This week was rough. My mental health took a toll on me.
I recently transitioned between jobs. I was working two counseling jobs, easily adding up to sixty hours a week. This was all while experiencing an ongoing battle with family conflict and medical issues (fibromyalgia). I just could not keep up with it like I used to be able to. I had to make a change. I left full-time job working with young adults experiencing psychosis. I ended up picking up more hours at my part-time position doing in-home counseling with children. However, another conundrum popped up with this switch.
In the state of New Jersey, I am licensed as an “associate counselor,” meaning I am not quite a full fledge mental health counselor yet. For those of you not in the mental health field, this means I require a supervisor to monitor my counseling skills for 4500 hours before I can completely leave the nest for private practice. My present supervisor is the director at my former full-time position, and she informed that I need to be working for her agency to continue receiving supervision. However, you can receive supervision outside of your workplace, but usually those supervisors want to be paid for their time. I do not blame them one bit because you need a special certification and extra graduate-level courses in New Jersey to be a supervisor. On top of that, one-on-one supervision is an hour weekly. Therefore, the supervisor must set aside that time for you in place of other work (i.e. seeing a client). My wallet went into the fetal position after doing a little bit of research though. The prices I saw ranged anywhere from $100-$180 per hour to be supervised. Ouch.
My current supervisor made me an offer. She offered me a per diem position on the crisis screening unit she oversees to continue receiving free supervision. I simply needed to complete a few training shifts on the unit and then work one shift every sixty days to remain active as an agency employee. It sounded easy enough and like a no-brainer.
A little over a week later, I started picking up more cases with the in-home counseling and scheduled four training shifts on the crisis units spread out over the course of two weeks. Let me say this. I knew that making this change was not going to be easy. The position I left working with young adults with psychosis was literally my dream job. Leaving this job was heartbreaking to begin with. Luckily, I already had a good handle on my part-time job. The only part I figured I would struggle with was being organized and developing a schedule since most of my appointments would be nights and weekends. I was also familiar with about three quarters of the paperwork on the crisis unit since it was the same from my last position. It was still a transition that would take some getting used to though. I had to keep that in mind.
I woke up early that Friday (early being before ten in the morning). I drove to the hospital in preparation for my first training shift. When I arrived, lady luck really did seem to be on my side. One of my best friends was working the same shift when she typically works overnights. The shift manager greeted me cordially and provided a brief synopsis of what to expect. She then paired me up with my friend.
The first hour or two went smoothly. My friend reviewed the paperwork and process with me. She then brought me down to the emergency room where a young man having a psychotic break was sitting in the hallway with his mother. He had expressed suicidal ideations and homicidal thoughts towards his mother. To say the least, this young man was not going home, and he did not want to hear that. When we brought him onto the actual crisis unit to be monitored, he predictably grew irritable. This was when the fun began. The young man started cursing at us. He was threatening us. My friend and I walked out for a moment. She walked back into the young man’s room with four security guards to administer medication to calm him down. It required the young man to be put into restraints. I walked his mother outside into the hallway to comfort her and prevent her from seeing the incident. A few minute later, he was sleeping like a baby. I would be lying if I said I was not a little rattled, but I calmed down enough to get back to work.
A few hours passed. My friend told me that there was a gentleman in the emergency room that needed an assessment, but that it did not seem like he needed to be admitted. Looking over the file, the gentleman reported having a panic attack and pain. The doctor requested the assessment. My friend and I met with the gentleman who reported that he ran out of his Xanax and was hoping that a doctor would be able to prescribe him a short-term supply until he could see his doctor early the following week. We went back to the office and shook our heads in confusion. This guy was med-seeking, and I had two hours of paperwork for that.
I finished out the remainder of my shift and went home. I made it.
Everything was fine over the weekend. I went about my usual business. When Monday rolled around, it was a different story. My body was in excruciating pain. I attributed it to a nasty flare up of fibromyalgia. I slightly expected it to happen with the stress associated with the transition. Unfortunately, I had to call out of my next shift due to the pain. I barely left bed for the next few days.
Another peculiar trend emerged. I felt one of two ways throughout that week: numb or irritable. There was no in between. At first, I did not think much of it because I figured I was just having an “off” day. When a day turned into two, two into three, and so on, I knew something was wrong.
Even though I was not emotionally or mentally all there, my pain subsided over the next few days. I figured I would be ready for my next training shift the following Tuesday morning. That morning I woke with a jerk. My chest rising in rapid successions. My heart beating out of my chest. Several tears welled up on either eyelid. I was in a state of panic.
After a few minutes, I calmed myself back down to my baseline. Rational thought restored. I knew I could not go into a crisis setting when I was experiencing a minor crisis of my own. I immediately texted my supervisor to let her know that I would not be able to make it “due to stomach issues.” I was afraid of how she would respond to a mental health counselor saying he would be missing work due to mental health issues. She texted back quickly, “This is getting to be concerning. We will need to discuss this when you return.” At this point, I caught a case of the “f**k it’s.” I texted her back telling her the truth that I woke up in a state of panic and that I was unsure of the reason why. She offered a few suggestions on what to do. She followed them with a generic, yet appropriate, “Take care of yourself.”
