In this interview, Networker Assistant Editor Chris Lyford talks to family therapist and trauma specialist Mary Jo Barrett about the evolution of trauma treatment and the importance of bringing families into the mix.

By Mary Jo Barrett - Family violence remains a national health problem that few therapists have been trained to deal with and, sadly, few of us want to address. On a good day, it’s a messy, complicated business, which doesn’t bring much financial reward or professional status. But over 40 years, we've amassed a wealth of knowledge on how to help traumatized families.

By Mary Jo Barrett - As the status of the therapist has shifted from that of an oversized figure with Svengali-like powers to that of an overworked and underpaid service provider at the mercy of the client-consumer who might sue him or her for some infraction, what are we to make of our traditional ethical codes?

As the status of therapist has shifted from an oversized figure with Svengali-like powers to an overworked and underpaid service provider at the mercy of the client-consumer who might sue him or her for some infraction, what are we to make of our traditional ethical codes.

If we don’t open up the one-on-one therapeutic cloister, trauma sufferers may never learn how to engage in the give and take of real-life relationships. By failing to include their families, we too often fail to help them weave change into their daily lives.

In one violent Chicago neighborhood, embattled gang members see themselves as UPOWs—urban prisoners of war. To introduce them to a new set of survival skills, a therapist specializing in complex trauma helps take them off the streets and into the wilderness. Can her unlikely approach, which at times resembles a seminar on brain science, make a real difference in their lives?

In the past few decades, we’ve made important strides in our ability to help overwhelmed and hopeless people overcome the stigma previously attached to trauma symptoms, learn new thinking and self-regulation skills, and even find a new sense of restored well-being. But then they go home, and far more often than we’d like, when they’re back in their daily lives with family, friends, and coworkers, they don’t do so well.

By Mary Jo Barrett - Mostly, I think we avoid family therapy because families can be so exhausting, creating an atmosphere of great emotional volatility, which requires us to be on our toes all the time. But the therapy experience takes on an entirely different dimension when family members learn to be healing agents for each other. Clients, especially those who’ve been traumatized, often feel disconnected from themselves and somehow separate and cut off from other people.

Far too often, trauma survivors appear to progress in therapy and then go home and fall right back into the same old patterns of negative emotion and dysfunctional relationships. According to Mary Jo Barrett, author of Treating Complex Trauma, a client’s family can be the therapist’s biggest ally in making sure progress is sustained outside the consulting room. Still, she says, many clinicians overlook how family therapy can support recovery.

By Mary Jo Barrett - Before it happened to me, I had never heard even my closest colleague talk about falling in love with a client. In our consultation group, the subject was once broached purely theoretically, and everyone became uncomfortably quiet. Yet, I want to break our conspiracy of silence so that we can get help when we need it. And believe me, when it came to Scott, I did.

By Mary Jo Barrett - Families suffering from trauma, abuse, and neglect can begin to make the crucial distinction between a chronic state of overarousal and vigilance and "reality" only once a sense of physical and psychological safety has been established. Only after this first stage is it even possible to focus on changing dysfunctional mindsets, counterproductive behavior, and destructive family patterns.

By Mary Jo Barrett - I'm on a five-day camping trip with 20 gang members as part of a program called Pride ROC. Most of these guys have suffered repeated abuse and severe poverty, seen friends and family members shot, stabbed, or fatally overdosed on drugs. Not surprisingly, every one of them suffers from complex trauma—which is why I’m here as a therapist, trying to apply what I know and use in my office in a place far away from the comfortable world I usually inhabit.

A group of innovators and leaders look back over different realms of therapeutic practice and offer their view of the eureka moments, the mistakes and misdirections, and the inevitable trial-and-error processes that have shaped the evolution of different specialty areas within the field. 

Before it happened to me, I had never heard even my closest colleague talk about falling in love with a client. In our consultation group, the subject was once broached purely theoretically, and everyone became uncomfortably quiet. Nobody shared a personal experience. The message we gave each other was clear: Whatever you do, don't talk about having a crush on a client! And that may be why I would rather write about being seen naked by a client at the health club, or dealing with anti-Semitic remarks in session, than describe to you what happened.

Before it happened to me, I had never heard even my closest colleague talk about falling in love with a client. In our consultation group, the subject was once broached purely theoretically, and everyone became uncomfortably quiet. Nobody shared a personal experience. The message we gave each other was clear: Whatever you do, don't talk about having a crush on a client! And that may be why I would rather write about being seen naked by a client at the health club, or dealing with anti-Semitic remarks in session, than describe to you what happened. Yet, I want to break our conspiracy of silence so that we can get help when we need it. And believe me, when it came to Scott, I did.

Before it happened to me, I had never heard even my closest colleague talk about falling in love with a client. In our consultation group, the subject was once broached purely theoretically, and everyone became uncomfortably quiet. The message we gave each other was clear: Whatever you do, don't talk about having a crush on a client. Yet, I want to break our conspiracy of silence so that we can get help when we need it. And believe me, when it came to Scott, I did.

By Mary Jo Barrett - My very first case was the Byford family. The father was serving a six-month sentence for domestic abuse. During a home visit several months into treatment, the daughter, Laura, announced, “Dad is getting out of jail today! And he’s coming here!” My mind went blank. Her mother looked at me. Suddenly, it was as though I passed whatever strength I had to her, and she then passed it back to me.

The Family Dialogue Project grew out of my attempt to help therapists, abuse survivors, and their families caught in the meshes of terrible conflicts from which there seemed to be no relief or exit.

There's no more emotionally demanding work than that with an incestuous family. A therapist offers an uncensored look at the fear, loathing, and fascination of the struggle to help a family emerge from the transgenerational legacy of abuse.

Increasingly the general public has come to regard therapists as just another kind of service provider, rather than a potential Svengali. Thus the relative power of therapist and client has shifted as has the role of professional boundaries.

We know that our primary initial responsibility as a therapist is to listen intently to what the client says, giving them our undivided attention. But being only human, there are times when we get distracted and are no longer focused on what the client is telling us.

Sometimes ethical violations we face with our clients become so subtle and complex that we risk alienating clients when we’re trying our best to protect them.

Clients may experience and respond to trauma in any number of ways, so the first step to determining how to best help them work through their trauma is to understand their growth cycle.

We all know that the collaboration between therapist and client is the keystone of therapy. What many therapists may not realize is how much clarifying boundary issues contributes to establishing and strengthening that collaboration.