Thank you so much for once again joining me for this episode from the Lessons from the Playroom podcast. And wow, do I feel like the topic that we’re going to get into is so unbelievably important, like critically important. And my hope is that this conversation will impact you, will get you thinking, will get you reflecting, and that you’ll also share this episode with as many other play therapists that you know and anyone else that is in some type of a helping profession.
So let me share a little bit about where the inspiration for this topic is coming from. One is just my own observation of what is happening in our field since COVID especially, meaning that we have a lot of clinicians that are in some level of burnout, some level of struggle. And this was reflected back to me yesterday in a conversation with one of my Synergetic Play Therapy supervisors who was just sharing her heart on the sadness as she’s just watching therapists and play therapists, just like doing this mass exit in our field.
And it really just got me thinking about a topic that feels really important to me, which is that what happens when the therapist is also in crisis? And what does that mean? What does that look like? What do we need to be thinking about so that when we are the ones in Cris that we have a better idea about what to do? Or are there things that we can do to help ourselves so that we aren’t living in a place of crisis when we are trying to be of help to others? So that’s what this whole conversation is dedicated to. It is dedicated to us because I have yet to meet a play therapist who wasn’t asked to be a helper while they were simultaneously struggling. So this one is for us, everyone.
So I want to address a couple of questions in this. The first is what happens to us right when we are the ones that are experiencing the secondary trauma? And what is the impact on us of listening to the stories, to being a part of the play, to even in some cases, actually being a part of a moment when there is the actual trauma happening. So for example, maybe there is a play therapist that is literally on the front line and they are helping out a family or they’re helping out a child and something happens and they are there, right? And they are part of whatever has just happened.
I also want to address when we are impacted, how does then that impact the people that we’re trying to help? Right? How does that impact the kids and the families that we’re trying to work with when we’re overwhelmed, when we’re impacted by trauma? Here’s a big one for all of us. What happens when our own unresolved trauma comes into the playroom? Because it does. And I guarantee it happens a lot more frequently than we give ourselves.
I’m going to use the word permission to even become aware of because we’ve been so trained that it’s such a no no, but yet it is so inevitable that it is going to come into the room. So what are the implications there? And then how do we help ourselves? How do we help ourselves with the impact of the trauma that we hold? Because we are in this role of helping others process their trauma. What can be done about that? So I want to address those questions as we go through this.
So the first thing I just want to honor in all of us is that we’ve chosen a profession that puts us on the front line. We’ve chosen a profession that actually directly puts ourselves in trauma exposure. I don’t know if you’ve ever stopped to really reflect on that, but I’m going to encourage you to stop and reflect on that.
I’m going to say it again. We have chosen a profession that requires us to be right there in the midst of trauma exposure, day in, day out, session after session after session after session after session. That is a lot of trauma exposure.
We are asked to listen, we are asked to witness, we’re asked to play through the trauma in many ways. We are asked to experience the trauma alongside our clients. Now, for a long time in our field there really was this kind of idea that somehow the therapist needs to stay objective, that it’s important for them not to be impacted.
And I’m here to tell you that that is absolutely impossible. I’m going to explain why here in a minute. But it is impossible to be an objective observer when you are facilitating someone else because you are designed to feel what is going on inside of them.
Let me give you a couple of stats that I think are really important because I know I’m talking about being a witness to someone else’s trauma exposure. But I also said that one of the things we’re going to get into is, well, what if it’s our trauma that’s being activated? And what happens when our own unresolved trauma comes into the room? So my research is pointing me to that. We all have something in our background.
If you just look at the Aces study alone and I know we’re all familiar with Aces if by chance you’re not Aces, refer to adverse childhood experiences. There’s lots of different studies and it’s upwards of 70% of individuals have at least one ace in their history. And we know that since COVID we can just put that number right on up there to close to 100% because we’re all impacted.
Which means that we all have experiences, our own history that have landed as traumatic for us. So let’s jump into this. I just made a statement that was a pretty important statement, which is that we cannot avoid being impacted and that has a lot to do with our mirror neuron system.
So how this plays out is this that when we are in the midst of listening, when we’re in the midst of playing through trauma with a child, et cetera, et cetera, we are tracking our clients nonverbal cues. And as we’re tracking their nonverbal cues, their nonverbal cues are giving us insight into what’s happening inside of them. So for example, let’s say that the child is playing out something, that their experience with it is that of anxiety.
