Supporting People in Trauma

Podcast Transcript

Steph Bayer: Welcome to another episode of Studies in Empathy, a Cleveland Clinic Podcast exploring empathy and patient experience. I'm your host, Steph Bayer, senior director of the Office of Patient Experience here at the Cleveland Clinic in Cleveland, Ohio. I'm very pleased to have with me today, Katharine Manning. Welcome to Studies in Empathy.

Katharine Manning: It's so great to be here. Thank you for having me.

Steph Bayer: I'm very excited for our talk today. Katharine's the author of The Empathetic Workplace: 5 Steps to a Compassionate, Calm, and Confident Response to Trauma on the Job. And she's a president of Blackbird DC. She's worked on issues of trauma and victimization for more than 25 years. As a senior attorney advisor with the Executive Office for United States Attorneys, for 15 years, she guided the Justice Department through its response to victims in cases ranging from terrorism to large scale financial fraud, to child exploitation. Some of the cases she's advised on include the Boston Marathon bombing, the Pulse nightclub and South Carolina AME Church shootings, the uprising in Charlottesville, the Madoff investigation, and the federal case against Larry Nassar doctor for the US Women's Olympic Gymnastics team. Katharine now uses her expertise to help organizations prepare for and respond to challenges they face involving employees and clients who may be in trauma. We're so excited to have you here today.

Katharine Manning: I'm really excited for this conversation. Thank you.

Steph Bayer: Well, let's start at the beginning. You are a trained attorney, and I say this with love, but people don't often associate attorneys with leading empathy support. How'd you get involved in this line of work?

Katharine Manning: You're totally right. And I must say I learned most of what I know about empathy and supporting people in trauma from the victim advocates that I worked with at the Justice Department for so many years. They were just incredible, incredible. And it was through watching them and modeling what they were doing that I kind of came to where I am.

But the way, just to answer your question, the way I got involved in this area, I had a family history of domestic violence, and I was very fortunate that my mother was able to leave and had resources and was able to get out of the situation. But that early experience was sort of formative for me.

And basically as soon as I got to college, I started working on the hotline at the local Domestic Violence Shelter. And I did hotline work on domestic violence and rape crisis all through college and law school, and then eventually ended up at DOJ.

And my role at DOJ was I was not a prosecutor, I was an attorney advisor. And what that meant was it was my role to advise the department on its work in the area of victims' rights. And through that, I advised, as you just mentioned, on just a wide array of cases, kind of everything the department prosecuted. And I started to see the similarities in what the victims needed.

DOJ, as I'm sure in many other workplaces, it can be very siloed. And so, the fraud prosecutors and the human trafficking prosecutors and everybody said, "Well, my cases are different." And I saw them all, and I said, "They're not." Every victim needs to feel acknowledged. Every victim needs the chance to speak. They need to feel heard. They need resources. Everybody needs the same things. And then, I started to realize that it wasn't just our victims who needed those things. It was my colleagues too.

If I was talking to a prosecutor who was struggling with how do I balance these difficult things that I'm having to hear about every day, "What am I doing to support myself as I'm kind of repeatedly being exposed to trauma," or a colleague whose father was dying, it was obvious that everybody had challenges that they were facing in terms of their mental health. And everybody needed the same kinds of support through it.

So that was probably in 2018, 2019, right around when MeToo happened that I started thinking about these issues more broadly, that they were not just happening in the criminal justice system, but in a lot of other industries as well. And that was ultimately what got me into what I do now, which is training and consulting on empathy at work. And I like to say it's empathy when it matters most. How do you support your colleagues and your clients, your community through periods of trauma and distress?

Steph Bayer: I'm so grateful for you for applying your unique life experiences and support to victims in this broader way. Not only have you figured out a way to help others, but you've shared those learnings. And I reached out to you because I read your book. And the focus of our podcast is on empathy. And your book, he Empathetic Workplace: 5 Steps to a Compassionate, Calm, and Confident Response to Trauma On the Job, it really aligns with this conversation around empathy and the focus of what we're trying to talk about more. I just want to make a plug for you. I encourage all the listeners to pick up the book. I found it very valuable. But can you help explain why you found a space for that book, why you wrote it?

Katharine Manning: Absolutely. And thank you so much for your kind words. I have to admit stuff, I have never read the book since it was published.

Steph Bayer: Really?

