Compassion Strengths

Workshops, consultations, education and support for care givers.

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Transform Compassion Fatigue Into Flow: Chapter 1


“We are living through the most exciting, challenging, and critical times in human history—possibly the most critical time in the history of life on Earth. Never before has so much been possible; never before has so much been at stake. And never before has the rate of change been so fast. We are being led ever more rapidly toward what I have called a ‘white hole in time.’”

— Peter Russell Waking Up in Time 

“I know I’m burned out,” said a recent participant in my Compassion Fatigue seminar, “I don’t have any energy or enthusiasm as a social worker anymore. The strange thing is, when I get home from work I can’t go to sleep. No matter how tired I feel, I can’t seem to turn my mind off. I can stare at the T.V. for hours, but all I see are the faces of the patients I didn’t have the time or energy to help. All I want to do anymore is just go numb….”

A great and growing crisis exists in care giving. Healthcare professionals from nurses and social workers in hospitals to those working in nursing homes are experiencing more stress and burnout than ever before. Particularly since the national trauma of 9-11, healthcare professionals are being called upon to give more of themselves to help others. More of their time, energy, attention, and intention have been called upon to help alleviate the pain and suffering of others. Their response has been consistent with the caregiving personality—they have given, and given, and given.

Although the events of September 11 and the ongoing “War or Terrorism” have certainly placed an immediate and additional strain on healthcare providers — particularly those who work with trauma survivors—the healthcare industry has been facing its own crises for a number of years.

According to a “60 Minutes” investigation reported on June 9, 2002 there are currently 120,000 open nursing positions nationwide with an expected 400,000 open positions in the next twenty years. In fact, the shortage of qualified nurses is so severe that companies are recruiting from third world countries where pay and benefits are low, although need is high.

Nursing is not the only profession within the healthcare industry to experience stress. Social workers, psychologists, mental health therapists, case managers, and residential care facility workers are just a few of the other care providers who are also experiencing stress. They all face increasing caseloads of severe physically, emotionally and mentally ill patients. As if this were not bad enough, they also face continually diminishing resources.

One of the results of this kind of increasing care provider stress is compassion fatigue, also known as secondary or vicarious trauma.

Compassion fatigue is the result of unconsciously absorbing and internalizing Energy in MOTION. This can lead to distraction, hypersensitivity, overload, and misperception in our communication and relationships with self and others. As one participant put it: “I can feel myself getting heavier as the week goes by; It’s as though I am carrying more and more weight on my shoulders each day. By Friday I am so tense in my neck I can barely move my head.”

Compassion fatigue is secondary trauma. It is often, although not exclusively, experienced by healthcare professionals who work with physically and/or psychologically/emotionally traumatized patients. It may manifest as disturbances in information processing similar to some of those reported to us by our patients.

Compassion fatigue presents a “Crisis in Care Giving” because like the Chinese character for crisis indicates, it signifies both danger and opportunity.

The danger is clear and present. With increasing caseloads and diminishing resources, care providers are required to “multi-task.” Translated into caregiver experience this often means more time and energy being spent on crisis stabilization and less on education and long-term management—resulting in risk management rather than health management. For care providers this is likely to be frustrating as well as exhausting. It also renders us more susceptible to unconsciously absorbing and internalizing the frozen energy of secondary trauma.

The opportunity is less clear although very present.

Compassion fatigue can be transformed into flow. Flow is a condition of mind and body that is experienced when challenges and skills are in balance. As University of Chicago Professor Mihaly Csikszentmihalyi states in his book Finding Flow:

“When goals are clear, feedback relevant, and challenges and skills are in balance, attention becomes ordered and fully invested. Because of the total demand on psychic energy, a person in flow is completely focused. There is no space in consciousness for distracting thoughts, irrelevant feelings. Self-consciousness disappears, yet one feels stronger than usual.”

The body’s mind-utilizing capability is known as the “felt sense.” When the frozen energy of compassion fatigue impacts the body’s felt sense, one of two things happens: the energy accumulates and exacerbates compassion fatigue; or the energy is discharged through expression that transforms it into flow and peak performance.

