Wednesday, 13 January 2016


Real World Clinical Social Work Blog: Twin Traumas


Us and Them

The false dichotomy of us and them.

by Dr. Danna Bodenheimer, LCSW. author of Real World Clinical Social Work: Find Your Voice and Find Your Way

     Following the attacks of September 11, 2001, there was a tremendous amount of literature written about the impact of having a shared trauma in clinical dyads (Coates, Rosenthal, & Schechter, 2003; Pierce, 2006; Tosone, Minami, Bettmann, & Jasperson, 2010). It was an amazing clinical moment, because the shared vulnerability of the therapist and client, alike, was crystal clear. It also became totally acceptable for the therapist to not be more evolved in negotiating trauma than the client. For a moment, we were all admittedly in the confusion, rage, fear, and sadness together.

     What feels so stunning about the passing of that moment is that we, clinically, have lost sight of the very real fact that 9/11 was one of many shared traumas that clinicians and clients co-occupy. It was an acceptable issue, at the time, to discuss, because it was so obvious and so huge and there was no shame in being affected by it.

     I think it is fair to say that we have receded back into the fantastical recesses of believing that our clients are traumatized, while we, their social workers, are not. The power of this false dichotomy pervades our work as we learn about the trauma of our clients, as if we are not talking about ourselves the whole time. Most of the time, our clients have some sort of trauma histories. But the hard truth is that so do we. We, of course, are supposed to be on the side of either not having been traumatized or on the side of having worked through our trauma enough that we are not at risk for feeling triggered or unhinged by our own pasts.

     For starters, let me offer a definition of trauma that will help us all to know what I am talking about. The definition of trauma is clearly debatable and complex. To combat that, I am going to use the Webster’s definition of it, to simplify that part of the discussion. The dictionary defines trauma:

1.       an injury (as a wound) to living tissue caused by an extrinsic agent

2.       a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury

3.       an emotional upset

     The broadness of the definition of trauma is useful here, because I am trying to acknowledge the far-reaching impact of trauma. To add to the definition, I will say (in my own words) that trauma usually includes an attack on an attachment, a feeling of being out of control, and a loss of internal and external sites for safety.

     We don’t know how many people are traumatized. It would be impossible to calculate, not only because of underreporting, but because we don’t all fully agree on the definition of it. We do know (at the least) that 1 in 4 college women report having been sexually assaulted in their lifetimes. That number has remained constant since the 1980s. And that is just sexual assault. Given that statistic alone, it makes sense to finally acknowledge that clinicians are often trauma survivors, and we bring this to our treatment.

     I write this as a trauma survivor, myself. In a way, I feel inhibited saying that and at the same time, of course, there really shouldn’t be any surprise there. There are many of us who are trauma survivors, and oftentimes the only thing that separates one trauma survivor from another is the willingness to identify as such.

     Okay, so what about all of this? What does it mean if we ourselves are traumatized? Can we still be good at our jobs? How evolved beyond our trauma do we have to be?

     I operate with these questions in mind all the time. I think about them as a professor, a therapist, and a supervisor. I know my students, when I am teaching about trauma, are trying to learn more about their clients, but are also listening for information to better understand themselves. I see them taking dutiful notes, while I see them internalizing the information to deepen their own understandings of themselves. I know they are hiding this, and I also want them to really know that it is okay.

     I want you all to know that it is okay that you have been traumatized. I want you to know that it is okay that sometimes you feel really triggered and scared and ashamed. I know that you wonder if you can be good at this work when you have been through your own histories, and I know that this question is terrifying.

     It is amazing, because in the field of substance abuse, there is shame when the clinician has not been through some sort of addiction and come out the other side. Clinicians who are not sober often wonder if they can really help their addicted clients. Why is the opposite true for trauma? Why are we often made to feel that if have been traumatized, we can’t help people because we are too messed up? Perhaps the answer has something to do with gender, but I don’t think it is that simple. And I am not exactly sure that the answer matters. What does matter is that the shame transforms into something else, something powerful.

     This is what I have come to believe: I am not sure that we can do this work well unless we have gone through some sort of a trauma.

     There is something quite magical and painful about the traumatized mind.

