VICARIOUS TRAUMATIZATION
The nature of this calling, as a therapist, is such that if you want to give your best you must willingly enter some very dark places with deeply wounded people. It is not enough to be merely an observer or teacher or even kindly guide. You must walk beside them and feel the harsh texture of their pain with them if you would ever hope to truly appreciate their situation or earn their fragile trust. This is hard and it is costly.
Some conflicts and problems can be resolved through a solution oriented therapy that relies upon analysis, insight and a bit of personal support and encouragement. We have all given this kind of counsel and done some real good in the process. We have also received it from time to time and been grateful for the gift. There is another level of need, however, for which this is starkly inadequate. A spirit, twisted and broken by devastating and intimate cruelties such as are known in far too many families and elsewhere as well needs a heartfelt connection with someone who is able and willing to tolerate and empathically connect with the grief and distress of a deeply wounded soul.
As we all know from our own lives, some painful stories can only be safely told within the confines of a loving, authentic relationship. Such a relationship becomes possible when the listener allows him or herself to be emotionally impacted by the pain the other is disclosing. Without emotional resonance there is no relationship in any significant sense of the term. The depth of a person’s healing has always seemed to me to be more or less proportionate to the depth of relationship that person has with the therapist. Emotional attunement and nonjudgmental respect create the bond and safe environment necessary for a traumatized person to dare to hope for a life unburdened of its weight of darkness and pain. When the therapist is willing and able to allow in the emotions and existential questions occasioned by significant trauma and abuse, the client will be given the best chance possible to face the horrors of her life and the maelstrom of emotions and questions that are their immediate and unavoidable consequence. Offering this as best I can to my clients and keeping my balance at the same time has proven to be a significant challenge.
The anguish and terrible knowledge of the dark side of the human condition that these stories inevitably convey are burdensome to hear and struggle with. My emotional equilibrium and my desire to maintain a trusting, optimistic view of life are severely challenged by helping bear the weight of my clients darkness. It can’t be otherwise. Some degree of vicarious traumatization is necessary and inevitable.
The Adam and Eve myth tells us that we were cast out of paradise because we dared to taste of the tree of the knowledge of good and evil. I believe that the felt knowledge of our client’s wounding is precisely what this story is about. This is powerful and dangerous knowledge. If I let myself really know how depraved and mean spirited life can be in the lives of my clients then my world no longer feels as safe or as good as it had seemed before I tasted this bitter fruit. Those who do not or will not face the terrible darkness of the human condition can have the comfort of easily believing that a benign force is in charge of everything and that everything that happens, happens for a reason and all is well in the end. I don’t have that comfort anymore. I have been cast out of paradise by the force of my own personal life experience, but more especially by its reiteration over and over, day after day in my office by men and women about whom I care deeply. I don’t even have the comfort of being able honestly to tell myself or my clients that all will be well after the therapy is concluded. No one ever heals altogether from severe, prolonged trauma. Therapy always hits a point where it becomes clear that certain affective, relational and cognitive limitations must simply be accepted and worked around.
Although dealing with trauma effectively can lead to depth of character and a compassionate heart, there are other better ways to get there. Such as growing up in a home where the early attachment bond with your mother is deep and trustworthy; where your parents celebrate your individuality and do all they can to promote the emergence of your authentic self and leave you have no doubt you are loved deeply; where depth of character is modeled by your parents and compassion is celebrated by your culture. It’s hard for me to believe in a compassionate father/mother God who has everything under control when I spend so much time with people who have known no such thing in their lives and instead present such immediate, constant and varied examples of lives deeply compromised by the out of control behavior of those who were entrusted with my clients’ welfare. For me, this philosophical\spiritual consequence is one of my most significant vicarious responses to my clients’ pain. It has forced me to dig very deep in order to build a viable spiritual foundation for my life.
The next most impactful aspect of my clients’ suffering is the ongoing struggle with attachment disorders and enmeshment problems that are endemic in dysfunctional and abusive families. Most of the wounded people I know began their lives immersed in abandonment pain flowing out of insecure attachment to their mothers and proceeded to grow up faced with innumerable boundary violations and every kind of enmeshment. This is personally difficult for me at two levels. First it keeps before my mind facets of my own life that I would just as soon not have to think about for a while. However, over the years as my own healing has unfolded and genuine forgiveness of my parents has begun to flourish. This is less painful than it used to be. The second level of difficulty flowing out of the clients’ abandonment/enmeshment diad is the manner in which it constantly intrudes into the therapy arena. Clients have been conditioned to anticipate and invite interactions that energize either end of the polarity, especially with people with whom they have an intimate bond such as their therapist. All too often I catch myself accepting the invitation either because my own unresolved wounds are being activated by the clients’ material or I simply miss what is going on between us until my inclination to abandon or become enmeshed with the client becomes so obvious that I can no longer not see it. When I become thrown off balance by becoming caught up in the process of abandoning or becoming enmeshed with a client some of the worst patterns out of my own history are activated with significant ramifications for the therapeutic process as well as my every day life. Both client and I suffer.