Healthcare professionals are uniquely positioned to experience flow and peak performance in their daily work. It is a win-win situation in every respect. By learning to flow rather than freeze, healthcare professionals can transform the frozen energy of trauma into synergy, harmony, and peak performance.

In my seminars on How to Transform Compassion Fatigue Into…Flow and Peak Performance, I share three basic governing principles of the Healer-Warrior philosophy. These principles provide the foundation for each seminar; Self-honesty, personal responsibility, and self expression.

Each of these principles contains elements essential to the process of personal transformation.

Self-honesty is the key. It is the primary, essential process that allows a depth of access into parts of your personal self that cannot be attained any other way.

In this context, self-honesty means self-transparency—the ability to look inward to cultivate insight. Self-honesty is both a process and a skillful activity that can be learned and nurtured.

What is most essential to developing self-honesty is a courageous willingness to suspend judgment; to halt the automatic response of immediately categorizing a concept or idea according to an already existing category of what may be right or wrong, good or bad, possible or impossible.

It’s not an easy thing to do; it requires courageous willingness. Temporarily suspending your belief systems can cause you to feel uneasy, even lost. This is because most people rely on their unquestioned beliefs to try to make sense out of a world that becomes ever more unpredictable and traumatic.

Unquestioned beliefs have remarkable powers to shape our perception. What we attend to physically, mentally, and emotionally is selected and shaped to a great extent by what we expect to experience.

To suspend these beliefs is to invite you to look clearly and intently inside yourself as you read the words written in this book with as much courageous transparency as possible. Resist the temptation to immediately judge and classify the ideas shared before you have the chance to “try them on.”

Personal responsibility is the continual willingness to take ownership of my personal experience. The problem I usually run into with personal responsibility is my willingness to surrender the need to be right.

The need to be right is one of our strongest and most strongly defended intentions. This is because the need to be right supports and enforces the ego-illusion that I alone am special, different, and somehow more entitled than others. It is the basis of our misguided concept of what it means to be independent.

Personal responsibility is the degree of my willingness to take both individual and collective ownership for my perceptions, thoughts, beliefs, emotions, and behaviors; my communication with self and others; all my relationships; and the conditions of my life that I am now experiencing.

This is not self-blame. To blame myself I must split myself into both the part of me that is doing the blaming and the part of me that is getting blamed. This splitting of my self into opposing parts weakens my sense of self and distorts my perception of others.

The action of personal responsibility is looking, listening, and letting go. This is the art of surrendering.

Surrendering is the Warrior’s art. To surrender is to give in, not give up. Giving in is accepting the reality of the situation as it is without meeting my ego’s demand to be right. To surrender means to bring my ego-perception more into alignment with my here and now, in the moment— in my body experience.

Self-expression is the magic of transformation. When you become clear and open to the intuitive signals— the music of your Natural Self—you will begin to experience a deep sense of enjoyment and empowerment. Self-expression is the dance of energy and enjoyment of the Natural Self when allowed to play.

The Natural Self is that place of connection between mind, body, Energy in MOTION, intuition, and insight that is in a constant state of flow; it is both in the heart and from the heart. To express myself honestly and with responsibility is to engage and empower my Natural Self to create and re-create itself spontaneously in my life.

The Natural Self is a wise, gentle, powerful, and playful being inside each of us that is usually invisible to the ego’s eye. This is mostly because the Natural Self lives in the heart and the ego lives in the head. The Natural Self perceives the world in terms of “us,” while the ego sees the world in terms of “me.” The Natural Self senses connection and commonality while the ego notices separation and specialness.

Self-expression becomes the action of clearly tuning into the music of the Natural Self and allowing that music to move you moment to moment as you dance in evergrowing harmony and synchrony. Self-expression is the spontaneous alignment of who you are with what you are doing.

As you read this book, remember to relax your shoulders and breathe fully from your diaphragm. Allow a sense of connection and flow between your head and heart to develop so that you can listen to yourself with your intuition as well as your conscious mind. Allow yourself to become immersed while observing moment to moment what is happening in your body and mind as you dance in harmony and empowerment with your Natural Self. 


