Case Consultation Service - Working With Extreme Stress

How Can Case Consults Be Helpful?

Traumatic dissociation as a result of extreme stress is fundamental to understanding post-traumatic stress. There is a growing awareness of the need for adequate undergraduate training in working with extreme stress, trauma, or abuse for most psychiatrists, psychologists, social workers, psychiatric nurses, expressive therapists, counsellors, family therapists, psychotherapists, medical practitioners, allied health and related professionals.

Case consults are a useful way of learning new skills, getting on track and reinforcing or restoring faith and confidence in what you have to offer your clients.

Working in this field, at times leaves many people feeling de-skilled, confused, emotionally drained, personally affected and unsure of what, or how, or if, they would better serve these clients in different ways.

Information and perspective from another person's clinical experience is of substantial benefit. Equally important is the value of supportive strategies and ways of dealing with the inevitable personal impact (vicarious traumatization) from this field of work.

Many counsellors or support people feel anxious they have overstepped professional boundaries or under-responded in their uncertainty about working compassionately and responsibly with this client population. Many feel ashamed of feelings they have had. Working with extreme stress adds, in many challenging ways, to life's opportunities to learn about who we are.

These counter-transferential issues can be a significantly stressful aspect for the health care professional and can inadvertently have a negative impact in working with clients, despite the practitioner's best intentions. To varying degrees, at different stages in this work, people find it also impacts their personal life as well as the sense of self professionally. It is necessary that we seek and provide non-judgemental, empathic assistance for colleagues in these matters.

It is essential for health professionals to recognize they offer much to their clients from their professional experience and also their personal qualities and abilities. Working with people who have experienced extreme stress teaches many valuable lessons both professionally and personally. However, the health care worker also needs to be confident in what he or she has to offer, respecting his or her insight and professional judgement while remaining open to learning and modifying perspective all the time.

Both client and therapist have different roles and contributions that deserve respect.

Issues of power, control, trust, intense emotion and safety are understandably highlighted in response to extreme stress. Clients need to test the boundaries and security of the therapeutic situation and the therapist's skill at compassionate clarity or alternatively, his or her potential to re-enact power and control dynamics (inadvertently or not). The therapist is responsible for the therapy session while the client is responsible for his/her healing. Skills in achieving this are developed in case consultations.