Vicarious traumatization Dr. Patricia Sherman June 19, 2008.

Vicarious traumatization

Dr. Patricia Sherman

June 19, 2008

The capacity for compassion and empathy seems to be at the core of our ability to be

wounded by the workStamm, B,H, (1995). Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators.

Introductions and what do you take home with you?

CountertransferenceAdapted from Pearlman, L.A., & Saakvitne, K.W. (1995). Trauma and the therapist. NJ: W.W. Norton & Co.

• The affective, ideational, and physical responses a therapist has to the client, the client’s clinical material, transference, and reenactments.

• The conscious and unconscious defenses against the affects, intra-psychic conflicts, and associations aroused by the above.

Some signs of countertransference in trauma

workAdapted from Wilson, J. (2004). Empathy, trauma transmission, and countertransference in posttraumatic psychotherapy.

In J. Wilson & B. Drozdek (Eds.) Broken spirits. NY: Brunner-Routledge. P. 306

• Unreasonable dislike for client• Failure to identify with client• Non-responsiveness to emotional distress of

client• Overwhelmed by client’s problems• Excessive liking of client

• Dread therapy session/uncomfortable during session

• Preoccupation with client outside office• Inattention, problems of concentration,

drowsiness, sleepiness during session• Preoccupation with own personal affairs• Coming late to session• Argumentative with client• Client appears in dreams

Vicarious traumatizationAdapted from Pearlman, L.A., & Saakvitne, K.W. (1995). Trauma and the therapist. NJ: W.W. Norton & Co.

• The transformation in the inner experience of the therapist that comes about as a result of empathic engagement with clients’ trauma material.

• It is the result of an accumulation of experiences across clients.

• It is permanently transformative, while countertransference is temporally and temporarily linked to a particular client.

Effects of Vicarious traumatization

• Frame of reference• Identity • World view• Spirituality • Self capacities• Ego resources

• Psychological needs– Safety

– Trust

– Self esteem

– Intimacy

– Control

• Sensory system– Imagery

– Bodily experiences

– Sensitivity to sounds, smells, and tastes

aspects of the work

• Empathic engagement– Graphic trauma material– Intentional cruelty– Client resentment

• Context – Workload– Confidentiality– Management support

• Nature of trauma treatment• Clientele – Current living situation– Adaptation• Suicidal preoccupation• Interpersonal style (BPD)

• Professional context• Social context

Aspects of the therapist

• Self– Identity– Worldview– Spirituality– Affect style– Ability to recognize and meet one’s needs

• Personal history

• Current personal circumstances

• Current professional circumstances– Training and supervision– Professional identity– Control

Type of empathic connection

Cognitive Empathic

Time Frame

CognitivePast

EmpathicPast*

*Most stressful

CognitivePresent

Empathic Present

Hazards of practiceAdapted from Skovnit, T.M. (2001). The resilient practitioner

The difficult nature of the work with clients, students, and

patients

• They have an unsolvable problem that must be solved

• They are not “Honors students”

• They have motivational conflicts

• There is often a readiness gap between them and us

• Sometimes they project negative feelings onto us

• Sometimes we cannot help because we are not good enough

• They have needs greater than the social service, educational, or health system can meet

Managing major professional stressors

• Our inability to say “No” – The treadmill effect

• Living in an ocean of stress emotions

• Ambiguous professional loss – ending before the ending

• The covert nature of the work

• Constant empathy, interpersonal sensitivity, and one-way caring

• Elusive measures of success

• Normative failure

• Regulation oversight and control by external, often unknown others

• Cognitive deprivation and boredom

• Cynical, negative colleagues and managers

• Legal and ethical fears

• Practitioner emotional trauma

• Practitioner physical trauma

Videothe cost of empathy

Self tests

• ProQOL R IV

• Silencing Response

• Personal mission statement

How to cope with vicarious traumatization

• Recognize and accept VT• Limit exposure• Attend to empathy• Name re-enactments• Set limits• Create balance

• Maintain professional connections– Personal psychotherapy– Rest and play– Education– Support groups– Supervision and consultation– VT consultation

• Seek spiritual renewal• General self care

Overcoming vicarious traumatization

Videotransforming the pain

How do you cope with stress?

Some stress reduction techniques

progressive muscle relaxation

• Lie down or sit comfortably and close your eyes

• Tense the muscles of a particular body part• Hold the tension for about 10 seconds• Let go of the tension quickly, letting the

muscles go limp• Repeat • Go on to different muscle groups

• Stretch• Massage – self; partner• Shake it out• Shower or bath• Breathing• Aromatherapy• Exercise• Hypnosis

• Animal therapy• Gardening • Spiritual practices• Expressive therapies• Acupuncture/acupressure• Homeopathy• Self-help groups• Any other pleasurable activity

Imagery – guided exercise

Irrational beliefs - ellis• It is a dire necessity for adult humans to be

loved or approved by virtually every significant other person in their community.

• One absolutely must be competent, adequate and achieving in all important respects or else one is an inadequate, worthless person.

• People absolutely must act considerately and fairly and they are damnable villains ifthey do not. They are their bad acts.

• It is awful and terrible when things are not the way one would very much like them to

be.• Emotional disturbance is mainly externally

caused and people have little or no ability to increase or decrease their dysfunctional feelings and behaviors.

• If something is or may be dangerous or fearsome, then one should be constantly and excessively concerned about it and should keep dwelling on the possibility of it occurring.

• One cannot and must not face life's responsibilities and difficulties and it is easier to avoid them.

• One must be quite dependent on others and need them and one cannot mainly run one's own life.

• One's past history is an all-important determiner of one's present behavior andbecause something once strongly affectedone's life, it should indefinitely have a similar effect.

• Other people's disturbances are horrible and one must feel upset about them.

• There is invariably a right, precise and perfect solution to human problems and it is awful if this perfect solution is not found.

Rebt – albert ellis

• A – activating event or potentially stressful situation

• B – beliefs, thoughts, or perceptions about A• C – emotional consequence that results from

holding these beliefs

• A potentially stressful situation + your perceptions = your stress level

Plan of action• Stress diary

• Stress dots

• Stress reduction program

• Fifteen things to add to quality of life

• Ten habits of highly effective stress managers

GOAL SETTING: WHAT DO I WANT AND WHY DO I WANT IT?

•WHEN THE WHY GETS STRONGER, THE HOW GETS EASIER

•GOALS NEED TO BE SPECIFIC,DOABLE, and MEASUREABLE

SETTING PRIORITIES

• WORK• FAMILY• FRIENDS• COMMUNITY• SPIRITUAL/RELIGIOUS• RELAXATION• HEALTH

GOAL SETTING

GOALREASON

Objective #1Objective #2Objective #3

Example:Improve health in order to

have more energy Exercise 30 minutes 4

times/week Lose 1.5 pounds/week

for a total of 25 pounds Eat 1800-2000

calories/day

SUCCESS QUESTION

WHAT CAN I DO TODAY THAT WILL HELP ME TOWARDS MY GOAL?

What can I do for exercise today?What can I do today to enhance myrelationship with my partner?What can I do today to nurture myself?