Presented by Mark Purcell PsyD OBJECTIVES Provide definitions and brief history of Vicarious Traumatization To understand how we are transformed and impacted in our work To identify effects on helpers ID: 705354
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Slide1
Vicarious Trauma: The Effects of Working with Victims of Trauma
Presented by Mark Purcell,
PsyDSlide2
OBJECTIVES:
Provide
definitions and brief history of Vicarious
Traumatization
To understand how we are “transformed” and “impacted” in our work
To identify effects on helpers
To begin to plan individual, team and organizational strategies to reduce the risk of vicarious
traumatization
Describe Symptoms of PTSD and
Complex
TraumaSlide3
Vicarious Trauma
Vicarious
traumatization
(
VT
) is a transformation in the self of a trauma worker or helper that results
from:
empathic engagement with traumatized
clients and their reports of traumatic experiences.
Includes disrupted sense of meaning
and hopeSlide4
CONTEXT OF WORK
Defines self, skills and values
Often drives economic viability and security (health benefits, retirement)
Personal lifestyle, and lifestyle of family
Provides structure, routine and predictability
May define social groupingsSlide5
DEFINITIONS OF
VICARIOUS TRAUMATIZATION (VT)
“…as the transformation that occurs within the therapist (or other trauma worker) as a result of empathic engagement with clients’ trauma experiences and their sequelae.”
(Pearlman & Mac Ian, 1995)
“…clinicians who work with sexually abused clients or other victims of trauma may experience profound psychological effects, effects that can be disruptive and painful for the helper and can persist for month and years after work with traumatized persons.”
(McCann & Pearlman, 1990a; Pearlman & Saakvitne, 1995))Slide6
“VT occurs through exposure to the realities of people’s intentional cruelty to one another, and through the inevitable participation in traumatic reenactment in the therapy relationship, the therapist is vulnerable through his or her empathic openness to the emotional and spiritual effects of vicarious traumatization. Their effects are cumulative and permanent, and evident in both a therapist’s professional and personal life”
(Figley, 1995)Slide7
Emotional impact of trauma and painful material can be contagious and transmitted through the process of empathy
(Figley, 1995; Pearlman and Saakvitne, 1995a; Stamm, 1995)
“…the natural consequent behaviours and emotions resulting from knowing about a traumatizing event experienced by a significant other – the stress resulting from helping or wanting to help the traumatized or suffering person.”
(Figley, 1993a)Slide8
Schauben and Frazier (1995) tied these results to a number of factors:
Hearing painful stories and experiencing the distress of survivors is emotionally draining
Counselling process more difficult with trauma survivors given the challenges of trust and shattered beliefs
Institutional barriers within the legal and mental health systems that clients must navigate are frustrating to the therapistSlide9
SHATTERED BASIC ASSUMPTIONS
- Janoff-Bulman
Traumatizing and victimizing events challenge basic belief structures – structures which drive our ability to organize and make sense out of our world
CHANGES IN THESE SCHEMAS
TAKE PLACE THROUGH:
Accommodation (Sudden and Acute)
Assimilation ( A more incremental shifting of belief systems)Slide10
CONSTRUCTIVIST
SELF-DEVELOPMENT THEORY
-Pearlman
We construct our personal realities through the development of complex cognitive structures which are used to interpret events
These structures are called “schemas”
(Piaget)
Schemas evolve and become increasingly complex over the lifespan as individuals interact with their meaningful environmentsSlide11
Helpers may find a long-term alteration in their own cognitive schemas, beliefs, expectations and assumptions about self, others and the world at large.
Lisa McCann and Laurie Anne Pearlman, Vicarious Traumatization: A Framework for Understanding the Psychological Effects of Working with Victims,
Journal of Traumatic Stress
, Vol.3, No.1, 1990, p. 131.
SCHEMASSlide12
FRAME OF REFERENCE ABOUT THE SELF AND WORLD
Helpers may question his or her identity, role and self-worth
As helpers hear painful stories, the view of the world may change – values can be alteredSlide13
TRUST
SAFETY
Enhanced awareness of the fragility of life
Increased thoughts of our own vulnerability
Helpers’ exposure to hearing stories of cruelty, deception, betrayal, etc… can create cynicism, suspicion towards others – and to expect the worst in othersSlide14
POWER AND CONTROL
Can be impacted by the helplessness and powerlessness that clients and families may talk about
Helpers may find themselves seeking an increase in control in their personal/familial/colleagial relationships to combat thisSlide15
INDEPENDENCE
Helpers may experience a loss of independence as a result of feeling personally vulnerable and out of control
SELF-ESTEEM
May question self-worth (what good am I if I cannot help others?)
Loss of faith in humanity; shattering of belief systems
Views may become more cynical and pessimisticSlide16
INTIMACY
May become emotionally unavailable to self and others as a result of feeling too emotionally invested in clients
Alienation and isolation from others
May be reinforced by others who view “helping work” as
Sad
Horrific
“Better you than me”
Triggers to their angerSlide17
ACUTE STRESS REACTIONS
Can occur as a result of vicarious traumatization
Alterations in sensory experiences
Physiologic activation
Inability to modulate affects
Substance abuse
Overeating
Bingeing
Hypersensitivity to emotionally charged stimuliSlide18
VT can result in physiological symptoms that resemble post traumatic stress reactions
Intrusive Symptoms
Flashbacks
Nightmares
Obsessive thoughts
Constrictive Symptoms
Numbing
Dissociation
(Beaton & Murphy, 1995)Slide19
EFFECTS OF TRAUMA WORK
ON
HELPING PROFESSIONAL
Pervasive
Affects all realms of person’s life
Cumulative
Each client can reinforce gradual change of schemas
Permanent
Even if worked through, experiences leave scars
(McDermott, Fellbaum & Associates. Wounded Helpers & Healers: Shattered and Eroded Assumptions of Vicarious Traumatization. Presentation, March 26, 1993, London)Slide20
The “stories” we hear do affect us
In our work we bear witness to daily pain, despair, victimization as well as the rewards of our work
We listen
support
engage
validate feelings and experiences
As pain is released, we absorb it
At the end of the day, we have gathered numerous accounts of hurtSlide21
WHAT MAY WE FEEL?
