In the realm of trauma treatment, establishing and maintaining healthy boundaries with trauma clients is an indispensable cornerstone of the healing process. These healthy boundaries form a protective framework that fosters trust, safety, and empowerment, enabling clients and trauma treatment professionals the space to navigate the healing journey with greater clarity and stability. By clearly defining limits, roles, and expectations for themselves and clients, treatment professionals create a conducive environment where clients can openly explore their trauma, emotions, and vulnerabilities. There can be some challenges along the healing journey such as the trauma treatment professional being triggered by the client’s trauma story or the trauma treatment professional experiencing vicarious trauma or burnout. Even with these challenges, boundaries within the healing relationship can be a stabilizing force.
Before I go any further, let me say that I think sometimes the word boundaries is used to indicate some kind of rule that others have to follow. For me, I believe boundaries are filters that 1) allow in what is pleasant, supportive, and nurturing and 2) expel what is harmful, draining, and disruptive. With that definition in mind, boundaries with our clients can fall in a number of different areas. Below I will review a couple that might be helpful to be clear about before seeing your first trauma client. No worries if you have been in the field for many years… you can still consider the boundaries and make them your own. This of course is not an exhaustive list, but my hope is it will get you thinking.
Boundaries about Type of Clients
We don’t all work in an environment where we can choose our own caseload, but we can have conversations with our supervisors, intake director, etc. and share our desires. People are more likely to support our strengths if they know them.
Boundaries with Caseload
This is another tricky one when we don’t work for ourselves and can also be tricky when we are the boss. Being clear about how many clients you can see in a week to maintain your health is important. Again if you don’t have control, advocating for yourself and expressing your needs to your supervisor can be helpful. Sometimes having a mixture of presenting issues can help with this. A caseload of 35 is very different if they are not all heavy trauma cases.
Boundaries with Availability Outside of Session
I find this boundary moves based on how well I am managing other boundaries. If I am doing well sticking to other boundaries, I find I have more capacity to respond to outside session issues that might arise. Being clear about emergency protocol and what constitutes an emergency is important.
What are some boundaries you would like to establish with your clients?
Boundaries also can be helpful to you and your clients throughout the treatment process. One place that healthy boundaries can be helpful is when you notice signs of vicarious trauma or burnout showing up for you as the trauma treatment professional.
Over the years, I’ve come to learn my red flags when it comes to burnout and vicarious trauma. I have also learned to do things and not do other things that I know will put me at risk. I will share a couple of things I have learned to watch for.
Before I share my exact experiences, I want to say that one overall way of thinking about this is imagining myself as a mixing board that sound engineers work with. I imagine that I am constantly checking in with myself and noticing what needs attention or adjusting. I never just leave it alone, but I have come to understand this is a lifelong journey of taking care of myself. It has honestly become a lifestyle.
One telltale sign is increased irritability. I have also heard other colleagues talk about this too. Sometimes I know we can be a little shy to say we are irritated with our clients but if we can acknowledge it as information and be curious about it, it could be an indicator of need for rest and resourcing.
Another red flag that I will experience is feelings of not wanting to do the work. I will notice that I am dragging to get to work in the morning, or I am spending a good deal of my time in the evening thinking about how I don’t want to go to work the next day.
Lastly, I have noticed feeling consumed with thoughts about my clients’ situations outside of session. I may see signs of client content creeping up in my dreams or intrusive thoughts throughout the day.
These are not the only signs but just a few. We are all different, and we will also show signs of burnout and vicarious trauma differently. I think the best thing I could do for myself is learn my signs, identify them, and tend to them as soon as they appear.
Ways I have found to help myself move through burnout and vicarious trauma is re-engaging my healthy boundaries such as reducing and/or adjusting my caseload as soon as it is therapeutically appropriate, having a variety of things I am doing outside of direct services as my only source of income, and tracking and self-regulating in session when I am working with heavier client content.
What are your red flags for vicarious trauma or burnout?
I have also run into the situation where I am doing great self-care and sticking to my healthy boundaries, but I am still triggered by a client’s trauma story. I want to first say this will more than likely happen sometime in your career (or even multiple times). It can feel as if it came out of nowhere or sometimes you know the case will be a hard one. Sometimes our first thought is, “I need to refer this client out.” Or we wonder if we will be able to be effective. I want to encourage you to notice it and acknowledge it. Get some support and then set some non-negotiables that will help you know when and if it is time to refer.
The second thing I would like to say is learn to track what happens right before you notice you are triggered. For me, I can tell you I am about to be triggered before it happens. This skill can be helpful because it allows us the opportunity to interrupt the trauma response and quickly take care of ourselves in a way that helps us return to our role in the treatment process.
The third and final thing I will mention on this topic is to have a mentor or consultant that you can reach out to talk through these types of situations. A second set of eyes on the situation can be helpful to ensure that you are considering all the possible factors and making the best decision for all parties involved. I heard someone say the other day, “we can’t do this work alone.” I agree 100%.
Having support with maintaining your healthy boundaries in this situation is helpful. Sometimes when we are triggered, it is harder to maintain healthy boundaries because things might be a little murky. Bringing in support allows you to lean on another and examine your boundaries to see if they need to be adjusted or maybe even new ones need to be enlisted.
At Trauma Treatment Collective, we provide individual and group consults for trauma treatment providers. Consider joining us and letting us help support you in maintaining your healthy boundaries. Whether you are working at an agency, facility, or in private practice, treating trauma is intense work. I always recommend being intentional about creating a supportive community around you where you can feel seen, heard, and supported.
For each of us, this support could look different. Some of us find support in meeting with other trauma treatment professionals on a regular basis. Others find it helpful to have regular therapy/healing sessions of their own. Others enjoy disconnecting from work altogether and engaging with family or friends. Some of us appreciate mentorship and consultation on a regular basis. The list could go on and on.
Whatever the form, I think it is important to have social connection and support as a trauma treatment professional. This is not just my opinion but actual science as to why when you are supported, you can better support your clients.
In conclusion, the significance of maintaining healthy boundaries throughout the course of trauma treatment cannot be overstated. These boundaries serve as a compass to guide trauma treatment professionals and clients through the complexities of healing, promoting a sense of security and predictability in what may otherwise be an overwhelming process.