When Caring Hurts: Secondary Traumatization & Self-Care

Kristen DeLangeMS, LPC, NCC, CAADC

IntroductionOutline of the dayLearning Objectives

Discuss and identify the history and causation of secondary traumatization, burn-out, and compassion fatigue and their treatment

Learn and practice tools for self-regulation and relaxation

Cultivate skills necessary to prevent compassion fatigue through increased resiliency

Discuss and identify how to increase support system

Part I: Secondary Traumatization & Self-CareWhy Self-Care and Secondary Traumatization?

“That which is to give off light must endure burning.”-Viktor Frankl

Trauma and PTSDWhat is a traumatic event?

-DSM IV TR (2000)

Posttramatic Stress Disorder

Sympathetic vs. Parasympathetic Dominance

How Our Work Affects Us

What are 3 negative reactions/effects from your work you have experienced?

-Saakvitne & Pearlman (1996)

Key Terms and ConceptsSecondary Traumatization

Burnout

Compassion Fatigue

Jung (1907)

Vicarious Traumatization & Secondary Traumatic Stress“Harmful changes in professionals’ views of

themselves, others, and the world as a result of exposure to the graphic and/or traumatic material of their clients.”

Secondary Traumatic Stress-”a set of psychological symptoms that mimic posttraumatic stress disorder but is acquired through exposure to persons suffering the affects of trauma.”

-Baird et al (2006)

Secondary Traumatic Stress Symptoms

-Gentry (2002)

Causes of STPast traumatic experience(s)ImagesEmpathyCurrent safety concerns of the ones we helpChildrenNature of the work/settingPersonalNew staff

-Saakvitne & Pearlman (1996)

Secondary Trauma VS. PTSD

BurnoutProcess, steadily worsensGradual exposure to work stress and tension,

attrition of optimism and ideals, with a lack of success/accomplishment

Results in exhaustion, isolation, and decreased effectiveness

-Cherniss (1980); Maslach (1976, 1982); Soy (2002)

Compassion Fatigue

Compassion Fatigue =Secondary Traumatization + Burnout

-Figley (1995)

How Can We Heal From This?Healing compassion fatigue-relaxation,

building and maintaining relationships (personal and colleagues), sharing narratives (anonymity)

 Healing of burnout-relaxation/self-regulation + changing perceptions and increased work support

VT-Awareness, Balance, Connection-Gentry (2002); Saakvitne & Pearlman (1996)

Healing ExercisesBreathingMindfulness: 3-2-1Assignments:

Mindful eatingJournalFavorite verse(s) regarding God’s character

-Gentry (2009)

Part II: Self-CareReviewMindfulness“Mindfulness can be thought of as moment-to-

moment, non-judgmental awareness, cultivated by paying attention in a specific way, that is, in the present moment, and as non-reactively as possible…mindfulness is perhaps the most basic, the most powerful, the most universal, among the easiest to grasp and engage in, and arguably, the most sorely needed now. For mindfulness is non other than the capacity we all already have to know what is actually happening as it is happening.”

-Kabat-Zinn (2005), pp. 108-109

Mindfulness Cont.observe, describe, participate, non-

judgmental stance, focus on one thing in the moment, be effective

Exercise

-Linehan (1993)

Mindfulness Cont.

Research has shown that mindfulness helps to decrease worry and anxiety, heart problems, substance abuse, depression, stress, smoking urges, insomnia, and chronic pain

Orsillo & Roemer (2011)

Intentionality & Acceptance“Pain is inevitable, suffering is optional”-

FranklRadical Acceptance-Linehan (1993)

4 Ways to Respond to a Crisis:1.Solve it2.Change how you think/feel about it3.Accept it4.Stay miserableAcceptance does not equal agreement or resignation!

Intentionality & Acceptance Cont.What happens when we accept?Pain + Non-acceptance = SufferingPain + Acceptance = Normal PainIntentionality: to address STS symptoms, to

grow professionally and personally, finding balance and taking care of self in order to fully live out God’s calling for our lives.

-Gentry (2009)

My Mission StatementEmpowering, represents the deepest and

best within yourselfFulfillment of your distinctive gifts to

contribute and fulfill God’s call on your life (in all areas)

Vision + ValuesWritten to inspire you and you alone

Taking Physical CareBreathe!Exercise-Aerobic 3x/week or more + anaerobicSleepNutritionSpend time outdoorsMassage, stretch, acupuncture, progressive

muscle relaxationRelaxation-HR, muscle tension-Howard, P. (2006); Severin, S. & Severin T.

