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Let Us Heal Series —Course 1

Ending the Punishment of Survivors

Trauma-Informed Advocacy for Domestic Violence, Sexual Trauma, and Coercive Control

3.0 CEUs • APA and Judicial Council of California (JCC) CE Credits Approved*

Presenter

Christy Wise, PsyD

Global health advocate and survivor advocate specializing in trauma-informed care

and systemic responses to interpersonal violence.

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Dr. Christy Wise; Global health Leader/Mental Health Expert |Survivor Advocate

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I am a survivor, shattered by the systems meant to protect me. Let Us Organizational Overview

Let Us Heal is a survivor-led nonprofit organization dedicated to eradicating secondary

victimization for individuals impacted by domestic violence, sexual trauma, and coercive

control.

• Our mission is to transform the systems that perpetuate harm by embedding
• trauma-informed education, survivor-centered advocacy, and institutional reform at
• every level of care and policy. We envision a society where every survivor is
• empowered to heal in safety, dignity, and power.Heal is my fight to end the punishment of survivors for surviving.
• Healing revealed a truth too many people share: the trauma didn’t end with abuser, it multiplied through silence, shame, & systemic betrayal.
• Inspired by my experience at Harvard Medical School, Let Us Heal is my response and my life’s work.

The Clinical Imperative�

• Heading: Beyond the Exam Room: The Global Burden of Interpersonal Trauma
• Prevalence: Intimate Partner Violence (IPV) and sexual trauma as leading determinants of long-term morbidity.
• The "Shadow Pandemic": Escalation of coercive control in global contexts.
• Economic Impact: The multi-billion-dollar cost of untreated trauma and systemic inefficiency.
• Physician Role: Moving from passive screening to active, trauma-informed advocacy.

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The Clinical Imperative�Example:

A 34-year-old woman presents to the ED with chronic abdominal pain….

The Problem: Institutional Betrayal�

• Heading: Systemic Re-traumatization and the "Punishment" of Survival
• Institutional Betrayal: When trusted institutions (healthcare, legal, social) fail to protect or actively harm survivors.
• Silencing Dynamics: Procedural rigidity that prioritizes administrative efficiency over patient safety.
• Documentation Misuse: How clinical notes are weaponized in legal proceedings to discredit survivors.
• Pathologizing Adaptation: Misinterpreting survival strategies as personality disorders or non-compliance.

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The Problem: Institutional Betrayal�Example:

A survivor of domestic violence seeks help at a clinic.

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PART B: MORAL INJURY

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WHEN THE SYSTEM SHATTERS MEANING

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What Moral Injury Is (and Is Not)

Moral Injury IS:

• Psychological distress that occurs when deeply held moral beliefs are violated
• Accompanied by shame, grief, rage, & existential disorientation

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Moral injury is not:

• A DSM diagnosis
• A cognitive distortion
• Weakness or overreaction

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Insight:�“Moral injury happens when the world proves itself unsafe in ways that violate what someone believed about justice, care, or humanity.”

This Photo by Unknown Author is licensed under CC BY-NC-ND

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Moral Injury in Survivors of Systems

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Common moral injury statements:

• “I did everything right—and they still didn’t protect me.”
• “The people who were supposed to help made it worse.”
• “If this is how the system works, what does that say about me?”

This injury is especially severe when:

• Survivors are punished for reporting
• Clinicians or systems remain “neutral”
• Harm is bureaucratic rather than personal

The Neurobiology of Survival: Trauma Without Shame: A Neurobiological Framework�

• The HPA Axis & Amygdala: Chronic activation and the "Survival Brain."
• Prefrontal Cortex Compromise: Impact on executive function and narrative memory during crisis.
• Dissociation as Adaptation: Recognizing neurobiological "shut down" vs. clinical "flat affect."
• Tonic Immobility: The physiological reality of the "freeze" response in sexual trauma.

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The Neurobiology of Survival�Example:

A teenage survivor of sexual assault is brought in for forensic examination.

This Photo by Unknown Author is licensed under CC BY-NC

Understanding Coercive Control�

Understanding Coercive Control�Example:

• An elderly patient with diabetes presents with recurrent hypoglycemia.

Differential Diagnosis vs. Misinterpretation�

• Heading: Distinguishing Trauma Responses from Pathology
• The Misdiagnosis Trap: Over-diagnosis of Borderline Personality Disorder (BPD) or Oppositional Defiant Disorder (ODD) in trauma survivors.
• Adaptive vs. Maladaptive: Re-framing "resistance" as a protective mechanism against perceived threats.
• Assessment Accuracy: Utilizing validated trauma screening tools (e.g., ACEs, PC-PTSD-5) over subjective behavioral observation.

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Section 3: WHEN CLINICIAN BECOMES PART OF THE INJURY

Teaching Ethical Accountability Without Shame or Defense

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• “We aren’t talking about bad people. We are talking about a profession that has not always known how to protect survivors, and a system that rewards neutrality more than accountability.”

