally useful and healing with the population of adolescent Black males, in that their history also involves one of kidnapping, assimilating and historical grieving, and harmony and balance among these aspects of self (4 directions and soul wounding) must be achieved. 112
  • Process-Oriented Group therapy has also been favored in the treatment of male adolescent youth, in particular African American adolescents (Boyd- Franklin, 1995?) In particular the communal aspect, as opposed to the individualistic approach to treatment, provides a sense of commonality, emphasizing the importance of normalizing mental health and destigmatizing therapy specifically among communities of color. The process-oriented group will also benefit individuals because of the therapist’s interpretation of the interpersonal dynamics, themes, and nonverbal behaviors that emerge from the group members’. The use of multiple methods to address the underlying issues that maintain traumatic behaviors and the intergenerational transmission of trauma might be more successful in a group intervention since groups have been found to be especially effective for adolescents who have endured traumatic experiences (Glodich & Allen, 1998; Scott, 2001; Williams et al., 2001). Adolescents are at a formative stage in development and the integration of nonverbal and verbal interventions to practice in a group setting can enable new relational patterns to enable effective methods of expression. Conclusion The intergenerational transmission of trauma exists in the psychology of African American male youth growing up in the United States. The intergenerational transmission of trauma derived from slavery, coupled with current complex trauma, has prompted many African American males to resort to the externalization and internalization of their pain (Abdullah, 1994; Akbar, 1996; 113
  • Hines & Boyd-Franklin, 1996). The intergenerational transmission of trauma has serious ramifications for our Black male youth, and for the course of mental- health treatment with this population. Effective programs and treatments for young Black men affected by the aftereffects of slavery not only benefit the youth themselves, but also the society that surrounds them, due to the decreased possibility of victimization of reduction of misdiagnosis in this population. Historically, intergenerational-trauma treatment has essentially been PTSD treatment; however, along with other mental health professionals cited in this dissertation (e.g. Latif & Latif, 1991; Brave Heart, 1996; Duran, 1996; Eyerman, 2001; Leary, 2005; Mims et al., 2006), I feel strongly that African American male youth require acknowledgement, attention, treatment, and interventions targeting this particular form of trauma. The research in this literature review supports the development of treatment strategies that are culturally sensitive (Duran & Duran, 1998; Leary, 2005; Mims et al., 1996), adapted to the Black adolescent male residing in the inner city, and that target the powerlessness as a primary trait of traumatization (Van der Kolk, 2005). The conceptual model program proposed in Chapter 5 was informed by this literature review and the reoccurring theme that culture, historical events related to that culture, and mental health should be closely wedded when developing a program targeting the intergenerational transmission of trauma. The Trauma Treatment section described specific treatments that continue to be effective for individuals living with the manifestations of complex trauma 114
  • and that will be incorporated in the model program offered in Chapter 5. Of the trauma treatments explored, exploration of the unconscious, transference, and attachment within the psychoanalytic frame of therapy offer a solid foundation for the conceptualization of the proposed model program. This approach will allow the unconscious material related to the indirect and direct methods of intergenerational trauma to be projected onto other group members and processed (Makler et al., 1990; Yalom, 1995; Marshall et al., 2000). The proposed model program also utilizes elements of Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT) and the Intergenerational Trauma Treatment Model (ITTM), the PTSlaveryD model, Indigenous theories and models, and Process-Oriented Group therapy. CBT interventions could effectively reduce the strong emotions and negative self-talk that can affect interpersonal relationships in Black adolescent males, particularly anger (Novaco, 1996). Such interventions could further assist individuals in identifying and expressing their needs in an appropriate manner while focusing on monitoring anger frequency, intensity, and triggers. Treatment for adolescents who are exposed to complex trauma must account for the deficits in executive functioning and verbal skills that tend to manifest around pre-verbal trauma. Sensorimotor- and body-focused approaches described in the literature review point to the significance of meeting traumatized individuals at a more primitive level, if need be (Cohen et al., 2004; Van der Kolk, 2001). Treatment interventions need to focus on how to ground the group participants so as to not elicit extreme states of emotional overload that could lead to injurious behaviors, 115
  • yet the process must also involve some therapeutically appropriate provocative questioning and exercises in order to elicit unconscious projective material, rather than what is often part of traditional “talk therapy” (Van der Kolk, 2001). While there are limits to quantitative research on the benefits of sensorimotor and bodily approaches to treatment with African American male adolescents, elements of this therapy appear promising with this population (Resick, 2001; Van der Kolk, 2001). Additionally, certain principles of DBT appear to be beneficial, haves been utilized in the treatment of severe forms of trauma, and are likely to work well with this study’s population: specifically, the principles of acceptance and compassion as well as the use of labeling feelings (Cloitre et al., 2002). Theoretically, creative interventions also appear promising for addressing core issues that maintain vacant or low self-esteem, unconscious rage, and racist socializations (Emunah, 1996). Play and art have been understood as allowing integration between the internal and external worlds in a less threatening manner, and have the added benefit of feeling like they are not therapy, which seems of particular importance for a population hypersensitive to being pathologized and for who respect is crucial (Zlotnick et al., 1997). As described above, primary experience exists separate from language, and different forms of action- approaches (including artistic expression) might alter habitual patterns of thinking, feeling, and behaving (Wiener, 1999). Art can be both a projective activity and a replacement behavior in the cycle of externalizing behaviors, as well as a coping skill (Emunah, 1996). 116
  • The ITTM offers many aspects of the treatment interventions mentioned throughout the Trauma Treatment section and is useful for this present model. Psychodynamic theory to work on issues of attachment, trauma theory, and CBT techniques are all utilized in the ITTM in order to heal unresolved trauma (Copping & Scott, 2001). In addition, bringing the caregiver into the adolescents’ trauma treatment may be useful for the proposed model. The proposed model focuses on African American male youth as the key agents of change, specifically because of the mistrust, misdiagnosis, overpathologizing, and racist behaviors inflicted by the mental health field as a whole (Abdullah, 1994; Jarret, 1995; Eyerman, 2004). Often, mature African American men and women see therapy as something for people who are psychotic or severely mentally ill—not as a resource for the condition of trauma (Jarrett, 1995; Boyd-Franklin & Hines, 1996). However, the optional request to involve caregivers within the treatment model may prove useful, as if the adolescents are affected by the affects of slavery, the parents or caregivers may be as well. The PTSlaveryD model also contributes to the foundation of treatment for African American male youth, as it provides a cultural paradigm that stresses the importance of a culturally sensitive form of trauma treatment for the impact of slavery on African Americans (Mims et al., 2005). The model program proposed in Chapter 5 weaves together the threads of the history and effects of slavery, loss and reclaiming of cultural history, the victim identity, isolation of affect, anger, impaired personal relationships, and the importance of the collective spirit and identity of African Americans (Mims et al., 2005). 117
  • The Indigenous theories described above are grounded in the symptoms of trauma associated with PTSD that has been passed down from generation to generation. These theories challenge the Eurocentric perspective of mental health, particularly diagnosis and the DSM diagnosis of PTSD in many people of color. These theories are relevant in working with African American male youth in that they consider the individual and individual events as part of a larger historical context, as well as acknowledging that racism and discrimination have immense impact on the individual and community. In particular, the proposed program model uses the Medicine Wheel, the concept of soul wounding, and the four directions; these Indigenous tools are potentially helpful because adolescent Black males’ history also involves kidnapping, assimilating, and historical grieving. Finally, Process-Oriented Group therapy has also been favored in the treatment of male adolescent youth, in particular African American adolescents (Boyd-Franklin, 1995?). The proposed model program draws on the communal aspect of Process-Oriented Group therapy, which provides a sense of commonality and emphasizes the importance of normalizing mental health and destigmatizing therapy, specifically among communities of color. In addition, the therapist’s interpretation of the interpersonal dynamics, themes, and nonverbal behaviors that emerge from the group members’ participation will also benefit individuals. The use of multiple methods to address the underlying issues that maintain traumatic behaviors and the intergenerational transmission of trauma might be more successful in a group intervention, since groups have been found to 118
  • be especially effective for adolescents who have endured traumatic experiences (Glodich & Allen, 1998; Scott, 2001; Williams et al., 2001). Adolescents are at a formative stage in development, and the integration of nonverbal and verbal interventions through practice in a group setting can enable new relational patterns and effective methods of expression (Williams et al., 2001). CHAPTER 4: METHODOLOGY You gotta make a change. It's time for us as a people to start making some changes, let’s change the way we eat, let’s change the way we live, and lets change the way we treat each other. You see the old way wasn't working so it’s on us, to do what we gotta do to survive. –Tupac Shakur, “Changes“ (1992, paragraph 4) “Isolation is a favored weapon of psychological terrorists.” –bell hooks (year, p. XX) Of the relevant literature synthesized in Chapter 2, this study expanded upon specific sections identified as offering unique and valuable perspectives that support creating a psychologically holistic model to build upon the strengths of African American male youth. Those sections are as follows: historical literature on American chattel slavery from the 1600s to the present, the current strengths for this population, the reported multiple levels of traumatic stress experienced by inner city African American adolescents today, and historical examples of intergenerational trauma. In addition, the study investigated both literature on the 119
  • role of racial oppression as complex trauma in African American males as well as the specific types of mechanisms of trauma. Overview of Sections Literature on the history of American chattel slavery from the 1600s to the present provided information on the threads of connectivity between slavery and the collective and cultural trauma that so many Africans endured from 1619-1865, as well as the 100 years of Jim Crow into U.S. culture after the ending of the legalization of slavery. The impact of the failed program of American chattel slavery, known as slavery, lingers after 127 years in the form of a conflict between African Americans and the dominant culture over values (Stovall, 2005). Supplementary literature on the system of slavery lent further credence to the cultural foundations of the identity and current belief systems of Black adolescent males in the United States today, and the question of whether their experiences are part of intergenerational trauma. Literature around the current strengths for this population was used to expand the concept of the identity and cultural belief systems of Black adolescent males living in the U.S. inner cities. Current research supported the notion that therapists frequently focus on deficits, and that therapists overlook strengths and opportunities for identifying and building resilience in African American adolescent male clients (Zimmerman, Ramirez-Valles, & Malton, 1999). It was crucial for the present study to identify some of the adaptive strengths of the adolescent Black male population specifically. In particular, further discussion is offered on the following specific areas that research supports as impacting the 120
  • Black male adolescent psyche: resilience, the role of family, gender roles, religion and spirituality, homicide rates and the prison industrial complex, the education system, skin tone and attractiveness, and adolescent development. These areas provided further insight into the natural life processes that Black adolescent males currently encounter and the ways those processes may affect the mind, bodies, and spirits of youth. In addition, the study expanded upon the reported multiple levels of traumatic stress that African American adolescents today experience, in particular, those youth living in the inner city (Berton & Stabb, 1996; van der Kolk et al., 2005). This discussion focuses on understanding the impact of complex trauma, in the form of violence, and the prevalence of adolescent violence (whether from family, gang-related, witnessing, or physical, sexual, or emotional). The literature review in Chapter 2 suggests that environmental violence can further compound the intergenerational effects of slavery, and further investigation of the layers of traumatic stress and their effects on intergenerational trauma was helpful in better understanding the influence these actions have on African American male youth’s psyches and physical bodies. This study also offers a synthesis of literature on historical examples of intergenerational trauma. Chapter 2 briefly discussed research related to Vietnam War veterans and the PTSD prevalence, Japanese Americans and U.S. internment camps, and the historical trauma and “soul wounding” that has occurred for many Native Americans for over 500 years (BraveHeart, 2003, 2004; Danieli, 1984; Duran &Duran,1990, 1995, 2006; Kulkas et al., 1990; Nagata, 1993; Wiseman & 121
  • Barber, 2008). A more in-depth summary of clinical findings on the studies of the offspring of Holocaust survivors was beneficial to the understanding of massive group trauma and its effects. Understanding other cultural perspectives and the clinical literature related to the experience of group cultural trauma and the transmission of intergenerational trauma (e.g., that of the Japanese, Jewish, and Native Americans) expanded understanding of the impact and present-day effects of slavery on Africans in the United States. In the study, an additional section focuses on the specific types of mechanisms of trauma. There are numerous theories on the mechanisms of trauma transmission and many hypotheses regarding how trauma is transmitted between generations. Both direct and indirect mechanisms of intergenerational trauma transmission are addressed, along with the biological, intrapsychic, attachment, social learning, and family systems mechanisms of transmission. This additional investigation of the literature supported the identification of themes and mechanisms related to trauma transmission in the theories discussed, in particular, the physiological vulnerabilities, unconscious intrapsychic aspects, attachment styles and patterns, social learning theories, and family systems context of “debts” and “entitlements,” as well as the role of communication in trauma transmission. This summary of the direct and indirect methods of trauma transmission allowed an expansive perspective on the effects, if any, of slavery on Black male youth today. Finally, the study addresses the role of racial oppression as complex trauma in African American males as part of the formation of the model program 122
  • proposed below. Research from Thelma Bryant-Davis (2007) on the case for race-based traumatic stress and Robert Carter’s (2007) original conceptualization of the recognition and multiplicative effect of race-based traumatic stress on survivors and their offspring were examined and synthesized for the purpose of understanding the role that race-based traumatic stress has on African American male adolescents today. Process The review of the theoretical and research literature described above focused on gleaning points crucial to treating trauma with this population, with special attention paid to those aspects of the phenomenon of intergenerational trauma unique to African American male adolescents. As an initial step in program development, existing treatments for trauma were reviewed in relationship to the particular needs of this population as discerned in the literature review. A variety of treatments have been shown to help children and adolescents (as well as their caretakers) in overcoming trauma-related difficulties. Both more traditional and less conventional therapies were included to build a better understanding of the characteristics, strengths, weaknesses, and applicability of each preferred treatment approach for trauma-related stress, and to identify an eclectic or singular approach that would work best with this study’s model program. Within the field of psychology, more traditional and empirically validated as efficacious trauma treatments were explored and synthesized, including Cognitive Behavioral Therapy (CBT) (Novaco, 1996), Psychodynamic Psychotherapy (Brom et al., 1989), Trauma-Focused Cognitive Behavioral 123
  • Therapy (TF-CBT) (Cohen et al., 2004), Eye Movement Desensitization Reprocessing (EMDR) (Shapiro, 2000), Dialectical Behavior Therapy (DBT) (McCain & Korman, 2001), Process Oriented Group Psychotherapy (Makler, Salvatore, Sigal & Mircea, 1990; Yalom, 1995), Mindfulness Interventions of Integrated Treatment of Complex Trauma for Adolescents (ITCT-A) (Briere & Lanktree, 2008). In addition, I investigated and synthesized some of the more unconventional methods for trauma treatment, such as Bessel Van der Kolk’s Theory of Affect Deregulation and Increased Arousal (Van der Kolk, 2001), Peter Levine’s theory of Charging Frozen Energy (Levine, 1997), the promising Intergenerational Trauma Treatment Model or ITTM (Scott & Copping, 1996, 2001), the Posttraumatic Slavery Disorder treatment model (Mims, Higginbottom, & Reid, 2005), and some of the interventions, benefits, and perspectives of Indigeous Models of Healing (Duran, 1989, 1995; Root, 1992; Braveheart, 1996, 2002, 2003). While conducting the expanded literature review described above, I was open to reviewing and including further literature and research on the areas of African American males, intergenerational mechanisms of trauma transmission and treatment, diagnosis and racial bias, poverty and socioeconomic status effects on Black adolescent males, externalization of depression, peer influences, media and self-concept, consequences of omitting intergenerational trauma as part of treatment, and psychoeducational practices and their efficacy. Being open to other areas of Black adolescent male identity, values, norms, social stigmas, and mental health needs allowed me to create a program model imbued with greater 124
  • understanding from practitioners, and hopefully with stronger outcomes for healthier adolescents. Approach The primary focus of the proposed program model was on the needs of African American adolescent males living in the inner city. The method utilized was theoretical in nature and consisted of several parts. First, I defined the process and theories of how intergenerational trauma is transmitted, both directly and indirectly, as well as defining the population and the particular form of intergenerational trauma. Next, through critical review of the current popular psychological treatment methods, I assessed both the strengths and weaknesses of treating intergenerational transmission of trauma in African American male adolescents. Then, based on the findings of the literature review, I designed a new program describing a specific treatment stance, focus, goals, and ways in which the program would be implemented; the program blends appropriate aspects of trauma treatment specific to intergenerational transmission of trauma. Finally, I submitted the program to a representative sample of five people for review and feedback regarding their impressions of the strengths and weaknesses of the program model. Selection and Orientation of Reviewers When the program design was completed, program reviewers were given a copy of the design and asked to identify the strengths and weaknesses of the model program. Volunteer reviewers were recruited primarily from the New Jersey Black Psychological Association, New Jersey City University’s Jersey 125
  • City, New Jersey professional staff and faculty, New Jersey’s Anti-Racist Alliance, and the clinicians of the University of Medicine and Dentistry’s University Behavioral Healthcare Outpatient and Partial Care Units. As these universities and organizations are primarily within urban areas and they provide care and treatment to underserved populations, the likelihood was very high that professionals from those organizations would meet the selection criteria. The five reviewers met at least five of these eight inclusion criteria: 1. Professional degree such as LPC, MSW, LCSW, Ph.D, Ed.D, or Psy.D. 2. Degree in psychology, social work, or Ethnic, Multicultural, or African American Studies. 3. Interest or expertise with African American adolescent males. 4. Current or previous experience with clinical work, whether group or individual therapy, with African American adolescents. 5. Self-identification as a “culturally competent clinician” or substantial experience with research and clients who identify as African American males. 6. Expertise in trauma. 7. Substantial knowledge of the history of slavery in the United States. 8. Experience working with young men or women who reside in an urban area that would be identified as the “inner city.” Eligible reviewers were sent a letter asking if they were willing to volunteer as a reviewer. When a volunteer reviewer agreed verbally to 126
  • participate, I provided them with informed consent documents to sign (Appendix B) that explained rights of the volunteer including potential gains and risks and a brief description of their task as a volunteer reviewer. This packet also included a copy of the proposed program design (Chapter V) for the volunteer reviewer to read, and a feedback sheet to be filled out by the volunteer reviewer. The feedback form asked the following questions: 1. What are the strengths of this program design? 2. What are the weaknesses? 3. In your professional opinion, would this program benefit African American adolescent males who are being raised in an urban area? 4. How well do you believe this program will target symptoms of anger, hopelessness, vacant self-esteem, and racial discrimination? 5. How well do you believe this program will be able to treat intergenerational trauma? 6. Any other comments or suggestions? Once volunteers completed the review, they were asked to contact me in order to arrange a time to collect the information. At that time, I asked the reviewers verbally about their experiences and if they had any concerns. I then thanked them in writing for their time and participation and invited them to contact me with any issues, feelings, or feedback that might arise concerning the program review. The completed forms were evaluated and included in the Results (Chapter X) in chart form. Chapter X then discusses the reviewers’ feedback in detail, 127
  • exploring the implications for the new model program; the strengths and weaknesses of the new model program are reviewed and methods for incorporating reviewer suggestions are explored. Chapter 5: MODEL PROGRAM “…the wound is sacred, and the healing is endless” -Anonymous, as cited in Suicide Handbook: Prevention and Intervention with Native Americans (Duran, 1989, p. 48) “The task is a difficult one in that we’re in the process of healing our ancestors, as we try to heal ourselves.” Phil Tingley, MSW, as cited in Suicide Handbook: Prevention and Intervention with Native Americans, p. 58) Overview Conceptualizations of the intergenerational transmission of trauma continue to evolve, but the treatment approaches reviewed in this study often fail to address a myriad of symptoms and manifestations that may arise within adolescent African American males living in the inner city. In response to the absence of comprehensive treatment for this population’s trauma survivors within the community mental health and school systems, an alternative model is proposed. Introduction to the Model Program This 12-week group intervention for African American adolescent males who reside in an urban city is divided into sessions according to problem areas or specific sociocultural themes identified in the literature review above. In particular, sessions are divided according to three stages, Phase I: The Hood, is 128
