Trauma-Informed Care for LGBTQ Survivors of Sexual Violence

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Trauma-Informed Care for LGBTQ Survivors of Sexual Violence

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Providing trauma informed and survivor-centered care to individuals who have been sexually assaulted requires deep knowledge about the layered physical, mental and spiritual impacts of sexual trauma. However, care can be greatly enhanced when the practitioner also understands and is sensitive to the survivor’s unique identity/identities and how it/they might impact their experience, perspective and healing journey after sexual violence.

Our national statistics demonstrate that sexual violence impacts people of all genders and sexual orientations. Yet, there remain multiple barriers to receiving care and support services for LGBTQ survivors resulting from the institutionalized patriarchy, heterosexism, homophobia and transphobia in our society. Many of our support systems are designed in such a way that accessing them as an LGBTQ survivor may be prohibitive, and in fact, might increase vulnerability and reduce safety for the survivor, or possibly, further traumatize them.

In the city of Chicago, a healing center named Live Oak has been at the forefront of providing specialized, holistic healing arts services to survivors within the LGBTQ community for nearly a decade. At their two locations, Live Oak offers individual, family and group support services and a variety of therapeutic interventions that engage the body, mind and spirit. Importantly, Live Oak also provides professional training for practitioners that want to expand and improve their ability to support this community as well as support their own self-care practice. The Breathe Network has been fortunate to call Live Oak a partner in our work and we were inspired by the conversation we had with one of their co-founders, Jeff Levy, and think you will be too!

The Breathe Network: Can you tell me about why you and Bruce Koff decided to create Live Oak?

Jeff Levy: Although Live Oak has been incorporated since 2004, its history goes back to 1995 when Bruce and I first met as the result of a shared client. Bruce was in private practice in Chicago and had been seeing a young woman–a survivor of childhood sexual abuse, and I was facilitating a group for female survivors of sexual abuse. Bruce’s client was in the group, and we began collaborating about how to best meet her needs. As we got to know each other in those first months, we quickly learned that our styles were similar, our philosophies consistent, and our beliefs about “good therapy” were synonymous. We developed a professional relationship based on trust and mutual respect. Within months, we began to think about how we could work together more regularly.

With Bruce’s practice focusing on gay men and my practice focusing on trauma, we decided to co-facilitate a group for gay male survivors of childhood sexual abuse. In 1996, we launched this first group with eight gay men. Neither of us having facilitated a group of this nature, and not having worked so closely, we were faced with many challenges. Certainly, there were the clinical challenges of working with men who were dealing with the effects of interrelated stigmas. Additionally, there were the challenges of learning to work together this closely – learning to support one another, have constructive conflict with one another, and learning to grow together in ways neither of us thought possible. We continued this collaboration for several more groups and I eventually moved my practice to Chicago, across the hall from Bruce’s practice.

With greater geographic proximity came additional conversations about growing our practices and moving them together in some way, shape, or form. We began sharing more and more cases. Bruce would see a couple and I would see one of the individuals in the couple. I would see an individual who was in one of Bruce’s other groups. Bruce would see an individual who was in my group. We began having regular weekly consultation meetings. We talked clinically about our cases, we talked about professional issues, and we talked about the challenges of being in solo private practice and the comfort we found in being able to depend on one another.

Our conversations became more serious about creating a practice together. We dreamed about space, others with whom we would work, training other professionals, collegiality, and how we could do better work for and with our clients. As our conversations became more serious about creating some type of “entity” we also learned more about each other. We struggled with how to create something within which we could feel fully authentic, be vulnerable when necessary, and trust that conflict would be resolved quickly and productively. One of our biggest conflicts, believe it or not, was what to call ourselves!

In 2003, we began developing an action plan to consolidate our practices. We started thinking of names and nothing seemed to fit. The Center for This or That didn’t feel right to either of us. We wanted something that represented strength, growth, integration, connection, life…that didn’t sound sterile or antiseptic or like a building somewhere. Bruce shared with me a Walt Whitman poem to which he felt drawn about a live oak growing in Louisiana. The poem touched me as well and within minutes, “Live Oak” was born. Months later, I shared with Bruce a poem I had written when I was 14 years old—about a lonely oak tree. We incorporated as Live Oak, Inc. on July 1, 2004 and are now beginning just beginning our 10th year of services.

