Vicarious TraumaVicarious Trauma
Care for the CaregiverCare for the Caregiver
Dan L. Petersen, Ph.D.Dan L. Petersen, Ph.D.
““You cannot describe it unless you have You cannot describe it unless you have seen it, seen it,
you cannot explain it unless you have you cannot explain it unless you have done it,done it,
you cannot imagine it unless you have you cannot imagine it unless you have been there,been there,
then it never goes away”then it never goes away”
Bill Bessington, Retired Reporter, Chugiak, Bill Bessington, Retired Reporter, Chugiak, AlaskaAlaska
StressStress
Distress and EustressDistress and Eustress
Biological and Psychological stressBiological and Psychological stress
TraumaTrauma
BurnoutBurnout
Burnout is not vicarious traumaBurnout is not vicarious trauma
Burnout refers to a response to the work Burnout refers to a response to the work environment which may be too environment which may be too demanding, stressful, or unrewarding.demanding, stressful, or unrewarding.
Behaviors characteristic of burnout include Behaviors characteristic of burnout include lack of motivation, poor work lack of motivation, poor work performance, time problems, and general performance, time problems, and general dissatisfaction with the job.dissatisfaction with the job.
Vicarious traumaVicarious trauma
Terms: secondary trauma, Terms: secondary trauma, compassion fatigue (Figley), PTSD, compassion fatigue (Figley), PTSD, secondary traumatic stress, indirect secondary traumatic stress, indirect victimization and traumatic victimization and traumatic countertransference.countertransference.
Vicarious traumaVicarious trauma
““The transformation that occurs within The transformation that occurs within the trauma worker as a result of the trauma worker as a result of empathetic engagement with the client’s empathetic engagement with the client’s trauma experiences. Such engagement trauma experiences. Such engagement includes listening to graphic descriptions includes listening to graphic descriptions of horrific events, bearing witness to of horrific events, bearing witness to peoples’ cruelty to one another, and peoples’ cruelty to one another, and witnessing and participating in traumatic witnessing and participating in traumatic reenactments”reenactments”
Pearlman & Saakvitne, 1995Pearlman & Saakvitne, 1995
Studies have shown that approximately Studies have shown that approximately 24 to 38% of professionals who work 24 to 38% of professionals who work with clients who have experienced with clients who have experienced trauma experience moderate to high trauma experience moderate to high levels of traumatic stress.levels of traumatic stress.
(Dalton, 2001; Cornille & Meyers, 1999; Johnson (Dalton, 2001; Cornille & Meyers, 1999; Johnson & Hunter, 1997; Reghr & Cadell, 1999; & Hunter, 1997; Reghr & Cadell, 1999; Chrestman, 1995; Pearlman & Mac Ian, 1995)Chrestman, 1995; Pearlman & Mac Ian, 1995)
McCann and Pearlman’s SchemaMcCann and Pearlman’s Schema
Personal frame of referencePersonal frame of reference SafetySafety Dependency and trustDependency and trust PowerPower EsteemEsteem IndependenceIndependence IntimacyIntimacy
Cognitive AlterationsCognitive Alterations
Feelings and statements of Feelings and statements of despair/hopelessnessdespair/hopelessness
CynicismCynicism AngerAnger Withdrawal and numbnessWithdrawal and numbness Irrational cognitions Irrational cognitions
Common cognitive coping Common cognitive coping mechanisms that often are mechanisms that often are
problematicproblematic
Comparing one’s self with those less Comparing one’s self with those less fortunatefortunate
Selectively focusing on the positive Selectively focusing on the positive attributes of one’s self to feel advantagedattributes of one’s self to feel advantaged
Imagining a potentially worse situationImagining a potentially worse situation Construing benefits from the crash victim’s Construing benefits from the crash victim’s
