Secondary Traumatic Secondary Traumatic Stress in the WorkplaceStress in the Workplace

Dr. Kim Shackelford, LCSWDr. Kim Shackelford, LCSW

Deputy AdministratorDeputy Administrator

Department of Human ServicesDepartment of Human Services

Division of Family and Children’s ServicesDivision of Family and Children’s Services

Objectives:Objectives:Participants will acquire knowledge and skills to be able to:Participants will acquire knowledge and skills to be able to:

Understand the dynamics of Post-traumatic Stress, Burnout, and Understand the dynamics of Post-traumatic Stress, Burnout, and Secondary Traumatic StressSecondary Traumatic Stress

Determine the relationship of traumatic stress to professionals Determine the relationship of traumatic stress to professionals who work with trauma victimswho work with trauma victims

Assess personal and professional self-careAssess personal and professional self-care Manage direct and secondary traumatic stressManage direct and secondary traumatic stress Determine and identify appropriate responses to supervisees and Determine and identify appropriate responses to supervisees and

co-workers who are experiencing traumatic stressco-workers who are experiencing traumatic stress Plan for personal and professional care/social support and Plan for personal and professional care/social support and

management of direct and secondary traumatic stress management of direct and secondary traumatic stress Examine organizational response needs and provisions for helping Examine organizational response needs and provisions for helping

staff manage Direct and Secondary Trauma responsesstaff manage Direct and Secondary Trauma responses

What is the responsibility of What is the responsibility of professionals to prepare professionals to prepare

themselves and others for working themselves and others for working with victims of trauma?with victims of trauma?

Before….Before….

SecuritySecurity SafetySafety EquilibriumEquilibrium HomeostasisHomeostasis Normal StressNormal Stress Overall – the Overall – the

world/life is world/life is predictable, ok, fairpredictable, ok, fair

After…After…

Security is threatenedSecurity is threatened Safe feelings are goneSafe feelings are gone DisequilibriumDisequilibrium Abnormal stressorsAbnormal stressors The world/life is not The world/life is not

fair, predictablefair, predictable Nothing will ever be Nothing will ever be

the samethe same

Types of Posttraumatic StressTypes of Posttraumatic Stress

PrimaryPrimary SecondarySecondary Not to be confused with BurnoutNot to be confused with Burnout Not to be confused with Not to be confused with

CountertransferenceCountertransference

Previously held beliefs…Previously held beliefs…

about a fair and just world are no about a fair and just world are no longer valid.longer valid.

Literature & TheoryLiterature & Theory

McCann, I.L., Sakheim, D.K., & McCann, I.L., Sakheim, D.K., & Abrahamson, D.J. (1988). Abrahamson, D.J. (1988). Trauma Trauma and Victimization: A Model of and Victimization: A Model of Pyschological Adaptation.Pyschological Adaptation.

McCann, I.L. & Pearlman, L.A. (1990). McCann, I.L. & Pearlman, L.A. (1990). Vicarious Traumatization: A Vicarious Traumatization: A Framework for Understanding the Framework for Understanding the Psychological Effects of Working with Psychological Effects of Working with VictimsVictims..

Literature and TheoryLiterature and Theory

Figley, C.R. (1995). Figley, C.R. (1995). Compassion Compassion Fatigue: Coping with Secondary Fatigue: Coping with Secondary Traumatic Stress Disorder in those Traumatic Stress Disorder in those who Treat the Traumatizedwho Treat the Traumatized

Figley, C.R. (2002). Figley, C.R. (2002). Treating Treating Compassion Fatigue.Compassion Fatigue.

Pryce, J., Shackelford, K., Pryce, D. Pryce, J., Shackelford, K., Pryce, D. (2007). Secondary Traumatic Stress (2007). Secondary Traumatic Stress and the Child Welfare Professional.and the Child Welfare Professional.

