What Makes A Good Trauma Therapist?

Holds Firm, But Flexible Boundaries

  • Benefits of boundaries

    • Structure & Consistency: Gives clients structure and sense of control on what to expect 

    • Protection: Boundaries protect both client and therapist 

  • The goal is to have flexible enough boundaries so that while the boundaries honor and protect the client, they also are flexible enough to honor the client’s individual needs 

    • Example: While accepting a gift is frowned upon by the social work code of ethics, there are unique circumstances where accepting a gift would be beneficial and not accepting a gift would be harmful and detrimental to the therapeutic work. Such gifts might include: accepting food from a client whose culture values sharing food and food as connection 

Considers The Role of Culture and Systemic Factors

  • Versus simply focusing on individual/micro factors

  • Considers how systemic factors and areas of difference impact mental and physical health including:

    • Racism and racial trauma

    • Internalized racism and oppression

    • Sexism

    • Cissexism

    • Classism and economic factors

    • Culture

    • Race

    • Ethnicity

    • Gender

    • Migration

    • Dis(ability)

    • Faith and religion

    • Age

    • Veteran status

    • Educational attainment

    • And more

  • Brings up issues of difference including race, gender, culture, and ethnicity first through curiosity and inquiring questions

  • Continually does their own “work” in terms of: power, privilege, oppression, difference, othering to work with a variety of clients who are different than them and have different life experiences and identities

  • Doesn’t shame spiral when making a mistake and thank clients for bringing up issues

  • Question #1 you can ask: What is it like for you to work with someone who looks like me?

  • Question #2 you can ask: What has been your experience in therapy? What has been helpful and unhelpful?

  • Question #3 you can ask: Is seeking help for therapy common in your family or culture?

  • Question #4 you can ask: How does your family or culture resolve conflicts or find solutions to problems?

Flexibility & Dialectic (Rather Than Rigid or All Or Nothing)

  • Thinking in binary ways is one of the symptoms of trauma. When we go through something extraordinary like abuse, violence, and neglect, it can be confusing, overwhelming, and dysregulating to make sense of the world. We might ask questions like, “Why did this happen to me?” Or “ What did I do to deserve this treatment?” 

  • One of the goals of trauma therapy is to move from a strict, binary way of thinking to more flexible and nuanced. 

  • An effective trauma therapist will be able to hold your thoughts and emotions in therapy through dialectical thinking

  • Note: The goal isn’t to change your thoughts, but to have new ways of thinking about our thoughts and to ultimately have a different relationship to our thoughts (e.g. acceptance, noticing, curiosity) without quickly reacting and attaching ourselves to them. Thinking in unhelpful ways like self-criticism, judgement, and disgust can be ineffective or unhelpful. The goal is to move toward a more effective or helpful way of thinking. 

Ways To Practice Flexibility & Dialectic Thinking

  • Tip 1: Replace the word “but” with “and” in your vocabulary 

  • Tip 2: Ask yourself, “How would I treat someone I really care about if they were talking like this to themselves?” 

  • Tip 3: Notice your thoughts when they come up without attaching yourself to them (pay attention without judgment) 

Understands Their Own Wounds, Hurt & Pain & How It Shows Up In Therapy

  • Transference is the feeling clients have about their therapists

  • Countertransference is the feeling therapists have about their clients 

  • There is the stereotype that those who become therapists are often wounded and have experienced trauma themselves. This can be true for any profession, not just mental health (e.g. medicine, law).

  • Self care in any profession is necessary, but for those who work with trauma, it is a mandate to do so 

  • They might ask themselves questions like:

    • Am I entering this field to better understand and heal myself?

    • Have I participated in my own healing?

    • Have I explored my own limits and boundaries?

    • Have I worked toward increasing my sense of Self?

    • Do I have a support system?

Engages In Self & Community Care 

  • Trauma therapists have certain occupational hazards such as experiencing vicarious trauma, secondary trauma, compassion fatigue, depression, anxiety, and even increased suicidality. 

  • Burnout is likely in a trauma therapist’s career. 

  • Some ways to engage in self care

    • Assert and hold boundaries such as

      • Regularly ending session on time

      • Starting session on time

      • Asserting and honoring their boundaries around communication outside of the therapy hour 

    • Takes time off regularly or on a schedule that works for them and their energy level/capacity 

    • Understands their own wounds and trauma and how it may/eventually show up in the room without acting on it

    • Practicing self compassion to themselves 

    • Engages in their own healing work 

    • Practicing what they preach to their clients 

  • Some ways to engage in community care

    • Spending time with friends and family (chosen and/or family of orign)

    • Reconnecting with one’s own spirituality

    • Reconnecting with one’s own culture

    • Taking action toward one’s values

    • Asking for and receiving emotional support

    • Asking for and receiving feedback

Understands The Healing Power of Healthy Relationship 

  • Trauma almost always happens in the context of a relationship, especially one where there is supposed to be trust, mutuality, and care like caregivers, parents, teachers, and caregivers. 

  • Even systemic trauma like racism, while occurring societally, institutionally, and at a broader level, ultimately impacts our relationship with ourselves and others. 

  • Healing can also happen in the context of a relationship. The therapeutic relationship can be one of these healing sources.

