Open letter to mental health professional colleagues as they witness the pain of their clients.

A colleague wrote in part : “This has been an ugly week of multiple clients upset with the executive orders. The thing that continues to strike me is how der Trumpenfuhrer embodies the sum of all fears…..I spent two hours on Zoom today with crying people in the midst of the total meltdown of their lives, having lost jobs in the past several months and now worried about the ways in which the executive orders will effect them and the world. It was an ugly day.”

My reply is below:

It seems very important for therapists to support one another in what they are observing and experiencing. Vicarious trauma may be on the rise in our profession when therapists witness and describe days like the one you just had.

Psychopaths like pain. Inflicting pain is the point because it makes them feel powerful. Perhaps one of the most challenging things for therapists to observe and attempt to mitigate is cruelty and sadism.

In recent days not only is cruelty and sadism being perpetrated but it is being normalized with "pardons" that lift external constraints and restrictions and allows those so inclined to behave in further cruel and sadistic ways with impunity.

As I learned working on inpatient psych units and psych ed what works best with these behaviors is injections of Haldol and four point restraint with a skilled team trained to exert a "show of force". These tactics are used only after de-escalation techniques have failed.

After such interventions staff always met for a brief de-debriefing so that calm could be restored and confidence in maintaining safe order was reinforced.

As therapists we need to find ways to keep each other safe so we can keep our clients safe as best we can.

Remember, cruelty is not a byproduct of what is being perpetrated, but the cruelty is the point to dominate, coerce, and subjugate. It is important for us as MH professionals to confront it head on, lean into it, and mitigate it. Some of us will be harmed in the process, but in the end justice, compassion, dignity, and peace will be achieved.

Keep the faith. Stay strong. Be courageous, Do the right thing.