The AAMFT Blog

“Are Your People in Sri Lanka okay?”: After Exposure to Traumatic Violence, Reflecting on the Patterns that affect Families across Space and Place

by Laurie L. Charlés PhD LMFT

AAMFT Approved Supervisor and Clinical Fellow

In Boston, in Light of the Easter Sunday Attacks in Sri Lanka

Danaa walked into my class a few minutes early Tuesday night, breathless: “Are your friends in Sri Lanka okay?” Danaa is a student in my Sociology of the Family class, a seminar with students in Boston who are mid career professionals, re-training or finishing their degrees after having families or after migrating to the U.S. from the Global South. Our conversations about family life and family issues are constantly fascinating for me because of the stories they bring from their world. I did not ever expect that the class would become so keenly sensitive to my stories, however, and to the Easter Sunday bombing that had happened in far and away Sri Lanka only two days earlier. But somehow, they had.

During the 48+hours that had passed since the attacks in Sri Lanka, which, as of this writing, has claimed the lives of hundreds of people and injured more than 500 across three cities on the island, I’d also received messages of concern from loved ones and colleagues across the globe—San Antonio, Beirut, New York City, Istanbul, Washington DC, Santiago, California, and Syria. Essentially, the message was the same: “Are your people okay?” Traumatic incidents truly reach across space and place; the patterns resonate across global barriers, connecting us. Concern for my colleagues in Sri Lanka was also what I saw on my students’ faces Tuesday night—a few minutes before I began the lecture, Andrae walked into class with the same question that Danaa had: “Are your people okay?” Like her, he didn’t wait to sit down before he asked.

I am a family therapist who, through a profound stroke of luck in a life full of good fortune, is deeply embedded in Sri Lanka. My first experience in the country was in 2010 as a Fulbright Scholar; I taught at the University of Colombo, where I am still an affiliated faculty member. Back then, I met many of the colleagues whom I now consider dear friends. Bookend that with a trip the week before Christmas in 2018, when I was there under contract with the United Nations as a “Consultant/International Master Trainer” for the United Nations Family Therapy (UNFT) Program. Our training program in the capital of Colombo was held at the Cinnamon Grand, one of the hotels where a bomb went off on Easter Sunday.

My class last night had at least two spaces and places in it: Boston and Colombo. The effects of traumatic incidents on family life had been our topic of discussion, as the week prior to the Easter Sunday attacks was “Marathon Monday” in Boston. Our class was held the day after the event, but the Marathon Monday joie de vivre was still in the air, that heady spirit of end-of-winter and almost-Spring, of the celebration of sport, endurance, and since 2013, of reflection and commemoration for those we lost and for those who survived the Boston Marathon bombing. With insider knowledge, my class discussed what it was like to be immersed in the exposure to that traumatic incident, and then, graciously, they allowed me to guide them to think viscerally about effects of traumatic incidents on individual, family, and community health, across other spaces and places. I discussed my own work in conflict affected states, including Sri Lanka but also other countries. I talked about Judith Herman’s[1] work, how the severity of traumatic events cannot fit on a linear scale or dimension; there are complex layers of experiences and external events particular to each person, each setting, each intersection of identity and social location. This is a fit for my systemic family work, and I have found her writings invaluable as I work across the globe. Herman goes on to say that in spite of the complexity of experiences, there are common salient characteristics across the severity of traumatic events. In other words, there are patterns: Exposure to extreme violence; Physical violation or injury; Witnessing grotesque death; Sense of helplessness in the face of the event(s); threats to life or bodily integrity; a close personal encounter with violence and death; a feeling of “intense fear, helplessness, loss of control, threat of
annihilation” (p. 33). 


The students, keenly sensitive to and still freshly remembering what had happened in Boston in 2013, seemed to understand the points about how traumatic incidents, while contextual and diverse, share particular patterns. Sri Lanka had been fresh in our class discussions for another reason: I had just returned from a vacation there the week prior. Arriving back at Logan airport a day later than planned, and after being delayed over two hours upon arrival, I had barely made it to class on time. I was jetlagged, ragged, and disoriented. As I tried to do the lecture, one student raised her hand: “Is your hair blue?” I’d forgotten—a stylist I often see at Crescat Mall in Colombo, Ananda, had died some of it blue. I don’t know if it was my lecture on Sri Lanka, or my stories, or my blue hair, or something else altogether, but somehow, the students had become highly sensitized to what had happened there, to traumatic incidents beyond their own geographical home. The Easter Sunday Attacks had confirmed that their insider knowledge had indeed crossed space and place. They understood what exposure to violence could do to a person, a family, and that knowledge had opened a door, viscerally and theoretically.