     The traumatized mind is one that is highly sensitive, attuned, and capable of understanding nuance and complexity. It is sensitive because traumatized folks typically had to study their abusers to try and survive their trauma. This study of psychology was initiated by something horrible, but it was initiated early and has left many of us as experts in our field. It is attuned because those who have been traumatized have typically learned how to really tune into the needs of others in order to keep themselves safe. This is a complex phenomenon and typically the byproduct of two things. First, for many who have been traumatized, the pain of being in one’s own mind can be unbearable, and we have vacated our own mind to be in the mind of another for relief. Second, because we know the pain of trauma so well, we can carefully pick up on it in others. Some say that those who have survived trauma have antennae. I think this is true. Trauma survivors are capable of understanding complexity and nuance, because many of us know our abusers and simultaneously love and hate them. We know that many emotions can be held at one time, because we have done it ourselves. Ambiguity is something we are well versed in.

There is a sense, oftentimes, that we should be solutions oriented, identify goals, and arrive at clear destinations in treatment. For example, if a woman is being physically attacked by her husband, she should leave. But the statistics state that it takes about 7-8 times to finally leave a truly abusive relationship. The parts of ourselves that won’t acknowledge the complexity of trauma can become easily frustrated by the 5th time. The parts of ourselves that do acknowledge the complexity of trauma can dig deep within to know the depth of self doubt that comes with trauma and abuse and can find more empathy for the struggling client.

     I don’t suggest that we should be activated by PTSD symptoms in order to practice effectively. Our trauma is something that we need to have worked on and made some meaning of. However, the truth about trauma work is that it is alinear and often laboriously sluggish. We don’t need to be at the other end of our work to help a client out. There is no other end, really. Instead, I am arguing that there is a clinical space between being totally healed (a myth) and totally activated (a danger zone) from which our best work can occur.

     Yesterday, I had a supervisee describing a case that had powerful overlapping qualities with my own story. I felt myself moving between a million different places internally. The first was the wish to run. The second was the wish for simple answers and demands (tell her to get out!). The third was a pathologization of the client. The fourth was physical disgust. The fifth was doubt about the client’s actual story, and the sixth was some dissociation about what I was having for dinner. The last was the ability to finally sit still and hear the story unfold. These are crazy places to go. But the truth is that these are the places that the client is moving between, as well - the doubt, the oversimplification, the self blame. If I were not able to visit these places myself, I could never properly understand the perimeter of the clients’ walk around the crevices of their own mind.

     My own therapy and clinical work has offered me the space to finally sit still. It has also offered me the possibility of observing all of these internal states and to survive them intact and not overly stimulated. Do I wish that I went to all of these places? Of course not. It is crazy making. But could I really offer the possibility of my client ever being able to observe their own self states and find an internal safe haven without my own stuff? I doubt it. Somehow I just doubt it.

     9/11 was a long time ago, but our world is not less traumatized and neither are our individual psyches. If anything, things feel harder and more painful now than they did then. I think that true clinical social work calls for the honoring of that truth. I also think that it calls for the refusal to separate ourselves from our clients in some deceptively binaried way that denies the complexity of our internal worlds. It is precisely this complexity, our ability to know darkness and light, which truly helps us to read the whole truth of our clients’ suffering. 

References

Coates, S. (Ed), Rosenthal, J. (Ed), & Schechter, D. (Ed). (2003). September 11: Trauma and human bonds. The Analytic Press/Taylor & Francis Group, New York, NY. 

Pierce, M. (2006). Intergenerational transmission of trauma: What we have learned from our work with mother and infants affected by the trauma of 9/11. The International Journal of Psychoanalysis, 87(2), 555-557.

Tosone, C., Minami, T, Bettmann, J.; Jasperson, R. (2010). New York City social workers after 9/11: Their attachment, resiliency, and compassion fatigue. International Journal of Emergency Mental Health, 12 (2), 103-116.

Dr. Danna R. Bodenheimer, LCSW, is in private practice at Walnut Psychotherapy Center in Philadelphia, PA, and teaches at Bryn Mawr College Graduate School of Social Work and Social Research. She is the author of Real World Clinical Social Work: Find Your Voice and Find Your Way.

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