Therapist Reflection: 11 Things I’ve Working as a Trauma Therapist
Practicing trauma therapy is hard work. The liability in this career is burn out, compassion fatigue, and vicarious trauma are all higher risks and probability.
I still remember my first session with a client as a mental health intern presenting with PTSD. I was so nervous, anxious, and unsure how to “fix” their symptoms and make them feel better.
Three years later, I understand the phases of trauma therapy through a traditional talk therapy lens (e.g. Evidence Based or gold standard models of trauma therapy). I also am understanding more and more how individuals heal from trauma outside of talk therapy (there are so many ways including through the body, movement, and reconnection to one’s culture). In a first session, I should have listened to the client attentively, provided education on symptoms of trauma, what to expect in therapy, and hold hope for the client that healing is possible.
Thousands of clinical hours later, sitting in the therapist chair has been my greatest experience and teacher for what healing is and what healing can be.
These are 10 things I’ve learned since practicing as a trauma therapist in 2018.
Note: This post was written in March 2021.
Boundaries: Learn To Say No
Saying no is a complete sentence. Practice saying this over and over again until it becomes normal and metabolized in your body and mind.
No, you don’t have to see that client during your lunch hour. Do not over schedule yourself and prioritize your clients over yourself.
Eventually, if you don’t assert your boundaries, this will creep up on you and so many things could happen. You could slowly burn out, feel exhausted, resent your clients, resent your work, feel annoyed at yourself, and so much more.
P.S. Boundaries are not bad; they are necessary and helpful for both you, the client, and the therapeutic relationship. Clients need boundaries (duh, we all need boundaries) to thrive and heal!
You Are The Instrument/Tool In Therapy
We hurt in relationships, yet we can also heal in relationships. We are always in relationship with ourselves.
Your body, presence, and self is one of the key tools and instruments in therapy. Therefore, it’s so important to not just take care of yourself, but understand and be aware of how you show up in the room, what triggers you, how you say what you say, your mannerisms, and more.
I am more intentional, thoughtful, and aware of myself, my thoughts, and my feelings and use it to my benefit (e.g. sharing it with the client in the moment if appropriate). If I am grounded and intentional in my work, there will very little that will sway me when discomfort and uncertainty pops up.
Practice What You Preach: Take Good Care of Yourself
Everything you suggest to your clients? Take that advice too. Seriously. No seriously, do it.
Go to therapy, move your body, eat delicious foods, reach out to others you love, speak nicely to yourself, practice self compassion, take deep breaths under stress, reflect rather than react, and realize you are a whole and complex human being with many parts and selves.
Don’t be a hypocrite and start reflecting and internalizing what you say to your clients weekly. It’ll eventually sink in. I promise you.
We are what we practice. Keep practicing.
Have A Life Outside Of Work
For so long, what I learned, studied, and practice was trauma. My caseload was predominately was trauma. My book shelf was trauma informed and trauma specific. My media consumption was trauma. It’s not surprising then that because I had so much space devoted for trauma, I didn’t have much space and time for other things, like living.
So much of my identity was based on trauma, survival, violence, oppression, and abuse that I forgot about life, joy, peace, wonder, and freedom.
There Is Nothing Wrong With You (Even If You Feel Crazy)
Some days will be excruciating, humiliating, and terrifying. You’ll wonder why you went back to school to learn, study, and practice something so foreign, scary, and uncomfortable.
Why? You are a human being with your own wants, needs, pain, suffering, trauma, and hurt. Being a wounded healer is hard enough without supporting others.
Some days will ache and hurt more than others. Some days you will question how you can hold space for others when you can barely hold space for yourself.
I want you to know this during these moments when they eventually do happen again.
There’s nothing wrong with you. You are not flawed or broken. You’re human.
You are a therapist, not a magician, mother, father, sister, brother, or friend to your clients. Go back to what your role is and what therapy is. You can care for your clients without caretaking them.
Take a break from time to time. Sleep in. See the world. Visit your friends who live out of state. Go to the beach. Sit still. Cry. Laugh. Take time off to rest.
It’s okay to call out sick and cancel on your clients. You don’t have to work when you are not feeling well, physically or emotionally.
