First

do

No

Harm

VICARIOUS TRAUMATIZATION

Written By Susan Stubbings
“Make a habit of two things: to help; or at least to do no harm”.
Hippocrates
So What is Vicarious Traumatization?
 
Vicarious traumatization is secondary trauma or indirect trauma and affects people who support others who are suffering any type of trauma. Your role might be a first responder to accidents, disasters or homicides, nurse, GP, Consultant, psychiatrist, psychologist, morgue technicians working in social care as a career, therapists and counsellors’ voluntary or paid workers in short anyone who works professionally intimately with intense traumatic situations or emotions on a regular basis. 
 
Vicarious traumatization can alter the world view of the counsellor; it goes beyond parallel process.  Vicarious traumatization hits at the core of the professional, it disrupts and disturbs the spirituality and can alter the person's perceived meaning and hope (McCann & Pearlman 1990).  If you are working in trauma, bereavement care or palliative care you may be particular susceptible to vicarious traumatization.

"First do no harm"! that also means too ‘YOU’ as the supporter and nurturer of others.  When we are caring for others we also need to pay attention to caring for ourselves the work we undertake with clients can be challenging, upsetting and traumatising; especially if we are working with clients who have suffered trauma are sharing their experiences with us and offloading onto us. Self-care is a basic need best practiced on daily basis so your skills become second nature and before any dynamics begin to play out.

We cannot, not be affected by the stories which others tell us when we are a caring and compassionate person.  Some of the effects from our clients can be positive such as in the sharing of others sufferings our compassion and empathy gets deeper, which in turn supports the clients with understanding and the ability to be alongside them with ease. We learn to appreciate what we have in our own lives; family, friends and colleague; we can come to deeply value what we have in life and we can find the attitude of gratitude for life and living itself. 
   
When does caring for others become problematic to the caretaker and in turn to those whom we are trying to support?

The answer to that question is when we as caretakers, counsellors, supervisors or family members caring for others become stressed or traumatised by the relatives or clients’ experiences.  Known as “Compassion fatigue” which can happen to anyone and on a continuum of being stressed by our work we can quickly head towards being burnt out or find ourselves in a personal crisis known as vicarious traumatisation.  If not in our frame of awareness, then we leave it unattended too and vicarious traumatisation can greatly affect our inner world as a caregiver or professional and in turn affects the very people we are trying to support and facilitate healing in.

VICARIOUS TRAMUMATISATION (McCann & Pearlman)
Or secondary trauma reactions:

 “Refers to the cumulative transformative effect upon the trauma therapist of working with survivors of traumatic life events. .... It is a process through which the therapist's inner experience is negatively transformed through empathic engagement with clients' trauma material”; (McCann & Pearlman 1990) the helpers’ inner world mirrors the client’s experiences or mirrors post-traumatic stress symptoms, depressive symptoms, a full blown vicarious traumatisation changes the counsellor’ spirituality, beliefs regarding meaning, connections and relationships disrupts and distresses the counsellor. Who may be feeling hopeless or powerless, lack of safety and security, may be suspicious not able to trust fully. 

Changes in identity in the way you practice or think about your identity as a supporter to clients, family and friends.  Changes in psychological needs and beliefs relating to trust, intimacy, safety, control and confidence and self-esteem; the symptoms are not consistent with the person suffering and their behaviour will be seen abnormal or strange to colleagues, friends and family. You may be taking on too much responsibility, difficulty leaving work at the end of the day and switching off.  Your motivation may be low and Spiritual disruption, despondency or cheerlessness; a counsellor, supporter or carer who was suffering with these symptoms would be in crisis and unlike burn out which can be elevated quickly by rest and recuperation vicarious traumatisation is more difficult to heal due to its disruption to the ‘whole’ person who needs to restore hope and meaning into their living.

COMPASSION FATIGUE
Any experience that involves unacknowledged and suppressed emotions.

Transforming Vicarious Traumatisation

If we find our self in a state of high anxiety heading towards burnout or into a full blow crisis because of our client work we need to transform our vicarious traumatisation because it alters our Spirituality, our identity and our core Self-concept.  We may find ourselves questioning our beliefs, our way of life and the deeper questions of the way of the Universe.  This is not negative if we have chosen to ask these questions for our personal development in an objective and structured way.  Vicarious traumatisation on the other hand has overtaken, overwhelmed and it is debilitating emotionally and psychologically; has built up over time and we will not be in a place to choose.  We may have lost at our deeper levels our personal meaning for life, for our work and if it has got a firm grip on us then we may lose hope.  So what can we do if we are in this place?

