Reality Acceptance: A Practical Tool for Promoting a Victim-Protective System

Dawnyshia Griffin, MSN RN–Guest Contributor

A Survivor’s Story

My hands are quivering uncontrollably as I open the door to the safe space I fled to in order to escape the threat of harm I’d been suffering under for a number of months. In front of me I see three people, likely called by someone who was concerned about my recent statements that’d I’d been expressing on a nearly daily basis in hopes that someone could interpret the meanings of the words I spoke and help me figure out a plan to get to safety–unfortunately, my words did not have the desired effect of eliciting support but did, in fact, make a number of people concerned.

As soon as I see the three would-be helpers I immediately burst into tears, I’m an introvert with a significant history of trauma and having three authority figures at the door of my safe space instantly floods me with feelings of shame and doubt—you’re in trouble now, my thoughts say, look at what you did! they continue more aggressively. I try to shut down the spiral before I start forgetting the words I need to form in order to help them understand but I’m not having a very easy time.

So there I stand, crying nearly hysterically, simply because I opened a door and became emotionally overwhelmed, and now I can’t seem to get the words out that I’ve been trying to shout at the world for months. Wow, we’re not off to a great start, I think to myself. There are so many things I want to say: thank you for coming, yes you’re here please help me, somebody does care. I open my mouth and manage to sob out a hardly coherent:

 “Why are there so many of you!?” Umm so that sounds accusatory, unappreciative, and confrontational…I think to myself. I’m thinking a lot of things to myself, I just can’t seem to make my lips form the words that I mean. I can barely get my lungs to fill with the air that I need. With tears streaming down my face and with the awareness that I appear hysterical, I slowly back into the room and ask to have a seat.

My would-be helpers assure me, of course you can have a seat, this is your space. They seem taken aback that I would even ask, and feelings of shame and embarrassment heighten as I’m flooded with memories of all the times throughout my life where I did, in fact, get in trouble.

I think back years and years and see the pattern forming before I can stop it: I ask permission, I’m denied permission, I ask again, I’m in trouble for asking, I don’t ask for permission, I’m in trouble for doing it without permission, I ask for permission in front of an audience, I’m in trouble for asking in front of an audience and on it and on it goes.

The spiral continues, my sobs shake my chest. My eyes squeeze shut. I know I must look so…crazy.

All I did was open the door, why am I so emotional? I can’t really reason well in this heightened emotional state. All I can think of is the fact that with this introduction, with my history, existing as the person I am, and everything I know that’s already happened thus far in my life…

I see the concern in their eyes, I hear the soft pitch voices they use in an attempt not to upset me further, I quiver seated in a hotel room chair. And before the interaction has truly even begun, it’s over–I can see it in their faces…they’re not going to believe me either.

A Survivor’s Reflection

As I write this some weeks after the incident, my breath still quickens, my hands still shake. I’m still actively dealing with the ramifications of asking for help in an unconventional way, but in a way that made sense to me at the time. The solace I provide myself in the fallout of such a life-altering incident is that everything I did, I did to survive. I place a hand over my heart and speak words of encouragement to myself:

           I know it hurts. I say.

           I know how hard you tried. I continue.

           You’re doing a great job. My body relaxes.

           It’s going to be okay. My breathing slows.

           I believe you.

I open my eyes that I hadn’t realized I had even shut. I look around my home office to center myself. I’m at home. I believe me. I am safe.

And with those words, I continue what I’ve found one of my main focuses in life to be: turning my pain into change. I want to quit on that mission several times a day, because this mission hurts. However, I find reassurance in the fact that others will be able to walk over what I went through by taking the bridge I made over it with the words I share. May no one else ever know this pain. I wish to myself. And with that sliver, I hope I continue.

A Survivor’s Suggestion

So, how can we support survivors?

As a survivor and a health professional, I have a suggestion.

In nursing school I was taught that pain is “whatever the patient says it is” (Fink, 2000). As a registered nurse what I observed was that this definition was not usually extended to emotional and mental pain. Knowing for myself that when I get sad I feel a pang in my chest, and a heaviness in my arm, I found it confusing that the definition of pain didn’t seem to, in practice, enter the mental health realm. And then I wondered what could help.

My mind immediately went to one of my favorite practices as a registered nurse in behavioral health: Dialectical Behavioral Therapy, a relatively new therapeutic technique developed by Marsha Linehan to provide an effective intervention for clients with what is typically significant and unrelenting distress.

One of my favorite skills–that I’m sure my patients are tired of hearing about–is called: Reality Acceptance. Reality Acceptance skills have been used to reduce dissociative symptoms which can occur when an individual, such as a survivor, is acutely distressed and overwhelmed (Lyons, 2020). So then the question becomes, how to practically integrate a manualized skill with roots in Buddhism to a workable solution.

A survivor’s suggestion?

Start with “I believe you.”

Those three words, especially when genuine, especially when repeated and reinforced, have the power to change the course of a survivor's entire interaction, treatment, or case.

