An Everyday Guide to Caring for Self While Caring for Others
Publication date: 05/01/2009
Bestseller over 70,000+ copies sold
“This is an extraordinary book, written by an extraordinary woman. Qazi is a master storyteller, capturing the emotion as well as...
This third edition of an international bestseller—over 2 million copies sold worldwide and translated into 33 languages—details how its powerful insights...
A longtime trauma worker, Laura van Dernoot Lipsky offers a deep and empathetic survey of the often-unrecognized toll taken on those working to make the world a better place. We may feel tired, cynical, or numb or like we can never do enough. These, and other symptoms, affect us individually and collectively, sapping the energy and effectiveness we so desperately need if we are to benefit humankind, other living things, and the planet itself. In Trauma Stewardship, we are called to meet these challenges in an intentional way—to keep from becoming overwhelmed by developing a quality of mindful presence. Joining the wisdom of ancient cultural traditions with modern psychological research, Lipsky offers a variety of simple and profound practices that will allow us to remake ourselves—and ultimately the world.
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Foreword by Jon Conte, Ph.D.
About the Coauthor
Introduction: On the Cliff of Awakening
Part One: Understanding Trauma Stewardship
Chapter One: A New Vision for Our Collective Work
Chapter Two: The Three Levels of Trauma Stewardship
Part Two: Mapping Your Response to Trauma Exposure
Chapter Three: What Is Trauma Exposure Response?
Chapter Four: The 16 Warning Signs of Trauma Exposure Response
Part Three: Creating Change from the Inside Out
Chapter Five: New Ways to Navigate
Chapter Six: Coming into the Present Moment
Part Four: Finding Your Way to Trauma Stewardship
Chapter Seven: Following the Five Directions
Chapter Eight: North: Creating Space for Inquiry
Chapter Nine: East: Choosing Our Focus
Chapter Ten: South: Building Compassion and Community
Chapter Eleven: West: Finding Balance
Chapter Twelve: The Fifth Direction: A Daily Practice of Centering Ourselves
Conclusion: Closing Intention
About the Author
“Are you sure all this trauma work hasn’t gotten to you?” he asked.
We were visiting our relatives in the Caribbean. We had hiked to the top of some cliffs on a small island, and for a moment the entire family stood quietly together, marveling, looking out at the sea. It was an exquisite sight. There was turquoise water as far as you could see, a vast, cloudless sky, and air that felt incredible to breathe. As we reached the edge of the cliffs, my first thought was, “This is unbelievably beautiful.” My second thought was,“I wonder how many people have killed themselves by jumping off these cliffs.”
Assuming that everyone around me would be having exactly the same thought, I posed my question out loud. My stepfather-in-law turned to me slowly and asked his question with such sincerity that I finally understood: My work had gotten to me. I didn’t even tell him the rest of what I was thinking: “Where will the helicopter land? Where is the closest Level 1 trauma center? Can they transport from this island to a hospital? How long will that take? Does all of the Caribbean share a trauma center?” It was quite a list. I had always considered myself a self-aware person, but this was the first time I truly comprehended the degree to which my work had transformed the way that I engaged with the world.
That was in 1997. I had already spent more than a decade working, by choice, for social change. My jobs had brought me into intimate contact with people who were living close to or actually experiencing different types of acute trauma: homelessness, child abuse, domestic violence, substance abuse, community tragedies, natural disasters. As I continued on this path, my roles had grown and shifted. I had been an emergency room social worker, a community organizer, an immigrant and refugee advocate, an educator. I had been a front-line worker and a manager. I had worked days, evenings, and graveyard shifts. I had worked in my local community, elsewhere in the United States, and internationally.
Over time, there had been a number of people—friends, family, even clients—urging me to “take some time off,” “think about some other work,” or “stop taking it all so seriously.” But I could not hear them. I was impassioned, perhaps to the point of selective blindness. I was blazing my own trail, and I believed that others just didn’t get it. I was certain that this work was my calling, my life’s mission. I was arrogant and self-righteous. I was convinced that I was just fine.
“The ringing in your ears—I think I can help.”
And so in that moment, on those cliffs, my sudden clarity about the work’s toll on my life had a profound impact. Over the next days and weeks, I slowly began to make the connections. Not everyone stands on top of cliffs wondering how many people have jumped. Not everyone feels like crying when they see a room full of people with plastic lids on their to-go coffee containers. Not everyone is doing background checks on people they date, and pity is not everyone’s first response when they receive a wedding invitation.