CHAPTER 1: The Caregiving Personality 

"Many survivors of childhood sexual abuse have developed heightened capacities to be attentive to the needs of others, to be excellent caretakers, and simultaneously to know and not know. It is not surprising that children who have organized their lives around such functions might become psychotherapists, a role in which they can continue patterns begun in their families of origin, and which allow a therapist to receive recognition that may have been missing.”

— Pearlman and Saakvitne: “Trauma and the Therapist” 

Care providers are unique people. We have the gift of being able to connect with others in ways that are difficult to explain and even more difficult for others to understand. Our unique ability to emotionally join with our clients that allows us a near first-hand experience of their inner world is perhaps our greatest gift; it is also our greatest challenge.

I often ask participants in my Compassion Fatigue workshop how many of them knew they were going to be caregivers before they reached college. Consistently around 50 – 60 percent of the participants raise their hands. When asked what percentage of healthcare providers who specialize in work with traumatized clients were exposed to childhood trauma is, most participants say they believe it is between 75 and 90 percent.

It is really no mystery that people who share certain traumatic life experiences would find their way to making some positive use out of those experiences as professional caregivers. It is from these traumatic experiences that we learn the art of empathy – the ability to experience heart to heart – what another person is feeling. It is the same set of experiences that can render us more vulnerable to unconsciously absorbing and internalizing – as secondary trauma – the freezing cold fear that our clients experience in their own bodies and minds. 

Personality and Profession

“Who taught you all this Doctor?”

The reply came promptly:


— Albert Camus: “The Plague” 

The personality traits that attracted us to care giving as a profession are the very same traits that can render us vulnerable to stress, burnout and depression. For those of us who took the Strong-Campbell Vocational Interest Inventory (that long, boring test that tells us what we are suppose to be when we grow up), will recognize it as a type of personality test. Its validity is based upon years of trials that show a strong correlation between basic personality styles and the kinds of jobs those styles are drawn to.

As a care provider, it is my experience that most of us are drawn to the profession. We are drawn sometimes by strong emotions and beliefs as well as the desire to be of service to other people. We are also often drawn in by the need to understand how and why people can think, feel and behave the way that they do.

Take a moment and reflect for yourself. Why did you become a care provider? It certainly wasn’t for the money! I don’t know of another profession that draws the number of highly trained and qualified people who are routinely challenged with large caseloads, diminishing resources and expectations to produce results at a pay that may not be equal with the task.

Dr. Paul Pearsall in his book “The Heart’s Code” identifies several personality traits that he calls “cardio-sensitive.” He describes these traits as unique to people who were more “tuned in” to the subtle energies of the heart. These traits include:

A feminine point of view.

Nurses, social workers, case managers, counselors and psychologists are usually the lion’s share of participants who attend my seminar. One of the core competencies these professionals share is their ability to directly intuit other peoples’ experiences, to empathize.

Empathy has traditionally been viewed a feminine trait. It is the basis for interpersonal and intra-personal intelligence. The ability to intuit other people’s feelings and knowing how to creatively respond are essential skills in any helping profession.

As one nurse at a recent seminar states: “I use my empathy more everyday in almost every situation with clients than any interviewing technique I learned in nursing school. In fact, I think empathy may be just as important in my relationships with co-workers as it is with clients.”

Open minded.

One of the real pleasures in providing workshops is the opportunity to interact with large numbers of healthcare professionals who I have found to be – for the most part, open to new ideas, interested in the new research and very often will point me in directions I have never considered.

Being open minded is also more than the desire to examine new research and therapy techniques; it is the willingness to suspend judgment, to courageously step outside the (often) narrow parameters of our scientifically-culturally biased perceptions and look at ourselves from a new and fresh perspective. Real open mindedness requires the ability to look at ourselves with the same clarity and transparency we observe others.

Dr. Pearsall writes that most cardio-sensitive people he interviewed were “accommodators rather than assimilators. Psychologist Jean Piaget described the process of accommodation as revising existing schemata, our mental models of persons, objects, events and situations.”

Body aware.

