Resourcing for Mental Health Workers
© 2005, 2006, 2007, 2008, 2009 by David A. Lillie, S.E.P., MUSABP
Abstract: All of us are aware of the need to prepare for a physically difficult event. Athletes who want to excel are very conscious of the need for proper rest, good diet, careful training that builds strength and/or speed without injury, and a positive mental attitude. These are all "resources" that give the athlete the best chance to perform well. In the same way, therapy sessions can involve extremes of emotion and mental work and are most likely to result in a positive outcome for the client when s/he is adequately resourced. Just as trying to perform an extreme sport without preparing can lead to injury, beginning work on a traumatic episode with an unresourced client can lead to retraumatization or injure the client-therapist relationship. This article reviews the spectrum of resources available and ways to allow clients to access them.
Introduction: The overall process or resourcing begins by connecting with clients in a warm, friendly, non-judgemental manner, interviewing them for their trauma and resource history (and/or a genogram), invoking the resources as needed before the therapy process deepens in each session, or during the session when clients lose contact or escalate towards overwhelm.
There are at least four general areas of resource that need to be considered for each client:
1. Physical 2. Mental 3. Spiritual 4. Relational
Each of these will be covered in more detail below.
1. Physical Resources
a. General Health
If a person is homeless, starving, cold or exhausted, don't try to get them to feel better about themselves -- help them find a home, a job, good food, warmer clothes, sleep. When the fundamental needs are met, then help them heal from their past.
Carefully consider the client's general appearance and demeanour. If there are outward signs of illness or exhaustion, ask questions to get more details about how they are doing. If they're ill, have them visit a doctor, work less, get more rest, etc.
Is the client eating sufficient, nourishing foods? Many mental and physical difficulties are caused by vitamin deficiencies (especially B vitamins), too much caffeine, too low (not eating enough or often enough) or too high blood sugar (eating too much refined sugar, candy, soft drinks, carbohydrates), not enough or too much water. Make sure the client (and yourself!) is eating a good diet, including varieties of fresh produce, protein, minimally processed/fast food, good oils (no fried foods or trans-fatty acids), good exercise and sunshine (or foods rich in Vitamin D). Large numbers of mental and physical health problems would go away if people would only eat well.
Is the client taking any prescribed medications? If they are not aware of the side effects of the drugs, check them out with a drug reference manual or on the web at a site like www.rxlist.com or www.drugs.com. Are the drugs affecting them so seriously that they can't process? Are they too activated to work without the help of a drug? Are they abusing alcohol or recreational drugs?
d. Sleep, dreams
How is the client sleeping? If they are apparently sleeping but awake exhausted, have them check for apnoea (air ways clog during sleep, low oxygen levels forces them awake with a gasp, then they return to sleep only to repeat cycle - sleep destroys short term memory and they forget what happened). Adequate sleep is one of the client's greatest resources. Education about the necessity of sleep, and changes to their work or childcare schedule may be needed.
What is the nature and content of their dreams? If the client is having nightmares that wake them up or prevent sleeping, it is important to deal with that as soon as possible. Also note if dream patterns have changed between sessions. Nightmares may indicate traumatic material that is ready to come into consciousness. Look for dreams that might be pleasurable or bring up humour or playfulness or other resources.
e. Living Conditions, work
What is the client's living situation? A stable, supportive home is a great resource. A stressful or frightening one can quickly undo healing work. Similarly, what is the client's work situation. Look for examples of pride or success in their work. If work is exacerbating their difficulties, try to help them improve the situation, and look for hobbies or other activities that are resourcing.
Many people are resourced by the outdoors. Walking, hiking, climbing, fishing, hunting, caving, swimming, skiing, boating, bird watching, wildflowers, and many other activities bring people pleasure, exercise and engagement. Asking the client to remember a place or activity that brings them joy or peace or sacredness will often bring up a special lake or valley or forest. In childhood there may be a tree or tree house, hiding place, room, and so forth that might invoke a place of safety. These are all powerful resources to invoke as needed.
g. Instinctual Defences
Humans have a variety of physical defence mechanisms to protect us from attacks and falls. An infant for example, can turn its head away when it doesn't like something being put in its mouth or doesn't like being held. Our body and head instinctively turn towards the source of a strange noise, then turn away and run from a threat, or approach and hug a friend. When something is thrown at us or we're attacked, our arms go up across our heads in a "ward off" movement. When we fall, our hand and arms automatically are spread out to catch the fall.