After so many years of hearing stories of abuse, death, tragic accidents, and unhappiness; of seeing photos of crime scenes, missing children, and deported loved ones; and of visiting the homes of those I was trying to help—in other words, of bearing witness to others’ suffering—I finally came to understand that my exposure to other people’s trauma had changed me on a fundamental level. There had been an osmosis: I had absorbed and accumulated trauma to the point that it had become part of me, and my view of the world had changed. I realized eventually that I had come into my work armed with a burning passion and a tremendous commitment, but few other internal resources. As you know, there is a time for fire, but what sustains the heat—for the long haul—is the coals. And coals I had none of. I did the work for a long time with very little ability to integrate my experiences emotionally, cognitively, spiritually, or physically.
Rather than staying in touch with the heart that was breaking, again and again, as a result of what I was witnessing, I had started building up walls. In my case, this meant becoming increasingly cocky. I had no access to the humility that we all need if we are to honestly engage our own internal process. Rather than acknowledge my own pain and helplessness in the face of things I could not control, I raged at the possible external causes. I sharpened my critique of systems and society. I became more dogmatic, opinionated, and intolerant of others’ views than ever before. It never occurred to me that my anger might in part be functioning as a shield against what I was experiencing. I had no clue that I was warding off anguish, or that I was secretly terrified that I wouldn’t be able to hold my life together if I lost my long-held conviction that all could be made well with the world if only we could do the right thing. Without my noticing it, this trail I was blazing had led me into a tangled wilderness. I was exhausted and thirsty, and no longer had the emotional or physical supplies I needed to continue.
I could have ignored the realization that began on those cliffs. In the fields where I work, there is historically a widely held belief that if you’re tough enough and cool enough and committed to your cause enough, you’ll keep on keeping on, you’ll suck it up: Self-care is for the weaker set. I had internalized this belief to a large degree, but once I realized that this way of dealing with trauma exposure was creating deep inroads in my life, I could not return to my former relationship with my work.
Instead, I began the long haul of making change. I knew that if I wanted to bring skill, insight, and energy to my work, my family, my community, and my own life, I had to alter my course. I had to learn new navigational skills. First, I needed to take responsibility for acknowledging the effects of trauma exposure within myself. Second, I had to learn how to make room for my own internal process—to create the space within to heal and to discover what I would need to continue with clarity on my chosen path. I had to find some way to bear witness to trauma without surrendering my ability to live fully. I needed a new framework of meaning—the concept that I would eventually come to call trauma stewardship.
Seung Sahn, the founder of the Kwan Um School of Zen, once said, “The Great Way is easy; all you have to do is let go of all your ideas, opinions, and preferences.” Following his advice, I began to reconnect with myself. I learned how to be honest about how I was doing, moment by moment. I put myself at the feet of a great many teachers, medicine people, healers, brilliant minds, and loved ones. I asked for help. I began to reengage the wilderness around my home and to learn all the lessons I could from the endless intermingling of beauty and brutality that makes us so keenly feel the preciousness of life in the natural world. I began a daily practice that has allowed me to be present for my life and my work in a way that keeps me well and allows me to work with integrity and to the best of my ability.
Ultimately, I recognized that it was ego that had motivated me to keep on keeping on in my work long after I stopped being truly available to my clients or myself. Over the years, I gradually let go of that façade, and I reached a deep understanding of how our exposure to the suffering of others takes a toll on us personally and professionally. The depth, scope, and causes are different for everyone, but the fact that we are affected by the suffering of others and of our planet—that we have a trauma exposure response—is universal.
Trauma exposure response is only slowly coming to the fore as a larger social concern rather than simply an issue for isolated individuals. It was first recognized a decade ago in family members of Holocaust survivors and spouses of war veterans, but it has only recently attracted wide attention from researchers, who are working to assess its broader societal implications. To cite one example:
According to a March 2007 Newsweek article, a U.S. Army internal advisory report on health care for troops in Iraq in 2006 indicated that 33 percent of behavioral-health personnel, 45 percent of primary-care specialists, and 27 percent of chaplains described feeling high or very high levels of “provider fatigue.”The article concluded with this blunt appraisal: “Now homecoming vets have to deal with one more kind of collateral damage: traumatized caregivers.”
In 2007, CNN.com published an article by Andree LeRoy, M.D., titled “Exhaustion, anger of caregiving get a name.” It begins,“Do you take care of someone in your family with a chronic medical illness or dementia? Have you felt depression, anger or guilt? Has your health deteriorated since taking on the responsibility of caregiving? If your answer is yes to any one of these, you may be suffering from caregiver stress.” The article reports a finding by the American Academy of Geriatric Psychiatrists that one out of every four families in the United States is caring for someone over the age of 50, with projections that this number will increase dramatically as the population in America ages. Another source for the article is Peter Vitaliano, a professor of geriatric psychiatry at the University of Washington and an expert on caregiving. He reports that many caregivers suffer from high blood pressure, diabetes, a compromised immune system, and other symptoms that can be linked to prolonged exposure to elevated levels of stress hormones. Unfortunately, many “don’t seek help because they don’t realize that they have a recognizable condition,” the article says. In addition, Vitaliano explains, “caregivers are usually so immersed in their role that they neglect their own care.” The article cites online conversations among caregivers who acknowledge that in such an emotional state, it’s difficult to provide high-quality care to their loved ones.
