Working with Trauma Survivors: What workers need to know
After a terroristic event, many individuals working as rescue
workers, health care workers, journalists, and volunteers may come
into contact with trauma survivors. Some of these people interact
with survivors as the traumatic incident is unfolding, and other
situations may require contacting and working with survivors of
trauma weeks, months, or even years after a traumatic event has
occurred. These contacts may be precipitated by a memorial service,
developments in a criminal or disaster case (e.g., a trial ten
months after the event), an anniversary (e.g., commemorating a
disaster), or other events.
Why is it important for those who work with trauma survivors to
know about traumatic stress?
Increases Ability to Help
It is important for those who work with trauma survivors to know
about traumatic stress because trauma survivors are in an ongoing
process of healing and recovery. For instance, a journalist knowledgeable about
traumatic stress will be more sensitive to a violent crime
victim's need to feel humanized and respected, especially after an
intentionally cruel experience.
Approaching survivors with genuine respect, concern, and
knowledge about their process increases the likelihood that you
can:
Answer some of their questions about what they may be
experiencing
Normalize their distress by letting them know that what they
are experiencing is normal
Help them to learn effective coping strategies
Help them to be aware of possible symptoms that may require
additional assistance
Reduce their perception of helpers' potential
insensitivity
Give them a positive experience that will increase their
chances of seeking help in the future
Decreases Chance of Doing Harm
It is important to keep in mind that pressing someone into
discussion of a traumatic event soon after exposure may have a
detrimental effect on some traumatized individuals. While some
trauma survivors prefer to discuss the traumatic experience,
overriding a reluctant individual's need (1) for distance, (2) to
avoid reminders of the trauma, and (3) to dissociate in the
immediate phase of a trauma, particularly in situations where
bereavement is involved, may be associated with increased risk for
developing PTSD in some individuals. This is particularly true for
those with heightened distress. Experts on traumatic stress emphasize that people have their own
pace for processing trauma, and it is important for helpers to let
survivors know that they should listen to and honor their own inner
pace.
Increases Self-Care
Another reason why it is important to know about traumatic
stress is so you can apply this knowledge to yourself. While many
individuals who work with trauma survivors experience an enhanced
sense of meaning, self-esteem, respect for the strength of others,
and connection with humanity, research is beginning to show that,
for some individuals, working with trauma survivors, under certain
conditions, may have negative effects. Those who work with
survivors may begin to show signs of stress disorders ranging from
difficulty sleeping to PTSD symptoms such as intrusive thoughts,
avoidance, and heightened reactivity. While this area of research
is relatively new, researchers have coined a number of terms to
describe the effects of working with trauma. These terms are
described below to explain the changes workers may observe in
themselves as a result of experiencing traumatic events or
witnessing the effects of those events on others.
Burnout
The term "burnout" has been applied across helping professions
and refers to the cumulative psychological strain of working with
many different stressors. It often manifests as a gradual wearing
down over time.
The factors contributing to burnout include:
Professional isolation
Emotional drain from empathizing
Difficult client population
Long hours with few resources
Ambiguous success
Unreciprocated giving and attentiveness
Failure to live up to one's own expectations for effecting
positive change
The symptoms of burnout include:
Depression
Cynicism
Boredom
Loss of compassion
Discouragement
Secondary Traumatic Stress
The term "Secondary Traumatic Stress" has been coined by various
authors
1 to describe professional workers' subclinical or clinical
signs and symptoms of PTSD that mirror those experienced by trauma
clients, friends, or family members. While it is not recognized by
current psychiatric standards as a clinical disorder, many
clinicians note that those who witness traumatic stress in others
may develop symptoms similar to or associated with PTSD. These
symptoms include:
Charles Figley
2 coined this term as a "non-clinical, non-pathological" way
to characterize the stress of helping or wanting to help a trauma
survivor. Compassion stress is seen as a
natural outcome of knowing about trauma experienced by a
client, friend, or family member, rather than a pathological
process. It can be of sudden onset, and the symptoms include:
Helplessness
Confusion
Isolation
Secondary traumatic stress symptoms
Compassion Fatigue
Compassion fatigue, also coined by Figley, is considered a more
severe example of cumulative compassion stress. It is a defined as
"a state of exhaustion and dysfunction, biologically,
physiologically, and emotionally, as a result of prolonged exposure
to compassion stress"
2.
