This is my dog Sydney. We got him from a rescue shelter five years ago. After Sydney had been with us for three days, he bit me in the face. I went to the ER for stitches. My children refer to him affectionately as “Dad’s little trauma survivor.” Lately, with my clinical supervision groups, we’ve been reading the new book, Clinical Applications of Polyvagal Theory, eds. Porges and Dana (Norton, 2018) and I’ve been thinking about dogs and trauma, and how their experience yields insight into humans, their brilliant nervous systems, and healing from adversity.

When we adopted Sydney from the rescue shelter–he’s the first dog I’ve adopted as an adult–I imagined I’d meet other dog owners. They seemed like such a social bunch. But again and again I’d be out walking with Sydney and notice that other dog walkers would walk across the street or turn in another direction. It happened so many times, I was sure it had to be something to do with me.

The few times we did encounter a passerby face to face, I understood better. When seeing any man or larger dog, Sydney would, without warning, go ballistic, snarling and barking and lunging as if confronting a life-threatening danger. It made every stranger jump. It was frightening and unprovoked. Soon we were like those other dog walkers, avoiding everyone on the street. And, of course, Oregon, where I live, has one of the highest adoption rates for rescue dogs in the country. In my neighborhood traumatized rescue dogs are everywhere.

We don’t know what happened to Sydney before he came to us other than he had two other owners and one (a man) had been physically abusive. As a dog owner who happens to be a trauma therapist, I know that Sydney’s healing from his past is possible but constrained, largely because of the limits of the dog brain. As his family we help with his healing though forming trusting relationships. We protect him from his triggers (men, other dogs, squirrels, all surprises really). We take him to a weekly dog group therapy walk with an animal behaviorist. He has a steady and boring routine and over time he seems to have calmed down.

This brings me to my first point about our amazing human nervous system, informed by this new volume on polyvagal theory.

All creatures are equipped to deal with life in a dangerous and violent world. In a strange way, trauma is normal. It’s ubiquitous. Not in a moral sense, like we should seek out trauma or allow it to occur. But more in the sense that we should not be surprised when it happens. The fact that our nervous systems respond when we are threatened in a way that gives us a chance to survive is wonderful.

What is most troubling really are the effects of trauma, after the danger has passed, the way trauma imprints us, a filter on all later experience. One of the reasons I love being a psychotherapist is I bear continual witness to human beings healing from the effects. We transform lived experience through revisions of the story we tell ourselves about what happened; in short, we become wise. And we accomplish this transformation through the marvels of our advanced nervous system and its linkages to the human brain, with its sophisticated capacity for language.

As our species evolved, our neurobiological menu for dealing with danger got more sophisticated, layered with vestiges of our evolutionary heritage. We evolved from fish who resorted to a freeze response (giving up, shutting down) to amphibians and bony fish who had fight or flight responses, to mammals who bonded together in tribes (the ventral vagal or social engagement system). Humans have the most evolved brains and nervous systems, drawing on this whole repertoire of possible responses, especially when we grow up within healthy secure relationships. Most crucially we have a sophisticated system of language. This gives us the ability to abstract on our lives, our brains and our bodies, to metabolize the effects of trauma through story, a language where it is both shared and transformed.

The body may keep the score, but the human brain, with its extraordinary capacity for integration and meaning-making, wins the game.

Sydney’s capacity to heal from trauma is limited by his mammalian brain. He has a smaller cortex, so no ability to use language that would enable him to metabolize the effects of trauma, to transform scary experiences encoded in his limbic system into a different story, to mature beyond its impacts. Maybe, from an evolutionary perspective, this “stuckness” in trauma effects, that deep alertness to danger, makes sense for mammals that used to live in the wilderness; comparatively they live in a wilder, more deadly world that humans in their civil societies with their built-in protections.

But he’s still really cute.

The post What My Rescue Dog Taught Me About Healing first appeared on Wayne Scott.

Is the phrase “vicarious trauma” out-of-date? A relic from another era that tries imperfectly to describe a hazard that affects people in the helping professions? And what words do we use to replace it?

So, where did it come from? When I entered the field of social work, in 1989, “vicarious trauma” didn’t exist. At twenty-five years old, I had a caseload that was half boys who had been physically and sexually abused, half men who had committed sexual offenses. Every day–every hour!–I listened to stories of sexual and physical violence. Day and night I thought about patriarchy, male socialization and oppression, and how these combined forces were devastating the world, boulders barreling down the hill, razing everything, with so few of us to stop them. When I wasn’t wide-eyed and fretting, I had horrible dreams about work, waking me in a panic.

At first my colleagues talked about “burnout,” a condition we shared with anyone in any field who worked hard. Later I heard the phrase “compassion fatigue” and that hit a little closer to home. It explained why my reserves of empathy were running low, but it didn’t explain the range of other afflictions: a wordless misery that didn’t improve with clinical supervision or weekends, unpredictable spikes of anxiety and irritability, endless worrying, gastrointestinal woes, an obsession with male evil, and a sense of separation from loved ones who wanted to be close to me. 

I was used up. 

Then, in the nineties, psychologists Laurie Anne Pearlman and Karen Saakvitne came out with the first books on vicarious trauma: Trauma and the Therapist (1995) and Transforming the Pain: A Workbook on Vicarious Traumatization (1996). Dense with psychological jargon, terms and phrases that gave me an cool clinical distance from my lost humanness, at the time they were nevertheless helpful and clarifying. They used words that resonated with my soul. They called out “the cumulative, transformative impact upon the [professional] of working with survivors of traumatic life events…. The pervasive effect of doing this work on the identity, world view, psychological needs and beliefs, and memory system of the [professional].” 

Pervasive. Cumulative. Transformative. 

Their words explained why I had changed, irreversibly. 