One of the things I often like to ask participants is what percentage of their day do they spend in their bodies; in the here/now - present moment, rather than “in their heads” regretting the past and/or worrying about the future, dissociated from their physical experience. Many people, after honestly thinking about it have to admit that a large portion of time is spent out of the immediacy of their present, physical, in-the-body experience.

Care providers tend to fall into two fairly distinct groups – those who have done considerable work on and in their bodies, and those who tend to be somewhat disconnected from their physical being.

I often find a considerable number of social workers, nurses and counselors who come to seminars on Compassion Fatigue are very experienced in some form of body oriented therapy, discipline or exercise. Even before current research suggested the importance of a mind/body approach to working with trauma survivors, these survivor-helpers were intuitively tuned to their body. I believe almost any honest and persistent pursuit in self-healing will lead a survivor at some point, back to their body.

Care providers who appear somewhat disconnected from their physical being often have a curiosity or previous experience with a mind/body approach but have not pursued or practiced their method because of how chaotic their work lives have gotten. It is especially for this group that the seated flow motion exercises described later in the book have been developed. They are possibly the simplest, most direct method to develop body awareness.

Highly creative

When we feel safe enough to explore new ideas, particularly in teams, healthcare providers are tremendously creative. Dr. Ellen Langer, Harvard Psychologist in her book “Mindfulness” believes creativity is an essential quality of Mindfulness. She states: “Many if not all, of the qualities that make up a mindful attitude are characteristic of creative people. Those who can free themselves of old mindsets, who can open themselves to new information and surprise, play with perspective and context, and focus on process rather than outcome are likely to be creative whether they are scientists, artists, or cooks.”

Creativity is natural to children. Traumatic stress often results in physical and emotional constriction that is expressed emotionally as an almost deadly seriousness. Seriousness is the anticipation of pain.

Creativity is a condition of the Natural self. When you feel “safe enough” and “good enough” in your body and your environment, the Natural self will come out to play. The willingness to play with new ideas, perceptions and perspectives is the core of creativity.

Good visualization ability

Visualization can be a double-edged sword; we can unconsciously visualize what we don’t want (and usually do by default) as well as begin to consciously form our experience through directed visualization.

The use of directed imagery in visualization has been studied and utilized extensively in sports psychology. From “Applied Sport Psychology: Personal Growth to Peak Performance,” contributing author Robin S. Vealey from Miami University in her chapter “Imagery Training for Performance Enhancement” states: “The evidence supporting the positive influence of imagery on sport performance is impressive. Both scientifically controlled studies and experiential accounts of the use of imagery to enhance performance report positive results.”

Visualization is also more than directed imaging; it includes the use of memory fragments – both implicit and explicit, body motion, emotional or affective charging and cognitive mapping. Visualization is inevitable; we either visualize with conscious intent, or by default.

When conscious directed visualization is performed utilizing multi-sensory rehearsal the enhancement of performance and enjoyment is significant. When visualization is done by default, we most often visualize that which we fear. It is the same mechanism behind a “self-fulfilling prophecy.” 

Compulsive/dependent/unresolved grief

These personality traits are very consistent with compassion fatigue; they often develop as a result of the traumatic experiences many care providers have experienced in their lives that also helped develop heightened capacities for empathy.

Traumatic personal experiences can be the wellspring of empathy and wisdom; they can also result in unresolved grief that is often expressed as dependency and compulsive behavior.

One common personality trait of care providers is our compulsiveness. This is actually a valued trait sought out by managers and supervisors. As a former clinical director and program manager, having employees who were somewhat rigid about completing tasks and taking a high degree of responsibility for their work was highly valued. It can also result in burnout, especially when combined with emotional dependency and unresolved grief.

I believe a high percentage of care providers have experienced significant loss in their lives that may still remain as unresolved grief. It is no mystery that a surprising number of us have, do or will experience major depression that often requires medication and therapy.

Dependency is often the result of unresolved grief. Unresolved grief can take root in the body’s mind as “need-desire,” a desire or want that is experienced with the same intensity and tenacity as an unmet basic need. Dependency can be experienced as “emotional “hunger” with the same intensity as physical hunger. It can draw our attention and intention inward towards its constantly aching emptiness.