We need to remember and reconnect with our sources of hope, meaning, and purpose; regain our perspective by nurturing a sense of meaning back into our daily living and be actively engaging in some of the following:

  • Hold reasonable expectations of our self recognise and accept it is normal to be affected by working with intensely stressed and traumatised people.It is the sign of a committed and sensitive therapist and a wise professional who can accept they may need support or time out for a while in order to offer best practice.
  • Take responsibility for your self-care and balance work and personal life and if necessary take a complete break from work, rest until you no longer feel stressed.
  • Engage in daily relaxation exercises for example visualisations, mindfulness, and meditation for mental, emotional and Spiritual well-being.
  • Undertake gentle physical exercise such as yoga, swimming or walking.
  • Connect with family, friends and colleagues; enjoy some ‘play’ time.
  • Seek additional supervision so you can off load, gain support and validation; identify successes and areas for personal development.
  • Be honest with yourself about how you are really feeling.Seek personal counselling; address any boundary issues, explore your Inner Child reconnect with the deeper you access and/or reconnect with your higher self, or engage in group therapy.
  • Allow your inner child out to play colour in with crayons, sit and let out sighs, fly a kite, take a bike ride, go to a park, climb a tree (or hug a tree instead).
  • Escape physically and mentally lose yourself in a film, watch a comedian, read books, play visualisation CD’s or just lay on a bed and let your mind wonder to a fantasy land you have built where you are safe, secure and at peace.
  • Talk with others about anything other than work engage in ‘normal’ life for a while.
  • Notice.... just notice all the little things in your day for example really taste that cup of coffee, eat a meal slow and deliberately taste each mouth full, smell a favourite perfume or light a candle and watch its flame and take in the aroma be fully present in each moment.This will slow you down and as such your adrenaline with calm.
  • Create a sanctuary where you have lots of things around you which calm you when you see them; build a place you can go to and won’t be disturbed for a while.
  • Build an Angel alter (you don’t need to be religious) or have a dedicated shelf where you place affirmation cards, candles, aromatherapy oils, crystals, shells or stones.
  • Create a “coping toolbox” find a nice box, fill it with something to calm all your senses include affirmation, thank you cards, calming music & mediation CD’s, scented candles, healing stones and crystals, lavender to smell and a stress ball.Collect calming poems and quotes, a note book to write how you are feeling at the time don’t analyse it at the time just write the words down to reflect on when you are feeling calmer.Having all your tools in one place ready makes it easier when you are stress to use them when times feel difficult.
  • Challenge negative beliefs clarify or change how you think with the ABCDE of CBT, write a list and at the side of them the reasons they may not be true
  • Act positively you may not feel like it but by ‘acting as if’ you can become it.
  • Remind yourself of the reasons you wanted to undertake supporting work.... write the reasons down in a journal, note book or diary... clarify.
  • Verbalise in a journal the painful and intense feelings try and separate what belongs to you and what belongs to clients or others.
  • Write a list of all your strengths (journaling) so you can reflect and re-read when mood gets low or confidence needs a boost.
  • Write positive affirmations on post it notes and stick all around house so you can see them wherever you turn, read them.Write them in a little note pad and carry them with you re-read throughout your day.
  • Give yourself permission to separate yourself from your work, leave the work place leave the stress, develop a conscious ritual which allows you to let go of the day when you leave work.Ensure you debrief if you’ve seen particular intense client/s.
  • Maintain connections with others outside the field of counselling and support engage in activities outside the field of counselling and support on a regular basis.
  • Pay attention to your physical needs eat regular meals and built and maintain sleep patterns if you’re not sleeping address it as a matter of urgency.
  • Set goals work SMART i.e. be specific, measurable, achievable, relevant, time-bound.
  • Engage in on-going professional training “knowledge is power” when we know what to do we are naturally calmer and in control.
  • Take stock identify what is working for you and what is not, who are the people in your life who can provide a ‘holding environment’.
  • Seek peer support ask them to help you understand your feelings and develop a perspective that will be helpful and self-supportive.
  • Get back to basics with SWOT explore your strengths, weaknesses, opportunities and threats, make a list and reflect upon what needs strengthening and celebrate your strengths and find solutions to any perceived threats.
  • Emotionally release the pressure yell into a pillow, allow tears and sob, or put on a humorous DVD and laugh it out or go to the gym and box, aerobics or dance it out.
  • Massage your own hands and feet with some lovely cream, or aromatherapy oils.
  • Manage your time, plan your day or morning or afternoon, after breakfast make a list of all the things you’ve got to do today and prioritise in order and stick to that order cross of each item on your agenda as you complete it.

Never forget you are equally as important as the clients you support and if you don't take care of yourself then it is unlikely the support you are offering others is the best you can offer.  Two fatigued and worn out people in the therapeutic space are not in a position to nurture themselves and as a counsellor the client comes first in that space.  That can in all reality only happen if the counselling therapist is in peak condition psychologically and emotionally, if you are feeling burnt out you will need to take a break, rest and recuperate and if you are on your way to vicarious traumatization you will need professional support yourself.  Contact for support!

Susan Stubbings Doncaster