While most research to date has concentrated on the effects of trauma exposure on those who watch humans suffer, we know that responding to trauma exposure is critical for those who bear witness to tragedies afflicting other species as well. Among these are veterinarians, animal rescue workers, biologists, and ecologists. We cannot ignore emerging information about the profound levels of trauma exposure among people in the front lines of the environmental movement—those fighting to stop the juggernaut of global warming and those who strive desperately, in the face of mounting losses, to ward off the extinction of countless species of plants and animals.
Pioneering researchers have given our experience of being affected by others’ pain a number of names. In this book, we refer to “trauma exposure response.” Charles Figley uses the terms “compassion fatigue” and “secondary traumatic stress disorder.” Laurie Anne Pearlman, Karen W. Saakvitne, and I. L. McCann refer to the process as “vicarious traumatization.” Jon Conte uses the words “empathic strain.” Still others call it “secondary trauma.”
Here, we include trauma exposure response under a larger rubric:trauma stewardship. As I see it, trauma stewardship refers to the entire conversation about how we come to do this work, how we are affected by it, and how we make sense of and learn from our experiences. In the dictionary, stewardship is defined as “the careful and responsible management of something entrusted to one’s care.”These days, the term is widely used in connection with conservation and natural-resource management. In the January 2000 issue of the Journal of Agricultural and Environmental Ethics, Richard Worrell and Michael Appleby defined stewardship as taking care “in a way that takes full and balanced account of the interests of society, future generations, and other species, as well as of private needs, and accepts significant answerability to society.”
When we talk about trauma in terms of stewardship, we remember that we are being entrusted with people’s stories and their very lives, animals’ well-being, and our planet’s health. We understand that this is an incredible honor as well as a tremendous responsibility. We know that as stewards, we create a space for and honor others’ hardship and suffering, and yet we do not assume their pain as our own. We care for others to the best of our ability without taking on their paths as our paths. We act with integrity toward our environment rather than being immobilized by the enormity of the current global climate crisis. We develop and maintain a long-term strategy that enables us to remain whole and helpful to others and our surroundings even amid great challenges. To participate in trauma stewardship is to always remember the privilege and sacredness of being called to help. It means maintaining our highest ethics, integrity, and responsibility every step of the way. In this book, I will attempt to provide readers with a meaningful guide to becoming a trauma steward.
The essayist E. B. White once wrote that the early American author, naturalist, and philosopher Henry Thoreau appeared to have been “torn by two powerful and opposing drives—the desire to enjoy the world, and the urge to set the world straight.” This book is written for anyone who is doing work with an intention to make the world more sustainable and hopeful—all in all, a better place—and who, through this work, is exposed to the hardship, pain, crisis, trauma, or suffering of other living beings or the planet itself. It is for those who notice that they are not the same people they once were, or are being told by their families, friends, colleagues, or pets that something is different about them.
“I’m afraid you bave bumans.”
If even a few of the readers of this book can enhance their capacity for trauma stewardship, we can expect to see consequences, large and small, that will extend beyond us as individuals to affect our organizations, our movements, our communities, and ultimately society as a whole. In part 1, I talk more about what trauma stewardship is and how we can embark on our journey of change. Since the first step toward repair is always to understand what isn’t working, I’ve devoted part 2 to mapping our trauma exposure response. Many readers may be startled by how intimately they already know the 16 warning signs I present in chapter 4. Even if you haven’t experienced these feelings or behaviors yourself, you are certain to know others who have.
How do we escape the constriction and suffering that often accompany trauma exposure response? In part 3, I provide some general tips, along with an in-depth exploration of the importance of coming into the present moment. In part 4, I offer the Five Directions, a guide that combines instructions for personal inquiry with practical advice that can greatly enhance our ability to care for ourselves, others, and the planet. I have included numerous brief exercises that you may choose to try as you develop your daily practice. Throughout the book, you will encounter profiles of inspiring people, perhaps much like you, who are deeply committed to the struggle to reconcile the hardships and joys of doing this work. As we illuminate the path of trauma stewardship, we will also shine light on the larger contexts in which we interact with suffering. We will delve deeply into how to carefully and responsibly manage what is being entrusted to us.
This book is a navigational tool for remembering that we have options at every step of our lives. We choose our own path. We can make a difference without suffering; we can do meaningful work in a way that works for us and for those we serve. We can enjoy the world and set it straight. We can leave a legacy that embodies our deepest wisdom and greatest gifts instead of one that is burdened with our struggles and despair.