How so?

With the list of seemingly never-ending tasks that I’ve carried while working as a nurse, I found it to be easy to let one or two things fall through the cracks. Especially time-consuming tasks that require nuance. My call to action for the supporters of survivors is as follows: start with “I believe you”.

Unfortunately, I’ve had people I’ve cared dearly about go through similar traumas. I remember when I heard them tell their story, I was full of so many questions. I thought I needed to know the details to understand what happened so that it wouldn’t happen again, so that I could protect them somehow, I thought more information meant a better outcome, and maybe it does and maybe it doesn’t, but as someone who has walked through the pain of becoming a survivor I would suggest believing the person first, the details will come with time and the promotion of emotional safety.

Although I am a healthcare professional, I am only speaking from my perspective and experience. Here are a few ways well-intentioned words promote the revictimization process.

What is said

What may be interpreted

I know you already said this…but can you say it again so I can hear it

I know you already said this…but repeat yourself so we can decide if we believe you

We need to know specific details

We don’t care about the emotional toll reliving this traumatic experience costs you.

Are you sure that’s what they meant?

There are multiple ways their actions could be interpreted, and yours is not very convincing.

I could go on. However, I think the key takeaway is to start with, “I believe you.” Whether a survivor shares what they share with perfect accuracy is less urgent than moving them to a place of emotional safety and environmental calm so that they can achieve the mental space and capacity to finally breathe again, because honestly, holding this trauma inside is like waiting to exhale. The pressure builds up until you're frantic with your need to release it.

So I’ll end by saying thank you to all the supporters of survivors. You have given me space to breathe. And that means the world to me.

References:

Fink R. Pain assessment: the cornerstone to optimal pain management. Proc (Bayl Univ Med Cent). 2000;13(3):236-239. doi:10.1080/08998280.2000.11927681

Lisa S. Lyons (2020) Embracing Reality: Mindfulness, Acceptance and Affect Regulation; Integrating Relational Psychoanalysis and Dialectical Behavior Therapy, Psychoanalytic Inquiry, 40:6, 422-434, DOI: 10.1080/07351690.2020.1782143

Resiliency: Not Born This Way

Gleibys Gonzalez, Sexual Assault Forensic Services Coordinator

Resiliency protects us from the adverse effects of trauma. It is a skill that is learned and strengthened throughout our lifetime.

Resiliency is the ability to “bounce back” from an adverse event or difficulty and emerge strengthened, with more life strategies and skills, more confidence, and more hope.^[1] Resiliency can be viewed as a set of protective factors, defined as those things that “help build and strengthen the sense of belonging and connection.” ^[2]

“Family resiliency does not develop through the evasion of risk, but through successful application of protective factors to engage in adverse situations and emerge from them stronger.”^[3]

The Attachment, Regulation and Competency Model (ARC) is a resiliency-building framework for children and adolescents and can be used in both individual clinical interventions, as well as in an organizational framework.^[4] The ARC model was developed by Dr. Margaret Blaustein and Kristine Kinniburgh, LICSW, focusing on strengthening the caregiving system and building self-regulating skills.^[5] The third component in the ARC model, competency, aims to address competence in decision-making skills, social connections, community involvement, and developing a positive self-identity.^[6]

So, how do we build resiliency as adults?

Resilience is developed and strengthened through relationships and our social networks.^[7] Resiliency is both individually and community driven, and healthy relationships are the number one protective factor and most important resiliency factor. Healthy relationships allow us to rebuild trust, safety, confidence, and connection after a traumatic event.^[8]

Individual resiliency is a learned skill from others in the community or contextual experience developed throughout our lifespan. “Like building a muscle, increasing your resilience takes time and intentionality. Focusing on four core components—connection, wellness, healthy thinking, and meaning—can empower you to withstand and learn from difficult and traumatic experiences.”^[9]

Therefore, when we think about resiliency, remember that it is not something we are born with or inherent within us. Instead, it is a set of protective factors and positive life strategies, which can include mindfulness, meditation, exercise, journaling, and other activities that promote internal regulation and healthy patterns in our lives.^[10]

[1] Community Resilience Initiative, Trauma Informed Level One Certification: Training for Trainers, CRIResilient.org.

[2] Community Resilience Initiative.

[3] Karen Benzies and Richelle Mychasiuk, Child and Family Social Work, Volume 14, Issue 1, “Fostering Family Resiliency: A Review of the Key Protective Factors”, page 103.

[4] https://arcframework.org/what-is-arc/.

[5] https://arcframework.org/what-is-arc/.

[6] https://arcframework.org/what-is-arc/.

[7] Community Resilience Initiative.

[8] Community Resilience Initiative.

[9] American Psychological Association, “Building Your Resilience”, https://www.apa.org/topics/resilience/building-your-resilience.

[10] Community Resilience Initiative.

