Since the launch of SJPC 2.0 this August, we have made the decision to focus on storytelling and consistently uplifting the stories and experiences of our community members.
SJPC’s focus this month is Health Equity; in our first newsletter we provided education around Sacramento County’s Community Wellness Response Team (AKA alt to 911 program), and for this piece we’re telling the story of someone working in our community to provide information and guidance on how to approach social work through a trauma-informed and intersectional lens.
The following write-up captures a conversation between SJPC’s Editor and Jennifer Kenney, PhD, MSW, MPH (pictured right), an Assistant Professor at the Sacramento State University’s School of Social Work; it has been edited down and formatted for clarity.
Jennifer approaches social work through an intersectional and trauma-informed lens, recognizes that there are bigger systems at play that impact people’s health, and works to use social work - and more specifically training future social workers - to find ways to meet people where they’re at, provide them with all the beneficial skills/resources possible, and if that’s not possible, provide a safe space for them be heard and feel supported.
In this piece Jennifer discusses her journey to becoming a professor, challenges she has faced both as a provider and in the classroom, the importance of being curious with clients, with creating safe spaces, sitting in discomfort, and setting realistic goals with clients. She also discusses the challenges of providing services and keeping each other safe within the bounds of our capitalist, individualistic society. Crucially, she discusses the importance of naming, discussing, and learning from our privilege, and the importance of collective self-care.
In this piece, “provider” and “clinician” are used interchangeably
Additionally, “patient” and “client” are used interchangeably
Large headings indicate the topic being discussed, remaining text indicates Jennifer’s responses.
Table of contents
Meet Jennifer Kenney (she/her), PhD, MSW, MPH
I am an assistant professor at Sac State in the School of Social Work. I've been here since 2019.
Prior to that, I was an Assistant Professor at the University of Alabama in Criminology and Criminal Justice. Prior to that, I was an adjunct at the University of Pittsburgh School of Social Work. For the last 10 years or so, I have taught quite a bit in the areas of social work and social justice and behavioral health. Right now I'm teaching graduate students primarily, as well as undergraduate students who are going to go off and do social work practice.
Prior to entering academia, I was a provider for about 10 years. I provided individual mental health groups, mental health support, primarily with women and men who were impacted by the criminal justice system, and also primarily with folks who were struggling with substance use issues. Those were my main areas of interest - the legal system and substance use.
Challenges treating trauma as a provider
One of the things that I found really frustrating as a clinician was that I could not find a lot of evidence-based interventions for women who were impacted by the legal system and also who struggled with substance use, primarily around their trauma. When I first was training to be a social worker - this was the late 90s - there was this idea that if a woman was in substance use treatment and she brought up a trauma, like an assault or domestic violence issue, or something like that, at that point [those traumas] were called “back burner” issues.
We were taught - which always seemed very weird to me - that the person had to get clean and sober before we could delve into anything about their trauma, and we didn't call it trauma back then, we called it things like “abuse” and whatnot. As I was becoming a more experienced clinician it became clear that a lot of times the trauma and the substance use and the mental health were really interlinked. I started seeking out ways to become more trauma-informed - even though that's not really what the language was back then.
It seemed like people would stop using, and then they would have flashbacks or triggers related to their trauma, and we were basically taught to ask them to put [their trauma] on hold until they had a little bit more recovery under their belts
That always felt really weird to me, that's not something that I felt comfortable doing, and I didn't do it very often.
For me, it seemed like [trauma] was an issue that affected their recovery, that affected their substance use. As social workers we’re taught to start where a client is at, and if the client was bringing these things up, that was what I was going to talk about, right? Not say, well, put a pin in that, let's talk about that in six months, because that didn't seem realistic. Within a few years, it became apparent to me, and a lot of other clinicians, that you had to really think about these [multiple issues] together.
You had to really think about substance use and mental health and trauma and all the things that impact people: people's ability to seek care, people's ability to engage in care, people's ability to talk through what was going on with them.
For example, again, late 90s, early 2000s, there was this idea that mental health and substance use were separate; that we had to get people clean and sober so we could then assess their mental health and then put them on medication or then have them seek programmatic change or then have them engage in mental health related strategies. Again, it seemed like that was a very weird way of going about it. It always seemed to me like they were so interlinked and there was no separating them.
