Written by Laurie Belanger, LCSW-R
Hello fellow curious thinkers and interested helpers. Laurie Belanger LCSWR here, writing about being and assisting others in being healthy humans. Today I’d like to share with you a little about my passion for something called Felt Safety. Felt Safety as I have heard it described in TBRI® (Trust Based Relational Interventions) or the “Neuroception of Safety” as Polyvagal Theory likes to call it, is when not just the mind agrees you are safe, but your entire self, including your autonomic nervous system, experiences feeling safe. This is an area of education that has a long way to go in becoming “common sense” as I hope it will be someday. Understanding the ‘why and how’ behind becoming deeply self-regulated is powerful stuff. This information is applicable to every aspect of our lives, whether you are part of our professional mental health community or simply, well, a …person. Do you have a mind, a body, a nervous system at your disposal? Bingo! Then this blog is for you!
Being able to return to an experience of feeling steady, (mind, body, and spirit) is essential for learning and growing as humans. You don’t get much more foundational/basic than this. For this reason, Felt Safety is a crucial component for both therapists and educators (really all humans) to deeply understand.
In today’s blog, I’m going to focus on why Felt Safety is essential for the mental health professional community. I am not assuming you are a helping professional in the mental health field as I write this (if you are from outside the field, thank you so much for being interested as I had hoped you would be). My goal is for this to feel approachable for anyone. And while many professional therapists may already believe they know what I am about to put down here….I encourage you to read on. There is a good reason I am willing to spend my summer developing an all-day workshop on Emotional Safety for therapists. After all, after over 20yrs in the field, I am still deepening my understanding of the essentials- I hope that you are too.
Felt Safety and the Clinician. Working as a therapist can be emotionally expensive. I don’t say this to complain, only to be real about it. Dedicating your practice to complex developmental trauma as I have been doing for the past decade or so runs the very real risk of emotional & spiritual bankruptcy. Being real about that risk is part of how we avoid what many will call “burn out”. One of my passions is helping fellow therapists take on this level of therapy provision long term without becoming less effective (burn out in place) or leaving the field entirely (self preservation burn out). This balancing act is something I have managed to do for myself (I have over 20 yrs experience and still going strong!) and I am committed to passing the torch.
In this line of work there is a need to be 100% deeply present and aware of both the self and of another human being for very long stretches of time. Outside of this profession, the closest most will be able to compare this to is to that rare deep and profound conversation with a close friend or family member…maybe they are telling you about a possible divorce, or opening up about a family member’s cancer diagnosis. These conversations are tough, right? Your mind, spirit, and yes…your body, all take something of a hit. Now- do this for a solid hour, but also track what is being shared and how it might fit with a treatment plan at the same time, connect emotionally, but remember not to share your own personal history too much or mistakenly glob on your own history onto another person’s unique personal experience and own family system, oh and make certain you are tracking the time the entire time as you only have 50–60min and will need to find a way to create a healthy and somewhat natural feeling of closure to the conversation so that you can do this all over again with someone else 5–7 more times today. Now add in that these conversations will range over topics like childhood sexual abuse, violent deaths, severe and repeated harm, painful memories of neglect and betrayal. After that, you will need to document all of these meetings, reliving them to some extent and making certain you connected to the treatment plan, asked the right safety questions, and have a plan for your next meeting. Really, there is quite a bit more than this that goes into psychotherapy, but this is the bare minimum of a solid therapeutic relationship. Sounds a little intense? It is.
For our non-mental health professionals reading this, what I have described is only the basics of any quality counseling appointment. Psychotherapy takes this to an entirely different level, requiring quite a bit of additional training and skill, yet it always has this essential therapeutic relationship underneath whatever else is being accomplished in the therapy room. The question then becomes: Can the mental health professional, as a human being, manage to both experience and offer Felt Safety consistently throughout their workday? And how will they return to Felt Safety as they leave work and re-integrate into their own family lives?
This is a big ask, especially for those clinicians working in busy clinic settings. When I was fresh out of graduate school, this is where I started my therapist journey. Today, I often see therapists in my private practice as clients themselves. I would like to tell you that the caseloads are more manageable, the paperwork more streamlined with the advent of electronic health records, and that morale and rates of burnout are improved. I cannot tell you that. I could not tell you that before we had a global pandemic, and I certainly cannot tell you that today.
Instead, I regularly hear about caseloads that are impossibly high, full of clinically complex cases that are under resourced and often at high risk for suicide and overdoses. Yet, this is the expected caseload for our greenest therapists straight out of graduate school programs and internships. It has always been something of a backwards problem in American mental health care delivery; that the most experienced clinicians often move on to private practices where they can better control their professional lives, make a better income, and improve work/life balance; only to leave the less experienced and resourced clinicians serving the most complex and vulnerable clients. I am not here to beat up on our large mental health clinics. They are doing the best they believe they can under some incredible strain. Yet, this is American Mental Health Care generally speaking. Therapist turnover and burnout is very high for good reasons. There are exceptions. I know some amazing veteran therapists working hard in local clinics providing high quality therapy, supervision, and leadership. It’s just not enough nationally to change the overall picture for your average new therapist/social worker in the U.S.
So what is the cost and what to do about it? There is a shortage of qualified clinicians to serve the general public in the U.S. This has gotten worse, but was still an issue before the pandemic. Why is there a shortage? That is not a simple question.(I’m glad I asked?) Let’s think about this.
