I started to train trauma care professionals (eg. mental health professional, emergency responders and other trauma care providers) in 1997 and have learned so much from the dedicated, emphatic and skilled individuals taking courses through the Traumatology Institute both online and in-class. What I have also learned from in-depth conversations with these incredible care providers are the top 11 pitfalls in becoming an excellent trauma therapist.
1. Embrace trauma history.
I agree that we need to approach trauma stories with great compassion and care for the survivor, but encouraging the work to unfold in a timely and skilled manner allows for the pivotal growth needed in trauma recovery. Not doing the work can leave people stuck and burdened for years with unresolved trauma history.
2. Deal with trauma history in a timely manner.
This item is obviously in stark contrast to the first item but needs to be addressed. If we move too quickly without first establishing the powerful ingredients of therapeutic alliance, stabilization, or finding comfort and practiced self-reflection, we can open wounds with no balm in sight.
3. Find the core of Traumatic Distress.
Sometimes clients arrive to my office experiencing very noteworthy feelings of distress about some recent event. At times the client admits that their response to the event is much stronger than they would expect given the circumstances and even they are surprised at the intensity of their response. When we look closer and do our investigative work, we often find that the current event has reminders or triggers to a much stronger historical trauma.
If we focus on the here and now and fail to address the core or the more powerful history triggering the current reaction of dread and panic, the client will remain at risk for intense reactions over lower level events. Working through the core gives the opportunity of profound relief from triggers of the past.
A great example is a client who arrived at my office in a state of extreme despair. A red car drove past her quickly just moments before. She was a passenger in a serious car accident a few years earlier – the car was red. Now, any noteworthy exposure to reminders of the car accident results in significant symptoms of emotional strain.
4. Manage physiology so it doesn’t rule the therapy session.
Rapid heart rate, shallow breathing, body tension, sweaty palms and other signs of physical distress linked to emotional trauma triggers can undermine progress and hinder recovery unless the individual learns daily tools for self-soothing. Practiced regularly these tools change lives.
5. Understand the pain of the “Good Copers”.
One very high functioning client arrived with a significant story of historical trauma. There were numerous events of a very disturbing nature. His way of handling his traumatic past was to thrive at school and then in his very impressive career. He admitted that no one in his life had any idea of how much emotional pain he experienced every single day.
I am always impressed by how skilled trauma survivors can be at navigating the demands of their lives despite terrible events and losses. This does not mean that help in trauma recovery is not needed; only that humans as a species are incredibly resourceful and resilient.
Sometimes the most resourceful can appear to be quite well on the outside when their internal suffering is exquisitely painful. This individual admitted after working through some of the trauma stories that this was the first time that anyone had ever listened to or helped him address his traumatic past. He said that no one ever thought he really needed any assistance.
6. Never work harder than your clients.
I try my best to meet my clients’ half-way in effort and care. Going beyond this point can push a person to work too hard and too fast, crumbling an emotional infrastructure needed to tolerate the recovery journey.
7. Care for yourself as well as you care for your clients.
Funny how as professional care providers we can be sadly neglectful of our own hopes, dreams and personal growth. The trauma clinicians whom I have witnessed to thrive in this work tend to have a well-developed system of self-care through daily practices and a well woven interpersonal network, interests, hobbies and imagination – more than anything, a commitment to play time is crucial.
8. Keep THE ESSENTIAL Master Trauma Events list.
Back to successful clinical work. With every client, a detailed trauma events list holds a guide to next steps and current progress. Our Master Event List is an essential tool to cataloging unresolved historical trauma. This exercise will help therapists and trauma survivors to track unresolved historical trauma and to provide focused efforts to resolving memories in a timely manner. Very encouraging for clients and instructive for therapists. Download our Master Event List.
9. Work through your own trauma history.
Carrying a personal history of ignitable trauma into therapeutic work with others can create a land mine effect. We will never quite know when we might experience our own ignition – because we are human first – this is only reasonable. But when ignition occurs, we must work through our own vulnerability to ensure the best work with our clients as well as a respect for our own lives. Remember, if nothing else, in doing this work you are giving an incredible gift to those needing care. Care equally for yourself.
10. Keep learning and growing.
Easy to do but keeps us from the joy of this work. Keep learning. There are so many routes of exploration and innovation. Be inspired by Psychology, art, literature, science, animals, love, friendship, philosophy, cartoons, playgrounds, comedy, travel and wherever else your imagination takes you.
11. Set healthy boundaries with clients.
This item, recommended by Clinical Traumatologist, Ramona Bray, TITC-CT, is clearly imperative when working with clients with a trauma history. It is not unusual for those with a trauma history to have experienced exploitation of their boundaries, leaving them with an impaired sense of what is reasonable and realistic in terms of expectations or relationships.
Some people might feel incorrectly, that they have no right to set appropriate boundaries with others. Alternatively, they might push boundaries and become “intruders” upon others. Whether they are allowing others to “intrude” on their boundaries or have no concept of boundaries at all in their own lives will result in complicated feelings.
Not being able to say “no” to a request that we feel is unreasonable or that we simply do not wish to fulfill, or pushing others to do what they do not want to do is a sign of distorted boundary perceptions that can result in grave suffering and undermine relationships.
The skilled trauma therapist can be the first person in the clients’ lives to point out healthy boundaries; to challenge clients who test relationship boundaries within the therapeutic setting; and to provide a safe environment to mirror and teach clients about healthy boundaries in relationships.
One client I worked with was so grateful to learn this skill. She admitted that she finally had the strength to say “no” to her boss who would insist that she buy coffee for the staff on her way into work. Over the years, her boss never reimbursed her for the coffee or compensated her for the extra time it took on her way to work. By saying “no”, she was able to let go of the resentment that she was feeling toward her boss and re-focus her attention on the job that she loved.
Becoming a great Trauma Therapist takes courage, intelligence, wit, constancy, determination, compassion and a deep ability to go the distance.
We wish you the inner strength and wisdom that we know it takes to follow your journey into this work.
Dr. Anna B. Baranowsky, Ph.D., C.Psych., CEO