Often during a sudden trauma, there is no time for the defence to be activated, or in the case of abuse, using the defence might only intensify the abuse. In these cases the instincts have been disabled and the client will not have this resource to provide protection from subsequent events.
These defences can be assessed by the therapist and then retrained into action if disabled. For many traumas, therapy cannot proceed until the defences are restored.
2. Mental Resources
a. Safety (vs fearful, anxious)
The creation of a safe space is vital for therapeutic work. The room, furnishings, lighting, temperature and amount of space should be welcoming and comfortable for the client. The position of the client relative to the client should be checked out. If the client is willing, do a boundary survey and a proximity test to see what angle and distance between the therapist and client is most comfortable, then change your position to work, from that angle and distance.
For some clients, modifications to the setting or doing a small ritual to create a safe, contained space may be necessary before beginning trauma work.
Sometimes it may be necessary to work with the client on the floor in order to process larger movements or for their comfort. Since being on the floor may make the client feel more vulnerable, careful, sensitive checking with the client should precede and follow any movement from a chair to the floor. The therapist can also move to the floor at an appropriate distance to minimize the vulnerability.
Have the client visualize a safe place for them. Either one from their childhood or from the present or one newly created. For some clients, the therapy room may be the only safe place.
Another way to increase safety is to have the client visualize that they are surrounded by a protective sphere. Have them notice the sphere in detail and see where it is strong and where it seems weak. Have them bring in a resource to strengthen the weak areas -- objects (a sheet of steel, an oak tree, a person, etc.). Once the sphere is complete and safe, then proceed with the work.
b. Present (vs dissociated, distant)
Being present - experiencing and being able to report on what is currently happening in the body and the immediate surroundings - is an indication of an excellent state of resource. Being distant (off in another world or time), confused, lost, worried, etc. indicates poor resourcing and should be attended to before proceeding. There are effective techniques for helping to bring the client back to the present (breathing, grounding, orienting, etc.). After working on difficult or traumatic events, it is especially important to support presence in the client before ending the session. The orienting exercise is good for this purpose - have them slowly get a sense of Up, Down, Front, Back, Left, Right, Inside, Outside, Past, Future, Present.
c. Engaged (vs isolated, shut down)
When the client is not engaged, there may have or no response to your questions or greetings. In severe cases it may be necessary to hold a client's hand (assuming you have permission to touch) or make a noise to get their attention. Get them to stand up, move around, look outside, find something they like in the room or other activity to end the isolation.
d. Variety of emotions (vs stuck, depressed)
A well resourced, present, engaged client will be able to express humour, pleasure, fear, anger, and other emotions, and be able to flow from one to another. Attempting to engage them in a variety of ways will determine how resourced they are. When stuck in one emotion or showing no emotion, resource them before continuing.
e. Positive attitude (vs critical, negative, sceptical)
When a client is not present, they are operating from patterns created in the past, as sometimes evidenced by a critical, judgemental attitude. When presence and a non-judgemental attitude are modelled well by the therapist the client can be resourced -- N.B. it must be genuine.
f. Self esteem
Low self esteem may be obvious or hidden. One quick way to check the level of self esteem or worth is to ask the client to list several things they like about themselves. If they can't come up with any, or immediately begin crying or shut down, you know there's much to explore in this area. The internalization of oppression and years of criticism and blame result in well-defended patterns. To get around them, the therapist needs to get to know the client well. Learn enough of their history (see life story below) to know what their strengths and talents really are, and use those resources to remind them of good things that they've done, other people that they've helped, awards that they've won (or should have won, etc.). An exercise that can be very helpful in improving self esteem is to have the client remember a time when they clearly felt love for another person (or if no person, an object or pet, etc.). When that feeling is clear and strong, then have them turn it back on themselves and feel it coming back in.
How sensitive is the client to what's going on around them and inside them? Numbness or hypersensitivity can be "normalized" by letting the client know that the way they are has helped them to survive, and that it was smart to do what they did (shutdown or become very aware) under the circumstances they faced, turning what may have been perceived as a fault into a resource.
