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When Caring Hurts: Secondary Traumatization & Self-Care

When Caring Hurts: Secondary Traumatization & Self-Care. Kristen DeLange MS, LPC, NCC, CAADC. Introduction. Outline of the day Learning Objectives Discuss and identify the history and causation of secondary traumatization, burn-out, and compassion fatigue and their treatment

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When Caring Hurts: Secondary Traumatization & Self-Care

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  1. When Caring Hurts:Secondary Traumatization & Self-Care Kristen DeLange MS, LPC, NCC, CAADC

  2. Introduction • Outline of the day • Learning Objectives • Discuss and identify the history and causation of secondary traumatization, burn-out, and compassion fatigue and their treatment • Learn and practice tools for self-regulation and relaxation • Cultivate skills necessary to prevent compassion fatigue through increased resiliency • Discuss and identify how to increase support system

  3. Part I: Secondary Traumatization & Self-Care Why Self-Care and Secondary Traumatization? “That which is to give off light must endure burning.” -Viktor Frankl

  4. Trauma and PTSD • What is a traumatic event? -DSM IV TR (2000) • Posttramatic Stress Disorder

  5. Sympathetic vs. Parasympathetic Dominance Sympathetic • Learned (trauma) • Fight/flight/freeze • Tense • Hypervigilience • Reduced brain operation • Reactive • Intimacy distance • Stress hormones Parasympathetic • Lack of TI • Agile • Relaxed • Challenge • Optimum Functioning • Intentional • Regulated • Tolerance of intimacy

  6. How Our Work Affects Us What are 3 negative reactions/effects from your work you have experienced? -Saakvitne & Pearlman (1996)

  7. Key Terms and Concepts • Secondary Traumatization • Burnout • Compassion Fatigue • Jung (1907)

  8. Vicarious Traumatization & Secondary Traumatic Stress • “Harmful changes in professionals’ views of themselves, others, and the world as a result of exposure to the graphic and/or traumatic material of their clients.” • Secondary Traumatic Stress-”a set of psychological symptoms that mimic posttraumatic stress disorder but is acquired through exposure to persons suffering the affects of trauma.” -Baird et al (2006)

  9. Secondary Traumatic Stress Symptoms • Anxious • Reactive • Heightened threat perception • Sleep problems • Lack of concentration • Physical problems • Intrusive thoughts • Work interfering with personal • Feeling inadequate • Avoidance • Loss of energy, gratification, and hope • Separation • Self-medication -Gentry (2002)

  10. Causes of ST • Past traumatic experience(s) • Images • Empathy • Current safety concerns of the ones we help • Children • Nature of the work/setting • Personal • New staff -Saakvitne & Pearlman (1996)

  11. Secondary Trauma VS. PTSD Similarities • Arousal • Intrusion • Avoidance Differences • Listening vs. Experiencing • Work affecting personal • Level of distress/impairment

  12. Burnout • Process, steadily worsens • Gradual exposure to work stress and tension, attrition of optimism and ideals, with a lack of success/accomplishment • Results in exhaustion, isolation, and decreased effectiveness -Cherniss (1980); Maslach (1976, 1982); Soy (2002)

  13. Compassion Fatigue • Compassion Fatigue = Secondary Traumatization + Burnout -Figley (1995)

  14. How Can We Heal From This? • Healing compassion fatigue-relaxation, building and maintaining relationships (personal and colleagues), sharing narratives (anonymity) •  Healing of burnout-relaxation/self-regulation + changing perceptions and increased work support • VT-Awareness, Balance, Connection -Gentry (2002); Saakvitne & Pearlman (1996)

  15. Healing Exercises • Breathing • Mindfulness: 3-2-1 • Assignments: • Mindful eating • Journal • Favorite verse(s) regarding God’s character -Gentry (2009)

  16. Part II: Self-Care • Review • Mindfulness “Mindfulness can be thought of as moment-to-moment, non-judgmental awareness, cultivated by paying attention in a specific way, that is, in the present moment, and as non-reactively as possible…mindfulness is perhaps the most basic, the most powerful, the most universal, among the easiest to grasp and engage in, and arguably, the most sorely needed now. For mindfulness is non other than the capacity we all already have to know what is actually happening as it is happening.” -Kabat-Zinn(2005), pp. 108-109

  17. Mindfulness Cont. • observe, describe, participate, non-judgmental stance, focus on one thing in the moment, be effective • Exercise -Linehan (1993)

  18. Mindfulness Cont. Research has shown that mindfulness helps to decrease worry and anxiety, heart problems, substance abuse, depression, stress, smoking urges, insomnia, and chronic pain Orsillo & Roemer (2011)

  19. Intentionality & Acceptance • “Pain is inevitable, suffering is optional”-Frankl • Radical Acceptance-Linehan(1993) 4 Ways to Respond to a Crisis: • Solve it • Change how you think/feel about it • Accept it • Stay miserable Acceptance does not equal agreement or resignation!

