vicarious trauma for front-line service providers & … · canadian mental health association...

Vicarious Trauma for Front-Line Service Providers & Parents Dr. Wanda Polzin, MA, RSW, EdD

1 Copyright CASA 2014

What will be Covered

• Definition of vicarious trauma and its importance

• The impact of self-care on both personal and professional lives

• The role of stress with respect to self-care

• Strategies that reduce stress at home and at work while promoting self care (practical skills!)

• Key related concepts (toxic stress, brain architecture, serve & return)

• Ways to begin building a trauma-informed environment


Presenter

Presentation Notes

The Dalai Lama on Self Care

Copyright CASA 2014 3

‘In dealing with those who are undergoing great suffering, if you feel “burnout” setting in, if you feel demoralized and

exhausted, it is best, for the sake of everyone, to withdraw and restore yourself. The point is to have a long-term

perspective.’

What are your reactions, thoughts, or feelings when you hear “self-care”, compassion fatigue, vicarious trauma, burn-out, stress,…?


Presenter

Presentation Notes

Seems simple enough…

Why Self-Care is Ignored


• Most days, the amount of energy devoted to others’ needs far exceeds any energy directed to own well-being.

• Demands of work and family – sandwich generation • Many people simply do not know what would help them. They

know something is missing, but can’t put their finger on just what might make them feel better.

• Many helping professionals believe they somehow shouldn’t need support.

• Prolonged ignoring leads to greater risk for Vicarious Trauma

Barriers to Self Care


1. Negative feelings 2. Lack of awareness or knowledge 3. Negative self–talk, attitudes and misperceptions 4. Time or too many responsibilities 5. Perfectionism 6. Lack of support 7. Finance 8. Preoccupation with loved one’s substance abuse

Why learn (develop mindfulness) about Vicarious Trauma?

• Can provide a “check-in” process

• Importance of understanding “warning signs” because this dramatically impacts our therapeutic relationship(s)

• Can be proactive (inside-out approach) to act as role-model

• Importance of both “little t” versus “big t” trauma(s)



Why do we ignore the “signs”? http://www.youtube.com/watch?v=t7wmPWTnDbE

Presenter

Presentation Notes

What not to do!

http://www.youtube.com/watch?v=t7wmPWTnDbE

Potential Hazards of Lack of Self-Care


• Depression • Anxiety • Emotional Depletion • Isolation • Disrupted Relationships • Children -related Issues • Sense of Helplessness or Ineffectiveness • Bio-psycho-social difficulties

Presenter

Presentation Notes

The literature points out that many addiction and mental health practitioners are faced with unique hazards of this profession. Since 1985, research has consistently shown these types of distress emerging among clinicians. Working with people who are in pain, in crisis, ambivalent, or who have experienced trauma can take a toll on us. Some of the work is slow and with some it may feel like we are making no progress. This can lead us to feel exhausted at the end of the day, with some of us preferring to be alone, while for others of us we struggle to stop the overflow of burdening events. Taken from: Eric Nicely, San Francisco Psychologist, 2004 Ofer Zur, Taking Care of the Caretaker, 2011 Norcross & Guy, 2007

Compassion Fatigue in Case Workers & Carers 1. Empathy: Empathy is needed to care for traumatized children but if you

over-empathize or over-identify with clients, you place themselves at risk for internalizing the children's trauma.

2. Insufficient Recovery Time: Case workers may hear similar, horrific stories over and over again, often seven days a week, without the respite needed to heal or to get some distance from the stories. Thus, an accumulated secondary trauma load builds and can lead to CF.

3. Unresolved Personal Trauma: Many of us have had traumatic experiences in our own lives. (e.g., loss of a family member, childhood abuse or neglect, accidents, addiction or mental illness in parents, serious illness or disability in family of origin, immigration trauma and others).


