Vicarious Trauma: Organizational and Supervisory Strategies Presented by Marguerite McCormack, MA, LPC

2. The WayStart and End with the Body

3. Feelings in essence consist of thought that represent the body in a reactive process

4. Body is continually mapped State of map = feelings

5. Mind is built from ideas that are brain representations of body. Fluency of ideation is reduced in sadness and increases in happiness

6. Empathy is an �As If� body loop from �mirror Neurons� in prefrontal cortices Changes in skin conductance precede feeling that is being felt.

7. Empathy Two impaired groups Damage to visual association cortices Damage to insula of right cerebral hemisphere

8. Empathy Ekman�s research on face-reading Rothschild�s research on postural mirroring Damasio�s research on somatic markers �Automatic empathy has all the [force] of running downhill; controlled empathy is as effortful as climbing up a mountainside.� Hodges & Wegner, 1997

9. Empathic Attunement is the capacity to efficiently and accurately monitor anothers state of being. (Wilson & Thomas 2004)

10. Empathic capacity is aptitude for empathic attunement; it varies enormously among therapists with PTSD clients (Dalalenberg, 2000) Empathic Brain � (pg. 21)

11. �Abyss� is the intense emotional cauldron of dysregulated affective state expressed in altered patterns of attachment relationships; experience of horror, abandonment by humanity; cosmic challenge of meaning.

12. Trauma Algorithm Perception of Powerlessness Plus Overwhelming Experience

13. Traumatoid States Compassion Fatigue VT Secondary traumatic stress Empathic strain Trauma � related affective reactions Trauma � related counter transference processes Wilson & Thomas, 2004

14. Critical Therapeutic Structure A safe holding environment with clear and appropriate role boundaries, in which the survivor�s affects and therapists� empathic strain are successfully managed (Wilson & Lindy, 2004)

15. Right Brain modality, in which understanding, cadence, rhythm nonverbals and more important, in some ways, than speech. (Schore, 2003)

16. Affect & synchrony crucial Evenly hovering attention Repatterning of right brain

17. Dual forms of countertransference and stress Institution Each other

18. ISTSS Survey Results 79.9% - difficulty discussing 75% - alienated from peers 72.6% aware of lack of support 61.7% - reluctant to speak honestly about TT, CT, VT

19. Positive Results Transformation of client Transformation of therapist as professional Transformation of therapist as person

20. Allostasis Efforts to achieve stability in functioning following changes produce by stress. New �set point� of baseline functioning and system regulation. System �ratchets up�.

21. Four Types Repeated hits Prolonged stress response Lack of adaptation response (system wears down) Inadequate response (system failure)

22. PTSD = dysregulated psychobiological state; complex allostasis

23. PTSD sensitization hyperactivity distorted information processing lack of self-monitoring non-habituation over consolidated subcortical reactions

24. Institutions change allostatically, too Transformation of trauma is �mutual journey of shared influence�

25. Transformation of negative allostasis

26. Transformation of traumatoid state to therapist: Transference Countertransference Affective dysregulation Hyperarousal Avoidance Reexperiencing Allostatic dynamic

27. What Does This Mean For Supervisors?

28. Exposure to trauma Emotional contagion Repeated attempts for social change Environmental variables Organizational variables

32. who work in emergency and crisis settings new to the field new to trauma work who work in agency settings who have more than 50% trauma clients in their caseload who work with children or in situations involving suicide Those who discuss clients in personal therapy

40. Organizational requirements Prioritization, beginning with the CEO Dedication of resources Multilevel creation of containment Supervision of supervision Recognition of �organizational complex trauma� Sandra Bloom, 2005

41. Goal: Transform clinical and empathetic capacity through focus on clinical skill and sense of moral purpose.

42. Review of Current Tangibleand Intangible Losses Turnover rates Recruitment costs Worker�s comp and disability benefits payouts Employee liability insurance Litigation costs Reputation of self and agency Cost of sloppy work Cost of sick days Cost of OSRS

43. Dirty DozenConsequences of Downsizing, Trauma & Crisis Centralization Threat � rigidity response Loss of creativity Decreasing morale Politicized environment Loss of trust Restricted communication Loss of teamwork Loss of loyalty Scapgoating leaders Short-term perspective � resistance to change

44. Damaged interpersonal relationships Reduced information sharing, increased duplicity Resistance to change, conversation and formalism Increased conflict, anger, vindictiveness, feelings of victimization Elevation in selfishness and turnover > cooperation Inability to lead because of distrust

45. Virtuousness Gratitude Forgiveness Integrity Compassion Optimism Trust

46. Productivity Quality Innovation Industry Stated goals

47. Downsizing and/or Trauma

48. Sandler O�Neil � 9/11 Lost 2/3 of management committee 39% of workforce All of physical plant

49. �A compelling invocation of moral purpose� Rebuild for dead colleagues Provide for families Combat terrorism

50. �Visionary Organizations� �Premier institution widely admired by peers�

51. Mindfulness

52. Individual Self-responsibility Attitude of excellence Other orientation Attribute most associated with clinical skill and empathic capacity

53. Apollo 13 Resilience

54. Strong core values Psychological containment Cognitive capabilities Organic structural characteristic Resiliencies Reserves

55. Implications

57. REVOLUTION

59. Start With Body Create a leaning community through training Obtain consultation for yourselves for support and meet regularly Be safe � NEVER penalize anyone for CT or revealing VT Alignment among levels Try stuff and see what works Honor one another Support wellness Build cognitive complexity Build culture of excellence Reward clinical skill Set audacious goals Amplify buffering strategies Back up your team Build support for your vision in organization

62. Supervision Strategies Take the test! ProQL Compassion Satisfaction & Fatigue Scale http://www.isu.edu/~bhstamm

63. Supervisory Strategies Mindfulness Dual Awareness �Shuttling Between� Rothschild, 2006

64. Supervisory Strategies Revising images Controlled self-talk �Thickening of Skin� Body Armor Awareness of Postural Mirroring Averting gaze Rothschild, 2006

65. Supervisory Strategies Internal Supervisor Therapeutic Impasse Intervention Invitation to Curiousity Awareness of Countertransference

66. Techniques in the Room Seeing healed self of client Imagining being held in loving community Awareness & building of �edges� Attention to intrusive imagery Knowledge of Triggers Set-up of Office �Pushing away with eyes� Grounding �Staying in Your Own Chair� Cleansing rituals Breathing and self-soothing

67. Supervisory Strategies End of session/day rituals Creation of the �bright line��need to protect brain and body from the impact of constant stress Car yelling Five minute vent

68. Supervisory Strategies Rigorous self-care A personal life Spirituality Humor Nature