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Vicarious traumatization Dr. Patricia Sherman June 19, 2008.

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1 Vicarious traumatization Dr. Patricia Sherman June 19, 2008

2 The capacity for compassion and empathy seems to be at the core of our ability to be wounded by the work Stamm, B,H, (1995). Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators.

3 Introductions and what do you take home with you?

4 Countertransference Adapted from Pearlman, L.A., & Saakvitne, K.W. (1995). Trauma and the therapist. NJ: W.W. Norton & Co. The affective, ideational, and physical responses a therapist has to the client, the clients clinical material, transference, and reenactments. The conscious and unconscious defenses against the affects, intra-psychic conflicts, and associations aroused by the above.

5 Some signs of countertransference in trauma work Adapted from Wilson, J. (2004). Empathy, trauma transmission, and countertransference in posttraumatic psychotherapy. In J. Wilson & B. Drozdek (Eds.) Broken spirits. NY: Brunner-Routledge. P. 306 Unreasonable dislike for client Failure to identify with client Non-responsiveness to emotional distress of client Overwhelmed by clients problems Excessive liking of client

6 Dread therapy session/uncomfortable during session Preoccupation with client outside office Inattention, problems of concentration, drowsiness, sleepiness during session Preoccupation with own personal affairs Coming late to session Argumentative with client Client appears in dreams

7 Vicarious traumatization Adapted from Pearlman, L.A., & Saakvitne, K.W. (1995). Trauma and the therapist. NJ: W.W. Norton & Co. The transformation in the inner experience of the therapist that comes about as a result of empathic engagement with clients trauma material. It is the result of an accumulation of experiences across clients. It is permanently transformative, while countertransference is temporally and temporarily linked to a particular client.

8 Effects of Vicarious traumatization Frame of reference Identity World view Spirituality Self capacities Ego resources

9 Psychological needs – Safety – Trust – Self esteem – Intimacy – Control

10 Sensory system – Imagery – Bodily experiences – Sensitivity to sounds, smells, and tastes

11 aspects of the work Empathic engagement – Graphic trauma material – Intentional cruelty – Client resentment Context – Workload – Confidentiality – Management support

12 Nature of trauma treatment Clientele – Current living situation – Adaptation Suicidal preoccupation Interpersonal style (BPD) Professional context Social context

13 Aspects of the therapist Self – Identity – Worldview – Spirituality – Affect style – Ability to recognize and meet ones needs Personal history

14 Current personal circumstances Current professional circumstances – Training and supervision – Professional identity – Control

15 Type of empathic connection Cognitive Empathic Time Frame Cognitive Past Empathic Past* *Most stressful Cognitive Present Empathic Present

16 Hazards of practice Adapted from Skovnit, T.M. (2001). The resilient practitioner

17 The difficult nature of the work with clients, students, and patients They have an unsolvable problem that must be solved They are not Honors students

18 They have motivational conflicts There is often a readiness gap between them and us Sometimes they project negative feelings onto us

19 Sometimes we cannot help because we are not good enough They have needs greater than the social service, educational, or health system can meet

20 Managing major professional stressors Our inability to say No – The treadmill effect Living in an ocean of stress emotions

21 Ambiguous professional loss – ending before the ending The covert nature of the work Constant empathy, interpersonal sensitivity, and one-way caring

22 Elusive measures of success Normative failure Regulation oversight and control by external, often unknown others

23 Cognitive deprivation and boredom Cynical, negative colleagues and managers

24 Legal and ethical fears Practitioner emotional trauma Practitioner physical trauma

25 Video the cost of empathy

26 Self tests ProQOL R IV Silencing Response Personal mission statement

27 How to cope with vicarious traumatization Recognize and accept VT Limit exposure Attend to empathy Name re-enactments Set limits Create balance

28 Maintain professional connections – Personal psychotherapy – Rest and play – Education – Support groups – Supervision and consultation – VT consultation Seek spiritual renewal General self care

29 Overcoming vicarious traumatization

30 Video transforming the pain

31 How do you cope with stress?

32 Some stress reduction techniques

33 progressive muscle relaxation Lie down or sit comfortably and close your eyes Tense the muscles of a particular body part Hold the tension for about 10 seconds Let go of the tension quickly, letting the muscles go limp Repeat Go on to different muscle groups

34 Stretch Massage – self; partner Shake it out Shower or bath Breathing Aromatherapy Exercise Hypnosis

35 Animal therapy Gardening Spiritual practices Expressive therapies Acupuncture/acupressure Homeopathy Self-help groups Any other pleasurable activity

36 Imagery – guided exercise

37 Irrational beliefs - ellis It is a dire necessity for adult humans to be loved or approved by virtually every significant other person in their community. One absolutely must be competent, adequate and achieving in all important respects or else one is an inadequate, worthless person. People absolutely must act considerately and fairly and they are damnable villains if they do not. They are their bad acts.

38 It is awful and terrible when things are not the way one would very much like them to be. Emotional disturbance is mainly externally caused and people have little or no ability to increase or decrease their dysfunctional feelings and behaviors. If something is or may be dangerous or fearsome, then one should be constantly and excessively concerned about it and should keep dwelling on the possibility of it occurring.

39 One cannot and must not face life's responsibilities and difficulties and it is easier to avoid them. One must be quite dependent on others and need them and one cannot mainly run one's own life. One's past history is an all-important determiner of one's present behavior and because something once strongly affected one's life, it should indefinitely have a similar effect.

40 Other people's disturbances are horrible and one must feel upset about them. There is invariably a right, precise and perfect solution to human problems and it is awful if this perfect solution is not found.

41 Rebt – albert ellis A – activating event or potentially stressful situation B – beliefs, thoughts, or perceptions about A C – emotional consequence that results from holding these beliefs A potentially stressful situation + your perceptions = your stress level

42 Plan of action Stress diary Stress dots Stress reduction program Fifteen things to add to quality of life Ten habits of highly effective stress managers



45 GOAL SETTING GOAL REASON Objective #1 Objective #2 Objective #3 Example: Improve health in order to have more energy Exercise 30 minutes 4 times/week Lose 1.5 pounds/week for a total of 25 pounds Eat 1800-2000 calories/day

46 SUCCESS QUESTION WHAT CAN I DO TODAY THAT WILL HELP ME TOWARDS MY GOAL? What can I do for exercise today? What can I do today to enhance my relationship with my partner? What can I do today to nurture myself?

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