Social Impact LIVE: Richard Beck on Care for the Caregivers

Richard Hara is joined by guest Richard Beck, CSSW adjunct professor and a clinician in private practice who provides group therapy for many clients who have experienced psychological trauma, sexual abuse, and incest. Mr. Beck discusses the importance of self-care for caregivers and how caregivers can transform fatigue into hope and resiliency.

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(Music)
Richard Hara: Hello and welcome to Social Impact LIVE, a weekly conversation with members of the Columbia School of Social Work community. I’m Richard Hara, host and I’m happy to welcome today to the program Richard Beck, who’s on our adjunct faculty here at the Columbia School of Social Work. Mr. Beck is a clinician in private practice specializing in issues related to group therapy psychological trauma sexual abuse and incest. He’s currently president of the International Association of Group Psychotherapy and Group Process and formerly president of the Eastern Group Psychotherapy Society. Mr. Beck lectures nationally and internationally on issues of trauma and therapists self-care and has been to Istanbul, Belfast, Berlin, Cairo, and I think recently returned from Italy…

Richard Beck: Two times.

Richard Hara: Two times. Okay. Mr. Beck teaches courses on the treatment of childhood sexual abuse and on comparative group approaches here at the school and has so for many years. Mr. Beck, welcome to Social Impact LIVE, it’s great to have you here to talk about the topic of therapist self care in particular. But before we do that, I want to make note of one thing first of all, that you’re an accomplished fisherman and landed, what, a 150-pound halibut over the summer, is that correct?

Richard Beck: That’s correct.

Richard Hara: Yes. And also in relation to that created what were we called a “Gone Fishing” photo series that that we feature here on our various school social media platforms.

Richard Beck: I don’t think anybody expected me to bring a picture of a fish on the “Gone Fishing” series but that’s what I did for my self-care each summer.

Richard Hara: Okay. And so just to sort of go into your personal story a little bit, what was your journey to becoming a therapist and how did you come to specialize in group work in particular?

Richard Beck: How long is this program? My specialty is really psychological trauma and as many of us our training begins in our childhood. Both of my parents were Holocaust survivors and I lecture on this. And when I gave a keynote just recently in both Greece and in Italy I’ve referenced that in terms of my childhood. Today being Yom Kippur was a decision for me to come and present on the topic of self-care here for Colombia. It’s meaningful. I used to watch my mother weep every Friday evening as she lit the Sabbath candles for her sister who
was killed in a gas chamber. And never discussed the experience, but she would cry every time she lit the candle for her sister who was killed. This speaks to the component of listening and
bearing witness, which Judith Herman — the psychiatrist Judith Herman — writes about this. And that was the beginning of my trajectory in terms of helping and listening to people and also recognizing the need for self-care, given all that we as social workers will listen to in the course of our work. Clinical work, administrators… we all hear things which take a toll on us
as human beings.

Richard Hara: And I had the opportunity to read the chapter that you published on care for the caregiver. The Wiley-Blackwell handbook on group psychotherapy I believe and it’s it’s a wonderful chapter.

Richard Beck: I’m glad you liked it.

Richard Hara: I did. And what I particularly appreciated was at the opening you talk about, you know, the I guess the costs of doing this work and and you use the word “loneliness.” and it just you know it just sort of sets such a tone for the article because it just humanized the experience. I mean we in the discipline we talk about vicarious traumatization, secondary traumatic stress, and so on. But to see that word “loneliness” to me just just captured just the humanity of the people who try to do this work as well as they can.

Richard Beck: It comes with the territory.

Richard Hara: It comes with the territory. Yeah.

Richard Beck: It comes with the territory, Richard. The presentation I was just invited to give in Italy two weeks ago was on interpersonal intrapsychic loneliness, the treatment of childhood sexual abuse.

Richard Hara: okay.

Richard Beck: Which is really related to the course I teach here at Columbia, plus additional experiences that I’ve had over the years. And there’s the loneliness of the survivor of the abuse but there’s also the loneliness of the clinician. We sit, we listen, doing individual work, we do group work, and we hold all the the feelings the experiences of the clients that we are privileged to help. And loneliness, I think, takes a toll on us, as as treaters, even as professors, there’s a loneliness to the experience of it. And it’s important both to recognize and acknowledge it and be aware of it in terms of our own humanity in our own self-care.

Richard Hara: Yeah. When I think about group work, you think about people getting together, right, and I think that’s the primary value of doing group work for people who participate in groups and certainly for us as facilitators of groups. So just thinking about the people that we are trying to help. I mean, what is it about group work that you see is sort of special or specific to to do in group therapy.