As the author of this book, I don’t believe that I am imparting new information. Rather, I’m offering reminders of lore that people from different walks of life, cultural traditions, and spiritual practices have known for millennia. There is a Native American teaching that babies come into the world knowing all they will need for their entire lifetimes—but the challenges of living in our strained, confusing world make them forget their innate wisdom. They spend their lives trying to remember what they once knew. (Some say this is the reason why the elderly and very young children so often have a magical connection: One is on the cusp of going where the other just came from.) This book aims to guide you, the reader, in finding a way home to yourself. All of the wisdom you are about to encounter is known to you already. This text is simply a way to help you remember.Back to Top ↑
“Reading this book is like looking into a mirror.We will see ourselves much more clearly, will understand ourselves much better and will come up with better ways of being It and doing It. Compassion, yes, Compassion is Happiness itself. Enjoy.”
— THICH NHAT HANH, Zen Master and peace activist
“Anyone who works with traumatized people can be caught in the grip of anxiety, irritability, or overwhelming sadness. By shutting out those feelings, you may sink into emotional numbness.You wish for wise words and a fresh perspec- tive.You long for an understanding heart.You can find all that and more in Laura van Dernoot Lipsky's terrific book...It will get you through hard times. It will help you feel better and work smarter. No trauma worker should be without it.”
— GINNY NICARTHY, counselor, educator, and author of Getting Free:You Can End Abuse andTake BackYour Life
“Trauma Stewardship provides valuable advice for all those who toil for the bet- terment of society and the environment we share. Author Laura van Dernoot Lipsky's lifetime of caring and service has given her powerful insights into those who have similarly devoted their lives to the greater good. She reminds us all to embrace the joy of connecting with the people and planet that we cherish and serve.”
— JOHN FLICKER, President and CEO, National Audubon Society
“Laura makes a superb case for ‘trauma stewardship' as an approach that will benefit all of us in the service community who must deal with the struggles of our work with a hurting world. Her real-life stories hit home and clearly illus- trate the ways that the traumatic situations we experience at work can carry into our personal view of our world. Laura helps us understand our own responses to trauma and provides a path of renewal. Her book offers tools to bring us back to a place of balance where we can be more effective in our work, more pres- ent with our families, and more importantly, more at peace in our own soul.”
— MICHAEL L. TUGGY, MD, Director, Swedish Medical Center Family Medicine Residency Program; Medical Director, Swedish Family Medicine First Hill Clinic; and recipient of the Bronze Star from the US Army
“Laura van Dernoot Lipsky and Trauma Stewardship gave me language to describe what I was feeling after three trips to Iraq and subsequent work among US service members struggling to heal from war. Trauma Stewardship helped me acknowledge that my pain was not weakness to be suppressed or anesthetized but secondary trauma. But perhaps most important, Trauma Stewardship has shown me a path—not an easy one, to be sure, but a concrete one—toward a better and healthier life.”
— BRIAN PALMER, journalist
“Having been an attorney for only two years, I was both surprised and relieved to recognize many signs of secondary trauma in myself. Surprised because I had never been able to acknowledge the impact of my work as a public defender in such a way; relieved for the very same reason. I have come to rely on this book as a means to help me bear the weight of what can feel like inexorable human tragedy. It is only through the practices articulated and encouraged in Trauma Stewardship that my spirit remains intact. Each person I represent is better served for my having used this book. I recommend it to every public interest attorney and law student.”
— ELIZABETH LATIMER, public defense attorney, Brooklyn Defender Services
“It is extremely easy, especially as caregivers, to overlook ourselves and our care. Laura takes us, the trauma stewards, on a journey of self-healing: her book's humor will make you laugh; its tools will help make us whole. She reminds us that the work we do as caregivers not only impacts our clients but also deeply affects us. Trauma Stewardship provides us with methods to help us get in touch with habits and feelings that no longer serve us, our communities, or our work. A must-read for all those who understand that this work we do is sacred.”
— KANIKA TAYLOR-MURPHY, community activist
“Laura is a weaver. She takes the harsh yet resilient fibers that are the stories of trauma survivors and workers, including her own, threads them together with common-sense advice, and creates a warm and soft blanket that comforts and protects. It is an important book because it reminds you to care for yourself as you care for others and then offers practical tools for doing so. I wish I'd had this book when I first began my work with women and children experiencing domestic violence!”
— GRETCHEN TEST, Program Associate for Child Welfare, Annie E. Casey Foundation
“In this groundbreaking guide to trauma stewardship, van Dernoot Lipsky shines new light on the care of the healers in the helping professions and provides a useful and loving guide to developing our ability to care for ourselves as much as we care for others. Anyone in the helping professions will benefit from the profound insights offered in this book.”
— MIA EISENSTADT, consultant, activist, and anthropologist