“I would never do what you do,” is a phrase I often hear when I tell people I’m a trauma therapist. I get it. Who would choose to be constantly exposed to the consequences of malicious child abuse, immeasurable loss, vicious violence, and other traumatic experiences? My colleagues and I make this choice every day, and we do so with resilience, compassion, courage, and tenacity. Here are some insights into this unique group of clinicians.
1) We’ve Experienced Trauma
Many trauma therapists have experienced trauma because many human beings have experienced trauma. Psychological trauma is defined as injury that occurs as a result of an event or series of experiences which cause overwhelming stress that exceeds one’s ability to cope. Trauma is not defined as the event or experiences that cause the injury, but is the injury itself. Many people have experienced an emotional injury as a result of an experience, whether it be significant or relatively minor.
Some trauma therapists are drawn to this work because of their own trauma histories. I experienced severe emotional and physical neglect as a child, and as damaging as it was, it has also benefited my work as a therapist. My colleagues report experiencing child abuse, war, sexual assault, unloving parents, domestic violence, religious persecution, and substance abuse, to name a few.
Trauma therapists may have experienced trauma that they processed soon after the event, many years later, or that they are still processing, and it is important for them to be cognizant of their own traumas in order to best meet the needs of their clients. Michael Shahan, MFT , says that “therapists knowing their own trauma is KEY to their own work with clients. If I don’t see and understand my own traumatic reactions to things clients bring up, I won’t be able to set them aside and work with a client in a healthy way. I will just get stuck right alongside them.” Visit Michael’s Instagram to learn more.
2) We Go to Therapy
There are doctors who don’t go to the doctor, accountants who are late filing their own taxes, and stylists who’ve haven’t had a haircut in years. And there are therapists who don’t go to therapy. Yet, there are many therapists who do attend therapy. Some are in therapy for years, while others receive therapy intermittently depending upon their needs.
As Dana Carretta-Stein, LPC , writes, “some of the best therapists practice self-care and practice what they preach. To be a good therapist, you should know what it’s like to be on the other side of the couch. And a great therapist is always working on themself.”
“Self-care is essential for therapists, especially those helping clients process their traumatic experiences,” writes Dr. LaRonda Starling . “When we think about self-care as therapists, it should be a wholistic approach including mind, body, and spirit. What better way to care for your mind than to go to therapy to ensure your own good mental health? In this way therapy can be used as a preventative measure or as an active way to take care of our own symptoms and issues. I see it as the equivalent of a personal trainer also having their time in the gym or a physician going to their own annual checkup.” Visit Dr. Starling on Instagram and Pinterest to learn more.
3) We Use “Strange” Interventions
You’ve heard of talk therapy, but what about Somatic Experiencing, Neurofeedback, Expressive Arts, or EMDR (Eye Movement Desensitization and Reprocessing)? Trauma therapists integrate interventions from a variety of psychological theories and disciplines. These methods can be highly effective in addressing trauma, but they might appear and feel quite strange.
“My secret, not so well kept, to helping my clients and myself, not just cope with their struggles but to heal them at their core – is Neurofeedback,” writes Leanne Hershkowitz, LPC . “Neurofeedback teaches you to calm and regulate your own brain waves. And the electrical circuits of the brain are far, far more important than most people realize. Our reptilian and limbic brains are the foundation on which our whole world and lives are built, and when that system is stuck in survivor/fight-flight-freeze mode, we can’t be ourselves. And neurofeedback helps calm the fear driven brain.” Visit Leanne’s Instagram to learn more.
Mallory Welsh, LCSW , remarks that “belly breathing to me feels like such a weird intervention. Breathing slowly in your nose, holding it for a few seconds, and breathing out your mouth for a total of 15 minutes, 3 times a week, seems strange to me that it can actually help reduce trauma responses. It is weird to me how much slowing down our bodies can then slow down our minds and our trauma responses. I highly recommend doing the belly breathing with some essential oils as well! Visit Mallory’s Instagram to learn more.
Psychodrama is an action-orientated therapy in which spontaneous dramatization, role playing, and dramatic self-presentation are used to investigate and gain insight. Certified psychodramatist Eve Brownstone, LCPC , states that “our issues are in our tissues. Our past is stored in our bodies. Psychodrama helps us get out of our heads and into our bodies through action.” Visit Eve’s Instagram to learn more.
4) We Navigate a Difficult Healthcare System
“If they’re not suicidal, then it sounds like they don’t need to continue therapy,” said an insurance representative referring to my client who experiences daily panic attacks and severe depression. The agent eventually agreed to approve additional therapy sessions, but only after I advocated for my client. They could have refused, and then my client would have needed to manage a lengthy and stressful appeal process.
There are many stressors involved in working as a trauma therapist in the American healthcare system (so many that this topic could be an entire blog in itself). Here is a glimpse into the many obstacles therapists contend with on a regular basis:
- Clients not being able to continue therapy due to high deductibles, unaffordable copays/coinsurance, insurance companies not authorizing future services, and clients losing insurance benefits.
- It can take therapists 6-12 months (or more) to be credentialed by an insurance company (approved to be in-network) before clients with insurance are able to use their insurance benefits to see them.
- Medicaid/Medicare reimbursement rates for providers are low, which makes it difficult for therapists to make ends meet while providing services to underserved populations. As a result, many therapists do not seek credentialing with Medicare and Medicaid.