Katharine Manning: Yeah.

Steph Bayer: It's excellent.

Katharine Manning: It's so hard. It's the same thing. I can't watch for recordings of myself. So I'm so glad to hear that you liked it. Thank you. The book, honestly, came to be around that same time when MeToo happened. And I started thinking about how these issues of trauma were so much more broad than just in the criminal justice system. And MeToo, I had a diametrically opposed reaction to it.

On the one hand, I was thrilled when MeToo happened because I'd been working on these issues for so long, and I was so grateful that they were being talked about more broadly all over the world. But I also found myself getting very frustrated when MeToo happened because I felt like it puts so much on survivors, like, "Share your story. Everybody needs to hear your story." I kept getting text messages from friends saying, "I've never told anybody. If I don't share my story, am I letting down the side? Do I have to share my story?"

I was like, "No, no, no. You never have to share your story. It's always yours to decide when and whether to share." I just felt like there was so much put on survivors to share their stories. And then, what was missing was the understanding that when somebody shares their story, you have an obligation to listen in a certain way and provide support that they might need.

And I knew because of the work I'd been doing at DOJ for so long, I knew that it was possible to conduct a full and fair investigation and find out factual information that you might need in a way that was supportive of the person coming forward to talk about what they had experienced in a way that help them heal, get to the kinds of services that they need.

And I just started to realize that maybe this experience that I'd had for so many years advising DOJ could be translated to other contexts. And that's really where the book came about, was trying to help people understand how to support others at work in particular, who are going through periods of trauma in a way that doesn't jump to conclusions. If somebody discloses something, you still can investigate and should investigate if you need to. But a way to understand what happened with compassion and empathy while also taking care of yourself and the organization, understanding we still have our organization's mission that we have to be fulfilling.

Steph Bayer: I think your book would resonate strongly with anyone in healthcare, but not just healthcare. I think HR workers and managers, there's a lot to gain from what you shared. One of the things... And hey, in healthcare we love mnemonic. So one of the things I picked up from your book though is a communication technique, and it's LASER. Can you talk to us about what LASER means?

Katharine Manning: Yeah. Government, we love it too. My friend used to say, "Oh, you've moved to DC so you're going to be familiar with the TLAs," which are the three-letter acronyms.

Steph Bayer: That's awesome.

Katharine Manning: Yeah. It becomes almost how you think. So, yeah, the five steps to what I call it is the empathetic response to trauma on the job. So the steps are intended as a reminder for what you should do when somebody comes to you at work to share something difficult that they're going through.

So how do you navigate that conversation in an empathetic way? And so, the five steps are listen, acknowledge, share, empower, and return. And I say it's to help you stay laser-focused on the person in front of you and what they need.

Steph Bayer:  What I do love about these mnemonics is that in times of stress, it can be difficult to remember what to do. So when you can lean in to an abbreviation like LASER, it does provides that pathway to know what to do next.

Katharine Manning: Yeah, absolutely. And I mean, I got to say, it's still hard for me. I mean, I had a conversation within the last three months with a friend who we were just having lunch. And then, she shared something really difficult from her past. And I felt like I'd been punched in the stomach, and it took me 60 seconds to turn my head around, "Okay. Right now, we are having a conversation about trauma." So write LASER, listen, acknowledge, right? It is hard. Our brains kind of shut down. We sort of freeze in those moments. So it does help to have a little bit of a roadmap.

Steph Bayer: Absolutely. Here at the Cleveland Clinic, we use HEART as our communication empathy roadmap, and it's hear an empathetic statement, apologize for the person's going through, respond, and then thank them for being comfortable to share. And I think this LASER builds right into that HEART philosophy. So it's just very interesting to see another way to use it.

Katharine Manning: Yeah. Absolutely. So listening obviously is built into that. And then, I think some of those steps are getting at what I call acknowledge. It's just rather than jumping to like, "Oh, you probably misunderstood, or I'm sure it's not as bad as you think, or let's fix this problem," just let them know you hurt them. I think that's so important. And it's often the hardest thing.

Steph Bayer: And it can't be skipped.

Katharine Manning: It really can't. I find whenever a conversation seems to be going badly, it's because the person needs more acknowledgement. They need to know that you heard them before they can hear anything you say.

