The subject of trauma is an enormously wide-ranging topic, with a vast amount of literature written on it. Even the matter of what in fact constitutes trauma is the topic of an abundance of books and articles. According to Fanita English, “the word “trauma” usually refers to one or more shocks to a person’s system” (2017, p. 343). It can refer to a single traumatic event, or to “repeated and anticipated shocks (as in chronic illness, continuous child abuse, or wartime situations)” (English, 2017, p. 343). The type and extent of the traumatic experience can lead to varying levels of Post-Traumatic Stress Disorder, in which “the imprint of certain traumatic events is so powerful that even after the original reasons for mobilizing the organism to action no longer exist, the residual anxiety persists, and mortal danger continues to be anticipated” (English, 2017, p. 343). Recently, a distinction has been made between PTSD resulting from a one-off traumatic event, and Complex PTSD (C-PTSD), which takes into account that there can be “more layers to the emotional suffering experienced by people who have been through long-lasting stressors like childhood sexual abuse, or years of domestic violence” (The Center for Treatment of Anxiety and Mood Disorders, 2017). For Richard Erskine, “it is not the traumatic event itself that creates such scars: it is the event unmitigated by healing through relationship” (2014, p. 6), suggesting another distinction between the types of after-effects that can be experienced, depending on the nature of a person’s traumatic experience and the support or healing they received. In fact, he suggests that as well as arising from abusive or distressing incidents, trauma can also arise from “the absence of relationship itself”, and that “neglect and isolation produce a kind of cumulative trauma” (Erskine, 2014, p. 6). In Transactional Analysis terms, trauma can disrupt the Adult ego state’s ability to “form a narrative self or coherent sense of identity” and can result in “excluded ego states and a disorganised self” (Jo Stuthridge, 2006, p. 270). This can lead to a person growing up to develop a traumatic script, which can include script decisions such as “Never forget”, “Never go this way again” and “Be prepared”, expressed through physiological symptoms of PTSD or C-PTSD such as flashbacks, panic attacks, nightmares, dissociation, hypervigilance, denial and substance abuse (Stuthridge, 2006, p. 275).
We can see just from this brief snapshot of what constitutes and causes trauma, what a complex and multifaceted issue it is, and how prevalent these types of experiences are in our society. Bessel van der Kolk points out that “one does not have to be a combat soldier, or visit a refugee camp in Syria or the Congo to encounter trauma. Trauma happens to us, our friends, our families, and our neighbours” (2014, p. 1). For the purposes of this research, however, I’m interested in more than the origins of trauma itself; I want to investigate how a person’s experience of past trauma may affect their therapeutic work with traumatised clients.
A recurrent theme that presented itself during the reading I did around the subject of trauma was the effect that trauma can have on one’s sense of self. According to Stuthridge, sense of self is “more like a process than a structure” (2006, p. 273). It begins in the A0 ego state and as a person develops, their Adult ego state “acts as a narrator” for their sense of self. Stuthridge suggests that trauma “impairs the Adult ego state’s capacity to form self-narrative, which results in dissociated ego states” (2006, p. 273). It’s possible that traumatic experiences reduce a person’s ability to form and store autobiographical memory, a theory which is backed up by neuroscience – the hippocampus is responsible for the “contextualisation of experience in time and place”, and studies show “reductions in the size of the left hippocampus in adult survivors of child sexual abuse” (Stuthridge, 2006, p. 274). Van der Kolk also supports this theory, stating that “trauma interferes with the proper functioning of brain areas that manage and interpret experience” (2014, p. 247). During trauma, the hippocampus can become so flooded with stress hormones that it fails to function, which means that “without the hippocampal time stamps of beginning, middle, and – especially – end, the brain and body will continue to perceive the trauma as ongoing or repeating” (Babette Rothschild, 2010, p. 63). The failure in the brain’s ability to integrate traumatic memories can mean that “the experience of trauma is fragmented into emotional and sensory elements that are split off from ordinary consciousness or dissociated (Stuthridge, 2006, p. 273). This splitting off or dissociation from parts of ourselves can severely affect our sense of self and identity. This is why symptoms of PTSD can include statements such as “I have permanently changed for the worse”, “I feel like an object, not a person” and “I feel like I don’t know myself anymore” (van der Kolk, 2014, p. 233).
So what does this mean for trauma survivors who go on to become trauma therapists? In reviewing literature around the subject, I found a lot written about the treatment of clients presenting with trauma, which wasn’t really what I was looking for, and quite a bit about the effect of the work on the therapist in terms of transference and vicarious trauma. Jo Stuthridge identifies three main transference patterns that often occur when working with trauma – “The Good Child” in relation to an idealised parent, “The Abused Child” in relation to the abuser, and “The Empty Child” in relation to the uninvolved parent” (2006, p. 277 – 278). Stuthridge gives an example from her own practice to illustrate the difficulty of navigating a transferential relationship where the client became the “abused child” and the therapist the “abuser”. She doesn’t, however, explore if and how this could be even more complex and challenging for a therapist who has themselves once been the abused child in reality.
