Managing Vicarious Trauma in Behavioral Health Artwork courtesy of the International Child Art Foundation (www.icaf.org) 1

Objectives Identify burnout/stress, compassion fatigue and vicarious trauma and how they differ The impact on providers of behavioral health services, How to identify it in yourself and What to do

Managing Vicarious Trauma in Behavioral Health Working with addicts is a high-intensity profession. Staff may empathize with victims; feelings of helplessness, anger, and fear are common. Staff who are parents, or who have histories of childhood trauma, might be at particular risk for experiencing such reactions. 3 3

Impact of Working in a High Intensity Profession Burnout: Physical or emotional exhaustion, especially as a result of long-term stress. Compassion Fatigue: A state of tension and preoccupation with individual or cumulative trauma of clients. Vicarious Trauma: The transformation or change in a helper’s inner experience as a result of responsibility for an empathic engagement with traumatized clients.

Vicarious Trauma Compassion Fatigue Burnout can impact people in the following ways: Coping mechanisms become overwhelmed; The effectiveness as a caregiver is reduced; Feeling helpless; Detachment from co-workers not involved in the work; Detachment from family and friends; Shortened tenure as service provider.

Vicarious trauma/Compassion Fatigue/Burnout can negatively affect your work, your colleagues, the overall functioning of the organization, and the quality of assistance being provided to those you are working to help. They influence the way you act and interact with people you love. This affects your family and friends.

Vicarious Trauma Compassion Fatigue Burnout These terms are often used interchangeably. Also, these conditions often look the same. But, they mean different things. And, because they mean different things, they can be treated differently. And, finally, they all look a bit like PTSD.

Symptoms of PTSD Feelings of fear, hopelessness, anger, rage, horror Sleep disturbances Changes in memory Difficulty concentrating Difficulty maintaining boundaries

Burnout Definition Burnout is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed and unable to meet constant demands. As the stress continues, you begin to lose the interest or motivation that led you to take on a certain role in the first place Burnout can happen with any job.

Define Compassion Fatigue A feeling of deep sympathy and sorrow for another who is stricken by suffering or misfortune, accompanied by a strong desire to alleviate the pain or remove its cause Is a problem for counselors, and can limit their effectiveness.

Before Vicarious Trauma Comes Secondary Trauma – ‘the stress resulting from helping or wanting to help a traumatized or suffering person.’ This can occur with any professionals working with victims of trauma. This means lawyers, judges, court staff or interpreters.

Vicarious Trauma Vicarious trauma-The "cumulative transformative effect of working with survivors of traumatic life events is a natural reaction resulting from exposure to experiences and feelings of a traumatic event experienced by another person. THIS IS MUCH MORE SERIOUS THAN BURNOUT OR COMPASSION FATIGUE. Not direct trauma; Caused by second hand exposure; Accrual of exposure to other people’s trauma

What are the results of Vicarious Trauma? It contributes to feeling burdened, overwhelmed, and hopeless in the face of need and suffering. It leads people to extend themselves beyond what is reasonable for their own well-being. It can bring changes in spirituality which can, in turn, deeply impact the way a people see the world and their deepest sense of meaning and hope.

What is Vicarious Trauma? A gradual process that may unfold over time Cumulative effect of contact with survivors of violence or disaster or other trauma Happens because a person cares (empathizes with people who are hurting ) An individual feels committed or responsible to help and at times, cannot help.

Common Signs of Vicarious Trauma Difficulty managing your emotions; Difficulty accepting or feeling okay about yourself; Difficulty making good decisions; Problems managing the boundaries between yourself and others (e.g., taking on too much responsibility, having difficulty leaving work at the end of the day, trying to step in and control other’s lives);

OR Sleeping problems; Nightmares; Intrusive thoughts, memories and flashbacks; Hyper-vigilance; General anxiety and anxiety attacks; Isolation and disconnection Substance abuse and high risk behaviors; Changes in appetite and sex drive; Irritability and depression; Cynicism, negativity, and apathy about life and the world.

Who may be most at Risk for Vicarious Trauma? People Who: Tend to avoid problems or difficult feelings Blame others for their difficulties, Withdraw from others when things get hard Have experienced trauma themselves Lack connection with a source of meaning, purpose, and hope Have stress in multiple areas of life

Can you identify the signs in Yourself? Other Staff? The Clients?

Then What???

Self Care What does self-care mean to you?

Self - Care Should address the whole person physically, emotionally, behaviorally, spiritually and include stress reducing activities in which you will regularly and habitually engage.

Self - Care Know your own triggers and warning signs. Be alert to what you expose yourself to outside of work. Set boundaries. Add variety to your work. Maintain your relationships outside of work. Build self-care into your routine – at work and at home.

Self- Care Develop a personalized self-care plan that fits into your: Lifestyle personality, resources, Interests

What to do with burnout The easiest to address – that ‘s why you get a vacation Use the “Three R’ Approach Recognize: Watch for the warning signs of burnout Reverse: Undo the damage by managing stress and seeking support Resilience: Build your resilience to stress by taking care of your physical and emotional health

Coping Strategies Escape: Getting away from it all, physically or mentally (books or films, taking a day or a week off, playing video games, talking to friends about things other than work); Rest: Having no goal or time-line, or doing things you find relaxing (lying on the grass watching the clouds, sipping a cup of tea, taking a nap, getting a massage); and Play: Engaging in activities that make you laugh or lighten your spirits (sharing funny stories with a friend, playing with a child, being creative, being physically active).

Coping Strategies Remind yourself of the importance and value of humanitarian work; Stay connected with family, friends, and colleagues; Notice and deliberately pay attention to the “little things” that really aren’t so little – small moments of quiet, the sound of the wind in the trees, or brief connections with others;

Coping Strategies Mark transitions, celebrate joys, and mourn losses with people you care about through traditions, rituals, or ceremonies; Take time to reflect (e.g., by reading, writing, prayer, and meditation); Identify and challenge your own cynical beliefs; and Undertake growth-promoting activities (learning, writing in a journal, being creative and artistic).

TAKE CARE OF YOURSELF Write/journal Meditate Tell your story Relax Exercise Play Educate yourself Get a hobby Dream/hope Take Risks Sing Dance Make music

OR Enjoy nature Eat well Meet basic needs Raise plants Seek help Name the abuse Read or listen to Take vacations books on tape Watch sunrises and Weigh your options and sunsets Live ‘ one day at a time’ Use affirmations

AND Watch movies Do what you enjoy Say ‘no’ Find listeners Set boundaries Feel safe Play with animals Laugh Pray Make art Talk

Managing Stress: What You Can Do Utilize peer support. Consider therapy for unresolved trauma, which your work may be activating. 31

Consistency and Predictability How can you increase consistency and predictability in your work?

CONTACT INFORMATION Kay M. Doughty, MA, CAP, CPP VP, Family and Community Services Operation PAR, Inc. 6655 66th St. N. Pinellas Park, FL 33781 (727) 422-8060 kdoughty@operpar.org Renee Carter-Guru, LMHC, CAP Administrator, WEI, PREP 6150 150th Avenue North, Clearwater, FL 33760 (727) 524-4311 rcguru@operpar.org