In the responses to my post yesterday, Self-Care and Trauma Survivors, a commenter raised such good points it inspired me to write more about the complexities of self-care as part of trauma therapy.

Imagine your therapist introduces the topic of self-care, or assesses how you currently handle strong negative feelings or times of crisis. How would you interpret this sort of intervention? Does it mean your therapist doesn’t care? That others can’t care for or comfort you? Is it a kind of passing the buck? Do specific coping behaviors feel trivial compared to the magnitude of your pain?

The following comment describes one type of reaction trauma survivors may have:

Since you are a therapist, I want to tell you something since I know for sure that I am not the only abuse survivor who has ever experienced this. In the past when I heard about ‘self-care’, I interpreted that as, “No one else wants you or really cares what happens to you. Not even me, your therapist who claims to want your trust. Go away and take care of YOURSELF alone. Because you’re disgusting and no one else wants you or cares about you. You’re on your own. Don’t come crying to me when you have a flashback. I don’t care if you are trapped in the closet hugging a pile of smelly shoes for comfort. If that’s all you have, then that’s all you deserve. Get away from me and stop your sniveling, you wretched freak. A mindful bubble bath is plenty good to erase your trauma. Now go away and take care of yourself alone. I can’t stand your bleeding. GO DIE OUTSIDE. I can’t have your filthy blood on my carpet.

I would bet this is nothing like what most therapists mean to convey when they talk about self-care! Without feedback, they may indeed remain clueless about why this intervention is going over like a lead balloon! So how does this happen? How does this sort of difference in perception between client and therapist occur?

The psychodynamic part of my training gives me a way to understand this sort of miscommunication. I approach therapy with the theoretical understanding that our current day relationships and interactions are also colored by our past experiences. We all have different filters through which we see the world.

Many trauma survivors are coming into therapy with the expectation that the therapist will treat them as poorly as others in the past did. This is their default filter. As a trauma-informed therapist I am well aware of this; that survivors may not understand the intention behind my actions, or may not assume that my intentions are good. Why would they? This was not their lived experience!

The idea that how clients react to the therapist can be about their past experiences in no way means it is only about the past. As a therapist am also responsible for looking at my own behavior and learning how to best communicate what I mean with each individual. One part of the job of therapy is to sort out the past from the present. I highly encourage clients to express their reactions to therapy interventions and the therapist her/himself as a valuable part of this process. Sorting out the past from the present is part of the work of therapy. Is your therapist uncaring and minimizing of your experience or did someone in the past treat you that way?

After over 20 years of practice I am not surprised but I am still saddened at the reminder that expecting disregard is the default for many trauma survivors. I think it is crucial for trauma therapists to spell out that which they take as a given: that they are coming from a place of caring and concern, that self-care activities are just one tool of many to help you along your healing path, that no one self-care action will erase all your pain.

Sometimes when I work with clients on making a list of comforting. pleasurable activities that they can engage in in times of emotional distress, I can tell they are perceiving this as minimizing. I try to give the context, that this is one tool, one small step that can add up to feeling better over time. I also think it is important to add contact with safe others and/or the therapist, to convey the message that self-care happens in the context of a larger circle of support.

This sort of reaction reminds me that many survivors are prone to black or white, either or thinking. Again, this is a natural part of the aftermath of complex trauma. It is not your fault, but it is something you can learn to overcome. In therapy, we can work on the “ands”: your therapist can care for you and you can learn to take better care of yourself, you can engage in self-care and form healthy, caring relationships with others.

Trauma survivors have every right to want, desire and expect to feel connection, caring and comfort in the therapeutic relationship. Every human needs this kind of connection! I truly believe that that is the foundation from which all other trauma therapy work occurs.

There is another important message I want to share regarding healing: your therapist cannot do it alone. No amount of caring alone, by your therapist (or anyone in the present), will heal you. Positive connection can and will help. Your therapist caring and providing comfort can and will help. In addition, there are small, tangible things you can learn to do every day that will help as well. It is very much a team effort. Some adult survivors may have the understandable wish (often unconscious) that someone will finally care enough to rescue them in the ways they were not cared for or rescued as a child. If only it could work that way! Healing can and does happen. It happens when you have positive connections in the present and learn the skills you need to cope with and process trauma in order to live a life that is meaningful to you.

Kathleen Young, Psy.D.