For therapists working with trauma, in addition to navigating the minefield of transference and countertransference, there also exists the risk of experiencing vicarious trauma. This was first presented as a distinct category of therapists’ reactions to clients by McCann & Pearlman in 1990. Unlike countertransference, vicarious trauma is “a direct reaction to traumatic client material and is not a reaction to past personal life experiences” (Trippany, White Kress & Allen Wilcoxon, 2004, p. 32). Symptoms of vicarious trauma can include loss of identity, interpersonal difficulties, difficulty controlling emotions, heightened fear or paranoia, disruptions in the memory or belief system, and profound changes in the core aspects of the therapist’s self (Trippany et al, 2004, p. 31 – 33). But what if a trauma therapist, with trauma in their history, experiences vicarious trauma which is not only a direct reaction to client material, but also a reaction to their own traumatic past personal life experiences? As discussed earlier, trauma can have a profound effect on a person’s sense of self, and some of the symptoms of vicarious trauma are centred around changes in and loss of the therapist’s self or identity. What does this mean for a therapist who, due to their own traumatic past, may already have a less stable sense of self? Trippany et al also detail how, through vicarious trauma, a client’s memory fragments may intrude upon the therapist, even to the point of “the counsellor having nightmares of being raped [when working with a client who has been raped]” (2004, p. 34). A therapist who has experienced rape or sexual abuse may be much more deeply affected or distressed by this than one who hasn’t, but this isn’t explored in the article.
During my search for literature on this subject, I found a research study which explored countertransference in trauma therapy (Cavanagh, Wiese-Batista, Lachal, Baubet & Moro, Journal of Traumatic Stress Disorders & Treatment, 2015). They interviewed seven trauma therapists, some of whom had experienced trauma in their life and/or genealogy. The interviews followed a special protocol where the method of “emergent scenarios” was applied (where the therapists described their client’s traumatic event, then described the emotions that experience has evoked in them). The results of this study indicated that “therapists who have experienced trauma in their life course and/or genealogy showed stronger countertransference emotions and reactions” (Cavanagh et al, 2015, p. 1). This is interesting as it supports the idea that countertransference may indeed be a different experience for a therapist who has experienced trauma in their past. However, the study also found that “the most experienced participants have a higher level and the less experienced participants have a lower level [of countertransference emotions]” (Cavanagh et al, 2015, p. 6), suggesting that therapeutic experience also influences countertransference – or at least the willingness to report it. The therapists were also asked about their opinion on whether “they thought that the fact that a therapist experienced a traumatic event could change her/his behaviour and efficiency as therapist” (Cavanagh et al, 2015, p. 4). They generally felt that having trauma in their own history was beneficial and indeed motivating to their work as a therapist. This was an area I wanted to explore further in my own research, hence my choice of my own question 2 – “How, if at all, does your personal experience of trauma inform your professional approach to the work?”.
I think this study benefited from analysing the experiences of seven therapists of various ages, cultural backgrounds, level of traumatic history and stages of career. This provided a diverse insight into countertransference in trauma therapists. The qualitative nature of the study enabled an in-depth exploration of the therapists’ emotional reactions to their clients’ material. There was also a more quantitative aspect to it, whereby the therapists were asked to rate their emotional reactions on an intensity scale of 0 – 5. This was useful in allowing the researchers to compare the results of the seven different participants, but for my own research I didn’t feel this kind of method would be valuable as I interviewed only one therapist.
I felt quite early on in planning this research project that I probably wanted to use a qualitative, phenomenological methodology. The reason for this was that I really wanted to give my co-researcher a chance to express their personal thoughts and feelings about working with trauma and the emotional, psychological and physical effect on them. The best way to achieve this seemed to be via phenomenological enquiry. However, I didn’t want to exclude the possibility of finding another approach, so I researched some other methodologies in order to get a feel of the types of approaches available to me. Judith Bell characterises research done from a qualitative perspective as being “concerned to understand individuals’ perceptions of the world” (Bell, 2005, p. 7). She contrasts this to quantitative research, which sets out to “collect facts and study the relationship of one set of facts to another” (Bell, 2005, p. 7). This helped to confirm that qualitative research was the best choice for my project as I wasn’t concerned with statistical facts, but with understanding the subjective, existential experience of my co-researcher. For this reason, I chose to use an unstructured interview technique with three broad, open questions from which I could elicit further material if necessary. I considered the use of Narrative Enquiry, whereby the researcher encourages the participant/s to “speak in a story form” (Bell, 2005, p. 21). This appealed to me in that it seemed to offer the possibility of obtaining a deep, personal account of my co-researcher’s experience, so I decided to incorporate in my first planned question, where I invite the co-researcher to tell me the story of them becoming a trauma therapist. I then formulated my other two questions as more focused enquiries about how my co-researcher’s personal trauma informs their professional approach to the work, and the impact on them of client material. It was important to keep these questions focused in order to give me the best chance of obtaining material relevant to my topic.
Finding my co-researcher and arranging the interview
I didn’t have a specific person in mind when I chose my topic, which meant I needed to advertise for a co-researcher. Initially, I used my peer network to distribute my advert. I felt that as the subject of my research is quite personal, I’d have more success in finding a volunteer through a “friend of a friend” referral. One friend/contact (A) sent the advert round his colleagues at an organisation that provides trauma therapy, and another friend/contact (B) sent it round her colleagues at a charity she works for as a counsellor. Both friends also sent it to several other friends, supervisees and peers they know in the therapeutic field.
I made this initial request for a co-researcher in early January 2018. Within a week, I had my first volunteer through friend A – unfortunately, they must have changed their mind as I didn’t hear back from them after the initial offer. A while later, friend B came to me with another possible volunteer, although again this didn’t work out and they decided against participating.
