Our Associations With Work
Is it really vicarious trauma or is the work environment itself, in a way, traumatic?
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Over the past couple months, I’ve been focusing a lot less on “doing” and more focused on “being”.
I’ve been slowing down.
Reflecting.
Feeling.
Noticing.
Rather than pushing, forcing or grasping.
This process has led me to think a bit more about work and our associations with work. A while ago, I spent time with a friend and colleague. We had initially met a handful of years ago where we worked at the same agency. More recently, she has been trying to adjust into the world of doing private practice rather than agency work.
“I feel like my nervous system just associates all work now with the work I did at the agency” she said to me recently.
“I feel you there,” I replied, “It took me at least a few months just to feel relatively back to normal again, but it’s been a years-long process.”
This got me thinking a lot about work, our associations with work, and how to change our relationship with work to prevent burnout and foster sustainability.
Before I entered private practice I worked in two different agency jobs for about 3 years total.
Simply put, working at an agency job is extremely different from working in private practice. In agency, there are very high paperwork expectations and a strong push to meet your monthly “quota” in terms of billable time spent in sessions and consultations in order to show that you’ve made the agency enough money in order for them to keep you. Essentially, you’re told that if you don’t meet your “quota” after a certain amount of time (and a fair amount of pressure), they can let you go.
So that’s the dynamic going on behind the scenes while you’re also expected to manage multiple crisis situations in a day or week, have all paperwork errors corrected in a certain amount of time for the insurance company, and still have time to sleep and have a life outside of work.
Private practice can also be stressful. But has the potential to be a very different environment in many ways, and that’s why it is appealing to so many therapists. There’s still a natural ebb and flow to the business that you have to manage, which can be stressful in and of itself, but you have the ability to make decisions and structure things in a way that work best for you.
You get to determine when you don’t want to take on more clients.
You get to refer someone out when you’ve determined it’s not a good fit or if you believe they need additional services that you can’t provide.
You get to determine your worth in regards to what you should be paid for services provided based on your energy level, needs, and skill set.
It’s a complete 180 in many ways. And it’s quite a shift to make — psychologically, emotionally, and even physically. Because when your brain and body has become so used to “go go go” (a flight mode), it’s hard to get back to a place of feeling grounded and neutral.
And this is exactly what I experienced a month or so ago after I saw my last clients for the week.
I felt buzzy. I felt on edge.
I was very aware of how I was feeling so I attempted to manage it through a number of different ways:
A very long walk with my dog
Breathwork
Yin yoga
A long warm bath with candles and soothing music
But, unfortunately, nothing seemed to work. Eventually, it was midnight and I still felt “buzzy” and on edge.
Fortunately, I had my own therapy the next morning with my Brainspotting therapist.
“How have you been doing?” she asked.
“I’ve been okay, but I have been feeling particularly tense since I finished up sessions yesterday. I spent the entire late afternoon and evening yesterday trying to calm down and “unplug” but nothing seemed to work” I responded.
“Was there anything that came up in sessions?”
“That’s the weird thing — there wasn’t. I actually felt good about all the sessions. I do think part of the issue, though, is that I have had a lot of emails and messages to respond to this week, so that put me on edge a bit.”
“Did you have a lot of emails yesterday? Do you have anymore to respond to today?”
“No,” I laughed, “That’s the funny thing. I only had an email or two to respond to yesterday morning, but then after that I felt kind of locked in to this buzzing feeling in anticipation of having more to do even though I know there was nothing more to do.”
“So you knew there’s nothing more to do, but you still felt as if there was.”
“Exactly.”
“Does this buzzy feeling feel familiar in some way?”
“Yes — it reminds me of exactly how I felt when I worked at my first agency job. I had phone calls interrupting my sessions, an intercom going off whenever someone didn’t answer their phone, a lot of emails, and constant pressure to get clients in so I could bill more and meet my quota.” As I said it out loud I could feel the buzzy feeling increase throughout my body.
“Are there any other memories that come up with this feeling or just that?”
“Right now it’s just that.”
At that point she brought out the pointer to do some Brainspotting. As she moved the pointer along my field of vision I felt pretty activated. The overall “buzzy” feeling in my body was fairly pronounced. I contemplated telling her to stop, but moments after having that thought she stopped the pointer at a spot that immediately caused my stomach to drop and my face muscles to tense up. This was different than what I had been feeling before, but it felt far more intense.
“Oh that’s pretty charged right there” I said.
“Okay,” she responded, “Now let’s just stay here and see what happens. If you notice a release, let me know and we can continue to find another spots.”
As we stayed on the spot, I began to feel my legs really need to move. So I readjusted myself to allow room for them to move.
They quickly began bouncing at a rapid pace. First one and then the other. And this continued on throughout the session.
In the therapist and social work world, we talk a lot about vicarious trauma.
Vicarious trauma essentially refers to experiences where you yourself are traumatized as a result of working with people who are experiencing or have experienced traumatic events.
The term is often associated with burnout and “compassion fatigue”.
Obviously, this is an important term to talk about if you work in mental health. It’s important for mental health providers to to be aware of how the stories they hear and the experiences that they witness while working with their clients are impacting them.
However, I don’t think this only happens to therapists and social workers. I can think of countless career paths where vicarious trauma can occur, including (but not limited to): doctors, nurses, teachers working with high-risk youth, emergency personnel, firefighters, police officers, etc. etc.
Unfortunately, the term isn’t used nearly as often in these fields as it is for those who are working in mental health. And, frankly, even in mental health — particularly in community mental health — I do not believe that it is talked about often enough.
However, I don’t believe for a second that the experience of vicarious trauma is 100% the reason why people burnout at their jobs. To say that it is completely due to vicarious trauma, it would imply that the cause has 100% to do with the interactions between the therapist and client (or doctor/nurse and patient, etc.).
But unless you’re working in private practice that is 100% private pay and you are only working with fully consenting adults who have voluntarily chosen their treatment, there is always more than those two parties (the client and the therapist) involved in the treatment.
You also have:
The insurance company
The agency or employer
Your supervisors and managers
The clients caregivers and family, if a minor
The work environment itself (ie - Do you have technology that works? Do you have the tools needed to complete your job and do it in the amount of time that you’re expected to complete it in? Does your fax machine work? Are there systems in place to help you when and if you are in an unsafe situation? etc. etc.)
And most importantly you have:
The systems and models put in place by the insurance company and employer themselves, which could be very conducive to healing. Or, it might be traumatizing in its own way if the systems in place cause the environment to be inherently dysregulating to people’s nervous systems.
Back in my Brainspotting session my legs continued to bounce back and forth at a rapid pace.
10 minutes went by.
Then 20.
Then 30.
Once it hit about the 35 minute mark and I glanced over at the clock I wondered to myself if this would ever stop. The thought brought up even more anxiety.
And then I realized: Wondering if it would ever stop was a thought I commonly had at this job. There were mornings when I came in at 6 AM tired and exhausted wondering when and if there will ever be an end.
I missed sunlight.
I missed being able to rest when I needed to.
I missed having normal sleep.
I missed having energy on the weekends to be able to socialize do things I enjoyed.
I missed going to class with enough energy so I could put my full attention into it and actually enjoy learning.
Then, with my legs still bouncing back and forth, I had the thought:
You went against your body for this job.
And my legs stopped bouncing.
And, finally, I was calm.