Richard Beck: How long we got? I use humor, and even in our interview, there’s a way to bring people together and bridge gaps. But never at the expense of somebody, not that kind of humor. But it’s a way to share our humanity and in a group we can help reduce someone’s isolation, we really can metabolize people’s sense of shame, and shame is such a pervasive and toxic experience. And my sense and experience is that shame is best treated in group, as is interpersonal loneliness, that someone’s not alone with the experience. I’m not the only one who lost a sibling. I’m not the only one who experienced incest. I’m not the only one whose parents got divorced. I’m not the only one who has a problem with substance abuse. And this sharing and being able to help someone else with an issue even before you can help yourself, you can begin to help someone else, you develop a sense — we’ll call it mastery — to take ownership of one’s own life, it’s profoundly a gift that we can offer someone by giving them that opportunity, right, in a safe space where they can begin to trust others and trust themselves, maybe for the first time.

Richard Hara: Right, right. But as group facilitators I mean we don’t have all the answers right? I mean we’re there to listen and to hopefully help people to just sort of figure out for themselves…?

Richard Beck: Absolutely! I tell my students I wish them the gift of ignorance. Not stupidity, none of us are stupid. But ignorance, then the curiosity of what makes each person unique, what is it about your life that you’ve developed into this person in this way, that you’re struggling with this issue? I’m curious about it. And if we can instill within our students and within ourselves a sense of curiosity, and I use the word ignorance tongue-in-cheek, but not to be experts, let our clients be the experts in their own lives, let them take ownership, let them figure out what’s really right for them. So important.

Richard Hara: Yeah. So how do we do that?

Richard Beck: Interviews like this!

Richard Hara: Interviews like this.

Richard Beck: Facebook is very powerful, social media is very powerful. A way to connect with people.

Richard Hara: Okay, yeah, yeah. So we create a space for people to talk–

Richard Beck: A boundary. Because people, especially people who’ve been traumatized, their boundaries have been violated. Broken. Not just by sexual abuse but disasters, whatever types of issues, boundaries have been shifted and violated.

Richard Hara: So creating certain boundaries, limits if you will, gives people a sense of safety or groundedness.

Richard Beck: Absolutely, yeah. One of the first things I do when I teach, I tell my students here, “I started on time and we end on time.” And it’s nonverbal intervention, but it’s so important to maintain a frame, to set a frame, for whatever it is we’re doing. And for some people who have had their boundaries violated, the concept of a frame, and us as professors or clinicians establishing that frame might be for the very first time developing that kind of a membrane within someone that they’re cultivating and developing, and they’re internalizing within themselves.

Richard Hara: Interesting. I’m curious because you’ve got experience internationally and so you’ve talked with people who’ve done groups in different countries, different cultures, and so on. Is there, does culture make a difference in how these these kinds of frames or boundaries are are set, or is it something that you you find pretty universal in the way people are doing group work in different places?

Richard Beck: What a good question. First, internationally, different paradigms occur and exist around the world, which are different than those that we use here in the United States. And it’s not as if one is better or worse or more right. There are some more active. The psychodrama is used around the world, analytic models, cognitive models, there are different models which are used. But the impact of culture I think really circumscribes all of the different theoretical paradigms. I’ll give you an example: the same natural disaster, the hurricane, when the hurricane destroyed Haiti, and it was another hurricane that affected Japan, it’s the same natural disaster, but within the culture it was experienced very differently. And how one works with, and how the different clinicians work with, really needed to take into consideration the impact of the culture in Japan. And my Asian colleagues have, what you’d call, the sense of saving face, the cultural expression saving face. And clinically one needs to be very respectful of such cultural norms, we’ll call them norms. And a colleague of mine, a Japanese psychologist, brilliant guy, developed a paradigm to work with people after the nuclear disaster, the tsunami, and the earthquake, called “story-making group.” And culturally people don’t talk about their own personal experiences, but you can create a story and talk about the experience within the context of a story, within the Asian culture, within the Japanese culture. And he was able to run groups with people who lost loved ones and he himself came from a family that survived Hiroshima. And I know he’s a wonderful human being and grew up in Japan and works within the culture of Japan, he’s a psychologist. In Haiti, what was fascinating in a very macabre way, is I forget the year that the hurricane devastated Haiti, hundreds of thousands of people died, and they died because in Haiti people don’t expect hurricanes, they expect earthquakes. I’m sorry, it’s the other way around, it’s the earthquake. So what they did was they built their homes with large slabs of concrete to protect themselves from the winds, but what happened was when the earthquake came that’s what caused the extraordinary amount of deaths. So what was built to protect against one disaster caused massive death in the other, that was the cultural component. So it’s a long way to answer your question.

