Embodied Psychotherapy - Somatic Psychotherapy, Consultation & Training

The Wounded Healer and Vicarious Traumatization 

"All of the trauma work that we do, hour after hour, day after day, week after week, contributes to inner changes in the self of the therapist. It’s an inevitable part of the work…because we’re entering into a very dark world, and if we’re open emotionally, in the way we need to be to be effective helpers, we’re going to be impacted."
                                                                                             – Laurie Anne Pearlman

What is Vicarious Trauma?: Vicarious trauma, “secondary traumatic stress,” “compassion fatigue,” or/and "empathic strain," (McCann & Pearlman, 1990; Pearlman & Saakvitne, 1995; Figley, 1983), is the impact left on health care professionals as a result of listening to trauma narratives and bearing witness to the effects of trauma in those we serve and support. Because the very qualities that help us to be sensitive, empathic, and caring witnesses, healers, and therapists, also cause us to be vulnerable to vicarious traumatization, therapists and helpers are at risk to the harmful effects of trauma work. The effects may be numerous, both subtle and severe, and may be out of the awareness of the helper. Among other things, they can include, heightened feelings of vulnerability, an extreme sense of helplessness and or exaggerated sense of control, chronic suspicion about the motives of others, loss of a sense of personal control, loss of sense of freedom, chronic bitterness, cynicism and alienation (Gabriel, 2001). They can also parallel many of the same symptoms of PTSD that our clients experience (e.g., re-experiencing, avoidance and hyperarousal). It is my experience that many survivors come into the world as very sensitive beings- empaths. That sensitivity then gets compounded, as we get broken open by the traumas and enduring conditions that imprint upon and wound us. This sensitivity is a double-edged sword. It is what can cause us to feel too much, to be overwhelmed, to be anxious, flooded and have trouble maintaining emotional and energetic boundaries. Yet, it is also this very sensitivity that can make it possible to experience the tremendous empathy and somatic resonance that facilitates a more intimate understanding of another’s experience, helping us discern what is needful to support a client in moving towards recovery and well being. As an adult and a psychotherapist, I have had to rediscover and redefine my understanding of my own sensitivity. I have had to learn how to care for my self and my system in ways that allow me to maintain clarity, balance, and ease. The journey has been about learning to treasure and navigate this sensitivity and  “broken openness” as a gift, while simultaneously recognizing that it can also be a debilitating vulnerability if left unattended and unmanaged. Additionally, as a trauma survivor and “wounded healer,” our own attachment issues and traumatic experiences can allow us to join with and comprehend our client’s experience in a more intimate way, frequently facilitating a sense of deep understanding and connection.  Simultaneously, our traumatic experiences can cause us to merge with the pain, suffering, terror, rage, shame etc., of our clients.  Resulting in either triggering of our own material and/or a taking on of the somatic and emotional experiences of the other. When I first began to sit with others, I did identify as sensitive, empathic, and perhaps even psychic, but I had not yet identified myself as a trauma survivor.  My very first clients were survivors of heavy trauma, with yet unrecalled childhood sexual abuse histories.  I felt very present, connected and committed to my clients. I felt aspects of what they felt, and had such deep empathy for their suffering that I too suffered along with them. I found that I would jump right into their pool of pain while simultaneously trying to throw them a rope. In my work with others, the underground drives hidden within my own trauma history drove me to overextend my self and my boundaries. I saw too many clients in a day without a break, and did too many sessions in a week. I went over session time, always wanting to offer a little bit more. I carried a pager and called people back at all hours. I was driven by the desire to be there for each one of my clients like no one else had ever been. I wanted to save them all, to fulfill my unconscious wish that someone, anyone, could have been there for me, loved me, and saved me from all that I went through. During sessions I took on so much of their experience, energy, and feelings, that I found myself throwing up in between each session. After continued exposure and consistent lack of self-care and sufficient support, I found that I was experiencing depression, anxiety, feeling triggered all the time, self abusing and having nightmares. Then I started to have recovered memories. There was trauma that I knew and trauma that I did not know. Not just mine but also my mother’s- things she had never told me started showing up in my dreams. After a fairly short time, I had two very real “nervous breakdowns” (or trauma breakdowns as the case may be), during my psychotherapy internships/practice. Self-reflection, consultation, therapy and my partner, helped me to realize that I simply could not continue on in this fashion. It became clear that I had to take a break and reorganize my practice. I had to stabilize myself and try to find some ground, for myself and to be of help to anyone else. I had to heal myself and remake my practice in a way that was grounded, balanced and healthy.   