1. Bearing Witness to Pain: Coping with Secondary Trauma April 29, 2016 Scott Webb, LCSW Supporting the Division of Mental Health and Substance Abuse Services 1

2. Learning Objectives 2 123 Identify the differences between vicarious trauma, compassion fatigue, and burnout Understand the impact of vicarious trauma on staff and on systems of care Create and put into practice a personal plan to prevent compassion fatigue

3. Cleveland Clinic Video on Empathy https://www.youtube.com/watch?v=cDDWvj_q-o8 3

4. What is to give light must endure burning. -Viktor E. Frankl 4

5. Trauma Pair up with a neighbor and discuss:  What is trauma?  How would you define trauma based on your clinical and/or personal experiences? 5

6. Trauma  Refers to extreme stress (e.g. threat to life, bodily integrity or sanity) that overwhelms a person’s ability to cope  Is subjective  Often results in feeling vulnerable, helpless and afraid  Often interferes with relationships and fundamental beliefs about oneself, others, and one’s place in the world  Disrupts the nervous system 6

7. How Have You Changed?  How has my work changed me personally?  How has my work changed me professionally? 7

8. Vicarious Trauma (VT) and Secondary Traumatic Stress (STS) Compassion FatigueBurnout 8

9. Vicarious Traumatization and Secondary Traumatic Stress  Work-related, secondary exposure to extremely or traumatically stressful events.  Can be the result of the exposure of helpers to experiences of clients, in tandem with empathy experienced for clients. (Collins and Long, 2003)  Can be sudden and acute.  Anything that interferes with the helper’s ability to fulfill his/her responsibility to assist traumatized clients can contribute to VT. (Pryce et al., 2007) (Adolescent Health Working Group, 2013) 9

10. Vicarious Traumatization and Secondary Trauma STS study by Bride, 2007  Master’s level social workers:  Fifteen percent of respondents reported STS as a result of indirect exposure to trauma material at a level that meets diagnostic criteria for Post Traumatic Stress Disorder (PTSD)  Behavioral health professionals’ experience of STS was a contributing factor in staff turnover and a significant reason why these professionals leave the field 10

11. Secondary Trauma Newall and Mac Neil in 2010 identified individual STS risk factors:  Preexisting anxiety or mood disorders.  Prior history of personal trauma.  High caseloads of clients with trauma-related disorders.  Being younger in age and new to the field with little clinical experience.  Unhealthy coping styles; e.g., distancing and detachment from clients and co-workers.  Lack of tolerance for strong emotions.  Others? 11

12. Compassion Fatigue  Deep physical, emotional and spiritual exhaustion accompanied by acute emotional pain. Compassion fatigue practitioners continue to give themselves fully to their clients, finding it difficult to maintain a healthy balance of empathy and objectivity (Leiter and Maslach, 1998) 12

13. Burn Out  A syndrome of emotional exhaustion, depersonalization, and reduced sense of personal accomplishment, which can occur among individuals who work with people in some capacity. It includes a loss of empathy (Leiter and Maslach, 1988)  Associated with feelings of hopelessness and difficulties in doing one’s job effectively (Stamm, 2010) 13

14. Impact on Staff  Cognitively  Socially  Emotionally  Physically 14

15. Impact on Staff CognitiveSocialEmotionalPhysical Negative bias Reduced collaboration HelplessHeadaches PessimismWithdrawalHopelessTense muscles Loss of perspective Easily angeredOverwhelmedFatigue Decreased self- monitoring Difficulty trusting Depressed, worried Lowered immune system Intrusive thoughts Avoidance Numb-shutting down Black and white thinking IsolationHyper vigilant 15 (Administration for Children’s Services – New York University Children’s Trauma Institute )

16. Organizational Secondary Trauma  Organizations create a social context with risk factors that could increase the likelihood of VT reactions.  Lack of resources for consumers.  Lack of clinical supervision for counselors.  Lack of support from colleagues.  Lack of acknowledgement by the organizational culture that STS exists and that it is a normal reaction to counselors to client’s trauma. (Newall and Mac Neil, 2010) 16

17. System Level Impact 17 Increased attrition, poor system outcomes Decreased motivation, increased absenteeism Impaired judgment Lack of psychological safety Greater staff friction: Distrust among colleagues, supervisors Impact on ability to assess safety and risk Decreased compliance with organizational requirements

18. Organizational Secondary Trauma  Organizations also contain the protective factors that can lessen the risk of and impact of STS Mixing caseloads Supporting ongoing counselor training Regular supervision Recognizing counselor’s efforts Empowering work environment Bring in-house outside activities:  Yoga  Book clubs  Brown-bag training  Meditation  Others? 18

19. Full Engagement Spiritually Mentally Emotionally Physically 19 Aligned Focused Connected Energized

20. Personal Energy Rituals (PERs) PERs work on three levels:  Helps us effectively manage our energy in our service to others  It reduces the need to rely on our limited conscious will and discipline to take action  PERs translate our values and priorities into action. They help us embody what matters most to us 20

21. Resiliency  The ability to adapt well to stress, adversity, trauma, or tragedy  To remain stable and maintain healthy levels of psychological and physical functioning in the face of disruption and chaos 21

22. Resilient People  They control their destiny  They accept their battle  They use adversity as their compass  They practice patience  They let go  They live in the moment  They develop flexibility  They find the right travelling partners  They take the next step forward (Faisal Hoque, 2014) 22

23. Prevention of Compassion Fatigue You need a personal plan  Mission (Why do I do what I do?)  Self-Compassion  Relaxation Skills  Intentionality  Self-Validation  Support Systems  Self-Care  Supporting Others 23

24. Self Care  Proper nutrition  Get plenty of rest  Exercise  Avoid drugs and alcohol  Do things that you enjoy  Talk to people you trust-reach out  Set limits with others  Write down your thoughts and feelings  Manage your energy-PERs 24

25. Questions? Scott Webb, LCSW Trauma-Informed Care (TIC) Coordinator Division of Mental Health and Substance Abuse Services 608-266-3610 Scott.Webb@wisconsin.gov DHS TIC Website : https://www.dhs.wisconsin.gov/tic/index.htmhttps://www.dhs.wisconsin.gov/tic/index.htm If you would like to be added to the Wisconsin TIC Listserv, please follow this link: http://www.dhs.wisconsin.gov/tic/signup.htmhttp://www.dhs.wisconsin.gov/tic/signup.htm 25