Abstract
Increased attention to the prevalence and impact of traumatic experiences have been highlighted within the mental health field since Felitti et al.'s study of adverse childhood experiences. Black communities experience traumatic events at a higher rate than other racial groups. The phenomena of historical trauma, race-based trauma, and intergenerational trauma have been speculated to be reasons for this discrepancy. In this article, the authors explore factors that compound the traumatic experiences of Black communities, review socioculturally attuned family therapy and trauma-informed care, and propose an approach to addressing intergenerational trauma in Black families that integrates socioculturally attuned family therapy and trauma-informed care.
INTRODUCTION
Across helping professions, there has been increased attention to the high prevalence rates of trauma among the general population and the needs of clients who have experienced trauma. Through meta-analytic studies, researchers have discovered disparities in the experience of trauma based on race and ethnicity. Roberts et al. (2011) found that of White, Black, Hispanic, and Asian individuals, Black individuals had an 8.7% lifetime prevalence rate of posttraumatic stress disorder (PTSD), the highest compared to other groups. Although researchers have highlighted the cultural limitations of PTSD as a diagnosis (Kirkinis et al., 2018), an examination of possible reasons for this discrepancy is warranted. For example, the high pervasiveness of violence experienced within Black communities could be a contributing factor to the imbalanced prevalence of PTSD. Homicide is a leading cause of death for Black males aged 15–19 (52.6%), 20–24 (47%), and 25–34 (32.7%). For every Black male death, there are four others hospitalized for gunshot injuries (Adams, 2014; Stopford, 2014). Furthermore, homicide is the second leading cause of death for Black females aged 1–4 (11.3%), 5–9 (11.7%), 15–19 (23.4%), and 20–24 (19.3%). Much of this exposure to trauma occurs in impoverished neighborhoods (Stopford, 2014). Black individuals, who make up 13.2% of the US population, represent 23.8% of impoverished communities, having the highest rate, 18.8%, of poverty as compared to their racial counterparts (Stopford, 2014; US Census Bureau, 2020).
One way to examine the prevalence of psychological trauma in Black communities is through the lens of historical and intergenerational trauma, which posits that an individual continues to experience the effects of the trauma experienced by their family members in previous generations (R. M. Phipps & Degges-White, 2014). For example, when a Black woman enters the counseling room after witnessing the shooting death of a family member, she may not only be carrying the present trauma, but also the trauma of racism experienced by her great-grandmother. In this scenario, it is imperative that the mental health professional (MHP) exhibits the cultural competence and cultural humility suggested by the Multicultural and Social Justice Counseling Competencies (MSJCC; Ratts et al., 2016). Throughout the article, the authors define MHPs as any licensed or prelicensed therapist or social worker, regardless of social, cultural, and ethnic identity, who serve clients with mental health and well-being challenges.
The MSJCC, a revision of the multicultural counseling competencies discussed by Sue et al. (1992), considers the intersectionality (i.e., the overlapping cultural identities that contribute to one's worldview; Crenshaw, 1989) of individuals and the multiple systems (e.g., family system, community system, religious system, etc.) they are impacted by every day. Ratts et al. (2016) note that multicultural and social justice competency is not a destination but a lifelong journey toward increased understanding of the complexity of culture and social justice advocacy. The American Association for Marriage and Family Therapy's (AAMFT) code of ethics (2015) notes the importance of advocacy alongside service and public participation. As such, MHPs who serve families, particularly families with marginalized identities, must also engage in cultural humility (i.e., an aspect of clinicians' multicultural orientation that involves being open, other-oriented, and collaborative; Hook et al., 2013) and social justice advocacy.
One way MHPs can do so is by integrating socioculturally attuned family therapy (SAFT; Knudson-Martin et al., 2019), an approach that centers the sociocultural positions of the family and its members by infusing sociocultural concepts into the framework, into their work with families. Further, infusing this lens with trauma-informed principles (TIP) allows for a distinct transtheoretical framework that can more effectively meet the needs of Black families (Haskins & Singh, 2015). However, researchers have yet to explore the notion of trauma-informed SAFT as an approach that can be integrated with an evidence-based trauma treatment to address intergenerational trauma in Black communities and families. Therefore, the purpose of this article is (a) to highlight the prevalence and subsequent needed attention to trauma in the Black family, (b) to discuss the SAFT framework (c) to describe trauma-informed care and principles, and (d) to apply the construct of trauma-informed SAFT to intergenerational trauma in the Black families.
