The Practice of Therapy

Dr Jenny Hughes
Okay, do the floor. Hi, I am Jenny Hughes and I am a clinical psychologist. And I work with a lot of trauma and PTSD in my private practice. And I also help support other therapists with vicarious trauma. And I'm super excited to be here on the practice of there be with you today, Gordon?

Gordon Brewer
Awesome. Glad to have you. Well, hello, everyone, and welcome again to the podcast. And I'm so happy for you to get to know Jenny Hughes. Jenny, welcome.

Dr Jenny Hughes
Thank you. I'm so glad to be here.

Gordon Brewer
Yes. And this, this is a topic that I don't know that we've, the we quite we've done, we might have hit on it somewhere along the way. But I love just delving into topics as we were chatting about before we started recording around self care. And the big one being the chair, kind of your expertise is in vicarious trauma. But before we get to that, if you don't mind, tell folks a little bit more about yourself and how you've landed where you landed.

Dr Jenny Hughes
Yeah, so my professional journey has always been in the area of trauma. But I was initially trained as a child psychologist, and worked with children and families affected by child abuse and neglect, actually, all the way down to babies, you know, working, trained in child parent psychotherapy. And I loved that work. And then my career took me in a different direction that I wasn't anticipating. And I ended up becoming a trauma psychologist at a level one trauma center. And so that was when I really started working with adults. And found that I really loved that too. And then when I went to start my private practice, I really wanted to make it an online practice even before COVID. And with that, just kind of with like legal stuff, and all of the things I decided to focus on adults, just getting started in private practice. So that has been my primary focus for the past few years is working with adults using telehealth and doing EMDR cognitive processing therapy, prolonged exposure, but I didn't anticipate being where I am. Because wherever we land right now, we can't ever predict that. And yet, I'm so grateful and thankful for it.

Gordon Brewer
Wow, wow. Yeah. It's, yeah, it's, it's, I think, sometimes our niche can kind of finds us at times, and then we start doing the work and then realize, oh, wow, this is, this is fascinating. This is, or this is something that I really enjoy doing kind of things. Yeah. So that's, I think your story is not too untypical, in that sense. But, yeah. So tell folks a little bit about how you got interested in this whole concept of vicarious trauma. And maybe for folks that aren't familiar with that term to kind of describe that.

Dr Jenny Hughes
Yeah, so let me define it first. So vicarious trauma. There's a lot of terms that are thrown out there about kind of some of the things that happen to helpers and healers in their profession, vicarious trauma being one of them. The way that I define it is, it's that stress and trauma that we soak up by being empathic humans who want to help and heal others. Other kinds of synonyms that are used are like secondary traumatic stress, compassion, fatigue, burnout, I actually see those as all separate constructs, all kind of on a similar spectrum. But I focus in on vague Carius trauma because I see it as kind of the port of entry to the therapist burnout process, really, where if vicarious trauma is inevitable, if you are an empathic human, and you're working with other people, you're gonna soak up their stress and trauma, then why don't we start there and address the vicarious trauma so it doesn't turn into compassion, fatigue, secondary traumatic stress, and then burnout. And I got into this work, really, through my work at the Trauma Center. My colleague and I were asked to start a wellness program for the whole hospital. And a huge component of that was teaching anyone that came to listen to us about vicarious trauma. And so I've been teaching about this to other health care professionals and therapists for a number of years, and I had never really done direct work in terms of supporting people with it until COVID. And at that time, so many therapists were just we were all everyone was experiencing COVID together and everyone was overloaded. And so then I started to figure out how I could start to support therapists specifically with it. And from there, it has is grown.

Gordon Brewer
Right, right. Yeah, it's, uh, you know, some one little story that I've kind of told about myself in the past. years ago, I was in a different career, and I worked in the funeral business and, you know, industry and did all the backroom stuff that funeral homes do. And when you said vicarious trauma, I was reminded of those those years that I worked in that and that I didn't have a name for it at the time. But I remember that there were there were times when you deal with some tragic death, and, you know, might be a child or something like that. And then to how it affected me emotionally at the time. You know, I think that's eventually what led me into changing careers and getting into therapy. That becoming a therapist, I think,

