Reactions to Secondary Reactions to Secondary Traumatic ExposuresTraumatic Exposures

Dorothy Morgos, PH.DDorothy Morgos, PH.DUNMIS Staff CounselorUNMIS Staff CounselorAhfad University, 2010Ahfad University, 2010

What is Secondary Traumatic What is Secondary Traumatic Exposure?Exposure?

Exposure to traumatic material when working with traumatized individualsExposure to traumatic material when working with traumatized individuals

Traumatic situations are not a direct threat to helpers themselvesTraumatic situations are not a direct threat to helpers themselves

Exposures are common among:Exposures are common among:Trauma counselorsTrauma counselorsRescue workersRescue workersHumanitarian workers/crisis intervention volunteersHumanitarian workers/crisis intervention volunteersMedical workersMedical workers

Exposures range from a single episode to frequent and high intensityExposures range from a single episode to frequent and high intensity

Reactions to Secondary Traumatic Reactions to Secondary Traumatic ExposuresExposures

Range from stressful to full blown traumatic reactionsRange from stressful to full blown traumatic reactions

Could be both short and long termCould be both short and long term

General terms used to describe a range of reactions:General terms used to describe a range of reactions:– Emotional exhaustionEmotional exhaustion– Burn outBurn out– Compassion fatigueCompassion fatigue

Traumatic reactions are usually called Vicarious Trauma Traumatic reactions are usually called Vicarious Trauma (VT) or Secondary Trauma (ST)(VT) or Secondary Trauma (ST)

Differences Between Burnout and Differences Between Burnout and Vicarious Trauma (VT)Vicarious Trauma (VT)

Burnout SymptomsBurnout Symptoms

Result of general stress in a working environmentResult of general stress in a working environment

Feeling overloaded secondary to workloadFeeling overloaded secondary to workload

Feeling overwhelmed by clients problems of chronicity and Feeling overwhelmed by clients problems of chronicity and complexitycomplexity

Gradual progression of “emotional exhaustion”Gradual progression of “emotional exhaustion”

Does Does NOTNOT usually lead to usually lead to Changes of core believes known as “cognitive schema”Changes of core believes known as “cognitive schema”Safety concernsSafety concernsSignificant relationship difficultiesSignificant relationship difficulties

What are Traumatic ReactionsWhat are Traumatic Reactions

Traumatic reactions are a higher level of stressful symptoms Traumatic reactions are a higher level of stressful symptoms

Common term is Posttraumatic Stress Disorder ( PTSD)Common term is Posttraumatic Stress Disorder ( PTSD)

Symptoms are usually present for at least one month or more when Symptoms are usually present for at least one month or more when stressful event is no longer presentstressful event is no longer present

Intrusive reactions:Intrusive reactions:– Dreams/nightmaresDreams/nightmares– FlashbacksFlashbacks– Obsessive thoughtsObsessive thoughts– Physiological reactionsPhysiological reactions– Persistent re-experiencing of eventPersistent re-experiencing of event

What are Traumatic Reactions What are Traumatic Reactions Cont..Cont..

Hyper-Arousal Reactions:Hyper-Arousal Reactions:Hyper-vigilanceHyper-vigilance

Difficulty concentratingDifficulty concentrating

Avoidant Reactions:Avoidant Reactions:General numbing in responsiveness General numbing in responsiveness

Avoidant behaviors related to traumatic situations Avoidant behaviors related to traumatic situations

Symptoms are usually pervasive in nature Symptoms are usually pervasive in nature

What is Vicarious TraumaWhat is Vicarious Trauma

The inner transformation that occurs in the inner The inner transformation that occurs in the inner experience of the professional that comes about as a experience of the professional that comes about as a result of empathic engagement with the clients “trauma”result of empathic engagement with the clients “trauma”

Cumulative in natureCumulative in nature

May parallel those experienced by the traumatized May parallel those experienced by the traumatized victimsvictims

More common among those who work with traumatized More common among those who work with traumatized populationpopulation

What is Vicarious Trauma Cont..What is Vicarious Trauma Cont..