How Can I Check Up on Myself (a tool for self and others)? • Checklist adapted from Saakvitne, Pearlman, & Staff of

TSI/CAAP (1996). Transforming the pain: A workbook on vicarious traumatization. Norton.

http://www.socialwork.buffalo.edu/students/self-care/documents/plan/Self-Care_Assessment.pdf

• Physical Self Care • Psychological Self Care • Emotional Self Care • Spiritual Self Care • Relationship Self Care • Workplace Self Care • Overall





Types of Stress


•POSITIVE STRESS/EUSTRESS •The “good stress” •motivating

•NEGATIVE STRESS/DISTRESS/TOXIC STRESS

•Too much to cope with •No relief in sight •“Overload to the System”

Presenter

Presentation Notes

Exercise & Review of ACE study

What is “Vicarious Trauma” Term coined by McCann and Pearlmann (1990) OTHER RELATED TERMINOLOGY:

• Compassion Fatigue • Secondary Trauma • “Burn Out” • Secondary Stress Disorder • “Karōshi”

• Medical cause: heart attack and stroke due to stress


Presenter

Presentation Notes

-first case reported in 1969 Japan is one of few countries that reports this type of stat

Risk Factors for Vicarious Trauma • Neglected self-care and lifestyle barriers • Loss of hope • High responsibility with low ‘power’ or high (-) outcomes • Own past unresolved trauma(s)…ACES

– minimization

• + illusion without accurate feedback • Tendency toward guilt • Poor/unclear boundaries • Working with high needs/competing demands • Potential therapeutic ‘double-bind’


The “Wounded Healer”


• Term created by Carl Jung • The “analyst”/helper is compelled to treat patients because s/he

is “wounded” himself/herself. • Research (Barr, 2006) has shown that approximately 74% of

counselors and therapists have experienced one or more wounding experiences, often leading to career choice

• Importance to understand Transference and Countertransference Principles as well as catharsis

• Bearing witness to another’s trauma is part of the healing process

Impact of our Childhood

LOOKING AT OURSELVES….

• What was our “template”?

– The Core Story – How Brains are Built

• Understanding ACES


Presenter

Presentation Notes

How Brains are Built VIDEO

How Brains are Built (and applying this to those you help)

THE CORE STORY (AFWI) • BRAIN ARCHITECTURE

• TOXIC STRESS

• SERVE & RETURN

http://www.albertafamilywellness.org/resources/video/how-brains-are-built-core-story-brain-development


Presenter

Presentation Notes

VIDEO Considerations

The Brain 101 • Model from Dr. Daniel Siegel

http://www.youtube.com/watch?v=DD-lfP1FBFk

BRAINSTEM

Automatic; not something you control Reptilian Brain (Fight/Flight/Freeze/Fall)

LIMBIC SYSTEM Mammalian Brain Emotional Memory (which gets “toxified” by stress)

NEO-CORTEX Separates us from animals Flexible Thinking; Executive Functioning


http://www.youtube.com/watch?v=DD-lfP1FBFk

A Word about “Mirror Neurons” • What are they?

– Neurons that fire both when an animal acts, and when the animal observes the same action performed by another.

• More research required in this area • Speculation that these neurons might be important for:

• understanding other peoples’ actions, • Learning new skills (imitating) • Involved with one’s ability to display empathy


What Does Toxic Stress Do to The Brain…AND attachment? • Dr. Michael Meaney animal studies

– Negative impacts associated with trauma and attachment – Key Concept: “more cuddles, less stress!”

“ The single most important factor determining the quality of mother-offspring interactions is the mental and physical health 0f the mother…” (2004, Bulletin of the Centre of Excellence for Early Childhood Development”)


Importance of Understanding Trauma and Attachment & Brain Biology

• TRAUMA (the children and families with whom you work)

• THE BRAIN IN A NUTSHELL – (bottom up versus top down) – Significant to understand for treatment/intervention – Need to understand child at a deep level

• IMPLICATIONS FOR WHAT YOU DO DAY TO DAY

• TRAUMA INFORMED CARE (for self and others)


The ACE Study (www.acestudy.org) • Study involved CDC and Kaiser (10 Questions) • 1998- (Felitti, Anda, et al) SUMMARY:

– Adverse childhood experiences are relatively common – Childhood trauma(s) can negatively impair the “architecture” of the

brain – Correlation b/w care-givers and children – Toxic Stress during developing years increase likelihood of

significant long-term health, social and behavioral problems


So…what can I do? (personally, professionally…) • The goal is not necessarily to eliminate…but rather, to

mindfully manage the symptoms.

