© 2018 Ruth Crowley Brown

 

Having a label to summarize an experience that is difficult to put into words can be therapeutic. Before the term Post-Traumatic Stress Disorder entered our vocabulary, it was much harder to recognize and address the psychological symptoms associated with traumatic experiences. Vicarious Trauma, another modern term, refers to the symptomatic thoughts, feelings, and behavior(s) that adversely affect our well-being, and whose origins often fly under the radar. Vicarious Trauma has been defined as: “the negative transformation in the helper that results (across time) from empathic engagement with trauma survivors and their traumatic material, combined with a commitment or responsibility to help them” (Pearlman and Caringi, Blue Knot Foundation). Indicators include: intrusive thoughts, excessive rumination that feels out of our conscious control, insomnia and anxiety, issues with patterns of eating (from skipping meals to comfort eating) and generally feeling low, irritable, and depleted. In addition, in terms of relating to clients and peers, we may feel under pressure regarding our professional boundaries, and find ourselves oscillating between over-involved/too close and under-involved/disconnected, or feeling stuck in one or the other of those limiting positions.

That emotions are “contagious” has been documented by neuroscience and psychoanalysis: the former in the exploration of mirror neurons, and the latter in the elaboration of the therapeutic transference. In everyday life we constantly pick-up on feelings from others – a sharp or distracted remark at home or at work can affect our mood, sometimes more than feels rational. Relationships with clients, which usually involve a high degree of commitment, are bound to have a marked impact.

The casework/therapeutic relationship involves a number of aspects – from bearing witness to the client’s painful emotional journey as they work through the grief associated with their trauma, to representing their interests (where appropriate) within the matrix of agency/government bureaucracy. Also, and perhaps more importantly, utilizing the interpersonal psychodynamic relationship to offer emotional holding and support, which in turn facilitates healing and integration, requires considerable “emotional labor” from the therapist.

Furthermore, there is the additional risk that any emotional correspondences, however vague, may trigger unresolved personal issues that have been lying low in the therapist’s own unconscious mind. This potential “double whammy” can institute brittle psychological defenses but also enhance empathy (albeit via identification). As seen here in various case studies, practitioners must often navigate these complex emotional landscapes while simultaneously managing the needs of their clients. The inner work required by practitioners to process such complexity and intensity can be significant, demanding both high-level internal skills (see below) and external resources, such as good supervision and peer support.

Growth and change for anyone – be they therapist or client – can be challenging, largely because human functioning is rooted in habit, which can be seen as, paradoxically, humanity’s greatest vulnerability as well as our greatest strength. Once a skill has been mastered it becomes automatic – saving us prime mental real estate to think about other things. But given that many of our key skills are learned during childhood (when our autopilot is shaped and colored by that time and place) inner conflicts can emerge between old habits and current needs, with old habits often winning out because they’ve become “automatized” and operate from deep within the neural networks of our unconscious mind. Sometimes these old “dinosaur” habits need updating or replacing if we are to truly thrive.

 

Stoicism and Cognitive Behavioral Therapy

There has recently been a resurgence of interest in some therapy circles in the ancient Greek philosophy of Stoicism that arose around 300BCE (the founding fathers of modern Cognitive Behavioural Therapy (CBT), Albert Ellis and Aaron T Beck, both attributed Stoic philosophy as a significant influence). Following Socrates, the Stoics believed that an “examined life” was crucial to countering akrasia – the ancient word for a “failure of the will.”

CBT revolutionized mental health treatment in the late twentieth century, partly by shifting perspective from content to process – in other words from what we’re thinking about (such as ruminating about particular dilemmas) to how we’re thinking (for example, recognizing when we’re being caught in a cognitive distortion such as “catastrophizing”). A similar shift in mental perspective was advocated by the Stoics. According to the French philosopher Pierre Hadot in Philosophy as a Way of Life, the Roman Emperor Marcus Aurelius implicitly elaborated a threestage Stoic method of self-exploration (akin to emotional journaling) in his second century AD Meditations.

