Transcript Strategies for Ameliorating Secondary Trauma in Mental

Joseph Springer, PhD
Department of Psychology & Counseling
Georgian Court University
 “You can search the entire universe for a being who is
more deserving of compassion than yourself. No such
being will be found”
-The Buddha
 “Love your neighbor as you love yourself” (italics added)
-Jesus
Secondary Trauma
 Often used interchangeably with “Vicarious
Traumatization”
 Other terms which are sometimes mentioned
with secondary trauma are compassion fatigue,
secondary stress disorder and burnout
 Secondary Trauma and Vicarious Trauma will
be used interchangeably
 Compassion fatigue, secondary stress disorder
and burnout may overlap in some areas,
however they also differ from ST and VT
 SR/VT initially described by McCann &
Perlman (1990) referring primarily to
psychotherapists who work with trauma
survivor clients. Has since been expanded by
others to include first responders, health care
providers and humanitarian workers, among
others
 The hallmark of ST/VT is a disruption of the trauma
workers’ perceived meaning and hope (McCann and
Pearlman (1990)
 ST/VT differs from compassion fatigue, secondary
stress disorder and burnout in that trauma-related
symptoms, such as intrusive imagery, increased
emotional arousal and avoidance or numbing may be
present
 ST/VT can overlap considerably with PTSD, and in some
cases can meet the criteria for PTSD:
-Exposure to a traumatic event
-Persistent re-experiencing of the event
-Persistent avoidance or emotional numbing
- Persistent symptoms of increase emotional arousal
Duration of more than one month (otherwise acute Stress
Disorder); Causes significant distress or impairment in
functioning
 In most instances, mental health professionals are
exposed to trauma through hearing about (rather than
directly witnessing) traumatic events as described by
their clients
 The central mechanism in ST/VT is empathy
(Rothschild, 2006)
 It is certainly the experience of most mental health
professionals to feel acute psychological pain when
hearing about the traumatic experiences of their
clients
 If helpers identify with their client and imagine
what it would be like if the situation happened
to them they are more likely to experience
distress
 If helpers imagine what the traumatic event
was like for their client they are more likely to
experience compassion (Lamm et al., 2007)
 Over-identifying with a client and his/her
experience is more likely to occur if the
professional has had a similar experience
(either directly of vicariously)
 Over-identification may also occur in less
experienced clinicians
Countertransference
 If exposure to a client’s reports of traumatic
experience(s) has activated a clinician’s own
memories and reactions to significant events
that they have experienced in their own lives,
treatment for the clinician may be
recommended
 PTSD-oriented treatment would be appropriate
 Evidence-based psychological treatments for PTSD are
Prolonged Exposure therapy (CBT) and EMDR (Bisson et
al., 2007).
 SSRI’s considered first-line medications for PTSD
(Cooper, Carty & Creamer, 2005).
 Benzodiazepines are contraindicated (although they are
often prescribed), and although they may provide shortterm anxiety relief, they can interfere with psychological
treatments and are associate with poorer long-term
outcomes (Berger et al., 2009)
Overlap with Compassion Fatigue,
Burnout, Secondary Stress
Disruption of sense of meaning and hope
can also occur with heavy workloads,
chronic clients, socialized passivity on the
part of some clients, sense of entitlement
on the part of some clients, sense of
powerlessness on the part of clinicians
Countertransference
 A helpful model in understanding countertransferential
reactions is the moving toward/moving away concept
 It can be thought of as a continuum between two polarities
Moving________________________________Moving
Towards
Away
Countertransference
 Moving Towards: “Buying into” or validating a
client’s world-view
 Moving Away: Rejecting or invalidating a
client’s world view
 The countertransferential “traps” lie at the
extremes
Countertransference
 Moving towards: Over-identifying with client
as victim, taking on “rescuer” role, not
confronting unhealthy behavior
 Moving Away: Minimizing or invalidating the
client’s experience, acting in a judgmental
manner, overly confrontational
Countertransference
 The therapeutic stance is to be in the mid-range
and to be able to move within this range in a
flexible and self-aware manner (e.g., able to
validate the client’s experience while also
keeping in mind that the client’s world view is
not functioning well for them)
 “I’m not your boss, I’m your consultant”
Additional Factors to Reduce Risk
of ST/VT and Compassion Fatigue
 Manageable client load or workload
 Peer support and respectful supervisors
 Sense of meaning and importance of work
 Self-Care: Mind/body/spirit (see opening
quotes)
 Supportive social network
 Diversity of interests
Vicarious Transformation
 Results from witnessing the resiliency and
courage shown by some individuals in the face
of very adverse life-events
 Deepened sense of connection to all living
beings, greater capacity for empathy, increased
inclusiveness, greater appreciation for what one
has, enhanced humility (Saakvitne & Pearlman,
1996)
References
 Berger, W. et al., (2009) Pharmacological alternatives to
antidepressants in post-traumatic stress disorder: a systematic
review. Prog Neuropsych Biol Psychiatry, 33,169-180.
 Bisson, J.I. et al., (2007). Psychological treatment of chronic
post-traumatic stress disorder: systematic review and
metanalysis. Br J of Psychiatry, 190, 97-104.
 Cooper, J. Carty, J. & Creamer, M. (2005). Pharmacotherapy
for post traumatic stress disorder: empirical review and
recommendations. Aust NZ J Psychiatry, 32, 674-682.
 Lamm, C. et al., (2007). The neural substrate of human
empathy. J Cog Neuroscience, 19, 42-58.
References (cont’d)
 McCann, I.L & Pearlman, L.A. (1990). Vicarious
traumatization: A framework of the psychological effects of
working with victims. J Traumatic Stress, 3, 131-149.
 Rothschild, B. (2006). Help for the helper. New York: Norton
 Saakvitne, K.W.& Pearlman, L.A. (1996). Transforming the
pain: A workbook on vicarious traumatization. New York:
Norton.