Does Self-Care Mean Others Don’t?

In the responses to my post yesterday, Self-Care and Trauma Survivors, a commenter raised such good points it inspired me to write more about the complexities of self-care as part of trauma therapy.

Imagine your therapist introduces the topic of self-care, or assesses how you currently handle strong negative feelings or times of crisis. How would you interpret this sort of intervention? Does it mean your therapist doesn’t care? That others can’t care for or comfort you? Is it a kind of passing the buck? Do specific coping behaviors feel trivial compared to the magnitude of your pain?

The following comment describes one type of reaction trauma survivors may have:

Since you are a therapist, I want to tell you something since I know for sure that I am not the only abuse survivor who has ever experienced this. In the past when I heard about ‘self-care’, I interpreted that as, “No one else wants you or really cares what happens to you. Not even me, your therapist who claims to want your trust. Go away and take care of YOURSELF alone. Because you’re disgusting and no one else wants you or cares about you. You’re on your own. Don’t come crying to me when you have a flashback. I don’t care if you are trapped in the closet hugging a pile of smelly shoes for comfort. If that’s all you have, then that’s all you deserve. Get away from me and stop your sniveling, you wretched freak. A mindful bubble bath is plenty good to erase your trauma. Now go away and take care of yourself alone. I can’t stand your bleeding. GO DIE OUTSIDE. I can’t have your filthy blood on my carpet.

I would bet this is nothing like what most therapists mean to convey when they talk about self-care! Without feedback, they may indeed remain clueless about why this intervention is going over like a lead balloon! So how does this happen? How does this sort of difference in perception between client and therapist occur?

The psychodynamic part of my training gives me a way to understand this sort of miscommunication.  I approach therapy with the theoretical understanding that our current day relationships and interactions are also colored by our past experiences. We all have different filters through which we see the world.

Many trauma survivors are coming into therapy with the expectation that the therapist will treat them as poorly as others in the past did. This is their default filter. As a trauma-informed therapist I am well aware of this; that survivors may not understand the intention behind my actions, or may not assume that my intentions are good. Why would they?  This was not their lived experience!

The idea that how clients react to the therapist can be about their past experiences in no way means it is only about the past. As a therapist am also responsible for looking at my own behavior and learning how to best communicate what I mean with each individual. One part of the job of therapy is to sort out the past from the present. I highly encourage clients to express their reactions to therapy interventions and the therapist her/himself as a valuable part of this process. Sorting out the past from the present is part of the work of therapy. Is your therapist uncaring and minimizing of your experience or did someone in the past treat you that way?

After over 20 years of practice I am not surprised but I am still saddened at the reminder that expecting disregard is the default for many trauma survivors.  I think it is crucial for trauma therapists to spell out that which they take as a given: that they are coming from a place of caring and concern, that self-care activities are just one tool of many to help you along your healing path, that no one self-care action will erase all your pain.

Sometimes when I work with clients on making a list of comforting. pleasurable activities that they can engage in in times of emotional distress, I can tell they are perceiving this as minimizing. I try to give the context, that this is one tool, one small step that can add up to feeling better over time. I also think it is important to add contact with safe others and/or the therapist, to convey the message that self-care happens in the context of a larger circle of support.

This sort of reaction reminds me that many survivors are prone to black or white, either or thinking. Again, this is a natural part of the aftermath of complex trauma. It is not your fault, but it is something you can learn to overcome. In therapy, we can work on the “ands”: your therapist can care for you and you can learn to take better care of yourself, you can engage in self-care and form healthy, caring relationships with others.

Trauma survivors have every right to want, desire and expect to feel connection, caring and comfort in the therapeutic relationship. Every human needs this kind of connection! I truly believe that that is the foundation from which all other trauma therapy work occurs.

There is another important message I want to share regarding healing: your therapist cannot do it alone. No amount of caring alone, by your therapist (or anyone in the present), will heal you. Positive connection can and will help. Your therapist caring and providing comfort can and will help. In addition, there are small, tangible things you can learn to do every day that will help as well. It is very much a team effort. Some adult survivors may have the understandable wish (often unconscious) that someone will finally care enough to rescue them in the ways they were not cared for or rescued as a child. If only it could work that way! Healing can and does happen. It happens when you have positive connections in the present and learn the skills you need to cope with and process trauma in order to live a life that is meaningful to you.