Sad
Angry
Joy
Horror
Vulnerable
Satisfaction
Frustration
Creative
Isolated
Appreciated
Anxious
RewardedSlide22
MANAGING OUR WORK
Acknowledge that the work will affect you
Create and maintain a healthy balance to minimize the effects of vicarious traumatization
Recognize the potential for trauma and VT in our lives
Be attentive and mindful of your “unique warning signs”Slide23
WARNING SIGNALS
Increasing thoughts of client’s pain and trauma
Diminishing sense of safety and trust in the world
Intrusive imagery or nightmaresSlide24
Decreasing sense of competency
Cynicism
Isolation and withdrawal from others
Changes in ability to establish and maintain healthy boundariesSlide25
Feeling numb
Changes in eating and sleep patterns
Questioning personal values
Difficulty in managing usual stress situations and responsesSlide26
INFLUENCING FACTORS TO VT
Current personal stresses
Relationship/family challenges
Mental health issues
Social system
Organizational influences
Legislative changes and frustrations
Maturational factors
Physical/medical challengesSlide27
SELF-CARE STRATEGIES
“Balance” between personal and professional life
Respect for personal/professional boundaries
Develop realistic expectationsSlide28
Balanced dietHealthy lifestyle choices
Moderate caffeine/alcohol use
Exercise/movementSlide29
Maintain professional contacts
Engage in social and family relationships and events
Pursue leisure activities
Body therapy, e.g. massage, yogaSlide30
Personal therapyRest/Relaxation
Reflect
Evaluate your priorities and goals on an ongoing basisSlide31
Coming to terms with loss such as the effects of work that can shake or shatter religious or spiritual beliefs
Permitting our sadness to be expressed so that we can receive comfort and support, and helps us to maintain intimacy in our personal lives
Recognizing and accepting that VT is a normal response to doing painful and difficult workSlide32
Give yourself permission to experience the emotion of your work
Value your efforts as well as your successes
LaughSlide33
TEAM STRATEGIES
Break familiar patterns
Overcome fears and barriers
Acknowledge contributions of others – respect for each other’s rolesSlide34
Debrief
Formal and informal structures
Regular Meetings
Discuss situations
Allow feelings to be shared
Problem solve
Provide ongoing education
Encourage innovation
Develop a mechanism in which to understand and process the effects and personal responses to the workSlide35
Avoid nay-sayersBuild dreams and ideas togetherExperiment with creativitySlide36
Guard against censoring your ideasSeek positive solutionsOffer a helping handSlide37
Allow team members to show their feelings and vulnerabilitiesCelebrate your successes
LaughSlide38
CONTRIBUTORS TO SIGNIFICANT STRESS IN HELPERS
Role strain
Staff conflict
Lack of perceived support from peers
Lack of role claritySlide39
Signs & Symptoms of Trauma
Posttraumatic Stress Disorder
Symptom Clusters:
Re-
expereincing
, Avoidance, Arousal
Complex Trauma
E
ffects of Relationships
E
ffects on PersonalitySlide40
PTSD Symptoms: Re-Experiencing
Intrusive
, upsetting memories of the event
Flashbacks (acting or feeling like the event is happening again)
Nightmares (either of the event or of other frightening things)
Feelings of intense distress when reminded of the trauma
Intense physical reactions to reminders of the event (e.g. pounding heart, rapid breathing, nausea, muscle tension, sweating)Slide41
PTSD symptoms of avoidance and emotional numbing
Avoiding activities, places, thoughts, or feelings that remind you of the trauma
Inability to remember important aspects of the trauma
Loss of interest in activities and life in general
Feeling detached from others and emotionally numb
Sense of a limited future (you don’t expect to live a normal life span, get married, have a career)Slide42
PTSD symptoms of increased arousal
Difficulty falling or staying asleep
Irritability or outbursts of anger
Difficulty concentrating
Hypervigilance
(on constant “red alert”)
Feeling jumpy and easily startledSlide43
Other common symptoms of post-traumatic stress disorder
Anger and irritability
Guilt, shame, or self-blame
Substance abuse
Depression and hopelessness
Suicidal thoughts and feelings
Feeling alienated and alone
Feelings of mistrust and betrayal
Headaches, stomach problems, chest painSlide44
Complex Trauma Symptoms
Alterations in regulating affective arousal
(1) chronic affect
dysregulation
(2) difficulty modulating anger
(3) self-destructive and suicidal behavior
(4) difficulty modulating sexual involvement
(5) impulsive and risk-taking behaviorsSlide45
Complex Trauma Symptoms
Alterations in attention and concentration
(1) amnesia
(2) dissociation
SomatizationSlide46
Complex Trauma Symptoms
Chronic
chacterological
changes
(1) alterations in self-perception: chronic guilt and shame; feelings of self-blame, of ineffectiveness, and of being permanently damaged
(2) alterations in perception of perpetrator: adopting distorted beliefs and idealizing the perpetrator
(3) alterations in perceptions of others:
(a) an inability to trust or maintain relationships with others
(b) tendency to be re-victimized
(c) a tendency to victimize othersSlide47
Complex Trauma Symptoms
Alterations in systems of meaning
(1) despair and hopelessness
(2) loss of previously self-sustaining beliefs