I’ve had the privilege to be mentored by some exceptional clinicians including renowned trauma specialist Babette Rothschild and senior clinicians from Marsha Linehan’s Behavioral Tech. Babette’s Somatic Trauma Therapy and mentoring has strengthened my clinical practice and broadened my mind to further consider the modalities I integrate into my practice (Dialectical Behaviour Therapy, Mindfulness, Motivational Interviewing, Interpersonal Psychotherapy). Added to this is my PhD which also identified the importance of psychotherapy integration, a notion that Joel Paris (2015) advocates combining the most useful interventions from all sources to best meet the individual needs of our clients.
A lot of my clinical work is with emergency services and mental health service employees. For the individuals I supervise, assess and support… burnout, post-traumatic stress disorder symptoms, vicarious trauma, compassion fatigue and suicide are all too common!
The statistics are overwhelming for mental health and emergency service workers.
- 1 in 10 active emergency workers had symptoms consistent with PTSD
- 1 in 4 emergency workers have thought about ending their lives
- 92% of emergency workers report experiencing stress
- 62% of emergency workers report having experienced a mental health problem
- suicide among female health professional groups was over twice as high for medical practitioners and close to three times as high for midwives and nurses –when compared to women in the broader workforce
When working with mental health and emergency service workers, my approach remains consistent with my other trauma therapy approaches in that I advocate and review Babette Rothschild’s 8 Keys to Safe Trauma Recovery to see how they apply to my clients.
- mindfully identify what is helpful,
- recognising survival
- having the option to not remember,
- stopping flashbacks,
- forgiving not being able to stop the trauma, understanding and sharing shame,
- finding your own recovery pace;
- mobilising your body;
- helping others.
Whilst the 8 Keys of Safe Trauma Recovery may seem obvious to some, the reality is that many mental health professionals still experience burnout, post-traumatic stress disorder symptoms, vicarious trauma, and/or compassion fatigue. Therapist burnout is a pressing issue in our industry! Self-care is possible only when therapists actively help themselves. I support Rothschild’s belief, in her book Help for the Helper that just like the individuals we seek to assist, therapists can suffer too! Strategies for dealing with burnout and stress are just as important as acquisition of therapeutic approaches when performing trauma-informed work.
Rothschild (2000), in her seminal text The Body Remembers, identifies ten Foundations for Safe Trauma Therapy.
- First and foremost: establish safety for the client within and outside the therapy
- Have a broad knowledge of theory – both psychology and physiology (neurobiology) of trauma and PTSD. This reduces errors and allows the therapist to create techniques tailored to a particular client’s needs.
- View the trauma system as a ‘pressure cooker’. Always work to reduce – never to increase – the pressure.
- Identify and build on the client’s internal and external resources
- Develop good contact between therapist and client as a pre-requisite to addressing traumatic memories or applying any techniques – even if it takes months or years
- Client and therapist must be confident in applying the ‘brake’ before they use the ‘accelerator’ (also GLUE and SOLVENT)
- Regard defences as resources. Never attempt to ‘get rid of’ coping strategies / defences: instead, create more choices
- Adapt the therapy to the client, rather than expecting the client to adapt to the therapy. Thus requires that the therapist be familiar with several theory and treatment models.
- Regard the client with his/her individual differences, and do not judge her for noncompliance or for the failure of an intervention. Never expect one intervention to have the same result with two clients.
- The therapist must be prepared, at times – or even for a whole course of therapy – to put aside and all techniques and just talk with the client
The before mentioned Foundations for Safe Trauma Therapy offers a guide towards the goal of trauma recovery, that being a Quality of Life and Professional Obsolescence for the individuals we seek to assist. To achieve this, we as therapists, need to ensure that we have the a personal level of stabilization, health and resources to also remain safe and regulated! As Babette tells me “There should always be one person during therapy regulated at all times!” And you guessed it… it is you!
As a mental health professional my ANS, somatic markers, breathing, previous experiences, resources and dual awareness are tools as important to me as thy are for the individuals I support. Being present and aware (mindful) is certainly my first line defense and I hope it is yours too! As Thich Nhat Hanh articulately points out below… I also consider those around me who may are my source of balance, strength and connection to the present moment!
We talk about social service, service to the people, service to humanity, service to others who are far away, helping to bring peace to the world – but often we forget that it is the very people around us that we must live for first of all. If you cannot serve your wife or husband or child or parent – how are you going to serve society? If you cannot make your own child happy, how do you expect to be able to make anyone else happy? If all our friends in the peace movement or of service communities of any kind do not love and help each other, whom can we love and help? – Thich Nhat Hanh
CPD OPPORTUNITIES IN SAFE TRAUMA THERAPY APPROACHES
If you get a chance go and see Babette’s last Australian tour by clicking the image below! For supervisors and clinicians seeking to reduce burnout, post-traumatic stress disorder symptoms, vicarious trauma, and/or compassion fatigue, Babette is also running a workshop in Sydney on the 10th March Supervision Essentials: Strategies for Avoiding Vicarious Trauma and Therapist Burnout