TRAUMA AND MENTAL HEALTH IN BLACK COMMUNITIES
According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), trauma is the experience of actual or threatened death, serious injury, or sexual violence (American Psychiatric Association, 2013). Additionally, in the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), complex PTSD is defined as prolonged exposure to a significantly horrific or threatening event or a sequence of events characterized whereby escaping is difficult or impossible (World Health Organization, 2019). PTSD in the DSM-V and ICD-11 have several overlaps, however, the latter specifically notes the impact trauma has on relational aspects of an individual's life (World Health Organization, 2019). This definition gives further insight into why Black individuals have reported a higher lifetime prevalence of PTSD than their White, Afro-Caribbean, Latinx, and Asian counterparts (Alegría et al., 2013; Roberts et al., 2011). Alegría et al. (2013) highlighted the need to understand the reasons for such discrepancy in PTSD prevalence across racial/ethnic groups. The phenomenon of intergenerational trauma can begin to provide some insight into these discrepancies.
INTERGENERATIONAL TRAUMA AND BLACK FAMILIES
Before discussing intergenerational trauma, it is necessary to understand salient concepts that can undergird this phenomenon specifically as it relates to Black families. One such concept is race-based traumatic stress injury (RBTSI). RBTSI is defined by Carter (2007) as the threat of or actual “physical and emotional pain that results from racism in the forms of racial harassment (hostility), racial discrimination (avoidance), or discriminatory harassment (aversive hostility)” (p. 88). Further, researchers have defined the phenomenon as the physical, emotional, psychological, and spiritual impact an individual endures after their safety and sense of self has been threatened due to racism (Evans et al., 2016; Hardy, 2013; Paradies et al., 2015). Symptoms of RBTSI have been likened to those experienced by survivors of domestic violence and sexual assault to include rage, depression, devaluation of the self, alcohol use, and health complications (Evans et al., 2016; Hardy, 2013; Ullman et al., 2013). Carter (2007) recognized RBTSI as a result of the historical oppression, or trauma, that has been perpetuated by distorted beliefs about people of color.
Historical trauma, another concept that undergirds intergenerational trauma, is the “cumulative emotional and psychological wounding over the lifespan and across generations, emanating from massive group trauma experiences” (Brave Heart, 2003, p. 7). Other scholars describe historical trauma as a “subjective re-experiencing and recollection of traumatic events by an individual or a community over multiple generations” (R. M. Phipps & Degges-White, 2014, p. 177). In considering slavery as a historical trauma within Black communities, it is recognized that Black individuals and families may still be wounded from the kidnaping and stripping of their ancestors' culture, separation of family members during slave auctions, and the inhumane treatment permitted by Slave Codes (DeGruy, 2017; Graff, 2011; Iliffe, 2017). While slavery was legally abolished in 1865, its impact continued through the years of Jim Crow, where Black communities continued to be subjected to racial segregation, unequal education, lynching, and various brutalities (Graff, 2011). The subjugation of the African people during the time of enslavement is speculated to have permitted the subsequent oppression of Black communities (DeGruy, 2017).
Described as the renewing of traumatic stress through each generation as the effects of the original trauma are continually witnessed, research on intergenerational trauma has focused on the survivors of the Holocaust (Milner et al., 2010). From this, intergenerational transmission has been described as the process of children learning how to respond to their surroundings in a similar way as their parents responded to their own surroundings (Bowers & Yehuda, 2016). Thus, intergenerational transmission of trauma is inherently systemic as traumatic stress can be passed from parent to child and subsequent children. Systemic thinkers understand the salience of attachment for childhood development, which can be impacted due to caregivers' trauma responses (i.e., avoidance, hypervigilance, etc.; R. M. Phipps & Degges-White, 2014). With this, they can recall that adverse childhood experiences such as parental abuse and neglect can have long-term physical and psychological effects (Felitti et al., 1998).
