VicariousVicarious TraumatizationTraumatization

PresentedPresented by:by:

HollyHolly Falkner,Falkner, LGSWLGSW AlabamaAlabama Pre/PostPre/Post AdoptionAdoption ConnectionsConnections Birmingham,Birmingham, AlabamaAlabama VicariousVicarious TraumaTrauma McCannMcCann && Pearlman,Pearlman, 1990:1990: „ AA normalnormal andand inevitableinevitable stressstress reactionreaction experiencedexperienced byby therapiststherapists andand researchersresearchers whowho areare exposedexposed toto disclosuresdisclosures ofof traumatictraumatic imagesimages andand materialsmaterials byby clientsclients andand researchresearch participants,participants, inin whichwhich therapiststherapists oror researchersresearchers experienceexperience enduringenduring changeschanges inin thethe mannermanner inin whichwhich theythey viewview self,self, othersothers andand thethe world.world. ThreeThree KeyKey ElementsElements ofof VTVT

„ RepeatedRepeated exposureexposure toto clientsclients’’ traumatictraumatic experiencesexperiences couldcould causecause aa shiftshift inin thethe wayway thatthat traumatrauma counselorscounselors perceiveperceive themselves,themselves, others,others, andand thethe world.world. „ VTVT characterizescharacterizes thethe cumulativecumulative effectseffects ofof workingworking withwith survivorssurvivors ofof traumatictraumatic events,events, suchsuch asas rape,rape, incest,incest, childchild abuseabuse and/orand/or domesticdomestic violenceviolence onon thethe therapist.therapist. TheThe effecteffect onon workersworkers intensifiesintensifies overover timetime andand withwith multiplemultiple clients.clients. „ VTVT isis pervasivepervasive,, affectingaffecting allall areasareas ofof aa therapisttherapist’’ss life,life, includingincluding emotions,emotions, relationshipsrelationships andand worldworld perceptions.perceptions. RelatedRelated ConceptsConcepts

„„ SecondarySecondary TraumaticTraumatic StressStress „„ CompassionCompassion FatigueFatigue

OftenOften times,times, thesethese conceptsconcepts areare usedused oror statedstated inin thethe placeplace ofof VTVT however;however; theythey areare notnot thethe same.same. Vicarious Trauma Secondary Trauma Compassion Fatigue Vicarious Trauma is Secondary Trauma Compassion can occur following Fatigue is a state repeated exposure to one single event. experience by traumatic experiences. During any kind of those helping VT builds up over time interaction between people in and affects many areas adult caregiver and a distress. It is an of your life including traumatized child or extreme state of personal relationships, professional and tension and pre work performance and client, Secondary occupation with one’s perception of the Trauma can occur. the suffering of world. Therapeutic This is not a those being intervention may be cumulative effect, helped to the needed to reverse the and it may or may degree that it effects of VT. not affect different becomes

areas of life. traumatizing for

the helper.

LookLook OutOut ForFor……..

„ Burnout:Burnout: BurnoutBurnout isis thethe resultresult ofof generalgeneral psychologicalpsychological stress.stress. OneOne’’ss physicalphysical environment,environment, workwork hourshours oror personalpersonal lifelife cancan causecause concreteconcrete stress.stress. ThisThis differsdiffers fromfrom VTVT asas VTVT isis aa reactionreaction toto specific,specific, clientclient presentedpresented information.information. ItIt isis possiblepossible toto havehave burnoutburnout andand VTVT atat thethe samesame time.time. CounterCounter TransferenceTransference

„ CounterCounter transference:transference: AA conditioncondition wherewhere thethe therapist,therapist, asas aa resultresult ofof thethe therapytherapy sessions,sessions, beginsbegins toto transfertransfer thethe therapisttherapist’’ss ownown unconsciousunconscious feelingsfeelings toto thethe patient.patient. Secondary Trauma Vicarious Compassion Trauma Fatigue

Burnout and Counter Transference WordsWords ofof WisdomWisdom

““TheThe ExpectationExpectation thatthat wewe cancan bebe immersedimmersed inin sufferingsuffering andand lossloss dailydaily andand notnot bebe touchedtouched byby itit isis asas unrealisticunrealistic asas expectingexpecting toto bebe ableable toto walkwalk throughthrough waterwater withoutwithout gettinggetting wet.wet.””

RachelRachel RemenRemen,, KitchenKitchen TableTable WisdomWisdom WhyWhy ProfessionalsProfessionals AreAre atat RiskRisk forfor DevelopingDeveloping VicariousVicarious TraumaTrauma Empathy – become vulnerable to internalize the child’s or adult’s trauma related pain.

Insufficient Recovery Time – listen to traumatic events over and over, 24/7, don’t have time off to heal or distance away. Small stresses are cumulative and add up!

Unresolved Personal Trauma – have own trauma that is “reactivated” when talking with child, increased risk for internalizing.

