SocialWork.Career

Social Work Career Development Resources and More

You are here: Home / Education and Training / Got Triggered by Client in Therapy? Use Coping Tools!

Comments

  1. Amy Maricle says

    Hi Dorlee:

    This is a great post. Since you invited a comment on Google +, I thought I’d better share my lengthy response here.

    I want to preface my comments by saying that I am not quite sure if I have read the post correctly. Please clarify if I haven’t.

    Are they suggesting the therapist using these techniques in session while feeling triggered? Or is this for the therapist using during one’s own supervision or therapy? If it is meant to be used in session, I have some questions. If it’s meant for out of session, I feel it could be incredibly useful in helping a therapist work through his/her own emotional reactions to a client and teasing apart what part of her reaction is about the therapist herself and what is about the client.

    These are great resourcing, body based techniques. I feel like ideally these would be used in the context of therapy or supervision to help develop some resources for the therapist. For instance, the sacred place could be practiced outside of session and called upon in session.

    It does seem important to have some methods to use in session should we get surprised and find ourselves triggered, but if we are consistently triggered to the point that we need to use these techniques while in session, then I am not sure that treatment is going the way I would like. I believe that in order for sessions to be safe and productive, the client AND the therapist must feel safe with what is happening in the room. For example, if the client is verbally attacking the therapist, this is not safe for anyone. The therapist needs to intervene to somehow shift the dynamic.

    The client may pick the therapist’s discomfort up and also feel unsafe or feel that they are perpetrating on the therapist. How can the therapist hold the therapeutic space if she/he is so triggered that he must put so much energy into these visualization exercises? How can he be attentive?

    I am a strong believer in using self-as-instrument. This means being very aware and attentive to the therapist’s own internal responses in session. This also means the therapist has the insight to discriminate between her own issues and the client’s.

    I own too that it is natural as a therapist to have times where one’s own traumatic material gets called up. Again, I’m not sure if I am reading this wrong, or if it belongs in a larger context that speaks to the role of supervision, etc. However, I don’t think it’s appropriate for therapists to work with someone if they are consistently triggered by them and can’t focus most of their attention on the client and the work.

    If this came up for me in session with a client, I would want to talk with a supervisor about the following: Am I emotionally prepared to work on this issue without being triggered and be present?

    What about this client or session was so overwhelming for me? Has the client has dug too deep too quickly? Should I be helping to set some boundaries on how much and how quickly she shares?

    Or is some of my traumatic material getting called up? Am I holding appropriate boundaries with the client? Am I too involved? Do they remind me of someone? Can I work this through in supervision and/or therapy? Can I provide safe, quality care for this client?

    Part I….

  2. Amy Maricle says

    Part II:

    Will using some of these techniques in supervision outside of session offer me the resources I need in session to do the work in a present, boundaried, and relaxed way?

    In my own work with clients, when I have felt triggered, I have usually found that I need to examine some of the questions I stated above. Sometimes I need to make my boundaries less permeable. I may need to be very empathic, but not get “in the hole” with the client, or create a bit of a psychic bubble around myself with a client who is spewing a lot of anger or fear my way. I may need to change my expectations of progress, etc.

    I am curious what others have to say because for me being triggered in session speaks to needing to do some exploration around why I am getting triggered and what the best next steps might be. It always speaks to the need for supervision, and sometimes my own therapy work.

    I wonder how you read it, Dorlee? Thanks so much for engaging me in this thought provoking post. While I am not sure I will fully use these tools while in session, I may well use them outside, and call upon some aspect of them as a reminder about my goals in session.

    Cheers,

    Amy

  3. DorleeM says

    Hi Amy,

    Thanks so much for taking the time to share your thoughtful feedback and suggestions on triggers that may come up for us during our work with clients.

    You’ve raised many good questions/points… First, you’ve interpreted the grounding exercises correctly – they are indeed to be practiced outside of session so that they will only take up literally a second or two of our time to access if/when needed during a session.

    Second, that is an interesting idea – to actually employ these exercises within your own therapy session with your therapist. I suppose we could if we feel safer doing so for at least the beginning phase of our practice but it probably wouldn’t be practical to rely on our therapy sessions as where we engage in our practice tools.

    The way these exercises were presented was more of in a “do-it-yourself” approach from which you gain learnings that you then take to your therapist. The exercise > helps you see what your issue/unhealed wound is etc. plus you have a resource to use while working with the client.

    However, I must stress that these tools will only work in a quick way during a session if we’ve practiced using them a number of times (and are comfortable doing them) outside of session. If we’re still at the awkward/unsure stage of using these tools outside of session, they are likely to serve as a distraction etc during session.

