THE SECONDARY TRAUMA & EMPATHIC STRAIN TOOLKIT Developed by Françoise Mathieu, M.Ed., CCC., RP Executive Director, TEND MULTIPLE EXPOSURE: INCREASED RISK Personal Vulnerabilities Socio-Cultural Context Working Work-related Conditions Traumatic Grief/Loss Direct Exposure Systems Failure Indirect Trauma Empathic Strain Image courtesy of Dr. Leslie Anne Ross, UCLA © TEND 2020 | www.tendacademy.ca | 2 Indirect Trauma Secondary or Vicarious trauma is caused by an indirect exposure to trauma: you are not in actual danger, you are not at the scene of the traumatic event seeing first-hand the results of a shooting rampage or an accident. Instead, those stories are described to you verbally, in writing or through audio or video recordings. Secondary traumatic exposure can happen through counselling a client who is retelling a story of abuse, reading case files, debriefing a colleague or a client, sitting in court and hearing graphic testimonies or watching a disturbing movie or traumatic news footage. Many first responders such as firefighters and paramedics are at risk of developing primary trauma in addition to the secondary trauma they are exposed to in the line of duty. Empathic Strain (Compassion Fatigue) Compassion fatigue, now more commonly referred to as Empathic Strain (ES) refers to the profound emotional and physical exhaustion that helping professionals and caregivers can develop over the course of their career as helpers. It is a gradual erosion of all the things that keep us connected to others in our caregiver role: our empathy, our hope, and of course our empathy - not only for others but also for ourselves. When we are suffering from Empathic Strain, we start seeing changes in our personal and professional lives: we can become dispirited and increasingly bitter at work, we may contribute to a toxic work environment, we are more prone to work errors, we may violate confidentiality and lose a respectful stance towards our students and colleagues. We become short-tempered with our loved ones and feel constant guilt or resentment at the never-ending demands on our personal time. Systems failure Grappling with roadblocks in the systems that we work with. Feeling angry and/or frustrated about a lack of resources, disagreeing about someone’s eligibility for a service, there are many examples of systems failure. One result of facing these numerous challenges is moral distress. Moral distress occurs when we are told to do things that we fundamentally disagree with or are morally opposed to. When our values conflict with what is required by law or other rules and regulations. Working Conditions Working conditions are profoundly affected by our workplace relationships, sense of trust, quality of communication, perceptions of fairness, workload, who we directly report to, overall workplace climate, rewards, recognitions and many other factors. Socio-cultural Context The socio-cultural context of the community, state or country that we live in can profoundly impact our daily levels of stress. Being a member of a minority group and having to navigate discrimination or safety concerns on our way to and from work and even in the workplace. The current political climate, media, being exposed to cyber bullying etc. © TEND 2020 | www.tendacademy.ca | 3 ASSESS YOUR PHYSICAL & PSYCHOLOGICAL RESILIENCE Adapted from: Saakvitne, K. W., and Pearlman, L. A. (1996). Transforming the Pain: A Workbook on Vicarious Traumatization. New York, NY: W.W. Norton. & Loehr, J., and Schwartz, T. (2003). The Power of Full Engagement: Managing Energy, Not Time, Is the Key to High Performance and Personal Renewal. Free Press. Instructions: X Indicate what you already do 0 Circle what you wish you did more often Body I eat regularly, eating when hungry and stopping when full I maintain a healthy weight I eat lots of vegetables and fruits throughout the day I choose whole grains, non-processed fruits, and limit my sugar intake I have healthy snacks with me in my office, on the road, and at home I drink at least 8 cups of fluid (water or other healthy options) throughout my day I use the stairs whenever possible I walk or cycle to meetings, appointments, and other outings whenever possible I use work breaks or lunchtime to stretch, go for a walk, or take an exercise class I do activities that strengthen my muscles, bones, and improve posture 2-3 times a week I do stretching and balancing activities 2-3 times a week I accumulate 150 minutes of active living/increased heart rate every week I get regular preventative and required health care I do physical activities that I find fun I make sure to get enough sleep I limit the amount of screen time I engage in I take regular vacations or time off Mind I play challenging games or puzzles I am curious and like to learn new things I break out of my normal routine or do things that are out of