Interactions With Vicarious Trauma: The Healer's Search for Absolution by Jennifer Harwood, LCSW, LCAC
After 30 years of working in the field of behavioral health in various capacities, I’m owning the fact that I have dealt with vicarious trauma and PTSD related issues for many years. While I can joke and discount many of the encounters I’ve had through the years as “part of the job,” I wasn’t counting on was the physical and emotional toll the job really had on me. Had I heard some of these stories from others, I wouldn’t hesitate to be concerned at the symptoms and events; but for me, I could handle anything. After a while, I had to discard my cape and realize I was not a superhero with powers to deflect the toxins that had been thrown my way. As much as I dove in and stayed in the trenches to help people overcome their disturbances, I had to pull myself out of those same trenches to find my own healing.
So, what is vicarious trauma, clinician burnout, compassion fatigue? Vicarious trauma occurs when we have been exposed to, experienced, witnessed, or listened to other’s experiences of traumatic material, usually over a period of time. When someone shares their traumatic stories with us in such a way that we can visually experience it with them, we are at risk of activating our own trauma responses. This leads to what some refer to as “burnout”, but what I call vicarious trauma. It is being personally traumatized through the eyes of someone else. Vicarious trauma has a host of signs and symptoms, such as disconnection and/or depersonalization, lack of energy, social withdrawal or isolation, cynicism, despair and hopelessness, sleep and appetite disturbances, disrupted frame of reference, such as an inability to trust our own decisions, minimization, hyper-vigilance, self-loathing, emotional numbness, feeling overwhelmed, intense rage or bouts of crying, anxiety, nightmares, resentments towards others, including clients, feeling unsafe, poor self-care, concentration problems, and feelings of being on an emotional rollercoaster. This list could go on and sounds in large part like the symptoms of Post-Traumatic Stress Disorder. They are indeed trauma reactions, even if we did not directly witness the trauma, and have been a large piece of my life for quite a while now. I’ve worked to gain an understanding of my own vicarious trauma reactions and feel lead to share this with others. We are not “burned out clinicians” who need to retire; on the contrary, we are wounded healers who understand some things so intensely. Our clients are actually in the best hands they can be in, when we are well ourselves.
When the whole of your work is to help others bear the weight of their souls, the pressure of their pasts, and the anguish of their current situations, it bears on us in a profound way. We dissociate from our emotions just enough to show compassions and empathy but be still able to cut off from those feelings in order to help clients heal. We may find ourselves subject to this pendulating force regardless of the situation, including in our own personal lives.
I have come to believe in the practice of self-care. For me, it’s more than just compassion and healing – it’s survival. When I am in a spiral of negative cause and effects related to the vicarious trauma I’ve witnessed, the replay of my own demons, or a combination of the dark side of the world in which we live, I have to have the escape, the outlet, the life that still exists. Expressions of art, music, prose, or meaningful conversations help me to share that emotional wound. When I write, my soul unburdens itself without fear of judgement, accusations, or denial. What I have inside me needs to be expressed from a place of non-judgement or I will not allow it to purge, and, not purging those feelings is disastrous. It can mean the shutting down of emotional regulation, the disregard for others and myself in a variety of areas, and a general sense of mistrust with the world around me. I need to have light in the times of darkness, for if the cold dampness is allowed to fester, the beauty within is left to ruin. Expression is my escape from the center of my mind which I so desperately need at times. Without the escape, I become tainted and ineffective as a clinician and as a person. And so, my hope in writing about this is that this act of self-expression and owning my experiences with vicarious trauma will help others find an outlet to express their own feelings and experiences. What is left alone too long no longer serves any purpose, except to destroy.
And so, this writing comes from a state of necessity. I am now noticing that the depth of the pain of what I hear all day has had a tremendous effect on me over the course of 30 years, and I’m sure other clinicians feel this way as well. By sharing this experience, I hope we are all able to find the core piece of ourselves that was what started our paths on this journey again. The times of wanting to cancel clients and take the day off, sleep disturbances, experiences with hyper-vigilance and intrusive thoughts were creeping in again like a familiar, but terrifying, old friend. The ghosts of those past mentors, clients, clinicians, and eras had been overtaking each other until I no longer heard the words which needed now be spoken, to me or others. When I can no longer distinguish between clinical appropriateness, my own bias, therapeutic boundaries, and personal fears, it’s time to pull back the reigns and allow some healing to occur. So, as I offer these perspectives to my colleagues, I should also note how very personal this is for me. My life’s work in the field of behavioral health has taken different avenues, but I have never lost my desire to be a guide to those who may need a light. By shedding light on this issue, I hope to find my own light source again in a way that it no longer burns down quite so far. This is how I make amends with my own past mistakes and come to a place of true trauma-informed care, that starts, inevitably, with me.
They’re doing it for the attention.
It’s a refrain uttered everywhere, as people attempt to explain why troubled adults, adolescents, and children behave the way they do. Overused and indiscriminately applied, doing it for the attention has bothered me since I was a trainee in child psychology. Surely, humans do what they do for a wide range of reasons. And if someone is crying out for attention, don’t they deserve—need—us to notice? To attend?