In considering the children of slavery survivors (i.e., many Black individuals and families), the phenomenon of posttraumatic slave syndrome (PTSS) theory was first discussed by Leary (2001) within the context of African American male youth violence. Leary (2001) noted that as a direct result of slavery and the dismantling of the African culture, African Americans continue to endure traumatic injury through the inequity, racism, and oppression perpetuated by society. PTSS theory differs from PTSD, a diagnosis criticized for its lack of cultural considerations (Kirkinis et al., 2018), as it involves perpetuated racism and oppression. However, the symptoms of PTSS are similar to PTSD (e.g., angry outbursts, difficulty concentrating, and hypervigilance), and were likely exhibited by survivors of slavery (Leary, 2001). The traumatic effects of slavery are transmitted through family systems and society's continued oppression of Black communities. Thus, survivors of slavery raised their children while managing its psychological impact (i.e., PTSD) and the resulting symptoms became a learned behavior in descendents of slavery survivors.
While MHPs have given more attention to trauma and its impact on the general population, there remains a gap regarding intergenerational trauma. The impact of race-based historical events on generations of Black families has not been thoroughly explored and considered in current approaches to trauma and family counseling. Although MHPs are becoming more aware of the intergenerational trauma Black families and communities have and continue to experience, they may have difficulty understanding how to give space to the realities of intergenerational trauma and systemic oppression in family counseling. Professionals serving families should consider integrating SAFT into their practice to provide a systemic lens to their evidence-based trauma approach of choice.
TRAUMA-INFORMED CARE
Felitti et al. (1998) study of adverse childhood experiences, which posits that the experience of abuse or neglect during childhood increased an individual's risk for multiple fatal diseases, increased MHPs' attention to trauma-informed care. However, the skewed racial demographics of the study, with approximately 5% of participants identifying as Black as compared to 80% White, 5% Hispanic, 6% Asian, and 4% other (Felitti et al., 1998), researchers began to recognize the need to treat trauma survivors without retraumatizing (i.e., triggering traumatic memories that interfere with healing) them. More recently, researchers have noted that many individuals from marginalized communities also have symptoms of traumatic stress and PTSD (Brooks Holliday et al., 2020). Thus, to avoid further harm, the trauma-informed provider (TIP) has an awareness of an individual's history of trauma and cultural implications of trauma, is cognizant of relational dynamics that may be a reminder of a traumatic experience, and uses a holistic approach to treatment (Butler et al., 2011; Freeman, 2001; Harris & Fallot, 2001). Additionally, the TIP understands trauma is a formative experience, in which past experiences can continue to impact an individual's current functioning (Butler et al., 2011).
Before discussing the specific principles of trauma-informed care, it is necessary to distinguish being a TIP and providing evidence-based trauma treatment or intervention. The TIP engages with their clients from a set of principles that provides the context in which an evidence-based trauma treatment is best employed (Substance Abuse and Mental Health Services Administration, 2014). Evidence-based trauma treatments include cognitive processing therapy (Resick et al., 2017), prolonged exposure therapy (Foa et al., 2007), and trauma-informed cognitive behavioral therapy (TF-CBT) (Cohen & Mannarino, 2008) to name a few. The TIP engages clients in evidence-based treatment (EBT) in which they have received the necessary training. However, it is noted that the way in which evidence-based trauma interventions are engaged and delivered (i.e., through trauma-informed practices) have an impact on the effectiveness of treatment (Substance Abuse and Mental Health Services Administration, 2014).
Researchers have identified specific principles or components for which a TIP or organization should ascribe. The primary tenets include a focus on (a) safety, (b) trust and transparency, (c) power and empowerment, and (d) collaboration. First, TIPs should strive to maintain the physical (e.g., a secured facility) and psychological (e.g., staff who are welcoming and accommodating) safety of their clients (Butler et al., 2011; Substance Abuse and Mental Health Services Administration, 2014; Sweeney & Taggart, 2018). Second, TIPs promote trust and transparently communicate the mission of the therapeutic process and organization (e.g., being open about reasons client information is gathered; Substance Abuse and Mental Health Services Administration, 2014; Sweeney & Taggart, 2018). Third, utilizing a strengths-based approach, TIPs address the power differentials within the therapeutic relationship while simultaneously fostering an environment in which the client can assert their voice and feel empowered (Substance Abuse and Mental Health Services Administration, 2014; Sweeney & Taggart, 2018). Finally, to assist with leveling of power, MHPs replace the helper–helpee role with a collaborative partnership, involving the client in their care (e.g., inviting the client into the diagnosis process; Substance Abuse and Mental Health Services Administration, 2014; Sweeney & Taggart, 2018).