  • related to complex trauma, creating a place of mindfulness, and interpersonal connections; Phase II: The History, is related to slavery, the intergenerational transmission of trauma, and the symptoms Leary (2005) discusses as associated with Posttraumatic Slave Syndrome: ever present anger, vacant esteem, and racist socialization; and Phase III: The Healing is related to the process of guiding the young men towards a healthier, holistic, and spiritual way of living, with the goal of healing. The program includes individual and group components; family therapy is optional, yet strongly encouraged. Additionally, the program includes psychoeducational interventions, creative arts, skill building, and guest speakers. The program consists of 90-minute group sessions once per week for 12 weeks; however, the same frame and format could be tailored to other timeframes (i.e., consolidation of interventions into longer groups, meeting every two weeks, meeting multiple times a week, etc.). The rationale for the time frame of 12 sessions, or three months, is based on the following findings: a) behavior change takes roughly 60 – 90 days to form a new habit (Lally et al., 2009); b) adolescents often need to repeat the behavior that is desired in a similar situation in which it was created, therefore, a group of males in their peer group would be a similar recreation of their external environment in a contained and therapeutic setting (Boyd-Franklin & Hines, 1996; Mims et al., 2005); and c) a 12 week group is long enough to establish safety, interpersonal connection, psychoeducation, yet not too arduous of a commitment for adolescent male youth who may be wary of 129
  • lengthy programs (Yalom, 1995; Hardy, 2006), as well as long enough to facilitate change to help adolescents begin to create new habits and behaviors. Many consider group therapy the treatment modality of choice for adolescents in general and for traumatized adolescents in particular (Scheidlinger, 1985). Many adolescents spend the majority of their time in peer groups, gravitate towards being with their peers, and are more comfortable with peers than adults. Adolescents require peer connections in order to accomplish the necessary separation individuation work of this developmental stage, particularly because on of the symptoms of trauma is a withdrawal from peers (Klein & Schermer, 2000). Without the benefit of group therapy, the withdrawn traumatized adolescent would end up dealing with the effects of the trauma, but also the additional secondary effects of the disconnection from peers, therefore arresting developmental advancement (Scheidliner, 1955, 1974). Group therapy provides a relief from the isolation that trauma creates and reestablishes connections with peers through the mutual identifications of the group members (Yalom, 1995; Scheidliner, 1955, 1974). The group provides a holding and support, and in psychoanalytic theory is seen as the transitional object fir the adolescent, allowing the adolescent to proceed along the normal developmental pathways (Scheidliner, 1974; Yalom, 1995). According to Barlow (2008) four, six, eight and eighteen sessions was less effective than twelve sessions of cognitive behavioral, psychodynamic, or group therapy treatments, either therapist delivered, for emotional disorders, specifically anxiety disorders. 130
  • Frequently, when an adolescent experiences trauma, the family also has either been traumatized directly from the event or indirectly from the adolescent’s trauma (Yalom, 1995). Adolescents can show amazing resilience if the key elements of social support from significant adults in their environment are in place. Traumatized adolescents need a support network to help “frame and transform the event” (Janoff-Bulman, 1992); in this way the adolescent can work toward obtaining some resolution. The group therapy experience provides restoration of an ideal caring “family,” consisting of empathic adults and other teenagers who are supportive, understanding and accepting (Janoff-Bulman, 1992; Keyser, Seelaus & Kahn, 2000). The group creates a caring circle of people who will accompany each of them through their suffering, allowing them to verbalize the stories of their experience (Keyser, Seelaus & Kahn, 2000). The literature supports the notions that creating safety (Keyser, Seelaus & Kahn, 2000), reduction of problematic feelings and behaviors (Janoff-Bulman, 1992), relieving isolation and establishing peer connections (Yalom, 1995), addressing changes in the assumptive world that occurred as a result of the trauma (Janoff-Bulman, 1992), and a sense of universality (Yalom, 1995), are ideal group goals in a therapeutic group for traumatized adolescents. Additionally, many African American communities uphold collective values, where family and community are an important part of the culture and is the focus of many individuals’ lives’ (Williams et al., 1999). Counseling practices are viewed very differently in individualist and collectivist cultures. In 131
  • the United States, counseling is seen as an acceptable form of treatment for both minor and major problems. Going for outside help is often seen as better than going to family, and third party input allows the client to maintain their independence form the family, but still work through their problems (Morris, 2011). In collectivist cultures, family is central, and if an individual is having a problem family, churches and close friends are seen as safe, however mental health professional may be seen as highly mistrusted and families may doubt their accuracy (McCarthy, 2005). Therefore, this model program will attempt to target a healthy balance between utilizing the group as community, while attending a form of therapy and allowing for treatment to be The group therapy venue is cost-effective and it offers opportunities for acquiring new information and new coping skills that are easier for adolescents to learn and accept from peers. Wigtil and Wigtil (1991) point out that when effective group counseling with adolescents is employed in mental health settings, the participants are better able to deal with some of their dysfunctional thinking and behaviors before these factors become disciplinary problems for them. Group counseling with adolescents can be viewed as one of the interventions that will enable adolescents to deal with problems that have already surfaced in their lives (Corey & Corey, 1992). The therapeutic approaches from the literature review’s Trauma Treatment section created the interventions in the proposed model program. The themes and problem areas addressed in each section were selected to occur in accordance with the stages of a group as defined by Tuckman (1965). Tuckman's model is 132
  • significant because it recognizes the fact that groups do not start off fully formed and functioning. He suggests that groups grow through clearly defined stages, from their creation as groups of individuals, to cohesive, task-focused teams. Tuckman describes working with a team of social psychologists, on behalf of the U.S. navy and he studied small group behavior, from several perspectives. In doing so, Tuckman reviewed 50 articles on group development and noticed that there were two features common to these small groups: the interpersonal or group structure, and the task activity. From this he identified that groups evolved into teams via four common stages (1965). Firstly an orientation, testing phase which often led to a period characterized by a degree of conflict. This then generally resolved itself, leading to a more socially cohesive phase. Finally, groups settled to a functional phase, during which they focused on role-relatedness. To summarize these four phases, Tuckman coined the oft-quoted terms: "forming", "storming", "norming" and "performing." The optimal or "performing" position is reached when relationships have developed within the group and it has started delivering with a clear focus on the task. However, Tuckman's ideas clearly indicate that it takes time to reach the "performing" stage, and it's normal for these teams to go through ups and downs as they develop relationships. Particularly in the early period, which is perhaps why Tuckman called it the "storming" phase. The model program described in this dissertation has been created to address Tuckman’s (1965) stages of group. Below will be a brief description of the stages of group as related to the proposed model program. 133
  • Forming: The initial stage of team development during which individuals have not yet gelled together. The participants are attempting to locate their “place in the group,” “sizing each one other up,” and asking themselves, “Why am I here?” According to the proposed model program, Phase I: The Hood, would be synonymous with Tuckman’s stage of Forming, because trust, safety, cohesion, rules and a sense of camaraderie need to be established before venturing onto the latter phases of the group where race and trauma will be discussed. Storming: The group members begin to see themselves as part of a peer group or family. However at this stage they may challenge each other, and the facilitators, about such things as what the group is doing, how things should be done, and level of commitment in the other group members (Tuckman, 1965). As the stage title suggests, conflict and confrontation typify this stage, as differences surface. This may result in some loss of performance or focus on the task. With the proposed model program, it is hypothesized that around session four to five; typically between the end of Phase I: The Hood, and the beginning of Phase II: The History; there will be some disagreement because of the increased level of communication, comfortability, and adolescent developmental issues of identity versus role confusion (Erikson, 1970). This stage, according to Erikson (1970), contends that development generally depends upon what is done to us. From adolescence forward, development depends primarily upon what one decides to do. And while adolescence is a stage at which individuals are neither a 134
  • child nor an adult, life becomes more complex as youth attempt to find their own identity, struggle with social interactions, and grapple with moral issues. Coupled with the storming stage, the adolescents in the proposed group have a task to discover who they are as individuals separate from their family of origin and as members of a wider society (Erikson, 1970; Yalom, 1995). Norming: This is the phase where group members initiate coming together, developing processes, establishing ground rules, clarifying tasks and member roles, as well as how things will be done (Tuckman, 1965). This phase is characterized by a growing sense of "togetherness.” During the norming phase, the proposed model group will likely begin to function on their own without the support of the facilitators. This initiation may occur in the form of members facilitating their own questions with one another; requesting special activities or lectures from the facilitators; the use of humor; healthy confronting and conflict mediation amongst members; as well as increased sharing of personal histories (Rachman, 1975). Performing: This is the final stage where increased focus on both the task, and group relationships, combine to provide a synergy. Performance is delivered through group members’ working effectively together. Within therapeutic groups (Rachman, 1975) effective work signifies a sense of authentic communication, internalized and externalized hope, honesty between confronting and processing among group members, and an increase in the facilitator’s feedback and group process 135
  • comments (Yalom, 1995). In the proposed model program, the performing phase is hypothesized to occur during Phase III: The Healing. The members of the group will ideally begin to internalize the cohesion, safety and healthy communication with the process group, along with the psychoeducational aspects of the model program. The group’s performing will provide for another significant task, to establish a philosophy of life, which generally forms around peers. Additionally, research indicates that the most significant relationships are with peer groups (Erikson, 1970). The value of Tuckman's model is that it helps facilitators understand that groups evolve. It also allows for consideration of how groups may encounter a myriad of problems at different stages of their development. The benefit of the model may be that it clarifies that the stages of group are not linear and sequential, and many groups may "loop" around in their development. For example, not all teams evolve smoothly through Tuckman's stages but may yo-yo between norming and storming until they either begin to function, or are disbanded. While the presentation of the model treatment phases theoretically appears linear, it is anticipated that the clients’ movement and participation through the program may not be so. This understanding requires that the program structure be flexible and fluid enough to respond to the needs of a population that may be required to attend to basic needs and deal with crises, as well as experiencing the expected resistance to the therapeutic process. Group Purpose 136
  • The purpose of the model program is the early identification and/or treatment of “at-risk” behaviors, which academically are often treated as behavioral issues within the school and mental health systems (Boyd-Franklin & Hines, 1996). This program was designed to identify and reassess treatment goals, add healthier and possibly more accurate symptoms (e.g., vacant esteem, ever-present anger, racist socialization), and provide a culturally sensitive model of healing for African American adolescents who reside in urban areas. It is important to keep in mind that the participants will be at various levels of change, resistance, and commitment to healing, and therefore this model is supportive of the stages of change. Each of the three phases has specific goals, described below. In order to achieve these goals, treatment will be administered using a multimodal approach. As discussed in Chapter 4, psychodynamic theory will play a large role within the program, as clients’ developmental and unconscious conflicts will surface through the group process and interactive exercises. The stages of the group (Tuckman, 1965) will provide access to interpersonal dynamics as well as underlying concerns related to trust and safety. Through the cognitive behavioral component, clients are taught problem-solving techniques to deal with stressful situations, as well as alternative thinking and pro-social skills. Clients will also explore issues related to racial identity and racism, and learn aspects of cultural history (discussed in Chapter 4). Potential Participants 137
  • Group Members. Referral sources for group participants (i.e., parents, schools, therapists, psychiatrists, YMCA, self) may vary depending on the setting (i.e., community mental health center, school, day treatment program, therapeutic school, outpatient facility, residential treatment center, hospital, etc.). After a referral is submitted, an in-person intake interview will be held to screen for inclusion and exclusion criteria. The inclusion criteria are as follows: • Male • Between the ages of 14 and 18 years • Identification as African American • Current home or childhood home in an urban area • Commitment to a three-month program • Participation in individual therapy, either ongoing or agreed to for the duration of the program (release for communication between the two therapists should be permitted). The exclusion criteria are as follows: • Diagnosis or episodes of psychosis, mental retardation, or autism (due to differences in developmental comprehension and treatment needs) • Active suicidal or homicidal ideation • Active substance-abuse issues that are impairing functioning. It is important to note that substance abuse issues will be defined as having either a daily habit of drug and/ or alcohol use; or when the client does 138
  • drink or utilize drugs there is a loss of impulse control, memory, and/ or aggression. Exceptions to these guidelines can occur if there is clinical justification, such as if the group is being facilitated in a residential treatment facility or hospital unit that can accommodate the needs of the potentially excluded population. Group Leaders. The program model is designed to be implemented by two leaders, and one male and one female leader would be ideal to elicit gender identification and transference. Having a female leader would allow for the projection of the maternal figure, whether she is or is not present in clients’ current lives, and the male facilitator would allow both the projection of the intelligent and capable male figure and the male figure or father present (or not present) in clients’ lives. Staffing is critical to the program’s success, and a large priority should be placed on hiring responsible and culturally competent group facilitators. The group leaders should be trained clinicians in the mental health field (LPC, LCSW, Psy.D, Ph.D) with particular training in group process (Yalom, 1995). They should have a strong foundation and knowledge in sociopolitical issues specific to African Americans, psychodynamic theory, trauma recovery, adolescent development, cognitive-behavioral interventions and therapy, the intergenerational transmission of trauma, at minimum Level I training in Dialectical Behavior Therapy (DBT), and some knowledge and interest in Indigenous ways of knowing. It is highly recommended that the group leaders 139
  • have direct experience working with adolescent males and be highly competent in the area of complex trauma, assessment, and crisis intervention. A weekend staff orientation will be held before the program begins. The orientation curriculum will be The People’s Institute for Survival and Beyond’s “Undoing Racism” weekend training (http://www.pisab.org/) facilitated by the University of Medicine & Dentistry’s Robert Wood Johnson Medical School in Newark, NJ. This training explores and begins the process of dismantling institutionalized racism, and creates power analyses in various underserved and “at-risk” communities. Group leaders will be expected to model effective communication, address conflict between members and other leaders, offer healthy conflict mediation, support open and amicable disagreement, address group process themes and defense mechanisms present in the group process, and have strong processing skills. Due to the high levels of emotion, as well as possible crisis intervention and vicarious retraumatization, it is advised that both leaders have supervision weekly, process immediately after each session, and be involved in their own therapy to process reactions to the group, personal triggers, and areas of projection and countertransference, as well as to prevent burn out and increase safety. Session Structure. Each group session is designed to be conducted for 90 minutes. Within that time, the facilitators are constantly aware of their role not only as group clinicians but also as objects of attachment (Mahler, 1998; Klein, 1989) and projection (Yalom, 1995); they also monitor issues of projective 140
  • identification (Foa et al., 2000) and the overall psychological safety and presence of the individuals and the group as a whole. At the start of treatment, each participant is advised of the limits of confidentiality. Participants’ legal guardians will sign consent to treatment, as the group members are minors. Depending on the setting for the group and the referral source, there may be variations or clauses in the agency’s documentation and limits to confidentiality and informed consent. Additionally, at the start of each group session the members will be reminded: “Whatever is said in this group, stays in this group.” Sessions begin with a check-in, a “Feeling Check” that consists of an emotion the participant is feeling at that time. This practice provides a sense of where the group member is emotionally and whether the group should be aware of any resistance, anger, pessimism, or unsafe behaviors. Additionally, a “warm fuzzy” or affirmation card (or quote) is chosen by the participant at random from a provided pack. Self-affirmations and affirmation cards are positive statements or self-scripts that can condition the subconscious mind so that the adolescent can develop a more positive perception of themselves (Hay, 1999; Myss, 2003; Smiley, 2003). Affirmations can help individuals to change harmful behaviors or accomplish goals, and they can also help undo the damage caused by negative scripts, those things that individuals repeatedly tell themselves (or which others repeatedly tell us) that contribute to a negative self-perception (Hay, 1999). Affirmations, both written and verbalized, are utilized in Dialectical Behavior Therapy (McCain & Korman, 2001); Cognitive Behavioral therapies (Novaco, 141
  • 1996); and other forms of drama and art therapies (Emunah, 1996) in order to create positive self-scripts and perceptions of self. The participant is then asked, “How does this ‘warm fuzzy’ speak to you today? or this week?” The warm fuzzies provide a sense of hope, positivity, universality, commonality within the group, and a “softening” and reacclimating of the self and spirit back into the group process, from the stress and protectiveness that many young Black males must psychically, psychically, and psychologically maintain when surviving in the inner city. Finally, the participant is asked, “What do you need the group to know right now?” As part of the check-in, members are encouraged to provide feedback and any process comments such as, “I think it’s interesting that you received the same message two weeks in a row,” or “You say you can’t relate to the message of letting go of anger, but when you came in I sensed you were real mad and I didn’t think I should approach you.” This process will allow the group to recommit to one another and the group process, developing the foundations of stability, safety, family, and a healthier community, in the form of the group. Each session focuses on addressing one of the themes (noted in the clinically relevant literature) that maintains the intergenerational transmission of trauma and related externalizing behaviors. The leader starts each group with a period of psychodynamic group process, which leads into psychoeducation about the related theme for the session, followed by an experiential group or artistic hands-on activity and a process-oriented group discussion (in the whole group or in dyads). The sessions therefore have a mixed percentage of psychodynamic 142
  • group process (Yalom, 1995; Horowitz, 2001; Winnicott, 1971), cognitive behavioral interventions/techniques (Novaco, 1996; Resnick, 2001), trauma- centered therapy (Levine, 1997; van der Kolk, 2001; Cohen et al., 2004; Saxe et al., 2007), psychoeducation on racial identity (Leary, 2005; Mims et al., 2005; Bryant, 2007), creative or experiential activities (Moreno, 2007), and other empirically supported theoretical interventions (Duran, 1995; Copping et al., 2001, Mims et al., 2005). After the check-in, each session consists of 30-45 minutes of psychoeducation, a 30-45 minute activity phase, and 30-45 minutes of process discussion, with a final checkout at the end. Members are also encouraged to bring their material (psychological or artistic) to their individual or family therapist for further processing at a deeper psychodynamic level. Sessions end with another “Feeling Check” where the participants state an emotion that they are currently feeling. Additionally, the following questions are asked: “Who in the room do you most identify with today, and why?” and “Is there anyone or anything that occurred today in group that you feel particularly proud of or concerned about?” These questions support a crucial aspect of group treatment—the intimacy that Makler et al. (1990) identified in his research. The interpersonal dynamics emerging during group interactions can assist in eliciting participants’ accounts of and reactions to current life relationships, as well as provide valuable re-parenting or provide a group member with the opportunity to have a caring or appropriately verbal sibling or parent whom they did not have while growing up (Foy et al., 2000). 143
  • Additionally, this model program encourages the use of journaling, spoken word, short stories, memoirs, poems, short monologues, and raps to facilitate the emergence of unconscious material that the creative psychological process may unearth. According to psychodynamic theory, the unconscious can be brought to the physical world in many ways, one of which is projection, which in turn can be processed through artwork (Rosso, 1997). From a Kleinian perspective, Rosso (1997) described that the earliest danger situation for an infant is an attack by the mother; the act creates a loss of the love-object, and the result is a feeling of emptiness. The experience of emptiness can be described by the artist as the empty space on the wall. The space is later filled with art, which acts as representation and reparation for the early infantile situation. According to Segal (1952), object relations theory views art as the creation of a world of its own, separate from the external world, and art can become a recreation of a person’s internal “destroyed” world. Therefore, artistic expression can be a form of therapy as one works through to the depressive state, or the position from which a person can think symbolically. The Model Program Structure The program model places emphasis on the role of introspection and is comprised of three phases: The Hood, The History, and The Healing. Each phase has 4 sessions, for a total of 12 sessions. 144