Instead, seeking attention from others is all too often reviled. It’s dismissed as indulgent, considered a reward for undesirable behavior, a reinforcement of disavowed emotion. So, we stop being curious about others’ internal experiences — disconnecting from what they know, feel, need, want, fear — and, necessarily, we disconnect from our own. Rather than noticing, bringing attention to what’s happening inside no matter how confusing or intense or messy, we learn to turn our attention away. We numb, avoid, put aside. It feels safer to stop noticing. If we don’t give it attention, we can make it disappear or pretend it’s not real.
Not so in the process of EMDR therapy. There, the words, “Just notice,” are the foundational guideposts.
“Just notice,” we therapists say. “Let whatever happens, happen.” We may repeat this mantra countless times a day-- a reflex woven into procedural memory as we support clients dealing with trauma.
Just notice? The mother wonders, just notice what?, as she stands over the warming bed of her two-pound baby in the NICU. She tries desperately, silently, to notice what the nurse is showing her about her newborn baby’s skin tone. What if I never get it? she thinks. What if my ability to notice what’s important is broken?
“…and let whatever happens, happen,” we say, as the newly bereaved parent of a baby who died at birth looks at us with wide eyes.
“Let whatever happens, happen? I can’t just notice. I can’t trust my judgment. Just look at this baby, who my body failed, who I have failed…”
We say these words because we know that the key to healing begins with simply noticing. Pay attention. Be curious, see what happens next.
But it’s a catch-22. Trauma fractures our natural ability to notice. It disrupts our capacity to access that calm curiosity that allows us to stay connected to what’s happening inside. Bringing our attention to pain, even though it’s uncomfortable, seems to be essential to recovery. It’s as if we need people to be healed in order to access the healing.
Fortunately, as in all relational psychotherapy, EMDR therapists offer our attuned presence as scaffolding and support as people begin to turn their attention to their internal world. With EMDR therapy, we provide precisely the sort of nuanced appreciation for the ebb and flow of thought and feeling, somatic sensation, and memory that parents must bring to their babies and that, especially in the face of disruptions on the road to parenthood, can seem both frightening and out of reach.
It goes something like this:
As you bring your attention to yourself, just noticing, I will help you. I will notice with you. I will notice the subtle changes in your skin tone, as your cheeks redden and clear, as the tears rise and fall. I will note your breathing and breathe with you. I will not turn away from your fear or your pain or your anger. My nervous system will listen to the rhythms coming from yours. I will notice and then you can notice, too.
That subtle sensation, that flickering emotion, it all matters. “Notice that,” we say, inviting gentle curiosity, remaining just as engaged and attentive as when tears are flowing. “What are you noticing now?” we ask. So often, language is elusive but the emotion, the emergent shift, is palpable and so we lean in. “Just notice it,” we say, affirming that it exists even when it can’t yet be articulated. “That blossoming warmth? That stab in your chest? Just notice it. And when you do, when you let whatever happens happen, we will notice together. We will know its truth and meaning together.”
This is how we walk with our clients into the process of EMDR therapy where everything they notice, no matter how subtle, counts, not just the sobs or the searing flash of memory. It’s also how we accompany bereaved and traumatized parents into the new world born in the face of perinatal trauma. We notice the shrapnel causing pain and blocking healing. Just as important, we nourish and support the gradual creation of connective tissue that forms the foundation of a new sense of self: as a parent to this baby within the matrix of relationships, within this family.
All of it, every single nuance, counts.
“My baby only spent a few days in the NICU,” said one father to me in response to a call for interviewees for our book. “Are you sure you want our story?” “Our baby died,” whispered another. “Do you really want to interview us?”
It’s a common concern that parents express to therapists. Does it count? Does our experience really matter? Even if my baby is fine now, or if there are no marks on my body to prove that we’ve walked through the fire or no living baby to parent after all we endured? Do I have permission to notice what this means to me, how it actually feels? And if I do notice where it hurts, can I show you? Will you pay attention?
So we sit across from the families who land in our offices-- parents unmoored from what they used to know about themselves, about babies, pregnancies, and the way the world is supposed to work when you’ve followed all the rules, and we pay attention. We notice and most importantly, we trust what they notice. We show them with our engaged, calm presence, staying out of the way but staying.
If we’ve been fortunate to become a parent to a full-term, healthy baby, conceived, gestated, and born without incident, it can be challenging to learn to decipher these signs of dislocation and the consequences. When the road to parenthood has been pitted with earthquakes and storms, parents cannot trust in what once seemed natural and easy. Without that steady sense of “I can figure this out,” or “everything will be okay,” parents feel unmoored and may desperately turn to others to steady themselves.
They often turn to professionals, like us.
And yes, they are doing it for the attention.
And in fact, they benefit when we pay attention-- when we see them as they are, validate their experience of their journey, acknowledge their pain, and accompany them as nonjudgmental witnesses. Our attention is what helps them learn to notice both the obvious and the nuanced and let what happens happen. Our attention is what helps them regain feelings of confidence and competence. Gradually, they begin to believe in themselves as parents, including, “I can learn to read this baby’s cues,” or, “I can trust my sense that something is wrong (or right) with myself or my baby,” or, “My pain counts even though other parents are experiencing a grief and fear I can’t even fathom.” Or even, “I feel love and hope and joy even though strangers glance at my baby and turn away,” or, “I am a loving parent even though my baby died.”
