Presentation on theme: "Sarah Hessenauer, PhD University of Wisconsin – Whitewater"— Presentation transcript:
1Sarah Hessenauer, PhD University of Wisconsin – Whitewater Assisting Interns, Staff and Colleagues in Detecting Secondary Traumatic Stress and Vicarious TraumaSarah Hessenauer, PhDUniversity of Wisconsin – Whitewater
2Rules for Self-CareWhen social workers are exposed to traumatic stories and / or situations, it may cause uncomfortable thoughts and responses.If you start to feel uncomfortable, take care of yourself. Stand up, take a walk, take deep breathes, employ relaxation techniques, take a break, talk to others, or do whatever works best for you! -Take care of yourselfBe mindful of your feelingsBe respectful to others
3ExamplesA colleague called to tell me about an incident where staff were talking about a death of a client the night before. Two students were in the room as the staff basically said “too bad” and went about their meeting. The colleague admitted they paid no attention to their co-worker who had been the direct worker nor to the students involved who may have never experienced this in their past.A student in her internship called to state that the agency had been put on alert due to a threatening call, but that they told her to go ahead with her group. During her group, an alarm sounded and she had no training on how to handle the situation.
4“Often we are not aware we have brought home an un- welcome visitor unless we notice that we are agitated rather than relaxed, have trouble sleeping, or pick a useless fight with our partner and make a connection” (Rothschild & Rand, 2006)“A profession cannot successfully retain its workforce when issues of personal safety go unaddressed” (NASW & University of Albany, 2006)
5Social Workers and Trauma Work Social workers have higher rates of burnout than other helping professionals, such as occupational therapists (Brown, 2008).In a study of British social workers 74% were experiencing high levels of anxiety (Lloyd et al., 2002)62% of experienced Child Protective Service workers scored high on a measure of emotional exhaustion. (Anderson, 2001)In a study by Meyers & Cornille, (2002), of CPS workers interviewed, 82% reported a trauma prior to working in the CPS field, and 77% reported trauma while on job (versus 76% of American adults).
6Social Workers and Trauma Work Cont. In 1995, Beaton & Murphy reported social workers experience physiological and physical symptoms, some extending to serious illnesses, and ultimately a higher mortality rate among controls (Figley, 1995).In one study 17.7% of caseworkers suffered from secondary traumatic stress, while only 15.2% of Vietnam Vets reported post traumatic stress disorder (Kulka et al, 1990).About 48% of the total workforce in the United States experiences high levels of personal distress as a result of their work (Strozier & Evans, 1998).
7Self-CareSocial work self-care requires proper functioning at least three neuropsychological symptoms:Interpersonal empathyRothschild and Rand (2006) cite Stern who said “we have the capacity to experience what others experience” and “empathy is an integral, necessary tool of our work” (p. 10).Impact of motor neurons – brain cells reflect the activity of another’s brain cells (p.42)Balance in autonomic nervous system and arousal regulationClear thinking relying on the balanced functioning of all brain structures
8StressStressors are situations, conditions, people or things that have the potential to trigger the stress response in us.Stress can be protective; stress helps us adapt to situations and is important for survival.
9Impact of StressIf we allow stress reactions to build, they accumulate and their impact spreads beyond our work life into home and relationships.Research shows that about 20% of professional helpers are greatly impacted by taking on negative energy from their clients or patients (Thivierge, 2011).
10Top 10 Signs You Are Too Stressed You find yourself hoping to get the flu just so you can stay in bed for a dayYour children shutter in fear when your bosses name is mentionedYou have wondered if your cell phone would float when you hurled it into the riveYou start using a pencil instead of a pen to put dates with your partner in your scheduleMedical journals or case files have become “light bedtime readings”Your best friends think you have moved away since they have not hear from you in so longYou consider Red Bull a part of a balanced dietYou fall asleep during trips to the dentist office, because it is the only time you put your feet upYou are too tired to remember the name of your dogIt takes you six days of vacation to even begin to feel relaxed, and six minutes back at your office to make you forget that you took a vacationVolk, Guarino, Grandin & Clervil, 2008
11Cognitive Stress Signs Stress ReactionsPhysical Stress SignsCognitive Stress SignsHeadachesExhaustionTeeth grindingNegative ruminationInsomniaInability to focus on a taskIrritability, angerReduced libidoMuscle tensionReduction in joyGastric disturbanceMental fatigueHigh blood pressureFeelings of futilityRapid heartbeatDevaluing of co-workers
12How Is Your Life Affected By Stress? How does your body react to stress?How is your personal life affected by stress?
