Therapy Talk Podcast: Navigating Compassion Fatigue with Rebekka Lehmann

Last Updated on November 23, 2023 by It’s Complicated

Johanne: As I bear witness to some of the worst atrocities carried out in the name of war that I’ve come across in my 35 years of living, a concept that has lingered in my thoughts is that of secondary trauma and compassion fatigue. In this episode, I’m joined by Rebekka Lehmann, a therapist specialising in these very issues. We’ll delve into the relevance of her work, especially during times when we extend ourselves to care for others, whether it’s through caregiving, writing, volunteering, activism, or teaching. The risk of neglecting our own needs and experiencing burnout is ever-present. Rebekka’s expertise lies in helping those who support others. In the next 30 minutes, we’ll unfold the nuances of her work and explore methods for maintaining our ability to support and stand up for others. Also, if you stick around until the end of the interview, Rebekka will graciously lead us through a meditation. I hope you find it as beneficial as I did.

If you would like to go straight to the guided meditation, please skip to [00:24:40].

Season 2 Episode 2 Transcript

Johanne: I am so happy to have you on today, Rebekka.

Rebekka: Thanks for having me.

Johanne: I wanted to hear if you can give a quick introduction of yourself to the listeners.

Rebekka: Sure. My name is Rebekka. I’m a clinical and health psychologist and a trauma therapist. I live and work in Berlin, mostly online. I’m German, East German, actually, because I was raised by parents who were very much involved in the system. I think that’s always interesting to reflect on where we actually come from. I practice yoga and mindfulness, and I think it has a big influence on my work too. I focus on working with people in helping professions. My passion lies in making sure that those who care for others are also taking good care of themselves.

Johanne: And is that also the majority of your clients? Are they in different types of helping professions, or is it more diverse than that?

Rebekka: It’s quite diverse. I think people feel very called in this way. People in helping professions often focus on other people’s needs instead of their own, putting their own wellbeing very low on the list of priorities. The clients that come to me are not all in a helping profession, but many identify with putting themselves last on their list of priorities and want to change that.

Johanne: So they can be carrying a mental load due to other factors than being a nurse or therapist, like caring for everyone in their family’s needs or in their relationships.

Rebekka: Exactly.

Johanne: And you mentioned that you’re a trauma therapist. Can you explain what that entails?

Rebekka: Trauma therapy means I’m trained to be very aware of the role that trauma plays in our lives and how it translates into the present moment. I work with a lens for this demographic of people in helping professions, which is very useful because they’re at risk for what is called secondary trauma. This means we can become traumatized by only listening to the stories of others. This knowledge and background are very useful in my work.

Johanne: I remember when I was a psychology student, understanding secondary trauma and seeing it show up when I started practicing. Many of my clients experienced secondary trauma without knowing that was what they were going through. They felt they didn’t have the right to feel such pain because they didn’t experience the event firsthand.

Rebekka: Yes. It can be a very lonely place.

Johanne: Helping professionals often don’t focus on the witnesses of traumatic events. I think it’s a really interesting, important phenomenon.

Rebekka: Yes, and it’s still not always included in our training. It’s great that you came into working with this awareness.

Johanne: Is secondary trauma an umbrella term that entails trauma experienced if a person witnesses a car crash, for instance, but also from being in a helping profession and hearing traumatic stories regularly?

Rebekka: The difference isn’t that big depending on who’s telling you, but it’s more about how exposed you are. Psychologists, social workers, and psychiatrists are more prone to this due to the duration and regularity of exposure. If it’s a one-time event, like hearing something about your sister-in-law, you have more time to process. But in helping professions, you constantly hear these stories, making it harder to process and increasing the risk of burnout.

Johanne: So you knew from learning about secondary trauma that this was something you’d bring into your private practice work?

Rebekka: Yes, there was a development. I got curious about the topic and saw parallels in how much our focus is trained to be outside of ourselves, anticipating others’ needs. This realization that I love working with people and didn’t want to have to stop due to burnout, led me to look for ways where I can be well and take care of others at the same time. I decided to become one of the resources for our population of helpers. We do important work and it’s a problem how little we are appreciated both by the systems we work in and individually.

Johanne: This focus of your work becomes especially pertinent in a world with more quick-fix solutions to mental health problems, leading to fast-paced therapists and stressed-out therapists doing numerous sessions a week.

Rebekka: Yes, it’s not only about taking care of ourselves but also about the systems we live and work in. We need to consider what isn’t working for us and how we can get better.

Johanne: I was reminded of the idea that sometimes therapy focuses so much on inner work that it fails to look at concrete things like how you’re scheduling your time and if you’re constantly staying busy to avoid what’s really going on.

Rebekka: It’s very important, especially for self-employed people. What kind of system do I create for myself? Am I a harsh boss to myself or compassionate? Do I set up my life in a way that serves my wellbeing?

Johanne: And I’ve worked in Berlin like you for seven years. It seems to be a mecca of freelancers and self-employed people. This creates a lot of flexibility but also entails a high risk of burnout.

Rebekka: Yes, and it leads to a lot of confrontations around how we’re treating ourselves. It’s a path on its own.