In addition to utilizing an evidence-based trauma treatment and implementing the principles in your practice, trauma-informed MHPs must be aware of and move past their own biases, provide inclusive care, and be aware of the nuanced needs and vulnerabilities of various cultures (Butler et al., 2011; Substance Abuse and Mental Health Services Administration, 2014). However, there remains a gap in understanding how to engage in culturally appropriate trauma-informed care with families of color, which is an important consideration in avoiding retraumatization. As a socially just way of engaging in the therapeutic process, trauma-informed SAFT can fill this gap.
SAFT
Due to the pervasive nature of intergenerational trauma in Black communities, therapeutic approaches that give attention to the sociopolitical location of a family, as well as the social justice issues they may face, must be considered when counseling Black families. Knudson-Martin et al. (2019) developed SAFT to give attention to social justice issues within the family system and promote third-order change (i.e., connecting families' experiences to broader systems to promote socially transformative change; McDowell et al., 2018). More specifically, SAFT is defined as practicing awareness and being responsive “to the intersections of societal context, culture, and power in client experience and positioned to promote equity” (Knudson-Martin et al., 2019, p. 1). Socioculturally attuned therapy involves attunement, which involves being with clients while emotionally connecting with their experience (D'Aniello et al., 2016; Knudson-Martin et al., 2019). Sociocultural attunement may be integrated into family and couples therapy by way of instilling social context and power disparities into existing family and couple interventions and strategies (McDowell et al., 2018).
A socioculturally attuned therapist understands the impact of power dynamics and oppressive systems on the familial issues presented in the session (Knudson-Martin et al., 2019). According to Knudson-Martin et al. (2019), MHPs can do this through six transtheoretical guidelines: attune to context and power, name injustice, value what is minimized, intervene in power dynamics, envision just alternatives and transform to make the imagined reality. While these guidelines can help MHPs attune to the sociocultural factors that are impacting a family's functioning, they are missing an explicit consideration of trauma, specifically generational trauma, that is inherent when families navigate oppression. Thus, trauma-informed care and TIP should also be taken into consideration.
TRAUMA-INFORMED SAFT
The presented approach illuminates the complexity of intergenerational trauma in Black families with the goal of engaging the family in culturally responsive and trauma-informed care. To do this, the trauma-informed SAFT model (TI-SAFT) integrates TIP into sociocultural attuned family therapy. The proposed framework is transtheoretical and should be utilized in conjunction with an EBT for trauma and PTSD. An overview of EBTs for PTSD is beyond the scope of this article. However, MHPs are encouraged to consider the use of evidence-based approaches such as cognitive processing therapy (Resick et al., 2017) or prolonged exposure therapy (Foa et al., 2007) when treating trauma. It is necessary to note, though, that there are no evidence-based family therapy approaches for treating cultural or intergenerational trauma in Black families. MHPs are encouraged to explore culturally adapted cognitive behavioral therapy (CA-CBT), which is an empirically supported approach (see Hinton et al., 2004, 2005, 2011) to treat PTSD among refugees and ethnic minorities. MHPs can also explore TF-CBT, which is a culturally responsive systems-oriented, evidence-based approach to addressing trauma experienced by children and adolescents (Cohen et al., 2006; Hinton et al., 2012; R. Phipps & Thorne, 2019).
Attune to context and power
A trauma-informed socioculturally attuned provider working with Black families recognizes the disenfranchisement and abuse Black communities have experienced by healthcare providers for centuries (Armstrong et al., 2013; Harris et al., 2020). The MHP is aware of the threat of power differentials within the therapeutic relationship due to sociopolitical factors and strives to create an environment of safety and trustworthiness. The MHP can foster safety and trustworthiness through transparency about themselves (i.e., clinical background and cultural identities) and the therapeutic process. Further, Day-Vines et al. (2020) note the importance of MHPs discussing cultural differences between themselves and the family while also expressing acceptance and affirmation of the family's cultural experiences. Openness to the family's worldview, culture, and how their identity influences their lives (Ratts et al., 2016; Tervalon & Murray-García, 1998) promotes trust and safety in the therapeutic relationship as well (Ratts et al., 2016). The MHP can then begin to decrease any hypervigilance the family may be experiencing engaging in counseling.
The MHP moves slowly in forming the relationship and joining with the family, being sure to note that the family members, not the clinician, are the experts of their experience. Scholars indicate that it is important for the MHP to convey that they want to understand more of the family's lived experience (Knudson-Martin et al., 2019; Owen, 2013). During this process, the MHP invites the family to discuss their life circumstances and current functioning by ascertaining information about their histories and daily life. While listening, the MHP begins to note how the intersection of the family's cultural identities, cultural history, and the current sociopolitical climate may impact the family's presenting concerns.