Our attention validates these truths. Noticing them guides our clients to turn their own attention back to their lived experience in all its mess and meaning. Only then can they weave together the strands of their experience, appreciating them all as part of a larger whole.
In the last two weeks I have suffered three injuries. None of them so terrible that I required major medical intervention, but bad enough to leave me generally pretty bruised and crappy feeling. It was on the heels of some bruised ribs and a fall down the stairs that my partner invited me to attend a woodshop orientation workshop in which we’d be introduced to various saws and machinery and how to use them correctly. You can see where this is going…
The second saw in, the instructor casually referenced the availability of a safety mechanism and cavalierly noted that most people find it a nuisance and moved along without showing us how to use it. Naturally, when it came to my turn the saw spit back a piece of wood at me which rocketed into my hip at what felt like 8,000 mph. The pain shot down my leg and my body went tingly then numb. I could barely stand. The instructor and other participant just looked on in silence and moved on to the next machine. My partner, who’d invited me, looked at me with genuine concern and whispered, “are you ok??” I clenched my jaw and nodded and hobbled along behind the group to the next machine where I put on a brave face and completed shaving off an eighth of an inch of a piece of wood on a drum saw. Afterwards, I began to feel overheated and a little faint, so I turned to my fella and said, “I think I’m gonna sit this one out, you stay here!” It was at this point that I exited to the parking lot and proceeded to cry my eyes out. Every part of my body hurt, and I was so tired and overwhelmed there was no way to keep it in. Awhile later, I sent him a kindly text explaining that I was not feeling well and I’d walk back home and for him to enjoy the rest of the workshop. My partner responded in the sanest way possible by immediately calling me, asking where I was and if I was ok. After admitting that I’d been crying in a parking lot by myself, he said rather plainly, “you sitting in a parking lot crying by yourself is more important than me learning to use a band saw. You hide what you’re feeling really well.”
He’s not wrong. I grew up in a feelings phobic household. Sure, my parents cared for us and treated us well, but I don’t even need one hand to count the number of times I’ve seen family members cry in front of me. Sadness was treated as a medical problem, rather than a natural emotional response. So many people have it worse! Pull yourself up by your bootstraps! And power through! Were the well-intended mantras of our household. Sadness was something tucked away and saved for the medical professionals. And to be clear, I have dealt with diagnosable depression that has required medical intervention. But I do wonder if the inability to express sadness only compounded those feelings.
It wasn’t until the day after my woodworking injury when talking with a friend that I realized how insane my response had been. My natural response had been to save those feelings until I was by myself and walk home on a crippled hip so as not to bother anyone. In that moment I did not believe that my pain and experience might be more important than someone else learning to use a dumb saw. I did not realize that it might be a little out there to suppose I needed to keep it together in front of an instructor who clearly wasn’t interested in my safety, a stranger, and a person who cares deeply about my well-being.
These are the lies we tell ourselves: my pain isn’t important, or least not important enough to bother anyone. I cannot show what I’m feeling. It’s better to suffer in silence. No one likes someone who’s always complaining. I cannot look weak. I need to have it together. It’s always a little funny when I become aware of this stuff, because like hey, it’s literally my job to help people process feelings in a variety of ways. And as much as I write about it, and give talks, and work with others, I’m still a human for whom this exists. Honestly, it kind of makes me feel like a fraud sometimes. I guess that’s the other lie: you’re not good enough.
I think it takes most of us awhile before we even realize that some of the beliefs that underpin the way we operate in the world are lies – mostly, we just think this is the way we are, and the way we handle things without subjecting those beliefs to any litmus tests. It usually takes someone else asking me, “how is that serving you?” before I put those beliefs to the test. How does it serve us to buy into these beliefs we have about ourselves, what we deserve, and what we should do? Are these beliefs and the actions that extend from them benefiting us? Or are they hurting us? Do they make my life better? Or worse? I’m going out on a limb here, but in retrospect it seems like deciding to walk home on a busted leg because of the belief that I cannot show my feelings wasn’t making my life any better.
But seeing the lie still isn’t always enough for me to do things differently. It’s hard to get away from that initial gut reaction to default into the same old way of doing things. There are a million reasons we find to not do things different. It’s hard. It might not even be better anyway. It will definitely be uncomfortable. These are just a few that I can buy into. I mean if you grow up in a household where crying in front of another person is never experienced, how do you even begin to test out that kind of vulnerability? Truthfully, I’m not sure. But I know this, after I let it all out to someone I care about and whom I trust in return, I went home, was tucked in under some blankets and fed chocolate in front of the TV until I fell asleep. And you know what? I felt better. I’m not always sure I know the answer, but I am fairly sure at this point that if I don’t try being vulnerable with the right people in the moment, I will always end up crying by myself in a parking lot. And at this point, that just isn’t serving me well anymore.
Institute for creative mindfulness
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