With no apparent signs of trauma, Kate* is by all appearances a put-together woman in her early 40s: professional, well-spoken, immaculate and confident.
When I ask her what has brought her to treatment, she simply says that she needs help coping with the pressures of her job. What Kate doesn’t know yet is that there’s so much more lurking under the surface.
Workplace trauma has long been associated with emergency or frontline workers – police officers, firefighters, ambulance officers, paramedics, doctors and nurses.
But it can affect anyone in any workplace setting.
Trauma is an emotional response that can affect someone both physically and mentally. Workplace trauma can be either direct or indirect (secondary or vicarious) trauma, and include events such as accidents or injury, deaths, bullying, sexual assault and even severe workload stress or a toxic work environment.
It may affect attendance, job performance and productivity, and can be linked with developmental (childhood) trauma. Workplace trauma can also lead to post-traumatic stress disorder, which affects about 3 million Australians at some time in their lives.
Like with all patients, it’s important to understand how Kate’s trauma response may have been shaped, so we begin by discussing her childhood. As the youngest of six children, Kate endured a difficult upbringing. When she was five years old, her parents separated. She was repeatedly told by her mother, who was extremely irritable and critical of Kate, that she never wanted a sixth child and that her conception was when “all of the trouble in the family started”.
Not long after the separation, and with very little financial means, her mother’s life began to spiral out of control with a behavioural addiction. They were living in a shelter when Kate was just 12, and it was here that she was groomed by an older 18-year-old who repeatedly sexually abused her. She never disclosed the abuse to her mother or anyone else out of fear of not being believed.
It was a poignant moment for Kate to reveal this secret to me – one that had burdened her for much of her life. She said it felt as if she finally had a weight lifted from her shoulders. Feelings of shame and guilt are often the greatest challenges in therapy treatment.
After a troubled childhood, Kate worked hard at school and university, before embarking on a career in advertising. She was a diligent worker but also a chronic perfectionist – something she later realised was an adaptation she learned from her childhood environment and not an asset.
While working hard and striving for excellence are great assets to take to work, chronic checking and ruminating over her work in fear of making a mistake was not helpful to her producing her best work or to her mental wellbeing.
Kate was often the target of sexual jokes and sexual advances by some clients and colleagues which in and of itself was stressful enough, but this also triggered her previous trauma from sexual abuse – all of which continued to leave Kate feeling overwhelmed and unable to cope.
It wasn’t until Kate was under the guidance of a new boss that her life began to really unravel. Her new boss was hard on her, and Kate became anxious, experiencing heart palpitations, racing thoughts and overwhelming emotions before going to work. Like many people I see in treatment, she felt undervalued, depressed and as if she had no voice.
In rehab, Kate was diagnosed with complex trauma as a result of her repeated trauma.
Regulating emotions to improve self-worth
In treatment, I explained to Kate that just as physical trauma can leave lasting scars, so too can psychological and emotional trauma.
First, we began explaining her stressful feelings arising from exposure to inappropriate sexual innuendoes in the workplace.
Kate learned effective communication skills so that she could let her colleagues know she felt uncomfortable with their language and ask them to stop. Previously Kate would freeze and fear speaking up.
Kate was now able to see that by not speaking up for herself, she was not being responsible for her own wellbeing. She was not exhibiting compassion for herself.
We also discussed boundaries; Kate learned that “no” was a complete sentence and was able to say no to sexual advances.
Although she felt guilty for saying no, she learned she was still entitled to say it. It wasn’t until Kate started processing the trauma from her childhood that the guilt and shame she carried subsided. Kate learned how to regulate her emotions, identify unhelpful thinking styles and implement healthy behaviour to improve self worth.
When children are repeatedly exposed to abuse where their boundaries are violated, they develop entrenched beliefs. Kate had believed she was powerless – period – when she was repeatedly sexually abused.
She also identified that although her boss was critical and not very personable – her boss was not her mother. Kate came to understand that her new boss triggered her own inner critic. We call this a parental introject.
She was then able to discern between her internal harsh messages and core beliefs and those of her boss. She learned to detach from her boss’s messages and would identify her learned behaviour of “walking on eggshells” as an opportunity to pause and check in to regulate her emotions, reframe internal dialogue and self soothe before moving on with her tasks.
Kate was also able to understand that as a five-year-old, she was not responsible for her parent’s separation, and that she overcompensated by being perfectionistic. She understood that her parents were adults at the time and were responsible for their own emotional wellbeing and stress.
Kate also learned to fawn in response to her mother’s neglect.
This behaviour was repeated in her interpersonal relationships and she came to understand that she abandoned herself by not taking care of her own wants and needs.
Kate continues to learn to develop self-esteem by communicating her wants and needs, living her values and focusing on behaviours that move her towards her goals – even if she has to “act as if” she has self-esteem some days.
* Name has been changed for privacy and the client’s story is an amalgam of several cases