At the end of Tuesday’s class, Danaa asked me a surprising question: “So, will you go to Sri Lanka?” This was a question I did not expect. I am always going to Sri Lanka! I thought to myself. I have lost count of the number of times I have been there, but it now averages more than once a year.[2] Almost in every case, the projects are brought forward by my Sri Lankan colleagues themselves, and inspired by work we do together. I adapt to what their suggestions are, as they are the best ones to know the needs of the communities in their country, and how I can best support them. Their work also generates new questions for me; I’ve published three books with colleagues in Sri Lanka. Together, we can find so many ways to focus on how to support professionals in their capacity to support families in the context of Sri Lanka.

I answered Danaa as thoughtfully as I could: “Sri Lanka is well resourced; there are many trained people who do what I do, they are incredibly innovative and sharp and creative. So, no, I don’t expect to go.” It’s true. Most low and middle income countries face a shortage of professionals in mental health, and Sri Lanka faces that challenge as well, but they also have a robust segment of professionals working to meet that challenge head on, and they are already inside the country. Sri Lanka is a fragile state, a post conflict state, and in fragile, conflict-affected states, the government is challenged to provide direct security to its citizens and is limited in its ability to deliver basic services. However, the sophistication of the professionals who do what I do in spite of limited state capacity is incredible. It’s inspiring. Sometimes, psychosocial innovation comes from the need to be at high capacity. Sri Lankans know this intimately after the Boxing Day Tsunami, after three decades of war, and other key critical incidents of violence throughout the nation’s recent history. In fact, it has made them even more expert. As Richard Mollica put it, we can become higher in our awareness after a severe traumatic event, exquisitely sensitive to what needs to be done to reconnect the “before” and “after”, precisely because of our exposure to it.[3]

However, I understand the meta message that is part of Danaa’s question. It is a very natural human impulse to want to intervene, to do something. This impulse is particularly powerful amongst those of us in the helping professions; I have felt it before, many times. But I don’t experience that impulse when it comes to Sri Lanka—I’ve been there too often and I’m too keenly aware of its assets, its internal and often hidden set of strengths. Although I have certainly delivered my share of trainings in Sri Lanka, I am just as likely to be the one observing, learning, while Sri Lankans are busy on the ground, as they are right now, focusing on how to support families within their context. Two days ago, I was added to a WhatsApp group for MHPSS response to the emergency; the group originates inside Sri Lanka, and its activities are managed and conducted by local people for local people. (The foreigners who were affected by the bombings in Sri Lanka seem to be supported primarily by their embassies). It is an honor to be witness to the sensitivity of our Sri Lankan colleagues, beginning the hard work to support families exposed to this traumatic violence. We experienced that in Boston, too, during the Marathon bombing, when my colleague Richard Mollica offered our clinical team a guide and set of recommendations. For everyday Sri Lankans, who have already lived through three decades of war, this current situation is painful in a new but also familiar way. Of course, I will support them any way I can. But most of all, I am proud to stand alongside them, across all of the spaces and places, as they teach me and others the way forward.

 

Laurie L Charlés, Ph.D., L.M.F.T., implements systemic family therapy practice in international humanitarian relief contexts, in low- and middle-income countries, and with vulnerable populations in conflict-affected states. She is the author and co-editor of several books in family therapy and qualitative research, including Family Systems and Global Humanitarian Mental Health: Approaches in the Field (2019) and Family Therapy in Global Humanitarian Contexts: Voices and Issues from the Field (2016), both with Dr. Gameela Samarasinghe, as well as the forthcoming Family Therapy Supervision in Extraordinary Settings, with Dr. Thorana Nelson. She is an AAMFT Approved Supervisor and Clinical Fellow.