Actually, let’s even go further. Let’s go with fear. So the memory that they’re working on, which is not always conscious, has fear attached to it and as they are playing it out, their body is simultaneously going to embody the fear that is related and connected in with that memory.
So what does that mean? That means that as they’re playing out whatever they’re playing out, let’s say that it’s fear that’s translating into sympathetic arousal. Our clients all of a sudden their pace might pick up, we might notice more activity in their arms and in their legs. We may notice that their face begins to show signs of being afraid and all of those nonverbal cues we’re registering.
And what’s so cool about the mirror neuron system is that the mirror neuron system actually helps us notice and track this so that we have an understanding of what the other person is feeling. So you might even think of it like this. Our mirror neuron system, one of its functions is to help us feel what other people feel.
So as we are watching and listening and participating in the plays and the stories with our clients and as they are getting activated and our mirror neuron system is picking it up, we are then simultaneously going to have somatic shifts in our own physiology that give us clues about what they might be experiencing, putting us directly in the experience with our client. What that means, very bluntly is that we will experience the trauma together, we will experience the fear together, we will experience the anxiety together, the sadness, the overwhelm, whatever it is that’s going on because we are designed to so trauma exposure and the impact of it is unavoidable play therapists. I just want to pause there and I want you to let that land.
If we are putting ourselves in a situation where we’re being exposed to trauma, we are going to feel the trauma period. Now there are effects of this. So as we have our own somatic activation, as we have our own associations with that activation, if we’re not able to integrate it, if we’re not able to regulate through it, then we might start to show signs of what’s been referred to as compassion fatigue or vicarious trauma or secondary traumatization.
And this can look like dysregulation in the nervous system. This can look like higher levels of agitation, anxiety, depression, it can go into emotional numbing, it can bring up hyper, vigilance, it can even translate into intrusive images, nightmares. It can continue to impact the physical body where there’s higher levels of illness.
We also know from research that there is a correlation between addiction and secondary traumatization. So all of these things that I am talking about here, these symptoms are symptoms of trauma exposure and we are susceptible because we are in the midst of trauma exposure every single day on the job. And as I mentioned, we are most of us helping the child integrate after the fact.
But there are some individuals where they’re actually in it with them. So I’m going to give a little example here outside the play therapy context. So let’s just take a frontline worker that was at a hospital during COVID right? So they are right there in the midst of the trauma itself with the very person that they are trying to help.
So talk about an added complexity into the mix and that their own physiology is to some degree staying activated in a trauma response. So no wonder there’s so much exhaustion. No wonder that there are so many clinicians and helpers that are at the point of burnout where they’re feeling like they need to leave their job or leave the field because their nervous system has said I can’t handle this much trauma exposure, right, enough is enough is enough.
So I’m just going to pause here and allow just a breath. As we’re listening, I’m going to share another impact which is that over time and by the way, we can have symptoms of secondary traumatization after just like a single incident exposure or it can be something that happens over a period of time. But one of the other things that can happen is our perception starts to change.
We can become a bit more cynical, we can start to feel a little bit more helpless and hopeless ourselves. We can actually start to not feel safe in the world. We can start to feel like the world is a really not so great place and that can actually then impact our own worldview and can impact our hope for even the individuals that we are trying to support.
So let’s keep going into this. So here I am, I’m a play therapist. I’m having sessions.
I’m putting myself right there in the moment of trauma exposure. My body is feeling it alongside my client. And if I am not able to integrate in the moment or work with it in the moment, I now become susceptible to the symptoms of compassion, fatigue, vicarious trauma and secondary traumatization.
The other thing that can happen in these moments is that my own protective patterns come into play, which can then impact my client. So where we can really see this is when our own unresolved history comes into the room. So let’s say that a client is playing through physical abuse.
And let’s say as the play therapist, I have unresolved trauma around physical abuse in my own history. Well, as I am playing through this with my client and my body’s getting activated, there is a high probability that there will be a we’ll call it a trigger or an activator of my own trauma history. And if I am not able to work with that in the moment, and I am going to talk about what that means, then there’s a high probability that my own protective pattern, what I did when I was a child, when I was being abused, is going to come into play.