Several studies called for the inclusion of Several studies called for the inclusion of information regarding the effects of indirect information regarding the effects of indirect trauma on persons working with victims of trauma on persons working with victims of trauma in social work education programs.trauma in social work education programs.

(Bell, Kulkarni, & Dalton, 2003; Black, Jeffreys, & (Bell, Kulkarni, & Dalton, 2003; Black, Jeffreys, & Hartley, 1993; Cunningham, 2003, 2004; Dalton, Hartley, 1993; Cunningham, 2003, 2004; Dalton, 2001; Dane, 2000; Fournier, 2002; Maidment, 2001; Dane, 2000; Fournier, 2002; Maidment, 2003; McCammon (1999); Morrison, 1990; 2003; McCammon (1999); Morrison, 1990; Nelson-Gardell & Harris, 2003; Pryce, Shackelford, Nelson-Gardell & Harris, 2003; Pryce, Shackelford, & Pryce, in press) & Pryce, in press)

““Those who work with the suffering Those who work with the suffering suffer themselves because of the suffer themselves because of the work.”work.”

C.R. Figley, 2002C.R. Figley, 2002Treating Compassion FatigueTreating Compassion Fatigue

Indirect TraumaIndirect Trauma

Why indirect trauma?Why indirect trauma?

Trauma is part of our world and social workers are Trauma is part of our world and social workers are often there to help pick up the pieces – indirect often there to help pick up the pieces – indirect trauma is what happens to the social worker trauma is what happens to the social worker when others face traumatic situations and social when others face traumatic situations and social workers attempt to help them.workers attempt to help them.

Social Work often involves restoration of lives of Social Work often involves restoration of lives of persons who have been traumatized.persons who have been traumatized.

(Bride, in press; Cunningham, 2003, Pryce, J., (Bride, in press; Cunningham, 2003, Pryce, J., Shackelford, K., Pryce, D. 2007)Shackelford, K., Pryce, D. 2007)

When working with traumatized individuals, When working with traumatized individuals, professionals can be affected…professionals can be affected…

emotionallyemotionally physicallyphysically cognitivelycognitively sociallysocially interpersonallyinterpersonally spirituallyspiritually(Bride, 2004; Bride, in press; McCann & (Bride, 2004; Bride, in press; McCann &

Pearlman, 1990; Morrison, 1990; Pearlman Pearlman, 1990; Morrison, 1990; Pearlman & Saakvitne, 1995; Pryce, Shackelford, & & Saakvitne, 1995; Pryce, Shackelford, & Pryce, 2007; Valent, 1995)Pryce, 2007; Valent, 1995)

Effects on the ProfessionalEffects on the Professional

changes in frame of referencechanges in frame of reference changes in self capacitychanges in self capacity changes in ego resourceschanges in ego resources psychological needs & thought processes,psychological needs & thought processes,

safety, esteem, trust, control, safety, esteem, trust, control, intimacy, independence intimacy, independence

memory and perception changememory and perception change

(Saakvitne & Pearlman, 1996)(Saakvitne & Pearlman, 1996)

Effects on the clientsEffects on the clients

A soul weary social worker is not able to A soul weary social worker is not able to be helpful to the client (Stamm, 1999) be helpful to the client (Stamm, 1999)

Compassion fatigue results in Compassion fatigue results in professionals leaving the field (Figley, professionals leaving the field (Figley, 1995; Pryce, Shackelford, & Pryce, 2007)1995; Pryce, Shackelford, & Pryce, 2007)

Impaired professionals should not continue Impaired professionals should not continue to practice – duty to clients (NASW Code of to practice – duty to clients (NASW Code of Ethics, 1999)Ethics, 1999)

Saakvitne & Pearlman (1996)Saakvitne & Pearlman (1996)

““self-care is an ethical imperative. We self-care is an ethical imperative. We have an obligation to our clients – as have an obligation to our clients – as well as to ourselves, our colleagues, well as to ourselves, our colleagues, and our loved ones – not to be and our loved ones – not to be damaged by the work we do.”damaged by the work we do.”