Grant Management Basics: Preparing for Site Visits 

Efficient and Effective Grants Management Series 

Amia Barrows, Victims Services Grant Monitoring Team Supervisor 

Site visits are a way to demonstrate grant stewardship as well as compliance with the awarded funds. They give the awarding agency the opportunity to assess your organization’s infrastructure so that your program can deliver on its mission successfully. Effectiveness in grant compliance relies on having the proper policies and procedures in place and a robust system of internal controls and mechanisms to prevent fraud, waste, and abuse. Site visits examine all those aspects and more. In the life cycle of a grant, most folks say that site visits can be the most anxiety-inducing, especially if it is your first time or at a time when you feel less than prepared or if your organization is in a season of unexpected, unending transitions such as staff vacancies or funding fluctuations. You might be surprised to also know that the same folks also reported how, once they got through a visit, they were a lot less stressed and felt that they had a clearer understanding of what is required.

For those who have received a site visit, you know that they allow programs to demonstrate compliance, share achievements, and receive technical assistance on the policies or procedures that need to be implemented or revised to ensure that all grant requirements are satisfied. However, we also understand that folks who have never had a site visit do not know where, when, or how to get started or what to expect. A good process can be worth the reward and help you and your staff approach the process confidently without causing undue stress. Having a firm understanding of the grant requirements is essential to being prepared for the site visit process. In this edition, we’ve focused on helping your organization to be more efficient and effective in grant management. This article will walk you through the ins and outs of the monitoring process and site visit basics: how to prepare, what to expect, and ways you can increase your competence with the requirements and reduce any anxieties before, during, and after the monitoring process.

Please click the button below to read more on preparing for a grant monitoring site visit.

Amazing Advocacy  

Dione Bassett, Victims Services Program Specialist 

The Virginia Center on Aging (VCoA), which is part of the Virginia Commonwealth University College of Health Professions (https://vcoa.chp.vcu.edu/about-us/), is an excellent resource. It is a statewide agency created by the Virginia General Assembly in 1978 (https://law.lis.virginia.gov/vacode/title23.1/chapter23/section23.1-2311/). Their goal is to improve the quality of life for aging Virginians through research, education, service, and resources.

There are many examples of the huge impact of the VCoA. One is the creation of a toolkit that serves as a helpful resource for law enforcement and advocates. More information can be found here: https://vcoa.chp.vcu.edu/initiatives/abuse-in-later-life/projects/toolkit/

Another example is the Elder Justice Learning and Research Hub, created through collaborations with law enforcement, victim advocates, social services, faith communities, aging services, and more to create a “whole person” and “whole system” approach to improving the lives of individuals affected by abuse in later life. Find more information Another example is the Elder Justice Learning and Research Hub, created through collaborations with law enforcement, victim advocates, social services, faith communities, aging services, and more to create a “whole person” and “whole system” approach to improving the lives of individuals affected by abuse in later life. Find more information here.

Additionally, the Lifelong Learning Institute in Chesterfield is dedicated to providing educational and social opportunities for “adults age 50 and ‘better’”. For more information: https://vcoa.chp.vcu.edu/initiatives/lli/

And, last but NOT least, I started attending meetings with the Central Virginia Task Force on Domestic Violence in Later Life many years ago while working as an advocate in Henrico County. It educated me on the many barriers faced by this population but also about the opportunities and resources available to support them. It’s an AMAZING Task Force! If you are interested in joining the Central Virginia Task Force on Domestic Violence in Later Life, please visit the link found here: https://vcoa.chp.vcu.edu/initiatives/abuse-in-later-life/projects/dvill/

The Meaning Behind the Medusa Tattoo

Andrea Sutton, Sexual and Domestic Violence Program Professional Standards Compliance Coordinator

Medusa tattoos in recent years have been reclaimed by sexual assault survivors as a symbol of overcoming assault and survival. I was recently browsing through social media and came across some individuals posting about their Medusa tattoos. This piqued my interest, and I began researching this trend and wanted to share the information.  

According to certain interpretations of Greek mythology, Medusa was a beautiful young woman who devoted herself to Athena, the goddess of war and wisdom. As a priestess, Medusa remained celibate, keeping her promise to the goddess. Poseidon, god of the sea, saw Medusa's beauty and tried to seduce her. Medusa rejected him. Poseidon then raped Medusa in Athena’s temple. Athena was upset that her temple was desecrated and took her anger out on Medusa. Medusa was banished and cursed with the look we all know: the green gorgon with snakes for hair. Also, anyone who looked in Medusa’s eyes would be turned to stone, a power that Medusa used to protect herself.

How does this myth turn into an empowerment tattoo for sexual assault? The tattoo of Medusa has always been a representation of strength, female empowerment, and warding off evil. By showcasing the tattoo, sexual assault survivors are showing that they are unashamed, and it’s also a statement of power, protection, and overcoming trauma. Medusa was raped, cursed, and banished, but she lived to fight another day. That's exactly what survivors of sexual assault are doing today - living to fight another day with a renewed strength, a new sense of self, and a voice that will not be silenced.