13Student Specific Stressors Beginning workersRole conflictsExpectations of field and academic learningNature of field settingPopulation servedSupervisors lack of attention to students’ emotional reactions; current emphasis on an education model rather than on a growth model (Litvack, Bogo, & Mishna, 2010)
15Trauma Exposure to a situation in which: The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or othersThe person’s response involved intense fear, helplessness or horrorPTSD (Post Traumatic Stress Disorder)An anxiety disorder in which one may experience nightmares, flashbacks, heightened arousal, etc., related to a traumatic event.APA, 2000
16TraumaFigley (1995) suggested that PTSD should be called primary post-traumatic stress disorder, whereas the same symptoms appearing secondarily to the victim care in helpers should be called secondary traumatic stress disorder (exposure to the traumatized person rather than to the traumatic event itself).
17Re-TraumatizationThe individual having experienced their own traumatic event may develop symptoms that are reactivated by hearing the client tell their story of trauma.
18Secondary Traumatic Stress Zimering, Munroe, and Bird Gulliver (2003) identify secondary traumatic stress as “indirect exposure to trauma through a firsthand account or narrative of a traumatic event” (n.p).Bober and Regher (2005) stated that secondary traumatic stress has symptoms similar to PTSD; however the trauma is due to working with someone else who has experienced the direct trauma and not the social worker.
19Secondary Trauma and the Brain 1990’s, research began to look at the role of mirror neurons in the brain and their association with Compassion Fatigue (which will be discussed further). There is some speculation that the contagiousness of laughter and yawning may be connected to the function of the mirror neuron. There is a mimicking response observed, that may be triggered by these mirror neurons. The mirror neurons reflect the activity of someone else’s brain cells (Rothschild, 2006).Mimicking can work both ways.
20The Brain and Countertransference “Unconscious attunement to and absorption of victims’ stresses and traumas” (Figley, 2002, p. 19)Not easily accessible via wordsIntrusive type countertransference leads to loss of boundaries, over-involvement, reciprocal dependency, and pathological bondingAvoidance type countertransference leads to withdrawal, numbness, intellectualization, denial.
21Vicarious TraumaMcCann and Pearlman (1995) identified vicarious traumatization (VT) as the transformation that occurs when an individual begins to change in a manner that mimics a client’s trauma-related symptoms (experience in social workers’ nervous systems).Vicarious traumatization tends to be the result of repeated exposure to traumatic stories which results in a change in the social workers thinking / core beliefs.The social worker begins to interpret and relate to the world in a new manner and his/her inner experience is altered by exposure to trauma work (Figley, 2002, p. 157).
22Vicarious TraumaVT emphasizes the way the therapist’s experience of the self is altered in terms of identity, world view, spirituality, self capacities, ego resources, psychological needs, and the sensory system. Moreover, VT disrupts the therapist’s sense of safety, trust, esteem, intimacy, and sense of control (Pearlman & Saakvitne, 1995).In effect, VT resembles the effects of trauma on the client. Over time, the therapist is changed as a consequence of empathic engagement in clients’ stories of sadism, cruelty, betrayal, neglect, abandonment, and exploitation.
23Vicarious TraumaIn psychotherapy with traumatized individuals, it has to be assumed that our subjectivity, including our organizing principles, are altered by VT.First, vicarious trauma weakens the therapist’s capacity to be emotionally flexible and available to the client’s emotional needs, that is, to provide a holding environment and to sustain affective attunement through empathic immersion in the client’s subjective experience.Second, the intersubjective field of the client–therapist is always shaped by the therapist’s emotional experience of this relational domain, in addition to the client’s experience.
24Compassion Satisfaction Compassion satisfaction is about the pleasure you derive from being able to do your work well.For example, you may feel like it is a pleasure to help others through your work and that we provide them with some relief, growth or healing.