I could not believe I had engaged in this magnitude of self-inflicted damage. Now that I had the words, however imperfect, it was suddenly too real. I quit my counseling job. I left the field for almost three years.

Why are the words “vicarious trauma” so problematic? When I returned to the helping professionals, I had a determination to prove that I could do difficult, soul-battering work while staying physically and emotionally healthy, and I made it my mission to keep the conversation about this commitment alive with my community of fellow travelers. Talking with professionals all over the country, I came to appreciate what we have in common, how much is solved by connecting with authenticity. But I also started to see the limitations of these particular words.

Why did we call it “vicarious” or “secondary”? What is the purpose of that remove, that absence of ownership?

The fields of psychology and social work are notorious for their heavy-handed jargon. It otherizes clients and keeps us at an unhelpful clinical distance. It invents words that valorize the objectivity, elitism, and expertise of the therapist, often at the expense of the client. Take the term “countertransference.” The idea is that the client shows up for session, unwittingly displays their transference, born of neurosis and early psychological imprinting, but that we, objective thinkers that we are–pristine blank slates of mental health, really–only have countertransference as a response. 

Why wouldn’t psychologists and social workers call all of it “transference,” regardless of who starts it? Why shouldn’t we equalize this condition that defines our complex emotional response to each other?

What power do we lose when we name it? Why can’t we be human and vulnerable together?

The term “vicarious trauma” has the same problem. It implies that the professional wouldn’t struggle if the client hadn’t brought their trauma into the room. Clients have the original trauma, it seems to suggest, which then infects us, like a cold or a venereal disease. In fact, we know from the Adverse Childhood Experiences Study and the research that followed it, that psychologists, social workers, and other helping professionals, like all humans, are just as likely to have their own trauma and childhood adversity that shapes who we are. Trauma is trauma is trauma is trauma.  

Toxic stress and co-suffering are the realities. Nowadays I find myself using the more general phrase “toxic stress” to describe the oppressive conditions in which clients often live, wreaking havoc on their bodies, spirits, and nervous systems, as well as the working conditions of helping professionals who join with them. Toxic stress refers to levels of challenge and adversity so intense that they can make all of us physically and emotionally sick. “Toxic stress” isn’t encoded with power differences. In her book Being a Brain-wise Therapist, Bonnie Badenoch coins the lovely term “co-suffering” to describe our work: a way of being with the client, in mutual resonance, as human equals on the same journey. “This sense of partnership rests on humility about the state of our own mind,” she writes.

So, is the phrase “vicarious trauma” really out-of-date?

There are no habits of avoidance.  As I was walking through northeast Portland on my way to a coffee shop to write this post, my mind already sifting over these questions, in just nine city blocks I passed four encampments of people living in tents, then two people huddled in sleeping bags on the bare ground, with nothing separating them from the street noises and chilly weather. 

Like most urban dwellers, each time I neared these folks, partly out of deference to their privacy, I cut across the street. But the bigger meaning of this gesture was the habit of avoidance, common to all people who live in urban chaos: a reluctance to get too close to the realities of outdoor suffering; the looks of pain and fatigue and desperation; evidence of the absence of mercy. The closer we get to the sounds and smells, the visceral emotional realities of being unhoused on the dirty streets, the more the details absorb our psychic energy, imprint us, take up mental space that could be expended differently, clutter our attention with discomfort, even aversion. In the early morning hours, not encumbered by any professional role, I can cut across the street like so many other people.

But to be effective in our professional work with deeply challenged and traumatized clients, there are no such habits of avoidance. We have to come close all the time, in spite of the pain it brings up in us. And we have to be honest about how that intimacy with oppression–theirs, ours; ours, theirs–humbles, pains, and transforms us. We have to name it for the poison that it is, acknowledge it without distance or pretense or hierarchy, or we will never find our way back to each other.

The post Why “Vicarious Trauma” is Going Out of Style first appeared on Wayne Scott.

TRIGGER WARNING: While this post is about self-care, I won’t mention anything expensive, like therapy, massages, fancy aromatherapy concoctions, craft chocolate, or shopping for new clothes. Television is in no way involved in self-care, although it can be a fun way to connect with colleagues.

Before I share my Top Five Antidotes to Toxic Stress in the Workplace, I need to make a confession. This June I will have been a psychotherapist for a whopping thirty years. Unquestionably I love this profession with all my heart; however, it hasn’t been a rosy journey. Since my first job, I’ve worked with people impacted by interpersonal violence (both perpetrators and victims). I’ve worked in hospitals and broken-down schools and jails and prisons and austere residential addiction treatment centers that felt a lot like jails and prisons.

And I’ve been sick for a hefty portion of that time: irritable bowel syndrome, rosacea, chronic fatigue and insomnia, depression and anxiety, shingles, and a few conditions that no one could even diagnose. Going to doctors and naturopaths and homeopaths and herbalists and body workers and acupuncturists and therapists has become a weird hobby of sorts, one that reminded me that I felt sick, but didn’t always deliver healing. I’ve had all manner of diagnoses, some that felt accurate and some that were tossed at me because the professional couldn’t figure out anything else, and I’ve had an equal measure of treatments, a few that worked and more that didn’t.

Few of my healers saw any connections between my stress-related illnesses and my work as a psychotherapist and social worker. When they did see a connection, they advised me to quit–not an antidote I desired–or pathologized me for staying–also not helpful.

It’s been frustrating, until, over time, I hit on what I’ll call the five epiphanies. These are strategies that helped me to stay healthy while doing the difficult work that I love

It’s All About the Body. Above and beyond how I made cognitive sense of the work, I was doing a terrible job taking care of my body. Chronic stress stimulates the release of cortisol and adrenaline, pesky hormones that pitch us into survival mode, narrow our focus, and compel us forget what our body needs, like sleep and healthy food and kind people to hang out with. Often times I go to work with noble ambitions to run or exercise at lunch. As the morning progresses, stressful things accumulate. Before I know it, I start to rationalize that I don’t need to exercise, that I should stay nose to the grindstone and work through lunch.