Because of the time I’d invested waiting on these two leads, by this time it was late February and I was feeling quite desperate. I made the decision to post my advert on the Facebook group “Transactional Analysis Group”, which is run by Bob and Rory. I felt some resistance to doing this, mainly due to how exposed I felt by advertising the fact I still didn’t have a co-researcher in late February. Two days later, I got an email from someone who wanted to participate and sounded perfect for the role of co-researcher – until I read that they lived in Stratford upon Avon. I wrote back to thank them for their offer and advise that sadly I don’t have the time or means to travel that distance to conduct my interview.
Later the same day, I received an email from a woman called Marcia, who was a friend and colleague of friend A at the trauma organisation, and who had been interested in the project when my initial advert went out in January but had moved to a new job in the meantime and forgotten all about it. My friend, aware of my difficulties in finding someone, had reminded her and she told me she’d be happy to participate. She lives quite locally in Stretford, so we arranged to meet at MIP for the interview. I sent her details of my research topic, along with a copy of the interview questions and the participant consent form. The consent form explained the following ethical guidelines:
- Marcia’s right to withdraw from the interview at any time and to choose not to answer any questions that made her uncomfortable.
- The contents of the interview would be entirely confidential and not seen by anyone except me, Bob Cooke and Karen Burke.
- Marcia could choose to use a pseudonym if she wished and if so her real name would not be used anywhere.
- Marcia would have access to the transcript of the interview if she wished, and that she had the right to ask for the tape and transcript to be destroyed.
- Marcia had the right to ask for any particular material not to be included in the transcript or finished work.
Marcia and I met at 17:30 on a Thursday evening, in a room on the top floor at MIP. Before she arrived, I rearranged the chairs slightly, so that we could sit at right-angles to one another rather than facing each other at opposite sides of the room – I felt this would provide a more relaxed, informal setting, along with ensuring my voice recording software was able to pick up both our voices. I put a copy of the research questions and the consent form on the table, and when Marcia arrived I offered her a drink which she accepted. After the interview, I checked with Marcia if she wished to use a pseudonym which she didn’t, and I advised her not to hesitate to get in touch if she decided she didn’t wish for me to use any part of what she’d said. I advised her that the recording of the interview on my phone would be taken home immediately, and that I would transfer it to my personal laptop that night and delete the file from my phone. I did this as soon as I got home. I advised Marcia both the files and laptop were password protected.
Reflections on my process
I found the process of finding a co-researcher quite stressful. I think it was made difficult partly because my choice of topic is quite an intense subject to ask people to talk about, and I don’t have particularly easy access to a pool of trauma therapists who I could call on to participate. Also, the process was made difficult and stressful by my leaving it until January 2018 to advertise for a co-researcher. Had I advertised earlier, there would have been much less pressure. On reflection I can see that this was part of my process whereby I feel I need to leave things until the last minute and make them into “a struggle”. This is something I’m working and will continue to work on in therapy. Also, looking back I think it could have been beneficial to post the advert on Facebook earlier, and what stopped me was my fear of being seen and considered to be “not good enough”. This fear continued into some anxiety in the days leading up to the interview that I’d somehow get it “wrong”, or that the co-researcher would be unsatisfied with some aspect of my questions or methods.
Bias and assumptions
Before embarking on this research, I reflected on what bias I may hold on the subject. Personally, I’ve never considered myself to have any childhood trauma in my history, although I do have experience of abandonment and emotional neglect, along with experience of domestic violence as an adult. I think in one way, this could be a positive influence on my research in that it doesn’t allow me to project my own experience onto the project – I am not a trauma therapist with trauma in my history so I’m open to learning about the experience of being one. I do have experience of working with clients in the MIP low-cost clinic who have experienced childhood trauma and are dealing with PTSD, and I’ve sometimes wondered whether my lack of personal experience in this area makes me less good at trauma therapy or less able to relate to these clients. So, in a way, my lack of trauma experience may provoke just as much of an assumption about what it’s like to have that experience when working with trauma clients, as if I did have trauma experience. I acknowledge that I may well hold the biased assumption that a person having trauma in their history equips them to be a better, more attuned trauma therapist.
When embarking on this project I was aware I needed to ensure I bracketed any biases I held. In order to do this, it was important for me to reflect on how I’d come to hold the view that a history of trauma may positively influence a person’s ability to provide trauma therapy. I realised this was partly due to my own script around not being “good enough” – this was allowing me to find reasons why other, different therapists may be a better choice for a client seeking trauma therapy. I also realised that I may have been putting too much pressure on myself as a trainee therapist to “know it all” without acknowledging that just because a person has experience of a certain issue in their history, it doesn’t mean they automatically have all the skills needed to provide effective therapy.
Transcribing and analysing
In order to transcribe my interview with Marcia, I listened to the tape on my laptop through headphones and typed it up. At first, I also had another blank document open on which I’d write notes about anything I noticed that was particularly interesting, but I found this hugely slowed down the process of transcribing. Also, because I found the process of transcribing to be quite a fast-paced mechanical process of listening to a few seconds of speech, pausing, typing it up, listening again etc, it was very difficult while doing this to absorb the flow of what Marcia was saying or recognise any kind of themes behind it. So after about the first hour of transcribing I stopped making notes as I went along; instead I did all the transcribing first and printed it out. To analyse the material, I used interpretative phenomenological analysis, which allowed me to focus on understanding Marcia’s world and experience from her point of view. I used thematic analysis to identify the main themes of Marcia’s interview and to separate out her story into different areas of interest to be analysed. First, I spent around two hours reading through the transcript, and while doing this I identified and made brief notes on a flipchart sheet about some main themes. I then sat with the transcript and went through it with five differently coloured highlighters, picking out quotes that fit in with the five main themes I’d identified, and built up a detailed mind map on the flipchart.