25Compassion FatigueThe term compassion fatigue has been around since 1992, defined by both Johnson and Kottler (Figley, 2002).Compassion fatigue is experienced by caregivers who are overly focused and upset by the cumulative trauma of those they are trying to help.The symptoms are similar to those of post traumatic stress disorder (PTSD).
26Compassion Fatigue Defined Compassion Fatigue is defined as the social workers decreased ability to be empathic or able to “bear the suffering of clients” and is “the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced or suffered by a person” (Figley, 1995, p. 7).Siegel, 2010, indicates it affects our ability to be fully “present” with our clients. Our past, especially histories of trauma, restrict our plateau’s and create valenced states that bias how we will view certain situations. When we sense danger, we cannot activate the social engagement system or self- engagement system. It will cause us to disengage from our clients.
27Compassion Fatigue Examples A female case manager working with women who have been sexually assaulted assumes that all men she encounters are unsafeStaff working at an eating disorder center start to believe that 100 lbs. is a good weight for an adult femaleSomeone you have supervised for years has developed a recent habit of checking with you before making any decisions, questioning whether his actions have any value to the clients he once felt confident working withAdapted from Volk, Guarino, Grandin & Clervil, 2008
28Compassion Fatigue Symptoms Excessive BlamingBottled Up EmotionsIsolation from OthersPoor Self-CareDiminished Sense of SafetyNightmareDifficulty Maintaining BoundariesExhaustionApathySadness / DepressionAggression towards OthersDecreasing Sense of CompetencyQuestioning Personal Values
30BurnoutThe state which occurs when stress reactions reach a crisis point. More commonly experienced by staff and caregivers in response to continual exposure to other peoples pain.Health may be suffering or outlook on life becomes negative.It grows over time and unlike Compassion Fatigue, burnout is caused by stress and hassles, such as paperwork/phone calls, rather than over-empathizing with the trauma of those you work with.It is the predictable, cumulative effect from the impact or overload of their work.
31Unaddressed burnout can lead to compassion fatigue. Remember the instructions from the flight attendant, “If the cabin loses air pressure, oxygen masks will drop from the ceiling. Please put on your own mask before assisting others.”Help yourself before you can help othersAdapted from Volk, Guarino, Grandin & Clervil, 2008
32Burnout Physical symptoms include: Emotional symptoms include: fatigue, low energypoor sleep and headachesirritabilityEmotional symptoms include:anxiety and depressionhopelessnessaggression and cynicismsubstance abuse
33Other Warning SignsBaranowsky (2002) identifies other warning signs as:Wishing the client would just get over it.Using anger or sarcasm with clients.Blaming a client for their problems.Fearing what the client will want to talk about.Using humor with a client to minimize his / her problems.
34Organizational Symptoms of Compassion Fatigue High absenteeismConstant changes in co-workers relationshipsInability for teams to work well togetherDesire among staff members to break company rulesOutbreaks of aggressive behaviors among staffInability of staff to complete assignments and tasksInability of staff to respect and meet deadlinesLack of flexibility among staff membersNegativism towards managementStrong reluctance toward changeInability of staff to believe improvement is possibleLack of a vision for the future
35Cost of Not AddressingJob performance decreases in terms of productivityMistakes increaseOffice morale dropsWork relationships sufferingPersonal life suffers, increased risk for substance abuseCan lead to problems with healthIsolation from support networksDecreased sense of self esteem and confidenceHigh staff turn over ($)Increase use of sick leave ($)Lack of collaboration with other offices
36Risk Factors for Social Workers CaseloadHistory of personal traumaLower level of trauma trainingLack of control over work scheduleLack of organizational supportPoor self-care
37Evaluating Professional Quality of Life Scale: Score_ pdf
38Mean scores of PROQOL Subscale UWW BSW N=49 Prior BSW Study (Knight, 2010)N=42Research Participants(Stamm, 2005)N=1000 (Mental health professionals)Compassion Satisfaction43.65/43.8941.337Secondary Traumatic Stress18.19/17.3711.213Burnout19/1718.522
39NASW Code of EthicsWe have an ethical responsibility to engage in appropriate and responsible self-care.The NASW Code of Ethics states that “a social worker’s ethical behavior should result from their personal commitment to engage in ethical practice.”Ongoing self-care is the foundation of that “commitment” to ethical practice.We need to identify our secondary trauma and vicarious trauma so that we can address to prevent related negative consequences.
