“This work is very hard work. People talk about vicarious trauma; my sense is that actually I have not had to deal with a lot of vicarious trauma, because I think maybe vicarious trauma is a function of working for an institution that does not believe in what you are doing. The trauma is not dealing with a very difficult patient because that is what we do for a living. The trauma is to work for an organization that humiliates you, puts you down, and doesn’t value the very hard work that you do. And then you get harassed for working with very difficult patients; that breaks your heart. So you can only do this work in supportive networks and I am always looking for ways in which people can talk and connect with each other so we can form supportive networks for each other.”
Bessel van der Kolk at Trauma, Attachment, & Neuroscience: Brain, Mind, & Body in the Healing of Trauma workshop in Bloomington, MN April 17, 2015.
Two years ago, I had the opportunity to hear Dr. Bessel van der Kolk present at a workshop in MN. During the course of the workshop, I was able to share with him the web address for MN Trauma Project in our hope that it could be a resource for supporting healing professionals in attendance. He did, in fact, end up sharing the information and then he made this statement about vicarious traumatization, which I have continued to reflect on ever since.
Trauma is sometimes defined as an experience or series of experiences in which the person’s resources, either internal or external, are overwhelmed, leaving them unable to comprehend, make sense of, or cope with their experience. While one element of the lingering impact of a potentially traumatic event is the experience itself, often times, it is the absence of an attuning, supportive other who is able to validate the difficulty of the experience, help dyadically calm the nervous system, and support the person in making sense of it that moves the experience from potentially traumatic to traumatic. Research shows that many of the people who are most impacted by traumatic events, particularly those people who are exposed to trauma as children, were either met with no response or were met with a response that furthered the sense of isolation and overwhelm initially experienced during the traumatic event(s).
All throughout my graduate training, I heard the admonishment from my professors to engage in adequate levels of self-care, so as to avoid burn out. From day one of my training as a mental health professional, I heard warnings of how much of a toll that the work of providing psychological support could take on the professional. However, as I have reflected on Dr. van der Kolk’s words over the past 18 months or so, and particularly sought to make sense of them in light of my own work experiences, I have realized the profound wisdom of his observation.
As the client begins to heal from trauma, inevitably one of the changes that enables and strengthens their healing is the rebuilding of relationships. The lingering impact of trauma frequently includes an increased sense of isolation and relational disconnect; the experience of healing often is hastened when there is a strong relational system that either exists in advance or is developed in the process. In a 2015 MN workshop with Bruce Perry (a leader in the study and treatment of trauma in children) he made the case that the strength of the relational network is one of the greatest buffers of subsequent traumatic symptoms.
In the Army, I have completed training in Traumatic Event Management, which is essentially a process of assessing and providing support for groups and individuals in the aftermath of a traumatic event. One of the powerful aspects of this model is the opportunity for a squad or company to gather together and provide each person the space to reflect on what they saw, heard, felt at the time of the event and to listen as others do the same. The aim is to increase the experience of feeling like your experience has been heard, to decrease a sense of aloneness in the aftermath of a potentially traumatic event, and to locate their experiences within the greater community.
As human beings, relationships are one of our greatest resources. As children, the greater degree of attunement and contingent responsiveness that is experienced in the developmental years, the greater likelihood that a secure attachment relationship will form and the greater degree of resilience the child will possess going into adulthood. This does not change for the adult mental health professional, relationships remain the greatest buffer to burnout and overwhelm. If the work of helping people heal from trauma makes its calling on your life, you cannot do the work alone. You must be resourced to do it and the resourcing must include both internal and external supports. The internal will require that you take care of your inner world, finding the points of your particular struggles and woundedness and doing your own work of healing. We must tend to our physical, psychological, emotional, cognitive, and spiritual needs. And given the innate relationality that marks the human experience, we must have relational support as well.
And this is the difficulty that Dr. van der Kolk highlights in the statement above. Many of us who are participating in the sacred work of helping people heal are in one of two settings. Many have eschewed working for larger systems and set out to work in private practice and in the process can find themselves isolated in the work, daily bearing witness to the difficult and tragic experiences that have led clients to our offices, with little to no support afterwards. People in private practice frequently are faced with the challenge of trying to endure on their own or to intentionally seek out support and opportunities to connect with other providers and find connection and the resonance that comes with hearing that other people have similar experiences.
An even worse scenario, as Dr. van der Kolk highlights, is to work for the types of organizations that represent the status quo in the mental health field, organizations that fail to recognize the profound role that trauma plays in the lives of the clients and the development and maintenance of the mental health difficulties that frequently result. Our “industry” is increasingly driven by the micro-managing focus of managed care, where the treatment of symptoms become primary over the healing of persons. Our standard manual for understanding symptoms (the DSM-5) inadequately addresses etiology, therefore neglecting the traumatic origins of many of the symptoms and struggles with which our clients come to therapy.
Consequently, those of us who would seek to help people heal from the traumatic experiences, reactions, and efforts to cope that underlie their symptom presentation are frequently met with criticism and disparagement from organizational leaders or peers. We are told that our clients do not belong in treatment settings where the focus is on eating disorders or chemical dependency, despite the fact that dissociation and histories of trauma have been shown to play a significant role in the later development of both “disorders.” When we shift our focus to helping people heal from trauma and to rely less on their dissociative abilities to cope and maintain functioning, we are frequently dismissed as not treating symptoms on which the system focuses its attention, even though treating the underlying cause will lead to a reduction in the symptoms that historically have been means of coping. Time and again I have heard stories and have had similar experiences in which significant amounts of energy get consumed advocating to the organization or system to keep a client in a particular setting or explaining why clients struggle in the ways that they do, versus getting support and getting asked the question of what the organization or leadership can do to support the work.
As Dr. van der Kolk highlights in his eloquent statement, often times the organization ends up denigrating not only the traumatized clients, but also the providers who are trying to provide care. In consultation groups I have attended, stories have been told of instances where providers become identified with the clients, so when the client struggles and/or behaves in a problematic manner, the provider gets blamed or gets asked the question of why the client behaved in such a way. And this is where vicarious trauma occurs, when what should be the provider’s greatest resource, the leadership and people within the organization within which they work, is taken from them. Instead of being a source of encouragement and support the organization adds to the stress. When the organization stops being a resource to the provider, the provider is far more likely to get overwhelmed by the stories that they hear and the struggles that they witness. This is why the shift to trauma informed organizational cultures is never just about the clients and the type of treatment provided, but is about recognizing the needs of clients and providers alike to be supported, met with compassion, and have their experiences acknowledged. This essential shift in focus is what helps to restore the workplace to a place of safety for both client and provider and supports and sustains the work of healing.