Three Ways of Working on the Front Lines

It’s not easy to stay present, engaged and connected when working the front lines with people who have experienced severe trauma. There are basically three ways of dealing with it. One of them is harmful to yourself, another is harmful to the others who you are working with, the third is the only way to do it.

First Way – No Barrier

The first way is to have no barrier between yourself and the other, you just take all of their suffering. When you go home you think about it. It’s always on your mind and you’re always working and extending yourself. That is a great way to get burnt out very quickly, by not having a barrier, making it all your own, and identifying with it. If you notice yourself doing that, what is really happening is that your own trauma is being triggered. Then you have to work that through.

Second Way – Absolute Barrier

The second way, is where you can protect yourself but hurt the other, by putting an absolute barrier between yourself and the other. You’re the professional and you are the helper and they are the one with the problem. You want to fix the problem. You diagnose the problem and prescribe the treatment or symptom relief. You are the expert. You understand, they don’t. You tell them what the facts are and it’s their problem and you are going to help them and fix it for them. But you don’t allow much of a human exchange to occur between you and them, and your heart doesn’t open. You are professional, rigid. You don’t want to disclose anything about yourself because that’s unprofessional.

You are going to hurt people because you don’t see them for who they are. You see them as a diagnosis. You see them as a set of problems. In other words, you are going to medicalize them. This is the way the medical profession is trained to look at people. You are going to pathologize them. That’s the way of psychiatry for the most part. That’s the way that people are trained. By that very distance that you’ve created between yourself and them, you are going to hurt them because the whole problem in the first place is that they were not connected with. So, when you don’t know how to connect with them, you are simply re-enacting what happened to them at the very beginning of their lives.

Now, you might not burn out that way, but you also won’t be very satisfied in your work because there’s not going to be much in it. You are certainly not going to help people very much either.

Third Way – Be Like a Semi-Permeable Membrane

There’s always a middle way, and the middle way is to develop what’s called in biological terms, a semi-permeable membrane. The cell has a membrane around it. If there is no membrane around it, it dissolves and dissipates and dies. If the membrane is too thick, then nothing can come out, and nothing can go in either. So, the semi-permeable membrane allows some stuff to come in and some stuff to go out, or not everything to come in and not everything to go out. It is a matter of learning to develop a semi-permeable membrane, which means your heart is open but you’re not identifying with the person, you’re not making yourself the same as them. It is their pain, it is not your pain.

You have your own pain, but their pain is not your pain. The resolution of their pain doesn’t come from you, it comes from them. So, that sense of responsibility that you have to fix it – you just give that one up.


Gabor Maté

Dr. Gabor Maté is a Vancouver physician, author and public speaker who specializes in the study and treatment of addiction and mind/body health. He has authored the best-selling In the Realm of Hungry Ghosts: Close Encounters with Addiction, Hold Onto Your Kids, When the Body Says No and Scattered Minds: A New Look at the Origins and Healing of Attention Deficit Disorder. Dr. Maté was honoured as a member of the Order of Canada in 2018 for his compassion, work with trauma and addiction, and recognition of the mind-body connection in health and illness.

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