Secondary Trauma When Helping Hurts

1. Dr. Samuel Pfeifer Secondary Trauma When Helping Hurts

2. Receiving yourself in the fires of sorrow “You can always recognize who has been through the fires of sorrow and received himself, and you know that you can go to him in your moment of trouble and find that he has plenty of time for you. But if a person has not been through the fires of sorrow, he is apt to be contemptuous, having no respect or time for you, only turning you away. If you will receive yourself in the fires of sorrow, God will make you nourishment for other people.” Oswald Chambers, (My Utmost for His Highest 25. June) - http://www.rbc.org/utmost/

3. “Moved with compassion” • “But when he saw the multitudes, he was moved with compassion 4697 on them, because they fainted, and were scattered abroad, as sheep having no shepherd.” (Mat.9,36) G4697 σπλαγχνίζομαι splagchnizomai splangkh-nid'-zom-ahee Middle voice from G4698; to have the bowels yearn, that is, (figuratively) feelsympathy, to pity: - have (be moved with) compassion.

4. Trauma is contagious Trauma is contagious. The therapist, in his role as a witness … is often overwhelmed by his emotions. He goes – somewhat less than the patient – through his feelings of dread, anger and despair. Judith Hermann, Trauma Therapist

5. Contagion effect • Figley (1995) identified the mirroring or contagion effect of symptoms from client to therapist and argued that "those who have enormous capacity for feeling and expressing empathy tend to be more at risk of compassion stress"

6. Primary Trauma Aftereffects • Physical and psychological Hyperarousal (e.g. difficulty staying/falling asleep, hypervigilance, irritability), • Intrusion (painful memories, flashbacks, memoriesimages, feelings, anxieties, day dreams, nightmares etc.) • Avoidance (detachment from others, avoiding activities or positive experiences, diminished ability to enjoy life). – „How can I enjoy life, when others are hurting?“

7. Secondary Trauma • Listening to the stories of traumatized people and feeling with hte victims of traumatic experiences leads to similar reactions as if the trauma had happened to you.

8. Possible effects • The reports elicits memories of your own. • The report triggers mental images (in day dreams or nightmares) • You realize your own vulnerability • Your own confidence in life and security is shaken. • Feelings of anger and despair. Accusations against police, the government, other „responsible“ authorities. • Reproaches against God? „How can he allow this happening?“ • "Traumatic events shake the foundations of our beliefs, and may shatter our trust..."

9. Possible effects • You feel overwhelmed and helpless in addressing the other person‘s distress. • Some develop explanations or apply methods (psychological or spiritual) which are irrational, perhaps even magical (accusing Christian parents of Satanism, spiritual forces – Shamanism). • Some try to overcome their helplessness with inadequate hyperactivity (often with a lack of respect for a patient‘s borders and his or her well-being) – e.g. reporting sexual abuse to the police – or even taking revenge in self-justice.

10. Possible effects • Distrust and reproach to other helpers: • „they don‘t understand the needs of my client.“ • „they are hushing up the problems.“ • „they don‘t take actions!“ • General devaluation of other helping persons • Avoiding trauma patients or avoiding to confront the diagnosis, in order not to be traumatized. • Refusing supervision, holding back their own reactions, because of shame.

11. Dangers for Therapy / Counselling • Avoidance behavior of the counsellor: he / she doesn‘t want to address the trauma although the patient / clients would like to talk about it. • „Therapeutic Intrusion“: The counsellor insists on details of the traumatic event, although the person does not want to reveal or repeat such details. • General avoidance or withdrawal: As the counsellor is suffering from sleep disorders, nightmares or physical hyperarousal, he or she is not available for the patient at all.

12. False ambitions • False ambition, „to heal all, to know everything, to love all.“ • Healing everything: Therapy until final and complete recovery. • Knowing everything: Exact and detailed reconstruction (despite negative emotional consequences), hope for catharsis through knowledge and revelation. • Loving everything: Trying to give the victim vicarious love (making up for all the love she missed in life). Danger of transgressing borders in therapy and counselling.

13. Security Recollection and mourning Social Integration Providing Boundaries Supervision, Intervision Normal Relationships Coping strategies

14. Prophetic word in Burnout A pastor, who went though a severe burnout, received the following prophtic words through a counsellor-friend: „You will be restored. You will be healed. And my anointment will flow again through your life and through your ministry. My minstry through your life. You will witness that in communion with me this anointment will flow again. And you will be amazed how the Lord will use you – and there will be no pressure on you.“

15. The values of debriefing • When the disciples returned from their first missionary endeavors, Jesus gave them time to tell their stories and to share their questions. Broadly speaking this is what debriefing is about. • The following thoughts have been inspired by a paper which was written by Dr. Debbie Lovell-Hawker.

16. Definitions • Operational debriefing: Asking for information about the work performed, and what was achieved. • Personal debriefing: Asking how the experience was for the individual (what was best/ worst? How is the readjustment process going?). Aims to help them integrate their experience into their life as a whole, perceive the experience more meaningfully, and bring a sense of closure. • Critical incident debriefing (CID): A highly structured form of personal debriefing, which can take place after a traumatic experience (such as a natural disaster, a violent incident, or a traffic accident).

17. A Biblical Framework of Debriefing • a) We are called to care for each other (e.g. Isaiah 61: 1-2; John 13: 35; John 21: 16; 2 Cor 1: 3-4; Gal. 6:2). • Debriefing is a way of showing we care. We do not tend to question whether there is a Biblical framework for practising medicine - we know that it relieves suffering, so we encourage it. Providing emotional help also brings people to greater health and healing. Research indicates that some people who do not receive a debriefing feel devalued. Those who receive a debriefing tend to find it a positive experience and have fewer trauma-related symptoms.