You can let your clients know at the beginning of session in the most vague terms that you might be off today. Offer them the reassurance that if they feel like the session isn’t helpful, you can end it and waive the session for them.
Doing these things will actually normalize and humanize your clients to you because you are so overly boundaried and worried about making an ethical mistake or boundary crossing, that it can feel robotic and sterile at times. Smile, laugh, and at other times humanize sadness and pain too.
Not Every Client Is A Good Fit (And That’s Okay)
I have a deep yearning to be liked by everyone due to part of my wounds growing up. So when a client would request a clinician transfer to a different therapist, I would beat myself up inside and catastrophize what could have possibly occurred. “It was probably because I offended them”. “It was probably because I’m not well versed in this speciality and I need to learn more about it”.
It’s totally okay for clients (or anyone really) to not like me. That’s not my business. Plus, it could be me, but it also could not be me.
Refer these clients out to someone who has more training in area you don’t feel confident in. Refer your clients out to someone who fits their personality more and what they want from therapy. Refer your clients out when you feel they have plateaued after a year or two and perhaps need to find another clinician to do reinvigorating work.
Healing Takes Time (Even If Clients And You Want The Answers Now)
Reminder: You want people to feel better and heal quickly, but that isn’t how healing works. People heal in different ways and there are many ways to heal. We meet people in different stages in their healing journey.
Some are brand new to therapy and are extremely anxious. They want fixes and answers now.
Others have been in therapy for decades and need a tune up.
Everyone is on their journey. Trust them. Therapy is for them, not for you.
Trauma Affects Not Just Your Mind, But Your Spirit, Soul, and Body
You’ll learn more and more how pervasive trauma is. That you don’t even have to directly experience the event or experience to have symptoms of trauma. Trauma is everywhere and our society is not trauma informed. In fact, our society causes trauma. Policies, government, law enforcement, schools, colleges, hospitals, and yes, even the mental health system.
Trauma overwhelms the soul, body, and mind. Nearly always, it gets “stuck” in the body and no amount of talking will help release these tensions and stress. Think about cultural ways of healing and what people used to do before prior to formal mental health. Dancing, laughing, song, food, religion, communities, relationships, and more.
Get out of your head so that your clients can get our of their head and drop into their body and reconnect to their culture.
You’ll Have To Unlearn & Relearn So Much
You’ll need time to unpack all that you learned in your internship and school, especially how Eurocentric it was and how much of the medical model it focused on.
Stop panicking that you don’t know the DSM back and forth. That’s okay. You can learn it as you go along. Plus, pathologizing people shouldn’t be your priority anyhow. You do this work in service of healing, not to fix or solve clients because they aren’t broken or flawed.
You worry about your competency and skillset and want to have a theoretical orientation pronto. This makes you feel more in control and at ease if you can label healing in a straightforward manner.
However, healing from trauma is complex and not simplistic. There are many ways to heal. Therapy is just one way.
You need to consider culture, context, time, place, gender, sexuality, ability status, language, and more. Because of this, there is no one size fits all theoretical orientation for each and every client.
Normalize & Get Comfortable With Self Harm and Suicide
Self harm and suicide is scary and overwhelming for you. You worry so much about ethics and liability, but it’ll be okay.
Not everyone who self harms and/or expresses suicidal ideation wants to kill themself. Some people are in tremendous and intense pain and these are ways they have learned to survive. These clients may not have anyone else to talk about these sensitive topics too since they don’t want to worry their family or friends. Perhaps they don’t have a support system. Or maybe others are uncomfortable with these topics of self harm and suicide.
Sometimes, self harm and suicidal ideation are manifestations of that pain. It’s actually adaptive.
Your job is not to panic, but to understand where these feelings and urges come from. What purpose do they serve the client? How have they helped the client adapt and survive? Then you can brainstorm a safety plan after.
Get comfortable with self harm and suicide so you can create ample space for these topics should they come up.
Silence Is Okay (Stop Talking So Much)
Tip: Take a breath and be silent. Just for a minute or two.
Let the client speak and take up space. If not, it’ll be quiet in the room. And that’s okay. This will be rich clinical information for both of you.
Sometimes, silence is more helpful than anything that could be said. When someone is grieving and in pain, that silence could be exactly what they need because everyone in their life wants to distract them, fix them, or offer them advice.