 

A Stoic’s Approach to Self-Exploration

The Stoic’s first stage – the discipline of judgement – involves recognizing that the thoughts which automatically arise in our heads are not facts, but rather impressions, and should therefore be treated as hypothetical and potentially untrustworthy. This radical idea (that you can’t believe everything you think) is the same as CBT’s formulation of automatic thoughts that arise without conscious intent, and are attached to higher order cognitive distortions.

The second stage – the discipline of relating to natural causation – involves establishing exactly what is, and is not, within our personal control. The Stoics called this “dichotomy of control”

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(modern day psychologists refer to an internal or external “locus of control”). The Stoics concluded that the only thing that we can really control is our relationship to our own thoughts, feelings, and behavior. We can’t control the behavior of others, including clients or even close family members (with the exception perhaps of children of a certain age and temperament). Similarly, even our physical health is largely beyond our control (though a commitment to healthy living can make a difference). Substantial investment in external things, over which we have no direct control, therefore leads inexorably to misery, and the Stoics promoted developing an attitude of a “benign indifference” to such matters. This approach has obvious correspondences with the Serenity Prayer: God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

The third stage – the discipline of action – involves consciously deciding how to live one’s life by identifying specific “virtues” to follow. Rather than the ad hoc psychological inheritance from our family-of-origin or blindly following our passions or instincts – the Stoics believed that reasoningout virtuous guidelines to follow in the present moment lead to a more rational approach to life.

Four key Stoic virtues – courage, temperance, wisdom and justice – fall into three categories: emotional, cognitive and relational:

(i) Courage and Temperance: courage requires pushing forward in spite of feeling anxious, not letting fear hold one back; and temperance (or moderation) involves calming angry emotions, and expressing oneself without becoming defensive (e.g. using assertive communication rather than blaming and aggression).

(ii) Wisdom: involves learning from experience, self-knowledge and knowing one’s limits and capabilities (as in the Delphic oracle’s “Know Thyself”).

(iii) Justice: involves honesty and integrity, empathy, and a win/win mindset (it’s no coincidence that ancient Greece was the birthplace of democracy). Such inner deliberations can establish new default psychological templates for how to live a good life.

Before journeying deeper into the heart of Stoic strategies, let’s briefly reflect on the context. The ancient Greek philosophical academies were, surprisingly, structured more like monasteries than universities, as members needed to retreat from everyday life in order to develop the discipline to practice their new way of living. This was because these ancient Greeks also understood the challenge involved in changing long-established mental schemas. Stoicism actually stood out from its contemporaries (such as Epicureanism) because it was more open; rather than keeping their esoteric knowledge completely behind closed doors, Stoics sometimes met “under the porch” (stoa being the ancient Greek word for porch). But a high level of intensity and commitment was still required to achieve sustainable change

Stoicism and Mindfulness

Stoics aimed to develop two different skill sets which both hinged upon cognition (deliberate thinking) taking the lead role in functioning, by means of sustained conscious intention.

The first skill set involved actively engaging with mental processes to change behavior (as we’ve seen above with the three stages/disciplines). The following examples all draw on the imagination:

(i) Viewing from above to gain perspective on dilemmas by seeing oneself more objectively (from a distance in space how small we seem; how will this seem in 10 years’ time?). The idea here is that, rather than having a straight forward perception of an objective reality, we recognize that our experience is based on our own unique, subjective take on life, including its roots in the past.

(ii) Imagining what a wise Stoic sage would do in any given challenging situation (remain calm, hold on to their rationality under pressure, always be kind).

(iii) Mentally rehearsing successful future outcomes, but always with a caveat that things may not turn out as one hopes, so taking into account any eventuality that may arise (be prepared, but don’t put all your eggs in one basket).