Sound familiar? This is cortisol and adrenaline talking–not my best selves in this pressured moment–and they’re not doing me any favors. Even though it may feel “counter-intuitive,” RESIST this siren call to stay put and veg at your desk. Even ten minutes of activity makes a difference. Now I think of running and working out and yoga as my medicine. I don’t do them to look great or lose weight. I do them to counteract the effects of toxic stress. I do them to stay healthy and of sound mind, which I need more than a non-clinical professional to do my best work with clients.

Get Outside. We already know that time outdoors, whether in sunshine or rain or snow or hail, walking or running, is good for the soul. It counteracts the crappy onslaught of cortisol and adrenaline. But time in nature has other powerful qualities. Reminders of the changing seasons recalls the cycle of birth, growth, maturity, decline, and renewal; that nature is always in a state of development, and we (and the systems we inhabit, whether a workplace or a community) are part of that natural progression. It normalizes the entropy we see all around us, reminds us that nothing is permanent, that eventually all things change and grow. The awareness, for me, keeps hope alive.

Every Job is Temporary. We get our jobs and then we pile all our debt on them (student loans, mortgages, credit cards, etc.). Our jobs don’t pay much, at least not in the beginning. It is easy to feel trapped, cornered by a brutal economy, rising needs and limited resources, and our own fatigue, which compounds the sense of hardship. This feeling, too, like the voices of cortisol and adrenaline, is false. We are never trapped in a job. It can just feel that way. With people I work with in clinical supervision, I often feel like a career coach, reminding them of their worth and their options, both of which are considerable. Every job is one developmental step in your career. SET SMALL GOALS you want to achieve before moving onto the next job. Get you LCSW or LPC. Finish building a program. See a few clients through long-term treatment. As Laura van Dernoot Lipsky is fond of saving, “Everyone needs a plan B.” Not so much because we’ll always pursue it; more because it reminds us that we aren’t trapped.

Accept Suffering. It seems weird to mention now. In the early stages of my career I could not get used to my proximity to the toxic stresses of my clients’ lives, even though I knew that, as a social worker, I had a commitment to working with the most vulnerable communities of people. Their suffering reverberated with my life, absorbed into my soul, stuck to my guts. It took me a long time to develop a tougher skin and even longer to develop grace to recognize that this is what I signed up for. Part of the delay was that I couldn’t accept that suffering was part of my job description; what the Northwest therapist and writer Bonnie Badenoch calls “co-suffering.” It continues to mystify me that agencies don’t include suffering as part of our job description. That might sound like a joke, but it’s not.

Find Meaning in Work. The American poet Adrienne Rich thought the most radical political act was to find meaningful work. She wrote, ” Insist on a life of meaningful work, insist that work be as meaningful as love and friendship in our lives.”

Many of us chose this field because we wanted to have a social impact, to be part of a social change that was greater than ourselves. The onslaught of bureaucratic demands, administrative rules and audits, agency politics, and the insidious ways in which those stress hormones can narrow our focus: these factors can lead us to lose perspective and forgot who we are and who we need to be. My brother, an engineer, tells the story of a pro bono project he did once: designing a database for a huge historic gathering at the Vietnam Veteran’s Memorial, a tool that enabled war vets to find fellow travelers, other vets, with whom they had lost touch. He found the experience exhilarating–and exceptional. He told me it was the first time he had felt like he had the opportunity, as a professional, to produce a social good. I try to remember that not everyone has the privilege of doing this kind of mission-driven work. Doing work that is less meaningful is stressful in a completely different way.

WORKSHOP

Getting Unstuck: Expanding Use of Self in Trauma-informed Practice

If you want to go more deeply into ways to combat toxic stress and feeling stuck and trapped, consider joining me for my fall workshop on “Getting Unstuck: Expanding Use of Self in Trauma-informed Practice” November 8, 2019 at Lane Community College in Eugene, Oregon. We’ll go more deeply into the neurobiological framework, both to understand how it contributes to a sense of stuckness, with our clients, our families, and ourselves, and also to pave the way forward toward movement and creativity.

The post Top Five Antidotes to Toxic Workplace Stress (for professionals who work with people in crisis) first appeared on Wayne Scott.

What are agencies supposed to do when traumatic events happen to their workers? In my experience doing social work over the past three decades, this question has always hung in the background. Andrew R. Laue, LCSW has pioneered an innovative, embodied model of critical incident debriefing that integrates cutting-edge research on interpersonal neurobiology and trauma. Last week I reached out to him to talk about his work. I wanted to understand some of the differences between Critical Incident Stress Management (CISM), the approach familiar to most people, and his model. [This interview has been edited for length and clarity.] 

Andrew’s two-day introductory workshop, “Debriefing Critical Incidents, Creating Healing Spaces” will be delivered virtually October 13-14, 2022.REGISTER

First of all, Andy, why did you get into this type of work?  

I have suffered the impact of trauma connected to my work personally and have seen the deep impacts on some of my best colleagues. Chronic illness, stress disorders, substance abuse disorders, and relational stress are present in some of the most effective workers. Due to my efforts in developing interventions for these distressed workers, I emerged as someone who could be of support to teams in acute crisis. Without formal training in a CISM model I was asked to do debriefings with first responders, legal teams, jury pools, and medical staff in my community.  

Why did you think it needed attention or a different take?  

