Month: October 2020

Vicarious trauma, secondary traumatic stress or compassion fatigue, and burnout are all forms of stress that may affect those working “helping” professions because that work involves direct exposure to other’s trauma.

In the past twenty years there has been a movement to bring awareness and solutions to profound negative psychological effects caused by being exposed to the trauma of others-ranging from a serious injury to the body from violence or an accident to an emotional wound creates lasting damage to a person’s psyche.

Research indicates that domestic and sexual violence advocates, therapists, nurses, physicians, social workers, law enforcement professionals, prosecutors and judges-astounding number of people in the “helping” professions are being affected by vicarious trauma, compassion fatigue, secondary trauma, and burnout daily.

What’s in the Terms?

Although there is significant overlap in concepts, there are some key differences, Francoise Mathieu, for instance, suggests that the terms compassion fatigue, vicarious trauma, and burnout are complementary, yet different from one another (2012). Here’s a summary:

1. Compassion fatigue refers to the deep emotional and physical wearing down that takes place when helping professionals are unable to refuel and renew (Figley, 1995).
2. Vicarious trauma describes profound negative changes in our worldview due to the exposure to traumatic content of clients (Saakvine & Pearlman,1996).
3. Secondary traumatic stress is the result of being a witness to a traumatic event or series of traumatic events, which can lead to PTSD-like symptoms (Figley, 1995). .
4. Burnout has to do with stress and frustration caused by the workplace (Saakvine & Pearlman,1996).

Continuous exposure to the trauma of others may lead trauma professionals to manifest the same or similar symptoms as the victims they work with. In other words, the symptoms of vicarious trauma (VT) are essentially the same as symptoms of primary trauma, and include re‐experience, avoidance, and hyper‐arousal.

Untreated, VT leads to burnout or compassion fatigue, which manifests in feeling exhausted and worn out; leads to a deep sense of ineffectiveness at one’s work; and can result in emotional distress, detachment, ineffective professional behavior, and depression.

Helpers who are worn out, traumatized, and fatigued, often tend to work harder, thus going farther down a dangerous path, which often leads to physical and mental health difficulties, such as depression, chronic pain, substance abuse, and even suicide.

Risk Factors

1. A personal history of trauma
2. Geographical and social isolation
3. Being overworked and overwhelmed
4. Working with too many clients
5. Having limited professional experience
6. Having limited training about vicarious trauma and its prevention
7. Working with a high percentage of traumatized children
8. Working with client who are underserved and disadvantaged
9. Working for poor pay, under stressful conditions, with limited resources

Statistics from the Field

Between 40% and 85% of “helping professionals” develop vicarious trauma, compassion fatigue and/or high rates of traumatic symptoms, according to compassion fatigue expert Francoise Mathieu (2012).

1. Social Workers, MSW:

• 70% exhibited at least one symptom of secondary traumatic stress (Bride, 2007).

2. Social Workers:

• 42% said they suffered from secondary traumatic stress (Adams et al., 2006).

3. Social Workers, Domestic Violence and Sexual Assault:

• 65 % had at least one symptom of secondary traumatic stress (Bride, 2007).

4. Therapists, Sexual Assault:

• 70% experienced vicarious trauma (Lobel, 1997).

5. Hospice Nurses:

• 79% moderate to high rates of compassion fatigue;
• 83% didn’t have a debriefing support after a patient’s death (Abendroth & Flannery, 2006).

6. Immigration Judges:

• Higher burnout levels than hospital physicians and prison wardens (Curtis, 2010).

7. Law Enforcement:

• 33% showed high levels of emotional exhaustion and reduced personal accomplishment; 56.1 percent scored high on the depersonalization scale (Hawkins, 2001).
• Only 15% of LE professionals were willing to seek personal counseling as a result of vicarious trauma vs. 59 % of mental health professionals (Bell, et al., 2003).

8. Forensic Investigators, Internet Crimes Against Children:

• 36 percent of investigators were experiencing moderate to high levels of secondary trauma (Perez et al., 2010).

9. Child Welfare Workers:

• 50% traumatic stress symptoms in severe range (Conrad& Kellar-Guenther, 2006).

10. Child Welfare Workers:

• 34% met the PTSD diagnostic criteria, due to secondary traumatic stress Bride (2007).

11. Child Protection Service Workers:

• 37 % reported clinical levels of emotional distress associated with secondary traumatic stress. (Cornille and Meyers,1999).

12. Child Protection Workers:

• 50% suffered from ‘high’ to ‘very high’ levels of compassion fatigue (Conrad & Kellar-Guenther, 2006).

13. Female Forensic Interviewers:

• 34 % reported experiencing symptoms of secondary traumatic stress (Perron & Hiltz, 2006).