    And yes – I completely agree – whenever there is consistently triggering situation/person, this is something to bring up in supervision and work on with our therapist. It is definitely an indication of something in need of attention and we do not want our issues to interfere with the work with our clients.

    I love the questions you’ve proposed for asking/figuring out what is going on when feeling triggered. Those are excellent ones to consider and review with one’s therapist or supervisor (vis a vis the goals for work with your client).

    I would perhaps add to the suggestions to also engage in mindfulness meditation on a regular basis – This helps in building one’s own self-awareness. You become more attuned to what you are feeling as well as what others are feeling and it gives you a pause to take in what others are saying before you respond.

    And your idea of perhaps just using the exercises outside of session may also be a useful method/tool… this would provide the learning (what is going on/triggering) and perhaps it would yield some of the additional strength of presence b/c of having done the extra work outside of session (plus now you’d have the knowledge of what to work on in supervision/therapy).

    Thanks so much for your thought-provoking questions and wonderful suggestions, Amy!

  5. Jackie Yun says

    Hello Dorlee,

    While your post is titled: “Got Triggered By Client in Therapy? Use Coping Tools!”, I can see this retitled to “Got Triggered By Your Staff in a 1-on-1? Use Coping Tools!”.

    Not only would the four CRM Resources for Therapists be helpful for an executive, manager or supervisor provided we practiced these; but your list of somatic responses is useful in pinpointing when we are being triggered. Many executives, managers and supervisors tend to be head people and consequently, we aren’t as attuned to our physical responses.

    Thank you for another post that is applicable for many, not just social workers.

    Jackie Yun

  6. DorleeM says

    Hi Jackie,

    Thanks so much for stopping by and sharing how you view the CRM Resources as also beneficial for executives, managers and supervisors outside the mental health arena.

    I hadn’t thought about extending these countertransference lessons to the general population but you are absolutely correct in noting that we all tend to sometimes react in ways that are atypical for ourselves with a particular person/situation… as a result of something that happened in our past… therefore I agree that it would benefit all professionals (regardless of what field they are in) to become more mindful of their reactions/thoughts, noting whether they have any of these triggers etc. (and applying these techniques, seeing a therapist etc.). This type of strategy is likely to assist anyone who is interested to become more effective in their interpersonal interactions as well as feel more whole inside.

    Thanks so much for #takingamoment to extend your leadership wisdom here and further developing this post!

    Warmly,
    Dorlee

  7. Andrea B. Goldberg, LCSW says

    Hi Dorlee,

    I enjoyed reading about Lisa Schwartz’s Comprehensive Resource Model and her approach to helping therapists when triggered by clients. Some of the exercises you described include an eye position component, which sounds like it comes from David Grand’s Brainspotting method, which makes sense since I believe Lisa Schwartz was once a Brainspotting trainer. The exercises also integrate ideas from somatic, ego state and other methods. I am a great believer in integrative treatment so this approach sounds appealing to me.

    I also liked Amy’s comments and your response. I particularly liked your suggestion regarding practicing mindfulness meditation. I have been taking an online course in Mindfulness and Psychotherapy with Ron Siegel through NICABM and we are reading the book by the same name by Ron Siegel and Chris Germer. In the book, they describe an equanimity practice developed by Chris Germer to use when triggered in session by situations we are powerless to control. The phrases to say to ourselves are as follows:
    Everyone is on his or her own life journey
    I am not the cause of my patient’s suffering, nor is it entirely within my power to alleviate it
    Though moments like this are difficult to bear, I may still try to help to the extent that I can

    All the best,
    Andrea

  8. DorleeM says

    Hi Andrea,

    You are spot on in identifying some of Lisa Schwartz’s CRM’s exercises as being associated with David Grand’s brainspotting method. In fact, one of Lisa’s recommendations was that we all get trained in brainspotting prior to taking her training to be fully prepared for our work with clients.

    Thank you for also pointing out the integrative aspect of these exercises – this characteristic is likely to enhance/contribute to their effectiveness.

    How wonderful that you are taking Ron Siegel’s mindfulness course. I wish I were taking it! Thank you for sharing Chris Gerner’s recommended equanimity practice. It is simple yet so powerful.

    It also reminds me of what Jack Kornfield had shared in a talk that he and Dan Siegel gave on a “Wise Heart and the Mindful Brain” – he had shared that the burdens of the world are too heavy for any one person to bear and to help us (and our clients) remember this, he suggested that we place somewhere in our offices, different symbols of religion representing g-d and to make a point of looking at this everyday before leaving the office.

    The one issue with the symbols is that this conflicts with certain beliefs in some religions. Therefore, I really like the practice you shared – it acknowledges our humanity without requiring symbolism.

    Thank you so much for your valuable additions to this post!

    Best wishes,
    Dorlee