The Vulnerable Therapist and theEthics of Self Care

One thing that stands out for me from my occasional visits to Twitter is that trauma clients know only too well what their therapists can and can’t bear. They test us to see how safe they really are, in telling us the things they imagine are too bad to tell. Or revealing to us how ‘bad’ they really are. Or both. They need so urgently to stay in relationship with us, not to scare us away.

Of course this is a challenge for us, to bear the unbearable with them, to witness some of the worst things that happen to people, the deepest suffering, the greatest cruelties. Trauma takes us all to extremes that we’d really rather not know about. Our natural defenses kick in, just as they do for the client. And it’s our job, for better or worse, to acknowledge and come alongside.

It’s tempting, in the face of unimaginable pain, to fool ourselves that we have power over trauma, that our theories and techniques will see us through. Of course we need them to anchor us, but as soon as we take a position of power in relation to our clients, we risk repeating a harmful relational dynamic. If we invite our clients to take better care of themselves, and don’t do so ourselves, we are implying that we are somehow ‘more resilient’ than them, and I don’t think that is healthy modelling.

When I sit with a client in a highly traumatized state, I have two choices. One is to stay very focused on helping them to leave the trauma state, using my technical skill and knowledge. The other is to open myself to offer a more heartfelt, human contact. It is when I do this that I pick up the trauma energy, the waves of nausea, the horror, the terror. Of course this is what most changes the quality of the work, and is the most therapeutic support in the long run. I put myself on the line; it’s risky. I don’t want the power inherent in certainty; I allow this suffering human to teach me. And in return, that changes me.

We must never underestimate the impact on us of working with people in dissociated states, who are reliving horrendous terror. We are prone to vicarious traumatization, and do well to reflect how we might contribute to it. Yes. We are in the mess with them, and our responses are sometimes messy, with echoes of our own histories showing up. That’s what having a relationship means! It saddens me to see therapists overwork, get burnt out, stressed, irritable with their clients. It really helps when we can recognize the dynamics that we get caught in, the roles our clients invite us into, the potent energy of trauma contagion, and watch out for how we get caught in them. It is also avoidable.

Of course many therapists have had to deal with their own trauma and that’s part of what informs their practice. Whether or not we have our own trauma history, we are all vulnerable, and that is not a weakness or a lack of professionalism. As Cozolino reminds us, we are wired to resonate with others; it’s part of our physiology. Our interpersonal connections can’t hold out if we are unable to resonate with others, or if we shut ourselves down defensively. Trauma therapists need extra wide windows of tolerance!

It’s certainly been my experience that the more work I’ve done on myself, the more clients have opened up. Some of that work on myself has been in the arena of self-care. I wrote in my book that I make no apologies for going for a walk, meditating, doing some art or having coffee with friends during my working day – it is part and parcel of my work. In fact, I would go so far as to say it’s that piece that my clients pay me for, so that the relationship I offer them is freed up. Time and again I notice that when I am more supported, clients come forward. As a student recently said ‘I change myself and then the therapy changes’.  I imagine that if you stop and consider, you’ll notice the same is true for you too.

Speaking personally, I crave the beauty of the natural world, an inner stillness, my sense of creativity, the delight in the company of others as a real counterpoint to the awfulness of trauma. I choose not to get immersed in it, and have to remind myself daily that there is more to life than this.

I think this is tricky for us in our society. Teaching recently in Mexico, the students got this message far more quickly than those in this country tend to. We are often programmed from our early years to take care of others, to put our own needs second. We live in an increasingly individualistic culture. But what if to look after our own needs is actually looking after others? Aware of the interdependence of relationships, I can’t separate the two. How difficult it is to see that self-care is a resource for the therapy, not for yourself. I am sad, for example, when people on a limited CPD budget say they have to prioritize client-focused training over a nourishing weekend in the countryside. (The Well-Grounded Therapist in June – there are still some places left!)

So I have come to believe that there is an ethic in self-care, which goes along with maintaining safe practice and competence to work. This is the ethic of accepting our vulnerability, of personal responsibility, and self-reflection. And then doing something about it. To my mind, it’s every bit as important as appropriate ongoing training, supervision and personal therapy. Have a wonderful day!

Cozolino, L, 2004, The Making of a Therapist, New York, Norton: 192


3 thoughts on “The Vulnerable Therapist and theEthics of Self Care

  1. Thank you Miriam.. you speak beautifully to the importance of self-care. It saddens me not just that skills training gets prioritised in the face of limited resources, but that we have a system that doesn’t value a nourishing weekend in the country as a necessary and importance resource for practitioners.


  2. Thank you Miriam this arrived just as I needed it! I’ve been questioning my self care as I work with trauma while pregnant and nurturing a young infant and wondering how do I support myself and look after myself so that I give the best posible support and be ethical in my circumstances. Can I provide this? I’ve been asking myself or worrying as I do 🙂
    There is only one thing I am not sure I can agree with. I believe that in individualistic cultures is much easier to look after yourself. In collective or con fluent cultures like the one I come from looking after yourself is breaking the confluence and being selfish. I think English people are masters in self care and there’s so much on offer but unfortunately it is the values of what a good worker is and the expectations of the system that get in the way.
    Also I sometimes think that working with trauma similar to looking after young family will inevitably involve is going beyond our selfs and forgetting self care and that is just a brilliant gift.


    • Hello Evgenija, Thank you for your thoughtful response, it’s good to hear from you. I think perhaps we are on a similar page, as it happens. What I tried – or hoped – to say is that in this society it is harder to value ourselves in relation to other people; in the ‘selfishness’ the connection gets missed. So we have less ground for understanding the impact we have on one another, either the trauma ‘contagion’ or the shared mindful field, as I argue in my book and in my teaching. I am talking about the care we need to support staying in relationship, not for doing our own thing. And I couldn’t agree more that this can be the most brilliant gift, when the benefits outweigh the costs, and we don’t lose ourselves in it. You and I might call this inclusion :). Hope you and your little ones are well. Miriam


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