So that might be going into a dorsal withdrawal, shutting down, pulling back, or it may be revving up into needing to protect, stop, set boundaries in some way. Or it could be a counter to, let’s say as a child I was very helpless in these situations. But now that this is coming into the playroom, there’s this part of me that’s like, no, this is not okay.
And then that protective pattern comes into the playroom. There’s so many ways that this can be expressed. Just what I want you to hear is that our own protective patterns can come into play.
The effect for the client is that I now am more susceptible to projecting my experience onto them, not being able to be present with them in their experience, directing them away from their own experience, because the intensity is so much in my system. So this can look like asking questions, shifting the play somehow, not naming an emotion that’s coming into the room, but doing something to redirect because I, as the therapist, am having a hard time staying connected to this intensity in my own system. So the impact on the client is potentially not feeling seen, not feeling heard misattunement, maybe a rupture in the relationship in that moment, et cetera, et cetera.
So there is impact. Now, if that happens, which it will, and it does, I think it’s important to always remind play therapists that we always have the ability to come back in and do repair. But we do need to recognize that our own relationship with our own activation does impact in one way or the other what is happening with our clients.
So there is a great quote that I want to read to you because it sets the stage for the last part of our conversation which is what do we do about all this? We’re on the front line. We are in trauma exposure. It’s hard enough as it is because we are reliving the child’s trauma with them.
And then we have the compounded effect if we’re actually literally in the trauma with them. And then we have the other experience of and then what happens when our own unresolved trauma comes into the room? Three really challenging situations to navigate. But here’s the quote that I want to read because it’s just the crux of our work and it’s just so beautiful.
So this is by SIF S-I-E-F-F-I hope I’m pronouncing that name correctly. So the quote is this when a therapist’s wounds are hit, can she regulate her own bodily based emotions and shame dynamics well enough to be able to stay connected to her client? Can the therapist tolerate what is happening in her own body when it mirrors her client’s terror, rage and physiological hyper arousal? Herein lies the art of psychotherapy. So that’s the question.
Everyone activation is inevitable and it’s unavoidable. But there is so much that can be done about it. So I want to finish this conversation in two parts.
There’s the what can we do outside of the playroom? And then there’s the what can we do in the moment in the playroom when we’re helping? So outside of the playroom, we absolutely need to create a lifestyle that involves and includes things to help us mitigate the trauma exposure or the impact of the trauma exposure. The first one that is obvious to all of us is you got to get support. So therapists need therapists.
We need someone to help us process the different traumas that we are experiencing simply from being a therapist. And we definitely need the support when our own stuff is coming up into the room. So finding other people to help us find our own internal sense of safety so that we can keep doing what we’re doing and we can stay connected to ourselves a little bit more.
Having a self care strategy this can be anything. It’s important, from my perspective, that this is really individualized because what might feel like self care to one person may not feel like self care to another person. But this is everything from connection to quiet time to dancing to singing to creating to exercising to journaling to meditation to massage so that we can have safe touch in our bodies, to breath work.
Whatever it is that helps the body heal right, that helps the body move energy, process energy through to be able to work through that fight or flight responses and those dorsal responses that naturally are emerging in session for us. Big one is know our limits and set boundaries. We need to be able to know where we are within our window of tolerance.
We need to know what is too much, how much trauma is too much trauma on our caseload. I’m going to repeat that one again because there’s a lot of people that need to hear that one. How much trauma is too much trauma on your caseload, where it’s outside your window of tolerance? Do you need to say no sometimes? Do you need to set boundaries? Do you need to figure out how to do your sessions in ways where there is a little bit of containment so that your nervous system does get a break? What do you need to do so that you stay in your window of tolerance? Refuel.
My definition of refuel is doing what you love when you find things that are deeply meaningful, inspiring to you, not only do you get your autonomics back in a place of integration and in a place of optimal functioning, but you also find inspiration. And when we are sitting in trauma day after day after day after day after day and our perception is starting to get impacted, finding things that feel deeply inspiring bring hope. And they remind us that there is still joy in this world.
