Secondary Vicarious Trauma Recognizing and Dealing with it

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Secondary (Vicarious) TraumaRecognizing and
Dealing with it

• Indiana State System of Care
• Annual Conference
• Indianapolis, Indiana
• October 1, 2009

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Presenters

• John Kennedy, MHR
• Director,
• Youth Emergency Services and Reception Center
• Lisa Goldberg-Mitton, MSW
• Clinical Manager,
• Youth Emergency Services
• Tim Owens, MSW
• Program Manager,
• Marion County Youth Reception Center

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Choices, Inc. is the Care Management Organization
that manages YES Visit our Web site at
www.ChoicesTeam.org Check out our NEW systems of
care blog at www.NeedsArentServices.org
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Learning Objectives

• Definition of Vicarious Trauma
• What are the subtle differences between VT and
  burnout?
• Basis of Vicarious Trauma
• Organizational Approaches
• Strategies for Supervisors
• Creating a Self Support Plan

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Vicarious Trauma

• We choose our profession.
• Why did you choose to be a helper or change
• agent?
• How will you go about staying in your
  profession?

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Beliefs that prevent helpers from getting help

• We should not experience personal problem.that
  we know better.
• We view personal problems as a sign of inadequacy
  or failure.
• We think that the is not safe place for us to get
  help
• We should be aware of all helping resources for
  all problems
• We have helping skills and can take care of
  ourselves
• We often intellectualize and or disassociate from
  the emotional impact of our problems
• We often counsel family, friends, and significant
  othersas violations of boundaries.
• We feel responsible for and often take the blame
  if a family member or significant other has a
  personal problem.
• We feel embarrassed to seek help from fellow
  professionals.
• As a result of the above, we often wait longer
  than others to let people help and often sabotage
  our own treatment.

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Vicarious Trauma

• This is what we know (Research)
• The initial research done in workplace stress of
  Social Workers focused on Burnout. Maslach,
  1993
• Early research identifies personal and
  organizational correlates.
• Concept of Vicarious Trauma is particularly
  related to those that work with trauma.
• Adult survivors/therapist of sex abuse research.
• VT happens over time
• Duration of exposure to traumatic stories is the
  key
• Schauben and Frasiier 1995

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Research

• Helpers are profoundly affected by trauma
  stories.
• Helpers frustration is external toward client,
  family and societal factors. Intense feeling of
  unfairness
• Responses vary depending on age of victim, type
  of abuse
• Others reported greater depth of compassion, more
  introspectiveness Perlman 1993
• Negative coping is reported by the increase of
  high risk behaviors (smoking, drinking, emotional
  eating, forgetting details of own life, never in
  the moment)

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Vicarious Trauma what it is not

• Subtle but distinct differences in
• Sympathy
• Empathy
• Burnout
• Compassion Fatigue
• Post Traumatic Stress
• Maslach, 1993

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Defining Vicarious Trauma

• A change in a service provider's inner
  experience as a result of empathic engagement
  with survivors of trauma and hearing their story.
• Intellectual shutting downcynicism, denial,
  shift in frame of reference
• Changes that occur in the service providers
  physical, emotional, and /or behavioral states as
  a result of exposure to traumatic stories.
• Increase of tiredness, loss of energy
• Sleep disturbance / eating poorly
• Pearlman and Saakvitne, 1995

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Symptoms PIES

• (P) physical tiredness, loss of energy, trouble
  sleeping,
• (I ) intellectual/cognitive shift. frame of
  reference changes, interpretation of memory
  changes thru the VT lens, internalizing client
  memories to alter own, intrusive thoughts,
  dreams, negativity, de-personalization,
  avoidance, blaming, seriousness
• (E) feelings of sadness despair, anger, grief,
  anxiety
• (S) spirit/soul is powerlessness, wavering of
  confidence in practice, loss in faith the
  individuals ability to adapt and survive, loss of
  empathy, crisis of faith in helpers

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Vicarious Trauma

• Agency What providers can affect to
• reduce VT
• Organizational culture
• Work environment
• Workload
• Education
• Group support
• Supervision
• Resource for self care
• Yassen, 1995

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Vicarious Trauma

• Organizational Management
• Set work expectations that value the worker as
  much as performance.
• Create a supportive environment where open door
  policy is not merely a saying.
• Provide staff immediate access to debriefing
• Encourage workers to take time off

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Vicarious Trauma

• Work Environment
• Safe environment, private. Dalton 1993
• Worker safety primary concern.
• Personalized and meaningful workspaces and group
  spaces.
• Inspiring guiding principles, missions as visual
  reminders.
• Fun committee
• Popcorn
• Pearlman and Saakvitne, 1995

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Vicarious Trauma

• Workload
• Workload high increased vulnerability
• Diverse caseload keeps perspective
• Proper tools to get the job done (computers,
  community resources)
• Variety of tasks outside of job description
• Chrestman, 1995 Perlman and Saakvitne, 1995

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What are the risks for VT?

• High Risk for Vicarious Trauma
• Case load is high
• Same type of client
• Personal connection to story increases with each
  client
• Not enough psychological distance
• Work Settings has high exposure to trauma
• Medium Risk for Vicarious Trauma
• Diverse caseload
• Participates in other activities at the agency
• Age and experience inversely correlated with VT
• Low Risk for Vicarious Trauma
• Agency is supportive and located in nice
  environment
• Lots of supervision, peer support, peer
  debriefing, team work
• Social connections with co-workers are high
• Small case load of trauma clients
• On going education/training

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Vicarious Trauma

• Education
• Master degreed less Vicarious Trauma
• Tuition reimbursement
• On going training and workshops to increase
  confidence
• Informed consent at hiring so worker knows what
  can happen
• Reinforcement of training back at the shop
• Constructionist self development
• Dalton, 2001 Regehr and Cadell, 1999

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Vicarious Trauma

• Group Support
• Build trust by using team building activities.
• Positive regard for colleagues a guiding
  principle
• Team works for a common goals
• Group case review
• Peer debriefing
• Pitfalls of group support
• Allow for social time fun stuff
• Catherall, 1995 Munroe et al 1995

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Vicarious Trauma

• Supervision
• Parallel process
• Supervision is safe for expression of fears,
  concerns
• Weekly group supervision
• Individual supervision as needed
• Separate as much as possible supportive
  supervision with evaluation of performance.
• Simple acknowledgement of impact of hearing
  trauma stories.
• Normalize it by talking about it
• Welfell, 1995

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Vicarious Trauma

• Self Care
• Understand the Body Mind Connection
• Maintaining optimum physical health is important.
  
• Chose a physical activity that you are likely to
  commit
• Do something to support your mental health,
  support your own boundaries
• Involve yourself in specific leisure time
  activities which inspire you

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Vicarious Trauma

• Prevention
• Endeavor to keep fears separate
• Personal awareness/self monitoring
• Know when to seek supervision and support
• Education and training to keep confidence up
• Knowledge that the effects of vicarious trauma is
  essential to take proactive measures
• Concentrate on role, therapeutic response in the
  moment

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Vicarious Trauma

• ABCs
• Its easy as ... 123
• Awareness being attuned to ones needs, limits,
  emotions, and resources practice
  self-acceptance.
• Balance maintaining balance among activities,
  especially work, play and rest .
• Connection maintaining supportive
  relationships communication is part of
  connection and breaks the silence of
  unacknowledged pain these connections help
  prevent isolation and increase validation and
  hope.