witness and narrator: addressing problems of secondary traumatic stress and compassion fatigue in...

Witness and narrator: Addressing problems of secondary traumatic stress and

compassion fatigue in spoken language interpreting

Dr. Emily Becher and Chris Mehus, MA, doctoral candidate

Who we are• Couple and Family Therapists• Work a lot with trauma• We have each worked with interpreters

through our research

How we got here

• We observed a lot of variety within the interpreters we have worked with

• We highly value and are grateful for interpreters and the work you do

• We are still outsiders and still learning

Overview

• Defining secondary traumatic stress• Research in this area• What to do about it

– Prevention– Intervention

Terminology

• Secondary traumatic stress• Burnout• Compassion satisfaction

Secondary traumatic stress

• Sometimes called compassion fatigue • A little different than vicarious trauma• Refers to the presence of symptoms

similar to PTSD resulting from indirect exposure to traumatic material

Burnout

• Exhaustion • Less satisfaction • Can be unrelated to secondary

traumatic stress

Compassion Satisfaction

• Positive feelings related to work• Feeling good about the difference you

make through your work• Can protect against burnout

Secondary Traumatic Stress• Hypervigilance• Avoidance/ coping• Intrusive thoughts• Anger or irritability • Loss of empathy

• Fearful or jumpy • Exhaustion• Social withdrawal• Emotionally down

or feeling numb

Secondary Traumatic Stress

• Symptoms might impact personal life and/or professional life

Secondary Traumatic Stress• Hypervigilance• Avoidance/ coping• Intrusive thoughts• Anger or irritability • Loss of empathy

• Fearful or jumpy • Exhaustion• Social withdrawal• Emotionally down

or feeling numb

Our brains protect us!

• This is all a result of our brains doing what they are supposed to do

• Our brain learns to look out for things that hurt us and then try to avoid them

Really abbreviated brain info

• Primitive brain: emotion and immediate reaction (fight, flight, or freeze)

• Cognitive brain: logic and reasoning

Memories

• Sensory information• Thoughts• Physiological changes• Emotions

Example

Think of a positive memory

Sensory Thoughts Emotions Physical

Sweet Smell

Sound of Mixing

Singing

Warmth from Oven

I love Sweets

I’m safe

Happy

Calm

Content

Slow Breath

Muscles Relax

Slow HR

Sensory Thoughts Emotions Physical

Sight of ___

Crying

Loud noise

Smell of ___

I’m going to

die

Police aren’t safe

Scared

Rage

Helpless

Heart racing

Muscles Tense

Sweaty palms

Old and new memories

• Past experiences (or memory webs) can get brought up

• New associations (or memory webs) are created

Our brains protect us

• Making this connections is protective • Symptoms of secondary traumatic

sense make more sense now

Secondary Traumatic Stress• Hypervigilance• Avoidance/ coping• Intrusive thoughts• Anger or irritability • Loss of empathy

• Fearful or jumpy • Exhaustion• Social withdrawal• Emotionally down

or feeling numb

A metaphor

• Books in a cabinet

Research

Research: Background

• Increasing attention since 1995• Recognition that professionals may face

direct and indirect exposure, as well as having a personal trauma history

Research: Prevalence

• Some researchers have found similar rates of secondary traumatic stress across disciplines

• Although some may be at higher risk (e.g., as many as 50% of child welfare workers vs. 5-25% of trauma therapists)

Research: Risk Factors

• Personal history of psychological trauma

• High levels of empathy • Sharing a similar background with the

client

Research: Risk Factors

• Work environment and stress– High demand and low control– Workload– Lack of support

• Working primarily with trauma-related cases

Research: Risk Factors

• Possibly gender• Interpreters convey traumatic content in

first person • Interpreters are more likely to be from

the same community as the client

Protective Factors

• Supportive work environments • Good self-care• Debriefing or consultation

This will be covered more later today

Our Research

• Online survey with a measure of secondary traumatic stress, compassion satisfaction, and burnout

• Also asked open ended questions• Interpreters across Minnesota

Our Research• Before we share our results, what do

you expect?– Levels of STS, CS, and burnout?– What do you think people said in terms of

stress related to interpreting?– Do you think your experience is similar to

the experiences of other interpreters?