It was a combination of somatic psychology and strategic interventions that provided the necessary tools and practices required to heal and to rebuild my practice in a functional way. Increasing my consultation sessions and meeting specifically with a supervisor who specialized in trauma and had her own trauma history was vital. Getting rid of my pager and limiting my availability in between sessions and on weekends was the next step. Looking more carefully at my caseload, I realized that the type of clients I was treating was also significantly contributing to my experience of overwhelm. All of my clients had severe trauma histories, PTSD, and were usually dual diagnosis. Many of them were severely depressed, self-abusing, and actively or bordering on suicidal. As connected as I felt to all of them and their stories, I needed to find a separation between my suffering and theirs. I needed to not just follow my gut and my emotional connection with clients, but to begin to include my neo-cortex; to consider and discriminate who I invited into my practice. I needed to learn to include myself in my practice and to consider who was good for me to see, not just whether or not I could help them. In order to do that I had to learn to tolerate the self doubt that caused me to anxiously grasp onto clients and learn to develop trust that if I turned people away, there would be others that would come. Balancing the fullness and rhythm of my day and weeks was also essential. It was important that I decide how many clients I could see in a day and how many sessions I could comfortably do in a week. It was necessary to discover how long my breaks in between sessions needed to be and what type of activities I needed to do throughout the day in order to help me feel more spacious, regulated, and resourced inside. Thirty (30) minute breaks in between each client allowed me to eat, drink plenty of water, walk, get fresh air and develop a repertoire of clearing and resourcing exercises (see the Somatic Resourcing Exercise Page) which began to help me regulate my nervous system and traumatic arousal patterns. Continued resourcing helped me to find my center and build ground for me to sit in, allowing me to be present with my own and my clients’ responses and experience. Through somatic boundary building on my own and in my own psychotherapy, I began to be able to feel myself as separate from my clients and was more and more able to easily differentiate what was mine and what was theirs. Increasing my own observing self and awareness helped me to learn to track those ways of being that caused me to get merged with a client, to lose my center, or to leave myself and locate in the other. I explored my own boundaries with each client by experimenting with how close or far away from them I needed to sit in order to feel spacious and well seated in side.  I watched how I would sit forward in my seat and get over-engaged with a client’s experience and I actively sat back in my seat. I constantly practiced breathing deeply into my own belly which allowed my parasympathetic nervous system to remain engaged and thus to maintain a sense of calm. After writing my chart notes, I meditated on each client for one minute with the intention of letting them go on their way. I utilized herbs and flower waters for cleansing and purification in between sessions to support my ability to let go of each client after they left the office. Then I drank plenty of water and spent 5 minutes breathing into my own body and practiced somatic containment, grounding and centering techniques that helped me to feel and be inside my self with a sense of ease and space to breathe. Continued development of mindful tracking in addition to these interventions and practices, allowed me to become more and more solid inside and to have a clear experience of when I was activated or in a resourced state and gave me tools to re-regulate my nervous system. Over time, the tools I developed became second nature and I became more and more able to readjust myself even within a session. As I became clear that I was getting activated or merging with a client’s experience, I would be able to get up and move around, breathe, and ground myself even within the session itself. While somatic resourcing and awareness practices may be unfamiliar to many healing professionals, they provide tools that are invaluable for preventing and recovering from vicarious traumatization and compassion fatigue. I invite each of you to take stock of your practice, your nature, and your state of being to assess the impact of the work you do on your sense of well-being, your outlook, your relationships, and your nervous system. If you discover that you are feeling dull, irritable, anxious, too full, overwhelmed, scared, losing joy or any other number of things that might be a variant on your self at best, then please consider committing yourself to a mindfulness practice, revamping your therapy practice and practicing some of the somatic resourcing experiments below on a daily basis.  
For Somatic Resourcing Exercises, go to the Somatic Resourcing Exercise page.
Things to Notice:
  • How do you organize towards your client when they are in the room? What is your body posture? How close do you sit? How fully do you breathe? What do you feel in your center (heart, belly, solar plexus) as you sit with or imagine sitting with them? What shifts could you make in order to be more balanced inside your self or antidote whatever is going on that is not working for you?  
Things to do while sitting in the room:
  • Get up and walk around. Don’t feel obliged to stay in your seat!
  • Pushing feet exercise
  • Belly Breathing
  • Move further away from the client in your chair
  • Gently rock your pelvis
  • Push your hands together isometrically and feel your muscles engage
  • Do a somatic resourcing experiment with your client! If you are needing something, perhaps they are too!  

 References:
Bowen. (2000-2010). Conversations and Trainings in Psycho-Physical Therapy. www.psychophysicaltherapy.com
Figley, C.(1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner/Mazel.
Gabriel, M. (August 2001). “Surviving Listening and Witnessing: Vicarious Traumatization in Social Workers Practitioners.” National Association of Social Work, New York City Chapter Website, http://www.naswnyc.org/p30.html
McCann, I. & Pearlman, L. (1990). "Vicarious traumatization: A framework for understanding the psychological effects of working with victims." Journal of Traumatic Stress. 3,(1), 131-49. ·      
Ogden, Minton, and Paine. (2006). Trauma and the Body. New York: W.W. Norton & Co., Inc. www.sensorimotorpsychotherapy.org
Pearlman, L, & Saakvitne, K. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivor. New York: Norton.  
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