TBN: Your area of expertise is in working with the LGBTQ community and with survivors of sexual violence. Can you talk about the importance of having a deep understanding of this population when providing support services to an LGBTQ survivor?

JL: Currently at Live Oak, we have four areas of focus: affirmative practice with LGBTQ individuals and their families; trauma informed practice: creative, expressive and body-centered practice; and multicultural/multi-systemic practice. Working with LGBTQ survivors of sexual violence is at the interface of these four areas of practice.

Even prior to experiencing any kind of sexual violence, LGBTQ individuals often have had to negotiate the effects of stigma and shame. Histories of micro-aggression and insidious trauma create a vulnerability for LGBTQ individuals that has potential to magnify the shame and stigma so often associated with sexual violence. Possible secrecy about sexual orientation and/or gender identity also may magnify the secrecy associated with sexual violence. It is imperative that anyone working with LGBTQ survivors understand these multiple marginalized and intersecting identities in order to provide competent services.

We also need to consider the impact of other systems when working with LGBTQ survivors, especially when the survivor comes from a family or community in which an LGBTQ identity was ostracized. Many people with whom I have worked struggle with understanding if their LGBTQ identity exists because they were assaulted (especially in the cases of childhood sexual assault), or if they were assaulted because they identify as LGBTQ. It is important to understand both of these questions in order to foster an awareness of how being LGBTQ created an additional vulnerability for assault. And, that the very systems designed to protect us from harm often perpetrated, ignored, or minimized the harm we experienced as LGBTQ survivors.

TBN: One of the challenges (that is fortunately changing) I have seen in the rape victim advocacy movement in the United States is that often the services, advocacy, and support groups are geared towards heterosexual, female-identified persons. We obviously know that people of all genders and sexual orientations are impacted by sexual violence, so I am curious if you’ve developed any partnerships with local rape crisis centers, or perhaps offer some of the similar services one might find at a crisis center in your space?

JL: I wish I could say that services were more coordinated in general, but sadly I find fragmentation exists among service providers and first responders which makes access to services for LGBTQ identified survivors that much more difficult.

In the past, we have collaborated with Rape Victim Advocates (RVA) in Chicago, especially when they have been referred a gay male survivor of adult sexual assault. We have also received direct referrals from other community service providers when a gay male survivor of sexual assault has been identified. More frequently, however, LGBTQ survivors of sexual assault are referred to us by their friends or others who are clients at Live Oak.

We are committed to offering groups for LGBTQ adult survivors of sexual assault, but our sense both anecdotally and from research is that these assaults are generally underreported. That being the case, we often don’t have enough survivors at any one time to offer a group – though this is one of our goals. We do, however, offer individual and couples therapy for LGBTQ survivors (and/or their partners).

TBN: Do you do any specific outreach to male or LGBTQ survivors of sexual violence?

For almost 18 years, we have been offering closed, 30-week groups for gay male survivors of childhood sexual abuse. Over 100 men have participated in these groups to date. Even in providing these groups however, the process of identifying referrals, talking to men about being in a group, and dealing with the shame and stigma of engaging in such a process takes a great deal of support from family, friends, and individual therapists.

TBN: I am so inspired by the way in which Live Oak offers a vast diversity of healing arts modalities, that is something that The Breathe Network clearly identifies with in order to make healing accessible to a variety of personalities, comfort levels, and to be able to fully address the depth of the trauma on a person’s mind, body and spirit. Can you tell me about some of the various modalities offered at Live Oak and any in particular that you’ve seen specifically resonate with survivors of sexual violence?

JL: We are firm believers that trauma often cannot be processed through language – or at least not through language alone. More current trauma and neuroscience research supports that traumatic memory isn’t stored in parts of the brain that are easily accessed through language and that to truly metabolize traumatic experiences, it’s important to explore other forms of healing, accessing other parts of the brain.