The themes that I saw in Marcia’s work turned out to be somewhat different to what I may have been expecting. I was hoping to learn a lot about her experience as a trauma therapist, which I did, but I also learnt a great deal of fascinating information about Marcia’s life leading up to her becoming a trauma therapist. My first question was about her journey to becoming a trauma therapist, because as my research is specifically focused on someone with trauma in their history, I felt it was important to give her a chance to reflect on her past experiences and how, if at all, they’d contributed to her training as a therapist. I made it clear to Marcia that there was no requirement for her to talk about her own trauma and that I wouldn’t ask directly about that, so it was completely up to her whether or not she volunteered any information about it.
One of the main themes that came up while talking to Marcia was the subject of her race – Marcia and her family are black Caribbean. I didn’t know this about Marcia before I met her for the interview, so it wasn’t a factor I’d considered when planning my research, although I was of course aware of the trauma that can be and is caused to people by racism. When I asked Marcia to tell me about her journey to becoming a trauma therapist, she said “I think one of the main things is about my race” (line M6). Marcia, growing up as part of a black family in an area where she reports there weren’t many black families, found it very difficult to be herself unless she was inside her home: “I as a young black kid with siblings and my mum and dad are both black, it was a little bit like…my parents were very Caribbean inside our household, and we had to…it was almost like we had to have two personalities” (M24). She explains this further, saying “it was almost like we had the personality in the household, because we could be free, and we could do whatever, and we were understood…but then when we were out in the community, it was almost as if we weren’t understood for who we were, we were too loud, we were, erm, too cheeky, too, erm, confident” (M25).
For Marcia, this resulted in a “suppression of self” (M34), because she was forced to spend a lot of her early life being unable to express herself: “I wasn’t, you know, the same at school as I was at home…if I just wanted to be like expressive…you know, it was, it was squashed” (M37). She describes the reactions she received from other people in the community who were not black: “it’d be seen as, you know, gosh! you’re too lively, or gosh! you’re too loud, or what’s wrong? or stop! or…you know, there were lots of negative connotations” (M42). She felt this as a trauma: “when you have to suppress certain parts of you…there are things that come out in our personalities…we can become slightly traumatised like a repetition” (M36).
In Transactional Analysis terms, something that really stood out for me listening to Marcia’s story was how limited she was while growing up in her ability to live and express herself as a Free Child unless she was at home: “I can be a bit free-er when I’m in my household” (M33) and how much she was forced to take an Adapted Child approach in order to be accepted in school and in the community: “I became a little bit quieter…I learnt not to be expressive” (M36). Not only that, but Marcia was aware from an early age that, because of her race, she was required to put in extra effort to achieve the same as her white counterparts, saying: “my dad has always said that it’s gonna be hard” (M50) and “you have to try harder than everyboy else, that’s in your – in the same position as you…you need to try harder because your level of, of attainment won’t be seen as the same as everybody else’s” (M51-53). This points to Marcia having grown up with a strong Try Hard driver, along with possibly the powerful injunctions of Don’t Belong, Don’t Exist and even just Don’t, from being told repeatedly that the way she was naturally as a child wasn’t ok. This is of course purely speculation on my part, as although Marcia’s story was rich and full of detail, we only spent an hour together so I’m aware I would need to spend a lot longer with her in order to build up a comprehensive understanding of her early experiences and script.
As well as Marcia’s own difficulties and trauma around racism, she was also aware of the effect on other black people growing up in Britain: “I think communities have sort of got used to seeing our faces but not used to knowing how we behave, and not sort of understanding how we see ourselves, and our mannerisms, so I feel that…there are expectations, or there were more – there probably still are now – but there were more so, as I was growing up, to conform, and to be very English, because…it was like well, but you live here, you know, you’re part of our community, why don’t you, why are you not doing exactly the same things as us” (M28-29). Something that came to mind for me while listening to this was the sense that Marcia grew up with a very strong Cultural Parent, which was highly critical of her and in conflict with the messages she received from her own parents, who allowed her to be free and expressive. Marcia witnessed this and saw the unfairness of the situation and the effect on both herself and others around her: “It’s totally unjust…part of that contributed to me seeing other people in my community in pain” (M56). Reflecting on it as an adult, Marcia can see the devastating consequences of this type of trauma: “there’s a lot of people in pain and there’s nowhere to go with this pain…it can be daily, you know…through things like racism which, you know, exist, they exist in my world anyway” (M57). She makes the link between early trauma and the effect on mental health: “through these sort of systematic types of abusive situations that people are placed into…they suppress who they are, and it comes out, it’s gotta come out somewhere…so, you know, it comes out in people’s mental health a lot” (M58-59).