At my last job as a provider, I was the manager of a halfway house for women in early recovery from substance abuse. This was maybe 2005, we were starting to lean into this idea of being trauma-informed, and we were consulting with folks who were experts in the area. As the manager of the halfway house, I was really trying to integrate a lot of these strategies into the program that I was in charge of, and doing a lot of trainings with my staff.
But it was still very new, and there was this idea that sobriety was either/or, either you were using or you were sober and any kind of slip or fall meant you had to leave the program. I had a lot of conversations with my clinical director about that, since back then the policy was if you relapsed you had to leave the program. I remember having lots and lots of conversations with my clinical director about that, and It became really frustrating.
Transitioning into academia
And so I thought, maybe getting a PhD would help me expand my understanding of trauma and social work and mental health and substance use, then hopefully I could be a little more effective, and possibly then be a professor and teach students how to do this work.
I went to get my PhD at Columbia University around 2006, and I wrote my dissertation using secondary data - the original study was looking at [a group of women in] treatment as usual versus treatment that was trauma-informed. Then what I wanted to look at was if there were any connections with the legal system, and how were women - who had a diagnosis of PTSD and also had a diagnosis of substance use disorder - interacting in these programs, and were there other things that were associated with their legal involvement. What I found in the dissertation was that folks [specifically women with a diagnosis of PTSD and substance use disorder] who were assigned to the trauma-informed care program actually were less likely to be arrested in the next year or so. Also, social support had a lot to do with them staying out of the legal system as well.
So, it really got me thinking about the connections between those things, and specifically how we would help women stay out of the legal system. Women, with PTSD and with substance use disorder, and then add in poverty, add in racism, add in disability, add in healthcare inequity, add in [any number of inequities], those were the women that were more likely to end up in the legal system.
The legal system is oftentimes where folks go after all other systems have failed them
Being able to talk about these things with emerging social workers in the school of social work has been really exciting and really fun and also has allowed me to think more deeply about some of these things in my own research, and my own community work.
Experience as consumer in our mental healthcare system
I am not only teaching about mental health. I'm also a consumer. I have a therapist. I would say as a consumer, the biggest challenge was finding somebody because they're just not enough [mental healthcare providers]. It took me a lot of trial and error to find a therapist and psychiatrist that I felt I could work with. I have a good therapist and psychiatrist now, but prior to that, it was hard to find a good fit. In the past, I have felt like my past therapists and psychiatrists had their own ideas of what I needed and didn’t really listen to me.
Working in an acute psychiatric unit
I worked for a couple of years in a community hospital in an acute psychiatric unit. I saw a lot of folks who were coming in with suicidal ideation, homicidal ideation, people who had severe disability, psychosis, hallucinations, delusions, etc., and who were unable to be in the community in a safe way.
We talked about it as a multidisciplinary team [providers working in the hospital], but oftentimes the psychiatrist was the one who made the final decision, which is understandable because they assume the majority of the liability. But it also didn't encourage a lot of conversation [between providers], at least in the community hospital that I worked at.
I also did pretty much the same work in a men's maximum security prison. It really was that the psychiatrist wanted to hear what we had to say, but, if we veered into something that the psychiatrist disagreed with (and it was depending on the psychiatrist, I’ve worked with many psychiatrists in my career), oftentimes it went their way. They would ask us what we thought, but if we disagreed with them, there wasn't a lot of changing their minds.
So, as a clinician, I had to work on not only building relationships with my clients and patients, but I also had to work on building relationships with the psychiatrist, so that they would take me seriously. Because [in their eyes] I'm just a social worker, what do I know? But the psychiatrist would also lean heavily on us like, oh, find this person housing as if we had a magic wand that we could use to find housing.
Certainly, I don't want to ever discharge anyone to the street. I don't want to discharge people to shelters. But, oftentimes the services weren't there for us to give someone a step down when they didn't need to be in a locked unit anymore. There weren’t a lot of services for folks who had been doing better, but also still needed some level of support
Coming back to the present moment
Really, I wanted to get my PhD so I could learn more about what other providers are doing and what other providers have found beneficial, and I think I have done that. But, honestly, not much has changed in [service provision] - the research that I do is interesting - but we already know what helps.
We know that having safe and supportive housing helps with mental health, having a support system helps, being able to earn a living wage, all these things help, right? If we were to eradicate poverty, if we were to reduce social inequality as well as wealth inequality - these are the things that would be helpful
But oftentimes what we end up doing are social workers and people in behavioral health, is putting band-aids on, right? I'm doing mental health therapy with someone and they don't have a place to live - if they had a place to live, if they had a meaningful job or if they had assistance that was able to help them get through the day and, buy enough food for themselves and, pay rent and take care of their kids etc., I think it would make a radical difference as far as the way that I would be engaging with their treatment.
