This post focuses on the importance of self-care for therapists who work with trauma. Without a commitment to self-care, maintaining a practice focused on the treatment of PTSD can have a significant impact on the mental, emotional, and physical health of the therapist. You can think of this impact as existing on a Burnout Continuum that begins with relatively mild caregiver stress that builds over time progressing into compassion fatigue, vicarious trauma, secondary trauma symptoms, and, in the worst case, into complete burnout. Trauma counselors, such as those who practice EMDR therapy or Somatic therapy, need to have sufficient support to process the mental, emotional, and physical weight of the traumatic material that they are exposed to. Otherwise, it is common to begin to feel weighed down by the heaviness of this work and, as a result feel tension in the body, fatigue, and emotions of anger or resentment.
Clients with trauma often come in with extreme states of high or low arousal. They might be trembling with anxiety and panic, flattened by depression and despair, or numbed by dissociation. The psychophysiology of these states can be induced in therapists. When therapists recognize that they have joined with the physiology of the client they are better able to engage their boundaries or explore valuable self-care strategies. In addition, we must remember that therapists are people first. We come into the field of trauma work with our own historical wounds and injuries. This work tends to flush to the surface personal unfinished business such as unprocessed traumatic memories or attachment related material.
“We must take a preventative approach to mitigate therapist burnout by addressing risk factors and responding to early symptoms of caregiver stress. Too much empathy can have negative repercussions. A therapist must first start by resourcing and re-energizing the self. A therapist who focuses on self-regulation during a session can serve as an important model for the client. This process also allows the physiology of the therapist to be an available, present-centered resource for the client.”
-Dr. Arielle Schwartz
It is common for therapists to arrive in the field of trauma treatment with enthusiasm which dampens over time through experiences that are both frustrating and painful. This process might be useful to refine unrealistic expectations and help clients develop stronger boundaries if they are over-identified with their clients. However, in situations where there on ongoing stressors without sufficient support therapists are at risk for feeling overwhelmed and incompetent. Let’s take a closer look at the Burnout Continuum as related to therapists working with traumatized clients:
Embodied self-care emphasizes developing nervous system flexibility. Initially, this process is fostered as therapists learn their own vulnerabilities to get stuck in high or low arousal states. For example, the therapist who has his or her own anxiety might have difficult down regulating with a client who is experiencing panic in the office or may feel a residue of anxiety after the session. Self-awareness of arousal patterns can help therapists stay regulated during sessions by recognizing the need for self-care strategies such as grounding or breath awareness. A therapist who focuses on self-regulation during a session can serve as an important model for the client. This process also allows the physiology of the therapist to be an available, present-centered resource for the client.
The realities of working with trauma is that therapists sit with extreme and often debilitating experiences with our clients such as helplessness, hopelessness, despair, isolation, loneliness, injustice, unfairness, suffering, rage, and evil. Often clients have lost faith, and the meaning or purpose of life is put into question. Self-care during a session might involve connecting to your own meaning making or spiritual perspectives that helps you orient to trauma, loss, and suffering without getting stuck with your client. However, it is also common to “shut down” with the client as the natural impulse to empathize and understand the client evokes within the therapist the fogginess of dissociation or the hopelessness of despair.
As discussed in Babette Rothschild‘s book Help for the Helper, when therapists join strongly with client’s stuck or shut-down emotion and arousal states it is important to have strategies to disengage from the client’s somatic process. Here, the therapist compassionately differentiates from the client in order to access personal self-care resources. This helps to prevent the session and client from remaining stuck. Differentiation asks the therapist to consciously uncouple their somatic resonance and arousal state from that of the client. Otherwise, too much empathy can have negative repercussions. In order to disengage from a client’s “shut down” or dissociative states, the therapist must first start by resourcing and re-energizing the self. You can think of this process as similar to putting your own oxygen mask on during a hazardous flight. Once you have yourself resourced you can better attend to the need of another.
During a session, the differentiation process involves recognizing when you are mirroring a client’s posture or facial expressions and consciously choosing to change how you are sitting or allowing your face to relax. This process, in turn, can inform the client about how to support their own psychophysiology. In short, the therapist can attune to the client’s dysregulated arousal states; however, this process can also work in the opposite direction where the therapist invites the client to attune to the therapist’s regulated and resourced body and mind.
Connect to this post? The Complex PTSD Workbook, is now available on Amazon! Click here to check it out and increase your toolbox for healing. Whether you are a client or a therapist this book will offer a guided approach to trauma recovery.
Dr. Arielle Schwartz is a licensed clinical psychologist, wife, and mother in Boulder, CO. She offers trainings for therapists, maintains a private practice, and has passions for the outdoors, yoga, and writing. Dr. Schwartz is the author of The Complex PTSD Workbook: A Mind-Body Approach to Regaining Emotional Control and Becoming Whole. She is the developer of Resilience-Informed Therapy which applies research on trauma recovery to form a strength-based, trauma treatment model that includes Eye Movement Desensitization and Reprocessing (EMDR), somatic (body-centered) psychology and time-tested relational psychotherapy. Like Dr. Arielle Schwartz on Facebook, follow her on Linkedin and sign up for email updates to stay up to date with all her posts.
Arielle Schwartz, PhD, is a psychologist, internationally sought-out teacher, yoga instructor, and leading voice in the healing of PTSD and complex trauma. She is the author of five books, including The Complex PTSD Workbook, EMDR Therapy and Somatic Psychology, and The Post Traumatic Growth Guidebook.
Dr. Schwartz is an accomplished teacher who guides therapists in the application of EMDR, somatic psychology, parts work therapy, and mindfulness-based interventions for the treatment of trauma and complex PTSD. She guides you through a personal journey of healing in her Sounds True audio program, Trauma Recovery.
She has a depth of understanding, passion, kindness, compassion, joy, and a succinct way of speaking about very complex topics. She is the founder of the Center for Resilience Informed Therapy in Boulder, Colorado where she maintains a private practice providing psychotherapy, supervision, and consultation. Dr. Schwartz believes that that the journey of trauma recovery is an awakening of the spiritual heart.
