Secondary Trauma and the Holidays for Therapists

For many of our patients with a history of trauma, the holidays stir up difficult memories and dashed hopes for the family that might have been – and wasn’t – and isn’t. Pain they thought they were managing comes back anew because of idealistic and nostalgic holiday TV shows, music and advertising. They come to us for support, solace, and review of the skills they are working so hard to master; skills that let them cope with their past and sustain a better present.

For the therapist, this can mean up to 30 hours a week listening attentively to patient anxiety and pain about the holiday season. From the run up to Thanksgiving in the first weeks of November to well into the post-holiday months of January and February, the increased reactivity and of patients put additional stress on any clinician. It is particularly hard on therapists who have a personal history of abuse. If we don’t prepare for it, it can catch us unaware.

Secondary trauma is indirect experience of others’ traumatic material. Regular and repeated exposure can result in PTSD-like symptoms for the listener. Some studies have shown that up to 15% – 39% of clinicians who are regularly exposed to client trauma material experience secondary trauma. Further, the greater the percentage of survivors in a therapist’s caseload, the greater the number of reported secondary trauma symptoms. That’s a reality throughout the year.

Are therapists more vulnerable during the winter months? I was unable to find studies that measure whether secondary trauma increases for therapists during the holidays. I can tell you anecdotally from my experience as a supervisor in a large clinic that I found the greater number of patients going into crisis during the winter was hard on my staff.

If this is true for you, it is only self-protective and wise to take some time to think about how to take care of yourself over the next few months.

Managing Secondary Trauma During the Holidays

Factors that have been found to generally make therapists more vulnerable to secondary trauma are insufficient self care, inadequate training, an overwhelming or hostile workplace and not having enough social support. During the holidays, it’s particularly important that we pay attention to these stressors.

Self-Care

While self-care is always important, it is particularly so during the winter holidays if your caseload has a high percentage of trauma survivors. This is even more essential true if your own history of trauma may be triggered.

• Be even more mindful than usual about the basics. Get seven to eight hours of sleep every night. Get outside and active – preferably every day. Eat sensibly.
• Take care of your mental health too. If you are being triggered, get back into therapy for yourself.
• Use your vacation days. You need and deserve time off. Instead or (or in addition to) a week long break, consider spreading vacation days out so you have three or four day work weeks.

Training

Are you over your head with some of your clients? Did you accept some clients you aren’t really prepared for because you needed to fill your productivity requirements? The holiday season is not the time to stress yourself this way.

• Consider transferring any client you really aren’t equipped to handle.
• Resist the pressure to take on clients you don’t feel quite prepared to treat.
• Make a New Year’s resolution to get further training in the treatment of trauma so you will be better prepared in the future.
• In the meantime, mindfulness and stress reduction training websites may help you manage a stressful caseload.

Workplace

If you are in a challenging or hostile workplace environment, the new year may be the time to seriously think about finding another job. For now, do what you can to make your job a little less taxing during the holiday and post-holiday season:

• Manipulate your schedule if you can so you don’t see many patients with PTSD in the same day. If most or all of your patients are trauma survivors, don’t see individuals who are in maximum stress back to back. Manage your schedule so that you see people in varying states of recovery hour to hour.
• Talk directly with your supervisor about whatever support you would find helpful during this time.
• Arrange to meet with some colleagues to provide mutual support as you all manage client holiday stress and the impact it has on you.
• Resist participating in discussions about negative aspects of your workplace. The negativity will only add to your stress.

Your Personal Supports

Managing feelings of being triggered or stressed is exhausting. It may be tempting to isolate. Don’t. Sharing some joy in the season is the antidote to feeling down.

• Emphasize the positive in your personal life. Participate in holiday rituals and activities that give you joy with your partner and kids. Call your relatives to wish them a happy holiday. If you are alone or at a distance from family and friends, do some volunteer work to make the holiday brighter for others. Enjoy the camaraderie of being with other people who are also trying to make a difference.
• Let your friends do for you what you so willingly do for them. Ask for help with holiday tasks when you need it. Turn to them for comfort and care.
• Transition from your work day to the rest of your life with some kind of intermediary activity that focuses on the positives in the season. Listen to holiday music in the car. Pay attention to the scenery and decorations. Do your workout to the beat of holiday tunes. Call a friend for a quick and friendly chat before leaving the office.

We therapists have a reputation, probably deserved, for not taking sufficient care of ourselves when we are stressed or overworked. Givers by nature, we are vulnerable to giving too much, especially when our clients are struggling. Their distress often comes to a head during the months before, during and immediately after the winter holidays. If you are feeling over-stressed or concerned that your own issues may be triggered, do take care of yourself.  You deserve the same empathy and support from you as you are giving to your clients.

 

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