You can only go halfway into the darkest forest; then you re coming out the other side. Chinese proverb

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2 You can only go halfway into the darkest forest; then you re coming out the other side. Chinese proverb

3 Burnout Secondary trauma Vicarious trauma (VT) Compassion fatigue Secondary post traumatic stress disorder ITW Impact of Trauma Work Trauma Stewardship

4 The negative transformation in a helper s inner experience as a result of responsibility for and empathic engagement with traumatized clients. McCann and Pearlman

5 Vicarious traumatization is the natural consequence of our being human, connecting to and caring about our clients as we hear about and see the effects of trauma in their lives We believe that VT is an inescapable effect of trauma work. Risking Connection

6 The trauma in the lives of our clients Trauma in our own lives and in those we love Trauma in our society/culture Institutionalized trauma The absence of understanding the primal impact of trauma in the behavioral health sciences

7 Perhaps more than any other factor, trauma work is difficult when clinicians do not understand trauma dynamics. Arledge and Wolfson

8 Was your school mascot the: Savior Helper or Healer?

9 Whether we are working in mental health centers, psychiatric hospitals, jails, substance abuse programs, domestic violence or homeless shelters We are working with the survivors of trauma. We need to adopt universal precautions. We can also adopt universal solutions empowerment and connection.

10 Mad Bad Grad

11 I m tired, a lot I m not sleeping well I m angry, a lot I count the days until vacation I m down I feel alone I don t really care any more

12 Distrust and changed worldview Threatened sense of personal safety and fosters paranoia Disrupted sense of spiritual connectedness Physical and emotional exhaustion vandernoot Lipsky and Burk

13 Is it me? Is it those I serve? Is it where I work? Is it a combination?

14 Traditional biopsychiatric beliefs, interventions, and coercive measures have caused harm to those we have committed ourselves to serving. How does it feel, when transforming to a trauma-informed perspective and practice, to sit with the awareness of having caused harm? How do we tend to ourselves and others in systems that still cause harm?

15 Our struggles with our clients with all that our clients evoke in us, with all that we bring to our work are essentially about how we transform our responses so we can be helpful It is up to us to discern and take the right action, and to sustain and nourish ourselves. Robin Connors

16 Trauma disempowers and disconnects. These consequences can be addressed. Principles of Trauma-informed care exist. Applying the principles of traumainformed care to people who work in service agencies is as important as applying them to people who receive services.

17 In a trauma-informed system the human dimension should always be at the forefront, with consideration given to the whole person, regardless of whether that person is a consumer, a clinician, or a program administrator. Arledge and Wolfson

18 RICH relationships: Respect Information Connection Hope Sidran Institute

19 Safety Trustworthiness Choice Collaboration Empowerment Harris and Fallot

20 If your compassion does not include yourself, it is incomplete. Jack Kornfield

21 Providers must be able to speak openly about their negative feelings about their work. (Arledge and Wolfson) negative vs. disturbing vs. challenging?

22 Why don t I take my own advice about self-care? How do I know what I need? Why do my needs change?

23 Awareness Balance Connection

24 Self-determination - having reasonable influence in your own life What roles/identities help you feel strong? Professional, parent, dog walker What keeps your identity grounded? Spiritual practice, boundaries, relationships, work Under what conditions do you lose track of these things? A daily ritual to center yourself If you didn t do this work, what would you do?

25 Clinical guidance and peer support Supportive climate Health benefits massage? Acknowledge stressors Reasonable expectations and staffing patterns Continue to provide training/support on all aspects of trauma

26 Wait. Give up hope. Keep the faith.

27 Witnessing pain as we do brings with it the possibility of witnessing healing. Humans who survive trauma have great inner strengths and wisdom that can be used on their own behalf. Humans capacity for love, kindness, and generosity is as real as the human capacity for cruelty and selfishness.

28 Although firsthand experience with trauma leads to personal suffering, it can be sublimated into social or artistic action and thus can serve as a powerful agent for social change. Bessel van der Kolk

29 Ultimately, every individual must choose whether or not to overcome any hardship or oppression inflicted by the family, society, or psychiatry. Human beings retain a measure of free will as long as they remain conscious it is the helper s role to encourage every hint of self-determination. Peter R. Breggin, M.D.

30 and don t forget to: celebrate, sing, dance, laugh, and live

31 Risking Connection: A Training Curriculum for Working with Survivors of Childhood Abuse. Saakvitne, K.W., Gamble, S., Pearlman, L.A., Ley, B.T Baltimore, MD: The Sidran Press. Transforming the Pain: A Workbook on Vicarious Traumatization. Saakvitne, K.W., Pearlman, L.A. and the staff of the Traumatic Stress Institute New York: WW Norton. The Therapist s Emotional Survival: Dealing with the Pain of Exploring Trauma. Pearlman, S.D Northvale, NJ: Jason Aronson, Inc.

32 Secondary Traumatic Stress: Self-Care Issues for Clinicians, Researchers, and Educators. Stamm, B.H. (Ed.) The Sidran Press. Trauma and the Therapist: Countertransference and Vicarious Traumatization in Psychotherapy with Incest Survivors. Pearlman, L.A. and Saakvitne, K.W WW Norton. Guidebook on Vicarious Trauma: Recommended Solutions for Anti-Violence Workers. Richardson, J.I National Clearinghouse on Family Violence (Canada):

33 Risking Connection: A Training Curriculum for Working with Survivors of Childhood Abuse. Saakvitne, Ph.D., Gamble, Ph.D., Pearlman, Ph.D., Tabor Lev, Ph.D Sidran Institute, sidran.org. Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others. Van Dernoot Lipsky and Burk Berrett-Koehler Publishers. The Joy of Burnout: How the end of the world can be a new beginning. Glouberman, D Inner Ocean Publishing.

34 How Can I Help? Stories and reflections on service. Dass and Gorman Alfred A. Knopf. Using Trauma Theory to Design Service Systems. Harris and Fallot Jossey-Bass.