How Far Do You Go for a Client in Need?
Mental health practitioners play a crucial role in supporting people with trauma backgrounds as trauma counsellors, caseworkers, and in community capacity building roles. Many of us are drawn to this field by a passion for social justice. We may work with refugees and asylum seekers, sexual assault survivors, family violence survivors or with other people who have been subject to cruelty. While our value in social justice fuels our commitment to our work, the complex nature of trauma work can bring significant professional and personal challenges.
In any organisation, burnout is a risk, but when working with vulnerable clients like refugees and asylum seekers or sexual assault survivors, mental health practitioners also face unique stressors, including:
- Organisations stretched thin by changing government policies.
- Community attitudes toward asylum seekers or diverse groups, which may be unsupportive.
- The nature of gendered violence against women.
- Funding constraints within organisations.
- Systemic barriers to asylum seeker settlement, including risks of homelessness.
- The deep therapeutic relationship required to support clients with complex needs.
Each of these factors are worthy of discussion by themselves, however in this blog I am focusing on the last point about navigating the interpersonal dynamics between mental health practitioners and clients.
How do our clients affect us? How far should we go for a client in need? What impact do clients’ stories have on our well-being? And how can we maintain professional boundaries while still providing the best care and support?
The Treatment Triangle
Dr. Stephen Karpman’s Drama Triangle, derived from Dr. Eric Berne’s Transactional Analysis, explores how we often adopt roles when interacting with others. In clinical settings, this model is adapted as the Treatment Triangle, offering insight into the dynamics between mental health workers and clients with complex needs. Understanding this model can help us:
- Identify transference (when clients associate the worker with a past relationship) and counter-transference (when the worker emotionally responds to this) in client relationships.
- Recognise the impact of vicarious trauma—the toll of witnessing another’s trauma on our own mental health.
- Notice when professional boundaries may be slipping.
Three Roles
In traditional storytelling, we typically see a victim (Snow White), a rescuer (Prince Charming), and a persecutor (the evil Stepmother). In our practice, we can unconsciously play out these roles in our work with clients. Without awareness, we may fall into an unhealthy cycle, shifting among these roles. Here’s how each role might manifest in our work:
1. Rescuer
The drive for social justice that motivates many mental health practitioners to support, empower and even lobby for clients may, at times of stress, spill into client rescuing. Most of us aim to provide a fair and equal level of care for all clients, but as each client will have unique individual needs, some people inevitably touch us more personally.
Some clients may present with particularly distressing trauma stories, leaving us feeling helpless and hopeless about our ability to help. Or they may, consciously or unconsciously, also remind us of someone close to us. These things may lead us to offer more support and practical involvement than we’d offer another client. This might include giving preferential treatment, being more available to one client, working overtime for them, pushing strongly for referrals or lobbying. Mental health practitioners may also find it difficult to stay emotionally present, with feelings of inadequacy when working with stories of human rights abuses. You may end up trying to fill a growing sense of helplessness with activity as it can be easier sometimes to feel useful by focusing on tasks rather than facing personal helplessness. You may schedule additional client sessions, contact clients between sessions, offer to accompany clients more often than usual to appointments, and/or offer additional advocacy. It is not unknown for workers to have invited asylum seekers home. In your desire to be of service you can breach professional boundaries.
Rescuing is more than being client centred and supportive. In the rescuer role, you take full responsibility and ownership of your client’s issues and you are generally not aware of it. While many refugee and asylum seeker clients require some level of support to address their trauma history and help them settle in Australia, many also have a level of resilience and resourcefulness because of their refugee experience. Many have managed a journey to Australia in extreme conditions and have found the means to meet many of these needs.
Excessive helping can deny clients the ability to make their own decisions or have greater independence and choice in navigating their own way through new circumstances. It can discourage client consultation, self-determination and empowerment, which are important professional values.
2. Victim
Rescuing someone else generally has a time limit. Inevitably, mental health practitioners taking on a rescuer role may experience exhaustion, resentment or lack of appreciation. This may be triggered when clients miss multiple appointments or turn up at different times, refuse housing offers that have been difficult to secure, don’t follow up on the external referrals you took ages to organise, don’t engage well in counselling, strongly lobby for services that feels like pushing, complain about the service or make a complaint about your work. Perhaps they didn’t find you as available as they needed, or where disappointed when you were no longer available.
When frustration builds from our unmet expectations of the client, we may begin to see ourselves as a ‘victim’. We may feel that we have wasted our time with little outcomes, been relied upon too much or been taken for granted, especially if we are busy with other client issues or administrative deadlines. The small (and sometimes natural) rejections of assistance or complaints may feel particularly frustrating and unfair.
As well as experiencing victimhood, mental health workers may also feel like victims of the system, working within a constantly changing socio-political context and within organisational constraints. Becoming overwhelmed from an increased workload, along with hearing traumatised client stories, may result in a sense of reduced personal efficacy and motivation, and an increase in vulnerability, inadequacy and/or powerlessness.