Dr Jenny Hughes
yeah, and what you're describing, so certainly people who work in the funeral industry and around supporting people through end of life, even people like lawyers, I have someone right now that I work with who's an ombudsman, and she I've taught her a lot about vicarious trauma. But what happens is what you were just describing, we take this stuff home with us, we aren't able to do our, you know, superpower of compartmentalizing, and then we're having trouble sleeping, and we can't stop thinking about certain cases. Other sneaky things, too, though, like being really irritable. That's one of my red flags when I'm not taking care of my own VT. And often, my husband has to call me out on it, because God forbid, you know, I acknowledge that I need to help myself and right. And like, you know, isolating withdrawing from people that we love, because we just are feel like we don't have more to give, you know, that's what happens is helpers and healers therapists when we're not taking care of our vicarious trauma.

Gordon Brewer
Right, right. So as in the work that you've done, what would you say? You mentioned being irritable, when, you know, I would think that the symptoms are be symptoms that we would be familiar with, and other folks that have trauma. But are Is there any other any other symptoms to vicarious trauma that maybe we might not be aware of? Or might not be on the radar quite as much?

Dr Jenny Hughes
Yeah, I mean, you're totally right, in that a lot of the signs and stuff that come up for ve T are similar to trauma symptoms, depression symptoms, anxiety symptoms. I always like to preface though that vicarious trauma is not a diagnosis, and I'm so grateful that it's not in the DSM five, I hope it's never put in there. Because it's not a disorder, right. It's something that happens as a part of our job. And yet, it can be really scary to think about naming it and addressing it because it looks so much like what is going on with many of our clients. And so, you know, vicarious trauma looks different for everyone. So when we're thinking about more hidden signs, I think a lot of times, it's important that people do their own kind of internal sort of checklists to see kind of what is off for them. And I have a tool that helps people with that. But, you know, other things are like not feeling like you're interested or enjoying things that you usually do. That's like a depression symptom, right. But if you're feeling overloaded, it's hard to experience joy when you feel the weight of all the stress and trauma from your work, right, or just not wanting to go do things like that. Also, specific to therapists is avoiding our work. So avoiding answering emails, or voicemails, or, you know, really, really trying to avoid certain people or certain clients. There's nothing wrong with taking a mental health day. And I highly encourage that. But when we start to call in sick more and more, because we just can't make it to work, because we're so overloaded. That's a big red flag. For me something that would happen when I was not doing telehealth I was in person. And dealing with vicarious trauma is I remember, I would get to work and I would park and it was like I couldn't get out of the car. And I would sit in the car for 510 15 more minutes, just sort of gearing up to go inside. And that was a big red flag for me when I was struggling to even walk into the building that I worked in.

Gordon Brewer
Sure, sure. Yeah, it's uh, you know, there's, it's, as you were describing all of that I was, you know, another element that might fall into the category of vicarious trauma. As I was thinking about an intern I was working with one One time and and the they had had they had a client who was has had suicidal ideations and was, you know, you know, had kind of a high risk client. And I just remember walking through that with them and just how they were kind of traumatized by, you know, I guess as much as anything fear of not knowing what to do to help this person and you know, just would they, you know, just feeling feeling like they, the client was putting such a big burden on on the visit it What would you say that that kind of falls in that category?

Dr Jenny Hughes
I think so. And I think something that's common, especially for newer therapists is that they may try to work too much, they may try to work with overwork themselves, because they want to be able to serve the people that they're caring for. And when we are new therapists, we're so nervous, right? All the imposter syndrome stuff, we feel ineffective, even if we're doing really great work. And so sometimes we'll overwork and not have good boundaries around our time and taking care of ourselves. Because we feel like we have to like it's the only way to prove ourselves. And then that is a big risk factor.

Gordon Brewer
Right, right. Yeah. And I think it's, it's something that comes with a little bit of experience as being able to kind of create being able to come out part mentalize. The thing about it is, though, is you want to have a boundary between the stuff, that's your stuff, and the client stuff. And not cart, compartmentalize the client stuff within yourself.