  • This is why finding a good fit therapist is very important. 

  • There have been numerous research studies on the power of the therapeutic relationship and how this accounts for more than 50% of therapeutic effectiveness.

Practices Patience

  • Clients with a history of trauma tend to be impatient and want to bypass the process of healing. This makes total sense. Healing is humiliating, painful, and exhausting. 

  • Sit with your client in the questions. Knowing that them showing up may already be a huge achievement.

  • Therapists should strive to practice patience with:

    • Themselves

    • The therapeutic process

    • Their clients 

Has Thick Skin (Doesn’t Take Things Personally) 

  • You’re going to hear all sorts of horrible and terrifying stories. These harrowing experiences affect your clients and of course, they will have reactions during the course of trauma treatment.

  • Grief, sadness as well as rage, indignation, and anger are all necessary components of healing. Of course, there will also be joy, peace, and calm.

  • Sometimes, clients get dysregulated and say or do things that are difficult to process, explore, and work through

  • Other time, clients’ transference show up in therapy in various ways (e.g. hatred, platonic love, romantic love, envy, jealousy, parental) and this can be especially difficult work to process

Process Vs. Content

  • Many of our clients are charismatic story tellers. They get lost in their stories and this is what keeps them stuck, at times. 

  • Remember the subtext of what’s not being said. The dynamics happening over and over in the client’s life. The hidden emotional life yearning to be seen, believed, and felt.

  • Content includes:

    • The narrative/stories 

    • Literal facts 

  • Process includes:

    • What isn’t being explicitly said

    • What is occurring between client and therapist (dynamics and patterns such as transference and countertransference) 

    • Focusing on emotional/experiential content rather than literal/narrative content 

Mutuality & Collaboration 

  • Therapy is a collaborative process.  

  • Mutuality and collaboration can include: 

    • Providing education on what to expect, risks and benefits, other types of treatment available, offering a treatment plan, limits to confidentiality, giving client knowledge on how to complain or solicit feedback when they are unhappy

    • Not assuming and remaining open, curious, and nonjudgmental 

    • Sharing power by explicitly naming the power dynamics between client and therapist and asking for feedback/how the client feels

  • Try not to assume, even if you’ve practiced as a therapist for years and years. Each client is unique and different. 

Measures For Progress

  • While this doesn’t necessarily have to be a written feedback form, checking in from time to time is helpful (soliciting feedback)

  • Having a treatment plan is one of the best ways to do this so this serves as their initial goals

  • Otherwise, clients may be in treatment for an indeterminable amount of time and may want to take a break, pause, find another type of treatment, or something else

Strength Based (Resilience)

  • Focuses on a client’s inherent strengths rather than pathologizing and/or pitying them

  • Re-framing unhelpful ways of being/living as a form of survival 

  • What are they really good at?

  • How have they learned how to survive?

  • How have they handled past challenging experiences? 

Authentic 

  • Many clients can pick up on a therapist who is deceptive or playing a role

  • Authenticity is a trait that is cultivated through intentional hard work 

  • Because trauma therapy is most effective in the context of a safe, warm, and nonjudgmental relationship, authenticity is one of the key 

Repairs After Ruptures

  • Mistakes are to be expected in therapy. This doesn’t mean that your therapist will touch you without your consent, become your friend, hire you for a job outside of being a client, or anything of this nature.

    • Mistakes like being late to session, forgetting a detail from your life, or having an “off” day will probably most likely occur during the therapeutic process, especially if you have a relationship longer than a year. 

  • Ruptures are inevitable. They will happen. Sometimes, they are large and overwhelming. Other times, they are smaller and easier to contain and process.

  • Repairing can be very healing for clients, especially if they’ve haven’t had many experiences in life where someone holds healthy boundaries and communication to work through the discomfort and pain toward resolution (e.g. lashing out at them, ignoring their needs, minimizing their emotions, etc.).

Refers Out

  • When they know an issue/concern is not something they are trained or specialized in.

  • When the client needs a higher level of care than what the therapist can offer.

  • Or refers out to another therapist if they lack adequate training in a certain area while working with them simultaneously:

    • Example: Referring client for EMDR treatment while still working with client if the therapist doesn’t offer EMDR

      • This is complex and depends on many factors

Understands That Healing Is Nonlinear

  • Perfection doesn’t exist

  • Healing is messy and complex

  • Many clients with a history of trauma for good reason seek control and power in the therapeutic process by wanting a neat timeline of what to expect and when they will feel better

  • The thing is trauma cannot disappear or go away completely. Rather, we find new healthy ways to manage symptoms, practice compassionate ways to respond to ourselves during moments of dysregulation

Dear Trauma Therapist 

  • This letter circulated among trauma therapists in the EMDR community 

  • For clients who I have shared this with, many have expressed relief and understanding for their own experiences (even if the entire letter may not have resonated with them)

  • Read it here

Trauma Resources

  • Looking for more trauma resources? Click here for a list of evidenced based trauma therapies, books, and workbooks.

Previous
Previous

Therapist Reflection: 11 Things I’ve Working as a Trauma Therapist

Next
Next

List of Post-MSW Fellowships