experienceexperience Manufacturing normative standards that Manufacturing normative standards that
make one’s adjustment seem normalmake one’s adjustment seem normal Taylor, Wood and Lechtman, 1999Taylor, Wood and Lechtman, 1999
Victim advocates mayVictim advocates may
WithdrawWithdraw Have boundary violationsHave boundary violations Become controlling and intrusiveBecome controlling and intrusive Deny the victim’s realityDeny the victim’s reality Minimize the victim’s experiencesMinimize the victim’s experiences Refocusing (“how did you survive” as Refocusing (“how did you survive” as
opposed to “what happened to you” opposed to “what happened to you” or “what did you go through”or “what did you go through”
Risk FactorsRisk Factors
Helper’s personal historyHelper’s personal history Type of client/victimType of client/victim Level of trauma experienced by the Level of trauma experienced by the
victimvictim Helper’s attempts to copeHelper’s attempts to cope EnvironmentEnvironment
Supportive or non-supportiveSupportive or non-supportive High traffic with high pressureHigh traffic with high pressure
Symptoms of vicarious traumaSymptoms of vicarious trauma No time, no energyNo time, no energy Disconnection (depersonalization)Disconnection (depersonalization) Social withdrawalSocial withdrawal Sensitivity to violenceSensitivity to violence CynicismCynicism Despair and hopelessnessDespair and hopelessness Sleep problemsSleep problems Disrupted frame of referenceDisrupted frame of reference Diminished self-efficacy (e.g., inability to trust Diminished self-efficacy (e.g., inability to trust
your own decisions)your own decisions) Alterations in sensory experiencesAlterations in sensory experiences
ScenarioScenario Jane has been working at the center for about four months. Jane Jane has been working at the center for about four months. Jane
applied for the position because as she indicated in her interview applied for the position because as she indicated in her interview for the job:for the job:
“ “I want to give back. I want to help others as I was helped. I know I want to give back. I want to help others as I was helped. I know what it is like to be a victim of a crime and I know in my heart that what it is like to be a victim of a crime and I know in my heart that I can help others.”I can help others.”Jane’s supervisor upon entering the break room sees Jane with her Jane’s supervisor upon entering the break room sees Jane with her head down on the table crying. The supervisor asks Jane if she is head down on the table crying. The supervisor asks Jane if she is alright and Jane responds that she will be okay and that it is just alright and Jane responds that she will be okay and that it is just that she feels so bad sometimes after working with a client. Then that she feels so bad sometimes after working with a client. Then she looks up at the supervisor and earnestly asks, “It will get she looks up at the supervisor and earnestly asks, “It will get better, won’t it?” Then she says that she use to talk to her friends better, won’t it?” Then she says that she use to talk to her friends about her feelings after the crime and that it helped a lot but about her feelings after the crime and that it helped a lot but lately talking about it seems to maker her feel worse rather than lately talking about it seems to maker her feel worse rather than better. The supervisor consoles Jane by gently touching her on better. The supervisor consoles Jane by gently touching her on the shoulder. “I know we are all busy and I have a client waiting the shoulder. “I know we are all busy and I have a client waiting right now, but if you want to talk about it stop by some day when right now, but if you want to talk about it stop by some day when we are both free. Come on, let’s get back to work.”we are both free. Come on, let’s get back to work.”