18. Listening • Listening is central to debriefing, and the Bible teaches us to listen (Proverbs 18:13; James 1:19). • In modern society, it can be difficult to find someone willing to make time to really listen. In particular, eyes glaze over when someone starts to talk about their experience overseas. Mission partners often feel isolated. Listening breaks down this isolation, and helps them move forward.

19. Teaching about emotions • Emotions are normal and valid. The Bible also teaches this. The Bible contains plenty of anger, fear, and tears (e.g. in the Psalms). ‘Don’t be afraid’ may imply ‘there’s no need for you to be afraid’ rather than ‘it’s wrong to fear’. Jesus did not condemn a man who admitted unbelief, but rather allowed him to express this (Mark 9: 24). • The Bible reminds us that there is ‘a time to weep and a time to laugh, a time to mourn and a time to dance ... a time to be silent and a time to speak, a time to love and a time to hate’ (Ecc 3:4-8). • Jesus taught by example that it was OK to cry (Luke 19: 41; John 11:35; Heb. 5: 7). He expressed anguish in the Garden of Gethsemane, and said that his soul was ‘overwhelmed with sorrow’ (Matt. 26:38). • In past times and different cultures, people have known that it is normal to feel certain emotions after trauma, and they did not need to be taught this. Today, some people need to be told this explicitly.

20. Biblical examples: Telling one‘s story • The Disciples walking along the Emmaus road had gone through the trauma of witnessing the crucifixion of Jesus. They were talking about what had happened (Luke 24:13-24). Jesus joined them, and asked what had happened. That wasn’t for His benefit – he knew. It gave them the opportunity to tell their story – the facts of what had happened, and their feelings of disappointment. He then helped them put things into context.

21. Biblical Examples II • A woman who had been bleeding for 12 years (possibly following trauma) touched Jesus (Luke 8: 43-48). He asked, ‘who touched me’. Why did He ask? Not to embarrass her, but to allow her to tell her story, so that she would gain emotional healing as well as physical healing. (Otherwise no-one else would have known that she had been healed, and she would still have been thought of as an outcast). • Joseph: In Genesis 44 - 45, we see Joseph listening to his brothers’ story, then telling them about his experiences, to produce a clearer picture and make the events more meaningful. Joseph recognised their feelings of distres s and anger. They all expressed their feelings freely, weeping together and embracing one another, before making plans for the future.

22. Listening to stories • Nehemiah heard a traumatic report about his people being exiled, and living in ‘great trouble and disgrace’ in a ruined city (Neh. 1:3). Nehemiah didn’t disguise his feelings. The king noticed that he looked sad. Nehemiah normalised this - ‘why should my face not look sad when the city ... lies in ruins?’ (2:3). The king listened as Nehemiah spoke about his plans, and he helped Nehemiah do what was necessary to move forward from this point of despair. • Jesus invited people to tell him their stories (e.g. the sick; the disciples when they returned after being sent out two by two). He listened to them, and helped to bring closure to experiences, and helped people move on.

23. Reviewing the past – moving on • The Bible affirms that there is a place both for reviewing the past together (Isaiah 43:26), and for moving on to new things (Isaiah 43:19). Both occur during debriefing. • A good example is God’s counselling of Elijah, when he suffered a burnout and had to flee for his life into the wilderness. (1. Kings 19) • Elijah experienced a death threat (1 Kings 19:2), and fled for his life. He was afraid, and prayed that he might die. An angel provided physical care for him (food, drink and sleep). Forty days later, after his physical needs had been met, God asked what was going on. Elijah told God his story- twice (v. 10, v. 14). Then God moved Elijah to think about the future, and told him that he would not be alone - there was support available in the form of 7000 other believers (v.18). Moreover, God directed Elijah to Elisha (v.16ff), who would give him more support. • Physical regeneration (sleep and food) • Spiritual review • A new (and unusual experience of God • A new direction and a new task

24. Literature • B. Hudnall Stamm (ed.) Secondary Traumatic Stress: Self-Care Issues for Clinicians, Researchers, and Educators. Sidran Press. • Judith Herman: Trauma and Recovery: The Aftermath of Violence. Basic Books. • Fawcett, G. (1999). Ad-Mission: The briefing and debriefing of teams of missionaries and aid workers. Harpenden: Self-published. Available directly from the author - e-mail: gfawcett@oval.com or phone 01582 463252. • Gamble, K., Lovell, D.M., Lankester, T. & Keystone, J. (2001). Aid workers, expatriates and travel. In J. Zukerman & A. J. Zukerman (Eds), Principals and Practice of Travel Medicine. Chichester, England: John Wiley & Sons. • Jordan, P. (1992). Re-entry: Making the transition from missions to life at home. Seattle: YWAM. • Lovell-Hawker, D.M. (2002). Debriefing after traumatic incidents, and at the end of assignments. In K. O’Donnell (Ed.) Doing Member Care Well: Perspectives and Practices from around the world. Pasadena, CA: William Carey. • Mitchell, J. & Gray, B. (1990). Emergency Services Stress. New Jersey: Brady. Parkinson, F. (1997). Critical Incident Debriefing. London, UK: Souvenir Press. • Pollock, D.C. & Van Reken, R. E. (1999). The Third Culture Kid Experience. Maine USA: Intercultural Press. • Rose, S. & Bisson, J. (1998). Brief early psychological interventions following trauma: A systematic review of the literature. Journal of Traumatic Stress, 11, 4, 697-710.

25. Helpful Links • http://www.asbury.edu/academ/psych/mis_care/trauma.htm • http://trauma-pages.com/

26. Group activity • Share your own experience of “secondary trauma” • What are stories that touch your heart. • How do you prevent the pain of others to invade your emotions? • Discuss the balance of compassion and self-protection. Group Activity / Questions