Richard Hara: No, no, it’s fascinating. Yeah, incorporating culture into our work.

Richard Beck: And the ignorance, if I might go back to ignorance. I just came back from Italy, where I talked about childhood sexual abuse, and I was in Greece talking about research there, but I don’t know the culture and the ignorance is, “well what’s it like, how is it approached in your country? Can you tell me how one experiences it?” And to ask and be curious about it within the culture rather than assuming, “well this is the right way to do it because in the United States this is how we do it.”

Richard Hara: Yeah. Practicing a certain amount of cultural humility.

Richard Beck: That’s a good phrase.

Richard Hara: Yeah. More than anything else. So let’s flip it around now. So the therapist and the the impact of doing this kind of work, listening to people’s stories, witnessing shame and guilt, or you know, all of the negative emotions, let’s put it that way, that can can happen. So how does that affect people, you as a therapist, for example, and how do you manage that?

Richard Beck: I thought you might ask me that. It takes a toll. There are different ways that doing trauma work can take its toll. We can burnout, which is simply our batteries are flashing low energy, so we take some time off and we rest and we recuperate. We need to find ways in which are meaningful to us to really take care of ourselves. Karen Saakvitne and Laurie Pearlman conceptualized vicarious traumatization, and that’s a little bit different. That’s like when you go to the dentist and he or she takes an x-ray, it’s cumulative. And the same thing with the impact of listening to people’s lives and problems and dramas and that can take a toll on the way we view the world, when we listen to people who are supposed to take care of others doing awful things to people they should be taken care of. And that we need to recognize that it affects us in a way that consultation is really important, supervision, peer supervision. When I did all of my 9/11 work, and I did over a thousand hours of travel in groups after 9/11, I had a consultant who was in Kansas City who really helped hold me together, given all the horrible things that I was listening to. Some things that I didn’t even tell my consultant because they were just so awful to really listen to. So supervision, individual supervision, peer supervision. I was ipeer so provision for many years in Long Island with colleagues. Even personal therapy, if things really begin to affect us I think that it’s important to know when to say no. That’s one of the
important things: “no heroes welcome,” as my colleague, Suzanne Phillips, who’s a psychologist writes. No heroes welcome while we’re doing this work. It’s a lot.

Richard Hara: It’s tough to do right? I think, you know, all of us — I don’t want to speak for everyone — but as a social worker I kind of feel like I want to put these things on my shoulders, right?

Richard Beck: Even as a social work student, not even as a professional. It’s — you’re studying to be aware of the toll that this is taking on us. I’m sorry, I didn’t mean to interrupt.

Richard Hara: So first, to recognize the toll. Maybe see if we’re exhibiting some signs that the work is getting to us. What might be some warning signs that people might look for to indicate that maybe they need a break or that they need, let’s say, supervision to help.

Richard Beck: Startled reactions. Sleeping too much. Sleeping too little. Numbness. Becoming indifferent to the problems that you’re listening to. These are signs that the work is starting to get to you. Or even studying is starting to get to you. You know, it’s okay to talk to someone about this. The cluster symptoms of PTSD, they can secondarily affect us, given the work that we do as social workers, as clinicians. And listen to your friends. If two people say, you know, you should sit down, well, maybe it’s two people. If twenty-five people say sit down, you sit down.

Richard Hara: So listen to what the people around you–

Richard Beck: Who you trust.

Richard Hara: Yeah, that you trust and respect. And other things that we can do to kind of replenish ourselves, physically, spiritually, emotionally that you would recommend?

Richard Beck: I fish. I garden. I take photographs. Self-care is unique as your fingerprint. Everyone has to figure it out for themselves. What I might enjoy for self-care, someone might hate. “I get seasick, why should I go fishing?” But they might like drawing, they might like yoga, or dancing. Everyone has to find a way that’s meaningful for them subjectively, that recharges their lives and their batteries. Spirituality is important for some people. Everyone has to figure this out themselves, but to be aware of and recognize the importance of it. It’s as important a part of the work, self-care is, is important a part of the work as doing the work itself.

