VICARIOUS TRAUMATIZATION, SECONDARY TRAUMATIC STRESS, AND BURNOUT IN SEXUAL ASSAULT AND DOMESTIC VIOLENCE AGENCY STAFF AND VOLUNTEERS Stephanie Baird, B.S. Thesis Prepared for the Degree of MASTER OF SCIENCE UNIVERSITY OF NORTH TEXAS August 1999 APPROVED: Sharon R. Jenkins, Major Professor Vicki Campbell, Committee Member Ed Watkins, Committee Member Ernest Harrell, Chair of the Department of Psychology C. Neal Tate, Dean of the Robert B. Toulouse School of Graduate Studies Baird, Stephanie, Vicarious traumatization, secondary traumatic stress, and burnout in sexual assault and domestic violence agency staff and volunteers. Master of Science (Counseling Psychology), August 1999, 180 pp., 17 tables, 110 references. Two constructs, vicarious trauma (VT) and secondary traumatic stress (STS), describe therapists’ reactions to clients’ traumatic material. VT (TSI Belief Scale [BSL]), emphasizes cognitive belief system changes resulting from cumulative exposure to survivors. STS, (Compassion Fatigue Self-test for Psychotherapists [CFST]) combines PTSD and burnout symptomatology explaining sudden adverse reactions to survivors. Burnout (BO; Maslach Burnout Inventory [MBI]), links emotional exhaustion, depersonalization, and deficient personal accomplishment to inadequate institutional supports in interpersonally demanding work. This study investigated BSL and CFST validity, counselor trauma history, and client exposure-related VT, STS, and BO in 105 trauma counselors. Results demonstrate concurrent validity between BSL and CFST; other results dispute adequate validity. BO, and client exposure were related. Traumatized counselors scored higher than non- traumatized counselors on CFST, BSL, and SCL-90-R. ACKNOWLEDGMENTS I would like to acknowledge and thank the following people who provided invaluable help, support, and inspiration throughout this process. Foremost, I thank the chair of my committee, Dr. Sharon Rae Jenkins, for her countless hours, weeks, and months of time and energy devoted to shaping and polishing this research. This would not be the product it is without her immeasurable insight and editing skill. Shaneka Morris and Sarah Roby spent several hours coding open-ended data, easing my workload. Carlos Partido helped with bureaucratic tasks. Veronica Vivero provided essential statistical help. Rebecca Weston, Kay Wilcots, Craig Henderson, Kitty Roberts provided technical support at various junctures. Belinda and Alan Baird, Kevin Lindstrom, Alifair Skebe, Evelinn Borrayo, Diana Conner, David Shepard, and Jonnalee Barta provided emotional support. Julie Behnken helped jump-start my work, providing several months of constant motivation. Dr. Claire Sahlin unwaveringly voiced her belief and support regarding my abilities. Members of Dr. Jenkin’s research team, from 1996 to 1999, also provided insight and support. I thank my best friends who always believed in me: Lindsey Seigle, Melinda Barsales, Tanika Kumar, Karla Krupala, Lynn Murray, and Stephanie Rasbury. Ethan Brown rendered a constant source of humor, peace, and reality-checking during the final phases, helping me remember what it’s all about. Bruce and Carol Baird, my parents, provided monetary assistance at various points, always assuming I could do this project, another fact I appreciate. I acknowledge the 1998 UNT Women’s and Gender Studies Summer Research Fellowship I received for this project. Lastly, I acknowledge and thank the hard-working, motivated, and socially-conscious participants and individuals involved in data collection (agency coordinators, staff and volunteer respondents). I only hope that this research provides them with as much insight and assistance as they provided me. ii TABLE OF CONTENTS Page ACKNOWLEDGMENTS.............................................................................................. ii TABLE OF CONTENTS.............................................................................................. iii LIST OF TABLES........................................................................................................ v Chapter I. INTRODUCTION AND LITERATURE REVIEW..................................... 1 Survivor's Responses to Trauma Sexual Assault Survivors Domestic Violence Survivors Others' Responses to Trauma Countertransference Secondary Traumatic Stress Vicarious Traumatization Burnout Paired Comparisons Between the Theoretical Constructs Present Study II. METHODOLOGY...................................................................................... 87 Participants Procedure Instruments III. RESULTS................................................................................................... 105 Descriptive Statistics Measurement Validity Analyses Hypothesis-testing Analyses iii IV. DISCUSSION........................................................................................… 130 Introduction Measurement Validity Therapists’ Exposure to Trauma Clients Therapists’ Trauma History Associations Between Trauma and Counseling History and Symptoms Other Demographic, Predictor, and Outcome Variable Analyses Strengths and Limitations/Recommendations for Future Research VI. APPENDICES........................................................................................... 157 REFERENCES...........................................................................…………….............. 168 iv LIST OF TABLES Table Page 1. Sample's Demographic Characteristics........................................................ 89 2. Predictor Descriptive Frequency Statistics................................................... 107 3. Predictor Descriptive Statistics..................................................................... 108 4. Sexual Assault and Domestic Violence History (TSI-Life Events Checklist)...................................................................................................... 109 5. Trauma and Personal Counseling History.................................................... 109 6. Outcome Measure Descriptive Statistics...................................................... 110 7. Associations Among Demographics............................................................. 112 8. Correlational Associations between Demographics and Outcome Variables........................................................................................................ 115 9. T-Test Analyses of Staff/Volunteer Status and MBI Scores........................ 116 10. T-Test Analyses of Race and Outcome Variables...................................... 116 11. T-Tests of Sexual Assault and/or Domestic Violence Trauma History and Outcome Variables....................................................................................... 117 12. T-Tests for Independent Samples of Sexual Assault Trauma History and the CFST..................................................................................................... 118 13. T-Tests for Independent Samples of Domestic Violence Trauma History and Outcome Variables.............................................................................. 119 14. Validity Correlations Among Outcome Variables..................................... 122 15. Hypothesis 1: Associations Among Predictor and Outcome Variables...... 126 v 16. Hypothesis 2: T-Tests of Personal Sexual Assault and Counseling History with the TSI-BSL and SCL-90-R............................................................... 128 17. Hypothesis 2: T-Tests of Personal Domestic Violence and Counseling History with the CFST............................................................................... 129 vi CHAPTER I INTRODUCTION AND LITERATURE REVIEW An event may be considered traumatic if the sufferer is unprepared for the unexpected event, with the event overwhelming their ability to adapt, resulting in the disruption and shattering of their basic cognitive schemas and assumptions about the world (Figley, 1985; Janoff-Bulman,1985; and McCann & Pearlman, 1990). To clarify, the DSM-IV stipulates that an extreme traumatic stressor can involve direct personal experience of an event that involves threatened death, actual, or threatened serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or close associates. (APA, 1994, p. 424) However, as this definition implies, traumatic events do not occur in a vacuum. Rather, traumatic events hold tremendous meaning for those touching the survivors' lives, affecting all persons involved. In fact, the effects and ramifications of trauma are not limited solely to the survivor, but have also been shown to affect those that help the survivor, such as emergency medical workers or health care providers for seriously ill patients, and most recently in the literature, mental health professionals. These effects 1 are now being conceptualized as secondary traumatic stress (STS) and vicarious traumatization (VT). An examination of the current major research validates the concept that those who work with trauma clients may indeed develop reactions specific to the traumatic nature of the client material. Most commonly, service providers such as sexual assault (SA) counselors or police officers with high numbers of SA clients begin to suffer PTSD-like symptoms after frequent exposure to SA survivors (Alexander, de Chasney, Marshall, Campbell, Johnson, & Wright, 1989; Farrenkopf,