Consider the case of Nicole, a 34-year-old cisgender, biracial, female family therapist who is seeing an African American family presenting for family therapy due to their 8-year-old son's, Damon, struggle with anger. In beginning her work with the Harris family, Nicole utilizes the genogram as a tool to join with the family and get to know their story from their perspective. The genogram is an assessment tool used in systems family therapy and an original Bowenian technique (Sherman & Fredman, 1986). The genogram illuminates the context in which maladaptive behaviors, in response to multigenerational oppressive systems, were passed down through generations. Within this exploration, Nicole also begins to examine how family members may have been enacting societal power through familial relationships.
In discussing their genogram, Nicole learns about the experiences Vivian, a 44-year-old home healthcare business owner, and Darius's, a 46-year-old realtor, parents had with race-based trauma and its generational effects. Darius shares that he has been in recovery from drinking for 7 years. However, he suffers from bouts of depression for which he has sought no medical or clinical intervention as he just tries to “power through” those times. When Nicole inquires about Darius's need to “power through,” he recalls his father, Walter, drinking throughout his childhood to, presumably, cope with being beaten and nearly killed by a group of White teenagers. Walter suffered permanent damage to his leg, losing physical power and autonomy, preventing him from getting many jobs. As a way to alleviate employment-related stress from Darius, Vivian asserts that she is a hard worker who learned the value of work from her mother and grandmother, who killed their happiness to provide for their families. Vivian learned that to feel a sense of power in her role as a mother, she minimized her needs to work hard for her family.
Considering the context of historical and generational trauma, Nicole recognizes the pervasive impact the removal of power from Black communities has made on Black families. As such, the need for safety and trustworthiness in the therapeutic process is heightened, as it is necessary for the family, particularly the parents, to know that she will not usurp their power. Nicole is transparent with the family about how she sees the impact of generational trauma contributing to Vivian and Darius's stress as well as Damon's anger. Through this transparency, safety is continually fostered and Nicole is able to gain pertinent information that highlights the context in which the family's current situation lives. Additionally, Nicole considers how her own upbringing may have been privileged in its absence of overt racism and racial trauma due to differing family history.
Name injustice
The trauma-informed socioculturally attuned clinician names injustices the family and its members have experienced. The MHP humbles their ego to acknowledge their areas of ignorance and becomes curious about the family's experience of racial, historical, and intergenerational injustice, being sure not to impose their own view of social injustice on the family. For example, continuing to utilize the genogram, Nicole notes the sociopolitical climate each generation represented on the genogram may have experienced. While doing this, she takes the time to name the injustices the family's ancestors and the family themselves have endured. Furthermore, Nicole emphasizes that the impact of these injustices may have been passed down in the form of maladaptive behaviors, such as the anger Damon presents. Specifically, while naming the injustice Walter suffered, Nicole's reflection may start with the following, “I have not had the same experience, but in having a Black father, I can imagine the anger you (Darius) must have felt after this injustice happened to your family. I would not be surprised if that anger still remains after all these years.” With this, Nicole has named the injustice while leveling the power dynamic (i.e., naming her lack of experience with this injustice). Nicole is also continuing to create a safe environment through her recognition of her own limitations and the injustice the family experienced. With continued shifting in power dynamics, Darius uses his voice in the therapeutic relationship to agree that he feels underlying anger all the time. Vivian expresses her shock as she has never heard Darius admit to being angry all the time.
From here, Nicole continues to process the impact of this injustice on Darius and his family, using verbal and nonverbal affirmations (e.g., saying “mhm” or gently nodding head) while being careful not to impede her own perspective or reactions so that Darius's story can be told without biases and assumptions. With humility, Nicole encourages and empowers Darius and the rest of the family to utilize their voices in the session as the expert of their own experience (Substance Abuse and Mental Health Services Administration, 2014; Sweeney & Taggart, 2018). Vivian and Damon continue to express the anger they have felt from Darius and how it has affected them.
Value what is minimized
The trauma-informed socioculturally attuned MHP takes particular interest in and time to highlight the values and strengths of the family that may not be appreciated in the dominant culture. Valuing what is minimized promotes safety, trust, and transparency in the therapeutic relationship. Furthermore, by valuing family traits that are minimized in the dominant culture, the MHP empowers the family's innate understanding of their culture and familial needs.