 

[1] Herman, J. (1997) Trauma  & Recovery: The aftermath of violence—from Domestic Abuse to Political Terror. NY: Basic Books.

[2] For example, from April to September, 2018, I was consultant to an international NGO in Colombo, contracted to help write and develop a grassroots toolkit to be used by practitioners engaged in transitional justice work, increasing their knowledge on how/what impacts can be expected following a traumatic experience and guide them on how to engage people in storytelling and memorialization in a psychosocially sensitive manner. I’ve conducted trainings and workshops for NGOs in Sri Lanka across the years 2011-2018, in “Group Methods/Counselling” training for psychosocial workers based in north and eastern regions of post-conflict Sri Lanka; to introduce the concept of self-reflection in psychosocial work; in using Appreciative Inquiry and Richard Mollica’s “The Trauma Story” in psychosocial work with war affected communities. I’ve taught family therapy methods, interventions, and interviewing at the University of Colombo Faculty of Graduate Studies, as a Visiting Professor and a Guest Lecturer; conducted focus groups with psychosocial workers in research projects that resulted in manuals published in Tamil, Sinhala and English. I’ve been a Fulbright Scholar there twice, first in 2010 and again in 2017/2018, as a Fulbright Global Scholar in two conflict affected regions of the globe, including in Sri Lanka, where I focused on the challenges of family-focused mental health and psychosocial support (MHPSS) project delivery in the context of each country’s state structures and international partnerships.

[3] Mollica, R. (2006). Healing Invisible Wounds: Paths to Hope and Recovery in a Violent World. Harcourt: NY

photos courtesy of Laurie Charlés

“Small world, isn’t it?” Multiple Relationships in Small Communities & Subcultures

Join Dr. Sheila Addison, LMFT, for a webinar on multiple relationships on Friday, May 10, from 3:00-4:30 pm EST, presented by the Queer and Trans Advocacy Network. Register here.

Many MFTs enter the field because we belong to communities that have historically been poorly served by mental health.  We want to bring our expertise to bear, and offer culturally-sensitive services to groups of people whose well-being is important to us. Often, we wind up a minority within a minority – one of the few professionals with lived experience that relates to the people we most want to help.

At the same time, if we are also a part of those same communities, we may find ourselves repeatedly facing questions about how to manage multiple relationships in an ethical way. 

• Can my children and I participate in social activities at my temple if I’m one of the very few Jewish therapists in in my area and I have many Jewish clients?
• I attend a consultation group for Black therapists in my area. Now my partner and I are looking for relationship counseling, and all the Black therapists who take my insurance sometimes attend this same group.
• I’m a transgender man who works with many trans and non-binary clients. There’s an annual trans healing retreat coming up that I really need for my own self-care, but at least three of my clients are also talking about going.
• My spouse and I are non-monogamous, and I see a lot of non-monogamous clients as well. I’m always afraid one of my clients is going to turn out to have intimate connections to people who are connected to me, my spouse, or our other partners, and then what do I do?
• My kids go to school at the same school as some of my kid and family clients. What if my kid becomes friends with a kid client? Or worse yet, enemies? I’m the only therapist in my area with my specialty.

Most of us were taught that the ethical choice is to avoid these multiple relationships as much as possible.  But what about when it’s not possible? And what if avoiding them means cutting yourself off from relationships and resources that are important to you or your family?

This workshop will look at how we can move beyond a simple “avoidance” framework and engage with the work of how to identify, anticipate, and manage issues of overlap.  We will look at the AAMFT Code of Ethics in dialogue with other organizations’ codes, and consider various decision-making frameworks to use when considering the benefits and harms of our complex relationships with our communities.

You will have the opportunity to consider how your own connections, and those of your supervisees or students, can be both a benefit and a liability when it comes to navigating the dual role of “insider” and “service provider.”  Together, we’ll identify examples of the dilemmas that the “avoidance” framework creates for MFTs who are part of small communities, subcultures, and minority groups, and practice applying more nuanced thinking to the difficult choices we face.

 

Dr. Sheila Addison, LMFT, is a clinical fellow of AAMFT. She heads Margin to Center Consulting which encompasses her private practice and supervision, and cultural competency trainings for mental health professionals. She provides diversity and inclusion support, including the Ally Skills Workshop, to corporate, academic, and community clients. She resides in Oakland, California where her practice, focused on couples and relationships, is also located. In 2018 she was named “Best Psychotherapist in the East Bay” by the East Bay Express.