  • Phase 1: The Hood. The Hood is designed for the individual, within the group context, to examine his mental and emotional processes related to his own history of trauma. Phase 1 involves psychoeducation, discussion, processing, and narratives related to the adolescents’ experience or witness of trauma(s) within their families, schools, churches, communities, gangs, friend groups, and so on. This phase is designed to help participants to identify that the group is “safe” and to create connectivity between group members. These connections and safety are needed for participants to then be open to being educated about the history of kidnapping Africans and creating slaves in the United States; the effects of slavery on their grandparents, parents, and themselves; Posttraumatic Slave Syndrome; racism in the United States today; and internalized oppression; much less to begin looking at whether any aspect of their spirit needs healing. As the literature review discussed, African American adolescent males in particular struggle with a sense of safety, with identification of themselves as a victim or survivor of trauma, and with resistance to the mental health system (Abdullah, 1995; Akbar, 1996; Coleman & Cressey, 1996; Canada, 1998; Eyerman, 2001; Leary, 2005; Mims et al., 2005). Therefore, Phase 1 is designed to establish a solid therapeutic container; work with identity development; discuss family and community; educate participants on what trauma is and what it does to the body, mind, and psyche; and provide a narrative and identification of the adolescents’ primary forms of trauma. Specific goals for Phase 1 of the model program are as follows: 145
  • • Provide a safe and containing environment to allow clients to explore difficult topics. • Educate clients (and possibly family members/caregivers) regarding mental health and dispel stereotypes and myths about mental health and self-care. • Examine past and present forms of trauma that may have impacted clients (i.e., community violence, domestic violence, emotional abuse, sexual abuse, neglect, slavery, microaggressions of prejudice and racism), and facilitate the process of recovery and healing from those traumas. • Empower the client to notice sensorimotor and physiological reactions to stress. The four sessions of Phase 1: The Hood is described in detail in Appendix A. Phase 2: The History. The History builds upon Phase 1 through discussion on the effects of trauma on human beings and illustrates how the injuries sustained by prior generations can impact the generations that follow. Phase 2 encourages and broadens participants’ awareness on issues related to the intergenerational transmission of the functional and dysfunctional attitudes and behaviors, both what they have received and what they transmit to others. Participants are encouraged to further understand the role of slavery in U.S. history and how it is intergenerationally transmitted, directly and indirectly. In order to have this discussion with adolescent African American males, it is imperative to first address race and the statement, “But I am Black, I’m not African…” with the associated worldview that many inner city, self-identified 146
  • African American adolescent males may have. Discussion in this phase opens the question of how people arrive at their beliefs about “race,” and how pseudo- scientific approaches provide humanity with labels and concepts that ignore the subtle truth about what African Americans are and are not (Abdullah, 1995; Eyerman, 1996; Mims et al., 2005; Leary, 2005). Discussion topics in The History sessions include the influence of African culture on African American society, American chattel slavery, and the creation of U.S. constitutional laws to justify slavery as an institution. Phase 2 then introduces the concept of Posttraumatic Slave Syndrome (Leary, 2005) and PTSlaveryD (Mims et al., 2005) to discuss what the terms conjure up, participants’ personal experiences that may have exemplified the concept of PTSS, ways members of their families may have been impacted by PTSS, and ways PTSS may have been unconsciously transmitted intergenerationally. Additionally, the transmission of intergenerational trauma in the form of slavery is further defined by the three manifestations: vacant esteem, ever-present anger/ rage, and racist socialization. These manifestations and their intergenerational transmission are discussed in Phase 2, and exercises are applied that relate the participants’ experiences to these concepts. Within that flexible framework, the goals for Phase 2 of the model program are as follows: • Help clients acknowledge the link between historical and personal history and current attitudes and behaviors. 147
  • • Help clients identify how they have come to understand and deal with issues of ethnic identity and cultural values. • Educate and help clients assess how and why African Americans may have been impacted over centuries by European efforts to dehumanize them. • Explore the principles and components of the theory of PTSS, in particular how vacant esteem, ever-present anger, and racist socialization may be affecting clients’ lives. • Gain a general overview (snapshot) of clients’ historical familial evolution, including their family system, choices, coping mechanisms, stresses, and strengths, as well as overall adaptation to their environment from generation to generation. The four sessions of Phase 2: The History are described in detail in Appendix A. Phase 3: The Healing The Healing involves integrating the previous two phases, The Hood and The History, and reevaluating what it means to be human again, since the process of slavery has had a dehumanizing affect on Africans in the United States. Sessions of The Healing develop understanding that self- concept is not the only contributor to the current plight and externalization of feelings amongst African American males. The model program refocuses on Indigenous ways of honoring families and traditions, creating new and healthier traditions, and identifying the ways in which participants can continue to contribute to their family legacy. 148
  • Phase 3 proposes seven steps toward healing the wounds of slavery and racial oppression: Truthfulness, Know Yourself, Tell Your Story, Build Esteem, Control Your Inner World, Racial Socialization, Be the Healing You Seek, and Look in the Mirror. These steps are woven throughout Phase III of the model program and are areas for the facilitators to consider and become conscious of throughout the group process. Depending on the make-up of a particular group of adolescent males, the facilitators(s) may opt for more or less work on one of the described areas in the model program appendix, or, for example, to further explore the usefulness of being truthful and honest, within the group and/ or the community and family systems. Dr. Leary (2005) frequently speaks of sankofa, which means “return and get it”—in Phase 2 the group examines and synthesizes what this means for each of the participants in relation to the previous phases. They piece together their own personal timelines and examine what traumas, historically and presently, may contribute to their current emotions, behaviors, and feelings of low self-worth. The goal for Phase 3 is to develop a process for self-reflection, evaluation, and self-efficacy, which will then lead to the establishment of healthy and accurate self-esteem (Hardy, 1995; Leary, 2005; Boyd-Franklin, 1998; Abdullah, 1995). Within the flexible framework, the goals for Phase 3, of the model program are as follows: • Encourage and foster growth, accountability, and responsibility. • Develop healthy coping skills. • Help connect, reconnect, or maintain family and community. 149
  • • Enable clients to identify triggers and to replace the responses with new behaviors and skills. • Empower the use of spiritual or nontraditional forms of healing (e.g., prayer, reiki, meditation, mindfulness techniques, bodywork, etc.). • Bring about clarity regarding ways to begin the process of change, growth, and ultimately, “healing.” The four sessions of Phase 3: The Healing is attached described in detail in Appendix A. The next section will present feedback from the five identified reviewers on the model program presented in Appendix A. The feedback will be incorporated into a discussion about the strengths and weaknesses of this model program in Chapter 6 the Results. Additionally, this dissertation will conclude with Chapter 7 on the Discussion and Conclusion section, which will focus on limitations of this model program, as well as future directions for research and study. CHAPTER 6: DISCUSSION The model program is a16-week group intervention for African American adolescent males who reside in an urban city. The program is divided into sessions according to problem areas or specific sociocultural themes identified in the literature review above. The program includes individual and group components; family therapy is optional, yet strongly encouraged. The program 150
  • consists of 90-minute group sessions once per week for 12 weeks; however, the same frame and format could be tailored to other timeframes (i.e., consolidation of interventions into longer groups, meeting every two weeks, meeting multiple times a week, etc.). The themes and problem areas addressed in each section were selected to occur in accordance with the stages of a group as defined by Tuckman (1965). While the presentation of the treatment phases theoretically appears linear, it is anticipated that the clients’ movement and participation through the program may not be so. This understanding requires that the program structure be flexible and fluid enough to respond to the needs of a population that may be required to attend to basic needs and deal with crises, as well as experiencing the expected resistance to the therapeutic process. Phase 1: The Hood The survivor who has accomplished her/his recovery faces life with few illusions and a great deal of gratitude. Her/his view of life may be tragic, but for that very reason she/he has learned to cherish laughter. She/ he has a clear sense of what is important and what is not. Having encountered evil, she/ he knows how to cling to what is good. Having encountered the fear of death, she/ he knows how to celebrate life. (Herman, 1997, p. 213) Session 1: Community, Groups, and Containment: “Scoping Out the Joint” Purpose/Rationale 151
  • This first session facilitates the group process, creates a sense of normalcy, and is very task-oriented. This session contains the disrupted internal state often associated with traumatized individuals. Young Black males who have experienced trauma directly or indirectly often experience difficulties containing their emotions and may utilize externalizing behaviors as a means to modulate their emotions (Abdullah, 1995). Therefore, group participants are likely to have experienced unsafe situations or caregivers who were unable to help with emotional regulation (van der Kolk, 1996). Coming into the group, many of the participants may feel as though they cannot or should not trust the facilitators and perhaps other group members. The sessions in Phase 1 are designed to provide a corrective emotional experience by developing safety and a container in the group. Goals • Create a sense of safety by developing coping skills. • Improve affect regulation. • Symbolize the journey of the group in a concrete manner. • Create a sense of universality and commonality among group members. Group Process The group begins with introductions including a sense of why the group members have decided to join the group, concerns, and a “Feeling Check-in.” The check-in is used consistently to start each session. Sessions begin with a check-in, a “Feeling Check” that consists of an emotion the participant is feeling 152
  • at that time. This practice provides a sense of where the group member is emotionally and whether the group should be aware of any resistance, anger, pessimism, or unsafe behaviors. Additionally, a “warm fuzzy” or affirmation card (or quote) is chosen by the participant at random from a provided pack. The participant is then asked, “How does this ‘warm fuzzy’ speak to you today? or this week?” The warm fuzzies provide a sense of hope, positivity, universality, commonality within the group, and a “softening” and reacclimating of the self and spirit back into the group process, from the stress and protectiveness that many young Black males find themselves struggling to maintain, psychically, psychically, and psychologically when surviving in the inner city (Mims et al., 2005). Finally, the participant is asked, “What do you need the group to know right now?” As part of the check-in, members are encouraged to provide feedback and any process comments such as, “I think it’s interesting that you received the same message two weeks in a row,” or “You say you can’t relate to the message of letting go of anger, but when you came in I sensed you were real mad and I didn’t think I should approach you.” This process will allow the group to recommit to one another and the group process, developing the foundations of stability, safety, family, and a healthier community, in the form of the group. Each participant must name a feeling; facilitators should be ready to process with clients to get to the “root of the feeling” if needed. For example, should a group member state that he is “exhausted,” further inquiry regarding what is exhausting him and 153
  • process questions such as, "If you could peel back the exhaustion, what feeling would be there?" are warranted. Then, the group process is described, with emphasis on how participants are currently in the beginning stages of the group. "Forming, storming, norming" (Tuckman, 1965, p. 6) is explained with a discussion of how this may relate to the group. As Yalom contends (1995), the curative factors in a group are hope, universality, catharsis, imitative behavior, altruism, and existential awareness. This program is grounded in the following belief system regarding safety and growth. Safety is the experience of being protected from danger and hurt; within a safe environment we can relax and be ourselves because we know that our well-being is secure (Davis, 1990; Hendricks, 2001). In safety, people usually feel free to take manageable risks towards growth and change (Davis, 1990). When group members are able to speak honestly and openly about their lives, in a safe environment, healing naturally begins (Duran, 1996). In Session 1, group members are supported to create group norms to improve each other’s investment in the expectations of the group, start the process of group-formation and safety, and create group rules. One of the facilitators writes down the rules on a large easel paper as the group members provide ideas for rules that will keep the group safe, interesting, and workable. These rules are saved and displayed for every group session. The other facilitator provokes thought and asks questions about what each rule means, how it creates stability and safety, and what the expectations should be if someone does not follow the group rule(s). 154
  • After the rules are designed, the facilitators describe their interest in the program and why they chose to lead the program. The facilitators should provide a structured yet honest view of who they are, where they grew up, and what value they place on mental health and therapy in their own lives. In this way they model the roles and the process that they expect the group to participate in, enhancing comfort and interest among the group participants (Boyd-Franklin & Hines, 1996). The facilitators then proceed with psychoeducation regarding mental health and, particularly, mental health stigmas within the Black community. Important aspects of how the Black community receives support (i.e., church, extended family, music, dance, various forms of prayer, Sunday dinners, etc.) are discussed, and the strengths and weaknesses of the common phrase “I don’t need any therapy/help—I am not crazy” are processed with the participants in a candid discussion (Akbar, 1996; Mims et al., 2005). During this time, one facilitator starts a new page on the easel paper and create a list of pros and cons for “having a place to talk,” better known as therapy. Participants are encouraged to discuss any negative experiences with past counselors or service workers. Activity: “Locate Yourself” 1. Instruct members to move into dyads and begin an interview process. 2. Members take turns asking each other questions about their family, how they grew up, what school they attend, if they have ever been involved in therapy, and who they have for support in their lives. In addition, members are asked to answer fun questions such as their favorite song, artist, way to “blow off 155
  • steam,” or genre of music. They also answer two main questions: “How will the group know if you are upset, angry or sad?” and “What is the best way for someone to support you if you are angry or sad?” 3. After both participants in the dyads have been interviewed, they all return to the main group circle and begin telling the group about their partner. Each dyad introduces each other and tells their partner’s name. As a twist, the facilitators ask the group members to pick a paper randomly from a hat. In the hat are various forms of expression or genres such as: country, hip hop, jazz, angry, silly, hyperactive, you are selling a car, you are in an emergency. They must then present their dyad partner in the style indicated on the paper, which allows for laughter and silliness, provoking a sense of containment and enjoyment among group members. This approach also allows members to become more relaxed in that every other group member will be moving out of their comfort zone as well. 4. The group then further discusses safety and questions related to safety in their lives currently and in their life history. Encourage discussion by asking the following questions: • What does safety mean to you? • What is a safe place you currently inhabit (emotionally or physically)? • Have you ever felt safe? • If yes, describe one time. What about the experience made you feel safe? 156
  • • If you haven’t felt safe, what are some of the beliefs that have kept you from feeling safe? (i.e., People hurt me, I can’t depend on anyone, etc.). • For me to feel safe I would need… • When I consider feeling safe in the world I feel… Session 2: Interpersonal Connections: “Blood In—Blood Out” Purpose/Rationale: Session 2 addresses the theme of interpersonal ineffectiveness, in particular within the relationships of family and friends. One of the most common triggers for traumatized individuals is problems in interpersonal relationships (Herman, 1992; Eyerman, 2004) in which the individual might experience difficulties understanding the differences between his needs and the needs of others after repeated exposure to traumas. Many of the young men in the group will likely have been exposed to repeated forms of interpersonal assault (i.e., verbal and physical abuse, neglect, bullying, gang violence), creating a sense of confusion, isolation, and anger. They are likely to be questioning whether that violence could have been prevented, whether it is their fault, or if they deserved it (Kellerman, 2001). Teaching healthy boundaries, conflict resolution skills, and direct communication might improve the members’ relationships with themselves and others. This session explores the role of the family in their lives as well. Goals • Identify dysfunction patterns in communication. 157
  • • Improve communication. • Identify misperceptions and fears in interpersonal communications. • Improve expression of emotion. Group Process After the usual check-in, the facilitators pose these questions: “How are your relationships? Are you satisfied? Can you trust people? Does it seem like you are frequently alone with everybody?” Members can then begin to process what they expect from relationships and, most likely, how little they expect from interpersonal relationships. Then the facilitators pose the questions: “Do you consider yourself a good friend? A good son? A decent brother?” Members can then process and address their feelings and begin to provide feedback to the other participants. They process what it means to be “blood relatives,” and what that means where they are from. Ask process questions, such as the following: “Do you often feel like you HAVE to be there for your cousins?” “Have you ever been asked to do things you haven’t wanted to do or you felt were unsafe, but did them for family?” “Have you ever been in trouble in order to protect family members or close friends?” “How do you feel about that?” Allow identification and feedback among members. At this time the facilitators share psychoeducation on family dynamics and discuss family roles (i.e., clown, forgotten child, martyr, and scapegoat). After discussing communication skills, interpersonal boundaries, and safety, the facilitators begin to discuss DBT skills and mindfulness concepts from McKay, Wood and Brantley’s (2007) dialectical behavior skills workbook. Participants in 158
  • the group are provided with the definition of mindfulness. Mindfulness is defined, by McKay, Wood, and Brantley (2007) in their DBT skills workbook, as the “ability to be aware of your thoughts, emotions, physical sensations, and actions —in the present moment without judging or criticizing yourself or your own experience” (p. 64). They later state, “Mindfulness is like a FLAME” (p. 108) in the DBT skills workbook, and the facilitators of the group begin to engage in a psychoeducational dialogue for learning mindfulness, interpersonal effectiveness, emotional regulation, & distress tolerance. The goal of the discussion is for members to identify maladaptive patterns of communication. According to Boyd-Franklin (1996), family is often where the most significant and complex traumas occur. Specifically, the facilitators should help participants clarify and identify messages they have received in abuse or invalidation, and elicit whether they had learned that sharing their feelings or expressing discomfort was not a safe activity. It is important to help members identify alternative ways they have used in the past to communicate, manipulate, or withdraw. This discussion can aid the members in reevaluating old communication patterns to recreate new and healthier ways of relating. Group members then engage in an activity. Activity: “Taming the FLAME Within”—Writing, Mindfulness, and Role Play Exercises The facilitator writes FLAME and the following definitions for the mindfulness exercise on the dry-erase board. FLAME stands for: 159
  • • Focus and shift your attention to be mindful in the present moment. • Let go of distracting thoughts and judgments • Use radical Acceptance to remain nonjudgmental • Use wise Mind to make healthy decisions, and • Do what is Effective to accomplish your goals. 1. Ask the members to write about a recent conflict in their lives. Ask them to be detailed and honest in their portrayal of the conflict. Stress that there is no pettiness, and that honesty with themselves is the first step toward health and toward Phase 2 of the program. 2. Assign group members into groups of three to role-play the conflict the way they would normally interact and react with that family member. (Can be unhealthy). 3. Then ask the members to participate in a brief mindfulness exercise with their eyes closed or cast down. (Note many abused youth will feel uncomfortable, especially after only two sessions, with closing their eyes completely.) 4. Ask the group to focus and shift their attention to being mindful in the present moment. 5. Ask them to let go of distractions and gently put aside any specific thoughts or judgments. 6. Ask them to take a deep breath and imagine themselves in that situation again with that family member. Ask them to send the family member acceptance, love, and compassion NO MATTER WHAT. 160
  • 7. Ask them to try and utilize their intelligent and wise mind to make a healthier and more mature decision. 8. Ask them to see themselves doing something effective to accomplish their goal of having a happier relationship with that family member. 9. Then ask the members to open their eyes and come together again in triads. 10. Ask the triads again to role-play their skits, this time using the wise mind in the FLAME technique. At the end of the role-plays, ask each group member to state a feeling after having done the exercises. 11. End with these questions to the whole group: • “How would you describe effective communication versus ineffective communication?” • “What do you realize about how people in your life communicate with you?” • “How are we going to communicate in group?” • “How do your behaviors (“acting out behaviors”) at school or home communicate something to others?” • “What do you want people to know?” • “How do you prefer to communicate (i.e., musically, verbally, physically, artistically)?” • Allow time for group feedback, discussion, and any reactions to others’ role-plays, as well as the closing “Feeling Check.” Session 3: Complex Trauma: “Around My Way…” 161