Dr Jenny Hughes
Right, exactly. Yeah. Yeah. So my EMDR consultant actually has a cool little skill that she uses that she taught me recently, and she calls it a somatic stop. And for anyone who's listening, who is familiar with EMDR, we use a resource called the container. Do you know about the container I've heard? Yes. And so it's this visualization, usually that you teach your client to help them in a healthy way contain trauma stuff, that's not helping them in that moment. And what my consultant does is she actually has little boxes on her desk. And when she's noticing that whatever the content is that she is working with, with a client is really activating her body, she takes one of the boxes and just pretend that these sticky notes are so open it outside of the clients view, but she'll open it just for a second, so that she can give herself permission to put that somatic stuff or thought or feeling in there, and then she'll put it back on her desk, so that she can be even more present with the client while honoring that she's having reactions that she's going to come back to later.

Gordon Brewer
Yes, yes. Yeah, I love that. So speaking of strategies with all of this, and if somebody is noticing that they are, you know, showing, showing the signs of vicarious trauma, what, what's the starting place, would you say?

Dr Jenny Hughes
I think the starting place, and also the most powerful thing to do is talk to a trusted colleague. So, you know, HIPAA, and everything aside, as therapists, we sign up for this work, because we want to be able to help people, but not everyone signs up for that. And for myself, as a trauma therapist, even therapists don't sign up to do trauma work. And so I think it's really important to honor everyone's choices and to then also be intentional with who you choose as the people that are going to be supporting you. And so reaching out to a trusted colleague, to be able to say, like, wow, this, this case was really difficult, or I've really been struggling to take care of myself for whatever reason, knowing that they are going to be able to understand that that there's gonna be some level of shared understanding and the experience so that you're not alone. And being able to talk to other people and having community around us is one of the most healing things for vicarious trauma.

Gordon Brewer
Oh, yeah. Oh, yeah, I would totally agree. I think I'm reminded of a quote. There's a there's a grief, a grief therapist that I've followed for years now. His name is Alan wolfelt, Dr. Alan wolfelt. And he did a lot of stuff around death and dying and that kind of thing. But he he talked about this, this idea of the quote is grief, shared, equals grief diminished. And I would say that The same for trauma, trauma shared equals trauma diminished. And so like you said, having a trusted colleague to, to process with the kind of unload, because I think we can carry, we carry, like, like you You suggested with the somatic stuff, we do carry it within our bodies and, and it comes out in all a lot of different ways.

Dr Jenny Hughes
Right exactly like when I'm snapping unnecessarily at my family. And so, you know, I love that quote, too. And it's so true, it really does apply to trauma and to for survivors, and also the people that are helping those survivors. And, and of course, there's also things that we can be doing in our days to be addressing vicarious trauma. Honestly, one of the most important things that I work with folks around is being as present as we can in our work with our clients, so that their stories and the emotions that we're experiencing with them can have a beginning, middle and end. Because just like it, you know, the funny thing is in working with vicarious trauma is a lot of it is very similar to working with trauma and PTSD. So with trauma, we try and avoid everything that reminds us of it, we don't want to be triggered, we don't want to feel that way. As therapists, we try to do the same thing when we're not addressing our VT. But being present with those experiences in session with clients. One, it helps us to feel even greater compassion for others, which is really healing and that fills our cup back up. It also lets our brain know that there has been a beginning, middle and end of this experience and that it's not happening anymore. And so when we can sit with those feelings with our clients use things like somatic stops appropriately so that we're coming back to be able to look at it later. It's going to let our body move through that process more naturally. So it doesn't get all cramped up in there. Yeah, right.

Gordon Brewer
Right. Yeah, it's, yeah, I know. And the work I've done with people that are experiencing trauma, again, it's the difficulty for us, as therapists is applying the stuff we know to ourself. But I mean, it's just the you know, the, one of the things that I've been trained in is trauma focused CBT. And part of that process is, is getting people to a place where they can begin to tell the story about what has happened. But it takes kind of building up those, those skills, the kind of the self regulation skills to be able to get there. But I think really one of the things that is I tell clients, and I think we're, this would apply to us as well, as you know, every time you tell the story about what happened, it changes a little bit and takes on new meaning. And so being able to give ourselves the space to tell the story about what happened in the session, and how it affected us it sounds like would be a great strategy.

