Managing a Trauma-Heavy Caseload in Psychotherapy
- 1d
- 4 min read
It’s the age old saying - you can’t pour from an empty cup. We can’t be at our best to support our clients in their healing journeys if we are not feeling okay ourselves.
So it begs the question, how do trauma-focused therapists manage such trauma-heavy caseloads?
It becomes a matter of balancing an engagement with practical and consistent self-care strategies whilst continuing to show up authentically and professionally for our clients. Here are some actionable strategies that trauma-focused therapists can implement to help protect themselves from experiencing burnout, compassion fatigue and the impacts of vicarious trauma.
Prioritize Self-Care!
As trauma-focused therapists, we need to practice what we preach, and that means recognizing that our own personal needs are just as important as those of our clients. When we say self-care, it is common to think of bubble baths and meditation, but self-care actually goes far beyond this.
In this realm, self-care also looks like setting boundaries. For trauma-therapists that might look like having set working hours in which we engage in sessions and respond to emails, or even having a limit of how many clients we see in a day. Self-care may also look like taking regular breaks between sessions, or on particular days of the week. It is not uncommon for trauma-focused therapists to set break times every two to three clients, or limiting how many days they work in a week while guarding a day or two for self-care, our own appointments, therapy, and recovery. By taking good care of ourselves, we are in a much stronger position to show up more presently and fully for our clients!
Develop a support network!
Having a strong support network within the trauma field can help therapists to feel well supported, understood, and less alone. This might look like having a group of professionals you regularly collaborate with in order to debrief from difficult cases, seek advice and support, or simply receive validation of the impact of our efforts after a very trauma-heavy session or week.
Here at the Centre for Treatment of Sexual Abuse and Childhood Trauma, our team meets on a weekly basis to provide support, advice, offer a shoulder to lean on, and offer a safe space to just be!
Engage in regular supervision and consultation!
Having a strong trauma-focused supervisor is important for delivering consistent and balanced trauma-focused services. Seeking supervision and/or peer consultation can be highly effective for discussing difficult and challenging cases, as well as for receiving guidance and ideas for strategies that may be worth exploring with the client.
By engaging in ongoing supervision sessions, even past the point as mandated by the governing college, therapists are taking steps to prevent burnout and vicarious trauma while also ensuring their clients are receiving high quality therapeutic services.
Create Structured and Consistent Routines!
Having consistent session frameworks and time set aside for treatment planning, progress note completion and personal recovery time can be highly effective in managing a heavy trauma-caseload. By developing and implementing set routines and methods for work completion, this helps to provide predictability, balance and expected lower intensity points to the therapy work day. Many trauma-focused therapists also schedule their clients mindfully and make efforts to avoid scheduling trauma-heavy sessions back to back in order to protect themselves against emotional exhaustion and burnout.
Safe and Effective Use of Self!
As therapists, we all come into the therapeutic space with our own past experiences and relationships. A powerful component to the therapeutic process is our own abilities to manage our own emotional impacts or interpretations and recognize how the work may be affecting us personally.
Engaging in regular personal reflections, allows us as therapists to tend to and process the difficult emotions that arise for us in sessions. Being in the role of the trauma-focused therapist can be emotionally heavy, especially as we strive to be highly present and connected to our clients as they process their painful past experiences. It is very important to maintain a strong ability to self-reflect in order to support us in identifying any point that may require us to seek our own support.
Engage in trauma-informed practices!
In trauma-focused therapy, the pacing of sessions is very important in order to ensure we are balancing reconnecting with the client, doing some psychotherapy work, and ensuring we leave sufficient time at the conclusion of a session to reground and stabilize prior to exiting the room. We have a unique opportunity here to co-regulate with our clients and engage in grounding exercises alongside them. Are you finishing a session with a couple minutes of box breathing? Breathe with them! Are you taking a moment to visit your peaceful place? Take a moment to connect to your own! Is your client visualizing filling and locking up their container? Maybe you are carrying some things that may be beneficial to put in your own container. Using the set aside grounding time to regulate and support ourselves can be a powerful practice, and can support our clients in co-regulating with us.
To conclude, it is important to acknowledge that trauma-focused therapy is hard work. We hear about and help carry the weight of impacts of abuse, neglect, life-changing injuries or diagnoses, betrayals and much more. By regularly attuning to our own bodies and assessing for any lingering sensations and impacts, we are taking a proactive approach to prevent burnout by prioritizing trauma-informed responses.