Kathleen Young, Psy.D.


 

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26 Responses to Does Self-Care Mean Others Don’t?

  1. Kristin says:

    Thank you for this post. My reaction isn’t quite that strong as the one mentioned, but it is hard (and terribly frustrating) to finally speak the words to describe the amount of fear and pain that are not only always present, but building in times of stress — then to hear “Take a bubble bath, a walk, sunggle with your cat, read a book, go have coffee”. Uh…. I know better now, but I still get in to those dark times where hearing that is about the worst thing in the world. And i think something like “Well f-” to myself, stuff it all back in, try to pretend i didn’t just spill some of the dark out, and then wonder why i’m a wreck at home and seem to not be able to do anything about it. Perhaps your explanation would help soften that (seemingly) blow a bit. My first idea when I started therapy was “you’re the professional/dr/therapist – fix it! Make it better!” Like a wound or broken bone. It takes a lot of time (for me anyway) to realize that isn’t how it works. And to stop seeing “Self care” as “get rid” of me.

    • I really appreciate your comment, Kristin!

      It makes me think about how timing really makes such a difference! I would hope in the situation you describe I would first make explicit to the client that I am so glad they are sharing their experience, how valuable that is in itself.

      I think we as therapists can sometimes be so immersed in what we are so familiar with that we forget it is not so familiar to others. It totally makes sense that a client might come in expecting the professional to make it better! It is our job to educate about how therapy works, how it involves a collaboration instead.

  2. Anonymous says:

    I had a similar reaction when my therapist suggested that I reassure myself after a reexperience! My immediate thought was, “I was stupid to even ask for help to begin with, since nobody ever wants to give it. I should just shut up.” Luckily I have a good relationship with my therapist and we talked about it often enough that I could see how he meant I could both get help from him and give it to myself.

    The programming from trauma and abuse is powerful, but my own voice (I am finding) is strong, too.

  3. nobody says:

    This is helpful, but it would be nice if you could address the flipside. As a survivor of twenty-some years of trauma with an advanced degree in brainstuff, I get the therapist end of things. I get talking about selfcare and all that. And I get that to deal with my trauma I’ve got to take some initiative and do things for myself. That’s really never been an issue for me and I’ve always understood why therapists talk about self care. It’s empowering. But my endless frustration is from being blown off from lots of people in my life who think that my therapist should fix everything 100% in her office with no behavior changes on my part or, god forbid, discussion of my needs as they relate to the world at large.

    People don’t seem to understand that therapy is work. And they don’t understand that therapy is going to lead to changes outside of the office. And they don’t understand that my therapist might give me homework. Or that the best step I can take in my healing is, for example, confronting a friend for engaging in victim-blaming behavior. The expectation is that I should spend countless sessions whining about my friend’s victim-blaming behavior to my therapist and then presumably I wouldn’t care a whit if my friend victim-blamed. I honestly would deal a whole lot better with “no, I just get a rise out of bullying people so I’m not going to stop” a lot more easily than I deal with “how horrible of you to expect me to stop bullying you. And how dare you raise the issue with me because I want to pretend that my bullying doesn’t really hurt you that bad! You should go get your therapist to wave her magic wand and make bullying not bother you.”

    I know how to deal with a lot of things, but I don’t know how to deal with the popular notion that my therapist has super-powers. It means I can’t confront people who need confronting. It means people with toxic behaviors don’t need to change them because my therapist will use her magic to make me feel better about the entire proceedings. How does one deal with this?

    • Ah yes, the myths and misconceptions about therapy! Some people think there is a quick fix magic wand, others think it is completely useless.

      I think all we can do is attempt to educate those in our lives about what therapy is and isn’t. I think we also get to decide who is worth having those conversations with. If someone in your life repeatedly says/does things that feel hurtful and invalidating it may be time to re-evaluate that relationship.

      I have touched on this topic in this post

      It may be worth writing more about in the future!

