Treading gently through the minefield: a rough guide to

vicarious traumaDr. Roxane Agnew-Davies

Domestic Violence Training Ltd.

Manchester, 2007

Objectives

• Explore issues that come up for you or other staff when working with women who have experienced violence

• Support building on self-care strategies

• Implications for supervision

The first few minutes

What do you need before you are ready to start? – Write down what you have done today already

– Think about your ‘to do’ list; what do you need to commit to do another time

– Write 1 phrase what you want from this session;

how will you know you got what you want?

& how this applies to work..

Making staff sessions safe

Perhaps by discussing confidentiality space to learn, to be honest; not to be alone freedom from judgment (yours and others) responsibilities (yours and others) pacing and priorities

Challenges for professionals working with violence and abuse

Fear of offending clients

Myths hook us too

Feelings of inadequacy and frustration

Feeling dumped upon

Lack of training or time to read/reflect

Coping with the stigma

Inability to ‘cure’ the problem

Lack of time to deal with everything

Close identification from own experience abuse

Fear of opening Pandora’s box

Women experiencing abuse

Primary abuse

impacts of

physical, sexual and emotional violence

Secondary victimisation

impacts of responses of friends and family

and professionals

…….look for the shadows

How does domestic violence impact way(s) she is with staff?

Avoiding pain/at risk-

she does not turn up

Still frightened-

asks the impossible

Powerless-

sees staff as rescuer

Furious-

‘leaks’ anger at staff

Blamed-

blames self or staff

Traumatic bonding-

eager to please

Mourning-

flat, hard to be with

Vulnerable-

acts tough, scary

Connecting our reaction with woman’s difficulties

• Woman is numbing

• Woman is grieving

• Woman is furious

• Woman feels helpless

• Worker feels pressure to invade her space

• Worker allows special ‘demand’eg extra time

• Worker feels fear, or defensive - aggressive

• Worker feels helpless

impatient or powerful

Secondary effects of domestic violence

Also called ‘vicarious traumatisation’

‘traumatic counter-transference’

Are a normal reaction

to working with abuse and violence

therefore

No-one should work with trauma alone

I want to know if you can sit with pain, mine or your own, without moving to hide, or fade it or fix it…

Workers bear witnesses

We can

Know the trauma will somehow be replayed

Explore the effects on our feelings

Contain our reactions and get/offer support

See our reaction as an index, just like the client’s behaviour as something to

reattribute to the violence

Exercise (in 2 or 3)

Think of a woman you work(ed) with, who you had strong feelings about

Anxiety? Sadness? Guilt? Fear?Anger? Frustration?

Then remember what you did? Achieved? Offered?

Separate what happened to her from your roleHow are you different in her life?

What opportunities did you create?

Options to help you and her

Don’t take it personally! See the shadows…

Ask Is that what (abuser) said/ made her feel? What happened that she had to learn to.. What she feels is happening (what is triggered)

Separating your relationship with client from what others did to her will help you both

Ex. in 2s: Re-attribute responsibility

Are you/she taking blame for things that are not your fault?

Do you focus on what you haven’t done / she hasn’t achieved?

What’s your time scale for client change?

Discuss her role and who’sresponsible for problems

Ask what she did do / say what you have done

Think short & long term not ‘now’ vs never

Options to regain self worth

Key message:

The abuser, not you, is accountable for the problems

What stage was the earthquake?

Who else could have helped and didn’t?

Who was the cause of the problem?

Can you reattribute responsibility?

Ex: How does work affect you?

• Physically- Fear reactions- Sleeping difficulties

• Mentally- Memories- Doubts

• Emotionally- Irritable, sad- Feeling overwhelmed

• Beliefs– Trust (all men danger)– Safety (no safe place)– Power (have none/all)– Reference (her/him)

• Behaviour- Denial of feelings- Self medication- Sickness, absences

Why do you go to work?

Take a few minutes to discuss in 3s

- Why you get out of bed & go to work

- What you stand for; who you are at work

- What your success moments look like

Key messages

Having emotional reactions to work does not make us wrong or bad at our job.

We are not responsible for the violence or its effects on the client or us

Our self esteem should not depend on the outcome of the case

Questions

• How often do you celebrate who you are?

• When/who do you tell about your success?

• How do you feel as you go home most days?

Endorse strengths/successes

Counteract abuseself doubtcriticismblameproblems

By Recognisingstrength

couragecreativity

perseverance

Key messages:Reframe causes ofproblems to D.V. Counterct emtional abuseCriticism punshmtWithWhat do you admire?What are you proud of?

