7/12/2012. The Cultural Implications of Secondary Traumatic Stress

Transcription

1 Secondary Traumatic Stress Speaker Series The Cultural Implications of Secondary Traumatic Stress Secondary Traumatic Stress and Culture Susana Rivera, Ph.D., LPC, SCAN, Laredo, TX Blanca N. Hernández, Ph.D., LPC, DePelchin Children s Center, Houston, TX Marta Casas, MA, Child Witness to Violence Project, Boston, MA Susana Rivera, Ph.D., LPC Serving Children and Adolescents in Need, Inc. Laredo, TX STS, Vicarious Trauma, Burnout The Hispanic Professional Secondary Traumatic Stress Emotional stress resulting form indirect exposure to trauma through hearing about the trauma experiences of others Vicarious Trauma Changes in the inner experience of the therapist that result from empathic engagement with a traumatized client (Pearlman & Saakvitne, 1995) Burnout Emotional exhaustion, depersonalization and a reduced feeling of personal accomplishment What does it mean to be Hispanic? Acculturation level Cultural values Gender roles (Machismo, Marianismo) Personalismo Familismo Fatalismo Religion/spirituality What is my role? As a helper, what if I can t help them, or what if I miss something? Did I fail them? Cultural View of Mental Health and Counseling How Does A Hispanic Counselor Experience STS? Trauma symptoms (susto; ataque de nervios; mal de ojo; somatic symptoms are more culturally acceptable) How does the Hispanic culture view counseling? Is counseling for the weak-minded or for the weak of faith? Does going to counseling imply going against God s will if it was His will or a test of faith that trauma occur? How does the Hispanic culture view counselors? STS does not only comes from the work itself or the client s stories, it also comes from lack of support. The difficulty of the population, high or trauma-only case load, cultural attitudes. If the culture perceives the counseling profession negatively, this can cause a counselor to feel ineffective and lead to increased STS. Alternative therapies (curanderismo) and the effectiveness of counseling 1

2 Child Trauma and Hispanic STS Barriers to staff self-care: Creating a culture of support and resilience Child trauma is one of the least talked about subjects in the Hispanic culture, often because of cultural stigma. Discussion of a taboo topic while respecting cultural values. Cultural bias within the Hispanic culture. Are we judging ourselves/each other? How does a counselor talk about trauma with a client when it is not something that we are supposed to talk about? Accountability - who is accountable for staff well-being? Is self-care integrated into supervision? What kind of training do supervisors receive that addresses the management of STS for themselves es and for their staff? Are there policies in place to respond to staff who have negative experiences in the field when they are directly exposed to dangerous or frightening events? Therapist Background Secondary Traumatic Stress (STS) and Culture: A Case Example Blanca N. Hernández, Ph.D., LPC DePelchin Children s Center Houston, TX Second generation Mexican-American Born and raised in South Texas Practicing Catholic At the time of this case, working primarily with traumatized Latino families in Houston, TX Used Culturally Modified Trauma Focused Therapy (CMTFT) by Dr. Michael de Arellano Case History Memorable Experiences Within Sessions 5 year old Latina, Elida (name changed for confidentiality) Family Traumas = witnessed domestic violence, exposure to father s alcoholism, parental separation, deportation of father 9 year old sister attending therapy with colleague Therapy for almost a year, every 1-2 wks Conducted farewell session with child Exchanged drawings Planned on assisting mother with trauma grant closing paperwork while Elida played in background and then closing case Elida accidentally forgot drawing I gave her Planned on giving it back to her when she returned with her mother at the last session 2

3 The Day Before the Scheduled Last Session Challenges with Empathy and Objectivity The mother called while I was in therapy with a traumatized, hypervigilant child The mother said crying, Elida left us! She died in a car accident! Struggled to hold back emotion Empathy= Understand someone s current emotional experiences with their own issue. Emotional challenges with being present and supportive with the family. Sharing grief with the family impaired objectivity My client asked if a child had been hurt Held my composure as best possible to finish session with client and other clients that day How I Coped with Loss of Elida Had difficulty focusing and being present with clients Had tearful moments throughout the day Needed to retreat from trauma-work Took a week off of work Prayed and went to church Went to counseling Talked to co-workers and supervisor Culture and Boundaries Attended funeral mass to give el pesame (condolences) to the family Skipped wake ( velorio ) and burial ( entierro ) Framed drawing I had made for Elida which she left behind saying, Adios and gave as a gift to family Maintained confidentiality as I reached out to my support systems (church, family) Difficulties in Continuing with Therapy Resolution Objectivity decreased due to relationship with the deceased Brother struggling with depression and guilt Family vs. Self-care Referred family to a colleague and sources of support in their community Talked to the family about decision not to see them in therapy Family struggled with returning to therapy DePelchin building and therapist were triggers 3

4 Countertransference Secondary Traumatic Stress in the Immigrant Clinician Therapist s emotional reaction to the patient and/or the patient s situation. (Reyes, G., Elhai, J., and Ford, J) Marta Casas, MA Child Witness to Violence Project Boston Medical Center Concept has evolved to incorporate responses evoked by a combination of the patient s transference, the therapist s unique psychodynamics, and the real relationship in the therapeutic dyad. Harris A. Transference, countertransference, and the real relationship. The Clinician's Unresolved Trauma The majority of the literature suggests that therapists with a personal history of trauma may be more vulnerable to the impact of trauma work than therapists without such history The Immigrant Clinician's Secondary Traumatization (Ghahramanlou & Brodbeck, 2000; Peralman & Saakvitne, 1995; Ryan, 1999). Risk Factors What are the Potential Consequences? Clinician s Pre-migration traumas Clinician s Identity problems that stem from immigration Clinician s sense of loneliness and foreignness within agency Supervisor s lack of cultural responsiveness Over-identification with patient s vulnerabilities Inability to contain aspects of patient similar to her/his own Ethnocultural disorientation." 4

5 What are the Potential Consequences? Vicarious Resilience (HERNANDEZ,P. PH.D, GANGSEI,D., PH.D.& ENGSTROM,D., PH.D 2007) Repression of parts of self that are perceived as nonhelp in adapting to new culture Projection in the patient of [own] unresolved conflicts Definition VR: Personal Implications Reassessment of the significance of the therapists own problems Specific resilience process that occurs as a result of psychotherapists' work with trauma survivors, through which therapists learn something about overcoming adversity from their clients Renovation of hope and commitment levels Articulation of personal and professional positions regarding violence Increased tolerance to frustration Increased use of self in therapy. Use what they learn from their clients in their own times of crisis. VR: Clinical Implications VR: Clinical Implications Counteracts therapist s fatiguing processes ( victims of victims). Reinforces the motivation to work with trauma survivors. Therapists amplify and find new meaning in their work. Decreases clients worry about the toxic effect of their traumas Incorporation of spirituality as a valuable dimension in treatment Use of community/culturally-appropriate interventions Witnessing transformations in clients storytelling might inspire therapists to expand their trauma work into other non-clinical fields. 5

6 Questions? 6