Traumatized

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Work with traumatized individuals can traumatize the therapist, too. Hearing about blood, gore, loss of safety, life threatening experiences, witnessing hideous sights that play and replay in the mind--all of these are the stuff of Posttraumatic Stress Disorder.

I can't talk about my clients or say anything that would give away their identities. But I can tell you about my response to what I see and hear over the weeks and months that I work with my them. In the beginning of my work with a new client who has been traumatized, I typically have secondary traumatization symptoms for a day or two. There are unwanted dreams, preoccupation with what was heard in session, and a lull in my mood. I tend to want to be left alone and not talk to anyone until I can work it through in my mind and separate their story from my personal story which doesn't include the threats to safety that they have had.

So today I heard a story of incredible bravery in the face of danger. Heroic acts were performed that most of us wouldn't even think of. Lives were saved and death averted. But it emotionally disabled the heroes. They are afraid to burden their families with the horror of their story, so they come talk to me about it every week. I know the course of treated PTSD: initial exhiliration that they have survived (several weeks) followed by awareness of fear and vulnerability (few weeks), followed by major symptoms and relational difficulties due to intrusive flashbacks, nightmares, panic, dissociation, etc. If they are faithful in working it through--which is a daunting and frightening experience for many traumatized people--the symptoms will start to fall away after about nine months and they will be functional without crippling fears or memories. My client is just getting to the major symptom manifestation stage and is particularly anxious.

Most of the time in therapy I'm listening for exceptions to the hopelessness, pain, vulnerability, and negative symptoms so I'm focusing on something other than the sensational details they spill out. I think of what I'm hearing as a piece of a larger puzzle, and I'm thinking about what needs to happen so clients can think about their trauma in a less pathologizing way and move on with their lives after they work it through. Maybe I'm listening to the way they are expressing themselves: what isn't said or acknowledged? What is the focal point of their comments? How does this tie in with their interpretation of their value as a person? Where are the entry points to the story where new interpretations can be explored?

But there are times when the rawness of the story takes me by surprise and I carry it away on the inside of my soul. Today was such a day. It was a session that left me feeling as though I needed to come home and soak in a hot tub until I was like a piece of warm taffy. All these little bits of trauma, sadness, and pain that I pick up in therapy have to go somewhere. Since my worldview is that awful things do happen to good people, and that it's not safe here and that good-hearted people are placed in untenable situations, then I'm typically not shocked by hearing too much. But alas, I am human, too. My clients' panic as they explored another facet to their story, the horrifying experience that was endured, and the way they were reduced to survival behaviors--all of this impacted me more than usual. Perhaps I wasn't emotionally prepared for our session today. I noticed that as they spoke, I was struggling to step back and see the forest rather than the leaves on the trees, and I wasn't fully successful. A good night's sleep will rearrange all the facts, impressions, and story fragments in my head so that the stories of my clients will become part of the story of my life without eclipsing the future. I am grateful that I will wake up feeling considerably better and more clear-headed. They will wake up frightened, disoriented, and struggling to recognize that they are living now, December 22, 2008--not back when their trauma occurred.

God bless all these good folks.