3. Persecutor
When an experience of perceived victimhood is prolonged, mental health practioners may become angry and begin to blame or punish their clients. Persecution can occur in subtle ways. You may withdraw your caretaking by becoming less available, referring clients back to drop-in intake services, reducing appointments or stopping your work with the client altogether. You may become less invested in your client’s needs and less active in providing advocacy or support. You may even start complaining about them to your colleagues, labelling people as dominating, demanding, needy or persistent.
In the persecutor role, mental health practitioners often forget the impact of our own professional power over the client and, minimise the powerlessness of clients who have been traumatised, faced dangerous refugee journeys, prolonged detention and insecure settlement, or interpersonal violence and control. When clients push for help and services, they may only be doing what they have done to survive to get to Australia.
Inevitably, mental health practitioners reconnect with their client’s potential powerlessness, potential for suffering and the unjust system. We are reminded of our original motivation for entering the human services sector, which is often out of our concern for the political and personal rights of the client group we work with.
When you realise how your reactions and behaviour have led you to the persecutor role, however subtle, you can begin to feel guilt. And once you feel guilt, you can feel also feel shame and generally want to make up for it by reengaging with your client. As you start helping your client again, it is easy to fall back into the rescuer role again and the cycle begins again. This is not helpful to the client, nor to you. So, what can you do?
Stepping Outside the Treatment Triangle
Maintain Awareness
Good practice means stepping outside the ongoing cycle of the triangle. Clinical and professional supervision can be particularly helpful in exploring how and why this common pattern keeps occurring. Take a bird’s eye view of the situation, become aware and take self-responsibility for your attitudes and actions.
- Identify the red flag situations that may result in you rescuing someone. Are you most likely to feel a strong attachment to someone close in age? Or someone that reminds you of a family member who has a trauma history? Or to vulnerable women? Or to someone with a sexual assault history? Or someone else?
- Recognise personal secondary gains such as feeling better about yourself by helping someone or feeling less helpless by doing more for someone.
- Ask yourself whether you have become over or under involved with your client and your work in general. Is this a symptom of a bigger issue such as burnout?
- Understand the inevitable personal impact of working with traumatised clients. Are you experiencing compassion fatigue? Or vicarious trauma? You may feel most vulnerable at the beginning of your career as you first come into contact with traumatised clients, and toward the end of your career when you have worked with many traumatised clients. Seek help.
Reclaim Personal Power
Many mental health practitioners experience helplessness and hopelessness in the face of atrocities in our clients’ stories, hearing world news events beyond our control, Australian government policies that restrict settlement for refugees and asylum seekers or community dialogue that targets other diverse marginalised groups such as LGBTIQ or women.
When you are facing your own feelings of helplessness, look for areas in your work and life that give you a greater sense of personal power. Focus on work practices within your control such as your day-to-day client work and attempts at advocacy (within the boundaries of the organisation). Regain work energy by thinking about what your client really needs right now. It may be as simple (or difficult) as sitting with them as they recount their story rather than trying to ‘fix’ their situation. Remind yourself why you are doing this valuable work, involve yourself in staff support activities and take self-care measures such as balancing work/life, connecting to colleagues and community, and finding personal and professional meaning.
Recognise the Importance of Your Role
As a mental health practitioner in a casework or intake role, you are in an important position as a first point of contact for many traumatised clients from refugee and asylum seeker backgrounds. Being experienced by clients as reliable, consistent and caring, is vital in helping them feel safe, and rebuilding or even beginning to trust someone else. When you’re feeling overwhelmed by the work, it can be easy to forget that the therapeutic relationship is as valuable, if not more, than the casework work tasks you do for a client.
Conclusion
It is important to recognise that we all have the potential to fall into the roles of rescuer, victim and persecutor in any of our relationships, including with our work with traumatised and vulnerable clients. The professional relationship between a worker and a client is a precious one. Becoming more self-reflective will help you to maintain personal and professional boundaries, acknowledge client strengths and stay tuned to your self-care needs; all of which will ensure better practice, best client outcomes and greater work satisfaction. Keep up the good work!
Note: This blog article was originally published (in its original form) in the Social Work Connect Magazine and STARTTS Transitions Magazine in 2014. I wrote it for the Red Cross caseworkers I supervised in the refugee and asylum seeker sector after our many fruitful discussions in individual and group supervision sessions.
About Melinda Austen
Melinda Austen is a clinical supervisor and workplace and leadership coach with over three decades of clinical experience working with refugees, asylum seekers, Defence veterans, Police and couples. She now helps the helpers. Melinda supports colleagues, including social workers, clinicians and other professionals such as lawyers and allied health who work with vulnerable clients. In her supervision and workplace coaching practice at person2person Consulting, she is driven by a desire to help people foster healthy, productive teams and thrive in their work. www.person2personconsulting.com