  • Purpose/Rationale Session 3 begins to define trauma and allow the group members to explore what trauma is and how it affects their everyday lives. Judith Herman (1992) describes trauma as an experience in which an individual is directly involved in or witness to an event that evokes feelings of a loss of safety, helplessness, fear, horror, and a threat of annihilation. This session is a practical exploration of components and manifestations of trauma, and distinguishes between acute and secondary trauma, complex PTSD, and the general definition of intergenerational trauma. Additionally, the emotional and physical manifestations of complex trauma are discussed, such as hyperarousal, intrusion, disconnection, and constriction and numbing. Both the psychoeducation and the activities focus on the definition and manifestations of complex trauma. As the research states in the literature review, African American male youth disproportionately experience violence, compared to other young men their age (Davis, 2009; Eyerman, 2001) as well as experience some form—if not multiple levels—of trauma because of this violence (van der Kolk et al., 2005). Additionally, a prospective study performed at two urban emergency departments suggests “acute stress symptoms assessed in the emergency department in the immediate aftermath of traumatic injury are useful indicators of risk for later post- traumatic stress” (Fein, Kassam-Adams et al. 2002). This applies not only to acute care settings but also pervades primary care settings. Additionally, the ACE Study contends that the impact of trauma and adversity on the lives of young men of color have not been, specifically, studied in urban environments. Given the 162
  • health outcomes of boys and men of color, the ACE study group asserts that they are almost certain that adversity and trauma play a large role in bringing about the diminished health outcomes (Felitti, Anda et al. 1998). Furthermore, Dr. John Rich, in his work interviewing young men that had been shot, reveals the complexities of the lives of these young men: “... aspects of the code of the street and lack of faith in the police combined with traumatic stress and substance use to accentuate their sense of vulnerability. The young men then react to protect themselves in ways that could increase their risk of reinjury” (Rich, Grey et al. 2005). Many of the social service systems that serve boys, young men and their families are fragmented, exist as silos, do not share a common knowledge base or language, compete for diminishing resources, and are chronically stressed (Drexel University, 2009). When African American male youth interface with these stressed systems, their problems are often compounded. Hence, this session within Phase I places support and pursues inquiries that are community-based consistent with a trauma informed approach. Goals • Define trauma, PTSD, acute and secondary trauma, and complex trauma. • Identify and examine forms of trauma in members’ lives. 163
  • • Identify forms of trauma (past and present) that may have impacted members. • Improve members’ self-awareness. • Improve members’ empowerment and decrease helplessness. Group Process After the standard check-in sequence, one of the facilitators asks for three volunteers. Each volunteer is given a bottle of a liquid identified as seltzer water and stands in the middle of the group. Ask the group members what they have heard or what they know about PTSD and trauma. Various answers and responses will arise related to safety and abuse. Begin to talk about unsafe versus uncomfortable. Ask for examples and feedback as to what is seen as unsafe or uncomfortable. Ask the first volunteer to open the bottle without shaking it—tell him to not shake or move it. One facilitator should explain that that bottle is an example of a life without trauma: There is no disruption, no problems, it seems quiet and easy, and there is no reaction. “The waters are calm.” Ask the second volunteer to shake their bottle slightly and then open it. As it opens and the carbonated seltzer spills over the member’s hands, the facilitator explains that the shaking is the “trauma” (use the members’ own terminology in relating to them regarding the word trauma) and the overflowing liquid represents how trauma frequently disrupts a person’s life. The facilitator then asks the third volunteer to shake the bottle like the second volunteer did, but this time to wait 10 seconds until the carbonation settles, then gently twist the cap, then wait another few seconds, then slowly twist again—until the seltzer does not spill over and it is 164
  • bubbling and the cap is off. This third bottle is an example of a life with trauma but also with treatment. The facilitator takes a few minutes to discuss how important it is to share in a safe environment, both to respect the obvious and hidden aspects of traumas’ effects on a person and to honor the process of when talking about trauma in the group is uncomfortable and when it could be potentially unsafe (van der Kolk, 1996). The facilitators then begin to discuss complex trauma and its effects on the body, mind, and spirit. They discuss how trauma can become locked in people’s bodies, “acted out,” or internalized and smothered within, leading to depression and anxiety (van der Kolk, 1996). The group begins to discuss symptoms and manifestations of complex trauma and the facilitators guide a gentle discussion on the definitions, manifestations, and dangers of attempting to “ignore the bad stuff” or “minimize the pain” because looking scared is not acceptable where the group members have grown up (van der kolk, 1996; Walsh, 2006). The group is now beginning to form a sense of trust and is witness to the participants’ commonality with one another. Examples may be provided, whether in the first or third person, and the psychodynamic process is able to come alive and move the discussion into psychodynamic group work (Foa et al., 2000). Throughout the group, facilitators should be making connections between the behaviors, thoughts, actions, and intrapsychic processes that are occurring within the group members. Activity: “The Role of Trauma in My Life” 165
  • 1. Ask members to define “What is uncomfortable?” to them. Ask the group members to provide examples and facilitate identification among members. 2. Ask the group members to define “What is unsafe?” to them. Ask the group to provide examples and identify when appropriate. 3. Ask the group to provide three examples in their life when they have experienced acute trauma/ experiences that have happened directly to them (ex, car accident, abuse, war, fire, gang activity). 4. Ask the group to discuss one occurrence in their life when they have experienced secondary trauma/ “bystander” (ex. when someone close to you has suffered from being shot, hurt, abused, prison, etc), and it has affected you (e.g., makes you angry, sad, violent, etc). 5. Ask the group to identify three ways that the above acute and secondary trauma has affected you on a daily basis (ex. anger, mistrust, physical impairment, drug abuse, overeating). Facilitators should provide examples for the group. 6. Ask the group which beliefs or behaviors that the identified manifesting on a daily basis continues to affect them, and process whether they are aware whether it is a healthy or unhealthy behavior. 7. Then ask the members to notice where in their bodies they feel tense, upset, or uncomfortable (Gendlin, 1996). 8. Encourage discussion by asking participants the following questions: • “What feelings came up for you during this activity?” • “How are your stories similar to or different from those of other people in the group?” 166
  • • “What feelings would you like to be more aware of?” • “What were you afraid people would know about you?” • “Did the group respond the way you hoped they would?” 1. Conclude the session with a lengthy reminder about Session 2 and the interpersonal and coping skills they established. Remind the group members to practice self-care in whatever form feels most comfortable for them. Session 4: Coping: “I’m a Survivor…not a Victim.” Purpose/Rationale Session 4 continues to strengthen the group members’ individual and interpersonal coping skills, as well as allow for the exploration and acknowledgement of the role of resilience in their lives. As cited in the literature review, some African American children seem to have an innate ability to overcome extreme obstacles and embrace life’s transitions without apparent effort. They seem to demonstrate healthy coping skills, positive social interactions, and possibly academic achievement—in spite of social challenges. As Rutter (1987) and Garmezy (1985, 1994) referenced, protective factors and the mechanisms that employ them are crucial when describing how people cope and employ resilience (which describes an individual’s ability to overcome obstacles related to vulnerability). Goals • Identify the healthy and unhealthy coping mechanisms in group members. • Identify the coping mechanisms that may no longer serve individuals. 167
  • • Acknowledge areas in group members’ lives where they feel particularly strong and foster resilience. • Enable members to begin to accept and forgive themselves for some of the self-destructive aspects of coping that have been learned. Group Process After the initial check-in, the facilitators ask the group whether there are any thoughts or feelings from the week prior. Process any reactions and leave time for any feelings of anger, worthlessness, sadness, or confusion. Be sure to check in with the group and question whether anyone else in the group can identify with the member speaking. Activity: “How I do…” 1. Ask the members to split into groups of two and ask one of the group member’s of the duo to begin and set the tone of the small groups by volunteering to be the interviewee. The other person will be the interviewer. 2. One of the facilitators will begin to explain how no two people who have survived trauma have the same set of coping mechanisms. The other facilitator will write on a large easel post-it the list below. The first facilitator will continue to explain how the list reflects some of the common ways that people cope with traumatic things happening to them. abusing others perfectionism not sleeping enough 168
  • overeating drug addiction suicide attempts working too much cutting denial creating drama not eating enough excessive pornography leaving your body gambling fighting selling drugs lying taking care of others compulsive sex spacing out being super-aware/ alert running away shoplifting acting like you don’t care joining a gang alcohol abuse staying busy minimizing over exercising fantasizing hurting others humor about the abuse ignoring schoolwork staying in control bullying truancy smoking marijuana justifying actions excessive videogame playing 169
  • defensiveness over-controlling creating new personalities 3. The group members are then asked to “interview the other” in a respectful and compassionate way. Facilitators will be walking around to answer any questions or to assist with any areas of emotional resistance, anger, sadness, and/ or support when and if necessary. 4. At the end of roughly 20-30 minutes of the groups of two; the facilitators will ask one triad to sit in the center of the larger circle. This will facilitate the beginning of the “fish bowl,” which allows the outer circle members to be process observers and to witness and “contain” the inner circle, physically and emotionally. The fishbowl is a psychodynamics technique that allows the inside triad to feel a sense of safety, intimacy, and connectedness once discussion has begun (Rosso, 1997). Should any member not feel comfortable at any time, they may choose to be excused from the fishbowl or to not participate as the inner circle. Ideally, each group member will take turns as both the processor and the process observer. 5. Once in the fishbowl, the triad members share their coping mechanisms and discuss any conclusions they have made related to how they cope, with particular attention to the mechanisms they have used but for some 170
  • reason chose not to write about or identify on paper. The process observers should not comment, talk, or engage at all with the inner group at this time. The following two questions will be asked, as usual, the group members have a choice of whether to answer. 6. “When I look at the coping mechanisms I circled above, I feel…” and “I realize that…” 7. After the entire group has had a turn in the fishbowl as the processors, the following questions are processed within the larger circle. These questions are adapted from The Courage to Heal Workbook (Davis, 1990). • Are there coping mechanisms that I used as a child that I don’t use anymore? • What new coping mechanism(s) have I developed as an adult? • How have my coping skills changed over the years? • Which coping mechanisms do I feel ashamed about? • Which, if any, feel okay to me? • What’s the difference between those I feel ashamed about and those that feel okay? 8. After the discussion, one of the facilitators briefly summarizes for the group and begins to acknowledge the members’ honesty and authenticity, as well as the facilitators’ sense of pride in the courage that the young men are taking towards healing. 171
  • 9. Briefly address forgiveness of oneself and ask the members which coping mechanisms they may need to forgive themselves for, and why they should. 10. At the end of the session the facilitators should engage the group in a closing feeling check, to allow the young men to identify with their true feelings, while allowing them to relate it back to their coping skills individually. Phase 2: The History The basic purpose is for our people to have a voice. To be heard is the important thing, no matter what it is we’re talking about … and that we have a lot of offer our society. But we also have to look at the bad stuff, and what has happened to us, and why … We cannot do this without going through the past, and watching ourselves and analyzing ourselves, because we’re carrying a pain that is 400 hundred years old. We don’t just carry out everyday pain. We’re carrying the pain of our fathers, our mothers, our grandfathers, our grandmothers – it’s part of the land. (Alioff & Schouten Levine, 1987, p. 13) Phase 2: The History encourages the participants to nurture and broaden their awareness of how functional and dysfunctional attitudes and behaviors have been transmitted intergenerationally and of what is being transmitted to others. In this phase participants are encouraged to further understand the role of slavery in U.S. history and how it is intergenerationally transmitted directly and indirectly. Phase 2 builds upon Phase 1: The Hood through discussion on the effects of trauma on human beings, and illustrates how the injuries sustained by prior generations can impact the generations that follow. As previously stated in the Overview, the goals for Phase 2 of the model program are as follows: 172
  • • Help clients acknowledge the link between historical and personal history and current attitudes and behaviors. • Help clients identify how they have come to understand and deal with issues of ethnic identity and cultural values. • Educate and help clients assess how and why African Americans may have been impacted over centuries by European efforts to dehumanize them. • Explore the principles and components of the theory of PTSS, in particular how vacant esteem, ever-present anger, and racist socialization may be affecting clients’ lives. • Gain a general overview (snapshot) of clients’ historical familial evolution, including their family system, choices, coping mechanisms, stresses, and strengths, as well as overall adaptation to their environment from generation to generation. Session 5: Ancestry and Roots: “But I am Black…I’m not African…” Purpose/Rationale Session 5 educates group members on the history of the Transatlantic Slave Trade and the ways American chattel slavery benefited rich White men in Europe (and eventually in the United States). This session also describes how in 1808 the United States officially ended the transatlantic slave trade, and how America’s constitutional laws were created to justify slavery as an institution (Pinderhughes, 1996; Hicks-Ray, 2004). The group members also identify how 173
  • they, as individuals, have come understand ethnic identity. A brief introduction is provided on the falsehoods associated with the proposition of distinctly different biologically fixed races, and the reasons for perpetuating the “myth of race” are explored. In addition to education, the purpose of this session is to help the adolescent male participants assess and truly understand how and why African Americans may have been impacted over centuries by European efforts to dehumanize them. The questions pursued in Session 5 are designed to open up a broader discussion for the next lesson, where Posttraumatic Slave Syndrome is introduced and explored (Leary, 2005). Reflection is therefore a key piece of this session focusing on the implications of these issues for individual group members, their families, their communities, and their society in general. Goals • Educate group members on the history of American chattel slavery as an institution. • Educate members on the meaning of race and its history in the United States. • Help members begin to understand the definitions of racial superiority and inferiority. • Help members identify how each of them has come to understand and deal with issues of ethnic identity and cultural values. Group Process 174
  • During the check-in, the affirmations shift focus into quotes that reflect role models and revolutionaries from people of color, particularly people who have helped to shape race discourse on systemic oppression in the United States. The group then begins with a concise synopsis and comparative glimpse of American chattel slavery and other forms of slavery, along with the construction of U.S. constitutional laws to substantiate slavery as an institution. The group will then watch short (5-8 minute) clips of Katrina Browne’s documentary, Traces of the Trade: A Story from the Deep North (2008). This documentary provides the group members with startling examples of how the trading of enslaved Africans continued long after it was made illegal in 1808, as well as reveals how Ms. Browne’s ancestors, the De Wolfs—the largest slave-holding family in U.S. history—gained their place among the wealthiest families in the United States. The discussion and psychoeducation then moves into how Africans in the United States continue to suffer from the consequences of slavery and Jim Crow, long after both systems were formally abolished (Eyerman, 2004). The crucial aspects of the conversation include a discussion on the meaning of power, the members’ creation of a small power analysis in their community, a discussion on race, and a working definition of race developed and agreed upon by the group. Members also view portions of the CBS documentary, Africans in America (Bellows/ Bagwell, 1998) namely the parts that focus on Africans forced assimilation in the United States, Part I, The Terrible Transformation. 175
  • Activity: Undoing Racism Workshop: Presented by the People’s Institute of Survival & Beyond’s Teen Presenters Group For the Session 5 activity, the facilitators invite three facilitators from the People’s Institute for Survival and Beyond, Inc. to present a portion of the Undoing Racism workshop. The People’s Institute of Survival and Beyond’s training provides a common working analysis of racism and of the particular role of human service workers and other individuals involved in mental health as "gatekeepers" within institutions. This understanding provides a springboard to generate institutional transformation and undertake accountable antiracist community organizing. Undoing Racism is normally an intensive 2½-day workshop designed to train, educate, challenge, and empower people to undo the racist structures that hinder effective social change. However, for the purposes of this model program the trainers will present for 60 minutes and provides working definitions of racism, internalized oppression, and gate-keeping within underserved communities. The training is based on the premise that racism has been systematically constructed and that it can be undone when people understand where it comes from, how it functions, why it is perpetuated, and what can be done to dismantle it. There are numerous reasons for brining the Undoing Racism curriculum into this model program curriculum with African American male youth. Goals of this group’s participation in the Undoing Racism training include the following: • Define race, prejudice, power, and racism and understand the historical and current application of racism; 176
  • • Define individual, institutional, and cultural manifestations of racism and how it manifests today; • Define internalized racial oppression, where it comes from, and how it operates within daily life and in the communities in which the youth live and may possibly work in the future; • Examine the value of relationship-building in communities, beginning with the participants’ therapeutic group; • Recognize how socialization produces worldviews that limit people’s ability to undo racism; • Recognize socialization and biases regarding class, wealth, and poverty; • Examine institutional reasons for poverty, and institutional and individual relationships to poor communities, as well as how some of the those limitations are part of a larger construct related to racism; and • Define the concept of “White” and its implication in the construct of race and its historical advantage in the United States. After the Undoing Racism discussion, the facilitators will engage in the group members in a group-oriented dialogue including the following questions about their own racial identity: • What have you been taught about the meaning of race? • What did your family teach you about being “Black in America?” 177
  • • What did you learn about being Black from teachers, friends, society, etc.? • What are some cultural values and traditions that you have? • With what you know about race, what changes can be made in regard to family, community, and society? • How do you identify yourself (biracial, African American, Black, Colored, Mixed, etc.)? • How do you learn about your world best (i.e., I tend to trust my instincts, written information, television, verbal information, from family, etc.)? Allow time for process and group dynamics to arise. Session 6: Post Traumatic Slave Syndrome (PTSS): “Passing It Down” Purpose/Rationale Session 6 focuses on the effects of trauma on African Americans in the United States and illustrates how the injuries sustained by prior generations can impact following generations of African Americans. Post Traumatic Slave Syndrome (PTSS) is defined by Leary (2005) as the impact of multigenerationl, intra-culturally transmitted behaviors and beliefs, combined with differential treatment and access to the benefits offered to others in the society (p. 30). The purpose of Session 6 is to explain to the group members how PTSS develops from prolonged exposure to a myriad of emotional, mental, and physical abuse coupled 178
  • with the ongoing discrimination and oppressive practices (discussed in Session 5), leads to PTSS (Leary, 2005). Goals • Educate and help participants assess how and why African Americans may have been impacted by American chattel slavery. • Help each participant acknowledge the link between historical and personal history and current attitudes and behaviors. • Explore the principles of the theory of Posttraumatic Slave Syndrome (PTSS). Group Process Both facilitators take turns and add feedback, providing education as well as asking questions. After the usual check-in, one facilitator leads a 15-minute discussion about the Undoing Racism training, eliciting and addressing any feelings and concerns that arose due to the information and exercises during the training, as well as the group process and questions after the training. Members also receive a brief refresher on PTSS. The facilitators then proceed to ask group members to raise their hands to identify whether they were hit or beaten as children. The facilitators ask group members whether they feel that disciplining children with physical means was (and is) appropriate. It is likely that many of the members, having received physical punishment for “acting up,” will respond with answers such as, “It was out of love,” “It was for my own good—look at me now,” or “I turned out okay.” One facilitator then inquires whether any of the participants are familiar with the 179
  • practice of having to go and get the belt, or a switch from a tree, so it could be used to hit them. Again, it is likely that many members will agree and become quite affirmative in their responses. The other facilitator then begins to expand upon the concept and ask whether any of the participants are familiar with or have experienced having to retrieve several twigs from a tree, so the adult giving the punishment could braid them together. More affirmative responses are likely, from a smaller group. Finally, that facilitator asks group members whether any of them have experienced or witnessed the braided twigs being dipped in water prior to the punishment. At this time, it is likely that many of the group members will feel uncomfortable and begin to understand a vague connection, or perhaps an obvious one. One of the facilitators then inquires what the soaked twigs resembled. A group member may answer, “A whip.” The next question is, “Where did this particular practice originate?”, and the answer is, “Slavery.” This purposeful storytelling and dialogue establishes a foundation for the later introduction of Posttraumatic Slave Syndrome (PTSS), as well as making connections between how group members were disciplined as children, and perhaps how their parent(s) were disciplined by their grandparent(s), and so on. Facilitators then discuss the Willie Lynch Letters of 1716 (Lynch, 1716) along with the questions about the validity of those letters and the reasons for their creation. Group members are educated about how the Lynch letters created a “formula”—a scientific plan and method for creating and maintaining a slave. The purpose of this “scientific” methodology was to increase production and reduce economic losses for White slaveholders, as well as to enable Africans 180