  4. Anon says:

    Dr. Young,

    Thank you for this post in response to my comment. It’s very well written. I just want to mention that sometimes reactions like mine can be from mixed sources (which makes it more difficult for the client to figure out what’s going on). Of course my childhood left me feeling pretty worthless already, but I was actually mostly correct in the moment about my therapist’s meaning with certain things he would say about self-care, etc. One day I was crying because of an assault and he yelled at me, cut short our appointment and cancelled our next appointment on the spot and said some very damaging and hurtful things to me. He abandoned me in the middle of a crisis of memory. It was not until that incident that any talk of self-care began having such extreme negative meaning for me. To make matters worse, I dissociated what he did to me that day and after that it was often a very angry insider who presented for therapy so he could yell at and insult the therapist and I felt like a lunatic because I didn’t understand what was going on until a year and a half later when I remembered that awful day with the therapist. He apologized, but the damage was done. I can’t get over what he did to me. I still have flashbacks from it.

    I just want to point out that if someone feels this kind of extreme reaction to self-care suggestions it is possible for some that those feelings might be coming partly from something that actually has to do with therapy, whether it be the present one or a past one. Some therapists have not done their own work and they use self-care as a weapon to ward off their own material and this can have devastating effects on the clients. Before the trauma with that therapist, I never had a therapist who went ANY further than self-care and relaxation and things that really did NOTHING to uncover and heal trauma. It seemed like they figured I could build my life around walks and baths and that should be good enough. :-) I was frustrated by those therapists and could never figure out just why it was that therapy never seemed to help me much, but I did not have an extreme reaction to them as what I explained having with the therapist who hurt me. What he did took something that was a frustration and turned it into a new trauma and it has really messed me up bad. My new therapist knows that I will probably get up and walk out if I hear anything about taking bubble baths, etc. He understands what happened to me with the last therapist and he has been considerate of it. Yet just tonight, when he spoke very kindly to the girl who got stomped on by the other therapist, her response was, “Leave me alone.” Considering what happened to me I think it is normal that I cringe (or curse) when I hear certain things. There ARE some therapists out there who really can’t help with trauma and they use self-care and other things as distractions to keep the client from working with traumatic material, not because the client can’t tolerate it, but because the therapist can’t. It’s been really frightening to realise the social constructs that have contributed to where I am right now. It makes me feel that the world is much more dangerous and unsavory than what I first thought (and I had a low opinion of the place to start with).

    I wish there were more therapists who are truly qualified to deal with trauma honestly. It’s very scary out here for those of us who have been hurt in therapy.

    • Anon-

      Thanks for continuing the conversation! I bet what you say resonates with others.

      You are completely right! Not every therapist is prepared to do complex trauma work with survivors. My wish is that they would acknowledge that and refer out! More damage can indeed be done by therapists who are not self-aware and able to acknowledge their limitations.

      So many people, some therapists included, are uncomfortable with the intensity of pain that is present for trauma survivors. I agree, the move to offer concrete coping skills may come from the therapist’s own discomfort. What you describe would understandably be retraumatizing! I think you are courageous indeed, to persevere with therapy after being hurt in that context.

      I also agree that if a client has a strong negative reaction to any technique or intervention it just isn’t going to work for them at that time. Seems obvious, huh? Some people can’t ever make use of deep breathing techniques, for example. Everyone is unique. Understanding the whys of the negative reaction is crucial.

      Thanks again for generating so much more conversation on this topic!

  5. Tom says:

    Thank you for this post, which resonates with me as many of your posts do. I know that I hear discussions of “self-care” as being less isolating when there is an acknowledgment that my therapist actually does care about me, within the frame of the therapeutic relationship. But there is in those conversations a big reminder of grief, too; it is too late for the people who were supposed to care to do that (even separate from whatever harm took place), and it will never happen. If that is happening, learning self-care can feel (to me anyway) like abandoning that hope, or being disloyal to those deep unmet needs. That, is hard.

    • Beautifully said, Tom.

      I think there is tremendous grief involved in this process, in learning to do that which should have been done for you so long ago.

      Thank you for adding this important piece to the subject!

  6. Freemartin says:

    Hi!

    I´m a struggling survivor of complex trauma (including structural dissociation), and I´d like to add one more detail to this interesting conversation. My perspective has this twisted second level of living with structural dissociation and its consequences.