Agencies did not experience the local CISM team as responsive following a critical incident. When I began to understand the CISM model I realized it was developed in a period before some of the latest research on trauma and interpersonal neurobiology. Some of the CISM strategies risk re-traumatization when they are not implemented with a rich regulatory presence in the group interventions. They rely upon narrative reprocessing which at times can be re-traumatizing. Due to the absence of awareness of embodied techniques, the original models were not effective in touching the trauma that is stored in the body.

What was wrong with how organizations did critical incident debriefing?  

Typically the debriefing was offered with very little prevention or education work and very little follow up. The stand alone debriefing can be effective for some workers, but can create risk for other participants. We seek to present the debriefings with dynamic leadership that focuses on creating a regulatory environment, teaching body-centered awareness, and focusing on reprocessing for the purpose of resiliency building. 

I hear this question a lot when I talk to agency leaders: How do I determine if an incident is “bad enough” that I should slow everyone down and initiate a critical incident debriefing?  

There is not a discrete level of “bad enough” that determines the need for a debriefing.  Obviously dramatic acute incidents such as sudden death, suicide, violence in the work place, and catastrophic community events are situations when the need is obvious.  

But it shouldn’t stop there. We seek to create community resources or members within teams who are identified as secondary trauma responsive resources. They are available to staff to identify distressing events of many types that come up within the course of work. They are available to do more “experience near” debriefings. We have organized the debriefing process into discrete steps that can be used as appropriate for various settings. Having “experience near” resources that are familiar to workers increases the identification of secondary traumatic events and provides scaled resources. 

Does this criteria change for agencies that work with deeply vulnerable populations, like adults who are unhoused and struggling with addiction and mental illness, where the death of clients happens not infrequently?   

Yes. In settings of high distress, it is encouraged that regular secondary trauma processing resources are integrated into supervision relationships and regular team processes. This way when more acute or intense events occur there will be a dynamic team culture already activated that can make the positive impact of debriefings increase.

What are the main ways that organizations need to update their protocols and beliefs about critical incident debriefing?

Six big ideas come to mind:

1. Challenging the idea that debriefings are single incident solutions to the secondary distress that human service workers encounter.
2. Taking seriously the need to bring regular secondary trauma support into worker skill-building, supervision relationships, and organizational culture. 
3. Engaging staff inside the agency to be resources for extreme distress and to be prepared to facilitate “experience near” debriefings. 
4. Integrating the latest findings from trauma theory and attachment theory into the debriefing process. 
5. Emphasizing resources that address the fact that trauma is stored in the body. 
6. Realizing that resources of team and money spent on debriefings have huge pay off in terms of effective work culture and the reduction of worker recidivism. 

One question I hear a lot at agencies is: Can someone who is inside the agency or work group facilitate a debriefing? 

Yes, having specialists or specialty teams within organizations can be very effective in integrating experience near critical incidents. These workers should have access to regular training and support.  

What are the pros and cons? 

The dilemma of having on-site workers as debriefers is that they can be subject to carrying more of the burden of the trauma for the organization. They will need to be in dynamic support networks. Team-based approaches can be effective facilitating this. 

The post Why Care About Debriefing Critical Incidents?  first appeared on Wayne Scott.

As people in the helping professions, is it ever ok–ethically, humanly–to allow ourselves to look away from another’s suffering? To turn empathy off?

A few years ago, when my daughter was a teenager, she was drawn into a whirlpool of human need. She had been volunteering at a soup kitchen in our neighborhood, and one of the attendees latched onto her. He was physically disabled, very alone in the world, and struggled with mental health challenges; he had a house that suffered from years of neglect. She offered to help him clean his debris-covered yard, which led to an unending number of requests. 

The child of not one but two social workers, she has an expansive compassion. When she was little, whenever we passed an unhoused person on the street or in our car, she would complain if we looked away or didn’t give them money or food. She criticized me if I didn’t pay attention, and I had to try, however fitfully, to explain myself. When I listened to the words out of my mouth, it didn’t make sense.

For my teenage daughter, there was such enormity of unmet need, and he was such a likable, kind man. Having a degree of privilege, she felt a principled obligation to pitch in. Seeing her growing overwhelm, we wanted to protect her. But there was no suggesting any limits. Weekend after weekend was consumed with trying to help her friend, until eventually she broke down in tears, flooded, exhausted, and depressed. 

How was she to make sense of her limitations when she cared so deeply?

This year I’m back to teaching advanced clinical practice  to graduate students. Last week the topic was “Empathy and Attunement,” and I had a weird thought. We’re teaching students to maximize a sense of safety and trust in their work with people, to use the non-verbal (most important) and verbal skills that facilitate connection. Most students is social work are already intuitively good at this–that’s what led them to the field–and many get exponentially better when they have a more explicit understanding of the nuances.

We spend so much time helping clinicians learn how to “turn it on,” accelerate, pedal to the empathic metal. But do we ever talk with them about how, with intention, to turn it off? The longer I am in this field, the more I recognize that this–the inability to turn off empathy–is a professional hazard. Why is this important? 

Exhaustion. 

So many professionals with whom I work feel a deep, principled desire to do well in their jobs, to serve their clients who need so much, to help their agencies achieve their mission and to please their bosses. They struggle to reconcile the expansiveness of their concern for their clients–this is a feeling, I am convinced, that is rooted in deep, maybe endless reserves of love–with the limitations of their human bodies. 

Loss of self.

To further complicate matters, I hear from many practitioners that they feel locked into a professional stance with people in their personal lives, that they struggle with centering their own feelings and needs, that they default to these same professional attuning skills without thinking. They do it so well and people love them for it. And it gets worse. I’ve heard from helping professionals that they’ve tolerated unhealthy behaviors from loved ones–in the same way sometimes that we must tolerate maladaptive behaviors from clients to help them–until the dynamics reach such a pitch that the personal relationship is unbearable. We have stopped using our own needs and feelings as a guide to our own relationship health.