Our Study: Participants

• N = 119• 81 women, 36 men• 24 reported refugee or asylee status • Age:

Our Study: Participants

• 30 languages represented in total, most common:– Spanish (25%)– French (6%)– Somali (6%)– Hmong (5%)

Our Study: Participants

• Most commonly-reported highest level of training was 40-hour training for medical interpreters (41%), followed by 18% completing certificate or degree

Our Study: Participants• Country of origin: • Fields interpreted in:

United States 41

Mexico 13

Laos 8

Somalia 7

29 other countries 50

Mental Health 94

Medical 109

Legal/Court 43

Human Services 85

Other Gov. 47

Our Study: Findings

* CS: t = 9.94, d = .77* ST: t = 4.48, d = 1.25p < .017

Our Study: Findings

Our Study: Findings

• “Average” interpreter: high compassion satisfaction and high secondary traumatic stress with similar rates of burnout to other helping professionals

• Some comments from participants who reported high CS and high STS:

Our Study: Summary • Compared to other helping professions, our

sample reported high STS, high CS, and normal levels of burnout

• Some reported feeling supported and valued, while other reported feeling disrespected, exhausted, and in need of support

So what to do about it?

What to do - Prevention• Psycho-education

– Signs and symptoms• Professional Development & skills training

– Feeling competent and understanding your role• Supervision and support

– Debriefing

Psycho-education

• Understand what STS is, the symptoms, and what you are most likely to see change in yourself

• Know you are not crazy

Secondary Traumatic Stress• Hypervigilance• Avoidance/ coping• Intrusive thoughts• Anger or irritability • Loss of empathy

• Fearful or jumpy • Exhaustion• Social withdrawal• Emotionally down

or feeling numb

Psycho-education

• Really, you are not crazy• Our brains try to protect us• Teach your family about the possible

impact of your work and about STS

Professional Development

• Competence is protective– Decreases stress– Increases likelihood of compassion

satisfaction• Know the bounds of your role

Professional Development

• Remember that you are integral to patient care and a valuable member of the human services community

• Create and validate this narrative

Supervision and Support

• Important to have people who can listen and support you

• Who are those people for you?• Confidentiality and debriefing

ExampleYou recently worked with a family and a caseworker about reported child abuse. You know of this family because they are part of your community but you don’t personally know them. Something about the child reminded you of something from your past. You get through the meeting but after it is over you feel exhausted, numb, and detached from the world.

Example

• Talk with a few people about what would be appropriate to share or not share with a supervisor. How about with a family member?

ExampleYou recently worked with a family and a caseworker about reported child abuse. You know of this family because they are part of your community but you don’t personally know them. Something about the child reminded you of something from your past. You get through the meeting but after it is over you feel exhausted, numb, and detached from the world.

Practicing prevention

• Role-play debriefing with a peer while maintaining confidentiality

Supervision and Support

• Helpful to have people who understand your situation– Validation that you aren’t crazy– Prevents isolation– Reminds you that your work is valuable

Workplace best practices

Nurses: Offer on-site counseling, support groups for staff, de-briefing sessions, art therapy, massage sessions, bereavement interventions, and attention to spiritual needs (Boyle, 2011)

Workplace best practices

Social workers: • Organizational culture and values• What does it mean to be a supportive organization?

Vacations, diverse case-load, opportunities for prof. development, emphasis on self-care

• Environment is safe, comfortable and private

Workplace best practices

Social workers continued: • Trauma specific-education• Group support, social support within the organization,

spectrum of less formal to more formal structured de-briefing, peer support groups

• Supervision and resources (Bell, Kulkarmi, & Dalton, 2013).

Workplace best practices

• Students:• Same as previously discussed• Addition of Empowerment• Feeling in control, working towards

political/social change, feeling like you are apart of proactive problem solving (Zurbriggen, 2011)

What does interpreter empowerment look like?

Quick poll: How many people in the audience have been in professional interpreting situations and have observed unethical professional behavior or behaviors that you just felt were “not right”? Please raise your hand.

What does interpreter empowerment look like?

• Quick poll: Now, in those experiences, how many of you felt that you knew who to report that unethical or uncomfortable behavior to? Or felt that reporting that behavior would actually lead to a positive outcome? Please raise your hand.