Oftentimes, the mental health and substance use is really serious, but without all the other supports, it easily falls apart. The mental health stuff easily falls apart because they don't feel safe
A lot of the folks that I work with have had years and years and years of trauma, and giving them some level of real safety would really help with any mental health intervention that we give them.
I knew from the very beginning when I was getting my Master of Social Work - and the more I learn, the more firm I am in that thinking - that we live in a capitalist society where you're only as valuable as the work you're able to produce.
And so, if you're not able to produce the work this capitalist society wants from us, then you're seen as deviant, you're seen as bad, you're seen as weak, you're seen as mentally ill, crazy, mad, all those things, but it's not the individual's fault
These systems are created to work this way, but they’re systems that aren't working in the way that we want them to work to be supportive.
So again, it has been really amazing to be able to be taught about all these systems and all the ways that people can be served and seeing the person as a whole person, but it also can be really frustrating because then we see all the flaws in the system.
People say the criminal justice system, the criminal legal system isn’t broken, it’s doing exactly what it’s meant to be doing
Question from SJPC: as you and your colleagues were coming to understand trauma-informed care in the late 90s and early 2000s, did you feel that you were part of a bigger movement in social work across the country?
Yes, we actually brought Stephanie Covington (pictured right) in [during Jennifer’s time working at the halfway house]. She is a social worker who got her PhD at Columbia and she does a lot of work with women, trauma informed care, substance use, and also women who are impacted by the legal system (she is kind of a big deal). We brought her in for a whole week to instruct us what to do, tell us how we can do things better.
Stephanie Covington has typically been on the cutting edge of this trauma informed care and social work. So, it did feel like we were catching up, in a way that made a lot of sense to everybody who I was working with. We just didn't know how to do it. We didn't know what the best strategies were. And so when we brought Stephanie in, it was a really worthwhile investment.
On why providers may struggle to be present with their clients
Say I'm a social worker, and I am meeting with someone, and I don't have the resources, or I don't have the intervention, or I don't know what to do, I don't have the solution - what happens often, is that this creates a lot of discomfort in the practitioner, and the practitioner then takes it out on the client.
I've seen that happen with me, as a client. I've also seen it happen with peers that I've had. Because they don't have a solution, and the client or the patient is still saying, I'm still struggling, I'm still suffering, then it's like, well you client are not doing what I said, and then it becomes about blaming the patient. You're blaming the victim for being in this system that doesn't work for them, or for not having the resources available.
It ends up creating, I think, tension between the private provider and the client. What I really try to do with my students is teach them how to sit with suffering, and acknowledge that, yes, you came into this field because you want to help. You came into this field because you want to be able to give resources and you want to be able to help people find solutions. However, there are going to be a lot of times when there is no solution, when there is no resource, when there is no next step.
Part of our job then is to be able to sit with that person and validate where they are, and also validate that there is no solution and really give them a safe place to talk about what that's like. A lot of social work students, a lot of current clinicians who've been in the field for a long time, have a really hard time with that.
You know, if you watch Grey's Anatomy someone will come in with this weird medical mystery, right? And everyone in Grey's Anatomy is like, oh, we have to do research and we have to send the residents to find things in all of our medical journals and we have to spend all this time at the whiteboard and we have to rule out this and rule out that - that doesn't happen in the real world.
[The real world is] like, if I don't have a fast diagnosis, if I don't have a thing I can give you, there's something wrong with you as the client and that's just the way it is, too bad.
There is a lack of curiosity sometimes, and there's also this lack of understanding that sometimes you do have to do a little bit of extra research
Sometimes you do have to jump in and try to find some evidence-based interventions. However, how do you do that if you're no longer connected to a university, right?
Research journal subscriptions are incredibly expensive. Unless you're connected to university, you don't even have the resources to find another evidence-based intervention or another strategy to help your client. I think that's a huge limitation for clinicians who are in the field right now, unless they do somehow have access to that research for those resources.
