Let’s Talk Harm Reduction.

This article discusses trauma and systems of oppression and death.

For me, as a dietitian in the US medical system, harm reduction is recognizing that there is always a context that my clients are living within that is informing the ways that they take care of themselves and cope. Harm reduction is letting go of the idea that the client has access to everything that they need, letting go of the idea that there is a straightforward way towards healing, and letting go of bootstrap mentality. Some people can’t recover, don’t have access to care or meds, or are unduly burdened by inner chaos from trauma. How do we hold space and witness and keep people as safe as possible within these realities- this is harm reduction.  

And it’s really challenging, because in this space, we have to hold and manage our own fear around what could happen. In the absence of managing that discomfort ourselves we risk burdening our client with the fear and shame of not being a “good” client in impossible circumstances. By widening the lens and highlighting the realities: including the barriers, trauma stories, harms and lack of access related to oppression that our client is navigating, we can hopefully lessen the shame that comes from the individualistic, ableist, boot strap narratives that keep so many of us stuck.

It involves sitting with our own lack of power and control. How do we hold ourselves through situations where we are not in control? What do we need to take care of the parts of us that want to come out and fix, predict, and make healing into something it’s not: a one size fits all approach.

We need to get wide in these spaces, and continue to cultivate trust in our clients ability to take care of themselves. Because really, at the end of the day, we don’t have the control and power we were taught we do and that we were instructed to strive for within our schooling and most of our trainings. The reality is that we are witnesses, not wizards (a quote from Anna Sweeney, RDN that I hold onto often in my practice).

We can discuss guard rails collaboratively together with our clients, behaviors and reminders that can help keep them in a realm of safety that we can check in on when we meet with them. We can discuss symptoms, what they could mean or indicate, and how to address them to move the body and mind towards safety.

In this process, it is vital that we remember the healing power of holding space. This can really involve sitting our hands when fix-it mentality rears it’s head. It’s so hard because our egos want to have the solutions and answers, but we know that only the client has the wisdom to find those, which is aided by appropriate care and support and education with consent. Holding space for whatever is getting in the way of a client’s healing process, with compassion and judgement, is the magic ingredient and can sometimes get lost when we are doing harm reduction work. Holding space is necessary.

We have to embrace that like everything, healing is on a spectrum. Sometimes in this work the goal is keeping someone alive, keeping them from passing out or being hospitalized, and sometimes the goals are moving someone towards more expansive embodiment. No process is superior over the other. And all of the work involves client and clinician deepening into their own healing process. We can’t want it more than them, and, we can adjust our approaches to meet the realities of our client’s lives.