Experiencing personal trauma as a therapist: how to heal

I experienced vicarious trauma in my career as a therapist without even realizing it. As someone who has always been able to push through the hard stuff in life, I prided myself on not "letting them see me sweat" under the stress of my academic and professional careers. I was deep into my practice by the time I realized that I was being impacted by vicarious trauma. And I am far from the only therapist to experience this! 

I recently saw a Reddit post about a therapist having their house randomly shot at. Other therapists have also shared about being harassed or attacked by clients. However, it was reading about therapists struggling with workloads while working through their own personal traumas that hit home the hardest. It made me recall the times I forced myself to work while grieving a loved one or approaching the anniversary of a traumatic event in my life. What made me think I was so unbreakable?

I also know therapist colleagues who have continued to work while struggling with miscarriage, infertility, divorce, loss of loved ones, memories of childhood abuse, and serious illness without stopping to consider how their own fears and anxieties were piling up with all of the heavy things being revealed to them by clients on a daily basis. In recent forums I've read, I've seen therapists finally realize they had hit trauma walls after experiencing the following:

• Becoming overly emotional with clients.
• Suddenly having flashbacks of past traumatic events triggered by things their clients share.
• Intense burnout.
• Being preoccupied with thoughts of patients based on the intense experiences they shared.
• Persistent feelings of shame, guilt, or self-doubt.
• Emotional exhaustion and irritability.
• Increased sensitivity.
• Vacillating between numbness, avoidance, and intense arousal. 

In this post, I'll share important reasons why therapists shouldn't sideline their own life trauma. In addition, I'll run through some blueprints for how to work through trauma in a professional, responsible way while treating yourself like a human instead of just a "helper."

How recent trauma can affect your work as a therapist

I wish I could tell my younger self that pushing through when my own trauma was bubbling to the surface didn't make me a hero. In fact, our own trauma can affect our work as therapists. A 2023 review of burnout among mental health professionals found that therapists who experience vicarious trauma deal with difficulties regarding their own emotion regulation and personal relationships. It's common for them to experience or re-experience traumatic conditions. And, the research shows that our own unresolved traumas show up in our work. 

Furthermore, the research also shows that the negative effects of vicarious trauma may cause mental health care providers long-lasting impairment. 

On the positive side, appropriate interventions have been shown to prevent long-term negative effects, improve quality of care and patient satisfaction, and allow mental health care providers to stay in their positions. However, the truth is that even those of us who may not be actively struggling with overt secondary trauma while practicing are probably still dealing with some degree of compassion fatigue. You're at risk if you provide therapy that introduces you to extreme or severe experiences. This includes working with people experiencing depression, grief, and suicidal ideation. The risk of compassion fatigue skyrockets if you've been verbally or physically threatened.

What to do – 6 tips from me, Emily Mendez

What should you do if trauma is impacting your ability to do your job? First, this isn't a time to do anything drastic. The fact that you're dealing with personal trauma or secondary trauma doesn't mean that you're bad at your job, incapable of doing your job, or in need of a career change. Resist the urge to make a dramatic change. Here's how to handle trauma with a proportionate response.

1. Take time off

If you're gritting your teeth through each day, it's time to consider taking some vacation days or requesting a leave of absence. It becomes much harder to hold space for others when you're operating from a place of overwhelm. What's more, every moment you spend sitting at your desk with a clenched jaw and rushed heart rate is delaying your own healing.

2. Therapy

Physician, heal thyself. You know the tools for handling trauma better than anyone. As you face your own bubbling memories and out-of-control feelings, it's time to turn to a professional. We are truly living in the golden age of trauma-informed care. Some therapy modes I'm especially excited about right now for managing trauma are dialectical behavior therapy (DBT), cognitive processing therapy (CPT), somatic therapy, and eye movement desensitization and reprocessing (EMDR). While I know I'm probably singing to the choir, I do want to take a minute to share some current research on some of these therapies to help encourage you to take advantage of them.

