The Basics of Trauma Counseling for Urban Communities

As behavioral health professionals know, trauma is an unfortunate reality in many urban communities. Trauma is worsened by a lack of social and financial resources, substandard housing, and violence experienced by many urban residents.

How can we better understand urban trauma and prevent long-term negative effects on the brains and spirits of people living in urban communities?

Trauma in Urban Communities

In Daryl McGraw’s CWC training, “An Introduction to Trauma in Urban Communities: The Product of My Environment,” the trainer shares his personal experiences in the service of creating more understanding of the challenges faced by urban communities.

“I myself am a survivor of urban trauma,” McGraw writes, “For many years, I was oblivious to how my past events were controlling my current situations. What would appear as abnormal to some people was normal in my environment. Such as selling drugs or shooting someone for disrespecting you or retaliating for a friend or event that may have happened in your hood.”

McGraw emphasizes the importance of identifying trauma and understanding the ways it shapes behavior. “The brain is always capable of change,” says McGraw. “Human beings are not doomed to live in the past. But how do we change something that we don’t even know was a problem to begin with?”

When children are growing up in communities that experience high levels of trauma, that trauma needs to be recognized and treated.

Trauma in Childhood

In the Connecticut Women’s Consortium training, “The Long Reach of Childhood Trauma,” CWC executive director Colette Anderson, LCSW, explains that trauma is caused by an event or by the extreme stress of an event or circumstances that overwhelms a person’s ability to cope. Trauma threatens people’s physical or emotional health, and it can manifest in violence, hate crimes, sexual abuse, or anything that causes extreme stress.

It has an unequal impact on low-income people of color who live in under-resourced neighborhoods; racism and discrimination are forms of trauma.

McGraw explains that trauma can be situational or personal and that an individual’s response to traumatic experiences involves intense fear, horror, and helplessness.

One of the most common tools that behavioral health professionals use to assess whether someone has experienced trauma is called the adverse childhood experience (ACE) study.

Trauma in Mental Health and Substance Abuse Treatment

To illustrate the unequal and compound effects of trauma, McGraw cites studies showing that:

• 90% of public mental health clients have been exposed to trauma, and most have experienced trauma firsthand.
• 75% of people in substance use treatment report histories of abuse and trauma.
• 97% of unhoused women with mental illness have experienced severe physical and/or sexual abuse.

Urban Trauma

Urban trauma is not an official diagnosis or condition; it is a framework used to describe the way that racism, biology, and toxic environments affect the lives of urban people of color. One of the most well-known experts on urban trauma is Dr. Maysa Akbar, a Yale-educated psychologist and bestselling author. Dr. Akbar’s website, Urban Trauma: A Legacy of Racism, provides valuable resources for understanding the complex interplay of racism and trauma.

Urban trauma, according to McGraw, “keeps our prisons and jails filled and people stuck in poverty.”

Racial Trauma

Racial trauma, or race-based traumatic stress, is the physical, emotional, and psychological pain connected with experiencing or witnessing racism and discrimination. It intersects with the toxic stress that keeps people in a constant state of arousal as they respond to actual and perceived threats.

Toxic stress affects the brain, making it difficult for people to sit still, pay attention, or learn. It can affect impulse control and behavior and can cause extremes in emotion. It also makes people more vulnerable to heart conditions and strokes, obesity, and infections. It even has an impact on the hormones that affect growth, development, and puberty.

Racial trauma is especially present for people whose ancestors survived difficult experiences, passing along qualities called legacy burdens.

Author Dr. Joy DeGruy describes some of the experiences of Black urban residents as Post Traumatic Slave Syndrome. In her book by the same name, DeGruy explores her theory that many adaptive survival behaviors in Black communities in the United States and the diaspora are the result of generations of oppression of Africans and their descendants, who still experience institutionalized racism.

 DeGruy’s framework is M.A.P.

• Multigenerational trauma together with continued oppression;
• Absence of opportunities to heal or to access the benefits available in society; leading to
• Post Traumatic Slave Syndrome

Antiracist Clinical Practice

One of the key aspects of treating urban trauma is to acknowledge the profound impact that racism and discrimination have on clients' lives. Ignoring racism or taking a “colorblind” approach is ignoring the very factors that traumatize and harm communities of color.

A trauma-informed approach to treating people who live in urban communities of color means opening the door to discussions about race and racism. Many experts recommend bringing up race in the very first session with clients. After all, healing from racial trauma is part of the healing process.

Start with the ACEs

The CDC‑Kaiser Permanente adverse childhood experiences (ACE) study is one of the largest studies ever conducted to try to determine the effects of trauma on individuals. The ACE questionnaire is often the starting point for understanding what a person has experienced or witnessed in the past that informs their present.

The study, based on research by Dr. Vincent Felitti and Dr. Robert Anda, provided evidence that childhood exposure to violence, especially harm done by caretakers, has a lasting impact on mental and physical health.

The ACE Score Questionnaire includes questions designed to determine whether abuse of others was occurring in the home, and whether they grew up feeling like they didn’t have enough to eat, or if their parents were too impaired by drugs and alcohol to take care of them.

What Is Considered an ACE?

• Physical, sexual, or verbal abuse
• Physical or emotional neglect
• Witnessing your mother being abused
• Losing a parent
• Having a family member who is
• Depressed or diagnosed with another mental illness
• Addicted to alcohol or another substance
• Incarcerated

Cultural Humility and Cultural Empathy

Once behavioral health professionals understand the types and levels of trauma a client has experienced, they can approach clients with a sense of cultural humility. This means listening to and honoring the experiences of clients and recognizing the wisdom and resilience they have developed through their life experiences.

McGraw suggests an approach called “cultural empathy.” He suggests that we should:

• Respectfully experience the other person’s world
• Avoid assumptions about who they are and what they need
• Understand that there can be more than one truth in the same moment

When we become sensitized to the different ways that people adapt and survive in communities that experience high levels of racism and trauma, we lay the groundwork for recovery and thriving.