Vicarious Traumatization
Vicarious traumatization was coined by Pearlman and Saakvitne
3 to describe
those permanently transformative, inevitable
changes that result from doing therapeutic work with trauma
survivors. In their research, they noted that a number of changes
were common among those mental-health workers who had clients who
were trauma survivors. The changes were considered not
pathological, as described for secondary traumatic stress, and were
seen instead as normal cognitive or emotional changes relating to
how the mental-health worker felt and thought about him- or
herself. The changes were cumulative as, over time, the
mental-health workers worked with several trauma survivors The
changes were also pervasive in their effects on an individual's
life. These changes tended to occur more often in highly empathic,
sensitive individuals, those with a previous history of trauma, and
newer therapists.
Vicarious traumatization can detrimentally affect one's:
Relationship with meaning and hope
Ability to get one's psychological needs met
Intelligence
Willpower
Sense of humor
Ability to protect oneself
Memory/Imagery
Existential sense of connection to others
Self-capacities, including:
The enduring ability to maintain a steady sense of self
Tolerance for a range of emotional reactions in one's self and
others
A sense of inner connection to others
A sense of self as viable, worth loving, deserving
A sense of self that is grounded
There are a number of possible behavioral changes that might
result from vicarious traumatization, including:
Becoming judgmental of others
Tuning out
Having a reduced sense of connection with loved ones and
colleagues
Becoming cynical or angry and losing hope or a sense of
meaning
Developing rescue fantasies, becoming overinvolved, taking on
others' problems
Developing overly rigid, strict boundaries
Feeling heightened protectiveness as a result of a decreased
sense of the safety of loved ones
Avoiding social contact
Avoiding work contact
If You Recognize These Changes in Yourself
It is recommended that an individual take steps toward self-care
and lifestyle balance if he or she is experiencing symptoms of
burnout, secondary stress, or vicarious traumatization. These steps
are defined in
self care following disasters.
Compassion Satisfaction
It is important to note that while the information above focuses
on the possible negative effects one might experience when working
with trauma survivors, there is also the possibility of a powerful
sense of satisfaction with this work. Figley has coined the term
"Compassion Satisfaction" to describe this process, which involves
the development over time of a much stronger:
Sense of strength
Self-knowledge
Confidence
Sense of meaning
Spiritual connection
Respect for human resiliency
Individuals who have worked with trauma survivors over time may
experience negative effects during times of heavier workloads,
heightened personal stress, and overwhelming exposure to
terroristic events and their aftereffects. However, a large
majority of individuals who work with trauma survivors indicate
that it has brought great meaning into their lives, increased their
sense of purpose and strength, and heightened their sense of
connection with others. Often these individuals took breaks, sought
assistance or mentoring, or increased self-care when they began to
see signs of negative effects. These professionals were able to
resume their work and/or feel decreased stress and an overall
gratitude for this work with time.
References
1.
Stamm, B.
H. (Ed.). (1995).
Secondary traumatic stress: Self-care issues for clinicians,
researchers, and educators. Lutherville, Maryland: Sidran
Press.
2.
Figley,
C. R. (Ed.). (1995).
Compassion fatigue: Coping with secondary traumatic stress
disorder in those who treat the traumatized. New York:
Brunner/Mazel.
3.
Pearlman, L. A., & Saakvitne, K.
W. (1995).
Trauma and the therapist: Countertransference and vicarious
traumatization in psychotherapy with incest survivors. New
York: Norton.