    I was raised by my mother, who most probably suffers from structural dissociation as well. That led, naturally, to very unreliable care. At one time she was present and caring, and then, in a second, she was totally somewhere else. So I grew up with the idea that people tend to be emotionally available only at short intervals. They listen and connect for a couple of minutes (just enough for me to “open my wounds” and become vulnerable with those difficult emotions), and then I´m on my own. I learned to interpret subtle changes of emotional availability, and often that resulted in misinterpretations. I felt rejected by other people when no rejection actually took place. But it was crucial for me to anticipate those “you are on your own” -moments and be prepared for them.

    So, this has caused some problems with these self-care issues. I used to interpret every “you can help yourself” -suggestion as a signal of that emotional abandoning taking place. To me it meant that the therapist just switched to the “you are on your own, and I will take no measure to help you or even know what you are talking about” mode. It took me a really long time to realize that normal people don´t just stop knowing things.

    I guess the reasons why this self-care issue is problematic for many survivors are multiple and varying. But the theme of abandoning seems to be prominent in many comments. My case, in my point of view, somehow represents the tragedy of mental problems manifesting themselves in several generations and in all kinds of relationhips. This abandonment pattern is inherited and reproduced over and over again. It is very difficult to break that chain, or even form new possible interpretations and abilities to heal these wounds. And in the middle of all this, therapists often are given the role of the ever-unreliable and revictimizing person against whom it´s crucial to protect oneself. At least this is my own experience.

    I wish you all readers the very best, and hope that you´ll have the courage needed to confront these unbelievable challenges of healing traumatic issues, whether as survivors or as therapists. (And I also apologize for my English)

    Freemartin

  7. Freemartin-

    Thank you for a very nuanced addition to the conversation. You describe very well a type of early attachment problem that can pave the way for later relationship difficulties. It sounds like you have gained insight into this, knowing sometimes you perceive rejection when it is not intended for example.

    (your English is just fine, by the way!)

  8. Ezelle says:

    Wow – thank you so much for posting this. The ‘reaction trauma survivors may have’ except is EXACTLY what I’ve been interpreting my therapist as saying in my own therapy. This is something I may print out and take to my next therapy session to discuss because it puts so perfectly in to words everything I’ve been thinking.

    I’ve been doing a lot of self care, and both my therapist (I only know from what she tells me) and I have seen progress. As I’m sure a lot of complex trauma survivors have experienced, I’ve come to rely upon myself. I’ve been the only person I can trust and I’m not even that nice to myself but I’m at least predictable. Accepting help makes me very uneasy – I’ve actually fought my therapist on some of her interventions and I worry I’ve made her feel unappreciated. I try to explain I’m scared. There was one time she called to check in on me which I appreciated so much but she called right as I was walking out the door. I answered in a hurry thinking she was calling about a scheduling issue and her immediate question was ‘It sounds like you’re heading out somewhere’ and I said yes, then we talked and she checked in with me as I got on my way. The next time I saw her I thanked her for checking in and she brought up that I had been in a rush and added that she figured I ‘must not need her’. Which kind of hurt and since then I’ve felt like I’ve made her not want to care because I’ll just offend her.

    Another time she tried to assist me by setting up an appointment for me which was unfortunately a huge boundary violation for me, as having that kind of control over me has been related to some of my past trauma. I’d held the boundary softly for a while, saying a polite ‘no’ when she would try to extend her help in to the area and then one day she really felt it was warranted and set something up for me. I was so angry, I told her immediately I was frustrated with her and she couldn’t understand why. We had to talk about it for two sessions before I could work out that she was coming from a caring place (not an abusive, controlling, scary place which is where it felt to me emotionally). Still, I cognitively understand this situation but emotionally it has caused a big rupture in my therapy. I’m working through it and my therapist has apologized, promised not to do it again, explained to me that she understands the reason why I rejected this, etc. It still colors almost every session with a deeper haze of the suspicion I carry with me as a trauma survivor already.