Protective FactorsProtective Factors
Social supportSocial support Supervision/consultationSupervision/consultation CompetenceCompetence Self-awarenessSelf-awareness Ethics or moral senseEthics or moral sense Number of personal issues resolved with a Number of personal issues resolved with a
success strategysuccess strategy Defined boundariesDefined boundaries
Personal limitationPersonal limitation Ability to be a resource for othersAbility to be a resource for others
Framework for healthFramework for health
Physical healthPhysical health Body/exerciseBody/exercise DiseaseDisease Nutrition/food intakeNutrition/food intake
PsychologicalPsychological ProfessionalProfessional OrganizationalOrganizational Community/familyCommunity/family
Actions to prevent or assist in Actions to prevent or assist in reducing vicarious traumareducing vicarious trauma
JournalingJournaling Develop personal rituals/routinesDevelop personal rituals/routines MindfulnessMindfulness Find balance (work, play, family, others)Find balance (work, play, family, others) Extend identity beyond workExtend identity beyond work Diversify caseloadDiversify caseload Seek consultation on difficult casesSeek consultation on difficult cases Take breaks during the dayTake breaks during the day Gain competenceGain competence Modify work schedule as needed with case Modify work schedule as needed with case
severity/loadseverity/load
Be curiousBe curious Self-reflect, notice your inner experiencesSelf-reflect, notice your inner experiences Read literature unrelated to workRead literature unrelated to work Practice receiving from othersPractice receiving from others Wear clothes you likeWear clothes you like Eat healthilyEat healthily Take time off when sickTake time off when sick ExerciseExercise Get regular careGet regular care Get enough sleepGet enough sleep Take day trips or mini vacationsTake day trips or mini vacations Spend time with others whose company you enjoySpend time with others whose company you enjoy Learn to say “no” to extra responsibilities sometimesLearn to say “no” to extra responsibilities sometimes Find things that make you laughFind things that make you laugh
Spiritual self-careSpiritual self-care Make time for reflectionMake time for reflection Spend time in natureSpend time in nature Find spiritual connection or communityFind spiritual connection or community Be open to inspirationBe open to inspiration Cherish your optimism and hopeCherish your optimism and hope Be aware of the non material aspects of lifeBe aware of the non material aspects of life Try at times not to be in charge or the expertTry at times not to be in charge or the expert MeditateMeditate PrayPray SingSing Contribute to causes in which you believeContribute to causes in which you believe Read inspirational literatureRead inspirational literature
Saakvitne & Pearlman; 1996 excerptedSaakvitne & Pearlman; 1996 excerpted
Autogenic RelaxationAutogenic Relaxation
History History
Johannes Schulz published “Autogenic Johannes Schulz published “Autogenic Therapy in 1932Therapy in 1932
Based on passive concentration and Based on passive concentration and body awarenessbody awareness
Detached but alert state of mindDetached but alert state of mind Requires no equipment and takes only Requires no equipment and takes only
about 10 to 15 minutes per sessionabout 10 to 15 minutes per session Can be practiced anywhereCan be practiced anywhere Is similar to many meditative Is similar to many meditative
techniquestechniques
Schulz’s six autogenic “states”Schulz’s six autogenic “states”
Heaviness in the arms and legsHeaviness in the arms and legs Warmth in the arms and legsWarmth in the arms and legs Warmth and heaviness in the heart Warmth and heaviness in the heart
areaarea Focus on breathingFocus on breathing Focus on warmth in the abdomenFocus on warmth in the abdomen Focus on coolness in the foreheadFocus on coolness in the forehead
BreathingBreathing
Slow breathingSlow breathing““Breathe in, 1 2 3; Breathe out, 1 2 3”Breathe in, 1 2 3; Breathe out, 1 2 3”
Deep breathingDeep breathingStomach expands as diaphragm moves Stomach expands as diaphragm moves to to
pull in pull in more airmore air
Let your body breathe (the air is breathing me)Let your body breathe (the air is breathing me)
Breathe in through the nose and out through the Breathe in through the nose and out through the mouthmouth
I feel quietI feel quiet My feet feel heavy, heavy and relaxedMy feet feel heavy, heavy and relaxed My calves, my knees, thighs and hips feel My calves, my knees, thighs and hips feel
heavy, relaxed and comfortableheavy, relaxed and comfortable My stomach feels relaxed and quietMy stomach feels relaxed and quiet My hands are heavyMy hands are heavy My arms and shoulders are relaxed.My arms and shoulders are relaxed. My arms are heavy and warm.My arms are heavy and warm. I feel quietI feel quiet