HOW?...


So…?...What Can I do? • Same principles apply to self and to others

• HERE ARE SOME STRATEGIES…


At Work • Training and education • Manageable caseloads • Peer Support • Paperwork days versus client days (carve out) • Regular Breaks • Inclusion – be a part of decision process


“Outside the Box” Take-Aways • Celebrations

• Highlight Positive Experiences

• Renewal retreats

• Office ‘Cleansing Parties’

• Recognize each other


Work Towards a Trauma-Informed Environment • Awareness of environment (physical as well as subtleties)

• Starts immediately upon hiring

• Non-harassment Policies & anti-violence training – Effective and accountable

• Empower staff (empower oneself)

• Training

• Ongoing Support (1:1 as well as group)


Self-Care Strategies


• Mind the Body – Eat a healthy diet

– Get adequate sleep – Engage in aerobic exercise

– Participate in physical touch such as being held or holding others

– Utilize massage or other alternative healing practices – Foster conscious breathing

– Acquire self-regulation skills

Presenter

Presentation Notes

Our bodies are also receivers (Norcross & Guy, 2007) They receive the pain, the joy…the stories our clients share. We have all heard this over the years, but what we eat, how much sleep, and engaging in some form of exercise can have a significant impact on our mood and our overall well-being. Edmund Ross, a neuroscientist states that touch is fundamental to being human, activating the brain’s frontal cortex which is linked to rewards and compassion. Touch has the capacity to sooth. Massage and other healing practices provide an opportunity for us to receive, instead of being the one that gives (Norcross & Guy, 2007). Breathing is central to keeping ourselves in a state of balance. It is the one regular, life-sustaining process we can always observe within ourselves.

Support System


• Who is your network of support?

• Who can you count on in times of crisis?

• Who can you vent to when you have a bad day? Hour? Week? Month?

• How can they help you and your family?

Strategies for Self-Care


• Keep it simple. Make life choices that fit your family. Develop consistent routines. Create a safe environment

• Stop comparing yourself to other adults and families. They do not live your life, and they are not raising your children

• Know which part of the day is the hardest and have a plan to make it go more smoothly. If getting ready for school is rough, prepare as much as you can the night before.

• Join a support group.

• Get a good therapist!

• Don’t wait to ask for help!

Strategies To Avoid Burnout


• Have down time every day. Maybe it’s a morning walk. It might be

10 minutes with the paper and a good cup of coffee. • Routinely have something to which you can look forward. Maybe

it’s coffee with a neighbor after the kids are at school. • Accentuate the positive. It may not be easy, but as you step back to

evaluate how you and the family are doing, find time to laugh at the silly situations that come up

• If you can find a balance between your job and/or caring for your children and meeting your own needs, you will ultimately be much better equipped to do both.

Mindfulness


WHAT IS MINDFULNESS? •Mindfulness is developing an awareness for or paying attention to what is going on in a particular moment •It is an experience which promotes a connection with the experiences of our world in a specific moment •It allows awareness of our thoughts, sensations, and feelings and promotes the ability to see, feel, and understand things as they are, not as we want them or think them to be •It allows us to think differently about situations and devote the appropriate resources to respond (e.g., time and energy to choose how to act)

Mindfulness and Stress Reduction


When paying attention to how we are in any given moment: •we can actively choose how we are going to respond to our current internal and external stressors •we are empowered to have some control over the stressors we are experiencing •we can actively choose to enact strategies to reduce our stress reaction

Lao Tzu (6th Century BC, Chinese Philosopher) “ If you are depressed, you are living in the Past. If you are anxious, living in the Future. If you are at peace, you are living in the moment.”