A theme that I saw quite frequently throughout Marcia’s story was the various different worlds she has experienced, worked in and adapted to. As we’ve seen, as Marcia was growing up she was forced to exist in two highly contrasting worlds and develop two corresponding personalities. She went on to explain how, after a career of many years in the media, she decided to leave her job and train as a counsellor: “it started to make me think, ok, I need to kind of do something here because I see this, I feel it…and…I’d like to be able to contribute in some way” (M61) and she felt this was a move she needed to make after experiencing first-hand the difficulties faced by the black community where she grew up: “I know I have the wherewithal to do this, and to re-train, and put something in, or answer a few questions that you may not feel that you can get answered any other way…I kind of felt I owed it a little bit, to…to give back, I really did” (M62-63). Alongside her initial training as a counsellor, Marcia took a job working with a charity providing care for people with autism. She provided in-home support for two women with autism and experienced a world quite different from what she was used to: “I was the team leader in that household, so I got to have the absolute privilege of working with, erm, people with autism…people with complex learning disabilities, I got let into their world really, because it is a very different world” (M135-136). She goes on to detail some aspects of that world which she was able to learn about: “I got to understand how they focused, how they got flooded with information…erm…how some of the ladies especially that I worked with communicated with each other, how they felt their pain, how they understood the world, how they communicated within it, and I just got to watch and, and be part of, and try to get a really deep understanding of difference, you know? And it was amazing as well” (M140-142). As well as observing and coming to understand what the world was like for the people she worked with, Marcia also needed to adapt to this world: “I just thought ok, you’ve gotta be different here, you know, it was not my home, it was somebody else’s home, and I’m thinking I’m coming into your home so I need to behave accordingly in your house, you know, so I had to learn to be, you know, a guest in your house and to fit into your house” (M151-152). I was struck, both during the interview and while listening back to it, by the parallel between the different, largely unseen, world these women occupied within their home and Marcia’s own experience as a child of having a life within her home that most people didn’t witness. I checked this out with her at the time, asking if she also felt there was a parallel there, to which Marcia confirmed “yeah, yeah, I think I’ve had a few parallels in my life” (M143).
Marcia talks about other new worlds she’s been involved in, too. Her second placement when training as a counsellor was at an organisation providing support for victims of sexual assault. She remembers being scared of starting work there: “I was scared shitless when I went into…that organisation, it was like, ok, what the hell’s going on in here” (M158-159) and recalls how she was able to deal with learning to deal with it: “I think like any, sort of, rookie therapist you have to cut your teeth don’t you? And you just have to get in there…that first client…” (M159) and “I think I listened a lot…I was like, you know, really listen, take your cues from other people…and that’s a skill isn’t it, to learn” (M164-165). As part of Marcia’s job as a trauma therapist now, she works one day per week in a prison, providing therapeutic services for male prisoners. Again, prison is a world which remains closed off to the majority of society. She talks about the difference in working with prisoners compared to working with other therapy clients: “it’s different working with prisoners” (M246) and “there’s certain things you can’t open up because they wouldn’t, they wouldn’t survive” (M247). From my point of view, what really stands out is Marcia’s ability to survive and adapt in different worlds. As she says, “I’m open to seeing the world cos I think that’s a big part of…how I sort of conduct myself with my work, you know, I’m open, to whatever comes my way, and it is a vast array of stuff” (M145).
Experience of working with trauma
This is a theme I deliberately asked Marcia a lot about, as it was the main focus of my research. I found her responses could be grouped loosely into three main categories: gender, how Marcia’s own experience of trauma informs her work, and the impact of client material on Marcia.
In recent years, Marcia has worked in settings that provide trauma therapy for both women and men. The organisation providing support for victims of sexual assault at which Marcia did her placement was available only for women, and the organisation at which Marcia currently works as a trauma therapist is solely for male survivors of sexual violence. Her experience is that the work varies greatly between men and women, explaining: “there’s a vast difference as well, it’s so interesting, between men in trauma therapy and women in trauma therapy” (M204) and “because I worked with pure women, and now I work with pure men in trauma, it’s like…black and white” (M207). When working with women, Marcia found they held more emotionally, and spent a lot of energy taking care of others, including Marcia as the therapist. She explains: “the women, first of all, when they come into therapy, as women do, they will hold everything, and they will almost be like, apologetic for giving this stuff to you, for putting it out on the table, and they’ll almost be like…I want to make sure you’re ok, you know?” (M208) and “women are more like that, they’re more holding, they’re more…able to see the other person in front of them, and to look after the other person in front of them” (M210). She reflects on the fact she found women would do this even though they had undergone a trauma and were in a vulnerable place: “they’re finding it hard to look after themselves but they’re still going to go that extra mile to look after you” (M211).
Marcia’s experience of working with men has been quite different. She finds that men have often taken a lot longer to come to therapy: “a lot of the guys, it’s taken them so long to be able to report this…we’re talking like 30 years, 40 years sometimes to be able to, you know acknowledge, and to be able to open up about this” (M212-214) and that they’re not as able to hold their trauma as the women she’s worked with: “the stability is off the scale, they’re not stable, and a lot of the time I don’t know whether I’m going to see my clients the next week because I don’t know if they can hold everything they’ve got” (M220). Unlike the women, Marcia reports that men who’ve experienced trauma often don’t have a way of expressing the way they feel: “male clients come to see me that don’t have a pattern to, erm, to express their emotional self” (M233). She finds that the men she works with tend to have a lot of unhealthy coping mechanisms such as drugs, alcohol, and violence towards others: “the alcohol comes in, the drugs come in, the violence comes in, you know…violent to other men, they’ll get it out there, it’ll come in aggression” (M217-219). As well as violence to others, Marcia is aware of the risk of suicide particularly among the men she works with and she explains how she approaches that: “I do a lot of work around suicide, I do a lot of work around, you know, safety plans, grounding, stabilisation work…really opening up a dialogue about suicide, you know, talking a lot more about suicide” (M221).