my comfort zone I read literature that is unrelated to work I do things that I am not an expert at or in charge of Heart I practice deep breathing during stressful times like short deadlines, traffic jams, etc. I have people I can share things with I practice receiving from others © TEND 2020 | www.tendacademy.ca | 4 I nurture intimate relationships I deal with situations directly I take time for myself everyday I volunteer for something that I feel is worthwhile I see the class as half full, rather than half empty I know when and how to say “no” I accept other people’s differences and the things I cannot change I treat myself with loving kindness as I would speak to someone I care about I allow myself to cry when needed I smile and laugh daily I engage in play regularly Spirit I take time to self-reflect I know what my values are I have a sense of purpose in life I seek to make a contribution in life I have hope I am aware of the non-material aspects of life I identify what is meaningful to me and notice its place in my life I take time to meditate/pray/contemplate I have experiences of awe I connect with things larger than myself e.g. nature, spiritual group, etc. REFLECTION Which section has more circles than X’s for you? MAKE A COMMITMENT Highlight one statement that you indicated you ‘wish you did more often’ and make a plan to incorporate that activity/statement into your day. © TEND 2020 | www.tendacademy.ca | 5 IDENTIFYING YOUR BIG THREE WARNING SIGNS Write down three warning signs that you are getting overloaded with stress (could be physical, emotional or behavioural): 1. 2. 3. © TEND 2020 | www.tendacademy.ca | 6 THE WINDOW OF TOLERANCE From: Ogden, P., Minton, K., and Pain, C. (2006). Trauma and the Body: A Sensorimotor Approach to Psychotherapy. New York, NY: Norton. Siegel, D.J. (1999). The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are. New York, NY: Guilford Press. Image credit: St. Michael’s Hospital, Toronto, ON. Mindful Awareness Stabilization Training (MAST). REFLECTION What am I like when I am stressed, upset or overwhelmed? Are these hyper or hypo arousal symptoms? What am I like when I am the best version of myself? © TEND 2020 | www.tendacademy.ca | 7 STRATEGIES TO REMAIN HEALTHY & COMPASSIONATE © TEND 2020 | www.tendacademy.ca | 8 © TEND 2020 | www.tendacademy.ca | 9 RECOMMENDED RESOURCES TEND Covid-19 Resources: www.tendacademy.ca/covid19/ TEND Covid-19 Articles: This is a Marathon, Not a Sprint: Strategies to Address Wear & Tear in Helping Professionals during Covid-19: www.tendacademy.ca/marathon-not-sprint-covid19/ Dealing with Stress & Uncertainty: www.tendacademy.ca/dealing-with-stress/ Leaders are People too: Staying Well During Covid-19: www.tendacademy.ca/leaders-are-people-too/ Today, Spare a Thought for The Call Centre Operators: www.tendacademy.ca/spare-a-thought-for-call- centre-operators/ Videos: Feet on the Floor: Grounding Strategy: www.tendacademy.ca/feet-on-the-floor/ Ten Strategies for Managing Compassion Fatigue & Secondary Trauma: www.youtube.com/watch?v=zy3MkhGyOrQ Empathic Strain/Compassion Fatigue, Secondary Traumatic Stress & Burnout: Borysenko, J. (2011). Fried: Why Your Burn Out and How to Revive. Carlsbad, CA: Hay House. Mathieu, F. (2012). The Compassion Fatigue Workbook: Creative Tools for Transforming Compassion Fatigue and Vicarious Traumatization. New York, NY: Routledge. Remen, R. N. (1996). Kitchen Table Wisdom. New York, NY: Riverhead Books. Rothschild, B. (2006). Help for the Helper: The Psychophysiology of Compassion Fatigue and Vicarious Trauma. New York, NY: W. W. Norton. Saakvitne, K. W., and Pearlman, L. A. (1996). Transforming the Pain: A Workbook on Vicarious Traumatization. New York, NY: W.W. Norton. © TEND 2020 | www.tendacademy.ca | 10 Stamm, B.H. (Ed.). (1999). Secondary Traumatic Stress: Self-care Issues for Clinicians, Researchers and Educators. (2nd Ed.). Lutherville, MD: Sidran Press. van Dernoot Lipsky, L. & Burke, C. (2009). Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others. San Francisco, CA: Berrett-Koehler. Resources Specific to Secondary Trauma & Culture, Race and Historical Trauma: Compiled by the National Child Traumatic Stress Network (NCTSN) Webinars: Cultural Implications of Secondary Traumatic Stress: National Child Traumatic Stress Network Webinar: https://learn.nctsn.org/enrol/index.php?id=234 STS Webinar Series: https://www.nctsn.org/trauma-informed-care/secondary-traumatic-stress It's Not All Black and White: Working with African-American Families in Post-Katrina New Orleans: National Child Traumatic Stress Network Webinar: https://learn.nctsn.org/enrol/index.php?id=351 Publications: Implicit Bias Tests: https://implicit.harvard.edu/implicit/takeatest.html Comas-Diaz, L.C., Hall, G.N., and Neville, H.A. (2019). Racial trauma: Theory, research, and healing: Introduction to the special issue.