40Protective Factors for Social Workers Job satisfaction and personal gratification protect usManagement of vital functions (sleep, food, recreation) (Yassen, 1995)Proper training, including helpers’ ability to read and care for their own stress responsesTraining in safety/debriefing after “traumatic” eventBalanced number/level of trauma clients in your caseloadRelationships with others that convey cooperation and respectBenefits that allow for time-off, vacation, and mental health careGood self-careGood boundaries
41Meyers & Cornille’s Study Recommends: Improved trainingRecognize and normalize secondary traumatic stressOwning personal trauma historyRecognize gender differences (recognize how males and females react differently after being exposed to abuse)Coping strategiesHandling on-the-job victimizationProviding a supportive work environmentLimiting work hoursPersonal care
42Caregiving Organizations “Holding Fast” – Kahn (2005)What is Object Relations?How people internalize and externalize their relationships with others.“Good enough” others.What is a Caregiving Organization?Those agencies whose primary task is the effective providing for people seeking healing, growth, learning or support form another.Relationships are based on premise that growth, healing, and learning involves risk and vulnerability on part of those we treat.Caregivers must contain (absorb thoughts and feelings), provide empathic acknowledgement, and provide an enabling perspective (take over others ego functioning until they can do this on their own). Each of these require a unique set of skill and sophistication, along with stamina. Stress is an inevitable by product.
43Caregiving Organizations (Cont.) Object Relations view of self-care in organizations“the quality of care given to care seekers depends on the extent to which caregivers are emotionally ‘held’ within their own organizations…the institution as a whole becomes therapeutic and its members model caretaking behaviors toward one another”“the extent to which caregivers are emotionally held within their own organizations is related to their abilities to ‘hold’ others”Leadership in Caregiving OrganizationsCreate strong vision and mission which supports resiliencySupervision is key – allow staff to explore issuesLeaders become ultimate attachment figures – contain emotion and model appropriate behaviorLeaders must assist with change“Leaders must hold lightly, hold firmly, and hold courageously”
44Helping Student / Interns Discuss strategies to address any potential violence prior to student starting: help student to potential situations, teach safety education, help students understand rights, and discuss fearsAddress students over-identification (distorted reality) and low sense of coherence (confidence) (Ying, 2009)Offer agency debriefing and support to students after a stressful situationCritical incident stress debriefingCounseling referral as neededSchools should provide training for field educators on client violence issues
45Self-Care Defined“A person’s emotional and psychological capacity to cope with demands across time, circumstance, and setting’ (Ashford, Lecroy, & Lortie, 2006)Self-care enhances well-being and involves purposeful and continuous efforts that are undertaken to ensure that all dimensions of self-care receive the attention that is needed to make the person fit to assist others (Moore, Bledsoe, Perry & Robinson, 2011)
46Self-Care Strategies How do you care for yourself? What are the benefits?
48Self-Care Strategies at Work Seek supervision and guidancePeer consultation about clientsRegular lunch breaksTaking short breaks at workUtilize Employee Assistance Programs(Eastwood, C.D. & Ecklund, K, 2008)
49General Self-Care Strategies Acknowledge your work will affect you“Know thyself”Obtain trauma trainingLearn about burnoutMixed literature on this however, many of us know the fact but do not live it.Seek consultation and supervisionSeek professional help when needed“Heal old pain”Get proper nutrition, sleep, and exerciseUse humor to relieve tensionDevelop realistic expectations about your roleExamine self-talk
50General Self-Care Cont. Build a strong support networkBalance between personal and professional life“Sick days versus wellness days”Pursue leisure activitiesModerate caffeine / alcohol useMaintain professional contactsMeditation and body therapy (yoga, massages, etc.)ReflectEvaluate and set new goalsBe kind to yourself
51Other Ideas Attending cultural events Hobbies Take medications as prescribedTake trips for pleasureVolunteerJournalChurch / worship services
52How to Help OthersWhen approaching your colleagues about their stress, compassion fatigue or burnout---make sure to have this conversation while they are not distracted or overly stressed.Identify stress-relief solutions such as retreats and workshops.
