Preface

Life brings its blessings and its tragedies, and in the midst of it all, growth-fostering, healing relationships can leave an indelible mark on our psyches and in our lives. The literature is replete with data that now show the intrinsic value of supportive therapeutic relationships and the ways in which they can inspire growth and promote healing following devastating losses. As an introductory text to crisis and trauma counseling, we present an integration of cutting-edge, evidence-based theoretical constructs and models used in crisis and trauma work by counselors—such as cognitive behavioral therapy, behavioral therapy, neurofeedback, and mindfulness-based practices—and we underscore the fundamental role that relationship plays in therapeutic healing.

Throughout the course of our more than 15-year collaboration, we (Thelma and Shane) continue to discuss challenges and opportunities related to counseling and the complexities that people face in living life. As referenced in Chapter 11, we have partnered in responding to numerous community traumas and challenges, and we have worked with hundreds of people who have shared their healing journeys with us. We have also researched and published various works and imagined the content and tenor of a book that focused on a counselor’s work with crisis and trauma. When we were afforded the opportunity to write this introductory text on crisis and trauma counseling, we had a vision for what we hoped to offer our readers. We also invited the visions of colleagues who generously shared their expertise and experiences related to their practices in crisis and trauma counseling. As you read this text, know that you have a community of scholars and practitioners who share in this most important work with you.

Now, we invite you to think for a moment to a time when you may have desperately wanted to help a client or another person, but in spite of your best efforts, you were unsuccessful. Consider the dynamics that interfered with your ability to truly connect in a way that your client could trust. Perhaps it was hard for your client to trust that she or he could be helped or that you would know how to help. Perhaps, the latter may have even been the case. It could also be that your client feared being truly genuine and honest with you, afraid that your judgment would be ultimately painful. Perhaps your client’s painful experiences with previous authority figures made it difficult to imagine a different outcome with you. Alternatively, oppressive societal messages could induce shame and mistrust within your client that could make authentic disclosure understandably challenging.

One of the goals of this text is to think about our clients by considering their current and historical social contexts and by exploring nuanced and progressive views of relational dynamics to help navigate the process of healing. We also provide a relational roadmap for how to truly see and be with your clients in ways that take into account the challenges that all relationships, including therapeutic ones, invariably bring. We explore the role that power, privilege, culture, and context play in navigating a growth-fostering therapeutic process in crisis and trauma work.

This book is intended for counselors and mental health professionals interested in learning evidence-based, cutting-edge theories and practices in crisis and trauma counseling, and we introduce a relational framework attuned to offering dignity and respectful care. Relational-cultural theory (RCT) affords dignity and provides theory-grounded guidance to conceptualize the complexities inherent in healing counseling relationships. We also introduce and describe the wide range of modalities used in trauma-specific counseling and trauma-informed care. We believe that readers familiar with RCT will resonate with the growth-fostering principles involved in therapeutic work as applied to crisis and trauma counseling. In addition to evidence-based models frequently used in crisis and trauma work, readers unfamiliar with RCT will be introduced to a progressive counseling theory that informs and complements the numerous evidence-based practices and models included in this text.

Manualized practices offer potential structures for what many counselors do in crisis and trauma counseling. For example, cognitive processing therapy (Resick, Monson, & Chard, 2014) and trauma-focused cognitive-behavioral therapy (TF-CBT; Cohen, Mannarino, & Deblinger, 2006) outline processes to explore maladaptive trauma-related cognitions and provide steps to desensitize people to the acute distress and avoidance of traumatic memories (Resick et al., 2014). As we outline the informed research base and structure offered by evidence-based treatments, we invite you to share in our commitment to provide relational and creative counseling with people living in the immediacy or aftermath of crises and traumas.

A major emphasis in this text explores how and who we are with people in distress. Chapters 1 and 2 provide a rich framework for conceptualizing the dynamics and processes in relationships that bring life-sustaining connections, authentic experiencing, and shared power. The established literature in counseling and trauma research emphasizes the centrality of the bonds and shared creativity formed in the counseling space. In this introductory preface and throughout the text, we articulate how we see the extant research into the counseling relationship, creativity in counseling, and relational neuroscience support, and we validate the tenets of RCT proposed more than 40 years ago (Miller, 1976).

The Counseling Relationship

Meta-analytic research into counseling outcomes has revealed that when counselors (a) establish and maintain connections with a wide variety of clients, (b) work with people collaboratively and responsively toward mutual goals, and (c) infuse evidence-based and theoretical constructs naturally and authentically, they most benefit their clients (Wampold, 2015). In fact, Wampold’s (2015) research clearly shows that counselors who focus solely on manualized treatments and prescriptive approaches are minimally effective at best. By contrast, Wampold has articulated a contextual model of counseling in which people experience a real relationship in counseling, work toward mutually defined goals, and experience hope that counseling will work for them. These relational principles overwhelmingly predict counseling outcomes and are foundational for crisis and trauma work.

Mutual Empathy

In reviewing how contemporary researchers articulate empathy in counseling, we found that they reiterate what RCT scholars define as mutual empathy (Jordan, 2018). As cited in Wampold (2015, p. 271), Gelso (2014) defined the therapeutic relationship as “the personal relationship between therapist and patient marked by the extent to which each is genuine with the other and perceives/experiences the other in ways that befit the other.” Likewise, Bessel van der Kolk (2014) has contended that social reciprocity builds the kind of relational contexts where people can feel safe, connected, and less alone in their suffering. Our social reciprocity (van der Kolk, 2014) and engagement in real counseling relationships (Wampold, 2015) closely reflect what RCT scholars call mutual empathy. Jordan (2018, p. 7) has explained mutual empathy as “I empathize with you, with your experience and pain, and I am letting you see that your pain has affected me, and you matter to me.” We navigate this mutuality following principles of relational ethics, and we describe the nuances of ethical connection and mutual empathy in Chapters 1 and 2. When working with people in crisis, or those who have experienced trauma, the mutuality we share and the real connections we support and nourish can begin to invite the potential for hope on the basis of authentic and affirming experiences in the counseling process.

Integrating Creative and Relational Practice With Trauma-Informed Care

Creativity is a key feature in many evidence-based and manualized treatments for trauma. On the TF-CBT training site, the Medical University of South Carolina (n.d.) states that “TF-CBT is best delivered by creative, resourceful therapists who have developed close therapeutic alliances with their clients” (para. 7). Many other prominent cognitive-focused, evidence-based treatments highlight the role of creativity as an effective practice, including cognitive therapy (Beck, 2012), cognitive processing therapy (Resick et al., 2014), and the Cognitive Behavioral Intervention for Trauma in Schools intervention (Jaycox, Langley, & Hoover, 2018). Although manuals and protocols can provide structure and protocols, a counselor’s and client’s shared creativity fuel the process of counseling (Duffey, Haberstroh, & Trepal, 2016). Finally, expressive and creative approaches— such as movement, music, yoga, dance, play, and art—allow for creative expression of pain that transcends words. Whole body approaches (Porges, 2011) that ignite our inner rhythms through expressive mediums can integrate sensory and fragmented memories, calling on the strength of community when shared in groups (van der Kolk, 2014).

Context, Culture, and Society

Throughout this text, and specifically in Chapter 3, the authors explore how societal messages, cultural norms, and historical and cultural traumas create expectations that can support healing or isolate people from resources and connections that can provide hope. Historical collective traumatic experiences pervade generations of people...