As Marcia explained the differences she’d found in the way male and female trauma clients presented, I was curious to know what the differences were, if any, in Marcia’s experience of working with each set of clients. I asked what it had been like for her, as a woman, to have those two polar opposite experiences. Her response was that “it’s been more intrigue than anything” (M227), and she goes on to explain that “I can’t say to be honest I feel more comfortable working with men or more comfortable working with women…I feel comfortable working with both” (M230-231).
How Marcia’s own experience of trauma informs her work
As soon as I asked Marcia if she could tell me about this topic, she told me she was wary of the question. She explains: “it almost feels like I’m saying well, you know, this next person who does trauma, they don’t have the same experiences so they won’t have the awareness, but it’s not, it’s not what I’m saying – I just had to preface it with that” (M180-181). She goes on to use the example of a drug counsellor who has themselves taken drugs to explain how she feels a therapist’s past experience can help the client: “I think there’s something in there, in that pairing, that gives the client…a little bit of a different route in, in sessions, because they’re sat in front of somebody who’s been there, you know, who’s suffered” (M183) and how it can also benefit the therapist to be able to identify with what the client has been through: “I think it gives you a little bit more, erm I don’t know, maybe a bit more depth, a bit more understanding…it’s really hard to put your finger on, I think, this, but I feel when I’m in sessions with people, there’s a lot of stuff that comes up that I identify with” (M184). Marcia goes on to tell me about her own personal past experience of drug use and how this has provided her with an understanding of the drug culture which is a part of many of her clients’ lives. She also explains how there is historical sexual abuse in her family but that, to her knowledge, she herself wasn’t abused – and refers back to an earlier part of our conversation about her childhood to explain why she thinks that is: “you know that free kid I was telling you about? That free kid would have told…in my household I was that free kid, you know, so I didn’t, I was not one to be trusted, I don’t think I’d have kept these secrets” (M196-198). However, the experience of sexual abuse having happened in her family means Marcia feels she can relate to clients who come to therapy with issues around sexual abuse: “when people are talking about things I can- I, I get it, I hear it, I understand some of it” (M193).
Impact of client material
In order to discuss the impact that client material has on her, Marcia explains that the way she works has changed since she started work as a therapist. When she first started working with trauma clients, she would hear a lot of material: “I wasn’t versed enough in, in doing this sort of work, I would hear material…and maybe I would hear it at a time in the process of therapy that it didn’t need to be heard” (M255-256). She identifies that clients often needed to “purge” and that “a few years back, I used to sort of put more emphasis on that purge than I do now” (M261), contrasting that with the way she works now which means she doesn’t absorb as much of this purge: “I listen to it, but I don’t take too much of it in, because I’m aware that it’s a purge” (M259). Marcia feels she now has a better understanding of if and when it’s necessary for a client to go into detail about their trauma: “it’s not always about you giving me material, you know…sometimes, it’s really important, sometimes it’s not, because that’s not where the pain is, or that’s not where the block is” (M263). She feels this has come with experience: “I’m at a level now where I hopefully can recognise when it needs to happen and when it doesn’t need to happen, so it’s not that I’m protecting myself…but it’s that I’m working maybe in a bit smarter way, and it’s not always necessary, so I’m not always hearing material” (M266-267). Marcia explains how she’s also now able to better contain the client’s purging of their traumatic material if they do need to do it: “now I can say, you know, listen I know you really want to get this out, but I’m just going to give you some alternatives…and I can say if you need to, absolutely fine but can we put it on the clock, so that we’re not saying it, you know, for an hour” (M273).
Marcia feels that because of this progression in her experience and way of working, the client material impacts on her less than it used to. She makes imitation distressed sounds to illustrate how she used to feel when “I couldn’t breathe, cos they’ve just thrown all this stuff at me” (M280). She also feels it has improved the experience of therapy for her clients: “it impacts on the client differently…they’re not talking for an hour about, you know, hideous details of stuff until we say, I’m so sorry we’ve ran out of time” (M279). She reports the way she works now is “more controlled” (M277) and “safer” (M278).
Marcia did also reflect on the ways in which she used to cope when she first started working at the organisation providing support for victims of sexual assault and found the client material harder to deal with: “I used to go into the office, and there was always our lead or another therapist, and I’d talk it through…and this is how I started to, you know, put it into some sort of shape where it wasn’t, you know, like some sort of hot potato that we had to hold in session, then we both had to hold for another week” (M290-291). She no longer feels the same level of impact from client material, but still appreciates being able to discuss cases with colleagues: “thank goodness I’ve got…my colleagues around me, who can handle all that sort of stuff” (M300) and can also disconnect from it when necessary: “sometimes if I think about it too much, then it has more of an impact, but I can leave it at work…I have that ability, always have” (M303-305). She also feels that, over time, she’s become somewhat desensitised to the material: “I probably think I’m quite desensitised” (M294) and that this is likely true of a lot of trauma therapists: “I think we’re all slightly desensitised, I think you can’t not be, because we literally deal with…if I really think about some of the material, it’s hideous” (M300).
My experience of interviewing Marcia
Just before we began the interview, Marcia warned me that she could be quite sparse in the way she spoke, so I may need to ask her to elaborate if any of her responses were too brief. I felt slightly worried by this, concerned that I would find it difficult to elicit enough material. However, this wasn’t the case at all – if anything, Marcia’s responses were so thorough and detailed that it was a challenge to cover all my planned questions in the hour we had together.