As one counselor who works with battered women stated; “I never imagined that unresolved grief could actually affect how and where I would be drawn to find work. The fact is I am most fulfilled when I am able to consciously work on some of my own dependency issues while being of service to other women with similar issues.”


This last set of personality traits speaks to our capacity to engage the natural self in spontaneous and playful creative flow. Flow is the condition of alignment and synchrony between mind, body and Energy in MOTION that results in higher levels of satisfaction and performance with each activity in which we consciously engage these traits.

Sensuality in this context refers to being in touch with your physical self from the inside out. It is the ability to delight in the experience of physical touch as well as sense that sweet place where physical and emotional energies intertwine and circulate throughout the body and mind. Sensuality dances in the heart of the Natural self.

The dreamer is the playful, imaginative, child-like self that we often tell to “stand still and be quiet” as we attend to our important, serious, adult work. The dreamer is the flowing, unformed, creative impulse that is just below the surface of consciousness. It is waiting, always ready to come out and play.

To flow is to consciously engage the sensual dreamer in playful, creative activity. Flow is the result of surrendering to the present moment and aligning who I am with what I am doing in spontaneous action. Repeating and Remembering.

Long ago Sigmund Freud said, “You will repeat instead of remember.” I believe he was talking about the repetition compulsion, or the tendency in some clients to compulsively repeat patterns of behavior rather than remember their origins often in an attempt to ”master the stimulus retrospectively.”

Van der Kolk (1996) calls it “compulsive re-exposure,” and states: “One set of behaviors that is not mentioned in the diagnostic criteria for PTSD is the compulsive re-exposure of some traumatized individuals to situations reminiscent of the trauma…In this reenactment of the trauma, an individual may play the role of either victimizer or victim.”

In some ways, care providers may compulsively expose themselves at work to the very same kind of trauma that they experienced at home earlier in their lives. One care provider at a recent workshop states: “I didn’t realize it at the time, but the very same conditions of danger and unpredictability that characterized my childhood home environment were also some of the same conditions as my last job.”

The tendency to repeat patterns of trauma through compulsive re-exposure is one of the major psychological mechanisms at work in compassion fatigue. The re-exposure may be in the form of working with survivors who experienced similar trauma as ours, and/or working in an emotionally toxic environment with unpredictable rules and relationships.

As a survivor therapist just out of graduate school, I was initially drawn to crisis intervention in a very busy emergency room. As I look back on it now, I realize I was drawn to the chaos, unpredictability and even danger in a job position that was brand new and not well formulated with little definition or boundaries; a perfect repetition of my family of origin with all of the dramatic relationships that would eventually play out.

Re-exposure to personal trauma by working with clients who experienced trauma similar to yours is one of the most direct ways care providers can reactivate their own frozen-in-fear body memory as well as absorb and internalize the emotions of their clients.

Emotion really is Energy in MOTION. As Gary Zukov writes in “The Seat of the Soul": “Emotions are currents of energy with different frequencies. Emotions that we think of as negative, such as hatred, envy, disdain and fear have a lower frequency, and less energy, than emotions that we think of as positive, such as affection, joy, love and compassion.”

As care providers empathically attune their receiving heart to the frequency of their clients’ sending heart that energy stamp is recorded in the receivers’ heart and body. When the energy received is felt to be familiar in its tone and frequency, a sympathetic response may develop resulting in absorption and internalization of that energy.

The more difficult to identify situation in which re-exposure to personal, individual and collective trauma can manifest in working relationships with co-workers, supervisors and in organizations. As Pearlman and Saakvitne: in their book, “Trauma and the Therapist” state:

“Organizations have a powerful influence on therapists they employ and on the therapeutic relationships that exist within the organization. Sensitivity on the part of members, and particularly leaders, of the organization to times when organizational dynamics call for an external consultation will allow those involved to develop a clearer sense of the dynamics and options for change.”

Personal and collective patterns of perception, reaction and inaction can and do form as a result of dynamics that can be re-enacted in relationships at work. It may be as simple as; “consciously or unconsciously, with intent or with inertia, we bring who we are to what we do and who we do it with.” 

Empathy and Sympathy 

The core competence for all care providers and all care giving is the capacity for, and the ability to develop, empathy.