More troublesome than exhaustion, for many helping professionals, they risk losing a sense of who they are. They feel empty inside. 

These attuning skills are embedded in a distinctly mammalian part of our nervous system called the ventral vagal: herd- and tribe-oriented ways of communicating to others that we are safe and can be trusted. Think about what message we send, on such a powerful but subtle level, when our gaze is soft and direct, when we nod, when our voice is calm and our breath is even and slow, when the muscles in our face and body convey a relaxed openness, when we can listen so closely that we reflect back what we’ve heard accurately and with feeling. For most people who gravitate toward the helping fields, these nuanced gestures and movements are autonomic; we do them without thinking. When we train to be professional helpers, however, we begin to do them frequently and with intention, as part of our role.

In  workshops with professionals, when I explain this aspect of the nervous system, I am always acutely aware that everyone is looking at me intently, nodding, smiling, deeply attuned. “See, you’re doing it right now!” I say. The head-bobble of compassion never ceases.

I posted these mind-wanderings on my Facebook page (Healing Vicarious Trauma), and a couple colleagues commented in ways that shed more light:

From my whip-smart former graduate student Jenna Nevills Napier, MSW, QMHP, CADC II, who’s now a manager: “It’s sort of like gaining any new skill but we all need to have so much intention around how we turn on and turn off and being better at communicating what we need when turned off and how often we need to turn off. Many of us might not get enough opportunities to fully and intentionally turn off and that can negatively impact us, particularly relationships at home when we don’t always have to be on. And then we can feel guilty for ever having turned off in the first place.”

From my friend Alyssa Gasca, an organizational development consultant: “For those of us whose work is based on empathy, we can burn ourselves out by over-using the thing that makes us effective at our work. How do I unburden myself from the desire to prevent another’s pain when I can so clearly see I can help, but it is not my responsibility to do so (and may not be what the person wants).”

From another former student and kick-ass therapist, Michelle Harvey, LCSW: “I don’t know if it’s the ‘feeling’ that is exhausting as much as the sense of helplessness that can accompany those feelings, because we can’t ‘fix’ it and therefore make ourselves feel less uncomfortable.”

Recently, in a clinical supervision group I run, someone was complaining about overwhelm. Their caseload at a residential treatment facility had just spiked and the acuity level felt unbearable. Time became meaningless as they were swept from one emotion-drenched conversation to another. This is someone with deep, seemingly boundless, reserves of empathy.

As they talked about the near-impossibility of their job, an image came to my mind. I wondered what would happen if this person, a deeply compassionate soul, framed every conversation at work with a time limit, “I have fifteen minutes and I’d really like to check in….,” and really held to that limit. It would feel unnatural, sure, but would it possibly be good enough?

Some of you know that I love fiction. As I was thinking about the hazard of compassionate presence, I flashed on characters in the novels of Virginia Woolf. Woolf lost her mother early in life and her fiction often explores how the mother’s presence holds together a house full of people by the centrifugal force of caring. Here’s a line from her semi-autobiographical novel, To the Lighthouse, that could have been written about a helping professional at the end of the day:

“For now she need not think of anybody. She could be herself, by herself. And that was what now she often felt the need of – to think; well not even to think. To be silent; to be alone. All the being and the doing, expansive, glittering, vocal, evaporated; and one shrunk, with a sense of solemnity, to being oneself, a wedge-shaped core of darkness, something invisible to others… and this self having shed its attachments was free for the strangest adventures.”

But there’s an intersectional lens to consider when we talk about the hazards of compassionate presence. My friend Tori Lopez, LCSW, piped up on the Facebook conversation: “As a POC who has POC family and friends I find we often have to be the supports for each other. Because for many of us the systems of care we work in are still terribly white-centered. It’s about finding balance and being willing to be there for one another as best we can. It’s the ability to say a word or just a nod and know ‘we get it;’ no explanation needed.”

As a white cisgendered male from an educated, middle class background, I have been given more permission/privilege than most to turn empathy off, to trust that others, particularly women, will take up the emotional work of any household or an agency where I belong. But as the burden on me lessens, it increases for them. That isn’t fair. Certainly one solution to the emotional drain and the havoc it wreaks on the bodies and souls of the compassionate is for those who are stepping back–i.e. especially men who look like me–to step more frequently into relationship in this caring way.

Most helping professionals are placed into impossible situations — let me repeat that word: IMPOSSIBLE — and we must do our best. We begin in innocence and must quickly move toward wisdom to survive. We must become our own consciences and seats of integrity. That’s why I so often question my supervisees about what is ‘good enough,’ and is their personal standard of care realistic given the enormity of the work? What’s the right dose of compassion? How can we pace ourselves, so that we can make a sustained and meaningful contribution? How can we draw on other people, personally and professionally, for sustenance and validation?

People who don’t do this kind of work never believe me that it is deeply physical work. But when we do it right, we throw ourselves in, body and soul. And our bodies are finite. We can only work so hard before we need to rest; our energy and attention flags; we lose touch with our own feelings compass. Human life is finite: We have only so many waking hours in a day and a limited number of years that we can spend in productive work. To transcend burnout, we have to accept, really embrace, a paradox: the near-infinite expansiveness of our love and care for the people that come to us for help, balanced against the finite nature of our bodies and lives. 

The post Turning Empathy Off?: Reflections on the Hazards of Compassionate Presence first appeared on Wayne Scott.

Overwhelm is a natural, human response to a perception of life-threatening emergency.

AFTER A VERY PANIC-EDGED WEEK of tracking news about Oregon’s forest fires, following the latest pandemic news, and feeling threatened by our cruelly divisive national politics, for the first time today the air is so unhealthy that neither myself nor any family member is leaving the house, except to walk the dog. This past week I have been talking to therapists, counselors, and social workers about how hard it is to do therapy with clients. One of the common questions, hanging in the background of these supervision discussions, is: What do I do with my own distracting sense of overwhelm, when I am trying to be present for my clients? Everyone is exhausted.