Reflecting on my possible transference with Marcia, I know I felt very aware that she was an experienced trauma therapist along with being several years older than me. I think both these things, along with my anxiety about “getting it right” and some social anxiety around meeting a new person, contributed to my having a noticeable feeling of being “not good enough”. I went to a “I’m not ok, you’re ok” position which in turn triggered my drive to please Marcia. I think this may have meant that I was more inclined to let Marcia lead, rather than managing the time more closely to ensure we were able to cover each of my planned questions equally. The disadvantage of this was that there were follow-on questions I would have liked to ask in relation to the later part of the interview, specifically around countertransference, vicarious trauma and coping strategies, but didn’t as we were running out of time by that point. However overall, I don’t see the effect of my transferential behaviour as negative as it also contributed to our spending almost half the interview on the first question, which was about Marcia’s journey to becoming a trauma therapist. Her responses to this question provided, in my opinion, the richest material of the entire interview. Also, as the interview progressed, I found Marcia so warm, interesting and frankly inspiring that much of my initial anxiety melted away and I thoroughly enjoyed listening to her – in fact, I vividly recall leaving the interview feeling decidedly exhilarated, inspired, and grateful to have had the chance to meet her.
In analysing Marcia’s interview, we can see that she feels her own past experiences of trauma improve her efficacy as a trauma therapist. She finds it difficult to put her finger on how this works, but she reports feeling that her own personal experience of trauma enables her to better relate to the clients, on both an emotional level in terms of “getting it” and on a more practical level when she explains how her history around taking drugs allows her an understanding of the drug culture in which a lot of her clients find themselves. This mirrors the study by Cavanagh et al which found most of the participants felt a personal experience of trauma was beneficial to their work. Marcia reported that, as well the benefit to herself in having an understanding of her clients’ trauma, she also feels the clients themselves benefit from having a therapist who has been through similarly traumatic experiences to those they’ve been through. This is in line with Maslov’s relational need for mutuality – to have a person who understands what it’s like to walk in your shoes without having to explain it. It’s not clear whether this is something clients have reported directly, and of course we can’t compare this to the experience Marcia would have had with clients without having trauma in her history, but the clear message we get from Marcia is that her experience of trauma is a strong benefit in her work as a trauma therapist. Not only that, but her experience of trauma, particularly around racism, in her early life has also provided her with a great amount of motivation and passion for working with traumatised people – both in the service of helping others deal with the pain of trauma and of giving back to her community.
In terms of the impact on her of client material, Marcia feels this is inversely proportional to her level of experience, i.e. the longer she’s worked as a trauma therapist, the less impact she feels from client material. She attributes this to having developed a better understanding of if and when details of clients’ trauma need to be heard, and to an increased level of desensitisation. Interestingly, Cavanagh et al found in their study that the more experienced therapists exhibited a greater level of countertransference than the ones at the beginning of their career did. Countertransference and impact of client material are two very different things and when interviewing Marcia, I didn’t explore specifically her countertransference, so I don’t have any findings on this issue. For Marcia, her levels of countertransference may or may not follow the same pattern as her levels of impact from client material. Another factor present with Marcia is that she qualified as a counsellor 3.5 years ago and as a CBT therapist 6 months ago, so in certain contexts she would be considered still fairly close to the beginning of her career, meaning that her ability to report on change in experience over a long period is limited.
In Marcia’s account of her experience as a trauma therapist, she appears to have experienced some level of vicarious trauma early in her work, when she would focus more than she does now on details of clients’ trauma, and sometimes be overwhelmed by entire sessions of what she refers to as the clients “purging”, after which she sometimes “couldn’t breathe”. This seems to have largely been limited to Marcia’s experience in-session, as she reports always having had the ability to leave any impact she felt at work. She mentioned vicarious trauma directly only once during the interview, when she explained how she avoids mentioning any details of her case work to colleagues who don’t work in the field of trauma, in order to avoid “passing on vicarious trauma”. This suggests that Marcia believes trauma can be passed on vicariously, even third hand, and that perhaps it’s something she’s experienced. I didn’t find any evidence of Marcia having felt any of the more serious characteristics of vicarious trauma, such as intrusion of clients’ memory fragments or disruption of the therapist’s identity. If I’d had more time with Marcia, I would have liked to ask her in more detail about vicarious trauma and how she feels about it as an aspect of trauma work for herself and her colleagues, as I believe it can be a significant part of the process for trauma therapists.
The main coping strategy Marcia described for when she needed support with the impact of working with trauma was talking it through with colleagues, superiors, or in supervision. This is something she reports relying on more heavily in the earlier stages of her career, particularly in her placement when working with victims of sexual assault. She talked in particular to her colleagues in the office, as supervision wasn’t always immediate enough – which I think highlights a problem faced by many therapists when dealing with the issues of working day-to-day with disturbed clients yet having supervision scheduled once per month. I know this is something I’ve struggled with personally as a trainee therapist and heard as a difficulty reported by others in the field, and similarly to Marcia I’ve turned to colleagues for support when supervision wasn’t immediately available.
There was a limitation in the amount of information provided by Marcia about her coping strategies as she seems to feel a lot less impact from client material now, so her need for coping strategies is greatly reduced. She did however mention case discussions that take place at her workplace now, so between that and supervision perhaps her needs are fulfilled.