When the wounding is deep only love can bring genuine healing. I think it would help a lot if the graduate seminar on techniques in counseling included a section on how to love your clients in a deep, heartfelt fashion. The best text I can think of for such a course would Eric Fromm’s classic, The Art of Loving. As he points out, love consists of four distinct but interrelated attributes; care, knowledge, respect and responsibility. As applied to the therapeutic relationship I must genuinely care about the welfare of the client. How well he or she is doing must matter significantly to me. I must also seek to truly know who this person is who is inviting me to help her find the Self that she doesn’t yet know. It takes an enormous amount of awareness and sensitivity to begin to know the wounded self and the full complexity of its story. It takes even more to begin to sense the underlying authentic self and help it emerge out of the ruins. It goes without saying that I must be able to hold this distorted, usually regressed, often manipulative and nearly always angry Ego with infinite respect, the kind of respect in which the divine within me bows before the divine within the other. If I don’t I can be assured that I will almost certainly do more harm than good. Finally I must be responsible to the relationship with all of its myriad, implicit and explicit needs, demands and wants which can be akin to walking through a mine field. If I do not execute my responsibilities to the relationship well, both client and I will be hurt, perhaps deeply. I am not talking here about getting in trouble with an ethics board or getting sued. What I am alluding to here is that if I deeply interact with people in a way that is not loving at its core, I will slowly lose my soul. I will become dehumanized and lose connection with the very energies that give life meaning. Choosing to offer oneself as a healer is a glorious and dangerous thing. You will either grow significantly or it can harden your heart which to my mind is the greatest tragedy that can befall anyone. Of all of the facets of vicarious traumatization this is the worst.
The violation of love in the therapeutic relationship will inevitably be expressed as some form of abandonment or enmeshment. Moreover, abandonment and enmeshment lies at the heart of the pain in the lives of most traumatized clients. It also constitutes the most fundamental dynamic that must be kept in balance throughout the therapeutic process. All therapists will err in both directions occasionally. Those with a personal history of pain around these two issues will have the added pressure of repetition compulsion pushing them to lose their balance. Most therapists will be more inclined to lose balance toward one end of the polarity or the other due to factors of temperament and personal history.
When I stop and think about it too deeply, such as right now, doing in depth therapy with those who most need it can feel almost overwhelmingly difficult. On the one hand you must be emotionally attuned and responsive if there is going to be even a chance of the client taking the risk of baring her soul. Letting myself sense the hurt, grief, terror, hopelessness and shame of this devastated lost soul sitting before me is painful and tiring. I am not the kind of person who enjoys horror movies. On the other hand when I do open myself to that other’s story I then find myself walking a tightrope. I must be careful not to inappropriately connect and thus exacerbate the clients enmcshment wounds or at the very least discmpower the therapy. But I must also be equally careful not to abandon the client and activate what is usually the most fundamental and destructive wound of all.
Years ago as I became aware of the power and centrality of the abandonment/enmeshment diad I saw it principally as something caregivers did to children. Then it dawned on me that this is what constitutes the essence of bad therapy. All those incompetent therapists out there are basically people losing their balance either toward the abandonment or the enmeshment side of the polarity. Finally, as I appreciated more fully the specifics of abandonment and enmeshment I saw that I was one of the incompetent therapists, at least some of the time, as are we all.
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Children who suffer from enmeshmcnt are not allowed or helped to find their own voice or live out their own best potential. They have a connection with their parents, but the cost of that connection is that they sacrifice themselves to serve the needs of the parents. Something comparable happens when therapists become enmeshed with their clients. The therapist inclined toward enmeshment is typically kind and compassionate and is willing to go the extra mile to help, just the kind of therapist any one of us would like if we needed therapy. In itself it is an ideal stance for anyone engaged in depth psychotherapy. Since the therapist’s intentions are so pure and openhearted it’s difficult to see how this could be harmful which only makes it all the more dangerous for both parties. A traumatized client’s truth is nearly always complex and subtle. The unfolding of that truth is usually going to be hampered by ingrained secretiveness, distrust of others, especially authority figures, shame and the client’s fear of her own dark aspects some of which can be quite awful. The enmeshed or overinvolved therapist blocks the full evolution of that truth by unwittingly imposing his own usually well intentioned agenda.
The enmeshed therapist usually violates the therapeutic relationship in one or more of several fairly predictable patterns. Like the enmeshed parent he may allow to develop reciprocal dependency in which he needs the clients attention and support as much as the client needs his. Although very affirming to the client over the short term it is the same kind of false empowerment through role reversal that robs children of their childhood and a chance to mature appropriately and will do the same to the client.. Another form of inappropriate therapeutic dependency is pathological bonding. ~You and I against the world,” is one expression of it. Getting caught up in the reenactment of the client’s trauma bond with an abuser is another.
