There is a particular kind of exhaustion that doesn’t come from lifting heavy things or running long distances. It comes from sitting very still, listening to someone’s worst day, and then doing it again. And again. And again. It is the exhaustion of proximity — of spending forty or more hours a week hovering at the edges of other people’s most painful, most desperate, most human moments, without a clinical framework to hold any of it, without institutional structures designed to protect you from it, and without anyone asking whether you’re okay. This is the exhaustion I know. This is the exhaustion of the Eligibility Specialist.
We are not therapists. We are not crisis counselors, trauma-response team members, or social workers with clinical training. We are the people who answer the phone when someone has run out of food. We process the paperwork when a family has just lost everything. We navigate federal policy on behalf of people who are navigating grief, domestic violence, addiction, housing instability, job loss, and the particular despair that comes from needing help and not knowing if help is coming. We sit at the crossroads of bureaucracy and authentic human need — and authentic human need does not follow rules. It does not adhere to deadlines. It does not observe office hours or pause politely while we sort through verification requirements. It runs rampant through people’s lives without regard for the trauma it leaves behind, and we are the ones who receive it, call by call, case by case, day after day.
What we are doing — what we have always been doing — is community psychology in one of its most immediate and unglamorous forms. Foster-Fishman, Nowell, and Yang (2007) remind us that systems are defined by the interactions among their parts, and that the people who live within distressed systems are shaped by the norms, resources, regulations, and power structures that surround them. The families who call our offices are not calling in a vacuum. They are calling from within systems — systems of poverty, systems of trauma, systems of chronic stress — that have been operating on them long before they dialed our number. When a client misses a deadline, it is rarely because they don’t care. It is because the system they are navigating has been grinding them down for years, and a missed deadline is often the smallest symptom of a much larger wound. Understanding that is not just compassionate — it is accurate. It is what the evidence tells us, if we know how to read it.
Mendenhall and Berge (2010) wrote about family therapists on trauma-response teams, and the specific challenges of doing clinical work in the chaotic, fast-paced conditions of disaster fieldwork. They described providers being pushed beyond their conventional comfort zones, being asked to attend not just to the clinical content of what they were hearing but to their own psychological and physical well-being in the midst of it. They described the necessity of self-care not as a personal luxury but as a professional obligation — something owed not just to the worker but to every person that worker would serve. Reading that, I thought: yes. And also: we are doing this without any of those structures. We are doing this without the mandatory rest cycles, without the compassion fatigue specialists, without the deliberate protocols for protecting the people doing the hardest emotional work. We are doing disaster-level emotional labor in a change center, and the institutional response is largely silence.
Papero (2017), drawing on Bowen’s family systems theory, describes the way chronic anxiety embeds itself not just in individuals but in entire relational systems — the shared perceptual field, the interlocking patterns of reactivity, the fear that passes from one person to another faster than any of us can track. A chronically anxious family, Papero writes, walks on eggshells. People censor their communications. Conversations happen around the symptomatic person rather than with them. The fear is contagious, and it shapes everything. What Papero is describing, I have watched happen in real time on phone calls that were supposed to be about food stamp renewals. The anxiety on the other end of the line is not abstract. It is audible. It is in the voice of the parent who hasn’t eaten so their children could, the person who waited until the very last possible moment to call because asking for help felt like failure, the elderly woman who cried because she didn’t understand the letter she received and was afraid of what it meant. That anxiety transfers. That is not a metaphor. It is a clinical reality, and we absorb it forty hours a week.
What nobody tells you when you take a job like this is that you will become, over time, a repository for other people’s crises. Not because you sought it out, not because you are trained for it, but because you are the person on the other end of the line when someone’s world is falling apart, and being present for that moment leaves a mark. Figley (1995) named this compassion fatigue — the secondary traumatic stress that accumulates in those who care for the traumatized — and the research on vicarious traumatization makes clear that you do not have to be a clinician to be affected by it. You just have to care. And eligibility specialists, by and large, care enormously. That is why we keep showing up. That is the thing I want to say clearly, because I don’t think it gets said enough: the people who do this work are not doing it by accident or inertia. They are choosing, every single day, to show up for their fellow human beings at the moments of greatest need, with inadequate tools and insufficient protection and no particular recognition for the emotional cost of doing so. That is a form of quiet heroism, and it deserves to be named.