5) We’re Brain Nerds
Try this: ask a trauma therapist about the human brain. Then stand back and watch as they light up and then geek out. Contemporary trauma therapy tends to focus on the brain, and we’re learning more about it each day. As an EMDR practitioner, I often see changes in the brain in real time, which are expressed in my client’s facial features and body movements.
Neurofeedback practitioner Leanne Hershkowitz, LPC writes that “experience shapes the brain and the brain in turn shapes us. And that process is forever continuing even into old age. Scientists once thought that process stopped after childhood, but we now know that the brain can change at any age and that is what we call neuroplasticity. Which means, if you have anxiety or PTSD now, it DOES NOT mean you will experience those symptoms forever.”
6) We’re at Risk for Vicarious Trauma
Trauma therapists are highly susceptible to developing vicarious trauma. Vicarious trauma is unique to those in the helping field, and is defined as “negative changes in the clinician’s view of self, others, and the world resulting from repeated empathic engagement with patients’ trauma-related thoughts, memories, and emotions” ( www.psychatrictimes.com ). Vicarious trauma is a serious condition, as it not only impacts therapists but also all of the clients under their care. At times it feels like the more we empathize, the more susceptible we are to vicarious trauma.
Due to these risks, trauma therapists must practice self-care. “Consistently processing the traumatic experiences of others, without proper self-care, can lead to negative consequences for the mental health professional,” writes Dr. LaRonda Starling . “Experiencing a trauma response, emotional exhaustion, and weariness due to consistent exposure to the trauma of others is possible but not inevitable with good self-care and a healthy social support network.”
7) We Want Clients to Leave Us (When It’s Not A Good Fit)
Not every therapist-client pairing is going to be a good match, and we know it. These mismatches are caused by a number of factors such as personality clashes, cultural differences, the therapist’s training, scheduling issues, and patterns of transference and countertransference, to name a few. Clients must experience a safe and healthy relationship with their therapist in order to benefit the most from therapy. Therefore, when the client or therapist decides that they’re not a good fit, it’s an opportunity for the client to find a better match. Therapists provide referrals to clients and care coordination with new therapists in order to ease these transitions.
Therapists also encourage clients to leave when they no longer need therapy. “As true as this is, it’s painful because I’ve developed a deep relationship with clients,” writes Michael Shahan, MFT . “I simultaneously feel so proud and so sad at the same time when clients begin talking about how they need to come to therapy less and less.”
8) We Think About Our Clients Outside of Session
I wonder how their interview went.
They would love this movie.
I need to tell them about this.
I hope they’re ok.
I’ve had these thoughts about my clients in my daily life. Trauma therapists do think of their clients from time to time. It’s important to manage such thoughts because they can cause emotional boundary issues, yet it’s a lie to say that we don’t think about our clients outside of our offices, and in a way we always carry them with us.
Maggie Reynolds, LCPC, reports that “there are many times where I will continue to think about a client after and between sessions. Sometimes it is to seek and engage resources I can use to help them. Often, it is also reflecting on what I learn from them and processing my feelings of concern and hope for them.” Visit Maggie’s LinkedIn to learn more.
9) We Never Work Alone
Trauma therapists rely on a network of people to assist them in treatment. Team members can include medical doctors, psychiatrists, teachers, caseworkers, co-therapists, and juvenile/parole officers. Additional support can come from people who are not directly involved in treatment and who may never meet the therapist. Such people may be family members, friends, mentors, community members, coworkers, and even pets.
One of the most important networks of support for every trauma therapist consists of other therapists. “I could never do the work that I do without supportive clinicians in my practice with me,” writes Michael Shahan , MFT . “After a particularly difficult client, knowing that I have multiple therapists across the hall that love and care about me and who are willing to talk about it for a minute or two gives me the strength to keep moving on. So many times, I’ve walked across the hall, simply hugged another therapist, and walked away telling them that’s all I needed.”
10) We’re Trying to Work Ourselves Out of the Job
We don’t want to be needed. We want our clients to heal so that they no longer need to see us. We want trauma to disappear. In fact, I’ve never met a trauma therapist who wanted trauma to thrive so that they could have a successful career.
As Lucinda Gordon Lennox, MBACP , writes, “I want to spread the word about trauma so far that we are all out of jobs because family trauma cycles have been broken, and abuse (overt and covert) is completely non-existent.”
Bridgette W. Gottwald, LPC , stated, “Us therapists want our clients to heal and to not depend on therapy long term. Essentially, we strive to teach them to be their own therapists and deal with challenges that life throws at them in productive ways. When clients are ready to discharge, we get excited. This means that we have done our job effectively, and that we have made a positive affect upon the client’s life that they are trying to improve.” Visit Bridgette’s Instagram for more information.
Trauma therapists are a brave group of healers whose dedication and sacrifices are remarkable. “I think clients who are struggling with relational trauma may be surprised if they knew how much their therapist is rooting for them,” writes Sarah Marie Pierce, LCSW . “I am often inspired by my clients’ bravery and when they have a win in their healing journey. It is truly a joyful experience for me as well.”
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References
Quitangon, G. (2019, July 26). Vicarious Trauma in Clinicians: Fostering Resilience and Preventing Burnout. Psychiatric Times. Retrieved from