As with so many things, once we can figure it out for ourselves, we are better able to help our clients. In part one of this post, I’ll talk about managinng overwhelm. In part two, due out in a few weeks, I’m going to explore what makes a ‘good enough’ therapist during a time of chaos.

Rethinking Overwhelm. We need to re-frame how we think about overwhelm. For many folks, especially action-oriented helping professionals, this incapacitating state of shut-down is not a familiar state. We may be used to lives of productivity and creativity and energy. So when we feel overwhelmed, it’s natural to go to a place of pathological self-judgment: What’s wrong with me? Why can’t I cope with this more effectively?  But that interpretation, while human, is neither helpful nor kind. The extra layer of shame is toxic. It just makes things worse. In his classic book about the Holocaust, Man’s Search for Meaning, Viktor Frankl wrote, “An abnormal reaction to an abnormal situation is normal behavior.”¹

So, how do we make sense of this ‘abnormal reaction?’ It helps to place overwhelm, or the freeze response, in the context of the autonomic nervous system (ANS). The ANS threads through our body, connecting the brain, heart, gut, and muscles. It controls many bodily functions that happen whether or not we are thinking about them (for example: breathing, heart rate, digestion, sexual arousal, etc.); hence the word “autonomic.” It’s also brilliantly equipped to recognize threats to our lives, to help us mobilize to act when we face those dangers, and, yes, to heal when the danger has passed.

In its simplest terms, you can think of the ANS as a menu of responses to perceived danger. The most primitive set–the fight, flight, or freeze defenses familiar to everyone–are survival functions built into our nervous system that we share with most creatures on the face of the earth. They activate powerful chemicals that allow our bodies to mobilize, to respond and survive. The most evolved aspect of the ANS is the ventral vagal, or social engagement system. the social part of our nervous system, which allows us to manage stress and danger through bonding with others.

Car metaphor. One way of thinking about the three strands of the ANS is that it’s like a car. The sympathetic nervous system, or fight or flight response, is like the car’s accelerator, helping us rush toward a challenge, or giving us the momentum to drive away. The ventral vagal, or social engagement system, is like the driver of the car, scanning the horizon, making eye contact with other drivers, bringing self- and other-awareness into the balancing act.

The “dorsal vagal,” or freeze response, resembles the brakes. It slows us down when we sense something that could endanger us, or bring us to a halt.

Overwhelm is a natural, human response to a perception of life-threatening emergency. But how is it helpful to freeze? Why would it be adaptive for any creature to freeze in the face of extreme adversity?

It can be helpful to think of the immobilization response in terms of evolution. It evolved in the earliest boneless creatures (cartilaginous fish) over 600 million years ago. First of all, it’s a way of conserving energy in extreme circumstances. The body slows down dramatically. A potential predator might lose interest in a creature that looks dead. Or if he’s going to kill you anyway, the parasympathetic response helps the body shut down in preparation for death. (The freeze response also is related to defecation, which some animals do when terrified, which also repels predators.)

In a less extreme situation, human beings can lean on this stream of the nervous system to achieve a sense of stillness and calm. One yoga metaphor for thinking of the parasympathetic is savasana, or the death pose, a state of deep calm.

How do we re-set when we feel overwhelmed? Neuroscience experiments confirm that it is difficult to shake one’s self out of a freeze state. One reason for the stuckness is that this autonomic response sits very closely to the human experience of shame, or outsiderhood, or not belonging. We don’t want to admit our vulnerability to anyone. Often, when I experience a freeze response in my work, I know it because I literally forget that I can ask for help. Loneliness for other people magnifies the sense of stuckness.

Some simple steps to re-set when you feel overwhelmed:

1. Accept it without judgment. It is a natural human response to extreme adversity, an evolutionary gift that enables both survival and healing. It just might not feel that way. It might feel dissonant with your usual ways of engaging the world and stressors. What would it be like to allow your sense of overwhelm without judgment?
2. Make a slow intentional shift. Recognize that, while the freeze response is natural and highly adaptive, it is also strong and immediate. We might be lured into thinking we can’t control it, when in fact we can influence it. And although it’s powerful, we have more control over it than we might realize. But we have to slow down and focus inward. Forget how to make cognitive sense of it for a minute and just focus on your body.
3. Find your voice. Neuroscientists such as Stephen Porges talk about the intentional use of prosody to bring the shut-down nervous system back into balance: chanting, humming, vocalizing, song, reading poetry or prose out loud. In My Grandmother’s Hands: Racialized Trauma and the Pathway to Mending Our Hearts and Bodies, Resmaa Menakem shares numerous embodied strategies that involve prosody, including humming, buzzing, om-ing, singing aloud, among others. Check out this book!
4. Seek support from nice people–eventually. For extreme overwhelm, it’s often counterintuitive to set up an emergency visit with your therapist or have an intimate face-to-face with your bestie right away. It can compound the sense of threat and make the shut down worse. Try sitting side by side and talking, experiencing a sense of connection while reducing the full-on assault of human niceness (think: car ride). This was helpful for me during the pandemic when I noticed, to my surprise, that sometimes I was having deeper, more vulnerable sessions with my clients when we were talking on the telephone, instead of meeting face-to-face. The titrated sense of human connection was easier to tolerate for their frightened systems.
5. Manage expectations. Some of these steps will produce temporary, here-and-now relief. But the world is still in crisis. Our bodies are alert to the shifting danger. It is likely we will find ourselves again overwhelmed. And that’s OK. The next time you find yourself struggling with overwhelm, do this instead: a. Say hello to the overwhelm; b. Thank it for how it helps your body survive; c. Remind yourself that you can influence it; d. Focus on your body; e. Sing or hum or buzz or om … or speak.