And they remind us that this world is still a beautiful place to live in and that there are still people that are doing inspiring things and that we can find a sense of purpose and that it can be. You that’s also doing those inspiring things and that can walk through the world feeling purposeful and feeling like this is a good place to be. So that’s an important thing for the refueling the last part of this conversation, and I’ve been planting seeds all along the way when I said if the therapist is not able to regulate if the therapist is not able to stay connected to themselves, right, they increase the probability of symptoms of compassion fatigue and vicarious trauma and secondary traumatization.
And this is where bringing in interpersonal neurobiology and polyvagal theory is so unbelievably useful in our work. So much of the research that I read about how to work with secondary traumatization focuses on the things I just mentioned that happen outside of the moment when we’re trying to be of help, but in the moment when we’re trying to be of help. In that moment when you’re sitting across from your client and that fear enters your body because you are having a shared experience with your client, when that anxiety arises in you, when that sadness arises, when that memory in you is activated.
Learning how to connect to yourself in the midst of that intensity is the key to mitigating the effects of trauma exposure. And it is also the thing that your client needs so that they can still feel you present, they can still feel you connected. They know that you’re in it with them, but they also know you’re not getting lost in the activation so that means mindfully tracking your experience.
That means learning how to be with the different sensations that are arising in you. It means learning how to access your ventral state to bring in a felt sense of safety in the moment when you are activated. That can look like a breath.
It can look like moving your body. It can look like naming your experience out loud. It can look like getting a sip of water.
It can look like just putting your hand on your heart or touching the ground to remind you that you are still here. All of these things that we can do in the midst of the activation, not trying to make it go away, but learning how to connect and be with ourselves so that we can feel the activation while simultaneously knowing in this moment, I am not actually being physically abused in this moment, this is not my trauma. It is my client’s trauma in this moment.
I am aware that my history is coming into the room, but I am an adult. I am not that kid in this moment. But there’s a part of us that can wrap our arm around our little one that has just entered the room and we can acknowledge to that part of ourself, I see you.
I feel you here with me. And together we are in a therapy session facilitating this process for this child. You can hear in my language, it’s about feeling it and not getting swept up in it.
And every time you connect with yourself, every time you have a moment of regulation, every time you have a moment of bringing in that safety in the midst of the activation, in that trauma exposure, you are going to open up new possibility for your nervous system. You’re going to open up possibility for your client to continue to move towards their trauma rather than our protective patterns coming in and us reacting instead of responding in the moment and inadvertently shifting our client away from the very thing that they are trying to process and that they need us in with them so that they can process it. Play therapists.
You are extraordinary, truly. I want you to do some reflection on this. I want you to really allow yourself to think about how you put yourself in trauma exposure every day and you are exposed.
And as a result, there are moments when you are also in crisis, crisis in the moment, moments when you’re having a parallel trauma with your client. We can think of COVID right, where we’re literally having to facilitate our client, but we are also in a similar trauma with them and moments when our own history gets activated. So it is a real deal that sometimes we are in crisis too.
And it is a real deal that we feel this stuff alongside our clients, which puts us directly in the line of susceptibility for symptoms of compassion fatigue and secondary traumatization. So no wonder that we have so many therapists that are burning out. And it’s not just therapists, right? It’s teachers.
It’s medical workers. There’s so many people that are helpers, that are exiting because it’s just become too much. And many of them may not know that there are things that can be done.
There are ways to help mitigate the impact. And it starts with learning how to be with ourselves through the impact and then also creating a lifestyle that supports the particular careers that we have chosen. Play therapists.
I know I say this at the end of every podcast, but it feels even more meaningful through this conversation. You are the most important toy in the playroom, and it is important that you take care of yourself and that we take care of each other and that we help each other through these. Just part of the very nature of being a play therapist.
The hard parts. So take a moment to connect with yourself. Find some time to reflect on this extraordinary profession that you are a part of and the sacrifices that you make and the extraordinary I’m almost at a loss for words, everyone.
It’s like we consciously choose to do hard things when we are helping kids and families heal. And sometimes we need to take a step back and recognize, number one, that we’re freaking awesome, and number two, that there’s an impact to our decision to do so. And then what is our responsibility in mitigating the effects of that impact? So I’ll say it again.
You are the most important toy in that playroom. Take care of yourselves, and I look forward to the next time that we get to spend time together.
