Understanding Vicarious Trauma

Katherine Manners, M.Ed., LMFTLisa Tieszen, MA, LICSW

Advocate Education and Support ProjectBeth Israel/Deaconess Medical Center

Kmanners@bidmc.harvard.eduLtieszen@bidmc.harvard.edu

It’s probably just stress…

True or False?

If you’re not overstressed, you are not contributing…

Traumatic Stress

Trauma is an experience that is outside one’s normal experience that causes intense fear for life.

Traumatic Stress is the stress response to a traumatic event(s).

Repeated traumatic events can chronically elevate the body’s stress response

Vicarious Trauma

“…the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by another…the stress resulting from helping or wanting to help a traumatized or suffering person.”

Charles Figley, 1995, Compassion Fatigue

Learning the difference between Stress / VT STRESS

Sleeplessness due to workload

Call out sick from work

Anxious about deadline

Secondary Traumatic Stress

Sleeplessness due to nightmares mirroring the story of a victim with whom you are working.

Call out sick because what difference does it make? People are just going to keep hurting each other-I can’t stop it.

Worry and anxiety about the safety of a DV victim

True or False?

The only people to experience VT are those who are weak and not cut out for this type of work…

Who Experiences Vicarious Trauma?

Pro Bono Attorneys Prosecutors & Victim Witness Advocates DV & Rape Crisis Advocates Law Enforcement Mental Health Workers Emergency Medical Personnel Firefighters Public Safety Officers Rescue/Relief Workers

Atty General Eric Holder:

“It’s not an easy thing, especially if you’re doing violent crime cases…even drug cases…There’s only so much that the human psyche can take before those experiences start to change you.”

How to be a Prosecutor, Washington Lawyer, January, 2007

Vicarious TraumaAn “occupational hazard” for those

working with trauma survivors

Ethical mandate of “duty to train” where workers are taught about the potential negative effects of the work and how to cope.

- Munroe, J. F., in Compassion Fatigue, 1995

Literature Findings on Vicarious Trauma/ STS

Degree of Exposure A high number of traumatized clients Current and cumulative exposure

Personal Characteristics of the Trauma Worker

Age Gender Personal History of Abuse

Studies of Lawyers have found…

15-18% will have substance abuse problem vs. 10% general population. Florida Lawyers Assistance

Highest rate of depression among workers in 104 occupations. Johns Hopkins

8-15 times the anxiety, hostility and depression of the general population. University of Arizona

The Development of Vicarious Trauma

RoleYour responsibilities

Input

What do you hear? What do you observe?From the population with whom you work.

©AESP, 2004

The Development of STS - Influencing Factors. ©AESP, 2004

Personal

Professional

Organizational

Community

Personal Factors

Personal historyPersonalityDefensive styleCoping styleCurrent life contextPersonal therapy

Professional Factors

Training & professional historySupervisionNature of the workNature of the clienteleCumulative exposure to trauma

material

Organizational Factors

Organizational structureRole definitionWork relationshipsSupervisory/management supportQuality of physical environment

Community Factors

Socio/Cultural/Economic contextReligious contextPolitical contextRacism/Sexism/Ageism, etc.Neighborhood

The Development of STS - Influencing Factors. ©AESP, 2004

Personal

Professional

Organizational

Community

The Development of STS - Impact

Personal/Professional Impact

 [______I______I________I______I_____]

Severe distress No

Distress Range of Distress Response

©AESP, 2004

STS: Levels of Effect

Affects individuals at multiple levels: Interpersonal relationships

(personal/professional) Physical Cognitive Emotional Behavioral Spiritual Job Performance & Morale

McCann & Pearlman, 1990; Yassen, 1995

Examples of Effect: Personal

Physical

Psychological

Behavioral

Spiritual

Cognitive

Relational

Rapid pulse/breathing, aches & pains, headaches, tension

Feelings of powerlessness, numbness, anxiety, sadness

Irritability, sleep/appetite changes, isolation, intolerance, substance abuse

Loss of purpose, questioning meaning of life, goodness/evil

Diminished concentration/self esteem, traumatic imagery

Withdrawn/clingy; mistrust; lack of interest in sex

Examples of Effect: Professional

Performance

Morale

Interpersonal

Behavioral

Decrease in quality/quantity of workload; low motivation, task avoidance or obsession

Decrease in confidence/interest; negative attitude; apathy

Detached/withdrawn from co-workers; poor communication; conflict; impatience

Absent/tardiness; overwork exhaustion; irresponsibility

True or False?

The Vicarious Trauma symptoms that I feel indicate how committed I am! They come with the job and show that I am

110% committed, dedicated and more hardworking than the next person - Who needs a personal life? Bah!

Contemplating the effects…

True or False?

If you can’t stand the heat, get out of the kitchen…

What keeps you in the work?

?

Strategies to Reduce the Effects of STS

Personal

Professional

Organizational

Community

True or False

The best strategy for reducing STS is to drink to excess every night after work…

Personal Strategies

Body work Sleep Good nutrition Social support Asking for help Balance Relaxation

Contact with nature Creative expression Skill-development Meditation/Spiritual

practice Humor Reading

Leaving work at work

Check that tasks are finished & documentation completed

Deal with outstanding issues Hand over responsibility for your clients/patients Acknowledge the day Say your goodbyes De-role

Jayne Huggard, 2003

Professional Strategies

Work/life balance Boundaries/limit-setting Professional

development (on & off work site)

Supervision

Consultation Peer support Job commitment Opportunities for

replenishment

Organizational Strategies

Clear values of the institution

Advocate for additional support, supervision, & training, as needed

Improve physical setting

Ample salary/benefits

Enhance safety in the workplace

Clarify job role, tasks, & personnel guidelines

Flexibility Opportunity for

growth and alternative job responsibilities

Peer support

Teach effective communication skills Encourage trusting, mutual

relationships Model conflict resolution Emphasize collaboration & teamwork Advocate for increased salaries and

flexible benefits

Community Strategies

Participate in public awareness activities Build coalitions with other agencies/

stakeholders Get involved in legislative reform Create or participate in social action effort Participate in community, school or elder

activities Engage in religious/spiritual community

Questions??

Lisa Tieszen, LICSWKatherine Manners, LMFTAdvocate Education and Support ProjectCenter for Violence Prevention and RecoveryBeth Israel/Deaconess Medical Center

Ltieszen@bidmc.harvard.edukmanners@bidmc.harvard.edu