Therapy Case Management. Assessment

Transcription

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3 Therapy Case Management Assessment

4 Ample time v. Time crunch

5 Solo practice v. team work Individuals v. groups Mass representation Group therapy Individual case work Community Organizing

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7 Lawyers & Trauma

8 Psychological Trauma Experience that involves actual or threatened death, serious injury or sexual violence in 1 or more of the following ways: 1. Direct experience 2. Witnessing it in person 3. Learning that it occurred to family or close friend 4. Repeated/extreme exposure to aversive details of the event (American Psychiatric Assn 2013)

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10 CS-CF Model (Beth Hudnall Stamm, 2009) Professional Quality of Life Compassion Satisfaction Compassion Fatigue Burnout Secondary Trauma

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15 -Rachel Naomi Remen, 1996

16 BURNOUT COMPASSION FATIGUE SECONDARY TRAUMA Builds up over time Builds up over time/symptoms unique to provider Immediate; mirrors client Predictable Less predictable Less predictable Work dissatisfaction Life dissatisfaction Life dissatisfaction Related to work environment conditions Can lead to health problems Related to empathic relationship w/multiple clients traumas Can lead to health problems Related to empathic relationship w/one client s trauma Can lead to health problems Feel under pressure Feel out of control Feel out of control Adapted From: Best Start Resource Center, 2012

17 Possible Signs/Symptoms of Secondary Trauma Include But Are Not Limited To Intrusive thoughts of the case Nightmares related to case content Fear/Horror Helplessness Anger/Rage Sleep Disturbance Irritability Concentration problems Avoidance/Numbing to avoid thoughts/feelings associated with traumatic events Detachment from others Increased intake of alcohol or junk food Reduced intimacy in significant relationships, including reduced interest in sex Intense emotional reactions ranging from denial to overidentification

18 Impact on Provider s World View Feelings of lack of safety, trust or control Shattered assumptions about former beliefs about people/life Changes in spirituality Changes in Identity

19 INDIVIDUAL RISK FACTORS WORK RISK FACTORS COMMUNITY RISK FACTORS Personality Temperament Work style Coping Style Role at work Like it? Feeling stuck? New to the field? Realistic expectations? Culture Similar/Conflicting? Language Barriers? Cultural Norms Personal History Triggers from past Current life circumstances Work setting Resources Quantity of exposure to trauma Community resources Enough available to meet client needs?

20 INDIVIDUAL RISK FACTORS WORK RISK FACTORS COMMUNITY RISK FACTORS Social supports Spiritual connection/resources Work conditions Training Continuing education Time off Feeling unsafe due to inconsistent policies, communication, respect Amount of organizational support when difficulties occur Barriers to supervision & consultation Other community factors that create obstacles

21 Risk Factors for Secondary Trauma (Adapted from Best Start Resource Center, 2012; Saakvitne & Pearlman, 1996) INDIVIDUAL RISK FACTORS WORK RISK FACTORS COMMUNITY RISK FACTORS Lack of motivation/energy PTSD symptoms PTSD symptoms No evident triggers Remedy: time away to recharge or changes in work environment May have triggers unique to service provider Remedy: Treatment of selfsimilar to trauma treatment Often triggers similar to client s triggers Remedy: Treatment of selfsimilar to trauma treatment

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24 For more information see c Beth Hudnall Stamm, 2009

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29 Vicarious Resiliency and Coping with Secondary Trauma

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32 A M B I G U O U S L O S S M I L L E N N I A L S A N D V I C A R I O U S T R A U M A V I C A R I O U S R E S I L I E N C Y S T R E N G T H F O R T H E S T R U G G L E A C T I O N S T E P S R E S I L I E N C Y E X E R C I S E

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35 Brittany Stringfellow Otey, Buffering Burnout: Preparing the Online Generation for the Occupational Hazards of the Legal Profession, 24 S. CAL. INTERDISC. L.J. 147 (Fall 2014)

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44 And friendship, exercise, healthy eating, time off, reflection, appropriate self-care....