Richard Hara: I’ve been so caught up in this conversation that I forgot to remind the audience that we do have a Q&A period coming up very soon. So if you have a question, a comment, that you want to post to our chat box, please do so and we’ll be able to put it up on the screen and ask Mr. Beck to answer, address, comment.

Richard Beck: And, as can you.

Richard Hara: And, me as well.

Richard Beck: Of course.

Richard Hara: Sort of thinking about self-care, sort of recharging your batteries in a way, but in a way that is meaningful. There’s no prescription. You have to sort of figure out something that resonates, right–

Richard Beck: –Absolutely.–

Richard Hara: –with you and, at some level, who you are as a person.

Richard Beck: Healthy self-care. First, when I ran support groups for clinicians, they were the least attended, because I think we’re terrible at taking care of ourselves. That’s why I wrote the chapter, because I’m not so great at self-care. So, it forced me to really think about it. There are maladaptive ways and there are adaptive ways. It’s better to find the adaptive ways.

Richard Hara: Well, I think one of the things that we do here at the School of Social Work every year is our community/self-care day, when–

Richard Beck: –Absolutely. It should be once a week, by the way.

Richard Hara: It should be once a week. Yeah, or at least once a semester, right? Once a month. As often as we can squeeze it in to complement what is happening it the field. Also, I think just generally, with students as they’re trying to manage their lives as emerging professionals–

Richard Beck: –Absolutely.–

Richard Hara: –but also as people and here at the School of Social Work.

Richard Beck: People first, actually. People first. We’re the instruments of our work.

Richard Hara: That’s right, we are the instruments and again, we have to keep that instrument–

Richard Beck: –Fine-tuned.

Richard Hara: –fine-tuned. So, I want to talk a little bit about maybe some of the things that — resources and so on that maybe we could recommend to students. I think we have questions here. Yeah, what resources would you recommend for social work students? For context, I’m a first year reduced residency student and have been in the public defense field for about four years already. I’m only starting my formal social work education now. Okay, so someone who’s got some professional experience, has been out there, but now is being introduced to the social work lens. Some resources you could recommend?

Richard Beck: I would connect with other students and discuss the experience together that this student is not alone and to be able to share what it’s like starting school, changing careers, and work together rather than you or I say, “This is what you should do.” Allow the student to figure out a way for him or herself to figure this out in conjunction with other students who might be going through a similar transition in their own lives. That’s both using a group, recognizing the need for self-care, and using Columbia’s resources at the same time. So, it’s really knitting — my mother used to knit. So, I used to knit three components together as a way to really help the fabric of the person and really deepen the connection with the school and with the other students as well.

Richard Hara: Okay, wonderful. Next question–

Richard Beck: You can read the screen. You’ve got better eyes than I do.

Richard Hara: For now. As an anthropology major who is pursuing social work, I’m interested in the points you brought up about being conscious of cultural differences/cultural humility. How do you best navigate an individual’s understanding of sickness or attitudes about health while considering their culture and environment?

Richard Beck: It goes back to my concept of ignorance. I don’t know within the particular culture what the symptom represents. Is it idiosyncratic to the person? I take it it’s a psychological symptom and not a physical medical symptom, which you always want to reduce. It’s important to always rule out medical issues as well. I would never minimize that. I know somebody whose wife died because they were just discussing what the symptom might mean and it turned out to be breast cancer and eventually she did die. So, it’s something that I take very seriously.

Richard Hara: Yeah, and obviously there is a distinction between sort of the biological disease that might be — somebody might be experiencing, but also just the meaning of illness for a person.

Richard Beck: And, the meaning — and Richard, the meaning of discussing the illness within the concept of — context of the culture that the person–

Richard Hara: –Right, that’s–

Richard Beck: That’s the intersection.

Richard Hara: –Exactly.

Richard Beck: The intersectionality of the — I hate the word symptom, but we’ll call it a symptom, a presentation of ways of being within a culture.

Richard Hara: This is happening to you. What does it mean to you?

Richard Beck: Exactly.

Richard Hara: What does it mean in the context of your culture? Yes.

Richard Beck: Within a culture, exactly. You’re supposed to feel this way.

Richard Hara: Possibly.

Richard Beck: Right.

Richard Hara: Next question, what would systemic self-care look like in agency policy?