As the Harris family sometimes found it difficult to show up to all the sessions in person, Nicole introduced the Home Visits technique. The home visit allows the MHP to observe the family in the home and develop a fuller understanding of family functioning (Sherman & Fredman, 1986). From a socioculturally attuned standpoint, this allows the therapist to further attune to the experiences of the family and gain more insight into their strengths.
Once the family has agreed to home visits, Nicole highlights their vulnerability and willingness to let her in their home. Nicole also empowers the family to voice any boundaries they may have in their home before she visits. During the home visits, Nicole learns more about the family's values and rituals. Nicole notes the family's unique values and rituals as strengths that appear to contribute to a comfortable home environment. The home visits confirm that Damon's behavior is displayed more at school and as such Nicole emphasizes the positive impact of the family's values and home rituals. During discussions regarding the difference in Damon's behavior, it is noted that his school is located in a White-dominant area and Damon shares that he does not feel safe there. The other boys in his class are white and always want to know why he “has black skin.” Damon shared that his grandfather, Walter, told him to not trust the other boys and although he is scared of them he tends to lash out first when they talk about his skin color. Damon told the therapist he “gets scared and doesn't feel safe,” so he hits them. Damon says he doesn't know why he is scared and that all the teachers “hate him” and think he is “bad.”
Through fostering safety and empowerment, Nicole has provided Damon a space to give voice to his internal process. Considering the context of systemic oppression the Harris family and their ancestors live within, Nicole notes Walter's attempt to protect his grandson through his advice to not trust the boys at school as a byproduct of historical and intergenerational trauma. As home visits continue, Nicole continues to value the traits and strengths of the family. In turn, the family becomes more comfortable and trusting of Nicole. Being invited deeper into the family's experience, Nicole becomes more aware of how systemic marginalization has led to maladaptive coping strategies within the family over multiple generations. The visits have highlighted how Damon is the most recent descendant to be the recipient of generational trauma and anxiety.
Intervene in power dynamics
The trauma-informed socioculturally attuned MHP pays attention to, names, and intervenes in power dynamics in and outside of the therapeutic relationship. Intervening in power dynamics within the relationship involves empowering the family through collaboration on the therapeutic plan and process. Through this, all family members have voice and choice in the therapeutic relationship and process, including youth.
Nicole began intervening in power dynamics at the beginning of the relationship by (a) being transparent about the nature of power dynamics in the therapeutic relationship, (b) inviting the family to collaborate on the therapeutic process (i.e., formulating goals, objectives, and interventions together), and (c) inviting Damon into conversations and asking his opinion early in the relationship. Furthermore, Nicole's implementation of home visits prompted a shift in dynamics as Nicole positioned herself as a “follower” while in the family's home.
To examine and intervene in power dynamics outside of the family, Nicole utilized the Ecomap technique. The Ecomap (Guerin, 1976; Hartman, 1979), a family sociometric technique, is a map developed to show the family's connection with organizations, institutions, and other families (Sherman & Fredman, 1986). The intention is to highlight where support, tensions, and issues affect the relationship. The goal of this technique is to facilitate conversation as it shows each person's place in the community and the connection with systems and stressors as a result of interacting with these systems (Sherman & Fredman, 1986). While engaging in these discussions, the MHP can ask probing questions such as “How much power do you feel you have or do not have in this system (e.g., school system)?” to engage in discussions about the oppressive power imbalance the family may be experiencing.
During the ecomap exercise, Darius shares his distrust in systems and institutions helping African American people, a byproduct of historical and generational trauma (Armstrong et al., 2013; Harris et al., 2020). However, he realizes that Damon needs help and admits to the genogram helping him see how this particular generational trauma has been passed down. The ecomap displays areas where support should be, but the family questions whether they really can rely on support from these institutions, noting that they feel they have little to no power in them. Vivian wonders about the presence of African American parents on the school board, or at the very least, allies in understanding the family's needs. Damon recognizes the lack of power he feels at school and still struggles to identify who he can trust to share his fears and the truth behind his anger. Nicole offers to use her power as an MHP to be an advocate for Damon and requests a release so she can visit and speak to the school counselor and teacher. As the family has developed a collaborative and trusting relationship with Nicole, they do not hesitate to complete a release and accept Nicole's offer.