  • enslaved in America to unconsciously be “trained…[so they] could train other slaves (p. 8).” One of the main premises of the Willie Lynch Letters is the psychological and physical regime of “beating” African males into submission. African women often were led and taught to “beat and scare” their African boys into submission, thereby splitting Africans, based on gender, skin tone, and age, who were then enslaved in the United States, as a whole. The term internalized oppression is introduced and examples are provided of how external oppression is the unjust exercise of authority and power by one group over another (Akbar, 1996), it includes imposing one group's belief system, values and life ways over another group. External oppression becomes internalized oppression when we come to believe and act as if the oppressor's beliefs system, values, and life way is reality. "Self- hate" and "internalized racism" are other ways of saying internalized oppression. The result of internalized oppression is shame and the disowning of an individual’s cultural reality (Akbar, 1996). Activity: “My African-ness” Facilitators educate the group on the effects internalized oppression and how it is currently reflected in gang violence, domestic violence, “black-on- black” crime, child abuse, and the number of incarcerated African American males in the United States (Akbar, 1996). One facilitator creates a flow chart to elicit examples, as follows: historical event  psychological or other possible reason  personal/familial/societal example  usual response  181
  • example (offered by group member)  consequence to the community, family, or self (because of the intergenerationally transmitted belief). The following is one example of how this flow chart might be filled in from a specific example. Flow chart event Example Historical example  Slave mother beating her young slave son for “stealing” an extra piece of fruit from the basket for the Master’s family  Psychological or other possible reason  Fear of her child being “disciplined” and ultimately murdered and/or lynched by a slaveholder  Family example  Recreated and passed down practice where a current parent uses excessive “discipline” to consequence their child; underlying fear that the child will be “made an example of” or “make the family look foolish,” or a police officer will “discipline” or murder the child  Usual response  Perceived “unloving and uncaring” females or mothers who are “belittling, nagging, vicious, loud, and excessive in force.”  Consequence to community, family, or self  African American male–female dynamics and intimate relationships may suffer due to this intergenerationally supported belief system, which was created by a structure of slavery. Following the psychoeducational component, facilitators lead a rigorous group process. To begin a dialogue about PTSS, members are provided with various questions from Leary’s (2005) publication on PTSS: • Have you ever heard of the term Post Traumatic Slave Syndrome? • What does the term bring up for you? • Do you believe that anyone you know is affected by PTSS? • Do you believe that you are affected by PTSS? 182
  • • Based on our discussions and activities in Session 5, and on today’s group process, do you believe that PTSS has impacted members of your family? • How has it been transmitted? • Who or what has been responsible for transmitting it intergenerationally? Facilitators complete the session by discussing PTSS further and providing ample time to process the fears of some of current behaviors (e.g., beating children with switches, distrust of fellow Black professionals, family members’ concerns with how “light or dark” a baby is upon birth, etc.). It is essential for facilitators to ensure that the therapeutic container is sealed with a sense of community, safety, and identification amongst the group members. These foundations of group therapy do not have to be communicated and created solely through traditional psychodynamic methods of reframing and projection; rather, the frame and foundation should allow free expression in the form of healthy and safe anger, stories, spoken word verses, song, and any other method that is healthy and will maintain the free association between the participants’ anger and disbelief at slavery and its connection (in a tangible way) to their upbringing, families, and above all, their own behaviors. It is important for the group members’ and facilitators to maintain conscious awareness of how difficult the process of realization can be and how painful it may be for group members to reopen very old wounds. 183
  • The connection between slavery and members’ own behaviors is deepened in the next three sessions, in which Vacant Esteem, Rage, and Internalized Oppression are discussed. Session 7: Shame and Vacant Self Esteem: “The Child Within” Purpose/Rationale Session 7 focuses on the battle between group members’ sense of value and worth, and the feeling that deep down there is “something wrong with them.” Grounded on Leary’s (2005) manifestation of PTSS and Vacant Esteem, this session also delves further into the psychological symptomatology of shame and the near-universal feelings of shame among survivors of abuse and trauma. Vacant esteem is the state of believing oneself to have little or no worth (Leary, 2005). Vacant Esteem is often exacerbated by a societal and group pronouncement of inferiority and is often is the result of three aspects of influence: society, community and family (Leary, 2005). More important to this program, however, is how shame seeps into the fabric of the psyches of African American male youth and alters their sense of worth and consciousness, creating a trauma-induced reaction (Akbar, 1996; Abdullah, 1994; Gardner, 1999; Eyerman, 2001; Leary, 2005; Horowitz et al., 2005). There are many reasons why children and adolescents (and later adults) hold themselves responsible for traumatic event(s), of importance for this program is how a plegthora of African American male youth residing in the inner city often feel a deep sense of shame and blame for actions that are outside of their control (Canada, 1998; Leary, 2005; Boyd-Franklin & Hines, 1996). 184
  • Victims of intergenerational and interpersonal trauma can have a limited sense of trust and comfort in others, making intimacy difficult and even nonexistent (Foa et al., 1999). Furthermore, intimacy with oneself can be another difficult barrier to self-love and self-growth for adolescents who have been exposed to significant trauma. Within the frame of Post Traumatic Slave Syndrome, the current generation often struggles with understanding how the manifestations of PTSS affect their self-concept and self-esteem in overt and covert ways; over time, the experience of repeated traumatic stressors becomes normalized and incorporated into the cultural expression and expectations of successive generations (Danieli, 1995; Leary, 2005; Mims et al., 2005). The activity and group process in Session 7 are designed to help the group understand that the traumas inflicted on their ancestors, grandparents, and parents —and now on themselves—were not their fault (Akbar, 1996; Latif & Latif, 1996). Being treated like a criminal when shopping in a store is not their fault. Being pulled over while driving the speed limit with a seatbelt on while wearing a doo-rag is not their fault. In this session, reasons why they may feel responsible for various traumas within their family and community are identified and addressed. This model is based on the assertion that when shame and poor self- concept are kept a secret, they gain power over the person; however, admitting shame is the first step in deflating its power (Davis, 1990). Goals • Help group members acknowledge the link between historical and personal history and current attitudes and behaviors. 185
  • • Help group members acknowledge, recognize, and begin to let go of guilt and shame. • Help each member identify how he has come to understand and deal with issues of self-concept and feelings of worthlessness. • Explore the concept and manifestation of Post Traumatic Slave Syndrome and ways to survive with vacant self-esteem. • Improve members’ self-esteem and self-empowerment, and instill hope. Group Process Prior to discussing Vacant Esteem, one of the facilitators utilizes a mixture of psychodynamic theory and CBT techniques in an exercise that encourages members to assess their own self-image and self-worth. Leary (2005) identifies healthy self-esteem as the result of an accurate and honest assessment of one’s worth, with worth being the degree to which one contributes (spiritually, intellectually, emotionally, and materially) and improves one’s life in the process. The facilitators provide psychoeducation on Vacant Esteem and the affects and manifestations on their self concept and behaviors. In this exercise, the facilitator asks one of the members to come up and stand in front of a large mirror. The facilitator begins to ask the young man a series of questions that opens a dialogue with himself related to his self-image in relation to his goals, his contributions to his own successes or lack thereof, his contributions to his family, contributions to his community, and in general, his willingness to accept responsibility for his actions no matter how difficult that 186
  • may be. This therapeutic dialogue that should begin to open his level of emotionality. The facilitator asks the youth to look in the mirror in silence after answering some of these questions after asking the young man to look at himself for 20 seconds: • What do you see? • Who do you look like? • How healthy or unhealthy is your self-esteem? • What is your worth? • How do you see yourself? • How do you feel others’ see you? The other facilitator begins to discuss the process of measuring one’s beliefs about self-value. After the young men have each stepped in front of the mirror, one facilitator introduces the term En Lak Ech or In Lak’ech, which can be translated from Nahuatl as “The other me” or “I am you, You are Me, and We are Us (Duran, 1996; Foor, 2004). The group discusses what they understand the Mayan term In Lak'ech to mean based on the definition provided and why this term was introduced during this lesson. The facilitator explains that the greeting is an honoring for each other and a statement of unity. In Lak'ech mirrors the sentiment of other beautiful greetings (e.g., Namaste for East India and Wiracocha for the Inca), but goes beyond these other unity statements. In Lak'ech is a moral code— it is a way to live, not only with human beings, but also with all forms of life in the cosmos. As a statement, it signifies that people are mirrors of one another and 187
  • that what our family and society reflects onto us, we reflect onto it, and hence into ourselves. The facilitator begins to provide examples of how individuals arrive at their self-esteem: first, as a result of the appraisals of the significant others in their lives; then, as a result of having their contributions and efforts recognized; and lastly, as the result of the meaningfulness of their own lives. The group begins to discuss the ways in which they were given little responsibility and great praise, or received little appreciation for the extent of their contributions, and so on, and how this experience may have affected their belief in themselves as having little to no self-worth. Facilitators continue providing appropriate prompts and restatements as the members discuss various instances where Vacant Esteem is present in the behaviors and attitudes in their own lives, and that of their friends, families, and community. Examples may include community standards and values regarding acceptable behaviors, educational attainment, unexamined child-rearing practices, undermining the achievements of other African Americans, suicide in the form of Black-on-Black crimes, feelings of responsibility for the entire community, and higher interest rates on homes and auto loans. These are all examples of contributions to the formation of vacant esteem in that they frequently display African Americans as having disadvantages and being academically deficient, sexually irresponsible, and criminal (Leary, 2005; Akbar, 1996; Mims et al., 2005). The examples provided above should be processed and teased out with the group members, encouraging the use of new examples, in their own lives’. 188
  • Activity: “What I Like About You” One facilitator starts a list on a large easel paper entitled: What I Like About Being African American. Group members go around and identify various traits and characteristics that they like related to being African American, from music, to family, to community—anything goes. The purpose is to begin to create a working list of healthy attributes, coping skills, and traits that the Black community encompasses, as opposed to discussing what is not healthy or enjoyable. At the end of Session 7, warm group members to “be prepared to create and get messy!” when they come to Session 8. Session 8: Healing Rage: “Taking the Mask Off” Purpose/Rationale Session 8 focuses on why anger is such a large part of the experience of most African Americans, and why the young men in the group are “so angry.” It is important for the group members to understand that anger is usually in response to frustration at a blocked goal, and that one of the most significant blocked goals for African Americans (according to Leary, 2005) has been lack of acceptance and full “community integration into greater American [U.S.] society with all of the rights, responsibilities and privileges concomitant with membership” (p. 136). A very lasting rage is present among African Americans, especially due to the multitude of lies that have been perpetuated about equality, slavery, fair and equal access, inclusion, being free, civil rights, fair housing, education, and jobs, to 189
  • name a few (Grier & Cobbs, 1968; Akbar, 1996; Eyerman, 2004; Leary, 2005; Mims et al., 2005). Additionally, slavery was a brutal and violent process that stripped many human beings of their free will, families, culture, and physical bodies. The psychodynamic therapeutic focus of this session is for the participants to understand that this group allows and provides a container for their rage—this group is giving them permission to rage, permission to find healthier outlets, and permission to begin to notice when utilizing those outlets is necessary. Traumatic experiences change how people regulate their affective impulses, which often appear as problems in controlling anger and self- destructiveness (Silverman et al., 2008). In victims of repeated trauma, symptoms include mood lability, relational instability, and impulsivity van der Kolk, 1996). Individuals who were victims of long-term abuse often deal with altered perceptions of the self, chronic shame, and guilt (Herman, 1992). Often, victims blame themselves, feel hopeless and helpless, and even overestimate the dangers in the world, which leads to feelings of anger, abandonment, and self-loathing (Foa et al., 1999). According to Ruth King (2004), “trauma gives birth to rage, as an experience of severe emotional shock that causes substantial and lasting damage to our psychological well-bring” (p. 4). As King (2004) asserts, rage is naturally born in the face of trauma, but becomes problematic when vulnerability goes unaddressed, with a cumulative effect on development as the person matures. Utilizing slavery and the intergenerational transmission of trauma as the lens for the therapeutic treatment 190
  • of African American adolescent males in the inner city, the group members’ may be better able to connect their sense of rage with the manifestations of powerlessness, inadequacy, and countless generations of trauma and rage. Goals • Help group members acknowledge the link between historical and personal history and current attitudes and behaviors. • Help group members name, recognize, and begin to honor their rage children. • Help group members identify what goals have been blocked in their lives. • Explore the concept and manifestation of Post Traumatic Slave Syndrome and ways to survive with ever-present anger and rage (as defined in this program). Group Process After the usual check-in, the facilitators begin by asking the group, “Are Black people inherently angry?” Members begin to provide feedback, examples, and intellectual reasons for why African Americans are perceived to be “so angry.” The facilitators then pose the question, “What is the difference between anger and rage?” Again, members provide examples from interpersonal disagreements to intergenerational legacies of rage. Then, one facilitator begins to provide psychoeducation on the PTSS manifestation of Ever-Present Anger and on rage. As the group members offer a 191
  • round of responses, the other facilitator begins to prepare the supplies for the activity. Activity: “Birthing Our Rage Child” Facilitators set out the following materials: plaster for making casts, sheets of newspaper, Vaseline, scissors, paints, old clothing, towels, bowls of warm water, and face wash. Sheets of newspaper are laid out to protect the floor. In this session, members make a mask that is a representation of their inner anger which is usually derived from early childhood trauma, as King (2004) identifies as an individual’s inner rage child. Facilitators play background music to evoke feelings related to members’ rage children, in soothing tones. A facilitator asks the group to join in dyads by choosing another member they feel comfortable with and would possibly like to get to know better. The pairs are told to stand in front of a station. The station would consist of newspaper laid on the floor, a bowl of warm water, cut strips of plaster, Vaseline, a towel, and a pen and paper. The facilitators ask the groups of two to choose who goes first as the creator (the one having the mask made) and who will be the helper. The helpers coat the creators with Vaseline over all the hair areas on the face and hairline, and remove any jewelry. The Vaseline is used so that when the plaster masks are hardened and ready to remove, they can be removed more easily with Vaseline over areas on the face with hair, The facilitators name the three rules necessary for the birthing of the rage children: (1) safety, (2) comfort, and (3) communication. Each pair chooses a sign indicating discomfort or feelings of being unsafe, such as lifting up a fist to 192
  • indicate that they need the mask removed immediately, as well as a sign showing good feelings, such as making a peace sign to indicate that they are feeling good. The helpers proceed to create paper-mache masks on the creators’ faces. Prior to the mask setting process the pairs discuss whether they would like their eyes “open” with no plaster covering, or whether they would prefer them closed and plastered over; as well as whether their mouths and nose areas will be open or closed. All the details of their masks will be discussed and should be honored. Once the masks are complete and set aside to dry, the creators use the face wash and then the pairs switch roles to make the second mask. Throughout the mask-making process, the facilitators gently come around checking on each team and ensuring that the process is relaxing, safe, and full of healing. As the process ends, each pair is asked to walk over to a quiet and comfortable area of the room and begin to journal write. After a free write of five minutes the following questions are asked by the facilitators orally so the participant can write about it in their journal. These questions are from Healing Rage (King, 2004): • What is your rage child’s name and age? • Where does he typically live in your body? • What circumstances provoke him? • When does he make himself known? • What is his most common story or mantra? • What does he want you to know? • What does he want you to do for him, specifically? 193
  • Additionally, the facilitators gently and softly remind the group to acknowledge that rage is tied to the need for self-compassion and to longing to be free from suffering. As Ruth King (2004) so eloquently states in her book, Healing Rage, “The deeper truth that wants to be revealed is in the expression of pain and shame we have hidden, inherited and passed on, and that we are now called upon to dignify” (p. 119). The completed masks are laid out to dry over the week. After the clean up and journal writing the group members return to group and briefly identify a current feeling and their experience with their partner. There should be special attention paid by the facilitators to the process of intimacy, friendship and trust. The group should process for roughly 15 minutes prior to leaving. Session 9: Race & Internalized Oppression: “Loving You is Loving Me’ Purpose/Rationale Session 9 provides a comprehensive look into the lives of the group members and their communities, to examine one of the most insidious symptoms of Post Traumatic Slave Syndrome: how the slave master’s value system has been adopted unconsciously. The manifestations of racist socialization include beauty standards, individualism, success, material wealth, violence, and brutality (Latif & Latif, 1991; Akbar, 1996; Leary, 2005; Mims et al., 2005). It is not uncommon for people being held captive to take on the attitudes and views of their captors, and even to identify with their tormentors, under extremely stressful situations (Leary, 194
  • 2005; Garbarino, 1999). Additionally, victims who spend extended periods of time with their perpetrators can end up taking on some of the beliefs of the perpetrator, as when children who grow up with antisocial parents take on their parents’ antisocial behaviors (Garbarino, 1999). Session 9 focuses on a comprehensive look at racist socialization. Through extensive questioning, utilizing the group as a vehicle for change and reflection, this session requires members to look in depth at family systems, personal choices and coping mechanisms, stresses and strengths, and their overall acclimatization to their milieu from generation to generation (Leary, 2005). Goals • Help group members acknowledge the link between historical and personal history and current attitudes and behaviors, as related to PTSS. • Help group members begin to name, recognize, and acknowledge internalized oppression. • Help group memebrs identify the microaggressions of racism and prejudice in their psyches. • Explore the concept and manifestation of Post Traumatic Slave Syndrome. Group Process “Can I get a witness?” is often a call for being seen and heard, and is essential in the African American community. Having a group of like-minded people is fundamental to being raised in a community-focused culture, as often 195
  • occurs within churches in African American communities. However, the group witnessing process can occur in Sister/Brother Circles, in support groups, and in family functions, as well as in therapeutic groups. In this program, group cohesion is developed during the psychodynamic group framework of asking other group members whether they can identify with the person speaking or emoting. This practice ensures a sense of community, universality, and being seen (which is necessary in groups where individuals have experienced trauma), and allows the healthy and natural expression of strong emotion (Yalom, 1995). Session 9 is centered on the “forming” phase of group (Tuckman, 1965; Yalom, 1995) where the members have begun to flush out conflicts, express criticism constructively, and accept membership within the group. Harmony is achieved as some conflicts have already been processed, there is more friendliness and confiding in one another, a sense of team cohesion is present, spirit and goals are being shared, and boundaries are being maintained and established. The facilitators begin the group process by asking members the following discussion and reflection questions for the next thirty to forty minutes in the larger group: • What values do you place on the following: skin tone, hair texture, and facial features? • Are you satisfied or self-conscious about any of these areas? • What value did/does each of your family members place on skin tone? • What value did/does each of your family members place on hair texture? 196
  • • What value did/does each of your family members place on facial features? (For example, some individuals place a higher value and consider a person “beautiful” if they have light colored skin, as opposed to darker-colored skin, or place more value on skin tone as opposed to eye color and facial features.) • Which of the following did/do you and each member of your family engage in as a means of coping with the daily struggles of life? Consumerism Alcohol and drugs Prayer or religious spiritual activities Mental health counseling Sex Friends and family for support Other After the larger group process questions one of the facilitators should ask the group to state one thing the y realized because of this group that they had no realized previously. Sharing should take roughly fifteen minutes prior to the activity that follow below. Activity: “Creating My Handsome Self” In a continuation of the Session 8 activity, “Birthing Our Rage Child,” group members continue the creation of their Rage Child masks through creative art expression. Facilitators ask the group to review their thoughts and journals entries on the Session 8 questions regarding their rage child. They ask members to begin to think about the following two aspects of their Selves: (a) Who are you? (b) How does the world perceive you? What do you show the world? 197
