1. Joseph Springer, PhD Department of Psychology & Counseling Georgian Court University

2. “You can search the entire universe for a being who is more deserving of compassion than yourself. No such being will be found” -The Buddha “Love your neighbor as you love yourself” (italics added) -Jesus

3. Secondary Trauma Often used interchangeably with “Vicarious Traumatization” Other terms which are sometimes mentioned with secondary trauma are compassion fatigue, secondary stress disorder and burnout

4. Secondary Trauma and Vicarious Trauma will be used interchangeably Compassion fatigue, secondary stress disorder and burnout may overlap in some areas, however they also differ from ST and VT

5. SR/VT initially described by McCann & Perlman (1990) referring primarily to psychotherapists who work with trauma survivor clients. Has since been expanded by others to include first responders, health care providers and humanitarian workers, among others

6. The hallmark of ST/VT is a disruption of the trauma workers’ perceived meaning and hope (McCann and Pearlman (1990) ST/VT differs from compassion fatigue, secondary stress disorder and burnout in that trauma-related symptoms, such as intrusive imagery, increased emotional arousal and avoidance or numbing may be present

7. ST/VT can overlap considerably with PTSD, and in some cases can meet the criteria for PTSD: -Exposure to a traumatic event -Persistent re-experiencing of the event -Persistent avoidance or emotional numbing - Persistent symptoms of increase emotional arousal Duration of more than one month (otherwise acute Stress Disorder); Causes significant distress or impairment in functioning

8. In most instances, mental health professionals are exposed to trauma through hearing about (rather than directly witnessing) traumatic events as described by their clients The central mechanism in ST/VT is empathy (Rothschild, 2006) It is certainly the experience of most mental health professionals to feel acute psychological pain when hearing about the traumatic experiences of their clients

9. If helpers identify with their client and imagine what it would be like if the situation happened to them they are more likely to experience distress If helpers imagine what the traumatic event was like for their client they are more likely to experience compassion (Lamm et al., 2007)

10. Over-identifying with a client and his/her experience is more likely to occur if the professional has had a similar experience (either directly of vicariously) Over-identification may also occur in less experienced clinicians

11. Countertransference If exposure to a client’s reports of traumatic experience(s) has activated a clinician’s own memories and reactions to significant events that they have experienced in their own lives, treatment for the clinician may be recommended PTSD-oriented treatment would be appropriate

12. Evidence-based psychological treatments for PTSD are Prolonged Exposure therapy (CBT) and EMDR (Bisson et al., 2007). SSRI’s considered first-line medications for PTSD (Cooper, Carty & Creamer, 2005). Benzodiazepines are contraindicated (although they are often prescribed), and although they may provide short- term anxiety relief, they can interfere with psychological treatments and are associate with poorer long-term outcomes (Berger et al., 2009)

13. Overlap with Compassion Fatigue, Burnout, Secondary Stress Disruption of sense of meaning and hope can also occur with heavy workloads, chronic clients, socialized passivity on the part of some clients, sense of entitlement on the part of some clients, sense of powerlessness on the part of clinicians

14. Countertransference A helpful model in understanding countertransferential reactions is the moving toward/moving away concept It can be thought of as a continuum between two polarities Moving________________________________Moving Towards Away

15. Countertransference Moving Towards: “Buying into” or validating a client’s world-view Moving Away: Rejecting or invalidating a client’s world view The countertransferential “traps” lie at the extremes

16. Countertransference Moving towards: Over-identifying with client as victim, taking on “rescuer” role, not confronting unhealthy behavior Moving Away: Minimizing or invalidating the client’s experience, acting in a judgmental manner, overly confrontational

17. Countertransference The therapeutic stance is to be in the mid-range and to be able to move within this range in a flexible and self-aware manner (e.g., able to validate the client’s experience while also keeping in mind that the client’s world view is not functioning well for them) “I’m not your boss, I’m your consultant”

18. Additional Factors to Reduce Risk of ST/VT and Compassion Fatigue Manageable client load or workload Peer support and respectful supervisors Sense of meaning and importance of work Self-Care: Mind/body/spirit (see opening quotes) Supportive social network Diversity of interests

19. Vicarious Transformation Results from witnessing the resiliency and courage shown by some individuals in the face of very adverse life-events Deepened sense of connection to all living beings, greater capacity for empathy, increased inclusiveness, greater appreciation for what one has, enhanced humility (Saakvitne & Pearlman, 1996)

20. References Berger, W. et al., (2009) Pharmacological alternatives to antidepressants in post-traumatic stress disorder: a systematic review. Prog Neuropsych Biol Psychiatry, 33,169-180. Bisson, J.I. et al., (2007). Psychological treatment of chronic post-traumatic stress disorder: systematic review and metanalysis. Br J of Psychiatry, 190, 97-104. Cooper, J. Carty, J. & Creamer, M. (2005). Pharmacotherapy for post traumatic stress disorder: empirical review and recommendations. Aust NZ J Psychiatry, 32, 674-682. Lamm, C. et al., (2007). The neural substrate of human empathy. J Cog Neuroscience, 19, 42-58.

21. References (cont’d) McCann, I.L & Pearlman, L.A. (1990). Vicarious traumatization: A framework of the psychological effects of working with victims. J Traumatic Stress, 3, 131-149. Rothschild, B. (2006). Help for the helper. New York: Norton Saakvitne, K.W.& Pearlman, L.A. (1996). Transforming the pain: A workbook on vicarious traumatization. New York: Norton.