Vicarious Trauma The Effects of Working with Victims

Vicarious Trauma: The Effects of Working with Victims of Trauma Presented by Mark Purcell, Psy. D

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 Trauma

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 hope

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 groupings

DEFINITIONS OF VICARIOUS TRAUMATIZATION (VT) �“…as the transformation that occurs within 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. ” (Mc. Cann & Pearlman, 1990 a; Pearlman & Saakvitne, 1995))

�“VT occurs through exposure to the realities of people’s intentional cruelty to one another, and through the inevitable participation in traumatic reenactment in therapy relationship, 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)

�Emotional impact of trauma and painful material can be contagious and transmitted through the process of empathy (Figley, 1995; Pearlman and Saakvitne, 1995 a; 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, 1993 a)

� Schauben and Frazier (1995) tied these results to a number of factors: Hearing painful stories and experiencing the distress of survivors is emotionally draining B. Counselling process more difficult with trauma survivors given the challenges of trust and shattered beliefs C. Institutional barriers within the legal and mental health systems that clients must navigate are frustrating to therapist A.

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)

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 environments

SCHEMAS �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 Mc. Cann 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.

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 altered

TRUST Helpers’ exposure to hearing stories of cruelty, deception, betrayal, etc… can create cynicism, suspicion towards others – and to expect the worst in others SAFETY �Enhanced awareness of the fragility of life �Increased thoughts of our own vulnerability

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 this

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 pessimistic

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 anger

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 stimuli

�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)

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 (Mc. Dermott, Fellbaum & Associates. Wounded Helpers & Healers: Shattered and Eroded Assumptions of Vicarious Traumatization. Presentation, March 26, 1993, London)

�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 hurt

WHAT MAY WE FEEL? �Sad �Angry �Joy �Horror �Vulnerable �Satisfaction Frustration Creative Isolated Appreciated Anxious Rewarded

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”

WARNING SIGNALS �Increasing thoughts of client’s pain and trauma �Diminishing sense of safety and trust in the world �Intrusive imagery or nightmares

�Decreasing sense of competency �Cynicism �Isolation and withdrawal from others �Changes in ability to establish and maintain healthy boundaries

�Feeling numb �Changes in eating and sleep patterns �Questioning personal values �Difficulty in managing usual stress situations and responses

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 challenges

SELF-CARE STRATEGIES �“Balance” between personal and professional life �Respect for personal/professional boundaries �Develop realistic expectations

�Balanced diet �Healthy lifestyle choices �Moderate caffeine/alcohol use �Exercise/movement

�Maintain professional contacts �Engage in social and family relationships and events �Pursue leisure activities �Body therapy, e. g. massage, yoga

�Personal therapy �Rest/Relaxation �Reflect �Evaluate your priorities and goals on an ongoing basis

�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 work

�Give yourself permission to experience the emotion of your work �Value your efforts as well as your successes �Laugh

TEAM STRATEGIES �Break familiar patterns �Overcome fears and barriers �Acknowledge contributions of others – respect for each other’s roles

�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 process the effects and personal responses to the work

�Avoid nay-sayers �Build dreams and ideas together �Experiment with creativity

�Guard against censoring your ideas �Seek positive solutions �Offer a helping hand

�Allow team members to show their feelings and vulnerabilities �Celebrate your successes �Laugh

CONTRIBUTORS TO SIGNIFICANT STRESS IN HELPERS �Role strain �Staff conflict �Lack of perceived support from peers �Lack of role clarity

Signs & Symptoms of Trauma �Posttraumatic Stress Disorder �Symptom Clusters: � Re-expereincing, Avoidance, Arousal �Complex Trauma �Effects of Relationships �Effects on Personality

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)

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)

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 startled

Other common symptoms of posttraumatic 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 pain

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 behaviors

Complex Trauma Symptoms �Alterations in attention and concentration �(1) amnesia �(2) dissociation �Somatization

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 others

Complex Trauma Symptoms �Alterations in systems of meaning �(1) despair and hopelessness �(2) loss of previously self-sustaining beliefs