When the system hurts twice
What I have learned is that people rarely come to therapy because of the injury alone. More often, they come because of what happened afterwards - the months of uncertainty, the repeated need to justify their pain, and the slow erosion of confidence, identity and hope. This article is a reflection on those experiences, informed by my work as a psychologist and the emerging science of trauma and recovery.
Brett Ruehland MAPS, psychologist
“There are days I leave sessions feeling enraged on behalf of my clients - not because of what happened at work, but because of what happened when they reached out for help.”
Recovery from workplace trauma often involves two injuries. The first happens at work - through stress, moral compromise, or chronic emotional harm. The second comes later, when people reach out for help and are met with disbelief, delay, and bureaucracy.
This article is for patients, clinicians, and case managers alike - anyone navigating rehabilitation in a system that can sometimes miss the mark.
When work wears you down
Many clients don’t realise they’re struggling until something gives way. Often, it isn’t one dramatic event, but the slow grind of pushing through, staying quiet, and hiding the cost.
“I kept smiling. Pushing through. That’s just what was expected of us.”
Sometimes the harm is interpersonal. Sometimes it’s moral. But it’s almost always visceral. The body records each slight, each compromise, each dismissal – not as minor inconveniences but as tiny traumas. It’s the accumulation - a death by a thousand paper cuts - until the body, in its wisdom, says: no more.
The second injury: systemic invalidation
For many, lodging a WorkCover claim feels like relief. A doctor validates their injury, a case manager is assigned and it seems like they’ll finally get the acknowledgement and support they need.
But often the system itself becomes another source of harm. You’re assessed by strangers. Asked to justify your distress. And all at a time when you’re destabilised and vulnerable. From the outset, you’re asked: Is this physical or psychological?
Trauma doesn’t fit neatly into either. But psychological injuries are harder to prove, so people downplay them or wrap them in physical symptoms. Often, they don’t even know they’re traumatised. They just know they feel broken - not because they are, but because they’ve absorbed the belief that their distress is inconvenient.
“They kept telling me this is just what teaching is. After a while, I believed them - I thought I was the problem.”
Another client who was led down the path of seeking WorkCover support for physical injuries, spent two years being treated for the wrong thing - caught in a cycle of invalidation by the very systems that were supposed to help her - because she lacked the support and language to adequately describe her injuries.
“I was called a liar told I was making it up. I felt like giving up”
What invalidation sounds like
- “You’re only approved for treatment of your physical injury.”
- “That’s not covered under this claim.”
- “Your injuries have healed, so you should be able to get back to work.”
- “Pain shouldn’t still be an issue at this stage.”
Comments like these, may sound procedural. But for someone already struggling, they cut deep. They reopen wounds, reinforce shame, and stall recovery. They also reflect a lack of understanding, that after physical injuries heal, chronic pain can remain, due to neurological changes.
A system under pressure
Most people in the system are doing their best under strain. Case managers, assessors, and medical providers often work within significant constraints. But the structure isn’t designed to hold trauma’s complexity. It favours neat diagnoses, measurable outcomes, and quick returns.
It also struggles to meaningfully address workplace culture issues - the subtle, persistent dynamics that often contribute to injuries in the first place. For many of my clients, the injury wasn’t just a single incident, but the product of long-standing dysfunction: bullying cloaked as performance management, unmanaged risk, poor leadership, or ethical conflict left unresolved.
WorkCover may offer some scaffolding - therapy, time off work, rehabilitation support - but there are no reliable mechanisms to supervise or reform dysfunctional workplaces. So clients often feel pressured to 'get well' just to return to the same environment that harmed them, as if recovery alone can somehow fix the problems. This gap can leave clients feeling blamed, gaslit, or even punished for speaking up.
When systems focus on individual recovery without examining organisational harm, we risk retraumatising the very people we aim to support. That’s where clinicians come in.
Trauma and the body: what the research tells us
Trauma doesn't end when the danger has passed. For many people, the body continues to carry the story long after the mind has tried to move on. It shows up as a nervous system stuck on high alert, low-grade inflammation that won’t switch off, and pain that lingers long after the original wound heals (Costa, Gonçalves, Martins, & Pais-Vieira, 2025; Driscoll et al., 2021).
Recent studies confirm what many clients already sense: trauma leaves a physiological echo. Autonomic dysregulation - the tug-of-war between fight-or-flight and rest-and-digest - has been shown to link childhood trauma with later pain severity (Costa et al., 2025). Elevated inflammatory markers are another common thread, potentially sensitising the nervous system to pain and complicating recovery long after the original injury has healed (Sun et al., 2021; Bussières et al., 2023).