53ResourcesBaird, K. & Kracken, A. (2006). Vicarious traumatization and secondary traumatic stress: A research synthesis. Counseling Psychology Quarterly, 19(2): 181–188.Baranowsky, Anna B.; In: Treating compassion fatigue. Figley, Charles R. (Ed.); New York, NY, US: Brunner-Routledge, ppBober, T. & Regehr, C. (2006). Strategies for Reducing Secondary or Vicarious Trauma. Brief Treatment and Crisis Intervention 6 (1); 1-9.Criss, P. (2010). Effects of client violence on social work students: a national study. Journal of Social Work Education, 46 (3),Figley, C. R. (Ed.) (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. NY: Brunner/Mazel.Figley, C. R. (2001). Renewing Spirits: Lessons From Thirty Years of Trauma Work, Invited keynote address to the William Wendt Center for Loss and Health Conference on Illness, Grief & Trauma, Washington, DC, October 6.Figley, C. R. (Ed.) (2002). Treating Compassion Fatigue. New York: Brunner- Routledge.Harr, C. & Moore, B. (2011) Compassion fatigue among social work students in field placements. Journal of Teaching in Social Work, 31(3),
54ResourcesKabat-Zinn, J. (1994). Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life, New York: HyperionKnight, C. (2010).Indirect trauma in the field practicum: Secondary traumatic stress, vicarious trauma, and compassion fatigue among social work students and their field instructors. Journal of Baccalaureate Social Work, 15(1),Kulka, R. A.,Schlenger, W. E.,Fairbank, J. A.,Hough, R. L.,Jordan, B. K., Marmar, C. R.,Weiss, Daniel S. (1990). Trauma and the Vietnam war generation: report of findings from the National Vietnam Veterans readjustment study. Philadelphia, PA, US.Litvak, A., Bogo, M., & Mishna, F. (2010). Emotional reactions of student in field education: an exploratory study. Journal of Social Work Education, 46(2),Maslach, C. and Jackson, S. E. (1981). The measurement of burnout. Journal of Occupational Behavior, 2,Maslach, C. (1976). Burn-out. Human Behavior, 5 (9),McCann, I. L. and Pearlman, L. A. (1990). Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3:2,
55ResourcesMiller, K. I., Stiff, J. B., & Ellis, B. H. (1988). Communication and empathy as precursors to burnout among human service workers. Communication Monographs, 55(9),Moore, S.E., Bledsoe, L.K., Perry, A.R., Robinson, M.A. (2011) Social work students and self-care. Journal of Social Work Education, 47 (3),Morrisette, P. J. (2004). The Pain of Helping: Psychological Injury of Helping Professionals. NY: Brunner-Routledge.Pearlman, L A. & Saakvitne, K. W. (1995). Treating therapists with vicarious traumatization and secondary traumatic stress disorders. In C. R. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorders in those who treat the traumatized, NY: Brunner/Mazel.Pierson, J.E. Vicarious Trauma and Self-Care. Retrieved from: dhss.delaware.gov/si08/files/si09_1314_vicarioustrauma_selfcare.pdf, April 10,Rothschild, B. & Rand, M. (2006). Help for Helpers. NY: W.W. Norton & Company, Inc.
56ResourcesSiegel, D. (2010). The mindful therapist: a clinician's guide to mindsight and neural Integration (1st ed). New York: W. W. Norton & Company.Stamm, B.H. (2005) The ProQol Manual. Lutherville, MD: Sidran Press.Thivierge, R. (2001). Healing from Secondary Trauma and Vicarious Trauma. Retrieved from: on April 5, 2011.van der Kolk, B. (2005). Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society (1st ed). Guildord Press. New York: New York.Ying, Y (2009). Contribution of self-compassion to competence and mental health in social work students. Journal of Social Work Education, 45(2),Zimering, R., Gulliver, S.B.; Knight, Jeffrey; Munroe, James; Keane, Terence M.; Journal of Traumatic Stress, Vol 19(4), Aug, pp
57Web Resources Websites on CF http://www.breathofrelief.com/