When flight attendants give their safety talk at the beginning of each flight- where everyone listens to their iPod or begins to read a magazine- they state: “If there is a loss of cabin pressure, oxygen masks will fall from above. If you are traveling with a child or someone who needs your assistance place the mask over yourself first before assisting others.” What…really? This seemed counterintuitive. I have always been a helper. If someone is in danger, how do I not help them?
I began my work as a therapist over ten years ago and nothing prepared me for the impact of this work. I learned theory, practice, and various modalities of treatment to work with clients carrying many diagnoses. But no theorist or faculty ever taught me what it would feel like to be a therapist…nonetheless a trauma therapist. No one readied me for the emotions I would feel when a child shared their traumas or their disappointment when they couldn’t go home. No one taught me how to manage an overflowing caseload and unrealistic paperwork demands. I worked in a long-term residential program, where children with severe psychopathology and complex trauma resided often without family connections due to abandonment or termination of rights. Progress was slow, at best. We all felt overwhelmed and ineffective.
After only two years in the field, I was feeling helpless and hopeless. I wondered why I didn’t follow my parents’ advice and become an accountant. Problems that could be solved and where there was always a right answer. This became my imaginary job, the one you fantasize about when you are feeling overwhelmed.
These feelings of hopelessness and helplessness didn’t go away. I started feeling anxious, had difficulty sleeping and it became more and more difficult to get out of bed for work. As a therapist, I recognized something was wrong and I needed to go back to therapy. As a therapist, I delayed this for as long as possible. My symptoms became unavoidable. Where were they coming from? Why did they look like post-traumatic stress symptoms? I never imagined it could be the work.
With further examination I realized that I was always helping others and not helping myself. Most of my clients were trauma survivors. I worked long days and brought work home. I spent a great deal of my free time reading and engaged in lectures at my post-grad trauma program… then my therapist talked to me about vicarious trauma. Could this be? My work impact was beyond normal empathy or even compassion fatigue. So, what to do…first, recognize that I have a problem—check. Second, make strides to address the problem—not so easy. I was asked to examine five areas of self-care and see how I measured up.
Exercise. I walked up the stairs to my office. Take Breaks. Rarely, to use the restroom, nonetheless take lunch. Mindfulness. I ate my lunch- or should I say inhaled my lunch- at my desk while checking email and phone messages. Leave Work at Work. I read articles on emerging trauma treatment and thought about how I could apply it to my cases. Have Fun. Hmm… does going to a lecture on “Facilitating Trauma Narratives” count?
There was a lot of literature out there on self-care offering a great deal of advice and it all seemed ideal and undoable. I didn’t need my “treatment plan” leaving me feeling overwhelmed and ineffective too. My work demands were not going to change; I didn’t have time for daily lunch hours and long trips to the gym. I couldn’t afford weekly massages and extravagant vacations. I needed to do something every day in small blocks of time. So, I kept it short and simple. Everyone has five minutes. Instead of becoming discouraged and not doing anything, I chose to do something with the time I had. Exercise. I began using those five minutes to get up from my desk to walk, stretch, get outside and breathe the fresh air. Even on rainy days, I would walk up and down a few flights of stairs. Exercise increases endorphins… and guess what, I began to feel better, I had more energy and my mood improved. Take Breaks. I drank lots of water and took as many restroom breaks as needed—simple AND effective. I brought in pictures of my favorite place and found a moment of escape between clients for relaxation and grounding as I looked at soothing images. Mindfulness. I became mindful about eating—even if it was at my desk and even when I only had 15 minutes. I limited distractions and didn’t multitask. I focused my senses on what I was eating- what it tasted like, smelled like, felt like in my mouth? Leave Work at Work. Creating this boundary was very difficult but I began using my commute home to unwind. When I got home, I spent more quality time with family and friends and began reading fiction as a contrast to my work life. Have Fun. In addition to laughing more, I began studying karate—which became my perfect blend of meditation and catharsis—nothing like kicking and punching a heavy bag to release frustration! Everyday in our work as therapists we expend energy—through the normal act of empathy we experience compassion fatigue. How do we recharge? How do we balance energy expenditure and replenishment? Self-Care. It looks different for each of us but we all need to do something every day to achieve this balance. Today, I am very diligent about personal self-care and teach caregivers how they can ameliorate the impact of vicarious trauma. The best treatment is prevention. If we know how to take care of ourselves, we don’t need to experience what myself and many others have. So, turn off your iPod, put down that magazine and listen to the flight attendant… “You need to take care of yourself before assisting others.” I can honestly say… I don’t want to be an accountant anymore.
Christina Grosso is the Director of Training at the Center for Trauma Program Innovation at the Jewish Board of Family and Children’s Services. She has worked as a clinician, supervisor, and master trainer specializing in the treatment of trauma and complex trauma in children and adolescents. Ms. Grosso has extensive experience in the practice, implementation and training of trauma-based assessment and evidence based and evidence informed practices. Ms. Grosso maintains a private practice in New York City and is an Adjunct Faculty in the Graduate Art Therapy Department at New York University.