Marcia’s own trauma isn’t something I enquired about directly or expected to hear a lot about. I was aware that she and I were meeting for the first time at the interview, and out of respect for her need for safety I had already advised her I wouldn’t be asking her to go into any details of her historical trauma. However, she did choose to share with me some powerful material about her experience of growing up as part of a black Caribbean family in a largely white society, and the trauma caused by being forced to suppress her true self and adapt in order to be viewed as acceptable when out of the family home. She felt this as a cumulative, repetitive trauma – one that felt painful and unjust, and that as a child she couldn’t understand. As previously discussed, much of the literature around trauma describes the serious effect it can have on a person’s sense of self, and for Marcia the trauma of growing up being told repeatedly that there was something fundamentally wrong with the way she was can’t have failed but to impact on her sense of self and identity. I don’t know enough about the work Marcia has done in her own therapy and I wouldn’t disrespect her agency by attempting a diagnosis after one meeting, but I would suggest from what I learnt from Marcia that her long-lasting traumatic experiences fit the criteria that may lead to Complex PTSD.
Marcia’s story is one I found very moving and I felt honoured for her to have shared it with me. Having grown up as a white British person, I’m full aware of the privilege this affords me in not having had to deal with racism or any of the challenges of growing up in a society which doesn’t respect your family’s culture or heritage. Listening to Marcia has reinforced for me the importance of making space to listen to and understand the lived experiences of people of colour. It also highlights the severe lack of mental health support – both for society in general, and in particular for people from black and ethnic minority communities.
I set out to explore the impact on one therapist of working with trauma, when they have historical experience of trauma. This being the first time I’ve undertaken a research project, I’ve learnt an awful lot throughout the process. On reflection, I can see there may have been certain questions underlying the choice of topic for me, such as “does having trauma in a person’s history make them a better trauma therapist?” and “does trauma work have a greater impact on therapists who have trauma in their history?”. Upon beginning my analysis of Marcia’s interview, I felt a certain disappointment that I appeared to have “failed” to answer these questions in my research. However, these are questions which, although pertinent, are not realistically going to be answered in a qualitative study of one person’s experience. It surprised me the extent to which my findings diverged from the original topic, to the point where I considered actually changing the topic to focus entirely on Marcia’s experience around race and identity while she was growing up. However, having spent many months planning, reading and reflecting on the subject of trauma and trauma therapy, I felt it would be counterproductive and inappropriate to retrofit a new focus onto an existing project.
Considering the strengths and weaknesses of my research, I can see that my choice of questions was perhaps not directed clearly enough at the specific question of how Marcia experiences working with trauma clients. If I were to do further research in this area, I would like to enquire about the transference and countertransference between therapist and client, along with asking explicitly about vicarious trauma. I think there’s scope within my topic to carry out a wider study on the impact of therapists’ histories on their work. In terms of the research method used, I’m aware that the reliability of results obtained from an interview of just one person could be less reliable than research carried out with multiple participants, such as the previously mentioned study by Cavanagh et al. Also, I have to consider that the use of an unstructured one-on-one interview could cause transferences between researcher and co-researcher which could affect the process, and that Marcia having never met me before the interview could have affected her willingness to divulge information about her personal or professional life that may have made her feel vulnerable. Both these factors have the potential to affect the reliability of results obtained. On the other hand, the use of qualitative phenomenological research had exactly the outcome I hoped for in enabling me to gain a wealth of understanding about the subjective, existential experience of my co-researcher. Also, I believe choosing to interview someone who’s been through counselling and therapy training and works as a therapist meant she was very used to talking about and reflecting on herself and her psychological processes, so her responses were highly articulate and emotionally intelligent.
Overall, I learnt a great deal about one woman’s life, perspective and passion for her work. Would this passion and commitment be the same if it weren’t for her childhood trauma? I don’t know but, based on the hour I spent with her, her clients and colleagues are very lucky people.
Bell, J., (2005). Doing Your Research Project. Maidenhead: Open University Press.
Erskine, R.G., Moursund, J.P. and Trautmann, R.L. (1999). Beyond Empathy: A Therapy of Contact-in-Relationship. London: Taylor & Francis.
Rothschild, B. (2010). 8 Keys to Safe Trauma Recovery. New York: W. W. Norton & Company, Inc.
Van der Kolk, B. (2014). The Body Keeps The Score. New York: Viking Penguin.
Cavanagh, A., Wiese-Batista, E., Lachal, C., Baubet, T. and Moro, M. R. (2015). Countertransference in Trauma Therapy. Journal of Traumatic Stress Disorders & Treatment. 4:4.
English, F. (2008). What Motivates Resilience after Trauma?. Transactional Analysis Journal. 38:4, p343-351.
Stuthridge, J. (2006). Inside Out: A Transactional Analysis Model of Trauma. Transactional Analysis Journal. 36:4, p270-283.
Trippany, R. L., White Kress, V. E., Allen Wilcoxon, S. (2004). Preventing Vicarious Trauma: What Counselors Should Know When Working With Trauma Survivors. Journal of Counseling & Development. 82, p31-37.
The Center for Treatment of Anxiety and Mood Disorders. (2017). Complex PTSD. Available: http://centerforanxietydisorders.com/complex-ptsd/. Last accessed 2nd March 2018.
Appendix I: Research Project Proposal
Appendix II: Participant Consent Form
Appendix III: Research Project Advert
Appendix IV: Interview Questions
Appendix V: Emails between myself and my Co-researcher
Appendix VI: Transcript of Interview