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Relationships, Trauma, and the Personal Narrative: Survival Relationships

Posted on April 29, 2016

At times I struggle with language around trauma’s impact on personal narratives. I find it difficult to present research in a way that doesn’t paint a negative picture of those who are struggling with trauma. Nowhere is this harder than in this next area of focus, how those who experienced complex interpersonal trauma often view relationships primarily for survival.

My struggle with this concept is rooted in the fact that I have witnessed many amazing relationships between people who are both living with mental health struggles, working through addiction, experiencing homelessness, and facing other traumatic situations. Even with these experiences, I have seen many clients use others, including myself, to make their survival possible. While this often doesn’t feel good, I have realized a few things.

1. Part of my job was to help people access resources to help them survive and meet their basic needs. On one hand, I felt used – on the other, I was being paid to fulfill this very role.
2. Due to past interpersonal trauma and negative experiences with the system, clients did not always feel comfortable connecting with me on a deeper level. I don’t get asked a ton of personal questions or talk about my traumatic history when I buy food or pay my mortgage. Sometimes you just need a resource without having an empathetic deep conversation!
3. We all rely on others for survival, but some of us are lucky to have more. The guy at Costco and the women at Safeway provide me nourishment. On a basic level, we use each other and both benefit from the interaction. I’m lucky enough to have the time and energy to have relationships where I don’t need something from the other person and we can just enjoy each other’s company. This is a luxury that people who are worried about where they are going to sleep, get food, or get the next hit do not often have the opportunity to enjoy.

One of my past, and most popular, posts goes into this reality in more detail, as it examines the “Entitled Client.” I’m not sure I have found better words, written or verbal, to express my thinking about this reality. If you have not read the post or want a refresher, it starts now!

In my self-care trainings I do a small group exercise where I have people reflect on causes of helping satisfaction and helping fatigue. I enjoy this exercise because it balances the stress and trauma we face as helpers with our passion and joy for the work we do and the clients we serve. One answer I hear from every group related to helping fatigue is that clients feel and act in an entitled way. In other words, clients expect us as helpers to give them everything they need, and to do so immediately. Even when we are able to pull this off, there is often no recognition from our clients that we helped them, and the “thank you” might be rare.

I share this frustration in my work and have many times been dumbfounded at what can feel like being used by clients. If someone offered me free health care, free housing, and free food, I would be incredibly grateful and jump through any hoop necessary, looking forward to the long-term benefits that would result. But my world is very different from the one many of our clients exist in, and it is this difference that has given me insight and empathy into a behavior and mindset that in the past triggered an angry and frustrated response.

Recently, I asked a group I was training to consider the issue of the “Entitled Client” further and see if we could build empathy for this way of existing. Here is what we came up with:

1. Life on the Street: Living in extreme poverty, homelessness, or with an addiction puts our clients in a whole different economic environment. On the streets, you need to get what you can get when you can get it. You don’t know the next time you’ll have food, shelter, or a hit that will calm the demons of an addiction. Many of our clients live in a black market of drugs and prostitution. This is rarely an intellectual activity, but one of survival. The short-term survival mentality of the streets helped us understand the urgency and immediacy of clients’ requests and why they tried to get as much as they could whenever they had the opportunity to do so.
2. Life in the System: Next, think about how our systems are set up. Is there much difference between the line to get a morning hit of heroin and the line trying to get a bed at a shelter or health care from a clinic? Hopefully, we provide a much safer and more healing experience, but in reality the system can be as much of a hustle as the streets. We set the rules, often based on white middle class values and expectations, and expect clients with intense physical, social, mental, and emotional health issues to jump through our hoops in order to get services that most of us would agree are basic human rights (housing, health care, social support, food). As long as the resources available fail to meet the complex needs of our clients, how can we blame those clients for trying to get everything they can at every opportunity, and utilizing what works on the street to try to meet their basic needs in our systems?
3. The Brain: For most of our clients, especially those who have experienced complex trauma, the brain adapts to survive the short-term. This survival mindset relies heavily on the part of the brain called the amygdala, which is responsible for meeting short-term needs and struggles with little thought paid to the benefits of delaying gratification or long-term outcomes. Permanent housing, suppressed HIV viral load, or getting children back from social services are all things most clients really want, but when they do not know where their next meal or hit is coming from, these long-term goals are lost. The emotional intensity of the amygdala helps explain the urgency, panic, and anger we experience from clients when we ask them to bring in one more piece of paperwork or follow “our” rules in order to get their basic human needs met by the system.

After this discussion, the group and I realized that entitlement is really a survival skill that works well within the environments in which many of our clients live. Pushing ourselves further, we could see that in many ways they were trying to advocate for themselves to secure the services they need to stay safe and alive. Clients are not entitled; entitlement is a label we use to externalize our reactions and frustrations related to what is actually a logical way of surviving.

We have to be careful where we put this frustration. We are rarely the ones who create the paperwork, regulations, and restrictions we have to put our clients through. We are not given the resources to solve society’s problems – we are lucky if we get enough resources to try to manage it from getting worse. We work with clients with high levels of needs and have to sit with the pain when we cannot find them a bed to sleep in, food to feed their children, or an empathetic health care provider who can really understand their emotional, as well as physical, needs.

We are left with a choice: blame the client or advocate for a better system. I challenge you this week to look at your “entitled clients” and instead of labeling them, look at the system and see which is more dysfunctional – the client advocating for basic needs, or an illogical and underfunded system in which they must participate. Alone, none of us have the power to change the system, but there is a level of frustration around the country regarding systems of care that reinforce, rather than help solve, society’s problems. We can learn something from our clients about how to advocate from a position that often seems powerless and disenfranchised.