The loss of innocence; I thought I understood it. As a licensed marriage and family therapist, it is something I have seen over and over again. From substance abuse and overdoses, car accidents resulting in the loss of a parent, attachment figures breaking social norms as protectors and becoming the culprit of physical and/or sexual abuse, observing the fear of a family member joining a gang, watching a parentally-deemed “out of control” teenager break down during session and sharing “I was raped”, witnessing the deep desire to not be alive in this world anymore, to hearing someone’s experience of objectification due to their race, class, gender, sexual orientation, ethnicity, nationality and/or class resulting in fear for their wellbeing and life. Words spoken of these experiences expose you to a deep rooted shift in a person. Suddenly the loss of innocence can be viewed through the human eyes as you attune to the depth of their pain spoken before you, despite never having experienced it personally.
These disclosures, moments, and shared experiences within a clinical setting are things no textbook can prepare you for. While teaching, I was asked each semester by my graduate students what the hardest part of being a clinician was. Simple answer; it is the unfathomable stories of abuse, trauma and pain you are exposed to client after client on a daily basis and the toll it can take on you personally. This response was often met with surprise by my students.
As a therapist, you are the keeper of space for all the grief, depression, anxiety, thoughts of suicidality, intergenerational patterns of trauma, oppression and emotional turmoil as your client moves through their healing process. As you can imagine, over time, this can be quite taxing. Therefore, psychological researchers have spent time studying and observing “burn out”, which encompasses emotional exhaustion, depersonalization (feeling that you are detached from yourself, an observer of self rather than active participant) and experiencing lack of personal accomplishments. (Morse, Salyers, Rollins, Monroe-DeVita, & Pfahler, 2012) Within the field, “burn out” can also be referred to as “compassion fatigue” and can happen throughout one’s career when adequate self-care is not practiced and boundaries are not set.
It was my understanding, from my education, research, and clinical training that I could positively manage both my professional and personal life if I could do the following: maintain positive boundaries and self-care while simultaneously holding space for my clients’ process and utilizing therapeutic theory to meet their therapeutic goals. (Norcross & VandenBos, 2018) It was so neatly wrapped into an infallible, strategic system for one to follow. The necessity of self-care was drilled into our graduate student brains as we prepared to dive into clinical work. As interns, we worked hard to perfect taking care of ourselves and as licensed clinicians we could, with confidence, articulate how we navigated the waters of “burn out”.
But, what happens when life happens to you and there is no infallible, strategic system to follow? There are traumatic experiences in life that fundamentally change who you are; not just chemically or physiologically, that happens too, but at the core of who you are as a person. I thought my career gave me a special seat in the arena of therapeutic work, having witnessed clients battling through soul awakening experiences while redefining their narratives to the trauma as survivors. I thought my years of studying, researching and entrenching myself in the psychological world exposed me to the full depth of human pain. I was wrong. I was deeply mistaken.
There was simply no course, test or clinical practicum that could have prepared me for the words “Matt has cancer”. The words delivered to me by my husband’s gastroenterologist following Matt’s colonoscopy. Matt was 32 years old and I was 7 months pregnant with our son. That happy-ever-after life was shattered. There was no shielding me from the peaks and valleys of my husband’s 16-month fight against cancer, the conflicting emotions of having a new baby while dealing with the reality of cancer and the hustle of running a full-time therapeutic practice. This was life; sudden, unpredictable. Cancer showed no regard for the plans we had made. The biggest lesson I experienced was how ill-prepared I was to escape the wreckage of losing my husband to colon cancer and becoming a widowed mother of a 14-month old all by the age of 31.
