“We are the tools of our trade,” declared Laurie Pearlman and Kay Saakvitne in their book Trauma and the Therapist. Plainly, our capacity to provide mental health care rests on our own mental health. No doubt, we are in an emotionally hazardous occupation. Therapists who treat traumatized patients are subjected to vicarious trauma as they resonate emotionally with their patients’ psychological pain and imagine vividly scenes from their patients’ stories. Like their patients, therapists can experience intrusive memories and nightmares. Moreover, therapists may have a trauma history that resonates with that of their patients, whether it be in the context of combat trauma or childhood maltreatment. Ironically, the fundamental basis of therapists’ helpfulness, empathy and compassion places them at risk for vicarious trauma.
Are we mental health professionals who are at risk any less deterred by shame and stigma from obtaining the care we need than others in the community?
Perhaps. There is some evidence that therapists with a trauma history are more likely to seek treatment, and we should be encouraged that such therapists value personal therapy as being most helpful.
All we can do to maintain our mental health is practicing what we preach, and availing ourselves of personal therapy is one example. More generally, we advocate that our patients “process” traumatic experience by allowing themselves to think and talk about it while experiencing and expressing the associated emotional pain. Yet this “processing” is liable to evoke symptoms of posttraumatic stress disorder by evoking disruptive emotional memories.
Accordingly, we recommend that processing be balanced by containment, most importantly, in the form of trusting, secure attachment relationships coupled with the capacity to regulate emotional distress with coping skills such as relaxation, mindfulness, physical activity and self-soothing. Such containment also can be bolstered by knowledge about trauma and by structure in one’s life as evidenced in stable routines.
There is nothing more for us therapists than for our patients: If we are to provide help, we too must have opportunities to talk about painful experience in the context of secure attachments (in personal therapy, supervision and other confiding relationships) as well as the skills to cope with our emotional distress and well-structured lives. We should have the benefit of expert knowledge; yet, as with much else, it’s easier said than done.