Results

1. Physical: Exhaustion, insomnia, hipersomnia, headaches, susceptibility to illness.
2. Behavioral: Increased use of drugs and alcohol, compulsive overeating, other addictions, absenteeism, anger, avoidance of clients, blurred boundaries at work, isolation.
3. Psychological: Distancing, negative self-image, depression, inability to empathize, cynicism, bitterness, low job satisfaction and performance, heightened anxiety, irrational fear, problems with intimacy, hypervigilance, intrusive imagery, loss of hope, inability to have life outside of work.

Bottom Line

We lose dedicated, passionate, qualified, and educated employees to vicarious and secondary trauma every day, because we do not provide them with tools to address and prevent this very serious condition. Organizational leadership, including Boards, has significant capacity, and ethical responsibility, to create supportive work environments of vicarious and secondary trauma awareness and prevention. Individual prevention efforts work, but sound organizational interventions, prevention and sustainability processes ensure wellness of organization as a whole, thus strong and effective services to our communities.

References:

1. Abendroth and Flannery.(2006) Predicting the risk of compassion fatigue: A study of hospice nurses. Journal of Hospice and Palliative Nursing, 8(6), 346-356.

2. Adams, R. E., Boscarino, J. A., & Figley, C. R. (2006). Compassion fatigue and psychological distress among social workers: A validation study. American Journal of Orthopsychiatry, 76(1), 103-108.

3. Bell, H., Kulkarni, S. & Dalton, L. (2003). Organizational prevention of vicarious trauma. Families in Society, 84(4), 463-470.

4. Bride, B. E. (2007). Prevalence of secondary traumatic stress among social workers. Social Work, 52(1), 63–70.

5. Conrad, D., & Kellar-Guenther, Y. (2006). Compassion fatigue, burnout, and compassion satisfaction among Colorado child protection workers. Child Abuse and Neglect, 30(10), 1071-1080.

6. Cornille, T. A., & Meyers, T. W. (1999). Secondary traumatic stress among child protective service workers: Prevalence, severity and predictive factors. Traumatology, 5(1), 15-31.

7. Curtis, L. (2010). Case backload postponing deportations proceedings increases 26 percent, but immigration judges swamped. Las Vegan Review Journal, May 30.

8. Figley, C. (1995). Compassion Fatigue: Coping With Secondary Traumatic Stress Disorder In Those Who Treat The Traumatized (Routledge Psychosocial Stress Series, 1995).

9. Figley, C. (1995). Compassion fatigue as secondary traumatic stress disorder: An overview. In C. R. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. (New York: Brunner/Mazel).

10. Hawkins, H.C. (2001). Police officer burnout: A partial replication of Maslach’s burnout inventory. Police Quarterly, 4(3), 343-360.

11. Lipsky, L.(2009). Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others. (Berrett-Koehler Publishers).

12.Lobel,The vicarious effects of treating female rape survivors: The therapist’s perspective. (DoctoralDissertation, University of Pennsylvania, 1997). Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 57(11‐B), May 1997. pp. 7230.

13. Mathieu, F. (2012). The Compassion Fatigue Workbook. (Routledge, NY).

14. Perez, L. M., Jones, J., Englert, D. R., & Sachau, D. (2010). Secondary traumatic stress and burnout among law enforcement investigators exposed to disturbing media images. Journal of Police and Criminal Psychology, 25(2), 113-124.

15. Perron, B., & Hiltz, B. (2006). Burnout and secondary trauma among forensic interviewers of abused children. Child and Adolescent Social Work Journal, 23(2), 216-234

16. Saakvine K., and Pearlman, L. (1996). Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others (W.W.Norton).

Thousands of trauma professionals around the country are making New Year resolution to Self-Care more effectively, in order to lead productive, rich, and full lives, while thriving in trauma field. Self-Care Wheel has been voted #1 Self-Care Tool of 2014 by trauma professionals like yourself!

Self-Care Wheel is an empowering, affirming, and positive tool for helping professionals to manage stress, increase contentment and life satisfaction. With over 80 self-care exercises and healing modalities, Self-Care Wheel is a great beginning for your personalized, preventative, and sustainable Self-Care plan.

Please visit www.olgaphoenix.com for a pdf copy of the Self-Care Wheel or to learn more follow this link to my book “Victim Advocate’s Guide to Wellness: Six Dimensions of Vicarious Trauma-Free Life”, which lays out a powerful, foolproof blueprint for your Self-Care plan! Let’s make radical Self-Care our priority in 2015!

“While we believe that the effects of vicarious traumatization are inevitable and permanent, we also believe they are modifiable. Thus, while this will change you, there is a lot you can do about it”(Saakvine and Pearlman, 1996, p.71).

