Frontline Initiative: Self-Care for DSPs

But What about Trauma in the Life of the Direct Support Professional?


Karyn Harvey , PhD, is a psychologist and the director of program and development at Park Avenue Group in Baltimore, Maryland. She is the author of Trauma-Informed Behavioral Interventions: What Works and What Doesn’t. Karyn can be reached at

We have heard a lot lately about trauma and its effect on people with intellectual disabilities. But what about trauma in the lives of Direct Support Professionals (DSPs)? What are its effects on a day-to-day basis? How does it affect the work that DSPs do? Traumatic events can include sexual or physical abuse, or horrific events such as accidents or sudden deaths. But they can also be small, accumulated hurts. This can include ongoing difficulties and discriminations. Trauma can affect us in ways we do not realize. It may create emotional “mine fields.” This means that the effects of the trauma do not impact us until we accidentally hit them, and we explode with an emotional response. This can happen at the most unexpected times.

Consider a couple of examples:


John did two tours in Iraq. When he returned home, he became a DSP. He loved the work and found it rewarding. He supported a man named Bernie in a day program. Bernie had good days and bad days. John was able to understand Bernie and all that he had been through. Bernie lived in an institution at a young age. He had endured some horrible things while living there. Sometimes Bernie became very upset. When upset, he would scream or throw things. However, Bernie liked John. They were close. John always gave Bernie the space when he needed it. John also comforted Bernie when he needed it. John understood him.

Abstract painting of a woman who looks worried. One hand is touching her face.

One day, Bernie had a particularly bad day. He had been unable to find his lunch. He thought that John gave his lunch to someone else. All of a sudden, Bernie came from behind John and hit him on the shoulder. This reminded John of a time when his unit had been attacked in Iraq. John’s best friend was killed in that attack. When Bernie hit John from behind, it triggered John’s memory of this traumatic event and it caused John to flip out. John grabbed Bernie and flipped him over. Both men were screaming. Everyone came running. By the time they got there, John had a confused look on his face and Bernie was crying. John did not even realize what he had done.

Fortunately, John’s boss did not fire him. She listened to him. She documented the encounter between John and Bernie, and shared a resource about trauma. John found a therapist who specialized in treating trauma. He started seeing the therapist regularly. This helped John in other aspects of his life as well as his work.


Mandy worked as a DSP in a home where three women lived together. Sadly, one of the women passed away. Shortly after, another woman named Kim came to live with them. Kim talked a lot. In particular, she talked about some bad things that happened to her. She had been homeless when she was young. She talked about being left in scary places. And she talked about being sexually molested by her uncle. She talked and talked. Kim was seeing a therapist. Mandy brought her every Tuesday to her appointment. On the way home, Kim talked about her traumatic experiences. Finally, Mandy couldn’t stand it. She started yelling and screaming at Kim. She couldn’t stand the sound of Kim’s voice. She couldn’t stand the things Kim said. At that moment, she couldn’t stand her! Emotionally, she exploded. “That’s enough!” She shouted, “Please stop talking!”

When Mandy regained control of her emotions, she was so upset by her own response. She had always seen herself as a warm and caring person. In that moment, she didn’t even recognize herself. She was flooded with her own memories of being molested by her grandfather. She had stuffed so many of these memories down deep to just focus on moving forward in her life. Kim’s memories reminded her of all the things that she tried to forget. It wasn’t rational. It made no sense. But it was real.

Mandy and John are good, sincere people trying to support others. But they also need their own support. Neither of them understood the ongoing impact of trauma in their life. Enduring traumatic experiences can affect us in ways we don’t always understand. Everyone deserves support. Everyone deserves space to heal.

Everyone deserves support. Everyone deserves space to heal.

The work of direct support can also be traumatizing. Some DSPs are cursed at; some endure racial slurs; others may even be hit. All kinds of things can happen and we are all only human. The strength, courage, perseverance and endurance it takes to be a capable DSP is extraordinary. Over time, the work can take its toll. Self-care is needed in this work, and seeking additional help may be needed when DSPs have endured trauma throughout life. These are called “trauma-informed practices.” Treatment is available in many places through referrals from your human resources department. Insurance may cover it as well. It helps.

It is important that DSPs understand just how important they are, and how much they deserve the best possible support. Great support is needed to be the great supporters that they truly are!

Learn more about trauma-informed practices in this past issue of Frontline Initiative on Trauma-Informed Care.


  • Rowell, K., & Thomley, R. (2013). Recovering emotionally from disaster. APA Help Center. Retrieved from