Dr Jenny Hughes
Yeah. And there's actually a whole practice around narratives in terms of how we can use that to address vicarious trauma. So we have to think about are we call them antecedent narratives? So what are the things we're telling ourselves? As we're getting ready for the day, as we're preparing for a certain session? Are we saying oh, my gosh, this is gonna be so hard and stressful? Or are we saying, I know, this is tough work? And I know what to do. Right? So like, what is kind of that narrative that leads up to it? There's the things we say to ourselves during the stressful experience during those difficult sessions again, is it Oh, my God, I can't do this. It's too much. Or I have the abilities to sit with this client or whatever that kind of, you know, monitoring needs to be. And then the narrative afterwards and telling of our story, and telling our story. intense experiences deserve to be shared, right? They deserve to be acknowledged, and sharing it with someone, it again creates this, it closes the loop so that our brain and body know that that stressor is not happening right now. And that it really internalizes I do know what to do. I do have the abilities to respond to this, both internally and externally.

Gordon Brewer
Yes, yes. That's yeah, I think you're exactly right. Well, I know, Jenny, that you have created some resources for people just around all of it. Do you want to say some more about that?

Dr Jenny Hughes
Yeah, so I sort of mentioned it earlier, I've created a vicarious trauma tracker. That is really, really helpful. It gives people a real really accessible way to start naming vicarious trauma and what it looks like for them. And it's not kind of a one time use thing. I really encourage people to use it over and over again, because vicarious trauma, it's it's a shapeshifter, and it'll sneak up on you in different ways at different points in your career. And so the tracker helps you go through a checklist to see how am I doing emotionally and relationally occupationally, and then it gives you a tracker. So you can kind of go through a week and not change anything. But just notice what do all these different things look like for for me this week. And then it prepares you to develop a realistic and a sustainable way to address the ways that vicarious trauma is showing up right now. And so people can find that on my website, it which is brave, providers.com/ve t tracker. So it stands for vicarious trauma tracker, but VT tracker,

Gordon Brewer
right, right? And we'll be sure to have those links in the show notes in the show summary. So well, Jenny, I want to be respectful of your time. And just this has been a great conversation. And I think there's a lot to think about here. And just really just around self care what So what other thoughts parting thoughts would you have for folks around this topic?

Dr Jenny Hughes
Two main things. So one is all therapists deserve to be cared for too. So, so important. And two is, I know how hard it is to ask for help. I'm really, really not very good at that either. And yet asking for help is one of the strongest things we can do. And it doesn't mean there's anything deficient in you, as a therapist, it's hard to walk the walk, and we can get stuck in that negative thought cycle of I'm not doing the things I'm telling my clients to do. But once we we are able to break that shell and tell someone Alright, this is the change I'm going to be making. It opens up so many doors for us.

Gordon Brewer
Yes, yes. And I would say, you know, to echo what you said a little bit earlier is find those trusted colleagues and the support that you need around being able to talk talk to folks I know. Thank you, my clients are surprised when I dropped the nugget Yeah, when I work with my therapist and just go into therapy yourself is, you know, something that probably the majority of folks don't really do. And I know I went years without doing that. And it's been a much better thing for me here lately. And then I would say to just, you know, being being a part of like mastermind groups and other, you know, groups within therapy circles can be of huge support.

Dr Jenny Hughes
Yeah, and I do have a community that will be opening up in the fall specifically for folks to be able to come and talk about what the what it's like to be a trauma therapist, and to deal with vicarious trauma is called the brave trauma therapists collective. And anyone who goes and grabs the VT tracker, they'll be able to get lots more information about it. But that's exactly what it is, is it's just another option for us to be able to get support around this stuff specifically. And I think it's really helpful when people don't feel like they know kind of which colleague to reach out to. Or maybe they're working in an agency where they don't really feel safe asking for help. Or perhaps they're in private practice. And the consultation groups that they're in are great, but they're so focused on cases that they're not able to process their own experience as being a therapist. Yes,

Gordon Brewer
yes. Yeah, that's great. And again, we're gonna have links in the show notes here for folks to get in touch with Jenny easily. So Jenny, tell folks how they can't what is the best way for them to get in touch with you if they have more questions. So

Dr Jenny Hughes
download the VT tracker. I'm also really active on Instagram at Brave providers, and I have a bunch of stuff on tick tock, but that's a whole new world for me. So you can follow me there too, and that's also at Brave providers. But those are those are good places to find me.

Gordon Brewer
Awesome. Well, Jenny has been great to have you on the podcast. I'm so glad you joined me and hopefully you will be able to do this again soon.

Dr Jenny Hughes
Yeah, I love that. Gordon, thank you so much. Take care