  20. Intentionality & Acceptance Cont. • What happens when we accept? • Pain + Non-acceptance = Suffering • Pain + Acceptance = Normal Pain • Intentionality: to address STS symptoms, to grow professionally and personally, finding balance and taking care of self in order to fully live out God’s calling for our lives. -Gentry (2009)

  21. My Mission Statement • Empowering, represents the deepest and best within yourself • Fulfillment of your distinctive gifts to contribute and fulfill God’s call on your life (in all areas) • Vision + Values • Written to inspire you and you alone

  22. Taking Physical Care • Breathe! • Exercise-Aerobic 3x/week or more + anaerobic • Sleep • Nutrition • Spend time outdoors • Massage, stretch, acupuncture, progressive muscle relaxation • Relaxation-HR, muscle tension -Howard, P. (2006); Severin, S. & Severin T. (2005)

  23. Taking Spiritual Care • Reading the Word, studying, committing it to memory • Prayer • Meditation and Listening (solitude) • Fasting • Worship • Stewardship • Submission • Service • Confession • Guidance • Celebration -Foster (1978)

  24. Taking Emotional Care Support, Support, Support! Individual Group Colleagues & Supervisors Loved Ones Personal Therapy Creativity Have fun!

  25. Exercises • Toxic Waste Dump • Reclaiming • Letter -Saakvitne & Pearlman (1996)

  26. Maintenance • Why maintain our commitment? • I am in pain • I matter • The ones I help matter • The ones I love matter • The work I do matters • It is imperative -Saakvitne & Pearlman (1996)

  27. Maintenance Cont. • How can we maintain our commitment? • Not on your own: support person/group • One day at a time • Do something in each area • Make one change at a time • Increase acceptance and mindfulness • Realistic and non-judgmental • Don’t forget, don’t give up -Saakvitne & Pearlman (1996)

  28. Maintenance Cont. Obstacles? Solutions?

  29. Taking a Personal Inventory • Make note of personal vulnerabilities • Resiliency Plan

  30. Final Exercise • What we do well & the rewards of our work • Thank you!

  31. References • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, D.C. American Psychiatric Association, 2000. • Baird, K., & Kracen, A.C., “Vicarious Traumatization and Secondary Traumatic Stress: A research synthesis.” CounsellingPsychology Quarterly, Volume 19, Number 2, June 2006 , pp. 181-188(8). Routledge, part of the Taylor & Francis Group. • Cherniss, C. (1980). Professional Burnout in Human Services Organizations. New York: Praeger. • Figley, C. R., (1995). Compassion Fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Bruner/Mazel. • Foster, R. (1978). Celebration of Discipline. New York: Harper Collins. • Frankl, V. (1963). Man’s Search for Meaning. New York: Washington Square Press, Simon and Schuster.

  32. References Cont. • Gentry, J. E. “Compassion Fatigue: A crucible of transformation.” Journal of Trauma Practice, Spring 2002. • Gentry, J.E. (2009). “Compassion Fatigue” from PESI. • Gentry, J.E. (2009). “Trauma: Tools for Stabilization and Recovery” from PESI. • Howard, P. (2006). The Owner’s Manual for the Brain, 3rd Ed. Austin, TX: Bard Press. • Jung, C.G. (1907) The Psychology of dementia praecox. Read, M. Fordham, G. Adler and W. McGuire (eds.), The Collected Works of C.G. Jung, H. Vol. 3. Bollingen Series XX, Princeton: Princeton University Press. • Kabat-Zinn, J. (2005). Coming to Our Senses: Healing ourselves and the world through mindfulness. New York: Hyperion.

  33. References Cont. • Linehan, M. M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. New York: The Guilford Press. • Maslach, C. (1976). “Burnout.” Human Behavior, 5, 16-22. • Maslach, C. (1982). Understanding Burnout: Definitional issues in analyzing a complex phenomenon. In W.S. Paine (Ed.) Job Stress and Burnout: Research, theory and intervention perspectives (pp. 29-40). Beverly Hills, CA: Sage Publications. • Orsillo, S. & Roemer, L. (2011). The Mindful Way Through Anxiety. New York: The Guildford Press. • Saakvitne, K.W., & Pearlman, L.A. (1996) Transforming the Pain: A workbook on vicarious traumatization. New York: Norton. • Severin, S. & Severin, T. (2005). TriEngergetics: Balancing nutrition, exercise, and mindfulness. Oakland, CA: New Harbinger Publications, Inc.

  34. References Cont. • Smith, J. (2012). “Dialectical Behavior Therapy 5-Day Comprehensive” by MACMHB. • Soy, S. (2002). “Communication, Social Support, and Burnout: A Brief Literature Review.” World Wide Web: http://www.ischool.utexas.edu/~ssoy/pubs/micro-communication/2micro.htm • Covey, S. R., Merrill, A.R., & Merrill, R.R. (1997). First Things first. New York: Simon & Schuster.

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