  • To exemplify their answers, participants create and express their inner rage child on their masks through painting, creating collage, drawing, and so on. The inside of the mask depicts who they are, and the outside of the mask shows how the world sees them. The artistic process may include any of the above areas discussed in prior group sessions, but particularly this session as it pertains to racist socialization and internalized oppression. Facilitators conclude the session by asking the group, “If I healed, I would be giving up…” The purpose of this open ended projective psychodynamic statement is to allow any unconscious emotional material to arise. Some sample responses may be, “If I healed, I would be giving up my manhood/ my family’s respect/ my knowledge of racism and slavery.” Phase 3: The Healing “A healing ritual changes a person from an isolated (diseased) state to one of Incorporation (health) … In the transformation from one state to another, the prior state or condition must cease to exist. It must die …to be reborn.” (Allen, 1986, p. 80) Phase 3: The Healing establishes the foundation for the question, “Where do we go from here?” In this phase, a conceptual framework is laid in a therapeutic manner that is respectful to the indigenous soul wound healing process (Duran, 1996) outlined in the literature review. Phase III: The Healing is centered on creating the change necessary for the group members to begin a positive and healing transformation. The interventions and group process will be focused on many of the culturally appropriate forms of healing discussed in the 198
  • literature review. This change is discussed through a careful assessment of how African Americans have been impacted and affected by Post Traumatic Slave Syndrome and learning how to gradually replace past maladaptive behaviors with healthier ones. Change will be discussed through culturally appropriate methods that allow the adolescent African American males to find their own comfortable balance between indigenous healing traditions and urban modern forms of expression and ritual (Danieli, 1980; Copping, 1996; Duran, 1996; Brave Heart, 1996, 2003, 2004; Leary, 2005; Mims et al., 2005). The ultimate goal of Phase III of the model program proposed is to help set the young men of the group on a healthier road to success and physical, emotional, and spiritual well-being. The Healing, will allow the survivors of the intergenerational transmission of trauma that is slavery, to set the pace, rate and direction of their healing journey. The healing will be holistic and include the spiritual dimensions of healing, as well as continue to address the intergenerational effects of removal from Africa to the Americas. Phase III is intended to be more of the healing component of the program, rather than “therapy” or a “treatment.” The purpose for the healing component is to allow a reconnection to occur between the disconnect of the youth from their culture, bodies, and psyches that has been intergenerationally passed down to them to the reconnection and reclaiming their identity and self again to eventually arrive at a place of peace and strength, instead of externalizing behaviors that are unconsciously raging at the world to scream “PAY ATTENTION WE ARE DYING!!” 199
  • Phase III: The Healing, will begin the process of excavation and focus on reconnecting the youth to their self-esteem, truthfulness, knowing oneself, not fear telling their stories, being healthy, taking control of their inner world, having an awareness and a healthier perspective of racist socialization, building upon past and present strengths’, healthy modeling, and continuing healing work in a supportive holistic and culturally contained mental health frame. (Danieli, 1980; Davis, 1990; Herman, 1992; Yalom, 1995; Copping, 1996; Duran, 1996; van der Kolk, 1996; Levine, 1997; Brave Heart, 1996, 2003, 2004; Foor, 2004; Leary, 2005; Mims et al., 2005). Some of the goals for Phase III, as previously stated, would be: • Help the client acknowledge the link between historical and personal history and current attitudes and behaviors. • Empower the use of spiritual and or nontraditional forms of healing, such as prayer, reiki, meditation, mindfulness techniques, body work, to name a few. • Bring about clarity about the ways to begin the process of change, growth, and ultimately “healing.” • Promote healthier lives for the group members. • Bring about clarity about ways to begin and sustain the process of change, growth and ultimately ‘healing.” Session 10: Trauma & Inter-Connectedness: “Healing Our Inner Children” Purpose/Rationale 200
  • Session 10 begins the process of creating a climate of revival and change. This program is based on the belief that it is vitally important to understand the mechanisms by which practice (i.e., African Americans’ lives, today and in the past) and identities (i.e., the ways African Americans interpret themselves and their positions in the world outside their communities) are linked with past events and past experiences (Latif & Latif, 1996; Leary, 2005). Understanding the link from past to present may be helpful for the healing process within African American people to regain lost social and cultural selves—much more so than simply finding a handy definition for the underlying fabric of these identities and practices (Mims et al., 2005). Since the urge to resolve trauma through re-enactment can be severe and compulsive, Session 10 allows participants to connect the manifestations of Post Traumatic Slave Syndrome that replicate the original intergenerational legacy of trauma, in both obvious and non-obvious ways. The group members discuss how re-enactments may be acted out in intimate relationships, work situations, repetitive accidents, and other random events, as well as appear in the form of bodily symptoms or psychosomatic diseases (Levine, 1997). During this session, participants learn more about survival knowledge in other cultures, and how behaviors that are as powerful and compelling as re-enactment fall into a category of “survival strategy” (Levine, 1997). This session confirms for the group that instinct and insight are two separate processes, and that instinct may be more governed by trauma and therefore create unhealthy re-enactments. The Session 10 activity consists of building upon members’ strengths and preparation for the 201
  • future through both psychodynamic and cognitive behavioral inquiry into cognitive distortions, as well as via a creative outlet to connect the past with the present. Goals • Help group members acknowledge the link between historical and personal history and current attitudes and behaviors. • Empower the use of spiritual or nontraditional forms of healing. • Understand and review Cognitive Distortions and identify those most frequently utilized. • Bring about clarity regarding ways to begin and sustain the process of change. Group Process After the initial check-in, the facilitators review and begin to process the past 10 weeks of sessions. They introduce Phase 3: The Healing and provide process-questions centered around managing stress and conflict, building upon personal strengths, and truthfulness. The facilitators inform the group that the goal of the session is the establishment of healthy and accurate self-esteem, and then lead a discussion about identity, ways that young Black men preserve their identity, trauma re-enactments, and survival. The discussion begins with the manifestations of PTSS—namely Vacant Esteem, Ever Present Anger (Rage), and Racist Socialization—and how these continue to “play out” in reality. The concept of being “disrespected and played” 202
  • is discussed so that the participants can dialogue about what is deemed “off limits” and what the usual reactions and consequences are to “being dissed.” The discussion flows to the following questions related to healing within participants’ lives. Knowing what you know now after the past ten weeks: • What has the ability to make you “snap?” • What is your interpretation of racist remarks and how would you handle them? • What in your family legacy is perpetuated (related to disrespect) that reminds you of what you have learned about slavery? • How well do you manage stress in your life? Does being “played” bring out a larger reaction when you are stressed? • Considering your coping strategies, are there things you can do to better manage stress in your life? • Given the effects of racist socialization, which of your beliefs and behaviors will you retain or discard? Facilitators then proceed with the activity involving Cognitive Distortions. Activities: “Distorting My Truth” Participants break up into four small groups and facilitators begin to write Cognitive Distortions listed below, on the large post it board. • Probability Overestimations • Mind Reading • Personalization • “Should” Statements • Catastrophic Thinking 203
  • • All-or-Nothing Thinking (a.k.a. - Black-and-White Thinking) • Selective Attention and Memory • Negative Core Beliefs • Magnification • Discounting the Positive • Confusing “Needs” with “Wants” • Confusing “Choosing To” with “Having To” • Can’t Stand-it-it is Magical Worry • Confusing Relying with Depending • Confusing Inability with Unwillingness • Confusing Possibility with Probability • Projection • “Gut” Thinking • Jumping to Conclusions Each small group is given their own large piece of easel paper. Each small group member writes out one insult, or a time or moment when they had the feeling of “Going crazy” or “wanting to snap/bust out on someone.” Ask the groups to be specific and identify moments that could change (or that changed) their lives and their safety in an instant. They may write a word, a phrase, or a short specific event in one sentence, for example, “You are a punk! You aren’t gonna do anything, PUNK!” For many young African American males, this statement has been and can be enough to kill another man. The facilitators are asking for the unconscious underlying processes to surface by insinuating that these statements strike at the core of a youth’s fragile sense of self and manhood, as well as esteem; disrespect is lodged in the cultural consciousness, to be expected and ready to be defended (Leary, 2007). The facilitators then ask group members to identify which of the cognitive distortions from the worksheet fit best with the reaction to the behavior that they 204
  • created or have experienced. Each group is working on this on their own. Continuing with the above example, a small group might generate the following: Trigger statement: “You are a punk!” Reaction: To fight or curse and escalate Cognitive Distortion: Magnification and Gut Thinking Body Response: I feel the rage in my stomach and it makes me sick. Healthier Reaction: To question where the rage is emanating from—“My father used to tell me I am a baby and a ‘girl’ when I cried. I might actually be having a reaction to that.” The facilitators call the group back to the larger process circle, to discuss perceived disrespect and the way events are internalized somatically, emotionally, and spiritually. Issues of respect and disrespect are then discussed as central to the African American experience. The facilitators briefly educate the group further on their history as a people experiencing hundreds of years of slavery, Jim Crow, the Klan, lynching, police brutality, and murder, and on the ways these events could —and do—influence perceptions of respect and disrespect. The facilitators articulate with the group the relationship between the strength of the impact of Post Traumatic Slave Syndrome on an individual and community, and increased likelihood of a person in that community responding in a way that will not be in his best interest, whether that be violence, depression, or suicide (Akbar, 1996; Mims et al., 2005; Leary, 2005). These responses should be processed within the larger group, making the point that the negative consequences of the PTSS 205
  • manifestation reaction can and will momentarily outweigh one’s sense of justice. In other words, that it is often difficult not to react to negative and often disrespectful behaviors in the moment. After the usual checkout, the facilitators offer an optional Home Activity: Create a Vision Board/Collage. Members create a collage of what they each envision “Brotherhood” full of respect to look like as they evolve and get older. They can cut out pictures, quotes, phrases, and any statements supporting this sense of camaraderie, love, and support between themselves and other Black males, and then (if they wish) bring the results to the next session to share and process. Session 11: Honoring Traditions: “Re-Creating Your Village” Purpose/Rationale Session 11 summarizes and identifies the healing work group members can do to promote healthier lives. This healing work can incorporate the numerous techniques and interventions learned and utilized in the previous phases. In this session, the shift toward wellness slowly and gradually begins include supportive family members, friends, and members of the community who will help reinforce the growth and sustainability of this program. In traditional African culture, the family is extended to embrace both blood and non-blood relatives, and West African culture has a foundational belief in a collective social network as well as a strong belief in common ancestry (Leary, 2005). Therefore, 206
  • a popular African proverb states, “It takes a whole village to raise a child,” which translates to it also taking a whole village to raise and preserve a family, teach customs, and offer protection, guidance, and modeling. Goals • Help group members acknowledge the link between historical and personal history and current attitudes and behaviors. • Specify ways to begin the process of change, growth, and ultimately “healing.” • Promote healthier lives for the group members and their communities. Group Process After the usual check-in, the facilitators begin to discuss community as it relates to the African American community, asking for examples of the meaning of support. They begin to discuss the word village to describe the individuals who constitute a team of people that will remain part of a member’s special supporters throughout his life. A member’s village residents are a reflection of him, and are likely to be as committed to their own personal growth as he is to his. The facilitators then discuss individualistic (e.g., U.S.) cultures versus collectivistic (e.g., African) cultures. Connection and family are discussed and the group revisits their Phase 1 discussion of family in the context of trauma and the biological (or court-mandated) family system. Within this context, the members discuss family and whether the therapeutic group has become a healthier family constellation. This is a time for the psychodynamic container to provide solace, camaraderie, unity, and hope, and 207
  • highlight the universality of issues between the participants. Trust and empathy are being displayed during this group session. Activity: “Identifying Your Village” This exercise requires the group members to begin to think about their community, families, friends, and self as a healthy, supportive presence in their lives. Participants are asked to make their village from any people who support their commitment to personal growth and the achievement of their goals. The goal is for the members to identify what areas in their lives need more growth and support, and then identify the human resources necessary to help achieve that growth. In their village, each member names a person (or, hopefully, people) in the following roles, which are adapted from Dr. Leary’s (2005) PTSS publication (p. 48). Parents: Individuals who represent parental figures in your life. Mentors: Individuals who act as teachers and advisors. Educators: Individuals you go to who understand the subjects close to your heart in a manner that helps you unravel their meaning. Counselors: Individuals who provide personal and sometimes therapeutic guidance. Spiritual Supporters/Advisors: Individuals who provide guidance through methods like meditation, prayer, and so on. Health Advisors: Individuals who advise you about general health. 208
  • Confidants: Individuals with whom you speak in confidence about your deepest thoughts and feelings. Motivators: Individuals who encourage and inspire you in various aspects of your life. Defenders: Individuals you can call on for protection, who can protect you from physical and emotional harm. Advocates: Individuals who support and promote you, privately and publically. Preparation for the Termination Group (Session 12) The facilitators leave time at the end of the group to process the upcoming termination group session and provide an outline of the itinerary for Session 12. The group members are asked to invite family, friends, and community members who are part of their “Village” to attend the final Session. Group members are explicitly told that the circle of trust will be “opened up” to the Villages they have carefully selected and some of their stories will be entrusted to those Villages. Facilitators explain that the cultural community share is completely optional and that brining family or community is optional if they feel unsafe. Additionally, for the final session group members are asked to present a token of their appreciation and an offering to the group and their fellow members by utilizing one of their strengths to communicate their feelings about the 12-week, 3-phase process of healing the intergenerational soul wound. Their offerings can be expressed in any medium: monologues, stories, memoirs, poetry, Spoken Word, skits, drawings, collages, songs, and so on. 209
  • Session 12: The Spirit of Community: “Telling Our Stories” Purpose/Rationale Session 12 explores the healing aspect of “the village” through a celebration, a “coming out party” of sorts. The group members have begun the process of understanding their historical pain, the manifestations of the intergenerational transmission of trauma, and now the daunting road ahead. To help these young African American males growing up in the inner city who have and currently do experience trauma, this program has offered many healing modalities, including psychodynamic therapy, cognitive-behavioral therapy, group therapy, dialectical behavior therapy, and drama and art therapy, just to name a few. All these modalities have proven effective in helping people who experience learned helplessness and vacant esteem, and who possess an external locus of control. In this program, these healing modalities have been reworked to deal with socially transmitted, albeit muted, memories of trauma and despair. The key to this program is that the community mental health workers and healers (i.e., facilitators) remember to address the whole spectrum of conditions associated with the responses to the intergenerational transmission of trauma. Session 12 identifies the importance of community and of openness to culturally appropriate avenues for producing change in existing memory structures, to allow African American males to regain their collective strength. Healing for this model requires deconstructing the terrible legacy of the past, and paying close attention to the dialectical interplay between what has happened to 210
  • African people and how they have interpreted and continue to interpret that experience (Morrisseau, 1998; Hicks-Raye, 2004). This program, as a healing modality, seeks to restructure the past and reconnect participants to the present, to empower, to incorporate, and to help heal participants from fear and despair. In this session, facilitators reiterate that healing is a process, and that the therapeutic safe container that was provided by the group for the 12 sessions will continue in the “villages” the participants identified in Session 11. Session 12 models healthy “good-byes” and empowers the group members to model healthy and concrete farewells to one another, meanwhile connecting the safety of the group with the trust that will grow in the villages they are creating in their communities. Goals • Connect group members with self, family, and community. • Empower healthy family systems and communities. • Utilize nontraditional and/or Indigenous methods to bring about healing. • Specify ways to begin the process of change, growth, and ultimately “healing.” • Promote healthier lives for the group members and their communities. • Empower group members to be heard and seen for who they are. • Model and engage in healthy closure and group termination. Group Process 211
  • Before the usual check-in, the facilitators acknowledge that today is the last session for the program and group. The feeling check then relates to the emotions arising related to moving on and saying good-bye. The facilitators should expect to process emotions such as abandonment, sadness, regret, anger, and numbness, to name a few. Facilitators acknowledge the hard work involved in re-examining one’s behaviors, thoughts, and ways of speaking to one another, treating one another, and showing (or not showing) love. Then the family, friends, and community members are invited to enter. Facilitators provide a brief summary of the program and a brief overview of the three-phase process and the members’ level of commitment in examining their trauma, their legacy of intergenerational trauma, and their specialized plan of healing. Village members are educated on how difficult it is to retrain and reconceptualize what is ingrained and automatic, to move toward a more natural, relaxed way of living. They are told that the work ahead requires that the young men question some of their reactions and behaviors towards healing parts of their history, community, family and themselves. Village members are asked to examine how they support and question each other’s achievements, and asked to be elated and encouraging of the young men, rather than critical. Facilitators encourage the guests to reexamine how we raise our children and defend ourselves from real or perceived insults, and to lead with wisdom and integrity, rather than with habits born from our fragmented past. Each guest is honored with a small token (a poem or a pin) to indicate that they have been named by one of the group members as part of his family and 212
  • Village. A brief story is provided that illustrates the importance of their role, the specifics of that role, and the importance of their modeling and guidance to the youth. The group member requests the person’s specific support (i.e., “Will you stand as my Spiritual Advisor in helping me lead a life where I can commit to my Self?”). The guest can accept or decline the request, and love is shared. Activity: Celebration Itinerary 20 minutes Feeling check-in and processing of termination and final session 25 minutes Honoring the Person Exercise: Each group member stands in the center of the circle while the rest of the group begin to “witness” and call out the wonderful attributes that the young man encapsulates. The individual in the center is asked to “hold” all of the positive qualities and intimate moments that have made them a trustworthy group member and brother. 40 minutes The Village Listens: The young men begin to share their offerings (as described in Session 11). Whether their offering is a song about their trauma, a rap about the streets, a quote and monologue about slavery and the intergenerational wound, a painting about the therapeutic container and Brotherhood, or an art piece painted and collaged with stories of their ancestors, every member of the group is Witnessed and Heard. No questions are asked, and every 213
  • member of the Community is asked to “hold the space” and reminded, “Whatever is said in the group stays in the group.” 20 minutes The Honoring: The Village members are asked to say a few words supporting the young men and their journey. 30 minutes CELEBRATION! Food is shared, music is played, and everyone dances. The Cha Cha Slide is a must. In unity with community, with ritual and through dance and song, the young males exit the rite of passage and are better prepared to increase their capacity to love themselves and their fellow Brothers. Aftercare Recommendations Once the group members have finished the recommended 12-session CFCJ program, and the required post three sessions of individual therapy are underway or completed, they enter the Aftercare phase. Should the youth continue with individual therapy, follow-up regarding the CFCJ work is specifically are advised as part of the larger treatment plan. After the structured section of the program is completed and the youth is engaged in regular individual therapy, it is recommended that the therapist check-in regarding the affects and particular matters regarding their CFCJ work. The therapist may ask questions related to the trauma related material that arose during the CFCJ model program sessions, as well as issues related to racism, internalized oppression, vacant esteem, and rage. 214
  • These topics, would likely be regular areas of process during the individual sessions, however suggestions would be provided to therapists who are outside of the referral network, as well as consultation with the co-facilitators, should the youth agree to the consultations, and always with a consent to release information form. Additionally, when the need arises, the therapist may want to reiterate the main tenants of the CFCJ intervention program, recalling with the youth, what they had identified as areas of distress, and continue to work with the Phase III: The Healing aspects of the program. Finally, the CFCJ model program will coordinate, upon participant interest, Reflection Groups. The Reflection Group would be held once a month to continue to provide therapeutic continuity; a healthy continued connection with the co-facilitators and fellow group members; a group venue where it is safe to discuss the CFCJ program topics, such as: trauma, slavery, and indigenous ways of healing; as well as to promote a continuation of healthy self-awareness and expression. The individuals may report new or old issues, however the hope is that the youth will also display a better capacity to cope with the challenges, as well as an increase in self-esteem and resiliency. The next section, Chapter 7: Discussion will focus on feedback from the five identified reviewers on the model program presented. The feedback will be incorporated into a discussion about the strengths and weaknesses of this model program in Chapter 7 the Discussion. 215