(iv) Tuning in to Nature with an attitude of accepting “what is” – we’re not fighting with fate or what the universe has delivered to us, but rather viewing it as an opportunity for growth and learning (reframing, glass-half-full, etc.).

(v) Consideration of death by recognizing how short our time here on earth really is, making conscious efforts to not fritter it away, squander it on trivialities, or worse.

The Stoic’s second skill set is strikingly similar to the Eastern Buddhist concept of mindfulness in that it involved letting “mental phenomena” go, and focusing one’s attention on the “present instant.”

This mindful aspect of Stoic practice wasn’t picked up on by CBT’s Ellis or Beck, perhaps because the idea of mindfulness was counter-cultural in the West at that time (the 1950s): it certainly wasn’t taught in University philosophy departments. However, Hadot was an exception, and it was his close reading/interpretation of the ancient texts that revealed the mindful nature of the Stoic spiritual exercises. In fact, the texts from ancient Greece and Rome came to modernity via a very circuitous route indeed – after the fall of the Roman Empire, they survived a long hiatus during Medieval times, before their rediscovery by Europeans (albeit in fragments, and often in the form of Arabic translations) a thousand years later, during the Renaissance.

Mindfulness can actually be seen as the polar opposite of active mental engagement; instead it involves releasing mental impressions and returning attention to the present moment. Whereas Buddhist practice often uses a mantra (word, sound or object) as a point of focus to keep returning to, the spiritual teacher Eckhart Tolle’s method of actively cultivating conscious awareness by tuning in to the universe by means of present-moment sensory appreciation may be more similar to the ancient Stoic’s spiritual exercises. Furthermore, the Stoics devised pithy aphorisms as mnemonics, which they advised to always keep “ready-to-hand” – they knew that constant reminders were necessary to swim upstream against the deep-seated power of ingrained habit.

Keep hold of this alone and remember it: each one of us lives only now, this brief instant. –Marcus Aurelius.

Using Mindfulness and Cognition to Mitigate the Effects of Vicarious Trauma

Perspectives on Self-Care

Be careful with all self-help methods (including those presented in this Bulletin), which are no substitute for working with a licensed healthcare practitioner. People vary, and what works for someone else may not be a good fit for you. When you try something, start slowly and carefully, and stop immediately if it feels bad or makes things worse.

Mindfulness practice isn’t about deciding to disengage with negative thoughts and engage with positive ones, though this can be a useful exercise. Rather, it’s about developing the mental muscle to be able to detach from mental representations per se so that we have the choice to mentally engage or disengage at will, rather than feeling at the mercy of our automatic thoughts or passions.

Given the increase in positive outcomes as a result of adding the practices of Eastern mindfulness to modern cognitive therapy models, perhaps we can assume that Stoicism lasted for so many centuries because it too was beneficial in cultivating lasting, beneficial change for its practitioners. Its eventual dissolution into early Christianity, around the fourth century AD, followed the rise and domination of monotheism. Yet the extent to which ancient wisdom, from the East and the West, has contributed to modern psychological treatments can feel surprising in modern times – demonstrating perhaps that some basic human needs haven’t changed so much after all.

In conclusion, combining active mental processes and strategies with mindfulness practice (in tandem with external support) can go a long way towards combating the insidious effects of vicarious trauma. Conditions can be created to hone current skills, and master new ones, though – like the difference between slipping-on comfortable old worn-out sneakers, and wearing-in smart new quality shoes – perseverance and patience is required. But improvements in both personal well-being and professional practice will amply reward the investment.

ABOUT THE AUTHOR

Ruth Crowley Brown is a psychotherapist, social worker and writer. She has worked in London, England, and Brisbane, Australia in Child and Adolescent Mental Health, Domestic and Family Violence, Foster Care, and with Refugees, and Aboriginal and Torres Strait Islanders. She’s also a longtime practitioner of Vipassana meditation and the Alexander technique.

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Posted by mkeane on Friday, September 6th, 2019 @ 10:59PM
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