The Oxford American Dictionary defines empathy as: “1. The ability to identify oneself mentally with a person or things and so understand his feelings or its meaning. 2. Do not confuse empathy with sympathy.”

In his book Emotional Intelligence, Daniel Goleman states: “Empathy builds on self-awareness; the more open we are to our own emotions, the more skilled we will be in reading feelings.” In other words, our ability to connect with others is closely tied to our ability to be open and honest about our own emotions. Self-honesty and transparency really is one of the keys to personal growth and transformation. Empathy is the ability to attune our own sense-perception to the “frequency” of another as though we could actually pick up on another person’s personal frequency.

Heinz Kohut, a Chicago psychoanalyst and author of the classic book, The Analysis of the Self, defines empathy as: “…a mode of cognition which is specifically attuned to the perception of complex psychological configurations.” Empathy—or the ability to attune ourselves to the inner workings of our client’s experience—is at the heart of every care provider’s core competence. How do we attune ourselves to others?

Again, Dr. Goleman provides some clues. He states: “For all rapport, the root of caring, stems from emotional attunement, from the capacity for empathy. The key to intuiting another’s feelings is in the ability to read nonverbal channels.”

Empathy is the process of developing rapport through emotional attunement, the ability to intuit another person’s feelings and read non-verbal cues. In a way, empathy sets in motion the internal mental and emotional conditions necessary to still your mind, suspend judgment and listen with your heart and gut.

Empathy is a fundamental therapeutic skill that allows you to become a “participant/observer” during the process of communicating with your client.

The participant part of you— your feeling-intuitive side—joins with your clients by developing rapport and alignment with them. The observer part of you detaches without disconnecting from the content of what is occurring and is able to clearly and objectively observe the process of your transactions with your client as they unfold. The observer is watching/feeling/experiencing from inside the body as well as attending to what is transpiring outside as well.

The art of cultivating a helping relationship depends on the ability to join, intuit, move, and mirror another person’s emotion. This ability involves simultaneously “hovering” in the transaction zone, while you observe, process, and respond to the unfolding of the interaction between yourself and your client. It’s the dance of flow between care provider and client.

The Oxford American Dictionary defines sympathy as: “1. sharing or the ability to share another person’s emotions or sensations.” So what is the difference between empathy and sympathy and how do you know which one you are feeling?

Firstly, there is no clear dividing line between the subtle energies of empathy and sympathy – just because we need one to draw differences. In fact, I do not believe there is a clear dividing line between most concepts in the human service field; most divisions and separations are self-induced because we believe the division in our thinking will provide more clarity. In fact, it produces more confusion. It is probably closer to the truth that we employ a different “mix” of empathy and sympathy to each person or situation we focus our attention on.

There is however a useful guideline in noticing when your empathy/sympathy mix may be out of balance.

Accurate empathy is a fundamental skill and ability that allows you to become a participant/observer while you are emotionally engaged with your client. As one of my professors (many years ago) said; “Listen to the music and not just the words.” The participant part of you that is open and receptive to the “music” of your client while the observer is also listening to the words. The observer is the part of you that is detached (not disconnected) from the “pull” of the emotional interchange while clearly and objectively observing the content and process of your transactions as they unfold.

The emergence of an out of balance sympathetic response occurs when your client (or coworker/supervisor) says something that draws your observing self in causing you to lose your connection with the “being” inside your body. Rather than noticing how the emotion is experienced inside your body, you become the emotion. Rather than observing from a viewing point you are now engulfed and locked into your point of view. Being right begins to become more important that being clear.

In one of my first seminars on Compassion Fatigue an insightful social worker who works primarily with “Borderline Personality Disorders” said; “I know I’ve taken the bait and gotten hooked by my client when the focus of my attention, my central awareness suddenly changes, from a wide angle flowing perspective to a tight, narrow, constricted beam. And always, I begin to tighten my neck and shoulders and restrict my breath.” 