BAD JOKE!!!

• Past, Present, and Future Walked into a Bar…


Relaxation • Progressive Relaxation • Methods to promote calm and well-being • May involve meditation, deep breathing, muscle

relaxation, visualization • Relaxation helps to slow down our internal processes

(e.g., thinking, feeling, acting) which allows us space from our stressors and a chance to recharge our coping resources

Copyright CASA 2014

36


Learning the ABCs of CBT! Thoughts/Feelings/Actions – easier said than done? • Dr. David Burns (Cognitive Behavioral

Therapy – “CBT”) • Albert Ellis (Rational Emotive)

Practice…practice…practice

CBT 101: “The A-B-Cs” A: ANTECEDANT/ACTIVATING EVENT

“Triggers”/”Buttons”

Negative Internal Dialogue

B: BEHAVIOR OR BELIEF

Anger Outburst

Moodiness

I HAVE to keep doing this…

No one else can do this like me…

Etc…


CBT (Cont’d) C: CONSEQUENCE(S)

– Depression

– Hopelessness

– Panic/Anxiety

– No Hope

– Anger Management Concerns (try to get “control”)

– Etc., etc……..

VICARIOUS TRAUMA ?


CBT Framework for Change • When you become aware of the

stressors/triggers as well as the Internal Dialogue, you have the ability to mindfully act and make a decision to change it


Useful Metaphors: The power of narrative storytelling • Africa and Indian Legend

– “How to Catch a Monkey”

• Cherokee Legend of Grandfather teaching young child – “Grandfather Tells” – Also known as “The Wolves Within”


Questions?

THANK YOU FOR YOUR VALUABLE TIME!!


References


Barr, A. (2006). An investigation into the extent to which Psychological Wounds inspire Counsellors and Psychotherapists to Become Wounded Healers, the significance of these Wounds on their Career Choice, the Causes of these Wounds and the overall significance of Demographic Factors.” The Green Rooms. Retrieved January 15, 2014. CAMH, Families CARE Program J. Katab-Zinn. Full catastrope living – how to cope with stress, pain and illness using mindfulness meditation. AADAC Day Treatment Workshop manual, Stress Management. Stöppler, M.C., MD; Stress http://www.medicinenet.com/stress/article.htm McCann, I.L. & Pearlmann, L. A. (1990). Vicarious traumatization: A framework of the psychological effects of working with victims. Journal of Traumatic Stress, 3(1), 131-149. Mills, H., Reiss, N., & Dombeck, M. (2008). Stress reduction and management. Retrieved July 22, 2010 from http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=1229

http://www.medicinenet.com/stress/article.htm

http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=1229

References (cont’d) Canadian Mental Health Association (n.d.). Coping with stress [Booklet]. Retrieved July 22, 2010 from http://www.cmha.ca/data/1/rec_docs/403_CMHA_coping_with_stress_EN.pdf

http://stress.about.com/od/stressmanagementtools/Stress_Management_Tools_For_Parents.htm

http://isma.org.uk/pdf/Downloads/Stress-questionnaire.pdf

http://www.apa.org/news/press/releases/stress/key-findings.aspx

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2575655/


Mindfulness Training and Stress Reactivity in Substance Abuse: Results from A Randomized, Controlled Stage I Pilot Study http://www.umassmed.edu/Content.aspx?id=41252 Center for Mindfulness

Saakvitne, Pearlman, & Staff of TSI/CAAP (1996). Transforming the pain: A workbook on vicarious traumatization. Norton.


http://www.cmha.ca/data/1/rec_docs/403_CMHA_coping_with_stress_EN.pdf

http://stress.about.com/od/stressmanagementtools/Stress_Management_Tools_For_Parents.htm

http://isma.org.uk/pdf/Downloads/Stress-questionnaire.pdf

http://www.apa.org/news/press/releases/stress/key-findings.aspx



http://www.umassmed.edu/Content.aspx?id=41252

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