At Live Oak, we use art therapy, music therapy, recreation therapy, yoga therapy, EMDR, and other body-inclusive approaches in doing trauma work. While I’ve seen all these modalities resonate with survivors of sexual violence, I have found that engaging in art, movement, and other modalities that do not require the survivor to “language” experience are particularly powerful. Just recently I was working with a gale male survivor of long-term childhood sexual assault who could not emotionally access the impact of his experiences. We spent several sessions engaging in art, where he was able to use crayon and markers to draw his experience in very “non-literal” ways and it was through this process that he accessed stored emotion he had previously been unable to access.

TBN: It seems you have an incredible team of practitioners, how did you go about building your team and what is the connection like among your colleagues and interns in the space?

JL: Creating a shared community space that is healing, cohesive, supportive, and collaborative has not been an easy process. When Bruce and I created Live Oak, our vision was to create a community of therapists with shared values and shared expertise.  Through much discussion and intentionality, we have developed a model where all of our staff are asked to be full-time therapists at Live Oak (with the exception of interns and post-graduate trainees). By having only full-time staff who do not have commitments elsewhere, we’ve been able to develop a truly collaborative community, with a shared philosophy of treatment. We’ve also been able to further refine our four areas of expertise: affirmative practice with LGBTQ individuals and their families; trauma informed practice; creative, expressive, and body-inclusive therapies; and multicultural/multi-systemic treatment.

Because we believe we are a community, we also see our graduate interns and post-graduate trainees as integral to the work we do. They participate in all staff meetings, retreats, and organization workshops. And, because they are constantly bringing to us new research, new approaches, and questions about our work, we are constantly growing and evolving.

TBN: The work you do around trauma, depression, grief and loss is so important and simultaneously can take a huge toll on practitioners. How do you practice self-care and what is the value or emphasis on self-care like among your team of practitioners?

JL: I do many workshops around contemporary trauma practice and workshops that focus on compassion fatigue and vicarious traumatization. There are always four premises I am explicit about at the beginning of any workshop related to trauma:

  • All of our work is trauma work
  • We are all survivors and perpetrators of trauma, even when we don’t know it and don’t intend it
  • We cannot avoid hurting a client
  • We cannot avoid taking our work home with us

By frontloading these premises both in workshops and in our Live Oak community, I believe we are explicit about the toll that trauma work can take on us as helpers. When I share these premises aloud, most people share a sense of relief. I even had one clinician with 20 years of experience say something like: “I wish someone would have said this to me in graduate school.” Others have trouble understanding that we are all survivors and perpetrators, and/or that we can’t avoid hurting a client.

I share these premises not because I believe we intentionally hurt clients, but because there is no way we can know the way our words, expressions, body-language, or appearance will impact each person we work with; there is no way to be so “careful”. Accepting this premise (and the others) requires that each of us at Live Oak be aware of the impact our work has on us.

We talk about our work daily with one another and in supervision. Our weekly staff meetings become a much depended upon place for collaborating and garnering support. And, we have regular staff retreats that emphasize self-care not only through “talk”, but also through engaging in the very same activities we encourage are clients to access.

TBN: Do you have any plans or dreams for the future of Live Oak in the coming years/decades?

JL: In the immediate future (by October of 2013), we will be opening a satellite office in downtown Chicago to provide services to our clients who live further south and/or who work in the downtown area. We also have longer term plans to open a satellite office in the northern suburbs.

Another one of our dreams is to develop a not-for-profit arm of our organization. Although we are incorporated as a “for-profit” organization, in almost all ways, we function more as a not-for-profit. Our sliding scale offers lower fees than most not-for-profit organizations in Chicago and, in fact, we receive many referrals from community not-for-profits who either have long waiting lists, or whose fee is greater than a client’s ability to pay. We hope that by creating a not-for-profit arm of Live Oak, we would be able to accept donations, apply for grants, and provide services to people who might otherwise not be able to access the quality of services we provide at Live Oak.

TBN: Thank you, Jeff for the amazing work you and your team at Live Oak provide to the community!

To learn more about Live Oak’s services, programs and workshops, please visit their website at: If you would like to learn more about how sexual violence impacts the LGBTQ community, visit Bluegrass Rape Crisis Center’s website here.