I spend time with my students giving them the opportunity to find strategies where they can just be with that person, and validate how hard it is to be with that person, and validate how hard it is for that person for whom there might not be an answer
A lot of students want to jump to the solution. They want to jump to asking questions about coping skills. They want to jump to how did you manage “y” in past, and so I try to slow them down and say no no no we're just we're asking clarifying questions, we're reflecting feelings, we're paraphrasing, we're just being present, and to a lot of students (and clinicians) that feels like a waste of time, because, again, we live in a capitalist society where we are rewarded by finding solutions and we are rewarded for finishing tasks. So people struggle with sitting in those really hard ugly feelings with their clients, and I hope it's getting better, I hope people are understanding that sometimes the best next strategy is just being with that person and connecting with that person and validating that person, but the default really is well I’ve got to find a solution, and if you aren't following through on that solution or you're not getting better even though I gave you this great solution, you must not be doing it right, or you must not be consistent, there must be a flaw in you client, because you’re not getting better.
That's just so destructive. It's so destructive. I've seen it be so destructive for clients.
A lot of social workers, because they're frustrated, they take it out on the clients, because they don't know the answer, but it's not always about knowing the answer, because we live in a society where the services just aren't there. They're just not there.
When clients come to us, and we don't have the answer, we don't have the service, it's our responsibility to be able to sit with that person, and support them, and really validate their experience. I think that's something that's really, really hard for clinicians, whether it be medical doctors, psychiatrists, or social workers, we don't teach that. We don't teach that enough
Staying up to date on best practices once you’re out of university
Part of what we expect when social workers graduate from MSW is two years under supervision of a licensed practitioner, but also engaging in other kinds of continued education, and then also there are agencies that are bringing in people with resources and evidence-based interventions and whatnot. I think those are the main ways that people are able to stay up to date.
But part of it [staying up to date] is they have to be curious, and they have to be open to it. There are a lot of folks who just keep doing what they've always done, and they're not open to any new things
One of the things I've been trying to integrate more in the work that I do with students, and also the work in the community, is somatic practices. I think talk therapy can be really effective, but I also think that, especially with people who've experienced trauma and who experience depression and anxiety [among other things], getting back into their bodies and feeling comfortable in their bodies is a new way of helping folks manage their trauma.
I think in order to keep on top of things, they [providers] have to be curious and they have to be wanting to try and learn something new, and not just keep going to the same cognitive behavioral therapy trainings that they've been going to, but really try something different.
I always really try to encourage my students to be lifelong learners because we don't know everything.
On the importance of providers sitting in the pain and discomfort with their clients
There are a lot of strategies that we can use as clinicians to really be present and mindful with people who are in pain, and then not take that on. I think people are afraid that, if I open up that Pandora's box then the client is going to be an open wound and we're not going to be able to close the door on that trauma, but that's not true.
That's not true because there are also strategies to help ground clients and patients before they leave. You don't ever want to send a client out the door sobbing hysterically because we just talked about something really really awful.
Sometimes it's not possible, but oftentimes it is possible if you’re being aware of what you're doing and you're being intentional with what you're doing
Thoughts on treatment goal-setting with clients vs. for clients
When I'm training, or talking to students about creating goals, we want them to be measurable because we want to be able to know when it's done, right? We also want it to be doable, but we want to co-create these goals with clients. I might have an idea for a goal, but part of my job is to co-create these goals with clients - so, if I have an idea about a goal, I'm going to check in with a client before we make a decision about it.
Certainly, there are going to be times when my idea of a goal isn't the same as a client's idea of a goal, and sometimes my idea of a goal is going to have to win out because it could be a funding issue, or if they don't do this, they're going to go back to jail. So I might put that as a goal, even though the client's like, I don't want to do that. Also, just because we have it as a goal doesn't mean it has to be reached. It's just the idea of putting something down, to guide the intervention.
Part of our job as social workers is to assess if we’re setting good goals, because for some people, I might not have any idea [what a good goal is]. I think about what you [SJPC Editor] said about not feeling comfortable with clinicians, right? That's the clinician's fault.
It's my job as a clinician to build relationships. We know clients that do well in their treatment, in their healing, is partly because they feel that they have a decent relationship with their clinician
I stress [as a professor] that so many times without having a good relationship, you're not going to be able to do good work. That [relationship building] has to always, always, always be your priority. I'm always building relationships with the client, even if we disagree. Even if I have to do something really, really hard, I'm always, always keeping an eye on prioritizing the relationship.
On the struggle to provide care to folks on temporary involuntary psychiatric holds
I've worked in those settings [acute psychiatric units], and part of my job was to build that relationship.
