Vicarious TraumaVicarious Trauma

Care for the CaregiverCare for the Caregiver

Dan L. Petersen, Ph.D.Dan L. Petersen, Ph.D.

““You cannot describe it unless you have You cannot describe it unless you have seen it, seen it,

you cannot explain it unless you have you cannot explain it unless you have done it,done it,

you cannot imagine it unless you have you cannot imagine it unless you have been there,been there,

then it never goes away”then it never goes away”

Bill Bessington, Retired Reporter, Chugiak, Bill Bessington, Retired Reporter, Chugiak, AlaskaAlaska

StressStress

Distress and EustressDistress and Eustress

Biological and Psychological stressBiological and Psychological stress

TraumaTrauma

BurnoutBurnout

Burnout is not vicarious traumaBurnout is not vicarious trauma

Burnout refers to a response to the work Burnout refers to a response to the work environment which may be too environment which may be too demanding, stressful, or unrewarding.demanding, stressful, or unrewarding.

Behaviors characteristic of burnout include Behaviors characteristic of burnout include lack of motivation, poor work lack of motivation, poor work performance, time problems, and general performance, time problems, and general dissatisfaction with the job.dissatisfaction with the job.

Vicarious traumaVicarious trauma

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

Vicarious traumaVicarious trauma

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

Pearlman & Saakvitne, 1995Pearlman & Saakvitne, 1995

Studies have shown that approximately Studies have shown that approximately 24 to 38% of professionals who work 24 to 38% of professionals who work with clients who have experienced with clients who have experienced trauma experience moderate to high trauma experience moderate to high levels of traumatic stress.levels of traumatic stress.

(Dalton, 2001; Cornille & Meyers, 1999; Johnson (Dalton, 2001; Cornille & Meyers, 1999; Johnson & Hunter, 1997; Reghr & Cadell, 1999; & Hunter, 1997; Reghr & Cadell, 1999; Chrestman, 1995; Pearlman & Mac Ian, 1995)Chrestman, 1995; Pearlman & Mac Ian, 1995)

McCann and Pearlman’s SchemaMcCann and Pearlman’s Schema

Personal frame of referencePersonal frame of reference SafetySafety Dependency and trustDependency and trust PowerPower EsteemEsteem IndependenceIndependence IntimacyIntimacy

Cognitive AlterationsCognitive Alterations

Feelings and statements of Feelings and statements of despair/hopelessnessdespair/hopelessness

CynicismCynicism AngerAnger Withdrawal and numbnessWithdrawal and numbness Irrational cognitions Irrational cognitions

Common cognitive coping Common cognitive coping mechanisms that often are mechanisms that often are

problematicproblematic

Comparing one’s self with those less Comparing one’s self with those less fortunatefortunate

Selectively focusing on the positive Selectively focusing on the positive attributes of one’s self to feel advantagedattributes of one’s self to feel advantaged

Imagining a potentially worse situationImagining a potentially worse situation Construing benefits from the crash victim’s Construing benefits from the crash victim’s

experienceexperience Manufacturing normative standards that Manufacturing normative standards that

make one’s adjustment seem normalmake one’s adjustment seem normal Taylor, Wood and Lechtman, 1999Taylor, Wood and Lechtman, 1999

Victim advocates mayVictim advocates may

WithdrawWithdraw Have boundary violationsHave boundary violations Become controlling and intrusiveBecome controlling and intrusive Deny the victim’s realityDeny the victim’s reality Minimize the victim’s experiencesMinimize the victim’s experiences Refocusing (“how did you survive” as Refocusing (“how did you survive” as

opposed to “what happened to you” opposed to “what happened to you” or “what did you go through”or “what did you go through”

Risk FactorsRisk Factors

Helper’s personal historyHelper’s personal history Type of client/victimType of client/victim Level of trauma experienced by the Level of trauma experienced by the

victimvictim Helper’s attempts to copeHelper’s attempts to cope EnvironmentEnvironment

Supportive or non-supportiveSupportive or non-supportive High traffic with high pressureHigh traffic with high pressure

Symptoms of vicarious traumaSymptoms of vicarious trauma No time, no energyNo time, no energy Disconnection (depersonalization)Disconnection (depersonalization) Social withdrawalSocial withdrawal Sensitivity to violenceSensitivity to violence CynicismCynicism Despair and hopelessnessDespair and hopelessness Sleep problemsSleep problems Disrupted frame of referenceDisrupted frame of reference Diminished self-efficacy (e.g., inability to trust Diminished self-efficacy (e.g., inability to trust

your own decisions)your own decisions) Alterations in sensory experiencesAlterations in sensory experiences

ScenarioScenario Jane has been working at the center for about four months. Jane Jane has been working at the center for about four months. Jane

applied for the position because as she indicated in her interview applied for the position because as she indicated in her interview for the job:for the job:

“ “I want to give back. I want to help others as I was helped. I know 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 what it is like to be a victim of a crime and I know in my heart that I can help others.”I can help others.”Jane’s supervisor upon entering the break room sees Jane with her 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 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 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 that she feels so bad sometimes after working with a client. Then she looks up at the supervisor and earnestly asks, “It will get 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 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 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 lately talking about it seems to maker her feel worse rather than better. The supervisor consoles Jane by gently touching her on better. The supervisor consoles Jane by gently touching her on the shoulder. “I know we are all busy and I have a client waiting 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 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.”we are both free. Come on, let’s get back to work.”