MFTs Matter: Advocating for Medicare Access

In March, we- Dr. Heather Katafiasz and, Doctoral Student, Eman Tadros, from The University of Akron- met with Senators and Representatives on Capitol Hill to advocate for the Mental Health Access Improvement Act (S.286/H.R.945). This bill is incredibly important to us because, currently, Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs), who make up 40% of the mental health workforce, cannot bill Medicare. The passage of this bill would greatly improve access to mental health services for Medicare beneficiaries, which will represent 20% of the United States population by 2050, including disabled persons and persons over 65 across the nation. This would be a huge contribution to creating access to underserved populations, which is something we are both very passionate about.

Reflecting on our experiences visiting Capitol Hill, we both noticed that we seem to be accustomed to an on-the-go, fast-paced lifestyle due to the multiple hats that we wear (therapists, researchers, supervisors, and teachers … ), which was mirrored during our experience at Capitol Hill. Flexibility and spontaneity are a must in that environment. When we met with Staffer Kate McCann (Representative Marcia Fudge), we had to go on a little bit of a scavenger hunt to find a location to conduct our meeting. We tried for Staffer McCann’s planned location, but it was closed, so we were forced to move to “Plan B”. This required us to go for a bit of a walk, getting a unique tour of the Rayburn House Office Building, and eventually ending up in an empty stairwell. It sounded like this was a common experience on Capitol Hill, as space and time are in short supply. Eman wore (beautiful) high heels, which Staffer McCann admired, but clearly wearing your walking shoes is a must there.

It can sound intimidating, meeting with these very important people who we see “on TV at night” (per David Connolly, the AAMFT & CAMFT Lobbyist), but they are not that different from us. We generally meet with the staff members, who gather the information and advise the Member of Congress on issues. Staffer Sara Bell (Senator Robert Portman) comes from a Social Work background and Staffer McCann is a teacher, who is spending a year on Capitol Hill as part of a Fellowship. They are people who are passionate about the issues, just like us.

Don’t underestimate how your own passion and experience can directly connect. We are their constituents, but being in Washington, DC, and not in the locations they represent (e.g. Ohio), they need us to come to them to talk about our experiences and advocate for the issues that are important to us and we think should be important to them. These meetings are very important because we need to put a face and a story to the issue. For instance, Eman has clinical and research experience with the incarcerated and in-patient psychiatric populations. She spoke about how those populations are often able to receive comprehensive in-house mental health services, including relational therapy performed by well-trained systemic therapists, but are then unable to receive the same care if they have Medicare once released from that controlled environment. Thus, when they reintegrate into the broader systems in which they belong, they no longer have access to that same quality of care. Representative Fudge is very passionate about issues related to incarceration and we were able to provide a link to why Medicare is an important issue for her and her district.

We are passionate about creating systemic change in not only our MFT profession, but the overall state of mental health care in our society. We would like to invite MFTs at any level to advocate for our profession just as we would advocate for our individual clients. Below are some suggestions on how all of us can advocate:

• Become a member of AAMFT’s Family TEAM
• Get connected with your state’s TEAM Leader, or become a TEAM Leader yourself by emailing [email protected]
• Participate in Capitol Hill visits (AKA “Fly-in Day”)
• Write to your legislators- a simple email will go a long way
• Attend the AAMFT Leadership Symposium

               

Heather Katafiasz, PhD, IMFT-S, AAMFT Approved Supervisor is faculty in The University of Akron’s Marriage and Family Therapy Program. Heather also works part time as a private practitioner. Her research involves increasing the systemic understanding of Intimate Partner Violence and its intersection with Substance Use.

Eman Tadros, M.S. IMFT is a Ph.D. Student at The University of Akron’s Counselor Education & Supervision: MFT program as well as an adjunct professor at Cleveland State University. Eman is an independently licensed marriage and family therapist in a private practice and currently working towards the AAMFT Approved Supervision Designation. Her research follows the trajectory of incarcerated co-parenting and incorporating family therapy into incarcerated settings as well as displaying the efficacy of family systems theories within these settings.