Mastodawn

drkkolmes (they/them)

@gramjoeldavies For me, the #burnout became much more of an issue when I started sharing the #chronic #trauma my clients were experiencing. Somewhere, oh, about 2016…the sense of collective trauma was growing. I used to treat people for issues that weren’t directly causing me distress even though I experience #sexism #homophobia and #transphobia It has felt qualitatively different since the Trump years.

drkkolmes (they/them)Dec 28, 2022

@gramjoeldavies And I also am talking about #covid and #pandemic here too. Just massively different to be in the collective trauma that is having such a major impact on #mentalhealth

I also feel like this was a turning point of so many of us having to turn people away and find referrals. A good part of my time is spent trying to find referrals because I am full and so are most of my trusted colleagues. I think this touches on the systemic issues you are mentioning.

drkkolmes (they/them)Dec 28, 2022

@gramjoeldavies But this is all from someone who isn’t even dealing directly with insurance or institutions!

David Paul, M.D., Ph.D.Dec 28, 2022

@drkkolmes @gramjoeldavies In my experience, #burnout is a consequence of multiple traumatic experiences (#chronic #trauma)..

drkkolmes (they/them)Dec 30, 2022

@DavidPaulMDPhD @gramjoeldavies Interesting. I see this is your specialty. But I also think a lot of burnout may not come from trauma at all, but, rather, inadequate rest and recovery. Maybe you think we are speaking of the same thing?

David Paul, M.D., Ph.D.Dec 30, 2022

@drkkolmes @gramjoeldavies #Burnout is typically an end result of situations/experiences that have activated the fight/flight/freeze (FFF) system, repetitively (small chronic traumas) or extremely (life threatening such as military combat). The extreme traumas can result in Post Traumatic Stress Disorder. Up regulation of the FFF system has multiple psychological and physiological consequences. Rest & recovery are always valuable, but do not address the causes of the chronic FFF activation.

Gram Dec 30, 2022

@DavidPaulMDPhD @drkkolmes I agree. And perhaps also fawn, if it means endless kowtowing to cold, faceless or kafkaesque establishments.

What I found pertinent about my original quote is the reminder therapists aren't necessarily (just) activated by proximity to others' suffering. In fact, if practicing with he offer of a ventral vagal presence, this impact could be low. But working in oppressive systems IS activating, for the practitioner.

David Paul, M.D., Ph.D.Dec 30, 2022

@gramjoeldavies @drkkolmes The current "full" name of what used to called the fight or flight system is now: Fight, Flight, Freeze, Faint and Appease. I appreciate the word Fawn since it starts with the letter F, but it's less commonly used. Most therapists are highly empathic, and even the business world recognizes that emotions are contagious (Daniel Golman, for example).

Gram Dec 31, 2022

@DavidPaulMDPhD @drkkolmes I really welcome the expansion of that model. Personally, I like "fawn" because I think it says something specific about the human context. It's roughly synonymous with "appease" but it's a social response.

Fight/flight being the classic sympathetic arousal reactions, freeze being the parasympathetic one... But fawn is interesting because, I think, it reflects what happens when the instinct to "disappear" is active while... /1

Gram Dec 31, 2022

@DavidPaulMDPhD @drkkolmes... while our social engagement system is still running. When the urge toward self negation, not existing, activates in a social context then the behaviour is all about shoring up the other, elevating the other, supporting the other.

This is really important for therapy because, on the surface, it may look like presence, social interaction, but it's still activation of the dorsal-vagal system associated with trauma. /2

Gram Dec 31, 2022

@DavidPaulMDPhD @drkkolmes Therapists who habitually focus on being "nice" and "supportive" could also fall foul of this and be subject to burnout more easily. It's not empathy per se that vicariously traumatises, but when it overwhelms the therapists own sense of self it can do. Therapists who fawn are particularly vulnerable to this. /3 end

David Paul, M.D., Ph.D.Jan 3, 2023

@gramjoeldavies @drkkolmes This is certainly a complex area! I'm not aware of research regarding therapists who "fawn" with clients. In my experience, the old saying is still accurate: "The client can't go anywhere the therapist hasn't already been." The ongoing opportunity for therapists is continued learning, growing and #healing, in service to themselves and their clients.

Gram Jan 4, 2023

@DavidPaulMDPhD @drkkolmes I am not aware of specific research either, it's true. Nevertheless, fawning is relatively commonplace, especially among compulsively caring people. It is something to be watchful of and reflexive about when in practice.

David Paul, M.D., Ph.D.Jan 3, 2023

@gramjoeldavies @drkkolmes The "freeze" is one element of the sympathetic response, and activation is reflexive - for example, "freezing in place" (suddenly stopping without movement) when a hiker hears the rattle of a rattlesnake. Or during a grizzly bear encounter while hiking. (Real life examples of workshop participants.)

Gram Dec 29, 2022

@drkkolmes Oppression is one of the worst traumas, probably. Insidious.

Sharing trauma feels like something different to vicarious trauma, don't you think?

drkkolmes (they/them)Dec 30, 2022

@gramjoeldavies Oh absolutely. Vicarious trauma comes from empathic engagement vs actual exposure to the same trauma.

Gram Dec 30, 2022

@drkkolmes I think I conceive of vicarious trauma as a mix of mirroring the other's state but also of not feeling held in the work oneself. Good networks, personal therapy, colleagues, and home life mean the therapist isnt the echo chamber of suffering alone. But for a therapist in a hard, oprressive organisation where their work is not understood, this may not be the case.