  • Chapter 7 DISCUSSION This section begins with a demographic description of the reviewers who participated in the evaluation of the From the Cotton Fields to the Concrete Jungle (CFCJ) model and continues with a summary of the reviewers’ feedback. Participating Reviewers Five reviewers participated in the evaluation of the CFCJ Overview and Syllabus program. Prior to participation, recruited clinicians were asked to complete the Reviewer Questionnaire (see Appendix A ), which was used to evaluate their qualifications as reviewers. The selection criteria included number of licensure years, active clinical work, experience facilitating clinical groups, level of knowledge and/or expertise in working with African American youth, knowledge of slavery, as well as trauma and/or, intergenerational trauma. To participate in the study, the clinician needed to indicate a sufficient level of awareness in working with African American youth in a culturally competent manner, as well as experience in facilitating psychodynamically oriented groups and treating trauma. This is meant to ensure that participants have both practical and theoretical grounding in trauma theory and intervention, a history of working with young men of color, as well as knowledge and experience facilitating group therapy, the three are crucial tenets on which the CFCJ program is built. The participating reviewers were all licensed clinical social workers or psychologists, with 3-15 plus years of clinical experience. They all had significant graduate or post-graduate clinical training and are all currently 216
  • working with predominantly people of color living in economically disadvantaged areas, most of which are dealing with issues of oppression, trauma, low self esteem, and anger/ rage. All five of the reviewers identify themselves with having had an “average to more than average” understanding of racism, slavery and the process of the intergenerational transmission of trauma. Additionally, two out of the five reviewers have been extensively trained in The People’s Institute of Survival and Beyond’s weekend Undoing Racism training on how to begin to evaluate and take ownership for dismantling institutionalized racism. This training is also identified in CFCJ’s model program syllabus, as a workshop for the young men in the program. Two of the five reviewers identify themselves as people of color; and two reviewers who have identified as Jewish, are two of the three reviewers who were trained in the antiracist trainings described above. The selected reviewers received an electronic packet, which included the Reviewer Feedback Sheet (Appendix B ), the CFCJ model program overview, and the CFCJ model program syllabus for their review. After reviewing these materials, reviewers were asked to fill out the Feedback Sheet and return it electronically (Word document). The reviewers’ feedback will be presented and discussed in following sections. Description of Reviewer Feedback This section will provide a summary of reviewer responses to the Feedback Sheet. The full record of reviewer responses is available in Appendix C. In response to Question 1, “What are the strengths of the program design?,” reviewers found the CFCJ protocol to follow a natural progression that 217
  • made sense clinically, for example safety was established in a culturally competent manner, then trust building exercises were woven throughout, trauma was discussed, then their trauma was discussed prior to examining the intergenerational transmission of trauma which is slavery. The reviewer’s also found the CFCJ syllabus to be particularly strong related to educating African American males on how slavery impacts their own lives on a daily basis, the utilization of group and peer education as a means of reforming healthy attachments, detailed and structured goals and activities, utilizing a treatment model that is culturally aware of the population it is serving. The majority of reviewers also saw the connections made between community and African American culture, therapeutic activities that raise levels of resilience and self- esteem, as well as utilizing creative therapeutic art techniques in order to allow emotional release and reduce internalized oppression and shame. Additionally, one reviewer identified the point that the model program can assist African- American males to tap into an emotional side that they have been forced to suppress. The reviewer also likened current lyrics of rap music, which is abundant in African-American culture, as a way to express pain, as well as visually through the use of graffiti and tattoos “in the hood” that is the youths’ homes. In response to Question 2, “What are the weaknesses?,” reviewers were consistent in their critique of the CFCJ model program as needing a clear requirement to have the young men in individual therapy during the course of the program in order to allow for time and space to process the unconscious and conscious feelings that may arise during the program. Roughly three reviewers 218
  • felt that the youth in the program would benefit from more processing time within the sessions. Additionally, a majority of the reviewers identified that the phases are full of “dense information” and that the group members may benefit from either longer sessions (i.e. two hours) to allow for further discussion, or a model program that is longer than 12 weeks. Another issue that arose in two of the reviewer’s feedback was the lack of explanation, general recommendations, and/ or referrals once the model program is complete and the graduation occurs. Both reviewers recommended a “continuation of the process” for the young men and whether individual, family, or any form of support will continue as the young men move on from the CFCJ program. One reviewer was very adamant that one of the facilitators be a person of color, specifically someone of African American descent. The reviewer remarked that the possibility of two White culturally competent therapists could be possibly paired together to facilitate the group; potentially leading to a misperception to the youth about the capacity for leadership in the African American community and clearly within their group. The reviewer identified, at worst, a potential perpetuation of institutional racism within the agency milieu, and possibly adding to further mistrust, cultural and personal trauma related to racist socialization and oppression. Other issues mentioned sporadically were the prospect of including spiritual leaders/ church/ mosque, etc in the dialogue related to the transmission of intergenerational trauma. The reviewer noted that spiritual communities might 219
  • also perpetuate some of the manifestations of intergenerational trauma. One reviewer commented that the “Identifying Your Village” exercise would benefit from having the young men identify at minimal number of roles, such as six or seven, as opposed to the ten roles listed. The youth may be unable to identify one person for each of the particular roles. The reviewer cautioned against identifying a name for each role, particularly in cases where the young man may have been part of the foster care system, or at this time cannot identify a healthy parental role model. One reviewer remarked that the model does not clearly identify how the participants in the group are explained the purpose of the group prior go their agreement to join the group. This reviewer felt it was crucial for the African American youth to be informed about the psychoeducation related to slavery and trauma. Finally, two reviewers mentioned the use of the term “warm fuzzies” as a relatable phrase for the young African American male youth. One reviewer suggested the possibility of the term “Soul Food,” instead of “warm fuzzies,” to indicate the use to affirmations. In conclusion, the majority of the criticism was directed at: the length of the model program or the duration of the sessions; the use of the term “warm fuzzies” to indicate affirmations; and the benefits of an individual therapy requirement. None of the five reviewers objected to the CFCJ model program as a valid therapeutic intervention as a protocol or therapeutic framework. The reviewer’s feedback was associated with adding increasing the efficacy, safety and expansion of the model program. 220
  • In response to Question 3, “In your professional opinion, would this program benefit African American adolescent males who are being raised in an urban area?,” all five reviewers appeared extremely adamant that the CFCJ model program would benefit the targeted population of African American male youth in urban areas. Many of the reviewers indicated that they believe the program would provide the youth with the language to “articulate what’s happening in their community and how it continues to impact them.” Other areas of feedback included that the model would inspire a sense of unity in the youth; that the program considers almost all of the dynamics that are currently affects the youth’s lives and that the issues raised are critical for alliance building and therapeutic change. Additionally, one reviewer noted that the program is exactly what is needed to benefit African American males who are raised in urban environments, and that the struggle is about culture and risk. The reviewer contended that the males are faced with a difficult and vital question, “Will they risk losing a culture that is embedded with intergenerational trauma (PTSS) because they seek approval/ love of others, or will they risk exposing their emotions in an effort to create a new culture?” The reviewer verbalized that the CFCJ starts the conversation about healing and provides an opportunity to “free themselves” from their own manifestations of PTSS, as well as many of their “brothers in the process.” In response to Question 4, “How well do you believe this program will target symptoms of anger, hopelessness, vacant self-esteem, and racial 221
  • discrimination?,” all five of the reviewers agreed that the model program effectively targets and are designed to elicit the potential resolutions/ awareness of feelings of vacant esteem, anger, hopelessness, and racial discrimination. Three of the reviewers felt that the model is structured so that feelings and the mindfulness of their feelings are brought to the forefront o each session allowing for these manifestations of PTSS to be addressed. Another reviewer commented that the model is a “comprehensive, yet beautifully targeted, intervention approach.” Reviewers generally commented that the program does a good job of providing comprehensive definitions of each of the aforementioned terms, and then solidifying the terms in exercise and group process. One reviewer felt that this is one of the first programs that she has encountered which “targets issues that are hurting black men, in such an empowering way.” Finally, one reviewer acknowledged the resistance that will and may naturally occur within the group because of their upbringing and the effects of PTSS on their psyches. The reviewer contended that the continued use of creative art expression is crucial and will continue to be crucial in maintaining the success of the program. In response to Question 5, “How well do you believe this program will be able to treat intergenerational trauma?,” all of the reviewers felt that the CFCJ model program offers many of the tools necessary to treat internalized oppression an intergenerational trauma in the current generation. The reviewers felt that the benefits of the model in treating intergenerational trauma are the use of culturally sensitive therapeutic tools, structure, and psychoeducation (i.e., historical education, redefining oneself, awareness, self-love, collectivism) in order to begin 222
  • to heal the wounds of oppression for generations to come. The reviewers generally identified that the program allowed for the normalization of pathologizing behaviors, labels and attitudes; thereby removing some of the blame placed upon African American males for some time. Additionally, three of the reviewers noted that with additional supports extended beyond the CFCJ model program, the skills and insights the group members would learn can lay the foundation to break the intergenerational cycles of unhealthy coping patterns. The reviewers identified the benefits of including family and community members allowing for the program an opportunity to begin the process of creating healing within the family and community systems, not just within the targeted individual. One reviewer suggested having successful and strong graduates return in order to become potential mentors for other African American males attending the group. In conclusion, all of the reviewers noted that the CFCJ model program could serve as a healthy form of coping skills for the intergenerational transmission of slavery as trauma. In response to Question 6, “ Any other comments or suggestions?,” one reviewer summarized: As an African-American male who was raised in multiple urban environments and who now works with young people residing in the city of Newark, NJ, I found this model to be astounding! To be honest, I have not had the opportunity to work alongside a professional team who would dive so deep into the mind and soul of young African-American males because of their perceived threat. I was moved by the tenacity of the facilitators and their fearlessness when challenging these young men to connect with their inner rage and feel safe when releasing it. You demonstrated that you cared about their futures and their lives and hopefully they now see what you see. Continue this 223
  • journey and identify colleagues who care as much as you do to ensure the program’s success. This model from start to finish was phenomenal and I appreciated the activities that were more introspective in nature. I would definitely support this model and would love to adopt some of the processes to be utilized in the work that I do with African- American lesbian-identified females. In general, the reviewers tended to view the concepts of the CFCJ model program as a positive, healing, plausible and worthwhile program that would effectively target the manifestations and symptoms of PTSS, and begin the process of establishing healthier coping skills for the intergenerational transmission of trauma. The reviewers’ also consistently expressed consistent feedback wanting a longer program model, or longer durations for each group, as well as a tentative aftercare plan or goals for the individual group members, to further build upon the therapeutic work provided. Reviewer Feedback Integrated Into Model The current study aims to construct a viable short-term model of intergenerational healing. Reviewer results led to the conclusion that the CFCJ model is sufficiently safe and ready for use, provided the main areas of the reviewer feedback is incorporated into the model overview and syllabus. The decision to make adjustments to the CFCJ model program came from the hope of developing an improved and more effective program that fosters healing and safety for African American male youth. The main themes that emerged from the reviewer feedback and will be incorporated will be addressed below. In this 224
  • section, I discuss in detail each item of reviewer feedback that was integrated into the CFCJ model. One of the themes involved the possible problems that could arise should the program not require the group member’s to attend their own individual therapy sessions in conjunction with the group CFCJ program. One reviewer mentioned, “I have concerns about participants who may not be in individual therapy and may need addition attention.” This statement addresses the concern that due to the complex trauma psychoeducation and group processing within Phase I of the model program: The Hood; it can be assumed that many of the participants will be entering the program with a history of trauma. Therefore, the reviewer is suggesting that it would be most efficacious for the CFCJ model program to require ongoing individual therapy during the duration of the program. This point is valid, and although the CFCJ model program overview indicates that the program includes individual and group components; with family being strongly encouraged, however the overview section does not clearly articulate the individual therapy requirement for the duration of the CFCJ program. The implementation of adding the individual therapy requirement includes three sessions of therapy (whether individual or family) prior to the youth’s entrance to the program, throughout the duration of the 12-week model program, and for a minimum of three sessions prior to the graduation and completion of the model program. The purpose of the pre-program therapy requirement is to allow the youth an opportunity to begin to form a therapeutic relationship with the individual therapist. The requirement is created with the goal to establish safety 225
  • for the youth prior to the start of the program, as well as increase the percentage of the youth’s program retention, should he have a connection to someone outside of the group in which he can confide and speak too. The purpose of the individual therapy requirement during the program is to allow the youth to connect and process outside of the CFCJ model group and relate some of the larger concepts and interventions in a more personal and in depth manner. In groups, many youth consciously or unconsciously hide, or they do not feel safe enough to share. The individual therapy component will allow for the space to engage in meaningful dialogue and therapeutic work that may not occur in group. The purpose of the post-program session requirement is to allow for the youth to continue to process any group material that may arise, as well as to attempt to increase the possibility of him continuing individual therapy and expanding upon the CFCJ program model’s therapeutic foundation and interventions. A referral list of individual therapists will be provided to the caregiver and youth upon expressed interest to the CFCJ program. The requirement of individual therapy will be clearly articulated to the caregiver and youth upon referral as well. Second, the CFCJ model program will require for one of the co-facilitators to be a self-identified person of color, ideally someone of African American descent. One reviewer was very adamant that at minimum one of the co- facilitators be a person of color, specifically someone of African American descent. According to the reviewer the possibility that “two White culturally competent therapists could possibly be paired together to facilitate the group could potentially lead to a misperception among the youth about the capacity for 226
  • leadership in the African American community and clearly within their group.” The reviewer identified, at worst, a potential perpetuation of institutional racism within the agency milieu, and possibly adding to further mistrust, cultural and personal trauma related to racist socialization and oppression. According to Mims et al. (2005) and Akbar (1995) a lack of leadership exemplified by African American males in particular, as role models, teachers, and presidents, can lead to a perpetuation of internalized oppression and result in a sense of lowered esteem. Additionally, many young African American males struggle with connecting themselves with a multitude of other professions, with the exception of athlete or rapper, due to the lack of media attention towards positive healthy role models (Akbar, 1996; Mims et al., 2005). The model program will strongly recommend for one of the co-facilitators to be a person of color, ideally an African American self-identified male, in order to model a healthy, professional man of color, as a facilitator. Third, the CFCJ model program will change the terms “Warm Fuzzy” to “Food for the Soul,” creating a more mature, less vulnerable and perhaps “weak” voice and phrasing. The CFCJ model program overview and syllabus includes a term “Warm Fuzzy” that is utilized to describe affirmations and positive psychology terminology in order to promote increased self-esteem, mindfulness, as well as a constructive and creative aid in order to begin to change harmful behaviors or accomplish goals. Additionally, the “Warm Fuzzies” can also help to undo the damage caused by negative scripts, those things that individuals repeatedly tell themselves (or which others repeatedly tell us) that contribute to a 227
  • negative self-perception (Hay, 1999). Two of the reviewers noted that “Warm Fuzzies” may be too emasculating and may not work for a group of African American male youth with such a history of complex and intergenerational trauma. These points were noted, and this model program will be updated to include the term “Food for the Soul” to indicate affirmations and any other form of supportive and creative art therapies (Emunah, 1996). The name change may allow for the young men to utilize the affirmations yet not lose their sense of strength and sense of manhood, yet the activity will fulfill the goal of creating positive self-scripts and perceptions for the young men in the CFCJ group check- in process within each session. Fourth, the program will reduce the number of mandatory roles that the young men need to identify for the CFCJ model program, Session 11: Honoring Traditions Activity: “It Takes a Village...” One reviewer commented that the “Identifying Your Village” exercise would benefit from having the young men identify a minimal number of roles, such as six or seven, as opposed to the ten roles listed. The roles have been adapted from Dr. Leary’s (2005) PTSS publication (p. 48) of: Parents: Individuals who represent parental figures in your life. Mentors: Individuals who act as teachers and advisors. Educators: Individuals you go to who understand the subjects close to your hear in a manner that helps you unravel their meaning. Counselors: Individuals who provide personal and sometimes therapeutic guidance. Spiritual Supporters/Advisors: Individuals who provide guidance through methods like meditation, prayer, and so on. Health Advisors: Individuals who advise you about general health. Confidants: Individuals with whom you speak in confidence about your deepest 228
  • thoughts and feelings. Motivators: Individuals who encourage and inspire you in various aspects of your life. Defenders: Individuals you can call on for protection, who can protect you from physical and emotional harm. Advocates: Individuals who support and promote you, privately and publicly. The reviewer noted that the youth might be unable to identify one person for each of the particular roles. The reviewer cautioned against identifying a name for each role, particularly in cases where the youth may have been part of the foster care system, or he may feel unsafe identifying a healthy parental role model due to events in his trauma history. The CFCJ published model program will adjust the directions so that the group members can individually decide how many roles they have already filled with members of their community/ team, and what kinds of people in their community they may want to begin to build connections with in order to create these roles in their lives. The model program will recommend for the “Identifying Your Village” exercise to allow the young men to decide upon how many roles they would like to fill, rather than dictating who or what they need in their lives’ for this exercise. This will allow for the opportunity for exploration among the group members as to what roles are missing in their lives’, whether they want a person supporting them in that role, and what that would look like. A list of process questions and a clarification of the directions, as per the reviewer’s feedback, were added to Session 11: Honoring Traditions Activity: “It Takes a Village...”, section of the model program syllabus. 229
  • Finally, the CFCJ program will be published to include a section on aftercare recommendations and referrals for the youth once graduated from the program. A final issue that arose in two of the reviewer’s feedback was the lack of general recommendations for the youth once the CFCJ model program is complete and the graduation occurs. Both reviewers recommended a “continuation of the process” for the young men. The reviewers recommended that some form of connection and support should be fostered as the young men move on from the CFCJ program. According to the literature review, the treatment of intergenerational trauma is a process, and not a time limited treatment that can be implemented and healed within weeks (Copping et al., 2001; Danieli, 1995). Much the way it has taken years to create the manifestations of ever present anger, vacant esteem and racist socialization; the CFCJ program is based on the treatment of these manifestations as a form of intergenerational trauma, and identifies itself as beginning the process and laying the foundation for the healing of African American male youth residing in the inner city. Therefore, it would benefit the CFCJ program participants, their communities, and their descendants to continue the process laying down the framework for model program with structured recommendations for post- CFCJ group. The published CFCJ model program syllabus will have a brief explanation of the aftercare process and the possible future implications for the program and its participants. Reviewer Feedback Not Incorporated into Model 230
