When Self-Care Is Not Enough: Reflections on How to Make Intensive Clinical Work More Sustainable

Abstract

As a psychology resident on the psychiatry consultation-liaison service at a trauma center, I was asked by another trainee how I cope with the devastating cases of traumatic injury and abuse that we witnessed regularly on the service. This trainee's courageous question about how we as providers cope sustainably with bearing witness to trauma coincided with my own reflection on the limits of "self-care" as it is often discussed and practiced in human service professions. In this article, I argue that an activity-based approach to self-care is not enough for providers in trauma-intensive service settings and must be complemented with an ongoing, self-caring engagement with the existential impact of bearing witness to trauma. Part of this impact is the "unspeakable" nature of trauma, which is most profound for victims, but is also an important consideration for bystanders, helping professionals, and larger systems of care. Major dialectical tensions of bearing witness to trauma as a provider (such as between denial and awareness, problem solving and acceptance) are described, with reflection on ways that trainees can practice the integration of caring for both self and others in their encounters with trauma survivors. Concluding recommendations are offered for a trauma-informed theory and practice of self-care for trainees, training programs, and the field.