Vicarious Trauma

1. Vicarious Trauma Care for the Caregiver Dan L. Petersen, Ph.D.

2. “You cannot describe it unless you have seen it, you cannot explain it unless you have done it, you cannot imagine it unless you have been there, then it never goes away” • Bill Bessington, Retired Reporter, Chugiak, Alaska

3. Stress • Distress and Eustress • Biological and Psychological stress • Trauma

4. Burnout • Burnout is not vicarious trauma • Burnout refers to a response to the work environment which may be too demanding, stressful, or unrewarding. • Behaviors characteristic of burnout include lack of motivation, poor work performance, time problems, and general dissatisfaction with the job.

5. Vicarious trauma • Terms: secondary trauma, compassion fatigue (Figley), PTSD, secondary traumatic stress, indirect victimization and traumatic countertransference.

6. Vicarious trauma • “The transformation that occurs within the trauma worker as a result of empathetic engagement with the client’s trauma experiences. Such engagement includes listening to graphic descriptions of horrific events, bearing witness to peoples’ cruelty to one another, and witnessing and participating in traumatic reenactments” • Pearlman & Saakvitne, 1995

7. Studies have shown that approximately 24 to 38% of professionals who work with clients who have experienced trauma experience moderate to high levels of traumatic stress. • (Dalton, 2001; Cornille & Meyers, 1999; Johnson & Hunter, 1997; Reghr & Cadell, 1999; Chrestman, 1995; Pearlman & Mac Ian, 1995)

8. McCann and Pearlman’s Schema • Personal frame of reference • Safety • Dependency and trust • Power • Esteem • Independence • Intimacy

9. Cognitive Alterations • Feelings and statements of despair/hopelessness • Cynicism • Anger • Withdrawal and numbness • Irrational cognitions

10. Common cognitive coping mechanisms that often are problematic • Comparing one’s self with those less fortunate • Selectively focusing on the positive attributes of one’s self to feel advantaged • Imagining a potentially worse situation • Construing benefits from the crash victim’s experience • Manufacturing normative standards that make one’s adjustment seem normal • Taylor, Wood and Lechtman, 1999

11. Victim advocates may • Withdraw • Have boundary violations • Become controlling and intrusive • Deny the victim’s reality • Minimize the victim’s experiences • Refocusing (“how did you survive” as opposed to “what happened to you” or “what did you go through”

12. Risk Factors • Helper’s personal history • Type of client/victim • Level of trauma experienced by the victim • Helper’s attempts to cope • Environment • Supportive or non-supportive • High traffic with high pressure

13. Symptoms of vicarious trauma • No time, no energy • Disconnection (depersonalization) • Social withdrawal • Sensitivity to violence • Cynicism • Despair and hopelessness • Sleep problems • Disrupted frame of reference • Diminished self-efficacy (e.g., inability to trust your own decisions) • Alterations in sensory experiences

14. Scenario • Jane has been working at the center for about four months. Jane applied for the position because as she indicated in her interview for the job: “I want to give back. I want to help others as I was helped. I know what it is like to be a victim of a crime and I know in my heart that I can help others.” Jane’s supervisor upon entering the break room sees Jane with her head down on the table crying. The supervisor asks Jane if she is alright and Jane responds that she will be okay and that it is just that she feels so bad sometimes after working with a client. Then she looks up at the supervisor and earnestly asks, “It will get better, won’t it?” Then she says that she use to talk to her friends about her feelings after the crime and that it helped a lot but lately talking about it seems to maker her feel worse rather than better. The supervisor consoles Jane by gently touching her on the shoulder. “I know we are all busy and I have a client waiting right now, but if you want to talk about it stop by some day when we are both free. Come on, let’s get back to work.”

15. Protective Factors • Social support • Supervision/consultation • Competence • Self-awareness • Ethics or moral sense • Number of personal issues resolved with a success strategy • Defined boundaries • Personal limitation • Ability to be a resource for others

16. Framework for health • Physical health • Body/exercise • Disease • Nutrition/food intake • Psychological • Professional • Organizational • Community/family

17. Actions to prevent or assist in reducing vicarious trauma • Journaling • Develop personal rituals/routines • Mindfulness • Find balance (work, play, family, others) • Extend identity beyond work • Diversify caseload • Seek consultation on difficult cases • Take breaks during the day • Gain competence • Modify work schedule as needed with case severity/load

18. Be curious • Self-reflect, notice your inner experiences • Read literature unrelated to work • Practice receiving from others • Wear clothes you like • Eat healthily • Take time off when sick • Exercise • Get regular care • Get enough sleep • Take day trips or mini vacations • Spend time with others whose company you enjoy • Learn to say “no” to extra responsibilities sometimes • Find things that make you laugh

19. Spiritual self-care • Make time for reflection • Spend time in nature • Find spiritual connection or community • Be open to inspiration • Cherish your optimism and hope • Be aware of the non material aspects of life • Try at times not to be in charge or the expert • Meditate • Pray • Sing • Contribute to causes in which you believe • Read inspirational literature • Saakvitne & Pearlman; 1996 excerpted

20. Autogenic Relaxation

21. History • Johannes Schulz published “Autogenic Therapy in 1932 • Based on passive concentration and body awareness • Detached but alert state of mind • Requires no equipment and takes only about 10 to 15 minutes per session • Can be practiced anywhere • Is similar to many meditative techniques

22. Schulz’s six autogenic “states” • Heaviness in the arms and legs • Warmth in the arms and legs • Warmth and heaviness in the heart area • Focus on breathing • Focus on warmth in the abdomen • Focus on coolness in the forehead

23. Breathing Slow breathing “Breathe in, 1 2 3; Breathe out, 1 2 3” Deep breathing Stomach expands as diaphragm moves to pull in more air Let your body breathe (the air is breathing me) Breathe in through the nose and out through the mouth

24. I feel quiet • My feet feel heavy, heavy and relaxed • My calves, my knees, thighs and hips feel heavy, relaxed and comfortable • My stomach feels relaxed and quiet • My hands are heavy • My arms and shoulders are relaxed. • My arms are heavy and warm. • I feel quiet