Sunday, September 16, 2012

Hearing others' stories

Over the years, I've discovered that my patients appreciate consistency.  They like knowing what to expect when they come to see me.  I've noticed that even significant changes to my appearance can be unsettling for some. 

I get it.  People come to therapy when the problems they're dealing with become overwhelming.  Often, their entire world seems unpredictable and chaotic.  Therapy becomes a sort of haven of stability where they can try to sort things out.  The consistency is comforting and provides a sense of safety. 

This works for me.  I too have a deep appreciation for stability.  When I do make changes, it is almost always incrementally.  I like knowing that even if I can't fix a patient's problems, I can at least give him somewhere to feel safe and accepted. 

The first and sometimes only service I provide in this role is to bear witness to a patient's story.  I listen and I validate.  I did not initially realize how important this is.  After all, anybody can listen, right?  Apparently not.  The mission of the clinic I work in is to provide interventions to those who have had one or more traumatic experiences.  A lot of the patients I see have never shared their stories with anyone.  Having the opportunity to talk about what they've been through is often quite powerful. 

So imagine if I were to interrupt their narrative and say, "Stop.  It's too horrible.  I don't want to hear anymore!" It would confirm what they've long suspected: their suffering is theirs to bear, alone.  No one can help them.

All of us at the clinic are aware of the risk for "vicarious traumatization" - being traumatized by someone else's trauma.  I've been lucky; for the most part, patients' stories don't bother me.  Of course I feel bad that they've gone through such terrible things, but hearing about it doesn't unnerve me; I maintain the same steady, reliable presence that my patients have come to expect from me.  For me, tt's almost like when a patient leaves my office he takes his story with him.  I don't hold onto it and I don't really think about it until the patient's next visit.

Something different happened this week.  It was my first session with this particular patient.  She'd seen one of the psychiatrists and was referred to me for therapy.  I wanted to take the initial session to get to know her and to get an understanding of the problems she's dealing with.  About halfway through the session, I asked if she felt comfortable giving a brief summary of her traumatic experiences.  

My patient began sharing her story.  I interjected a few times to ask questions for clarification.  Mostly, I listened.  Everything was fine until the patient reached a point in her story that involved being conscious for a medical procedure in which she lost massive amounts of blood. 

I started becoming dizzy.  Suddenly I felt hot and I began sweating profusely.  (It was literally dripping off of me; when it was all said and done, I noticed that my clothes were wet).  I was lighthead and the room looked like it was spinning.  My patient was still talking but she sounded far away, or maybe muffled. 

It occured to me that I've experienced this sort of thing before.  You see, I have a strong aversion to needles.  For years I used to faint everytime I had to give blood.  Eventually, I discovered that I could prevent myself from passing out if I took deep breaths during the procedure and avoided looking at the needle or the blood.  Still, even now I get anxious whenever I'm faced with the prospect of getting stuck with a needle. 

So here I am in session with a patient and I think I might pass out from hearing her story.  I didn't want to ask her to stop -- what kind of message would that send?  On the other hand, how would she feel if I passed out right there?  To make matters worse, the room was still spinning and I couldn't think clearly. 

Finally, I lifted my hand and said, "Hold on a minute." I tried to recompose myself but it was so hot and I felt so lightheaded. 

"Was it the blood?" my patient asked.

"Yeah," I said.  "Just give me a minute.  I am so sorry."

Eventually, I excused myself.  A coworker's door was open and I slipped into her office.  "Are you okay?" she asked, alarmed.  "Your face is green!  Why are you all wet?  What's wrong?" 

Fortunately, the temperature in my coworker's office was much cooler than that of my own.  The blast of cool air did the trick.  Within a few minutes, I was feeling better.  I ended up going back to talk to the patient.  I apologized and told her we'd meet again next week (if she still wanted to, of course).

I felt like I needed to share this because I didn't want to allow myself to become embarrassed (anymore than I was at the time) about it.  In my opinion, the sooner I can look back on something and laugh, the better.  I've also been mentally rehearsing my patient's story so that I'm ready to hear it when the time comes for her to tell it again.


  1. Oh, I so feel for you... I too have this problem that I can feel faint or have fainted when someone goes into too much detail about medical procedures.

    It never occurred to me that it could also happen in session. Thank you so much for sharing this. I'm wondering what could be some possible antidotes to this... By the way, I think you handled it very well and honestly.

    Perhaps if you have a water bottle near you, as well as a particular photo that you find soothing that you make a point of looking at when you need grounding, so to speak. Alternatively, perhaps a plant or some sort of material (with which you have a positive association) could be something soothing to touch.

    Wishing you the best of luck next week!

  2. Blood doesn't bother me so much but needles give me the creeps...I have found that if I pinch myself elsewhere and or count as they are poking me I fare much better.

    I was sewn up as a child with needles and no anesthesia. Needless to say after being held down and terrorized (The puncture was next to my heart and through my lung) I still have trauma from the incident...

    I have learned a few tricks to get through it and some work better than others...

    I certainly can see why your clients need consistency. Comfort/Safety and Trust are the cornerstones of your business...


  3. I wonder how much vicarious trauma I experienced in the Recovery School District.

    When I was teaching, I experienced anxeity attacks and insomnia for about 4 years. Sometimes this would manifest as uncontrolable crying, and I'd have to go hide in a closet (though, by some point, the students could put it together).

    Thank you for this offering. Any tricks on how to take care of one's own vicarious trauma?


    1. I think the best thing is to take care of yourself. I also try to leave work at work. I never sit around thinking about my patients' traumas when I'm at home.

  4. Sounds like counter-transference to me. Maybe those feelings were what your patient was going through herself during the procedure. Your strong reaction likely pinpoints where she needs to do her own work, maybe?

  5. Isn't it amazing what mind can put you through? You did not experience what your client did, only hear it. Try watching your body sensations and know that this will all change....bad or unpleasant and good. Your body sensations tap into your own fears, but only accessed through your ears, taste, smell, touch, eyes...or mind.

  6. Thanks for all the feedback guys!


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