Children are the most vulnerable members of society - young children are completely dependent on adults when maltreatment happens, which evokes strong reactions in a person who cares about children. Caregivers have an increased risk for strong emotional reactions. EmpathyEmpathy IsIs thethe KeyKey

Empathy is the ability to identify with another person, to understand and feel another person’s pain and joy.

The cumulative impact of trauma clients’ stories and reenactments can carry enormous emotional costs for therapists.

Vicarious trauma happens because you care about people who have been hurt.

When you identify with the pain of people who have endured terrible things, you bring their grief, fear, anger, and despair into your own awareness and experience. EmpathyEmpathy ContinuedContinued

„ Vicarious trauma happens not only because you care about people who have been hurt, but because you feel committed or responsible to help.

„ Your commitment and sense of responsibility can lead to high expectations and eventually contribute to your feeling burdened, overwhelmed, and perhaps hopeless. RecognizingRecognizing MyMy OwnOwn VTVT

„ HasHas VTVT affectedaffected mymy worldworld view?view?

„ HasHas VTVT affectedaffected mymy personalpersonal relationships?relationships?

„ HasHas VTVT affectedaffected mymy sensesense ofof hopehope oror meaningmeaning inin life?life? PhysicalPhysical IndicatorsIndicators

„ HeadachesHeadaches

„ StomachStomach achesaches

„ LethargyLethargy PersonalPersonal IndicatorsIndicators

„ SelfSelf--isolationisolation

„ CynicismCynicism

„ MoodMood swingsswings

„ IrritabilityIrritability withwith spouse/familyspouse/family WorkplaceWorkplace IndicatorsIndicators

„ AvoidanceAvoidance ofof certaincertain clientsclients

„ MissedMissed appointmentsappointments

„ TardinessTardiness

„ LackLack ofof motivationmotivation TheThe EffectsEffects ofof VTVT

„ PersistentPersistent feelingsfeelings ofof fearfear andand vulnerabilityvulnerability toto assaultassault „ DifficultyDifficulty trustingtrusting othersothers „ IntrusiveIntrusive thoughtsthoughts ofof violenceviolence „ HopelessnessHopelessness regardingregarding makingmaking aa differencedifference inin clientsclients’’ liveslives „ CynicalCynical viewview ofof thethe worldworld HowHow toto AddressAddress VTVT

33 levels:levels:

I.I. ProfessionalProfessional LifeLife II.II. OrganizationalOrganizational LevelLevel III.III. PersonalPersonal LifeLife ProfessionalProfessional LifeLife

„ ProfessionalProfessional ConnectionConnection

„ SupervisionSupervision andand ConsultationConsultation

„ AdvancedAdvanced TrainingTraining

„ BALANCEBALANCE OrganizationalOrganizational LevelLevel

„ OrganizationalOrganizational SupportSupport

„ NetworkingNetworking withwith OtherOther TherapistsTherapists

„ BOUNDARIESBOUNDARIES PersonalPersonal LifeLife

„ CreatingCreating SpaceSpace toto bebe HumanHuman „ PhysicalPhysical ActivityActivity „ SpiritualitySpirituality „ SocialSocial ActivismActivism „ PersonalPersonal TherapyTherapy „ VTVT ConsultationConsultation ParallelParallel EmotionalEmotional ReactionsReactions

„ WorkersWorkers oror fosterfoster parentsparents maymay findfind themselvesthemselves experiencingexperiencing symptomssymptoms thatthat mirrormirror theirtheir clients,clients, suchsuch asas nightmares,nightmares, dissociation,dissociation, angeranger andand otherother elementselements ofof PTSD.PTSD. „ VTVT reactionsreactions toto clientclient--presentedpresented traumastraumas areare normalnormal andand adaptiveadaptive.. „ ThisThis isis aa painful,painful, butbut preventablepreventable processprocess forfor workers.workers. HowHow AreAre YouYou TakingTaking CareCare OfOf Yourself?Yourself?

„ DoDo youyou havehave soso muchmuch vacationvacation timetime builtbuilt upup thatthat youyou couldcould nevernever useuse itit all?all? „ WhenWhen waswas thethe lastlast timetime youyou tooktook thethe dayday offoff toto relax?relax? „ HowHow dodo youyou ““treattreat”” yourself?yourself? „ DoDo youyou findfind yourselfyourself soothingsoothing oror treatingtreating moremore oftenoften thanthan youyou usedused to?to? InappropriateInappropriate MethodsMethods ofof SoothingSoothing

„ OverOver EatingEating „ OverOver SpendingSpending „ CoCo DependentDependent RelationshipsRelationships „ Alcohol/DrugsAlcohol/Drugs „ InappropriateInappropriate SexualSexual OutletsOutlets AppropriateAppropriate MethodsMethods ofof SoothingSoothing