(2005)

Taking Spiritual CareReading the Word, studying, committing it to memory PrayerMeditation and Listening (solitude)FastingWorship StewardshipSubmissionServiceConfessionGuidanceCelebration-Foster (1978)

Taking Emotional CareSupport, Support, Support!

IndividualGroupColleagues & SupervisorsLoved OnesPersonal Therapy CreativityHave fun!

ExercisesToxic Waste DumpReclaimingLetter

-Saakvitne & Pearlman (1996)

MaintenanceWhy maintain our commitment?

I am in painI matterThe ones I help matterThe ones I love matterThe work I do mattersIt is imperative

-Saakvitne & Pearlman (1996)

Maintenance Cont.How can we maintain our commitment?

Not on your own: support person/groupOne day at a timeDo something in each areaMake one change at a timeIncrease acceptance and mindfulnessRealistic and non-judgmentalDon’t forget, don’t give up-Saakvitne & Pearlman (1996)

Maintenance Cont.Obstacles?

Solutions?

Taking a Personal InventoryMake note of personal vulnerabilities

Resiliency Plan

Final ExerciseWhat we do well & the rewards of our work Thank you!

ReferencesAmerican Psychiatric Association: Diagnostic and Statistical

Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, D.C. American Psychiatric Association, 2000.

Baird, K., & Kracen, A.C., “Vicarious Traumatization and Secondary Traumatic Stress: A research synthesis.” Counselling Psychology Quarterly, Volume 19, Number 2, June 2006 , pp. 181-188(8). Routledge, part of the Taylor & Francis Group.

Cherniss, C. (1980). Professional Burnout in Human Services Organizations. New York: Praeger.

Figley, C. R., (1995). Compassion Fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Bruner/Mazel.

Foster, R. (1978). Celebration of Discipline. New York: Harper Collins.

Frankl, V. (1963). Man’s Search for Meaning. New York: Washington Square Press, Simon and Schuster.

References Cont. Gentry, J. E. “Compassion Fatigue: A crucible of

transformation.” Journal of Trauma Practice, Spring 2002.Gentry, J.E. (2009). “Compassion Fatigue” from PESI.Gentry, J.E. (2009). “Trauma: Tools for Stabilization and

Recovery” from PESI.Howard, P. (2006). The Owner’s Manual for the Brain, 3rd

Ed. Austin, TX: Bard Press. Jung, C.G. (1907) The Psychology of dementia praecox.

Read, M. Fordham, G. Adler and W. McGuire (eds.), The Collected Works of C.G. Jung, H. Vol. 3. Bollingen Series XX, Princeton: Princeton University Press.

Kabat-Zinn, J. (2005). Coming to Our Senses: Healing ourselves and the world through mindfulness. New York: Hyperion.

References Cont.Linehan, M. M. (1993). Skills Training Manual for Treating

Borderline Personality Disorder. New York: The Guilford Press.

Maslach, C. (1976). “Burnout.” Human Behavior, 5, 16-22.Maslach, C. (1982). Understanding Burnout: Definitional

issues in analyzing a complex phenomenon. In W.S. Paine (Ed.) Job Stress and Burnout: Research, theory and intervention perspectives (pp. 29-40). Beverly Hills, CA: Sage Publications.

Orsillo, S. & Roemer, L. (2011). The Mindful Way Through Anxiety. New York: The Guildford Press.

Saakvitne, K.W., & Pearlman, L.A. (1996) Transforming the Pain: A workbook on vicarious traumatization. New York: Norton.

Severin, S. & Severin, T. (2005). TriEngergetics: Balancing nutrition, exercise, and mindfulness. Oakland, CA: New Harbinger Publications, Inc.

References Cont.Smith, J. (2012). “Dialectical Behavior

Therapy 5-Day Comprehensive” by MACMHB.Soy, S. (2002). “Communication, Social

Support, and Burnout: A Brief Literature Review.” World Wide Web:

http://www.ischool.utexas.edu/~ssoy/pubs/micro-communication/2micro.htm

Covey, S. R., Merrill, A.R., & Merrill, R.R. (1997). First Things first. New York: Simon & Schuster.