As trauma therapists, we are privileged to watch our clients’ trauma fade from terrible, here-and-now experiences to mere memories; their dissociation shift to integrated presence, and their pain disappear. We are also privy to the gut-wrenching details of rape, accidents, war, and story after story of child abuse, domestic violence, and horrible neglect. The more terrible the abuse and the more dissociated the clients, the more they project the actual emotions of their trauma into us. Some therapists become grim. Some avoid complex trauma clients. Some help their clients avoid expressing affect in the sessions. Some burn out and leave the profession. Here are some ways to keep yourself whole while doing this important work.
1. Do your own work. If you’re not able to tolerate your own history and your current affect, you won’t be able to tolerate the despair, rage, shame, and grief that move through many trauma survivors.
2. Learn mindfulness. Meditate, do yoga, do chi gong, do breathing exercises. It will help you “stay in the chair” while witnessing whatever is there to see. Learn to breathe and ground yourself while being with anything.
3. Know yourself. If you start a session in a state of equilibrium, and you start feeling rage or exhaustion in the session, guess that it may be the client’s rage or dissociation. If you then say “What are you feeling right now? There’s something in the room.” The client is likely to say, “Oh, I’m angry, I guess it’s about X.” or “Oh, I was just spacing out.” When you know where you are, you’ll know when you are being drawn into someone else’s experience and use it for their benefit.
4. Know the signs of burn out:
a. You aren’t excited to go to work.
b. You talk only about work and have no other interests.
c. You treat everyone on earth like a client.
d. You dream about clients, all the time.
e. You’re angry at clients for being the way they are.
f. You feel shame for your human limitations.
g. You have vicarious PTSD: flashbacks, anxiety, depression, avoidance around client material.
h. You want to drink, gamble, or otherwise dissociate after work.
5. Get support.
a. Join a supportive consultation group. (Not just about the technique, but about you, too. And no shaming allowed.)
b. You might get individual consultation for the most troubling cases. As a consultant, I’m going step-by-step with a few consultees with their most fragile, barely tractable cases. It’s good for the therapists and good for the clients.
c. Increase your therapeutic arsenal. If what you’re doing isn’t working, find something else that does.
d. Do your own work. Hire a good trauma therapist who can help you clear your vicarious trauma.
6. Develop other interests that have nothing to do with therapy. Make sure some of them involve unmitigated joy.
7. Do things that bring you into your body: Run, stretch, work out, dance, do yoga.
8. If you have any control over your schedule, limit the number of the most complex, dissociated, abused, unstable clients. And don’t put them all on one day.
9. You will probably learn your tolerance the way most of us do, by exceeding it. Once you know, keep your own boundaries. Follow the Platinum Rule: “Fill your own cup first, then give away what’s left over.” And another rule, “To Thine Own Self Be Nice.” Trauma is compelling, but don’t let it run your entire life.
10. Watch out for grandiosity. You can’t fix everything. Know your limits.
11. If you have a spiritual practice, use it to support your work. Ask whatever higher power you have for help when stuck.
Hi Robin, thanks for all of your great tips! As part of cultivating healing and also staying connected to self-awareness – I also work with helping professionals to foster a reflective writing practice (for those interested in this self-nurturing tool). There is some great research on Writing to Heal Trauma (and it can also be used to heal vicarious trauma) written by James Pennebaker. Wishing you wellness and fulfillment in your life and work, Lynda
There are strong mechanisms that contribute to natural recovery from traumatic events. Many trauma experts (Staab, Foa, Friedman) agree that the psychological outcome of our community as a whole will be resilience, not psychopathology. For most survivors, symptoms of fear, anxiety, re-experiencing, urges to avoid, and hyper-arousal, if present, will gradually decrease over time.