It is inevitable. We will cause pain to our clients.
Initially, it must seem counterintuitive to consider that, at some point, we will cause pain to one or more of our clients. In fact, at the very core of our work is the idea of “doing no harm”. As we consider the idea of causing pain to our clients as a component of trauma informed practice, I’d invite us to make a distinction between causing pain, and causing harm—though for most of us, this is entirely subjective.
Many times in discussions with other social workers and students, there arises a fear of doing anything that may hurt someone or cause anguish in some way. In fact, sometimes the commitment not to cause a client pain creates a type of inordinate carefulness. We try to predict all the possible things we may say or do that could cause a negative reaction with our clients. We weigh our words. We avoid certain topics. We gingerly ask questions in a very roundabout way. All of this, we hope, will avoid our clients feeling “triggered”.
Truth be told, we never actually know for certain what will trigger any one of our clients. Our attempt to be careful could be triggering. The clothes we have on could be triggering. The way we walk into the room and sit down could be triggering. Worrying about triggering could be triggering. It is not possible to ever know all the possible ways we may say or do something that is painful for our clients, or that resonates with past experiences of trauma. More important than triggering a reaction is what we do once we have a sense we have caused someone pain.
For many of us who have experienced trauma, the rippling effects of past and present traumas throughout our lives result in various coping strategies. Many of these were initially adaptive and remain adaptive. Some of these were initially adaptive but in the present, impede our functioning and negatively impact how we see ourselves, our relationships, and the world. As we engage in trauma informed practice and inevitably and inadvertently trigger one of our client’s survival strategies, we have an opportunity. We have an opportunity for change, in the moment, in real time, in the here and how.
There was a time I was a few minutes late in starting my appointment with a man I had been seeing in therapy for approximately three years. When I started the session, he was furious with me. I had never heard him so explicitly angry, raising his voice, fists clenched, almost frozen in his seat. I was surprised (and of course had an immediate urge to apologize which I thankfully squelched). I listened. I asked questions about the anger. I sat with him in it. We were together in it and we held it together. Gradually, he relaxed into the couch and his breathing slowed. I saw his eyes—moist with tears. Quietly and directly I asked him about the energy behind the anger—where he thought it came from and what it was about.
Through hurting him—completely unintentionally—we stumbled into old hurts, feelings of not being heard, being dismissed, not being taken seriously, and not being believed about the trauma he experienced as a boy. While we had discussed his history of abuse, we had never felt it together. In fact, I would guess that not many people had felt his experience with him. Our relationship shifted ever so slightly after that experience. I could not have planned for it no matter how “careful” I was.
We will inevitably cause pain to our clients. What we do with the pain, how we respond, and how it is acknowledged creates a window of opportunity for change that, had we not stumbled, we would never have found.
by Jeff Levy, LCSW, CTRS