Shavaun Scott, a licensed marriage and family therapist, has been working with traumatized clients for more than 25 years. Co-editor of The Forgotten Survivors of Gun VIolence: Wounded, with Sandy and Lonnie Phillips, as well as Loren Kleinman, Shavaun recently offered some tips on the specific ways survivors can and should seek help, and shared some of her background and more general observations.
The following is an edited version of our exchange:
The first hours and days
Immediately after a shooting, people need crisis support. Trained peers as well as professionals can provide this — survivors need to feel safe, they need to understand that their reactions are normal. Their nervous systems are dysregulated from the trauma and they need to be comforted by soothing and supportive others. There will be immediate needs that must be met — perhaps children to care for. Jobs must be notified and arrangements for time off made. Practical concerns take priority as people receive emergency healthcare and work just to stay alive. No one should be alone during the crisis phase. People need people.
The place of therapy
Once survivors are medically stable, the long work of healing continues. Sleep is typically dysregulated, which is a major impediment to healing. Sleep is often fraught with nightmares. It's normal for people to have a loss of appetite, to be intensely emotional. They may be tearful or irritable. Moods are all over the place, and they may not know what they want or need. They just know that everything feels different now and that nothing is okay. Often they don't have words to describe how they feel. They don't know what kind of help they need.
Therapy is often part of the recovery process, and there are many tools and techniques that therapists trained in working with trauma survivors use. People are often given referrals by their local victim's advocate or sometimes a hospital social worker. It's important to have a mental health therapist who has a particular interest and skill set for working with survivors of violence. Unfortunately, this is not something that people come out of grad school equipped for. It is more often acquired during years of internship with good clinical supervisors and extensive training.
Categories of Mental Health Treatment, and the One Non-Negotiable: “Resonance”
There are two broad categories of mental health treatment: "Talk" therapy (psychotherapy), and psychopharmacology (medication can be prescribed which helps diminish PTSD symptoms). Therapists provide psychotherapy and psychiatrists (or another medical practitioner) can provide medication. They often work together.
We have extensive research on what makes therapy helpful to people. Eighty percent of the benefits of therapy come from the quality of the personal relationship between a given therapist and a client. We call this the therapeutic alliance. The quality of the personality match between the client and therapist determines it. The client needs to feel safe with the therapist; they need to feel understood. They need to feel cared for, and not judged. The client needs to feel that the therapist understands their experience and holds hope for their healing. We call this resonance.
This resonance between the therapist and client is the most crucial element; it's more important than any particular modality that may be used. If the resonance isn't there, no technique will do much good.
Initial overtures to therapists
One should always begin with a phone call when looking for a therapist. Ask for a 15-minute consultation (this should be free). Consider it an interview. You are interviewing them.
Ask the therapist to explain how they help people. You might give them a bit of information on your situation, but let them do most of the talking. "How would you help me?"
Do they make sense to you? Are they speaking in terms you understand? How do you feel when you listen to them? Do you feel comfortable with the person? If not, move on down the list.
Always interview several before booking an appointment with anyone. If you do book an appointment, trust your feelings in the same way. If you don't feel that they understand you, or they don't seem to have anything helpful to offer, move on. You are NEVER obligated to continue with someone.
Types of treatment
There are a plethora of techniques that we use. These include EMDR, guided meditation, narrative therapy, clinical hypnosis, somatic experiencing, etc., the list grows longer all the time. We're always looking for new techniques. But the key point is that the techniques are layers on top of that wonderful therapeutic alliance because, without that, it doesn't work.
Are there specific treatment modalities that you believe are especially helpful? Is there anything you would counsel against?
I like to see people sleeping well because this is important to restore the mind/body balance. If a trauma client cannot sleep, I want to see if they will consider using something mild, short term, from their doctor to restore their sleep cycle. It helps things along. There are medications that are safe and non-addictive, and I encourage people to talk with their physicians about it. Sleep is critical. Sometimes people try to down-regulate their nervous systems by drinking alcohol, but that ultimately makes things worse. I discourage alcohol.
Guided meditation is one of my favorite tools. We all need tools to regulate our nervous systems, and that's a very easy and effective one we can all use every day.
Nature is also very healing, so I like to see people get outdoors. Animals are soothing. Our pets love us exactly as we are. They don't see us as broken. I tell people, "Whatever is soothing — do more of that."
What about peer-to-peer approaches?
The more support survivors have, the better! Other survivors may offer the most powerful healing medicine. They've walked the path. They know the way through. They've lived it.
What special considerations might apply to children or teens?
