Therapist Peer Groups, the “Emotional Lifeboat”

One morning, a few days after the school shooting in Parkland, Florida, a female client left me a voicemail just minutes before her 8 a.m. appointment. Her voice shook as she struggled to speak. An hour earlier, her son had showed her pictures on Twitter of a classmate posing with an assault rifle. The day before, this classmate had been beaten up for mocking students who cried after hearing about the Parkland attack. “I might be a little late to our appointment,” she said. “I’ve already spoken about this with the police, and I’m waiting for a call back from the school principal.”

Rushing out the door to meet the woman at my office, I quickly told my partner about the message. I heard my voice crack, and instinctively tried to hide it by pretending to clear my throat. Driving too fast to work, I could feel my body tense. I knew from my years spent working with anxious and traumatized clients that I was showing the classic signs of hyperarousal.

When I got to a red light, I took a breath and began to practice what I teach my clients who find themselves in stressful situations: I focused on the tension in my body—for me, in my shoulders—and my cracking voice. For a moment, I simply sat and observed these feelings. Soon, an image came to my mind of the scared, protective father in me. Although my children are no longer young, I still felt fear just imagining them having to go to school under these circumstances.

I also connected with the part of myself that had been a Marine infantryman in Vietnam. I knew the damage that assault rifles could do. The thought made me nauseous. I had almost two miles to go before arriving at my office. I need to slow down, breathe, and get this sorted out, I told myself. I knew my client’s own trauma response had been activated, and she’d need me to be regulated in order to help her.

In the Sea of Trauma

As far as the nervous system is concerned, there’s no such thing as “secondary trauma.” It’s a term we’ve come up with to explain how working with traumatized clients can take an enormous toll on us. In the sea of trauma that surrounds us in our daily lives and in our offices, self-care is a life jacket. I hear from many therapists who work with traumatized populations that they need especially strong strategies to stave off feelings of overwhelm, hopelessness, and burnout.

Although practicing self-care is essential, it doesn’t always help us acknowledge and fully process the deep impact our traumatized clients can have on us. We often feel ashamed of the inner turmoil and stress we experience in working with them, sometimes because we’re aware of how much worse our clients have it. By comparison, our stress, our problems, can seem very minor.

Our nervous systems, however, disagree. Emotions don’t make comparisons between our suffering and someone else’s—they’re simply trying to tell us to pay attention: This is what you need right now! Sometimes, simple self-care like the grounding and breathing exercise I used during my drive to work isn’t enough to quiet this inner stress.

From Life Jacket to Lifeboat

For moments when doing self-care on your own isn’t enough, being part of a group of therapists dedicated to talking about vicarious trauma and sharing their own experiences can make a huge difference. When we seek help from others who understand us, we not only have a life jacket: we have a human lifeboat. When we’re connected to others, we have more resilience than we could ever generate alone.

I recently finished a year-long training in Israel that focused on working through collective trauma. Our group was comprised of more than 150 people from 39 countries. In Skype and Zoom meetings, we learned together. We shared our personal experiences, including what we’d found most helpful when working with traumatized clients.

Perhaps the major takeaway from this training is that collective trauma needs a collective response. Trauma is just too big and powerful for us to deal with alone. We all need support. If you work with populations such as people of color, veterans, childhood abuse survivors, domestic abuse survivors, and the like, then you probably know that they’re trying to heal their trauma in a culture that not only largely denies, resists, and avoids acknowledging that trauma happens, but sometimes condones and enables it.
 
As we expand our understanding of trauma and the myriad forms that exist—individual, historical, collective, and intergenerational, to name a few—we can better understand why it’s so difficult for many of our clients to heal, and why our work with these clients can be so taxing.
 
Right now, there’s not only a need to help our clients heal trauma in one-on-one therapy sessions, but also a need to help them navigate the culture outside our offices, a culture that largely refuses to acknowledge its complicity in perpetuating trauma and tries to quiet those who bring it to our attention.
 
As we become aware that our clients need us to step up to this challenge, we also see our own need for a container in the form of group support and collaboration. After all, collective trauma exists in every one of us.

Group Self-Care in Action

When we share our experiences and personal responses to treating clients’ trauma with a group of energetic, supportive colleagues, the group can see more, process more, hold more, and give us more space to process what we’re dealing with.

But what does this look like in practice? How do you begin to build the lifeboat and maintain it?

The group I work, which operates internationally, often uses guided meditations or rituals throughout our discussions, with an explicit focus on an embodied connection between the group members. When I work with this group of therapists, I start each session by asking the members to close their eyes and relax their whole body. Then, I softly announce the shared values and intention of the group, the shared goodness of everyone in the room whose desire is to help whomever may be coming to them for help.

Next, I ask each group member to visualize some form of connection with the other members. I offer some examples, such as the mental image of the group in a boat with a light shining in each member’s heart, or a web of light connecting each member’s heart together. After they’ve done this, I ask them to try to locate a resulting sensation in their body. I find this to be a powerful, effective way to begin articulating what’s going on in their nervous systems, a technique they can also return to outside of our meetings. I reuse this technique several times in between our discussions.

After we’ve spent some time going around the room sharing our experiences and providing feedback, occasionally turning to the guided meditation, I remind the group of the importance of having these meetings regularly so that we can build our personal and collective resilience. Then, we schedule our next session. Sessions can be weekly or monthly—whatever the group deems necessary to maintain the connection and resilience of the group.

As we shift from seeing ourselves as just healers for our clients to healing the collective trauma in ourselves and our colleagues, we start to see our role and potential in healing the wider world and culture.

Remembering the Group

As I neared my office the morning I got the frantic call from my client, I recalled the many times over the past year that I’d been in groups with my colleagues. I began to remember times when they’d been in similarly stressful situations, and the solutions we offered.

I remembered a Skype meeting I’d had with two other therapists three days earlier. One lived in Germany, the other in South Africa. Despite both being hundreds of miles away, my experience of our video conference was fresh in my mind and body. I recalled the safety and connection I felt with them during our meeting, and imagined telling them what I was feeling at now in the car.

Slowly, my body began to relax as I imagined telling them about how I’d become activated as a protective father and former solider. A few tears fell down my cheek. To my surprise, I quickly felt a sense of calm—not so much from the tears but from feeling me being held by something bigger then myself. It was a little boat of safety and care, the two humans who’d be holding space for me, my client, and everything that would show up. 

Photo © iStock/erhui1979