Death and grief are humbling. The loss of my husband took me to a rock bottom I could have never imagined possible within my suburban life; a life I created while desperately running away from my working poor, inner city, racist, oppressive, drug-infested childhood community; a life I fought so hard to get away from. The aftermath of cancer hurt at a depth I had never experienced before. Suddenly, I was the client sitting on a red couch across from a therapist surrendering to the therapeutic process of going through the shadows of brievement with a measurable goal of still living once I weathered the relentless storms of grief. I was now the one who sobbed gut-wrenching, hysterical cries and gasped for air in the same way I witnessed my clients expel their inner suffering. I experienced pain in my heart; pain so intense that my chest hurt to the touch, much in the same way some of my client’s described while going through substance abuse treatment. Their sobriety left them with no external numbing tools to mask the pain and the intensity of their emotions were felt deeply in their body. I was the one assessing if I needed to go to the hospital for a heart attack or if I was having a panic attack, just as I had done countless times with clients. It was now me experiencing grief so deep that my soul felt shattered. Now, I could see the depth of my own pain reflected back to me as I looked into the mirror. I recognized this level of heartache. It was the pain I previously witnessed while sitting across from many of my clients.
As a therapist, I know that trauma changes you. It can change your body and brain, from the shifts in how chemicals are released to the way that they communicate with one another following the traumatic experience. (Sherin, J. E., & Nemeroff, C. B., 2011) That traumatic occurrence often results in a loss of innocence. The innocence that, prior to the traumatic event, being hurt or losing one’s life was unthinkable. Suddenly, that traumatic experience happens and it is all encompassing and consuming; nightmares, flashbacks, ruminating thoughts, triggers, sleep disturbances, changes in mood, difficulty seeing a positive future for one self, difficulty concentrating, hypervigilance, and even destructive behaviors; life feels hopeless in a way once unimaginable.
However, what I was most surprised to personally experience is that when you are so broken, empathy is exchanged with fear, frustration, and a loss of understanding within your support groups; shocking for a therapist who made a professional commitment to go through some of my client’s most heartbreaking moments by their side. I have come to realize how isolating this work is on the client’s side. Far too often, people try to fix it; put a bandaid on it or simply walk out of your life because it is all just too much for them. However, in the deepest trench of healing, we don’t need anyone to repair it; we simply need our pain to be witnessed. We need people to show up and just be with us through the good, the bad, and the ugly.
Yet, as time journeys on, the social, familial and peer support are not impacted by your experience on a daily basis as you are. The flowers stop coming, the check-in texts vanish, the phone calls are lost and the support slowly trickles down to a select few, if any. Suddenly, people create boundaries because you are deemed too much and their self-care is to withdraw; they are protecting themselves from “burn-out”. This process is much less transparent than it is in the therapist-client relationship. The truth is, sitting in your pain is exhausting, triggering, and overwhelming for most outsiders.
How could people you thought would be there through thick and thin walk out on you when you needed them the most? What I realized was, that within the four walls of a therapeutic office, it was okay to vulnerably share the emotional wounds that one was working to heal. However, in this society, continuous deep pain has a time limit. This becomes clear that your time for being sad, anxious, angry, grief stricken, or any emotion really, is up when those around you believe it is time for you to “move on”. They believe this despite their lack of understanding of the depth of your trauma and the time it takes to truly heal from the wounding that occurred. Apparently, empathy has a shelf life I was unaware of. If people know you are in pain, they definitely have an opinion about you going to therapy so someone can help fix you. Ironic when you were once the “fixer”.
What happens when you are still struggling, still crying, still hurting, still not wanting to live life, still scared after the time frame for “getting better” by society is up? Suddenly, the experience you went through is minimized and it is now somehow your fault for not pulling through in a timely matter. With more people leaving your life, more questions (“Are you still going to therapy?”, “Are you working?” “Are you dating?”), deeper regression of empathy and further isolation occurs. I simply could not have imagined that, as an expert in sitting in pain, that others in my life would be unable to do so for me. They would in fact “burn out” on me. Suddenly, I was the reason for the compassion fatigue. Ouch!
The truth is that there is no “easy button” for trauma work, personally or professionally. Clinically, it often requires additional training and certification. As the client, it is taxing, both emotionally and physically exhausting; it takes courage to surrender to the process of it all in hopes to one day make it out the other side as a survivor. It takes grit to not give up during the setbacks and triggers because, without a doubt, they come. Additionally, it takes a tribe of people in your life, outside of a therapist, who are willing to show up for you in a way that is sometimes uncomfortable, unpredictable, and unscheduled to just be with you in your pain.