As a therapist, I am remembering to be patient with what can feel like the “slow” progress I sometimes see in my clients during the pandemic. It is important to continually reframe these self-judgments, reduce their sting, to see the ways in which “slowness” might be adaptive, even healthy, during crazy times. In The Heart of Trauma: Healing the Embodied Brain in the Context of Relationships, Bonnie Badenoch challenges us with the question, “How do we begin to trust and ride upon the unsure, tentative groundswells of remaining present with what is here in each moment?”

WE.  WILL.  GET.  THROUGH.  THIS.

The post Staying Present While Coping with Overwhelm, part 1: The Five Steps first appeared on Wayne Scott.

OVER THE YEARS there have been so many New Yorker cartoons about psychotherapists and clients and not a few recycled that antiquated cliche of the client lying on a couch. Recently, I saw a cartoon where the counselor and client were both lying side-by-side on a sofa, staring numbly into space. Of course, a few ethical red flags fluttered in my head, but a bigger part of me shouted:

BINGO!

That really is what it feels like these days.

A few weeks ago I shared a blog entitled “Staying Present While Coping with Overwhelm.” I wanted to respond to a question I was hearing in a lot of clinical supervision meetings: What do I do with my own distracting sense of overwhelm, when I am trying to be present for my clients? I made the case that overwhelm is a natural response to global upheaval, an adaptive function of our autonomic nervous systems, but that there were small embodied changes therapists could make to diminish its power to sidetrack us in our sessions and in our lives.

A few questions remained, though: How do we use our own suffering in service to our clients? What is a “good enough” therapist in an era of unfathomable crisis and uncertainty, with no end in sight?

About that couch. Before I launch into any writing that would suggest I’m an expert on coping in an apocalypse, I want to share a confession: I love the couch in my office. Before the pandemic, I never used it. It was for my clients. Now, between virtual sessions, I make a point of lying down with my eyes closed and listening to music. I tell myself that I am giving myself 10-15 minutes to feel overwhelmed, to be exhausted even though I’ve mostly had enough sleep, to accept the bone-weariness of it all. Weirdly I feel better afterwards,or at least better enough to go into the next session.

The dead-inside hour. Once before the pandemic, in one of my clinical supervision groups, one of my supervisees, who had an awesome sense of humor, mentioned that by 4:00 pm every afternoon, after a day of counseling clients and often with two to three more to go, she felt “dead inside:” robotically going through the motions. This awareness took on new urgency when her own therapist, whom she loved, had to switch the supervisee’s therapy time to 4:00 pm. “What if that’s her ‘dead-inside hour’?!?” she wondered. “I don’t want a dead-inside therapist.” Another group member suggested that maybe there could be a discount rate for the dead-inside hour. Everyone thought this was hilarious. Then, because emerging therapists are often a bit cash-strapped, a few said they might even be willing to deal with the dead-insideness, if it saved a few bucks.

Are we who are practicing during this dark time “dead inside”?

Misattunement. During the same group we were reading Bonnie Badenoch’s classic book, “Being a Brain-Wise Therapist.” Most of the women in the group were of an age when they were thinking about whether children would be part of their life picture, but because they were bombarded in their work with the childhood disappointments of their clients, they were more ambivalent than the average human being. Then we came across this following tidbit from the attachment research: “Tronick (2003) estimates that mothers are misattuned to their infants 66% of the time. However his research also revealed that quick repair builds resilience in the bodies and brains of infants.”

There was an odd sigh of relief in this room of perfectionist achievers. If you reverse the math, that means that these “good enough” caregivers were accurately attuned only 34% of the time. That is, in academic terms, what would be a “failing” grade. These were people who had never gotten anything less than a C in their lives. I had this fantasy that every woman in the group went home to her partner and said, “I’m ready.” Anybody can pull off a high 34%.

There is a parallel in my experience of parenting. At the time of this group discussion I had teenagers. Talking with my own kids, I recalled some of my worst parenting moments, stuff I’m too ashamed even to mention here, and found a surprising fact: my kids didn’t even remember (they reminded me of other stuff, issues about which I had no regrets, just not the bits that stung my memory). At the time, I‘m sure I thought I was damaging them, but that turned out not to be the case. Keeping a long-view perspective can reduce pressure.

How do these two stories apply to our work during this moment of upheaval? I think that the effort of trying to be present, to the best of our ability, is more meaningful to our clients than perfection. For well-meaning therapists, and parents for that matter, we’re rarely as “bad” as we think. And the real work of therapy, and parenting, is not so much that we get it accurately 100% of the time but that we work with goodwill, sincerity, and love to repair those times when we don’t.

Accepting suffering. During this dark time, which seems like it’s been going on forever, it has helped me to practice acceptance, both of my own psychological suffering and of my clients’. Prior to the pandemic, my clients and I might have developed a contract to relieve certain symptoms, to make their lives better, but every treatment plan needs to be updated to reflect the constraints and realities of what we’re going through. Goals might need to be delayed or revised, or new ones introduced. Nowadays I find that I am supporting my clients to acknowledge their suffering, to sit with it in all its never-ending bone-weariness, to come to terms with its evolving meanings, knowing that there is still a long journey ahead of us.

There’s nothing exceptional about now. In my own grappling, it has helped me to read deeply the literature of other eras when the world turned upside down. I’m re-reading Holocaust literature. The Diary of Anne Frank helped me understand how confinement, worry, and political oppression were impacting my children. In Viktor Frankl’s Man’s Search for Meaning, the psychiatrist recounts the impact of his four years in a Nazi concentration camp. During this time he observed many prisoners’ coping. He writes:

In spite of all the enforced physical and mental primitiveness of the life in a concentration camp, it was possible for spiritual life to deepen. Sensitive people who were used to a rich intellectual life may have suffered much pain (they were often of a delicate constitution), but the damage to their inner selves was less. They were able to retreat from their terrible surroundings to a life of inner riches and spiritual freedom. Only in this way can one explain the apparent paradox that some prisoners of a less hardy makeup often seemed to survive camp life better than did those of a robust nature.