Hope has been defined as "seeing a clear path to a desired outcome." When this type of hope is present, it is a strong resource in the face of current difficulties. The more you can help a client see that things will not always be this bad, that they CAN change, that healing is possible, the more resourced they will be. On the other hand, giving false hope where no change is possible can be disastrous, destroying trust and credibility.
3. Spiritual Resources
A deep sense of spirituality can be a great resource. When a client, from a very young age, has been neglected or abused by humans who were supposed to love and care for them, a spiritual connection - something larger than human relations - might be the only thing which can provide enough resource to allow such a deep wound to be healed. Thus it is important to determine what spiritual resources the client has and use them.
Belonging to a particular religious group can provide great resources: a sense of community, comfort and help in times of illness, grief or need, and a structured belief system in which one can have a place. Guardian angels, Saints, spirits, and prayers for help and guidance can all be excellent resources.
b. Sense of larger self
For those without a strong religious connection, there may be a sense of a larger self. Something that may consist of the sum of past lives, or of a spiritual force that helps that person. It can be a resource for the client to pray to, or ask for help and guidance from.
c. Connection to Earth - Universe
Others, through a love of nature or the environment, may feel a connection to the Earth or the Universe. They may find resources in being outdoors, noticing plants and animals, the seasons, the stars, a sense of being connected to everything from this life, to their ancestors, to the beginning of life, to the beginning of the universe. They might appreciate the knowledge that we all contain iron in our blood, and iron is only created by a collapsing star which creates a supernova. We are made of stars!
d. Sense of spirit
Many indigenous peoples have a sense of spirit, the great Creator of all things. They might have prayer circles, sweat lodges or many other rituals which are resourcing.
Meditating may be resourcing to people with no particular spiritual connection or as part of a religious practice. For many clients, beginning a session with a few minutes of meditation or some other ritual to create sacred space can be very resourcing.
f. Connection to humanity
For those with no proclaimed connection to a sense of spirituality, there may still be a sense of connection with humanity as a whole. This resource consists of all our ancestors and the great tree of life which includes all humans (we are all 8th cousins or closer, and all came from a common mother, probably in Africa, about 250,000 years ago). There are many people who, because of their wounding, have injured or neglected other people. However, there are still billions of people who are loving and take good care of their children and their relatives.
4. Relational Resources
It has been said that all of life is dependent on relationship. Our relationship with the earth and its plants and animals and water is fundamental to our survival. We are social animals, and if we don't receive love and attention from SOMEONE when we are born, we'll die. Relationships provide some of the strongest resources.
Having a partner, whether through marriage or living together or dating, can be a great resource. These close relationships, however, also bring up all the differences in how we were raised. Our patterns may clash, leading to great difficulties and much therapy. Where the relationship is not the issue, find the resources in it that can be promoted and utilised.
Like partners, families can be a great resource or very difficult and damaging. In difficult families, look for any member(s) who is a resource for the client - parents, grandparents, aunts, uncles, cousins, even good friends of the family. Note that often there are systemic difficulties or secrets in the family (such as miscarriages, abortions, murders, suicides, institutionalized relatives). When these are cleared up (with Hellinger or family system work), the family can prove to be a powerful resource for the client.
Friends can be an even better resource than family, since we choose our friends. The lack of any friends is a sign of isolation and needs to be addressed as a high priority. Look for past friends, connection with someone that was meaningful. Pets can also be good friends and big resources.
d. School or Work relationships
Since we spend so much time at school and work, relationships there can be great resources. The loss of work friends when a job is lost or changed can be quite traumatic, but may not be recognized by the client. It is important to continue with some of the old job relationships at least until new ones can be formed. Look for old school and/or work connections that are still active, or dormant but activatable. Someone who played on a sports team or musical group may still be significant to the client.
Church relationships may often be overlooked as resources. Good connections with the leaders of the church, taking part in church groups, performing music, taking leadership, doing charitable work -- all can be resourcing.
Many people find joy in taking part in community activities. Organizing functions, taking part in politics, attending meetings, going on walks with a club, having connections in a local pub, playing games or attending sports, and so on can all be resourcing.