Steph Bayer: Yeah. That's so true. I'm going to shift us a little bit into the healthcare realm and just kind of call out that healthcare workers have emerged from trauma of a pandemic without having a chance to really unpack that. They find themselves still caring for sick, needing and vulnerable patients in a new normal where there's a staffing crisis now. There's rising unmet mental health needs.

They're also caring for victims of gun violence. It feels like it's compounded traumas one on top of another in many ways for those working in hospitals. What are some steps that we can take to help these workers? I'm wondering both as an individual colleague, but also as a leader in an organization.

Katharine Manning: You're so right. I really feel for people in healthcare right now because it has been so difficult. I spoke to a leader at a hospital not too long ago. And he said, "I realized recently that every person that I talk to on a daily basis is experiencing trauma."

And he meant the patients, but also all of his colleagues as well.

Steph Bayer: Yeah.

Katharine Manning: Yeah. And I remember one statistic that I saw that said that rates of moral injury, which is the sense where you are required to take an action that you fear, is going to harm somebody either physically or psychologically. So rates of moral injury among people in healthcare are now higher than among combat veterans.

Steph Bayer: Oh, wow.

Katharine Manning: Isn't that astonishing to think about that? And in the article that I read, they quoted a nurse as saying, "In my entire career, I have never had the experience of thinking that patient care was suffering due to physician neglect." And that is happening regularly at this point. And this was in the midst of the pandemic.

I think you go into healthcare because you want to care for people, you want to help people get better, and to be put in a situation where you are having to make impossible decisions and being criticized so often. And now, we're also seeing rates of violence against healthcare workers increasing. So it has just been a really, really difficult time.

In terms of what to do about that, I mean, I think I have to say, "You've got to take care of yourself first." And I know if you're in healthcare, you are a very good caretaker. You are so, so good at supporting everybody around you, but you have to take care of yourself first because you are never going to be able to take care of others if you're not taking care of yourself first, just in terms of your own energy, your mental and physical health. But also, it's modeling to others.

So if you practice what I like to call noisy self-care, so it's not just like you are privately going back into therapy, but you talk about it. You say, "Gosh, I just went back into therapy, and I really am finding it already is making such a big difference." When you say something like that, you make it okay for everybody around you to also go back to therapy and know that it's okay to verbalize.

Steph Bayer: That's a great point.

Katharine Manning: Yeah. It's hard. And I think in particular for leaders, you feel like people are going to think more poorly of you or something. But what I'm seeing is actually the opposite where you have the confidence to say, "Yeah, I got to take care of my mental health, or I know I'd never be able to do this work."

That's really the thing that can build respect. And I think in particular, there's this study that the military did that I lean on all the time. It was back in 1985. There was a military air disaster in which 200 members of the 101st Airborne Division died. And the military did a study afterward to find out the impact on unit cohesion and mission readiness after this tragedy.

And they found the thing that made the biggest difference was leadership. And in particular, it was leaders who could acknowledge that this was a horrific thing that happened, really sit with people who were struggling and acknowledge their pain, provide them support that they actually needed, and then crucially model healthy responses to trauma, that, that was really what made the biggest difference in terms of units that were able to pull together in this time of crisis or spin apart and in units that were able to continue to do their work at a high quality through that period of trauma.

And I really feel like that's the key for healthcare as well. I mean, I know it's not an air disaster, but this is, to me, it's equivalent. I mean, I remember another healthcare woman who was head of people at a large healthcare system in Asia. And she said, "Our attrition rate right now is a body count." They had lost so many people to COVID.

And when I think about in healthcare, all of the trauma, I mean, to me, it's equivalent to something like an air disaster. And so, I think that's essential, both on an individual level and a leadership level that you're willing to call out that this has been really hard, that you're willing to reach out and support people, "How can I help you," and then crucially that you're taking care of yourself first.

Steph Bayer: That's such good advice. It's feels, in some ways, simple and basic, yet it's crucial. And it's such good advice. And I love the analogy to the military leadership and finding that leading through those healthy responses are just so vital.

Katharine Manning: Yeah. Absolutely. Absolutely. I'm so sorry to you and to all of your listeners, this has been a really, really difficult time. Thank you for everything that you've been doing.

Steph Bayer: Thank you. I'm wondering, because we, as humans, learn a lot from stories, I'm wondering if there's a story that you can share that captures the impact that empathetic responses can have. Can you think of anything from your past that might be relevant here?

