OBJECTIVES: Provide definitions and brief history of Vicarious
Traumatization To understand how we are transformed and impacted in
our work To identify effects on helpers To begin to plan
individual, team and organizational strategies to reduce the risk
of vicarious traumatization Describe Symptoms of PTSD and Complex
Trauma
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Vicarious Trauma Vicarious traumatization (VT) is a
transformation in the self of a trauma worker or helper that
results from: empathic engagement with traumatized clients and
their reports of traumatic experiences. Includes disrupted sense of
meaning and hope
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CONTEXT OF WORK Defines self, skills and values Often drives
economic viability and security (health benefits, retirement)
Personal lifestyle, and lifestyle of family Provides structure,
routine and predictability May define social groupings
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DEFINITIONS OF VICARIOUS TRAUMATIZATION (VT) as the
transformation that occurs within the therapist (or other trauma
worker) as a result of empathic engagement with clients trauma
experiences and their sequelae. (Pearlman & Mac Ian, 1995)
clinicians who work with sexually abused clients or other victims
of trauma may experience profound psychological effects, effects
that can be disruptive and painful for the helper and can persist
for month and years after work with traumatized persons. (McCann
& Pearlman, 1990a; Pearlman & Saakvitne, 1995))
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VT occurs through exposure to the realities of peoples
intentional cruelty to one another, and through the inevitable
participation in traumatic reenactment in the therapy relationship,
the therapist is vulnerable through his or her empathic openness to
the emotional and spiritual effects of vicarious traumatization.
Their effects are cumulative and permanent, and evident in both a
therapists professional and personal life (Figley, 1995)
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Emotional impact of trauma and painful material can be
contagious and transmitted through the process of empathy (Figley,
1995; Pearlman and Saakvitne, 1995a; Stamm, 1995) the natural
consequent behaviours and emotions resulting from knowing about a
traumatizing event experienced by a significant other the stress
resulting from helping or wanting to help the traumatized or
suffering person. (Figley, 1993a)
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Schauben and Frazier (1995) tied these results to a number of
factors: A. Hearing painful stories and experiencing the distress
of survivors is emotionally draining B. Counselling process more
difficult with trauma survivors given the challenges of trust and
shattered beliefs C. Institutional barriers within the legal and
mental health systems that clients must navigate are frustrating to
the therapist
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SHATTERED BASIC ASSUMPTIONS - Janoff-Bulman Traumatizing and
victimizing events challenge basic belief structures structures
which drive our ability to organize and make sense out of our world
CHANGES IN THESE SCHEMAS TAKE PLACE THROUGH: Accommodation (Sudden
and Acute) Assimilation ( A more incremental shifting of belief
systems)
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CONSTRUCTIVIST SELF-DEVELOPMENT THEORY -Pearlman We construct
our personal realities through the development of complex cognitive
structures which are used to interpret events These structures are
called schemas (Piaget) Schemas evolve and become increasingly
complex over the lifespan as individuals interact with their
meaningful environments
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Helpers may find a long-term alteration in their own cognitive
schemas, beliefs, expectations and assumptions about self, others
and the world at large. Lisa McCann and Laurie Anne Pearlman,
Vicarious Traumatization: A Framework for Understanding the
Psychological Effects of Working with Victims, Journal of Traumatic
Stress, Vol.3, No.1, 1990, p. 131. SCHEMAS
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FRAME OF REFERENCE ABOUT THE SELF AND WORLD Helpers may
question his or her identity, role and self-worth As helpers hear
painful stories, the view of the world may change values can be
altered
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TRUST SAFETY Enhanced awareness of the fragility of life
Increased thoughts of our own vulnerability Helpers exposure to
hearing stories of cruelty, deception, betrayal, etc can create
cynicism, suspicion towards others and to expect the worst in
others
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POWER AND CONTROL Can be impacted by the helplessness and
powerlessness that clients and families may talk about Helpers may
find themselves seeking an increase in control in their
personal/familial/colleagial relationships to combat this
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INDEPENDENCE Helpers may experience a loss of independence as a
result of feeling personally vulnerable and out of control
SELF-ESTEEM May question self-worth (what good am I if I cannot
help others?) Loss of faith in humanity; shattering of belief
systems Views may become more cynical and pessimistic
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INTIMACY May become emotionally unavailable to self and others
as a result of feeling too emotionally invested in clients
Alienation and isolation from others May be reinforced by others
who view helping work as Sad Horrific Better you than me Triggers
to their anger
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ACUTE STRESS REACTIONS Can occur as a result of vicarious
traumatization Alterations in sensory experiences Physiologic
activation Inability to modulate affects Substance abuse Overeating
Bingeing Hypersensitivity to emotionally charged stimuli
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VT can result in physiological symptoms that resemble post
traumatic stress reactions Intrusive Symptoms Flashbacks Nightmares
Obsessive thoughts Constrictive Symptoms Numbing Dissociation
(Beaton & Murphy, 1995)
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EFFECTS OF TRAUMA WORK ON HELPING PROFESSIONAL Pervasive
Affects all realms of persons life Cumulative Each client can
reinforce gradual change of schemas Permanent Even if worked
through, experiences leave scars (McDermott, Fellbaum &
Associates. Wounded Helpers & Healers: Shattered and Eroded
Assumptions of Vicarious Traumatization. Presentation, March 26,
1993, London)
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The stories we hear do affect us In our work we bear witness to
