Preventing and Healing Secondary Trauma. Objectives 2/2/15 JULIA WESTHOFF

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1 Preventing and Healing Secondary Trauma JULIA WESTHOFF Objectives IDENTIFY SECONDARY TRAUMA RECOGNIZE THE EFFECTS OF TRAUMA EXPOSURE (HOW WE ARE TRANSFORMED OR IMPACTED BY OUR WORK) IDENTIFY RED FLAGS DEVELOP STRATEGIES TO MITIGATE THE EFFECTS OF SECONDARY TRAUMA THROUGH SELF CARE DETERMINE HOW TO INCORPORATE SELF CARE PRACTICES INTO PERSONAL LIFE AND THE WORK SETTING 1

2 What is Secondary Trauma? The effect of witnessing and/or hearing about traumatic events. A side effect or result of seeing or hearing about acts of cruelty or suffering which causes permanent and often profound change in workers. CASE STUDY Historical and social factors Why do we have it so tough? We serve clients whose needs are neglected. Predominantly female-dominated field. Backgrounds may be similar to those we serve. We do this work because we love it. The problems we attempt to solve are complex. The support for our programs reflects these factors. 2

3 What makes our jobs unique? Emotional/personal situations Large caseloads High levels of responsibility Public opinion Private opinion Funding insecurities Comparatively low salaries Inadequate equipment/ resources Our own lives What else? The paperwork Responses to Trauma Feeling Helpless and Hopeless! Why am I even getting out of bed? Experiencing Diminished Creativity Having the Inability to Embrace Complexity Minimizing! We ve seen this a million times at least she s still alive.! You think your job is hard pushing papers? Let me tell you about people who have hard days. Having Chronic Exhaustion/Physical Ailments 3

4 Trauma Exposure Responses (2) Having the Inability to Listen/Deliberate Avoidance! I leave when my voice mailbox is full. Nurse Having a Sense of Persecution Experiencing Guilt! I went shopping last week for a pair of shoes and I thought to myself what kind of person would go shopping for a pair of shoes right now? Community activist, New Orleans, nine months after Hurricane Katrina Fear Trauma Exposure Responses (3) Feeling Anger and Cynicism Suffering from Addictions Experiencing Grandiosity: An Inflated Sense of Importance Related to One s Work! Throughout the hospital, the only social workers who connected so strongly to their work, as if it was their total identity, were the ER social workers. They are the only group that if you asked them, they would say, I m an ER Social Worker. It was their whole identity. Hospital administrator. Unforeseen consequences of trauma work 4

5 Are we at risk? In a nutshell Yes! There are risk factors that contribute to the intensity and the symptoms of secondary trauma and each individual may have specific triggers for responding to secondary trauma, but exposure is inevitable in this field of work. The issue is not IF we are effected by secondary trauma, it is WHEN we are effected. Red Flags of Trauma Exposure Sleep disruption Diminished sense of safety Nightmares or intrusive imagery Isolation or withdrawal from others Change in eating habits Inability to establish healthy boundaries Cynicism Problems in relationships Red Flags Self doubt Questioning of personal values Unable to manage usual stress situations Apathy Rigidity Anxiety Physical ailments 5

6 How secondary trauma changes us 1. When you undergo stress neurotransmitters and hormones tell your body that you are undergoing some type of threat. 2. The adrenal glands, on top of you kidneys, get the message and flood your entire body with stress hormones. 3. These hormones affect all bodily systems. If these hormones and chemicals go uncontrolled, they shut down your ability to make good decisions or think about anything other than the immediate threat. 4. If your system stays on high alert, you end up with a brain that isn't thinking clearly and every physiological system on overload. ALLOSTASIS, ALLOSTATIC LOAD Allostasis refers to the way the brain and body respond to challenges or stresses: by reacting, adapting and then recovering. But if the stress is extreme, negative and unrelenting, the brain and body pay a price. That accumulated wear-and-tear, called allostatic load, can cause chemical imbalances, accelerate certain diseases, and even alter brain structures. Genetics, early brain development, the social and physical environment, diet and other behaviors can all influence a person s allostatic load. How trauma plays out at work Ignoring or dismissing a client s concerns Not knowing how to de-escalate Not listening/validating concerns Reinforcing harmful messages Creating hard/fast rules (lack of flexibility) Expecting clients to be respectful/grateful Black and white thinking Not recognizing your own attitudes, biases and discourse. 6

