Transcript Dana Neitlich, MSW, Massachusetts Department of

Vicarious Traumatization in
Treatment Providers and Law
Enforcement Personnel:
Recognition, Response and
Prevention
Dana P Neitlich, MSW
Assistant Director of Clinical Programs
Massachusetts Department of Correction
MHM Services, Inc.
July 12, 2011
Adapted from presentation developed by Maria Masotta, Psy.D.
Workshop Outline
• What is Trauma?
• Trauma Exposure in Inmate Populations
• Impact of Trauma in Law Enforcement
• What is Vicarious Traumatization?
• Risk and Protective Factors
• Prevention and Intervention
What is Trauma?
• Direct personal experience or event involving:
– Actual or threatened death
– Serious injury
– Other threat to one’s physical safety
• Witnessing an event involving:
– Death
– Injury
– Threat to physical integrity of another person
What is Trauma?
• Learning about
– Unexpected or violent death
– Serious harm
– Threat experienced by family member or other
close associate
• Response must involve intense fear, horror
or helplessness
Traumatic Events...
• Emotional abuse
• Rape or assault
• Sexual abuse
• Mugging
• Physical abuse
• Domestic violence
• Painful or frightening
medical procedure
• Burglary
• Catastrophic injuries
or illnesses
• Witnessing murder/
assault
• Natural disasters
• Immigration
• Combat
Trauma History Among Inmates
Physical Abuse:
Males
43% - 66%
Females
38% - 77%
Threatened/Injured with a Weapon:
Males
35% - 46%
Females
29% - 52%
Wolf & Shi, 2009
More Trauma Among Inmates…
Choked or Experienced Attempt to Drown:
Males
14% - 40%
Females
17% - 41%
Burned with Hot Object:
Males
Females
11% - 29%
7% - 29%
Wolf & Shi, 2009
More Trauma Among Inmates…
Sexual Abuse:
Males
Females
2% - 26%
19% - 65%
Emotional Abuse:
Males
34% - 53%
Females
35% - 59%
Wolf & Shi, 2009
Not So Fun Facts
• Incarcerated males with a mental disorder
compared to incarcerated males without a
mental disorder:
– 33% more likely to report being physically
victimized in the past 6 months
– Nearly twice as likely to report being sexually
victimized
• 20% of male inmates report sexual assault
during prison incarceration
Polych, 1992
What’s important to know?
• Acknowledging trauma ≠ excusing
antisocial behavior
• Acknowledging trauma ≠ digging trauma
memories up
• Acknowledging trauma = proactive
management
• Acknowledging trauma = staff support and
care
Impact on the Workplace
• Risk of re-victimization
• Increased risk of:
– prison paranoia
– physical aggression
– self-injury/suicide attempts
– crisis calls
– codes
– uses of force
– disciplinary reports
Impact of Trauma on Culture:
• Symptomatic inmates could result in:
– Tension in the facility
– Tension among inmates
– Creates a stressful work environment
• Development of Vicarious Traumatization
What is Vicarious Traumatization?
Developed by those that are exposed to a
client’s trauma experiences…
• Includes listening to graphic descriptions of
horrific events
• Bearing witness to people’s cruelty to one
another and
• Witnessing traumatic reenactments
Pearlman & MacIan, 1995
Signs and Symptoms
• Behavioral changes
• Intrusion of inmate
stories
• Burn-out
• Feeling
overwhelmed
• Withdrawal from
inmates/colleagues
•
•
•
•
•
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Impaired self-care
Numbing/flooding
Denial
PTSD symptoms
Nausea
Headaches
Sleeplessness
Difficulty trusting
It is a Normal Experience…
Vicarious traumatization is:
– Neither a reflection of inadequacy on the part
of the staff
– Nor the toxicity or badness on the part of the
inmate
– Best conceptualized as an occupational
hazard within corrections
Pearlman, 1999, p. 52
It Can Happen to Anyone
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Administrators
Law Enforcement /Correctional officers
Program staff
Parole
Medical staff
Mental health staff
Other inmates
Basic Statistics About Clinicians
• More than 50% of clinicians providing
treatment to either a sex offender or victim
experience symptoms in clinical range
• 33% of clinicians providing sex offender
treatment experience hyper-vigilance
regarding safety
– Generally mistrustful of others, particularly
those who have regular contact with children
Moulden & Firestone, 2007
Elevated Vicarious Traumatization
in Secure Settings
• Increased emotional exhaustion
• Feeling like nothing is real
• Decreased feelings of accomplishment
• May be result of:
– Hardened environment
– Isolation
– Dangerousness of inmate population
Moulden & Firestone, 2007, p . 67
Staff Exposure to Trauma
Direct
Vicarious
• Witnessing use of
force
• Hearing details of
violent crimes
• Witnessing or
responding to selfinjurious or suicidal
behaviors
• Learning of inmates’
trauma in community
and in prison
• Being threatened or
assaulted
• Witnessing inmate
relive trauma
Protective Factors
• Professional experience
• Training
• Social engagement/support system
• Balanced lifestyle
Risk Factors for LE/Custody Staff
• Forced overtime
• Responding to fights
• Responding to emergencies
• Use of force
• Unable to take breaks
• Limited support from peers, supervisors
• Code of silence
Risk Factors for Clinical Staff
• Substantial involvement in direct treatment
• High caseloads with trauma histories
• High exposure to inmates with trauma
• Female gender
• Personal history of trauma
Preventive Strategies
• Avoid professional and personal isolation
• Form/participate in a support group
• Stress self-care
• Training in vicarious traumatization
• Make time to relax
Prevention….
• Healthy personal life
• Maintain a supportive work environment
• Provide supervision
• Seek supervision
Healthy Coping Strategies
• Balancing personal and professional lives
• Maintaining personal boundaries
• Maintaining realistic expectations for self
in doing this work
• Allow yourself to experience emotional
reactions
• Seek out non-victim related activities
More Healthy Coping Strategies
• Be aware of unresolved issues that may
be impacted
• Get plenty of rest
• Use humor!
• Exercise
• Sports
• Hobbies
More Healthy Coping Strategies
• Eat healthy foods
• Remind yourself that you are having a
natural reaction
• Talk to friends/family
• Spend time with others
• Provide support to other co-workers who
may feel similarly
Not So Healthy Coping Strategies
• Drugs
• Alcohol
• Denial
• Isolating
• Code of silence
Systemic Responses
(When Feasible)
• Supportive work environment
• Supervision
• Training in vicarious traumatization
• Support time away from work (breaks,
PDO)
• Support an EAP program
Maintain Optimism and Hopefulness
• Identify and talk about positive aspects of
work
• Recognize and cherish human resilience
• Take pride in having an impact on the
effects of violence
– All of these increase social activism
Questions?
Dana P Neitlich, MSW
[email protected]