New York City, NY

Managing the Trauma of Being a Complex Trauma Therapist

Rev. Sheri Heller, LCSW

This past week was taxing. As an NYC trauma therapist of over three decades, you would think I’d be immune to the atrocities of life, but there are still catastrophic upheavals that shake me to the core. Serving as a therapist and a witness to a mother desperately trying to save her young child from continuous sexual abuse can take its toll, especially when molestation escalates and litigation ensues. The backdrop of bureaucratic ineptitude and collective skepticism, in spite of the glaring evidence, could make a pacifist run amok. Fortunately, in peer supervision, my colleagues offered me the opportunity to process this troubling situation. It was only then that I recognized how disembodied and numb I was.

Indeed, this is not the first time, nor will it be the last that the horrors of the human condition will permeate therapy sessions. There is my client of twenty years whose father is a rapist and serial killer, another client whose life was decimated in childhood by a pedophile, a young woman who was repeatedly sexually violated by her mother, and another woman who was pimped out by her parents to a lecherous ‘entertainment’ rep. The list is endless. Survivors of complex trauma have seen it all, first within their families of origin and subsequently through the victimization that gets reenacted as they mature.

If this wasn’t my calling I couldn’t imagine choosing this path. In fact, based on what I’ve encountered sublimation of personal psychological wounding through guiding others towards healing seems to be a shared motive amongst trauma therapists.

It was initially my mother’s harrowing struggle with schizophrenia that ignited my immersion in psychology. However, it was my own history of traumatic abuse and eventual recovery that prompted me to become a therapist. Although this career choice reaps countless rewards, it most definitely necessitates a level of self-awareness and self-care that eludes other professions.

The ability to remain effectively present and empathic for clients while maintaining appropriate boundaries and regulating the self ripens and achieves refinement with experience. Nevertheless, trauma therapists are always at risk for vicarious traumatization. Likewise, when lines get blurred overidentification can occur. Moreover, soldiering through and numbing out is a common scenario when flooding crescendos and dissociative defenses take over.

According to compassion fatigue expert Francoise Mathieu (2012) it is estimated that between 40% and 85% of “helping professionals” develop vicarious trauma and compassion fatigue along with high rates of traumatic symptoms. If left untreated burnout is inevitable.

To maintain a semblance of balance and stability there are fundamental practices I rely on. First and foremost is consistently processing my personal and professional struggles in therapy and peer supervision. Through collegial and therapeutic support I’m able to drop into the truth of what I’m feeling. This affords me the space to identify how the treatment sessions I facilitate may be activating traumatic material from my personal history. Reaching out to my therapist and peers not only assists with effectively regulating myself but also guides me to best support my client with navigating their difficulties.

Just as critical is how I manage my time. This may seem mundane, but it’s an essential part of keeping me on track with carrying out all necessary tasks. Being a therapist doesn’t end when sessions are over. There are professional trainings, emergency sessions, making contact with ancillary supports, check-in emails between sessions, handling new referrals, marketing, providing billing statements so folks can collect insurance, and of course, meeting for supervision. Hence, structuring an organized schedule to accommodate not just the clinical work, but all the surrounding minutiae redirects potential chaos into decisive order. This allows me to carve out opportunities for self-care routines and basic chores like doing the laundry and making sure there’s enough food in the house (especially coffee!).

With time set aside solely for me, I am able to commence with my practice of prayer and meditation, and slate adequate time for exercise. I am also able to fulfill my writing objectives. Writing creatively is a vehicle for distracting from the rigors of clinical work while crafting mental health articles offers me a platform to elucidate theoretical concepts and abstract treatment concerns. This is not only useful for my audience but also helpful in reminding me of the guiding principles fundamental to administering treatment.

All these routines sustain and strengthen me through the daily emotional strain of providing a meticulous therapeutic focus and genuine empathic attunement.

I’d be remiss if I failed to mention how essential the arts are to my health and happiness. My watchlist on Amazon Prime ranges from Masterpiece Theatre to Ru Paul’s Drag Race and everything in between. That my husband is a musician ensures that the healing balm of music is a consistent source of joy. In like manner, being blessed with clients who compose, photograph, sing, paint, write, film and dance also ensures that my life is enriched by their creative expression.

In the domain of hedonistic indulgence, deep tissue massage loosens the knots of somatized stress and the back pain that comes from being seated in a static posture for hours at a time. The physiological release I experience through massage is coupled with emotional catharsis. All my worries dissipate. I’m encouraged to release all the thoughts and disturbances circumnavigating my brain. When a massage is especially healing I may find myself in complete surrender, gently retreating into a hypnotic trance. That’s when I experience the apex of a heightened sense of renewal.

When I’ve really reached the end of my rope and depletion kicks in I need to get off the urban grid. This is probably the most meaningful way that I recalibrate. By traveling to a beautiful natural setting I can benefit from the healing power of nature, whether it’s the ocean, the mountains, or a forest. In this setting my mind, body, and spirit are restored. The excitement of embarking on an adventure and discovering a new place affirms the pleasures and beauty that life has to offer. This awakens my curiosity and the intrinsic desire to play. Aside from my personal experience, there is considerable evidentiary support that nature provides a range of health benefits from improved mental health to enhanced relational capacities and immune functioning.

Founder of psychoanalysis Sigmund Freud wrote in a letter to the founder of analytical depth psychology Carl Jung (1906) that psychoanalysis is, in essence, a cure through love. It is only through love that a clinician can responsibly bear witness to another’s pain. It is only through the love conveyed in the therapeutic bond that difficult challenges can be traversed and growth can happen.

Indeed the most consistent finding of psychotherapy research is that “the quality of the therapeutic alliance is the most robust predictor of outcome.” (Safran & Muran).

For the trauma therapist, this means being fully emotionally present for unbearable suffering so that healing can ensue. It means holding a humane compassionate space as clients revisit stories of inconceivable brutality and heartbreak. By joining the client as a witness to their torment, they are no longer alone.

Yet in the aftermath, the trauma therapist carries all that was shared and processed. In those moments I am urged to remember the words of writer Charles Bukowski who said, “If you have the ability to love, love yourself first.”

This is a critical rule of thumb for all clinicians and those in the helping professions who are required to stay sane and resilient in the eye of the storm.

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As a survivor (and thriver) of complex trauma and a seasoned therapist specializing in treating complex trauma, narcissistic abuse syndrome and addictions, I am intent on creating content that affords informative insight, hope and healing from psychological disorders. I aim for my creative content to assist readers with tapping into the resiliency of the human condition while recognizing the countless challenges of being human.

New York City, NY

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