At the very least, the client needs to have a trusting, resourcing relationship with the therapist. There may be times that in the client's perception, there is no one else in the world that cares about them. The degree to which the therapist can resource the client while carefully maintaining therapeutic boundaries can make a significant difference to the healing process. To do this clearly, the therapist needs to have done a great deal of their own processing on relationship issues. As the treatment continues, always look for ways to build additional resources outside the client-therapist relationship.
How to Bring Resource to a Client
a. Contact, Human Connection, Dress/Adornment
Your first contact with a client may be the most important in terms of creating a relationship that will last. When you connect in a way that resources the client, they will more likely feel safe and comfortable with you. Look for ways in which they dress or wear jewellery or other adornment, and after exchanging greetings and welcoming them, ask a leading question of interest about them. Examples:
• That's an interesting pendant; I've never seen one like it before. Does it have a particular meaning?
• I notice your tee shirt says Mt. Snowdon on it. Have you climbed it?
b. Current emotional state, life story/timeline/genogram
Ask the client about their current state, tell the truth if you notice that they're upset, but check your perceptions out by asking the client. "Have you been crying?" "You look excited today. What is going on?" Being genuinely interested in someone is resourcing. If you cannot care for and show delight with someone because of their appearance, ethnic group or other identity -- work on it!
As appropriate, show interest in and have them tell you a brief story of their life. This will give you a wealth of information about them, especially if you can notice expressions or tone of voice that indicate an earlier (or older) age than they are, self-deprecations, subtle indications of pain/regret, and pieces/ages that are left out. A big clue is something like "I don't remember anything before age 10," reported in an off-handed and minimizing fashion.
If the client has difficulty with telling the story, you can also try to develop (with your help) a timeline of significant events in their lives. Be sure to get both positive events which indicate resources as well as difficult events. Another tool is a genogram - a diagram of their family connections - showing the quality of connections with various family members. Go back at least to Grandparents and include all family members - including miscarriages and abortions, suicides, "left out" members, multiple spouses and parents and so on. If the client becomes activated or has difficulty doing this, stop and let them process. As you get information later that they forgot to include, go back and keep the timeline and genogram up to date. Highlight the resources in some way so you can quickly access them when needed.
For well resourced clients, have them do the timeline and genogram and perhaps life story as homework for the next session.
If you're not familiar with genograms and their uses, here are 3 good references:
1. Genograms: Assessment and Intervention (Norton Professional Books) -- by Monica McGoldrick, et al; Paperback $21.95 Used: $18.00
2. Genograms-- by Emily Marlin; Paperback: $11.53 Used: $1.78
3. Focused Genograms: Intergenerational Assessment of Individuals, Couples, and Families -- by Rita Demaria, et al; Paperback: $31.95 Used: $22.40
c. Listening with empathy
Marshal Rosenberg wrote a book called Non-Violent Communication - A Language of Compassion which is well worth reading. This has started an entire movement which often provides trainings and workshops. Using these techniques, you not only learn to listen well to a client, but also express empathy that shows you understand what they're saying. This is very resourcing for the client.
d. Trauma and Resource History
If you are planning on doing any work on traumatic material (anytime the nervous system was overwhelmed), it is imperative that you get the history of traumas that the client has suffered. It is also an excellent tool for any type of therapy, and can be included or noted with the client's life story and/or timeline.
Note that traumas can include: surgery with ether, early or recent surgery, electric shock, hallucinogens, drowning, suffocation, foetal distress (hypoxia/hypercarbia, traumatic birth, circumcision, intrauterine toxicity, invasive procedures in utero, etc.), inescapable attack: rape, attack by wild animals, war (often including bombing situations, loud noise), physical abuse, incest, molestation, anaesthesia, burns, poison, hospitalizations (particularly prolonged); wounds (stabbings, gunshot etc.) are a combination of inescapable attack and physical injury, falls, high impact accidents, head injury, anytime you quickly lose your ability to defend yourself, severe neglect and abandonment, severe loss, ongoing abuse such as by a family member, earthquakes, fires, tornadoes, floods, social dislocation from the natural world and community, seeing an accident, especially with blood/gore; watching someone else be abused, raped, killed or tortured, killing or hurting someone yourself, war torture, repeated rape in war, concentration camps, ritual abuse where there is repeated abuse in a ritualized atmosphere, often with the person drugged, car/motorcycle/horse/farm accidents, sports injuries, dental work, training for war.