Oftentimes, folks who are on a hold, they may not be in the best place to be able to communicate who they are, what they need, what they want. But, that doesn't mean I'm not going to try to build some relationship with this person, because everything comes from that
Everything has to come from that.
Also, oftentimes in-patient hospital settings are very, very fast paced for the social worker - there's just so, so, so much to do. And, because we live in capitalist society, we get rewarded for making sure our notes are on time, we get rewarded for making sure we make a good referral. We don't get rewarded for the client saying, oh, I really felt like I could talk to this person.
That's not an assessment. That's not a way we evaluate ourselves in those settings.
On self care and being a Social Worker within the bounds of our capitalist system
There’s this idea of self that’s like, oh I have a yoga class once a week or, oh, I go get a massage once a month, but self care is also making sure that your workplace is a place where you feel okay, where you feel valued, where you feel you have a purpose.
A lot of social workers enter these systems, and they get chewed up and spit out. Then they get jaded, and they stay [at the job], and they might have yoga every Monday night, but they're not pushing. They're not working to change the workplace because that's the kind of self-care that we don't talk about very much in school, right? [We don’t talk about] changing the systems - what can you do in this awful, awful system to actually take care of yourself?
It [self care] has to be collective. There's a new book by Judith Herman (pictured above). She wrote a book called Trauma and Recovery back in the 90s and it's one of those seminal books on trauma recovery. She just came out with another one called Truth and Repair, it has four stages, with the fourth stage being finding purpose within community. It really has helped me understand things in a deeper way.
Of course, we live in a capitalist society, where we're very individualistic - but I can't heal from my trauma all by myself. I have to do my own work, of course, but I also have to do my own work in community with others. [Others] who may or may not have experienced similar traumas, who may or may not experience the same mental health issues that I experience. But, none of us can do this work alone. Part of that work is working with others to change these systems
I don't think that's talked about very much.
On our individualistic culture
One of the things that I've really learned more about since the beginning of this larger conflict in Palestine, is how individualistic we are in the United States. Looking at what's happening in Gaza and Palestine and the way that they're approaching this tremendous ongoing trauma is so much more communal.
We're here in the States trying to put our own individualistic values on what's happening there, and we're not being curious about how Gazans and Palestinians see their own healing, and see their own way forward, and how they are managing their own trauma. Their ongoing, awful, awful trauma
The fact that so many families, generations of family members are living in the same house, and generations of family members are wiped out, because of one bomb from Israel.
That's not something that's part of my lived experience. I have family members across this country, and thinking about all of us being wiped out, because of one event is, I can't even wrap my brain around it…and so I've been really, really trying to think more deeply about my place in this community and what I am doing and what I need to be doing differently, or more of. Because, I really do think of myself as an individual first, and I know that not everybody thinks that way, and I know that that's not always the best way to think, so I have a lot of unlearning to do around that.
Understanding privilege as a provider
The thing that I have been really exploring is how I use my own privilege when I come to this work, especially my privilege as a white cis woman, as a white middle class cis woman, really working hard to acknowledge my privilege as a white person, as this person. [I’m also working on] being open to talking about that [privilege] in the therapy session [with clients] and being open to talking about that with other clinicians. White people are afraid to talk about their whiteness, it's like privilege is a dirty word.
I always tell my students, privilege is not a dirty word - we have to figure out ways talk about it, because even if I don't acknowledge my whiteness in the room, when I am talking to another white person, or I'm talking to a person of color, it's there, it's there
We work with disproportionate numbers of people who are people of color, who have disabilities, who may be from marginalized communities that I don't have experience with, or I don't have lived experience with. It's really important that I am aware of my positionality and also that I name it in the session. I name it in the classroom, and whenever I do any kind of community service.
I did a presentation [recently] and I talked about trauma, the sort of institutional trauma that's created when white people don't acknowledge their privilege. Or [for example] when I show up and it's like, oh, another white cis middle-class social worker, here's another one who's going to treat me terribly. So [I’m working on] acknowledging my [privilege], especially my white privilege, because that's the first thing that I think that comes up for folks.
We need to be calling each other in as white people. We need to be calling each other in as cis people. I would like to see able-bodied people calling each other in, and talking about how people with disabilities navigate the world differently than they do.
I do think that we all need to be really aware of our privilege, and we need to really listen to people who come from these marginalized groups, whether it be people of color, whether it be people with disabilities.