By Manuela Mischke-Reeds, MFT
When I was in graduate school I was not taught much on self-care as a health professional. In fact, I was told in a side comment that we needed to stay healthy but my teacher failed to mention how. I was briefly instructed to exercise, hold my boundaries and not take the work home. I was sent into clinical settings equipped with lots of theory, some basic clinical practicum experience and a healthy dose of good-luck-out-there optimism.
On my first big clinical assignment working as a hospital therapy intern with political torture / PTSD survivors, I got a taste of how much I was out of my depth. Naively optimistic I thought that my clinical training, positive attitude and wanting to help was enough. It got me a long way and my innocent stance was welcomed by the patients.
What I did not account for was that taking care of severely depressed and anxious clients was slowly eroding my own mental health. I did not notice the first signs of being fatigued after work. It seemed normal: I had a demanding job, I told my friends, when I turned down their requests for socializing. Not joining my friends on a night out seemed like a badge of honor. An endless stack of books on trauma, stress, recovery and mental health were arrayed along the floor next to my bedside table. My life was getting small, my interests shrank and I found myself changing from a generally optimistic outlook to a gloomier view.
I felt weighed down. I could no longer shed the pain others had endured and go on enjoying my life. I started to live a split life as the worries of the day were not welcomed conversations by my friends. “Lighten up”, one friend told me, “not everything is traumatic.” Yet in the back of my mind I was thinking about my Latin American torture-survivor client, going back to her unsafe apartment, concerned if she would make it through the night.
Many trauma clients live a traumatic life. The torture survivors had found a safe haven in the US, no longer subject to physical threats, yet the emotional impact of the trauma experiences suffered were now deep inside their bodies and psyche. These symptoms unleashed each night as crippling flashbacks, repetitive nightmares and severe states of anxiety.
In my office, I would hear accounts of how my clients were interrogated, treated in degrading ways I had never imagined possible. My idealistic world view came tumbling down, as a clinician just 27 years old. I was brought up to believe in the goodness of human beings, that the good will win over evil. I saw little evidence of that in the stories of these victims. Their vacant stares and anxiety-ridden bodies told another story. There was not much spark, just a tired will to survive, to find a place of peace.
One night I came home, wrecked with tiredness, wanting to crawl into bed. A deep sadness washed over me and I began to cry. These were tears of grief, helplessness and despair. As I was surfacing from the ocean of tears, I searched for the cause. I could not locate this amount of emotional intensity in my own narrative. I got quiet and listened into my body. Images of people fleeing, being hurt and tortured emerged. I was haunted by the memories of my clients as if I had stepped into the story myself. How could that be? Was I too close? Was I too involved and too attached? Was I too sensitive? Was I incompetent? Perhaps my inexperience got in the way? Surely a seasoned clinician would not be sobbing with such despair for the suffering of others? What was wrong with me?
I lay on the floor, my cat stretched out next to me. I could not possibly muster a single flex of muscle. Collapsed like a sack of potatoes, I was feeling sorry for myself. My body heavy with the post-crying fatigue, I felt my breath pushing against the floor. The back of my body was solidly resting against the floor. My breath began to slowly calm. The pressure of the floor was feeding sensory cues into the emotional numbness I was experiencing. It was as if the floor was providing a direct and steady support.
I got curious about the relationship between the back of my body and the ground. The earth was holding my aching body. No matter how exhausted I was, here was a basic resource that was always there. A moment of comfort arose.
In the years since, I have continued to experiment with this sense of awareness that the earth underneath is a literal resource. In between client sessions, I sometimes lie on the ground, touching into the awareness of gravity, breath and body pressure. What I have come to realize is that the earth is always awaiting my return, ready to help.
Given that empathic attunement and compassion are key tools for any therapist, we are susceptible to the risk of fear overtaking our biological responses of fight or flight. We need to be connected and resourced in ways that are bigger than us, that can hold the magnitude of suffering we are facing. We are tender towards the suffering of one, but can quickly get overwhelmed when there are many. One of our human responses to overwhelm is to become self-preserving: to shut down emotionally, run away literally, set strict clinical boundaries, anything to contain what we can’t manage.
No therapist should be alone in holding these trauma stories. Each helper needs to be held themselves. I believe that connecting through the body and into the awareness of earth underneath us resources the heart and mind needed to be effective and helpful.
“Backbody” is a simple body awareness practice any therapist (or anyone needing self-care) can employ regardless of their orientation. The therapist becomes aware of the back of their body sitting upright, feeling the strength of their back muscles, the alignment between shoulders and hips, the connection to earth through the sitz bones. This backbody awareness practice can be done while you are working with a client. This “taking care of yourself while working” approach can make the difference between getting tired and burned out in your work or sustaining your positive outlook.
In this approach you are taking moments within the work to resource your mental and physical state. This is in contrast to the self-care model that emphasizes taking care of oneself before and after therapy. While self-care is important it does not address the empathy and compassion fatigue that can arise while in the thick of your empathic engagement with your client.
By adding this simple awareness practice to your repertoire of self-resourcing you are practicing the value that you need to “be well while working.” By connecting self resourcing within the work the therapist is making it part of the work itself.
Manuela Mischke-Reeds, MA, MFT, is an international teacher and writer of mindfulness-based somatic psychology. She co-directs the Hakomi Institute of California and teaches in the US, Europe, Israel and Australia. She also lectures, consults and trains professionals in mindfulness, attachment, trauma, and movement therapy as adjunct faculty at JFK University and Sofia University. Manuela is the author of 8 Keys to Practicing Mindfulness, (2015, W.W. Norton). She has developed a Somatic and Mindfulness-based Trauma Training: “From Trauma to Dharma” that uniquely focuses on the Clinician’s challenges with trauma.
In addition she has trained in various methods of working with trauma, counseled survivors of political oppression and torture and victims of trauma. She is a graduate of Somatic Experiencing Practitioner, a Fellow at the Napa Infant Mental Health Fellowship Program (Dr. Ed Tronick) and a graduate of the Child Trauma Institute of San Francisco (Dr. Alicia Lieberman).
Manuela maintains her private psychotherapy practice in Menlo Park, CA. To learn more about Manuela, click here.
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This article appears in:
2015 Catalyst, Issue 19: The Next Wave of Psychotherapy