Johanne: I also want to get into the nitty-gritty of your therapeutic practice. Your profile says you work in a culturally sensitive and feminist way. I’m curious to hear what this means and how it shapes your work.

Rebekka: Helping professions, especially those not paid well enough, are still systematically women’s work. About two-thirds of the global care workforce are women, and they experience 53% more stress than men. This difference is particularly big between the ages of 35 and 45. Caregiving roles in families, like taking care of children, the elderly, or sick family members, are still distributed unequally. We have to be very conscious about creating fair distribution in our relationships and families. This can be seen on a personal level too, like who was the caregiver in the family I grew up in? What was taught to me about my role as a woman or a man in taking care of others? Where was my mother on her list of priorities, and where am I on my list? Women are often encouraged to ignore their boundaries, please everyone, and make sure everyone’s taken care of, sometimes at the expense of their wellbeing. This can be harmful not only to themselves but also in becoming resentful toward others. It’s important to look at the system around us and how it supports or hinders our wellbeing.

Connected to feminism is also becoming aware of the culture we grew up in. How patriarchal is it? How does machismo influence our stress levels? As a therapist, I’m mindful of these influences, which differ depending on which country you come from, which culture you grew up in, and the expectations put on you by family, peers, society, and religion. It’s very individual. Having lived abroad for many years helps me relate to clients from different backgrounds.

Johanne: What about the connection between mind and body in your therapeutic work?

Rebekka: Stress, particularly chronic stress, often settles in the body. There are areas that are considered typical for stress, like tense shoulders, headaches, digestive issues, back pain, and high blood pressure. Identifying areas of tension and observing bodily reactions to stressors can inform us about how these affect us. In my work, we might identify tension in the shoulders, for example, and look at exercises specifically targeted for this area. I’m also trained in trauma-sensitive yoga, which is helpful for people working with traumatized populations. Mindfulness is another tool I often bring into sessions, as it helps observe our feelings and pause before reacting. It’s helpful when we’re affected by the suffering of others and in conflicts with colleagues or bosses. Guided mindfulness practices are something I often use with clients, either in sessions or as recordings between sessions.

Johanne: Do you bring yoga and mindfulness into your practice room?

Rebekka: I practice yoga myself very religiously. It’s my anchor in the day. In my work with clients, it depends on their needs. If they’re interested, I could bring yoga in, but the mindfulness part is definitely more common. It helps explore and experience situations non-judgmentally, staying with feelings, and learning to observe them. It gives us a chance to pause and reflect before reacting.

Johanne: We wrote about whether you’d be up for doing a mindfulness meditation. I don’t remember whether you said yes, and how much time we’d then need.

Rebekka: I brought something. It will take around seven minutes. If you’d like, we can start.

Johanne: I’d really love that. Please, go ahead.

Rebekka: Welcome to the self-compassion practice, inspired by the three-center check-in from the Center for Mindful Self Compassion. This practice is a way to include mindfulness into a challenging day or situation. It gives you the chance to pause and reflect, and regulate yourself instead of simply reacting.

To begin, find a comfortable seat where you can let your breath flow naturally. Perhaps sit up a bit more instead of leaning back. Place your feet on the ground if you’re in a chair, or adjust until you find a seat where you can breathe deeply. I’ll give you a moment to settle in.

If you wish, you can close your eyes. If that doesn’t feel safe today, simply find a soft focus in front of you.

Take a deep breath in, and out. Inhale deeply, and exhale completely. One more time, inhale all the way, and exhale. Let your breath return to a natural rhythm as you arrive in the present moment, in this space we’re creating together.

Take a moment to notice how you are today. How you’re really doing right now. Begin by asking yourself, ‘How’s my body?’ Is it tired or awake? Tense or relaxed? What bodily sensations do you notice? Observe any tension in your body, and if you observe any, invite it to gently relax as you exhale.

Next, ask yourself, ‘How is my mind?’ Is it busy or calm? Curious or judgmental? Observe your thoughts with openness and curiosity. Consider that you are not your thoughts but more than them. Notice that you can observe your thoughts, which means you can be free from them too.

Lastly, ask yourself, ‘How am I on an emotional level?’ Are there any emotions present that you can name? Notice if these feelings connect to a sensation in your body. Often, when we notice our feelings, our body becomes tense. If that’s the case, invite your body to relax again as you exhale.

Now, bring your attention back to your breath. Notice how it feels to inhale and exhale. Your body breathes for you, in and out. Simply notice what it’s like to be aware of this moment.

If you like, offer yourself a moment of kindness, perhaps by putting a hand on your heart or any other place in your body that wants to be held. Or tell yourself some words of kindness. May I be kind to myself. May I be free from all suffering. May I be at peace.

When you’re ready, take a deep breath in and out, slowly coming back to the space. Open your eyes if they were closed, letting the outer world enter once again.

Thank you for joining me and for making time to tend to yourself today. May this practice benefit you and everyone around you.

Johanne: Thank you, Rebekka. That was truly calming and insightful. I’m sure our listeners will find it incredibly beneficial.

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