Information has been found to be the Information has been found to be the key to mitigating the effects of key to mitigating the effects of indirect trauma.indirect trauma.

(Bell, Kulkarni, & Dalton, 2003)(Bell, Kulkarni, & Dalton, 2003)

Preparation of Undergraduate Social Work Students to Preparation of Undergraduate Social Work Students to Cope with the Effects of Indirect TraumaCope with the Effects of Indirect Trauma

Shackelford (2006)Shackelford (2006)

Cross-sectional survey of recently graduated BSW social Cross-sectional survey of recently graduated BSW social workers in the United States (random selection)workers in the United States (random selection)

Recently graduated BSW students – NASW members in Recently graduated BSW students – NASW members in transition (N=192) (30% response rate)transition (N=192) (30% response rate)

From 39 states and the District of ColumbiaFrom 39 states and the District of Columbia Recently graduated BSW’s recognized burnout and Recently graduated BSW’s recognized burnout and

posttraumatic stress disorder more often than secondary posttraumatic stress disorder more often than secondary traumatic stress, compassion fatigue and vicarious traumatic stress, compassion fatigue and vicarious traumatizationtraumatization

Recently graduated BSW social workers do not have Recently graduated BSW social workers do not have adequate knowledge of indirect trauma.adequate knowledge of indirect trauma.

Cross Tabulation of History of Cross Tabulation of History of Trauma as a Child and as an AdultTrauma as a Child and as an Adult

Trauma as Adult – No Trauma as Adult - YesTrauma as Adult – No Trauma as Adult - Yes

Trauma as a Child – NoTrauma as a Child – No 3434 26 26

Trauma as a Child – Yes Trauma as a Child – Yes 23 10723 107

TotalTotal 5757 133 133

Out of 190 respondents who answered these questions, 130 reported Out of 190 respondents who answered these questions, 130 reported childhood trauma and 26 more reported adult trauma. childhood trauma and 26 more reported adult trauma.

Study of Child Welfare WorkersStudy of Child Welfare WorkersPryce, Shackelford, Pryce (2007)Pryce, Shackelford, Pryce (2007)

All five states endorsed the following:All five states endorsed the following:

Avoided thoughts and feelingsAvoided thoughts and feelings

Experienced traumatic events in adult lifeExperienced traumatic events in adult life

Feel trappedFeel trapped in my workin my work

Feel hopelessness working with clientsFeel hopelessness working with clients

Have been in danger working with clientsHave been in danger working with clients

Study of Child Welfare WorkersStudy of Child Welfare WorkersPryce, Shackelford, Pryce (2007)Pryce, Shackelford, Pryce (2007)

4 states endorsed the following:4 states endorsed the following:

Feel estranged from othersFeel estranged from othersHave difficulty falling or staying asleepHave difficulty falling or staying asleepStartle easilyStartle easilyExperienced traumatic events in childhoodExperienced traumatic events in childhoodAm preoccupied with more than one clientAm preoccupied with more than one client

10 of the 17 posttraumatic stress 10 of the 17 posttraumatic stress symptoms were endorsed symptoms were endorsed

Building Worker ResiliencyBuilding Worker Resiliency

Describe the work realisticallyDescribe the work realistically Educate at the beginning about STSEducate at the beginning about STS Address personal traumatic stress and Address personal traumatic stress and

unresolved traumaunresolved trauma Clarify the agencies responsibilities to the Clarify the agencies responsibilities to the

worker regarding STS as an occupational worker regarding STS as an occupational hazardhazard

Clarify worker’s responsibility for self careClarify worker’s responsibility for self care Give extra care to new and younger Give extra care to new and younger

workersworkers

Management of STS increases the Management of STS increases the ability to keep hope alive for ability to keep hope alive for

professionals and clients!professionals and clients!