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Vicarious Posttraumatic Growth in Trauma Clinicians Christopher Howard Antioch University - Santa Barbara

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Vicarious Posttraumatic Growth in Trauma Clinicians Christopher Howard Antioch University - Santa Barbara Antioch University AURA - Antioch University Repository and Archive Student & Alumni Scholarship, including Dissertations & Theses Dissertations & Theses 2010 Promoting Resiliency: Vicarious Posttraumatic Growth in Trauma Clinicians Christopher Howard Antioch University - Santa Barbara Follow this and additional works at: http://aura.antioch.edu/etds Part of the Clinical Psychology Commons Recommended Citation Howard, Christopher, "Promoting Resiliency: Vicarious Posttraumatic Growth in Trauma Clinicians" (2010). Dissertations & Theses. 124. http://aura.antioch.edu/etds/124 This Dissertation is brought to you for free and open access by the Student & Alumni Scholarship, including Dissertations & Theses at AURA - Antioch University Repository and Archive. It has been accepted for inclusion in Dissertations & Theses by an authorized administrator of AURA - Antioch University Repository and Archive. For more information, please contact [email protected], [email protected]. 1 PROMOTING RESILIENCY: VICARIOUS POSTTRAUMATIC GROWTH IN TRAUMA CLINICIANS A dissertation submitted by CHRISTOPHER J. HOWARD to ANTIOCH UNIVERSITY SANTA BARBARA in partial fulfillment of the requirements for the degree of DOCTOR OF PSYCHOLOGY in CLINICAL PSYCHOLOGY _________________________________ Michele Harway, Ph.D., Dissertation Chair _________________________________ Peter Claydon, Ph.D. Faculty ________________________________ Ryan Smith Student Reviewer _______________________________ Alex P. Linley, Expert Consultant 2 TABLE OF CONTENTS DEDICATION…………………………………………………………. ACKNOWLEDGEMENTS…………………………………………. … ABSTRACT……………………………………………………………. CHAPTER ONE: INTRODUCTION…………………………………. Problem Statement……………………………………………… 10 Significance…………………………………………………….. 11 Research Questions and Hypotheses…………………………… 14 Definition of Key Terms……………………………………….. 18 CHAPTER TWO: REVIEW OF THE LITERATURE………………… 20 Vicarious Posttramautic Growth……………………………….. 20 Spirituality………………………………………………………. 27 Self-Care………………………………………………………… 37 CHAPTER THREE: METHODOLOGY Design……………………………………………………………. 45 Population and Sample………………………………………….. 46 Data Collection Procedures………………………………………. 47 Instrumentation…………………………………………………… 49 Data Analysis………………………………………………………53 CHAPTER FOUR: RESULTS Preliminary Analysis………………………………………………..55 Investigation of Research Questions and Hypotheses………………58 3 Summary of Findings Related to Research Hypotheses…………….66 CHAPTER FIVE: DISCUSSION…………………………………………..69 Limitations………………………………………………………….75 Recommendations for Research…………………………………….76 Recommendations for Practice……………………………………...77 APPENDICES……………………………………………………………….. A) Informed Consent…………………………………………….. …79 B) Demographic Questionnaire……………………………………...82 C) The Assessment of Self-Care……………………………………..83 D) The Posttraumatic Growth Inventory……………………………..87 E) The Spiritual Involvement and Beliefs Scale-Revised…………….89 F) The Trauma Symptom Inventory ………………………………….91 G) IRB Forms…………………………………………………………92 H) Ethnic Origin: Frequency and Percent……………………………..95 REFERENCES………………………………………………………………...96 4 LIST OF TABLES Table 1: Intercorrelations among study variables.…………………………….. Table 2: Regression predicting Vicarious Posttraumatic Growth……………. Table 3: Regression predicting Anxious Arousal……………………………. Table 4: Regression predicting Depression………………………………….. Table 5: Regression predicting Anger/Irritability…………………………… Table 6: Regression predicting Intrusive Experiences………………………. Table 7: Regression predicting Defensive Avoidance………………………. Table 8: Regression predicting Dissociation……………………………… Table 9: Regression predicting Impaired Self-Reference………………… Table 10: Regression predicting Tension Reduction Behavior…………….. 5 Dedication This work is dedicated to Jozefa Kulakowski, my babcia (great-grandmother) without whose pilgrimage and fortitude none of this would be possible. Also, to my heroes Ronald D. Howard and Peter G. Rossi who served dutifully as both warriors and fathers. And finally to Edgar Marquez whose legacy continues. 