Clinical Intersections: The Remnants of Trauma and the Role of Self-Care

by Danna Bodenheimer

by Dr. Danna Bodenheimer, LCSW, author of Real World Clinical Social Work: Find Your Voice and Find Your Way and On Clinical Social Work: Meditations and Truths From the Field

Lately, I have been storing the majority of the stories that I hear in the space between my neck and left shoulder. It’s a crevice that holds a surprising amount of pain and data, and I just keep rubbing it, taking Advil, praying for the relief of the heat from a hot shower on this inflamed tissue.

It has long been established that trauma lives in the body. We have many groundbreaking theorists to thank for that: Gabor Mate, Bessel Van Der Kolk, Jody Davies, Sandra Bloom, Carol Tosone. The list goes on. Bessel Van Der Kolk’s The Body Keeps the Score has been on the New York Times best seller list for nearly a year. The reason why these writers, and their work, is so important is because we need constant reminding of the psychological minefields that we practice in and the related injuries to our minds and bodies that occur.

I say this because I want to remind you all that we are not okay. And it is okay to not be okay. It is not okay to have no idea what to do about not being okay. That’s what I want to write about.

For starters, the reason why we aren’t okay is because we are social workers who are bound by the Code of Ethics to serve the most underrepresented and struggling members of our community. In doing this, we bear witness to their trauma, to the role that chaos plays in sustaining unbearable status quos and the cycle of violence that our clients are enduring. Our literal job is to hold the information that no one else wants to hear and no one else wants to know about. There is beauty in that fact, and there is pain in it, too.

The other reason we aren’t okay is because we have trauma of our own - we all do. Perhaps it doesn’t exist on the same scale as the persistent and chronic stress that our clients live with, but perhaps it does; perhaps it is even worse. We are all drawn to this profession because we are working our stuff out, and there is no shame in that. There is only the savvy knowledge of it and the self-care that should be correlated with it.

Given that trauma, which I am defining as an assault on vulnerability, attachment, and development that leads us to feel endangered and out of control, enters us throughout our work days as social workers, what are we supposed to do about that?

Here are some ideas.

The first step is to admit we have a problem.

I frequently have this feeling that I want to cry or that something is wrong. I try to do a little archaeological dig of my most recent thoughts and feelings to try and find the trigger. I often can’t. It can be something as simple as an Instagram post that sat me the wrong way or a story that my 9:00 a.m. client told me that is finally hitting me at 2:30 p.m. The onslaught of information that we are faced with can leave us feeling incompetent and confused about our responses. We need to get better at this. We need to master the identification of our feelings in the moment and letting ourselves experience them. There is nothing easy about this in the pace of an American workday in a capitalist economy. It has to be intentional and actually kind of rigid. If it is 15 minutes between appointments you need, then it is 15. If it is that you need to do your paperwork at the end of the day instead of during it, then so it is. If it is that you need to write your note immediately to get it off your chest and clear space for the next client, then do that. Whatever it is that gives you room to breathe and process will help the trauma from settling like a painful plague onto your muscles.

The chair you sit in matters.

I know this doesn’t seem like a big deal, but it is. We all have a relationship with our chairs. Some of us have extremely uncomfortable ones, and some of us have shopped for the perfect one for years. The actual physical seat you are in and the comfort level you feel in that seat changes the way your body absorbs the trauma you are hearing about. If you are already uncomfortable or moving between offices every single session, the trauma will have more access into your muscles and body. If we are sitting in a way that is comfortable and we feel some ease in our body, that is a small defense against the onslaught.

These are a few weird tools that I have found, and this is not a sales pitch: a microwaveable stuffed animal filled with lavender that I rest on my muscles between sessions. This is a $21 intervention that you can have at work - that is not an endorsement of Amazon. It is simply an offering of a tender act to help get you through the day and to remember that you have a body. Here’s another one that I used recently to get me through sessions with a client that I had been having some migraine pain with: therapy dough. Also, Advil. Just Advil. It’s okay to treat the body first and the mind later.

Make meaning of the work you are doing.

Most trauma theorists agree that the only way out of trauma is through the effort to make meaning of it, to create a narrative out of what feels chaotic and non-sensical. I often ask myself about what it is that I am actually doing. I think that is a question that warrants a real answer, and that answer is different for all of us. But we need to ask it and we need to answer it. And if we can’t answer it, the vicarious trauma is worsened and the possibility of self-love and self-containment diminishes. These are the things that I am doing:

Shifting attachment styles into more secure realms through offering a predictable and secure holding environment that is free of chaos and unmanageable stimuli.
Fine-tuning my expectations for my clients away from their chronological age to their psychological age and offering interventions that are developmentally attuned to their realities and capacities
Setting boundaries that remind me and my clients that we all have limits and that the denial of these limits creates more trauma
Honoring the complexity of identity, which is often intersecting between race, ethnicity, socioeconomic status, sexuality, and gender. And I am creating the space for the whole of one’s identity to exist fully in the room with me.
Being in relationship with the darkest parts of my clients to help them understand that they can survive traveling to any part of the interior of their minds.

Get coverage when you take a break or a vacation.

If we don’t take a complete break from our work, at least sometimes, we are never able to properly refuel. Vacations for social workers matter more than vacations for other people. I

think we should all be boarding planes first class, but our salaries are not exactly allowing for that - although we deserve it. This is what we can afford, though - using all the days we are given by our employers, letting a colleague cover our caseload when we are gone, not checking our work email, leaving our phone inside when we are outside, doing easy crossword puzzles, winning at words with friends, thinking about ourselves. Every year, I try to take a few weeks off in August, and it is never easy or simple for me. However, I do use the time to re-set my intentions for the year and try to think carefully about these things that I will need to sustain me in the coming months.

Read the news cautiously.

I am a news junkie, like totally and completely obsessed. What this basically means is that I work all the time, because the news is a window to trauma and the desperate need for social work. I recently decided that I can’t keep reading about the border crisis, the imprisonment of children in holding facilities (aka concentration camps) without committing to do something about it. The fundamental mechanism of trauma is panic without the opportunity for action, safety, or resolution. So, I am going to go to the border and I am going to spend a few days doing biopsychosocial assessments. That is what I am going to do. It is out of my lane, and my lane is already pretty crowded, but the continued exposure to the trauma without action feels like a repetition of past trauma to me and I am going to try and change it. This is all to say that you are all doing enough. More than enough. And if you need to do more, then do so. But if you are just exposing yourself to stimuli with no way of regulating the intake of that stimuli, then you aren’t taking proper care of yourself.

Use supervision.

Find and use supervision that you walk out of feeling lighter because your supervisor has offered to help hold some of this with you. If you are not in supervision that allows for this, find it. Find it with a peer, a mentor, or a group. Just find it. The spread of trauma inside of the body is facilitated by the secrets that we keep about it. And discharge of it is the simple answer. Finding that space for discharge is the challenge and one that we are all responsible for both offering to others and finding for ourselves.

Dr. Danna Bodenheimer, LCSW, is the founder of Walnut Psychotherapy Center, and the executive director of the Walnut Wellness Fund. She is the author of Real World Clinical Social Work: Find Your Voice and Find Your Way and On Clinical Social Work: Meditations and Truths From the Field (The New Social Worker Press).

Check out Danna Bodenheimer's books on Amazon.