“If you are not a part of the solution, you are a part of the problem.”
Working with traumatized populations, and the life problems they tend to be enmeshed in, is challenging work, fraught with difficult, sometimes impossible circumstances. Resources are scarce. Options are often limited. To be effective, much less compassionate and present, you must be absolutely on top of your game. Not merely competent, but creative, resourceful, passionate and energetic. Your self-care, then, is not about you at all. It is an absolute ethical imperative. To be less, to offer less, merely serves your need to be doing something, rather than the client’s need for help or solutions.
To be effective with traumatized clients, you must maintain the ability to be both mindful and conscious. These require and consume prodigious amounts of energy. They demand that we be well rested, well nourished, healthy, calm and energetically replenished at regular intervals.
Mindfulness is the intentional, accepting and non-judgmental focus of one's attention on the emotions, thoughts and sensations occurring in the present moment. It is this ability, applied to our interactions with clients as well as our internal processes, that creates safety.
Consciousness is the quality or state of being aware, especially of something within oneself. What we refer to as trauma actually consists of traumatic memory. These are memories that, due to an overwhelm of our sympathetic nervous system at the moment we experienced them, did not fully process into conscious memory. Traumas then, are powerful sensory emotional experiences that remain fully or partially unconscious. They drive and deceive us. They move, motivate and mislead us. Clients with severe trauma histories are continually tormented by what remains unconscious within them. To be effective and helpful, you must be as fully conscious of your own internal landscape as is possible.
Here are some of the risks you incur in working with traumatized populations that will impair your effectiveness, and/or shorten your career if not promptly addressed with appropriate self-care. Some of the distinctions may seem trivial, but they highlight specific and slightly different risks that may not occur naturally in, say, a career in information systems management or advertising copywriting.
Personal Trauma –Nearly everyone experiences overwhelming events at some time in their lives. You will too. You probably already have. These will impact you in ways that impair your health, emotional state, and ability to work effectively unless and until you resolve them.
Direct Trauma from Clients – Practically speaking, there is no real distinction between direct trauma from work or clients, and direct personal trauma. Yet working with traumatized populations exposes you to risks of direct trauma that aren’t as likely to arise in your personal life, likewise, when they occur, they are directly tied to your job, your office and your work with your clients. Thus they can be more easily triggered by your work. These must be immediately addressed and resolved as they occur. Examples might be that a client or past client is murdered, or overdoses, or is convicted and sentenced to prison, commits or is a victim of a crime of violence, or a client’s abuser may turn up at your office angry and threatening violence. You may feel reluctant to go to work after just reading that sentence, but such events do occur. When they do, it is essential that you and affected co-workers get help with the impact of trauma.
Triggers from Client Stories or Life Events- Even if you’ve worked to resolve your prior personal trauma, there may be things that you did not remember, or did not seem traumatic to you until a similar client story or life event triggers them. Again, when these arise and while you are conscious of the upset is the best time to address and resolve them. Working with that client or clients in similar circumstances may be difficult or impossible until that is done.
Vicarious or Secondary Traumatization – Sometimes you will have no similar personal trauma or life experience, but the overwhelming horror of a client’s experience may traumatize you nonetheless. This is a risk of being a compassionate, empathetic human being. When this happens, you need to address the trauma you suffered by hearing the story, as if it were a direct personal trauma, as indeed it is.
“The meeting of two personalities is like the contact of two chemical substances: if there is any reaction, both are transformed.”
Psychological Projection, also known as blame shifting, is a theory in psychology in which humans defend themselves against their own unpleasant impulses by denying their existence while attributing them to others. These impulses may, or may not arise from unresolved trauma. Recognizing, owning and taking responsibility for them is sometimes referred to as shadow work, for the Jungian shadow archetype. Becoming aware of and confronting these truths about ourselves is a normal part of the personal growth or Individuation process. Yet, such unconscious material tends to arise more quickly and insistently when we interact in intimate ways with others. We understand it as part of our intimate relationship with a significant other, yet being present for and listening non-judgmentally to another, as we do in trauma work, is perhaps one of the most intimate things we can do. We are quite likely to have our own unconscious material stirred by such interaction. It takes considerable mindfulness and consciousness on a day-to-day basis to catch such instances as they arise. When we do, they become a great opportunity. They give us the chance to grow personally and professionally. They allow us to deactivate unconscious drives that move us against our will or intention. One of the great truths of shadow work, is that these characteristics we are so reluctant to admit about ourselves, are nearly always connected to unrealized abilities and gifts. Unwrapping them is massively empowering.