In my own searching, I am picking up books written during other times of world crisis: Tolstoy’s War and Peace; James Baldwin’s Giovanni’s Room, written at the height of the McCarthy Era, also a painful period of racial unrest; the poetry of Wisława Szymborska, who wrote within an oppressive anti-artist communist regime. Times of cataclysmic crisis can generate game-changing art and stunning shifts in how we think of ourselves and the meaning of life.

James Baldwin, who was justifiably angry so much of his life, was not, in fact, cynical about the possibility for a better life. “Hope must be reinvented every day,” he wrote. That is the unfinished task before us as healers during this time of despair: the reinvention of hope, both for ourselves and for our clients, the small ways in which, day by day, we find the courage and persistence to be present in the here and now and to go on; the commitment, even in our darkest moods, that hope, what Emily Dickinson called “the thing with feathers,” is reachable, even if we can’t grasp it just yet.

The post The “Good Enough” Therapist in a Time of Global Upheaval first appeared on Wayne Scott.

Welcome to 2021!

Especially as we crest the start of the New Year, I am thinking about what I’ve learned from this period and what has made me (and the people around me) stronger.

LAST FALL A GROUP OF THERAPISTS and I did a slow read of Viktor Frankl’s “Man’s Search for Meaning.”  There is one story from the book that renewed my sense of resolve in counseling during the pandemic, and I want to share it.

Frankl was a psychiatrist who spent four years in a Nazi concentration camp, a time when he formed many of the theories of psychological healing that guided his later work with clients and provided the substance of his famous books. Mostly he kept his status as a psychiatrist secret. When it was discovered that he was a doctor, he worked with typhoid patients, but he still didn’t want anyone to know he healed souls. When his profession was discovered, on a day when morale was low, he was asked to deliver an encouraging talk to his fellow prisoners.

God knows, I was not in the mood to give psychological explanations or to preach any sermons–to offer my comrades a kind of medical care of their souls. I was cold and hungry, irritable and tired,…

Sound familiar? Like many psychotherapists, counselors, and other helping professionals working today, Frankl was enduring the same calamities as the people he was asked to counsel. He lacked emotional distance to view their experience objectively and to generate insight. This is an exhaustion particular to the experience of collective trauma, a calamity that touches a whole population, sparing no one.

“…[B]ut I had to make the effort to use this unique opportunity,” he writes, mustering his inner strength. “Encouragement was now more necessary than ever.” Looking at the haggard prisoners staring at him, he tells them about hope and resilience, how they are rooted in hard experiences, that suffering and sacrifice are parts of life that underscore a deep sense of existential purpose. “They must not lose hope but should keep their courage in the certainty that the hopelessness of our struggle did not detract from its dignity and its meaning.”

As he does continually throughout the narrative, Frankl finds his own strength in an unwavering sense of purpose and duty to his family and community, reminding himself of these core aspects of his identity–moorings we often forget when we are struggling, daunted, and uncomfortable. This is who he is. 

I saw the miserable figures of my friends limping toward me to thank me with tears in their eyes.

Like many people I’m cautiously optimistic that the end of the pandemic is in sight; however, we’re not yet out of the thick of it. Like many of you I go in and out of periods when I feel worn down by the unrelenting-ness of it. Many of my clients battle anxiety, depression, and isolation. They’re struggling with family and living situations that have become unbearably stressed. This story from “Man’s Search for Meaning” gives me a kind of “tough talk,” reminds me who I am, what makes me strong. 

Even when I am at risk of forgetting that I am strong.

These are questions we can ask ourselves and our clients in the last months of the pandemic: What have we learned from this experience? What makes us stronger?

The post What Makes Us Stronger first appeared on Wayne Scott.

MAYBE YOU’RE BOTH AT A POINT of marital transition, significant growth, or a daunting impasse.

Maybe you’re wondering if your current couples counseling is giving you what you need.

Or you’re exploring the risks and benefits of nonmonogamy. 

Or looking at strategies to heal after an infidelity or a breach of an agreement. 

Maybe you’re splitting up and need to figure out the collective story you share with friends and family and kids, a narrative that doesn’t blame anyone or polarize your support system.

Or you’ve already chosen nonmonogamy and are developing agreements or addressing obstacles as you map your collective course. 

It can be very complicated.

FOR COUPLES EXPLORING ASPECTS OF CONSENSUAL NONMONOGAMY and other creative marital adaptations and transitions, once a week I keep an appointment open for a special two-hour consultation meeting to explore and resolve a specific challenge. This is not ongoing couples therapy, but a short-term, strengths-based, solution-focused consultation to address specific partnership challenges and provide clear, actionable recommendations as you move forward. Same-sex, heterosexual, and mixed-orientation couples, and other alternative arrangements, are all welcome.

LOGISTICS: Prior to meeting each partner completes a questionnaire about the strengths and challenges of their relationship, their individual needs and obstacles at this point in their partnership, and their intention in asking for consultation. We schedule 1-2 ninety minute consultation sessions, often with time in between to do homework. We move rapidly toward concrete recommendations for moving into the future. These  may include tasks, homework, readings, referrals to ongoing marriage counseling or recommendations for clarifying or revising the approach or goals of existing couples counseling.

COST: For one ninety minute consultation, the cost is $400.

If you are interested in scheduling 1 – 2 consultation meetings, please contact Wayne.

SELECTED READINGS

The post Marital Coaching first appeared on Wayne Scott.