daily pain, despair, victimization as well as the rewards of our
work We listen support engage validate feelings and experiences As
pain is released, we absorb it At the end of the day, we have
gathered numerous accounts of hurt
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WHAT MAY WE FEEL? Sad Angry Joy Horror Vulnerable Satisfaction
Frustration Creative Isolated Appreciated Anxious Rewarded
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MANAGING OUR WORK Acknowledge that the work will affect you
Create and maintain a healthy balance to minimize the effects of
vicarious traumatization Recognize the potential for trauma and VT
in our lives Be attentive and mindful of your unique warning
signs
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WARNING SIGNALS Increasing thoughts of clients pain and trauma
Diminishing sense of safety and trust in the world Intrusive
imagery or nightmares
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Decreasing sense of competency Cynicism Isolation and
withdrawal from others Changes in ability to establish and maintain
healthy boundaries
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Feeling numb Changes in eating and sleep patterns Questioning
personal values Difficulty in managing usual stress situations and
responses
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INFLUENCING FACTORS TO VT Current personal stresses
Relationship/family challenges Mental health issues Social system
Organizational influences Legislative changes and frustrations
Maturational factors Physical/medical challenges
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SELF-CARE STRATEGIES Balance between personal and professional
life Respect for personal/professional boundaries Develop realistic
expectations
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Balanced diet Healthy lifestyle choices Moderate
caffeine/alcohol use Exercise/movement
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Maintain professional contacts Engage in social and family
relationships and events Pursue leisure activities Body therapy,
e.g. massage, yoga
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Personal therapy Rest/Relaxation Reflect Evaluate your
priorities and goals on an ongoing basis
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Coming to terms with loss such as the effects of work that can
shake or shatter religious or spiritual beliefs Permitting our
sadness to be expressed so that we can receive comfort and support,
and helps us to maintain intimacy in our personal lives Recognizing
and accepting that VT is a normal response to doing painful and
difficult work
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Give yourself permission to experience the emotion of your work
Value your efforts as well as your successes Laugh
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TEAM STRATEGIES Break familiar patterns Overcome fears and
barriers Acknowledge contributions of others respect for each
others roles
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Debrief Formal and informal structures Regular Meetings Discuss
situations Allow feelings to be shared Problem solve Provide
ongoing education Encourage innovation Develop a mechanism in which
to understand and process the effects and personal responses to the
work
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Avoid nay-sayers Build dreams and ideas together Experiment
with creativity
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Guard against censoring your ideas Seek positive solutions
Offer a helping hand
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Allow team members to show their feelings and vulnerabilities
Celebrate your successes Laugh
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CONTRIBUTORS TO SIGNIFICANT STRESS IN HELPERS Role strain Staff
conflict Lack of perceived support from peers Lack of role
clarity
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Signs & Symptoms of Trauma Posttraumatic Stress Disorder
Symptom Clusters: Re-expereincing, Avoidance, Arousal Complex
Trauma Effects of Relationships Effects on Personality
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PTSD Symptoms: Re-Experiencing Intrusive, upsetting memories of
the event Flashbacks (acting or feeling like the event is happening
again) Nightmares (either of the event or of other frightening
things) Feelings of intense distress when reminded of the trauma
Intense physical reactions to reminders of the event (e.g. pounding
heart, rapid breathing, nausea, muscle tension, sweating)
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PTSD symptoms of avoidance and emotional numbing Avoiding
activities, places, thoughts, or feelings that remind you of the
trauma Inability to remember important aspects of the trauma Loss
of interest in activities and life in general Feeling detached from
others and emotionally numb Sense of a limited future (you dont
expect to live a normal life span, get married, have a career)
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PTSD symptoms of increased arousal Difficulty falling or
staying asleep Irritability or outbursts of anger Difficulty
concentrating Hypervigilance (on constant red alert) Feeling jumpy
and easily startled
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Other common symptoms of post- traumatic stress disorder Anger
and irritability Guilt, shame, or self-blame Substance abuse
Depression and hopelessness Suicidal thoughts and feelings Feeling
alienated and alone Feelings of mistrust and betrayal Headaches,
stomach problems, chest pain
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Complex Trauma Symptoms Alterations in regulating affective
arousal (1) chronic affect dysregulation (2) difficulty modulating
anger (3) self-destructive and suicidal behavior (4) difficulty
modulating sexual involvement (5) impulsive and risk-taking
behaviors
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Complex Trauma Symptoms Alterations in attention and
concentration (1) amnesia (2) dissociation Somatization
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Complex Trauma Symptoms Chronic chacterological changes (1)
alterations in self-perception: chronic guilt and shame; feelings
of self-blame, of ineffectiveness, and of being permanently damaged
(2) alterations in perception of perpetrator: adopting distorted
beliefs and idealizing the perpetrator (3) alterations in
perceptions of others: (a) an inability to trust or maintain
relationships with others (b) tendency to be re-victimized (c) a
tendency to victimize others
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Complex Trauma Symptoms Alterations in systems of meaning (1)
despair and hopelessness (2) loss of previously self-sustaining
beliefs