Envision just alternatives
From the Ecomap, the family begins to envision just alternatives, such as Nicole helping to advocate for Damon at school. More specifically, Nicole names the injustices Damon and his parents are experiencing while connecting the injustices to feelings and actions the family has been experiencing (i.e., Damon's school behavior and Darius's anger). Vivian admits that she is often confused in school meetings because she does not understand much of the jargon used by school professionals. Nicole normalizes this feeling, noting that school professionals often have language that is not accessible to parents who are unfamiliar with the school system. This language and knowledge capital held by school professionals imbalances the power in the room. The family and Nicole collaboratively agreed that Nicole's presence at the next school meeting was a just alternative to Vivian going alone. In addition, during the session before the school meeting, Nicole will review previous behavioral documentation from the school and help the family understand what it means. The family agreed preparing before the meeting will give the family more power in the room when decisions are being made about Damon's education.
It is important to note that Nicole does not use her cultural and institutional power to save the Harris family from institutional marginalization. Instead, Nicole is partnering with the Harris family to amplify their own voice in service of Damon's education. Nicole's continual reflection of her sociocultural locations (i.e., one's identities and the power they hold) has allowed her to operate from a space of cultural humility in conjunction with cultural competency.
Transform to make the imagined real
Beyond assisting the family in envisioning just alternatives, the trauma-informed socioculturally attuned MHP continues to follow up with the family on their progress. For example, beyond the one school meeting, Vivian's goal was to be more active in Damon's education. Recognizing her and Darius's families were not active in their education, leading to a difficult relationship with the educational system, Vivian's goal of being more involved combats the generational narrative about education. A few weeks after the school meeting, Nicole follows up with Vivian and the rest of the family on Vivian's goal. Vivian admits she continues to be wary of contacting Damon's teacher and school counselor because she does not want to sound uneducated. Nicole normalizes this fear and provides Vivian space to explore this emotion and its relation to generational trauma. Darius and Nicole then remind Vivian of how well she engaged with Damon's teacher and school counselor at the meeting and empower Vivian to continue to use her voice. Recognizing the physical support she may need, Darius also offers to sit next to Vivian as she makes the calls to help calm her fear.
The case study presented is a brief example of how an MHP can incorporate a trauma-informed socioculturally attuned framework into their work to address intergenerational trauma in Black families. It is important to note that when working with marginalized communities, such as Black communities, the MHP should be active in gaining cultural knowledge about the adversities these communities face (i.e., various forms of oppression). While families are the best source of information on their experiences, additional knowledge about cultural adversities can be gained through scholarly literature, continuing education, or engaging in culturally educational activities in the community. Gaining such knowledge will bring an awareness to the MHP that can be used to expand their understanding of the experience their family shares with them. Throughout this process of learning, the MHP remains self-reflective, utilizing supervision, and consultation when needed.
DISCUSSION AND IMPLICATIONS
The proposed framework incorporates TIP into SAFT to address intergenerational trauma within Black families. The trauma-informed SAFT framework provides MHPs a foundation from which to employ an evidence-based trauma approach to adequately counsel Black families whose current functioning has likely been impacted by the historical trauma and perpetuated oppression endured by Black communities throughout generations. With the proposition of this framework, there are a few implications for education, practice, and research.
Implications for education
As a framework that provides context to an MHP's practice, MHPs must seek external training in evidence-based trauma treatments to utilize in tandem with the proposed model. It is imperative that any MHP who works with or intends to work with those affected by trauma receive adequate training in evidence-based trauma therapy. We have already mentioned a few evidence-based approaches (e.g., cognitive processing therapy, prolonged exposure therapy, trauma-focused CBT, etc.), however, MHPs can also consider the use of Narrative Exposure Therapy which has garnered significant results in treating those with complex cultural traumatic experiences (Lely et al., 2019; Neuner et al., 2004).
Implications for practice
While there are family therapy approaches that consider culture and generational factors in addressing family concerns (e.g., Minuchin and generational therapies), growth in the family therapy field is needed. Overall, the foundational systems models including structural, human validation process, strategic, and transgenerational models, do not focus on the distinctive psychological outcomes resulting from intergenerational trauma in Black families. Additionally, family therapy models specifically focus on the present and the future, with only the transgenerational model considering the impact of, at minimum, the last three generations (Alzoubi, 2018; Goldenberg et al., 2017). Oftentimes, time is not spent on the historical and generational transmission of race-based traumatic injuries inflicted before the last three generations or in the past at all. Therefore, Black families are not given the space to unpack how their cultural history affects the present. With the proposed approach, Black parents will be encouraged to look into familial anxiety, stress, and trauma resulting from the history of slavery, reconstruction, redemption (Emberton, 2013; Gates, 2020), and Jim Crow laws.