Be specific

Coping strategies

• Legal strategies• Formal help-seeking• Informal help-seeking• Escape strategies• Separation• Hiding• Appeals to abuser

• Compliance• Resistance• Self-defence• Manages children• Personal strategies

outcome vs achievement

for us and our clients

Tips if you feel anxious

• Identify triggers• Prioritise your own safety• Separate yourself from the client• Identify thinking – ‘burglar’ vs ‘cat’• Check you/client set realistic goals• Look after your bodily needs – exercise,

caffeine, smoking, lunch, relaxation, breathing, sleep….dancing!

Tips if you keep remembering…

Tell someone about it; include feelingsWrite it down; include thoughts/ feelingsSeparate client memory from what you didBuild a safe container (real/imagined)VCR technique: replay the ending the way

you want

Suggestions if you can’t sleep

• Make a routine

• Make bed and bedroom a place to rest

• Eat at least 2 hours before – go easy on sugar, alcohol, cigarettes, horror!

• Exercise during day

• Try relaxation, meditation

• Focus on the positives – put problems away

Exercise

• Think of something at work you haven’t done –been putting off

or

• Has someone criticised you for not doing something?

and

how that makes you feel about yourself

Suggestions if you feel low

• Remember its normal to feel sad

• Plan for time spent, not outcome– Break tasks into small chunks

• Identify & challenge negative thoughts

• Focus on what you have done not what is still to be done

• Express anger!

Exercise

On a post-it

Write a sentence– I am angry at you for– I resent you for

Workers have the right to feel angry

• as a natural reaction to the abuse

• as normal as breathing

• as not the same as violence

• as healthy to express rather than suppress

• as part of assertion

• As possible to separate into manageable, directed chunks

Encourage assertion

• What are a worker’s personal rights– e.g. to make mistakes, to feel safe

• Watch for inner dialogue –» about yourself or other person» About what it means» About the worst that can happen (bag lady?!)

• Being assertive means– Be brief; use ‘I’ not ‘you’; ask for information– Respect the other person’s point of view

Helping to be assertive

• Say what you want/prefer - not ‘I ‘can’t’

• Being empathic does not mean being blamed

• Ask for time to think, to plan, walk away

• Look for parts to agree/disagree, rather than all-nothing thinking

• Separate past from present and person(s)

How DV can affect beliefs

Justice

Safety

Trust

Power

Esteem

Relationships

• What sort of world?• Can I be safe?• Can I trust anyone?• Do I have power if I

cannot stop..• Am I worth anything

given how they see me• How do I relate to..

The miracle worker

Offers support examinesattitudes understands DVcollaborates with others

advocates acts as role model can cope with complexity deals with own anger tolerates horror and terror respects believes creates support system

The miracle worker

The ideal supervisor

Offers:Safe structureRegular meetingsAcknowledgement

of feelingsRespect rather than

criticism

Open door in response to crises

Offers support & empowerment

Models the process

Keeps clinical and operational issues separate

And the ideal supervisor..

is:

Polite not PatronisingHonest, not SarcasticInterested, not BoredListens; doesn’t Interrupt

Empowers; doesn’t Fix it Ready to ask, not assume

Asks: Why were you…?• Frustration/overload• Fear (maybe of losing.. ..)• Personal life events or

pressures• Feels no-one is listening• Previous experience of

problematic staff/other• Enacting p& c • Defence/self-worth low

Set Boundaries (your own)

Clear limitsAgreed timeAgreed durationContact between meetingsAgreed number/end

Set expectations that arerealistic

achievablechosen by

both/clear

Our roles should beexplicit

defined by limitsempowering

Foster trust

Success depends on our trusting others and our integrity to be worthy of trust:

-be honest, even if its difficult-ask if you are not sure-check she is getting what she wants-think degrees not splits-resist omnipotence or helplessness-tolerate differences with respect

And get endings right!

- An opportunity to learn about completion

- You will never end with clients if all problems have to be solved – your role is to provide the tools not the answers

- You have the right to manage your own ending, whatever the client chooses

Exercise

• One thing you are taking away – that you learned or achieved. Did you get what you wanted?

• One thing you are disappointed about/ can you commit to sort another time/place?

• Then say goodbye (the actual words!)

Dr. Roxane Agnew-Davies

Mental Health Advisor, GLDVP

Research Fellow, South Bank University

Domestic Violence Training Ltd

roxane @ dvtltd.com

0797 495 2313