6 Acknowledgements I would like to personally thank the many others who have supported me throughout my journey, including my wife, Naomi Howard, mother Joanne Rossi, sensei Allen and sensei Kiyama, whose provision of a “hospital” has enriched my life. And finally, to Jessica whose spirit of sacrifice initiated a deeper search for meaning and purpose in my life. 7 Abstract Vicarious Posttraumatic Growth (VPG) and Vicarious Traumatization (VT) are two potential outcomes of clinical work with trauma survivors. The aim of this study was to test a predictive model of these constructs, allowing a fuller understanding of preventive strategies clinicians might employ to inoculate themselves against the potential hazards of service provision and provide the highest quality of clinical care. VPG and VT were investigated in 63 self-identified trauma therapists. The results showed that VPG is facilitated by engagement in successful services subsequent to a traumatic event. Self-Care emerged as a poignant buffer against various indices of vicarious traumatization. Other study variables including spiritual beliefs and practices, and years practicing were correlated with vicarious traumatization but failed to reach significance in a majority of regression models due to the small sample size. Directions for future research and practice are discussed. 8 Solve et Coagule or “Dissolve and Reform” is an ancient concept, beckoning attention to the phenomenon of growth through adversity. Spiritual traditions worldwide have discussed the vicissitudes of personal transformation, or “trial by fire”. It is in the spirit of this ancient tradition of personal alchemy or turning lead into gold that this study is born. As others can attest (Arnold, Calhoun, Tedeschi & Cann, 2005; Brady, Guy, Poelstra, & Brokaw, 1999; Decker, 1993; Joseph & Linley 2006; Herman 1992; Pearlman & Saakvitne, 1990; Pearlman & Mac Ian, 1995; Schauben & Frazier, 1995; Zoellner & Maercker, 2006), trauma has a pivotal role in both pathology and growth. In fact, these may not be dichotomous outcomes, as trauma leaves an individual transformed on a biological, as well as a psychological level (Christopher, 2004). What is the nature of this transformation? Traumatic sequelae are multidetermined, based not only on the nature of the stressor, but the response of the individual. The outcome of this transformation can have deleterious as well as growth producing effects. Several recent studies have continued to warn us of the deleterious effects of trauma work or empathic engagement with another’s experience of trauma (Lerias & Byrne, 2003; Mclean, Wade, & Encel, 2003; Collins & Long, 2003; Sabin-Farrell & Turpin, 2003). These effects may include symptoms of PTSD (Brady et al., 1999; Kassam-Adams, 1995; Schaben & Frazier, 1995; Pearlman & MacIan, 1995), burnout (Jenaro, Flores, & Arias, 2007; Johnson & Hunter, 1997; Rupert & Morgan, 2005), general psychological distress (Iliffe & Steed, 2000; Sabin-Farrell & Turnpin, 2003; Steed & Downing, 1998) and cognitive changes in beliefs and attitudes (Schauben & Frazier, 1995; Pearlman & MacIan, 1995, Ilife & Steed, 2000; Ortlepp & Friedman, 2002; Steed & Downing, 1998). These experiences are often referred to in the 9 literature by various names including “vicarious traumatization” (VT), “secondary stress”, “compassion fatigue”, and “burnout”. These terms merit further consideration and will be expounded upon later in this text. Interestingly, the DSM-IV diagnostic criteria for posttraumatic stress disorder (PTSD) acknowledges that learning about traumatic events experienced by a family member or close friend can lead to the diagnosis (American Psychiatric Association, 1994). The aforementioned authors posit that engaging empathically with trauma survivors can thus result in vicarious traumatization and secondary traumatic stress. Interestingly, empathic work with clients is likely to activate a “sympathetic pain”, which has been demonstrated using functional imaging techniques as activity in the cingulate cortex, but not the somatosensory cortex of the brain (Singer et al., 2004). Further, a recent meta-analytic review by Segerstrom and Miller (2004) concluded that “in the thirty years since work in the field of psychoneuroimmunology began, studies have convincingly established that stressful experiences alter features of the immune response as well as confer vulnerability to adverse medical outcomes that are either mediated by or resisted by the immune system” (p. 619). Research informed preventative strategies can foster the requisite resilience to ameliorate trauma’s negative effects on client and clinician alike. When clinicians in particular, attend to their own self care, they are reducing the likelihood of not only adverse psychological, but physical effects as well (Norcross, 2007). Further, as clinicians become more mindful of their own care, they can subsequently provide the requisite ecology or safe environment for survivor clients to thrive. Interestingly, the word ecology is derived from the Greek root oiko or oeco. This is a concept of home, not 10 an individual dwelling but a habitat or environment, especially as a factor significantly influencing the mode of life or the course of development (McDaniel, Lusterman, & Philpot, 2001). Thus, it appears that the creation of such a therapeutic environment for clients may be contingent upon clinicians’ creation of a balanced internal environment through the process of self-care. Problem Statement According to Ozer (2003)
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