understanding vicarious trauma katherine manners, m.ed., lmft lisa tieszen, ma, licsw advocate...
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Understanding Vicarious Trauma
Katherine Manners, M.Ed., LMFTLisa Tieszen, MA, LICSW
Advocate Education and Support ProjectBeth Israel/Deaconess Medical Center
[email protected]@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
[email protected]@bidmc.harvard.edu