Title: Keeping IT REAL: The Relational Effects of Trauma Among African American Women and Their Substance Abuse Treatment Counselors

Background and Purpose

African American women experience disproportionately high rates of interpersonal trauma. Studies report that 65%–88% of African Americans have had exposure to trauma in their lifetime. Women with histories of substance abuse report even higher rates of trauma, with lifetime estimates between 55% and 100% compared to women without a history of substance abuse.

Women who have histories of trauma have more difficulty maintaining positive, healthy relationships with others and have poorer substance abuse treatment outcomes such as shorter lengths of stay in treatment, higher rates of relapse, and continued drug use. Therapeutic relationships are a vehicle for emotional change and growth, as well as to repair damage resulting from interpersonal traumatic experiences. Using Relational Cultural Theory (RCT) as the theoretical lens, this study identified the types of relationships that African American women with extensive histories of trauma had with their substance abuse treatment counselors and the ways those relationships impacted their recovery. Studies regarding the client-drug counselor relationship are limited; this study increases our knowledge about trauma’s impact on the client-counselor relationship.

Methods

Using the Case Study Method, 26 in-depth interviews were conducted with African American women between the ages of 19 and 43 with extensive histories of trauma and substance abuse. The women used alcohol and other drugs between 3 and 37 years. One hundred percent of women experienced some form of interpersonal trauma ranging from 2 to 12 traumatic/adverse events. Participants were recruited from a gender specific substance abuse treatment center. The interviews were digitally recorded and transcribed verbatim by a professional transcription company. Data analysis consisted of coding the interviews to identify salient themes, using a case study technique of looking within and between cases to disconfirm, corroborate, and identify alternative explanations.

Findings

Data analysis revealed three types of relationships women had with their substance abuse treatment counselors: Reparative, Transactional, and Damaging. Sixty-eight percent of women had reparative relationships with their counselors. Reparative relationships consisted of positive characteristics that women attributed to their restoration and healing from interpersonal traumatic experiences. Reparative relationships had two primary characteristics: Empowering and Mattering. Forty-three percent of women had transactional relationships with their substance abuse treatment counselors. Transactional relationships have a scope of work limited to specific, short-term tasks in which parties maintain separate identities and have limited closeness. Transactional relationships had two primary characteristics: Task-focused and Superficial. Eight percent of women had damaging relationships with their substance abuse treatment counselors. Damaging relationships consisted of negative characteristics that made women feel unimportant, disempowered, and unsafe. They reinforced the women’s belief that people cannot be trusted or counted on when they need help.

Conclusions

Reparative relationships between counselors and clients may be the first positive, transformative relationship that many women have had. As RCT suggests, these relationships have the power to help African American women who have experienced trauma establish new ways of relating to others and increase their power in personal, interpersonal, and political realms. Creating positive, culturally sensitive, therapeutic relationships between clients and professionals is essential.