  • Each element of the reviewer feedback was considered, however several points did not lead to revision in the final program design. This section will explain the author’s choice of not incorporating these inputs. A reviewer noted that the youth in the program would benefit from a longer time frame within the sessions. Currently the model is at a 90-minute session for twelve weeks. Research from the literature review indicates that adolescents often struggle with maintaining focus for long periods of time, specifically because of the biological and emotional, developmental functioning of their brain during adolescence (Santrock, 2009). The literature supports the notions that creating safety (Keyser, Seelaus & Kahn, 2000), reduction of problematic feelings and behaviors (Janoff-Bulman, 1992), and relieving isolation and establishing peer connections (Yalom, 1995), however groups longer than 90 minutes are not documented as efficacious, as the adolescent may not retain information after 60-90 minutes (Santrock, 2009). For this reason, the CFCJ model is also broken down into psychodynamic group process, psychoeducation, and interactive therapeutic exercises, in order to engage the interest and focus of the group participants for a 90-minute time span. Additionally, many traumatized youth struggle with issues of attention because of the trauma (Janoff-Bulman, 1992). Therefore, it was decided that this feedback was helpful, however the 90 minutes sessions will be kept for the purposes of working with adolescents in the CFCJ model. Another reviewer noted how effective it might be to invite and have the participation of spiritual leaders within the CFCJ program. The reviewer noted 231
  • that the church and religion plays a large role in the lives’ and communities, as well as culture of African Americans. Although this author is in agreement with this statement, the published version of this model program will not include the collaboration with mosques, churches, or other places and people of worship as inclusion in the sessions. This model, as discussed in the Overview, is adaptable to the African American male youth identified population. Many individuals in America identify as African American or Black, however are also of Muslim, Caribbean, African, or Aboriginal descent. Therefore, it would be difficult to identify just one pastor, or priest, for a particular session. The CFCJ model program would strongly advise the clinician and co- facilitators adapting the model to spend time on the aspects of the CFCJ model syllabus, such as the invitation of more guest speakers, which are relevant to the African American youth CFCJ group population they are currently treating. Even within the 12-session timeline, it is recommended to adapt the pace, timing, and guest speakers of each activity and intervention, according to what emerges in the process, rather than sticking to a rigid pre-set syllabus or model. It can be expected that each group of young men will have different needs and interests, as well as different crucial aspects of their culture that need to be further addressed. A flexible attitude on the co-facilitator’s part will allow this dialectical process to take place within the CFCJ model program. Study Limitations 232
  • The model program has not been implemented and evaluated to provide empirical evidence regarding the efficacy. Another limitation to the model program is the limited focus on a specific population (i.e, African American adolescent males residing in the inner city). The stringent inclusion and exclusion criteria are likely to exclude many individuals who could benefit the program. Another limitation to the model was the length of the treatment. It can be argued that 12 weeks is to long for a population known for noncompliance with treatment, as well as issues of mistrust with the mental health system as a whole. This increases the chance and risk of individual absences and treatment drop out that would inevitably create consequences and feelings of abandonment for the entire group. Other confounding factors not addressed in the program include the type of individual therapy, including medication therapy, used in conjunction with the group. Resiliency factors, such as home environment, school support/ success, and pro-social activities could be factors when considering how group members process, communicate, retain information, and succeed in meeting the CFCJ program objectives. The model program also has specific qualifications for the group leaders, and without these qualifications for facilitation, the group may not have the expected quality of effectiveness. Future Research 233
  • There are many areas this dissertation has touched upon that warrant future research. The fields of African American youth, complex and intergenerational trauma, the soul wound, slavery, urban youth, and indigenous ways of healing are vast, and in some ways, perhaps still in their infancy. This dissertation has touched on a few of the current theories and methods for treating African American male youth and intergenerational trauma, but the understanding of this population and these disorders is far from comprehensive. The construction of the new model program begins with a hunch, and then receives grounding through theoretical inquiry. The CFCJ model is based on the synthesis of the literature between the constructs of slavery as a form of intergenerational trauma on the psyches of African American male youth, and as such has gained theoretical support. Some specific suggestions for future research are as follows. To assess the actual therapeutic effects of the CFCJ model program, a clinical study would be the clear next step. It would be beneficial to put the program into practice to investigate if in fact it meets the goals it has set out to reach. It is necessary to test many of the ideas for their efficacy on the population they aim to serve to assess how this new program model and treatment actually affects African American youths’ sense of esteem and behaviors. It is unknown whether the new model program does support clients in healing and processing the intergenerational transmission of trauma through targeting its manifestations. Questions come up related to a positive psychosocial change as a product of treatment, clinical significance, and what aspects of the program’s treatment create specific changes in the youth. 234
  • Due to the broad structure of the program, implementing the syllabus in its total without initially studying and testing the effectiveness of its parts may be premature. In addition to researching the model as a whole, it would be useful to validate some of its underlying theoretical supports through research. One main area that would need further research validation is the Posttraumatic Slave Syndrome model (PTSS) and Post-Traumatic Slavery Disorder Treatment Model (PTSlaveryD). For the PTSS model each manifestation of PTSS would need to be assessed. Options for investigating the various components of these theories are discussed below. The proposed model program needs to be implemented and evaluated in order to better gauge what aspects were more or less effective. Additionally, the hypotheses that the CFCJ model program participants will benefit from increased self esteem, a decrease in ever present anger and rage, as well as a decrease in behaviors related to being raised in an environment that unconsciously encourages racist socialization, should be measured quantitatively, as well as qualitatively. A control group would also be useful to compare the results. Additional studies may help identify the benefit of creative arts and indigenous interventions specifically in compassion to other more empirically supported treatments. One possible strategy is constructive, where it would be possible for existing programs to adapt some of the ideas into their model of treatment. This would involve isolating an assortment of components of the program design and testing each for efficacy. An example would be, one group of the clients could obtain the psychoeducation session on the intergenerational transmission of 235
  • trauma, and the other group would not. Existing programs might choose one or two elements to incorporate into their current design, and test allowing for the use of control groups in researching the effectiveness of program elements. The results of the client’s improvement on specific areas, such as a decrease in the symptom of rage or an increase in the awareness of rage impulses, could be compared through self-reports, with an analysis of program compliance. Additionally, follow-up studies could be completed that examine whether long- term change has occurred. Each element of the new model program could be studied in this way, including the specific manifestations of PTSS such as specific areas of racist socialization, low self-esteem, and complex trauma symptoms. This constructive strategy would yield information about aspects of the program, however it would still not be possible to predict how the program as a whole would affect the youth. A dismantling strategy can also be utilized to study the entire program and its components. This would start by implementing the program in its entirety and test to see if the program produces therapeutic change. This could be done utilizing pre- and post-program measures and by comparing the outcomes of the new model to current programs. In this case it would be important to use measures that focus on the intergenerational transmission of trauma, in many cases this may be difficult, since many programs focus on a decrease of posttraumatic stress disorder as a measure of success. There are many options for investigating the effectiveness of the program, and are discussed in the succeeding paragraphs. 236
  • Ideally, however, the program would be implemented in its entirety. This process would allow for studies using an analysis of variance to answer many questions, including: How does acts of rage relate to healing or recovery from intergenerational trauma? How do indigenous ad traditional ways of healing relate to the healing or recovery from intergenerational trauma? The new model program offers many ideas that need to be researched. Intergenerational trauma is not a diagnosis; therefore more research is needed in understanding the exact manifestation of this form of trauma and the treatments that best serve those individuals affected by it. Intergenerational trauma research would benefit from longitudinal studies that evaluate the progression of the affects and the methods of treating intergenerational transmission of trauma and the risk factors that lead to the behavioral symptoms from the disorder. It is also essential to understand what makes certain individuals susceptible to the effects of intergenerational trauma, as this understanding could help in designing preventative measures. The link between adolescents living in the inner city and intergenerational trauma should also be measured. What are the exact markers of intergenerational trauma? How is it related to internalized racism for youth? What are the differences between complex trauma and intergenerational trauma for these youth? How is intergenerational trauma related to Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)? More research is needed in relation to the intergenerational transmission of trauma that is slavery and hat type of treatment would best benefit from those who suffer the manifestations from it. Is treating externalizing behaviors, such as 237
  • violence, incarceration rates, and suicide, the only plausible way to treat intergenerational trauma? The premise of this dissertation was not to focus on externalizing behaviors, however research related to African American male youth is linked with many other disorders like substance abuse, ODD, CD, ADHD, etc. These links will hopefully be researched. Liberation psychology approaches might also be used to research the various aspects of the program. The goal of liberation research approaches is to ….**** One other aspect that could be added to the existing programs is the incorporation of the family as part of the treatment and education of the program. Research could observe whether the involvement of the family affects treatment outcomes, as the inclusion of the family is an important area to research because of how family dynamics and their level of intergenerational trauma is involved in directly or indirectly passing it on to their offspring. Comparison studies could serve well in this endeavor. One could investigate whether weekly family therapy would suffice. It would be relevant to discuss how the trauma of a particular family member affects the intergenerational transmission of trauma with the offspring. The need for further research with adult African American males and female youth and adults would be specifically interesting in investigating intergenerational trauma. The research should look at what determinants involved with slavery as trauma, distinguish men from women, and the factors within each 238
  • gender that promote and inhibit these conditions. This is especially true with how female slaves were historically treated, as opposed to African males who were enslaved. This research could also focus on what styles of treatment best serve adult African American males, as opposed to adolescent males, and vice versa for African American females. Also what modifications to the treatment can be made to better meet each gender and each age group’s developmental and emotional needs. These elements could be studied both qualitatively and quantitatively. The use of utilizing Posttraumatic Slave Syndrome (PTSS) as a theoretical foundation for treatment is a novel idea in treating the clinical manifestations of the intergenerational transmission of trauma. Since it is a fairly new theory it is possible that PTSS is currently being implemented or utilized as a foundation in programs; however the literature has yet to reflect this. It may work best to train therapists in this technique and employ the PTSS theory in already existing programs to study the effectiveness of this technique in treating clients who are living with the symptoms of intergenerational trauma. Additionally, the use of utilizing Post-Traumatic Slavery Disorder (PTSlavery D) as one of the theoretical foundations for treatment is a novel idea in treating the clinical manifestations of the intergenerational transmission of trauma with African American male youth. Since it is a fairly new theory it is possible that PTSlaveryD is also being implemented or utilized as a foundation in programs; however the literature has yet to reflect this. Research is needed in understanding how the concept of “Mental-cide” is utilized within a clinical 239
  • frame, and whether the omission of areas of the PTSlaveryD frame, such as the health, money and political aspects, would relate to the efficacy of the treatment. Furthermore, the use of indigenous and predominantly Native American ways of knowing and healing, as one of the main theoretical foundations is also an innovative way of treating intergenerational trauma with African American youth. Research needs to be done on the CFCJ model program intervention with the youth, as demographic variable on the traditional and indigenous interventions, are likely to effect clients’ reactions to the work. Additionally, it would be interesting to look for an implementation of the CFCJ model program with Native-identified youth, replacing the slavery psychoeducational piece, with psychoeducation regarding the youths’ tribe of origin and their spiritual belief system. It is likely that the model program would provoke different types of reactions between these two groups. If outcomes in the Native American population are significant, researchers may want to look at changes in the manifestations of intergenerational trauma patterns and style of coping. Lengthening the treatment is also an area in need of research. Because the new model is looking at the intergenerational transmission of trauma that is slavery in African American youth, as a beginning process within the 12-session model, long-term treatment is recommended. However, future research will need to investigate if lengthening the treatment makes a clinically significant difference in terms of a decrease in intergenerational trauma symptoms. This could be done by follow-up studies on client self-reports using a Likert scale as a psychometric measure. 240
  • Overall, the intergenerational transmission of trauma is a growing and resounding problem in our society and the clinical population, which is often overlooked. Specifically, how slavery has impacted adolescent African American male youth, and how this is externalized in the community. Further research could identify whether African American males living with an elevated sense of racial inferiority and racist socialization are more often diagnosed with Oppositional Defiant Disorder, Conduct Disorder, and Antisocial Personality Disorder. Hopefully, the focus of this program as a form of healing provides an alternative option that focuses on treating the sources that maintain the behavior, rather than the symptom. It is the hope of this author that this new model program will aide clinicians in providing new strategies to eventually overcome this growing societal problem. This research endeavor has opened the door to a myriad of possibilities when treating African American male youth and slavery as a form of intergenerational trauma. There is yet much to explore in regard to the intergenerational transmission of trauma, as well as the method of treatment and intervention that lead towards optimal generational healing. 241
  • CONCLUSION The treatment model presented in this dissertation was designed to address United States chattel slavery as a form of intergenerational trauma affecting African American male youth. The CFCJ model program was designed to provide a creative, psychodynamic group with which the youth can connect and engage. The comprehensive nature of this new program model addresses many of 242
  • the areas of concern that account for the psychological issues, both internalized and externalized, that are plaguing African American youth in the United States. The CFCJ model program acknowledges and is built upon the understanding that the African American identity was created, in significant part, by the reality of slavery. Eyerman (2001) contends that trauma of forced servitude came to be central of attempts…to forge a collective identity. An identity was formed, one of trauma, of resilience, of hopelessness, of survivor, of rage, of tradition, of racism, and finally of consciousness and healing. Herman (1996) asserts that traumatic events are extraordinary, not because they rarely occur, but rather because they overwhelm the ordinary human adaptations of life. The model program addresses many aspects of trauma and recovery that have been unaccounted for in the treatment goals and psychology of psychological youth clinical treatment programs. The CFCJ model program offers comprehensive psychoeducation on the following areas: complex and intergenerational trauma, the history of slavery, connectivity in the ways in which personal and collective history is manifested in daily interactions, provides indigenous/ traditional ways of healing, and allows for a collectivist perspective. The program attempts to connect the strengths of African American culture, particularly of male youth, in order to combat the manifestations of intergenerational trauma. The CFCJ model program offers a comprehensive psychoeducation on aspects of African American culture that many Africans in America, let alone other cultures and races, are familiar and comfortable with discussing, in a nonbiased and factual manner. 243
  • The CFCJ model program specifies that treating the intergenerational transmission of trauma in African American male youth is imperative, particularly in conjunction with the symptoms of rage, vacant or low self-esteem and racist socializations. The program assists African American youth in the process of understanding how their cultural history as Africans in American, and the trauma that has been collectively absorbed, has shaped many of their unconscious daily decisions. The program also provides refuge from the isolation of dealing with the microaggressions of interpersonal and systemic racism for the youth. Unlike many programs that attempt to treat externalizing behaviors and pathology, the CFCJ model program addresses the internal symptoms of intergenerational trauma, head on by reevaluating treatment methods, goals, and discussing the unaddressed comorbid factors of racist socialization and Eurocentric paradigms. Perhaps most importantly, the model program places the knowledge and power in the hands of the youth. The three phases of the program are designed to allow the youth to create connections of their own historically, psychosocially, and most important to this dissertation, psychologically. The CFCJ model program is created upon an interest in a distinct shift in consciousness that illuminates the path of traditional ways of healing, rather than statistical results. The needs of African American male youth residing in the inner city were vigilantly considered, and surmising from the reviewer feedback, the CFCJ model program has the capacity to expand beyond theory and into practice. The program has the potential to increase African American youths’ self esteem, 244
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  • APPENDIX A: REVIEWER RECRUITMENT LETTER Dear ____________, I am writing to you as a Psy.D candidate at the California Institute of Integral Studies. Thank you for offering your service to me in helping me to complete my dissertation. Your time and feedback are very much appreciated. As my dissertation thesis I have designed a 12-week treatment intervention group program model in order to target the manifestations and symptoms of the intergenerational transmission of trauma in inner city African American male youth. One of the ways to check if this program would be of benefit to African American male youth is for me to elicit feedback from other professionals with a strong understanding of issues related to the youth, history of U.S. chattel slavery and trauma. At this stage of the study, I’m looking for reviewers who will evaluate the potential of this new treatment model. If you have interest in the topic of intergenerational trauma and the way it relates to African American male youth, I would be honored if you considered serving as a reviewer for this project. As a reviewer you will receive an electronic copy of the model program protocol From the Cotton Field to the Concrete Jungle, the syllabus proposed for its implementation and be asked to fill-out a short six-question feedback sheet. Before we begin, I would like to inform you of a few things. 1) Your participation as a reviewer is voluntary, which means that at any time you have the right to withdraw your participation. 265
  • 2) The information you share will be confidential. Although your suggestions and feedback will be incorporated into this project, no identifying information about you will be in the dissertation without your permission. 3) There is no guarantee of direct benefit to you for participating in reviewing this program. 4) The risks to you in participating as a reviewer are minimal. There may be feelings of discomfort in reading the program design, which I welcome you to express. I welcome you to share any feedback, feelings or concerns with me. Please sign here to acknowledge that you have read and understand the above. Name Date If you are interested in possibly participating, please email me back the Reviewers Questionnaire and we will proceed from there. I appreciate your interest and look forward to your reply. Yours sincerely, Jennifer Mullan-Gonzalez, MA. Psy.D Candidate Clinical Psychology Doctoral Program California Institute of Integral Studies 1390 Market, Suite 111 San Francisco, CA 94103 Email: Jennyjennm (at) gmail.com 266
  • APPENDIX B: REVIEWER QUESTIONNAIRE Please reply to the following questions and email the complete form. 1. How many years have you been practicing as a licensed clinician/ psychologist? 2. In what types of treatment settings do you work (e.g., community mental- health clinic, hospital, private practice, academia etc.)? 3. Have you ever conducted group therapy with a psychodynamic framework? 4. Are you currently, or have you been engaged, in therapeutic work with African American men/ youth? Please address your therapeutic perspective in working with young men of color. 4. What kind of education or training have you had in the history of slavery? What is your perspective on the impact of slavery on African Americans today? 5. How much knowledge do you have related to trauma? Are you aware of the term intergenerational transmission of trauma? If so, what clinical relevance does this term have to you? 6. How do you self-identify racially/ ethnically? Is this important to you? I would be happy to discuss any questions regarding this study over the phone or via email. Please feel free to contact me at any time. Thank you for your interest, Jennifer Mullan-Gonzalez, MA 267
  • APPENDIX C: REVIEWER FEEDBACK SHEET After having read From the Cotton Field to the Concrete Jungle model program protocol and reviewed the program designed for its implementation, please reply to the following questions: 7. What are the strengths of this program design? 8. What are the weaknesses? 9. In your professional opinion, would this program benefit African American adolescent males who are being raised in an urban area? 10. How well do you believe this program will target symptoms of anger, hopelessness, vacant self-esteem, and racial discrimination? 11. How well do you believe this program will be able to treat intergenerational trauma? 12. Any other comments or suggestions? The Feedback Sheet will be emailed to you as a Word document for convenience. Please type in your replies and send the document back to: [withheld for privacy]. Thank you for your participation! 268