The empowered professional

• In the field of MFThttp://mn.gov/health-licensing-boards/marriage-and-family/public/complaints.jsp

Lawyers

Police officers: Must file a formal complaint to the local agency that employs the officer

For example: http://www.ci.minneapolis.mn.us/police/opcr-complaint

Personal best practices

• Self-care• Stress-management

Small group discussion

Question 1: Are there strategies that your organization could implement, or that you could implement within your organization that would decrease the likelihood of secondary traumatic stress and burnout for interpreters?

Small group discussion

• Question 2: What self-care or stress management practices do you engage in that help you cope with a difficult interpreting session?

How do I know if there’s a problem?

STS symptom list: • Feeling emotionally numb• Heart pounding when thinking about work with patients• Feeling like you’re reliving the trauma of your patients/clients• Trouble sleeping• Feeling discouraged about the future• Reminders of work upset you• Little interest in being around others• Feeling jumpy• Being less active than usual

How do I know if there’s a problem?

• Thinking about work with patients/clients when you didn’t intend to• Trouble concentrating• Avoiding people, places or things that remind you of work with patients• Disturbing dreams about work with patients• Wanting to avoid working with some patients• Easily annoyed• Expecting something bad to happen• Noticing gaps in memory about patient sessions (Bride et al., 2004)

Who should I go to?• Trusted mentor and peers • Medical doctor• Mental health professional • Spiritual advisor • Trusted supervisor• Family

What options are available to get help?

• Depends on your level and duration of symptoms• Low levels may be helped by decreasing/diversifying

work-load, sharing experiences with trusted person, increasing stress management/ self-care

• Prolonged moderate to high levels may need professional help – Working 1 on 1 with a therapist– Joining a psycho-education, support group

Can I still work if I’m experiencing symptoms?

• Typically a spectrum• Low level: Distress• Moderate level: Impairment• High level: Improper behavior

Definitions

• Distress “unresolved intense stress”, “distracting”, “difficult to manage”.

• Impairment: “functionality of the professional is compromised”.

• Improper behavior: dual relationships, etc. (APA Advisory Committee on Colleague Assistance,2015)

Improper behavior and STS

Question: When you think of colleagues you have known, can you identify a time when you observed someone who perhaps was experiencing Secondary Traumatic Stress who also started seeming professionally impaired and engaging in improper behavior?

Listen to your warning signs

• If you are distressed, experiencing some symptoms, you most likely can still work, but it is CRITICAL that you address your symptoms head on and implement a plan for action TODAY

When you could be dangerous…

• If you fail to address the problem when you are distressed, this most likely will lead to impairment and eventually improper behavior

• If you are impaired or exhibit improper behavior, you ethically should not be practicing your profession

Practicing prevention • A body-scan exercise• Close your eyes, get comfortable• Breath deeply and slowly from your belly • Start with your head, notice how your head feels, is there any tightness,

pain, tension, stress? Pay attention to those feelings and breath. • Move slowly through the rest of your body. Paying attention to what you

are feeling and where and breathing, relaxing. • The goal is to notice where you are carrying stress from your day and

begin to address it.

Future plans

• Focus groups• Maybe a psycho-education support

group? • Other ideas?

Final thoughts?

Thank you!

Please contact us:

Emily Becher, 612-624-3335, bech0079@umn.edu

Chris Mehus, 651-785-3660,

cjmehus@umn.edu

ReferencesAdvisory Committee on Colleague Assistance. (2015). The stress-distress-

impairement continuum for psychologists. APA. http://www.apapracticecentral.org/ce/self-care/colleague-assist.aspx

Bell, H., Kulkarmi, S., & Dalton, L. (2013). Organizational prevention of vicarious prevention. Families in Society: The Journal of Contemporary Social Services, 84(4), 463-470.

Boyle, D.A. (January 31st, 2011). Countering compassion fatigue: A requisite nursing agenda. The Online Journal of Issues in Nursing, 16(1).

• Killian, K.D. (2008). Helping till it hurts? A multimethod study of compassion fatigue, burnout, and self-care in clinicians working with trauma survivors. Traumatology: An International Journal, 14(2), 32-44.

• Zurbrigen, E. L. (2011). Preventing secondary traumatization in the undergraduate classroom: Lessons from theory and clinical practice. Psychological Trauma: Theory, Research, Practice, and Policy, 3(3), 223-228.

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