„ RelaxationRelaxation „ BriefBrief MeditationMeditation „ ExerciseExercise ofof DisciplineDiscipline „ RecognizeRecognize thatthat youyou havehave aa choicechoice andand thatthat itit’’ss okok toto saysay NO.NO. LimitLimit YourYour ExposureExposure toto TraumaTrauma

„ If you are a foster parent, be careful not to take too many traumatized children into your home. If you are over-extended, you risk re-traumatizing them by not being able to meet their emotional needs. „ To be truly compassionate and helpful, learn and stick to your own limits about what you can and can not handle, not what (you think) others expect you to be able to handle. „ There is a preferred time and place to talk about past trauma (in therapy or during private time, not at church, school, or during family breakfast). FindingFinding ConsultationConsultation (information,(information, advice,advice, helphelp andand support)support)

„ InIn mymy organizationorganization „ AmongAmong mymy colleaguescolleagues „ InIn mymy personalpersonal lifelife

Who?Who? WhatWhat kindkind ofof help?help? DonDon’’tt WaitWait UntilUntil YouYou CanCan’’tt HandleHandle AnyAny MoreMore

„ IfIf youyou areare havinghaving problemsproblems getget helphelp rightright away.away. „ BeBe honesthonest withwith yourselfyourself ifif thethe thingsthings youryour clientclient’’ss oror childrenchildren telltell youyou areare bothersome.bothersome. „ WhenWhen speakingspeaking withwith children,children, reinforcereinforce thatthat abuseabuse isis nevernever thethe childchild’’ss fault,fault, andand neitherneither areare youryour strugglesstruggles withwith it.it. BEWAREBEWARE ofof thethe ““Yes,Yes, butbut…”…” SyndromeSyndrome

„ Have you been sitting in this training thinking that the advice is good for others, but your family or job has too many immediate needs to put your self- care first?

„ Would you say “Yes, but…” if a doctor told you lifestyle changes would save your health and give you more years with your family?

„ If you find yourself making excuses, ask people you trust to help you stay on track. ProcessingProcessing ThisThis DifficultDifficult WorkWork

WhatWhat II StillStill NeedNeed…… Thanks,Thanks, ThanksThanks andand MoreMore Thanks!Thanks!

„ ThanksThanks forfor allall thethe workwork youyou dodo everydayeveryday forfor children.children. NeverNever minimizeminimize youryour importanceimportance andand significance.significance. „ RememberRemember 100100 yearsyears fromfrom now,now, itit willwill notnot mattermatter howhow muchmuch moneymoney waswas inin mymy bankbank account,account, thethe typetype ofof househouse II livedlived in,in, oror thethe kindkind oror carcar II drove,drove, butbut whatwhat willwill mattermatter isis thatthat II waswas importantimportant inin thethe lifelife ofof another.another. ConclusionConclusion

„„ KnowKnow whatwhat VicariousVicarious TraumaTrauma isis „„ KnowKnow whatwhat symptoms/indicatorssymptoms/indicators toto looklook forfor „„ KnowKnow youryour limitslimits „„ KnowKnow youryour supportsupport systemsystem andand useuse itit „„ TakeTake advantageadvantage ofof allall youryour resourcesresources ResourcesResources

„ APAC for support/training/answers to questions www.casapac.org

„ ADAP for help with school issues www.adap.net

„ ARC help for children with mental retardation www.thearc.org

„ www.ChildTrauma.org

„ www.CrisisCounseling.org

„ The Traumatic Stress Institute (860) 644-2541 http://www.tsicaap.com

„ The Traumatology Institute School of Social Work FSU (850)644-4751 http://learningforlife.fsu.edu/traumatology

„ International Society for Traumatic Stress Studies (ISTSS) (847)480-9028 http://www.istss.org ResourcesResources

„ The Cost of Sharing: Secondary Traumatic Stress. David Conrad, LCSW. Vol. XVIII No. 3 The Secondary Trauma Prevention Project: sponsored by the Colorado Department of Human Resources. Fall 2004

„ The Cost of Sharing: Secondary Traumatic Stress and the Impact of Working with High- Risk Children and Families. Bruce D. Perry, M.D., Ph.D. The Child Trauma Academy. 2003

„ Daddy, Are we going to have World War III? Understanding and Dealing with Secondary Trauma in Children. Michael G. Conner, Psy.D, Clinical, Medical & Family Psychologist. Published in the Family News, 2001

„ Strategies for Reducing Secondary or Vicarious Trauma: Do they work? Ted Bober, MSW, Cheryl Regehr, PhD. Oxford University Press. December 30, 2005.

„ C.R. Figley: Compassion fatigue: Coping with secondary traumatic stress in those who treat the traumatized

„ David Conrad: Secondary Trauma and Foster Parents: Understanding its Impact and Taking Steps to Protect Them

„ Marc Parent: Turning Stones: My Days and Nights with Children at Risk

„ Rachel Remen: Kitchen Table Wisdom