This is why unresolved trauma so often walks hand-in-hand with chronic pain syndromes like fibromyalgia, irritable bowel, or widespread musculoskeletal pain (Psychological Medicine, 2021; Guekht et al., 2024). These aren’t “in someone’s head.” They’re survival strategies written into physiology.
As van der Kolk (2014) framed it: the body keeps the score. Today’s science simply gives us sharper language for what our clients have been telling us all along: trauma leaves traces. If we overlook the psychological components of pain, we risk reinforcing shame, invalidation, and misdiagnosis.
Understanding this doesn’t require specialist training - just a trauma-informed lens. When we integrate mind and body, we start to see the full story.
What we need to remember
Patients: If something feels wrong, it probably is. You don’t need to be falling apart to deserve help. Trauma doesn’t always look like panic. Sometimes it’s numbness, guilt, or just not feeling like yourself.
Clinicians: You might be the first person to name what’s really happening. Don’t wait for a diagnosis to believe someone. Use your words - in session and in reports - to name what others have missed. Even within limits, we can advocate for dignity.
Recovery starts with belief
If you’ve been left confused or ashamed by the process, you’re not alone. You’re not weak. And you’re not imagining it. The system is evolving. There are thoughtful people inside it doing good work. But when someone is told their pain doesn’t matter, that harm lingers. Recovery begins with belief - from clinicians, case managers, and the system itself.
A call to action
We don’t need to be experts to validate what we see. We just need to be curious. We need to listen for what hasn’t been said and believe what our clients are trying to communicate.
We also need to be honest about the system’s limitations. If returning to the workplace is likely to retraumatise a client, we must say so. Clinicians shouldn’t shy away from naming when a return to work is clinically contraindicated. Recovery doesn’t mean returning to a harmful environment and pretending it didn’t hurt. It means helping our clients reclaim safety, dignity, and agency - wherever that may be.
Coordinated care is clinical care
The current structure of the compensation system places an outsized burden on GPs to make key decisions about a client’s recovery - particularly around returning to work. These decisions are often made without adequate input from treating psychologists. This isn’t a failure of individual practitioners - it’s a gap created by the system.
Psychologists are often the clinicians who know the client best. We see the emotional trajectory over time. We understand the relational dynamics, the internal blocks, the unspoken fears. It’s our responsibility to step into a case management mindset - to ensure that our insights are shared with GPs, case managers, and rehabilitation providers, even if we haven’t been formally invited into that conversation.
It is not enough to assume the system will coordinate this communication. We must proactively build comprehensive formulations and treatment plans, share them regularly, and adapt them as clients change. We must make the invisible visible - because if we don’t, our clients are the ones who fall through the cracks.
Dignity is where recovery begins. And sometimes, the most powerful thing we can offer a client is simply to believe them. For many, it’s the first step back toward healing.
References
- Bussières, A., Hancock, M. J., Elklit, A., Ferreira, M. L., Ferreira, P. H., Stone, L. S., Wideman, T. H., Boruff, J. T., Al Zoubi, F., Chaudhry, F., Tolentino, R., & Hartvigsen, J. (2023). Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: a stystematic review and meta-analysis. European journal of psychotraumatology, 14(2), 2284025. https://doi.org/10.1080/20008066.2023.2284025
- Costa, P., Gonçalves, S., Martins, F., & Pais-Vieira, C. (2025). Autonomic dysregulation mediates the association between childhood trauma and pain severity. Healthcare, 13(18), 2310. https://doi.org/10.3390/healthcare13182310
- Driscoll, P., Higgins, D. M., Haskell, S. G., & Heapy, A. A. (2021). Psychological treatment for chronic pain: Improving access and integration. Journal of General Internal Medicine, 36(12), 3783–3788. https://doi.org/10.1007/s11606-021-06778-7
- Guekht, M., et al. (2024). Current views on the relationship between fibromyalgia and mental disorders. Neurology and Therapy, 13(1), 45–62. https://doi.org/10.1007/ s40120-023-00452-1
- Psychological Medicine. (2021). Childhood trauma and fibromyalgia: A systematic review and meta-analysis. Psychological Medicine, 51(6), 949–960. https://doi.org/10.1017/ S0033291721000312
- Sun, Y., Qu, Y., & Zhu, J. (2021). The Relationship Between Inflammation and Post-traumatic Stress Disorder. Frontiers in psychiatry, 12, 707543. https://doi.org/10.3389/fpsyt.2021.707543
- van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
Disclaimer: Published on Insights in 2026. The APS aims to ensure that information published is current and accurate at the time of publication. Changes after publication may affect the accuracy of this information. Views expressed are the author's own and do not necessarily reflect the position of the APS. Readers are responsible for ascertaining the currency and completeness of information they rely on, which is particularly important for government initiatives, legislation or best-practice principles which are open to amendment. The information provided in Insights does not replace obtaining appropriate professional and/or legal advice.