7 Symptoms of Secondary Trauma Combat stress through resiliency " THE ABILITY TO CARE FOR SELF WHILE CARING FOR OTHERS " BECOMING STRONGER THROUGH EXPERIENCE " A DAILY PRACTICE THROUGH WHICH INDIVIDUALS, ORGANIZATIONS, AND SOCIETIES TEND TO THE HARDSHIP, PAIN, OR TRAUMA EXPERIENCED BY OTHERS. " COMES FROM THE BELIEF THAT BOTH JOY AND PAIN ARE REALITIES OF LIFE, AND THAT SUFFERING CAN BE TRANSFORMED INTO MEANINGFUL GROWTH AND HEALING. - LAURA VAN DERNOOT LIPSKY. Building Resiliency Three core psychological attributes at the heart of resilience: Strength - You feel equipped to handle both daily life and those challenging moments when you have to dig deeper. Meaning/purpose - You also believe that you re contributing to the world in a way that helps others, consistent with what seems most important to you. Pleasure - You are enriched by life experiences. Whether it be poetry or pottery, movies or theater, having experiences that bring you a deep sense of pleasure are essential. If your personal life is characterized by these traits, you have the core components needed to build resilience. 7

8 A multi-leveled approach to building resiliency The elephant in the room Where to start?: Self Care Be aware of your own needs and seek support or debriefing with peers, trauma stewardship buddy or supervisor. It is unethical not to attend to your needs so that you do no harm to those you serve. Ultimately you are responsible for own trauma stewardship. 8

9 Self Care Action Steps Ask for help Take breaks/use vacation leave Set boundaries for self at home and work Engage in social/family relationships and events Maintain healthy lifestyle Create rituals as you leave work Seek consultation or support (therapy/support groups/ spirituality) Find a role model Self Care Action Steps Be willing to lean into discomfort:! Acupuncture! Massage! Meditation! Book clubs! Support groups! Creative outlets! Group exercise! Tai Chi Self Care Action Steps Know your options! Create a menu of practices for yourself! Explore what your agency has available! Identify opportunities within the community Community Centers/YMCAs Church Local Universities Professional Networks 9

10 Self Care on the Job Determine how to work protectively:! How you do your work: Change things that bother you Find ways to regain perspective during the day Invest in professional networks/connect with people Try something different at work! How you think about work: Why do you do this work? How do you measure success? What can you control at work? What are the costs of this work? Rewards? How are you personally changing? (Headington Institute) We must equip ourselves with the tools to take care of our business. In order to be trauma stewards, we must be prepared. Filling our buckets Brainstorm self care ideas to fill your bucket. No idea is too small, too big, too costly or too time consuming Taking Care of Your Business: Supervisor s Role o A supervisor is responsible for being a trauma stewardship role model. Supervisors cannot expect direct reports to be stewards of their trauma if they are not practicing self care, advocating systemic change and encouraging a healthy workplace. o Supervision must be a safe place to share difficult experiences, solve problems and learn. Supervision dedicated to self-care cannot be connected to performance evaluation. 10

11 How Can Supervisors Intervene? Encourage self-care and hold employees accountable Provide effective supervision Advocate within the agency / organization Effective feedback? Supervisor s Action Steps Recognize link between performance, secondary trauma, organizational culture and stress. Support flexibility in policy, practices and meeting staff needs (as we would with clients). Develop opportunities for peer consultation, supervision and performance supervision. Develop a performance system based on a model that promotes continuous learning. Express concern for well-being of your staff, not just the quality of the work they are doing. Develop a mentoring program 11

12 Risk Factors The interaction between traumatized clients, stressed staff, pressured organizations and challenging social, political and economic environments combine to create the perfect conditions for secondary trauma. (Warsaw & Pease, 2010) Major factors include:! Personal! Occupational! Organizational! Cultural Taking Care of Your Business: Organizational Culture When people perceive their organizations to be supportive, they experience lower levels of secondary trauma. (WCSAP, 2004) Caring for trauma workers is not a luxury, but rather essential, both for the service provider s physical and mental health and for the welfare of the clients. (Alaska Network on DV & Sexual Assault) Agency evaluation Examine your agency s:! Training! Physical environment! Benefits! Hiring, orientation and exiting! Capacity building! Board! Senior staff 12

13 NEXT STEPS What does this agency do well? What do you love about this office? Is there anything about your job that contributes to secondary trauma? Big or small. Agency will receive coded responses Senior staff will conduct agency evaluation Staff sets priorities REVISITING THE CASE STUDY 13

14 If you can only do 2 things 1. Work on your social connections and support. Research from many diverse fields all support the notion that having deep and varied social connections help us to have healthier and even longer lives. 2. Exercise Combat depression and anxiety, sleep better, help brain process stress, become physically fit etc Resources Further Reading Trauma Stewardship Institute Alaska Network on DV & Sexual Assault Van Dernoot Lipsky, Laura (2009). Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others. San Francisco: Berret-Koehler Publishers. The National Child Traumatic Stress Network Figley, Charles. Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those who Treat the Traumatized. Bristol, Penn.: Brunner/Mazel,