Despite one’s inability to always verabilize their needs it is clear that throughout this healing process continuous support is vital. Often times people say they want to provide support to those in need, however, are unsure how to do so. Though it may vary from person to person, the answer for someone may be as simple as just being present with them in that moment. Because throughout my experience it has become clear that sometimes you simply need to know you are not alone in this world despite the trauma you have experienced. Additionally, you may need someone to sit with you while you cry, laugh at the intensity of your life, help you take a break from it all while knowing you are not suddenly better because you smiled. It takes a tribe to adventure with you with the understanding that you are working to continue living, despite days you can’t get out of bed (those days are okay too), and to just love you unconditionally with pure empathy and no judgment of you while honoring your process.
Recently, while at a conference to raise awareness for colon cancer to Congress, I wondered why it was so emotionally filling to be with those struggling within the cancer world or navigating the aftermath of cancer following a loved ones passing. What I realized was that it was in that room of over 100 people that we all felt a loss of innocence and had experienced a shared trauma of cancer. We were not alone in our pain and we were utilizing our suffering to work towards change. This fundamental shift in narrative, from victim to survivor, propelled each and every one of us to not only sit in pain, witness each other’s pain, but to fight with the hope of ending pain for others.
This reminded me of a time when Matt and I sat on our couch in the depths of sorrow following Matt’s cancer diagnosis. When our son was born and entered life and light into our hearts there was a fight within us both that was undeniable. We realized within that moment that we were given a choice. We could let the fear of cancer take us whole and become a victim to it or we could choose to take every day as a gift to live. We chose to live and that choice manifested into a lifestyle apparel brand called Live Moore Co. The hope was that in sharing our story we could inspire others to live in the present because you never know what tomorrow holds, including a shocking and unplanned diagnosis like cancer, to be kind to others because you never know what someone else is going through and to simply choose life every second of the day: to Live Moore!
We are not all given equal footing in this life and things happen to us that are outside of our control. No one ever asks for the trauma they endure, nor do they ask to lose their innocence in this life. However, we are given the choice of how we respond to these heartbreaks and experiential hurricanes that catastrophically can take away everything we once knew. We get to make the choice to live or be swallowed alive by it all. Sometimes that choice is minute by minute; sometimes it is hour by hour; and other times, it is day by day. Our support systems also get a choice in how they show up. Therefore, it is imperative that both support systems (family, friends, schools, communities etc.) and therapists continuously reevaluate and assess the levels of support needed by the person making the journey to healing.
As a communal species, what if instead of turning away from those within our world who are in pain and suffering we turned towards them? Often the fear is that if someone’s light is dimming than we will be so deeply impacted by them that they will somehow dim our light too. However, what if we sat with someone whose light was flickering from pain and just in being with them and acknowledging their experiences within our light that they got a little brighter. Just maybe we could find the empathy within our hearts to not shun those who are hurting the most but rather work to collectively heal our fellow humans from the pain of this world. As a therapist, a widow, a mother, a client I have learned that you never know what a genuine offering of kindness and just simply showing up for someone on a dark day could do.
**Blog By Nikki Moore**
Follow along Nikki’s journey at https://www.livemooreco.com/
Scott Wilson – https://www.wilsonaxpe.com/
Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2012). Burnout in mental health services: A review of the problem and its remediation. Administration and Policy in Mental Health and Mental Health Services Research, 39(5), 341-352. doi:10.1007/s10488-011-0352-1.
Norcross, J. C., & VandenBos, G. R. (2018). Leaving it at the office: A guide to psychotherapist self-care. New York: The Guilford Press.
Sherin, J. E., & Nemeroff, C. B. (2011). Post-traumatic stress disorder: The neurobiological impact of psychological trauma. Dialogues in Clinical Neuroscience, 13(3), 263–278.