Clinicians are charged with being diligent in gaining competency in the latest trauma-informed interventions when working with relational trauma. This may invest therapists with an overresponsibility that is not only overwhelming and unrealistic, but serves to reduce autonomous functioning in family members. Therefore, clinicians need to become clear about what they are responsible for and what they are not, particularly when family members present as irresponsible or too anxious to think and act more effectively. Using a case vignette, this paper discusses how a clinician's focus on increasing their differentiation of self, a concept embeded in Bowen family systems theory, protects against vicarious traumatisation, secondary traumatic stress, and burnout whilst contributing to more autonomous functioning and better wellbeing outcomes for both clinicians and clients alike.Keywords: vicarious trauma, secondary traumatic stress, burnout, Bowen family systems theory, self-care, resilience, autonomy
Key Points1 The trauma milieu demands increasing therapist commitment to ongoing and extensive training in a multiplicity of trauma-informed interventions. 2 The intensity of this work may leave clinicians vulnerable to vicarious traumatisation (VT), secondary traumatic stress (STS), and burnout. 3 A focus on enhancing the clinician's differentiation of self, based on Bowen family systems theory (BFST) principles, is imperative when managing issues of risk and safety. 4 BFST functions to protect against VT, STS, and burnout by assisting to reduce the heightened reactivity that is evoked when working with the most vulnerable and challenged families. 5 This focus enhances resiliency and contributes to more autonomous functioning and better wellbeing outcomes for both clinicians and clients.
Introduction: The Challenges of Relational Trauma WorkInformed by researchers such as Bryant et al. (2010), most clinicians working with trauma are aware that not all clients who have experienced prolonged exposure to overwhelming events develop post-traumatic stress disorder (PTSD), as diagnosed in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5). Nevertheless, many clients, particularly children and adolescents who have experienced relational disruption and abuse, present to therapy with 'a wide range of affective, anxiety, and behavioural symptoms ' (Bryant et al., 2010; Levin, Kleinman, & Adler, 2014, p. 150) (Porges, 2011;Siegel, 2012). They devote time and energy to gain competency in the latest evidenced-based trauma-informed interventions, which can include mindfulness, neurofeedback, eye movement desensitisation reprocessing (EMDR; Shapiro, 2001), tapping, and other exposure techniques designed to reduce symptomatology. Co-morbidity across mental health diagnoses for traumatised children and adults will also require practitioners to be able to assess and work with multiple mental health presentations, ranging from depression and anxiety to diagnosable personality disorders. In addition, clinician...