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Just as a healthy parent recognizes that she has a special role in the life of her child that demands certain kinds of interactions and disallows others so must a healthy therapist. Wounded, suffering people need someone who is confident in her skills and competent to understand their real needs. They prefer a therapist who has known significant wounding herself and is willing to admit it, but they do not want or need a “me too” in which their stories become the occasion for more of the therapist’s own story. Our personal stories can come close to the client’s but can never be the same. Too much attention to them will invite role reversal, but even when that does not happen they will block perception of the uniqueness of the client’s own truth which, of course, is part of what happened to them as part of their original wounding.
Like a healthy parent, the effective therapist must be able to tolerate the sometimes overwhelming needs and feelings of the client without becoming defensively disconnected or detached. This can be very difficult. Some stories are heartbreaking, and some are terrifying evoking horror and shock. Yet the therapist must stay in balance and a solid point of reference as the client struggles with the intense feelings triggered by these remembrances. Not only must the therapist be able to tolerate the stories, she must also be able to tolerate the clients intense painful emotions and not withdraw or be overcome herself.
When the therapist engages the client is a spirit of loving respect care must be taken that this does not degenerate into idealization of the client which is merely another facet of enmeshment. Once again the client’s reality is discounted and healing is thwarted. It is easy to fall into a good/bad dichotomized world view when people speak of the atrocities done to them. The perpetrators are bad and the victims are good. Comforting as this model may be, it is seldom true. Perpetrators are usually complex people driven by their own pain and may have had a much more convoluted
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relationship with the client than a good/bad model can entail. Additionally, the client will almost inevitably have been so distorted and compromised by his suffering that he may well have made choices about which he feels great shame or guilt, some of which may be appropriate. By idealizing the client the therapist implicitly makes some of the most important things the client must explore, his own shame and guilt, off limits. Again, enmeshment deprives the client of his own truth.
Related to the inclination to idealize the client is the inclination to take a position of excessive advocacy or responsibility for the client’s life. A kind therapist may be so touched by the very real unmet needs of the client that she may be tempted to make the client’s life a personal project. Drawing the line here can be very difficult. After all a person without minimal food, shelter and safety in her life is not going to be ready to do in depth therapy. Nonetheless when a therapist becomes a primary source of support for clients outside of the therapy context it often ends badly for both parties.
A final destructive expression of therapeutic enmeshment has to do with how the recollection of the traumatic event or events is handled. For healing to happen the story must be told and felt. Sometimes, many times over. The therapist must be willing and able to truly hear it without judgment and with empathy. She much not, however, become overly fascinated by it or let herself too fully identify with the client as the story unfolds. This will make the story part of her agenda and again rob the client of her own unique reality and diminish the possibility of achieving resolution. The power and drama of the trauma must be diminished through the telling of the story, not intensified. Then the trauma can be placed in the broader context of the person’s whole life history which is the essence of healing.
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The other alternative for doing bad therapy by robbing the client of the possibility of a healing relationship is to give into the abandonment side of the dichotomy by taking an avoidant or detached stance to the therapeutic relationship. There arc innumerable ways to do this. Many of which are considered highly appropriate and ~professionaI.” They are in fact the cruelest thing a therapist can do to a client, and echo the awful potential for damage of early life maternal abandonment. At its most fundamental level the therapeutic abandonment of the traumatized client begins with the denial of the validity of the client’s story or the denial of the phenomena of PTSD as either real or significant. A variation on this theme of abandonment is the unwillingness to discuss traumatic history unless corroborating evidence can be offered “proving” that it really happened. Another way of detaching from the client is to fail to explore the trauma story which will guarantee that it will remain unresolved. Pushing the client to recover quickly and or minimizing the impact of the trauma may please a managed care company, but it is just another form of abandonment. Victims are usually already predisposed to minimize their traumas and “slower is faster in the long run” is an important axiom to hold onto in the working through process.
Even with therapists who are open to the subjective truth of their clients’ stories and willingly engage in the working through process will sometimes find themselves slipping into an avoidant, abandoning posture. The awful content of the stories and the myriad ways in which the clients can be difficult can evoke dread, disgust, loathing, numbing, shame, horror and any number of psychophysiologic reactions such as nightmares, anxiety states, depression, insomnia and other somatoform problems. Not surprisingly, therapists dealing with this tend to be relieved when their clients cancel and will themselves cancel sessions for any plausible excuse. Often they will detach by taking a hostile,
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blaming, judgmental or disdainful stance toward the client. Eventually they may abandon the client altogether by referring the client elsewhere, overmedicating the client or by declaring the client “well enough” and prematurely terminating therapy.
As bad as the damage done by enmeshment may be, the harm done by abandonment is even worse.
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