My Thoughts

This is a really good question. Honestly, this is something that I haven’t really thought of. I’ve certainly had many different traumatic events described to me in therapy as well as vivid and/or violent fantasies, hallucinations etc. Personally, I don’t know that anything would ever be too graphic for me. When I’m working, I am certainly in a different mode. It’s not that I stop feeling, but I’m much more unflappable and curious than I am in daily life. I’ve had people share details about the gritty visceral details of how they fantasize about killing their family, I’ve had people talk about torturing animals, I’ve had people describe horrific rapes that have happened to them. They certainly elicit a reaction of some kind in me, but as I said, it’s somewhat different than my everyday reactions to those things. I don’t close off my feelings, because I still think it’s important to be human as a therapist, so I tend to roll with whatever emotions come up, but I don’t find myself in a place where I can’t tolerate it or anything.

Therapists don’t have to work with everyone

That said, not everyone is this way. There are people that are more sensitive in general or have specific triggers that are extremely difficult for them to encounter professionally. That’s totally okay. One misconception about being a therapist or psychologist is that you have to work with everyone. That’s not the case. It’s a bit different than being a medical doctor in the ER where you need to treat any person that comes through the door. Now that I think about it, it’s not all that different because someone who is unable to deal with the intensity of cases that come through the ER would generally choose to work in a different setting, like primary care. Similarly, mental health professionals are encouraged to be aware of their own limitations, their own psychiatric vulnerabilities, their traumas etc. If someone can’t work with a particular type of issue due to their personal factors, they simply have to make that clear and choose a setting/clientele that is safer for them. Of course, you can’t control for everything. Someone that you didn’t expect to have a certain experience may slip through and then you find yourself doing therapy and becoming super triggered by a very sensitive topic. In these cases, the most appropriate thing to do is not shame the person, but gently let them know that this isn’t something that you are well-equipped to help with because of your own personal factors and suggest that you work together to find a better fit. Ensuring that they know it’s not personal and they didn’t do anything wrong.

Taking a deeper dive

Now, there’s another side to all of this. There are situations where it’s not necessarily that the client is more than I can handle, but I might have questions about WHY they are so inclined to be graphic. This can go a million different directions. It is possible that the client is being unnecessarily graphic in an attempt to get a rise out of me. It could be a challenge of some kind. As well, there are a number of reasons that someone might do that. There are certain personality types that would lead someone to require people to earn their respect in a way. Or people who have really been through a lot of treatment and have had bad experiences with mental health providers, so they might be trying to see if I’m a “rookie”.

In other cases, someone might be so disconnected from the experience of their trauma that they can talk about it in a robotic, matter of fact way, which involves a ton of unnecessary details, but they don’t even really notice because they aren’t connected to the emotion of it. Alternatively, if someone checks in and asks if it’s okay that they share details of traumatic events, that can reveal things about them as well, such as a high level of empathy and consideration. Taken too far, the client may be trying to protect the therapist by AVOIDING details. This could mean that they think they are damaged goods and too much for people to handle.

Helping to approach and understand

At times, I may also want to help a client find the appropriate level of detail for them. They may not know how to approach the issue and diving in so deeply and so detailed might be really disturbing and destabilizing for them. If that’s the case, you can help them understand that they can communicate the events and feelings attached to it in a way that feels safer to them and that they can adjust the intensity and detail as the work continues if need be. In line with the whole lack of emotional connection to the trauma, there are also people that simply need help understanding how to talk about their trauma with others. I have a case that comes to mind of an old war veteran who would share graphic details of being on the frontlines during casual get togethers with friends and family at restaurants and it made people feel very uncomfortable. This is a whole skill set to help the person understand that they are not a bad person for what happened to them, but it is useful to read the social cues and adjust accordingly.

If you are on the client side and ever have questions about whether a topic is appropriate in therapy, just ask. It can be really productive to have conversations like that with your therapist. Likewise, if you are a professional and you feel the need to check in about it, you can do that as well. Here’s an example of what that might look like: Let’s say a client asks whether it would be appropriate to talk about details of a violent traumatic event. You could say something like, “It’s definitely valid to talk about and I’m proud of you for being brave enough to go there. You definitely don’t need to feel the need to hold back to protect my feelings, but there are a few particular sticking points for me based on my own experience. Could we talk generally about it first so I can feel out if I’m going to be able to be helpful to you?”

So, this is a very nuanced question that really depends on the situation. Thank you for the fantastic question!