Influence of multimedia in the therapy room and beyond

Whilst only one participant talked about her experiences of using visual aids during her work, it had a significant bearing upon her psychological and physiological symptoms impacting on her sense of self. Susan disclosed her client had been involved in a high profile traumatic incident and she was working with him using trauma-focused CBT to address his resulting PTSD. Due to the case’s high profile, Susan and her client were able to look at footage of the incident on the internet, as well as on her client’s phone. It is not clear through Susan’s interview whether this action was client or therapist led and at what stage during the treatment this happened. She also does not specifically state whether the intention of this action was for general information gathering or exposure work. However, she didn’t believe she would have looked at the footage during an EMDR session as she didn’t consider it part of the treatment, which is suggestive that viewing the footage in Susan’s mind was part of her CBT exposure work.

(Susan) 65-71 … I think because we’d looked at the images on

the internet and then also looked at the footage that had been shot on his phone, it made it all more seem like as if I was there and also as well, with his kind of like, narrative, his dialogue about his experience of what the [pause]. When we were working through hot spots and updating hot spots, he was, there was two particular hot spots in particular within that, that were extremely distressing, extremely distressing. Those were the two hot spots that just kept kind of like popping back into my mind…

Susan’s extract clearly shows the action of viewing her client’s trauma footage personalised the trauma for her, as she literally placed herself in the position of the client. Susan talks about updating client hotspots (specific, emotionally distressing trauma memories, frozen in time). From her extract and use of repetition, these were not only distressing for the client to relive, but with the resulting disruptions to Susan’s imagery and memory systems crossing the boundaries of her professional and personal life and impacting upon her sense of self, it is clear Susan’s feelings echoed those of her client.

(Susan) 89-94 … I knew that it was kind of, really getting under

my skin if you like. Do you know what I mean? That’s the only phrase I can use. It’s like getting under my skin because as I said, I was thinking about it at home and as I said, I was waking up in

the morning sometimes thinking about it, and it was like, I was waking up, it was more than once that I was waking up thinking about it, so I knew that it was kind of, as I say, kind of like, gotten under my skin...

Susan’s metaphor of “getting under my skin”, clearly illustrates the effects of working with her client’s trauma as the haunting trauma images repeatedly played in her mind, permeating her outer layer through to her core and resulting in her emotional and cognitive changes.

5.1.2.4. Personal triggers and significant life events

Ten out of eleven participants discussed occasions where they have been personally triggered by client material. Seven found personal triggers or significant life events had impacted on their trauma work. These included becoming a parent, illness, family events, bereavement and moving locations. Particularly relevant to the theme of personal triggers upon those participants who disclosed they were parents themselves, was the impact to their sense of self when working with trauma narrative involving children.

(Paul) 106-9 … as a parent myself it’s like my worst nightmare thinking anything happening to my kids and so y’know, when you’re being empathic and you’re thinking [pause] “for fucks sake how mad must that be, to experience that”. Y’know? It’s then that it gets me…

From Paul’s extract, it is easy to deduce the strong emotional bond with his children in his role as a father. Described as his worst nightmare and reflective of Justin’s earlier feelings (page 103), the thought of anything happening to his children is inconceivable to Paul and painful and frightening to comprehend. However, when using empathy and walking alongside his client placing himself in their shoes, Paul’s vulnerability comes to the surface and he is touched on an emotional level. It is then that Paul, like Adrian (page 96), is caught in the clutches of ‘Trauma’ and rendered helpless to fend off the emotional impact as it ‘gets’ him.

Two participants identified changes within themselves as therapists since becoming parents. Justin and David were in agreement that although they both enjoy trauma work, they recognised their feelings of vulnerability have increased since becoming parents during their therapeutic career.

(David) 71-82 …I think I’m probably a bit more alert to danger

than I would normally be [………] I think it initially started with that [road traffic accidents] but I think it’s generalised actually and I think it’s increased since I’ve had children as well. I never used to have a problem y’know, but now with children I think it makes you more vulnerable [………]. I think in my experience of working with post-traumatic injuries, the irrational fear that people often have relate to those closest to them, okay? And my child, children would be one of the first things that comes into my mind, so it does play itself out like that…

Although David denied making any changes to his working practice resulting from any negative effects of his work, when asked about his personal life his extract points to a disparity between his identification with his former self and his current self since starting trauma work. David’s current self may be difficult for him to accept as he distances himself from his vulnerability by slipping into the second person. David’s identification with his lost self who “never used to

have a problem” leaks out when talking about being more alert to danger than

he “would normally be”. However, contradicting his statement, he goes on to describe his current experience as a generalised awareness of danger which has been heightened since becoming a parent, suggestive of a new ‘normal’ and changes to his meaning making. This is supported further by the disruptions to his sense of safety and irrational fears for himself and his children.

Justin also acknowledged the significant impact that becoming a father has had on his identity as a practicing therapist.

(Justin) 317-25…It makes a big difference and this is something

that I have been talking about in my own supervision. The difference of I guess experience. I don’t know if you have children yourself but to me for the first time experiencing that intense connection and just overwhelming love that you can only experience with a child of your own. I don’t know, maybe I’m wrong, but that’s my experience. Quite surprising really, something I knew but didn’t really feel or didn’t know what it was like to feel. [………] and yes, I’ve never had that before…

Justin’s use of supervision to support this change denotes an increase in his professional and personal vulnerability, heightened through his capacity as a father, from identifying on a much deeper level with clients he was previously unable to. He continued to talk about the influence of his own child on his trauma work when working with rape or abuse clients.

337-40 … it does really impact on my work so I think my passion has probably deepened when I’m working with people that have been through these things [rape/abuse]. So I’m more impassioned to give the best service I can for people with those kinds of presentations…

Justin has made sense of his changes since becoming a father and balanced his vulnerability by working harder for rape or abuse clients. Whether his passion has deepened due to the fact he is the father of a daughter or just because he is a father, is unclear. However, Justin’s drive and willingness to work harder to support victims of such crimes, fuels his passion for trauma work and supports his sense of self.

Jenny’s work with one client was interrupted for a brief period when her husband was admitted to hospital for planned surgery. Due to the nature of the client’s PTSD presentation resulting from surgical clinical negligence, Jenny felt unable to see her.

(Jenny) 102-3 … There was an awful lot of storytelling involved

and blow-by-blow narrative of how badly it had all gone wrong and that’s when I realised I can’t, I just can’t do this at this precise moment…

Although the effects were relatively short-term and Jenny was able to resume her work with her client as soon as her husband was discharged from hospital, her extract highlights the effect that personal triggers or significant life events have upon therapists during their work. Whilst this may have been a worrying time for Jenny in normal circumstances, her description and use of the metaphor “blow-by-blow” reinforces how hard-hitting listening to the details of her client’s trauma narrative was on her sense of self. Furthermore, Jenny’s use of language and repetition also signifies the level to which she found this particular presentation both frightening and unbearable to hear.

5.1.2.5. Negative psychological, physiological and behavioural changes to