Katharine Manning: I mean, the story that comes to mind for that for me is from a long time ago, back when I first started doing this work. And I have to warn you and our listeners that it does involve family violence. So if you are listening and that is kind of not your jam, maybe just skip the next couple minutes.

So I mentioned that I started when I was in college working on the hotline at the local Domestic Violence Shelter. Hotline calls are anonymous. But there was one woman who I had spoken to a number of times and gotten to know a little bit. So let's call her Margaux. And I had spoken to Margaux as she left her abusive husband and got her own apartment, moved in with her five-year-old daughter, got a job for the first time.

And I also talked to her as she was making her way through the legal system, getting the divorce and the restraining order, and getting custody of her daughter and fighting against visitation, which she did not succeed in fighting against, because the legal system assumes that just because you were an abusive husband doesn't mean you were a bad father, which sadly is still the rule today.

But there was one day when I answered the phone on the hotline, and what I heard on the other end was just a screaming, like a very, very long screaming wailing cry. And I eventually figured out that it was Margaux. And over a few minutes of just sobbing and kind of choking out her story, what I was able to ascertain was that she had just left the pediatrician's office where she had learned that her daughter's bruising that she had found was the result of abuse by her father during that court ordered visitation.

And I was the first person that she spoke to after finding that out. And I was 19 years old. I was not a doctor or a nurse. I was not a lawyer then. I wasn't a parent. I wasn't married. I had no idea what to say.

But in retrospect, I feel like that is what saved me on that call because I didn't have any advice to give her. All I could do was listen. And that's what I did. I just held onto that phone and I kept saying, "Oh, Margaux, I am so sorry. I'm so sorry." And eventually, she was able to calm down, and she started to breathe a little bit more. And then, she got quiet for a minute, and I just kind of sat with her.

And then she said, "Okay. Okay." And she hung up. And what I know, because I sort of heard after the fact from other people from the hotline, what I know is that after that call, she went on and was like fierce warrior mama for that little girl and really protected her through the legal system, through psychological support. And I know that that little girl is okay today because of the work that her mom was able to do.

And I know that part of why her mom was able to do the work she needed to do is because she was able to talk about it with somebody who could listen with empathy. And that to me is the key. I mean, I was not particularly great at this. I just was willing to sit with her.

And I think that is really the thing that can make all the difference in the world. If you happen to be the one who somebody comes to, to open up about what they are struggling with, and you have the ability to sit with them and just hold that space and listen with compassion, let them know that you care, offer help if you can, that really can make all the difference in their ability to go on and heal and to do the really important work that they need to do in the world.

Steph Bayer: Thank you for sharing that story. That's a powerful example of how empathy matters. And the fact that you were able to do that at 19, this says a lot about you, and thank you for sharing that.

Katharine Manning: Oh, thank you, Steph. All I wanted to do was drop the phone and go see if there was anybody else-

Steph Bayer: Run.

Katharine Manning: ... who can do it.

Steph Bayer: Right?

Katharine Manning: It was like, "Nope, just me here in the store."

Steph Bayer: I mean from a very young age, you've had to learn to establish some healthy boundaries for yourself, especially when you have such heavy conversations and such heavy work. How do you do that? How do you that today? How did you do it? What do you do for setting boundaries?

Katharine Manning: I mean, I feel like that was one of my main tasks in my 20s, was learning about boundaries, because I started off doing domestic violence. And I realized I was going to have to stop doing direct service work, or I was going to have a house full of women and children.

I was like, "My car is right outside. Let's just go get in." And it really took me a long time to recognize a few things. So I will share those with you, and with the listeners in case this is helpful to you.

So a few things that I eventually came to realize. So, one, the solution that I come up with for somebody else is never going to be as good as the solution they come up with for themselves like just going back to that domestic violence example. If I say, "Oh, I've got you a great spot at a shelter, and they can take you tonight, so let's just get you there," but what I don't know is she is also caring for her mother who has a doctor's appointment, and it's taken forever to get or whatever. There's always information I don't have, and that her solution is always going to be better than mine.

Two is if I push too hard for my solution, not respecting the boundaries and say like, "No, no, no, I got this shelter for you. It's so great. Really, you should listen to my advice on how to do this," I take away myself as a resource because she's going to feel guilty that she didn't follow my advice. And so now, she's not going to come back to me. She's going to feel less likely, less comfortable coming to me in the future.