Protective FactorsProtective Factors

Social supportSocial support Supervision/consultationSupervision/consultation CompetenceCompetence Self-awarenessSelf-awareness Ethics or moral senseEthics or moral sense Number of personal issues resolved with a Number of personal issues resolved with a

success strategysuccess strategy Defined boundariesDefined boundaries

Personal limitationPersonal limitation Ability to be a resource for othersAbility to be a resource for others

Framework for healthFramework for health

Physical healthPhysical health Body/exerciseBody/exercise DiseaseDisease Nutrition/food intakeNutrition/food intake

PsychologicalPsychological ProfessionalProfessional OrganizationalOrganizational Community/familyCommunity/family

Actions to prevent or assist in Actions to prevent or assist in reducing vicarious traumareducing vicarious trauma

JournalingJournaling Develop personal rituals/routinesDevelop personal rituals/routines MindfulnessMindfulness Find balance (work, play, family, others)Find balance (work, play, family, others) Extend identity beyond workExtend identity beyond work Diversify caseloadDiversify caseload Seek consultation on difficult casesSeek consultation on difficult cases Take breaks during the dayTake breaks during the day Gain competenceGain competence Modify work schedule as needed with case Modify work schedule as needed with case

severity/loadseverity/load

Be curiousBe curious Self-reflect, notice your inner experiencesSelf-reflect, notice your inner experiences Read literature unrelated to workRead literature unrelated to work Practice receiving from othersPractice receiving from others Wear clothes you likeWear clothes you like Eat healthilyEat healthily Take time off when sickTake time off when sick ExerciseExercise Get regular careGet regular care Get enough sleepGet enough sleep Take day trips or mini vacationsTake day trips or mini vacations Spend time with others whose company you enjoySpend time with others whose company you enjoy Learn to say “no” to extra responsibilities sometimesLearn to say “no” to extra responsibilities sometimes Find things that make you laughFind things that make you laugh

Spiritual self-careSpiritual self-care Make time for reflectionMake time for reflection Spend time in natureSpend time in nature Find spiritual connection or communityFind spiritual connection or community Be open to inspirationBe open to inspiration Cherish your optimism and hopeCherish your optimism and hope Be aware of the non material aspects of lifeBe aware of the non material aspects of life Try at times not to be in charge or the expertTry at times not to be in charge or the expert MeditateMeditate PrayPray SingSing Contribute to causes in which you believeContribute to causes in which you believe Read inspirational literatureRead inspirational literature

Saakvitne & Pearlman; 1996 excerptedSaakvitne & Pearlman; 1996 excerpted

Autogenic RelaxationAutogenic Relaxation

History History

Johannes Schulz published “Autogenic Johannes Schulz published “Autogenic Therapy in 1932Therapy in 1932

Based on passive concentration and Based on passive concentration and body awarenessbody awareness

Detached but alert state of mindDetached but alert state of mind Requires no equipment and takes only Requires no equipment and takes only

about 10 to 15 minutes per sessionabout 10 to 15 minutes per session Can be practiced anywhereCan be practiced anywhere Is similar to many meditative Is similar to many meditative

techniquestechniques

Schulz’s six autogenic “states”Schulz’s six autogenic “states”

Heaviness in the arms and legsHeaviness in the arms and legs Warmth in the arms and legsWarmth in the arms and legs Warmth and heaviness in the heart Warmth and heaviness in the heart

areaarea Focus on breathingFocus on breathing Focus on warmth in the abdomenFocus on warmth in the abdomen Focus on coolness in the foreheadFocus on coolness in the forehead

BreathingBreathing

Slow breathingSlow breathing““Breathe in, 1 2 3; Breathe out, 1 2 3”Breathe in, 1 2 3; Breathe out, 1 2 3”

Deep breathingDeep breathingStomach expands as diaphragm moves Stomach expands as diaphragm moves to to

pull in pull in more airmore air

Let your body breathe (the air is breathing me)Let your body breathe (the air is breathing me)

Breathe in through the nose and out through the Breathe in through the nose and out through the mouthmouth

I feel quietI feel quiet My feet feel heavy, heavy and relaxedMy feet feel heavy, heavy and relaxed My calves, my knees, thighs and hips feel My calves, my knees, thighs and hips feel

heavy, relaxed and comfortableheavy, relaxed and comfortable My stomach feels relaxed and quietMy stomach feels relaxed and quiet My hands are heavyMy hands are heavy My arms and shoulders are relaxed.My arms and shoulders are relaxed. My arms are heavy and warm.My arms are heavy and warm. I feel quietI feel quiet