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• Most Clinicians do not intend harm… But intention is not protection.
• “Impact ≠ Intent” is not a judgment it’s an ethical awareness practice.

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• Even ethical psychologists can become instruments of re-traumatization if they:
• Misunderstand power
• Misuse documentation
• Over-prioritize policy or liability
• Prioritize ‘clinical objectivity’ over survivor dignity

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HIGH-RISK CLINICAL BEHAVIORS

What They Are, Why They Happen, and What to Do Differently

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1. Reporting Without Consent (When Alternatives Exist)

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What happens:

• A clinician reports trauma disclosures without warning or consent
• Survivor feels blindsided/betrayed

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Why it harms:

• Echoes past coercive systems
• Reinforces the belief: “Help = exposure”

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Survivor Thought:

“Even the therapist turned me in.”

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What to do differently:

• Explain limits
• Collaborate
• Shared protection

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2. Questioning Credibility Instead of Exploring Context

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• What happens?
• Why it harms!
• Survivor Thought…
• What to do differently…

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3. Framing Reactions as Pathology

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What happens:

Survivor reactions -hypervigilance, emotional outbursts, numbness

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Survivors are then labeled:

• “Borderline”
• “Oppositional”
• “Noncompliant”
• “Manipulative”

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3. Framing Reactions

as Pathology (cont.)

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Why it harms

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• Mislabels protection as dysfunction

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• Can follow the survivor across systems

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3. Framing Reactions as Pathology (cont)

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Survivor Thought:

“Even my pain is a problem here.”

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What to do differently??

• View
• Ask
• Use

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4. Defaulting to Policy Without Naming Harm

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What happens:

• Clinician enforces policy without acknowledging the harm it causes

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Why it harms:

• Reinforces survivor invisibility
• Uses clinical neutrality to sidestep empathy

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4. Defaulting to Policy Without Naming Harm

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Survivor Thought:

“They cared more about rules than me.”

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What to do differently:

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• Say: “I know this policy may feel unsafe or unfair. I’m here to talk through it, not to defend it.”

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• Name the harm, even if you didn’t cause it.

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• Offer voice, choice, and validation

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5. Documenting in Ways That Harm Survivors Later

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What happens: (Clinical notes)

• labels like “claims,” “alleges,” “appears manipulative”
• No trauma context
• Ignore requests

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Why it harms:

• Records
• Survivors may read
• Impact

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5. Documenting in Ways That Harm Survivors Later (cont)

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Survivor Thought:

• “They wrote me off in writing.”

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What to do differently:

• Use neutral, observational language
• Include trauma-informed context
• Write notes for the survivor, not about them

Differential Diagnosis vs. Misinterpretation�Example:

• A young male survivor of childhood abuse is referred to psychiatry for “borderline personality disorder.”

 Ethical Responsibility in Documentation�

• Heading: Documentation-Aware Care: The Power of the Clinical Record
• Forensic Precision: Using objective, descriptive language (e.g., "Patient reports..." vs. "Patient claims...").
• Avoiding Bias: Eliminating pejorative adjectives and victim-blaming shorthand.
• Safety in the Record: Strategies for documenting abuse when the perpetrator may have access to the portal.
• The Legal Interface: Understanding how medical records influence judicial outcomes in domestic violence cases.

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Ethical Responsibility in Documentation�Example:

• A clinician documents a survivor’s history: “Patient claims abuse but presents as calm and well-groomed.”

Survivor-Centered Healing Models�

• Heading: Principles of Trauma-Informed Advocacy
• Safety: Physical and psychological stabilization as the first priority.
• Trustworthiness: Transparency in clinical intent and mandatory reporting limits.
• Empowerment: Returning agency to the patient in every clinical decision.
• Collaboration: Integrating social work, legal advocacy, and specialized trauma therapy.

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Survivor-Centered Healing Models�Example:

• A survivor of human trafficking is admitted to a trauma center. The team employs a survivor-centered model:

Global Leadership & Policy Change�

• Heading: A Call to Action for Healthcare Leaders
• Institutional Reform: Implementing trauma-informed audits of hospital policies.
• Education: Mandatory forensic and trauma training for all medical staff.
• Advocacy: Supporting legislation that recognizes coercive control and protects survivor privacy.
• Accountability: Measuring patient outcomes through the lens of trauma-informed care metrics.

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Global Leadership & Policy Change�Example:

• A hospital system in a developing country implements trauma-informed audits.

Conclusion & Summary�

Conclusion & Summary�Example:

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Key Takeaway Message

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“The nervous system is not broken.

It’s doing its job protecting the person.

Trauma-informed psychology requires that we learn its language.”

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“We cannot claim to treat trauma if we don’t recognize its language…

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Every ‘resistance’ may be a request for safety.

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Every shutdown may be a message:

“Please don’t hurt me like they did.”

Thank you from the bottom of my heart.

This is not only a passion project but a mission, and I invite you to stay connected and help us continue the work of Let Us Heal.

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Dr.christyw@gmail.com www.letushealmovement.com

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