Need has certainly gone up, some happily because we have been doing better at decreasing stigma around receiving mental health services. Some likely because of added stress in our society during a very politically, socially divisive time in our history. Some because we have all been through a global pandemic together and the emotional toll caused by job losses, relationship ruptures, grief & loss, unmet needs (educational, mental health, and physical health) continue to have effects. It is also likely because some clinicians have walked away from the field, feeling burned out and unsupported. I’ve met some who have completely changed careers at this point. And then there are those that take one look at the helping fields as a future career option and rightly shutter. Would it be worth it? The initial pay for a masters level minimum position is not great. The responsibility and work loads are very high. And I believe most importantly, the felt experience of doing the work well is not well supported by our society. Our counselors are tired, physically and emotionally.
If you have read any of my previous blogs, you’ll know that I am not here to sound warning bells and then just complain. I am a fan of something called “tragic optimism”, essentially meaning that I find it necessary to be brutally honest about what is and yet also believe strongly in the power of created meaning and the possibility of resilient outcomes. So, I have just told you that the mental health field is in dire straits, overworked, under supported, underpaid, and many are choosing to walk away or never get started in this emotionally rough profession. And yet…..
I know therapists who are on fire for the advances we are making in the field of clinical psychotherapy. Many of my colleagues, myself included, are out there pounding the drum of change as we learn in conferences, workshops, and consultation groups how to integrate some of the amazing advances this last decade has brought. The general public, maybe even the general counseling community at large, may be mostly unaware of how much hope and energy is out there just now. Where is this bright beacon of forward progress and good cheer? Here’s a kicker…It’s in the trauma community. Yes, the folks who have dedicated their careers to serving the most complicated and yes, those listening to the most awful narratives of human experience….this is where the upbeat and hopeful can be found. Does this sound weird to you? If you know the trauma therapist community as I do, it’s expected actually.
The trauma psychotherapy community has an orientation towards mental health and healing that is pretty client centered and positive about the power of human beings to heal. The trauma perspective sees much of our mental health struggles (not all, just many) to be experience based. This is opposed to the traditional medical model of mental health, that views human struggles mostly as medical disorders that can be treated with medications and scripted treatments. While medication and scripted treatments for many mental health conditions are often appropriate, the trauma community spends extra time during assessments ruling out the complications of lived experience.
Assisting our clients in better understanding how their minds and bodies react to chronic and/or acute high stress empowers them. Through high quality psycho-education, clients learn various methods available in trauma therapy to essentially unlearn stress responses built during previous highly challenging life experiences. This changes how our clients view themselves and provides hope for lasting healing. It’s not so much, “I’m ill” as “I am recovering, thanking my body and brain for using the built in life-threat responses that are natural, but also perhaps no longer necessary”. In my office I often find myself saying to a client, “you’re not broken, just tangled. We can work together to help you untangle”.
This more hopeful, strengths-based approach to mental health isn’t only for the client. As we unpack what it means to value our nervous system responses to chronic and acute stress, we learn what is good and not so good for the therapist as well. If a mental health counselor is going to weigh in, every day, to the lived experience of people who are hurting, there needs to be clearer, better supported self-care for the helpers, and this begins with clearer understandings of what works.
Long term, agencies will need to find ways to decrease caseloads, support therapists in setting healthier work/life boundaries, encourage use of vacation and PTO hours, and create space for more consultation and therapy for therapists (outside of agency supervision for privacy). Our vulnerable and low-income clients deserve high quality care. If we can agree on that, society needs to support counselors so that they are willing to stay and grow as therapists in the clinics that support that population.
In the meantime, the trauma therapy lens has much to offer our exhausted therapist and counselor community. When I started this new blogging hobby, I decided I would offer up at least three practical helps in each blog. So, here we are. If you would like to learn more about trauma-informed strategies for helping your nervous system feel safer check out the following: Unyte.com offers something called the SSP (Safe and Sound Protocol). This is something I use in my practice and will be explaining in more depth in my next workshop. You might also check out https://alpha-stim.com/. I use this device frequently in practice and have found it to be helpful in my own self-care routine. Lastly, I’d encourage you to check out HearthMath Inner Balance. This device is great for teaching yourself and others a little something about bio-feedback. I used mine almost daily during the most challenging days of the pandemic to help re-center myself. I do not get any financial gain by sharing these three tools with you. This is just your friendly neighborhood trauma therapist sharing a little of what I have actual training and positive experience within the land of endless possible mind-body tools that get advertised out there.
If you do think this all sounds promising, then I do invite the mental health professionals to consider signing up for my full day workshop on exactly this sort of thing. We are going to do a deep dive together on Emotional Safety. For the parents, curious learners, educators out there reading this, check out Beth Tyson’s FB Group: Emotiminds. Emotiminds is an educational support group for caregivers and professionals who would like to learn tools and best practices for children’s mental health, specifically around trauma and loss. While you’re at it, check out one of my quick tips podcasts on music and the SSP.
If nothing else, please take this blog as encouragement that a deeper understanding of the natural responses that the human body and mind has to stress is happening in the mental health field. Someday, this will all seem like common sense. Everyone will have tools and strategies for helping ourselves and our community come back into a safer/healthier relationship with ourselves and with one another.
Until that day, I’ll keep talking about it and equipping others where I can. Best wishes to you. May you be safe, and may your nervous system and body believe you.
Published August 11, 2023