Moreover, traditional family therapy approaches do not consider third-order change, which is the consideration of sociopolitical systems that affect the family members and the initiation of actions required to make social change (McDowell et al., 2018). Rather, systems family therapy focuses on second-order change (i.e., changing how family members relate to each other). Given this, support in the therapeutic space for Black families will be strengthened with the proposed model's focus and acknowledgment of the systemic social systems that sustain race-based inequities. The proposed approach does not pathologize Black family members, but recognizes the impact of deeply entrenched societal systems and a dominant culture resulting in generational trauma. The MHP can use this proposed model to create trust, safety, and transparency for Black families in the therapeutic space by naming, incorporating, and addressing cultural components when providing care. As the family counseling field is moving toward a more critical examination of itself and its practices, foundational models are being repositioned as models that can serve more diverse populations.
The MHP can use the trauma-informed SAFT approach to make a paradigmatic shift in understanding the lived experiences of Black families, specifically unpacking the role of racism, intersectionality, and other sociopolitical factors. Part of this understanding should be the recognition that Black communities are vast and diverse. With this, MHPs should engage in culturally competent and humble practices including the continuum of self-reflection and critique to remain humble, seeking to learn rather than confirm prior knowledge. Further, MHPs should increase awareness of their cultural background, strengths, limitations, and biases related to race and other marginalized identities (Mosher et al., 2017; Sue et al., 1992; Tervalon & Murray-García, 1998). One way to assist MHPs in self-reflection and critique is engagement in supervision and consultation to strengthen their competence and develop humility. Additionally, using the MSJCC competencies (Ratts et al., 2016) is a helpful tool for MHPs to reflect on and address their own sociopolitical location in relation to the Black families/communities they work with.
Implications for research
As a theoretical model, future research is needed to develop and strengthen the proposed approach as well as the assertions made in this article that supported its inception. To develop and strengthen the model, more empirical research is needed to understand intergenerational trauma in Black families, the varying levels/types of trauma experienced and how it manifests generationally, and how intergenerational trauma shows up across Black families with different cultural identifiers (e.g., socioeconomic status). Additionally, future research is needed within the mental health field on how intergenerational trauma can be assessed, attended to, and engaged within the therapeutic space. The authors propose that by engaging in this research, it will provide MHPs increased competence in working with intergenerational trauma and implementing the model proposed in this article.
With the outcomes generated from this research, scholars can implement this to not only strengthen the model, but have a solid foundation to begin testing its efficacy. Here, the efficacy being tested would be twofold: (a) to assess how the model works when providing mental health services to Black families and (b) to demonstrate the validity of the model. To test the efficacy, exploratory methods of research, such as qualitative or mixed method designs, can be used to collect data on how MHPs learn and incorporate the model into their clinical practice. Further, exploratory research can assess what does and does not work within the model when working with Black families and provide feedback on the effectiveness of the model with Black families.
Furthermore, while researchers have begun to examine the similarities between the impact of race-based trauma and PTSD symptoms (Carter et al., 2020; Kirkinis et al., 2018), continued research on the complexity and impact of race-based, historical, and intergenerational trauma is needed. Specifically, researchers are urged to examine these phenomena and the impact of specific, current traumatic experiences (e.g., mass incarceration, the Black Lives Matter movement, and systemic oppression) to poignantly address the experience of Black families and increase positive therapeutic outcomes. Qualitative approaches to explore these issues can further inform trauma approaches.
CONCLUSION
Black communities are vast and complex and thus there are many ways to support Black families on their journey to healing intergenerational trauma. The authors have provided one theoretical way MHPs can address intergenerational trauma in family counseling. Knudson-Martin et al. (2019) developed a therapeutic framework that centers the sociopolitical location of the family and its family members. SAFT can be useful in counseling Black families. However, a Black family's presenting concerns may be compounded by the impact of historical, race-based, and intergenerational trauma. As such, MHPs may consider incorporating a trauma-informed approach into their use of SAFT (i.e., TI-SAFT). In this, professionals can utilize evidence-based trauma treatments with a trauma-informed sociocultural attuned family framework to address the impact of intergenerational trauma in Black families.