“Countertransference provides the therapist with invaluable information to inform and shape their clinical interventions. Therapists can gather crucial diagnostic information through responses to unspoken, unconscious events in the therapy relationship. Our subjective experience of confusion and disorientation during history-taking for example, often provides early clues about a client’s lack of access to basic information or about his discomfort as he tries to hold contradictory pieces of information simultaneously.”

— Pearlman and Saakvitne: "Trauma and the Therapist" 

In the context I am using here, “countertransference” refers in part to the description given by Pearlman and Saakvitne: in their book, Trauma and the Therapist: “Our definition of countertransference includes two components: (1) the affective, ideational, and physical response a therapist has to her client, his clinical material, transference, and reenactments, and (2) the therapist’s conscious and unconscious defenses against the affects, intrapsychic conflicts, and associations aroused by the former.”  

The Care Provider’s Physical/Affective/Ideational Response to His or Her Client 

It’s a good idea to get in touch with your personal sense of physical-emotional being, where most of the action takes place. As you will discover in the chapter on Parallel Process, human beings are actually much more connected than we like to believe. One of the best ways for me to know what is transpiring with my client is to listen with my own “felt-sense” to what is transpiring in my own body, my emotions, thoughts, and images.

When we sit and listen to our clients we are receiving energy as well as information. It is inevitable. We can, will, and do absorb the emotions of our clients.

Becoming body aware makes you more sensitive to your own internal movement of energy, sensations, affects, various tension levels, and—most importantly—of your breathing. You are more able to identify which physical and emotional sensations are responding to what your client is describing to you. This understanding allows you to separate the client-caused reactions from those arising from your own personal history.

In addition to the body/emotional response to countertransference, there is also the ideational and information processing response.

“Ideational” refers to the content of information being processed. This content can present itself as thoughts or ideas, sounds, visual images, and memory fragments. Fear is the emotion most often associated with such content. This gives most ideational content the power to intrude upon the screen of our conscious mind or be projected unconsciously onto others.  

The Therapist’s Conscious and Unconscious Defenses 

What is our immediate, conscious physical and emotional response to another person with whom we have an empathic connection that is experiencing fear and pain – especially if our own body-mind is attuned to that particular kind of pain and/or fear?

Generally we freeze up as well; even if it is something as subtle as holding or restricting your breath throughout the session. How many times have you come out of an intensive interview with a client gasping for air? The first physical response to the experience of fear—yours or that of your client—is to hold your breath.

In addition to holding your breath, you’ll also feel a frozen-like acute or chronic muscle tension—usually in the neck, shoulders, and back. This hardened tension results from constantly squeezing your shoulders up and in. This is the body’s frozen-in-fear-like-a-statue stance.

Countertransference can also be unconscious and is usually the result of projection:

“Projection occurs in two ways. One is the projection of the whole self, that is, the use of the client as a self-object, a mirror of the therapist’s self. Thus, the survivor therapist may assume the client’s experiences are just like her own, that the client felt the same way, had the same conflicts, and coped in the same ways. The second way projection occurs is as a vehicle for ridding the therapist of uncomfortable affects by attributing them to the client.”

— Pearlman and Saakvitne: "Trauma and the Therapist" 

When you can, allow yourself to be as honest and transparent as possible, look out into the world from a very still and quiet place within the center of your body/mind and notice what really gives shape, form and color to what you “see.” A great deal of what you actually physically perceive and most of what you notice or pay attention to has been given shape, form and color by projecting or transferring your own personal reality onto the screen of your perception of others and the “world out there.”

Certain countertransference reactions can be a type of projection that is usually unconscious and develops between care provider and client that can result in the provider perceiving the client as either a mirror of the providers self, or as the “paranoid object” (other).

In a mirroring countertransference, the client is primarily perceived by the care provider as an extension of the providers own self. In this way, the client is perceived and valued to the extent that he/she is seen to share certain common experiences, values, preferences, coping styles, etc., with the care giver. The care giver can become quite taken with the client personally and begin to lose the observer self as he/she participates more fully in mirroring and being mirrored by, the client.

The flip side to a mirroring countertransference is the devaluation of the client by depositing the unwanted – unworthy, disowned parts of the care providers self onto the screen of the client. The client becomes the receptacle for the care givers persecutory self-representations, the “paranoid object.”