• The trauma history should also include any resources that the client remembers around the time of the trauma. The trauma history should start from the present and work backwards (less likely to restimulate the client) and should include:
o The approximate date or age of the client.
o A brief description of the incident (don't let them get into a long description or they might become activated), for example "car accident, broke right arm," "fell off roof, hit head, knocked out."
o For each big item - "You survived, what got you through it?" or "Who was there to help you" or similar words to discover resources (if any) at the time of the incident.
• Go all the way back to birth, and before, if they know any of the story of the gestation. If someone is still alive who remembers the birth, have the client interview them to get the details if they can. If they can listen with empathy to their mother talk about it, she may get some healing as well.
Don't be surprised if the client lists only a few traumas, and then after doing some work, they remember more. In one case, the client started out with 3 traumas. After a year of treatment, they had remembered 106!
e. Resource in the past, at the time of wounding or trauma
A client needs to have sufficient resources to begin any kind of process work, but when you're going to work on a traumatic event, they will tend to re-experience the event as if they were back in time. Therefore, the best kind of resource is one that existed at that time. If you can, always begin a session of this type getting them in their body and resourced in the time of the trauma. For example, a client had a traumatic event in a hospital. When asked if there was anything he liked about the hospital, he said that the best thing was that his dad would always take him to his favourite ice cream shop which was across the street from the hospital and get him a big sundae. The therapist then had him close his eyes, get an image of the shop, go inside, describe what it looked like and how the sundaes were served, and see if he could taste the ice cream. After a few minutes of this, he was smiling and ready to go into the trauma work.
If a client begins to become too activated, direct them back to a resource -- in the example above, the client could be directed to seeing his dad beside him, or to go back in the ice cream store for awhile. A good resource history is vital for these occasions.
f. Reversal of developmental wounding
When a client did not complete some part of childhood development (didn't attach to a parent or other caregiver, never crawled, wasn't allowed to run, wasn't allowed to cry, etc.) it is important to allow these developments to be completed in order for the client to have these basic resources. Therapy may proceed for awhile and then become "stuck" until this resource is restored.
In addition, when traumatized and instinctual responses such as orienting towards the danger or putting up hands to ward off blows or putting out hand and arm to catch a fall did not have time to complete, the client may not be able to access those defences. It is vital to test and restore these resources before attempting to work on the event that caused this deficit. In general the client has to have the fundamental resource of self defence to go into a traumatic event without overwhelm.
Many people spend most of their time on intellectual activities and rarely do activities that allow them to deeply experience their bodies. Just as the instinctual defences are stored in the body and may require practice to re-activate them, it may be necessary to help clients learn to "get into" their bodies and relearn to appreciate subtle sensations and movements, the quality of breath, the pleasure of gestures, the wide variety of internal sensations and feelings, etc. This can greatly resource the client in doing work on traumas. They may also need to extend their vocabulary to describe internal and external events.
Fear is a great disabler. People are weaker when they are afraid. They become terrorized when something is happening to them and they don't know what it is. They fear they are "going crazy" or that they're so weird no one will want to be around them. Anytime you can explain how, why and what is happening to them in simple language, connect them with many others who have experienced the same thing, show them that you do not and will not reject them because of their behaviour, etc., the more you will build resources for that client.
i. Dual Activation, Anchoring
When a client is feeling well resourced, Dual Activation, as practiced with EMDR, can be used to strengthen that body state. Anchoring is another way of connecting a resourced state with touch at a special place and then recalling it later when needed. See NLP books or articles to learn about anchoring.
People are amazing and complex. Enjoy finding creative ways of building resource in yourself and clients.
ABOUT DAVID A. LILLIE
David has had an interest in healing traumatic wounds since 1988, when he discovered Re-evaluation Counseling® (RC) which he continues to study and practice. This led him to study Somatic Experiencing® (SE) with Dr. Peter Levine and others for five years, receiving an SE Practitioner Certificate, and also took Level I EMDR training in January, 2003, developing expertise in this form of treatment through many sessions with clients. Contact David at
amuart at eircom.net (replace at with @)
Return to http://www.amuart.com
Last Updated 4 June 1009