Key Characteristics include:Key Characteristics include:

Feeling helpless/hopeless regarding taking care of Feeling helpless/hopeless regarding taking care of themselves and othersthemselves and others

Disillusionment about concepts of justice and freedomDisillusionment about concepts of justice and freedom

Change in person’s beliefs ( Cognitive schema)Change in person’s beliefs ( Cognitive schema)SelfSelf

OthersOthers

WorldWorld

Characteristics of Vicarious Trauma Characteristics of Vicarious Trauma Cont…Cont…

Mood disturbance ( e.g. anxiety, depression)Mood disturbance ( e.g. anxiety, depression)

De-personalizationDe-personalization

Feeling of reduced personal accomplishmentsFeeling of reduced personal accomplishments

Change in “psycho-social” relationshipsChange in “psycho-social” relationships

Increased feelings of cynicism, sadness or seriousnessIncreased feelings of cynicism, sadness or seriousness

Increased sensitivity towards violenceIncreased sensitivity towards violence

Distrustful and alienationDistrustful and alienation

Alcohol and drug abuseAlcohol and drug abuse

Impact of Vicarious TraumaImpact of Vicarious Trauma

OrganizationsOrganizations

High worker turnoverHigh worker turnover

Ongoing conflicts within and between organizationsOngoing conflicts within and between organizations

Poor productivity and/or over conscientiousPoor productivity and/or over conscientious

Re-enactment of issuesRe-enactment of issuesBetrayalBetrayalSecrecySecrecyMistrustMistrustRageRageBoundary violationsBoundary violations

Impact of Vicarious Trauma Impact of Vicarious Trauma Cont..Cont..

When working with traumatized individualsWhen working with traumatized individuals

Clinical errors and impassesClinical errors and impasses

Compromising boundaries with victimsCompromising boundaries with victims

Anger towards clientsAnger towards clients

Doubts in judgment/assessment and techniquesDoubts in judgment/assessment and techniques

Loss of focus on individual’s resilienceLoss of focus on individual’s resilience

Avoidance or untimely intrusiveness when going in depth with Avoidance or untimely intrusiveness when going in depth with traumatized individualstraumatized individuals

Reversal of rolesReversal of roles

Effective Peer Support StrategiesEffective Peer Support Strategies

Use effective listening and assessment skillsUse effective listening and assessment skills

Acknowledge that sharing provides social Acknowledge that sharing provides social supportsupport

Vending avenueVending avenueDecreases sense of isolationDecreases sense of isolationIncreases empathy and compassionIncreases empathy and compassion

Normalization of VT experiencesNormalization of VT experiencesAmends cognitive distortions/disruptionsAmends cognitive distortions/disruptionsIncreases objectivity and empathyIncreases objectivity and empathy

Effective Peer Support Cont..Effective Peer Support Cont..

Provide an avenue to assess ideologiesProvide an avenue to assess ideologiesEthical issuesEthical issuesView of self and othersView of self and othersSpiritual strugglesSpiritual strugglesViews of justiceViews of justice

EducationEducationLearning the different types of traumatic events and their Learning the different types of traumatic events and their impactimpactTraumatic material affects different areas of ones well beingTraumatic material affects different areas of ones well beingIntensity of exposure, personal history and level of training Intensity of exposure, personal history and level of training impact VTimpact VT

Effective Peer Support Cont..Effective Peer Support Cont..

Organizational supportOrganizational support

Reduce case loadsReduce case loads

Provide effective and supportive supervisionsProvide effective and supportive supervisions

Keep supervision separate from evaluationKeep supervision separate from evaluation

Provide debriefing opportunitiesProvide debriefing opportunities

Increase social interactions between co-workersIncrease social interactions between co-workers

Provide respite care system and means for self-careProvide respite care system and means for self-care

Create a non shaming work environmentCreate a non shaming work environment

Encourage staff to provide feedback and suggestions on Encourage staff to provide feedback and suggestions on increasing a “supportive working culture”increasing a “supportive working culture”

Effective Peer SupportEffective Peer Support

Self-Care strategies for VTSelf-Care strategies for VTPhysical self-carePhysical self-care

DietDietExerciseExerciseSleep hygieneSleep hygieneFrequent recreational activitiesFrequent recreational activities

Relying on religious beliefs or spiritualityRelying on religious beliefs or spiritualitySocial support within and outside working environmentSocial support within and outside working environmentSeeking counseling/consultation as neededSeeking counseling/consultation as neededSocio-political involvementSocio-political involvementContinuing educationContinuing educationSustaining professional support outside working environmentSustaining professional support outside working environmentHUMORHUMORIdentifying, reminding oneself and owning successIdentifying, reminding oneself and owning success