Compassion Fatigue – This is not trauma per se. It occurs when your desire to help someone, often in the context of your job or a volunteer position, is thwarted. It is a particularly painful form of frustration. It has complex implications and can lead to feelings of futility and burnout. It can happen, or you may believe that it has happened, due to a lack of skill or competence on your part, overwork and inability to devote enough time or resources to a client, systemic limitations on what you can do to resolve the situation, a lack of cooperation on the part of others, failure or inability of the client to do for themselves those things that only they can do, or for a host of other reasons. Traumatized clients often have troubled lives and our culture does not offer adequate help or resources. Laws and rules frequently do not favor them. You will lose sometimes and your clients will suffer. You will suffer as well. When you believe it was your own failure that caused this suffering, you will suffer even more as a result of your feelings of guilt. You are likely to believe that even when it is not true. You can address these in sessions with another clinician as a trauma or series of traumas, but overall, your job must allow for enough success to nourish you, you can’t ‘treat’ yourself out of impossible job circumstances.
“There are some days when I think I'm going to die from an overdose of satisfaction.”
Compassion Satisfaction - When you are effective in helping your clients, you will experience compassion satisfaction! This may range from a merely contented feeling at the end of a day, to an ecstatic, almost orgasmic, sense of elation at having been a part of a major life turnaround for a particularly deserving client. While the catalog of risks I just presented can seem daunting and discouraging, I simply can’t overstate the importance or value of Compassion Satisfaction. For those of us called or driven to help others it is our rai·son d'ê·tre, the most important and compelling reason for our own existence. It fuels and feeds us. It gives us purpose and meaning. It heals and reassures us.
It’s essential that there be a positive balance of compassion satisfaction over compassion fatigue in our work. This is not a neat mathematical formula. You must feel, day to day, on balance, that you are accomplishing more good than not. It may take several big successes to overcome the depression and discouragement of a particular failure. Supportive and encouraging supervisors and administration are necessary to maintaining this positive balance. Yet you must advocate for yourself. Be sure you are not assigned a disproportionate number of impossible cases. Don’t allow yourself to be assigned work that drains or discourages you without offsetting duties that feed and nourish you. If your agency or company overwhelmingly fails to help clients and you are unable to change the culture or outcomes, leave. Find a job where you can have a positive balance of success. This is better for you, and for clients. Burnt out practitioners neglect and harm clients. They become resentful and mean spirited. They become the problem, often a greater problem, rather than a solution for the client.
Appropriate self care – Whereas the aforementioned information systems manager may be completely regenerated and fulfilled by weekends with the family, time with friends watching sports or dining out, punctuated with the occasional ski trip, or cruise, those involved in the helping professions will need much more, greater variety, and a measure of balance.
Every dimension of your health and well-being must be consciously fed and supported. It’s easy to say that includes meeting your physical, emotional, mental and spiritual needs. It’s more difficult to embrace this as a practice in mindfulness and consciousness. To be continually aware of how you feel, to take note of it, to respond to it, to understand what works for you, what energizes you, clears your mind, opens your heart, to actively confront your own shortcomings, to seek clarity, insight and advice from others. Many people never do this, some only at significant life crossroads or crises.
It should be a daily contemplation. Practiced in this way, self-care is not a series of tasks to do, but rather a new way to live. Seeing the panoramic narrative of your life and embracing all its accomplishments and challenges as absolutely necessary and perfectly timed, to render you the right person, in the right place, at the right time, with the right skills, right now and in every ‘now’ you have experienced from birth, and every ‘now’ you will experience until you pass from this life. Such an epiphany alters the emphasis from what you are doing, moment by moment, to who you are, essentially, forever and irrevocably. To live from that place empowers and informs all that you attempt. Work and struggle cease to be synonymous. Work is simply you manifesting your being. Struggle is a signal that you are out of touch with your being, a reminder to see yourself. When you can be as gentle and kind with yourself as you would like to be with those you serve, then, and only then, can you be the best, most appropriate person your client could meet, in that particular moment, to help them on their way.
What more could you possibly expect of life?
What greater wish could you have for your client?
The reciprocal action of karma, the paradoxical duality of the universe both insist on this truth: You are the artisan, the tools and the creative intention. Tending to yourself is the only way to improve your client outcomes.
Who can wait quietly while the mud settles?
Who can remain still until the moment of action?
-Tao Te Ching 15, Lao Tse
Consciousness is a full time job. The more we crowd it out with frantic doings, the more poorly and infrequently we engage in it. Consciousness requires immense space and time. We will list, discuss and may demonstrate practices that can help you create that space and time. A partial list follows in this section. You can easily add to that list. It is not meant to be exhaustive, merely suggestive.
Some Self-Care Practices
Attending a sweat lodge
Caring for a pet
Getting Enough Rest
Going to the Beach
Participating in sports
Sound Bowl Meditation
Spending time in nature
This is one of the topics we explore in the Intimacy, Connection Healing Series, a workshop for all those in the healing professions. Massage Therapists, Acupuncturists, Yogis, Counselors, Social Workers, Nurses, Breath workers, Energy workers and anyone with an interest in connecting more powerfully to heal.
We explore the powerful connection that sources healing and arises naturally in all healing work. Florida CEs for LTMs, LCSW, LMFT, & LMHC. New York CEs for LMTs.
Join me for my first workshop in Costa Rica, at Living Forest Retreat Center November 11-17
Follow this link for more information, cost, lodging, meal and transportation options!