    Anyhow, when my therapist talks about self-care I assume it is because she doesn’t want to extend any caring to me because I’ve ‘burned’ her in the past. I let her know this a couple of sessions ago and she really didn’t have anything to say. I’m not sure what she could have said. So I struggle with wanting to rely only on myself, realizing that I do need help and then further accepting help or care without being convinced it is something else. If we didn’t work on self-care I’d really be accepting no care at all (and it is so difficult to WANT to care for myself) but it helps me to feel like unlovable and rejected to know that self-care isn’t a supposed to be a substitute for all kinds of care in life.

    Thank you again for this article, it was so helpful to read and exactly what I needed right now.

    • Hi Ezelle-

      I am so glad you found this when you needed it too! I think it is a great idea to share it with your therapist.

      I think you are also bringing up a really important issue in trauma therapy. Some survivors have experienced “caring” that came in the form of boundary violations. I am not talking about the kind of obvious violations like physical or sexual abuse, but the more subtle emotional ones. Enmeshment, blurred emotional boundaries, feeling like someone is doing for you out of their own need not yours, these could be a few examples.

      That, like any other dynamic, can get replicated in therapy. It is why we therapists often feel it is so important to adhere to a consistent frame, consistent boundaries around how we interact. I think it is one thing that can help create a safe, different space in which to sort these issues out. There is a lot of middle ground between abandonment and feeling like your boundaries are being invaded. Somewhere in the middle is the kind of healthy connection that works for each individual.

      I am glad you are talking about these issues with your therapist! That is where the valuable work happens!

  9. KatieK says:

    I understand the role of “self-care” in the therapy process. I don’t have childhood trauma, but got nailed with nasty PTSD symptoms after an illness. I’m working with a wonderful therapist, but when she suggested “self-care” measures, I reminded her, “Reaching out for help IS self-care. There is only so much that bubble baths, books, and walks can do. Part of healing is connecting with others, and by my being here, I’m trying to do just that. ”

    Just some food for thought…

    • Thanks for sharing your thoughts, KatieK!

      Reaching out to others for help is very much self-care! And something many survivors have considerable difficulty doing. I am a big cheerleader for those who can and do!

  10. Ealasaid Witt says:

    Thank you for a wonderfully articulated reaction to what I perceive as the ‘lectures about self-care’. Since I am extraordinarily counterdependent and have a horrible time asking for any kind of help whatsoever, when I finally do muster the courage to ask for help, it’s usually for a very, very important reason. To get the ‘go do this or that’ gets interpreted as ‘your needs are an annoying intrusion. Stop bothering me’. I interpret this as unasked for advice about how to fix myself on my own. I have to learn that self care does not mean ‘do everything yourself and bother no one with your annoying needs.’

    • I appreciate your comment, Ealasaid.

      Yes, I am nodding with recognition reading this. Counterdependent is a great word to describe the reactions of some survivors to never having their needs adequately met. It really highlights how important it is for a therapist to get this, and to communicate an understanding of what asking for help means to the individual.

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  14. Excellent comment string with great contributions! Each one of you has further clarified the subject.
    Pointing out that the words “self-care” are absorbed into an emotional context totally different from the intention in which the words were spoken is brilliant. Clarifying this difference is essential to successful therapy.

    Black/white thinking intensifies all emotional issues. It informs the way “reality” shows up. Take for example: the underlying assumption that one person can and will survive and get his/her needs met while the other will be pushed into non-existence. This either/or assumption often lurks in the background after early trauma. Negotiating simple needs in relationship can show up as a life-and-death struggle.

    In the context of Care: Terror of dependency on the therapist can show up as a strong desire to push the therapist away. Note the absence of middle ground. B/W thinking supports the fantasy that suddenly you will be completely okay and not need anyone at all in any way–and in the meantime you cannot live without them. In this either/or experience, getting better is frightening because it may “mean” abandonment. Being able to do effective self-care can be threatening if it means losing the support of the therapist. In B/W land you do ALL of your care yourself or NONE of it.

    In early trauma, Mommy doesn’t exist if she is out of sight and earshot. The pain –under personal control–of removing one’s self in anger feels safer than the panic and uncertainty of potential abandonment. So rejecting the therapist may feel safer.

    Important to remember that no matter how healthy we are, we may enjoy and benefit from some on-going support, perhaps at a reduced frequency.

    Teresa

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