Richard Beck: Oh, that’s such a good question. I think you need–

Richard Hara: –I work–

Richard Beck: –Oh, please.–

Richard Hara: I work predominantly with survivors of various forms of exploitation and violence, but there is a recurring pattern within an organization, a failure to hold space for employees in terms of their wellness. This includes government and non-profit, with the understanding that we are individuals who hold a core most responsible for our own wellbeing, what or should be the systems based responsibility in the field? And, I think this is a great question because this whole issue of–

Richard Beck: –It’s a great question.–

Richard Hara: –of self-care, it falls two ways. One, on the practitioner who feels guilty about attending to their own needs and is resistant, and also–

Richard Beck: –Or the system not allowing for the time to take care of the person.

Richard Hara: –But, in the system, the administrator, the manager, who says, “Well, I don’t want to talk about it because then that reflects on me in my ability to really support my employees and my staff.” So, there’s this reluctance to talk about it on both sides.–

Richard Beck: –Oh, I’m so aware of what you’re–

Richard Hara: So, yeah? You think so? So, systemically, how can we manage that? What’s the fix?

Richard Beck: I’m a storyteller. Let me tell you a story. I was running a group with a colleague of mine in San Diego. It was care for the military caregiver. I was running this group with my friend who’s a dear friend who’s a psychologist, a really ethical smart psych — smart guy. And, everybody in the group worked for the VA as a system, psychiatrist, psychologist, social workers, and they were all traumatized, not by the horrible stories of the soldiers, men and women that they listened to, to a person. This was, Richard, what I found fascinating, to a person. They were traumatized by the system within which they worked in terms of the paperwork, in terms of the processes that this question really speaks to.

How does one address a system like the VA or whichever system –whichever agency that we might find ourselves working for? That’s really a profound question, a macro type question, which needs to be addressed by many levels of people, higher up in the food chain than you or me. I think it’s important to recognize the issue and to be able to address it systemically so that there are components of self-care built into the system so that the employees can do their jobs even better. That’s my answer as I’m thinking and brainstorming with you, that the system needs to understand and respect the need for self-care of its employees.

Richard Hara: So, it’s not necessarily a deficit of the individual.–

Richard Beck: –Far from it. It could be, but it’s not necessarily.

Richard Hara: Yeah, but if we’re not addressing it systemically, then really, we’re not doing the best that we can do. And, it’s not just for us, but for our clients as well, and I think–

Richard Beck: If you and I are sitting on chairs with two legs and we’re balancing like this, it’s not that we can’t sit comfortably. It’s just that the chairs only have two legs, and that’s the system. And, I’m not saying that every system only has two legs, but the system needs to understand there needs to be a balance between the functionality of the system and the employees who work within it.

Richard Hara: So, just framing it as a win/win for staff, for the agency, and ultimately for–

Richard Beck: –The consumer, whomever it is you’re working for.

Richard Hara: Yeah, absolutely. Okay, oh this is for both of us. Have either of you reviewed the literature comparing burnout rates for therapists with meditation or mindfulness practice versus those without? I agree with the view that self-care is subjective, but I wonder if the topic deserves an objective stance as well. So, empirical studies looking at specific components of self-care that seem to have observable, measurable outcomes, what would they look like and what are your thoughts on that?

Richard Beck: I don’t know them. I really don’t know the current literature on this. I’d be interested. It sounds as if the person who asked this question might have some ideas in terms of the answer to it, him or herself. What are your thoughts?

Richard Hara: My initial thought is that there probably are studies that demonstrate, certainly, that mindfulness can reduce stress, can–

Richard Beck: –Absolutely.–

Richard Hara: –And, I would think that it would be extended to self-care for therapists as well. And, I’m just — yeah, probably thinking that this is an area where we do need more research focus and looking — or having studies that really do, I think, follow up with what you suggest in your chapters, that you have compassion fatigue on the one hand, but how do we build hope? How do we build resilience? And, I think mindfulness and those kinds of techniques speak–

Richard Beck: –Absolutely.–

Richard Hara: –to that resilience factor and so on. So, it’s kind of like, well it’s not necessarily treating you, but it is giving–

Richard Beck: –It’s not treating.

Richard Hara: Right?

Richard Beck: It’s not treating. It’s cultivating hope and a sense of resilience within the human being in whichever role we find ourselves in. And, often, we are in multiple roles.

Richard Hara: Yeah. Well, on that note, I’d like to say thank you again, Mr. Beck, for joining us here on Social Impact Live. It was a pleasure. That concludes today’s episode. We’ll be joined next week by Columbia School of Social Work faculty member, Andre Ivanoff, [PHONIC] who will share her thoughts on her work on dialectical behavioral therapy. So, until then, have a great week. Bye-bye.