Karen Saakvine and Laurie Anne Pearlman, leaders in the field of vicarious trauma (VT) prevention, and women who coined the term “vicarious trauma” suggest that VT prevention is two-fold: first, we must address the stress of VT through self-care, nurturing activities, and escape; secondly, we can transform the despair, demoralization, and loss of hope of VT by creating meaning, challenging negative beliefs and assumptions, and participating in community-building activities.

This 2-part solution to vicarious trauma is very important. In the past several years self-care in victim advocacy has been brought to the forefront of the movement, and this is great. However, the second part of the solution, the negative psychological effects transforming activities, such as rich life outside of work, identifying, working on, and fulfilling long-term goals, discovering and pursuing your passions, building a strong support systems outside of work, are not emphasized at all, and often are completely forgotten.

Realistically, one cannot transform despair, loss of hope, and nihilism brought on by vicarious trauma by taking a bubble bath or getting a massage. This is just not going to happen. Therefore, when we only talk about self-care as a vicarious trauma prevention tool, we are only talking about half of the solution. And of course, when it comes to vicarious trauma, half measures are very much inadequate.

References

Saakvitne, K. & Pearlman, L. (1996). Transforming the Pain: A Workbook on Vicarious Traumatization. Norton Publishing, NY.

Clinical and research literature describes a multitude of personal and organizational risk factors associated with vicarious trauma in the trauma field. We cannot change some of them, for instance, a personal history of trauma, but we can definitely modify others, such as learning more positive coping mechanisms or providing vicarious trauma prevention trainings in our agencies.

Personal Risk Factors:

• A personal history of trauma
• Preexisting mood disorders
• Unhealthy coping mechanisms
• Being younger in age
• Lack of life outside of work
• Lack of hobbies and support groups
• Having limited professional experience

Organizational Risk Factors:

• Limited supervision
• Working with too many clients
• Geographical and social isolation
• Having limited training about vicarious trauma and its prevention
• Working with a high percentage of traumatized children
• Working with clients who are underserved and disadvantaged
• Working for poor pay, under stressful conditions, with limited resources
• Lack of acknowledgement by agency that vicarious trauma exists
• Lack of acknowledgement by agency that vicarious trauma is a normal reaction to clients’ trauma

Of course, having some or all of these risk factors does not necessarily mean that you or your organization are in deep trouble. For example, not everyone in the family where there diabetes is prevalent will definitely get it. However, doctors will always point out that risks factors are there, and encourage the person at risk to practice caution and mindfulness, eat more healthy, and exercise. The same approach applies with vicarious trauma risk factors as well. And when it all seem overwhelming, remember that a 1000 mile journey always begins with 1st step! Go Forth, Do Incredible Things, and Self-Care!

This posted is adapted from “Victim Advocate’s Guide to Wellness: Six Dimensions of Vicarious Trauma-Free Life.” by Olga Phoenix, MPA, MA.

Leadership, including Boards of Directors, has primary ethical responsibility for creating environments which promote and support organizational and individual vicarious trauma prevention. While personal efforts are important, individual health can still be compromised in contexts where people are denied the opportunity to make use of these skills and knowledge. The most effective way to address and prevent vicarious trauma is through sound organizational processes. Here are some ways healthy trauma organizations promote thriving environments for their staff:

1. Provide sufficient training for every member of their team on vicarious trauma, it’s symptoms, effects, and tools to address and prevent it.

2. Assure their staff that vicarious trauma symptoms are a completely normal reaction to trauma work and encourage them to seek help.

3. Establish organizational systems of care for staff who disclose or present with vicarious trauma symptoms.

4. Provide adequate training in trauma-specific and trauma-informed outreach, intake, and service delivery strategies, to increase staff’ sense of effectiveness in helping clients and reduces the sense of demoralization brought on by trauma work.

5. Establish a diverse caseload of clients in order to limit the traumatic exposure of any one worker.

6. Create work environments which facilitate staff bonding and emotional support of each other, as this limits emotional fatigue and depersonalization, and creates a greater sense of personal accomplishment (e.g.: a vicarious trauma prevention support group).

7. Institute regular relationally based clinical supervision to normalize staff’ feelings and experiences and provide support and tools to address and prevent vicarious trauma.

8. Provide safe and comfortable space for staff to engage in their personal vicarious trauma prevention activities during the work day (e.g.: therapy, 12 step meetings, meditation, long lunch with support group).

9. Nurture a culture of shared power in making organizational decisions, empower a sense of autonomy in staff-as trust, empowerment, and self-efficacy are the antidotes to a sense of powerlessness associated with vicarious trauma.

10 As an organization, continuously planning and taking steps towards improving their organizational health and practices.

Would any of these work for your trauma organization? What are your organizational secrets you can share with us?

For more please see “Victim Advocate’s Guide to Wellness: Six Dimensions of Vicarious Trauma-Free Life” by Olga Phoenix, MPA, MA.