And then, the third thing is when we solve problems, it feels so good. It feels phenomenal. So I always think of it's like you feel like a superhero when somebody comes to you and it's like, "I'm really struggling. I don't know what to do," and you're like, "Oh, I have the answer." And you're like, "You got your cape. You put them under your arm, and you [inaudible 00:24:58] away to safety." And it feels fantastic.

Let them wear the cape. Let them have that feeling of, "I was able to take the steps that I needed to heal myself." And that might be a different path than you think they should take. It might be a longer path than you wish for them, but it's the right path for them. So let them take it.

And what I have found is what that means is I recognize that my role to play is really important, that listening is incredibly important, but it's also limited. I can't take this problem away from them. I can't solve it for them. All I can do is listen. And for me, that is actually, I think, the thing that is most helpful for me and my ability to keep doing this work.

I spoke with a woman once who said that what she does, she was working with women who were coming out of prison, and she would want for them all of the things they wanted, to stay off drugs, to get their kids back to school. And she said, "What I had to realize was that I can provide the support, but I have to let go of the outcome because I don't have any control over that." So let them decide what is the right outcome for them. My role is just to provide the support and then let go.

Steph Bayer: That is such good advice for so many reasons.

Katharine Manning: Yeah. It's hard though.

Steph Bayer: It is, isn't it?

Katharine Manning: Yeah.

Steph Bayer: But it's the right thing to do.

Katharine Manning: Yeah.

Steph Bayer: What's your hope for the future of empathy and how we deliver empathy?

Katharine Manning: My focus is on the workplace. And my goal is for all workplaces to understand that empathy and compassion at work are not a nice to have, not if we have time for it kind of thing, but are truly essential to your mission, regardless of what your mission is. You are never going to be able to get there if you aren't bringing people along with you. And the only way you can do that is with empathy.

So I hope that people understand that it is central to their mission and that they understand how to do it in a way that is supportive of others, while also being something that we can sustain over the long term, that we aren't getting burned out, and then having to take a week off of work and all that, that we can just keep it at an even level and even keel and be able to provide empathy continuously on an ongoing basis.

Steph Bayer: I share your hope. That's so well put. Is there anything that you thought we should talk about today that we missed, or is there anything that you want to leave the listeners with as we wrap up here?

Katharine Manning: Just because I know that you all have been through so much, let me share my self-care tips with you. So I think that when it comes to taking care of yourself, there's really three things that I always advocate for, and these are also kind of hard one because this is something I've struggled with a lot.

One, have something that you're doing for yourself every day. So this is what I call a daily reset. Mine is a little bit of yoga, a little bit of meditation every day, and be going for a walk at lunch, like listening to music as you are doing dishes, saying a quick prayer before bed, just whatever it is that helps you really feed your own self. So one thing that you do every day for yourself.

Two, is have a community of support around you. I hope that each of you listening can think of five people that you could call when you're having a hard day. So just think about it for a second. Can you name five people? And if you are struggling with that, don't underestimate the benefits of therapy. You can also journal. That can be a great thing. And also work on building some of those relationships. Reach out to a colleague and see if they want to have lunch or notice the neighbor who walks dogs at the same time that you do and see if they want to walk together.

Start building those relationships because those are the things that are going to see you through this period and everything that's coming down the road. And then, finally, start to know your warning signs that you are beginning to suffer from burnout. So this could be like a persistent sore throat or headache. It could be insomnia. It could be a sharper edge to your sarcasm. It could be if you are somebody who struggles with addiction. This could be when it kind of taps you on the shoulder. Just notice what are the things that start to happen for you when you're struggling. And when you start to see those signs, that's the time to double down on your daily reset and reaching out for support.

Steph Bayer: Thank you. That's such great advice. I've really enjoyed our conversation today. You're a gift, and I'm so grateful that you share your gifts.

Katharine Manning: Oh, thank you. I feel the same way about you, Steph.

Steph Bayer: This concludes the Studies in Empathy Podcast. You can find additional podcast episodes on our website, my.clevelandclinic.org/podcasts. Subscribe to the Studies in Empathy Podcast in iTunes, Google Play, SoundCloud, Stitcher, or wherever you get your podcast. Thank you for listening. Join us again soon.