I took conscious steps to do just that. I called my counselor’s office as soon as it opened at 9:00AM. I unfortunately to leave a voicemail, but her receptionist called me back within the hour. I was just trying to get an appointment within the next few days since my next appointment was not for nearly another week. Luckily, my counselor had an opening in the early afternoon. I jumped at the opportunity.
My counselor was shocked to see me because it was unusual for me to make an appointment out of nowhere. The second I opened my mouth I was realized how overwhelmed and confused I was. My counselor stopped me several times and broke it down area-by-area. We discussed work, family, finances, and dating since making this transition. As I broke it down, there came clarity. Most of the “bigger” issues started after my training shift on the crisis unit. The events that transpired (i.e. feeling numb/irritable, isolation, and the panic attack) were the result of a traumatic response.
I am a mental health counselor. How did I let a day on the job evolve into a trauma? I experienced what is called “vicarious” or “secondary” trauma. This is when someone has indirect exposure to a traumatic event through someone else’s firsthand experience or a narrative of the account (Vicarious Trauma, 2016). It can happen to anyone, but those in helping professions are more susceptible than most. We are in high stress environments surrounded by individuals who have likely experienced or are experiencing trauma. Other risk factors for vicarious trauma include one’s own trauma history and overextending one’s self beyond self-care and professional boundaries (Bloom, 2003).
Taking all these factors into account, yours truly created a perfect storm for vicarious trauma. I am already predisposed to be an anxious wreck given my history of panic attacks and rumination. My trauma history includes, but is not limited to the following: codependency, cheating, drugs, alcohol, house fire, psychiatric hospitalization, medical issues, bullying, nearly losing a parent, domestic violence, and poverty. Working in an outpatient setting, I can often separate my own issues from my clients. On the crisis unit though, you see individuals at their absolute worst and full of raw emotion. I could not “unplug” when I got home. I also did a little bit of math. I was still working the same number of hours as prior to the job switch, which completely defeated the purpose of the transition. I was overextending myself and dismissing my own self-care.
I made the decision to confront it head-on. I emailed my supervisor the following morning now that I had the chance to process what happened. I sent her the following message:
I know you said you would reach out to me tomorrow, but I just feel the need to put this out there because I am ruminating badly. I saw my counselor yesterday afternoon thankfully about what happened in the morning.
I was honestly in a lot of pain from the fibromyalgia last week when I called out of the training, but yesterday was due to what ended up being a panic attack. I apologize for initially saying “stomach issues,” but I was genuinely afraid of the reaction/stigma attached to saying anxiety. After I spoke with you in the morning, I ended up having chest pains practically all morning. I ended up having a similar experience this morning waking up again in a panic.
After talking to my counselor, it seems like a lot of my anxiety is coming from being in the crisis setting. I really don’t think I am cut out for it because it triggered a lot of vicarious trauma. I thought I could handle it. It was difficult for me to separate myself from the experience after I left, and I numbed my feelings for about a week after my initial training.
I am hoping that tomorrow we can discuss if there are any alternative options to working crisis. If not, it is totally okay, and I am more than appreciative of what you have done to help me. You are an amazing supervisor, and I have nothing but respect for you. However, I don’t want to risk my mental health over it.
I have to say I was proud of myself for the way I handled the situation. The good thing is that there are options to address and prevent vicarious trauma from occurring.
Self Inventory. Nobody knows us better than ourselves (except maybe for our moms). I can never emphasize the importance of simply checking in with yourself. There are formal assessments you can use, but this could be simply asking yourself, “How am I feeling?” The first step to fixing a problem is acknowledging it and bringing awareness to it.
Set Limits and Stick to Them. This includes emotional, mental, and physical limits. I personally separate my work from my home by going to a local café to write notes and review paperwork. I seldom do it at home. Work stays out of the home.
This could also include setting a maximum to how many people you see in a day, or varying the type of work throughout the day to not burnout. It could even just a mental or emotional boundary telling yourself that you will only experience specific feelings while at work and not take it home with you. Therefore, you are mentally separating yourself.
Reach Out. I purposely informed my supervisor of my vicarious trauma because I knew in the back of my mind that either she or another colleague of hers had been through this before. It is more common than we like to admit. It helps sometimes to know that you are just not alone in this. Reaching out also includes professional help of your own. Therapy allows designated time for an individual to focus on his or her own thoughts, experiences, and feelings.
Self-Care Plan. Often individuals who experienced vicarious trauma have difficulty separating themselves from the primary trauma. Engaging in one’s own self-care allows this opportunity. This includes basic self-care activities (i.e. eating right, sleep) to self-indulgence (special occasions). Self-care helps someone get back in touch with who they are and pull the focus off the vicarious trauma.
Don’t let secondary trauma make you forget who comes first.
-The Caring Counselor
References
Bloom, S. (2003). Vicarious Trauma. Retrieved from The Sanctuary Model: http://sanctuaryweb.com/TheSanctuaryModel/THESANCTUARYMODELFOURPILLARS/Pillar1SharedKnowledge/GROUPSUNDERSTRESS/WorkplaceStress/VicariousTrauma.aspx
Vicarious Trauma. (2016, July 14). Retrieved from GoodTherapy.org: https://www.goodtherapy.org/blog/psychpedia/vicarious-trauma
Wendt Center for Loss and Healing. (2018). For Professionals. Retrieved from Vicarious Trauma: https://www.wendtcenter.org/resources/for-professionals/