It also deserves a framework. Understanding trauma — its symptoms, its manifestations, the way it shapes behavior and perception and the capacity to meet a deadline — is not just relevant to therapists. It is essential to anyone whose job brings them into regular contact with people in crisis. When I know that a client who seems hostile or evasive may be responding from a place of profound helplessness, I respond differently. When I understand that the missed verification deadline may reflect not indifference but the executive function disruption that Papero (2017) describes as a hallmark of chronic stress — difficulty with goal setting, planning, and the basic operations of daily life — I stop interpreting the missed deadline as a character flaw and start asking what was happening in that person’s life that made the deadline impossible to meet. That shift in interpretation is not just kinder. It is more effective. It leads to better outcomes for the client, and it protects the provider from the corrosive accumulation of cynicism that so often follows years of interpreting human struggle as personal failing.
Foster-Fishman and colleagues (2007) argue that real systems change requires attending to both the deep structures of a system — its values, norms, and assumptions — and its apparent structures — its policies, procedures, and operational practices. The eligibility system in which I work has apparent structures in abundance: verification requirements, renewal deadlines, income thresholds, computer systems that accept or reject. What it largely lacks is attention to its deep structures — the assumptions baked into its design about who needs help and why, about what compliance looks like for someone managing trauma, about what it means to ask a person in crisis to navigate a bureaucratic process built for someone whose life is functioning smoothly. Changing the deep structures is slow and complicated work, and I am not naive about how much any single person can move them. But understanding that they exist — that the system is generating some of its own failures — is where the work of change begins.
In the meantime, there is the work of protection. Not the institutional kind, because that is largely not available to us, but the personal kind. The deliberate construction of a buffer between ourselves and the conditions we vicariously inhabit forty hours a week. This is not indifference — indifference would destroy the work as surely as burnout does. It is the practice Mendenhall and Berge (2010) describe as essential to every trauma provider: the conscious attention to one’s own emotional processes, the willingness to acknowledge that this work costs something, and the commitment to replenishing what it takes. For me, that buffer is made of writing and dogs and the particular solace of fiction, which has always been my way of processing the human experiences I encounter and can’t stop thinking about. For others it will look different. What matters is that it exists — that we build it deliberately, protect it fiercely, and refuse the cultural pressure that tells us caring for ourselves is somehow in tension with caring for others.
Papero (2017) writes that the goal of a systems-oriented clinician is not to provide answers but to help the family develop the capacity to find its own way through — to trust that the people in front of you have both the responsibility and the capability to navigate their own lives, given the right conditions. That principle lives at the heart of the work I do now and the practice I am building toward. I am not my clients’ savior, and the eligibility office is not a rescue operation. It is a point of contact, a moment of access, a place where the system can either open a door or close one. My job is to keep as many doors open as I can, with as much information, compassion, and clarity as I can bring to bear, while understanding that what I am seeing is a small cross-section of a much larger story.
That story, more often than not, involves trauma. Not always the acute, catastrophic kind that makes the news — though sometimes that too — but the chronic, grinding, invisible kind that Papero (2017) describes as leaving its fingerprints on every system a person inhabits: their body, their relationships, their capacity for trust, their ability to return a phone call or meet a deadline or sit still long enough to fill out a form. The trauma of poverty is real. The trauma of food insecurity is real. The trauma of being made to feel that needing help is a moral failure is real, and we have the power, in every interaction, to either confirm that narrative or offer a different one.
I think about this every time I pick up the phone. I think about the question I keep returning to — not what is wrong with this person, but what has happened to them, and what might still be possible. That question is the axis around which my future practice will turn, and it is already shaping the way I do the work I have now. We are not therapists. But we are, in the truest sense of the word, helpers — and that comes with its own set of obligations. To our clients, yes. But also to ourselves, to our colleagues, and to the communities we serve by continuing to show up, day after day, choosing again and again the harder and more generous road.
References
Foster-Fishman, P. G., Nowell, B., & Yang, H. (2007). Putting the system back into systems change: A framework for understanding and changing organizational and community systems. American Journal of Community Psychology, 39(3–4), 197–215. https://doi.org/10.1007/s10464-007-9109-0
Mendenhall, T. J., & Berge, J. M. (2010). Family therapists in trauma-response teams: Bringing systems thinking into interdisciplinary fieldwork. Journal of Family Therapy, 32, 43–57.
Papero, D. V. (2017). Trauma and the family: A systems-oriented approach. Australian and New Zealand Journal of Family Therapy, 38, 582–594. https://doi.org/10.1002/anzf.1269
Figley, C. (1995). Compassion fatigue as secondary traumatic stress disorder: An overview. In C. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (pp. 1–20). Psychology Press.
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