A visitor to this site might wonder how I came to serve what appear to be two very different kinds of clients – people who might seem to have little in common. It’s partly a story about how a professional psychotherapy practice can develop and grow over the course of twenty five years. It’s also a story of discovery that people can have surprising connections and common ground.
1. Civilian-level trauma
Twenty-six years ago, when I began planning my practice, I decided I wanted to serve everyday people who had experienced severe or extreme civilian-level (meaning, not military-level) trauma on the job (critical incidents). I took intensive training to help them – usually at their work locations – in the immediate aftermath (24-72 hours) of these tragic losses. For years, I served on 1-2 incidents per week. This is a small sampling of thewhere I provided service to traumatized people:
- bank tellers who had a robber’s gun put under their nose
- jewelry store staff invaded by criminals firing automatic weapons to create mortal fear
- electrical workers witnessing a co-worker in flames, electrocuted by a multi-thousand ampere short circuit
- construction workers who saw suicide victims jumping from a bridge hit the ground near them
- the powerful Nisqually earthquake of February 2001, which produced many terrifying outcomes
- 911 workers cleaning up wreckage of the World Trade Center (amongst many other 911-related incidents I served)
- shooting murder of a 20 year employee at the workplace by a jealous ex-spouse
- a natural gas pipeline fire that killed co-workers and devastated land that people once used for municipal park picnics.
I learned many things in over two decades of work like this. A small sample:
- the importance of my being humble in the presence of people’s trauma recovery – NOT presenting myself as an expert who knew more about their experience and resilience than they did.
- to affirm that I had to earn the privilege of listening to their pain.
- as an “outsider” to their close working relationships, my role was to honor the deceased and the struggle to someday and somehow help them find a “new normal”.
- to honor all of their perspectives of the loss, and chart a pathway for them to support each other – the most powerful healing method – and mindfully grieve.
- interpreting their painful, persistent symptoms as clear evidence of their humanity and “normalcy” while suggesting evidence-based choices to aid their recovery.
I was often asked if this work made me chronically grief-stricken. On the contrary, the work was uplifting and sustaining. Many times over, I witnessed the absolute best in people emerge as they began to recover.
2. Office practice; integrating relational & sexual therapy
Critical incident work was not how I spent the majority of time at work. Therapists in private practice typically spend the most time seeing clients in an office.. Working with people in committed relationships was my chosen specialty.
For ten years I trained in a complex model that integrated human sexuality into relationship therapy. Differences in sexual desire, erectile disorder, vaginal or vestibular pain, and infidelity/promiscuity were used to advance personal development and deepen interpersonal intimacy. The effects of sexual trauma, race & culture was a frequent factor.
3. 911, Afghanistan & Iraq
Major historical events intervened, as they always do. In October of 2001, the U.S. military deployed to Afghanistan and in March of 2003 to Iraq. Multiple & prolonged deployments were the rule. By 2004, Veterans Administration (VA) hospitals began to be overwhelmed with returning combat veterans, many with PTSD. I joined other Seattle area clinical social workers to create a project that would train us in military culture and war trauma. and create a community resource to receive veteran referrals. My office at that time was located near military family housing, expanding my practice to include family members.
You may see one connection right now. A few years of experience with severe civilian level trauma was a good foundation for working with veterans.
And another you might not know. There are certainly differences between civilian and military trauma. Research indicates that veterans with trauma histories before they joined the military (pre-deployment) have significantly higher levels of trauma symptoms. Therapists must know to assess these histories and their possible effects.
4. Kink, non-monogamy and authority transfer
Even in 2000, it didn’t take long to learn that many relationship partners were kinky. Monogamy wasn’t the only choice they made and some purposely preferred partnerships involving unequal levels of power and autonomy. Serving any of these clients was challenging early on because there was virtually no professional training available – book study was my sole resource for years!
You’ve probably already seen another connection. Serving these clients and my training in relationship therapy was a unique opportunity to understand a very wide spectrum of sexuality and relationships.
Did you see this connection too?. Some people think that kinky practices must inflict trauma via pathologic sadism. But familiarity with kink research reveals substantial evidence that consensual, risk-aware kink offers a pathway for healing trauma for some victims of past abuse. See here, here and here.
And this one. One of the primary problems for veterans is making adult relationships with other civilians.
Synergy
This post establishes how my practice came to serve different – and apparently disparate – underserved populations. Hopefully it further illustrates that there is actually a synergy involved. It’s very helpful to have broad experience and training about trauma and different ways to treat it.