In both types of countertransference, the care provider is unconsciously attempting to maintain emotional balance and self-consolidation by over-identifying with what he/she perceives as positive that is projected onto the person of the client and splitting off and disowning what is experienced to be bad or contaminated.  

When Wanting Feels Like Needing 

When our desire to be seen and heard is mutated by our need to be right, needed, important, or special we are experiencing a state I call “need-desire.”

Need-desire is a want that is experienced with the same intensity and tenacity as a physical need. It is a desire that feels like a need. The desire to be right or to feel special, for example, can be experienced with the same force and intensity as our physical and safety needs.

For care providers, our need-desire to be right or special can trap us in the compulsion to give more of ourselves to our clients, our work, and our co-workers than is healthy for us or them. It can also cause us to react strongly—and at times without our conscious awareness—towards our clients or co-workers in ways that support division and conflict rather than unity and cooperation.

One of our strongest “needs” is the desire to be seen and heard. To be seen and mirrored, heard and accurately empathized with is one of the strongest needs infants have in their development. To be seen, heard, held, mirrored and protected is highly associated with the infant’s sense of physical and psychological survival. It is the basis for the development of the self.

It is interesting that while being seen, heard and appreciated by others is one of the strongest, human motivations, the fear of humiliation is one of our strongest counter-motivations. What we want/need the very most is what we are also most vulnerable to and dependent upon. We want to be seen but are also afraid of being seen. This is because the possibility of being seen also brings the possibility of shame – of appearing bad or wrong. 

The “Need-Desire” to Be Right 

“If being right is your goal,

you will find error in the world, and seek to correct it.

But do not expect peace of mind.

If peace of mind is your goal,

look for the errors in your beliefs and expectations.

Seek to change them, not the world.

And be always prepared to be wrong."

— Peter Russell: "Waking Up in Time" 

Some care providers are burdened with a self-image that requires other people to respond to them in ways that they expect will make them feel right, important, and special. Such a burden can render opaque what would be transparent to someone less burdened. The need to be right can be experienced with the same or greater force and intensity than the need to survive; many people are willing to be dead-right.

Eckhart Tolle in his recent book: Practicing The Power of Now, states; “Even such a seemingly trivial and ‘normal’ thing as the compulsive need to be right in an argument and make the other person wrong – defending the mental position with which you have identified – is due to the fear of death. If you identify with a mental position, then if you are wrong, your mind-based sense of self is seriously threatened with annihilation. So you as the ego cannot be wrong.”

When the desire to be seen and heard is mutated into the compulsive need to be right, the force of that need-desire can be so strong that the experience of being wrong is tantamount to emotional death. This is often the intensity of emotion that accompanies the experience of being shamed, or being wrong (in contrast to doing something “wrong”.

This also accounts for why it is often so difficult to make conscious the unconscious dynamics behind some types of countertransference particularly if you are experiencing a high degree of compassion fatigue.

The tendency to “sleepwalk” or lose your view point as the “observer” at the time you are experiencing intense countertransference reactions is increasingly intense and automatic the higher the degree of your compassion fatigue. This is because the rational, processing portion of the brain is progressively deactivated and the Limbic system or emotional brain is progressively hyper-activated as you experience more and more vicarious trauma.

Unless your awareness is grounded inside of your body and you can notice the tightening and restriction of the muscles in your neck, shoulders, stomach and breathing, you will experience a shift of perception from being present and observing to getting caught up inside the drama that is taking place in your mind, emotions and body sensations. You are no longer watching your thoughts and emotions, you have identified with them – you experience that they are you.

Eckhart Tolle, again states; “Intense presence is needed when certain situations trigger a reaction with a strong emotional charge, such as when your self-image is threatened, a challenge comes into your life that triggers fear, things ‘go wrong;’ or an emotional complex from the past is brought up. In those instances, the tendency is for you to become ‘unconscious.’”

An “intense presence” is the result of being grounded in the body, emotionally centered and consciously awake in the present moment. “Unconsciousness” is the result of losing that presence when you feel your self-image is being challenged; your body begins to freeze, your perception constricts and your awareness narrows, locked into the need to be right. 


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