Dear Therapists,
A Letter to Therapists:
As you are hopefully getting some rest this weekend and regrouping from probably the most difficult 2 weeks in your career; I want to name something. None of us know what we are doing and that is okay. We were not trained on how to respond to clients in crisis due to a pandemic. For those of us who work with trauma, we either are working with survivors of a different type of trauma from our own or we have gone through extensive healing and our own therapy to be able to work with a type of trauma we have experienced ourselves.
If we are trauma survivors, we like our clients, may carry some shame around triggers, especially when countertransference comes up. When we feel the empathy go so far and wide that we for a moment we might have some re-experiencing going on. We catch ourselves, we ground, we breath, we notice, we find a space to respond clinically and ethically to our clients. It is like a beautiful dance they tell us something, we process, we feel, and we respond.
If s topic is particularly triggering, we might consult with a colleague or bring it up to our own therapist. If it wakes us up and night or we are thinking too much about something we said or did not say in a session, we notice that and decide what to do.
If we are going through our own hard time in our life, it is often a different hard thing than our clients. We are masters at compartmentalizing. I can literally be in my car 15 minutes before a session in an argument with my husband or feeling triggered by a family member and I will walk in to my office and go into my “therapist mode” or put on the figurative “social work super hero cape.” My clients will have no idea that there is anything off with me or wrong with me.
Also, if we are lucky there is diversity in our caseload. We go from the woman who’s having the affair, to the depressed man who is afraid of failing, to the angsty teen, to the lost millennial and so on. Sometimes there might be a general theme that emerges that week and it’s kind of a fun intellectual exercise to figure out why everyone seemed to be struggling with this or that or just take a moment to notice the interconnectedness in the universe.
This shit is completely different. We have protocols to have therapists from other parts of a state to respond to a natural disaster or a school shooting. If a therapist personally lost their home in a hurricane, they may take a few weeks off to re-group. If we experience a loss or have to have a surgery, we take a couple of weeks off. I have literally never been in crisis and trying to help people experiencing the exact same crisis. My sense is most of us have not had this experience.
So, what do we do?! As a small private group practice owner and clinical supervisor, I am tasked with managing my own caseload, my own responses to the pandemic, and support the other therapists in my care. Here are a few ideas that we have come up with:
1. Our own therapy. If you are not in your own therapy at this time, start now. Just like you would if you had your own loss or triggers going on.
2. Join a consultation group. If one does not exist in your community, start one. We have to support one another and get ideas, resources, and support.
3. Start understanding Poly Vagal Theory. I had already started incorporating aspects of this into my work with trauma survivors. More than ever before, do we need to embrace body-based techniques for managing Acute Stress Disorder, PTSD, and Anxiety.As Seth Porges, states in his lecture, The Poly Vagal Theory: The New Science of Safety and Trauma we need to effectively move, with ease, between states of flight or fight and freeze or submission; into the middle response of connection and assessment of safety. We need to go into the parasympathetic state after we have been in a tightly bound compartmentalization of the sympathetic nervous system.
4. Find a colleague to co-regulate with. Lead each other through guided visualizations, meditations, and breathing techniques.
5. Find a friend who is not in the helping profession. Tell them that you need some playful, easy time. Take a socially distant walk and DO NOT TALK about the Coronavirus. Talk about Netflix shows, fashion trends, hobbies, and other frivolous things.
6. Do not stop your outsourced self-care routines. Do your own hair. Do your own nails. Explore the Ayurveda tradition of self-massage. Support your yoga studio or trainer by taking on-line classes. Cook some good, healthy meals.
7. Treat yourself as a Healthcare Professional. This is what we are! Tell the people you are living with that you need extra help and support. Since you are still working, outsource some of the chore related tasks or ask for help with this.
8. When you are off, actually be off. Journal. Write. Externalize all of the rattling in your head. You have to recharge and soulfully rest in order to keep going. Our side of the Healthcare Professionals is likely going be needed longer, after the immediate crisis passes.
I will be leading a consultation zoom call on Tuesday night’s at 6pm for the next few months. Send me a message for the link. We are in this together.