Children and teens are extra vulnerable. They will let us know by their behavior that they are not doing OK, but they may not tell us with words. They may not want to talk to family members. With children, it's important to find a clinician who uses play therapy techniques designed specifically for youngsters.
Can you talk a bit about the neuroscience that undergirds your practice, and informs your understanding of what gun violence survivors need, or can find useful?
For decades, we've studied what helps people feel better after traumatic events. We knew that certain things helped, but until recently, we didn't always know why. In the past 20 years, we've learned so much about the brain and how the nervous system extends throughout the entire body, and how the mind and body are so intimately connected. Interpersonal neurobiology is one of my favorite fields of study because it's based on the science of our nervous system; it incorporates the body and emphasizes how each person's nervous system influences others. We can help heal other nervous systems by just being a healthy presence.
Could you explain a little about guided meditation and other meditative practices?
Meditation can be a powerful tool for personal awareness and growth. There are many different ways people practice meditation, from sitting in complete silence to listening to someone "guide" them into a peaceful state with a soothing story. Silent meditation may be triggering for trauma survivors because sometimes their brains fill in the silence with disturbing memories or sensations. They may start flooding with unhelpful images or feelings. I usually use guided meditation or soothing music. We want the body to be in a state of peace, the mind tranquil. We want the person to feel regulated, not flooded.
What about techniques such as EMDR?
EMDR is a simple protocol that has evolved since its development in the late 1980s. It originally involved lateral eye movements, but is often done differently now (though the name remains "eye movement desensitization and reprocessing"). Some people find it helpful; some do not. It's one of many things survivors can utilize once they find a mental health therapist they resonate with.
There is never a technique that everyone likes equally.
What are some of the things you have learned from your encounters with survivors?
I have learned that we are all stronger than we know. We can all break, we can all heal, though our journeys will all be unique.
Some people feel the desire or need to “go at it alone.” What’s your thinking about not being ready for, or resistant to, therapy?
I like to think that there is a therapist for everyone, but in truth, it's arrogant of me to think that. I don't know everything. I know that there have been certain key therapists in my own life journey who kept me going, people who helped me move through unimaginable pain. But perhaps I would have done so anyway. I'll never know. I can only say I'm grateful to a few people who were there for me when I didn't think I could find a way to keep going.
The moral injury of gun violence, rippling out and plaguing us all?
Gun violence is as shocking and catastrophic as it is unexpected. Lives are changed forever, in an instant and with no forewarning. The trauma reverberates out beyond those who are directly physically impacted — it changes the lives of those who witness it as well as all their families and loved ones. A bullet doesn't just scar a body; it injures souls. I think it is this very deep soul injury that America is experiencing now. We are a country in very deep pain. We have all experienced repetitive, deeply traumatic moral injuries.
Could you tell us a little bit about your background, and how you have encountered gun violence/survivors?
I was drawn to the helping professions since childhood, and I believe that one factor in that was my family's extensive history of various types of trauma. My mother died when I was 16 of cancer, but I understand now with hindsight that she was troubled with severe and untreated PTSD for most of her life. Additionally, one of her sisters lived with us when I was a child, and she was afflicted with schizophrenia, which caused psychosis. My family did not understand what was wrong with my aunt, and she received no treatment until decades after the illness had essentially ruined her life. Needless to say, observing these untreated mental health conditions left me with a compulsive desire to understand the human mind and to hopefully make a difference for people. I have always been a compulsive student of psychology and everything about the human mind.
I began working as a counselor in residential treatment centers with adults with severe mental illness in 1985. As I pursued my graduate degree and clinical license in 1987, I began providing therapy in a variety of agency settings which included substance abuse treatment centers, domestic violence shelters and rape crisis centers. I was plunged into the world of trauma treatment and saw victims of every type of violent crime imaginable. After earning my clinical license as an LMFT in 1991, I served as a clinical supervisor for the local domestic violence shelter and counseling program, and the sexual assault response and prevention agency while I also started my private practice. I worked in partnership with the local Victims of Violent Crime program in San Luis Obispo County, California, for over two decades in my private practice.
Along with private practice, I spent a decade working in community mental health, where in addition to providing individual and group therapy, I worked as a mobile crisis response clinician. Gun violence was a tragic and regular occurrence, and it was also my responsibility to support law enforcement officers and victims in critical incident debriefings after shooting incidents.
Thank you, Shavaun!
And sharing another therapist’s insights:
For more about how to choose a therapist and the importance of trauma-informed care, read this piece in Armed with Reason by Survivors Empowered friend and trauma therapist Angela Schellenberg, who we profiled in an earlier issue of this newsletter.