One clinical sample of PTSD patients found that EMDR was associated with reductions in symptoms of PTSD, anxiety, and depression while simultaneously producing improvements in quality of life. Additionally, I've seen some very promising research on somatic therapy's ability to reduce both psychological and somatic symptoms of anxiety. Both DBT and CPT have been shown to create significant improvements in PTSD severity for complex presentations of PTSD in women survivors of childhood abuse. I highlight these studies because they show that there are advantageous therapy types for trauma that we can experience as therapists stemming from all different origins.

3. Supervision

Your supervisor can be an incredible resource for managing trauma that you believe is affecting your quality of work or ability to handle certain cases. In truth, it's a supervisor's duty to be mindful of the potential for vicarious trauma. They should also be on the lookout for signs of withdrawal, burnout, and being overwhelmed among the therapists they manage and mentor. However, the truth is that most of us are so "stealthy" when it comes to our own personal suffering that it would be nearly impossible for an outsider to notice trouble signs. That's why it may be up to you to bring the issue up with your supervisor.

My tip for approaching the issue is simple. You don't need to share the details of your own personal trauma triggers. Start by expressing how the trauma you're experiencing impacts your work, well-being, and ability to serve clients. If you're already receiving support or therapy, this could be something to share with your supervisor as part of a going-forward plan.

4. Support groups

I'm a big fan of support groups because I've seen their impact both for myself as well as clients. A 2017 study on trauma-focused group therapy backs me up by finding that group therapy actually offers some advantages over individual therapy by normalizing trauma symptoms and creating social support. A publication from the American Psychological Association (APA) actually ascertains that group therapy can be both as effective and more efficient than individual therapy in certain circumstances. It's not really an either/or matter for me. I think group therapy can be a wonderful supplement when you're working one-on-one with a counselor.

If getting to group meetings is just too difficult with your schedule, online support groups can be great substitutes. While not much about COVID-19 was great, one thing the pandemic did give us was some useful data on in-person versus virtual therapy once group sessions were shut down around the country. Based on a comparison of telehealth versus in‐person group therapy published in 2022, large reductions in symptoms of anxiety, depression, and stress were experienced following both. In fact, there were no significant differences in symptom reduction between the two.

5. Take extra care of yourself

Some therapist problems can be handled like any other problems. We need to remember to bring it back to basics. Carving out time for exercise and physical activity can be so healing when we have operated on hectic schedules since our undergrad days. Need some inspiration? Research shows that a routine as simple as combining resistance exercise and walking for 30 minutes three times a week over a 12-week period can result in a significant decrease in PTSD symptoms. Journaling, yoga, or taking up a new hobby can also be so healing and restorative. Take a moment to think about all the ways in which you can hit pause and go back to those very necessary “basics” we sometimes override when in a busy period. 

6. Use a tool like Upheal

Are you taking steps to make your workload as stress-free and efficient as possible? If you haven’t yet, consider investing in a tool like Upheal, so you can win back some precious self-care time. You might not know it, but you can have your progress notes drafted for you; AI-generated treatment plans effortlessly created from select sessions; and both client and therapist data points analyzed for each session. Some tools, like Upheal, even have built-in scheduling that will sync with your calendar. It doesn’t replace your expertise, it supports it. Although everyone has their preferences regarding this, I believe it’s a great way to save time.

Dealing with your personal trauma as a therapist is so important

While vicarious trauma, compassion fatigue, and burnout share overlapping features, they are different experiences. Recognizing which you're dealing with – whether it's trauma reactivation, prolonged stress exposure, or emotional depletion can help you find the right kind of support.

If your trauma symptoms are affecting your ability to assess for client risk or intervene appropriately, that’s a clear sign it may be necessary to pause clinical work and seek support. 

Prioritizing your well-being is essential for ethical clinical practice and ensuring the care of your clients.

If any of this is hitting close to home, it's important to seek therapy for past trauma for the sake of both your personal well-being and your career.